Recommendations From the Common Terminology Panel of the American Council of Academic Physical Therapy

Abstract

Background

In 2015, the American Council for Academic Physical Therapy (ACAPT) developed 3 strategic initiative panels to address integrated clinical education, student readiness, and common terminology for physical therapist clinical education.

Objective

The purpose of this paper is to describe the results of the work from the Common Terminology Panel.

Design

This was a descriptive, consensus-based study.

Methods

Using a consensus process and data that were collected from a review of literature, a document analysis of core and historical professional documents, focus group discussions, and an online open comment period, panel members developed a glossary for physical therapist clinical education.

Results

The final glossary included 34 terms in 4 categories. The categories included clinical education infrastructure, sites, stakeholders, and assessment. The ACAPT Board of Directors approved the glossary in June 2017, and the ACAPT membership approved the glossary in October 2017.

Limitations

The focus of the glossary was on physical therapist clinical education. A future, similar project should be undertaken for physical therapist assistant clinical education.

Conclusion

This process resulted in a comprehensive glossary for physical therapist clinical education; changes to several current terms, including “internship” and “full-time clinical education experience”; and the addition of new terms, including “preceptor” and “site coordinator for clinical education.” New terminology will provide standard language for consistent communication and a common framework for all stakeholders.

Physical therapist education has, since its inception, consisted of both didactic and clinical instruction. Although there were some early models where these 2 phases were fully integrated in clinical settings, for the most part, didactic education has been academic institution based and the clinical portion has been clinical institution based. This arrangement allows each type of institution to make the contribution to physical therapist education for which it is best suited, but it results in a complex system that requires a great deal of communication, negotiation, and collaboration. Over the past 60 years, there have been many efforts to study this aspect of physical therapist education. There have been large-scale studies,^1–3 and many examples of smaller-scale work. A search on the term “clinical education” in PTJ produces more than 1700 results, and it is the second most common topic for articles in the Journal of Physical Therapy Education.⁴ In addition, clinical education has been the subject of much work at the American Physical Therapy Association (APTA), where there has long been staff dedicated to the issue of clinical education. The work of APTA staff, along with countless volunteers, has produced several documents that provide guidance for clinical education, including several forms that are designed to reduce variability in clinical education, such as the Physical Therapist Clinical Performance Instrument (CPI), which is widely used across the country.⁵

More recently, 3 major groups were tasked with examining the current status of clinical education. In October 2014, the American Council of Academic Physical Therapy (ACAPT), in collaboration with APTA and the Education Section of APTA, hosted a Clinical Education Summit, which was supported by 7 invited papers published in advance of the summit and used to enlighten the conversation.^6–12 The report from the summit contained 15 recommendations that were later prioritized by the ACAPT Board of Directors and integrated into that organization's strategic plan.¹³ Based on the prioritization, ACAPT developed 3 strategic initiative panels to address the following topics: integrated clinical education, assessment of student readiness, and common terminology for physical therapist clinical education. This paper presents the work and results of the Common Terminology Panel.

Methods

Analysis of Core Professional and Historical Documents and a Systematic Review

The work of the Common Terminology Panel was initiated in February 2016. Panel members reviewed relevant sources to identify terms and their definitions related to any aspect of physical therapist clinical education. Relevant sources included APTA, ACAPT, Federation of State Boards of Physical Therapy (FSBPT), Commission on Accreditation in Physical Therapy Education (CAPTE), Clinical Education Special Interest Group of the APTA Education Section, regional and national clinical education consortia, and residency and fellowship documents; clinical education evaluation tools; A Normative Model of Physical Therapist Professional Education¹⁴; and materials from the Clinical Education Summit. Historical documents also were retrieved from APTA archives. A systematic review of the clinical education literature was performed.

The systematic review included a MeSH and keyword search in PubMed and CINAHL (1960 to present) using the terms “physical therapy” AND “clinical education,” internship, “clinical instruct,*” preceptor, residency, fellowship, and terminology. Additional articles not identified in the literature search were retrieved from Clinical Education: An Anthology (vols. 1 and 2).^15,16 Relevant definitions from all data sources were extracted and placed into a master spreadsheet with the reference information.

