Identifying Core Competencies for Prefieldwork Occupational Therapy Students in Adult Therapy: A Delphi Study With Clinical Therapists.

Introduction: Prefieldwork students often experience challenges transitioning from academic learning to clinical practice due to gaps in competency development. While established frameworks define postgraduate competencies, the specific needs of prefieldwork students remain underexplored. This study is aimed at identifying core competencies essential for prefieldwork students in adult therapy settings. Method: A two-phase study design was employed. In Phase 1, focus group discussions involving clinical supervisors, faculty members, and prefieldwork students identified key competency domains. In Phase 2, a modified Delphi method was conducted with clinical supervisors (n = 22 in Round 1, n = 20 in Round 2) to establish consensus on competency inclusion and definitions. Data analysis included thematic coding, interrater reliability assessment (Cohen's kappa), and statistical evaluation using mean scores, interquartile range (IQR), and content validity ratio (CVR). Results: The focus group discussions identified key competency challenges, including insufficient knowledge of splinting principles, limited assessment skills, and difficulties in professional communication. Initial thematic analysis mapped these challenges to nine established competency domains. The Delphi survey further added five emerging competencies: reflection, coping strategies, resource linking, multiple perspectives, and local-global awareness. Five emerging competencies were organized into three thematic groups: interpersonal adaptation, contextual cognition, and system navigation. However, the management competency was excluded due to low consensus. Conclusion: This study highlights critical competency gaps in prefieldwork OT education, emphasizing the need for structured curriculum interventions. Prefieldwork OT curricula should strengthen coping, reflection, and resource linking through reflective journaling, stress management, and resource planning. The role of local-global awareness should be clarified. The management competency was excluded from the final competency list due to limited appropriateness.