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The Development of an Assessment Tool to Measure the Clinical Performance of Orthopedic Residents

Cunningham, Shala, PT, DPT, PhD; Jackson, Richard, PT, BSc; Herbel, Ken, PT, MS; Godges, Joseph J., PT, DPT

Journal of Physical Therapy Education: March 2019 - Volume 33 - Issue 1 - p 31–39
doi: 10.1097/JTE.0000000000000076
Research Report

Introduction. Residency programs have been developed to provide formal instruction and mentorship after professional education to accelerate the development of the physical therapists' knowledge, skills, and clinical decision making for patient management. An assessment tool that could be used during the assessment and treatment of patients would provide valuable information regarding the progression of the multiple skills required for a high level of clinical practice throughout residency education. The purpose of this study was to develop a reliable and valid tool to assess the multiple clinical skills used in the examination, evaluation, and treatment of patients with common musculoskeletal conditions.

Methods. To meet the purpose, a sequential interrater reliability and known-groups validity study was performed. The original clinical performance assessment tool was developed using the practice dimensions outlined by the Orthopaedic Physical Therapy Description of Specialty Practice. The tool underwent 3 rounds of reliability testing. In addition, known-groups validity was established using residency graduates and experienced matched controls.

Results. The overall reliability of the 64-item assessment tool was found to be high. Fifty-four of the items on the examination had high to perfect reliability and 10 items demonstrated moderate reliability. Furthermore, the tool was accurate in determining physical therapists with residency training versus experienced matched controls, establishing known-groups validity.

Discussion and Conclusion. The assessment tool was able to evaluate clinical performance during patient care activities in both residency trained physical therapists and therapists without advanced instruction with a moderate to high interrater reliability on all items.

Shala Cunningham is the assistant professor at the Radford University, 101 Elm Avenue SE, Roanoke, VA 24013 ( Please address all correspondence to Shala Cunningham.

Richard Jackson is the founder and executive director of Clinical Services at the Jackson Clinics Foundation, Middleburg, VA.

Ken Herbel is a residency mentor and physical therapist at the Jackson Clinics Foundation, Middleburg, VA.

Joseph J. Godges is an adjunct and associate professor of clinical physical therapy in the Division of Biokinesiology & Physical Therapy at the University of Southern California, Los Angeles, CA.

Supported by the Radford University Waldron College Research Award.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Institutional Review Board Approval: The Kenya Medical Training College Ethics and Research Committee and the Institutional Review Board of Radford University approved this research.

Received December 18, 2017

Accepted September 20, 2018

Copyright 2019 © Academy of Physical Theraphy Education
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