Focus Group Discussions and Open Comment Period

The 10 panel members divided into 5 subgroups (1 subgroup for each of the aforementioned constructs) and initiated the first round of consensus building to arrive at a definition for each term. In addition, data extracted from the literature of other professions and from international publications were added as needed when there were conflicts or when an adequate definition did not exist. In this initial round, the number of terms was reduced to eliminate duplication and redundancy and to aim the group's focus on terms that describe relevant components of physical therapist clinical education. Remaining terms included: (1) those that were relevant to physical therapist clinical education and that had existing consensus, (2) those without a prior, relevant definition, and (3) those with multiple or inconsistent existing definitions. Terms were included to advance the work of the other, ongoing ACAPT clinical education panels (Integrated Clinical Education and Student Readiness). Special emphasis was given to areas that described curricular sequence and placement, length, number of hours, and supervision because these are areas of variability across physical therapist education programs. A draft definition for remaining terms was presented by each subgroup to the entire panel for additional discussion and further consensus building.

The definitions of terms that did not achieve consensus by the panel in this initial round were presented to the audience in a presentation at the Education Leadership Conference (ELC) in October 2016. Terms and definitions were discussed in small groups, and feedback from the small groups was provided to the panel. All terms and definitions were made available, and additional feedback was sought from the physical therapy community in a 3-week open comment period (SurveyMonkey, San Mateo, California) in October 2016. Also in Fall 2016, student focus groups were held at the National Student Conclave in Miami, Florida; and virtual focus groups were held to seek input on all terms and definitions from physical therapist students who were unable to meet at the conclave. Members of the Common Terminology Panel reached out to other stakeholder groups, collaborating and sharing the work being done across groups (eg, Clinical Education Special Interest Group, National Consortium of Clinical Educators). There was ongoing and extensive collaboration with the Integrated Clinical Education and Student Readiness panels. Focus group participants were also asked for feedback on terms needing to be defined to ensure that the Common Terminology Panel was addressing stakeholder needs.

The panel reviewed feedback from the small groups at ELC, the open comment period, and student focus groups. Subgroups integrated feedback on definitions of terms as appropriate in a second round of consensus building. These edits were further reviewed by the entire panel between January and March 2017 when consensus on all definitions of terms was achieved.

Review and Approval by ACAPT

A glossary was presented to the ACAPT Board of Directors in June 2017. Subsequently, the glossary and a webinar describing the methods and highlights from the glossary were made available to the ACAPT membership. A discussion forum was also created to allow individuals to comment or ask questions about the glossary. This forum was monitored by the panel chairperson in the months prior to ELC. The glossary was next presented for member comment at an ACAPT open forum during the October 2017 ELC. Questions and suggestions for edits were taken from the audience. A final draft of the glossary was presented to the membership the next day at the ACAPT business meeting.

An additional recommendation was made related to ACAPT Motion AC-2–13 that was adopted in 2013 regarding use of the following terms: “integrated clinical experience,” “full-time clinical experience,” and “clinical internship.”¹⁷ The panel recommended that definitions previously adopted for these terms be rescinded.

Role of the Funding Source

ACAPT provided funding for this study. ACAPT did not have any role in the design or in the consensus process used in developing the clinical education glossary. The glossary was put forth to the ACAPT Board and membership for final approval after it was completed. Minor editorial changes were made based on feedback from the ACAPT membership.

Results

There were 452 articles in the initial screening (244 from PubMed, 184 from CINAHL, 23 from the clinical education anthologies, and 1 from the APTA historical archives). Following the article screening, excluding duplicates and content that did not contain definitions, there were 42 remaining articles from which definitions were extracted. There were 125 participants in the roundtable discussions at ELC 2016, and there were 154 respondents to the open comment period (62% academicians and 38% clinicians). Seventeen physical therapist students participated in the student focus groups.

On completion of the document analysis and systematic review, the master spreadsheet included 260 terms with 6 definitions for clinical education, 12 definitions for academic coordinator of clinical education, and 15 definitions for clinical instructor. The 260 terms were categorized into 1 of 5 clinical education constructs reported in the literature.^18,19 The 5 constructs were “infrastructure,” “site,” “stakeholder,” “assessment,” and “other.”

Following the focus groups, the 5 initial categories used to categorize terms were reduced to 4 (infrastructure, site, stakeholder, and assessment) because there were no terms remaining in the “other” category. Terms and definitions were placed into a clinical education glossary sorted by category. The glossary contained 19 terms related to clinical education infrastructure, 2 related to clinical education sites, 9 related to stakeholders, and 4 related to clinical education assessment (Table).

Table.

