American Speech-Language-Hearing Association

How Does One Urban Program Manage Clinical Education?

Elaine Mormer, MA, CCC-A, Audiology Clinical Coordinator, University of Pittsburgh 
Cheryl Messick, PhD, CCC-SLP, Director of Clinical Education, University of Pittsburgh 

Question

What makes the University of Pittsburgh clinical training model different than most other CSD clinical programs?

Answer

First, it is probably important to provide some background on our department and the environment in which we are situated. The University of Pittsburgh Communication Science and Disorders (CSD) department is housed within the School of Health and Rehabilitation Sciences. The department is located on a dense urban campus that includes schools of nursing, medicine, pharmacy, public health, and others. The Pitt campus includes a major medical center with multiple hospitals, outpatient clinics, and physician practice offices. Students can access a variety of clinical practicum sites on foot or via a short (and free) bus ride.

While these elements are similar to those of other CSD programs around the country, there is one big difference: When prospective students visit, they expect to see the usual in-house clinic for evaluation and treatment of patients and the training of students. At Pitt there is no traditional in-house clinic, and the absence of the traditional university speech and hearing clinic is by design. In August 1997, under the leadership of the department's chair Dr. Malcolm McNeil, the CSD department closed the University of Pittsburgh Speech & Hearing Clinic. This closure was part of a vision to develop collaboration, rather than competition, with the variety of rich clinical facilities in our university neighborhood. The changes occurred at the time in health care history when managed health care and third party payer requirements were changing the level of support staff needed to manage clinical services. With the closure of our own clinic we moved to partner with existing "real world" clinics in the region to provide frontline clinical experiences for first-year students. Agreements with existing clinical facilities were forged, allowing CSD faculty/staff to practice and conduct clinical education in community facilities. These sites became known as the CSD Clinical Network (the Network). Students engaged in clinical practice in these sites are considered to be "in-house," though geographically they are at off-campus sites. Network facilities include the University of Pittsburgh Medical Center (UPMC) hospitals and outpatient clinics, VA Healthcare System sites, schools, early intervention programs, and private practices. Each term, students rotate to a new Network site for a totally different experience from the previous semester. Students learn the intricacies of varied clinical sites and learn early on that procedures (e.g., billing, documentation, qualification for services), philosophy of service, and guidelines vary across sites and settings.

Question

What makes the Network training sites so special? How are they different from traditional outplacement sites?

Answer

A student in a Network training facility could be in one of many clinics, any of which can be described as "in the trenches" of clinical service provision. These sites include a diverse collection of facilities providing students with an opportunity to experience varied clinical service options. Students experience a wide range of communication disorders and learn the challenges and professional expectations of clinicians in real community settings. For example, a first-year audiology student might spend their first semester at the UPMC Eye and Ear Institute. She would typically be working with patients, under the supervision of Associate Professor Catherine Palmer. Dr. Palmer teaches first-year students in the Amplification I class during that same semester. Similarly, a first-year SLP student might be assigned to clinic practicum at UPMC Passavant Hospital, under the supervision of Dr. James Coyle, Assistant Professor in the CSD department. Dr. Coyle teaches the Dysphagia course that first-semester SLP students attend. The Network sites are not defined so much by where they are located or what types of patients they see. Instead, a Network clinical placement is defined by the personnel engaged in clinical education. In Network sites, the clinical instructor is a CSD staff or faculty member whose primary objective is education, while servicing clients in the facility. This is in contrast to outplacement (off-campus) sites where practica are supervised by facility employees. In outplacement practica the clinical instructor's primary objective is patient care, while providing clinical education to University of Pittsburgh students.

From the administrative perspective, our program has neither the challenges nor the benefits gained from running a typical in-house clinic. Since clinical activities and procedures are so varied across Network sites, we focus on maintaining consistency of Network clinical education expectations. This is accomplished via our Network Curriculum and associated with required learning activities.

Question

When do students begin their clinical placements in the Network?

Answer

Students begin Network clinical education their first week in the first term of the program. All graduate students complete their initial 25 hours of clinical training in the Network, and many students complete 50–75 hours in the Network, before moving to an outplacement (off-campus) experience. Students must meet set criteria before moving to outplacement practicum, with students achieving the criteria at different rates. As noted above, first-year students are supervised by clinicians who are primary members of the University of Pittsburgh faculty, an arrangement that promotes maximum integration of academic and clinical training. Most students move out of the Network after two to three semesters. At that point the typical student has developed and demonstrated a set of Core Competencies. Second- or third-year students who require clinical remediation activities are sometimes brought back into a Network placement to refine clinical skills.

Question

What types of learning activities happen in the Network practica?

Answer

Clinical education in the Network has been designed to provide students with a closely supervised practicum experience to facilitate the acquisition of a set of Basic Clinical Competencies. Training activities within the Network include participation in clinical contact experiences, observation of clinical instructors providing services to patients, and teaching time with clinical instructors, as well as assignments and preparation time outside of clinic. Because of the complexity of the case load, "teaching time" (with no patients present!) is structured to provide students with the knowledge and skills needed to work with the clinical instructor's caseload. Teaching time for clinical instructors includes time spent training students to understand how to review patient files/charts, gather information from sources, plan for sessions, implement diagnostic and intervention strategies, measure client behaviors, analyze client data, and document sessions. Additionally, Network clinical instructors teach background information on various disorders that are unfamiliar to the student. Students in Network practicum engage in a variety of required clinical education activities including reflective journal entries, self-evaluations, case presentations, and clinical documentation exercises.

Question

How do students react to the Network model?

Answer

We prepare students for this model of clinical training from the first time they inquire about the program. Before they begin the program they are often intimidated about going into our bustling medical center for the first day of practicum. During CSD orientation activities we try to allay the fears they have. In most cases they are able to meet their assigned clinical instructor during the orientation week. This is reassuring and allows for both student and clinical instructor to discuss plans and expectations prior to facing the first patient/client. We tell the students that "your instructor knows you have no clinical experience" and help them understand the role of clinical teaching in our program. Most of our graduates look back on their Network experiences and are grateful for the both the challenges and comfort of the Network model. Students cite our Network model as a major strength of our program and they appreciate the number and range of different sites and experiences available in the first year. Potential employers are impressed with the range of sites and experiences students describe during job interviews.


This article first appeared in the August 2010 issue of Access Academics and Research.

 

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