From Vision to Reality: Early years of Implementing a Paid Yearlong Internship and Lessons Learned Along the Way
Purpose: Over the past several decades, there has been a great deal of discussion regarding challenges in clinical education (CE), such as variability in length, timing, and quality of each experience; economic constraints; uncertainty in healthcare environments; along with a lack of evidence to support what clinical education should look like.1-3 More recently, professional organizations have dedicated both financial and human resources to explore, study, and make recommendations regarding best practices and excellence in clinical education.4-7 These initiatives have generated widespread dialogue and interest in finding feasible solutions that ultimately can lead to meaningful change in CE. In 2010, our Program began strategic planning for the CE component leading to the creation of a new mission and vision. Two significant changes were made in the CE curriculum: 1) addition of integrated clinical education and 2) implementation of a paid yearlong internship (YLI) as the final clinical education experience. The decision to implement a paid YLI as the final clinical experience was based on careful consideration of contemporary literature available at the time, focused conversations with PT Programs that had adopted innovative models of CE, and input from academic and clinical faculty, as well as administrators from our close clinical partners. Our YLI model is comprised of 2 parts: 1) a pre-graduation phase (4 months) that occurs in the final semester of the Program 2) a post-graduation phase (8 months) following graduation from our Program. The intern is a licensed, practicing physical therapist during the post-graduation phase. The class of 2016 was the first cohort to participate in the YLI in 2016-17. Our ultimate vision is that all students within our Program will participate in the YLI. However, until we establish a consistent group of internship sites, students have the option to apply to the YLI or finish the Program with the traditional 16-week final CE experience in these early years of implementation. Nearly 32 percent of the first cohort (20/63) participated in the YLI. The purpose of this session is to describe one Academic Program’s experience with implementing and evaluating a paid yearlong internship (YLI). Presenters will highlight lessons learned to date on establishing sustainable clinical partnerships, managing communication and processes among stakeholders, reporting data collected from the first cohort of students who completed the internship, and adopting changes for coming years. Both positive aspects and challenges will be discussed.Methods and/or Description of Project: Establishing Sustainable Partnerships with Clinical Sites: Our overall goal in creating this sustainable model of CE is to develop strong partnerships with fewer numbers of sites who are able to provide consistent high quality CE experiences. With this in mind, we initially targeted established, committed partners, some of whom participated in the strategic planning process. The DCE and Program Director conducted as many meetings as necessary with the CCCE and appropriate Administrators from each potential partner to discuss the model, necessary site resources, and financial implications. Creating processes / communication with stakeholders Students are exposed to information about the internship upon matriculation, and during each subsequent semester. The complexity of logistics, application and match process require ongoing student advising and a significant amount of communication between CE Team and Sites, and CE Team and students. Expectations for the pre and post-graduation phases of the internship are shared during initial recruitment meetings with sites; with CCCEs and CIs during the application and match process; and through webinars for specific CIs/mentors prior to the start of the internship. General guidelines are provided for structuring the post-graduation phase, with suggestions for time spent in patient care, time with mentor, and time with additional learning activities to facilitate ongoing professional development. The expectations in the post-graduation phase are flexible to allow for variations across organizations. Evaluating Intern experience: The first phase of evaluation focused on the intern’s experience. A mixed method study approach was used with the first cohort who had the option to participate in the YLI. An anonymous survey adapted from the nursing profession was provided to all graduates in the 2016 cohort; those who participated in the YLI and those who completed the traditional CE model. The survey solicited responses related to self-efficacy in the clinical environment as well as respondents’ perception of their clinical reasoning based on the Dreyfus Skill Acquisition model. Those who completed the YLI were invited to partipate in focus groups or individual interviews to share more detailed information about their experiences. A standard set of questions revealed opinions about the overall experience, what went well, what did not go well, and recommendations for the Program moving forward with the YLI. The interview/focus group conversations were de-identified and transcribed verbatim to retain authenticity. Hand coding for themes is on-going.Results/Outcomes: Establishing Sustainable Partnerships with Clinical Sites: We have been successful in building a core number of clinical sites who have committed annually since