Upload
joseph-brousseau
View
218
Download
1
Embed Size (px)
Citation preview
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 1/49
with
4 Preparation forTeaching in Clinical
Settings
Jody Gandy
Undertaking New Challenges: Preparation for Teaching in Clinical Settings
!Calvin and Hobbes © 1995 Watterson. Distributed by Universal Press Syndi-
cate. Reprinted with permission. All rights reserved.)
119
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 2/49
120 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
Mter 1 year of clinical practice, I was informed that I was now
ready to serve as a clinical instructor for a student. I was final
ly comfortable with flexibly managing a full patient caseload
and all related activities, including new evaluations, discharge
summaries, interim and progress reports, case and family con
ferences, utilization review coD.ferences, patient treatmentsand attainment of the patient's functional goals within the
expected time duration, establishing and seeking positive rela
tionships with other professionals, participating in journal
club and weekly in-services, training support personnel, and
attending monthly professional meetings. Now, without more
than a simple proclamation, I was to be assigned to a student
for her first clinical education experience from a 2-year post
baccalaureate physical therapist professional program. Just
when I was feeling like I finally had a handle on performing asa competent practitioner and meeting departmental expecta
tions, one more responsibility was 11dumped" on me.
The center coordinator of clinical education had reviewed a
copy of the academic program's curriculum and course objec
tives, dates of the clinical experience, name of the academic
coordinator of clinical education, and the evaluation tool to be
used to assess the student's performance for this first clinical
experience. In addition, there was. a brief student profile that
was written in the student's handwriting, albeit somewhat
illegibly, that indicated her address, preferred learning style,and housing and parking requests. I was informed that she
would be arriving at our clinical facility in 1 week and would
need an orientation, 11good" patients with whom to practice
her skills, and a schedule. The center coordinator asked me i fI had any questions.Mter a brief pause, I quietly replied, liNo."
Not only did I not know where to begin to ask the first ques
tion, but I was absolutely terrified and overwhelmed by the
responsibility. I assumed that everyone who was assigned a
student after 1 year of clinical practice must be capable to
serve as a clinical instructor, and I did not want to respond any
differently than my peers.
Mterwards, I realized that in 1 week I would be responsible
for this student's clinical learning experience and had not a
clue as to how to structure an experience or perform a student
evaluation, especially since I was not familiar with the instru
ment to be used, and at best I had only completed a new
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 3/49
Chapter Objectives 121
employee orientation. In reality, I knew very little about
teaching students in the clinic other than remembering what
it was like to be a student during my clinical experiences. For
the next week, I tried to informally question more experi-
enced physical therapists about how they taught their stu-
dents. I did not want them to know that I felt incompetent. Ialso tried to reflect on what my clinical instructors did during
my four clinical experiences by posing questions such as: How
did they provide an orientation to the facility and the specific
health care environment? What issues were discussed during
the first few days of the experience? What were their expecta-
tions for my performance? Did I get a schedule on the first day
and what was included on that schedulel What did they do to
make me feel comfortable or uncomfortable? What did I
remember most about my clinical educators that was positive
or negative? Based on my limited discussions with profes-sional peers and my personal reflections, I developed a better,
albeit limited, understanding of my perceived roles and
responsibilities. All too soon, it was time for me to teach my
first student.
This sketch is all too common in contemporary clinical education, but
it illustrates a situation that can be prevented or eliminated given adequate
training and resources. This chapter provides the clinical educator with
information and resources about the clinical education milieu; the roles andresponsibilities of faculty, clinicians, and students involved in clinical edu-
cation; how to prepare to be a successful clinical instructor; and alternative
models for delivery of clinical education.
ChapterObjectives
After reading this chapter the reader will be able to:
1. Understand the complexities of and the relationships between the
different contextual frameworks in which the students' academicand clinical learning occur.
2. Recognize the dynamic organizational structure of clinical educa-
tion and the roles and responsibilities of persons functioning within
this structure.
3. Define the preferred attributes of clinical educators that contribute
to enhanced student learning.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 4/49
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 5/49
Higher Education and Health Care Environments 123
prehend these issues, it is helpful to examine some of the pervasive and
influential macroeconomic factors before focusing on more specific issues
related to physical therapy. Understanding the larger context of change in
health care and higher education facilitates greater awareness of some of the
issues challenging physical therapy clinical education and its teachers.
Both systems are in dramatic flux because they are responding to issuesof public accountability, credibility, cost containment, outcome measure
ments, service orientation, and cultural diversity.a-lO Each of these issues
has altered the systems in ways that most would have thought unimaginable
10 years ago. No longer is health care or higher education funded merely on
the basis of historical precedent, longevity, or reputation, but rather funding
also depends on consistently attaining explicitly defined outcomes. Both
systems must provide, for patients and students, services that are rendered
in a timely and cost-effective manner. Each system is held to a consistent
standard of performance that is based on predetermined or institutionally
defined norms that cannot be easily compromised, no matter how justifiable
the reasons, without consequences. Possible repercussions include loss of
funding or reimbursement and organizational restructuring, which can
result in a workforce reduction or reconstitution.llOutcomes assessment research, a relatively new term to contempo
rary society, began 15 years ago but has now become the predominant
health care buzzword of the 1990s. Health care facilities are expected to
describe and attain explicit and defined measurable outcomes for the facil
ity, patients, and patients' families. Likewise, inst itut ions of higher educa
tion are required to account for and be able to define measurable outcomesfor students in each of the programs offered that relate to the functional
needs of society at large and the demands of students and their parents for
future employment.
Not surprisingly, the outcomes assessment movement was initiated
during the sweeping business reform of the 1980s, when terms such as total
quality management and continuous quality improvement were coined,
which have now permeated higher education and health care.I2 The quality
movement in business streamlined the organization of middle management,
reduced unnecessary costs, improved customer services through technology,
and increased employees' vested interest in an organization by helping them
take pride in delivering better customer services.13- IS The fact that health
care and higher education are perceived as big business enterprises should no
longer be surprising given the influence of business on both of these systems.
The idea of If customer service" has profoundly influenced health care
and higher education. Customer service no longer applies exclusively to
traditional business services but also to all human services provided to
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 6/49
124 PREPARATION FOR TEACHING IN CLINICAL SETIINGS
persons of all cultures. Certainly the customer (whether a patient or a
student and his or her family) has become more enlightened and asks
more probing and sophisticated questions that translate into better quali
ty of service, value for his or her hard-earned dollars, and, at times, cyni
cism or distrust of the system. Consumers are no longer willing to pay top
dollar for services rendered by teaching assistants rather than the tenuredresearch professor or medical students rather than board-certified special
ist physicians. Like it or not, society demands that service providers be
more efficient and cost-effective while still delivering measurable out
comes to the recipient.16-18
Society has also become far more aware of and sensitive to issues of cul
tural diversity. Higher education and health care are confronted by issues of
a£fordability and accessibility. Society is struggling to create systems that
provide access to all but do not stigmatize or differentiate among individu
als. Students and patients are asking that educators and practitioners better
represent the cultural needs of society by bridging an understanding between
students and teachers and patients and practitioners and delivering better
services to persons of all customs, beliefs, and values. In addition, if teach
ers and practitioners in physical therapy are to be adequately prepared, it is
incumbent on the profession to provide culturally diverse role models who
can prepare future generations to provide services that better meet the needs
and demands of a multicultural society.19,2O
Many similarities between higher education and health care have been
described. Closer examination of the relationship between physical therapy
academic and clinical education, however, reveals significant differencesbetween the two environments.
Differences Between Academic
and Clinical Education
The greatest fundamental difference between academic edu
cation and clinical education lies in their service orientations. Physical
therapy academic education, situated within higher education, exists for
the primary purpose of educating students to attain core knowledge, skills,
and behaviors. In contrast, clinical education, situated within the practice
environment, exists first and foremost to provide cost-effective quality care
and education for patients, clients, and their families and caregivers. Aca
demic faculty are remunerated for their teaching, scholarship, and commu
nity and professional services. Clinical educators are compensated for their
services as practitioners by rendering patient care and related activities. In'
most cases, unless as a function of experience, clinical educators receive lit
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 7/49
125ifferences Between Academic and Clinical Education
tie or no compensation for teaching students.21 Physical therapy clinical
educators are placed in the precarious position of trying to effectively bal
ance and respond to two 11masters." The first master, the practice setting,
requires that the practitioner deliver cost-effective and quality patient ser
vices. The second master, higher education, wants the clinical educator to
respond to the needs of the student learner and the educational outcomesof the academic program.
Other differences between physical therapy clinical education and aca
demic education relate to the design of the learning experience. Educating
students in higher education most often occurs in a predictable classroom
environment that is characterized by a beginning and end of the learning ses
sion and a method (written, oral, practical) of assessing the student's readi
ness for clinical practice. Student instruction can be provided in numerous
formats with varying degrees of structure, including lecture augmented by
the use of audiovisuals, laboratory practice, discussion seminars, collabora
tive and cooperative peer activities, tutorials, problem .based case discussions, computer-based instruction, and independent or group work
practicums. With the emergence of technology, such as distance learning,
hypermedia, and virtual reality, the traditional archetype is being challenged
by some educators and may eventually lead to an alternative paradigm for
classroom learning.22, 23
Higher education has evolved in its.design to provide more active adult
learning that stresses the learner, not the teacher. Fundamental concepts
and theories and their application to physical therapy practice must be fully
developed in the academic program to ensure' that students are capable ofprogressing through each phase of the curriculum into the real world of
practice.24,25 Students, however, have found it difficult to divest them
selves of the conventional role of the professor as the expert or Ilsage on the
stage,,26 who transmits all the knowledge needed to move successfully
through the curriculum and accept responsibility and accountability for
their own learning.
In contrast, the clinical classroom by its very nature is dynamic and
flexible. It is a more unpredictable learning laboratory that is constrained
by time only as it relates to the length of the patient's visit or the work
day schedule. Sometimes to an observer, delivery of patient care and educating students in the practice environment may seem analogous in that
they appear unstructured and at times even chaotic. Remarkably, student
learning in the clinical setting occurs with or without patients and is not
constrained by walls or by location (e.g., community-based services, walk
ing or driving to patients). Student learning is not measured by written
examination, but rather is assessed based on the quality, efficiency, and
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 8/49
126 PREPARATION FOR TEACHING IN CLINICAL SEITINGS
outcomes of a student's care when measured against a standard of clinical
performance.27 Resources available to the clinical teacher may include
many of those used by academic faculty, such as instruction using audio
visuals, practice on a fellow student or the clinical educator, or review
and discussion of a journal article. Additional resources re!1dily available
to the educator in practice include collaborative and cooperative studentlearning among and between disciplines, video libra:ries of patient cases,
in-service education, grand rounds, surgery observation, special clinics
and screenings (e.g., seating clinic, scoliosis screening, community-based
education to prevent common falls in the elderly), presurgical evalua
tions, on-site continuing education course offerings, observation and
interactions with other health professionals, and participation in clinical
research. Rich learning opportunities are available in practice that com
plement and clarify much of what is provided in physical therapy acade
mic education.28
Because learning occurs within the context of practice and patient care,
the clinical teacher is characterized as a "a guide by the side"26 rather than
an expert. The clinical teacher teaches primarily through interactions and
handling of patients and assumes multiple roles, including facilitator,
coach, supervisor, role model, and performance evaluator.27 The clinicaleducator provides opportunities for students to experience safe practice.