Physical Therapist Clinical Education Glossary^a

Term	Definition
Clinical Education Infrastructure
Clinical education	A formal supervised experiential learning, focused on development and application of patient/client-centered skills and professional behaviors. It is designed so that students gain substantial, relevant clinical experience and skills, engage in contemporary practice, and demonstrate competence before beginning independent practice.18,22,23
Clinical education agreement	A formal and legally binding agreement that is negotiated between academic institutions and clinical education sites or individual providers of clinical education that specifies each party's roles, responsibilities, and liabilities relating to student clinical education.24
Clinical education curriculum	The portion of the physical therapist professional education program that includes all part-time and full-time clinical education experiences as well as the supportive preparatory and administrative components.24
Clinical education experience	Experiences that allow students to apply and attain professional knowledge, skills, and behaviors within a variety of environments. Experiences include those of short and long duration (eg, part-time, full-time), provide a variety of learning opportunities, and include physical therapy services for patients/clients across the lifespan and practice settings. Although the emphasis is on the development of patient/client physical therapy skills, experiences also may include interprofessional experiences and non–patient/client service delivery, such as research, teaching, supervision, and administration. Clinical education experiences are a part of the professional curriculum and include formal student assessment17,18,21,25
Collaborative clinical education model	A clinical education experience in which 2 (or more) physical therapist students are assigned to 1 (or more) preceptor/clinical instructor(s). The students work cooperatively under the preceptor/clinical instructor(s). Examples include 2:1, 2:2, or 3:1 student to preceptor/clinical instructor ratio. Students may be from the same or different programs and may be at the same or different levels of training.26–29
Didactic curriculum	The component of the physical therapist professional education program that is comprised of the content, instruction, learning experiences, and assessment directed by the academic faculty.18,21
Fellowship	A postprofessional planned learning experience in a focused advanced area of practice. Similar to the medical model, a fellowship is a structured educational experience (both didactic and clinical) for physical therapists that combines opportunities for ongoing mentoring with a theoretical basis for advanced practice and scientific inquiry in a defined area of subspecialization beyond that of a defined specialty area of practice. A fellowship candidate either has completed a residency program in a related specialty area or is a board-certified specialist in the related area of specialty. Fellowship training is not appropriate for new physical therapist education program graduates30 (http://www.abptrfe.org/uploadedFiles/ABPTRFEorg/For_Programs/Apply/ABPTRFE_CredentialingHandbook.pdf). [Note: This definition will be updated to remain consistent with future revisions to the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) Accreditation Handbook.]
Full-time clinical education experience	A clinical education experience in which a student is engaged for a minimum of 35 hours per week. Full-time clinical education experiences designated to achieve the minimum number of weeks set forth by CAPTE are directed by a physical therapist clinical instructor.17,21,25 An integrated clinical education experience may be a full-time clinical education experience.
First full-time clinical education experience	The first clinical education experience designated to achieve the minimum number of weeks set forth by CAPTE in which a student engages for a minimum of 35 hours per week.
Intermediate full-time clinical education experience	A clinical education experience designated to achieve the minimum number of weeks set forth by CAPTE in which a student engages for a minimum of 35 hours per week and returns to the academic program for further completion of the didactic curriculum.
Terminal full-time clinical education experience	A single, or set of, full-time clinical education experience(s) designated to achieve the minimum number of weeks set forth by CAPTE that occurs after the student has completed the didactic curriculum of a physical therapist professional education program. Students may return to the academic program for didactic instruction that does not require additional clinical education experiences. The expected outcome of the final, or terminal, experience is entry-level performance.
Integrated clinical education (ICE)	ICE is a curriculum design model whereby clinical education experiences are purposefully organized within a curriculum. In physical therapist education, these experiences are obtained through the exploration of authentic physical therapist roles, responsibilities, and values that occur prior to the terminal full-time clinical education experiences. Integrated experiences are coordinated by the academic program and are driven by learning objectives that are aligned with didactic content delivery across the curricular continuum. These experiences allow students to attain professional behaviors, knowledge, and/or skills within a variety of environments. The supervised experiences also allow for exposure and acquisition across all domains of learning and include student performance assessment. For integrated clinical education experiences to qualify toward the minimum number of full-time clinical education weeks required by accreditation (CAPTE) standards, they must be full time and supervised by a physical therapist within a physical therapy workplace environment or practice setting.
International clinical education experiences	A student education opportunity outside of the country in which the physical therapist education program is situated, for which the student obtains clinical education credit.31 [Note: The abbreviation ICE should not be used to describe an international clinical education experience.]
Internship	A terminal full-time clinical education experience that provides recompense to participants in accordance with federal labor laws under the Fair Labor Standards Act.20
Learning experience	Any experience that allows or facilitates a change in attitude or behavior. A planned learning experience includes a learner, an objective for the learner, a situation devised to produce a response that contributes to the objective, a response by the student, and reinforcement to encourage the desired response.18
