IMPLEMENTING AN ALTERNATIVE MODEL OF CLINICAL INSTRUCTION IN ORTHOPEDICS FOR ENTRY-LEVEL PHYSICAL THERAPY STUDENTS. David Levine*1; Cassy Englert2; Debbie Ingram1; Larry Tillman1 1. Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN; 2. BenchMark Physical Therapy, Chattanooga, TN UNIQUE: The typical physical therapy educational model in orthopaedics consists of academic coursework followed by a clinical experience. The academic coursework is taught by a university faculty member, while the clinical experience is supervised by a clinical instructor (CI) employed by the clinic site. The CI is responsible for the instruction and evaluation of the clinical proficiencies. This educational model leaves the potential for major discrepancies between the knowledge base the student has acquired in class and the CI's level of academic and clinical preparation. Using this typical physical therapy model, academic faculty members rarely have the opportunity to directly observe and assess the students' level of competence outside the academic classroom. As the physical therapy profession advances and requires enhanced clinical decision making skills we must explore alternative models for clinical education. An example is to explore the traditional medical model with academic faculty directly supervising groups of students in the clinical environment. PURPOSE: The purpose of this project was to develop and implement a clinical experience in orthopedics supervised by academic faculty. FOUNDATION: Academics has relied on the CI to provide most if not all of the clinical instruction provided during clinical education experiences. Rarely do academic faculty members work directly with students in the clinic, unlike in many other medical fields such as medicine, dentistry, and nursing. DESCRIPTION: An elective course in orthopedics was taught to ten students in their final didactic semester of an entry-level DPT program. All students had previously completed the required orthopaedic coursework and a seven week clinical experience in outpatient orthopaedics. The students were directly supervised at a single outpatient orthopedic setting by the academic faculty member who teaches orthopaedics. A CI employed by the site was also involved in the supervision. Both individuals were board certified in orthopaedics by the American Board of Physical Therapy Specialties. The CI was an APTA credentialed clinical instructor and also had been a lab instructor at the university in the orthopedic courses. This elective course met one day per week, and students worked in teams of two and alternated being the lead therapist. Five patients were scheduled hourly and students were given relevant medical information two days prior to examining the patients to allow for review of previous coursework and investigation of the literature. All students and both instructors participated in a wrap up session at the conclusion of the day to discuss a number of factors including, but not limited to, challenges, clinical evidence for decision making, interventions chosen, outcomes, and prognosis. OBSERVATIONS: By using the same instructor to teach orthopaedics in both the classroom and clinical environment we were able to accomplish several important things: all elements of patient/client management taught in the classroom were directly observed and assessed with actual patients; student comprehension of academic material was assessed; professionalism and client/patient interaction were addressed; other professional roles (consultation, education, critical inquiry and administration) were implemented; and challenges in the clinical setting were discussed. Retention and transferability of the academic coursework was able to be assessed giving valuable feedback to the academic instructor. CONCLUSIONS: Educators may find value in direct involvement in the entire educational process related to the orthopaedic coursework and clinical assessment section of the curriculum. The first hand observation of the development of student clinical skills with clients/patients can give valuable insights as to the effectiveness of the instruction in the classroom. The financial and logistical limitations of this type of clinical education model present challenges that are certainly possible to overcome with adequate faculty loads. The student learning outcomes may be worth the effort required to deliver this new clinical education model. FUNDING SOURCE: None. KEYWORDS: Clinical Education, Orthopedics Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.