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December 15, 2016

September 30, 2016

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Accreditation.  The word we love to hate.  We’ve all heard of or experienced the accreditation process at some point within our careers-either as a student, a clinical instructor, or a faculty member. But do we really understand the purpose of accreditation or the role of CAPTE plays in accreditation of physical therapy education programs? Most will say they know only as much as they need to, however a brief refresher of its importance, its role in entry-level education, and highlights of some components that could be enhanced during clinical education experiences never hurt anyone. 

 

For starters, accreditation guarantees the education and training of our next generation of physical therapists is possible. Accreditation is voluntary, however without it, graduates are unable to site for the licensure exam.  Accreditation is a valuable service to the public, students, educational institutions, the programs and the profession as it ensures a standard of quality that otherwise would go unchecked.   It ensures to the public the training provided to graduates conforms to general expectations within our profession. It ensures to students that the program selected will train them for the current practice standards. It ensures institutions and programs participate in regular and ongoing self-evaluation and self-directed improvement processes. And it ensures the professions commitment to excellence in education, which in turn reflects excellence in clinical practice. 

 

CAPTE, the Commission on Accreditation in Physical Therapy Education, is the only organization that can regulate the quality of entry-level physical therapy education. Accreditation by CAPTE is a statement that physical therapist or physical therapist assistant education programs meet the standards for quality set by the profession.  CAPTE is responsible for the oversight of compliance with the published Standards and Required Elements of the physical therapist or physical therapist assistant education programs.  The minimal standards set by CAPTE are reviewed, revised and published every 10 years.

In January 2016, CAPTE published the 2016 set of minimum standards.  I recently contacted Ellen Price, PT, MEd, Lead PT Programs Specialist for CAPTE, to ask her about 2016 CAPTE Standards and Elements that clinical educators should be aware.  Ellen highlighted 2 main areas that often appear to not be well addressed in clinical education. These include student participation in non-patient care activities and inter-professional education. Each will be briefly reviewed.

  1.  Student participation in non-patient care activities

Relevant Elements:

7D25  Determine those components of the plan of care that may, or may not, be directed to the physical therapist assistant (PTA) based on (a) the needs of the patient/client, (b) the role, education, and training of the PTA,  (c) competence of the individual PTA, (d) jurisdictional law, (e) practice guidelines policies, and (f) facility policies.

 

7D29 Delineate, communicate and supervise those areas of the plan of care that will be directed to the PTA.

 

CAPTE expects educational programs to prepare PT students to determine those components of interventions that may be directed to the PTA.  These considerations should include the level of skill and training required to perform the procedure, the level of experience/advanced competency of the individual PTA, the practice setting in which the procedure is performed, and the type of monitoring needed to accurately assess the patient’s response to the intervention.  In addition, the acuity and complexity of the patient’s condition and other clinical factors should be considered when directing PTAs to safely and competently perform any intervention.”

 

Five other elements in non-patient care management include:

 

7D2 Report to appropriate authorities suspected cases of abuse of vulnerable populations.

 

7D3 Report to appropriate authorities suspected cases of fraud and abuse related to the utilization of and payment for physical therapy and other health care services.

 

7D36  Participate in the case management process.

 

7D42   Participate in the financial management of the practice setting, including accurate billing and payment for services rendered.

 

7D43  Participate in practice management, including marketing, public relations, regulatory and legal requirements, risk management, staffing and continuous quality improvement.

 

These five areas require graduates to participate in the management of the practice of physical therapy.  The professional roles and responsibilities of physical therapists extends beyond just the patient-client interaction.  It also includes managing his/her own individual practice, regardless of who “owns” the practice.   The case management process can extend from “ownership” of the patient case from first visit to discharge and anything in between, including calling referring physicians, reporting during interdisciplinary team meetings, or advocating for the patient with third party payers.   

 

Graduates also must understand the reimbursement and payment processes within the practice settings in which they work. Students should be given the opportunity not just to charge for the services provided, but also have discussions with accounts payable/receivable staff to understand the bigger picture of reimbursement at all levels.  Students need to internalize the responsibility of billing for services to third party payers. It’s not enough to claim that an encounter was billed a certain way because I was told to do so.  Graduates must assume responsibility for the outcomes of the actions they take in regard to delivery of care and remuneration of services-and what is legal and ethical. 

 

Finally, graduates also need hands on experience during clinical education experiences to appreciate how a practice markets itself in its community, how the practice impacts the community’s overall health, any rules/laws/policies that impact the delivery of service, and also the determination of case-mix and staff mix.

