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Chapter XV

AMEDD Corps History > Medical Specialist > Publication

Occupational Therapy Educational Programs
April 1947 to January 1961

Lieutenant Colonel Myra L. McDaniel, USA (Ret.)

Educational programs in occupational therapy are not foreign to the Army Medical Service because at three different periods in the history of Army occupational therapy training courses have been given.1 Each course has been born of need-the need for qualified personnel to assist in the comprehensive patient care available to Army personnel and their dependents.

Army hospitals, by tradition and practice, are geared to the educational process: intern and residency programs are conducted in many of the large general hospitals, and courses for student dietitians and student physical therapists have been given almost continuously since 1922. The range in clinical material is comparable to that in most civilian hospitals inasmuch as men, women, and children of all ages comprise the hospital population.

The purposes of Army occupational therapy educational and training2 programs are basically identical to those of similar programs given in civilian institutions, as these programs are established to meet the need for qualified personnel and to contribute to the development of the profession. The programs which concern the occupational therapy student are carefully coordinated with the requirements of the American Occupational Therapy Association3 and the directors of occupational therapy curriculums in order that student eligibility for registration by that organization is assured.

Planning for Army occupational therapy educational programs is a responsibility of the Surgeon General's Office.4 This responsibility includes the formulation of directives, indication of subjects and hours, selection and assignment of officer personnel to serve as faculty, determination with the Manpower Division of the number of personnel spaces authorized, and selection of hospitals to conduct the program. In addition, the Surgeon General's Office is responsible for the selection

1Course for Reconstruction Aids in Occupational Therapy, Walter Reed General Hospital, Washington, D.C., 1918; Postgraduate Course for Occupational Therapists, Army Medical School (now Walter Reed Army Institute of Research, Walter Reed Army Medical Center), 1924-33; War Emergency Course, participating civilian schools, 1945.
2Army Regulations No. 350-5, 14 May 1952, differentiates between "education" and "training" as follows: "(1) Education implies formal instruction and study leading to intellectual development to include the making of sound decisions. (2) Training implies instruction and supervised practice toward acquisition of a skill."
3Essentials of an Acceptable School of Occupational Therapy as prepared by the Council on Medical Education and Hospitals, American Medical Association.
4Plans are generated in the Occupational Therapist Section and then circulated to divisions such as Personnel, Professional, and Education and Training for comment and concurrence.


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of students, their appointment, and call to active duty. The selected military installation is responsible for conducting the program which, in turn, is monitored by the Chief, Occupational Therapist Section, Surgeon General's Office.

AFFILIATION PROGRAMS

The professional preparation of occupational therapy students consists of a 4-year academic education which includes an approved curriculum of occupational therapy and leads to a baccalaureate degree. This period is followed by a minimum of 9 months' supervised clinical experience, known as the clinical affiliation, in a hospital or medical setting in specified areas of medical conditions. Although these clinical affiliation centers are not approved or accredited, some control is maintained through liaison with school and hospital center councils and by the curriculum directors through their selection of centers where their students affiliate. The Army Medical Service conducts supervised clinical experience in the treatment of patients with psychiatric, orthopedic, neurological, and general medical and surgical conditions.

The affiliation period is stimulating to both the student and the hospital teaching staff, for it is during this period that the theories learned in the classroom are tested and accepted or modified through the realities of practice. Many of the affiliates have had some previous experience5 with patients (fig. 135) and hospital life, but the affiliation program for all is the setting for their final performance as students of the occupational therapy school curriculums.

During the period covered by this chapter, affiliation programs for civilian and military students were conducted in selected Army general hospitals. The training programs for the two groups were identical insofar as professional content and instructor interest and dedication were concerned. Because civilian occupational therapy students had little knowledge of Army and Medical Department organization, lectures on these subjects were included in their program.

From 1948 to 1958, the Army clinical affiliation program was structured around four basic areas of practice, as follows:

 

Minimum period6 (weeks)

Psychiatric conditions

12

Physical disabilities (surgical, neuromuscular, and orthopedic)

12

Tuberculous conditions

4

General medical and surgical conditions (other than physical disabilities)

8

A training guide, prepared in the Surgeon General's Office, was furnished to each hospital conducting the affiliation to assure uniformity

5Clerkship programs, one afternoon each week, included as a scheduled course in the academic phase or an affiliation program between the junior and senior year.
6The minimum periods are those established by the Council on Medical Education and Hospitals, American Medical Association. Experience in pediatrics was not offered in the Army program.


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FIGURE 135-Students in academic phase at Medical Field Service School observing treatment procedures at Brooke General Hospital, Fort Sam Houston, Tex. (Top) 1st Lt. Norma Learned demonstrates use of sling suspension in treatment of patient with poliomyelitis to 2d Lt. Patricia Acuzar, 1952. (Bottom) Capt. Barbara M. Knickerbocker explains the benefit obtained from patient's use of bilateral sanding block. 2d Lts. Rosemary McEachern and Kathryn Goll observe, 1954. (U.S. Army photographs.)


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in the Army program. Copies of the guide were furnished to the curriculum directors of occupational therapy to orient them to the program which was available to their students. The program was planned for a 40-hour week with approximately 80 percent of the affiliate's time to be spent in clinical practice, the remaining time to be spent in orientation and lectures pertinent to the administrative and professional knowledge needed in the training areas concerned.

The didactic portion of the hospital experience was delineated as to the lectures required, number of hours, and the scope of the material to be covered.7 The programs were under the direct supervision of the chief occupational therapist of the hospital and under the professional supervision of the chief of the physical medicine service except in the fields of psychiatry and tuberculosis where professional supervision was vested in the chiefs of the services concerned in coordination with the chief of physical medicine.

The scope of the physical disabilities clinical affiliation in occupational therapy for 1948 is shown, as follows, to indicate subject coverage:

Subject

Hours

Orientation to hospital or section or both

2

Orientation to course of training

1

Pretesting

1

Review of anatomy and physiology

3

Review of kinesiology

3

Basic concept of-

Orthopedic conditions

3

Neurological conditions

3

Patient-therapist relationships

2

Student conferences

12

Organization and function of a physical medicine service

2

Organization and administration of an occupational therapy section

2

Physical therapy application

2

Physical reconditioning application

1

Orthopedic application

6

Neurological application

6

Craft instruction

12

Shop practice

1

Required reading discussions

12

Professional and hospital ethics

2

Staff seminars

6

Field trips

As indicated.

