Transcript
Marla: Welcome, Lauren. It's a pleasure to have you on our Practice Growth Podcast today. For the audience, tell us a little bit about your background and your position at Seton Hall.
Lauren: Sure! So I'm Lauren Snowdon. I've been a practicing clinician for. 24 years, which feels like a lot to say. I worked in the rehab space for a long time.
But really early my career I started working with students. So I was a psych coordinator for clinical education at a big rehab hospital placing hundreds of students per year. I loved that part of my job. I ran a neurologic residency, so a lot of advanced student training.
So in 2019, I had the opportunity to transition and do the reverse of my world where I took a job at a university where I teach half the time in neurologic practice, which is my clinical practice area, and then half the time I'm a director of clinical education. So it was a no-brainer moment to take that job and be able to work with students on the opposite end. Heading out into clinic.
Marla: Fantastic. And you are very much well in demand as all of the clinics love to have students now. It's rewarding to be able to bring those students into the clinic and to provide them a great clinical experience.
And I actually came across you at the ELC, the education learning conference, and was able to watch and listen to a research study that you presented on about providing exceptional clinical experiences for students and what helped them feel like they were belonging. Can you tell me a little bit about research study and what it was about?
Lauren: Sure. So I'm really fortunate that I am the co-chair actually of a member of all the DCEs in New York and New Jersey, the New York, New Jersey Physical Therapy Clinical Education Consortium.
So a big name for a lot of DCE and clinical partners in my region who work together. So I've had the opportunity to collaborate with some of those other people who are DCE or clinicians who are like-minded in terms of wanting to support students. So we've done a few studies in recent years, and that study was one where there was a publication by Pool et al in 2023 that talked about a survey for student belonging.
And we said, wow, this is great, but this is available for us to really systematically look at this and delve into what we think is helping them to feel like they belong at a time where there's a lot going on in the world and a lot of different things going on in their lives. So how do we help them to integrate in a really important point in their training?
So we myself and two colleagues, Michelle Donahue from Nazareth University and Kelly Myers from Upstate Medical Center collaborated on this study. We put out a survey to a large group of students. We really put it out to our big network to get as many responses as we could.
And we looked at both the survey, like quantitative survey about student belonging as well as two qualitative questions to say really what helped you to feel belonging in a clinical education experience and what maybe was a barrier to your belonging in clin-ed?
And we really just felt like it was something that started coming up with the literature and things we hear in our own job roles, like in this clinic, I feel this way, maybe better, in this clinic I don't as much. So we were anecdotally maybe hearing some of those things and we said, let's get to the evidence and really try and hone in on it.
So that was the kind of impetus behind the study.
Marla: Great. And to share with all of the clinic owners and clinicians out there that want to provide this fantastic experience for students and want them to feel like they are belonging. Can you tell us a little bit about the findings and what you discover during the study?
Lauren: Sure. So I think we have big picture ideas when we do research, like there is going to be some variable that we can control, that we can exactly make this match to give them that. So in the study we looked at, student supervision to clinical instructor? Was it one to one, two to one, four to one.
We looked at first clinicals, second clinicals, terminal clinicals. We looked at regional differences. We looked at all these things and we expected some big aha moment from that. And funny enough, we didn't find any relationships, so I'm the quantitative person on the study and I said, oh goodness.
We were supposed to find something we didn't. And what was funny is you said, sometimes no relationship is a relationship, right? So we said those things that we thought mattered maybe didn't. But what came out there were really three big questions that came out as much lower scores than other ones.
And they were about being invited to social gatherings and having social interaction, having meals with colleagues, and being asked about their personal life. Those were the three questions that ended up when they were lower scored. That's when students felt like they didn't belong. So that was the quantitative part.
And then I went to my qualitative colleagues and said, is that matching what you're seeing in the themes? And they came out and they said that came out in droves. So we jokingly called our presentation at ELC, TikTok and Guac because we said these students were looking for social media interaction sharing, funny posts, sharing I watched this great show on Netflix. Sharing recipes, bringing things in for lunch, and we said, wow. Those were not what came to the forefront of our mind of what we thought would be really that, that in that meaning for them. When we really delve in and delved deep, it was about the culture of the clinic.
It was about the team dynamic and the culture and the welcoming atmosphere of not being just a student but being a colleague.
