ewu clinical education handbook · this clinical education handbook is dedicated to you – the...
TRANSCRIPT
EWU Clinical Education Handbook
- 2 -
Introduction
Clinical education is a rewarding and exciting component of a physical therapists’ education. Students will spend 32 weeks in full-time clinical internships with clinical instructors who willingly share their time, expertise, professional values and patients. This Clinical Education Handbook is dedicated to you – the students and clinical faculty in the Physical Therapy Program at Eastern Washington University.
Amelia Jay, PT, DPT Director of Clinical Education Department of Physical Therapy Eastern Washington University 509-828-1362 – phone 509-828-1389 – fax [email protected]
Cindy Arlt Program Specialist Department of Physical Therapy Eastern Washington University 509-828-1374 - phone 509-828-1389 – fax [email protected]
- 3 -
Table of Contents
I. Program Mission ..................................................................................................................... - 7 -
II. Program Philosophy ............................................................................................................ - 7 -
III. Goals ................................................................................................................................... - 8 -
IV. Clinical Education Philosophy .............................................................................................. - 8 -
V. Acronyms/Definitions ............................................................................................................. - 9 -
Chapter 1 ............................................................................................................................................... - 10 -
Chapter 2 ............................................................................................................................................... - 11 - Internship Site Selection .............................................................................................................................................. - 11 -
Procedure on site selection: ................................................................................................................... - 13 - DPT I students .............................................................................................................................................................. - 13 - DPT II students ............................................................................................................................................................. - 13 - All students .................................................................................................................................................................. - 14 -
Chapter 3 ............................................................................................................................................... - 16 - Preparation for Clinical Internships ............................................................................................................................. - 16 -
Chapter 4 ............................................................................................................................................... - 20 - Policies ......................................................................................................................................................................... - 20 -
Chapter 5 ............................................................................................................................................... - 47 - Clinical Education Courses and Internships ................................................................................................................. - 47 -
Site Visits ............................................................................................................................................... - 49 -
Clinical Education Advisory Committee .................................................................................................. - 50 -
Student Rights and Responsibilities ........................................................................................................ - 50 - The student has the right to: ....................................................................................................................................... - 50 - The student has the responsibility to: ......................................................................................................................... - 51 -
Chapter 6 ............................................................................................................................................... - 52 - Clinical Faculty ............................................................................................................................................................. - 52 - Definitions of Roles ...................................................................................................................................................... - 52 - Organization of a Clinical Education Program ............................................................................................................. - 53 - Clinical Instructor Rights and Responsibilities ............................................................................................................. - 53 - The CI has the right to expect the student to: ............................................................................................................. - 53 - The CI has the responsibility to: .................................................................................................................................. - 54 - The CCCE has the responsibility to: ............................................................................................................................. - 55 - Clinical Education Resources ....................................................................................................................................... - 56 -
- 4 -
Chapter 7 ............................................................................................................................................... - 57 - Evaluation and Self-Assessment .................................................................................................................................. - 57 - DCE Assessment ........................................................................................................................................................... - 57 - Clinical Experience and Instruction Evaluation ............................................................................................................ - 57 - Student Evaluation Procedure ..................................................................................................................................... - 59 - Clinical Internship Awards ........................................................................................................................................... - 59 - Clinical Internship/Fieldwork Site Award: The purpose of this award is to acknowledge a clinical internship/fieldwork site that provides students with exemplary clinical experiences and demonstrates the following criteria: .............................................................................................................................................. - 59 - Clinical Instructor/Clinical Educator Award ................................................................................................................. - 60 -
Eastern Washington University Department of Physical Therapy ................................................................ 61
Essential Functions for Admission, Promotion, and Graduation .................................................................. 61
Introduction ............................................................................................................................................... 61
Essential Functions ..................................................................................................................................... 61 A. Observation ............................................................................................................................................................ 61 B. Communication .......................................................................................................................................................... 62 C. Motor .......................................................................................................................................................................... 62 D. Intellectual- conceptual, integrative and quantitative abilities .................................................................................. 62 Behavioral and Social Attributes ...................................................................................................................................... 63 F. Curriculum Requirements ........................................................................................................................................... 63 G. Tests and Evaluations .................................................................................................................................................. 63 H. Clinical Assessments ................................................................................................................................................... 63 Reasonable Accommodation ........................................................................................................................................... 64
Professional Behaviors for the 21st Century ................................................................................................ 64 Definitions of Behavioral Criteria Levels .......................................................................................................................... 64
Background Information ............................................................................................................................. 65
Preamble .................................................................................................................................................... 66
Professional Behaviors ............................................................................................................................... 68 Critical Thinking ............................................................................................................................................................... 68 Beginning Level: ............................................................................................................................................................... 68 Intermediate Level: .......................................................................................................................................................... 68 Entry Level: ...................................................................................................................................................................... 68 Post-Entry Level: .............................................................................................................................................................. 69 Communication ................................................................................................................................................................ 69 Beginning Level: ............................................................................................................................................................... 69 Intermediate Level: .......................................................................................................................................................... 69 Entry Level: ...................................................................................................................................................................... 70
- 5 -
Post Entry Level: .............................................................................................................................................................. 70
Problem Solving ......................................................................................................................................... 70
Interpersonal Skills ..................................................................................................................................... 71 Beginning Level: ............................................................................................................................................................... 71 Intermediate Level: .......................................................................................................................................................... 71 Entry Level: ...................................................................................................................................................................... 72 Post Entry Level: .............................................................................................................................................................. 72
Responsibility ............................................................................................................................................. 72 Beginning Level: ............................................................................................................................................................... 72 Intermediate Level: .......................................................................................................................................................... 73 Entry Level: ...................................................................................................................................................................... 73 Post Entry Level: .............................................................................................................................................................. 73
Professionalism .......................................................................................................................................... 73 Beginning Level: ............................................................................................................................................................... 73 Intermediate Level: .......................................................................................................................................................... 74 Entry Level: ...................................................................................................................................................................... 74 Post Entry Level: .............................................................................................................................................................. 75
Use of Constructive Feedback ..................................................................................................................... 75 Beginning Level: ............................................................................................................................................................... 75 Intermediate Level: .......................................................................................................................................................... 75 Entry Level: ...................................................................................................................................................................... 75 Post Entry Level: .............................................................................................................................................................. 76
Effective Use of Time and Resources .......................................................................................................... 76 Beginning Level: ............................................................................................................................................................... 76 Intermediate Level: .......................................................................................................................................................... 77 Entry Level: ...................................................................................................................................................................... 77 Post Entry Level: .............................................................................................................................................................. 77
Stress Management – ................................................................................................................................. 77 Beginning Level: ............................................................................................................................................................... 78 Intermediate Level: .......................................................................................................................................................... 78 Entry Level: ...................................................................................................................................................................... 78 Post Entry Level: .............................................................................................................................................................. 78
Commitment to Learning ............................................................................................................................ 79 Beginning Level: ............................................................................................................................................................... 79 Intermediate Level: .......................................................................................................................................................... 79 Entry Level: ...................................................................................................................................................................... 79 Post Entry Level: .............................................................................................................................................................. 79
- 6 -
Behavioral Objectives ................................................................................................................................. 80 Components .................................................................................................................................................................... 80 LEVEL ONE ........................................................................................................................................................................ 81 LEVEL TWO ....................................................................................................................................................................... 82 LEVEL THREE .................................................................................................................................................................... 82 LEVEL FOUR ..................................................................................................................................................................... 83 LEVEL FIVE ........................................................................................................................................................................ 84 LEVEL SIX .......................................................................................................................................................................... 85 LEVEL SEVEN .................................................................................................................................................................... 85
Directions for Creating an Action Plan ........................................................................................................ 86 The Action Plan consists of the following components: .................................................................................................. 86
Sample Plan of Action Form ....................................................................................................................... 88 Outcome Measurement .............................................................................................................................................. 88
Plan of Action Form .................................................................................................................................... 90
Specific Activities ............................................................................................................................... 90 Outcome Measurement .............................................................................................................................................. 90
Clinical Internship/Fieldwork Site Award .................................................................................................... 92
Clinical Instructor/Clinical Educator Award ................................................................................................. 92
STUDENT AGREEMENT OF UNDERSTANDING .............................................................................................. 94
CLINICAL EDUCATION AND SELECTION PROCESS ......................................................................................... 94
- 7 -
I. Program Mission The Mission of the Department of Physical Therapy at Eastern Washington University is to graduate an entry-level physical therapist. Additionally, the Department will contribute to the growth of the profession and professional colleagues, as well as support its communities through consultation, education and service.
II. Program Philosophy We believe that the educational program in physical therapy should develop a physical therapist who has entry-level knowledge, attitudes, and skills and who is prepared to practice in a variety of settings. The ability to think independently in all instances is important and would be fostered by giving the learner opportunities in the program to integrate the knowledge, attitudes and skills through problem solving.
We believe that the faculty should serve as exemplary role models in education practice, community service and scholarly activities. They should influence the students by their behaviors in all of these professional areas and through personal demeanor.
We believe that the University and the Spokane community provide a rich environment in which to build and expand the education of a physical therapist. We look to the strong liberal arts and sciences departments for support of a well prepared undergraduate and as colleagues in the education process within the University. We look to the Spokane healthcare community and our professional colleagues within that community for support of the clinical education of our students, collegial interaction and networking to further the educational process and for partnerships in growth for all of us.
We believe that the product of the Program, the graduate, is in the best position to deliver services to the ultimate focus of the Program, the consumer, through an analytical sequenced client centered curriculum. We believe that we should provide the support of such a curriculum through a qualified faculty who offer the learner opportunities to think critically, solve problems, and make decisions that empower them towards life-long learning.
We believe that a professional program has a responsibility to further the base of the profession it represents and serves.
We also believe that it is important to provide opportunities for the professional education of physical therapists in our community, provide consultation to others and engage in interaction and networking throughout the community.
We believe that this educational philosophy has the potential to influence the education of our graduates and colleagues, provide service to our University and community, and enhance the profession we represent in a positive way by promoting growth for all.
- 8 -
III. Goals In order to achieve the mission, the department will:
1. Incorporate opportunities for experiential learning in the curriculum and extracurricular activities.
2. Create a department culture that supports and engages faculty in scholarly activity and professional development.
3. Develop collaborative relationships with community partners. 4. Develop resources to enhance academic quality.
IV. Clinical Education Philosophy 1. Our purpose is to prepare a generalist physical therapist that is capable of
practicing and providing service in any setting and to any patient population. To this end, we encourage the widest possible exposure to a variety of practice settings throughout a student’s clinical education.
