Pioneering Allied Health

Clinical Education Reform

sponsored by

Department of Health and Human Services

Health Resources and Services Administration

Bureau of Health Professions

Division of Public Health and Allied Health

hosted by

The Department of Medical and Research Technology

University of Maryland School of Medicine

100 Penn Street, Allied Health Building, Room 340

Baltimore, Maryland 21201-1082

http://som1.umaryland.edu/smdmrt

PROCEEDINGS

The Tremont Suite Hotels

Baltimore, Maryland

A NATIONAL CONSENSUS CONFERENCE
PROCEEDINGS

sponsored by

Department of Health and Human Services

Health Resources and Services Administration

Bureau of Health Professions

Division of Public Health and Allied Health

hosted by

The Department of Medical and Research Technology

University of Maryland School of Medicine

100 Penn Street, Allied Health Building, Room 340

Baltimore, Maryland 21201-1082

http://som1.umaryland.edu/smdmrt

Editor

Denise M. Harmening, Ph.D., MT(ASCP), CLS(NCA)

Chair and Professor

Julie Archibald, B.S.

Publication Design

July 12 - 13, 1999

The Tremont Suite Hotels

Baltimore, Maryland

PROCEEDINGS

Publication of the Proceedings of Pioneering Allied Health Clinical Education Reform: A National Consensus Conference was funded by

Contract No: 98-0754(P), issued by the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of

Health and Human Services.

Copyright 2000 © Department of Health and Human Services

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means both electronic or mechanical,

including photocopying, recording, or by an information retrieval system, without prior written consent.

First printing

Printed in the United States of America

ALLIED HEALTH
TABLE OF CONTENTS

i

Economically-Driven Changes Impacting Clinical Education/Training

George B. Rowland, M.D., M.P.H. ...................................................................................................................... 12

Reaction Panel: Response and Recomendations:

Linda Johnson, Ph.D., R.N. ................................................................................................................................. 21

Julie O’Sullivan Maillet, Ph.D. ............................................................................................................................. 23

Arthur Cooper, M.D., M.S. ................................................................................................................................. 26

Gail Nielsen, BSHCA – Moderator

Overcoming Barriers to Clinical Education/Training Reform

Lawrence Abrams, Ed.D. ..................................................................................................................................... 28

Reaction Panel: Response and Recommendations:

Diane J. Youngs, B.S., RT(R), RDMS .................................................................................................................. 40

Rumaldo Z. Juarez, Ph.D. .................................................................................................................................... 43

Jody Gandy, Ph.D., P.T. ...................................................................................................................................... 47

Marilyn S. Harrington, Ph.D., R.D.H. – Moderator

The Role of Professional Societies in Clinical Education/Training Reform

Patricia Crist, Ph.D. OTR/L, FAOTA ................................................................................................................... 51

Reaction Panel: Response and Recommendations:

Ann F. Sosnowski, B.S., MT ............................................................................................................................... 63

Lydia Wingate, Ph.D. .......................................................................................................................................... 66

Harriet Rolen-Mark, M.A., MT (ASCP) ............................................................................................................... 68

Virginia Pappas, CAE – Moderator

V. Closing Panel: Summary and Review of Final Recommendations

Gail Nielsen, BSHCA ........................................................................................................................................... 70

Rumaldo Z. Juarez, Ph.D. .................................................................................................................................... 73

Peggy Valentine, Ed.D. ....................................................................................................................................... 74

Denise M. Harmening, Ph.D. – Moderator

VI. Open Forum - Recommendations ............................................................................................................. 76

VII. Critical Issue Survey and Results ............................................................................................................ 81

VIII. List of Participants .................................................................................................................................... 87

Preface

Denise Harmening, Ph.D., MT(ASCP), CLS(NCA) ................................................................................... ii

Opening Remarks

Norman L. Clark, DDS, MPH, JD ............................................................................................................... iv

Planning Committee ................................................................................................................................ vii

Agenda ..................................................................................................................................................... ix

Presentations

Contents

ALLIED HEALTH

I.

II.

III.

IV.

V.
PREFACE

ii

As Chair of the Department of Medical and Research Technology at University of Maryland’s

School of Medicine, it is a pleasure to present the Proceedings from this national, historic conference, Pioneering Allied Health Clinical Education Reform.

The logo for this conference was developed by Art therapists within the Coalition for Allied

Health Leadership under a contract funded by the Bureau of Health Professions. The text added

by the Planning Committee reflected the goal for this Conference. We hoped that through

consensus gathering we could emerge with one vision, one voice, focused on the patient.

The conference was a national consensus conference, and was funded by the Division of Associated Dental and Public Health Professions, the Bureau of Health Professions of the Health

Resources and Services Administration. The purpose of this conference was to provide an

opportunity to collaborate on a strategic plan for clinical education reform, which will ensure the

availability of health care professionals qualified to meet the needs of patient populations and

health care service providers. Table 1 outlines the objectives of the conference.

The conference gave participants the opportunity to address and examine clinical education on a

national level. We are fortunate that the Bureau has become so proactive by funding so many

contracts which focus on these issues.

Preface

ALLIED HEALTH

• Define the key opportunities and challenges to preserving and enhancing clinical education

and training.

• Develop recommendations to overcome barriers and maximize opportunities for clinical

education reform.

• Disseminate the final blueprint to policymakers and key stakeholders.

Table 1: Objectives

Denise M. Harmening, Ph.D., MT(ASCP), CLS (NCA)

Chair and Professor

Department of Medical and Research Technology

University of Maryland School of Medicine
PREFACE

iii

Three major issues are presented through keynote addresses: economically-driven changes

impacting clinical education and training; overcoming barriers to clinical education and training

reform; and the role of professional societies in clinical education training reform. The format of

the meeting is outlined in Table 2.

The three-keynote speakers defined the major issues from their perspective. Reaction panels

provided analysis and recommendations and a general reaction to these issues. A voice representing HMOs in the hospital sector; someone voicing the opinion of educational institutions representing both two and four-year colleges; and finally a voice from professional societies, accrediting and certifying agencies were standard presentations in the three reaction panels. In open

forums, the audience voiced their opinions and reactions based on their institutional setting and

region of the country.

The Planning Committee consisted of the following individuals who represented various constituencies:

• Deborah Astroth - the National Commission on Allied Health and the Implementation Task

Force

• Richard Boan - National Network of Health Career Programs in the Two-Year Community

Colleges

• Tom Elwood - Association of Schools of Allied Health

• Marilyn Harrington - Commission on Accreditation of Allied Health Education Programs

• Rumaldo Z. Juarez - Hispanics in Allied Health

• Virginia Pappas - Health Professions Network

• Peggy Valentine - National Society of Allied Health

• Donald Young - American Association of Health Care Plans

Participants at this meeting represented 32 states, the District of Columbia and Canada and more

than 17 allied health professions, as well as physicians, educators and administrators. There were

representatives from managed care organizations and hospitals, and representatives from at least

22 professional societies and accrediting agencies.

Our hope is that this basic blueprint for allied health clinical education reform will serve as a

resource for both policy makers and stakeholders as we face the new millennium.

July 12, 1999

• Three Keynote Speakers: define the major issues

• Three Reaction Panels: provide analysis and recommendations

• Three Open Forums: audience-wide discussion and consensus-gathering

• Closing Panel

Table 2: Meeting Format
OPENING REMARKS

iv

So, you see, the sparks flew because there were

varying perspectives on the issue. Perhaps, the

two companies should have had a national consensus conference!

How did we get here today? Briefly, there were

two national commissions on allied health that

brought us to the point (Table 1). The National

Commission on Allied Health, a congressionallymandated commission under Title VII legislation,

was created to provide advice to the Senate

Committee on Labor and Human Resources, the

House of Representatives Committee on Energy

and Commerce, and to the Secretary of the

Department of Health and Human Services. The

focus of this commission was to assess issues

relating to allied health and to the future role the

allied health professions will play in the emerging

health care delivery system for the 21st century.

The final report of the National Commission on

Allied Health was issued in 1995. The report

made twelve recommendations directing the future of allied health and four recommendations

relating to education, workforce, research, and

data. In addition, several white papers, testimony,

and information gathered from many interested

parties were integrated into the twelve recommendations (Table 2).

I would like to welcome each of you this morning.

You are very important to this consensus conference. We want you to express your opinions and

help us reach some conclusions about the direction that we should follow in the future. I would

like to also thank Dr. Denise Harmening and her

staff for bringing us to this point.

This is a consensus conference. That means

sparks may fly. That’s great! We need your ideas

as we look at the difficult challenges facing allied

health clinical education in the future.

At a recent meeting, Bill Gates reportedly stated,

“If GM had kept up with technology like the

computer industry has, we would all be driving

$25.00 cars that get 100 miles to the gallon.” In

response, General Motors issued a press release

stating, “If GM had developed technology like

Microsoft®, we would all be driving cars with the

following characteristics:

• Your car would crash twice a day for no

reason whatsoever.

• Occasionally, your car would die on the

freeway for no reason, and you would just

accept this, restart, and drive on.

• The air bag system would ask, “Are you

sure”, before going off.

• You would press the start button to shut off

the engine.”

Opening Remarks

Norman L. Clark, DDS, MPH, JD

Chief, Allied Health and Associated Professions Branch

Division of Public Health and Allied Health

Bureau of Health Professions

Health Resources and Services Administration

ALLIED HEALTH
OPENING REMARKS

v

Based upon the recommendations of the National Commission on Allied Health, an “Implementation

Task Force” was subsequently established to develop strategies for implementing the recommendations . We have several participants in the audience who have served on the National Commission

on Allied Health and on the Implementation Task Force.

The Implementation Task Force concentrated on three areas: education reform, outcomes research,

and collaboration (Table 3). Three contracts are to be awarded to implement the recommended

strategies. One of these contracts was designed to plan and conduct a National Conference on Allied

Health Clinical Education Reform involving key stakeholders, and this is the conference. A second

contract has been awarded to determine how the allied health professions can work together better;

and a third contract will be awarded in mid-August that focuses on outcomes research.

Table 1: Conference Background

• Product of the analysis and recommendations of two national task forces: – National Commission on Allied Health – National Commission on Allied Health Implementation Task Force

Table 2: National Commission on Allied Health

• Purpose was to provide advice to the : – Senate Committee on Labor and Human Resources – House of Representatives Committee on Energy and Commerce – Secretary of the Department of Health and Human Services • Focus of the National Commission on Allied Health was to assess issues relating to allied

health and the future role the allied health professions will play in the emerging health care

delivery system.

• The final report of the Commission, published in 1995, made twelve recommendations

directing the future of allied health and four recommendations related to education,

workforce, research, and data.

Table 3: Implementation Task Force

• To ensure that the recommendations of the National Commission on Allied Health were

carried out, the U.S. Department of Health and Human Services, Public Health Service,

Health Resources and Services Administration, established an Implementation Task Force

•

• The Implementation Task Force was to address recommendations related to: – education reform – outcomes research – collaboration

 Recommendations • Three contracts were created and funded as a result of the recommendations of the

Implementation Task Force

• One of these contracts was designed to plan and conduct a national conference on allied

health clinical education reform involving key stakeholders
OPENING REMARKS

vi

The desired outcome for this conference is to establish the basis for an interface between key

stakeholders (Table 4). This is very, very important. We need to hear your voices and your opinions

because the blueprint that you will develop here will give us guidance for the future. Your

recommendations will be taken seriously and we will act upon the guidance that you provide.

I wish you a very productive conference and good luck!

Table 4: Pioneering Allied Health Clinical Education Reform:

A National Consensus Conference

• To provide key stakeholders an opportunity to collaborate on a strategic plan for clinical

education/training to ensure the availability of health care professionals who are qualified

to meet the needs of patient populations and health care service providers
PLANNING COMMITTEE

vii

CONFERENCE DIRECTOR

Denise M. Harmening, Ph.D., MT(ASCP), CLS(NCA)

Chair and Professor

Department of Medical & Research Technology

University of Maryland School of Medicine

Baltimore, Maryland

PROJECT DIRECTOR

Norman L. Clark, D.D.S., M.P.H., J.D.

Chief, Allied Health and Associated Professions Branch

Division of Public Health and Allied Health

Bureau of Health Professions

Health Resources and Services Administration

U.S. Department of Health and Human Services

SPECIAL GUESTS

Jennifer Burks, RN, M.S.N.

Deputy Director

Young Song

Program Officer

Division of Public Health and Allied Health

Bureau of Health Professions

Health Resources and Services Administration

U.S. Department of Health and Human Services

CONFERENCE COORDINATOR

Cynthia Carr Stambach, M.A.S.

Coordinator

Department of Medical and Research Technology

University of Maryland School of Medicine

Baltimore, Maryland

Planning Committee

ALLIED HEALTH
PLANNING COMMITTEE

viii

MEMBERS OF THE CONFERENCE PLANNING COMMITTEE

Deborah Bailey Astroth, R.D.H., B.S.

National Commission on Allied Health

Implementation Task Force

Assistant Professor

Departments of Dental Hygiene and Surgical Dentistry

University of Colorado School of Dentistry

Denver, Colorado

Richard Boan, Ph.D.

National Network of Health Career Programs in

Two-year Colleges

Chair of Health Sciences

Midlands Technical College

Columbia, South Carolina

Thomas Elwood, Dr.P.H.

Executive Director

Association of Schools of Allied Health

Professions

Washington, D.C.

Marilyn S. Harrington. Ph.D., R.D.H.

Commission on Accreditation of Allied Health

Education Programs

Dean, School of Allied Health Sciences

University of Texas Health Sciences Center

at San Antonio

San Antonio, Texas

Rumaldo Z. Juarez, Ph.D.

Hispanics in Allied Health

Dean, School of Health Professions

Southwest Texas State University

San Marcos, Texas

Gail Nielsen, BSHCA

Hospital Sector Representative

Managed Care Performance Administrator

Iowa Health System Corporate Headquarters

Des Moines, Iowa

Virginia Pappas, CAE

Health Professions Network

Deputy Executive Director

Society of Nuclear Medicine

Reston, Virginia

Peggy Valentine, Ed.D.

National Society of Allied Health

Interim Associate Dean

Division of Allied Health Sciences

Howard University

Washington, DC

Donald Young, M.D.

Senior Vice President for Policy and

Clinical Services

American Association of Hospital Plans

Washington, D.C.

 CONFERENCE STAFF

Department of Medical and Research Technology (DMRT)

 University of Maryland School of Medicine

Faculty

Paul Griffey, M.B.A., MT(ASCP) Lisa J. Johnson, M.H.S., MT(ASCP)SC

Assistant Professor Assistant Professor

 Staff

Julie Archibald, B.S. Joanne Manning

IT Programmer Executive Administrative Assistant

Don Koonce, B.F.A. Alicia Walters

LAN Systems Administrator Contract Administrator

Graphic Artist
AGENDA

ix

8:00 a.m. – 8:30 a.m. Continental Breakfast

Mason Temple: Corinthian Foyer

8:30 a.m. – 8: 45 a.m. Welcome and Introductions

Mason Temple

Corinthian Ballroom

Denise M. Harmening, Ph.D., MT(ASCP), CLS(NCA)

Conference Director

Chair and Professor

Department of Medical and Research Technology

University of Maryland School of Medicine

Jennifer Burks, RN, MSN

Deputy Director

Division of Associated Dental and

Public Health Professions

Bureau of Health Professions

Health Resources and Services Administration

U.S. Department of Health and Human Services

8:45 a.m. – 9:00 a.m. Opening Remarks: Conference Background

and Objectives

Norman L. Clark, DDS, MPH, JD

Chief, Allied Health and Associated Professions Branch

Bureau of Health Professions

Health Resources and Services Administration

9:00 a.m. – 9:45 a.m. Keynote Address: Economically-Driven Changes

Impacting Clinical Education/Training

George B. Rowland, M.D., M.P.H.

Rowland Associates

9:45 a.m. – 10:30 a.m. Reaction Panel: Response and Recommendations

Reaction Panelists

Linda Johnson, Ph.D., R.N., Acting Director Arthur Cooper, M.D., M.S.

Associated Health Education Office Chief, Division of Pediatric Surgery

Department of Veterans Affairs Columbia University/Harlem Hospital

Representing the Joint Review Committee on

Julie O’Sullivan Maillet, Ph.D. Educational Programs for Emergency

Associate Dean for Academic MedicineTechnicians and Paramedics

Affairs and Research

University of Medicine and Dentistry of New Jersey

Agenda

ALLIED HEALTH

Monday,

July 12, 1999
AGENDA

x

Moderator Recorder

Gail Nielsen, BSHCA Thomas Elwood, Dr.P.H.

Managed Care Performance Administrator Executive Director

Iowa Health System Corporate Headquarters Association of Schools of Allied

Health Professions

10:30 a.m. – 11:00 a.m. Coffee Break

Mason Temple: Corinthian Foyer

11:00 a.m. – 12:00 p.m. Open Forum: Recommendations and Consensus Gathering

Moderator: Gail Nielsen, BSHCA

12:00 p.m. – 1:30 p.m. Luncheon

Tremont Suite Hotels: Plaza B (Third Floor)

1:30 p.m. – 2:15 p.m. Keynote Address: Overcoming Barriers to Clinical

Education/Training Reform

Mason Temple

Corinthian Ballroom

Lawrence Abrams, Ed.D.

Dean, College of Health Professions

Thomas Jefferson University

2:15 p.m. – 3:00 p.m. Reaction Panel: Responses and Recommendations.

Reaction Panelists

Diane J. Youngs, B.S., RT(R), RDMS

Program Instructor

Diagnostic Medical Sonography

Rumaldo Z. Juarez, Ph.D.

Dean, School of Health Professions

Southwest Texas State University

Jody Gandy, Ph.D., P.T.

Director, Physical Therapy Education

American Physical Therapy Association

Associate Dean, College of Health Professions

SUNY Health Science Center at Syracuse

3:00 p.m. – 3:30 p.m. Refreshments

Mason Temple: Corinthian Foyer

3:30 p.m. – 4:30 p.m. Open Forum: Recommendations and Consensus Gathering

Moderator: Marilyn S. Harrington, Ph.D., R.D.H.

5:30 p.m. Reception

Tremont Suite Hotels: Plaza B (Third Floor)

8:00 a.m. – 8:30 a.m. Continental Breakfast

Mason Temple: Corinthian Foyer

8:30 a.m. – 8:45 a.m. Review and Summation of Day 1 Recommendations

Denise M. Harmening, Ph.D., MT(ASCP), CLS(NCA)

Conference Director

Moderator

Marilyn S. Harrington, Ph.D., R.D.H.

Dean, School of Allied Health Sciences

University of Texas Health Science Center

at San Antonio

Recorder

Peggy Valentine, Ed.D., Interim Associate Dean

Division of Allied Health Sciences

Howard University

Tuesday,

July 13, 1999
AGENDA

xi

8:45 a.m. – 9:30 a.m. Keynote Address: The Role of Professional Societies in

Clinical Education/Training Reform

Patricia Crist, Ph.D., OTR/L, FAOTA

Chair and Professor

Department of Occupational Therapy

Duquesne University

9:30 a.m. – 10: 15 a.m. Reaction Panel: Responses and Recommendations

Reaction Panelists

Ann F. Sosnowski, B.S., MT

Coordinator, Student Recruitment

Schools of Allied Health

William Beaumont Hospital

Lydia Wingate, Ph.D.

Dean, College of Health Professions

Weber State University

Harriet Rolen-Mark, M.A., MT(ASCP)

Past Chair, ASCP-AMS

Associate Dean, College of Health Professions

SUNY Health Science Center at Syracuse

10:15 a.m. – 11:15 a.m. Open Forum: Recommendations and Consensus Gathering

Moderator: Virginia Pappas, CAE

11:15 a.m. – 11:45 a.m. Coffee Break

Mason Temple: Corinthian Foyer

11:45 a.m. – 12:30 p.m. Closing Panel: Summary and Review of

Final Recommendations

Moderator

Denise M. Harmening, Ph.D., MT(ASCP), CLS(NCA)

Conference Director

Panelists

Gail Nielsen, BSHCA

Managed Care Performance Administrator

Iowa Health System Corporate Headquarters

Rumaldo Z. Juarez, Ph.D.

Dean, School of Health Professions

Southwest Texas State University

Peggy Valentine, Ed.D., Interim Associate Dean

Division of Allied Health Sciences

Howard University

Moderator

Virginia Pappas, CAE

Associate Executive Director

Society of Nuclear Medicine

Recorder

Deborah Bailey Astroth, B.S., R.D.H.

Assistant Professor

Departments of Dental Hygiene and

Surgical Dentistry

University of Colorado School of Dentistry
KEYNOTE ADDRESS

12

who decides on the care that’s provided? The

physician? The patient? The insurance company? The government? How is this decision

linked to who pays for this care? If an individual

can decide, should he or she have some responsibility to pay for all or part of his decisions, or

should he be able to write checks out of other

people’s checkbooks? And ultimately, who will

be accountable for cost and quality?

It also would be helpful, I think, as we go through

the day, to be careful of words that we use. It’s

very easy to say “if it wasn’t for managed care,

everything would be fine”. But almost no one has

a clear definition of what managed care is in any

kind of real operational sense. It has come to

symbolize the new Satan that’s responsible for

many of our ills. But when you’ve seen one

managed care company, you’ve seen one managed care company. They are all different. They

have different kinds of operational issues. They

have different kinds of controls. And I think it

would be helpful as you talk and as you think about

these issues that you be specific as to what aspect

of managed care or what aspect of the many cost

control strategies, are causing the particular problem or are contributing to the problem.

We are all here today for one simple reason, and

that is that everybody who pays for care decided

Thank you very much. It’s a pleasure to be here

today.

My role is to talk about the financial realities that

impact us all in our daily work. And my job is to

provide a context for your discussion and your

problem solving later in the day. I have a second

job, and that is to preemptively use all the material

that was going to be used by subsequent speakers

and to leave them without anything to talk about.

And from feedback I’ve gotten, I think I’m going

to do a good job at that.

Because I’m very acutely aware of the controversies on plagiarism, I would like to thank all those

living and dead for the material I’m about to use

that they developed.

As we talk through the day and we give our

thoughts and opinions on what’s going on in the

health care field, there are some serious and

significant underlying personal and philosophical

issues that get cloaked in other terms. I just want

to highlight them because I think it’s useful to

keep them in mind as you ask questions or as you

consider the material. One of these and perhaps

the most significant, is whether health care is a

right of all individuals or whether it's a matter of

a contractual relationship between the patient and

the insurer. Another related fundamental belief is

Keynote Address

Economically-Driven Changes Impacting Clinical

Education/Training

George B. Rowland, M.D., M.P.H.

Rowland Associates

ALLIED HEALTH
KEYNOTE ADDRESS

13

that the cost of care was going up faster than they were willing to pay for it. This happened with

employers who were experiencing 10 to 15 percent increases in their premiums. And it’s happening

even more significantly, although it sometimes doesn’t get as much attention, on the part of the

government.

As long as we had, for hospitals, “cost plus” reimbursement, and as long as we had for insurers, cost

plus premium structures, there really wasn’t a lot of pressure on anybody to do anything except do what

they wanted to do, and have a good time doing it. But when the employers and the government said

the increases have to stop, the pressure started building. That was really what stimulated the

development of many of the managed care organizations that have shaped our current system and

brought us to the point where we are today.

Figure 1 is taken from some of the Advisory Board material, and demonstrates the rate of increase

or the percentage increase in premium structures in the ’90s. It shows the rather dramatic impact

of the efforts of the employers and the government, along with the insurance companies who

responded to contain the rates of increase in premiums. The premiums have now begun to go up again,

but there are many reasons that this is not a real surprise.

The diminished funding has created a situation

where nobody’s incentives are aligned. The purchasers - employers and government - want the

best care at the lowest cost. The insurers are often

said to want the least care at the lowest cost.

Actually they really want the best care at the

lowest cost also, but they are at risk, so they

appear to want the least care in their attempt to

contain costs. They are probably more closely

aligned with the purchasers. The providers want

any care at the highest cost because the cost to

the insurance plan is the revenue stream for the

providers. Finally, the consumers want the most

care and they don’t care what the cost is because

they pay for almost none of it.

In this environment, the insurers are really caught

in the middle between the employers who don’t

want to pay much, and the providers and the

consumers who don’t particularly care about

cost, but certainly want to provide or receive lots

of care.

So I don’t really view the insurers as bad. I will

acknowledge that some are overly greedy, that

they are financially driven, and that many are only

marginally competent. But I have some sympathy

for their position because they are, at the moment,

the ones that are “accountable” for cost and

quality. Whether that should be so, I think, is a

matter that we can talk about as the day goes on.

Figure 2 shows the Golden Rule, and it’s useful in

Figure 1: Spotlight Off Pricing Nationwide

Percentage Change on Previous Year HMO Costs

15.7%

13.5%

8.8%

6.5%

3.8%

(3.8%)

(2.2%)

3.0%

5.0%

1997 Projected

Premium Increases

United 5%

NYLCare 5%

AEtna 3-5%

Pacificare 3-5%

Prudential 0-5%

Humana 2-3%

1990 1991 1992 1993 1994 1995 1996 1997(E) 199(E)

Source: Health Affairs (spring 1996); Foster

Higgins , “N ational Surv ey of Em ploy ers-Sponsored

Health Plans” (1990-1996); Sanford Berns tein’

Health Care Adv isory Board estimates

(E)=estimated

9(E)
KEYNOTE ADDRESS

14

showing a little bit about how the money flows down. The Golden Rule, of course, is that he who has

the gold makes the rules. And the insurer at the moment is the one that collects the premium dollar

in most cases, and the insurer then distributes that money out to various providers to provide care to

the patients or customers or consumers. And in the middle box, there is a box called “Medical

Manager” which really has to do with utilization, network development, and quality. Historically,

medical management has been a function of the insurance companies. Nowadays, there is at least

more discussion and more interest in moving some or all of the medical management box down to a

more provider-located area where the actual responsibility for cost and quality ends up in the hands

of the providers, not the hands of the insurance companies. That is something I advocate with my

clients, and frequently, is what I am brought in to develop. There are some good reasons to support

that kind of movement.

The current reality is that within the given fixed

budgets that are made available by the employers

and the government, there is significant redistribution of costs, which means revenues, among

and between various aspects of the medical pie. I

am seeing both in the literature and personally,

that for the first time, pharmacy costs on a permember, per-month basis are exceeding the costs

of inpatient care. Pharmacy costs, as you probably are aware, are the fastest growing and least

controllable part of the medical care budget at the

moment. And because the inpatient care has

received a lot of attention in terms of concurrent

review and reductions of inpatient stay and avoidance of hospital admissions, the cost of pharmaceuticals is actually exceeding that of inpatient

care. That is a huge redistribution of money.

Similarly, you find redistribution of money among

professionals, among various kinds of professions, and between specialists and primary care

physicians. That is one of the realities that occurs

when you have a fixed budget that is shrinking in

real terms, and everybody is trying to maintain

their personal and professional income.

M edical M anag er

utilization

network

quality

P hysicians

prim ary

specialist

Institutions

Acute

Extended

Home based

Pharm acy A ncillaries

laboratory

im a

g ing

com plim entary

Insurer

Figure 2: The Golden Rule

There has been a reduction in real costs. In the

insurance model, this is achieved by a set of

oppressive cost-control strategies, which I’ll outline in a moment. This causes a wholesale loss of

professional control on the part of physicians and

other professionals in terms of the way their care

is delivered.

Even with all these activities, the insurance companies have, in many cases, run out of gas in terms

of being able to maintain their financial performance. They’ve run through their toolbox. They

had a certain number of things they could do; they

did these pretty well; and now their margins are

falling, and many are having considerable difficulty. This is evidenced by companies beginning

to pull out of less profitable markets, raising

premiums, and initiating internal cost controls to

improve their bottom line.

The oppressive cost-control strategies that I talked

about, and you probably are more familiar with

than I on a day-to-day basis, are reductions in

reimbursement, which can take two forms. One
KEYNOTE ADDRESS

15

is changing the methodology of reimbursement

such as moving from a cost-based reimbursement to a case rate reimbursement such as you

see with DRGs in hospitals, or more recently, with

Prospective Payment Systems (PPS) and skilled

nursing facilities. Another is to reduce the amounts

paid on the fee schedules used to pay for professional, procedural, or facility services. Another

change in method is the move from fee for service

to capitation payment. This has been seen in the

payment for outpatient laboratory work.

In terms of fee changes, you find these in legislative or regulatory modifications which reduce

DRG payments, or in a move to an RBRVS

system for physicians (or fee schedule for ancillaries) often with subsequent application of withholds which are not returned.

