Examining relationships between the clinical learning environment and clinical reasoning in physical therapy education
Main Article Content
Abstract
Purpose: Newly graduated physical therapists are expected to demonstrate high levels of clinical reasoning. Doctor of Physical Therapy (DPT) programs should ensure clinical education experiences foster clinical reasoning. Minimal evidence exists regarding factors that influence physical therapy clinical learning environments (CLE). The purpose of this study was to examine associations between factors DPT students perceive to impact CLE and students’ self-efficacy in clinical reasoning.
Methods: This quantitative exploratory correlational study electronically surveyed 45 graduate physical therapy students enrolled in their final year of DPT education programs upon completing their terminal clinical education experience. The Physical Therapy Self-Efficacy Scale and the abbreviated Clinical Learning Environment Inventory-19 (CLEI-19) were used to assess self-efficacy in clinical reasoning and perceived personalization, student involvement, task orientation, innovation, and student satisfaction in CLE, respectively. Inferential and descriptive statistics assessed the relationships between self-efficacy in clinical reasoning and the previously mentioned CLEI-19 factors.
Results: Very weak to weak, positive relationships that were not statistically significant were identified between self-efficacy in clinical reasoning and perceived personalization (rs(43) = 0.21, P = 0.163), student involvement (rs(43) = 0.14, P = 0.375), task orientation (rs(43) = 0.03, P = 0.867), innovation (rs(43) = 0.16, P = 0.286), and student satisfaction (rs(43) = 0.28, P = 0.064), respectively, in CLE.
Conclusion: DPT programs can use this study to determine which factors in physical therapy CLE relate to self-efficacy in clinical reasoning. The results of this study can be used to guide future research in identifying perceived influential factors in physical therapy CLE.
References
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23. Lowe L, Flowers M, Fletcher J, et al. The effects of experiential learning on perceived clinical reasoning and self-efficacy of Doctor of Physical therapy students. J Phys Ther Educ (2022) 36(2): 122–7. doi: 10.1097/JTE.0000000000000225
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41. Suikkala A, Timonen L, Leino-Kilpi H, et al. Healthcare student-patient relationship and the quality of the clinical learning environment – a cross-sectional study. BMC Med Educ (2021) 21(1): 230. doi: 10.1186/s12909-021-02676-x
2. Commission on Accreditation in Physical Therapy Education. Standards and required elements for accreditation of physical therapist education programs. November 3, 2020. Available from: https://www.capteonline.org/globalassets/capte-docs/capte-pt-standards-required-elements.pdf [cited 3 November 2020].
3. A vision for excellence in physical therapy education: culmination of the work of the Education Leadership Partnership August 2021. J Phys Ther Educ (2021) 35(Suppl 1): 1–35. doi: 10.1097/JTE.0000000000000216
4. Wolden M, Drevyn E, Flom-Meland C, et al. Evaluation and modification of the physical therapist clinical performance instrument. J Phys Ther Educ. (2021) 35(2): 85–94. doi: 10.1097/JTE.0000000000000216
5. Yu M, Tong H, Li S, et al. Clinical competence and its association with self-efficacy and clinical learning environments among Chinese undergraduate nursing students. Nur Educ Pract (2021) 53: 103055. doi: 10.1016/j.nepr.2021.103055
6. Venskus DG, Craig JA. Development and validation of a self-efficacy scale for clinical reasoning in physical therapists. J Phys Ther Educ (2017) 31(1): 14–20. doi: 10.1097/00001416-201731010-00005
7. Kobal KL, Rubertone PP, Kelly SP, et al. A comparison of instructional methods on clinical reasoning in entry-level physical therapy students: a pilot study. J Phys Ther Educ (2021) 35(2): 138–45. doi: 10.1097/JTE.0000000000000181
8. George LE, Locasto LW, Pyo KA, et al. Effect of the dedicated education unit on nursing student self-efficacy: a quasi-experimental research study. Nur Educ Pract. (2017) 23: 48–53. doi: 10.1016/j.nepr.2017.02.007