Professional motion pictures

Do.

Final testing

2

Clinical practice

396

 
Total

480

The other affiliation programs followed much the same pattern except that subject matter pertinent to the area of affiliation was substituted.

In 1958, in line with the general trend of affiliate education, the scope of the program was focused on three major areas of practice: medical,

7Training guides, Occupational Therapy Clinical Affiliation Program.


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orthopedic-neurological, and psychiatric conditions. The primary purpose for this change in focus was to emphasize concepts and common denominators in treatment and to deemphasize treatment of specific diagnostic entities. Compartmentalization of the training experience continued to exist, but the effort was made to stress similarities of patients' needs and problems and the similarity of techniques used in the different areas of practice. Instead of a formal lecture series, emphasis was placed on direct communication with each affiliate through the media of case presentations by the medical officers; daily discussion periods with the supervising occupational therapist and other affiliates; ward rounds, conferences on pulmonary diseases, or intake conference with the medical officers; weekly individual conferences with the supervising occupational therapist; and journal club activities. The affiliations were phased into three 12-week periods, and notification of the modified program was sent to both curriculum and affiliation directors.

Reports on the students' clinical performance in each affiliation area were made out by the appropriate training supervisor and sent through the Surgeon General's Office to the occupational therapy curriculum concerned. The report form, devised by the American Occupational Therapy Association, is a standard one used by all affiliation centers in the United States.

Civilian Student Clinical Affiliation Program

The program for civilian students authorized in December 1947 began in the fall of 1948 with 37 students.8 To be eligible to participate, students at the time of application and appointment had to be enrolled in a curriculum of occupational therapy approved by The Surgeon General and, at the time of entrance to the Army program, had to have completed the didactic phase of the curriculum. Women under 27 years of age were eligible for appointment. Although preference was given to unmarried applicants, married applicants were accepted if they had no dependents under 14 years of age. Citizenship in the United States was required.

Students who were appointed were given a final Army physical examination upon reporting to the hospital for training. The primary reason for this examination was to insure that the student would be eligible for a commission if she wished to apply upon completion of her training. Notification of the physical examination was made to each curriculum director inasmuch as failure to pass it could result in cancellation of the student's affiliation in an Army hospital.

All requests for appointment in the Army program were made to the Surgeon General's Office by the curriculum directors who specified the areas of affiliation needed, the length of the affiliation, and, in many

p8Circular No. 164, Office of The Surgeon General, 29 Dec. 1947. (Authorization continued under Circular No. 162, 19 Dec. 1949; Circular 220, 26 Dec. 1951; Administrative Letters Nos. 12-53, 16 Feb. 1953, 621-300, 2 Feb. 1956, and 621-300, 17 Dec. 1959, Office of The Surgeon General.)


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instances, indicated the hospital preferred.9 Appointments were limited to the number of training spaces available and were made for not less than 3 nor more than 12 months of training. The most frequent requests were for affiliations in the medical and orthopedic-neurological areas.

Although the student was classified as a civil service employee, the student positions were not counted against the hospital civilian ceiling authorizations because the appointments were obtained from the Civil Service Commission by the Surgeon General's Office. An estimated number of civilian student spaces was projected annually for each budget year.

The stipend paid to the student was a modest one. Students were furnished subsistence, quarters, and maid service, the cost of which was deducted from the stipend, leaving the student with approximately $5 per biweekly pay period for miscellaneous expenses. The students furnished their uniforms and paid their transportation expenses. In 1959, a change in the stipend calculation increased this amount to approximately $35 per pay period.

Evaluation of program

The Department of the Army determined, in March 1961, that all personnel spaces utilized by civilians for training programs would be counted against civilian personnel authorization. The decision had adverse effects upon the training program for civilian occupational therapy students as hospital commanders, understandably, were unwilling to give up civilian personnel spaces for training purposes. Nine to fifteen civilian students were annually receiving one or more phases of their clinical affiliation in Army hospitals. This decision resulted in the discontinuation of the program at that time.

To evaluate the civilian affiliation program, it is necessary to consider if it fulfilled the general purposes for which it was established: to meet the need for qualified personnel and to contribute to the development of the profession.

If the value of the program is to be determined from the standpoint of the numbers of commissioned occupational therapists this program brought into the Women's Medical Specialist Corps, its value is limited, for during this period, 1947-61, approximately 7 percent of the 230 civilian students who participated came into the Army.

Generally speaking, it is during the affiliation process that the student finds the area of practice in which she believes she wants to specialize upon completion of the affiliation. The civilian student observed that specialization at this early stage was not compatible with Army career

9Hospitals designated for the program were: Brooke General Hospital, Fort Sam Houston, Tex.; Fitzsimons General Hospital, Denver, Colo.; Letterman General Hospital, San Francisco, Calif.; Madigan General Hospital, Fort Lewis, Wash.; McCornack General Hospital, Pasadena, Calif.; Murphy General Hospital, Waltham, Mass.; Oliver General Hospital, Augusta, Ga.; Percy Jones General Hospital, Battle Creek, Mich.; Valley Forge General Hospital, Phoenixville, Pa.; Walter Reed General Hospital, Washington, D.C.; and William Beaumont General Hospital, El Paso, Tex.


487

management policy. Rotation among areas of practice is considered especially essential for the young Army occupational therapist to prepare her to assume leadership and supervisory responsibilities.

Through her experience in the Army, the civilian student also learned that military assignments are based on the needs of the service with consideration given to individual preferences whenever possible, and that as an officer she would have to take the chances that she would get the hospital and area of practice of her choice. It is understandable also that the 2-year commitment for active duty might have appeared to be an interminably long period to one who had just completed almost 5 years of education.

If the value of the civilian affiliation program is to be determined from the contribution made to the growth and development of occupational therapy, then its value is illimitable and the program can be rated high in comparison with other courses of training which are directed toward acquisition of competence and knowledge in a professional area. The training process was not stereotyped, and, through the process of instruction, both the instructors and students experienced educational growth. The training was of the highest quality and was continuously updated to include improved methods and techniques as these became known.