You also see the control strategies in reduction in

benefits. This can occur through formulary for

pharmacy, constricted coverage of investigational treatments, and the application of “medical

necessity" criteria for payment. Equally often,

the issue is not a reduction in benefits as much as

it is a reluctance to expand benefits. In the last

year or so, we’ve had the introduction of lyme

vaccine and Viagra - both costly but important to

the patients who need them. The introduction of

cholesterol lowering drugs, the “statins,” have

constituted a needed additional benefit which

really should be used far more extensively than

they are. All of these have significant cost impacts on any kind of insurance product, and the

reluctance of insurance companies to cover them

is just an indication again of their position in the

middle between the purchasers and the providers/

consumers of service.

The impacts of reduced revenues on the operating units that have to live within their budgets are

typically higher productivity requirements. We

see primary care physicians and other professionals under the gun to see more patients per day than

they used to. This makes it more difficult to find

the time among the practicing professionals to

undertake teaching or research activities. This

has had a direct impact on your programs. The

need to see more patients also results in an

increased competition among professionals because the supply/demand relationship for the

particular profession has changed due to higher

productivity per professional.

Every hospital and other institution that I work

with is on an endless hunt to eliminate nonessential costs, and unfortunately you feel the

brunt of some of those. The necessity to reduce

costs is exacerbated by the virtual elimination of

cost shifting which allowed the “better” reimbursement from some payers (Medicare and

insurance) to subsidize less profitable services or

payers.

There was a recent article in the Boston Globe

from an academic center in which a physician

listened each year to the same speech from administration as to how bad the reimbursement picture

was, and every year nobody paid much attention

to it and they went about their business. Somehow

everything worked out. The message from this

article was that for the first time, he saw that the

administration was not “crying wolf” and that the

things had gotten to the point where serious

negative impacts were going to occur in the

academic teaching programs of the hospital.

At the same time, the next day, on the news in

reaction to President Clinton’s pharmacy proposals, you saw the spokesman for the pharmaceutical industry whining and moaning about how any

kind of cost controls on pharmaceuticals would

damage their research and development efforts

and impair the quality of pharmaceuticals available to the United States and its citizens over the

next 20 years. The last time I looked, the pharmaceutical stocks were doing just fine.

In all of this attention to costs, there is some effort

to search for quality. Some of the activities have

continued validity but others seem increasingly

irrelevant for improving quality. Accreditation of

medical personnel is, I think, historically one of the

major efforts to ensure quality. This is represented by licensing professional personnel. I’m

convinced that at least for physicians, the state

medical licensing activity is a waste of time and

effort. I don’t know about your profession, but it

doesn’t appear to significantly contribute to quality. And, in fact, it’s often suggested that they

don’t even police their own licensing activities in

a particularly effective way.

Institutional accreditation, JCHO or NCQA, is

another effort that certainly has been long-standing. More recently, I think, recognizing the

limitations of those kinds of accreditation activi-
KEYNOTE ADDRESS

16

ties, the development of report cards has been more prevalent. HEDIS measures when done in

conjunction with NCQA have really made a significant impact in focusing on some population-based

health measures that really put the insurance companies on notice, and make them work on some

things that they might not otherwise work on.

Report cards for hospitals are being talked about. They are still pretty crude, limited to some acuity

adjusted mortality statistics. We are beginning to see on the Internet physician report cards from some

of the more progressive insurance companies who provide networks. When well done, this is certainly

a useful way to present consumers with performance information and to monitor the quality of

individual providers and provider units.

Finally and unfortunately, much of the “quality” is still driven by lawsuits and legislation, which is

probably not the optimum way to handle complex problems in the delivery of medical services.

I think the sad news is that quality doesn’t play a very big part in the health care choices made by those

who are purchasing health care. Cost is still by far

the most important factor that most employers

use in selecting insurance plans.

In the last several years, I think there has been a

lot more consideration of the word “value” which

is a concept which includes both cost and quality.

It is a concept I find useful in my own work even

though it is often hard to quantify. It is helpful to

force the discussion that balances cost and quality

and marginal value added because that is likely to

be more important ultimately in health care decisions.

There are four components that I see as relevant

for value in health care activities. (Table 1) One

Figure 3: Information Employers Used on Selecting Health Plans; 1996 and 1997

0 20 40 60 80 100

Percentage of Respondents

O ther report cards

C ondition-specific outcomes

Plan-sponsored practice protocols

H EDIS

A ccess

U tilization data

Employer satisfaction

Member services (to employees)

Cost

Type of

information

1996

1997

S ou rc e: W a tson W y att W orldw ide

is price or cost. Now, price is different than cost,

as you all know. The cost to a hospital may or may

not bear much relationship to the price they

charge for the particular service. The second is

service. Customer service is properly receiving

more attention by a public that demands greater

consideration of their time and their opinions. I

know that if a retail establishment, Sears or my

local grocery store, had the same customer service as our local emergency department or most

of the physician offices that I am familiar with,

they would go out of business in a minute and a

half. Competency is a concept that we’ll talk

about throughout the day. I think that the public

expects a certain level of competence. They
KEYNOTE ADDRESS

17

don’t want to wonder whether a particular physician or particular institution is delivering competent care; the institution will need to make it as

predictable as a McDonald’s Big Mac®.

And finally, and most difficult, is the search for

and publication of outcomes data. This requires

physicians, hospitals, and institutions to go beyond

good food or timely service, to the evaluation of

the proportion of patients that recover function

and improved life. This requires longitudinal

follow up and evaluation of clinical and functional

outcomes. This is an emerging field but one that

is going to be critical, especially as you look for

relevance and value in the medical sector.

Future realities will be more of the same. We’re

going to be faced with continued financial constraints. The employers are not going to get more

generous. Medicare plans to reduce its expenditures further. And, in fact, we’re going to have to

find additional money to take care of the 43 million

people that are uninsured. In addition, the baby

boomers are moving into the older and medicallycostly age group. Part of that will somehow have

to come out of improved efficiencies of what we

already do.

There’s going to be increased provider competition for the small financial pie. There’s going to

be increasing consumer demands for both service

and for specific services. The population is going

to continue to age, and as they age, they require

greater amount of medical care. I think we’ll see

a diminished role of the gatekeeper in terms of a

primary-care gatekeeper. And we’ll see a continued growth of outpatient and home-care alternatives to inpatient services.

To some extent, the consolidation that’s occurring in the HMO industry or the hospital industry

represents the kind of competition for market

strengths, negotiating power, and available funds

that will be continuing over the next years. One

of the things that you need to do individually and

as a group is to decide where you are on the food

chain; and if you are on the bottom, you probably

really need to do something to get moved towards

the top.

I’d like to suggest three areas where there are

opportunities to improve your position. One area

is the issue of practice and status (Table 2). The

second area which you might want to look at is the

whole issue of reimbursement (Table 3). And the

third issue is training and education (Table 4).

I’m not an academician. I sat on the receiving end

of academia for 20 or so years, but that was quite

a while ago. I don’t interface a lot with the

academic community in my current work. I’m

much more involved in the day-to-day practical

issues of hospitals and physicians. Neither do I

work extensively with allied health professionals.

Most of my contacts are with managed care

companies, hospital administrators, or hospital

administrative staff, and physicians. So I may not

be totally up to date on some of the issues that you

face, but nonetheless, I’ll charge ahead.

The whole issue with practice and status is to

know where to move. Along with everybody

else, I was watching the American women’s

soccer team, and I was reminded of a speech that

Don Burwick from the Institute of Health Care

Improvement gave a couple of years ago at his

annual conference. The title of his speech was

“Run to Space.” The theme was coaching his

daughter’s soccer team where he tried a variety

of motivating efforts to try and get this team to

win, which they never did. He tried to yell at them

for not scoring goals, he tried to give them

chocolate bars when they got a goal, and he tried

to excite the whole team by having parties if they

won the game. All the usual motivating methods

didn’t work because they did not have the basic

Table 2: Practice and Status

• Be part of value improvement effort

–Reduce waste

–Reduce demand

–Track, trend, report outcomes

• Get outside the silo

–Engage in collaborative efforts

–Expand definition of clients

Table 1: Components of Value in

Health Care

• Cost

• Customer Service

• Competency

• Outcomes Data
KEYNOTE ADDRESS

18

competencies to win. They always ran to the ball

rather than to the place the ball was going - hence

the title “Run to Space”. You need to run where

nobody is because that’s where the ball is probably going to go when it emerges from this little

pack of kids. The two lessons from this talk were

that motivation without basic competency is insufficient and that you need to anticipate where

health care is moving in order to be there at the

right time.

While I can’t tell you exactly where that is, I can

suggest a couple of things that will be relatively

enduring in terms of adding value. One is to be

part of the value improvement effort, both in your

individual institutions and probably more importantly at a national level through your associations

and through your professional organizations. And

the value improvement effort that I would have in

mind is made up of three sets of actions.

One is to reduce waste. It is remarkable to me how

much we do that is making up for something else

that wasn’t done right. It could be the staff on the

hospital floor that is looking for the lab results

that didn’t somehow get up to the floor in time for

the physician to pick it up in the morning. It could

be somebody waiting in line for a thallium stress

test, and staying in the hospital two extra days

because the technician doesn’t come in on the

weekend, or because it was booked that day.

Waste in all its forms needs to be discovered and

fixed.

Second is to reduce demand. This can be done

through patient empowerment, communication,

and care-management techniques.

Third is to focus on outcome and to systematically

track and trend outcome data for the particular

activity that is important for the success of your

unit or your profession or your organization.

I think it’s extremely important to get outside the

silos that often characterize the health care organization. I remember when I was in the Indian

Health Service a long time ago, we had one

person in our little clinic that did all the lab work,

did all the x-rays, did much of the translation, and

generally kept things moving. She was accountable for cost and quality for a wide array of

services that were important to the clinic operation. In a larger context, the more a single group

can organize all the services that make up a

particular service line and can be accountable for

cost and quality, the more value they will add and

the more successful they will be at delivering the

product at an acceptable price.

Once the service is set, a broadened client base

will help shield you and your profession from a

catastrophic event such as the PPS reimbursement system for skilled nursing facilities. The

potential for new clients may be quite significant.

I notice around our area, many of the physical

therapists are now getting into personal training

activities which gives them a different kind of

approach. Certainly, the amount of interest in

money spent on alternative or complementary

modes of therapy is growing significantly. And

there are opportunities to rethink who your customers and clients are probably in every field.

Matching capacity and demand is an important

issue driving reimbursement. If I recollect back,

I was talking to a group of cardiologists, and we

were talking about frequency of certain kinds of

diagnostic tests, and we were talking about some

issues having to do with the relationship between

primary care physicians and cardiologists. The

willingness of the cardiologists to examine their

own practices and utilization and the willingness

to develop guidelines that help distribute their care

between primary care physicians and cardiologists is largely dependent on how many cardiologists there are in town and how hungry they are.

If you have an excess capacity in any particular

specialty, it really does distort and make difficult

some of the work that has to get done in trying to

rationalize the amount of care provided.

One of the most important things you can do is to

look at assuming some risk, meaning financial

risk, and accountability for costs and quality risks

for parts of what you do. When I was with the

HMO, we did capitate physical therapy. We paid

Table 3: Reimbursement

• Match capacity to demand

• Assume risk

–Episode

–Service line

• Redesign service delivery

–Care management techniques
KEYNOTE ADDRESS

19

a fixed amount per member per month to a

physical therapy group who was fairly entrepreneurial and fairly aggressive. There were a lot of

lessons to be learned from that. One was we

probably didn’t pay them enough, but that was a

lesson we learned a little bit later. The most

profound lesson to me was that all of a sudden, the

physical therapists took back control over the

entire process of deciding the type, frequency, and

method of treatment. Now, most of the orthopedic

surgeons and some of the other physicians had

trouble with this. They were used to ordering

exactly what they thought they wanted to order.

And we said no; you can’t do that anymore. All

you do is make the referral for physical therapy.

Physical therapists will decide what the treatment

plan should be and they decide the frequency and

the kinds of modalities they’ll use in performing

their work. That one little example, I think, shows

how you can return professional autonomy and

control back to a professional group by that group

assuming responsibility for costs and quality.

The other thing you can do is look at service line

responsibility, which is really across the continuum. Treatment is often fragmented among

the rehabilitation therapies since patients' stays

are limited in the hospitals and care must be given

in various settings; e.g. hospitals, nursing or subacute facilities and in the home. It doesn’t make

a lot of sense to somebody who is looking at the

most efficient way to provide care to the patient.

I think there’s lots of room for different collaborative efforts both across therapies and across

the continuum to assume responsibility for cost

and quality.

And lastly, I think you can participate in redesign

of service delivery through disease-management

and care-management techniques and case-management. This is a huge field. There’s no reason

that a nutritionist or a dietician can’t be the case

manager for a group of diabetics. There’s no

reason that a respiratory therapist can’t be case

managers for asthmatics or people with chronic

obstructive pulmonary disease. So I think there’s

a whole field of case management out there that

is waiting to be tapped.

In terms of clinical training, you need to identify

what value can you add to the institutions and

organizations with which you partner in clinical

training. You need to entice them to make

investments in your students and in your programs. Clearly what it takes is collaboration with

local employers and providers. I don’t see any

way around that. We’re certainly working locally

with our community college on several programs

in an early stage that I think are going to be very

fruitful, and I think we’re going to succeed in

finding some value-added services that are beneficial to both parties.

From the HMOs’ standpoint, it is difficult to find

a value to be added to managed-care companies

through collaboration in clinical training. They

don’t typically employ professional staff so the

benefit would be through research and outcome

measurement. The partners are likely to remain

the provider communities from the hospitals, the

physicians, and the local health care institutions.

Value added services can include outcomes and

guidelines research, process improvement, quality improvement, and organization redesign. You,

as academic institutions, certainly have something to contribute to the effort to rationalize the

quantity and type of care with the outcome of

care.

You also have an opportunity to assist institutions

in recruitment, retention, placement, and continuing education for your students who are going to

be in the workplace.

Figure 4 demonstrates the impact of a group of

physicians - in this case cardiologists - who

become accountable for cost and quality. This

dramatic decrease in rates of cardiac catheterization before and after they were receiving fixed

amounts for services is depicted in this figure.

While the question of whether they were doing

too many when they were doing 277 per hundred

thousand, or whether they were doing too few

when they were doing 88 per hundred thousand

remains, there was no indication of adverse

outcomes in the report.

If you subscribe to the Dartmouth Atlas and are

familiar with Wennberg’s work on small area

variation, this is a dramatic example, but still not

an uncommon example, of rather remarkable

differences in rates of consumption to medical

resources in different geographic areas. A lot of

the work suggests that these are really patterns

that grow up on a very local basis, based on where

they were trained, local peer practices, and per-
KEYNOTE ADDRESS

20

haps supply and demand. There is nothing more dangerous than a hungry surgeon. Perhaps a hungry

lawyer would be more dangerous, but certainly they are right up there together. And a hungry

cardiologist behaves roughly the same way.

Finally, I do think that collaborative learning is extremely important. The workplace is increasingly

collaborative these days, and unless professionals know how to collaborate and cross lines, cross

disciplines, using some of the process improvement or quality improvement techniques, they’re not

going to be trained for the new work environment. Technical competence is necessary but not

sufficient to be successful in the changing work environment of today’s health care institutions.

Figure 4: Low Utilization in Broad Panel

277

8 8

Before A fter

Calif. HM O

Benchmark

230

Before A fter

Calif. HM O

Benchmark

110

6 3

2 9

S ource : A desso S pecialty S ervices O rganization, Inc .;

M edical L eadership C ouncil interview s.

Cardiac

Catheterizations/100,000

PTCAs/100,000

Table 4: Education

• Competency based education

– Technical

– Collaborative learning

• Collaboration with related professions

– Complimentary providers

• Economics and career alternatives

– PT as personal trainers

– Dietitian/nutrition as diabetic educators

Collaboration with related professions is particularly important. I remember spending hours on a

coverage problem that should never have occurred. For some reason, the plan that I worked

with in New York did not cover occupational

therapy; in our particular community, all the hand

rehabilitation was done by occupational therapists rather than physical therapists. We went

round and round for hours and days and months

as to how we were going to cover occupational

therapy for hands, which was clearly medically

appropriate and necessary without covering occupational therapy for all the other things that the plan did not wish to include. This problem could

have been avoided if the therapists had gotten together and said, "hey, look, we’ll do your rehab and

be accountable for cost and quality." That becomes an attractive package both for the insurance

companies and for the profession which recovers the professional autonomy that is appropriate.

It is important that every student understand the practice context into which they’re going, both in terms

of the economic realities, and the opportunities to expand their career alternatives, find new customers,

and grow themselves and their profession.
REACTION PANEL

21

First is the improved clinician recruitment and

retention. The clinical facility has an opportunity

to recruit some of the trainees that it has educated

and also recruit and retain faculty and staff.

There are clinicians who really enjoy teaching,

are good teachers, and like being in clinical settings that provide education. They also like the

recognition of faculty appointments. From the

education standpoint and from the clinical facility

standpoint, it is important to recognize the clinical

educators for their essential roles. There are

many ways to recognize them in addition to

faculty appointments. Recognition means a lot to

individuals and they frequently don’t get what

they should.

We also need to look at the impact of clinical

education on the quality of patient care. It could

have some negative impact; for example, the

patient has to repeat a lot of information to

different kinds of trainees. However, in today’s

world with fewer and fewer health care providers,

students can add a lot in terms of providing direct

care to patients. They can’t be expected to

assume direct responsibility for patient care but

they certainly can help out.

Another benefit of educating trainees is that those

trainees that are hired after graduation in the

institution where they trained will need less orientation, and this would be a major cost saving for

the clinical facility.

As Dr. Rowland said, today’s health care environment is frequently seen as negatively impacting on training and education of not only allied

health professionals but also all health professionals (Table 1). There is an emphasis on eliminating

non-essential costs, and sadly enough, research

and education are sometimes seen in the short

term as non-essential costs. One of the major

outcomes is reduced availability for clinical rotations. However, I believe we can look at the

current situation as a glass half full or a glass half

empty. There are always costs to everything,

including clinical education, but there are also

benefits. Sadly enough, there are not many, if

any, good objective studies of the costs and the

benefits. We have lots of ways to identify costs

but not so many in terms of benefits. I would like

to identify what VA perceives as some of the

major benefits of continuing an active role in

health professions education (Table 2).

Response & Recommendations

Linda Johnson, Ph.D., R.N.

Acting Director

Associated Health Education Office

Department of Veteran Affairs

ALLIED HEALTH

Table 1: Current Environment

Negatively Impacts Clinical

Education

• Emphasis on eliminating non-essential

activities

• Education is perceived as a cost - it uses

resources

– people

– supplies

 – facilities
REACTION PANEL

22

In addition, the clinical facility, whether it’s a hospital, an outpatient clinic, or any other setting, has

an obligation to contribute to the education of future health providers in our country. The clinical

facility shouldn’t expect students to be trained if it won’t participate. Students can learn only so much

in a classroom or simulated setting. It is very important for the clinical facility to provide a setting

where the students are presented with clinical realities. Clinical facilities also need to work with the

professions to identify the manpower needs for the future. This is more difficult to do than one might

imagine. In 1997, Department of Veterans Affairs convened a group of health professions leaders

and tried to identify what VA’s role would be in the future of health profession's education. We

surveyed 50 professional organizations, accrediting organizations as well as professional associations,

trying to determine future directions. It was amazing that very little data was available on what the

individual professions thought they needed to do to prepare for the future health care needs. As a

delivery system heavily involved in clinical education, VA finds it difficult to have a collaborative role

with the professions when they themselves don’t know where they are going.

I believe that the health care system, both the clinical and educational components, needs to thoroughly

evaluate the cost and the benefits of providing clinical training for our future health care workforce.

We need to determine ways to decrease the cost and increase the benefits as well as emphasize the

benefits. Education for the future is a necessity for having an adequate supply of properly trained

clinicians to meet future health care needs. Education is also a public good that should require

contributions from a broad spectrum of our society that benefits from the educational outcomes. This

means all health care delivery systems should be involved in education for the future.

Table 2: Benefits

• Recruitment of former students who will require less orientation than other new employees • Recruitment and retention of clinical staff who enjoy teaching • Rewards for involved clinical staff • Improved quality of patient care due to – scholarly atmosphere – additional people to assist with patient care • Education of future health providers is a public good and clinical facilities should be

responsible. – Those that benefit by having trained workers should participate in their education.
REACTION PANEL

23

Good morning. These are my opinions on the economic impact on colleges and universities. I want you

to close your eyes for a minute. Don’t fall asleep, just close your eyes for a minute and think what will

health care look like in 2010? And then think what allied health will look like? If your mind is totally blank,

you’ve got to start thinking about it. Because if you think about it, education is supposed to be ahead

of practice, and if we particularly, as the educators, close our eyes and don’t even see a fuzzy vision of

the future, then we really are in trouble. I think about it and I say practice is going to be forecasting and

preventing disease and doing less treatment. The question then is, what do I do in allied health education

to work there?

We’re going to change because the type of care we give is going to change as well. As Dr. Rowland

has discussed, we have higher clinical productivity issues out there and we have different sites of care

(Table 1).

Clinical sites have done a fabulous job educating our students. Since allied health is very different from

medicine and nursing, it is the clinical sites that tend to absorb the cost of our students. And we’ve sent

them in as totally green individuals and said "now, you’re going to make good allied health practitioners";

and they have done it, with willingness and their own time. Allied health individuals are fabulous in

Response & Recommendations

Julie O'Sullivan Maillet, Ph.D.

Associate Dean for Academic Affairs and Research

University of Medicine and Dentistry of NewJersey

ALLIED HEALTH

Higher Clinical Productivity

• reduces availability of sites

• reduces time to educate students

• reduces time on formal evaluations

Table 1: Higher Clinical Productivity and Different Sites for Care

Different Sites for Care

• clients expectations different

• space issues

• more contracts

• more training
REACTION PANEL

24

contracts in more detail and negotiating more

with us in what’s going to be in there.

And finally, we have more training, because the

more clinical preceptors you have out there, the

more you have to train them if you’re ever going

to have a quality product. So we have all sorts of

issues affecting us in the college and university

settings in allied health.

I always believe there are lots of solutions out

there for us (Table 2). One is, I think we’re going

to have to change how we view clinical education

so that it becomes more capstone more than basic

education. I’m a skier, so I always talk about

green students and black diamond trails. Well, I

think we’re going to send blue students out that

will do blue trails, and that clinical sites will never

do that green type education again. Project

ahead a decade and they’re not going to do the

base. They may do the black diamond, but

probably they’ll do the blue slope education.

Now, does everyone know that skiing has green,

blue, and black slopes? Black is tough, blue is

semi-tough, and green is easy; most of us could do

green trails even if we’re totally non-coordinated.

We cannot send green students to do clinical

education where the clinical setting is only doing

blue and black diamond care and education. It is

not safe.

Next, the students are going to have to do more

self-evaluation, and then preceptors are going to

have to concur, so students are going to have to

learn constructive feedback, which means we

have to give them the skills to assess themselves

and then let the sites sign off and say, yes, I agree

with this assessment. We’re definitely going to

have to do more simulated learning. You realize

that pilots fly their first plane in the real air with

you on board. That scared me. But that means

that we really could simulate learning much,

much better before the first time we interact with

promoting education. But now the question is

who is going to pay for this education? Is it the

practitioners that are going to have to do it on their

own time, or are the sites going to be willing to

pay?

Right now we have a situation, which everyone in

this room knows, where we have reduced availability of sites because many sites are saying,

“Sorry, I’m not in the business of education,

figure out a different way of doing it.” We have

reduced time to educate students because of the

higher productivity so that we have individuals

saying, "I’d love to sit with the student and

describe how to do this from scratch, but I can’t

do it, I don’t have the time. You know, I’m

spending an extra hour or two a day because of

the students already. I can’t spend three or four."

And they have reduced time for formal evaluations which we’ve as well given to the clinical

sites to do. We ask the sites to evaluate our

students and tell us if they’re competent, and then

program directors sign off on their competence

based on what the clinical sites say.

We have an added problem of different sites for

different care. Because we’re moving out of

institutional care, clients have different expectations. For example, patients residing in V.A.

nursing homes are willing to participate in lengthy

interviews; whereas no outpatient ambulatory

care patient wants to spend an hour and a half

with the new allied health practitioner who is

learning to interview. The change in where we

give care is changing how we do clinical education.

We have space issues in the new environments.

Hospitals have a lot of space. They may not say

they have a lot of space, but there’s generally

space for training, there is space for students,

there are tables and chairs they can set up. When

you go into the community setting, there isn’t the

extra space to put the student to give them their

space to work. Most people aren’t designing their

community centers to have a lot of space to

educate all of the allied health students. We’re

lucky if they’re training some of the medical

students in their environments.

We also have more contracts so that all of us have

extra work because now, rather than having one

or two key sites that we’re dealing with, we have

25 or 30 sites, and everyone is reading those

Table 2: Some Solutions

• clinical education more capstone than

 basic education

• more student self evaluation signed by

 preceptor

• more simulated learning

• more clinical competency testing at

 academic site
REACTION PANEL

25

patients. And the academic sites are going to

have to figure out how they test clinical competency, so it is not just the clinical site doing that.

Now, we have a big challenge from the colleges

and universities base, and I’m actually going to

add a second challenge here. The first is that we

have to reduce clinical costs, i.e. do more for the

clinical sites, without increasing higher education

costs. That’s really a challenge. Every single

academic institution could do a large part of the

education themselves very, very well. That’s why

they’re there. But now they have to do it without

increasing their costs substantially, or we have a

whole different charge system where individuals

pay more for allied health education. I mean,

most of us charge the same tuitions for general

education courses, and maybe that needs to be

different. Maybe there needs to be different costs

or maybe the Bureau needs to invest more money

in training students that are going into allied

health to offset some of the costs because those

demands are out there.

Our second challenge is to figure out how we meet

market demands and don’t over-produce allied

health individuals. Now, we’ve seen medicine

over-produce doctors. It would be very good if we

could figure out how we have supply and demand

balance, but again, you better have a vision of

what’s going to happen to the profession so that

you can in fact make decisions on which ones are

going to grow and which ones are going to shrink.

I have a few solutions for that as well (Table 3).

One is we need to create more independent

learners, and that’s the higher ed challenge everywhere at the moment, not just for allied health.

Students' progress shouldn’t be measured on seat

time. Students' should be participating in their

own learning, and there are many students that

are very resistant to this. So it’s a major obstacle

for us, that students like sitting there and absorbing information rather than getting into a debate

and participating in their own education.

Next, we need to figure out how we share

simulations, so that it’s cross-disciplinary and

we’re all learning together. We must do this

across schools because creating good simulations

requires a lot of additional staff who know institutional design and technology. And if we try to

do it by ourselves, the quality isn’t going to be that

good; we’re not going to be able to afford it; and

if you’re sitting in liberal arts colleges and universities, people are going to say allied health is too

expensive, we can’t afford it. And that may

relegate many of us to just academic health

science centers. Next we need to look at computer technologies; how do we use computers

with students, and how do we do testing? You

know, you heard the Bureau representative ask

what do we do in under-served areas. There is

the possibility that we can do much of the education where people do their learning in their own

environment through technology, and perform

competency testing when they’re finished. So

it’s really capstone education on site and then you

get people going back out to their communities.

There are lots of solutions there if we’re willing to

say you don’t have to sit in the class for eight

hours a day, four days a week for your first six

months, and then you have to go into clinical four

days a week.

For the clinical sites, we’ve got to create valueadded projects and we have to continue to promote students as wonderful for the clinical environment. We send in strong students to the

environment, they add value and that helps with

recruitment. It helps with keeping staff up to date.

We can make evaluation of services part of all of

our students' clinical education. We give back to

the clinical sites and when the students graduate

so they can in fact know how to reduce costs and

how they reduce wastes, and measure their

outcomes.

So with that, I’ll give my three summary points.

Those three points would be 1) to envision the

future and find solutions; 2) to think about how

you use technology to teach teams in a variety of

settings; and 3) to design clinical activities that the

sites will value, the students will value, and that

will promote quality education.

Table 3: Some Solutions • creating more independent learners • designing shared simulations across disci-

 plines and schools • using computer technology and testing for

skill development

• create value added projects • make evaluation of services part of clinical education
REACTION PANEL

26

fore it is difficult to hold them accountable to any

standard when they’re giving freely of their own

time.

As you might imagine, in such an environment,

there’s quite a spread between those who see

themselves primarily as technicians providing a

service to their communities, and those who see

themselves as professionals providing services to

the public. In addition, emergency medical technology is a very new profession and in a tremendous state of flux. It is a moving target in terms of

planning appropriately for the future. Most of the

instructors are also volunteers, not professional

educators. Maintaining quality education in such

an environment is a real challenge.

