October 14, 2025 • 55 mins
How do we train this generation of PT students? What is being asked of them that our Clinical Instructors need to recognize? How do I connect with young people in my clinic?
If you're asking any of these questions, this episode is for you. Ashlee Butler, PT works across the country to help bridge the gap between academic knowledge and clinical competencies. She joins Richard today to share insights about the needs of students and CIs for how to be successful in the clinical placement process.
To learn more about us, visit our website at https://www.allianceptp.com/
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Alliance Physical Ther (00:00):
Alliance Physical Therapy Partners and
Agile Virtual Physical Therapyproudly present Agile and Me, a
physical therapy leadershippodcast devised to help emerging
and experienced therapy leaderslearn more about various topics
relevant to outpatient therapyservices.
Richard Leaver (00:19):
Welcome back to Agile and Me, a physical therapy
leadership podcast series.
Today, I'm extremely excited towelcome Ashley Butler.
So Ashley, welcome to the show.
Ashley Butler (00:29):
Thank you.
Richard Leaver (00:32):
So today we're going to talk about clinical
placements and clinicaleducation in general, perhaps a
little bit for physical therapystudents specifically.
And Ashley, you have aremarkable background in PT and
also education.
When I looked you up and typedin Ashley Butler PT, there's
(00:55):
actually another Ashley ButlerPT in Nashville as well.
So I didn't know whether youknew that or not.
There's two of you.
Ashley Butler (01:01):
I knew there was an Ashley Butler.
I didn't know that she was alsoa PT, but I did know there were
two of us in Nashville.
Richard Leaver (01:08):
That's funny.
So for the listeners, would yoube so kind as to perhaps give
them a little bit of yourbackground as to how we perhaps
ended up talking today and yourexperience in clinical
education?
Ashley Butler (01:22):
Absolutely happy to.
I'm proud of it.
I graduated from a program inrural North Georgia that was
actually designed to be one ofthe first DPT programs in the
country.
So pre a lot of people gettingDPTs, the program I went to was
designed for that.
So becoming a clinical educatorwas very much a part of that
(01:43):
curricula.
And I became very passionateabout doing that in my very
first job.
out of PT school, the sitecoordinator of clinical
education left.
And so my boss said, would youlike to do this?
Would you like to be the sitecoordinator?
And I was like, oh gosh, whatdoes that mean?
And she explained it to me isbasically I would be the liaison
(02:04):
between academic programs inour specific clinic and I would
be a clinical instructor.
And then I would also help toonboard the students that came,
whether or not they were with meas the clinical instructor or
another one of our physicaltherapists.
So I took that job, smallclinic.
I think we only had like fouror five academic partnerships,
(02:25):
but I became really excitedabout working with the academic
programs and bridging that gapbetween academic knowledge and
clinical application.
I got married in the processand my husband's a musician.
So he moved me from NorthGeorgia to Nashville, Tennessee,
and I got a job with outpatientorthopedic company that did not
(02:49):
have a coordinator of clinicaleducation, although they were
taking students.
And I was assigned a studentand my student was subpar, to
say the least.
She was only in Nashvillebecause she wanted to come to
Nashville.
She didn't want to learn manualtherapy.
She didn't necessarily want tolearn what I was teaching her.
She just wanted to be inNashville, Tennessee.
This checked a box and I saw aneed.
(03:12):
So I asked my boss if I coulddo it.
And I decided that I wanted toapply what I learned from
school, making things structuredand I designed a curricula for
our students and grew thatprogram as the company grew.
And we went from just a MiddleTennessee-based company to a
(03:33):
nine-state, 160-clinic company.
And I helped plant differentparts of the company in
different states and grew thestudent program, which actually
grew to a really robust new hireprogram.
And super proud of what webuilt.
And then COVID.
(03:54):
And when COVID COVID happened,I had to transition out of my
role as a clinical educator.
And I took another job withinthe company and realized that
that's not what I wanted to do.
So I started looking for moreclinical education jobs.
And I went to work forTennessee State University.
So I was on staff at TSU intheir DPT department.
(04:17):
I worked right alongside thedirector of clinical education.
So I actually was on theacademic side of the clinical
education coin helping to placestudents in clinical sites.
I'm also, and I still am, aclinical instructor in the pro
bono clinic on campus.
So I work with first year andsecond year students as I treat
(04:39):
patients and I guide thestudents along in the treatment
of patients.
So I'm still actually clinical.
And then I had a colleague tellme about Alliance and
everything that Alliance wasdoing and that they needed a
clinical coordinator.
And so I found myself atAlliance doing again what I'm
really passionate about, whichis developing relationships with
(05:02):
academic programs and workingto bridge the gap between
academic knowledge and clinicalcompetencies.
Richard Leaver (05:08):
That's quite a journey.
Ashley Butler (05:11):
I've been doing it since 99.
Richard Leaver (05:13):
99.
Since you were five years old,so congratulations.
Exactly, exactly.
Maybe seven.
Maybe seven.
I think what's interesting isreally your perspective as it
pertains to the responsibilityto assist with education of
others.
I think there's definitealignment there.
(05:34):
When I trained as a therapist,it was really made very clear
that as a professional, one ofthe responsibilities of such is
to assist in the development offuture clinicians.
And the education in variousforms was really a
(06:00):
responsibility of everyonewithin that profession to
maintain and continue to growthat profession and really help
those that will you know followin footsteps and I think some of
that expectation or perceptionof being almost a requirement of
(06:20):
being a professional has beenlost or was never taught because
you know there's a lot ofclinicians that aren't involved
with education and maybe forvery good reason.
But I've certainly embracedthis concept all the way through
my career that education andsupporting education is really
an imperative as a professional.
Ashley Butler (06:41):
Absolutely, 100%.
And I mean, to me, the mostbasic part of that is you
wouldn't be where you are and Iwouldn't be where I am unless a
clinical instructor sewed intomy life And so how is our
profession going to grow if wedon't continue to emphasize
(07:01):
clinical education?
Yeah.
Richard Leaver (07:04):
So obviously, as it pertains to clinical
education, let's dive into theweeds a little bit and really
take a look at clinicaleducation, particularly
placements as part of thatclinical education and, you
know, clinical instructors, therole thereof, and see what
(07:25):
perhaps we we can learn from youand for our listeners, which
are primarily PT leaders withinoutpatient.
So to kick off, tell us alittle bit about kind of
clinical placements generally.
How are they structured forstudents, duration, and how are
(07:47):
they perhaps chosen?
So a little bit of background.
Ashley Butler (07:51):
Right.
So on the academic side, everyprogram is different.
and how they design a clinicalrotation.
Some schools start students inthe clinic within their very
first year of the didacticcurriculum because they want the
students to have exposure andto see that what they're
learning in the classroomactually has application outside
(08:14):
of the classroom.
However, more and more programsare going towards having all of
their clinical rotations towardthe end of their didactic
curriculum where the studentsare able to assimilate all the
coursework that they've satthrough for two plus years and
then apply it clinically.
(08:34):
So it depends on the program.
I will say there is a trend inacademic physical therapy
education to have fewerrotations, but longer in
duration.
So instead of like when I wasin school, I had like three,
four week rotations and then aneight week rotation.
(08:56):
and then another eight weekrotation.
Now it's way more common to see12, 12, 12 and all at the end
of the didactic curriculum.
So you're giving students moreopportunity to really delve into
the patient population to beable to use clinical decision
(09:16):
making, learn differentials,really progress with that
student.
I mean, sorry, with thatpatient, take a patient from
initial evaluation through todischarge.
which is much easier to do witha longer affiliation versus
sort of little bursts ofexperiences.
So you're seeing that inclinical education, the push
(09:37):
towards longer rotations.
With the development of moreand more hybrid PT programs,
that's especially importantbecause one of the I'll say
criticisms with a hybrid programis that the students aren't
necessarily onboarded to a lotof the professional behaviors
(10:01):
that your traditional studenthas because you're not dealing
with faculty in person face toface on a day in day out basis.
It's primarily distancelearning where students come to
campus in short spurts of time.
So the students are actuallyreally doing a lot better with
longer affiliation.
so that they can learn thoseprofessional behaviors and what
(10:25):
it looks like to be a physicaltherapist in every facet.
So that's the trend forclinical rotations.
Most programs are utilizing acompany called Exact for their
clinical placements.
And Exact is a software companythat is actually designed to
(10:45):
help logarithmically assignstudents to clinical sites.
And you have to have anaffiliation with the program for
the students to be able to seeyour clinical site.
And then they take into accountfactors like where the student
lives, where they have housingavailable, things of that
nature.
So it can be random, random,like exact decides what the
(11:09):
placement is, or the academicinstructors hand place students
in different clinical sitesbased on students' goals,
students' needs studentshousing.
One of the challenges inclinical education is the fact
that it costs a lot.
Students are still paying fulltuition, yet they're needing to
get to a clinical site,sometimes pay for housing at a
(11:31):
clinical site.
I think the last research thatI saw that was published was
that each clinical rotationcosts the student about $2,000.
So it's costly for the studentto actually be involved in
clinics.
So that's something that theytry to, they, the schools, the
(11:54):
programs, try to have clinicalsites that are close to student
housing so they can cut down onsome of those costs.
But that's basically, it reallydepends on the program in terms
of how clinical sites arechosen.
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(12:28):
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Richard Leaver (12:35):
it's interesting how clinical education has
changed because A few years agowhen I trained, I'm not saying
it was a good way of training,but certainly a different way of
training is first and foremost,we had a minimum of 2000
clinical hours just within ourtraining, which is substantially
more than current studentshave.
I think current students havejust over a little over 1000
(12:58):
hours in total, if I'm correct.
Ashley Butler (13:00):
The CAPTIA requirement is 32 weeks of
clinical education.
Richard Leaver (13:06):
Okay.
And then not only was thenumber of hours significantly
different, but how it wasstructured.
So in the first year, we wereactually placed treating as a PT
student, but actually placed asessentially as a aid, nursing
aid.
And it was a humblingexperience, if nothing else.
