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ADVANCE Perspective: Physical Therapy & Rehab Medicine

The 2008 Rothstein Debate

Published June 16, 2008 12:07 PM by Lisa Lombardo
SAN ANTONIO—Preparing Students For Clinical Practice: Does the Current CI Model Work?

Clinical education for physical therapy is getting much scrutiny recently from both educators and the employers who hire newly minted graduates following their clinical instruction (CI).

In the opinion of those in the practice community, these new grads do not have the required skills to serve full caseloads in the clinical environment. The opinion of some others is that what students are learning, and how they are learning, in their clinical affiliations doesn't adequately mirror what they will encounter in the clinic setting.

Many PT educators and CA providers do agree that change is needed, and quickly, but can the current model of clinical education be changed for the better, or is an entirely new model needed in order to prepare students for practice under the goals of Vision 2020?

The 2008 Rothstein Debate asked those questions and more, as Larry N. Benz, DPT, MBA, ECS, OCS, with the Kentucky Orthopedic Rehab Team in Louisville, and Michael J. Emery, EdD, PT, FAPTA, of Sacred Heart University in Fairfield, CT (pictured below).

Dr. Emery held the supporting position of the main debate question: Does the Current Model of Clinical Education Really Prepare Students for Practice? "It's hard to just argue for the status quo when we really do need changes," he admitted. "We don't have a model of differing lengths of instruction, for one. There are really three defining characteristics of our current model: 1) a divided locus of control; 2) simulations of practice, ideally to introduce students to a higher level of practice while they are not practicing, and 3) a student apprenticeship that both allows variability but also is fixed."

Dr. Benz said he wished that he could say that the clinical model now practiced "fits perfectly. But I have to say it is completely broken."

Dr. Emery argued that the outcomes support keeping the clinical education model-but that addressing its execution is needed. "The first-time pass rates on exams are going up despite these clinical problems, and 99.6 percent of new graduates still report getting a job within a month of graduating," he said. "The CI system has absorbed the enormous capacity of graduates to fill all the needed positions. So is the execution of the program done properly, or is the model broken entirely? Do we really need an entire replacement strategy?" Dr. Emery advocated reviewing the preparedness of CI instructors and how well CI programs fill their CI instructor slots. "Before we throw it out entirely we need to compare this model to any other new ideas," he said.

But Dr. Benz said pass rates don't necessarily reflect preparedness on the part of students following their CI. "Employers still report a disconnect between what [students learn] in CI than what they see from them working in a clinic. The model turns CI students around in a very short amount of time. Often, clinics facing staff shortages and declining reimbursement take these students on for CI merely to pump their own recruitment."

Both panelists agreed that what drives any model of clinical instruction planning should not be how clinics are reimbursed for students' work in the clinic.


I agree that the current model does not properly prepare students for employment.  They are not independent enough, especially in the current envirnonment of autonomous practice.

I suggest adopting something closer to the medical model, where there are clerkships (4-8 weeks each) throughout the academic experience followed but a full-year paid internship (or fellowship like SLPs).  During that internship or fellowship you are not expected to be independent but you would have completed all the rest of your education.  There could be rotations though different practice settings during that time, such as out-pt orthopedics, rehab, acute care, home care, pediatrics, etc.  By the end of the year, students would be better prepared to practice autonomously or even pursue direct access certification.  By having these internships be paid (even if not at full salary), it would lessen the burden of educational costs while better preparing students.  The workload for the facility would not be much more than mentoring a new grad and the facility may be able to convince that student to stay on as a full PT after graduation (if so desired), thus reducing the orientation period and costs of hiring a new employee.

Also, there should be more residency opportunities available, especially for new graduates.  These residencies could segway into specialist examination and certification.  This would elevate the profession, making PTs more likely to be perceived as primary care providers and practitioners of choice for neuromusculoskeletal conditions.

Christina, physical therapy - DPT, out-patient June 18, 2008 2:28 PM
Lansdale PA

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