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RESEARCH REPORT

Assessing the Accuracy of Director of Clinical Education Roles/Responsibilities Taxonomy and Matrix: A Delphi Study

Engelhard, Chalee PT, EdD, MBA; McCallum, Christine PT, PhD; Murray, Leigh K. PT, PhD

Author Information
Journal of Physical Therapy Education: December 2021 - Volume 35 - Issue 4 - p 340-349
doi: 10.1097/JTE.0000000000000202
  • Free

Abstract

INTRODUCTION

Clinical education is an integral component of many health professions’ educational curricula.1,2 Studies have suggested that the time spent in clinical training is the most important and memorable aspect of student educational experiences.3-5 Most health profession education programs have identified a key individual to direct the clinical training of its students. These key individuals serve to bridge didactic and practical learning. In entry-level Physical Therapy Education Programs (PTEPs), the Director of Clinical Education (DCE) is the faculty member responsible to plan, direct, and coordinate the clinical education curriculum.6

Today, the DCE is a core faculty member with multiple responsibilities to fulfill. The individual who holds this appointment is asked to meet the expectations and requirements of a faculty member while also acting as the bridge agent between the academic and clinical environments.7-10

When analyzing work positions, it is vital to understand the duties and level of responsibility for the particular position. This clarification of duties and levels of responsibilities can be accomplished through developing a taxonomy and matrix. A taxonomy is a grouping presented in a hierarchical structure and defines the tasks that are required for a particular position,11-13 whereas a matrix is a part of organizational management that allows for comparison across performance characteristics and task fit. A matrix assigns at what level a task is appropriate for the level of training a position may require.14 Utilizing both will aid an organization in identifying individuals who best fit the position, understanding the roles and responsibilities that occur at various levels of maturation in the position, and job satisfaction for the individuals who hold those positions. With this in mind, there is not a taxonomy that has been fully vetted for traditional positions in PTEPs and it is not known what efficiencies could be afforded by employing a taxonomy and matrix for the DCE position, specifically.12

Purpose

The Matrix and Taxonomy proposed by the study by Engelhard et al12 may aid in determining a pathway to greater understanding of the organization of PTEPs specifically as it relates to the DCE's competing roles and responsibilities both as a traditional faculty member and those that pertain specifically to the DCE. To ensure the proposed understanding was accurate, the following research questions were posed to fulfill this study's purpose of ascertaining consensus and accuracy of the DCE Taxonomy levels and characteristics of the Matrix elements as illustrated in the study by Engelhard et al12:

  1. Within the Taxonomy, do each of the levels' responsibilities and sample tasks accurately match the levels' definition, as duties performed by a DCE at that level?
  2. Within the Matrix, do the characteristics serve as a common descriptor across all Taxonomy levels?
  3. Within the Matrix, do each of the characteristics and ranges align with the Taxonomy levels?

We hypothesized that the DCE Taxonomy and Matrix would require minor revisions to confirm accurate descriptions of the DCE roles and responsibilities.

REVIEW OF LITERATURE

Director of Clinical Education workload is frequently divided into teaching, service, scholarship, and administration. Commonly, there is a wide variation of workloads for DCEs with no universally accepted method of approaching workload assignment.8,9,15,16 The root of this variability could be traced to the ill-defined position roles and responsibilities.5,7-10,15 Foundational work by McCallum et al17 examined the understanding of the workload of the DCE and the impact of this role in clinical education. In this qualitative study, 22 interviews were conducted across 11 PTEPs. As demonstrated in Figure 1, 5 themes emerged from the study. The fifth theme stated there is a common vision for the future of the DCE position, but to achieve this vision, there is a necessity that the DCE's roles and responsibilities continue to evolve.17

Figure 1.
Figure 1.:
Relationship Between McCallum et al17 and Engelhard et al12 Themes and Subthemes. The Data From Theme 5 Yielded the Work of Engelhard et al12 With the DCE Roles and Responsibilities Taxonomy and DCE Matrix

