Prevalence of Stress and Burnout in Physical Therapist Clinical Instructors

Abstract

Introduction

This study investigates the prevalence of stress and burnout among Physical Therapy Clinical Instructors (PT CIs) using the Perceived Stress Scale - 10 (PSS-10) and Oldenburg Burnout Inventory (OLBI) surveys. Given the critical role of PT CIs in student education, understanding their stress and burnout levels is essential.

Review of Literature

The, PSS-10, a 10-item self-report survey, measures perceived stress with scores ranging from 0–40. It has demonstrated good psychometric properties, including test-retest reliability (r = 0.77) and criterion validity (r = −0.70 with SF-36). The OLBI, a 16-item survey, assesses burnout through disengagement and exhaustion subscales, showing strong reliability (r = 0.85) and validity.

Subjects

The study included 494 PT CIs who met the inclusion criteria of having supervised a student physical therapist (SPT) within the past 12 months and working full-time. Participants were nationally recruited via emails and social media.

Methods

A cross-sectional design was employed. Participants completed an electronic survey consisting of a demographic form and the PSS-10 and OLBI measures. Data were analyzed using IBM SPSS Statistics, with one-way ANOVAs conducted to assess differences between demographic groups. This study was conducted midway through the COVID-19 pandemic.

Results

The mean PSS-10 score was 15, indicating moderate stress for 56.1% of participants. The mean OLBI score was 36.95, indicating moderate burnout for 65.4% of participants. Significant differences between groups in both stress and burnout were found across age and marital status variables. Notably, women reported higher burnout levels than men.

Discussion and Conclusion

PT CIs exhibit moderate stress and burnout levels, similar to general PT populations. The findings highlight the need for targeted interventions supporting PT CIs, particularly considering the COVID-19 pandemic impact. Future research should explore additional factors influencing PT CI stress and burnout and develop strategies of mitigation.

INTRODUCTION

To earn the Doctor of Physical Therapy (DPT) degree, a student must complete a minimum of 30 weeks of full-time clinical education.¹ This required component of a student physical therapist’s (SPT’s) education requires licensed physical therapists (PTs) to mentor and supervise the SPTs during these clinical experiences. Mentoring and supervising an SPT may be considered burdensome to an already overloaded PT; however, it may decrease stress and burnout on the PT clinical instructor (CI).² This study investigated the prevalence of stress and burnout among PT CIs.

REVIEW OF LITERATURE

In 1982, Christina Maslach expanded Frudenberger’s original 1974 concept of burnout through the creation of 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA).^3–5 Over the past 4 decades, burnout has been widely studied due to its impact on employees’ mental and physical health and the work environment. Exploring its dimensions is necessary to enable a deeper understanding of burnout. The first dimension, EE, is defined as “the state of being physically and emotionally exhausted by work stress.”^6(p2) The concept of work influencing individual burnout levels is a central principle to burnout and its various dimensions.⁷ A person experiencing exhaustion may also experience DP, the second dimension of the burnout construct. DP is “the interpersonal aspect of burnout that manifests in unfeeling, negative behaviors towards others, and detachment from caring and instructions.”^6(p2) DP may be evidenced by the callous manner in which an individual experiencing burnout may respond to team members and individuals relying on their services.⁸ Such behaviors may result in detachment from coworkers, patients, and job duties.^9,10 The third dimension of burnout, PA, is “a state of negatively evaluating oneself as being incompetent, unsuccessful, and inadequate.”^6(p2) The dimension of PA refers to an individual who becomes inefficient with work tasks and thus demonstrates reduced work performance and job morale.¹¹