Part-time clinical education experience	A clinical education experience in which a student engages in clinical education for less than 35 hours per week. Part-time experiences vary in length. A part-time clinical education experience may be considered an integrated clinical education experience depending on the design of the experience and the learning objectives.
Physical therapist professional education program	Education comprised of didactic and clinical education designed to assure that students acquire the professional knowledge, skills, and behaviors required for entry-level physical therapist practice.18,32
Physical therapist postprofessional education program	Degree- and nondegree-based professional development for the physical therapist to enhance professional knowledge, skills, and abilities beyond entry level. Examples include, but are not limited to, continuing education courses, postprofessional doctoral education programs, certificate programs, residencies, and fellowships.33
Residency	A postprofessional planned learning experience in a focused area of practice. Similar to the medical model, a residency program is a structured educational experience (both didactic and clinical) for physical therapists following professional education and licensure that is designed to significantly advance the physical therapist's knowledge, skills, and attributes in a specific area of practice (eg, cardiovascular/pulmonary, faculty, orthopedics, sports, pediatrics). It combines opportunities for ongoing mentoring, with a theoretical basis for advanced practice and scientific inquiry based on a Description of Specialty Practice (see definition), Description of Residency Practice (see definition), or valid analysis of practice/comprehensive needs assessment for that specific area of practice. When board certification exists through the American Board of Physical Therapy Specialties (ABPTS) for that specialty, the residency training prepares the physical therapist to pass the certification examination following graduation. A residency candidate must be licensed as a physical therapist in the state where the program is located or where clinical training will occur prior to entry into the program. Neither “residency” nor “fellowship” is synonymous with “internship”30 (http://www.abptrfe.org/uploadedFiles/ABPTRFEorg/For_Programs/Apply/ABPTRFE_CredentialingHandbook.pdf). [Note: This definition will be updated to remain consistent with future revisions to the ABPTRFE Accreditation Handbook.]
Clinical Education Sites
Clinical education site	A health service delivery agency or other setting in which clinical education experiences are provided for physical therapist students. The clinical education site may be, but is not limited to, a hospital, agency, clinic, office, school, or home and is affiliated with the education program(s) through a contractual agreement.18,24
Clinical education environment	The physical space(s) and/or the structures, policies, procedures, and culture within the clinical education site.
Clinical Education Stakeholders
Academic faculty	Educators and scholars within the academic institution dedicated to preparing students with the skills and aptitudes needed to practice physical therapy.
Academic institution	University or college through which an academic degree is granted.24
Clinical education consortia	National and regional groups that include academic and clinical education faculty for the purpose of sharing resources, ideas, and efforts.27
Clinical education faculty	The individuals engaged in providing the clinical education components of the curriculum, generally referred to as either site coordinators of clinical education (SCCEs), preceptors, or clinical Instructors. Although the academic institution does not usually employ these individuals, they do agree to certain standards of behavior through contractual arrangements for their services.25
Clinical instructor (CI)	The physical therapist responsible for the physical therapist student and for directly instructing, guiding, supervising, and formally assessing the student during the clinical education experience. When engaged in full-time clinical education designated to meet the minimum number of weeks required by CAPTE, the clinical instructor must be a licensed physical therapist with a minimum of one year of full-time (or equivalent) post-licensure clinical experience.24
Director of clinical education (DCE)	Academic faculty member who is responsible for planning, directing, and evaluating the clinical education program for the academic institution, including facilitating clinical site and clinical faculty development.32,34
Physical therapist student	Student enrolled in a CAPTE-accredited or CAPTE-approved developing physical therapist professional education program. Students should not be referred to as “physical therapy students.”
Preceptor	An individual who provides short-term specialized instruction, guidance, and supervision for the physical therapist student during a clinical education experience. This individual may or may not be a physical therapist as permitted by law.
Site coordinator of clinical education (SCCE)	A professional who administers, manages, and coordinates clinical assignments and learning activities for students during their clinical education experience. In addition, this person determines the readiness of people to serve as preceptors and clinical instructors for students, supervises preceptors and clinical instructors in the delivery of clinical education experiences, communicates with the academic program regarding student performance, and provides essential information to academic programs.24,35
Clinical Education Assessment
Clinical performance assessment	Formal and informal processes designed to appraise physical therapist student performance during clinical education experiences. Assessment may be formative or summative in nature and performed for the purposes of providing feedback, improving learning, revising learning experiences, and determining successful attainment of student performance expectations during clinical education experiences.18,36,37
Clinical performance evaluation tool	A valid, reliable, and multidimensional clinical performance assessment tool utilized to determine if, and how well, a student meets established objectives during clinical education experiences.24,38–40
Entry-level physical therapist clinical performance	Performance that demonstrates knowledge, skills, and behaviors consistent with effective, efficient, and safe patient/client management to achieve optimal outcomes.38
Supervision	Guidance and direction provided to a physical therapist student by the preceptor or clinical instructor. This varies based on the complexity of the patient/client or environment, jurisdiction and payer rules and regulations, and abilities of the physical therapist student.27

