Clinical Education Curriculum Research Articles

Determining the Optimal Length of Clinical Education Experiences: Surveying Doctor of Physical Therapy Academic and Clinical Faculty.

There is wide variability in the length of full-time clinical education experiences (CEEs) among Doctor of Physical Therapy (DPT) programs. We investigated academic and clinical faculty perspectives on the optimal length and level of agreement on the length, timing, and offering of full-time CEEs. A survey assessing perspectives on the optimal length and level of agreement for the length, timing, and offering of full-time CEEs was completed by 100 academic and 240 clinical faculty. Differences between academic and clinical faculty responses on the optimal length and level of agreement were assessed with a 2-sample test of proportions and 2-sample t -test. Participants believed that the length of full-time CEEs (in weeks) should be single CEE 10.6 (SD 2.3); first CEE 7.8 (SD 2.1); terminal CEE 12.5 (SD 5.4); integrated CEE 9.6 (SD 1.9); and total CEEs 37.2 (SD 6.9). There were significant differences (MD = -3.0; 95% confidence interval [CI] -4.6 to -1.6) between academic and clinical faculty perspectives for the total length of CEEs. No significant differences between academic and clinical faculty perspectives for the length of single, first, terminal, or integrated CEEs. There were significant differences between academic and clinical faculty perspectives for the optimal length of inpatient (MD = 1.1; 95% CI 0.6-1.6) and specialty (MD = 0.8; 95% CI 0.2-1.3) settings. There were significant differences between academic and clinical faculty level of agreement for 8 of 15 items. There was consistency between academic and clinical faculty regarding the perceived optimal length of full-time CEEs. Academic and clinical faculty perspectives for the optimal length of terminal full-time CEEs (12.5 weeks) were different than those for the national average (21.8 weeks) length of terminal full-time CEEs. Our study provides evidence to support DPT programs' clinical education curriculum decisions regarding the length of full-time CEEs to optimize students learning and maturation.

Design and Validation of Clinical Education Curriculum Pattern Based on Social Accountability for General Medicine Course: A Mixed Method Study

Introduction: In the social accountability of the curriculum, all medical education activities are aimed at training doctors who are able to meet the health needs of society. In Iran's medical education system, there is a weakness in responding to the needs of society, and the connection between students and society has gradually weakened. The purpose of this study was to design and validate a clinical education curriculum model based on social accountability for general medicine students. Methods: A sequential exploratory mixed-method approach was used to conduct this study at Tabriz University of Medical Sciences, combining qualitative and quantitative methods. The model was designed using the inductive content analysis method in the qualitative stage and validated through the descriptive-survey method in the quantitative stage. In order to collect data in the qualitative part, the method of studying previous documents, scientific texts and semi-structured interviews with experts and specialists was used, and in the quantitative part, a questionnaire prepared by the researcher was used. The model was developed using the views of 14 professors and 5 general practitioners, selected through purposive and sequential sampling until information saturation was reached. The model was validated by obtaining opinions from 15 experts using a purposeful and criteria-based method. The content validity ratio (CVR) was estimated using the Lawshe's formula. Results: In the qualitative phase, this study identified the characteristics of an ideal clinical education curriculum for a general medicine course based on a social responsibility approach. The characteristics identified were based on the four elements of Tyler's model. Based on the findings of this part of the research, the extracted codes in 114 subcategories and 13 main categories include goals: knowledge, attitude, and skills; Content: clinical sciences and skills, health sciences, behavioral sciences, social and professional ethics, communication and leadership skills, and content organization; Teaching-learning methods: educational strategies, and teaching-learning methods; Assessment methods: performance assessment in vivo, performance assessment in vitro, and essay assignments. In the quantitative phase, the designed model's components and elements underwent validation through expert agreement and received approval with a content validity ratio of CVR=0.81. Conclusion: In the proposed pattern, the clinical competencies required by general practitioners were the main focus of designing, explaining and describing curriculum elements. Also, this model is designed in such a way that it can meet the needs of society and medical students. It is suggested that medical school officials and curriculum planners use the proposed model in designing the curriculum of general medicine courses to enable medical students to respond to the needs of society.