Further investigation by Engelhard et al expanded on the vision of the DCE being more intricately involved in translational educational practices and used Watts Taxonomy as a guide to develop the DCE Roles and Responsibilities Taxonomy and Matrix.12,17 To explain, Watts11 categorized tasks being performed in delivering physical therapy patient care and matched the tasks to the responsible personnel that had attained a certain level of competency. Engelhard et al12 took this foundational look at building taxonomies in the physical therapy environment and applied it to the work of the DCE. Hence, the study by McCallum et al17 necessitated a focus on the fifth theme data, and using the Watts Taxonomy as a guide, the researchers yielded the development of the DCE Roles and Responsibilities Taxonomy and Matrix. The DCE Taxonomy grouped tasks and responsibilities into Processor, Coordinator, and Director Levels. The DCE Matrix illustrates the potential task fit line as it relates to given DCE characteristics as seen in Figure 2. The Matrix also elucidates when poor task fit occurs in comparing the level at which skills versus characteristics coincide, thus resulting in potential nonoptimal task fit. When nonoptimal task fit does occur, the level of job satisfaction can become an issue.18

Figure 2.
Figure 2.:
DCE Roles and Responsibilities Matrix

Utilizing the Taxonomy and Matrix for the position of DCE may allow a physical therapy program to better identify the tasks that are a priority for the organization as well as the appropriate individual who may fit the position of DCE. As in business, taxonomies are used to facilitate more efficient systems and provide a hierarchy and meaningful context.19 Hence, integrating a taxonomy and matrix into physical therapy (PT) programs beginning with the DCE position could create an enhanced understanding of effectiveness of the position and enhance efficiency. However, previous research has not confirmed that the components of this Taxonomy and Matrix are accurate for the position of DCE in physical therapy entry-level education.12

SUBJECTS

Selection of participants occurred through purposive sampling. Using the American Council of Academic Physical Therapy (ACAPT) web site and each physical therapy program's web site, an email was sent with an invitation to participate to Program Directors (PDs) and DCEs. The Dillman20 method for enhancing survey responses was used by sending participation email reminders weekly after the initial email as well as a final appeal email to participate was sent in the final week of the survey being available.

Inclusion criteria included either a current or previous PD or DCE of a physical therapy program in the United States, who is a member of ACAPT, a licensed physical therapist in the United States, have 2 or more years of clinical experience, and actively teach in a Doctor of Physical Therapy (DPT) program that is accredited by the Commission on Accreditation of Physical Therapy Education. Each regional category listed for the ACAPT institutions was used as a guide to ensure broad representation. The exclusion criteria consisted of being any other DPT academic faculty member who is not a PD or DCE.

Recruitment emails were sent to 391 ACAPT PDs and Directors of Clinical Education. Of the 391 faculty, 59 DCEs, 2 Associate Directors of Clinical Education (ADCEs), 18 PDs, and 7 undesignated faculty, for a total of 86 faculty, participated in the first round of the Delphi study. The undesignated faculty included Assistant DCEs and a Program Chair. Less the undesignated faculty, 13 faculty had bachelors, 13 had masters, and 53 had doctoral level degrees. Although the range of time in position varied from less than 1 year to more than 15 years, the average was between 5 and 10 years. By a small majority, most participants were in private institutions and Carnegie classified as Doctoral/Research. The participants’ institutions were from every ACAPT geographical area, with the heaviest concentration in West North Central and Great Lakes regions. Table 1 illustrates the complete demographics of the data.

