1 CLINICAL EDUCATION - CHALLENGES AND STRATEGIES MARCH 28, 2004THE CANADIAN SOCIETY FOR MEDICAL LABORATORY SCIENCE CLINICAL PLACEMENTS FOR MEDICAL LABORATORY TECHNOLOGISTS WORK IN PROGRESS CLINICAL EDUCATION - CHALLENGES AND STRATEGIES MARCH 28, 2004 In this presentation, I report on a study currently being conducted by the Canadian Society for Medical Laboratory Science Not intended to discuss data but to inform the health professions education community about research that is being done on clinical placements
2 THE STUDY CLINICAL PLACEMENTS FOR MEDICAL LABORATORY TECHNOLOGISTSCOSTS, BENEFITS AND ALTERNATIVES February - September 2004 Conducted by the CSMLS Funded by Health Canada The full title of the study is: Clinical placements for medical laboratory technologists: Costs, benefits and alternatives The study will not only report on current models for clinical education of medical laboratory technologists but will discuss alternative models. This research project began in February of this year and will be completed at the end of September 2004 This work is being funded by Health Canada. I am the principal investigator.
3 THE INFORMATION GAPS incomplete information on MLT programspartial information on costs acknowledged need for data on health professions urgent need to address human resources issues through educational processes This study was initiated as a result of gaps noted in the information about medical laboratory education. We realized that, as medical laboratory professionals, we were not well-informed about the differing ways in which clinical education, and medical laboratory curricula in general, were implemented in programs across the country. We had some information on costs but no sense of how generalizable that information is to other educational settings. The lack of data on medical laboratory technologists and other health professions has been acknowledged by the CSMLS, the Advisory Committee on Health Delivery Human Resources, the Kirby Commission and the Romanow report, among others. These information gaps were perceived to be hindering addressing educational resolutions to human resources issues in this and other health professions.
4 RESEARCH QUESTIONS 1. Which models for clinical placements are currently in use in Canadian medical laboratory programs? 2. Do the different models for clinical placement produce discernible and significant differences in student performance? 3. What are the costs and benefits of (and possible alternatives for) clinical placements in the education of Canadian MLTs? To begin to address these gaps, the CSMLS submitted to Health Canada a proposal for a study that dealt with these three research questions: 1. Which models for clinical placements are currently in use n Canadian medical laboratory programs? 2. Do the different models for clinical placement produce discernible and significant differences in student performance? 3. What are the costs and benefits of (and possible alternatives for) clinical placements in the education of Canadian MLTs)? The study consists of two phases:
5 PROJECT OUTLINE Phase 1 Mailed surveys to program directors Outcomestable and details of program variations identification of program models preliminary observations on student outcomes selection of sites for Phase 2 Phase 1 began in February and consisted of mailed surveys to more than 30 program directors in Canada’s medical laboratory, cytology, clinical genetics, and related programs. These surveys inquired into details about the didactic and clinical characteristics of the programs. What is expected to come out of this first phase of the study are a table that summarizes salient features of the programs in an ‘at-a-glance’ format (an attempt to get MLT programs ‘on the same page’ both literally and figuratively) descriptions of the variations seen in the programs a scheme for categorizing these programs into ‘models’ to facilitate discussion about the similarities and differences observed among the programs preliminary observations on student outcomes as evidenced in performance on CSMLS certification examinations criteria for selection of sites for further examination in Phase 2
6 PROJECT OUTLINE Phase 2 Mailed surveys to laboratory directors, clinical instructors and students and five sites Site visits and interviews at up to 5 sites Outcomes multiple perspectives on the costs and benefits of clinical education a C&B algorithm that includes intangibles, observations of stakeholders, correlations between models and student outcomes Phase 2, to begin shortly, will consist of information-gathering in two forms: mailed surveys to laboratory directors, clinical instructors and students at five clinical sites; and visits to up to five clinical sites with interviews of laboratory directors, clinical instructors and students. What will emerge from this part of the study is a fairly broad appreciation of the costs and benefits of clinical education from the perspectives of a number of stakeholders in the process. It is expected that the detailed questioning involved in this process will permit the creation of an algorithm that encompasses the various costs and benefits of clinical education as seen by those directly involved in the various models in use in medical laboratory programs.