we first implemented the YLI in 2016 and continue to add new sites each year. We have found that commitments are still fluid, with some sites choosing not to offer the internship annually, despite being supportive of the model. Primary challenges are changes in staffing, financial constraints, and general uncertainty of the future. These results indicate that establishing long standing, clinical partnerships will take longer than initially anticipated. However, we are committed to this effort and believe it is worth the investment. Creating processes / communication with stakeholders We continue to refine our communication strategies and processes to simplify the logistics and to provide more effective, efficient and transparent information to students, academic faculty, and sites. Our initial approach to the post-graduation phase was to give sites autonomy with setting up their own structure of mentorship, however, we have learned that sites need more specific guidelines to provide consistency across experiences and to ensure interns have mentor time built in. Evaluating Intern Experience: Twenty nine graduates (46%) completed the survey and 10 former interns (50%) agreed to participate in focus groups/individual interviews. Results of both the quantitative and qualitative data will be shared within the session. Additionally, comparisons between self-efficacy and Dreyfus Skill Acquisition ranking between YLI and traditional clinical education participants will be discussed.Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: The long term sustainability of traditional models of physical therapy entry level CE is uncertain at best.1,2,5 The paid YLI is an innovative model that, although not unique to this Program, has only been adopted by a few PT education programs to address contemporary concerns of entry level clinical education. Although not without challenges, we have found the early implementation of the YLI to be an effective way of building meaningful, sustainable and equitable partnerships with clinical sites. Moreover, we believe the YLI is valuable in helping bridge the challenges between graduation and first year of clinical practice. Because this model has not yet gained widespread adoption, there is limited assessment (both formal and anecdotal) related to efficacy for all stakeholders involved (clinical partners, students, and academic programs). We feel it is our responsibility to take a leadership role in providing an opportunity to share with our colleagues our experiences to date. We further have a vision for continued formal assessment on the value of this innovative model for PT CE. This presentation of our successes and challenges with implementation will provide valuable perspective to other entry level physical therapy programs who are exploring or planning to implement non-traditional CE models such as the YLI.References: 1. McCallum CA, Mosher PD, Jacobson PJ, Gallivan SP, Giuffre SM. Quality in physical therapist clinical education: a systematic review. Phys Ther.2013;93(10):1298–1311. 2. Jette DU, Nelson L, Palaima M, Wetherbee E. How do we improve quality in clinical education? Examination of structures, processes, and outcomes.J of Phys Ther Ed. 2014;28(Suppl.1):6-12. 3. Recker-Hughes C, Wetherbee E, Buccieri KM, Timmerberg JF, Stolfi AM. Essential characteristics of quality clinical education experiences: standards to facilitate student learning.J of Phys Ther Ed. 2014;28(Suppl.1):48-55. 4. American Council of Academic Physical Therapy Clinical Education Summit Report and Recommendations. Available from: http://www.acapt.org/docs/default-source/default-document-library/post-summit-report-sept-2015.pdf. Accessed March 5, 2018. 5. Best Practice for Physical Therapist Clinical Education Task Force. Best Practice for Physical Therapist Clinical Education (RC 13-14), Annual Report to the 2017 House of Delegates. Available from: http://www.acapt.org/docs/default-source/hot-topics/best-practice-for-physical-therapist-clinical-education-(rc-13-14)-report-to-2017-house-of-delegates.pdf?sfvrsn=4. Accessed March 5, 2018. 6. Jensen GM, Nordstrom T, Mostrom EM, Hack LM, Gyer J. National study of excellence and innovation in physical therapist education: Part 1 - design, methods, and results.Phys Ther. 2017;97(9):857-874. 7. Jensen GM, Hack LM, Nordstrom T, Gyer J, Mostrom E. National study of excellence and innovation in physical therapist education: Part 2 - A call to reform. Phys Ther.2017; 97(9):875-888. 8. Carracio CL, Benson BJ, Nixon LJ, Derstine PL. From the educational bench to the clinical bedside: Translating the Dreyfus developmental model to the learning of clinical skills. Academic Medicine.2008;83(8):761-767.Course Objectives: 1. Identify early successes and challenges related to implementation of the YLI. 2. Discuss identified themes specific to first phase of mixed-method investigation with former interns. 3. Evaluate the pros and cons of adopting the YLI as a model of clinical education in your own academic or clinical setting.Instructional Methods: Interactive Lecture Discussion Question & AnswerTentative Outline/Schedule: Introduction; Review of the YLI model; and groundwork done at the Program level to date - 20 minutes Lessons learned on building clinical partnerships; managing communication and processes among stakeholders; and mixed methods data collection and analysis from first cohort participants - 40 minutes Next steps for our Program’s full implementation of the YLI - 10 minutes Question and Answer - 20 minutes