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Creighton creatively addresses need for clinical experiences

Creighton UniversityClinical experience, or “experiential learning” has long been a mandatory component for physicians, dentists, nurses, pharmacists and occupational and physical therapists, all of whom must hone their skills treating people before they may hang a diploma.

Given the centrality of that requirement, the COVID-19 pandemic has called on Creighton University educators to think creatively as campuses and clinics closed and social distancing requirements eliminated the close-quarters engagement inherent to the medical, dental, nursing and health professions.

Michael Del Core, MD, associate dean of medical education at the Creighton School of Medicine, says the challenge hit in March when third-year medical students were removed from clinical rotations not only because of concern for their personal safety but also to preserve personal protection equipment such as masks, gowns and gloves needed by hospital medical staff.

They transitioned to online studies, he said, to great effect since 40% of them scored above the 75th percentile in a subsequent nationally standardized test.

“That speaks to the success of our online conversion for the clinical experiences,” he said.

Current expectations have the third-year students resuming their clinical rotations June 8, with current second-year students beginning theirs July 6. d

Del Core said the fourth-year students who will graduate this month, and who learned of their residency assignments during Match Day ceremonies on March 20, had just one rotation left and that was completed online.

“That was what we call ‘Capstone,’ which puts everything together and gets them prepared for their residencies,” he says. “We switched that from a clinical experience to an online experience, and it went very well. Now they are completely done.”

The Creighton College of Nursing secured permission from its accrediting agencies, both in Nebraska and Arizona, to move a multitude of clinical experiences online. These newly created virtual formats included maternal/child, pediatrics, behavioral health, medical-surgical, critical care, and community-based/population-based health specialties.

“This was done with a variety of approaches, including virtual simulations, virtual case studies, virtual grand rounds, virtual journal clubs, use of augmented reality posters, and small group discussion facilitated by a clinical faculty member,” says Julie Manz, PhD, RN, assistant dean of the undergraduate program and associate professor at the College of Nursing.

“We kept the faculty-to-student ratio at 1:10 in order to maintain small groups so students could engage in clinical reasoning scenarios and discussions with each other and maintain faculty oversight and contact. This was intentional to add to the rigor of discussion, to maintain cura personalis during this time of distancing, and to keep the connection strong between and among nursing students and faculty.”

Evan Robinson, RPh, MS, PhD, dean of the School of Pharmacy and Health Professions, and Mark Latta, DMD, MS, dean of the School of Dentistry, are upbeat about how the clinical experience problem was addressed.

“The experiential education professionals in occupational therapy, physical therapy and pharmacy did an extremely good job working with our clinical partners and with our full-time faculty,” Robinson says. “They ensured that we satisfied the expectations of the experiential educational experience — that quality was maintained so that our students in all three programs would graduate on time and enter the workforce they so desperately want to join.”

Which they did. All pharmacy students scheduled to graduate in May did so.

Dental students spent more time than usual with mannequins equipped with removable jaws.

“We have always done some form of this, typically before students go into the clinic,” Latta says. “We were unable, because of our physical infrastructure before we built the new school to do it very much, but now we are able to respond well to a situation where our clinic was closed for a while and our students needed to keep their skills up.”

Robinson says the physical therapy Class of ’20 met the aspects of the requirements for practical experience before COVID-19 restrictions hit and Creighton faculty devised telehealth programs that added additional educational experiences to complete the outcomes.

Occupational therapy faculty have been working closely with the clinical sites that provide students with patient experience, ensuring that capstone projects will be met, both for seniors and the classes immediately behind them.

Within the pharmacy program the Accreditation Council for Pharmacy Education (ACPE) granted flexibility to pharmacy colleges and schools regarding rotation completion through remote and virtual activities.

Fourth-year pharmacy students were just beginning their final clinical rotations when COVID-19 restrictions hit, Robinson says, and while retail pharmacies welcomed their involvement, hospitals and medical facilities faced different challenges due to the shortages of personal protective equipment.

“Due to the pharmacist’s unique role on the healthcare team, which allows pharmacists and pharmacy students to provide patient care without having to be in direct, close contact with the patient, ACPE allowed flexibility for students to complete certain rotation activities through remote and virtual activities,” Robinson says.

“As a result, all pharmacy students were able to stay on track for graduation in May.”

Mike Miller, EdD, RN, NRP, director of Emergency Medical Service Education at Creighton, said his paramedic students are fortunate because they won’t graduate until August, which gives them time to gain the clinical experience they need.

They have been able to engage students in virtual simulations and case studies, and soon will simulate some clinical experience through the use of mannequins, Miller says, but the campus and clinic shutdowns undoubtedly had a significant impact.

“Students normally spend a big chunk of time in the field under the direction of a paramedic, which is what they are training to become,” he says. “The hospitals suspended all students, mostly because of the difficulties in securing PPE for their own personnel let alone students, which is why you saw hospitals across the country suspending elective surgery procedures.”

All of that is understandable, Miller says, but it did challenge the program.

“A recent survey of nearly 600 paramedic programs in the country revealed that 90% of them have had clinical learning suspended or have limited access,” he says.

“One of the things I try to point out to people, even my own colleagues, is there's a different mindset in a student’s decision-making processes — how they analyze and collect information — if they are dealing with a simulation mannequin and not a real human being. Students know that if they make a mistake in simulation it's not going to harm or kill somebody, but when it's a real patient who’s breathing and talking, the stakes are so much higher.

“So it's difficult to completely replicate what a health sciences student is being educated to do solely through simulation.”


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