Military Student Clinical Affiliation Program

In 1948, the sluggish interest of occupational therapists in accepting commissions in the Women's Medical Specialist Corps stimulated an intensified procurement program directed toward graduate and student occupational therapists. Although the affiliation program for civilian students was to begin in the fall of 1948, it was anticipated that the majority of these affiliations might be of a minimum 3-month duration and, since no military obligation was incurred, no great increase in the number of Reserve officers could be assured. Some civilian occupational therapists were still on duty in Army hospitals, but as position vacancies occurred, these vacancies were to be filled by commissioned occupational therapists only, so that eventually all hospital occupational therapy staffs would be military.

A proposed solution to the problem of need for commissioned occupational therapists was to establish a program whereby an entire 12-month affiliation program10 would be completed in Army hospitals by students who would be appointed as Reserve officers in the Women's Medical Specialist Corps. The student would be obligated to serve for a period of 2 years which would include the affiliation period and the basic orientation course at the Medical Field Service School, Fort Sam

10Areas to be covered were: Physical disabilities, 4 months; neuropsychiatric conditions, 4 months; tuberculous conditions, 2 months; and general medical and surgical conditions, 2 months. It will be noted that the length of the affiliation areas exceeds the minimum periods required. It was believed that the additional time spent in supervised practice would assure increased competence and knowledge for performance in the staff appointments which would immediately follow the affiliation program.


488

Houston, Tex. In this program, the student would not only receive all of her training, but would also have the opportunity to function in a staff capacity following her training period.

The proposal was tentatively approved in February 1948 by the Education and Training Division, Surgeon General's Office. The program was then presented to the Council on Education, American Occupational Therapy Association, which reviewed it at their 1948 midyear meeting. It was important to inform this council of the plan in order to gain support, interest, and cooperation from its members. Although this council had no authority to approve the clinical affiliation, it was directly concerned with all education of occupational therapy students.

In contrast to the civilian affiliation program in which the curriculum director requested the specific affiliations for the students, application for appointment to the military affiliation program would be made by the student herself with, of course, the knowledge and approval of the curriculum director and with the assistance of the Women's Medical Specialist Corps procurement officer in that particular Army area.

By the spring of 1949, a formal announcement of the program had been published,11 and announcements were forwarded to all curriculum directors; by June 1949, seven students had been appointed to participate in the program which would begin in the fall. All students were required to sign a statement that they would apply for Regular Army commissions upon completion of the affiliation program. This requirement, however, was dropped in the spring of 1952 as it proved detrimental to the procurement of students for the program.

The application process did not differ greatly from that followed by a graduate occupational therapist who applied for a commission. The appointment process differed, however, in that all applications for the affiliation program were submitted to a board of officers in the Surgeon General's Office appointed specifically to select the military affiliates. The number of affiliates selected depended upon the number of spaces approved by the Manpower Control Branch, Personnel Division. Their figure was based on the estimated gains, losses, and requirements which would occur during the coming fiscal year.

In September 1951, the 12-month affiliation period was shortened to 9 months. The areas of affiliation were programed to meet the minimum time requirements of the American Occupational Therapy Association. Before 1958, an affiliate was assigned for the entire affiliation period regardless of any previous affiliation experience she might have had before entering the Army program. After 1958, the military affiliate took only those affiliation areas which she needed to complete the association's requirements. This, of course, was advantageous to the Army as the affiliate was available for staff assignment at an earlier date.

Upon completion of the affiliation program, it was considered desirable to assign the new staff occupational therapists to hospitals other

11Special Regulations No. 605-60-50, 4 Feb. 1949.


489

than the ones in which they had taken their training. This, of course, was not always possible and had to be governed by the availability of staff openings and staffing levels in the different hospitals.

Only three Army hospitals were originally used for the military program: Brooke General Hospital, Fort Sam Houston, Tex., Fitzsimons General Hospital, Denver, Colo., and Walter Reed General Hospital, Washington, D.C. (fig. 136). Effort was made to keep the number of students assigned consistent with the amount of clinical material available. These hospitals were among those used for the civilian affiliation program, thus careful coordination of the two programs was essential. Brooke and Walter Reed General Hospitals were used for the neuropsychiatric and orthopedic-neurological affiliations and Fitzsimons General Hospital was used for the affiliations in general medicine and surgery and tuberculosis.

As the number of military students increased, Valley Forge General Hospital, Phoenixville, Pa., was included in the military training program and was primarily used for the affiliations in general medicine and surgery and tuberculosis. With this addition, it was possible to use paired hospitals for training and thus concentrate the affiliates in two geographic areas: Walter Reed and Valley Forge General Hospitals in the East and Brooke and Fitzsimons General Hospitals in the West. When the number of students decreased to that which could be accommodated in one pair of hospitals, Brooke and Fitzsimons General Hospitals were used since the students were already in that geographic area, having attended the basic military orientation course at Fort Sam Houston.

In fiscal year 1956, the students were assigned to one of the four hospitals for the entire affiliation program. This freed the other hospitals for a similar type of assignment for the students completing the academic phase of the Army Occupational Therapy Course. In the previous 2 years, the groups had been scheduled for the same hospitals, and the different input dates involved imposed a heavy training burden for all concerned. In fiscal year 1957, assignment to paired hospitals was begun again since the Army course was discontinued and there had been a noted decrease in the amount of clinical material available in some of the hospitals (for example, tuberculous patients at Brooke and Walter Reed General Hospitals and orthopedic-neurological patients at Fitzsimons and Valley Forge General Hospitals).

As of 30 June 1959, 10 classes totaling 170 military students had completed the clinical affiliation program. (See Appendix P, p. 623.) The limited number of students who applied for the August 1959 affiliation program was a forewarning of greater procurement problems to come. Only five students entered that affiliation. An additional student entered the program in February 1960. This midyear affiliation proved so successful that the practice of commissioning students for a midyear affiliation became an established procedure beginning in 1962. Through this measure, the affiliation program would be available to students finishing their academic work at the end of the fall semester.


490

FIGURE 136-Military occupational therapy affiliates, 1953. (Top) Maj. Elizabeth M. Nachod reviews techniques of printing, Walter Reed General Hospital, Washington, D.C. (Bottom) A medical officer discusses treatment of pulmonary tuberculosis, Fitzsimons General Hospital, Denver, Colo. (U.S. Army photograph.)


