AT EDUCATION
An Instrument for Measurement
of Clinical Instructor Behaviors
Christine A. Lauber, EdD, ATC, LAT and Clyde B. Killian, PhD, PT • University of
Indianapolis
CLINICAL EDUCATION is a critical compo-
nent of athletic training education; it provides
students with opportunities to apply skills in
real situations while fostering clinical reason-
ing skills.1,2 Additionally, clinical education
fosters a unique relationship between clini-
cal instructors and students that facilitates
student learning of cognitive knowledge and
psychomotor skills and
fosters the develop-
Key Points ment of professional
Athletic training education program admin- behaviors that are fun-
istrators should evaluate clinical instructor damental for the prac-
effectiveness on the basis of sound mea- tice of athletic training.
surement procedures. Thus, clinical instructor
behaviors are key com-
Categories of clinical instructor behaviors ponents of the profes-
include Interpersonal and Professional sional development of
behaviors. athletic training stu-
dents.
Use of a psychometrically sound instrument The Commission
can identify ACI development needs. on Accreditation of
Athletic Training Edu-
cation (CAATE) Stan-
dards for the Accreditation of Entry-Level Ath-
letic Training Education Programs3 includes
standards related to the training and respon-
sibilities of an Approved Clinical Instructor
(ACI). Additionally, the Standards3 indicate
that Athletic Training Education Programs
(ATEP) must include measures of the quality
and effectiveness of clinical instruction and
16  january 2009 Athletic Therapy Today
Shane Caswell, PhD, ATC, Report Editor
provide data that demonstrate outcomes
related to this quality and effectiveness in a
comprehensive assessment plan. In addition
to student evaluation of clinical instructors,
ATEP program administrators should evalu-
ate the effectiveness of clinical instructors.
Moreover, each ACI should be given the
opportunity for self-assessment of his or her
effectiveness as an ACI.
Administrators of ATEPs often develop
and share tools for evaluation of clinical
instruction that may not be psychometri-
cally sound. Instruments that provide valid
and reliable data are essential for mea-
surement of clinical instructor behaviors.
Healthcare professions such as medicine,4-7
nursing,8-10 dentistry,11,12 and nurse anes-
thesia13 have developed tools with sound
psychometric properties to assess the effec-
tiveness of clinical instruction and clinical
instructor behaviors, while athletic training
has modified observational tools.14 Recently,
Weidner and Henning15 established stan-
dards and criteria for selection, retention,
and evaluation of ACIs, which have been
found important and applicable to a variety
of clinical education settings.16 The purpose
of this report is twofold: (a) to describe the
process that we followed to develop an
instrument that demonstrates reliable and
valid properties for evaluation of ACIs and
(b) to discuss its practical applications for
© 2009 Human Kinetics • Att 14(1), pp. 16-20
 ATEP administrators and ACIs to identify areas of
strength and weakness.
Clinical Instructor Behavior Instrument
Initial Development
Based on a review of the health professions education
literature, the Clinical Instructor Behavior Instrument
(CIBI) was developed to identify the relative impor-
tance of various clinical instructor behaviors. The
initial survey contained 30 behavior statements that
were grouped into five categories: (a) evaluative, (b)
instructional, (c) interpersonal, (d) personal, and (e)
professional. Each category contained six behavior
statements. In previously published research using
this survey, 75 program directors and 242 clinical
instructors rated the importance of each behavior
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statement on a Likert Scale (1 = least important, 5
= most important).17 The initial CIBI demonstrated a
high level of internal consistency (Cronbach’s alpha =
0.94. Reliability values for the five behavior categories
ranged from 0.73–0.85). A panel of experts attested
to its face validity and content validity.
Clinical Instructor Behavior Category Analysis
We performed factor analysis to determine whether or
not the 30 behavior statements could be grouped into
the five categories indicated by the literature. Recom-
mended load cut-off points range from 0.30 to 0.55.18
Because we wanted statements to be substantially
representative of a concept, we chose an 0.40 criterion.
The five-category model accounted for 55% of the
variance, but several behavior statements loaded on
more than one category (>0.40) or did not meet our
criteria to load on a category. The behavior statement,
“demonstrates honesty when working with students
and athletes/patients,” loaded as its own category.
To determine whether or not the statements could
be reduced to four categories, we performed another
analysis, which indicated that several statements
loaded on more than one category. Thus, further survey
refinement was needed.
Expert Panel Review
To determine whether or not behavior statements
could be categorized into a more meaningful and
practical framework, five athletic training educators
and clinical instructors served as a panel of experts.
Athletic Therapy Today
We asked the panel to review both the five-category
and four-category models. For each model, we asked
the panel to (a) review the behavior statements in
each category and to determine whether or not the
statements belong to its assigned conceptual category,
and (b) provide a label for the category. If a statement
loaded on more than one category or did not load on
any category, we asked the panel to determine whether
