The Impact of Brief Health Equity/Implicit Bias Education on Patient-Centered Communication Among Clinical Teaching Faculty

Effective academic-clinical partnerships require a greater understanding of how academic programs can best support clinical education (CE) faculty. This study aimed to determine resources and support that clinical partners need. As the number of physical therapist (PT) programs, cohort sizes, and CE weeks have risen, so has demand for CE sites. Conversely, staffing reductions, increased administrative duties, and rising productivity expectations have decreased the time available for clinical instruction. To promote a successful CE experience, there must be a renewed understanding of CE faculty needs. Clinical education faculty affiliated with any of the 8 contributing programs from the Ohio-Kentucky Consortium participated in survey research (n = 24) and subsequent interview (n = 4) and focus group (n = 6) research. Constructivist grounded theory design was used to explore the needs of CE faculty. Academic and clinical partners developed the initial survey and used survey results to establish interview questions. The investigators iteratively assessed data saturation and clarity of results of coded survey, interview, and focus group data to determine whether the study's aims of identifying CE faculty needs had been met. The aggregated results yielded 5 main themes of Director of Clinical Education support for CE faculty needs: student readiness for CE experience; effective academic-clinical partner communication; collaborative management of exceptional students; judicious standardization of CE processes; and provision of CE faculty development resources. Clinical education faculty have noted challenges that affect their ability to mentor students. They want academic programs to be more collaborative and proactive with communication, resources, and support. Future research should address aids and barriers to proactive communication, resource provision, and academic-clinical partner collaboration.

A competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the Clinical Teaching Competency Framework by gathering input specifically from clinical education faculty. This study used an explanatory sequential mixed-methods approach to seek input from clinical instructors (CIs) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom. Survey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and improvement in the quality of clinical education (94.1%). Concern regarding the ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of collective impact, with 4 subthemes: assessment, CI development, implementation, and guidelines. Clinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework should be collaborative and consistent across academic and clinical education programs. This study moves the profession one step closer to the use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework, and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.

At the College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain, a system has been introduced in which clerkship students evaluate clinical faculty using Visual Indicators of Teaching and Learning Success (VITALS). To describe the use of VITALS in reporting student feedback on teaching and learning effectiveness of clinical faculty in the clerkship. Descriptive study. A total of 210 clerkship students evaluated 76 clinical tutors over a period of 3 years. Feedback was also obtained from seven programme managers and one supportive staff member. Nine indicators of effective clinical teaching were identified through a literature search. Students individually reported on clinical faculty teaching capabilities using a 5-point, Likert-type scale. Cumulative reports of students' feedback on clinical faculty teaching were prepared using opposing bar graphs, reflecting perceived areas of strength or weakness in each teacher's performance. A total of 1450 evaluation forms were completed by 180 of 210 students (85.7%). VITALS graph representations of students' perceptions of clinical tutors were communicated to each clinical tutor at the end of each clerkship and academic year. Twenty-one students out of 53 who gave written comments were related to VITALS. They reflected a positive view of VITALS as a process or tool of faculty evaluation. Clinical faculty (18), programme managers(7) and supporting staff (1) gave comments indicating acceptance of the system. This preliminary study suggests that VITALS could be an effective tool for improving clinical teaching. It is acceptable to students, faculty and managers of educational programmes. The database reflecting their teaching and educational profiles were used to provide clinical faculty with constructive feedback.

Background and Purpose. Academic coordinators/directors of clinical education (DCEs) serve unique roles in physical therapist education programs with responsibilities that extend beyond those of teaching, service, and scholarship. Traditional faculty evaluation tools frequently fail to capture the diverse leadership, administrative, managerial, and experiential teaching responsibilities of these faculty members. The purpose of this project was to develop a set of assessment surveys for the DCE to use to solicit comprehensive performance feedback. Method/Model Description and Evaluation. A comprehensive literature review, analysis of professional documents and existing institutional tools, and feedback solicited from evaluator groups informed the development of the DCE Performance Assessment Surveys (Surveys). Fifty-six accredited physical therapist (PT) and physical therapist assistant (PTA) programs self-identified as the sample of convenience to pilot test the Surveys. Outcomes. The majority of program directors (88%) indicated they would consider using the Surveys. Clinical education faculty (88.6%) and academic faculty (84%) respondents stated they would be willing to complete a Survey for the evaluation of a DCE. A range of 85.0%-93.3% of respondents stated they could adequately evaluate the DCE using the Survey unique to their rater group and reported a range of 13.0-15.9 minutes to complete the Survey. Discussion and Conclusion. This project used a systematic process to develop a comprehensive set of Surveys for use in physical therapy academic programs. The Surveys solicit 360-degree performance feedback on the role of the DCE from the program director, DCE, clinical education faculty (clinical instructors, center coordinators of clinical education), academic faculty, and students. Data obtained may be useful to DCEs in professional and program development, workload allocation, promotion and tenure applications, and accreditation reports.