(13:30):
But certainly that was the thebeginning of clinical practice
and whilst the you know theactual task didn't necessarily
directly translate but thecertainly the interaction with
patients was was invaluable andthen thereafter we had multiple
(13:52):
placements to really give us adepth well not necessarily depth
but certainly a breadth of allthe subspecialties that
therapists work within.
So I worked in an amputee limbfitting centre, I worked in a
burns unit, worked in intensivecare, ER, orthopaedics, neuro,
etc, etc.
(14:13):
So it gave me a greatperspective of the profession,
perhaps didn't go into the depthand perhaps the clinical
reasoning skills so much, butcertainly allowed me to really
have a great perspective of atleast what was available
available as a therapist.
Ashley Butler (14:34):
Right.
And there are definite pros tothat.
I think especially sinceCOVID-19 and the amount of
burnout from the healthcareprofession, there have been
fewer and fewer cliniciansavailable to become clinical
instructors.
So that's a whole other ball ofwax to talk about, especially
(14:56):
in the inpatient setting.
So inpatient sites are gettingfewer and further between.
And then if you want to kind ofcombine that with the number of
new PT programs that areopening up across the country,
now we have more programscompeting for fewer slots.
It's easier to find anoutpatient rotation than it is
(15:17):
an inpatient rotation, but noweven an inpatient rotation, the
variety of what's available tothe students is so much less
than what it used to be.
Students that get placed inhospitals now are either unless
it's a small rural hospitalwhere the PT department does
everything, you're designated toyour space, your acute care,
(15:40):
your trauma, your burns, yourneuro.
That's where you stay.
You stay in your lane.
And then there's very littlevariety involved.
And they don't have theclinical instructors for it.
Richard Leaver (15:55):
Yeah.
So going into the weeds alittle bit, what do students
need to know before starting aclinical placement?
So we'll talk about perhaps theCIs in a minute, but what do
students really should know?
And I don't think necessarilysometimes they do really know,
but what is it they need to betold or advised before
(16:19):
placement?
Ashley Butler (16:20):
Great question.
First and foremost, I think youhave to emphasize
professionalism.
It's a non-negotiable.
They need to be communicatedwith in a timely manner in terms
of what the dress code is.
You know, they need to bepunctual.
And what that means, punctualdoesn't mean if you, you know,
start treating at eight that youshow up at eight.
(16:42):
You know, you have to be thereearly, prepared, ready to go.
All onboarding needs to becomplete before your affiliation
starts.
So all of these things would beconsidered professional
behaviors.
And in my experience, I feellike that is where students are
lacking the most right now.
(17:02):
They've got the didacticskills.
They haven't really learned howto navigate being a
professional at the same time.
So professionalism is anon-negotiable, and I think the
CIs need to be very upfrontabout that and make it very
(17:22):
clear that, you know, what youlack in experience, you will
make up for in appearance andbehavior.
So you've got to carry yourselfwell.
I think that's first andforemost.
Secondly, you've got to knowyour basics, like the back of
your hand, and depending onwhere you are in your curriculum
and what the expectations arefor that experience, you've got
(17:43):
to know your didactic basics,your manual muscle tests, your
goniometers, where does thestable hand go, where does the
moving hand go, where's theaxis, what are my norms, what
are the vitals that I need to belooking at, whether it's a
blood pressure, respiratoryrate, heart rate, what are the
common exercise principles thatI need to remember so that I can
(18:06):
build on or regress dependingon who the patient is.
I need to know the red flags.
I need to know thecontraindications for certain
treatments and modalities.
And I really need to know thebasics of documentation.
What goes in the subjective?
What goes in the objective?
Students, if they're in theirfirst or second year of their
(18:26):
curriculum, they might not begreat at making an assessment.
That's okay.
You should at least have thesubjective and objective down
pat and really have an idea ofwhat good therapeutic goals are.
Of course, all students needneed assistance with that, and
it'll differ setting to setting,but they really have to know
the basics of documentation.
(18:48):
And then lastly, I think thatthe student needs to come and
prepare knowing the patientpopulation.
So again, this circles back tocommunication with the clinical
instructor so that the CI iscommunicating these are the
types of patients that we see,these are the diagnoses that you
need to be familiar with, andthe student needs to prep for
that.
They need to know commontreatment protocols for those
(19:09):
common diagnoses, and And theycan talk to other students that
have been to the same site orthey can research online what
types of patients is this clinicaffiliated with and
communication with the CI.
So know your patient populationbefore you're walking in.
And if you walk in day one withthose things and get ready to
(19:31):
build on those, you'll have asuccessful affiliation.
Richard Leaver (19:35):
Yeah, that's great.
It's interesting that the firstthing you talk about is
professionalism, and that was byaccident, really, because we've
talked about it a little bitbefore, but we cannot make
assumptions.
I don't know whether this is alittle sad or not, but the
reality is we cannot makeassumptions as it pertains to
what is perceived asprofessional behavior, certainly
(19:56):
for those on perhaps theplacements that are earlier on
in their education.
But there's a lot of qualifiedtherapists that are still
perhaps lack what I would say isthe appropriate level of
professionalism, and that mightget me in trouble a little bit.
But certainly with students,From what I understand, many
(20:17):
students actually have neveractually had paid employment
before actually training as atherapist.
So how can we expect them toadopt what we call professional
behaviors when they've hadactually no experience of the
workplace?
And I think that that's greatwisdom to pass on.
Ashley Butler (20:38):
It's interesting.
There's been a shift inacademia to the student is the
customer, and therefore thecustomer is always right.
And it's very challenging to bein the position of a teacher
when the students can, you know,it's...
(20:59):
they're the customer andthey're always right.
And even if something is wrongthat they're doing, you have to
negotiate and work it out andmake accommodations for.
And that's what our academicsystem has become.
It's still creating someamazing therapists, still
(21:20):
teaching very valuable skills,but it's very different.
It's, it's much less real lifetraining and much more.
This is the safe place for thisfor the student to learn.
If they have anxiety, you givethem extra time.
You accept excuses and canchange grades because it's just,
(21:44):
they're not getting thattraining in school.
And so many of them have, likeyou said, have never had real
world employment.
So they've never had to answerto a boss.
Richard Leaver (21:56):
I don't think I'll go down the rabbit hole of
this concept of students beingcustomers.
Jeez, that's just a little bitdifferent.
But anyway, before I get intotrouble.
Yes, before I get into trouble,let's talk about perhaps not so
much what the students need toknow before clinical placement,
(22:18):
but what do the CIs need toprepare for for the placement?
Because it's important thatthey prepare so it's successful.
placement as well isn't it theycan't just wing it so what do
they need to know
Ashley Butler (22:30):
To be the best CI which I don't understand why
someone wouldn't want to be thebest CI to be the best CI you've
got to communicate with yoursite coordinator you need to
know your clinic's requirementsfor students what the students
have to do you know have anorientation scheduled out you
(22:50):
need to be proactive with yourscheduling so that your student
has adequate time to orient tothe clinic that you can spend
some one-on-one time with yourstudent.
So being proactive in yourscheduling requires some
forethought.
So that to me is first andforemost.
And then you also need toreview the academic programs
requirement for that specificaffiliation.
(23:11):
Where should my student be atthe end of the affiliation?
What's required of my studentfor this affiliation?
If it's a first-year student,they're probably not going to be
doing evaluations independentlyAnd I say that with air quotes
because they're still treatingunder your license.
So they're not independentregardless of where they are in
(23:33):
the curriculum.
But if it's a first affiliationand they haven't completed
their didactic coursework,they're not going to be doing
full evaluation.
So you need to know where theyare in their curriculum and what
the academic programsrequirements are.
And then you want to learnabout your student.
Students send a bunch ofinformation like this is my
learning style.
This is my communicationpreference.
(23:53):
And while you might not alwaysbe able to communicate with a
student in their preferredstyle.
You at least need toacknowledge it and know it so
you can have conversations.
So communication with yourstudent is key.
Getting to know your student.
How are they going to learnbest?
How can I teach best?
I think that makes for asuccessful clinical instructor.
Unknown (24:17):
Great.
Richard Leaver (24:18):
Now, I would imagine with the number of
students that you've directlybeen a CI and you've managed in
various capacities throughoutthe last few years, there's
probably challenges that arequite common as it pertains to
students on clinical placement.
What are those commonchallenges for the students and
(24:42):
what can perhaps the CI or theclinic do to address them
proactively perhaps?
Ashley Butler (24:48):
Yeah, so the thread that I've seen, I'm going
to go back to professionalism.
That's probably been the mostcommon thread when CIs are
having a challenging time or adifficult time with the student.
It's less to do with theirdidactic knowledge and their
ability to perform tests andmeasures, but more their
(25:12):
behaviors and theirprofessionalism.
And the CI just doesn't knowwhat to do with it because they
feel like the bad guy forcalling the student out.
So I think to...
to proactively be on top ofthis, you've got to communicate
clear expectations about whenyou want the student in the
(25:35):
clinic and how you would likethem to prepare for each day.
Case conferencing every day, inmy opinion, is vital.
Sitting down with your studentbefore the day even begins to
talk through a game plan for theday so that the student has
clear set expectations.
And then document those timeswhere the student does not meet
(25:56):
those expectations if they comein not in dress code you can't
be afraid to say that is notdress code i need you to go home
and change you can't be in theclinic with your midriff showing
cis are afraid to say that theydon't want to be the bad guy i
mean we get into pt because wewant to help people where most
of us are like type a nicepeople and we want to be helpful
(26:19):
and we have a hard time havinghard conversations sometimes but
these professors Sometimes it'sbecause there's a lack of
professionalism, but other timesit's the expectations have not
been laid out clearly enough.
So you can manage thatproactively by laying out your
expectations very clearly.
Another challenge that I see isthat students often struggle in
(26:44):
applying academic knowledge ina faster paced clinical setting
where they feel like they'regetting graded.
And that's what they're usedto.
They're accustomed to beinggraded and they're afraid
they're going to do somethingwrong.
So they get self-conscious andthey get anxious and they choke
up on their words and they don'tknow exactly what to do.
(27:05):
And a CI can actually reallyassist with that by reminding
the student that this is alearning environment.
