Eastern Washington University Department of Physical Therapy
Presents:
APTA Advanced
Clinical Instructor Credentialing Course
(16.75 Hours)
Saturday February 28th, 2009 and
Sunday March 1st, 2009
Course Location: Spokane,WA
APTA Advanced
Clinical Instructor Credentialing Course
The Advanced Clinical Instructor Credentialing Program brings two constructs together in one professional development program that
advances both clinical teaching and best practice when providing student clinical education. Using a case-based and interactive approach
to education, this program will provide participants with the essential knowledge and skill to more effectively teach and mentor students in
the context of a doctoring profession. Through the program’s unique philosophy and design, best outcomes will be achieved for student
learning.
Eligibility: Physical Therapists who are APTA Credentialed Clinical Instructors and who have had at least one student since completing
the credentialing program.
Course Instructor:
Reva P. Rauk PT, PhD, MMSc, NCS
Reva brings over 20 years experience in clinical education from both clinical and academic perspectives. She has served as clinical
instructor, Center Coordinator of Clinical Education, Academic Coordinator of Clinical Education, and academic faculty member. She
received her PhD in Education from the University of Minnesota in 2006, her Masters of Medical Science (clinical neurosciences) from
Emory in 1986 and her professional PT degree from the Mayo School of Health Sciences in 1982.Reva has been a board certified
neurological clinical specialist since 1993. She is currently a faculty member in the University of Utah, Department of Physical Therapy and
Manager, Staff Development and Research for the University Hospital Rehab Services.
At the conclusion of Advanced Clinical Instructor Credentialing Program…
1. CIs will be able to teach using pedagogical methods that enable learners with patients/clients to integrate more complex concepts by
demonstrating.
a. Consistent application of professional standards and regulations in clinical education.
b. Six elements of Vision 2020, professionalism, evidenced-based practice in a consistent and clinically relevant manner.
c. Correct use of the patient/client management model.
d. Professional communication in clinical practice including documentation.
e. Clinical decision making using patient values,
professional skills, and the best available evidence.
f. Professional responsibilities through participation in professional association activities.
g. Lifelong learning through an individual professional development plan.
2. Is will be more effective and efficient practitioners and clinical teachers by
a. Advancing clinical teaching concepts.
b. Modeling, integrating, and promoting behaviors that are congruent with and reflective of the six elements of Vision and the core
values.
c. Synthesizing information from APTA, FSBPT, CAPTE, and State and Federal regulations.
d. Demonstrating best practice in documentation.
e. Applying the Patient/client management model, evidenced-based practice, clinical decision-making approaches and professional
ethics in every day practice.
f. Living the philosophy of lifelong learning.
COURSE AGENDA
Saturday, February 28, 2009
7:30 AM - Registration
8:00 AM - Welcome and Introductions
- Participant expectations
- Participant evaluation and information
release forms.
8:15 AM - Program Introduction
8:45 AM - Section I - Professionalism
10:30 AM - Break
10:45 AM - Section II - Clinical Reasoning
12:15 PM – Lunch on your own
1:15 PM - Section III - Patient/Client Management
Model and documentation.
2:45 PM - Break
3:00 PM - Section III continued
4:00 PM – Assessment : Part I
- Sections I, II, III
5:00 PM – Score Assessment Center
- Part 1
5:30 PM – Debriefing Assessment
6:00 PM - Adjourn
Sunday, March 1, 2009
7:30 AM – Check in for Day 2
8:00 AM - Section IV
- Evidenced Based Practice, Part 1
10:00 AM - Break
10:15 AM – Evidenced Based Practice, Part 2
12:00 PM – Lunch on your own
1:00 PM – Section V- Advanced Clinical Teaching Concepts
2:30 PM – Section VI - Guide to Physical Therapist Practice and Case Based Application.
3:15 PM - Break
3:30 PM – Assessment Center: Part II
- Sections IV, V, and VI
4:15 PM - Assessment Center: Part III
- Complete Professional and Clinical
Instructor Development Plan.
4:45 PM – Score Assessment Center: Part III
- Complete Participant Evals/Feedback forms.
- Complete Participant Info. Release form.
5:15 PM – Debriefing Final Assessment
5:30 PM - Adjourn
To Register: Print, complete and mail the following documents by February 5, 2009.
Complete the attached Registration form.
Complete the attached Advanced Participant Dossier.
Complete the attached Agreement of Participation.
