Physical Therapist Clinical Education Research Articles

A New Model to Advance a Collaborative Clinical Education Placement Process: A Consortium Core Network.

The 2014 Clinical Education (CE) Summit and subsequent scholarly work prompted development of collaborative, mutually beneficial, innovative processes to mitigate CE challenges and inefficiencies. Contemporary practice advocates for collaboration among physical therapist (PT) academic programs (Programs) and clinical partners (Partners) to create a sustainable placement process with mutual benefits for stakeholders. The purpose of this article is to describe the design and implementation of the Ohio Kentucky Consortium of Physical Therapy Educators (Consortium) Consortium Core Network's (CCN) centralized PT CE Placement Process (PT-CEPP) model and share participants' experience perspectives. The Consortium established the CCN and a Steering Committee, representing stakeholders, and designed a novel 5-phase centralized PT-CEPP model, in Exxat, an educational management platform. The phases included Request, Offer, Placement, Reallocation, and Confirmation and Release. A postimplementation Qualtrics survey was disseminated to obtain participant perspectives. Open-text survey responses were compiled, reviewed, thematically analyzed, and presented in this article (part 1). The resulting quantitative CCN PT-CEPP analyses were deferred to a companion article (part 2). The CCN participation included invited Partners (n = 101/364; 28%) and Programs (n = 14/14; 100%). During initial PT-CEPP implementation, 1,005 offers resulted in 549 CE placements. Participant perspectives from 20 of 101 SCCEs (20%) and eight of 14 DCEs (57%) were dichotomized into "Benefits and What Worked Well" and "Challenges and What Did Not Work Well." Perspectives were unique to participant roles, with partners valuing "centralization" and Programs "process." Lessons gleaned from the PT-CEPP paradigm shift to a CCN-centralized model may optimize processes and improve sustainability with future iterations.

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

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.

Development of a Tool to Determine Excellence in the Provision of Physical Therapist Clinical Education: A Modified Delphi Study.

The purpose of this study was to create a Site of Excellence in Clinical Education (SECE-PT) tool with the essential criteria used to determine excellence in the provision of physical therapist clinical education at a clinical site using a consensus-building approach. The development of the SECE-PT tool was divided into 2 parts. Part 1 involved the development of an initial set of proposed criteria, whereas part 2 employed a modified Delphi approach for consensus building. Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, site coordinators of clinical education, and directors of clinical education who met the inclusion criteria for the modified Delphi study. Three web-based survey rounds were used to achieve consensus, defined as a mean score of ≥7 on the 11-point Likert scale. The first round gathered demographic information on participants and collected information about clarity and redundancy in the criteria provided, the second gathered information once again about clarity and redundancy on the revised criteria provided, and the third asked participants to rate how essential it was for a site of excellence to demonstrate each of the final criteria. A total of 123 participants, equally representing clinical and academic perspectives, completed the demographic survey and round 1. Ninety-four participants completed round 2, and 80 participants completed the third and final round. Consensus revealed that 44 criteria were deemed essential for a SECE-PT to demonstrate. This study provides a measure to evaluate clinical sites providing clinical education. The SECE-PT tool should be widely adopted to evaluate the quality of the clinical site providing the education to student physical therapists. The SECE-PT tool can be used by clinical sites for self-assessment to examine aspects of their clinical education programs and determine whether parts of their program should be further developed. This can provide a framework for discussion and collaboration between clinical and academic partners, as well as regional consortia.

Impact of Preadmission Observation Hours on Key Physical Therapist Clinical Education Stakeholders: Quantitative Analysis

Introduction and Review of Literature. Physical therapist (PT) and PT assistant (PTA) education programs have historically required preadmission observation hours (ObHr) as an admission requirement. The variability of conditions surrounding ObHr lends itself to investigation. The aims of this study were to (1) identify the perceived value of ObHr to Admission Committee (AC) members, Directors of Clinical Education, current Doctor of Physical Therapy (DPT) students, and PT clinicians, (2) examine the effect that ObHr have on the decision-making process of AC members, and (3) examine the effect that ObHr had on current DPT students’ decisions to pursue a PT career. Subjects. Four stakeholder groups were targeted (N = 4,471). Methods. This descriptive, cross-sectional study utilized surveys to collect quantitative and qualitative data through closed-ended and open-ended questions. This article encompasses the analysis of the quantitative components by analyzing fixed responses on stakeholder surveys. Qualitative findings are reported in a separate article. Results. Perceived purposes of ObHr by stakeholders were as follows: (1) to gain an accurate understanding of the depth and breadth of the profession, (2) to confirm a desire to pursue PT as a profession, and (3) to better understand the roles and responsibilities of PT. The number of necessary ObHr varied among the groups ranging from 0 to 100 hours. Student perception that completing more hours than required would assist in their favorability for acceptance was debunked. Discussion. There was consensus among all groups regarding the perceived purposes. Variability of stakeholder perception of necessary ObHr to achieve goals was revealed. Doctor of Physical Therapy programs should be transparent and clarify the purpose and quantity of required ObHr. Conclusion. Long-standing requirements could be taxing current resources and limiting entry into the profession. Determining the minimum number of necessary ObHr, considering virtual methods, and employing distinct transparency on how ObHr are used in the decision-making process are opportunities for further study to address these issues.

