Practices of Exemplary Leaders in Clinical Education: A Qualitative Study of Director and Site Coordinator of Clinical Education Perspectives

Abstract

Introduction. 

Frequent turnover in director of clinical education (DCE) and site coordinator of clinical education (SCCE) positions may affect excellence in physical therapist (PT) clinical education (CE). Recognized CE leaders have demonstrated longevity and success in these roles. Understanding excellence in CE leadership may enhance delivery of PT CE. The purposes of this qualitative study were to explore characteristics of recognized PT CE leaders and identify the behaviors, thoughts, and actions of successful DCEs and SCCEs with demonstrated longevity.

Methods. 

Purposeful sampling was used to identify PTs who have been either a DCE or a SCCE for at least 10 years and were recognized by their peers as a leader in PT CE. An interpretive phenomenological inquiry was conducted to explore the lived experience of CE leaders. Cognitive mapping and unstructured interviews were used to elicit perspectives on the factors that contributed to longevity and success. Using an inductive approach, DCE and SCCE data were analyzed separately. Due to substantial overlap in themes, the DCE and SCCE data were combined. Member checks and a peer review were conducted.

Results. 

Seven DCEs and 6 SCCEs from the Northeast United States, with 8–26 (average 17) years in their position, completed the study. Five themes identifying their role success were the following: (1) Professional identity as a bridge between academic and clinical practices, (2) strong work ethic for excellence, (3) build meaningful relationships, (4) “bring-it-on” attitude, and (5) influence.

Discussion and Conclusion. 

The participants shared common characteristics as exemplary leaders in CE. The main themes were in remarkable alignment with The 5 Practices of Exemplary Leaders, a well-established leadership model. These findings provide a framework to identify and develop the leadership qualities needed to fulfill these positions. These exemplary practices should be incorporated into leadership training for DCEs and SCCEs.

INTRODUCTION

Collaboration and shared responsibility between academic and clinical partners is necessary for sustainable clinical education (CE) programs in physical therapy.^1-3 Quality CE coordination, instruction, and assessment require the ongoing interplay of directors of clinical education (DCEs) and site coordinators of clinical education (SCCEs). Capacity concerns, clinic productivity, regulatory and reimbursement factors, and variability in processes, preparation, and expectations are considerable challenges that task CE leaders on a daily basis.^1-4 These challenges have put CE at the forefront of the national dialogue among physical therapist (PT) educators.^1-4 Frequent turnover and stress in both DCE and SCCE positions also contribute to inefficiencies and inconsistencies, possibly impacting the partnerships critical for excellence in PT CE.^2,4,5 Despite these challenges, there are recognized CE leaders who have demonstrated longevity and success in these positions. In keeping with recent efforts exploring excellence in PT education,^5,6 a greater understanding of successful CE leaders may enhance delivery of PT CE. The purpose of this qualitative study was to explore characteristics of recognized leaders in PT CE. We hoped to identify the behaviors, thoughts, and actions of successful DCEs and SCCEs who have demonstrated longevity in their positions.

REVIEW OF LITERATURE

The DCE and the SCCE fill unique roles in academic and clinical settings, respectively. Communication, student mentorship, administration, assessment, program development, leadership, collaboration, and professional skills are important components of these multifaceted positions.^4,9 Most individuals enter these positions with little to no formal training,^1,7,8 which may contribute to stress and turnover. Most DCEs have been in the position with an average of 4.6 years and do not see it as a career goal,⁷ as many view the position as a stepping-stone into academia.⁸ Significant variability exists in DCEs' tenure and promotion, with most untenured and at lower faculty ranks.^7,8 Lack of recognition and preparation for academia hinders DCE longevity.^7,8 Frequent turnover is concerning for the health of a robust CE program and contributes to the national shortage of PT faculty.^5,9,10 There has been renewed interest in defining the contemporary DCE roles and responsibilities,^8,11 but little investigation of the SCCE and limited understanding of the preparation needed for both of these positions.^1,2,7,9,12

