Developing Diverse and Culturally Competent Physical Therapists through Utilization of Rural Clinical Education Experiences
Clinical education is a critical element of entry level physical therapy education and has evolved over the years as practice has changed. Expectations are that entry-level physical therapists are competent across a breadth and depth of clinical practice for patient centered care. Rural practice sites may expand opportunities for entry level physical therapy students to support flexibility and adaptability in clinical care by the diversity of settings in which physical therapy students are exposed to in rural sites. These sites may expand opportunities for entry level physical therapy students to provide continuity of care to clients across the lifespan and engage in the patient/client management process with a diverse case mix across all systems. The unique culture of a rural community allows students to develop cultural competence as they learn the nuances of a community which goes beyond the walls of the physical therapy practice. Many rural practice sites also include acute care experiences which are significantly limited in the urban practice sites. The purpose of this qualitative study was to describe the clinical education experiences offered by physical therapists in three rural critical access hospitals in Nebraska.
A qualitative, multiple case design was the method chosen for this study. Researchers conducted interviews at three critical access hospitals (cases) located in rural Nebraska. Each case represented a rural practice site that participates in clinical education of physical therapy students. Interview participants included those individuals who work at the rural practice site and consisted of Site Coordinators of Clinical Education, physical therapists, administrators, healthcare professionals, physical therapist assistants, and support personnel. These stakeholders were selected because each one directly or indirectly influences the clinical education of physical therapy students. In addition, each participant has a vital role in the success of clinical education at that site. Focus groups and/or semi-structured interviews with individuals were completed with key stakeholders in each of the rural practice sites. These interviews were recorded and transcribed by an external source. Transcriptions were reviewed by the research team and a descriptive case study was written for each site. Member checks followed; the case studies were returned to the rural sites to ensure accuracy. Data analysis included review of transcripts, interpretation of the data, inductive analysis and coding to compare, find and build themes.
The results of this multiple case study indicate that rural health care settings offer a breadth and depth of patient care opportunities, across the continuum of care. Common themes identified from the case studies reveal similarities between the rural health care sites including clinical education as immersion in the rural community, learning opportunities across the breadth and depth of care, and cultural aspects of care in rural communities. Student physical therapists learned key qualities in a rural health site including adaptability, strong communication skills, open-mindedness, cultural competence, and flexibility. Results of this study have strong potential to reframe the current model of clinical education to one that embraces underutilized, high quality rural health practice sites as a sustainable, comprehensive, meaningful, and innovative opportunity to educate student physical therapists.
Conclusions/Relevance to the conference theme:
Clinical education at rural sites provide opportunities for continuity of care and experience working with clients across the lifespan. These rural health opportunities improve the patient experience by developing clinicians that are flexible and adaptable in the patient continuum of care and diversity of case mix across all settings. This study provides a conceptualization of the clinical education experience in rural settings, thus fostering the conversation about future clinical education opportunities in order to develop physical therapists competent in all practice settings. This information can influence how academic programs approach clinical education at the local, regional, and national level. Rural health care settings offer a team based, collaborative, and innovative model of clinical education, thus building bridges for sustainable clinical education opportunities in the future.