Using Progressive and Cumulative Practical Exams to Determine Student Clinical Readiness


Determination of student readiness for advancement in the educational program and for entry into full time clinical education (CE) is an absolute requirement for physical therapist education programs. This determination requires an assessment of student performance yielding a comprehensive view of the student’s clinical skills, professional behavior, documentation, and time management. The purpose of this presentation is to describe an assessment model using cumulative practical examinations (CPE) to determine clinical readiness for physical therapy (PT) practice.


The five part examination process occurs throughout the first two didactic years of a DPT program, prior to full time CE experiences. Each exam is designed to assess the new skills acquired within that academic semester while incorporating previously learned skills and knowledge. These progressive and cumulative examinations build from basic interventions to comprehensive patient management for any type of patient, including supervision of personnel and billing. Advancing expectations for complexity with documentation begin with a basic note outlining a patient encounter to the completion of a full PT examination and episode of care. Time management is addressed in the first CPE with a liberal amount of time for the preparation, delivery, and documentation of a PT intervention. Culminating in the final CPE, students encounter multiple patients in a variety of settings at different stages of rehabilitation that require clinical skills, time management, professional behavior and documentation reflective of that of an entry-level therapist.


Our students report that the multiple CPEs have prepared them well for full time CE experiences and the expectations for clinical practice. This comprehensive assessment model identifies students early in the academic program who are in need of additional support for their learning. Our experience has allowed some students supplemental clinical observations and faculty mentoring, specifically targeting their areas of weakness. This has set most students on a path to success; however, some reflect on their career choice and realize that PT is not a match for them.

Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education

A progressive model that incorporates professional expectations, clinical skills, and clinical decision making is a good match for determining student readiness for full time CE and PT practice. Building a sequential examination model for an entry-level program requires full faculty participation, clear student expectations, supportive policies and procedures, and organizational support for full implementation. It is the duty of PT entry level education to assure that students meet expectations for clinical readiness in advance of full time CE. This should provide clinical sites and consumers the confidence that our PT students are safe and prepared for the level of patient care expected in CE. This model of progressive and comprehensive assessment is applicable in any healthcare profession.


American Physical Therapy Association. Minimum required skills of physical therapist graduates at entry-level. Web site. 04/06/15. Accessed April 6, 2015

APTA Professionalism in Physical Therapy: Core Values. American Physical Therapy Association. Web site. Accessed April 6, 2015.

Boissonnault JS, Boissonnault WH, Hetzel SJ. Development of a physical therapy patient-interview student assessment tool: a pilot study. J Phys Ther Educ. 2013;27(1):35-47.

Commission on Accreditation in Physical Therapy Education. Evaluative Criteria for Accreditation of PT Programs, August 2014. Web site. Criteria for Accreditation of Education Programs for the Preparation of Physical Therapists.%22. Accessed April 6, 2015.

Epstein RM, Dannefar EF, Nofziger AC, et al. Comprehensive assessment of professional competence: the Rochester experiment. Teach Learn Med. 2004;16(2):186-196.

Gorman SL, Lazaro R, Fairchild J, Kennedy B. Development and implementation of an objective structured clinical examination (OSCE) in neuromuscular physical therapy. J Phys Ther Educ. 2010; 24(3):62-68.

Jette DU, Portney LG. Construct validity of a model for professional behavior in physical therapist students. Phys Ther. 2003;83(5):432- 443.

Ladyshewsky R, Gotjamanos E. Communication skill development in health professional education: the use of standardized patients in combination with a peer assessment strategy. J Allied Health. 1997;26(4):177-186.

Ladyshewsky R, Jones M, Baker R, Nelson L. Evaluating clinical performance in physical therapy with simulated patients. J Phys Ther Educ. 2000;14(1):31-34.

May WM, Morgan B, Lemke JC, et al. Model for ability-based assessment in physical therapy assessment. J Phys Ther Educ. 1995;9(1):3-6.

Nayer M. An overview of the objective structured clinical examination. Physiother Can. 1993; 45(3):171-8.

Paparella-Pitzel S, Edmond S, DeCaro C. The use of standardized patients in physical therapy education programs. J Phys Ther Educ. 2009; 23(2), 15-21.

Statford PW, Thomson MA, Sanford J, Saarinen H, Dilworth P, Solomon P, et al. Effect of station examination item sampling on generalizability of student performance. Phys Ther. 1990; 70(1): 31-6.

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  • Control #: 2246185
  • Type: Posters
  • Event/Year: ELC2015
  • Authors: Dr. Janna Kucharski-Howard, Linda Tsoumas, Daniel McGovern, Ann Charrette, Frances Kistner, Bruce Elliott, Cheryl Babin, Constance Inacio, Greta von der Luft
  • Keywords:

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