———————————-———-—————
Essential Characteristics of Quality
Clinical Education Experiences: Standards to
Facilitate Student Learning
Carol Recker-Hughes, PT, PhD, Ellen Wetherbee, PT, DPT, MEd, OCS,
Kathleen M. Buccieri, PT, DPT, MS, PCS, Jean FitzpatrickTimmerberg, PT, PhD, MHS, OCS,
and Angela M. Stolfi, PT, DPT
Background and Purpose. Clinical
education experiences (CEEs) provide
physical therapist (PT) students with op-
portunities to be immersed in clinical
practice to develop professional skills and
behaviors under the supervision of a clini-
cal instructor (CI). Essential characteris-
tics 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 quali-
fications and essential characteristics of
CIs and of practice environments that our
Carol Recker-Hughes is associate professor, vice
chair, and director of clinical education in the
Physical Therapy Education Program, SUNY
Upstate Medical University, Syracuse, NY 13210
(reckerhc@upstate.edu). Please address all corre-
spondence to Carol Recker-Hughes.
Ellen Wetherbee is clinical associate professor
and academic coordinator of clinical education
at Quinnipiac University, North Haven, CT.
Kathleen M. Buccieri is a physical therapy
manager at the Children’s Hospital of the King’s
Daughters, Norfolk, VA.
Jean Fitzpatrick Timmerberg is an assistant
professor and director of clinical education at
Columbia University, New York, NY.
Angela Stolfi is the director of physical therapy
and the center coordinator of clinical education
at Rusk Rehabilitation, NYU Langone Medical
Center, New York, NY.
The authors declare no conflicts of interest.
Received October 1, 2013, and accepted January
31, 2014.
48 Journal of Physical Therapy Education Vol 28, Supplement 1, 2014
position paper ———————-———————————--
profession should consider as standards
for clinical education and to make recom-
mendations for changes that are needed to
promote consistently high quality CEEs.
Position and Rationale. It is our position
that all stakeholders in clinical educa-
tion need to engage in a deliberate effort
to ensure that all students have access to
quality CEEs that demonstrate agreed
upon, evidence-based professional stan-
dards. 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 to-
gether through regional consortium, can
meet the identified professional develop-
ment needs of CIs and of center coordina-
tors of clinical education (CCCEs) in an
efficient and timely manner. Furthermore,
we recommend that the expert CI be rec-
ognized as a clinical education specialist
in the same way other specialists are rec-
ognized by the American Board of Physi-
cal 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 fos-
ter the development of expert CIs and of
learning environments conducive to stu-
dent learning.
Discussion and Conclusion. Physical
therapist education programs and clini-
cal 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 profes-
sional standards for all CEEs are realized.
Key Words: Clinical education, Faculty
development, Educational leadership.
BACKGROUND AND PURPOSE
Physical therapist (PT) education programs
devote up to 48% of contact/clock hours in
the curriculum to clinical education experi-
ences (CEEs) where students engage in expe-
riential learning activities with real patients
under the supervision of a clinical instructor
(CI).1 In recent years numerous professional
studies, across several health occupations,
have provided insight regarding the essential
components of quality CEEs.2-8 In addition,
physical therapy professional documents ar-
ticulate the qualities and characteristics PT
education programs should meet in order to
promote quality CEEs.9,10 Based on national
level conversations it is apparent that, in spite
of these evidence- and consensus-based pa-
rameters, the quality of students’ CEEs is
inconsistent.
Multiple factors contribute to the vari-
ability in quality that students encounter dur-
ing CEEs. These include, but are not limited
to, the CI’s competence and confidence as a
teacher, the clinical practice setting’s moti-
vation and ability to provide a high-quality
teaching environment, supports provided
by the PT education program, and fiscal and
regulatory pressures at the clinical site. Stud-
ies demonstrate that CIs are conflicted by
opposing demands on their time in filling
their dual roles as practitioners and as teach-
ers of students.11-13 Furthermore, health care
administrators may value clinical education
conceptually; however, in reality, patient
care and productivity often take precedence
over providing tangible resources to support
CEEs. These factors create considerable ten-
sion for the CI who attempts to balance clini-
cal practice demands with student-focused
clinical teaching14,15 and can impact the qual-
ity of a CEE.
It is widely agreed that CEEs are an es-
sential component of the preparation for
professional practice.16-18 However, there is
currently a critical shortage of quality CEEs
and insufficient mechanisms in place to en-
sure that evidence-based and agreed-upon
professional standards are consistently pres-
ent. The purpose of this paper is to articulate
the necessary qualifications and characteris-
tics of CIs and practice settings that are es-
sential to the provision of quality CE. In
addition, we make recommendations that
should be implemented by PT education
programs, clinical sites, and the profession
at large to achieve greater consistency in pro-
ducing high quality CEEs.
POSITION AND RATIONALE
It is our position that all stakeholders in
clinical education must engage in a deliberate
effort to ensure that all students have access
to high-quality CEEs that demonstrate evi-
dence-based professional standards. Clinical
education experiences should be monitored
in a standardized manner, such that PT edu-
cation programs, working in collaboration
with clinical practice sites, will provide the
supports to meet the developmental needs of
CIs and center coordinators of clinical educa-
tion (CCCEs) in their roles as clinical educa-
