Impact of In-class Patient and Integrated Clinical Experiences on Physical Therapist Students’ Clinical Performance

Rationale: A variety of clinical education (CE) exist. Models emphasizing full-time clinical experiences (FTCE) have higher number of full-time hours (high-hours) with less prior didactic preparation and integration with the curriculum. Models including integrated clinical experiences (ICE), part-time ICE (PTICE), and in-class patient experiences (IcPE) integrate experiences with didactic content but include a lower number of full-time hours (low-hours). The purpose of this study is to determine if a re-designed CE curricular model that emphasized IcPEs and ICE with low-hours better prepares students than a version that emphasized FTCEs with high-hours as measured by scores on the Clinical Performance Instrument (CPI). Methods: A retrospective cohort study was conducted on a data set of 183 Doctor of Physical Therapy students who participated in an initial and final terminal CE experience. Data included student pre-admission data, demographics, and evaluation type, period, and rating for all 18 CPI criteria for the initial and final terminal CE experiences. Data were analyzed using SPSS Statistics. Results: A statistically significant difference was found between cohorts for the initial terminal CE experience midterm assessment. One CPI factor was significant on the initial terminal CE experience final assessment and the final terminal CE experience midterm assessment (p < .05). Within cohort analysis for all three CPI factors at all assessment periods were statistically significant. Conclusion: All students significantly improved from midterm to final assessment periods of the initial and final terminal CE experiences. Therefore, IcPE, allowing faculty to mentor and provide feedback to students should be considered an alternative to FTCE prior to students’ initial terminal CE experience. MeSH Terms: curriculum, education, students

Burnout and grit in student physical therapists before and after terminal clinical education experiences: a prospective longitudinal study of a single class-year cohort

Rationale: Burnout has been reported by graduate healthcare students during several phases of preprofessional education. The purpose of this study was to explore changes in levels of Doctor of Physical Therapy (DPT) student burnout and grit before and after clinical education. Additional aims included exploring how burnout and grit might differ based on student gender and over time and what relationships might exist between burnout and grit in this population. Methods: All enrolled third year DPT students (n = 50) at a single physical therapist education program participated in this study. Participants were surveyed using the Maslach Burnout Inventory Human Services Survey and the 12-Item Grit Scale at the end of curricular Year 3 and at graduation after terminal clinical education experiences. Descriptive, exploratory, and comparative statistical methods were used. Results: Male participants reported significantly decreased emotional exhaustion (EE) from Year 3 to graduation, p ≤ 0.0001. Overall, the cohort reported significantly decreased EE, F(1,48) = 12.35, p = 0.001, d = 0.44 and increased personal accomplishment, F(1,48) = 13.322, p = 0.001, d = 0.58 after terminal clinical experiences. The main effect of time on grit scores was also significant, p = 0.035. A moderate inverse relationship existed between student grit levels at Year 3 and EE levels at graduation, r = –0.447, p = 0.01. Conclusions: Cohort burnout scores did not meet the Maslach Burnout Inventory criteria definition for burnout; mean EE and personal accomplishment subscale scores significantly changed over time. Male DPT students reported moderate levels of EE at the start of terminal clinical experiences that dropped significantly to low levels compared to female students. Student grit levels in this study were high compared to recent investigations of other DPT cohorts. Grit may have a protective effect against DPT students experiencing burnout. Meshterms: Burnout, Professional; Physical Therapists/education; Achievement.

Entry level caseload expectations and perception of full caseload capability during student physical therapist terminal clinical experiences: A pilot study

Purpose: The purpose of this study was to explore expected student physical therapist (PT) full caseload expectations across and within clinical settings and identify factors Clinical Instructor’s (CI) routinely report as contributing to their assessment of a student’s ability to manage a full caseload. Methods: A cross-sectional electronic survey design was used to collect data from CIs for student PTs in Michigan. A sample of convenience was utilized. Results: CIs (n=128) from six settings participated in this study. Respondents reported 32% of their employers had established caseload expectations for new graduate and student PTs. Within an 8-hour day, CIs considered a full student caseload measured in billable units to be 26 in outpatient ortho, 22.5 in outpatient neuro, 29 in outpatient mixed, 17.5 in paediatric, 18.5 in acute care, and 21.9 in inpatient rehab settings. Within an 8-hour day, CIs considered a full student caseload measured in patients per day to be 8.8 in outpatient ortho, 6.9 in outpatient neuro, 8.5 in outpatient mixed, 5.4 in paediatric, 7.1 in acute care, and 4.5 in inpatient rehab settings. Student capability was considered by 80% of CIs when determining student caseload. CIs reported patient complexity and accuracy of clinical reasoning as the most influential in determining a student’s capability to manage a full caseload. The ability to implement and retain feedback was reported as least influential. Conclusion: Most respondents indicated their site lacked defined and differing expectations for student PTs. The CIs consistently reported considering student capability of carrying a full caseload when making determinations of student performance on the CPI and were most influenced by patient complexity and clinical reasoning accuracy. CIs reported a range of full caseload productivity expectations for students both within and across settings, which may contribute to inconsistent assessment of student performance on the CPI. A poster presentation of this work was presented at APTA Educational Leadership Conference 2019.

