Stereotyping between physical therapy students and occupational therapy students.

Stereotyping Between Physical Therapy Students and Occupational Therapy Students As professionals who work closely together, physical therapists (PTs) and occupational therapists (OTs) need to demonstrate teamwork and cooperation to provide optimal patient care. They frequently share equipment and work space and often jointly treat patients. Developing smooth clinical relationships requires coordination of treatment goals and activities. Are these areas of shared knowledge and responsibility affected by the views each group holds of the other? Could the presence of certain types of positive or negative sterotypic views in the clinical situation influence patient care behaviors? Social psychology has shown that beliefs about groups may influence actions toward individuals [1-3] and that a group's social identity can have implications for intergroup behaviors. [4]

Stereotyping is commonly defined as beliefs or ideas about the characteristics of a group of people, held in common by a separate group. [5] The process of stereotyping is functionally utilized in everyday interactions to increase efficiency and allow us to generally anticipate appropriate forms of behavior. [2] Although some group attitudes have elements of truth, stereotypes may also represent oversimplified and uncritical opinions or attitudes. [1-4] The formation of stereotypes begins with a lock of information about a group. The fewer people available in the group to help form an impression, the more likely a group will be judged on the basis of an individual's characteristics. Simplification and categorization magnify intergroup differences and may understate intragroup differences. [4]

Although a number of stereotyping studies have been perfomed for closely interacting professions, [6-8] only a few have focused on the health care professions. [9,10] Parker and Reisch [9] investigated stereotyping between employment and rehabilitation counselors, using the Health Team Stereotyping Scale (HTSS). They found that both groups of counselors viewed their own group more positively than they believed the other group viewed them. The rehabilitation counselors viewed the employment counselors both inaccurately and negatively. The authors concluded that these attitudes inhibit team effort in rehabilitation, suggesting that stereotypic attitudes may influence clinical behaviors.

Parker and Chan [10] studied the existence of stereotypes between PTs and OTs, using the HTSS. They found that PTs viewed themselves more positively than Ots viewed Pts, Ots viewed themselves equally as positively as PTs viewed OTs, and PTs and OTs viewed themselves equally as positively. The authors suggest that work experience or interaction between the two professions may have an impact on the degree of stereotyping between PTs and OTs. They did not propose whether stereotyping would increase or decrease in relation to work experience, or how it might influence the work environment.

Both articles [9,10] address stereotyping only between working health care professionals. Little attention has been given to when and where in the professionalization process stereotypes develop. If, as Parker and Chan [10] suggest, work experience affects stereotyping, would attitudes based on less work experience, such as those of students, be more or less stereotypic? The stereotypes may or may not be present even before the PT or the OT enters the clinical environment. Physical theraphy students and OT students, like other college students, are subject to home and nonschool influences, but their professional development is subject primarily to the standards of the major department in which they are enrolled. [11,12] Being a source of occupational values, goals, and aspirations, the major department has been characterized as the "locus of vocation-related experiences." [13] Within this environment, both the faculty and peer groups act as major agents of socialization. [14,15] Although there is a growing literature on OT and Pt student characteristics, [16-18] little research has described the environmental and organizational aspects of OT and PT. academic departments. Establishing the existence of stereotypes held by PT and OT students may provide information about the preprofessional nature of stereotyping.

The purpose of this study was to examine stereotypes at the college level in the junior classes of OT and Pt students at the University of Illinois at Chicago (UIC). The students enrolled in these curricula have little or no clinical experience and little oppurtunity to interact between academic departments. We hypothesized (1) that junior Pt students would score more positively on the HTSS than junior OT students when describing PTs and (2) that junior OT students would score more positively on the HTSS than junior PT students when describing OTs.

METHOD

Subjects

The subjects consisted of 42 junior PT students (32 women, 10 men) and 42 junior OT students (39 women, 3 men) at UIC. The students were predominately midwesterners attending a major public, urban university. Each group was required to succesfully complete 2 years of studies in the liberal arts and sciences prior to admission to the College of Associated Health Professions at UIC. ALthough some students reported minimal experience in clinical observation prior to admission, at the time of the administration of the survey, which was 3 months into an 18-month curriculum, the students had no formal clinical affiliation experince. The OT and PT students had no formal classroom contact prior to their participation in the study. All students volunteered for the study.

Instrument

The Health Team Stereotyping Scale (HTSS> ia a survey queationnaire that uses 54 pairs of bipolar adjectives. One adjective in each pair is viewed as positive and the other as negative (Figure) (HJ Parker, PhD; unpublished manuscript; 1973). This survey style is known as the semantic differential, based on the seminal work of Osgood in 1957.[19] The adjectives include personal and occupational performance-related attributes, and nearly all are evaluative in nature. They are random and counterbalanced to avoid bias and to improve reliability. In a study of rehabilitation counsolors and employment counselor, [9] a three-way partition analysis of variance showed the coefficient of reliability to be .93. Similarity between the Adjective Checklist (ACL) [6] and the HTSS support the validity of the HTSS.