She or he also asks probing questions that ~ c o u r a g e the student to reflect
by posing questions to herself or himself, reinforces students' thinking and
curiosity by fostering scholarly inquiry and by sorting fact from fiction,
and, by example, teaches students how to manage ambiguities (e.g., balancing functional and psychosocial need$ of the patient within the constraintsof the health care system).29-31
In summary, higher education and health care are confronted by many
of the same challenges, although strategies used to manage these chal
lenges may differ given their organizational and funding structures and
accountability measures. Not surprisingly, these environments differ in
relation to student learning because educators in each assume distinct
roles and responsibilities that are circumscribed by the context in which
learning occurs and the primary customer being served. Despite these dif
ferences, the two systems must communicate and interact on a regularbasis to fulfill curricular outcomes in physical therapy programs. In fact, a
concerted effort must be made by academic and clinical educators, as part
ners, to consciously bridge their differences. liThe frightening prospect is
that these forces, i f left to run their course without intervention, will like
ly drive education and practice further apart."32 To understand how these
systems currently interact to ensure that curriculum outcomes are real
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 9/49
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 10/49
128 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
sider faculty's perspectives, because such experiences represent critical
stepping stones that will enable students to at tain desired program goals.
While physical therapy clinical education 1s largely managed by the
three primary players and the students, it is important to remember that
it is every physical therapy and physical therapist assistant educator's
responsibility to be vested in clinical education. Without a collaborativeeffort between academic and clinical educators and students, achieve
ment of programmatic outcomes would not be possible. Also, the acade
mic program has a responsibility to visibly demonstrate its commitment
to clinical educators by actively communicating and involving them in
relevant aspects of curriculum development and assessment. Roles and
responsibilities of individuals recognized as integral to clinical education
are defined below.
Rolesand
Responsibilitiesof
StudentsStudents, and their responsibility to actively contribute to
clinical learning experiences, provide the most critical link in the organi
zational structure. The true messengers in clinical education are students.
Students provide feedback to everyone involved in the clinical education
system. Given the configuration of clinical education, students bear a
heavy burden, because learning experiences are provided based on informa
tion received from academic programs that may be incomplete or inaccu
rate in relation to perceived learning needs. Only students can articulate
their needs to the CIon a daily basis; therefore, they must take responsibility for their learning i f they wish to maximize their time in practice. Stu
dents ultimately will be held accountable for their learning. They must
actively participate in the decision-making process of clinical site selec
tion38 and be willing to assume a risk in openly asking for available clinical
learning experiences that permit successful progression through the cur
riculum. This means that ongoing student self-assessment and reflection,
which recognizes the student's knowledge and performance strengths, defi
ciencies, and inconsistencies, must occur.39 As part of this responsibility,
students must feel comfortable providing constructive feedback to academ
ic and clinical faculty. This feedback can enhance the curriculum andensure that succeeding classes will benefit from their experiences.
Self-accountability for behavior and actions is critically important for
students as part of their learning contract. However, faculty should guide
and model appropriate professional behavior and be willing to confront
areas in which the students ' professional values and behaviors are consid
ered inappropriate or problematic.4o Faculty must remain open and flexible
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 11/49
Organizational Structure of Clinical Education 1 2 9 ~ · · .
to student needs and be willing to modify the curriculum when revisions
are shown to be necessary.
Roles and Responsibilities of the Academic
Coordinator of Clinical Education
Since 1982, the roles, responsibilities, and career issues of the
ACCE in physical therapy education have been investigated and discussed
by several authors.41 -44 Even though issues associated with the ACCE have
been investigated, the role remains rather unique to higher education, with
comparable positions found primarily in professionally based academic pro
grams (e.g., occupational therapy, speech therapy). Although these studies
span more than a decade, the responsibilities assumed by the ACCE have
essentially remained consistent, except for those areas in which technology
and collaborative initiatives have enhanced administrative efficiency and
effectiveness and those times when the ACCE is on a tenure rather than aclinical track.
The ACCE is a pivotal faculty role in physical therapy education. She
or he serves as the liaison between the didactic and clinical components
of the program. In some programs, due to the number of students and the
resultant number of clinical education sites required, more than one per
son has assumed ACCE responsibilities jas co-ACCEs or as ACCE and
assistant ACCE). In some cases, the ACCE may also be called the direc
tor of clinical education. This occurs when the responsibilities are con
sidered to be commensurate with managing and directing a program(including its budget).
The ACCE's responsibilities are multidimensional and permeate class
room and clinical settings. She or he is challenged by a demanding role that
expects the same performance (if tenured or on a tenure track) as other fac
ulty members. This means the ACCE must teach students, engage in schol
arship, and provide community and professional service while balancing the
many other unique responsibilities associated with the position.45 If on a
clinical track, the ACCE is expected to teach on a limited basis and to per
form only those responsibilities associated with beingACCE.46 The distinct
responsibilities of an ACCE generally include:
1. Managing the clinical education program.
2. Coordinating and facilitating clinical education within the aca
demic program.
3. Developing and maintaining quality clinical education sites com
mitted to providing student clinical learning experiences.
.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 12/49
130 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
4. Educating and empowering clinical instructors to more effectively
fulfill their roles as clinical teachers.
5. Fostering and encouraging ongoing, open, and reciprocal c o m m u n i ~ cation between academicians, clinicians, and students by phone,
written and computer correspondence, and o n ~ s i t e visitations.
6. Developing policy and procedures associated with clinical education.7. Maintaining the academic program's records (including databases)
associated with all aspects of clinical education.
8. Coordinating student clinical placements with the CCCE.
9. Educating and advising students about clinical education, including
their responsibility to actively participate in the outcome of their
clinical learning experiences.
10. Counseling students about their clinical performance, including
strengths and limitations.47
11. Determining whether students have successfully met explicit
learning objectives for the specific clinical experience to enablecontinued progression through the curriculum.
12. Obtaining feedback about students' performance and the program's
curriculum to assist in ongoing curricular assessment and r e v i ~ sions.43, 44, 46
Additional activities that the ACCE may·be involved in include (1) par
ticipation in consortia activities (e.g., a group of regional academic programs,
clinical educators that sponsor collaborative initiatives), (2) accreditation
related activities, (3) curriculum committee activities, 14} clinical educationresearch, (5) management of budget allocations related to clinical education,
and 16} coordination of clinical education advisory committees. In some
cases, ACCEs assume a "broker" role in clinical education by linking c l i n i ~ cal educators to facilitate clinical education research, arranging creative
alternative student clinical experiences (e.g., forming cooperative relation
ships for solo or rural practices), and forming collaborative working rela
tionships with other academic institutions to increase access to clinical sites
by developing alternative supervisory designs to accommodate even greater
numbers of students.43
Deusinger and Rose challenged ACCEs to re-examine their role in phys
ical therapy education at their first national conference by saying, "Like the
dinosaur, the position of the ACCE is certain to become extinct in physical
therapy education. The viability of this position is threatened because of
the present preoccupation with administrative logistics and student coun
seling, a preoccupation that prohibits full participation as an academic
physical therapist." They go on to suggest that "the role of the ACCE must
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 13/49
Organizational Structure of Clinical Education 131
be redefined in order for this faculty member to survive the demands of
academia and serve the needs of the profession."48 They expressed the hope
that ACCEs would not become extinct in this position but instead would
be transformed and emerge as an equal, valued, and respected member of
the academic community.
The greatest challenge for ACCEs is to develop the body of knowl-edge called clinical education. This can be achieved by critically explor
ing research on clinical teaching, educating others about the clinical
science of clinical education, actively seeking equal status with and
recognition of other faculty members by embracing the demands of aca
demia rather than functioning as administrators, and by serving the pro
fession's needs by constantly challenging clinical educators to maximize
student learning experiences based on strong theoretical constructs and
experientiallearning.43 Confronting these challenges may allow ACCEs
to be thought of as valued, recognized, and integral members of the phys
ical therapy faculty.
Roles and Responsibilities of the Center
Coordinator of Clinical Education
The CCCE's primary role is to serve as a liaison between the
clinic_al site and the academic instit:utions. From the student's perspec
tive, the CCCE functions in a unique but critical capacity. The CCCE is
viewed as the neutral party at the clinical site who functions in the role
of active listener, problem solver, conflict manager, and ,negotiator when
differences occur between a student's perception of his or her performance
and the Cl's perception of the performance. In some situations, CCCEs
also function as mentors for individuals serving as or potentially interest-
ed in becoming Cls.2
Because of the current pressure in health care to maximize human
resources, it is as likely that the CCCE is a physical therapist or physical
therapist assistant as it is that the individual is a non-physical therapy pro
fessional (e.g., an occupational therapist or speech therapist). Whether the
CCCE is a physical therapist or another health care professional, certain
qualities are considered universal to the role. This individual should effectively demonstrate the following attributes:
1. Experience as a practitioner.
2. Ethical professional behaviors.
3. Experience in providing clinical education to professional students.
4. Interest in providing quality learning experiences.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 14/49
132 PREPARATION FOR TEAClfING IN CLINICAL SETTINGS
5. Good interpersonal and communication skills.
6. Knowledge of the clinical facility and it s resources.
7. Capability to consult in the evaluation process.
8. Administrative, organizational, and managerial skills.
9. Knowledge of contemporary issues in clinical practice, practice
management, clinical education, and scholarship.
If the CCCE is a physical therapy professional, it is expected that he or
she will have attributes commensurate with that of CIs (see description
below). CCCEs should assess their capabilities and competence by complet
ing the American Physical Therapy Association's (APTA) self-assessment for
the CCCE.2
Responsibilities that are considered specific to the CCCE role associat
ed with clinical site development include:
1. Obtaining administrative support to develop a clinical education
program by providing clinical site administrators with sound ratio
nale and evidence for development.
2. Determining clinical site readiness to accept students.
3. Contacting academic programs to determine if the clinical site's
clinical education philosophy and mission is congruent with the
academic program's.
4. Completing the necessary documentation to become an affiliated clin
ical education program le.g., legal contracts that define the roles and
responsibilities of the clinical site and the academic institut ion andclinical center information forms, which document all essentialinfor
mation about the clinical facility, its personnel, and available student
learning experiences). The CCCE ensures that all required documenta
tion is completed accurately and in a timely manner and is updated as
warranted by changes in personnel and the clinical facility.33
Activities of the CCCE that·are associated with preparing for and pro
Viding on-site student learning experiences include:
1. Coordinating the assignments and learning activities of students at
the clinical site.
2. Scheduling the number of students that can be reasonably accom
modated by the clinical site on an annual basis.
3. Developing guidelines to determine when physical therapists and
physical therapist assistants are competent to serve as CIs for
students.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 15/49
Organizational Structure of Clinical Education 133
4. Providing mechanisms whereby Cls can receive the necessary train
ing to provide quality student clinical instruction.
5. Reviewing student clinical performance assessments to ensure their
accuracy and timely completion.
6. Understanding legal risks associated with teaching and supervising
students in the clinic.49-51
Although this position is considered essential to the physical therapy
clinical education, a word of caution must be provided given the context in
which contemporary physical therapy clinical education occurs. As health
care reform contim,J.es, especially in hospital-based practices, the CCCE who
is on senior staff and carries a partial to full caseload may be the first to have
his or her position eliminated. It is also important to note· that the profes
sion is finding itself in precarious situations in which no CCCE is designated
or the individuals who serve asCCCEs lack the appropriate qualifications
and clinical teaching experience to serve in this capacity. Of even greaterconcern is the possible loss of qualified mentors in clinical practice to edu
cate the next generation of clinical teachers who are ultimately responsible
for ensuring the future quality and effectiveness of physical therapy ser
vices.ll The profession must be sensitive to this situation rather than mini
mizing or denying its existence. Therefore, it must be open to exploring
alternative and collaborative strategies that are mutually beneficial and that
ensure the continuation of this role and its essential functions by providing
support to the physical therapy department or by advocating and negotiating
a position with the clinical facility's administration.
Roles and Responsibilities ofthe Clinical Instructor
When asked if they can recall any of their Cls, most health care
professionals will invariably answer "yes." Many say they remember not
only the Cls who were exemplary but also those who were perceived to be
poor role models. Likewise, they will remember why a particular Cl was
remarkable or why they were disappointed in a Cl's clinical teaching perfor
mance. Impressions left by clinical educators are lifelong; a laudable tribute
and commentary on the role that the Cl plays in the life of every health pro
fession student.