Impact of Pre-admission Observation Hours on Key Physical Therapist Clinical Education Stakeholders: Qualitative Analysis

Introduction. Inclusion of preadmission observation hours (ObHr) as one component of the admissions process is commonly required in physical therapy education programs. The purpose of this study was to describe the value and impact of ObHr on 4 key stakeholder groups: doctor of physical therapy students, physical therapy clinicians, directors of clinical education, and admissions committee (AC) members. Review of Literature. The number of required and/or recommended ObHr and practice settings varies greatly. No previous study has explored a national dataset of key stakeholders' perspectives on ObHr experiences. Subjects. Four key stakeholder groups were targeted in the study (N = 4,471). Methods. Four stakeholder surveys were developed and distributed via email using a snowball sampling technique. Responses to the open-ended questions were analyzed using conventional content analysis for creating codes, categories, and themes within and across groups. Results. Five main themes emerged: 1) ObHr have value in career decision making; 2) students driven by hours, but all stakeholders value variety; 3) use of ObHr for program admissions decisions varies; 4) as the number of hours and settings increase, so do the challenges for students; and 5) there is interest in developing alternative ObHr experiences. Discussion and Conclusion. There was consensus among all stakeholder groups regarding ObHr's value for exploring the profession of physical therapy and helping applicants determine if the profession is a good fit. Respondents highlighted the value of observing in a variety of practice settings. Perspectives differed between AC members and students regarding the impact of ObHr on admissions decision making. Students reported a variety of personal and organizational challenges associated with ObHr completion. Physical therapy programs should reexamine their current ObHr practices and consider alternative methods that support all applicants in their pursuit of a career in physical therapy.

Part 2. Payment for Clinical Education Experiences in Physical Therapy: Perspectives From Stakeholders

Introduction/Review of the Literature: Payment for clinical education (CE) experiences is a current topic of discussion within health care professions wherein incidence of payment is described as rare but growing. The American Council of Academic Physical Therapy (ACAPT) Board charged the National Consortium of Clinical Educators (NCCE) to investigate payment for physical therapist (PT) CE experiences. The ACAPT NCCE Task Force (TF) on Payment for Clinical Experience surveyed academic, clinical, and student CE stakeholders to explore perspectives on the current landscape for payment of PT CE experience. Methods: Two surveys were constructed using an exploratory research design: an academic and clinical stakeholder survey and a student survey. For the academic and clinical survey, the TF used member content expertise and literature review to draft questions. Final questions were crafted after conducting 2 validation rounds by an expert panel. For the student survey, student focus groups created and validated final survey questions. Snowball sampling was employed for survey dissemination through ACAPT and NCCE networks. Descriptive statistics were examined and significant differences (P < .05) between stakeholder groups were analyzed. Analysis of open-text responses was conducted to categorize and identify common concepts. There were 1,883 academic and clinical stakeholder survey respondents, with 84.3% identifying as a clinical-only role; all NCCE regions and practice settings were represented. First-, second-, and third-year doctor of physical therapy student survey respondents (2,815) represented both private and public academic programs. Results: Less than 5% of academic institutions reported paying any portion of full-time CE experiences. A majority of respondents (1,153, 71.9%) were neutral or disagreed that clinical instructors (CIs) should receive direct payment for supervising students and 76.9% indicated that students should not be required to pay for CE experiences. Both intrinsic and extrinsic factors were cited as reasons not to seek payment and as benefits for providing CE experiences. Supervision restrictions and productivity expectations were identified as key barriers to providing CE experiences. Students indicated that prior knowledge of site and CI qualifications would be expected should students be required to pay for CE experiences. Discussion and Conclusion: Most academic, clinical, and student CE stakeholders did not support payment for CE experiences. The stakeholder-identified motivators and nonmonetary incentives to provide CE experiences present an opportunity to explore initiatives that will enhance availability of PT CE experiences aligned with an ACAPT strategic plan on a national level.

