Effects of Clinical Field-Experience Setting on Athletic Training Students' Perceived Percentage of Time Spent on Active Learning

Abstract

Objective:

Our purpose was to examine undergraduate athletic training students' perceptions of how time is utilized during clinical field experiences while enrolled in Commission on Accreditation of Allied Health Education Program (CAAHEP)-accredited athletic training programs and to determine the effects of clinical field-experience length and setting, academic standing, sex, clinical assignment, and National Collegiate Athletic Association level on active learning.

Design and Setting:

Using the Athletic Training-Clinical Education Time Framework (AT-CETF) and Utilizing Time and Active Learning Survey, subjects completed a 1-day, self-reported observation of how their clinical field-experience time was utilized.

Subjects:

Program directors at 131 CAAHEP-accredited athletic training programs were sent survey packages. Seventy-two (41%) male subjects and 105 (59%) female subjects from 25 institutions completed the survey packages. Eight of the 10 National Athletic Trainers' Association districts were represented in the study.

Measurements:

The AT-CETF is a behavioral time-profiling framework that measures athletic training students' perceptions of utilization of clinical field-experience time based on the performance domains associated with the 1999 National Athletic Trainers' Association Board of Certification Role Delineation Study and literature related to time and learning.

Results:

Subjects spent 51% of their clinical field-experience time engaged in active learning, 9% in managerial activities, 17% in unengaged activities, and 23% in waiting activities. Multiple 2 × 2 × 3 analyses of variance (length of clinical field experience × academic standing × clinical field-experience setting) revealed a significant difference between the levels of clinical field-experience setting and the dependent variables of perceived percentage of active learning time and waiting time. A 2 × 3 analysis of variance (sex × clinical assignment) revealed a significant difference between the levels of clinical assignment and the dependent variable of perceived percentage of active learning time.

Conclusions:

The type of clinical field-experience setting and clinical assignment affects the amount of time spent in active learning. Therefore, profiling students' use of time may allow educators to identify clinical field-experience settings that maximize active learning time, expose students to their own unique learning situations, and offer students access to clinical field-experience settings aligned with their professional goals.

Athletic training clinical field experiences (CFEs), or experiential learning, have occurred in athletic facilities since the inception of athletic training¹ and are designed to allow students access to hands-on learning. The CFEs offer students the opportunity to integrate and execute theoretic knowledge learned in the academic classroom into real-life situations and aid in preparing students to become sensitive, competent, and successful professional practitioners.^2–11 However, simply participating in a CFE (eg, being there) does not guarantee that students will become competent professionals. Competence should occur as a result of students engaging in academic and clinical curriculums consistent with their ability levels, while at the same time having sufficient time to learn, perform, and master clinical skills and competencies (proficiencies).^9,12,13

Researchers investigating time and learning in the academic classroom and laboratory settings have categorized the time spent there according to the behaviors of both the instructors and students.^14–18 Opportunity time typically refers to the time allotted during a specific time segment (eg, CFE). Opportunity time varies among researchers but usually includes instructional time, managerial time (eg, instructor/student preparation time), transition time (eg, moving from one task to another), waiting time, unengaged time (eg, lunch and bathroom breaks), and active learning or engaged time.^13–17 Active learning time (ALT), or engaged time, is considered the amount of time students are engaged in activities contributing to their academic success.^3,15,17,19 Research suggests that ALT is a strong determinant of student academic achievement^14,20,21 and that a positive relationship exists between engaged time and student learning.²² Time depleted in noninstructional activities such as transition time is negatively correlated with student achievement and task success²³ and is thought to be the largest cause of a reduction in opportunity time.²⁴

One choice for educators to maximize student-learning time is to lengthen the available opportunity time. However, simply increasing opportunity time does not guarantee an increase in the quality of education, especially if the same educational techniques are employed.^14,20,25,26 Instead of increasing time, educators should identify ways to manage time spent on activities such as transition, waiting, and unengaged time and consciously assess the quality of instruction and the amount of time students are engaged in ALT.²⁶ Profiling a student's use of time in the classroom or CFE then becomes a helpful tool for determining how student time is managed and whether the students are provided with adequate opportunities to master athletic training clinical proficiencies. Therefore, our purpose was to examine athletic training students' perceptions of how time is partitioned during CFEs while enrolled in Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs. A second purpose was to determine differences among the length and setting of the CFE, academic standing, sex, and National Collegiate Athletic Association (NCAA) athletic level with respect to the utilization of CFE time.

