Abstract

Doctor of Physical Therapy (DPT) programs use various methods to match students with sites for clinical experiences. This paper discusses the role of the placement process in PT clinical education, describes the methods currently in use, and outlines advantages, disadvantages, and best practices for each method.

Clinical experience placements are vital to quality Physical Therapy education.

 

Introduction

Physical Therapy education today prepares students to practice in an ever-changing landscape. Experience in clinical settings is critical to students achieving competence as practitioners. Because students’ clinical experiences are so important, Directors of Clinical Education (DCEs) must make the most of every aspect of the student placement. A suitable placement method can facilitate quality assignments and optimize utilization of clinical placements available to the program

DCEs face many challenges while attempting to satisfy all stakeholders in the clinical experience placement process. They must choose from various placement methods, each with its own advantages and disadvantages.

 

Stakeholders

Effective clinical education depends on academic programs, clinical education sites, and students working together to achieve the shared goal of clinical competence for each student. To this end, the process must be mutually beneficial.

                                                 

Effective clinical education depends on programs, clinical education sites, and students working together.

 

Programs

Programs must provide students with the didactic underpinnings that enable students to safely and effectively treat patients in the clinic. The DCE matches each student with a clinical placement that meets their needs and preferences as well as helps the student to fulfil the graduation requirements for the program. These needs must be balanced with the need to maintain positive and ongoing relationships with clinics.

 

Clinical Education Sites

Clinical education sites provide an environment in which the student can achieve clinical competence. This requires resources and planning on the part of the clinical education site. While the right students can add value for a clinical site, a mismatched student may be a liability and receiving no student at all makes planning difficult.

 

Students

Students must develop the appropriate knowledge during their didactic coursework to be able to safely interact with patients during their individual clinical experiences. Each student deserves a placement that suits their educational needs, fulfills various required clinical settings for their program and allows them to develop needed clinical competencies.

An effective placement process will balance the needs of clinical education sites, programs, and students in a mutually beneficial way

 

Challenges for the DCE

The clinical education placement process is challenging no matter what placement method programs use. On a basic level, it is a multi-step process:

Throughout this process, the DCE faces many challenges including:

• Annual placement volume

• Clinical Education Site capacity in a competitive environment

• Ensuring program and CAPTE requirements are met

• Limited time and administrative resources

• Staff and faculty turnover

• Struggle to maintain any current contractual agreements

 

As departments seek to increase their enrollment numbers, clinical educators will have to work hard to ensure continued site and slot capacity.

Annual Placement Volume

The average DPT student spends 27.5% of their education in the clinic across 3 or more individual full-time clinical experiences.1 This results in a substantial need for placements. For example, a 3-year program with 60 students per cohort must assign 180 placements annually.

Clinical Education Site Capacity in a Competitive Environment

Currently, nearly 250 DPT programs nationwide compete for slots. As programs increase enrollment numbers and clinical education sites are forced to prioritize staff productivity over acceptance of students, DCEs must work hard to ensure continued recruitment of the needed number of slots.

Ensuring Program and CAPTE Requirements Are Met

CAPTE requires students’ clinical experiences that “encompass… practice settings representative of those in which physical therapy is commonly practiced,” “representative…across the lifespan and continuum of care,” include “involvement in interprofessional practice,” allow for participation in a PT/PTA team, and “lead to the achievement of the program’s defined expected student outcomes.”

The choice of placement method is also a factor in accreditation as programs are required to “Describe the methods used to assign students to clinical education experiences”

In addition to the evaluative criteria set forth by CAPTE, many programs also require students to complete clinical rotations in various settings, such as inpatient, outpatient, and neuro, and across a diversity of populations.

Limited Time and Resources

Now more than ever, programs are being asked to work with limited resources. Many placement processes are inefficient, take hundreds of person-hours to complete, consuming these valuable resources. Programs must find a way to balance this critical process with available resources.

Staff and Faculty Turnover

When dealing with high volumes of data and the high stakes of the clinical placement process, institutional knowledge is critical. Unfortunately, clinical education programs struggle to document this knowledge and often lose it in the face of staff and faculty turnover.

 

Placement Methods

Most DPT programs use one of the following methods:

Programs must consider their unique needs and challenges in selecting a method including available time and resources, volume of students and slots, the level of control given to students and the amount of individualized attention they wish to provide.

 

Lottery Method

Overview

In the “lottery method,” each student has to select their own placement in order of a randomly selected or assigned number.

 

Advantages

Lottery placements give students the impression of a high level of choice and freedom in their placements. This can increase student buy-in with the process and because of this, they tend to like the idea of a lottery system.

The lottery process is very transparent and does not allow for favoritism. When each student makes their selection, they are fully aware of what the students before them have chosen and what will be left for those behind them.