Quality of Clinical Education as a Propulsive Engine for Academic Satisfaction: A Cross-Sectional Study at Birjand University of Medical Sciences, Birjand, Iran

Background: Clinical education is known as an essential part of education in medicine and medical education. Beyond factors that can affect the quality of clinical education, academic satisfaction is a factor that can either affect or is affected by the quality of clinical education. Objectives: The present study was designed to investigate the relationship between the quality of clinical education and academic satisfaction through medical students’ viewpoints at Birjand University of Medical Science, Birjand, Iran. Methods: In the present cross-sectional study, medical students in both the externship and internship courses of Birjand University of Medical Sciences were evaluated with a self-report questionnaire. The quality of clinical education was assessed by a specific scale developed by Rezaei. Academic satisfaction was evaluated by Motlagh et al.’s questionnaire. Results: A total of 180 medical students were included in the study. The findings indicated that despite the poor quality of clinical education from the perspective of the studied medical students (P = 0.017), their academic satisfaction with the current situation was acceptable (P = 0.0001). Further correlational analysis revealed a significant relationship between the quality of clinical education and its subgroups with academic satisfaction (P < 0.01). Conclusions: It can be concluded that higher clinical education quality leads to higher levels of academic satisfaction among medical students. Therefore, this issue requires continuous revisions of the clinical education curriculum and adherence to improve its outcomes.

Creating opportunities for telehealth education, assessment, and care through Hotspotting (CO-TEACH): An interprofessional telehealth delivery curriculum and guide

Telehealth offers a healthcare solution when functional, social, or geographic barriers arise; however, many clinical education curricula are ill-equipped to prepare learners for effective, multidisciplinary telehealth consultations. The COVID-19 pandemic drastically expanded reliance on telehealth in clinical practice and highlighted the urgent need to educate students across health professions in telehealth delivery. To address this educational gap, student and faculty collaborators from Duke University and the University of North Carolina at Chapel Hill utilized a developmental evaluation approach to rapidly design and pilot a compact, five-session, virtual curriculum to train students from a broad range of health professions in telehealth delivery. Through focused readings, large group didactics, and small group discussion, the curriculum provided a general overview of telehealth, addressed specific issues in health equity and access in virtual care both locally and nationally, introduced skills for conducting telehealth visits, and employed a patient simulation for students to practice their newly learned skills. The curriculum was delivered virtually over eight weeks to 36 students from ten health professions programs (occupational therapy, social work, pharmacy, audiology, speech-language pathology, dentistry, medicine, nursing, physical therapy, and physician assistants) across two universities. End-of-course feedback surveys identified that students most valued the opportunity to work with learners from different professions, practical instruction for telehealth, and a standardized patient experience. On post-course surveys students reported high self-efficacy in their telehealth competencies and indicated very positive attitudes toward interprofessional education. Overall, the compact nature of this curriculum facilitates adaptability to other student-led groups.

Characteristics of Athletic Training Students' Patient Encounters During Immersive and Nonimmersive Clinical Experiences: A Report From the Association for Athletic Training Education Research Network

Context The 2020 Standards for the Accreditation of Professional Athletic Training Programs from the Commission on Accreditation of Athletic Training Education require programs to include at least one immersive clinical experience (ICE) in their clinical education curricula. Yet, it is unknown whether ICEs provide more opportunities and benefits than nonimmersive clinical experiences (N-ICEs). The purpose of this study was to compare characteristics of patient encounters (PEs) that occurred during ICEs and N-ICEs. Design Multisite panel design. Setting Twelve professional programs (5 undergraduate, 7 graduate). Patients or Other Participants Three hundred thirty-eight athletic training students logged PEs in the E*Value system. Main Outcome Measures For each PE, students reported clinical experience type (ICE, N-ICE), clinical site type, student role (observed, assisted, performed), diagnoses reported, and procedure(s) performed. Descriptive statistics were used to summarize PE characteristics. Generalized estimating equations were used to compare student role and clinical site type during PEs in ICEs and N-ICEs (P < .05). Results A total of 10 999 PEs occurred at ICEs and 18 228 PEs occurred at N-ICEs. Sixty-four percent of ICEs and 67.2% of N-ICEs occurred at collegiate settings. Students performed 70.6% of reported PEs during ICEs, and 72% of PEs at N-ICEs. Participants averaged 0.80 ± 0.64 diagnoses and 1.35 ± 1.12 procedures per PE during ICEs, compared with 0.82 ± 0.63 diagnoses and 1.33 ± 1.04 procedures per PE during N-ICEs. No significant differences between ICEs and N-ICEs were found in either student role (P = .50) or clinical site type (P = .71). Conclusion(s) Programs may intend to use ICEs later in their curricula to demonstrate progressive clinical autonomy; however, we found no statistically significant differences in student role for ICEs versus N-ICEs. The ICEs examined in this study may have been implemented without specific objectives, which may explain the lack of characteristic differences between the clinical experience types.