METHODS

Subjects

The population selected for this study was athletic training students enrolled in CAAHEP-accredited athletic training educational programs (ATEPs). A listing of undergraduate accredited ATEPs published by the National Athletic Trainers' Association (NATA) as of January 2001 identified 131 academic institutions offering such programs.²⁷ A total of 177 students (72 males, 105 females) from 25 (19%) of the 131 accredited programs completed and returned the surveys. Although the return was low, there were enough subjects to ensure adequate statistical power (.80). Athletic training education programs in 8 of the 10 NATA districts participated in the study, with District 5 having the highest percentage of schools (5 of 14 schools, or 36%) responding. The average response rate was 7.08 ± 6.27 students per institution, with a range of 1 to 23 students per institution. All study materials were approved by the supporting institution's human subject's institutional review board.

Athletic Training-Clinical Education Time Framework

In order to measure athletic training students' perception of how time is utilized while engaged in clinical field experiences, we modified the conceptual behavioral time framework created by Miller and Berry¹² in the examination of athletic training clinical-placement hours. This framework identifies specific behavioral time categories associated with athletic training clinical placements, identifying how much time students were generally spending in specific areas of their clinical placement. The modifications to the Athletic Training-Clinical Education Time Framework (AT-CETF) consisted of providing clearer definitions for each of the time categories, reclassifying the unengaged time category, and adding waiting time as a variable. The original framework¹² was based on Murphy's Time Profiling Model,¹⁸ literature from the American Association of School Administrators,²⁸ and a review of the general education and athletic training literature on time and learning.

In the current study, we again substituted the performance domains (prevention; recognition, evaluation, and assessment; immediate care; treatment, rehabilitation, and reconditioning; organization and administration) found in the NATA Board of Certification's 1999 Role Delineation Study²⁹ to create a time-profiling model that adequately represents an athletic training student's use of CFE time. The Study, which originally functioned as a resource document for the Competencies in Athletic Training,³⁰ serves as a blueprint for the development of the NATA Board of Certification's certification examination and identifies the essential skills, tasks, and behaviors that certified entry-level athletic trainers should be able to perform. We modified the performance domains by providing further examples of specific tasks under each of the behavioral categories that we substituted into the AT-CETF to allow for easier data collection while still representing the educational experiences encountered by students during their clinical field experiences (Table 1).

Table 1.

Athletic Training Clinical Education Time Framework (AT-CETF) Time Management Sheet

The AT-CETF includes the following time categories: 1) instructional time, (2) clinical time, (3) managerial time, (4) unengaged time, and (5) waiting time (see Table 1 for definitions of these terms). A combination of instructional time and clinical time yielded the variable of ALT, which theoretically represents the time students are engaged in performing skills or behaviors related to athletic training. The perceived percentage of time spent in active learning was determined by using the formula % ALT = (instructional time + clinical time)/opportunity time. Perceived percentage of unengaged time, determined by summing the categories of down time and transition time divided by opportunity time, refers to the activities performed by students that do not necessarily address any cognitive, psychomotor, or affective skills or behaviors related to athletic training. Perceived percentage of managerial time was considered a neutral activity that did not necessarily encourage or detract from student learning; rather, it was viewed as the necessary day-to-day operations of CFEs. Students recorded the amount of time spent in each of the AT-CETF categories on the AT-CETF Time Management Sheet.

Pilot Study

Validity

Five athletic trainers were asked to assess the face validity of the AT-CETF to determine whether the framework accurately represented the skills, tasks, and behaviors performed by athletic training students engaged in CFEs. The panel consisted of 4 athletic training educators (2 undergraduate ATEPs and 1 graduate ATEP program director and 1 ATEP instructor) and one certified athletic trainer working in the clinical/industrial/corporate setting. All the panel members were familiar with the supervision process of athletic training students. They were informed about the nature of the study and the construction of the AT-CETF. They all agreed the framework was a fair representation of skills, tasks, and behaviors regularly performed by athletic training students.

