STRATEGICINITIATIVEPANELS

FinalReportsfrom:CommonTerminologyPanel

IntegratedClinicalEducationPanelStudentReadinessPanel

June2017

TABLEOFCONTENTS

PANELSUMMARYREPORTS• GLOSSARY• DOCUMENTLISTING• ICEAPPENDIX• READINESSAPPENDIX• SUMMARYOFRECOMMENDATIONS

COMMONTERMINOLOGYPANEL–FULLREPORT• GLOSSARY• DOCUMENTLISTINGINTEGRATEDCLINICALEDUCATIONPANEL-FULLREPORT• TABLE1• TABLE2• APPENDIXASTUDENTREADINESSPANEL–FULLREPORT• APPENDIXC

AmericanCouncilofAcademicPhysicalTherapyPost-SummitStrategicPanelReports

FinalReportsfrom:CommonTerminologyPanel

IntegratedClinicalEducationPanelStudentReadinessPanel

June2017

OVERVIEWInOctober2014theAmericanCouncilofAcademicPhysicalTherapy(ACAPT)coordinatedaClinicalEducationSummitwiththesupportoftheAmericanPhysicalTherapyAssociation(APTA),theEducationSectionoftheAPTA,theFederationofStateBoardsofPhysicalTherapy(FSBPT),andtheJournalofPhysicalTherapyEducation(JOPTE).

FollowingtheSummit,theACAPTBoardofDirectorsassembledandprioritizedtheSummitfindingsandrecommendations.ACAPTsubsequentlyappointed3strategicinitiativepanelstoaddressthehighestprioritySummitrecommendations.Thisdocumentisacompilationofthefinalreportsfromthese3panelstotheACAPTBoard.

REPORTFORMATThereare3componentstothisreport:

• Summary–thisdocumentcontainsanoverviewoftheprocessandthefinalworkproductsfromeachpanel.

• Recommendationsforconsideration–thisdocumentincludestherecommendationsfromeachpanelthatwillbeconsideredbythemembership.

• Finalreportsfrompanels–thisdocumentisacompilationofthefinalreportfromall3panelsandcontainsthedetailedmethodologyleadingtothefinalworkproducts.

SUMMARY

BACKGROUNDTheClinicalEducationSummitbroughttogetherclinicalandacademiceducatorstodiscusstheconcernsofthephysicaltherapyclinicaleducationsystemanddevelopoptionstoaddressidentifiedissueswithinthephysicaltherapist(PT)clinicaleducationsystem.TheSummitgoalwastoreachagreementonbestpracticeinPTclinicaleducation.Representativesincludedacademicandclinicalfacultyfrom202ofthe212ACAPTmemberinstitutionsaswellasotherkeystakeholders.TheresultoftheSummitwasareportcontaining11harmonizingrecommendationsand3innovativerecommendations.

(ClinicalEducationSummitReport)

Followingthereceiptofthereport,theACAPTBoardofDirectorsprioritizedtherecommendations,integratedtheworkintotheorganization’sstrategicplan,andformed3strategicinitiativepanelstoaddressthehighestprioritytopics.The3topicschosenwerecommonterminologyforphysicaltherapisteducation,integratedclinicaleducation,andassessmentofstudentreadiness.

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PANELSTRUCTUREANDMEMBERSHIPACAPTidentifiedachairofeachpanelandacoordinatortohelpfacilitatetheongoingworkofall3groups.Inmid-November2015acallforvolunteerstoserveonthethreepanelswasdistributedresultingin62applicants,severalofwhomappliedtomultiplepanels.Thepanelchairsandcoordinatorreviewedallapplicationsanddevelopedalistofmemberswhopossessedthenecessarystrengthsandexperiencestoaddressthepanelchargesandwererepresentativeoftheprofession’svariability.ThenomineesweresubsequentlyappointedtothepanelsbytheACAPTBoardonJanuary20,2016.ACAPTalsoappointedaliaisonfromtheBoardtofacilitatecommunicationandassistthepanelsinaccomplishingtheirwork.CommonTerminologyPanelMiaErickson,PT,EdD,CHT,ATC–MidwesternUniversity(Chair)DebbieIngram,PT,EdD,FAPTA–UniversityofTennesseeChattanoogaEmmaWheeler,PT,DPT–VirginiaCommonwealthUniversityJanetJackson-Coty,PT,DPT–ThomasJeffersonUniversityJohnBorstad,PT,PhD–TheCollegeofSt.ScholasticaJulieHartmann,PT,DSc.–GannonUniversityLauritaHack,PT,DPT,MBA,PhD,FAPTA–ArcadiaUniversityMarisaBirkmeier,PT,DPT–GeorgeWashingtonUniversityMelissaBooth,PT,DPT–UniversityofCentralArkansasVickiLaFayPT,DPT–ClarksonUniversityIntegratedClinicalEducationPanelChristineMcCallum,PT,PhD-WalshUniversity(Chair)JamieBayliss,PT,DHSc-MountSt.JosephUniversityElaineBeckerPT,DPT,MA–NewYorkUniversityYvonneColgrove,PT,PhD-UniversityofKansasMedicalCenterKimeranEvans,PT,DPT-WestVirginiaUniversityJannaKucharski-Howard,PT,DPT,MSM-MCPHSUniversityTaraLegar,PT,MPT-OhioUniversityKimNixon-Cave,PT,PhD-ThomasJeffersonUniversityByronRussell,PT,PhD-MidwesternUniversityDebraStern,PT,DPT,DBA-NovaSoutheasternUniversity,FortLauderdale,FLAValerieStrunk,PT,MS-IndianaUniversity,Indianapolis,INEllenWetherbee,PT,DPT,Med-QuinnipiacUniversity,NorthHaven,CTStudentReadinessPanelJeanFitzpatrickTimmerbergPT,PhD,MHS-ColumbiaUniversity(Chair) RobinDole,PT,DPT,EdD-WidenerUniversity StephenL.Goffar,PT,PhD-UniversityoftheIncarnateWord DivyaMathur,PT,MPA-NYUHospitalforJointDisease AmyMiller,PT,DPT,EdD-ArcadiaUniversity LeighMurray,PT,PhD,MA-WalshUniversityDeborahPelletier,PT-SpringfieldCollegeNickiSilberman,PT,DPT,PhD-HunterCollegeMichaelSimpson,PT,DPT-UniversityofSouthernCaliforniaAngelaStolfi,PT,DPT-NYULangoneMedicalCenter AnneThompson,PT,EdD-ArmstrongStateUniversity RalphUtzman,PT,MPH,PhD-WestVirginiaUniversityShawneSoper,PT,DPT,MBA,VirginiaCommonwealthUniversity(StrategicInitiativePanelCoordinator)MichaelSheldon,PT,PhD,NewEnglandUniversity(ACAPTBoardLiaison)

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PANELPROCESSTheworkofthepanelsisintendedtoaddressspecificrecommendationsfromtheClinicalEducationSummitreport.TheACAPTBoardofDirectorsdevelopedaspecificchargeforeachgroup,providingsomeadditionaldetailandcontexttohelpframetheirwork.TherecommendationsfromtheSummitreportandthepanelchargesaresummarizedbelow.

CommonTerminologySummitRecommendationI:Academicandclinicalfacultywilldevelop,disseminate,use,andperiodicallyreviewstandardterminologyanddefinitionsforphysicaltherapyeducation.

Charge:TheACAPTCommonTerminologyPanelwilldevelopcommonterminologyrelatedtoclinicaleducation.Thisworkmayalsoresultintemplatesandmodelstosupportclinicaleducation,suchasplacementrequestformsandstudentinformationforms.Thisrecommendationalsorelatestootherrecommendationsdefiningdifferentaspectsofclinicaleducation.Thespecificchargetothisworkingpanelis:

• InvestigateandidentifyallcurrentsourcesofterminologyrelatedtoclinicaleducationbyinvitingparticipationoftheNationalConsortiumofClinicalEducators(NCCE),APTAEducationSectionandSpecialInterestGroups,CommissiononAccreditationinPhysicalTherapyEducation(CAPTE),andothergroups

• Reviewallcurrentsupportdocuments–CAPTE,ClinicalPerformanceInstrument(CPI),theGuidetoPTPractice,andotherrelateddocuments

• Considertemplatesandmodelstosupportclinicaleducationsuchasplacementrequestformsandstudentinformationforms

• Recommendotheritemsforconsiderationrelatedtoacommonterminology • Developguidelinesforimplementationoftheproposedterminology

IntegratedClinicalEducationSummitRecommendationVII:Allprogramswilloffergoaloriented,diverseactive-learningexperiencesthataredevelopedincollaborationwithinvestedstakeholdersandembeddedwithinthedidacticcurriculum,priortoterminalexperiences.Charge:TheACAPTIntegratedClinicalEducationStrategicInitiativePanelwilldeveloparecommendationforimplementationofintegratedclinicaleducationasacomponentofphysicaltherapisteducation.Thespecificchargetothisworkingpanelis:

• Define‘integratedclinicaleducation’• Makerecommendationsforachievingconsistentuseoftheterm‘integratedclinicaleducation’

acrossACAPT,APTAandCAPTE• Discernanddescribemodelsofintegratedclinicaleducationthatcurrentlyexistwithinphysical

therapistcurricula• Definebaselineexpectationsandparametersforqualityintegratedclinicaleducationinphysical

therapisteducation• Developguidelinesforcollaborativedevelopmentandimplementationofintegratedclinical

experiences

StudentReadinessSummitRecommendationsIXandX:Developarequisitecoresetofknowledge,skills,attitudesandprofessionalbehaviorstomoveintoearly,intermediate,andfinalfull-timeclinicalexperiences.Establishaprocessforidentifyinghowandifstudentsmeetclinicalcoreperformancecompetenciesuponenteringeachleveloffull-timeclinicalexperience.

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(Note:RecommendationsIXandXwereinterrelated.BecausetheyweredevelopedbyseparateteamsattheSummittheywerebothreportedtopreservethefullnessoftheirproposal.Arelatedrecommendation(XI)wasalsoincludedintheSummitreport.ItwasnotaddressedbytheStudentReadinessPanel;however,itisreferencedlaterinthisreport.)Charge:TheACAPTStudentReadinessStrategicInitiativePanelwillidentifyanddefineacoresetofcompetencies(knowledge,skills,attitudesandprofessionalbehaviors)thataretobedemonstratedbystudentspriortofull-timeclinicaleducation.Theinitialfocusofthepanelwillbeonentrytotheinitialfull-timeclinicalexperience.Thespecificchargetothisworkingpanelis:

• Investigateanddescribemodelsofcompetencyassessmentusedacrossotherhealthprofessions

• Proposetwoformatoptionsforestablishingcompetenciestotheboardmembership• Collectbroad-based,representativedataonminimumcompetencyexpectationsfromthe

physicaltherapypracticecommunity• Onceapreferredmodelisselectedandminimumcompetenciesareidentified,proposebaseline

expectationsandcriteriaforminimumcompetenciesthatmustbemetwithintheacademicprogrambystudentpriortoprogressingintofull-timeclinicaleducationexperiences.

• Developguidelinesforacademicprogramstoimplementthesecompetencyrequirementswithintheircurriculum.

EachpanelheldafacetofaceinitialmeetingattheCombinedSectionsMeeting(CSM)inFebruary2016followedbybothvirtualandfacetofacemeetingsspanningthepast18months.

Thepanelshaveworkedinconcertwithoneanotherthroughoutthisprocess.Thecoordinatorandpanelchairshavemetonaregularbasis,bothvirtuallyandfacetoface.Eachmeetinghasincludedanupdatefromthepanelchairsandidentificationofareasinwhichthe3groupsmustcollaboratetoensurethattheworkproductsaresupportiveandwell-coordinated.

InOctoberof2016thecoordinatorandpanelchairspresentedaneducationalsessionattheEducationLeadershipConference.Thesession,entitledClinicalEducationSummitStrategicInitiatives:UpdatesandIdeas,servedtopresentthefindingsofeachpanelandengageparticipantsindiscussiontohelpshapethefuturerecommendationstobemadetotheACAPTBoardandmembership.Thisoutcomeoftheroundtablediscussionsthatoccurredduringthesessionprovedbothtimelyandvaluabletothefutureworkofthepanels.

Studentswerealsoinvolvedintheprocessofshapingpanelrecommendations.Thecoordinatorhostedtwostudentfocusgroups:onefacetofacesessionduringtheNationalStudentConclaveinOctober2016andavirtualsessiononNovember16,2016.Intotal17studentsrepresenting5universitiesparticipatedinthefocusgroups.Informationfromthesesessionswassummarizedandprovidedtothepanelsforconsiderationasthegroupsdevelopedtheirrecommendations.

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COMMONTERMINOLOGYSTRATEGICINITIATIVEPANELSUMMARYOFWORKFromFebruarytoApril2016,membersofthePanelgathereddata,whichincludedtermsandtheirdefinitionsrelatedtoanyaspectofphysicaltherapistclinicaleducation,fromallrelevantsources.SourcesincludedACAPT,APTA,CAPTE,ClinicalEducationSpecialInterestGroup(CESIG),FSBPT,clinicaleducationconsortia,residency,andfellowshipdocuments;clinicaleducationevaluationtools;ANormativeModelofPhysicalTherapistProfessionalEducation1;andmaterialsfromtheClinicalEducationSummit.Asystematicreviewoftheclinicaleducationliteraturewasalsoperformed.Theprocessdescribedaboveledtoasetoftermsforphysicaltherapistclinicaleducation.ThesetermshavebeenassembledintothePhysicalTherapistClinicalEducationGlossaryandareprovidedinAppendixA.AfterdevelopmentoftheGlossary,acomprehensivereviewofprofessionaldocumentswasconductedtoidentifythosethatwouldneedtobechangedtobeconsistentwiththeterminologybeingproposedbythePanel.MembersofthePanelreachedouttootherstakeholdergroups,collaboratingandsharingtheworkbeingdoneacrossgroups.TherehasbeenongoingandextensivecollaborationwiththeIntegratedClinicalEducationPanelandtheStudentReadinessPanel.Wealsoinvitedcollaborationwithothersthrough1)roundtablediscussionswiththeparticipantsatthe2016EducationalLeadershipConference,2)anopencommentperiodprovidedformembersofthephysicaltherapyacademicandclinicalcommunities,and3)studentfocusgroupsduringtheNationalStudentConclaveandvirtuallyinNovember2016.ThisallowedmemberstoprovidefeedbackonadraftoftheGlossary.FeedbackwasusedfromtheroundtablediscussionsandthecommentperiodtodevelopthefinalGlossary.Anadditionalitemforconsiderationisrelatedtotheuseoftheterm‘internship.’Theinformationdetailedabovehasledthepaneltotheconclusionthatinthecurrentphysicaltherapistclinicaleducationinfrastructure,thetermisbeingusedinappropriatelyandtheclinicaleducationcommunityneedstotakestepstoeliminatetheuseoftheterm.ThePanelrecognizesthatsomeoftheinnovativechangescurrentlybeingexaminedmaypresentopportunityforappropriateuseoftheterminthefuture.

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PHYSICALTHERAPISTCLINICALEDUCATIONGLOSSARY

Thisglossaryoftermswasdevelopedafterareviewofthephysicaltherapyliterature,extensivediscussionanddebatebytheACAPTCommonTerminologyPanel,andengagementofkeystakeholderswithinthephysicaltherapyclinicaleducationcommunity.TheGlossaryisdividedintomajorcategoriesand,asapplicable,definitionsarereferenced. CLINICALEDUCATIONINFRASTRUCTURE Clinicaleducation Aformaltypeofsupervisedexperientiallearning,focusedon

developmentandapplicationofpatient-centeredskillsandprofessionalbehaviors.Itisdesignedsothatstudentsgainsubstantial,relevantclinicalexperienceandskills,engageincontemporarypractice,anddemonstratecompetencebeforebeginningindependentpractice.1-3

Clinicaleducationagreement

Aformalandlegallybindingagreementthatisnegotiatedbetweenacademicinstitutionsandclinicaleducationsitesorindividualprovidersofclinicaleducationthatspecifieseachparty'sroles,responsibilities,andliabilitiesrelatingtostudentclinicaleducation.4

Clinicaleducationcurriculum

Theportionofaphysicaltherapyeducationprogramthatincludesallpart-timeandfull-timeclinicaleducationexperiencesaswellasthesupportivepreparatoryandadministrativecomponents.4

Clinicaleducationexperience

Experiencesthatallowstudentstoapplyandattainprofessionalknowledge,skills,andbehaviorswithinavarietyofenvironments.Experiencesincludethoseofshortandlongduration(e.g.,part-time,full-time),provideavarietyoflearningopportunities,andincludecareofpatients/clientsacrossthelifespanandpracticesettings.Whiletheemphasisisonpatient-careskills,experiencesmayalsoincludeinter-professionalexperiencesandnon-patientcaredutiessuchasresearch,teaching,supervision,andadministration.Clinicaleducationexperiencesareapartoftheprofessionalcurriculumandincludeformalstudentassessment.5-8

Collaborativeclinicaleducationmodel

Aclinicaleducationexperienceinwhichtwo(ormore)physicaltherapiststudentsareassignedtoone(ormore)preceptor/clinicalinstructor(s).Thestudentsworkcooperativelyunderthepreceptor/clinicalinstructor(s).Examplesinclude2:1,2:2,3:1,etc.studenttopreceptor/clinicalinstructorratio.Studentsmaybefromthesameordifferentprogramsandmaybeatthesameordifferentlevelsoftraining.9-11

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Didacticcurriculum Thecomponentofthephysicaltherapistprofessionaleducationprogramthatiscomprisedofthecontent,instruction,learningexperiences,andassessmentdirectedbytheacademicfaculty.3,12,13

Fellowship Apost-professionalfundedandplannedlearningexperienceinafocusedareaofclinicalpractice,education,orresearch(notinfrequentlypost-doctoralorforpost-residencyorboardcertifiedtherapists).14

Full-timeclinicaleducationexperience

Aclinicaleducationexperienceinwhichastudentengagesforaminimumof35hoursperweek.Anintegratedclinicaleducationexperiencemaybeafull-timeclinicaleducationexperience;however,full-timeclinicaleducationexperiencesdesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEaredirectedbyaphysicaltherapistclinicalinstructor.5,7

Firstfull-timeclinicaleducationexperience

ThefirstclinicaleducationexperiencedesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEinwhichastudentengagesforaminimumof35hoursperweek.

Intermediatefull-timeclinicaleducationexperience

AclinicaleducationexperiencedesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEinwhichastudentengagesforaminimumof35hoursperweekandreturnstotheacademicprogramforfurthercompletionofthedidacticcurriculum.

Terminalfull-timeclinicaleducationexperience

Asingle,orsetof,full-timeclinicaleducationexperience(s)designatedtoachievetheminimumnumberofweekssetforthbyCAPTEthatoccurafterthestudenthascompletedthedidacticcurriculumofaphysicaltherapistprofessionaleducationprogram.Studentsmayreturntotheacademicprogramfordidacticinstructionthatdoesnotrequireadditionalclinicaleducationexperiences.Theexpectedoutcomeofthefinal,orlastterminalexperienceisentry-levelperformance.7

Internationalclinicaleducationexperiences

Aneducationalopportunitythatastudentparticipatesin,outsideofthecountrywherethephysicaltherapisteducationprogramissituated,forwhichhe/sheobtainsclinicaleducationcredit.TheabbreviationICEshouldnotbeusedtodescribeaninternationalclinicaleducationexperience.7,15

Internship Aterminalfull-timeclinicaleducationexperiencethatprovidesrecompensetoparticipantsinaccordancewithfederallaborlawsundertheFairLaborStandardsAct.16

Learningexperience Anyexperiencewhichallowsorfacilitatesachangeinattitudeorbehavior.Aplannedlearningexperienceincludesalearner,anobjectiveforthelearner,asituationdevisedtoproducearesponsethatcontributestotheobjective,aresponsebythestudent,andreinforcementtoencouragethedesiredresponse.3

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Part-timeclinicaleducationexperience

Aclinicaleducationexperienceinwhichastudentengagesinclinicaleducationforlessthan35hoursperweek.Part-timeexperiencesvaryinlength.Apart-timeclinicaleducationexperiencemaybeconsideredanintegratedclinicaleducationexperiencedependingonthedesignoftheexperienceandthelearningobjectives.7,17

Physicaltherapistprofessionaleducationprogram

Educationcomprisedofdidacticandclinicaleducationdesignedtoassurethatstudentsacquiretheprofessionalknowledge,skills,andbehaviorsrequiredforentry-levelphysicaltherapistpractice.3,18,19

Physicaltherapistpost-professionaleducationprogram

Degreeandnon-degreebasedprofessionaldevelopmentforthephysicaltherapisttoenhanceprofessionalknowledge,skills,andabilitiesbeyondentrylevel.Examplesinclude,butarenotlimitedto,continuingeducationcourses,post-professionaldoctoraleducationprograms,certificateprograms,residency,andfellowship.19

Residency Post-professionalprogramsthatoccurafterthegraduatephysicaltherapisthasobtainedalicensetopractice.Theymaybeclinicalprogramsthatadvanceaphysicaltherapist'sknowledgeandskillsinpatient/clientmanagement,ornonclinicalfocusingonadvancingaphysicaltherapist'scareeroutsideofclinicalduties.20

CLINICALEDUCATIONSITES Clinicaleducationsite

Ahealthcareagencyorothersettinginwhichclinicaleducationexperiencesareprovidedforphysicaltherapiststudents.Theclinicaleducationsitemaybe,butisnotlimitedto,ahospital,agency,clinic,office,school,orhomeandisaffiliatedwithoneormoreeducationalprogramsthroughacontractualagreement.3,4

Clinicaleducationenvironment

Thephysicalspace(s),aswellasthestructures,policies,procedures,andculturewithintheclinicaleducationsite.

CLINICALEDUCATIONSTAKEHOLDERS Academicfaculty Teachersandscholarswithintheacademicinstitutiondedicatedto

preparingstudentsintheskillsandaptitudesneededtopracticephysicaltherapy.21

Academicinstitution Universityorcollegethroughwhichanacademicdegreeisgranted.4

Clinicaleducationconsortia

Nationalandregionalgroupsthatincludeacademicandclinicaleducationfacultyforthepurposeofsharingresources,ideas,andefforts.4

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Clinicaleducationfaculty

Theindividualsengagedinprovidingtheclinicaleducationcomponentsofthecurriculum,generallyreferredtoaseitherSiteCoordinatorsofClinicalEducation(SCCEs),preceptors,orclinicalInstructors.Whiletheacademicinstitutiondoesnotusuallyemploytheseindividuals,theydoagreetocertainstandardsofbehaviorthroughcontractualarrangementsfortheirservices.7

Clinicalinstructor(CI)

Thephysicaltherapistresponsibleforthephysicaltherapiststudentanddirectlyinstructs,guides,supervises,andformallyassessesthestudentduringtheclinicaleducationexperience.Whenengagedinfull-timeclinicaleducationdesignatedtomeettheminimumnumberofweeksrequiredbyCAPTE,theclinicalinstructormustbealicensedphysicaltherapistwithaminimumofoneyearoffulltime(orequivalent)post-licensureclinicalexperience.4,22,23

DirectorofClinicalEducation(DCE)

Academicfacultymemberwhoisresponsibleforplanning,directingandevaluatingtheclinicaleducationprogramfortheacademicinstitution,includingfacilitatingclinicalsiteandclinicalfacultydevelopment.22,24,25

Physicaltherapiststudent

StudentenrolledinaCAPTE-accreditedorapproveddevelopingphysicaltherapistprofessionaleducationprogram.Studentsshouldnotbereferredtoasaphysicaltherapystudent.

Preceptor Anindividualwhoprovidesshort-termspecializedinstruction,guidance,andsupervisionforthephysicaltherapiststudentduringaclinicaleducationexperience.Thisindividualmayormaynotbeaphysicaltherapistaspermittedbylaw.

SiteCoordinatorofClinicalEducation(SCCE)

Professionalwhoadministers,manages,andcoordinatesclinicalassignmentsandlearningactivitiesforstudentsduringtheirclinicaleducationexperience.Inaddition,thispersondeterminesthereadinessofpersonstoserveaspreceptorsandclinicalinstructorsforstudents,supervisespreceptorsandclinicalinstructorsinthedeliveryofclinicaleducationexperiences,communicateswiththeacademicprogramregardingstudentperformance,andprovidesessentialinformationtoacademicprograms.4,22,26

CLINICALEDUCATIONASSESSMENT Clinicalperformanceassessment

Clinicalperformanceassessmentencompassesformalandinformalprocessesdesignedtoappraisephysicaltherapiststudentperformanceduringclinicaleducationexperiences.Assessmentmaybeformativeorsummativeinnatureandperformedforthepurposesofprovidingfeedback,improvinglearning,revisinglearningexperiences,anddeterminingsuccessfulattainmentofstudentperformanceexpectationsduringclinicaleducationexperiences.3,22,27,28

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Clinicalperformanceevaluationtool

Avalid,reliable,andmultidimensionalclinicalperformanceassessmenttoolutilizedtodetermineif,andhowwell,astudentmeetsestablishedbehavioralobjectivesduringclinicaleducationexperiences.4,29,30,31

Entry-levelphysicaltherapistclinicalperformance

Performancethatdemonstratesknowledge,skills,andbehaviorsconsistentwitheffective,efficient,andsafepatient/clientmanagementtoachieveoptimaloutcomes.22,28

Supervision Theguidanceanddirectionprovidedtoaphysicaltherapiststudentbythepreceptororclinicalinstructor.Thisvariesbasedonthecomplexityofthepatientorenvironment;jurisdictionandpayerrulesandregulations;andabilitiesofthephysicaltherapiststudent.4,22,27

References

1. DelanyC,BraggeP.Astudyofphysiotherapystudents’andclinicaleducators’perceptionsof

learningandteaching.MedicalTeacher.2009;31(9):402-411.

2. OʼBrienB,TeheraniA.UsingWorkplaceLearningtoImprovePatientCare.AcadMed.2011;86(11):e12.

3. MooreML,PerryJF.ClinicalEducationinPhysicalTherapy:PresentStatus/FutureNeeds.Final

ReportoftheProjectonClinicalEducationinPhysicalTherapy.Washington,DC:SectionforEducationAmericanPhysicalTherapyAssociation;June1976;NO1-AH.

4. AmericanPhysicalTherapyAssociation.ThePhysicalTherapyClinicalInstructorEducationandCredentialingProgramManual.Alexandria,VA:AmericanPhysicalTherapyAssociation;2009.

5. TerminologyforClinicalEducationExperiencesProposedbyAcademicCouncilBoardofDirectors[ACAPTmotionAC-2-13].http://acapt.myriadmedia.com/docs/default-source/motions/2013-motions/ac-2-13_terminology_for_clincal_education_passed.pdf?sfvrsn=2.AccessedMay16,2017.

6. PivkoSE,AbbruzzeseLD,DuttarovP,HansenRL,RyansK.Effectofphysicaltherapystudents'clinicalexperiencesonclinicianproductivity.JAlliedHealth.2016;45(1):33-40.

7. CommissiononAccreditationinPhysicalTherapyEducation.StandardsandRequiredElementsforAccreditationofPhysicalTherapistEducationPrograms,2016.http://www.capteonline.org/AccreditationHandbook/.PublishedNovember11,2015,UpdatedMarch4,2016.AccessedApril10,2017.

8. GibersonTR,BlackB,PinkertonE.Theimpactofstudent-clinicalinstructorfitandstudent-organizationfitonphysicaltherapistclinicaleducationexperienceoutcomes.JPhysTherEduc.2008;22(1):59-64.

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9. RindfleschAB,DunfeeHJ,CieslakKR,etal.CollaborativemodelofclinicaleducationinphysicalandoccupationaltherapyattheMayoClinic.JAlliedHealth.2009;38(3):132-142.

10. DecluteJ,LadyshewskyR.Enhancingclinicalcompetenceusingacollaborativeclinicaleducationmodel.PhysTher.1993;73(10):683-689.

11. LadyshewskyRK.Peerassistedlearninginclinicaleducation:areviewoftermsandlearningprinciples.JPhysTherEduc.2000;14(2):15-22.

12. CommissiononAccreditationinPhysicalTherapyEducation.EvaluativeCriteriaforAccreditationofEducationProgramsforthePreparationofPhysicalTherapists.CommissiononAccreditationinPhysicalTherapyEducationWebsite.http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/EvaluativeCriteria_PT.pdf.UpdatedAugust2014.AccessedApril10,2017.

13. KenyonLK,DoleRL,KellySP.Perspectivesofacademicfacultyandclinicalinstructorsonentry-leveldptpreparationforpediatricphysicaltherapistpractice.PhysTher.2013;93(12):1661-1672.

14. AmericanPhysicalTherapyAssociation.Clinicalexperienceterminologyforphysicaltherapists.http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Terminology/ClinicalExperienceTerminology.pdf.UpdatedDecember2009.AccessedApril10,2017.

15. PechakCM.Surveyofinternationalclinicaleducationinphysicaltherapisteducation.JPhysTherEduc.2012;26(1):69-77.

16. U.S.DepartmentofLaborWageandHourDivision.FactSheet#71:InternshipprogramsundertheFairLaborStandardsAct.https://www.dol.gov/whd/regs/compliance/whdfs71.pdf.UpdatedApril2010.AccessedMay16,2017.

17. AmericanPhysicalTherapyAssociation.2007-2008Factsheet:physicaltherapisteducationprograms.AmericanPhysicalTherapyAssociationWebsite.http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/.AccessedApril10,2017.

18. BarrJS,GwyerJ,TalmorZ.Evaluationofclinicaleducationcentersinphysicaltherapy.PhysTher.1982;62(6):850-861.

19. AmericanPhysicalTherapyAssociation.EducationForPhysicalTherapists:TerminologyUsedToDescribe[HODP05-07-11-04].https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/HOD/Terminology/Education.pdf.UpdatedDecember14,2009.AccessedApril10,2017.

20. AmericanBoardofPhysicalTherapyResidencyandFellowshipEducation.Aboutresidencyprograms.http://www.abptrfe.org/ResidencyPrograms/About/.AccessedApril10,2017.

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21. Kondela-CebulskiPM.Counselingfunctionofacademiccoordinatorsofclinicaleducationfrom

selectentry-levelphysicaltherapyeducationalprograms.PhysTher.1982;62(4):470-476.

22. AmericanPhysicalTherapyAssociation.PhysicalTherapistClinicalPerformanceInstruments:Version2006.Alexandria,VA:AmericanPhysicalTherapyAssociation;2006.

23. HalcarzPA,MarzoukDK,AvilaE,BowserMS,Hurm,L.Preparationofentrylevelstudentsforfuturerolesasclinicalinstructors.JPhysTherEduc.1991;5(2):78-80.

24. BucciereiKM,BrownR,MaltaS.Evaluatingtheperformanceoftheacademiccoordinator/directorofclinicaleducation:toolstosolicitinputfromprogramdirectors,academicfaculty,andstudents.JPhysTherEduc.2011;25(2):26-35.

25. PerryJF.Amodelfordesigningclinicaleducation.PhysTher.1981;61(10):1427-1432.

26. PhilipsBU,McphailS,RoemerS.Roleandfunctionsoftheacademiccoordinatorofclinicaleducationinphysicaltherapyeducation:asurvey.PhysTher.1986;66(6):981-985.

27. KernBP,MickelsonJM.Thedevelopmentanduseofanevaluationinstrumentforclinicaleducation.PhysTher.1971;51(5):540-546.

28. TexasConsortiumforPhysicalTherapyEducationandResearchFoundation.PhysicalTherapistManualfortheAssessmentofClinicalSkills.Austin,TX:2004.

29. BeckelC,AustinT,KettenbachG,SargeantD.Computerandinternetaccessforphysicaltherapistclinicaleducation.JPhysTherEduc.2008;22(3):19-23.

30. FitzgeraldLM,DelittoA,IrrgangJJ.Validationoftheclinicalinternshipevaluationtool.PhysTher.2007;87(7):844-860.

31. HouselN,GandyJ.Clinicalinstructorcredentialinganditseffectonstudentclinicalperformanceoutcomes.JPhysTherEduc.2008;22(3):43-51.

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AppendixB.Typesofdocuments,methodsofchangeSectionAliststhematerialsanddocumentsthathavelanguagerelatedtoclinicaleducationthatwouldneedtobechangedtobeconsistentwiththeterminologyrecommendedinthisreport.SectionBprovidesthemechanismtoachievechange.A.Typeofdocument/site B.MethodforchangeAPTA’sHouseofDelegates(HOD)positions,standards,guidelines,policies,procedures

ProposerevisiontotheHODbyadelegation(Chapter,Section,Board)totheHouse

APTA’sBoardofDirectors(BOD)positions,standards,guidelines,policies,procedures

RequesttheBODtoconsiderrevision

APTAdocuments/site CPI,CSIF,CCCEmanual RequesttheBODtoconsiderrevisionAPTACCIP RequesttheBODtoconsiderrevisionAPTAWebsite RequesttheBODtoconsiderrevision WouldalsoneedtobeconsistentwithHODpolicies EducationSectionWebsite RequesttheSectiontoconsiderrevisionClinicalEducatorsSIGoftheSectionForm:Requestforclinicalsites

RequesttheSection/CESIGtoconsiderrevision

AmericanCouncilonAcademicPhysicalTherapy

Website ACAPTshouldmakechangeswhennewdefinitionsadoptedACAPTpolicyonClinEd ACAPTshouldmakechangeswhennewdefinitionsadoptedNCCE ACAPTshouldmakechangeswhennewdefinitionsadopted CommissiononAccreditationofPhysicalTherapyEducation(CAPTE)Standards

PetitionCAPTEasamajorstakeholderforchangesinStandards

FederationofStateBoardsofPhysicalTherapy(FSBPT)ModelPracticeActandindividualstatepracticeacts

WorkthroughFSBPTandindividualstateboards,incollaborationwithAPTA

Journalstylemanuals PTJshouldchangewithHODpolicy,requestothersdosothrough

informationpackettojournaleditorsandtheirsupportingSections Chapters Materialsformembers Requestchangethroughinformationpacket StatePracticeActs Requestchangethroughinformationpacket,interactwithFSBPTas

wellasindividualboardsSections/Academies Materialsformembers Requestchangethroughinformationpacket InformationtoABPTRFE,ABPTS RequesttheBODtodirectanynecessarychanges PTAcommunity WorkthroughtheEducationSectionPTASIG

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INTEGRATEDCLINICALEDUCATIONSTRATEGICINITIATIVEPANELSUMMARYOFWORKPhase1:Weembarkedon2concurrentmethodsofdatacollectiontoestablishabroadviewofcurrenteducationalpracticesinvolvingclinicaleducationdeliveredthroughthelensofanintegratedcurriculumperspective.Thedatacollectionmethodsincludedasystematicreviewoftheliteratureandthedevelopmentanddistributionofadescriptivesurvey.Reviewoftheliterature.Onesubgroupofpanelmemberscompletedthesystematicreviewoftheliteratureusingstandarddatabasesknownforpublicationofeducationalresearchofthehealthprofessions.ThePreferredReportingItemsforSystematicReviewsandMeta-Analysis(PRISMA)guidelineswereselectedtoguidetheprocess.Theinitialsearchresultedin3808articles.Searchtermswererefinedusingkeyworksandsubjectheadingsandarticleswerescreenedfortitleandabstractwhichyielded83articles.Furtherreviewresultedinatotalof22articlesincludedinthefinalreviewoftheliterature.Thesearticlesrepresentthebestavailableevidenceaboutthetopicofintegratedclinicaleducationinhealthprofessions.Surveyresearch.Asecondsubgrouputilizedsurveyresearchtogatherinformationaboutcurrentprogrampracticesthatwereperceivedasintegratedclinicaleducationexperiences.Theresultsofeachofthesedatacollectionmethodswerethematicallycategorizedindependentfromtheother,followedbyanaggregationofthecategoriesforgroupdiscussiontodetermineiftheidentifiedcategorieswereconsideredsoundeducationalpracticesintermsofclinicaleducationexperiencesofferedinanintegratedfashionwithinaprofessionaleducationprogram.Phase2:Twoseriesoffocusgroupswereconductedtogainperspectivefromstakeholdersinvolvedinclinicaleducation:onewithparticipantsatthe2016EducationalLeadershipConferenceandthesecondwithphysicaltherapiststudents.Afterreviewofbothsetsoftranscribedfocusgroupdata,itwasdeterminedapointofdatasaturationwasachieved.Nofurtherdatawassoughtfromotheracademicorclinicalfaculty,orDPTstudentstodeveloptheparameters.ThefinalresultsofPhases1and2includedidentificationofeight(8)categoricalparametersthatdescribecomponentsrequiredforintegratedclinicaleducationexperiences;developmentofthedefinitionofintegratedclinicaleducation,anddevelopmentofdescriptivemodelsofintegratedclinicaleducationbasedonselectedpeer-reviewedarticles.

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ICEAppendixA

INTEGRATEDCLINICALEDUCATIONFORPHYSICALTHERAPISTSTUDENTSDefinition,Parameters,andGuidelines

Educationalliteraturesuggeststhatintegratedclinicaleducationexperiences,aformofexperientiallearning,canexposestudentstoaspectsofpatientcenteredcareduringflexibleclinicaltrainingperiodsthroughoutthecurriculum.Theseexperiencesaffordstudentsanopportunitytofacilitatedevelopmentoftheircognitive,affective,andpsychomotorskillswhileconcurrentlyallowingacademicand/orclinicalfacultytofacilitatestudentdevelopmentwithrespecttothetransferofdidacticknowledgeintoclinicalapplication.(Hakimetal,2014)Thedefinition,parameters,andguidingprinciplespresentedinthisdocumentareprovidedtoassistprogramsinthedevelopmentofintegratedclinicaleducationexperiences.

