Preparing to “Go Live” With the 2:1 Model


Changes in healthcare have precipitated the need to reconsider the structure and delivery model of clinical education for physical therapy students. The Clinical Education Summit generated a national conversation that challenged educators and clinicians to consider alternative approaches for clinical education. The need to consider current regulations, priorities, and system constraints emerged from those discussions resulting in the need for a focus on increased collaboration between academic institution and clinical facility. Many clinicians and healthcare leaders expressed the desire to have targeted resources to support clinical instructor (CI) development. By increasing the efficiency and skills of the CI, student programs within clinical facilities are likely to be maintained longer and often emerge of higher quality. Academic institutions must pro-actively invest in their community partners and CIs to create win-win situations for all stakeholders: university, clinical facility, and student. This presentation will describe a University’s actions to provide comprehensive preparatory education to CIs within two acute care facilities willing to engage in a two-to-one (2:1) model of clinical education. The intent of early CI mentoring (involving completion of online modules, observation of master clinicians successfully implementing the 2:1 model, and direct discussions with academicians with acute care practice expertise) demonstrates the University’s investment in the site and clinician and aids in maximizing the likelihood of model sustainability.

Methods and/or Description of Project

In an effort to better partner with local clinical hospital facilities, University resources were directed towards relationship building. Similarly, in an effort to increase connections with a smaller cadre of academic institutions, hospital facilities invested resources to carefully select their academic collaborators. Preliminary site visits performed by University faculty facilitated conversations on the priorities, philosophies, and practices of the clinical organizations, and ascertained their willingness to collaborate to transform clinical education through implementation of different delivery models. Clinical sites were advised that students placed in this model from this University were exceptionally familiar with the 2:1 structure from prior integrated clinical experiences within the curriculum. Facilities that expressed interest in exploring the 2:1 model of clinical education were provided with a proposal from the University outlining a “curriculum” to prepare both the site and CI for success. After the clinical facility identified an appropriate CI to implement the 2:1 model, the University initiated the preparatory curriculum with the Center Coordinator of Clinical Education (CCCE) and the designated CI. The first educational activity involved clinician review of CEU-approved online modules created by the area’s clinical education consortium that elaborated upon the 2:1 model. Next, CIs and CCCEs observed the 2:1 model in practice at the University’s in-house clinics. This was followed-by debriefing on mechanisms to translate the observed outpatient 2:1 mentoring approaches with those required of inpatient settings. Finally, additional discussions with the CI and CCCE followed on topics related to student assessment and progression; maximizing individual student learning and overall team efficiency; development of approaches to address exceptional or deficient student performance, as well as CI absence; and assignment of meaningful student projects. Feedback received from participating clinicians highlighted the need to include greater discussion on billing practices. At the request of one facility, the Director of Clinical Education (DCE) observed clinical practice at the site so more specific recommendations could be provided on integrating two students into the daily operational flow. The DCE retained responsibility for appropriately assigning students to the 2:1 experience.


Within one year of preliminary conversations introducing the 2:1 model, two acute care facilities expressed willingness to undertake the design. One site completed the 2:1 model with students from two different DPT programs, while the other site will run the model with both students from the same University. A third program, an affiliate of the first site, has agreed to participate in the program in 2016. Use of the 2:1 model increased the number of student placements in highly sought out practice settings. In addition, early training and interaction with CIs and CCCEs enhanced DCE understanding of the tempo and characteristics of the clinical setting, the facility’s expectations of student performance, and the teaching style of the designated CI. All stakeholders agreed this opportunity helped strengthen partnerships between the academic site and the respective clinical facility. Clinician feedback to date has supported continuation and broadening of opportunities to utilize the 2:1 model in the future. Early participation in the 2:1 model also served as a venue for the professional development of seasoned clinical educators. Finally, rehabilitation managers expressed enthusiasm over the model’s ability to positively impact productivity metrics of the department.

Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education

As healthcare becomes more value-driven, and as the number of physical therapy students in need of clinical education rise, it is imperative that creative and collaborative initiatives are implemented to enhance clinical education. Supporting the 2:1 model with pre-implementation training has increased the willingness of sites to explore less-familiar and seemingly daunting models of clinical education. With the investment of the University, clinical champions of the 2:1 model were educated and supported to operate a successful internship experience. While the 2:1 model promoted additional student placements, the focused training provided to CIs provided greater assurance that students would receive quality clinical experiences. Specific to the clinical facility, pre-implementation training offered organized and motivated clinicians the opportunity to engage in advanced clinical teaching to expand their skills. Use of the 2:1 model has emerged as a reasonable approach to allow facilities to increase the number of students educated without expanding the number of CIs. Consensus documents from the Clinical Education Summit calls for a changed clinical education approach and implementation of strategies that convert obstacles into opportunities. Assuming a potential obstacle to the 2:1 model is lack of CI support and education, this pre-implementation University-sponsored curriculum provides a solution to directly minimize that concern.


Engelhard, C., & Seo, K. K. (2015). Assessing the effectiveness of a clinical instructor online training module as measured by student perception and sustained best practices. Journal of Allied Health, 44(1), 17-24. Retrieved from

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Course Objectives

At the conclusion of this presentation, the participant will:
Analyze the impact of the current state of education and healthcare upon the clinical training of students.
Justify need for alternative methods to deliver clinical education.
Identify the components of a clinician-training program to prepare for a 2:1 clinical education model.
Determine additional strategies to further increase the acceptance and functioning of the 2:1 model.

Instructional Methods

lecture, Q&A

Tentative Outline/Schedule

I. Current climate and influences (20min)
A. University stressors
B. Health care stressors
C. Models of collaboration
II. Pre -implementation training program (30min)
A.Online modules
B. 2:1 observation
1. Debriefing
C.Additional discussions
1. Student assessment and progression
2. Strategies to maximize learning and efficiency on the designated hospital unit
3. Communication approaches
4. Back-up plans to address student struggles or CI absence
5. Creation and implementation of meaningful student projects.
III.Evaluation of the 2:1 model (20min)
A. University outcomes and next steps
B. Clinical facility outcomes and next steps
IV.Question and answer (20min)

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  • Control #: 2248044
  • Type: Educational Session
  • Event/Year: ELC2015
  • Authors: Eric Stewart, Carly Funk, Lauren Tigani, Kristy Recek, Cari A Rose, Ellen Wruble Hakim
  • Keywords:

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