Part 2. Payment for Clinical Education Experiences in Physical Therapy: Perspectives From Stakeholders

Abstract

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.

Facilitators and Barriers to Providing Clinical Education Experiences Through the Lens of Clinical Stakeholders

“…39 To what extent this is accomplished is not known and there may be opportunities to strengthen student self-efficacy as a clinical educator. As a large percentage of students believe that serving as a CI is a professional duty and one that aligns with our profession's core values, 20 academic programs must find a way to facilitate this development and empower students to encourage and contribute to an organizational culture of teaching. Clinical sites have this same opportunity by modeling a positive CE culture, being transparent about existing organizational barriers, and discussing ways in which to overcome these challenges.…”

“…Common definitions for CE experiences included integrated CE experience (full or part time experience occurring during the didactic curriculum with coordinated learning objectives) and full-time (at least 35 hours per week) CE experience. 20 Exempt status through Institutional Review Board was obtained. Quantitative data were collected and compiled in Microsoft Excel.…”

“…This study includes responses from participants of a previous study that explored perspectives and practices related to payment for CE experiences. 20 The survey was distributed before the pandemic, and full clinical respondent information was presented in a previous manuscript. 20 For the purposes of this study, survey questions analyzed included responses provided by 501 clinical administrators (ie, executive/manager such as chief executive officer, president, rehabilitation manager, practice owner), 445 SCCEs, and 657 CIs.…”

“…20 The survey was distributed before the pandemic, and full clinical respondent information was presented in a previous manuscript. 20 For the purposes of this study, survey questions analyzed included responses provided by 501 clinical administrators (ie, executive/manager such as chief executive officer, president, rehabilitation manager, practice owner), 445 SCCEs, and 657 CIs. Clinical respondents represented different geographic regions and a variety of clinical settings including private practice, acute care hospital, inpatient rehabilitation, home health, and others.…”

“…[1][2][3][4][5][6][7][8]10 Employers have suggested that students afford their CIs an opportunity to learn and acquire new skills and knowledge, not only in the area of clinical practice but also in leadership skills that prepare their employees to assume supervisory roles within the organization. 3 Similarly, CIs identify benefits to providing CE experiences as a way to give back to the profession, 2,6,20 gain intrinsic benefits from teaching/mentoring, 6 and advance their knowledge to maintain currency in their field. 2,3,6,21 Providing CE also improves communication and connection with the students' academic programs, 2 which may lead to opportunities for CIs to assist as adjunct faculty or new core faculty for physical therapy programs.…”