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8/3/2019 Preparation for Teaching in Clinical Settings
employee orientation. In reality, I knew very little about
teaching students in the clinic other than remembering what
it was like to be a student during my clinical experiences. For
the next week, I tried to informally question more experi-
enced physical therapists about how they taught their stu-
dents. I did not want them to know that I felt incompetent. Ialso tried to reflect on what my clinical instructors did during
my four clinical experiences by posing questions such as: How
did they provide an orientation to the facility and the specific
health care environment? What issues were discussed during
the first few days of the experience? What were their expecta-
tions for my performance? Did I get a schedule on the first day
and what was included on that schedulel What did they do to
make me feel comfortable or uncomfortable? What did I
remember most about my clinical educators that was positive
or negative? Based on my limited discussions with profes-sional peers and my personal reflections, I developed a better,
albeit limited, understanding of my perceived roles and
responsibilities. All too soon, it was time for me to teach my
first student.
This sketch is all too common in contemporary clinical education, but
it illustrates a situation that can be prevented or eliminated given adequate
training and resources. This chapter provides the clinical educator with
information and resources about the clinical education milieu; the roles andresponsibilities of faculty, clinicians, and students involved in clinical edu-
cation; how to prepare to be a successful clinical instructor; and alternative
models for delivery of clinical education.
ChapterObjectives
After reading this chapter the reader will be able to:
1. Understand the complexities of and the relationships between the
different contextual frameworks in which the students' academicand clinical learning occur.
2. Recognize the dynamic organizational structure of clinical educa-
tion and the roles and responsibilities of persons functioning within
this structure.
3. Define the preferred attributes of clinical educators that contribute
to enhanced student learning.
8/3/2019 Preparation for Teaching in Clinical Settings
outcomes of a student's care when measured against a standard of clinical
performance.27 Resources available to the clinical teacher may include
many of those used by academic faculty, such as instruction using audio
visuals, practice on a fellow student or the clinical educator, or review
and discussion of a journal article. Additional resources re!1dily available
to the educator in practice include collaborative and cooperative studentlearning among and between disciplines, video libra:ries of patient cases,
in-service education, grand rounds, surgery observation, special clinics
and screenings (e.g., seating clinic, scoliosis screening, community-based
education to prevent common falls in the elderly), presurgical evalua
tions, on-site continuing education course offerings, observation and
interactions with other health professionals, and participation in clinical
research. Rich learning opportunities are available in practice that com
plement and clarify much of what is provided in physical therapy acade
mic education.28
Because learning occurs within the context of practice and patient care,
the clinical teacher is characterized as a "a guide by the side"26 rather than
an expert. The clinical teacher teaches primarily through interactions and
handling of patients and assumes multiple roles, including facilitator,
coach, supervisor, role model, and performance evaluator.27 The clinicaleducator provides opportunities for students to experience safe practice.
She or he also asks probing questions that ~ c o u r a g e the student to reflect
by posing questions to herself or himself, reinforces students' thinking and
curiosity by fostering scholarly inquiry and by sorting fact from fiction,
and, by example, teaches students how to manage ambiguities (e.g., balancing functional and psychosocial need$ of the patient within the constraintsof the health care system).29-31
In summary, higher education and health care are confronted by many
of the same challenges, although strategies used to manage these chal
lenges may differ given their organizational and funding structures and
accountability measures. Not surprisingly, these environments differ in
relation to student learning because educators in each assume distinct
roles and responsibilities that are circumscribed by the context in which
learning occurs and the primary customer being served. Despite these dif
ferences, the two systems must communicate and interact on a regularbasis to fulfill curricular outcomes in physical therapy programs. In fact, a
concerted effort must be made by academic and clinical educators, as part
ners, to consciously bridge their differences. liThe frightening prospect is
that these forces, i f left to run their course without intervention, will like
ly drive education and practice further apart."32 To understand how these
systems currently interact to ensure that curriculum outcomes are real
sider faculty's perspectives, because such experiences represent critical
stepping stones that will enable students to at tain desired program goals.
While physical therapy clinical education 1s largely managed by the
three primary players and the students, it is important to remember that
it is every physical therapy and physical therapist assistant educator's
responsibility to be vested in clinical education. Without a collaborativeeffort between academic and clinical educators and students, achieve
ment of programmatic outcomes would not be possible. Also, the acade
mic program has a responsibility to visibly demonstrate its commitment
to clinical educators by actively communicating and involving them in
relevant aspects of curriculum development and assessment. Roles and
responsibilities of individuals recognized as integral to clinical education
are defined below.
