Clinical Education Model: Revisited

I must say that the few readers of this blog have impressed me with their incite regarding the state of the current clinical education model across the country as a whole. There's a lot of strong feelings about clinical education and this has been known, the bruise has just been irritated. As a current student, it is easy to state the imperfections. It is a whole other beast to come up with solutions. The solutions are difficult to implement because they must attempt to create a win-win situation for students, clinical sites, academic institutions, and most importantly the patients. I'll begin by stating that I don't believe any one component of clinical education is to blame, I believe that the current Doctor of Physical Therapy clinical education model is just a longer version of the Bachelor's of Physical Therapy model. Additionally I want to make a clear distinction between PT students and PT interns. PT interns are technically students, but are participating in their longer, final affiliations preparing to "enter the work-force." PT students are everything before being an intern, they are doing class and shorter affiliations.

The Orthopaedic updates course offered by U. of Colorado Denver is great start because Paul Mintken and Tim Noteboom are correct that we shouldn't "come down" on the CI's that are graciously giving up productivity time to interns. Torey Gilbertson brings up great points from a CI/CCCE perspective:

Speaking from the CI side of things, some of us are very interested in taking students, but there are many who are assigned students against their will and desire. This is the main problem as I see it. CI's need to want to be instructors...As my clinic's CCCE I have a hard time accepting commitments to take students that I can't be the primary CI for. I am surrounded by several absolutely fabulous clinicians and can learn a lot from simply watching them work. But none of them are interested in taking students for an extended time and I don't want a student's experience to suffer because of this. Part of this is because of the extra work it takes to have a student (and please don't ever think that it's not extra work to take a student, if you spend any time with that student). The other part is because they are clinicians and neither see themselves as clinical instructors, nor have a desire to teach people other than the clients and families they work with.

Interns should not be assigned to CI's that don't want to be CI's, period. This is neither productive nor desirable for all parties involved; essentially it is a lose-lose situation. The Clinical Instructor certification is a positive move on the APTA to potentially thwart the aforementioned lose-lose situation; The assumption being credentialed CI's want to be CI's. John Duffy from PTupdate (love your website BTW) is entitled to his opinion about potential lack of utility of CI credentialing because it is truly not an end-all be-all solution, but I'm sure a few non-credentialed one-in-a-million CI's such as yourself is OK. John Duffy also expressed his dis-content with taking interns that resemble the apathy exhibited by a large percentage our PT colleagues; I can make assumptions to where your 8 out of 10 interns have learned this apathetic behavior from.

The current model HAS produced some of our professions greatest minds. Why change it? This is also a valid point that Roderick Henderson makes and he has posted about it on his blog (check it out-great stuff). While I agree that the go-getter will benefit from the current model and seek the great opportunities, I myself sought out the best clinical education opportunity that I posted about while spending my last night in Texas. Although I do argue that the current model does lend itself to create more apathetic PT's which ultimately limits the profession. Additionally MOST of us think that the model is due for a change, including the APTA.

So...back to the creating a win-win situation for all. The following are just thoughts and are fully available for scrutinization. Instead of PT institutions having 200+ clinical sites, have just a few available for the longer internships. The school and clinical sites will work closely with each other. The clinics take on 4+ interns at a time; 1 good CI, 4+ interns. Understandably, this may sound impossible from financial and feasible standpoint on the clinic at first, but delve a little deeper and it could be very beneficial for the clinic. Interns work in pairs initially with the CI and the CI's productivity does and will "take a hit" initially. In no time really the CI is then supervising 4 interns each with their own caseload, and the CI is not consumed with seeing their own patients but rather mentoring and supervising. All the while the CI's productivity is climbing the ranks and soon potentially reaching 300%, maybe more. Yes, I know there are MediCare limitations and getting enough patients through the door could be difficult; Once again I'm just spit-balling thoughts that truly are in their infancy. Additionally the interns benefit from critically thinking through each other and their CI; also the interns aren't being taught how to model the apathetic PT. The potential for the clinic to benefit is possible. The academic institution benefits from knowing their didactic structure is being followed up with a structured clinical. The patients benefit because they are getting high quality PT that is supervised by a high quality PT (CI), rather than the patient getting seen by an aspiring PT intern while the apathetic CI is managing their own caseload. I know of one institution already implementing such a model.

That is the basic gist of a thought to create the win-win situation without completely remodeling the system. It's not perfect, but it's a start. Thoughts? Fire-away!