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Guest Post: Evidence-based Clinical Education: A New Vision

By:  Jimmy Pajuheshfar, PT, DPT

2012 Rocky Mountain University Graduate

As a recent graduate, I wanted to write about something I feel needs to be addressed in how we educate our future professionals. Recent advancements in physical therapy research have helped place physical therapists on the forefront as the “movement experts” in healthcare. This has helped unlock doors to direct access and other career expanding opportunities as our healthcare system continues to evolve. With these increased opportunities comes a great responsibility to not only become lifelong learners ourselves but also to educate the future of our profession, a large portion of which are today’s DPT students.

In light of our rapidly growing roles in the healthcare system, it has never been more important that DPT programs pursue the most effective learning strategies in both the didactic and clinical education settings to optimally prepare students to reach and exceed their potential. I’ve had the opportunity to meet students from across the country, and unfortunately frequently hear criticism about the current clinical education model in particular. When a student says, “My clinical is so easy” or “My CI doesn’t really challenge me,” it should raise a red flag. The clinical experience is our time to absorb, to grow, and to be challenged. The internship phase isn’t when we’re supposed to get a break from the rigors of the classroom, but is a time for applying knowledge learned in the classroom. So what will it take to get the best clinical experiences possible, and how can we get it? Where can we find it? How do we know it when we see it? Unfortunately, we don’t know until it’s too late. What we need is a new age in physical therapy clinical education where we don’t have to blindly choose a clinical experience with the hopes that we learn enough to be competent and pass the licensure exam. In my humble opinion, as a debt ridden graduate student, is it too much to ask that our tuition dollars should afford us more than blind faith when it comes to clinical education?

Recent advancements in our understanding of new clinical standards of care in physical therapy, the results of which improve patient outcomes, reduce costs, minimize chronicity, and ultimately result in happier patients with an improved quality of life. Manual therapy, for example, is just a single example of a powerful group of interventions that has taken our profession to a higher level.  As a physical therapy student, I fortunately had the opportunity to attend a program where evidence-based practice was the core of our curriculum. As the time neared for me to start my clinical rotations, I was eager to start putting what I had read and internalized into hands-on practice.

Six months ago I completed what I think could be the future of clinical education. I was lucky to be part of a “new” internship model as part of Evidence in Motion’s Clinical Education Network (CEN). This model will continue to evolve into the future, but I really appreciated specific elements, which make me wonder “why aren’t we doing something like this already?” The CEN model created an opportunity for me to be engaged in a structured, organized network of evidence-based instructors and students. This group learning environment really challenged me to learn the fundamentals and foundational skills that every entry-level PT should know how to do very well. The structure of the experience tracked my progress to ensure that I was actually learning what is important for me to be an evidence-based clinician and pass the board exam. 

Some things I think are very important for the future of PT clinical education is having a connection between the didactic phase and clinical phase. Right now, other students aren’t well connected to their academic program once they leave the classroom. They are left to hope their one clinical instructor shares with them this essential knowledge. Outside of an informal phone call or the burdensome Clinical Performance Instrument (CPI), nothing currently exists to connect the two parties and ensure a quality experience is taking place. Why not? Why can’t these partnerships be improved? Similarly, why isn’t there a plan out there for us to follow while we are trying to “soak it all up” in the clinic? Are we really supposed to leave it by chance that we experience most of what will be on the board exam, or most what we will be expected to cover, and bill for in a professional setting once we are licensed?

My job right now as a physical therapist comes with many challenges. I am expected to know A LOT of information and be able to implement that information in a short amount of time working with a diverse group of patients. If I was left to guess during my clinical experiences as to what was important, or leave it to some other “qualified” clinician to teach me, I can’t imagine how much more difficult my job would be, and I would feel very badly for my patients who I care about very much. I would probably still be doing ultrasound and other completely ineffective treatments for my patients, and billing for them. Perhaps it is time we come up with a system where everyone works together in a collaborative setting so more students are able to engage with the “best” clinical instructors our great profession has to offer. Right now, according to CAPTE’s website, there are 214 existing DPT programs, and already 25 developing programs. Where are these students going to learn once they finish in the classroom? Are we going to be proud of these clinicians and actually want to work alongside them as PTs? 

So to summarize my frustrations and recommendations, I propose a new way of thinking for clinical education. Let’s take a step back and realize how inconsistent our current methods of teaching really are. Let’s realize how unprepared some of our students, and so called “Doctors of Physical Therapy” really are coming out of school and clinical education programs. Now, let’s work together and actually do something about it.

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4 replies »

  1. Dear Joseph, I was lucky enough to attend the University of Coventry to study my BSc in PT. Although most other UK universities serperated academic and clinical practise ( when I graduated in 2009) Coventry has created a syllabus to merge the two. Throughout our clinical placements we were given a mark of which 50% reflected our clinical performance but 50% on our clinical reasoning and EBP. At the end of each placement an academic tutors and clinical educator attended the placement to complete the clinical reasoning VIVA examination. Students presented 2 case studies of patients we had seen throughout each placement .
    No other university in the UK used this style of clinical placment marking , however from speaking to professional after graduation they praised Coventry student on there ability to use EBP in the clinical setting. I agree that to move the profession forwards other academic estabilishments should consider employing a simular stratergy.

  2. Jimmy,
    Great vision and post here! I am all open arms to this movement. I am a big component of clinical education and have had horror stories from students that have come to me from past clinicals (and even future ones through emails back).

    I just got on my soap box on a post on my site yesterday: http://www.intouchpt.wordpress.com

    Question remains, other than CEN, how can we improve clinical education ???

    Hv

  3. Great Post….Jimmy you show excellent insight into a solution. This is definitely a component of education that needs to evolve. As we Move Forward PT this actually HAS to change.

    As a PT of 22 years I have found myself over the past years “helping” students find Internships that will do exactly what you have addressed.
    Unfortunately, as I have seen students ASK for these settings and wanting to be challenged, the schools have been the biggest roadblock! This has happened on more than one occasion. So, how much should I continue to help if the programs are gonna push back.

    I bring this up because as we move forward we have to get to the Core of how and where to change this. I will assume there is not a student in the Country who is opposed to this idea.

  4. Great Post! I’m all for growing our profession any way possible. It’s obvious that clinical instruction makes a profound impact on interns (and can do so in both positive and negative ways).

    One of my big irritations is when I hear of CIs who shut down an interns idea for evidence based treatments. For example, thoracic spinal thrusts for cervical neck pain. I’ve hear of CIs who don’t feel comfortable doing them and therefore skip even though the interns know. That undermines our profession as when that student is out in the real world are they going to perform the thrusts then?

    I agree more interaction is needed to Move Forward!

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