A recent investigation by McCallum et al⁸ explored the roles and responsibilities of the DCE by interviewing 11 teams of DCEs and program directors. Qualitative analysis revealed 5 themes and 19 subthemes that were used to develop a contemporary conceptual framework that provides insight into the dynamic roles and responsibilities of the DCE.⁸ The DCE's responsibilities extend far beyond the traditional faculty roles of teaching, service, and scholarship.^8,11,12 Further analysis by Englehard et al¹¹ of the theme common vision for the future of the DCE position explored 3 subthemes: improve efficiencies of systems, optimize clinical partnerships, and collaboration with translational research. A taxonomy was developed that presents 3 levels (processor, coordinator, and director) that further describe the DCE roles and responsibilities.¹¹ Novice DCEs typically fill the processor and coordinator roles, with more experienced DCEs functioning as directors.¹¹ These studies enhance our understanding of this unique position within PT academia and its associated requirements, but did not explore characteristics of those who have success and longevity at the director level. Participant selection was determined by academic program demographics rather than DCE-specific criteria; only 28% of the DCE participants had more than 10 years of experience in their position.^8,11

Salzman⁹ conducted a qualitative study in 2009 exploring characteristics of 6 successful DCEs. Participants were nominated by their peers based upon longevity in their roles and scholarly productivity; 5 DCEs had between 11 and 17 years of experience, and 1 participant had 6 years of experience. The following themes were identified: (1) responding to unexpected events, (2) match in interests and skills, (3) excitement for facilitating growth, (4) networking with colleagues, (5) supportive environments, and (6) mindful practice.⁹ Salzman⁹ recommended that the process of building success and longevity begins at the interview, clearly articulating the expectations of the position. Peer mentorship, time and support for administrative tasks, and scholarship were identified as essential elements to facilitate DCE professional growth.

A charge resulting from the 2014 American Counsel of Academic Physical Therapy (ACAPT) CE summit led to a national examination of the SCCE role.¹ Timmerberg et al¹ gathered demographics, CE program structure, and routine duties and preparation for their role from 1,109 SCCEs. The results indicated great variability in roles, responsibilities, expectations, and support. Responsibilities included scheduling, orientation and meeting with students, clinical instructor (CI) development, and crisis intervention, with most indicating inadequate time to perform these duties.^1(p.40) Few SCCEs had support for CE related professional development. The SCCEs had neither mentorship nor a job description, and their role was not considered part of the career ladder within their organization.¹ These findings are consistent with Recker-Hughes et al² who recommended that SCCEs be recognized for their critical role in CE, provided opportunity and support for professional development, time for teaching, and administrative support.

Academic program directors have also been noted to have a lack of formal preparation or previous experience in academia.¹³ They struggle with limited support, demanding workload, and other factors that contribute to a high rate of attrition.¹³ Leadership training programs are being developed to address these shared concerns for academic and CE leaders. The ACAPT Leadership Academy advocates that, “the future of excellence in academic physical therapy is intimately tied to having a plentiful pool of leaders who have conscientiously and deliberately prepared themselves to provide the superior leadership required to affect such excellence.”¹⁴ It is possible that the training needed for those in CE leadership may differ than those in other leadership (program director or chair) positions. Knowledge gained from this study may help identify and develop future CE leaders who contribute to a culture of excellence in PT CE.

PARTICIPANTS

Purposeful sampling was used to identify PTs who have been either a DCE or a SCCE for at least 10 years and were recognized by their peers as a leader in PT CE. The term leader was intentionally left undefined, purposefully allowing nominators the opportunity to identify individuals they viewed as leaders without a restrictive definition. By not defining the term leader, the study was able to explore CE leaders from an open, undirected perspective. Participants were recruited from the New York/New Jersey, Philadelphia, and New England CE consortia. The DCEs either self-identified or were nominated by a peer; SCCEs were nominated by a DCE. As members of the sample community, the researchers verified that DCEs who self-nominated were viewed as leaders in CE. These decisions were based upon the researcher's own perspectives of leadership; they considered the nominees' influence and participation in CE at the regional and national levels, and their personal experiences interacting with the nominees in leadership or mentorship roles. This was consistent with the request to all other nominators. Participants were recruited until data saturation was achieved. This study was approved by the participating institutions' institutional review boards.

