Inter-University Exploration of the Collaborative Model in Physical Therapy Clinical Education: the Impact on the Clinical Instructor Experience.
Purpose
Entry-level doctor of physical therapy (DPT) curricula offer opportunities for students to gain knowledge and skills in the academic setting, and then apply their newly acquired knowledge to the clinical environment during the clinical education component of the curricula. Clinical education (CE) experiences are integral to the completion of the degree and the quality of the experiences have a major impact on the development of entry level DPT students. Consequently, CE experiences also have an effect on the clinical instructor (CI) and clinical site.
The traditional DPT clinical education model is one student to one clinical instructor, known as the 1:1 model. Research indicates this model is time intensive, places higher burden on clinical staff, is uneconomical and does not appear to earn the designation as a more effective model in clinical education.1-6 With the changing healthcare landscape comes ever-present challenges in reimbursement and increased productivity demands on physical therapists who also serve as clinical instructors. These factors, coupled with a growing demand for clinical placements for DPT students, suggest there is a critical need to investigate other more sustainable clinical education delivery models.
In response to these challenges, collaborative models of clinical education are beginning to gain attention. The collaborative model is defined as two or more students working together under the supervision of one or more CI.7 Studies of the collaborative model have largely focused on the impact to student learning and to the clinical site as a whole. The benefits of this model for students include increased self-confidence, deeper learning through peer-to-peer collaboration, deeper critical thinking, and greater interdependence. 8-10 From a clinical site perspective, the advantages of the collaborative model include increased productivity and cost-effectiveness, enhanced CI skill development, and increased CI satisfaction.2, 4
Ultimately, the literature suggests that students, clinical sites, and academic institutions may all benefit from the increased use of the collaborative model to deliver the clinical education component of the DPT curriculum. Academic institutions benefit from the prospect of increased clinical placements, stronger clinical partnerships and improved communication and collaboration with the clinical community.2,10 Communication and collaboration between academic programs and clinical faculty to prepare, train, and problem-solve is the key to the successful implementation of this model of education.11
While there has been some literature that cites the challenges CIs face in the collaborative model, including increased workload and administrative duties and difficulty engaging students when there is a mismatch in learning style or knowledge base,1,2 there has not been a focus on the perceptions and experiences of the clinical instructor when teaching within this model. These perceived barriers may be impacting the desire to even consider participating in this collaborative model. Furthermore, the preparation, training, and support needs of the CI have not been fully explored, which leaves both academic programs and clinical sites with a knowledge gap as to how to best implement this model of clinical education. Two leading DPT programs collaborated to further explore the clinical instructor experience when teaching within the collaborative model, and to better understand how intentional CI training and support prior to and during a collaborative model CE experience affects the CI experience. This interactive session will describe the step-by-step specific training resources developed collaboratively by the institutions, present the outcomes of the qualitative research project exploring the CI experience, and offer suggestions on how the perceptions and experiences of our clinical instructors can help to improve successful implementation of a collaborative model between academic and clinical sites.
Methods and/or Description of Project
Participants in this multicenter, convenience sampled, qualitative study included four clinical instructors from two academic physical therapy programs (APTPs). These CIs agreed to teach students using the collaborative model during a first or second year full-time clinical experience. CIs were interviewed pre-experience and post-experience using an interview format and interview guide based on previously validated research.1,12The interview questions explored perceptions, fears, prior knowledge and vision of the collaborative model. The two APTPs developed a toolkit document that provided guidelines and suggestions for CIs on how to prepare for and structure a collaborative model experience. Immediately following the pre-experience interview, the CIs were provided with the toolkit and were given the opportunity to ask questions and seek guidance from the academic program in preparation for the teaching experience. During the CE experiences, both APTPs provided intentional support to the CIs, beginning with more frequent communication at the start of the experience and diminishing communication as the CE experiences continued, allowing the CI to reach out if needed. CIs participated in a post-experience interview following completion of the CE experience. During this interview clinical instructors identified the specific training and support they felt was most needed from the APTPs so as to achieve a successful clinical experience utilizing the 2:1 model. The interviews were transcribed verbatim to retain authenticity and hand coded into themes by the two researchers who did not perform the interview to prevent bias. To retain reliability, themes were discussed systematically with prime interviewers to assess fit for both APTP interviews.
