Introduction.To date, there is a lack of standardization across physical therapist education programs (PTEPs) in the United States as to what qualifies students to be ready for first, full-time clinical education experiences (CEEs). This study aimed to develop readiness objectives for first, full-time CEEs that will be applicable to all clinical settings, based on input from regional clinical faculty.Methods.Clinical faculty (n = 50) accepted an email invitation from the New England Consortium of Clinical Educators to participate in the study. Academic faculty (n = 20) served as facilitators and scribes during the in-person data collection and also completed the survey. Data saturation and consensus building were used in a 2-round modified-Delphi process. Readiness objectives were developed in-person, during the initial round, using the categories of the American Physical Therapy Association'sClinical Performance Instrument(CPI) and Bloom's Taxonomy to inform the process. The second round of data collection asked participants to rate the previously developed readiness objectives for degree of importance and appropriateness of performance level for first, full-time CEEs. This phase was completed via electronic survey.Results.Participants agreed that 22 readiness objectives were “very important.” Eleven of these readiness objectives were within the affective domain, specifically in theCPIcategories of Accountability, Professional Behaviors, Communication, and Cultural Competence. Of the remaining readiness objectives, 5 were directly related to patient safety.Discussion and Conclusion.The results of this study are consistent with other health care professional literatures that indicate clinical faculty prioritize students' behaviors in the affective domain and their ability to maintain patient safety. It is incumbent on the PTEPs to provide students opportunities for development and practice in these areas and assess performance related to these readiness objectives before the first, full-time CEEs. Utilization of these 22 readiness objectives is one method by which PTEPs may meet this expectation.

Background Clinical education curricular models specifically related to integrated clinical education (ICE) vary across physical therapist education programs. The interconnectedness of ICE to the advancement of a shared vision for clinical education in professional physical therapist education needs investigating. Purpose The purpose of this scoping review was to: (1) define ICE, (2) define baseline expectations and parameters of ICE, and (3) discern and describe current ICE models. Data Sources Databases accessed included Medline, MedlinePlus with Full, CINAHL, and CINAHL Plus with full text. Study Selection A multimodal data collection scoping review was completed. Data collection included survey research, a systematic review of the literature, and a series of focus groups. The McMaster Critical Appraisal Tool assessed methodological study quality. A qualitative, metasynthesis approach was used for data synthesis. Consensus agreement produced results. Data Extraction Twenty-two articles were included in the literature review from the health disciplines of medicine, nursing, physical therapy, occupational therapy, and speech-language pathology. Data synthesis produced 8 parameters defining the factors essential to categorizing clinical education experiences as ICE in physical therapist education. The 8 parameters and ICE definition are supported by a description of models of ICE that currently exist within health profession curricula. Data Synthesis Data synthesis followed a qualitative, metasynthesis approach. Themes emerged from the surveys, literature review, and focus group data. Patterns were compared, analyzed, and synthesized to generate the themes and ICE parameters. Limitations Selection bias from the literature search could have limited the richness of the model descriptions by unintentional exclusion of articles, and might limit the applicability of results beyond the United States. Sampling bias from survey and focus groups, although purposeful, might have limited a broader description of current viewpoints about ICE. However, the data sources, including multiple health profession perspectives coupled with consensus agreement, provide sound evidence in development of profession-based parameters. Conclusions The results of this scoping review provide the profession with a standard definition of ICE and parameters that can guide a program in designing a curriculum using ICE experiences as a foundation. A recommended next step is to design education research studies using reliable and valid outcome measures across programs to determine impact and effectiveness of ICE as an educational intervention.