tors. Physical therapist education programs
must dedicate adequate resources, commen-
surate with the significant percentage of the
curriculum devoted to clinical education, in
order to achieve these outcomes. The clinical
community must also recognize its essential
responsibility in the education of PTs who
are prepared to meet public health care needs
and create environments conducive to learn-
ing at practice sites. Ultimately, PT education
programs and clinical practice sites must be
held accountable for ensuring that all stu-
dents consistently have access to quality CEEs
that consistently exemplify agreed-upon pro-
fessional qualifications, qualities, and charac-
teristics.
Baseline Qualifications of CIs
In setting baseline qualifications for CIs, we
attempted to balance visionary pursuit of ex-
cellence with the reality of constraints of the
current health care environment, higher edu-
cation, and the physical therapy profession.
Following an extensive review of professional
Vol 28, Supplement 1, 2014 Journal of Physical Therapy Education 49
documents,9,19-21 reflection on our cumula-
tive experiences, and shared dialogue, we
propose that to qualify for consideration as a
CI, one must:
• be a licensed PT in the state in which
the CEE occurs,
• demonstrate competence as a clinician,
• practice in a legal and ethical manner
consistent with the American Physical
Therapy Association (APTA) Code of
Ethics22 and governing laws and regu-
lations,
• demonstrate a desire to educate stu-
dents, and
• display evidence of teaching skills.
These recommendations are well support-
ed in professional documents9,19-21; however,
there are currently limited mechanisms in
place to ensure that all CIs meet these base-
line qualifications. Direct oversight of each
student’s experience by the PT education pro-
gram and communication between the DCE,
student, CI, and CCCE should be required to
assess CIs’ qualifications and baseline skills
and to identify professional development
needs. While the Commission on Accredita-
tion in Physical Therapy Education (CAPTE)
requires PT education programs to include
instruction in clinical teaching skills as part
of the curriculum, 9 CIs may have limited or
no formal preparation to be a clinical educa-
tor. Physical therapist education programs,
working individually or collectively through
clinical education consortia, should be held
accountable to provide professional devel-
opment programs to promote adherence to
these baseline qualifications.
Developing Characteristics of CIs:
From Novice to Expert
The baseline qualifications described above
do not assure high quality CEEs. A review
of health care literature and relevant physi-
cal therapy professional documents10,19,21,23
reveals a set of characteristics of effective
CIs that, for organizational purposes, can be
broadly categorized as:
• Interpersonal/communication
skills24-29
• Professional behaviors4,6,24,27,30-32
• Instructional/teaching skills4,24,28,33-36
• Evaluation/performance
skills5,24-26,28,32,33
The essential characteristics of CIs and
sample indicators linked to each of the cat-
egories above are displayed in Table 1. The
development of these essential clinical teach-
ing skills is analogous to clinicians’ develop-
ment of skills in clinical practice,37 such that
CIs move from being novice to expert clinical
teachers.36,38,39
Research in physical therapy demonstrates
that as CIs develop greater expertise in their
teaching roles, they become highly skilled and
reflective communicators, striving to develop
positive relationships with students and pro-
mote learning in authentic situations.4,6,7,36,40
The highly complex role of CIs requires
them to adapt their supervisory styles in re-
sponse to real-time assessment of teaching
and learning, and in response to students’
skill level and learning style, across variable
clinical situations.3,38 In addition to taking
the time to explain and demonstrate tech-
niques, they engage students in discussion
and foster higher-level thought processes
with challenging, thought-provoking teach-
ing strategies.4,35,36,41 Skilled CIs provide
ongoing formative and summative feedback,
that is specific and timely, and they encour-
age students to reflect and engage in self-
assessment.3,6,7,38,42,43
It would be faulty to assume that all CIs
inherently possess the related knowledge,
skills, and behaviors consistently observed
in experienced and expert CIs. Research has
indicated that CIs are inconsistent in the use
of effective teaching strategies, such as pro-
viding time for student dialogue or in using
questions to prompt reflection and complex
clinical decision making,44,45 and are reluc-
tant to share negative feedback with students,
especially when deficits are related to profes-
sional behaviors.46 The development of these
essential teaching skills demands ongoing
assessment of CIs’ areas of strengths, weak-
nesses, and needs for continuing professional
development. Ultimately, it should be recog-
nized that the development of a skilled CI is
an evolving process that needs to be assessed
and supported by the PT education program,
the clinical practice, and through individual
motivation and action.
There is currently limited formal recog-
nition for CIs (eg, PT education program or
consortia award) who consistently demon-
strate expertise in the qualities and character-
istics displayed in Table 1. A recent survey of
employers of PTs who have American Board
of Physical Therapy Specialties (ABPTS)
certifications indicate that these specialists
assume non-patient care roles (eg, educator,
researcher, consultant) more effectively than
PTs without these credentials.47 We propose
that the profession identify a mechanism to
provide recognition for a Clinical Education
Specialist (CES) analogous to current ABPTS
certifications in order to elevate the role of
the CI. The presence of a CES may also en-
hance the learning environment of a clinical
practice.
Table 1. Essential Characteristics of a CI