DefinitionThefollowingisthedefinitionofIntegratedClinicalEducation(ICE).Integratedclinicaleducationisacurriculumdesignmodelwherebyclinicaleducationexperiencesarepurposivelyorganizedwithinacurriculum.Inphysicaltherapisteducation,theseexperiencesareobtainedthroughtheexplorationofauthenticphysicaltherapistroles,responsibilitiesandvaluesthatoccurpriortotheterminalfulltimeclinicaleducationexperience.

Integratedexperiencesarecoordinatedbytheacademicprogramandaredrivenbylearningobjectivesthataresynchronouswithdidacticcontentdeliveryacrossthecurricularcontinuum.Theseexperiencesallowstudentstoattainprofessionalbehaviors,knowledgeand/orskillswithinavarietyofenvironments.Thesupervisedexperiencesalsoallowforexposureandacquisitionacrossalldomainsoflearningandincludestudentperformanceassessment.

Forintegratedclinicaleducationexperiencestoqualifytowardstheminimumnumberoffull-timeclinicaleducationweeksrequiredbyaccreditation(CAPTE)standards,itmustbefulltimeandsupervisedbyaphysicaltherapistwithinaphysicaltherapyworkplaceenvironmentorpracticesetting.

ICE=IntegratedClinicalEducation

ParametersforIntegratedClinicalEducationThefollowingaretheparametersandbaselineexpectationsforICEinphysicaltherapisteducation.Pleaseseethefullreportfortheevidencesupportingtheseparameters.

1.Integratedclinicaleducationmayoccurinanyacademictermpriortothecompletionofthedidacticcourseworkleadingtothecompletionofaterminalfulltimeclinicaleducationexperience.

2.Integratedclinicaleducationexperienceswillhavespecificdesiredoutcomesthatcorrespondtocourseand/orprogrammaticobjectives.

3.Integratedclinicaleducationexperiencesmayberepresentedasacomponentofadidacticcourseorastandalonecoursethatoccursinasynchronousfashionwithotherdidacticcoursework.

4.Integratedclinicaleducationexperiencetimeframesaredevelopedbytheacademicprogrambaseduponthecourseand/orprogrammaticobjectives.Integratedclinicaleducationmayincludefulltimeand/orparttimeexperiences.

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ICEAppendixA

5.Integratedclinicaleducationexperiencesmayoccurinavarietyoflearningenvironmentsincludingcampusorcommunitybasedclinicalornon-clinicalsettings,baseduponthecourseand/orprogrammaticobjectives.Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbecompletedinaphysicaltherapyworkplaceenvironmentorpracticesetting.

6.Integratedclinicaleducationexperiencesshallincludestudentassessmentsthataredesignedtolinktothecourseorprogramobjectiveswithexpectedstudentprogressioninprofessionalbehaviors,clinicalknowledge,and/orskills.

7. Integrated clinical education experiences are coordinated by a faculty member of the academicprogram,inpartnershipwithacoordinatorfromtheclinicaleducationsite.

8. Integrated clinical education experiences are typically supervised by a course instructor and apreceptor. The preceptormay be an academic course facultymember, a clinical instructor, or otherhealthcareprofessionalatthesitethestudentisengagedintheexperience,dependinguponthecourseand/orprogrammaticobjectives. Integrated full time clinical educationexperiences thatqualify for aprogram’s minimum number of clinical education weeks shall be supervised by a licensed physicaltherapist.

GuidelinesforDevelopmentofICE

The following are guidelines for collaborative development and implementation of integrated clinicaleducationexperiences.PleaserefertotheICEPanelreportfortheprovocativequestionsandevidencethataccompanytheseguidelines.

Thekeytowell-developedintegratedclinicaleducationexperiencesisintentionality.Intentionalandtargetedinstructionencompassesplanningwithapurpose,cultivatingthelearningenvironment,instructingwithintention,andassessingtheimpactthatthemodelhasonstudentlearningwhichiswhattheguidingprinciplesareattemptingtodirect(Fisher,Frey&Hite,2016).Theguidingprinciplesprovidedfocusonthekeyelementsthatprogramsshouldconsiderindevelopingorrefiningintegratedclinicalexperiences.Theseinclude:

1. Anacademicprogramidentifiestheprogrammaticoutcomesthatareexpectedwhenstudentsparticipateinintegratedclinicalexperiences.

2. Theacademicprogramconsiderstheintentionalplacementofintegratedclinicaleducation

experienceswithinitscurriculum.3. Theacademicprogramidentifiesthecourse(s)whereclinicaleducationshouldbeintegrated

withintheprogram.

4. Theacademicprogram,incollaborationwithprogramfacultydevelopsthecoursespecificobjectivesforstudentachievementwithinanintegratedclinicaleducationexperience.

5. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthetimingand

timeframesofwhenclinicaleducationexperiencesshouldbeintegratedwithincourse(s).

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ICEAppendixA

6. Theacademicprogram,incollaborationwithprogramfaculty,identifiestheindividualorindividualswhowilloverseetheintegratedclinicaleducationexperiences.

7. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthemethodsofstudent

andcourseassessmenttomeettheintendedcourseand/orprogramoutcomes.8. Theacademicprogramidentifiesresourcesandlegal/regulatoryparametersthatimpacts

deliveryofintegratedclinicaleducationexperienceswithinprogram.9. Theacademicprogram,incollaborationwithprogramfaculty,selectsthetypeofclinicalor

communitysitesrequiredforintegratedclinicaleducationexperiences.10. Theacademicprogram,incollaborationwithprogramfaculty,acceptsresponsibilityforthe

developmentofrelationshipswithrepresentativesoftheclinicaleducationsite.

Currentevidenceoutlinestheintentionalityofintegratedclinicaleducationexperienceplacement,purpose,necessaryresourceallocation,anddesiredoutcomeswithinphysicaltherapisteducationattheprogramlevel.Assuch,integratedclinicaleducationexperiencesmaybeembeddedwithinacourseoroccurconcurrentwithothercourseworkdependingonthedesiredprogrammaticand/orcourseobjectivesanddesireoutcomes.Intentionalityalsooccursinthedesign,resourcenecessities,andplacementofobjectivedrivencollaborativelearningexperiencesthatadheretopedagogicallysoundprinciplesthatareinnovativeand/orflexible(Fisheretal,2016)

Whilemuchattentionshouldbeplacedonthedesignandimplementationofintegratedclinicaleducation,planningforandcompletingawell-roundedassessmentisalsorequired(Weddle&Sellheim,2009).Outcomeassessmentofstudentlearning,overallcoursesuccess,andtheintegratedclinicaleducationprogramdesignarethreetargetedareasforconsideration.Selectionofvalidandreliableoutcomemeasuresthatprovidefacultyandstudentssummativeandformativefeedbacktoguidelearningisimperative.Table2providesanexampleofoutcomemeasuresusedandtypeofdatacollectedthathaveguidedacademicprograms.Itisimportanttonotethatnoattemptsweremadetocomparemodelsoroutcomedata;ratherthedatageneratedprovidedathematicanalysisofimportantconceptswithintheliterature.

Despitethefactchallengesineducationalresearchexist(Jensenetal,2016),itbehoovesourprofessiontocontinueresearchingoutcomesofinnovativecurricularmodels,includingintegratedclinicaleducationexperiences,tocontinuetostriveforexcellenceinphysicaltherapisteducation.Therefore,furtherinvestigationintobestpracticeforICEexperiencesshouldcontinueinacollaborativemannerbetweeninstitutionaladministrators,academicphysicaltherapyfaculty,clinicalfaculty,patients,andstudents.Itishungerforimprovementthatpushesboundariestopromoteexcellence(Fullan,2005).

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STUDENTREADINESSSTRATEGICINITIATIVEPANELSUMMARYOFWORKThepanelbeganbyreviewingliteraturefromdifferenthealthprofessionsincludingmedicine,pharmacy,nursing,speech,athletictrainingandoccupationaltherapy.Thepanelinvestigatedthevariedcompetencyexpectationsofthedifferentprofessionsaswellaswhenandhowtheyassessedstudentsatvariouspointsalongtheircontinuumoflearning.Theliteraturereviewrevealedthatcompetencybasededucationandsubsequentassessmentispresentthroughoutvarioushealthprofessions.Themedicalprofessionseemsmostevolvedandcanprovideuswithastructureandprocessthatwemightwanttoconsiderassuchsystemsaredevelopedforphysicaltherapisteducation.Beforeonecantrulydeveloptheappropriateassessmentsystem,theminimalknowledge,skills,attitudesandprofessionalbehaviors,collectivelyreferredtoasKSAs,andatwhatlevelofproficiencymustfirstbeidentified.Thepaneldiscussedvariouspossibleoptionstoestablishcompetenciesincludingobtainingconsensuswithinourpanel,focusgroups,consensusconference,surveys,andaDelphistudy.Toachievetheaimofourpanel,thegroupselectedtheDelphimethodofconsensusdevelopment.ADelphistudyallowsindividualswithexpertiseandinsighttoprovideinformationandtoreachconsensusonaparticulartopic.Thismethodengagesagroupofparticipantsorexpertsovermultipleroundsofsurveystoestablishaconsensusontheparticulartopicofinterest(Keeney,2011;Soma,2009).ThepurposeofthisDelphistudywastogainconsensus,definedas80%agreement,onthepre-requisitesforstudentsenteringafirstfull-timeclinicaleducationexperience,specificallyfocusingonwhatattributessignaledreadiness.Thisreadinessforthefirstfull-timeclinicaleducationexperiencewouldberelevantregardlessofwhereitfallswithinaprogram’scurriculumortheparticularsettinginwhichtheexperiencetakesplace.TheDelphimethodwasidentifiedasthemostpracticalmethodtogainconsensusamongthevariousmembersofthephysicaltherapypracticecommunity.Clinicians,recentgraduates,academicfaculty,andDirectorsofClinicalEducation/AcademicCoordinatorsofClinicalEducationwereidentifiedaskeystakeholders.GiventhevariabilityofcurriculuminCAPTEaccreditedphysicaltherapyprogramsaswellastheplacementofclinicalexperienceswithinthatcurriculum,thepanelthoughtitbesttobeginwithastudentsentranceintothefirstfull-timeclinicaleducationexperience.ThepanelalsofeltthattheearlyclinicalexperiencescanbeinanypracticesettingandareoftenthemostchallengingforDCEs/ACCEstofindstudentplacements,ascliniciansarereluctanttotakeonastudentwhileontheirfirstclinicalexperience.Startingwithcompetenciesforthisexperiencewouldonlybeonepointalongthecontinuumoflearningwherestudentswouldbeassessedbutwasanimportantplacetostart.AfterfourroundsoftheDelphistudywerecompleted,therewere95elementsidentifiedandagreeduponbythecombinedstakeholdersasbeingnecessaryforreadinessforafirstfull-timeclinicalexperience.These95elementsweregroupedunder14themes.Participantsalsoprovidedthelevelofproficiency(Familiar,Emerging,orProficient)deemedappropriateforeachitemidentified.Nineelementswereidentifiedasrequiringproficiencypriortothefirstfull-timeclinicalexperience(Table7).Themajorityoftheseelementsfellintheareaofprofessionalbehaviorswhileotherssurroundedsuccessfulacademicperformance.ParticipantsratedthevastmajorityofelementsasrequiringatleastanEmerginglevelofmastery(ratingsofEmergingorProficient)priortobeginningthefirstfulltimeclinicalexperience(AppendixA).Therewere,however,34elementsthatdidnotachievethelevelofconsensusrequiredtoindicatethattheybemorethanFamiliartothestudentpriortothefirstfulltimeclinicalexperience(AppendixA).

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AppendixC

StudentReadinessfortheFirstFull-TimeClinicalExperience

Thefollowingtablesummarizestheminimalknowledge,skillsandabilities(KSAs)inwhichphysicaltherapiststudentsmustdemonstratecompetencepriortoentryintothefirstfull-timeclinicalexperience.TheKSAsaregroupedinto14themes,numberedandindicatedinboldtextwiththecorrespondingKSAslistedbelow.Greaterthan80%ofparticipantsintheDelphistudyindicatedthattheseitemswerenecessary.

StudentReadinessThemesandKSAsTheme1 Studentsshouldhavefoundationalknowledgetosupportapplicationandsynthesisinthe

followingcontentareas:1.1 Anatomy(i.e.functionalanatomy)1.2 Commondiagnosesrelatedtosystemsreview(e.g.medical,physicaltherapy1.3 Kinesiology(i.e.biomechanics,exercisescience,movementscience)1.4 Physiology/Pathophysiology(relatedtogeneralsystemsreview)1.5 Tissuemechanics(e.g.stagesofhealing,use/disuse,load/overload)

Theme2 Studentsshouldmeetthespecificprogramidentifiedcurricularrequirementsincluding:2.1 achieveminimumGPA2.2 meetminimumexpectationsforpracticalexaminations2.3 remediationofanyandallsafetyconcerns

Theme3 Studentsshouldtakeinitiativetoapplyevidence-basedstrategiesto:3.1 generateinterventionsideas3.2 guidedecision-making3.3 measureoutcomes3.4 researchunfamiliarinformationorconditions

Theme4 Studentsshouldengageinself-assessmentincluding:4.1 self-assessmentoftheimpactofone’sbehaviorsonothers4.2 theunderstandingofone’sownthoughtprocesses(metacognition)4.3 self-reflectionandidentificationofareasofstrengthandthoseneedingimprovement,

developmentofaplantoimprove,anddiscussionofthatplanwithinstructors4.4 seekingoutresources,includingsupportfromotherswhenneeded,toassistinimplementationof

theplanTheme5 Studentsshouldutilizeconstructivefeedbackby:

5.1 beingopenandreceptive,verbally/non-verbally5.2 implementingactionstoaddressissuespromptly5.3 reflectingonfeedbackprovided

Theme6 Studentsshoulddemonstrateeffectivecommunicationabilitieswithinthefollowinggroups:

6.1 diversepatientpopulations6.2 familiesandotherindividualsimportanttothepatients6.3 healthcareprofessionals

Theme7 Studentsshouldexhibiteffectiveverbal,non-verbalandwrittencommunicationabilitiesto:7.1 listenactively7.2 demonstratepolite,personable,engagingandfriendlybehaviors7.3 independentlyseekinformationfromappropriatesources7.4 buildrapport

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AppendixC

7.5 seekassistancewhenneeded7.6 engageinshareddecision-makingwithpatients7.7 demonstratealevelofcomfortandrespectwithpatienthandling7.8 demonstrateempathy7.9 uselanguageandterminologyappropriatefortheaudience

7.10 introduceone’sselftoCI,clinicalstaff,andpatientsTheme8 Studentsshouldbepreparedtoengageinlearningthroughdemonstrating:

8.1 accountabilityforactionsandbehaviors8.2 resilience/perseverance8.3 culturalcompetenceandsensitivity8.4 aneager,optimisticandmotivatedattitude8.5 respectforpatients,peers,healthcareprofessionalsandcommunity8.6 open-mindednesstoalternativeideas8.7 punctualitywithallassignments8.8 self-caretomanagestress8.9 responsibilityforlearning

8.10 self-organization8.11 takingactiontochangewhenneeded8.12 willingnesstoadapttonewandchangingsituations8.13 appropriateworkethic8.14 maturityduringdifficultorawkwardsituationswithpatients,familiesandhealthcare

professionalsTheme9 Studentsshoulddevelopthefollowingelementsincludingthedocumentationof:

9.1 examination/re-examination(History,systemsreview,andtestsandmeasures)9.2 establishanddocumenttheproblemlist9.3 dailyinterventions

Theme10 Studentshouldrecognizeandaddressissuesrelatedtosafepatientcareincludingtheabilityto:

10.1 identifycontraindicationsandprecautions10.2 assessandmonitorvitalsigns10.3 identifyandrespondtophysiologicchanges10.4 assesstheenvironmentforsafety,includinglines,tubes,andotherequipment10.5 appropriatelyapplyinfectioncontrolproceduresincludinguniversalprecautions10.6 provideassistanceandguardingforpatientsafety10.7 utilizeappropriatebodymechanicstoavoidinjurytoselforpatients10.8 provideappropriatedrapingduringpatientcareactivities

Theme11 Studentshoulddemonstratethefollowingclinicalreasoningskillsforanon-complexpatient:11.1 utilizetheelementsofthepatient-clientmanagementmodelincluding:addressvariousbody

systems(cardiopulmonary,integumentary,musculoskeletal,neuromuscular)duringtheexamination

11.2 articulateaclinicalrationaleinpatientevaluation11.3 developgoalsthatarelinkedtothepatient’sactivitylimitationsandparticipationrestrictions11.4 determineappropriatenessfortherapywithinscopeofPTpractice11.5 interpretexaminationfindings11.6 screentorulein/outconditionsandconcerns

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AppendixC

Theme12 StudentshouldhaveBOTHtheunderstandingandskilltoperformthefollowingexaminationskills:

12.1 balanceassessment12.2 chartreviewtoextractrelevanthistory12.3 dermatomescreening12.4 functionalmobilityassessment12.5 gaitassessment12.6 goniometry12.7 interview/historytaking12.8 lowerquadrantscreening12.9 manualmuscletesting

12.10 musclelengthtesting12.11 myotomescreening12.12 reflextesting12.13 sensoryexamination12.14 medicalscreeningforredflags12.15 systemsreview12.16 upperquadrantscreening

Theme13 Studentshouldhavetheunderstandingandskilltoperformthefollowinginterventions:13.1 prescribe,fit,andinstructpatientsinproperuseofassistivedevices13.2 functionaltraining(includingbedmobility,transfers,andgait)withappropriateguardingand

assistance13.3 individualizedpatienteducation13.4 therapeuticexercise:specificallystrengthening13.5 therapeuticexercise:specificallystretching13.6 therapeuticexercise:specificallyaerobicexercise

Theme14 Studentshouldrecognizeandfollowspecificprofessionalstandards,including:14.1 appropriatedresscode14.2 corevaluesidentifiedbytheAPTAasaccountability,altruism,compassion/caring,excellence,

integrity,professionalduty,andsocialresponsibility14.3 clinicalexpectationsspecifictosetting14.4 HIPAAregulations14.5 legalaspectsrelatedtopatientcare14.6 obligationsofthepatient-providerrelationship14.7 passionfortheprofession14.8 patientrights14.9 maintainingprofessionalboundaries

14.10 understandingphysicaltherapy'sroleinthehealthcaresystem

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ACAPTStrategicInitiativePanels:SummaryofRecommendationsCommonTerminology

IntegratedClinicalEducationStudentReadiness

Eachofthe3panelsdevelopedrecommendationsbasedontheirwork.TheserecommendationshavebeenreviewedbytheACAPTBoardofDirectorsandwillbeconsideredbythememberinstitutionsattheACAPTbusinessmeetinginOctober2017.Thisdocumentisasummaryoftherecommendations.Astheserecommendationsarebeingreviewed,itisessentialtoreflectontheworkoftheClinicalEducationSummit.TheSummitgeneratedasignificantamountofenergyandenthusiasmaroundthetopicofPTclinicaleducation.AttendeeslefttheSummitanxioustotackletheideasgeneratedduringthetwo-daymeeting.

Asaresult,workonsomerecommendationshasbeenpickedupbygroupsoutsideofACAPTandsomehasbeguntooccurorganicallywithinthePTclinicaleducationcommunity.TheHouseofDelegateschargedtheAPTAtoassessissuesaroundPTclinicaleducationresultinginareporttotheAPTABoardfromtheAPTABestPracticeforClinicalEducationTaskForce.TworecentarticleshavebeenpublishedinthePhysicalTherapyJournal(PTJ)becauseoftheNationalStudyofExcellenceandInnovationinPhysicalTherapistEducation,aqualitativeresearchprojectrecentlycompleted.Thesethreeworksoutlineinnovativeresponsestotheissuesthatplagueourclinicaleducationsystem.

ThesepanelrecommendationsgrewoutoftheharmonizingrecommendationsfromtheClinicalEducationSummit.Thelistofharmonizingrecommendationssentaclearmessagethatweneedmorestandardizationinsomeareasofourclinicaleducationsystem.AchievingthisharmonizationisnecessarytomovetomoreinnovativeideasthatcanshapethefutureofPTclinicaleducation.TherecommendationsoftheACAPTpanels,ifadopted,willlayastrongfoundationwithcommonterminology,standardsforintegratedclinicaleducation,andconsistentassessmentofstudentreadinessforentryintofull-timeclinicalexperiencesonwhichinnovativeideascanbebuilt.COMMONTERMINOLOGYRECOMMENDATIONSRECOMMENDATION1(Terminology)ThatthePhysicalTherapistClinicalEducationGlossary(AppendixA)beadoptedandusedfordiscussionanddescriptionofphysicaltherapistclinicaleducation.SS:Usingacommonlanguagetodiscussphysicaltherapistclinicaleducationisessentialtoefficientandeffectivecommunication.TheparticipantsattheSummitcertainlyacknowledgedthisfactandthusdevelopedaSummitrecommendationrequestingacommonsetofterms.Inorderforthisinitiativetobesuccessful,itisessentialthatphysicaltherapisteducationprogramscommittoadoptionofthecommonterms.ItwillalsobeessentialthatprogramsrefrainfromuseofadditionaltermsnotincludedintheGlossarytodescribephysicaltherapistclinicaleducation.Thereisnodoubtthatchangeishardanditwilltakeworkforthecommontermstofilterdownintoorganizationaldocuments.However,inorderfortheinnovativechangesneededtorestructurethephysicaltherapistclinicaleducationinfrastructuretobeeffective,wemustbeginwithastrongfoundation.Commonterminologyenableseveryonetospeakthesamelanguageandhaveclear

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understandingabouttheclinicaleducationsystemwhichisanessentialbuildingblockofthesolidfoundation.RECOMMENDATION2(Terminology)That,followingadoptionofthePhysicalTherapistClinicalEducationGlossary,ACAPTworktoencourageadoptionofthenewterminologyinthedocumentsandsitesidentifiedinAppendixB.SS:AdoptionofthePhysicalTherapistClinicalEducationGlossarybyACAPTmemberinstitutionsisanessentialcomponentofdevelopingacommonlanguage.ThesecondcomponentofthisprocessistoensurethatthecommontermsareincludedindocumentsthroughoutACAPT,APTA,theEducationSection,andotherorganizationsthatimpactPTeducationsuchastheCommissionontheAccreditationofPhysicalTherapyEducation(CAPTE)andpotentiallytheFederationofStateBoardsofPhysicalTherapy(FSBPT).Speakingacommonlanguagerequiresthatallinterestedstakeholdersadoptthetermsandassociateddefinitions.ThisrecommendationsuggeststhatACAPTtakealeadershiproleinassistingwiththebroaddisseminationandrequestsforadoptionofthecommonterminology.CertainlyACAPTadoptionoftheGlossarydoesnotmakeitincumbentonsomeoftheorganizationslistedinAppendixBtoadopttheseterms.ItisthehopeofthePanelsthatACAPTleaderswillbeabletonegotiateoptionsandassistintheprocessfortheprofessiontoembracethesesuggestedtermsforcommonuse.RECOMMENDATION3(Terminology)ThatACAPTassistmemberinstitutionsindisseminatingthePhysicalTherapistClinicalEducationGlossarytotheirclinicalpartners.SS:Consideringtheimportanceoftheclinicaleducationcommunityembracingthenewcommonterminology,itisessentialtotheoverallsuccessofthisinitiativethatthedisseminationofthetermsandaneducationalprogramortoolstoassistclinicalfacultyinadaptingtothenewterms.Optionstoassistschoolsinthisprocessmayincludetrainingmaterials,linkstoonlineresources,etc.RECOMMENDATION4(Terminology)ThattheACAPTpolicyTerminologyforClinicalEducationExperiences(AC2-13)berescinded.SS:TheproposedPhysicalTherapistClinicalEducationGlossaryaddressesthetermsandsituationspreviouslydescribedbythispolicy.TheGlossaryisamorecomprehensivedocumentandthereforethecurrentpolicyshouldberescinded.Inaddition,thefinalreportfortheIntegratedClinicalEducationPanelincludesarecommendationtoaddthedefinitionforintegratedclinicaleducationtothePhysicalTherapistClinicalEducationGlossary.Onceapproved,theacronymICEwillbeassociatedwiththeterm‘integratedclinicaleducation’–not‘integratedclinicalexperience.’INTEGRATEDCLINICALEDUCATIONRECOMMENDATIONSRECOMMENDATION1(ICE)Thattheproposeddefinitionofintegratedclinicaleducation(ICE)beadoptedasthedefinitionforusewithintheprofession.

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SS:Consistentandproperuseoftheterm‘integratedclinicaleducation’isessentialtosuccessfulcommunicationwithintheacademicandclinicalenvironmentsofphysicaltherapisteducation.Thepanel,afterextensiveresearch,discussion,anddebatehasdevelopedadefinitionthatisclearandrepresentativeofthevarietyofsettingsandtypesofexperiencesthathavedevelopedwithinourprofession.ThedefinitionalsoincludesareferencetotheCAPTEcriteriaforfull-timeclinicaleducation,thusrecognizingthatICEcantakemanyforms,someofwhichmeetthecriteriasetforthinaccreditationstandards.RECOMMENDATION2(ICE)ThatthedefinitionofintegratedclinicaleducationbeaddedtotheglossarydevelopedbytheCommonTerminologypanel.SS:TheworkoftheCommonTerminologyPanelandICEPanelwascoordinatedtoensureconsistencyofterms.BecausedevelopmentofadefinitionforICEwasacomponentofthispanel’scharge,thedefinitionisprovidedinthereportandproposedforadoption.Onceadopted,itshouldbeincludedintheglossaryofterms,ensuringconsistentdisseminationofthetermandacronym.RECOMMENDATION3(ICE)ThatthecurrentlypublisheddefinitionofintegratedclinicalexperienceintheACAPTpolicyentitledTerminologyforClinicalEducationExperiences(AC2-13)berescinded.SS:AdefinitionforintegratedclinicalexperiencewasadoptedbyACAPTin2014.TheworkoftheICEpanelhasledtoarecommendationthattheappropriatetermisintegratedclinicaleducationandthattheexperiencesofICEarereferredtoasICEexperiences.Oncethisnewdefinitionforintegratedclinicaleducationisadopted,thetermanddefinitionfor‘integratedclinicalexperience’shouldberescindedtoensureconsistencyintheuseoftermsanddefinitions.RECOMMENDATION4(ICE)Thatthe8parametersaspresentedasbaselineexpectationsforintegratedclinicaleducationbeadoptedanddisseminatedforusebyphysicaltherapisteducationalprograms.SS:ParticipantsintheSummitrecognizedboththevalueofICEandthevariabilityofICEexperienceswithintheeducationalprograms.Asaresult,theparticipantsagreedthattheprofessionisbestservedbyinclusionofICEthatisbuiltonagreeduponstandardsfordesignandimplementation.The8parametersdevelopedbytheICEpanelprovidesuchguidance.Theseparametersweredevelopedafterextensivereviewoftheliterature,engagementwithstakeholders,discussion,anddebate.AdoptionoftheseparametersbyACAPTmemberinstitutionswillensurethatICEaredevelopedusingastandardizedsetofexpectationsyetcontinuetoallowandencourageeducationalprogramstoinvolvetheirstudentsinawidevarietyofICEexperiencestomeetuniqueneedsortakeadvantageofuniquesituations.ThisguidanceforICEdevelopmentwillalsoassistfacultyinensuringthattheexperiencesprovidedtostudentsarebasedonsoundeducationalpractices.RECOMMENDATION5(ICE)Thatthe10guidelinesfordevelopmentofintegratedclinicaleducationexperiencesbedisseminatedtophysicaltherapisteducationalprograms.

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SS:Distinctfromtheparametersdescribedabove,thepanelwasalsoaskedtoprovideguidancetoprogramsinterestedindevelopingICE.Thepaneldevelopedalistof10guidelinesthataddresstheintentionalstepsthatfacultyshoulduseandconsiderintheprocessofdevelopingICEexperiences.ThepanelbelievesthatthecombinationoftheparametersbeingusedasqualitystandardsalongwiththeguidelinestohelpguideICEdevelopmentwillensurethatphysicaltherapisteducationalprogramshavethetoolsnecessarytoprovidehighqualityandeffectiveICEtotheirphysicaltherapiststudents.RECOMMENDATION6(ICE)ThattheACAPTBoardofDirectorssharethisdocument,onceapproved,withthemembersoftheEducationalLeadershipPartnership(ELP)fordiscussiononhowtomoveforwardwithconsistentuseofthetermintegratedclinicaleducationwithinthephysicaltherapistclinicaleducationcommunity.SS:Ifwearetoachieveconsistentuseofthetermintegratedclinicaleducation,thetermanditsdefinitionwillneedtobedisseminatedbroadly.ThistermrepresentsachangefromthetermpreviouslyadoptedbyACAPTinthepolicy‘TerminologyforClinicalEducationExperiences’(AC2-13)andthusthechangewillrequireacoordinatedefforttoeducateeducationalprogramsandclinicalfacultyonthepropertermandproperusage.ELPiswellpositionedtoassistinthisinitiative.RECOMMENDATION7(ICE)ThatACAPTsupporteducationalresearchfocusedonprogrammaticoutcomesofdifferentmodelsofintegratedclinicaleducationusingstandardizedoutcomemeasures.SS:ThepanelwasaskedtodiscernanddescribemodelsofICEthatexistwithinphysicaltherapistcurricula.Thisportionofthechargewasaccomplishedbyathoroughreviewoftheliteratureandthemodelsweredescribedastheyrelatetothe8establishedparametersproposedbythepanel.Throughthisprocessthepaneldiscoveredthatalthoughmodelsaredescribedintheliterature,thereislittletonoassessmentoftheoutcomesofthevariousmodelsdescribed.Inresponsetothisfinding,thepanelisrecommendingthatadditionalresearchbedevelopedandsupported.FindingsfromthisresearchcanthenbeusedbythephysicaltherapyeducationalcommunitytodevelopthemosteffectiveandefficientmodelsofICE,thusenhancingtheeducationofthephysicaltherapiststudents.STUDENTREADINESSRECOMMENDATIONSRECOMMENDATION1(StudentReadiness)Thatthelistofknowledge,skills,andabilities(KSAs),groupedinto14themes,requiringstudents’demonstrationofcompetencepriortoenteringtheirfirstfull-timeclinicalexperienceasshowninAppendixC(FirstFull-timeClinicalExperienceKSAs)beadopted.SS:Academicprogramsshouldbeencouragedtoprovidestudentswiththeappropriateeducationalexperiences/modulessothatthestudentmayachievethelevelofproficiencyindicatedforthesaiditems(AppendixA).Thisinformationwouldensureconsistentpreparationpriortoastudent’sfirstfull-timeclinicalexperience.Giventhisinformation,clinicalinstructorscanbeconfidentthatstudentswouldbegintheirclinicalexperiencewithcompetencyintheseitemsandcanthereforedevelopandprovideamoreappropriatelearningenvironmentforastudenttocontinuetogrow.Theformatofthethemesandelementsmaybestartingpointsforthepotentialdevelopmentofentrustableprofessionalactivitiesandcompetencymilestonesthatwouldbeapplicabletoallstudentsinphysicaltherapisteducationpriortoentranceintotheirfirstfull-timeclinicalexperience.

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Attachment1

RECOMMENDATION2(StudentReadiness)ThatACAPTdevelopaplan,includinganimplementationtimeline,toguidephysicaltherapisteducationalprogramsinimplementingtheuseoftheFirstFullTimeClinicalEducationExperienceKSAs.Thisplanshallalsoincludeguidanceoncommunicationtoclinicalpartners.SS:AdoptingtheidentifiedKSAsisanimportantfirststepofthisinitiative.TheparticipantsintheSummitclearlyidentifiedaneedforconsistencyinthelevelofcompetenceofstudentsenteringtheirfirstfulltimeclinicalexperience.ThissetofKSAsprovidestheminimalexpectationsforthosestudents.InorderfortheeducationalprogramsandclinicalpartnerstoimplementtheseKSAs,additionalconsiderationstocommunication,assessment,expectations,andtimelinesneedtobeconsidered.RECOMMENDATION3(StudentReadiness)ThatACAPTencouragephysicaltherapisteducationalprogramstoevaluateandmakeappropriatechangestotheircurriculumtoenablestudentstoachievecompetencyintheFirstFull-timeClinicalExperienceKSAs.SS:Asdescribedabove,theclinicalsitesareanxiousforastandardsetofcompetenciesthatallfirstfull-timestudentshaveachievedpriortoarrivingintheirclinics.Onestepinachievingthisgoalrequireseducationalprogramstoassesstheircurriculumanddetermineifchangesareneededtoenablestudentstoachievethedescribedlevelsofcompetence.ManyprogramslikelyhavethecomponentsinplacethatenablestudentstomeettheseKSAs;otherprogramsmayneedtomakeonlysmallchangestoachievethisgoal;andstillothersmayneedtoconsidershiftintheprogramdesign.Inanycase,beingresponsivetotheSummitrecommendationsandthusthevoiceofourclinicalpartners,startswithanassessmentofcurrentstateandnecessarychanges.RECOMMENDATION4(StudentReadiness)Thatstudentreadinesspriortoentranceintoclinicalpractice(entry-level)beexaminedasthenextsteptoachievingtheSummitrecommendationsrelatedtoreadinessandcompetency.SS:Thispanelfocusedonstudentreadinessforentranceintothefirstfull-timeclinicaleducationexperience.Itrepresentsonemomentalongastudent’scontinuumoflearning.TheSummitparticipantsidentifiedtheneedforadditionalpointsofcompetenceassessment.Thevariabilityofnumber,length,andtimingofclinicalexperienceswithinphysicaltherapistcurriculamakestandardizationofcompetenceexpectationsatseveralpointsalongthestudent’seducationimpossible.ThisrealizationledtheStudentReadinesspaneltochoosethepointofentryintothefirstfull-timeclinicalexperienceasacommonpointthatwasappropriateforstandardization.Theotherpointintimethatlendsitselftostandardcompetenceassessmentisjustpriortoentryintopractice.Identifyingstandardelementsofcompetencethatshouldexistaftercompletionofalldidacticandclinicalcourseworkwillprovidevaluableinformationtoclinicalinstructorsandensureacommonlevelofpreparationforstudentsatentryintopractice.RECOMMENDATION5(StudentReadiness)ThatACAPTsupporttheneededcollaborativeeducationalresearchtodeterminethemostappropriatetypesofassessmentsofstudentreadinessandatimelineforimplementation.

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Attachment1

SS:ParticipantsindicatedthevariousassessmentmethodsthatcanbeutilizedforeachitemthatachievedconsensusintheDelphistudy(Table7).Thislistisnotmeanttobeprescriptivebuttoprovideoptionsforacademicprograms.TheseitemsreflectcurrentmethodsofassessmentandmaynotbethemostconnectedtowhatisusedinCBME.Nowthatconsensushasbeenachievedontheknowledge,skills,attitudesandprofessionalbehaviorsstudentsmusthaveordisplayandgiventheimportanceofassessmentandevaluationincompetency-basededucation,additionalresearchtodeterminethebestassessmentmethodsiswarranted.Bestpracticeshouldbeutilizedtodevelopacontinuedandfrequentassessmentprocesstoensurephysicaltherapiststudentsachievethemilestonesattheappropriatetimeintheircontinuumoflearning.Competency-basedphysicaltherapistclinicaleducation(CBPTCE)necessitatesarobustandmultifacetedassessmentsystem.Theleadershipwithinourprofessionmustattendtothecontextofthemultiplesettingswhereclinicaleducationoccurs.CBPTCE,likeCBME,furtherrequiresassessmentprocessesthataremorecontinuousandfrequent,criterion-based,developmental,work-basedwherepossible,useassessmentmethodsandtoolsthatmeetminimumrequirementsforquality,usebothquantitativeandqualitativemeasuresandmethods,andinvolvethewisdomofgroupprocessinmakingjudgmentsaboutstudentprogress.Inaddition,ashiftinthinkingneedstooccurfromassessmentoflearningtoassessmentforlearning.Researchintothequalityofassessmentprograms,howassessmentinfluenceslearningandteaching,newpsychometricmodelsandtheroleofhumanjudgmentismuchneeded(Schuwirth&VanderVleuten,2011)TheStudentReadinessStrategicInitiativePanel’srecommendationcomplimentswiththerecommendation#5bytheExcellenceinPhysicalTherapyEducationTaskForce(APTA,2015).Theynotetheprofessionshouldsupportthedevelopmentofastandardizedassessmentforphysicaltherapiststudentspriortoenteringtheirterminalclinicalexperience.Theassessmentwouldevaluatestudents’readinessfortheclinicaleducationandassistinimprovingrelationshipswithclinicaleducationsitesbysettingconsistentstandardsforstudentsbeforetheybegintheseexperiences.Theassessmentmayalsodecreaseunwarrantedvariationinstudentpreparation,whichwoulddecreasetheburdenonclinicalsitesduetodifferencesincurriculumacrossprograms.