The Cl is integral to clinical education and is involved with daily
responsibility and overall direct provision of quality student clinical learn
ing experiences. In the organizational structure, the Cl works at the center
of the clinical education process. Students often believe that the success or
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 16/49
134 PREPARATION FOR 'TEACHING IN CLINICAL SETTINGS
failure of their clinicalleaming experience can be attributed to this indi
vidual. The Cl has also been called a clinical tutor, clinical supervisor, clin
ical preceptor, clinical teacher, and clinical educator. Each of these labels
can be identified with one or more roles that this individual routinely per
forms. Much has been written in the literature of health care about the Cl's
role and responsibilities and the attributes of the Cl that enhance student
leaming.27,52-57 Cls significantly contribute to students' understanding of
and competence in physical therapy clinical practice and serve as strong
role models that guide students' visions of how they would like to practice
in the future. The Cl should remember that the ultimate goal of clinical
education is to provide an environment that fosters students' professional
ism and encourages the development of an independent problem solver and
a reflective and competent practitioner.58 Entry-level practice expectations
for new graduates are fully described in the Normative Model of Physical
Therapist Professional Education, which represents a consensus-based view
of what the physical therapy profession believes are the preferred entrylevel practice expectations, content, and clinical education components in
physical therapist professional education.58
Skills and Qualifications of a Successful Clinical Instructor
In general, CIs' roles are multifaceted and include a range of
behaviors, such as facilitating, supervising, coaching, guiding, consulting,
teaching, evaluating, counseling, a d v i s i n g ~ career planning, role modeling,
and socializing. Before serving as a Cl for students in physical therapy,
competence should be demonstrated by the Cl in seven performance
dimensions:
1. Professional skills, including ethical and legal behavior.
2. Clinical competence demonstrated by critical inquiry, problem
solving skills, and reflective practice.
3. Communication skills, including the ability to address difficult situations.
4. Proficient interpersonal skills in relationships with patients,
clients, students, colleagues, and others.
5. Instructional skills, including organizing, facilitating, implement
ing, and evaluating planned learning experiences given the availablefacility resources.
6. Supervisory and observation skills leading to student perfor
mance expectations, timely feedback, periodic adjustments to.
structured learning experiences, and the development of reflec
tive practice skills.29
7. Performance evaluation skilis to determine professional compe
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 17/49
135rganizational Structure of Clinical Education
tence, ineffective or unsafe practices, and performance deficits or
exemplary practices.2, 58, 59
In addition, individuals should evaluate their readiness for or competence in
serving as a Cl by completing the self-assessment for clinical instructors.2
Minimal qualifications for persons serving as Cls include (I) a mini-mum of 1 year of clinical experience (or less in special programs or areas
of expertise in which less experience has proved satisfactory); (2) a will
ingness to work with students by pursuing learning experiences in clini
cal teaching; (3) a current state license, registration, or both (as required
by specific state practice acts) or graduation from an accredited physical
therapist assistant program; (4) positive representation of the profession
by assuming responsibili ty for professional self-development and demon
strating this responsibility to students; and (5) willingness to act as a pro
fessional role model and the ability to recognize the impact of this role
on students.60
Developing skills as a Cl begins with an awareness of the parallels that
exist between the roles of practitioner and Cl. By recognizing these parallels,
one can better understand how to transfer knowledge, skill, and behaviors
used in delivering patient care to the task of designing a clinical student
learning experience. Understanding the relationship between the role of the
practitioner and the Cl role allows the instructor to analyze the Cl attributes
that can be used to augment the teaching experience. Table 4-1 illustrates
parallel relationships between practitioners and their management of physi
cal therapy service delivery and Cls and their coordination and implementation of student learning experiences. Furthermore, exploration of the
practitioner-patient relationship can serve as a useful tool in exploring the
Cl-student relationship and the learning process.61
Qualities of a Successful Clinical Instructor
A successful Cl develops a framework for the teaching-learn
ing model by determining characteristics of the teacher, student, and pat ient
and the dynamics between them to facilitate teaching and learning while
maintaining patient satisfaction with clinical services. Moore and Perry62
found that the follOWing factors were essential to enable all students to have
a successful clinical education experience: (1) an atmosphere that is recep
tive to students, (2) staff who are interested in teaching students, (3) an
opportunity for students to practice patient care, (4) students who have spe
cific goals, (5) feedback on performance provided, (6) clinical assignments
that are long enough to accomplish objectives, and (7) students who are well
prepared. Additional essential factors for advanced students are patient vari
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 18/49
136 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
Table 4·1 Roles of the Practitioner and Clinical Inst ructor
Roles of the practitioner Roles of the clinical instructor
Patient referral and taking a patienthistory
Performing initial patient evaluationand problem identification
Determining long-term goals mutuallywith the patient
Defining short-term patient goals
Clarifying patient treatment plan
Performing patient re-evaluations andassessing the level of progression
Performing patient outcomes assessment and discharging patientsfrom physical therapy
Preplanning for the learning experienceand providing an orientation to theclinical site
Assessing students by identifying theirstrengths, learning needs, and previous
experiences
Setting overall student objectives andclarifying learning expectations withthe assistance of the students and theacademic program
Defining specific student behavioral andlearning objectives
Designing creative student learning expe-
riences
PrOviding formative student evaluationsand assessing the level of progressiontoward defined outcomes
ProViding summative student evaluationsand assessing students' readiness forcontinued progress through the cur
. riculum or entry into practice
Source: Adapted from The New England Consortium of Academic Coordinators of Clini
cal Education, Inc. The Role of the Clinician as Clinical Educator. Boston: The New Eng-
land Consortium of Academic Coordinators of Clinical Education, 1994i3.
ety, talented staff, a variety of educational experiences, and an opportunity
for th e students to explore their own objectives.
Clinical Instructor: Communication Skills
Sheets and Schwenk focused on one or more components of
the triangular relationship between the teacher, student, and patient or one
or more of the relationships within that triangle.63 However, a number of
studies have focused on factors related to affective behaviors that are critical
to effective learning experiences.52, 56, 63, 64 Affective characteristics of phys
ical therapists found to contribute positively to patient care as well as effec
tive clinical teaching include a positive attitude toward work, flexibility,
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 19/49
137
,
Organizational Structure of Clinical Education
compassion, sense of humor, openness to ideas and suggestions, friendliness,
discipline and organization within the setting, and confidence in abilities
and knowledge.65 Studies have examined students' and clinical instructors'
perceptions of attributes contributing to the Cl's effectiveness.52,66, 67 In sev-
eral studies, students consistently ranked communication, interpersonal
relations, and teaching behaviors as the most valuable instructor behaviorsin the clinical learning process. Communication and interpersonal relations
include intrapersonal, small group, conflict, organizational, and professional
types of communication.66 The smallest statistical differences found
between "best" and "worst" clinical teachers were demonstrated in profes-
sional skills and knowledge.52, 67, 68
Asa component of a comprehensive study of clinical education in phys-
ical therapy in the early 1970s, Moore and Perry62 surveyed clinicians who
ranked selected behaviors of communication and interpersonal relations as
the most essential traits of an effective Cl. However, in actuality, Cls were
shown to demonstrate these behaviors less frequently. They offered one
explanation for the discrepancy seen between those traits ranked as impor-
tant and the actual behaviors demonstrated by the Cl. They postulated that
this divergence resulted from a lack of adequate preparation on the part of
the Cl rather than from a lack of appreciation for the importance of those
behaviors. This was supported by the fact that at that time only 25% of CIs
surveyed had attended any type of teacher training.
In a study by Emery, students ranked many of the behaviors identified
to be necessary for effective clinical teaching as weak in their Cls.52 Since
more Cls are attending clinical education training courses,21 it might beassumed that these deficiencies would be reported less frequently. One must
probe further to determine if there are other explanations for inconsistencies
between affective behaviors desired in a Cl and affected behaviors actually
demonstrated by Cls.
The area of student performance most frequently cited by Cls as lack-
ing is also in the affective domain, specifically interpersonal relations and
communication.69, 70 However, ACCEs have reported that they are unlikely
to fail students for solely affective problems unless they occur in conjunc-
tion with psychomotor or cognitive deficiencies or both.71 Perhaps a flaw
exists in physical therapy education, which does not adequately define spe-
cific behavioral expectations for students and then assesses those profes-
Sional, affective behaviors throughout the curricular process in classroom
and clinic settings. If students are provided with clear behavioral perfor-
mance expectations and held accountable for their behaviors, perhaps they
will demonstrate better interpersonal relations and communication skills
as practitioners.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 20/49
138 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
Successful Clinical Instructors: Other Factors
Other factors that contribute to the success of clinical teach
ing and supervision are Ul the provision of student-centered teaching strate
gies that encourage activities such as reflection 26, 29-31; (2) support for
increased student autonomy; (3) application of situational leadership theo
ries applied in clinical learning that help students participate more responsibly in their learning experiences 72• 73; (4) belief in a model of the best
clinical practices in physical therapy; and 15) explication of the models of
problem solving and decision making, which are used to assist students in
making better management decisions with sound clinical judgment, espe
cially under ambiguous situations.74-80 Clinical teaching has also been
shown to be more effective when systematic instructional strategies (e.g.,
preparation, briefing, planning, practice, debriefing) and repeated learning
opportunities are available to students to reinforce learning.73, 81 Enhance
ment of student learning occurs when the purpose of the learning experience
is defined, expectations for student and Cl performance are clarified, the
level of commitment is determined for all persons involved in the learning
experience, and the timing, structure, frequency, and method of formative
and surnmative evaluations are provided.63, 78 One of the greatest challenges
for the Cl is to find a balance in the relationship with students between nur
turance and separateness: This is not unlike the delicate balance needed
with patients when providing physical ther:apy services.82 Specific tech
niques for teaching in clinical settings are presented in Chapter 5.
In a qualitative case study examining the outcome of the clinical learn
ing experience, Harris and Naylo:r83 showed that student motivation andenthusiasm were enhanced when the learning experience was focused on
education and feedback rather than socialization into the environment. The
physical therapy student with 11good clinical experiences" became patient
focused rather than technique-focused. This change of focus is a critical tran
sition that students must make to become effective practitioners.
Preparation for Clinical Instmction
To develop the requisite knowledge, skills, and behaviors
needed to effectively perform their responsibilities as clinical educators, Cls
must have adequate formal preparation in the areas of teaching, supervision,
interpersonal relations, communication, evaluation, and profesSional skills
and competence. Montgomery84 believes that in addition to lack of formal
training, many CIs also lack the "experience, maturity, and wisdom" to
serve as mentors to physical therapy students. In an ideal world, there would
be an abundance of trained and experienced persons willing to teach the
ever-increasing numbers of physical therapy students in the clinical setting.
/,
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 21/49
139rganizational Structure of Clinical Education
However, evidence shows the contrary. Cls report on average between 1 and
2 years of clinical experience before beginning to teach, and only slightly
more than half 153.4%) having attended a clinical training course.21
Development of national Clinical Education Guidelines in Physical
Therapy2 has influenced clinical training courses for Cls to use the seven
performance dimensions described previously in this chapter under "Skillsand Qualifications of a Successful Clinical Instructor" as a basis for defining
training objectives. Nevertheless, the development of formal training pro
grams for Cls does not adequately address issues of quality in clinical
instruction. In addition to academic programs and consortia that provide for-
mal training programs for CIs, students can also be better prepared by aca
demic programs and clinical educators for their eventual role as Os by
teaching them about learning and evaluation processes.
Many Cls believe that they are inadequately prepared for teaching.27, 84
Preparation for clinical teaching requires experiences that relate to teaching
issues. This includes (1) application of questioning and problem-solving
techniques; /2) application of levels of questioning in the domains of learn
ing (see Chapter 2); /3) application of behavioral questioning to address affec
tive issues and ways of improving the quality of questions; (4) application of
learning theory, including domains of learning and their hierarchies and an
understanding of the elements of and methods used to assess learning
styles85; (S) application of educational methodology, including adult learning·
and teaching theories and principles86; and (6) understanding of the context
in which learning occurS.84 Clinical teaching provides opportunities for
obtaining knowledge and developing skills in articulating and writing measurable cognitive, psychomotor, perceptual, and affective performance objec:'
tives; revising performance objectives64; and clarifying academic, student,
and Cl performance expectations. Aspects related to performance. expecta
tions and objectives are discussed in the section entitled "Student Objec
tives and Expectations of Clinical Learning Experiences."