Quality Delivered: How a Pandemic Fostered Innovation and Creative Solutions in Clinical Education

Background: Clinical education placements for students enrolled in healthcare programs were abruptly upended in March 2020 due to COVID-19. Programs were faced with decisions of how to mitigate substantive challenges due to an unforeseen pandemic within timeframes that would align with curricular sequences and graduation dates. Schools quickly modified curriculum formats, implemented alternative teaching and learning instruction and developed safety protocols to protect students, clinical faculty, and patients. Purpose: The aim of this study explored the strategies employed by one physical therapy school’s clinical education team, which resulted in successful completion of clinical course requirements and on-time graduation. Method: Data was collected on a single cohort of eighty (n=80) students who experienced changes in the timing, location, and/or progression of their clinical experiences due to COVID-19 related complications. The use of innovative clinically-oriented teaching strategies including web-based patient case simulation, virtual grand rounds, and other creative learning activities effectively supported student engagement both in and outside of clinical settings. Alternative learning strategies provided students the opportunity to progress through the clinical education curriculum, meet educational objectives, and satisfy the standard requirements by the Commission on Accreditation in Physical Therapy Education (CAPTE). Performance on the Clinical Performance Instrument (CPI) for the cohort of students affected by COVID-19 was compared to a cohort from 2019 who were not affected by COVID-19 related issues. Results: Analysis using Mann Whitney U statistics showed there were no significant differences in performance on the CPI between the groups (p=0.874). Conclusion: Looking forward, there is an opportunity for schools to build on what was learned during the pandemic and apply those strategies to other non-pandemic related situations with successful outcomes. Innovative teaching and learning strategies can help to bridge the gap of time out of clinic for any student who may experience an interruption in clinical education due to injury, illness, or other situation, and can provide a way for students to progress successfully through their physical therapy education.

Experience-based learning: how a crisis solution informed fundamental change in a clinical education curriculum.

Clinical education represents the most important formative period in undergraduate medical education. It is often criticised as haphazard and inefficient. Experience-based learning (ExBL) is a novel clinical education design that utilises practices of support, learner participation and real patient learning to enhance students' development of vital professional capabilities. We introduced ExBL to address the challenges of a 50% reduction in clinical placement time that arose during the COVID-19 pandemic. Final year medical students were assimilated into clinical teams as co-workers to facilitate learning through participation rather than observation. Placement education was supported by an integrated case-based learning and high-fidelity simulation program. Real patient learning in workplace contexts was supported by a network of clinician mentors. A qualitative evaluation revealed that granting students co-worker status strongly supported participatory learning and professional identity formation. Furthermore, the triangulation of placements with cognitive coaching and high-fidelity simulation greatly enhanced skills development and students' sense of readiness for practice. Utilisation of ExBL significantly enhanced the quality of informal learning on clinical placements despite the reduced clinical placement time. In addition, the integration of cognitive coaching with simulation opportunities meant students were better prepared for meaningful participation as members of clinical teams. The introduction of ExBL increased the workload of clinical teachers. Moreover, favouring learning through participatory experience reduced exposure to more traditional formal bedside teaching encounters. Despite these challenges, we have adopted an ExBL model created in a crisis as our core educational design for our final year clinical programme.

Chiropractic and osteopathic students' perceptions of readiness for transition to practice: The educational value of university clinic vs community and private clinics.

