Clinical Instructors’ Interpretation of the Clinical Performance Definition of Entry-Level Performance: A Qualitative Analysis
Most PT education programs1 require clinical instructors (CIs) to use the Clinical Performance Instrument (CPI) 2, which has been tested for reliability and validity3,4, to assess students during full time clinical experiences (CEs). A regional group of Directors of Clinical Educations perceived inconsistencies between the rating points on the CPI and supporting narrative comments provided by CIs, particularly regarding “entry-level performance” (ELP). The purpose of this focus group study was to identify common themes regarding CIs' interpretation of definitions and terminology used to define ELP on the CPI.
Participants, 52 CIs from 4 states within 5 practice settings, were grouped into tables of 6-7 people and listened to a presentation on the language and definitions of the CPI, as described by the CPI instructions. A facilitator posed 5 questions to the small groups and a scribe recorded the responses. Responses were read and coded by 5 researchers, individually. Initial codes were developed from words, phrases, and concepts that were frequently repeated. Using quotes to support decisions, 2 subgroups of the researchers compared their initial codes and came to consensus on which themes represented the data. All researchers reconvened to compare findings and finalize decisions about major themes.
Comparative thematic analysis led to the identification of 4 terms used in the CPI instructions and definition of ELP that participants further characterized, and 3 overarching concepts that are important for clinical performance. Terms identified were: 1) Complexity refers to psychosocial factors, stability of patients' condition, and setting; 2) Consultation is initiated by students either seeking confirmation of plans or discussion as would occur between 2 clinicians; 3) Guidance requires the CI to prompt and facilitate; 4) Caseload expectations are considered a percentage of a newly hired employee. Caseload is also influenced by the complexity of patients and the students' efficient use of time. Overarching concepts were, students should: 1) demonstrate clinical reasoning that ensures they will do no harm and is based on hypotheses of gathered information and explain decisions with confidence, even if it is not the "best" decision; 2) reflect on their decisions and actions, and 3) be flexible in learning and problem-solving.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
The CPI is an outcome measure that is commonly used to determine students’ capacity for ELP. CIs must include narrative comments to support the rating points on the CPI and they often use terminology from the definition of ELP. Narrative comments used to support a rating of ELP should be interpreted consistently to ensure that students are ready for clinical practice and to face the challenges of the current health care system. This study is a first step toward better determining how CIs are interpreting the terminology used in the CPI.
1. American Physical Therapy Association. About the PT CPI Version 2006 Update. <a href="http://www.apta.org/PTCPI/Version2006/">http://www.apta.org/PTCPI/Version2006/</a>. Accessed April 9,2016.
2. American Physical Therapy Association. Physical Therapist Clinical Performance Instrument for Students. Alexandria, VA: American Physical Therapy Association; 2006.
3. Roach KE, Frost J, Francis NJ, Giles G, Nordrum JT, Delitto A. Validation of the Revised Physical Therapist Clinical Performance
Instrument (PT CPI): Version 2006. J Phys Ther Ed. 2012;92(3):416-428.
4.Adams CL, Glavin K, Hutchins K, Lee T, Zimmerman C. An Evaluation of the Internal Reliability, Construct Validity, and Predictive Validity of the Physical Therapist Clinical Performance Instrument (PT CPI). J Phys Ther Ed. 2008;22(2):42-50.