Clinical Decision-making in DPT Graduates Completing a Yearlong Terminal Internship Compared with DPT Graduates Who Do Not


Today’s healthcare system demands that graduates immediately provide quality services to their patients and the community.1 Managers express a desire to hire graduates who are confident and competent, capable of demonstrating independent, critical thinking.2 Adequately preparing students requires a change in physical therapist education, especially clinical education which accounts for greater than 30% of physical therapist education.3 Many have called for uniformity in clinical education, recommending the inclusion of a yearlong internship. 4-6 However, an ideal model for clinical education implementation has not been delineated.
Even with a lack of consensus, many institutions have implemented yearlong internships. The MGH Institute of Health Professions (MGH IHP) is one such institution that implemented a yearlong internship to address the challenges.8 An internship offers the opportunity to train for capability, which includes problem solving and decision-making, in addition to mastering skills.9 Clinical decision making (CDM) was identified as a basic skill for DPT graduates necessary to practice at the entry level.10 However, it is unknown if CDM improves more in students who engage in a yearlong internship compared with students who do not. The purpose of the study was to measure and compare CDM skills between two groups of DPT graduates at the end of their program; one with a yearlong internship and one without.


This descriptive, cross-sectional study compared students at 2 institutions: MGH IHP and University of Massachusetts- Lowell (UML). The students at MGH IHP completed a yearlong internship in addition to 2, full-time, 10-week clinical affiliations after their first and second years of classes. The students at UML completed 3, full-time, 12-week clinical affiliations after each year of classes. The outcome measure was the CDM Tool, a 12-item tool that assesses CDM across physical therapy curricula.11,12 The UML students were assessed after the completion of their last clinical. The MGH IHP students were assessed at two points: 14 weeks into their internship and the conclusion of the yearlong internship. The results were compared using a Kruskal- Wallis due to non-normal data distribution.


A Kruskal-Wallis test was used to assess the difference in CDM between 3 groups of students: UML (n=20), MGH IHP at graduation (n=30), and MGH IHP at internship end (n=11). The median CDM scores were not statistically different between the groups, x2(2)= 3.001, p = 0.223.

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

MGH IHP students who participated in a yearlong internship demonstrated the same level of decision-making as UML and MGH IHP students who completed only the required 14-week clinical affiliation prior to graduation. While there are limitations to the study, including a small sample size and the use of cross sectional data, the results challenge the assumption that all clinical education should end in a yearlong internship.


1. Deusinger SS, Crowner B, Burlis T, Stith J. Meeting contemporary expectations for physical therapists: Imperatives, challenges, and proposed solutions for professional education. Journal of Physical Therapy Education. 2014;28(1b):56-61.
2. Hofherr J. Why so many managers think recent college graduates are unprepared for work. May 18 2016. Available from:
3. Sass K, Frank L, Thiele A, et al. Physical therapy clinical educators' perspectives on students achieving entry-level clinical performance. Journal of Physical Therapy Education. 2011;25(3):46-52.
4. Rapport MJ, Kelly MK, Hankin TR, Rodriguez JW, Tomlinson SS. A shared vision for clinical education: The year-long internship. Journal of Physical Therapy Education. 2014;28:22-29.
5. Delitto A. We are what we do. Physical Therapy. 2008;88(10):1219-1227.
6. Portney L, Knab M. Implementation of a 1 year paid internship in physical therapy. J of Phys Ther Educ. 2001;15(4):31-35.
7. McCallum CA, Mosher PD, Jacobson PJ, Gallivan SP, Giuffre SM. Quality in physical therapist clinical education: A systematic review. Phys Ther. 2013;93(10):1298-311.
8. Swigris JJ, Swick J, Wamboldt FS, et al. Heart rate recovery after 6-min walk test predicts survival in patients with idiopathic pulmonary fibrosis. Chest. 2009;136(3):841-848. doi: 10.1378/chest.09-0211.
9. Fraser SW, Greenhalgh T. Coping with complexity: Educating for capability. BMJ. 2001;323(7316):799-803. doi: 10.1136/bmj.323.7316.799.
10. Jette DU, Bertoni A, Coots R, Johnson H, McLaughlin C, Weisbach C. Clinical instructors' perceptions of behaviors that comprise entry-level clinical performance in physical therapist students: A qualitative study. Phys Ther. 2007;87(7):833-843.
11. Brudvig T, Macauley K. Clinical decision making tool for DPT students. Academic Exchange Quarterly. 2015;19(2):61-67.
12. Brudvig T, Macauley K, Segal N. Measuring clinical decision-making and clinical skills in DPT students across a curriculum. Journal of Allied Health. 2017;46(1):23-27.

BACK to Abstract Results

  • Control #: 2745822
  • Type: Posters
  • Event/Year: ELC2017
  • Authors: Kelly Macauley, Tracy Brudvig, Keith Hallbourg
  • Keywords:

BACK to Abstract Results