from Inquiry, Volume 1, Number 2, Fall 1997, 67-71
© Copyright 1997 Virginia Community College System
Abstract
The teaching of a number of
skills and the reintroduction of traditions of master
craftsmanship better prepare students for the workplace.
The health care industry and the education of health technology providers are amidst the most dramatic changes ever documented. With diminished health revenues, innovative initiatives in the development of true skills in our students, rather than the simple teaching of tasks, require closer attention and development (Begun and Lippincott, 1995). Our own initiative, which combines the teaching of a number of skills with the reintroduction of the traditions of the “master craftsman,” appears very promising.
Our research and development activity was funded by a Health Education Act, Title III grant entitled “Health Technologies in the 1990s.” The grant was co-directed by the author and Mr. Ron Proffitt, MS, RT(R), for five years. This grant funded new program and course development, modifications of existing programs, and equipment updates.
Basic reviews of the literature opened doors of opportunity for us. Our research made it clear that health technology providers were being summarily removed from health systems to diminish the cost of operations. Beyond this, a survey we conducted showed that health care providers were spending only 23 percent of their time with patients; 80 percent of those surveyed stated that they were just not doing what they were trained to do.
While health care delivery systems have been re-engineered and the “patient-focused” model has taken the lead, many employees were (and still are) receiving short-term basic training for a variety of tasks ( “multitasking” ). Such quick-fix solutions as multitasking do not provide the real skills needed. “McDonaldization,” the process in which the principles of the fast-food restaurant are coming to dominate more and more sectors of American society as well as of the rest of the world (Ritzer, 1995), has found its way into health care education and training. This development has been further exacerbated by the fact that the personnel being hired and trained for multitasking do not come up to the standards expected in a college health technology program.
Add-A-Comps® and similar efforts to provide employees with the basic training required for performing additional health care tasks have existed in some shape or form for nearly twenty-five years. Training of this sort has been provided in such areas as nuclear medicine, radiation therapy, polysomnographic technologies, and pulmonary function technologies; other examples include the pediatric/neonatal respiratory care practitioner specialty and nurse practitioner programs. All present themselves as “add-ons” to already learned skills as well as licensure and credentialing activities. Ex post facto“add-ons” for existing programs have appeared in a number of areas. First, to the existing radiologic technology program were added magnetic resonance imaging, computerized tomography, and diagnostic medical sonography. Added to the exisiting respiratory care programs were advanced practitioner, polysomnographic technologies, phlebotomy, and 12-lead electrocardiographic diagnostics. Other traditional add-ons have combined respiratory care and physical therapy, respiratory care and phlebotomy, and respiratory care and nursing.
We have concluded that a real education should provide health providers with the skills and understanding that enable them to be autonomous in the performance of their duties. Furthermore, as a result of our own research and that of others, we decided to adopt “the paradigm of timeliness”: “appropriate skills performance to meet patient needs, provided at the right place and time, will improve recovery and demand less expense” (DiPietro and Proffitt, 1996). This paradigm, while not really new, would go a long way in improving health care.
Our efforts focused on a new venue: simultaneous multiskilling, providing skills in a number of areas—not just one—during the student’s education. As far as we could determine, such an approach had not been tried. Disparate professions, i.e., those traditionally not overlapped, were rarely part of any multiskilling efforts. In addition, following the traditional model of the master craftsman also made sense. After all, had health technology providers existed one hundred years ago, they would have been master craftsman (DiPietro and Proffitt, 1994). It is a fact often overlooked that all of the health technology professions were patterned after the apprenticeship, journeyman, and master craftsman approach to learning a trade that may have started well over 5,000 years ago. Vestiges of this approach still remain in health education today: residencies, clerkships, clinicals, and coordinated practice programs still play a crucial role in the education of health technology providers.
Yet, we realized that something was missing. Master craftsmanship requires “practice,” actually performing the skills one has learned. Were we, in our own college programs, sending graduates out to “practice”? Were we preparing our students to function in the new milieu of health care? As noted above, our survey of health technology providers showed that they were not doing what they had been educated to do. Multiskilling and master craftsmanship require sufficient time for the development of adequate skill levels (DiPietro, 1996). But finding that time in our own programs at Southwest Virginia Community College is an uphill battle, particularly in the face of the recent reduction in the number of credits required for associate degrees. We have always felt that “students are the number one client and product” (O’Banion, 1994), and it was clear under the changing circumstances that we had to look at the teaching/learning experience from a totally new perspective.
Our non-traditional, simultaneous multiskilling efforts began in 1993 with a focus on a pilot program combining Radiologic Technology and Respiratory Care. The pilot effort has proven successful for three learners engaging in this activity. They have functioned well in this high-stress program; they have maintained grade point averages well over 3.60 (on a 4.0 scale); two have been employed full-time. And the newest learner has been employed in a cardiovascular laboratory, while still maintaining a grade point average of 3.74.