Marla: That's so enlightening because it really is a focus to be able to provide a student with a phenomenal clinical experience to make sure they're learning, to make sure they're treating patients, make sure they have that hands on.
And it's almost a second afterthought of what are we doing with them at lunch after hours? Or just making them feel part of the clinic. And that even may be some people say, no, you can't invite them out. They're students. So tell me a little bit more about that and some of the comments and feedback that you received from the students about those pieces.
Lauren: Yeah, that's a great question. We thought the same. And I joked, I said, oh, maybe I have to modify my things I'm telling students before they go out, because we do say, and I believe that, there are professional boundaries and personal boundaries, and that's with all colleagues.
But a matter of if there are events that the student is part of the team in is their opportunity to include them. So again, we had heard students say a lot of the qualitative come and said, I eat lunch alone in a room by myself. And we said, oh goodness. Can't they even be part of the team for lunch? Or they're being asked to report on things clinically, come to a team meeting and report on a patient.
But then afterwards, when the team is all gathered, the students who were feeling like they were part of it, they were then saying, oh, that was a great team meeting. I'm so happy that patient's doing well. How have you been doing? What'd you do this weekend? Just talking as teams do. Whereas the students who didn't as much weren't included in those nonclinical conversations.
It was just, you're here for totally a clinical conversation, which of course is valid. But then there wasn't anything else about them. And I think what really comes down to is students who were looking at where they might track to a job placement, we're saying, I want a place where I feel like I'm involved in all those aspects.
Not just that I come to be a number for productivity. Or someone who just is again, doing the job and not part of the group. So I think that really came out a lot.
Marla: So they were really striving for that human connection. That ability to feel like they were treated no differently than another colleague at the clinic, and that they were getting to know their cis and the other clinicians.
And really bonding in the clinic and outside of the clinic.
Lauren: And the idea was also, it wasn't these deep personal things. It wasn't telling your deepest life story. It was just, again, things that we tell them to ask patients about, right? We tell our students, ask your patient about their day.
Ask them about their family, make salient connections so you can treat them well. And they were saying people aren't making those connections with me. Doesn't that make me be motivated? Doesn't make that make me feel like I'm part of the group. So that really came out. And then again, alternatively, when we asked about barriers, what makes you feel like you belong less?
It really is when I was spoken to or treated not as a colleague, just as a student. Even someone said they would refer to me as student, like to the CI, can you get “your student” as opposed to, can you get Marla? So it was just a, a category of a number.
And then the other piece that tied into that was discussions about having high productivity or workload expectations that, again, solely address them as a number to accomplish something as opposed to someone who was bringing other components to the team, including their personality and their, the things they effectively bought to the team.
Marla: Yeah, so it really is a opening into that clinic's culture. They're there for six weeks, eight weeks, so they're experiencing everything about it and it's almost your best sales to be able to get that student to come to your clinic afterwards and be an employee.
So love to see that was really showing up in the research, in the survey. Did you also find that those students that felt like they belonged better and had those connections did better in their affiliations.
Lauren: It's funny–we didn't look at that factor, so we can only go on kind of personal comments.
We didn't look at it in this study, but when we look at what you just mentioned about when people apply to jobs, we often say to students, this is a six week interview. An eight week interview. You are trying to see if it's a match for you. And then alternatively we're saying the clinics also want it to show the student it might be a match for them too.
So it is a, if you want to work here instead of the one-off interview. Sometimes where you're saying, this is what we do, the student is seeing what they do, and seeing what their day in the life would be like. For everyone kind of recognizing that, that part of it, how valuable that is from a recruitment perspective from seeing again, what the job would be like.
You're not talking hypothetically about what it would be like you're in that situation, but in terms of outcomes we didn't specifically look at, did you then get hired there or did you reach back out or something. We didn't look at that.
Marla: So looking back at the data, did you see any differences between a first year student, a second year, or one going into their final year?
And can you tell us a little bit about that?
Lauren: Yeah, and I think one of the variables, one of the reasons we looked at that is we said, I imagine or hypothesize that maybe over time as people were later and they got more used to the clin-ed process, that they would have this feeling of belonging more.
And we actually didn't see that. We saw really that factor of which clinical was not relevant to that feeling. It was really what happened within that clinical and it reminded us of some other work we've done with some people in this consortium and about just the path to clinical education. So we did a study a few years ago about strategies to support first clinical education experiences.