Salary and mobility, and to a lesser extent, professional status, are the major issues for the EMT

paramedics themselves.EMTs make about

$15,000 to $20,000 (if they are paid). Paramedics

may make $10,000 to $15,000 or more. So for

many EMTs, climbing the career ladder to Paramedic is a very large economic incentive. Yet,

there’s little incentive for the volunteer EMT to

make that jump, as you might imagine, even

though many treatments that are required for

modern emergency medical technology do require the provision of the advance life support

skills traditionally within the paramedic's domain.

Good morning, everyone. It’s my pleasure to be

here. Like my colleagues on the panel, I will be

representing primarily my own views as a member of a relatively small accrediting body for a

relatively small profession. I suspect that you will

hear some common themes in my remarks that

are similar to what you’ve heard others report.

I do want to begin, however, by pointing out that

the profession, which the organization with which

I work accredits, is a little atypical of the professions that are assembled in this room in that it is

not really a health profession per se. It sits at the

junction of public health and public safety and has

elements of both in the training. It has a somewhat

different view on our keynote speaker’s initial

question: “Is health care a right or a contract?”

With respect to emergency medical services, the

public has largely determined that it is a right.

They can and should be made available for the

public at large. Of course, that does not necessarily translate into the appropriate level of support

for that public good.

There are also some very unique aspects to emergency medical technology as a profession. It is at

the intersection of public health and public safety.

Its history - grows largely out of communitybased, volunteer rescue squads. This has resulted in large numbers of EMTs, and lesser

numbers of paramedics being volunteers. ThereResponse & Recommendations

Arthur Cooper, M.D., M.S.

Chief

Division of Pediatric Surgery

Columbia University/Harlem Hospital

ALLIED HEALTH
REACTION PANEL

27

As a result, because we have so many volunteers,

particularly at the EMT level, the wish for accreditation services is not always as strong as it

might be. Since accreditation services are really

the only significant guarantor of quality, given that

the instructor pool is not terribly well developed,

we’re in a bit of a bind. What are the main issues

for the employers? Cost and flexibility, and to a

lesser extent, the technical level of skills that

they’re able to provide. HCFA is now paying less

and less for ambulance services. No surprise. In

addition, the ambulance world has been taken

over by conglomerates in a way that the health

care industry has not. Yes, there are some large

health-care giants out there, but we’re now facing a situation where the ambulance world is

basically owned by three or four multi-national

conglomerates, plus a smattering of small volunteer fire departments and rescue squads all around

the nation. Neither the volunteer squads, which

have no money, nor the big conglomerates, which

want to make money, want to pay for accreditation services. So that impacts upon the desire of

the professional to seek this additional status.

Employers are hardly ready to pay the additional

price for certification of paramedics for work

that, in some minds, might just as well be provided

by technicians at a far lesser cost rather than by

para-professionals.

So what are our challenges? In terms of the actual

programmatic end of things, there are limitations

in terms of the clinical sites that paramedics have

access to, particularly with respect to intubation

training and delivery room training. These are

historic stumbling blocks in this type of education,

and the problems are only getting worse. In

addition, there’s a tremendous reconsideration of

what is a paramedic. There’s a study ongoing at

the Ontario Pre-Hospital Advance Life Support

Study, which is looking at every aspect of paramedicine and examining whether this profession

provides true additional value in terms of patient

outcome.

With respect to accreditation, where’s the proof

that we need it? We may not, but no one is willing

to take the chance because there’s no instructor

pool out there of any quality to ensure the educational standards of accreditation are being met.

We also have an EMS education agenda for the

future that the Federal Government is sponsoring,

which is seeking to reorganize and restructure the way

educational standards are designed and derived to

provide uniformity. And, of course, we continue to have

the problem of finding appropriate medical control

physicians to sign off on the competency of graduates.

As revenue decreases on the clinical side of the profession, fire based services have more time on their hands

because they’ve been so effective at preventing fires.

This has caused a shift of para-medicine from the public

health model to the public safety model, to training

oriented rather than education oriented. This is really a

very difficult problem, which has yet to be solved.

What is the reality? We are switching to terminal

performance objectives and competency-based outcomes similar to other professions. How many repeats

of a skill is enough to be competent? There is no data

in para-medicine. At the present time, only seven states

mandate accreditation and only about 20 percent of the

programs are currently accredited nationally. Yet, the

EMS education agenda for the future is calling for, by

the year 2010, universal national accreditation, not only

at the paramedic level but also the remaining professions as well.

The cost of accreditation is relatively inexpensive. It’s

about $40 per student, less than about one percent of the

tuition costs for the average paramedic program. So if

there is value, the value of accreditation is probably

pretty high because it represents a relatively small piece

of the overall cost. Yet we don’t have the data to prove

that.

There is finally a consensus building toward the need for

accreditation nationally, but that is going to require

some work before it comes to fruition.

In summation: • We have a new growing profession in a constant

state of flux, which presents a moving target in

terms of future planning.

• Quality education needs quality educators, and

we have yet to develop an appropriate instructor pool that will meet that need.

• Accreditation standards access to educational opportunities will decrease because there

are a number of schools out there that don’t

have the funds to improve the standards.

These are tall orders for the next decade, and I hope to

learn from you and to take some information and

guidance back to my group. Thank you very much.
KEYNOTE ADDRESS

28

education work, there is no reason why we

cannot make it work. Changing the words and

talking about similar issues that we have been

talking about for the last 20 years, as we did this

morning, will not accomplish what is needed to

deal effectively with clinical education. We need

to take what we know has to be done, in cooperation with all the interested parties, and change that

into action, not protect vested interests, not protect what we used to do, not protect what we do

not yet know we want to do because we have no

information to say that’s going to be any better.

Then, we have to deal with economics and the

bottom line, whether it affects patient care or not.

That is generally the attitude of everyone who is

involved in the system, and that is also economics.

Are we going to sacrifice the clinical education of

our students for a new MRI or new CT technology, or are we going to deal with what is really

important to patients, which is the responsibility

we should all have in our respective positions to do

what is best for patients, which is to protect what

we need to do in terms of patient care.

I will not dwell that much on historical background. I will try to provide a historical overview,

including many changes over the years. While the

past has served us well, it doesn’t necessarily

mean that we should continue in the future everything we’ve done in the past. Change can work to

Let me begin with a quote from Sir William Osler:

“To study the phenomena of disease without

books is to sail an uncharted sea, while to study

books without patients is not to go to sea at all.”

We could probably stop there and just talk about

the patient because that is essentially why we are

all here today. Our clinical education responsibilities are what they are because we are trying to

do something for patient care. It isn’t necessarily

whose responsibility it is, whether it is the

hospital’s, or the clinical site’s, or the education

program’s, or the faculty’s, but some day you or

I might become a patient, and we should want to

make sure that as much experience that the clinician has works to the advantage of the patient.

That experience has to start somewhere, and I

trust it should start in the clinician’s educational

program.

If we did not want to focus on the patient, we could

just talk about the following three words: attitude, professionalism, and economics, which sum

up all that we have to deal with regarding clinical

education, at least in my view.

We are talking about the attitude of individuals, of

agencies and organizations, both profits and nonprofits. We are talking about professionalism or

the lack thereof. If we want to make clinical

Keynote Address

Overcoming Barriers to

Clinical Education/Training Reform

Lawrence Abrams, Ed.D.

Dean, College of Health Professions

Thomas Jefferson University

ALLIED HEALTH
KEYNOTE ADDRESS

29

our advantage as much as it might work to our

disadvantage.

Allied health programs represent a broad diversity of clinical experiences and settings. For this

presentation, for example, I reviewed information

from 31 different allied health disciplines, including literature from our professional organizations, from the accrediting agencies, from the

certification, registration and licensing organizations, and from other constituents that are involved in the system. Although some similarities

exist, essentially there are several differences.

Moreover, there is very little documented research on clinical education to support what we

have done in the past, what we are doing now, and

what might lead to what we should be doing in the

future.

Generally, the literature classifies the several

types of clinical education programs into two

broad categories related to patient contact. The

laboratory is usually referred to as a non-patient

contact setting, although we do know that that is

not universal. Some laboratory personnel do have

patient contact, as we know that clinical personnel are usually referred to as having patient

contact. In traditional models/settings, students

essentially served as staff in hospitals. This onthe-job training represented the first semi-formalization of educational training, as practiced in

some hospital-based programs.

With the advent of certificate, diploma and degree

programs, more informal, less structured experiences and evaluation methods were introduced,

although current trends in many allied health

disciplines include more structure and increased

regulation. The one-on-one teaching models,

with hands-on, direct patient interactions or experiences, provided an excellent opportunity for

students to learn as well as they could during

those times (Table 1). Whether this approach to

clinical education is ideal now, whether it can be

continued, remains to be seen. But now we are

moving into other kinds of settings that I think will

serve all of our clinical education responsibilities

better (Table 2).

Non-traditional settings are becoming much more

prevalent. At Thomas Jefferson University’s

College of Health Professions, for example, several of our clinical experiences now are set in

Table 1: Traditional Model/Setting

• Students served as staff in hospitals

• On-the-job training

– first semi-formalization of

 education/ training

• Hospital-based programs

• Certificate, diploma, degree programs

– more informal, less structured

 experiences and evaluation methods

• One-on-one teaching models

– hands on, direct patient interactions

 or experiences

Table 2: Newer Model/Setting

Considerations

• Non-traditional settings

– home care, community-based clinics,

 homeless shelters

• Collaborative group model

– one instructor + 2 to 4 student peer

 groups;students utilize one another

 as resources

• Split supervision model

– one student splits time between two

 sites and two supervisors

• Indirect/offsite supervision model

– occupational therapy: six hours per

 week direct supervision by an OTR

 with indirect supervision the

 remainder of the 40 hour week,

 including supervision by a non-OT

• One year internship model

– student is paid one-half years salary

over 12 months (student rotates for

six months in several supervised

settings and then moves into six months

of employment)

• Computer and virtual reality simulations

• Case studies

• Interactive ideas

“Clinical skills are very different from

classroom skills and demand higher levels

of initiative, responsibility, flexibility, net

working, time management, communica

tion and negotiation.”

Gina F. Collier and Lisa O’Connor

April, 1998, OT Practice
KEYNOTE ADDRESS

30

home-care, community-based clinics and homeless shelters. Both the students and faculty champion these new settings/experiences. Rather than

restricting all of our clinical experiences to tertiary

care centers, this diversification is working to

provide our students with a more well-rounded,

balanced curriculum. We also have an opportunity to use a collaborative group model, with one

instructor and peer groups of two to four students,

who can utilize one another as resources. We are

finding that the more students can learn from each

other in these groups, the more they favor that

kind of clinical education. They are going to be

working in teams after graduation, so they should

get used to the idea of working in teams during

their educational experience.

Another non-traditional approach to clinical education is the split supervision model, where a

student splits the time between two sites and two

supervisors. This is a value-added opportunity

for most students. The expense of travelling from

one site to the next, if they’re not in close proximity, could work to the disadvantage of the student;

however, that hasn’t presented itself as a problem.

The occupational therapy literature describes the

indirect off-site supervision model, where a student spends six hours per week in direct supervision by a registered occupational therapist with

indirect supervision the remainder of the week,

including supervision by a non-OT. This represents another of the several kinds of changes to

clinical education currently in practice.

Another approach that makes some sense is the

one-year internship model, where students rotate

for six months in several supervised settings

followed by six months of paid employment.

Whether this method is feasible with the number

of students that are in our programs remains to be

seen. However, it does provide a concentrated

opportunity for experience, and it is probably

very ideal if the institutions can afford to do it. It

is costly, but the return on the investment probably would work well for the student and the

healthcare delivery system. It also tends to increase both the patient volume and the patient

revenue.

Other options include computer and virtual reality

simulations, case studies and interactive ideas.

As Gina Collier and Lisa O’Connor state in OT

Practice (1998), “Clinical skills are very different

from classroom skills and demand higher levels of

initiative, responsibility, flexibility, networking, time

management, communication, and negotiation.”

Now, where do we learn these clinical skills?

Can they be transferred from the hospital into the

classroom? Can the dexterity skills that go with

the laboratory science professional be learned

just as easily in a classroom situation, using the

latest technology? It remains to be seen if what

appear to be good ideas today will work as well

as expected in the future.

There are several issues related to clinical education reform that we need to discuss. I am going to

identify some general issues, then focus more

specifically on the key ones.

Much has been written in the literature about

issues concerning the scope of practice and core

clinical competencies as defined by the various

professional organizations and the state/national

boards of medical/healthcare education and licensure. It is difficult to determine which point of

view is best because they are very often selfserving and political. On certain issues, the professional organizations, including the accrediting

agencies, stand firm until they are challenged.

However, it is interesting that when they are

challenged, they often tend to modify their position.

Many of the changes occurring in clinical education are driven by the increased number of programs; there just are not enough sites available

for students to get adequate clinical experience. It

is not that the experiences that they used to get

were bad or not working, it is because of the

proliferation of so many programs in several of

the health professions that we do not have a

choice. We have to make changes to accommodate the number of students in the system. And

whether that is good or bad, remains to be seen.

There is a lack of reliable documentation regarding just how much time is needed for clinical

education. Some health professions are a little bit

ahead of others in this regard; but on balance, we

don’t really know over a long period of time

precisely how much clinical education is needed

for the programs that we offer. The literature

does agree that the longer the clinical experience

is, the better it is. But, again, it is questionable

whether sufficient documentation exists to support this conclusion.
KEYNOTE ADDRESS

31

The impact of accreditation standards on clinical

education addresses minimum standards and individual program flexibility. The question arises:

the minimum standards are based on what? In the

past, when I called some of the accrediting

organizations, I was told that, well, that is just the

way it has been. But based on what did we have

those minimum standards? Some professional

organizations have done a much better job than

others. Although I do not wish to say that one is

ahead of or better than the other, I agree with

Judy’s comment this morning that the American

Physical Therapy Association has done an excellent job in documenting as much as they can, not

only in terms of clinical education, but in terms of

cost benefit and things of that nature as well. And

that is helpful. We should have more activity

among the professional organizations, as some of

the professional organizations are trying to do, to

provide us with that information.

Although we have some individual program flexibility, we still lack the outcome studies necessary

to justify the individual accreditation requirements. Regarding the medical technology laboratory science professionals, NAACLS says that

graduates must meet competencies outlined in the

Essentials; there are no rules requiring clinical

rotations. This prompts the question: what is the

connection between board exam results and clinical practice? Is there a connection? We do not

know with certainty. In fact, this day-and-a-half

program could generate hundreds of doctoral

dissertations that need attention. If we could get

doctoral dissertations in the health professions

around the country to deal with some of these

issues, we might be better served than by some of

the projects that people are doing for doctoral

dissertations that aren’t really doing much to help

the system.

In occupational therapy, for example, the literature says that nine months used to be required in

mental health, geriatrics, pediatrics and physical

disability. Currently, there is a six-month requirement, which focuses on the age of the client

served, the arena of practice (whether it is in a

hospital, school or community), the acuity of

injury (chronic to severe), and type of condition

addressed by the setting. While these changes

make a lot of sense, it doesn’t mean that working

for nine months in those four areas was the wrong

thing to do either. By initiating innovative changes

that are in concert with the Essentials of their

profession, academic programs in occupational

therapy and its graduates have served the

healthcare delivery system very well. And so we

can learn a lot from what is going on in the

profession of occupational therapy, as it is described in the literature.

One of the major issues that is frequently reiterated relates to the decreased staff and increased

case loads in clinical settings due to mergers and

restructuring. How does this situation relate to

“attitude and professionalism and economics?”

Considering that each of us will likely someday be

a patient in a hospital, should decreased staffing

and increased case loads in clinical settings due to

mergers, restructuring and the bottom line be the

reason why we do not have the most qualified

practitioner taking care of us? I do not believe so.

At Thomas Jefferson University, where I work,

we are erring on the side of standards. That is, we

are not making changes that will compromise

patient care, no matter how reliable or economical

we think they are. Although we have done things

a certain way, we definitely do not just do something for the sake of doing the same thing; we also

modify and change based on an evaluation of

what will make a difference to our curricula and

our programs. While some of the hospitals agree

with us, some do not, which can be problematic,

and lead to losing a site that fails to correlate with

our curriculum and what we are trying to have our

graduates do. Clinical education at Jefferson is

essentially no different than anywhere else. We

have 1,610 clinical sites worldwide, where our

students get their education and that is really

cumbersome to administer. Although it is difficult, we are extremely pleased with the results we

are getting as reflected in the Longitudinal Study

that Dr. Kevin Lyons conducts through our Center for Collaborative Research, relative to employer evaluations of our graduates. Approximately 90 percent of what we are doing continues

to be supported because we survey current students and our graduates periodically for 10 years,

and they tell us which part of the curriculum we

should continue and which we shouldn’t continue.

We sometimes have more of a problem with our

faculty making changes in the curriculum because we are listening to our employers, but

slowly we do get the changes in place. Then we

feel good about our graduates and their preparation for their professional careers. We have put
KEYNOTE ADDRESS

32

all this in place so that, relative to clinical education, we are doing something that we believe will

maintain the strength of our programs and their

accreditation status.

As mentioned previously, in some disciplines,

such as occupational therapy and physical therapy,

the proliferation of programs and students has

sharply increased competition for the limited increase in clinical education training sites. For

example, the Commonwealth of Pennsylvania

and in our neighboring states, New Jersey and

Delaware, we have 17 physical therapy programs

and 16 occupational therapy programs. I don’t

know precisely where the responsibility lies, but

it is poor management and poor planning from the

professional organizations and the accrediting

agencies to allow the proliferation of that many

programs. There is no other place to put that

responsibility. While it is true that restraint-oftrade legislation prohibits stopping a program

from coming into existence, presidents and officers at universities can and should be made aware

that such programs cannot survive long term.

Recently, I was in a faculty club at a leading

institution with a president who said that they

were going to start a program, and when they

couldn’t get enough students, they would close it.

The professional organizations are aware of that

attitude. And as much as they are in a very

difficult position to bring their influence to bear in

order to persuade the right people, whether it is the

president or the board, they have to stop the

proliferation of new programs for short term,

expeditious reasons. It is not working and it is

adversely affecting other programs. If permitted

to continue, it will also negatively affect the

educational delivery system and the healthcare

delivery system. There must be a way to control

that.

We know from the preliminary information we

have and from the Health Professions Data Collaborative (that is supported by the U. S.

Bureau of Health Professions) that we have a very

poor grasp on supply, a worse grasp on demand,

and no grasp at all on utilization. We don’t even

know if the graduates of our programs are being

utilized in the healthcare delivery system in the

same ways they were prepared by their educational programs for entry into their respective

professions. So we have to be much more responsible, and that impacts clinical education. There

is no way of getting around it. If we don’t put

those strong enforcements in place, we are going

to continue to have problems that we can say are

related to clinical education, but, in fact, we are

contributing to and participating in the making of

those problems.

The topic of student preparation for clinical education and training was addressed this morning.

In a study completed in the field of occupational

therapy, it was found that students were being

sent into clinical sites without any course work in

abnormal psychology or special education. The

students couldn’t even speak the language of the

environment in which they were working. That

situation has changed. After learning what the

problems were from surveying the sites, the faculty and the programs corrected the situation.

That is definitely a step in the right direction.

The problem of fewer employment opportunities,

as stated earlier, is a direct result of the proliferation of college and university programs, which is

one of the most significant contributors to the

problems that we have in this regard.

Regarding risk management, which is an area

with serious implications, students generally carry

their own malpractice insurance plans via the

college or university or hospital group policy.

But many sites are also imposing other criteria in

terms of risk management. Although I do not

think that we currently have any major problems

with an abundance of law suits (as reflected in the

College Law Digest), the insurance companies

are saying that we can anticipate problems if we

do not have properly prepared students going into

the clinical sites. The proliferation of programs in

some disciplines clearly jeopardizes the standards

of admission at institutions where tuition revenues or filling seats have high priorities. Bringing in students that are not qualified to be in the

health professions programs will only serve to

undermine patient care. We must be vigilant

about maintaining high standards in admitting

students who are capable not only to do, but to

think and have the comprehension skills needed in

the health professions.

Can clinical affiliation agreements really be enforced? I can give you just a very small survey.

I talked to three attorneys who regularly review

corporate compliance agreements, and they say,
KEYNOTE ADDRESS

33

“Absolutely not.” What is on paper sounds good,

and everybody signs these agreements, even

though it might take months to circulate the

documents and obtain all the signatures. Yet, I’m

told that they cannot really be enforced because

they are so general that you can interpret whatever you want if you have a problem. But all the

colleges and universities, all the programs - everybody has to have a clinical affiliation agreement. I review each of the 1,610 that I sign every

year and we have our directors of clinical education in the departments review them; we have our

attorneys review them and we have our insurance/risk management personnel review them

also. It is a major job. Because we have not had

a problem, so far, is it worth it? There is no

guarantee that we won’t have a problem, even

though we go through all that review. At least we

have a standardized agreement that we’ve asked

the clinical sites and their attorneys and their

administrators to approve. So we do not impose

upon them; it is a two-way agreement. Without

question, the issue of clinical affiliation agreements is important in clinical education.

The evaluation process normally includes written

and/or oral evaluations provided by site personnel. The educational institution faculty has the

responsibility, shared or not. Legally, it is an

institutional responsibility, as well as the responsibility of the student in the curriculum, to deal

with clinical education. We may share it, we may

be partners, but we are responsible for it.

The issue of “territoriality” deals with the concept

that education “owns” the students while the

service providers “own” the patients/clients. Several cases in the College Law Digest support this

notion. Again, the educational institution owns

the student, but the clinical environment owns the

patients. It should be a joint, collaborative existence. It sometimes is, but not all the time.

Now, I will address the “pros” related to the

clinical education issue (Table 3). The pros

include: it frees the schools of the tremendous

labor burden of placing and supporting students

while providing clinical faculty with the opportunity for more innovation. Also, strong clinical

education support should increase student recruitment. We have found that strong clinical

education support does increase student recruitment because almost 50 percent of surveyed

students that had a favorable/positive clinical

experience expressed interest in working at that

institution, and our Career Development Center is

confirming whether or not they are going to have

an opportunity to work. We expect that in a few

months, data for this past year will confirm that it

saves recruitment costs for the hospital or the

healthcare facility. This also gives them an opportunity to recruit our students before someone else

does because we put in place several years ago

a Career Development Center in the College of

Health Professions that helps the student from

day one prepare to conduct a job search, how to

interview for a job, and how they are supposed to

work on a job, either as a student or as an

employee. We also have a career fair where we

have recruiters coming from all over the United

States, twice a year, to Jefferson to talk to and to

meet our students and to find out what they’re

interested in, which has helped our students,

helped our College with recruitment, and definitely helped those hospitals and healthcare facilities that have invested in that process.

Other pros include the fact that hiring their own

graduates should save clinical sites substantial

recruitment costs. There are also incentives for

clinical education sites/personnel, including faculty appointments and continuing education opportunities. We are very willing to do a lot to help

the faculty at our clinical sites. We include them

in our continuing education programs. We appreciate their teaching skills and their expertise which

strengthens the knowledge base connection between our faculty and the clinical professionals. I

have long been a proponent of the notion that you

cannot teach what you do not do. Although our

faculty don’t go back into practice as often as I

would like, if at all, I am convinced that our

faculty would be that much stronger if they spent

more time in the clinical area every year or two to

keep their clinical skills current. Whenever we

have an opportunity to do things for the hospitals

and the clinical personnel, we are willing and

happy to do it, such as obtaining and demonstrating new technology. On the other hand, something that we didn’t do years ago, in response to

a hospital in Philadelphia proved to be beneficial

also. This hospital warned all the colleges in the

area that it would stop providing clinical slots for

nursing and allied health students unless the schools

were willing to pay for clinical experiences. Considering the importance of clinical education for
KEYNOTE ADDRESS

34

our students, the hospital’s position was a tough thing with which to deal. So a couple of key individuals

got together, got some more colleges and universities involved, and we had a meeting with the hospital

administrator and with the person who made that decision. At this meeting, we said that we

understand the hospital’s position, but we are also aware that the hospital is one of the leading

institutions for patient care. If you really feel strongly about the change in policy, none of our programs

will send our students to you, nor will we be willing to pay for it. After about 20 minutes, the hospital

administrator said, “Let’s forget about it. We’ll study the issue for a couple of years, and then if it’s

still a problem, we’ll come back to you.” The issue has never come back in the nine years since it

was first raised.

This indicates that we can do something when we need to, if we are unified because clinical education

is imperative to all of our health professions’ programs. And if we compromise those, if we

compromise our standards, we are in trouble. This does not mean we can’t change what we’re doing

and do it a little differently. In fact, we can and, when indicated, consider change. Even if we don’t

really agree, try changes for a few years to see if it works, and then we can either change our minds,

or those things can change that we tried for several years. We cannot fail to have clinical experience

because a major hospital would threaten to withdraw its site unless it is paid for. Admittedly, some

educational institutions around the country do pay for clinical education. While I am not a proponent

of that, neither do I presume to say what you should do in your particular area. I do caution, however,

that this practice can become an expense to a college or university or to a program that is beyond which

it could survive, because there is no cost analysis or cost accounting approach to determine precisely

how much you should pay for a student. It is a situation that could get out of hand and become a serious

problem.

Another point in favor of clinical education is that the presence of students should stimulate staff to

stay current and sharp, which we often overlook. We want to keep our clinical personnel as sharp and

current as our faculty. Students strongly encourage those individuals to read their journals to find out

what is current. In the literature, data have shown that turnover of teaching staff is less than for nonteaching staff, which is a cost factor. Also, the literature states that all the work gets done, whether

or not the staff are teaching. At Jefferson, we never had a situation where we were told that clinical

• free schools of tremendous labor burden of placing and supporting students and clinical

faculty opportunity for more innovation

• strong clinical education support should increase student recruitment • hiring their own graduates should save clinical sites heavy recruitment costs • incentives for clinical education sites/personnel

– faculty appointments

– continuing education opportunities

• presence of students should stimulate staff to stay current/sharp • turnover of teaching staff is less than for non-teaching staff • all of the work gets done whether or not staff are teaching • toward the end of training, students might increase productivity

– time of supervision offset by student’s contribution to patient care (cost/benefit) • students perform clerical and aid duties in general and, thus, increase

 patient care income in particular • students attend patient-related meetings

Table 3: "Opinions" on the Issue - PROS
KEYNOTE ADDRESS

35

personnel can’t do their work. Somehow it gets

done, and it really isn’t compromised.

On the other side of the issues related to clinical

education are the “cons.” (Table 4) Some of

these involve the lack of money, time, interest,

and/or ability of clinical sites and personnel. In

addition, some program departments do not have

a full-time clinical education faculty person. Given

the importance of clinical education, I think that is

something that we all have to become more

responsible for if we are going to be managing

educational programs.

Other cons are the annual requirements to update

the clinical affiliation agreements. Additionally,

there has been an increased trend for accreditation agencies to charge a fee for each clinical site.

Some opponents of clinical education hold the

view that teaching decreases productivity of the

clinical education/training professionals. While

there might be some truth to this view, there is no

definitive documentation to support it. As stated

earlier, the presence of students can also be an

incentive to and positive influence on clinical

personnel.

In one study, the author states, “The reduction in

clinical training time for students may provide

immediate relief by decreasing the amount of

time hospital staff spend teaching at clinical sites.

However, this may be a short-term benefit if it

causes an increase in the time required for new

employee orientation and achievement of expected competency levels for new graduates

entering the workplace.” Our hospital administrator at Thomas Jefferson University Hospital

and three of the other 21 healthcare facilities that

comprise the Jefferson Health System have asked

me to make the curriculum work so that they

don’t have to put in unnecessary in-service for

our graduates who are not adequately prepared.

They recognize that there is a learning curve, but

they want assurance that the curriculum includes

what it should in order to avoid an added unnecessary expense. And they’re absolutely right.

Although, the entire faculty in the College did not

agree with me or with the hospital administrator,

they did see the merit in his argument and made

the necessary changes. It did not cost us anything

in terms of the curriculum, it didn’t cause any

problems with accreditation, and we made changes

that worked to the advantage of the healthcare

delivery system.

Additional cons include: providing clinical education is expensive for the clinical site. While it is

expensive initially, if students are prepared better,

then it won’t be as much of an expense in the long

term. Another disadvantage is that students do

little or no useful work during their initial early

clinical education/training experience. The same

is true for medical education and nursing education. Hospital administrators take a year of

course work and a year of an internship and still

require a learning curve on the job, even though

they have had a year of paid internship. And they

still don’t know everything they need to. In fact,

if you look at the curricula of the hospital administration programs around the country, most of

them require only a single course in finance, yet

90 percent of their job involves finance. They

don’t even have their curricula in place to prepare

hospital administrators properly for their responsibilities, yet they often pass judgment on everything else that goes into the hospital and the

services that are provided.

Clinical sites can save money by eliminating

education programs, and many are doing that.

