Experiential learning supervised by a qualified preceptor has been an enduring requirement for accredited allied health academic programs.1 Data show that students benefit from participating in experiential learning activities, such as an internship.2 Further, studies show organizations are eager to hire new graduates who took part in some type of external hands-on experience.3
Health information management (HIM) programs accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) require students to complete a supervised professional practice experience (PPE) before graduation to show proficiency of the curriculum requirements.4
This study explored the challenges and barriers of professional practice experience for placing local and online baccalaureate students in hospital-based HIM departments from the preceptors’ viewpoint. This study focused on the hospital setting for several reasons: gaining site approval is complicated, the centralized HIM department poses unique problems for hosting students, and to narrow the research focus to a setting commonly used among HIM academic programs.
The PPE problems with placing and precepting students have been a long-standing concern in HIM education;5 however, there was limited literature available directly related to this problem of practice. An extensive literature search was conducted that yielded only a few research-based articles that provided limited information about the problem. Therefore, the literature review included related works from other allied health disciplines with similar issues with experiential learning.
The overarching findings for allied health academic programs centered on issues at the healthcare organizational level, including legal concerns, cost, time, and productivity.6 Geographic location was yet another issue that prevented student placement. Additional concerns focused on lack of student or preceptor preparation for the experience.7
This was a qualitative multi-case study conducted in 2021. A total of six cases, or participants, took part in this study. Participants completed a pre-interview survey to obtain demographic information before conducting semi-structured interviews online with health information management preceptors. The survey data were compiled and analyzed to inform the interviews.
The study results indicate that HIM preceptors are challenged with placing and precepting students at their hospitals. Lack of support from senior leadership is a contributing factor. Additional issues center on planning and preparation. Keeping students engaged with the learning experience was another key finding. Lastly, this research uncovered an anecdotal finding about the lack of preceptor training provided to HIM professionals.
A variety of issues contribute to the problem of placing and precepting students at the organizational level. Despite these challenges, the participants in this study expressed dedication to serving in the preceptor role. Further, this study identified plausible solutions for improving the PPE by incorporating creative ways to deliver learning activities. Finally, this study was carried out during the pandemic at a time when preceptors had to employ innovative strategies for precepting HIM students.
Keywords: allied health, experiential learning, health information management, preceptor, professional practice experience
Professional practice experience (PPE) is the cornerstone of health information management education.8 While these experiences are highly beneficial to students and health information management practitioners, academic programs are challenged with securing sites for students to complete the experience.
Experiential learning has been a long-standing requirement for academic health information management (HIM) programs accredited by the Commission on Health Informatics and Information Management Education (CAHIIM).9 Students enrolled in CAHIIM-accredited programs must complete a PPE before graduation.10 The PPE provides opportunities for students to apply theory learned in class to real-world work in HIM. During the PPE, health information management students are supervised by a preceptor with content knowledge. Even though PPE preceptors have intrinsic and extrinsic motivation to serve this role, HIM programs struggle to place students with a site.
This study used a qualitative multi-case study design to answer two research questions. The research questions centered on preceptors’ experiences on the challenges and barriers of placing and precepting student interns. A pilot study was conducted with two volunteers to test the efficacy of the pre-interview survey and interview guide. Purposive sampling techniques were carried out, and six participants were included in this study.
The study setting occurred with hospital-based health information management departments located throughout the United States. The study population included health information management professionals with recent precepting experience. Each study participant serves as a preceptor for different HIM programs throughout the country. After obtaining approval from the institutional review board, participants were recruited using the researcher’s list of professional contacts. Each participant signed an informed consent form before any data were collected. Once consent forms were obtained, participants completed a pre-interview survey that included basic professional demographic information. Participants provided their job title, years of precepting experience, healthcare setting, and work location. Also, participants indicated the number of students that can be accommodated at one time, and their ability to precept students virtually.
Kolb’s Experiential Learning Theory (ELT) served as the theoretical structure for this study.11 ELT comprises elements of human learning and development theories and emphasizes that learning is an interactive process built by experiences. Experiential learning may be designed as an internship, study abroad, or various other fieldwork opportunities.
