The 2:1 Model of Clinical Education: Debunking Myths with Data


Despite documented success with the 2:1 clinical education model, inpatient practice settings maintain reservation about implementing this alternate model. In part, the hesitation reflects current pressures to balance human and fiscal resources required for delivery of high quality patient care against those required to operate a quality student clinical education program. At the same time, academic programs currently report increased difficulty securing inpatient internships, as facilities have been scaling back clinical education programs given competing internal priorities. A stalemate, at times, is felt: facilities reluctant to participate in a changed model and academic programs hesitant to push too vigorously for fear of damaging necessary relationships. To dispel the myths of the 2:1 model and to document its realities in achieving curricular, clinical, and professional benchmarks, data was collected on a variety of implementation patterns across a broad array of inpatient settings. While the future of clinical education is uncertain, the outcomes established by this model demonstrate significant promise and potential.

Methods and/or Description of Project

Over a 3-year period, data was collected on the implementation of the 2:1 model in inpatient rehabilitation and acute hospital settings (academic medical centers, community hospitals, and rural hospitals). Questions of interest included: Are double the students double the work for the clinical instructor (CI)? Does the 2:1 model allow both students to carry a full caseload independently? Does this model work equally well both inside and outside of the ICU? Is the model feasible when CIs are responsible for patient care on multiple units and/or floors? What productivity trends exist when comparing that of a therapist treating alone to a CI with one student and a CI with two students? How does the 2:1 model impact staffing, especially on inpatient rehabilitation units that maintain a fixed bed:therapist ratio? Is this an appropriate model for implementation by both novice and experienced CIs? Is the model more or less successful if paired students are from the same or different universities? What training in this model exists for CIs and is such training necessary for success? Is the effort required by the Director of Clinical Education to prep the 2:1 model the same as that required for the 1:1 model? What is student and CI satisfaction relative to this model? Do students achieve learning outcomes comparable to those achieved through standard 1:1 models?


Center Coordinators of Clinical Education from three distinctly different facilities, along with their academic partner, will present an overview of collected data that elucidates academic (placement) outcomes, clinical (patient and CI) outcomes, fiscal outcomes, and student learning outcomes associated with the 2:1 model. Trends in the data will be discussed along with implemented strategies designed to close gaps specific to the model’s efficiency and effectiveness. Data reflective of ten pairs of students placed in diverse inpatient settings has established the 2:1 model to not only be a fiscally responsible vehicle for promoting positive outcomes in clinical education, but also an effective approach for preserving clinical education programs during a challenging time of healthcare delivery. This presentation will debunk current myths about the 2:1 model through presentation of objective evidence and outcomes specific to the previously stated questions of interest. Further, the outcomes and strategies discussed will elucidate the flexibility of the model in being applied across a variety of settings wherein differences in coverage, physical layout, and patient populations exist.

Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education

The state of clinical education requires careful analysis as its sustainability using current approaches has become increasingly questioned. A growing body of evidence exists to establish both the viability and vitality of the 2:1 model in achieving academic and clinical benchmarks. However, despite these emerging findings, an overall reluctance often exists, sometimes borne out of fear and sometimes out of the inability to conceptualize the model within the unique dimensions and constraints of the clinical facility. However, to ensure an existing venue for the clinical training of students and the professional development of clinical instructors, academicians and clinicians should partner to devise strategies wherein the 2:1 model can be effectively incorporated within a variety of clinical settings in a manner that garners similar positive outcomes. Greater implementation of this model within physical therapy curricula may serve as an initial touchpoint for responding to and providing a realistic solution for stabilizing the clinical education crisis of today.


Deusinger, S., Crowner, B., Burlis, T., & Stith, J. (2013). Meeting Contemporary Expectations for Physical Therapists: Imperatives, Challenges, and Proposed Solutions for Professional Education. Journal of Physical Therapy Education 28(1), 56-61
Jette, D., Nelson, L., Palaima, M., & Wetherbee, E. (2013). How do we Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes. Journal of Physical Therapy Education 28(1), 6-12
McCallum, C., Mosher, P., Howman, J., Engelhard, C., Euype, S., & Cook, C. (2013). Development of Regional Core Networks for the Administration of Physical Therapist Clinical Education. . Journal of Physical Therapy Education 28(1), 39-47
Recker-Hughes, C, WEtherbee, E, Buccieri, K., Timmerberg, J., & Stolfi, A. (2013). Essential Characteristics of Quality Clinical Education Experiences: Standards to Facilitate Student Learning. Journal of Physical Therapy Education 28(1), 48-55
Rindflesch, A. B., Dunfee, H. J., Cieslak, K. R., Eischen, S. L., Trenary, T., Calley, D. Q., & Heinle, D. K. (2009). Collaborative model of clinical education in physical and occupational therapy at the mayo clinic. Journal of Allied Health, 38(3), 132-142. Retrieved from
Tigani, L. Funk, C., Palmieri, T., Stewart, E., Neely,L., & Wruble-Hakim, E. Outcomes of Clinical Instructor (CI) Effort and Productivity with Implementation of the 2 Students: 1 CI (2:1) Clinical Education Model in the Acute Care Setting. APTA Combined Section Meeting, Anaheim CA, 2016
Wruble-Hakim, E., Johnson, D., & Stewart, E. Visioning and Implementing a Sustainable Clinical Education Program within a Large Health Network. Education Leadership Conference of the American Physical Therapy Association, Phoenix AZ, 2016

Course Objectives

1. Articulate and discuss benefits of the 2:1 model of clinical education model and its associated outcomes
2. Recognize and appreciate the strategies used to enable model success in varied practice settings
3. Devise a timeline and identify resources necessary to implement the 2:1 model within their academic program or clinical facility

Instructional Methods

Panel discussion

Tentative Outline/Schedule

I. Overview of 2:1 model (20min)
a. Rationale for creative approaches to clinical education
b. Commonly stated academic and clinical concerns
c. Evidence supporting use
II. Presentation of model in action at differing sites (50 min)
a. Essential considerations
b. Data supporting analysis of effectiveness
III. Question and answer (20 min)

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  • Control #: 2740956
  • Type: Educational Session
  • Event/Year: ELC2017
  • Authors: Eric Stewart, Kristy Recek, Carly Funk, Michele Uhler, Ellen Wruble Hakim
  • Keywords:

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