Table 1. - Delphi Demographics
Total DCE/ACCE ADCE PD Unknown
Total respondents
 Round 1 86 59 2 18 7
 Round 2 69 54 2 13 1
Highest earned degree
 Certificate 0 0 0 0
 Bachelors 13 4 0 9
 Masters 13 8 0 5
 Doctoral (DPT) 53 47 2 4
Years as licensed physical therapist
 Less than 1 year 0 0 0 0
 At least 1 but less than 3 years 0 0 0 0
 At least 3 but less than 5 years 0 0 0 0
 At least 5 years but less than 10 years 1 1 0 0
 At least 10 years but less than 15 years 7 6 0 1
 15 years or more 71 52 2 17
Years at current position
 less than 1 year 3 3 0 0
 at least 1 but less than 3 years 9 5 1 3
 at least 3 but less than 5 years 15 9 0 6
 at least 5 years but less than 10 years 19 17 1 1
 at least 10 years but less than 15 years 9 6 0 3
 15 years or more 24 19 0 5
Type of institution
 Public 33 25 0 8
 Private 46 34 2 10
Carnegie classification
 Doctoral/Research 23 18 0 5
 Research University (very high activity) 13 11 0 2
 Research University (high activity) 11 7 2 2
 Masters Colleges/University (larger programs) 3 2 0 1
 Masters Colleges/University (medium programs) 3 2 0 1
 Masters Colleges/University (smaller programs) 12 11 0 1
 Baccalaureate colleges—arts and sciences 3 1 0 2
 Baccalaureate colleges—diverse fields 0 0 0 0
 Special focus institutions—medical 5 2 0 3
 Unsure 6 5 0 1
Geographical region
 Middle Atlantic (DE, MD, PA, WV, DC, VA) 10 8 1 1
 South Atlantic (FL, GA, NC, SC, AL, PR, MS, TN) 8 6 1 1
 New York/New Jersey (NY, NJ) 8 8 0 0
 Great Lakes (IN, IL, MI, OH, WI, KY) 20 15 0 5
 West North Central (IA, KS, MN, MO, NE, ND, SD, AR, OK) 14 10 0 4
 West South Central (LA, TX) 7 5 0 2
 North East Coast (CT, ME, MA, NH, RI, VT) 3 2 0 1
 Pacific (CA) 4 2 0 2
 West Mountain States (CO, ID, MT, NM, UT, AZ, OR, WA, NV) 5 3 0 2
 Other (Canada, Scotland) 0 0 0 0
Abbreviations: ACCE = Academic Coordinator of Clinical Education; ADCE = Associate Directors of Clinical Education; DCE = Director of Clinical Education; DPT = Doctor of Physical Therapy; PD = Program Director.

METHODS

Research Design

This was a triangulation design mixed methods, nonexperimental Delphi study. Triangulation design mixed methods was chosen because the qualitative and quantitative methods were expected to bring different but synergistic data to provide a fuller understanding of the research topic.21 Brady22 clarified that to improve the rigor of Delphi studies, qualitative methods can be used so that refinement of data occurs throughout the study by coding occurring simultaneously until consensus is reached. Internal Review Board (IRB) approval was received through the university #2019-0855.

As directed, formal consent was not needed as completion of the survey was the method of consenting to the study.23 The Participant Information Form outlined all information needed for potential participants to make an informed choice regarding whether to participate.

As a part of the Delphi method, surveying the participants occurred until consensus was achieved. This typically occurs within a total of 3–4 survey rounds.22-24 In theory, the first round of this Delphi study occurred in the study by McCallum et al, where 5 primary themes emerged from that data and led to the development of the DCE Taxonomy and Matrix. The 2 subsequent rounds were performed as a part of this Delphi study. Delphi studies typically define both “consensus” and “near consensus” with percentages of agreement typically ranging from 51 to 100%.23 Consensus levels were defined as ≥80% and determined by the researchers as part of the data analysis process outlined below.

With this in mind, each survey in this study was provided in an online format through Survey Monkey.25 In accordance with the Delphi method, surveys in these subsequent rounds built on the responses collected in the previous round and asked participants to rank their agreement with statements provided using a 4-point Likert scale ranging from strongly agree to strongly disagree. No neutral option was exercised as supported through Dillman and DeCastellamau.26 Finally, open text boxes were also used for data collection for the qualitative aspect of the study.

The content of the first round Delphi survey questions was developed by the research team knowing that we were creating a new model for viewing the roles and responsibilities of the DCE. Questions came from reviewing each level of DCE Taxonomy by Engelhard et al.12 Furthermore, questions centered on level of agreement for each listed role, responsibility, and sample task listed. This was immediately followed by open-ended questions asking if any needed to be removed or any additional role, responsibility, or sample task needed to be added. With respect to the DCE Roles and Responsibilities Matrix, participants were asked to share at what level of agreement they have with the commonality of occurrence with each professional characteristic listed, including variety, routinization, skill set, and strategic leadership. Additionally, the participants were asked to consider each professional characteristic with the Taxonomy role that is reflected within the Matrix itself including Processor, Coordinator, and Director.

