Katie Myers and Ashley Poole: Clinical Education

Introduction [00:00:02] WELCOME TO THE DUKE DPT podcast a show designed to bridge academics and researchers with health care professionals. Now here is your host Derek Clewey a faculty member and a budding academician at Duke University and the doctor of physical therapy division.

Clewey [00:00:19] Today we are joined by two very special guest Katie Meyers and Ashley pool Katie Myers join the Duke DPT faculty in 2017 as an assistant professor and as the director of clinical education here before moving to North Carolina. Katie enjoyed five humidity free years as the Assistant Director of Clinical Education at the University of Colorado's DPT Program. Katie attended Ithaca College and graduated in 2002 with a masters a science degree in physical therapy. She then obtained her doctor a physical therapy degree from the University of South Alabama in 2008. Her clinical background is in acute care and spent much of her clinical career focused on the treatment of cardiopulmonary and oncology patients in the acute care setting. Katie has been involved in clinical education throughout her career first as a C.I. then as the C.C.C.E at two different large academic medical centers before taking on a new challenge in the academic setting. When Katie is not working she enjoys binge watching TV shows on Netflix listening to true crime broadcasts on very slow runs around her neighborhood and hanging out with her two sons and husband. Also joining us on the show today is Ashley Poole. Ashley has been a physical therapist for nearly 20 years and has been a credentialed clinical instructor since 2002. She has since achieved her board certification as a clinical specialist in the area of cardiovascular and pulmonary physical therapy and is an advanced clinical instructor to the PTA. She currently practices at Duke University's hospital and is in the cardiac ICU and step down units. But throughout her career she has worked in all sorts of settings including acute care outpatient inpatient rehab home health and skilled nursing. She even had a brief side career as a professional actress in New York City. She is heavily involved in clinical education in her current position as a preceptor of education for both her department and she has supervised both individual PT students as well as student teams. In her free time, she also loves escaping from work by binge watching TV shows and spending time with her husband and two children. It sounds like you've got some very similar guests on our show today especially from a binge watching perspective.

Clewey [00:02:22] All right. So welcome to the show. Katie and Ashley and welcome to the humble Duke DPT podcast studios also known as my office. So glad the two of you could join us on the show and to be honest with you. I've been looking forward to this show for quite some time now. This topic is actually of great interest to me personally but I think it will also be of interest to a bulk of our listeners and they should probably find it very stimulating. But with that said, before we jump into the topic of clinical education, which I know our listeners are really grasping to get to. Can you both give us our give our listeners a little bit of background about yourselves including maybe your current roles and then also maybe how or why you became involved in clinical education so whoever wants to take a first is welcome to go - rock paper scissors or whatever you guys want to do here.

Clewey [00:03:07] All right.

Poole [00:03:08] All right I'll go first. So I'm Ashley Poole. I graduated from PT school nearly 20 years ago and I first fell into the role in clinical education because I was working at an inpatient rehab unit who did not have a center coordinator of clinical education so I, just by default kind of became that person, which got me heavily involved in kind of

education from the get go. So I was doing that role and also having my first student. So I did that CIA credentialing course that year, and that was I guess 16 years ago now, and ever since then I've loved taking students. And then I guess. I don't know. Several years ago now I took the Advanced C.I. course. My current role at Duke Hospital and the acute care arena, and I work on cardiology. I have both cardiac ICU and step down patients. And I'm also the preceptor of education for our department so I do all the trainings for new students and new employees and that also makes me kind of a liaison to students when they're there. So yeah and I'm also board certified in cardiovascular and pulmonary. Yeah. So I love cardiovascular and physical therapy and I want to recruit all students and convert them to cardiopulmonary therapies. That's my goal.

Clewey [00:04:27] Very nice. All right. Katie

Myers [00:04:29] All right. So I have been involved in clinical education since I was a clinician my first year out, so I graduated in 2002 and I think I took my first student in like 2003 right away and really started as C.I. I was at a large academic medical center in Chicago and we did only two to ones there and just really fell in love with teaching and as an aspect of my role as a therapist, and just kind of offsetting the craziness seeing patients I was in the acute care setting as well and so I just thought it's such a nice balance of you know keeping me on my toes and keeping me excited and invigorated about my practice. And then I moved into the CCCE role there and was really a CCCE & CI for the next I don't even know how many years I can't keep track of all the years. And when I moved to Colorado I served as the CCCE at the medical center that I worked at there before I joined the faculty at University of Colorado's PT program as the assistant director of clinical education and I really just saw that as a really nice leap into a new challenge. I think I was about 10 years or so into my career and kind of ready for a new change and a new challenge and just wanted to stick with education and finding a new way to challenge myself and just remain connected to students. And during that role there at Colorado is really where I started to really find passion for curriculum development and all of the life challenges that I'm sure we'll talk about today with clinical education and what we can do to really partner between academic and clinical side to really provide the best experience for students.

Clewey [00:06:22] It sounds like your stories are probably pretty similar to a lot of individuals that have become CI's and then later on take administrative roles with becoming clinical instructors I know for me personally my my story was very similar to Ashley's in that I took probably my first student when I was six months out of school.

