Week 3: Collaborative vs. Traditional PT Clinical Education Models

What is the primary issue with traditional physical therapy (PT) clinical education?

It has largely remained a 1:1 student-to-instructor model, which limits collaboration and efficiency.

What was a key finding regarding the collaborative model of PT education?

The collaborative model did not increase productivity or efficiency, but it also did not decrease them.

What are some problems associated with the traditional 1:1 model?

-Fragmented learning

-Less collaboration

-Variable clinical experiences

-Significant burden on clinical sites

-Short rotations limit the student's usefulness

-Students repeatedly have to learn administrative systems at each new site

Collaborative/ 2:1 model

Students train in groups/cohorts under multiple clinical instructors.

What is a significant drawback of short rotations in clinical education?

Students may spend substantial time learning administrative systems only to leave once they become proficient.

What Did the Researchers Measure in the Army-Baylor article

-FTE

-RVU

-Patient encounters

What does FTE stand for in the context of measuring productivity in PT education?

Full-Time Equivalent, representing hours worked relative to a full-time schedule.

What does RVU represent in healthcare services?

Relative Value Unit, used to quantify the resources associated with providing healthcare services.

What are the five major constructs/themes for conceptualizing quality in PT clinical education?

1. Framework

2. Sites

3. Structure

4. Assessment

5. Faculty

Why is clinical education difficult to standardize?

Because the Physical Therapy Education Program (PTEP) is ultimately responsible for quality, but clinical sites control many resources affecting that quality.

What does a 14-point Critical Appraisal Score (CAS) indicate?

13-14: High quality / low risk of bias

10-12: Moderate quality / moderate risk of bias

0-9

Low quality / high risk of bias

Duration of CEs

Longer + full-time → potentially better productivity, student performance, and teaching

Assessment in clinical education

-Aspects used to measure and document student performance during clinical education.

-Cognitive performance

-Psychomotor/clinical skills

-Behavioral/professional dimensions

What are the benefits of the 2:1 collaborative model?

Peer mentoring, collaboration, teamwork, shared learning, increased productivity, and more opportunities for teaching.

Traditional model benefits

-Strong CI/Student relationship

-Student-perceived benefits

traditional model barriers

- Time-intensive

-Higher burden on clinical staff

-Uneconomical

-Not proven to be a more effective model

Additional 2:1 model benefits

-Increased CI satisfaction

-Less time burden on CI

-Student learning benefits

-Academic institution benefits

-Increased productivity?

-Cost effective?

What are some barriers to the 2:1 collaborative model?

CI-perceived barriers, student-perceived barriers, and clinic-perceived barriers.

What do Clinical Instructors (CIs) generally think about the collaborative model?

-Generally view the model favourably, particularly if they have taught in the model

-The workload is manageable

-Reduced student dependence on CI because the students rely on each other

-Can positively impact productivity

-Perceive that their students have enhanced clinical competence in this model

What is a major challenge for implementing the 2:1 model?

CIs need preparation, teaching strategies, training, and adequate support.

What components are essential for preparing students for the 2:1 model?

Student orientation, clear communication, and structured experiences.

Academic Preparation of Student

-2:1 design talks

-Individual expectations/goals

-Team expectations/goals

-Learning styles

-Peer to Peer Learning research

-Conflict Management

-Academic support during experience

What benefits does a formal orientation provide for students in a clinical setting?

-A formal orientation sets the stage for a positive experience

-Students place value in the process

-Creates a sense of security and belonging

-Correlates with improved student outcomes

-Improved interpersonal relationships and communication during the experience

-By creating an orientation, the CI is also better prepared!

What is the role of the Academic site in preparing students for clinical experiences?

To prepare students through orientation and setting individual and team expectations.

What is the significance of peer-to-peer learning in the 2:1 model?

It reduces student dependence on the CI and fosters collaboration among students.

What is the impact of longer and full-time clinical experiences?

They potentially lead to better productivity, student performance, and teaching.

What aspects of performance are assessed in clinical education?

Cognitive performance, psychomotor/clinical skills, and behavioral/professional dimensions.

What is one of the primary responsibilities of Clinical Instructors (CIs) in the 2:1 model?

To create a structured experience and identify teaching strategies ahead of the clinical experience.

What is the role of the Student Clinical Coordinator (SCCE) in the 2:1 model?

To support the clinical education experience and facilitate communication between students and CIs.

Communications: University tasks prior to start of clinical

-Student's name and contact info sent months before experience

-Students send individual information and introductory letter outlining individual and collaborative learning goals for experience

-Program contacts SCCE and CI just prior to start of rotation:

-Answer final questions

-Offer support as needed

-Recommend timeline for University-site communications during CE

Communications: Clinical site tasks prior to start of clinical

-SCCE contacts students via email to confirm 2:1 model and provide onboarding information. Information unique to 2:1 model might include:

-Patient caseload mix if differences between students

-Second student's contact information (if student from different university)

What does SCCE stand for?

Site Coordinator of Clinical Education.