Telehealth Physical Therapy as an Innovative Clinical Education Model With Positive Patient Impact: A Case Report in the Context of the COVID-19 Pandemic

Background and Purpose. The potential benefits of telehealth physical therapy on patient access and outcomes have been explored in previous research. However, little is known regarding its role in physical therapist education and its impact on patient quality of life during a public health crisis. The purpose of this case report is to illustrate the twofold benefit of telehealth physical therapy as (1) a novel clinical education model that emphasizes adaptive learning and develops innovative physical therapists and, (2) a flexible care delivery model that has the potential to positively affect patient satisfaction and outcomes. Case Description. During the 2020 COVID-19 pandemic, students and faculty in the University of Minnesota Division of Physical Therapy education program rapidly established an innovative pro bono telehealth physical therapy clinic (TeleMNPT) in response to limited access to outpatient clinics for both patient physical therapy service provision and student physical therapist clinical education needs. This case report details the use of TeleMNPT services by a patient presenting with vertigo and the role telehealth played in facilitating student clinical learning while also improving patient outcomes and quality of life. Outcomes. The telehealth format offered challenges and benefits in student clinical education, including promotion of adaptive learning and role modeling, and produced positive functional outcomes and symptom reduction in the patient. Discussion and Conclusion. New insights were formed regarding telehealth's potential contributions to the development of future physical therapists and the profession's approach to serving patients. This case report serves as a stepping stone for examining the potential role telehealth can play as both a mode of care and as an educational tool.

Practices of Exemplary Leaders in Clinical Education: A Qualitative Study of Director and Site Coordinator of Clinical Education Perspectives

Introduction. Frequent turnover in director of clinical education (DCE) and site coordinator of clinical education (SCCE) positions may affect excellence in physical therapist (PT) clinical education (CE). Recognized CE leaders have demonstrated longevity and success in these roles. Understanding excellence in CE leadership may enhance delivery of PT CE. The purposes of this qualitative study were to explore characteristics of recognized PT CE leaders and identify the behaviors, thoughts, and actions of successful DCEs and SCCEs with demonstrated longevity. Methods. Purposeful sampling was used to identify PTs who have been either a DCE or a SCCE for at least 10 years and were recognized by their peers as a leader in PT CE. An interpretive phenomenological inquiry was conducted to explore the lived experience of CE leaders. Cognitive mapping and unstructured interviews were used to elicit perspectives on the factors that contributed to longevity and success. Using an inductive approach, DCE and SCCE data were analyzed separately. Due to substantial overlap in themes, the DCE and SCCE data were combined. Member checks and a peer review were conducted. Results. Seven DCEs and 6 SCCEs from the Northeast United States, with 8–26 (average 17) years in their position, completed the study. Five themes identifying their role success were the following: (1) Professional identity as a bridge between academic and clinical practices, (2) strong work ethic for excellence, (3) build meaningful relationships, (4) “bring-it-on” attitude, and (5) influence. Discussion and Conclusion. The participants shared common characteristics as exemplary leaders in CE. The main themes were in remarkable alignment with The 5 Practices of Exemplary Leaders, a well-established leadership model. These findings provide a framework to identify and develop the leadership qualities needed to fulfill these positions. These exemplary practices should be incorporated into leadership training for DCEs and SCCEs.

Physical Therapist Clinical Education in Pelvic Health: Survey of Current Views

Background: Physical therapists have expressed an interest in understanding the current standards of entry-level clinical education (CE) in pelvic floor (PF) physical therapy. Objective: To report the views among the American Physical Therapy Association Section on Women's Health (SoWH) members on structuring PF CE for student physical therapists (SPTs). Study Design: Survey research report. Methods: A survey developed by the SoWH CE Task Force was e-mailed to 2287 members of the SoWH in July 2017, with 351 members responding (17.9% response rate). Results were analyzed using descriptive statistics to provide insight into member characteristics and perceptions of SPT participation in PF CE. Results: Most respondents (73.2%) reported that SPTs should participate in PF CE, whereas 26.8% reported that SPTs should participate in PF CE only at exposure level or not at all. Less than half of the respondents thought SPTs should have opportunities to perform external perineal (41.2%), internal vaginal (34.7%), or internal rectal (24.2%) examination and treatment. There were relationships between indicating the view that SPTs should participate above exposure level in PF CE and respondents being younger than 50 years, having a DPT degree, having Women's Health Clinical Specialist certification, or being a credentialed clinical instructor. Conversely, there were relationships between indicating the view that SPTs should not participate above exposure level and respondents being aged 50+ years or having Certificate of Achievement in Pregnancy & Postpartum certification (P < .05). Conclusion: There is agreement among SoWH member respondents that SPTs should have opportunities to participate in PF CE, and agreement with this view is associated with level of education and younger age.