METHODS

An interpretive phenomenological inquiry was conducted to explore the lived experience of identified leaders in CE. “The aim of ‘interpretive phenomenology’, also referred to as ‘hermeneutics’, is to describe, understand, and interpret participants' experiences.”^15(p.18) Both researchers have extensive experience as DCEs and therefore identified closely with the participants. Pre-understanding, an essential component of the Hermeneutic Circle, allows greater insight into the participants' experience.¹⁶ In reflection upon our pre-understanding, we acknowledged our own assumptions as to the characteristics of effective CE leaders. As we are in the world of the participant, we applied our previous knowledge and experience to drive our understanding; bracketing in the traditional sense was, therefore, not applicable.^16,17

This study incorporated a participant-driven process of cognitive mapping, through unstructured, one-on-one interviews, to elicit perspectives on the critical factors that have contributed to longevity and success in their roles as DCEs and SCCEs. Participants completed a demographic survey as seen in Table 1. A cognitive mapping process was then conducted, including creation of an individual map followed by the interview. Cognitive mapping has been utilized as a qualitative methodology to explore individuals' perspectives about their lived experiences with various health conditions.^18,19 Cognitive mapping allows for a more robust and organic concept development than can be achieved through more structured interview or questionnaire processes.¹⁹ This qualitative method was well-suited to the exploratory nature of this research, allowing each participant to self-construct a unique visual representation of their story, identifying interconnections and relationships between concepts from their cognitive map.^18,19

Table 1.: Participant Demographic Data

Participants were instructed to think about factors that contributed to their longevity and success in their position and write words, phrases, or sentences on as many sticky notes as they liked. They then arranged the sticky notes into categories or a pattern to describe the story of their professional development. The cognitive maps served as a visual representation of self-identified themes and patterns. Participants were asked, “Please tell me the story of your map.” There was no specific set of predetermined questions, as the interviewer engaged the participant in an open-ended conversation to explore concepts and clarify responses. Vertical and horizontal linkages to elucidate interconnections and meaning in the data were created as participants told the story of their map to the interviewer. The conversation was audio recorded and the interviewer took field notes. The entire process took approximately 1 hour. All audio recordings were transcribed using pseudonyms.

DATA ANALYSIS

Demographic data were analyzed with descriptive statistics including frequencies, ranges, and percentages using Microsoft Excel (2013). The DCE and SCCE qualitative data were analyzed separately, using an inductive approach to derive themes from the raw data.²⁰ The investigators' initial impressions were documented; each independently examined transcripts, field notes, recorded interviews and physical maps, analyzing, and coding data continuously while data were being collected, searching for concepts and connections in the data. Co-investigators then discussed and resolved any discrepancies in data interpretation. Ongoing cross-group analysis was used to reduce the qualitative data into common interconnections, repeated concepts and themes. Throughout this process, the investigators searched for negative cases and contradictory evidence. Due to substantial overlap in results between groups, the DCE and SCCE data were combined for further analysis.

Member checking was used to verify the trustworthiness of the findings. Participants received a copy of their transcript and were asked to review it for accuracy and to add or clarify any information. All changes requested by the participants were made to best reflect the true intent of their statements. A peer review was conducted to challenge or support the researchers' assumptions, methods, and interpretations and establish dependability and credibility, enhancing methodological rigor.²¹ The peer review was performed by a PT educator with experience in leadership and qualitative research, who was not involved in data collection or initial analysis. The reviewer was provided the transcripts using pseudonyms along with the primary investigators' initial interpretations.

