PT and PTA Clinical Performance Instruments: Validation Study | ©2023 American Physical Therapy Association 4
• Making comparisons about the relative effectiveness of education programs.
• Using the CPI as the single deciding factor for whether a student should be recommended for
removal from the PT/PTA program.
Revisiting Alignment with Essential Elements of Clinical Practice
During the third phase, HumRRO addressed the first high-priority recommendation identified by
Sinclair (2020): Revisit Alignment with Essential Elements of Clinical Practice (Crawford, et al.,
2022a). When the PT CPI was developed in 1997, the APTA Board of Directors recommended that
CPIs be reviewed every three years to maintain alignment with current APTA documentation and
terminology (Roach et al., 2012, p.417). HumRRO found no documentation of such reviews. Thus,
HumRRO compiled the most recent professional documentation and guidelines on PT and PTA
practice and then re-examined the alignment of the CPIs’ content to the most recent practice
standards. We also identified any important changes to the profession since the CPIs were last
revised over 15 years ago. This was an important step in supporting the validity of the CPIs, as
accurate interpretation of indicators of performance on a set of standards relies heavily on the
alignment of the assessment to the standards (AERA, APA, & NCME, 2014).
With support from APTA, HumRRO compiled the most recent professional documentation and
guidelines against which the content on the existing CPIs was evaluated, including (a) Commission on
Accreditation in Physical Therapy Education’s (CAPTE’s) Standards and Required Elements for
Accreditation of Physical Therapist/Physical Therapist Assistant Education Programs (CAPTE, 2020a,
2020b), (b) APTA’s Core Competencies of a Physical Therapist Resident (2020), (c) APTA’s Core
Values for the Physical Therapist and Physical Therapist Assistant (2021), and (d) the findings from a
recent practice analysis conducted by HumRRO and the Federation of State Boards of Physical
Therapy (FSBPT; Harris et al., 2021) that included an evaluation of ongoing and emerging trends in
entry-level PT requirements and changes in the profession that necessitated adjustments to PT
licensure examinations. HumRRO developed separate PT and PTA workbooks that included
descriptions of the relevant practice standards for stakeholders to use as a reference in the subsequent
focus group workshops.
In March 2022, HumRRO facilitated a series of focus group workshops to gain an initial understanding
of the alignment of the current CPI content to current practice. Seventeen stakeholders participated,
including nine DCEs, four ACCEs, two SCCE/CIs, and two CIs. Stakeholders reflected and provided
feedback on a variety of topics, including (a) their experiences evaluating PT or PTA students in their
clinical experience, (b) the most important skills and behaviors that should be evaluated during a
student’s clinical experience, (c) performance criteria or essential skills that are not captured by the CPI
content, (d) performance criteria that could be considered outdated or redundant, (d)
language/terminology that could be considered more current or intuitive, and (e) examples of how the
CPI content could be reorganized. Then, HumRRO consolidated the feedback from the stakeholder
workshops to develop a “Content Re-examination Survey.”
The Content Re-examination Survey was administered to gather input from a larger, representative
sample of experts on the relevancy of the existing CPI content to current practice and updated
content recommendations that were provided during the focus group workshops. The survey link was
distributed by APTA via email to 58,814 CPI users and shared by APTA via the Clinical Education
Hub (approximately 344 subscribers), the National Consortium of Clinical Educators email newsletter
(425 members), and the Clinical Education Special Interest Group Discussion Forum (approximate
number of subscribers/users unknown). Responses were collected between April 19
th
- May 3
rd
, 2022,
and the final analytic sample consisted of 2,253 PT and/or PTA CPI users.