Introduction to the NOTCE

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What is it?

The National Occupational Therapy Certification Exam (NOTCE), formerly known as the Canadian Association of Occupational Therapists (CAOT) Exam, is the nationwide written test of OT knowledge of theory and applications here in Canada.  Its prime purpose is to protect the public by assessing individuals who wish to practice occupational therapy (OT) all over the country.  Second, since OT is a regulated health profession, all regulatory organizations require the NOTCE for full registration.  It is held twice a year on the first Saturdays of July and November.  Exam sites are available nationwide.  You can choose which province you want to take the exam early in registration, although the specific location is not given until a few weeks before the exam date.  As you go on reading this, we will delve on the resources you need to read, question formats and scoring method of the NOTCE.  Essential web reads and stuff to browse and download are linked in the text.  

The Blueprint, Profile and Essentials

In order for you to be successful in any exam, there are many things to know aside from the content of the exam.  To be fully ready, one must know how the exam is written.  You might remember from highschool or college days how teachers and professors have different formulations of their quizzes.  Who gives out keywords?  Who doesn't?  Who likes essays and tables?  Who likes identification or multiple choice type of questions?  Some of those may seem minuscule to the content of the exam but it might surprise you to know that how you organize the content of your review to a certain design may score you more points than just merely memorizing the books from page 1 to the glossary page.

To start off knowing the NOTCE, let me tell you, there is nothing quite like the Resource Manual to let you have a peak at your Lady Victory.  It has it all!  The purpose of the exam, question formats, reference source and even sample exam questions.  It's like our lovable Spacky - everything essential condensed in one.  Now, the most important thing to take note of in this manual is the BLUEPRINT.  The blueprint is a graphic representation of the exam components and its framework.  In a simpler angle, I'd like to think of it as a flower in a plant box.

The Blueprint¹

It displays the dynamics of OT knowledge of the client, environment, occupation, practice process and the OT roles which we as therapists assume in the profession.  The big center where the seeds are located compose of the examinee's knowledge of the CEO and OT process.  This stands for sixty to seventy percent (60-70%) of the exam and can be found tabulated in more detail in figure 2.

The Matrix²

The colorful petals represent the six (6) major roles we assume in professional practice. These overlap at the center to show the dynamic unfolding of the roles centralized on the knowledge we know to enable our clients through the occupations they deem meaningful in their lives.  This comprises of the thirty to forty percent (30-40%) of the exam.  Lastly, the plant box nurtures the flower of knowledge and roles by supporting the practice with theories that we apply in clinics; vice versa, the applications evolve the theories we use through research.

Upon introduction to the blueprint, I'm sure more questions will surface in your mind - most especially, on the definition of each role in professional practice.  This is where we turn to the Profile of Occupational Therapists in Canada (a.k.a. the Profile) and the Essential Competencies of Practice for Occupational Therapists in Canada (a.k.a. the Essentials).  The PROFILE provides the big picture of Canada's vision for its occupational therapists and is updated/revised every so often by the council.

Canada's vision for every OT - from competent to proficient and eventually to advanced practice³

The Profile briefly defines the competencies that OTs need to achieve in practice.  These are the OT roles I have enlisted below: (1) expert in enabling occupation; (2) communicator; (3) collaborator; (4) practice manager; (5) change agent; (6) scholarly practitioner and (7) professional.

Figure in the Profile similar to the exam blueprint ⁴

There is a table after the image that delineates each component.  Though this is just a very general description of each role.  To further explain these competencies, we will need to turn to the ESSENTIALS.  You'll be able to understand more about the profile more and what are the criteria that deem all practitioners "competent".  To put it simply, the essentials is the detailed qualities that make a "competent" OT.



Resources and Reads

So now that you are familiar with the manual, profile and essentials, we will be discovering important resources for your review.  Although you might be with lots of OT resources, there are other references you might not be aware of just like the Profile and Essentials.  The first place you look into for identifying potential review materials would be the Resource Manual.  They are magnificently chronicled at the back of the manual.

The start of the reference list, perfectly written in APA format⁵

I marked all of the books I have then I browsed on the web to have information on the others.   I checked the local library if they had any occupational therapy books.  Sadly, they don't have much OT books there.  I heard from a friend thought that I can access the University of British Columbia Library where they have a large collection of allied health professional books.  If you can, borrow books to save money.

Here I list the resources that I have referenced from in my review:

