Introduction/Review of the Literature: Payment for clinical education (CE) experiences is a current topic of discussion within health care professions wherein incidence of payment is described as rare but growing. The American Council of Academic Physical Therapy (ACAPT) Board charged the National Consortium of Clinical Educators (NCCE) to investigate payment for physical therapist (PT) CE experiences. The ACAPT NCCE Task Force (TF) on Payment for Clinical Experience surveyed academic, clinical, and student CE stakeholders to explore perspectives on the current landscape for payment of PT CE experience. Methods: Two surveys were constructed using an exploratory research design: an academic and clinical stakeholder survey and a student survey. For the academic and clinical survey, the TF used member content expertise and literature review to draft questions. Final questions were crafted after conducting 2 validation rounds by an expert panel. For the student survey, student focus groups created and validated final survey questions. Snowball sampling was employed for survey dissemination through ACAPT and NCCE networks. Descriptive statistics were examined and significant differences (P < .05) between stakeholder groups were analyzed. Analysis of open-text responses was conducted to categorize and identify common concepts. There were 1,883 academic and clinical stakeholder survey respondents, with 84.3% identifying as a clinical-only role; all NCCE regions and practice settings were represented. First-, second-, and third-year doctor of physical therapy student survey respondents (2,815) represented both private and public academic programs. Results: Less than 5% of academic institutions reported paying any portion of full-time CE experiences. A majority of respondents (1,153, 71.9%) were neutral or disagreed that clinical instructors (CIs) should receive direct payment for supervising students and 76.9% indicated that students should not be required to pay for CE experiences. Both intrinsic and extrinsic factors were cited as reasons not to seek payment and as benefits for providing CE experiences. Supervision restrictions and productivity expectations were identified as key barriers to providing CE experiences. Students indicated that prior knowledge of site and CI qualifications would be expected should students be required to pay for CE experiences. Discussion and Conclusion: Most academic, clinical, and student CE stakeholders did not support payment for CE experiences. The stakeholder-identified motivators and nonmonetary incentives to provide CE experiences present an opportunity to explore initiatives that will enhance availability of PT CE experiences aligned with an ACAPT strategic plan on a national level.
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.
Doctor of physical therapy preparation requires extensive time in precepted clinical education, which involves multiple stakeholders. Student outcomes in clinical education are impacted by many factors, and, in the case of failure, it can be challenging to determine which factors played a primary role in the poor result. Using existing root-cause analysis processes, the authors developed and implemented a framework designed to identify the causes of student failure in clinical education. This framework, when applied to a specific student failure event, can be used to identify the factors that contributed to the situation and to reveal opportunities for improvement in both the clinical and academic environments. A root-cause analysis framework can help to drive change at the programmatic level, and future studies should focus on the framework’s application to a variety of clinical and didactic settings.
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