Purpose/Hypothesis : Background: The early integration of clinical education presents invaluable practical experience for physical therapist students. Hands-on learning fosters clinical reasoning that is essential for quality patient care. Because clinical learning is unpredictable and contextual, students often become frustrated by singular experiences. Narratives provide students a method to reflect on experiences and develop practical knowledge. Objectives: To explore issues physical therapist students face during initial clinical experiences, through the use of reflective narratives. The study also explored the level of reflection in the student narratives.Number of Subjects : An initial sample of 47 student narratives was screened for reflection level based on Hatton and Smith framework. Purely descriptive narratives were eliminated. The final sample contained 30 narratives.Materials/Methods : This study was a retrospective interpretative analysis of narratives written by former and current students in the Doctor of Physical Therapy program at Emory University. Transcripts of each narrative were coded into memos with particular statements identified, which lead to the selection of themes and level of reflection for each reflective account; The framework developed by Hatton and Smith was used to categorized levels of reflection..Results : This retrospective interpretative analysis identified six major themes: patient centered care, student-clinical instructor communication, ethical conflict, professional identity, confidence, and classroom to clinic integration. The most frequent theme was patient centered care, followed by ethical conflict and confidence. Narratives addressed multiple issues, resulting in the emergence of primary and secondary themes. There was an overlap of the Hatton and Smith reflection levels creating two additional levels. Most narratives exhibited lower levels of reflection; therefore, implicating the need to train students in reflective practice.Conclusions : The themes from this study were similar to previous studies based on novice and student therapistsÕ initial clinical experiences.Clinical Relevance : The levels of reflection in the student narratives indicated a lack of reflective skill, revealing a need to educate students on reflective practice and its significance to their development into expert clinicians.