Several steps were taken to enhance the survey's ability to measure PDs' and DCEs' perceptions of the roles and responsibilities of the DCE. A consultant reviewed the survey and made recommendations to enhance the survey's readability. Additionally, a pilot of the survey was performed utilizing 1 program director and 1 faculty member. Revisions to the survey occurred based on their feedback.

The second round Delphi survey was based on the results of the first round and focused on the Taxonomy. Revisions of the Taxonomy were needed based on the participants' responses. After reviewing each of the Taxonomy's roles, responsibilities, and sample tasks, those that had reached consensus were set to remain in the Taxonomy where indicated, and others were deleted. Revisions were made to some degree to almost half of the taxonomy by moving a responsibility or task to another level, to refine the language to provide clarity of intent, and to add not previously identified responsibilities or tasks. Additionally, a column was added to the Taxonomy because many comments related to not understanding the amount of complexity of the responsibilities at the different Taxonomy levels.

Data Analysis

Quantitative data from closed items in the surveys, including demographics, were analyzed using descriptive statistics. The Taxonomy and Matrix questions, answered by Likert scale, were collapsed and consensus occurred if the percentages achieving “agree” and “strongly agree” were equal to or greater than 80%. Further inquiry also asked questions regarding if items should be kept or removed or if there were missing items. As the researchers moved through the survey rounds, these were also analyzed, and modifications to the Taxonomy and Matrix were completed if needed.

Qualitative data collected from open survey questions in each of the survey rounds were analyzed using a constant comparative method for content analysis as a part of the overall qualitative data analysis.27 The content analysis provided the direct option to analyze text as a part of the survey's open-ended questions. This included a 3-tiered process, as recommended by Miles and Huberman.28 The process included data reduction, data display, and data conclusion/verification. Data reduction in this study incorporated coding data to determine common themes and concepts identified by the qualitative researchers. As such, each qualitative research team member individually reviewed the data and then presented data codes and themes as derived from the raw data. Common areas of agreement were then reduced to establish common themes of roles, responsibilities, and sample tasks. Data display through review of the original Taxonomy and then suggested revisions led to further reduction and understanding of the data. Data conclusion occurred through review of the coding and themes, both added and removed, to determine the resulting next version of the Taxonomy for the second round survey. With the consensus levels established, when the second round survey responses returned, the revised Taxonomy's level of consensus was reviewed in comparison with the set consensus standard.

Trustworthiness of the qualitative methods included the researchers reviewing the database to confirm agreement with codes derived from the initial coding analysis. In addition, a consultant was engaged to support the study by reviewing the surveys to ensure that the questions aligned with the purpose of the study. Secure email exchanges between researchers served as a chronological account of the researchers’ notes along with maintaining minutes of researcher meetings. A secure, web-based platform was used to house spreadsheets. This process promoted a built-in audit trail that reflected the necessary steps to determine when consensus was achieved and ultimately secured the desired level of trustworthiness in the study.29

Roles of the Funding Source

The American Physical Therapy Association (APTA) Academy of Education supported this Delphi study but had no role in the design, conduct, or reporting of this study.

RESULTS

Round 1

Taxonomy

Round 1 data analysis occurred across the 3 levels of the Taxonomy, including Processor, Coordinator, and Director, as well as the Matrix. Within each level of the Taxonomy, the roles and responsibilities and sample tasks were evaluated. Qualitative analysis was completed and themes from the participants’ comments suggested new items and revised language for each level. The Matrix was analyzed with 4 DCE characteristics (variety, routinization, strategic leadership, and skill set) as the axis anchors and compared how they aligned with the 3 levels of the Taxonomy. The response rate for Round 1 was 78.2%.

Taxonomy—Processor Level

The Processor level analysis revealed that all items reached consensus. However, 15% of participants voiced that there were missing roles and responsibilities and 26% stated that there were missing sample tasks from this level. Qualitative analysis resulted in additions to the Taxonomy including the following sample tasks: onboarding students to meet clinical site requirements and data entry into database. Language refinements to produce clarity for the following roles and responsibilities: decisions produce consistent and predictable outcomes, and sample tasks refinements included: process clinical education (CE) documents, noncomplex contract maintenance, and identifies compliance with current policies and procedures.