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COMMONTERMINOLOGYSTRATEGICINITIATIVEPANELFinalReportJune2017

BACKGROUNDTheSummitrecommendationrelatedtocommonterminologywasbasedontheunderstandingandbeliefthattheabilitytouseconsistentlanguagebetweenacademicandclinicalfacilitiesisessentialforeffectiveandefficientbesteducationpractice.ThechargefortheCommonTerminologypanelwasbasedonthisSummitrecommendation.(RecommendationI)CHARGEInJanuary2016,theCommonTerminologyPanelwasconvenedtoaccomplishthefollowing:

1. Developcommonterminologyrelatedtophysicaltherapistclinicaleducation2. Developtemplatesormodelstosupportclinicaleducationsuchasrequestformsand

studentinformationforms.Inthespringof2017,thiswasmodifiedto:Suggestelementsofformstosupportclinicaleducation*

3. Investigateandidentifyallcurrentsourcesofterminologyrelatedtoclinicaleducationbyinvitingcollaborationwithvariousgroups,NCCE,EducationSection,CAPTE

4. Reviewallcurrentsupportdocuments,i.e.,CAPTE,CPI,GuidetoPTPractice5. Recommenditemsforconsiderationrelatedtocommonterminology6. Developguidelinesforimplementationoftheproposedterminology

*Therationaleforthischangeisbasedonanunderstandingthatmoreprogramsareadoptingelectronicsystemsbuiltbythird-partyvendorstomanageslotrequests,placementnotifications,andstudentinformationandthuspaperformsareusedlessfrequently.Inaddition,membersofthisPanelareawareofothergroupsattemptingtodevelopformsandhaveconcludedthattheirmostvaluablecontributionistosuggestelementstobeincludedoneitherpaperorelectronicforms.SUMMARYOFWORKFromFebruarytoApril2016,membersofthePanelgathereddata,whichincludedtermsandtheirdefinitionsrelatedtoanyaspectofphysicaltherapistclinicaleducation,fromallrelevantsources.SourcesincludedACAPT,APTA,CAPTE,ClinicalEducationSpecialInterestGroup(CESIG),FSBPT,clinicaleducationconsortia,residency,andfellowshipdocuments;clinicaleducationevaluationtools;ANormativeModelofPhysicalTherapistProfessionalEducation1;andmaterialsfromtheClinicalEducationSummit.Asystematicreviewoftheclinicaleducationliteraturewasalsoperformed.SystematicreviewThesystematicreviewincludedaMeSHandkeywordsearchinPubMedandCINAHL(1960topresent)usingtheterms“physicaltherapy”AND“clinicaleducation,”internship,“clinical

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instruct,*”preceptor,residency,fellowship,andterminology.HistoricaldocumentswerealsoretrievedfromtheAPTAandadditionalarticles,notalreadyidentifiedintheliteraturesearchwereretrievedfromtheAnthologyofClinicalEducation,Volumes1and2(Figure).Figure.Articlescreeningforsystematicreview.

Data,includingallrelevantdefinitionsrelatedtoclinicaleducationfromallrelevantsources,wereextractedfromallsources.Theterm,definition,andreferencewereplacedintoamasterspreadsheet.Themasterspreadsheetincluded260termsincluding6definitionsforclinicaleducation,12definitionsforacademiccoordinatorofclinicalinstruction,and15definitionsforclinicalinstructor.The260termswerecategorizedinto1of5clinicaleducationconstructsreportedintheliterature.2,3The5categorieswereinfrastructure,site,stakeholder,assessment,andother.ThePaneldividedintosubgroups(oneforeachoftheaforementionedconstructs)andunderwentthefirstroundofconsensusbuildingtoarriveatadefinition.Also,additionalliteraturefromotherprofessionsandfromnon-USpublicationswereaddedasneededwhentherewereconflictsfromtheinitialsearchinordertohelpinconsensusbuilding.Inthisinitialround,thenumberoftermswasreducedtoeliminateredundancyandadraftdefinitionforremainingtermswaspresentedbacktotheentirePanelforadditionaldiscussionandfurtherconsensusbuilding.ThetermsthatdidnotachieveconsensusbythePanelwerepresentedtotheaudienceinapresentationattheEducationLeadershipConferenceinOctoberof2016.Termswerediscussedinsmallgroupsandfeedbackfromthesmallgroupswasprovidedbackto

ScreenedTitles/Abstracts (n=452): PubMed=244 CINAHL=184 Historicaldocuments=24

PubMed=219 CINAHL=141 Historicaldocuments=24

Total=42

Excludedduplicates,non-US(n=68)

Excludedthosethatdidnotcontaindefinitions

(n=342)

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thePanel.Alltermsanddefinitionsweremadeavailabletoandadditionalfeedbackwassoughtfromthephysicaltherapycommunityina3-weekopencommentperiod(SurveyMonkey®,SanMateo,CA)inOctober2016.Therewere154respondentstotheopencommentperiod,62%academiciansand38%clinicians.UsingfeedbackfromtheEducationLeadershipConferenceandtheopencommentperiod,thePanelsubgroupsrevieweddefinitionsandintegratedfeedbackasappropriate.EditstothetermswerefurtherreviewedbytheentirePanelbetweenJanuaryandMarch2017whenconsensusonalltermswasachieved.ThefinalsetoftermscanbefoundinAppendixA.Useoftheterm“Internship”Followingtheinitialroundofconsensusbuilding,thePanelagreedthatthetermInternshipwouldbeusedtodescribeanyclinicaleducationexperiencethatoccurredfollowingthedidacticcurriculum.However,feedbackfromtheEducationalLeadershipConferenceandtheopencommentperiodindicatedthatsomestatesdonotallowuseoftheterminternshiptodescribeclinicaleducationexperiencesthattypicallyoccurinaphysicaltherapisteducationprogram.AdditionalresearchontheuseoftheterminternshipwasconductedbythePanelmembers.AccordingtotheUSDepartmentofLabor,WageandHourDivision,undertheFairLaborStandardsAct,therearecriteriathatmustbemettodetermineifaninternmustbepaidtheminimumwageandovertimewhenprovidingservicesinthe“for-profit”privatesector.Thefollowing6criteriamustbeappliedwhenmakingthedetermination:1.Theinternship,eventhoughitincludesactualoperationofthefacilitiesoftheemployer,issimilartotrainingwhichwouldbegiveninaneducationalenvironment;2.Theinternshipexperienceisforthebenefitoftheintern;3.Theinterndoesnotdisplaceregularemployees,butworksunderclosesupervisionofexistingstaff;4.Theemployerthatprovidesthetrainingderivesnoimmediateadvantagefromtheactivitiesoftheintern;andonoccasionitsoperationsmayactuallybeimpeded;5.Theinternisnotnecessarilyentitledtoajobattheconclusionoftheinternship;and6.Theemployerandtheinternunderstandthattheinternisnotentitledtowagesforthetimespentintheinternship.Ifallofthecriteriaaremet,anemploymentrelationshipdoesnotexistundertheFLSA,andtheAct’sminimumwageandovertimeprovisionsdonotapplytotheintern.4

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BaseduponreviewofthecriteriaandagreementwithinthePanelthata)studentsdoprovidepositivecontributionstotheclinicalsiteandb)theemployerdoesreceiveanadvantagefromthephysicaltherapiststudent,thereisthepossibilitythatanemploymentrelationshipcouldbeconstrued.Also,datafromthesmall-groupdiscussionsandopencommentperiodindicatedtherearestatelawsthatprecludeuseoftheterms“intern”and“internship.”Therefore,wearerecommending:a)theterminternshipshouldnotbeusedtodescribephysicaltherapistclinicaleducationexperiencesinwhichstudentsareeitherunpaidorpaidlessthanthefederalminimumwage;andb)theterminternshipcouldbeusedtodescribeaclinicaleducationexperienceinwhichparticipantsarebeingpaidinaccordancewithfederallaborlawsundertheFairLaborStandardsAct.Charge1:Developcommonterminologyrelatedtophysicaltherapistclinicaleducation.Theprocessdescribedaboveledtoasetoftermsforphysicaltherapistclinicaleducation.ThesetermshavebeenassembledintothePhysicalTherapistClinicalEducationGlossaryandareprovidedinAppendixA.Charges2,4,and6:SuggestelementsofformstosupportclinicaleducationReviewallcurrentsupportdocuments,ie,CAPTE,CPI,GuidetoPTPracticeDevelopguidelinesforimplementationoftheproposedterminologyAsdescribedabove,allsupportdocumentswereincludedintheinitialreviewofdocumentstodevelopthelistoftermsrelatedtophysicaltherapistclinicaleducation.AfterdevelopmentoftheGlossary,acomprehensivereviewofprofessionaldocumentswasconductedtoidentifythosethatwouldneedtobechangedtobeconsistentwiththeterminologybeingproposedbythePanel.Inadditiontothemanyformsinuse,policyandregulatorydocumentswereincludedinthereview.OnlyonedocumentwasidentifiedthatisinthepurviewofACAPT.TheresponsiblepartiesforthedocumentsandthegeneralmeansnecessarytomakechangesinthedocumentsarelistedinAppendixB.Charge3:Investigateandidentifyallcurrentsourcesofterminologyrelatedtoclinicaleducationbyinvitingcollaborationwithvariousgroups,NCCE,EducationSection,CAPTE.MembersofthePanelhavereachedouttootherstakeholdergroups,collaboratingandsharingtheworkbeingdoneacrossgroups.TherehasbeenongoingandextensivecollaborationwiththeIntegratedClinicalEducationPanelandtheStudentReadinessPanel.Wealsoinvitedcollaborationwithothersthrough1)roundtablediscussionswiththeparticipantsatthe2016EducationalLeadershipConference,2)anopencommentperiodprovidedformembersofthephysicaltherapyacademicandclinicalcommunities,and3)studentfocusgroupsduringthe

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NationalStudentConclaveandvirtuallyinNovember2016.ThisallowedmemberstoprovidefeedbackonadraftoftheGlossary.FeedbackwasusedfromtheroundtablediscussionsandthecommentperiodtodevelopthefinalGlossary.Charge5:Recommenditemsforconsiderationrelatedtocommonterminology.Primaryconsiderationsarerelatedtoadoption,inclusion,anddisseminationoftheterms.ThePanelhasdevelopedthreerecommendationstoaddresstheseitems.Anadditionalitemforconsiderationisrelatedtotheuseoftheterm‘internship.’Theinformationdetailedabovehasledthepaneltotheconclusionthatinthecurrentphysicaltherapistclinicaleducationinfrastructure,thetermisbeingusedinappropriatelyandtheclinicaleducationcommunityneedstotakestepstoeliminatetheuseoftheterm.ThePanelrecognizesthatsomeoftheinnovativechangescurrentlybeingexaminedmaypresentopportunityforappropriateuseoftheterminthefuture.ThePanelhasdevelopedonerecommendationrelatedtothisissue.RECOMMENDATION1:ThatthePhysicalTherapistClinicalEducationGlossary(AppendixA)beadoptedbytheACAPTmemberinstitutionsandusedfordiscussionanddescriptionofphysicaltherapistclinicaleducation.SS:Usingacommonlanguagetodiscussphysicaltherapistclinicaleducationisessentialtoefficientandeffectivecommunication.TheparticipantsattheSummitcertainlyacknowledgedthisfactandthusdevelopedaSummitrecommendationrequestingacommonsetofterms.Inorderforthisinitiativetobesuccessful,itisessentialthatphysicaltherapistprogramscommittoadoptionofthecommonterms.ItwillalsobeessentialthatprogramsrefrainfromuseofadditionaltermsnotincludedintheGlossarytodescribephysicaltherapistclinicaleducation.Thereisnodoubtthatchangeishard,anditwilltakeworkforthecommontermstofilterdownintoorganizationaldocuments.However,inorderfortheinnovativechangesthatareneededtorestructurethephysicaltherapistclinicaleducationinfrastructuretobeeffective,wemustbeginwithastrongfoundation.Commonterminologyenableseveryonetospeakthesamelanguageandhaveclearunderstandingabouttheclinicaleducationsystemwhichisanessentialbuildingblockofthesolidfoundation.RECOMMENDATION2:That,followingadoptionofthePhysicalTherapistClinicalEducationGlossary,ACAPTworktoencourageadoptionofthenewterminologyinthedocumentsandsitesidentifiedinAppendixB.

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SS:AdoptionofthePhysicalTherapistClinicalEducationGlossarybyACAPTmemberinstitutionsisanessentialcomponentofdevelopingacommonlanguage.ThesecondcomponentofthisprocessistoensurethatthecommontermsareincludedindocumentsthroughoutACAPT,APTA,theEducationSection,andotherorganizationsthatimpactPTeducationsuchasCAPTEandpotentiallyFSBPT.Speakingacommonlanguagerequiresthatallinterestedstakeholdersadoptthetermsandassociateddefinitions.ThisrecommendationsuggeststhatACAPTtakealeadershiproleinassistingwiththebroaddisseminationandrequestsforadoptionofthecommonterminology.CertainlyACAPTadoptionoftheGlossarydoesnotmakeitincumbentonsomeoftheorganizationslistedinAppendixBtoadopttheseterms.ItisthehopeofthePanelsthatACAPTleaderswillbeabletonegotiateoptionsandassistintheprocessfortheprofessiontoembracethesesuggestedtermsforcommonuse.RECOMMENDATION3:ThatACAPTassistmemberinstitutionsindisseminatingthePhysicalTherapistClinicalEducationGlossarytotheirclinicalpartners.SS:Consideringtheimportanceoftheclinicaleducationcommunityembracingthenewcommonterminology,itisessentialtotheoverallsuccessofthisinitiativethateducationalprogramsassistindisseminatingandaidclinicalfacultyinadaptingthenewterms.Optionstoassistschoolsinthisprocessmayincludetrainingmaterials,linkstoonlineresources,etc.RECOMMENDATION4:ThattheACAPTpolicyTerminologyforClinicalEducationExperiences(AC2-13)berescinded.SS:TheproposedPhysicalTherapistClinicalEducationGlossaryaddressesthetermsandsituationspreviouslydescribedbythispolicy.TheGlossaryisamorecomprehensivedocumentandthereforethecurrentpolicyshouldberescinded.Inaddition,thefinalreportfortheIntegratedClinicalEducationPanelincludesarecommendationtoaddthedefinitionforintegratedclinicaleducationtothePhysicalTherapistClinicalEducationGlossary.Onceapproved,theacronymICEwillbeassociatedwiththeterm‘integratedclinicaleducation’–not‘integratedclinicalexperience.’MEETINGHISTORYFace-to-facemeetings:February20,2016andOctober6,2016Conferencecalls:(2016)April12,May27,August12,August23,November28(2017)January24,January25,March28,May4,2017

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References1. AmericanPhysicalTherapyAssociation.ANormativeModelofPhysicalTherapist

ProfessionalEducation.Alexandria,VA;AmericanPhysicalTherapyAssociation;2004.

2. MooreML,PerryJF.Clinicaleducationinphysicaltherapy:presentstatus/futureneeds.Finalreportoftheprojectonclinicaleducationinphysicaltherapy.Washington,D.C.:SectionforEducationAmericanPhysicalTherapyAssociation;June1976;NO1-AH.

3. GwyerJ,OdomC,GandyJ.HistoryofclinicaleducationintheUnitedstates.JPhysTherEduc.2003:17(3):34-43.

4. U.S.DepartmentofLaborWageandHourDivision.FactSheet#71:Internship

programsundertheFairLaborStandardsAct.https://www.dol.gov/whd/regs/compliance/whdfs71.pdf.AccessedMay16,2017.

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PHYSICALTHERAPISTCLINICALEDUCATIONGLOSSARY

Thisglossaryoftermswasdevelopedafterareviewofthephysicaltherapyliterature,extensivediscussionanddebatebytheACAPTCommonTerminologyPanel,andengagementofkeystakeholderswithinthephysicaltherapyclinicaleducationcommunity.TheGlossaryisdividedintomajorcategoriesand,asapplicable,definitionsarereferenced. CLINICALEDUCATIONINFRASTRUCTURE Clinicaleducation Aformaltypeofsupervisedexperientiallearning,focusedon

developmentandapplicationofpatient-centeredskillsandprofessionalbehaviors.Itisdesignedsothatstudentsgainsubstantial,relevantclinicalexperienceandskills,engageincontemporarypractice,anddemonstratecompetencebeforebeginningindependentpractice.1-3

Clinicaleducationagreement

Aformalandlegallybindingagreementthatisnegotiatedbetweenacademicinstitutionsandclinicaleducationsitesorindividualprovidersofclinicaleducationthatspecifieseachparty'sroles,responsibilities,andliabilitiesrelatingtostudentclinicaleducation.4

Clinicaleducationcurriculum

Theportionofaphysicaltherapyeducationprogramthatincludesallpart-timeandfull-timeclinicaleducationexperiencesaswellasthesupportivepreparatoryandadministrativecomponents.4

Clinicaleducationexperience

Experiencesthatallowstudentstoapplyandattainprofessionalknowledge,skills,andbehaviorswithinavarietyofenvironments.Experiencesincludethoseofshortandlongduration(e.g.,part-time,full-time),provideavarietyoflearningopportunities,andincludecareofpatients/clientsacrossthelifespanandpracticesettings.Whiletheemphasisisonpatient-careskills,experiencesmayalsoincludeinter-professionalexperiencesandnon-patientcaredutiessuchasresearch,teaching,supervision,andadministration.Clinicaleducationexperiencesareapartoftheprofessionalcurriculumandincludeformalstudentassessment.5-8

Collaborativeclinicaleducationmodel

Aclinicaleducationexperienceinwhichtwo(ormore)physicaltherapiststudentsareassignedtoone(ormore)preceptor/clinicalinstructor(s).Thestudentsworkcooperativelyunderthepreceptor/clinicalinstructor(s).Examplesinclude2:1,2:2,3:1,etc.studenttopreceptor/clinicalinstructorratio.Studentsmaybefromthesameordifferentprogramsandmaybeatthesameordifferentlevelsoftraining.9-11

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Didacticcurriculum Thecomponentofthephysicaltherapistprofessionaleducationprogramthatiscomprisedofthecontent,instruction,learningexperiences,andassessmentdirectedbytheacademicfaculty.3,12,13

Fellowship Apost-professionalfundedandplannedlearningexperienceinafocusedareaofclinicalpractice,education,orresearch(notinfrequentlypost-doctoralorforpost-residencyorboardcertifiedtherapists).14

Full-timeclinicaleducationexperience

Aclinicaleducationexperienceinwhichastudentengagesforaminimumof35hoursperweek.Anintegratedclinicaleducationexperiencemaybeafull-timeclinicaleducationexperience;however,full-timeclinicaleducationexperiencesdesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEaredirectedbyaphysicaltherapistclinicalinstructor.5,7

Firstfull-timeclinicaleducationexperience

ThefirstclinicaleducationexperiencedesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEinwhichastudentengagesforaminimumof35hoursperweek.

Intermediatefull-timeclinicaleducationexperience

AclinicaleducationexperiencedesignatedtoachievetheminimumnumberofweekssetforthbyCAPTEinwhichastudentengagesforaminimumof35hoursperweekandreturnstotheacademicprogramforfurthercompletionofthedidacticcurriculum.

Terminalfull-timeclinicaleducationexperience

Asingle,orsetof,full-timeclinicaleducationexperience(s)designatedtoachievetheminimumnumberofweekssetforthbyCAPTEthatoccurafterthestudenthascompletedthedidacticcurriculumofaphysicaltherapistprofessionaleducationprogram.Studentsmayreturntotheacademicprogramfordidacticinstructionthatdoesnotrequireadditionalclinicaleducationexperiences.Theexpectedoutcomeofthefinal,orlastterminalexperienceisentry-levelperformance.7

Internationalclinicaleducationexperiences

Aneducationalopportunitythatastudentparticipatesin,outsideofthecountrywherethephysicaltherapisteducationprogramissituated,forwhichhe/sheobtainsclinicaleducationcredit.TheabbreviationICEshouldnotbeusedtodescribeaninternationalclinicaleducationexperience.7,15

Internship Aterminalfull-timeclinicaleducationexperiencethatprovidesrecompensetoparticipantsinaccordancewithfederallaborlawsundertheFairLaborStandardsAct.16

Learningexperience Anyexperiencewhichallowsorfacilitatesachangeinattitudeorbehavior.Aplannedlearningexperienceincludesalearner,anobjectiveforthelearner,asituationdevisedtoproducearesponsethatcontributestotheobjective,aresponsebythestudent,andreinforcementtoencouragethedesiredresponse.3

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Part-timeclinicaleducationexperience

Aclinicaleducationexperienceinwhichastudentengagesinclinicaleducationforlessthan35hoursperweek.Part-timeexperiencesvaryinlength.Apart-timeclinicaleducationexperiencemaybeconsideredanintegratedclinicaleducationexperiencedependingonthedesignoftheexperienceandthelearningobjectives.7,17

Physicaltherapistprofessionaleducationprogram

Educationcomprisedofdidacticandclinicaleducationdesignedtoassurethatstudentsacquiretheprofessionalknowledge,skills,andbehaviorsrequiredforentry-levelphysicaltherapistpractice.3,18,19

Physicaltherapistpost-professionaleducationprogram

Degreeandnon-degreebasedprofessionaldevelopmentforthephysicaltherapisttoenhanceprofessionalknowledge,skills,andabilitiesbeyondentrylevel.Examplesinclude,butarenotlimitedto,continuingeducationcourses,post-professionaldoctoraleducationprograms,certificateprograms,residency,andfellowship.19

Residency Post-professionalprogramsthatoccurafterthegraduatephysicaltherapisthasobtainedalicensetopractice.Theymaybeclinicalprogramsthatadvanceaphysicaltherapist'sknowledgeandskillsinpatient/clientmanagement,ornonclinicalfocusingonadvancingaphysicaltherapist'scareeroutsideofclinicalduties.20

CLINICALEDUCATIONSITES Clinicaleducationsite

Ahealthcareagencyorothersettinginwhichclinicaleducationexperiencesareprovidedforphysicaltherapiststudents.Theclinicaleducationsitemaybe,butisnotlimitedto,ahospital,agency,clinic,office,school,orhomeandisaffiliatedwithoneormoreeducationalprogramsthroughacontractualagreement.3,4

Clinicaleducationenvironment

Thephysicalspace(s),aswellasthestructures,policies,procedures,andculturewithintheclinicaleducationsite.

CLINICALEDUCATIONSTAKEHOLDERS Academicfaculty Teachersandscholarswithintheacademicinstitutiondedicatedto

preparingstudentsintheskillsandaptitudesneededtopracticephysicaltherapy.21

Academicinstitution Universityorcollegethroughwhichanacademicdegreeisgranted.4

Clinicaleducationconsortia

Nationalandregionalgroupsthatincludeacademicandclinicaleducationfacultyforthepurposeofsharingresources,ideas,andefforts.4

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Clinicaleducationfaculty

Theindividualsengagedinprovidingtheclinicaleducationcomponentsofthecurriculum,generallyreferredtoaseitherSiteCoordinatorsofClinicalEducation(SCCEs),preceptors,orclinicalInstructors.Whiletheacademicinstitutiondoesnotusuallyemploytheseindividuals,theydoagreetocertainstandardsofbehaviorthroughcontractualarrangementsfortheirservices.7

Clinicalinstructor(CI)

Thephysicaltherapistresponsibleforthephysicaltherapiststudentanddirectlyinstructs,guides,supervises,andformallyassessesthestudentduringtheclinicaleducationexperience.Whenengagedinfull-timeclinicaleducationdesignatedtomeettheminimumnumberofweeksrequiredbyCAPTE,theclinicalinstructormustbealicensedphysicaltherapistwithaminimumofoneyearoffulltime(orequivalent)post-licensureclinicalexperience.4,22,23

DirectorofClinicalEducation(DCE)

Academicfacultymemberwhoisresponsibleforplanning,directingandevaluatingtheclinicaleducationprogramfortheacademicinstitution,includingfacilitatingclinicalsiteandclinicalfacultydevelopment.22,24,25

Physicaltherapiststudent

StudentenrolledinaCAPTE-accreditedorapproveddevelopingphysicaltherapistprofessionaleducationprogram.Studentsshouldnotbereferredtoasaphysicaltherapystudent.

Preceptor Anindividualwhoprovidesshort-termspecializedinstruction,guidance,andsupervisionforthephysicaltherapiststudentduringaclinicaleducationexperience.Thisindividualmayormaynotbeaphysicaltherapistaspermittedbylaw.

SiteCoordinatorofClinicalEducation(SCCE)

Professionalwhoadministers,manages,andcoordinatesclinicalassignmentsandlearningactivitiesforstudentsduringtheirclinicaleducationexperience.Inaddition,thispersondeterminesthereadinessofpersonstoserveaspreceptorsandclinicalinstructorsforstudents,supervisespreceptorsandclinicalinstructorsinthedeliveryofclinicaleducationexperiences,communicateswiththeacademicprogramregardingstudentperformance,andprovidesessentialinformationtoacademicprograms.4,22,26

CLINICALEDUCATIONASSESSMENT Clinicalperformanceassessment

Clinicalperformanceassessmentencompassesformalandinformalprocessesdesignedtoappraisephysicaltherapiststudentperformanceduringclinicaleducationexperiences.Assessmentmaybeformativeorsummativeinnatureandperformedforthepurposesofprovidingfeedback,improvinglearning,revisinglearningexperiences,anddeterminingsuccessfulattainmentofstudentperformanceexpectationsduringclinicaleducationexperiences.3,22,27,28

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Clinicalperformanceevaluationtool

Avalid,reliable,andmultidimensionalclinicalperformanceassessmenttoolutilizedtodetermineif,andhowwell,astudentmeetsestablishedbehavioralobjectivesduringclinicaleducationexperiences.4,29,30,31

Entry-levelphysicaltherapistclinicalperformance

Performancethatdemonstratesknowledge,skills,andbehaviorsconsistentwitheffective,efficient,andsafepatient/clientmanagementtoachieveoptimaloutcomes.22,28

Supervision Theguidanceanddirectionprovidedtoaphysicaltherapiststudentbythepreceptororclinicalinstructor.Thisvariesbasedonthecomplexityofthepatientorenvironment;jurisdictionandpayerrulesandregulations;andabilitiesofthephysicaltherapiststudent.4,22,27

References

1. DelanyC,BraggeP.Astudyofphysiotherapystudents’andclinicaleducators’perceptionsof

learningandteaching.MedicalTeacher.2009;31(9):402-411.

2. OʼBrienB,TeheraniA.UsingWorkplaceLearningtoImprovePatientCare.AcadMed.2011;86(11):e12.

3. MooreML,PerryJF.ClinicalEducationinPhysicalTherapy:PresentStatus/FutureNeeds.Final

ReportoftheProjectonClinicalEducationinPhysicalTherapy.Washington,DC:SectionforEducationAmericanPhysicalTherapyAssociation;June1976;NO1-AH.

4. AmericanPhysicalTherapyAssociation.ThePhysicalTherapyClinicalInstructorEducationandCredentialingProgramManual.Alexandria,VA:AmericanPhysicalTherapyAssociation;2009.

5. TerminologyforClinicalEducationExperiencesProposedbyAcademicCouncilBoardofDirectors[ACAPTmotionAC-2-13].http://acapt.myriadmedia.com/docs/default-source/motions/2013-motions/ac-2-13_terminology_for_clincal_education_passed.pdf?sfvrsn=2.AccessedMay16,2017.

6. PivkoSE,AbbruzzeseLD,DuttarovP,HansenRL,RyansK.Effectofphysicaltherapystudents'clinicalexperiencesonclinicianproductivity.JAlliedHealth.2016;45(1):33-40.

7. CommissiononAccreditationinPhysicalTherapyEducation.StandardsandRequiredElementsforAccreditationofPhysicalTherapistEducationPrograms,2016.http://www.capteonline.org/AccreditationHandbook/.PublishedNovember11,2015,UpdatedMarch4,2016.AccessedApril10,2017.

8. GibersonTR,BlackB,PinkertonE.Theimpactofstudent-clinicalinstructorfitandstudent-organizationfitonphysicaltherapistclinicaleducationexperienceoutcomes.JPhysTherEduc.2008;22(1):59-64.

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9. RindfleschAB,DunfeeHJ,CieslakKR,etal.CollaborativemodelofclinicaleducationinphysicalandoccupationaltherapyattheMayoClinic.JAlliedHealth.2009;38(3):132-142.

10. DecluteJ,LadyshewskyR.Enhancingclinicalcompetenceusingacollaborativeclinicaleducationmodel.PhysTher.1993;73(10):683-689.

11. LadyshewskyRK.Peerassistedlearninginclinicaleducation:areviewoftermsandlearningprinciples.JPhysTherEduc.2000;14(2):15-22.

12. CommissiononAccreditationinPhysicalTherapyEducation.EvaluativeCriteriaforAccreditationofEducationProgramsforthePreparationofPhysicalTherapists.CommissiononAccreditationinPhysicalTherapyEducationWebsite.http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/EvaluativeCriteria_PT.pdf.UpdatedAugust2014.AccessedApril10,2017.

13. KenyonLK,DoleRL,KellySP.Perspectivesofacademicfacultyandclinicalinstructorsonentry-leveldptpreparationforpediatricphysicaltherapistpractice.PhysTher.2013;93(12):1661-1672.

14. AmericanPhysicalTherapyAssociation.Clinicalexperienceterminologyforphysicaltherapists.http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Terminology/ClinicalExperienceTerminology.pdf.UpdatedDecember2009.AccessedApril10,2017.

15. PechakCM.Surveyofinternationalclinicaleducationinphysicaltherapisteducation.JPhysTherEduc.2012;26(1):69-77.

16. U.S.DepartmentofLaborWageandHourDivision.FactSheet#71:InternshipprogramsundertheFairLaborStandardsAct.https://www.dol.gov/whd/regs/compliance/whdfs71.pdf.UpdatedApril2010.AccessedMay16,2017.

17. AmericanPhysicalTherapyAssociation.2007-2008Factsheet:physicaltherapisteducationprograms.AmericanPhysicalTherapyAssociationWebsite.http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/.AccessedApril10,2017.

18. BarrJS,GwyerJ,TalmorZ.Evaluationofclinicaleducationcentersinphysicaltherapy.PhysTher.1982;62(6):850-861.

19. AmericanPhysicalTherapyAssociation.EducationForPhysicalTherapists:TerminologyUsedToDescribe[HODP05-07-11-04].https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/HOD/Terminology/Education.pdf.UpdatedDecember14,2009.AccessedApril10,2017.

20. AmericanBoardofPhysicalTherapyResidencyandFellowshipEducation.Aboutresidencyprograms.http://www.abptrfe.org/ResidencyPrograms/About/.AccessedApril10,2017.

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21. Kondela-CebulskiPM.Counselingfunctionofacademiccoordinatorsofclinicaleducationfrom

selectentry-levelphysicaltherapyeducationalprograms.PhysTher.1982;62(4):470-476.

22. AmericanPhysicalTherapyAssociation.PhysicalTherapistClinicalPerformanceInstruments:Version2006.Alexandria,VA:AmericanPhysicalTherapyAssociation;2006.

23. HalcarzPA,MarzoukDK,AvilaE,BowserMS,Hurm,L.Preparationofentrylevelstudentsforfuturerolesasclinicalinstructors.JPhysTherEduc.1991;5(2):78-80.

24. BucciereiKM,BrownR,MaltaS.Evaluatingtheperformanceoftheacademiccoordinator/directorofclinicaleducation:toolstosolicitinputfromprogramdirectors,academicfaculty,andstudents.JPhysTherEduc.2011;25(2):26-35.

25. PerryJF.Amodelfordesigningclinicaleducation.PhysTher.1981;61(10):1427-1432.

26. PhilipsBU,McphailS,RoemerS.Roleandfunctionsoftheacademiccoordinatorofclinicaleducationinphysicaltherapyeducation:asurvey.PhysTher.1986;66(6):981-985.

27. KernBP,MickelsonJM.Thedevelopmentanduseofanevaluationinstrumentforclinicaleducation.PhysTher.1971;51(5):540-546.

28. TexasConsortiumforPhysicalTherapyEducationandResearchFoundation.PhysicalTherapistManualfortheAssessmentofClinicalSkills.Austin,TX:2004.

29. BeckelC,AustinT,KettenbachG,SargeantD.Computerandinternetaccessforphysicaltherapistclinicaleducation.JPhysTherEduc.2008;22(3):19-23.

30. FitzgeraldLM,DelittoA,IrrgangJJ.Validationoftheclinicalinternshipevaluationtool.PhysTher.2007;87(7):844-860.

31. HouselN,GandyJ.Clinicalinstructorcredentialinganditseffectonstudentclinicalperformanceoutcomes.JPhysTherEduc.2008;22(3):43-51.

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AppendixB.Typesofdocuments,methodsofchangeSectionAliststhematerialsanddocumentsthathavelanguagerelatedtoclinicaleducationthatwouldneedtobechangedtobeconsistentwiththeterminologyrecommendedinthisreport.SectionBprovidesthemechanismtoachievechange.A.Typeofdocument/site B.MethodforchangeAPTA’sHouseofDelegates(HOD)positions,standards,guidelines,policies,procedures

ProposerevisiontotheHODbyadelegation(Chapter,Section,Board)totheHouse

APTA’sBoardofDirectors(BOD)positions,standards,guidelines,policies,procedures

RequesttheBODtoconsiderrevision

APTAdocuments/site CPI,CSIF,CCCEmanual RequesttheBODtoconsiderrevisionAPTACCIP RequesttheBODtoconsiderrevisionAPTAWebsite RequesttheBODtoconsiderrevision WouldalsoneedtobeconsistentwithHODpolicies EducationSectionWebsite RequesttheSectiontoconsiderrevisionClinicalEducatorsSIGoftheSectionForm:Requestforclinicalsites

RequesttheSection/CESIGtoconsiderrevision

AmericanCouncilonAcademicPhysicalTherapy

Website ACAPTshouldmakechangeswhennewdefinitionsadoptedACAPTpolicyonClinEd ACAPTshouldmakechangeswhennewdefinitionsadoptedNCCE ACAPTshouldmakechangeswhennewdefinitionsadopted CommissiononAccreditationofPhysicalTherapyEducation(CAPTE)Standards

PetitionCAPTEasamajorstakeholderforchangesinStandards

FederationofStateBoardsofPhysicalTherapy(FSBPT)ModelPracticeActandindividualstatepracticeacts

WorkthroughFSBPTandindividualstateboards,incollaborationwithAPTA

Journalstylemanuals PTJshouldchangewithHODpolicy,requestothersdosothrough

informationpackettojournaleditorsandtheirsupportingSections Chapters Materialsformembers Requestchangethroughinformationpacket StatePracticeActs Requestchangethroughinformationpacket,interactwithFSBPTas

wellasindividualboardsSections/Academies Materialsformembers Requestchangethroughinformationpacket InformationtoABPTRFE,ABPTS RequesttheBODtodirectanynecessarychanges PTAcommunity WorkthroughtheEducationSectionPTASIG

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INTEGRATEDCLINICALEDUCATIONSTRATEGICINITIATIVEPANELFinalReportJune2017

BACKGROUNDTheSummitrecommendationrelatedtointegratedclinicaleducation(ICE)wasdevelopedaroundthepremisethatICE‘allowsstudentstodevelopcognitivepsychomotor,andaffectivebehaviorsforsuccessfulterminalexperiences.’(SummitReport)TheSummitparticipantsrecognizedthevariabilityinmodelsandapproachestoICEinthephysicaltherapisteducationcurriculaandthusidentifiedvalueinestablishmentofbaselineexpectationsforICE.ThechargefortheIntegratedClinicalEducationpaneladdressedthisSummitrecommendation(RecommendationVII)

CHARGEThespecificchargetothisworkpanelisto:1. Define‘integratedclinicaleducation.2. Makerecommendationsforachievingconsistentuseoftheterm‘integratedclinicaleducation’

acrossACAPT,APTAandCAPTE.3. Definebaselineexpectationsandparametersforqualityintegratedclinicaleducationinphysical

therapisteducation.4. Discernanddescribemodelsofintegratedclinicaleducationthatcurrentlyexistwithinphysical

therapistcurricula.5. Developguidelinesforcollaborativedevelopmentandimplementationofintegratedclinical

experiences.

Stakeholdersinvolved

TheWorkgroupwaspurposefullyselectedtorepresentstakeholdersfromboththeacademicandclinicalenvironments.Considerationsinselectingtheworkpanelmembersincluded:previousexperience/knowledgeofprofessionaleducationprogramswhereanintegratedmodelofclinicaleducationwasused,academicorclinicalpositionheld,geographiclocationandtypeofinstitutionrepresented(public/private).Theintentwastoselectadiversegroupthatwouldbeabletobringmultipleperspectivestotheconversation.Thepositionsheldofworkgroupmembersincluded:academicprogramdirectors,directorsofclinicaleducation,andacentercoordinatorofclinicaleducation/clinicalinstructor.

IndividualsinvolvedduringdatacollectionincludedacademicandclinicalfacultyaswellascurrentDPTstudentsfromacrossthecountry.

SUMMARYOFWORKPhase1:Weembarkedon2concurrentmethodsofdatacollectiontoestablishabroadviewofcurrenteducationalpracticesinvolvingclinicaleducationdeliveredthroughthelensofanintegratedcurriculumperspective.Thedatacollectionmethodsincludedasystematicreviewoftheliteratureandthedevelopmentanddistributionofadescriptivesurvey.Work-panelmembersvolunteeredtoworkinoneofthesetwogroupstogatherandanalyzethedata.Reviewoftheliterature.Thefirstsubgroupmemberswereinvolvedinasystematicreviewoftheliterature.Thesubgroupidentifiedthefollowinghealthprofessiondisciplinesforinclusion:medicine,nursing,physicaltherapy(PT),occupationaltherapy(OT)physicianassistant(PA)andspeechtherapy

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(SP).Theliteraturewassearchedusingstandarddatabasesknownforpublicationofeducationalresearchofthehealthprofessions.TheseincludedMEDLINEandCINAHL.Additionaldatabasesweresearchedformedicine,howevernofurtherarticleswereidentifiedthereforeMEDLINEandCINAHLweretheprimarydatabasesutilizedtocollectmedicineliterature.

ThePreferredReportingItemsforSystematicReviewsandMeta-Analysis(PRISMA)guidelineswereselectedtoguidetheprocess.Aworkgroupmemberwasassignedtooneofthesixselectedhealthprofessions.Eachindividualsearchedtheliteraturefromtheselectedhealthprofessiontonarrowtheliteraturebytitleandabstractreview.Inclusioncriteriaforthebroadinitialsearchincludedthesearchterms“integratedclinicaleducation”andthehealthprofession(i.e.medicine,nursing,physicaltherapy,physicianassistant,occupationaltherapyandspeech-languagepathology).Thisresultedin3808articles.SearchtermswererefinedusingkeyworksandsubjectheadingsineitherCINAHLorMEDLINE.Articleswerescreenedfortitleandabstractbythesubgroupmembers,whichyielded83articles.