^aThis glossary of terms was developed after a review of the physical therapy literature, extensive discussion and debate by the American Council for Academic Physical Therapy (ACAPT) Common Terminology Panel, and engagement of key stakeholders within the physical therapist clinical education community. The glossary is divided into major categories, and, as applicable, definitions are referenced. © American Council of Academic Physical Therapy (ACAPT) 2018. Used with permission.

The glossary was approved by the ACAPT Board of Directors at the June 2017 meeting and approved by the ACAPT membership in October 2017. The motion to rescind ACAPT Motion AC-2–13 was made and approved at ELC 2017. Current definitions for each of approved terms appear in the Physical Therapist Clinical Education Glossary (Table).

Discussion

The results of the consensus-building process resulted in changes in several terms and definitions that warrant further discussion.

Use of the Term “Internship”

Following the initial round of consensus building, the panel agreed that the term “internship” would be used to describe any clinical education experience that occurred following the didactic curriculum. However, feedback from the ELC discussions and the open comment period indicated that some states do not allow use of the term “internship” to describe clinical education experiences that typically occur in a physical therapist education program.

Additional research on the use of the term “internship” was conducted by the panel members. According to the US Department of Labor, Wage and Hour Division, under the Fair Labor Standards Act (FLSA), there are criteria that must be met to determine if an intern must be paid the minimum wage and overtime when providing services in the “for-profit” private sector.²⁰ The following 6 criteria must be applied when making the determination:

The internship, even though it includes actual operation of the facilities of the employer, is similar to training that would be given in an education environment.

The internship experience is for the benefit of the intern.

The intern does not displace regular employees, but works under close supervision of existing staff.

The employer that provides the training derives no immediate advantage from the activities of the intern, and, on occasion, its operations may actually be impeded.

The intern is not necessarily entitled to a job at the conclusion of the internship.

The employer and the intern understand that the intern is not entitled to wages for the time spent in the internship.

If all of the criteria are met, an employment relationship does not exist under the FLSA, and the act's minimum wage and overtime provisions do not apply to the intern.²⁰

Based on review of the criteria and agreement within the panel that (a) students do provide positive contributions to the clinical site, and (b) the employer does receive an advantage from the physical therapist student, the possibility exists that an employment relationship could be construed. In addition, data from the small-group discussions and open comment period indicated that some state laws preclude use of the terms “intern” and “internship.” Therefore, the Common Terminology Panel is recommending that (a) “internship” should not be used to describe physical therapist clinical education experiences in which students are either unpaid or paid less than the federal minimum wage, and (b) “internship” could be used to describe a clinical education experience in which participants are being paid in accordance with federal labor laws under the FLSA.

Preceptor

The panel identified the need for a term that describes someone other than a physical therapist who might supervise a student during a clinical education experience. The term “clinical instructor” historically has been used as a label for a licensed physical therapist supervising a student. Additionally, CAPTE standards identify that a “clinical instructor” is required to be the primary supervisor for a physical therapist student for any experiences that are intended to meet CAPTE requirements for full-time clinical education.²¹ However, although some learning experiences in clinical education may not be specific to physical therapist skills and behaviors, they enhance the students’ overall professional development and broaden the scope of understanding of the health care environment. These experiences may be supervised by professionals other than physical therapists. After researching a variety of terms and discussing different options, the panel agreed to include the term “preceptor” to describe an individual who provides short-term specialized instruction, guidance, or supervision for a physical therapist student during a clinical education experience. As a profession, we will need to be aware of the different uses of the term “preceptor” in other health care disciplines and reiterate the use of this term in physical therapist education to minimize confusion.

