A Description of Comments Written by Clinical Instructors on the Clinical Performance Instrument

Abstract

Background and Purpose. The Clinical Performance Instrument (CPI), developed by the American Physical Therapy Association (APTA), is used by clinical instructors (CIs) to evaluate physical therapist (PT) student and physical therapist assistant (PTA) student performance. This tool includes quantitative scores using a Visual Analog Scale (VAS) and qualitative comments to support the ratings on the VAS. These narrative comments are also intended to provide students with feedback on their performance. The purpose of this study is to describe and compare the ratings on the VAS with written comments for each criterion, including the performance dimensions (PDs) of quality, supervision, consistency, complexity, and efficiency. Subjects. Twelve educational programs in California participated in this field study which included the 13 corresponding academic coordinators of clinical education (ACCEs) and directors of clinical education (DCEs), 320 PT and 101 PTA students, and their respective CIs. Methods. Data recorded by the 12 programs included VAS scores at mid term and conclusion of student affiliations, written comments, and any checks of the following boxes: “Not Observed” (NO), “Significant Concerns” (SCs), or “With Distinction” (WD). ACCEs and DCEs rated all written comments that were noted for any of the PDs (quality, supervision, consistency, complexity, and efficiency). The ACCEs and DCEs rating evaluated whether the final VAS score for each criterion was considered “passing” by their respective education program. Interrater and intrarater reliability was established using percent agreement prior to rating inclusion of the PDs. Frequency distributions of all variables were calculated. Results. Fifty-four percent of the PT CPIs had at least 1 criterion listed as “NO” at the final evaluation, 40% of all PT CPIs had criterion #17 (consultation) listed as “NO” by the end of the affiliation, and 30% of PTA CPIs had criterion #15 (other services) listed as “NO” by the end of the affiliation. SCs were checked in only 4 of the 320 PT CPIs, although 50% of these had at least 1 criterion that did not meet a program's standard for passing. At least 1 criterion was marked WD in 40% of all CPI's. Ninety percent of all CPI's had at least 1 comment written for each criterion, and 68% of those comments only addressed 1 or no PDs. The frequency with which each performance dimension was addressed was 42% for quality, 10% for supervision, 15% for consistency, 12% for complexity, and 12% for efficiency. Discussion and Conclusion. While many comments are written in the CPIs, most do not provide an adequate description of the student's performance relative to the 5 PDs. CIs may benefit from additional training to make comment writing more relevant and efficient. Future research should further explore the reasons for the prevalence of “NO” marks on criteria considered to be part of professional practice.