Physical Therapist Student Difficulty in Clinical Education: Incidence and Outcomes


Predictors of physical therapist (PT) student academic success have investigated performance on the national licensure examination, but there is little examination of factors that may predict successful outcomes or difficulty during clinical experiences (CE). Challenging Clinical Learning Environments (CCLE) are reported in other disciplines to influence student success, but this information is lacking in physical therapy literature. The purposes of this study were to describe the: 1) incidence of difficulty in CE related to practice setting, level of CE, and domain of learning; 2) relationship between those factors; and 3) relationship between resources utilized by the academic program and incidence of difficulty in CEs.


Ten of 24 Directors of Clinical Education (DCE) from the New York-New Jersey Clinical Education Consortium completed a survey, reporting 76 incidences of student difficulty during a CE from 3 student cohorts. Program demographics and information about each individual case of student difficulty was collected. The survey was validated for face and content validity.


The most frequent practice setting with reported difficulty was acute care (34.2%), followed by outpatient (31.6%), with fewer students experiencing difficulty in rehab (17%) and pediatric settings (14.5%). Difficulty in acute care was identified across all levels of CE, whereas outpatient and rehab had greater incidences in more advanced CEs. Most incidences of difficulty in acute care occurred on the students’ first CE and were noted to be primarily in the affective domain. In the outpatient setting, difficulty was reported more frequently during intermediate or final CE, commonly in the cognitive domain. Affective issues were reported across all levels of CE, whereas cognitive concerns reported mostly on intermediate or final CEs. Prior academic difficulty was identified in 34.2% of cases and prior professional behavior concerns in 27.6%. More than two-thirds of students identified as having difficulty passed the CE. All students with psychomotor difficulties passed the CE while 40% of students with cognitive and 23.5% of students with affective concerns failed the experience. Less experienced DCEs reported higher numbers of incidences of student difficulty. The most common strategies used were DCE involvement and site visits, with little utilization of critical incident reports or anecdotal records.

Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education

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


Hayes KW, Huber G, Rogers J, Sanders B. Behaviors That Cause Clinical Instructors to Question the Clinical Competence of Physical Therapist Students Phys Ther. 1999; 79:653-667.

O'Mara L, McDonald J, Gillespie M, Brown H, Miles L. Challenging clinical learning environments: Experiences of undergraduate nursing students. Nurse Educ Pract. 2014;14(2):208-213.

Recker-Hughes C, Wetherbee E, Buccieri K, Fitzpatrick Timmerberg J, Stolfi A. Essential characteristics of quality clinical education experiences: standards to facilitate student learning. J Phys Ther Educ. 2014;28: 48-55.

Riddle DL, Utzman RR, Jewell DV, et al. Academic difficulty and program level variables predict performance on the NPT for licensure: a population-based cohort study Phys Ther. 2009; 89:1182-1191.

The Commision on Accreditation in Physical Therapy Education. 2014-2015 Aggregate program data: PT programs. Updated 2015. Accessed January 22, 2016.

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  • Control #: 2523565
  • Type: Platforms
  • Event/Year: ELC2016
  • Authors: Dr. Nicki Silberman, Dr. Vicki LaFay, Ruth Lyons Hansen, Patricia Fay
  • Keywords:

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