PTJ: Physical Therapy & Rehabilitation Journal | Physical Therapy, 2022;102:1–12

https://doi.org/10.1093/ptj/pzac063
Advance access publication date May 24, 2022
Original Research

Clinical Teaching Competencies in Physical Therapist

Education: A Modified Delphi Study

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Katherine Myers , PT, DPT1 ,* , Catherine Bilyeu, PT, DPT2 , Kyle Covington, PT, DPT, PhD1 ,
Amanda Sharp , PT, DPT3
1 Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
2 Physical Therapy Program, School of Medicine, University of Colorado, Aurora, Colorado, USA
3 Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA

*Address all correspondence to Dr Myers at: Katherine.D.Myers@duke.edu

Abstract
Objective. Clinical instructors play a key role in physical therapist professional education but may serve with minimal
preparation and without clearly defined expectations for their teaching performance. The objective of this study was to
utilize a consensus-building process to establish core competencies of clinical teaching within physical therapist education.
Methods. A modified Delphi approach was used to identify core competencies of clinical teaching. An expert panel
consisted of clinical instructors, site coordinators of clinical education, and directors of clinical education, representing
multiple geographic regions in the United States. The panel assessed the relevance of 30 original competencies. Criteria
for consensus included 75% of participants perceiving the competency as very or extremely relevant and a median score
of 2 (very relevant) on a 5-point Likert scale. Consistent with a Modified Delphi approach, quantitative and qualitative data
analysis were completed for each of the 3 rounds. Revised surveys were used in Rounds 2 and 3 based on the results from
previous data analysis.
Results. Twenty-four competencies achieved final consensus. The competencies were categorized within 3 domains: learner-
centered educator (n = 8), assessor/evaluator (n = 7), and professional role model (n = 9).
Conclusion. The 24 competencies and 3 domains provide the foundation for a competency framework for clinical teaching
in physical therapy. This framework provides clarity for the expected knowledge, skills, and attitudes of clinical instructors in
physical therapist professional education.
Impact. This is the first study, to our knowledge, to utilize a consensus-building strategy to clearly define competencies
of clinical teaching in physical therapist professional education. Like efforts in nursing and medical education, adoption of
these competencies could promote consistency in clinical instructor teaching behaviors and contribute to the creation of
assessment and professional development mechanisms for clinical instructors, positively impacting the preparation of the
next generation of excellent physical therapist clinicians.
Keywords: Education: Clinical, Education: Competency-Based, Education: Faculty, Education: Physical Therapist Students