Introduction. Clinical instructors (CIs) use narratives to qualify anchor points for 18 performance criteria on the Clinical Performance Instrument: Version 2006 (CPI'06) when assessing students' performance during clinical experiences. Directors of Clinical Education (DCE) final narratives and anchor points on the CPI'06 to make sure that the narratives and anchor points are in alignment with each other. CIs and DCEs should have a mutual understanding of the terminology used on the CPI'06. The purpose of this study was to determine the level of agreement (concordance) between raters on whether examples of narratives supported the term, “entry-level performance” (ELP), before and after focus group discussions. Methods. Fifty-four CIs discussed the CPI'06 terminology. A pretest/posttest design was used with the intervention being focus group discussions. Participants compared the definition of ELP with sample narratives and agreed, disagreed, or remained undecided about whether the narratives supported ELP. Statistical tests were analyzed to determine participants' concordance about whether the narratives supported ELP. Their rationale to support their decisions was analyzed using qualitative methodology. Results. Participants' percent of pairwise agreement about whether the narratives supported ELP for testing conditions were highest for safety (65.2–95.3%) and lowest for professional behaviors (34.4–44.0%). Intraclass correlation for multiple raters using ICC(2,1) model indicated interrater reliability for absolute agreement on each test, across five performance criteria, was fair to poor. Qualitative assessment for participants' rationale about decisions indicated inconsistencies in the interpretation of CPI'06 terminology. Discussion and Conclusion. Agreement among professionals about the interpretation of the language used on the CPI'06 to ensure that students graduate with the requisite skills and behaviors is essential. This study indicates that there was a lack of participants' concordance with the interpretation of ELP on the CPI'06.

Background and Purpose: An essential component of students' preparation as physical therapists is to participate in fulltime clinical education experiences. The contemporary environment in physical therapist practice has created challenges to the provision of these clinical education experiences, particularly as it relates to the regulatory environment and the productivity demands on clinical facilities. This report summarizes the outcomes of focus group discussions conducted with physical therapists in New England to more clearly identify how the partnership between clinical facilities and physical therapist education programs could be strengthened. Subjects: A total of 33 focus group discussions were held throughout New England, in which 257 clinicians participated. Methods: A semi-structured focus group survey process was developed to obtain physical therapists' feedback and perspectives on current clinical education issues and challenges. Participants in the focus groups were asked a series of questions about what the academic-clinical partnership should look like and strategies they would suggest to manage current challenges related to clinical education. Results: Focus group analysis identified 2 major themes from the discussions: communication/collaboration and economic factors of clinical education. Specifically, this report summarizes the subthemes identified under the economic impact of clinical education, including: (1) influences of payers for physical therapy services; (2) concerns about how clinical education impacts costs to the facility and personnel; and (3) strategies to offset some of the perceived costs of clinical education. Discussion and Conclusion: Focus group discussions highlighted multiple challenges associated with offering clinical education experiences that included staffing issues, third-party payment, and the economic impact on clinical facilities. Participants provided suggestions on how to offset some of these perceived challenges. Further research is needed to determine how clinical education experiences impact clinicians' productivity and personnel issues in a highly demanding work environment. Most important, physical therapist education programs and clinical facilities need to work in partnership to determine how clinical education can be sustained given the challenges associated with it.

Background and Purpose. The current state of clinical education curricula in physical therapist education programs across the United States reflects disparate approaches to clinical education experiences for students. Using Donabedian's classic conceptual framework for examining health care quality, this position paper describes the structures, processes, and outcomes of the current approach to clinical education in physical therapist education programs and makes recommendations for taking steps toward improving quality. Position and Rationale. Wide variation in the organizational structure and processes of clinical education, and in expected student outcomes may not be advantageous or appropriate. Costs to all stakeholders are a concern and may be unsustainable. Although the problem is complex, to successfully manage clinical education, improve outcomes, and reduce costs, some degree of profession-wide consensus must be reached about best practices related to structure, processes, and outcomes. Discussion and Conclusion. Although published literature is insufficient to support any one structure or process in any aspect of clinical education, scholarly practitioners in any profession must weigh the best available evidence in making necessary decisions. The physical therapy profession must decide if there is a compelling reason to make changes using the existing sparse and flawed evidence, and, if so, what those changes should be. Given the complexity of the problem, a national dialogue should open regarding viable standardized structures, processes, and outcomes measurement, with an eye toward improved quality.

