If you Build It, They will Come: Advocacy in the Development of a Community Learning-Spaced Clinic in a PTA Program
Purpose
Traditionally, physical therapy education programs “outsource” clinical education to clinical facilities and clinical instructors who are independent of the academic institutions. This is becoming more difficult for academic programs due to productivity requirements at the clinical site, fewer available providers, student reimbursement regulations, and the increasing numbers of physical therapy education programs (both DPT and PTA). In response to these challenges, creative solutions need to be considered such as the self-contained, learning spaced clinic described in this presentation.
This presentation will share strategies for the development and three year outcomes of a community based clinic in a physical therapist assistant education program. Located in the program’s learning spaces, the clinic serves the local community by providing pro bono care in concert with integrated clinical education for students.
Methods and/or Description of Project
The clinic is a joint venture between the College and the Community. The space provides a structured teaching setting for the PTA students and a resource for disadvantaged citizens to receive physical therapy services at little or no cost. The community laboratory, learning space in the clinic was intentionally created to allow students to gain confidence as a clinician, in a non-threatening environment. Learning spaces, (Kolb, 2005) are areas which allow for conversational learning, development of expertise, acting, reflecting, feeling and thinking. Learning space in a clinical setting allows students to benefit from the interactions and feedback from faculty, community instructors (patients), and peers. The clinic design provides students a natural clinic setting to learn and practice skills. The community laboratory is providing pro bono physical therapy services to patients which eliminates time restraints, productivity requirements, and reimbursement restrictions which are prevalent in more formal clinical education experiences.
This free standing 8500 square foot facility, across from the campus, was an abandoned car dealership which was renovated to house the PTA program laboratory, faculty offices and clinic space. A custom electronic medical record has also been developed for documentation and virtual billing.
Results/Outcomes
High levels of satisfaction with this clinic have been reported by faculty, community participants, and students. The clinic has been operational for almost three years and monthly averages of 65 patient visits and patient charges, if billed, exceed $10,000. To date, almost $400,000 of billable physical therapy has been provided to the community by faculty supervised students.
Each student is required to complete 30 hours of integrated clinical education in the clinic, although many students volunteer additional time. These required hours occur over 3 semesters. Faculty also utilize the clinic for observational class assignments and targeted learning experiences. Establishment of the clinic has allowed the PTA program to reduce outsourced clinical education by 18% without a negative impact on student performance. Analysis of Clinical Performance Instrument (CPI) results show a strong trend towards students reaching expected performance levels sooner in terminal clinical experiences.
Efficiencies of this model include better utilization of faculty time due to scheduling fewer outsourced clinical placements, better time management for students with the on-campus location of the clinic and the reduced transportation costs for students traveling to area clinics. The ability to remediate student clinical performance "in house" opposed to affiliated clinical education sites is a notable result, too.
Operating expenses for the program have slightly increased with the initiation of the clinic. This increase has been offset by institutional funding and community support to the program through ongoing donations. This College and Community partnership was recently recognized by the National Council for Workforce Education as the Clinic was the recipient of the 2016 Exemplary Program Award.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
This project reflects leadership and advocacy in physical therapy education that not only transformed our physical therapy education program but impacts the lives of the individuals who are treated in the clinic by our faculty and students. The PTA Program Director developed a conceptual business plan that was present to the College President and the Board of Regents. She also provided the leadership essential for the implementation and success of the clinic. The advocacy efforts of the College and PTA faculty to the community raised the necessary funds for the clinic. This clinic is a safe learning place for students and provides much needed physical therapy services to individuals of all ages, especially those with complex chronic conditions.
References
Hakim, E, Moffat, M, Becker, E, Bell, K, Manal, T, Schmitt, L, Ciolek, C. Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education. J Phys Ther Educ. 2014;28(1)13-21.
Wilson, A. Integrated Clinical Experiences in a Campus Onsite Clinic: A Self-Contained Model of Physical Therapy Clinical Education. Internet J Allied Health Sci Pract. 2014; 12(3)1-9.
Mai, J, Thiele, A, O'Dell, B, Kruse, B, Vaassen, M, Priest, A. Utilization of an Integrated Clinical Experience in a Physical Therapist Education Program. J of Phys Ther Educ. 2013;27(2) 25-32.
Dunfee, H. Clinical Education: Past, Present, and Future. J of Phys Ther Educ. 2008;22(3) 3-6
Kolb, A, Kolb, D. Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education. Acad Manag Learn Educ. 2005; 4(2)193-212
Palombaro, K, Dole, R, Lattanzi, J. A Case Report of a Student-Led Pro Bono Clinic: A Proposed Model for Meeting Student and Community Needs in a Sustainable Manner. Phys Ther. 2011; 91(11)1627-1635.
Black, J, Palombaro, K, Dole, R.. Student Experiences in Creating and Launching a Student-Led Physical Therapy Pro Bono Clinic: A Qualitative Investigation. Phys Ther. 2013;93(5)637-647.
Jette, D, Nelson, L, Palaima, M, Wetherbee, E. How Do We Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes. J of Phys Ther Educ. 2014;28(1)6-12.
Course Objectives
Participants will be able to:
1. Describe the role of patients as community instructors in a physical therapy education (DPT and PTA) curriculum
2. Outline critical components of a program development plan for a self-contained clinical education model.
3. Identify key resources from their own institution and community that could help with fund raising for a self-contained clinic.
4. Perform a SWOT analysis of a self-contained model within their institution
Instructional Methods
Instructional methods will include an electronic slide presentation, videos, and group discussions. Participants will also have a business plan template and SWOT template in course materials to appreciate planning efforts unique to their educational setting.
Tentative Outline/Schedule
Brief Introduction of Speaker and Plans for the Presentation (5 minutes)
Project Description (10 minutes)
The Risks and Rewards of Patients as Community Instructors (15 minutes)
Impact on the Program and Curriculum (15 minutes)
Development of a Business Plan to include, pitching the idea, getting to yes, and fundraising campaign (20 minutes)
Finding Resources w/in the College and Community (5 minutes)
SWOT analysis of a potential similar model for participants (10 minutes)
Questions and Answers (10 minutes)