Department of Health Services & Information Management, East Carolina University, USA
Received date: December 16, 2015; Accepted date: January 20, 2016; Published date:January 31, 2016
Citation: Sasnett B, Ross T (2016) Maximizing Internship Value by Comparing Student Satisfaction and Program Competencies. J Community Med Health 6:390. doi:10.4172/2161-0711.1000390
Copyright: © 2016 Sasnett B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Internships are opportunities to apply academic learning to practical experiences and integral components of many academic programs. Internships provide many advantages to students by introducing them to the world of work and skills needed for them to succeed in their future careers. Limited research documents the importance of student voices in identifying internships that reinforce learning. A question to consider is: “What are students saying about their internship experience?” This study compared student survey results against course competencies in a health services management program. Students rated their soft skills, communication, teamwork, and professionalism higher than hard skills of data management, analysis, and problem solving. Findings indicate more curricular emphasis should be placed on written communication, data analysis, and problem solving to ensure students have a tool box of skills to offer employers.
Internships; Student satisfaction; Program competencies; Gap analysis
Internships are opportunities to apply academic learning to practical experiences. Universities have incorporated experiential education at the graduate and undergraduate level in the forms of internships, practicums, professional practice experiences, clerkships, and cooperative education into their curriculums for years. Internships are integral components of many academic programs including business, geography, psychology, nursing, and medicine [1-4].
Faculty and preceptors, like students, range from outstanding to apathetic and a failure by any party can doom an internship. When students fail to perform professionally in an internship it has serious consequences for an academic program – the internship site may discontinue participation or reconsider hiring graduates of a program. Unsuccessful internships may not be solely due to lack of effort of students but can arise from the failures of faculty advisors and preceptors. Academic programs to avoid internship problems should have detailed standards to guide student behavior and establish goals for preceptors.
Internships serve many purposes: recruitment, transition from college to work, provide training experiences, develop interpersonal and team skills, and connect practical experiences to theoretical concepts in classroom [3,5-8]. Internships provide many advantages to students, employers, and program faculty. Internships introduce students to the world of work and skills needed for them to succeed in their future careers and connect practical experiences to the classroom to demonstrate the relevance of their learning. Professional experience often provides students with an inside track to future employment. Employers are able to evaluate the work ethic of potential employees without a formal commitment to hire the student. Barnett  states that internships provide students with realistic expectations about work versus their pre-conceived ideas developed in school or through part-time employment. Internship faculty should encourage students to critically think about their internship observations and what they mean for their future employment. Erlandson  recommends individual planning for each student in an internship with a plan that recognize students’ personal and professional goals and include experiences to meet these goals. Faculty should use internships as a continuous improvement tool for curriculum and programmatic changes to close the loop between academic learning and experiential training .
Communication should be established and maintained between students, faculty, and preceptors to avoid surprises and address potential challenges. A structured preceptor evaluation at the end of the experience is important to the student’s understanding of their performance during the internship. A well-structured internship will provide positive outcomes for the student, preceptor, and faculty [3,6,7].
A question to consider is: “What are students saying about their internship experience?” McGlothlin  found the highest levels of student satisfaction for internships were: learning skills, interacting with management, gaining confidence in technical skills, and obtaining career related experiences. Barnett  reported students were surprised by the importance of communication in the workplace and that teamwork is a highly valued skill. Barnett’s survey showed an organization’s willingness to commit time, grant the student autonomy, and build relationships was important to creating a positive internship experience. Student comments from Jackson and Jackson’s  study indicated increasing internship hours, better preceptor feedback, meaningful work, and pre-internship training increased their satisfaction. The limited research regarding student assessments of health services management internships was the primary motivation for this study.
The health service management (HSM) program at East Carolina University admitted its first students in 2003. HSM students complete a 160 hour internship during the spring semester of their senior year at sites such as hospitals, nursing homes, physician practices, retirement centers, and ambulatory care settings. In the first year of the program (2003) there was limited time for internship planning resulting in a lack of structure which challenged students, preceptors, and faculty coordinators. Enrollment increases placed further pressure on the program. In 2005, the first eleven students completed their internships and by 2010 the program was annually graduating 62 students. As the program grew internship placements were not finalized until midway through students’ final semester making it difficult to complete the required 160 hours before graduation. This led faculty coordinators to establish a timeline for students, preceptors, and themselves to follow as they plan the internship as well as an internship manual for guidance with identified roles and responsibilities to streamline the process.