The objective was to determine final-year students' self-perceptions of readiness for transition to practice, professional identity, and experiences of interprofessional clinical practice. Findings will inform the clinical education curriculum. We used repeated measures individual case studies with a self-selecting sample from the total final-year student population at 2 chiropractic and 2 osteopathic programs offered by Australian universities. Cases were not compared. Amalgamated data are presented. There were interviews with students in 2 chiropractic programs (n = 15) and 2 osteopathic programs (n = 13). Perceptions indicate that clinical education in university health clinics prepares them for transition to practice through scaffolded supervision of their consultations with reasonably healthy patients. Students perceived that other clinics (community clinics or private practices) prepared their readiness for transition to practice substantially better. Community clinics and private practices allowed students to consult people from diverse socioeconomic and cultural backgrounds and treat complex health care issues, and the model of supervision allows students a degree of autonomy. Students lacked a clear understanding of the behaviors that demonstrate their professionalism. Interprofessional learning activities were ad hoc and opportunistic. University health clinics, private practices, and community clinics prepare students for transition to practice in different ways. Most students feel prepared. There is a clear indication that a focused discussion related to the development of students' understanding of competencies related to professionalism and another related to interprofessional clinical education in curriculum are needed.

Lived Clinical Education Experiences of Professional Master’s Athletic Training Program Graduates

Purpose: Clinical education has been identified as a key aspect in the professional preparation of athletic trainers. The literature, however, has focused on clinical education at the undergraduate level rather than the graduate level, which is the future population of all CAATE-accredited athletic training programs. This study sought to describe the experiences of those who have completed athletic training clinical education at the master’s level, specifically focusing on the type of learning experiences they were granted and what influence the preceptor and the setting played in the overall experience. Method: This was a phenomenology study. Twelve graduates of CAATE-accredited professional master’s athletic training programs served as participants. All participants graduated after Spring 2014 and completed clinical education as a degree requirement. Three methods of data collection were utilized, including semi-structured interviews, prompted journaling and asynchronous online focus group discussion boards. Data was analyzed using a phenomenological reduction approach. Credibility of the data was confirmed with member checking, peer review and data triangulation. Results: Clinical education was determined to be a significant contributor to professional preparation of professional master’s athletic training students. Hands on-experiences, active preceptors and variety in clinical setting and opportunity were all cited as contributors to the success of clinical education. Participants described their experience as a significant commitment but valuable. Conclusions: Our findings suggest that clinical education should continue to be a requirement at the graduate level and that the clinical education curriculum should be designed to encourage hands-on learning and variety.

Begin With the End in Mind: Implementing a Series of Integrated Clinical Experience Courses

Background and Purpose. The evolving nature of clinical education requires program evaluation to inform intentional curriculum development. However, descriptions of the application of curriculum development frameworks in physical therapy are sparse. We used the context/input/process/product (CIPP) model to guide a didactic and clinical education curriculum reorganization that included the creation of a series of five integrated clinical experience (ICE) courses threaded throughout the first two years of a Doctor of Physical Therapy (DPT) program. Method/Model Description and Evaluation. The CIPP model guided comprehensive program evaluation. Context evaluation summarized strengths, weaknesses, opportunities, and threats. Input evaluation of information from multiple stakeholders and external influences, including accreditation standards, practices at other academic institutions, and published literature, was used to guide changes in the clinical education curriculum. Goals, objectives, and themes were developed for intentional alignment of didactic and clinical education curricula, alongside clinical site development and logistical planning. Process evaluation monitored the implementation of the new clinical education program to identify and address problems. The program is currently in the process of detailed product evaluation. Outcomes. ICE courses were initially implemented at eight clinical sites. Course assessments were selected and administered at established intervals. Program outcome measures were identified and administered to 2 control cohorts from the original DPT curriculum, and the first cohort in the new DPT curriculum. Discussion and Conclusion. The process used a structured approach to curriculum development. It emphasized the necessity of engaging multiple stakeholders, developing strong clinical partnerships, and intentional design and placement of courses within the overall curriculum to ensure the quality of ICE courses.

Investigational Overview of Supervised Clinical Practice Experiences.