or not the statement described an important clinical
instructor behavior and to place the statement in a
category where it conceptually belongs. Each member
of the panel indicated that all 30 behavior statements
were important.
Final Analysis
After reviewing the expert panel’s feedback, three
categories of behavior statements emerged; however,
we did not find profound differences in behavior
statements among the three categories. The three
categories were then collapsed into two categories,
which were reviewed again by the panel of experts to
(a) determine whether or not the statements belong to
its assigned category and (b) to provide a label for the
category. The final instrument identifies two catego-
ries of clinical instructor behaviors to provide clarity
in interpretation and sound psychometric properties.
Each category consists of 15 separate statements that
identify “interpersonal” or “professional” behaviors
(Table 1). The Cronbach’s alpha for both of the two
categories indicates high reliability (Interpersonal =
0.90; Professional = 0.90). Deletion of any statement
from either category would not increase the reliability.
To further demonstrate that these two categories rep-
resent different concepts, the Wilcoxon Signed-Ranks
Test revealed a large difference between the two cat-
egories (z = -7.353; p < .001). Figure 1 provides a
summary of the Clinical Instructor Behavior Instrument
development process.
Discussion
The CIBI is a psychometrically sound instrument that
quantifies interpersonal and professional behaviors
that are important to program directors and clinical
instructors. The interpersonal behaviors identified by
the CIBI pertain to interaction between the ACI and
the student and characteristics that are associated
with personality. Interpersonal behaviors can also be
january 2009  17
 Table 1. Important Clinical Instructor Behaviors
Interpersonal Behaviors
Demonstrates honesty when working with students and
athletes/patients.
Displays a sense of humor.
Demonstrates interest in athletes and their care.
Demonstrates flexibility when working with students.
Corrects students tactfully without belittling them.
Demonstrates self-control and patience.
Demonstrates enthusiasm for teaching and athletic
training.
Maintains an atmosphere that allows expression of
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opinions.
Encourages students to feel free to ask questions or
to ask for help.
Is available and accessible to students when needed.
Exhibits a genuine interest in the student.
Demonstrates confidence in and respect for the student.
Accepts responsibility for own actions.
Is friendly and outgoing when working with students.
Provides support and encouragement to students.
characterized as humanistic attributes in that they
portray personal values such as integrity and honesty.
Additionally, these behaviors relate to provision of a
caring and open atmosphere for learning. After per-
forming the initial factor analysis, we were surprised to
find that the statement, “demonstrates honesty when
working with students and athletes/patients,” loaded as
a separate distinct factor. Weidner and Henning16 found
the ACI standard of legal and ethical behavior to be the
most crucial standard of the seven standards that they
developed. It is apparent that ATEP directors and ACIs
view honesty as a critically important behavior.
The professional behaviors identified by the CIBI
relate to the teaching, evaluative, and mentoring roles
of the ACI. These professional behaviors may be more
easily developed and may be more modifiable than inter-
personal behaviors. Personal continuing education and
ACI training sessions might address professional behav-
iors through review of literature pertaining to teaching,
learning, and developing mentoring relationships.
18  january 2009 Athletic Therapy Today
Professional Behaviors
Explains procedures clearly.
Demonstrates clinical skills for students.
Facilitates students’ awareness of their own professional
responsibility.
Provides useful and constructive feedback.
Explains the basis for actions and decisions.
Provides practice opportunities for students.
Demonstrates objectivity and fairness in the evaluation of
the student.
Observes and assesses student clinical performance
frequently.
Demonstrates clinical knowledge, competence,
and judgment.
Relates underlying theory to athletic training clinical
practice.
Stimulates student problem solving and critical thinking.
Provides specific suggestions for student improvement.
Acts as a professional role model.
Answers student questions clearly and precisely.
Defines clearly the expectations of students.
Implications
for Athletic Training Educators
In addition to tools used in the healthcare professions
and the standards created by Weidner and Henning,15
the CIBI provides a tool for ATEP administrators to
evaluate clinical instruction effectiveness and a tool for
ACIs to perform self-assessment of clinical instruction.
Program directors and clinical education coordinators
are encouraged to use this tool to provide feedback
to ACIs. After completing the CIBI, program admin-
istrators are better able to identify specific topics to
address in continuing ACI training and for individual
ACI development. By evaluating ACIs in two broad cat-
egories, program administrators can more efficiently
identify areas of strength and weakness. Program
administrators can rate specific behaviors in the two
categories to improve teaching, rather than having to
interpret ratings for a greater number of categories.
After reviewing the five-category model, a program
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Figure 1 Summary of the clinical instructor behavior instrument development.

