Failure in Clinical Education: Using Mindfulness as a Conceptual Framework to Explore the Lived Experiences of 8 Physical Therapists

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Literature Review.

Mindfulness, a purposeful and nonjudgmental awareness of internal affective states, is an emerging, evidence-based practice that has not yet gained credibility in physical therapist education. Each year, a small but significant number of graduate students fail a clinical course due to difficulty integrating affective domain skills. These skills are embedded in what is commonly known as generic abilities and include patient safety, professionalism, interpersonal skills, stress management, and communication. To date, it is unknown how they think or why they struggle.


This retrospective, phenomenological study explored the lived experiences of 8 physical therapists (PTs) between the ages of 25 and 30 who, at some point, failed a clinical education course. Within the context of mindfulness theory, semistructured interviews were used to explore internal barriers prior to failure and transformative experiences upon successful completion.


Three themes emerged from the data. “Disconnect” occurred in the pre-failure phase, representing a lack of communication internally and externally. “Failure as Nothingness” was illustrative of the time that participants learned that they had failed the clinical experience. “Reconnect” occurred post-failure as participants worked with new clinical instructors and began to refocus on affective domain skills and the human side of patient care.


In the pre-failure phase, all 8 participants demonstrated behaviors consistent with mindlessness. In the post-failure phase, each participant revealed a significant shift toward an expanded patient focus, but none learned to suspend self-judgment or gain present moment awareness. These elements of mindful practice have been found to reduce medical errors, improve patient-centered care, reduce burnout, and promote well-being. Adding mindful practice to the formal physical therapy curriculum may offer a means to promote intrapersonal awareness for students who struggle in clinical education experiences.

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