They would often rather have MRI or CT technology which generates income and generates a lot of

other activity than an educational program. Until

we have more data about supply, demand and

utilization in the health professions work force, I

think hospital administrators need to be very

circumspect about removing an student clinical

experience opportunities.

Technology and automation are also impacting

clinical sites by eliminating the need for some

jobs. And, in some areas, clinical/laboratory

education is no longer a priority.

In addition, we have more competition for the

limited sites resulting in only the “best students”

getting the best placements, as well as the risk of

all students not finding a placement. The lack of

quality control that comes from schools and

accrediting agencies as well as the absence of

certification/credentialling for the site of clinical

educators are quality control issues.

The following quote from the literature makes

sense to me: “We seem to be caught in a dilemma

of our affiliates telling us they would not want to

hire a graduate without clinical experience but are

not willing to provide the clinical experience for

the students.”
KEYNOTE ADDRESS

36

Again, on most of these issues, I consulted with

hospital administrators or attorneys or accrediting

agencies because I do not have the depth of

knowledge or experience to be an expert on this

subject. When I raised the issues, both pros and

cons with them, they acknowledged the importance of clinical education. They said that they

are not dealing with attitudes now. They are not

dealing with anything other than finance, survival.

I told them that continuing to think that way would

be detrimental to their jobs because everyone,

including boards of trustees, is interested in having a strong health professional being able to

provide the best patient care. Yes, dollars are

important, but it is equally important to know that

your graduates are able to do the right thing, so

that at commencement, the faculty and the administration and the university feel good about

who is getting a certificate or a credential to be a

health care provider.

We may want to, as one solution, maintain the

ideal proven one-on-one model. We haven’t yet

determined that model doesn’t work. We may

also consider the newer models that have been

proposed. We can adjust the length and the

location of the clinical experiences. We can

shorten the duration of clinical rotations to accommodate more students. We can move instrumentation into the classroom. Whether you get all

the skills and dexterity being supervised by the

clinical professionals remains to be seen, but we

can do all of those things. There is no reason why

we cannot. I think they should be studied while

we try to implement them.

Additional options/solutions (Table 5) include the

following: we can identify more flexible accreditation and certification eligibility requirements.

Accreditation agencies can be very good, especially if you include them upfront when you wish

to make a change. I’ve had experience with

accrediting agencies and organizations and professional organizations in terms of making a

change that took two years, which is a very long

time to obtain approval. But they finally agreed to

• money, time, interest, ability of clinical sites and personnel • some program departments do not have a full-time clinical education faculty person • annual update of clinical affiliation agreements • accreditation agencies charge a fee for each clinical site • teaching decreases productivity of the clinical education/training professionals • “The reduction in clinical training time for students may provide immediate relief by

decreasing the amount of time hospital staff spend teaching at clinical sites. However, this

may be a short-term benefit, if it causes an increase in the time required for new

employee orientation and achievement of expected competency levels for new graduates

entering the workplace.”

• teaching is expensive for the clinical site • students do little to no useful work during their initial/early clinical

education/training experience

• clinical sites can save money by eliminating education programs • technology/automation is eliminating the need for some professionals • laboratory/clinical education is no longer a priority

Table 4: "Opinions" on the Issue - CONS
KEYNOTE ADDRESS

37

approve a pilot study. “We won’t hold you to

what’s in place right now.” It has been my

experience, then, that they’ve been very liberal,

generous and objective in trying to work with the

educational institutions. Ultimately, it isn’t a

battle between the educational institutions and the

accrediting agencies. They’ve done a great deal

to help the health professions and allied health,

and they are very good to work with. It requires

that the communication, the cooperation, and the

collaboration must be in place. That is what

makes the difference. Because, after all, the

accrediting agencies are us. We may have a

problem with the way we relate to them, but they

have been very helpful. At least the 22 different

programs that we’ve had in place at Jefferson

never had a major problem with an accrediting

organization. We have disagreed, and it is healthy

to disagree, but it has never cost us our accreditation because we disagreed. And I think we

need to have that approach. It isn’t what the

accrediting agencies will do or not do. They’re

really very good, and they represent what we are

all about.

We need to do something in order to promote

collaboration and cooperation with the stakeholders. We haven’t really changed from what we’ve

been doing for many years. We could consider

appointing an appropriate commission, at the

federal level, of educational institutions, healthcare

facilities, and others, to study the issue of direct

patient care and indirect care for the student

learning experiences. We really haven’t done

this. This conference that Dr. Harmening has put

together so very well is a step in that direction, but

as a result of this, we have to go at least one step

further, or we are going to lose much, if not all,

that we have gained here. We have to encourage

the development of regional training consortiums.

Some cities are trying to do that, but if we work

together, if all the clinical education directors

work together, we would have fewer problems

with clinical education than we have right now.

And we can seek and endorse and reward academic corporate clinical partnerships.

I do not believe that the managed care companies

are against us. I think we have a mindset that

they’re not with us, that they don’t want to

support us. But where are the specific proposals

that have gone to managed-care companies when

they have denied educational institutions a partnership in trying to resolve a problem? We just

say that they don’t want to work with us, and that

they are only interested in the bottom line. We

really haven’t challenged them. There are some

managed-care organizations that have funded

significant educational projects, although very

few in allied health, more in the medical profession and nursing. Again, we really haven’t

challenged them sufficiently. Why don’t we go

together to managed-care organizations, some of

the bigger ones with adequate resources, and say

that we have a problem, we have a dilemma. Will

you work with us? And I think we’ll be surprised

that they might say they are interested in working

with us. They want to find out, too, because what

they thought was in place years ago isn’t really

working now totally. I think they are more willing

to be a partner in trying to resolve this problem

because they, too, really have a stake in this. You

might not think so, but they really do.

Another solution would be the streamlining of the

clinical education process to minimize the documentation that clinical and laboratory educators

must complete. It is required paperwork; we

don’t have a choice. The physical therapy profession came up with the Universal Center Information Form and Clinical Performance Instrument,

which seems to make sense. It would be productive and effective if we could all standardize on

one instrument and take our biases away. It is like

trying to get one patient insurance form. There is

no reason why we can’t do it if we want to do it.

If we want to be professional, I believe that

something like that to start with would probably

be a step in the right direction.

I believe strongly that we need to monitor and

limit new program approvals. Although I have

said enough about that issue, it is an embarrassment that we have the problem because we have

known for years that this was going to happen. It

is not new. It happened in the medical profession;

it happened in other professions. We made changes

years ago because we had too many nurses. Now

nursing is one of the most needed health professions we have. You cannot get students into

school because everyone is saying that there are

no jobs, when in fact there are many jobs. The

same is true with radiography. Everyone said that

we have too many radiographers. Now, at least in

the area where I work, equity increases were

given to all the radiographers because they couldn’t
KEYNOTE ADDRESS

38

afford to lose them. And significant increases were also provided to other radiography professionals.

So, we know a lot less about what we think we know a lot of, and we need to realize that. And the

hospitals need to be educated about that. It isn’t what we want to keep in our own domain, it is what

we need to tell the hospital administrators and

other clinical sites about what they should know.

I think that we ought to establish this commission

to study all the consumer, financial, and standards

issues regarding clinical education and training.

We should also fund comprehensive cost/benefit

studies of allied health education programs. I

would recommend earmarking a major percentage of all federal projects to deal just with these

outcome studies and to deal with what we have

been talking about for years, but not doing anything about. We are just now beginning to talk

about it a little bit more. And we ought to monitor

and strengthen the approval process for new

programs within allied health accrediting agencies and organizations. I think that also would be

a major step in the right direction.

Lastly, I return to the three key terms: attitude,

professionalism, and economics. We can do

anything we want to do. We just have to have the

right attitude, we have to be professional about it,

• maintain ideal/proven one-on-one model • consider newer models, including internships, technology solutions

 (e.g., computer simulations, “virtual” laboratory/clinic) • adjust length/location of clinical experiences

– shorten the duration of clinical rotations to accommodate more students in the same time

period

– move instrumentation (laboratory programs) training into the classroom setting and

bring in hospital personnel to provide instruction; then, shorten the actual clinical laboratory training time

• identify more flexible accreditation and certification eligibility requirements

(e.g., time, site types/locations)

• promote collaboration/cooperation among the stakeholders

 – consider appointing an appropriate Commission, at the federal level, of educational

institutions, healthcare facilities, et al, to study the issue of direct patient care and

indirect patient care student learning experiences

• encourage development of regional training consortiums

• seek, endorse and reward academic/corporate clinical partnerships (including contracts

with managed care companies, home care agencies)

•streamline clinical evaluation process to minimize documentation that clinical/laboratory

 educators must complete • PT: Universal Center Information Form and Clinical Performance Instrument • monitor/limit new program approvals • determine, through collaboration with employers, actual competencies required of

graduates and modify curriculum as needed

Table 5: Solutions/Opinions
KEYNOTE ADDRESS

39

and we have to see that it makes sense economically. There isn’t anything that has to be done that

we can’t do, at least from all the reading and all

the time I’ve spent in my former and current

position responsibilities. If we try to develop an

attitude where I want it my way, or this way only

is right, or your way is wrong, we are never going

to get anywhere because what is right and what

is wrong? There are a multitude of philosophy

books written about what is right and what is

wrong, and it doesn’t make any difference at all.

It is what we know has to be done and should be

done. And we must do that without compromising standards. That is the key to everything:

standards. We don’t want to compromise standards and the students we admit into the programs. We don’t want to compromise standards

to get a faculty member who is less qualified than

he or she should be. We don’t want to compromise the investment we need to make in our

health professions' programs. We should provide

programs with the support they need to offer

quality training. These are the keys, and standards are at the top. If we put our minds together,

we can go forward from this conference, doing a

great deal to improve and to make stronger our

educational and healthcare delivery systems.
REACTION PANEL

40

Part of the Mayo experience includes hospitalbased or certificate programs such as the diagnostic medical sonography program. We utilize

mainly internal clinical sites. However, our physical therapy program has onboard over 200 clinical sites. Mayo programs expect close collaboration with the clinical sites and involvement in a

clinical evaluation process. Our clinical sites are

chosen with specific educational goals in mind,

and the length of the students’ rotation is adjusted

accordingly. Preceptors, mentors, and clinical

instructors must be appropriately certified or

licensed. This harkens back to achieving the

primary value of quality patient care.

Maintaining and fostering quality clinical sites is

accomplished through offering continuing educational opportunities for employees. We make

these opportunities convenient and accessible.

Our program, for instance, provides resources

and review classes tailored to sonographers pursuing advanced certification. Physical therapy

participates in a multitude of continuing education opportunities, for other programs as well as

their own. Tuition reimbursement makes continuing education a reality rather than a dream for

many employees. So by way of example, Mayo

exhibits and encourages stewardship. I think that

encouraging stewardship and responsibility may

be one of the most important themes to come out

Thank you. I’m not an allied health education

expert, nor am I in management at Mayo Medical

Center. I do have 25 years experience in the

allied health professions, 10 years as a radiographer, 15 years as a diagnostic medical sonographer,

and 10 years on the academic faculty of the

Diagnostic Medical Sonography program at Mayo.

With the help of our School of Health Related

Sciences administrator, we came up with some

reactions to Dr. Abrams’ outline. Our reactions

are based on Mayo Medical Center’s experience

and philosophy, which I will share with you

briefly.

The three shields of Mayo stand for clinical

practice, education, and research. The primary

value is that the needs of the patient come first.

Because of the diversity and the increasingly

complex cases referred to Mayo, the quality of the

allied health staff is very important.

Mayo expects to employ more than 20,000 allied

health personnel by the year 2000. Attracting

health professionals to rural southern Minnesota

is no small task and very expensive. It is therefore

easy to understand why Mayo considers allied

health education a worthwhile and necessary investment.

Response & Recommendations

Diane Youngs, B.S., RT(R), RDMS

Program Instructor

Diagnostic Medical Sonography

Mayo Foundation/Mayo Clinic

ALLIED HEALTH
REACTION PANEL

41

of a conference such as this, because the students

are potential employees for participating clinical

sites.

Even with institutional support such as ours,

many of our programs in the School of Health

Related Sciences are experiencing difficulties

(Table 1) associated with staffing shortages and

program expansions meant to address those shortages. Faculty are usually recruited from the allied

health staff, and it is understandably difficult to

release your most experienced staff to prepare

and present lectures. Program expansions, often

mandated, present the challenge to optimize the

clinical experience. Having enough clinical sites

for all the added students is a major problem.

Space limitations are also an issue. Finding

rooms to accommodate additional students and

office space for faculty is a current problem we

are dealing with. The need for additional computers and technical equipment compounds the problem. Whenever we grow, we must also consider

the downstream effect this has on operational

mechanisms such as parking and affordable housing. This is a very real problem we’re facing in

Rochester.

Our success and model suggest that any reforms

that may negatively affect quality need to be

approached with caution. Any of the points

outlined below may serve to lessen the primary

value of quality patient care (Table 2).

Shortening quality clinical rotations.

I think sometimes there is a perception that at a

non-physician level a program can be accelerated.

Adding clinical sites that cannot meet

educational goals.

Utilizing small rural hospitals as primary clinical

sites to accommodate additional students does

not provide an equitable clinical experience compared to students at a metropolitan medical center. By using less than optimal clinical sites, we

would risk losing our accreditation, which brings

me to the next point.

Relaxing current accreditation standards.

 Accreditation requirements may be a program’s

only leverage for acquiring adequate staffing and

quality clinical sites.

Financial rewards for clinical sites.

The Mayo School of Health Related Sciences

agrees with Dr. Abrams in that they are against

financial rewards for clinical sites. This is a very

complex issue; there are actually bidding wars

going on for clinical sites, which I think is only

going to, in the end, drive up health-care costs.

Computer simulation should not be considered a major replacement for clinical experience.

Streamlining the clinical evaluation process.

If streamlining means shortening the evaluation

process so that specific information is not obtained, then it is detrimental. A good clinical

evaluation process does take time, and perhaps a

standardized evaluation process would be more in

line.

The increased demand for allied health graduates

have many programs, including ours, scrambling

to meet the challenges of maintaining quality and

quantity. Some promising changes (Table 3)

include:

Table 1: Barriers

• Limited dedicated faculty

– Staffing shortages

• Mandated program expansions

– Optimizing clinical experience

• Space limitations

• Computer and technical equipment

• Operational mechanisms

– Parking, affordable housing, etc.

Table 2: Guarded Reactions

• Factors that affect quality of training

– Shortening quality clinical rotations

– Adding clinical sites that cannot meet

educational goals

– Relaxing current accreditation standards

– Financial rewards for clinical sites

– Computer simulation as substitute for

“clinical” experience

– Streamlining clinical evaluation

 process
REACTION PANEL

42

Blending new methods with the old.

An example would be computer simulation used

as an adjunct. Distance learning is also offering

some very exciting opportunities.

Moving instrumentation training into the classroom setting.

Certain laboratory programs that do not have

patient contact can achieve this.

Encourage regional training consortiums.

Regional training consortiums encourage resource

sharing rather than competition. Once again, distance learning provides increased opportunities.

Monitoring or limiting new program

approvals.

We feel new programs, especially those who

choose not to be accredited, or for those professions with no required licensing such as medical

sonography, should be monitored. Poorly prepared allied health staff perpetuates the cycle of

non-qualified clinical sites.

Encourage clinical site partnership.

By encouraging an atmosphere of partnership

with clinical sites, we will see more investment

and responsibility.

Obtain information.

By obtaining information, allied health will be

better equipped to address the needs of the

occupational groups. Data regarding the cost

benefit of their training and the services they

render can be used to foster clinical site participation. Assessing regional needs makes allied

health more socially responsive. An allied health

commission may be one mechanism to provide

this data.

Creating and maintaining a well-rounded program requires a committed investment and the

support of administration, staff, and faculty. It is

to everyone’s benefit to invest in quality clinical

education, which must be seen as a solution and

not as an unnecessary drain on health-care dollars.

Table 3: Positive Reactions

• Blend of new methods (simulation,

distance learning, etc.) with old methods

• Moving instrumentation training into the

classroom setting

• Encourage regional training consortiums

• Monitor/limit new program approvals

– for those professions with no required

 accreditation or licensing

• Encourage clinical site partnership

– investment

– responsibility

• Obtain information

– needs of occupational groups

– cost/benefit of training and the services

 rendered

– regional needs

• Allied Health Commission may be one

 mechanism to provide this data
REACTION PANEL

43

grams. What is surprising is that we are able to

do this despite the fact that we usually do not have

access to good supply and demand data regarding

the various allied health professions. What winds

up happening is that educational institutions may

in fact request new training programs at the

urging of local or regional professional groups or

healthcare providers, elected officials, or a perceived need by administrators or interested faculty in our institutions. More often than not, State

Boards of Education wind up getting caught in the

middle between an influential state legislator who

wants a particular training program in their district and a State Advisory Board who may decide

that the program is not needed. Absent from this

process is any type of supply/demand health

workforce data. Thus, we really don’t know at the

state level whether a new educational training

program is needed or not, or for that matter,

whether there are sufficient clinical sites and

faculty to support the proposed new programs.

The unfortunate outcome is that the existing

training programs in the state end up competing

with each other for limited clinical sites and

qualified faculty.

It should give us some comfort, nevertheless, that

the Bureau of Health Professions of the U.S.

Department of Health and Human Services is

beginning to address this issue via the creation of

Health Workforce Data Centers throughout the

First, I want to compliment and thank Dr. Abrams

for such a comprehensive presentation.

Second, as you will notice from my comments, the

issues I will address either overlap or restate some

of the same issues that have already been mentioned by several of the speakers representing the

various constituencies attending this conference,

i.e, those representing the educational/ academic

institutions, healthcare organizations, and health

professional societies. What this illustrates is that

no matter what constituency we are representing,

there appears to be a great deal of convergence

about the issues or problems that all of us are

facing.

There are four issues that I would like to address.

These are:

1. Approval of New Programs

2. Rural Minority and other Underserved

 Populations

3. Affiliation Agreements

4. Allied Health Legislation

1. Approval of New Programs

Based on my past experience as a member of the

Health Affairs Committee of our State’s Higher

Education Coordinating Board, we as educators

seem to be very effective at justifying our needs

and requests for new allied health training proResponse & Recommendations

Rumaldo Z. Juarez, Ph.D.

Dean

College of Health Professions

Southwest Texas State University

ALLIED HEALTH
REACTION PANEL

44

country. In the state of Texas, we have recently formed a Health Personnel Data Ad Hoc Committee

of the Statewide Health Coordinating Council to explore ways of collecting health professions

workforce data. What we have already discovered is that it is not too difficult to have access to

workforce data on health professions that are licensed by the state, especially such occupations like

physicians, dentists, veterinarians, psychologists, nurses, etc. When it comes to data about most of

the allied health professions, however, it is not as easily accessible or collected. Some of these

professions are not licensed and others, if they are licensed, have no government unit or professional

association that keeps track of the number of practitioners in allied health.

So what can we do about this? I recommend that allied health professionals make their voices known

and get involved with their state boards of higher education (Table 1). Become an active participant

in the decision-making process that approves new educational training programs in the state and also

an advocate for the collection of allied health workforce data.

2. Rural Minority and other Underserved

Populations

The second issue I want to address is related to

one of Dr. Abrams’ points about the need for

using non-traditional settings for some of our

clinical education sites. A category of these nontraditional settings are located in geographic regions that have high concentrations of rural

minority and other underserved populations. A

significant proportion of these populations are still

being left out of the loop, not only in regards to

lack of healthcare services, but also in regards to

being used as clinical education sites (Table 2).

Located in these regions are home healthcare

agencies, community-based clinics, homeless shelters, nursing homes, small rural hospitals, and

migrant health centers. Specific examples in the

state of Texas are communities that are located

along the Texas-Mexico Border that are densely

populated by a Mexican-American population.

The “downside” of the proliferation of new allied

health training programs is that there are fewer

clinical training sites; but, this problem also has an

“upside,” and that is, it is forcing many of us to

look harder for these non-traditional training sites

and finding them quite rewarding.

Besides serving as non-traditional clinical training sites, there are also some latent bonuses, e.g.,

using these sites for providing healthcare services

to populations that are medically underserved and

also as prime recruitment geographic areas for

minority and other disadvantaged students that

are severely under represented in the allied health

professions. In the long run, students recruited

from these areas are more likely to return and

practice in their communities of origin and contribute toward increased healthcare services in

the region.

In order to make better use of these non-traditional sites as clinical settings, we need to work

closer with federally funded programs like the

Area Health Education Centers and the Health

Education Training Centers. In the past,

AHECs have primarily been concerned with increasing the number of physicians. More reTable 1: Response/Recommendations

I. APPROVAL OF NEW PROGRAMS BY STATE BOARDS OF HIGHER

 EDUCATION:

– need for the program

– supply/demand workforce data

– impact on available clinical education training sites

– availability of qualified faculty

II. RECOMMENDATION: Greater involvement of Allied Health Professionals in State

 Boards of Higher Education decision-making committees.
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45

cently, this appears to be changing and they are beginning to address the wider needs of the health

professions inclusive of allied health. These programs are being underutilized by programs in allied

health. Our experience with both of these programs has been very rewarding, especially as it relates

to the recruitment of under-represented populations in the health professions.

By the way of recommendations, I recommend that allied health programs expand and make better use

of non-traditional clinical training sites in rural and underserved population areas. Use these sites not

only for meeting the clinical education needs but also as recruitment sites for minority and other underrepresented populations in the allied health professions. In addition, work closer with the Area Health

Education Centers and the Health Education Training Centers in your state.

3. Affiliation Agreements

The third issue I want to address are the affiliation

agreements that are so vital to our clinical education training sites. We currently have over 600

affiliation agreements in our College of Health

Professions and they are a challenge to keep up

with.

Perhaps some ways to “ease the pain” of affiliation agreements are to: • Keep them simple • Keep the costs of the clinical site to a minimum and the benefits to a maximum • Keep the paperwork processing to a minimum, strive for multi-year agreements, and

maximize the number of allied health profes

sions that can be included within one agreement

• Keep the clinical sites “engaged” with

complimentary correspondence: don’t take

them for granted after the agreements are

signed

• Recognize their value and their contributions

toward training the next generation of allied

health professionals

• Reward them with public relations

opportunities when possible

• Recognize your Preceptors • Send letters of recognition with cc to their

CEO’s

• If possible, provide “Clinical Adjunct Faculty Appointments” along with certificates of

such appointments

• Maintain continued dialogue and contact with

the preceptor–don’t just “dump” the intern at

their doorstep

• Have the intern follow up with a thank you

letter at the end of the internship

• Invite the preceptors to your organizations’

athletic and cultural events

• Socialize/train your next generation of preceptors

Table 3 outlined and summarizes some recommendations related to clinical affiliation agreements.

Table 2: Rural, Minority, and Other Underserved Populations are Still Being Left

Out of the Loop

• Rural hospitals • Community health centers in rural areas and inner-city neighborhoods, especially those

with high-density minority populations

• U.S.- Mexico Border Communities

Recommendations: • Recruit students from these areas - then place these same students back in their communities

of origin to do their internships

• Work with the "What the hecs" - i.e.

– Area Health Education Centers (AHECs)

– Health Education Training Centers(HETCs)
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4. Allied Health Legislation

The last issue I will address is allied health legislation. This is an area that I believe the allied health

professions are not getting involved to the extent that we should or that we can. I recommend that

we: • Implement tax credits for healthcare organizations that serve as clinical education sites • Revisit legislation for AHECs/HETCs for a greater emphasis on allied health professions

and assistance in clinical education training sites in particular

• Ensure allied health professionals are represented in every state board of higher education

Table 3: Recommendations • Keep them simple • Keep the costs to the clinical site to a minimum and the benefits to a maximum • Keep the paperwork processing to a minimum, strive for multi-year agreements, and

maximize the number of allied health professions that can be included within one agreement

• Keep the clinical sites "engaged" with complimentary correspondence:

– don't take them for granted after the agreements are signed

– recognize their value and their contributions toward training the next generation of

 allied health professionals

– reward them with public relations opportunities when possible
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47

viewing the Proceedings from the 1997 Conference on Integrative Learning on Restructuring

Health Professional’s Education.

We can view the obstacles to clinical education

reform as encompassing five “C’s”, that are as

follows: (1) Competition, (2) Control, (3) Confidence and trust, (4) Change relative to attitudes,

and (5) Capable of seeing a larger view or interest beyond a narrow view of a specific discipline,

facility or organization. Given our time constraints, I will provide just a few examples of each

to help you to understand what each “C” encompasses.

The first “C” competition, encompasses obstacles

that relate to competition for qualified and competent personnel, time, money, available clinical

education sites between and among disciplines,

and other related resources. Competition for

limited resources has become increasingly difficult given internal pressures between and among

professions for qualified clinical educators and

sites as well as external demands placed on the

health care system by managed care and the

balanced budget act.

The second “C”, control, examines issues related

to locus of control and decision-making authority.

For example, decisions related to student progression within a curriculum, assignment of grades,

Thank you for the opportunity to briefly share my

thoughts and reactions. As background information, please understand that my comments are

being offered as the Director of Physical Therapy

Education at the American Physical Therapy

Association and not from the position of the

profession’s accrediting agency, the Commission

on Accreditation of Physical Therapy Education

(CAPTE).

In examining the numerous obstacles to clinical

education, it is important to recognize that we are

attempting to “fix” a highly complex, dynamic,

and interrelated system. I am reminded of the boy

who tried to stop the dike from overflowing. It

seems that as soon as we attempt to plug one hole

by implementing a workable solution, three more

holes burst open that necessitate far more expansive and complex solutions. As a result, in

reviewing Dr. Abram’s presentation it is apparent

that there are numerous barriers and issues that

warrant our attention in clinical education. Given

the myriad and complexity of these issues, it

seemed prudent to attempt to provide a fundamental framework in which to view these barriers in

order to develop workable recommendations.

Resources used to develop these five themes

included not only Dr. Abrams' keynote but also

prior experiences realized from participating in

education consensus-building conferences in

physical therapy, and parallels drawn from reResponse & Recommendations

Jody S. Gandy, Ph.D., P.T.

Director

Physical Therapy Education

American Physical Therapy Association

ALLIED HEALTH
REACTION PANEL

48

determining when learners have achieved established performance outcomes, determining when

students are competent and safe to enter practice, and whether or not to develop a program, all

represent control-based decisions. The obstacle

posed by the issue of control is focused not only

on who is responsible for making these decisions

but also who is willing to relinquish control over

some of these decisions. In listening to some of the

comments made thus far, it is apparent that we

view obstacles to clinical education differently

based on our lens and locus of control. Often we

attempt to frame clinical education to serve our

particular need or interest. An alternative perspective might be to consider that the purpose of

clinical education is to determine when the learner

has satisfactorily attained established performance

outcomes to enter practice at a level that ensures

safe, effective, competent practitioners, as opposed to deliberating about who has control and

authority over a specific aspect of learning in the

practice environment.

Let’s move on to the third “C,” confidence and

trust as it relates to clinical education reform.

Confidence relates to respect and how decisions

are made within an organization or profession that

affect members and ultimately consumers. Trust

relates to our ability to trust one another as health

professions with differing interests and needs.

Consider this...ideally if we had confidence and

trust in each other as health professions, then we

would be able to commit to clinical education

reform without having every health profession

represented if we viewed the obstacles similarly.

Thus, no matter which disciplines were present to

develop solutions, we could have confidence and

trust that proposed solutions would have been

made with the consideration and interest of all

professions. I propose, that currently, this is not

the case. If remedies were developed, it is more

likely that each profession would reserve the

prerogative to tweak the outcome just a little bit

differently to suit its needs. This behavior is

certainly understandable but perhaps does not

move us closer toward addressing clinical education reform. Hence, until we move to a place

where we have confidence about decision-making within our respective disciplines and trust that

decisions can be made without every discipline

being present, reaching solutions as a group of

professions will be fraught with frustration and,

more likely, a near impossibility.

The fourth “C” has to do with changing attitudes.

Dr. Abrams addressed this issue in his keynote as

a general, universal resistance to change. On the

one hand, we may state we do not like the status

quo, however, at least we know what the status

quo represents. On the other hand, making the

leap to an unknown, may seem attractive, and

yet, we may be unsure as to how far we are

willing to go to achieve a workable solution. On

balance, the incentive to change must be greater

than the resistance to change or inertia required

to make a paradigm shift. We might ask ourselves “How urgent is the need for change?” Are

we willing to delay change until the external

environment drives us toward change? Dr.

Abrams alluded to the fact that perhaps the

accelerated change that we’re all experiencing in

clinical education would not have occurred so

rapidly without changes in Medicare, the Balanced Budget Act, and managed care in the past

six months. Perhaps without these external accelerated changes we might not be viewing clinical education in crisis and in need of reform.