Received: September 2, 2021. Revised: January 7, 2022. Accepted: April 5, 2022

© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com
2 Clinical Teaching Competencies
Introduction
Clinical education experiences in doctor of physical therapy
(DPT) programs account for up to one-third of the curricu-
lum.1 This means that practicing clinicians serving as clinical
instructors guide a significant portion of a DPT student’s
professional education.2,3 It is not surprising then that the
landmark study published in 2017 by Jensen et al4 specifically
identified the role of the clinical instructor as a key factor in
achieving excellence in physical therapist education. Previous
research described the impact of clinical instructor teaching
characteristics on student experience and educational out-
comes.5–7 However, despite recognizing the importance of the
clinical instructor in the professional education of the entry-
level DPT student, several questions about clinical instructor
preparation and teaching skill remain. The means by which
clinicians transition into the role of clinical instructor, the
ways in which clinical instructors attain the skills to be an
effective educator, and how clinical instructors develop their
teaching skills over time all warrant further exploration.2
Taken together, a gap emerges between the clinical instructor’s
role as educator and the goal of achieving excellence in
professional education.
The Commission on Accreditation in Physical Therapy
(CAPTE) sets a minimum standard for physical therapists to
be eligible to serve as a clinical instructor. Currently, CAPTE
requires a clinical instructor to have 1 year of full-time (or
equivalent) post-licensure clinical experience and that clinical
instructors are “effective role models and clinical teachers.”8
CAPTE allows academic programs the leeway to provide their
own criteria for how they define and ensure the competence
and effectiveness of their affiliated clinical instructors.
Effective clinical teaching has not been clearly defined in
physical therapist education, although both physical therapy
and other health profession literature describes traits that
enhance effectiveness. Previous research has relied on student
perceptions of clinical instructors to develop a description of
desired behaviors and characteristics.9–12 Students perceive
characteristics related to communication, interpersonal skills,
and instructional methods to be important to the effectiveness
of their clinical instructor.2,13–15 Student feedback is also the
primary method of assessing clinical instructor teaching, with
no consistent assessment method utilized across academic pro-
grams.2,3 Most academic programs use the American Physical
Therapy Association (APTA) Physical Therapy Student Eval-
uation for clinical instructor evaluation, but the reliability of
the tool as an assessment measure is yet to be established.16,17
Although the literature describes clinical instructor char-
acteristics and behaviors, a gap remains between how
to consistently identify those behaviors and how clinical
instructors can develop and refine their clinical teaching
skills. The literature suggests that most clinical instructors
acquire skills related to teaching through trial and error and
experience, implying that these skills develop naturally over
time from each subsequent experience.18–20 Dreyfus’ model
of skill acquisition suggests that adults learn through both
instruction and experience, passing through 5 developmental
stages from novice to master.21 To achieve masterly levels,
an individual must have ongoing experience to utilize high-
level skill and decision-making, although experience alone is
insufficient without formal instruction. Instruction in clinical
teaching is available to clinical instructors through the APTA
Credentialed Clinical Instructor Program. The Credentialed
Clinical Instructor Program is the predominant method
of clinical instructor training, but academic programs and
clinical sites do not consistently require it of their clinical
instructors.2 Furthermore, there is mixed evidence of its
impact on teaching and clinical instructor effectiveness.6,12
Prior research investigating clinical teaching effectiveness
reinforces the idea that there are essential skills and character-
istics sought after in clinical instructors. However, beyond stu-
dent feedback and self-assessment mechanisms, there remains
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no consistent mechanism to identify clinical instructor com-
petence in clinical teaching. Competence is described as the
knowledge, abilities, skills, and attitudes displayed in partic-
ular professional contexts.22 Other professional fields such
as medicine and nursing identified the importance of clearly
defining the expected behaviors of clinical teachers. Through
various consensus-building processes, these 2 fields devel-
oped competency frameworks to define the expected level
of competence for clinicians teaching in the clinical environ-
ment.23–27
Competency frameworks provide a clear description of
the knowledge, skills, abilities, and attitudes expected of an
individual.28 Further, these frameworks are specific to a par-
ticular context in which an individual is practicing. This is
useful for promoting consistency in identifying and evaluating
competence within a profession.28,29 For example, medical
education competency models for clinical teaching use their
profession-specific clinical competence models as a basis for
expected teaching outcomes.23,24 The nursing educator com-
petency model considers the various roles that nurse educa-
tors have within their education programs and outlines the
expected behaviors around those roles.27
The concepts of competency and competency frameworks