Eighteen students at various academic levels (sophomores, juniors, and seniors) completing CFEs at a midwestern CAAHEP-accredited athletic training program volunteered to participate in a 2-part pilot study as a convenience sample to assess the face validity and sampling-content validity. Students in the convenience sample were not included in the actual study. After completing each half of the pilot study, students were debriefed regarding their experiences. Students agreed that the AT-CETF represented the skills, tasks, and behaviors performed during the daily course of their CFEs. The students suggested providing more specific examples of skills and behaviors performed under the clinical time category of therapeutic modalities and therapeutic exercises.

Reliability

A measure of consistency across the 2 parts of the pilot study was calculated by measuring the students' perceived percentage of time spent in active learning over occasions. A 1-way random-effect intraclass correlation coefficient (ICC) indicated satisfactory overall repeatability measuring of the students perceived percentage of ALT over occasion, r_ICC = .7392. Therefore, the instrument displayed satisfactory reliability for measuring athletic training students' perceived percentage of active learning time while completing CFEs.

Procedures

Survey packages, including a cover letter explaining the study's purpose and all supporting documents, were mailed to CAAHEP ATEP program directors. Program directors were asked to distribute survey packages to subjects of various academic levels enrolled in a CFE. We first asked subjects to review the AT-CETF-Time Management Sheet, allowing them to become familiar with each area of time being studied and what constituted specific athletic training skills and behaviors within each behavior category. Subjects in the athletic training room (eg, college, university, or high school) were asked to select an observation day when their clinical instructor or supervisor covered a regularly scheduled athletic practice. This was defined as a day that did not precede or follow an athletic event. In the event a day could not be selected to meet this criterion, subjects were instructed to select a pregame day rather than a postgame day to record the data. Those in the corporate/industrial/clinical setting recorded time during one regular CFE day. To properly record use of time, directions for completing the survey and Time Management Sheet were provided to each subject. Subjects returned the completed survey and AT-CETF Time Management Sheet to the program director, who then returned the surveys to the principal investigator.

Statistical Analysis

We calculated means and standard deviations for each of the AT-CETF behavioral time categories. Four 2 × 2 × 3 factorial analyses of variance (ANOVAs) were computed to investigate the main effects and interactions between length of CFE (≤2.5 years and ≥3 years), academic standing (novice = sophomore- and junior-level students and advanced = senior-level students), and CFE setting (college/university, high school, and clinical/industrial/corporate) with respect to the dependent variables of perceived percentage of active learning, managerial, unengaged, and waiting time. Four 2 × 3 ANOVAs were calculated to examine the main effects and interactions between sex and clinical assignments (Table 2) with respect to the previous dependent variables. Using four 2 × 2 × 3 ANOVAs, we explored the main effects and interactions among sex, playing season (in season and out of season), and NCAA athletic level (3 levels) with respect to the dependent variables. Post hoc analysis of significant tests was completed using multiple pairwise comparisons based on a t statistic, adjusted with a Sidak correction procedure. A Sidak correction procedure adjusts the significance level for multiple comparisons and provides tighter bounds than a Bonferroni test.³¹ We used a Pearson product moment correlation coefficient to examine the relationship among cumulative grade point average, athletic training grade point average, and perceived time supervised by a clinical instructor or supervisor with respect to perceived percentage of ALT. All statistical testing was 2 tailed, and the level of statistical significance was set a priori at P < .05. The Statistical Package for Social Sciences (version 9.0; SPSS Inc, Chicago, IL) was used to calculate the statistics.

Table 2.

Classification of Clinical Assignments

RESULTS

The results of a Kolmogorov-Smirnov 1-sample test using perceived opportunity time revealed that the sample analyzed in the study was from a normal distribution, z = 1.20, P ≤ .05. The mean opportunity time according to the AT-CETF was 315 minutes (± 131.46 minutes), with 80% of the subjects responding that the day recorded was a typical CFE day. The means and standard deviations for the students' overall utilization of time according to the AT-CETF behavioral time categories are presented in Table 3; ALT accounted for 51% of the subjects' CFE time. Results of the Pearson product moment correlation coefficients revealed no significant relationships between cumulative grade point average, athletic training grade point average, and perceived time supervised by a clinical instructor or supervisor with respect to perceived percentage of ALT.

Table 3.

