Adopting an Integrated Apprenticeship Model in a University Clinic

Ronald B. Gillam

The University of Texas at Austin

At the University of Texas at Austin, we have set two important goals for the education of our undergraduate and graduate students. First, we want our students to understand how speech, hearing, and language are integrated within a larger communication system. We also want students to value empirical research as the basis for sound clinical decisions about best practices in assessment and treatment. To accomplish these goals, we have been exploring new ways to integrate academic coursework, research experiences, and clinical practicum experiences in speech, hearing, and language. As part of this change process, a number of academic and clinical faculty members are applying cognitive apprenticeship models of teaching and learning in the classroom, in the laboratory, and in the clinic.

As explained by Gillam and Peña (1995), there are two basic assumptions that underlie our efforts to integrate classroom, research, and clinical learning experiences. First, we believe that conducting clinical research leads to high quality services for clients and high quality education for students. Secondly, we believe that members of our academic and clinical faculty should view themselves as master clinicians and master clinical researchers who teach a research approach to the clinical process through demonstration, mediation, and coaching. We believe these two assumptions are important for the advancement of the scientific basis of our profession, to enhancement of our students’ education, and the success of our services to clients.

Social Constructivism

The cognitive apprenticeship model of social constructivism asserts that knowledge is co-constructed by learners and teachers as they are engaged in meaningful activities in the classroom, laboratory, and clinic. The primary idea behind cognitive apprenticeship is that learning is best facilitated in contexts in which experts model best practices to students. Classroom teachers lead their students in case study discussions. Researchers design studies, collect data, and analyze results in research teams that include students. Supervisors demonstrate and explain what they are doing as they and their students conduct clinical research as they provide services to clients together. After observing and learning with competent teachers, researchers, and clinicians, students gradually assume more responsibility for their own learning. Teachers gradually shift more and more responsibility to students as they sense that students are ready. In this way, students are projected into the professions in ways that integrate classroom, laboratory, and clinical experiences.

Mediated Learning Experiences

Many of us have adopted a teaching process called mediated learning experiences (MLE). In MLE, experts support students’ learning at a level that is somewhat above what students would be capable of without extra support. Teachers, researchers, and supervisors do this by pointing out the learning goal, explaining why that goal is important, helping students develop and follow their own plans for learning, and helping students think about possible relationships between what they are doing in one learning context (e.g., the classroom) and what they might do in another context (e.g., the laboratory or clinic).

MLE sessions incorporate several of the following mediation strategies:

Multilayered Mediation Structures

At the University of Texas at Austin, we have devised three multilayered structures for integrating coursework, research, and clinical practicum. The three structures that are currently being used include the on-campus master clinician model, the off-campus master clinician model, and researcher/clinician teams.

On-Campus Master Clinician Structure. In this structure, master clinicians provide services with teams of students. Clients are assigned to student-supervisor teams who take a research approach to service delivery. Sometimes one student or a group of students will take primary responsibility for studying, assessing, and treating a client. In other cases, the supervisor may take primary responsibility. This gives students on the team and other students who may be in the clinic an opportunity to see master clinicians at work.

Off-Campus Master Clinician Structure. In this structure, a member of our faculty takes a team of students to an off-campus site. The faculty member and the students work together to assess, treat, and/or conduct clinical research with clients at that site. We have implemented this structure in nursing homes, public schools, preschools, private schools, and in community outreach settings. In most cases, the university contracts with the agency for the services that our faculty members and our students provide.

Researcher/Clinician Team Structure. Faculty members who are conducting clinical research studies often include students on their research teams. For example, students are involved in research on the identification of developmental apraxia, assessment strategies for bilingual children, and treatment strategies for school-age children with language impairments. Faculty members and students are also collaborating with local school districts on efficacy studies that need to be completed in those districts. We believe these are extremely important experiences for students because they enable students to experience first hand how hypothesis testing and theoretical sampling can serve as heuristics for assessment and intervention processes. These experiences also help students begin to value research.

Summary

This paper has summarized recent attempts by faculty members at the University of Texas at Austin to use a master clinician/apprenticeship model as part of our efforts to integrate students’ academic, research, and clinical experiences. Working from a social constructivist perspective, supervisors, teachers, and researchers model a research attitude toward clinical services, and they use MLE teaching strategies in the classroom, the laboratory, and the clinic. We provide our students with multilevel experiences that relate to on-campus teams, off-campus teams, and researcher/clinician teams. We hope these efforts will show students how to apply a research orientation to solving clinical problems and, at the same time, help them integrate information learned in academic, research, and clinical practicum experiences.

References

Gillam, R. B., & Peña, E. D. (1995). Clinical education: A social constructivist perspective. The Supervisors’ Forum, 2, 24-29.

Gillam, R. B., Roussos, C. S., & Anderson, J. (1990). Facilitating changes in supervisees' clinical behaviors: An experimental investigation of supervisory effectiveness. Journal of Speech and Hearing Disorders, 55, 729-739.