K-TEAM: Empowering Students
Jane R. Wegner, Ph.D.
University of Kansas
I am honored to be here to talk about the K-TEAM model of clinical teaching that we have developed in the Schiefelbusch Speech-Language-Hearing Clinic at the University of Kansas in Lawrence. I am here representing my clinical colleagues Casandra Banks, Betty Bunce, Lisa Cuny, Julie Gatts, Kris Grosche, Larry Marston, and Bobbie Trowbridge.
K-TEAM stands for Kansas Teaming Educating And Mentoring. Through the K-TEAM clinical instructional model, we have collaboratively developed a shared vision and are committed to our vision. We have a philosophy of teaching and learning that focuses on the collaboration of faculty and students in the learning process. Our educational model empowers students and includes a sense of trust. We acknowledge the flexibility and responsiveness necessary for implementation of this clinical teaching model. The model utilizes student teams to enhance teaching, learning, and service.
Until January 1995, the Schiefelbusch Speech-Language-Hearing Clinic was a typical university clinic providing "in-house" practicum experiences for students and service to the university and local community. We, the clinical faculty, were frustrated with the clinical teaching model we were using which was the traditional student-client-supervisor triad. When our frustration reached its peak, we met to discuss who we were, what we did well, what we did not do so well, and what we wanted to change. From this we developed an action plan that became the vision for ourselves, our students, and our clients and their families for the next five years.
A recurring concern in our discussions involved supervisory models and how to create learning opportunities for students in which they would get first hand knowledge of changing therapeutic and diagnostic services. Topics such as transdisciplinary assessment and service provisions, inclusion, collaboration, integrated therapy, professional partnerships, and family guided services kept cropping up. Team membership was the common thread in all our discussions. The need to teach students to be effective team leaders and members was very apparent but how to do it was not as clear. Consequently, one of the immediate goals of our action plan became the development and implementation of a team clinical teaching model that was more supportive of the experiences and skills we wanted for our students and consumers. We believed that a team clinical instructional model would be more efficient, flexible, and responsive to the changing needs of all involved. We spent five months developing the K-TEAM model and began implementing it in the summer of 1995. The result has been a more integrated teaching, learning and administrative structure for the Clinic.
The Schiefelbusch Speech-Language-Hearing Clinic
I'd like to briefly describe our clinical situation to you so that you can better appreciate what we do. We, the students and faculty, participate in clinical service, community service, teaching, and research. Table 1 presents the demographics of the Clinic.
Table 1. Schiefelbusch Clinic Demographics
Teams and How They Function
We have three levels of teams. These are the Clinical Faculty Team, the student practicum teams, and finally, the undergraduate preclinical teams. See Figure 1.
Figure 1. Clinical Teams
Each clinical faculty member facilitates one of the student teams and one clinical faculty member also facilitates the assessment team. Each clinical faculty member has developed a specialty area of expertise that has defined the functioning of our individual practicum teams. The teams are: the Communication Advocacy Team (CAT), the Essential Audiology Reference (EAR) team, the Facilitating Adult Communication Team (FACT), the Language Acquisition Preschool and Reading Activities Program (LAP/RAP) team, the Toddlers At Play (TAP) team, and the Schiefelbusch Assessment Team (SAT). The CAT team serves primarily individuals who use augmentative and alternative communication systems and/or have developmental disabilities while the EAR team provides the Clinic's audiological services. The FACT team provides intervention to adults with primarily neurogenically based communication disabilities. The LAP/RAP team provides intervention in the Language Acquisition Preschool and to individuals with language based reading disabilities. The TAP team services infants and toddlers and their families. This kind of specialization has allowed the clinical faculty to be more focused, and we think, more effective in our teaching. This specialization has also been beneficial for community ties and relationships. The clinical faculty are members of community teams (see Table 2) and bring experiences and knowledge back to the students as well as bringing the students to the community teams.
Another group of students participating on the teams are undergraduate students enrolled in the course Introduction to Speech-Language Pathology. The course is an introduction to the clinical practice of speech-language pathology. These students are usually second semester juniors or seniors when they enroll. The students rotate through three different teams in four week blocks of time (ABCDE in Table 2). They observe clients receiving services through the team, observe the team process and participate as much as possible in the activities of the team. They write observations, note the teamwork skills they observe each week and keep agendas of the team process. In addition, they complete three clinical projects per rotation. This experience is the "laboratory" for the course.
At the beginning of each semester the clinical faculty team meets to assign students to the clinical teams and to apportion clients to specific teams based on therapeutic needs and diagnosis. The number of students assigned to a team depends on enrollment for that semester and the caseload of particular teams. Typically, there are between four and seven students per team. We have had a few as four and as many as nine. Student preferences, clock hour needs, academic preparation, and strengths and weaknesses contribute to the assignments. A meeting is held at the beginning of the semester, the Big Team Meeting, where assignments are announced to the students. At this meeting, students receive an overview of the Schiefelbusch Clinic, receive their team manuals, and have an opportunity to participate in team building activities. The students familiarize themselves with the information in the team manuals prior to the first meeting of the team.