1. Enabling Occupation I and II - both books are definitely a necessity to read.  You can buy it in the CAOT store or borrow it from a library that has it.  Important to note the CPPF and the OPPM.
2. Trial Occupational Therapy Exam Manual (TOTEM) and the Trial Occupational Therapy Exam (TOTE) - contains exam questions you can practice on.  Check out CAOT website for more details.
3. Occupational Therapy for Physical Dysfunction (Pedretti or Trombly) - covering for the physical dysfunction knowledge.
4. Willard and Spackman's Occupational Therapy - need I say more?  It's your Yorozuya and it has it all.
5. Quick References to Occupational Therapy - good for when you need to quickly refer to conditions
6. Conditions in Occupational Therapy - much like the "Quick References" book, this is also a nice book in which they condensed all of the conditions.
7. Group Dynamics in Occupational Therapy - best resource for knowledge on groups, from theory to application.
8. Psychosocial Occupational Therapy: Frames of Reference for Intervention - greatest reference on theory in psychosocial practice.
9. Kaplan and Sadock's Symptoms of Psychiatry - where all the psychological conditions can be found.  The resource manual has listed the DSM-IV-TR but I find this easier to remember.
10. Occupational Therapy for Children - the pediatrics Bible.
11. Ethical and Legal Dilemmas in Occupational Therapy - this book is magnificent for knowing ethical practice with case scenarios.
12.  Introduction to Splinting - the foundation for splinting.   The review questions every chapter is great for igniting your clinical reasoning skills concerning with this OT task.  Case studies available as well.
13. Cook and Hussey's Assistive Technologies - essentials on the types of assistive devices, assessment procedures. Another thing that is wonderful about this book is that it has a list of organizations in which these devices are available. I'm pretty sure that there was another book on assistive devices but I wasn't able to borrow it from the library.  Everytime I went there, it's always borrowed.
14. Measuring Occupational Performance - worried about your knowledge on assessments and performance measures?  This is the ultimate book!  It classifies them into categories and tabulates its information.  This is a definite must-read for review.
15.  Guidelines on Controlled Acts and Delegation - list of controlled acts in the profession.
16.  Regulated Health Professions Act - it is most important to know certain legislation that concerns the practice.
17.  Canadian Health Act - yet another legislation we must be aware of.
18.  Health Professions Act - another legislation on the health care world.  Pretty long but knowing it early on will help you in practice in the future.  Especially when it comes to claiming your rights as a professional and to have an idea on how the regulatory body works.
19.  Accessible Housing by Design (ramps) - a question on accessibility might come out and knowing about the design acceptable is sufficient.
20. Occupational Therapy Assessment Tools:An Annotated Index - again, another magnificent book on instruments used in practice.
21. Functional Performance in Older Adults - knowledge on geriatrics practice.
22. Conceptual Foundations of Occupational Therapy Practice - a great book that summates the most widely used body of theories in practice.
23. Research in Occupational Therapy - best book to read about research in our field.  In fact, it is very easily understood that you needn't look elsewhere.  I'm pretty sure I browsed another book about research but I totally forgot that other one.


Additional resources:
1. Occupational Therapy examination and practice preparation project for IEOTS (aka OTepp project)

A wonderful organization which helps you understand the health care system here in Canada.  It is also, as I have described in my previous post, a virtual agora in which occupational therapists worldwide gathers and shares their knowledge.  I learned a lot from the OTepp program and I have to say, I never would have imagined starting from elsewhere.  Check out their website and see for yourself how magnificent the program is.

2. CAOT's Occupational Therapy Exam Module (aka OTEM) 

This used to be offered by OTepp but it was carried over to CAOT.  It is an online discussion group which assists examinees in preparing for the exam.  It has over 100+ questions in reserve to discuss with in order to mold the quick rationalizing during the actual exam.  

3. Orientation to the Canadian Health Care System, Culture and Context 

They offer online courses for internationally educated health professionals (IEHPs) on the Canadian Health Care system.  

For your basic sciences and medical-surgical review, I suggest that you stick to resources you feel comfortable with.  After all, there can be lots I can suggest but it will be up to you and on how your reinforcement system works.  I decided to stick wiht my old books Seeley, Snell, Guyton and Gilroy for I've used them quite a lot since college; thus, retrieval of information may be easier due to the repetitive factor.

Questions and Format

The way the examiner formulate the questions are quite unique.  They present a case to you in such a way that you might be in front of the actual client.  From there, they derive 2 to 5 questions.  I suggest from here, you must have at least read the resource manual.  If not, please do.  It will be less confusing.

Now, here is the number 1 case and question example on the resource manual⁶:

Client: Mrs. C is a 66 year old woman. 

Situation: 

• She is recently divorced. 

• She lives alone in a seniors’ apartment 

• She has decreased functioning as a result of a degenerative neurological disorder 

• She was getting home-making services in her apartment 

• She was going to a geriatric day hospital to receive treatment related to physical problems 

• Her physical problems include unstable gait, decreased balance, potential risks for falls, 

decreased vision and general safety 

• She has been admitted to an in-patient geriatric unit due to increasing depression 

• On admission to the in-patient geriatric unit, she is withdrawn, irritable, expressed vague 

suicidal ideation, and has stopped doing previous leisure activities 

• Her previous leisure activities included music and sewing 

• She has few close friends who are of the same age nearby 

• She has one daughter who lives several hundred kilometers away 

ITEM 1 

What should the occupational therapist do FIRST to address Mrs. C’s depression? 

1. Arrange a visit from her friends. 

2. Challenge her with new activities. 

3. Engage her in short term, familiar activities. 

4. Suggest she attend the unit’s Friday evening social event. 

ITEM 2 

Mrs. C. tells the occupational therapist that she is upset that her decreased vision means that she is no 

longer able to sew. Using a client-centred perspective, what should the therapist do FIRST? 

1. Suggest other leisure activities using the Interest Check List 

2. Explore low vision aids and techniques that could allow Mrs. C. to sew 

3. Encourage Mrs. C. to join activities at her local Senior’s Center 

4. Assist Mrs. C. to find a volunteer to help her do her leisure activities 

ITEM 3 

At discharge, the occupational therapist will recommend that Mrs. C. attend an activity at her local 

Seniors’ Centre. Which activity would be MOST appropriate for the therapist to suggest? 

1. Music enjoyment group. 

2. Recreational dancing. 

3. Playing cards. 

4. Recreational swimming. 

ITEM 4 

Mrs. C. is often impulsive and is not following safety guidelines when walking with her walker. What 

should the occupational therapist do? 