9. Bandura A. Self-efficacy: the exercise of control. W.H. Freeman; 1997, New York.
10. Scott K, Wissinger J, Hand B, et al. Considering domain-specific experiential learning: self-efficacy in pediatric physical therapy education. Pediatr Phys Ther (2021) 33(3): 163–9. doi: 10.1097/PEP.0000000000000797
11. Bains M, Kaliski DZ. An anatomy workshop for improving anatomy self-efficacy and competency when transitioning into a problem-based learning, Doctor of Physical Therapy program. Adv Physiol Educ (2020) 44(1): 39–49. doi: 10.1152/advan.00048.2019
12. Hough J, Levan D, Steele M, et al. Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients. BMC Med Educ 2019; 19(1): 463. doi: 10.1186/s12909-019-1894-2
13. Milne N, Louwen C, Reidlinger D, et al. Creating a supportive clinical learning environment for physiotherapy students: a feasibility study to enhance collaboration between students and educators using the ‘Everything DiSC’. Aust J Clin Educ (2022) 11(2): 37–60. doi: 10.53300/001c.55653
14. Chan D. Development of the Clinical Learning Environment Inventory: using the theoretical framework of learning environment studies to assess nursing students’ perceptions of the hospital as a learning environment. J Nurs Educ (2002) 41(2): 69–75. doi: 10.3928/0148-4834-20020201-06
15. Shivers E, Hasson F, Slater P. Pre-registration nursing student’s quality of practice learning: clinical learning environment inventory (actual) questionnaire. Nur Educ Today (2017) 55: 58–64. doi: 10.1016/j.nedt.2017.05.004
16. Hamshire C, Wibberley C. Fitting in with the team: facilitative mentors in physiotherapy student placements’. Teach Learn Inq (2017) 5(2) 80. doi: 10.20343/teachlearninqu.5.2.7
17. Reilly M, Beran-Shepler K, Paschal KA. Pedagogy for effective learning of clinical skills: an integrated laboratory model. J Phys Ther Educ. (2020) 34(3): 234–41. doi: 10.1097/JTE.0000000000000145
18. Salamonson Y, Bourgeois S, Everett B, et al. Psychometric testing of the abbreviated Clinical Learning Environment Inventory (CLEI-19): psychometric testing of CLEI-19. J Adv Nurs. (2011) 67(12): 2668–76. doi: 10.1111/j.1365-2648.2011.05704.x
19. BodysCupak I, Ścisło L, Kózka M. Psychosocial determinants of stress perceived among Polish nursing students during their education in clinical practice. Int J Environ Res Public Health (2022) 19(6): 3410. doi: 10.3390/ijerph19063410
20. Williamson GR, Rowe LM, Knowles S, et al. Preparation and support for students in community placements: a mixed methods study. Nur Educ Pract (2020) 44: 102747. doi: 10.1016/j.nepr.2020.102747
21. Salamonson Y, Everett B, Halcomb E, et al. Unravelling the complexities of nursing students’ feedback on the clinical learning environment: a mixed methods approach. Nurs Educ Today (2015) 35(1): 206–11. doi: 10.1016/j.nedt.2014.08.005
22. Campbell DF, Brismee JM, Allen B, et al. Self-efficacy with telehealth examination: the Doctor of Physical Therapy student perspective. Philipp J Phys Ther (2023) 2(2): 12–9. doi: 10.46409/002.UDAV8455
23. Lowe L, Flowers M, Fletcher J, et al. The effects of experiential learning on perceived clinical reasoning and self-efficacy of Doctor of Physical therapy students. J Phys Ther Educ (2022) 36(2): 122–7. doi: 10.1097/JTE.0000000000000225
24. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organ Res Methods (2001) 4(1): 62–83. doi: 10.1177/109442810141004
