A Comprehensive, Experiential Learning Model of ICE: It Is So Much More Than Observation
Integrated Clinical Education (ICE) is an integral component of physical therapy (PT) education and now a requirement of the updated accreditation standards as outlined by the Commission on Accreditation in Physical Therapy Education (CAPTE). ICE provides a developmental learning experience, access to a variety of patients and professionals, and exposure to settings representing the breadth of PT practice. The purpose of this session is to present a variety of experiential learning activities used within an ICE model to prepare DPT students for full time clinical education experiences and future clinical practice. The variety of experiential learning activities within one curriculum will be outlined, highlighting the benefits of each experience.
Methods and/or Description of Project
Experiential learning is a form of practice-based education that provides exposure and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Practice-based education prepares students for their professional career, and in addition facilitates professional identity formation.(Higgs, 2013) Experiential learning is founded on the concept that individuals learn best by experience. Specifically, experiential learning occurs within applicable settings, while promoting the acquisition and application of knowledge, skills, and feelings. Strong support exists to offer experiential learning throughout an academic curriculum, as opposed to reserving terminal clinical experiences until the end of the didactic curriculum.(NCATE, 2010) Additionally, under the mentorship of practicing professional, students attain professional identity, confidence, and motivation to learn.(Dornan, 2009)
The American Council of Academic Physical Therapy (ACAPT) defines ICE as “a clinical education experience that occurs during an academic term in a coordinated fashion concurrent with didactic courses.”(ACAPT, 2013) In a study by Wetherbee, new graduates and clinical instructors recommended physical therapist students to have early exposure to patients/clients with faculty supervision prior to the full-time clinical education experiences. Integrated experiences maximize student professional growth in the areas of knowledge, clinical skills and professional behavior while building confidence in their clinical expertise. Essential components of this model include direct and timely feedback, experiences across multiple practice areas, along with variety of patient populations.(Wetherbee, 2010)
Integrated clinical educational should be more than sending students out to a variety of clinical sites and hoping that they learn something.(Hyams, 2011) Described as “learning by doing,” experiential learning has been incorporated into physical therapist education since its inception.
An ICE model that includes experiential learning allows students to build clinical decision-making and psychomotor skills while addressing principles from the American Physical Therapy Association’s (APTA’s) Code of Ethics. (APTA, n.d.)
The ICE model at Massachusetts College of Pharmacy and Health Sciences (MCPHS) allows students to observe in settings that are parallel to the current curriculum and includes numerous experiential learning activities. ICE provides students with the opportunity to integrate acquired classroom knowledge along with clinical practice and to develop skills that can be acquired only in the clinical setting within a supportive learning environment.
Overview of models
The Balance Movement and Wellness (BMW) Center is a SOPT faculty supervised pro bono center that affords students opportunities for clinical skill, professional behavior, and documentation development. Second year students work collaboratively with first year students as mentors for clinical skill development, documentation practice and professional behavior modeling. Assessment and feedback is a vital component to student development. As students progress through the 2 year didactic curriculum, expectations are appropriately increased to maintain a constant challenge starting in the first semester with basic safety and communication and culminating with mentoring and case management.
Developed in 2012 by the Seven Hills Foundation, ASPiRE! supports individuals with disabilities or other significant life challenges. The model includes day habilitation, workforce readiness, and employment services in a dynamic, dignified, community-driven environment. DPT1 and DPT2 students, supervised by a faculty member, participate in an ongoing exercise group that encourages strengthening, flexibility, balance and fun.
In the very first semester, DPT1 students provide therapeutic massage to two different populations at three different settings. The first is with an at risk pediatric population with youth 6-17 years old. The second population is with adults with developmental disabilities, cognitive impairment, and visual and hearing impairments. Students work with both of these populations to provide positive touch to children and adults on their arms, shoulders, neck and upper back.
In the 5th semester, DPT2 students provide therapeutic exercise programs to children 7-17. The focus of these exercise programs is cardiovascular training, balance, strengthening and flexibility and is conducted in a variety of ways including obstacle courses, one on one circuit training and group instruction.