Activities: University tasks prior to start of clinical

-Training with SCCE and CIs participating in collaborative model several months ahead of experiences

-Student preparation for collaborative model occurs during on-campus prep sessions and/or meetings. Topics may include:

-Benefits and challenges of 2:1

-Student, team, CI/SCCE expectations

-If students are from the same school, arrange a meeting to review expectations together

Activities: Clinical site tasks prior to start of clinical

-SCCE meets with CI(s) to discuss schedules:

-Patient schedules

-Teaching time (individual and team meetings)

-SCCE and CI discuss any potential challenges and create possible solutions or alternatives

-SCCE connects students via email or online meeting platform to discuss 2:1 collaborative process

What should students prepare during on-campus prep sessions?

Topics include benefits and challenges of the 2:1 model, and expectations for students, teams, and CIs.

Why is preparation critical for the Clinical Instructor (CI)?

-Recognize anticipated challenges

-Provide Intentional Support

-Enhanced CI Preparation

Preparation of the CI

-Maximize your understanding of the collaborative model

-Expand your understanding of adult learning principles and peer to peer learning

-Create a structured experience

-Establish teaching and organizational strategies ahead of time

What are some strategies for structuring the clinical experience?

Organizing activities, workload distribution, and scheduling meetings.

How do the early weeks of the early clinical experience look?

-Students & CI working together

-Morning huddles

-Caseload management- more team based

-Documentation time

-Peer to peer learning w/out CI

-Time away from students-CI tasks

-Team meetings

-CI and individual student meetings

How do the late weeks of the early clinical experience look?

-Students working together

-Shifting responsibilities

-Caseload management-team and individual

-Peer to Peer learning w/out CI

-Time away from students-CPI and other obligations

-Team meetings

-CI and individual student meetings

How do the early weeks of the late clinical experience look?

-Students plan and coordinate

-Students facilitate morning huddles

-CI does not have a caseload; patients only on a limited basis

-Caseload management (students)

-Peer to peer learning w/out CI

-Time away from students-CI tasks and other non-student related tasks

-Team meetings

-CI and individual student meetings

How do the late weeks of the late clinical experience look?

-Students are independently managing their caseloads

-CI consults. Students provide more feedback on Clinical decision making

-Student inservices/projects

-Other learning opportunities

-Peer to Peer learning w/out CI

-Time away from students

-Team meetings

-CI and individual student meetings

Strategies to make student learning successful:

-Understand learning styles

-Faded feedback

-Socratic questioning

-Have students teach each other with your feedback

-One Minute CI model

-Consider learning activities that are unique to your setting within these teaching strategies

Teaching Strategies: Early Experience

-Conduct a student needs assessment for each student

-Preferred learning styles

-Student Observation/ and CI modeling for students

-Provide hands-on guidance

-Model questioning/feedback

-Peer to Peer learning with "fish-bowl": CI may need to provide topics

Teaching Strategies: Late Experience

-Conduct a student needs assessment for each student

-Self-directed learning

-Add in more variety

-Feedback is more self-directed and peer-to-peer feedback deeper level of problem solving

-CI facilitates higher levels of reasoning

What are perceived barriers to initiating a 2:1 experience?

-Increased administrative duties

-Increased CI workload

-Challenging student partnership

-Limited knowledge about 2:1

-Decreased productivity

What is a suggested solution for increased CI workload?

Relinquishing caseload to students.

What is a suggested solution for Challenging student partnership ?

Gain Academic program support

What is a suggested solution for Limited knowledge about 2:1

Learn from training

What is a suggested solution for Decreased productivity

Literature from acute care says no, not true

Addressing Challenges : Low Census

Create paper patients

Allow team based learning

Challenge: Performance/skill differences between students

-Possibly gain another CI

-Work through challenges with practice

COVID-19: implications for the 2:1

-Social distancing

-Focus on competency based outcomes vs clinical hours

-Telehealth

-Alternative learning experiences

How can challenges related to COVID-19 be addressed in a clinical setting?

By planning ahead and focusing on competency-based outcomes instead of clinical hours.

What is the role of academic programs in supporting CIs?

Providing training and resources for CIs and facilitating regular communication.

What is the significance of regular and timely communication in clinical education?

To ensure effective preparation and support for students and CIs.

What should be discussed in team meetings during the clinical experience?

Caseload management, peer learning, and individual student meetings.

What is the focus of the later clinical experience for students?

Independently managing their caseloads and providing feedback on clinical decision-making.

What is the benefit of creating paper patients in low census situations?

To facilitate team-based learning when actual patient numbers are low.

What is a challenge related to personality differences between students?

It can affect collaboration and learning; open communication is essential.

What is the importance of understanding adult learning principles in clinical education?

To maximize the effectiveness of the collaborative model and enhance student learning.

What is the goal of establishing teaching strategies in clinical education?

To create a structured experience that promotes successful student learning.

Why should CI and SCCE discuss patient schedules?

To ensure effective teaching time and manage individual and team meetings.