Rolesand
Responsibilitiesof
StudentsStudents, and their responsibility to actively contribute to
clinical learning experiences, provide the most critical link in the organi
zational structure. The true messengers in clinical education are students.
Students provide feedback to everyone involved in the clinical education
system. Given the configuration of clinical education, students bear a
heavy burden, because learning experiences are provided based on informa
tion received from academic programs that may be incomplete or inaccu
rate in relation to perceived learning needs. Only students can articulate
their needs to the CIon a daily basis; therefore, they must take responsibility for their learning i f they wish to maximize their time in practice. Stu
dents ultimately will be held accountable for their learning. They must
actively participate in the decision-making process of clinical site selec
tion38 and be willing to assume a risk in openly asking for available clinical
learning experiences that permit successful progression through the cur
riculum. This means that ongoing student self-assessment and reflection,
which recognizes the student's knowledge and performance strengths, defi
ciencies, and inconsistencies, must occur.39 As part of this responsibility,
students must feel comfortable providing constructive feedback to academ
ic and clinical faculty. This feedback can enhance the curriculum andensure that succeeding classes will benefit from their experiences.
Self-accountability for behavior and actions is critically important for
students as part of their learning contract. However, faculty should guide
and model appropriate professional behavior and be willing to confront
areas in which the students ' professional values and behaviors are consid
ered inappropriate or problematic.4o Faculty must remain open and flexible
4. Educating and empowering clinical instructors to more effectively
fulfill their roles as clinical teachers.
5. Fostering and encouraging ongoing, open, and reciprocal c o m m u n i ~ cation between academicians, clinicians, and students by phone,
written and computer correspondence, and o n ~ s i t e visitations.
6. Developing policy and procedures associated with clinical education.7. Maintaining the academic program's records (including databases)
associated with all aspects of clinical education.
8. Coordinating student clinical placements with the CCCE.
9. Educating and advising students about clinical education, including
their responsibility to actively participate in the outcome of their
clinical learning experiences.
10. Counseling students about their clinical performance, including
strengths and limitations.47
11. Determining whether students have successfully met explicit
learning objectives for the specific clinical experience to enablecontinued progression through the curriculum.
12. Obtaining feedback about students' performance and the program's
curriculum to assist in ongoing curricular assessment and r e v i ~ sions.43, 44, 46
Additional activities that the ACCE may·be involved in include (1) par
ticipation in consortia activities (e.g., a group of regional academic programs,
clinical educators that sponsor collaborative initiatives), (2) accreditation
related activities, (3) curriculum committee activities, 14} clinical educationresearch, (5) management of budget allocations related to clinical education,
and 16} coordination of clinical education advisory committees. In some
cases, ACCEs assume a "broker" role in clinical education by linking c l i n i ~ cal educators to facilitate clinical education research, arranging creative
alternative student clinical experiences (e.g., forming cooperative relation
ships for solo or rural practices), and forming collaborative working rela
tionships with other academic institutions to increase access to clinical sites
by developing alternative supervisory designs to accommodate even greater
numbers of students.43
Deusinger and Rose challenged ACCEs to re-examine their role in phys
ical therapy education at their first national conference by saying, "Like the
dinosaur, the position of the ACCE is certain to become extinct in physical
therapy education. The viability of this position is threatened because of
the present preoccupation with administrative logistics and student coun
seling, a preoccupation that prohibits full participation as an academic
physical therapist." They go on to suggest that "the role of the ACCE must
Organizational Structure of Clinical Education 133
4. Providing mechanisms whereby Cls can receive the necessary train
ing to provide quality student clinical instruction.
5. Reviewing student clinical performance assessments to ensure their
accuracy and timely completion.
6. Understanding legal risks associated with teaching and supervising
students in the clinic.49-51
Although this position is considered essential to the physical therapy
clinical education, a word of caution must be provided given the context in
which contemporary physical therapy clinical education occurs. As health
care reform contim,J.es, especially in hospital-based practices, the CCCE who
is on senior staff and carries a partial to full caseload may be the first to have
his or her position eliminated. It is also important to note· that the profes
sion is finding itself in precarious situations in which no CCCE is designated
or the individuals who serve asCCCEs lack the appropriate qualifications
and clinical teaching experience to serve in this capacity. Of even greaterconcern is the possible loss of qualified mentors in clinical practice to edu
cate the next generation of clinical teachers who are ultimately responsible
for ensuring the future quality and effectiveness of physical therapy ser
vices.ll The profession must be sensitive to this situation rather than mini
mizing or denying its existence. Therefore, it must be open to exploring
alternative and collaborative strategies that are mutually beneficial and that
ensure the continuation of this role and its essential functions by providing
support to the physical therapy department or by advocating and negotiating
a position with the clinical facility's administration.
