February 3, 2023


Marisa Circle, 

Staten Island, NewYork

16th December 2021.


The Instructor of Record,

The Department of Occupational Therapy,

School of Pharmacy and Health Professions,

Creighton University.


The Associate Dean for Academic Affairs,

School of Pharmacy and Health Professions,

Creighton University.


Academic Issues Hearing Board,

Creighton University.


Dear All,




This letter serves as a humble request for a reconsideration appeal of my grades, which were awarded in my clinical experience on fieldwork level IIB. I participated in the said clinical experience in partial fulfillment of my Postgraduate Doctorate Degree in Occupational Therapy. Accordingly, this letter shall first provide an outline of my experience at the fieldwork. I shall then explain the circumstances that led to the award of my grades. Lastly, I shall point out why a review of the grading is inappropriate in this circumstances. 


My experience at fieldwork


I did my fieldwork at the Kessler Rehab Institute as an oOccupational therapy student. My role at the said instituteDuring my Level IIA fieldwork, I was able to greatly enhanced my cClinical reasoning and occupational therapy knowledge. Besides, working thereThis fieldwork experience allowed me to acquire the necessary OT skills set required of a proper healthcare professional and leader. Working aBesides. the fieldwork rotation at the institution also gave me an opportunity to get hands-on experience on Kessler Foundation Neglect Assessment Process (KF-NAP), which help clinicians detect the presence of spatial neglect and measure the severity of the syndrome. I also got experience on the Wolf Motor Function Assessment, where I familiarized myself with the standardized protocol for assessing upper extremity function.   gain knowledge in operating equipment.   I also obtained pertinent skills from their special assessments such as the KFNAP, the WOLF-Motor Assessment, and KFPAT. Further, I learnt how the symptoms of spatial neglect can be reduced by administering the Kessler Foundation Prism Adaptation Treatment (KF-PAT). 


It is instrumental to note that during the fieldwork at the said institution, I exercised intellectual curiosity and endeavored to acquire new information during my rotations. This zeal and enthusiasm reflected in my weekly verbal and written evaluations. My Cclinical iInstructor attested to my improvements and progress. Notably, I grew in communication, documentation, professionalism, patient handling and evaluation. 




In light of the foregoing, I was utterly surprised when at the end of the mid-term week, my final grade was lower than I had expected. I attribute this performance to the incidence that occurred on my last session on the last day. Notably, as already seen above, I began my fieldwork with naivety due to inexperience. However, I soon began learning and became adept to the systems and operations. 


The incident that led to the low award of grades happened when I was handling a patient on a wheelchair around the kitchen. I observed that the patient was motivated and mentally ready for another trial but I later figured out that the patient did not have enough physical strength and endurance for a continuity of the activities. Therefore, I unlocked the brakes to manually shift the wheelchair midway of the kitchen path as a safety plan, since rest breaks did not progress as anticipated. I had previously observed from my Cclinical Iinstructor that it is imperative to trust one’s patients, especially when they are progressing unto discharge. For that reason, I could see apparent progress with this patient, as he had previously carried out similar assigned tasks and functional transfers without difficulty, so I decided to trust him, and left the wheelchair brakes unlocked. However, the patient unexpectedly needed a seated break and unexpectedly verbally expressed fatigue, while the cClinical Instructor was present. The Cclinical Iinstructor reprimanded me for my erroneous judgment. 


Therefore, when I inquired about the low grades, my cClinical Instructor informed me that although my clinical judgment was reasonable, it was questionable due to lack of supplemental support and that I had not properly assessed and anticipated the patient’s level of fatigue.


The cClinical instructor then educated me on additional methods of handling patients in order to ensure that in the future, I could gather confidence to request assistance for wheelchair stabilization and or to be escorted with the wheelchair. 


The incidence also made me understand how anticipation and alternatives are imperative for health professionals. 


Areas of Concern with the Assessment


I aver that the grade I received was erroneous. First, the CI did not follow the grading policy. Pursuant to Creighton’s Grade Appeals Policy document, instructors are mandated to evaluate the performance of students in a fair, unbiased, and consistent manner. It is in that regard that the policy states that an assessment would be arbitrary or capricious if the instructor makes the assessment in an erratic or irregular manner, which is inconsistent with the laid-out grading policies.   


