Section II: The Clinical Education Program and Policies

Designing the Clinical Education Experience

Guidelines for the Clinical Instructor

The clinical education experiences transform the physical therapy student into a clinician.  An enormous responsibility is thus placed on the clinical instructor (CI), because the clinical education process not only affects the student, but can ultimately impact the profession as well (1). Yet, clinicians are often asked to assume the role of CI with little or no preparation for the responsibility. Hopefully, the following guidelines will assist the CI when designing the clinical experience.

            The first step in designing the clinical affiliation is to determine the competency for the experience. Competency is defined as skilled, complex performance. Furthermore, competency includes cognition, psychomotor and affective behaviors (2). The desired competency for each clinical experience is usually specified by the education program but may be further defined by the clinical facility.

Objectives for the experience are determined next.  The academic coordinator for clinical education (ACCE) provides a list of general objectives from the education program for each clinical experience. In addition, the clinical facility may have objectives of its own.  However, the student should also have input into the clinical objectives.  These should be based on offerings of the clinical facility and the student’s background and interest areas. Thus, honest self-assessment by the student of their strengths and weaknesses is important (3).

            Learning experiences that allow the student to accomplish the objectives are then selected, organized and implemented.  These experiences should progress the student from observer to a participant. Furthermore, they should allow the student to begin with simple and progress to more complex skills (1, 3). For example, patient care skills may begin with the development of treatment, and goal setting and the treatment progression and discharge planning. Communication skills can be developed by first stressing interaction with the CI and patients, then the health care team, and finally the physician (1).

            When designing learning experiences, the problem solving process should also be incorporated because it is believed that people learn and retain more effectively when actively involved in the learning process.  Thus the learner is allowed to discover relationships and explore alternatives.  The steps in the problem-solving process are as follows: problem recognition and definition, problem analysis, data management, solution development, implementation and evaluation of outcome (2).

            Supervision is the final component of the clinical education experience.  Feedback is usually provided on an ongoing basis in addition to mid-term and final evaluations.  Students require close supervision initially, which may be followed by “coaching” before and after performance of a task, and then progress to more distant supervision as the student assumes more independence with patient management (1, 3, and 4).  Although a strong knowledge base is important, communication, interpersonal and teaching skills have been identified by students as being the qualities that are most desired in their CI’s (5).

            In conclusion, careful planning is required to ensure that the student achieves the desired competency by the end of their clinical experience. This involves determining objectives, selecting and organizing learning experiences that incorporate a problem-solving approach, and providing feedback. Input from the student, the ACCE and the CCCE is also helpful when designing the learning experience. Hopefully, these general guidelines will assist the CI to facilitate the transformation from student to clinician.

References

  1. Wilson, P; Lyons-Olski, E; Sweetman, NA; Et al: The road to clinical practice.  Clinical Management 10(6): 26-29, 1990.
  2. Newman, JH: Designing problem solving clinical learning experiences. In: Newman, JH (ed): Readings in Clinical Education: A Resource Manual for Clinical Instruction.  Augusta, GA, Medical College of Georgia, 1980, p 76-83.
  3. Perry, JF: A Model for Designing Clinical Education. Physical Therapy 61: 1427-1432, 1981.
  4. Scully, RM and Shepard, KF: Clinical teaching in physical therapy. An ethnographic study. Physical Therapy 63: 349-358, 1983.
  5. Emery, MJ: Effectiveness of the Clinical Instructor. A Student’s Perspective. Physical Therapy 64: 1079-1083, 1984.

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