Athletic Training-Clinical Education Time Framework (AT-CETF) Behavior Categories*

Clinical Field-Experience Length and Setting and Academic Standing

The means and standard deviations for use of time by clinical field-experience length, setting, and academic standing are presented in Tables 4 through 6. Our results revealed a significant main effect between the levels of CFE setting with respect to the subjects' perceived percentage of ALT (F_2,165 = 5.036, P < .05). Subjects in the clinical/industrial/corporate setting engaged in significantly more ALT (76.53 ± 11.09 minutes) than subjects in the college/university (50.68 ± 18.53 minutes) and high school (44.17 ± 18.10 minutes) setting (P < .05). We also found a significant main effect for CFE setting with respect to subjects' perceived percentage of waiting time (F_2,165 = 4.88, P < .05). Subjects in the clinical/industrial/ corporate setting spent a significantly smaller percentage of their CFE time waiting (2.09 ± 2.85 minutes) compared with subjects in the college/university (22.14 ± 16.90 minutes) and high school (31.06 ± 18.82 minutes) settings (P < .05).

Table 4.

Use of Time by Clinical Field-Experience Length*

Table 6.

Usage of Time by Academic Program Standing*

Table 5.

Use of Time by Clinical-Experience Setting*

Active Learning Time and Clinical Assignment

A significant main effect was noted between the levels of clinical assignment with respect to subjects' perceived percentage of ALT (F_2,171 = 6.40, P < .05) (Table 7). Subjects working with mixed extremity sport populations perceived spending a significantly larger percentage of time in active learning (56.64 ± 20.17 minutes) than subjects working with upper extremity sport populations (45.76 ± 16.73 minutes). A significant main effect for clinical assignment with respect to perceived percentage of waiting time was also found (F_2,171 = 8.57, P ≤ .05). Subjects working with mixed extremity sport populations perceived spending a significantly smaller percentage of time (16.54 ± 16.63 minutes) waiting compared with subjects working with upper extremity sport populations (28.59 ± 18.61 minutes).

Table 7.

Use of Time by Clinical Assignment*

Sex, Athletic Playing Season, and National Collegiate Athletic Association Athletic Level

A significant higher-order interaction was demonstrated among sex, playing season, and NCAA athletic level with respect to subjects' perceived percentage of unengaged time (F_2,123 = 4.48, P < .05) (Table 8). The effects of perceived percentage of unengaged time suggest that males assigned to clinical instructors or supervisors with out-of-season sports at an NCAA Division I institution spent more time unengaged (19.32 ± 13.81 minutes) than females in the same situation (14.32 ± 8.61 minutes). Males assigned to clinical instructors or supervisors working with in-season sports at NCAA Division II institutions perceived spending a larger percentage of their time unengaged (48.18 ± 13.94 minutes) compared with females working with in-season sports (13.51 ± 5.02 minutes) and males assigned to clinical instructors or supervisors working with out-of-season sports at NCAA Division II academic institutions (19.98 ± 14.80 minutes). At the NCAA Division III level, males assigned to clinical instructors or supervisors working with in-season athletic teams perceived spending less time unengaged (18.16 ± 10.84 minutes) than females assigned to clinical instructors or supervisors also working with in-season athletic teams (27.33 ± 19.11 minutes). Males working with clinical instructors or supervisors assigned to out-of-season athletic teams perceived spending a larger percentage of time unengaged (20.72 ± 0.83 minutes) compared with females in the same situation (13.39 ± 10.23 minutes). Therefore, the effects of perceived percentage of unengaged time depend on sex, playing season, and the type of NCAA academic institution attended.

Table 8.

Use of Time by National Collegiate Athletic Association (NCAA) Athletic Division*

We also noted a significant main effect between playing seasons with respect to perceived percentage of ALT (F_1,123 = 4.22, P < .05). Subjects assigned to clinical instructors or supervisors with in-season NCAA athletic teams perceived spending a significantly smaller percentage of their time in active learning (48.34 ± 16.87 minutes) than subjects assigned to clinical instructors or supervisors with out-of-season NCAA athletic teams (52.32 ± 19.03 minutes). A significant main effect was seen between NCAA athletic levels with respect to perceived percentage of ALT (F_2,123 = 3.48, P < .05). Subjects assigned to clinical instructors or supervisors working with NCAA Division I athletic teams perceived spending a significantly smaller percentage of their time in active learning (49.36 ± 17.35 minutes) compared with subjects assigned to clinical instructors or supervisors working at NCAA Division III athletic teams (53.02 ± 20.09 minutes).