Training Programs for Clinical Instructors
Training programs for Cls should provide specific information
about selecting appropriate, creative, and effective teaching methods that
actively involve learners in self-directed and guided experiences.30, 86, 87
These approaches should guide students to use available resources to access
information, maximize learning opportunities, assume responsibility for
self-directed and lifelong learning, apply critical thinking skills to solve
problems,88 apply skills learned to new situations, communicate learning
needs effectively, enhance observation skills, and develop as professionals.
Clinical teaching methods can include demonstration-performance, teacher
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 22/49
140 PREPARATION FOR TEACHING IN CLINICAL SETI'lNGS
exposition, seminars, case analyses, case incident studies, role playing, jour
nals, conferences, brainstorming sessions, reflective discussions, self-direct
ed activities, and so on.89-91
Clinical training programs should also address the process of clinical
evaluation. Basic concepts of clinical evaluation include (1) feedback, sum
mative, and formative evaluations; (2) evaluation terminology, such ascompetency-based evaluations and outcomes performance assessment;
(3) methods and techniques of evaluation, such as competency-based eval
uations, outcomes performance assessments, use of portfolios,3l,39 and
student self-assessment; (4) problems in and legal aspects of clinical eval
uation50; and (5) a basic understanding of different evaluat ion instruments,
including how to critique their relative strengths and limitations and how
to determine the most appropriate evaluation instruments for the specific
clinical setting.89, 92-95
Development of effective communication and conflict management
skil ls should also be included as part of clinical training programs. Specific
content to be addressed includes components of and barriers to communica
tion; ways of improving interpersonal, profeSSional, and organizational com
munication; sources of conflict in the clinical setting; and techniques for
identifying, managing, and resolving conflict.89
Fundamental components of clinical training should include an under
standing of the roles, characteristics, and responsibilities of the Cl and the
organizational structure of clinical education within the total curriculum
and management of the clinical environment and students' experiences
within that environment. 96, 97 Management of the environment includes:
1. Assessment of available learning resources.
2. Establishment of guidelines for a safe environment for pat ients and
students.
3. Understanding federal regulations related to the Americans with
Disabilities Act.
4. Creation of a filing system for confidential documents and other
forms.
5. Development of a schedule for students.
6. Motivating students to perform required tasks.
7. Development of a policy and procedure manual for students.
8. Selection of a student orientation method that is efficient and
comprehensive.
9. Understanding the management of patients wi th diverse backgrounds.
10. Promotion of positive learning experiences through learning con
tracts or other approaches.89 f"
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 23/49
141rganizational structure of Clinical Education
Successful clinical training programs are reported to be most frequent
ly accessed by clinical educators at physical therapy academic programs,
clinical education consortia, and individual clinical facilities.21 Frequent
ly, academic programs, clinical education consortia, or other clinical edu
cation special interest groups will sponsor 1- to 2-day annual, biannual,
or concurrent multisite disciplinary and interdisciplinary continuingeducation training programs for their clinical faculty at little to no
cost.21 , 98, 99 In addition, continuing education training programs are gen
erally offered as basic or advanced courses in clinical education. Training
issues addressed in this chapter, in general, reflect content found in basic
Cl training courses.
Some training programs offer state or regional certification or recogni
tion, continuing education units, or recognition by APTA as a course deliv
ered by an approved provider. However, many continuing education Cl
training programs do not have a mechanism for assessing the ability of the
program to instil l knowledge, skills, and competence,lOO, 101 To address this
concern, a 1994-1995 pilot study, which was funded by APTA and direct
ed by principal investigator Michael Emery in collaboration with Nancy
Peatman and Lynn Foord, was assigned to develop a valid and reliable
training and assessment system for credentialing clinical educators.102 The
outcome of this study has yet to be determined, but it may have far-reach
ing implications in providing quality training programs for physical therapy
clinical educators.
In addition to continuing education programs in clinical education,
formal postprofessional graduate programs specializing in education andtraining for academic and clinical faculty exist in physical therapy. Like
wise, self-instructional programs available in clinical education in other
health profeSSions !e.g., occupational therapy's Self-Paced Instruction for
Clinical Education Series [SPICESP03 or Health Occupations Clinical
Teacher Education Series for Secondary and Post-Secondary Teachers89)
could also provide an alternative mechanism for clinical educators in phys
ical therapy to further their continuing education. Another method for
enhancing clinical teaching skills is through formalized mentor or precep
tor programs, which are similar to teacher education programs. In such
programs, the clinical teacher and mentor jointly identify specific goals
and expectations for learning and performance. Once engaged in the clini
cal teaching process, the mentor provides ongoing feedback and evaluation
of the teacher's performance used in conjunction with teacher self
appraisals. 104, 105 However, a significant limitation to this approach is that
an experienced clinical educator must be available and willing to give time
and energy to the mentoring relationship.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 24/49
142 PREPARATION FOR TEACHING IN CLINICAL SE'ITINGS
Realistically, developing expertise as a Cl requires knowledge, skill,
and experience with positive and problematic student learning situations.
Not unlike the learning experiences designed for students, Cls require
opportunities to practice and reinforce knowledge and skills learned in
clinical training programs and to apply this knowledge to real student s i t ~ uations, preferably with the guidance of a clinical teaching mentor. 106
Thus, the process of learning to become a master clinical teacher is not
unlike that of learning to become an expert clinician.107 Mastery of the
subject matter related to prOviding effective clinical education, under-
standing the context in which clinical learning occurs, competence and
confidence in one's ability as a practitioner, and the ability to translate
educational theory into the practice of providing quality clinical instruc-
tion through reflective practices all contribute to developing qualities of a
master clinical teacher.108-110
Student Objectives and Expectations
of Clinical Learning Experiences
Designing a clinical education program for students requires a
structural framework, or road map, for ensuring that each planned learning
experience meets the expected performance outcomes. In addition, the aca-
demic program must determine, in the aggregate, how progressive clinical
experiences will, in conjunction with the didactic curriculum, accomplish
the curricular performance outcomes required of students for entry into
practice. Although at times the road may wind and even detour, i f students,clinicians, and academic faculty can clearly articulate specific, expected
learning and performance outcomes, the program can be adjusted through-
out the clinical experience according to the student's needs.
Determining student performance outcomes for clinical education
requires coordinated effort from students and faculty within academia and
practice. Each party must be actively involved in developing learning objec-
tives and setting performance expectations for each clinical experience pro-
vided within the curriculum. Academic programs determine objectives that
students must achieve and those that students can choose for progression
through the curriculum. In certain circumstances, students and academic
faculty may have curricular gaps and needs that can only be addressed by the
clinical site.
The clinical site must determine what experiences it can offer and objec-
tives for those experiences that can be accomplished within the specific clin-
ical setting and available time frame. The clinical site must also consider
how the academic program's objectives coincide with or differ from the c l i n ~
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 25/49
143
.
\
Student Objectives and Expectations
ical site's learning objectives. Ultimately, the Cl's function is to make stu-
dent learning experiences coherent.
Students are accountable for setting specific learning objectives for each
clinical experience and adjusting them accordingly during the experience.
These objectives are based on the expected knowledge, skills, and behaviors
they hope to acquire within a particular setting. Objectives are influenced byfactors such as area of special interest or patient care provided, congruence
with organizational structure provided for learning, and personal knowledge
of the facility and it s reputation. Students must actively seek learning expe-
riences in areas in which their knowledge is deficient or with which they
have no prior exposure.
The literature is consistent in considering the determination of objec-
tives in clinical education as fundamental to planning learning experiences.
Although several methods can be used to provide objectives, many authors
prefer the use of objectives expressed in behavioral terms.64 In this format,
the objectives describe the learner's behavior at the completion of the learn-ing experience, the conditions under which the learner must function, and
the evaluation method/sI that will be used to assess the learning. Thus, the
Cl is explicitly aware of the planning and evaluative components required to
determine student competence, and the students understand precisely what
is expected of them during the experience.58
Objectives for clinical education serve four purposes: (1J design and
development of the clinical education program, (2) help in determining the
teaching methods to be used, (3) a method for assessing the learning experi-
ence and students' achievement of the objectives, and (4) augmentation ofthe abilities of persons involved in developing the objectives.64 Objectives of
a learning experience may be culled from multiple sources, all of which
result from some type of evaluative process involving questions about what
is needed, what is available, and where gaps in knowledge exist.37, 92
The four major factors that determine the objectives in health profes-
sional programs are 11) the health needs and demands of society, (2) the
nature of the subject matter , (3) characteristics of the learners, and (4) pro-
fessional standards.64 Obviously, with the rapidly changing and expanding
need for physical therapy services, dramatic shifts in technology, and fluc-
tuations in health care, it is critical that academic programs continuallyreassess performance outcomes, reflected by curricular objectives, to ensure
their relevancy. Curriculum content must be adjusted accordingly to equip
graduates with the tools necessary to cope with contemporary and future
health care. Evidence shows that in the past 5 years, characteristics of
learners within physical therapy programs have remained essentially
unchanged. I I I However, faculty report anecdotally that learners have changed
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 26/49
144 PREPARATION FOR TEACHING IN CLINICAL SETI1NGS
their values and attitudes about their education, and this has subsequently
influenced curricular design, implementation, and performance out
comes.16 Lastly, as part of a profession's responsibility, it must, on a regular
basis, determine those behaviors that are believed to be essential for all
graduates when entering practice.58
Behavioral objectives in clinical education should address all domains oflearning at multiple hierarchical levels to ensure that learning experiences
are incremental and comprehensive (see Chapter 2). As students progress
through successive clinical experiences, consideration should be given to
defining behavioral objectives that progressively move up the hierarchy
within each domain. For example, early student experiences may define
behavioral objectives in the cognitive domain at the levels of knowledge,
comprehension, and basic application, compared to later clinical experiences
that expect students to perform in the cognitive domain at the levels of
analysiS, synthesis, and evaluation. This process can be used to identify the
degree to which students are able to successfully meet expected levels of per
formance for entry into practice.
Effective clinical educators use global and behavioral objectives. Global
objectives describe the broader, more general outcome expectations for stu
dent performance, while behavioral objectives are more specific and help to
further define each incremental learning experience.64 For example, a global
objective in the psychomotor domain fi1:ight state, 1/ • • • the student will be
able to evaluate a patient." A specific behavioral objective accompanying
this global objective might state, 1/ • • • the student will accurately evaluate a
patient with complex shoulder pathology in 30 minutes using a systematicapproach substantiated by the literature." The progression of a set of behav
ioral objectives should lead to achievement of global objectives. Four essen
tial components of a written behavioral objective are a behavior, condition,
criterion, and. the audience or leamer.64 Each of these four components is
clarified in Table 4-2 with examples provided for each component.
Well-written objectives should be leamer-centered rather than teacher
centered, be outcome-oriented rather than process-oriented, be outcome-ori
ented rather than a statement of the material to be addressed, be a
description of only one outcome, be specific rather than general, and be
observable and measurable. Table 4-3 illustrates each of these requirements
and contrasts correct and incorrect methods of writing an objective.
Global objectives should provide broad experience or overall structure
for determining behavioral objectives in each of the learning domains. With
subsequent clinical experiences, some global objectives will be cumulative
in nature, while others may be distinctive. However, the sum total of all
global objectives in clinical education, in conjunction with the didactic cur
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 27/49
146lternative Supervisory Patterns in Clinical Education
Table 4·2 Components of a Behavioral Objective
Component Description Examples
Behavior
Condition
Criterion
Learner or audience
Describes what the learnermust specifically do
Describes the circum-stances under whichthe objective will beachieved and the meth-ods used
Describes the level ofacceptable performance
Focuses on the learner oraudience rather thanthe instructor
Palpate the greater trochanter.Describe the signs and symp-
toms of rheumatoid
arthritis.Following a patient demon-
stration...Given a skeleton ..