Much of the healthcare literature focuses on physician and nurse burnout, with limited published research focusing on burnout in PTs. Available studies report burnout characteristics among PTs similar to other healthcare providers. Anderson’s¹² 2014 study, using the Maslach Burnout Inventory (MBI) and Perceived Stress Scale – 10 (PSS-10) found 13% of PTs had burnout with 15% experiencing high stress from a national sample with 1,366 respondents from various practice settings.¹² Anderson¹² concluded that 29% of PT respondents experienced high EE, while 7.8% demonstrated high DP, and 7.2% presented with low PA.¹² Noting the increase in EE, Link et al.² in 2021 conducted a correlational study involving 384 surveys from across the United States on physical therapy and burnout.² The authors found that their data suggested a potential correlation between EE and years of practice.² Recent work by Pugliese et al.¹³ in 2023, explored the prevalence of burnout in 2,813 PTs through a national cross-sectional study using the Burnout Clinical Subtypes Questionnaire.¹³ This study found nearly 50% of PTs were currently experiencing burnout.¹³ However, of those who received and provided mentorship, a significantly lower rate of burnout was found.¹³

The National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention state work stress occurs when a misalignment between job requirements and resources exists.¹⁴ NIOSH recognizes the working conditions for healthcare workers as “intensely stressful” due to work demands related to patient care.¹⁴ The COVID-19 pandemic presented new challenges, such as increased work demands, fatigue, stress, and strain.¹⁴ Stress is frequently seen as a burnout precursor. In 2007, Podsakoff et al.¹⁵ conducted a meta-analysis to examine the impacts of different stressors on employee job attitudes, turnover intentions, and withdrawal behaviors.¹⁵ Podsakoff et al.¹⁵ noted that an individual may view stress as constraining personal and work-related development while associating stress with lower job satisfaction and company loyalty.¹⁵ Expanding on the notion of work-related stressors, in 2021, Patel and Bartholomew¹⁶ conducted a cross-sectional survey exploring the impact of job resources and demands on burnout in physical therapy. Similar to Podsakoff and Maslach, Patel and Batholomew¹⁶ noted factors such as provider autonomy, competence, and relatedness as essential for psychological well-being, while physical demands and accumulated traumatic stress were significant sources of stress for PTs.¹⁶

Burnout studies often include a stress outcome measure such as the PSS-10. A 2012 systematic review by Lee¹⁷ found the PSS-10 highly reliable (r > 0.70) and valid across demographic groups.¹⁷ When reviewing the known-groups validity, Lee¹⁷ noted that there were significantly lower PSS scores related to age, employment, race, income, marital status, and number of dependents in the household.¹⁷ However, findings of gender differences in PSS-10 scores were inconsistent.¹⁷

Without providing an aggregate score, the MBI measures burnout through three dimensions: EE, DP, and PA.¹⁸ The Oldenburg Burnout Inventory (OLBI) offers an alternative method of measuring exhaustion and disengagement while providing an aggregate score.¹⁹ The OLBI does not include the subscale of PA because the authors did not consider PA to be a core dimension of burnout.²⁰ Unlike the MBI, the OLBI offers both positive and negative questions, which may reduce the participants’ ability to guess the intent of the questions and is freely available for research purposes.²⁰

Though literature suggests that stress and burnout may impact PTs, assessing stress and burnout in PTs who are also CIs is important due to their critical role in student education. CIs may be unable or unwilling to supervise and mentor a student if they are already experiencing stress and burnout. Likewise, PTs taking on a CI role may report stress and burnout differently than those not in that additional role. No publications have been identified that explore the prevalence of burnout in PT CIs. The study’s first aim was to address this gap in the literature by determining the prevalence of stress and burnout in PT CIs. The second aim was to determine if there was a significant difference in stress and burnout aggregate and subscales of exhaustion and disengagement based on collected demographic factors.

SUBJECTS

According to the American Physical Therapy Association (APTA) in 2019, there were over 310,000 licensed PTs in the United States; however, in May 2021, the United States Bureau of Labor reported 225,350 employed PTs.^21,22 To determine an appropriate sample size needed for survey research, Taherdoost²³ determined that 384 survey respondents were needed to achieve a 5% margin of error and 95% confidence level for a population size greater than 250,000.²³ For this study, inclusion criteria included PTs who had supervised an SPT for a clinical education experience within the past 12 months and who practiced full time (at least 32 hours a week). Exclusion criteria included CIs who were not the primary instructors for an SPT in the past year. “Primary” was defined as having greater than 50% responsibility for the SPT education and performance evaluation.