2. We feel that clinical education is an integral part of the physical therapy curriculum and serves to enhance and enrich the didactic components. Therefore, we utilize an integrated approach to clinical education with clinical opportunities under faculty supervision, with integrated clinical experiences (ICE) during years one and two and two 10-week and one 12-week internships at the completion of the didactic work.
3. Our program was established to serve the Inland Empire and Spokane, since no physical therapy program was available on the eastern side of the state. We receive a great deal of support from local clinicians and facilities, and therefore try to place students in internships locally whenever such placements meet the best educational interests of the student.
4. We feel that ties between the University and the affiliating clinical centers are vital to successful clinical education. Good communication, on-site visits and personal acquaintance with the staff and programs of each facility improves the chances of appropriate placements and facilitate problem solving when difficulties arise. Therefore, we select most of our affiliating centers in geographical clusters in the Northwest. This enables the Director of Clinical Education to visit the sites economically, provide in-service education to the facilities, and provide on-site student support when needed.
5. The role of the Director of Clinical Education is to make the best possible match between available internship positions and the student’s educational needs and interests. Where and when possible, personal considerations will also be accommodated, but not at the expense of providing a well-rounded educational experience. Clinical assignments are arranged through a mutual decision-making process between the Director of Clinical Education, the student and the facility.
- 9 -
However, the University and the Director of Clinical Education retain final decision-making authority in order to best meet the educational goals of the program.
V. Acronyms/Definitions
APTA – American Physical Therapy Association.
CAPTE – The Commission on Accreditation in Physical Therapy Education. The accrediting agency that is nationally recognized by the US Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). CAPTE grants specialized accreditation status to qualified entry-level education programs for physical therapists and physical therapist assistants.
SCCE – Site Coordinator of Clinical Education. The clinical site liaison who works with the university to establish clinical internships. The SCCE will assign the student to a Clinical Instructor. The SCCE can also act as the Clinical Instructor.
CI – Clinical Instructor. The licensed therapist the student has been assigned to for supervision and mentoring during the clinical experience.
CSIF – Clinical Site Information Form. The primary purpose of the Clinical Site Information Form (CSIF) is to assist academic programs in the collection of information from the clinical education sites to facilitate clinical site selections, as well as provide assistance with completion of site documentation requirements.
DCE – Director of Clinical Education (EWU Faculty position). Some facilities refer to this position as the Academic Coordinator of Clinical Education or ACCE.
NIC – Northwest Intermountain Consortium, an organization with the goal of providing professional development opportunities for SCCEs and CIs.
On-boarding – The process of meeting specific site requirements to participate in an internship in that facility.
PAS – The Performance Assessment System. The Acadaware instrument used in PT education to assess student competence in clinical internship practice. Completed by both the student and CI at mid-term/final (10 and 12 week internships).
- 10 -
Chapter 1
Welcome!
The primary purpose of the Department of Physical Therapy is to prepare a generalist physical therapist that is capable of practicing and providing service in any setting and to any patient population. For this reason, we encourage the widest possible exposure to a variety of practice settings throughout a student’s clinical education. The Program has contracts with over 300 clinical facilities. These facilities include hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, outpatient adult and pediatric orthopedic and neurologic clinics, school districts and others. Facilities are located in rural and urban areas. Some include specialties such as wound care, lymphedema rehabilitation, vestibular rehabilitation, industrial rehabilitation, hand therapy and others. New clinical sites are continuously added and current sites are consistently evaluated to help us provide students with quality and variety. The majority of clinical internship sites are in the Northwest (Washington, Oregon, Idaho) but other areas are also available including Alaska, Arizona, California, Colorado, Georgia, Hawaii, Minnesota, Montana, Nebraska, Nevada, Texas, Utah, and Wyoming. Please note that due to the dynamic nature of health care, sites and locations are subject to change.
The clinical internships include two 10-week and one 12-week internships for a total of 32 weeks in a minimum of three different clinical settings. All of these internships are full time experiences for the student. The final three internships are scheduled in the fall, winter and spring quarters of the final year of the Program. Please note the current internship curriculum may change. Should that occur, students will be given as much notification as possible.
- 11 -
Chapter 2
Internship Site Selection
Physical therapy programs differ in their methods of site selection with some offering significant student input and others less student input. Our Program encourages student input within the guidelines provided and the mission and philosophy of the clinical education program. The Guide to the Clinical Selections Process provides important general information on the process of choosing internship sites and definitions of the different clinical settings used. All site selection requirements are subject to change at the discretion of the site.
It is the responsibility of the DCE to utilize the clinical sites of the Program in an efficient manner, assuring the continued participation and development of the facilities contracted. The Program maintains over 300 contracts with clinical sites with about one-third of the sites used on a regular basis. In order to assure that students have good quality clinical internships, the Program has adopted the policy of regularly utilizing those clinical sites that have consistently provided students with good learning experiences. The Program faculty believes that when clinical sites are used regularly by EWU students, the CIs at those sites become more familiar with the Program and curriculum. Also, those sites tend to develop a commitment to continue providing clinical education experiences for the Program, year after year. New clinical internship sites are opened only when the DCE sees a need for additional sites in a specific area of practice due to closure of previous sites, changes in staffing patterns limiting the number of students or other reasons affecting the clinical education component of the Program.
Clinical internship sites are located in Alaska, Arizona, California, Colorado, Hawaii, Idaho, Minnesota, Montana, Nebraska, Nevada, Oregon, Texas, Utah, Washington and Wyoming. The majority of sites are in the Pacific Northwest. This enables the DCE to visit the sites economically, provide professional development to the staff and provide on-site student support when needed.
The clinical internship site list changes frequently as clinical sites are added or deleted and contact information changes. Students have access to the list of contracted internship
- 12 -
sites and are instructed that the list changes and all contracted sites are not available for all internships.
The majority of our clinical education facilities take students from other physical therapy programs. When requesting internships, the DCE uses the uniform mailing dates recommended by the Clinical Education Special Interest Group of the Education Section of the APTA. This voluntary guideline supports requesting sites on March 1st for the next calendar year. The purpose of using the uniform mailing dates is to increase the SCCE’s efficiency for determining the number of students interning at a facility. The number, location and variety of positions available vary from year to year depending upon staffing, numbers of students accepted and changes at the specific facility. After completion of each selections process, the DCE will inform the SCCE of student internship placements in writing and the SCCE is asked to confirm the internship.
Students have the opportunity to share their preference for specific site assignments from a list of sites available for each clinical internship. Student input is shared via the Acadaware System or comparable Clinical Education software. The number of choices requested by the DCE from the student changes dependent upon the pool of available sites for each specific internship. Students have the opportunity to meet with the DCE as frequently as needed during the selections process. Each year, there are several students who are interested in the same clinical site or sites and every effort is made to be as fair as possible. However, it is not possible to accommodate the preferences of all students for all clinical internships.
In some circumstances, a student may have a special need arise, educational or otherwise, that requires individual consideration in the placement process. If accommodations are needed, they must be arranged with the DCE. The role of the DCE is to make the match between available internship sites and the student’s educational needs and interests. Where and when possible, personal considerations will also be accommodated but not at the expense of providing a well-rounded educational experience. Clinical assignments are arranged through a mutual decision-making process in order to best meet the educational goals of the Program. However, the Program and DCE retain final decision authority for site placement. If special accommodations are needed due to learning or other disability, you must work with the office of Disability Support Services as you would for any other class.
Students have several resources to use when considering clinical sites for internships:
• Available site lists posted on the Acadaware system. • Student evaluations in the Acadaware system. • APTA Student evaluations of the facility.
- 13 -
• Facility web sites • DCE • Other faculty, classmates and graduates of the Program
Procedure on site selection:
DPT I students • Informed of the site selection process in Clinical Education Seminar classes. • Available site lists posted and site selection completed on the Acadaware system or
comparable Clinical Education software.
DPT II students • Informed of the site selection process in Clinical Education Seminar classes. • Available site lists posted and site selection completed on the Acadaware system or
comparable Clinical Education software.
Internship
Name
Selection Process Begins
Assignments Made
PHTH 780 Clinical Internship I
10 weeks
February - first year
May - first year
PHTH 781 Clinical Internship II
10 weeks
February - first year May - first year
PHTH 782 Clinical Internship III
12 weeks
February - second year
May - second year
- 14 -
All students • Some internship facilities require the student to interview. If a facility does require
an interview, students will be notified by the DCE. Interviews may be done by phone or in person but students will not miss any class time or be expected to travel out of town. Interview information for specific facilities is shared with students during the selection process.
• Students will have the opportunity to submit requests made on their behalf to specific clinics on the Uniform Mailing Date.
• All First Come, First Serve offers will be posted via Acadaware or comparable Clinical Education software as they are received.
• Students participating in the lottery process for reserved internship sites will do so through the Acadaware system.
The following issues are considered in totality and in no particular order:
§ Student choice. § Goal of providing a minimum of one first choice to each student over the
course of the internships. § Students interviewing for internships. If a student interviews for an
internship and is accepted by the facility, the student is scheduled at that facility for the setting and time frame that the SCCE determines will work for the facility staff.
§ Students’ written and verbal communication during any part of the process. § The use of new facilities by one or two students to trial the site and allow
evaluation. § The need for all students to meet the requirements for variety of settings,
continuum of care and lifespan. § The mission of the Program. § The value of partnerships with facilities. It is important to use facilities
that offer sound clinical internships on a regular basis. § A review of the individual student’s entire clinical education sequence to
ensure each student meets the requirements of the Program. § Some facilities offer internships on a first come – first served basis. In
these instances, students are notified of the internship opportunity when the information is made available (may be earlier than the usual selection process or during the selection process). Students who are interested in the opportunity are asked to notify the DCE via the Acadaware (or comparable) system. If the DCE determines that the student would be a good match for the clinical site and the internship setting meets the educational needs of the student, the slot will be assigned to the first appropriate student who responds to the notification of availability. If selected to a first come – first serve (FCFS) site, this is counted as a “first choice” for data and record keeping.
