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How to Work in Hand Therapy as an OT

So, you made it through the grueling and exhausting process of applying to occupational therapy (OT) school and you got accepted; you deserve a HUGE congratulations (and maybe even a vacation)!

Over the course of applying, I’m sure friends and family asked endless times, “What exactly is occupational therapy?” At times I feel like I need the answer to this tattooed on my forehead. But I’d be willing to bet you weren’t asked nearly as much what TYPE of occupational therapist you wanted to be.

As most of you are aware, OT is a unique profession because of its diversity – from school-based to burns and nursing homes, OT’s can work in so many different settings. How much thought have you given to what setting you want to work in?

I’m writing this article through the lens of a hand therapist, in which I have been for nearly two years now (crazy how time flies). I feel it is important to articulate my experiences throughout graduate school (and now the real world) to help anyone I can in this process now.

I hope to give advice, and some tips and tricks, which hopefully will make your journey of becoming a hand therapist enjoyable and exciting!

Graduate School

If you have already enrolled in an OT program, you can skip down to the next section.

I thought it would be beneficial to talk to those who may be interested in hand therapy and are currently applying to OT school. Having been through this process recently, I have a few pieces of advice I would consider:

Is there a certified hand therapist (CHT) on staff in the program?

Having a CHT on staff is ideal, as they could provide mentorship throughout your time in school. CHT’s have a wealth of knowledge and experiences that could give you a “leg up” during your fieldwork rotations and when applying for jobs.

Does the program have a splinting lab?

If possible, tour the campus and see the lab for yourself. Having a splinting lab is ideal (but uncommon in many programs).

What does the splinting component of the curriculum look like?

The curriculum in my program consisted of a semester long physical dysfunction course and a four hour splinting lab. OT programs are meant to prepare us to be general OT’s, however, some programs may highlight splinting and other hand specific components more than others.

What You Should Do While In Graduate School

Shadow!!!

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This is one thing I wish I had done during school. It is a great opportunity to network with other hand therapists and clinics if you want to work in the area you go to school. It also gives you insight into what your rotations will look like.

Complete a Level 1 Fieldwork in Hand Therapy

In some programs, this can be completed at the same location as one of your level 2 rotations. Doing this will help you to be more familiar with the clinic and staff.

Level 1 rotations are meant to be mainly observation, so take many notes and absorb all the information you can. This will only help you in your level 2 rotations.

Complete a Level 2 Hand Therapy Fieldwork Rotation

This may be the most obvious advice, but also the most important. A 12-week level 2 rotation in hand therapy will not only show you what being a hand therapist entails, it will also prepare you for the real world in a controlled environment.

Some people ask if they should do more than one level 2 rotation in hand therapy. A few thoughts on this…

First, in some programs this is not allowed as they encourage a more generalized education. Second, I think it is very important to be competent in a variety of settings and not limit yourself so early in your career. You never know what setting you may end up working in!

Bonus tip: Make sure to complete a mock interview during your rotation, update your resume, and practice answering questions and making splints (I had to make a splint in my interview, nerve-wracking!)

”The Real World” (After Graduation)

There are many differing opinions about going straight into hand therapy out of grad school. Honestly, I have heard both pros & cons. For me I was fortunate to work in a small community hospital initially where I did 50% hands and 50% inpatient acute.

I truly believe it is important to be a competent general OT before specializing, but I know many people who went directly into hands and were successful. In short, there is not a right or wrong, you just have to determine what path is best for you.

One way I have found to keep my inpatient skills up-to-date is by having a casual or “PRN” job, in which I typically work one weekend a month in an inpatient acute setting. This is also a great way to start paying off those pesky student loans!

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Interviewing

Simply put: the more prepared you feel, the less scary of a process this will be!

How should you prepare for your interview?

First, you hopefully completed one in your level 2 so you should have a basic understanding of the process. Seriously, make sure you do this.

Make sure to review basic diagnoses (ex: post-surgical distal radius, carpal tunnel syndrome and release, thumb carpometacarpal osteoarthritis). You will absolutely be asked about these during the interview, most likely in terms of treatment ideas or splint options.

Don’t memorize protocols, just familiarize yourself with them. In my experience, I was not asked what week is appropriate to start strengthening after a distal radius fracture repair or when to discontinue a splint, but more general questions about the diagnoses.

Familiarize yourself with fabricating basic splints (ex: hand and forearm-based thumb spicas, resting hand, wrist cock-up, hand or forearm-based ulnar or radial gutter) as you will likely be asked to make one in the interview.

This can be a really scary thought – having to make a splint in an interview, but don’t stress… PRACTICE! Make as many as you can during your rotation, and if your instructor is okay with it, bring scrap splint materials home and practice on family or friends.

Final Thoughts

One question you may be asking is – when can I sit for the Hand Therapy Certification (CHT) exam? In order to sit for the board exam, you must work three years or 5,000 hours in a direct hand setting. There are review texts and courses available to help you prepare.

When you do get to the point of considering taking the exam, make sure to give yourself adequate time to study. I have been told by many CHT’s that they studied for 6-9 months. It is a rigorous exam and quite the accomplishment.

A follow-up question to the CHT exam I hear a lot is whether or not you are required to take the exam if you work in hands. Short answer is no, BUT many surgeons prefer marketing CHTs on staff, while patients also tend to prefer to be seen by a CHT for their expertise level.

Seek out a mentor to help ease the transition as a new hand therapist. This is possibly the most important piece of advice I can give you. I owe a lot of my success (and sanity) to some amazing mentors who have given me invaluable advice. Ask questions, observe, and ask more questions!

 

Additional Readings

A Day in the Life of an Outpatient Hand Therapist (My OT Spot)

What is a Hand Therapist? (ASSH)

The Unique Role of Occupational Therapy in Rehabilitation of the Hand (AOTA)

Learn The 5 Steps To Become A Certified Hand Therapist (My OT Spot)

 

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