Not just a Lesson – A lived experience: Understanding Experiences of Implicit Bias in Fieldwork 

Posted in Disparities Diversity, Equity, Inclusion Intervention

When you’re training to become an occupational therapist, you’re taught to see the whole person. You learn about empathy, therapeutic use of self, client centered care; all the important things. But there’s something we don’t talk about nearly enough in our lectures and programs: bias.

Not the kind you hear about in diversity training, I’m referring to the silent, often overlooked, everyday kind. The subtle looks, the offhand comments, the unspoken assumptions about each other as the student, patient or clinical instructor.

Interviews were conducted with occupational therapy students from different programs in the DC, Maryland, Virginia (DMV) area to learn about if and how their perceptions of bias changed after fieldwork. The stories they shared were real, eye-opening, and sometimes heavy. Many students expressed how they felt like they weren’t prepared for how often they’d see or experience bias in the field.

“In the moment, it’s a lot different than sitting down and having these conversations in a safe space. It’s a lot more uncomfortable.” – DMV Occupational Therapy Student

Some students described how clients from certain racial backgrounds, income levels or disabilities were treated differently – often in subtle, almost invisible ways. Others realized feeling like they were “walking on eggshells” limited by the power dynamic of the setting. Although these experiences are not the first, and will not be the last. But what’s troubling is that students are often left to navigate them alone. 

What if OT education included real conversations led by experts on the topic to guide students through the tough, real-world moments? What if fieldwork educators were not just trained to supervise but to help students unpack these experiences instead of brushing past them? What if we incorporated literature on the topic that students can explore in small group discussions? These are suggestions straight from the students; things they wish they had been part of their programs.

Based on the findings during the interviews, OT programs should incorporate activities that move beyond checking a box for cultural competency and instead focus on fostering cultural humility. We need to talk about bias honestly – what it looks like in real life, and how it shapes our thinking. Research shows that consistent self-reflection and group-based activities can make this happen. The potential for growth in this area is huge. This is the beginning of the positive shift to improve experiences for our clients, our profession and each other.

Collese Daley, OTD (GUCEI’25)