Overview of the Geriatrics Curriculum There is a specific emphasis on geriatrics and gerontology in each of the four years of the Louisiana State University School of Medicine curriculum. Information on the biology and physiology of aging is included in each of five courses in the Core Concepts module early in the first year (see Figure 1). Specific aspects of organ system aging and disease processes common in older people are presented in each course of a systems module that extends throughout the remainder of the first and second years. Correlative lectures and experiences during these two years in the Patient, Physician, and Society Module are designed to address students’ attitudes about aging and prepare them to encounter older people in the clinical setting. In the third and fourth years, students build on this foundation by following older patients in a unique longitudinal care clinic and by performing additional structured evaluations of elderly patients encountered during clerkships or visits to long-term care facilities. A fourth-year elective in geriatrics is available.FIGURE 1.: Medical School CurriculumCurriculum Management and Governance Structure A new curriculum governance structure was put in place shortly before the geriatrics program was initiated. The Medical Curriculum Council (MCC) replaced the previous Curriculum Committee and was given authority both to implement a revised curriculum and also to evaluate and manage all aspects of the curriculum on an ongoing basis. The associate dean for academic affairs chairs the MCC. The membership includes two representatives from the school's administrative council, which is composed of all department chairpersons and other key administrators; two from the elected faculty council (an advisory group chosen by the faculty ballot); four representatives appointed by the dean/chancellor; and representatives from each module of the first- and second-year curriculum and from the third- and fourth- year clerkships. The registrar and curriculum coordinators who work under the office of the associate dean for academic affairs are nonvoting members of the committee. Members are appointed for staggered terms ranging from two to five years. Subcommittees of the MCC deal with each of the modules of the first- and second-year curriculum and with the third- and fourth-year clerkships and electives. First- and second-year students submit weekly evalua-tions of all courses. In addition, students’ focus groups provide feedback at the end of each course. All results are collated, distributed to course directors, and reviewed by the MCC and its subcommittees. Third-year students complete a course and faculty evaluation at the conclu-sion of each clerkship. These are collated and reviewed at the end of each academic year. Fourth-year students complete an online evaluation of the curriculum near the end of the year and participate in focus groups as well. Within the Office of the Associate Dean for Academic Affairs, a curriculum coordinator and a PhD educator with expertise in curriculum evaluation and assessment are responsible for much of the implementation of the curriculum. A member of the clinical faculty is course director for the Standardized Patient Program. Under the revised curriculum, interdepartmental, multidisciplinary teams of both clinical and basic science faculty direct all courses in the first and second years. Each combines the traditional core information for that system with introductory clinical concepts, instruction in physical diagnosis skills, and standardized and real patient exposures. Management of the geriatrics curriculum The multidisciplinary Planning and Implementation Committee administers the curriculum. It is composed of the associate dean for academic affairs, representatives of the Geriatrics Section of the Department of Medicine, the director of the student Comprehensive Care Clinic, and other faculty with responsibilities for the oversight of the overall curriculum. This group meets as needed to discuss and review the progress of the curriculum and to formulate changes in policy. A master's-degree-level coordinator provides direct oversight and day-by-day management of the geriatrics curriculum. This person works closely with the Planning and Implementation Committee, with clinic managers, and with students. The MCC maintains oversight of all aspects of the geriatrics curriculum and makes overview decisions related to grading and transcript credit. THE AAMC/HARTFORD GERIATRICS CURRICULUM PROGRAM Institutional Involvement in Curricular Change A major curriculum revision was implemented with the matriculation of the class of 2005. The new emphasis in geriatrics was incorporated over a two-year period that was coincident with the implementation of the new first- and second-year curriculum. Years One and Two of the new curriculum were introduced over the same years in which the Hartford grant was in place and in which the development and implementation of the gerontology/geriatrics medicine education program occurred. Under the new curriculum, there are no departmentally directed and run courses in the first and second years. Lecture hours have been dramatically reduced in number. Small groups, personal study time, computers/technology-assisted learning, and independent problem solving are stressed. Five integrated core knowledge courses over the first five months (Module I) are followed by 11 system-based courses in the second half of the first year and throughout the second year (Module II). Concurrent with Modules I and II is a series of weekly lectures and clinical experiences that emphasize various aspects of the practice of medicine, including the doctor-patient relationship, physical diagnosis, social and economic issues in medicine, and medicolegal issues (Module III). In addition, Module III features an “immersion month” at the completion of the Module I courses. In 2001, third-year students (Class of 2003) began following older patients in the Comprehensive Care Clinic, a