Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence

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Derrick F. Campbell
Jean-Michel Brismée
Brad Allen
Troy L. Hooper
Manuel A. Domenech
Kathleen J. Manella


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 ( = 14.2) compared to residential DPT students ( = 15.2) (P < 0.05). No significant student differences were found in (1) Flex ( = 2.1) and residential ( = 2.2) confidence with treating at the initial visit (P = 0.59), (2) Flex ( = 2.8) and residential ( = 3.0) confidence with treating subsequent same-patient visits (P = 0.15), and (3) Flex ( = 15.8) and residential ( = 16.5) CPI clinical reasoning (P = 0.17), and (4) Flex ( = 16.1) and residential ( = 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.


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Article Details

Clinical performance, Flexible program, Confidence, Self-efficacy, Hybrid
Original Research Articles
How to Cite
Campbell, D. F., Brismée, J.-M., Allen, B., Hooper, T. L. ., Domenech, M. A. ., & Manella, K. J. (2023). Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence. The Journal of Clinical Education in Physical Therapy, 5.