Physical Therapist Student Experiences With Ethical and Legal Violations During Clinical Rotations: Reporting and Barriers to Reporting

Background and Purpose. The specific aims of this research were to: (1) gather insight on students' ability to identify, address, and report ethical and legal violations encountered in the clinic; (2) gain insight into barriers that prevent students from reporting these violations; and (3) collect student suggestions for the curriculum and clinical supervision that might assist them in identifying and reporting ethical and legal violations. Subjects and Methods. A survey was developed, based on an extensive review of the literature, to assess 6 potential areas for ethical and legal violations: resource utilization, supervision, sexual harassment, truth telling, respect, and blatant wrongdoing. After survey administration, students were invited to participate in a voluntary group discussion in which they gave feedback on the survey and their answers. Sixty-nine surveys were completed. Results. The survey response rate was 98.5% (69/70). The length of participant clinical experience ranged from 16 to 24 weeks. Seventy-one percent of the participants were female. In all areas investigated, students reported violations, often reporting appropriately but also at times failing to respond. The reason chosen for failure to respond from most often to least often was: (1) “low position of hierarchy,” (2) “fear of not being a team player,” (3) “did not recognize as an issue,” and (4) “personal consequences.” Discussion and Conclusion. In many cases students did recognize legal and ethical wrongdoing in the clinical environment and responded appropriately. Among those who recognized the problems but did not report, the most common barrier was “low position of hierarchy.” The second most common barrier reported was “did not recognize as an issue.” Results from the discussion groups indicated that the survey reflected topics covered in didactic coursework; however, students felt they would have benefited from having courses covering these violations earlier in their curriculum and incorporating ethical and legal issues into the more clinically based didactic coursework. Although all the students had been exposed to the legal and ethical issues covered in the survey, there was a marked inability to set aside self-interest and responsibly report violations in the clinic. In response to claims that they were unaware of legal requirements for practice, we offer the suggestion of a mandatory competency test on the state practice act prior to clinical affiliations. For other barriers, we recommend optimal course construction and placement to foster moral reasoning and courage, policy changes to recognize clinical time prior to reporting if replacement is required and education policies modeled after state licensure laws that punish observers of wrongdoing who fail to respond or report.