Doctoral Dissertations

Melissa Wolff

Date of Award

12-2000

Degree Type

Dissertation

Degree Name

Doctor of Education

Major

Educational Administration

Major Professor

Norma Mertz

Abstract

Physical Therapy clinical education emphasizes "hands-on" patient care and begins with exposure to patients, practice policies and standards of care. As the student progresses through the clinical program, higher expectations are held by the clinical instructor (CI) for the student's performance. The CI assesses the student's performance and reports to the academic institution the level of competence the student has achieved. One area of this assessment about which little is known is how CIs deal with inappropriate behaviors. The purpose of this study was to describe how clinical instructors in physical therapy address inappropriate professional behaviors demonstrated by students during their clinical rotations, and how they perceive they should be addressed. Eleven clinical instructors were recruited via a letter sent to a random sample of clinical sites in Virginia. Audiotaped, in-depth interviews, a pre-interview form, an optional student evaluation record and a methodological journal were used for analysis. Following a member check of the transcriptions, the written and verbal comments of the CIs were analyzed inductively to describe the strategies used when addressing inappropriate professional behaviors of students. The written evaluation of the student was compared to the interview to determine if reported practice matched the written documentation. Four categories of appropriate behaviors (Accepting Responsibility for Learning, Conununication, Empathy, Professionalism) and four categories of unprofessional behavior (Attitude, Lack of Interest, Poor Communication, Unprofessional) were identified. CIs used five tactics to address inappropriate behaviors with the student: Verbal Communication, Written Communication, Physical Intervention, Using Resources at the Clinical Facility, Using Resources of the Academic Institution. Reasons for choosing a particular action were based on the responsibility the CI felt to various parties (student, patients, self, the profession), the role of past experience, and the support of peers or the school. Reasons why a CI did not do something that he/she felt should have been done were lack of confidence and experience as a CI, and lack of support from the school, perhaps due to fear of litigation. Establishing clear expectations for appropriate behavior early in the clinical experience was a characteristic of more experienced CIs. Experienced CIs also tended to pre-empt student problems by being able to identify and address inappropriate behaviors directly and early. Five CIs provided written material for evaluation on eight students. Three of the written reports did not reflect the reported behavior problem identified by the CI. Five reports did document the professional behavior problems and left the decision for failure of the clinical experience to the academic institution.

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