1. Set up a behaviour modification program for Mrs. C. 

2. Continue teaching walker use, providing only 1 to 2 step instructions. 

3. Further assess Mrs. C’s comprehension and ability to remember information. 

4. Encourage Mrs. C. to regain internal locus of control and take responsibility for her safety. 

ITEM 5 

The multidisciplinary term is not confident that Mrs. C. has the functional ability needed to return to 

her apartment. Mrs. C. strongly states that she wishes to return to her apartment. What should the  occupational therapist do? 

1. Have a discussion with Mrs. C. about safety and her ability to manage at home. 

2. Arrange for increased home care services. 

3. Investigate the potential for repeated hospitalizations. 

4. Provide legal documentation of Mrs. C.’s incompetence. 

For rationale, you can refer to the resource manual.  If you change information on the following case such as this:

-Mrs. C's leisure activities include watching television and walking.

-Mrs. C has macular degeneration.

NOTE:  This change in the sample number 1 of the resource manual is by NO MEANS AN OFFICIAL ONE.  It is just formulated by me in a mere example of knowing the client and their occupation. Also, the answer and rationale I have provided is again not in the official document.

If a question surfaces on which activity would be MOST difficult for her? Which would you choose? Think first before you read ahead.

1.watching television 

2. walking outside around their house

3. dogsitting 

4. playing UNO

It might surprise you that it would be number 1 because in this activity central vision is vital.  Since Mrs. C has macular degeneration thus we know that central vision is compromised.  The other activities can be done with intact peripheral vision.  See how each case can vary differently with just those alterations? It test how well you know the client in their environment and how it affects the occupations they deem meaningful in their lives. My best advice is to see it upon yourself that you view each case as if you are facing a client.  When you move on to the next question, it means that you get to meet another client who may have similarities but they are most definitely not one in the same. 

Items and Scoring

The exam for my batch was composed of two hundred (200) questions.  I assume that it was two points if you get the answer correct and zero if you pick the wrong choice.  That means overall, the exam would be a total of four hundred and in order to pass you need 70% - that is 290.  Funny though, if you calculate the 70% from the 400 it would be 280.  They added 2.5% to make it 72.5% so yeah, it's 290 points according to the PROCEDURES MANUAL.   Also some exceptions are made for certain questions.  You see, every batch of exams, a different set of questions are pulled from a "bank" and some are "experimental".  If the experimental questions are drawn from the bank, and a lot of the examinees have varied answers rather than the expected one, the question gets reviewed and possibly thrown out of the count.   That is probably why the waiting time for your exam results is a span of 6 to 8 weeks.  A council still reviews it.  

Although in the procedures manual, they indicate that they just put on the range of 290 - 450  (I'm not sure either why it's up until 450 instead of 400) if you passed, my results came in a very detailed breakdown of the components patterned to the blueprint.  I noted that they have revised it in 2010 as indicated in the copyright page.  Maybe they have yet to change it in the manual.

Of course this amateur collation of information is useful for those who are already registered to take the examination.  Please do refer to my previous post - The Unofficial Guide to CAOT Application for IEOTs for the procedures on applying for the NOTCE.  And do check the CAOT website for updates of the resource manual and other official documents.

Footnotes:

¹Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
²Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
³Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from the website on January 11, 2014: http://www.caot.ca/pdfs/2012otprofile.pdf
⁴Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from the website on January 11, 2014: http://www.caot.ca/pdfs/2012otprofile.pdf
⁵Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf
⁶Canadian Association of Occupational Therapists. (2006). National Occupational Therapy Certification Exam (NOTCE)        Resource Manual. Ottawa, ON: CAOT Publication ACE. Retrieved from the website on January 11, 2014:  http://www.caot.ca/pdfs/Exam/ExamResMan10.pdf

Seven Ways To Motivate Yourself

As part of the rehabilitation team, we occupational therapists use our disposition to be therapeutic.  In the purest sense, we must be motivated to move others.  For how can a full-fledged bonfire start without the tiny sparks?  But, of course... we are human as well; and oftentimes in our adult lives, we face daunting situations that leave us feeling dejected.  Even for some, the everyday "normal" lives make us feel dull and jaded - that we are stagnant of some sort.  This slump can go on for as long as you allow it to.  And yes, when you're in that pit of boredom and frustration, you might start to think that that is where you ought to be - decrepit and useless.  As Dr. Seuss said, "Un-slumping yourself is not easily done."

Here I share with you the things I usually do when I'm in a slump.

1. Take a walk 

I've found that when you wake up in the morning and you feel that certain uncomfortable nudge of the slump, it will set out to keep you at home.  If it starts to whisper, then the best thing to do is to GO OUT. Take a walk!  By taking a slow walk outside, you'll be able to give yourself time to reflect. You'll notice small things that you've never concerned yourself with before.  Minuscule circumstances like a child walking with their parents, an old lady waiting for the bus, teenagers walking with their friends on the pavement and cars bustling by as you take your walk.  Random acts of kindness like a man opening a door for the next person or walking by the dangerous side of the pavement to shield a stranger.  And in that simple walk you took, you'll be filled with obscurity of wonders - how people in your small community live their best in small ways.  That your existence may be small but significant and surely, as you traveled from your house to whichever direction you went, you're unmotivated self too shall pass.  