They're there to guide.
They're there to help.
Have the student ask goodquestions.
Ask the student, not in frontof the patient necessarily,
right?
Would you like to observe thisthe first time, and then the
(27:27):
next time they come in, I'll letyou take the lead.
So just having conversationslike that really reduces a lot
of the stress because studentsdo have a hard time turning off
that student mentality.
I'm being graded.
I might get graded wrong orwhatever the case may be.
So that's a big challenge.
You want to give them anopportunity to apply their
(27:48):
academic knowledge withoutfeeling like they're always
being tested.
And then there's usually achallenge involved with
adjusting to workflow.
Again, students sit in aclassroom or go to a lab and
then they go home and study.
And this could be the firsttime that they're actually
(28:09):
needing to start on time and endat a certain time and be ready
for the next patient.
So just giving space and notexpecting too much from A, your
earlier students, whether it's afirst year or a second year
student And then B, coachingstrategies on how to manage
caseload, just like we do withour new grads.
This is, let me give you somestrategies for how to schedule
(28:33):
and how to manage this andutilizing our extenders of care,
whether that's a PTA or atechnician.
Students can also delegatetasks to extenders of care.
So assisting the student withthat to help them feel like
they're less crunched for time.
And then C, the biggest successdeterminant.
(28:55):
on the student side for whetheror not the affiliation was a
successful affiliation was ifthey felt welcome in the clinic.
That is the number one, severalstudies back this up, that if
students feel like they'reactively welcomed and are a part
(29:15):
of the team, they feel likeit's a successful affiliation.
They want to do more.
They want to engage more.
And the CI can do something assimple is have a welcome sign at
the student's desk welcome toadvent physical therapy we're
glad to have you invite them tolunch to sit at lunch with you
(29:37):
as the staff meets invite themto staff meetings want engage
them and have them be a part ofwhat's going on ask their
opinion about things like whatwould you do in this situation
you know and just engage themmake them feel like they're a
part of the team and whenstudents feel like they're a
part of the team they are moremore likely.
(29:57):
to function at their highestand consider the affiliation
successful.
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Richard Leaver (30:44):
There's so many great points, kind of going
through a few of them.
Setting expectations.
I am a generation where theconcept of perhaps somebody
setting expectations would beperceived as micromanagement,
but that's furthest from thetruth, isn't it, with regards to
(31:05):
other generations.
They need that very clear anddirect guidance because that's
what they've had and that's whatthey're used to and in fact if
they don't get that then itusually creates a lot of anxiety
for them so it's it'sdefinitely a generational piece
(31:28):
not wholly but i think there isdefinitely a generational
component there
Ashley Butler (31:32):
And i've done some classes on like the
difference because when I wasstarting it I'm a Gen Xer and I
had to learn about millennialsand now having to learn about
Gen Zers and all those things.
And there are stereotypes for areason.
(31:53):
Everybody doesn't fit into one,but there are generational
differences.
Presently, the the thought isambiguity breeds anxiety and
more and more students haveanxiety and not feeling like
they know what's expected ofthem and what to do, they'll get
anxious and then they startmaking mistakes.
(32:14):
So those clear expectations area must right now.
Like I grew up in anenvironment where I had
unsupervised playtime.
I didn't have a syllabus forclasses.
I didn't have rubrics fortests.
Like Nothing like that.
But students now, they didn'thave free play.
(32:37):
They had play dates.
Everything was structured fromwho they played with to what
they did in their play time.
And I'm talking as early astoddlerhood.
And now in the academicworld...
They have a syllabus for everysingle day.
They know every day whatthey're going to learn.
(32:57):
They have preloaded PowerPointfor exactly what the lecture is
going to be.
They get rubrics for almost forevery lab practical.
They know exactly what they'regoing to be checked off on.
And if they don't see a rubricbefore a lab practical, it's
almost like panic town.
They, well, what am I, what amI supposed to do?
(33:19):
It's a patient.
You treat them.
But I don't know what I'm goingto be graded on.
It's a patient.
You treat them.
It's pretty crazy howstructured education is and how
students need that bridge whenthey get into the clinic.
Richard Leaver (33:36):
Yeah, I think the last thing I'll say about
expectation is nobody has toworry about me showing my
midriff, particularly with mymiddle age spread.
So everyone's safe there, Ithink.
And then I find it reassuring,but perhaps slightly amusing as
well, that the one of the keydeterminants is feeling welcome.
(33:57):
But I can understand that.
It's really making sure thatthey're given the time to
support and enhance and developthe student.
I remember as a CI thatessentially the way that I
tackled it or where I approachedit is really whatever I was
doing, wherever I was, thestudent was with me, either
(34:20):
taking the lead whereappropriate or being by my side.
even to the point where youknow I worked in high security
prison I would take the studentwith me when I was treating high
security prisoners as wellright and they had a great
experience not perhaps not withthe the actual the prison
visiting the prison but they hada great experience from a
(34:40):
clinical perspective becausethey were an integral part of
the team during their clinicalplacement and you know they had
the same similar kind of basicresponsibilities obviously
clinically very different butbut you know, they had the same
expectations as the clinicians,whether it pertained to
(35:01):
timekeeping, dress code, etcetera, et cetera.
And they definitely appreciatedthat.
And I'm sure that, you know,many students who have good
placements remember it for manyyears to come.
Ashley Butler (35:15):
I would have liked it, I think.
Richard Leaver (35:18):
That's right.
So I think clinicians and alsostudents, but clinicians are
sometimes reluctant to takestudents because there's common
myths, misconceptions regardingstudent placements and having
students.
What are some of those myths ormisconceptions about student
(35:42):
placements?
Ashley Butler (35:43):
Well, there are a handful of them and And they
reappear not just in PTeducation, but in nursing
education, really any of theallied health fields.
And there's a lot of researchbehind this.
So what I'm about to talkabout, there's a lot of data
behind.
The biggest misconception isthat a student will always
negatively impact yourproductivity, that you won't be
(36:05):
able to be as productive with astudent.
And that's been shown to beuntrue over and over again, in
that while onboarding andorientation, yes, takes time.
There is a ramp up, butwell-prepared students become
assets to the clinicalinstructor and to the clinic
themselves.
Students can assist withdocumentation.
They can assist with patienteducation where a therapist is
(36:29):
needing to do someadministrative task.
They can really dive deeperinto patient education and work
with that patient to help withthat therapeutic alliance and
the buy-in for treatment.
They can help with treatmentprogressions, treatment
regressions.
If a patient comes in superflared up, and you're like, oh
my goodness, I wasn't expectingthis today.
I don't know if I have time.
(36:49):
If you have a student with you,your student can spend
one-on-one time with thatpatient while you're doing
something else or as long asyou're supervising them.
So students can assist withclinical education.
Students can assist within-services to educate the rest
of the staff on new modalitiesor new techniques or new
(37:09):
equipment.
And so as long as students areadequately onboarded and
oriented they can actuallyreally help increase your
productivity and become assetsto the clinic.
So that's, to me, the biggestroadblock that I see is the
misconception that students willnegatively impact productivity.
(37:32):
And time and time again, itshows that they don't, not over
the long haul.
Like the first two weeks, yes,it's a little slower.
You have to take things alittle slower, but over the long
haul, no.
The other thing that I hear allthe time is I don't have enough
space.
Our clinic is too crowded.
We don't have enough desks.
We don't have enough space tohave a student.
(37:53):
But the answer to that isactually, if you have enough
space to treat a patient, thenyou can have a student with you.
You don't have to run toindependent schedules.
Your student can coach And aslong as you're mindful about
your scheduling, where a patientcan go, a student can be with
you while you treat them.
You don't have to have two bedsto treat two patients at the
(38:14):
same time.
It can be a co-treat scenario.
Another thing, a roadblock, amisconception that I hear is
that I'm more liable.
I'm putting myself or mylicense at risk if I have a
student.
And yes, your student istreating under your license, but
your student comes to you toyou from an accredited program.
(38:35):
And that program carries withit liability and malpractice
insurance that the student comeswith.
And if you supervise correctly,then that should not be a
concern at all.
I like to educate and coach myclinical instructors on kind of
sort of like the Maitland modelof evaluations, like assess,
(38:56):
treat, reassess.
I do it with students where Idiscuss, treat, discuss, treat.
So the student is constantlyengaged in their thoughts.
This is what I want to ask.
This is why I want to ask it.
Okay, ask away.
Okay, this is what the patientsaid.
So because this is what thepatient said, this is what I
want to look at.
And okay, so this is what thepatient looks like.
(39:19):
So this is what I want to do.
So as long as you're havingthose conversations and seeing
the clinical reasoning and thejudgment behind the treatment
that the student is providing,you don't have to worry about
liability.
They're doing the right stuff.
Another excuse that I hear fornot wanting to take students is
I can't bill Medicare or afederal payer if I have a
(39:41):
student with me, and that's nottrue.
Now, there are requirements forsupervision when it comes to
federal payers, andunfortunately, a lot of other
commercial insurances areadopting those supervision
requirements, but students canabsolutely participate in
treatment as long as thetherapist is directing, and you
can bill it the same way as longas you're directing the
(40:04):
treatment and you're not billingfor your time elsewhere, which
is even if you didn't have astudent would be the same thing.
So that's false.
You can bill for the time thatthe student spends with the
patient as long as it's underthose supervision requirements.
CIs often think that there'snot a benefit to having a
student in the clinic, that it'smore hassle than good.
(40:25):
And again, I'm going to go backto research and research shows
time and time again, that thoseclinics that accept students
actually have higherproductivity, higher staff
engagement, higher, what's theword I'm looking for?
The people that work there havehigher job satisfaction because
they're more engaged.
They're learning more.
(40:45):
Students come to you with thelatest and greatest knowledge.
They've been in the research alittle bit more than those of us
who've been in the field for along time.
So they can come and talk toyou about new studies and what
this has found.
And you can learn from astudent equally as much as you
can teach a student.
So clinics that take the moststudents actually have higher
professional satisfaction fromtheir clinicians.
