Exemplary Clinical Instructor: A Qualitative Case Study, The

Journal of Physical Therapy Education, Spring 2007 by Kelly, Stephanie P

Background and Purpose. Clinical instructors play an important role in the professional education of physical therapist students. Although characteristics of effective clinical instructors have been described in the literature, some evidence exists that these approaches are not consistently implemented by clinical instructors. Describing in depth the nature of the clinical instructor experience from the viewpoint of an exemplary clinical teacher can provide valuable insight into the clinical teaching process. The purpose of this qualitative case study is to describe instructional reasoning and teaching strategies used by 1 exemplary clinical instructor.

Case Description. Student evaluations of clinical instructors were used to identify an exemplary clinical instructor. Two interviews and a review of artifacts with the clinical instructor were used to collect data. Triangulation of data occurred through interviews with a former student and a coworker. Taped interviews were transcribed and coded to develop the identified themes.

Outcomes. Five tJiemes were identified: creating and maintaining an open, collégial environment; facilitating clinical reasoning; adapting the experience to the student; making time for the student; and receiving environmental support.

Discussion. The exemplary clinical instructor's approach encouraged active learning and reflection by the student and was focused on development of the clinical reasoning abilities of a future colleague. The support she received from her work environment had an important impact on the clinical instructor's approach. The clinical instructor shared specific teaching strategies that she used to implement her approach, providing insight into clinical instruction not previously described in the literature.

Key Words: Clinical instructor, Clinical teaching, Clinical reasoning, Instructional reasoning, Teaching strategies.

BACKGROUND AND PURPOSE

Clinical education is an important component of physical therapist professional education. Supervision of student learning within the clinical setting is provided by practicing clinicians who serve in the role of clinical instructor (CI).1 The literature recognizes that the CI plays an important role in the social and professional development of physical therapist (PT) students.24 Recognizing this role, several studies have been performed describing characteristics of effective CIs.5"8 These studies primarily have included surveys of stakeholders with involvement in clinical education including students,5'8 CIs,6"8 center coordinators of clinical education (CCCEs),6 and academic faculty.8 These studies have identified key characteristics of an effective CI as interpersonal skills, communication skills, teaching skills, and professional skills.5"8

Page and Ross9 studied the instructional strategies used by CIs during a clinical experience. They found that CIs heavily used independent practice and apprenticeship strategies that modeled performance of tasks; however, the teaching strategies theorized to best facilitate development of clinical reasoning were those least used by CIs. Babyar10 studied student perceptions of the development of clinical reasoning and reported similar results. Most of the student respondents (78.8%) believed clinical reasoning was taught by their CIs during clinical experiences; however, only 32.1% believed it was taught by all of their CIs. This echoes results by Dunlevy and Wolf," who reported that, although CIs recognized many clinical teaching behaviors to be important, they were only able to implement 30% of these behaviors more than "occasionally," primarily due to time limitations. Although characteristics of effective clinical instruction have been described, implementation of these strategies in PT clinical education has been reported as inconsistent.9""

Wolff-Burke12 noted there was some difference in expectations between the novice and more experienced CIs and recommended further research on the perceptions and teaching strategies used by experienced CIs. In the profession of medicine, Irby"·14 studied expert clinical teachers in order to gain new insights into their instructional reasoning strategies and knowledge foundations. He reported that expert clinical teachers used both professional knowledge and educational knowledge and closely linked the reasoning processes of the 2 when teaching students. Strohschein4 lamented the lack of research in PT clinical education that closely examines the processes as they occur in clinical education, and recommended that "a qualitative approach, such as grounded theory or focused ethnography, could be used to identify the most salient features of the current clinical education process. "(pl71)

One strategy for more closely examining the processes of clinical education is to use a qualitative approach to describe a single case. According to Yin,15 a descriptive case study is useful for providing a "complete description of a phenomenon within its context."