longitudinal care experience designed exclusively for students, and continued to do so in their fourth year. The exposure of this class to geriatrics in their first and second years was limited to lectures given under the previous curriculum. Thus, by the end of the second year of the grant, an identifiable geriatrics experience was a reality in all four years. The classes of 2002 through 2005 constitute a continuum of education experience in geriatrics: second-year lectures with no prescribed third- and fourth-year clinical experiences (Class of 2002); second-year lectures with third- and fourth-year clinical experiences (Classes of 2003 and 2004); and a full four-year educational experience (Class of 2005). Thus, the impact of the new geriatrics curriculum on the students’ knowledge, clinical skills, and attitudes related to geriatrics can be studied, although the analysis will not be completed during the period of the grant. Issues related to incorporating geriatrics concurrent with major curriculum revision. The MCC and the Geriatrics Planning and Implementation Committee believed that the curriculum revision process offered an ideal opportunity to introduce an expanded emphasis on geriatrics, including early clinical exposure to older people and their problems, standardized patients, nursing home visits, and physical examination skills. The incorporation of additional aging content into the Module I core knowledge courses came at a time when these courses were being shortened drastically from the corresponding courses under the previous curriculum. Thus, conflicting goals were in play, and there was some inevitable resistance among faculty members. As a part of the restructuring of the third- and fourth-year rotations, the Comprehensive Care Clinic experience was decreased from two sessions per week to one. The incorporation of required geriatric patient evaluations into this experience presented a challenge to the clinical faculty, who are charged with providing students with a wide variety of patient encounters. Theme for the Geriatrics Program The geriatric planning group developed a general goal of establishing, as part of an overall curriculum revision, a gerontology and geriatrics education program that is integrated across all four years of the curriculum and incorporates multidisciplinary basic science and clinical faculty teaching. The guiding concept has been to teach geriatrics to medical students apart from the traditional model of a defined rotation period on a medical subspecialty service. LSU Health Sciences Center-Shreveport has a very limited number of faculty members with added qualifications in geriatrics medicine, as well as limited geriatrics clinical services. There is no geriatrics fellowship program. Thus, it is not feasible to give students meaningful rotations in the care of older patients under the more traditional models. The concept for the program further sought to use our unique and established longitudinal student Comprehensive Care Clinic as a principal site for geriatrics education. This clinic, which is under the direction of the Department of Family Medicine, has educational goals that are commensurate with those of the geriatrics program. A secondary objective was to develop a model/prototype for similar interdepartmental and interdisciplinary education programs in other disciplines for the future. Learning Outcomes for the Geriatrics Curriculum Specific goals were developed for each year in the curriculum. First year: Overcome barriers to effective interaction with older people in the medical care setting, including recognizing and overcoming the common societal and medical biases against older people; understanding the impact of limitations imposed by the demographic, physiologic, psychological, and sociologic changes of usual aging; appreciating the contribution of life experiences to the health status, belief systems, values, and personal preferences of older people; learning to communicate with older persons by taking into account education, sensory impairment, and cognitive dysfunction; understanding the ethical principles that have particular application to the elderly. First and second years: Understand the heterogeneity of normal human aging, including age-related changes in tissues, organs and physiologic function, homeostasis, pharmacology, and predisposition to disease; recognize the expected alterations in anatomy and physiology in each major organ system and homeostatic function; recognize the range of physical findings in usual aging and common age-related diseases; and learn to modify the medical history and physical examination for common or suspected pathologic conditions in older persons. Third year: Establish a student-patient relationship with older individuals and understand the interrelationships of disease, lifestyle, and social issues in managing the care of such individuals; understand the clinical features, natural history, predisposing causes, complications, and management of common geriatric syndromes and conditions, including dementia, depression, delirium, urinary incontinence, deconditioning, sensory impairment, falls, immobility, gait disturbances, pressure ulcers, sleep disorders, iatrogenic conditions, and polypharmacy; understand and learn to apply the clinical and social variables germane to the management of older people with common medical disorders, including the interaction of multiple diseases and treatments; changes in pharmacokinetics and pharmacodynamics, and patient preferences and quality of life issues; incorporate preventive medicine practices into the care of patients, including vaccinations, health screening modalities, and education concerning lifestyle modification; learn to discuss patient preferences and advance directives with patients; and learn to incorporate other disciplines into the care of elderly patients and to access community resources to assist in the care of older people. Fourth year: Continue the objectives of the third year and develop an