2. Read something inspirational 

I always believe that words have spirit. That whatever kind of words you speak can hold a person captive or unbind them if you will.  It goes the same for whatever you feed your mind.  Words that you read can inspire you into motion or keep you prisoner in your current mindset.  True to my belief, I have survived the adjustment phase in Canada by living on my everyday "inspirational something".  Be it a quote from a scientist of the past century, a contemporary poem or a Dr. Seuss book, I read them and let them linger in my mind.  It's even funny to admit that I look forward to reading Vancouver 24 Hours's horoscope because I find them inspiring.  The way in which they construct their sentences are always so positive and encouraging. I also have this application with lots of motivational quotes that randomizes quotes everyday. I start my day empowered by such words and still do.

Here is a list of quick motivational reads and links to quote sites I frequent:

1. Don't Quit Poem - a very famous poem since I was a child.  Whoever wrote it, kudos to you.

2. If - by Rudyard Kipling - this is a great poem to make you start reflecting on yourself.

3. Mutability by Percy Bysshe Shelley  - a poem that will make you realize the world is never stagnant.

4. On Quitting by Edgar Guest - a poem telling on how hard it is to let go of something you truly love.

5. Brainy Quotes - frequent site I visit for quotes.  They have an archive of quotes in landscape backgrounds.

6.  Think Exist - frequent site I visit again for quotes.  No pictures however.

7. I Like To Quote - an imageboard for quotes that is easy to share with social media.
8. Incidental Comics - I recently discovered the genius of Grant Snider.  He has some really great stuff in his site about a variety of topics.  Well, mostly art but still his works are quite inspiring.

3. Listen to music

Much like how words move you, add melody to that and you have magic.  I grew up in a house filled with song and I've realized how music can generally empathize with you to heal your soul.  To me, listening to music is like breathing, like going back to the basics of life.  There's nothing like a song that can express your remorse and unmotivated self then another different song to cheer you up out of that slump.  Listening to music always has that connection to one's soul.  It hooks deep and fishes out those bad feelings and can patch it up nicely with warm, positive ones.  

Here is a list of some moving songs I like and recommend (may contain Japanese songs):

1.  Closer To The Edge by 30 Seconds to Mars - a song about determination in life and looking past your regrets.

2.  What Doesn't Kill You (Makes You Stronger) by Kelly Clarkson - definitely one of those songs to pump up your day with self confidence

3.  Firework by Katy Perry - an uplifting song on inner beauty and potential.

4.  Unwritten by Natasha Bedingfield - I heard this song first from a shampoo commercial and got hooked!  It's about taking the future into your hands.

5. What A Wonderful World by Louis Armstrong - quite an old song that will make you reflect on the bigger picture of everything. You'll be thankful for the small things that make up your life.

6. It's My Life by Bon Jovi - it's a lovely rock song about following your will and pursuing life with unrelented passion.

7. Have A Nice Day by Bon Jovi - another Bon Jovi song that string up the daily dose of courage you need.
8. Defying Gravity (from Wicked) by Idina Menzel and Kristin Chenoweth - from a broadway musicale about fighting for what you believe in.  There is  a Glee version but I prefer this better.

9. One Step At A Time by Jordin Sparks - a song about reaching your goal by taking one small step after another.

10. Skyscraper by Demi Lovato - Demi's comeback song rising up after failing many times

11. Who You Are by Jessie J - a very powerful song speaking of loving yourself as you are.

12. The Climb by Miley Cyrus - Disney Miley's song on facing obstacles in life.  

13. Try by Pink - a new song by Pink about taking chances in love.

14. When You Believe by Whitney Houston and Mariah Carey - a classic song by two unbeatable divas of our time regarding having faith.

15. Bad Day by Daniel Powter - probably the most famous song in the list if I might say so. The most empathetic song in the list too. Who would've thought it was released a decade ago?  

16. Complain by David Archuleta - a song from Archie's 2nd album which moves you to action.  

17.  That's The Way It Is by Celine Dion - a love song released almost 15 years ago that never fails to uplift my mood.  It's about not giving up and working hard in your relationship.

18.  Chances Are by Five for Fighting - actually a love song but speaks of taking chances on life.

19.  Warattetainda by Ikimonogakari  LYRICS TRANSLATION - a song that describes strongly moving into an optimistic future .

20. Dareka ga by Puffy AmiYumi  LYRICS TRANSLATION - a popular song from the anime Naruto that speaks of supporting each other in fretful times.

21. Muteki no Kimi by Fukuyama Masaharu  LYRICS TRANSLATION - a song by my favorite J-artist about independent women and their courageous souls.

22. Against Wind by Akutagawa Jirou - a song from the anime Prince of Tennis about adversity and how you could overcome it.

23. Brave by Sara Bareilles - a fairly new song about standing up for yourself.  The video is quite interesting as well like here "Uncharted" one.

24.  Makenaide by ZARD  LYRICS TRANSLATION - an old Japanese song from the 90s about not giving up.

25. Uncharted by Sara Bareilles - I love this song!  It speaks of moving forward from where you are now to your goal.  

4. Do something productive

Unbeknownst to many, accomplishing a little task everyday could greatly improve your disposition.  Setting a small goal such as arranging your clothes in the closet or trimming your house plants and finishing it can help you feel fulfilled throughout the day.  Take a moment to think about the time when you are in an upsetting mood, then you engaged yourself into something that produced results. There is a certain satisfaction in that. The feeling is small but its effect in your soul resounds through your body - like a raindrop creating a ripple in a larger body of water.  Start by doing small things a day then proceed to bigger tasks to complete.

