A Case Study and Pilot for developing and implementing the yearlong internship: Building a Sustainable Model of Clinical Education through an Academic and Clinical Partnership
Purpose
In fall of 2014, the American Council of Academic Physical Therapy sponsored the Clinical Education Summit to create a new shared vision for clinical education. Partnering of academic and clinical institutions to provide best practices in clinical education was one of the recommendations that emerged from this summit. Several authors also promote strong academic and clinical partnerships to improve the quality of clinical education, with suggestions for developing sustainable models of clinical education, and recommending that representatives from both academic and clinical sites contribute to curriculum development.
The purpose of this session is to describe the experience of one Physical Therapy Program in partnering with clinical sites to develop and implement a yearlong internship which incorporates the concepts of partnership, sustainable clinical education, and the need for structured, mentored experiences. This session will focus on three aspects of the process 1) the academic and clinical partnership with one site in creating an infrastructure to support this new clinical education model; 2) the development of partnerships with sites locally and across the US to implement the yearlong internship and 3) the development of a 6-month pilot experience.
Key players in the partnership, including the Director of Clinical Education (DCE) and Program Director from the academic institution and the Rehabilitation Educator from the clinical site will discuss their roles and share perspectives on this process.
This session will offer a framework and tools that other PT Programs may use to develop their own approach in building the yearlong internship or other sustainable models of clinical education at their institutions.
Methods and/or Description of Project
Creating the infrastructure for the yearlong internship:
Following a strategic planning process with stakeholders from academic and clinical settings, a DPT Program designed a new clinical education curriculum that would be sustainable, innovative, and based on available evidence. The primary goal of this new curriculum was to prepare graduates for demands of the current and future healthcare system. This new curriculum culminates in a paid, yearlong internship, which allows for structured, mentored experiences over an extended period of time to promote professional growth and readiness to enter the workforce. The academic institution partnered with a core affiliated hospital to develop the internship and infrastructure to support this model.
Concurrently, the DPT Program participated in a network of PT Programs including those that were also engaged in developing the yearlong internship and those that had already implemented this model. The latter programs were willing to share their experiences: the rationale, benefits, challenges, resources, and strategies for implementing the yearlong internship, with the ultimate goal of developing some standardization in clinical education across Programs. The network created a basic framework for Programs to use, including structure for the experience, benchmarks, performance measures, economic models, and ideas for mentor training.
The DCE and Program Director from the academic program met regularly for a year with the Director of Rehabilitation and Rehabilitation Educator at the affiliated hospital. Together, they determined the infrastructure needed at their respective facilities to implement the yearlong internship. Building on the work completed with the network, the academic and clinical partner were able to determine: agreed upon expectations and responsibilities for interns, mentors, clinical site and DPT Program; time line of activities; and application process. They also developed a 6-month pilot experience. This collaboration provided a platform for discussion for the DCE and Program Director when approaching additional clinical sites with the intent of creating similar partnerships.
Developing Partnerships with Clinical Sites:
The DCE and Program Director developed a site recruitment strategy with input from the clinical partner’s Director of Rehabilitation. They targeted sites with established relationships, and met with CCCEs and Site Administration (e.g., rehab managers, practice owners, Hospital CEOs, etc.) to explore feasibility of implementing the yearlong internship at their sites. The DCE was able to present the educational components of the internship, including support for CIs and mentors, while the Program Director provided expertise on the financial implications, often trouble-shooting possible budgetary concerns.
Pilot
A critical step in this process was the development of a 6-month pilot experience prior to full implementation in 2016. This was a true collaboration between DCE, the clinical site Rehabilitation Educator and Rehabilitation Department Director. The Rehabilitation Educator and Director of Rehabilitation adapted the yearlong internship structure for a six-month experience (specific to their clinical facility), with input from the DCE. This included the application process, compensation, identification of mentors, structured intern learning experiences as well the responsibilities of the intern while employed at the site. The DCE developed the mentor training program with guidance from the rehabilitation educator. Feedback surveys and debriefing session with pilot participants (interns, mentors, rehabilitation education, rehabilitation department director, and DCE) will be used to assess the experience and further develop the yearlong internship.
Results/Outcomes
Partnering with clinical sites from the onset of the curricular development process was critical. Ongoing discussions between academic and clinical institutions helped to identify the curricular components most valued by clinical sites, such as financial considerations, structure for the experience in the pre and post-graduation phases, and clinical faculty development. Networking with other Programs that had already implemented the yearlong internship provided necessary information and resources to share with clinical sites to allow them to determine feasibility. Obtaining commitments through this process has been successful, with 43% of internships needed already confirmed for a start date of September 2016, and another eight sites close to confirming. Approximately 67% of sites approached thus far responded favorably to the yearlong internship. Of the 33% who declined, half remain interested, but are unable to implement with the first cohort due to staffing or organizational changes or focus on other initiatives within the facility. The primary reason for sites not choosing to commit was lack of financial feasibility.
Implementing the 6-month pilot experience will provide the educational program and clinical site an opportunity to refine the operational aspects of the internship. Feedback from all those involved will shape the model for the year- long internship.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
The Clinical Education Summit resulted in a commitment to a shared vision for best practice in clinical education with themes of strong partnerships, shared responsibility, and sustainability. This case study is one example of a successful academic and clinical partnership leading to the development of a yearlong internship, which may provide a platform for continued dialogue and a framework for other academic and clinical institutions to follow.
References
1. 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.
2. Applebaum D, Portney LG, Kolosky L, et. al. Building physical therapist education networks. J Phys Ther Educ. 2014;28 Supplement 1:30-38.
3. McCallum CA, Mosher PD, Howman J, et. al. Development of regional core networks for the administration of physical therapist clinical education. J Phys Ther Educ. 2014;28 Supplement 1:39-47.
4. Jette DU, Nelson L, Palaima M, Wetherbee E. How do we improve quality in clinical education? Examination of structures, processes, and outcomes. J Phys Ther Educ. 2014;28 Supplement 1:6-12.
5. Rapport MJ, Kelly MK, Hankin TR, et.al. A shared vision for clinical education: The yearlong internship. J Phys Ther Educ. 2014;28 Supplement 1:22-29.
6. Black LL, Jensen GM, Mostrom E, et. al. The first year of practice: an investigation of the professional learning and development of promising novice physical therapists. Phys Ther. 2010;90:1758-1773.
Course Objectives
1. Appreciate the necessity of a strong academic and clinical partnership when developing a new model of Clinical Education.
2. Discuss steps involved in planning and implementing the yearlong internship.
3. Apply a framework and strategies that will lead to successful implementation of the yearlong internship.
Instructional Methods
Interactive Lecture, Discussion, Question / Answer session
Tentative Outline/Schedule
5 minutes: Intro to topic and speakers
15 minutes: Academic - Clinical Partnership - Perspectives from academic program and clinical site
15 minutes: CE Model - yearlong internship - framework / infrastructure
15 minutes: Expanding Partnerships - Application of framework and strategies to delvelop partnerships with additional clinical sites
15 minutes: Pilot Experience and outcomes
20 minutes: Question / Answer Session
5 minutes: Next Steps - Application to other academic programs and clinical sites