Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence
Main Article Content
Purpose: Alternative flexible (Flex) path Doctor of Physical Therapy (DPT) programs may have an emerging footprint. The differences between Flex and traditional residential DPT program clinical experience outcomes remain unknown. The purpose of this study was to evaluate Flex and residential DPT students’ clinical reasoning self-efficacy, confidence with treating, and Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences.
Methods: A descriptive and exploratory cross-sectional survey was used with a voluntary convenience sample of 211 university DPT students during Fall 2020 full-time clinical experiences. Descriptive and inferential statistics evaluated differences in Flex and residential DPT program students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final CPI clinical reasoning and summative scores during clinical experiences.
Results: Mean PTSE scores were significantly lower for Flex (x̄ = 14.2) compared to residential DPT students (x̄ = 15.2) (P < 0.05). No significant student differences were found in (1) Flex (x̄ = 2.1) and residential (x̄ = 2.2) confidence with treating at the initial visit (P = 0.59), (2) Flex (x̄ = 2.8) and residential (x̄ = 3.0) confidence with treating subsequent same-patient visits (P = 0.15), and (3) Flex (x̄ = 15.8) and residential (x̄ = 16.5) CPI clinical reasoning (P = 0.17), and (4) Flex (x̄ = 16.1) and residential (x̄ = 16.7) CPI summative scores (P = 0.21).
Conclusion: Clinical reasoning self-efficacy among Flex DPT students was lower, but there was no difference in CPI clinical reasoning or summative results between Flex and residential DPT students. In the university investigated, the Flex distance learning DPT program curriculum appeared effective in preparing students’ clinical reasoning readiness for the available full-time clinical experiences. We recommend academic institutions consider expanding Flex entry-level DPT program availability options because the outcomes were comparable. Additional flex entry programs may help address the underrepresentation of nontraditional students in entry-level DPT programs and societal demands for physical therapy services.
2. Occupational outlook handbook. U.S. Bureau of Labor Statistics. Updated April 18, 2022. Available from: https://www.bls.gov/ooh/healthcare/physical-therapists.htm [cited 26 June 2022].
3. Quick facts United States. www.census.gov. Available from: https://www.census.gov/quickfacts/fact/table/US/PST045221 [cited 28 September 2022].
4. Campbell DF, Brismée JM, Allen B, et al. Ethnicity does not impact physical therapy students’ clinical readiness and performance, a United States exploratory study. Internet J Allied Health Sci Pract (2023) 21(1): 9.
5. EduAdmin. Non-traditional students: how are they different and why does it matter? Focusedsolutions.com. Available from: https://focusedusolutions.com/2018/09/25/non-traditional-students-how-are-they-different-and-why-does-it-matter/ [cited 30 May 2022].
6. Tepper D. Opportunities exist in projected workforce demand. APTA.org; 2021. Available from: https://www.apta.org/apta-magazine/2021/04/01/opportunities-exist-in-projected-workforce-demand%20 [cited 1 July 2022].
7. Loria K. Physical therapy education: a vision for excellence and a call to action. APTA Mag (2022) 14(5): 34.
8. Brzozowski C. Component DEI committees reap benefits. APTA Mag (2022) 14(5): 20–30.
9. Schuetze HG, Slowey M. Participation and exclusion: a comparative analysis of non-traditional students and lifelong learners in higher education. High Educ (2002) 44: 309–27. doi: 10.1023/A:1019898114335
10. College of Rehabilitation Sciences, University of St. Augustine for Health Sciences. Flex DPT students talk about their experience [Video] YouTube. 2019. Available from: https://www.youtube.com/watch?v=DgKHEswVzjg [cited 30 May 2022].
11. Zvalo-Martyn J. Why my students like online learning. www.aacu.org.; 2020. Available from: https://www.aacu.org/liberaleducation/articles/why-my-students-like-online-learning [cited 3 July 2022].