Finally, in the second year of the curriculum, DPT2 students participate in a walking program at a 300+ bed acute care hospital. Students work in pairs with patients to review therapeutic exercise, mobility activities and gait training, while supervised by a licensed physical therapist. The purpose of this activity is to acclimate the students to this complex medical environment prior to full time clinical education experiences. In addition, it is the hope that the “extra” exercise and gait training that the patients receive will enhance their hospital stay and progress them quicker through their rehabilitation process.
DPT Students at MCPHS are prepared for full time clinical education experiences and future clinical practice and have reported that the progressive and experiential curricular design was the primary reason for their preparedness. Students reported that experiential learning on and off campus developed skills in safe clinical practice, documentation, and communication with peers, patients and other healthcare professionals. Specifically, students identified their BMW experiences to be the most influential with exposure to patients, clinical teaching and mentoring. Due to the mentoring thread throughout the ICE model, students reported feeling prepared for supervision of PT personnel, specifically PT aides and technicians. Students felt well prepared for communicating with and providing feedback to others because of the practice received within the ICE model.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Experiential learning is an ideal way for students to gain confidence, develop professional behavior, and improve skills with clinical interventions, communication, documentation, case management and mentoring. Students that have an opportunity to participate in experiential learning for two years prior to full time clinical education experiences reported feeling prepared and ready to work with a variety of patients. Early exposure also provides opportunity for faculty to address any issues that may arise early on, provide needed support and resources, and to develop an improvement plan in the areas of professional behavior and/or clinical skills.
Now that ICE is required through the newly revised CAPTE accreditation standards, DPT programs will need to consider early clinical exposure for their students. Experiential learning is highly encouraged to be a part of those ICE experiences. If educators invest the time and provide early experiential learning opportunities that parallel concurrent didactic topics, DPT students will be better equipped to be successful on their full time clinical education experiences and future clinical practice.
American Council of Academic Physical Therapy. AC-2-13: terminology for clinical education. http://www.acapt.org/images/AC-
2-13_Terminology_for_Clincal_Education_ PASSED.pdf. Accessed April 11, 2016.
American Physical Therapy Association. Code of ethics for the physical therapist. http://www. apta.org/uploadedFiles/APTAorg/About_Us/ Policies/HOD/Ethics/CodeofEthics.pdf. Accessed April 11, 2016.
Dornan T, Scherpbier A, Boshuizen H. Supporting medical students’ workplace learning: experience-based learning (ExBL). Clin Teach. 2009;6:167–171.
Higgs J, Sheehan D, Baldry Currens J, Letts W, Jensen GM, eds. Realising Exemplary Practice- Based Education. Rotterdam, The Netherlands: Sense Publishers; 2013.
Hyams R. Nurturing multiple intelligences through clinical legal Education. Univ Western Sydney Law Rev. 2011;15:80-93.
NCATE Blue Ribbon Panel on Clinical Preparation and Partnerships for Improved Student Learning. Transforming teacher education through clinical practice: a national strategy to prepare effective teachers.. Washington, DC: National Council for Accreditation of Teacher Education; 2010. http://www.ncate.org/LinkClick.aspx?fileticket=zzeiB1OoqPk%3d&tabid=715 Accessed April 11, 2016.
Wetherbee E, Peatman N, Kenney D, Cusson M, Applebaum D. Standards for clinical education: a qualitative study. J Phys Ther Educ. 2010;24(3):35-43.
Upon completion of this session, the audience members will be able to:
recognize the benefits of an early, comprehensive, experiential learning model within a DPT curriculum
discuss essential components of a comprehensive progressive ICE program that promote student learning, professional behavior development, and clinical readiness
identify opportunities to introduce or enhance their current ICE model
Questions and Answer session
15 minutes – introduction to presenters and audience
30 minutes – presentation, overview of models, benefits, outcomes
15 minutes – breakout sessions
15 minutes – summary
15 minutes – Q&A