are not widespread within the physical therapy profession.
Academies and working groups within APTA identified core
competencies of various clinical practice areas30,31 and of
resident-level education.32 Similarly, APTA-backed initiatives
through the Education Leadership Partnership are focused on
development of a framework for competency-based physical
therapist education and identification of profession-based
entrustable professional activities.33 Much of the focus of
the Education Leadership Partnership has been on ensuring
students are sufficiently prepared to enter and succeed in the
clinical learning environment and less so on the development
of academic and clinical faculty teaching effectiveness.34
Whereas stakeholder groups and educators within the pro-
fession are focused on student competency development, the
development of clinical instructor teaching competence does
not receive the same attention. In an earlier perspective, the
authors issued a call to action with regard to the importance of
clinical instructor support through directed training, prepara-
tion, and development.35 Following a path similar to nursing
and medical education, identifying clinical instructor teach-
ing competencies for physical therapist education provides a
foundation for future work related to assessment methods and
professional development opportunities.24,35,36
When other health professions took the time to define
the role of the clinical teacher and the associated skills and
characteristics, they were able to implement competency-
based professional development opportunities and consistent
methods to assess competence. The purpose of this study was
to reach consensus on core competencies of clinical teaching
for clinical instructors in physical therapy.
Myers et al
Methods
Research Design
This descriptive study used the Modified Delphi method to
establish core competencies of clinical teaching. The Del-
phi method uses a series of questionnaires to collect data
from a selected panel of expert participants.37 Each iter-
ation of questions represents a feedback process, allowing
participants to reassess their opinions and judgments on a
specific topic.37 The method allows participants to remain
anonymous throughout the study while still being privy to
the perspective of others, thus eliminating potential bias and
influence that may occur in face-to-face processes or those
where participants are known.37,38 This study sought to
include perspectives from a diverse group of stakeholders,
free from the influence of the traditional dynamics inherent
between common stakeholder groups in clinical education
representing academic and clinical interests.
Conceptual Framework
Competency frameworks in nursing, medical, and adult edu-
cation were identified from a literature review.24,27,39 These
existing competency frameworks use 3 levels to capture the
concepts of competence and break them down into measur-
able indicators. Each framework is grounded in associated
domains that represent broad areas of activity associated
with teaching. Domains are then subdivided into associated
competencies representing knowledge, skills, and attitudes
necessary for success in that domain. The competencies are
further delineated through specific competence indicators that
describe how a competency might be performed or demon-
strated. This study focused on defining the competencies and
identifying associated domains for physical therapy clinical
instructors. Organization of the competency framework in
this way provides a description of identifiable and measurable
clinical instructor attributes.
Participants
Recruitment was designed to maximize representation of 3
clinical education stakeholder groups: clinical instructors, site
coordinators of clinical education (SCCEs), and directors
of clinical education (DCEs) as each group aligns primarily
with either an academic or clinical perspective. Each group
also provides a distinct and valuable lens for identifying
the necessary attributes for clinical instructor success. The
Delphi methodology relies on a sample of identified “experts”
to serve as the panel for the entire study. Creation of the
panel becomes challenging when there is no clear method to
delineate levels of expertise between individuals.40 To deter-
mine inclusion criteria related to expertise in clinical educa-
tion, the researchers reviewed the literature for definitions of
“expert” clinical instructors, SCCEs, and DCEs. Descriptions
of the development of expertise in clinical instructors focus
on experience and practice.18,19,41 As such, years as a clinical
instructor and number of students supervised were used as
select inclusion criteria and indicators of participant expertise.
A clear definition of expertise for SCCEs and DCEs was not
located; therefore, years of experience was utilized for these 2
participant groups in parallel with clinical instructor inclusion
criteria.
A broad geographic representation of participants was also
desired, and all participants were required to be currently
licensed as a physical therapist in the United States. Following
3
the initial call for participants, purposive sampling methods
were utilized for participant selection to balance role rep-
resentation (clinical instructor, SCCE, DCE) and geographic
location, as depicted in Figure 1.
Survey Development and Instrumentation
In a Modified Delphi approach, items included in the first
round of the survey are based on existing knowledge or mate-
rial about the topic being studied.38 In this study, competen-
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cies for the first round were established through an extensive
literature review process. Sources included nurse educator
competencies,36,42 the APTA Physical Therapy Student Eval-
uation of Clinical Experience and Clinical Instruction,43 and