Clewey [00:06:43] Don't tell that to a DCE in the room but it was almost a sort of an emergency kind of thing where there was no placement for the student and so they asked if I would take this did and there was actually a pretty strong student and it was a transitional student from a PTA to a PT program and so I took my first student within six months and I was the CCCE for this relatively larger clinical group within 10 or 11 months of my career so I certainly as I said in the intro there I have a big interest in clinical education because really is sort of how I think all of us even in academia have become involved in education and really taste the education side of things.

Clewey [00:07:27] It's also interesting too because both of you have a clinical passion and interest and I think that that's also very important to maintain and uphold how you go into the clinical education world. I love Ashley's sort of marketing for cardiopulmonary PT and I think it's very well deserved, but I think that that also makes Ashley to be one heck of a great CI because loving what you do is probably as equally important as being able to

actually instruct so but very much happy to have you guys both on the show. I've got a few questions lined up for you and hopefully we can go into some really nice deeper discussion into clinical education. So I guess the first question that I will ask for both of you - and we'll do this whole rock paper scissors round thing - and whoever wants the questions first are you guys going fingerpointing who's in do it. I don't know. Are you going to handle it.

Clewey [00:08:19] Or maybe I will actually say the name first but when you look at your role in clinical education or whether that be CI or DCE What is the one thing that you would say that you love most about being in clinical education and obviously if there's more than one thing then take the liberty take more than one thing but what would be one thing that you love most about clinical education.

Myers [00:08:42] Well I think what I love the most is it's the same as it was even when I was the C.I. And that's really the broad statement of watching the development of a student but really for me now it's not the development of their knowledge and their skills. I mean our students are so strong in their knowledge and skills and reasoning and but really I really enjoy seeing the development of students and the behavioral side the professionalism and and their passion for what they're doing ignites when they go to the clinic. So you know the students that come back from our steps are integrating experiences in the first time they've been in the clinic as a PT student. The first time they've actually gotten to apply some of their knowledge. They're so invigorated and they're so excited about it. And then you get to see that growth over the three years by the time they're done with their third rotation. You know they just have a totally different sense of identity and their professional identity has grown. I find that just that's really what drives me is how do I continue to help our students grow and that that affective domain if we want to use sort of more of an academic term. But in that in their behaviors and attitudes in the clinic and and also you know the core of that is how they're connecting with patients. And so again, you know our students can be very smart and great you know with their clinical skills, but as they grow in their ability to connect with that patient and and learn how to change the way they're communicating and find ways to connect. And that really ignites their passion to like that all. I don't get to see that firsthand now because I'm not the C.I. but I get to see it as I watch them grow for their time in our curriculum.

Poole [00:10:36] It's two fold for me why I love kind of education and personally why I love taking students. First is similar to what Katie said. Like I what I love watching the growth and development. I do you know when they come into the clinic they've had all this textbook knowledge and they've had all this didactic and you know they come in like deer in headlights because they have all this stuff in their brain. And they don't really know what to do with it. And so it's really fun watching them go from because I work in an ICU. So when they first walk in there and they see the patient and all the lines and leaves they're just like deer in headlights like what do I do with this. You know and so I love watching them go from that aspect to being terrified to talk to the nurse or being so intimidated to approach the medical team. And by the end you watch them like walk in there like it's nothing and they know what they're doing and they go talk to the doctors and they talk to the nurses and you watch that confidence build.

Poole [00:11:31] I love watching like somebody go from being kind of timid and unsure to like self-assured and confident and bold and then the other thing I love about it is for my own development. I love it when I get a student because it challenges me to think outside the box. And I have to explain why I'm doing things and why would you make that decision and why do you think that patient's safe to go home. So it's really fun for me too and they

challenge me and make me learn more about the field and myself and my own decision making. And then they also challenge what you do in the clinic is not always what you've learned in a textbook. So when they say what the textbook said this Why are you doing it like this you know and so you have to explain why we do it like this sometimes in real life because of this that and the other. And so it's fun to kind of for me to justify that to them and to see them also start thinking outside the box a little bit more and not being so like in this one lane and then looking things up together and I learn more from it and hopefully they learn more from it. So it's kind of a two-fold for me. Yeah.

Myers [00:12:48] I also think the other part of it for me is finding students who like when I said they they find their passion. I also love the fact that Clint ad is designed to give our students like a breath of experience right. And many students not just in our program but it programs come in really thinking they know what they want to do. There's many students that come in thinking they know what they want to do. They have a vision they have a background perhaps in athletic training or whatever it is they know they want to do pediatrics and they're forced to do something different - and to learn outside of what their they their perceived interests are and be challenged in that way. And I love when we have students that are completely changed by their experiences and that comes from the guys like Ashley who are super passionate about what they do. They're in a really challenging field and one and setting where one that's most students don't even think about that they want to practice in and then they go and spend time at the CI like Ashley and they see all the reasoning and all the knowledge takes and all the skills it takes. And they go "Oh wait a minute this is actually really exciting too." And that part of it is is really fun for me.

Clewey [00:14:01] Yeah that was a story just dovetailing off of Katie's comments there. I had a student once - Of course if this gets out to my student they're going to who they are - but walk in the door a literally the very first day. And of course a CI would say don't do this but they told me that she didn't want do orthopedics that she wanted to be a pediatric physical therapist yada yada yada. Long story short she's now a board certified in orthopedics and is directing many orthopedic clinical practices and such so it's really been changed and sort of always makes it feel good to expose them to things that maybe they didn't get excited about initially and I think that that is something that is very powerful that you don't get as traditional academic that you really get that sort of response from your students.

