My Patients Were Assigned to a Student
Because I work in a teaching hospital, my department frequently serves as a clinical education site. At any given time we could have a PT, PTA, OT or COTA student completing a rotation. Currently we have a PTA student. I am not her CI but I have observed her to be an average student. She is on our unit to get experience working with neurologic patients, particularly strokes. Since the last few patients I've evaluated have been assigned to her, I began to consider the value of experience.
I have many years of experience and specialize in stroke patients. As a rule, my stroke patients are able to ambulate at discharge. Both of the patients I recently passed to the student were strokes. I knew exactly what to do and how to do it to achieve safe gait. I knew I could get them to walk. Instead they have a student working with them. It is her third rotation and she has a supervising therapist, so a certain level of competency is expected. Still, there is a giant gap between our skills levels and that will be reflected in the treatments the patients receive.
I'm not being negative about students. Everyone was a student. Students need to come into the clinics to master the techniques they've been taught. There are pros and cons associated with this. Generally those patients get more one-on-one time. The treatments are well planned out. They get the benefit of both the student's and the CI's knowledge. But students don't have the skills of an experienced therapist. It can take longer to achieve goals. Treatment performance is less refined. They usually don't catch the nuances a more experienced therapist would.
As a result, I started wondering how fair it was for my two patients to be treated by a student with a CI other than myself. I'm not saying the other CI is a bad therapist. She is very skilled. Her patients tend to do well. But she does things differently than I do. Sometimes I disagree with her decisions, particularly about orthotics and gait training. I have evidence to support what I do. She doesn't. She does the things that have been working for her.
There are so many tangents calling to me. But it boils down to whether or not the patient is getting the same level of care as I would have provided. I think they're getting good care but not at the level I would have provided. Is that ethical? Is it fair? We know there is a difference in skill level and knowledge prior to assigning the patients to the student. We know her CI and I do things differently. Obviously the patient is still getting good therapy but is the trade off worth the potential difference in outcomes?
That same question can be raised about experienced therapists. A therapist with a lot of experience in one area is going to do better with those patients than someone with less experience. However, generally patients are assigned based on caseload level rather specific skill level. Is that ethical and fair to a patient? Does it really make that big of a difference? I'm not sure. Research shows quicker improvement when therapy is initiated early for stroke patients. By one year post-stroke, functional levels are similar. This is true with other diagnoses, particularly total joint replacements. Does that mean skill level doesn't matter since it balances out at the end? Again, I don't know.
Therapists tend to agree that skill level is important. I think so. There is something to be said for quicker recoveries, shorter overall duration of therapy and being able to go home with families sooner. This would be an interesting research topic but I'm not sure how you could manipulate the independent variable, much less measure it.