DISCUSSION

Researchers have proposed that the environment of the classroom or, in this context, the CFE setting cannot be overlooked when examining how educational time is utilized.^{6–7,11,32–37} Exposing students to a quality CFE is just as important as providing them with the appropriate classroom instruction¹² but much more difficult to achieve and measure. Investigators believe that, when the CFE environment offers quality instruction and supervision^1,32,38 (eg, communication, ethics and morals, understanding student learning styles), social support^32,33,39,40 (staff-student and student-student relationships), and appropriate level of clinical activities,^1,13,37 the likelihood of student engagement, critical thinking, autonomy, and positive learning outcomes is increased.^1,35,41 Therefore, a goal of athletic training educators would be to ensure that a student's time is effectively utilized and the CFE incorporates each of the above components.

Time and Learning

Profiling a classroom's use of time allows educators to manage time more effectively,^19,42 increasing the efficiency of their educational programs. Rich and McNeils²⁴ found that, when instructors began profiling how their classroom time was managed, they developed a certain level of awareness for time and learned to efficiently organize classroom and lesson plans, thereby increasing the amount of productive ALT. In our study, lost or unproductive time (unengaged time) accounted for approximately 17% of the opportunity time, whereas active learning accounted for 51% of students' use of time. These findings are in contrast with a previous study of clinical placement time in which ALT and unengaged time accounted for 30% and 59% of students' use of time, respectively.¹² Differences in methods and a refinement of the behavioral time framework used in each study may explain the differences between the studies.

Clinical Field-Experience Setting

In general education, factors such as inefficient classroom management, ineffective instructional techniques, and waiting time creep into the curriculum, gradually eroding the time dedicated to learning.^{14–15,17,21,43} Similarly, the time devoted to active learning during CFEs also seems to vary and has been found to be utilized ineffectively not only in athletic training¹² but in other allied health care profession preparation programs.^35,44,45 Our results revealed that students completing their CFE assignment in the clinical/industrial/corporate setting perceived spending a significantly larger percentage of their time engaged in ALT compared with students in the athletic training room settings, even with a small sample size (n = 8; Levene test of equality of error variance revealed that the variances were not significantly different, F_11,165 = 1.510, P = .132). According to the AT-CETF, students in the clinical/ industrial/corporate setting spent approximately twice as much time engaged in the category of clinical time (50%) than students in the college/university (30%) and high school settings (25%), particularly in the area of therapeutic modalities. Students assigned to clinical/industrial/corporate settings perceived spending a significantly smaller percentage of time waiting than students assigned to athletic training room settings. It is logical to assume that athletic training students in the clinical/industrial/corporate setting spend significantly less time waiting because they are not responsible for covering athletic practices and contests. In fact, athletic training students in a clinical/industrial/corporate setting appear to have different responsibilities and function more like nursing and physical therapy students, who are directly involved in a multidimensional health care team approach to patient and family care, providing rehabilitative care and dealing with a diverse and complex patient population.^39,46,47

When students spend a large percentage of their time in 1 or 2 specific categories, other components of the CFE must be compromised. Educators need to find a balance between these time categories because some researchers suggest that prior educational experience influences not only a student's current behavior but also his or her professional career.^47–50 Students choosing a career path that focuses on becoming a college/ university or high school athletic trainer may decide to spend extra time studying in the areas of prevention, immediate care of injuries, learning how to identify potential catastrophic situations, and interacting with coaches and administrators. Students choosing a career in the clinical/industrial/corporate setting may need to learn to develop positive physician-athletic trainer-therapist relationships, understand insurance and billing procedures, and deal with the demands and complexities of the general medical population. These variations in CFE settings are one facet affecting the quality of a student's clinical education, which is why professional educators encourage using multiple clinical affiliation sites to enrich the learning process.^11,51,52

Clinical Assignments

We found that students assigned to CFE settings where injuries predominantly occurred to mixed extremity sport populations perceived spending a significantly larger percentage of perceived time in active learning and a smaller percentage of time waiting. An observational study assessing students' clinical-placement behaviors found just the opposite.¹² Students assigned to upper extremity clinical assignments spent significantly more time in unengaged activities than mixed extremity clinical assignments.¹² We noted that students assigned to mixed extremity clinical assignments spent 54% of their opportunity time in active learning compared with 29% in the observational study.¹²

One explanation for these differences is the inclusion of students in clinical/industrial/corporate and general athletic training room settings to the mixed extremity group. This inclusion may have influenced the results because students in the clinical/industrial/corporate setting previously demonstrated a significant difference between the perceived percentage of ALT and waiting time. Other possible explanations for the differences between the clinical assignments include the availability of adequate supervision of certified athletic trainer clinical instructors or supervisors during athletic practices,³² clinical engagement opportunities provided by the clinical instructors or supervisors,¹² clinical instructor or supervisor-to-student ratio for playing season and clinical assignment (softball and baseball were both upper extremity clinical assignments in season, which possibly required more students to be assigned to one clinical instructor or supervisor, thereby limiting student opportunity time), and faculty workloads.

