Alternative Clinical Education Model for Level I and Level II Occupational Therapy Students:

Tamra Trenary OTD, OTR/L, BCPRDonna Heinle OTD, OTR/L, BCPR10/26/2012

OBJECTIVES

• Describe the qualities, similarities and differences of the collaborative model.

• Describe the advantages/considerations, to both students, fieldwork educators, and schools of the collaborative model.

• Envision methods for implementing the collaborative model of supervision in fieldwork programs.

Collaborative Model

Mayo Collaborative ModelOne Center Coordinator of Clinical Education/Six Clinical

Education Coordinators

• History of 6:1 (1930’s)

• Present day: 3:1, 4:1

• Six collaborative model work units• Four PT

• Out-patient• Two acute care• Acute neuro rehab

• Two OT• Acute care• Acute neuro rehab

What is a Center Coordinator of Clinical Education (CCCE)

• Full time 1.0 FTE dedicated to student education

• Organizes center’s clinical education• Full time clinical rotations• Observation experiences

• Manages Clinical Education Coordinators

• Is a resource for students and FWEd’s

What is a Clinical Education Coordinator (CEC)

• Full time 1.0 FTE dedicated to student education

• Accountable to all aspects of student program education

• Accountable to all levels of education – observation students, first year experiences, international professionals, full time interns

Differences Between Traditional and Collaborative Learning

Traditional CollaborativeEducator establishes learning structure

Group shares responsibility for structure

Educator is autonomous Group is interdependent/share individual roles

Students are more passive learners

Students are more active learners

Students work independently, little interaction, impersonal transaction among students

Prolonged interaction, oral rehearsal of material being studied, peer tutoring/learning and general support

(Cohn, E.S, Dooley, N. R., Simmons, L. A. 2001)

Collaborative ModelSimilarities/Differences

• Exceptional student management

• Caseload expectations

• Productivity

• FWEd style/interaction/supervision is patient and student dependent

• Group dynamics• Share examples + and –• Professional dialogue• AFWC involvement

Collaborative ModelSimilarities/Differences

Work load demands

• Billing, meeting with student 1:1, documentation review, signing and follow up discussion, student and department expectations, unexpected schedules

• Availability balanced with professional commitments within the department

• Fill-in FWEd’s when on vacation or absent• Adjusting to feedback from one group to the next

Collaborative Model Similarities/Differences

Supervision

• Meeting legal requirements• Medicare/Medicaid patient mix• Being at the right place at the right

time• When to schedule new patients• More or less supervision based on

student and specific patient need

Collaborative Model Similarities/Differences

Student Expectations

• Professionalism

• Safety

• Attitude of learning

• Communicate clinical reasoning

• Progressive independence

• Progressive efficiency

• Page FWEd whenever they need to

Collaborative Model Similarities/Differences

Student Preparation for Daily Tasks• Be prepared to discuss patients

• Communicate with FWEd & group

• Brief review of patient history, complexities, difficult patients, unique symptoms, problem solving, review techniques, ask for group suggestions, review goals, plan A, plan B, role play FWEd, etc.

Collaborative Model Similarities/Differences

Student Directed Teaching/Learning

• Be prepared to learn in a group

• Role playing

• Peer assessments

• Open dialogue

• Co-treatments

• Demonstration/Inservices

Advantages of Collaborative Model to Students

• Group Interaction – allowed to share/develop ideas, support each other

• Develop communication skills

• Professional development of group collaboration as colleagues

• Independent learning, consultation of resources, more learning opportunities

Advantages of Collaborative Model to Students

• Improved clinical reasoning/thinking skills

• Increased opportunity for discussion & reflection

• Opportunity to learn about other patients beyond their own case load

• Fosters mentorship from student to student sharing strengths

• Learn teaching strategies to match learning styles

Advantages of Collaborative Model to Students

• Learn from students from other OT programs and varied clinical rotations

• Utilize each other as resources –to help with problem solving, assist with difficult patients

Advantages of Collaborative Model for Fieldwork Educators

• Leadership position

• Improved clinical knowledge and management skills for FWEd

• Easy to implement evidence based practice/best practice

• Improved handling of exceptional students and challenged students

• Experience of working with more students, and networking with many OT programs

• Increased productivity

• Cutting edge of practice

• Enhance orientation process

• Promoting entry-level practitioner• Peer support, discussions, teamwork, reflection