Background and Purpose. Clinical education experiences (CEEs) provide physical therapist (PT) students with opportunities to be immersed in clinical practice to develop professional skills and behaviors under the supervision of a clinical instructor (CI). Essential characteristics and qualities of CIs and of the clinical practice environments in which CEEs take place that promote student learning are clearly described in the literature and in professional documents. However, there are currently wide variations in the quality of CEEs. Factors that appear to contribute to this variability include the CIs' teaching skills, the culture of the clinical site, and supports extended by physical therapist (PT) education programs. The purpose of this paper is to define the baseline qualifications and essential characteristics of CIs and of practice environments that our profession should consider as standards for clinical education and to make recommendations for changes that are needed to promote consistently high quality CEEs. Position and Rationale. It is our position that all stakeholders in clinical education need to engage in a deliberate effort to ensure that all students have access to quality CEEs that demonstrate agreed upon, evidence-based professional standards. We propose that the development of CIs is analogous to the development of a skilled PT, such that CIs move from being novice to expert clinical teachers. Clinical instructors and clinical education sites should be assessed in a standardized manner and the results shared across PT education programs education programs to cultivate high quality CEEs. Directors of clinical education (DCEs), working together through regional consortium, can meet the identified professional development needs of CIs and of center coordinators of clinical education (CCCEs) in an efficient and timely manner. Furthermore, we recommend that the expert CI be recognized as a clinical education specialist in the same way other specialists are recognized by the American Board of Physical Therapy Specialties (ABPTS). Physical therapist education programs, clinical education sites, and the profession at large must acknowledge the benefits of quality CEEs and assume responsibility to foster the development of expert CIs and of learning environments conducive to student learning. Discussion and Conclusion. Physical therapist education programs and clinical sites need to be held accountable to ensure that evidence-based and agreed upon standards for CEEs are available to all students. This will require negotiation and compromise by administrators at both settings. National-level discussion is required to develop a strategic plan to determine how these recommendations might be implemented so that professional standards for all CEEs are realized.

Background and Purpose. Partnerships need to exist between the clinical and academic communities in order to maintain the quality of clinical education. This qualitative study reports the outcomes of discussions between academic and clinical faculty concerning standards for clinical education. Subjects. Participants were 43 clinical and academic physical therapist (PT) educators, new graduates, and students. Methods. An overall concept of phenomenology was used in this qualitative study. We conducted interviews using a focus-group methodology. Participants were asked: (1) If we were to build clinical education from scratch with considerations given to Vision 2020, what would or should clinical education look like? (2) Looking at the state of clinical education as it exists today, what are the components that could or should be standardized? (3) What should not be standardized? We then determined common themes among the interviews. Results. Analysis identified 5 major themes related to standards for clinical education: (1) format and length of clinical experiences (CEs), (2) breadth of CEs, (3) expected outcomes and assessment of students' clinical performance, (4) standards for clinical instructors (CIs), and (5) standards for clinical education facilities. Discussion and Conclusions. Academic and clinical faculty did not agree on the need to standardize length, breadth, and credentials for CIs. Participants expressed interest in using clinical competencies as an outcome assessment for clinical education and described some qualities that clinical education facilities should possess.

Background and Purpose. Recently, there has been a heightened expectation that physical therapy education programs assess the competence of physical therapists (PTs) serving as clinical instructors (CIs). The purpose of this study was to determine whether students perceived APTA-credentialed CIs to demonstrate a greater number of effective clinical teaching behaviors than noncredentialed CIs. Subjects. 158 PT students, participating in full-time clinical experiences (CEs), and their respective CIs (73 credentialed, 85 noncredentialed) were included in this study. Methods. Subjects were recruited from the 209 accredited PT education programs in the United States. Students completed an adapted version of the Nursing Clinical Teacher Effectiveness Inventory (NCTEI), which listed CI teaching behaviors within 5 general domains. A multiple linear regression model was utilized to evaluate confounding variables among the CI demographics. Chi-square or Fisher exact tests were calculated for nominal variables and Wilcoxon rank sum tests were calculated for ordinal and continuous variables to examine differences in student ratings of teaching behaviors for their CIs. Spearman rank correlation coefficients (r) were also utilized in subsequent data analysis to determine relationships between years of experience as a CI and the aggregate score of the NCTEI. A P = .05 level of significance was utilized for all analyses. Results. Data analysis revealed no significant difference in aggregate NCTEI scores between APTA-credentialed CIs and noncredentialed CIs. Additionally, the 2 groups did not differ significantly in any of the individual domain scores. A positive correlation existed between the number of years a PT functioned as a CI and a higher NCTEI aggregate score. Discussion and Conclusion. These results fail to support the hypothesis that APTA-credentialed CIs obtain higher scores on the adapted NCTEI than clinicians who were not credentialed, as perceived by their respective students. Results suggest that years of experience as a CI are more positively associated with effective teaching behaviors.