The last “C”, which I believe is the most important, addresses the capability to see the larger

interests rather than a narrower view. Credit for

the last ‘C” goes to Joseph Black, PhD, Senior

Vice President/Division of Education at the

American Physical Therapy Association. Dr.

Black has shared his perspective on this issue

with many persons in physical therapy through

education consensus-building conferences. In

essence, this means that the individual or profession is able to view the problem and solutions

considering the larger interest of the profession,

rather than a narrower view of a program institution or clinic. In this case it could mean the very

survival of clinical education within the health

care environment. To assume this posture would

mean that an individual would need to set aside

his/her personal bias or a particular position to

find solutions that are workable for the greater

good, even if the solution is not his/her preferred

outcome or is not currently attainable. The example that Dr. Abrams shared in physical therapy

of the development of a national voluntary clinical

performance instrument for physical therapist

(PT) and physical therapist assistant (PTA) students represented such an achievement. At one

point, there were more than 50 different tools

being used to evaluate PT and PTA student

performance in clinical education. The willing-
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49

ness on the part of academic programs, consortia,

and clinical education sites to let go of any one

particular instrument to develop a new uniform

evaluation instrument was not an easy task. It

took this profession three years to get to that

position and to achieve agreement on an evaluation instrument that was both consensus-based

and evidenced-based. In the final analysis, persons or organizations must believe that in anticipation of outcomes that can be achieved that

serve a larger interest are worthy of relinquishing

something that maybe familiar but may no longer

be effective.

Finally, when considering all five “C’s,” to be

able to achieve clinical education reform requires

an examination of the incentives of each of the

stakeholder groups that are needed to achieve

workable solutions. We must clearly understand

what each group brings to the discussion and

what are their incentives relative to clinical education reform. If common ground can be found

among all stakeholder groups, then we can begin

to move toward finding mutually agreeable solutions. If, however, the incentives driving each

stakeholder group is different (eg, bottom line

dollars, quality product, number of students, safety,

etc) then the ability to achieve consensus among

all groups to achieve a common solution may be

problematic.

Given these five “C’s,” I would like to offer three

recommendations (Table 1).

1. Building on the earlier suggestion to establish

a commission, I believe that it is imperative that

all stakeholder groups involved with clinical education are convened to include students, consumers, higher education, clinical sites, managed care

representatives, payors, etc. To facilitate consensus building would require the development of

agreed upon assumptions to establish boundaries

to focus the discussion. In addition, persons must

be able to demonstrate, in advance, their commitment to achieving consensus-based solutions such

as signing a covenant that describes preferred

attitudes and behaviors needed to reach agreement and solutions that address a larger view.

The work of this commission would be to develop

a set of sufficiently broad and applicable guiding

principles that each profession would be able to

apply to its clinical education. Each discipline

would be able to take the work of this commission

back to their respective members to enable them

to achieve a sense of “buy in” with the outcomes

and to offer alternative solutions that might not

have been considered. This perspective is based

upon principles that have been used successfully

within physical therapy education to achieve widespread consensus on controversial issues. This

process is intended to build confidence and trust,

ensure a larger view, minimize competition, and

allow for shared control.

2. A second recommendation relates to suggestions for expanding the evidence-base of clinical

education that we addressed this morning. We

might seek to obtain data on the “best clinical

education practices” across disciplines that meet

productivity standards, are cost-effective, and

achieve discipline specific performance outcomes.

We need to publish these "best clinical education

practices" across disciplines. We also need to

consider the best clinical education practices that

meet the incentives of all stakeholder groups

while achieving performance outcomes of learners.

A secondary study would examine the qualifications or attributes of those clinical educators who

have demonstrated the best clinical education

practices. As a result, education and training

programs could be developed for clinical educators based on both best clinical education practices and attributes of clinical educators teaching

in those programs.

A follow-up to the above study would evaluate

whether or not there is a difference in the performance outcomes achieved by students when provided clinical education with persons who have

completed the education and training program.

The bottom line is: does research and training

make a difference, and does it result in raising the

standard for clinical education?

3. A final recommendation is to develop a comprehensive and systematic plan for designing,

implementing, and evaluating clinical education

structures that include new structures, partnerships, and changing current paradigms. This

long-range strategic plan should coordinate all

aspects of change to bring about clinical education reform, rather than a splintered approach that

“plugs the dike” with quick short-term fixes.

In summary, we need to offer recommendations
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50

that focus on outcomes rather than control, foster confidence and trust, minimize competition and

maximize cooperation/collaboration, empower persons to positively embrace change, and enable

professions to value decisions that consider the larger view and interests in order to effect broad-based

reform. Our future in clinical education depends on achieving these changes if we are to survive in

the next millennium.

• Establish a commission: All stakeholder groups involved with clinical education are convened

to include students, consumers, higher education, clinical sites, managed care representatives,

payors, etc.

• Seek to obtain data on the “best clinical education practices” across disciplines that meet

productivity standards, are cost-effective, and achieve discipline specific performance

outcomes

• Develop a comprehensive and systematic plan for designing, implementing, and evaluating

clinical education structures that include new structures, partnerships, and changing current

paradigms

Table 1: Recommendations
KEYNOTE ADDRESS

51

active member in my own society and have

had the pleasure and challenge of doing many

interdisciplinary workshops to clinical

educators.

• Last, I apologize for reading, as I seldom use

notes. I have limited time and much to cover.

This will also prevent me from side-tracking

into ‘preachable moments.’

I have been asked to discuss the role of professional societies in clinical education reform. The

three pre-conference foci given to me were:

1. the impact of practice and core competencies;

2. the influence of accreditation standards; and

3. the potential resources for reform if the allied

health professions cooperate and collaborate on

the critical issue of clinical education reform. I do

not come to you with expert knowledge of all the

professional societies. I was told that each of you

would do the tweaking as needed for the group as

a whole as well as applying the issues I discuss to

your own professional societies. During this 30-

minute presentation, I will:

• Briefly review the context in which

professional societies operate

• Describe the 8 major contributions of

societies to the health of our national

community followed by an expansion of our

notion of clinical education stakeholders

I want to thank the planning committee for the

invitation to speak before this important meeting.

I commend the previous speakers and the salient

points they have already addressed in considering

the ‘pioneering of new approaches to clinical

education/training.’ I also am aware of the great

anxiety created within me as I listened to their

presentations in fear that all my main points

would be taken. Seldom do I ever find myself

speaking last; I always volunteer to go first. So,

some of my comments will validate previous

statements and recommendations while the majority will be furthering our discussion.

First, I need to create a context for the basis of my

presentation:

• I do not see clinical education and clinical

training as one in the same. My preference

is education at this time is not just to

habituate behavior but to integrate knowledge and enhance skill development as the

foundation for professional reasoning.

• Please excuse my own professional

socialization process if I slip and call clinical

education: fieldwork.

• I do not portray myself as a scholar of

professional societies but will share my per

spective as a member because members are

the ‘engines’ that run societies. I am an

Keynote Address

The Role of Professional Societies in Clinical

Education/Training Reform

Patricia Crist, Ph.D., OTR/L, FAOTA

Chair and Professor

Department of Occupational Therapy

Duquesne University

ALLIED HEALTH
KEYNOTE ADDRESS

52

• Then one-by-one, I will provide possible

scenarios that professional societies can

engage in to respond to emerging issues in

clinical education

• Finally, I will call upon the unique contributions that collectively societies could make

together to ensure excellence in clinical edu

cation while boldly providing cost effective,

accountable, quality health-care delivery.

By the way - if I was publishing this in my own

society - I would now have to do the appropriate

disclaimer . . . . “The opinions expressed in this

presentation are not necessarily those of the society” ....and so on.

Think of your professional society.

Got it in mind?

Write down the 3 most critical issues or current

priorities your professional society is addressing today.

How many of you identified specifically clinical

education on your list?

[Authors Note: Less than 20% of audience raises

their hand.]

This is exactly my point. Even though I am

speaking to the clinical education leaders in our

societies, we must recognize that this is seldom a

priority issue for our organizations. This issue is a

secondary concern for societies and for some a

‘hot potato’ regarding assuming responsibility for

clinical education. For some, clinical education is

a thorn in the side of our societies’ priorities.

While others have neglected clinical education,

failing to note that a buried treasure awaits. From

the vote just taken, only a handful of our allied

health societies currently address clinical education as a priority.

So what is the role of professional societies?

What do members and the public believe that they

do?

THE ROLE OF PROFESSIONAL

SOCIETIES

Professional societies have been acknowledged

as representing the core values of their members,

contributing to, if not setting, practice standards,

as well as providing leadership to health care

issues and policy. Societies have facilitated the

development of the work force through education

of members in the latest technologies and practice environments.

Certainly, there are as many different approaches

to addressing these issues as there are health

professions represented because each of our

societies has its own unique ‘way of doing

business.’ I will outline today how we might

mobilize this diversity among our professional

societies to enhance clinical education (Table 1).

Professional societies are the conventional keystones uniting members with common background

and interests nationally. For the most part, they

are made of volunteer members who may have

joined to support the collective good of the profession or may only be members as long as they get

access to valued services.

Thus, professional societies are the keystone for

assessing, planning, and supporting universal

clinical education issues. The three critical components of clinical education formulate the critical questions that must be addressed during our

discussion of the role of professional training

reform:

What will health sciences graduates need to

know in the year 2010?

What will clinical educators need to know in

2010?

What type of sites will provide health care in the

year 2010?

Without a vision capturing our response to these

questions, our responses today will re-create

Table 1: The Role of Professional

Societies*

• Play a major role in developing the work

force

• Provide education for new career opportunities and mobility

• Develop resources to address issues and

trends in the profession

• Introduce, if not identify, new innovations

and technologies enhancing service

delivery

*Dr. Marie Reed, President, National Organization for Competency Assurance (NOCA) personal communication, May 1999.
KEYNOTE ADDRESS

53

today - not invent tomorrow. Regardless, first

and foremost our responsibility is our recipient of

care - next we must answer these questions

presented here. I ask you, yesterday, did we do

this in our discussions and consensus-building?

Or did we only reinforce traditions? Our challenge is for each us to stop fine-tuning the old and

pioneer a new future!

PRECIPITATING EVENTS

As an educator, the call for reformation of health

care education and training is rooted in a variety

of reports, like the Pew Commission Reports that

began and continue to appear earlier in this

decade. Close at hand, was the emerging ‘tug-ofwar’ between business and humanistic approaches

to caring advocated by our professions. One of

the bigger players, managed care organizations

(MCOs) reformed practice around cost efficiency and complained how our entry-level practitioners were unprepared to practice in these

organizational contexts successfully.

Ironically, the emergence of MCOs drastically

eliminated many clinical education programs seeing them as expenditures and even revenue deterrents. In essence, MCOs became their own worst

enemy. How could any entry-level practitioner

embrace managed care when they were not trained

within this system? .... A system that was not

only negligent in its clinical education responsibilities but constantly used cost efficiency as the

exclusive characteristic determining quality of

care; the cost/reimbursement area is very low in

value for many direct service providers including

students.

THE IMPORTANT CONTRIBUTION TO

PROFESSIONAL SOCIALIZATION

While clinical education is a major component of

professional socialization for our practitioners, we

cannot fully comprehend responses to reforming

clinical education without also considering the

supply of individuals or students who are entering

our training programs. Certainly, I am in awe that

the majority of my students in the classroom:

• do not remember Vietnam and some now

even the Gulf War

• prefer the Internet over the library to gather

information

• cannot go to college without an answering

machine and microwave and

• are challenged to tell time in the classroom

because I have an antiquated clock with

hands on the wall.

I will avoid even discussing the impact of videos,

video games, South Park and MTV on their need

for high stimulus entertainment-based instruction

in 10 minute segments! Who would have thought

that Bart Simpson would become a highly-rated

family -entertainment show? ...or that 36% of

students now report being bored in class.

Before you call me a cynic, let me give a few

details about our students today that Hansen

(1998) has gleaned from scholarly research and

government reports. • The percentage of high school graduates age

16-24 enrolled in colleges rose from 46% in

1973 to 65% in 1996. 31.6 % in 1997

received “A” grades in courses considered

for college admission compared to 12.5% in

1969 and the time spent in high school homework among seniors is at an all-time low: 3.8

hours in 1997.

• 69% of full-time students are now employed

compared to 36% in 1973 with slightly over 1

in 3 working 20 or more hours a week.

• 100% of colleges offer remedial programs

now serving an average 20% of the freshman class.

• Only 10.6% of their mothers are fulltime

homemakers compared to 33.9% in 1976.

And 3 times more were from divorced

families with an estimated 32% of children

living with only one parent. Suicide, murder,

sexual assault and other forms of violence

are rising to become everyday events in our

youth under the ages of 18.

Today’s college students are different from what

we were as students. This difference influences

who we admit to our health science programs,

their ‘educate-ability’ and ultimately what comes

to clinical education. Regardless, professional

socialization reflects a complex interaction of

important environmental and interpersonal variables influencing clinical education students (Figure 1). These must be recognized in our clinical

education reform, if we are to ensure future

quality practice.
KEYNOTE ADDRESS

54

THE INFLUENTIAL PROFESSIONAL

ASSOCIATION

As a result of dynamic, external forces, our

professional societies are faced with responding

to the changing demands of the health care

systems and the changing demographics of their

membership. Association concerns include, but

are not limited to: • Matching association business with the needs

of members in the trenches

• Changing reimbursement patterns and practice expectations • Role models for new environments and practice

In planning for clinical education reform, one

must always question what percentage of practitioners in a given health care discipline are currently being served as members of a given society? Estimates of member/non-member ratios

are probably inflated or inaccurate if provided by

the society themselves. Possibly comparison of

society membership data with numbers from state

licensing boards or national certification agencies

might provide a more accurate estimate of the

health care practitioner pool.

Societies are consistently balancing between responding to grassroots needs versus evangelizing

or in some cases, ruminating over critical issues.

Why is this important? In planning clinical education reform, we need to get to the individuals in

the’trenches’ or the ‘babble from the pulpit’ will

fall on deaf ears!

STUDENTS

 ??? P rofession al Q u ality of

 S ocialization P ractice

m atu ration prepared ness life exp erien ces

m ass m ed ia attitu d es fam ily

F rom Th ro ug h To

Figure 1: Influences on the Professional Socializing Process

My suggestion is that professional societies must

be one of the major ‘cogs’ in our training wheel,

if we wish to ensure implementation of our

blueprint activities. We must acknowledge that

without the proactive engagement of our professional societies, we cannot move ahead.

What role will professional societies play in the

future? • proactive: facilitating, advocating and leading

or• reactive: supporting, hindering or ignored

We must acknowledge that without the proactive

engagement of our professional societies, we cannot move ahead. Clinical education is every

practitioner’s business, be they an educator or

direct service provider. Thus, supporting the

student training role might actually increase membership in societies if continuing education, even

certification were part of membership services.

At minimum , any society that distributes annual

awards for commendable professionals activities,

should have an outstanding clinical educator

award.

Members may also question the wisdom of some

societies’ priorities for clinical education. For

instance, while I admire my own society’s initiation of innovation to address the needs of our

fieldwork educators through workshops, on-line

self studies and news stories, I continue to question that releasing the program coordinator over

fieldwork eduction during our most recent waves

of down-sizing was wise. Of course, members
KEYNOTE ADDRESS

55

were assured that the individual’s activities were

re-assigned—but then I must question who is

focussing on clinical education and giving it adequate support? My fear is that the recent change

in my society’s organization only buries this issue

deep within the muck of society business, as no

strong advocate is apparent or accountable for

clinical education in day-to-day operations.

Again I return to your responses on the pop

test...What importance does your society give to

clinical education? How do they ‘walk the talk”

or is it just given ‘lip service?’

PROFESSIONAL SOCIETIES & LEADERSHIP OPPORTUNITIES

Our professional societies can be leaders in the

area of clinical education. They are one of the

largest and most powerful forces in the U.S.

today. Their collective membership represents

one of the largest, most powerful forces in the

U.S. today. Some societies are trade associations

while others are membership societies or professional development organizations. Thus, their

ability to impart social and economic changes and

benefits is insurmountable. By placing clinical

education high on association agendas as a central component of all our business, clinical education reform can succeed.

PROFESSIONAL SOCIETIES &

LEADERSHIP CHALLENGES

To be effective as a leader in clinical education

reform, we must be cognizant of the public’s

perception, if not skepticism, in permitting societies to lead necessary changes that benefit the

public we serve. At the heart of this skepticism,

is the growing public, and now organizational

management tiredness, with the ‘turf wars’ between professions and the consumption of society

resources to protect professional turf! Societies

work quietly, giving rise to suspicions by observers that their goal is on protecting the sanctity of

the profession which ultimately detracts from

their ability to serve society as originally intended.

So, what do we need to do to create working as a

team among respectful, responsible professionals? Our societies can extend a collective leadership role to foster team-building across professions. Clinical education reform might be one of

the safest areas to demonstrate our team-building

potential to the public...

EIGHT PROFOUND ASSOCIATION

IMPACTS

Societies or associations are noted as having a

profound impact on eight major areas that are

worthy of noting in our deliberations (Table 2).

Let me quickly read the list of association impacts

as they become the foundation for the remainder

of my presentation.

CREDENTIALING MECHANISMS FOR

PROGRAMS OR INDIVIDUALS

Before proceeding, I must acknowledge three

major activities that contribute to the professions

which also have an investment in clinical education reform but are not considered in traditional

definitions of professional societies, but who also

are major stakeholders in clinical education reform. Each is represented by their own collective

groupings and boundaries of interest that must be

acknowledged. I share with you, definitions of

these stakeholders to seek their cooperation in this

blueprint and to guide our own taxonomy and

communication regarding clinical education reform.

Licensure gives the qualified individual the right

to deliver a specific set of services in a given

jurisdiction. A government agency grants permission for the individual to practice.

Certification ensures a uniform set of professional competence in service delivery across all

similar providers. Mandatory or voluntary certification is validation for that public that an individual possesses sufficient qualifications and

1. Educating members and the public

2. Setting and policing performance and safety

standards

3. Promulgating and enforcing codes of ethics

and professional standards

4. Conducting research and compiling

statistics

5. Political education and group advocacy

6. Directing member talents toward

community service

7. Self-funding countless programs that relieve government of the burden

8. Create invaluable services to the commu-

 nity

GWSAE Report, 1997

Table 2: The Eight Professional

Association Impacts
KEYNOTE ADDRESS

56

knowledge to practice competently in the area certified.

Accreditation deals with institutions and not individual qualifications of service. Accreditation is a

voluntary process assessing and giving status that predicts or safeguards performance of the

institution or academic program for the public.

Each of these three credentialing mechanisms are deeply vested in clinical education reform as they

require direct or standardized practice in some way. Some of these credentialing activities overlap

with those of societies which hopefully could increase the support of mutual interests. Thus, the

diversity of interests of societies is influenced by the critical professional activities of licensure,

certification, and accreditation each of which warrants attention in our blue-print planning.

THE POTENTIAL IMPACT OF SOCIETIES IN CLINICAL EDUCATION REFORM

I want to return now to the role of professional societies using the eight important roles that are served

by societies to delineate how these groups might focus on clinical education or training. Table 3

provides a list of these eight association impacts and potential considerations of actions regarding

reforming clinical education.

Educating members and the public

· Setting and policing performance and safety standards

· Promulgating and enforcing codes of ethics and professional standards

· Conducting research and compiling statistics

Setting and policing performance and safety standards

· Ensure educational standards specify entry-level preparation in the clinical education role

· Assess who should ‘control/direct’ clinical education: education or practice?

Promulgating & enforcing codes of ethics and professional standards

· Certification of supervisor and training site

· Educate regarding ethical use of students and ethical organizational behaviors

· Maintain educational integrity of clinical education

Conducting research and compiling statistics

· Fund studies and disseminate results

-Government and association (single and joint)

-Best practices

quality of care provided through clinical education

supervisory effectiveness

cost-benefits

-Model clinical education programs

Political education and group advocacy

· What about co-treatment outcomes?

· Student-supervisor interaction

· Interdisciplinary

· Population-based

· Community focussed

· Health promotion and disease prevention

Directing member talents toward community service

· Emerging practice environments

· Encourage servant leadership

· Recognize and reward clinical education activities

Self-funding countless programs that relieve government of the burden

· Partnerships between associations

· Common CE interests

· Likely to practice together

· Demonstration projects as models

Create invaluable services to the community

· Help academic programs open new practice environments and place students

· MCO’s: consumer education; screening

· Students serve those who do not have reimbursement

Table 3: The Eight Profound Impacts of Professional Societies on

Clinical Education Reform
KEYNOTE ADDRESS

57

Reviewing each one provides an initial list of

themes and opportunities that each society can

undertake to support clinical education and may

provide ideas for this consensus conference.

Educating members and the public • Setting and policing performance and

safety standards

• Promulgating and enforcing codes of

ethics and professional standards

• Conducting research and compiling

statistics

First, society members must encourage the best

and brightest to come our way. I am greatly

discouraged by clinical educators who in times of

work stress or distress, discourage potential students, and ESPECIALLY current clinical students from pursuing their chosen health profession. We all know that this approach is frequently

self-serving not to mention being, a cruel assault

on one’s hopes and dreams. The cumulative,

long-term effect on the profession could be devastating.

Second, we need to specify the competency and

outcomes from our clinical education process to

ensure accountability and garner public recognition of our contribution...including the important

contributions of clinical education.

Setting and policing performance and safety

standards • Ensure that educational standards

require entry-level preparation in the

clinical education role before graduation

• Assess who should ‘control/direct’ clini

cal education: education or practice?

Professional societies should ensure that every

individual entering the profession has the fundamental knowledge to serve as a clinical educator

and that serving as a clinical educator is a professional responsibility.

I’ll even risk saying today that every society

should not advance the status of members as

experts, specialists, and so forth unless these

individuals are actively engaged in mentoring

junior members—especially clinical education

students!

After years of reflective thinking, we must engage the long-standing debates about whose

responsibility is clinical education? Education or

practice? These arguments appear ludicrous as

clinical education or some type of professionally

supervised process in the ‘real world’ is critical to

the long-term term viability of a profession!

However, until we resolve ownership claims and

avoidances we will halt progress. Several models

exist within the allied health professions represented here. Can a comparative analysis provide

information for us all? For instance, the contractual arrangement between the academic and clinical settings has nearly become a nightmare to

both. Further, doesn’t it make sense with our

long-term placements that practice evaluate future practitioners for professional competence

and socialization? Dependence on the academy is

looking backwards and not forwards.

Promulgating and enforcing codes of ethics

and professional standards • Certification of supervisor and training site • Educate regarding ethical use of students and ethical organizational

behaviors

• Maintain educational integrity of clinical education

I believe that it is a travesty that, for the most part,

the health care professions have relied on clinical

competence and not educator competence to be

the primary criteria to serve as a clinical educator.

Being a clinical educator is different than being a

clinician! A good clinician is not automatically a

good clinical educator. Professional societies can

serve the very important role of establishing universal standards across all clinical education.

Since, the role of the clinical educator seldom

receives attention during entry-level education,

we need to develop clinical educator training

programs if not certification processes. Most

importantly all accreditation standards for academic programs should include mandates for

students to be prepared for the roles and functions

of clinical education.

Further, certification of the clinical educator’s

competence is necessary but not sufficient. We

must also specify the learning tasks during clinical training. Failing to do this, we leave the
KEYNOTE ADDRESS

58

student with qualified supervision but without the

specific skills deemed essential for practice.

Two important considerations in our reform must

be included. First, in today’s health care changes,

education and implementation of clinical actions

that emulate ethical practice is essential. Second,

we must avoid losing the educational integrity of

clinical education by allowing ‘on-the-job training’ expectations to overtake the goal for this

learning experience. Anything less would mean

that we were only training our students for today’s

practice and not educating them for future possibilities.

Conducting research and compiling statistics • Fund studies and disseminate results

-Government and association

(single and joint)

-Best practices

quality of care provided through

clinical education

supervisory effectiveness

cost-benefits

-Model clinical education programs

Our blueprint must include plans to study and

disseminate information regarding model clinical

education programs and ‘best practices’ in both

current and emerging health care settings. Our

societies should be encouraged to approach professional foundations as well as external funding

agencies, including the federal government to

support these studies. When approaching the

federal government or private agencies regarding

support of our direct service delivery interests,

professional societies must pledge to advocate for

the critical importance the role clinical education

serves in ensuring qualified services to our customers.

If service providers do not provide quality services, then the need for a profession or a professional society will become defunct and as a result

there will be no members to pay dues to our

societies to sustain their activities!

Clinical education, using best practices and implementing model programs, are critical to serving

our public responsibility and sustaining our professional interests.

Political education and group advocacy • What about co-treatment outcomes? • Student-supervisor interaction • Interdisciplinary • Population-based • Community focussed • Health promotion & disease prevention

In these model programs and study of best practices, let’s risk demonstrating critical outcomes

from exciting possibilities such as co-treatment,

and interdisciplinary clinical education to promote the emerging health care needs in a proactive

manner. Further, encourage clinical education to

occur in settings that are population-based, community focused, involve health promotion and

disease prevention and for some, help individuals

with chronic illness and disability achieve quality

of life.

I advocate the importance of ‘same discipline’

modeling and supervision during clinical education training. Consequently, moving into these

new arenas is challenging as I am not convinced

that direct supervision by an ‘outsider’ is in the

best interest of student's professional development. Thus, funding appropriate clinical education supervisors in the health care environments

of the future is essential if we are going to have

dramatic beneficial changes in health care delivery!

Directing member talents toward community

service • Emerging practice environments • Encourage servant leadership • Recognize and reward clinical education activities

I have previously addressed emerging practice

environments and encouragement of members to

engage in clinical education as a part of professional servant leadership responsibilities.

Finally, each society needs to publicly recognize

significant contributions made by clinical educators. Official recognition of outstanding clinical

educators and administrative support of clinical

education should be advocated by every society.
KEYNOTE ADDRESS

59

Self-funding countless programs that relieve

government of the burden • Partnerships between associations • Common CE interests • Likely to practice together • Demonstration projects as models

Partnerships between associations could be costsaving by pooling resources and reducing duplication of clinical education activities. Demonstration projects of these collaborations between

societies is needed. A beginning position would

be those interdisciplinary activities that naturally

occur in practice as well as considering whole

new interactions. The new Triallance formed

between occupational, physical and speech language pathology is an example. While certainly

the presidents must be politically astute during

these interactions, a variety of other beneficial

collaborations are initiated during day-to-day

business.

Create invaluable services to the community • Help academic programs open new practice environments and place students • MCO’s: consumer education; screening • Students serve those who do not have

reimbursement

Professional societies can encourage clinical education models that provide community service

such as consumer education, screening and providing health-care services to those individuals

who are being significantly underserved today.

This creative use of students would demonstrate

the efficacy of services in new health care environments as well as provide services to individuals who would benefit from our care but are not

supported by the usual reimbursement sources.

In some settings, this suggestion will take student

time away from the revenue-generating activities

that may not be palatable. In others, this utilization of student effort may positively address the

institutional mission initially, and even result in

new sources of practice or revenue-generation.

Remember, we all are here to “serve the greater

public good”. However, I must reiterate that the

'community of interest' regarding clinical education reform is much broader than just professional

membership societies.

[Author's Note: The release of the July 30th

Medicare Regulations after this conference is

naïve regarding students and disastrous to health

care services, in general. The new regulations

indicate that student interventions are not reimbursable and that all student activities must be ‘inline-of-site’ with their supervisor. First, who will

train students if they are unable to obtain compensation for their time and costs? The long-term

implication is that we will not have future practitioners prepared to practice effectively within

Medicare-driven environments. Second, they

have negatively impacted overall quality of care

beyond that which can be delivered by professionals within the reimbursements caps set for

services. The ‘line-of-site’ supervisory mandate

for students significantly limits the extension of

innovative use of students to deliver needed

services.

The important role our professional societies play

in preserving service delivery is essential, but

they must always be simultaneously politically

active in preserving the roles of clinical education

of students to ensure qualified future practitioners.]

How did this happen with our societies as our

watchdogs? We should have been proactive

instead of having to be reactive.

MORE POTENTIAL ACTION STEPS

Beneficial political reform will consider all of

four players interested in the professional competency of entry-level practitioners and service providers as a result of clinical education

outcomes (Figure 2).

With this in mind, I briefly will propose 10 more

potential action steps this group could take to plan

clinical education for 2010 (Table 4).

1. Elevate clinical education as an essential

role, not an apology, gift or burden

 Licensure

Certification Accreditation Association

Figure 2: Professional Societies
KEYNOTE ADDRESS

60

We need to either create or mandate, if the later is possible, that clinical education is a responsibility

of all members of the profession. Education adds new members to our family. Clinical education is

a rite of passage similar to the emancipation of adolescents. We acknowledge the hard work in raising

a young professional, but good parenting or supervision by a qualified clinical educator is essential for

a healthy start.