- 15 -
• The internship placements are made available via the Acadaware (or comparable) system. Each student will have two days to review his/her internship placement and to contact the DCE in person, by phone or by email if there are any concerns or questions. Student concerns and questions are addressed prior to sending the letters to the clinical site. Students are NOT to contact their sites until officially notified by the DCE.
• All students are expected to go out of the Spokane area for a minimum of one full-time internship. During clinical experiences that require relocation, students are responsible for securing their own housing. Students are expected to demonstrate flexibility in being willing to relocate to areas where they may not have friends and/or family and to budget funds for relocation expenses.
• Some internships are scheduled back-to-back in the same facility. These are large facilities where the student can do two different settings within the system: acute care and outpatient, acute care and rehabilitation, etc. Students scheduled for back-to-back internships stay in the same city for two ten week internships. This model was developed to reduce students’ financial burden and increase learning opportunities. Students may request this sequence of internships in writing or during a meeting with the DCE during the selections process.
• Due to the dynamic healthcare environment, there will be changes in the clinical internship schedule between the time that the site selection process is completed and the start of each internship. When an internship is cancelled (for any reason), the DCE will meet with the student individually to talk about alternative options. At this point, students must understand that the previous “pool” of internship sites is no longer available. The student will need to demonstrate flexibility and openness to alternative sites and geographical locations. Every effort will be made to locate an internship in the same setting as the one cancelled and during the same dates. The student will be notified in writing when a new site is confirmed.
- 16 -
Chapter 3
Preparation for Clinical Internships
Prerequisites for PHTH 780, 781 and 782 Clinical Internships I, II, III include:
• successful completion of all DPT coursework to date.
• successful completion of ICE.
• a passing score on the comprehensive examination.
• compliance with all policies per the Student Handbook and the Clinical Education Handbook and proof of all site specific and Program “on-boarding” requirements.
Clinical education classes are held throughout the academic portion of the curriculum to share information about the clinical internships, discuss clinical education topics and concerns, and assist the student in the procedures of internship site selection. Included in these classes are definitions of clinical education terminology, policies and procedures of clinical education, a review of the Clinical Education Handbook, discussion of the expectations for students during internships, discussion of learning styles, teaching the use of the Performance Assessment System (PAS) that is used for evaluation during the clinical internships, and discussion of ethics, legal issues, patient confidentiality and professionalism.
Participation in the clinical internships allows each student to apply the knowledge, skills and behaviors acquired in the academic setting. However, sometimes the transition from the academic environment to the clinical setting is stressful and challenging for students. In the clinic, students must demonstrate synthesis of academic knowledge, safe and effective intervention skills and appropriate professional behaviors simultaneously while focusing on the patient. Responsibilities and expectations progress during each internship with entry level competency expected at the end of the Program. In addition, upon completion of each3rd year internship, students are expected to demonstrate performance at a level of professional clinical competency consistent with the expectations of a physical therapist in a similar practice setting (acute care, rehabilitation, outpatient orthopedics, etc).
- 17 -
A number of strategies are offered to facilitate student preparation, decrease stress for each internship and facilitate a successful experience. We suggest you:
§ Review previous student assessments related to a specific site in Acadaware. § Review available resources about the facility (web page, previous student
evaluations, comments from the DCE, comments from peers) where you are going for each internship.
§ Review the Clinical Education Handbook. Take the Handbook with you as a resource while on each internship.
§ Review the practice act in each state where you are completing an internship. § Review the Performance Assessment System (PAS) or comparable evaluation and
be prepared to complete your self-assessment efficiently and appropriately. § Review appropriate course material prior to the internship with a focus on
clinically relevant topics and skills. Practice skills and problem solving with your peers prior to the internships.
§ Analyze your own learning style but be willing and open to using other styles. Your CI may have a different style and will work with you to find the most effective teaching and learning methodology.
§ Practice your self-assessment skills and be prepared to use them on a consistent basis. Analyze your own performance prior to asking for feedback from your CI. When you request feedback, ask for specific comments on performance rather than asking, “How did I do?”
§ Start each internship by building a positive and professional relationship with your CI and the staff at the facility. This relationship may start with your first contact with the SCCE as you will be asked to phone or email this person about 8 weeks prior to the start of each internship. Once you arrive at the facility, remember that you are a guest in the facility and are expected to follow the spoken and unspoken rules, as well as treat everyone with respect. Dress according to the facility dress code.
§ Take the following items with you to each internship: the Clinical Education Handbook, your notebook with clinical education resources and documentation, your name tag, a notebook and pen with black ink, a watch and the appropriate textbooks and/or class notes for the specific setting.
§ Follow HIPAA (Health Insurance Portability and Accountability Act) guidelines at all times. If you are in a situation that seems challenging to HIPAA rules, talk
- 18 -
candidly with your CI about the situation and work together on options that will provide appropriate levels of confidentiality.
§ Remember, students are responsible for all EWU policies as well as all clinical site policies.
§ Value what you know and what you do not know. Demonstrate humility by being able to say “I don’t know” and use your own resources to locate the answer. Remember, CIs do not expect students to know everything nor do they expect students to function independently. They do expect students to demonstrate initiative by practicing skills on their own time, preparing for new experiences, reviewing theory and academic knowledge and asking questions appropriately.
§ Take responsibility for your education by setting realistic goals, seeking additional learning opportunities, practicing skills, being familiar with the internship performance assessment tool and internship expectations per the syllabi, writing down questions for discussion at an appropriate time and providing feedback to your CI.
§ Be efficient with clinic time. You may need to be resourceful in facilitating formal meeting times with your CI. To minimize meeting time, come prepared for all meetings with written goals, questions and comments. Wear a watch and be aware of time for effective management of your day and your patient’s time.
§ Look for ways to contribute by helping the staff, seeking out learning opportunities, demonstrating initiative and being friendly. Scan the environment – help clean up, share space and equipment and pick up obstacles. Be a team player.
§ Self-assess. Critical components of the clinical education process are evaluation of the student by the CI and self–assessment using the Performance Assessment System (PAS) and other forms of verbal and written feedback. Seek out the feedback and apply it in the clinical environment without defensiveness.
§ Don’t expect your CI to know everything or to have all of the answers. Learning is a life-long process and each patient provides unique challenges and life experiences.
§ Take a notebook and write down questions to ask your CI later, topics to research, medical terms to learn, self-assessment comments to add to your Performance Assessment System (PAS) or to discussions with your CI. Bring outlines of evaluations and functional assessments from the Program (“cheat sheets”) to use in the clinic. Share these outlines with your CI as they provide insight into your academic preparation.
§ Demonstrate awareness of your responsibility to the patient and the family. Remember, you joined the physical therapy profession to work with patients and provide evidence based practice.
- 19 -
§ Recognize the value of working with patients across the continuum of care. The opportunity to see patients in different settings is critical to your development as a generalist physical therapist.
§ Seek all learning aspects from each setting regardless of your specific practice interests or plans for practice setting after graduation. As a student, you have the unique opportunity to learn from numerous experienced clinicians in a variety of settings. The knowledge, skills and behaviors that you learn in each setting are applicable to the next setting and to your employment after graduation. Reflect on each learning opportunity and consider how to use what you have learned in another situation.
§ Know your rights and responsibilities as a student and be confident in your ability to demonstrate them.
§ Try to get regular exercise and sleep. § Enjoy every moment. § Contact the DCE immediately ([email protected] or 509-828-1362) if you have
concerns. Don’t wait – ask for help and work together on strategies or solutions to your question or concerns.
Students from previous classes developed strategies for specific clinical settings and internship sites. These strategies can be found in the following locations:
• Strategies specific to a clinical setting (acute care, outpatient orthopedics, inpatient rehabilitation, etc.) are listed in the appropriate Clinical Education Canvas courses.
• Strategies specific to a clinical internship site are located on page 6 of the Student Evaluation of the Clinical Experience form in the specific facility file.
Packets of information are sent to the SCCE about 4 weeks prior to each clinical internship. The packet includes a letter from the DCE about the internship, the course syllabus and other relevant information and documents. After allowing 7 – 10 days for the packets to arrive at the facilities, students are asked to contact the SCCE by email or by phone. This initial contact facilitates communication between the student and the SCCE, provides an opportunity for both to discuss questions and begins the professional relationship. The DCE will remind the students in writing of the appropriate time frame for the initial contact.
- 20 -
Chapter 4
Policies The Student Handbook includes the policies for the Program. The policies in this section relate specifically to clinical education and are consistent with the policies in the Student Handbook.
Policy on Nondiscrimination No person shall, on the basis of age, race, religion, color, gender, sexual orientation, gender identity, national origin or disability, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity of Eastern Washington University.
Policy on ADA Eastern Washington University is committed to providing support for students with disabilities. If you are a student with physical, learning, emotional, or psychological disabilities needing an accommodation, you are encouraged to stop by Disability Support Services (DSS), TAW 124 and speak with Kevin Hills, the Manager DSS or call 509-359-6871 to initiate the collaborative process for reasonable accommodation in clinical experiences.
Policy on Affirmative Action Eastern Washington University adheres to affirmative action policies to promote diversity and equal opportunity for all faculty and students.
Policy on Academic Integrity Any question of Academic Integrity will be handled as stated in the EWU Academic Integrity Policy. This policy is on the EWU web site at: https://sites.ewu.edu/universitycollege/policies-procedures/academic-integrity/
Violations will result in a course grade of X.
- 21 -
Policy on Registration and Tuition The student will register for clinical internships following the guidelines provided by EWU. It is the student’s responsibility to acquire the information and register in a timely manner. Registration is required to maintain a full time student status for the purposes of financial aid and insurance. Delayed registration requires a signature from the Department Chair and places the student’s internship at risk due to lack of coverage under the liability insurance policy. Until registered, the student will not be able to participate in the internship.
Students will register for the following clinical internships:
PHTH 780 for 10 credits PHTH 781 for 10 credits
PHTH 782 for 10 credits
Contact information for the Registrar:
Office of Records & Registration 201 Sutton Cheney WA 99004
Register on line at [email protected]
Phone (509) 359-2321
Fax (509) 359-6153
Fees and tuition must be paid according to EWU guidelines.
- 22 -
Policy on Clinical Education Internship Dates All students are expected to attend and complete the clinical internships according to the Department schedule which is predetermined by the EWU academic calendar. The Program makes every effort to establish dates for the clinical education internships two to three years in advance utilizing EWU’s calendar, however students are advised that dates and schedules are subject to change. Every effort will be made to inform students of significant date changes with as much notification as possible.