previous studies that identified desirable characteristics of
clinical instructors.2,3,19 The initial survey was piloted with a
group of DCE, clinical instructor, SCCE, and academic faculty.
Competency statements were then modified for clarity based
on feedback. The Round 1 survey and all subsequent surveys
were created in and distributed through Qualtrics (Provo,
UT, USA).
Data Collection
Participants received a personalized survey link through
Qualtrics to access the survey. Data regarding the participants’
clinical education role and their geographic region were
collected as part of the initial invitation to participate and
were included as part of each response in subsequent survey
rounds. No other identifying information was collected during
the study. Participants were given 3 weeks to complete the
survey. Reminder emails were sent weekly to encourage
all participants to complete the survey. For each round,
participants were asked to rate competency statements for
relevance and to comment on clarity. Relevance was first
rated using a 5-point scale (extremely relevant, very relevant,
moderately relevant, slightly relevant, and not at all relevant).
Participants were then required to provide a justification of
their rating in an open text response. Next, an opportunity to
provide suggestions to improve the clarity of the competency
in an open text field was provided. At the end of the Round
1, participants were requested to suggest any competencies
they felt were missing from the initial list and provide a
justification for inclusion of the competency. Suggestions were
only solicited in the first round of data collection.
In a Delphi Study, the initial or Round 1 survey provides a
starting point for the consensus process. Subsequent surveys
build on results of the previous round.38 Therefore, at the end
of Round 1, each competency was analyzed to determine if
consensus was achieved. If consensus was not achieved, that
competency was moved forward to Round 2. The second-
round survey included percent agreement scores for each com-
petency statement. A summary of the participants’ rationale
for supporting or rejecting the competency was also included.
Providing a summary of previous scores and participant ratio-
nale is consistent with the Delphi design, which allows for
participants to understand others’ perspectives and opinions
without compromising anonymity.37,38 Competencies that
did not reach consensus and had suggestions for improved
clarity were modified for the second round. Any competency
that reached consensus was not included in the Round 2 sur-
vey for further consideration but was included for reference
by participants. The Round 3 survey was built in the same
manner based on Round 2 results. The process used in this
study is shown in Figure 2.
4 Clinical Teaching Competencies
Figure 1. Recruitment process. CI = clinical instructor; DCE = director of clinical education; SCCE = site coordinator of clinical education.
Data collection occurred over a 10-month period. The time
between survey rounds was prolonged due to participant non-
responses. Individual responses remained anonymous to the
researchers throughout the data collection process. This study
was declared exempt from institutional review board (IRB)
review at each investigator’s institution (Duke University
Health System IRB, Colorado Multiple IRB, University of
Minnesota IRB).
Data Analysis
Quantitative and qualitative data analysis can occur in the
Delphi Method, consistent with recommended practices for
Delphi studies.37,40 For this study, quantitative analysis
included analysis of measures of central tendency. The first
quantitative consensus criterion was a median score of 2
(very relevant) on the 5-point categorical scale described
above. An established level of agreement between 51%
and 80% among respondents for determining consensus is
recommended in Delphi methodology.37,40 In this study, the
second quantitative consensus criterion was a requirement
that 75% or more of respondents perceived the competency
as extremely or very relevant. Furthermore, competencies
were excluded from subsequent rounds if the percentage
of respondents who perceived them as slightly or not at all
relevant was greater than the percentage that found them to
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be extremely or very relevant. In Rounds 2 and 3, participants
were provided median and percent agreement scores from
previous rounds for each competency.
Qualitative analysis was utilized throughout this Modified
Delphi study. Thematic analysis is an accepted approach in
qualitative Delphi studies to provide explanations and sum-
maries of participants’ responses throughout each round of
the study.44 Three members of the research team reviewed
all respondent comments and performed thematic analysis
of the responses. Independent open coding to saturation was
followed by axial coding and then a collaborative discussion
of each competency. Discrepancies among the 3 coders were
resolved and consensus was achieved. Using this process,
themes and summary comments of the rationale for accepting
or rejecting a competency were provided to participants in the
subsequent survey round. Survey rounds were continued until
all competencies achieved consensus or were rejected using the
criterion described above.
After competencies were established, the researchers once
again used a thematic analysis approach to categorize the
competencies into broader domains.44 The competency state-
ments were first analyzed and coded independently by each
of the research team members. Through subsequent axial
coding and collaborative discussion, competency statements
were merged into 3 domains. These became the domains of
competency within this study’s competency framework.
Myers et al 5

