Shared Steps to Independence: Qualitative Exploration of a 4:1 Collaborative Pediatric Clinical Education Model

Authors

Kathryn E. Sawyer, Tufts UniversityFollow
Megan B. Flores, Baylor UniversityFollow
Elizabeth M. Ardolino, Baylor UniversityFollow

Abstract

Purpose: As demand for pediatric clinical placements increases, innovative supervision models are needed to expand capacity while supporting student learning. Grounded in situated learning and Communities of Practice theory, a 4:1 collaborative clinical education model was designed with four students to one clinical instructor (CI). This study explored how participation in this 4:1 collaborative pediatric clinical education model influenced physical therapy students’ learning, professional identity development, and clinical practice. Method: A qualitative study using a social constructivist paradigm was conducted. Nine Doctor of Physical Therapy students who completed a 4:1 collaborative pediatric clinical placement participated in semi-structured interviews immediately following the experience. Interviews were transcribed verbatim and analyzed using constant comparative methodology and thematic analysis. Two researchers independently coded transcripts, developed a shared codebook, and ensured analytic rigor through researcher triangulation, audit trails, consensus meetings, and NVivo reliability checks (percent agreement 99.06%, κ = 0.75). Data saturation was achieved after nine interviews. Results: Three major themes emerged: (1) Learning environment: students described a psychologically safe, supportive, and informal environment that encouraged inquiry, collaboration, and risk-taking; (2) Communication and interpersonal dynamics: peer feedback, shared decision-making, and caregiver communication enhanced confidence and interpersonal awareness; and (3) Student taking ownership: students progressed from reliance on the clinical instructor to increasing autonomy and initiative in patient care. The overarching theme, Shared Steps to Independence, reflected how peers and the clinical instructor collectively supported students as they moved from peripheral participation toward independent practice. Students valued learning alongside peers and described the clinical instructor as approachable and collaborative; however, some desired more structured feedback within the otherwise informal setting. Conclusions: The 4:1 collaborative model supported clinical skill development while also fostering professional identity formation and confidence. Functioning as a Community of Practice, the model provided psychological safety, shared responsibility, and opportunities for autonomy. These findings suggest the 4:1 collaborative model may expand clinical placement capacity while enhancing student learning outcomes. Programs implementing this approach should include clear expectations and structured feedback to maximize learning.

Author Bio(s)

Kathryn Sawyer is an Assistant Professor and Director of Clinical Education in the Doctor of Physical Therapy Program at Tufts University School of Medicine. A board-certified orthopedic clinical specialist, her academic and research interests focus on clinical education, communication in patient care, and innovative models for preparing future physical therapists.

Megan Flores is Clinical Associate Professor in the Doctor of Physical Therapy Program at Baylor University. A board-certified pediatric clinical specialist, her clinical and scholarly work emphasize pediatric physical therapy practice and education. She is committed to advancing clinical training models that enhance student learning and patient outcomes across pediatric populations.

Elizabeth Ardolino is Clinical Associate Professor in the Doctor of Physical Therapy Program at Baylor University. Her clinical experience centers on neurorehabilitation of both pediatric and adult clients. She brings this expertise to her teaching and scholarship, focusing on clinical education, interprofessional practice, and innovative strategies to support student success.

Acknowledgements

The authors would like to thank the students who volunteered to participate in this study. We appreciate their time and thoughtful reflections. Thank you to the clinical instructor who continues to embrace the 4:1 collaborative model. The authors used artificial intelligence (AI) assistance (ChatGPT, OpenAI) to improve the clarity and flow of the manuscript. The AI was not used to generate content or conduct data analysis. All intellectual content, interpretations, and conclusions are the sole responsibility of the authors. The authors have no relevant financial or non-financial interests to disclose. The authors have no con¬flicts of interest to declare that are relevant to the content of this article. The author certifies that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial inter¬est in the subject matter or materials discussed in this manuscript. The author has no financial or proprietary interests in any material discussed in this article. Data availability Data is provided within the manuscript or supplementary information files. Declarations Ethical approval Research Investigation Approved by the University of St. Augustine for Health Sciences IRB (case no. PT-0413-332) Consent to participate Informed consent was obtained from all individual participants included in the study. Competing interests The authors declare no competing interests.

Recommended Citation

Sawyer KE, Flores MB, Ardolino EM. Shared Steps to Independence: Qualitative Exploration of a 4:1 Collaborative Pediatric Clinical Education Model. The Internet Journal of Allied Health Sciences and Practice. 2026 Mar 03;24(1), Article 28.