Use of learner-driven, formative, ad-hoc, prospective assessment of competence in physical therapist clinical education in the United States: a prospective cohort study

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The purpose of this project was to implement a process for learner-driven, formative, prospective, ad-hoc, entrustment assessment in Doctor of Physical Therapy clinical education. Our goals were to develop an innovative entrustment assessment tool, and then explore whether the tool detected (1) differences between learners at different stages of development and (2) differences within learners across the course of a clinical education experience. We also investigated whether there was a relationship between the number of assessments and change in performance. A prospective, observational, cohort of clinical instructors (CIs) was recruited to perform learner-driven, formative, ad-hoc, prospective, entrustment assessments. Two entrustable professional activities (EPAs) were used: (1) gather a history and perform an examination and (2) implement and modify the plan of care, as needed. CIs provided a rating on the entrustment scale and provided narrative support for their rating. Forty-nine learners participated across 4 clinical experiences (CEs), resulting in 453 EPA learner-driven assessments. For both EPAs, statistically significant changes were detected both between learners at different stages of development and within learners across the course of a CE. Improvement within each CE was significantly related to the number of feedback opportunities. The results of this pilot study provide preliminary support for the use of learner-driven, formative, ad-hoc assessments of competence based on EPAs with a novel entrustment scale. The number of formative assessments requested correlated with change on the EPA scale, suggesting that formative feedback may augment performance improvement.