Effect of Clinical Experience on Comprehensive Examination Performance in a Physical Therapist Education Program

Abstract

BACKGROUND AND PURPOSEClinical education is an integral component of physical therapist (PT) education programs. Among accredited PT education programs in the United States in 2013, the average length of the professional program is 122 weeks (range 75-180 weeks), with 35.9 weeks (range 23-60 weeks) dedicated to fulltime clinical education experiences (CEEs).1 While clinical education curriculum is required for accreditation, the Commission on Accreditation in Physical Therapy Education (CAPTE),2 the accrediting body for PT education programs, does not prescribe the focus of CEEs. CAPTE does, however, expect experiences to be representative of common physical therapy practice areas and patient populations. Guidelines for curriculum development3 indicate PT students should experience a variety of CEEs to achieve program outcomes; however, PT education programs are free to determine what focus of CEEs are best for the program and the students.During CEEs, PT students provide services to patients under the guidance of experienced clinicians. Such experiential learning allows students to utilize and integrate knowledge and skills gained during the didactic portion of the program in the clinical setting.2,3 During these experiences, didactic concepts are continually recognized and reevaluated.4 This is essential for the development of competent professional practitioners.5A variety of CEEs are thought to give PT students the opportunity to apply concepts learned during the didactic portion of the curriculum in the clinical environment. Wetherbee et al6 reported clinicians favored a variety of CEEs as compared to students and clinical coordinators. Students supported interest over depth, while clinical coordinators stressed efficiency and feasibility in scheduling of CEEs. Securing a variety of CEEs is increasingly a challenge for program administrators, with a reported 21.8% of programs adjusting requirements for a specific focus of CEEs in 2012-2013.1 A changing health care environment, staffing changes, increased productivity standards, and increased need for student placements are all potential constraints on the educational opportunities offered by clinical partners to these PT education programs.7There is a lack of research to support the notion that a variety of experiences increase a student's knowledge and potential success within the professional program and subsequently in entry-level practice. Multiple measures are used by PT education programs to assess student success and learning. A common measure of success important for PT education programs is the outcome of cognitive knowledge-based examinations such as the National Physical Therapy Examination (NPTE) or written comprehensive examinations.6,8-16 Traditionally, didactic learning outcomes in graduate and professional programs have been measured by high-stakes written examinations.17-19 Subject-level examinations emphasize narrow content area and evaluate focused cognitive knowledge. Comprehensive examinations focus on the specific discipline curriculum. Licensure preparation examinations are similar to comprehensive examinations but focus on content and strategies for passing standardized licensure examinations. Licensure examinations reflect a broad-based content previously determined as necessary to practice the profession and are characterized by strong validity and security of the content.20 Subject level examinations, comprehensive, and licensure preparation examinations are commercially available or faculty-developed, while access to licensure examinations is often regulated by governmental agencies.NPTE results are used for benchmarking by stakeholder groups. No standardized subject matter exams or comprehensive content exams are available to PT education programs based on a review of the websites of the major commercial licensure examination preparation companies.21,22 Commercially available licensure preparation examinations are available, but the exams do not make available to PT education programs individual item reliability and validity data, nor sample comparison data. …