Taxonomy—Coordinator Level

The Coordinator level analysis demonstrated only 1 of the 4 roles and responsibilities, Problem solving necessary skill, achieved consensus. Student remediation was the only sample task that did not achieve consensus for this level. Although the respondents felt that no items should be removed, 23% participants felt that there were missing roles and responsibilities and 32% reported that there are missing sample tasks. Qualitative analysis revealed language refinement including: awareness of impact of decisions and operationalize answer to achieve desired outcome, effective problem solving, and multitasking skills for roles and responsibilities. Sample tasks language refinement included: matching students to clinical sites for placement; noncomplex student remediation with collaboration from others; and serve as a CE resource for academic and clinical faculty. Suggested items to add included efficient and effective communication for roles and responsibilities and student advising and CE orientation for sample tasks.

Taxonomy—Director Level

The Director level analysis revealed all roles and responsibilities and sample tasks achieved consensus. However, 35% of participants stated there were missing roles and responsibilities and 36% reported missing sample tasks. Qualitative analysis indicated only 1 item, bridge agent between clinic and academy, needed language refinement. Roles and responsibilities additions included: oversee and guide CE team; data outcome assessment; executive function; provide representation at the local, state, regional, and national levels; and key resource for potential collaborative opportunities. Sample tasks additions included development, revision, and enforcement of policies and procedures; ensures adherence with accreditation and regulatory needs; and provides impact on development of curriculum based on contemporary practice.

Matrix

With respect to the Matrix, the 4 DCE characteristics that serve as axis anchors had that competency needed for skill set was most necessary at the Director level at 95% consensus, 90% at the Coordinator level, and 70% at the Processor Level consensus. With respect to strategic leadership, this too had this most necessary for the Director level at 98%, then the Coordinator and Processor level came in at 91%. Variety had 94% consensus at the Director level and then 80% and 68% for the Coordinator and Processor levels, respectively. These 3 levels indicate that these DCE characteristics demonstrate an accurate understanding of the levels within the Taxonomy. Regarding routinization, the Director level achieved the least necessary at 73%, Coordinator was considered moderately necessary at 83% and the Processor level was most necessary at 77%. Hence, the routine characteristic reveals that DCE's routine duties occur more at the Coordinator and Processor level and not at the Director level. From here, the research team determined no further revision to the Matrix was indicated. Finally, when asked where participants spend a majority of their time, they reported that their time is most spent in the Coordinator level as evidenced by the outcome of 56.63%.

Round 2

Taxonomy

Round 2 data analysis occurred across the 3 levels of the Taxonomy after revisions to language and added items within roles and responsibilities and sample tasks from Round 1. Qualitative analysis was completed to assure there was no additional language revisions or additional items that needed to be removed or added for each level. The response rate for Round 2 was 62.2%. See Table 2 for response rates by both rounds.

Table 2. - Responses by Round
Round 1 Round 2
Survey's delivered 110 113
Survey's returned 86 69
Return rate (%) 78 61
DCE/ACCE 59 54
ADCE 2 2
PD 18 13
Unknown 7 1
Total no. of respondents meeting inclusion criteria 86 69
Abbreviations: ADCE =Associate Directors of Clinical Education; DCE = Director of Clinical Education; ACCE = Academic Coordinator of Clinical Education PD = Program Director.

Taxonomy—Processor Level

The Processor analysis revealed that all revised roles and responsibilities achieved consensus (range: 89.86–94.20%). All revised samples tasks also achieved consensus (range: 86.95–98.55%).

Coordinator Level

The Coordinator analysis demonstrated similar results with all revised roles and responsibilities achieving consensus (range: 95.66–98.55%). With respect to sample tasks, consensus was demonstrated (range: 85.51–98.55%).

Director Level

Finally, the Director level analysis illustrated most roles and responsibilities, and sample tasks achieved 100% consensus. One sample task, acts as a bridge agent between clinic and academy, demonstrated 97.10% agreement.

