Qualifications and Credentials of Clinical Instructors Supervising Physical Therapist Students
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 nor a board 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.
Key Words: Clinical education, Clinical instructors, Physical therapist education, Qualifications, Credentials.
Clinical education is an integral component of a physical therapist education program. The 2000 Biannual Accreditation Report (BAR), completed in April 2000 by 212 accredited and developing physical therapist education programs, reported mat full-time clinical education represents an average of 25.60% of the total weeks of a physical therapist education program and an average of 41% of the total contact hours.1 The BAR defines full-time clinical education as “35 or more hours per week” that a student spends In the clinical setting.2
There is much in the medical and allied health literature to support the assumption that clinical education faculty assume an influential role in the professional and social development of their respective students.3-8 Therefore, it is essential for physical therapist education programs to identify and monitor the qualifications and credentials of the clinicians who assume the role of clinical instructors (CIs) for their students, especially when one considers the significant amount of time that physical therapist students spend in clinical cducation experiences.
Background and Purpose
Students are supervised on clinical education experiences by 1 or more physical therapists who serve as the students’ CIs. The CIs directly instruct and supervise the students’ learning in the clinic and adjust the learning environment so that it is appropriate to students’ learning styles. Additionally, CIs must assess students’ ability to perform physical therapy-related skills and compare their performance of these skills to the expectations of the entry-level clinician and the academic institution’s requirements of its students.9
The Commission on Accreditation in Physical Therapy Education (CAPTE) requires academic programs to assess the clinical education faculty and the clinical education program. According to these guidelines, clinical faculty must demonstrate clinical expertise in their area of practice and be effective clinical teachers. Judgments regarding CIs’ competence is based on “appropriate past and current involvement with: in-service or continuing education courses; advanced degree courses; clinical experience; research experience; and teaching experience.”10(p61)
The importance of the clinical educator as a role model has been examined, and findings that support this concept are published in a number of journals and publications related to health care professions.3-6 Additionally, there are numerous physical therapy professional publications that reflect this idea.7-,8 For example, the American Physical Therapy Association’s (APTA) Guidelines and Self-Assessments for Clinical Education9 emphasizes that the CI models the behavior and conduct expected of a physical therapist. Furthermore, the CI must be aware of the impact that this role modeling has on the student.9 This same concept is reinforced in the American Physical Therapy Association Clinical Instructor Education and Credeiitialing Program.11
The academic coordinator of clinical education/director of clinical education (ACCE/DCF) is the academic faculty member primarily responsible for assessing the clinical education program. In an effort to characterize the current clinical education environment and make informed decisions regarding future clinical education faculty development, the ACCE/DCE must evaluate the qualifications and credentials of CIs.
The APTA’s Clinical Site Information Form (CSIF) offers a profile of the CIs at a given clinical site. Academic institutions require clinical faculty to update this form annually for the purpose of gathering information for accreditation and to provide students with information regarding its contracted sites. It provides an outline of the type of clinical facility and lists the site’s physical therapy personnel and their academic background, clinical practice, and clinical teaching experience.
It is difficult, however, for academic programs to collect specific information using this form since a typical program has 100 to 400 clinical sites on contract, with each facility having anywhere from 1 to 20 CIs. Additional factors such as the reliance on the center coordinator of clinical education (CCCE) for annual updates and employee turnover further complicate the process of the ACCE/DCE to maintain current information about each clinical site.