 

Summary of this focus area: Education programs must provide classroom training on the PT-PTA relationship and the practice management that impact the day to day delivery of physical therapy care.  Educational programs are also responsible for ensuring this classroom training is then applied with intentional clinical education experiences to ensure all graduates are competent with the knowledge, skill and behaviors pertaining to these elements.  CAPTE does not mandate how this is done within a program, as it leaves latitude at the program level to determine the breadth and depth of the content. 

 

Applied learning examples: As center coordinators of clinical education and clinical instructors examine their practice clinical education curriculum, it may be helpful to purposefully design learning activities to ensure students participate in discussions about the PT-PTA relationship and practice management activities.  It would be very helpful not to leave these issues to chance.  Activities that you can require every student to do include:

  • Require students to review state specific practice acts about the PT-PTA roles and responsibilities AND the APTA documents on the same topic.Follow up reviews with CI discussion;

  • Develop opportunities where students can participate in treatment sessions alongside a PTA to learn from them about their delivery of therapeutic interventions;

  • Require students to interview/spend time with case managers for discharge planning, office staff for scheduling or billing/reimbursement, rehab managers for big picture discussion on role PT practices within the community or the organization;

  • Participate in community events alongside their CI.

Directors of Clinical Education could also complement the clinical experiences by asking students to reflect on these experiences during concurrent online discussion, end of course reflection papers or onsite class discussions upon return to the academic program.  The key to enhancing student exposure to these elements is making the learning intentional during the learning experience.

 

2. Inter-professional activities

 

The topic of inter-professional education is addressed in both Standard 6 and 7 (there are 8 total standards). The expectation for inter-professional education was always “assumed” would occur in the clinic, however the new standards require programs to provide evidence of inter-professional education is purposefully covered in the didactic curriculum, coupled with clinical education experiences. Learning activities that build inter-professional competencies that can be delivered in the classroom and clinic include: values/ethics, communication, professional roles/responsibilities and teamwork. 

 

Summary of this focus area: A collaborative approach to bridging the didactic and clinical education activities of inter-professional education will enhance entry-level physical therapist practice.  We often “assume” students have opportunities to practice these skills, or discuss their knowledge about inter-professional care, however without purposeful, intentional planning, many times opportunities are not provided to students.  We shouldn’t take for granted that applied learning will happen by chance.  We must make them happen.

 

Applied learning examples: Example activities that clinical educators can require every student to do include, while out on a clinical education experience include:

  • Require students to report at interdisciplinary team meetings;

  • Arrange for students to follow a patient they may have evaluated during treatment sessions with an occupational therapist, or speech-language pathologist;

  • Arrange for students to spend a day at your local prosthetics/orthotics business;

  • Ask students to investigate and gather information about local community agencies where patients/clients could be referred. Require them to interview (not through email) with a local service agency (I.E. Area Agency on Aging).

Remember, it is acceptable to provide students learning opportunities during a clinical education experience that is not direct patient care.  Students will only learn about the “big picture” of physical therapy practice if they are given time and opportunity to put what they learn in the classroom into practice during clinical education experiences.  I am sure that there are MANY MORE examples of applied learning that already exist out in the clinical environments. I encourage your clinical practice to discuss these areas with all CIs to develop system wide experiences for all students, rather than leaving it up to individual CIs to develop themselves. There is strength in numbers-and this can apply to the development of your clinical education curriculum as well.

 

Other Standards and Required Elements that pertain to clinical education that are nice to be aware of include:

  • A minimum of 30 weeks of full-time clinical education is required.

  • Integrated clinical education experiences (either full or part time) is required. This means a program must build into its curriculum student opportunities for actual workplace exposure before the end of the didactic portion of the program.

  • Clinical instructors are licensed physical therapists with a minimum of 1-year full time (or equivalent) post-licensure clinical experience, AND are effective role models and clinical teachers.

    • CCCEs may want to begin thinking about an internal, site specific mechanism to assure all your CIs exhibit abilities to be role models and clinical teachers.

If you have the will power (or need something to help you sleep at night) you may access the CAPTE Standards and Elements documents for physical therapist education, at:

 

http://www.capteonline.org/uploadedFiles/CAPTEorg/Portal/CAPTEPortal_PTStandardsEvidence.doc

 

In final summary, similar to accreditation in health care settings, the accreditation process for physical therapy education requires academic programs to commit to a continuous quality improvement program, which in turn enhances the outcomes of professional education.  The Standards and Elements of how programs are assessed for quality are well thought out, are multi-dimensional, and are NOT prescriptive in nature.  They allow for programs and clinical sites to build curriculum that will develop our next generation of physical therapists and will meet the growing needs of society.

 

Please contact your local DCE should you have any questions-or you are also free to contact me at: cmccallum@walsh.edu

 

Clinical education would not be possible without the academic and clinical faculty AND the academic and clinical education curriculum.  We can work together to build a better tomorrow.

 

 

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