Clinical Education Challenges and Strategies March 28, 2004 Presented by: Paul A.W. Gamble DrPH President & CEO

Why are we here? Clinical placement and education is a national concern There are solutions and innovations Research needs to be shared We can learn from each other

Concerns and Challenges “Although the allied health professions represent a multitude of therapeutic, diagnostic, and preventative areas of health care – their practice and education have common elements including the dependence on Clinical Education.”

Historical Context Allied health professionals emerged as a sub division of medical labour beginning in the early 20 th century By the late 1920s various allied assistants/ technicians were established under the direction of a physician By the late 1940s clinical laboratory techniques, and patient testing were firmly established in hospitals as part of the practice of medicine In the 1950’s and 1960’s the exponential growth in medical knowledge created the need for well defined and more academically organized technology and clinical educational programmes

Historical Context (con’t) What had begun as an on the job training program with the addition of formal lectures soon became organized curricula delivered by educational institutions By the late 1970s and ’80s a number of the allied health professions saw their education beginning delivered by degree granting institutions Most recently we have seen the evolution of Masters level preparation for some allied healths

Realities The role (of allied health professionals) is critical and meaningful because allied health practitioners make up almost a majority of the health care workforce. “The allied health graduates of the future must posses critical thinking, decision making, interpersonal and information technology skills”

Challenges “The access to appropriate clinical education sites must be addressed to assure the continued quality of education for allied health professions” “Major reports on health care reform call for clinical education” The interpretation of Critical Criterion 2.9 of CMA’s Requirements for Accreditation states “The program provides a clinical placement for each student who successfully completes the requirements for entry to the clinical phase of the program” Requirements for Accreditation; CMA 2003

Clinical Education Objectives 1: Achievement of Clinical Competence The principle purpose of clinical education is to provide the student with the opportunity to apply his/her learning to acquire a satisfactory level of clinical competence and to gain confidence through supervised clinical experience. 2: Graded Clinical Responsibility Clinical education should be structured to allow the student to progress through a series of well-designed levels of graded responsibility, which progress from the level of "observation only" to the level of "supervised independent practice."

Clinical Education Objectives (cont’d) 3: Development of Professional Behaviours Opportunities must be provided for the student to acquire an understanding of the obligations and privileges accompanying registration as a health science professional. The emphasis on the graduate's obligations to the regulatory colleges and professional societies and their responsibility to the public and the employer. 4: Development of a Commitment to Ongoing Continuing Education New graduates should enter practice with the sense that they have only begun to experience the opportunities available in their chosen field. Providing the student with a clinical education experience that is consistently challenging is the first step in developing a commitment to life-long learning.

Reality Check “Clinical sites have done a fabulous job educating our students. Since allied health is very different from medicine and nursing, it is the clinical sites that tend to absorb the cost of our students. And we’ve sent them in as totally green individuals and said “now, you’re going to make good allied health practitioners”, and they have done it, with willingness and their own time.”

Reality Check Benefits: Recruitment of former students / less orientation Recruitment and retention of clinical staff who enjoy teaching Rewards for involved clinical staff Improved quality of patient care due to  scholarly atmosphere  additional people to assist with patient care Education of future health care professionals is a public good  those who benefit by having trained workers should participate in their education

For our Clinical Partners: Emphasis on eliminating non – essential activities Education is perceived as a cost – it uses resources –People –Supplies –Facilities Issues Increasingly the question is now – “Who is going to pay for this model of education??

For Academic Programs: –The absolute number of clinical partners and clinical placements within partners is declining –Increasing competition between academic institutions for securing clinical placements –Clinical “log jams” resulting –Clinical placements in small and/or rural settings may present limitations –Increasing pressure for inclusion of “non traditional” clinical sites Results

Higher Clinical Productivity and Different Sites of Care Higher Clinical Productivity Different Sites of Care Reduces availability of sites Clients expectation different Reduces time to educate students Space issues Reduces time on formal evaluation More training More Contracts Johnson, L., Pioneering Allied Health Clinical Education Reform: A National Consensus Conference: US Department of Health and Human Services, 1999.

So What does the Future Hold? Allied Health Professionals will continue to make a significant contribution to health care Clinical education and clinical skill acquisition will remain an essential component of allied health education However new and innovative responses to this clinical education component must evolve to address the realities of the industry

So What does the Future Hold? Some of the “systemic” suggested solutions include: 1.Clinical education more of a capstone than basic education 2.More student self evaluation signed by preceptor – Can it happen? 3.More simulated learning 4.More clinical competency testing at academic site

So What does the Future Hold? 5.Creating more independent learners 6.Designing shared simulations across disciplines and where practical across schools 7.Using computer technology and testing for skill development 8.Advocate for and work to ensure clinical education is “awarded” credit in any PLA exercise

So What does the Future Hold? At the “local” level there are also things that can be done: 1.Replace inter academic institution “competition” for clinical sites with a co-operative co-ordinated approach modeled on the JPPC 2.Recognize the academic contribution of clinical teaching by awarding status only appointments 3.Recognize clinical teaching excellence through awards

The Future is Now! In summary my main points are: 1.Envision the future and find solutions – don’t settle for status quo 2.Determine how technology can be used to enhance teaching teams, not solo professions, and how such teaching can be done in a variety of sites 3.Design your clinical activities in a manner that your clinical partners will value, provide students they will value (and ultimately wish to hire), and promote quality education