Advantages of Collaborative Model for Facility

• Financial Viability/Productivity

• Education of staff on evidence based practice best practices

• Staff Recognition

• Recruitment

• Cultural Competence

• Practice Competence

• Patient Care

• Enhance Public RelationsAOTA 2009

Advantages of Collaborative Model for Academic Program

• Increase in clinical slots

• Enhances evidence based practice/best practice

• Students are integrated into one another's OT programs by sharing learned knowledge

• Excellence in practice

• Students are exposed to more clinical scenarios

Collaborative Model

Considerations

• Time constraints• Limited availability of FWEd if working with

other students• Personality and learning style differences• Differences in student competencies• Delivery of feedback by FWEd in a timely

manner• Student decides they don’t like the model or the

setting

THEORIES

Used to Guide Collaborative Model Clinical Curriculum

Transformative Learning Theory

The transformative learning approach is where the status quo is questioned and underlying assumptions are challenged in an effort to gain a higher level of understanding about a phenomenon.

AOTA 2009

Transformative Learning Theory Role of Fieldwork Educator

• Experiences to shape our beliefs, attitudes, feelings and emotional reactions.

• Assess consequences of assumptions

• Identify and explore alternative sets of assumptions

• Test the validity of assumptions through effective participation in reflective dialogue or critical reflection.

AOTA 2009

Constructivist Learning Theory• Constuctivism is a parallel learning theory in which

people construct their own understanding and knowledge of an occurrence through actively experiencing things and reflecting on those experiences

• Constructivism is often associated with pedagogic approaches that promote active learning, or learning by doing

AOTA 2009

Teacher vs FacilitatorRole of Fieldwork Educator

• A teacher….tells, lectures, give answers, delivers monologue

• A facilitator….asks, supports, provides guidelines and creates the learning environment, encourages a dialogue, adapts to learning experience

AOTA 2009

Fear of collaborative models(aka “it will never work” crowd)

Are there elevated fears that you may have about working with a 3:1 collaborative

model?

Implementation of Collaborative Model of Clinical Curriculum

Begin with the End in Mind

What should the student know and be able to do by the end of this clinical internship?

Implementation of Collaborative Model of Clinical Curriculum

• Identify most commonly encountered conditions/diagnoses

• What unique experiences do you have to offer?

• What topics do you seem to have to review with every student?

• What safety issues do students need to know?

Implementation of Collaborative Model of Clinical Curriculum

• Set overall objectives

• Set weekly objectives/plan• General to specific• Simple to complex

• Decide on an acceptable standard of performance – Where is the bar?

• Design learning experiences

• Implement

• Evaluate learning experience and overall curriculum

Implementation of Collaborative Model of Clinical Curriculum

Identify core concepts to be incorporated with every student:• Learning style• Adult learning and expectations• Giving and receiving feedback• Reflection• Professionalism• Service learning• Cultural competency

Implementation of Collaborative Model of Clinical Curriculum

For each core concept include:• Reading assignment• Key discussion questions• Students self assess• Establish goals for upcoming week(s)• Students reflect later on growth

Implementation of Collaborative Model of Clinical Curriculum

• Orientation – 1st week and beyond• Department structure, location & use of

equipment, philosophy to patient care

• Expectations – goals, learning objectives, signed forms for learning commitment

• 1:1 meetings: with each student; daily, week, impromptu

• Feedback, review, reflection, planning, supervision styles

Implementation of Collaborative Model of Clinical Curriculum

• Triage patients

• FWEd transparency

• Clinical Instruction goals• Consistency of performance• Demonstration and carryover of learning• Challenging through variety

• Co-evaluations – independence

• Co-treatments

Implementation of Collaborative Model of Clinical Curriculum

FWEd Directed Teaching/Learning

• Diagnosis Worksheet

• Plan of Care Worksheet

• Window of Time

• Continuum of Care predictions

• Literature Review

• Self Assessments

• Peer Assessments

Implementation of Collaborative Model of Clinical Curriculum

• AOTA Fieldwork Education Form

• Weekly feedback meetings

• Midterm and final student evaluations

• Patient and staff feedback

• AFWC feedback

Student Comments

• Using the collaborative student model allowed me to experiences other’s learning/communication styles and learn from them as well as share my own thoughts and receive/give feedback.