Category Characteristics of a CI Sample Indicators

Interpersonal Skills/ • Demonstrates motivation to teach • Is enthusiastic

Communication • Conveys a positive attitude towards • Exhibits genuine interest in student learning
teaching • Makes time for student discussions

• Creates a positive learning environment • Is open to student ideas

• Creates a comfortable atmosphere
• Encourages the safe sharing of knowledge

• Communicates effectively • Engages students in dialogue with positive regard

• Responds to students’ ideas and learning needs

• Reflects in, on, and for teaching actions • S eeks student feedback on the effectiveness of CI/student
interactions
• Modifies teaching strategies to enhance effectiveness

Professionalism • Models APTA Core Values • Is accountable for actions

• Is altruistic, placing patients’ needs above their own
• Promotes the profession of physical therapy
• Epitomizes legal/ethical values
• Practices with integrity
• Displays compassion/caring in patient care
• Embodies a sense of social responsibility

• D
 emonstrates competence in clinical • D
 elivers evidence-based therapy that is patient-focused
practice (knowledge, skills, and behaviors) and outcomes-oriented

• P
 romotes a comprehensive team approach • P articipates in a collaborative practice with the
to care intraprofessional team members
• Engages students as active members of the health
care team (eg, participation in rounds, meetings,
communications)

Instruction/Teaching
• C
 reates and adapts learning experiences
appropriate for student needs
• P aces learning by providing appropriate levels of challenge
and support
• Adjusts supervision consistent with students’ performance
• Engages other health professionals in providing learning
opportunities for students

• Engages the student as an adult learner • Promotes students’ accountability for their own learning
• Seeks and considers students’ input regarding pace of
learning and the planning of learning activities

• U
 ses multiple types of instructional • A
 djusts the teaching style to accommodate students’
strategies learning styles
• Modifies preferred styles based on situational needs

• P
 romotes student self-assessment and • A
 sks questions before, during, and/or after patient
reflection interactions
• Reviews and discusses students’ weekly reflection sheets

• Facilitates student decision making • Encourages students to verbalize clinical reasoning

• Safely allows students to implement their own ideas

• S eeks continual self-improvement as a • Considers feedback about teaching performance

teacher • Employs self-improvement strategies and seeks
professional development activities to meet identified
teaching needs

Evaluation/ • A
 nalyzes multiple data sources in • U
 ses feedback to identify students’ strengths and areas
Performance developing feedback to provide to needing improvement
Assessment students

• P
 rovides formative and summative • Offers real-time input
feedback that is accurate, objective, timely, • Completes the PT CPI and reviews it with students in a
and specific timely manner
• Collaborates with the physical therapist education
program and CCCE to promote students’ outcomes

Abbreviations: APTA, American Physical Therapy Association; CCCE, center coordinator of clinical education; CI, clinical instructor; PT CPI, Physical
Therapy Clinical Performance Instrument.