Roles and Responsibilities ofthe Clinical Instructor
When asked if they can recall any of their Cls, most health care
professionals will invariably answer "yes." Many say they remember not
only the Cls who were exemplary but also those who were perceived to be
poor role models. Likewise, they will remember why a particular Cl was
remarkable or why they were disappointed in a Cl's clinical teaching perfor
mance. Impressions left by clinical educators are lifelong; a laudable tribute
and commentary on the role that the Cl plays in the life of every health pro
fession student.
The Cl is integral to clinical education and is involved with daily
responsibility and overall direct provision of quality student clinical learn
ing experiences. In the organizational structure, the Cl works at the center
of the clinical education process. Students often believe that the success or
Other factors that contribute to the success of clinical teach
ing and supervision are Ul the provision of student-centered teaching strate
gies that encourage activities such as reflection 26, 29-31; (2) support for
increased student autonomy; (3) application of situational leadership theo
ries applied in clinical learning that help students participate more responsibly in their learning experiences 72• 73; (4) belief in a model of the best
clinical practices in physical therapy; and 15) explication of the models of
problem solving and decision making, which are used to assist students in
making better management decisions with sound clinical judgment, espe
cially under ambiguous situations.74-80 Clinical teaching has also been
shown to be more effective when systematic instructional strategies (e.g.,
preparation, briefing, planning, practice, debriefing) and repeated learning
opportunities are available to students to reinforce learning.73, 81 Enhance
ment of student learning occurs when the purpose of the learning experience
is defined, expectations for student and Cl performance are clarified, the
level of commitment is determined for all persons involved in the learning
experience, and the timing, structure, frequency, and method of formative
and surnmative evaluations are provided.63, 78 One of the greatest challenges
for the Cl is to find a balance in the relationship with students between nur
turance and separateness: This is not unlike the delicate balance needed
with patients when providing physical ther:apy services.82 Specific tech
niques for teaching in clinical settings are presented in Chapter 5.
In a qualitative case study examining the outcome of the clinical learn
ing experience, Harris and Naylo:r83 showed that student motivation andenthusiasm were enhanced when the learning experience was focused on
education and feedback rather than socialization into the environment. The
physical therapy student with 11good clinical experiences" became patient
focused rather than technique-focused. This change of focus is a critical tran
sition that students must make to become effective practitioners.
Preparation for Clinical Instmction
To develop the requisite knowledge, skills, and behaviors
needed to effectively perform their responsibilities as clinical educators, Cls
must have adequate formal preparation in the areas of teaching, supervision,
interpersonal relations, communication, evaluation, and profesSional skills
and competence. Montgomery84 believes that in addition to lack of formal
training, many CIs also lack the "experience, maturity, and wisdom" to
serve as mentors to physical therapy students. In an ideal world, there would
be an abundance of trained and experienced persons willing to teach the
ever-increasing numbers of physical therapy students in the clinical setting.
However, evidence shows the contrary. Cls report on average between 1 and
2 years of clinical experience before beginning to teach, and only slightly
more than half 153.4%) having attended a clinical training course.21
Development of national Clinical Education Guidelines in Physical
Therapy2 has influenced clinical training courses for Cls to use the seven
performance dimensions described previously in this chapter under "Skillsand Qualifications of a Successful Clinical Instructor" as a basis for defining
training objectives. Nevertheless, the development of formal training pro
grams for Cls does not adequately address issues of quality in clinical
instruction. In addition to academic programs and consortia that provide for-
mal training programs for CIs, students can also be better prepared by aca
demic programs and clinical educators for their eventual role as Os by
teaching them about learning and evaluation processes.
