The Journal of Clinical Education in Physical Therapy

How crisis management led to enduring collaboration in clinical education: a case report

Elsa Drevyn — 2025-01-29

Rationale: Historical challenges in clinical education were intensified by the global health pandemic. This paper describes how clinical educators in Florida collaborated during the crisis to strategize to meet immediate clinical education needs of clinical sites and academic programs while creating a roadmap for sustainable future success.

Clinical education scenario: A task force of clinical educators was formed to assess the current state of clinical education and manage the evolving crisis. Two unique needs assessments were developed and disseminated to both academic and clinical educators. A descriptive research design was used. Quantitative findings were reported through descriptive statistics.

Outcomes: Obtaining objective data was crucial for decision-making and implementing solutions during this crisis. Data analysis informed a series of coordinated, phased, action items that were implemented. Not only opportunities for immediate support were identified, but also longstanding challenges within clinical education were confirmed. The study results led to informed crisis management, reduced competition, and enduring collaboration.

Discussion and implications: Without collaboration, the pandemic’s impact on clinical education could have been more severe. Implementing data-driven crisis management strategies mitigated challenges posed by the pandemic and improved processes, enhancing the future state of clinical education in Florida.

Stress to be managed and managing stress in clinical education

Christopher Kevin Wong — 2025-01-28

We introduced the Journal of Clinical Education in Physical Therapy (JCEPT) in 2019 as an open-access peer-reviewed journal with the twin goals of disseminating educational scholarship related to clinical education and developing physical therapy educational scholars. We were first indexed to the Directory of Open Access Journals (DOAJ) in 2022, and recently passed the scientific quality review for PubMed Central (PMC) indexing. As JCEPT has become more and more established the acceptance rate has declined somewhat, yet our editorial team remains true to the developmental aspect of our mission as we work with authors through multiple iterations of their manuscripts. Over the years, JCEPT abstract views have increased five-fold and indexing will further enhance the visibility and credibility of physical therapy clinical education scholarship.

A theme arising from this year’s volume was the focus on issues within the psychosocial domain across the continuum of people involved in clinical education. Student stress during their clinical education experiences including student debt and overall financial stress was explored. Also concerning was the ~66% average rate of inappropriate sexual advances by patients towards physical therapy students and the need to manage related stress and circumstances. Clinical instructors also experience stress as indicated in those with fewer than five years of experience by low compassion satisfaction. The experience may be the opposite for those at the other end of the experience spectrum as those with over 25 years in the field reported low levels of burnout. Directors of Clinical Education also manage stressful scenarios as highlighted by a case report about clinical education adjustments to the challenges of the COVID-19 pandemic as well as a perspective suggesting adopting common clinical education setting terminology to reduce confusion. And for fellows, who are licensed physical therapists managing life beyond school with further training, the impact of life circumstances is suggested by better functional outcomes and more efficient episodes of care for fellows without kids at home.

JCEPT publishes scholarly work affecting any aspect of clinical education in physical therapy addressing academic or clinical faculty; entry-level students, residents, or fellows; and curricula or teaching and learning methods. In addition to original research, systematic reviews, and innovative teaching methods, JCEPT publishes clinical education case reports, case reports from residency or fellowship training, excellent critically appraised topics, and the occasional perspective. We look forward to supporting educational scholars and developing the evidence underpinning physical therapy clinical education.

Christopher Kevin Wong and Jean Fitzpatrick
Founding Editors in Chief

Variability and inconsistency in clinical education setting terminology: a call to action

Lori Hochman — 2025-03-05

Purpose: Significant variation exists in clinical education placement setting terminology amongst clinical education stakeholders. The lack of agreed-upon terminology impacts clear communication between academic institutions and clinical sites while also impacting researchers’ abilities to successfully conduct large-scale national studies. This study explored the variability of physical therapist (PT) student clinical education placement setting nomenclature across the United States.