Because we often hear in the field, sometimes people don't offer students first clin-ed. And certainly there's an attractiveness to that final experience, like they're gonna come right into my clinic and work. And I recognize that. I certainly thought that on the back end as well. But the importance of knowing that every clinical helps a student build towards that job, and if we don't have first clinicals, we can't get to last clinicals.
So I think that openness of the clinic in recognizing there's value in all of them and having a diversity of experience, because we very often see. Students who do their first clinical experience, they have a great experience, right? They have all those things we've talked about and they feel like they're part of that team.
They love the culture. They might interview them and say, I'll come back. Or they'll go to another clinical and say, that is not what I had in the first one, and that's where I want to be. And it solidifies it. So there is benefit to doing things in the different order. And I think just everyone recognizing that the path doesn't have to be always at this point there, there's value in it, and it's really what happens within that moment, whether it's earlier in their clinical education experiences or later at the end.
Marla: So you're saying whether it's the first or second or the third, if they make that great connection, if they have that sense of belonging and they feel like they've really been immersed in that culture, it doesn't matter if they're graduating in two or three years, they're gonna want to come back.
That's exactly right. Got it. And I know the students go back and they talk to their whole entire class about their affiliation, so it's absolutely important for them to have a good experience and to come back feeling that sense of belonging. What are you hearing from students in terms of when they are about to graduate and looking for their first job?
What are they looking for these days? What are they craving in that first experience?
Lauren: Yeah, and I think I'm right embedded in this right now, right? In New Jersey we have a lot of students who are about to take boards, about to graduate. So it's a hot topic right now. Really the ability to have someone to go to is top.
And again, that can look different because based on the setting, that might be very variable, right? So students who are going to maybe a large hospital where I did a lot of work. They might have 30 people on a unit. So in theory, that's a lot of voices, but it's not the number, it's the quality of that interaction.
So it's the fact that there's, and they often use the word mentor. I want a mentor in this job, but again, the things they're going to are multifaceted. It's not show me how to do, this walking task for a person that I've never worked with that diagnosis, it’s tell me about your other job roles.
How can I help you? If I had a question that was novel to me, how would I seek you out? Are you available? So they do talk about a mentor in some way, and again, that way that looks is different. And then I think also they look at growth in a company, so to say do I have a chance to stay here?
Because again, part of that belonging is do I do this and move on? Or do I do it and want to stay part of it? So what opportunities do you have beyond the, now I've gotten this job, how do I stay in this job? And conversely, how do I give back? I'm very fortunate a plug my own university for a minute.
We have a really strong community. So when I'm looking for students to go somewhere, often the CIs are like. I want to give back. So even looking at that, what is my opportunity to give back in reverse? So those opportunities to give and receive feedback they, they like that, they like to be, I'm now in a leadership role.
I'm now someone who can teach others. And how great is it to know what you're doing when you can actually teach back?
Marla: Yeah. That looped mentorship model where you're always a mentee and a mentor at the same time is so critical and important. I really, I have to say this is very important for clinic owners, for clinicians themselves as a CI because we all go into therapy wanting to help people, wanting to connect with them.
And then when you have that student, you almost forget, like you said, it's almost like treating your patient. You should be connecting with them and just in the same, not just student A is here for their affiliation. So what would you say as some feedback to clinical nurse and clinicians preparing to have students, any big takeaways that you'd say is your your guidance to them?
Lauren: Yeah, I think everyone has different structures for how people connect and the way they get to know each other. I think the clinics having some system where you make a pre connection. Some students, they send an email out to say, how should I best prepare? What do they do when they're oriented?
That really, that entry in of, if you walk in and it's just, follow me along and you'll figure it out, feels a little less comfortable as opposed to here's the objectives, here's what, how we do, and again. How do you like to learn and not necessarily what's your learning style? Because again, we in the real world, we can't match it.
So some people, if they say, I'm a visual learner, I'm an auditor. You say that might not work in this scenario, but it's to say, okay, if you like to learn this way or you found to be successful this way, let me do it this way. You try it and then next time we might reverse it so that you are again, developing that rapport with each other that you are both contributing to the experience and that you are not always in a.
More of a power dynamic of I'm always telling you what to do, I want you to ask questions, I want to establish when you like to get feedback, I think is always really important. Obviously for safety feedback in the moment, of course, but it's uncomfortable maybe if a student gets feedback in front of a patient that, disestablishes trust with that patient.