12. Campbell DF, Brismée JM, Allen B, et al. Doctor of physical therapy students’ clinical reasoning readiness and confidence treating with telehealth: a United States survey. J Clin Ed Phys Ther (2022) 4: 1–10. doi: 10.52214/jcept.v4.8537
13. Musolino GM, Jensen GM. Clinical reasoning and decision making in physical therapy: facilitation, assessment, and implementation. Thorofare, NJ: SLACK Incorporated; 2020.
14. Huhn K. Developing clinical reasoning and decision-making skills: simulations and debriefing. Thorofare, NJ: SLACK Incorporated; 2020.
15. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev (1977) 84(2): 191–215. doi: 10.1037/0033-295X.84.2.191
16. Sherer M, Maddux JE, Mercandante B, et al. The self-efficacy scale: construction and validation. Psychol Rep (1982) 51: 663–71. doi: 10.2466/pr0.19126.96.36.1993
17. Babyar SR, Pivko S, Rosen E. Pedagogical tools to develop clinical reasoning: physical therapy students’ perspective. J Allied Health (2010) 39(3): e97–104.
18. 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
19. Jones A, Sheppard L. Self-efficacy and clinical performance: a physiotherapy example. Adv Physiother (2011) 13(2): 79–83. doi: 10.3109/14038196.2011.565072
20. Higgs J, ed. Clinical reasoning in the health professions. 3rd ed. Amsterdam: Elsevier; 2011.
21. Roach KE, Frost JS, Francis NJ, et al. Validation of the revised physical therapist clinical performance instrument (PT CPI): version 2006. Phys Ther (2012) 92(3): 416–28. doi: 10.2522/ptj.20110129
22. Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ (2010) 340: c332. doi: 10.1136/bmj.c332
23. English ML, Wurth RO, Ponsler M, et al. Use of the physical therapist clinical performance instrument as a grading tool as reported by academic coordinators of clinical education. J Phys Ther Educ (2004) 18(1): 87–92. doi: 10.1097/00001416-200401000-00012
24. van Lankveld W, Jones A, Brunnekreef JJ, et al. Assessing physical therapist students’ self-efficacy: measurement properties of the physiotherapist self-efficacy (PSE) questionnaire. BMC Med Educ (2017) 17(1): 250. doi: 10.1186/s12909-017-1094-x
25. Exporting evaluation results-clinical assessment suite help center. Liaisonedu.com website. Available from: https://help.liaisonedu.com/Clinical_Assessment_Suite_Help_Center/CPI/PT/01_ACCE%2F%2FDCE%2F%2FProgram_Staff/03_Exporting_Evaluation_Results [cited 21 January 2021].
26. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med (2007) 4(10): e297. doi: 10.1371/journal.pmed.0040297
27. IBM Corp. IBM SPSS statistics for windows, Version 26.0. Armonk, NY: IBM Corp.; 2019.
28. DeVellis RF. Scale development: theory and applications. 4th ed. Thousand Oaks, CA: Sage; 2016.
29. Aggregate program data-2019 physical therapist education programs fact sheets. Capteonline.org website. Available from: http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Aggregate_Program_Data/AggregateProgramData_PTPrograms.pdf [cited 18 January 2021].
30. Fosnacht K, Sarraf S, Howe E, et al. How important are high response rates for college surveys? Rev High Educ (2017) 40(2): 245–65. doi: 10.1353/rhe.2017.0003
31. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York, NY: Routledge; 1988.
32. Reynolds B, Unverzagt C, Koszalinski A, et al. Predictors of success on the national physical therapy examination in 2 US accelerated-hybrid doctor of physical therapy programs. J Phys Ther Educ (2022) 36(3): 225–31. doi: 10.1097/JTE.0000000000000227
33. Lewis J, McAuliffe S, O’Sullivan K, et al. Musculoskeletal physical therapy after COVID-19: time for a new ‘normal’. J Orthop Sports Phys Ther (2021) 51(1): 5–7. doi: 10.2519/jospt.2021.0102
34. Stern DF, Rosenthal R. Clinical education in physical therapy: the evolution from student to clinical instructor and beyond. Burlington, MA: Jones & Bartlett Learning; 2020.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.