491

Heretofore, it was necessary that they wait 7 months until the fall affiliation began. For some students, this was impractical and an unnecessary delay in completing their professional education.

ARMY OCCUPATIONAL THERAPY COURSE

In view of the seriousness of the Korean War, in July 1950, Lt. Col. (later Col.) Ruth A. Robinson, Chief, Occupational Therapist Section, Surgeon General's Office, recommended among other actions, that an accelerated training program for occupational therapists be implemented to assure smooth operation of any expansion of the Army occupational therapy program.

The experiences in World War II proved that (1) sufficient numbers of occupational therapists could not be recruited to meet an emergency need, (2) training programs to fulfill their purpose of providing trained personnel had to be initiated before the need for that specialized personnel became acute, and (3) a training program sponsored by the Army was feasible.

Proposed Course

The need for an accelerated program was obvious. The time required under normal conditions for a properly qualified college graduate to complete an occupational therapy course in one of the accredited schools was 1 academic hour plus a minimum period of 10 months of clinical affiliation. The program recommended by Colonel Robinson was similar in content and administrative procedure to the War Emergency Course for occupational therapists but was planned for 54 rather than 52 weeks in length: 18 weeks in civilian schools and 36 weeks in Army hospitals.12

It must be borne in mind that a course such as Colonel Robinson recommended had to be approved not only by the Army Medical Service, but by the American Occupational Therapy Association and the American Medical Association Council on Medical Education and Hospitals which had established the Essentials of an Acceptable School of Occupational Therapy in 1934.13

The content of the proposed accelerated course was approved by the Education and Training Division, but the plan itself was considered a matter which should be approved by the Personnel Division because of the anticipated input of personnel into Army hospitals with resulting impact on personnel ceilings and personnel costs, both of which would have to be projected and budgeted.

The Chief, Personnel Division, wrote the President, American Occu-

12The War Emergency Course is discussed in chapter VI, pp. 160-167. The proposed course differed from the War Emergency Course as follows: (1) Academic phase-addition of 2 hours in physiology and 2 hours in occupational therapy; decrease of 1 hour in rehabilitation, and 6 hours in manual skills. (2) Eighteen-week academic phase rather than 4 months. (3) No substitution of experience years for educational requirements. (4) Nine months' clinical practice required rather than 8 months. 13Hereafter the terms "Council" and "Essentials" will be used.


492

pational Therapy Association, to request that Colonel Robinson be permitted to meet with the association's Board of Management and Committee on Education at its annual meeting in October 1950 to discuss the problems created by the lack of occupational therapy personnel and the proposed accelerated course. Both of these groups unanimously recommended approval of the plan for the proposed course. The  American Occupational Therapy Association recognized that this training would have to be subsidized if it was to be made available to the greatest possible number of participants and suggested two means of subsidization: (1) By paying tuition and maintenance costs as was done in the War Emergency Course, or (2) by appointing trainees as second lieutenants in the Women's Medical Specialist Corps Reserve.

By the end of 1950, the events in Korea indicated a lesser need for occupational therapists than had originally been anticipated. No further consideration, therefore, was given to the proposed course at that time.

By February 1951, an anticipated shortage of occupational therapists necessitated renewed consideration of the proposed accelerated course. At this time, the commissioning of the trainees as second lieutenants was added to the original recommendation. Before definite action could be taken in the Surgeon General's Office, approval of the proposed course by the American Medical Association Council had to be obtained. The American Occupational Therapy Association's request for this approval was channeled through the Council to the Committee on Physical Medicine and Rehabilitation, American Medical Association, and referred to its Advisory Committee on Education.14

The Advisory Committee on Education believed that the program was not a suitable one inasmuch as it did not account for all of the theoretical training required in the Essentials. They pointed out that the Council set standards for only one type of program-that outlined in the Essentials-and approval for any other type of program would require a change in the Essentials. The committee insisted that acceleration be achieved through shortening the time and not through reduction of course content.

It was the opinion of the Advisory Committee on Education that the civilian schools would not be in a position to assume responsibility for that part of the program which was not directly under their own supervision. In other words, approval had to be extended to the institution where the major portion of the training was to be carried out. In this instance, then, the Army would have to assume responsibility for the training if they conducted the 54-week course. It was the general feeling of the committee that the Army would be able to sponsor this course in occupational therapy utilizing the administrative facilities of the Medical Field Service School and selected Army general hospitals.

The Advisory Committee on Education, together with Dr. Miland E. Knapp, a member of the Council and Dr. Fritjof H. Arestad, associate secretary of the Council, proposed a substitute program in May 1951.

14Earl C. Elkins, M.D., Donald L. Rose, M.D., and Sedgwick Mead, M.D.


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This program projected a total of 46 semester hours plus 36 weeks of clinical training, as follows:15

Semester hours

Educational prerequisites, college degree including-

 

 
Psychology

4

Sociology

3

Manual or creative arts or both

9

Electives

2

Total

18

Theoretical instruction (in approved civilian occupational therapy schools):

 

Biologic sciences (anatomy, physiology, kinesiology)

14

Social Sciences (individual readjustment; social and educational agencies)

1

Theory and technique of occupational therapy

6

Technical instruction (in Army hospitals)

10

Clinical subjects (in Army hospitals):

 

Clinical subjects (neurology, psychiatry, tuberculosis, orthopedics, medical)

7

Theory of occupational therapy as related to clinical subjects

8

Total

46

 

Weeks

Clinical training (in Army hospitals)

36

Inasmuch as the Advisory Committee on Education's plan was not considered entirely suitable by members of the Committee on Education nor the Surgeon General's Office, Dr. Arestad requested that a meeting of representatives of all groups concerned be held on 6 June 1951 in Philadelphia, Pa., in order that he might be fully aware of all opinions before presenting the courses to the Council for action at their meeting on 8 June. Organizations represented at the meeting were the American Medical Association, the American Occupational Therapy Association, the Philadelphia School of Occupational Therapy, and the Surgeon General's Office.16

At this meeting, Colonel Robinson was asked to indicate the reaction of the Surgeon General's Office to the counter proposal from the Advisory Committee on Education. She pointed out that the program was too long and did not represent any acceleration which was the foremost objective of the original plan. She indicated that the Army was still interested in conducting the 54-week course, that it was interested in the possibility of establishing its own training course for occupational therapists within the Army, and that it was further interested in continuing to take clinical affiliates from the accredited civilian schools.