So having those conversations early, I think set the tone both in a clinical experience or in a job of what are my expectations of you? What are your expectations of me? And do we have regular ways to. To touch base that makes sense for us in our clinic time, in our patient care. How do we consistently connect again in the way peers do.
Because when we work, that's what we do all the time.
Marla: Yeah. And what would you guide them in terms of how many times to maybe set a point to take them out to lunch or to do something outside the clinic? Would you recommend that happens once an affiliation or what would you recommend?
Lauren: Yeah, I think that's a really interesting question.
I think you can tie formal things with that informality in a good way. So again, a lot of times people will meet and have maybe a weekly meeting for feedback, either written feedback or they meet at midterm for their to fill out whatever tool they're using, which is great. And again, it should be formal, but possibly when finishing that okay, let's have lunch together after and catch up on other things of what's been going on.
So you don't say this is just, oh, all social time, but it is tied to a, let's catch up so you can do something like that. Again, lunches are an easy one, or in my head, they're an easy one because they're happening all the time. So just sitting in the same space could be something that's just part of the experience, but you still have your formal time.
So there's clear boundaries of, this is when we're formally talking. We're not going be in the office discussing your CPI or your CIET scores in front of the whole team. But we might be, talking about patient cases with the team altogether, and that's a nice way to collaborate. I think outside of work could be a little dicier, but I think it's a matter of if it is tied to something related to the clinics.
A lot of times people do it at the end like you are moving on. I think that's great. Other times, if it's an event that's for something specific, so a lot of times they were saying parties or someone's having a baby, like I'd love to bring a gift. Those are life events that people want to be a part of.
Or a lot of clinics tie it to something else. So are we having an in-service today, a webinar today? And then afterwards we might be going to talk about it later in a social setting. Those kind of things where you can tie it in. And I think, again, like everything else, we have boundaries at work, which we should, if the team is maintaining those, that just comes through.
Again, that's part of the culture, and the student will see that.
Marla: That's great advice. I think it's absolutely something that, that as a new clinician, a new CI, or even an experienced one, that's really busy and sometimes it's oof, I have to get everything done and take this student just to remember that they're there seeking out your engagement as much as you are there to teach them and help them grow.
And they're learning that culture in the clinic. So anything else that you may have now taken back to? Your university and maybe tools that you have created to help students before going out or to help place them in better settings with this knowledge that you've now learned?
Lauren: That's a great question.
I think it's always great and everyone has a different process, but to know that on our end, students are not a number either, right? So depending on the size of your program, making sure that you have support to really advise them. That when you're looking at clinical sites, it shouldn't just be, I live in this area and hence I'm going to that clinic five minutes down the road.
It should be conversations about what are your interests, your preferences, helping to guide them, maybe things they don't understand. You seem to like this if you thought about this, but also having them recognize the wide range of what's available in PT practice. I think sometimes our students just don't know, and that's, you don't know until you try it sometimes.
So I think trying to have some individual advisement components that people are, getting to know the student a little more on the academic side in hopes to match with clinical partners that would help them along this path to success. I think that's something we've tried to do and I think it, it works really well when you see it.
Students usually come back when they say my CI and I spoke right away and established it, and thank you for telling me to do that. So we do say tell them about yourself. Set that tone early. So I think on the back end we try and do that at the university level as well, so they get comfortable doing it because it is hard when you go into a new setting.
It's unique in clin-ed. We don't in our lives, work somewhere for six weeks, another place for six weeks, another place for eight weeks, so to say how do you really infuse yourself as part of the team and put your best foot forward? So practicing before you go out, there's important role playing in school is important so that they know that this is a skill to develop too.
Marla: Yeah, that's a great point because that's something that they need to put their self out there too and be open and then that's just gonna help with patient care as well. Because it's the same skillset that's going translate to treating patients. Okay. So I'm gonna ask for all those practices out there.
What is the secret sauce as you being the DCE? What can you hear from the clinics or do you want to see from the clinics to make you more likely to place a student in those clinics? Is there anything that just take us into your mind and tell us what you feel is really impactful there.
Lauren: Yeah, I think when we establish clinical placements, we usually call them clinical partnerships, and I find myself saying it without even realizing it because that is it, right?