While the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) provides standards, there is variation allowed in design and implementation of supervised clinical practice experiences (SCPEs). Limited research has assessed for a correlation between SCPE design and program outcomes, including PANCE "First-Time Taker Pass Rate." The objective of this research is to evaluate for trends and best practices in clinical education design, as well as any correlation to PANCE pass rate. Data were gathered through an online survey with 14 multiple-choice questions referring to "core" clinical rotations and then anonymously tabulated. Participants were identified by ARC-PA's listing of PA programs as of May 2014, excluding those programs with "Accreditation-Provisional" or "Accreditation-Probation" statuses. Contact was initiated with one faculty member at each program. A post hoc analysis was performed to evaluate for correlations between SCPE design and PANCE pass rates. Our research quantifies variation in many aspects of the administration and design of the clinical education curriculum. During post hoc analysis, the groups were divided into "above average" and "average or below" in relation to PANCE pass rates compared with the national average, with several significant differences identified. These differences include the average length of rotation, programs that require a minimum end-of-rotation passing score, and programs that require a minimum score on the preceptor evaluation. This research demonstrated many viable options and approaches to various components of clinical education, as well as some correlations between supervised clinical practice experience (SCPE) design and PANCE first-time taker pass rates.

Clinical nurse leaders' and academics' perspectives in clinical assessment of final-year nursing students: A qualitative study.

The nature of nursing practice is diverse; therefore, clinical assessment is a complex process. This study explores the perceptions of clinical nurse leaders and academics on clinical assessment for undergraduate nursing education during transition to practice. An explorative qualitative approach was applied. Eight nurse managers, six clinical nurse educators, and eight academics from two tertiary hospitals and a university in Singapore participated in four focus group discussions. Thematic analysis was conducted. Four overriding themes were revealed: the need for a valid and reliable clinical assessment tool, preceptors' competency in clinical assessment, challenges encountered by the students in clinical assessment, and the need for close academic and clinical collaboration to support preceptors and students. Closer academic-clinical partnership is recommended to review the clinical education curriculum. Clinical and educational institutions need to work closely to design a learning program to enhance preceptors' competence in clinical pedagogy and assessment. Furthermore, a stress management program could build students' resiliency in coping with unfamiliar clinical environments. Ongoing support needs to be provided for both preceptors and students to enrich the preceptorship and learning experiences.

Antecedents and Consequences of Therapeutic Communication in Iranian Nursing Students: A Qualitative Research

In recent years, particular attention has been paid to nursing students' therapeutic communication (TC) with patients, due to a strong emphasis on patient-centered education in the Iranian healthcare reform. However, various studies have highlighted the poor communication of future nurses. Therefore, researchers have used qualitative methodology to shed light on the antecedents and consequences of nursing students' TC and promote it. We carried out a conventional content analysis using semistructured interviews with a purposefully selected sample of 18 participants, including nursing instructors, students, and patients in hospitals affiliated to Tehran University of Medical Sciences. “Communication readiness,” “predisposing factors,” and “continuity of care” were identified as the three major themes. “Communication readiness” consisted of “physical readiness,” “academic readiness,” and “developmental readiness.” “Predisposing factors” included “contextual factors” and “educational condition.” “Continuity of care” included “patient satisfaction” and “improving nursing student's motivation to communicate with patients.” “Communication readiness” and “predisposing factors” constitute the antecedents of nursing student's TC with patients, and “continuity of care” is considered as its consequence. More attention needs to be paid by the regulators to TC instruction in both theoretical and clinical educational curriculum. Furthermore, all nurses must be informed about the importance of TC in promoting patient outcomes and quality of care.

