Academic and Clinical Dissonance in Physical Therapist Education: How Do Students Cope?

Introduction and Review of Literature. A recent study of the informal and hidden curriculum in physical therapist education found that students experience areas of dissonance between what they learn in the classroom and what they experience in clinical practice. In other health professions, research suggests that curricular dissonance can lead to indifference or a negative view of a particular value, undermine explicit curriculum content areas, or create the expectation that students will be the kind of practitioners that their teachers are not. It may also lead to negative emotional reactions, such as stress, frustration, and cynicism. Students may respond to dissonance with direct or indirect action; however, some literature suggests that few students take action in the face of potential negative consequences. The purpose of this research study was to explore how physical therapist students experience and cope with dissonance between the didactic curriculum and clinical practice. Subjects. A total of 528 third-year physical therapist education students from 13 educational programs were invited to participate in the study, and 122 responses were received, for a response rate of 23.1%. Methods. Qualitative data were gathered via an online survey asking students to share personal incident narratives describing their experiences of didactic curriculum and clinical practice dissonance. Data were coded by use of an inductive approach, with no predefined coding criteria or hypotheses, to generate categories from the raw narrative data. Results. Two primary categories of academic-clinical dissonance emerged from the student narratives. A small percentage of students described academic-clinical dissonance experiences related to professionalism and, in particular, to the core value of integrity. The remainder of the experiences were associated with patient/client management in the context of the current health care environment. Dissonance in the category of patient/client management included 3 subcategories: physical therapy examination, intervention, and documentation. Emotions evoked from the dissonance experience were primarily negative and, in nearly all cases, students took no or little action in response to curricular dissonance and deferred to the clinician's or clinic's standard of practice. Discussion and Conclusion. These results suggest that there are opportunities for academic faculty to better educate students for the realities of clinical practice, particularly in the areas of examination and documentation. Also needed are improvements in students’ preparation to take substantive action when indicated and the creation of academic and clinical cultures that support appropriate challenges to existing structures and practices. A greater understanding of how physical therapist students experience and cope with cognitive dissonance caused by competing curricular factors has the potential to provide the basis for targeted educational approaches, reduced student emotional stress and, in some cases, improved health care.