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A Look At The Evidence: How Does One Become an Expert CI?

We often hear the term “evidence based practice” in regard to patient care, but did you ever stop to consider how evidence based practice can impact your clinical teaching? There is a growing body of evidence in education that pertains to clinical education-and in particular physical therapist clinical education. We hope to highlight some studies that may assist clinicians in their endeavors to improve clinical teaching. This month we highlight the article:

Buccieri KM, Pivko SE, Olzenak DL. Development of an expert clinical instructor: a theoretical model for clinical teaching. JOPTE; 27(1): 48-57. Available at:

Many of us can identify someone who performs exceptionally well in their role as a clinical instructor (CI), and we often wonder, what do they do that others don’t? The authors of this article set out to answer the question: “How do physical therapist CIs attain expertise as clinical teachers?”

In an exploratory, qualitative research process, 9 physical therapist (PT) clinical instructors from the New York-New Jersey Physical Therapy Clinical Education Consortium region were interviewed to answer this question. The authors defined an expert CI as a CI who, via self-assessment and peer review, embodies both expert clinical practice and exemplary or effective clinical teaching characteristics. Current literature documents that exceptional clinical and teaching skills include a reflective practice, intuition, problem solving and hypothesizing.

The results of this study reveal the process of becoming an expert clinical teacher is dynamic, complex and multi-faceted. Expert CIs acquire skills through professional development, relationships and participation in teaching and learning activities themselves. The authors adapted the APTA’s patient-client management problem solving process into the “Clinical Instructor Expertise in Action Model”, which “redefines the familiar elements of examination, evaluation, diagnosis, prognosis, intervention, and outcomes in terms of a teaching and learning episode” (p52). The CI works through this fluid process during a student in clinical encounter, and uses a process of reflection to guide clinical teaching. (Please refer to Figure 3 within the article to view this Action Model-it is really worth taking a look at).

Expert CIs used a process of reflection to improve student clinical learning. They watched how others taught during professional development activities, and incorporated components of this teaching into their clinical practice; they prepared for student encounters and provided clear expectations, and identified real time needs and solutions to build relationships with their students. Expert CIs “use student feedback to consider their own needs and seek opportunities to enhance effectiveness as a clinical teacher” (p 52). Expert CIs use reflection to 1) prepare and organize clinical teaching encounters (reflection FOR action); 2) during real time clinical teaching interactions to adjust situations to the learner (reflection IN action); and 3) Analyzing successes and challenges to modify own behaviors to achieve intended outcomes (reflection ON action).

One participant stated:

“I try for every single learning experience to be a pivotal experience…I don’t follow things blindly. I look at it closely. IF it is something that appears to really have a value to it, I apply it. (CI6).

Expert CIs work to become experts-it is a developmental process whereby effort is made to develop teaching skills and in their interactions with student learners in the clinical environment. The results of the study identified characteristics of expert CIs across practice settings, whether or not the subject was an APTA member, had completed the APTA Credential Clinical Instructor Program, or had obtained specialty certification.

This well designed research study about the development of an expert clinical instructor can give us all some things to think about. Clinical instruction is more than just volunteering our time to provide students an opportunity to practice what they’ve been taught in the classroom. Expert clinical instructors plan, implement and assess not only student performance and outcomes, but also their own performance and outcomes as a clinical instructor. Future research can build on this theatrical model and CI training programs should look to include key content from this study to help systematically develop expert CI skills.

In summary, there is a process of development to becoming an expert clinical instructor. It is likely that any model of PT clinical education will rely on clinicians to facilitate student attainment of clinical competence of an entry-level clinician (p. 48). While the results are not generalizable due to the nature of the study, it well understood from these results that expert clinical teachers develop over time, just as expert clinical practitioners develop.

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