Exploring DPT Studentsʼ Perceptions of Team Function in a Collaborative Integrated Clinical Education Experience

Introduction. Integrated clinical education (ICE), defined as clinical learning experiences embedded within the didactic portion of a DPT curriculum, is an integral component of an overall clinical education curriculum. The collaborative supervisory model has been applied to ICE experiences in DPT curricula. Two physical therapist (PT) education programs developed similar ICE experiences incorporating the collaborative model as a component of their clinical education curricula. Benefits for student learning have been described in the literature for both of these models—in isolation, but not combined. The purpose of this study was to determine factors that students felt contributed to successful team function in a collaborative ICE experience. Review of Literature. ICE can provide opportunities for students to develop knowledge, skill, and professional behaviors in preparation for full-time and final clinical experiences. There is a great deal of literature that supports the collaborative model of clinical education to facilitate teamwork and collaboration, deeper level of critical thinking and problem solving, and enhanced clinical competence. Despite the benefits of including ICE in a DPT curriculum, as well as the benefits of the collaborative model of clinical education, the physical therapy literature does not describe factors leading to successful team function when these 2 models of CE are combined. Methods and Subjects. Subjects were 51 PT student teams (3 to 4 people each) from Duke University (2 cohorts) and the University of Colorado (1 cohort) who participated in a collaborative ICE experience. Following their first 2 weeks of ICE, student teams were instructed to create a mind map that depicted how their team functioned together in the clinic. Teams utilized an online mapping tool, “Coggle It,” to complete the mapping. The research team employed incident coding processes established in the literature to code the primary concepts of the team mind maps. Chi Square analysis was used to determine numeric differences across all codes among the 3 student team cohorts. Results. Twenty-four distinct codes were assigned to the primary concepts. Chi Square analysis revealed no significant differences between the 3 cohorts (P > .01) across all codes. More than 50% of teams indicated that “group dynamics” and “team communication” were vital to the effective functioning of their team in the clinic. More than 25% of the teams included “individual student qualities,” “the learning environment,” “practicing skills,” “the instructor's teaching strategies,” “adult learner characteristics,” and the “clinical instructor” of key importance. From the data, 4 themes emerged as being important for effective collaborative learning in an ICE: The Team, the Clinical Environment, the Individual Student, and the Clinical Instructor. Discussion and Conclusion. The 4 themes identified in this study contribute to the literature surrounding student learning in clinical education, specifically a collaborative ICE experience. This study suggests that these characteristics are important for positive experiences and should be factors that are considered by both academic programs and clinical instructors when designing, implementing, and teaching in a collaborative ICE experience.

Effect of Clinical Experience on Comprehensive Examination Performance in a Physical Therapist Education Program

BACKGROUND AND PURPOSEClinical education is an integral component of physical therapist (PT) education programs. Among accredited PT education programs in the United States in 2013, the average length of the professional program is 122 weeks (range 75-180 weeks), with 35.9 weeks (range 23-60 weeks) dedicated to fulltime clinical education experiences (CEEs).1 While clinical education curriculum is required for accreditation, the Commission on Accreditation in Physical Therapy Education (CAPTE),2 the accrediting body for PT education programs, does not prescribe the focus of CEEs. CAPTE does, however, expect experiences to be representative of common physical therapy practice areas and patient populations. Guidelines for curriculum development3 indicate PT students should experience a variety of CEEs to achieve program outcomes; however, PT education programs are free to determine what focus of CEEs are best for the program and the students.During CEEs, PT students provide services to patients under the guidance of experienced clinicians. Such experiential learning allows students to utilize and integrate knowledge and skills gained during the didactic portion of the program in the clinical setting.2,3 During these experiences, didactic concepts are continually recognized and reevaluated.4 This is essential for the development of competent professional practitioners.5A variety of CEEs are thought to give PT students the opportunity to apply concepts learned during the didactic portion of the curriculum in the clinical environment. Wetherbee et al6 reported clinicians favored a variety of CEEs as compared to students and clinical coordinators. Students supported interest over depth, while clinical coordinators stressed efficiency and feasibility in scheduling of CEEs. Securing a variety of CEEs is increasingly a challenge for program administrators, with a reported 21.8% of programs adjusting requirements for a specific focus of CEEs in 2012-2013.1 A changing health care environment, staffing changes, increased productivity standards, and increased need for student placements are all potential constraints on the educational opportunities offered by clinical partners to these PT education programs.7There is a lack of research to support the notion that a variety of experiences increase a student's knowledge and potential success within the professional program and subsequently in entry-level practice. Multiple measures are used by PT education programs to assess student success and learning. A common measure of success important for PT education programs is the outcome of cognitive knowledge-based examinations such as the National Physical Therapy Examination (NPTE) or written comprehensive examinations.6,8-16 Traditionally, didactic learning outcomes in graduate and professional programs have been measured by high-stakes written examinations.17-19 Subject-level examinations emphasize narrow content area and evaluate focused cognitive knowledge. Comprehensive examinations focus on the specific discipline curriculum. Licensure preparation examinations are similar to comprehensive examinations but focus on content and strategies for passing standardized licensure examinations. Licensure examinations reflect a broad-based content previously determined as necessary to practice the profession and are characterized by strong validity and security of the content.20 Subject level examinations, comprehensive, and licensure preparation examinations are commercially available or faculty-developed, while access to licensure examinations is often regulated by governmental agencies.NPTE results are used for benchmarking by stakeholder groups. No standardized subject matter exams or comprehensive content exams are available to PT education programs based on a review of the websites of the major commercial licensure examination preparation companies.21,22 Commercially available licensure preparation examinations are available, but the exams do not make available to PT education programs individual item reliability and validity data, nor sample comparison data. …