The intervention teams meet each Friday beginning at 10:30 am. These meetings generally last two hours. The assessment team meets at 8:30 am as it is composed of a student representative from each of the intervention teams. After an introduction to the team, the students are given a list of clients that the team needs to serve and any other information available. The students then decide how to approach the task of scheduling the clients. Some teams approach it from clock hour needs (usually second semester), others by scheduling needs and time constraints, and still others by areas of interest. Once the scheduling has been completed, the students contact clients and families to finalize intervention arrangements. Most intervention begins within one week of the first team meeting. This is much sooner than in our previous, more traditional model. Some students provide 8 to 10 hours of intervention per week, others 5 hours over the 12 weeks of therapy each semester. Some students co-intervene with students from their own or other teams. Flexibility is the key to our service provision.
During the weekly team meetings, the students rotate the roles of facilitator and recorder. They set their own agenda and run the meetings. Clinical faculty add items to the agenda for discussion but do not direct the meetings. Just as in a traditional model of clinical supervision/teaching, students still want and need to discuss clinical issues (e.g., therapy techniques, how to write progress reports, how to code a language sample, how to talk with clients and families, how to interpret and apply research) but now these discussions take place in a team meeting. We do everything in the team meeting that used to take place in a traditional one on one meeting but now we have added collaboration, osmotic learning, and an opportunity for synthesis. Students learn far more than they would from only their own clients and a clinical faculty member. They learn from the experiences of others.
We believe this process helps the students learn to become team leaders and members. We have noticed a unity in the Clinic that was not there before. There is also a sense of ownership by the students. We rarely have someone enter the Clinic without a student greeting them and asking if they need help. We provide many opportunities for students to practice being team members.
Benefits and Disadvantages of the K-TEAM Model
In any clinical teaching model there are issues of time, intervention, teaching, and evaluating progress. This model is no exception. No matter what model is used, clients must be scheduled in a manner convenient to the clients, clinician, and clinical faculty member. In addition, appropriate guidance to the student must be provided which leads to intervention that meets the clients' needs.
The major benefits to the K-TEAM model are that it is more efficient in terms of clinical operations and instruction, provides broader and more self-directed learning experiences for students, and better teaching by faculty because of our more focused individual interests and experiences.
With the K-TEAM model, the organizational aspects of the Clinic are more efficient because the students are more responsible. The problem solving the teams do in dividing and scheduling the caseload is at least as efficient as when one faculty member was the master scheduler. In fact, we begin intervention sooner than in the past. One strategy we have found that helps in scheduling is to have weekly calendars posted on each of the clinical faculty and therapy room doors. Faculty members block off time that is committed (e.g., teaching classes, regular meetings). Students then mark therapy as it is scheduled on these doors. The students problem solve conflicts that occur around room and faculty schedules. As a result of their problem solving efforts, we have extended our Clinic hours until 7:00 pm Monday through Thursday this semester. In addition, our service delivery has become more responsive to family needs. There is a great deal of collaboration across and within teams among students, faculty and families. Our clients noted little difference in service when we changed models. Those who did comment noted that there were fewer cancellations and more continuity with the same faculty member each semester. Our client base and income have increased since adopting the K-TEAM model.
The K-TEAM model of clinical teaching is more efficient in terms of instruction. The team format allows the faculty member to teach all team members at the same time. Individual observations and written feedback are still provided but the broader aspects of clinical teaching take place in the team meeting.
The team format provides a forum for expanded learning opportunities as well as reflection and problem solving. We think it is critical for students to construct their own knowledge and that the team provides an appropriate environment for this constructive process to take place. The students are exposed to a variety of new situations and interventions that go beyond that of their own clients. The students also participate in community teams (schools, planning groups, agencies) and bring these experiences back to the group expanding everyone's learning.
The team model provides the clinical faculty opportunities to model problem-solving skills within a less authoritarian framework. Students ask and answer each other's questions. Students who are in their second practicum mentor those in their first, while other graduate students mentor undergraduates. The students learn how to collaborate and support one another. The students and faculty share therapy ideas, materials, and research information.
Another benefit to the team model is the flexibility it affords the clinical faculty and students. Each team has developed its own style to meet the needs of clients and team members. The team manuals that have been developed reflect this flexibility. The students have the opportunity to learn how to be team leaders and members early in their practicum experiences.
The major disadvantage of the K-TEAM model for faculty centers on giving up some control of our time to the students. Time is also a disadvantage for the students in that initially more time is spent in meetings with each other than in more traditional models.
We have found that the benefits to all involved far outweigh the disadvantages. We would not return to the previous, traditional clinical instructional format. We have noted far too many positive outcomes to turn back. The students demonstrate ownership of the Clinic's work; we have a collective self-image that all of us together are the Schiefelbusch Clinic. The process is effective, the clients make good progress and are satisfied with our services. The students learn collaboratively while they develop team member and leadership skills.
Where do we go from here? We will continue to refine the model and our service provision. Just this semester we have instituted a computerized system in which students log services provided. We are currently focusing efforts on the evaluation process, both student and faculty. We are investigating ways to incorporate other disciplines into our teams as well as having students on the same team for a longer period of time. Would we return to the previous supervisor-directed clinical instructional format? The answer is a resounding NO! We have seen too many positive outcomes for all involved.