director serving on our expert panel stated, “I don’t nesses. This information provides a framework for
like the categories – too many options.” ACIs to select continuing education options that will
ACIs can use the tool for self-assessment of address areas of weakness or perceived need, and
interpersonal and professional strengths and weak- they will have valid information to make suggestions

Athletic Therapy Today january 2009  19

 or professional behaviors that may be demonstrated
Table 2. Likert Scale Sugges- by ACIs. It may be tempting for ATEP administrators
tions for Practical Application to have students use the CIBI for evaluation of their
Program Director ACIs, but it was developed using ATEP directors and
The clinical instructor demonstrates the appropriate ACIs who may see the importance of interpersonal
behavior and does not need development. and professional behaviors differently than students
view them. 
Strongly disagree
Disagree
References
Neither agree nor disagree
1. Gaberson KB, Oermann MH. Clinical Teaching in Nursing. New York:
Agree Springer Publishing Company; 1999:12-21,57-75.
Strongly agree 2. Reilly DE, Oermann MH. Clinical Teaching in Nursing Education. 2nd
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The behavior is a strength. 3. Commission on Accreditation of Athletic Training Education. Stan-
dards for the accreditation of entry-level athletic training education
Strongly disagree programs. Available at http://caate.net/documents/standards.12.7.07.
pdf. Accessed August 11, 2008.
Disagree 4. Miller MD. Factorial validity of a clinical teaching scale. Educ Psychol
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Neither agree nor disagree Meas. 1982;42:1141-1147.

5. Shellenberger S, Mahan JM. A factor analytic study of teaching in off-
Agree campus general practice clerkships. Med Educ. 1982;16:151-155.
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I am confident in my ability to demonstrate the measure the effectiveness of clinical teaching in an academic medical
behavior, and do not need development. center. Acad Med. 2000;75:161-166.
8. Zimmerman L, Westfall J. The development and validation of a
Strongly disagree scale measuring effective clinical teaching behaviors. J Nurs Educ.
1988;27:272-277.
Disagree 9. Fong CM, McCauley GT. Measuring the nursing, teaching, and interper-
Neither agree nor disagree sonal effectiveness of clinical instructors. J Nurs Educ. 1993;32:325-
328.
Agree 10. Reeve MM. Development of an instrument to measure effectiveness
Strongly agree of clinical instructors. J Nurs Educ. 1994;33:15-20.
11. Myers B. Beliefs of dental faculty and students about effective clinical
The behavior is a strength. teaching behaviors. J Dent Educ. 1977;41:68-76.
12. Romberg E. A factor analysis of students’ ratings of clinical teaching.
Strongly disagree J Dent Educ. 1984;48:258-262.
Disagree 13. Haag GP, Schoeps NB. Development of a reliable nurse anesthesia
clinical instructor evaluation instrument. AANA J. 1993;61:158-164.
Neither agree nor disagree 14. Stemmans CL, Gangstead SK. A psychometric investigation of the
Agree clinical instruction analysis tool-athletic training II. Percept Mot Skills.
2000;91:1040-1044.
Strongly agree 15. Weidner TG, Henning JM. Development of standards and criteria for
the selection, training, and evaluation of athletic training approved
clinical instructors. J Athl Train. 2004;39:335-343.
for ­continuing ACI workshops that will best meet their 16. Weidner TG, Henning JM. Importance and applicability of approved
clinical instructor standards and criteria to certified athletic trainers in
needs. Additionally, ACIs can consult with program different clinical education settings. J Athl Train. 2005;40:326-332.
administrators for access to resources that will further 17. Lauber CA, Toth PE, Leary PA, Martin RD, Killian CB. Program directors’
their development. and clinical instructors’ perceptions of important clinical-instructor
behavior categories in the delivery of athletic training clinical instruc-
The original Likert Scale used to test the CIBI will tion. J Athl Train. 2003;38:336-341.
need modification to address the needs of ATEP admin- 18. Munro BH. Statistical Methods for Health Care Research. 5th ed. Phila-
istrators and for its use in ACI self-assessment. Table 2 delphia: Lippincott Williams & Wilkens; 2005:332.

provides examples of scales that may be useful to mea-

Christine Lauber is associate professor of athletic training and clinical
sure ACI strengths and weaknesses. Although the CIBI education coordinator at the University of Indianapolis.
demonstrates sound psychometric properties, it may Clyde Killian is an associate professor in the Krannert School of Physi-
not adequately assess the full range of interpersonal cal Therapy at the University of Indianapolis.

20  january 2009 Athletic Therapy Today