• All were great experiences and taught me professionalism and collaboration

• It was a very positive experience allowing me to be more independent and bounce ideas off of the other students.

Student Comments• Working with other students really helped me to be

creative with my treatments. I was also able to see their patients and how their treatment style differed. It was great to have PT students there also because we could co-treat.

• Very beneficial, constantly giving/getting feedback and evaluating each other’s experiences.

• My FWEd had enough time to supervise and help all 3 students

• It allowed me to feel very secure and facilitated a close and trusting interaction

Student Comments• I needed more 1:1 time with my FWEd (personal

learning style request)

• Keeping up with supervision guidelines

• Student in the group having difficulty takes too much time of the FWEd

• Comparison of patient load

• Comparison of student skill

Great moments….

• Educational expert

• Key player in department; cutting edge of department procedures and clinical practice

• Professional edge

• Seeing the students lean on each other vs. the FWEd

• Seeing students learn many skills about FWEd management and clinical practice

References• American Occupational Therapy Association. (2009). AOTA Fieldwork Educator Certificate Program Manual. Bethesda, MD: AOTA

Press.

• American Occupational Therapy Association. (2002, February). OT/OTA student supervision and Medicare requirements. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/StuSuprvsn/38386.aspx

• American Occupational Therapy Association. (2003). The purpose and value of occupational therapy fieldwork education. American Journal of Occupational Therapy, 57, 644.

• American Occupational Therapy Association. (2006). Role competencies for a fieldwork educator. American Journal of Occupational Therapy, 60, 650–651.

• American Occupational Therapy Association. (2007e). Medicare regulations and guidance. Available online to AOTA Members only at http://www.aota.org/Practitioners/Reimb/Pay/Medicare/Guidance.aspx

• American Occupational Therapy Association. (2007g). Recommendations for expanding fieldwork. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/Supervisor/38273.aspx

• American Occupational Therapy Association. (2007h). Recommended content for a student fieldwork manual. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/NewPrograms/38250.aspx

• American Occupational Therapy Association. (2007i). Steps to starting a fieldwork program. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/NewPrograms/38245.aspx

• American Occupational Therapy Association. (2007j). Strategies for creative fieldwork opportunities. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/NewPrograms/38246.aspx

• American Occupational Therapy Association. (2008a). Excellence in fieldwork criteria: Fieldwork educator. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/Supervisor/41770/41772.aspx

References

• American Occupational Therapy Association. (2008b). Excellence in fieldwork criteria: Fieldwork site. Available online at http://www.aota.org/Educate/EdRes/Fieldwork/Supervisor/41770/41771.aspx

• Bernard, J., & Goodyear, R. (2009). Fundamentals of clinical supervision (4th ed.). Boston: Pearson.

• BMJ 2003;326:268-270 ( 1 February )Clinical review

• Costa, D. (Ed.). (2004). Essential guide to occupational therapy fieldwork education: Resources for today’s educators and practitioners. Bethesda, MD: AOTA Press.

• Crist, P. A. (2000). Understanding the role of the fieldwork educator in occupational therapy education. In S. C. Merrill & P. A. Crist (Eds.), Meeting the fieldwork challenge (Self-Paced Clinical Course, pp. 1-53) Bethesda, MD: American Occupational Therapy Association.

• Cohn, E., Dooley, N., & Simmons, L. (2001). Collaborative learning applied to fieldwork education. Occupational Therapy in Health Care, 15(1/2), 69–83.

• Epstien R.M. Mindful Practice. JAMA. 1999; 282:833-839.

• Jack Mezirow & Associates. (Ed.). (1997). Learningas transformation: Critical perspectives on a theory in progress. San Francisco: Jossey-Bass.

• Rindflesch AB, et al. The Collaborative Model of Clinical Education in Physical and Occupational Therapy at the Mayo Clinic.” A Design Method.; Journal of Allied Heath, Fall 2009

• Student Supervision During Clinical Education. Minnesota Clinical Education Consortium (MCEC) Revised June 2007; Created October 28, 2006

• Westberg, J., & Jason, H. (1993). Collaborative clinical education: The foundation for effective health care. New York: Springer.

Contact Information

• Tamra Trenary OTD, OTR/L, BCPR• trenary.tamra@mayo.edu• 507-255-9683

• Donna Heinle OTD, OTR/L, BCPR• heinle.donna@mayo.edu• 507-255-4605