evidence-based approach to the care of older people, in order to gain an enhanced appreciation of the natural history of aging and the disease processes common in elderly people. Special Programs Community partnerships Since the program began, an alliance has been forged between the Louisiana State University Health Sciences Center—Shreveport (LSUHSC-S) and a large continuing care retirement community (CCRC) in the city of Shreveport. All students spend one-half day per week at this facility during the third-year clerkship in internal medicine. When fully developed, this association has the potential to be a site for more long-term student experiences. A second CCRC has joined with the health sciences center as a site for first-year students to have the first encounters with older individuals. Standardized patients A number of older individuals are now included in the panel of standardized patients, and geriatric syndromes are included in standardized patient/OSCE experiences. Faculty interest group A multidisciplinary geriatrics interest group for faculty began meeting in fall 2003. Students are encouraged to attend meetings. Palliative care and end of life An association between LSUHSC-S and a hospice organization has been developed. Palliative and end-of-life care is a major focus of the current geriatrics faculty. Resulting Pedagogical Changes Under the previous curriculum, there was no specific emphasis on geriatrics in the first year. Introductory lectures on the demographics and mechanisms of aging are now included in the early weeks of the academic year. First-year students also have the opportunity to learn firsthand about older people and the problems of aging through the Aging Game and life history interviews with elderly individuals living in various retirement or long-term care facilities. A series of ten lectures on geriatrics topics was presented in the previous curriculum as a part of the Introduction to Clinical Medicine course at the end of the second year. Under the revised curriculum, these topics are spread throughout the various system-based modules in the first and second years for improved integration. A major change in the third year has been the combination of the medicine and pediatrics clerkships into one 16-week block, which permits much more integration of primary care teaching. Over the next few years, a series of core topics, related to common acute and chronic illnesses, will be developed by a Primary Care Planning Team for presentation during this rotation. These exercises will be interdepartmental, with multidisciplinary team teaching and an emphasis on problem solving and the formulation of optimal management strategies in a small-group setting. One or two geriatrics topics will be included in this series. The fourth year now has no required department-based courses. Selective rotations are evolving that will ensure certain types of clinical experiences for all students, including an acting internship; outpatient care, with emphasis on office practice management and financial issues, such as Medicare for the elderly; and a community-based experience, which may be in a nursing home or other long-term care facility. Computer technology is now used throughout the curriculum. All first-year students are required to purchase and be proficient in the use of laptop computers. Much of the didactic material in the first two years is available on-line. Students in the Comprehensive Care Clinic can record the findings of standardized evaluations of geriatric patients using forms that can be accessed by Internet. The geriatrics section of the Department of Medicine has a Web site that is being developed as an educational tool for medical students, health care professionals, and patients. Students’ Clinical Experiences in Geriatrics Approximately 20% of the patients encountered by students during the third-year clerkship in internal medicine are over 65. One of these must be evaluated in depth using standardized geriatric assessment tools. One third of the third-year students are assigned to the Veterans’ Administration Medical Center, where there is a much larger proportion of older patients. Third-year students spend one half-day of the internal medicine clerkship evaluating patients at a community nursing home. Plans are being developed to assign some students to a two-week rotation at a continuing care retirement center during the third-year clerkship in medicine. Third- and fourth-year students have at least one elderly individual in their panels of patients in the Comprehensive Care Clinic. Fourth-year students may arrange a community medicine elective in a nursing home or long-term care facility. Fourth-year students may register for a one-month geriatrics elective, which includes a variety of experiences in different care settings. The Program’s Assessment and Evaluation Instruments Students participate in focus groups, which meet after each course (Modules I and II) and toward the end of the third and fourth years as part of curriculum evaluation. These groups discuss course activities and make suggestions for improvements all aspects of the curriculum, including geriatrics. At the beginning of the third year, students take a short multiple-choice exam on geriatrics and gerontology. Results from the graduating classes of 2003 and 2004, with geriatrics lectures as a part of the Introduction to Clinical Medicine course under the previous curriculum, are being compared with subsequent classes, who have been entirely under the revised curriculum. Beginning third-year students complete a questionnaire related to their learning experiences in geriatrics and their perceived ability to manage older patients. Results from the classes of 2003 and 2004 are being compared with those of subsequent classes. These two classes had didactic instruction in geriatrics under the previous curriculum, but no aging simulations or direct experience with an older person. Resources Required Personnel and time beyond the efforts of a program coordinator