Eastern Washington University
Department of Physical Therapy
Community Colleges of Spokane
Physical Therapist Assistant Program
Present:
(15 Hours)
th
st
Course Location: Spokane,WA
COURSE DESCRIPTION:
This program is recognized by the American Physical Therapy Association (APTA) as a
Clinical Instructor (CI) Education and Credentialing Program. The program was developed through a grant funded by APTA. It takes 15 hours to complete the entire program for CI
Education and Credentialing.
The program addresses issues of planning and preparing for physical therapist students during their clinical education experiences; developing learning experiences and supporting ongoing learning through questioning and effective feedback.
Skills of evaluation are discussed, as well as the identification and management of students with exceptional situations. The program closes with a brief look at legal implications for the clinical educator, including issues presented by ADA legislation.
The “Assessment Center” provides each participant with the opportunity to apply information from the program in simulated situations. Successful completion of each station in the
Assessment Center results in the awarding of APTA CI Credentialing. The six stations of the Assessment Center have been integrated into the program schedule. Therefore, it is necessary for each participant to attend all sessions of the Course and Assessment Center in its entirety in order to be eligible for credentialing.
The Course and Assessment Center will be useful for both new and experienced physical therapist educators involved in clinical education. While the information presented covers the basic skills for clinical instructors, the interactive tasks and large and small group discussions will be of benefit even to experienced educators.
COURSE INSTRUCTOR:
Beverly Johnson, PT, DSc, GCS - Bev is the Director of Clinical Education and an Associate Professor at the University of
North Dakota. She has 25 plus years of clinical administrative and educational experience in a variety of settings. Bev has been a Credentialed Clinical Instructor Trainer through the APTA since 1997.
COURSE AGENDA:
7:30 AM - Registration
7:45 – 9:15 AM
Welcome and Introductions - Section I
The Clinician as Clinical Educator
9:15 – 9:30 AM - Break
9:30 – 12:00 PM
Section II - Readiness to Learn
12:00 – 1:00 PM – Lunch on your own
1:00PM – 3:00 PM
Section III - Facilitating Learning in the Clinical Environment
3:00 PM - 3:30 PM
Questions & Answers
Orientation to the Assessment Center
3:30 – 4:00 PM – Assessment Center Station 1
4:00 – 4:30 PM – Assessment Center Station 2
st
7:30 AM - Check in for Day 2
7:45 – 9:15 AM
Section IV - Performance Assessment:
The Clinical Environment
9:45 – 10:00 AM - Break
10:00 – 12:00 PM - Section V
Legal, Regulatory, & ADA Issues in Clinical Education
12:00 – 1:00 PM – Lunch on your own
1:00PM – 3:00 PM - Section VI
Managing the Exceptional Student and Student with
Problems in Clinical Education.
3:00 PM - 5:00 PM - Assessment Centers
Stations 3, 4, 5, & 6
5:00 PM - Scoring Assessment Centers
Stations 3, 4, 5, & 6

4:30 – 5:00 PM – Scoring Assessment Center Station 1 & 2
5:00 PM – Adjourn
5:30 PM - Adjourn
APTA Clinical Instructor Credentialing Course
At completion of the course, the participant will be able to:
 Compare the roles of the clinician and the Clinic
Instructor;
 Determine the student’s readiness to learn;
 Develop learning experiences;
 Describe methods to facilitate learning in the clinic;
 Discuss rationale and strategies for evaluation of the student;
 Identify and address legal issues regarding clinical education.
To Register: Print, complete and mail the following documents by February
5, 2009 .
Complete the attached Registration form.
You and your direct supervisor complete the attached participant Dossier .
Complete the attached Agreement of Participation .
Complete the attached Statement of Confidentiality .
Send a copy of your state practice license.
Send a copy of your current APTA Membership card (if registering as an
APTA member).
Send a check made out to APTA or use the attached credit card authorization form to pay fee if needed for your participation.
Send all registration information to: regarding course to:
Eastern Washington University
Department of Physical Therapy
Attn: MellissaThoreson
310 N. Riverpoint Blvd. Box T
Direct questions
Mellissa Thoreson
(509) 368-6602 mthoreson@mail.ewu.edu
Spokane, WA 99202-0002
Register soon as participation is limited to 30 participants .
Course confirmation, facility information, and parking passes will be emailed after
February 5 th , 2009 .

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REGISTRATION FORM: APTA Clinical Instructor Credentialing Course
Sign up for:
( ) PT with APTA membership, employed by a facility with a current EWU contract in place, EWU pays APTA fee.
No Charge
( ) PT with APTA membership $ 70.00
( ) PT without APTA membership, employed by a facility with a current EWU contract in place, EWU pays ½ of APTA fee
$ 70.00
( ) PT without APTA membership, and not employed by a facility with a current EWU contract in place . $ 140.00
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( ) PTA with APTA membership, serving as a Clinical Instructor to SFCC PTA students, scholarships available .
Contact Spokane Falls Community College Physical Therapist Assistant Program.
( ) PTA with APTA membership $ 70.00
( ) PTA without APTA membership $ 140.00
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( ) Other Discipline $ 180.00
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__________________________________________________________________________________
Participant Name
_________________________________________________________________________________
Address
__________________________________________________________________________________
City State Zip
__________________________________________________________________________________
Facility Name