METHODS

A cross-sectional study design was used to address the aim of this study. Texas Woman’s University and the University of Texas Medical Branch institutional review boards approved this study. Participant’s completion of the electronic surveys constituted informed consent. The purpose of the study was stated in recruitment messaging and forms.

Procedures

Participants were recruited using a convenience sample and a snowball method. Recruitment emails were sent to the directors of clinical education (DCEs) for DPT programs across Texas utilizing the Texas Consortium for Physical Therapy Clinical Education listserv. Additionally, DCEs outside of Texas were contacted via publicly available email addresses from DPT program websites. Participation was also requested through social media (e.g., Facebook), and the member listservs of the APTA Academy of Education, Academy of Orthopedic Physical Therapy, and American Academy of Orthopedic Manual PTs, the listservs of state chapters of the APTA for NC, SC, FL, TX, and LA along with the Foundation for Physical Therapy Research listserv due to cost restrictions or denials from other listserves. The recruitment email requested recipients to forward the study invitation to anyone qualifying for the study. The recruitment email provided a link to the REDCap platform.

Data Collection

The secure web application software REDCap maintained the participant responses to the survey. The recruitment email requested a one-time completion of a demographic form, the OLBI, and the PSS-10. Consent was assumed when the participant submitted the survey responses. Data were collected anonymously, and responses were assigned a unique ID number. At the end of the demographic form, participants were asked to provide an email if they wished to participate in future studies about this research. All surverys were distributed, midway through the COVID-19 pandemic. Demographics collected may be found in Table 1.

Table 1.

Demographic Data of Study Participants (n = 494)

Variable	Frequency	Percentage
Gender
Man	157	31.8
Woman	329	66.6
Gender variant/Non-conforming	1	0.2
Not listed	1	0.2
Prefer not to say	6	1.2
Age in years
20–24	0	0
25–29	92	18.6
30–34	143	28.9
35–39	86	17.4
40–44	50	10.1
45–49	35	7.1
50–54	40	8.1
55–59	23	4.7
60–64	14	2.8
65–69	6	1.2
70+	3	0.6
Prefer not to say	1	0.2
Missing	1	0.2
Years as a PT
<1	1	0.2
>1–5	138	27.9
6–10	140	28.3
11–15	60	12.1
15+	152	30.8
Missing	3	0.6
Average amount of time on administration tasks
0 hours	61	12.3
1–2 hours	165	33.4
3–4 hours	123	24.9
5–6 hours	74	15.0
7–8 hours	30	6.1
9–10 hours	13	2.6
10+ hours	27	5.5
Missing	1	0.2
Setting of primary employment
Hospital based in-patient	116	23.5
Hospital based out-patient	149	30.2
Non-hospital based in-patient	3	0.6
Non-hospital based out-patient	197	39.9
Other	28	5.7
Missing	1	2
Caseload
Pediatrics	24	4.9
Adult Outpatient Orthopedics	290	58.7
Adult In-patient Neurologic	40	8.1
Adult Out-patient Neurologic	32	6.5
Acute care	69	14.0
Geriatrics	14	2.8
Other	21	4.3
Missing	4	0.8
Marital status
Single	109	22.1
Married	335	67.8
Divorced	17	3.4
Widowed	2	0.4
Partnered	26	5.3
Other	5	1.0
Number of children in the household who are dependents
0	252	51.0
1	91	18.4
2	106	21.5
3	35	7.1
4	6	1.2
5+	0	0
Missing	4	0.8
Entry-level physical therapy degree earned
Bachelors	55	11.1
Masters	80	16.2
Doctorate	356	72.1
Other	2	0.4
Missing	1	0.2
Highest degree earned
Bachelors	27	5.5
Masters	62	12.6
Doctorate	385	77.9
Doctorate-academic	11	2.2
Other	2	0.4
Missing	7	1.4
Ethnicity
Caucasian	412	83.4
African American	5	1.0
Latino or Hispanic	18	3.6
Asian	35	7.1
2 or more	14	2.8
Other/Unknown	3	0.6
Prefer not to say	7	1.4
Region of country practicing
Northeast	77	15.6
Midwest	98	19.8
Southeast	78	15.8
Southwest	166	33.6
West	74	15.0
Missing	1	0.2
Common number of days worked per week
0	2	0.4
1	0	0
2	4	0.8
3	16	3.2
4	92	18.6
5	359	72.7
6	17	3.4
7	2	0.4
Missing	2	0.4
Length of work shift
8 working hours	245	49.6
9 working hours	119	24.1
10 working hours	107	21.7
Other	21	4.3
Missing	2	0.4
Average number of SPTs mentored a year
0	4	0.8
1	206	44.7
2	139	28.1
3	77	15.6
4	29	5.9
5+	38	7.7
Missing	1	0.2
Number of students mentored in career
0–5	150	30.4
6–10	121	24.5
11–15	68	13.8
16–20	51	10.3
21+	101	20.4
Missing	3	0.6
Clinical education model used the most
1 CI: 1 Student	426	86.2
1 CI: 2 Students	27	5.5
2 CIs: 1 Student	30	6.1
Other	8	1.6
Missing	3	0.6
Preferred clinical model
1 CI: 1 Student	416	84.2
1 CI: 2 Students	39	7.9
2 CIs: 1 Student	32	6.5
Other	7	1.4
Type of students mentored
SPT only	388	78.7
Both SPT and SPTA	105	21.3
Missing	1	0.2

