Navigating Clinical Education Experiences

Any physical therapist (PT) student or physical therapist assistant (PTA) student will eventually embark on a series of clinical education experiences (CEEs). The National Consortium of Clinical Educators developed a glossary of accepted terms and recommends the use of clinical education experience (CEE) instead of “clinical rotation,” although you may hear both terms still used today. 

Academic programs may have specific requirements, such as having a student complete at least one acute care CEE, or one rural CEE. Schools may ask for your preferences when assigning CEEs, while other schools may simply assign your CEEs. Beyond the minimum total requirement set forth by the Commission on Accreditation in Physical Therapy Education, the number of experiences and weeks required at each CEE will vary from school to school. For example, one school may require 3, 12-week CEEs, while another school may require 5, 9-week CEEs. The goal for the student is to gain direct clinical experience during these CEEs to prepare for an entry-level career as a PT or PTA. CEEs are part of a professional curriculum and include a formal assessment.

As a past clinical instructor (CI) and site coordinator of clinical education (SCCE), I have insights into what to expect during your CEEs and how to excel during this crucial part of your education. First, it is normal to feel nervous and excited. The goal for the student is to eventually manage the majority of the CI’s case load. This will be a gradual progression, with the student usually managing at least half the case load by midterm. Second, this is an opportunity for hands-on learning directly interacting with patients in a supervised environment. The CI will supervise the student(s) and provide guidance when needed. You may have one or more CIs. Conversely, there may be multiple students to one CI. Usually, the SCCE or the CI provides an orientation upon your arrival.

1. Prepare. Usually, there is a version of a welcome packet sent out ahead of time that will guide you on your schedule, professional attire including nametag requirements, vaccination requirements, and your CI assignment. If you are arriving the night before, try driving to your CEE location to ensure you can find the building and where to park. What is the professional dress code? This can range from requiring a certain color of scrubs to dress pants and a tie. Some places will not allow cell phones to be out during the day. Do not guess—read your pre-CEE paperwork and check in with your SCCE or CI as instructed. Bring a pen and a notepad and be prepared to take notes at orientation. You only have one chance for a great first impression!

2. Be open to new possibilities. None of us know where our careers will take us 10, 20, or 30 years from now. If you are open to new possibilities, a new passion or skill may form that will be incredibly useful to you and your patients down the road. Take full advantage of all the offered learning opportunities to follow another discipline, department, or another CI for the day. If your site does not offer additional learning opportunities, it never hurts to ask. Bonus tip: These learning opportunities can help you in your preparation for the NPTE.

3. Act professional. This one is tough, because when prompted, most students think they are acting professionally during their CEEs. As a past SCCE, professionalism and professional expectations were the topics most often discussed between the CI and students. There may be a disconnect between how the student perceives a situation and how the CI sees it. Students are expected to be organized and prepared for the day, which may mean staying late the night before to prepare and/or coming in early before your patient day begins. Being professional also extends to your ability to have an appropriate conversation with your CI, your patients, and your patient’s caregivers while demonstrating respect for everyone. How is your eye contact? How is your ability to execute small talk? How is your phone conversation etiquette? Recognize that you are networking even as a student, so you want to leave a good impression. Treat this CEE like it is a full-time job.

4. Communicate. I have never heard a student say, “My CI and I over-communicated.” If the clinical education site does not provide a dedicated weekly meeting for the CI and student, I would ask for one. This creates a valuable opportunity to engage with your CI, assessing the week’s progress together. It’s also a chance for you to ask if you are meeting expectations, both at a clinical and professional level. If you are not sure that you are meeting expectations, then ask. If you do not get a clear answer, ask again. No student should ever be surprised at midterm with their evaluation. You will fill out a self-assessment on your own performance at midterm and final, and your CI will also fill out an assessment at midterm and final on your performance. Also, CIs and students will provide ongoing communication with the academic institution partner on the student’s progress and as needs arise—the word “partner” is important as the academic institution and clinical education site should have an established working relationship.

5. Accept and integrate feedback. Are you showing your willingness to learn and grow? Do you have a pen and piece of paper on you to write down feedback from your CI between patient sessions? Are you receptive to that feedback and do you actively incorporate it into your sessions? If your CI indicates that you have asked the same question multiple times, are you finding a way to retain the answer more effectively? Find a way to show your CI that you are actively listening to them and open to receiving feedback. 

6. Read the room. What are others around you doing? If the team is documenting in an office together, check in to see if that is the expectation for you. Usually teamwork occurs in the office, and you might miss those productive conversations if you have your noise cancellation headphones on or document elsewhere. Limit oversharing about your weekend or personal life. If your CI is attending a meeting outside of patient care duties, take the initiative to check in with them to see if there is an expectation for you to attend.

7. Patient care prioritized. Safe and effective patient care is always the top priority. Students should prepare appropriate interventions for patients and be ready to discuss how to make an intervention more challenging or less challenging for the patient depending on how the patient is presenting that day. However, there is also a schedule to maintain so it is important to monitor the time and assure you are working as efficiently as possible. There might be times when your CI prompts you to slow down to assure safety, and other times to pick up the speed to get to the next patient on time. There is a time and place to have a lengthy conversation with a patient, and sometimes those conversations are shortened to assure you are getting through all components of an evaluation. Asking your CI about efficiency is important—where can you improve? How is your flow of the evaluation? Are you completing all evaluation components in supine before moving to the sitting position while avoiding transitioning back and forth between positions? Are you multi-tasking putting on a blood pressure cuff while asking prior level of function questions? Point-of-service documentation may not be possible with every patient, but are you starting to implement it successfully with patients? If you have the learning opportunity to work in an open gym, observe others for their efficiency strategies. 

8. Assess your confidence. Although we strive for students to become confident and competent individuals, there is such a thing as being overly confident as a student. Don’t be afraid to ask questions. Your CI does not expect you to come in with all the answers, just like your CI will not have all the answers either. If you find yourself arguing with staff members, or refusing to learn something new, these are red flags. I would suggest checking in with yourself and your CI about your confidence levels.

9. Embrace your CEE even when it isn’t a great fit. Sometimes the inevitable occurs, and you do not enjoy your CEE, CI, city you are living in for the CEE, or the schedule. Bottom line – you will jive with some CEEs better than others. The good news is that this CEE is not necessarily a permanent job. Learning what it is that you don’t like about this CEE, such as co-workers, culture, or CI style, will be valuable for your personal growth and development as you prepare a list of questions for future job interviews. This may guide your career direction.

10. Consider your CI. You might be their first student. CIs juggle different responsibilities, and having a student is not their only responsibility. Perhaps your CI is rushing to leave work on time to pick up a child or take care of a family member, and the end of the day is not the best time to ask a long list of questions. You could check in with them and see what time of day works better for them to have those conversations. Remember that you will become a CI someday juggling similar responsibilities, so a little empathy and understanding goes a long way.

Having five CEEs may equate to starting and ending five different jobs. Each CEE may have different hours, CI styles, passwords, electronic medical requirements, cultures, patient schedules and parking requirements. Sometimes students will say, “By the time I figured it all out, it was time to move onto the next CEE.” You will only be a student once, so take a bit of time for reflection at the end of the CEE. If you felt your CEE was an incredible fit, it does not hurt to inquire about future career opportunities with that hospital or company. I encourage you to soak up the learning experience and strive for well-rounded CEEs in a variety of different settings.

About the author:  Sonya L. Irons, PT, DPT, CCS is a Board Certified Cardiovascular and Pulmonary Clinical Specialist and a course instructor for Scorebuilders.