One of the greatest barriers to the expansion of occupational therapy services in mainland China is the shortage of experienced therapists (Da Hong, 2006). Understanding the current status of occupational therapy education and using additional resources and strategies can help to promote the growth and sustainability of the profession.
Occupational Therapy Education in the Present
Currently, there are nine accredited professional degree programs offered in mainland China for occupational therapy, seven at the bachelor's level and two at the master's level (Shi, Howe, Hinojosa, & Wang, 2018). Hong Kong, an administrative region of the People's Republic of China, also offers a doctor of health science degree with an occupational therapy specialization (Hong Kong Polytechnic University, 2018). Hong Kong has been instrumental in improving education in the mainland because occupational therapy is more established in this area and programs are more fully developed (Wong & Fong, 2013). Occupational therapy professionals from Hong Kong and Taiwan support mainland China through collaborative efforts and by encouraging Chinese therapists and students to travel to other countries for educational opportunities (Da Hong, 2006).
Da Hong (2006) suggested that one of the challenges in training occupational therapists is the shortage of professional educators. Because the profession is relatively new and is less developed than in other countries, few experienced therapists are available. It is not uncommon for therapists with fewer than 5 years of practice to be educators, which may limit the complexity of clinical skills taught in the classroom setting. Although novice therapists tend to use procedural reasoning, experienced therapists use all types of clinical reasoning, including procedural, interactive, conditional, narrative, and pragmatic (Knecht-Sabres, 2013). Educators who have minimal clinical experience may not possess advanced clinical reasoning skills or provide examples of intervention strategies that are often used in didactic training. Da Hong (2006) suggested sending occupational therapy educators abroad or to Hong Kong so that they can obtain advanced degrees to improve their knowledge base and enhance classroom experiences.
In a clinical setting, it may be difficult to distinguish between occupational therapy and physical therapy. Many nonspecific degree programs include training in physical, occupational, and speech therapies as well as prosthetics/orthotics, electrotherapy, and traditional Chinese medicine (Erlandsson, 2011). Therefore, striving for separate degree programs and aligning programs with international standards for the development of professional competencies may create benefits for both therapists and patients (Da Hong, 2006; Rodger, Clark, Banks, O'Brien, & Martinez, 2009).
For Chinese occupational therapy students, international classrooms and fieldwork settings can enhance clinical reasoning and practice skills and increase the understanding of different views of disability and expectations for care. Lim et al. (2016) reported that Asian students in an Australian occupational therapy program believed that both the classroom and the clinical environment required students to be more assertive and communicative than is typical in China. They also expressed concern about the application of occupational therapy principles in their home country (Lim et al., 2016). Thus, international programs that accept Chinese students must consider these factors and assist students in developing strategies for cultural relevance on their return to China.
Occupational Therapy for the Future
Promotion of occupational therapy services is a crucial need for the survival and advancement of the profession in China. According to Asakawa et al. (2017), government support through restructuring of the health care system, training of therapists, and general health education is needed to assist those with disabilities in accessing services in the mainland. Occupational therapists in the mainland must establish the importance of educating the family in the process of recovery and the importance of participating in activities in conjunction with Chinese culture (Jang, 1995). Globally, occupational therapists from other countries can promote the growth of the profession in China through education, affiliations, partnerships, and technology.
Education. Occupational therapy is a well-established profession in the United States, Europe, and many developed countries. However, in countries where services are newer, promoting understanding of and respect for the profession can be difficult and may affect the growth of the profession (Peer & Pollard, 2012). Promotion of occupational therapy in China is congruent with the tenets of occupational justice and the use of occupation to enhance wellness. This perspective may provide a catalyst for encouraging internationally trained occupational therapists to share knowledge and expertise with colleagues and students in mainland China.
Shi and Howe (2016) suggested that more advanced education for occupational therapists and occupational therapy educators is needed to encourage professional growth. Methods for sharing may include guest lectureships, continuing education programs, and opportunities to collaborate on program development. For instance, the first author's personal experiences presenting lectures on orthopedic topics to various audiences in China, including medical students, rehabilitation students, and occupational and physical therapists, identified much interest in and appreciation for knowledge sharing. Additionally, using live teleconferencing to present information on pediatric conditions to occupational therapy students from an accredited Chinese university proved to be an efficient and effective means of collaboration. Such experiences can enhance both personal and professional development while facilitating the application of occupational therapy principles in clinical and educative settings. The use of similar strategies would greatly enrich cultural awareness and learning opportunities for therapists and educators as well as students and colleagues. Language barriers may be a challenge for international collaboration, so the use of a personal translator, as in the first author's experience, may be necessary.
