How Do We Improve Quality in Clinical Education? Examination of Structures, Processes, and Outcomes

Background and Purpose. The current state of clinical education curricula in physical therapist education programs across the United States reflects disparate approaches to clinical education experiences for students. Using Donabedian's classic conceptual framework for examining health care quality, this position paper describes the structures, processes, and outcomes of the current approach to clinical education in physical therapist education programs and makes recommendations for taking steps toward improving quality. Position and Rationale. Wide variation in the organizational structure and processes of clinical education, and in expected student outcomes may not be advantageous or appropriate. Costs to all stakeholders are a concern and may be unsustainable. Although the problem is complex, to successfully manage clinical education, improve outcomes, and reduce costs, some degree of profession-wide consensus must be reached about best practices related to structure, processes, and outcomes. Discussion and Conclusion. Although published literature is insufficient to support any one structure or process in any aspect of clinical education, scholarly practitioners in any profession must weigh the best available evidence in making necessary decisions. The physical therapy profession must decide if there is a compelling reason to make changes using the existing sparse and flawed evidence, and, if so, what those changes should be. Given the complexity of the problem, a national dialogue should open regarding viable standardized structures, processes, and outcomes measurement, with an eye toward improved quality.