Instrumentation

The electronic survey consisted of 3 forms: 1 demographic form and 2 self-report measures. The demographic form consisted of 20 closed-end items with specified response options for the participant. The participant additionally had the option not to respond or provide a write-in response if the pre-selected options did not represent them accurately. On the demographic form, age was gathered in increments of 5 years starting at 20 years old due to the prerequisite required for completing the DPT degree. Factors such as gender, time allowed for weekly administrative tasks, and practice setting were included.

Additionally, factors such as number of students mentored in a year, number of students mentored in a career, and the supervision model were gathered. To date, these characteristics have not been reported in the literature to determine their impact on PT CIs beyond anecdotal evidence. The 2 self-report measures consisted of the PSS-10 (stress) and the OLBI (burnout), which were used to measure stress and burnout prevalence among PT CIs at a single point in time.

The PSS-10 is a 10-item self-report survey using a 5-point Likert scale (0–4) to measure perceived stress. Four items are reverse-scored. Total scores range from 0–40, indicating low (0–13), moderate (14–26), or high (27–40) stress. A 2012 review of 19 studies by Lee, found the PSS-10 to have superior psychometric properties compared to PSS-14 and PSS-4, including good test-retest reliability (r = 0.77), criterion validity (r = −0.70 with SF-36), known-groups validity, and factorial validity (accounting for 66% of variance).¹⁷

The OLBI is a self-report survey that uses a 4-point Likert scale that ranges from (1) “Strongly Agree” to (4) “Strongly Disagree.” The OLBI comprises 16 questions, divided into 2 subscales representing disengagement and exhaustion scores. There are 8 reverse-scored questions, 4 for disengagement, and 4 for exhaustion. The participant’s composite score ranges from 16 to 64, with higher scores indicating increased burnout symptoms. The OLBI subscale scores range from 8 to 32, with a higher score indicating an increase in burnout level.

The OLBI demonstrates test-retest reliability and construct, as well as convergent and discriminant validity.^25,26 To explore the test-retest reliability, in 2007, Demerouti and Bakker²⁵ distributed the OLBI to 8 different groups of healthcare workers and those in white-collar occupations.²⁵ The authors found the test-retest reliability over 4 months to be r = 0.85 for both subscales with a Cronbach’s α = 0.85 for the global survey.²⁵ In a 2005 study with 2,431 participants from industries such as education, healthcare, and banking, Halbesleben and Demerouti²⁶ noted the reliability of the OLBI to be r = 0.51 for exhaustion subscale and r = 0.34 for disengagement subscale with Cronbach’s α of 0.74–0.87 for the summative OLBI score.²⁶ Divergence was present to support the independence of the scales resulting in construct validity.²⁶ The authors found convergent validity with the MBI–GS, which used a multi-trait, multi-method analysis.²⁶ Factorial validity was found to have a 2-factor best fit for data, accounting for 45.27% of the variance.²⁵

Data Analysis

All statistical analyses were conducted using IBM SPSS Statistics version 28.0.1.0 (142). Descriptive statistics were calculated for means, standard deviations, and frequency. One-way, independent ANOVAs were utilized to determine differences between demographic variables for the PSS-10 and OLBI aggregate and subscales and assess comparisons for any significant results.

