Efficacy of a Rural Clinician Panel to Promote Dpt Student Interest in Rural Clinical Rotations.
Purpose:
To demonstrate the efficacy of an on-site rural PT clinician information panel for first-year DPT students to promote student interest in full-time rural Colorado clinical experiences.
Methods/Description:
A panel of five licensed physical therapists representing diverse areas of rural Colorado was convened to speak to the University of Colorado’s first-year DPT class (Class of 2020) in the spring of 2019. Panel participants’ travel costs to and from the University were funded by the DPT Program. The panel focus was facilitating student questions and dialogue in an effort to dispel rural practice myths and stimulate interest in full-time rural clinical experiences. Additionally, facilitated questions were asked to further convey information about rural practice by the panel participants. Questions included: • Basic participant and individual community information, as well as why participants practice where they do
• Clinical settings/patient populations participants work in/with
• What a typical day looks like for each participant
• What the participants like most about rural PT practice
• The relationship each participant has with their community as a PT
• From each participant perspective, what previous students have experienced - both in the clinic and community
• Why participants think students should consider rural practice for clinical rotations and possibly their careers
• Participant responses on unique challenges that occur in rural PT practice and how are they addressed
The panel lasted one and one-half hours and attendance by the students was not mandatory. Roughly two-thirds of the 66-person cohort was in attendance. A short electronic survey was administered to the cohort asking attendees to provide information about changes in their perceptions and attitudes regarding rural clinical experiences. Respondents also had the opportunity to provide comments about the panel experience.
Results/Outcomes:
The anonymous post-session survey was completed by 29 students. 86.2% of respondents either strongly agreed (37.9%) or agreed (48.3%) the panel changed their perception about rural PT practice. The remaining 13.8% of respondents remained neutral. When asked if the rural panel changed their willingness to complete a clinical rotation in a rural location, 55% either strongly agreed (13.8%) or agreed (41.4%). 31% of the respondents to this second question already planned to complete at least one rural rotation, while the remaining 13.8% of respondents were neutral to the question.
Within the University of Colorado’s DPT program, students have the opportunity to select both their second (CE II) and third (final) (CE III) full-time clinical experience. In the summer of 2018, the Class of 2019 selected their CE II clinical experience. Out of 66 students, 6 chose rural Colorado rotations from 16 available offers. The cohort who attended the rural panel, the Class of 2020, will be selecting their CE II experiences in July of 2019. The author will compare the class of 2020 selection data when available to the data from the previous cohort (Class of 2019) to determine if the rural panel increased student selections of rural clinical experiences or if, despite the immediate positive survey data, no significant change occurs in the number of rural clinical experiences selected between the 2 cohorts.
Conclusions/Relevance to the conference theme:
The 2018 US Department of Labor statistics for Colorado indicate there are 5,280 physical therapists in the state. 82% of the state’s physical therapists practice along the primary population center known as the “Front Range”. This region spans the largest urban communities of Fort Collins, Boulder, the Denver-Metro area and Colorado Springs, and comprises roughly 10% of the state’s total geographic area. There are 1.89 physical therapists per 1000 people in this region of the state. The University of Colorado’s (CU) DPT program is within this urban corridor. 18% of Colorado physical therapists practice within the remaining 90% of the state’s geographic area in smaller, rural communities. The Department of Labor reports 1.33 physical therapists per 1000 people in the eastern and southern portion of the state, with a .84 location quotient (The location quotient is the ratio of the area concentration of occupational employment to the national average concentration. A location quotient greater than one indicates the occupation has a higher share of employment than average, and a location quotient less than one indicates the occupation is less prevalent in the area than average).
2019 Colorado rural health workforce data include: an average of 1-3 years to recruit a physician to rural Colorado; 6 months to recruit an advance practice nurse or physician assistant; and less than 40% of rural primary care providers remain in the same rural community for more than 5 years. Anecdotal evidence indicates similar shortages and hiring challenges exist for the physical therapy profession within rural portions of the state. These rural workforce challenges occur throughout the United States and are not unique to Colorado. In their systematic review and meta-analysis of 709 articles related to clinical medical education in rural and underserved areas, Guilbault and Vinson determined that “medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations”. Further study is needed to determine if similar outcomes for rural physical therapy clinical education results in increased employment within rural locations. However, it is reasonable to extrapolate consistency between medical and physical therapy clinical experiences. Therefore, it is imperative that entry level physical therapy programs explore creative ways to increase collaboration with rural clinical sites and clinicians to address the disparity between student interest in rural versus urban full-time clinical experiences.
Historically, students in the CU DPT program choose urban clinical experiences over rural opportunities. Less than 10% of the 2019 cohort chose a rural affiliation for their second clinical experience. The Clinical Education faculty within the CU DPT program have been exploring ways to increase student interest in rural clinical experiences in order to address the disparity between urban and rural physical therapy practice within the state of Colorado. The rural clinician panel in the spring of 2019 appears to have had an initial positive impact on student’s attitudes regarding rural physical therapy practice. Indeed, the most common comment within the anonymous survey was that those who attended wished more of their classmates had attended to hear the conversation. Further investigation will occur to determine if the positive changes in attitude to rural PT practice that occurred in the spring of 2019 will carry over into the clinical experience selection process by the cohort who attended. However, the preliminary data suggest that, even with a short exposure to rural clinicians, student perceptions can change regarding rural clinical interest. Ultimately it is hoped this will lead to increased interest in rural clinical affiliations followed by increased rural career choice.