RESULTS

Demographic data of the 13 participants who completed the study are found in Table 1. All participants were white, non-Hispanic females with American Physical Therapy Association (APTA) CI credentialing. Age ranged from 38 to 65 (average 52) years with 8–26 (average 17) years in their position and 16–42 (average 30) years as a licensed PT. Two participants had only 8 years of experience as an SCCE, outside the inclusion criteria. However, based upon several DCEs nominating these same 2 individuals, it was evident that they were clearly viewed as leaders in their CE community. The researchers, therefore, made an exception to the inclusion criteria for these 2 individuals. All DCEs worked in academic institutions, and the SCCEs were from acute care or large health systems, with only 1 working in a skilled nursing facility. Most participants described other roles they fulfilled, including managerial and supervisory positions in addition to service on advisory and state boards. They had engaged in various professional development activities, including the APTA Health Policy & Administration Section's LAMP Institute for Leadership programming, attendance at the Education Leadership Conference (ELC), Clinical Education Summit, and consortia activities.

The participants shared a common understanding of the importance of having a breadth of knowledge and experience to be successful in their roles. Although there were subtle variations in responses, no negative cases or contradictory evidence emerged during the qualitative analysis. Site coordinator of clinical education-6 described what eventually emerged as the 5 main themes, as presented in Table 2, as facets of herself that were “always me.” These themes were consistent across all participants, distinct from outside experiences and influences, and represent who they are in their multifaceted professional roles over the span of their careers.

Table 2.: Thematic Results: Characteristics of Successful CE Leaders

Professional Identity as a Bridge Between Academic and Clinical Practice

The participants described their roles as “who they are” and not just their job. As DCE-5 expressed, “although this job is my passion, I don't see it as a job, I just see it as part of my life right now, seamless you know.” They felt empowered by being part of something much bigger than themselves. There was a strong parallel in the characteristics needed to be a “good PT” and those needed to be a “good DCE or SCCE.” The same traits that facilitated their development and success as clinicians accelerated their professional growth in CE. Their identity as a DCE or an SCCE was not distinct from who they are or were as a practicing clinician; they described satisfaction in fulfilling their professional duty on a larger scale.

As the face of the profession or their departments, beyond their role in CE, the participants saw themselves as the bridge between academic and clinical practices. As DCE-1 described, “A good DCE is aware of what's going on in the profession… I need to know everything about everybody. I need to know my students so I must teach. I need to know my faculty, I need to know about practice, not just my areas of practice, but all areas. I need to know about the curriculum.”

This bridge requires DCEs and SCCEs to have knowledge and expertise in didactic and CE curricula, health policy, academic policy, and clinical practice, and have their finger on the pulse of national issues related to PT education. The SCCE's felt empowered and fulfilled by being part of the national dialogue, bridging the gap between academic and clinical expectations. As SCCE-3 related, “I know what's going on and I can relay it to the rest of the team… I feel like I'm bringing information to them and I'm being useful.” All participants demonstrated a true passion as they described their multifaceted roles, as DCE-1 stated, “Representing the profession, being available, being a liaison—all of those roles are part of the leadership.”

Strong Work Ethic For Excellence

Participants described a drive for excellence and an intrinsic motivation to set the bar high. Through dedication, commitment, strength, and determination, they seek to produce work worthy of recognition. All participants described themselves as self-motivated, having initiative, and thriving in an environment that allows independence, flexibility, and variety. Site coordinator of clinical education-2 described that they “keep the bar high and the expectations high and help them (students) achieve their objectives.” Director of clinical education-6 shared, “[I have a] personal drive for excellence, not everybody has that… earlier in my career that was frustrating to me to realize that well ‘why doesn't everybody have [that]? Why aren't people driven to do their very best?’”

The SCCEs indicated that knowing their work was valued and useful was a motivating factor in their drive for excellence. Site coordinator of clinical education-3 related, “I felt my time was devalued because I wasn't given enough time. But if I had that time I felt important. I need to feel appreciated.” Director of clinical education-1 expressed that she has “always felt validated and acknowledged as a faculty member and … we need to look at the DCE as a career path of its own with expertise.”

Build Meaningful Relationships

Pride and Joy in Personal Connections

All participants described significant personal satisfaction in helping others find their passion, including students, CIs, and other faculty. They take pride in being a mentor and facilitating others' growth. They are skilled at creating personal connections and felt fulfilled by individual interactions. Director of clinical education-2 related:

I do like the connection with the students outside the classroom. I think they see a different piece of me when I go and visit them, and you go, you get a hug, “so nice to see you”, that happy-to-see-you, kind of like home, like a friendly face of knowing that they can be open and honest with me and that I can help them make their experience better.