Results/Outcomes
Results of this IRB approved research study will be shared at this session, including the themes that emerged from the pre and post-interviews with clinical instructors. Additionally, results will contain the specific needs clinical instructors cited during interviews to successfully prepare for and teach within the collaborative model. Finally, the training toolkit provided by the APTPs will be presented with feedback provided by the clinical instructors for usability and quality improvement.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Clinical experiences are an integral and essential component of the formal training of entry-level doctor of physical therapy students. By integrating the art of the experience of the CI, together with the evidence of this model, the researchers aim to explore the effects of structured and intentional support from an academic program prior to and during the clinical teaching experience. This project will bring a focus to the clinical instructor’s perceptions and needs when teaching in a collaborative model, and will help academic institutions and clinical sites partner in a more intentional and effective manner to provide exceptional teaching and learning within the collaborative model of clinical education.
References
1. Price D, Whiteside M. Implementing the 2:1 student placement model in occupational therapy: Strategies for practice. Australian Occupational Therapy Journal. 2016; 63:123-129.
2. Rindflesch AB, Dunfee HJ, Cieslak KR, et al. Collaborative model of clinical education in physical and occupational therapy at the Mayo Clinic. J Allied Health. 2009; 38:132-142.
3. Moore JH, Glenesk KT, Hulsizer DK, et al. Impact of an innovative clinical internship model in the US Army-Baylor Doctoral Program in physical therapy. US Army Med Dep J. 2014; Jan-Mar: 30-34.
4. Ladyshewsky R. Enhancing service productivity in acute care inpatient settings using a collaborative clinical education model. Phys Ther. June 1995; 75:503-510.
5. Ladyshwesky RK, Barrie S, Drake V. A comparison of productivity and learning outcome in individual and cooperative physical therapy clinical education model. Phys Ther. 1998; 78:1288-1298.
6. Lekkas P, Larsen T, Saravana K, et al. No model of clinical education for physiotherapy students is superior to another: a systematic review. Aust J Physiother. 2007; 53:19-38.
7. Dillon LS, Tomaka JW, Chriss CE, Gutierrez CP, Hairston JM. The effect of student clinical experiences on clinician productivity. J of Allied Health. 2003: 32: 261-265.
8. Lynam AM, Corish C, Connolly D. Development of a framework to facilitate a collaborative peer learning 2:1 model of practice placement education. Nutrition & Dietetics. 2015; 72: 170-175. Available from: Academic Search Premier, Ipswich, MA. Accessed February 25, 2017.
9. Frost JS. Handbook of teaching and learning for physical therapists. In: Jensen GM, Mostrom E. eds. Vol 3rd. St. Louis, Mo.: Elsevier/Butterworth-Heinemann; 2013.14.
10.Strohschein J, Hagler P, May L. Assessing the need for change in clinical education practices. Phys Ther. 2002; 82: 160-172.
11. Zavadak KH, Dolnack CK, Polich S, Volkenburg M. Collaborative models. PT Magazine. 1995; 3: 45-54.
12. Currens JB, Bithell CP. The 2:1 clinical placement model: Perceptions of clinical educators and students. Physiotherapy. 2003; 89(4):204-218.
Course Objectives
1. Understand primary principles of collaborative models in physical therapy clinical education.
2. Differentiate between the pre and post interview themes analyzed in the inter-university research study.
3. Discuss identified themes specific to support the educational needs of stakeholders.
4. Execute strategies and templates provided in the collaborative toolkit.
5. Consider curricular design that can facilitate initiation of collaborative models within participant’s current academic and/or clinical program.
Instructional Methods
Instructional methods will include: PowerPoint presentation, facilitated small and larger group discussions, sharing of ideas/ best practices using the 2:1 model and questions and answer session.
Tentative Outline/Schedule
20 Min: Set the stage and the story about the collaborative model in PT Education history
20 Min: Presentation of study design, methods, results and conclusion
20 Min: Discussion of final themes and clinical instructor experience
20 Min: Present collaborative model toolkit
15 Min: Pair with a partner to strategize ways to implement the use of a collaborative model in participant’s work environment
15 Min: Share your great ideas and problems you couldn't share on your own? Group discussion regarding strategies, experiences in the
use of a collaborative model
10 Min: Conclusion and wrap up