The role of the CI has expanded as the profession has sought professional autonomy and as thirdparty payer systems have changed.12,13 It remains to be seen how this role will further develop as the profession moves toward evidence-based practice. As a result of this professional maturation, it has become increasingly important that CIs model professional behavior to physical therapist students, guide these students in making appropriate decisions regarding differential diagnosis and interventions, and demonstrate to students that physical therapists are essential personnel in the health care management team. According to the 2000 BAR report, the mean number of weeks of full time clinical education is different in bachelor’s, master’s, and doctoral degree physical therapist education programs: 23-8 weeks for bachelor’s degree programs, 27.4 weeks for master’s degree programs, and 40.1 weeks for doctorate programs.2 Therefore, it is reasonable to assume that the role of the CI will continue to expand and become more challenging to adequately fulfill than in the past given the profession’s transition to the entry-level doctoral degree,
The nursing profession has demonstrated a similar evolution in terms of professional and educational growth. In the 1980s, the education of nurse practitioners moved from a variety of entry-level preparations to preparation at the master’s degree level. Nurse practitioner’s academic credentialing bodies created specifications regarding the number of hours that students needed to spend in supervised clinical practice. Often, state boards of nursing dictated which practitioners were acceptable to act as preceptors in the clinical setting. At the same time that the nursing profession instituted these changes in academic preparation, there were greater pressures on clinical providers to increase productivity, determine outcome effectiveness, and control the cost of care due to the health care profession’s move to managed-care models of thirdparty payment. Nursing experienced a dilemma of having more stringent requirements placed on its preceptors by academic institutions while, at the same time, these preceptors faced increased productivity demands in their professional environment, making it difficult for them to spend adequate time teaching students during their clinical experiences.14
These same conditions are currently influencing physical therapy and other health care professions. Therefore, in an effort to determine a profile of the qualifications and credentials of CIs within various professions of health care, an exhaustive literature search was done. This search did not reveal any published articles on the current or past profiles of CIs within physical therapy. In 1989, Critical Care Nurse reported on the results of a preceptor survey for the purpose of reporting specific demographic information regarding preceptors within the nursing profession. Out of the 351 nurses participating in the survey, 92.3% were female, with most respondents having a baccalaureate degree in nursing. Over two thirds of those surveyed had graduated from their basic nursing education program more titan 6 years previous to the survey, and nearly 80% had worked as staff nurses for 3 or more years. Most of the respondents had worked as preceptors for 3 to 5 years at the time of the survey. Finally, nearly 62% of respondents received some type of educational preparation to prepare them for the preceptor role.15 The National League of Nursing’s Web site (nln.org) reports that it will be publishing updated statistics relating to nursing educators in November 2002; however, these statistics were not available at the time of this writing. Our literature search did not reveal any other published information regarding qualifications and credentials of CIs from other health care professions.
The purpose of this report is to describe the qualifications and credentials of Qs supervising physical therapist students. As the profession moves toward obtaining provisions for direct patient access and increases the educational demands on physical therapist students, it makes sense that the typical profile of CIs is more clearly described.
Two hundred fifty-five physical therapists serving as CIs for 45 physical therapist students from Simmons College and 40 physical therapist students from the University of New England between January 2000 and December 2001 served as subjects in our study. Students from Simmons College graduated with a professional (entry-level) Master of Science in Physical Therapy degree, and students from the University of New England graduated with an entrylevel Master of Physical Therapy degree. all 85 students completed three 8-weck clinical experiences prior to graduating in 2001. Each of these clinical experiences is indicated as roman numeral I, II, or III in Table I.
Information regarding the qualifications and credentials of CIs was taken from the Clinical Instructor Survey questionnaire (Appendix) developed at the University of New England by the first author (SG). Formal reliability and validity testing of the instrument has not occurred; however, the survey was evaluated and modified after being reviewed during 2 meetings of the New England Consortium of Academic Coordinators of Clinical Education (NECACCE). The feedback from the group and subsequent revisions helped to establish the survey’s content validity. Establishing survey content validity in this manner has been described in the literature.16 The NECACCE comprises 29 ACCE/DCEs representing 16 accredited physical therapist education programs. The survey is currently utilized by each of the physical therapist education programs in New England.
A copy of the Clinical Instructor Survey questionnaire was sent to the CIs prior to the beginning of each clinical experience. The CIs returned the survey instrument directly to the ACCE/DCE after each clinical experience in which they acted as the primary CI. (n 4 instances, 2 survey instruments were returned for a single student by 2 different CIs. In these cases, 1 of the survey instruments was randomly selected to be included in the study.
In addition to information regarding students’ CIs, the ACCE/DCE obtained data related to the type of rotation and assigned supervisory model for each student’s clinical experience. This information was obtained through phone conferences and site visits with the CI and student. Three rotation options were ldentiied: inpatient, outpatient, or inpalient and outpatient. Supervisory model was expressed as the teaching ratio of students to CIs on a given clinical education experience. The collected data was recorded by the ACCE/DCE following each clinical experience using Microsoft Excel.*
Descriptive statistics, including frequency counts, means, and standard deviations, were computed using Microsoft Excel. The University of New England’s Institutional Review Board determined that the study met the “exempt” status criteria.
Survey questionnaires were returned by 230 of the 255 CIs (90.20% response rate). The 230 returned survey instruments represent 226 different GIs, since 4 CIs supervised 2 students during the data collection period. We decided to include these data because it was likely that the CIs’ responses to selected items on the survey instrument would change during the 2-year data collection period. For example, the CI may have become a credentialed CI since last completing the survey or supervised a different number of students within the last 12 months.