Twogroupmemberscompletedthetaskoffull-textreviewofthe83articles.Inclusioncriteriawasrefinedtoincludearticlesthatincluded:amodeldescriptionofaclinicaleducationexperienceprovidedinanintegratedmanner,aclearpurposeofthearticle,identifiedoutcomemeasuresthatincludedatleastoneofthefollowing:studentoutcomes,courseoutcomesorprogrammaticoutcomes.ThearticlesalsowererequiredtobewritteninEnglishandaccessibleinfulltext.Thisprocessnarrowedtheselectedarticlesto19.Referencelistsofthesearticleswerereviewedwhichresultedinanadditional3articlesforinclusion.Atotalof22articleswereincludedinthefinalreviewoftheliterature.Thesearticlesrepresentthebestavailableevidenceaboutthetopicofintegratedclinicaleducationinhealthprofessions.

Surveyresearch.Thesecondsubgrouputilizedsurveyresearchtogatherinformationaboutcurrentprogrampracticesthatwereperceivedasintegratedclinicaleducationexperiences.AsurveytoolwasdevelopedanddistributedtotheICEwork-panelmembersusingSurveyMonkey(n-11).Thesurveyconsistedoftwodemographicquestions,threeglobalquestionsabouttheprogramsclinicaleducationcurriculum,and10questionsrelatedtoeachcourseconsideredasanintegratedclinicaleducationcourse-upto5courses.Thequestionsincluded1openended,and9closedquestionswithoptiontocomment,foramaximumofpotential50questionstobeanswered.

Analysis.Theresultsofeachofthesedatacollectionmethodswerethematicallycategorizedindependentfromtheother,followedbyanaggregationofthecategoriesforgroupdiscussion.Commoncategorieswereidentifiedbetweenthe2groupsofdata.Groupdiscussionensuedtodetermineiftheidentifiedcategorieswereconsideredsoundeducationalpracticesintermsofclinicaleducationexperiencesofferedinanintegratedfashionwithinaprofessionaleducationprogram.Agroupvotewastakenoneachidentifiedcategory.Thegroupagreedtousemajorityconsensusasanindicatorthecategoryshouldbeincludedasaprimaryparameterfordescribinganintegratedclinicaleducationexperience.

Phase2:Twoseriesoffocusgroupswereconductedtogainperspectivefromstakeholdersinvolvedinclinicaleducation.Thefirstfocusgroupwasanopeninvitationeducationalsessiontitled“ClinicalEducationSummitStrategicInitiatives:UpdatesandIdeas”atthe2016EducationalLeadershipConferenceinPhoenixArizona.Participantsincludedbothacademicandclinicaleducators.Duringthis90-minutesession,facilitatorsledsmallgroupdiscussionsusingpre-determinedquestionsaboutissues

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relatedtocurrentperceptionsofintegratedclinicaleducation.Theresultsweretranscribedonsite.Thetranscribeddatawasthencollatedthematicallyandanalyzedforcontent.

Thesecondseriesoffocusgroupswasheldwithphysicaltherapiststudents:thefirstatthe2016NationalStudentConclaveinMiami,FloridaandthesecondwasheldvirtuallyonNovember16,2016.Afacilitatorledapurposefuldiscussionwithstudentleadersofthenationalstudentbody.ThefacilitatortooknotesandcollatedthedatapriortosendingtotheICEwork-panel.

Afterreviewofbothsetsoftranscribedfocusgroupdata,itwasdeterminedapointofdatasaturationwasachieved.Nofurtherdatawassoughtfromotheracademicorclinicalfaculty,orDPTstudentstodeveloptheparameters.Whilecollectionofadditionaldatamayhaveprovidedthegroupwithadditionalexamplesofclinicaleducationexperiencesprovidedinanintegratedfashion,itwasdeterminedthemodeldescriptionsidentifiedintheliteraturewererichenoughforthegrouptomoveforward.

Results.ThefinalresultsofPhases1and2includedidentificationofeight(8)categoricalparametersthatachieved100%agreementbythe12work-panelmembers.Theseparametersdescribecomponentsrequiredforintegratedclinicaleducationexperiences.

Developmentofdefinition.

Oncethe8parameterswereidentifiedandapproved,asubgroupofthework-panelreviewedtheparameterdescriptionsandtheliteraturetodevelopthedefinitionofintegratedclinicaleducation.Thedevelopeddefinitionwasdistributedtothe12-memberwork-panel,followedbygroupdiscussionandaperiodofrevision.Afterrevision,agroupvotewastaken.Thegroupagreedtousemajorityconsensusasanindicatorthedefinitionshouldbeacceptedfordescribingintegratedclinicaleducation.Thedefinitionofintegratedclinicaleducationwasachievedby100%agreementbythe12work-panelmembers.

Developmentofdescriptivemodels

Themodeldescriptionsweregeneratedusingathematicanalysisprocessfromthe22selectedarticlesinthesystematicreview.Afullreviewofthemanuscriptswerecompletedbymembersofthework-panel,withdataextractedincluding:author(s),yearofpublication,discipline,placementofcourse(s)inrespecttotheentireeducationalcurriculum,courseorprogramobjectivesaddressesinmanuscript,frequencyoftheICEexperience,thetypeofcoursetheICEexperiencewasoffered(standalonecourseorembeddedwithinacourse),frequencyofICEexperience,locationofICEexperience,methodsofassessmentandoutcomesofassessments,andcoordinator/facilitatoroftheICEexperience.Datawassynthesizedbyparametertoprovideaqualitativedescriptionofeach.

TheworkpanelagreedthatthedescriptionsofmodelspresentintheliteraturewererichenoughtoprovideoutcomesforCharge4.Themembersrecognizethevarietyofeducationalcurricularmodelsanddesignspresenttodaywithinphysicaltherapyeducationprograms,anddeterminedthecollectivedescriptionofallavailablemodelswasoutsidethescopeofourcharge.Thereadersareencouragedtorefertoeachoftheselectedpeer-reviewedarticlesandtheirreferencesforacompletedescriptionofICEmodeldesigns.

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OUTCOMES

Charge1:Define‘integratedclinicaleducation.’Thefollowingdefinitionof‘integratedclinicaleducation’wasdevelopedasaresultoftheworkprocessdescribedabove.

Integratedclinicaleducationisacurriculumdesignmodelwherebyclinicaleducationexperiencesarepurposivelyorganizedwithinacurriculum.Inphysicaltherapisteducation,theseexperiencesareobtainedthroughtheexplorationofauthenticphysicaltherapistroles,responsibilitiesandvaluesthatoccurpriortotheterminalfulltimeclinicaleducationexperience.

Integratedexperiencesarecoordinatedbytheacademicprogramandaredrivenbylearningobjectivesthataresynchronouswithdidacticcontentdeliveryacrossthecurricularcontinuum.Theseexperiencesallowstudentstoattainprofessionalbehaviors,knowledgeand/orskillswithinavarietyofenvironments.Thesupervisedexperiencesalsoallowforexposureandacquisitionacrossalldomainsoflearningandincludestudentperformanceassessment.

Forintegratedclinicaleducationexperiencestoqualifytowardstheminimumnumberoffull-timeclinicaleducationweeksrequiredbyaccreditation(CAPTE)standards,itmustbefulltimeandsupervisedbyaphysicaltherapistwithinaphysicaltherapyworkplaceenvironmentorpracticesetting.

ICE=IntegratedClinicalEducation

Charge2:Makerecommendationsforachievingconsistentuseoftheterm‘integratedclinicaleducation’acrossACAPT,APTAandCAPTE

Thepanelhasprovidedrecommendationsrelatedtoachievingconsistentuseofthesetermsintherecommendationssectionofthereport.Theserecommendationsincludeadoptingthetermanddefinition,includingitinthePhysicalTherapistClinicalEducationGlossary,andengagingwiththeEducationLeadershipPartnership(ELP)tohelpdisseminateinformationandeducatestakeholders.

Inaddition,theterm“integratedclinicaleducation”willbedefinedinthesystematicreviewmanuscriptindevelopmentforpublication.Oncepublished,thedefinitionwillbeinprintforfuturereference.

Charge3:Definebaselineexpectationsandparametersforqualityintegratedclinicaleducationinphysicaltherapisteducation

Basedonthedescribedworkprocess,eight(8)parametershavebeendevelopedtodefinebaselineexpectationsforintegratedclinicaleducationexperiences.Theseinclude:

1.Integratedclinicaleducationmayoccurinanyacademictermpriortothecompletionofthedidacticcourseworkleadingtothecompletionofaterminalfulltimeclinicaleducationexperience.

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2.Integratedclinicaleducationexperienceswillhavespecificdesiredoutcomesthatcorrespondtocourseand/orprogrammaticobjectives.

3.Integratedclinicaleducationexperiencesmayberepresentedasacomponentofadidacticcourseorastandalonecoursethatoccursinasynchronousfashionwithotherdidacticcoursework.

4.Integratedclinicaleducationexperiencetimeframesaredevelopedbytheacademicprogrambaseduponthecourseand/orprogrammaticobjectives.Integratedclinicaleducationmayincludefulltimeand/orparttimeexperiences.

5.Integratedclinicaleducationexperiencesmayoccurinavarietyoflearningenvironmentsincludingcampusorcommunitybasedclinicalornon-clinicalsettings,baseduponthecourseand/orprogrammaticobjectives.Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbecompletedinaphysicaltherapyworkplaceenvironmentorpracticesetting.

6.Integratedclinicaleducationexperiencesshallincludestudentassessmentsthataredesignedtolinktothecourseorprogramobjectiveswithexpectedstudentprogressioninprofessionalbehaviors,clinicalknowledge,and/orskills.

7. Integratedclinicaleducationexperiencesarecoordinatedbya facultymemberof theacademicprogram,inpartnershipwithacoordinatorfromtheclinicaleducationsite.

8. Integrated clinical education experiences are typically supervised by a course instructor and apreceptor.Thepreceptormaybeanacademiccoursefacultymember,aclinicalinstructor,orotherhealthcareprofessional at the site the student is engaged in theexperience,dependingupon thecourse and/or programmatic objectives. Integrated full time clinical education experiences thatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbesupervisedbyalicensedphysicaltherapist.

Charge4:Discernanddescribemodelsofintegratedclinicaleducationthatcurrentlyexistwithinphysicaltherapistcurricula

Theeight(8)parametersrequiredofintegratedclinicaleducationexperiences(aslistedincharge3)areexplainedthroughmodeldescriptions.Thesedescriptionsweredevelopedfromthearticlesselectedduringthesystematicreviewoftheliterature.RefertoTable1foradescriptionofprogram/coursemodels.

1.Integratedclinicaleducationmayoccurinanyacademictermpriortothecompletionofthedidacticcourseworkleadingtothecompletionofaterminalfulltimeclinicaleducationexperience.

TheplacementandfrequencyofICEwithincurriculaisquitevariable.Integratedclinicaleducationhasbeenreportedtooccurasearlyasthefirstorsecondsemesterofyearone.WhilesomeprogramsincorporateICEaslateinaprogramasthethirdyear,themajorityofICEmodelsdescribedexperiencesthatoccurinyearsoneandtwo.Insomeprograms,ICEisnotanisolatedexperience,butratheronewherebystudentsareaffordedseveralopportunitiestoparticipateinoverthecourseofaprofessionalprogram.

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References:Coker,Doucet&Seale,2010;Doucet&Seale,2012;Faught,Gray,DiMeglio, Meadows&Menzies,2013;Goldberg,Richburg&Wood,2006;Hakim,Moffat&Beckeretal, 2014;Ingram&Hanks,2001;Mahendraetal2013;Maietal2013;Maietal,2014;O’Neil, Rubertone&Villaneuva,2007;Smith,Lutenbacher&McClure,2015;Stern&Rone-Adams, 2006;Weddle&Sellheim,2011;Wilson,2006;Wilson&Collins,2011;Yardley,Brosnan, Richardson&Hays2014.

2.Integratedclinicaleducationexperienceswillhavespecificdesiredoutcomesthatcorrespondtocourseand/orprogrammaticobjectives.

Integratedclinicaleducation(ICE)experiencesarepartofthephysicaltherapycurriculumthataredesignedtocontributetospecific,desiredoutcomesforcourseand/orprogramobjectives.Theoreticalknowledgethatstudentsgainintheclassroomcanbereinforcedwithconcrete,experienceswhenICEexperiencesareappropriatelyplacedinthecurriculumtoaugmentthecontentbeingtaughtanddesignedtomeetspecificlearningobjectives.Asthecurriculumprogresses,ICEexperiencescanbestructuredsothatstudentsdemonstrateagreaterbreadthandcomplexityofclinicalskills.PTstudentsmustapplyalldomainsoflearning(i.e.cognitive,affectiveandpsychomotor)tobesuccessfulinclinicalpractice.Theclassroomsettingdoesnotalwaysallowstudentstodemonstrateskillsinallthedomainsoflearning,astheywouldbeusedinprofessionalsettings.ICEexperiencesaffordstudentstheopportunitytodemonstratetheseskillsinsituationsthatreflectthecomplexityofthehealthcaredeliverysystem.Inthesesituations,studentsprioritizecare,demonstratecriticalthinking,andmakedecisionsinanevidence-basedmanner.ICEexperiencescanalsobedesignedtoincludeserviceactivitieswhichhavethepotentialtoinfluencestudents’futurebehaviorsrelatedtotheAPTACoreValuesandCodeofEthics.

Furthermore,ICEexperiencesmaybedesignedasinter-professionalactivitiessothatstudentscomprehendtheroleofothermembersofthehealthcareteam.ItisimportantthatacademicinstitutionspreparestudentPTstobeclinicalteachers,soICEexperiencescanbedesignedinwhichstudentsaregivenpeerteachingandassessmentopportunitiestopreparethemforfutureteachingroles.OtherexamplesofpracticeinwhichstudentscangainexperienceduringICEiswiththemanagementofpatientswhohavehighlyspecializeddiagnoseswhoareunderservedarechallengedwithcommunicationdisorders,havementalhealthdisordersandconveydivergentculturalvalues.

References:Benson,Provident&Szucs,2013;Doucet&Seale,2012;Faughtatal,2013; Goldbergetal,2006;Jensen,Mostrom,Gwyer,Hack&Nordstrom,2015;Maietal, 2013;Mehendraetal,2013;O’Neiletal,2007;Smithetal,2015;Stern&Rone-Adams, 2006;Stuhlmiller&Tolchard,2015;Weddle&Sellheim,2011;Wilson,2006.;Williams- Barnard,Sweatt,Harkness&DiNapoli,2004.

3.Integratedclinicaleducationexperiencesmayberepresentedasacomponentofadidacticcourseorastandalonecoursethatthatoccursinasynchronousfashionwithotherdidacticcoursework.

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Integratedclinicaleducationhasbeenfoundtooccurbothaspartofadidacticcontentcourseorasasingleorrepeatedstand-aloneclinicaleducationcourse(s).MostICEexperiencestendedtobeconductedparttimealthoughacoupleofexamplesincludedfulltimeexperiences.Incurrentphysicaltherapyliterature,therangeofstand-alonecourseswithinacurriculumhasrangedfromoneuptothreeseparatecourses.Withinasingledidacticcontentcourse,thesettingsaswellasthecoursesinwhichICEwasacomponentwerequitevariablewitharangefromneurological,geriatric,andbusinesscourses.Oneexamplethreadsintegratedclinicalexperiencesinavarietyofcommunitybasedsettingsthatarecomponentsofaseriesofcourseswithinthecurriculum.Literaturefromotherhealthcaredisciplines(includingmedicine,nursing,occupationaltherapy,andspeechpathologyrevealaslightlydifferentpictureinthatmostoftheintegratedexperienceswerepartofadidacticcontentcourse.Thesimilaritytothephysicaltherapyliteraturewasinthefactthatthetypeofcoursesinwhichtheseexperienceswerehousedwerequitevariableandincludedpediatrics,mentalhealth,dysphagia,aginganddementia,communityhealth,andalifespancourse.

References:Bensonetal,2013;Doucet&Seale,2012;Faughtetal,2013;Goldbergetal, 2006;Ingram&Hanks,2001;Maiatal,2013;Mahendraetal,2013;O’Neiletal,2007; Reneker,Weems,&Scaia,2016;Smithetal,2015;Stern&Rone-Adams,2006;Weddle &Sellheim,2011;Williams-Barnardetal,2004;Wilson&Collins,2011.

4.Integratedclinicaleducationexperiencetimeframesaredevelopedbytheacademicprogrambaseduponthecourseand/orprogrammaticobjectives.Integratedclinicaleducationmayincludefulltimeand/orparttimeexperiences.

Similartophysicaltherapisteducationcurricula,thetimeframesforICEexperiencesarequitevariable.ThetimeframesassociatedwithICEtendtobeselectedbasedonthecourseand/orprogrammaticobjectivesaswellaswhatismostfeasiblefortheacademicprogramandclinicalsite.SeveralacademicprogramshaveimbeddedICEintothecurriculumasearlyasthefirstsemester,whilealargemajorityofexperiencesareembeddedattheendoforfollowingthefirstyearoftheprogram.Integratedclinicaleducationexperiencesmayalsospanconsecutivesemestersandareembeddedaslateinacurriculumasyeartwooryearthree.Suchexperiencescanalsobeincorporatedafterafewweeksintoacourseorthelastfewweeksofacourse.

WhetherICEexperiencesareembeddedinacourseorareastandalonecourse,thereisalsovariabilityregardingthefrequencyandduration.Theexperiencesrangefromasmallnumberofhoursthatareprimarilyobservation(example:2hours/weekortotalof2hoursinasemester),toseveralweeksthatoccurthroughoutyear1,2andperhapsyear3,butallpriortotheterminalfulltimeterminalexperiences.Integratedclinicaleducationexperiencescanoccurasinfrequentasaquarterday/twiceweeklyone-halfday/weekoronefullday/weekandforlongerdurationsoftimesuchasparttimeforupto8weeksorfulltimefor1-4weeks.Theexperiencesdonotneedtooccuronaregularbasishowever,asstudentscanstillbenefitfromopportunitiestoparticipateinICEexperiencesthatoccurmultipletimes(6-16sessions)overthecourseofasemesterorseveralsemesters.

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References:Bensonetal,2013;Coker,2010;Goldbergetal,2006;Hakimetal,2014; Ingram&Hanks,2001;Jensenetal,2015;Mahendraetal,2013;Maietal,2013;O’Neil etal,2007;Renekeretal,2016;Stern&Rone-Adams,2006;Weddle&Sellheim,2011; Wilson,2006.

5.Integratedclinicaleducationexperiencesmayoccurinavarietyoflearningenvironmentsincludingcampusorcommunitybasedclinicalornon-clinicalsettings,baseduponthecourseand/orprogrammaticobjectives.Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbecompletedinaphysicaltherapyworkplaceenvironmentorpracticesetting.

Integratedclinicaleducation(ICE)canoccurinavarietyofclinical,non-clinicalandcommunitysettings.Campusprobonoclinics,probonoprogramssuchasexercisewellnessorkids’fitness,ormoreestablishedcampusfacilitiessuchasanoutpatientclinicorprimarycareclinic)allowtheintegratedclinicalexperiencestobeconductedintheconvenienceoftheacademicinstitution.

OtheracademicprogramsusedoffcampuscommunitysettingstoconductICEwithawiderangeofclinicalsettingsincludinglongtermcare,acutecare,inpatientrehabilitationfacilities,skillednursingfacilities,outpatientorthopedicclinics,VeteransAffairsMedicalCenteroutpatientclinic,pediatricinpatientandoutpatientfacilitiesandcommunityhealthcarecenters.SeveralICEexperiencesusedacombinationofonandoffcampussettingsasresourcestomeettheirlearningobjectives.ICEisalsoconductedinwhataretypicallyconsiderednon-clinicalsettingsthatincludeseniorliving/communityretirementhomes,childdevelopmentcentersorcommunitybasedpreschools,residentialhomelessassistancecentersorshelters,communitybasedprogramssuchasfamilyfitnessandaquaticprograms,orseniorcitizenprograms/adultdaycare.Theunifyingfactorwithalloftheselocationsisthatthesettingallowsforhumaninteractions.

References:Bensonetal,2013;Coker,2010;Ingram&Hanks,2001;Maietal,2013;Mai etal,2014;Renekeretal,2016;O’Neiletal,2007;Stern&Rone-Adams,2006; Stuhlmiller&Tolchard,2015;Weddle&Sellheim,2009;Weddle&Sellheim,2011; Wilson,2006;Wilson&Collins,2011.

6.Integratedclinicaleducationexperiencesshallincludestudentassessmentsthataredesignedtolinktotheprogramorcourseobjectiveswithstudentprogressioninprofessionalbehaviors,clinicalknowledge,and/orskills.

InorderforICEexperiencestocontributetolearning,assessmentoftheexperienceandstudentlearningshouldbecompletedwithdirectandtimelyfeedback.Formativeassessmentcanbeprovidedbypeersorclinicalfaculty,butacademicfacultyshouldbeprimarilyresponsibleforsummativeassessmentandgradingofstudents’clinicalbehaviors.Assessmentsarechosentodeterminetheprogressionofthestudent’slearning;assessmentandreflectioncanalsoserveasacatalystforheightenedengagementwiththelearningprocess.

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WhentheobjectiveoftheICEistopreparestudentsforfuturefulltimeclinicaleducationexperiences,studentassessmentoftenincludeduseofoutcomemeasurementtools,suchastheClinicalPerformanceInstrument(CPI),May’sProfessionalBehavior/GenericAbilities,oraschooltracking/assessmentformorotherselectedstandardizedoutcomemeasurementtoolassessingclinicalknowledge,skillsorprofessionalbehaviors.Forexample,Maietal(2013)selectedtheInterpersonalCommunicationQuestionnaireandtheMedicalCommunicationBehaviorScaletoassessstudentlearningofcommunicationabilities,whileWeddle&Sellheim(2009)utilizedaprogramdevelopedonlinereportingformtotrackeachICEsession.

Additionalstudentassessmentmethodsincludefacultyinstructorledverbaldebriefinganddiscussionsessions,wherebycriticalquestionswereaskedandformalreflectionpapersassignedtodeterminethelevelofthestudent’scriticalthinking.Peer-assistedlearningwasalsobeneficial,wherebyfirstyearstudentsarementoredbythirdyearstudentsduringICEexperiences.Authorsrecommendthatreflectionjournalsorpapersincorporatestudentself-assessmentofcriticalfactorstodeterminelearning,anddevelopmentofreflectivepractitioners.

WhentheICEexperiencewasmorefocusedonanovelpracticeenvironment,studentassessmentswereconcentratedontheunderstandingofthehealthcaremaze,theabilitytocompareandcontrastsites,identifyclinicalandsocialbenefits,ordemonstrateinter-professionalskills.

Whentheexperiencewasanexperientiallabwithinacourseorafocusedclinicaleducationexperiencewithaspecificpatientpopulation,suchaspatientswithchildhooddisabilitiesoradultswithdementia,studentassessmentsincludedfacultyreviewofstudentdocumentationincludingpatientexaminations,evidence-basedtreatmentplansoronsiteassessmentofthetreatmentsession,andevaluationofthetherapeuticmannerofstudentperformanceinestablishingtherelationshipformedbetweenthestudentandthepatient.

Inaddition,someacademicprogramsusedstudentfeedbackandstandardizedassessmenttodetermineifthecurriculardesignedexperiencewasthebestapproachtoaccomplishthislearning.

References:Bensonetal,2013;Coker,2010;Doucet&Seale,2012;Faughtetal,2013; Goldbergetal,2006;Faughtetal,2013;Hakimetal,2014;Ingram&Hanks,2001;Mai etal,2013;Mahendraetal,2013;O'Neiletal,2007;Smithetal,2015;Stern&Rone- Adams,2006;Stuhlmiller&Tolchard,2015;Weddle&Sellheim,2009;Weddle& Sellheim,2011;Williams-Barnardetal,2004;Wilson,2006;Wilson&Collins,2011.

7. Integratedclinicaleducationexperiencesarecoordinatedbya facultymemberof theacademicprogram,inpartnershipwithacoordinatorfromtheclinicaleducationsite.

Integratedclinicaleducationexperiencesarecoordinatedbyafacultymemberoftheacademic programandanindividual(s)fromclinical/communitybasededucationsites.Ithasbeen suggestedthattheacademicprogrambetheresponsiblepartyforfacilitatingapartnership, buildingrelationships,andsharingintheeducativeelement.Severalauthorshavedescribedthe

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roleoftheacademicfacultymemberorthedirectorsofclinicaleducationindevelopingand sustainingtheclinicalpartnerships.

Theacademicprogramselectsclinicaleducationsitestopartnerbaseduponfactorssuchasgeographicalproximitytotheacademicinstitution,theavailabilityofthepatientpopulationdesired,theavailabilityofanonsiterepresentativetoorganizeonsitelogisticsandtheavailabilityofonsitestaffsupervisionbyapreceptor.RegardlessofthelocalityoftheICEexperienceortheonsitesupervisoridentity,theacademicfacultymemberisresponsibleforgrading/assessmentofstudentprogresstowardsthecourseorprogramobjectives.

References:Bensonetal,2013;Coker,2010;Doucet&Seale,2012;Faughtetal,2013; Goldbergetal,2006;Hakimetal,2014;Mahendraetal,2013;Maietal,2013;Smithet al,2015;Stuhmiller&Tolchardetal,2015;Williams-Barnardetal,2004;Wilson,2006.

8. Integrated clinical education experiences are typically supervised by a course instructor and apreceptor.Thepreceptormaybeanacademiccoursefacultymember,aclinicalinstructor,orotherhealthcareprofessional at the site the student is engaged in theexperience,dependingupon thecourse and/or programmatic objectives. Integrated full time clinical education experiences thatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbesupervisedbyalicensedphysicaltherapist.

StudentswhoparticipateinICEmustbesupervised,atsomelevel,dependentontheobjective(s)oftheexperience.Threemodelsofsupervisionwereidentifiedintheliteraturethathighlightoversightoftheexperiences.Onsitesupervisionwasprovidedeitherby:1)anacademicfacultymember;2)anacademicfacultymemberplusacommunitybasedclinicianorotherrepresentativeor3)acommunitybasedclinicianorotherhealthcareprofessional.Manytimes,thecourseinstructoralsoservedastheclinicalpreceptorduringtheICEexperience.Regardlessofwhoservesastheonsitepreceptor,afacultycourseinstructoroverseesthecoursemanagementandgradingofstudentoutcomes.

References:Bensonetal,2013;Coker,2010;Doucet&Seale,2012;Goldbergetal, 2006; Ingram&Hanks,2001;Jensenetal,2015;Maietal,2013;O’Neiletal,2007; Renekeretal,2016;Stern&Rone-Adams,2006;Stuhlmiller&Tolchard,2015;Weddle &Sellehim,2009;Williams-Barnardetal,2004.

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Charge5.Developguidelinesforcollaborativedevelopmentandimplementationofintegratedclinicaleducationexperiences.

TheACAPTintegratedclinicaleducationwork-panelwaschargedwithdevelopingguidelinestoassistacademicprogramsinthedevelopmentandimplementationofintegratedclinicaleducationlearningexperiencesforstudents.Toaddressthischarge,thepanelcreatedguidingrecommendationsthatareofferedbelowinboldtext.Provocativequestionsfollowtheguidelineinitalicsforprogramstoconsiderandreflectonduringacurricularreviewprocess.Finally,eachguidingprincipleissummarizedusingtheevidencebehindtherecommendation(bullets).Thesummaryisinclusiveoftheliteraturereviewed,howevershouldnotbeconsideredanexhaustivereviewofeverypotentialpieceofevidencethatmaylendsupporttotheguidingprinciple.Figure1providesaframeworkforconsiderationinthedevelopmentandimplementationofintegratedclinicaleducationexperiences.

Figure1:GuidingPrinciplesforDevelopingandImplementingIntegratedClinicalEducation

OverallAcademicProgramDesign

Physicaltherapisteducationhashistoricallyincludedbothadidacticcomponentaswellasaclinicaleducationcomponentinitscurriculumdesign.Curricularmodelsvaryineducationalpatterns,includingtheoverallcurriculumdesign,aswellasthetimeandlengthofclinicaleducationpriortograduation(Jensenetal,2016).WhiletheclinicaldoctorateinphysicaltherapyistheexpecteddegreeearnedtoentertheprofessionofphysicaltherapytodayintheUnitedStates,nostandarddesignmodelsguidethedevelopmentofcurriculumtoincludeboththedidacticandclinicaleducationcomponents(Engelhard&McCallum,2015;Jensenetal,2016).

Whiledesignmodelsvary,thereisabodyofknowledgethatsupportsstudentlearninginauthenticworkplaceenvironments.Scholarsofeducationalphilosophyhavefoundthatearly,authentic

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experiencesenhancelearning(Dewey,1944;Shulman,2004;Jensenetal,2015;Weddle&Sellheim,2009).Theselearningexperiencesprovidestudentswithamechanismtoattachalifeexperiencewiththeoreticalknowledge,resultinginmorecomplexinsighttobasicconcepts(Hakimetal,2014).Theinclusionofclinicaleducationexperiencesthroughoutastudent’sacademicprogramappearstoprovideanenvironmentfortransformativepractice,wherestudentscanfocusonliveexperiencesduringimmersionactivities(Bensonetal,2013).Reallifeexperiencessupportthedevelopmentofskills,reinforcesacademicknowledge,facilitatestheclinicalreasoningprocessanddevelopsself-confidencewithservicedelivery(Bensonetal,2013).

Designingaprofessionaleducationcurriculumischallengingtoensurestudentsmastertheexpectedknowledge,skillsandbehaviorsoftheprofession.Itisan“educator’sresponsibilitytoprovidestudentswithlearningopportunitiesthatdeveloptheabilitytoengageincomplexitiesofclient-centeredpractice”(Knetch-SabresinBensonetal,2013).Itisevenmorechallengingtodesignclinicaleducationexperiencesthatareintegratedinapurposefulmannerthroughoutanacademicprogrambecauseoftheneedforaflexiblecurriculardesign,theneedforadministrativesupportandtheneedtostayabreastofthedynamicsofthehealthcareenvironment(Jensenetal,2015).Educatorsmustattendtocriticalcomponentsofcurriculumdesigntoensureeffectivelearningopportunitiesforstudents.Thesecriticalcomponentsinclude:timespentdesigningtheexperience,conductingtheapplication,evaluatingtheoutcomesandprovidingfeedbacktostudents(WolfeandByrneinBensonetal,2013).Asaresult,10keyguidelinesareofferedforacademicprogramconsiderationduringthedesign,implementationandreviewofintegratedclinicaleducationexperiences.

Guidelines

1. Anacademicprogramshouldidentifytheprogrammaticoutcomesthatareexpectedwhenstudentsparticipateinintegratedclinicalexperiences.

Questiontoconsider:Doesmyprogramhaveexpectedprogrammaticoutcomesthatcouldbeorshouldbemetbyprovidingstudentsintegratedclinicaleducationexperiences?

• Experientiallearningshouldbeintentionalfromaprogramlevelandnotjustacourselevel(Hakimetal,2014).Itisimportant,therefore,foreducatorstodeterminetherationalefor,andidentificationof,theexpectedprogramoutcomesexpectedtobeachievedbyparticipationinintegrationofclinicaleducationexperiencesinone’sacademiccurriculum.

• Opportunitiesshouldbeprovidedforstudentstodemonstrateknowledge,psychomotorand/orbehavioralskillsinactualclinicalsettingswithpatientswhomaypresentwithphysical,emotionalandcognitiveimpairments,inanunpredictableenvironment.Someexperiencescouldinclude:o 1)thecommunicationandprofessionalbehavioralskillsnecessaryforclinicalpractice;o 2)effectivepsychomotorskillsonindividualsotherthanhealthy,unimpairedclassmates;

ando 3)anappreciationoftheroleinter-professionalcollaborationinthedeliveryofhealthcare

(Bensonetal,2013;Jensonetal,2015;Maietal,2014).• Programmaticconsiderationofintegratedclinicaleducationexperiencescouldinclude:

o Physicaltherapiststudent’sdemonstrationofskillsinvolvingthedomainsoflearning-i.e.cognitive,affectiveandpsychomotor,aswellasdemonstrationofclinicalreasoningand

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problemsolvingskillstosuccessfullyentertheprofession.Students’expectationstodevelopanappreciationforethicalpracticeandthecorevaluesadoptedbytheprofession.

o Physicaltherapypracticeisexpandingintoareasofwellnessandotherareasofhealthcarewherepatientshavebeenunderserved.Studentexposuretotheseactivitiesinuniquesettingsallowstudentstodevelopanexpandedviewofprofessionalpossibilitiesforpracticeandtheneedsofcommunities.

• Physicaltherapiststudentsareeducatedtouseevidencetosupporttheirpractice.Applicationofevidencebasedpracticeinauthenticsettingsallowstudentstoapplyallaspectsofevidencebasedpracticethatisbasedonacombinationof“patientvalues,clinicalexpertiseandbestresearchevidence(Sackettetal,2000).

2. Theacademicprogramconsiderstheintentionalplacementofintegratedclinicaleducationexperienceswithinitscurriculum.

Questionstoconsider:Doesmyprogramconsidertheintentionalplacementofintegratedclinicaleducationexperiencesthroughouttheentiretyoftheprogram?Isthereasoundrationalewhereintegratedclinicaleducationexperiencesareplacedwithinthecurriculum?

• Avarietyofmodelscouldbeconsideredforintegratedclinicaleducationwithinaprogram,addressingplacementandtype(Hakimetal,2014;Jensenetal,2015).Threetimeframescouldbeconsidered:o Year1:EarlyICE,ineitherSemester1,2or3;o Year2:MidCurricularICE;ineitherSemester1,2or3;o Year3:LateICE;priortothecompletionofaterminalfulltimeclinicaleducationexperience.

• Typesofexperiences:o Full-timeorparttimemodelso Overaweeks’timeorspanmultipleweekso Offeredonetimeonlyordispersedthroughoutthecurriculumplano Decisionsaboutplacementandtimeframesshouldbebaseduponprogramandcourse

objectivesandthedecisionofthefaculty.• Considerationshouldbegiventothecomplexityoftheexperiencewithincreasinglevelsof

studentperformancewithsuccessiveexposuretoclinicalenvironmentsthroughoutthedidacticportionofthecurriculum(Hakimetal,2014).

• Considerationforpeerlearningmayalsobeacomponentofintentionalplacementofintegratedclinicaleducationexperienceswithinanacademicprogram.Integratedclinicaleducationexperiencesmaybedesignedsuchthatupperlevelstudentsmentorlowerlevelstudentstopreparethemforrolesasclinicalinstructors,orprovideastructuredenvironmentforbothsetsofstudentstolearnessentialskills(Wilson,2006).

3. Theacademicprogramidentifiesthecourse(s)whereclinicaleducationshouldbeintegratedwithintheprogram.

Questiontoconsider:Doesmyprogramhaveidentifiedcourseswhereintegratedclinicaleducationexperiencesareprovidedorcouldbeofferedinthefuture?

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• Integratedclinicaleducationexperiencesmaybeofferedasdistinct,stand-alonecoursesthatarecreditbearingwithinthecurriculumand/orexperiencesthatareembeddedwithinexistingcoursesinthedidacticcurriculum.

o Considerationstodetermineifintegratedclinicaleducationexperiencesshouldbeembeddedwithinacourseorastand-alonecourseshouldbegiventothegoalsandobjectivesofthecourseandexpectedstudentoutcomes.Thismaybeparticularlyusefulwhencoursecontentisabstractanddifficultforstudentstounderstand(e.g.BensonOT,1of-3interventionscoursesforNeurologicalandSensorimotorFunction)

o Itmaybebeneficialtodesignstand-aloneintegratedclinicaleducationcoursesiftheintendedgoaloftheexperienceistodemonstrateskillsandbehaviorswhichspanmultiplecontentareas.Thismayactuallypromotestudents’clinicalreasoningandintegrationofcoursematerialacrossthecurriculumbecausestudentslearnbycreatingtheirownunderstandingofinformation(Benson,2013).

4. Theacademicprogram,incollaborationwithprogramfaculty,developsthecoursespecificobjectivesforstudentachievementwithinanintegratedclinicaleducationexperience.

Questionstoconsider:Doeachoftheidentifiedcoursesthatofferanintegratedclinicaleducationexperiencehavespecificcourseobjectivesthataretobemetthroughtheexperientiallearningexperience?Dothecourseobjectivesrelatetotheoverallprogrammaticoutcomes?

• Courseobjectivesorprogrammaticobjectivesshouldguidestudentlearninginintegratedclinicaleducationexperiencesbyclearlyidentifyingthecognitive,psychomotorand/oraffectivedomainsoflearningexpectedofstudentsinordertomaximizeprofessionalgrowth(Hakimetal,2014;Jensenetal,2015;Maietal,2013).

• Objectivesforintegratedclinicaleducationexperiencescanguide:o thetransfer,applicationandreinforcementofclassroomlearningtoauthentic

patient/clientsituations(Hakimetal,2014);o thedevelopmentofcommunicationskills,interpersonalcommunicationskills

collaborationandconflictmanagement(Hakimetal,2014;Jensenetal,2015);o theapplicationofevidencebasedpracticeskills(Maietal,2013);o thedevelopmentoftherapeuticrelationshipsratherthansolelyanopportunityfor

learninginterventions(Bensonetal,2013); o theexposuretoemotional,psychologicalandsocialelementsofpatient/client

management(Hakimetal,2014);o theattainmentofaprofessionalidentityamongstudentphysicaltherapists.

5. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthetimingandtimeframesofwhenclinicaleducationexperiencesshouldbeintegratedwithincourse(s).

Questionstoconsider:Whereshouldtheintegratedclinicaleducationexperiencesbeplacedwithinacurriculum?Withinacourse?Howmuchtimeshouldbeallocatedtointegratedclinicaleducationexperiencestomeetthedesiredoutcomes?