Student mental health and clinical education: exploring the DCE experience

Purpose: There is a potential link between the clinical education phase of a physical therapist’s education and increased incidence of student mental health challenges. The Director of Clinical Education (DCE) has a complex role in supporting students and clinical sites during clinical education experiences (CEEs.) The purposes of this study were to explore DCE’s experiences and perceptions with supporting students with mental health challenges during CEEs. Methods: Two-hundred-twenty DCEs from accredited Doctor of Physical Therapy programs were invited to participate in an electronic survey. Survey questions included demographics, institutional and curricular characteristics, and current perceptions/experiences with student mental health challenges. DCEs (n = 106; 48.2%) responded and were included in the analyses. Analyses included descriptive statistics, simple frequencies, and binary logistic regression. Incident coding processes analyzed responses of open-ended questions. Results: Seventy-four percent of respondents indicated awareness of a student(s) experiencing a mental health concern during a full-time clinical experience in the past 3 years. Regression analyses showed that length of terminal clinical experience, out-of-state placement, cohort size, and availability of online/video counseling were related to prevalence of DCE’s experience. Forty-six percent of DCEs indicated feeling prepared to deal with these issues, while 35% were ‘unsure’. DCEs indicated experience, training, and workload support as contributors to successfully supporting students. Conclusion: Results contribute to the emerging understanding of the prevalence of student mental health challenges in physical therapist education from the DCE’s perspective. Our findings suggest that institutional and curricular characteristics are potential contributors to the prevalence of this issue. We recommend training and institutional support for the DCE in these situations.

Perspective for change: establishing the need for clinical instructor competencies in physical therapist education

Current issue: Clinical instructors (CIs) are instrumental in the development of competent, entry-level physical therapist graduates. Despite this key role, CIs are often deficient in formal knowledge of the learning sciences that influence quality of clinical education experiences. Clinical education stakeholders also lack a standardized and consistent approach to defining and assessing clinical teaching skills, resulting in an inability to provide adequate feedback and growth opportunities for CIs. Perspective: A gap exists between qualitative descriptions of clinical teaching behaviors and the ability to objectively assess those behaviors in CIs. Grounded in the Model of Excellence in Physical Therapist Education, this perspective calls attention to and proposes steps toward excellence in clinical education. Defining essential competencies of clinical teaching in the physical therapy profession requires a systematic approach. The competencies established through this approach then become the foundation for creating a meaningful assessment tool of CI performance. Implications for clinical education: Developing educator competencies and a related assessment tool for CIs allows for the provision of meaningful feedback, the creation of targeted professional development programs, and opportunities for recognition of clinical teaching excellence. Without effective CIs, new graduates may be inadequately equipped to contribute to the profession’s vision of educational excellence.

Interprofessional approach to the management of functional neurological symptoms with co-morbid concussions and hypermobility syndrome: a case report

Clinical education scenario: This case report describes the individualized treatment approach and clinical reasoning of a residency-trained physical therapist for an adolescent girl with symptoms of functional neurological symptom disorder (FNSD). Rationale for case study: There are limited research studies regarding successful treatment of pediatric FNSD. This case study provides evidence for an interprofessional treatment approach of an adolescent with symptoms of FNSD, including the role of a residency-trained physical therapist. Case description: A 15-year-old girl with symptoms of FNSD, multiple comorbidities, and history of concussions participated in an interprofessional treatment program lasting 1 year. Her treatment was assessed using the Energy Expenditure Index, Timed Up and Down Stairs, Five-Times Sit to Stand, 6-Minute Walk Test, and Functional Disability Index. The patient demonstrated improvement in all outcome measures post-treatment. Implications: The patient’s function was restored using an interprofessional treatment approach, which emphasized interpersonal communication. While future studies are needed to assess the efficacy of this treatment approach, this case report demonstrates that physical therapy residency training prepares a clinician to effectively treat complex patients with multi-system involvement.