Full-Time Clinical Education Experiences

Standards set forth by CAPTE²¹ require physical therapist professional education programs to have a minimum of 30 weeks of full-time clinical education experiences. The standards further define “full time” as a minimum of 35 hours per week. The panel determined that it is critical to remain consistent with the hour requirement provided in accreditation language, but also agreed there should be terminology to facilitate communication with clinicians on the timing of an experience within the clinical education curricular sequence. Therefore, the panel agreed the terms “first,” “intermediate,” and “terminal” should be used to describe the timing of the experience within a clinical education sequence. For example, “first full-time clinical education experience” should be used to describe the student's initial experience over 35 hours per week, regardless of the placement within the didactic curriculum. Any full-time experience that occurs at the end of all the didactic curriculum should be referred to as a “terminal clinical education experience.” This term may be utilized even when a program has more than 1 clinical education experience after the didactic curriculum has been completed (eg, Terminal Clinical Education Experience I and Terminal Clinical Education Experience II). Full-time clinical experiences that occur between the first full-time experience and the end of the didactic curriculum should be called intermediate full-time clinical education experiences. “Intermediate full-time clinical experience” should not be used interchangeably with “integrated clinical education experiences (ICE).” An intermediate full-time experience could be considered an ICE such that the requirements for ICE are being met.

Site Coordinator of Clinical Education (SCCE)

Historically, “center coordinator of clinical education” has been used to describe the individual on the clinical side who manages the clinical education program and serves as the liaison between the academic institution and the clinic.¹⁸ However, because of the changing landscape where physical therapists deliver services, the panel agreed that “site” should be used rather than “center.” There was consensus that “center” excluded clinical entities that were not housed in a traditional building or medical campus, and “site” is more inclusive of a broad range of settings or locations where physical therapy services may be delivered. “Site coordinator” was a natural progression that evolved from this decision.

Implementation of Approved Terms

A target implementation date for all approved clinical education terms has not been established. The desired outcome is that all education program documents related to physical therapist clinical education will be updated using the terms in the Physical Therapist Clinical Education Glossary. To meet that goal, synchronous information dissemination of the terminology changes is greatly needed. The panel also has provided recommendations regarding the implementation of the new clinical education terminology ( Appendix). Beginning at the academic institution level, the physical therapist professional education programs should adopt the recommendations and implement the revised terms in the student handbooks, catalogs, course nomenclature, syllabi, procedure manuals, and websites. In addition, it will be necessary for the directors of clinical education at each of the physical therapist education programs to disseminate the changes to their clinical communities, including the clinical sites, site coordinators of clinical education, clinical instructors, and administrators. As the voice for the clinical education community within ACAPT, the National Consortium of Clinical Educators and its regional consortia will play a vital role in disseminating the glossary to the academic institutions and clinic sites.

The Common Terminology Panel also recommend that ACAPT leadership notify FSBPT and CAPTE of the terminology changes in order to update all documents to facilitate consistency. In addition, the same procedure should occur with APTA leadership, with the request to make the changes to clinical education terms on the APTA.org website and in all clinical education documents. This will serve to enhance consistency in clinical education structure and communication. APTA section and academy leaders, consortia, and members also need to be notified to make the clinical education terminology changes in policies and procedures at the section, academy, and consortia levels. To assist with this communication, presentations to communicate changes should be made at APTA conferences.

Strengths of this project include the collaboration among various groups, the consensus-building process, and the use of existing literature. Although the focus of this project, as charged by the ACAPT Board of Directors, was on physical therapist education programs, there are terms that could apply to physical therapist assistant education. Due to the unique aspects of physical therapist assistant didactic and clinical education, investigation of terminology specific to physical therapist assistant education is warranted and could be addressed in a future study. Terms originally on the master list may have been eliminated in error. In addition, consensus on the definitions relied on the activity of this group of researchers and could be a source of bias. To overcome these limitations, time was allotted to triangulation using multiple data sources.

