Nine out of 10 healthcare program students run into onboarding problems before they ever set foot in a clinical rotation. That's not a rounding error. That's a system that's quietly failing the people it's supposed to serve.
On this episode of Cisive's podcast, Don't Get Played, host Matt Jaye sits down with Heather Pierce, Director of Rotations at the Kansas College of Osteopathic Medicine (KansasCOM).
Pierce’s school runs a deliberately distributed clinical model — with students at hundreds of hospitals and clinics, many in rural communities — because that's central to their mission. But distributed means fragmented. And fragmented means Heather is managing 366 active clinical sites with two coordinators and a process that's different at every single stop.
Her view is pragmatic: The pipeline isn't broken because students aren't trying. It's broken because systems weren't designed with students in mind. Her experience mirrors the operational reality facing many healthcare education programs, according to Cisive research. The next generation of healthcare workers — the students Pierce is nurturing — is being held back by fragmented, manual processes that delay clinical readiness and strain relationships between schools, students, and clinical partners.
Heather doesn’t believe that students are dropping the ball. It's more nuanced. Every site has compliance requirements. The problem is that no two sites have the same ones.
Some want documents emailed directly. Some require students to create accounts in a third-party platform — and occasionally pay for the privilege. Some send onboarding instructions from a system name nobody recognizes, and the email goes straight to spam. Heather remembers one site requiring an on-site drug screen on the first day of rotation, which created delays when lab results were slow to come back.
"Every single location is different," she explains, "and students don't know what to expect because it's the first time they've experienced this hospital or clinic."
That's the core problem — not negligence, but constant novelty. Nearly every administrator we surveyed said that students face at least occasional delays due to clinical site onboarding or documentation issues. Certainly, it’s important to verify credentials and weed out fake licenses and impostor nurses. But with clinical capacity already limited, preventable delays make staffing problems even more difficult to address.
Delays compound, and they create other problems. When a student arrives without completed documentation, the site can't set up electronic medical record (EMR) access or print a badge. The dayslong onboarding sequence remains on hold. The student loses time — sometimes a week, sometimes more.
"When students are off-schedule," she says, "they're not following the set plan with the rest of their classmates — and things do become a bit messy."
Delays are pervasive. Our research showed that, among students who had begun clinical placement approval or onboarding, 88.5% encountered at least one challenge.
In the fourth year, that's manageable. A four-week rotation becomes a three-week rotation, and the student makes up the last week later on.
Third year is a different story. Core rotations run on a fixed-block schedule. Miss one, and you're pushed to the makeup block at year's end.
"If that happens more than once," Heather says, "it could impact their graduation date."
That’s not the only ripple effect. Delayed students compete for preceptor slots with the incoming class. The harder-to-find rotations — surgery, OB-GYN, psych, peds — have the tightest supply of preceptors. If a student needs a makeup slot in one of those, they're competing with the next cohort for spots that are already spoken for.
The deadline window is shrinking — or rather, sites are expanding their own window.
What used to be a one-week lead time for students to deliver onboarding documents is now two months at many locations. Sites are wary enough of missed deadlines that they've proactively created buffers.
"I have noticed our sites push it back," Heather says. "I don't know if it's because they've discovered there's so much more they need to do to be ready, or that they've learned over time that students tend to miss the deadline."
The answer could be both.
The relationship risk is real. Clinical sites aren't obligated to keep accepting students. They're partners — and partners that get burned too often will start second-guessing. "They have the right to say at any time, ‘We're going to stop taking your students,’" Heather notes. "We don't want to be difficult."
There's no single platform fix here. Heather knows it. She'd love full interoperability — a world where students upload once, and every site pulls what it needs. "That would be lovely," she says. "Unfortunately, I just don't know that there would ever be enough consensus."
She’s not wrong. Our research showed that 99.3% of students navigated more than one system during screening, with the vast majority using two to four platforms. This reality clashes with the 31% of students who specifically want a single, unified platform for screening tasks.
The practical solution, for now, is more deliberate than revolutionary: Collect onboarding requirements from every site up front, put them somewhere students can actually find them, automate reminders where possible, and communicate in ways that drive action rather than inbox clutter.
"How we communicate with our students is a very key piece of this," she says.
Part of reducing delays is better communication and integration. One of the biggest takeaways from our research is the desire for standardized requirements. In addition, nearly 60% said that easier integration with institutional and clinical systems would most improve their screening process.
The clinical placement pipeline is broken in ways that are boring and operational but also entirely fixable. But the fix isn’t a moonshot. It can’t happen all at once or through a single, sweeping platform change.
A better way is possible: site by site, process by process, automation by automation. Heather Pierce is doing it with 366 sites, two coordinators, and a very good spreadsheet. Most programs don’t have an excuse not to get started.