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Analysis of Clinical Education Situation (ACES) Framework: identifying the root cause of student Failure in the United States.

ABSTRACT: Doctor of Physical Therapy preparation requires extensive time in precepted clinical education which involves multiple stakeholders. Student outcomes in clinical education are impacted by many factors, and, in the case of failure, it can be challenging to determine which factors played a primary role in the poor result. Using existing root-cause analysis processes, the authors developed and implemented a framework designed to identify the causes of student clinical education failure. The framework, when applied to a specific student failure event, identified specific factors that contributed to the situation and revealed opportunities for improvement in both the clinical and academic environments. A root-cause analysis framework can help to drive change at the programmatic level, and future studies should focus on the framework's application to a variety of clinical and didactic settings.

SUBMITTER: Myers K

PROVIDER: S-EPMC6538564 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Analysis of Clinical Education Situation (ACES) Framework: identifying the root cause of student Failure in the United States.

Myers Katherine K Covington Kyle K

Journal of educational evaluation for health professions 20190510

Doctor of Physical Therapy preparation requires extensive time in precepted clinical education which involves multiple stakeholders. Student outcomes in clinical education are impacted by many factors, and, in the case of failure, it can be challenging to determine which factors played a primary role in the poor result. Using existing root-cause analysis processes, the authors developed and implemented a framework designed to identify the causes of student clinical education failure. The framewo ...[more]

PMID: 31071763

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Project description:IntroductionGood handoffs require teamwork, clear communication, a cognitively safe environment, and a good understanding of the patient's medical needs. Complex tertiary care training institutions require multiple handoffs over a patient's time in the hospital. Medical students need better handoff education. We designed a handoff training exercise using a simulated patient care environment for students to practice and observe multiple handoffs over time.MethodsAn initial large-group didactic session provides direct instruction on handoffs. In small groups, students are subsequently assigned roles as individual physicians in a chain of providers during a simulated patient hospitalization over several days, with an additional student as an observer. Blinded to any prior discussion, student physicians sequentially give and receive handoffs about the patient from a previous physician as their simulated hospital course evolves. The observer shares his or her insights, and a large-group structured debriefing exercise follows.ResultsIn both 2015 and 2016, we implemented this session with a cohort of 30 fourth-year medical students. Most recently we implemented this with chief residents, and a group of 20 third-year pediatric clerkship students. We reviewed a selection of the discussion guides and found reporters/ observers noted that participants stated the primary problem 95% of the time (19 of 20 handoffs), the patient acuity 90% of the time (18 of 20 handoffs), and a clear contingency plan 85% of the time (17 of 20 handoffs).DiscussionWe found students initially to be preoccupied with making correct clinical decisions instead of giving effective handoffs, and consequently we clarified details and adjusted clinical information to be more transparent. Results suggest the session achieves our goals of using a structured handoff method to communicate higher-level information and debrief effectively with peers. We envision this activity to be applicable to teaching handoffs to residents, nurses, and other health care professionals, as well as possibly in diverse clinical environments or in collaboration with outpatient providers.

Dataset Information

Analysis of Clinical Education Situation (ACES) Framework: identifying the root cause of student Failure in the United States.

Publications

Analysis of Clinical Education Situation (ACES) Framework: identifying the root cause of student Failure in the United States.

Similar Datasets

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