(41:07):
And it helps you improve yourteaching skills, which not only
benefits your students, but itbenefits your patients too.
And it helps you onboard newgrads and new hires.
And I think the biggest benefitto taking students is you have
just golden recruitmentopportunities.
It's like a 12-week interview.
You see if the student fits theculture of the clinic, if they
(41:30):
have the same treatmentphilosophies.
And if they do, then you bringthem on board and you watch them
go into a new grad.
And then you want to grow theminto a clinic director
themselves or another leadershipposition.
So to me, that's so rewardingto see someone go from a student
to a leadership role.
And so recruiting is, I think,huge and it's such a benefit for
(41:52):
the clinic.
But to me, those are thebiggest roadblocks that I see
and the common misconceptions.
One of the other things reasonsI hear for I can't take this
student is I'm not a 40 hour aweek clinician.
I'm only part time.
I'm not in the clinic 40 hoursa week.
Well, you can absolutely have astudent if you're not a 40 hour
(42:14):
a week employee.
You can split that student withanother clinician in your
clinic.
You can split that student withanother clinician in a clinic
that's really close by.
We've had very successfulaffiliations with students that
have actually split time betweenclinics.
not just clinical instructors.
Yes, it takes a little bit oftime.
(42:34):
It takes some debriefing.
What did you learn here?
Show me that here.
Just more communication, but itcan 100% be done and be done
very successfully and isbeneficial for the student
because now the student getsmultiple people sewing into them
instead of just one.
So that's another thing thatyou don't have to be a 40 hour a
week clinician to take astudent.
(42:56):
And then I think one of the Ihear it all the time.
My last student was terrible.
Don't give me another one.
I don't want another student.
My last one was terrible.
Well, let's talk about whatwent wrong.
Let's figure out how we mightbe able to mitigate those things
prior to those happening.
And the fact of the matter ismost student experiences are
(43:19):
really good.
And I always tell my CIs thatsay that to me.
My last student was terrible.
I don't want another one.
I'm like, oh, have you everordered something from a
restaurant?
It wasn't good.
Do you just stop going torestaurants because you had one
bad experience no you don't youyou try it again and I think the
same goes with clinicaleducation so I I feel like as
(43:40):
long as CIs know that they'reappreciated and they're
supported and that their companyhas their back then they'll be
more likely to take students andI'm happy in my position to
coach clinicians through thesecommon misconceptions.
Richard Leaver (43:54):
Yeah so you know what I'm hearing basically and
my experience has been reallythere's no excuse not to take a
student because most of theexcuses are pretty lame, to be
honest.
Now, if you're out on surgeryor extended leave, then that's
fine.
But usually the excuses can beworked through or the reasons
(44:16):
perhaps can be worked through.
The other thing is the way thatplacements can be structured
can be different for differentschools.
So again, I'm not sure if thisis a model that's used in the
US, probably not because of thereimbursement constraints.
But when I was a CI many yearsago, I would actually have three
(44:38):
students, up to three studentsassigned to myself.
And at that point, I becamealmost a full-time clinical
instructor.
So, and they weren't studentswhilst they were assigned to me,
actually, we, I was part of arelatively small clinic with a
couple of other clinicians andwe were tag team.
It wasn't the fact that thestudent had to come to me it was
(45:01):
really whoever was a qualifiedtherapist at that time and most
convenient or who had perhapsthe most experience within that
perhaps condition or whateverthe criteria, that it was
definitely treating and managingthe placement as a team.
And I think there was a hugebenefit for the student for that
(45:21):
because they saw differentapproaches, different clinical
reasoning skills, et cetera, etcetera.
So I think the best placementsnot only have a clinician or CI
that is engaged, but really aclinic team that is equally
engaged and supportive, yes?
Ashley Butler (45:40):
A hundred percent.
Absolutely.
The students love, generallyspeaking, students love the
teamwork aspect of it.
And the surveys that I readfrom students that have come
through clinics over the lasttwo plus decades, the comment on
(46:01):
how the team works together oreverybody is there to help each
other.
And the student really doesn'teven differentiate between the
tech and the PTA and the CIbecause everybody works together
as a team.
And it's a great experienceacross the board.
So the more teamwork you canbring into it, the better the
(46:22):
experience for the student forthe most part.
Richard Leaver (46:26):
So for private practice owners, if they are
looking to to provide clinicalplacements.
What are the schools lookingfor specifically?
What do the practice ownershave to be able to provide in
order to be eligible to eventake on student placements?
Ashley Butler (46:47):
They have to sign an affiliation agreement, which
is a legal document, and theyhave to agree to the terms of
that legal document.
Most clinics will take theschool's affiliation agreement
and have their attorney look atit and sign it.
That will include things likeresponsibilities.
(47:08):
It's the school'sresponsibility to do this.
It's the clinic'sresponsibility to provide an
education experience, a placefor the student to get their
work done.
The school has to supply acertain amount of insurance and
liability type of things,amongst other legalities.
The clinic needs to be willingto teach.
(47:30):
There are plenty of clinicalsites out there.
Unfortunately, they give ClinEda bad rap.
They use students as techs andas free help and means to
schedule a lot of patients.
I think to be a good clinicalpartner, you've got to be
(47:51):
willing to teach and you've gotto be willing to be able to
block out your schedule every sooften for some one-on-one
mentoring, for some remediation.
If it comes to that, if thestudent's not behaving or
performing the way that theyneed to, you need to be able to
meet with the student, take timeout of your schedule to do so,
not just shoo them away from theclinic and send them back to
(48:13):
the school.
You've got to be able to givesome explanation as to why.
So you You need a desire toteach.
You need the ability toschedule to do so.
And then.
you've got to have a goodrelationship with the school.
So communication with thedirector of clinical education,
whoever they have coordinatingthose clinical experience for
the students.
I think that's really all youneed.
(48:34):
Sign the contract, be willingto be a teacher and have a good
relationship with the school.
Richard Leaver (48:42):
To finish off, if we can kind of look into the
crystal ball.
Ashley Butler (48:46):
Yeah.
Richard Leaver (48:47):
Where is clinical education perhaps
heading?
Obviously, where it's come fromand where it is currently is
very different.
But I'm sure that the theory ofclinical education or education
generally changes over time.
And I'm sure clinical educationcontinues to evolve.
So what are you seeing and whatdo you think is on the horizon
(49:11):
down the road as it pertains toclinical education for PT
students?
Ashley Butler (49:17):
Yeah, for sure.
So what I'm seeing right now isan increased use in technology.
and placing students, usingsoftware to place students in
clinical sites, which has itspros and cons.
So the pro is that it's easierfor the school and it's becoming
(49:38):
easier for the clinical site.
The con is that sometimesstudents get placed in sites
strictly for location orstrictly to check a box.
Like I have to have outpatientorthopedic.
This place looks good to me.
I'm you still have to maintainthose relationships with the
program.
You need to know when to reachout to the school.
(49:59):
to ask for some assistance tohave those open lines of
communication.
So that is presently happening,the increased use of technology
inside of clinical instruction.
What is also presentlyhappening is, I referred to it
earlier, is that programs areshifting to longer but fewer
rotations to give students ampletime to dig deeper and to
(50:23):
integrate their skills and theiracademic knowledge into
clinical skills and to seepatients progress through the
the plan of care.
increased number of PT programsthat are out there that are
(51:03):
graduating more students,there's a growing use of
two-to-one models, meaningschools are asking clinical
sites to take two students atonce instead of one-on-one, so
growing use of that model.
And then also being more opento splitting students between
multiple clinical instructors sothat they can fit more students
(51:24):
in.
There is a need, a growing needof emphasis non-clinical
skills.
We talked about this.
Professional behaviors,cultural humility, communication
and collaboration with otherpeople.
Students are fantastic attexting.
They're not so great atface-to-face communications.
(51:47):
So working on thosenon-clinical skills is having to
take a lot more time in theclinical education world.
The CIs are having to work withthat.
On the horizon, what's comingis called competency-based
clinical education.
(52:07):
It's starting in the medschools, but it's making its way
to allied health.
And competency-based clinicaleducation is a shift from
time-based, the 31 weeks ofrequired time in the clinic, to
competency-based.
Students won't pass a clinicalaffiliation unless they've
(52:28):
mastered these skills versus,oh, I've I finished my time.
I'm going to attach a number tothis rotation to give them a
grade and get them out of here.
So there's a shift tocompetency-based education and
it's coming.
It's coming for PT.
And I think we'll see somedifferences and making sure that
students master skills versusthey were here for their eight
(52:51):
weeks and now they're done.
Richard Leaver (52:52):
Interesting.
I always ask at the end ofpodcasts for any final words of
wisdom or any other pointsperhaps that we haven't covered
or haven't covered perhaps inthe depth you think that they
need to be.
So it's an opportunity toreally kind of sum up perhaps
(53:14):
and see if there's anything thatyou can perhaps share with
listeners that we haven'tcovered already.
Ashley Butler (53:19):
I think I can't...
talk about professionalismenough.
It needs to be emphasized moreand more and more.
I think so many of the issuesthat CIs have with students boil
down to professional behaviorversus a lack of skill and
(53:43):
setting clear expectations.
I don't want to beat a deadhorse, but that's number one,
that's key, and it can't beemphasized enough.
And then I just want toencourage practices owners and
clinicians out there thatthey're never gonna make a
change in the profession unlesswe train the new generation of
(54:06):
students to be who we want ourprofession to be and the only
way that we can do that is bybeing willing to mentor them and
teach them and train them andtake them as students so that we
can cultivate the correctbehaviors we can cultivate the
correct expectations.
(54:27):
We can turn our professionaround, but we're not going to
do it by being unwilling tomentor the next generation of
therapists.
Richard Leaver (54:36):
Wise words from somebody so young.
So Ashley, thank you so much.
Thanks for your time.
I've learned a lot andcertainly it's reassuring to
hear many of the points that youmake and certainly a lot of
work and dedication, time,effort is being done both by
(55:00):
schools and by many clinicalinstructors to really try and
deliver great outcomes forplacement.
So it's heartening to hear.
So thank you.
Thank you for having me.