Policy on Internship Setting Requirements The clinical internships include two ten-week internships and one twelve-week internship for a total of 32 weeks in a minimum of three different clinical settings. All of these internships are full-time experiences for the student. The final three internships are scheduled in the fall, winter and spring quarters of the final year of the Program. For the final internships:
• Students are required to complete one internship in a rehabilitation setting. This can be in an adult or pediatric inpatient rehabilitation facility, a sub-acute unit, a skilled nursing facility, an outpatient setting (i.e.: outpatient neurologic clinic, outpatient pediatric clinic, school system) or home health setting where the majority of the patients have neurologic diagnoses and the staff includes physical therapists, occupational therapists, speech language pathologists and other health care providers (social workers, nurses, physicians, dieticians and/or others) working in a collaborative or team format.
• Students are required to complete one internship in an acute care setting. This is a hospital setting that may include adults and/or children.
• Students are required to complete one internship in a setting of choice. Options may include an outpatient orthopedic clinic, an inpatient rehabilitation unit, an outpatient neurologic clinic, a sub-acute unit, an ambulatory outpatient unit, an acute care hospital, a skilled nursing facility, home health, an acute pediatric facility, an outpatient pediatric clinic or a school system.
• There are some sites that provide a combination of experiences during the internship. Examples include rural facilities where the physical therapists see patients in acute care, the outpatient clinic and the school system or home environment routinely. In these instances, the primary emphasis of the internship is based upon where the majority of the student’s experience will be as determined by the DCE, in consideration of the student’s entire Clinical Education program. A select few sites allow for the student to choose which practice setting to count as the experience in a “combination” of two settings: rehab and acute for example. The student will be notified by the DCE
- 23 -
when this situation occurs and must identify which practice setting they intend during the site selection process.
• The internships do not require any specific sequencing.
Policy on Out-of-Spokane Internships All students are expected to go out of the Spokane area for a minimum of one internship. Due to the number of students and clinical internship sites offered, it is not possible to place all students in the Spokane area for all internships. Clinical sites are considered out-of-Spokane if they are at least 40 miles away or provide difficult commutes from Spokane.
Policy on Canceling an Internship Due to the dynamic healthcare environment, there will be changes in the clinical internship schedule between the time that the site selection process is completed and the start of each internship. When an internship is cancelled (for any reason), the DCE will meet with the student individually to talk about alternative options. At this point, students must understand that the previous “pool” of internship sites is no longer available. The student will need to demonstrate flexibility and openness to alternative sites and geographical locations. Every effort will be made to locate an internship in the same setting as the one cancelled and during the same dates. The student will be notified in writing when a new site is confirmed.
An internship will not be cancelled or changed once it is scheduled unless there are extenuating circumstances. Extenuating circumstances might include student illness or injury, family issues that impact the student’s ability to participate or a problem at the clinical site identified by the SCCE or the DCE.
If the student is required to cancel or change the internship due to personal extenuating circumstances, it is the responsibility of the student to inform the DCE as soon as possible. It is not acceptable for any student to directly contact a clinical internship site to negotiate a change or cancel a planned clinical internship.
Students are not allowed to “swap” or exchange positions within internship sites.
If the SCCE identifies a problem (lack of staff, closing of the clinic, change in management, need for new contract, etc.) that requires a change or cancellation of an internship, it is the responsibility of the SCCE to inform the DCE as soon as possible.
- 24 -
When an internship is cancelled (for any reason), the DCE will meet with the student individually to talk about alternative options.
Policy on Establishing New Clinical Internship Sites
The decision to establish a formal relationship with a clinical facility is based upon the following:
• the desire of the staff at the facility to have students. • the belief that the student will participate in a high quality experience. • the type(s) of experiences provided by the facility. • the likelihood that the facility will be utilized on a regular basis. • the internship needs of the Program. • the cost to the Program of maintaining the site. • program recruitment areas. • community needs.
Policy on Professional Development for Clinical Instructors EWU Department of Physical Therapy will provide all physical therapists who have assumed the responsibilities of mentoring and supervising students in the past two years, are currently mentoring and supervising students or are planning to mentor and supervise students with the Beginning and the Advanced Clinical Instructor Education and Credentialing Program. We will sponsor the educational programs in a variety of locations and pay the registration fee at the APTA member rate. If the clinician is not an APTA member, they will be responsible for the difference.
Policy on Financial Incentives A student will not be placed in a clinical internship at a facility that is funding a portion or all of the student’s education in the Program based upon an agreement to hire him/her upon completion of the Program. This situation presents a conflict of interest for the facility, the CI, the employer, the student and the Program.
Upon entrance into the Program or if the situation occurs during the Program, a student who is receiving financial support from a facility with the expectation of becoming
- 25 -
employed upon successful completion of the Program is required to disclose this arrangement in writing to the DCE.
This policy does not prohibit students from accepting positions at facilities where they are currently doing an internship or have previously done an internship.
Policy on Returning to an Internship Facility If a student is at a facility for any internship, he/she will not be allowed to return to that facility for another internship unless this facility has multiple practice settings (i.e.: St. Luke’s Rehabilitation Institute in Spokane offers internships in outpatient orthopedics, acute care, pediatrics and inpatient rehabilitation). In these instances, the student may return in the facility if scheduled in a different setting.
Some internships are scheduled back-to-back in the same facility. These are large facilities where the student can do two different settings within the system: acute care and outpatient, acute care and rehabilitation, etc. Students scheduled for a back-to-back stay in the same city for two ten week internships. This model was developed to reduce students’ financial burden and increase learning opportunities.
Policy on Prior Work or Volunteering in an Internship Facility A student will not be placed at a facility in which the student has worked or volunteered in the physical therapy department or in a physical therapy related area within the last 3 years. A student will not be placed at a facility in which the student has been or is currently being treated as a patient in the physical therapy department or in a physical therapy related area within the last 3 years. The Program believes that it may be more difficult for students to establish themselves as a student professional in such a setting, since former colleagues and therapists may continue to interact with the student within the context of the previously established roles. These roles may not be appropriate for the student and may curtail the student’s ability to develop the professional behaviors and relationships essential to success as a student physical therapist.
- 26 -
Policy on Documentation Each physical therapist student will have personal access to the following documentation available on request by the SCCE at each clinical internship:
• Background Check • Cardiopulmonary Resuscitation certification • Cover sheet of the Medical Professional Liability Occurrence Insurance policy a copy
will be provided to each student during the Clinical Education Seminar classes and updated cover sheets will be posted on Canvas annually.
• HIPAA education certification • Proof of HIV/AIDS education • Required immunizations • Sterile techniques and standard precautions certification • First Aid certification
Some clinical sites require proof of on-boarding requirements. It is the preference of EWU DPT clinical education that the student provides their own site-required information to the clinical site. However, some sites require that confidential student on-boarding information come from the Program directly. Student permission for sharing this confidential information is obtained in the “Student Agreement of Understanding Clinical Education and Selection Process” document (see appendix of full document).
Policy on Contracts with Internship Facilities Prior to placing a student in a clinical facility for an internship, a written contract must be in effect with signatures from EWU and the facility. The Department has a standard agreement but also uses the specific agreements preferred by some facilities. Copies of the agreements are kept in the Clinical Education office and /or DCE’s office with originals located at each facility and on the EWU campus.
Policy on Immunizations and other On-Boarding Requirements Clinical facilities differ in their requirements for immunizations prior to the start of an internship. In order to prepare students for an internship in most facilities, we have established the following requirements. Students are responsible for reviewing any additional specific requirements for their specific internship facilities and meeting those requirements.
NOTE: DOCUMENTATION means written, “official” documentation from a health care provider/facility with the date of vaccination or screening, your name, the name of the facility administering and the clear explanation of results (in the case of titers).
- 27 -
Measles, Mumps, Rubella (MMR)
• Proof of vaccination OR • Proof of immunity by titer
Varicella (Chicken Pox):
• Proof of vaccination (2 doses) OR • Proof of immunity by titer
Tetunus,
Diphtheria, Pertussis (Tdap)
• Documentation of one dose of TDAP vaccine. • Documentation of tetanus (Td) booster in last 10 years.
Hepatitis B: Proof of immunity by vaccination and titer OR IF
• Negative titer → must repeat vaccine series. Student will be allowed in clinical during repeat series and considered a non-responder to vaccination after 2 complete vaccine series and negative titer OR
• Proof of vaccine series (without titer): o If series is < 5yrs old, draw titer only. If positive titer, ok. If
neg. titer, repeat vaccine series and redraw titer.
o If series is > 5yrs old, one dose of Hep B and titer 1-2 months later. positive titer, ok. If neg titer, complete vaccine series
(2 additional doses) and redraw titer. Neg. titer=nonresponder
• If positive titer and no history of vaccine, must obtain antiHBc test, the marker for past infection
marker for past infection.
- 28 -
Tuberculosis* • Documentation of 2-step test administered spring of first year of DPT program
• Documentation of 1-step test administered spring of second year of DPT program
• Other forms of documentation related to TB may be conducted at your health care provider’s discretion (QuantiFERON Gold or Chest x-ray)
Seasonal Flu Vaccine*
Documentation of one seasonal flu vaccine each year or declination of vavaccination(most facilities require the use of a mask during flu season if vavaccine is declined and some do not allow declination).
CPR* Certification of successful completion of Healthcare Provider CPR
First Aid* Certification of successful completion of First Aid
HIPAA* Certificate of two hours of HIPAA training
HIV/AIDS* Certificate of seven hours of HIV/AIDs education
Resource: www.cdc.gov/vaccines/
* Provided as part of the Clinical Education Seminar course content.
Policy on Cardiopulmonary Resuscitation Training The Program requires all students to complete the healthcare providers Cardiopulmonary Resuscitation certification course. The course is scheduled during the academic year within the Clinical Education Seminar classes.
If recertification is necessary, it is the responsibility of the student to obtain the recertification and provide proof to the DCE. Students will not be able to continue in a clinical internship if CPR certification lapses.