Development of an Innovative Taxonomy and Matrix Through Examination of the Director of Clinical Education's Roles and Responsibilities

Background. From the 2014 Clinical Education Summit, recommendations were made to strengthen physical therapist (PT) clinical education (CE). The Director of Clinical Education (DCE) is a key stakeholder in PT CE, and the roles and responsibilities of this position have come under review yet again. An investigation of this primary stakeholder is in alignment with the Summit's strategic plan and needed response to current inquiries. Objectives. To further the work of the study by McCallum et al 6 , the purpose of this study was to investigate and determine the evolution of DCE's roles and responsibilities, with the hypothesis that a new taxonomy would emerge, reflecting a distribution of responsibilities that would guide current and future roles of the DCE. Design. This study used a nonexperimental, descriptive, qualitative approach with a constructivist theoretical framework. Methods: The data set from the study by McCallum et al produced five primary themes. The fifth theme, studied in this report, produced three subthemes—improve efficiencies of systems, optimize clinical teaching, and collaboration with translational research. Watts' Taxonomy, as a foundational, theoretical construct, was the basis for the thematic analysis of these subthemes. Results. The development of an innovative DCE taxonomy with three responsibility levels—Processor, Coordinator, and Director emerged from the analysis of the fifth primary theme. Conclusions. Using the DCE taxonomy, DCE's roles and responsibilities matrix illustrates the importance of fitting tasks to the corresponding DCE's role and responsibility. The matrix shows how delegation of routine DCE tasks can promote the DCE's ability to engage in tasks higher in the taxonomy. This can lead to effective delivery of CE and DCE's engagement in strategic leadership in guiding the future direction of the CE aspect of the PT program.

Clinical Reasoning: Survey of Teaching Methods and Assessment in Entry-Level Physical Therapist Clinical Education

Background. Clinical reasoning skills have been identified as an integral part of physical therapist education developed in both the academic and clinical settings. There is limited understanding of clinical instructors (CIs) expectations related to the anticipated level of clinical reasoning (CR) skills achieved by students and how CR is taught and assessed in the clinic. Objective. The purpose of this research was to explore how CIs teach and assess student physical therapists' CR skills and garner an understanding of CIs' expectations related to CR skills attained at various levels of clinical experience. Design. A descriptive, cross-sectional survey was used to gather data from CIs. Methods. Participants identified from an American Physical Therapy Association database of credentialed CIs were asked to complete an 18-question electronically delivered survey. Results. A nationwide sample of 749 CIs completed the survey. The data clearly demonstrated that CIs value and recognize the importance of clinical education in the development of CR. They also value the use of engaged discussion and reflection to foster the development of reasoning skills. Most CIs did not expect students to achieve entry-level CR skills during the third year. Conclusions. Clinical instructors see the importance of clinical experiences and engaged discussion to foster the development of CR. Further research is needed to understand why most clinical educators did not expect students to achieve “entry-level” CR skills as defined by the Clinical Performance Instrument by the final year of the program.

Recommendations From the Common Terminology Panel of the American Council of Academic Physical Therapy.

In 2015, the American Council for Academic Physical Therapy (ACAPT) developed 3 strategic initiative panels to address integrated clinical education, student readiness, and common terminology for physical therapist clinical education. The purpose of this paper is to describe the results of the work from the Common Terminology Panel. This was a descriptive, consensus-based study. Using a consensus process and data that were collected from a review of literature, a document analysis of core and historical professional documents, focus group discussions, and an online open comment period, panel members developed a glossary for physical therapist clinical education. The final glossary included 34 terms in 4 categories. The categories included clinical education infrastructure, sites, stakeholders, and assessment. The ACAPT Board of Directors approved the glossary in June 2017, and the ACAPT membership approved the glossary in October 2017. The focus of the glossary was on physical therapist clinical education. A future, similar project should be undertaken for physical therapist assistant clinical education. This process resulted in a comprehensive glossary for physical therapist clinical education; changes to several current terms, including "internship" and "full-time clinical education experience"; and the addition of new terms, including "preceptor" and "site coordinator for clinical education." New terminology will provide standard language for consistent communication and a common framework for all stakeholders.