Methods: De-identified full-time PT student clinical education placements between January 2014 and September 2023 were extracted from Exxat^© Version 3. Using the American Physical Therapy Association membership profile data as guidance, researchers created broad categories that represented the clinical education placement settings. Eight unique settings along with one category for ‘mixed setting’ and one for ‘unclassified’ were identified: acute care, day rehabilitation, home care, inpatient rehabilitation, long-term acute care hospital, outpatient, school and sub-acute rehabilitation (sub-acute rehabilitation, long-term care and skilled nursing facilities). Extracted data were sorted into those categories.

Results: The dataset was composed of 132,320 clinical education placements from 178 PT education programs. There were 1,388 different labels in the dataset used to describe the settings for those clinical education placements.

Conclusions: Task forces have worked diligently to establish standardization in terminology in physical therapy clinical education. Due to the current variability in labelling clinical placement settings, the authors present a call to action for the development of agreed-upon placement setting terminology. A common naming system is proposed which may facilitate clear communication between all parties while also supporting research efforts in clinical education.

Physical therapy students’ perceived levels and sources of stress during clinical education experiences

Lisa L. Dutton — 2024-10-21

Purpose: Stress has been linked to poor performance and mental health disorders in health professions students. Very little is known about health professions students’ stress during clinical education. The purpose of this study was to explore the levels and sources of stress experienced by Doctor of Physical Therapy (DPT) students during the clinical education portion of their curriculum.

Methods: In this cross-sectional, descriptive study, 925 first-, second-, and third-year DPT students from eight Midwestern colleges and universities were invited to complete an electronic survey during a clinical experience. The survey included demographic information, the 10-item Perceived Stress Scale (PSS), and the Undergraduate Sources of Stress (USOS) scale.

Results: The response rate was 28% with a total of 259 returned surveys. The mean PSS score was 14.15 out of a possible 40, with a range from 0 to 30. There were significant differences in levels of stress based on program year and clinical level. No significant differences in level or sources of stress were noted based on gender or clinical setting. Academic sources were the greatest source of stress reported. Amount of student debt and percentage of responsibility for graduate education were significantly correlated with financial sources of stress.

Conclusion: Participants in this study reported mean PSS scores during clinical education experiences similar to those previously reported for physical therapy. Identifying perceived stress levels, sources of stress, and mitigating factors has the potential to improve the health of students and positively impact patient care.

Effectiveness and efficiency of patient care while enrolled in an orthopedic physical therapy fellowship program

Susan L. Edmond — 2024-09-10

Rationale: Post-professional orthopedic manual physical therapy education programs have proliferated, in part due to increasing therapist demand. Despite the time, effort, and money required to complete these programs, there is scant research addressing their impact.

We investigated whether physical therapists enrolled in an accredited manual physical therapy fellowship program achieved better outcomes, determined by patient changes in function, number of physical therapy visits, and episode of care duration while enrolled in the program. We also examined whether outcomes varied by clinician demographics, clinician life circumstances, and clinic characteristics.

Methods: Forty-two therapists contributed patient data addressing functional status, number of visits, and episode of care duration. We compared data from the first 30 patients with data from the last 30 patients seen by each therapist while enrolled in the program. We also surveyed therapists regarding their demographics, life circumstances, and clinic characteristics.

Results: There were no clinically meaningful or statistically significant differences in change in functional status when comparing results from the first 30 patients with the last 30 patients seen by therapists. However, there was a significant reduction in the number of visits and episode of care duration. Outcomes were influenced by entry-level degree and the presence of children at home.

Conclusion: In our study, enrollment in a physical therapy fellowship program did not improve patient functional status but did reduce the number of visits and episode of care duration. Outcomes were influenced by some clinician life circumstances and clinic characteristics.

Physical therapy students’ experiences of inappropriate patient sexual behavior: a narrative review

David Smelser — 2024-08-16

Primary objective: The purpose of this study is to identify the extent to which inappropriate patient sexual behavior (IPSB) is directed toward student physical therapists (PTs) and how this phenomenon is described in the current literature.

Review type: Narrative review.