7 PHASE 1 : CHALLENGES encompassing MLT & specialtieswithin-program variations programs in transition differences in titles and terminology defining ‘student outcomes’ for this study Some of the challenges of this type of project have included: the different specialties and emphasis in medical laboratory programs: general medical laboratory, cytotechnology, clinical genetics, laboratory assistants, and bridging for international graduates. Variations within individual programs: for example, several programs include both diploma and degree options; two programs share clinical sites several programs are in transition: developing new curricula, amalgamating with other programs with reference to the challenges of terminology, there are at least 11 different names used for clinical instructors, with multiple terms used within programs; took me a while to grasp French terminology for ‘rotations’, ‘sites’ and ‘student places’ what are meaningful measures of student outcomes? Performance on CSMLS examinations may only indicate good exam-takers. Interviews with those in clinical sites may be helpful, but a thorough picture of the relationship between clinical experiences and student outcomes will probably have to wait for a later study
8 CRITERIA FOR MODELS program length & typelength & timing of clinical placement use of simulations assignment of clinical instructors compensation to clinical sites I mentioned the goals of this study to establish categories or models to point to the similarities and differences among programs. Some of the characteristics that are going into this categorization process include: the length of the program and its specialty how long the clinical experience is (note variations between 12 and 50 weeks in MLT) and its timing (at end of didactic phase, staggered throughout, or fully integrated with simultaneous didactic and clinical education at a single site) whether simulations are used at any point in the program how clinical instructors duties are assigned. Although clinical instructors are, almost without exception, considered to be employees of the clinical institution, some instructors move back and forth between the didactic and clinical sites, teaching students in both locations whether clinical sites are compensated: there are examples of inter-Ministry agreements (education and health) regarding compensation. In addition, some educational institutions pay weekly or daily per-student fees to the clinical institutions.
9 RESPONDENTS’ CONCERNSInsufficient numbers of sites Inability to expand program Fluctuations in numbers of places: Withdrawal of sites Unavailability of teaching technologists Geographical issues for students Concerns about quality of learning experience Respondents to this survey mentioned a number of concerns they have had about their clinical placements, such as: not having enough sites (and therefore enough places for their students) the related issue of being unable to expand the program, despite pressures to do so, because of the lack of places for their students fluctuations in numbers of student places. This occurs sometimes when sites withdraw, either temporarily or permanently, and often on short notice, because of institutional issues such as renovations, mergers, or time-consuming technological change (LIS). It also occurs when staffing shortages or increases in workload make teaching technologists unavailable. student difficulties with respect to the locations of the clinical sites to which they are assigned their concerns about the quality of students’ clinical experiences, concerns that go unaddressed, I suggest, because of the enormity of the problems related to quantity of places
10 RESPONDENTS’ WISH LISTMore sites and more student places! Funding for teaching sites Alternatives to on-site placement More support for clinical instructors and sites Better integration of theory and practice Reorganization away from discipline orientation Changing timing of clinical placement in the program Longer/shorter rotations When asked what they would like to see changed about their current clinical education programs, respondents noted a number of items: READ LIST
11 COSTS & BENEFITS A CAVEATTANGIBLE INTANGIBLE COSTS BENEFITS Since this study aims to elucidate the costs and benefits of clinical placements, I wanted to have a clear picture of exactly what they were. A review of the literature suggested that both tangible and intangible benefits exist, so in the survey, I provided a chart like this one (except with the table filled in) of all the costs and benefits outlined in prior research and studies. I asked survey respondents to comment on the list and to identify cost and benefits based on their own experience. What my review of the literature initially suggested to me, and what respondents comments confirmed, is that many current discussions about the costs and benefits of clinical education for health professions actually look something like this ...
12 EMPLOYERCOSTS COSTS & BENEFITS . . . TANGIBLE INTANGIBLE BENEFITSMuch effort and discussion goes into spelling out the dollar figures involved for employers in providing clinical placements. This is understandable in the current economic climate but it is a priority of employers and governments, one that is imposed on health professions from the outside, and it offers a very one-sided view of the dialogue. While the purpose of this study is to create a means to better understand and approximate the costs of clinical placements, it is important to ensure that money is not the only thing under discussion. I am mindful of the need to ensure that the work of health professionals does not become devalued (or more devalued than it already is) simply because we cannot put a dollar figure to it. It is important to insist that considerations other than money remain part of the conversation about clinical placements for health professionals.
13 COSTS & BENEFITS . . . Benefits to students, clinical instructors, sites, non-teaching staff “vital” “invaluable” “essential” “irreplaceable” “The benefits outweigh any costs incurred” There are benefits to clinical education for the students, the clinical instructors, the clinical sites, and their non-teaching staff members. Medical laboratory program directors refer to clinical education as vital invaluable essential and irreplaceable. And they believe that the benefits outweigh the costs. Ensuring that both costs AND benefits of clinical education are addressed in this study will facilitate a balanced and fully informed discussion of the issues among the various stakeholders in the process.
14 AVAILABILITY OF FINDINGSPhase 1: From CSMLS after April 1, 2004 Phase 2 From CSMLS after October 1, 2004 The findings of Phase 1 of this study will be available from the CSMLS after April 1 of this year and the Phase 2 report will be issued in early October. Thank you.
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