The internship process begins with students identifying sites based on their career interests and exploring possibilities with potential preceptors. A preceptor is assigned to the student from the facility to develop an internship plan with emphasis on management opportunities and learning projects that will advance the student’s learning and benefit the facility. At the end of the internship students evaluate their experience and preceptors evaluate the performance of the interns. From 2003 through 2014 the evaluation instruments used by preceptors and students had been routinely modified. In 2014, a faculty coordinator decided to revise the student evaluation of the internship instrument and have students provide in-depth reflections of the experience similar to the evaluation completed by the preceptors. The existing student evaluation consisted of 16 items covering learning objectives, experience at the site, and preparation and follow-up rated from 1 (strongly agree) to 4 (strongly disagree). Each item provided area for open-ended comments which were rarely used. The limited information gained from the existing student evaluation propelled the need for a new instrument that could provide greater insight into student satisfaction with their internships.
The new instrument developed asked students to evaluate their internship objectives and skills, preceptor performance, and the overall quality of their internship. Students could provide any open-ended comments they desired at the end of the instrument. The revised instrument identified the agency, location of the internship, preceptor, and year of the internship.
Questions addressing the internship objectives included information on the opportunities presented to apply classroom concepts to activities and projects, observe interactions with staff members, and build professional skills. Students were asked if they were adequately prepared for their internship in the areas of oral and written communication, critical thinking and problem solving, time management, data management and analysis, and whether the site provided an opportunity to build and enhance these skills during the experience. Interns were asked to comment upon the preceptor performance and availability and faculty coordination in preparing them for their internship. Lastly, students were asked about the quality of the internship in career awareness, marketable skills, networking, and whether they grew professionally and personally from the experience. The revised instrument allowed students to critique their internship in specific areas and provided insight to the suitability of the site for future interns and whether the student had an effective preceptor. The revised instrument was implemented in Spring 2014 and 65 students completed the survey.
The revised student survey objectives listed herein are stated within these survey results in Table 1. The survey collected students’ perception of their skills and internship performance, their preceptors, faculty support, and the value of their internship, while the average rating for each major category were similar ranging from 4.49 to 4.65, inclinations if not predispositions can be seen. Students’ rated their performance during their internship highest, 4.65, and the quality of the internship the lowest, 4.49. The quality of the internship was pulled down by the ratings of chances of receiving a job offer, 3.82, the average for the other 7 items was 4.59.
|I was provided with opportunities to apply concepts learned in my courses||4.59|
|I felt my learning objectives for the internship were met||4.50|
|I participated in projects that built upon my academic learning||4.42|
|I expressed a willingness to learn new concepts and skills||4.84|
|I was provided opportunities to observe interactions between professionals||4.70|
|I was provided opportunities to become sensitive to interpersonal issues that arise at.||4.49|
|I was able to exhibit skills of professionalism as a result of my internship experience||4.81|
|I was responsible and dependable while at my internship site||4.84|
|My preceptor provided an adequate orientation||4.43|
|My preceptor provided specific and clear instructions||4.42|
|My preceptor gave suggestions for improvement||4.58|
|My preceptor included me in administrative meetings||4.47|
|My preceptor provided me with appropriate feedback||4.60|
|The culture of the internship was warm and willing to accept students at the site||4.84|
|I was provided opportunities to meet with my preceptor||4.74|
|My faculty coordinator was available to assist me in identifying a site||4.41|
|My faculty coordinator was available and provided answers to my questions during my i||4.65|
|My faculty coordinator was accessible and provided appropriate feedback about my per||4.64|
|Quality of Internship||4.49|
|Did the internship promote career awareness?||4.69|
|Did the internship enhance marketable skills for you?||4.50|
|Did the internship allow you to job network?||4.22|
|Do you feel that you grew personally from your internship experience?||4.75|
|Do you feel that you grew professionally from your internship experience?||4.71|
|Do you feel that the internship experience makes you a betterjob candidate?||4.76|
|Rank your experience in this internship? (1= lowest rank- 5= highest rank)||4.49|
|Rate your chances of being offered a job at your internship site||3.82|
|Bold indicates maximum, italicized indicates minimum|
Table 1: Survey results.