Alliance Physical Therapy (55:11):
This podcast was brought to you by
Alliance Physical TherapyPartners.
Want more expertise andinformation?
Visit our website atallianceptp.com and follow us on
social media.
You can find links below in thedescription.
As always, thank you forlistening.
Alliance Physical Therapy Partners and
Agile Virtual Physical Therapyproudly present Agile and Me, a
physical therapy leadershippodcast devised to help emerging
and experienced therapy leaderslearn more about various topics
relevant to outpatient therapyservices.
Richard Leaver (00:19):
Welcome back to Agile and Me, a physical therapy
leadership podcast series.
Today, I'm extremely excited towelcome Ashley Butler.
So Ashley, welcome to the show.
Ashley Butler (00:29):
Thank you.
Richard Leaver (00:32):
So today we're going to talk about clinical
placements and clinicaleducation in general, perhaps a
little bit for physical therapystudents specifically.
And Ashley, you have aremarkable background in PT and
also education.
When I looked you up and typedin Ashley Butler PT, there's
(00:55):
actually another Ashley ButlerPT in Nashville as well.
So I didn't know whether youknew that or not.
There's two of you.
Ashley Butler (01:01):
I knew there was an Ashley Butler.
I didn't know that she was alsoa PT, but I did know there were
two of us in Nashville.
Richard Leaver (01:08):
That's funny.
So for the listeners, would yoube so kind as to perhaps give
them a little bit of yourbackground as to how we perhaps
ended up talking today and yourexperience in clinical
education?
Ashley Butler (01:22):
Absolutely happy to.
I'm proud of it.
I graduated from a program inrural North Georgia that was
actually designed to be one ofthe first DPT programs in the
country.
So pre a lot of people gettingDPTs, the program I went to was
designed for that.
So becoming a clinical educatorwas very much a part of that
(01:43):
curricula.
And I became very passionateabout doing that in my very
first job.
out of PT school, the sitecoordinator of clinical
education left.
And so my boss said, would youlike to do this?
Would you like to be the sitecoordinator?
And I was like, oh gosh, whatdoes that mean?
And she explained it to me isbasically I would be the liaison
(02:04):
between academic programs inour specific clinic and I would
be a clinical instructor.
And then I would also help toonboard the students that came,
whether or not they were with meas the clinical instructor or
another one of our physicaltherapists.
So I took that job, smallclinic.
I think we only had like fouror five academic partnerships,
(02:25):
but I became really excitedabout working with the academic
programs and bridging that gapbetween academic knowledge and
clinical application.
I got married in the processand my husband's a musician.
So he moved me from NorthGeorgia to Nashville, Tennessee,
and I got a job with outpatientorthopedic company that did not
(02:49):
have a coordinator of clinicaleducation, although they were
taking students.
And I was assigned a studentand my student was subpar, to
say the least.
She was only in Nashvillebecause she wanted to come to
Nashville.
She didn't want to learn manualtherapy.
She didn't necessarily want tolearn what I was teaching her.
She just wanted to be inNashville, Tennessee.
This checked a box and I saw aneed.
(03:12):
So I asked my boss if I coulddo it.
And I decided that I wanted toapply what I learned from
school, making things structuredand I designed a curricula for
our students and grew thatprogram as the company grew.
And we went from just a MiddleTennessee-based company to a
(03:33):
nine-state, 160-clinic company.
And I helped plant differentparts of the company in
different states and grew thestudent program, which actually
grew to a really robust new hireprogram.
And super proud of what webuilt.
And then COVID.
(03:54):
And when COVID COVID happened,I had to transition out of my
role as a clinical educator.
And I took another job withinthe company and realized that
that's not what I wanted to do.
So I started looking for moreclinical education jobs.
And I went to work forTennessee State University.
So I was on staff at TSU intheir DPT department.
(04:17):
I worked right alongside thedirector of clinical education.
So I actually was on theacademic side of the clinical
education coin helping to placestudents in clinical sites.
I'm also, and I still am, aclinical instructor in the pro
bono clinic on campus.
So I work with first year andsecond year students as I treat
(04:39):
patients and I guide thestudents along in the treatment
of patients.
So I'm still actually clinical.
And then I had a colleague tellme about Alliance and
everything that Alliance wasdoing and that they needed a
clinical coordinator.
And so I found myself atAlliance doing again what I'm
really passionate about, whichis developing relationships with
(05:02):
academic programs and workingto bridge the gap between
academic knowledge and clinicalcompetencies.
Richard Leaver (05:08):
That's quite a journey.
Ashley Butler (05:11):
I've been doing it since 99.
Richard Leaver (05:13):
99.
Since you were five years old,so congratulations.
Exactly, exactly.
Maybe seven.
Maybe seven.
I think what's interesting isreally your perspective as it
pertains to the responsibilityto assist with education of
others.
I think there's definitealignment there.
(05:34):
When I trained as a therapist,it was really made very clear
that as a professional, one ofthe responsibilities of such is
to assist in the development offuture clinicians.
And the education in variousforms was really a
(06:00):
responsibility of everyonewithin that profession to
maintain and continue to growthat profession and really help
those that will you know followin footsteps and I think some of
that expectation or perceptionof being almost a requirement of
(06:20):
being a professional has beenlost or was never taught because
you know there's a lot ofclinicians that aren't involved
with education and maybe forvery good reason.
But I've certainly embracedthis concept all the way through
my career that education andsupporting education is really
an imperative as a professional.
Ashley Butler (06:41):
Absolutely, 100%.
And I mean, to me, the mostbasic part of that is you
wouldn't be where you are and Iwouldn't be where I am unless a
clinical instructor sewed intomy life And so how is our
profession going to grow if wedon't continue to emphasize
(07:01):
clinical education?
Yeah.
Richard Leaver (07:04):
So obviously, as it pertains to clinical
education, let's dive into theweeds a little bit and really
take a look at clinicaleducation, particularly
placements as part of thatclinical education and, you
know, clinical instructors, therole thereof, and see what
(07:25):
perhaps we we can learn from youand for our listeners, which
are primarily PT leaders withinoutpatient.
So to kick off, tell us alittle bit about kind of
clinical placements generally.
How are they structured forstudents, duration, and how are
(07:47):
they perhaps chosen?
So a little bit of background.
Ashley Butler (07:51):
Right.
So on the academic side, everyprogram is different.
and how they design a clinicalrotation.
Some schools start students inthe clinic within their very
first year of the didacticcurriculum because they want the
students to have exposure andto see that what they're
learning in the classroomactually has application outside
(08:14):
of the classroom.
However, more and more programsare going towards having all of
their clinical rotations towardthe end of their didactic
curriculum where the studentsare able to assimilate all the
coursework that they've satthrough for two plus years and
then apply it clinically.
(08:34):
So it depends on the program.
I will say there is a trend inacademic physical therapy
education to have fewerrotations, but longer in
duration.
So instead of like when I wasin school, I had like three,
four week rotations and then aneight week rotation.
(08:56):
and then another eight weekrotation.
Now it's way more common to see12, 12, 12 and all at the end
of the didactic curriculum.
So you're giving students moreopportunity to really delve into
the patient population to beable to use clinical decision
(09:16):
making, learn differentials,really progress with that
student.
I mean, sorry, with thatpatient, take a patient from
initial evaluation through todischarge.
which is much easier to do witha longer affiliation versus
sort of little bursts ofexperiences.
So you're seeing that inclinical education, the push
(09:37):
towards longer rotations.
With the development of moreand more hybrid PT programs,
that's especially importantbecause one of the I'll say
criticisms with a hybrid programis that the students aren't
necessarily onboarded to a lotof the professional behaviors
(10:01):
that your traditional studenthas because you're not dealing
with faculty in person face toface on a day in day out basis.
It's primarily distancelearning where students come to
campus in short spurts of time.
So the students are actuallyreally doing a lot better with
longer affiliation.
so that they can learn thoseprofessional behaviors and what
(10:25):
it looks like to be a physicaltherapist in every facet.
So that's the trend forclinical rotations.
Most programs are utilizing acompany called Exact for their
clinical placements.
And Exact is a software companythat is actually designed to
(10:45):
help logarithmically assignstudents to clinical sites.
And you have to have anaffiliation with the program for
the students to be able to seeyour clinical site.
And then they take into accountfactors like where the student
lives, where they have housingavailable, things of that
nature.
So it can be random, random,like exact decides what the
(11:09):
placement is, or the academicinstructors hand place students
in different clinical sitesbased on students' goals,
students' needs studentshousing.
One of the challenges inclinical education is the fact
that it costs a lot.
Students are still paying fulltuition, yet they're needing to
get to a clinical site,sometimes pay for housing at a
(11:31):
clinical site.
I think the last research thatI saw that was published was
that each clinical rotationcosts the student about $2,000.
So it's costly for the studentto actually be involved in
clinics.
So that's something that theytry to, they, the schools, the
(11:54):
programs, try to have clinicalsites that are close to student
housing so they can cut down onsome of those costs.
But that's basically, it reallydepends on the program in terms
of how clinical sites arechosen.
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Richard Leaver (12:35):
it's interesting how clinical education has
changed because A few years agowhen I trained, I'm not saying
it was a good way of training,but certainly a different way of
training is first and foremost,we had a minimum of 2000
clinical hours just within ourtraining, which is substantially
more than current studentshave.
I think current students havejust over a little over 1000
(12:58):
hours in total, if I'm correct.
Ashley Butler (13:00):
The CAPTIA requirement is 32 weeks of
clinical education.
Richard Leaver (13:06):
Okay.
And then not only was thenumber of hours significantly
different, but how it wasstructured.
So in the first year, we wereactually placed treating as a PT
student, but actually placed asessentially as a aid, nursing
aid.
And it was a humblingexperience, if nothing else.
(13:30):
But certainly that was the thebeginning of clinical practice
and whilst the you know theactual task didn't necessarily
directly translate but thecertainly the interaction with
patients was was invaluable andthen thereafter we had multiple
(13:52):
placements to really give us adepth well not necessarily depth
but certainly a breadth of allthe subspecialties that
therapists work within.
