INTRODUCTIONA primary goal of physical education is to graduate practitioners who will advance practice and the profession.1,2 Educational programs strive to provide students with cutting-edge information and to instill ideal attitudes, values, beliefs, and skills for providing high-quality care.3 However, students are taught is the right way in their didactic preparation may not be they encounter in clinical settings.4,5 For example, students may rarely see their clinical instructors search for and apply evidence or thoroughly document patient care. Conversely, students may wonder why a progressive intervention approach learned from a clinical instructor is not being taught in the classroom. In both of these situations, students are left to struggle with making sense of why they are taught one thing in school and something else in the clinic.4,5 The messages that students receive from this implicit or hidden curriculum in clinical education are particularly important because physical students spend a large amount of time exposed to the professional practice culture.6,7 If students experience different types of knowledge, values, and behaviors in clinical versus academic settings, then conflicting messages about it really means to be a good physical therapist can result in cognitive dissonance or feelings of discomfort from holding conflicting beliefs.5,8How students cope with and process dissonance can have important effects on educational activities.8 A greater understanding of how physical students experience and cope with cognitive dissonance caused by competing curricular factors has the potential to provide the basis for targeted educational approaches, enhanced learning environments, reduced student emotional stress and, in some cases, improved health care. The purpose of this research study was to explore how physical students experience and cope with dissonance in academic versus clinical settings.REVIEW OF LITERATURESeminal work on cognitive dissonance was published by psychologist Leon Festinger9 in the 1950s. His theory proposed that when a person experiences ideas or beliefs that are not psychologically consistent with one another, then he or she will try to reduce the inconsistency to maintain a state of consonance.10,11 Festinger10 explained dissonance in terms of a person's expectations. Throughout a person's life, he or she accumulates information and has expectations about what things go together and things do not.10(p94) When such an expectation is not met, dissonance results.10 This dissonance causes psychological discomfort, motivating the person to reduce the dissonance.12 The motivation to resolve dissonance impels a person to reassess beliefs and change opinions or behaviors.10,11In a qualitative study of medical students, Thompson et al8 indicated that the processing and reduction of dissonance occur in 2 forms: reconciliation and preservation. Reconciliation involved students altering their own internal ideals to align with external ideals. In preservation, students discounted or diminished external ideals so that they could maintain their internal ideals. In most cases, dissonance was found to be coupled with negative emotions; that is, students were uncomfortable when experiencing the inner conflict and tension of dissonance.8A common form of cognitive dissonance experienced by health care students and new graduates is the dissonance between they have learned in their educational programs and they have experienced in clinical practice.12-14 This dissonance leads students to question to believe: the academic ideal or the clinical reality.12 In a longitudinal study of newly qualified nurses, Maben et al13 found that professional and organizational constraints in the workplace were serious threats to the implementation and sustainability of nursing ideals and values in practice. Professional constraints included covert rules and a lack of positive attitudes and role models; organizational constraints included time pressures, staff shortages, and poor skill mix, resulting in intensification of nursing work, and role constraints. …