Internship objectives (performance): overall 4.65
Items rated highest by students pertained to their performance at the internship site including their willingness to learn (4.84), dependability (4.84), and professionalism (4.81). Items rated low pertained exclusively to performance of the internship and the opportunities it provided. The item rated the lowest was the opportunity to participate in projects that built upon their academic training (4.42). The rating for participating in projects that built upon their academic training (4.42) was not significantly different from opportunities to apply concepts (4.59). Other items rated low included opportunities to be sensitive to work issues (4.49) and internship objectives achieved (4.50). There was a significant difference between the top three items (4.81-4.84) that described student performance and the bottom four items pertaining to the usefulness of the internship (4.42-4.59) stated in the internship objectives.
Skills: overall 4.56
The “soft” skills of professionalism, teamwork, interpersonal skills, and time management were rated high (4.85-4.72). The “hard” skills of critical thinking, written communication, data management, problem solving, and data analysis were rated the lowest (4.48-4.22). There was a significant difference between time management (4.72) and critical thinking (4.48). In the middle were the skills of sensitivity to organizational culture, leadership, and oral communication (4.57). The question that arises is: Are student perceptions of their skills reflective of achievement or the recognition of difficulty? Or does it indicate the degree of difficulty in measuring professionalism, teamwork, interpersonal skills, and time management versus the readily understood and testable measures for written communication, data analysis, and etcetera?
Preceptor responsibilities: 4.58
Students rated the receptivity of their internship site organization and preceptor availability highest (4.74-4.84). The students rated opportunities to be included in administrative meetings, orientation, and instruction lowest (4.47-4.42). There was no significant difference in the ratings for any item in preceptor responsibilities.
Faculty Coordination: 4.56
Faculty were rated high on availability and performance feedback (4.64-4.65) and low on assistance in identifying an internship site (4.41). There was no significant difference in the ratings for any item in faculty coordination.
Quality of Internship: overall 4.49, without job prospect 4.59
Students thought the internship made them better job candidates, provided personal and professional growth, and increased their understanding of potential careers (4.69-4.76). Items rated the lowest included opportunities for networking (4.22) and chances of being offered a position (3.82). There was a significant difference between four items rated the highest and two items rated low.
Throughout the survey the ratings were high suggesting students were satisfied with their internship, only 182 responses were lower than 4 or 7.8% of the 2,319 items rated. There were three dissatisfied students, average rating across items < 4.0, or 4.58% of the 64 students responding to the survey.
The results were as expected, in the internship objectives students rated their performance higher than they rated the opportunities they were afforded by their preceptor or site. This was expected as most people are better at critically judging the performance of others than assessing their own work. Peer assessment of writing provides a notable example of being able to identify deficiencies in the work of others while overlooking our own faults.
The student’s assessment of their skills can be attributed to two factors: the first is the skills where students rated themselves high are difficult to objectively measure and are competencies that are addressed in multiple courses (GAP analysis). Table 2, Gap Analysis, provides the self-reported coverage by department faculty of course content and the Association of University Program for Health Administration (AUPHA) accrediting organization for health administration program competencies. Faculty reported they are covering the liberal arts foundation (communication, computational skills, critical thinking, and societal and cultural content in the majority of their classes. Critical thinking was reported in 14 classes while computational skills were covered in eight classes. The average for these four competencies was 10.25 indicating more than half of the classes addressed each of these skills. The question is: How well was a competency addressed, was it covered in a few minutes, a class, or across several classes?
|Crosstabulation of courses and competencies addressed by coursecontent||Course coverage||Domainaverage|
|Liberal Arts Foundation||Communication (Mitten andOral)||10|
|Societal and Cultural Context||9||10.25|
|Cultural and Technical Competency in Management||General Management||Theories of Management||Business||2|
|Functional Areasof Management||Accounting||2|
|Hunan Resources Management||5|
|Management Information Systems||1|
|Motivation for continued learning||9||7.50|
|Health Service Management||Determinantsand Measurement of Health and Disease||Epidemiology||3|
|Health Services Org & Del||...Variety/Across Care Continuum||3||3.00|
|Characteristics of ... Health Services Organization and Delivery||Bioethics||2|
|Quality/ Performance Improvement||5|
|Health Svcs Mgmt Applications and Integration||Faculty Supervised Practica/Internships||2||2.00|
Table 2: Gap analysis.