So I worked in an amputee limbfitting centre, I worked in a
burns unit, worked in intensivecare, ER, orthopaedics, neuro,
etc, etc.
(14:13):
So it gave me a greatperspective of the profession,
perhaps didn't go into the depthand perhaps the clinical
reasoning skills so much, butcertainly allowed me to really
have a great perspective of atleast what was available
available as a therapist.
Ashley Butler (14:34):
Right.
And there are definite pros tothat.
I think especially sinceCOVID-19 and the amount of
burnout from the healthcareprofession, there have been
fewer and fewer cliniciansavailable to become clinical
instructors.
So that's a whole other ball ofwax to talk about, especially
(14:56):
in the inpatient setting.
So inpatient sites are gettingfewer and further between.
And then if you want to kind ofcombine that with the number of
new PT programs that areopening up across the country,
now we have more programscompeting for fewer slots.
It's easier to find anoutpatient rotation than it is
(15:17):
an inpatient rotation, but noweven an inpatient rotation, the
variety of what's available tothe students is so much less
than what it used to be.
Students that get placed inhospitals now are either unless
it's a small rural hospitalwhere the PT department does
everything, you're designated toyour space, your acute care,
(15:40):
your trauma, your burns, yourneuro.
That's where you stay.
You stay in your lane.
And then there's very littlevariety involved.
And they don't have theclinical instructors for it.
Richard Leaver (15:55):
Yeah.
So going into the weeds alittle bit, what do students
need to know before starting aclinical placement?
So we'll talk about perhaps theCIs in a minute, but what do
students really should know?
And I don't think necessarilysometimes they do really know,
but what is it they need to betold or advised before
(16:19):
placement?
Ashley Butler (16:20):
Great question.
First and foremost, I think youhave to emphasize
professionalism.
It's a non-negotiable.
They need to be communicatedwith in a timely manner in terms
of what the dress code is.
You know, they need to bepunctual.
And what that means, punctualdoesn't mean if you, you know,
start treating at eight that youshow up at eight.
(16:42):
You know, you have to be thereearly, prepared, ready to go.
All onboarding needs to becomplete before your affiliation
starts.
So all of these things would beconsidered professional
behaviors.
And in my experience, I feellike that is where students are
lacking the most right now.
(17:02):
They've got the didacticskills.
They haven't really learned howto navigate being a
professional at the same time.
So professionalism is anon-negotiable, and I think the
CIs need to be very upfrontabout that and make it very
(17:22):
clear that, you know, what youlack in experience, you will
make up for in appearance andbehavior.
So you've got to carry yourselfwell.
I think that's first andforemost.
Secondly, you've got to knowyour basics, like the back of
your hand, and depending onwhere you are in your curriculum
and what the expectations arefor that experience, you've got
(17:43):
to know your didactic basics,your manual muscle tests, your
goniometers, where does thestable hand go, where does the
moving hand go, where's theaxis, what are my norms, what
are the vitals that I need to belooking at, whether it's a
blood pressure, respiratoryrate, heart rate, what are the
common exercise principles thatI need to remember so that I can
(18:06):
build on or regress dependingon who the patient is.
I need to know the red flags.
I need to know thecontraindications for certain
treatments and modalities.
And I really need to know thebasics of documentation.
What goes in the subjective?
What goes in the objective?
Students, if they're in theirfirst or second year of their
(18:26):
curriculum, they might not begreat at making an assessment.
That's okay.
You should at least have thesubjective and objective down
pat and really have an idea ofwhat good therapeutic goals are.
Of course, all students needneed assistance with that, and
it'll differ setting to setting,but they really have to know
the basics of documentation.
(18:48):
And then lastly, I think thatthe student needs to come and
prepare knowing the patientpopulation.
So again, this circles back tocommunication with the clinical
instructor so that the CI iscommunicating these are the
types of patients that we see,these are the diagnoses that you
need to be familiar with, andthe student needs to prep for
that.
They need to know commontreatment protocols for those
(19:09):
common diagnoses, and And theycan talk to other students that
have been to the same site orthey can research online what
types of patients is this clinicaffiliated with and
communication with the CI.
So know your patient populationbefore you're walking in.
And if you walk in day one withthose things and get ready to
(19:31):
build on those, you'll have asuccessful affiliation.
Richard Leaver (19:35):
Yeah, that's great.
It's interesting that the firstthing you talk about is
professionalism, and that was byaccident, really, because we've
talked about it a little bitbefore, but we cannot make
assumptions.
I don't know whether this is alittle sad or not, but the
reality is we cannot makeassumptions as it pertains to
what is perceived asprofessional behavior, certainly
(19:56):
for those on perhaps theplacements that are earlier on
in their education.
But there's a lot of qualifiedtherapists that are still
perhaps lack what I would say isthe appropriate level of
professionalism, and that mightget me in trouble a little bit.
But certainly with students,From what I understand, many
(20:17):
students actually have neveractually had paid employment
before actually training as atherapist.
So how can we expect them toadopt what we call professional
behaviors when they've hadactually no experience of the
workplace?
And I think that that's greatwisdom to pass on.
Ashley Butler (20:38):
It's interesting.
There's been a shift inacademia to the student is the
customer, and therefore thecustomer is always right.
And it's very challenging to bein the position of a teacher
when the students can, you know,it's...
(20:59):
they're the customer andthey're always right.
And even if something is wrongthat they're doing, you have to
negotiate and work it out andmake accommodations for.
And that's what our academicsystem has become.
It's still creating someamazing therapists, still
(21:20):
teaching very valuable skills,but it's very different.
It's, it's much less real lifetraining and much more.
This is the safe place for thisfor the student to learn.
If they have anxiety, you givethem extra time.
You accept excuses and canchange grades because it's just,
(21:44):
they're not getting thattraining in school.
And so many of them have, likeyou said, have never had real
world employment.
So they've never had to answerto a boss.
Richard Leaver (21:56):
I don't think I'll go down the rabbit hole of
this concept of students beingcustomers.
Jeez, that's just a little bitdifferent.
But anyway, before I get intotrouble.
Yes, before I get into trouble,let's talk about perhaps not so
much what the students need toknow before clinical placement,
(22:18):
but what do the CIs need toprepare for for the placement?
Because it's important thatthey prepare so it's successful.
placement as well isn't it theycan't just wing it so what do
they need to know
Ashley Butler (22:30):
To be the best CI which I don't understand why
someone wouldn't want to be thebest CI to be the best CI you've
got to communicate with yoursite coordinator you need to
know your clinic's requirementsfor students what the students
have to do you know have anorientation scheduled out you
(22:50):
need to be proactive with yourscheduling so that your student
has adequate time to orient tothe clinic that you can spend
some one-on-one time with yourstudent.
So being proactive in yourscheduling requires some
forethought.
So that to me is first andforemost.
And then you also need toreview the academic programs
requirement for that specificaffiliation.
(23:11):
Where should my student be atthe end of the affiliation?
What's required of my studentfor this affiliation?
If it's a first-year student,they're probably not going to be
doing evaluations independentlyAnd I say that with air quotes
because they're still treatingunder your license.
So they're not independentregardless of where they are in
(23:33):
the curriculum.
But if it's a first affiliationand they haven't completed
their didactic coursework,they're not going to be doing
full evaluation.
So you need to know where theyare in their curriculum and what
the academic programsrequirements are.
And then you want to learnabout your student.
Students send a bunch ofinformation like this is my
learning style.
This is my communicationpreference.
(23:53):
And while you might not alwaysbe able to communicate with a
student in their preferredstyle.
You at least need toacknowledge it and know it so
you can have conversations.
So communication with yourstudent is key.
Getting to know your student.
How are they going to learnbest?
How can I teach best?
I think that makes for asuccessful clinical instructor.
Unknown (24:17):
Great.
Richard Leaver (24:18):
Now, I would imagine with the number of
students that you've directlybeen a CI and you've managed in
various capacities throughoutthe last few years, there's
probably challenges that arequite common as it pertains to
students on clinical placement.
What are those commonchallenges for the students and
(24:42):
what can perhaps the CI or theclinic do to address them
proactively perhaps?
Ashley Butler (24:48):
Yeah, so the thread that I've seen, I'm going
to go back to professionalism.
That's probably been the mostcommon thread when CIs are
having a challenging time or adifficult time with the student.
It's less to do with theirdidactic knowledge and their
ability to perform tests andmeasures, but more their
(25:12):
behaviors and theirprofessionalism.
And the CI just doesn't knowwhat to do with it because they
feel like the bad guy forcalling the student out.
So I think to...
to proactively be on top ofthis, you've got to communicate
clear expectations about whenyou want the student in the
(25:35):
clinic and how you would likethem to prepare for each day.
Case conferencing every day, inmy opinion, is vital.
Sitting down with your studentbefore the day even begins to
talk through a game plan for theday so that the student has
clear set expectations.
And then document those timeswhere the student does not meet
(25:56):
those expectations if they comein not in dress code you can't
be afraid to say that is notdress code i need you to go home
and change you can't be in theclinic with your midriff showing
cis are afraid to say that theydon't want to be the bad guy i
mean we get into pt because wewant to help people where most
of us are like type a nicepeople and we want to be helpful
(26:19):
and we have a hard time havinghard conversations sometimes but
these professors Sometimes it'sbecause there's a lack of
professionalism, but other timesit's the expectations have not
been laid out clearly enough.
So you can manage thatproactively by laying out your
expectations very clearly.
Another challenge that I see isthat students often struggle in
(26:44):
applying academic knowledge ina faster paced clinical setting
where they feel like they'regetting graded.
And that's what they're usedto.
They're accustomed to beinggraded and they're afraid
they're going to do somethingwrong.
So they get self-conscious andthey get anxious and they choke
up on their words and they don'tknow exactly what to do.
(27:05):
And a CI can actually reallyassist with that by reminding
the student that this is alearning environment.
They're there to guide.
They're there to help.
Have the student ask goodquestions.
Ask the student, not in frontof the patient necessarily,
right?
Would you like to observe thisthe first time, and then the
(27:27):
next time they come in, I'll letyou take the lead.