Before collecting any data, the study prospectus was carefully reviewed by the Institutional Review Board. All collected data were de-identified and stored on a secure password-protected computer. Data were collected using pre-interview surveys and interviews. The surveys collected participant demographic data to provide context for the interviews. The interviews focused on open-ended questions so that participants could expound on their experiences. Data analysis was carried out using The Framework Method, a seven-step methodical process.12 First, the interviews were recorded, transcribed, and reviewed for accuracy by participants and this researcher. Then, the data were coded and grouped into themes. From there, a cross-case analysis was conducted. Next, the data were categorized and charted on a matrix. At this point, the nuances of the data were compared and contrasted to note similarities and differences, along with unanticipated findings. Data were triangulated to ensure the trustworthiness of this study. Detailed descriptions of the data were described to assure transferability to other contexts.
Six HIM professionals participated in this study. All participants were female and have a bachelor’s degree in health information management along with the registered health information administrator (RHIA) credential. Two of the participants hold a master’s degree. Four out of the six have more than 10 years of experience in health information management. These four participants have been hosting students for more than 10 years. All of the participants currently work in acute care, and four of them work remotely. Two of the participants work on-site, one in a suburban area and the other in a rural location. Five of the participants indicated they could host more than one student at a time, including virtually. Each participant’s direct quotes were assigned a number representing the participant [for example: Participant One = P1].
Theme One: Organizational Roadblocks
Preceptors indicated that their organizations impeded their ability to work with students. The participants noted that their organizations were concerned about potential privacy violations. For this reason, preceptors reported that it is challenging to secure signed affiliation agreements and gain student access to health information systems. Participants added that their organizations voiced concerns about hosting students’ impact on productivity. One participant described her experience working with the executive leadership team:
“I basically had to figure it out on my own. I didn't have help at the facilities I had worked for in the past; we didn’t have a support system. I had defined all of those resources. I had to connect with the right people, and then I had to repeatedly explain why this was so important.” (P6)
Theme Two: Planning and Preparation
Preceptors described the importance of planning for the student experience. Preceptors need adequate time to secure signatures, prepare tasks and projects, and schedule meetings with other staff and departments to ensure students gain a robust experience. Most preceptors described receiving a PPE guide or handbook to assist with hosting students. However, some preceptors shared that they would appreciate more information, particularly suggestions for projects that students could complete. One participated strongly recommended planning a few months in advance:
“We received the packet from the college so far in advance, so I reached out and started to make the schedule so that everybody knew. So, if there was going to be any variation to the schedule like somebody needed to decline or reschedule, that was all ironed out before the students started. And then, once they started, it was typically a smooth process.” (P2)
Theme Three: Student Engagement
Ensuring students were engaged with the PPE was a common concern among preceptors. As such, preceptors reported concerns about creating a schedule of interesting activities to increase student engagement. The participants agreed that keeping students busy was key to avoiding conduct issues, such as disrupting staff. Some preceptors noted that hosting small groups of students at a time increased the level of engagement. One of the participants expressed the importance of keeping students busy to ensure they remained engaged:
“Ensuring that I had every minute allocated to an activity or something for the student to do. Otherwise, I felt that they weren't engaged in what they were doing. So, ensuring that the instructions were given out, that the project that I gave, or the assignment, that they were complete and properly timed.” (P3)
Theme 4: Solutions
The findings concluded with participants suggesting solutions for placing and precepting HIM students. The primary solutions identified this study were providing a virtual experience, hosting small groups of students instead of one at a time, timely communication, and planning structured time for the students. Interestingly, most preceptors favored hosting students virtually, a shift from the traditional PPE format. However, as more HIM departments move to work remotely, the virtual PPE is a plausible solution. Some preceptors advocated for hosting students in small groups as a solution and fostering engagement among the students. Another participant explained how a remote centralized health information management department could be an advantage for hosting student interns:
“We did a centralized release of information, medical identity theft, a lot of those functions that were actually at the facilities, even less now centralized. So, there was a virtual experience where before it was face-to-face to capitalize on those efficiencies.” (P4)
The participants noted that early communication from the HIM program is vital. By receiving requests to host students in advance, preceptors can be better prepared for the student’s arrival, and thus provide a more meaningful experience. According to several participants, being asked to serve a preceptor a few weeks in advance is helpful, while some participants stated more time is needed to prepare.