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.
Note: Prior to the course complete the attached Pre-Program Participant Assignments.
Send all registration information to:
Direct questions regarding course to:
Eastern Washington University
Mellissa Thoreson
Department of Physical Therapy
(509) 368-6602
Attn: MellissaThoreson
mthoreson@mail.ewu.edu
310 N. Riverpoint Blvd. Box T
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 5th, 2009.
--------------------------------------------------------------------------------------------------------------------------------------REGISTRATION FORM:
Sign up for: Advanced Clinical Instructor Credentialing Course February 28th & March 1st, 2009
(
) 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.
$ 85.00
(
) PT without APTA membership, and not employed by a facility with a current EWU contract in place.
$ 175.00
---------------------------------------------------------------------------------------------------------------------------------------__________________________________________________________________________________
Participant Name
_________________________________________________________________________________
Address
__________________________________________________________________________________
City
State
Zip
__________________________________________________________________________________
Facility Name
(_____)____________________________________________________________________________
Phone
Email address
CLINICAL INSTRUCTOR EDUCATION AND
CREDENTIALING PROGRAM
Credit Card Payment Form
Full Name: ______________________________________________________________
Date of Course:
February 28th , 2009 & March 1st, 2009
Name of Trainer: Reva P. Rauk, PT, PhD, MMSc, NCS
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.
Name:
__________________________________
Please Print
Date:
February 28th & March 1st, 2009
Location:
Spokane, WA
Sponsor:
Eastern Washington University
Statement of Confidentiality
APTA Advanced 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
APTA ADVANCED CLINICAL INSTRUCTOR 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 ___________________________________________________________
Current Address
Date of Birth ____________________________
_____________________________________________________________________________________________
City ___________________________________________________State ______________ Zip _____________________________
Phone _________________________
FAX ________________________ E-Mail __________________________________
Entry-Level Degree _______
Graduated from an accredited PT Program MO/YR_____________
Highest Earned Degree:
______ Baccalaureate/Certificate
______ Post-professional Master's
______ Professional Master's (MPT/MSPT) ______ Post-professional Transition DPT (DPT)
______ Professional Doctorate (DPT)
______ Post-professional Doctorate (eg, PhD/EdD/ScD)
Are you certified as a clinical specialist by APTA?
Yes 
No 
If yes indicate type _____________________________
APTA Membership #
(Attach a copy of your current membership card)
Date of completion of APTA Clinical Instructor Credentialing
____________________Year
Do you require any special accommodation to complete this program? Yes 
No 
If yes, specify_______________________
States in Which Licensed (IMPORTANT: Attach a copy of your current state license.)
2.
Employment History/Practice Setting for the past 5 years (List most recent employer first)
Employer
City/State
Job Description
Dates
From ________ To________
In the past five years, describe the frequency of time spent in each of the following areas. Rate all items in the shaded columns using the
4-point scale provided below
1= Never
2=Rarely
3=Occasionally
4=Often
Diversity Of Case Mix
Musculoskeletal
Neuromuscular
Cardiopulmonary
Integumentary
Other (GI, GU, Renal, Metabolic,
Endocrine)
Rating
Patient Lifespan
0-12 years
13-21 years
22-65 years
over 65 years
Rating
Continuum Of Care
Critical care, ICU, Acute
SNF/ECF/Sub-acute
Rehabilitation
Ambulatory/Outpatient
Home Health/Hospice
Wellness/Fitness/Industry
Rating
3.
Clinical Education History
Indicate your current and past education roles for the last 5 years: (Check all that apply)
ACCE/DCE 
CCCE 
CI 
Faculty 
Adjunct Faculty 
Other  ___________
How many full-time PT students have you have supervised in clinical practice the last 5 years?
How many part-time PT students have you supervised in clinical practice in the last 5 years?
If you are an educator or a CCCE, how many students have you supervised or overseen in the last 5 years?
Have you been actively involved in student learning and education since receiving your APTA CI Credential?
_________students
_________students
_________students
Yes  No 
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.
2. Applicant has demonstrated a willingness to work with students by pursuing learning experiences to develop knowledge
and skills in the clinical/academic setting.