So just having conversationslike that really reduces a lot
of the stress because studentsdo have a hard time turning off
that student mentality.
I'm being graded.
I might get graded wrong orwhatever the case may be.
So that's a big challenge.
You want to give them anopportunity to apply their
(27:48):
academic knowledge withoutfeeling like they're always
being tested.
And then there's usually achallenge involved with
adjusting to workflow.
Again, students sit in aclassroom or go to a lab and
then they go home and study.
And this could be the firsttime that they're actually
(28:09):
needing to start on time and endat a certain time and be ready
for the next patient.
So just giving space and notexpecting too much from A, your
earlier students, whether it's afirst year or a second year
student And then B, coachingstrategies on how to manage
caseload, just like we do withour new grads.
This is, let me give you somestrategies for how to schedule
(28:33):
and how to manage this andutilizing our extenders of care,
whether that's a PTA or atechnician.
Students can also delegatetasks to extenders of care.
So assisting the student withthat to help them feel like
they're less crunched for time.
And then C, the biggest successdeterminant.
(28:55):
on the student side for whetheror not the affiliation was a
successful affiliation was ifthey felt welcome in the clinic.
That is the number one, severalstudies back this up, that if
students feel like they'reactively welcomed and are a part
(29:15):
of the team, they feel likeit's a successful affiliation.
They want to do more.
They want to engage more.
And the CI can do something assimple is have a welcome sign at
the student's desk welcome toadvent physical therapy we're
glad to have you invite them tolunch to sit at lunch with you
(29:37):
as the staff meets invite themto staff meetings want engage
them and have them be a part ofwhat's going on ask their
opinion about things like whatwould you do in this situation
you know and just engage themmake them feel like they're a
part of the team and whenstudents feel like they're a
part of the team they are moremore likely.
(29:57):
to function at their highestand consider the affiliation
successful.
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Richard Leaver (30:44):
There's so many great points, kind of going
through a few of them.
Setting expectations.
I am a generation where theconcept of perhaps somebody
setting expectations would beperceived as micromanagement,
but that's furthest from thetruth, isn't it, with regards to
(31:05):
other generations.
They need that very clear anddirect guidance because that's
what they've had and that's whatthey're used to and in fact if
they don't get that then itusually creates a lot of anxiety
for them so it's it'sdefinitely a generational piece
(31:28):
not wholly but i think there isdefinitely a generational
component there
Ashley Butler (31:32):
And i've done some classes on like the
difference because when I wasstarting it I'm a Gen Xer and I
had to learn about millennialsand now having to learn about
Gen Zers and all those things.
And there are stereotypes for areason.
(31:53):
Everybody doesn't fit into one,but there are generational
differences.
Presently, the the thought isambiguity breeds anxiety and
more and more students haveanxiety and not feeling like
they know what's expected ofthem and what to do, they'll get
anxious and then they startmaking mistakes.
(32:14):
So those clear expectations area must right now.
Like I grew up in anenvironment where I had
unsupervised playtime.
I didn't have a syllabus forclasses.
I didn't have rubrics fortests.
Like Nothing like that.
But students now, they didn'thave free play.
(32:37):
They had play dates.
Everything was structured fromwho they played with to what
they did in their play time.
And I'm talking as early astoddlerhood.
And now in the academicworld...
They have a syllabus for everysingle day.
They know every day whatthey're going to learn.
(32:57):
They have preloaded PowerPointfor exactly what the lecture is
going to be.
They get rubrics for almost forevery lab practical.
They know exactly what they'regoing to be checked off on.
And if they don't see a rubricbefore a lab practical, it's
almost like panic town.
They, well, what am I, what amI supposed to do?
(33:19):
It's a patient.
You treat them.
But I don't know what I'm goingto be graded on.
It's a patient.
You treat them.
It's pretty crazy howstructured education is and how
students need that bridge whenthey get into the clinic.
Richard Leaver (33:36):
Yeah, I think the last thing I'll say about
expectation is nobody has toworry about me showing my
midriff, particularly with mymiddle age spread.
So everyone's safe there, Ithink.
And then I find it reassuring,but perhaps slightly amusing as
well, that the one of the keydeterminants is feeling welcome.
(33:57):
But I can understand that.
It's really making sure thatthey're given the time to
support and enhance and developthe student.
I remember as a CI thatessentially the way that I
tackled it or where I approachedit is really whatever I was
doing, wherever I was, thestudent was with me, either
(34:20):
taking the lead whereappropriate or being by my side.
even to the point where youknow I worked in high security
prison I would take the studentwith me when I was treating high
security prisoners as wellright and they had a great
experience not perhaps not withthe the actual the prison
visiting the prison but they hada great experience from a
(34:40):
clinical perspective becausethey were an integral part of
the team during their clinicalplacement and you know they had
the same similar kind of basicresponsibilities obviously
clinically very different butbut you know, they had the same
expectations as the clinicians,whether it pertained to
(35:01):
timekeeping, dress code, etcetera, et cetera.
And they definitely appreciatedthat.
And I'm sure that, you know,many students who have good
placements remember it for manyyears to come.
Ashley Butler (35:15):
I would have liked it, I think.
Richard Leaver (35:18):
That's right.
So I think clinicians and alsostudents, but clinicians are
sometimes reluctant to takestudents because there's common
myths, misconceptions regardingstudent placements and having
students.
What are some of those myths ormisconceptions about student
(35:42):
placements?
Ashley Butler (35:43):
Well, there are a handful of them and And they
reappear not just in PTeducation, but in nursing
education, really any of theallied health fields.
And there's a lot of researchbehind this.
So what I'm about to talkabout, there's a lot of data
behind.
The biggest misconception isthat a student will always
negatively impact yourproductivity, that you won't be
(36:05):
able to be as productive with astudent.
And that's been shown to beuntrue over and over again, in
that while onboarding andorientation, yes, takes time.
There is a ramp up, butwell-prepared students become
assets to the clinicalinstructor and to the clinic
themselves.
Students can assist withdocumentation.
They can assist with patienteducation where a therapist is
(36:29):
needing to do someadministrative task.
They can really dive deeperinto patient education and work
with that patient to help withthat therapeutic alliance and
the buy-in for treatment.
They can help with treatmentprogressions, treatment
regressions.
If a patient comes in superflared up, and you're like, oh
my goodness, I wasn't expectingthis today.
I don't know if I have time.
(36:49):
If you have a student with you,your student can spend
one-on-one time with thatpatient while you're doing
something else or as long asyou're supervising them.
So students can assist withclinical education.
Students can assist within-services to educate the rest
of the staff on new modalitiesor new techniques or new
(37:09):
equipment.
And so as long as students areadequately onboarded and
oriented they can actuallyreally help increase your
productivity and become assetsto the clinic.
So that's, to me, the biggestroadblock that I see is the
misconception that students willnegatively impact productivity.
(37:32):
And time and time again, itshows that they don't, not over
the long haul.
Like the first two weeks, yes,it's a little slower.
You have to take things alittle slower, but over the long
haul, no.
The other thing that I hear allthe time is I don't have enough
space.
Our clinic is too crowded.
We don't have enough desks.
We don't have enough space tohave a student.
(37:53):
But the answer to that isactually, if you have enough
space to treat a patient, thenyou can have a student with you.
You don't have to run toindependent schedules.
Your student can coach And aslong as you're mindful about
your scheduling, where a patientcan go, a student can be with
you while you treat them.
You don't have to have two bedsto treat two patients at the
(38:14):
same time.
It can be a co-treat scenario.
Another thing, a roadblock, amisconception that I hear is
that I'm more liable.
I'm putting myself or mylicense at risk if I have a
student.
And yes, your student istreating under your license, but
your student comes to you toyou from an accredited program.
(38:35):
And that program carries withit liability and malpractice
insurance that the student comeswith.
And if you supervise correctly,then that should not be a
concern at all.
I like to educate and coach myclinical instructors on kind of
sort of like the Maitland modelof evaluations, like assess,
(38:56):
treat, reassess.
I do it with students where Idiscuss, treat, discuss, treat.
So the student is constantlyengaged in their thoughts.
This is what I want to ask.
This is why I want to ask it.
Okay, ask away.
Okay, this is what the patientsaid.
So because this is what thepatient said, this is what I
want to look at.
And okay, so this is what thepatient looks like.
(39:19):
So this is what I want to do.
So as long as you're havingthose conversations and seeing
the clinical reasoning and thejudgment behind the treatment
that the student is providing,you don't have to worry about
liability.
They're doing the right stuff.
Another excuse that I hear fornot wanting to take students is
I can't bill Medicare or afederal payer if I have a
(39:41):
student with me, and that's nottrue.
Now, there are requirements forsupervision when it comes to
federal payers, andunfortunately, a lot of other
commercial insurances areadopting those supervision
requirements, but students canabsolutely participate in
treatment as long as thetherapist is directing, and you
can bill it the same way as longas you're directing the
(40:04):
treatment and you're not billingfor your time elsewhere, which
is even if you didn't have astudent would be the same thing.
So that's false.
You can bill for the time thatthe student spends with the
patient as long as it's underthose supervision requirements.
CIs often think that there'snot a benefit to having a
student in the clinic, that it'smore hassle than good.
(40:25):
And again, I'm going to go backto research and research shows
time and time again, that thoseclinics that accept students
actually have higherproductivity, higher staff
engagement, higher, what's theword I'm looking for?
The people that work there havehigher job satisfaction because
they're more engaged.
They're learning more.
(40:45):
Students come to you with thelatest and greatest knowledge.
They've been in the research alittle bit more than those of us
who've been in the field for along time.
So they can come and talk toyou about new studies and what
this has found.
And you can learn from astudent equally as much as you
can teach a student.
So clinics that take the moststudents actually have higher
professional satisfaction fromtheir clinicians.
(41:07):
And it helps you improve yourteaching skills, which not only
benefits your students, but itbenefits your patients too.
And it helps you onboard newgrads and new hires.
And I think the biggest benefitto taking students is you have
just golden recruitmentopportunities.
It's like a 12-week interview.