With respect to the qualitative analysis for each of these levels, the same process for Round 1 occurred. The research team agreed that due to the themes revealing no new thematic roles, responsibilities or sample tasks and the level of consensus achieved indicated no further rounds of surveys were necessary. Table 3 reflects the ultimate consensus data achieved across all levels of the Taxonomy. Thus, Table 4 illustrates the final version of the revised Taxonomy.

Table 3. - Ultimate Consensus Across Taxonomy Levels
Director Level Roles and Responsibilities Overall Percent Consensus Sample Tasks Overall Percent Consensus
Oversees and guides CE team 100.00 Directs and guides overall coordination of CE aspects of physical therapy curricula 100.00
Serves as a key resource for potential collaborative opportunities 100.00 Acts as a bridge agent between clinic and academy 97.10
Observes CE trends/patterns through data outcome assessment and creates action plans 100.00 Provides valued input in curriculum development based on contemporary practice 100.00
Ensures adherence with accreditation and regulatory standards 100.00 Leads CE strategic planning and visioning 100.00
Provides representation at the local, state, regional, and national levels 100.00 Develops, revises, and enforces policies and procedures
Provides representation at the local, state, regional, and national level in the areas of scholarly work and service
100.00
Coordinator Level Roles and Responsibilities Overall Percent Consensus Sample Tasks Overall Percent Consensus
Manages noncomplex issues 95.66 Noncomplex student remediation with collaborative input from others 85.51
Makes decisions based on results of using current available data and creative problem-solving skills 98.55 CE resource for academic and clinical faculty 98.55
Has awareness of impact of decisions and able to operationalize solutions to achieve desired outcomes 98.55 Student advising 98.55
Uses exemplar communication skills to facilitate CE stakeholder relationship development 97.11 Matching students to clinical sites for placement 98.55
Prepares, supports, and debriefs students in aspects of CE 97.10 Clinical site visits
CE course instruction including prerotation student CE orientation, during rotation and postrotation debrief
98.55
Processor Level Roles and Responsibilities Overall Percent Consensus Sample Tasks Overall Percent Consensus
Executes standardized, routine procedures 94.21 Process CE documents 98.55
Decision making results in consistent, predictable outcomes 89.86 Gathers and enters data into database 97.10
Utilizes effective problem-solving and multitasking skills to complete tasks 94.20 Noncomplex contract maintenance 97.10
Communications result in maintenance of current CE stakeholder relationships 89.86 Onboarding students to meet clinical site requirements
Identifies noncompliance with current policies and procedures
92.75
86.95
Routine communications 97.10
Abbreviation: CE = clinical education.

Table 4. - Revised DCE Taxonomy
Levels Defined Category of Responsibilities Sample Responsibilities Sample Tasks
Director Consistently performs tasks that are not routine and little variability; requires high strategic leadership; incorporates decisions that require intramural and significant extramural representation, complex management, assessment and analysis • Oversees and guides CE team
• Serves as a key resource for potential collaborative opportunities
• Observes CE trends/patterns through data outcome assessment and creates action plans accordingly
• Ensures adherence with accreditation and regulatory standards
• Provides representation at the local, state, regional, and national levels
• Directs and guides overall coordination of CE aspect of physical therapy curricula
• Acts as a bridge agent between clinic and academic program
• Provides valued input in curriculum development based on contemporary practice
• Leads CE strategic planning and visioning
• Develops, revises, and enforces policies and procedures
• Disseminates scholarly work at the local, state, regional, and national levels
• Provides service at the local, state, regional, and national levels
Coordinator Consistently performs tasks that are moderately routine with some variability; requires moderate strategic leadership; incorporates decisions that require more intramural than extramural representation, and requires important and rapid responses based on standardized tasks • Manages noncomplex issues
• Makes decisions based on results of using current available data and creative problem-solving skills
• Has awareness of impact of decisions and able to operationalize solutions to achieve desired outcomes
• Uses exemplary communication skills to facilitate CE stakeholder relationship development
• Prepares, supports, and debriefs students in aspects of CE
• Noncomplex student remediation with collaborative input from others
• CE resource for academic and clinical faculty
• Student advising
• Matching students to clinical sites for placement
• Clinical site visits
• CE course instruction including prerotation student CE orientation, during rotation and postrotation debrief
Processor Consistently performs tasks that are mostly routine with low variety; requires minimal strategic leadership; incorporates decisions that require mostly intramural representation and requires responses based on standardized tasks that may lead to consult with others • Executes standardized, routine procedures
• Decision making results in consistent, predictable outcomes
• Utilizes effective problem-solving and multitasking skills to complete tasks
• Communications result in maintenance of current CE stakeholder relationships
• Process CE documents
• Gathers and enters data into database
• Noncomplex contract maintenance
• Onboarding students to meet clinical site requirements
• Identifies noncompliance with current policies and procedures
• Routine communications
Abbreviations: CE = clinical education; DCE = Director of Clinical Education.