3. Applicant demonstrates a systematic approach to patient/client care and/or job responsibilities.
4. Applicant uses critical thinking in the delivery of health services or managing job responsibilities.
5. Applicant provides rationale, including evidence, for decision making in patient/client care.
6. Applicant demonstrates appropriate time management skills.
7. Applicant represents the profession positively by assuming responsibility for professional self-development.
8. Applicant interacts effectively with patients, colleagues, and other health professionals to achieve identified goals.
 Yes  No
 Yes  No






Yes
Yes
Yes
Yes
Yes
Yes






No
No
No
No
No
No
5. Participant's signature indicates approval to release this information for purposes of this participant dossier.
______________________________________________
Participant’s Signature
______________________________________________
______________________________________________
Name of Direct Supervisor (Please Print)
Title
______________________________________________
______________________________________________
Signature of Direct Supervisor
Date
6. Participant Self-Assessment
Mentoring Roles – Indicate your level of expertise in the following areas: (check the appropriate column for each item)
Area
Inexperienced
Experienced
Highly Experienced
Academic Teaching (classroom lecture, lab)
Clinical Teaching (in-services, journal club, mentoring, instruction)
Clinical Supervision of PT students
Direction/Supervision of PTAs and Aides
Clinical Management (supervision, development, and evaluation of
staff and personnel)
Clinical Research Participation (systematic data collection, case
studies)
Use of Information Technology
Practice Roles – Indicate your level of expertise in the following areas:
Area
Inexperienced
Experienced
Highly Experienced
Evidenced Based Practice
Documentation
Patient/Client Management Model
Reflection and Clinical Reasoning
Professionalism
Novice to Master Clinician
Continuum
Do you have access to APTA electronic resources (eg, Hooked on Evidence, Open Door, Professional Development,
APTA website)?
Yes
No
Are you willing to review pre-course reading assignments, complete 3 sections of the APTA Professionalism Module
(Introduction, Sections 1 and 4 with assessments, participate in a 2-day instructional program, and satisfactorily
complete an assessment center and a professional development plan?
Yes
No
Department of Physical Therapy Education
1111 North Fairfax Street
Alexandria, Virginia 22314
ADVANCED CLINICAL INSTRUCTOR EDUCATION AND
CREDENTIALING PROGRAM
Pre-Program Participant Assignments
1. Complete APTA’s online Professionalism Series to include Module 1: Introduction,
Module 2: History of Professionalism in Physical Therapy, and Module 3: Ethical
Compass. To access these three Modules place your mouse over the underlined url
address and hit “ctrl” on your keyboard and left click on your mouse and it will take you
directly to the Web site.
Web access: http://www.apta.org/professionalismadvanced_ciecp
(This assignment will prepare you for the discussion and cases that will be addressed
during the onsite program in Section I: Professionalism of the Advanced Clinical
Instruction Education and Credentialing Program).
Please note: We are currently working on providing the assessments that will go with
each of these modules as well as offering CEUs for completing each of these modules.)
Guide to Physical Therapist Practice (Bring this publication, either in CD-ROM or
hard copy with you to the course. If you do not have this publication, you may
purchase either the hard copy or CD-ROM through the APTA Web site at: www.apta.org,
go to Store, and click on Guide to Physical Therapist Practice. )
2.

American Physical Therapy Association. Guide to Physical Therapist Practice.
Part One: A Description of Patient/Client Management; Alexandria, VA; 2003:31-42.

American Physical Therapy Association. Guide to Physical Therapist Practice.
Part II: How to Use the Preferred Practice Patterns; Alexandria, Val; 2003:125-130.
READ THESE ARTICLES
To access each of these articles, place your mouse over the blue underline, hit
“ctrl” on your keyboard and left click on your mouse simultaneously. A Web
page will come up with the download, wait a few seconds and the article will
appear for you to print!
3. Resnick L, Jensen GM: Using clinical outcomes to explore the theory of expert
practice in PT. Phys Ther. 2003; 83:1090-1106. (For this reading, focus on the
concepts of clinical outcomes as related to expert practice.)
4. Jensen GM, Gwyer J, Shepard KF, Hack LM. Expert practice in physical therapy.
Phys Ther. 2000; 80:28-43. (For this reading, obtain a broad understanding of the
description and hallmarks of expert practice.)
5. Fitz JM, Wainner RS. Examining diagnostic tests: An evidence-based perspective.
Phys Ther. 2001; 81:1546-1564. (For this reading, focus on the concepts of evidencebased practice related to specificity, sensitivity, likelihood ratios, and prediction rules.)