All participants discussed the value of paying-it-forward through CE. They each shared personal pride and joy in seeing students and colleagues attain their goals. Site coordinator of clinical education-1 articulated, “I like the opportunity to help develop… our staff in so many different ways, the opportunities to help develop the students, and you know that opportunity that I have to be a part of that and to, again help my staff grow in being CI's, and just helping them learn, but also helping me learn.”

Sense of Community

Clinical educators are skilled collaborators, understanding the value of a team approach. They demonstrate humility and appreciate that they are not in this alone. They avail themselves of supports in the form of consortia, other DCEs and SCCEs, academic faculty, and program and department chairs. All had a desire to actively participate in consortia, knowing their voice was part of the collective discussion. The SCCEs described their relationship with their consortia: “the supports that really helped me through the years… I just can't say enough about my membership in the consortium how much I learned the support that was always there and again my ability over the over time to feel like I had something to contribute.” (SCCE-5) “The consortium… bringing in the clinical educators and letting them, letting us, know that the [SCCEs] the CI's input is important, it's sought-after, it's valued.” (SCCE-2) The DCEs also expressed great appreciation for the consortia community, as described by DCE-5:

The greatest help to me was being part of a consortium. Our consortium is a source of strength and… helped me learn how to be an effective team member and when you have a common goal how you can really work together effectively to get where you need to go. And I never hesitated, I still don't, to pick up the phone and say, “hey, what do you think?”

The sense of community and collaboration extended to others, as SCCE-4 described, “I have great support from my manager. He is always willing to help when needed. He's always willing to listen to me if I have a problem… and I get support from schools. So I if I have a problem I can call the school. I have good relationships with all the DCEs.”

“Bring-it-on” Attitude

All participants expressed personal fulfillment and resilience when managing challenges and tackling problems, as DCE-5 described, “I like being thrown curveballs.” They consistently described joy in having new experiences and taking advantage of opportunities. Their desire for continued personal learning and growth leads them to embrace challenges.

Consummate Problem-Solver

Successful DCEs and SCCEs do not shy away from a challenge or crisis. Director of clinical education-6 said, “You move into crisis management a lot and some people are comfortable with crisis management and some are not. I have always been comfortable with it and I sought that early on and had success.” A strong sense of accomplishment was noted in guiding others through challenges as well. Director of clinical education-2 described how it “feeds your soul… although it can be stressful and difficult, I enjoy that interaction and kind of getting to the bottom of what's going on.”

Director of clinical education-6 related how she views herself and how others perceive her as a problem-solver:

The other thing that really sustains me is all that problem-solving that you're doing. It's so individualized, it's so “what is going on?” … and so with academic faculty when you come in and you start talking about some of what we do in meetings and they're going “Holy crap, I'm so glad you're doing that, I don't want to do that! What would ever make you want to do it?” And it's just such a different role.

Embrace Opportunities With Gusto

The participants reported a desire for discovery and personal growth. They enjoy new experiences that pushed them outside their comfort zone, embracing opportunities including the following: advanced education, conferences, presentations, research collaborations, and other service and leadership roles at the departmental, institutional, regional, and national levels. As DCE-3 reported “[it] keeps me learning all the time; there's always new things going on.” Site coordinator of clinical education-6 shared, “research and publications and presentations that I've done at ELC and CSM [Combined Sections Meeting] and NEXT. I think that I've had a lot of those opportunities because of the involvement in the consortia.”

Both DCEs and SCCEs recognized the importance of support from their peers and mentors to take full advantage of opportunities presented. Site coordinator of clinical education-4 expanded, “I've gotten opportunities to get more involved with schools…you teach a little bit at one school, I can just do whatever kind of is available to me. And I use them as resources.”

Influence

The participants expressed a desire to have a lasting impact on PT education. They spoke about building a legacy and having significant contributions and influence at both the individual and organizational levels. Site coordinator of clinical education-1 said, “I want to grow colleagues who are passionate about what they do, are good at what they do, you know, I want to be a part of that.”