Poole [00:14:58] I have a similar story because lots of times you don't always know where students go, and where they end up, and what field and route they ended up taking. But I have one experience where I had one of my team-based learning experience students come out to me and she spent a few weeks with me along with some other classmates. And like I said My goal is always to convert these students and make them want to be cardiopulmonary physical therapists.

Clewey [00:15:25] It's Very obvious sounding.

Poole [00:15:27] And she now just recently took her CBS exam. She's a board certified and cardiopulm and she's a faculty resident now and I don't know if I had anything to do with it but I like to think that maybe I had a hand in that direction. That gives me great pride.

Myers [00:15:44] I think we all have stories like that that you know, there's one or two students in every cohort that has completely changed their direction their career path or what they're thinking they're going to do based on clinical education. But you know that's

one or two and the rest of this class. You know they they've had this exposure and this experience in a field or a setting that they're not necessarily going to practice in but the challenge then is making sure they understand the importance of the value of spending time. Twelve weeks in a cardiac ICU when they want to be a sports PT or they want to be a pediatric therapist you know. And so we the DCE side, the academic side, you know really have to help mentor and advise students in that. But we rely on CI is also to demonstrate the value and the value of that experience and really help them learn reasoning and behaviors that will translate into no matter what setting that they're going into.

Clewey [00:16:53] I think that's a really good point. You know looking back on my career I think that we're all experienced roughly about the same amount of time. But when I look back on my own personal clinical education even though I knew that to some extent I wanted to do outpatient orthopedics and most valuable clinical education experience honestly was an inpatient rehab clinical experiences just because it allowed me to see where folks are at different stages and really appreciate it from that angle. But when I look back and think on my clinical days those are the days that stand out to me as being some of the most influential. Good point.

Clewey [00:17:33] So from the things that we love the things that are a lot of the more challenging sort of taking that polarizing discussion here. What do you see that are some of the challenges in clinical education.

Myers [00:17:47] There are so many.

Clewey [00:17:50] Like the first question you can take more than one if you want.

Myers [00:17:54] And you know what I might bring up there might be some overlap I think with Ashley will say but there are so many challenges right now, and there always have been I feel like in clinical education but there are so many challenges facing the academic programs that are facing the clinical sites and the challenges that the clinical sites are facing are impacting academic programs. And then of course then the student is in the middle of that. And so you know we could probably spend hours talking about all of the different conversations around the challenges and Petey right now. But you know overall I think what we're finding on the academic side and my perspective as the D.C.E is that we have an increasing number of PT & PTA programs in the country and yet we don't have an increasing number of clinical slots and placements, and in fact what we're finding is more challenges in placing our students and securing clinical site slots on a consistent basis with high quality sites and known partners because I my perception is that the challenge that the pressures on the clinical side are forcing clinicians to focus more on the bottom line on money and productivity and efficiency which often students the perception is that students have a negative impact and that might go into a myth that you know if we talk about myths of out later. But you know so we have this challenges on the clinical side of not having time or focus on student education but an increasing need for student placements on the academic side. So that right there is a huge piece. And then on top of that those of us who are lucky to have wonderful partners and clinical partners and programs that have a great basis of relationship with their partners are also still being challenged even with their known sort of consistent entities and finding ways to really continue to help support this sites and finding ways to help support the sites to demonstrate value in having students there. And that takes time and resources and money and all of those things which of course are at a premium.

Myers [00:20:19] That's like a broad overview.

Poole [00:20:21] And that's definitely the big picture and I would I would definitely agree with that and I would say on the smaller spectrum you know in the clinic some of the challenges the biggest challenges for us when we have a lot of students because you know I work at Duke. So there's a lot of students that influx of space you know a lot of people complain about the space - you know because we're increasing number of beds but we're not necessarily increasing our rehab space. Computers are at a premium. So like when there's an increasing number of students there's not always enough computers or a body to document write notes on. It. Personally. You know some of the challenges are you know when you have students you're gonna get all kinds of personalities and different professionalism behaviors and you know you may think that yes I'm going to take a student and it's going to be great and you know but then you get your challenging student who can make the job a lot more difficult and a lot more challenging and into that can definitely be one of the challenges because that's going to affect your productivity. You may be at play may affect your work life balance. And then I also take teams of students so I'll take three to four students to one C.I. at a time. And you know some of the most challenging things are the team dynamic you know the dynamics within the team and having to navigate not only that but also teaching them the skills and tools that they need to be successful in the working world.

[00:21:57] I think what you brought up with the student personalities. And whether or not that's you know is that going to be a positive or a negative. For that experience as a C.I. I think is also you know something that DCE and clinical sites need to have more conversations on how are we matching our students to the sites and worse. I'm seeing more and more sites requiring interviews or applications, or wanting and requesting some sort of input into which student comes to them. Which of course I completely understand and support, but it's also a logistical dare I say nightmare. You know so it can be very hard to manage the logistics of that on the academic side when you have many sites requesting an application process or an interview process and some sites are in-person interviews even if they're not local. But I again I completely understand why because you're investing three months or more of your time to bring this person into your culture into your clinic into your environment. And if that person is not going to be a good match or they have no interest in being there then of course that's going to they might you know treat their patients fine and your productivity may not be super affected by it but gosh what a long three. That's going to be for you. So I don't know the answer to that is other than to continue to keep those conversations going with sites as to how can we best you know. Is it a question. Sometimes I ask like what kind of student thrives best with you. So that on my end I can advise or mentor students like maybe you want to stay away from this site but this site sounds like it might be a really good fit for you.

