Use of the Physical Therapist Clinical Performance Instrument as a Grading Tool as Reported by Academic Coordinators of Clinical Education

Journal of Physical Therapy Education, Spring 2004 by English, M Lynn, Wurth, Renee Otte, Ponsler, Michelle, Milam, Andrea

Background and Purpose. Physical therapist education programs have been in transition in recent years toward using a uniform method of assessment of student clinical performance. The primary purpose of this study was to determine if the American Physical Therapy Association's (APTA) Physical Therapist Clinical Performance Instrument (CPI) is used among physical therapist education programs nationally and consistently as a grading instrument. A secondary purpose of the study was to demonstrate how the use of the CPI relates to demographics of the various institutions utilizing the tool. Subjects. The subjects were 179 academic coordinators of clinical education (ACCEs) identified from the list of physical therapist education programs available on the APTA Web site on October 30, 2000. Methods. Investigators created a 24-question survey tool to gather information about the individual physical therapist education program, the ACCE, and the use of the CPI. A pilot questionnaire was mailed to 10% (18/179) of the subjects. A revised final questionnaire was mailed to 179 subjects. Descriptive statistics for demographic data were computed as means and percentages. Cross tabulations were calculated to determine the cooccurrence of multiple responses on items in which more than one choice could apply to the program. Pearson chi-square and Fisher exact tests were used to examine correlation between demographic data and the use of the CPI as a grading tool. The McNemar chi-square test was used to verify the reliability of the investigator-generated questionnaire. Results. The response rates for the pilot and final questionnaires were 55% and 75%, respectively, indicating that 89.6% of respondents use the CPI to assess student clinical performance. Use of the CPI was significantly dependent (P=.000) on the region in which the program was located. Conclusions. The results of this study indicate that the CPl is used nationally as a grading tool, but that grading methods using the CPI varied among programs.

Key Words: Clinical education, Clinical performance, Grading tools, Physical therapy education.

INTRODUCTION

Historically, physical therapist (PT) education program faculty members have attempted to define and determine competence of graduates as they enter the profession of physical therapy.1-4 Clinical experience has been a key component of most PT education programs, with students assigned to clinical environments to apply the knowledge, skills, and critical thinking patterns developed in the academic environment.5 Historically, clinical instructors (CIs) have used a variety of approaches to evaluate PT students' performance in clinical settings. The Mastery and Assessment of Clinical Skills (Ae Blue MACS)6 and specific tools developed hy individual education programs or clinical facilities1,3 are examples of instruments currently or previously used. There has been ongoing debate ahout the effectiveness, efficiency, and consistency of clinical performance evaluation tools.7-9 Many PT education programs have reported using the Blue MACS.9 CIs using this instrument expressed a positive opinion and reported at least moderately consistent adherence to instructions for use.') However, one of the limitations of the Blue MACS is that clinicians perceive it to require very specific quantitative key behaviors or skills to be met if the student is to be successful in the clinical experienced.9

Discussion about the variety of evaluation tools in use eventually resulted in the development of the Physical Therapist Clinical Performance Instrument (CPI) in 1997 by the American Physical Therapy Association (APTA)J Educators developed this tool to establish uniform processes and instruments for assessing student clinical performance across education programs, and the CPI was designed to measure both the cognitive and noncognitivc factors in PT and PTA students' clinical education performance.5 The CPI consists of 24 performance criteria, with a 100-mm visual analog scale (WS) used for rating each criterion. "Novice clinical performance" and "entry-level performance" are the anchors of each end of the VAS. Sample behaviors are also included for each criterion.7 There is space for comments, and boxes can be checked to Indicate that performance is "of significant concern," "with distinction," or "not observed." The tool also includes areas for formative and summatlve comments by the CI or student.

One recent article reporting the psychometric properties of the CPI described intcrratcr reliability of the PT CPI total score as good (intraclass correlation coefficient=.87). Construct validity was supported by examining several correlations.4 PT student, CI, and ACCK satisfaction with this tool was reported as generally neutral. One exception was reflected in mild ACCE dissatisfaction with the use of the CPI "as a basis for grading."4 The responsibility for assigning grades for clinical experience rests with the ACCE. When using this new tool, each program had to determine how it would use the results to assign grades in clinical education courses. This resulted in some discomfort on the part of ACCEs. With the goal of APTA being the development of a tool for national consistency in grading performance in clinical education, the way the CPl is used nationally as a grading instrument by ACCEs who are somewhat dissatisfied becomes an important question.