Student ratings confirm McGlothlin  findings, students recognize the need to learn skills, interact with management, build their confidence in technical skills, and advance their career prospects. Student ratings and the reported coverage of competencies suggest the program should devote more class time to developing specific skill sets. Similar to Jackson and Jackson , the students were critical of their internship experience and echoed previous concerns with how students are orientated into the organization, the time spent in the internship, the desire for meaningful work, and performance feedback.
The areas where the HSM program should focus are clear given the student feedback, students rated their “soft” skills, inter-personal communication, teamwork, and professionalism, significantly higher than their “hard” skills. Curricular emphasis should be placed on written communication, data management, problem solving, and data analysis skills. This may include ensuring lessons learned in one course are advanced in other classes, for example integrating problem solving and data analysis across courses. Only two of the departments courses are designated “writing intensive” suggesting written communication should be given additional emphasis as students recognize this as a weaknesses and employers often cite it as an essential skill. What constitutes superior inter-personal communication, teamwork, and professionalism should also be more precisely defined. Professionalism is an oft-debated topics in faculty meetings given rampant use of personal electronics in the classroom, absenteeism, tardiness, and envelope pushing attire.
Faculty coordinators also need to establish expectations for preceptors. Students clearly desire better orientation to organizations, the tasks they will be assigned, and instructions on how to complete tasks.
The chief compliant regard faculty coordination was lack of faculty involvement in locating internship sites. The problem appears to be the result of not establishing clear expectations; prior to 2011, faculty provided extensive support in locating and securing internships. After 2012 the responsibility was shifted to students due to the growth in enrollment. Faculty coordinators advanced the orientation date for internships so students are informed early in the fall semester of what they must do to secure an internship but additional emphasis may be required. Students rated faculty accessibility and feedback to questions and internship performance high.
The primary limitations of this study were the use of a questionnaire and a small, one year sample. One of the difficulties with questionnaires is there is no way to assess the truthfulness of respondents, in this study rankings were high which may indicate response bias. A second disadvantage of questionnaires is the possibility that respondents will interpret questions differently and the inability of researchers to clarify meanings. A third problem is the evaluation occurs after the event and respondents may forget issues and contexts and/or initial thoughts or feelings may be tempered by the passage of time.
Despite the limitations, the survey has established a benchmark which can be used to judge future performance. An immediate benefit has been the identification and improvement of problematic internship sites.
Planning and preparing for an internship is an ongoing process for students, faculty, and preceptors. Extensive planning, streamlining of processes, and addressing previous student concerns have improved student satisfaction with internships. Ten students out of 58 (17%) in 2014 extended their time at their internship beyond the required 160 hours to further their skills and gain more exposure to the work environment. Preceptors should understand the time commitment required of a preceptor and their responsibilities to the intern including assigning meaningful projects, giving student feedback, and being accessible to the intern. Foremost, preceptors should be a partner in the learning process providing a variety of learning experiences that will benefit their facility and the student.Faculty coordinators should understand their duty wisely match interns to sites, provide effective internship support and supervision, and avoid overburdening preceptors with an excessive number of students.
Successful internships should be the culmination of high quality education, faculty should be clear in formulating their programs, know what skills will be required in the work force, and effectively deliver information and skills in the classroom. To augment the internship experience through the delivery of information and skills, a special topics course focusing upon the Patient Centered Medical Home for students interested in interning at family medicine clinics emphasizing data analysis, problem solving, and teamwork was added in Fall 2015. Students completed their internships at primary care sites after the class ended. The course was timely in that the health care environment is changing with the Patient Protection Affordable Care Act (2010) which reshaped primary care and its reimbursement approach . This new model of primary care can best address the needs of the chronically ill by utilizing the PCMH principles of physician directed team based holistic care to promote integrated quality care . Ciccone,  noted the Leonardo project used a team based approach to disease management as family physicians partnered with the patient and other health professionals. This is the impetus for care managers to serve as a bridge between patients, family medicine, and other specialist . In the PCMH internships HSM students will work collaboratively with clinical professionals to ensure health data is collected and documented and clinical parameters are met to achieve patient centered medical home recognition. Clinical teams must work collaboratively with the management team to affect these changes. Students will build upon their classroom skills in their internship and increase their job prospects in the ever changing health care marketplace. PCMH requirements are simply one way to demonstrate to students the applicability of their education to their internship and future careers. It is the responsibility of all program faculty to ensure improvements in curriculum are made and the ultimate measure of success may not only be the number of students who receive job offers as a result of their internship but their lesson learned and skills gained during their internship.