Procedure

The HTSS was given to the PT and OT students by the investigators as a self-administered survey questionnaire in the students' respective classrooms during regularly scheduled class periods. All participants were given a general explanation of the purpose of the study. The HTSS was administered twice for each group in a sequential manner. The first administration assessed the attributes of the profession as perceived by students of the profession, and the second administration assessed the attributes of the students of the related profession. For the first administration, the following statement was attached to the questionnaire: "My future occupation is that of a physical therapist/occupational therapist, and I feel that most people in this profession are ...." For the second administration, the following statement was attached to the questionnaire: "A typical physical therapy/occupational therapy student (the student filling out the questionnaire) generally sees a(n) physical therapy/occupational therapy student (the student of the alternate profession) as ...." The administration of the HTSS required 20 minutes to complete. The participants returned both questionnaires to a member of the research team.

Data Analysis

Semantic differential tests, such as the HTSS, provide ordinal data. Because the assumptions of parametric analysis cannot be met, a nonparametric statistic is the preferred method of data analysis. One of the most powerful nonparametric tests suitable for comparison of two groups when the level of measurement is ordinal is the Mann-Whitney U Test. [20] Two comparisons were made with four sets of data. The first comparison was between the PT students' total HTSS test scores reflecting their professional self-perception and the OT students' total HTSS test scores reflecting their professional view of PTs. The second comparison was again between OT students' HTSS total scores and PT students' HTSS total scores. The scores for individual word pairs from the HTSS were also compared using the Mann-Whitney U Test. The alpha level of significance was set at .05.

Results

The first comparison between the PT students' self-perception and the OT students' view of PTs indicated that the PT students' self-assessment was more positive than the OT students' view of PT students (U=375.0, z=4.4, [n.sub.1]=42, [n.sub.2]=41, P[is less than].001). The second comparison between the OT students' self-perception and the PT students' view of OT students indicated that the OT students' self-perception was more positive than the PT students' view of OT students (U=205.0, z=6.0, [n.sub.1]=42, [n.sub.2]=42, P[is less than].001). Both of the original hypotheses were supported.

Further analysis of group self-perception and word pairs was performed. A comparison of the OT students' self-perception and the PT students' self-perception indicated that the PT students' self-perceptions were not significantly different from the OT students' self-perceptions (U=832.5, z=.44, [n.sub.1]=42, [n.sub.2]=42, P[is less than].05). A total of nine adjectives were used more often by the OT students than by the PT students to describe Pt students. Of the nine adjectives, six were negative (Tab. 1) and three were positive (Tab. 2). Eight adjectives were used more often by the PT students than by the OT students to describe OT students. The PT students used six negative adjectives (Tab. 3) and two positive adjectives (Tab. 4) more often than the OT students to describe OT students.

Discussion

The purpose of this study was to examine stereotypes in college-level PT and OT students. Both of the original hypotheses were supported. The PT students' self-assessment was more positive than the OT students' view of the PT profession. Similarly, the OT student's self-assessment was more positive than the PT students' view of the OT profession. These findings are consistent with the view of Parker and Chan, [10] who state that, in general, a group's self-perception is more favorable than their view of any other group. This "ethnocentrism" [2,4] is a process by which we define a social identity for ourselves within the larger world. As a social group phenomenon, one's own group is viewed more favorably than other groups that are rated with reference to it. Although this preferential view of one's own group may result in feelings of professional pride and commitment, it may also result in labeling of the behaviors of other groups. This process tends to define traits or behaviors of one's own group as positive and the same traits or behaviors in the other group as negative. A clinician may view his or her extension of services to help a patient as positive, but may interpret the same behavior in another professional as infringement. To the extent that the stereotypes that result from ethnocentric views are accurate, the relationships of OTs and PTs should be facilitated. If the stereotypes are invalid and inaccurate, however, collegial relations may be increasingly difficult to achieve.

Another aspect of stereotyping that was investigated in this study was the specific word pairs that were significantly positive or negative between the groups. Significantly negative adjectives (followed by corresponding opposite adjectives from the word pairs) used by the OT students to describe PT students included "overrated" ("depreciated"), "competitive" ("cooperative"), and "strict" ("relaxed"). The PT students more often stated that OT students are "passive" ("active"), "dull" ("interesting"), and "narrow" ("comprehensive"). Each group thought the other is "conventional" ("original"), "conservative" ("innovative"), and "narrow" ("broad"). Parker and Chan [10] report that five of the six adjectives used by the OT students to describe PT students in our study were also used by OT clinicians to describe PTs. This overlap lends support for the origin of the stereotypic attitudes in the professional programs. In the academic environment, the intensely competitive nature of the programs could easily promote a stereotype of the students as competitive (ie, not cooperative), as strict (ie, not relaxed), and as narrow (ie, not broad). Competitive environments promote ethnocentrism and group conflict. [1] With limited student intergroup interaction, the program characteristics may be ascribed to the enrolled students.