Student completes an evalua-tion of the shoulder within10 minutes.
Student completes an evalua-tion thoroughly.
The student will...
The learner will ..
Source: Adapted from The New England Academic Coordinators of Clinical Education, Inc.
The Role of the Clinician as Clinical Educator. Boston: The New England Consortium of
Academic Coordinators of Clinical Education, 1994;14.
riculum, should adequately address those performance aspectsthat
arerequired of students to satisfactorily progress through the curriculum and be
prepared for init ial clinical practice.
In summary, it is critical that behavioral objectives in clinical education
are sequenced in light of didactic components that have been completed;
achievable within the specific clinical setting; comprehensive, in that they
address all domains of learning and progress students through each of the
respective hierarchies; and congruent with the philosophy, goals, mission,
and outcomes of the academic program.
Alternative Supervisory Patterns
in Clinical Education
To do justice to alternative supervisory patterns in clinical
education would require space beyond that which can be allocated in this
chapter. Therefore, only salient points will be highlighted. An attempt has
been made, however, to provide the reader with a table that consolidates
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 28/49
146 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
Table 4·3 Appropriate and Inappropriate Constructs for
Writing Behavioral Objectives
Requirement Appropriate example Inappropriate example
Learner centered vs The student will perform The teacher will show the
teacher centered goniometric measurements. student how to perform
goniometric measurements.
Outcome oriented The student will collect five The student will gather
vs process oriented articles on cystic fibrosis. information on cysticfibrosis.
Outcome oriented The student will evaluate The student will look at
vs merely stating biomechanics of the knee. biomechanical knee
the material to be problems.
addressed
Describes only one The student will conduct a The student will list theoutcome vs de- patient interview. questions to be asked in
scribing multiple an interview, conductoutcomes the interview/ and
assess the results.
Specific vs general The student will accurately The student will perform
perform manual muscle manual muscle testing.
testing on the ankle.
Observable and The student will provide a The student will know whymeasurable vs rationale for the treatment he or she is providing
not observable delivered based on research. treatment.and quantifiable
Source: Adapted from The New England Academic Coordinators of Clinical Education,Inc. The Role of the Clinician as Clinical Educator. Boston: The New England Consor-tium of Academic Coordinators of Clinical Education, 1994;14.
information into a quick and functional user-reference (Table 4-4). Never-
theless/ the reader is encouraged to further explore references cited in this
section. Propelled by changes within health care delivery, this issue has now
become one of the most exciting and explosive areas of clinical education
research within health professions disciplines.
Frequently/ physical therapy clinical educators will comment that alter
native student supervisory patterns were implemented in practice in the
1960s and 1970s and that this issue is no t altogether new. However, during
that time, little or no empirical evidence was reported that described these
supervisory patterns, their benefits or limitations, or their outcome effec
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 29/49
147lternative Supervisory Patterns in Clinical Education
tiveness. More recently, however, physical therapy clinical education
research has focused on an examination of the effectiveness of various
approaches to student supervision to determine how best to provide student
clinical education given limited personnel, patient, financial, and space
resources. Il2 In the 1995 issue of PT Magazine, Gandy113 provides a context
for understanding why the profession is confronted with the need to providemore collaborative and interdependent methods for providing high-quality
student learning experiences in varied practice settings. The fundamental
basis for these changes lies in the need to 11adjust our focus-even replace
the lens-and explore alternatives that more efficiently use available limit
ed practice and education resources and provide an environment for learning
that more closely approximates current and future practice. 1 113 In the past
decade, pervasive changes have occurred in the configuration of practice and
the delivery of physical therapy services, the design of physical therapy cur
ricula to accommodate increased numbers of students, and the level of expe
rience of persons providing on-site student clinical supervision. Collectively,
these changes have forced the profession to rethink the one Cl to one stu- .
dent supervisory model and to consider and evaluate the use of other super
visory designs.
Like the variance within physical therapy curricular configurations and
health care delivery systems, there are equally as many innovative and col
laborative approaches to the supervision of students in the clinic. Many of
these designs offer distinguishing features reflecting philosophical bent and
professed outcomes (e.g., active learning, collaborative peer teaching, coop
erative teaching, mentoring, clinical decision making and problem solving,and reflective practice). Some of these designs have been implemented mere
ly by happenstance or due to creative problem solving.114, 115 Others have
been intentional decisions to engage in an empirical and critical inquiry
process to systematically develop, implement, or evaluate specific supervi
sory approaches with an explicit outcome of expanding our knowledge of
supervisory patterns in clinical education.116-121 126 Although this list is by
no means fully inclusive, some of the supervisory designs used in clinical
education include:
• One Cl to one student (traditional designJ• One Cl to two or more students !collaborative-peer designJl16-126 t 142, 143
• A physical therapist and physical therapist assistant team to one phys
ical therapist and physical therapist assistant student team (supervi
sor-delegator designl1l4
• One Cl to two or more students paired from the same academic pro
gram where a student with more clinical experience supervises a
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 30/49
PREPARATION FOR TEACHING IN CLINICAL SE1TINGS48
Table 44 Strengths, Considerations, and Limitations of Alternative
Supervisory Designs in Clinical Education
Design Strengths Considerations and limitations
One Cl to one
student Itra
ditional designl
One Cl to twoor more students {collabor-ative-peer designj116-125,142,143
One PT and
PTA/Cl teamto one PT andPTA student
team {super-
visor -delegatordesignJl14
Allows the Cl to maintain
greater control of the
learning experienceCan easily monitor student
performance
Familiar student learning
design
Fosters collaborativelearning through peerinteractions
Enhances clinical competence related to clinicaljudgment
Develops greater selfreliance, independence,and interdependence
Teaches students to use
and maximize limited
resources
Allows the Cl to facilitate
and guide the learningexperience
Fosters student problem
solving and criticalthinking skills
Makes orientation lesscostly and time consuming
Teaches students grouppresentation skills by
providing collaborativeprojects or in-services
Enhances service producti
vity in some settings{e.g., acute careJl21
Is useful for structured part
time group learning experiencesl43
Enhances understanding
and skills associated
with supervision anddelegation
Enhances understanding ofthe roles and responsi
bilities of the PTA
Student less likely to learn from
other clinicians
Limits opportunities for collaborative learning
Fosters student dependence on
the Cl
Requires more plamring, effort,and organization time
Requires that the total patientload is able to accommodatestudent needs
Requires additional time to com
plete s tudent evaluationsPresents the possibility that too
many patients will remain for
the available clinicians afterstudents have completed thei r
training
Use more likely as an experi
enced Cl
Requires that the Cl be highly
flexibleCan be problematic for a s who
wish to control learning expe
riencesMay be problematic for "needy"
students
Assumes that a PTA works at
the clinical site
Requires that the PT/PTA/Clteam clearly understands the
appropriate delegation, supervision, and use of the PTA and
role models behaviors that
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 31/49
Alternative Supervisory Patterns in Clinical Education 149
Design Strengths Considerations and limitations
Provides opportunities for demonstrate this under-
PT students to learn standing
appropriate utilization of Assumes that the PTA and PT
the PTA through role value and respect each other
modeling by the PT/PTA/ as coworkers
Cl team Requires that PTA and PT stu-Provides for collaboration dents are comfortable with
and sharing of informa- their respective roles,
tion between PT and PTA strengths, and limitations sostudents that they can learn from each
Maximizes clinical site re- othersources and minimizescompetition for limitednumbers of clinical sites
when PT/PTA programs
provide the student clin
ical education concurrently
One Cl to two Same as one Cl to two or Same as one Cl to two or morestudents more students design students designpaired from Allows the experienced stu- Can be problematic i f studentsthe same pro- dent to develop supervisory are not compatible in theirgram at diff- skills learning styles or interpersonerent clinical Allows students to use each al interactionslevels {stu- other as a resource and ac- Requires alternative leadershipdent-peer cept feedback more easily design situations in which onementor Allows the experienced stu- student is the leader and thedesign1127-129 dent to orient the inexper- other the aide, and vice versa
ienced student when be
ginning times are staggered
Allows the experienced stu
dent to serve as the lead in
situations in which the in
experienced student has
not completed the didactic
content
Is useful in situations in which
the inexperienced student
has a shorter clinical experi
ence
Two part-time CIs Maximizes opportunities for Requires excellent communicaor two CIs on dif- part-time personnel to be in- tion between Clsferent rotations volved as Cls (often experi- Can confuse students if expectato one or more enced clinicians) tions of the Cls differstudents13o,144 Increases opportunities for Requires additional planning and
clinical s i ~ e s with part-time organization
clinicians to participate in Requires greater coordination
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 32/49
150 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
Table 4-4 (continued)
Design Strengths Considerations and limitations
clinical education
Exposes students to multiple
approaches to care delivery
Allows part-time and full-time
CIs to show comparableabilities in providing learn
ing experiencesl44
Permits students in the same
setting to be exposed to dif-
ferent learning experiences
with different Cls
Allows a clinical site toac-
commodate more students
by using multiple rotations
within the same setting
Allows for greater variability
in length of the clinical ex
perience
Increases Cl productivity in
comparison with clinicians
that are no t involved
Reduces supervisors' direct pa
tient-related responsibilities
Decreases the number ofsuper-ficial questions posed by
students
TWo CIs (one high- Provides a mechanism to men
ly experienced to r and develop an inexper
and one less ienced Cl through role
experienced) to modeling and teaching
two or more Allows students to learn using
students parallel processes as inex
(teacher-mentor perienced Clsdesignll23,m, 132 Ensures that the experienced
Cl's knowledge is passed on
to others
Allows students to be part of
a positive lea:pling CI model
that can be emulated
Multiple rural or Permits solo practice settings
single practices to network with other sites
offering collab to provide student clinical
omtive clinical experiences
learning experi- Provides a support system for
ences (coopera clinical teachers in rural
between CIs in completing
student evaluations
Allows the possibility that stu
dents may compare CIs or CIs
may compare studentsCan make it difficult for stu
dents to achieve their learning
objectives
Can decrease the variety and
number of patients in the stu
dents' caseload
Requires an open and trusting
relationship between CIs
Requires that the inexperienced
Cl is comfortable with stu
dents knowing that he or she
is inexperienced
Confuses students as to which
Cl they are accountable
Requires excellent communica
tion and clarity of roles be
tween CIs
Requires coordination and excel
lent communication between
practice settings and CIs
May be more difficult to imple
ment because of different
practice sett ing protocols and
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 33/49
151lternative Supervisory Patterns in Clinical Education
Design Strengths Considerations and limitations
tive-networkdesign)l33-136
One or more CIs
to one or more
students from
different disci
plUles (interdisciplUlaryIco-
operative des i ~ I I 3 3 , 136, 137
settings
Networking provides a mech
anism to access clinical fac
ulty training
Enhances opportunities for
students to be exposed torural and solo practices
Augments student learning ex
periences through interac
tions with multiple clini
cians who provide care in
different clinical settings
Provides a learning model that
teaches collaborative team
learning among different
disciplUles
Gives students a better understanding of the roles and re
lationships between differentdisciplines in real practice
Teaches students team leader
ship and follower skills
Models a more ideal learning
environment to learn how to
work more effectively in an
interdisciplinary setting
Assists in minimizing "turf
battles" that affect qualitylearning
regulations
Requires more complex coordi
nation by the academic pro
gram with different legal con
tracts
Applies only i f different disci
plUles exist at the clinical site
Requires excellent commurtica
tion between and among the
different wsciplUlesRequires exceptional planning
and organizational skills
Requires that CIs trust, respect,
and value each other'S exper
tise and contributions to the
learning process
May cause problematic llturf
battles" i f interdisciplUlary
cooperation does not exist or
where 11 turf battles" already
exist
Cl = clinical instructor; PT = physical therapist; PTA = physical therapist assistant.
student from the same program with less clinical experience Istudent
peer mentor designJl27-129
• Two part-time eIs (or on different rotations) to one or more students130, 144
• Two eIs (one highly experienced and one inexperienced) to two ormore students Iteacher-mentor design)l23, 131, 132
• Multiple distinct rural or single practices collaborating to offer stu
dent clinical experiences (cooperative-network designJ133-136
• One or more eIs to one or more students from different professional
disciplines to provide an interdisciplinary clinical learning experience
linterdisciplinary-cooperative design)133, 136, 137
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 34/49
152 PREPARATION FOR TEACHING IN CUNICAL SETI'lNGS
For each of the designs listed in Table 4-4, specific strengths, considera
tions, and limitations have been summarized to assist clinical educators in
determining if an approach is relevant for their particular practice setting.