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Figure 2. Overview of methodology.

Table 1. Participant Demographicsa

Completed Completed Completed

Characteristic Round 1 Round 2 Round 3
(n = 28), No. (n = 19), No. (n = 17), No.
Professional role
CI 6 3 2
DCE or ADCE 11 8 8
SCCE 7 4 3
Other–expert 1 1 1
Other–former DCE 3 3 3
Geographic regionb
Great Lakes 7 4 4
West South Central 3 1 1
Middle Atlantic 4 4 4
New York/New Jersey 1 1 1
Northeast Coast 2 2 1
Pacific 1 0 0
South Atlantic 1 1 1
West Mountain 6 4 3
West North Central 3 2 2
a ADCE = assistant director of clinical education; CI = clinical instructor; DCE = director of clinical education; SCCE = site coordinator of clinical education.
b Geographic regions are based on American Council of Academic Physical Therapy’s National Consortium of Clinical Educator’s regional designations.

Results Results by Round

Participant Data
From the initial call for participants, a total of 62 individuals
were invited via email to participate in the Modified Delphi
process. Selected participants represented a variety of areas
of professional expertise and geographic location, consistent
with the intent of the study. Survey links were sent to all 62
interested individuals. All participants met the inclusion cri-
teria for years of experience. Additionally, clinical instructor
respondents had supervised an average of 11.4 students. After
3 survey rounds, 17 participants remained for an ultimate
response rate of 45%. Table 1 outlines additional participant
demographics for each round of the study. Representation was
across all intended professional areas of expertise, and the
majority of the original 9 geographic regions was maintained
throughout the study.
Figure 2 provides a visual representation of the methodology,
and Figure 3 depicts the methodology with the results of the
study included. In Round 1, a total of 30 competencies were
proposed. Of these, 18 were accepted and 3 were rejected
(Table 2). Nine competencies did not reach consensus and
were carried forward to Round 2. Clarifications in wording
for the remaining 9 competencies were made prior to Round
2 based on collected participant feedback. No additional
competencies were accepted in Round 2, and 1 additional
competency was rejected. Further revisions for wording clarity
were completed on 3 of the remaining competencies. The
survey for Round 3 consisted of the remaining 8 compe-
tencies, of which 6 were accepted as written and 2 were
rejected. After 3 rounds, 24 competencies (80%) met consen-
sus and 6 competencies (20%) were rejected. No additional
6 Clinical Teaching Competencies
Figure 3. Modified Delphi process and summary results by round.
competencies were suggested by study participants. Of the
24 approved competencies, language was necessarily adjusted
for clarification based on feedback from survey respondents.
Clarification adjustments did not impact the root intent of any
of the associated competencies.
Through conventional qualitative processes outlined earlier,
the 24 accepted competencies were categorized into the 3
broader domains (Tab. 3). The research team identified the
domains as learner-centered educator (n = 8), assessor/evalu-
ator (n = 7), and professional role model (n = 9). Definitions
for each domain were developed by consensus of the research
team following independent review and group discussion.
Discussion
This is the first study, to our knowledge, to utilize a consensus-
building process to identify clinical teaching competencies
and associated domains specific to physical therapist edu-
cation. The 24 competencies and 3 domains identified in
this study represent the essential stakeholders in clinical edu-
cation and provide a foundation for the development of a
competency model for clinical instructors in physical therapy.
A competency model is useful for identifying the expected
skills, knowledge, and attributes associated with a particular
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role as represented by the domains.45 Although detailed and
specific, competency models are not intended to be restrictive
or unachievable for the novice educator. Instead, they help
establish a path for development of skill and, ultimately, exper-
tise.22 The Dreyfus Model of Skill Acquisition asserts that an
individual develops skill by participating in progressively chal-
lenging experiences while receiving specific and meaningful
feedback and performing frequent self-reflection.21 Ericcson
further describes the development of expertise occurring not
just through experience and practice, but also requiring delib-
erate strategies to improve, including training, feedback, and
reflection.46
Competencies identified in this study are similarly applica-
ble for clinical instructors as they progress along a develop-
mental path. For example, even a novice clinical instructor
is likely to seek feedback, utilize varied teaching strategies,
and model ethical and legal practice. A clinical instructor
with more training as an educator, with more expertise and
self-awareness, may be more likely to embody competencies
associated with planning learning experiences based on the
learning style of a student and to modify teaching strategies
based on needs within a learning domain. Research shows that
the expertise of a clinical instructor can have a positive impact
on student outcomes and student experiences in clinical
Table 2. Modified Delphi Results by Round