2. Create Funding

We should seek ways that clinical education can re-distribute health-care services to underserved

populations in our country. Potentially, funding options are needed such as loan deferments. I hope

that a representative from Iowa will present their Healthy People 2010 plan to address this issue.

Yesterday, AHECS & HTECS were proposed as potential partners in clinical education to

underserved regions. But more importantly, our blueprint recommendations could go a step further

1. Elevate clinical education as an essential role not an apology, gift or burden

2. Create funding to:

-re-distribute health care providers who actively train students

-training program/stipends for training in emerging, rural and underserved areas

3. Create an Association Cooperative

-centralized/uniform

contracting scheduling

evaluating reporting

regional consultants

share information and resources

clinical educator professional development & certification programs

4. Coordinate use of information technology

-professional development of clinical educators

-sample instructional approaches

-bulletin board of related events

-listserves around common interests

-use of video-conferencing for remote supervision

-electronic clinical education records

5. Publications

-identify and pursue special issues ( an electronic journal?)

-publicize clinical education role models for emerging areas of practice

-panel to compile all outcome studies

6. Declare the “Decade of Clinical Education” to place on all association agenda

-identify and pursue needs in ‘the trenches’

-stimulate collaborations

-coordinate external audience educational benefits

7. Educational campaign for MCOs

8. Ensure program and reimbursement regulation watchdogs are present and collaborating

9. Find those who have the PASSION and let them educate!

10. Make clinical education practice responsibility

Table 4: Additional Potential Actions for Professional Societies
KEYNOTE ADDRESS

61

by not sending the entry-level practitioners alone

to these underserved areas. They need qualified

role modeling. Our plan should create proactive

strategies to demonstrate the value of developing

a cadre of experienced clinical educators in these

settings who could serve as student supervisors

and mentor students launching their careers in

these settings.

3. Create an Association Cooperative

A consortium of health providers should be convened to develop a long term plan to increase the

efficiency and quality of clinical education activities. The goal is to centralize common tasks as

well as share ‘best practices’ across the health

professions.

The Health Professions Network (HPN) is one

example of a group that could undertake this task

of getting smaller collectives of health professions with similar clinical education processes to

work together to reform clinical education. For

instance, OT, PT, Speech, Psychology, Social

Work, and several others have common clinical

education interests ripe for discussion through a

cooperative model.

On a smaller scale, my current dean of health

sciences has streamlined clinical education contracting and the ease of establishing clinical education sites by simply requiring a universal contract. When a site signs an agreement, it covers

all eight disciplines in our school at one time. Of

course when more than one academic program

trains in this site, other efficiencies and qualities

could be served beyond this major process.

4. Coordinate use of information technology

A panel of clinical education experts should convene with information technologists to explore

new approaches to delivering traditional clinical

education activities. I have listed a few here.

Advancements in information technology applied

to clinical education activities would clearly expand the utility and quality of student training

activities.

5. Publications

The Information Age clearly indicates, that the

person who can access and use information most

effectively, will be the winner. We need to bring

clinical education into this new paradigm. Some

ideas are listed below.

Ready access to related information is essential

to support clinical education. Based on the groups

here, why not propose that a panel be convened to

compile, critically evaluate, and topically organize

all existing outcome data on quality clinical education approaches across the health professions?

Preferably, an Internet-based clearinghouse would

be ideal to make this information readily accessible, easily searched and rapidly updated with

new outcome studies. This site could be expanded to support dissemination of new training

models, too. This could become a resource for

clinical educators to promote involvement in training

as well as provide examples of alternative approaches to supervision, student development

and program development.

6. Declare the ‘Decade of Clinical Education’

Facilitate universal attention and development

in clinical education by proclaiming the Decade

of Clinical Education beginning in the Year

2000. This is a serious recommendation as the

majority of future practitioners in each of our

fields is likely to graduate in the next 10 years.

For the most part, our entering professional

groups each year are larger than previous ones,

challenging the ratio of experienced to inexperienced practice resources. At the same time

economic forces challenge and even hinder

good clinical education.

Thus, never before has it been more important for

professional societies to elevate clinical education as a primary issue. Attention to clinical

education activities must be placed on the agenda

of all our health professions societies, agencies,

etc. Leaders and members must comprehensively

address complex issues related to student training

and ultimately, our real goal, the preparation of

entry-level practitioners to ensure the public’s

demand for competence, quality and predictability in health care delivery.

7. Educational campaign for MCOs

MCOs, and other collectives, need to be educated

regarding the role of clinical education. A promotion campaign of sorts, needs to be launched.

8. Ensure program and reimbursement regulation ‘watchdogs’ are collaborating

Our professional associations need to closely

monitor and successfully challenge legislation or

funding patterns that negatively impact clinical
KEYNOTE ADDRESS

62

education. Power through professional consortiums would have more impact than any one

society could offer alone.

9. Find those who have a PASSION to

educate and let them educate!

Identify those clinical educators who have a passion for student training and let them educate.

Similarly, ensure they are encouraged if not

rewarded by employers for engaging in professional education.

10. Make clinical education a practice responsibility

The last one I know varies considerably across

each of the disciplines represented here. If many

of the previous resources were in place that I have

mentioned, then the responsibility of clinical education could move to it’s rightful owner—PRACTICE! Where professional development can

traject forward beyond educational foundations!

In closing, I believe we have the energy available

in our professional societies to create alliances to

improve clinical education (Table 5).

This blueprint we are creating can be the beginning of endless possibilities and new journeys.

It is not the strongest of the species that survives,

Nor the most intelligent;

It is the one most adaptable to change.

– Charles Darwin

For those of you who like simple answers, I

apologize for frustrating you. I simply could not

do this. Clinical education is not a linear, cause

& effect process. In fact it is more a system—

when one small drop of change falls, the ripple

effect undulates to all stakeholders — a consideration that began to emerge yesterday in this

consensus meeting. We are being asked to adapt

and lead - which we must. I observed us all

“tweaking” the familiar yesterday but not much

about paradigm-shifting - which I think may need

to happen.

Supervised clinical education is an essential need

for entry-level practitioners to be prepared for

safe, quality practice. Today, I have laid numerous ideas from my own thinking for you to

consider during your discussions.

Professional societies, collaborating with each

other, must identify, support and replicate the

‘best practices’ in clinical education. Simultaneously, societies are called upon to address

health care system demands and the professional

development of our future practitioners—ensuring a beneficial balance between professional,

scientific and humanistic values within and among

the health professions. This is the primary role of

our societies. I leave you with this important

message:

Excellence is never an accident.

It is always the result of

high intention,

sincere effort,

intelligent direction, and

skilled execution.

It represents the wise choice of

many alternatives.

– Author unknown

REFERENCES

Hansen, E.J (November, 1998). Essential Demographics of Today’s College Students. AAHE

Bulletin

Greater Washington Society of Association Executives. (1997) The Greater Washington

Association Community: Beyond the Special Interest to the Public Interest. Washington, D.C.: GWSAE [www.gwsae.org]

National Organization for Competency Assurance (NOCA). Washington, D.C.

[202-223-4579]

Oxbrow, N. (1998). Information literacy: The

final key to an information society. The

Electronic Library, 16(6), 359-360.

Professional Societies

Association Partnerships / Member Alliances • Educational Programs • Related Associations • Health Care Industry • The U.S. Government

Improving

Clinical

Education

Table 5: Professional Societies
REACTION PANEL

63

My topic is Professional Societies from the Hospital’s Perspective. Some of my points are going to

be repeated from Dr. Crist’s presentation simply because of the importance of some of the items she

had mentioned. I am a medical technologist, so I am speaking from that perspective, although the

points that I will be mentioning apply across all backgrounds and all allied health careers.

The professional societies are better equipped to identify the needs of the professions because they have

the data. They have data to offer advice for the ever-changing professions. For example, the American

Society of Clinical Pathologists, ASCP, surveys 1500 lab managers randomly, every other year, for

information on wages and vacancies. There are ten years of data broken down into categories of:

regions, disciplines, technical and supervisory levels, size of institution, and alternate work sites such

as doctor’s offices, clinics and the private labs. In addition, the regions further subdivide this

information into the level of education such as technician, technologist and assistant. There are other

laboratory surveys, such as the ASCP training program survey, wherein the program directors provide

information on the number of programs in existence; number of closed and on hold programs; number

of graduates; attrition rate out of the programs; job placement of graduates; and the quality of

applicants. The Advance magazine also publishes similar data annually.

The professional societies are better equipped today because their members have their finger on the

pulse of change; they come from many avenues. They come from hospitals, clinics, and private labs.

Information is made available to the members on large versus small hospitals, rural versus suburban

hospitals, or teaching versus research institutions. The professional societies have information coming

from all these different avenues to give to their members (Table 1).

Because professional society members are in the trenches, they know the latest in disease diagnosis

and management. They have experience, knowledge, and the resources needed to immediately begin

curriculum changes when they are warranted. This is something that hospital-based programs are

better able to do over the university programs because they can do it more quickly.

Our societies tend to be proactive rather than reactive, which Dr. Crist has mentioned earlier today.

Our students need to learn professionalism and have a positive attitude about their profession. It was

Response & Recommendations

Ann F. Sosnowski, B.S., MT

Coordinator, Student Recruitment

Schools of Allied Health

William Beaumont Hospital

ALLIED HEALTH
REACTION PANEL

64

mentioned yesterday that a positive attitude is one of the high points that students need to learn very

early on in their education. Students need to be introduced to professional societies early in their

professional education (Table 2). It is through attendance at professional symposia and meetings that

students and members alike benefit. Student membership in professional societies promotes lifelong

learning, and will make them aware of student scholarships if they need to take advantage of them.

By involvement in their professional societies, members and students get the most up-to-date

information on advances in technology and the latest testing methods. They get the latest methods of

cost containment— cheaper, faster, better, which they are all going to need. As we heard Dr. Crist

say earlier today, students need to know what current trends lie ahead. Students need to come out

of our programs almost as if they are going to be managers themselves some day. Students should

become aware of the wide range of topics that are addressed at these meetings and that these topics

are chosen because they may directly effect some members.

Table 2: Professional Societies Need to be Introduced to the Students Early in

their Professional Education

• Attendance at professional Symposia/Meetings benefits the student and all members

– Get most up-to-date information on:

• advances in technology/testing methods

• latest methods for cost containment (cheaper, faster, better)

• Societies try to be proactive rather than reactive

• Learn “Professionalism” and positive attitude about their profession

• Professional journals will keep students/members up-to-date when cannot attend S/C

• Promote life-long learning

– Networking

– Jobs

– Information

• Student Scholarships – often available

Table 1: Professional Societies are Better Equipped to Identify the Changing

Needs of the Profession

• Professional Societies, due to having many members, have their finger on the pulse of

 change because they come from many avenues

– Hospital vs. clinic

– Large vs. small hospitals

– Rural vs. suburban hospitals

– Teaching vs. research hospitals

• Professional Societies, due to having many members in hospitals, clinics, etc., have their

 finger on the pulse of change because they come from many avenues

– Know the latest diseases, conditions

– Know the greatest needs

– Have experience, knowledge and supplies to immediately begin curriculum changes

Professional journals are distributed to all members, even those who are unable to attend conferences.

These journals have the up-to-date information that our members and students need to know.
REACTION PANEL

65

Professional societies must make certification

carry more weight. As we have heard earlier

today, as well as yesterday, the PTs and the OTs

are very well known to the public. This is not true

of many of the other allied health programs,

especially clinical lab sciences. We are not well

recognized, although our certification is equitable

to any of the other allied health certifications. We

need to be recognized by the public. For example,

when they are having a laboratory test done, they

need to know that a certified professional is

performing it. Maybe that is why we need licensure? This has to be made known to the government and the administrators of hospitals, insurance agencies and HMO’s. Professional societies and organizations also need to do a better job

of educating the public.

Similar allied health programs need to band together for greater numbers. This will bring about

more recognition and preserve the quality within

the profession in times of change. Look what

happened with CLIA '88. We also need to band

together for the sharing of information. In Michigan, the Michigan Association of Laboratory

Science Educators, MALSE, consists of educators from university and hospital programs who

semi-annually discuss topics related or similar to

all. There is representation from all the clinical

lab sciences: histotechnologists, medical technologists, phlebotomists, and cytotechnologists.

Because we are similar and banded together, we

can disseminate accurate information to the students and to our members. Hospital educators

need to be represented on the certifying and the

accrediting agencies. The hospital personnel can

seldom get away to attend these meetings due to

teaching responsibilities and shortages of staff.

It often ends up being “who you know” that

determines the make up of these agencies and

committees. So, representation on the accrediting agencies and the certifying agencies tends to

come from academic institutions more so. I am

not saying that this is bad, but in some cases, we

do tend to be a little bit underrepresented.

So in summary, the three things that I would like

to impart to everyone here today, are: 1) We need

to get our students into professional organizations, professional societies, earlier in their education. This should start when they are in the

academic institutions, in their two-year and fouryear university settings. 2) We need to bring

more recognition to some of our programs, especially in the clinical lab sciences, similar to the

recognition of the PTs and OTs so that we can

preserve the quality of what we aspire to. 3) In

addition, we all need to be represented and accept

positions on the agencies that will make the

changes that will shape our profession and our

students.
REACTION PANEL

66

managed-care organizations, with the community, and perhaps, most importantly, with legislators. Dr. Crist also posed the questions: What will

graduates, clinics, and clinical educators need to

know in 2010 and what type of sites will be

available at that time?

How do we achieve all of the above, answer these

questions and tackle the recommendations from

this conference?

You will see in some of the recommendations that

we developed today in Table 1. Dr. Harmening,

earlier, very effectively summarized them, so I

will not dwell on them. I would, however, like to

make some observations and perhaps one or two

recommendations.

Thank you and good morning. I would like to

begin by saying what a very great pleasure it is to

participate in this important meeting and I would

like to extend my compliments to our keynote

speakers who have provided us with an excellent

conceptual framework. As Dr. Crist indicated,

one of the advantages of being at the end of a

conference is that everything has basically been

said. So this will not take very long.

First of all, I would like to remind you of some of

the issues that Deputy Director Jennifer Burks

suggested we consider during this consensus conference. Some of the issues she indicated were of

importance are: the need for us to be collaborating

with each other, the need to be developing effective partnerships, the need for us to be creative,

the need to focus on populations including minorities and ethnically-diverse populations for which

we will need cultural competence.

In addition, we need to educate our students to the

concept of teams, (and that is the buzzword now),

particularly interdisciplinary teams. We should

be looking at new settings for training our students, in rural, inner city, and other special areas.

One of the issues raised by Dr. Crist was the

future role of professional societies: Are they

going to be proactive, and how are they going to

become effective? It is critically important that

we do become effective with our members, with

Response & Recommendations

Lydia Wingate, Ph.D.

Dean

College of Health Professions

Weber State University

ALLIED HEALTH

Table 1: Recommendations Generated

• Program Accreditation should be

reflective of contemporary practice.

• Need for data on cost/benefit of Clin. Ed.

• Use of technology in Clin.Ed.

• Preparation & Recognition of Clinical

Educators.

• Need for development of a model that

accurately reflects & forecasts needs,

supply & demand for Allied Health

professions

• Develop state-wide consortium for Clin. Ed.
REACTION PANEL

67

First of all, regarding the year 2010, I would submit to you that very honestly, we do not know what’s

going to happen in 2010, what our graduates are going to need to know, and what sites will be available.

Who could have anticipated the changes in the health care system, including all of the mergers and

acquisitions that have taken place in the last five years, even seven years ago, or the technological

explosion? So, I am not sure anyone has the answer to that. And, with apologies to Jody, I had three

“C’s” to recommend; collaboration, collaboration, and collaboration is what we all need to be thinking

about. And in terms of that collaboration, it needs to be between many different communities of

interest. I think we need to have collaboration between our own allied health programs within our

colleges and schools. I think we need to have collaboration between the professional societies, such

as the Association of Allied Health Professions, and HPN that was mentioned this morning, as well

as between the professional societies themselves. I also believe that we need to have collaboration

between professional societies and academic programs and colleges.

What are some of the barriers that we need to be thinking about? Well, I’m afraid that as allied health

educators from different professional backgrounds, we do speak with different tongues. I like the

conference theme “one vision, one voice”, because I think that when we achieve that goal, our

legislators will be more inclined to listen to us!

I think that we need to help our legislators understand what it is we do and I think we need to educate

the community. I think that we in academia, have done a very poor job of letting communities and our

legislators know how we contribute to society in general and our local areas in particular.

Finally, I think the last item is probably very self-evident. We have to overcome self-interest and

territoriality, which has also been alluded to today.

I would just like to leave you with a quote by John Foster Dulles, and I don’t think you need me to read

it for you. I’m sure this doesn’t apply to anybody in this room, right?

“The meaning of success (in meeting our challenge) is not whether we have a tough problem, but

whether it’s the same problem we had last year!”
REACTION PANEL

68

fessional societies, indicated that clinical education reform would be something that is a current

high priority for the professional societies. This

illustrates the fact that clinical education reform is

but one of the challenges that professional organizations face every day.

The real strength of the professional society is its

resource pool (albeit finite), of funds, member

talent, and expertise to work both within and

outside the discipline’s silo. Several examples of

proposed recommendations at this conference to

date attest to the acknowledged role for the societies. For example, we’ve already heard suggestions for developing media to prepare clinical

educators, identify and showcase best practices,

and develop clinical case study media. These

activities can have a positive impact on the clinical education reform movement and have been

proposed as roles for the professional societies.

The societies also, as already noted, play an

inherent role on certification, accreditation, and

licensure activities.

Dr. Crist outlined the proactive role for professional societies as facilitating, advocating, and

leading. They can make their impact in educating

both members and the public, promulgating, enforcing and maintaining the codes of ethics and

professional standards, conducting research and

compiling statistics.

Good morning. It is my pleasure to speak to you

today concerning the role of professional societies

in clinical education reform.

My remarks are focused from the perspective of

the professional society’s viewpoint. I have done

much of my professional work with the American

Society of Clinical Pathologists, its Associate

Member Section, and the Board of Registry. The

ASCP Associate Member Section is a very large,

diverse group, representing medical technologists, medical laboratory technicians,

cytotechnologists,histologic technicians,

histotechnologists, laboratory specialists, and

clinical scientists. This gives us a broad focus

across the laboratory area within the narrow

focus of the clinical laboratory science arena.

In representing its professional community, any

society’s leadership must be two things. It must

be visionary, while at the same time keeping both

feet on the ground, and it must be reactive to

current issues; proactive for emerging trends.

This means maintaining the delicate balance between moving toward the future without a disconnect by present members. These members

have a direct role in setting association agendas

and this impact can be noted with the show of

hands in response to Dr. Crist’s “pop quiz” earlier

this morning. I noted that only about 25 % of us

here, many members and representatives of proResponse & Recommendations

Harriet Rolen-Mark, M.A., MT(ASCP)

Past Chair, ASCP-AMS

Associate Dean, College of Health Professions

SUNY Health Science Center at Syracuse

ALLIED HEALTH
REACTION PANEL

69

So overall, the role that professional societies can

have in impacting the reform is first to support

clinical education and its development. The second is conducting the research ( surveys of educators, employers, practitioners and other

stakeholders)which forms the foundation for

defining the scope of practice. The caveat is that

this research must extend beyond society membership to overcome the member,non-member

ratio bias.

Looking at where we’ve come and where we need

to go for reform, I have identified three issues.

The first is concerning the scope of practice. The

current scope of practice, key components of

clinical education and changing workplace needs

must be determined and maintained. One of the

key ways in which professional societies can

impact clinical education reform is in the allocation of their resources, whether actual funds,

member/staff talent, or by assigning it higher

priority on the agenda or strategic plan. For

example, the American Society of Cytopathology

has developed an employer survey for use by

cytotechnology programs for assessment of program effectiveness. The American Physical

Therapy Association has developed the Clinical

Performance Instrument (CPI). The American

Society of Clinical Pathologist’s Board of Registry is currently in the seventh year of a ten year

longitudinal study of a 1,000 member cohort of

Medical Technologists to determine scope of

professional practice and career development.

Therefore, the recommendation is that professional societies actively contribute to clinical

education reform through resource allocation.

The second issue is the duplication of clinical

education activities across allied health disciplines. Some examples of collaboration would be

funding demonstration projects, sharing clinical

education models, preparing interdisciplinary clinical case media, and using springboard foundations such as the Health Professions Network,

and other professional intersociety organizations.

Recommendation: Professional societies need

to collaborate, pool resources, and reduce duplication of clinical education activities.

The third issue takes us back to our roots is the

mandate to maintain codes of ethics and professional standards in the changing healthcare environment. This is one of the hallmarks of professional organizations.

Recommendation: Professional societies should

review educational reform models to maintain

ethical and professional standards as a public

trust.
CLOSING PANEL

70

In addition, we should coordinate standards between national and state accrediting or licensing

bodies and state boards of higher education. We

should determine the cost effectiveness of programmatic accreditation.

We should explore innovative models that are

based on performance outcomes of students as

well as cost and value benefits to achieve cost

neutral status. We should review policies by state

and educational institutions that inhibit collaboration and sharing of resources. We should

explore models of distance learning that support

collaboration and sharing among schools and

institutions. We should explore innovative uses

of technology for clinical education.

Professional societies should develop clinical case

study media including interdisciplinary which

would be available to all programs. We should

design systems to prepare and recognize clinical

educators. Professional societies should develop

media to help prepare these clinical educators.

Professional societies should also develop a clearinghouse of existing models for recognition. We

should promote early collaboration between clinical educators and curriculum development.

Other recommendations that we have supported:

Clinical education reform should include crossdiscipline and collaborative learning. Higher

Remarks, in summary, regarding the hospital,

health system and HMO perspective will include

the ideas and recommendations voiced during the

three conference segments that I believe to be of

interest to hospitals, health systems, and HMOs.

In addition, I will share comments from those

individuals whom I interviewed in preparation for

this meeting. The following are consensus points

that we are taking away from this conference and

that will be included in the conference report. The

ideas and recommendations come primarily out of

the consensus building of the first session: Economically Driven Changes Impacting Clinical

Education Reform. Additional items were gathered during the remainder of our discussions.

First of all, we have identified these issues: Programmatic accreditation should be more reflective of contemporary practices; data is missing on

cost and benefits regarding clinical education of

students; we should use technology in clinical

education; and we need to prepare and recognize

clinical educators.

Consensus-building identified these recommendations: Clinical education should move to outcomes based rather than processed-oriented accreditation; we should develop competency assessed by practice in addition to written examination; educational curricula and standards should

be reflective of current practice analysis; and we

should better anticipate future needs.

Summary and Review of

Recommendations

Gail Nielsen, BSHCA

Managed Care Performance Administrator

Iowa Health System Corporate Headquarters

ALLIED HEALTH
CLOSING PANEL

71

institutional collaboration should be used to improve quality and reduce costs of clinical education. Evaluation of clinical services provided by

students should be part of clinical education.

Considerable discussion of interest to employers

surrounded the concern that health professional

clinical education is not keeping pace with change.

Concerns were expressed with retraining of graduates to work in a managed-care environment.

The consensus recommendation was that we

need to work on incentives for health service

providers who would encourage their support of

clinical education and training. Concerns were

also voiced about clinical education and training

cost benefits, and concerns that clinical sites are

diminishing in numbers. Discussion also identified that we have an interest in capitated payments for various allied health disciplines.

During discussions of overcoming barriers, we

explored issues of interest to hospitals, health

systems and HMOs; primarily, excessive pressure continues to build in clinical sites. In discussions with hospitals and health systems, it is clear

that they do understand that there are issues.

They, however, have their own issues of survival

under diminishing reimbursement.

We also discussed the concern that there is a

dearth of information from outcome studies supporting or disputing assumptions made relative to

accreditation standards. Whether they’re from a

patient perspective or a professional perspective,

HMOs and other payers are interested in outcome

standards.

We discussed the need to promote collaboration

and cooperation among the stakeholders in clinical education. My recommendation is to be sure

to include representatives of hospitals, health

systems, and payers from the outset when conducting collaborative exercises among stakeholders.

The remaining recommendations and thoughts

are coming from me from a personal perspective

but also from a perspective of having interviewed

a number of individuals prior to coming to this

meeting and also during the Planning Committee’s

activities. There were a number of people, from

the payer, the health system, and the hospital

perspective with whom I was able to speak and

to draw out their thoughts on clinical education

reform. Based on those discussions, I believe

that these are good ideas. These stakeholders,

however, would ask how are you going to make

the recommendations happen? Who is going to

take it on? Are you really willing to put some

effort behind this now that you’ve identified and

agreed in such magnitude of consensus that the

work needs to be done?

How can you instill some "out-of-the-box" thinking as you go back to your colleagues and begin

to work on this with your professional societies

and your own individual departments? How can

you make it happen? The Chancellor of Allen

College in Waterloo, Iowa has identified to me

that there is an organization in her community that

has set a new standard for temporary placement

agencies. Dr Hasek draws a correlation between that level of service and what we need to

do in preparing our students for tomorrow. This

placement agency has provided Allen College

with temporaries who deliver far beyond any

expectation that we’ve ever had of a Kelly

Service or other temporary placement agency.

The agency comes into the workplace prior to

placing a temp, and reviews policy and procedural manuals and seeks to understand the responsibilities of preparing the temporary for your

workplace. If you have safety policies, performance policies, dress policies, they take on the

responsibility of preparing the temporary being

placed. Now, that goes above and beyond the call

of duty as we think of it for a temporary agency.

How can we use that concept to think in a

different context as we return to our own workplaces and share the issues and recommendations of this conference?

Also, I would like to share with you a perspective

of a radiology administrator, about 47 years old,

who, a couple of years ago, lost his 16-year-old

daughter to cystic fibrosis. After her death, he

decided to leave his profession and to fulfill her

dream of going into public education. He now

reports to me very excitedly that he loves the

classroom and that he loves the opportunity to be

with students and influence young minds. He also

tells me that he has grave concerns about his new

colleagues whom he describes as whiners and

small-minded thinkers. These colleagues, he

says, have lost the vision of working for the

students, exciting them, and moving them forward. They have lost their desire to think of
CLOSING PANEL

72

delivering education in a whole different way.

When Patricia mentioned the fact that more than

30 percent of the students are bored in the classroom, I thought of this gentleman and his newfound

enthusiasm for his work.

Using new and "out-of-the-box" thinking, there

are many ways that you can bring excitement into

your workplace. Tools and exercises abound

today. If you need some ideas, the planning

committee for the Coalition for Allied Health

Leadership would be glad to share ideas it has

collected. ENERGIZE, think forward!
CLOSING PANEL

73

needs or needs of our own professions, but when

it comes to the larger issues and making the larger

impact, especially at the national and state levels,

it behooves us to have the numbers. Let’s face

it, much of it boils down to how much impact we

can have in terms of numbers and how well we

can develop more effective collaborative models.

We also need to become more active participants in

state and national legislative affairs. Possible areas

for legislative action are: (1) tax credits for healthcare

organizations that are assisting with clinical education, (2) reviewing AHEC and HTEC legislation

with regards to how well are the training needs of

allied health professions being met, (3) establishing

a health commission to study clinical education

training and (4) creating or developing a systematic

approach for the collection of supply and demand

workforce data of the allied health professions.

And finally, another issue addressed was a rapidly

growing diverse population in the country and the

need for the allied health professions to expand their

clinical education training sites to non-traditional

areas and healthcare organizations. Related to this is

the need for the allied health professions to be more

inclusive of the rural, minority, and other

underrepresented populations in the ranks of the

allied health professions.

I will start out by quickly summarizing Dr. Rowland’s

concluding remarks in which he stated some of the

realities that we will continue to face in the future.

These are that we:

· will have continued financial constraints

· will have increasing consumer demands

· will have an aging population and

· will have a diminished role of gatekeepers

Within that context, I think much of what has been

said during this day and a half of this conference is

very appropriate.

It’s important for all of us to leave here today thinking

about the theme of this conference: “One Vision,

One Voice.” This type of thinking would be

consistent with what our three keynote speakers (Dr.

Abrams, Dr. Rowland, and Dr. Crist) shared with us.

All three of them emphasized the need for collaboration. It is necessary that academic institutions from

all levels (two and four-year colleges and health

science centers) work toward developing collaborative models of educational programs.

Dr. Rowland recommended that we get “outside the

silo,” and Gail Nielsen recommended we start thinking “outside the box.” In other words, we need to be

more innovative and think of new ways of doing our

jobs. We certainly need better linkages between two

and four-year colleges and health science centers.

We can continue to meet some of our individual

Summary and Review of

Recommendations

Rumaldo Z. Juarez, Ph.D.

Dean

College of Health Professions

Southwest Texas State University

ALLIED HEALTH
CLOSING PANEL

74

sented minority populations for future careers in

allied health. This is important because minority

professionals are more likely to work in underserved minority communities than others. Clinical education reform should be mindful of this

issue and the need for cultural competency in

education and practice.