15Letter, F. H. Arestad, M.D., Associate Secretary, Council on Medical Education and Hospitals, American Medical Association, to Miss Helen S. Willard, O.T.R., American Occupational Therapy Association, 25 May 1951.
16The representatives were: American Medical Association-Dr. Fritjof H. Arestad, Associate Secretary, Council on Medical Education and Hospitals, and Dr. George M. Piersal, Director of Physical Medicine, Graduate Hospital, Philadelphia, Pa.; American Occupational Therapy Association-Miss Helen S. Willard, Chairman, Committee on Education, and Miss Wilma L. West, Executive Director; Philadelphia School of Occupational Therapy-Miss Clare S. Spackman, Assistant Director, and Miss Eleanor Kyle, Administrative Assistant; University of Pennsylvania-Dr. Wesley G. Hutchinson, Dean, School of Auxiliary Medical Services; Surgeon General's Office-Lt. Col. Ruth A. Robinson, Chief, Occupational Therapy Section, Physical Medicine Consultants Division.


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The objections of the Army to the course were-

1. There were no basic biologic sciences in the prerequisites.

2. There was an unproportionate emphasis in the biologic sciences in the course, itself, and no provision was made for abnormal psychology or psychiatry.

3. The order of presentation of theory and clinical subjects as outlined had to be reversed. (In other words, theory of occupational therapy should follow clinical subject presentation. Without the clinical material for background information, theory lectures would lose their meaning.)

4. It was thought to be impossible to present 25 semester hours of clinical subject material, occupational therapy theory, and technical instruction in Army hospitals prior to the 36-week clinical training period.

The proposed 54-week course was not approved by the Council of the American Medical Association; therefore, representatives from the Surgeon General's Office (Education and Training Division and the Chief, Physical Medicine Consultants Division) met with members of the Council for further planning. The proposal which emanated from this group was that the Army should establish an 84-week occupational therapy course at the Medical Field Service School. As the length of this course negated its primary purpose of acceleration, after further discussion with the American Medical Association, it was agreed to reduce the 84-week course to 70 weeks: 34 weeks of didactic instruction at the Medical Field Service School, to be followed by 36 weeks of clinical affiliation in selected Army hospitals.17

Establishment of Course

The American Occupational Therapy Association had previously stated that it would have no objection to the Army establishing its own curriculum since the American Medical Association approval of the course outline had already been secured,18 approval by the pertinent divisions in the Surgeon General's Office and subsequent final approval by the Department of the Army were all that remained to be obtained. Final approval was received early in 1952.19 The first class of the Army Occupational Therapy Course (8-0-32) was scheduled for October 1952.

Medical Field Service School

Many courses for Army Medical Service personnel are given at the Medical Field Service School. The environment, although military, resembles that of any college or university campus. Students are enrolled

17Semiannual Report, Occupational Therapy Section, Physical Medicine Consultants Division, July-December 1951.
18(1) Report of Meeting on Accelerated Occupational Therapy Courses, 6 June 1951, Philadelphia, Pa. (2) It is a policy of the American Medical Association Council on Medical Education and Hospitals to withhold final approval of a course until the first class has been graduated. Its approval for the Army course was received in 1954.
19Special Regulations No. 605-60-52, 5 Mar. 1962.


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in classes ranging from basic military and medical orientation to graduate study in hospital administration.

The setting was particularly suitable for the young occupational therapy officers for here they had the advantage of early orientation to military tradition and procedures while in the process of obtaining the knowledge essential to the practice of their chosen profession. If one had simultaneously observed a civilian occupational therapy course and the Army one, other than the uniforms worn by the military during class hours, the only basic difference that would have been apparent was that the Army students were required to stand military formation before their first classes in the mornings and afternoons. At these formations, announcements were made and necessary information was communicated to the students. One member of the class was the student adjutant and as such was the leader and spokesman for her group. As a rule, the Medical Field Service School band provided music for the short period of marching which followed the formation. The students grew proficient in marching and drill maneuvers and it was never long before keen competition would exist between the occupational and physical therapy students as to which group performed intricate drill maneuvers more precisely. It must be admitted that for the majority of the 3-year period that the two courses were coexistent, the physical therapists consistently outperformed the occupational therapists in drill techniques.

Selection of Students

Students for the Army Occupational Therapy Course were selected in the Surgeon General's Office by a board of officers appointed for that purpose. Information available to the board for their guidance included the transcript of credits, autobiographical sketch, references from college or university personnel, character references, the Army application, and, in some instances, correspondence from the Army area procurement officers.

The prerequisites included:

1. The general criteria for appointment as a Reserve officer, Women's Medical Specialist Corps.

2. Baccalaureate degree from a college or university acceptable to the Surgeon General's Office, with 15 semester hours of psychology and science or sociology or both.

3. Aptitude as a teacher, above average degree of manual dexterity, and a demonstrated interest and ability in the manual and creative arts.

Selections were made in the spring and students were assigned in late summer to the Medical Field Service School for basic training, followed by the academic phase of the course. The students signed a 3-year service commitment which included the entire educational program. Students could be removed from the course because of lack of interest, academic failure, or for disciplinary reasons.


496

Selection of Faculty

The occupational therapy officer faculty was selected on the basis of aptitude for teaching, knowledge, and experience in specialized areas, and experience with students either in the affiliation program or in the academic phase. Members of the faculty during the entire period of the course were:

1st Lt. Virginia Coffin

1951-53

Capt. (later Maj.) Maryelle Dodds

1951-54

Capt. Wilma L. West, Director

1951-53

1st Lt. (later Capt.) Lottie V. Blanton

1951-53

1st Lt. (later Capt.) Eileen O'Brien

1952-55

Maj. (later Lt. Col.) Myra L. McDaniel, Director

1953-55

1st Lt. (later Capt.) Barbara M. Knickerbocker

1954-55

The enlisted members of the faculty were selected on the basis of their aptitude for teaching, personal qualifications, and knowledge and experience in the workshop activities. A minimum of three were assigned.