Great responsibility is associated with this influential position. As DCE-5 expressed, “The potential to have an impact on others is great, and so with that potential comes tremendous responsibility and accountability… I had no idea how many people I had the potential to impact in my role as a DCE until fairly recently.” Director of clinical education-4 concurred, “[you must be] the person that's willing to step up and take responsibility and accountability.” Furthermore, SCCE-5 sees SCCEs as the “quality gatekeepers in PT education.”

All participants felt they were influential in individual student success, watching students grow from entering the PT program to graduation and beyond. Director of clinical education-4 quaintly described:

I kind of get to the point… as they approach graduation that its mama-bird time to let them fly… after 3 years in the program, to watch them go from that student that doesn't know how the pieces fit together to then starting to learn all the pieces. And to watch them grow and to watch them be leaders and to see their confidence and then seeing them out on clinical… you get those little glimpses of them being a PT, that's what this is about… it's time to let them go and that's kind of a feeling of accomplishment.

In addition to these 5 themes, the participants described a broad skill set that facilitated their success in these multifaceted roles including the following: emotional intelligence, humility, and listening, communication, organizational, and counseling skills. They possess optimism, creativity, a passion for teaching, and an ability to self-manage. External factors including autonomy, flexibility in their schedules, and time were described as critical to success and longevity. Recognition as an equal member of the core faculty is important to DCEs; SCCEs expressed a desire for recognition and appreciation for their leadership role.

DISCUSSION

Physical therapist CE leaders share common characteristics that contribute to their longevity and success as DCEs and SCCEs. The overlap between DCE and SCCE perspectives throughout the cognitive mapping process and subsequent story telling was unexpectedly significant. No previous literature was identified that explored these 2 groups together. The current findings present a new understanding of the shared behaviors, thoughts, and actions of CE leaders across academic and clinical positions. Both DCEs and SCCEs exhibit characteristics of leaders with substantial influence.

Professional identity and strong work ethic for excellence are foundational characteristics of CE leaders. These CE leaders are able to act upon that foundation with their bring-it-on attitude and ability to build meaningful relationships. Those actions, in turn, lead to the strong influence CE leaders demonstrate in their multifaceted roles. This relationship between themes is illustrated in Figure 1. Each theme was equally represented as an important element in each participant's identity as a CE leader, consistent with SCCE-6 who described these practices as “always me.”

Figure 1.: Exemplary Practices of a Clinical Education Leader, “Always Me”

An in-depth search was conducted in an effort to align the thematic analysis with existing leadership models. Our pre-understanding was influenced by the focus on resilient leadership at the 2018 Education Leadership Conference²²; we expected a resilience leadership model to most closely align with our results. Resilient leaders demonstrate self-regulation, intentionality, perceptual maturation/self-validation, connection, and self-care.²³ Through adversity and change, transformative resilient leaders positively contribute to their community.²⁴ While a few of the participants described enjoying challenges, being able to pull from previous experience, and related skills in adaptability, there was no overall discussion by our participants about overcoming adversity or stressors that were particularly characteristic of resilience.

Given the interpersonal nature of DCE and SCCE roles, we also anticipated to find qualities including caring, compassion, reading other people, and skilled interpersonal relationships that resonate with a leadership framework of emotional intelligence.²⁵ The participants described qualities that included counseling and listening skills as well as learning from others and self-management, but these ideas were not predominant in the data.

Our pre-understanding also foresaw strong management-related skills to be prevalent. Two trait-based leadership models that focus on management skills, consistent with DCE and SCCE roles and responsibilities identified by McCallum et al⁸ and Timmerberg et al,¹ respectively, are the National Center for Health care Leadership: Health Leadership Competency Model²⁶ and The Health care Leadership Alliance Model.²⁷ Many of the traits listed in these models correlate well with our participants' description of their work, including skills in communication, collaboration, project management, professionalism, and relationship building. Neither of these models, however, encapsulated the gestalt of our participants' lived experiences.