A comment was made earlier regarding this

conference’s theme, and an analogy was made of

early pioneers. We should remember that many

Americans were not pioneers. The past history

and life experiences of many people of color in

this country included inadequate access to health

care, and as mentioned earlier, access continues

to be a concern in many minority communities.

There were several themes that emerged from the

session on professional societies and these included education, research, service, collaboration, and recruitment. Specific recommendations

were presented earlier. For professional societies

and other stakeholders, there is a need to fill the

gaps of missing data, through outcomes research.

And as Pat beautifully stated this morning, much

has been done. We need to gather that information. Where the gaps continue to exist, we need to

fill them. Furthermore, we must continue to

prepare qualified clinical educators. I love the

idea of preparing students for future clinical

educator roles as part of their training, and professional society members can serve as mentors.

I want to thank everyone, especially Dr. Harmening

for the opportunity to serve on the Planning

Committee, and to provide closing remarks on

this panel. My comments represent a personal

perspective as a board member of the National

Society of Allied Health. I will also share some

personal observations of the conference, and then

close with a few themes that emerged from the

professional societies session.

The National Society of Allied Health is predominantly an African-American organization, that

focuses on educational issues, clinical practice,

and legislative concerns that affect minority health

status. As highlighted by Dr. Juarez, there continues to be major access issues to quality health care

in minority and rural communities that must be

addressed. For these reasons, the National Society of Allied Health and other minority organizations play an important role in the dialogue on

clinical education reform.

As allied health professionals, we pride ourselves

on being the largest workforce in health care, but

our presence is small in terms of decision-making

in health care. We need to have a stronger voice

concerning health disparities in under-served communities. Looking at the future in America, we

know that a few decades from now, the current

minorities will be the majority, yet we have not

addressed the need to prepare more under-repreSummary and Review of

Recommendations

Peggy Valentine, Ed.D.

Interim Associate Dean

Division of Allied Health Sciences

Howard University

ALLIED HEALTH
CLOSING PANEL

75

Fostering collaborative relationships was another

theme that emerged. It is wise for educational

programs to work with professional societies.

These organizations can be helpful in recruiting

students, and providing support in education,

research, and professional services. Professional

societies can provide leadership in addressing

many of the issues presented today. As allied

health professionals, each of us can serve as

change agents. It would be interesting to follow up

this group a year or two years from now to

determine if this conference planted seeds of

change. As Gail asked earlier, “Have we begun

to think out of the box, and to what extent have we

encouraged others to do the same?”

Those are my closing remarks. This has been a

very good conference. We have learned much, and

hopefully, we are committed to implement many

of the proposed strategies as recommended.
RECOMMENDATIONS

76

Open Forum

Introduction

ALLIED HEALTH

The purpose of the Open Forum was to establish an initial interface among key stakeholders in allied

health clinical education and to gather consensus and recommendations. These “key stakeholders”

represented an extremely diverse population of professions, agencies, and institutions. The conference was attended by one hundred, forty-eight participants, who came from thirty-two states, the

District of Columbia, and Canada. More than twenty allied health professions and twenty-two

professional organizations and accrediting agencies were represented. In the planning phase, the

conference planning committee outlined three general categories that subsumed fundamental issues

relevant to clinical education reform. These three categories, which focused upon economic factors,

overcoming educational barriers, and the role of professional societies in clinical education reform,

were first addressed by conference keynote speakers and reaction panelists, respectively.

Open forum sessions provided all participants with a formal setting for the exchange of ideas and the

formulation of recommendations for education reform. Promoted as a national consensus conference,

the goal was to attempt to define issues and generate recommendations relevant to clinical education

reform that would transcend established territories and boundaries. Consensus was not determined

by a pre-established threshold or ratio; nor were precise participant polling methodologies employed.

Rather, consensus was conceptualized as defined by Webster’s Third New International Dictionary:

“a general agreement; the judgment arrived at by most of those concerned.” Perhaps, the consensusgathering process would be more accurately defined as a pattern of finding “common ground”.

Integral points from the keynote presentations and reaction panels were provided as a starting point

for the open forum discussions. Discussion points frequently led to recommendations, and

recommendations sometimes produced strategies. Areas of common ground were designed as (C),

if at least 50% of participants were in agreement. Those discussion points, recommendations, and

strategies that did not appear to be common among participants were designated as (NC) and those

for which neither end of the continuum could be ascertained were designated (M). In a few instances,

time constraints precluded a polling of participants to determine common ground, no common ground,

or mixed judgments.

In the post-conference evaluations, some participants expressed concern about presenting open

forum recommendations as truly “consensual”. In that light, the information presented herein should

be evaluated as areas in which a majority of participants could find some common ground. Although

not empirically consensual, such common themes are more likely to form the basis of any subsequent

blueprint for clinical education reform.
RECOMMENDATIONS

77

Open Forum

Recommendations

Economically-Driven Changes Impacting

Clinical Education Reform

ALLIED HEALTH

RECOMMENDATION 1

Programmatic accreditation should be more reflective of contemporary practices (C)

STRATEGIES

• Move to outcomes based rather than process oriented accreditation (C)

• Competency assessed by practice in addition to written examination (C)

• Educational curricula and standards should be reflective of current practice analysis and

anticipate future needs (C)

• Coordination of standards between national/state accrediting/licensing bodies and state boards of

higher education (MC)

• Determine cost effectiveness of programmatic accreditation (C)

RECOMMENDATION 2

Complete data should be collected on cost/benefit of clinical education of students (C)

STRATEGY

• Explore innovative models that are based on performance outcomes of students as well as cost

and value benefits to achieve cost neutral status (C)

RECOMMENDATION 3

Increase the utilization of technology in clinical education (C)

STRATEGIES

• Review of policies by state/educational institutions that inhibit collaboration and sharing of

resources (C)

• Explore models of distance learning that support collaboration and sharing among schools and

institutions (C)

• Explore innovative uses of technology for clinical education (C)

• Professional societies develop clinical case study media, including interdisciplinary, which could

be made available to all programs (C)
RECOMMENDATIONS

78

RECOMMENDATION 4

Increase preparation and recognition of clinical educators (C)

STRATEGIES

• Design systems to prepare and recognize clinical educators (C)

• Professional societies should be tapped to develop media to help prepare clinical educators (C)

• Professional societies could develop a clearing house of existing models for recognition of clinical

educators (C)

• Promote early collaboration between clinical educators and curriculum development (C)

RECOMMENDATION 5

Clinical education reform should include cross discipline and collaborative learning (C)

RECOMMENDATION 6

Employ interinstitutional collaborations to improve quality and reduce cost of clinical education (C)

RECOMMENDATION 7

An evaluation of clinical services provided by students should be part of clinical education (NC)
RECOMMENDATIONS

79

Consensus Gathering

Recommendations

Overcoming Barriers to

Clinical Education Reform

ALLIED HEALTH

RECOMMENDATION 1

Develop an assessment model that accurately reflects and forecasts the need, demand, and supply

for the allied health professions and support of clinical sites (C)

STRATEGIES

• Perform needs assessment before starting new programs

• Seek advice from professional societies in regard to duplication and proliferation of programs.

RECOMMENDATION 2

Reduce pressure on clinical sites (C)

STRATEGIES

• Develop a statewide/regional consortium for clinical education.

• Explore effective methods to support clinical education, i.e., tax credits

• List elements/major items included in affiliation agreements to reduce pressure on clinical sites

• Modify assignments performed at the clinical site to better match what the clinicians provide

• Explore the use of faculty for facilitating at clinical sites

RECOMMENDATION 3

Develop outcome studies that support/dispute assumptions made relative to accreditation standards,

e,g., length of field work (M)

DISCUSSION POINTS

• Move from evolution to revolution and overcome turf issues.

• How can we promote collaboration/cooperation among the stakeholders?

• Can more flexible accreditation and certification requirements aid in clinical education reform?

• How can changes in academic structure facilitate clinical education reform?

• Can we expand clinical education to community-based practice to increase teaching sites?

• Can new models, such as technology solutions/computer simulations/”virtual laboratory” facilitate clinical education?

• The need to adequately prepare students and faculty for clinical education

• The need for allied health faculty and professionals to increase their involvement in legislative/

policy making decisions.
RECOMMENDATIONS

80

Open Forum

Recommendations

ALLIED HEALTH

DISCUSSION POINTS

• Need for professional societies to acknowledge clinical education as a higher priority(C)

• The need for professional societies to be proactive in facilitating, advocating, and leading clinical

education reform(C)

• Need for collaborations and partnerships among professional societies(C)

• Need for collaborations and partnerships within and between allied health schools and colleges(C)

• The need to maintain student learning as the primary focus in clinical education(C)

• Need for a collaborative role of professional societies in recruiting and promoting clinical

educators (C)

• Need to develop clinical education standards, programs, and processes that support adult learner

needs and lifestyle concerns(C)

• Defining the appropriate role of professional societies in determining scope of practice and

core competencies(M)

• Need for key stakeholders to come together to address common interests regarding clinical

education(C)

• Defining professional societies/accrediting/ certifying agencies impact on clinical education

reform

• Need for professional societies to analyze the long term financing of clinical education(C)

The Role of Professional Societies in

Clinical Education Reform
CRITICAL ISSUE SURVEY

81

Critical Issue Survey

and Results

ALLIED HEALTH

1. What are the top three economic factors impacting Clinical Education/

Training in your area?

2. What new opportunities or challenges have evolved in Clinical Education/Training in your profession?

3. What are the top three barriers to Clinical Education/Training Reform

in your region?

4. What changes in Clinical Education/Training would make graduates

more adaptive to the current working environments?

5. What three recommendations do you have for your professional society in regard to facilitating Clinical Education/Training?

The Critical Issues Survey polled attendees in an informal, relaxed setting during the luncheon. The

survey solicited input to five questions that focused on economic factors, new opportunities and

challenges in clinical education, barriers to clinical education reform, making graduates more adaptive

to the working environment and the role of professional societies in facilitating clinical education and

training. Input derived from the Open Forums was designed to seek out issues on which a diverse

population of attendees could find common ground; while agendas and issues specific to particular

professions and organizations were identified in the responses to the Critical Issues Survey.

INTRODUCTION
CRITICAL ISSUE SURVEY

82

1. What are the top three economic factors impacting Clinical Education/Training in

your area?

• Very low employment.

• Short-staffing at clinical sites due to unfilled positions.

• Difficulty attracting students to lower wage positions.

• PPS - huge impact on OT/PT and long-term care.

• Distance from home school to clinical agency.

• Salaries of clinical instructors.

• (Dental Hygiene) The threat of the reduction of educational standards - thus threat of creation

of preceptor programs; flourish of non-accredited programs.

• Lack of dental hygiene educators.

• Hospitals receiving less money for payments thus not hiring individual when someone leaves.

• The Balance Budget Amendments and Prospective Payment System - many subacute care

facilities have had to cut staff and no longer hire student programs.

• The clinical educators do not have time, have productivity demands to meet are not

compensated and maybe afraid of losing their jobs to students who soon will be therapists.

• Fewer affiliates.

• Hospital cut backs resulting in fewer technologists with less time for teaching during clinical

rotations.

• Willingness of CIs to take students because they don’t want to train the job competition.

• Clinical staff are part time or PRN in LTC & HH.

• Fall out of BBA of 1997.

• Whether or not pay preceptors.

• Whether or not to reimburse students for travel/lodging.

• Not hiring enough core clinical faculty to adequately support the clinical preceptorship.

• Hospital sites

• Funding

• Loosing affiliates due to hospital mergers.

• Raise in Tuition costs/cost of training supplies.

• Increased demands on productivity in the clinic.

• Decreased number of jobs available.

• Managed care has affected employment.

• Employee salaries.

• Health professionals are overwhelmed and underpaid.

• Employee salaries - fewer people applying due to low wages.

• Fewer staff to do work, let alone teach/train.

• “Managed Care”

• DPPS capitation!!

• SLPs laid off .... per diem vs. salaried, etc. - no students welcome.

• Cost to the hospital in training students.

• Paying clinical sites - Pro/Con. Standardized preparation and recognition of clinical educators

(who will pay) should they get money?

• Managed Care

• Institutions opting for fiscal success/survival vs. clinical education.

• Education programs - increased recognition of clinical vs. didactic education.

• Funding

• Sufficient faculty

• Recruitment

• Faculty
CRITICAL ISSUE SURVEY

83

• Clinical sites

• Clinical education centers are inadequately staffed for patient load let alone student

supervision.

• Institutional financial support for laboratory equipment and maintenance (simulators, computers).

• Manpower shortages

• Student readiness with medical exam, health lab profile; vaccinations to start clinical.

• Providing our own on-site preceptors for students.

• PPS

• RPS and long term care placements.

• Loss of FTEs and downsizing in LTC and some hospitals.

• Fewer rehabilitation opportunities for full time clinical experiences.

• Many programs competing for the same sites.

• Reimbursement issues causing demand for productivity with less staff members therefore

reduction in willingness to instruct students.

2. What new opportunities or challenges have evolved in Clinical Education/Training

in your profession?

• Distance education

• Creation of teaching methodologies that meet the learning needs of the entering students. The

lack of preparation of entering students, re: independent learning and communication skills.

• Keeping schools active, many have closed.

• Encouraging clinical educators to do the training in new ways, for eg: using a collaborative

model, challenging the student clinical reasoning skills.

• Creation of multi-media teaching programs.

• Little chance to use instrumentation.

• Opportunities Challenges

more non-traditional less direct supervision of the licensed

(medical settings) professional during clinical ed

• Involving preceptors enough for them to communicate problems with student performance

to the program as well as to the student. Also, many preceptors are turning down students

due to “not enough staff” or “not enough time”.

• The salary has increased and there are more job opportunities.

• Opportunities - Internet technology

• Challenges - changing instruments

• Opportunities - not many, in fact none!

• Challenges - to do more with less

• Opportunities - availability of info on Internet

• Challenges - more lab techniques to teach in same amount of time with fewer people

• Keeping up with delivery of service changes and keeping curriculum current.

• Lack of quality candidates to train.

• Is there a greater focus on lower level jobs and greater emphasis on preparing these

individuals vs. professionals? (everything is of advanced technology now)

• Opportunities: Data Analysis

Chief Information Officer

Coder/Biller

• Challenges: Non-credential person being in charge of credential person.

Vocational schools offering training in professional field for short period.

Less funding from CE.
CRITICAL ISSUE SURVEY

84

• Advanced clinical practice in my area of training - allowing our profession to become

marketable.

• Education

• Administration

• Opportunities: Distance Education, Electronic Media

Challenges: Manpower shortages

• Lack of cooperation of preceptors to take students on a continuous basis.

• Movement to using new sites where OT services have not previously existed with 2 days/

week of OT faculty member salary “purchased” by the clinical site (to provide student

supervision and OT services).

• Now have a “majors fee” at the Univ. and additional fees for lab courses (helps a lot!).

• Credentialing for PT clinical educators.

• Discussion regarding the DPT as entry level degree

• Direct access opportunities in 32 states

• CPI

• Technology changes

• In cancellations due to clinic circumstances

• Reluctancy to promise too far in advance because of the staff problems.

3. What are the top three barriers to Clinical Education/Training Reform in your region?

• Finding clinical sites

• Preparing for the future of healthcare vs. reactions to the current situations.

• Availability of clinical instructors

• Availability of clinical spaces

• State regulations and politics that prevents teaching the full range of clinical skills needed for

the students that will later move to another region. In general, lack of funding. Regarding

competency education and evaluation, we are well established and not hindered.

• Increased work load and less staff

• No reward system for clinical educators, just more work.

• Same as the top 3 economic factors outlined above.

• Little incentive for additional training other than personal satisfaction and improvement.

• Too many universities/colleges wanting the same sites for clinical education.

• Receptiveness of the clinical staff.

• Optimism of the clinical staff about the job market.

• Dean of the college!!!

• I am the sole clinical coordinator for over 100 sites.

• Other programs competing for the same sites.

• In the County Hospital they do not allow the student to perform evasive procedures.

• There are too many schools that offer training quick and the cost is killing the students.

• Distance between university and affiliates.

• Decreased number of sites.

• What kind of reform? How are we to change a system? We need a bigger lobby. More

efforts are needed to work with Congress!

• Only 31 accredited programs in the U.S.:

- very little peer-teaching support

- very few number

• All disciplines separate. Not one body speaking for all.

• Republican Governor

• National Organization requirements re: hours SLP students need to obtain for certification.
CRITICAL ISSUE SURVEY

85

• Completing degree in 2 yr. program though scope of field has grown so much.

• Cost to have more clinical instructors.

• Licensure!

• Funding for technology equipment/programs.

• Establishment of special interest groups.

• Administration support/budget.

• Language (Spanish speaking clients)

• Qualified faculty who are willing to relocate to our area.

• Limited number of in-patient clinical sties.

• Rigid, min-set, antiquated administration ideas, policies, philosophies, etc.

• Difference between standards taught didactically and the students observing limited

standards routinely used in clinical practice.

• Clinical too long.

• Lack of trained preceptors willing to work w/students.

• Concern that the students will receive inadequate supervision.

• Supervisors blindly committed to training students in the same way they were trained.

• Staff turnover in local hospitals.

• Meyers.

• Lack of understanding clin-ed by institutional administrators.

• The educational programs must embrace and reform.

 • Listed above as economic factors & challenges.

4. What changes in Clinical Education/Training would make graduates more adaptive to

the current working environments?

• Additional time devoted to development of clinical skills i.e., apprenticeships.

• Creation of diverse clinical sites - which would need the condition of general or no dental

(dentists) supervision in those sites.

• Always having a certified/qualified CI

• Curriculum must reflect & train student for practice

• School taking more responsibility to ensure capability

• Outlining actions needed for entry level practice

• More instrumentation for outmoded labs.

• Earlier exposure

• Flexibility with placements

• Inclusion of more administrative practice.

• Graduates need to be paid better.

• Pay more to attract better students.

• More interdisciplinary training.

• Having tracks: medical vs. educational; ped vs. adult.

• Students are ill-prepared for entry into programs.

• Cultural diversity and sensitivity.

• Find the miracle to eradicate apathy of the clinical staff (providing pt. care & education) and

the students to be independent and responsible for learning.

• Completing training all up front in class then move to clinical - this is what we do now and

works best.

• Changes need to occur during the didactic/academic phase first to - independence in thinking

and clinical reasoning.

• Group models of supervision.

• Team approach.
CRITICAL ISSUE SURVEY

86

• Link clinical education to initial employment opportunity

• All the professional programs must work collaboratively with their colleges in the clinical.

Survey graduates/employers and adapt accordingly.

5. What three recommendations do you have for your professional society in regard to

facilitating Clinical Education/Training?

• Provide information regarding changes being experienced in clinical practice/funding.

• Provide mentors for students in clinical practice.

• I appreciate the need for parochial organizations. However, regarding national healthcare

and issues - create a dual membership, i.e., I would pay my dues to the American Dental

Hygienists’ Association and with that dues statement add $25 payment that will go toward

membership in a National Allied Health Organization, thus uniting the AH voice.

• Highlight clinical educators in the newsletters.

• Making sure that OR curriculum’s reflect more current practice.

• Taking more responsibility for some clinical education at the academic institution.

• Look to discourage the development of more programs.

• Review NAACLS requirements and develop something that is practical and realistic for the

entry-level technologist that can be taught in 2 years.

• Seek advice from the payors & policy makers.

• Seek advice from the clients/consumers.

• Preceptor workshops/seminars, esp. at the national conference level.

• Advertising CME credits for preceptoring.

• Limit number of new programs!!!

• More institutions should participate in their off site training. I mean that your certif. programs

that are not housed on a college campus do not monitor their students by visiting the site or

they wait until the student is a the end of training to send the student for hands-on training.

• Revise essentials to be more practical.

• Cl. Lab Sc. Society needs to do more to raise the standards of the profession.

• Laboratory scientists need to be recognized as scientists.

• Need to be paid better.

• Set-up training modules on Internet.

• Work on obtaining grants for innovative programs.

• Review training requirements re: hours in adult area during crisis.

• Contact APTA @ training CI project and get in on it!

• Keep those lobbyists aggressive on BBACF/PPS issue.

• Add the component or title of nurse practitioner to our curriculum.

• Changing the requirements for preceptors to allow more diversity to our students.

• Funding

• Determine if clinical education is part of the societies’ goals and philosophies.

• Request society divulge material to assist academic faculty with clinical faculty preparation

material.

• Promote changes to focus “entry” level upon competition of program and not require only one

avenue to certification in field, i.e., surgical tech only avenue AST CAAHEP. No

grandfather.

• I think AOTA has done very well with this:

In 1991 they produced a manual including videotape with 12-13 vignettes for clinical

educator supervision - it is currently being revised.

• New standards eliminate 1 hour specification.
LIST OF PARTICIPANTS

87

Carol J. Bancroft, PT

Coordinator

Physical Therapist Assistant Program

Delaware Technical & Community College

333 Shipley Street

Wilmington, DE 19806

Phone: (302) 888-5292

Fax: (302) 577-2548

Email: bancroft@hopi.dtcc.edu

Dale D. Barb, M.H.S, PT

Department of Physical Therapy

Wichita State University

1845 North Fairmont

Wichita, KS 67260-0043

Phone: (316) 978-5648

Fax: (316) 978-3025

Email: barb@chp.twsu.edu

Robert Baumiller, Ph.D.

Associate Dean, Health Education Programs

Xavier University

3800 Victory Parkway

Cincinnati, OH 45207

Phone: (513) 745-2870

Fax: (513) 745-4267

Email: baumiller@xavier.xu.edu

Phillip Bendick, Ph.D.

William Beaumont Hospital

3601 West Thirteen Mile Road

Royal Oak, MI 48073

Phone: (248) 551-1490

Fax: (248) 551-3023

Email: pbendick@beaumont.edu

Lawrence Abrams, Ed.D.

Dean, College of Health Professions

Thomas Jefferson University

Edison Building, Suite 715

130 South 9th Street

Philadelphia, PA 19107-5233

Phone: (215) 503-6595

Fax: (215) 503-2348

Morton Albert, M.D.

Associate Medical Director

Mid Atlantic Medical Services, Inc.

4 Taft Court

Rockville, MD 20850

Phone: (301) 545-5304

Fax: (301) 545-5382

Deborah Bailey Astroth, B.S., R.D.H.

Assistant Professor

Departments of Dental Hygiene

and Surgical Dentistry

University of Colorado School of Dentistry

4505 South Yosemite Street, #111

Denver, CO 80237

Phone: (303) 740-7956

Fax: (303) 721-0868

Email: dbastroth@aol.com

Donald A. Balasa, JD, MBA

Executive Director, Legal Counsel

American Association of Medical Assistants, Inc.

20 North Wacker Drive, Suite 1575

Chicago, IL 60606

Phone: (800) 228-2262

Fax: (312) 899-1259

Email: dbalasa@aama-ntl.org

List of Participants

ALLIED HEALTH
LIST OF PARTICIPANTS

88

Denise Bieszczad

Clinical Director

Tidewater Community College

1700 College Crescent

Virginia Beach, VA 23456-1999

Phone: (757) 321-7254

Fax: (757) 427-1338

Email: tcbiesd@tc.cc.va.us

Val Billey, MLT, M.Ed.

Team Leader, Diagnostic Service Programs

Northern Alberta Institute of Technology

11762 106th Street

Edmonton, Alberta CANADA T5G 2R1

Phone: (780) 471-7649

Fax: (780) 471-8902

Email: valb@nait.ab.ca

Joseph P.H. Black, Ph.D.

Senior Vice President

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314

Phone: (703) 706-3155

Fax: (703) 838-8910

Email: jphbphd@msn.com

Nancy Blake, M.Ed., OTR/L

Fieldwork Administrator

Occupational Therapy

Towson University

8000 York Road

Towson, MD 21252

Phone: (410) 830-2253

Fax: (410) 830-2322

Email: nblake@towson.edu

Charlotte Boston, ATR-BC

American Art Therapy Association, Inc.

1202 Allanson Road

Mundelein, IL 60060

Phone: (847) 949-6064

Fax: (847) 566-4580

Email: arttherapy@ntr.net

Denise M. Brown, Ph.D., RD, LD

Assistant Professor

William Carey College

School of Business

Gulfport, MS 39507

Phone: (228) 897-7116

Fax: (228) 897-7130

Email: denbrown@bellsouth.ne

Pamela Butler, BSRT, RDMS

Program Coordinator

Diagnostic Medical Sonography

Department of Radiologic Technologies

Health Technologies Building, Room 426

Owens Community College

P.O. Box 10000, Oregon Road

Toledo, OH 43699

Phone: (419) 661-7260

Fax: (419) 661-7251

Email: pbutler@owens.cc.oh.us

Bob Caruthers, CST, Ph.D.

Deputy Executive Director

Association of Surgical Technologists, Inc.

7108-C South Alton Way

Englewood, CO 80112

Phone: (303) 694-9130

Fax: (303) 694-9169

Email: bcaruthers@ast.org

Norman Clark, DDS, MPH, JD

Chief, Allied Health and Associated Professions

Branch

Bureau of Health Professions

Health Resources and Services Administration

Parklawn Building, Room 8C-02

5600 Fishers Lane

Rockville, MD 20857

Phone: (301) 443-1346

Fax: (301) 443-1164

Email: nclark@hrsa.ssw.dhhs.gov

Faye Coleman

Associate Professor

Old Dominion University

Medical Technology

115 William B. Spong Jr. Hall, Room 209

Norfolk, VA 23529

Phone: (757) 683-3588

Fax: (757) 683-5028

Email: fcoleman@odu.edu

Catherine N. Colucci, M.A., OTR

Academic Fieldwork Coordinator

Occupational Therapy Program

Seton Hall University

400 South Orange Avenue

South Orange, NJ 07079

Phone: (973) 275-2921

Fax: (973) 275-2370

Email: noblecat@shu.edu
LIST OF PARTICIPANTS

89

Anne Conner-Day, RT, RDMS

Board of Directors

Society of Diagnostic Medical Sonographers

Department Chair

Forsyth Technical Community College

7611 Lasater Road

Clemmons, NC 27012

Phone: (336) 766-1399

Fax: (336) 748-9395

Email: gday@riscy.forsyth.tec.nc.us

Arthur Cooper, M.D., M.S.

Chief, Division of Pediatric Surgery

Columbia University/Harlem Hospital

506 Lenox Avenue

New York, NY 10037

Phone: (212) 939-4003

Fax: (212) 939-4015

Email: ac38@columbia.edu

Renee S. Cornett, Assistant Professor

The University of Texas Health Science Center

@ San Antonio

Department of Dental Hygiene

7703 Floyd Curl Drive

San Antonio, TX 78284-6244

Phone: (210) 567-8834

Fax: (210) 567-8843

Email: cornett@uthscsa.edu

Patricia Crist, Ph.D., OTR/L, FAOTA

Chair and Professor

Department of Occupational Therapy

Duquesne University

600 Forbes Avenue, Room 211

Pittsburgh, PA 15282-0020

Phone: (412) 396-5945

Fax: (412) 396-4343

Email: crist@duq2.cc.duq.edu

Elaine Cuklanz, M.S.

Executive Director

Joint Review on Educational Programs

in Nuclear Medicine Technology

PMB 418, #1 2nd Avenue East, Suite C

Polson, MT 59860-2107

Phone: (406) 883-0003

Fax: (406) 883-0022

Email: jrcnmt@ptinet.net

Victoria Cutler, Director

Medical Assistant Program

College of Allied Health

Charles R. Drew University

1731 East 120th Street

Los Angeles, CA 90059

Phone: (323) 563-5851

Fax: (323) 563-4923

Dan deRegnier, M.S., MT(ASCP)

Associate Professor

Ferris State University

200 Ferris Drive, VFS 210A

Big Rapids, MI 49307

Phone: (616) 592-2327

Fax: (616) 592-3788

Email: daniel_P_deregnier@ferris.edu

Vera Dvorak, M.D.

Medical Director

Mid Atlantic Medical Services, Inc.

4 Taft Court

Rockville, MD 20850

Phone: (301) 545-5780

Fax: (301) 545-5892

Email: vdvorak@mamsi.com

Zoe Ann Durkin, M.Ed., HT(ASCP)

Program Director

School of Histotechnology

Hartford Hospital

560 Hudson Street

Hartford, CT 06106

Phone: (860) 545-3952

Fax: (860) 545-6461

Email: zdurkin@harthosp.org

Thomas Elwood, Dr.P.H.

Executive Director

Association of Schools of Allied Health Professions

1730 M Street, N.W., Suite 500

Washington, D.C. 20036

Phone: (202) 293-4848

Fax: (202) 293-4852

Email: asahp1@asahp.org

Traci Embrack, PT

Academic Coordinator of Clinical Education

Howard University

6th & Bryant Streets, N.W.