Sex, Athletic Playing Season, and National Collegiate Athletic Association Athletic Level

The effect of students' perceived percentage of unengaged time may depend on sex, playing season, and NCAA athletic level institution. The interaction among sex, playing season, and NCAA level is difficult to explain because of the higher-order effect and because the literature on this topic is sparse. One study examining clinical supervision of athletic training students at the college/university setting found that Division I athletic training students were often allowed to cover individual skill sessions and informal workouts unsupervised.³² This lack of supervision and interaction may help to explain why males in our study who were enrolled in NCAA I institutions assigned to a clinical instructor or supervisor working with out-of-season sports perceived spending more time unengaged than females assigned to out-of-season sports.

Our results suggest that males enrolled at NCAA II institutions spent more time unengaged when assigned to a clinical instructor or supervisor working with in-season sports compared with females assigned to a clinical instructor or supervisor responsible for in-season sports and males assigned to out-of-season sports. The opposite phenomenon occurred when males were assigned to clinical instructors or supervisors working with NCAA III in-season athletic teams. They reported spending less time unengaged than females in the same situation. Some of the possible explanations for the difference in time spent unengaged during clinical field experiences may be related to the motivation level of the student, workloads of the student and clinical instructor or supervisor,^12,35 relationship between students and clinical instructor or supervisor,⁵³ athletic teams, experience of the clinical instructor,³³ and the characteristic profiles of the academic institutions⁴³ themselves. However, Weidner and Pipkin's³² examination of clinical supervision of athletic training students engaged in CFEs in the college/university setting suggests that students received the same type and amount of supervision regardless of the NCAA division affiliation or status of the athletic training program. Perhaps the explanation of the differences among sex, athletic level, and playing season is associated with the type of student drawn to each NCAA institution.

Limitations/Recommendations

We want to stress that this study is exploratory in nature and only represents students' perceptions of time spent during a single CFE day. Because all ATEPs vary in their academic preparation and clinical education design, single, direct observational studies can only be generalized to specific programs. Our study design attempts to expose educators to a snapshot of the current status of CFE time utilization. Performing a large-scale observational study would be much more favorable and a more accurate means of measuring CFE time.

Subjects' time spent tracking and recording their CFE time may have influenced the overall amount of time spent in active learning. Self-reporting of time may have led to an overestimation or underestimation of the time spent in each categorical area, resulting in inaccuracies and misleading information. The length and perceived complexity of the study may also have caused subjects to become unmotivated and disengaged from the study, thereby providing inaccurate or false data simply in an effort to complete the study.

To clearly understand the use of CFE time, particularly among settings, we recommend a sample size more evenly distributed among the high school and college/university athletic training room and clinical/industrial/corporate settings. Athletic training educators should also identify inconsistencies within the different types of CFE settings in an attempt to ensure students are provided with the same educational opportunities and ALT. Finally, because clinical instructors or supervisors influence how students utilize CFE time, we should begin to recognize the differences in CFE settings in terms of differences between the education level of the clinical instructor or supervisor and teaching experiences with respect to their students' engagement in ALT and measure how the quality of instruction influences the students' percentage of ALT.

CONCLUSIONS

Athletic training CFEs are a vital component of students' professional preparation, and as such, educators should be concerned with the quality of these experiences. Determining whether an experience promotes a quality learning environment begins with exploring how students manage their clinical education time and requires asking questions such as, “Are students passive observers or active learners while engaged in a CFE?” and “Which CFE setting promotes the most active learning?” Tools such as the AT-CETF can help to answer these questions by providing a snapshot of how students utilize their time. Once initiated, time profiles can be implemented as often as needed and may be useful in determining the effectiveness of clinical instructor or supervisor management skills or different teaching techniques to maximize students' opportunity time, thereby creating a positive learning experience.