and student worker supported by Hartford funding: The faculty and staff of the Office of the Associate Dean for Academic Affairs, the geriatrics faculty, and Comprehensive Care Clinic Coordinator and manager have spent many hours in planning meetings and other work sessions related to the program. The Aging Game for first-year students is labor-intensive for the standardized patient coordinator, for the staff of the Office of Academic Affairs, and for a number of nurses and other Health Science Center personnel who volunteer to assist with the program. The geriatrics faculty of the Department of Medicine devote additional time beyond their usual clinical and educational responsibilities to supervising student experiences in the community nursing home and to critiquing student reports of encounters with elderly individuals. Computer service personnel have been enlisted as needed to provide listings of elderly patients and help design online tools for managing student patient panels and appointments. Family medicine staffing in the Comprehensive Care Clinic has had more time constraints due to Medicare and Medicaid billing issues and because of time requirements involved in seeing older patients who require more extensive care. Requirements to Sustain the Program Because of the multiple aspects of the program, some of which are interdepartmental, a coordinator will be required, at least on a part-time basis. It is unlikely that the time necessary to manage the geriatrics curriculum can be found within any single permanent position that now exists among the education and curriculum staff. Dividing the responsibilities among several individuals will result in a lack of cohesiveness of the curriculum and compromise the identity of the program. Part-time clerical support for the program must be maintained in the Comprehensive Care Clinic. The person with this responsibility may also assist in the identification and scheduling of other kinds of targeted patients for each student. An ongoing commitment by the faculty will be required to maintain the first-year activities of the program in particular. The Aging Game and initial encounters with older individuals are outside the scope of the usual teaching and patient care responsibilities of the faculty and will have to be assessed for their value in relation to the high labor demand. Faculty information and development activities will be necessary to maintain the overall commitment of the faculty to a geriatrics curriculum. Material costs will be modest, but must be borne by either the dean/chancellor's office or the involved departments collectively. Unanticipated Outcomes Students who had a single identified block of lectures in geriatrics under the previous curriculum reported more satisfaction with the instruction than did those who received the information in multiple different courses throughout the first two years. Although the total time spent in geriatrics instruction and experiences in the new program was much greater, it was necessary for students to link the information and experiences in their thinking. They were not necessarily aware they were learning “geriatrics” in the integrated format, as it was not listed on the schedule by subject as “Geriatrics.” Based on the examination given at the beginning of the third year, the fund of knowledge related to geriatrics appears to have decreased. We speculate that spreading the geriatrics content over multiple courses has not been as effective for learning as was the concentrated block of geriatrics lectures under the previous curriculum. An alternative explanation, however, is that the information presented in a block of geriatrics lectures at the end of the second year under the previous curriculum was recalled more easily than it was in the examination that was not administered until early in the third year. Retained knowledge in the fourth year or internship may be a more important measurement. Perception of knowledge and attitudes in some areas, such as understanding the emotions related to aging and overcoming the societal biases against older people, were unchanged among the three classes, although the instructional methods were radically different. Students felt strongly that preparing a structured life history on an elderly person during the first year made them more cognizant of the changes that occur with aging. More students in the class of 2005, who have had the entire revised first- and second-year curriculum, felt that their preparation to care for geriatric patients was inadequate. We feel that this assessment is based more on the perceived lack of focused subject knowledge than on their experiences with older patients in the first two years. The geriatrics program has given the faculty and MCC a unique opportunity to examine a specific content area in the curriculum, based on content delivery, teaching methods, and patient experiences. This has significance for the teaching of other cross-content areas in the curriculum. Arguably, most medical students of LSUHSC-S have been in a traditional education system throughout their elementary, high school, and college years. The mindset has been that of preparing for objective examinations. They have not been accustomed to self-directed learning, and this is evident in their evaluation of the curriculum changes and the new approach to education in geriatrics. This is a significant challenge for the school, one that may require specific methods to redirect the thinking of students early in their medical school careers. Impact of External Funding The addition of a new curriculum program concurrently with a far-reaching revision of the curriculum would probably not have been considered apart from the support gained from the foundation's funding. The grant, although time-limited, nonetheless has been sufficient in scope to establish the geriatrics program as an integral part of the curriculum, particularly in the first year. For more information, contact Peggy W. Murphy, PhD, at 〈[email protected]〉.