Table 4-4 is useful in beginning the investigative process to determine what
alternative supervisory designs might be possible in any given clinical site.
The majority of these designs are variations on the one Cl to two or morestudents design, which stresses active student learning through peer teach
ing and collaborative and cooperative learning.
Collaborative and cooperative learning were originally developed for
educating people of different ages, experience, and levels of mastery of inter
dependence. Cooperative learning was principally designed for primary
school education to assist children in becoming more efficient and effective
in learning to work together successfully on substantive issues, to hold stu
dents accountable for learning collectively rather than in competition with
one another, and to provide social integration regardless of issues of diver
sity. Collaborative learning is similar to cooperative learning in that the goalis to help persons work together on substantive issues. However, collabora
tive learning was developed primarily to make students emolled in higher
education more efficient and effective in aspects of education that are not
content driven, to shift the locus of classroom authority from the teacher to
student groups, and to facilitate structural reform and conceptual rethinking
of higher education.13B
Although perceived by some to be synonymous and interchangeable ter
minology, collaborative and cooperative learning within the context of small
gronp learning are markedly dissimilar. Dist inctions between collaborative
and cooperative learning are generally drawn between the nature and author
ity of knowledge. The major disadvantage of collaborative learning is that,
in attaining self-directed and peer learning, it sacrifices learner accountabil
ity.la8 Whereas, cooperative learning's major flaw is that by emphasizing
accountability it risks replicating within each small group the more tradi
tional model of teacher autonomy.139 These two approaches also differ in
terms of style, function, and teacher involvement; the extent to which stu
dents need to be trained to work together in groups; different outcomes, such
as mastery of facts, development of judgment and construction of knowl
edge; the importance of different aspects of personal, social, and cognitivegrowth among students; and implementation concerns (e.g., group forma
tion, task construction, and grading procedures).140
However, collaborative and cooperative learning are based on the fun
damental assumption that knowledge is a social construct and open-ended
tasks that facilitate collaboration and control by learners restructure the
classroom environment.138 The two philosophies also argue that learning in
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 35/49
Summary 153
an active mode is more effective than passive reception-the teacher is a
facilitator, coach, or 11guide by the side"26-teaching and learning are shared
experiences between teachers and students; participating in small group
activities develops higher-order thinking skills and enhances abilities to use
knowledge; accepting responsibility for learning as an individual and as a
member of a group enhances intellectual development; articulating one'sideas in a small group setting enhances students' abilities to critically
reflect on their own thOUght processes and assumptions; belonging to a
small group and supportive community increases student success and
retention; and appreciating diversity is essential for survival in a multicul
tural society.139 Although there aredistinctions between these two types of
learning, for the purposes of exploring and implementing alternative
designs in physical therapy clinical education, it is preferable to unite both
learning approaches by drawing on each of their strengths to enhance the
achievement of desired outcomes.
It is important to note that merely placing two or more students together during a clinical experience does not connote cooperative or collaborative
learning. Specific components must be present for small group learning to be
truly cooperative and collaborative. As Johnson et al. stated, "[a] group must
have clear positive interdependence and members must promote each other 's
learning and success face to face, hold each other individually accountable to
do his or her fair share of the work, appr9priately use interpersonal and small
group skills needed for cooperative efforts to be successful, and process as a
group how effectively members are working together. fl141
Finally, assessment of any approach should be considered in light of(1) the context in which learning must occur; (2) the academic program ex
pectations; (3) the available resources; (4) the availability of patients; (5) the
support of administration for clinical education specifically addressing pro
ductivity and cost-effectiveness of care delivery; (6) the expertise, experience,
and attributes of individuals serving as clinical educators; (7) the relationship
between all individuals involved in the teaching-learning process; (S) the
characteristics of students; (9) strengths, limitations, and considerations of a
particular supervisory design; (10) the time available for planning and evalu
ating the alternative design; (11) the desired outcomes of the learning experi
ence; and (12) the strategies for ensuring successful implementation.
Summary
This chapter discusses topics perceived to be most critical to
understanding how to adequately prepare effective physical therapy teachers
in clinical settings. It is understandable how situations like the one present
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 36/49
154 PREPARATION FOR TEACHING IN CLINICAL SETI1NGS
ed at the beginning of this chapter might readily occur, but such is not the
preferred approach for preparing future clinical educators. Many aspects of
clinical teaching have been shown to be grounded in literature that provides
conceptual models and investigative studies that help to define components
essential for quality education and training programs for clinical teachers.
The reader is encouraged to explore references provided in the annotated bibliography at the end of this chapter to learn more about clinical
instruction. As more clinical educators critically investigate the use of
alternative supervisory models, the profession will derive greater knowl
edge and understanding about the evidence-based differences between these
designs and their resultant outcomes and effectiveness. Perhaps then, dis
cussions espousing the benefits of one design over another will be resolved
based on empirical evidence rather than intuition, historical precedent, and
personal anecdotes. Before becoming a clinical educator, opportunities for
self-assessment, professional development and enhancement, and. mentor
ship should be made available to specifically address the learning needs ofclinical educators. ,
I t is my belief that advocating clinical teaching professional develop
ment programs is not sufficient. To pervasively impact the larger interests of
the physical therapy profession, the process of becoming a Cl should begin
when educating students during their profeSSional studies.58, 145 Students
should be oriented as part of their active participation in clinical education
to understand the roles and responsibilities of the ACCE, CCCE, and Cl
Students should also learn how to give feedback, critically evaluate their
learning experiences, and routinely perform self-assessments to monitortheir growth and development throughout progressive learning experiences.
They should also begin to develop an understanding and appreciation for the
analogous processes used in providing clinical teaching and physical therapy
services. In this way, students will learn to translate the process of service
delivery, which is the primary focus of their clinical education and initial
practice, to teaching students in clinical settings, which is one of the first
roles they will assume as practitioners.
Clinical educators must be held accountable for role modeling those
behaviors that they would like future practitioners to aspire to, and for
demonstrating good clinical teaching practices to ensure that students learnthe things that the profession believes are required for entry into practice.
Understanding the principles of pedagogy (i.e., that graduates will often
teach in the clinical setting in the way that they were taught) means that
CIs must critically examine their teaching to determine if their current
approach is the legacy they wish to pass on. Andragogy, principles of adult
learning, applies to physical therapy students and how they learn.86 Perhaps
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 37/49
References 155
if Cls can recall their clinical education experiences as students, it will
remind them of the pivotal role they play in the lives of all students. If Cls
live by this rule, they can begin to reshape clinical education. More impor
tant, individuals who serve to benefit most from these changes are the
future graduates of physical therapy and physical therapist assistant pro
grams who will deliver quality and cost-effective physical therapy care topatients in an uncertain health care environment.
References
1. Bames MR. The twenty-sixth Mary McMillan lecture. Phys Ther
1992; 72:817.
2. American Physical Therapy Association. Clinical Education Guide
lines and Self-Assessments. Alexandria, VA: American Physical Ther
apy Association, 1993.
3. Commission on Accreditation in PhYSical Therapy Education. Evalua
tive Criteria for Accreditation of Education Programs for the Prepara
tion of Physical Therapists. Alexandria, VA: American Physical
Therapy Association, 1992.
4. Ciccone CD, Wolfner ML. Clinical affiliations and postgraduate job
selection: a survey. Clin Manag 1988;8:16.
5. Emery MJ, Gandy JS, Goldstein M. Factors Influencing Career Selec
tion of Students. Presented at American Physical Therapy Association
Combined Sections Meeting. Reno, NV: February, 1995.
6. Buchanan Cl, Noonan AC, Q'Brien ML. Factors influencing job selection of new physical therapy graduates. J Phys Ther Educ 1994;8:39.
7. Gwyer J. Rewards of teaching physical therapy students: clinical
instructor 's perspective. J Phys Ther Educ 1993;7:63.
8. Bok D. Reclaiming the public trust. Change 1992;24:13.
9. Winston Gc. Hostility maximization and the public trust. Change
1992;24:20.
10. EI-Khawas E. Campus Trends 1993. Washington, DC: American Coun
cil on Education, Higher Education Panel Report (No. 83) 1993;8:3.
11. Emery MJ. The impact of the prospective payment system: perceived
changes in the nature of practice and clinical education. Phys Ther
1993;73:11.
12. Ewell PT. Total quality and academic practice: the idea we've been
waiting for? Change 1993;25:49.
13. Brigham SE. TQM: lessons we can learn from industry. Change
1993;25:42.
14. Marchese T. TQM: a time for ideas. Change 1993;25:10.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 38/49
156 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
15. Marchese T. How we work: a corporate view of campus practices.
AAHE Bull 1992;44:3.
16. Levine A. Student expectations of college [editorial]. Change
1993;25:4.
17. Kennedy D. Another century's end, another revolution for higher edu
cation. Change 1995;27:8.
18. Plater WM. Future work: faculty time in the 21st century. Change
1995;27:22.
19. Akst J. Minorities in continuing education: issues, trends, suggestions.
Quest 1995;1:1.
20. Collins H. The curriculum and multiculturalism: PC and the press.
Change 1992;24:12.
21. American Physical Therapy Association, Department of Clinical Edu
cation. 1992 Clinical Faculty Survey. Alexandria, VA: American Phys
ical Therapy Association, 1992.
22. Gallisath G. Building a virtual college in the cyber frontier. Quest1995;1:4.
23. Green KC, Gilbery SW. Great expectations: content, communications,
productivity, and the role of information technology in higher educa
tion. Change 1995;27:8.
24. Brookfield S. Self-Drrected Learning: From Theory to Practice. New
Directions for Continuing Education (No. 25). San Francisco: Jossey
Bass, 1985;31.
25. Chickering A Empowering lifelong self-development. AAHE Bull
1994;47:3.
26. Schon D. Educating the Reflective Practitioner. San Francisco: JosseyBass, 1987;3.
27. Scully RM, Shepard KF. Clinical teaching in physical therapyeduca
tion: an ethnographic study. Phys Ther 1983;63:349.
28. Department of Clinical Education. Clinical Center Information Form
(CCIF). Alexandria, VA: American Physical Therapy Association, 1994.
29. Jensen G, Denton B. Teaching physical therapy students to reflect:
a suggestion for clinical educat ion. J Phys Ther Educ 1991;5:33.
30. Shepard KF, Jensen GM. Physical therapist curricula for the 1990s:
educating the reflective practitioner. Phys Ther 1990;70:566.31. Gandy JS, Jensen G. Groupwork and reflective practicums in physical
therapy education: models for professional behavior development. J
Phys Ther Educ 1992;6:6.
32. Black JPH. The indispensable link between practice and education.
R.E.A.D. Education Division Newsletter. Alexandria, VA: American
Physical Therapy Association, 1995;8.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 39/49
References 157
33. Peatman N, Albro R, DeMont M, et al. Survey of center clinical coor
dinators: format of clinical education and preferred methods of com
munication. J Phys Ther Educ 1988;2:28.
34. Department of Education. Physical Therapy Professional Education
Programs Fact Sheet. Alexandria, VA: American Physical Therapy
Association, 1994;4.
35. Ebert MS. Guide to Visiting Physical Therapist and Physical Therapist
Assistant Students at Clinical Sites for Academic Coordinators of
Clinical Education and Other Faculty. New York: Columbia Univer
sity, 1995.