Clewey [00:24:06] I think I do. I remember one of my toward the end of my full time clinical career I had students three to one students and it was sort of this innovative model long term model six month one year type model.

Clewey [00:24:20] And I remember it was the greatest thing but I remember when I had the three students about always came up to the midterm or finals and having three students and three was a very impressive monumental task but that's another podcast later so well.

Clewey [00:24:37] So Katie already alluded to one of the questions I wanted to ask. I don't know how she got that question. Are there sort of either DCE or actually clinical instructor

or clinical education myths that you would like to take this opportunity in front of our audience to bust if you will.

Poole [00:25:04] Well I think I think if piggybacking on Katie's comment like I think one of the myths and it could go either way - I think CI's think oh you know I'm gonna I'm going to have a student and I'm going to get them up and running and then that's going to increase my productivity because I don't know how other sites do it but I know for us when you have a student you know obviously you're less productive in the beginning but as your students start seeing patients more independently you accumulate your students productivity as well. So it's almost like you get to phone productivity when you're students independent and a great student. So I think some CI's have the math that oh I'll just get my student trained I'll get them running and I'll sit back and relax a little bit. My productivity will be smooth sailing and then other people have the opposite perception of, oh gosh you know I don't want to student because that's going to take a lot of time effort and my productivity is going to be in the toilet for three months and I won't have to work really hard to get it up and running again, so I think it could go either way but some people think about having a student depending on what they've either witnessed or previous experience.

Myers [00:26:16] I think those are there similar myths like they're gboth myths and they're on to opposite spectrum but they're both they both can be true, and it really goes back to the student.

Myers [00:26:30] D.C.E myth you know I I'm not sure. I think one of the myths, maybe, I'm hesitant to call it a myth but maybe a perception of the D.C.E role. Historically maybe is that it's a very administrative role where you know our our job is to place the students into you know manage spreadsheets or to pieces or whatever you know in terms of just that administration of the Clin Ed curriculum what I think over the last five or 10 years has happened is there's been a much greater focus on the D.C.E role and the importance really of clinical education in the development of our students and how clinical education, the clinical education portion of the curriculum interplay is with the didactic portion, and because they're such an important interplay there. The D.C.E's role is really to help facilitate that. And so you know that I guess the perception that it's a very administrative role. You know I wouldn't want to bust and I think every D.C.E would because we spend a lot of time advising students. We spend a lot of time trying to support our clinical instructors and our partners and offering trainings and resources and really looking at what makes the most sense from an educational perspective for our students, site visits, and really you know partnering being visible you're oftentimes one of the few external faces of a program. Kind of on the ground going out to sites or meeting people and you're your present you're really representing the program and hearing firsthand from the clinicians what the challenges they're facing what's been helpful to them what are our students really good and we're getting the feedback on the curriculum in person and bringing that back to the program. And so facilitating that role as a program facilitating that D.C.E role to be integral to curriculum development curricular revisions to really make our students strong I think is a key part of the D.C.E role.

Clewey [00:28:45] I think you brought something up that was important. If I could dispel a myth, as the host, I guess I could take you liberty to do whatever I want, coming from the clinical side and then now being in the academic side and seeing that the D.C.E role still from the side, but seeing how much it actually takes in terms of resources to actually pull it off is pretty impressive.

Clewey [00:29:07] You know it's not just a one person job, as I think maybe some folks might think that is the case. That requires a fair bit of administrative work. And then on top of all of that all of the other components that are equally, if not more important, to the role of the D.C.E. So it's been sort of fun to see how much actually goes into really putting together a clinical education curriculum and coming from a role where you know I was the C.C.C.E.

Myers [00:29:38] Well now maybe now it's S.C.C.E.

Clewey [00:29:41] Oh it isn't really. I did not know that.

Myers [00:29:43] Site Coordinator of Clinical Education.

Clewey [00:29:44] I like that. I like that that's not too hard to get to C's with an E at the end and I never knew I had the right number of C's in there. But that may have been the hardest part as S.C.C.E.

Clewey [00:29:58] But you know there you're obviously managing a lot of the different universities and institutions and the clinics and things like that. But it really does exponentially explode when you have the number of students in a program and then the number of sites and the number of number of internships that are involved in that. It's pretty impressive what gets done, and then in addition to that and we make it to this a little bit later when we get to some of the innovations but obviously it's not just the long term clinical or terminal clinical education experiences all of those steps experiences and other components that go into clinical education.

Clewey [00:30:35] Good. So now taking off maybe to a little bit more of again some more positive vibes here.

Clewey [00:30:45] Where do you are how do you see clinical education evolving say over the next you know sort of short term two years, then five years, then ten years or beyond. I'd be really excited in hearing both of what you have what you have to say.

Myers [00:30:58] Well I mean I think if you look at some of the challenges that we were talking about earlier I mean I think clinical education is going to need to address those challenges. I think as a profession we're going to need to address the challenges that we're facing and student placements and clinical instructor support and training and preparation.