"The mannequins have been pink for a very long time." Navigating whiteness and realness in simulation.

Self-efficacy is the perceived confidence of students in their ability to learn new skills and knowledge. This study examined underrepresented ethnic minority students' perceptions of the factors that enhanced/hindered their self-efficacy in a bachelor of science in nursing program. Qualitative analysis revealed three themes: 1) doing it, 2) connecting with clinical faculty, and 3) dealing with multiple stressors. Students described clinical faculty's teaching strategies that enhanced their nursing self-efficacy as they managed multiple stressors in their lives.

188 Does Sex Bias Impact Faculty Clinical Teaching Awards?

BackgroundIn the medical education system of China, the contents of the undergraduate medical internship included practicing theoretical knowledge, clinical skills, communication ability, and human care in the teaching hospital. Multiple teaching objectives are encompassed in the teaching of this phase, which is significantly influenced by the environment. The abilities of this workplace-based teaching are difficult to observe and assess. The concepts of competency and entrustable professional activities (EPAs) are applied largely in education. This study aims to establish a set of qualities by merging competency and EPAs for clinical teaching faculty during the undergraduate medical internship.MethodsLiterature research, theoretical analysis, and focus group interviews on teaching abilities in the internship were conducted by our study group, followed by discussion among 9 experts in education/pedagogy and medical education from 6 institutions. The framework of qualities was drafted and formulated with item titles, definitions, and explanations. Then we sent the framework to another 50 clinical teachers and teaching administrators from two medical universities and three teaching hospitals in different regions. The content validation was completed with two rounds of modified Delphi procedure. The entropy weight method was utilized to calculate the weight of each indicator.ResultsThe response rate was 100% during the two Delphi rounds. Each item and the content description was revised and consensus was reached. The qualities of clinical teaching faculty in undergraduate medical internship comprised 11 items, which were categorized into three domains: education and teaching literacy, clinical skills instruction, and professional knowledge and application.ConclusionThis study applied a scientific, comprehensive, and systematic Delphi procedure and established qualities for clinical teaching faculty during the undergraduate medical internship with the concept of merging competency and EPAs. Our report on the qualities of clinical teachers may guide the assessment and development of faculty members.

Clinical education has been an integral part of the preparation of physical therapists from the inception of educational programs to train reconstruction aides until the current curricula to prepare Doctors of Physical Therapy. In this historical review of clinical education, the structure and format of the clinical education component of professional physical therapist education curricula are presented. The number of clinical education sites and characteristics of clinical education faculty for the past half century will be described, as will developments in methods used for the assessment of student performance. Descriptions of some of the major developments in clinical education are provided, including interinstitutional agreements, roles for clinical education faculty, professional development for the clinical instructor, clinical education consortia, clinical site selection, clinical education research, and conferences. Factors anticipated to have an effect on the future of clinical education in physical therapist educational programs are also discussed.

