One of the important jobs of the CI is accurate assessment of student performance in the clinic. The APTA's Clinical Performance Instrument (CPI) is completed based on direct observation of the student's performance, but other activities such as documentation, student interview, simulated activities, and patient reports can influence the score. There is common uncertainty in some aspects of CPI scoring that are worthy of review.
When completing the CPI, it is helpful to have the rating scale anchor definitions nearby. Recall that there are six rating scale anchors as identified below.
|Beginning Performance||Advanced Beginner Performance|
|Intermediate Performance||Advanced Intermediate Performance|
|Entry-level Performance||Beyond Entry-level Performance|
Two very important aspect of scoring include the student's ability to carry the caseload expected of an entry-level PT and the student's need for supervision. When considering the student's ability to handle the caseload, it is important to note that the CPI makes an important distinction between the Advanced Beginner Performance anchor and the Intermediate Performance anchor. For any anchor below the Intermediate Performance anchor, the definitions require that the student either does not carry a caseload or shares the caseload with the supervising clinical instructor. For any anchor at Intermediate Performance or above, the anchor definitions state "...the student is capable of maintaining" a caseload level. The importance in the "capability" is that the student has demonstrated the ability to carry out the responsibilities defined by the level regardless of the current clinic's census (particularly when the census might be low while the student is at the site) or regulatory rules surrounding supervision of patient care (considering in particular Medicare guidelines of supervision). Keep in mind that demonstration is key. It cannot be assumed that they could, there has to be some means by which the student has demonstrated the required competency. Further, the complexity of the patient is also taken into consideration. Each rating anchor identifies the amount of clinical supervision the student requires to perform at the anchor level. The amount of supervision is determined by a percentage of time and considers whether the conditions being treated are simple or complex. For example, if a student is independent with management of patients with simple conditions, but requires guidance and supervision with complex patients less that 25% of the time, the student would be performing at the Advanced Intermediate level.
Performance dimensions should be considered when rating a student's performance for each of the items on the CPI and include supervision/guidance, quality, complexity, consistency, and efficiency. It is expected that a student will improve in all these areas as they progress across their curriculum and in each successive clinical experience. Sample behaviors are also listed within each performance criterion, but note that a CI does not have to observe each of the sample behaviors to mark a student as entry-level. These behaviors are meant to be a guide, not an exhaustive list.
It should be noted that students in their early clinical rotations are not expected to achieve entry-level on any indicator. The students still have significant portions of the academic coursework left to complete. This includes the Red Flag items on the CPI including safety, cultural competency, professionalism, accountability, and communication. Consider that even with cultural competence in one clinical experience, they have not fully experienced the breadth of cultural experiences that might be offered across multiple settings. For safety, an early student will not have had coursework pertaining to safety issues encountered with populations they have yet to be introduced to. For CMU DPT students, in cases where students have a significant portion of their academic coursework left to complete, the expectation would be a minimum level of achievement of advanced beginner or a maximum level of achievement of intermediate performance. For students in their final rotations, achievement of entry-level is expected for all indicators across the final two rotations. Finally, regardless of student level, it is expected that a student is making progress from midterm to final in order to pass the clinical. It is not recommended to mark a student lower at midterm to "allow room for improvement." If the assessment is accurate and the student is learning and growing, an accurate midterm will allow room for growth. Comments are very useful for supporting the actual rating anchor tic-mark selected. Each of our clinical experiences have learning objectives and outcome expectations - these include expectations for passing performance on the CPI and are included in the CI Packets that we send prior to each clinical experience to the SCCE to transfer to the supervising Clinical Instructor.
Finally, #8 Patient Management - Screening is often marked as not having been observed. This competency was intended to be broader than fall screens, scoliosis screens, etc. It was intended to include medical screening, screening conducted for differential diagnosis, and screening of surrounding tissues (for example, for a person with right hip pain, one might screen the LE or the spine). Every student should have an opportunity to screen every patient - even if it is for red flags.
Please contact the Regional Clinical Coordinator in your area to answer any questions you may have about the CPI. Student assessment can be challenging, but we are here to help. We appreciate your dedication to clinical education and student growth!