DISCUSSION

It has been established through the studies by McCallum et al17 and Engelhard et al12 that there was a definitive need to identify and define the DCE's roles and responsibilities. Engelhard et al12 introduced the concept of a DCE Taxonomy and Matrix in 2018, which provided a visual representation of the roles and responsibilities of the DCE position. A need existed, however, to confirm the accuracy of these tools to integrate their use as proposed.

Our present study accomplished this goal by achieving consensus and confirming the accuracy of both tools through an evidence-based process. The results of this study provided the first investigation into the DCE position through the lens of taking DCE roles and responsibilities and building them into a Taxonomy and Matrix.

Insights gained by going through the process of confirming the accuracy with both the Taxonomy and the Matrix occurred. The Taxonomy revisions of the existing language promoted a clearer understanding of the DCE roles and responsibilities. Additions to the Taxonomy helped express the scope of each level. Participants were generous in sharing lists of roles and responsibilities but since an exhaustive list was not the intention, the emerged common themes that most accurately represented the DCE position were integrated into the Taxonomy. Hence, the Taxonomy became a conceptual framework that shares the emerged themes, noting that DCEs do much more than what the sample responsibilities and tasks share. With respect to the Matrix, we expected the levels of agreement to ascend or descend with what task or responsibility aligned with a particular Taxonomy level, which did happen. For example, the characteristic strategic leadership takes place mostly in the Director level, hence the highest percentage of agreement occurred at this level. The team also expected the Coordinator level to get the highest percentage of agreement due to that is where DCEs reported spend the most time.

Therefore, this Delphi study uncovered at what level the DCE Taxonomy and Matrix accurately reflects DCE practice as well as gained understanding of PD and DCE perceptions of DCE's skills and tasks with their role in the physical therapy program. When considering 3 different levels of work that will likely be accomplished in some cases by 1 person, does the program pause to assess the level of development of the DCE? Now a comparison can be made as to what the program needs and what development is further needed for the DCE so that there is an alignment of task fit and program goals. This can lead to further understanding of workload and the ambiguity that frequently surrounds the DCE position.

It is this DCE position's ambiguity that the study worked to bring understanding. The results identified a mental tug of war that occurs regularly in the work life of the DCE. It is the varying perceptions of the DCE roles and responsibilities by the DCE, program, and profession that leaves job satisfaction hanging in the balance. Triaging what needs to get done and how the impact of the stress that is associated with this dissonance could promote turnover and misperceptions. Delineation of the roles and responsibilities provides the DCE and program the opportunity to pause and see where time and energy are being spent. As the study by Watt illustrated, it is indeed wasteful for a physical therapist to consistently perform physical therapy aide duties, likewise a DCE should not overcommit time working at Processor level tasks when needing to address high-level tasks and demands.11

Keeping where DCEs and programs are spending their time in mind, alignment of this study with the contemporary issues of the profession must follow. The study by Jensen et al30 established a guide for future lines of educational research, with 1 specific call to foster innovation and cultivate shared values of excellence. This study indeed aligns with this edict within the dimension of Organizational Structures and Resources because it provides an organizational framework for DCEs and PDs when examining this key position in every physical therapy program. So as the profession turns its focus to exploring potential new educational frameworks such as Entrustable Professional Activities (EPAs), which could serve as a guide for assessing competency, we must do the same for the organization of physical therapy education.31 As the profession is working on contemporary competency assessments outwardly, we must also do the same inwardly. The DCE Taxonomy and Matrix provide the first tools to begin this inward-looking assessment.