RESULTS

Of the 580 participating PT survey respondents, 494 met the inclusion criteria and completed the survey. The other 86 participants’ data were excluded due to not having an SPT within the past 12 months or not completing the surveys. The survey sample included 329 (66.6%) females and 157 (31.8%) males. Eight individuals either preferred not to report their gender or identified as gender non-conforming. The sample’s age range in years with the most participants was 30–34 (28.9%), followed by 25–29 (18.6%). Most participants (56.2%) had practiced PT for 1–10 years and had an entry-level doctorate (72.1%). Respondents generally mentored 1 (44.7%) or 2 (28.2%) SPTs yearly. The reported number of students mentored throughout their career was most frequently 1 to 5 (30.4%) or 6 to 10 (24.5%), respectively. Demographic data are found in Table 1.

Prevalence of Stress and Burnout in PT Clinical Instructors

Table 2 presents the stress and burnout self-report measures’ mean ± standard deviation scores. Participants’ mean PSS-10 (stress) score of 15 was determined to be within the moderate stress category (a score of 14–26), as described by Lee,¹⁷ representing 56.1% of the participants.¹⁷ The aggregate PT CI respondent mean OLBI score of 36.95 was also within the moderate burnout level (30–44), representing 65.4% of the PT CI respondents. The mean values for exhaustion (19.24; score 16–32) and disengagement (17.70; score 15–22) were also within the moderate category and accounted for 64.6% and 66% of the PT CI respondents, respectively.

Table 2.

Prevalence of Stress and Burnout in Physical Therapy Clinical Instructors (n = 494)

Stress and Burnout Self-Report Measure	Mean Score of Aggregate Data ± Standard Deviation	Mean Score and Frequency of Low Category	Mean Score and Frequency of Moderate Category	Mean Score and Frequency of High Category
PSS-10	15.00 ± 6.50 /40	8.64 (40.89%)	18.87 (56.07%)	29.13 (3.04%)
OLBI	36.95 ± 7.69 /64	25.38 (17.81%)	37.11 (65.38%)	48.55 (16.80%)
Exhaustion Subscale	19.24 ± 4.26 /32	13.01 (20.04%)	19.66 (64.57%)	25.63 (15.38%)
Disengagement Subscale	17.70 ± 4.08 /32	12.23 (21.66%)	18.18 (65.99%)	24.74 (12.35%)

^*All mean scores are within the moderate category for that self-report measure.

Comparisons of Stress and Burnout Within Demographic Variables

The one-way ANOVA revealed significant differences between multiple demographic variables for the PSS-10, OLBI aggregate, and OLBI subscales. For the PSS-10, age, marital status, and region of the country practicing were found to have significant differences within the groups; however, the follow-up comparisons for the age group were not significant. The OLBI aggregate and subscales had more variables, which had significant differences within the group. Of note, the variables of age, years, as a PT, average amount of administrative time, entry-level PT degree, highest degree earned, the average number of students mentored over career, and average number of SPTs mentored in a year were found to have significant differences between groups for burnout aggregate and both subscales. Likewise, the follow-up pairwise comparisons of ANOVA for highest degree earned and number of students mentored in a year were not significant. Only age and marital status showed significant differences between groups in stress and burnout. Table 3 shows information regarding overall ANOVA, while Table 4 presents follow-up comparisons.

Table 3.

