Question: Who are clinical externs?
Answer: As described in the Ministry of Health’s document Enhanced Extern Program Guide 4.0 October 2021.pdf (oha.com), “externs are clinical learners who are employed as unregulated care providers to work under the supervision of regulated care providers. Types of eligible clinical learners includes those in nursing, respiratory therapy, medicine, physiotherapy, occupational therapy, and paramedic programs, or recent Canadian medical graduates awaiting start of residency.”
The document suggests that occupational therapy externs be students in any year of study in an occupational therapy training program accredited by the Canadian Association of Occupational Therapists (CAOT). The extern role is not a substitute for fieldwork placement. All extern roles are paid employment opportunities.
Question: How should externs identify themselves?
Answer: The title “occupational therapist” is protected in law. Therefore, externs cannot use this term nor call themselves “student occupational therapist” as they are not on a fieldwork placement. They may identify themselves as an extern in occupational therapy, as the term “occupational therapy” remains open for use in the public domain.
Question: Who is responsible for the extern?
Answer: The occupational therapist is accountable for the occupational therapy service and their supervisees. Many of the guiding principles for supervising occupational therapy assistants (OTAs) will apply to supervising externs. The requirements for supervising OTAs are outlined in indicators 6.1 to 6.5 in the Standard for the Supervision of Students and Occupational Therapy Assistants, 2023 (coto.org). Each organization needs to develop processes to address accountability, supervision/communication, obtaining client consent for extern involvement, and managing risks to client care.
Question: What type of activities can be assigned to the extern?
Answer: Each practice setting needs to determine which tasks would be appropriate for externs and provide any necessary training so that they have the competencies to perform them safely. Externs may require a focus on lower-risk activities compared to what they may be performing when on a fieldwork placement and fulfilling training requirements to become an occupational therapist. For example, externs cannot provide assessments.
Question: What if the occupational therapist is not available for supervision when the extern is working?
Answer: Occupational therapists are expected to have a process in place for back-up supervision if they are not available. (Standard for the Supervision of Students and Occupational Therapy Assistants, 2023 (coto.org), indicator 3.7). The back-up supervision does not necessarily need to be provided by another occupational therapist. It may be another health professional depending on the setting and client population, however this person is still only a “back up” and the occupational therapist is still accountable for what they have assigned to the extern. A clear supervision and communication plan will need to be place between all parties to ensure risks are managed and the extern knows what is expected.
Question: Can another health professional assign activities to the extern?
Answer: Activities assigned by other health professionals are not considered part of the occupational therapy service. Processes need to be established to clarify who is the regulated health professional that is accountable in these cases, and who the extern should go to for questions or concerns when carrying out their duties.