Consensus for this study combined business, health care, and higher education organizational knowledge. It is this organizational framework that the Taxonomy exemplifies, which led us to understanding what achieving consensus meant. Achieving consensus on the Taxonomy took into account the work of the DCE as a bridge agent. This study provides a pathway toward an organizational framework for our educational programs by grouping the duties of the DCE. We invest an enormous amount of time in getting the curriculum just right, the matriculation of the right students, and the students' ultimate success in our programs. We suggest that we also must take the time to focus on how our programs and departments are organized. There are responsibilities and tasks that arise in the daily operations of our programs that are shifted to the DCE because it is their area of expertise without thoughtful consideration for what is currently on their task list. What is the impact of this shifting and sometimes crisis management to the DCE, the program, and the profession? Seeking this new understanding is key not only to the DCE but also in each role in physical therapy education. Our study affirms that the DCE roles and responsibilities now have a structural framework but what about the impact of these tasks and their alignment with DCE characteristics? This will be understood as the next step in this study is completed.

Limitations

One of the biggest limitations of this study was the timing of its launch. Recruitment began at the end of February 2020, with Round 1 surveys being sent mid-March 2020. This is when the impact of the COVID 19 pandemic was beginning to be felt across the United States. Potential for participation likely could have been much higher if the study had been delayed. Another limitation potentially affected by the pandemic included retaining participants in the study across all rounds. Utilizing the Dillman method for recruitment and ongoing participation minimized these issues. Finally, examination of time in position for both DCEs and PDs would have enabled another lens to look through because it would relate to the perspective of the individual in the position by title and time. However, it was not necessary to do so to answer the research questions posed for this study.

Conclusion

The results of this study indeed set the stage for a better understanding of the roles and responsibilities of the DCE. The revised Taxonomy and Matrix serve to provide a framework to build upon in understanding the work and workload of the DCE. This study provides potential insights to DCE job satisfaction. Chi et al.18 elucidate the importance of job fit and its impact on turnover. Thus, the study brings to light elements that can contribute to burnout and alternatively success in the DCE position. Each of these factors is critical to the longevity of the DCE, which ultimately contributes to the success of the physical therapy program.

Collectively, these studies have demonstrated the multidimensional aspects of physical therapy clinical education and have begun to outline the complex role the DCE has in contributing to the overall success of a student's educational experience in a DPT program. We believe the findings of the studies by McCallum et al17 and Engelhard et al12 require a deeper investigation to gain further insights to the impact of the roles and responsibilities of the DCE.

Hence, future studies need to focus on the impact of task fit alignment for the DCE. A better understanding of impact could promote opportunities for improved job satisfaction, efficiencies of systems, and potentially causation for turnover in the DCE position. With the Matrix and Taxonomy now fully vetted, perhaps an evaluative tool could be developed to assess the effectiveness of the DCE in their role because it relates to these tools. The results of this study provide additional support for consideration of clinical education to become an area of specialization, which has been suggested in recent years.17 Should it be similar to other areas where there is not a direct patient touchpoint? Could it become a professional development leadership program like the APTA Fellowship in Education Leadership or LAMP Institute for Leadership? Finally, since business has a long history of utilizing taxonomies to facilitate efficiency and effectiveness, a similar study focusing on the Physical Therapist and Physical Therapist Assistant Program Director is imperative as the development of a Program Director Taxonomy and Matrix would bring invaluable insights to that position and its impact on PT and PTA Programs.

FUNDING

The American Physical Therapy Association (APTA) Academy of Education supported this Delphi study but had no role in the design, conduct, or reporting of this study.

ACKNOWLEDGMENTS

Special thanks to Dr. Diane Jette for her guidance throughout the development of the survey methods and analysis of this study. Also, special thanks to Sarah Doren, BHS, SPT for logistical support throughout the study.

REFERENCES

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Keywords:

Clinical education; Taxonomy; Matrix; Workload

© 2021 Academy of Physical Therapy Education, APTA