Clinical incidents involving students on placement: an analysis of incident reports to identify potential risk factors

BackgroundStudents are sometimes involved in incidents during clinical training. To the authors’ knowledge, no quantitative studies of incidents specifically involving physiotherapy students on clinical placement are available in the literature. MethodsA retrospective audit (2008 to 2011) of incident reports involving physiotherapy students was conducted to identify the nature and features of incidents. The study aimed to determine if injuries to a student or patient were more or less likely when the supervisor was in close proximity, and whether students with lower academic performance in their preclinical semester were more likely to be involved in an incident. ResultsThere were 19 care-delivery-related and three equipment-related incidents. There were no incidents of violent, aggressive or demeaning behaviour towards students. The incident rate was 9.0/100,000 student-hours for third-year students and 6.8/100,000 student-hours for fourth-year students. The majority of incidents (55%) occurred from 11am to 12-noon and from 3pm to 3.30pm. Incidents more often resulted in patient or student injury when the supervisor was not in close proximity (approximately 50% vs approximately 20%), although the difference was not significant (P=0.336). The academic results of students involved in incidents were equivalent to the whole cohort in their preclinical semester {mean 75 [standard deviation (SD) 6] vs 76 (SD 7); P=0.488}. ConclusionsThe unexpected temporal clustering of incidents warrants further investigation. Student fatigue may warrant attention as a potential contributor; however, contextual factors, such as staff workload, along with organisational systems, structures and procedures may be more relevant. The potential relationship between supervisor proximity and injury also warrants further exploration. The findings of the present study should be integrated into clinical education curricula and communicated to clinical educators.

How Do We Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes

BACKGROUND AND PURPOSEThe imperative of clinical education in health professions is development of students' knowledge, skills, and behaviors essential to competence as new professionals. The current state of clinical education in physical therapist (PT) education programs across the United States reflects disparate approaches to meeting this imperative. The relatively few similarities in clinical education curricula are determined by the criteria for accreditation, which state that the curriculum includes content and learning experiences designed to prepare students to achieve educational outcomes required for initial practice.1(p31) The criteria also require clinical education experiences (CEEs) that allow students to manage patients/clients in various practice settings, across the lifespan and continuum of care; to participate in interdisciplinary care; and to engage in other experiences that lead to the achievement of expected student outcomes.1 Being rather broad and nonprescriptive, these criteria allow a wide variety of models for clinical education. The variation may not be advantageous or appropriate given the high stakes for students, cost to all stakeholders, and increasing demand on clinical sites as the number of academic programs and students grows. Data collated by the Commission on Accreditation in Physical Therapy Education (CAPTE) for 2012-2013 show that 45% of students' total education time is spent in CEEs,2 suggesting the importance of its influence on student outcomes and the need to ensure that this vital component of curricula is of the highest quality.This position paper (1) provides a brief overview of the challenges associated with physical therapist clinical education models, (2) briefly compares components of those models to those of other health professions, and (3) recommends steps toward decreasing variation and improving quality.FrameworkDonabedian's3 classic conceptual framework for examining health care quality seems to be appropriate for considering the issue of quality in clinical education. This framework proposes 3 components of quality (see Figure).* Structures. These are the physical and organizational aspects of clinical education settings (eg, types of settings, personnel, and finances supporting clinical education).* Processes. Processes rely on the structures to provide resources and mechanisms for participants to engage in effective educational activities. Processes in clinical education include student supervision, evaluation mechanisms, and administrative procedures.* Outcomes. Students' clinical performance is the most commonly measured outcome of CEEs; however, stakeholder satisfaction, cost of providing CEEs to students, and the benefits to clinical education faculty might also be considered.Before quality of clinical education can be assessed, it needs to be defined. Because perceptions of the quality of clinical education vary based on the myriad values and goals espoused by PT education programs and clinical education sites, it is difficult to define. The Donabedian model assists in framing this definition. For example, the model suggests that students' clinical performance or other measures of outcome, although important, may be limited as measures of quality. The structures and processes of clinical education as components of quality might be equally important based on an assumption, for example, that students' experiences must be appropriate in scope and depth, with suitable expectations for demonstration of competency.There are limitations to examining clinical education quality using this framework. When evaluating processes, judgments must be made about appropriateness, completeness, coordination, and continuity of CEEs. These judgments are based on values and standards that are sometimes implicit and perhaps not thoroughly examined for biases. Measurement of the processes of clinical education may be difficult due to both lack of agreement as to what processes to measure and lack of reliable measurement tools. …