Results of One-Way Independent ANOVA

	F – Value for global ANOVA (p-value)
Variable	PSS-10	OLBI Aggregate	OLBI Exhaustion	OLBI Disengagement
Gender†	2.847 (0.059)	5.080 (0.007)*	13.223 (<0.001)*	.256 (0.774)
Age	1.928 (0.046)*	6.804 (<0.001)*	6.174 (<0.001)*	5.661 (<0.001)*
Years as PT	0.752 (0.522)	11.746 (<0.001)*	11.861 (<0.001)*	8.127 (<0.001)*
Average amount of administrative tasks	0.698 (0.651)	4.045 (<0.001)*	4.047 (<0.001)*	3.599 (0.002)*
Setting	1.481 (0.207)	0.718 (0.580)	0.999 (0.408)	0.322 (0.863)
Caseload	0.785 (0.582)	1.045 (0.395)	1.079 (0.374)	1.239 (0.285)
Marital Status	2.747 (0.018)*	2.804 (0.017)*	3.380 (0.005)*	1.809 (0.109)
Number of children who are dependents	0.697 (0.626)	1.713 (0.130)	2.091 (0.065)	1.073 (0.375)
Entry-level physical therapy degree earned	0.778 (0.507)	9.439 (<0.001)*	8.720 (<0.001)*	7.241 (<0.001)*
Highest Degree earned	0.405 (0.805)	3.111 (0.015)*	2.611 (0.035)*	3.731 (0.005)*
Ethnicity	0.096 (0.997)	2.228 (0.039)*	2.009 (0.063)	2.315 (0.033)*
Region of country practicing	3.134 (0.015)*	0.964 (0.427)	1.306 (0.267)	0.436 (0.783)
Common number of days worked per week	0.650 (0.690)	0.580 (0.746)	0.668 (0.676)	0.677 (0.668)
Length of Shift	2.546 (0.055)	0.106 (0.957)	0.692 (0.557)	0.768 (0.512)
Average number of SPT mentored in a year	1.089 (0.365)	2.501 (0.030)*	2.465 (0.032)*	2.110 (0.063)*
Average number of students mentored over career	0.547 (0.701)	9.593 (<0.001)*	9.954 (<0.001)*	6.811 (<0.001)*
Clinical education model most used	.751 (.522)	1.190 (0.313)	0.704 (0.550)	1.405 (0.241)
Preferred clinical model	1.241 (0.294)	1.176 (0.318)	1.267 (0.285)	0.888 (0.447)
Type of students mentored	1.518 (0.218)	0.088 (0.767)	0.007 (0.936)	0.226 (0.635)

^{* =}significant difference;

^{† =}conducted as a t-test due to 2 variable comparison

Table 4.

Pairwise Comparisons of ANOVA

	Groups with Significant Differences (p-value)
Variable	PSS-10	OLBI Aggregate	OLBI Exhaustion	OLBI Disengagement
Gender
Men vs Women		0.004	<0.001
Age
25–29 vs 45–49		0.033	0.002	0.005
25–29 vs 50–54		<0.001	<0.001
25–29 vs 60–64		<0.001	<0.001	0.001
25–29 vs 70+		0.037	0.042
30–34 vs 60–64		<0.001	<0.001	<0.001
35–39 vs 60–64		<0.001	0.006	<0.001
40–44 vs 60–64		0.004	0.017	0.010
45–49 vs 60–64		0.027		0.004
Years as a PT
>1–5 vs 15+		<0.001	<0.001	<0.001
6–10 vs 15+		<0.001	<0.001	0.003
11–15 vs 15+		0.034
Average amount of time on administration tasks
3–4 hours vs 10+		0.029		0.010
5–6 hours vs 9–10 hours		0.037	0.037
5–6 hours vs 10+
0 hours vs 5–6 hours		<0.001	0.014	<0.001
1–2 hours vs 5–6 hours			0.035
1–2 hours vs 10+ hours			0.019
Marital Status
Single vs Divorced	0.033
Married vs Divorced	0.022
Partnered vs Divorced	0.006
Married vs Partnered		0.047	0.011
Entry Degree
Bachelors vs DPT		<0.001	<0.001	<0.001
Masters vs DPT		0.024	0.040
Ethnicity
Latino or Hispanic vs Two or more		0.012		0.017
Region worked
Northwest vs Southwest	0.012
Number of SPT over Career
0–5 vs 16–20		0.013	0.001
0–5 vs 21+		<0.001	<0.001	<0.001
6–10 vs 16–20		0.029	0.002
6–10 vs 21+		<0.001	<0.001	<0.001