5. Keep a hobby

There is nothing comparable to immersing yourself in things in which you can express yourself freely. In the midst of the almost maddening effects of the slump, you'll find that engaging in your hobbies will keep you sane.  It is entirely different from other activities which we "put effort" in most of the time, as the motive to do them comes intrinsically.  The motivation to do them comes out naturally as though the hobby was already part of you even before you were born.  Thus, we rather than expending energy and getting tired, we become emotionally charged when we do our hobbies.  If you don't happen to have one or feel like you need a hobby change, then try looking at the community board and find something that may pique your interest.  

6. Self-reflect and move on

I confess to my abysmal habit of reflection.  Most especially towards myself.  I have always been delving in thoughts of queries and answers.  At times when I feel unmotivated, I try to look inside myself to find the reason as to why I am in such state.  Why do I feel down?  What events lead to me feeling suddenly unmotivated?  What did I do to remedy those?  If there weren't anything I can do about those things, then what am I supposed to do?  Those kinds of questions come up and somehow, through the long process of rationalizing with yourself, you'll be able to know just where you stand right now in life.  And from there, you'll pick up on your trail.

A beautiful art about self-reflection found in Incidental Comics!

7. Pray

I find that at times when everything just falls into chaos and that no matter what I do, I can't seem to relieve my restlessness, I pray.  When you've tried all of the things that can possibly cure your seasonal slump and still it won't go away, perhaps it's time to surrender your mind to a Higher Power.  You'll find the peace you need.


That's it for my 7 ways to motivating yourself. These are the things that work for an introvert like me.   I suggest browsing through the song list!  They are absolutely wonderful. And feel free to suggest things that work for you when you're unmotivated on the comment box!   I might try it out and see if it will fit for me too.  (*^_^*)

Here is a little advice I got from Aboriginal Day (@^ - ^@)

OTepp's Final Bow

For several years now, the Occupational Therapy examination and practice preparation (OTepp) project has assisted a multitude of internationally educated occupational therapists (IEOTs) seeking to enter the healthcare system in Canada.  OTepp has guided IEOTs to achieve the level of competency needed to enter occupational therapy practice here.  In fact, the program serves not only as a government funded program intended to develop IEOTs to the populace's liking but it also serves as a modern-day agora where OTs from all around the world can gather and illuminate each others' mind with cultural diversity.  Sadly, this wonderful program is in its last year.  

A farewell party was held at the Sheraton Vancouver Wall Centre Hotel in Burrard last July 16.  Most of the current students and even some former ones along with the McMaster University staff were present. It was nice to see and actually meet the people behind the voices during the online classes - Shami, Sue, Colleen and even Nancy to whom I was in contact with since I was an intern. (sorry if I missed some names) And even though I was only able to enroll for the 3rd and 4th module - which is the using evidence in practice and the clinical reasoning respectively - I was welcomed with much warmth.  

Here are some of the pictures from the party:  (courtesy of Miss Pinky Valerio)

Printed invitation for the farewell party

Sue Baptiste giving the opening speech

Group picture number 1!

Group picture number 2!

OTepp has made me realize a lot of things about the passion I pursue - that is occupational therapy.  Primarily, I realized that there is a huge difference of OT practice here and my home country, the Philippines.  Here in Canada, where the local communities play a big part in the overall country's development, an OT needs to know of the resources he/she can access in the community.  If you know your community well, you can better integrate the client into that community.  Like for example, what is the difference of a residential home versus an assisted living home?  And how would you utilize that resource in practice?  Subsequently, an OT does not only present literature as evidence of the management but he/she must also learn how to sift those articles to fineness.  With the lack of access to the large database during medical school, I am surprised how I even learned evidence-based practice.  I definitely learned a lot more about research in OTepp (inspite of the fact that we were best thesis in our year).   Lastly, I have realized that occupational therapy practice in the Philippines will remain stunted unless the government shifts its educational system to cater the Filipino mass.  I am quite inclined on the political situations happening in my home country since I entered College.  (Click this on my post about poverty and another Tagalog post about a 16 year old who committed suicide because of her tuition fee)  And it is easy to see how the social sciences have not grown that well for the past few decades.  What the Philippines needs is to have real identity through the social sciences.  Identity in which we can define the occupations every Filipino engages in.  This in turn will develop an occupational therapy of our own.  But yeah, maybe it's just me being too over reflective again.  Anyway, I think it's a nice brain candy.  

Perhaps we should trace back our roots for OT to thrive

Coming from a third world country myself, where the North American healthcare system seems more like fiction than reality, I feel relieved to know that there is an organization that can help you understand the complex framework of the health care.  And truthfully, with unintentionally jumping the first two modules due to complications with my documents, I have yet to completely understand how the health care system works.  I did a lot of self reads in order to properly engage myself in the online discussions; promptly following Shami's advise to improve my self-directed learning (aka assertive learning).  Still, when I reflect on the past year, I can't imagine starting from nowhere!  OTepp was my "start" sign on the game board of my career (and probably for most IEOTs as well).    

With OTepp's last curtain call, I bid the staff good luck with the program.  I pray you find alternative funding for this wonderful program.  And to those IEOTs I keep in touch with, may we meet in the health care world proudly carrying OTepp's legacy with us.