50 Journal of Physical Therapy Education Vol 28, Supplement 1, 2014

Table 2. Essential Characteristics of Clinical Practice Environments
Category Characteristics of the Clinical Practice
Culture of the All levels of administration and staff:
Clinical Learning • Value the clinical education of
Environment students
• C
 ontribute to the creation of a
supportive learning environment
• Integrate evidence-based education,
research, and patient care
Structure of the The CCCE:
Clinical Learning • Evaluates the clinical education
Environment program with outcomes, which are
shared with multiple stakeholders
• Is responsible for oversight and
development of the clinical
education program
• A
 rticulates explicit policies,
procedures, and expectations of
students related to clinical education
The clinical practice
• Values and provides tangible
supports to the CCCE
• P
 rovides dedicated teaching time
to CIs
• P
 rovides adequate resources to
support clinical education
Abbreviations: CCCE, Center Coordinator of Clinical Education; CI, clinical instructor; DCE, director of clinical education.
Vol 28, Supplement 1, 2014 Journal of Physical Therapy Education 51
Sample Indicators
• L earning and teaching is embedded and informs all aspects of
clinical practice
• Administration encourages relationships with academic
institutions (eg, contract development, research relationships,
conjoint appointments)
• Clinical teaching performance is used as a criterion for promotion/
career ladders
• The health care team demonstrates high morale and harmonious
work experience in which student contributions are valued
Students:
• Feel accepted and are encouraged to participate in professional
dialogue with all team members
• Interact informally with staff (eg, have lunch together, share a
common workspace)
• Are encouraged to become autonomous practitioners
The health care team:
• Models principles of best practice in patient management and in
clinical teaching
• Participates in activities to support best practice (eg, presenting at
conferences, engaging in research, publishing)
The CCCE:
• solicits feedback from students, CIs, DCEs, and all staff to ensure
quality teaching and learning
• Uses feedback from multiple sources to determine strengths and
areas which need development
• Determines the readiness of individuals to be CIs
• Develops meaningful relationships with DCEs
• Is responsible for the ongoing professional development of CIs
• Determines student placements balancing clinical practice needs
with physical therapy education program requests for slots
• P rovides students with a comprehensive orientation to the clinical
facility,
• Introduces and defines the role of the student and the CI to all
members of the health care team
• Develops and disseminates site-based objectives for student
performance
The clinical practice:
Provides time and opportunity for the CCCE:
• To participate in continuing professional development related to
clinical education (eg, attend clinical education consortia activities)
• To mentor CIs
• To communicate with DCEs
• P
 rovides time for CIs to participate in activities related to clinical
teaching (eg, development of teaching modules, dialogues
with student, formative and summative student assessment,
communication with the academic institution)
• P
 rovides and funds professional development opportunities
explicit to clinical education (eg, in-services, journal clubs, research
activities, participation in professional conferences)
• Provides administrative supports as needed
Baseline Qualifications of a Clinical
Practice
The importance of a positive clinical en-
vironment with a supportive culture was
referenced by students as being influential
in their assessment of the CEE and is a criti-
cal component in determining the success of
the learning experience.48-52 Although the
literature supports the premise that effective
CIs utilize specialized skills in their role as
clinical educators, there has been less focus
on identifying the environmental, adminis-
trative, and personnel factors of an effective
clinical education setting.53,54 We recom-
mend that, to qualify for consideration as a
clinical affiliation site a facility must:
• establish an affiliation agreement with
the academic institution.
• promote staff involvement in clinical
education.
• appoint a CCCE who is dedicated to
clinical education.
A CCCE must be appointed to orga-
nize, direct, evaluate and develop the clini-
cal education program at the clinical facility
(Table 2). Among other essential qualities,
this individual should have expertise in ef-
fective clinical teaching and understand
the expected student clinical performance
outcomes for each CEE.21 The ability of the
CCCE to perform in a manner consistent
with professional expectations is, to a large
extent, contingent upon the cultural and
structural characteristics of the practice Effective Mechanisms for PT
environment.
Cultural and Structural Characteristics
of a Clinical Practice Environment
Students thrive in an environment that rec-
ognizes the importance of lifelong learn-
ing,49,55,56 provides a culture that promotes
integration and inclusion of students,57,58
and is structured to support these ideals.56-58
