The cost-effectiveness and sustainability of physical therapist clinical education has recently been called into question. For academic programs, it is important that growing cohorts of student physical therapists receive diverse clinical education experiences under the direction of clinical instructors who not only possess the ability to foster clinical reasoning, but also to provide care demonstrable of best clinical practice. Increasing over the last decade is the desire for clinical facilities to receive a well-prepared and vetted student capable of learning from and contributing to the clinical care environment. Conversations have ensued following the Clinical Education Summit on mechanisms to more efficiently provide clinical education. The formation of academic – clinical partnerships and the implementation of alternate models of clinical education were suggested approaches to address the growing deficit of quality clinical education sites, as these strategies capitalize on shared resources and joint investment. This presentation will describe a University and Health Care Network’s partnership that has fostered a system-wide adoption of the two-to-one (2:1) model of clinical education.
Methods and/or Description of Project
To provide deeper and more meaningful partnerships with clinical hospital facilities, University resources were directed toward relationship-building. At the same time, a Health Care Network initiated the process of carefully analyzing and selecting academic collaborators who could best support their tripartite mission of education, research, and patient care. Consultation also occurred with entities who had already successfully implemented collaborative models of clinical education, and the literature was thoroughly mined to gain insight on global organizational benefits. Prior to formalizing a partnership arrangement, preliminary site visits to facilities within the Health Care Network were performed by University faculty. Creation of a symbiotic relationship between the University and Health Care Network was essential and the taxonomy of functional relationships, as outlined by Lewkonia, provided guiding principles for discussion by leadership teams within the distinct entities. For example, overt conversations occurred on the priorities, philosophies, and practices of the clinical organizations, as well as on the institutional value of clinical education. Further, conversations helped ascertain the presence or absence of a collaborative spirit towards the transformation of current practice standards and clinical education. Following the University visit to the various sites, a system-wide education-focused workgroup was charged with exploring the feasibility of the 2:1 model and with identifying the resources necessary for successful implementation. Rehabilitation Directors and Managers of the various sites contributed to the discussion as vested stakeholders. Ultimately consensus was reached by network leaders to systematically phase-in the 2:1 model across the system, pending training and ongoing support by the partner University.
While initially piloted in an academic medical center, agreement for implementation of the 2:1 model expanded within the Health Care Network to a rural hospital, a suburban community hospital, and a pediatric specialty hospital within a 2-year timespan. The 2:1 model not only increased the number of student placements in highly sought out practice settings, but also helped strengthen academic partnerships with each clinical facility and the Health Care Network at large. For example, approximately 2-3 students were placed within the Health Care Network pre-partnership as compared to 13 students post-partnership. While a top-down transformative change to clinical education practice occurred, the investment of the front-line clinicians was, in large part, credited for making the endeavor a success. The effectiveness of the clinical education program was also enhanced by significant training opportunities on the 2:1 model offered by the partner University. Broadening of the 2:1 model to additional facilities within the Health Care Network was largely driven by clinician feedback and early data to suggest the model’s positive impact on productivity metrics. Further, by adopting a 2:1 clinical education philosophy, the Health Care Network was able to exert more selectivity over the students accepted into the model and consequently have better ensured all participating students are maximally prepared by their academic institution for this experience.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
As the number of physical therapy students rises, and the culture of healthcare shifts from a volume to value driven model, it is imperative that academic – clinical partnerships be developed that leverage the maximal benefit for all involved. Through system-wide adoption of the 2:1 model, an increased number of students are able to receive quality clinical education experiences within notoriously difficult-to-place practice settings, such as the hospital and acute level rehab. For the Health Care Network, a mechanism was identified to fulfill the professional obligation in educating students without compromise to established facility operational benchmarks. In fact, the system-wide reinforcement of the 2:1 model expanded the Network’s reach to highly trained students, increased productivity measures, and promoted access to University resources and support for staff development and scholarship. The sustainability and advancement of clinical education will require Universities and Health Care Networks to appropriately utilize strategies that ensure maximal return on investment for all stakeholders. It is the hope that academic-clinical partnerships will propel the profession forward and promote transformative change to traditional operational designs for the delivery of clinical education.
Deusinger, S., Crowner, B., Burlis, T., & Stith, J. (2013). Meeting Contemporary Expectations for Physical Therapists: Imperatives, Challenges, and Proposed Solutions for Professional Education. Journal of Physical Therapy Education 28(1), 56-61
Jette, D., Nelson, L., Palaima, M., & Wetherbee, E. (2013). How do we Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes. Journal of Physical Therapy Education 28(1), 6-12
Juhnke C, Mohlbacher AC. Patient-centeredness in integrated healthcare delivery model systems- needs, expectations and priorities for organized healthcare systems. Int J Integr Care. Oct-Dec 2013: e051. PMC3860581
Lewkonia R. The functional relationships of medical schools and health services (2002). Medical Education. 36:289-295,
McCallum, C., Mosher, P., Howman, J., Engelhard, C., Euype, S., & Cook, C. (2013). Development of Regional Core Networks for the Administration of Physical Therapist Clinical Education. . Journal of Physical Therapy Education 28(1), 39-47
Nabavi FH, Vanaki Z, Mohammadi E. (2012) Systematic review: process of forming academic service partnerships to reform clinical education. Western J of Nurs Research. 34(1):118-141.
Ovseiko PV, Heitmueller A, Allen P, et al.(2014) Improving accountability through alignment: the role of academic health science centres and networks in England. BMC Health Serv Res.14(24): doi:10.1186/1472-6963-14-24
Recker-Hughes C, Wetherbee E, Buccieri KM, Timmerberg JF, Stolfi AM. Essential characteristics of quality education experiences: standards to facilitate student learning. JOPTE. 2014;28(sup1):48-55
Rindflesch, A. B., Dunfee, H. J., Cieslak, K. R., Eischen, S. L., Trenary, T., Calley, D. Q., & Heinle, D. K. (2009). Collaborative model of clinical education in physical and occupational therapy at the mayo clinic. Journal of Allied Health, 38(3), 132-142. Retrieved from http://search.proquest.com/docview/734046718?accountid=10457
Teel CS, MacIntyre RC, Murray TA, Rock KZ. Common themes in clinical education partnerships. J of Nursing Educ. 2011;50(7):365-372
Wetherbee E, Peatman N, Kenney D, Cusson M, Applebaum D. Standards for clinical education: a qualitative study. J Phys Ther Educ. 2010;24:35–43.
Upon completion of this presentation the audience will be able to:
1. Analyze how the current landscape of healthcare and academia affect clinical education.
2. Discuss a framework that supports the development of functional academic-clinic partnerships
3. Identify the obstacles and opportunities for system-wide adoption of the 2:1 model of clinical education
4. Analyze the outcomes and effectiveness of system wide adoption of the 2:1 model of clinical education
I. Overview of current landscape – 10 min
II. Formation of partnerships – 40 min
A. University philosophies, motives, and contributions
B. Health Network philosophies, motives, and contributions
C. Gaining traction for the 2:1
D. Implementation phase-in
III. Obstacles, opportunities, outcomes – 20 min
A. Health Network
IV. Questions – 20 min