Two hundred eight of the 255 clinical experiences (81.57%) occurred in New England (CT, MA, ME, NH, RI, and VT), and 47 (18.43%) occurred in the United States outside of New England. The gender composition of the CIs was 70 (30.43%) male and 160 (69.57%) female.
Table 1 summarizes the type of rotation and supervisory model used. One hundred thirty (50.98%) of the rotations were classified as outpatient, 101 (39.61%) were classified as inpatient, and 24 (9.41%) were classified as inpatient and outpatient. The most common model of clinical supervision was 1 student:! CI (69.80%), followed by 1 student:2 CIs (13.73%). Twenty-six (10.20%) of the clinical experiences incorporated several different supervisor)’ models and as a result were labeled “multiple supervisory models.”
Table 2 summarizes the CIs’ years of clinical practice, years of clinical teaching, and number of students supervised in the last 12 months. The CIs’ mean number of years of clinical practice was 8.71 (SD=7.62). One hundred fourteen CIs (49.56%) had 6 years or more of clinical practice, while 65 (28.26%) had 11 years or more of clinical practice. The mean number of years of clinical teaching was 6.02 (SD=6.09). Eighty-seven (37.83%) CIs had 6 years or more of clinical teaching experience, and 43 (18.70%) had 11 years or more of clinical teaching experience. The mean number of students the CIs supervised within the last 12 months was 2.09 (SD= 1.48), with the median being 2 students. Sixty-one CIs (26.52%) had accepted 3 or more students within the last 12 months.
Table 3 summarizes selected descriptive characteristics of the CIs. The highest earned degree for the majority of CIs (n=130 [56.52%]) was a bachelor’s degree. Ninety CIs (39.13%) were members of APTA, while only 4 (1.74%) were certified by the American Board of Physical Therapy Specialists as clinical specialists. Fifty-four CIs (23.48%) had successfully completed the American Physical Therapy Association’s Clinical Instructor Education and Credentlaling Program.11
DISCUSSION AND CONCLUSIONS
The APTA recommends that physical therapists have 1 year of clinical experience prior to becoming a CI.9 Our results revealed that the majority of CIs in this study have clinical practice and clinical teaching experience that far exceed this minimum recommendation. Despite being relatively experienced clinicians and teachers, the highest earned degree of the majority of the CIs (56.52%) was a bachelor’s degree. Since CAPTE will no longer accredit education programs at the baccalaureate level, the percentage of CIs with a bachelor’s degree as their highest earned degree should continue to decrease. As the transition from physical therapists graduating with a bachelor’s degree to a master’s degree or doctorate takes place, there will likely continue to be a disparity between the academic degree of the CI and the students they supervise.
The statistics related to professional and clinical teaching experience are comparable to those previously mentioned regarding the nursing profession. For example, 80% of the nursing preceptors had 3 or more years experience as staff nurses. In our study, slightly greater than 85% of the CIs had 3 or more years of clinical practice. The nursing article14 noted that most respondents had worked as preceptors for 3 to 5 years, and our survey showed that almost 63% of the CIs had 3 or more years of clinical teaching experience. The statistics regarding educational preparation of physical therapist CIs compared with nursing preceptors seem quite disparate. Nearly 62% of the nursing preceptors had received some type of education to prepare them for their role15; however, less than 25% of the physical therapist CIs were crcdcntialed as CIs. It is difficult to form specific conclusions based on this information since it is possible that physical therapist CIs may have received some type of educational preparation related to clinical education without attending the APTA Clinical Instructor and Credentialing Program.
Our research revealed that the majority of CIs (59.57%) served as clinical faculty for more than 1 physical therapist student per year and 26.52% of CIs accepted 3 or more students per year. In order to gain the most benefit from CI development activities, physical therapist education programs should develop the expertise of this core group of CIs. Needs analysis surveys could be administered to this group and used to decide future professional development activities.
Vinette Cross17 has reported on a needs analysis workshop for CIs serving physical therapist students from England’s Queen Elizabeth School of Physiotherapy, Birmingham. She slated that her academic institution’s attempts to facilitate clinicians’ development in clinical education skills through short courses had indicated limited success in effecting long-term behaviors in these CIs. She concluded that there is a need to create clinical education development programs in concert with clinicians in their specific workplaces where the clinicians will be enabled to direct their own learning more effectively.17
Other research related to CI instruction supports the notion that CIs’ perceptions regarding these courses should be taken into consideration and mat academic institutions should do their utmost to ensure that CIs feel adequately supported and informed.18,19 As ACCEs strive to develop professional development activities for CIs, it seems that the academic faculty need to he sensitive to the specific work conditions of clinical faculty and directly responsive to the perceived needs of these individuals. More research needs to be conducted to accurately determine the combined needs of clinical and academic faculty.