Our other non-traditional pilot programs have combined Respiratory Care and Nursing (begun in the Fall of 1996) and Respiratory Care and Occupational Therapy Assistant (started in the Spring of 1997).
Out of this flurry of activity came information related to student performance. Our research showed that 86% of entering freshman in the health technologies curricula had completed a minimum of one year of post-secondary education for the completion of developmental course work to improve skills and/or the completion of core requirements for the health technologies curricula. Pearson Product Moment data comparing entering freshman grade point averages with first and second semester grade point average performance in our programs yielded a positive correlation of 0.75, clearly demonstrating two things: (1) learners who had completed a year of post-secondary studies prior to entry and had demonstrated superior academic achievement were more likely to achieve academic success in the rigorous health curricula; and (2) the higher the grades for the core requirements, the more likely the success in health programs. Attrition data showed a similar correlation: Radiography and Respiratory Care experienced single-digit attrition (6% and 8% respectively) while national data for such programs indicated double-digit (well over 55%) attrition. The conclusion was clear: retention is predicated upon preparation and good advising, a combination which has been lauded in numerous articles and research.
When we developed our Health Technologies core curricula, our goal from the start was to accomplish several things.
(1) With 86% of the learners engaging in developmental or preparatory activities for health technologies programs, we wanted to establish a means for identifying these students before they entered our programs.
2) We also wanted the core curricula to provide the student with courses that can be used in transfer curricula or in any associate degree as core courses in the sciences, English composition, psychology, and health care ethics and law.
3) Finally, we wanted all of the 29 credits in the core to apply to our health technology programs. The core is the groundwork for all health technology students, and directly parallels Tech Prep initiatives we have undertaken within the health technology programs.
While simultaneous multiskilling has been revolutionary from its inception, neither this nor the ideas for a core curriculum for health technologies has ever been viewed as a panacea. Although the concepts are not new, the learner-focused presentations together with the evolving master craftsmanship activities have given our faculty a sense of active involvement in improving the education of their students.
Master craftsmanship - in which an apprentice worked under a master to attain fundamental skills before “graduating” and becoming a journeyman who honed his skills to become a master craftsman himself - has served as a model. This provided us with a different approach in the classroom setting as well. Repetition is one of the keys to craft mastery. So in the classroom, the interrelationships of information across course boundaries was captured to effectively “show” learners these relationships. To help the student achieve the closure paralleling the completion of an apprenticeship, capstone courses were developed in both the radiography and respiratory care programs. These courses help the student bring everything back together. Students review all of the essentials needed for their profession and then complete a summative examination based on the national credentialing examinations.
With the pass rates for our programs well above the 90th percentile, we compared our students’ success in content areas in our summative examination with the performance of students on the national credentialing examinations. Eighty students were used for the comparison; the Pearson correlation yielded a moment of 0.78. This correlation simply means that students who had matriculated and then completed the capstone course and summative examinations were more likely to achieve a passing score on national credentialing examinations.
A comparison between all of our students who had not yet taken the capstone courses and all those who had completed them showed a 35 percent improvement within the specific content areas. The results for our multiskilled students were especially interesting. These students showed a 39 percent improvement rate which we related to (1) their continued high academic achievement; (2) the redundant learning occurring in the multidisciplinary approach¾fundamental cognitive, psychomotor and affective skill domains were continuously being reused and reinforced; and (3) the tapping of synthesis and inductive reasoning skills that led to enhanced learning.
This presentation touches on the past, the present, and a vision of the future. We have concluded that in order for higher education to meet the needs of students desiring to serve those less fortunate, we must provide them with avenues for mastery of multiple skills. While there is no panacea, this approach offers new and refreshing options to address the changes in health care and health technologies education.
Multiskilling and multidisciplinary approaches, master craftsmanship, and core curricula take students well beyond simple task learning and prepare them for the autonomy and experience needed as we move into the next century.
Bibliography
Begun, J. and Lippincott, R. Strategic Adaptation in the Health Professions. Jossey-Bass, San Francisco, 1993.
DiPietro, J. and Proffitt, R. White Paper—Health Technology’s Programs at Southwest Virginia Community College, 1st in a Series, 1994.
O’Banion, T. Teaching and Learning in the Community College. The Community College Press, Washington, D.C., 1995
Ritzer, G. The McDonaldization of America. Pine Forge Press, Thousand Oaks, 1995.
DiPietro, J. and Proffitt, R. Multiskilling and Master Craftsmanship in Health Technology’s Education—Old Concepts, A New Paradigm. Presentation for the National Conference on Teaching Excellence, 1996.
Joe DiPietro is Professor and Director, Respiratory Care and Polysomography Programs, and Co-Director, Health Technologies Education, at Southwest Virginia Community College.