Final
Myers et al

Initial Competency (Revised Competency) Round 1 Round 2 Round 3

Competency
Extremely/Very Extremely/Very Extremely/Very
Median Median Median Yes/No
Relevant (%) Relevant (%) Relevant (%)
Facilitate student development through varied teaching strategiesa 1.5 96.43 Yes
Recognize opportunities to modify learning experiences to support 2.0 89.29 Yes
students with exceptional needs (high-and low-performing students, etc)a
Integrates students’ learning styles and unique learning needs into clinical 2.0 78.57 Yes
teaching approacha
Seek feedback from student regarding clinical teachinga 1.5 82.14 Yes
Plan learning experiences that support student in meeting clinical 2.0 89.28 Yes
experience objectivesa
Utilize all appropriate teaching and learning opportunities available in 2.0 60.71
clinical environment
Utilize appropriate variety of teaching and learning opportunities — — 2.0 57.90 No
available in clinical environment to meet objectives of clinical experienceb
Clearly define expectations for clinical experience with input from 2.0 92.85 Yes
student and academic programa
Facilitate student socialization into clinical setting 2.0 53.57
Facilitate student professional formation and understanding of unique — — 2.0 68.42
role of physical therapist in health careb
Facilitate development of student professional identitya , b — — — — 2.0 52.94 Yes
Engage in professional development opportunities in area of 2.0 60.72 2.5 47.37
education/teaching
Engage in formal and informal professional development related to role — — — — 2.0 70.59 Yes
of clinical teachinga , b
Seek feedback from peers and students on teaching effectivenessa 2.0 82.15 Yes
Use questioning to foster clinical reasoning and engage learners in 2.0 75 Yes
inquirya
Demonstrate objectivity in student performance assessment, absent of 1.0 92.86 Yes
personal biasesa
Consider all student factors (ie, current level of performance, academic 1.5 71.43
curriculum, level of didactic preparation) in analyzing their behavior
Consider relevant student factors (eg, level of didactic preparation, — — 2.0 73.68 2.0 70.59 Yes
academic curriculum, current level of performance) in analyzing
students’ performancea , b
Accurately identify learning domains (cognitive, psychomotor, affective) 2.0 60.72
in which student is having difficulty
Accurately diagnose difficulties in learning process (eg, learning domains — — 2.0 68.42
impacted, stage of learning)b
Accurately identify difficulties in learning process (eg, learning domains — — — — 2.0 88.84 Yes
impacted, stage of learning)a , b
Provide timely, constructive feedback during clinical experience to 1.0 96.43 Yes
support student learning and/or modify behaviora
Use data from assessment process to modify and progress clinical 2.0 71.43
learning experiences

(Continued)
7

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 8

Table 2. Continued

Final
Initial Competency (Revised Competency) Round 1 Round 2 Round 3
Competency
Extremely/Very Extremely/Very Extremely/Very
Median Median Median Yes/No
Relevant (%) Relevant (%) Relevant (%)
Effectively use information from assessment processes to modify clinical — — 2.0 68.42 2.0 52.49 Yes
learning experience to meet learners’ needsa , b
Accurately assess student performance through formal assessment 1.5 85.71 Yes
processesa
Foster students’ self-assessment skills and reflection on teaching and 2.0 85.72 Yes
learning activitiesa
Provide regular, detailed feedback to learners on their learning progressa 1.0 82.40 Yes
Employ effective, open, and non-threatening communication in all 1.0 100 Yes
professional interactionsa
Foster climate of respect, collegiality, professionalism, courage, and 1.0 100 Yes
caring within clinical settinga
Serve as mentor to students, new clinical educators, and/or new clinicians 2.0 71.43 2.5 52.63 3.0 35.29 No
in clinical settings
Prioritize professional commitments and responsibilities in healthy 2.0 53.57
manner
Model effective balance of professional commitments and — — 3.0 26.32 No
responsibilitiesb
Demonstrate commitment to life-long learning through participation in 2.0 82.14 Yes
professional development activitiesa
Engage as professional in district, state, regional, and/or national 4.0 22.04 No
activities
Promote ethical and legal principles of integrity, academic honesty, 1.0 96.43 Yes
flexibility, and respect through role modelinga
Use evidence to support clinical practicea 2.0 85.71 Yes
Disseminate information about clinical practice and education to support 3.0 28.57 No
learning among colleagues and students
Design, implement, and/or participate in research activities in area of 4.0 7.14 No
expertise
Enhance student learning through participation in interprofessional 2.0 64.29
practice
Enhance student learning through facilitation of deliberate — — 2.0 63.16 2.0 58.08 Yes
interprofessional practice opportunitiesa , b
a Accepted competency based on consensus criteria. b Revised competency based on panel feedback.
Clinical Teaching Competencies