- 29 -
Policy on Background Checks As a student who is considering a career in a health services field, you should familiarize yourself with the licensing and other legal requirements that may be required for you to obtain gainful employment following successful completion of your degree. For example, in Washington State, businesses and organizations are required by RCW 43.43.830 et. seq. to conduct criminal background checks of prospective employees or volunteers who may have unsupervised access to children under sixteen years of age or developmentally disabled persons or vulnerable adults during the course of their employment or involvement with the business or organization. A disqualifying conviction will prevent an employment or volunteer opportunity. Students are required to obtain two background checks prior to the start of clinical education; Washington State Patrol (WSP) and a national background check by way of Certified Background. The initial WSP and National check will be initiated by the PT department, however some facilities require a background check to be conducted closer to the internship start date. If that is the case, the student is responsible for the “re-check”.
Policy on Acquired Immunodeficiency Syndrome It shall be the policy of the Department of Physical Therapy for students enrolled in the Program to provide instruction about AIDS. The instruction is meant to benefit them as individuals and also as professional healthcare providers.
The policy consists of the following elements:
• Instructional units shall address the pathology, etiology, incidence and causal factors related to the Syndrome.
• Isolation and sterile technique classes shall address the practical approach to protection against the pathogen.
• The guidelines for each clinical facility the students are assigned to shall be made available to the students by the clinical facility. The clinical facility guidelines shall constitute the accepted standard.
• The Department shall instruct the student to the highest guidelines, that of Standard Precautions, where each client is a potential AIDS carrier.
The American Physical Therapy Association Guidelines and Policies will be honored whenever they meet or exceed the basic instruction as outlined above.
- 30 -
Training is provided as part of the Clinical Education Seminar series and the student is responsible for completing the course within the timeline provided by the DCE.
The student is responsible for submitting proof of satisfactory completion of the training to the DCE.
This training satisfies the state of Washington’s requirement for AIDS education and training necessary for WA PT licensure per WAC 246-12 and WAC 246-915-110.
Policy on Health Insurance Portability and Accountability Act (HIPAA) Students will adhere to HIPAA requirements per policies and procedures of each internship facility and applicable federal and state laws and regulations.
Policy on Patient’s Right to Refuse Treatment by a Student Students must identify themselves as student physical therapists and respect a patient’s right to refuse treatment by a student practitioner.
Policy on Health Insurance Most facilities for clinical internships are owned and operated by entities that are separate and independent of the University. Almost all clinical facilities require interns to obtain a health and accident insurance plan as a condition to placement at their location. Students participating in internships at these independent clinical sites must purchase a plan which meets the requirements of the facility. Proof of health insurance must be provided to the DCE prior to the clinical education experience. Information about health insurance policies may be obtained from the Office of Student Health at EWU, 359-4279. All students, who attend during the regular academic year, participate in EWU’s Comprehensive Health & Wellness Program which provides services within the Spokane area. The program provides eligible students with access to a basic level of ambulatory health clinic services at any Rockwood Clinic in Cheney, Medical Lake, and Spokane. EWU’s Comprehensive Health and Wellness Program is not considered “health insurance” by the University. Summer students do not automatically participate in this program. Consequently, these services are not included as part of summer tuition and fees and are not automatically charged in the summer. Students who wish to have EWU’s Comprehensive Health & Wellness services during the summer must: 1) either be registered for summer classes or be a continuing student in the fall; and 2) pay the health fee during the summer open enrollment dates. Clinical facilities located in the local region, who require health and accident insurance plans as a condition to placement, may accept the student’s participation in the EWU Program to satisfy their insurance requirement. Students going out of the local Spokane geographic area to a
- 31 -
clinical internship site that requires health insurance will need to purchase a plan to satisfy the site’s requirement. Students are responsible for consulting with their identified internship site to confirm its specific insurance requirements. Furthermore, students should plan accordingly for meeting above immunization requirements especially over the summer months.
Policy on Liability Insurance In order to participate in clinical education and laboratory experiences involving patient contact, each student must be covered by professional liability insurance in the amount of $1,000,000/occurrence, $3,000,000/aggregate. Students have the option of obtaining their own coverage and providing the DCE with written proof of such insurance, or participating in a blanket student liability policy. The blanket policy names only the "Students of Eastern Washington University", rather than individuals, but covers students during their enrollment in the program for any professional care provided in the role as a student.
Policy information will be provided during the first fall quarter. Policy premiums are paid for with course fees each fall quarter.
Policy on Sterile Techniques and Standard Precautions Students will follow the sterile techniques and standard precautions as required by the policies and procedures of each internship facility.
Policy on Release of Information SCCE and CIs are designated as Adjunct Faculty in the Department of Physical Therapy.
CIs are primarily responsible for the student’s clinical education in a specific facility. It is important to share information about the student with the clinical faculty for the purpose of making the clinical internship meaningful and the best possible learning experience for the student. For this reason, a consent signed by the student is requested.
Policy on Contact Information It is the responsibility of the students to provide the DCE with a current address, phone number and email address throughout the clinical internships. The DCE may contact the student at the current (home or cell) phone number to discuss the internship, advise the student of a change in an internship or for other reasons. Phone numbers, addresses and email addresses are needed during the following times:
• the break between the summer quarter and the first 10 week internship • during each of the 10 week internships
- 32 -
• the breaks between the 12 week internships
The student may provide this information to the DCE in writing, by email or by phone. If the student is traveling during the breaks, the student may provide the phone number and address of a family member or friend who would be able to contact him/her.
Policy on Professional Attire for Clinical Internships When entering the clinic, certain standards are raised due to contact with patients/clients and the general public. In addition, dressing professionally automatically commands a higher level of respect from those with whom the physical therapist student comes into contact. The dress expectation is for professional appearance that allows for patient treatment. In any facility where a more formal dress code exists, this code will supersede the EWU PT Program dress code.
Some facilities maintain a very informal dress code. Although not mandatory, it is suggested that students maintain the EWU Professional Attire for Clinical Internships dress code in these settings as well. By doing so, the student will be presenting a professional image to the community and patient population, as well as setting an example as a Doctor of Physical Therapy. It is the student’s responsibility to determine the minimum facility requirements prior to the first day of clinical internship (refer to the Clinical Site Information Form and communication with the Site Coordinator of Clinical Education prior to the start of the internship). Students should dress more formally on the first day of the clinical experience until a dress code is clarified.
Guidelines for/examples of appropriate clinical attire:
Men:
• Collared shirt (polo style) • Dress shirt with or without tie • Sweater • Pleated or flat-front khakis or similar dress style pants. Pants should be of
sufficient length and mobility to safely handle clients while maintaining professional modesty, including coverage of the torso (chest through buttocks covered).
• Clean closed toe shoes with socks • Relatively low heels are recommended for the student therapist’s safety.
- 33 -
Women:
• Dress shirts (no t-shirts or t-shirt collars) or blouses (cleavage should not be exposed when leaning over a patient).
• Sweater. • Pleated or flat-front khakis or similar dress style pants. Pants should be of
sufficient length and mobility to safely handle clients while maintaining professional modesty, including coverage of the torso (chest through buttocks covered).
• Skirts of sufficient length and looseness to cover when squatting or working on a mat table with a patient.
• Clean closed toe shoes with socks. • Relatively low heels are recommended for the student therapist’s safety.
The following items are not permitted: • T-shirt or similar style shirt • Midriff baring tops or other tops/bottoms with torso exposure • Low cut tops that could potentially expose breast/chest when leaning over a
patient • Shorts unless specifically cleared by clinical site • Low cut pants that may expose undergarments when working with patients (i.e.
squatting to floor) • Informal pants such as jeans or cargo style/painter’s pants • Skirts of insufficient length and looseness to cover undergarments and thighs
when squatting or working on a mat table with a patient • Open toed or open heeled shoes unless specifically cleared by clinical site • Tight pants and/or shirts that are anatomically revealing • Clothing that exposes a tattoo or body art while working with a patient • Jewelry, including body piercing, should be kept to a minimum and must not
interfere with the ability to communicate and safely and effectively treat clients/patients; therefore, no lip or tongue piercing will be allowed
• Excessively wrinkled, dirty or torn clothing • Hats/caps
- 34 -
Policy on Participation It is assumed that the physical therapist student will be physically, mentally, and emotionally capable of fully participating in all classroom and clinical activities. It is the responsibility of the student to inform the DCE and Disability Support Services in writing of any accommodation needed due to a condition that may limit the capability of the student to participate fully in the clinical environments.
Observation time does not replace practice. Time lost due to inability to participate fully will need to be made up.
The student will be asked to provide written consent allowing the Program to contact the physician or healthcare provider for a written release prior to consideration for rescheduling of an internship.
Policy on Name Tags Name tags will be provided to students at Orientation. The name tags will be worn during all clinical internships. According to the Washington State Practice Act, Washington Administrative Code (WAC) 246-915-140 “ Personal Identification. (1) Each person shall wear identification showing his or her clinical title, and/or role in the facility as a physical therapist, a physical therapist assistant, [or] a physical therapy aide, or a graduate physical therapist as appropriate. Supportive personnel shall not use any term or designation which indicates or implies that he or she is licensed in the state of Washington.” The Program recognizes the importance of the identification of healthcare providers to the consumer and requires the students to display proper identification in all clinical facilities.
If a name tag is lost, the student will be required to pay a replacement fee. The student may contact the Program Assistant/Clinical Education for information.
- 35 -
Policy on Schedule Worked During Clinical Internships The student is expected to work the same schedule as the CI(s). This schedule may include early or late hours, long days, weekends and holidays. Occasionally, the student may need to stay at the facility longer or arrive earlier to complete chart review and/or documentation. The student may not perform physical therapy examination, evaluation or interventions if the CI(s) is not on the premises.
The clinical hours for some students will be approximately 8:00 am – 5:00 pm, Monday through Friday. However, other students will not have this typical schedule. The student may be scheduled for four ten-hour days or long days on Monday, Wednesday and Friday, with shorter hours on Tuesday and Thursday. Other variable schedules are possible, including weekend hours. Start time may be earlier than 8:00 am and leaving time may be later than 5:00 pm. Students are expected to comply with the schedule assigned to them by the CI. If students have special needs that do not allow them to comply with an atypical schedule, the DCE must be informed of this restriction well in advance of clinical assignments.
Tardiness will not be tolerated. If a student is late, the CI should discuss the issue with the student when it first occurs and give a verbal warning. If it occurs a second time, tardiness should be documented in the performance assessment tool, with a verbal warning to the student. If there is a third occurrence, the DCE should be notified and the event documented again in the performance assessment tool. Any action taken by the Program and the CI will be communicated in writing to the student.