How Do We Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes

BACKGROUND AND PURPOSEThe imperative of clinical education in health professions is development of students' knowledge, skills, and behaviors essential to competence as new professionals. The current state of clinical education in physical therapist (PT) education programs across the United States reflects disparate approaches to meeting this imperative. The relatively few similarities in clinical education curricula are determined by the criteria for accreditation, which state that the curriculum includes content and learning experiences designed to prepare students to achieve educational outcomes required for initial practice.1(p31) The criteria also require clinical education experiences (CEEs) that allow students to manage patients/clients in various practice settings, across the lifespan and continuum of care; to participate in interdisciplinary care; and to engage in other experiences that lead to the achievement of expected student outcomes.1 Being rather broad and nonprescriptive, these criteria allow a wide variety of models for clinical education. The variation may not be advantageous or appropriate given the high stakes for students, cost to all stakeholders, and increasing demand on clinical sites as the number of academic programs and students grows. Data collated by the Commission on Accreditation in Physical Therapy Education (CAPTE) for 2012-2013 show that 45% of students' total education time is spent in CEEs,2 suggesting the importance of its influence on student outcomes and the need to ensure that this vital component of curricula is of the highest quality.This position paper (1) provides a brief overview of the challenges associated with physical therapist clinical education models, (2) briefly compares components of those models to those of other health professions, and (3) recommends steps toward decreasing variation and improving quality.FrameworkDonabedian's3 classic conceptual framework for examining health care quality seems to be appropriate for considering the issue of quality in clinical education. This framework proposes 3 components of quality (see Figure).* Structures. These are the physical and organizational aspects of clinical education settings (eg, types of settings, personnel, and finances supporting clinical education).* Processes. Processes rely on the structures to provide resources and mechanisms for participants to engage in effective educational activities. Processes in clinical education include student supervision, evaluation mechanisms, and administrative procedures.* Outcomes. Students' clinical performance is the most commonly measured outcome of CEEs; however, stakeholder satisfaction, cost of providing CEEs to students, and the benefits to clinical education faculty might also be considered.Before quality of clinical education can be assessed, it needs to be defined. Because perceptions of the quality of clinical education vary based on the myriad values and goals espoused by PT education programs and clinical education sites, it is difficult to define. The Donabedian model assists in framing this definition. For example, the model suggests that students' clinical performance or other measures of outcome, although important, may be limited as measures of quality. The structures and processes of clinical education as components of quality might be equally important based on an assumption, for example, that students' experiences must be appropriate in scope and depth, with suitable expectations for demonstration of competency.There are limitations to examining clinical education quality using this framework. When evaluating processes, judgments must be made about appropriateness, completeness, coordination, and continuity of CEEs. These judgments are based on values and standards that are sometimes implicit and perhaps not thoroughly examined for biases. Measurement of the processes of clinical education may be difficult due to both lack of agreement as to what processes to measure and lack of reliable measurement tools. …

On the Summit

I have been a physical therapist long enough to remember a 1994 article in the Wall Street Journal that had a huge impact on our profession. The article, titled Health: One Bum Knee Meets Five Physical Therapists, highlighted the variability in physical therapist practice that one patient experienced for a seemingly simple diagnosis.1 Since that time, our profession has made great strides in establishing best practice guidelines for the services we provide, while still enabling every clinician to approach each patient in a personalized manner. Yet, in the world of education, we continue to live with a significant level of variability in how we teach our students. We ask our clinical instructors to teach students who come from a variety of academic programs that have a variety of curricular structures. These students come in with varying levels of preparation and varying expectations for performance. Our peer professions, patients, and employers struggle with this level of variability as well. However, as Jette et al state in the first article in this issue, while the evidence on best practices in physical therapist clinical education is not always strong, as professionals we have to make decisions based on best available evidence. It is time for us to take that step as educators.I am excited to present you with this special issue of the Journal of Physical Therapy Education focused on clinical education as a key step in this process. As a former director of clinical education, I am well aware of our profession's efforts over many years to improve clinical education, often through standardization of processes and cooperation across programs. Our profession has had a number of successes in this process: the development of the Clinical Performance Instrument, the credentialing of clinical instructors, formation of many active regional consortia, to name just a few. However, any of us involved in clinical education are aware of many of the challenges that we face.As our profession has grown and developed, the climate surrounding physical therapist education has changed as well. Health care reform, changes in Medicare payment structures, population demographics, and the increased emphasis on chronic disease management have all influenced our current system of clinical education. The changing landscape of health care and its influence on education was part of the reason for the formation of the American Council of Academic Physical Therapy (ACAPT), which has provided physical therapist academic programs with a structure to facilitate decision making on issues related to physical therapist education. These past successes and current challenges in clinical education, combined with the efforts of ACAPT, that created the motivation to orchestrate a change in clinical education. At the 2012 APTA Combined Sections Meeting in Chicago, the construct of a process for developing a for physical therapist clinical education began. From this first meeting, it was recognized that a shared vision is one that recognizes and strengthens partnerships across the entire spectrum of physical therapist education, from entry-level through postprofessional, clinical through academic.As a current member of the ACAPT Board of Directors, I serve as co-chair on the steering committee that is guiding this process. This steering committee is comprised of 10 members representing the Education Section, the Clinical Education Special Interest Group (CESIG) of the Education Section, ACAPT, the Federation of State Boards of Physical Therapy (FSBPT), and APTA, and includes members who are directors of clinical education, academic program administrators, and clinical faculty. Together, we have collaborated on a process that leads us to a Clinical Education Summit in October 2014 where we anticipate reaching agreement on best practices for clinical education in entry-level physical therapist education with specific recommendations to ACAPT for implementation. …

