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Journey of a DPT Student

Do Test Grades Reflect Clinical Skills?

Published February 20, 2012 11:13 AM by Lauren Rosso

With the results of our recent exams back, there has inevitably been concern about our grades and the implications for those who did not do as well as they would have liked to. The question that always remains is to what degree written exams actually predict your success as a clinician in the future. I guess you can make the argument that this is where the practical portion of exams is useful, since they obviously reflect a more realistic application of the material. However, it doesn't change the fact that we all tend to stress about less-than-perfect exam grades.

I'm wondering what everyone thinks about this? It's so hard to let go of the ideas that have been ingrained in us throughout 16-plus years of schooling - that grades are of ultimate importance. Realistically, as we train to be future clinicians, what should matter is the application of our skills in clinical settings. However none of us, including myself, can let go of the feeling that our success is measured on a scale from A to F.

Some of the most talented people in my class, who will undoubtedly become incredible clinicians, are feeling the same way. And while I don't yet consider myself in their "class" as far as clinical skills are concerned, I can sympathize with how they are feeling. I hope that one day we will all stop basing our success on a grading scale and realize that what matters is how we perform in the clinic.


I would first like to thank you for the inspiration and comfort you give to many more SPTs than you know. I searched the archives for a post that matches the point at which my class is currently, and this post immediately spoke to me.

Many of us are currently (extremely) frustrated with this issue, and I think for the most part are significantly disheartened considering we have always been "great students" - studying hard and being rewarded with great grades. Recently, we have been spending more hours than ever before on our school work (largely because we WANT to learn the material now), but are not being "rewarded" with good grades and even coming up short here recently.

Speaking to the last comment as being a "mistake" has crossed our minds in the last few weeks, our professors have recently noticed this and assured us it is "normal" at this time in the program to be disheartened and assured us that we will be alright or even that "grades don't matter." While this is a bit frustrating to hear as hard as we are working to keep our grades above water, like many of the comments said, they do truly want us to succeed and believe in us even when we don't believe in ourselves, which is certainly my favorite thing about our program.

I almost felt as it if I wrote this post as I read it. I entirely agree with all the comments speaking to a concentration on actually LEARNING the material and feel that multiple choice exams, as ours are this kind of necessary evil, commonly inhibits my learning. I am just curious as to if anyone has found a better way to measure the learning in any other way? Or a tool to supplement this test-driven learning to apply it to an upcoming clinical? Thank you all for your encouraging posts!

Jennifer, , SPT ECU March 12, 2014 12:02 AM
Greenville NC

As I prepare for my first clinical rotation, I have been reflecting on this very issue. I look back on the material I have learned in PT school thus far, and it is difficult to determine which parts will be clinically relevant. I ask myself if my study methods have prepared me to apply my knowledge in a real life setting; sometimes I worry that they have not.

Our exams our largely multiple choice here in PT school. I have discovered that it is sometimes possible to perform well on a multiple choice test with only a nominal understanding of the material. By only studying to do well on a written exam, I sometimes fail to actually learn the subject matter. I have to support Martha's encouragement to "focus on LEARNING" and not on test grades. The responsibility rests on the shoulders of each student to really learn and understand the concepts of physical therapy; test performance will hopefully reflect that knowledge.

Perhaps this is why clinical rotations are such an integral part of our education. They are not graded to the same extent as a lecture course, but I suspect the necessity to really learn and apply the material is greater. As my first clinical rotation approaches, I am eager to see how how my skills and knowledge hold up under the pressure of real patient interaction.

Stephen March 15, 2013 8:06 AM
Greenville NC

For the majority of the last 7 years I made it my ultimate goal to make as many A's as possible in each class I took.  As several people have stated before me, this is simply something that is ingrained in us at a very early age.  

After my first clinical rotation of PT school I began to realize the importance of creating a balance between classroom and clinical knowledge.  I believe the exams we take in PT school should be viewed as tools to create a foundation of knowledge in which to draw from during each of our clinical experiences.

Although I have been fortunate enough to maintain a fairly high GPA throughout PT school, I do not feel that this is my greatest attribute as a future PT.  I place much greater value in my ability to build a rapport with my colleagues and my ability to connect with each patient I treat.  This is a skill that does not lend itself to classroom teaching but one that must be learned through practice out in the field.

Overall, I believe that as graduate students we all posses a certain innate drive to achieve academic success most often assessed through A-F testing.  However, with this we must understand that there are a multitude of skills required of us to be successful clinicians that cannot be taught in the classroom.