All values presented represent a significant difference (p <.05)

DISCUSSION AND CONCLUSION

This study aimed to determine the prevalence of stress and burnout in PT CIs and whether significant differences exist in stress and burnout aggregate and subscales of exhaustion and disengagement based on collected demographic factors. Study results demonstrate a moderate prevalence of stress and burnout within PT CIs based on the PSS-10 and OLBI aggregate mean scores, similar to results found by other researchers within the general PT population.^12,27,28 The stress levels of this study’s sample (n = 494 PTs) were very similar to that of Anderson¹² in 2012 of 1,340 PTs. Anderson¹² found the mean PSS-10 score to be 14.08 ± (6.38), while this study found it to be 15.00 ± (6.50).¹² Data from this study indicates that the stress and burnout levels of the PT CI are not greater than those of the general PT when compared to previous work.¹² It is also important to note that previous studies did not specifically stratify those who were or were not CIs. As a result, those who participated in Anderson’s¹² study may likely have also been CIs. Data from this study was novel in that it assessed the prevalence of stress and burnout levels within the PT CI population.

When using the OLBI to assess burnout levels, the exhaustion and disengagement of a PT CI can also be assessed. The OLBI subscales can be determined similarly to the EE and DP subscales of the MBI. To date, no published literature has explored exhaustion and disengagement in the PT CI. This study found a moderate level of both exhaustion and disengagement within PT CIs. These findings are similar to the results of Pustulka-Piwnik et al.,²⁷ who studied physiotherapists in Poland and reported moderate levels for the exhaustion subscale. However, Pustulka-Piwnik et al.²⁷ used the MBI, not the OLBI.^12,27 Additionally, mean subscale data from this study for EE and DP were in the moderate category compared to Anderson’s work, which found PTs to have low EE and DP on average.¹² This may suggest that supervising an SPT may negatively impact the EE and DP levels of the PT CI.

Also, significant differences were found among groups. Regarding gender, a significant difference was noted between men and women. This difference has been highlighted in a 2010 meta-analysis by Purvanova²⁹ and recently in a 2020 study of physicians.^29,30 These articles show that women tend to have higher rates of burnout, which may be related to area of work and differences in the lived experiences between men and women.^29,30 Interestingly, there was also a difference noted in the variables of age, years as a PT, number of SPTs mentored over a career, and number of SPTs mentored in a year. Each group differed significantly between the younger or less experienced and the older or more experienced. The results indicate that there may be a connection between experience and rates of stress and burnout. Further research is needed to explore correlations between these variables and stress and burnout rates.

The role of the PT CI in mentoring the SPT during the development of cognitive, psychomotor, and affective skills is critical. The mentoring skills attributed explicitly with being a PT CI may be less effective due to the stress and burnout a PT may experience in their everyday practice. While no studies have been published that explore the impact of stress and burnout on the mentoring ability of the PT CI, Kellish et al.³⁰ studied this concept in primary and secondary school teachers.³⁰ Those authors found that when the teacher was experiencing burnout, there was a negative impact on the student’s academic performance.³⁰ These results suggest that the PT CI has the potential to negatively impact the SPT if the PT CI is experiencing burnout.

The data from this study suggests that the stress and burnout levels of PT CIs are similar to those reported by Anderson¹² in the general PT population.¹² The similarity may suggest that the SPT has a limited impact on the overall PT CI stress and burnout. This information aligns with work by Link et al.,² who noted that those who receive mentorship and those who mentor others have significantly lower rates of burnout.² Thus, the mentorship provided by a PT CI to the SPT may have a protective mechanism or mitigating effect against burnout for the PT CI. Further research is needed to determine how the stress and burnout of the PT CI may impact the learning experience of the SPT and if supervising an SPT for a clinical education experience further influences the PT CI stress and burnout. Additionally, future research may explore if there are timeframes within the experience, such as the beginning, middle, or end, which may result in more significant stress and burnout due to varying demands placed on the PT CI.