Development of Regional Core Networks for the Administration of Physical Therapist Clinical Education

Background and Purpose. Steady growth for physical therapists (PTs) is predicted over the next decade. In turn, enrollment in PT education programs continues to grow, which results in additional clinical education resource needs. The current model to administer clinical education may be unsustainable considering reimbursement rates, productivity demands, staffing, and organizational changes due to health care regulation. Position and Rationale. Compelling evidence supports the context that clinical education is best delivered at a regional level. The collaboration of PT education programs and clinical practice facilities through a regional core network (RCN) should increase efficiency, improve collaboration, and reduce competition amongst stakeholders. The purpose of this paper is to describe the elements and structure of an RCN model for clinical education, and introduce the roles and responsibilities of its stakeholders. Discussion and Conclusion. The development of an RCN would be driven by both efficiency and quality enhancement through the collaboration of 3 associated parties: PT education programs, clinical education sites, and a regional office. The goals for an RCN include streamlining the clinical placement process; building clinical capacity; improving communications; standardizing policies and procedures; advancing use of technology; research development; and improving overall quality of clinical education. Directors of clinical education (DCE) and center coordinators of clinical education (CCCE) are the bridge agents in the development of this new administrative clinical education model. Challenges include funding sources and relinquishing selected elements of individual and institutional autonomy. The RCN model is intended to allow compromise, with the exact design of each network decided by the stakeholders for a shared approach to the delivery of clinical education within a region.

Quality in Physical Therapist Clinical Education: A Systematic Review

Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices. The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE. This study was a systematic review of English-language journals using the American Physical Therapy Association's Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis. Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14. Publication bias and outcome reporting bias may be inherent limitations to the results. The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.

Student Perception of Applying Joint Manipulation Skills During Physical Therapist Clinical Education: Identification of Barriers

Introduction/Review of Literature. A 2004 survey of physical therapist education programs indicated that out of 116 responding programs, 44% were including thrust joint manipulation (TIM) in their curriculums. CAPTE accreditation includes instruction of TJM during physical therapist professional education. TJM has been shown to be effective in certain patient populations and adoption of TJM by graduating students is likely dependent on both didactic and clinical education. The purpose of this study was to identify and describe potential student-perceived barriers to learning and practicing TJM. Subjects and Methods. Students targeted from all professional PT education programs in their final year of graduation and within 3 months following graduation were asked to complete a survey that was sent to program directors to distribute to students. Results. 460 subjects responded from 38 states (all US regions). The median age was 26 and 73% were female. Results indicated a level of didactic education in TIM (95%), but a lesser percentage of opportunities to utilize techniques clinically. When asked about their experience during outpatient orthopedic-based clinical education, 54% of the student respondents indicated that they perceived that their clinical instructors (CIs) were not completely comfortable with students performing TJM. When students did not utilize TIM, despite clinical indication, they cited lack of confidence (55%), personal skill level (48%), and not feeling academically prepared to utilize techniques (26%) as some of the reasons. Discussion and Conclusion. This survey suggests an increase in the number of professional physical therapist education programs teaching TJM. However, the students surveyed perceived barriers to practicing TJM during clinical experiences, which may limit their use of these techniques during their clinical practice. While TIM instruction in academic programs appears to be increasing, full adoption clinically requires practice. Enhanced CI education may increase the opportunity for student TJM practice during internships and may result in adoption of TJM practice after graduation. Key Words: Clinical education, Student learning, Teaching methods, Orthopedics/musculoskeletal, Professional development. INTRODUCTION/REVIEW OF LITERATURE Application of published evidence into clinical practice is an expectation as the profession of physical therapy evolves and grows. In particular, as practitioners with doctoral degrees, physical therapists are increasingly expected to integrate current best evidence into clinical practice. Sackett1 states that an essential tenet of evidence-based practice (EBP) is integrating individual clinical expertise with the best available external clinical evidence from systematic research.?71 Using the Levels of Evidence from the Oxford Centre for Evidence-Based Medicine,2 thrust joint manipulation (TIM) is an intervention that has a growing body of high-level evidence supporting its use.3'5 TIM is included in The Commission on Accreditation of Physical Therapy Education's (CAPTE) evaluative criteria for physical therapy programs, indicating that it is now considered an entry-level skill for physical therapist (PT) education program graduates.6 TIM has traditionally been included in the broad category of manual therapy, and specifically mobilization/manipulation, defined in the American Physical Therapy Association's (APTA) Guide to Physical Therapist Practice7 as ... comprising a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small-amplitude/ high-velocity therapeutic movement.1*80 For the purposes of this research, the term thrust joint manipulation is defined as a high velocity/low amplitude therapeutic movement directed at a joint. TIM has been a component of physical therapy practice since its inception8'9 and has been reported to be effective for numerous musculoskeletal conditions. …

