Essential Characteristics of Quality Clinical Education Experiences: Standards to Facilitate Student Learning

BACKGROUND AND PURPOSEPhysical therapist (PT) education programs devote up to 48% of contact/clock hours in the curriculum to clinical education experiences (CEEs) where students engage in experiential learning activities with real patients under the supervision of a clinical instructor (Cl).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 articulate 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 evidenceand consensus-based parameters, the quality of students' CEEs is inconsistent.Multiple factors contribute to the variability in quality that students encounter during CEEs. These include, but are not limited to, the Cl's competence and confidence as a teacher, the clinical practice setting's motivation 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. Studies demonstrate that CIs are conflicted by opposing demands on their time in filling their dual roles as practitioners and as teachers 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 tension for the Cl who attempts to balance clinical practice demands with student-focused clinical teaching14,15 and can impact the quality of a CEE.It is widely agreed that CEEs are an essential 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 ensure that evidence-based and agreed-upon professional standards are consistently present. The purpose of this paper is to articulate the necessary qualifications and characteristics of CIs and practice settings that are essential 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 producing high quality CEEs.POSITION AND RATIONALEIt 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 evidence-based professional standards. Clinical education experiences should be monitored in a standardized manner, such that PT education programs, working in collaboration with clinical practice sites, will provide the supports to meet the developmental needs of CIs and center coordinators of clinical education (CCCEs) in their roles as clinical educators. Physical therapist education programs must dedicate adequate resources, commensurate 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 learning at practice sites. Ultimately, PT education programs and clinical practice sites must be held accountable for ensuring that all students consistently have access to quality CEEs that consistently exemplify agreed-upon professional qualifications, qualities, and characteristics.Baseline Qualifications of CIsIn setting baseline qualifications for CIs, we attempted to balance visionary pursuit of excellence with the reality of constraints of the current health care environment, higher education, and the physical therapy profession. Following an extensive review of professional documents,9,19"21 reflection on our cumulative experiences, and shared dialogue, we propose that to qualify for consideration as a Cl, 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 regulations,* demonstrate a desire to educate students, and* display evidence of teaching skills. …