In the last ten years there have been many changes to health care delivery, and higher education in preparing students for professional practice. Occupational therapy has had to meet these demands by being more challenging and evaluative of the care they deliver. One way this has been addressed is through the inclusion of reflective thinking and reflective practice into the undergraduate curriculum of occupational therapy. This research looks at how reflective practice has been developed within the Course curriculum of Occupational Therapy at The University of Liverpool with the aims of investigating and establishing - • How the notion of reflective practice has been incorporated into the curriculum overtime • How students' perceptions of reflective practice have changed over time • How the changes in curriculum design are related to the values students place on reflection and reflective practice. The methodology uses a case study design involving document analysis. Three sources of data were gathered from: Public Records, Private Papers of students and Biographical teaching notes of staff. Findings: Several factors have emerged that have implications for future practice both in occupational therapy and other health science professions. When reflection is not explicitly taught and/or where reflection is only considered as a discrete part of a curriculum, students are unable to incorporate reflection into their daily practice. Students' capacity to develop reflective skills leads to students acquiring reflective abilities at differing levels and therefore curriculum design needs to provide practical ways in which students can enrich their reflective practice competencies. To be reflective a number of cognitive skills need to be taught and developed in order for reflection to be effective. Students also need to be taught how reflection works in practice and how their personal reflective abilities impact on the benefit to clients.Recommendations It is suggested that future curriculum design should embrace a model of education which encourages opportunities for 'learners' to develop their capacities which are fundamental to competent reflective practice and the acquisition of knowledge that should proceed interactively with reflecting about real practical situations. One possible consideration would be to identify early on in the course the students' reflective thinking, using a scheme for assessing students' writing and then employ a . variety of teaching strategies that bring together the material used and found in the progress of this study. Tutors need to be mindful that the teaching of reflection does not necessarily require changes in what is taught but instead more emphasis is needed on how to incorporate thinking skills into a repertoire of knowledge. Tutors also need to make more explicit the links reflection has with the skills of problem solving and clinical reasoning so that students can learn to "reflect effectively and practice reflectively" (Burton, 2000).

This research study investigated age as a predictor of success in the academic outcome and early professional performance of recent occupational therapy graduates. The study was divided into two parts. The analysis of age and academic performance in occupational therapy education initially provided a picture of mature student success when compared with the performance of younger students, but this finding was negated when the confounding variable of entry qualification was added to the analysis. The mature student data were strongly influenced by the superior academic performance of the students who had a previous degree on entry to occupational therapy education. When these degree-level entrants were removed from the age analysis, the academic performance of the remaining mature students did not differ significantly from that of the younger students. This result indicates that entry qualifications, in particular a previous degree, have a positive predictive affect on academic performance in occupational therapy education. The second part of the study investigated the impact of age on the early professional performance of recent occupational therapy graduates using a competency questionnaire adapted from the curriculum framework document for occupational therapy in the UK (COT, 1998). The hypotheses that age is a value-added factor in the early professional performance and level of threshold competence after graduation was partially upheld in the graduate self-ratings of competence but not in the employer ratings of new graduates in practice. No age differences were observed in the employer ratings of graduate abilities but academic performance at university was related to perceived levels of. competence. When graduates rated their self-perceived levels of competence, it was the mature graduates who consistently rated themselves as being more competent than their younger peers. The type of occupational therapy programme undertaken did not relate to either the employer or graduate ratings of competence. All respondents were provided with an opportunity to comment on the issue of professional competence. Mature students expressed high expectations of their professional competence yet were no different to all other new graduates in reporting stress when making the transition between being a student and qualified practitioner. A discrepancy in expectations of threshold competence was observed between the employer and the graduate comments.