36. May BJ, Smith HG, Dennis JR. Combined clinical site visits and
regional continuing education for clinical instructors. J Phys Ther
Educ 1992;6:52.
37. Division of Education. Physical Therapist Student Clinical Perfor
mance Instrument (second draft). Alexandria, VA: American Physical
Therapy Association, 1995.38. Wojcik B, Rogers J. Eilhancing clinical decision making through stu
dent self-selection of clinical education experiences. J Phys Ther Educ
1992;6:60.
39. Jensen GM. A conceptual model for teaching: reflection and the role of
portfolio assessment [abstract]. Phys Ther 1993;73:65.
40. Jacobson B. Characteristics of physical therapy role models. Phys Ther
1978;58:560.
41. Phillips BU Jr, McPhail S, Roemer S. Role and functions of the aca
demic coordinator of clinical education in physical therapy education:
a survey. Phys Ther 1996;66:981.42. Harris MJ, Fogel M, Blacconiere M. Job satisfaction among academic
coordinators of clinical education in physical therapy. Phys Ther
1987;67:958.
43. Strickler SM. The academic coordinator of clinical education: current
status, questions, and challenges for the 1990s and beyond. J Phys Ther
Educ 1991;5:3.
44. Clouten N. The academic coordinator of clinical education: career
issues. J Phys Ther Educ 1994;8:32.
45. Department of Education. Decade: A Historic Perspective of PhysicalTherapy Education. Alexandria, VA: American Physical Therapy Asso
ciation, 1994;6.
46. Department of Clinical Education, Division of Education. Position
Description-Physical Therapist Program. Alexandria, VA: American
Physical Therapy Association, 1993.
47. Kondela-Cebulski PM. Counseling function of academic coordinators
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 40/49
158 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
of clinical education from select entry-level physical therapy educa
tional programs. Phys Ther 1982;62:470.
48. Deusinger SS, Rose SJ. Opinions and comments: the dinosaur of aca
demic physical therapy. Phys Ther 1988;68:412.
49. Moore ML. Legal status of students of health sciences in clinical edu
cation. Phys Ther 1969;49:573.
50. Smith HG. Introduction to legal risks associated with clinical educa
tion. J Phys Ther Educ 1994;8:67.
51. Monahan B. Clinical educators-"Insights you can't find in a text
book." PT Mag 1993;1{1l):71.
52. Emery MJ. Effectiveness of .the clinical instructor: students' perspec
tive. Phys Ther 1982;64:1079.
53. Irby M. Clinical teaching and the clinical teacher. J Med Educ
1986;61:34.
54. Irby DM, Ramsey PG, Gillmore GM, et al. Characteristics of effective
clinical teachers of ambulatory care medicine. Acad Meq 1991;66:54.55. Dunlevy CL, Wolf KN . Perceived differences in the importance and
frequency of clinical teaching behaviors. J Allied Health 1992;21:175.
56. Emery MJ, Wilkinson CP. Perceived importance and frequency of clin
ical teaching behaviors: surveys of students, clinical instructors, and
center coordinators of clinical education. J PhysTher Educ 1987;1:29.
57. Jarski RW, Kulig K, Olson RE. Clinical. teaching in physical therapy:
student and teacher perceptions.Phys Ther 1990;70:173.
58. Division of Education. Normative Model for Physical Therapist Pro-
fessional Education (4th rev), Alexandria, VA: American Physical
·Therapy Association, 1996.59. The New England Consortium of Academic Coordinators of Clinical
Education, Inc. The Role of the Clinician as Clinical Educator. Boston:
The New England Consortium of Academic Coordinators of Clinical
Education, 1994.
60. Jacobson B. Role modeling in physical therapy. Phys Ther 1974;54:244.
61. Rolfe G. The role of clinical supervision in the education of student
psychiatric nurses: a theoretical approach. Nurse Educ Today 1990;
10:193.
62. Moore ML, PerryJP.
Clinical Education in Physical Therapy: PresentStatus/Future Needs. Washington, DC: Section for Education, Ameri
can Physical Therapy Association, 1976;3:l.
63. Sheets KJ, Schwenk TL. The Teaching Learning Triangle of Profes
sional Education: Implications for Research and Development
[abstract}. Presented at the Annual Meeting of the American Education
Research Association. San Francisco: March 28, 1989.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 41/49
References 169
64. Swinehart 5, Meyers SK. Level I fieldwork: creating a positive experi
ence. Am I Occup Ther 1993;47:68.
65. Wojcik R. Students' perceptions of the affective characteristics of
physical therapists. Master's thesis. University of lllinois, Health Sci
ences Center, 1984.
66. Farmer SS. Communication competence in 'clinical education/super
vision: critical notions. Clin Superv 1988;6:29.
67. Irby D. Clinical teacher effectiveness in medicine. I Med Educ
1978;53:808.
68. Mogan J, Knox JE. Characteristics of "Best" and "Worst" Clinical
Teachers as Perceived by Baccalaureate Nursing Students and Faculty
[abstract]. Presented at the Annual Research in Nursing Conference.
San Francisco: 1987.
69. Foord L, DeMont M. Teaching students in the clinical setting: manag
ing the problem situation. J Phys Ther Educ 1990;4:61.
70. Gandy JS, Bork CE. How clinicians address student clinical problems[abstract]. Phys Ther 1984;64:729.
71. Gandy IS. How academic coordinators of clinical education resolve
student problems [abstract]. Phys Ther 1985;65:695.
72. Sanko J. Clinical education with style. Clin Manag 1986;6:16.
73. Keenan MI, Hoover PS, Hoover R, et al. Leadership theory lets clinical
instructors guide students toward autonomy. Nurs Health Care
1988;9:82.
74. Denton B. Facilitating clinical judgment across the curriculum. I Phys
Ther Educ 1992;6:60.
75. May BI, Newman I. Developing competence in problem solving. Phys
Ther 1980;60: 1140.
76. Bumett CN, Mahoney PI, Chidley MI, et al. Problem-solving approach
to clinical education. Phys Ther 1986;66:1730.
77. Slaughter DSi Brown DS, Gardner DL, et al. Improving physical thera
py students ' clinical problem-solving skills: an analytical questioning
model. Phys Ther 1989;69:441.
78. Anderson DC, Harris IB, Allen 5, et al. Comparing students' feedback
about clinical instruction with their performances. Acad Med
1991;66:29.79. Dollase RH. Doctors' Stories of Teaching and Mentoring. Blooming
ton, IN: Phi Delta Kappa Educational Foundation, 1994;36.
80. Packer JL. Education for clinical practice: an alternativ:e approach. INurs Educ 1994;33:411.
81. Allen SS, Bland CI, Harris IB, et al. Structured clinical teaching strate
gy. Med Teach 1991;13:177.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 42/49
160 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
82. Plaut SM. Boundary issues in teacher-student relationships. J Sex Mar
ital Ther 1993;19:210.
83. Harris D, Naylor S. Case study: learner physiotherapist's perceptions
of clinical education. Educ Train Tech Intern 1992;29:124.
84. Montgomery J. Clinical Faculty: Revitalization for 2001. In Section
for Education and Department of Education, Pivotal Issues in Clinical
Education Present Status/Future Needs. Washington, DC: AmericanPhysical Therapy Association, 1988;7.
85. Claxton CS, Murrell PH. Learning Styles: Implications for Improving
Educational Practices. ASHE-ERIC Higher Education Report No. 4.
Washington, DC: Association for the Study of Higher Education, 1987.
86. Merriam SB. An Update on Adult Learning Theory. New Directions
for Adult and Continuing Education (No. 57). San Francisco: Jossey
Bass, 1993;15.
87. Bonwell CC, Eison JA. Active Learning: Creating Excitement in the
Classroom. ASHE-ERIC Higher Education Report No.1.
Washington,DC: The George Washington University, School of Education and
Human Development, 1991.
88. Kurfiss JG. Critical Thinking: Theory, Research, Practice and Possibil
ities. ASHE-ERIC Higher Education Report No. 2. Washington, DC:
Association for the Study of Higher Education, 1988.
89. Shea ML, Boyum PG, Spanke MM. Health Occupations Clinical.
Teacher Education Series for Secondary and Post-Secondary Educators.
Urbana, IL: Illinois University Department of Vocational and Techni
cal Education, 1985.
90. Hayes E. Effective Teaching Styles. New Directions for ContinuingEducation (No. 43). San Francisco: Jossey-Bass, 1989;17.
91. Watts N. Handbook of Clinical Teaching. New York: Churchill Liv-
ingstone, 1990;37.
92. Deusinger SS. Evaluating the effectiveness of clinical education. J Phys
Ther Educ 1990;4:66.
93. Henry}N. Using feedback and evaluation effectively in clinical super
visiop: model for interaction characteristics and strategies. Phys Ther
1985;65:354.
94. MayWW,
MorganBJ,
LemkeJC, et
al. Model for ability-based assessment in physical therapy education. J Phys Ther Educ 1995;9:3.
95. Barr JS, Gwyer J, Talmor A. Evaluation of clinical centers in physical
therapy. Phys Ther 1982;62:850.
96. Greenberg NS, Feifer I. A structured approach to the integration of the
clinical and didactic components of health career programs. J Allied
Health 1980;9:59.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 43/49
References 161
97. Windom PA. Developing a clinical education program from the clini
cian's prospective. Phys Ther 1982;52:1604.
98. Department of Education. Report on Clinical Education for the Entry
Level Physical Therapist: Consortia, Clinical Education Conferences,
and Students' Early Patient Contacts. Alexandria, VA: American Phys
ical Therapy Association, 1986.
99. Perry JF. Who is Responsible for Preparing Clinical Educators? In Sec
tion for Education and Department of Education, Pivotal Issues in
Clinical Education Present Status/Future Needs. Washington, DC:
American Physical Therapy Association, 1988;22.
100. Norcross JC, Stevenson JF. Evaluating Clinical Training: Measurement
and Utilization Implications from Three National Studies [abstract].
Presented at the Annual Meeting of the Evaluation and Research Soci
ety. Toronto: October, 1985.
101. Skeff KM, Stratos GA. Issues in the Improvement of Clinical Instruc
tion. Presented at the Annual Meeting of the American EducationResearch Association [abstract]. Chicago: April 1985.
102. Deusinger S, Cornbleet SL, Stith JS. Using assessment centers to
promote clinical faculty development. J Phys Ther Educ 1991;5:14.
103. Crepeau EB, Lagarde T. Self-Paced Instruction for Clinical Education
(SPICES). Bethesda, MD: American Occupational Therapy Associa
tion, 1990.
104. Kirsling RA, Kochner MS. Mentors in graduate medical education at
the Medical College of Wisconsin. Acad Med 1990;65:272.
105. Shahmoon R. The Supervisory Relationship: Integrator, Resource and
Guide. In E Fenichel (ed), Learning Through Supervision and Mentor
ship: A Source Book. Arlington, VA: Zero to Three/National Center for
Clinical Infant Programs, 1992;37.
106. Edwards JC, Brannan JR, Plavche WC, Marier RL. Teaching Residents
to Teach Medical Students: An Experimental Study [abstract]. Pre
sented at the Annual Meeting of the American Education Research
Association. Washington, DC: April 1987;137.
107. Jensen GM, Shepard KF, Hack LM. The novice versus the experienced
clinician: insights into the work of the physical therapist. Phys Ther
1990;70:314.108. Grossman PL. The Making of a Teacher: Teacher Knowledge and
Teacher Education. New York: Columbia University, 1990.
109. Meyer S. Cultivating reflection-in-action in trainer development.
Adult Learn 1992;3:16.I 110. Barr RB, Tagg J. From teaching to leaming-a new paradigm for under
1 graduate education. Change 1995;27:13.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 44/49
162 PREPARATION FOR TEACHING IN CLINICAL SE'ITlNGS
111. Division of Research, Analysis and Development. 1994 Applicant
Report. Alexandria, VA: American Physical Therapy Association, 1995.