The occupational therapists and enlisted instructors taught all craft and workshop activity classes. The occupational therapists included in their discussions and demonstrations the adaptations of activities for patient treatment and the analysis of activities for interest, exercise, and motion potential. It was believed that this approach was more meaningful and learning-centered for the student than the procedures followed in some of the civilian schools where activities were taught by skilled craftsmen and the analysis and adaptation taught by the occupational therapist in a separate class. Each craft and workshop activity in the Army course was planned to include a multitude of procedures in order to decrease the number of projects made in the limited time available (fig. 137).

Instructors for the medical and military subjects were drawn from the staff at the Medical Field Service School (Brig. Gen. James P. Cooney, MC, Commandant) and Brooke General Hospital (Brig. Gen. Martin E. Griffin, MC, Commanding General) (fig. 138). This arrangement was ideal in many respects and created increased interest in topic presentations as many of the medical officers had recent case material or current experiences with patients to which they could refer in their lecture series. Case presentations were used in selected lectures whenever possible.

In order to provide space for the workshop activity classes, a messhall was converted into an occupational therapy laboratory. Lathes, drill presses, power saws, looms, workbenches, soldering outfits, and shadow cupboards for small tools were installed in the dining area. The steamtables were boxed over with plywood to provide additional flat working surfaces. Cupboards for storage of dishes were ideal for storage of yarn and warp. The kitchen became the ceramic workshop


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FIGURE 137-Woodworking project, Army Occupational Therapy Course. Specifically planned to include not only the usual woodworking construction and finishing processes but also woodcarving, lathe work, and doweling.

once the stove and ovens were covered and the kiln and potter's wheels were installed (fig. 139). Water and sink facilities, usually so sparse in occupational therapy clinics, were in abundant supply. Printing was the only activity not provided and experience in this medium was obtained in the hospital affiliation.

Curriculum

In general, the Army Occupational Therapy Course content remained relatively stable during its 3 years' existence. Changes made are shown in table 22, and also noted are the subjects taken with the physical therapy students.

Following the 34-week didactic phase, the students were assigned to


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TABLE 22-Curriculum, Army Occupational Therapy Course, Medical Field Service School, Fort Sam Houston, Tex., 1952-54


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FIGURE 138-Instruction in the Army Occupational Therapy Course, Medical Field Service School, Fort Sam Houston, Tex., 1953. (Top) Lt. Col. John H. Kuitert, MC, Director, Department of Physical Medicine, Medical Field Service School, assists students in their study of neurology. (Bottom) Capt. Wilma L. West, director of the course, is assisted by a student in demonstration of supportive apparatus used in treatment of muscle weakness. (U.S. Army photographs.)

selected Army general hospitals to participate in the 36-week clinical affiliation phase. Upon successful completion of this program, certificates


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FIGURE 139-Ceramic workshop, Army Occupational Therapy Course, Medical Field Service School, Fort Sam Houston, Tex. (Top) Capt. Maryelle Dodds instructs 2d Lt. Rosemary McEachern in forming a bowl on the potter's wheel. (Bottom) Pvt. Robert Desjardin shows 2d Lt. Patricia Miller how to check for uniform contour without using a template. (U.S. Army photographs.)


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of graduation from the Army Occupational Therapy Course were awarded by the Surgeon General's Office.

Living Conditions

The students received the pay and allowances of second lieutenants and while attending the course at the Medical Field Service School lived in quarters adjacent to Brooke General Hospital. The quarters varied greatly depending on what was available when the students reported for duty. Each student had a private room whether it was in dormitory- or apartment-type housing. There was no regimentation in their living other than that imposed by their neighbors.

Recreational facilities were abundant and were conveniently located on the post of Fort Sam Houston. Each week the students were required to participate in some form of physical training and it seemed that swimming, golf, and tennis were the most popular activities.

Discontinuance of Course

The Army course was discontinued following completion of the didactic phase in 1955. The responsibility for the clinical affiliation program being vested in selected Army general hospitals, the discontinuance of the course caused no disruption of the affiliation schedules for class 3.

The Army Occupational Therapy Course was discontinued because it was believed in the Surgeon General's Office that the military clinical affiliation program was not only a more productive procurement source but also a much more economical program. The economical aspect was determined primarily on the basis of the cost of the course as related to the number of Army course graduates who indicated they might remain in the Army program following completion of the required 3-year tour of duty. The determination to discontinue the course was made in November 1954. The 3-year obligated tour of duty for the first class did not terminate until November 1955, so there was no experience factor on which to rely, thus the judgment had to be partially based on opinions expressed by the hospital staffs as to the intentions of these Army course graduates.

The Surgeon General's Office had originally planned to put the course on a standby basis; General Cooney (fig. 140), however, did not concur in this action. He believed that the standby basis was neither feasible nor practical to contemplate over an extended period of time. This standby basis meant that the course could be reactivated in a short period of time and implied that all equipment and supplies would have to be either retained in storage or procured on short notice. Also a staff of instructors would have to be reassembled.

Evaluation of Course

Although the course was conducted over too short a period to permit


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FIGURE 140-Brig. Gen. James P. Cooney, Commandant, Medical Field Service School, Fort Sam Houston, Tex., observes a demonstration of shaping a footstool leg on a wood lathe. (U.S. Army photograph.)

reliable statistical analysis and evaluation, the course can be evaluated in other respects. Five of the Army course graduates were still on active duty as of 31 December 1960: Two were members of class 1: Capt. Nancy McKnight and Capt. Anna L. Rodriquez; one of class 2: Capt. Jean Pennucci; and two of class 3: Capt. Gloria Parrella and Capt. Danessa Wise.

All 40 students who completed the course qualified for the examination for registration with the American Occupational Therapy Association. 1st Lt. Patricia Miller, a member of class 1 who took the examination in 1954 with students representative of all of the occupational therapy curriculums throughout the country, was one of five students completing the examination with honors.

It might be believed that inbreeding of ideas and concepts would be fostered as a result of the all-military environment in which the Army course students lived and worked in both their training and staff assignments. This kind of educational and learning stagnation requires a fixed staff and a paucity of participation by the staff in other than military educational opportunities. Such is not the case in Army occupational therapy. The maximum length of tours limited the assignment


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period at the Medical Field Service School and thus afforded continuous change in staff personnel. The scope of educational activities participated in by Army occupational therapists in specialized interest areas as well as in graduate study expanded each year. The policy of assigning staff who have had specialized or graduate education to the teaching hospitals where their increased knowledge and experience can be most effectively used provided a vitalizing influence in the Army programs.