Background and Purpose. Physical therapist (PT) education programs often establish rubrics to outline performance expectations on the Physical Therapist Clinical Performance Instrument (PT CPI). The purposes of this study were to determine if directors of clinical education/academic coordinators of clinical education (DCEs/ACCEs) establish minimum performance expectations on the PT CPI, if student performance was expected to increase from the initial to culminating clinical experience (CE), and whether Master of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT) programs expected different levels of student performance. Subjects. Representative DCEs/ACCEs of the nation's PT education programs. Methods. DCEs/ACCEs completed a survey describing how they establish and utilize minimum student performance expectations using the PT CPI. Descriptive statistics were used to identify frequencies, means, and standard deviations for the data. Multivariate analysis of variance (MANOVA) was used to determine differences in academic programs' performance expectations from initial to culminating CEs and between MPT and DPT programs. Results. A total of 103 (88.79%) of 116 DCEs/ACCEs reported that they use the PT CPI, and 84 (81.55%) reported that they establish rubrics to define minimum performance expectations. Range of rubric means for the initial CEs on performance criteria 1-24 was 41.73 mm-80.94 mm, and 89.42 mm-96.63 mm for the culminating CEs. MANOVA indicated that scores for culminating CEs were significantly greater than those for initial CEs. MANOVA did not indicate any significant differences between MPT and DPT programs' rubric means for performance criteria 1-24 for initial or culminating CEs. Discussion and Conclusions. The majority of surveyed schools utilized the PT CPI to define acceptable ratings on the PT CPI. PT education programs expect student ratings on the PT CPI to increase from the initial to the culminating CEs; however, the majority of programs do not require students to demonstrate “entry-level clinical performance” on all performance criteria. There were no significant differences in the performance expectations of MPT programs compared to those of DPT programs.

Background and Purpose. Full-time clinical education experiences represent an average of 41% of the total contact hours students spend in physical therapist education programs. As a result, clinical instructors (CIs) assume an influential role in the professional and social development of physical therapist students. Despite this important role, there is a paucity of published literature describing the qualifications and credentials of these individuals. The purpose of this study was to describe the qualifications and credentials of CIs supervising physical therapist students. Subjects. The participants were 255 physical therapists serving as CIs for 85 physical therapist students in the class of 2001 from 2 physical therapist education programs. Methods. Subjects were asked to complete a CI survey at the conclusion of each clinical experience. Survey instruments were returned by 230 of the 255 CIs (90.20% response rate). Each clinical education experience was 8 weeks in length, and the majority (81.57%) occurred at clinical sites in New England (CT, MA, ME, NH, RI, and VT). Results. The typical profile of a CI in our study is a female whose highest earned degree is a bachelor's degree. The typical CI is not a member of the American Physical Therapy Association and is neither a credentialed CI noraboard certified clinical specialist. Based on median responses, the typical CI has over 5 years of clinical practice and 4 years of clinical teaching and has supervised 2 students during the past 12 months. Discussion and Conclusion. Assessing the qualifications and credentials of CIs provides academic programs with a more accurate depiction of the individuals providing supervision to physical therapist students and may be useful information when planning future clinical faculty development activities.