Membership affiliation. Occupational therapy as a profession in China took a critical step forward in 2018 by joining the WFOT as a full member organization (WFOT, 2018). This membership affiliation allows for continued networking and collaboration as well as progression toward standardization of occupational therapy education and service provision. Membership allows Chinese occupational therapists the opportunity to learn from other member organizations and provides a global platform for identifying needs and creating solutions to barriers to access and delivery of services. Development of professional occupational therapy organizations nationally is also important for achieving a standard curriculum, ensuring the quality of practice, and improving professional status through education, conferences, and publications (Shi & Howe, 2016; Shi et al., 2018).
Sustainable partnerships. Sustainable partnerships with international universities provide another valuable tool for the advancement of occupational therapy in mainland China. International fieldwork placements for occupational therapy students from other countries who desire to experience China can offer many benefits for the student and the host facility. Immersion experiences help to create cultural competency and sensitivity, improve communication, and enhance clinical reasoning through innovation and leadership skills (Knecht-Sabres, 2013; Mu, Coppard, Bracciano, Doll, & Matthews, 2010). Student-led projects and workshops allow knowledge sharing through clinical training for leaders and therapists at the host facility as well as the provision of therapy in underserved areas (Cameron et al., 2013). Collaboration of the host facility, university, and students through the use of technology before and during fieldwork can ensure that the host facility has professional standards and expectations in place to prepare students for success (Cameron et al., 2013; Shields, Quilty, Dharamsi, & Drynan, 2016). Experiential learning in nontraditional environments, such as home health care or community-based practice, is also encouraged to allow practical application of learned concepts (Knecht-Sabres, 2013). Li-Tsang, Choi, Sinclair, and Wong (2009) found that students who were placed in emerging practice facilities reported that they were more able to engage in self-directed learning, problem solving, and creative thinking compared with students in established settings. Such facilities and nontraditional environments must not be overlooked for clinical placement in international settings, such as mainland China.
Similarly, giving Chinese students the opportunity for international education and fieldwork allows them to learn clinical skills that may not be as advanced in their own country and provides varied perspectives for client-centered practice. Lim et al. (2016) conducted a phenomenological study of Asian students studying occupational therapy in Australia. Although these students faced challenges that included the need to learn occupational therapy theory, different styles of learning, cultural adaptation, and socialization, many reported the importance of acceptance of client independence, client centeredness, role balance, and respect for disabled persons (Lim et al., 2016). Establishing English language proficiency based on the requirements of the host country and providing trained interpreters or access to English classes would help to minimize limitations that result from language barriers among Chinese students participating in international programs (Bennett, 2018).
Accessing resources through technology. Many occupational therapy students and practitioners who are from underdeveloped areas or who have limited access to resources experience difficulty securing reference and resource materials as well as continuing education (Peer & Pollard, 2012). According to the WFOT, one way to promote globalization of education is through free access to occupational therapy publications at the undergraduate level via the Internet as a benefit of membership (Peer & Pollard, 2012). This is a valid possibility because the use of the Internet has greatly opened lines of communication and collaboration for students and professionals. For instance, the Occupational Therapy Weekly Forum is an online community where participants attend virtual lectures and discussions via messaging, with sharing of presentations and documents through attachments (Yan, Sinclair, & Penman, 2012). This type of platform is useful for increasing participants' knowledge and awareness of cultural and local issues that affect occupational therapy practice. Another example of the use of technology is the alliance between Xavier University in Cincinnati, Ohio, and Seth G.S. Medical College in Mumbai, India. Occupational therapy students from these universities met online to discuss the provision of services in their respective countries and to present case studies to each other to allow an exchange of ideas and clinical reasoning (Asher, Estes, & Hill, 2014). This exchange benefited students from both countries by promoting cultural sensitivity and alternative views of treatment planning. These examples of the use of technology for education and promotion of occupational therapy are starting points for further innovative strategies to enhance collaboration.