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Table 3. Competencies by Domain
Domain
Learner-centered educator
Assessor/evaluator
Professional role model
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Definition
Commitment to integration of educational
theory and adult learning principles to
facilitate learner’s success
Accurate and systematic assessment of learner
performance to drive feedback and structure
learning experience
Evidence-based teaching approach;
evidence-based clinical practice; lifelong
learner; self-assessment
Myers et al
Associated Competency
Facilitate student development through varied teaching strategies
Recognize opportunities to modify learning experiences to support students with exceptional
needs (high- and low-performing students etc.)
Integrate students’ learning styles and unique learning needs into clinical teaching approach
Plan learning experiences that support student in meeting clinical experience objectives
Clearly define expectations for clinical experience with input from student and academic
program
Use questioning to foster clinical reasoning and engage learners in inquiry
Foster students’ self-assessment skills and reflection on teaching and learning activities
Enhance student learning through facilitation of deliberate interprofessional practice
opportunities
Demonstrate objectivity in student performance assessment, absent of personal biases
Consider relevant student factors (eg, level of didactic preparation, academic curriculum,
current level of performance) in analyzing students’ performance
Accurately identify difficulties in learning process (eg, learning domains impacted, stage of
learning)
Provide timely, constructive feedback during clinical experience to support student learning
and/or modify behavior
Effectively use information from assessment processes to modify clinical learning to experience
to meet learners’ needs
Accurately assess student performance through formal assessment processes
Provide regular, detailed feedback to learners on progress of learning
Seek feedback from student regarding clinical teaching
Facilitate development of student professional identity
Engage in formal and informal professional development related to role of clinical teaching
Seek feedback from peers and students on teaching effectiveness
Employ effective, open, and non-threatening communication in all professional interactions
Foster climate of respect, collegiality, professionalism, courage, and caring within clinical setting
Demonstrate commitment to life-long learning through participation in professional
development activities
Promote ethical and legal principles of integrity, academic honesty, flexibility, and respect
through role modeling
Use evidence to support clinical practice
9
10
education.19 Therefore, physical therapist student educators
have a vested interest in seeing clinical instructors progress
from novice to expert on the skill acquisition continuum. The
24 competencies from this study identify opportunity areas
for ongoing clinical instructor development.
Beyond the competencies, this study resulted in the creation
of 3 specific domains: learner-centered educator, assessor/eval-
uator, and professional role model. The National Excellence in
Education study placed learner-centered teaching and learn-
ing at the center of their conceptual framework.4 Similarly,
other health professions identified learner centeredness as a
component of clinical teaching competency.23,24 In this study,
competencies within the learner-centered domain emphasize
an integration of adult-learning principles and educational
theory in the approach to teaching. Utilizing varied teaching
approaches, such as including the student in the process of
setting expectations and learning experiences and fostering
self-reflection, places the learner at the center of the teaching
approach.47,48 Our results reveal learner-centered teaching
principles as the most accepted concepts across all rounds of
the study. Participants accepted all but one of the competen-
cies within this domain in the first round with no suggested
edits.
In the assessor/evaluator domain, 7 competencies met the
threshold for acceptance. The accepted competencies highlight
the importance of delivering adequate feedback, understand-
ing student academic preparation, and using student perfor-
mance to design learning experiences. Effective and accurate
assessment of and feedback to learners is crucial for educating
adult learners.48 The competencies in this domain reflect the
multiple factors that clinical instructors must consider when
evaluating their students, including the level of the learner, the
domains of learning, the need to facilitate the learner’s self-
reflection, and the importance of timely feedback. Effective
assessment skills are desired skills of clinical instructors in
physical therapist education.2,19,20 Our findings are also con-
sistent with those competency frameworks found in nursing27
and medical education.23,24
The domain of professional role model in our study includes
competencies associated with evidence-based practice, uti-