The successful conduct of this course proved, as did the War Emergency Course, that acceleration of an educational program can be accomplished without sacrifice of course content or student achievement. Granted that these were selected groups of participants, these courses present an acceptable solution to the problem of personnel needs in time of emergency. The prime factor in successful production of qualified personnel to meet mobilization needs is early initiation of the training program. Classes could be run on a staggered schedule basis to increase output.

One element of administration in the course limited its maximum effectiveness. This was lack of communication between the school and the selected Army hospitals and between the selected Army hospitals themselves. Personal communication could, of course, be carried on, but this had no official connotation. What was needed and had been recommended,20 but disapproved,21 was an official meeting of the occupational therapy clinical directors from the hospitals with the school personnel. A mutual understanding of problems and their solutions would have been precipitated and the program itself would have been strengthened by the interchange of new ideas.

OCCUPATIONAL THERAPY TECHNICIANS COURSE

The shortage of occupational therapists necessitated scrutiny of every means by which their services could be most effectively extended. To this end, planning a course for occupational therapy technicians was begun in 1948. The course (8-E-23) was approved in 1950 with a quota established of 20 enlisted students per class. Class 1 began its training in May 1951 with an enrollment of seven males and one female.

The purpose of the course was to train enlisted personnel to assist occupational therapists in the treatment of patients.22 Previous to this time, male enlisted personnel had received only on-the-job training in occupational therapy. As could be expected, this training had varied in scope and depth depending upon the individual hospital clinic in which it was given.

20Letter, Headquarters, Medical Field Service School, Fort Sam Houston, Tex., to The Surgeon General, 11 May 1953, subject: Inspection of Occupational Therapy Course.
21Disapproved on grounds that other than Army course students were involved with the clinical affiliation program; therefore, liaison between all curriculums and clinical training centers would be the responsibility of the Chief, Occupational Therapist Section, Surgeon General's Office.
22A course similar to this one, given during World War II to enlisted members of the Women's Army Corps, has been discussed in chapter VI, pp. 180-182.


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It was anticipated that the formal course training would more adequately prepare the technician to assist the occupational therapist in (1) instruction of patients in workshop activities, (2) fabrication of assistive devices, (3) adaptation of equipment, and (4) nonprofessional administrative procedures.

Selection of Faculty

The faculty for the enlisted course was drawn from the officer and enlisted staff at the Medical Field Service School. 1st Lt. Virginia Coffin was the only occupational therapist assigned to the school for the beginning classes. In November 1951, she was assisted by Capt. Wilma L. West and Capt. Maryelle Dodds who were assigned to prepare the program of instruction and lesson plans for the Army Occupational Therapy Course.23

Selection of Students

The prerequisites for the Army Occupational Therapy Course included: (1) Standard score of 90 or higher on aptitude area III, (2) grade E-5 (sergeant) or below, (3) no record of emotional instability, and (4) qualification as a medical corpsman (5657) or medical aidman (3666).

Application for the course was made through organizational channels to the Adjutant General's Office where selection was made in accordance with the quota established for the course. Information concerning the selected applicants was then forwarded to the Medical Field Service School for screening, following which the Adjutant General's Office issued appropriate assignment and travel instructions.

In fiscal year 1951, Army Field Forces estimated that there would be a requirement for 183 additional occupational therapy technicians during fiscal year 1952. The Education and Training Division, Surgeon General's Office, to meet the need, proposed that a class of 20 student occupational therapy technicians be instituted in August 1951 and each month thereafter. Inasmuch as there was an insufficient occupational therapy faculty at the Medical Field Service School, such a schedule could not be initiated. Six classes, however, were scheduled for calendar year 1952.

Approximately 300 enlisted technicians were graduated from the occupational therapy course during the period 1951 to 1954.

Curriculum

The 12-week Occupational Therapy Technicians Course was divided into two phases: The 8-week didactic phase which was given at the Medical Field Service School and the 4-week clinical practice phase

23The formulation and use of lesson plans are discussed in chapter XIV, p. 464, in relation to the Army Physical Therapy Course.


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which was given at selected Army hospitals. The curriculum for the didactic phase, 1951-54, follows:

Subject:

Hours

Anatomy, physiology, and kinesiology

156

Orientation to medical and surgical conditions

128

Psychology

18

Neuropsychiatry

26

Introduction to physical medicine

16

Physical medicine records

12

Introduction to occupational therapy

2

Administration and organization of the occupational therapy section

4

Occupational therapy for-

 

Neuropsychiatric patients

8

Physical disability patients

4

Tuberculous patients

2

General medical and surgical patients

6

Woodworking

20

Plastics

10

Printing

210

Leatherwork

10

Jewelry and metalwork

14

Minor crafts

17

Care of tools and equipment

4

Use of electrical equipment

4

Observation in occupational therapy clinic

4

Military subjects

64

Nonacademic subjects

43

Total

 


352

1Courses taken with physical therapy and physical reconditioning students when these courses were scheduled concurrently.
2Given at Brooke General Hospital. No printing equipment was authorized for occupational therapy at the Medical Field Service School.


In the second phase, the enlisted technicians were scheduled for 130 hours of clinical practice, 10 hours of observation, and 20 hours of student conferences. Effort was made to distribute these hours between the four major areas of occupational therapy practice to familiarize the technician with patient care problems he might encounter on his permanent-duty assignment.

Malassignments24

One of the most serious problems that arose concerning school-trained enlisted technicians was malassignment. In many instances, they were not utilized in the specialty for which they had been trained. This was of particular concern to the Surgeon General's Office as it appeared to be a waste of funds, personnel, and time to train technicians for specialized assignments and then to learn that they were assigned by the

24Information for this section was obtained from the following sources: (1) Semiannual Report, Occupational Therapist Section, July-December 1952. (2) Semiannual Report, Physical Medicine Consultants Division, July-December 1951. (3) Semiannual Report, Physical Reconditioning Section, Physical Medicine Consultants Division, July-December 1951. (4) Personal knowledge of the author.