You see if the student fits theculture of the clinic, if they
(41:30):
have the same treatmentphilosophies.
And if they do, then you bringthem on board and you watch them
go into a new grad.
And then you want to grow theminto a clinic director
themselves or another leadershipposition.
So to me, that's so rewardingto see someone go from a student
to a leadership role.
And so recruiting is, I think,huge and it's such a benefit for
(41:52):
the clinic.
But to me, those are thebiggest roadblocks that I see
and the common misconceptions.
One of the other things reasonsI hear for I can't take this
student is I'm not a 40 hour aweek clinician.
I'm only part time.
I'm not in the clinic 40 hoursa week.
Well, you can absolutely have astudent if you're not a 40 hour
(42:14):
a week employee.
You can split that student withanother clinician in your
clinic.
You can split that student withanother clinician in a clinic
that's really close by.
We've had very successfulaffiliations with students that
have actually split time betweenclinics.
not just clinical instructors.
Yes, it takes a little bit oftime.
(42:34):
It takes some debriefing.
What did you learn here?
Show me that here.
Just more communication, but itcan 100% be done and be done
very successfully and isbeneficial for the student
because now the student getsmultiple people sewing into them
instead of just one.
So that's another thing thatyou don't have to be a 40 hour a
week clinician to take astudent.
(42:56):
And then I think one of the Ihear it all the time.
My last student was terrible.
Don't give me another one.
I don't want another student.
My last one was terrible.
Well, let's talk about whatwent wrong.
Let's figure out how we mightbe able to mitigate those things
prior to those happening.
And the fact of the matter ismost student experiences are
(43:19):
really good.
And I always tell my CIs thatsay that to me.
My last student was terrible.
I don't want another one.
I'm like, oh, have you everordered something from a
restaurant?
It wasn't good.
Do you just stop going torestaurants because you had one
bad experience no you don't youyou try it again and I think the
same goes with clinicaleducation so I I feel like as
(43:40):
long as CIs know that they'reappreciated and they're
supported and that their companyhas their back then they'll be
more likely to take students andI'm happy in my position to
coach clinicians through thesecommon misconceptions.
Richard Leaver (43:54):
Yeah so you know what I'm hearing basically and
my experience has been reallythere's no excuse not to take a
student because most of theexcuses are pretty lame, to be
honest.
Now, if you're out on surgeryor extended leave, then that's
fine.
But usually the excuses can beworked through or the reasons
(44:16):
perhaps can be worked through.
The other thing is the way thatplacements can be structured
can be different for differentschools.
So again, I'm not sure if thisis a model that's used in the
US, probably not because of thereimbursement constraints.
But when I was a CI many yearsago, I would actually have three
(44:38):
students, up to three studentsassigned to myself.
And at that point, I becamealmost a full-time clinical
instructor.
So, and they weren't studentswhilst they were assigned to me,
actually, we, I was part of arelatively small clinic with a
couple of other clinicians andwe were tag team.
It wasn't the fact that thestudent had to come to me it was
(45:01):
really whoever was a qualifiedtherapist at that time and most
convenient or who had perhapsthe most experience within that
perhaps condition or whateverthe criteria, that it was
definitely treating and managingthe placement as a team.
And I think there was a hugebenefit for the student for that
(45:21):
because they saw differentapproaches, different clinical
reasoning skills, et cetera, etcetera.
So I think the best placementsnot only have a clinician or CI
that is engaged, but really aclinic team that is equally
engaged and supportive, yes?
Ashley Butler (45:40):
A hundred percent.
Absolutely.
The students love, generallyspeaking, students love the
teamwork aspect of it.
And the surveys that I readfrom students that have come
through clinics over the lasttwo plus decades, the comment on
(46:01):
how the team works together oreverybody is there to help each
other.
And the student really doesn'teven differentiate between the
tech and the PTA and the CIbecause everybody works together
as a team.
And it's a great experienceacross the board.
So the more teamwork you canbring into it, the better the
(46:22):
experience for the student forthe most part.
Richard Leaver (46:26):
So for private practice owners, if they are
looking to to provide clinicalplacements.
What are the schools lookingfor specifically?
What do the practice ownershave to be able to provide in
order to be eligible to eventake on student placements?
Ashley Butler (46:47):
They have to sign an affiliation agreement, which
is a legal document, and theyhave to agree to the terms of
that legal document.
Most clinics will take theschool's affiliation agreement
and have their attorney look atit and sign it.
That will include things likeresponsibilities.
(47:08):
It's the school'sresponsibility to do this.
It's the clinic'sresponsibility to provide an
education experience, a placefor the student to get their
work done.
The school has to supply acertain amount of insurance and
liability type of things,amongst other legalities.
The clinic needs to be willingto teach.
(47:30):
There are plenty of clinicalsites out there.
Unfortunately, they give ClinEda bad rap.
They use students as techs andas free help and means to
schedule a lot of patients.
I think to be a good clinicalpartner, you've got to be
(47:51):
willing to teach and you've gotto be willing to be able to
block out your schedule every sooften for some one-on-one
mentoring, for some remediation.
If it comes to that, if thestudent's not behaving or
performing the way that theyneed to, you need to be able to
meet with the student, take timeout of your schedule to do so,
not just shoo them away from theclinic and send them back to
(48:13):
the school.
You've got to be able to givesome explanation as to why.
So you You need a desire toteach.
You need the ability toschedule to do so.
And then.
you've got to have a goodrelationship with the school.
So communication with thedirector of clinical education,
whoever they have coordinatingthose clinical experience for
the students.
I think that's really all youneed.
(48:34):
Sign the contract, be willingto be a teacher and have a good
relationship with the school.
Richard Leaver (48:42):
To finish off, if we can kind of look into the
crystal ball.
Ashley Butler (48:46):
Yeah.
Richard Leaver (48:47):
Where is clinical education perhaps
heading?
Obviously, where it's come fromand where it is currently is
very different.
But I'm sure that the theory ofclinical education or education
generally changes over time.
And I'm sure clinical educationcontinues to evolve.
So what are you seeing and whatdo you think is on the horizon
(49:11):
down the road as it pertains toclinical education for PT
students?
Ashley Butler (49:17):
Yeah, for sure.
So what I'm seeing right now isan increased use in technology.
and placing students, usingsoftware to place students in
clinical sites, which has itspros and cons.
So the pro is that it's easierfor the school and it's becoming
(49:38):
easier for the clinical site.
The con is that sometimesstudents get placed in sites
strictly for location orstrictly to check a box.
Like I have to have outpatientorthopedic.
This place looks good to me.
I'm you still have to maintainthose relationships with the
program.
You need to know when to reachout to the school.
(49:59):
to ask for some assistance tohave those open lines of
communication.
So that is presently happening,the increased use of technology
inside of clinical instruction.
What is also presentlyhappening is, I referred to it
earlier, is that programs areshifting to longer but fewer
rotations to give students ampletime to dig deeper and to
(50:23):
integrate their skills and theiracademic knowledge into
clinical skills and to seepatients progress through the
the plan of care.
increased number of PT programsthat are out there that are
(51:03):
graduating more students,there's a growing use of
two-to-one models, meaningschools are asking clinical
sites to take two students atonce instead of one-on-one, so
growing use of that model.
And then also being more opento splitting students between
multiple clinical instructors sothat they can fit more students
(51:24):
in.
There is a need, a growing needof emphasis non-clinical
skills.
We talked about this.
Professional behaviors,cultural humility, communication
and collaboration with otherpeople.
Students are fantastic attexting.
They're not so great atface-to-face communications.
(51:47):
So working on thosenon-clinical skills is having to
take a lot more time in theclinical education world.
The CIs are having to work withthat.
On the horizon, what's comingis called competency-based
clinical education.
(52:07):
It's starting in the medschools, but it's making its way
to allied health.
And competency-based clinicaleducation is a shift from
time-based, the 31 weeks ofrequired time in the clinic, to
competency-based.
Students won't pass a clinicalaffiliation unless they've
(52:28):
mastered these skills versus,oh, I've I finished my time.
I'm going to attach a number tothis rotation to give them a
grade and get them out of here.
So there's a shift tocompetency-based education and
it's coming.
It's coming for PT.
And I think we'll see somedifferences and making sure that
students master skills versusthey were here for their eight
(52:51):
weeks and now they're done.
Richard Leaver (52:52):
Interesting.
I always ask at the end ofpodcasts for any final words of
wisdom or any other pointsperhaps that we haven't covered
or haven't covered perhaps inthe depth you think that they
need to be.
So it's an opportunity toreally kind of sum up perhaps
(53:14):
and see if there's anything thatyou can perhaps share with
listeners that we haven'tcovered already.
Ashley Butler (53:19):
I think I can't...
talk about professionalismenough.
It needs to be emphasized moreand more and more.
I think so many of the issuesthat CIs have with students boil
down to professional behaviorversus a lack of skill and
(53:43):
setting clear expectations.
I don't want to beat a deadhorse, but that's number one,
that's key, and it can't beemphasized enough.
And then I just want toencourage practices owners and
clinicians out there thatthey're never gonna make a
change in the profession unlesswe train the new generation of
(54:06):
students to be who we want ourprofession to be and the only
way that we can do that is bybeing willing to mentor them and
teach them and train them andtake them as students so that we
can cultivate the correctbehaviors we can cultivate the
correct expectations.
(54:27):
We can turn our professionaround, but we're not going to
do it by being unwilling tomentor the next generation of
therapists.
Richard Leaver (54:36):
Wise words from somebody so young.
So Ashley, thank you so much.
Thanks for your time.
I've learned a lot andcertainly it's reassuring to
hear many of the points that youmake and certainly a lot of
work and dedication, time,effort is being done both by
(55:00):
schools and by many clinicalinstructors to really try and
deliver great outcomes forplacement.
So it's heartening to hear.
So thank you.
Thank you for having me.
Alliance Physical Therapy (55:11):
This podcast was brought to you by
Alliance Physical TherapyPartners.
Want more expertise andinformation?
Visit our website atallianceptp.com and follow us on
social media.
You can find links below in thedescription.
As always, thank you forlistening.
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