(_____)____________________________________________________________________________
Phone Email address
APTA CLINICAL INSTRUCTOR EDUCATION AND CREDENTIALING PROGRAM PARTICIPANT DOSSIER
Each participant must complete this form and submit it with his/her registration form
PLEASE PRINT LEGIBLY [Please print your name the way you would like it to appear on your certificate(s)]
1.
Applicant Data
Name ___________________________________________________________ Date of Birth _______________________________
Current Address ___________________________________________________________________________________________________
City ___________________________________________________State ______________ Zip _______________________________
Phone _________________________ FAX ________________________ E-Mail ____________________________________________
Entry-Level Degree _______ Graduated from an accredited PT/PTA Program or other entry-level discipline MO/YR_____________
Years as a Clinician ________
Highest Earned Degree: ______ Associate
______ Master's
______ Baccalaureate/Certificate
Years Supervising Students___________________
______ Professional Doctorate (eg, DPT/AuD/PharmD)
______ Post-professional Master's
______ Post-professional Doctorate (eg, PhD/EdD/ScD)
Professional Designation (eg, PT/PTA/OT/SLP/RN) _________ APTA Membership # (PT/PTA Only)
(Attach a copy of your current membership card)
Do you require any special accommodation to complete this program?

Yes

No If yes, specify___________________________
2.
Employment History (List most recent first)
Employer City/State Job Description
Dates
From ________ To________
3.
S t t a t t e s s i i n W h i i c h L i i c e n s s e d / / R e g i i s s t t e r e d / / C e r t t i i f f i i e d ( ( I M P O R T A N T : : A t t t t a c h a c o p y o f f y o u r c u r r e n t t s s t t a t t e l l i i c e n s e .
.
) )
4.
To be Completed by Participant's Direct Supervisor (eg, Department Head/Senior Staff/CCCE/Program Director)
1. Applicant demonstrates clinical competence, professional skills, and ethical behavior in clinical practice and/or teaching.

Yes

No
2. Applicant has at least 1 year of clinical experience (if yes, please go to #4).

Yes

No
3. Applicant has less than 1 year of clinical experience but demonstrates the maturity, interest and professional behavior to
become a CI.
4. Applicant has demonstrated a willingness to work with students by pursuing learning experiences to develop knowledge
and skills in the clinical/academic setting.


Yes
Yes


No
No
5. Applicant demonstrates a systematic approach to patient/client care and/or job responsibilities.
6. Applicant uses critical thinking in the delivery of health services or managing job responsibilities.
7. Applicant provides rationale, including evidence, for decision making in patient/client care.
8. Applicant demonstrates appropriate time management skills.
9. Applicant represents the profession positively by assuming responsibility for professional self-development.
10. Applicant interacts effectively with patients, colleagues, and other health professionals to achieve identified goals.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

5 .
P a r t i i c i i p a n t ' ' s s s i g n a t t u r e i n d i c a t t e s a p p r o v a l l t o r e l l e a s e t t h i i s i n f o r m a t t i o n f o r p u r p o s e s s o f f t t h i i s s p a r t t i c i i p a n t d o s s s i i e r .
.
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P a r t t i i c i p a n t
’ s s S i i g n a t t u r r e
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N a m e o f f D i i r r e c t t S u p e r r v i i s s o r r ( ( P l l e a s s e P r r i i n t t ) )
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
S i g n a t u r r e o f f D i r r e c t S u p e r v i i s o r
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T i i t t l l e
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D a t e
APTA Clinical Instructor Education and Credentialing Program
AGREEMENT OF PARTICIPATION
The Clinical Instructor Education and Credentialing Program is being offered by Eastern
Washington University Physical Therapy program and Spokane Falls Community College Physical
Therapist Assistant program. Successful completion of the didactic component of the curriculum and the accompanying Assessment Center will result in credentialing by the APTA as a
Credentialed Clinical Instructor.
To be eligible for credentialing, the participant must:
1.
Submit a fully completed Participant Dossier, signed Agreement of Participation, and
Registration Fee by the course registration deadline.
2.
Attend each session of the program in its entirety and participate in all program activities.
3.
Successfully complete each portion of the Assessment Center.
NOTE:
If any part of any session is missed, the participant must repeat the entire program to be eligible for
CI Credentialing.
Only participants who have completed all program sessions will be permitted to sit for the
Assessment Center.
I have read and understand the above policies and agree to abide by the conditions as stated.
__________________________________________ _____________________
Participant Signature Date

Name: __________________________________
Please Print
Date: February 28 th & March 1 st , 2009
Location: Spokane, WA
Sponsor: Eastern Washington University
Spokane Falls Community College
APTA Clinical Instructor Credentialing
The Assessment Center was designed in order to provide a standard by which to measure the training of clinical instructors in physical therapist and physical therapist assistant clinical education.
The information and materials used in the Assessment Center were developed expressly for that purpose and will be used for future Assessment Centers.
By signing this form, you are agreeing to keep the contents, examples, scenarios, scoring, and all other materials used in the Assessment Center confidential, so that other clinical instructors may have the same opportunity, without undue advantage, to apply their knowledge and skills.
All participants must sign a Statement of Confidentiality before beginning the Assessment
Center.
_____________________________________
Participant’s Signature
__________________________
Date

Full Name: ______________________________________________________________
Date of Course: February 28 th & March 1 st , 2009
Name of Trainer: Beverly Johnson, PT, DSc, GCS
Fee: ___________________ APTA Membership #: ________________
Method of Payment: (Visa, MasterCard and American Express only)
Card #: ________________________________ Exp. Date: ___________________
Print Cardholder’s name: ______________________________________________
Billing Address: _______________________________________________________

Signature of Cardholder: ______________________________________________
Upon completion please mail or fax this form to the contract person for the course you will be attending.