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• Thetimingandtimeframesoftheintegratedclinicaleducationexperiencesaredeterminedbytheprogramfacultyandtheintendedcoursegoalsandobjectivesaswellasprogrammaticoutcomes(Hakimetal,2014).

o Curricularflexibilityisneededwhendesigningintegratedclinicaleducationexperienceswithinacurriculumtoallowformodificationoftimingandstructuretoensurestudentlearningandcourse/programoutcomesarebeingachieved.(Hakimetal,2014;Jensenetal,2015;Wilson,2006)

• Theacademicprogramshoulddetermineareasonableamountoftimeinwhichskillsshouldbepracticedcreatingafavorablelearningenvironment.(Bensonetal,2013)Studentsmaybeinvolvedinintegratedclinicaleducationexperiencesfortimeperiodsthatrange:

o from1-2hours,o tohalfdays,o tofulldays.o Thefrequencyoftheseexperiencesmayrangefromisolateddaysthroughouta

curriculumtoregularlyscheduled,frequentdaysthroughoutsemesters.• Theexacttimingandconstructionofthesetimeframesarehighlyvariablebutshouldbe

offeredinasynchronousmannerwithotherdidacticprogramming(Bensonetal,2013).

6. Theacademicprogram,incollaborationwithprogramfaculty,identifiestheindividualorindividualswhowilloverseetheintegratedclinicaleducationexperiences.

Questionstoconsider:Whoshouldoverseetheorganizationanddeliveryofintegratedclinicaleducationexperiences?Shouldoneormoreindividualsmanagethecourse?Whoisresponsiblefortheonsitesupervisionofstudentsduringintegratedclinicaleducationexperiences?Whatisafeasiblepreceptortostudentratioduringanintegratedclinicaleducationexperiencetomeetthedesiredoutcomes?

• Academicleadershipisrequiredtoidentifyacoursecoordinatortooverseetheintegratedclinicaleducationexperiencetoensurethecriticalcomponentsofdesign,applicationandevaluationofbothstudentandcourse/programoutcomesisachieved.

o Afacultymember,eitheracademicorclinical,isneededtoguidestudentlearningtomeetintendedoutcomes.Itshouldbeconsideredthatexperiences“thatoccurwithouteitherinstructorguidanceoradequateacademicpreparationonthepartofthestudentmayyieldtolittleinsightintothegeneralprocessestakingplace.”(Bensonetal,2013).

o Thefacultymembermayormaynotbethedirectorofclinicaleducation,asitdependsontheorganizationalstructureandneedsoftheacademicprogram.

• Theonsitesupervisionofphysicaltherapiststudentsmaybeprovidedbyoneormoreofthefollowing:

o anacademicfacultymember;o anacademicfacultymemberplusacommunitybasedclinicianorotherrepresentative;oro acommunitybasedclinicianorotherhealthcareprofessional(Bensonetal,2013;Coker,2010;Doucet&Seale,2012;Goldbergetal,2006;Ingram&Hanks,2001;Jensenetal,2015;O’Neilletal,2007;Renekeretal,2016;Weddle&Sellheim,2011;Williams-Barnardetal,2004).

• Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbesupervisedbyalicensedphysicaltherapist.

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• Preceptortostudentratioscanbeconfiguredbasedoncourseorprogramobjectiveswithconsiderationforstateandsupervisoryregulation(Wilson2006).

7. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthemethodsofstudentandcourseassessmenttomeettheintendedcourseand/orprogramoutcomes.

Questionstoconsider:Howshouldstudentlearningbeassessed?Whatassessmentmethodswouldbebesttoevaluatetheknowledge,psychomotorskills,orbehaviorsofstudentprogress?Whatassessmentsmethodsshouldbeconsideredtoassesstheoveralldesignandtheshort/longtermprogrammaticoutcomesofintegratedclinicaleducationexperiences?

• Integratedclinicaleducationexperiencesshouldhavemethodsofassessmentforbothstudentachievementoflearningasitrelatestothedesiredcourseobjectives,aswellascourseand/orprogramassessmenttodetermineiftheintegratedclinicaleducationcomponentofthecurriculumhasachievedtheacademicprogram’sdesiredoutcomes.

• Studentlearningcanbeassessedatvariestimesthroughoutthestudent’sclinicaleducationexperiences:

o eitherduringorafteranexperienceembeddedwithinacourse,o duringorattheendofastand–alonecourse,oro attheendofablockofcourses(Jensenetal,2015).

• Avarietyofassessmentmethodscouldbeusedtomeettheintendedstudentlearningoutcome.Theseinclude:

o reflectivejournals,papers,orportfolios;o standardizedtests;o surveys;o debriefingsessions;discussionsessions;o check-offlists;o useofaclinicalperformancetool/formforclinicalskillacquisitionandgenericabilities.

• Reflectiononaction,inactionandforactionareessentialcomponentsoflearninginintegratedclinicaleducationexperiences(Schon,1983;Wainwrightetal,2010).

• Thestakeholdersshouldincludestudents,academicfaculty,clinicians,andthosereceivingphysicaltherapyserviceswhocanprovidefeedbackandreflectiontodetermineastudent’sachievementandsuccessduringtheintegratedclinicaleducationcomponentoftheacademiccurriculum(Hakimetal,2014;Maietal,2013;O’Neiletal,2007;Wilson,2006).

o Assessmentscanbecompletedbythestudent,peers,peermentors,clinicians/preceptors,andfaculty.Facultymembersareresponsibleforthefinaldeterminationofthestudent’slearning(Maietal,2013;Weddle&Sellheim,2011;Smithetal,2015;Stern&Rone-Adams,2006;Wilson,2006).

• Programmatic,longitudinaloutcomesofintegratedclinicaleducationexperiencesshouldbeassessedbystudentperformanceduringsubsequentaffiliationsorinternships,bysuccessfulcompletionoflicensing\examinations,employers,andbyfutureclinicalperformanceandattitudes(IngramandHanks,2001;Weddle&Sellheim,2009;Weddle&Sellheim,2011;Wilson,2006).

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8.Theacademicprogramidentifiesresourcesandlegal/regulatoryparametersthatimpactsdeliveryofintegratedclinicaleducationexperienceswithintheprogram.Questiontoconsider:Whatresourceareneededtoensuresuccessfuldesignandimplementationofintegratedclinicaleducationexperiences?Whatarethelegalorregulatoryparametersthatmustbeconsideredbeforeimplementationofintegratedclinicaleducationexperiences?

• Identificationofresourcesisacriticalrequirementinthedevelopment,deliveryandassessmentofintegratedclinicaleducation.Resourcesmustinclude,butarenotlimitedto:

o Dedicatedprogramleadershipwithadministrationsupport(Jensenetal,2015;Weddle&Sellheim,2009).

o Soundfiscalmanagement(Jensenetal,2015)withadequatefinancialresourcesavailableforfacultyworkload,whichincludescoreandadjunctclinicalfaculty(Weddle&Sellheim,2009).

o Personnelanddedicatedtimenecessarytodevelopandnurturerelationshipswithclinicians,andcommunityeducatorstoadministerandcoordinateallactivitiesinvolvedwithintegratedclinicaleducationexperiences;(Hakimetal,2014;Jensenetal,2016;Stern&Rone-Adams,2006)

o Spaceandequipment,eitheron-campusorwithlocalfacilities,needtobesecured.• Negotiatedaffiliation-typeagreementswithliabilityinsurancemayberequiredforproviding

integratedclinicaleducationexperiencesatsitesexternallocationswhichmaybeusedforeducationalpurposes.Theseagreementsofteninclude,butarenotlimitedto,requirementsofhealthclearancesandcriminalbackgroundchecks(Maietal,2013).

• Determinationofgeneralliabilityrequirementsshouldbereviewedbytheprogramdirectorandappropriateinstitutionaladministrativeofficials,fordeliveryofclinicaleducationservicesoncampus(Maietal,2013;Wilson,2006).

• Considerationforgovernmentandstateregulationsshouldbeinvestigatedbytheinstitutiontoensureregulatorystatutesarefollowed(Romigetal,2017).

• Reviewofaccreditationstandardsattheinstitutionalandprogramlevelshouldoccurtoensurecompliance.ProgramsareaffordedleewayindesigningintegratedclinicaleducationinwhichtheexperiencesshouldtakeplaceasoutlinedintheCommissiononAccreditationofPhysicalTherapyEducationevaluativecriteria,howeverknowledgeofstandardsareneeded(Wilson,2006).

9.Theacademicprogram,incollaborationwithprogramfaculty,selectsthetypeofclinicalorcommunitysitesrequiredforintegratedclinicaleducationexperiences.Questiontoconsider:Wherearethemostappropriatesettings/placesconsideringthepatientpopulationmostappropriateforstudentstoachievetheintendedcourseand/orprogrammaticobjectives?

• Clinicaleducationsitesthathavetheresourcesavailabletomatchtheacademicprogramsdesiredintegratedclinicaleducationcourseandprogramobjectivesoutcomesshouldbeselectedinanefforttoachievedesiredoutcomes.

o Afacultyclinicalpracticehastheadvantageofhavingthecorefacultyfunctionasinstructorsintheclassroomandmentorsintheon-campusclinic,withsomeprogramschoosingtoaugmenttheexperiencebyincludingphysicaltherapistsfromthelocal

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community.Anotherapproachistohavetheacademicclinicalfacultyserveasmentorsinavarietyofcommunityenvironments(Jensenetal,2015;Stern&Rone-Adams,2006;Wilson,2006).

o Anotherapproachistouseclinicalsiteswithmentorsexternaltotheuniversity(Hakimetal,2014;Jensenetal,2015).

• Thefollowingshouldbeconsideredwhenselectingclinicalandcommunitysitestoassureaseamlesscollaborationbetweentheacademicandintegratedclinicaleducationsetting:

o Apopulationofpatients/clientsappropriatefortheparticularintegratedclinicaleducation(musculoskeletal,neuromuscular,integumentary,othersystems.)(Hakimetal,2014;Weddle&Sellheim,2011;Wilson,2006)

o Proximitytothecampusorreasonablecommuteforthestudent(s)(Bensonetal,2013;Weddle&Sellheim,2011).

o Physicaltherapistsandotherprofessionals,asappropriate,withexperiencefortheparticularintegratedclinicaleducationexperience.Considerationcanbegivento:

• Yearsofexperience,boardcertificationsrequiredorrecommendedandmembershiptoprofessionalorganizations(Hakimetal,2014;Weddle&Sellheim,2011;Wilson,2006);

• Professionalswithmentorship/teachingabilities(CIcredentialingrequiredorrecommended)(Hakimetal,2014;Weddle&Sellheim,2011;Wilson,2006);

• Professionalswithvaluesthatarecongruentwithuniversitystandardsforbestpracticeandphilosophiesofservicedelivery(Hakimetal,2014;Jensenetal,2015;Weddle&Sellheim,2011).

o Facultyclinicalpractices,probonoclinics,servicelearningenvironments,healthandwellnessprograms,andnovelcommunitycentershavebeenusedsuccessfullyforintegratedclinicaleducationexperiences.

• Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberoffulltimeclinicaleducationweeksshallbecompletedinaphysicaltherapyworkplaceenvironmentorpracticesetting.

10.Theacademicprogram,incollaborationwithprogramfaculty,acceptresponsibilityforthedevelopmentofrelationshipswithrepresentativesoftheclinicaleducationsite.

Questiontoconsider:Whataretherelationshipsrequiredtodevelopandsustainintegratedclinicaleducationexperienceswithinthecommunity?

• Academicprogramsthatwishtodevelopandimplementintegratedclinicaleducationexperiencesshouldfacilitateastructurethatsupportsacollaborativeworkingrelationshipbetweentheacademicenvironmentandtheclinicaleducationsite.(Hakimetal,2014;Jensenetal,2015)

• Ifclinicalsitesandinstructorsareexternaltotheacademicinstitution,abi-directionalpartnershipshouldbedevelopedtopromotetranslationofdidacticcontentintopracticeandtherebyinformcurricularstrengthsandweaknesses(Hakimetal,2014).

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RECOMMENDATION1:

Thattheproposeddefinitionofintegratedclinicaleducation(ICE)beadoptedasthedefinitionforusewithintheprofession.

SS:Consistentandproperuseoftheterm‘integratedclinicaleducation’isessentialtosuccessfulcommunicationwithintheacademicandclinicalenvironmentsofphysicaltherapisteducation.Thepanel,afterextensiveresearch,discussion,anddebatehasdevelopedadefinitionthatisclearandrepresentativeofthevarietyofsettingsandtypesofexperiencesthathavedevelopedwithinourprofession.ThedefinitionalsoincludesareferencetotheCAPTEcriteriaforfull-timeclinicaleducation,thusrecognizingthatICEcantakemanyforms,someofwhichmeetthecriteriasetforthinaccreditationstandards.

RECOMMENDATION2:

ThatthedefinitionofintegratedclinicaleducationbeaddedtotheglossarydevelopedbytheCommonTerminologypanel.

SS:TheworkoftheCommonTerminologyPanelandICEPanelwascoordinatedtoensureconsistencyofterms.BecausedevelopmentofadefinitionforICEwasacomponentofthispanel’scharge,thedefinitionisprovidedinthereportandproposedforadoption.Onceadopted,itshouldbeincludedintheglossaryofterms,ensuringconsistentdisseminationofthetermandacronym.

RECOMMENDATION3:

ThatthecurrentlypublisheddefinitionofintegratedclinicalexperienceintheACAPTpolicyentitledTerminologyforClinicalEducationExperiences(AC2-13)berescinded.

SS:AdefinitionforintegratedclinicalexperiencewasadoptedbyACAPTin2014.TheworkoftheICEpanelhasledtoarecommendationthattheappropriatetermisintegratedclinicaleducationandthattheexperiencesofICEarereferredtoasICEexperiences.Oncethisnewdefinitionforintegratedclinicaleducationisadopted,thetermanddefinitionfor‘integratedclinicalexperience’shouldberescindedtoensureconsistencyintheuseoftermsanddefinitions.

RECOMMENDATION4:

Thatthe8parametersaspresentedasbaselineexpectationsforintegratedclinicaleducationbeadoptedanddisseminatedforusebyphysicaltherapisteducationalprograms.

SS:ParticipantsintheSummitrecognizedboththevalueofICEandthevariabilityofICEexperienceswithintheeducationalprograms.Asaresult,theparticipantsagreedthattheprofessionisbestservedbyinclusionofICEthatisbuiltonagreeduponstandardsfordesignandimplementation.The8parametersdevelopedbytheICEpanelprovidesuchguidance.

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Theseparametersweredevelopedafterextensivereviewoftheliterature,engagementwithstakeholders,discussion,anddebate.AdoptionoftheseparametersbyACAPTmemberinstitutionswillensurethatICEaredevelopedusingastandardizedsetofexpectationsyetcontinuetoallowandencourageeducationalprogramstoinvolvetheirstudentsinawidevarietyofICEexperiencestomeetuniqueneedsortakeadvantageofuniquesituations.ThisguidanceforICEdevelopmentwillalsoassistfacultyinensuringthattheexperiencesprovidedtostudentsarebasedonsoundeducationalpractices.

RECOMMENDATION5:

Thatthe10guidelinesfordevelopmentofintegratedclinicaleducationexperiencesbedisseminatedtophysicaltherapisteducationalprograms.

SS:Distinctfromtheparametersdescribedabove,thepanelwasalsoaskedtoprovideguidancetoprogramsinterestedindevelopingICE.Thepaneldevelopedalistof10guidelinesthataddresstheintentionalstepsthatfacultyshoulduseandconsiderintheprocessofdevelopingICEexperiences.ThepanelbelievesthatthecombinationoftheparametersbeingusedasqualitystandardsalongwiththeguidelinestohelpguideICEdevelopmentwillensurethatphysicaltherapisteducationalprogramshavethetoolsnecessarytoprovidehighqualityandeffectiveICEtotheirphysicaltherapiststudents.

RECOMMENDATION6:

ThattheACAPTBoardofDirectorssharethisdocument,onceapproved,withthemembersoftheEducationalLeadershipPartnership(ELP)fordiscussiononhowtomoveforwardwithconsistentuseofthetermintegratedclinicaleducationwithinthephysicaltherapistclinicaleducationcommunity.

SS:Ifwearetoachieveconsistentuseofthetermintegratedclinicaleducation,thetermanditsdefinitionwillneedtobedisseminatedbroadly.ThistermrepresentsachangefromthetermpreviouslyadoptedbyACAPTinthepolicy‘TerminologyforClinicalEducationExperiences’(AC2-13)andthusthechangewillrequireacoordinatedefforttoeducateeducationalprogramsandclinicalfacultyonthepropertermandproperusage.ELPiswellpositionedtoassistinthisinitiative.

RECOMMENDATION7:

ThatACAPTsupporteducationalresearchfocusedonprogrammaticoutcomesofdifferentmodelsofintegratedclinicaleducationusingstandardizedoutcomemeasures.

SS:ThepanelwasaskedtodiscernanddescribemodelsofICEthatexistwithinphysicaltherapistcurricula.Thisportionofthechargewasaccomplishedbyathoroughreviewoftheliteratureandthemodelsweredescribedastheyrelatetothe8establishedparametersproposedbythepanel.

Throughthisprocessthepaneldiscoveredthatalthoughmodelsaredescribedintheliterature,thereislittletonoassessmentoftheoutcomesofthevariousmodelsdescribed.Inresponsetothisfinding,thepanelisrecommendingthatadditionalresearchbedevelopedandsupported.Findingsfromthis

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researchcanthenbeusedbythephysicaltherapyeducationalcommunitytodevelopthemosteffectiveandefficientmodelsofICE,thusenhancingtheeducationofthephysicaltherapiststudents.

MEETINGHISTORY

TheIntegratedClinicalEducation(ICE)WorkGroupmet14times,including11webconferencecallsand3onsitemeetings(CSM2016and2017andELC2016)fromFebruary2016-May2017.Manyadditionalsubgroupmeetingswereheldbetweenthemeetingsofthewhole.

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References

BensonJD,ProvidentI,SzucsKA.Anexperientiallearninglabembeddedinadidacticcourse:outcomesfromadidacticinterventioncourse.OTHC.2013;27(1):46-57.

BrusconiM,DamianR,SauriJG,et.al.TheConceptofExcellenceinHigherEducation.Brussels,Belguim.:EuropeanAssociationforQualityAssuranceinHigherEducation;2014.http://www.enqa.eu/indirme/papers-and-reports/occasional-papers/ENQA%20Excellence%20WG%20Report_The%20Concept%20of%20Excellence%20in%20Higher%20Education.pdf

CokerP.Effectsofanexperientiallearningprogramontheclinicalreasoningandcriticalthinkingskillsofoccupationaltherapystudents.JAlliedHealth.Winter2010;39(4):280-286.

DeweyJ.DemocracyandEducation.NewYork,NY:Simon&SchusterInc;1916,1944.

DoucetB,SealeJ.Thefreepost-strokeclinic:asuccessfulteachingandlearningmodel.JAlliedHealth.2012;41(4):162-169.

EngelhardC,McCallumCA.AdescriptionofcurrentcurriculardesignmodelsusedinphysicaltherapyclinicaleducationandtheirrelationshiptopassratesontheNationalPhysicalTherapyExamination.TheInternetJournalofAlliedHealthSciencesandPractice.Vol.13No.3ISSN1540-580X.October2015.

FaughtDD,Gray,DP,DiMeglioC,MeadowsS,MenziesV.Creatinganintegratedpsychiatric-mentalhealthnursingclinicalexperience.NurseEduc.May/June2013;38(3):122-125.

FisherD,FreyN,HiteSA.IntentionalandTargetedTeaching:AFrameworkforTeacherGrowthandLeadership.Alexandria,VA:AssociationforSupervisionandCurriculumDevelopment;2016.

FullanM.LeadershipandSustainability.SystemThinkersinAction.Ontario,Canada:CorwinPress;2005,57-58.

GoldbergLR,RichburgCM,WoodLA.Activelearningthroughservicelearning.CommunDisordQ.Spring2006;27(3):131-145.

HakimWE,MoffatM,BeckerEetal.Applicationofeducationaltheoryandevidenceinsupportofanintegratedmodelofclinicaleducation.JOPTE.2014;28(1):13-21.

IngramD,HanksJ.Acomparisonofclinicalperformanceoutcomesinshortintegratedversussinglelong-termclinicalexperiencesofphysicaltherapiststudents.JOPTE.2001;15(1):32-35.

JensenG,MostromE,GwyerJ,HackL,NordstromT.Learningforpractice:Early,integratedworkplaceexperiencesmatter.AERAOnlinePaperRepository.2015.Availableat:http://www.aera.net/repository

64

23

JensenGM,NordstromT,SegalRL,McCallumC,GrahamC,GreenfieldB.EducationResearchinPhysicalTherapy:VisionsofthePossible.PhysTher.2016;96(12):1874-1884.AccessedJanuary16,2016.

Knetch-SabresLJ.Theuseofexperientiallearninginanoccupationaltherapyprogram.Canitfosterskillsforclinicalpractice?OccupationalTherapyinHealthCare.2010;24:320-334.InBensonJD,ProvidentI,SzucsKA.Anexperientiallearninglabembeddedinadidacticcourse:outcomesfromadidacticinterventioncourse.OTHC.2013;27(1):46-57.

MahendraN,FremontK,DionneE.Teachingfutureprovidersaboutdementia:Theimpactofservicelearning.SeminSpeechandLang.2013;34(1):5-17.

MaiJ,ThieleA,O'DellB,KruseB,VaassenM,PriestA.Utilizationofanintegratedclinicalexperienceinaphysicaltherapisteducationprogram.JOPTE.2013;27(2):25-32.

MaiJ,SternD,HollmanJ,MelzerB,ThieleA,RosenthalR.Examiningtheimpactofanintegratedclinicalexperience(ICE)oninterpersonalskillspriortothefirst,full-timeclinicalinternship:coolasICE.JPhysTherEduc.2014;28(2):81-97.

O'NeilM,RubertoneP,VillaneuvaA.CommunityexperientiallearningopportunitiesintheDrexelUniversityprofessionalDoctorofPhysicalTherapyProgram.JOPTE.2007;21(2):66-72.

RenekerJ,WeemsK,ScaiaV.Effectsofanintegratedgeriatricgroupbalanceclasswithinanentry-levelDoctorateofPhysicalTherapyprogramonstudents'perceptionsofgeriatricsandgeriatriceducationintheUnitedStates.JEducEvalHealthProf.2016;13(35).doi:10.3352/jeehp.2016.13.35

RomigBD,HewittAM,MailletJO.Thefutureofclinicaleducation:opportunitiesandchallengesfromalliedhealthdeans’perspective.JAlliedHealth.2017;46(1):43-55.

SackettDL,StraussS,RichardsonS,RosenbergW,HaynesRB.Evidence-BasedMedicine:HowtoPracticeandTeachEBM.Edinburgh,Scotland.ChurchillLivingstone;2000.

Scho¨nD.TheReflectivePractitioner:HowProfessionalsThinkinAction.SanFrancisco,CA:Jossey-BassIncPublishers;1983.

ShulmanLS.TeachingasCommunityProperty:EssaysonHigherEducation.SanFrancisco,CA:Jossey-Bass;2004.

SmithKM,LutenbacherM,McClureN.Leveragingresourcestoimproveclinicaloutcomesandteachtransitionalcarethroughdevelopmentofacademic-clinicalpartnerships.NurseEduc.2015;40(6):303-307.

SternD,Rone-AdamsS.Analternativemodelforfirstlevelclinicaleducationexperiencesinphysicaltherapy.IJAHSP.2006;4(3).Availableat:http://ijahsp.nova.edu.AccessedJune23,2016.

StuhlmillerCMandTolchardB.Developingastudent-ledhealthandwellbeingclinicinanunderservedcommunity:collaborativelearning,healthoutcomesandcostsavings.BMCNurs.2015;14(32).

65

24

SzucsKA.Anexperientiallearninglabembeddedinadidacticcourse:outcomesfromadidacticinterventioncourse.OTHC.2013;27(1):46-57.

WainwrightSF,ShepartKF,HarmanLB,StephensJ.Noviceandexperiencedphysicaltherapistclinicians:Acomparisonofhowreflectionisusedtoinformtheclinicaldecision-makingprocess.PTJ.2010;90(1):75-88.

WeddleM.SellheimD.Anintegrativecurriculummodelpreparingphysicaltherapistsforvision2020practice.JOPTE.2009;23(1):12-21.

WeddleM.SellheimD.Linkingtheclassroomandtheclinic:amodelofintegratedclinicaleducationforfirst-yearphysicaltherapiststudents.JOPTE.2011;25(3):68-79.

Williams-BarnardCL,SweattAH,HarknessGA,DiNapoliP.Theclinicalhomecommunity:amodelforcommunity-basededucation.IntNursRev.2004;51:104-112.

WilsonA.Integratedclinicalexperiencesinacampusonsiteclinic:aself-containedmodelofphysicaltherapyeducation.IJAHSP.2014;12(3):1-17.Availableat:http://ijahsp.nova.edu

WilsonJ,CollinsJ.Physicaltherapiststudentlearningthroughauthenticexperiencesinmanagement:oneprogram’sinterpretationofservicelearning.JOPTE.2006;20(3):25-32.

Wolfe,D.E.,&Byrne,E.T.Researchonexperientiallearning:Enhancingtheprocess.ScandinavianJournalofOccupationalTherapy,1975.8,163–173.InBensonJD,ProvidentI,SzucsKA.Anexperientiallearninglabembeddedinadidacticcourse:outcomesfromadidacticinterventioncourse.OTHC.2013;27(1):46-57.

YardleyS,BrosnanC,RichardsonJ,HaysR.Authenticearlyexperienceinmedicaleducation:asocio-culturalanalysisidentifyingimportantvariablesinlearninginteractionswithinworkplaces.AdvHealthSciEduc.2013;18:873-891.

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Table1:ModeldescriptionsofIntegratedClinicalEducationthatcurrentlyexistintheliterature:Organizedbythe8parametersAuthor(s)YearDiscipline

Placement Course/ProgramObjectives

Frequency Typeofcourse

Occurrencew/incourse

Locality AssessmentandOutcomes

CoordinationSupervision

Benson,Provident&Szucs2013OccupationalTherapy

4interventioncourses,experientiallabinall,ICEinfirstNeurologicalcourse

Courselabobjectives:1)selecting,administeringandinterpretingresultsofassessmentinstrumentsandtechniques,forusewithclientswithperformance,deficitsrelatedtoneurological,sensory,motor,cognitiveandperceptualdysfunction;2)designingandimplementinginterventionplanstoremediateand/orrehabilitateoccupationalperformancedeficitsinthebirthtoadolescentpopulation;3)evaluatingandutilizingcurrentresearchinthedesignandimplementationofintervention;and4)producingappropriatedocumentationsupportingevaluationfindingsanddelineatinginterventionactivitiesandplansandprogressnotes

Notclearlypresented,first4weeksinclassroom-thenincommunity

Experientiallearninglabwithinacoursewithpediatriccontent

Firstexperientiallaboccurredafterweek4ofthecourse

Communitysite-Privateschooldeliveringservicestochildrenandadolescents;neededservicesnotavailableinpublicschoolsystem

Observationofstudentperformance,writtenandoralfeedbackofperformance,review/assessmentof/feedbackaboutinterventionplans,studentchoiceofevidenceandabilitytoapplytointerventionplan,andpatientevaluationreport;finalcourseassessment-masterytestingofclinicalskillstoensurereadinessforfieldwork

Courseinstructor;partneredwith5OTsfromschoolInstructorofcourseand/orcommunityclinician

67

Coker2010OccupationalTherapy

Afterfirstyearinprogram-partof2yearprogram

Course/programobjectivesnotdiscussed

1week(5days,6hoursday)

Stand-alonecourse

Afterfirstyearintheprogram

1weekday-campforchildrenwithCP

UsestudentfeedbackandstandardizedassessmentusingSelf-AssessmentofClinicalReflectionandReasoning(SACRR)andCaliforniaCriticalThinkingSkillsTest(CCTST)todetermineiftheirdesignedexperienceisthebestapproachtoaccomplishthislearning

OTfacultymember;OTclinicianatcampLicensedOTincludingthefacultywhocoordinatedtheexperience

Doucet&Seale2012PhysicalTherapyandOccupationalTherapy

SecondorthirdyearofPT/OTprograms

Course/programobjectivesnotdiscussed

1weekinlengthforclinic

Stand-alonecourse

Embeddedineducationalcourse

Oncampusclinic Writtenquestionnaireconsistingofmultiplequestionswithresponsesbasedona5-pointLikertscale;Patientsratedtheirperceptionofthestudentintern(s)assigned,thetreatmentgiven,andtheorganizationoftheclinic.Studentsratedtheirperceptionoftheclinicexperience,whetherclinicpreparedthemforfieldwork/clinicalrotations,connectiontodidacticknowledge,andoverallbenefit.Supervisorsratedstudentinternsontheirabilitytointeractwithpatients,

2facultymembers(oneOT,onePT)Facultyandcommunityclinicians(clinicalinstructors)

68

demonstrationofknowledge,andapplicationofappropriateinterventions,alongwiththeiroverallperceptionoftheeffectivenessandorganizationoftheclinic

Faught,Gray,DiMeglio,Meadows&Menzies2013RN

Unsure Goalthatstudentscould(1)gainskillinprovidingintegratedphysicalandmentalhealthcaretotheirpatients,(2)becomeawareofandpossiblyimproveperceptionsregardingmentalhealth/mentalillness,and(3)expandtheirunderstandingofthecriticalimportanceofthetherapeuticnurse-patientrelationshipincaringforallpatients

24hours Partofmentalhealthcourse

Unsure Inpatienthealthcareunit

Quantitativeend-of-semesterevaluationsoftheclinicalrotations,qualitativeevaluationsofthemodifiedclinicalexperience(nothingspecificidentified)

Facultymembers2clinicianswitheducatorexperiencewhowereemployedoninpatientmedicalunits,hadpsychiatricnursingclinicalexpertise

69

Goldberg,Richburg&Wood2006SLP

Secondyearcourse

Tofacilitatereflectiveproblem-basedlearninganddecision-making,integrationoftheoreticalandclinicalknowledge,andstudentawarenessoftheimportanceofevidence-basedpracticeintheareaofdysphagia.

15hours Partofadysphagiacourse

Secondyearcourseinspringsemester(15hours)

Communitypartnerswithdysphasiamanagementprogram

Competenciesonthestudents’analysis,synthesis,andevaluationofthefollowing:ethicalbehavior;ASHApoliciesandguidelinesandlocal,state,andnationallegislation;normalanddisorderedswallowing;effectivepreventionandassessment;researchprinciplesandevidence-basedtreatment;effectivespeakingandlistening;andwrittenreports,treatmentplans,andprofessionalcorrespondence,reflectivejournals

Facultymemberplacesstudentwithcommunitysupervisor(goaltobeplacedwithexternshippartner)Communitysupervisor

Hakim,Moffat,Beckeretal2014PhysicalTherapy

Earlyincurriculum(authenticearlyexperiences)-year1

Course/programobjectivesnotdiscussed

Variety Variety Variety Academic-communitypartnerships

Notdescribed Facultyled-placementproviders(DCE)Clinicalfaculty;masterclinicians

Ingram&Hanks2001PhysicalTherapy

Firstyearoftheprogram

Course/programobjectivesnotdiscussed

Fulltimeweeks;varyingpointsintimeduringthefirstyear

MPTstudents-stand-alonecourse;BSstudents-partofcourse

MPTstudents-7weekcourseendoffirstyear;BSstudents-integrated7weeks(1weekendoffallsemester,2weeksendofspringsemester,and4weeks

VarietyoftraditionalPTclinics

ClinicalPerformanceInstrument

FacultycoordinatedClinicalfaculty

70

endofsummersemester)

Jensen,Mostrom,Gwyer,Hack&Nordstrom2015PhysicalTherapy

Variety-highlightsearlyintegrated

Course/programobjectivesnotdiscussed

Variety Variety(bothstandaloneandpartsofcourses)

Variety Academic-communitypartners(facultypractice)

Variety-writtenpre-work,postdebriefing

FacultycoordinatedandsupervisedVariety(clinicalfacultyandacademicfaculty)

Mahendra,Fremont&Dionne2013SLP

Electivecourseover2years(SLP)

Learningoutcomesforthecoursewerederivedfromstudentself-reflectionsbuttheactualobjectiveswerenotdescribed

Last4weeksofcourse

Partofacourse

Last4weeksofcourse

Localdementiaunit

Quizondementia,personalreflectionpriortoandaftertheservicelearning(SL),ethnographicinterview,screeningofindividuals(forcognition,affect,hearingandvision),collaborativeinterpretationofresults,researchanddevelopmentofadiagnosisplan,andactualparticipationinSL

Notexplicitlystated--facultyandsitepersonnelNotspecified

Maietal2013PhysicalTherapy

3courses-successivesemesters,startsfirstyear

Specificcourse/programobjectivesnotmentioned

Semester-longcourses

Stand-alonecourses

BegininfirstyearofDPTprogram-2hourstwiceweekly(ClarkeUniversity);wintersemesterofyear1(NovaSoutheasternU)

Oncampuswellnessclinic:patientsreferredfromcommunityhealthclinicsandlocaldialysiscenter;andseniorlivingcenters,communitywellnesscentersorlongtermcarecenters

GenericabilitiesandCPI;groupdebriefings,servicelearningpapers

FacultycoordinatedandsupervisedLicensedPTfaculty

71

Maietal2014PhysicalTherapy

Firstyearofprogram

Course/programobjectivesnotdiscussed

Variety--2hourstwotimesperweekand40hours/week

Stand-alonecoursesandintegrated

Firstyear Communityclinics,wellnessactivities

InterpersonalCommunicationQuestionnaire(ICQ)andMedicalCommunicationBehaviorScale(MCBS);standardizedoutcometoolforassessment

Coursecoordinator;otherfacultyasassigned,includingDCECommunityclinicalsupervisors

O'Neil,Rubertone&Villanueva2007PhysicalTherapy

Early,presentat3differentpointsthroughoutcurriculum

Courseobjectivesthatcreateservicelearningexperiencesincludeengagement(aservicecomponentmeetingcommunityneeds),reflection(amechanismforstudentstolinkserviceexperiencestocoursecontent),reciprocity(teacherandlearnerrolesforallparticipantsintheexperience),andpublicdissemination(sharingoutcomesamongparticipants)

3phases Partofcourses

Seetable3ofarticle-varietyoftimesdependentuponspecificSLactivity

Communityworkplaces

Outcomesarereportedthroughclassdiscussion,reflectionexercises,andcourseevaluations

FacultycoordinatedwithcommunitypartnersFacultymembers,labinstructors,nursingassistant

Reneker,Weems&Scaia2016PhysicalTherapy

Secondyearofcurriculum

Course/programobjectivesnotdiscussed

8weeks,onetimeperweek

Partofaneurocourse

Notspecified-onlythatoccurrencewasfor8weeks

VeteransAffairsoutpatientclinic

Pre-andpost-ICEstudentperceptionsaboutthegeriatricpopulation

Facultycoordinated-PTsupervised2licensedPTs

Smith,Lutenbacher&McClure2015RN

Unsure UsingguidelinesfromtheAmericanAssociationofCollegesofNursingPublicHealthRecommendedBaccalaureateCompetenciesandCurricularGuidelinesforPublicHealthNursing,thefollowingobjectivesweredetermined:studentswererequiredtodevelop,implement,

3semesters Partofclinicalcommunityhealthcourse

Unsure Transitionalcareenvironment

Peerevaluationtool,clinicalperformanceevaluationtoolwasusedtoassessclinicalcompetenciesandinterprofessionalcollaboration;studentsalsowroteaweeklyjournalreflectionabouttheirexperiences

ACP-academic-clinicalpartnershipsdevelopedbefore,duringaftercoursesNursingfaculty

72

andevaluateanindividualizedplanbasedontheirassessmentofthepatientandtheircommunity

Stern&Rone-Adams2006PhysicalTherapy

Firstandsecondyearoftheprogram

Primarylearningobjectivesforthefirstyearstudentsincludedevaluation,examination,assessmentskills,anddevelopmentofprofessionalbehaviorsasdefinedbytheGenericAbilitiesbehaviors;learningobjectivesforsecondyearstudentsincludedcognitive,psychomotor,andaffectiveskillspracticedthefirstyearoftheprogram

Onedayperweekeveryotherweek

Stand-alonecourse

Notspecified-didbeginduringthesecondmonthofthecurriculumandcontinuedfor3consecutivesemesters

Clinicalpractices(SNF,Adultdaycare,homelessshelter,outpatientclinics)

GenericAbilitiesself-assessment,student-facultyclinicalinstructorself-assessmentdiscussionwithfeedback,studentreflectivejournalthatwasdiscussedattheendofeachrotation

Clinicaleducationteamcoordinated;facultyoversightinareaswithpriorexperienceFacultyclinicalinstructors

Stuhlmiller&Tolchard2015RN

Unsure Courseobjective:effectivelyengagewiththecommunity,itsleadersandotherstakeholdersinassessingandrespondingtohealthandsocialwell-beingneeds,2.increaseprovisionofevidence-basedintegratedhealthhelpthatpromotescollaborativelearning,self-determinationandresponsibility,and3.demonstratepositivehealthoutcomesasdeterminedbystandardizedmeasures

Ongoingclinic-rangeof80-120hoursattachedtoaunitofstudy

Notexplicitlystated

Unsure Student-ledclinic(Australia)-partneredwithanexistingcommunityclinic

Nonereported Principalinvestigatorfromacademicsidepartneredwithcommunitysupervisors;supervisorsonsiteprovideddaytodaysupervisionNoreferencetowhoprovidedspecificsupervision

73

Weddle&Sellheim2009PhysicalTherapy

Beginsfirstsemester,extendsintothesecondsemesterofsecondyear

Course/programobjectivesnotdiscussed

1/2day Partofcourses

Notspecific,butsecondweekofthecurriculumuntilthesecondsemesterofyear2

PhysicalTherapistpracticesettings

DirectoutcomesandmeasuresrelatedtoICEnotreported,NPTEpassratesofstudentswhoparticipatedinthenewmodelwere94%and100%overthetwoyearsdiscussed,oneyeargraduatesurveyandalumnisurveybothindicatedstudentsandemployersfeltthenewgradwaswell-preparedforpractice

