In October 08 BJOT, Marilyn Pattison asks us to create our own destiny. She states that "we need to distance ourselves even more from the medical model" and that we have much more to offer than the "traditional view" of occupational therapy. As an OT with 25 years experience working as a practitioner, a manager and now as an educator I have seen many developments and shifts in the profession - but what is happening now seems bigger and potentially more contentious then ever before. I agree with all that she says and welcome the shift in focus and delivery. In fact here at Salford we have been particularly pro-active in facilitating learning opportunities that enable our students to think outside the box and have a more creative approach to the role of the occupational therapist. For example, all of our final year students have a placement in a role-emerging and/or non-traditional area where they do not work alongside an OT on a day to day basis - but have to consider how occupational therapy may fit within the specific environment, for example working in a shelter for the homeless, a south asian women's project or working with charitable organisations such as Scope or Age concern. We have also posted previously on related issues of service provision and- the demise of a profession . that you may want to revisit. The dilemma seems to me to be how do we prepare current and future occupational therapists to work in a changed world when we are contracted to provide graduates specifically for the traditional environments. By this I mean that students tuition fees are paid for by local consortia who specifically negotiate service level agreements with higher education establishments on how many student places will be provided for health care professions. Therefore, our students still require and indeed experience what could be classed as "traditional" occupational therapy in NHS and social care settings. Students often express anxieties about not knowing enough anatomy and physiology etc and practitioners often expect students to have deep knowledge of conditions specific to any placement. In a world distanced from the medical model, these subjects and expectations may continue to be eroded (in such an obvious format) from curricula as we focus more and more on occupation, health and well being. Any suggestions as to how we can make the transition smooth both for our students and our practitioners - if indeed you agree with the need to change - would be most welcome.