Many Cls believe that they are inadequately prepared for teaching.27, 84
Preparation for clinical teaching requires experiences that relate to teaching
issues. This includes (1) application of questioning and problem-solving
techniques; /2) application of levels of questioning in the domains of learn
ing (see Chapter 2); /3) application of behavioral questioning to address affec
tive issues and ways of improving the quality of questions; (4) application of
learning theory, including domains of learning and their hierarchies and an
understanding of the elements of and methods used to assess learning
styles85; (S) application of educational methodology, including adult learning·
and teaching theories and principles86; and (6) understanding of the context
in which learning occurS.84 Clinical teaching provides opportunities for
obtaining knowledge and developing skills in articulating and writing measurable cognitive, psychomotor, perceptual, and affective performance objec:'
tives; revising performance objectives64; and clarifying academic, student,
and Cl performance expectations. Aspects related to performance. expecta
tions and objectives are discussed in the section entitled "Student Objec
tives and Expectations of Clinical Learning Experiences."
Training Programs for Clinical Instructors
Training programs for Cls should provide specific information
about selecting appropriate, creative, and effective teaching methods that
actively involve learners in self-directed and guided experiences.30, 86, 87
These approaches should guide students to use available resources to access
information, maximize learning opportunities, assume responsibility for
self-directed and lifelong learning, apply critical thinking skills to solve
problems,88 apply skills learned to new situations, communicate learning
needs effectively, enhance observation skills, and develop as professionals.
Clinical teaching methods can include demonstration-performance, teacher
142 PREPARATION FOR TEACHING IN CLINICAL SE'ITINGS
Realistically, developing expertise as a Cl requires knowledge, skill,
and experience with positive and problematic student learning situations.
Not unlike the learning experiences designed for students, Cls require
opportunities to practice and reinforce knowledge and skills learned in
clinical training programs and to apply this knowledge to real student s i t ~ uations, preferably with the guidance of a clinical teaching mentor. 106
Thus, the process of learning to become a master clinical teacher is not
unlike that of learning to become an expert clinician.107 Mastery of the
subject matter related to prOviding effective clinical education, under-
standing the context in which clinical learning occurs, competence and
confidence in one's ability as a practitioner, and the ability to translate
educational theory into the practice of providing quality clinical instruc-
tion through reflective practices all contribute to developing qualities of a
master clinical teacher.108-110
Student Objectives and Expectations
of Clinical Learning Experiences
Designing a clinical education program for students requires a
structural framework, or road map, for ensuring that each planned learning
experience meets the expected performance outcomes. In addition, the aca-
demic program must determine, in the aggregate, how progressive clinical
experiences will, in conjunction with the didactic curriculum, accomplish
the curricular performance outcomes required of students for entry into
practice. Although at times the road may wind and even detour, i f students,clinicians, and academic faculty can clearly articulate specific, expected
learning and performance outcomes, the program can be adjusted through-
out the clinical experience according to the student's needs.
Determining student performance outcomes for clinical education
requires coordinated effort from students and faculty within academia and
practice. Each party must be actively involved in developing learning objec-
tives and setting performance expectations for each clinical experience pro-
vided within the curriculum. Academic programs determine objectives that
students must achieve and those that students can choose for progression
through the curriculum. In certain circumstances, students and academic
faculty may have curricular gaps and needs that can only be addressed by the
clinical site.
The clinical site must determine what experiences it can offer and objec-
tives for those experiences that can be accomplished within the specific clin-
ical setting and available time frame. The clinical site must also consider
how the academic program's objectives coincide with or differ from the c l i n ~
8/3/2019 Preparation for Teaching in Clinical Settings
ical site's learning objectives. Ultimately, the Cl's function is to make stu-
dent learning experiences coherent.
Students are accountable for setting specific learning objectives for each
clinical experience and adjusting them accordingly during the experience.
These objectives are based on the expected knowledge, skills, and behaviors
they hope to acquire within a particular setting. Objectives are influenced byfactors such as area of special interest or patient care provided, congruence
with organizational structure provided for learning, and personal knowledge
of the facility and it s reputation. Students must actively seek learning expe-
riences in areas in which their knowledge is deficient or with which they
have no prior exposure.
The literature is consistent in considering the determination of objec-
tives in clinical education as fundamental to planning learning experiences.