Students are reminded that they are still students and, as such, they should expect to spend time outside of clinic hours reviewing information and completing assignments. It is appropriate for CI(s) to assign homework and students are expected to meet stated deadlines.
The student may not be able to maintain part-time employment during clinical education courses depending on location of placement assignment and hours for the clinical experiences. The student will be expected to comply with the working hours of the assigned facility. If employment hours conflict with facility hours, the student will be expected to change or forfeit employment hours.
- 36 -
Policy on Holidays When a recognized holiday (Christmas Day, New Year’s Day, Memorial Day, Labor Day, 4th of July, Thanksgiving Day) occurs during a student’s internship, the student will follow the same holiday schedule as the CI(s). Closure of the University does not excuse the student from participating in the scheduled clinical internship.
Policy on Illness/Injury or Emergencies on Site The student is not considered to be an employee of the clinical internship facility. If the student is injured during an internship, the facility shall provide emergency medical care to the student in case of need, but shall not bear the cost of such care (EWU/facility contract). In a nonemergency situation, the student may seek medical attention at the healthcare provider of his/her choice. The student is responsible for all costs of medical care received.
The policies of the internship facility will be followed when the filing of an incident report is necessary.
Policy on Clinical Internship Absences When a student misses a day from an internship, the CI and the student will schedule the make-up time, and the student will notify the DCE of the date of the absence, the reason for the absence, and the date of the make-up time within three working days.
A student's absence of two or more days will require discussion with the DCE, the SCCE, and the CI to schedule make-up days.
Any student absences for reasons other than illness must be discussed directly with the DCE. Any planned absence must be approved by the CI and DCE in advance. Please plan accordingly for weddings, reunions, family vacations, etc. during the clinical internship dates.
In all cases, the student will notify the facility prior to the start of the workday or as soon as the student knows of the pending absence, and will speak directly to the CI or SCCE regarding the absence (notifying your CI or SCCE of an absence via text message is unacceptable).
- 37 -
Failure to comply with this policy may result in a delay in the scheduled completion of the student's internships. Failure to complete an internship can result in dismissal from the Program.
Policy on Time Off Students are expected to adhere to the schedule of the clinical facility. Travel time to and/or from the clinical facility should not be requested as breaks between internships allow for adequate time. Time off for appointments for medical and dental care – either for the student or the student’s dependents, should be discussed with the CI prior to making the appointment. It is expected that the student will attempt to schedule appointments so that time away from the clinical setting is least disruptive to the functioning of the facility. Students may be required to make up the missed time. Time off for any other reason must be discussed with the CI. The CI may contact the DCE to discuss options.
Policy on Student Absences to Participate in Opportunities for Professional Development Students may be excused without penalty from academic classes and/or clinical internships in order to participate in opportunities for professional development such as state, national, or international professional conferences, student conclaves, research symposia, and professional political action events. These opportunities will be considered excused absences but must be communicated and approved by both the CI and DCE.
Students are required to obtain prior written approval from all academic and/or clinical faculty who would be involved in the students’ classes or clinical education during the time of their absence.
Such absences, however, do not lessen the student’s responsibility to meet the class requirements. Students are responsible for arranging with the faculty involved to make up class work as required by the faculty.
- 38 -
Policy on Leave of Absence Students who find it necessary to withdraw from the Program and wish to request a leave of absence must submit a written request to the Program Chair prior to withdrawal.
Leaves may be granted at the discretion of the Program faculty within the following guidelines:
The student is in good standing in the Program, the student has completed at least one quarter of professional courses, and the leave of absence will not exceed one calendar year.
A student who has been granted a leave of absence must notify the Program Chair in writing thirty days prior to the end date of the leave of absence of his/her desire to re-enter the Program. If the Program Chair has not been notified in writing, it will be assumed that the student is not returning and enrollment in the Program will be terminated.
If the student requests reentry into the Program, faculty will review coursework taken to date and determine if reentry will be granted. Further, if a review of the student’s records indicate that previously taken courses are outdated or that new requirements have been added, the faculty may stipulate that certain courses be taken or retaken to fulfill requirements.
Policy on Job Interviews Students will be allowed up to one day of excused absence for the purpose of a job or residency interview during their final 12 week internship (PHTH 782, for most students). The CI must approve the time off and all time must be made up before the end of the internship. Time off for job interviews in the other internship experiences (PHTH 780 and 781) will not be authorized. It is the expectation that students who take time for a job interview will contribute samples of interview questions they were asked to the DCE to add to an interview question bank being developed for subsequent DPT classes. Students must communicate this request to the DCE as soon as the absence date is known, with a statement of approval of the absence from the CI, in advance of participating in the job interview.
Policy on Withdrawal from Internship After consultation with the SCCE and/or the CI(s), the DCE and/or the faculty may withdraw a student from a clinical internship if, in their judgment, the student is performing incompetently or poses a safety threat to the patients, the staff of the facility,
- 39 -
or him/herself. The SCCE and/or the CI(s) may immediately remove any student from the premises who poses an immediate threat or danger, or for just cause under the clinical facility’s disciplinary policy. “The student shall be required to follow all the rules, regulations, and procedures of the facility as required of a facility employee” (EWU/facility contract). These rules, regulations, and procedures will be introduced to the student during orientation at the facility.
Policy on Withdrawal The Program adheres to the University withdrawal policy as stated in the course catalog.
Policy on Supervision According to the EWU/facility contract, the facility shall designate a SCCE to act as liaison with the School, to provide for supervision of the student in accordance with the Physical Therapy Practice Act by a physical therapist with a minimum of one year of clinical experience, and to provide the student and the school with feedback on the student’s performance.
A CI must be on the premises at all times when the student in performing physical therapy activities. The student cannot provide physical therapy services if a supervising therapist is not on-site and available for consultation.
If a student is assigned to a small clinic with only one physical therapist, the student cannot provide physical therapy services without the physical therapist on-site as may occur if the therapist calls in sick. In the event that there is no supervising physical therapist available on-site on any day that a student is scheduled to be in the clinic, alternative arrangements must be made for the student’s clinical hours. Options may include observation of another professional, assignment to another clinic for the day or make-up days after the assignment.
Students may participate in co-treatments with other professionals (occupational therapists, speech therapists, for example). The patient must be actively receiving physical therapy care.
- 40 -
Students can receive instruction from physical therapist assistants. In this case, the patient’s care must be directed by the CI.
Student supervision under Medicare A: Therapy students are not required to be in line-of-sight of the professional supervising therapist/assistant (Federal Register, August 8, 2011). Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line-of-sight supervision. Additionally all state and professional practice guidelines for student supervision must be followed. Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All time that the student spends with patients should be documented. Visit www.APTA.org/governance for more information.
Student supervision under Medicare B: The following criteria must be met in order for services provided by a student to be billed by the long-term-care facility:
• The qualified professional is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment. • The practitioner is not engaged in treating another patient or doing other tasks at the same time. • The qualified professional is the person responsible for the services and, as such, signs all documentation. (A student may, of course, also sign but it is not necessary because the Part B payment is for the clinician’s service, not for the student’s services.)
(RAI Version 3.0 Manual, October 2011).
Refer to CMS guidelines: www.cms.hhs.gov or to the APTA website under Advocacy, Medicare – section on Aides, Assistants and Students.
Policy on Grading The DCE is responsible for assigning the grade for each internship. All internships are graded on a Pass/No Credit basis. Grades are assigned based upon the CI(s)’s written evaluation and recommendations, phone conversations and/or site visits with the student and/or CI(s), as well as any other communication between the CI(s), SCCE and the DCE or between the DCE and the student during the internship and with consideration of the
- 41 -
entire record and performance of the student. The DCE will consult with the Chair of the Department and/or the faculty when needed.
The expectations for each internship are listed and described in the course syllabus. The expectations for professional behavior are listed and described in the course syllabus, the Student Handbook, the Clinical Education Handbook and the Performance Assessment System (or comparable assessment tool).
• A grade of Pass is assigned if the student demonstrates satisfactory performance that meets the course expectations.
• A grade of Deferred (X) is assigned if the student fails to submit the internship documentation by the assigned due date
• A grade of No Credit is assigned if the student demonstrates performance that is unsatisfactory and does not meet the course expectations. Unprofessional behavior or patient care that is considered unsafe will result in a grade of No Credit. If the student is assigned a grade of No Credit, the faculty will determine the consequences.
• Failure to pass one internship may be grounds for dismissal from the Program. A decision to offer an opportunity to repeat an internship may be made by the faculty with input from the DCE(s), SCCE, the CI(s) and the student. The reason(s) for failure of an internship will serve as the basis for remediation.
• Failure to pass two or more clinical internships will serve as grounds for dismissal from the program.
Grade Appeals The Department adheres to the Grade Appeal Policy and Procedures of the University:
EWU Grade Appeal Policy https://sites.ewu.edu/policies/policies-and-procedures/ap-303-24-grading-grade-changes-and-grade-appeals/ EWU Official Grade Appeal Form
- 42 -
https://sites.ewu.edu/records-and-registration/files/2017/02/GradeAppealNoticeIntentToFIle.pdf
Policy Dismissal from the Program The faculty has the responsibility to exercise its professional judgment in determining a student’s competence to continue in the program. Any unsafe, unprofessional, or unethical conduct is grounds for immediate dismissal at any stage in the program. Failure of one course is grounds for dismissal. Failure of two courses results in dismissal.
When a student is dismissed from the program, he/she may not register for classes for the upcoming term until and unless their appeal is granted. Should the student already have pre-registered, he/she must cancel the registration.
Policy for Dismissal from a Fieldwork/Internship or Clinical Internship It is the expectation that students will successfully complete all clinical experiences. However, should the student experience difficulty leading to the dismissal from the clinical experience, one of the following criteria will be applied:
Dismissal while Passing: The student, supervisor and coordinator mutually agree that the student is unable to perform to his/her potential due to personality differences or site-specific issues. The student will withdraw from the clinical experience and receive an incomplete. The student will be rescheduled for a new clinical experience when an alternative placement can be arranged.
Dismissal for Medical Reasons: If the student experiences a documented medical emergency or illness, a withdrawal or an incomplete for the course will be issued. Completion will occur when the student is medically stable and a clinical experience can be arranged.
