Physical Therapist Student Difficulty in Clinical Education Settings: Incidence and Outcomes
Authors: Silberman Nicki , LaFay Vicki , Hansen Ruth Lyons , Fay Patricia 
Published: May 2018

Introduction.
Physical therapists must have the academic and clinical preparation for the demands of current practice across the lifespan and continuum of care. Predictors of student physical therapist (SPT) academic success have been investigated, but there has been limited inquiry into factors associated with difficulty during clinical experiences (CEs). Challenging clinical learning environments are reported to influence student success in other disciplines, but this information is lacking in physical therapist student literature. Physical therapist education programs would benefit from knowledge of clinical settings that may present greater challenges and factors contributing to difficulty during CEs. The purposes of this study were to identify the: (1) incidence of SPT difficulty during CEs by practice setting and level of CE; (2) clinical instructor (CI) and SPT characteristics, including gender, ethnicity, and the primary domain of learning in which students experienced difficulty; and (3) CE outcomes for SPTs experiencing difficulty.

Methods.
In this descriptive, retrospective study, a two-part survey was delivered to the 24 Directors of Clinical Education from the New York-New Jersey Clinical Education Consortium requesting program, student and CI demographics, and details regarding all instances of student difficulty during CEs over three cohorts of students. The survey was validated for face and content validity. Mean values, ranges, and frequencies were calculated to analyze demographic data. Frequency distributions were performed for further descriptive analysis.

Results.
Ten programs completed the survey, reporting a total of 76 incidents of student difficulty during a CE. The most frequent practice setting with reported difficulty was acute care (34.2%), followed by outpatient (31.6%), with fewer incidents of difficulty in rehabilitation (17%) and pediatric settings (14.5%). Difficulty in acute care was identified across all levels of CE, whereas outpatient and rehabilitation had greater incidents reported in more advanced CEs. Most incidents of difficulty in acute care occurred on the first-level CE and noted primarily in the affective domain. In the outpatient setting, difficulty was reported more frequently during intermediate or final CEs in the cognitive domain. Affective issues were reported across all levels of CE, whereas cognitive concerns were described mostly on intermediate or final CEs. Prior academic difficulty was identified in 34.2% of cases and prior professional behavior concerns in 27.6%. None of the reported incidents in the psychomotor domain led to failure of the CE while 40% of incidents reported in the cognitive and 23.5% in the affective domains resulted in CE failure.

Discussion and Conclusions.
Evaluation of clinical performance outcomes is critical in physical therapist student education to prepare students for the demands of clinical practice. Knowledge of areas where students most frequently demonstrate difficulty during CEs may allow programs to evaluate and modify curriculum to improve outcomes. The acute care and outpatient settings may be challenging for PT students related to specific domains of learning. Knowledge gained from this study can inform student preparation for various CEs and the related affective and cognitive skills required for clinical success.