In the midst of ongoing debates within the legal academy and the American Bar Association on the need for practice-ready law school graduates through enhanced attention to law clinics and externships and on the status of faculty teaching in those courses, this report identifies and evaluates the most appropriate modes for clinical faculty appointments. Drawing on data collected through a survey of clinical program directors and faculty, the report analyzes the five most identifiable clinical faculty models: unitary tenure track; clinical tenure track; long-term contract; short-term contract; and clinical fellowships. It determines that, despite great strides in the growth of clinical legal education in the last 30 years, equality between clinical and non-clinical faculty remains elusive. Clinical faculty still lag behind non-clinical faculty in security of position and governance rights at most law schools. The report then identifies four core principles that should guide decisions about clinical faculty appointments: 1) clinical education is a foundational and essential component of legal education; 2) the legal academy and profession benefit from full inclusion of clinical faculty on all matters affecting the mission, function, and direction of law schools; 3) there is no justification for creating hierarchies between clinical and non-clinical faculty; and 4) the standards for hiring, retention, and promotion of clinical faculty must recognize and value the responsibilities and methodologies of clinical teaching. The report concludes that these core principles are best realized when full-time clinical faculty are appointed to a unitary tenure track. This conclusion does not ignore the imperfections of a tenure system. However, to the extent that tenure remains the strongest measure of the legal academy's investment in its faculty and is the surest guarantee of academic freedom, inclusion in faculty governance and job security, the report recommends that law schools predominantly place their clinical faculty on dedicated tenure lines. In addition, it recommends that schools implement standards for hiring, promotion, and retention that reflect the teaching responsibilities and methodologies, as well as practice and service obligations, unique to their clinical faculty. To facilitate the development of such standards, the report suggests good practices for the appointment of clinical faculty on a unitary tenure track.

The importance of supporting and promoting faculty scholarship in nursing is acknowledged, but the reality of scholarship for faculty engaged in clinical teaching can be challenging. The article describes the development and initial results of the scholarly practice program. Mentorship, time, and limited funding are essentials for the program. After submitting detailed proposals, 15 faculty were chosen to be project leaders in the first 2 years of the program, resulting in 15 presentations, three posters, 19 publications, and a webinar, to date. External continuing funding has been secured by three projects. Additional dissemination efforts are awaiting peer review. The program has successfully increased the level of scholarship among clinical teaching faculty and contributed to the faculty's professional satisfaction. Faculty have increased experience and ability to conduct clinical quality improvement. Experience supports targeted, substantial support for projects, rather than a general average faculty allocation strategy to promote scholarship. [J Nurs Educ. 2018;57(2):121-125.].

