Innovating Quality Clinical Education Relationships: Using Data to Reduce Partner Volume and Build CI Engagement
Purpose:
Over the past five years, national physical therapy education representatives including the American Council of Academic Physical Therapy and the Academy of Physical Therapy Education through the Education Leadership Partnership have put forward clear recommendations to pursue excellence in clinical education through strong academic-clinical partnerships with environments supporting clinical educators.1,2,3 This desired “Culture of Excellence” involves shared beliefs and values across the academic and clinical entities, collaborative leadership and vision, high expectations of excellence in education and practice, and true partnerships.4 Further, the desired clinical instructors (CIs) in these collaborative models would possess the fundamental characteristics shown to positively impact clinical education, including valuing clinical education, creating environments that support student involvement, adapting the experience to meet student needs, and maintaining open collegial relationships.5
Increased productivity demands and decreased student placement opportunities,6 particularly in inpatient settings, have driven many academic programs to expand their number of clinical partners. Unintended results of this expansion include reduced consistency and quality of CI relationships, unwarranted variability across student experiences, and high administrative burden on clinical and academic partners, all of which may negatively affect clinical experiences.
A community of educational researchers is needed to address these issues.7 Although our clinical education program is strong, we strive to be leaders in the pursuit of best practice in clinical education. We therefore aimed to embody a culture of excellence through dual-purpose innovation: 1) to quantitatively identify which clinical partners best serve our full-time clinical education needs to promote consistency, transparency, and quality in student clinical experiences and 2) to implement data-driven identification of and support for quality clinical instructors whose commitment to quality DPT education is acknowledged and rewarded by the collaboration between academic and clinical partners.
Methods and/or Description of Project:
Evaluating the quality of clinical partner relationships
To establish a baseline of the program’s perceived relationship quality with each clinical partner, the Director of Clinical Education (DCE) first subjectively “graded” each clinical partner on an ABCD scale (A= Excellent clinical partner to D = unacceptable clinical partner). Next, the DCE and the Director of Educational innovation (DEI) operationalized the key factors contributing to the quality of a clinical partner relationship. Factors were ranked in order of importance in the context of the institutional and program missions and weighted accordingly. A score of 20 points represented the highest quality clinical partner relationship. Through an iterative process, this formal, copywritten “Clinical Partner Prioritization Rubric” was developed. The rubric was applied to each clinical partner to determine a partner relationship score for each site. Statistical analysis was performed to examine correlations between subjective A-D grades assigned by the DCE and the 0-20 rubric scores and to assess the reliability of stratifying rubric scores on an action spectrum, with categories ranging from “enhance and maintain relationship” to “discontinue partnership”.
Identifying and supporting quality CIs
To enhance the role of the clinical educator as a mentor and address the placement barrier of administrative burden, the program Director, DCE, and DEI developed the “Designated Clinical Mentor” (DCM) model. This model is designed to identify and support clinicians who consistently provide high-quality student experiences across all full-time clinical experiences on an annual basis and who view education as a core part of their work. Identification of potential DCM therapists and DCM therapist teams occurred using placement data, student feedback, subjective reports from the DCE, clinical partner relationships per the newly established rubric, and nominations from healthcare leadership. The academic program generated and proposed a list of direct benefits to the DCM, then modified this list based on clinical partner feedback and individual clinician needs.
Results/Outcomes:
Evaluating the quality of clinical partner relationships
At the time of proposal submission, 149 clinical sites or organizations were scored using both the DCE subjective grading assessment and the Clinical Partner Prioritization Rubric. This presentation will share the results of the statistical analysis and outline the initial actions taken based on stratification of relationship strength. At the time of proposal submission, actions taken included discontinued affiliation agreements with those clinical partners with low subjective and objective scores and invigorated relationships with top scoring clinical partners. This process has led to further pursuit of innovation in collaborative scholarship, teaching, and clinical education models, including the DCM initiative.
Identifying and supporting quality CIs
Formal proposals were made by the academic program to key clinical partner organizations as identified by the Clinical Partner Prioritization Rubric, initially limited in number to ensure realistic establishment of the model. At the time of proposal submission, two clinicians from two unique organizations and practice settings were successfully identified, approved, and implemented as DCM. Updated data from the DCM pilot will be provided in this presentation, as will the identified facilitators, barriers, and lessons learned in the DCM implementation process.
Conclusions/Relevance to the conference theme:
Innovation in academic-clinical partnerships must be intentional and collaborative. We present two components of our data-driven approaches aimed at identifying and enhancing quality clinical partner and clinician relationships. These processes are accessible to other institutions seeking a culture of excellence and are designed for sustainable quality improvement over time. By promoting strategic selection of clinical partner and clinician relationships, both the clinical and didactic component of physical therapy education is enriched. A new world of opportunities for clinical education lies ahead, and we have only just set sail in exploring the possibilities to bridge the nexus between education and practice.