Conclusion

The adoption of the new terms and definitions will improve clarity and consistency in clinical education communication. The use of the standard language will provide a common framework to be used consistently by all parties. However, the time frames for implementation will vary, as comprehensive changes cannot be made immediately. The various stakeholders have different policies and procedures that will govern the processes, and obstacles to implementation may exist in individual facilities and institutions.

Consistent communication between academic and clinical education partners is essential to effective and efficient clinical education practice. The 2014 ACAPT Clinical Education Summit recommended that academic and clinical faculty develop, disseminate, use, and periodically review standard terminology and definitions for physical therapist education. The ACAPT Common Terminology Panel was formed following the summit and was charged with developing standard clinical education terminology. The panel identified and defined 33 terms in 4 categories (clinical education infrastructure, clinical education sites, clinical education stakeholders, and clinical education assessment). A glossary of these terms was adopted by the academic programs at the 2017 ACAPT business meeting at ELC. The panel recommends that these terms be disseminated to all clinical education stakeholders to ensure consistent implementation and use. Terms should also be reviewed regularly to reflect the dynamic nature of physical therapist clinical education.

Author Contributions

Concept/idea/research design: M. Erickson, M. Birkmeier, L.M. Hack, D.A. Ingram, J.M. Jackson-Coty, V.L. LaFay, E. Wheeler

Writing: M. Erickson, M. Birkmeier, M. Booth, L.M. Hack, J. Hartmann, J.M. Jackson-Coty, V.L. LaFay, E. Wheeler, S. Soper

Data collection: M. Erickson, M. Birkmeier, M. Booth, L.M. Hack, J. Hartmann, V.L. LaFay, S. Soper

Data analysis: M. Erickson, M. Birkmeier, L.M. Hack

Project management: M. Erickson, S. Soper

Providing facilities/equipment: M. Erickson

Clerical/secretarial support: M. Erickson

Consultation (including review of manuscript before submitting): M. Erickson, M. Birkmeier, M. Booth, L.M. Hack, J.M. Jackson-Coty

Funding

The American Council of Academic Physical Therapy (ACAPT) provided funding for this study.

Disclosures

The authors completed the ICJME Form for Disclosure of Potential Conflicts of Interest. M. Erickson, L. Hack, and S. Soper report funding from ACAPT. S. Soper reports receiving an honorarium for coordinating the work of the 3 panels.

Appendix. Types of Documents and Suggested Methods for Change^a

A. Type of Document/Site	B. Method for Change
APTA House of Delegates (HOD) positions, standards, guidelines, policies, procedures	Propose revision to the HOD documents by a delegation (eg, chapter, section, BOD) to the House.
APTA Board of Directors (BOD) positions, standards, guidelines, policies, procedures	Request that BOD consider revision.
APTA Documents/Sites
Clinical Performance Instrument, Clinical Site Information Form (CSIF), center coordinator of clinical education (CCCE) manual	Request that BOD consider revision.
APTA Credentialed Clinical Instructor Program (CCIP)	Request that BOD consider revision.
APTA website	Request that BOD consider revision.
	Revisions would also need to be consistent with HOD policies.
Education Section website	Request that section consider revision.
Clinical Educators Special Interest Group (CESIG) Form: Request for Clinical Sites	Request that CESIG consider revision.
American Council on Academic Physical Therapy (ACAPT)
Website	ACAPT should make changes when new definitions adopted.
ACAPT policy on clinical education	ACAPT should make changes when new definitions adopted.
National Consortium of Clinical Educators (NCCE)	ACAPT should make changes when new definitions adopted.
Commission on Accreditation of Physical Therapy Education (CAPTE) standards	Petition CAPTE as a major stakeholder for changes in standards.
Federation of State Boards of Physical Therapy (FSBPT) Model Practice Act and individual state practice acts	Work through FSBPT and individual state boards, in collaboration with APTA.
Journal style manuals	PTJ should change with HOD policy and encourage that section journals do so through information packet provided to journal editors and their supporting sections.
Chapters
Materials for members	Request change through information packet.
State practice acts	Request change through information packet; interact with FSBPT as well as individual boards.
Sections/Academies
Materials for members	Request change through information packet.
Information to the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) and the American Board of Physical Therapy Specialties (ABPTS)	Request that the BOD direct any necessary changes.
Physical therapist assistant (PTA) community	Work through the Education Section PTA Special Interest Group

^aSection A lists the materials and documents that have language related to clinical education that would need to be changed to be consistent with the terminology recommended in this report. Section B provides the mechanism to achieve change.