Beyond the Urban Model: Clinical Education Experiences in the Heartland
Background and Purpose: Clinical education is a critical element of entry level physical therapy education and has evolved over the years as practice has changed. There has been an increase in the number of clinical education hours required by entry level physical therapy programs, as well as changes in how clinical educators are educated and the relationship between clinical education sites and academic institutions. With a growing need for clinical education sites to accommodate the increasing number of physical therapy students across the nation, one area that is often overlooked is clinical education opportunities in rural communities. Due to the proliferation of physical therapist programs, the current model of clinical education is unsustainable. Rural practice sites may expand opportunities for entry level physical therapy students to provide continuity of care to clients across the lifespan. In addition, these opportunities may allow students to engage in the patient/client management process with a diverse case mix across all systems. Many rural practice sites also include acute care experiences which are significantly limited in the urban practice sites. The purpose of this qualitative study is to describe the clinical education experiences offered by physical therapists in three rural critical access hospitals in Nebraska.
Case Description: A qualitative, multiple case design was the method chosen for this study. Researchers conducted interviews at three critical access hospitals (cases) located in rural Nebraska. Each case represented a rural practice site that participates in clinical education of physical therapy students. Interview participants included those individuals who work at the rural practice site and consisted of Site Coordinators of Clinical Education, physical therapists, administrators, healthcare professionals, physical therapist assistants, and support personnel. These stakeholders were selected because each one directly or indirectly influences the clinical education of physical therapy students. In addition, each participant has a vital role in the success of clinical education at that site. Focus groups and/or semi-structured interviews with individuals were completed with key stakeholders in each of the rural practice sites. These interviews were recorded and transcribed by an external source. Transcriptions were reviewed by the research team and a descriptive case study was written for each site. Member checks followed; the case studies were returned to the rural sites to ensure accuracy. Data analysis included review of transcripts, interpretation of the data, inductive analysis and coding to compare, find and build themes.
Outcomes: The results of this multiple case study indicate that rural health care settings offer a breadth and depth of patient care opportunities, across the continuum of care. Common themes identified from the case studies reveal similarities between the rural health care sites including diversity of patient cases, a variety of learning experiences for the student, and a commitment to social responsibility. Results of this study have strong potential to reframe the current model of clinical education to one that embraces underutilized, high quality rural health practice sites as a sustainable, comprehensive, meaningful, and innovative opportunity to educate student physical therapists.
Discussion: Clinical education at rural sites provide opportunities for continuity of care and experience working with clients across the lifespan; however, these sites have been overlooked in the current clinical education model. Stakeholders in clinical education have an opportunity to change the current model of clinical education to one that not only includes, but also embraces the rural health landscape. This study provides a conceptualization of the clinical education experience in rural settings, thus fostering the conversation about future clinical education opportunities in order to develop physical therapists competent in all practice settings. This information can influence how academic programs approach clinical education at the local, regional, and national level. Rural health care settings offer a collaborative, innovative model of clinical education, thus building bridges for sustainable clinical education opportunities in the future.