The model that most strongly resounded with our findings was The 5 Practices of Exemplary Leaders, particularly the 10 associated commitments that pair with each of the 5 practices.²⁸The 5 Practices of Exemplary Leaders is the original evidence-based leadership model developed through intensive research conducted by Kouzes and Posner.²⁹ Over its 30-year history, their work has been translated into 12 languages and the associated measurement tool for the 5 practices, the Leadership Practices Inventory, is the most widely used leadership assessment in the world.²⁹Figure 2 provides a representation of the alignment of our findings with Kouzes and Posner's model. This well-established model captures the multifaceted nature of the DCE and SCCE positions and can be used to identify successful leaders in PT CE.

Figure 2.: The Five Practices of Exemplary Leaders, Ten Commitments¹ and Associated Themes

The exemplary practices of CE leaders identified in this study are consistent with the limited body of literature on this topic. Previous investigation of the DCE has recognized the importance of supportive environments and opportunities for networking with colleagues and the value of being part of community through involvement in professional organizations and activities.^8,9 The concept of being the bridge between classroom and clinic resonates across the literature.^1,8,9,30 The SCCEs' need for resources, including time and administrative support, and their perceived value of relationships with consortia and academic programs is consistent with previous findings.^1,3 Structured expectations and recognition are necessary elements for success.³ Both DCEs and SCCEs have consistently reported how their roles are neither well-understood nor recognized for their significant contributions to their organizations.^1,8,12,30

The current findings build upon previous knowledge by relating practices of CE leaders to an established leadership model. Although these multifaceted roles are unique to physical therapy, the leadership skills needed to be a successful DCE or SCCE parallel leadership skills in other professions. Kouzes and Posner's model of exemplary practices provides a common framework to guide the development of skilled leaders to not only address the national shortage in PT education leadership positions to but also promote excellence in these positions.

In an effort to bring PT professional education into the 21st century, Jensen et al⁶ conducted a national qualitative study of excellence and innovations. The study resulted in a conceptual model of excellence, which provided a foundation for the development of 9 action items included in a transformative agenda for PT education.⁵ Among those action items was a call to address the shortage of qualified faculty and academic leaders. The authors recommended efforts to cultivate a shared value of excellence and develop shared leadership models that facilitate innovation and excellence.⁵ The results of our study put forth a model focused on excellence in CE leadership that is consistent with Jensen et al's⁵ vision.

This study intentionally recruited recognized CE leaders with demonstrated success and longevity in their roles. It is important to understand not only the “mechanics” of performing these roles but also to study those who demonstrate excellence. Achor,³¹ a prominent advocate of positive psychology, commented, “if we study what is merely average, we will remain merely average, [if we study those who excel]…we will glean information, not just how to move people up to the average, but how to move the entire average up.”

Results of this study provide a better understanding of excellence in CE leadership and guide recruitment, training, and retention of future CE leaders. Characteristics of successful CE leaders can be recognized, allowing one to identify candidates with the potential for success in these positions. The characteristics of exemplary leaders should guide leadership training initiatives specifically designed to meet the needs of a complex and evolving CE landscape. We task those who are developing education leadership training initiatives to consider that the training for CE leaders be nuanced to incorporate the 5 Practices of Exemplary Leaders.²⁸

Limitations

Participants represented a narrow geographic area, men were not represented, and there was little variety in practice settings for SCCEs, which may limit transferability of these results. A larger study to include a broader representation of CE leaders would be valuable. It is unknown if CIs demonstrate similar leadership qualities. Experienced CIs may transition into SCCE or DCE roles; identifying individuals with potential for success along the CE career ladder may further enhance quality and consistency in CE programs.

CONCLUSIONS

Both DCEs and SCCEs should be recognized as leaders in PT education given their unique skill-set and multilevel influence within PT CE. The 5 Practices of Exemplary Leaders²⁸ aligns with results of this study, identifying actions and behaviors of CE leaders who have demonstrated success and longevity in their roles in both the academic and clinical settings. These findings provide a more structured approach to identify, mentor, and support individuals with the leadership qualities needed to fulfill these positions.