No special tools or infrastructure is required for a lottery process. Programs generally use a shared spreadsheet or complete this process in person during cohort-wide or individual meetings.

 

Disadvantages

The feeling of choice that students have is often an illusion. Lotteries by their very nature depend on luck, leaving placements to chance. Random distribution of numbers results in dissatisfaction among students with higher numbers. Taking steps to ensure that for at least one clinical experience, students have a low lottery number can improve results for students.

Unfortunately, even when programs take great care in assigning numbers, there is little guarantee that students will get low enough numbers to get their top choice of placements. So even though students are technically choosing their slots, they are choosing from a smaller selection of slots. This is particularly problematic when programs have few excess slots. For example, a program with 60 slots for 60 students leaves the last student “choosing” from 1 slot.

Furthermore, not all clinical experiences are created equal. Students typically place a higher value on their terminal clinical experience. They see this experience as a place to build critical relationships that can assist them in finding their first job and establishing themselves in the profession. Students who receive placements they don’t like for their terminal experience are usually very upset.

Lotteries by their very nature depend on luck, leaving placements to chance.

 

Lottery Method

Advantages

1. Provides the illusion of choice

2. Does not require special technology

3. Transparent

 

Disdvantages

1. Depends on chance

2. Potential for repeated poor lottery numbers and limited choices

3. Minimal input from DCE

 

Manual Method

Overview

When utilizing the “Manual” placement method, the clinical education team places each student individually into a slot using criteria defined by their program. Many programs also allow students to submit a ‘wish list’ of preferred slots that the clinical education team uses as a factor in placements.

 

Advantages

The hallmark of a manual process is a high level of control and individualization. In a manual process, the DCE takes responsibility for meeting all the needs of the program, clinical education sites, and students. A manual process allows the DCE and their team to take advantage of their knowledge of all stakeholders to find a perfect match.

This approach allows accommodation of a wide variety of special circumstances for both students and clinical education sites. For example, a student may require a specific type of learning environment or a clinical education site’s teaching style may best suited to a high caliber student. In making each placement by hand and accounting for these circumstances, there is an increased chance of a successful placement.

This process does not require any special infrastructure or tools. Rather, programs often rely on spreadsheets and team meetings to make the needed matches.

Disadvantages

A typical manual process requires a vast amount of data and the potential for human error is very high. It’s not uncommon for programs to use multiple spreadsheets, stacks of “wish list”, word documents, and other improvised tools to track the mountain of data. A clinical education placement tool capable of filtering and managing data can help reduce errors.

A manual process also depends heavily on institutional knowledge. The individuals placing students rely on their relationships with and understanding of each clinical education site and student’s strengths and areas for improvement. As mentioned previously, this knowledge is easily lost through faculty and staff turnover leaving newer DCEs less able to make informed matches.

This process also lacks transparency for students. Because the process happens behind the scenes and involves many individual decisions made by the clinical education team, it is common for students to perceive the system as unfair when they don’t receive a preferred placement.

Allowing students to fill out a “wish list” can mitigate some student dissatisfaction; however, adding a “wish list” to a manual process adds more information for the clinical education team to consider and manage. For example, with a class of 60 students, a “wish list” of 10 slots each adds 600 additional data points.

A typical manual process requires a vast amount of data. The potential for human error is very high.

 

Manual Method

Advantages

1. High level of DCE control

2. Can handle many special requests

3. Does not require special tools or infrastructure

 

Disdvantages

1. Depends on chance

2. Potential for repeated poor lottery numbers and limited choices

3. Minimal input from DCE

 

Automated Method

Overview

In the “Automated” method, a computer algorithm is used to match students with slots. Student preferences may or may not be considered in this process. Because of large number of variables at play in the placement process, it is difficult for humans make matches efficiently. Computers have no such limits; they can deal with the variables and complete needed calculations in minutes. That’s why many programs are moving toward automation.

All this said, randomly matching students to slots is insufficient. Quality automated systems must consider the needs of individual students in relation to the entire group of students including student preference, location, and required clinical settings. Any automated placement system must be able to consider multiple variables and be able to accommodate the needs of the entire class of students.

 

Advantages

Time savings is a key benefit for automated placements. Results are typically available within minutes or hours rather than the days or weeks with other methods.

Automated methods use data tracked and managed within a system, reducing the reliance on institutional memory and increasing the effectiveness of the placement process. When quality data is provided, the automated placement approach allows even a new DCE to easily produce quality placements.

An optimized algorithm considers the needs of the entire class to create the best possible placements from a statistical standpoint.. This can require over a million calculations – more than any DCE or clinical education team can do. Algorithms are also unbiased, treating each student the same. A widely-used algorithm placed 85% of students in 146 classes in their top choice.