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Adjutant General's Office to duty unrelated to their training or interest.

The Enlisted Section, Military Personnel Division, Surgeon General's Office, cooperated in providing information they had available on assignments. Remedial action could be taken if occupational therapy technicians were malassigned in Class II hospitals, as these hospitals are directly under the supervision of The Surgeon General, but they had limited influence on assignments of these technicians in Army areas or oversea commands.

As word spread about the possibility of duty assignment to other than occupational therapy, the morale and interest of the technicians were seriously affected. They seemed to feel that there was no advantage in making any effort to excel since even the top men and women in the classes had been malassigned as frequently as had those in the lower rankings.25

As the stress of the Korean War lessened, malassignment became less of a problem. To alleviate this problem in a future crisis, before the selection of candidates, the parent organization should reassess the needs, spaces, and authorizations within the command. The candidates' potential for immediate oversea assignment upon completion of training should also be carefully considered.

Discontinuance of Course

The Occupational Therapy Technicians Course was discontinued in June 1955. There were several reasons for its discontinuance: (1) There was a decreasing need for the course to be given on an annual basis, since there appeared to be a sufficient number of enlisted technicians already trained to meet any anticipated immediate requirement. (2) It was economically impractical to continue the course inasmuch as classes would be scheduled only as an anticipated need arose. If the enlisted course was not terminated at the same time as the officer occupational therapy course, this would necessitate keeping at least one officer and an enlisted technician on permanent assignment at the Medical Field Service School or assigning them on a temporary-duty basis for the scheduled course period. It also meant that the enlisted technicians work activity laboratory would have to be maintained. (3) It was believed that an on-the-job training program, similar in scope and depth to that given at the school, could be established in one or more Army general hospitals if the need arose.

ON-THE-JOB TRAINING PROGRAMS FOR
ENLISTED TECHNICIANS

By 1960, it became apparent that a formal on-the-job training program was needed for the enlisted occupational therapy specialist to assure that

25Malassignment affected all technician groups at the Medical Field Service School; it was not limited to the occupational therapy technicians.


507

he was technically qualified for his military occupational specialty designation-923.1 (fig. 141). Because of the shortage of qualified enlisted assistants, untrained personnel were being assigned to occupational therapy clinics and were being given the occupational therapy specialist military designation on the basis of the position assignment.

A number of clinics, particularly in the station hospitals where just one occupational therapist was assigned, were unable to secure even untrained personnel for extended periods of time. In many of these instances, the patients were helpful in keeping the clinics clean and neat, but the lack of a qualified assistant posed a quandary for the occupational therapists insofar as they were concerned with attending ward rounds, treating bed patients, starting new patients on their treatment programs, preparing or adapting equipment for patient use, and attending to the many nonprofessional duties associated with clinic routine.

By the fall of 1960, on-the-job training programs for enlisted occupational therapy specialists had been approved by the Department of the Army and were established at Letterman General Hospital, San Francisco, Calif., and at Valley Forge General Hospital.26 The 3-month courses were to be given several times a year, if indicated, and were generally limited to four students at each hospital in order that a maximum amount of supervised clinical experience could be accomplished.

A rough estimate of the division of time afforded to the different areas of training reveals 4 percent to orientation (hospital and department); 5 percent to anatomy, physiology, and kinesiology; 3 percent to orientation to the three major areas of occupational therapy practice; 14 percent to skills instruction; 2 percent to safety measures, maintenance, requisitioning of supplies and equipment, and reports; and 70 percent to clinical observation and application.

In contrast to the previous enlisted course in which all didactic material was taught first at the Medical Field Service School and the clinical experience was obtained last in a hospital setting, in the on-the-job training program, clinical observation and application were consistently offered throughout the entire training period.

Prerequisites for the course included a grade of E-4 (specialist) or below and completion of a basic medical training course. Priority in selection was given to former manual training instructors, personnel with an educational background in social work, and to Regular Army personnel. Many of the candidates entered the course directly upon completion of their basic medical training program.

EXTENSION COURSES FOR OFFICERS

Extension courses, available through the Medical Field Service School, provide nonresident military educational opportunities for both Reg-

26On-the-job training courses were also established for the physical reconditioning specialists at these hospitals.


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FIGURE 141-On-the-job training for enlisted occupational therapy technicians, Walter Reed General Hospital, Washington, D.C. (Top) 1st Lt. Peter J. Couchman, AMSC, gives instruction in setting type and using a composing stick. (Bottom) Lieutenant Couchman shows enlisted technicians and patient how to change a blade in a table saw.


509

ular Army and Army Reserve personnel. For the Army officer on active duty, they provide a means to increase his knowledge of military activity and function and to acquire knowledge of managerial and related subjects which will aid him to perform his duties more effectively and efficiently. For the Reserve officer not on active duty, these courses provide a means of obtaining current information while at the same time earning point credits for retirement purposes.

The extension courses are designed to furnish current thought and doctrine on Army function in general with particular emphasis on the activities of the Army Medical Service. They offer the student the breadth of subject coverage found in the same courses taught in the resident program at the Medical Field Service School.

Four extension courses specific to occupational therapy were prepared in 1952 by Captain West from manuscripts prepared by selected chiefs of Army occupational therapy programs. The courses included material on the establishment of occupational therapy in oversea hospitals, organization and administration, and on-the-job training of enlisted personnel.27

Periodic revision of these extension courses was not possible because no occupational therapist was assigned to the Medical Field Service School. Some of the material became obsolete, and these courses, therefore, were suspended in 1960.28 Occupational therapists, however, could take many of the Medical Field Service School subcourses for which they were qualified, so suspension of the specialty subcourses did not preclude their participation in extension course activity.

27The extension courses were, as follows:
    Subcourse No. 73-Army Occupational Therapy Section.
    Subcourse No. 75-On-the-job Training of Enlisted Occupational Therapy Personnel.
    Subcourse No. 77-Setting Up an Occupational Therapy Section in an Oversea Fixed Hospital.
    Subcourse No. 82-Administration for the Chief of the Occupational Therapy Section of an Army Hospital.
28In 1951, Lt. Col. Helen R. Sheehan was assigned to the Medical Field Service School and, in addition to her other duties, prepared new extension courses for use by Army Medical Specialist Corps officers.