Washington, D.C. 20059

Phone: (202) 806-5737

Fax: (202) 462-6194
LIST OF PARTICIPANTS

90

David G. Fowler, Ph.D., CLS(NCA)

Chairman, Clinical Laboratory Sciences

University of Mississippi Medical Center

2500 North State Street

Jackson, MS 39216

Phone: (601) 984-6309

Fax: (601) 984-6344

Email: dfowler@shrp.umsmed.edu

Janice Franklin, PT, M.S.

Assistant Professor

Department of Physical Therapy

Temple University

3307 North Broad Street

Philadelphia, PA 19140

Phone: (215) 704-4883

Fax: (215) 707-7656

Email: jfrankli@astro.temple.edu

Robert J. Friberg, Ph.D.

Assistant Professor

The University of Texas Health Science Center

 @ San Antonio

7703 Floyd Curl Drive

San Antonio, TX 78284-7966

Phone: (210) 567-8750

Fax: (210) 567-8774

Email: friberg@uthscsa.edu

Kathy Friel, M.S., RDH

Instructional Director, Allied Health Sciences

Wilmington Campus

Delaware Technical & Community College

333 Shipley Street

Wilmington, DE 19801

Phone: (302) 571-5355

Fax: (302) 571-6431

Email: friel@hopi.dtec.edu

Bill Galvin, M.S.Ed., RRT, CPFT

Program Director

Gwynedd Mercy College

P.O. Box 901

Gwynedd Valley, PA 19437

Phone: (215) 641-5536

Fax: (215) 641-5559

Email: galvin.w@gmc.edu

Jody S. Gandy, Ph.D., PT

Director, Physical Therapy Education

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314

Phone: (703) 706-3201

Fax: (703) 838-8910

Email: jodygandy@apta.org

Charlotte E. Exner, Ph.D., OTR/L

Dean, College of Health Professions

Towson University

8000 York Road

Towson, MD 21252

Phone: (410) 830-2132

Fax: (410) 830-3479

Email: cexner@towson.edu

Dave Falleur

Program Chair, CLS Program

Southwest Texas State University

601 University Drive

San Marcos, TX 78666

Phone: (512) 245-3504

Fax: (512) 245-7860

Email: dfalleur@swt.edu

Doris Fallon-Snyder

Clinical Coordinator

Temple University

Broad & Montgomery Streets

Philadelphia, PA 19122

Phone: (215) 204-7544

Fax: (215) 204-5954

Samuel B. Feitelberg, M.A., PT, FAPTA

Associate Dean/Chair

Clarkson University

Health Sciences, Box 5880

Potsdam, NY 13699-5880

Phone: (315) 268-3786

Fax: (315) 268-1539

Email: feitelsb@clarkson.edu

Thomas Fisher, M.S., OTR/L, CCM

Assistant Professor

Department of Occupational Therapy

Eastern Kentucky University

103 Dizney

Richmond, KY 40475

Phone: (606) 622-6322

Fax: (606) 622-1601

Email: otsfishe@acs.eku.edu

Polly A. Fitz, M.A.

Principal

Health Training Resources

1204 Main Street, PMB 200

Branford, CT 06405

Phone: (203) 488-7701

Fax: (203) 488-2426

Email: goodtable@aol.com
LIST OF PARTICIPANTS

91

Mary Jane Gentry, Ed.D., R.T.(R)

Chair, Radiography

Fayetteville Technical Community College

P.O. Box 35236

Health Technologies Center, 201D

Fayetteville, NC 28303

Phone: (910) 678-8303

Fax: (910) 678-8500

Email: gentrym@ftccmail.faytech.cc.nc.us

Rosalyn Ghitter, Ph.D.

Communications Sciences & Disorders

Towson University

8000 York Road

Towson, MD 21252

Phone: (410) 830-2404

Fax: (410) 830-4131

Joseph Gigandet, MA

Neuropsychotherapist

Behavioral Accountability Training Institute

6177 Boxer Drive

Bethal Park, PA 15102

Phone: (412) 835-2223

Lynn Gigandet, RDMS, M.S.Ed.

Professor and Program Director

Community College of Alleghany County, Boyce

Campus

595 Beatty Road

Monroeville, PA 15146

Phone: (724) 325-6731

Fax: (724) 325-6701

Email: lgigande@ccac.edu

Lori Gilbert, BHS, RDMS, RDCD, RVT

Assistant Program Director

Dade Community College Program in

Diagnostic Medical Sonographers

Miami Dade Community College

950 NW 20 Street

Miami, FL 33125

Phone: (305) 237-4244

Fax: (305) 237-4116

Email: lgilbert@mdcc.edu

Elizabeth Francis Giles, MS, PT

Director of Clinical Education

Program in Physical Therapy

Old Dominion University

115 William B. Spong Jr Hall

Norfolk, VA 23529

Phone: (757) 683-6112

Fax: (757) 683-4410

Email: egiles@odu.edu

Vic Gladstone, Ph.D.

Associate Director, Audiology

American Speech-Language-Hearing Association

10801 Rockville Pike

Rockville, MD 20852

Phone: (301) 897-5700

Fax: (301) 571-0481

Email: vgladstone@asha.org

Sharon Goldsmith, Ph.D.

Senior Advisor, Standards & Credentialing

American Speech-Language-Hearing Association

10801 Rockville Pike

Rockville, MD 20852

Phone: (301) 897-5700

Fax: (301) 571-0481

Email: sgoldsmith@asha.org

Paul A. Griffey, M.B.A., MT(ASCP)

Assistant Professor

Department of Medical and Research Technology

University of Maryland School of Medicine

AHB, 100 Penn Street, Room 340-E

Baltimore, MD 21201

Phone: (410) 706-3772

Fax: (410) 706-5229

Email: pgriffey@umaryland.edu

Marinell Guild, M.S.

Assistant Professor

College of Allied Health

University of Oklahoma Health Sciences Center

P.O. Box 26901

Oklahoma, OK 73190

Phone: (405) 271-2113

Fax: (405) 271-3120

Email: marinell-guild@ouhsc.edu

H. Jesse Guiles, Ed.D.

Associate Professor

UMDNJ – SHRP

Department of Clinical Laboratory Sciences

65 Bergen Street, Room 110

Newark, NJ 07107

Phone: (973) 972-6863

Fax: (973) 972-7028

Email: guiles@umdnj.edu
LIST OF PARTICIPANTS

92

Denise M. Harmening, Ph.D., MT(ASCP),

CLS(NCA)

Chair and Professor

Department of Medical and Research Technology

University of Maryland School of Medicine

AHB, 100 Penn Street, Room 340D

Baltimore, MD 21201

Phone: (410) 706-7729

Fax: (410) 706-5229

Email: dharm001@umaryland.edu

Marilyn S. Harrington, Ph.D., R.D.H.

Dean, School of Allied Health Sciences

The University of Texas Health Science Center

 @ San Antonio

7703 Floyd Curl Drive

San Antonio, TX 78284-6243

Phone: (210) 567-8800

Fax: (210) 567-8807

Email: harringtonm@uthscsa.edu

Tracy Harrison, M.S., MT(ASCP)

Assistant Professor

Old Dominion University

115 William B. Spong Jr. Hall, Room 209

Norfolk, VA 23529

Phone: (757) 683-4852

Fax: (757) 683-5028

Email: tharriso@odu.edu

Carolyn Harsh, O.T.R.

Consultant

15309 Rosecroft Road

Rockville, MD 20853

Phone: (301) 929-3149

Fax: (301) 929-1734

Donald F. Haydon

Executive Director

Society of Diagnostic Medical Sonographers

12770 Coit Road, Suite 708

Dallas, TX 75251

Phone: (972) 239-7367

Fax: (972) 239-7378

Email: dhaydon@sdms.org

Frances Hayes-Cushenberry

Director, Nurse-Midwifery

College of Allied Health

Charles R. Drew University

1731 East 120th Street

Los Angeles, CA 90059

Phone: (323) 563-5851

Fax: (323) 563-4923

Email: frcushen@cdrewu.edu

Morris Hunter

Director, Medical Imaging

College of Allied Health

Charles R. Drew University

1731 East 120th Street

Los Angeles, CA 90059

Phone: (323) 563-5851

Fax: (323) 563-4923

Email: mohunter@cdrewu.edu

India Jacobsen

Accreditation Specialist

ABHES

803 West Broad Street, Suite 730

Falls Church, VA 22046

Phone: (703) 533-2082

Fax: (703) 533-2095

Email: ijabhes@erols.com

Dan Johnson

Interim Dean and Campus Administrator

College of St. Catherine – Minneapolis

601 25th Avenue, South

Minneapolis, MN 55454

Phone: (651) 690-7702

Fax: (651) 690-7849

Email: dajohnson@stkate.edu

Linda Johnson, Ph.D., RN

Acting Director

Associated Health Education Office

Department of Veterans Affairs

810 Vermont Avenue, N.W.

Washington, DC 20420

Phone: (202) 273-8372

Fax: (202) 273-9031

Email: linda.johnson@hq.med.va
LIST OF PARTICIPANTS

93

Lisa Johnson, M.H.S., MT(ASCP)SC

Assistant Professor

Department of Medical & Research Technology

University of Maryland School of Medicine

AHB, 100 Penn Street, Room 435-C

Baltimore, MD 21201

Phone: (410) 706-3773

Fax: (410) 706-5229

Email: lisa@medresch.umaryland.edu

Mary Jane Joseph RN.C, C.P.H.Q.

Senior Director

Mid Atlantic Medical Services, Inc.

4 Taft Court

Rockville, MD 20850

Phone: (301) 545-5329

Fax: (301) 545-5382

Rumaldo Z. Juarez, Ph.D.

Dean, College of Health Professions

Southwest Texas State University

601 University Drive

San Marcos, TX 78666-4616

Phone: (512) 241-3300

Fax: (512) 245-3791

Email: rj05@swt.edu

Kristen Juliar, M.A.

Director, CAHN-TIP

Minnesota State University, Mankato

MSU 36, P.O. Box 8400

Mankato, MN 56001

Phone: (507) 389-2707

Fax: (507) 389-2958

Hemant B. Karnik, Ph.D.

Chairman

Department of Clinical Laboratory Science

Howard University

2400 Sixth Street, N.W.

Washington, D.C. 20059

Phone: (202) 806-7573

Fax: (202) 462-9569

Email: hkarnik@fac.howard.edu

Diane M. Kawamura, Ph.D., RT, RDMS

Professor, Educational Director, DMS Program

Radiologic Sciences

Weber State University

3925 University Circle

Ogden, UT 84408-3925

Phone: (801) 626-6841

Fax: (801) 626-7966

Email: dkawamura@weber.edu

Peter Koehneke, M.S., ATC

Chair, Joint Review Committee on

Educational Programs in Athletic Training

Canisius College

2001 Main Street

Buffalo, NY 14208

Phone: (716) 888-2954

Fax: (716) 888-3219

Email: koehneke@canisius.edu

Barbara Kopp-Miller, Ph.D.

Assistant Professor

Medical College of Ohio

3015 Arlington,Collier Building, 4th Floor

Toledo, OH 43614-5803

Phone: (419) 383-4299

Fax: (419) 383-5880

Email: bkoppmiller@mco.edu

Mary Jane Lack, M.S.P., CCC-SLP

Assistant Professor & Clinical Director

Communication Disorders

Arkansas State University

P.O. Box 910

State University, AR 72467-0910

Phone: (870) 972-3106

Fax: (870) 972-2040

Email: mlack@crow.astate.edu

Jerry Laurich, Ph.D., MT(ASCP)

Assistant Professor

Medical College of Georgia

Medical Technology, AL-106

Augusta, GA 30912

Phone: (706) 721-3046

Fax: (706) 721-7631

Email: jlaurich@mail.mcg.edu

Catherine Lekostaj, M.A., RT(R)

Program Coordinator

Radiologic Technologies

Triton College

2000 North Fifth Avenue

River Grove, IL 60171

Phone: (708) 456-0300 ext. 3370

Fax: (708) 583-3336

Email: clekosta@triton.cc.il.us
LIST OF PARTICIPANTS

94

Lynn Little, Ph.D.

Chair, Medical Laboratory Science

University of Texas Southwestern Medical Ctr.

5323 Harry Hines Blvd

Dallas, TX 75235-8878

Phone: (214) 648-1782

Fax: (214) 648-1029

Email: lynn.little@email.swmed.edu

Connie R. Mahon, M.S., MT(ASCP)CLS

Associate Professor

Clinical Laboratory Sciences

The University of Texas Health Science Center

 @ San Antonio

7703 Floyd Curl Drive

San Antonio, TX 78284-6246

Phone: (210) 567-8870

Fax: (210) 567-8875

Email: mahonc@uthscsa.edu

Maria Manna, RN, Manager

Mid Atlantic Medical Services, Inc.

4 Taft Court

Rockville, MD 20850

Phone: (410) 869-7442

Fax: (301) 545-5382

James Mayhew, RT(R)

Clinical Coordinator Radiography Program

Ferris State University

200 Ferris Drive, VFS 210A

Big Rapids, MI 49307

Phone: (616) 592-2320

Fax: (616) 592-3788

Email: mayhewj@ferris.edu

Stephanie McClure, PT, A.C.C.E.

Clinical Education Coordinator

Physical Therapy Department

Saint Louis University

3437 Caroline Street

St. Louis, MO 63104

Phone: (314) 577-8505

Fax: (314) 577-8503

Email: mcclures@slu.edu

Georgia McMann

Director of Certification Administration

American Speech-Language-Hearing Association

10801 Rockville Pike

Rockville, MD 20852-3279

Phone: (301) 897-0138

Fax: (301) 571-0481

Email: gmcmann@asha.org

Audra McPeak

Chair, Health Education Division

Tri-County Technical College

7900 Highway 76

Pendleton, SC 29670

Phone: (864) 646-8361

Fax: (864) 646-8256

Email: amcpeak@tricty.tricounty.sc.us

Barbara A. Melzer, Ph.D., PT

Director of Clinical Education

Department of Physical Therapy

Southwest Texas State University

601 University Drive

San Marcos, TX 78666

Phone: (512) 245-3519

Fax: (512) 245-8736

Email: bm06@swt.edu

Herb Miller, Ph.D., MT(ASCP)

Chairman/Director

Medical Technology Program

Rush University

600 South Paulina, Suite 1019A

Chicago, IL 60612

Phone: (312) 942-7251

Fax: (312) 942-6464

Email: hmiller@rush.edu

Beverly Mitchell, M.B.A., R.D.

Director, Education and Accreditation Team

The American Dietetic Association

216 West Jackson Boulevard

Chicago, IL 60606-6995

Phone: (312) 899-4872

Fax: (312) 899-4817

Email: bmitche@eatright.org

Greg Morrison, M.A., RT(R), CNMT

Executive Vice President of Professional Development

American Society of Radiologic Technologists

15000 Central Avenue, SE

Albuquerque, NM 87123-3917

Phone: (505) 298-4500

Fax: (505) 298-5063

Email: gmorrison@asrt.org
LIST OF PARTICIPANTS

95

Marion A. Mulholland, Ed.D., RN

Dean

Baltimore City Community College

15202 Poplar Hill Road

Accokeek, MD 20607

Phone: (410) 462-7710

Fax: (410) 462-7785

Carlene Murphy, R. EDT.

President, American Association

of Electrodiagnostic Technologists (AAET)

P.O. Box 79489

North Dartmouth, MA 02747

Phone: (401) 846-5446

Fax: (401) 846-5826

Email: rta1@aol.com

Earl P. Murphy

Dean, Allied Health

Trident Technical College

P.O. Box 118067

Charleston, SC 29423

Phone: (843) 574-6350

Fax: (843) 574-6585

Email: zpmurphye@trident.tec.sc.us.in

Janet L. Mutschler

Academic Coordinator of Clinical Education

Department of Physical Therapy

University of Maryland Eastern Shore

Princess Anne, MD 21853

Phone: (410) 651-6301

Fax: (410) 651-6259

Email: jlmutschler@mail.umes.edu

Gail Nielsen, BSHCA

Managed Care Performance Administrator

Iowa Health System Corporate Headquarters

1200 Pleasant Street

Des Moines, IA 50309

Phone: (515) 241-8626

Fax: (515) 241-5059

Email: nielsega@IHS.org

Julie O’Sullivan Maillet, Ph.D.

Associate Dean for Academic Affairs and Research

University of Medicine and Dentistry of New

Jersey

65 Bergen Street, Room 129

Newark, NJ 07107-3001

Phone: (973) 972-6245

Fax: (973) 972-7403

Email: maillet@umdnj.edu

Stephen Painton, Ph.D.

Associate Professor

College of Allied Health

University of Oklahoma Health Sciences Center

P.O. Box 26901

Oklahoma, OK 73190

Phone: (405) 271-4214

Fax: (405) 271-3360

Email: stephen-painton@ouhsc.edu

Virginia Pappas, CAE

Deputy Executive Director

Society of Nuclear Medicine

1850 Samuel Morse Drive

Reston, VA 20190

Phone: (703) 708-9000

Fax: (703) 708-9013

Email: vpappas@snm.org

Diane Parris, M.S., CCC-SLP

Clinical Assistant Professor

Boston University

635 Commonwealth Avenue

Boston, MA 02215

Phone: (617) 353-7479

Fax: (617) 353-5074

Email: dparris@bu.edu

Nancy Peatman, M.Ed. PT

Academic Coordinator of Clinical Education

Department of Physical Therapy

Boston University

635 Commonwealth Avenue

Boston, MA 02215

Phone: (617) 353-9731

Fax: (617) 353-9463

Email: peatman@bu.edu

Christopher L. Petrosino, PT, M.Ed., A.C.C.E.

Academic Coordinator of Clinical Education

School of Physical Therapy

Ohio University

174 Convocation Center

Athens, OH 45701

Phone: (740) 593-1614

Fax: (740) 593-0292

Email: petrosin@ohiou.edu
LIST OF PARTICIPANTS

96

Dan R. Points

Dean, Health Sciences Division

Rose State College

6420 SE 15th Street

Midwest City, OK 73110

Phone: (405) 733-7359

Fax: (405) 736-0338

Email: dpoints@ms.rose.cc.ok.us

Jennifer L. Prekeges, CNMT

Nuclear Medicine Technology

Certification/Registration

16701 Corliss Place, North

Shoreline, WA 98133

Phone: (206) 361-8923

Fax: (206) 344-7959

Email: radjlp@vmmc.org

Paul Price, CST/CFA, MBA

Accreditation Manager

Association of Surgical Technologists

7108-C South Alton Way

Englewood, CO 80112-2106

Phone: (303) 694-9262

Fax: (303) 741-3655

Email: pprice@ast.org

Camille Pridgen, Ed.D., MT(ASCP)SBB

Program Director

Texas Higher Education Coordinating Board

P.O. Box 12788

Austin, TX 78711

Phone: (512) 483-6240

Fax: (512) 483-6444

Email: pridgence@thecb.state.tx.us

Maria Ribeiro, PA-C

Clinical Coordinator

Physician Assistant Program

Anne Arundel Community College

101 College Parkway

Arnold, MD 21012

Phone: (410) 315-7045

Fax: (410) 315-7099

Email: mcribeir@mail.aacc.md.us

Jean Rogers, M.A., PT

Assistant Professor & Academic Coordinator

of Clinical Education

Northwestern University

645 North Michigan, Suite 100

Chicago, IL 60611

Phone: (312) 908-6787

Fax: (312) 908-0300

Email: j-rogers2@nwu.edu

Harriet Rolen-Mark, MA, MT(ASCP)

Past Chair, ASCP-AMS

Associate Dean

College of Health Related Professions

SUNY Health Sciences Center @ Syracuse

750 East Adams Street

Syracuse, NY 13210

Phone: (315) 464-5332

Fax: (315) 464-4609

Email: markh@vax.cs.hscsyr.edu

George B. Rowland, M.D., MPH

Rowland Associates

54 Scudder Road

Osterville, MA 02655

Phone: (508) 428-9785

Fax: (508) 428-1390

Email: rowlandgrp@capecod.net

Brenda Ryan, R.N., MSN, CETN

Assistant Professor/Nursing Program

College of St. Catherine – Minneapolis

601 25th Avenue, South

Minneapolis, MN 55454

Phone: (651) 690-7732

Fax: (651) 690-7849

Email: bmryan@stkate.edu

Lynne Schreiber, MS, RT(R), RDMS

Chair, Allied Health Department

Jackson Community College

2111 Emmons Road

Jackson, MI 49201

Phone: (517) 796-8535

Fax: (517) 796-8633

Email: lynne_schreiber@jackson.cc.mi.us

Laura L. Schulte, M.S., CCC-SLP

Speech Language Pathologist

Clinical Supervisor

Southwest Texas State University

601 University Drive

San Marcos, TX 78666

Phone: (512) 245-2031

Fax: (512) 245-2029

Email: ls20@swt.edu

Janet Sesser, B.S., RMA(AMT)

Corporate Education Director

High Tech Institute

1445 East Indian School Road

Phoenix, AR 85014

Phone: (602) 279-9700

Fax: (602) 264-8391

Email: jan@high-techinstitute.com
LIST OF PARTICIPANTS

97

Ann F. Sosnowski, B.S., MT

Coordinator, Student Recruitment

Schools of Allied Health

William Beaumont Hospital

3601 West Thirteen Mile Road

Royal Oak, MI 48073-6769

Phone: (248) 551-8047

Fax: (248) 551-3694

Email: asosnowski@beaumont.edu

Weymouth Spence

Dean of Health Professions

Anne Arundel Community College

101 College Parkway

Arnold, MD 21012

Phone: (410) 541-2234

Fax: (410) 541-2245

Karina S. Srugys, Ed.D., MT(ASCP)

Associate Dean, Allied Health

Nursing & Human Services

South Suburban College

15800 South State Street

South Holland, IL 60473

Phone: (708) 210-5718

Fax: (708) 210-5792

Email: ksrugys@ssc.cc.il.us

Halcyon St. Hill, Ed.D.

Chair, Department of Interdisciplinary Studies

Florida Gulf Coast University

10501 FGCU Boulevard, South

Fort Myers, FL 33965-6565

Phone: (941) 590-7495

Fax: (941) 590-7474

Email: hsthill@fgcu.edu

Cynthia Stambach, M.A.S.

Department of Medical & Research Technology

University of Maryland School of Medicine

AHB, 100 Penn Street, Room 340-B

Baltimore, MD 21201

Phone: (410) 706-7728

Fax: (410) 706-5229

Email: cynthia@medresch.umaryland.edu

Rhonda K. Stanley, Ph.D., PT

Assistant Professor

Department of Physical Therapy

University of Maryland, Baltimore

100 Penn Street, Suite 115

Baltimore, MD 21201

Phone: (410) 706-4543

Fax: (410) 706-6387

Email: rstanley@physio.umaryland.edu

Karen F. Steckol, Ph.D., CCC-SLP

Dean, College of Arts & Sciences

Cleveland State University

1860 East 22nd Street

Route 1822

Cleveland, OH 44114

Phone: (216) 687-3660

Fax: (216) 687-9209

Email: k.steckol@csuohio.edu

Suzanne Stone

Executive Director

Society of Vascular Technology

4601 President’s Drive, Suite 260

Lanham, MD 20706

Phone: (301) 459-7550

Fax: (301) 459-5651

Email: svtnet@msn.com

Carolyn Richmond Teich, M.S.

Program Associate for Economic Development

American Association of Community Colleges

One Dupont Circle, NW, Suite 410

Washington, DC 20036-1176

Phone: (202) 728-0200 x228

Fax: (202) 833-2467

Email: cteich@aacc.nche.edu

Dr. Lynda Thomas-Goodfellow

American Association for Respiratory Care

Department of Cardiopulmonary Care Sciences

Georgia State University

University Plaza

Atlanta, GA 30303

Phone: (404) 651-1498

Fax: (404) 651-1531

Email: resltg@panther.gsu.edu

Patti Tice

Director of Credentialing

American Speech-Language-Hearing Association

10801 Rockville Pike

Rockville, MD 20852

Phone: (301) 897-5700

Fax: (301) 571-0481

Email: ptice@asha.org
LIST OF PARTICIPANTS

98

Jan Tompkins

Rural Sites Coordinator

University of Nebraska Medical Center

2019 Stagecoach Road

Grand Island, NE 68001

Phone: (308) 389-5397

Fax: (308) 389-5383

Email: jitompkins@hotmail.com

Susan Tucker, M.P.H., OTR/L

College of Allied Health

University of Oklahoma Health Sciences Center

P.O. Box 26901

Oklahoma, OK 73190

Phone: (405) 271-2131

Fax: (405) 271-2432

Email: susan-tucker@ouhsc.edu

Steven B. Valand, M.S.

Dean, Health Sciences/Nursing

Greenville Technical College

P.O. Box 5616

Greenville, SC 29673

Phone: (864) 250-8263

Fax: (864) 250-8462

Email: valandsbv@gvltec.edu

Peggy Valentine, Ed.D.

Interim Associate Dean

Division of Allied Health Sciences

Howard University

Annex 1, 6th and Bryant Streets, N.W., Room 106

Washington, D.C. 20059

Phone: (202) 806-4960

Fax: (202) 806-7918

Email: pvalentine@howard.edu

Etta Vernon, Director

Medical Records

College of Allied Health

Charles R. Drew University

1731 East 120th Street

Los Angeles, CA 90059

Phone: (323) 563-5851

Fax: (323) 563-4923

Email: evernon@cdrewu.edu

Michael D. Ward, Ph.D., R.T.(R), FASRT

Director Allied Health (& ASRT President-elect)

Jewish Hospital College of Nursing and

Allied Health (& ASRT)

306 South Kingshighway Boulevard

St. Louis, MO 63110-1091

Phone: (314) 454-8987

Fax: (314) 454-5239

Email: mdw7263@bjcmail.carenet.org

Kristen Waterstram-Rich, M.S., CNMT,

FSNMTS

President-Elect – Technologist Section

Society of Nuclear Medicine

1850 Samuel Morse Drive

Reston, VA 20190

Phone: (716) 475-5117

Fax: (716) 475-5908

Email: kmw4088@rit.edu

Peggy A. Wenk, HTL(ASCP)

Program Director

School of Histotechnology

Department of Anatomic Pathology

William Beaumont Hospital

3601 West 13 Mile Road

Royal Oak, MI 48073

Phone: (248) 551-9079

Fax: (248) 551-9054

Email: pwenk@beaumont.edu

Cynthia S. Wharton, CNMT

President, Technologist Section

Society of Nuclear Medicine

1850 Samuel Morse Drive

Reston, VA 20190

Phone: (864) 560-6782

Fax: (860) 560-6944

Email: warroom01@teleplex.net

Katherine (Kitty) White, Ph.D., PT

Department Head

Western Carolina University

Cullowhee, NC 28723

Phone: (828) 227-2191

Fax: (828) 227-7071

Email: kwhite@wcu.edu
LIST OF PARTICIPANTS

99

Lillie Williams, Ph.D., RD

Chairman, Department of Nutritional Sciences

Howard University

Room 347 C/AHS

Washington, DC 20059

Phone: (202) 806-6239

Fax: (202) 806-9233

Email: lwilliams@fac.howard.edu

Stephen L. Wilson, Ph.D.

Director

School of Allied Medical Professions

Ohio State University

1583 Perry Street

Columbus, OH 43210-1234

Phone: (614) 292-5645

Fax: (614) 292-0210

Email: wilson.4@osu.edu

Lydia Wingate, Ph.D.

Dean, College of Health Professions

Weber State University

3901 University Circle

Ogden, UT 84408-3901

Phone: (801) 626-7117

Fax: (801) 626-7683

Email: lwingate@weber.edu

Jan Winn, M.Ed.

Assistant Professor

College of Allied Health

University of Oklahoma Health Sciences Center

P.O. Box 26901

Oklahoma, OK 73190

Phone: (405) 271-6477

Fax: (405) 271-1424

Email: jan_winn@ouhsc.edu

Michelle Woodbury, M.A., OTR/L

Assistant Professor

Medical University of South Carolina

675 Sterling Drive

Charleston, SC 29412

Phone: (843) 792-2399

Fax: (843) 792-0710

Email: woodbum1@musc.edu

Donald Young, M.D.

Senior Vice President for Policy and

 Clinical Services

American Association of Hospital Plans

1129 20th Street, NW Suite 600

Washington, D.C. 20036

Phone: (202) 861-1476

Fax: (202) 778-8486

Email: dyoung@aahp.org

Diane J. Youngs, B.S., RT(R), RDMS

Program Instructor

Diagnostic Medical Sonography

Mayo Foundation/Mayo Clinic

200 First Street, Siebens 1119

Rochester, MN 55905

Phone: (507) 255-3322

Fax: (507) 284-0656

Email: youngs.diane@mayo.edu