 

Disadvantages

Some programs worry about the perceived loss of control associated with an automated process. For programs that have been placing students manually, it can be a difficult transition to allow technology to make the placements. A quality placement system will allow human control as a second step to augment the advantages of automation.

Because of the automated nature of this system, programs must begin with clean accurate data. Without this, the quality of the results can be compromised.

A quality automated process requires an investment in technology to perform the placements. Only an optimized system that considers many variables and the entire class can truly provide satisfactory placements.

A quality automated placement system will allow human control and interventions alongside the advantages of automation.

 

Automated Method

Advantages

1. Saves time, reduces human error, decreases reliance on institutional memory

2. Fair and transparent

3. High level of student satisfaction

 

Disdvantages

1. Perceived loss of DCE control

2. Requires investment in technology

3. Depends on clean, correct data

 

Hybrid Method

Overview

The best practice when utilizing an automated placement method is to combine technology with a human touch. Programs can gain both time savings and optimized results of automated placements and the individualized approach of manual placements. The “Hybrid” approach achieves just that. Through a combination of Manual, Lottery and/or Automated placement outcomes are maximized.

The substantial time savings associated with an automated process is alluring to many programs. However, these programs also know the great value of human knowledge and judgment in making placement decisions. Programs who choose a hybrid process value both.

 

Advantages

Time savings is still a key factor in choosing a hybrid method. A hybrid method can accommodate special cases while benefitting from the optimized nature of automated placements. For example, programs often have key slots that require special attention. Other times, programs have arranged placements on behalf of specific students or have students with unique needs that require just the right slot.

In each of these cases, the clinical education team would manually make the placements and run the automated placements with the remaining slots and students. After the automated placements have been run, programs would then evaluate the placements and make changes as needed.

Student satisfaction with hybrid methods, as with automated placements, remain high. Programs get the benefits of the optimized placements in conjunction with providing special attention where needed. The quality of placements here is reflected in student satisfaction levels.

 

Disadvantages

The time savings associated with the hybrid method are not quite as high as with the automated method. However, most programs feel that this method allows them to put their time and resources where they are most needed.

As previously mentioned, automated placements depend on quality data. Because the hybrid process requires an automated algorithm, programs must invest in the automated placement technology to ensure that the data provided results in the best possible placements.

Lotteries by their very nature depend on luck, leaving placements to chance.

 

Hybrid Method

Advantages

1. Saves time

2. Accommodates special cases

3. High level of student satisfaction

 

Disdvantages

1. Requires investment in technology

2. Depends on clean, correct data

3. Time savings are not quite as high as automated placements

 

Placement Methods Summarized

Lottery, manual, automated, and hybrid methods each have their own advantages and disadvantages. It is useful for programs to compare methods and assess which one suits their needs, maximizing advantages and minimizing disadvantages as they relate to their individual circumstances.

 

Summary Table of Placement Methods

	Lottery	Manual	Automated	Hybrid
Overview	Students select placement in order of a randomly assigned number.	The clinical education team places each student in a slot according to various criteria	A computer algorithm matches students with slots using various criteria.	Combines manual and automated methods.
Advantages	Provides the illusion of student choice Does not require any special technology Transparent	High level of DCE control Can handle many special requests Does not require special tools or infrastructure	Saves time, reduces error, and decreases reliance on institutional memory Fair and transparent High level of student satisfaction	Saves time Accommodates special cases High levels of DCE control and student satisfaction
Disadvantages	Potential for repeated poor lottery numbers Minimal input from DCE Depends on chance	Time-intensive and prone to human error Depends on institutional memory Not transparent	Perceived loss of DCE control Requires investment in technology Depends on clean, correct data	Requires an investment in technology Depends on clean, correct data

 

Key Takeaways:

• There are pros and cons to all placement methods. Programs should asses the advantages and disadvantages to find a method that works for their student population and clinical partners.

• With so much at stake in clinical education, PT educators must utilize a placement process that matches the needs and values of their program, provides quality placements for students, and optimizes available resources.

• Lottery methods can be popular with students but have many disadvantages including a failure to deliver on the promise of choice.

• Manual methods offer high levels of DCE control and can accommodate special cases but are time-consuming and prone to errors.

• Automated methods are the most time-efficient, but programs must select a robust algorithm that can consider multiple factors.

• Hybrid methods combine automated and manual methods, offering programs the advantages of both while limiting the disadvantages.

 

 

About Prism:

Exxat Prism is an all-in-one Education Management Platform for Health Science Programs. It streamlines Clinical Education, Curriculum Management, Document Compliance, and Contract Tracking & Sharing.

Prism manages it all from placement availability, site details and accreditation reports to required documents, patient logs, curriculum mapping, and evaluations. Our integrated database helps you to seamlessly collect and manage everything through just a few clicks.

You can learn more about Prism and request a demo at https://exxat.com/solutions/prism/