Dismissal for Criminal Conviction: Agencies that provide fieldwork/internship opportunities may require students to complete a criminal background check. If students have a disqualifying criminal conviction(s) as set forth in RCW 43.43 and/or if an agency that provides fieldwork/internship opportunities denies access to a student based on criminal history as permitted by RCW 43.43.842, the student may be dismissed from the clinical program.
- 43 -
Dismissal while Failing: If the student demonstrates one or more of the following conditions, dismissal from the clinical experience will occur and a failing grade will be recorded:
• Does not meet competencies or expectations. Receives a non-satisfactory (failing) at mid-term or final evaluation from the clinical supervisor.
• Fails to officially withdraw. • Does not attend the clinical experience. • Threatens the patient’s safety or treatment. • Violates the terms of the contract between the University and facility. • Does not maintain attendance requirements. • Violates policy/procedure of clinical internship facility and/or university.
Dismissal for Violation of Academic Fieldwork/Internship Drug and Alcohol Policy: Any unsafe, unprofessional, or unethical conduct or failure of a course, including a clinical placement, is grounds for immediate dismissal at any stage in the program. A student who tests positive on a drug/alcohol test administered at a clinic’s direction for a federally controlled substance, except with a valid medical prescription for the use of such substance, will be immediately dismissed from the placement as the use of such substances will impact the student’s ability to provide safe treatment to patients. A student who is dismissed from a clinical internship, will receive a grade of No Credit (failure) for that clinical internship course. Failure of the course is grounds for immediate dismissal from the DPT program. Marijuana use remains prohibited under federal law.
As detailed in the Eastern Washington University Academic Fieldwork/Internship Drug and Alcohol Policy, agencies that provide fieldwork/internship opportunities will require students to comply with their Drug and Alcohol Policies and Procedures.
Those Policies and Procedures may include, but are not necessarily limited to, requirements prohibiting the use, possession, distribution or sale of drugs, drug paraphernalia, alcohol or marijuana. Agencies will dismiss students who fail to comply with Drug and Alcohol Policies and Procedures.
• Refer to specific Program for Appeals Policy • Refer to University policies for incomplete and withdrawal information • Refer to Student Handbook for Disqualifying Crimes, RCW 43.43 information
- 44 -
Policy on Drugs and Alcohol for Academic Fieldwork/Internship
EWU Student Conduct Code Note: WAC 172-121-12 (a) The Departments of Physical Therapy, Occupational Therapy and Communication Disorders at Eastern Washington University are committed to providing a safe work environment, to fostering the wellbeing and health of their students and safe guarding the patients' care. That commitment is jeopardized when a student illegally uses drugs or alcohol on the job, comes to work with these substances present in his/her body, or possesses, distributes, or sells drugs in the workplace.
As an extension of the American Physical Therapy Association, the Department has established the following guidelines:
• The use, sale, possession, manufacture and/or distribution of alcohol and illegal drugs, drug paraphernalia and marijuana are prohibited.
• Agencies that provide fieldwork/internship opportunities will require students to comply with their Policies and Procedures, which may include drug/alcohol tests. EWU does not mandate and is not responsible for payment or administration of drug/alcohol tests.
• Agencies may require students to pay the cost of a mandated alcohol or drug test. • Agencies that provide fieldwork/internship opportunities will dismiss students who
have a positive drug test. • It is a violation of the University’s policy for anyone to use prescription drugs
illegally. However, nothing in this policy precludes the appropriate use of legally prescribed medications.
• It is the student’s responsibility to notify the DCE if using drugs that may affect his/her professional performance.
Policy on Repeat Internship If a student is given the opportunity to participate in a repeat clinical internship, a clinical facility within easy travel distance from the Program will be assigned to the student by the DCE. Easy travel distance allows the DCE to visit the site and/or the student to come to the School for additional help from academic faculty. The clinical facility selected by the DCE will be chosen based upon factors that may include: 1) appropriate learning experiences for the student specific to the needs for remediation, 2) a known site or a known CI who is familiar with the Program expectations, and 3) an experienced CI or a CI who has passed the Clinical Instructor Education and Credentialing Program from the
- 45 -
American Physical Therapy Association.
If the student is offered the opportunity for a repeat internship, the internship will be scheduled during the regular internship timeframe. Areas of deficiency will be identified in writing by the DCE in consultation with the CI, SCCE and the student. The student will be responsible for developing a plan to remediate the deficiencies. The student will submit written documentation stating what has been done to decrease the deficiencies within the timeframe determined by the DCE. Following review, the faculty will determine readiness for the repeat internship opportunity. If readiness is not demonstrated, the opportunity for a repeat internship may be rescinded.
The reasons for remediation and strategies for learning will be discussed with the SCCE and the CIs) prior to assigning the student to the facility.
Grievance Policy If the internship facility is not meeting the responsibilities as defined in this handbook:
• Students should first attempt to resolve the problem with the CI(s). • If resolution of the situation does not occur at such a meeting, the student may
request to discuss the matter with the SCCE of the facility. • If the situation cannot be resolved at a meeting with the SCCE, the student will
request a meeting with the DCE.
Due Process Any student who thinks that he/she has been treated unfairly by a faculty member in connection with the conduct of a class has the right to appeal that faculty member’s decision. Any student who thinks that he/she has been treated unfairly by a decision of the Department Chair also has the right to appeal that decision.
The appeal process is as follows:
1) Request for reconsideration from the faculty member involved, providing reasons for that request.
2) If the reconsideration does not lead to a mutually acceptable resolution, the student may request a meeting with the Chair. The Chair will consult with the faculty member and suggest a resolution. (If the Chair is the faculty member involved, move directly to step 3).
- 46 -
3) If the resolution is still not mutually acceptable, the student should submit a written complaint to the Department faculty as a whole. The complaint will be reviewed by the faculty, and if necessary, an oral hearing will be scheduled. The decision of the Department faculty will be transmitted to the student.
4) If the resolution is still not mutually acceptable, the student may appeal to the Dean of the College of Science, Health and Engineering. If the decision hinges upon interpretation or application of Program rules, the decision of the Dean will be final.
5) If the decision hinges upon interpretation or application of EWU Graduate School regulations and the Dean’s decision does not lead to a mutually acceptable resolution, an appeal may be made to the Dean of the Graduate School.
- 47 -
Chapter 5
Clinical Education Courses and Internships There are six Clinical Education Seminars included within the academic curriculum, one each fall, winter and spring quarter. The purpose of these seminars is to prepare the students for the clinical internships.
PHTH 561
Clinical Education Seminar I includes an introduction to the clinical education program, procedures for clinical education, healthcare providers CPR, policies and procedures and training in the Health Insurance Portability and Accountability Act (HIPAA) .
PHTH 562
Clinical Education Seminar II includes discussions on clinical education, AIDS education, discussion of professional behaviors and documentation using a programmed text and career services for resume and cover letter writing.
PHTH 563
Clinical Education Seminar III includes discussions of clinical education, professional behaviors, learning how to use the Performance Assessment System (PAS) or similar assessment tool, Web PT and documentation practice. Students will complete site selection for PHTH 780 Clinical Internship I and PHTH 781 Clinical Internship II, and become certified in First Aid.
PHTH 661
Clinical Education Seminar IV includes discussions about the first clinical internship, clinical narratives, writing an action plan, communication, mindful practice. Success in clinical internships.
- 48 -
PHTH 662
Clinical Education Seminar V includes discussion of clinical education, collaborative activities with physical therapist assistants, dictation and Medicare updates.
PHTH 663
Clinical Education Seminar VI includes discussion of expectations and the Syllabi for all three internships, documentation practice and discussion of professional behaviors. Students will complete site selection for PHTH 782 Clinical Internship III. Career center speaker, on-boarding. Clinical narratives.
The clinical internship course descriptions and objectives are below.
Clinical Education I, II, III consist of full-time educational experiences in a clinical setting for two ten-week internships during the fall and winter, and one twelve-week internship during spring quarter of the third year of the Program. The primary purposes are to provide patient centered care in a clinical setting and demonstrate entry level performance. Upon completion of each internship, the student will demonstrate performance at a level of professional clinical competency consistent with the expectations of a physical therapist in a similar practice setting (acute care, rehabilitation, outpatient orthopaedics, etc). During the internship, the student will satisfactorily:
• Demonstrate professional conduct through legal competence and ethical practice in the clinical setting according to Standards of Practice, applicable state laws, APTA Code of Ethics, APTA Core Values, department and facility policies and procedures.
• Comply with EWU Student Conduct Code, University and Clinical Internship Facility Policies/Procedures, and this Handbook.
• Demonstrate professional behavior and safe patient care. Unprofessional behavior during any phase of the program, or patient care that is considered unsafe, is cause for dismissal from the program.
• Demonstrate the performance criteria listed in the Performance Assessment System (PAS) or comparable assessment tool. The student is expected to achieve entry-level competent performance by the completion of PHTH 782, the final 12-week internship (see PAS for specific requirements of each criteria). Per the PAS
- 49 -
descriptor: “Entry-level Competent: Student rarely if ever needs correction and monitoring (between 5 – 0%). Mentoring and/or demonstration is typically associated with the unusual, complex patient and/or situation; student appropriately consults for guidance. Performance is competent overall and is consistent with entry-level practice expectations of your facility. Student would be appropriate to practice as a new clinician colleague.”
• Demonstrate entry-level in the behavioral criteria in the Professional Behaviors. Many of these criteria are included in the PAS. The student may be evaluated using the professional behaviors tool if the CI(s), SCCE and/or the DCE feel further clarification is needed.
• Meet the specific expectations at each clinical education site. If the clinical
education site does not have specific expectations, the student will use the site-specific objectives provided by the Program. The Program’s site-specific objectives will be reviewed and modified as appropriate by the CI(s) and/or SCCE.
• Complete a project at each clinical education site. Students are strongly encouraged to do a project rather than a formal in-service. The project should be relevant to the staff at the facility and a learning opportunity for the student. A formal presentation of the project is not necessary. If possible, the student may complete a collaborative project with another student from any discipline. A list of project ideas is available on Canvas.
Objectives and expectations should reflect progress from concrete to conceptual or simple to more complex learning experiences. In all internships, the student is expected to progress from midterm to final in the performance dimensions and professional behaviors as evaluated on the Performance Assessment System (PAS) or similar tool. It is the responsibility of the DCE to assign a pass or no credit grade at the end of each internship.