Myers [00:31:22] I think we need to address the role of the S.C.C.E and who that person is and empower them to be, really embody that role of not just place the same in DCE not just placing a student but they're there to mentor their C.I.'s To train the CIs to be a resource for that site to develop an actual curriculum at the clinic for a clinical education at the site. Those are things that I think really we need to see happen in the next few years.

Myers [00:31:56] There's definitely discussions happening about that and movement I think happening at the national level and certainly at local levels too. If you look at there's consortiums people probably aren't even aware of this that there's clinical education consortiums in the regions and different regions in the country. And these are all of the academic programs that come together in the D.C.E's or anyone that's involved in clinical education at the programs. And so there's we have a Carolina Clinical Education Consortium here.

Myers [00:32:36] C.C.E.C. North and South Carolina.

Myers [00:32:39] You know there's there's a they're all over.

Myers [00:32:43] So there's one that's just for Texas. For example in Colorado it spanned nine states. It's called the Northwestern Intermountain consortium, anyway so these consortia really are working also on a lot of these challenges and coming together to try to collaborate to support our sites and our students and really try to develop mechanisms to address the challenges that we're facing. But I do overall think I see a trend and a need for close relationships between academic and clinical. You hear the word partnership a lot. I feel like it's a buzz word these days that people just throw out. Oh thanks, we want to be in a partnership with you. But really what does that mean. And and defining what a true academic practice partnership is - I think is going to be important to furthering that collaboration between the active and program and the clinical site in preparing the students to go to clinic and preparing the CI to accept the students to preparing the clinical side as an environment to helping to develop a clinical education curriculum at the site. All of those pieces can come from true collaboration, and I use that word instead of partnerships. So collaboration between the site and the program, and that's going to look individual and different between Duke DPT and Duke Health System, and Duke DPTT and other clinical sites and the role of the program in the DCE is to start to make those connections and to figure out what is that collaboration going to look like to really build up those partnerships or relationships.

Poole [00:34:29] From the clinical side, I think one thing that will probably have to see change is, as the number of programs grow and the number of students in that program grows in order to make the most of these partnerships I think you're going to have to see CI's being willing to take more than just one student at a time being willing to take like two students or three students or maybe even four.

Myers [00:34:57] Say it again - collaboration

Poole [00:35:03] But I think it's going to have to happen in order to accommodate larger class sizes. An increasing number of programs. But I think in order for that to happen I think there's going to have to be some incentives for the sea eyes.

Poole [00:35:16] Because I mean even myself personally I'm a C.I. but I don't get anything for being a CI of my own personal satisfaction and gratification. And so what.

Poole [00:35:30] This is totally my own theory, but I think what would be a great idea, If I were a director, manager, programmer or if I could have been the one in charge of that relationship, I think it would be great to instead of just hiring your staff physical therapist you're gonna hire a therapist in the role of a CI so you would hire a therapist with the understanding that that therapist knows they're going to be a C.I. They're gonna be responsible for taking students and maybe they get a higher pay level than a staff therapist who may still want to take a student from time to time but that not be their primary obligation.

Myers [00:36:11] Like the Mayo model.

Poole [00:36:13] Exactly. Yeah. So I really think that more sites are gonna have to go to like a Mayo Clinic kind of partnership in order to accommodate and as we move towards the future.

Myers [00:36:24] Well I think there's so CI's that want to teach. I think yeah I think there's more therapies out there that want to be CI's that don't than don't. But when they have these sort of external factors that prevent them from doing that whether it be their clinic culture or their lack of time or whatever it is then you know then we can't we can't empower CIs's we can't build them up to embody that role. So I totally agree. I love. that idea in that model.

Poole [00:36:54] But then the question is who pays for it.

Myers [00:36:58] And you know we need to continue I think to demonstrate the value of having students in the clinic. So and it's not just about productivity. I think we've been focused a lot on the productivity piece as an outcome of student placements and it certainly is a piece it's the most visible challenge I think. It's just like in the CPI where the definition of entry level or whatever is 100 percent right. Grab onto that number. So it's easy to grab on to productivity as an outcome positive or negative of having students. But we I think look a little bit differently at outcomes and value. And so is it patient outcomes? So if having a student in your clinic and having a student treat your patients what are the patient outcomes of having that student time there. Are they different? Are they better? Are they worse? What is the value ther? And what about students that come through and then you hire? How much money do you save without having to go through recruitment? And onboarding time? And mentoring of that new hire into your system? So how can we define those measures to really demonstrate that students are not a drain on the system but actually a value added piece to the system, but it really it takes a lot of work I think to put those measures into place. I think it takes people you know to start to think outside the box. You have to shift the perspective.

Clewey [00:38:33] One of the greatest experiences I was a kid was a utopic situation. To be honest with you is when I had an know springboard on the two to one three to one model it was a win-win-win situation. Use that too often right. But in this situation it really was it was a win for myself as a clinical instructor because I had three students who I was actively engaged in for long term internships able to actually teach them throughout the process and actually watch them develop and such. So as an instructor that was a very rewarding experience as a student it was an extremely rewarding experience because the student that point, versus a one to one model where I was treating and they were treating somewhere or something like that, now I was free to move about the clinic and can be relinquished from my direct role with a patient and really sort of fly all over the place and be there as needed and always be present and always be there for the student, which was great for the student. Obviously they didn't feel like they were bothering me or bugging me or things like that because I was that was my role.

