Changing to a Clinical Experience

(Last Updated On: November 15, 2011)

In the Summer 2011 issue of NAACLS News, NAACLS President Peggy Simpson discussed the change to a focus on program outcomes as they relate to student readiness for clinical education. This is only one of the many factors currently impacting laboratory education programs across the country. The economic state of affairs is forcing hospitals and colleges alike to make strategic changes in how they do business to control costs, and yet both have a vested interest in developing more laboratory practitioners for the next generation. Laboratories are consolidating services and out-sourcing testing so that many traditional internship offerings are no longer available. Productivity metrics which impact the workload evaluations of laboratory staff do not always acknowledge the effect of “taking a student” on workload or other reporting metrics. On the other side, colleges and universities are looking to increase enrollments, to improve the budget bottom line and yet the laboratory intensive nature of our profession is not conducive to massive enrollment numbers. Even without increasing enrollments it was getting harder and harder to find clinical placements for students.

Through support from a Department of Labor (DOL) grant awarded to St. Paul College, and through partnerships between education and industry, laboratory programs throughout the State of Minnesota significantly increased student enrollments creating a crisis in clinical site availability. At the University of Minnesota (UMN)  we needed a complete review of our curriculum and to find a new way to provide the “clinical” for our CLS students as our enrollment had gone from 30 to 65 students over 3 years time with no real increase in clinical sites.

The first activity was to determine what was being taught on campus vs. what truly needed to be learned in the clinical setting. We also needed to change our definition of what a clinical site should be from a vision of a traditional full-service hospital laboratory to medical laboratories in many different environments. We had the capacity to provide extensive hands-on experience in our campus laboratories but we lacked the ability to recreate the real hospital environment. Rather than the clinical internship or traditional rotation where bench preceptors teach students all of the testing methods from scratch, we needed a clinical experience. We decided to cut our clinical time from 22 weeks to 12 weeks on a trial basis. As you can imagine, this change was initially difficult to accept for both academic and clinical faculty. Most of us feel that the internship model we had as a student was the best model and yet each of us came from different schools and different program models; hospital-based programs, 2+2, 3+1 or 4+1 programs. As laboratorians we all have the same theory and skills and ultimately become the same end product, but we have arrived there by very different paths.

For us to move to the new model of a clinical experience we needed to make a significant transition in thinking for clinical faculty and employers refocusing on the student outcomes instead of process methods of the past. We began with a series of discipline specific web conferences to talk about the changes we needed to make on both sides and the rationale for shortening the clinical time. Most clinical preceptors, supervisors and managers did not realize the depth and intensity of our on-campus curriculum. We worked with our clinical affiliates to develop a concept of what we needed from them in this partnership and developed, with support from the DOL grant, web based preceptor training modules beginning with an overview of our campus curriculum. This web-based (Distance Ed) format was particularly helpful with the large number of non-metro clinical sites that we utilize throughout state.

Preceptor training modules described the educational background of our students and provided an understanding of a clinical experience rather than clinical training. The Preceptor modules we developed with DOL support include lessons on 1) Roles and Definitions; 2) What is Entry Level; 3) Student Affective Domain; 4) Positive Environments for Learning; and 5) Student Evaluations. We first held a number of synchronous sessions for our clinical site personnel again beginning with a discipline specific overview of didactic content and student laboratory activities along with a discussion of expectations for clinicals. The final sessions focused on preceptors behaviors and evaluations processes during the clinical experience. These discussions where then incorporated into the final modules.

Because the focus is on students applying what they have learned to the real world and not on theory training at the bench sites, we have been able to move to this new model of a clinical experience almost doubling our capacity for clinical assignments. Most importantly, our program outcome metrics of student employment rates and certification exam performance along with employer satisfaction rates have remained the same.

As part of the DOL grant criteria, the Preceptor training modules will be available for free public use through our program web site by the end of this year.

By Janice M. Conway-Klaassen, PhD, MT(ASCP)SM and Patricia J. Brennecke, MT(ASCP) Clinical Laboratory Sciences Program University of Minnesota, Minneapolis, MN

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