A Letter to My Wendy's Family

Dear My Wendy's Family,

It has been a long ten months since I have been welcomed in your home.  Although it seems to me that, I came as quickly as I had to leave.  I am writing this to all of you- crew members, shift supervisors and managers alike - to express my eternal gratitude for accepting me at Wendy's.  Since I landed in Canada last June 2012, I have been aggressively pursuing a job to fund my transition for occupational therapy practice here in Canada.  I felt hopeless and frustrated with the seemingly unlucky things that happened last year.  My diploma and other credentials were on hold because of my surname, two of my much anticipated volunteer works were pushed back and I literally had no money to invest in things that could start up my career as an occupational therapist here in Canada.  I felt utterly useless at home.  Looking even at the people who were carrying out their daily occupations made me miss my work as an occupational therapist. So when I was called in for an interview along with my little sister, Aiko, I was enthusiastic!  "This is it!", I thought.  I can earn money. Miraculously though, I wasn't just given a job; I was embraced wholly as part of a family.   The My Wendy's family.

And to my dear kin, I want to share the little achievements I have accomplished for the past year.  These are  the things that I proudly got from the opportunity you have given me.  First and foremost, I was able to reserve my spot for the National Occupational Therapy Certification Examination (NOTCE).  I had all my credentials assessed and I took an academic english test (TOEFL) in preparation for that.  Subsequently, I invested in books! Here are some of the books I have longed to own when I was still in med school.  Yep!  I have them now.

Latest editions of OT books I needed

Upper extremity rehab books that I wanted since internship

I was also able to buy myself a cellular phone to connect with my friends from far away.  But, needless to say, I am most proud of my decision to sponsor children from World Vision with my bi-weekly salary.  Much like Dave Thomas's Foundation for Adoption, I advocate for children as well.  My hard earned money is giving children in my parents's hometown a chance to have basic education.  They are given the privilege to have new bags, notepads and pencils that they normally can't afford every academic year.  Their washed away books can be replaced by new ones.  They can play in the fields and be kids as they should.  When Wendy's gave me this job, two kids are given back their childhood.  For that, I am evermore grateful.

Meet little Clarence

My Wendy's Family, I write this to you with heartfelt ardor. You have fostered in me qualities that every parent would be proud of. Each and everyone of you showed me the real light to seemingly jaded words like working hard, kindness and humility.  These are words that are used so casually today that it loses its essence.  You guys made me realize that we don't get paid just for every hour we stay there, we get paid for the value we bring to that hour.  And that surely, if you did your best and strive to improve, you will be rewarded. 

The fruit of hard labor! Yey!

I have learnt the true meaning of Dalai Lama's words, "Be kind whenever possible. It really is possible."  Customers love the service we give because of the kindness that flows in our smiles.  That simple hello with a bright smile is not just for show.  We are nice because we want to be nice.  And oh!  The things we do for even the most unreasonable requests by customers!  But that is real humility there.  Thinking less of how you could avoid getting responsibilities and focusing on giving the guests a positive experience. Everytime I work, I feel my name growing brighter by the second. (reference to 明美 - akemi)

With all that said, I close this letter with another thank you.  For having me, nurturing me to best that I can be and also for letting me go. I am sure that my ephemeral experience at Wendy's will permanently leave a mark on my life.  It will always be there - immutable, unshaken but magnificently resounding.  My time with you guys will be one of the many things that will shape my career; that I firmly believe.  I will be always proud to say that I have started out here in Wendy's Guildford.  Like this guy with a nice smile!

That serene smile catches everything I just wrote hahaha

Love,

Akemi

OTepp First Week

As I am currently in line for the November 2013 National Occupational Therapy Certification Examination here in Canada, I have decided to enroll in a program funded by CAOT called OTepp.   It is a program ran by the McMaster University in Ontario that assists internationally educated and returning occupational therapists integrate into the Canadian practice.  It consists of five (5) modules that started this January 2013 up until June, just before the July examination. I was a little late to register because of the status of my papers so I joined in the third module.

Interested in the program?  Click the link

We are currently studying evidence -based practice in which we are taught how to critically appraise articles to be used in practice.  In a virtual classroom!  I am so fascinated by this new experience that I can hardly contain my smile every start of the session. (Not that they could see my ridiculous smile though)  It really surprised me as well just how many Filipinos were engaged in the program.  And yes, it is perhaps one of the main reasons why I am happy with the classes.  Hearing a familiar accent calms me down and it reassures me (somehow) that we are one in the same.  We are seeking help to re-enter the world of occupational therapy.  Striving hard to re-ignite the flames of passion for the profession in a highly unfamiliar setting.

 Truly, support groups like this for internationally educated health care professionals like us is truly a blessing!      Can't imagine starting from nowhere.  Next week, I'll be posting about the process I underwent to apply for eligiblity to CAOT.  

World Vision Job Opportunity

For Children.  For Change.  For Life.

Today, I saw an advertisement in the newspaper that they had openings for their mall fundraising teams  in World Vision.  I desperately applied even though I had no sales background and technically even fundraising.  I think I sounded a little aggressive in my cover letter but I was willing to give it my all.  If they'd just call me up for an interview, I'll show them how passionate I am.  I have much to say and have much to advocate to fit it all in the cover letter.  This passion cannot be contained in an 8 1/2 x 11 inches of bond paper. I'd have had to take out even the margins and use the back page too! 

Anyway, they had an interesting form to fill in their job page.  They had a question at the end asking what was my motivation.  I answered:

"I came from the Philippines where poverty is widely seen and pitifully...ignored.  From a very young age, I have met parents and children who live just to survive.  Children forced into labor and sadly having dreams hindered by their educational attainment.  I have probably not seen all the hardships in the world but I have seen enough to know that I need to do something.  Right now, as I start a new life here in Canada, I want to do something I know I love - that is helping people."