Clinicians who have volunteered to serve as CIs have demonstrated a commitment to paiticipatc in the professional development of future physical therapists; however, only 59.13% of the CIs surveyed were members of APTA. Personal communication with the APTA Research Services Department (Marc Goldstein, EdD, Director of Research, AITA; oral communication; September 2002) indicated that as of August 2002,45,533 (39.59%) of the estimated 115,000 licensed physical therapists were members of APTA. We believe that this percentage is alarmingly low. If one considers that CIs are important role models for physical therapist students during their clinical education experiences, then logic would seem to dictate that the ideal CI would be an Individual who is a member of the professional organization.
Most CIs are not clinical specialists. One might question if mere is sufficient recognition or remuneration to motivate clinicians to become clinical specialists. Additionally, most CIs are not APTA credentialed CIs, despite evidence in the literature that (Us value instruction on how to become more effective teachers.17-19 The NECACCE continues to work on developing strategies to effectively promote and market the workshops, while striving to make them affordable.
One limitation in our study Is related to the number of students a CI supervised within the last 12 months. It is possible that the numbers reported in our study are slightly less than the actual number of students the CIs had supervised In the last 12 months because the Clinical Instructor Survey questionnaire did not specify whether to count the current student a CI was supervising.
Gathering information on the qualifications and credentials of CIs allows academic programs to make Informed decisions regarding a number of important clinical education issues. For example, If an ACCE/DCE learns that a small percentage of the physical therapists supervising students are credentialed CIs, then the ACCE/DCE could develop an action plan to address this perceived deficiency. Some of these actions might include hosting a CI crcdentialing program, devising a marketing initiative to promote the benefits of achieving credentialed CI status, and forming a focus group to identify the barriers to becoming a credentialed CI. In addition, the ACCE/DCE would be able to assess progress toward Increasing the number of physical therapists who are credentialed CIs by examining future data.
Specific knowledge related to the qualifications and credentials of CIs may have other far-reaching benefits. Continued data collection regarding the professional profile of CIs will be one tool academic institutions can use to assess whether or not there are changes in the number of credentialed CIs, board-certified specialists, or members of the professional organization, future research needs to be conducted to determine if these characteristics of CIs enhance clinical teaching. By determining which characteristics are most influential in student satisfaction, academic programs may be better able to Identify and support future CIs m their endeavors to more effectively educate physical therapist students. Further research also may examine the factors that would motivate physical therapists to become credentialed CIs, certified specialists, and members of APTA.
The potential benefit of this knowledge extends beyond the academic institution. Clinical education faculty may use the results of this study to compare the credentials of their own clinical faculty to clinical faculty outside of their own facility. Clinical sites may use this data to establish their own set of minimum qualifications and credentials to serve as a CI. Students may use the results of this study to gain general insight about the qualifications and credentials of CIs and may be more cognizant of this information when reviewing clinical site files during (lie site selection process.
The typical profile of a CI in our study is a female with a bachelor’s degree who is not a member of APTA and is neither a credentialed CI nor an APTA board-certified clinical specialist. Based on median responses, the CI has over 5 years of clinical practice and 4 years of clinical teaching and has taken 2 students during the past 12 months.
*MiciOSoft Corp, One Microsoft Way, Redmond, WA 98052-6399.
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Scott Giles, PT, MS
Ellen Wetherbee, PT, MEd, OCS
Stephanie Johnson, PT, MBA
Mr Giles is Academic Coordinator of Clinical Education and Clinical Associate Professor, Department of Physical Therapy, University of New England, 11 Hills Beach Rd, Biddeford, ME 04005 (email@example.com). Address all correspondence to Mr Giles.
Ms Wetherbee is Academic Coordinator of Clinical Education and Assistant Professor, Department of Physical Therapy, University of Hartford, 200 Btoomfield Ave, Dana 232, West Hartford, CT 06117 (firstname.lastname@example.org).
Ms Johnson is Director of Clinical Education and Assistant Professor, Graduate School for Health Studies, Simmons College, 300 The Fenway, Boston, MA 02115 (email@example.com).
Received June 18, 2002, and accepted December 31, 2002.
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