Clinical Education Models

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Introduction

The clinical education of the healthcare professionals prepare them to work effectively in healthcare environment. The development process of the clinical education program can be a complex task and requires good assessment of the resources available to conduct and support these programs. Clinical education models may focus on students' early exposure to clinical context, when others wait until the students complete their full academic curriculum. There are clinical eduction models that emphasis the individual learner knowledge and abilities or "collective competence" where individual's competence depends on share knowledge and teamwork. This article provides an overview of various clinical education models and the stakeholders’ responsibilities in maintain and conducting these models.

Key Stakeholders of Clinical Education

All the stakeholders play a key role in a successful clinical education experience. The academic institution and the clinical healthcare education healthcare site provide the foundation for the academic clinical education coordinator, clinical instructor, and student to unite and provide a clinical experience that meets the required competencies for the student to progress towards completing academic requirements and progressing into clinical practice. When in the student’s progression the clinical experience occurs varies across professions and degree programs.

Academic Institution

The role of the academic institution in clinical education include the following:

• establishes the curriculum for the students to meet entry level practice competencies and accreditation standards
  • curriculum sequence determines the timing of the clinical education experiences for appropriate placements to apply theory to practice
• provides program member that serves as the academic clinical education coordinator.

Clinical Education Healthcare Site

identifies and provides the academic institution placement opportunities for the students to complete their clinical education training. The site sets the standards for placement requirements such as trainings the students must have prior to their clinical education training. These may include CPR, first aid, immunizations, and other regulated requirements to practice in a healthcare facility. The site provides the clinical instructor and ensures that they meet the criteria to clinically educate students in their area of expertise. Finally, the site needs an established plan to welcome and orient the students as well as a program to ensure that the objectives of the experience are met. The establishment of a clinical education plan and manual will be discussed in other courses.

The clinical education healthcare site and the academic institution must collaborate on shared responsibilities. These shared responsibilities include an affiliation agreement, orientation procedures, and procedures for accident/injury that may occur during the experience. The affiliation agreement is a legal document that includes the scope of the clinical education experience and liability protections.

The Academic Clinical Education Coordinator (ACEC)

that is assigned by the academic institution is responsible for ensuring these shared responsibilities are complete. This person is the link between the academic institution and the clinical education healthcare site. Thus, bridging the student together with the clinical instructor. They communicate with the clinical instructor via phone call or email to make sure they are informed of the placement details and have the required resources for a successful student placement. They may also visit the healthcare site to confirm the site is an appropriate learning environment. The academic clinical education coordinator verifies that the student has completed required courses and orientation to meet the objectives of the placement and the requirements to pass the clinical education placement.

Site Coordinator of Clinical Education

This person is responsible for the administration and management of the clinical instructors at the site and provides additional oversight of learning activities for students during their clinical experiences. The site coordinator selects clinical instructors and ensures they are ready to educate students. They work with the clinical instructor and student through a supervisory role and participate in communication with the academic institutions. In the absence of a site coordinator of clinical education, the complete responsibilities of the clinical training fall on the clinical instructor with assistance from site administration.

Clinical Instructor

chosen by the clinical education healthcare site to teach and mentor the student during their clinical education experience. The clinical instructor or CI is responsible for supporting the student’s success by creating a learning environment that meets the objectives of the experience. The CI provides patient interactions in the placement specialty, assigns the student responsibilities, and provides constructive feedback. The CI is responsible for completing the student’s evaluation and a final recommendation for pass/fail based on the placement objectives. Beyond the responsibility for the student, the CI is also accountable for any risks that may arise with a student placement including patient safety. If any concerns arise during a student’s clinical education experience, the CI will be supported by the healthcare facility. The concerns will be communicated back to the academic clinical education coordinator. The CI and coordinator will collaborate to address the issues with the student performance or ability to meet objectives.

Student

Clinical education experiences are established for the student. The student qualifies for the experience by meeting the academic course objectives and requirements to begin learning in the healthcare facility. It is the responsibility of the student to complete all required orientation materials tasked to them by the healthcare facility. When it comes time to begin the experience the student should demonstrate professional skills by arriving on time, engaging in communication, following the facility requirements, and taking initiative for their learning. Clinical education experiences may be challenging and a new style of learning for the student. The student must take care of themselves to ensure they stay healthy physically and mentally.

Clinical Education Models

A one size fits all clinical education model is not feasible across all rehabilitation professions. Factors on the use of a clinical education model depends on the profession, location of the clinical education, accessibility of clinical instructors, regulation of clinical education, and/or level of clinical education experience. Commonly, no matter the model, the objective is to develop the student into a competent clinician that is confident in their knowledge and skills.

The length of a clinical placement varies across professions and globally. There is no consistent standard for length of a clinical education training. As an example, in the United States, the minimum requirements for medicine is 2 years, physical therapy is 30 weeks, speech language pathology requires 400 supervised hours, and occupational therapy has a minimum of 24 weeks. Learners can complete clinical education on a full time or part time basis depending on the timing of the training.

Clinical education can occur as the following:

• a clinical internship at the end of the education program.
  • The student completes all didactic coursework for their degree program then completes clinical education prior to graduation.

• a residency or fellowship in which the learner completes their required coursework and sits for a licensure exam prior to engaging in focused clinical education.
  • The learner gains certification in clinical competency prior to completing clinical learning.

• a clinical education is integrated throughout the curriculum.
  • The student has smaller chunks of time in a clinical setting as they are completing their didactic coursework.

• a combination of timing for clinical placements.
  • Students may have an opportunity in the middle of a semester to spend a week in a clinical setting to observe and apply concepts being learned in their courses
  • Students complete longer periods of clinical education when they have successfully completed their courses.

Clinical Education Models With a Theoretical Foundation

Provide consistent and reliable student assessment using goal setting, reflection on clinical experiences, and debriefing. These models have been investigated and have produced outcome data. The following four theoretical models have been utilised in rehabilitation: 

• The coaching model
• The educator-manager to self-directed learner model
• The Mandy model or reflective model
• The mastery pathway framework

Resources

• WCPT guideline for the clinical education component of the physical therapist professional entry-level programme.
• Preceptor Education Program
• Guidelines To Promote Excellence in Clinical Education Partnerships