Background and Purpose. Although professional education programs, including physical therapist education, require unique roles and qualifications of faculty, academic rank and promotion typically follow traditional university structure. Expectations that all physical therapist academic faculty members, including the director of clinical education (DCE), have a defined, ongoing scholarly agenda can perpetuate a traditional university construction of academic roles unless scholarship is extended to divergent ways of knowing. A feminist understanding of scholarship values connectivity of knowledge through direct community involvement and intensive student engagement. This article, a feminist critique of the DCE role, informs the scholarly potential of the DCE within a context of a more broadly defined and reconstructed definition of scholarship. Position and Rationale. Current academic roles in physical therapist education programs are aligned with engendered definitions of traditional academic structures which can lead to academic devaluation of the DCE. A social constructionist analysis of the DCE position in light of higher education feminist literature provides an alternative perspective of scholarship. Discussion and Conclusion. Academic structures ideally support realization of all faculty potential; however, a paternalistic metric determines faculty promotion with administration, management, and specialized research at the top of the hierarchy. A feminized metric would value those roles inherent to the DCE: student and community engagement, counseling, organization, and content integration. Acceptance and embrace of the feminized nature of the DCE position serves students and professional community more than have attempts to realign the DCE position to traditional masculine academic roles. Key Words: Clinical education, Feminist critique, Director of clinical education, Scholarship. BACKGROUND AND PURPOSE Physical therapist education program faculty comprises an academic administrator, a director of clinical education, academic faculty, clinical education faculty, and adjunct faculty. While all of these members serve integral roles in successful physical therapist academic programs, the director of clinical education (DCE) serves in a tenuous position in terms of academic definitions and traditional academic structures of promotion.1 The inherent qualifications and responsibilities associated with this position can make academic career advancement challenging. This position requires broad clinical perspectives and intensive and direct contact with practicing physical therapists and students through advising, counseling, and teaching. Organizational skills and information management are essential to the position. These responsibilities are not of high academic value in terms of academic promotion, which often situates the DCE as junior faculty or as an assistant professor within traditional academic structures. Rather than accept the prevailing rank of the DCE, the purpose of this article is to challenge the traditional academic status of the DCE and offer an alternative vision for this position based on feminist critique and critical social theory. Feminist perspective has been extended to higher education programs in medicine, nursing, business, engineering, basic sciences, the humanities, and economics to evaluate work distribution, promotional structures, and characteristics of leadership.2 As with these fields, physical therapy academic roles do not exist in isolation but are socially constructed and interpreted within the context of accepted norms, values, and shared beliefs. POSITION This article will present an evaluation of the DCE position as it is socially constructed. That is, the interpretation is developed from the unique viewpoint of the DCE and informed by a higher education and feminist literature. A social constructionist approach accepts multiple realities, as all individuals form knowledge and make meaning of experience contextually and through social understandings. …

Objective: This study has two interconnected aims. The first was to better understand how audiology students co-construct hearing assessments with patients while supervised by a clinical educator. The second was to investigate how students’ communication aligns with principles of patient-centred communication.Study Sample: Twenty-three final year audiology students from two Australian universities participated in the study.Results: The supervised student-patient hearing appointments were video-recorded and transcribed. Genre analysis, a form of discourse analysis, was carried out to identify the structure and communication patterns. The six-function model of medical communication was adopted as an analytical framework to map students’ patient-centred communication. The findings showed generic structure of the hearing assessments were the main stages of taking a history, providing a diagnosis, and initiating management plans. For patient-centred communication functions, students demonstrated their ability to foster the relationship and gather information. The communication functions of decision-making, enablement, and responding to patients’ emotions were rarely observed. A significant relationship was found between clinical educators’ interjection as a function of students’ patient-centred communication tendencies.Conclusion: To enhance students’ patient-centred communication, teaching should include explaining and planning as well as addressing additional aspects of patient-centred communication. Support of clinical educators is needed to optimise students’ communication skills learning.

Problem and Purpose Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited. Bias awareness can motivate behavior change. The objective was to evaluate whether exposure to a brief online course, Implicit Bias in the Clinical and Learning Environment, increased bias awareness. Materials and Methods The course included the history of racism in medicine, social determinants of health, implicit bias in healthcare, and strategies to reduce the impact of implicit bias in clinical care and teaching. A sample of U.S. academic family, internal, and emergency medicine providers were recruited into the study from August to December 2019. Measures of provider implicit and explicit bias, personal and practice characteristics, and pre–post-bias awareness measures were collected. Results Of 111 participants, 78 (70%) were female, 81 (73%) were White, and 63 (57%) were MDs. Providers held moderate implicit pro-White bias on the Race IAT (Cohen’s d = 0.68) and strong implicit stereotypes associating males rather than females with ‘career’ on the Gender-Career IAT (Cohen’s d = 1.15). Overall, providers held no explicit race bias (Cohen’s d = 0.05). Providers reported moderate explicit male-career (Cohen’s d = 0.68) and strong female-family stereotype (Cohen’s d = 0.83). A statistically significant increase in bias awareness was found after exposure to the course (p = 0.03). Provider implicit and explicit biases and personal and practice characteristics were not associated with an increase in bias awareness. Conclusions Implicit bias education is effective to increase providers’ bias awareness regardless of strength of their implicit and explicit biases and personal and practice characteristics. Increasing bias awareness is one step of many toward creating a positive learning environment and a system of more equitable healthcare.