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Volume 65 - Winter 1996
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Causes cited for decreasing numbers of clinical affiliates
by Cecile M. Sanders, MEd, MT(ASCP)
CLSPRC Member |
For some time, NAACLS has recognized many changes in the health care environment and, in particular, the effects those changes have had on clinical laboratory sciences education. Across the country, we continue to see downsizing in virtually all aspects of laboratory medicine, including the closure or merger of hospitals and laboratories, reduced utilization of laboratory services, laboratory workforce reduction and increased utilization of non certified personnel in laboratory settings.
All of these issues have resulted in a decreasing number and quality of clinical settings that we have traditionally used for clinical training experiences for students. One program director put it this way: "We seem to be caught in the dilemma of our affiliates telling us that they wouldn't want to hire a graduate without clinical experience, but are not willing to provide the clinical experience for students. " As previously mentioned, NAACLS is acutely aware of these issues and has remained sensitive to the needs of educational programs in interpreting the Essentials of Accredited Educational Programs. Furthermore, NAACLS would like to take a leadership role in identifying innovative and creative means by which program directors and other educators can provide quality clinical training experiences for students.
To this end, I undertook the task of conducting a survey of program directors to ascertain the problem of dwindling numbers of clinical affiliates and to investigate the use of alternative methods of achieving clinical competency.
Surveys were distributed at all major gatherings of clinical laboratory professionals this summer and early fall and were put on the CLS/MT educators' listserve. Twenty four surveys, including 14 from CLS/MT educators and 10 from CLT/MLT educators, were returned. The number of affiliates for these programs ranged from two to 20 with an average of seven each. All respondents except one reported a decrease in the number of affiliates over the past several years.
Program directors overwhelmingly attribute the decrease in affiliates to a reduction in the number of staff to train students, with 20 of the 24 responding affirmatively to this factor. Sixteen of those responding cited laboratory closures and/or mergers; one of the directors said there was a "cascade effect" laboratories closed or merged, resulting in layoffs. The remaining staff felt overworked and did not want the extra burden of students to train. Fourteen respondents indicated a lack of desire on the part of clinical staff to train students; several of those stated that some clinical laboratory personnel, especially clinical laboratory scientists, are reluctant to train their potential replacements since they believe their jobs are disappearing.
Other causes cited for decreased affiliates included loss of administrative support (6); budget cuts (3), and hospital closure (1). One of these responses included a comment about a change in the employment mix of laboratories toward the use of more CLT/MLTs. This was viewed as reducing the opportunities for training CLS/MTs. Another respondent stated they have lost the local military base as an affiliate because the army is now training its own CLT/MLTs. Two of the responding programs were struggling to find phlebotomy experiences; one said that nursing was now performing the phlebotomy in their hospital and that nurses were reluctant to train students to draw blood.
Most of these programs use a variety of strategies to counteract the loss of affiliates. Twelve rotate students through more than one affiliate to gain well rounded experiences. However, one director said that locating several different clinical rotations for each student placed a burden on the faculty with little benefit to the educational process. Ten programs use reference laboratories that lack sufficient variety of blood bank and microbiology procedures. Another respondent expressed fear that reference labs and "off peak" shifts may use students for "free help, " but another director stated evening shift personnel often have more time to teach and are not as "burned out" from having students regularly. Seven programs are using more outpatient facilities and military base hospital laboratories to expand clinical opportunities. Five of the programs are using some simulated labs on campus, capped off with abbreviated clinical rotations. Two of those responding indicated they would like to use more simulation, but were restricted by the cost of supplies and appropriate technology. At least one program said that some hospital labs were reluctant to release patient specimens for practice because of the fear of liability.
Two other stategies used to locate affiliates are to increase the geographic area of the program to add more rural affiliates and to provide "perks" for affiliates, including certificates, reduced cost for computers and library services. While the idea of reimbursing affiliates for the clinical experience was raised, more than one program argued strenuously against payment; one program director stated that having to pay affiliates could bankrupt her program.
This survey did not uncover a "quick fix" for the problem. The situation appears to be serious and undoubtedly irreversible. Because of the changes in today's health care environment, we must think differently about the way we teach. According to educational theory, it is best to start with outcomes and expected graduate competencies and then build learning activities to achieve the desired results. It is imperative, therefore, that each educational program spend quality time collaborating with employers of graduates to identify the actual expected graduates' competencies. It is possible these competencies can be met in ways other than those we have traditionally used. It is clear that we must think in non traditional ways about how to provide learning opportunities for students to achieve competency.
As programs struggle with the lack of affiliates, it is important to know that NAACLS is sensitive to the problem. There is no "right" or "wrong" way to train students in clinical skills programs should be as creative and innovative as possible to offer student opportunities to be competent at entry level.
Ms. Sanders is a member of the CLSPRC.
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