Belongingness in PT Education Matters . . . A Lot

Do I belong? It's a question I've often contemplated, whether I realized it or not. Human beings are hardwired to seek social connections. In some cultures, the ultimate punishment is to be shunned. We long to belong, but what happens when we don't?

I wish it weren't true, but we've all felt it. Not part of the "in crowd" at school. Subtle microaggressions at work. These experiences don't just affect our psychological wellbeing; they affect our ability to succeed. The worst part? This feeling of belonging lives inside us. It's a perception, so even when the intent is to create belonging, the impact may be felt very differently. All of our actions and interactions matter. Especially the subtle ones.

If this happens to our students, we may unintentionally be squandering their potential.

A team of insightful PT educators (Ashley Poole, Susan Hibbard, Karla Bell, Dawn Brown, Chris Condran, and Kyle Covington) published a study in 2023 in the Journal of Physical Therapy Education that validates the Belongingness Scale for use with DPT students in clinical settings. And while validation studies might not sound like page-turners, this one matters profoundly for anyone who cares about how we prepare the next generation of physical therapists.

**What They Found (and Why It Matters)**

The researchers adapted and validated the Belongingness Scale-Clinical Placement Experience (BES-CPE) for 159 DPT students during their terminal clinical experiences, identifying three core components: esteem, connectedness, and efficacy. Think about that trinity for a moment. When students feel valued (esteem), connected to their clinical team (connectedness), and capable in their developing skills (efficacy), they don't just perform better; they become better clinicians.

The research confirms what many of us have observed: belongingness is vital to mental, emotional, and physical health, and it's positively correlated with academic performance and achievement. But here's the sobering part: an absence of belongingness may hinder students' full participation in clinical experiences and compromise clinical achievement.

Read that again. We're not talking about minor inconveniences or hurt feelings. We're talking about students who might have the intellectual capacity and technical skill to become excellent PTs, but who disengage, underperform, or even leave the profession because they never felt like they belonged in the first place.

**The Therapeutic Relationship Starts in School**

As PTs, we all know about the therapeutic relationship in physical therapy; that essential connection between clinician and patient that can make or break rehabilitation outcomes. But we often forget that students are learning how to form these relationships by first experiencing them as learners themselves.

If a DPT student spends their clinical rotations feeling like an outsider, like their questions are burdensome, like they're tolerated rather than welcomed; what are they learning about relationship-building? What are they internalizing about professional identity? And most importantly, how will that shape the therapeutic relationships they create with their future patients?

The validation of this belongingness scale gives us a tool to measure something we've always felt but struggled to quantify. It allows us to move beyond anecdotal evidence and into systematic assessment and intervention.

Belonging is also where a compassionate culture begins. A clinical site that welcomes students, makes room for their questions, and supports them through mistakes is practicing the same habits it hopes they will one day bring to patients: noticing, attending, and responding to another person's needs. Students treated this way learn that compassion is simply how the team works, and they carry that template into every therapeutic relationship they go on to build. A culture that leaves students on the outside teaches the opposite lesson, just as reliably.

**Practical Implications for Clinical Educators**

**For Clinical Instructors:**

• Start the first day of each clinical rotation by explicitly communicating that your student belongs on your team

• Create structured opportunities for connectedness; don't assume it will happen organically

• Provide specific, affirming feedback that builds esteem, not just critique that identifies gaps

• Recognize that efficacy develops through supported challenge, not sink-or-swim experiences

**For Academic Programs:**

• Use the BES-CPE to identify students at risk during clinical experiences before they fail or withdraw

• Train clinical instructors on the components of belongingness and how to cultivate them

• Build belongingness development into your clinical education curriculum, not as a soft skill but as a core competency

• Create systems for early intervention when belongingness scores are low

**For Students:**

• Understand that feelings of not belonging are common, especially early in clinical rotations

• Advocate for what you need; good clinical instructors want to support your development

• Seek out communities of support among your cohort

• Remember that professional identity development is a process, not a switch that flips

**The Bigger Picture: Inclusion and Retention**

This research has particular significance for students from underrepresented and minoritized backgrounds in PT. As Naidoo, Powell, and Jette (2025) note, factors such as a lack of racially and ethnically minoritized mentors and a decreased sense of belonging contribute to disparate academic outcomes for racially and ethnically minoritized DPT students. If we're serious about diversifying our profession (and we should be, given the diverse populations we serve) we must be intentional about creating clinical environments where all students belong.

Belongingness isn't about making everyone comfortable all the time. It's about creating environments where students feel secure enough to be challenged, connected enough to ask for help, and valued enough to contribute their unique perspectives.

The work that Ashley Poole and her colleagues have done gives us more than a validated measurement tool. It gives us a framework for intentional culture change in clinical education. It gives us language to describe what we've observed. And most importantly, it gives us an evidence-based pathway to ensure that every physical therapy student IS seen, valued, and truly belongs to the profession they are preparing to enter.

Because belongingness isn't a nice-to-have in education, it's a must-have for excellence.

If you are a student finding your footing in clinical education, start with For Students.

References

Naidoo, K., Powell, C., & Jette, D. U. (2025). An improvement science framework to advance sense of belonging for physical therapist students from minoritized backgrounds. Physical Therapy, 105(6), Article pzaf045. https://doi.org/10.1093/ptj/pzaf045

Poole, A. K., Hibbard, S. T., Bell, K. A., Brown, D. S., Condran, C., & Covington, K. (2023). An exploration of Doctor of Physical Therapy students' belongingness in clinical education: A validation study. Journal of Physical Therapy Education, 37(3), 211-219. https://doi.org/10.1097/JTE.0000000000000292