Although several methods can be used to provide objectives, many authors
prefer the use of objectives expressed in behavioral terms.64 In this format,
the objectives describe the learner's behavior at the completion of the learn-ing experience, the conditions under which the learner must function, and
the evaluation method/sI that will be used to assess the learning. Thus, the
Cl is explicitly aware of the planning and evaluative components required to
determine student competence, and the students understand precisely what
is expected of them during the experience.58
Objectives for clinical education serve four purposes: (1J design and
development of the clinical education program, (2) help in determining the
teaching methods to be used, (3) a method for assessing the learning experi-
ence and students' achievement of the objectives, and (4) augmentation ofthe abilities of persons involved in developing the objectives.64 Objectives of
a learning experience may be culled from multiple sources, all of which
result from some type of evaluative process involving questions about what
is needed, what is available, and where gaps in knowledge exist.37, 92
The four major factors that determine the objectives in health profes-
sional programs are 11) the health needs and demands of society, (2) the
nature of the subject matter , (3) characteristics of the learners, and (4) pro-
fessional standards.64 Obviously, with the rapidly changing and expanding
need for physical therapy services, dramatic shifts in technology, and fluc-
tuations in health care, it is critical that academic programs continuallyreassess performance outcomes, reflected by curricular objectives, to ensure
their relevancy. Curriculum content must be adjusted accordingly to equip
graduates with the tools necessary to cope with contemporary and future
health care. Evidence shows that in the past 5 years, characteristics of
learners within physical therapy programs have remained essentially
unchanged. I I I However, faculty report anecdotally that learners have changed
Table 4·3 Appropriate and Inappropriate Constructs for
Writing Behavioral Objectives
Requirement Appropriate example Inappropriate example
Learner centered vs The student will perform The teacher will show the
teacher centered goniometric measurements. student how to perform
goniometric measurements.
Outcome oriented The student will collect five The student will gather
vs process oriented articles on cystic fibrosis. information on cysticfibrosis.
Outcome oriented The student will evaluate The student will look at
vs merely stating biomechanics of the knee. biomechanical knee
the material to be problems.
addressed
Describes only one The student will conduct a The student will list theoutcome vs de- patient interview. questions to be asked in
scribing multiple an interview, conductoutcomes the interview/ and
assess the results.
Specific vs general The student will accurately The student will perform
perform manual muscle manual muscle testing.
testing on the ankle.
Observable and The student will provide a The student will know whymeasurable vs rationale for the treatment he or she is providing
not observable delivered based on research. treatment.and quantifiable
Source: Adapted from The New England Academic Coordinators of Clinical Education,Inc. The Role of the Clinician as Clinical Educator. Boston: The New England Consor-tium of Academic Coordinators of Clinical Education, 1994;14.
information into a quick and functional user-reference (Table 4-4). Never-
theless/ the reader is encouraged to further explore references cited in this
section. Propelled by changes within health care delivery, this issue has now
become one of the most exciting and explosive areas of clinical education
research within health professions disciplines.
Frequently/ physical therapy clinical educators will comment that alter
native student supervisory patterns were implemented in practice in the
1960s and 1970s and that this issue is no t altogether new. However, during
that time, little or no empirical evidence was reported that described these
supervisory patterns, their benefits or limitations, or their outcome effec
8/3/2019 Preparation for Teaching in Clinical Settings
Alternative Supervisory Patterns in Clinical Education 149
Design Strengths Considerations and limitations
Provides opportunities for demonstrate this under-
PT students to learn standing
appropriate utilization of Assumes that the PTA and PT
the PTA through role value and respect each other
modeling by the PT/PTA/ as coworkers
Cl team Requires that PTA and PT stu-Provides for collaboration dents are comfortable with
and sharing of informa- their respective roles,
tion between PT and PTA strengths, and limitations sostudents that they can learn from each
Maximizes clinical site re- othersources and minimizescompetition for limitednumbers of clinical sites
when PT/PTA programs
provide the student clin
ical education concurrently
One Cl to two Same as one Cl to two or Same as one Cl to two or morestudents more students design students designpaired from Allows the experienced stu- Can be problematic i f studentsthe same pro- dent to develop supervisory are not compatible in theirgram at diff- skills learning styles or interpersonerent clinical Allows students to use each al interactionslevels {stu- other as a resource and ac- Requires alternative leadershipdent-peer cept feedback more easily design situations in which onementor Allows the experienced stu- student is the leader and thedesign1127-129 dent to orient the inexper- other the aide, and vice versa
ienced student when be
ginning times are staggered
Allows the experienced stu
dent to serve as the lead in
situations in which the in
experienced student has
not completed the didactic
content
Is useful in situations in which
the inexperienced student
has a shorter clinical experi
ence
Two part-time CIs Maximizes opportunities for Requires excellent communicaor two CIs on dif- part-time personnel to be in- tion between Clsferent rotations volved as Cls (often experi- Can confuse students if expectato one or more enced clinicians) tions of the Cls differstudents13o,144 Increases opportunities for Requires additional planning and
clinical s i ~ e s with part-time organization
clinicians to participate in Requires greater coordination
8/3/2019 Preparation for Teaching in Clinical Settings
For each of the designs listed in Table 4-4, specific strengths, considera
tions, and limitations have been summarized to assist clinical educators in
determining if an approach is relevant for their particular practice setting.