It's a partnership. We are all invested in the same thing. We're invested in patient care. We're invested in our own professional growth in the students in collaboration. So when we can have that partnership happening that really sets the tone for success. So from the student's end, a lot of times when they finish a clinical, we'll ask them, what, again, help that success or what was challenging.
At the onset, they often say if they had written objectives or even a written outline of what would be addressed in the clinical experience, that helps them to feel set up so that they know what they're doing. They know what they're heading in. Same as a semester, they get a syllabus with their whole world, right?
So they're used to that. So knowing, and it doesn't have to be every day, but over time, by the end, you're expected to do this about halfway there, we'll do this so that they know what they're looking ahead to. That's one piece that helps the students feel comfortable. And when we see that too, that helps us.
Know how to prepare the students. If we see, okay, this is what you're going to be doing do you have any questions about that before you go, how can we help you on the backend if this is what you know you're going to be doing? And then I think the other part is when they are when we're preparing for the experience, just open communication, which I know seems simple, but if we have something shift, so sometimes clinicals say.
We had a student placed somewhere, but then we had a CI leave, a maternity leave. That's life, right? But when we know that we work together to shift it, so feeling comfortable that people can call us, that we can say to them, sure, bring them down the road. Or when they're asking about student preference, if all things are equal, if they say, we have five clinics, which one would the student do best?
And we might say, this student has this more diagnostic interest. Could you veer them that way? Or do you see a different age population here? Those little nuances when they see that personal attention, if you have the choice, and of course we can’t control everything, but that helps too for us as a university to say, wow, that clinical partner wants to make this right for the student.
And again, in hopes that by the end, this student ends up being their colleague and someone who works with them. So I think that just collaboration and open communication, and equally if something goes wrong when we have partners. Things unexpected happen all the time. So not that we plan for these things, but when we have partners who we work with, who, if a student has an issue and they reach out and say, let's problem solve this together, that helps us know next time we'll be in the same situation, the same if an employee needed coaching, we'd coach them together.
So all those pieces I think go into our decision. To make sure that everyone's really on the same page.
Marla: Great. So the SCCE, the RSCCE, you don't mind them reaching out. You want it, you actually wanna have that relationship and that partnership with them.
Lauren: Absolutely. And that open communication over and over.
Yeah. And if we go back to this study, they, the reason we did this research, we did a clinical partner who takes so many students who knows things on her side. And yeah. When I say from my intro where I took this job, I always say to my students. I know what I wanted to receive on my side. I know when a student came in this is what we wanna see in the clinic.
So I'm trying to help 'em be that person at the onset, knowing that what we want on the back end, I always say begin with the end in mind. So knowing where we want them to be and trying to help them to get there.
Marla: So from that perspective, what are you gonna now do with this data? Or is there any follow up research that you're gonna do?
Lauren: Perfect question. It's like I gave you a plug to say that! We are actually running this study again with a more detailed survey. So when we first did it, we took a sample of a survey that's a standardized survey. And again, I think because this is not an issue with research, I think we thought we would find some things in the numbers and do a smaller version and just get a pulse.
And whenever you do research, it often leads to the follow up study is too, so we right now are. Literally completing the IRB to do the follow up study with the full batter tool of, it's a little bit longer tool. It's 33 questions, again from that article. That Pool at al published in 23, that's a full belongingness scale to delve into every component of belonging, which we didn't get to in this study.
It categorizes belonging into three sections, so it'll allow us to look at that a little bit more and to see if. When you take something as a snapshot, do things look different? It would be different cohorts of students responding because it would've been run last year at this time. So we're going to do that again, and then we're looking forward.
Funny enough, there's actually a journal called Belonging. I said, so this isn't just our interest seems. So we were looking at that for potential moving to a manuscript, but. We are really excited to take that next step after this next study is done, that data should be done by around summer. If anyone gets a survey, please fill it out.
And in the end trying to look at that compilation of all those and then put it to a manuscript because that really. I think just disseminates the word a little wider and helps to inform these things a little bit more.
Marla: Great. I'm really looking forward to that and we'll look forward to following the success there.
I really appreciate all of this coming on our show today, telling us about this and being able to tell other practice owners, other clinicians, and other faculty, as you just said, you've got to get to know your students just like the CI.
To get to know the students as well and it not count as another number. So impactful research and really look forward to what you're putting out there. And thank you for doing this research.
Lauren: Thank you so much. I really appreciate you inviting me here and the opportunity to speak about it.