25. Swinscow TDV, Campbell MJ. Statistics at square one. 9th ed. BMJ Publ. Group; 1996, London, England.
26. Al-Moteri M. Implementing Active Clinical Training Approach (ACTA) in clinical practice. Nur Educ Pract (2020) 49: 102893. doi: 10.1016/j.nepr.2020.102893
27. Cevik AA, ElZubeir M, Abu-Zidan FM, et al. Team-based learning improves knowledge and retention in an emergency medicine clerkship. Int J Emerg Med (2019) 12(1): 6. doi: 10.1186/s12245-019-0222-2
28. Seidel N, Haake JM, Burchart M. From diversity to adaptive personalization: the next generation learning management system as adaptive learning environment. Eleed e-Learn Educ (2021) 14. Available from: https://www.eleed.de/archive/se2021/5242
29. Niederhauser V, Schoessler M, Gubrud-Howe PM, et al. Creating innovative models of clinical nursing education. J Nurs Educ. (2012) 51(11): 603–8. doi: 10.3928/01484834-20121011-02 [cited 11 October 2012].
30. Kruger JS, Doloresco F, Maerten-Rivera J, et al. An innovation sprint to promote problem-solving and interprofessional skills among pharmacy and public health students. Am J Pharm Educ (2023) 87(1): ajpe8852. doi: 10.5688/ajpe8852
31. Papathanasiou IV, Tsaras K, Sarafis P. Views and perceptions of nursing students on their clinical learning environment: teaching and learning. Nur Educ Today (2014) 34(1): 57–60. doi: 10.1016/j.nedt.2013.02.007
32. Chan DSK. Associations between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment. Int J Nurs Stud (2002) 39(5): 517–24. doi: 10.1016/S0020-7489(01)00057-8
33. Naghsh Daemi M, Tahriri A, Mahdavi Zafarghandi A. The relationship between classroom environment and EFL learners’ academic self-efficacy. Int J Educ Liter Stud (2017) 5(4): 16. doi: 10.7575/aiac.ijels.v.5n.4p.16
34. D’Souza MS, Karkada SN, Parahoo K, et al. Perception of and satisfaction with the clinical learning environment among nursing students. Nur Educ Today (2015) 35(6): 833–40. doi: 10.1016/j.nedt.2015.02.005
35. Löfmark A, Thorkildsen K, Råholm MB, et al. Nursing students’ satisfaction with supervision from preceptors and teachers during clinical practice. Nur Educ Pract (2012) 12(3): 164–9. doi: 10.1016/j.nepr.2011.12.005
36. Obiosa N. Effects of students’ motivation and engagement on students’ satisfaction in a lecture: empirical analysis. Int J Instruction (2020) 13(3): 861–76. doi: 10.29333/iji.2020.13357a
37. DiMattio MJK, Hudacek SS. Educating generation Z: psychosocial dimensions of the clinical learning environment that predict student satisfaction. Nur Educ Pract (2020) 49: 102901. doi: 10.1016/j.nepr.2020.102901
38. American College of Health Association. Undergraduate Student Reference Group: executive summary Spring 2024. 2024. Available from: https://www.acha.org/wp-content/uploads/NCHA-IIIb_SPRING_2024_UNDERGRADUATE_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf [cited 21 January 2025].
39. American College of Health Association. Graduate/professional student Reference Group: executive summary Spring 2024. 2024. Available from: https://www.acha.org/wp-content/uploads/NCHA-IIIb_SPRING_2024_GRADUATE_PROFESSIONAL_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf [cited 21 January 2025].
40. Ickes MJ, Brown J, Reeves B, Zephyr PMD. Differences between undergraduate and graduate students in stress and coping strategies. Calif J Health Promot (2015) 13(1): 13–25. doi: 10.32398/cjhp.v13i1.1810
41. Suikkala A, Timonen L, Leino-Kilpi H, et al. Healthcare student-patient relationship and the quality of the clinical learning environment – a cross-sectional study. BMC Med Educ (2021) 21(1): 230. doi: 10.1186/s12909-021-02676-x
Article Details
Keywords:
clinical competence, self efficacy, clinical reasoning, physical therapy, clinical education
Issue
Section
Original Research Articles
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
Stoddard, S., Kupczynski, L., & Jameson, C. M. (2025). Examining relationships between the clinical learning environment and clinical reasoning in physical therapy education. The Journal of Clinical Education in Physical Therapy, 7. https://doi.org/10.52214/jcept.v7.12874