112. Sussman B. Effects of Staff Shortages on Clinical Education Now and
in the Future. In American Physical Therapy Association, Pivotal
Issues in Clinical Education Present Status/Future Needs. Alexandria,
VA: American Physical Therapy Association, 1987.113. Gandy JS. Clinical education through a new lens: collaboration and
interdependence. PT Mag 1995;3:40.
114. Foord L, Kaufman R. Strategies for use of a 2:1 teaching model in phys
ical therapist assistant clinical education [abstract). Phys Ther
1994;74.
115. Emery MJ, Nalette E. Student staffed clinics: creative clinical educa
tion during times of constraint. Clin Manage Phys Ther 1986;6:6.
116. DeClute J, Ladyshewsky R. Enhancing clinical education using a col
laborative clinical education model. Phys Ther 1993;73:683.
117. Nemshick MT, Shepard KF. Physical therapy clinical education in a2:1 student-instructor education model. Phys Ther 1996;76:968.
118. DeDea L. The Process, Design, and Implementation of an Alternative
Collaborative Approach to Clinical E d ~ c a t i o n Using the Three-to-One
Supervisory Model. Presented at 12th International Congress of the
World Confederation for Physical Therapy. Washington, DC: June
1995.
119. Koga KR. Use of the two students to one clinical instructor teaching
model in a rehabilitation setting [abstract). Phys Ther 1994;74:9.
120. Haffner Zavadak K, Konecky Dolnack C, Polich S, et al. Clinical edu
cation series: 2:1 collaborative models. PT Mag 1995;3:46.
121. Ladyshewsky RK. Enhancing service productivity in acute care inpa
tient settings using a collaborative clinical education model. Phys
Ther 1995;75:503.
122. Ladyshewsky R, Healey E. The 2:1 Teaching Model in Clinical Educa
tion. A Manu,al for Clinical Instructors. Toronto: Department of Reha
bilitation Medicine, Division of Physical Therapy, University of
Toronto, 1990.
123. Dupont L. Group Supervision of Students in Clinical Practice. Pre
sented at the Joint American Physical Therapy Association/CanadianPhysiotherapy Association Congress, Session on Framing Clinical
Education within Higher Education and Health Care: Exploring Mod
els and Measurements of Student Performance. Toronto: June 1994.
124. Ladyshewsky R. Clinical teaching and the 2:1 student to clinical
instructor ratio. J Phys Ther Educ 1995;7:31.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 45/49
References 163
125. Tiberius R, Gaiptman B. The supervisor student ratio: 1:1 versus 1:2.
Can J Occup Ther 1985;52:179.
126. Ozga K, Baker B. A Collaborative Clinical Education Model: One Aca
demic Faculty Member and Four Students. Presented at American
Physical Therapy Association Combined Sections Meeting. Reno, NV:
1995.
127. Gerace L, Sibilano H. Preparing students for peer collaboration: a clin
ical teaching model. J Nurs Educ 1984;23:206.
128. Slavin RE. Cooperative learning: can students help students learn?
Instructor 1987;96:74.
129. Escovitz ES. Using senior students as clinical skills teaching assis
tants. Acad Med 1990;65:733.
130. Solomon P, Sanford J. Innovative models of student supervision in a
home care setting: a pilot project. J Phys Ther Educ 1993;7:49.
131. Pruett KO. A Clinical Approach to the Training of Supervisors: The
Model of Cosupervision. In E Fenichel (ed), Learning Through Supervision and Mentorship: A Source Book. Arlington, VA: Zero to
Three/National Center for Clinical Infant Programs, 1992;61.
132. Kirkpatrick H, Byrne C, Martin ML, et al. A collaborative model for
the clinical education of baccalaureate nursing students. J Adv Nurs
1991;16:101.
133. Delehanty MJ. Recruitment and retention of physical therapists in
rural areas: an interdisciplinary approach [abstract]. Phys Ther
1993;73:70.
134. Clark SL, Schlachter S. Development of clinical education sites in an
area health education system. Phys Ther 1981;61:904.
135. Scherer S. What do I do now? Clin Manage Phys Ther 1992;12:66.
136. Blakely RL, Jackson-Brownlow V. Interdisciplinary rural health educa
tion and training IIRHET} [abstract]. Phys Ther 1993;73:66.
137. Perkins J, Tryssenaar J. Making interdisciplinary education effective
for rehabilitation students. J Allied Health 1994;23:133.
138. Brufee KA. Sharing our toys-cooperative learning versus collabora
tive learning. Change 1995;27:12.
139. Matthews RS, Cooper JL, Davidson N, et al. Building bridges between
cooperative and collaborative learning. Change 1995;27:35.140. Gamson ZF. Collaborative learning comes of age. Change 1994;26:44.
141. Johnson DW , Johnson RT, Smith KA. Cooperative Learning: Increas
ing College Faculty and Instructional Productivity. ASHE-ERIC High
er Education Report No. 4, Washington, DC: The George Washington
University, School of Education and Human Development, 1991i25.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 46/49
164 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
142. Whitman NA. Peer Teaching: To Leam is to Leam Twice. ASHE-ERIC
Higher Education Report No. 4. Washington, DC: Association for the
Study of Higher Education, 1988.
143. Grisetti GC. Planned small-group experience: model for part-time
clinical education. JPhys Ther Educ 1993;7:60.
144. WilliamsPt.
A comparison between the roles of part-time and fulltime clinical tutors: is there a difference? Nurse Educ Today
1994;14:427.
145. Halcarz PA, Marzouk DK, Avila E, et al. Preparation of entry-level stu
dents for a future roles as clinical instructors. J Phys Ther Educ
1991i5:78.
Annotated Bibliography
American Physical Therapy Association. Clinical Education: An Anthology
(Voll). Alexandria, VA: A m ~ c a n P h y s i c a l Therapy Association, 1992.This resource is a collection of 79 articles compiled primarily from the
physical therapy literature that collectively describes five critical
di.ri::tensions in clinical education. These dimensions include clinical fac
ulty (ACCl!.s, CCCEs, and CIs}, clini<;al. environment and resources,
design of clinical education, evaluation and research, and academic
resources. This is an excellent reference for persons involved in clinical
education because relevant literature is consolidated into one publica
tion. Volume n of this publication is a companion publication that
updates the physical therapy literature in clinical education since 1992
and includes articles from other disciplines.
American Physical Therapy Association. Clinical Education Guidelines and
Self·Assessments. Alexandria, VA: American Physical Therapy Associa
tion, 1993. This reference lists guidelines for clinical education sites,
CCCEs, and CIs that were endorsed by the APTA House of Delegates in
1993. These voluntary guidelines were designed to describe the funda
mental and essential performance criteria that shQuld guide the selec
tion and development of clinical sites and individuals who serve as
clinical educators. These guidelines are accompanied by three self
assessment documents that allow the clinical site and clinical educatorsto evaluate their areas of strengths or needed improvement. Information
gleaned from the self-assessments may be used by academic programs
for clinical si te and faculty development programs.
Fife J. ASHE·ERIC Higher Education Reports. Washington, DC: The
George Washington University, School of Education and Human
Development. These annual series of education-related publications
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 47/49
Annotated Bibliography 165
feature contemporary and forward-looking topics relevant to teaching
adults in higher education. Although the orientation of these publica
tions is directed toward the classroom environment, concepts, ideas,
and suggested examples are easily modified to enhance teaching in
the clinical environment. The five specific volumes listed below are
extremely relevant and applicableto content
presentedin this
chapter. The titles are self-explanatory and reflect the content provided in
the publication.
• Claxton CS, Murrell PH. Learning Styles: Implications for Improving
Educational Practices. ASHE-ERIC Higher Education Report No. 4.
Washington, DC: Association for the Study of Higher Education, 1987.
• Kurfiss GJ. Critical Thinking: Theory, Research, Practice, and Possi
bilities. ASHE-ERIC Higher Education Report No. 2. Washington, DC:
Association for the Study of Higher Education, 1988.
• Whitman N. Peer Teaching: To Teach is to Learn Twice. ASHE-ERIC
Higher Education Report No. 4. Washington, DC: Association for the
Study of Higher Education, 1988.
• Johnson D, Johnson R, SmithK. Cooperative Learning: Increasing Col
lege Facu1ty Instructional Productivity. ASHE-ERIC Higher Education
Report No. 4. Washington DC: The George Washington University,
School of Education and Human Development, 1991.
• Bonwell C, Eison J. Active Learning: Creating Excitement in the
Classroom. ASHE-ERIC Higher Education Report No. 1. Washington,
DC: The George Washington University, School of Education and
Human Development, 1991.
Grossman P. The Making of a Teacher: Teacher Knowledge and Teacher
Education. New York: Teachers College Press, 1990. This text provides
an insightful and deeper understanding of educational practice and
how to improve i t through a sound conceptual framework and the use
of case sketches. Her cutting-edge research provides an understanding
of the differences in what teachers believe and value, how those values
are actually enacted in the classroom, and how beliefs and values
affect content that teachers teach. At first glance, clinical educators
may perceive that an examination of six English teachers, as the subjects of this text, have little to no relationship to their roles in clinical
practice. However, of great significance is the realization that teacher
education programs that provide a coherent vision for teaching and
learning do influence the quality of teaching in any setting. In addi
tion, these teacher education programs ultimately affect how students
construct their emerging and evolving knowledge and understanding
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 48/49
166 PREPARATION FOR TEACHING IN CLINICAL SETTINGS
of content, which subsequently facilitates the integration of that
knowledge into practice.
Ladyshewsky R, Healy E. The 2:1 Teaching Model in Clinical Education. A
Manual for Clinical Instructors. Toronto: Department of Rehabilitation
Medicine, Division of Physical Therapy, University of Toronto, 1990.
This manual describes the two-student to one-clinical instructor collaborative clinical teaching design and provides the necessary steps to
implement this supervisory approach in the clinic. The manual is user
friendly, easy to understand, and provides a conceptual framework for
understanding some of the issues described in this chapter. This manu
al assists the Cl in organizing, planning, implementing, and evaluating
the collaborative learning design. This manual can be purchased through
the University of Toronto, Department of Rehabilitation· Medicine;
Division of Physical Therapy, 256 McCaul Street, Toronto, Ontario,
Canada M5T 1W5.
New Directions for Continuing Education. San Francisco: Jossey-Bass. Thevolumes in this series of quarterly sourcebooks address a broad range
of diverse topics of interest to instructors and administrators involved
with adul t and continuing education and higher education. Topics are
focused. on such issues as ways of involving adults in the learning
process and·selecting and developing instructional materials. Although
many of these volumes are relevant to clinical teaching and the
enhancement of adult learning, the three listed below are specifically
recommended. The titles are self-explanatory and reflect content pro
vided in the publication.
• Brookfield S. Self-Directed Learning: From Theory to Practice. New
Directions for Continuing Education INo. 25). San Francisco: Jossey
Bass, 1985.
• Hayes E. Effective Teaching Styles. New Directions for Higher Educa
tion (No. 43}. San Francisco: Jossey-Bass, 1989.
• Merriam S. AnUpdate on Adult Learning Theory. New Directions for
Adult and Continuing Education (No. 57). San Francisco: Jossey-Bass,
1993.
Watts N. Handbook of Clinical Teaching. New York: Churchill Livingstone,1990. This book provides a practical and user-friendly resource for
health professionals to augment their knowledge and skills in providing
clinical education for students. For illustrative and teaching purposes,
Watts uses a multidisciplinary approach to understanding clinical
teaching and encourages the completion of practice exercises in part
nerships or collaborative interdisciplinary teams to reinforce learning.
8/3/2019 Preparation for Teaching in Clinical Settings
http://slidepdf.com/reader/full/preparation-for-teaching-in-clinical-settings 49/49
Annotated Bibliography 167
She facilitates learning through three essential teaching components-
acquiring information, providing practice exercises, and giving imme-
diate feedback. Some of the topics addressed include planning for
student practice, performing a learning needs assessment, designing a
learning contract, supervising practice of a complex skill, influencing
student attitudes and values, giving effective feedback, and analyzingone's teaching style.