Matthew Lisk, PT - Student, East Carolina University April 24, 2012 5:37 PM
Greenville NC

I'd like to first say that I strongly agree with Taylor and Jane. Specifically, that our professors know that being a competent clinician means much more than making As on exams given throughout PT school; and I loved Taylor's words that it is more important to "internalize knowledge and ideas" than to simply study FOR THE TEST (or TO the test).

We cannot expect to be successful clinicians by memorizing what our professors say will be on a specific test; that is why it has always bothered me when classmates inquire about what exact material an exam will cover - down to the powerpoint slide number even! My response to that ... Just learn it!

Studying shouldn't be passive learning - reading through pages and pages of notes; instead, it should include active learning and reflection in order to truly engrain the foundational material so that we can implement this knowledge in the clinic, and have the necessary background to problem-solve in all different case scenarios. Some things in physical therapy practice are black-and-white, but most are not. How many exam questions throughout PT school have asked for the "best", "most likely", "least appropriate" answer choice from a list of 4 or 5 possible responses? I can say with pretty strong confidence that out of ALL the exam questions I've answered incorrectly throughout 3 years of PT school, most of them came in this kind of format - the others were usually because I simply hadn't learned the material being questioned (it happens :)). Another thing that I can say confidently and without doubt is this: you absolutely learn more from your mistakes than from your accomplishments. So, when we don't make an A on an exam - consider it a learning experience, really. Remember - everyone in the class, from the straight-A students to the 'borderline' students, gets that same DPT degree. My advice - maintain your institution's academic requirements, and so long as you're in good standing, forget about the As, Bs and sometimes Cs, and focus on LEARNING - not testing. It's not easy, but just consider it another "learning experience" :).

Martha Gwaltney, East Carolina University April 17, 2012 2:04 PM
Greenville NC

Jane and Taylor- great perspectives.  Grad school is a completely different beast than any other educational experience I've had (and I'm sure you can relate.)  I agree that tests are a necessary evil, but as they have been the constant throughout my education, it's hard to look past "grades" and realize that what matters is the actual clinical application of the material.  This goes both ways.  I've done well on tests that I would struggle to use practically, and on the other hand I've tested poorly on material I feel very comfortable implementing in the clinic.  Regardless, I can't seem to separate myself from the feelings of success/failure based on the grades I received.  

This semester is tough, but I feel like I'm learning more than I have ever learned before.  For better or for worse, it may be the semester that breaks me.  Thanks for the encouragement!  

Lauren Rosso March 13, 2012 8:15 AM

The pursuit of perfection on tests seems to be a quality shared by all of us who have chosen to pursue degrees in higher education.  We have all had some varying degree of success throughout school or we would not be where we are today.  

With this said, I agree that everything should not hinge on grades.  I have regularly been a borderline high B/low A grad student, and feel that I am just as formidable in the clinic as the students who have had greater classroom success.  

I believe tests are important litmus tests for progress and to help develop critical reasoning skills.  Someone could be an expert at fact memorization or expert test taker, but have horrible people skills or not be able to translate their knowledge into practical application in a hectic treatment setting.

Like Jane said in the comment above, there is much more to being a competent clinician than your classroom grades and the professors know that.  During our admission process, applicants go through an individual interview with a faculty member, one with a student, and then a panel interview.  It is important to find someone who is first and foremost a good person who has the right mix of intangibles and drive to succeed.  

Ultimately classroom testing is a necessary part of the curriculum  in place to prepare us for licensing, and weed out those students who do not have the aptitude to handle the level of responsibility needed to make important medical decisions about a patient's care.  It is more important to internalize knowledge and ideas rather than cram and stress over making a 89.5 on a test.  This is how I tried to approach testing in grad school.

Taylor McKinney, East Carolina University March 10, 2012 11:54 AM

Our PT instructors actually shared that the reason they have the interview process is because they know that good grades do not make good therapists. It is essential to be able to learn the information and implement it in the clinic, but there is another element in the "helping" professions that cannot be measured on a test. To a large extent, it can not even be taught. A DPT student has to have the whole package.

The professors in your program hand-picked the students in your program. They chose each one of you because they believe in you.

What if the professors made a mistake? Well, they have been selecting students for years. They should have reached a level of proficiency by now. But, if you want proof, their competency can be measured by evaluating their track record. What percentage of past classes have gone on to be gainfully employed as physical therapists?

Your professors believe that you possess what it takes to make it as a physical therapist: intellectually and relationally. Now believe in yourself. Encourage your fellow classmates to believe in themselves.

Jane Goude February 20, 2012 10:47 PM

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