I've been a clinical instructor to a few students since graduating myself a few years ago. I enjoy teaching and watching students execute skills they studied prior to arriving at the clinical. Over the past year or so, I've read a few physical therapy blogs and discussed with my coworkers the lack of structure for the clinical experience. Students are usually given a series of items to be assessed, including professionalism, safety, clinical judgment and decision making, as well as other qualities needed to be an entry-level physical therapist.
But beyond that, the bulk of the clinical is determined by the instructor and varies significantly between students as a result. The patients and diagnoses a student may encounter, the pace of work and need for efficiency, as well as the interactions with other health care providers, are not usually requirements of the school or necessary for licensure, but rather generally left to the discretion of the clinical instructor.
While having this extraordinary amount of freedom in a clinical certainly has its benefits, it also has some serious drawbacks. If one student works at a busy outpatient orthopedic clinic, seeing 10-12 patients a day with collaboration between physicians, chiropractors and athletic trainers, while another student in a slower setting is the only therapist on site and sees four to five patients a day -- which student do you think will have more opportunities to practice their skills? Which student would likely become more effective at treating common diagnoses? What happens if a student graduates from physical therapy school without having seen a hip or knee replacement -- two diagnoses common to our practice?
Without a standard of minimum experiences a student must have during a clinical, our profession should not be surprised by the variability between therapists. (I'm not even going to address the lack of screening for therapists to become clinical instructors. Currently, any therapist can be an instructor. There needs to be minimum criteria or letters of recommendation or some sort of other qualification process to teach students. Bad clinical instructors will only result in poor outcomes for the student).
I've noticed this pattern, or lack of structure, extend beyond the school years of the physical therapy profession. In the few clinics I've interviewed at or worked for, there seem to be inconsistent training schedules for new staff. It is assumed new physical therapists will be able to use all modality equipment, mold orthotics or perform any other "basic" task with no structured checklist.
Why is our profession hesitant, or unable, to develop criteria for clinical experiences as well as for new staff across all physical therapy settings? What do you think about this topic?