Lastly, the participants observed that structure and time are crucial for ensuring students receive a quality experience. Planning a daily schedule that includes allotted time for each task is a strategy that one preceptor identified. She stated, “Because I always made sure that I was working on something that a student could participate in, and then I would use our data, use what we were working on” (P6), and that ensuring students stayed focused and on task improved engagement and minimized potential conduct issues.
While HIM professionals agree about students’ importance in professional practice experiences, challenges remain with placing and precepting HIM students. This current study indicates that problems with placing students at PPE sites centered on organizational and preparation issues. First, all of the preceptors reported having organizational roadblocks with placing students at their hospitals. The organizational barriers centered on the lack of support from executive leadership, who have a different perspective to consider in keeping the hospital protected from potential liability. The leadership concerns focused on students’ ability to protect private patient information and potential impacts on staff productivity. Additionally, the centralized organizational structure of health information management departments is problematic for hosting students on-site. Lastly, participants reported that promptly obtaining the affiliation agreement between the hospital and college is a significant barrier.
Participants in this study also reported encountering problems with supervising student interns. The preceptors in this study expressed concerns about their ability to provide a valuable learning experience for student interns. These concerns stemmed from the challenges of acquiring student access to health information systems. Due to privacy concerns, hospitals may not be willing to allow students access, which makes it difficult for students to learn functions and tasks in an automated HIM department. For this reason, preceptors are challenged with keeping students engaged in the work and learning experience. Participants also noted that a lack of time to prepare for the student’s arrival and experience adequately is challenging. Finally, preceptors expressed difficulties with underprepared students, which takes more time to supervise.
This research study uncovered alarming anecdotal information. Surprisingly, none of the study participants received training before precepting their first student. Some preceptors reported receiving a written guidebook to assist them but no formal training or preparation. As a result, these preceptors did not feel prepared for their preceptor role.
While problems exist with placing and precepting students in hospital-based HIM departments, the participants in this study identified many plausible solutions. When it comes to placing students, HIM academic programs can plan out PPEs in advance and collaborate with one another to determine needs and work with preceptors that might be able to host small groups from different programs simultaneously. HIM departments could host students virtually and create pre-recorded sessions that can be delivered electronically and used repeatedly. To improve the precepting experience, academic programs should review expectations with students and provide a PPE guide with instructions, policies, and expectations, including conduct on-site. Additionally, academic programs should provide an orientation and training program for new preceptors, including the students’ needs and PPE expectations with the preceptors. While preceptors noted receiving a handbook prior to precepting students, they would feel more prepared with an orientation to the PPE that includes training on preparing, overseeing, and engaging students with relevant activities. Having clear-cut guidelines leads to an optimal experience for all stakeholders.
The study was limited by the perspectives of HIM preceptors in hospital-based HIM departments and did not include viewpoints from health information management faculty or students. Also, the study was limited to health information professionals currently working in the field with recent precepting experience. Lastly, the study was limited by the small sample size and time limitations were set for this study to ensure completion by the end of the summer term.
While PPEs serve as a valuable high-impact learning experience for HIM education, challenges and barriers exist with placing and precepting these students. Even so, HIM preceptors genuinely enjoy the precepting process and the ability to give back to their profession. Employing creative solutions to this study problem has been successful with some HIM departments.
In light of this study, this researcher recommends future research on factors that motivate HIM professionals to serve in the preceptor role. Additionally, a study to evaluate preceptor satisfaction rates could shed light on the problem. Lastly, a study about the ability of virtual PPEs to meet CAHIIM curriculum standards could highlight a viable solution to this problem of practice.
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Darla Branda (firstname.lastname@example.org) is clinical faculty of health professions at Southern New Hampshire University.