Summary of review method: A search of PubMed, CINAHL Plus, and Academic Search Complete was conducted using the Boolean phrase (‘sexual harassment’ OR ‘sexual assault’ OR ‘inappropriate sexual behavior’ OR ‘sexual behavior’) AND (‘physical therapy’ OR physiotherapy OR ‘physical therapist’ OR physiotherapist). After relevant articles were identified, references were searched for additional relevant material. Data and common themes were identified, extracted, and summarized.

Primary results: Studies indicate that 84% to 92.9% of PTs have IPSBs directed at them during their careers. There is less information on the rate at which student PTs are targets of IPSB, but the available studies indicate 66.2% to 78% of them experience IPSB during their clinical experiences. In one study, over 22% of PT students experienced severe forms of IPSB during clinical experiences. Other studies show that student PTs and novice PTs respond to IPSB with techniques that are less effective than those used by experienced PTs. Qualitative reports indicate that student PTs feel that they and their clinical instructors are unprepared for IPSB and believe more training on the topic is necessary.

Conclusion: The available literature indicates that most PT students have IPSB directed at them during their clinical experiences. Students report feeling unprepared and desire more training on this topic. Additional training may reduce IPSB.

Agreement between vestibular elective physical therapy students and experienced physical therapists in identifying nystagmus during positional testing and diagnosing benign paroxysmal positional vertigo (BPPV)

Laura P. Kennedy-Rynne — 2024-05-02

Purpose: The aim of this study is to measure the effectiveness of a vestibular elective in preparing students to perform nystagmus identification and diagnosing benign paroxysmal positional vertigo (BPPV) through an investigation of agreement between student performances and experienced physical therapists.

Methods: Seven students watched eye movement videos during positioning testing of 14 patients. Students recorded the nystagmus characteristics for each position and made diagnoses. The students completed additional surveys. Pairwise percent agreement and kappa statistics (κ) were used to compare agreement between each students’ conclusions to those of an experienced physical therapist obtained from a previous study. Krippendorff’s alpha (α) was used to analyze the overall reliability of student ability for these skills.

Results: Interrater agreement between students and the expert was fair to almost perfect (κ = 0.22 to 1) in identifying nystagmus, and slight to almost perfect (κ = −0.02 to 1) in diagnosing BPPV. There was moderate agreement between students to identify nystagmus (α = 0.58–0.65, average agreement = 80–83%) during positional testing, and fair to moderate agreement to diagnose BPPV (α = 0.38 to 0.53, average agreement = 64–74%). Agreement was higher in cases of typical BPPV presentations. Students reported the task as difficult, had the necessary knowledge, and wanted more practice. Correlations (r = 0.76 to 0.82) were seen between clinical experience with BPPV and lower perceived difficulty.

Conclusion: Students are capable of identifying nystagmus and diagnosing typical BPPV; however, students may require more practice, clinical experience, and mentorship to improve reliability. The results may help determine educational needs to prepare clinicians to manage individuals with BPPV.

Professional quality of life and organizational support: a survey of physical therapists with experience as clinical instructors

Andrea Mierau — 2024-04-29

Purpose: The purpose of this study was to determine the professional quality of life (ProQoL) of physical therapists (PTs) with experience as a clinical instructor and identify factors associated with compassion satisfaction, burnout, and secondary traumatic stress.

Methods: This study used a cross-sectional design and survey methodology. Participants were clinician PTs who have been clinical instructors, and completed an online survey that included the ProQoL scale, the eight-item Survey of Perceived Organizational Support, and demographics.

Results: Of the 259 participants who completed the survey, the majority experienced average to high levels of compassion satisfaction and low levels of burnout and secondary traumatic stress. Chi-square tests of independence indicated high ratings of compassion satisfaction were associated with the uppermost years licensed as a PT, years of clinical teaching experience, and age. Participants aged 26–35 or with less than 5 years of clinical instruction experience correlated with low ratings of compassion satisfaction. Participants with more than 25 years of experience as PTs correlated with low ratings of burnout. High levels of compassion satisfaction were associated with high levels of perceived organizational support.

Conclusion: Findings may assist clinical sites and site coordinators of clinical education in selecting and training clinical instructors.