Clewey [00:39:42] And then there was like surprise win-win-win-win because was a fourth win in there. A win for the organization because it did help with productivity but I think the ultimate winner on this one and we didn't track outcomes unfortunately I don't know if we could have as well as we would've liked to have but it would have been interesting and in a perfect world if we could have. But the win I did get to observe was that the patients got in an outpatient orthopaedic setting at least got one on one care for the entire duration that they were there. Whether they were doing theraband exercises or some low grade activity. They had somebody there with them the entire time and so from an alliance perspective

and things of that nature and then they knew who their PT was though because if we had a very standardized process on how we made sure that the patient knew that that was happening but it really was a great model. But we know the organization and certainly invested in it. And it really was a valuable thing.

Clewey [00:40:39] But it goes back to kind of I think early on in my career especially as the CCCE that I think a lot of us CI's we become the C.I. that we had as the CI.

Clewey [00:40:58] And so there is I think it was fascinating when you said there Katie and Ashley is that you know putting resources into the development of CI's will only make not only are our patients get better and then better as students but it's going to move our profession forward because as we develop ourselves at that stage of the game I think that's a really important piece that we need to learn how to become better C.I.'s and t is I think and an area that a lot of PT's are very interested in becoming not just taking students to take for the year taking over students but to take students to really truly instruct them to what seems to be a culture shifting happening.

Myers [00:41:36] I mean there's not always there's the intrinsic value that CI's think the intrinsic motivation of, this is why I want to do this. This is part of my role as a professional. But then you know you do need to have extrinsic an external external value as well. And I know this idea of recognizing our CI's and for excellence and qualities have been defined and there's been recent studies that have really looked at what is and what does it mean. What is the clinical excellence mean and clinical site for Clinical Excellence - what are the characteristics of that. So now what do we do when we actually have a site or a C.I. that embodies those characteristics? There are some tests where there's a task force being created or being in the process of perhaps being developed through ACAP and other other initiatives that are going on at the national level but again consortia that are doing these types of things as well where we're recognizing the CI's and trying to find ways to really demonstrate the importance of that role because there's not a lot of recognition I think at the site level. You know I don't think like clinical sites from the management perspective are really recognizing the importance and the time and the skill and the effort it takes to be a C.I. It's like you know, yes you want to be a CI. Great. Have a student. Oh you did a great job with that student they passed, but like all of the things that you have to do as a C.I. all of that time and effort, and you know just the role model that you are for those students, companies need to really be looking at that and to be fostering that. And I love that idea Ashley, and having that role of a clinical educator or whatever it's called in the Mayo model, where that person comes in knowing that that's their goal and they're seen at a higher and a different level because that's their role. They're valued because of that role.

Poole [00:43:45] And maybe that's part of the onboarding process too.

Clewey [00:43:49] A lot of people interested in a role like that at the moment. So a couple of last questions here.

Clewey [00:43:55] The first one, and I think we've alluded to a lot of these already, but what other innovations do you see in clinical education that you are both working on, maybe including some discussion about the partnership that you have here at Duke between the academic side as well as the clinical side.

Myers [00:44:16] So we're looking at this partnership piece, and really trying to figure out how can we really develop our relationships with our clinical sites in a way that, again, goes back to that ability to demonstrate value for on all sides, of all stakeholders -student,

clinic, program, patient, how can we create a partnership to an experience for our students that really kind of hits on all of all those values for all those stakeholders. So working right now with a large national company to develop a partnership ship that is going to offer experiences where the student is really kind of brought into the culture of that clinic through their existing professional development mentoring system, and really offered a pathway into that company for continued professional growth, and tracking things like patient outcomes, employment after graduation, as well as attributes and characteristics, like confidence are and be pieces of that outcome. So that's one kind of innovation, I guess we can call it, that I'm working on right now. I think there that's going to be a trend that we see here at Duke.

Poole [00:45:49] One of the things I started in our department I guess know how long ago it was now but I don't feel like there is a lot of like you say, training or support, from the clinic side for CI's. So we have all these different focus groups like a neuro focus, a cardio pump focus group, so I started a clinical education focus group. It allows, once a quarter, we sit down anybody who's interested in clinical education and we might have different topics, or different guest come in, and just talk about some of the challenges or aspects of clinical education that we feel like need either more support or sometimes it's literally just to bounce ideas off of each other like "OK I had the situation what would you have done" you know and then sometimes I bring in local DCE's like Katie to come in chat with us and talk with us about what's going on in clinic ed today and so we can kind of get up to speed on what's going on in the academic side because we're not always the ones to hear about what's going on on the academic side. You know we just kind of get the student and go with it. When there's sometimes are these larger things I guess developing, that are outside of our knowledge, you know. So that was one of the things that kind of did on the clinic side. I think there's so much more that could be done on the clinic side but it's hard for one person to do that.

