Exploring Experienced Clinical Instructors' Experiences in Physical Therapist Clinical Education: A Phenomenological Study

Article excerpt

Background and Purpose. Recent data indicates that approximately 46% of the time spent in physical therapist professional education consists of clinical experiences. The clinical instructor (CI) plays an instrumental role in providing effective clinical education. To improve the value and the consistency of clinical education, the American Physical Therapy Association (APTA) developed a training course for clinical instructors (CIs) titled the Clinical Instructor Education and Credentialing Program (CIECP). Subsequently, several studies have quantitatively examined the types and effectiveness of teaching behaviors of CIs based on who took the CIECP. Despite this research, we have limited information about the daily interactions between CIs and students.

The purpose of this phenomenological study was to explore and describe the roles and behaviors of experienced CIs as they conducted clinical education.

Subjects. Purposive sampling was used to select 6 experienced, APTA-credentialed CIs who worked in various clinical settings.

Methods. Semi-structured interviews were conducted.

Results. The experienced CIs in this study described their primary role as helping students transition from formal (classroom) learning experiences to clinical practice. Three educational strategy themes emerged from the CIs' behaviors while transitioning students to clinical practice: incremental learning, reflection in practice, and creating a caring environment with students.

Discussion and Conclusion. The results indicate that the experienced CIs exhibit teaching behaviors similar to those of competent and expert clinicians and, therefore, models of competent and expert clinicians may be applicable to understand the behaviors of experienced CIs.

Key Words: Clinical instruction, Physical therapist, Teaching behaviors, APTA Clinical Instructor Education and Credentialing Program.

BACKGROUND AND PURPOSE

During the 2004-2005 academic years, clinical education averaged 41.5% of all hours accumulated during physical therapist education. In 2009-2010, the proportion of clinical education to total academic hours increased to 45%.? This upward trend suggests that the use of clinical education to train future physical therapists (PTs) will most likely continue to grow.

Why is clinical education so important in training health care professionals? Clearly, clinical education offers students learning experiences not available in the classroom. Unlike the classroom, learning in the clinical setting is embedded in a complex social and physical environment that is highly demanding, unpredictable, and uncertain.2 Most prominently, the clinically embedded nature of clinical experiences provides students with authentic, student-centered learning- integrating theory with problem solving, facilitating professionalism, and enhancing clinical skills. Plack and Driscoll,3 discussing the importance of clinical experiences, write:

Clinical internships and other clinical education experiences are what provide the real life experiences or contextual, social and interactive experiences that help us translate some of the abstract theories learned in the dassroom to actual clinical practice. (p162)

For physical therapist students, meaningful practice emerges during clinical experience. Whereas classroom learning may simulate real-life clinical situations, Mostrom4 writes, "It is the clinical setting where theory, research, and text acquire contextual, relational, and personal meaning for health professional students."(p266)

Specifically, the clinic provides the educational experience for transitioning physical therapist students to physical therapists. As Emery5 explains, clinical education provides a "vital extension of the academic program because students practice their newly learned psychomotor skills and assume a role that incorporates the attitudes, values, and beliefs of the physical therapy profession. …