The Change of Basic and Postgraduate Medical Education after Intern Training System Dismantling

This study aimed to review the expected changes in the medical educational environment and to evaluate approaches to coping with the abolition of the postgraduate intern training system. It is expected that after the intern training system is dismantled, postgraduate medical students will be deprived of the opportunity to practice opportunity for clinical practice and to inquire into their medical specialization. Therefore, major improvements in the clinical education curriculum must be made so that students can do so through the clinical education program. Offering students the opportunity to perform clinical practice through the clinical education program might require a revision in the laws and regulations on clinical education as well as the standardization of the clinical education curriculum in line with international practices. Reform measures to provide students the opportunity to inquire their specializations might be the introduction of a medical curriculum containing diverse fields and the establishment of a matching program to assign medical students to their residency programs after medical school. Finally, the fact that the basic concern of postgraduate medical education is the cultivation of primary care physicians must not be forgotten even after the dismantling of the postgraduate intern training system.

Outcomes Assessment of Dental Hygiene Clinical Teaching Workshops

Faculty development courses related to acquiring clinical teaching skills in the health professions are limited. Consequently, the Department of Dental Hygiene at the University of Texas Health Science Center at San Antonio conducted a series of clinical teaching workshops to address clinical teaching methodology. The goal of these workshops was to promote a problem-solving learning atmosphere for dental hygiene faculty to acquire and share sound clinical teaching strategies. To determine the value of the annual workshops on clinical teaching and evaluation, a web-based qualitative program assessment was developed using software by Survey Tracker. Four open-ended questions were designed to elicit perceptions regarding what significant changes in teaching strategies were achieved, what barriers or challenges were encountered in making these changes, and what strategies were used to overcome the barriers. The assessment was sent to dental hygiene educators representing thirty-eight dental hygiene programs who had participated in two or more of these workshops. Twenty-eight programs provided collective responses to the questions, and the narrative data were analyzed, using a qualitative methodology. Responses revealed that programs had made productive changes to their clinical education curricula and the information gained from the workshops had a positive effect on clinical teaching.

From Random Access Opportunity to a Clinical Education Curriculum

The purpose of the clinical education curriculum is to improve student achievement of course competencies through the creation of structured learning experiences that are scaffolded to the curriculum and the level of the student; to ease the strain of clinical education on the clinical agencies; and to ease the transition of the student role to that of the professional nurse. As educators, we realize that we can no longer rely on random access opportunity for the development of practice skills. We must structure our clinical education, like we structure our course content, to be appropriate to the learning outcomes and the developmental level of the student. Several of the OCNE learning models are currently being developed and evaluated as OCNE pilot projects. As the curriculum is implemented, OCNE will continue to evaluate the effectiveness of the learning models and the combined effect of the integrated curriculum of achievement of the goals of the program.