Alternative Clinical Education: A Self Contained, Service Learning Model

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Alternative Clinical EducationA Self
Contained, Service Learning Model

• Debra F. Stern, MSM, PT, DBA (c)
• Presented NCEC 4/6/03
• Nova Southeastern University
• Ft. Lauderdale, FL
• 954-262-1662 email debras_at_nova.edu

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General Session Objectives

• Understand the differences among five
  professional and post-professional clinical
  education models.
• Examine aspects of the clinical education models
  that might pertain to their settings
• Analyze the benefits of each of the clinical
  education models
•  
• Understand current trends in staffing and
  delivery of physical therapy services and the
  relationship to clinical internship placements
•  
• Compare and contrast alternative clinical
  education models with traditional models
•  

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Traditional Models

• Inpatient / Outpatient
• Junior / Senior
• Adult / Peds
• Observation
• Occasional part days, single days, periodic days
• Blocks days, weeks
• Action oriented, full-time weeks, months
• 11
• 12

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The Good Times

• No need for change
• Staffing accommodated 11
• Productivity accommodated for clinical ed
• Students achieved entry level competence
• Comfort, tradition

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The Challenging Times

• 1998 -
• Mergers acquisitions
• Downsizing, reengineering, rightsizing
• Closings
• Increasing productivity demands
• Restructuring
• Layoffs
• Pay cuts
• Changing employment status
• Balanced Budget Act of 1997

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Results for Clinical EducationThe NSU Experience

• Clinics closing
• All venues
• Reorganization gt consolidation in staffing
• Increased productivity demands
• Approached 100 in some settings
• Facilities declined junior students
• Medicare no student rule
• Large geriatric contracting organizations
  cancelled contracts

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Contract Cancellation Impact

• TIER I Junior Affiliations
• Majority of sites lost
• 2 weeks at end of first year
• 12 in geriatric settings
• Selected as most senior internships not geriatric
  oriented in spite of population growth

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Result

• A proactive approach was needed to create
  educational opportunities at the junior level
  and to consider alternatives for future
  implications for senior full-time clinical
  education

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Alternatives

• Other professions

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Nursing and Medical Models

• 1 Instructor multiple students
• Preceptors Faculty (paid)
• Varied Settings
• Service Learning Precedence

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SERVICE LEARNING MODEL

• Programs involve students in activities that
  address local needs while developing their
  academic skills and commitment to their community
• Combines community service with classroom
  instruction, focusing on critical, reflective
  thinking as well as personal and civic
  responsibility
• American Association of Community
  Colleges Service Learning Clearinghouse

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Internal Resources

• University and college missions that foster
  community service
• Academic faculty
• Underserved populations with need
• Community relationships
• Personal
• University
• Professional

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External Resources

• APTA contract award in spring of 2002 to study
  alternative clinical education models
• A Hybrid Model of Clinical Education

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Two TIER Model

• TIER I
• One full day every other week
• Pilot project spring 1999
• Secondary to success, implemented fall 1999 and
  is ongoing
• TIER II
• Full-time 18 weeks at end of curriculum
• Traditional model 11 and 12
• Alternative model 14 self contained
• APTA Contract supported, with the thanks and
  appreciation of NSU PT faculty and students

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Integration of Academic Faculty Into Community
Settings Barriers

• Academic faculty viewed themselves as overworked
  and underpaid
• An integrated schedule needed to be developed to
  balance regular academic teaching
  responsibilities and the self contained (service
  learning) clinical education model
• Initial community rejection

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CAPSLE

• Community
• Alliance
• Partnerships
• Service
• Learning
• Education

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Community Partners TIER I

• Extended Care
• Childrens home
• Community Dwelling Adult Day Care
• Homeless Assistance Center
• University Clinic

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NSU Alternative Model

• TIER I
• 1 faculty CI to 10 students
• one Tuesday, every other week for each faculty
  and student group
• faculty has the alternate Tuesday for regular
  academic responsibilities
• no days are scheduled over holidays, breaks,
  summer or testing weeks. Facilities are notified
  of schedule in advance.

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TIER I cont.

• All student performed activities were directly
  supervised by faculty
• Students worked with clients in groups of 2 -3 in
  a collaborative model, 1st and 2nd year students
  together

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TIER I Results

• Academic faculty are afforded to opportunity to
  perform clinical work.
• Underserved populations receiving PT
• Site staff (where applicable)
• experienced no interference with their work or
  schedules
• found students were able to work as extenders
  providing services no longer reimbursable or no
  longer offered

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TIER II APTA Contract Supported

• TIER II
• 1 faculty CI 4 students
• 2 faculty for 8 students total
• Combo of homeless shelter and Migrant Health
  Association Medical Clinic
• Skilled Nursing with sub-acute rehab, mostly
  managed care
• Every day, Monday - Friday
• 18 weeks
• Students rotate sites each 9 weeks
• Students self selected

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Hypotheses

• H1 Physical therapy students that receive
  clinical training in a 11 verses a 14, CI to
  student model, will develop equivalent
  entry-level PT skills.
•  
• H2 Physical therapy students clinically trained
  in a fully self-contained service learning model
  verses students trained in a combined model (self
  contained and traditional component) will develop
  equivalent entry level PT skills.
•  
• H3 Physical therapy students that receive
  clinical training in a 11 verses a 14, CI to
  student model, will perceive that they have
  received appropriate input and feedback from the
  CI.
•  

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Hypotheses cont.

• H4 Physical therapy students that receive
  clinical training in a 11
• versus a 14, CI to student model, will perceive
  that they have
• benefited from peer feedback during the clinical
  affiliation.
•  
• H5 Physical therapy students clinically trained
  in a fully self-
• contained service learning model will
  demonstrate a
• higher level of commitment to serve underserved
  populations,
• professionally and socially, verses students
  trained in a combined
• model (self contained and traditional
  component).

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Outcome of NSU Alternative Model

• TIER I outcomes indicate students are meeting
  objectives of the program
• TIER II is yet to be determined
• CPI
• Generic abilities
• External assessment by 2 PTs blind to self
  contained versus traditional
• Self designed and statistically tested instrument
  with anchored behaviors

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Ultimate Goal

• Identification of a viable alternative clinical
  education model that can work in a changing
  environment

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The End

• Dr. Shari Rone-Adams and Debra F. Stern thank the
  APTA for support for this study.
• Additional thanks to the NCEC for the opportunity
  to share the NSU model with colleagues