Alternative Clinical Education Model
for Level I and Level II Occupational
Therapy Students:
Tamra Trenary OTD, OTR/L, BCPR
Donna Heinle OTD, OTR/L, BCPR
10/26/2012
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 Model
One 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
Educator establishes
learning structure
Collaborative
Group shares
responsibility for structure
Educator is autonomous
Group is
interdependent/share
individual roles
Students are more passive Students are more active
learners
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 Model
Similarities/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 Model
Similarities/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 Relations
AOTA 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 Facilitator
Role 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