Evidence-based characteristics of clinical
practice environments that facilitate learn-
ing are displayed in Table 2. In order to create
an environment that meets these standards,
the appointed CCCE must remain current in
contemporary issues regarding clinical edu-
cation at local, regional, and national levels,
disseminate relevant information to clinical
education stakeholders at the clinical site, and
engage in ongoing communication with CIs,
students, and PT education programs.21 Sim-
ilar to the development of a CI from novice to
expert, these cultural and structural charac-
teristics take time, resources, and intentional
effort by the personnel at the clinical site to
cultivate.
Administrators at clinical sites need to be
made aware of the potential benefits to in-
52 Journal of Physical Therapy Education Vol 28, Supplement 1, 2014
vesting resources to create an environment
conducive to hosting CEEs. A 2012 unpub-
lished survey study of PT clinical site direc-
tors/managers, undertaken by members of
the New York/New Jersey Physical Therapy
Clinical Education Consortium, inquired
about reasons for participation in clinical
education. Among others, directors reported
staff recruitment, staff professional develop-
ment, fulfilling the mission of the site, and
strengthening the reputation of the facility
as incentives for hosting students’ in clini-
cal education. A majority of the respondents
reported the same or increased productivity
and enhanced quality of patient care during
CEEs.
In addition to the allocation of time and
resources by the clinical site, we recommend
that CCCE-specific continuing professional
development activities be developed and
made available by PT education programs
and consortia. CCCEs should also be for-
mally recognized for the pivotal role that they
play for direction of the clinical education
program at the clinical site and be provided
with the opportunity to attain clinical or ad-
junct faculty appointments by affiliating PT
education programs. Lastly, we recommend
ongoing, standardized assessments of the
CCCE and clinical site by PT education pro-
grams to ensure that there is consistency in
the presence and quality of the sample indica-
tors displayed in Table 2.
Education Program Evaluation of
Clinical Learning Environment
CAPTE requires PT education programs to
provide a comprehensive evaluation of their
individual clinical education programs that
includes assessment of each student’s CEE.
The director of clinical education (DCE) is
the primary faculty member from the PT
education program who is responsible for
evaluating all aspects of clinical education,
including the quality of the clinical learning
environment.59 Site visits provide the most
direct mechanism for the DCE to assess the
overall quality of the CEE. Key components
of site visits include face-to-face communica-
tion with the student, CI, and CCCE, and ob-
servation of essential teaching characteristics
of CIs and the clinical learning environment
as described in Tables 1 and 2. During site
visits, DCEs can readily identify the teaching
and learning needs of clinical education fac-
ulty and the barriers or challenges to a quality
CEE. Alternate means of assessment include
information gleaned from telephone con-
ferences, video-calls,60 e-mails,61 the APTA
Physical Therapist Clinical Performance In-
strument (PT CPI),62 and the Physical Thera-
pist Student Evaluation: Clinical Experience
and Clinical Instruction.63 These methods
collectively provide information for the DCE
to make determinations about the strengths,
challenges, and developmental needs of the
clinical learning environment.
Currently, DCEs from each PT educa-
tion program perform independent evalu-
ations of CEEs using assessments unique to
their institution. There should be a uniform
assessment tool available to all PT education
programs that would require DCEs to evalu-
ate the characteristics and qualities in tables
1 and 2. Clinical sites may be unaware of the
criteria on which they are being assessed and
a uniform tool would inform them about the
developmental needs of their clinical educa-
tion program. Therefore, we propose that a
standardized instrument be developed and
implemented to permit the systematic collec-
tion and analysis of data related to teaching
and learning at a clinical practice site, simi-
lar to the instruments used in other profes-
sions.56,57,64,65 Training modules could be
developed for DCEs in the use of this tool to
promote consistency in its use. Information
collected in an aggregate manner could be
shared between PT education programs to
promote communication regarding the qual-
ity of the teaching and learning experiences
available. This mechanism should promote
efficiency for PT education programs to de-
termine how to individually and collectively
support clinical sites’ continuing professional
development needs. Data could also be used
to identify and recognize clinical sites that
consistently exemplify the attributes of a
high-quality clinical learning environment.
The Influence of Caseload and CI–
Student Ratio on Clinical Teaching
There is a known challenge to secure and
retain student placements in sufficient quan-