FacultyandclinicalfacultycoordinatedClinicalfaculty

Weddle&Sellheim2011PhysicalTherapy

Firstsemester ObjectivesofICEaretohavestudentspracticecomponentsofpatient/clientmanagement;begintoapplybasic,medical,andbehavioralsciencestoclinicalscience;andtodeepentheirunderstandingofthebreadthandcomplexitiesofphysicaltherapistpractice

75hourspriortofirstFTexperience

Partofcourses

Notspecific,but2experiencesoccurduringfirstsemesteryearone,and6experiencesoccursecondsemesteryearone

PhysicalTherapistpracticesettings

Learningactivitycheckoffform,skillscompetency-patientmanagement-anddocumentationchecksthroughoutmodellearningunits,onlinereportingforms,onceasemesterprofessionalbehaviorsmeetingbetweenstudentandfacultyadvisortogooverstudentself-assessmentandperformance,10itemprofessionalbehaviorsassessmentofstudentbytheclinicalfaculty

Facultycoordinated-clinicalfacultysupervisedClinicalfaculty

74

Williams-Barnard,Sweatt,Harkness&DiNapoli2004RN

Unsure Vagueobjective:engageinhealthpromotionanddiseasepreventionstrategies;2providenewavenuesforsecondaryandtertiarycare;and3offerinnovativetreatmentapproachesinthecommunitysettingtocareforpeoplethroughouttheirlives

Partofacourse

Partofparentchildhealthandmentalhealthcourse

Unsure Community-basedpartners

Unsure,possiblyfocusgroupstoassessstudentperceptionoftheexperience

Facultyled-communitysupervisorsFacultyandcommunitysupervisors

Wilson2006PhysicalTherapy

3consecutivesemestersinsecond/thirdyearofcurriculum

ICEI:Becomefamiliarwithclinicenvironment,Observeandassistwithpatientcare,Practicedocumentationandinterviewingskills,Prescribeexerciseforahealthypopulation;ICEII:Developpatient-professionalinteractionskills,Developdocumentationskills,Developskillinpatienthandlingandtreatmentinterventions,Developcriticalclinicalreasoningandclinicaldecision-makingskills;ICEIII:Refinepatient-professionalinteractionskills,Assumeresponsibilityforallaspectsofpatient,management,Refinedocumentationskills,Refineclinicalreasoningandclinicaldecision-makingskills,Begintodeveloppeermentoringandsupervisoryskills

Onedayperweek

Stand-alonecourse

N/Aasitisastand-alonecourse;beginsinthefallsemesterofyeartwofor3consecutivesemesters

Campusonsiteclinic

ICEI:writtenevaluationsofstudentperformancefrombothpeermentorsintheonsiteclinicandfromCIsintheexercise/wellnessgroup;ICEII:writtenmidtermandevaluationsoftheCI’sassessmentofthestudent’sperformanceintheareasofsafety,professionalbehavior,communication,examinationandinterventionskills,andclinicalreasoning;ICEIII:writtenmidtermandfinalevaluationsoftheCIsassessmentofthestudent’sperformanceintheareasofsafety,professionalbehavior,communication,

FacultycoordinatedandsupervisedCorefacultyandPTcliniciansfromthelocalcommunity

75

examinationandinterventionskills,andclinicalreasoning

Yardley,Brosnan,Richardson&Hays2014Medicine

Earlyincurriculum(authenticearlyexperiences)-year1

Learningoutcomesforindividualepisodesweregenericratherthancontextspecificandrelatedtothetitleofeachexperience

Partofacourse

Incorporatedintomedicalschoolactivities

Incorporatedintomedicalschoolactivities

Workplaces(health,social,voluntarycommunityservices)

Reflectivesummarieswithinaportfoliowhichwasgradedforpresentationofwork,depthofreflectionandself-awareness

Facultyled-placementprovidersObservationalexperienceswith"somesupervision"

Wilson&Collins2011PhysicalTherapy

Firstyearofprogram

Leadershipandmanagementprincipleswereprimaryfocus

Partofacourse-4to8hours/week)

Clinicalcoursecoordinatedwithmanagementcourse

Clinicalcoursecoordinatedwithmanagementcourse

Oncampusandoffcampus

Studentsatisfaction,surveys,courseevaluations,reflectiondiscussions,graduatesurveys1yearpost-graduation;Keythemes:delegation,communication,givingandreceivingfeedback;roleasmanager;developmentoffundamentalbusinessskills

Coursecoordinator;otherfacultyasassigned,includingDCECoursecoordinator

76

Table2:SelectOutcomeMeasuresandDataCollectedinIntegratedClinicalEducationModels

Author(s) Year Discipline

OutcomeMeasure/AssessmentofStudentLearning

OutcomesofStudentLearning

OutcomeMeasure/AssessmentofICEModel OutcomesofICEModel

Benson,Provident&Szucs

2013 OccupationalTherapy

StudentSurveys Studentsvaluedtheopportunityforexperientiallearning

StudentSurveys Instructorfeedbackanddesignofexperienceallabovea9on10pointscale

Coker 2010 OccupationalTherapy

Self-AssessmentofClinicalReflectionandReasoning(SACRR)andCaliforniaCriticalThinkingSkillsTest(CCTST)

Improvementsinclinicalprotocols,clinicalhypothesis,interventionstrategies,decisionmaking,judgement;criticalthinkingskills

None n/a

Doucet&Seale

2012 PhysicalTherapyandOccupationalTherapy

Self-developedquestionnairewithitemstoassessstudentperformanceduringclinic(un-validated):professionalbehaviors:multifactorial(patientevaluationofstudent)Facultyevaluationonstudentabilitytointeractwithpatients,knowledgeandapplicationofinterventions

Studentandclientresponseswereallpositiveatthestronglyagreedoragreelevel;instructorratingsofstudentperformancewerelowerthanofstudentassessment

Self-developedquestionnairewithitemstoassessstudentandclientperceptionsofclinicexperience;

Positiveresponsestowardsbenefitofclinicfrompatientperspective-100%stronglyagreedoragreedtorecommendorparticipateinclinicagain;studentsassessedclinicasavaluableadditiontocurricula.

Faught,Gray,DiMeglio,Meadows&Menzies

2013 RegisteredNurse

Pre-posttestscoresofLikertscalesurveybasedonobservationalcompetenciesMeanperformanceon10quizzeswithopenendedquestionsReflectiveJournals

Significantdifferenceinall7competenciesQuizscoresvariedImprovementindescriptionsinjournalentriesnotedfrombeginningtoend

Courseevaluations Studentsatisfactionwithcourseimprovedover3-yeartimeframeServicelearning(SL)inclusionimprovedstudentpreparationforexternships

Ingram&Hanks

2001 PhysicalTherapy

ClinicalPerformanceInstrument(CPI)Multipleshorttermvslongtermfull

NosignificantdifferencesinICEcurricularmodelinoneprogram

None n/a

77

timeIntegratedClinicalEducation(ICE)

Jensen,Mostrom,Gwyer,Hack&Nordstrom

2015 PhysicalTherapy

Qualitativedata Threecorethemes:1)organizationalcontext,2)people/expectationsand3)enactedcurriculum

Qualitativedata Early,integratedclinicaleducationexperiencesareakeycomponentandanessentialcomponentforclinicalauthenticityofthecurriculum

Mahedra,Fremont&Dionne

2013 SpeechLanguagePathology

Learningoutcomes:informalcourseevaluations;studentreflectionpapers

StudentsatisfactionwaspositiveNegativecommentsreflectedstudentanxietyanddiscomfortwiththepopulation

Formaluniversityadministrationcourseevaluations

Negativecommentsaboutlogisticsofoffcampusexperiencesbutrectifiedduringcourse;overallcourseratinga1.1(highlysatisfied);studentsappreciatedthehandsonlearningcomponent

Maietel 2013 PhysicalTherapy

ClinicalPerformanceInstrument(CPI)(usedinIntegratedClinicalEducation(ICE)1and2);progressinprofessionalbehaviors

Nomeasurableoutcomesreportedonstudentprogress

GroupdiscussionsabouttheICEexperiences;self-designedsurveyaboutICEexperiences

OutcomesofstudentperceptionsaboutICEexperiences

Maietel 2014 PhysicalTherapy

InterpersonalCommunicationQuestionnaire(ICQ)andMedicalCommunicationBehaviorSystem(MCBS)MCBSisanobservationalassessmentofperformanceobserved.

NosignificantdifferencewithICQbetweengroupsexceptforthosewithpriorworkexperienceinPTfieldasaideortechnician;studentswithICEpriortofirstfulltimeCEperformedbetterinsomecontentandaffectivecategories(studentbased)onMCBS-butstatisticalscoresnotreportedintable(only%

None Limitationwasvariationin4programcurriculardesign-where4ClinicalEducation(CE)rotationswereplaced

78

observed);othercategoriesnotsignificantOverallassessment:ICEpreparedstudentsself-perceivedreadinessincommunicationrealmwashigherthannon-ICEtrainedgroup

O'Neil,Rubertone&Villanueva

2007 PhysicalTherapy

Classdiscussions;reflectionexercises

Themes:newlevelofknowledgeandempathywhenworkingwithunderservedpopulations;betterunderstandingofphysicalandsocialenvironmentalfactorsthatarefacilitatorsorbarrierstoadoptinghealthylifestyles

CourseevaluationsParticipantandcommunityagencyoutcomesviaself-designedquestionnaires

Positiveresponses

Reneker,Weems&Scaia

2016 PhysicalTherapy

Surveyinstrumentmeasuringstudentperceptionofgeriatricphysicaltherapy(adaptedfrommedicine)

Studentsmorelikelytoseekoutemploymentwithgeriatricpopulationasaresultoftheexperience

Perceptionsofgeriatriceducationincourse-baseduponenjoyment

Studentsindicatemoregeriatriccontentneeded

Smith,Lutenbacher&McClure

2015 RegisteredNurse

Peerevaluationtool,ClinicalPerformanceEvaluationtool,Weeklyreflectionjournals

Positivefeedbackabouttheexperience;Studentprojectscompletedreported

Lessonslearned Studentparticipationvoluntarybecauseoftimecommitmentexceededcourserequirements;Studenttoolkitvaluableadditiontostructureofexperience

SternandRone-Adams

2006 PhysicalTherapy

None n/a Programoutcomespresented

Curriculardesign;Benefitsandchallenges

Stuhlmiller&Tolchard

2015 Unsure None n/a Programoutcomesreported

Numberofpatientsserved,servicesprovided;Inter-professionalClinicalEducation(IPE)exposure;costsavingstocommunity

79

WeddleandSelheim

2009 PhysicalTherapy

None n/a Programoutcomes CurriculumdesignDescriptionofclinicalpartnershipsandclinicalfacultyresponsibilities

WeddleandSelheim

2011 PhysicalTherapy

None n/a Programevaluationplan Descriptivestats7cohortsofstudentsinstudyoutcomesQualitativedataandsurveyresponsesStudentdata:benefitsofworkingwithpatientsratherthanwithclassmatesGraduatedata(priortograduation)Clinicalfacultydata(positiveandnegative)Corefacultydata

Williams-Barnard,Sweatt,Harkness&DiNapoli

2004 RegisteredNurse

CaliforniaCriticalThinkingSkillsTest(CCTST)

LooselypresenteddataPostscoreshavebeenabovestandardizedmeanwithwiderrangeofscoresbetweenpreandposttestsPostscoreshavebeenabovestandardizedmeanwithwiderrangeofscoresbetweenpreandposttests

IntegratedClinicalEducation(ICE)programassessment

ArnettStimulationTest(AST)andNationalLeagueforNursing(NLN)BaccalaureateAchievementTest(CNAT):variableresultsNationalCouncilLicensureExamination-RegisteredNurse(NCLEX-RN)outcomesrelatedtoclinicalcare:upwardtrendduringpilotwithICE

80

Wilson 2006 PhysicalTherapy

StudentandClinicalInstructor(CI)(oral)debriefingandquestionnaires

Positivefeedbackandenhancedstudentprofessionalandclinicaldevelopment

StudentandCI(oral)debriefingCIadvisorypanel

FeedbackresultsinchangestoIntegratedClinicalEducation(ICE)experiencesFeedbackduringfulltimeClinicalEducation(CE)(afterICE)-anecdotalevidenceGraduatesurveys=openendedqualitativedata-providesasolidfoundationtobuildconfidenceandprofessionaldevelopmentNumberofpatientvisits

Wilson&Collins

2011 PhysicalTherapy

Studentsatisfactionsurveys,reflectivejournaling,graduatesurveys1yearpostgraduation

StudentlearningobjectivesweremetandoftenexceededStudentsidentifiedandmanagedchallengesDevelopmentofsuccessandprofessionalism

CourseevaluationsRoleofPhysicalTherapistsasmanagerEndofsemesterfeedbacksessionsGraduatesurveys1yearpost

Programevaluationdatapresented:descriptivebothquantitativeandqualitative

Yardley,Bronan,Richardson&Hays

2014 Medicine LearningoutcomesforindividualepisodesofAuthenticEarlyExperience(AEE)

UnlessAEEisappropriatelyplacedoneachoftheworkplacespectra,thensocio-culturaltheoriessuggestthatstudentswillnotbeabletoadequatelyengageintheprocessesoftheeducationalspectra

Programevaluation Qualitativedataonexpectations,processesandconsequencesofAEE

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ICEAppendixA

INTEGRATEDCLINICALEDUCATIONFORPHYSICALTHERAPISTSTUDENTSDefinition,Parameters,andGuidelines

Educationalliteraturesuggeststhatintegratedclinicaleducationexperiences,aformofexperientiallearning,canexposestudentstoaspectsofpatientcenteredcareduringflexibleclinicaltrainingperiodsthroughoutthecurriculum.Theseexperiencesaffordstudentsanopportunitytofacilitatedevelopmentoftheircognitive,affective,andpsychomotorskillswhileconcurrentlyallowingacademicand/orclinicalfacultytofacilitatestudentdevelopmentwithrespecttothetransferofdidacticknowledgeintoclinicalapplication.(Hakimetal,2014)Thedefinition,parameters,andguidingprinciplespresentedinthisdocumentareprovidedtoassistprogramsinthedevelopmentofintegratedclinicaleducationexperiences.

DefinitionThefollowingisthedefinitionofIntegratedClinicalEducation(ICE).Integratedclinicaleducationisacurriculumdesignmodelwherebyclinicaleducationexperiencesarepurposivelyorganizedwithinacurriculum.Inphysicaltherapisteducation,theseexperiencesareobtainedthroughtheexplorationofauthenticphysicaltherapistroles,responsibilitiesandvaluesthatoccurpriortotheterminalfulltimeclinicaleducationexperience.

Integratedexperiencesarecoordinatedbytheacademicprogramandaredrivenbylearningobjectivesthataresynchronouswithdidacticcontentdeliveryacrossthecurricularcontinuum.Theseexperiencesallowstudentstoattainprofessionalbehaviors,knowledgeand/orskillswithinavarietyofenvironments.Thesupervisedexperiencesalsoallowforexposureandacquisitionacrossalldomainsoflearningandincludestudentperformanceassessment.

Forintegratedclinicaleducationexperiencestoqualifytowardstheminimumnumberoffull-timeclinicaleducationweeksrequiredbyaccreditation(CAPTE)standards,itmustbefulltimeandsupervisedbyaphysicaltherapistwithinaphysicaltherapyworkplaceenvironmentorpracticesetting.

ICE=IntegratedClinicalEducation

ParametersforIntegratedClinicalEducationThefollowingaretheparametersandbaselineexpectationsforICEinphysicaltherapisteducation.Pleaseseethefullreportfortheevidencesupportingtheseparameters.

1.Integratedclinicaleducationmayoccurinanyacademictermpriortothecompletionofthedidacticcourseworkleadingtothecompletionofaterminalfulltimeclinicaleducationexperience.

2.Integratedclinicaleducationexperienceswillhavespecificdesiredoutcomesthatcorrespondtocourseand/orprogrammaticobjectives.

3.Integratedclinicaleducationexperiencesmayberepresentedasacomponentofadidacticcourseorastandalonecoursethatoccursinasynchronousfashionwithotherdidacticcoursework.

4.Integratedclinicaleducationexperiencetimeframesaredevelopedbytheacademicprogrambaseduponthecourseand/orprogrammaticobjectives.Integratedclinicaleducationmayincludefulltimeand/orparttimeexperiences.

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5.Integratedclinicaleducationexperiencesmayoccurinavarietyoflearningenvironmentsincludingcampusorcommunitybasedclinicalornon-clinicalsettings,baseduponthecourseand/orprogrammaticobjectives.Integratedfulltimeclinicaleducationexperiencesthatqualifyforaprogram’sminimumnumberofclinicaleducationweeksshallbecompletedinaphysicaltherapyworkplaceenvironmentorpracticesetting.

6.Integratedclinicaleducationexperiencesshallincludestudentassessmentsthataredesignedtolinktothecourseorprogramobjectiveswithexpectedstudentprogressioninprofessionalbehaviors,clinicalknowledge,and/orskills.

7. Integrated clinical education experiences are coordinated by a faculty member of the academicprogram,inpartnershipwithacoordinatorfromtheclinicaleducationsite.

8. Integrated clinical education experiences are typically supervised by a course instructor and apreceptor. The preceptormay be an academic course facultymember, a clinical instructor, or otherhealthcareprofessionalatthesitethestudentisengagedintheexperience,dependinguponthecourseand/orprogrammaticobjectives. Integrated full time clinical educationexperiences thatqualify for aprogram’s minimum number of clinical education weeks shall be supervised by a licensed physicaltherapist.

GuidelinesforDevelopmentofICE

The following are guidelines for collaborative development and implementation of integrated clinicaleducationexperiences.PleaserefertotheICEPanelreportfortheprovocativequestionsandevidencethataccompanytheseguidelines.

Thekeytowell-developedintegratedclinicaleducationexperiencesisintentionality.Intentionalandtargetedinstructionencompassesplanningwithapurpose,cultivatingthelearningenvironment,instructingwithintention,andassessingtheimpactthatthemodelhasonstudentlearningwhichiswhattheguidingprinciplesareattemptingtodirect(Fisher,Frey&Hite,2016).Theguidingprinciplesprovidedfocusonthekeyelementsthatprogramsshouldconsiderindevelopingorrefiningintegratedclinicalexperiences.Theseinclude:

1. Anacademicprogramidentifiestheprogrammaticoutcomesthatareexpectedwhenstudentsparticipateinintegratedclinicalexperiences.

2. Theacademicprogramconsiderstheintentionalplacementofintegratedclinicaleducation

experienceswithinitscurriculum.3. Theacademicprogramidentifiesthecourse(s)whereclinicaleducationshouldbeintegrated

withintheprogram.

4. Theacademicprogram,incollaborationwithprogramfacultydevelopsthecoursespecificobjectivesforstudentachievementwithinanintegratedclinicaleducationexperience.

5. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthetimingand

timeframesofwhenclinicaleducationexperiencesshouldbeintegratedwithincourse(s).

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6. Theacademicprogram,incollaborationwithprogramfaculty,identifiestheindividualorindividualswhowilloverseetheintegratedclinicaleducationexperiences.

7. Theacademicprogram,incollaborationwithprogramfaculty,identifiesthemethodsofstudent

andcourseassessmenttomeettheintendedcourseand/orprogramoutcomes.8. Theacademicprogramidentifiesresourcesandlegal/regulatoryparametersthatimpacts

deliveryofintegratedclinicaleducationexperienceswithinprogram.9. Theacademicprogram,incollaborationwithprogramfaculty,selectsthetypeofclinicalor

communitysitesrequiredforintegratedclinicaleducationexperiences.10. Theacademicprogram,incollaborationwithprogramfaculty,acceptsresponsibilityforthe

developmentofrelationshipswithrepresentativesoftheclinicaleducationsite.

Currentevidenceoutlinestheintentionalityofintegratedclinicaleducationexperienceplacement,purpose,necessaryresourceallocation,anddesiredoutcomeswithinphysicaltherapisteducationattheprogramlevel.Assuch,integratedclinicaleducationexperiencesmaybeembeddedwithinacourseoroccurconcurrentwithothercourseworkdependingonthedesiredprogrammaticand/orcourseobjectivesanddesireoutcomes.Intentionalityalsooccursinthedesign,resourcenecessities,andplacementofobjectivedrivencollaborativelearningexperiencesthatadheretopedagogicallysoundprinciplesthatareinnovativeand/orflexible(Fisheretal,2016)

Whilemuchattentionshouldbeplacedonthedesignandimplementationofintegratedclinicaleducation,planningforandcompletingawell-roundedassessmentisalsorequired(Weddle&Sellheim,2009).Outcomeassessmentofstudentlearning,overallcoursesuccess,andtheintegratedclinicaleducationprogramdesignarethreetargetedareasforconsideration.Selectionofvalidandreliableoutcomemeasuresthatprovidefacultyandstudentssummativeandformativefeedbacktoguidelearningisimperative.Table2providesanexampleofoutcomemeasuresusedandtypeofdatacollectedthathaveguidedacademicprograms.Itisimportanttonotethatnoattemptsweremadetocomparemodelsoroutcomedata;ratherthedatageneratedprovidedathematicanalysisofimportantconceptswithintheliterature.

Despitethefactchallengesineducationalresearchexist(Jensenetal,2016),itbehoovesourprofessiontocontinueresearchingoutcomesofinnovativecurricularmodels,includingintegratedclinicaleducationexperiences,tocontinuetostriveforexcellenceinphysicaltherapisteducation.Therefore,furtherinvestigationintobestpracticeforICEexperiencesshouldcontinueinacollaborativemannerbetweeninstitutionaladministrators,academicphysicaltherapyfaculty,clinicalfaculty,patients,andstudents.Itishungerforimprovementthatpushesboundariestopromoteexcellence(Fullan,2005).

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STUDENTREADINESSSTRATEGICINITIATIVEPANELFinalReportJune2017

BACKGROUNDTwooftheSummitrecommendationsincludedaspectsofensuringconsistentpreparationofstudentsforvaryinglevelsofclinicaleducation.Thisconsistencywasdescribedas‘arequisitecoresetofknowledge,skills,attitudesandprofessionalbehaviors’(RecommendationIX)and‘clinicalcoreperformancecompetencies’(RecommendationX)foreachlevelofclinicalexperience,includingearlyclinicalexperiences.Athirdrelatedrecommendationsuggeststheneedfordefiningentry-levelgraduatecompetencewhichiscontemporaryandadaptabletoachanginghealthcareenvironment(RecommendationXI).ThechargefortheStudentReadinesspanelconsideredaddressedrecommendationsIXandX.CHARGETheACAPTStudentReadinessStrategicInitiativePanelwillidentifyanddefineacoresetofcompetencies(knowledge,skills,attitudesandprofessionalbehaviors)thataretobedemonstratedbystudentspriortoentryintofull-timeclinicaleducation.FortheperiodofOctober2015throughOctober2017theACAPTBoardofDirectors’determinedthechargefortheACAPTStudentReadinessTaskForceas:

1. Investigateanddescribemodelsofcompetencyassessmentusedacrossotherhealthprofessions

2. Proposetwoformatoptionsforestablishingcompetenciestotheboardmembership3. Collectbroad-based,representativedataonminimumcompetencysfromthephysicaltherapy

practicecommunity4. Onceapreferredmodelisselectedandminimumcompetenciesareidentified,proposebaseline

expectationsandcriteriaforminimumcompetencies(knowledge,skills,attitudesandprofessionalbehaviors)thatmustbemetwithintheacademicprogrambystudentpriortoprogressingintofull-timeclinicaleducationexperiences.

5. Developguidelinesforacademicprogramstoimplementthesecompetencyrequirementswithintheircurriculum.

AcallforvolunteersforthisStudentReadinessStrategicInitiativePanelwasmadeinthefallof2015withmembersappointedinDecemberof2015.TheStudentReadinessStrategicInitiativePanelconsistsofa12-memberteamwithawealthofinformationandexperience.Thereare4DirectorsofClinicalEducation,2CenterCoordinatorsofClinicalEducation,2AcademicFaculty,3ProgramDirectors,and2AssociateDeans.TheACAPTLiaisontothegroupisShawneSoper,PT,DPT,MBA.

SUMMARYOFWORKThepanelmetatCSM2016andbeganreviewingliteraturefromdifferenthealthprofessionsincludingmedicine,pharmacy,nursing,speech,athletictrainingandoccupationaltherapy.Thepanelinvestigatedthevariedcompetencyexpectationsofthedifferentprofessionsaswellaswhenandhowtheyassessedstudentsatvariouspointsalongtheircontinuumoflearning.Thisinformationwascollectedandsummarizedtomeetthefollowingcharge:Charge1:Investigateanddescribemodelsofcompetencyassessmentusedacrossotherhealthprofessions.

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Competencybasededucationtraining(CBET),whichisdefinedastheabilitytoperformataskoractivitysuccessfullyandefficiently,islearner-centeredandbeganintheteachereducationreformmovementofthe1960s(Sullivan,1995).AccordingtoShah(2016),competencyis“theabilityofahealthprofessionalwhichcanbeobserved.Itencompassesvariouscomponentssuchasknowledge,skills,values,andattitudes.”Astudentappliesthesecompetenciesinanactualsettingandoncetheycantheyareconsideredcompetent.Competency-basededucationinthehealthcareprofessionshasbecomeaprominentapproachtopostgraduatemedicaltraininginCanada,theNetherlands,theUnitedKingdom,theUnitedStates,andmanyothercountries.Otherhealthprofessions,suchasnursing,haveusedcompetencyframeworksfordecades,whileothers,suchasdentistry,havedescribedtherequiredcompetenciesoftheirprofessionsmorerecently.Thenursingprofessionembracesavarietyofeducationalprogramsandtrackstheirlearnersthroughoutacontinuumincludingcompetencyattheassociate,bachelors(AACN,2008),masters(AACN,1996;AACN,2011),andatthedoctorofnursingpractice(DNP)level(AACN,2006).Formedicaleducation,theAssociationofAmericanMedicalColleges(AAMC)haspublishedguidelinesformedicalschoolstofollowindesigningtheirpre-clinicalcurriculum(AAMC,2008).Thisdocumentoutlines12competencyareasformedicalstudentstoachievebeforeembarkingonclinicalclerkships:professionalism,patientengagementandcommunicationskills,applicationofbiomedicalknowledge,history-taking,patientexamination,clinicaltesting,clinicalprocedures,informationmanagement,diagnosis,clinicalintervention,prognosis,andpersonalizingpatientcare.Thedocumentprovidesaseriesofrecommendationstoguidemedicalschoolsindesigningcurriculathatenablestudentstoachievethesecompetencies.Oncemedicalstudentscompletetheirclerkshipsandgraduatefrommedicalschool,mostprogresstospecialtyresidencyprograms.AsaresultoftheOutcomesprojectinthelate1900s,theAAMCestablished8competencydomainsaswellasCoreEntrustableProfessionalActivities(EPAs)thatmedicalschoolgraduatesshouldachievepriortobeginningaresidency(AAMC,2014).TheseEPAsfocuson“activities”thatencompasstheday-to-dayworkoftheresidentphysicianratherthantraditionalcompetencies.TheEPAsaregenericinthattheyarenotspecifictoanyonemedicalspecialty.Foreachofthe10EPAs,thedocumentincludesdescriptionsandvignettesoflearnerswhohaveeithermetornotmettheexpectedlevelofperformance.“EPAsareobservableandmeasurableandthereforecanfunctionasaquantifiableoutcomethatcanaidintheassessmentofastudent(TenCate,2013).”

PhysicalTherapyLiterature:

Therearemanyestablishedrequirementsandcompetenciesforphysicaltherapystudentsatvariouspointsalongtheircontinuumoflearning.Therearepre-requisitesforstudentstoentertheDPTprogram(AC-4-12STANDARDPREREQUISITECOURSESFORADMISSIONINENTRY-LEVELPHYSICALTHERAPISTEDUCATIONPROGRAMS).Setting-specificcorecompetencieshavealsobeenestablished.Forexample,inpediatrics,aqualitativestudyusingtheDelphimethodbyKenyon,DoleandKelly(2013),lookedattheperspectivesofAcademicfacultyandClinicalInstructorsonEntry-LevelDPTPreparationforpediatricphysicaltherapistpractice.Theyfoundconsensusontheknowledge,skills,andabilitiesrequiredforpediatricPTpracticeatvariouspointsinthecurriculum;beforeapediatricclinicalexperience,followingapediatricclinicalexperienceandpriortoentranceintoclinicalpractice.Theauthorsalsodefinedlevelsofproficiencypertainingtoknowledgeaswellasskillsandabilitiesateachofthosepoints.Thisstudybringsforththeconceptofvariousskillsandabilitiesexpectedatvariouspointsofapediatricspecificcurriculum.AtaskforcefromtheSectiononWomen’sHealthdevelopedguidelinestoassistphysicaltherapisteducationprogramswithidentifyingspecificwomen’shealthcontentthatshouldbeincludedinentrylevelphysicaltherapyprograms(APTA:Women’sHealthSection,2014).Thestudyidentifiedcontent

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alongwithalevelofcompetencetheentry-levelstudentisexpectedtoachieverangingfromfamiliaritytomastery.Thisstudyprovidesacomprehensiveframeworkfordeterminingproficiencyofvariousskillsets.Gazsi(2011)exploredexpectationsofphysicaltherapyemployers,andacademicandclinicalfacultyregardingentry-levelknowledge,skills,andbehaviorofphysicaltherapistgraduatesinacuterehabilitationpractice.Theauthorfoundconsensusonselectentry-levelcharacteristicsandmostoftheparticipantsreportedthatnewDPTgraduatesaremeetingexpectationsintheacuterehabpracticesetting.Otherpopulationandsetting-specificcorecompetenciesforentranceintoclinicalpracticeexist,includingintegumentary,handtherapy,musculoskeletal,acutecare,andresearchtonameafew(Gazes,2011;Gorman,2010;APTA:NeurologySection,2011;Rapport,2014)

Entry-levelexpectationshavebeenreportedintheliteraturefromavarietyofviewpoints(Jette,2007;Lopopolo,2004;Mathwig,2001;Schafer,2007).AstudybyJetteetal(2007)surveyedphysicaltherapyclinicalinstructorsonwhataspectsofastudent’sperformancedemonstratethattheymeetentry-levelexpectationsforthephysicaltherapypractice.Participantsidentifiedsevenattributesincluding:knowledge,clinicalskills,safety,clinicaldecision-making,self-directedlearning,interpersonalcommunication,andprofessionaldemeanor.Thestudydescribedbehaviorsandcharacteristicsthatclinicalinstructorsbelievecompriseentry-levelperformancealongwithadecision-makingprocessbyinstructorsthatintegratescharacteristicsintosubjectiveperceptionofanentry-levelclinician.Thestudydidnotidentifythespecificclinicalskillsneededforentry-levelphysicaltherapyperformance.

Chipchaseetal(2012)examinedthecharacteristicsofstudentpreparednessforclinicallearningfromtheperspectiveofclinicaleducators.Thestudyidentifiescertainbehaviorssuchaswillingness,professionalism,andcommunicationasbeingmostimportantwhenenteringaclinicalexperience.Thisstudyfocusesonthestudentphysicaltherapistastheyenterclinicalexperiences,notonthebehaviorsrequiredforentry-levelpractice.Itidentifieskeybehaviorsandcharacteristicsfromtheclinicaleducator’sperspectiveonreadiness.However,itdoesnotprovideaconsensusamongstotherstakeholdersincludingacademicfacultyanddirectorsofclinicaleducation,whoareallintegrallyinvolvedinclinicaleducation.Nordoesitprovidelevelsofcompetenceneededintheknowledge,skillsandattitudesidentified.TheAmericanPhysicalTherapyAssociationhasdevelopedaframeworkidentifyingminimumrequiredskillsofphysicaltherapistgraduatesatentry-level(APTA,2005),howeverresearchstilldemonstratesthatdisparityexistsinperceptionsofwhatconstitutesentrylevelperformance.Withtheinceptionofthefirstresidencyandfellowshipeducationprogramsin2000,researchhasbegantoexaminecompetenceatthepost-professionallevel.ArecentpublicationbyFurzeetal(2016)lookedatPTResidencyandFellowshipEducation:ReflectionsonthePast,Present,andFuture.Theauthorsproposed7domainsofcompetence,similartothe8frommedicine,whichinclude:knowledgeofpractice,inquiryskills,clinicalskills,clinicalreasoning,systems-basedapproach,communication,andprofessionalism.Thesedomainsarethoughttotheoreticallygroundresidencyandfellowshipprogramsandfacilitateamoreconsistentapproachtocurriculardevelopmentandassessment.

Studiesfromvarioushealthprofessionsthathaveexaminedstudentreadinesshaveincludedsimilartermssuchasknowledge,skillsorabilities,aswellasthoserelatedtotheaffectivedomainincluding:attitudes,andprofessionalbehaviors.Whilethetermsbetweenthedifferentstudiesaresimilar,tobeclearmovingforwardwewillcallthetotalityofanythingthatisimportantforastudenttodemonstratepriortoaclinicalexperienceastheKSAs.AshealthcareprofessionsbegintoidentifytheessentialKSAsthatarerequiredatvariouspointsintheeducationalprocess,thequestionofhowtoassessthesecomponentsarise.Thehealthprofessionsliteraturedemonstratesavarietyoftoolsorassessmentstrategiesthatcanbeutilizedforpsychomotorandcommunicationskillsaswellasknowledgeand

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professionalbehaviorassessment(Peterson,Calhoun,andRider,2014;Zhuetal.,2017;Zarifsanaiey,Amini,andSaadat,2016;May,1995).Inmedicine,Competency-basedmedicaleducation(CBME)servesasthefoundationfortheNextAccreditationSystem(NAS)(ACGME,2016).ThissystemincludestheMilestonesandClinicalCompetencyCommittees(CCC),bothofwhicharedesignedtomonitorandcontinuallyimproveeducationaloutcomes,andthereforeclinicaloutcomes,attheleveloftheindividuallearnerandtheprogram(ACGME,2016).

Acompetencyisachievedgradually,step–by-step.Thesestepsaredesignatedasmilestones(Shah,2016).Milestonesdescribeperformancelevelsresidentsandfellowsareexpectedtodemonstrateforskills,knowledge,andbehaviorsintheclinicalcompetencydomains(ACGME,2016).Theylayoutaframeworkofobservablebehaviorsandotherattributesassociatedwitharesident’sorfellow’sdevelopmentasaphysician.Theyarecompetency-baseddevelopmentaloutcomesthatcanbedemonstratedprogressivelybyresidentsandfellowsfromthebeginningoftheireducationthroughgraduationtotheunsupervisedpracticeoftheirspecialties.AccordingtotheMilestoneGuidebook(2016),“Residents/fellowsareassessedroutinelythroughacombinationofassessmenttools.Theseinclude:directobservations;globalevaluation;auditsandreviewofclinicalperformancedata;CaseLogs;multisourcefeedbackfromteammembers,includingpeers,nurses,patients,andfamilies;simulation;in-servicetrainingexaminations(ITEs);self-assessment;andothers.”AnoverviewofthissystemisdepictedbelowinFigure1.

Figure1:OverviewofProfessionalSelf-RegulatoryAssessmentSystemintheU.S.

Physicaltherapyeducationliteraturehasbeguntoidentifyevaluationtechniquesaswellasspecificrubricsthatcanbeutilizedforvariousknowledge,skillsandbehaviors(Kanadaetal.,2016;Christensenetal.,2017;AndersonandIrwin,2013;Furzeetal.,2015).However,thereliabilityandvalidityofthesetoolsmustbeconsideredwhendecidingontheirusewithinindividualPTprograms.Beforeonecantrulydeveloptheappropriateassessmentsystem,theminimalknowledge,skills,andabilitiesandatwhatlevelofproficiencymustfirstbeidentified.

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Competencybasededucationandsubsequentassessmentispresentthroughoutvarioushealthprofessions.Themedicalprofessionseemsmostevolvedandcanprovideuswithastructureandprocessthatwemightwanttoconsiderassuchsystemsaredevelopedforphysicaltherapisteducation.Charge2:Proposetwoformatoptionsforestablishingcompetenciestotheboardmembership.

Thepaneldiscussedvariouspossibleoptionstoestablishcompetenciesincludingobtainingconsensuswithinourpanel,focusgroups,consensusconference,surveys,andaDelphistudy.Toachievetheaimofourpanel,thegroupselectedtheDelphimethodofconsensusdevelopment.ADelphistudyallowsindividualswithexpertiseandinsighttoprovideinformationandtoreachconsensusonaparticulartopic.Thismethodengagesagroupofparticipantsorexpertsovermultipleroundsofsurveystoestablishaconsensusontheparticulartopicofinterest(Keeney,2011;Soma,2009).ThepurposeofthisDelphistudywastogainconsensusonthepre-requisitesforstudentsenteringafirstfull-timeclinicaleducationexperience,specificallyfocusingonwhatattributessignaledreadiness.Thisreadinessforthefirstfull-timeclinicaleducationexperiencewouldberelevantregardlessofwhereitfallswithinaprogram’scurriculumortheparticularsettinginwhichtheexperiencetakesplace.