It also concerns me that the instructor had earlier sent me the Fieldwork Performance Evaluation (FWPE) even before the incident with the patient. At this time, the instructor was already expressing her pride and confidence in me for my good progress. Besides, the instructor had already began planning for the proceeding sessions while expressing belief and confidence that I would progress well. In connection with the aforesaid, the instructor had assured me of an increase in my gradesthat my grades would keep increasing as the fieldwork progressed. She verbally assured me that I would get all 4’s until my last week of fieldwork as opposed to a grading of my the overall performance of my skills. Therefore, the weekly grading was the norm until the sixth week.

I contend that the instructor was unfamiliar with Creighton’s passing score for midterm fieldwork. Besides, I was the first student she ever evaluated from Creighton. That notwithstanding, I therefore fail to understand why the instructor led me to believe she was pleased with my progress and even proceeded to plan for the coming weeks. 


The assessment grading created an untrue picture of my skills. It is worth noting that by week 6, I had the autonomy to retrieve, treat, and return patients in my own discretion. I performed the retrievals and returnswas able to transport the patients to and from their therapy appointments, transferring the patients from their beds to their wheelchairs, administering providing therapy, and returning them to their beds. On the issue of safety and precautions, I severally remindedremember moments where I reminded my instructor to lock the brakes on the wheelchairs. I also remember reminding the instructor to put on the spinal braces. These are a few examples of how I exercised good judgment, as evidenced in the feedback in week 3. 


I must also point out that I was subjected to a stricter assessment than my fellow students. At the start of my fieldwork, Rebecca, the therapy manager, expressed her concerns with my drowsiness. Accordingly, she demanded required a review of my weekly progress notes, and a written review of my weekly evaluations. She also required that I be subjected to daily questions from my instructor to ascertain whether I should continue to operate in the facility. Interestingly, my instructor herself showed her concerns that Rebecca’s demands were intimidating. My instructor therefore requested me to talk to Rebecca to clarify if there still were concerns that needed to be addressed, upon which Rebecca remained adamant that she would continue monitoring my performance and that I would be terminated if I did not perform well. Other students were not subjected to the same strict monitoring that I received. The students would still do notable entry-level mistakes even in their final weeks. It follows; I was a victim of misconstrued judgment.       


I admit that I only had challenges with epic navigating EPIC navigation, the complexities involved therein to locate the history and physical (H&P) of the patients, and theI also faced a challenge with patient chart reviews. My instructor herself also had the same challenge sometimes. I therefore developed a plan of action to address my challenges. In that regard, I created a treatment plan and a precautions logTherefore, I realized that I needed to work on the challenges, which I eventually did by creating a treatment plan and precautions log. I also customized and personalized my epic EPIC system by

 SSelf-research and trained myself at home. I also recited safety precautions of all patients prior to leaving the therapy session to start the day’s treatment sessions. Further, I began arriving at the facility early before my instructor so that I may be well-prepared for the day.  


It is also important to note that my in the past, when in the event I called my instructor to help out in any incident, the instructor would demonstrate what I would have done so that next time I would not have to call him for things I could handle myself. Therefore, on the day that I had an issue with the patient, I intended to show my instructor that I could take initiative in certain situations. Unfortunately, this was wrongly construed. 


Request for Reconsideration


As an entry level OToccupational therapy student, I am prone to make mistakes. Therefore, I am in need of mentorship and experience, so that I may grow into a better OT practitioner and leader. During my fieldwork experience, I made initiatives to address my mistakes and improve my occupational therapy skills. First, I began training myself at home by engaging in research on safety precautions. I also began reciting safety precautions of all patients so that I may work on my accountability. Next, I began arriving early at the facility so that I may be well-prepared. This helped me deal with my challenge in patient-review. For that reason, I reasonably believe that the aforesaid assessment does not truly and fairly reflect my robust professional capacities and adeptness. I am looking forward to learn further and advance my skills in OT. Therefore, I kindly request reconsideration of the fieldwork course grade. I affirm that with continued fieldwork training, experience and mentorship to augment my areas of opportunity, I can continue breaking barriers with occupation therapy. 


I humbly state that it will be unfair to rescind my observable years of remarkable development and successes due to an inexperienced intuitiveness. Accordingly, failure to reconsider the assessment would subject me to much psychological trauma since I would be dismissed from my three-year program at this distinguished institution, which I was due to finish by May 2022. For the past three years, I have dedicated my passion, tenacity and vigor into this program. A dismissal would therefore be to my utter detriment. Thank you.


Yours sincerely, 


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