It is essential for DCEs and Site Coordinators of Clinical Education (SCCEs) to recognize the impact mentoring a student may have on the CI and consider investing in resources to help mitigate the potential increase of stress and burnout. DCEs may consider providing alternate models of clinical education to reduce PT CI workload through additional faculty involvement or integrated clinical experiences (ICE). ICE activities may decrease the burden of the orientation process on the PT CI by prepping the SPT for enhanced interpersonal skills and how to document in an electronic medical record, interact with patients, perform basic skills, and demonstrate professionalism.³² In a 2016 APTA Education Leadership Conference research presentation, Neely et al.³² highlighted the benefits of ICE in physical therapy education through experiences such as part-time clinic visits, professional practice opportunities, and mock CI interactive experiences.³² The authors found that ICE helped with “enhancing interpersonal skills, understanding the importance of interprofessional education, defining the PT/PTA relationship in regards to state laws, and promoting lifelong learning and professional responsibility.”³² Keeping in mind the work by Link et al.,² a DCE and SCCE may be able to impact PT CI burnout by providing mentorship for any student opportunity.²

This study asked participants to rate their stress and burnout at a time during which the COVID-19 pandemic had been prominent for approximately 2 years. However, despite the stress and burnout that the pandemic may have brought into the participants’ lives, their stress and burnout ratings were similar to other time periods, such as Anderson’s¹² results that were gleaned 10 years prior. Initial observation may suggest that the pandemic potentially had a limited impact on the global scores of this sample; however, due to the 2 years that had lapsed since the initial onset of the pandemic, it is possible that the participants had adjusted to the situation and were able to cope with the stressors of the pandemic.

There are several study strengths that should be highlighted. This is the first known study to explore the prevalence of stress and burnout of the PT CI. Additionally, the sample size was sufficient to conduct statistical analyses between and among groups and included a variety of participant demographics, including age, race, area of country lived, and number of students mentored in a year, as well as the number over the PT CI’s career. This study assessed multiple variables when determining participants’ PSS-10 and OLBI scores. Lastly, this study utilized psychometrically sound tools to measure stress and burnout.

Along with the study’s strengths, the limitations of this study should be considered. The number of US PTs identifying as CIs is challenging to determine as there is no central or state registry of CIs. This study’s survey distribution methods limited the number and diversity of participants. Given the study’s design, no control groupo for comparison was assessed. Additionally, this study was a prevalence study designed to note if stress and burnout exist in this population and not designed to draw associations amongst variables or outcomes. The survey length may have negatively impacted the study results because it consisted of 46 questions.

Additionally, the topics of stress and burnout were introduced as a part of the recruitment procedures which may have biased PT CI participation depending on their feelings towards the topics. Furthermore, this study did not explore demographic information and its impact on stress and burnout. Finally, the COVID-19 pandemic must be considered when assessing study limitations. While the pandemic’s impact was not directly assessed, it is noted that it may have impacted the PT CI’s stress and burnout level, thus skewing the results of this study.

Future research should continue exploring stress and burnout related to clinical education and the associations between demographic variables, stress, and burnout. Studies are needed to understand what personal and work-related stress and burnout factors are related to the mentoring of an SPT. Additional research is needed to understand how mentoring an SPT impacts a PT CI’s mental health in other capacities beyond stress and burnout, as well as what coping strategies are effective.

PT CIs demonstrated moderate stress and burnout levels as measured by the PSS-10 and OLBI. Further research is needed to determine the clinical relevance of this data concerning how the stress and burnout of the PT CI impact their clinical practice, clinical teaching, and their decisions to accept future PT students for clinical education. If the PT CI is currently expressing symptoms of stress and burnout, the clinical education stakeholders, such as the DCE and SCCE, may wish to consider providing additional support for the PT CI due to the potential increase in stress and burnout related to supervising an SPT during a clinical education experience.