GiventhevariabilityofcurriculuminCAPTEaccreditedphysicaltherapyprogramsaswellastheplacementofclinicalexperienceswithinthatcurriculum,thepanelthoughtitbesttobeginwithastudentsentranceintothefirstfull-timeclinicaleducationexperience.ThepanelalsofeltthattheearlyclinicalexperiencescanbeinanypracticesettingandareoftenthemostchallengingforDCEs/ACCEstofindstudentplacements,ascliniciansarereluctanttotakeonastudentwhileontheirfirstclinicalexperience.Startingwithcompetenciesforthisexperiencewouldonlybeonepointalongthecontinuumoflearningwherestudentswouldbeassessedbutwasanimportantplacetostart.Akeyfeaturetocompetency-basededucationalprinciplesistheincreasedemphasisonassessment,especiallyongoing,longitudinalassessmentthatenablesthefacultytomoreaccuratelydeterminethedevelopmentalprogressofthelearner,aswellastohelpthelearnerthroughfrequentfeedback,coaching,andadjustmentstolearningplans(Holmboe,2010;Kogan,2013).TheDelphimethodwasidentifiedasthemostpracticalmethodtogainconsensusamongthevariousmembersofthephysicaltherapypracticecommunity.

Aspreviouslymentioned,thepanelchosetheDelphimethodasameanstoobtainconsensusontheknowledgeskills,attitudesandprofessionalbehaviorsforentranceintothefirstfulltimeclinicaleducationexperienceandtoalsoaddresscharges3and4:

Charges3and4:Collectbroad-based,representativedataonminimumcompetencyexpectationsfromthephysicaltherapypracticecommunity

Onceapreferredmodelisselectedandminimumcompetenciesareidentified,proposebaselineexpectationsandcriteriaforminimumcompetencies(knowledge,skills,attitudesandprofessionalbehaviors)thatmustbemetwithintheacademicprogrambystudentpriortoprogressingintofull-timeclinicaleducationexperiences.

Toobtainagroupofexpertparticipants,inNovember2016allACAPTmemberinstitutionswerecontactedandaskedtonominate4individualswho,basedontheirexposureandexperience(definedbelow),wouldbeabletoreflectandprovidetheirexpertopinionsandinsightsonstudentreadiness.TheprogramdirectorsofACAPTmemberinstitutionswereaskedtonominate:

• OneAcademicfacultymember(5yearsofexperienceasaCoreFacultymember)• OneDirectorofClinicalEducationorAcademicCoordinatorofClinicalEducation(5yearsof

experienceasaDCE/ACCE)• OneRecentGraduate(withinthepast8months,withsuccessfulpassageofthelicensureexam)

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• OneClinicianwhoserves(orwhohasserved)asclinicalinstructorforDPTstudents(atleast5firstfull-timeexperiencestudents);thisparticipantwasnominatedspecificallybytheprogram’sDCE/ACCE.

Programdirectorswereaskedtoforwardaninvitationemailtotheseindividualsandparticipantsindicatedtheirwillingnesstoparticipatebyrespondingtooneoftheresearchers.Specificquestionsinthefirstroundsurveyweredesignedtoconfirmthatparticipantsmettherelevantinclusioncriteria.Thesurveyfirstroundsurveywasdevelopedbasedontheinputofanexpertreviewpanelthatprovidedfeedbackandassistanceonindividualsurveyquestionsandinstructions.Thisfirstroundsurveyconsistedofaseriesofdemographicquestions(basedontheparticipantsgroup)aswellasopen-endedquestionswhichaskedparticipantstothinkabouttheirexperienceswithstudentsastheybegantheirfirstfull-timeclinicalexperience.Participantswereaskedtodescribethestudentthattheywouldconsiderreadyforthisclinicalexperienceandlisttheitemstheyconsideredrequisiteforastudentontheirfirstfulltimeclinicalexperience.Participantswereinstructedtoconsiderthisreadinessregardlessofwhenthefirstfull-timeexperienceoccurredwithinthestudent’sacademiccurriculumorthesettinginwhichthatfirstexperiencetookplace.Participantswerealsoaskedhowtheycouldknowormakethedeterminationthatthestudenttheydescribedwasreadyfortheclinicalexperience.InaccordancewiththeDelphimethod,surveysinsubsequentroundsthenbuiltontheresponsescollectedinpreviousrounds.ThesecondroundsurveyprovidedalloftheuniqueresponsestothequestionsfromRound1withregardtoreadinessandgatheredinformationaboutclarityandredundancyintheitemsprovided.Inordertocreatethesecondroundsurvey,theresearchersconductedcontentanalysisofthefirstroundresponsesandplacedtheresultsinbroadcategoriestoprovideorganizationtothedatainthemes.Researchersworkedinteamstoanalyzeinformationfromindividualstakeholdergroupsfirstandthencametogethertocompletethecontentanalysisoftheentiresetofdatafromthefirstround.Responsestothesecondroundsurveywerealsoanalyzedbyresearchersinsmallteamsinordertoconsolidateareasofredundancyandtoimproveonclaritybasedonparticipantfeedback.Wheneverthereweredisagreements,thegroupengagedindiscussionandconsensusonthefinalwordingormethodofconsolidationofitems.Thethirdroundaskedparticipantstoranktheiragreementwiththeremainingitems(within14identifiedthemes)usinga5-pointLikertscale(stronglyagree–stronglydisagree).Thisprocessidentifiesareasofconsensusonthoseitemsthatareessentialtostudentreadinessforafirstfulltimeclinicalexperience.Inthefourthroundparticipantsprovidedthelevelofproficiency,asdefinedinTable5,theyconsideredastudentshouldbeexpectedtoachievetodemonstratereadinessoneachitemthatachievedconsensusinRound3(>80%agreement).Ineachround,participantswereinvitedtoprovidecommentsandfeedbackonitemsandthemes.Afinalstepinthefourthandfinalroundwastoindicatethetypesofassessmentsthatwouldbeappropriatefordeterminingreadinessforeachthemeidentified.Thelistofavailableassessmentsprovidedforselectionwasgeneratedfromparticipantresponsestoquestionsfromthefirstroundsurveyonhowtodetermineorassessforreadiness.Results:

Surveysweredistributedtothe147individualswhoacceptedthenomination(39Academicfaculty,34DirectorsofClinicalEducation,37ClinicalInstructorsand38recentgraduates).ThetotalresponserateforRound1was88.4%,with130round-onesurveysreturned(Table1).Respondentstothesurveyrepresentedabroadgroupofstakeholdersdeeplyinterestedinclinicaleducation.TheywereaffiliatedwithDPTprogramsacrossallregionsoftheUnitedStates(Table2).

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RespondentsfromallcohortsrepresentedaffiliationswithDPTprogramsfromacrossthecountrybutfocusedprimarilyinurbanandsuburbanareas.Thetypicalprogramhadfourclinicaleducationexperiences,rangingfromatotalof30to54weeksoffulltimeclinicalexperiences(average=36weeks).Themajorityofprogramaffiliatesreportedtheirfirstfulltimeclinicalexperienceoccurredattheendofthefirstyearofthecurriculumand10respondentsindicatedthattheirfirstfulltimeclinicalexperiencebeganfollowingconclusionofalldidacticeducation.Somequestionswerespecifictoastakeholdergroupandthereforenotallgroupswerequeried.Forexample,thenumberofweeksonthe1stclinicalexperiencewasaskedofrecentgraduatesonly.Thoseindividualswithapreferenceofsettingforthefirstfulltimeclinicalexperiencepreferredoutpatientorthopedicoracutecare(Table3).Responsesregardingelementsofcompetencyfromeachcohortwereconsolidated,duplicateseliminated,andgroupedintotwentythemes.Eachthemehadbetweenoneand27supportingelements(total=193).Allthemesandelementswerereturnedto132participantsforconsiderationinRound2.Recommendedmethodsofassessingtheelementswerealsoconsolidatedacrossallgroupsanddistilleddowntoeight,whichrepresentabreadthofassessmentintheDPTcurriculum.Onehundredandfivesurveyswerecompletedandreturnedduringroundtwo(79.55%).Responseswerereviewedandclarificationsandeliminationswereexecutedbyconsensusoftheresearchteam.Roundtworesultedinconsolidationofsixthemesandtheconsolidationoreliminationof54elementsduetosimilarityorredundancy.ThemesandelementsderivedfromeachroundofdataanalysisarereportedinTable4.Thefinalremaining14themesandtheir139elementswerereturnedtoparticipantsinthethirdround.Onehundredthirty-twosurveysweredistributedinroundthreeand104(78.79%)werereturned.All14themesachievedgreaterthan80%agreementalongwith95specificelements.The44elementsthatdidnotachieve80%consensusweredeemedlessimportantornotessentialbyparticipantsandwereeliminatedfromthefinallistforroundfour.AppendixAcontainsthelistofthemesalongwiththelevelsofconsensusachievedforthe95survivingelements.AppendixBcontainsthe44elementseliminatedbythemeandthepercentconsensusachieved.

InthefinalroundofthisDelphisurvey,surveysweresenttothesame132ongoingparticipantsand104(78.79%)responseswerereceived.TotalresponsesbyroundarereportedinTable4.Basedongroupconsensusasestablishedbythe80%threshold,only9elementswereidentifiedasrequiringproficiencypriortothefirstfull-timeclinicalexperience(Table6).Themajorityoftheseelementsfellintheareaofprofessionalbehaviorswhileotherssurroundedsuccessfulacademicperformance.Therewasgeneralagreementbetweenstakeholdersforelementsdeterminedtorequireproficiencypriortothefirstclinicalexperience(AppendixA).Onlyfourelementsthatoneofthestakeholdergroupsreportedasrequiringproficiencydidnotreachthelevelneededtoreachachieveoverallconsensus.TwooftheseelementsbelievedbyexperiencedclinicalinstructorstobecriticalpriortothefirstclinicalexperiencewererelatedtoworkethicandthefamiliarityandadherencetothecorevaluesoftheAPTA.Recentgraduatesvaluedtwoelementshighlythatdidn’treachthelevelofoverallconsensus.Thesewererelatedtothewillingnesstoseek,andbereceptiveto,feedback.

ParticipantsratedthevastmajorityofelementsasrequiringatleastanEmerginglevelofmastery(ratingsofEmergingorProficient)priortobeginningthefirstfulltimeclinicalexperience(AppendixA).Therewere,however,34elementsthatdidnotachievethelevelofconsensusrequiredtoindicatethattheybemorethanFamiliartothestudentpriortothefirstfulltimeclinicalexperience(AppendixA).

Assessment:Respondentsidentifiedtheirpreferredmethodofassessingcompetenceineachofthefourteenthemesduringroundfour(Table7).Usingthepredeterminedlevelofconsensusof80%there

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were1to3methodsofassessmentthatreachedconsensusforeachtheme.Themesrepresentativeofthecognitivedomainwereidentifiedasbestassessedthroughwrittenexamsorskillschecks,whilethoseintheaffectivedomainwereidentifiedasbestassessedthroughfacultyandstudentassessment.Participantsreachedconsensusonassessingpsychomotorskillsthroughpracticalexaminationperformance.Discussion:

Asaresultofthisprocessthefindingshaveconfirmedthoseofpreviousstudies(Roach,2012;Kenyon,2013;May,1995)thathighlighttheimportanceearlyon,ofskillswithintheaffectivedomain.Inparticular,communicationandprofessionalism.

Theresultswereanalyzedbyeachstakeholdergroup,aswellasthenumericalaverageacrossgroups(combinedstakeholders).Therewere95elementsthatthecombinedstakeholdersagreedwereappropriateforreadinessforafirstclinicalexperience.Nineelementswereidentifiedasrequiringproficiencypriortothefirstfull-timeclinicalexperience(Table7).Threeofthenineweredichotomouschoices(accomplished/presentornot)whichthecombinedstakeholdersagreedshouldbepresent:studentsshouldhavetheminimumacademicGPA,meetminimumexpectationsforacademicpracticalexaminations,andhaveresolvedanyandallsafetyconcerns.The6additionalelementsfellintheareaofprofessionalbehaviorsalsoshowninTable7:demonstrationofpolite,personable,engagingandfriendlybehaviors;introductionofone’sselftoCI,clinicalstaff,andpatients;respectforpatients,peers,healthcareprofessionals,andcommunity;punctualitywithallassignments;understandingofHIPAAregulations;andappropriatedresscode.Thus,wehadconsensuson9elementsasessentialforreadiness,withaneedtobeproficientpriortothefirstfulltimeclinicalexperience.Whenlookingattheremaining86elementstherewere4elementsthatdidnotreceiveanoverallconsensusof80%foraparticularlevelofproficiency,butdidachieve80%proficiencyinatleastonestakeholdergroup.Theseincludeappropriateworkethic,whichachievedthresholdconsensusintheclinicalinstructorandrecentgraduategroups;corevaluesidentifiedbytheAPTA,whichachievedconsensusintheclinicalinstructorgroup;beingopenandreceptive,verballyandnon-verbally,whichachievedconsensusintherecentgraduategroup;andseekingassistancewhenneeded,alsointherecentgraduategroup.AsseeninAppendixA,theresultsfromemergingandproficientlevelsofproficiencywerecombined.Bydoingsowefoundthatthereare58itemsthatparticipantsfeltthatstudents,ataminimum,hadtodemonstrateatleastanemerginglevelofproficiency.Thisinformationcanbequitehelpfulforacademicprogramsinthattheymayneedtoincreasetheamountofcontentcoverageinthisareasothatstudentshaveabitmoredepth.Justbeingfamiliarwouldnotbesufficient.Findingsfromthisstudycanassistprogramsintheircurriculardevelopmenttostrategicallyplacecoursesthatcovercontentthatstudentswillneedtoknowpriortothefirstclinicalexperience.

RECOMMENDATION1:

Thatthelistofknowledge,skills,andabilities(KSAs),groupedinto14themes,requiringstudents’demonstrationofcompetencepriortoenteringtheirfirstfull-timeclinicalexperienceasshowninAppendixC(FirstFull-timeClinicalExperienceKSAs)beadopted.

SS:Academicprogramsshouldbeencouragedtoprovidestudentswiththeappropriateeducationalexperiences/modulessothatthestudentmayachievethelevelofproficiencyindicatedforthesaiditems(AppendixA).Thisinformationwouldensureconsistentpreparationpriortoastudent’sfirstfull-

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timeclinicalexperience.Giventhisinformation,clinicalinstructorscanbeconfidentthatstudentswouldbegintheirclinicalexperiencewithcompetencyintheseitemsandcanthereforedevelopandprovideamoreappropriatelearningenvironmentforastudenttocontinuetogrow.Theformatofthethemesandelementsmaybestartingpointsforthepotentialdevelopmentofentrustableprofessionalactivitiesandcompetencymilestonesthatwouldbeapplicabletoallstudentsinphysicaltherapisteducationpriortoentranceintotheirfirstfull-timeclinicalexperience.

RECOMMENDATION2:

ThatACAPTdevelopaplan,includinganimplementationtimeline,toguidephysicaltherapisteducationalprogramsinimplementingtheuseoftheFirstFullTimeClinicalEducationExperienceKSAs.Thisplanshallalsoincludeguidanceoncommunicationtoclinicalpartners.

SS:AdoptingtheidentifiedKSAsisanimportantfirststepofthisinitiative.TheparticipantsintheSummitclearlyidentifiedaneedforconsistencyinthelevelofcompetenceofstudentsenteringtheirfirstfulltimeclinicalexperience.ThissetofKSAsprovidestheminimalexpectationsforthosestudents.InorderfortheeducationalprogramsandclinicalpartnerstoimplementtheseKSAs,additionalconsiderationstocommunication,assessment,expectations,andtimelinesneedtobeconsidered.

RECOMMENDATION3:

ThatACAPTencouragephysicaltherapisteducationalprogramstoevaluateandmakeappropriatechangestotheircurriculumtoenablestudentstoachievecompetencyintheFirstFull-timeClinicalExperienceKSAs.

SS:Asdescribedabove,theclinicalsitesareanxiousforastandardsetofcompetenciesthatallfirstfull-timestudentshaveachievedpriortoarrivingintheirclinics.Onestepinachievingthisgoalrequireseducationalprogramstoassesstheircurriculumanddetermineifchangesareneededtoenablestudentstoachievethedescribedlevelsofcompetence.ManyprogramslikelyhavethecomponentsinplacethatenablestudentstomeettheseKSAs;otherprogramsmayneedtomakeonlysmallchangestoachievethisgoal;andstillothersmayneedtoconsidershiftintheprogramdesign.Inanycase,beingresponsivetotheSummitrecommendationsandthusthevoiceofourclinicalpartners,startswithanassessmentofcurrentstateandnecessarychanges.

RECOMMENDATION4:

Thatstudentreadinesspriortoentranceintotheclinicalpractice(entry-level)beexaminedasthenextsteptoachievingtheSummitrecommendationsrelatedtoreadinessandcompetency.

SS:Thispanelfocusedonstudentreadinessforentranceintothefirstfull-timeclinicaleducationexperience.Itrepresentsonemomentalongastudent’scontinuumoflearning.TheSummitparticipantsidentifiedtheneedforadditionalpointsofcompetenceassessment.

Thevariabilityofnumber,length,andtimingofclinicalexperienceswithinphysicaltherapistcurriculamakestandardizationofcompetenceexpectationsatseveralpointsalongthestudent’seducationimpossible.ThisrealizationledtheStudentReadinesspaneltochoosethepointofentryintothefirstfull-timeclinicalexperienceasacommonpointthatwasappropriateforstandardization.

Theothertwopointsintimethatlendthemselvestostandardcompetenceassessmentarepriortoentryintothefinalfulltimeclinicalexperienceandjustpriortoentryintopractice.Identifyingstandardelementsofcompetencethatshouldexistaftercompletionofalldidacticandclinicalcourseworkwillprovidevaluableinformationtoclinicalinstructorsandensureacommonlevelofpreparationforstudentsatthatphaseoftheireducation.

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RECOMMENDATION5:

ThatACAPTsupporttheneededcollaborativeeducationalresearchtodeterminethemostappropriatetypesofassessmentsofstudentreadinessandatimelineforimplementation.

SS:ParticipantsindicatedthevariousassessmentmethodsthatcanbeutilizedforeachitemthatachievedconsensusintheDelphistudy(Table7).Thislistisnotmeanttobeprescriptivebuttoprovideoptionsforacademicprograms.TheseitemsreflectcurrentmethodsofassessmentandmaynotbethemostconnectedtowhatisusedinCBME.NowthatconsensushasbeenachievedontheKSAsstudentsmusthaveordisplayandgiventheimportanceofassessmentandevaluationincompetency-basededucation,additionalresearchtodeterminethebestassessmentmethodsiswarranted.Bestpracticeshouldbeutilizedtodevelopacontinuedandfrequentassessmentprocesstoensurephysicaltherapiststudentsachievethemilestonesattheappropriatetimeintheircontinuumoflearning.

Competency-basedphysicaltherapistclinicaleducation(CBPTCE)necessitatesarobustandmultifacetedassessmentsystem.Theleadershipwithinourprofessionmustattendtothecontextofthemultiplesettingswhereclinicaleducationoccurs.CBPTCE,likeCBME,furtherrequiresassessmentprocessesthataremorecontinuousandfrequent,criterion-based,developmental,work-basedwherepossible,useassessmentmethodsandtoolsthatmeetminimumrequirementsforquality,usebothquantitativeandqualitativemeasuresandmethods,andinvolvethewisdomofgroupprocessinmakingjudgmentsaboutstudentprogress.Inaddition,ashiftinthinkingneedstooccurfromassessmentoflearningtoassessmentforlearning.Researchintothequalityofassessmentprograms,howassessmentinfluenceslearningandteaching,newpsychometricmodelsandtheroleofhumanjudgmentismuchneeded(Schuwirth&VanderVleuten,2011)

TheStudentReadinessStrategicInitiativePanel’srecommendationcomplimentswiththerecommendation#5bytheExcellenceinPhysicalTherapyEducationTaskForce(APTA,2015).Theynotetheprofessionshouldsupportthedevelopmentofastandardizedassessmentforphysicaltherapiststudentspriortoenteringtheirterminalclinicalexperience.Theassessmentwouldevaluatestudents’readinessfortheclinicaleducationandassistinimprovingrelationshipswithclinicaleducationsitesbysettingconsistentstandardsforstudentsbeforetheybegintheseexperiences.Theassessmentmayalsodecreaseunwarrantedvariationinstudentpreparation,whichwoulddecreasetheburdenonclinicalsitesduetodifferencesincurriculumacrossprograms.

MEETINGHISTORYFacetofacemeetingswereheldatCombinedSectionsMeeting(2016and2017),aswellastheEducationalLeadershipConference.

TheentirePanelheldthree-conferencecalls/monthfromFebruary2016–June2017.Inaddition,sub-groupsmetasneededduringthistimeframe.

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REFERENCES:

AccreditationCouncilforGraduateMedicalEducation(ACGME)OutcomeProject.Accessedhttp://www.acgme.org/outcomeAccreditationCouncilforGraduateMedicalEducation(ACGME)TheMilestoneBook,Version2016.http://www.acgme.org/Portals/0/MilestonesGuidebook.pdf?ver=2016-05-31-113245-103AccessedMay1st,2016.AccreditationCouncilforGraduateMedicalEducation(ACGME)ClinicalCompetencyCommittees;AGuidebookforPrograms.http://www.acgme.org/Portals/0/ACGMEClinicalCompetencyCommitteeGuidebook.pdf?ver=2015-11-06-115643-130AccessedMay1st,2017.AmericanAssociationofCollegesofNursing.TheEssentialsofMaster’sEducationforAdvancedNursingPractice.1996.http://www.aacn.nche.edu/education-resources/MasEssentials96.pdfAccessedMay1st,2016.AmericanAssociationofCollegesofNursing.TheEssentialsofDoctoralEducationforAdvancedNursingPractice.2006.http://www.aacn.nche.edu/publications/position/DNPEssentials.pdfAccessedMay1st,2016.AmericanAssociationofCollegesofNursing.TheEssentialsofBaccalaureateEducationforProfessionalNursingPractice.2008.http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdfAccessedMay1st,2016.AmericanAssociationofCollegesofNursing.TheEssentialsofMaster’sEducationinNursing.2011.http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdfAmericanAssociationofCollegesofNursing.EssentialsofCollegeandUniversityEducationforProfessionalNursing:FinalReport.Washington,DC:AmericanAssociationofCollegesofNursing;1986.AmericanPhysicalTherapyAssociationBoardofDirectors.ExcellenceinPhysicalTherapyEducationTaskForceReport.Alexandria,VA:AmericanPhysicalTherapyAssociation;2015.AmericanPhysicalTherapyAssociation.NormativeModelofPhysicalTherapistEducation.Alexandria,VA:AmericanPhysicalTherapyAssociation;2004.AmericanPhysicalTherapyAssociation.Minimumrequiredskillsofphysicaltherapistgraduatesatentry-level:BODG11-05-20-49[Guideline].AmericanPhysicalTherapyAssociationWebsite.http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BOD/Education/MinReqSkillsPTGrad.pdf.UpdatedOctober1,2013.AccessedApril,2016AmericanPhysicalTherapyAssociation:Women’sHealthSection.GuidelinesforWomen’sHealthcontentinprofessionalphysicaltherapisteducation:2014Update.http://www.womenshealthapta.org/wp-content/uploads/2014/05/SoWH-DPT-Curricular-Content-Guide-2014-1.pdfAccessedApril,2016.

95

AmericanPhysicalTherapyAssociation:NeurologySection.Neurologicentry-levelcurricularcontentintegratedwithanormativemodelofphysicaltherapistprofessionaleducation.2011.http://www.neuropt.org/docs/default-document-library/2011_neurologic_entry-level_curriculum_guidelines7E676FEAFF3D.pdfAccessedDec.2016.AndersonDKandIrwinKE.Self-assessmentofprofessionalisminphysicaltherapyeducation.Work.2013;275-281.AssociationofAmericanMedicalColleges(AAMC).RecommendationsforPreclerkshipClinicalSkillsEducationforUndergraduateMedicalEducation;TaskForceontheClinicalSkillsEducationofMedicalStudents.2010https://www.aamc.org/download/130608/data/clinicalskills_oct09.qxd.pdf.pdfAccessedMay1st,2017.

AssociationofAmericanMedicalColleges(AAMC).CoreEntrustableProfessionalActivitiesforEnteringResidency.2014.https://www.aamc.org/download/379308/data/coreentrustableprofessionalactivities.pdfAccessedMay1st,2017.

CanMEDS2000Project.SkillsfortheNewMillennium.ReportoftheSocietalNeedsWorkingGroup,Ottawa,September1996.ChipchaseLS,ButtrumPJ,DunwoodieR,HillAE,MandrusiakA,MoranM.Characteristicsofstudentpreparednessforclinicallearning:clinicaleducatorperspectivesusingtheDelphiapproach.BMCMedicalEducation.2012;12:112.https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-12-112ChristensenN,BlackL,FurzeJ,etal.Clinicalreasoning:Surveyofteachingmethods,integration,andassessmentinentry-levelphysicaltherapistacademiceducation.PTJ.2017;97(2):175-186.FurzeJA,TichenorCJ,FisherBE,JensenGM,RapportMJ.PhysicalTherapyResidencyandFellowshipEducation:Reflectionsonthepast,present,andfuture.PhysTher.2016;96(7):949-960.GazesCC.2011ExpectationsofPhysicalTherapistEmployers,andAcademicandClinicalFacultyRegardingEntry-levelKnowledge,Skills,andBehaviorofPhysicalTherapistGraduatesinAcuteRehabilitationPractice.Doctoraldissertation.NovaSoutheasternUniversity.RetrievedfromNSUWorks,CollegeofHealthCareSciences-PhysicalTherapyDepartment.http://nsuworks.nova.edu/hpd_pt_stuetd/19GormanSL,WrubleHakimE,JohnsonW,etal.Nationwideacutecarephysicaltherapistpracticeanalysisidentifiesknowledge,skills,andbehaviorsthatreflectacutecarepractice.PhysTher.2010;90(10):1453-1467.doi:10.2522/ptj.20090385Guidelinesforwomen’shealthcontentinprofessionalphysicaltherapisteducation:2014update.SectiononWomen’sHealthWebsite.http://www.womenshealthapta.org/wp-content/uploads/2014/05/SoWH-DPT-Curricular-Content-Guide-2014-1.pdf.UpdatedApril2014.AccessedDecember2016.HolmboeES,SherbinoJ,LongDM,SwingSR,&FrankJR.Theroleofassessmentincompetency-basedmedicaleducation.MedTeach.2010;32(8):676-682.

96

InterprofessionalEducationCollaborativeExpertPanel.Corecompetenciesforinterprofessionalcollaborativepractice:Reportofanexpertpanel.AmericanAssociationofCollegesofNursingWebsite.http://www.aacn.nche.edu/education-resources/ipecreport.pdf.PublishedMay2011.AccessedDecember,2016.JetteDU,BertoniA,CootsR,JohnsonH,McLaughlinC,WeisbachC.ClinicalInstructor’sperceptionsofbehaviorsthatcompromiseentry-levelclinicalperformanceinphysicaltherapiststudents:aqualitativestudy.PhysicalTherapy.July2007:87(7):833-843.KanadaY,SakuraiH,SugiuraY,etal.Developmentofaclinicalcompetenceassessmenttoolfornovicephysicalandoccupationaltherapists-amixedDelphistudy.JPhysTherSci.2016;28:971-975.KeeneyS,HassonF,MeKennaH.TlwDelphiTechniqueinNursingandHealthResearch.Oxford,UnitedKingdom;Wiley-Blaekwell;2011.KenyonLK,DoleRL,KellySP.Perspectivesofacademicfacultyandclinicalinstructorsonentry-levelPTpreparationforpediatricphysicaltherapypractice.2013;93(12):1661-1672.KoganJRandHolmboeES.RealizingthePromiseandImportanceofPerformance-basedAssessment.TeachLearnMed2013;25Suppl1:S68-74.LopopoloRB,SchaferDS,NosseLJ.Leadership,administration,management,andprofessionalism(LAMP)inphysicaltherapy:aDelphistudy.PhysicalTherapy.February2004;84(2):137-150.MathwigK,ClarkeF,OwensT,GrametP.Selectioncriteriaforemploymentofentry-levelphysicaltherapists:asurveyofNewYorkStateemployers.JournalofPhysicalTherapyEducation.2001;15(1):65-74.MayW,etal.Studentgenericabilitiesself-assessment.JournalofPhysicalTherapyEducation.1995;Neal,Ed."DukeAHEAD."Assessment.DukeUniversityHealthSystems,n.d.Web.20Sep.2015.https://dukeahead.duke.edu/educator-competencies/assessmentPetersonEB,CalhounAW,RiderEA.ThereliabilityofamodifiedKalamazooConsensusStatementChecklistforassessingthecommunicationskillsofmultidisciplinarycliniciansinthesimulatedenvironment.PatientEducationandCounseling.2014;96:411–418.RapportMJ,FurzeJ,MartinK,SchreiberJ,DannemillerLA,DibiasioPA,MoerchenVA.Essentialcompetenciesinentry-levelpediatricphysicaltherapyeducation.PediatrPhysTher.2014;26:7-18.Roach,KE,FrostJS,FrancisNJ,GilesS,NordrumJTetal.Validationoftherevisedphysicaltherapistclinicalperformanceinstrument(PTCPI):Version2006.PhysTher.2012;416-428.RouseLE.Introductiontothe2011–12ADEAAnnualProceedings.JDentEduc.2012;76:821–955.SchuwirthLWT,VanderVleutenCPM.Programmaticassessment:Fromassessmentoflearningtoassessmentforlearning.MedTeach.2011;33:478-85.

ShahN,DesaiC,JorwekarG,BadyalD,andSinghT.Competency-basedmedicaleducation:Anoverviewandapplicationinpharmacology.IndianJPharmacol.2016Oct;48(Suppl1):S5–S9.

97

SomaM,HosoiT,YaedaJ.ExploringhighpriorityresearchquestionsinphysicaltherapyusingtheDelphistudy.JPhysTherSei.2009:21:367-371.SullivanRL.1995.TheCompetency-BasedApproachtoTraining.StrategyPaperNo1.JHPIEGOCorporation:Baltimore,Maryland.TenCateO.ScheeleF.Competency-basedpostgraduatetraining:Canwebridgethegapbetweentheoryandclinicalpractice?AcadMed.2007June;82(6):542–547.TenCateO.Nutsandboltsofentrustableprofessionalactivities.JGradMedEduc.2013;5:157-158.BarrJS,GwyerJ,TalmorZ.Standardsforclinicaleducationinphysicaltherapy:amanualforevaluationandselectionofclinicaleducationcenters.Washington,DC:AmericanPhysicalTherapyAssociation;1981.WongR,AversD,BarrJ,CiolekC,KlimaD,ThompsonM.Essentialcompetenciesinthecareofolderadultsatthecompletionoftheentry-levelphysicaltherapistprofessionalprogramofstudy.AcademyofGeriatricPhysicalTherapyWebsite.https://www.geriatricspt.org/about-academy-geriatrics-physical-therapy/essential-competencies.cfm.Pub.2011.AccessedDec.2016.ZarifsanaieyN,AminiM,SaadatF.Acomparisonofeducationalstrategiesfortheacquisitionofnursingstudent’sperformanceandcriticalthinking:simulation-basedtrainingvs.integratedtraining(simulationandcriticalthinkingstrategies).BMCMedicalEducation.2016;16:294.ZhuX,YangL,LinP,etal.AssessingNursingstudents’clinicalcompetenciesusingaproblem-focusedobjectivestructuredclinicalexamination.WesternJournalofNursingResearch.2017;39(3):388-399.

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TABLES

Table1.TotalResponsesbyRound

Round1 Round2 Round3 Round4SurveysDelivered 147 132 132 132

ReturnRate 88.4% 79.55% 78.79% 78.79%ClinicalInstructor 20 20 23 24AcademicFaculty 34 32 30 32

DCE/ACCE 27 27 25 25RecentGraduates 31 26 26 23

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Table2.RespondentDemographics

ClinicalInstructors AcademicFaculty DCEs RecentGraduatesTotalRespondents: 20

6male34

10male27

2male31

9maleAverageAge: 38 54 52 26

AverageYearsofExperience:

11-15(asaclinician)

16(asafaculty)

11(asaDCE/ACCE)

<1year(asaclinician)

Entry-LevelPTDegree:Certificate

BSMPTDPT

03143

319100

01881

00031

PracticeSetting:Acutecare

HealthSystemPrivatePracticeSNF/ECF/ICF

AcademicInstitutionHomeHealth

648110

0000340

1000260

**7017301

Practice/ProgramLocation:Urban

SuburbanRural

875

2283

15102

18112

Practice/ProgramRegion:SAtlantic

MidAtlanticE.N.CentralW.N.CentralW.S.CentralNewEngland

PacificE.S.CentralMountain

213611033

546305433

534522312

343815322

ABPTSSpecialization:GCSOCSSCSNCSCVSPCS

221000

180600

440313

NA

CICertified:APTAOther

182

149

2412

NA

DCE,DirectorofClinicalEducation;ACCE.AcademicCoordinatorofClinicalEducation;ABPTS,AmericanBoardofPhysicalTherapySpecialties*Presentedasrangeofyears**Practicesettingwhererecentgraduatescompletedtheirfirstfull-timeclinicalexperience

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Table3.DPTProgramClinicalExperience(CE)Information

AcademicFaculty DCE/ACCEs RecentGraduatesAverageNumberofCEs 4 4 4AveragetotalweeksofCE 37(24-54) 36(34-43) 36(28-54)Numberofweeksin1stCE - - 71stCEfollowscompletionofalldidacticcoursework

9 1 Notasked

Timingof1stCE: Middleofthe1styear 0 1

Endofthe1styear 19 13 Beginningofthe2ndyear 5 5

Middleofthe2ndyear 4 2 NotAskedEndofthe2ndyear 3 4

Beginningofthe3rdyear 1 0 Middleofthe3rdyear 1 0

Endofthe3rdyear 0 1 PreferredSettingfor1stCE

AcuteCare 4 7*Outpatient Notasked 8 17*

Rehabilitation 3 0*Pediatrics 1 3*

HomeCare 2 1*

*Newgraduatesreportedonthesettingwheretheir1stCEwascompleted.

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Table4.ThemesandElementsDerivedfromEachRoundofDataAnalysis

*Themesaretitledfromthefirstround.Somethemesmayhavebeenreworded,oritemscondensedorredistributedinfuturerounds.

**Aselementsarenotlisted,severalthemesmayappearincomplete,asthelistedelementsarenotprovidedhere.

RetainedElementsbyRoundTheme* Round

1Round

2Round3 Round4

1.Studentsshouldhavefoundationalknowledgetosupportapplicationandsynthesisinthefollowingcontentareas:** 17 9 5 5

2.Studentsshouldmeetthespecificprogramidentifiedandcurricularrequirements 6 6 4 3

3.Studentsshouldtakeinitiativetoapplyevidence-basedpracticestrategies 8 8 4 4

4.Studentsshouldengageinself-assessment 10 6 4 45.Studentsshouldutilizeconstructivefeedback 3 3 3 36.Studentsshoulddemonstrateeffectivecommunicationabilities 4 3 3 3

7.Studentsshouldexhibiteffectiveverbal,non-verbalandwrittencommunicationabilities 15 14 10 10

8.Studentsshouldbepreparedtoengageinthelearningprocess 17 17 14 14

9.Studentsshouldbefamiliarwithelectronicmedicalrecords 1 0 0 010.Studentsshouldcompletedocumentationinaconcisefashion 1 0 0 0

11.Studentsshouldcompletedocumentationinatimelyfashion 1 0 0 0

12.Studentsshoulddevelopthefollowingelementsincludingthedocumentationof 8 10 3 3

13.Studentsshouldgatherrelevantinformationfromachartreview 1 0 0 0

14.Studentsshouldunderstandconceptsrelatedtobilling 1 0 0 015.Studentsshouldrecognizeandaddressissuesrelatedtosafepractice 19 8 8 8

16.Studentsshouldapplyclinicalreasoningandproblemsolving 6 0 0 0

17.Studentsshoulddesignexamination,evaluation,intervention,planofcareandoutcomeassessmentprocesses 10 10 6 6

18.Studentsshouldhavetheunderstandingandskilltoperformthefollowingexaminationskills:** 27 24 16 16

19.Studentsshouldhavetheunderstandingandskilltoperformthefollowinginterventions:** 18 9 6 6

20.Studentsshouldrecognizeandfollowspecificprofessionalstandards 20 12 10 10

TotalRetainedElements 193 139 95 95

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Table5.DefinitionsoflevelsofproficiencyLevel Definition

Familiarity Thestudenthasbasicknowledgeofthematerial/skill/behaviorandwillrequireguidancetoapplyitappropriatelyintheclinicalsetting.

EmergingThestudentunderstandshowtoapplythematerial/skill/behaviorsafelyandconsistentlyinsimplesituationsandwillrequireguidancetoapplytheconceptorperformthetaskinmorecomplexsituations.

ProficientThestudentcanintegratetheknowledge/skill/behaviorsafelyandindependentlyinall(simpleandcomplex)clinicalsituations.Thestudentisabletoidentifytheneedforguidanceappropriately.

Table6.Elementsachieving>80%consensusrequiringproficiencypriortothefirstfull-timeclinicalexperience

Element ClinicalInstructors

AcademicFaculty

DCEs/ACCEs

RecentGraduates

OverallPercent

ConsensusAchieveminimumGPA

MeetMinimumexpectationsforpracticalexaminations

N/A*

Remediationofanyandallsafetyconcerns

Demonstratepolite,personable,engagingandfriendlybehaviors

81.82 82.76 68.18 90.48 80.85

Introduceone’sselftoCI,clinicalstaff,andpatients

73.73 93.10 90.91 76.19 84.04

Respectforpatients,peers,healthcareprofessionalsand

community

80.95 75.86 77.27 90.00 80.43

Punctualitywithallassignments 80.95 100.00 95.45 95.24 93.55UnderstandingofHIPAA

regulations78.95 89.66 77.27 90.00 84.44

Appropriatedresscode 84.21 93.10 100.00 95.00 93.33*ThefirstthreeitemsaremarkedN/Aastheyachieved>80%consensusthattheyarerequiredpriortothefirstfull-timeclinicalexperience,butthedichotomousnatureoftheseelementsdoesnotrelatetoaratingoflevelofproficiency.