Myers [00:47:19] Yeah I mean I think like your focus group is a great example of activities that can occur at a clinical site that really helped to foster growth and an interest in the CI role. And so you know having the ability to to run a focus group or you know if you have journal clubs monthly or quarterly at your facility, well make one of them make one of them about clinical education. There's lots of articles and lots of great resources out there that you can pull and generate wonderful discussions and and you can focus on a topic whether it be clinical reasoning, maybe it's managing the difficult student, but use your journal clubs as an opportunity to reinforce the role of as a clinical teacher. You know the other thing I think that is happening here at Duke and really in our consortium as well is really looking at ways again going back to that partnership piece but really in the local regional area of how can we as a consortium work together to help support our sites to do things like a focus group or a panel discussion and can DCE go you know a few from their area go and sit on a panel and help facilitate a discussion or provide service for this for the site on a quarterly basis or something like that again- time and resources. But if you collaborate and we work together with other programs then you can perhaps you can can of share in the load and I think clinical sites can do that too. You could partner with other sites whether you're in a health system or maybe your private practice. But there's a couple private practices in the region come together and host clinical education journal club or something like that and work with your local university or local program and perhaps they can help find ways to make it a continuing competency points and that sort of thing. So I think looking at those kind of smaller ways and ones come small but grassroots kind of efforts to focus on clinical education at the facility.

Poole [00:49:31] It's funny you mention that made me think of something else. So for those of you who are CI's I would encourage you to look into who is your consortium because they have clinical reps on these consortia and I'm one of them and that has allowed me to learn who other D.C.E.'s are outside of just my immediate partners at Duke and I recently went to one of our consortia meetings and you know they offer some clin ed as a part of it. And one of the D.C. E's did this great presentation called the true color personality quiz. And so I was like think this would be great for our staff, could you come and do an in-service for our staff. And it would help them with like you know interpersonal relationships and the working around and also in student they have students that are different personality types and there's a how to manage that. And she came and did it and was great. Like so I would encourage you to like see who your consortium members are and let them know you're interested in being a clinical rep on it. And it's a great way to to learn more about what's going on in clin ed and to bring that back to your clinic and help develop things in your immediate department.

Clewey [00:50:45] You know one of the things that we did I guess in my prior role when I ran a residency program was that we actually required a online course, rudimentary to some extent, but it was on how to be a C.I. And that was a requirement for them to go through residency to you know sort of facilitate a kind of a medical model and that internship leading to the next level of expertise and and it's kind of trained them to move on from that and so kind of forced the resources on that point.

Clewey [00:51:19] So last question here I think anyway. So you've both alluded to this already but maybe make it more specific in terms of its focus here with the question if you're speaking to the new clinicians or the clinicians who have never taken a student. What advice might you have for them to become a C.I. And then second for those who are CI's what advice might you have for them in developing themselves to become a better CI.

Poole [00:51:57] Okay. There's a lot but I'll try to keep it simple to a couple of points but I think for the new CI think sometimes the hardest thing is two things. Number one that the student doesn't need to be a mini you. And I think that's a lots of times what's expected when you're a new C.I. is you want that student to do things exactly how you do it. But I think to allow that student to grow sometimes you just have to step back and let them do it their way and let them kind of come to things on their own accord not answer questions for them, encourage them to go look up answers and bring them back versus just giving them everything right at once.

Poole [00:52:42] And the one thing I tell all of my new CI's I'm like you know when the student gets to the point where you're ready to set them free and they're going to see patients on their own - still go watch them and be a fly on the wall. I think it's gonna be the hardest thing you do but don't say anything. Don't stop them. Don't interrupt them. Don't literally don't say a word unless there's a major red flag safety issue and you know if they leave the I.V. pull plug, let them leave it plugged in. If they forget to move a catheter and you know it's not a risk of being put out patient, let them forget it because those mistakes that they make and those moments where you don't say anything and you don't jump in are the ones they're going to remember and they're never going to repeat again.

Poole [00:53:30] So my biggest advice to new CI's eyes is number one don't expect a mini you let them kind of develop themselves and then just the hardest part I think is the new CI is not jumping in, and not saying anything, and letting them just go but being kind of that fly on the wall.

Myers [00:53:47] I feel like CI credentialing course like the next level. Part two should be like how to be quiet.

Poole [00:53:56] Yes.

Myers [00:53:57] Like how to like not talk as a CI and how or how to let your students struggle.

Poole [00:54:04] Yes.

Myers [00:54:07] There needs to be section - How do you how to let your steward how to let someone else struggle in front of you.

Poole [00:54:10] And I also tell them it will take them two or three times as long as it takes you to see the patient and to write the note, butlet them take that time. They need that time to figure it out because if you jump in and try to rush them they get frustrated they don't learn.

Clewey [00:54:28] And they lose their personality because I think that they feed off of that. You know trying to become of mini you. Cause I think that some of them go into that experience thinking OK I need to be like Ashley because this is how I am going to get through and letting them become their own person.

Myers [00:54:47] I think it's helpful when I CI actually says that up front to their student. Like in the first week you know when you're talking and I always encourage the students to try to open a conversation in the first few days with the C.I. about expectations. And it's I think it's so helpful for a student to hear from the CI. I'm not expecting you to be me.

Myers [00:55:08] II mean not every CI can actually can say that because I think there are some ideas that do expect that. They see a student as an ability to recreate what they do because they're proud of what they do, and they're passionate about how they take care of their patients. But I think it's really helpful for students to hear that from the CI's. I don't expect you to be me. I do expect you to learn from me but I expect you to find your own voice as a practitioner during this experience.

Poole [00:55:41] And I think for those out there who are more experienced CI's who are looking to go to the next level there is an advanced C.I. credentialing course. I would encourage them to take.

Myers [00:55:52] This revamped.

