Use of a Root-Cause Analysis Framework to Promote Change and Resiliency in Clinical Education
Purpose: The purpose of this session is to offer both academic programs and clinical education faculty strategies to formally and objectively analyze student challenges arising in clinical education so as to determine root-causes and effect change to prevent similar future situations. CAPTE requires physical therapist education programs to have a formal and comprehensive plan to determine program effectiveness and foster program improvement.1 However, the specific processes by which outcomes assessment occurs is at the discretion of each program. In the medical field, root-cause analysis (RCA) and morbidity and mortality conferences are utilized to examine sentinel events and determine what went wrong and what can be improved to prevent future circumstances.2,3 A similar RCA approach has been utilized in medical education to examine student academic failure by analyzing the circumstances from multiple perspectives, from admission practices to curricular factors.4 In physical therapy education, however, assessment of outcomes is typically focused at the curricular level, and may not address the role of institutional processes or external stakeholders in student outcomes.5 Clinical education is a unique aspect of the physical therapist education curriculum that is impacted by both internal and external factors.6-8 Therefore, analysis of outcomes and challenges during clinical education should take all stakeholders into account.9 Faculty at one leading DPT program recognized the need for a more formalized, objective mechanism to analyze student challenges in clinical education so as to clearly identify contributing factors, develop strategies to address these factors, and ultimately prevent similar situations from occurring in the future. This interactive session will describe the process we followed to develop and apply an RCA framework specifically designed for clinical education and offer suggestions for how other academic programs and clinical education faculty may utilize a similar framework to address challenging student situations.Methods and/or Description of Project: Faculty at one institution created a framework based on literature review of approaches to RCA and medical morbidity and mortality conferences. Faculty drew from sources within the health care system and medical education, as well as outside of healthcare in the project management and business realm. The framework was organized so as to capture the complexity of clinical education, providing opportunity to analyze contributions from all stakeholders potentially involved in the targeted situation. The framework, therefore, offers the user the opportunity to account for influences from multiple factors: student, clinical instructor, clinical environment, the director of clinical education, and the academic curriculum. Analysis of each factor occurs in three realms: Impact, Predictable, and Modifiable. The impact of each factor on the situation is rated on a five-point scale from Very Positive to Very Negative. The predictability of the factor by the academic program is answered with a yes or no response. Similarly, the opportunity to modify a factor is rated with a yes or no response. After all factors are considered, the framework leads the user(s) to determine a strategic response, resulting in specific action items and timeline for completion of the action.Results/Outcomes: The framework was utilized to analyze two specific clinical education challenges. As indicated by the framework, action items were created with specific timeframes to address the root causes of each situation. Actions included examining assessment strategies in specific coursework related to student challenges; modifying the advising strategies prior to matching students to clinical sites; and addressing the onboarding of new academic faculty to ensure that the DCE understands all available resources, policies, and procedures surrounding student progression. Strategies to address contributing factors were communicated to responsible parties, including internal stakeholders (Faculty, Program Director) and external stakeholders (Clinical Instructors, Site Coordinator of Clinical Education.) A plan was developed to follow-up and ensure implementation of the strategies by the established timeframes.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: A formal approach to analyzing student challenges in clinical education is an important mechanism to address the complexities inherent in in this aspect of physical therapist entry-level education. This interactive educational session will guide participants through the framework using audience participation and small group discussion methods. Participants will leave the session with ideas of how to implement a formal analysis method to address clinical education failures and challenges at their own institution. By engaging in processes whereby faculty can systematically reflect on problems that led to students’ inability to be successful in a clinical setting, faculty can effect change and ensure future resiliency across multiple stakeholders, including student, clinical education faculty, and the academic program.References: 1. Standards and Required Elements for Accreditation of Physical Therapist Education Programs. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTStandardsEvidence.pdf Accessed March 26, 2018. 2. Gregor A, Taylor D. Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory. Teaching and Learning in Medicine. 2016;28(4):439-447. 3. Bar-on M, Berkeley R. Early Engagement of Residents into the Root Cause Analysis Process. Journal of Graduate Medical Education. 2016;8(3):459-460. 4.Cohen DM, Clinchot DM, Werman HA. A Framework for Analysis of Sentinel Events in Medical Student Education. Academic Medicine. 2013;88:1680-1684. 5. Tippett S. Program Impact of Student Outcome Assessment in Physical Therapy Education. Journal of Physical Therapy Education. 2006;20(2):38-47. 6. Jensen G, Nordstrom T, Mostrom E, Hack L, Gwyer J. National Study of Excellence and Innovation in Physical Therapist Education: Part 1-Design, Method, and Results. Phys Ther. 2017;97(9):857-874. 7. Plack M. The Learning Triad: Potential Barriers and Supports to Learning in the Physical Therapy Clinical Environment. Journal of Physical Therapy Education. 2008;22(3):7-18. 8. Recker-Hughes C, Wetherbee E, Buccieri KM, Timmerberg JF, Stolfi AM. Essential Characteristics of Quality Clinical Education Experiences: Standards to Facilitate Learning. J Phys Ther Educ. 2014;28(Supp 1):48-55. 9. Foord L, DeMont M. Teaching Students in the Clinical Setting: Managing the Problem Situation. Journal of Physical Therapy Education. 1990;4(2):61-66.Course Objectives: At the completion of this course, participants will: 1. Appreciate the importance of a consistent process of clinical education program evaluation in physical therapy education 2. Understand how root-cause analysis can be applied to challenges that arise during the clinical education process 3. Recognize the value of including internal and external stakeholders in the analysis of clinical education challenges 4. Identify strategies to incorporate root-cause analysis of clinical education student challenges in their own program 5. Establish a plan for identifying and addressing concerns in your home institution.Instructional Methods: Lecture Small-group Discussion Audience participation/polling Q&ATentative Outline/Schedule: 10 min: Present background from the literature related to outcomes assessment in physical therapy education and review CAPTE criteria related to program evaluation and program improvement 10 minutes: Define and describe root-cause analysis? (What it is, how it’s been used) 15 minutes: Describe the methods utilized by presenters to develop the root-cause analysis framework for clinical education challenges 15 minutes: Description of how presenters applied the framework to a student challenge, including the results and action strategies 20 minutes: Interactive portion: Audience will apply the framework to an example case through small group discussion and audience participation/polling strategies 5 minutes: Summary and next steps for use of framework 15 minutes: Q & A with presenters and large group