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Table7.Consensusregardingassessmentmethodsforthemes*,**Themes

Thestudentshould:

Satisfactoryacademicperforman

ce

WrittenExaminatio

n

PracticalExamination(skillscheck)

Simulated

practiceexam(OSCE)

OralExam

SuccessfulICE

Facultyassessme

nt

Self-assessme

nt

1.Havefoundationalknowledgetosupportapplicationandsynthesisinthefollowingcontentareas…

89.58

87.50

88.54

62.50

28.13

45.83

53.13

40.63

2.Meetthespecificprogramidentifiedcurricularrequirementsincluding:GPA,remediationofsafetyconcerns,passallpracticalexams

3.Takeinitiativetoapplyevidence-basedstrategies…

88.42 77.89 70.53 58.95 33.68 53.68 47.37 40.00

4.Engageinself-assessment 67.37 22.11 26.32 38.95 20.00 49.47 91.58 90.53

5.Utilizeconstructivefeedback 50.00 10.64 36.17 41.49 20.21 55.32 91.49 88.30

6.Demonstrateeffectivecommunicationabilitieswithinthefollowinggroups…

44.68 17.02 38.30 54.26 34.04 63.83 79.79 69.15

7.Exhibiteffectiveverbal,non-verbalandwrittencommunicationabilitiesto…

42.55 19.15 56.38 68.09 34.04 70.21 90.43 80.85

8.Bepreparedtoengageinlearningthroughdemonstrating…

47.78 18.89 42.22 52.22 22.22 65.56 96.67 88.89

9.Beabletodocumentexamination/re-examination(History,systemsreview,testsandmeasures,problemlist,anddailyinterventions)

71.74 80.43 50.00 59.78 10.87 58.70 29.35 23.91

10.Recognizeandaddressissuesrelatedtosafepatientcareincludingtheabilityto…

69.57 54.35 93.48 72.83 22.83 65.22 43.48 35.87

11.Demonstratethefollowingclinicalreasoningskillsforanon-complexpatient

75.56 84.44 84.44 74.44 27.78 64.44 35.56 25.56

NotQueriedforrecommendationassessmentasmethodologyisintrinsictothetheme/items

104

12.HaveBOTHtheunderstandingandskilltoperformthefollowingexaminationskills

75.56 83.33 98.89 76.67 23.33 57.78 30.00 23.33

13.Havetheunderstandingandskilltoperformthefollowinginterventions

71.91 74.16 93.26 74.16 23.60 61.80 33.71 24.72

14.Recognizeandfollowspecificprofessionalstandards…

71.59 71.59 37.50 39.77 20.45 55.68 82.95 75.00

*Datapresentedattheoverallpercentageofrespondentsinagreementwiththemethodofassessmentforeachtheme.

**Datainboldindicated≥80%agreementwiththemethodofassessmentforthegiventheme.OSCE:Objectivestructuredclinicalexamination;ICE:Integratedclinicalexperience

105

AppendixA:Elementsreachingconsensusbytheme

Overall

Consensus*

Familiarity**

Emerging**

Proficientgreenfillisover80

Emerging&Proficientboxesareinpinkareover80%

1.Studentsshouldhavefoundationalknowledgetosupportapplicationandsynthesisinthefollowingcontentareas:

Anatomy(i.e.functionalanatomy)

100

OverallFaculty

DCEClinicians

NewGrads

3.130

13.6400

33.3332.2636.3636.3628.57

63.5467.74

5063.6471.43

96.87100

86.36100100

Commondiagnosesrelatedtosystemsreview(e.g.medical,physicaltherapy

95.1

OverallFaculty

DCEClinicians

NewGrads

18.756.45

36.3622.7314.29

58.3364.5245.4559.0961.9

22.9229.0318.1818.1823.81

81.2593.5563.6377.2785.71

Kinesiology(i.e.biomechanics,exercisescience,movementscience)

99.02

OverallFaculty

DCEClinicians

NewGrads

9.380

22.7318.18

0

54.1754.8445.4554.5561.9

36.4645.1631.8227.2738.1

90.63100

77.2781.82100

Physiology/Pathophysiology(relatedtogeneralsystemsreview)

92.16

OverallFaculty

DCEClinicians

NewGrads

16.6727.279.68

13.6419.05

52.0850

48.3963.6447.62

31.2522.7341.9422.7333.33

83.3372.7390.3386.3780.95

Tissuemechanics(e.g.stagesofhealing,use/disuse,load/overload)

92

OverallFaculty

DCEClinicians

NewGrads

15.633.23

27.2731.829.52

41.6738.71

5040.9147.62

42.7158.0622.7327.2742.86

84.3896.7772.7368.1890.48

2.Studentsshouldmeetthespecificprogramidentifiedcurricularrequirementsincluding:

achieveminimumGPA

85.29

OverallFaculty

DCEClinicians

NewGrads

NA NA NA

meetminimumexpectationsforpracticalexaminations

98.04

OverallFaculty

DCEClinicians

NewGrads

NA NA NA

remediationofanyandallsafetyconcerns

OverallFaculty

NA NA NA

106

98.04 DCEClinicians

NewGrads3.Studentsshouldtakeinitiativetoapplyevidence-basedstrategiesto:

generateinterventionsideas

88.35

OverallFaculty

DCEClinicians

NewGrads

25.266.67

36.3640.9123.81

70.5386.6759.0959.0971.43

4.216.674.55

04.76

74.7493.3463.6459.0976.19

guidedecision-making

86.45

OverallFaculty

DCEClinicians

NewGrads

26.326.67

45.4531.8228.57

67.3783.33

5063.6466.67

6.3210

4.554.554.76

73.6993.3354.5568.1971.43

measureoutcomes

88.35

OverallFaculty

DCEClinicians

NewGrads

28.4213.3340.9140.9123.81

58.9573.3354.5545.4557.14

12.6313.334.55

13.6419.05

71.5886.6659.1

59.0976.19

researchunfamiliarinformationorconditions

95.14

OverallFaculty

DCEClinicians

NewGrads

16.8410

27.2718.1814.29

49.976045.45

54.5533.33

33.6830

27.2727.2752.38

83.1590

72.7281.8285.71

4.Studentsshouldengageinself-assessmentincluding:

self-assessmentoftheimpactofone’sbehaviorsonothers

95.1

OverallFaculty

DCEClinicians

NewGrads

7.376.679.094.559.52

53.6850

72.7345.4547.62

38.9543.339.0950

42.86

92.6393.3381.8295.4590.48

theunderstandingofone’sownthoughtprocesses(metacognition)

88.11

OverallFaculty

DCEClinicians

NewGrads

12.6316.6718.189.094.76

70.5373.3372.7359.0976.19

16.8410

9.0931.8219.05

87.3783.3381.8290.9195.24

self-reflectionandidentificationofareasofstrengthandthoseneedingimprovement,developmentofaplantoimprove,anddiscussionofthat

planwithinstructors

93.13

OverallFaculty

DCEClinicians

NewGrads

9.476.67

18.184.559.52

62.1163.3363.6472.7347.62

28.4230

18.1822.7342.86

90.5393.3381.8295.4690.48

seekingoutresources,includingsupportfromotherswhenneeded,toassistinimplementationoftheplan

96.08

OverallFaculty

DCEClinicians

NewGrads

7.376.67

13.644.559.52

55.7950

68.1863.6442.86

36.8443.3318.1831.8252.38

92.6393.3386.3695.4695.24

5.Studentsshouldutilizeconstructivefeedbackby:

beingopenandreceptive, Overall 0 31.91 68.09 100

107

verbally/non-verbally 99.03

FacultyDCE

CliniciansNewGrads

0000

31.0345.4531.8219.05

68.9754.5568.1880.95

100100100100

implementingactionstoaddressissuespromptly

99.03

OverallFaculty

DCEClinicians

NewGrads

2.150

4.5505

52.6958.62

505050

45.1641.3845.45

5045

97.85100

95.4510095

reflectingonfeedbackprovided

98.04

OverallFaculty

DCEClinicians

NewGrads

1.080

4.5500

48.3944.8368.1831.82

50

50.5455.1727.2768.18

50

98.93100

95.45100100

6.Studentsshoulddemonstrateeffectivecommunicationabilitieswithinthefollowinggroups:

diversepatientpopulations

80.39

OverallFaculty

DCEClinicians

NewGrads

31.9124.2445.4531.8228.57

58.5168.9745.4554.5561.9

9.576.9

9.0913.649.52

68.0875.8754.5468.1971.42

familiesandotherindividualsimportanttothepatients

82.35

OverallFaculty

DCEClinicians

NewGrads

29.7917.2445.4540.9119.05

57.4575.8645.4545.4557.14

12.776.9

9.0913.6423.81

70.2282.7654.5459.0980.95

healthcareprofessionals

83.34

OverallFaculty

DCEClinicians

NewGrads

29.7917.2445.4531.8228.57

62.7779.31

5059.0957.14

7.453.454.559.09

23.81

70.2282.7654.5568.1880.95

7.Studentsshouldexhibiteffectiveverbal,non-verbalandwrittencommunicationabilitiesto:

listenactively

99.03

OverallFaculty

DCEClinicians

NewGrads

00000

42.5555.1740.9140.9128.57

57.4544.8359.0959.0971.43

100100100100100

demonstratepolite,personable,engagingandfriendlybehaviors

97.09

OverallFaculty

DCEClinicians

NewGrads

00000

19.1517.2431.8218.189.52

80.8582.7668.1881.8290.48

100100100100100

independentlyseekinformationfromappropriatesources

83.49

OverallFaculty

DCEClinicians

NewGrads

7.453.454.55

13.649.52

60.6451.7272.7359.0961.9

31.9144.8322.7327.2728.57

92.5596.5595.4686.3690.47

108

buildrapport

94.18

OverallFaculty

DCEClinicians

NewGrads

5.320

9.099.094.76

69.1589.6654.5563.6461.9

25.5310.3436.3627.2733.33

94.68100

90.9190.9195.23

seekassistancewhenneeded

100

OverallFaculty

DCEClinicians

NewGrads

1.063.45

000

26.624.1445.4522.7314.29

72.3472,4154.5577.2785.71

98.9496.55100100100

engageinshareddecision-makingwithpatients

82.35

OverallFaculty

DCEClinicians

NewGrads

25.8114.29

5022.7319.05

66.6782.1440.9168.1871.43

7.533.579.099.099.52

74.285.71

5077.2780.95

demonstratealevelofcomfortandrespectwithpatienthandling

82.52

OverallFaculty

DCEClinicians

NewGrads

20.2113.7918.1827.2723.81

59.5772.4154.5554.5552.38

20.2113.7927.2718.1823.81

79.7886.2

81.8272.7376.19

demonstrateempathy

95.14

OverallFaculty

DCEClinicians

NewGrads

1.06000

4.76

48.9465.5254.55

5019.05

5034.4845.45

5076.19

98.94100100100

95.24uselanguageandterminologyappropriatefortheaudience

90.29

OverallFaculty

DCEClinicians

NewGrads

11.830

19.0513.6419.05

69.8968.9761.9

72.7376.19

18.2831.0319.0513.644.76

88.17100

80.9586.3780.95

introduceone’sselftoCI,clinicalstaff,andpatients

97.09

OverallFaculty

DCEClinicians

NewGrads

1.0600

4.550

14.896.9

9.0922.7323.81

84.0493.1

90.9172.7376.19

98.93100100

95.46100

8.Studentsshouldbepreparedtoengageinlearningthroughdemonstrating:

accountabilityforactionsandbehaviors

98.05

OverallFaculty

DCEClinicians

NewGrads

3.2600

14.290

35.8739.29

5014.2938.1

60.8760.71

5071.4361.9

96.74100100

85.72100

resilience/perseverance

82.52

OverallFaculty

DCEClinicians

NewGrads

11.836.9

18.1819.054.76

46.2448.2845.4542.8647.62

41.9444.8336.3638.1

47.62

88.1893.1181.8180.9695.24

culturalcompetenceandsensitivity

OverallFaculty

16.310.34

54.3572.41

29.3517.24

83.789.65

109

90.29 DCEClinicians

NewGrads

18.1825

14.29

45.4545

47.62

36.3630

38.1

81.8175

85.72aneager,optimisticandmotivatedattitude

94.18

OverallFaculty

DCEClinicians

NewGrads

3.2300

4.769.52

21.5120.6936.3619.059.52

75.2779.3163.6476.1980.95

96.78100100

95.2490.47

respectforpatients,peers,healthcareprofessionalsandcommunity

98.05

OverallFaculty

DCEClinicians

NewGrads

1.0900

4.760

18.4824.1422.7314.29

10

80.4375.8677.2780.95

90

98.91100100

95.24100

open-mindednesstoalternativeideas

94.17

OverallFaculty

DCEClinicians

NewGrads

3.230

9.094.76

0

45.1644.8340.9142.8652.38

51.6155.17

5052.3847.62

96.77100

90.9195.24100

punctualitywithallassignments

98.06

OverallFaculty

DCEClinicians

NewGrads

1.0800

4.760

5.380

4.5514.294.76

93.55100

95.4580.9595.24

98.93100100

95.24100

self-caretomanagestress

80.58

OverallFaculty

DCEClinicians

NewGrads

9.680

13.6414.2914.29

58.0668.9740.9157.1461.9

32.2631.0345.4528.5723.81

90.32100

86.3685.7185.71

responsibilityforlearning

97.09

OverallFaculty

DCEClinicians

NewGrads

2.150

4.554.76

0

27.9624.1427.2723.8138.1

69.8975.8668.1871.4361.9

97.85100

95.4595.24100

self-organization

89.32

OverallFaculty

DCEClinicians

NewGrads

4.30

4.559.524.76

56.9951.7254.5561.961.9

38.7148.2840.9128.5733.33

95.7100

95.4690.4795.23

takingactiontochangewhenneeded

91.26

OverallFaculty

DCEClinicians

NewGrads

9.780

22.739.529.52

45.6557.1440.9133.3347.62

44.5742.8636.3657.1442.86

90.22100

77.2790.4790.48

willingnesstoadapttonewandchangingsituations

93.14

OverallFaculty

DCEClinicians

NewGrads

8.63.45

13.649.529.52

43.0144.8340.9142.8642.68

48.3951.7245.4547.6247.62

91.496.5586.3690.4890.48

appropriateworkethic

OverallFaculty

1.080

21.5127.59

77.4272.41

98.93100

110

97.08 DCEClinicians

NewGrads

04.76

0

31.829.52

14.29

68.1885.7185.71

10095.23100

maturityduringdifficultorawkwardsituationswithpatients,familiesandhealthcareprofessionals

84.47

OverallFaculty

DCEClinicians

NewGrads

11.8310.3413.6414.299.52

53.7665.5259.0928.5757.14

34.4124.1427.0757.1433.33

88.1789.6686.1685.7190.47

9.Studentsshoulddevelopthefollowingelementsincludingthedocumentationof:

examination/re-examination(History,systemsreview,andtestsandmeasures)

89.32

OverallFaculty

DCEClinicians

NewGrads

28.2620.6931.82

4519.05

63.0468.9754.55

4580.95

8.710.3413.64

100

71.7479.3168.19

5580.95

establishanddocumenttheproblemlist

84.46

OverallFaculty

DCEClinicians

NewGrads

30.4320.6931.82

4528.57

59.7868.97

5050

66.67

9.7810.3418.18

54.76

69.5679.3168.18

5571.43

dailyinterventions

93.13

OverallFaculty

DCEClinicians

NewGrads

26.0917.2427.27

4519.05

57.6165.52

5040

71.43

16.317.2422.73

159.52

73.9182.7672.73

5580.95

10.Studentshouldrecognizeandaddressissuesrelatedtosafepatientcareincludingtheabilityto:

identifycontraindicationsandprecautions

98.06

OverallFaculty

DCEClinicians

NewGrads

13.040

18.18309.52

45.6562.0740.91

3042.86

41.337.9340.9147.62

86.95100

81.8270

90.48assessandmonitorvitalsigns

99.03

OverallFaculty

DCEClinicians

NewGrads

7.613.454.5515

9.52

32.6127.5936.36

3533.33

59.7868.9759.09

5057.14

92.3996.5695.45

8590.47

identifyandrespondtophysiologicchanges

95.14

OverallFaculty

DCEClinicians

NewGrads

20.656.9

27.2735

19.05

60.8775.86

5060

52.38

18.4817.2422.73

528.57

79.3593.1

72.7365

80.95assesstheenvironmentforsafety,includinglines,tubes,andotherequipment

91.26

OverallFaculty

DCEClinicians

NewGrads

21.7413.7922.73

3023.81

51.0951.7259.09

5042.86

27.1734.4818.18

2033.33

78.2686.2

77.2770

76.19appropriatelyapplyinfectioncontrol Overall 11.96 33.7 54.35 88.05

111

proceduresincludinguniversalprecautions

97.09

FacultyDCE

CliniciansNewGrads

6.913.64

1019.05

27.5922.73

4542.86

65.5263.64

4538.1

93.1186.37

9080.96

provideassistanceandguardingforpatientsafety

99.03

OverallFaculty

DCEClinicians

NewGrads

10.876.9

13.6415

9.52

43.4837.9336.36

5547.62

45.6555.17

5030

42.86

89.1393.1

86.3685

90.48utilizeappropriatebodymechanicstoavoidinjurytoselforpatients

98.06

OverallFaculty

DCEClinicians

NewGrads

10.873.45

13.6415

14.29

47.8341.3845.45

6047.62

41.355.1740.91

2538.1

89.1396.5586.36

8585.72

provideappropriatedrapingduringpatientcareactivities

99.03

OverallFaculty

DCEClinicians

NewGrads

8.76.9

4.5515

9.52

29.3520.6931.82

3038.1

61.9672.4163.64

5552.38

91.3193.1

95.4685

90.4811.Studentshoulddemonstratethefollowingclinicalreasoningskillsforanon-complexpatient:

utilizetheelementsofthepatient-clientmanagementmodelincluding:addressvariousbodysystems(cardiopulmonary,integumentary,musculoskeletal,neuromuscular)duringtheexamination

88.35

OverallFaculty

DCEClinicians

NewGrads

27.4724.1436.36

3515

63.7465.5254.55

6570

8.7910.349.09

015

72.5375.8663.64

6585

articulateaclinicalrationaleinpatientevaluation

84.46

OverallFaculty

DCEClinicians

NewGrads

35.1620.6945.45

5030

59.3472.4145.45

5065

5.496.9

9.0905

64.8379.3154.545070

developgoalsthatarelinkedtothepatient’sactivitylimitationsandparticipationrestrictions

82.53

OverallFaculty

DCEClinicians

NewGrads

32.2224.1438.15020

62.2268.9752.38

5075

5.566.9

9.5205

67.7875.8761.95080

determineappropriatenessfortherapywithinscopeofPTpractice

82.36

OverallFaculty

DCEClinicians

NewGrads

27.4717.2440.91

4015

59.3465.52

505070

13.9117.249.091015

72.5382.7659.09

6085

interpretexaminationfindings

82.52

OverallFaculty

DCEClinicians

NewGrads

29.6720.6940.91

4020

65.9375.86

506075

4.43.459.09

05

70.3379.3159.09

6080

screentorulein/outconditionsand Overall 32.97 58.24 8.79 67.03

112

concerns 89.21

FacultyDCE

CliniciansNewGrads

24.1436.36

5025

65.52504570

10.3413.64

55

75.8663.64

5075

12.StudentshouldhaveBOTHtheunderstandingandskilltoperformthefollowingexaminationskills:

balanceassessment

87.25

OverallFaculty

DCEClinicians

NewGrads

38.4641.3845.45

4025

50.5541.3845.45

5565

10.9917.249.09

510

61.5458.6254.54

6075

chartreviewtoextractrelevanthistory

93.2

OverallFaculty

DCEClinicians

NewGrads

26.3713.7927.27

3040

52.7558.6245.45

5550

20.8827.5927.27

1510

73.6386.2172.72

7060

dermatomescreening

94.18

OverallFaculty

DCEClinicians

NewGrads

21.9813.7922.73

3025

35.1634.4836.36

3040

42.8651.7240.91

4035

78.0286.2

77.277075

functionalmobilityassessment

100

OverallFaculty

DCEClinicians

NewGrads

27.4727.5922.73

3525

52.7544.8359.09

5060

19.7827.5918.18

1515

72.5372.4277.27

6575

gaitassessment

92.23

OverallFaculty

DCEClinicians

NewGrads

29.6724.1427.27

4030

54.9551.7254.55

5065

15.3824.2418.18

105

70.3375.8672.73

6070

goniometry

99.03

OverallFaculty

DCEClinicians

NewGrads

8.793.45

18.18105

32.9727.5931.82

3540

58.2468.97

505555

91.2196.5681.82

9095

interview/historytaking

98.06

OverallFaculty

DCEClinicians

NewGrads

15.386.9

22.732015

60.4465.5245.457060

24.1827.5931.82

1025

84.6293.1177.27

8085

lowerquadrantscreening

87.38

OverallFaculty

DCEClinicians

NewGrads

21.9820.6922.73

2025

46.1537.9354.55

4550

31.8741.3822.73

3525

78.0279.3177.28

8075

manualmuscletesting

98.06

OverallFaculty

DCE

8.793.45

18.18

39.5641.3836.36

51.6555.1745.45

91.2196.5581.81

113

CliniciansNewGrads

105

4040

5055

9095

musclelengthtesting

88.24

OverallFaculty

DCEClinicians

NewGrads

15.383.45

18.182025

42.8637.9340.91

4550

41.7658.6240.91

3525

84.6296.5581.82

8075

myotomescreening

92.23

OverallFaculty

DCEClinicians

NewGrads

18.6813.7918.18

3015

39.5634.4840.91

3055

41.7651.7240.91

4030

81.3286.2

81.827085

reflextesting

84.47

OverallFaculty

DCEClinicians

NewGrads

16.4813.7918.18

2015

38.4637.9345.45

2545

45.0551.7236.36

4545

83.5189.6581.81

7090

sensoryexamination

97.06

OverallFaculty

DCEClinicians

NewGrads

16.4810.3418.18

3010

41.7641.3845.45

3545

41.7644.8336.36

4540

83.5286.2181.81

8085

medicalscreeningforredflags

90.29

OverallFaculty

DCEClinicians

NewGrads

20.8820.6918.18

2025

47.2551.7245.45

4545

31.8727.5936.36

3530

79.1279.3181.81

8075

systemsreview

92.23

OverallFaculty

DCEClinicians

NewGrads

24.1820.6918.18

3030

47.2551.7245.45

4050

28.5727.5936.36

3020

75.8279.3181.81

7070

upperquadrantscreening

85.44

OverallFaculty

DCEClinicians

NewGrads

25.5624.1423.81

2530

42.2234.4852.38

4045

32.2241.3823.81

3525

74.4475.8676.19

7570

13.Studentshouldhavetheunderstandingandskilltoperformthefollowinginterventions:

prescribe,fit,andinstructpatientsinproperuseofassistivedevices

87.38

OverallFaculty

93.21DCEClinicians

NewGrads

27.7820.6927.2736.84

30

48.8955.1731.8252.63

55

23.3324.1440.9110.53

15

72.2279.3172.7363.16

70functionaltraining(includingbedmobility,transfers,andgait)withappropriateguardingandassistance

93.21

OverallFaculty

DCEClinicians

NewGrads

22.2213.7931.8226.32

20

55.5658.6236.3652.63

75

22.2227.5931.8221.05

5

77.7886.2168.1873.68

80

114

individualizedpatienteducation

86.41

OverallFaculty

DCEClinicians

NewGrads

3013.7940.9147.37

25

57.7862.07

5047.37

70

12.2224.149.095.26

5

7086.2159.0952.63

75therapeuticexercise:specificallystrengthening

95.14

OverallFaculty

DCEClinicians

NewGrads

23.3310.3431.8247.37

10

54.4455.1745.4542.11

75

22.2234.4822.7310.53

15

76.6689.6568.1852.64

90therapeuticexercise:specificallystretching

94.18

OverallFaculty

DCEClinicians

NewGrads

23.3310.3431.8247.37

10

53.3355.1745.4536.84

75

23.3334.4822.7315.79

15

76.6689.6528.1852.63

90therapeuticexercise:specificallyaerobicexercise

89.32

OverallFaculty

DCEClinicians

NewGrads

24.4410.3431.8252.63

10

54.4455.1745.4536.84

80

21.1134.4822.7310.53

10

75.5589.6568.1852.63

9014.Studentshouldrecognizeandfollowspecificprofessionalstandards,including:

appropriatedresscode

100

OverallFaculty

DCEClinicians

NewGrads

1.1100

5.260

5.566.90

10.535

93.3393.1100

84.2195

98.89100100

94.74100

corevaluesidentifiedbytheAPTAasaccountability,altruism,compassion/caring,excellence,integrity,professionalduty,andsocialresponsibility

92.08

OverallFaculty

DCEClinicians

NewGrads

4.493.454.555.56

5

32.5841.3845.4511.11

25

62.9255.17

5083.33

70

95.596.5595.4594.44

95clinicalexpectationsspecifictosetting

90.3

OverallFaculty

DCEClinicians

NewGrads

8.896.9

9.0915.79

5

37.7837.9336.3615.79

60

53.3355.1754.5568.42

35

91.1193.1

90.9184.21

95HIPAAregulations

98.06

OverallFaculty

DCEClinicians

NewGrads

4.446.90

10.530

11.113.45

22.7310.53

10

84.4489.6677.2778.95

90

95.5593.11100

89.48100

legalaspectsrelatedtopatientcare

86.41

OverallFaculty

DCEClinicians

NewGrads

13.3310.349.09

15.7920

45.5655.17

5026.32

45

41.1134.4840.9157.89

35

86.6789.6590.9184.21

80obligationsofthepatient-providerrelationship

OverallFaculty

14.4410.34

4055.17

45.5634.48

85.5689.65

115

91.17 DCEClinicians

NewGrads

4.5521.05

20

31.8215.79

30

63.6463.16

50

95.4678.95

80passionfortheprofession

87.38

OverallFaculty

DCEClinicians

NewGrads

5.563.454.55

10.535

23.3327.5931.8215.79

30

71.1168.9763.6473.68

80

94.4496.5695.4689.47

95patientrights

98.05

OverallFaculty

DCEClinicians

NewGrads

6.673.459.09

00

41.1155.1736.3610.53

55

52.2241.3854.5573.68

45

93.3396.5590.9184.21100

maintainingprofessionalboundaries

93.2

OverallFaculty

DCEClinicians

NewGrads

3.333.459.09

00

33.3351.7231.8221.05

20

63.3344.8359.0978.95

80

96.6696.5590.91100100

understandingphysicaltherapy'sroleinthehealthcaresystem

92.23

OverallFaculty

DCEClinicians

NewGrads

8.896.9

9.0910.53

10

6075.8663.6436.84

55

31.1117.2427.2752.63

35

91.1193.1

90.9189.47

90

116

AppendixB:Elementsnotreachingconsensusbytheme:Theme Overall

Consensus*1. Studentsshouldhavefoundationalknowledgetosupportapplication

andsynthesisinthefollowingcontentareas:

Pharmacology(e.g.commonclassifications,sideeffects,impactontreatment,polypharmacology)

78.66

2. Studentsshouldmeetthespecificprogramidentifiedcurricularrequirementsincluding:

Participate,asaphysicaltherapiststudent,insomeclinicalexperience(includingbutnotlimitedto:integratedclinicalexperiences,part-timeclinicalexperiences)priortothefirstfull-timeclinicalexperience

70.87

3. Studentsshouldtakeinitiativetoapplyevidence-basedstrategiesto: Determinerelevanceofevidenceforspecificpatients 75.96 Establishefficacyofinterventionsforpatients,payers,otherhealthcare

professionals73.46

Find,evaluate,andsynthesizetheliterature 70.19 Applyconceptsrelatedtohealthpolicyandhealthservices 37.54. Studentsshouldengageinself-assessmentincluding: Demonstrationofconfidenceinlearnedmaterial 79.41 Demonstrationofconfidenceworkingwithrelevantindividuals 72.815. Studentsshouldutilizeconstructivefeedbackby: AllelementsreachedConsensus 6. Studentsshoulddemonstrateeffectivecommunicationabilitieswithin

thefollowinggroups:

AllelementsreachedConsensus 7. Studentsshouldexhibiteffectiveverbal,non-verbalandwritten

communicationabilitiesto:

ApplyStrategiestofacilitatepatientadherence 66.35 Interpretpatientcuesthatrequireachangeincommunicationstrategy 77.88 Resolveconflict 70.198. Studentsshouldbepreparedtoengageinlearningthrough

demonstrating:

Commitmenttolifelonglearning 74.04 Effectivetimemanagement/organization 70.199. Studentsshoulddevelopthefollowingelementsincludingthe

documentationof:

Navigateandidentifytherelevantcomponentsofamedicalrecord 72.11 Documentinaclearandconcisefashion 63.46 Completedocumentationinatimelyfashion 45.20 Documentevaluation/re-evaluation(interpretationoffindingsto

determinediagnosis,prognosis,andplanofcare)72.11

Establishanddocumentobjectiveandmeasurablegoals 79.80 Describeappropriatebillingandcodingpracticesrelevanttotheclinical

setting45.19

Gatherrelevantinformationfrommedicalrecordsandotherrelevant 75.00

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sources10. Studentshouldrecognizeandaddressissuesrelatedtosafepatient

careincludingtheabilityto:

AllelementsreachedConsensus 11. Studentshoulddemonstratethefollowingclinicalreasoningskillsfora

non-complexpatient:

Individualizetheexaminationtothepatientandpracticesetting 69.24 Followalogicalsequenceduringtheexaminationandintervention 65.38 Developaplanofcarethatislinkedtothepatientsactivitylimitations

andparticipationrestrictions76.93

Connectassessmentofoutcomestofunctionalanalysis 71.16 Recognizetheinfluenceofpersonalandcontextualfactors 76.70 Addresstheneedtoprogressorchangeacurrentplanofcare 65.05

12. StudentshouldhaveBOTHtheunderstandingandskilltoperformthefollowingexaminationskills:

Anthropometricmeasurements 76.93 Cranialnerves 67.31 Functionalperformancetests 73.03 Integumentassessment 75.96 Movementanalysis 77.88 Orthopedicspecialtests 66.34

13. Studentshouldhavetheunderstandingandskilltoperformthefollowinginterventions:

Prescribe,fit,andinstructpatientsinproperuseofadaptiveequipment 49.04 Manualtherapy:specificallysofttissuemassage 66.32 Manualtherapy:specificallyjointmobilizations(I-IV) 53.85 Manualtherapy:specificallyjointmanipulations/thrust(V) 23.08 Biophysicalagents:specificallythermal 65.38 Biophysicalagents:specificallymechanical 59.61 Biophysicalagents:specificallyelectrical 57.69 Progressionofplanofcare 77.86 Therapeuticexercise:specificallyneuromuscularre-education 77.89

14. Studentshouldrecognizeandfollowspecificprofessionalstandards,including:

Engageinprofessionalserviceandcommunityactivities 46.16 Interprofessionalpracticecompetencies-identifiedbythe

InterprofessionalEducationCollaborative(IPEC)asvalues/ethicsforInterprofessionalPractice,roles/responsibilities,interprofessionalcommunication,teamsandteamwork

65.39

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AppendixC

StudentReadinessfortheFirstFull-TimeClinicalExperience

Thefollowingtablesummarizestheminimalknowledge,skillsandabilities(KSAs)inwhichphysicaltherapiststudentsmustdemonstratecompetencepriortoentryintothefirstfull-timeclinicalexperience.TheKSAsaregroupedinto14themes,numberedandindicatedinboldtextwiththecorrespondingKSAslistedbelow.Greaterthan80%ofparticipantsintheDelphistudyindicatedthattheseitemswerenecessary.

StudentReadinessThemesandKSAsTheme1 Studentsshouldhavefoundationalknowledgetosupportapplicationandsynthesisinthe

followingcontentareas:1.1 Anatomy(i.e.functionalanatomy)1.2 Commondiagnosesrelatedtosystemsreview(e.g.medical,physicaltherapy1.3 Kinesiology(i.e.biomechanics,exercisescience,movementscience)1.4 Physiology/Pathophysiology(relatedtogeneralsystemsreview)1.5 Tissuemechanics(e.g.stagesofhealing,use/disuse,load/overload)

Theme2 Studentsshouldmeetthespecificprogramidentifiedcurricularrequirementsincluding:2.1 achieveminimumGPA2.2 meetminimumexpectationsforpracticalexaminations2.3 remediationofanyandallsafetyconcerns

Theme3 Studentsshouldtakeinitiativetoapplyevidence-basedstrategiesto:3.1 generateinterventionsideas3.2 guidedecision-making3.3 measureoutcomes3.4 researchunfamiliarinformationorconditions

Theme4 Studentsshouldengageinself-assessmentincluding:4.1 self-assessmentoftheimpactofone’sbehaviorsonothers4.2 theunderstandingofone’sownthoughtprocesses(metacognition)4.3 self-reflectionandidentificationofareasofstrengthandthoseneedingimprovement,

developmentofaplantoimprove,anddiscussionofthatplanwithinstructors4.4 seekingoutresources,includingsupportfromotherswhenneeded,toassistinimplementationof

theplanTheme5 Studentsshouldutilizeconstructivefeedbackby:

5.1 beingopenandreceptive,verbally/non-verbally5.2 implementingactionstoaddressissuespromptly5.3 reflectingonfeedbackprovided

Theme6 Studentsshoulddemonstrateeffectivecommunicationabilitieswithinthefollowinggroups:

6.1 diversepatientpopulations6.2 familiesandotherindividualsimportanttothepatients6.3 healthcareprofessionals

Theme7 Studentsshouldexhibiteffectiveverbal,non-verbalandwrittencommunicationabilitiesto:7.1 listenactively7.2 demonstratepolite,personable,engagingandfriendlybehaviors7.3 independentlyseekinformationfromappropriatesources7.4 buildrapport

119

AppendixC

7.5 seekassistancewhenneeded7.6 engageinshareddecision-makingwithpatients7.7 demonstratealevelofcomfortandrespectwithpatienthandling7.8 demonstrateempathy7.9 uselanguageandterminologyappropriatefortheaudience

7.10 introduceone’sselftoCI,clinicalstaff,andpatientsTheme8 Studentsshouldbepreparedtoengageinlearningthroughdemonstrating:

8.1 accountabilityforactionsandbehaviors8.2 resilience/perseverance8.3 culturalcompetenceandsensitivity8.4 aneager,optimisticandmotivatedattitude8.5 respectforpatients,peers,healthcareprofessionalsandcommunity8.6 open-mindednesstoalternativeideas8.7 punctualitywithallassignments8.8 self-caretomanagestress8.9 responsibilityforlearning

8.10 self-organization8.11 takingactiontochangewhenneeded8.12 willingnesstoadapttonewandchangingsituations8.13 appropriateworkethic8.14 maturityduringdifficultorawkwardsituationswithpatients,familiesandhealthcare

professionalsTheme9 Studentsshoulddevelopthefollowingelementsincludingthedocumentationof:

9.1 examination/re-examination(History,systemsreview,andtestsandmeasures)9.2 establishanddocumenttheproblemlist9.3 dailyinterventions

Theme10 Studentshouldrecognizeandaddressissuesrelatedtosafepatientcareincludingtheabilityto:

10.1 identifycontraindicationsandprecautions10.2 assessandmonitorvitalsigns10.3 identifyandrespondtophysiologicchanges10.4 assesstheenvironmentforsafety,includinglines,tubes,andotherequipment10.5 appropriatelyapplyinfectioncontrolproceduresincludinguniversalprecautions10.6 provideassistanceandguardingforpatientsafety10.7 utilizeappropriatebodymechanicstoavoidinjurytoselforpatients10.8 provideappropriatedrapingduringpatientcareactivities

Theme11 Studentshoulddemonstratethefollowingclinicalreasoningskillsforanon-complexpatient:11.1 utilizetheelementsofthepatient-clientmanagementmodelincluding:addressvariousbody

systems(cardiopulmonary,integumentary,musculoskeletal,neuromuscular)duringtheexamination

11.2 articulateaclinicalrationaleinpatientevaluation11.3 developgoalsthatarelinkedtothepatient’sactivitylimitationsandparticipationrestrictions11.4 determineappropriatenessfortherapywithinscopeofPTpractice11.5 interpretexaminationfindings11.6 screentorulein/outconditionsandconcerns

120

AppendixC

Theme12 StudentshouldhaveBOTHtheunderstandingandskilltoperformthefollowingexaminationskills:

12.1 balanceassessment12.2 chartreviewtoextractrelevanthistory12.3 dermatomescreening12.4 functionalmobilityassessment12.5 gaitassessment12.6 goniometry12.7 interview/historytaking12.8 lowerquadrantscreening12.9 manualmuscletesting

12.10 musclelengthtesting12.11 myotomescreening12.12 reflextesting12.13 sensoryexamination12.14 medicalscreeningforredflags12.15 systemsreview12.16 upperquadrantscreening

Theme13 Studentshouldhavetheunderstandingandskilltoperformthefollowinginterventions:13.1 prescribe,fit,andinstructpatientsinproperuseofassistivedevices13.2 functionaltraining(includingbedmobility,transfers,andgait)withappropriateguardingand

assistance13.3 individualizedpatienteducation13.4 therapeuticexercise:specificallystrengthening13.5 therapeuticexercise:specificallystretching13.6 therapeuticexercise:specificallyaerobicexercise

Theme14 Studentshouldrecognizeandfollowspecificprofessionalstandards,including:14.1 appropriatedresscode14.2 corevaluesidentifiedbytheAPTAasaccountability,altruism,compassion/caring,excellence,

integrity,professionalduty,andsocialresponsibility14.3 clinicalexpectationsspecifictosetting14.4 HIPAAregulations14.5 legalaspectsrelatedtopatientcare14.6 obligationsofthepatient-providerrelationship14.7 passionfortheprofession14.8 patientrights14.9 maintainingprofessionalboundaries

14.10 understandingphysicaltherapy'sroleinthehealthcaresystem

121