tity and quality to meet the demands of PT
education program class sizes and increasing
lengths of required CEEs. This reality is re-
flected in the most recent CAPTE Fact Sheet
in which 21.8% of PT education programs re-
ported that they had changed a requirement
that students have certain types of experienc-
es (eg, acute care, rehabilitation).1 Fiscal and
regulatory challenges of contemporary health
care practice affect the learning environment
and demand exploration of strategies that will
promote quality CEEs and meet the needs
of PT education programs and clinical set-
tings.19
One proposed strategy to increase the
number of student placements that has not
been widely embraced by clinical practice set-
tings, is to assign multiple students to 1 clini-
cal instructor. The physical therapy literature
has demonstrated that students who partici-
pate in these experiences value the oppor-
tunity to collaborate with peers, gain access
to multiple philosophies of patient manage-
ment, and have greater opportunities to make
clinical decisions independently.66,67 CIs have
also described satisfaction with this clinical
education model as they feel it has fostered
the development of their own management
and clinical teaching skills.68 There is some
evidence to support the premise that this
model increases clinical productivity19,69-71;
however, in the current reimbursement cli-
mate, regulations imposed by third-party
payers may be a barrier to implementation.
Recent literature demonstrates that this mod-
el may be a very effective means of provid-
ing instruction for integrated and short-term
CEEs.66,67 Professional development activi-
ties geared towards CCCEs and CIs should
include topics on alternate delivery models
for clinical education. With continuing pro-
fessional development and support from PT
education programs and clinical administra-
tors, some sites may find ways to implement
the multiple student to 1 CI model in a mutu-
ally beneficial manner.
PT education programs and clinical prac-
tices need to promote effective CEEs in an
environment that requires clinicians to be
highly productive. A study by Silén et al12
demonstrated the importance of allowing
physician clinical educators dedicated time to
the role of supervising students. Participants
in this study were assigned primary respon-
sibilities related to clinical teaching versus
patient care. This model allowed them to be
more focused on observing student perfor-
mance, developing students’ reasoning, and
supporting students’ sense of being a physi-
cian. Another study indicated that increasing
the number of patient encounters did not en-
hance medical students’ learning and that the
quality of student supervision was of greater
importance.72 Literature in both physical
therapy36 and medicine72 has indicated that
fast-paced workloads and limited time for
student reflection impede deep learning.
The physical therapy profession needs
to consider how productivity demands on
students and CIs have the potential to com-
promise the quality of the CEE. Available
evidence suggests that when students are
given the time to engage in reflection and
discuss their clinical performance with the
CI, it strengthens their clinical reasoning
skills in a meaningful and timely manner.73
Although CIs expect students to be efficient
during patient interactions, their assessments
of students are based on holistic, intuitive de-
terminations about student performance and
may not strictly adhere to expected produc-
Vol 28, Supplement 1, 2014 Journal of Physical Therapy Education 53
tivity requirements.74 Therefore, we recom-
mend that CIs consistently be provided with
dedicated time to perform their role as clini-
cal teachers. The PT CPI may over-emphasize
the role of caseload in student assessment,
consequently causing greater stress to the CI
who feels pressured to unnecessarily increase
the number of patients seen with students.74
The student–CI team might benefit from re-
moving the pressure of holding students re-
sponsible to manage a full caseload, thereby
providing the student with time to reflect
and CI time to maintain productivity levels.
Based on these considerations, we encourage
national-level discussion of this dimension
of the grading criterion of the PT CPI to as-
sess the current efficacy and consistency of
its use across CEEs, and to consider possible
revisions. Additionally, research is needed to
explore the relationship between productiv-
ity, designated time for CI–student meetings,
and student learning outcomes to inform de-
cision making and follow-up activities by the
profession at large.
Responsibilities of Key Stakeholders
to Foster Excellence in Clinical
Education
PT education programs, clinical sites, and
the profession at large (working through dents to facilitate productive learning
national-level organizations) have a respon-
sibility to provide students with quality
CEEs that will prepare them for professional
practice upon graduation. To achieve this
outcome we propose the following recom-
mendations for these stakeholder groups.
PT education programs need to:
• Consider the challenges faced by clini-
cal facilities when providing clinical