Too much?  What do you guys think?  Well, I just hope that they do call.  If they don't well...then...I'll just try again!  Ha!  That ain't the last they've heard of me.

Just be you...

You learn something new everyday.

If there was one statement that could greatly describe how I perceive this new life I'm trekking, that will be the quote right above.   Somehow, with all the foreign things surrounding me, I can't help but feel like a kid.  Getting out of your comfort zone has never been this extreme!  Believe me. There are what we call basic "awkward~" situations where you get a little uncomfortable. But with simple and basic socially awkward situations at least more or less you are self-aware of the comfort endagering situation.  You have at least a marker on this one.  You know, like crossing the imaginative line of personal space or going out of your house gate when you were still a child.  Think about leaving that marker and venturing out into an unknown place, where people speak different languages and everything just seems so...NEW!  Right now, after all the nerve-wracking (and not to mention painstakingly humiliating) awkwardness I have been secretly carrying on my back, I have reformed to being a child.  So socially awkward sometimes that I have no care if I have acted rather ridiculously - like a child telling a green joke by accident.

The thing is immigrants like us are welcomed here in Canada and being awkward is fine.  Hey nobody is perfect!  You can't be all good at mingling with people right away.  But you can try.  Just try and try and eventually you'll get better.  Like a baby learning how to walk.  You have to risk falling before you actually learn.  And I bet that didn't just happen overnight.  You had to learn how to turn over first, sit unguarded, stand with the help of furnitures and practice letting go.  You can't just skip it all.  Take risk and be awkward.  Be you.  Afterall, you're building relationships so as much as possible honesty must be present.  They may find you weird at first or ...well, I can't think of anything except for weird so we'll just go with that. That's just how it is!  I tried to talk "casually" as soon as I got here and woah...you wouldn't believe how excruciatingly awkward I was to those people I have talked to.  I stuttered, mumbled, went out of topic and in the end I was talking in one word descriptors.  Talk about desperate communication right?   Nevertheless, I tried because I know that that is the only way to go.  I'm glad I did strike up those childish conversations though.  I can say that I have gained confidence in speaking and the stuttering is almost gone. My flightiness is a little hard to deal with but I think I can manage that through PGH style modification.

Hooray for Sir Jerry and Ma'am Ai~!!!  Thanks for straightening me out when I was still in Ward 7.   It's a great help now.

So view everything like a child - without prejudice and malice. I bet you'll find the world a better place.  Let me tell you it is easy if you try.  Just let His wisdom guide you (or you could just go with the weather topic.  Yes, it always works.)

Occupational Therapists: The Unsung Heroes (CUT VERSION)

Introduction

            Here in the Philippines, the people have a great deal of respect for professionals. Most especially, medical professionals.  However, a strong stigma in the society exists - that individuals wearing white coats are doctors and that all other folks wearing white uniforms are nurses.  In fact, I’ve had my fair share of prejudice in the last 5 years of my life in medical school. From strangers who greet me on my way home, to friends and acquaintances I meet in social gatherings and yes, even from my own family. 

The conversation almost always start with the simplest question, “What is your course?”  As I would like to answer the question myself, almost always, the interviewer races me for the answer.  “Nursing? It’s a great course.”  You’ll be lucky enough if they actually had good impulse to respectfully wait for you to open your mouth and answer for yourself.  Of course, this rarely happens.  Instantaneously, I correct them, “It’s occupational therapy, OT for short.”  Now, here is where the jokes come in.  I have five (5) for you:

1.      “OT?  Overtime?”

The most common witticism you’ll ever hear if you announce the abbreviation. Yes, it’s funny...but the gag gets old.  

2.      “Physical Therapist? Reflexologist or Masahista?”

Yet another common mistake in identifying the role of an occupational therapist and a misperception on being physical therapists as well.  They did not go to medical school for five years like us to simply give a massage.  Physical therapists help people with disability achieve their maximum potential for functioning with more focus on their bodily aspects.  Likewise, we did not go to medical school for five years to be simply overshadowed by physical therapists or the misconceptions of the latter.

3.      “Psychologist?”

Yes, we do work in psychiatric facilities; however, we transcend beyond gathering data of the mind and couch counselling.  Moreover, both courses DO NOT; I repeat, do not involve reading people’s minds.  That is simply beyond human capabilities.

4.      “SPED?”

It is a widespread misconception that occupational therapists are equivalent to SPED teachers.  You see, children with special needs - kids with autism, ADHD, Down’s syndrome and the like - are also referred to us.  Well, we are not them.  And sadly, despite the longer availability of our course in the Philippines, even SPED teachers do not even know our course to properly explain the difference.

5.      “Huh? Nursing?”

Still, people must insist on the notion that “all white” is equivalent to being nursing students.  At times like this, I just repeat what I have already said and emphasize it more.  The most ludicrous thing is, their response would almost always land on the preceding four items and the cycle goes on.

            You might ask why am I telling you all this.  What’s so important about knowing what occupational therapists are anyway?   Why do I even need to know what they do?  If I’m not ill and if they’re not even going to cater me medical treatment if in the event that I do, why in the world should I care?  Well, to answer all that, let me take you to a muster of words exploring the wonderful profession I’ve been talking about – occupational therapy.

   What is occupation?