lization of self-reflection as a practitioner and teacher, and
demonstrating a commitment to lifelong learning. Previous
studies show that both students and clinical instructors per-
ceive these characteristics as essential to the effectiveness of
the clinical instructor.3,20,49 These characteristics are also
consistent with traditional faculty roles. Academic faculty are
considered key role models for professionalism and profes-
sional identify formation for students in the health profes-
sions.50–53 CAPTE considers clinical instructors as extensions
of the academic program faculty.8 Setting specific expecta-
tions within this domain for clinical instructors may foster
future development of professional development activities
that are consistent between academic and clinical faculty.
The current approach to clinical instructor skill develop-
ment is not consistent with Dreyfus and Ericsson’s theories of
skill development. Instead, clinical instructors rely on incon-
sistent and optional formal training opportunities and inef-
fective feedback typically provided by students.2,54 Clearly
defining the expected levels of competence provides a method
for addressing the gap between expectation and aspiration—
that clinical instructors are skilled educators and should strive
for expertise in clinical teaching. The competency model
described in this study is the foundation for continued efforts
to clearly define desired behaviors and characteristics of
Clinical Teaching Competencies
clinical educators. Future work to further develop the
model includes identifying components of the “competency
indicator” level. Linking broad domains, competencies, and
more specific competency indicators will provide a necessary
framework for clinical instructors to utilize in self-reflection
and for future development of assessment and professional
development approaches.
Limitations
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Although this study is the first, to our knowledge, within the
physical therapy profession to establish clinical teaching com-
petencies, it is not without limitations. The Delphi approach is
a widely accepted consensus-building methodology; however,
it requires a longitudinal commitment of participants and is
prone to attrition. We found a decreasing number of partic-
ipants through each round of the study, particularly in the
clinical instructor group, though the fact that the final round
still included perspectives from all key stakeholder groups
as well as broad geographic representation was encourag-
ing. As previously identified, a Delphi study relies heavily
on a panel of participants considered experts in their field.
Within clinical education, there is no clear definition of expert
DCE, expert SCCE, or expert clinical instructor; therefore,
inclusion criteria relied on years of experience and numbers
of students supervised. We approached this study assuming
that all participants had knowledge of educational learning
theory given their involvement in education. Because this
type of knowledge is not a defined characteristic of expertise,
we recognize that the participants may have had varying
understandings of learning theory, which may have impacted
the interpretation of competency statements. With these limi-
tations in mind, this work represents an initial exploration and
first step in establishing competencies of clinical educators. We
recognize that the clinical instructor and SCCE representation
was lower than the academic participants by the third round
and anticipate continued efforts to gather feedback from the
clinical community are necessary for broader endorsement.
This is the first study, to our knowledge, to formally address
clinical instructor clinical teaching competencies, and educa-
tors can use this work to further pursue excellence in physical
therapist education. Future steps include the refinement of
competencies and the development of competence indica-
tors. The competencies identified in this study can positively
influence clinical instructor development. By engaging the
profession and adopting these competencies as the requisite
knowledge, skills, and behaviors all clinical instructors should
strive to develop, we can most effectively facilitate the devel-
opment of the next generation of excellent physical therapist
clinicians.
Author Contributions
Concept/idea/research design: K. Myers, C. Bilyeu, A. Sharp
Writing: K. Myers, C. Bilyeu, K. Covington, A. Sharp
Data collection: K. Myers, A. Sharp
Data analysis: K. Myers, C. Bilyeu, K. Covington, A. Sharp
Project management: K. Myers, A. Sharp
Consultation (including review of manuscript before submitting):
C. Bilyeu, A. Sharp
Ethics Approval
This study was declared exempt from institutional review board review
at each author’s institution: Duke University Health System, Colorado
Multiple, and University of Minnesota.
Myers et al
Disclosures
The authors completed the ICMJE Form for Disclosure of Potential
Conflicts of Interest and reported no conflicts of interest.
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