education programs and limit class
sizes to match the availability of qual-
ity CEEs.
• Have formal mechanisms in place to
assess student readiness for upcoming
full-time CEEs.9
• Assess DCEs’ unique, nontraditional
teaching position and provide DCEs
with adequate resources and admin-
istrative support commensurate with
class size and scope of responsibilities
to permit them to fulfill this complex
role.39,75,76
• Enlist other core academic faculty to
assist the DCE(s) by investing time
and resources to effectively provide
traditional and nontraditional con-
tinuing professional development ac-
tivities to enhance CI teaching skills.
• Routinely extend supports and bene-
fits (eg, library privileges, clinical and/
or adjunct faculty appointments, ac-
cess to online resources, participation
in academic courses, etc) to clinical
educators to demonstrate that they are
valued and valuable members of the
PT education program.77
• Instill in students a professional com-
mitment to becoming a CI. Authentic
opportunities provided within the aca-
demic program to develop core com-
petencies for this teaching role may
enhance students’ confidence and mo-
tivation to become a CI.66
Clinical education sites should:
• Appoint a CCCE and provide ad-
equate supports and resources to assist
this individual in performing func-
tions identified in Table 2.
• Promote staff involvement in clinical
education as a professional practice
expectation and include the role of CI
in performance appraisals, clinical lad-
ders, and other incentive programs.
• Offer CEEs to PT education programs
commensurate with the number of CIs
who are motivated to develop quali-
ties and characteristics identified in
Table 1.
• Provide time for CIs to meet with stu-
and patient care outcomes.
• Provide supports for CCCEs and CIs
to promote their development as clini-
cal educators.
The American Council of Academic
Physical Therapy (ACAPT), working in part-
nership with the newly formed National Con-
sortium of Clinical Educators (NCCE) and
Clinical Education Special Interest Group
(CESIG) of the APTA Education Section,
must spearhead attainment of the initiatives
outlined above and should:
• Develop a CEE standardized assess-
ment tool to promote consistently
high-quality learning environments.
• Explore the development of a specialist
designation similar to the current AB-
PTS certifications, the Clinical Educa-
tion Specialist (CES), to recognize CIs
with advanced clinical teaching skills.
• Fund research to better define the fis-
cal impact of clinical education on PT
education programs and clinical sites.
DISCUSSION AND CONCLUSION
PT education programs and clinical sites
need to be held accountable to ensure that
evidence-based and agreed-upon standards
for CEEs, as displayed in Tables 1 and 2, are
realized. PT education programs must con-
sider clinical education sites with which they
hold contractual agreements as extensions of
the academic programs. As such, they need to
devote adequate resources to support the clin-
ical education portion of the academic pro-
gram. The development and implementation
of a standardized assessment tool for CEEs
is recommended. These assessments should
be conducted and results shared among PT
education programs to determine the devel-
opmental needs of the clinical education site.
Clinical education consortia can work collab-
oratively to promote efficiency and economy
in the development and delivery of continu-
ing professional development activities and
supports to meet identified needs. National
continuing professional development activi-
ties that focus on CCCE-specific skill devel-
opment and on CI progression from novice
to expert should be readily available. Clinical
education sites need to strategically and in-
tentionally build a culture that fosters quality
CEEs by appointing CCCEs who will work
in collaboration with DCEs at PT educa-
tion programs to support clinical education
initiatives. Clinical instructors and CCCEs,
who attain the certification of a CES will sup-
port the development of quality CEEs that
will benefit clinical sites and PT education
programs.
Clinical sites and PT education programs
must function in greater partnership with
each other to ensure all students have access
to quality CEEs to ensure preparation for
professional practice. This will require nego-
tiation and compromise by administrators at
both settings. Administrators at clinical sites
need to acknowledge the potential benefits
of hosting CEEs and demonstrate a com-
mitment to developing an optimal learning
environment. PT education programs must
recognize that clinical facilities need tangible
assistance to achieve this outcome. Ultimate-
ly, PT education programs and clinical facili-
ties need to reach agreement as to the models
of clinical education that are financially sus-
tainable for both entities and that will permit
CIs to effectively function as both clinical
educators and clinicians. National-level dis-
cussion, spearheaded by members of ACAPT,
NCCE, and CESIG is required to develop a
strategic plan for implementing these recom-
mendations so that professional standards for
all CEEs are realized.
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