Preparing Students For Clinical Practice: Does the Current CI Model Work?
Clinical education for physical therapy is getting much scrutiny recently from both educators and the employers who hire newly minted graduates following their clinical instruction (CI).
In the opinion of those in the practice community, these new grads do not have the required skills to serve full caseloads in the clinical environment. The opinion of some others is that what students are learning, and how they are learning, in their clinical affiliations doesn't adequately mirror what they will encounter in the clinic setting.
Many PT educators and CA providers do agree that change is needed, and quickly, but can the current model of clinical education be changed for the better, or is an entirely new model needed in order to prepare students for practice under the goals of Vision 2020?
The 2008 Rothstein Debate asked those questions and more, as Larry N. Benz, DPT, MBA, ECS, OCS, with the Kentucky Orthopedic Rehab Team in Louisville, and Michael J. Emery, EdD, PT, FAPTA, of Sacred Heart University in Fairfield, CT (pictured below).
Dr. Emery held the supporting position of the main debate question: Does the Current Model of Clinical Education Really Prepare Students for Practice? "It's hard to just argue for the status quo when we really do need changes," he admitted. "We don't have a model of differing lengths of instruction, for one. There are really three defining characteristics of our current model: 1) a divided locus of control; 2) simulations of practice, ideally to introduce students to a higher level of practice while they are not practicing, and 3) a student apprenticeship that both allows variability but also is fixed."
Dr. Benz said he wished that he could say that the clinical model now practiced "fits perfectly. But I have to say it is completely broken."
Dr. Emery argued that the outcomes support keeping the clinical education model-but that addressing its execution is needed. "The first-time pass rates on exams are going up despite these clinical problems, and 99.6 percent of new graduates still report getting a job within a month of graduating," he said. "The CI system has absorbed the enormous capacity of graduates to fill all the needed positions. So is the execution of the program done properly, or is the model broken entirely? Do we really need an entire replacement strategy?" Dr. Emery advocated reviewing the preparedness of CI instructors and how well CI programs fill their CI instructor slots. "Before we throw it out entirely we need to compare this model to any other new ideas," he said.
But Dr. Benz said pass rates don't necessarily reflect preparedness on the part of students following their CI. "Employers still report a disconnect between what [students learn] in CI than what they see from them working in a clinic. The model turns CI students around in a very short amount of time. Often, clinics facing staff shortages and declining reimbursement take these students on for CI merely to pump their own recruitment."
Both panelists agreed that what drives any model of clinical instruction planning should not be how clinics are reimbursed for students' work in the clinic.