For most people, when asked the question, it is one’s job, career, vocation, profession, work or employment they continuously engage in to make a living.   It is that affair that keeps us busy eight (8) hours a day, five (5) days a week, four (4) weeks in a month for almost eleven (11) months in a year.  Needless to say, our occupation is a dire part of our lives.  Yet, there are still remaining sixteen (16) hours in a day with our twenty-four (24) hours.  What do we do then?   Don’t we eat, bathe and sleep to physically charge ourselves?  Don’t we also engage ourselves in recreational hobbies and interests to invigorate our spirits?  The fact of the matter is those activities that occupy your time are considered to be your occupations.  It is not solely defined to be a job or employment that provide you livelihood.  It is every act or deed that you deem to be meaningful, enough to invest important time in. 

And whenever there is a disruption in your daily routine of occupation – whether it is due to physical dysfunction, psychosocial issues, congenital problems, genetic abnormalities, or chronic neurologic illnesses – we, occupational therapists intervene.

 Liminality

Let me ask you, have you ever tried to squeeze down an alley and then find yourself stuck?  Your hands and feet are pinned down by the cold concrete – immovable and useless.  You try to call someone out in the streets but they pay no heed.  A few will look, but since it’s too far and dark in the narrow alley, they walk past you.  Sooner or later, you’ll feel anxious of your current situation.  You try to break yourself free but now it seems that you can’t turn back and you can’t push forward either.  You’re in between, with no escape; and as the clock ticks hastily, you’re scared out of your wits. Ain’t that some luck!  Well, ladies and gentlemen, welcome to the world of those living in-between.  Those people who are not dead yet not fully alive, those who are neither sick nor fully well, those who are in our society but are not welcomed completely either. Welcome to the world of the people who have their occupations permanently disrupted.  Welcome to the world of the people with disabilities (PWDs).

More often than not, the populace have a limited view of people with disability.   Admit it, even as you read this now you’re imagining a person confined in a wheelchair or people with amputated feet who walk with crutches.  Well, let me tell you that they are only a tiny part of the disability spectrum we occupational therapists work with.  Disability encompasses physical impairment.  It also covers for psychological, emotional, social and developmental impediments in daily occupations.  It is anything that restricts you from engaging in activities that are meaningful in your life.  Therefore, PWDs include not only those who have a problem with walking; they are also those who have depression, schizophrenia, autism, Down’s syndrome, mental retardation and the like.   

Truly understanding it requires a lot more and perhaps, yes, one can’t fully understand the horrors of living with disability unless you experience it as well.  I attest to this.  Even though I work with them a lot, I can only imagine the weight of the difficulty so much to what I have already experienced. I remember watching Jay Taruc’s documentary, “Gulong ng Buhay” where he had his leg cast for a day to experience the prejudice of the Filipino community to its PWDs.  We do it as well in school during National Disability Prevention and Rehabilitation Week in July.  We dress ourselves with braces, act like schizophrenics and approach people to experience their situations just for a day.  Can you imagine the disgust people give you or the much hurtful ignorance they feign?  

  A Helping Hand

We occupational therapists help a lot of people live their lives independently after impairment strike. Can you envision now how magnificent this profession is? Studying mountains of textbook to comprehend the human body and mind, knowing the client and family to a level of comfort yet maintains an air of authority as a professional and respecting the culture and values of the people involved.  We are holistic.  And in order to be a helping hand to them, you need to be as well.  Well, what is the first step in that?

First, let me tell you the most important golden rule.  Ah yes, Confucius at work here.  Do unto others what you want others to do to you.  This means you treat them as you would like yourself to be treated.  Not at the first sight of his incapacitated body part, you render him/her useless.  Not when you see him having difficulty walking, you’ll just discourage him all the more to move.  Not some useless junk stored away in the closet after it’s broken! How would you feel about that if it was you in their place? Treat them as an equal, as people. What we can do, they can do.  It’s just a difference of the manner of doing so as they adapt to their new bodies and mind.  

Second, don’t treat them with sympathy.  They don’t need that.  They have experienced enough of those from ignorant people they don’t even know.  You always think “in their shoes”.  Empathize.

With the growing awareness and interest of the people in the last couple of years with people with disabilities, it is only natural that we pay heed to the proper way of treating them.  Subsequently, it is also greatly important to know which professions you seek help to and their differentiation with others. You have the right to know what services are given to you and the reason behind it.  It’s your body after all. I heard of a client once who went to a “therapist” and received only massages for treatment after his stroke. He just went with it. He didn’t know the difference between and massage therapist with the others. After a year, realizing that there was no improvement, he sought after an occupational therapist as his hand was already much worse than it should be. If only he knew that he was supposed to see an occupational therapist.  Heck, if only he had heard there was an occupational therapist! 

  The Promise of Tomorrow

Imagine the world formed by the people joining their hands, slowly setting the world into motion.  All of them have a place inside the circle as it progresses.  Each individual unique and irreplaceable, all of them have their own roles to fill.  As disability strike, they lose themselves – their roles.  They are led astray outside the circle, forming yet another one but with their hands not united.  They are neither alive nor dead, neither sick nor well.  No past to go back to and it seems no future as well.  They are close enough to seek help but are too far away to be pulled back by stares alone.  We, as occupational therapists, bridge this gap.  We are trained well to reach for them and help them connect with the ones in the inner circle - you.  Though few, we are strong.  Strong enough to bear the responsibility of pulling them back and wise to know that we alone do not suffice.  They need to be given back to society in order to be independent.  That is our ultimate goal – our promise.  Hear us out and make us known.  For we are heroes who are not willing to be unsung for long.