Exploring Experienced Clinical Instructorsʼ Experiences in Physical Therapist Clinical Education: A Phenomenological Study

Background and Purpose. Recent data indicates that approximately 46% of the time spent in physical therapist professional education consists of clinical experiences. The clinical instructor (CI) plays an instrumental role in providing effective clinical education. To improve the value and the consistency of clinical education, the American Physical Therapy Association (APTA) developed a training course for clinical instructors (CIs) titled the Clinical Instructor Education and Credentialing Program (CIECP). Subsequently, several studies have quantitatively examined the types and effectiveness of teaching behaviors of CIs based on who took the CIECP. Despite this research, we have limited information about the daily interactions between CIs and students. The purpose of this phenomenological study was to explore and describe the roles and behaviors of experienced CIs as they conducted clinical education. Subjects. Purposive sampling was used to select 6 experienced, APTA-credentialed CIs who worked in various clinical settings. Methods. Semi-structured interviews were conducted. Results. The experienced CIs in this study described their primary role as helping students transition from formal (classroom) learning experiences to clinical practice. Three educational strategy themes emerged from the CIs' behaviors while transitioning students to clinical practice: incremental learning, reflection in practice, and creating a caring environment with students. Discussion and Conclusion. The results indicate that the experienced CIs exhibit teaching behaviors similar to those of competent and expert clinicians and, therefore, models of competent and expert clinicians may be applicable to understand the behaviors of experienced CIs. Key Words: Clinical instruction, Physical therapist, Teaching behaviors, APTA Clinical Instructor Education and Credentialing Program. BACKGROUND AND PURPOSE During the 2004-2005 academic years, clinical education averaged 41.5% of all hours accumulated during physical therapist education. In 2009-2010, the proportion of clinical education to total academic hours increased to 45%.? This upward trend suggests that the use of clinical education to train future physical therapists (PTs) will most likely continue to grow. Why is clinical education so important in training health care professionals? Clearly, clinical education offers students learning experiences not available in the classroom. Unlike the classroom, learning in the clinical setting is embedded in a complex social and physical environment that is highly demanding, unpredictable, and uncertain.2 Most prominently, the clinically embedded nature of clinical experiences provides students with authentic, student-centered learning- integrating theory with problem solving, facilitating professionalism, and enhancing clinical skills. Plack and Driscoll,3 discussing the importance of clinical experiences, write: Clinical internships and other clinical education experiences are what provide the real life experiences or contextual, social and interactive experiences that help us translate some of the abstract theories learned in the dassroom to actual clinical practice. (p162) For physical therapist students, meaningful practice emerges during clinical experience. Whereas classroom learning may simulate real-life clinical situations, Mostrom4 writes, It is the clinical setting where theory, research, and text acquire contextual, relational, and personal meaning for health professional students.(p266) Specifically, the clinic provides the educational experience for transitioning physical therapist students to physical therapists. As Emery5 explains, clinical education provides a vital extension of the academic program because students practice their newly learned psychomotor skills and assume a role that incorporates the attitudes, values, and beliefs of the physical therapy profession. …

Is There a Relationship Between Performance During Physical Therapist Clinical Education and Scores on the National Physical Therapy Examination (NPTE)?

