History of Clinical Education in Physical Therapy in the United States

Article excerpt

Clinical education has been an integral part of the preparation of physical therapists from the inception of educational programs to train reconstruction aides until the current curricula to prepare Doctors of Physical Therapy. In this historical review of clinical education, the structure and format of the clinical education component of professional physical therapist education curricula are presented. The number of clinical education sites and characteristics of clinical education faculty for the past half century will be described, as will developments in methods used for the assessment of student performance. Descriptions of some of the major developments in clinical education are provided, including interinstitutional agreements, roles for clinical education faculty, professional development for the clinical instructor, clinical education consortia, clinical site selection, clinical education research, and conferences. Factors anticipated to have an effect on the future of clinical education in physical therapist educational programs are also discussed.

Key Words: Clinical education, History, Physical therapy.

INTRODUCTION

As a distinct element of the professional curriculum for physical therapists (PTs), clinical education has an interesting history. Physical therapist professional education has matured much like other health care professions, from training dependent largely on an apprenticeship model of teaching passed from one practitioner to another to curricula composed of both didactic and clinical components. Murphy, writing in Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, identifies what may be considered the first formalized clinical education for the "medical gymnasts,"1(p18) who were predecessors to today's PTs. Dr Sargent of Harvard University trained these women in postgraduate courses of 2 years in length.

When it became apparent the Sargent graduates were ideally suited to assist orthopedists in postsurgical rehabilitation, Sargent actively sought affiliations with the medical community. Beginning in 1886, his students were able to do clinical observations at Boston Children's Hospital.1(pp18-19)

However, the War Emergency Training Programs for Reconstruction Aides developed during World War I are considered the earliest PT educational programs. The Reed College program in Portland, Ore, was started in 1918 by Mary McMillan. Although short (conducted in just 3 months' time) and intense in format, 163 hours (26%) of the total 620 hours of training was devoted to clinical education and described as "practical experience in the treatment of patients at a local 'reconstruction clinic.'"1(p54) The first report of the Committee on Education and Publicity of the American Physiotherapy Association appeared in The Physiotherapy Review in September 1927(2) as the committee members requested information from PT educators about their curricula. By June 1928, the Association published Minimum Standard for Schools of Physical Therapy,3 indicating the desired length of the education programs to be 9 months, including 1,200 hours, 661 of which were to be theory hours and 539 practice or laboratory hours. Although clinical time was not specified, if the laboratory hours for basic science topics such as physiology, chemistry, and physics are removed from the practice or laboratory total, the remaining hours (395 [33%]) could represent the time spent in clinical practice. In the 1920s, the education programs that replaced the emergency training programs often were conducted in a single clinically based physical therapy setting using an apprenticeship model for clinical experience. Some early educators were dissatisfied with this model of professional education, such as Graham4, who wrote about her concerns for the profession's image in the 1928 volume of The Physiotherapy Review:

The subject of the professional education of Physiotherapists is one of vital interest and importance to all who are in the profession. …