Poole [00:55:53] Yeah they did. And it's much better from what I hear. I took it before the revamp but it's really great now from from the feedback I've gotten. But I would encourage them to do that I would encourage them to like rather than just teaching them like what you do on a day to day basis which is kind of like you know what you are doing in the beginning until you really learn the craft of being an educator. But I would say make your students dig into their research, you know you dig into the research, make it really evidence-based challenge them to trynew outcome measures they haven't ever tried before. You know and maybe you have to try a new outcome measures you've never tried before to do that. You can use some of them more like you can use clinical reasoning tools or rather you've got that student. I've done this before which is challenging for me to do as an experienced CI, but you know how did I make this decision? Because for me it's just

like bam this is my decision. But for a student to learn how you got to that decision maybe using like an ad hoc tool or something like that so they have to write out like all the steps they had to get to that decision using those. Breaking it down to like what are the impairments and what are the functional limitations. Cause that's not something we as experienced CI's do on a day to day basis but I think it's really helpful for the student but challenging for the CI. But it kind of takes it to the next level. I think for the CI and for the for the student as well. And then maybe have your student teach you you know and see how they can teach it back. Or if you're somebody who has a resident like I've used my residents before I make my residents teach my students you know and do that kind of medical model.

Poole [00:57:32] I just I feel like there's so many things out there you can do to take it to the next level but you have to want to do that and invest the time in doing that to. Even in note writing like stepping up your note writing so they can see that and make there is even more advanced level.

Myers [00:57:49] You should write a blog and because you have some many great ideas..

Poole [00:57:53] Oh I am not a blog writer. I can talk about it all day, but to put it into words - no.

Clewey [00:57:58] So maybe you should start a clinical education podcast.

Poole [00:58:01] There you go with your help I will do that.

Poole [00:58:04] I'm an idea person I'm not always an implement the idea a person.

Myers [00:58:10] I think you know I would ditto everything that Ashley just said in terms of advice for new CI's and experienced CI's. A couple other things that come to mind I would say for any C.I. whether you're new or experienced to remember that this students only learning experience with you at your facility. They may go to another outpatient orthopedic clinic during their clinical education time, they might be in another hospital setting, but this is the only time they're in your facility with your patients. And if you had to answer the question what is the most important thing you want that student to get out of the experience? What would that be? Think about that as you bring students in to work with you. What do you really want that student to get from this experience? Is it an earlier clinical experience for the student and so they are really focused on safety and maybe its line management? If it's an acute care setting or it's doing it the patient interview an early experience, but what do you really want to get? What do you think the most important things for the student to get out of that? Because I think that I'll help you as a CI sort of remember to focus your learning experiences for the student around the important pieces of that setting.

Myers [00:59:36] Don't be afraid to reach out to the program so don't be afraid as a C.I. to email or call the DCE if you have a question. We love to hear from our CI's and not just when there is a problem but certainly if there's a problem. So please don't forget about the program as your resource and as a support. Hopefully you work at a site that has a CCCE or SCCE that is supportive and is your first line of connection and help or support or resource. But that's not always the case and fortunately there is a lot of places that don't have CCCE's right in that same you know in that location or that's just not the role of the CCCE at that facility. And so if you feel like you're on an island or you don't feel like you

don't have the support then you should call the DCE. We're very nice people generally and we really do love to hear from you.

Poole [01:00:38] And you don't have to wait till midterm.

Myers [01:00:39] You don't have to wait till midterm, and in factyou don't even have to wait till the end of the first week. If you have a question. So I would say that's another piece to just remember. And then the last thing that comes to mind is just to remember that the student doesn't have to always be with you and touching a patient to learn. So don't be afraid to step away from your student and do what you need to do - Maybe you need to go see a patient, and the student can learn without you. They can write a note, they can review one of your notes, and give them an assignment around it reviewing documentation, they can prepare for a patient, they can dive into the research, maybe they can spend time with the O.T., or that the aide, or whoever the front desk staff to learn about things. So don't be afraid to send the student away from you from time to time so that you can maybe have a breather but also because a student can learn away from you. And in fact needs to learn away from you so that they can really understand all of the ins and outs of that setting. And what it really means to be in that setting as a professional and that can't just happen when they're just with you.

Clewey [01:01:59] There's some great points and you know honestly the assumption of knowledge sometimes when people are given when they become a C.I. which maybe is why we become CI like CI's that we had before us.

Clewey [01:02:14] I think you brought up both some really good points, and in reaching out and gaining mentorship in becoming a C.I. because it is not something that is innate natural it's not instructed. For my knowledge we don't teach how to become a C.I. in PT education.

Myers [01:02:31] Although its now a capte criteria that our students have opportunity to kind of function and learn to be what it's like to be a CI.

Clewey [01:02:38] I think that's great but kind of goes along with what we were doing our residency program and teaching folks how to do it early on and get that mentorship.

Clewey [01:02:46] Well if you haven't already figured out this is a long show but probably because there is so much talk about we have two individuals in here that love clin ed - and I should say actually three individuals in here that love clinical education. We could probably go on and on and on, and joke with Ashley that she should start a clin ed podcast, and it sounds like there's probably many topics, but as I said in the opening I'm hoping that this was stimulating for all of our listeners out there, especially those that are interested in becoming a clinical instructor, clinical educator, And so on. So I want to thank Katie and Ashley for being in these fly by night makeshift studios here and having a little hour of good discussion about clinic. So thank you both for coming on the show. Thanks for having.

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