Some adjectives that were more positive about the respective groups were also significant between groups. Occupational therapy students expressed their view that the adjectives "proud" ("humble"), "passive" ("aggressive"), and "precise" ("obscure") represented PT students; the PT students used the adjectives "casual" ("intentional") and "passive" ("aggressive") to describe OT students. Similar characteristics were identified by Rezler and French [16] in a study of PT and OT students' personality characteristics using the Myers-Briggs Test. Although there were some similarities in the personality types, differences were observed between the OT and PT students' profiles. The OT students exhibited more F (feeling) and P (perceiving) scores compared with the PT students, which could account for the PT students' descriptors of "casual" and "passive" in our study. The PT students in the study of Rezler and French [16] exhibited more T (thinking) and J (judging) scores compared with the OT students, which could account for OT students' descriptors of "proud" and "precise" in our study. The findings of Rezler and French [16] suggest that there may be some true intergroup differences that are not completely distinguishable from the stereotypes.

The presence of professional ethnocentrism and individual positive and negative stereotypic views in the PT and OT students in this study may, in part, be due to the departmental organization within the particular college. The absence of formal academic exchanges and informal social interaction between the two student groups may allow the formation of these sterotypic attitudes within the groups. In addition to the isolation of the departmental environment, professional students may be particularly susceptible to attitude formation. If the opinions of others, especially role models, can have an influence on developing ideas, students are particularly vulnerable to the opinions and even subtle implications of their academic and clinical faculty members. The more accurate the information level from these sources, the less stereotyped would be the attitudes of the students. [4] Another source of attitude formation in school would be peer networks, using informal communication methods, among the students themselves. Unexpectedly high or low levels of stereotyping might be due to an inaccurate or an accurate informal communication level within the departments. The academic environment thus may promote stereotypic views between groups through both isolation of structural and organizational elements and faculty and peer socialization process elements. [14,15]

Because similarity exists between our results and the results of Parker and Chan's [10] study, it may be that stereotyping begun in the university is subsequently carried through to the clinic. Limited exposure to alternate professions, in busy clinical environments, would not diminish the effects of the previously formed stereotypic views and could result in findings such as those of Parker and Chan. [10]

Social interactions in the clinic, as in other environments, are dependent on the assumptions, expectations, and social norms that the participants bring to a given situation. [2] Stereotypes can play a role in efficient and effective communication, facilitating interactions, or, when inaccurate, can limit positive relationships. Those attitudes that limit collegial relations deserve our attention.

The findings of this study may be limited by a number of factors. First, the assumption regarding the formation of stereotypes used in this study may be too restrictive. Degree of interaction may be only one component of a more general process of stereotyping. Second, the positive or negative nature of some adjective pairs is unclear in the HTSS. To decrease the possibility of confusion that was encountered among students with certain adjective pairs, a current revision of the HTSS, using more up-to-date definitions, could increase subjects' understanding. Last, the results reflect only the opinions of students at UIC and may not be representative of the opinions of other students.

Beyond these limitations, however, further research on stereotyping between health care professional groups and student groups could include attitudes of instructors, the degree to which they are expressed in the classroom, and their influence on students' attitudes. The organizational structure of OT and PT departments might also provide information on the influence of the physical proximity of the students and its relation to attitude formation. The findings of our study apply to students who attend classes in departments with close physical proximity (ie, same building on consecutive floors), but no formal social interaction. Because of the unique organizational and physical relationship at UIC, the findings of this study are not generalizable to other PT and OT departments.

Conclusion

Physical therapy and OT students in the studies academic environment exhibited ethnocentrism and both positive and negative stereotypic views of themselves and each other. The PT students' self-assessments were more positive than the OT students' assessment of PT students, and the OT students' view of themselves was more positive than the PT students' view of OT students. Recognition of the existence of positive and negative stereotypes may lead to strategies to promote those attitudes that facilitate collegial relations and minimize those attitudes that do not result in favorable outcomes.

Acknowledgments

We wish to thank Dr Harry J Parker for permission to use the HTSS. We also wish to thank Priscilla Mulesa, Anita Bundy, Margaret Ross, Kim Stuart, and Shannon Zorn for their help in this research.

References

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C Streed, BS, is Coodinator, Good Shepherd Hospital Satellite Physical Theraphy, 4950 Northwest Hwy, Crystal Lake, IL 60014 (USA). She was a student in the Department of Physical Therapy, College of Associated Health Professions, University of Chicago at Illinois, Chicago, IL, when this study was completed in partial fulfillment of the requirements for her baccalaureate degree. Address all correspondence to Ms Streed.

JStoecker, PhD, is Assistant Professor, Department of Physical Theraphy, College of Associated Health Professions, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL 60612.

This study was approved by the University of Illinois at Chicago Institutional Review Board.

The results of this study were presented in poster format at the 64th Annual Conference of the American Physical Therapy Association; Nashville, Tenn; June 11-15, 1989.

This article was submitted November 22, 1989, and was accepted September 5, 1990.