Impact of an innovative clinical internship model in the US Army-Baylor Doctoral Program in physical therapy

Retrospective case-control.

Physical therapy education has been characterized by positive reform including the transition to doctoral level education and the emergence of evidence-based practice as a standard part of the curricula. However, clinical education remains largely unaffected by these advancements and continues as a highly fragmented and ill-equipped model marked by an inefficient 1:1 student to faculty ratio. Current clinical educational models provide highly variable and suboptimal learning experiences for many students, which contribute to disjointed and noncollaborative learning. The purpose of this study is to examine the implications of a one-year collaborative internship model in the US Army-Baylor University Doctoral Program in Physical Therapy in which interns train in groups rather than 1:1 on productivity and efficiency of care.

The Army-Baylor program culminates in a 12-month clinical internship conducted at 4 locations within south central Texas (3 military academic medical centers and one multisite outpatient privately-owned physical therapy practice). Each site can accommodate up to 8 (range=4 to 8) students who complete a standardized internship curricula across the full continuum of learning experiences. In this retrospective case-control design, productivity and staffing metrics were extracted for the 3 military sites using the Department of Defense M2 database during the period from 2006-2010. A separate analysis was conducted for each site with descriptive statistics used to assess clinic productivity and efficiency.

Data from all 3 sites indicate the presence of interns resulted in little variability in clinic productivity and efficiency. Decreased productivity and/or efficiency would bring into question the long term viability and sustainability of the collaborative internship model. Additionally, this model maximized the opportunity for highly engaged mentorship, individual attention, and quality instruction.

The findings suggest clinics can accommodate multiple interns and provide high quality education in a collaborative model without a decline in productivity or efficiency. In addition to the standardized curricula across sites, this model facilitates a highly collaborative and peer learning environment in which the intern class supports, challenges, and holds one another accountable to a more standardized and higher level of practice. Each site contributes 1-2 clinical faculty who no longer engage their own patient schedule but rather are able to serve in a full time clinical mentorship role with the interns. In return, the clinical site receives 3-4 full time equivalents of productivity delivered by closely supervised interns who are afforded sufficient time to conduct their examinations and treatments in collaboration with the clinical faculty. Finally, the collaborative internship model supports the mission of each internship site, providing them a critical mass of labor via economies of scale in exchange for an enriched investment into their clinical education.