Background and Purpose. The determination of whether a student physical therapist (PT) has reached entry-level status for graduation purposes is partially determined by the physical therapist education program's evaluation tool used for rating student performance in the clinical setting. The determination of whether a graduate can practice physical therapy depends on graduate performance on the National Physical Therapy Examination (NPTE). Clinical performance as assessed by the clinical evaluation tool used by members of the Texas Consortium for Physical Therapy Clinical Education (Consortium), the Physical Therapist Manual for the Assessment of Clinical Skills (PT MACS), has not been evaluated with regard to the NPTE. Therefore, the purposes of this study were to assess the following: (1) the relationship between PT MACS section scores on the first and final clinical experiences with section scores on the NPTE among first-time test takers, (2) the relationship between PT MACS aggregate scores on the first and final experiences with the overall score on the NPTE among first-time test takers, and (3) the relationship of final PT grade point averages (GPAs) with NPTE scores among first time test takers. Subjects/Methods. This retrospective study used archived academic, clinical, and NPTE performance data collected by the directors of Clinical Education of 8 Texas PT professional education programs for classes graduating between 2004 and 2007. The total number of graduates was 985. Data were analyzed for relationships using Pearson product moment correlation coefficients. Results. Small, but significant, relationships were found between 2 PT MACS sections and corresponding sections on the NPTE (P Discussion and Conclusion. Although-several small, significant relationships were found between the PT MACS sections and corresponding NPTE sections, PT GPA demonstrated the greatest relationship with success on the NPTE, reinforcing the findings of previous studies. Based on results of the inter-item analysis, the PT MACS demonstrated good internal consistency reliability. Results of this study suggest that an assessment tool that tests all domains of learning cannot predict performance on a cognitive instrument such as the NPTE. Key Words: Physical therapy, Clinical education, Licensure examination. BACKGROUND AND PURPOSE Today's health care system requires that newly graduated physical therapists (PTs) enter the workforce prepared to meet the demands of total patient management. Graduates are expected to perform at a level that meets the standards of safe, effective, and efficient practice. The educational preparation of these graduates includes completion of both intense schedules of didactic classroom experience and complex clinical experiences. The combination of didactic preparation and clinical competence in entry-level skills must be assessed in order to determine the eligibility of a student to graduate from the PT education program. Clinical competence is assessed using evaluative tools specific to clinical skills that define entry-level standards. One such evaluative tool is the Physical Therapist Manual for the Assessment of Clinical Skills (PT MACS),1 developed by the Texas Consortium for Physical Therapy Clinical Education. Successful completion of an accredited professional physical therapist education program allows the graduate to apply for and take the National Physical Therapist Examination (NPTE). Entry-level competence is assessed using multiple-choice items that have been constructed based on a formal survey of physical therapists describing their current job activities and responsibilities. …

Linking the Classroom and the Clinic: A Model of Integrated Clinical Education for First-Year Physical Therapist Students

Background and Purpose. This article describes an education model in a doctor of physical therapy (DPT) program that collaborates with multiple (15) clinical facilities to provide integrated (part-time) clinical education (ICE) experiences for first-year physical therapist students. Features of this model include: (1) clinical faculty (CF) who partner with core faculty in promoting the learning and professional development of students and (2) a financial arrangement where the academic institution reimburses the clinical site for clinical faculty time. Method/Model Description and Evaluation. Starting the second week of the program, groups of 3 students are instructed by one CF who designs learning activities that precede, coincide, or review on-campus learning. Students practice components of patient/client management; begin to apply basic medical and behavioral science to practice; and deepen their understanding of the breadth and complexities of physical therapy practice. Mechanisms used to link clinic and classroom learning and assess student performance are described. Outcomes. Survey data and feedback on the ICE component of the curriculum reveals multiple themes related to student learning using this model, including establishing context/relevance for learning; increasing motivation for learning; reinforcement of learning; improving recall/review of knowledge; enrichment from peer learning; and preparation for full-time clinical education. Data from CF indicate multiple areas of satisfaction with this model of integrated clinical education, including professional development and growth as clinical educators. Core faculty also reported satisfaction with this model in several arenas. Discussion and Conclusion. Incorporating integrated clinical education experiences into the curriculum is one approach to adding context and relevance to learning for first-year DPT students. Early exposure to a variety of clinical settings may help DPT students to start thinking like physical therapists earlier rather than later in their professional education. BACKGROUND AND PURPOSE Physical therapist educators are faced with the challenge of preparing new graduates to assume the responsibilities of autonomous practice as called for in Vision 2020, l and also to meet rapidly growing productivity expectations in the workplace. It is imperative that new graduates enter the workplace with well- developed and established performance capabilities to meet these demands. To achieve this goal, physical therapist educators must strive to maximize student learning in the classroom and clinic. Using curricular models and teaching strategies that encourage students to approach their learning in a deep, rather than surface, manner may help students take full advantage of their classroom and clinical learning experiences.2-8 The importance of context and relevance in adult learning has been well documented and supports using mechanisms to help students link their classroom and clinical learning.912 Curricular designs in which didactic learning is not intentionally connected with clinical learning may not be conducive to deep learning processes because students could fail to see the relevance of their learning, making contextual application of that knowledge a challenge. If there is a disconnect between academic and clinical faculty, the problem may be compounded. Regular interaction with patients during clinical education experiences embedded within didactic on -campus courses may help physical therapist students integrate didactic knowledge with clinical application. Early, integrated exposure to clinical practice has been proposed as one aspect of the preferred infrastructure for physical therapist clinical education.13 The purpose of this article is to describe an integrated clinical education (ICE) model in which students have frequent, half- day clinical education experiences that start the second week of their first year and extend through most of the second year of the 3-year curriculum. …