Table 4-4 is useful in beginning the investigative process to determine what
alternative supervisory designs might be possible in any given clinical site.
The majority of these designs are variations on the one Cl to two or morestudents design, which stresses active student learning through peer teach
ing and collaborative and cooperative learning.
Collaborative and cooperative learning were originally developed for
educating people of different ages, experience, and levels of mastery of inter
dependence. Cooperative learning was principally designed for primary
school education to assist children in becoming more efficient and effective
in learning to work together successfully on substantive issues, to hold stu
dents accountable for learning collectively rather than in competition with
one another, and to provide social integration regardless of issues of diver
sity. Collaborative learning is similar to cooperative learning in that the goalis to help persons work together on substantive issues. However, collabora
tive learning was developed primarily to make students emolled in higher
education more efficient and effective in aspects of education that are not
content driven, to shift the locus of classroom authority from the teacher to
student groups, and to facilitate structural reform and conceptual rethinking
of higher education.13B
Although perceived by some to be synonymous and interchangeable ter
minology, collaborative and cooperative learning within the context of small
gronp learning are markedly dissimilar. Dist inctions between collaborative
and cooperative learning are generally drawn between the nature and author
ity of knowledge. The major disadvantage of collaborative learning is that,
in attaining self-directed and peer learning, it sacrifices learner accountabil
ity.la8 Whereas, cooperative learning's major flaw is that by emphasizing
accountability it risks replicating within each small group the more tradi
tional model of teacher autonomy.139 These two approaches also differ in
terms of style, function, and teacher involvement; the extent to which stu
dents need to be trained to work together in groups; different outcomes, such
as mastery of facts, development of judgment and construction of knowl
edge; the importance of different aspects of personal, social, and cognitivegrowth among students; and implementation concerns (e.g., group forma
tion, task construction, and grading procedures).140
However, collaborative and cooperative learning are based on the fun
damental assumption that knowledge is a social construct and open-ended
tasks that facilitate collaboration and control by learners restructure the
classroom environment.138 The two philosophies also argue that learning in
8/3/2019 Preparation for Teaching in Clinical Settings
ed at the beginning of this chapter might readily occur, but such is not the
preferred approach for preparing future clinical educators. Many aspects of
clinical teaching have been shown to be grounded in literature that provides
conceptual models and investigative studies that help to define components
essential for quality education and training programs for clinical teachers.
The reader is encouraged to explore references provided in the annotated bibliography at the end of this chapter to learn more about clinical
instruction. As more clinical educators critically investigate the use of
alternative supervisory models, the profession will derive greater knowl
edge and understanding about the evidence-based differences between these
designs and their resultant outcomes and effectiveness. Perhaps then, dis
cussions espousing the benefits of one design over another will be resolved
based on empirical evidence rather than intuition, historical precedent, and
personal anecdotes. Before becoming a clinical educator, opportunities for
self-assessment, professional development and enhancement, and. mentor
ship should be made available to specifically address the learning needs ofclinical educators. ,
I t is my belief that advocating clinical teaching professional develop
ment programs is not sufficient. To pervasively impact the larger interests of
the physical therapy profession, the process of becoming a Cl should begin
when educating students during their profeSSional studies.58, 145 Students
should be oriented as part of their active participation in clinical education
to understand the roles and responsibilities of the ACCE, CCCE, and Cl
Students should also learn how to give feedback, critically evaluate their
learning experiences, and routinely perform self-assessments to monitortheir growth and development throughout progressive learning experiences.
They should also begin to develop an understanding and appreciation for the
analogous processes used in providing clinical teaching and physical therapy
services. In this way, students will learn to translate the process of service
delivery, which is the primary focus of their clinical education and initial
practice, to teaching students in clinical settings, which is one of the first
roles they will assume as practitioners.
Clinical educators must be held accountable for role modeling those
behaviors that they would like future practitioners to aspire to, and for
demonstrating good clinical teaching practices to ensure that students learnthe things that the profession believes are required for entry into practice.
Understanding the principles of pedagogy (i.e., that graduates will often
teach in the clinical setting in the way that they were taught) means that
CIs must critically examine their teaching to determine if their current
approach is the legacy they wish to pass on. Andragogy, principles of adult
learning, applies to physical therapy students and how they learn.86 Perhaps