Using principles of curriculum development to develop and implement an Integrated Clinical Education experience
Integrated clinical education (ICE) is being incorporated into an increasing number of DPT programs based on recommendations of our professional organization and educational leaders. The American Council of Academic Physical Therapy (ACAPT) has adopted the following definition related to integrated clinical education: “Integrated clinical experience is a clinical education experience that occurs during an academic term in a coordinated fashion concurrent with didactic courses.”1 Additionally, at the Clinical Education Summit in Fall 2014, participants agreed upon recommendations that all entry-level DPT programs offer “goal oriented, diverse active-learning experiences that are developed in collaboration with invested stakeholders and embedded within the didactic curriculum” and should be structured by the academic program in a strong partnership with clinical sites.2 While these definitions and recommendations help to differentiate integrated experiences from full time clinical experiences, academic programs are still left questioning how best to develop a clinical education (CE) curriculum that coordinates with didactic courses and provides high quality experiences for all students. One approach to curriculum development used extensively in medical education, includes an intentional and strategic method that could be applied to the development of an ICE curriculum.3 By doing so, the academic program can develop integrated clinical experiences that ensure students are participating in CE that is clearly structured and will maximize learning, both important characteristics of integrated experiences.4,5 This session will describe the process that one leading academic program followed to design, implement, and evaluate a new ICE experience within their DPT curriculum. The session will draw on curriculum development principles employed in medical education and offer tools for other PT programs to develop their own approach to integrated clinical education.
Methods and/or Description of Project
Our DPT program evaluated our current CE curriculum to assess whether it was a sustainable model of clinical education, effective in preparing graduates to practice in the ever-changing health care system. We decided to revise our current approach to CE and opted to incorporate both the year-long internship and several early ICE experiences. This PT Program approached the development of a new model of ICE in a very deliberate manner utilizing both a Strategic Planning process as well as principles from Kern’s six-step approach to curriculum development beginning with “problem identification” and “needs assessment.” Utilizing feedback from students and CIs involved in the previously utilized ICE model, we identified areas for improvement related to consistency in experience, student readiness for CE, CI understanding of expectations, and teaching skills of the CI. Based on the needs assessment, the PT Program developed specific goals and objectives for the new ICE. These included: (1) consistency in experience for all students, (2) intentional and deliberate integration of didactic content into the clinical experience by instructors and students, (3) multiple opportunities for facilitation and development of clinical reasoning skills, and (4) high quality clinical instruction by CIs involved in ICE. Once the objectives of the experience were developed, educational strategies and structure of the experience were developed. Again with input from clinical partners, academic faculty, and another DPT Program utilizing an innovative ICE model, we decided on a unique structure utilizing a collaborative model of CE and developed assignments and clinical activities that would link didactic content to the clinical experience. Finally, this PT Program offered a CI training program to support the development of clinical teaching skills and ensure understanding of the objectives of this experience.
The successful implementation of ICE in Fall 2014 involved many steps that included putting supports into place for clinical sites such as online resources, in-person training sessions, and availability of academic faculty before and during the actual ICE experience. Development of the assignments and activities for students to complete during the ICE experience was done with intentional planning and academic faculty input to create a strong link between on-campus learning and clinical experience. Finally, students were prepared for the ICE week with multiple on-campus preparatory sessions that utilized lecture, small group discussion, and reflection. The ICE curriculum was evaluated post-experience via student feedback forms completed individually and as a team, as well as by CIs through feedback forms and focus group discussion. Feedback forms and transcription of the focus group were both reviewed for themes.
The overall feedback regarding the ICE experience, including the structure of the experience, the CI training, and actual student experience was positive. Questions on the surveys completed by CIs and students related to the quality of the experience, student and CI performance, and CI teaching strategies. All students agreed or strongly agreed that ICE provided them with a context for on-campus learning and 98% of students agreed that ICE was essential to their learning. In response to questions related to the activities and structure of ICE, >90% of students felt the activities reinforced didactic content and the collaborative model of CE enhanced their learning during ICE. Themes that arose from open-ended questions on the student feedback forms included the explicit link between didactic content and the ICE experience, the effect of the collaborative model on depth of learning, and effective strategies CIs used to facilitate learning during the experience. Clinical Instructors also responded positively to the ICE experience. In survey responses, all CIs agreed or strongly agreed that ICE provided students adequate opportunities to develop clinical reasoning skills, that the collaborative model enhanced student learning, and that the training provided by the PT Program adequately prepared them for the experience. CIs were also invited to attend a focus group discussion following the second ICE week. During the focus group CIs indicated that the training and support from the academic program helped them to have a clear understanding of the objectives of ICE, resulting in more meaningful learning opportunities for students. The collaborative model was also discussed as an effective way to facilitate teamwork and collaboration among students.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
This innovative approach to both designing and implementing a new integrated clinical education experience is consistent with the conference theme. Applying principles of curriculum development to clinical education resulted in a positive learning opportunity for students and a positive experience overall for clinical instructors. The process allowed this academic program to create a curriculum that prepared instructors effectively, provided intentional learning opportunities for students, and used a unique model of CE, all of which are consistent with the recommendations that emerged from the Clinical Education Summit. While integrated clinical education can take on various forms within DPT programs, developing an ICE curriculum using specific curriculum development processes and collaborating with clinical partners and other academic programs may lead to more effective learning experiences and positive outcomes.
1. American Council of Academic Physical Therapy. Terminology for Clinical Education. http://www.acapt.org/images/AC-2-13_Terminology_for_Clincal_Education_PASSED.pdf Accessed April 2, 2015.
2. American Council of Academic Physical Therapy. Clinical Education Summit: Summit Report and Recommendations. http://www.acapt.org/images/pdfs/Clinical%20Education%20Summit%202014%20Final%20Report%201.pdf Accessed April 2, 2015.
3. Kern DE, Thomas PA, Hughes MT. Curriculum Development in Medical Education. Baltimore: Johns Hopkins University Press; 2009. Pp 1-9.
4. Hakim EW, Moffat M, Bell KA, Schmitt LA. Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education. J Phys Ther Educ. 2014;28(1): 13-21.
5. Mai JA, Thiele A, O’Dell B, Kruse B, Vaassen M, Priest A. Utilization of an Integrated Clinical Experience in a Physical Therapist Education Program. J Phys Ther Educ. 2013; 27(2): 25-32.
At the completion of this course, the learner will be able to:
1. Recognize the impact of the recommendations regarding clinical education from ACAPT has on current models of integrated clinical education.
2. Describe principles of curriculum development including Kern’s six-step approach.
3. Appreciate the impact of an intentional curriculum development process has on the development and implementation of a new integrated clinical education model.
4. Identify aspects of curriculum development approaches that could be applied to creation or revision of a new clinical education model in your program.
5. Identify challenges and opportunities that exist when applying an intentional curriculum development process to clinical education curriculum.
10 minutes: Present background re: Integrated CLinical Education including recommendations from Clinical Education Summit
20 minutes: Describe curriculum development principles, including Kern's six-step approach
20 minutes: Describe this PT Program's use of the six-step approach to develop, implement, and evaluate a new ICE model
20 minutes: Small group discussion related to how curriculum development priniciples could be applied to existing programs, challenges/opportunities related to this
20 minutes: Small groups report discussion points; Q&A with presenter and large group