Site Visits The site visit is an opportunity for sharing information with the SCCE, CI, DCE and student. We feel that close ties between the University and the affiliating clinical centers are vital to successful clinical education. Good communications, on-site visits, and personal acquaintance with the staff and programs of each facility improve the chances of appropriate placements and facilitate problem solving when difficulties arise. Therefore, we select our affiliating centers in geographical clusters in the Northwest. This enables the DCE to visit the sites economically, provide in-service education to the facilities and provide on-site student support when needed.
Site visits are scheduled by the DCE for various reasons:
- 50 -
• new clinical internship sites • when requested by a student, SCCE or CI • when the faculty or the DCE have concerns about a student’s clinical performance • routinely during internships to monitor student progress • to share information with SCCE, CI • to provide in-services on clinical education topics to the clinical faculty.
During a routine site visit, the DCE will meet with the CI and the student. Topics of discussion include professional behaviors, patient variety, the evaluation tool, supervision, time management, academic preparation, goals, evaluations, documentation, and concerns. The SCCE, CI or the student may request to meet with the DCE privately. Site visits can be made during times when no student is present.
The DCE and Program have a goal to conduct a site visit at least one time for every student in the 3rd year of the program.
Clinical Education Advisory Committee The Clinical Education Advisory Committee advises the DCE and the Program faculty on issues related to the clinical education program. The committee is made up of 15 - 18 local physical therapists from a variety of clinical settings. Committee members include SCCEs, CIs, new graduates and the DCE.
Student Rights and Responsibilities
The student has the right to: • expect the CI to be prepared for the internship by reviewing the Program materials,
completing the Clinical Performance Instrument training module and discussing the student’s goals and objectives during orientation and at regular intervals during the internship.
• expect a helpful and supportive environment. • be supervised throughout the clinical internship in accordance with the rules and
regulations of the facility and Medicare. The CI must be on the premises when the student is performing physical therapy activities.
- 51 -
• meet regularly with the CI for formal and informal feedback regarding performance. Formal meetings should be scheduled at midterm and during the final week of the internship with informal meetings scheduled as needed.
• request feedback from the CI receive feedback in a timely manner. • expect learning opportunities and not be used to deal with staff shortages. • expect the CI to model professional behavior that embraces the APTA Code of
Ethics and the APTA Core Values.
The student has the responsibility to: • come to the facility prepared, to demonstrate professional behavior at all times and
to apply academic knowledge in a clinical environment. • be on time, prepared for the expectations at the facility each day, respectful of the
time constraints at the facility and to adhere to the policies of the Program and the facility.
• be accountable for his/her own education by seeking additional learning opportunities available, using his/her own resources, using appropriate strategies to facilitate success and practicing skills identified as deficient.
• request feedback, accept feedback without defensiveness and apply feedback appropriately.
• give feedback in a timely manner. • document and share his/her self-assessment appropriately using the Performance
Assessment System (PAS) or similar tool. • demonstrate competence with the Program documentation requirements related to
the internship and to submit all documentation to the DCE in a timely manner. • demonstrate professional behaviors as described in the Professional Behaviors, the
Performance Assessment System, the APTA Code of Ethics, the APTA Core Values and the state practice act where the facility is located.
• be proactive in resolving problems that may occur during the internship and to request assistance from the SCCE and/or the DCE. The student has the right to contact the DCE at any time for any reason. The student has the right to expect communication with the DCE during the internship in the form of a clinical site visit or by phone or email.
- 52 -
Chapter 6
Clinical Faculty The Physical Therapy Program is fortunate to have clinical education faculty who are supportive and willing to share their clinical expertise in the education of our students. Clinical education faculty (CIs and SCCEs) work with students because they enjoy teaching, have an inherent sense of responsibility within our profession to train future clinicians, value the students’ enthusiasm for learning and thirst for knowledge, and demonstrate life-long learning. They appreciate their role in modeling professionalism and evidence based practice. The clinical education faculty contribute significantly to the Program’s mission of graduating an entry-level physical therapist.
Definitions of Roles SCCE: The Clinical Coordinator of Clinical Education (SCCE) is the clinical faculty member designated by the facility to be responsible for the development and coordination of clinical education at that facility. The SCCE delegates responsibility for supervision of students to the appropriate CI, monitors the supervision of the student, provides problem-solving and communication strategies for the student and CI if needed, and provides the necessary documentation to the Program. The SCCE may also function as a CI.
CI: The Clinical Instructor (CI) is the physical therapist designated by the SCCE as responsible for the student’s clinical education in that facility. A CI may also function as the SCCE. The CI has a minimum of one year of clinical experience and demonstrates an interest in clinical education. The CI is able to implement an appropriate learning experience for the student, set clear expectations, provide frequent verbal and written feedback to the student, and complete a formal evaluation of the student. It is the CI’s responsibility to identify strengths and weaknesses in the student’s clinical performance, communicate any concerns to the student regarding clinical performance and share these concerns with the SCCE and the DCE. The CI also plans remedial activities with the student, the SCCE and the DCE, when appropriate.
- 53 -
Organization of a Clinical Education Program
• Student Manual: It is helpful for each clinical internship site to have a student manual and a structured orientation process. A student manual might include the mission and philosophy of the facility, an agenda for orientation, specific information about the facility, safety procedures and codes, specific objectives for the internship with week-by-week expectations, information on where to locate policies and procedures and guidelines for documentation. Many student manuals also include information on housing, parking, resources available for meals, dress code, an organizational chart and special programming or learning opportunities available. Examples of student manuals are available from the DCE.
• Guidelines for Clinical Education Sites: EWU supports the use of the SCCE Reference Manual available on the APTA website www.apta.org to Education Programs to Educator Resources). This manual provides multiple suggestions and self-assessments to facilitate the development and enhancement of clinical education in any setting.
• Sharing facility information with the Program: • Site specific objectives: It is helpful for both the student and the CI to have written
objectives that are specific to the internship site and progress in a sequential manner. Examples of objectives for a variety of sites are available on the EWU PT Clinical Education website www.ewu.edu/pt and can be modified for the specific facility. Examples of objectives are available for the following settings; acute care (adult), home health, outpatient orthopedics, outpatient pediatrics, inpatient rehabilitation, skilled nursing facility, transitional care units, acute pediatrics and acute rehab.
• Helpful websites on teaching and learning: www.learningandteaching.info/learning/bloomtax.htm
www.dynamicflight.com/avcfibook/learning_process/
Clinical Instructor Rights and Responsibilities
The CI has the right to expect the student to: • come to the facility prepared, to demonstrate professional behavior at all times and
to apply academic knowledge in a clinical environment. • be on time, prepared for the expectations at the facility each day, respectful of the
time constraints at the facility and to adhere to the policies of the Program and the facility.
- 54 -
• be responsible for his/her own education by seeking additional learning opportunities available, using his/her own resources, using appropriate strategies to facilitate success and to practice skills identified as deficient.
• request feedback, accept the feedback without defensiveness and to apply the feedback appropriately.
• give feedback in a timely manner. • document and share his/her self-assessment appropriately using the Performance
Assessment System or similar tool. • demonstrate competence with the Program documentation requirements related to
the internship and to be responsible for submission of all documentation to the DCE in a timely manner.
• demonstrate professional behaviors as described in the Professional Behaviors, Performance Assessment System (PAS) or similar tool, the APTA Code of Ethics, the APTA Core Values and the state practice act where the facility is located.
• be proactive in resolving problems that may occur during the internship and respect the student’s right to request assistance from the SCCE and/or the DCE. The CI has the right to contact the DCE at any time for any reason related to the clinical education of the student. The CI has the right to expect communication with the DCE during the student’s internship. This may be in the form of a clinical site visit or by phone or email.
The CI has the responsibility to: • be prepared for the student’s internship by reviewing the Program materials,
reading the Performance Assessment System Manual or similar tool, and discussing the student’s goals and objectives during orientation and at regular intervals during the internship.
• demonstrate clinical competence in the area of practice in which clinical instruction occurs.
• provide a helpful and supportive environment for the student. • sequence learning experiences throughout the internship with clear written
performance objectives and expectations. • supervise the student throughout the clinical internship in accordance with the
rules and regulations of the facility, state regulations and Medicare. The CI must be on the premises when the student is performing physical therapy activities.
• meet regularly with the student for formal and informal feedback regarding performance. Formal meetings should be scheduled at midterm and during the final week of the internship with informal meetings scheduled as needed.
• assess and document student strengths, weaknesses and deficiencies (knowledge, skills and professional behaviors) and work with the SCCE and DCE when appropriate to plan remediation.
• request feedback from the student and apply the feedback appropriately. • provide learning opportunities for the student but not use the student to deal with
staff shortages.
- 55 -
• model professional behavior that embraces the APTA Code of Ethics and the APTA Core Values.
• monitor and modify learning experiences in a timely manner based on the quality of the student’s performance and/or previous experience.
• provide student feedback by collecting information through direct observation and discussion with the student, review of the student’s patient documentation, observations made by others, patient feedback and student’s self-assessments.
• complete the APTA CI Credentialing or equivalent training successfully. • present clear performance expectations to students at the beginning and throughout
the learning experience incorporating the student’s academic curriculum, level of didactic preparation, current level of performance and the goals for the clinical learning experience.
• identify student errors and facilitate reflection and correction. • recognize the need to involve the SCCE and/or DCE in a timely and appropriate
manner for any issue or concern related to the student (performance, behavioral or other “red flag” issues).
• demonstrate open, honest, constructive and assertive communication (verbal, nonverbal and written) with students and others using people-first language in a way that demonstrates respect and professionalism.
• access and adhere to legal and regulatory practice standards, including all federal, state and institutional regulations related to patient care and fiscal management.
• know and adhere to the requirements for FERPA and HIPAA. • facilitate dialogue about ethical issues and dilemmas with the student and
possibilities for resolution.
The CCCE has the responsibility to: • Submit timely updates of the Clinical Site Information Form (CSIF) to the DCE. • Assist in the process of attaining and/or updating clinical education agreements
(EWU’s Memorandum of Understanding Affiliation Agreement or facility specific contract).
• Coordinate student assignments, orientation and CI development. • Communicate with the DCE. • Act as a resource for the student, CI and DCE.
In addition, the Program is a member of the Northwest Intermountain Consortium (NIC), an organization with the goal of providing professional development opportunities for SCCEs and CIs at an annual conference. Programming at the conference is presented at no charge or minimal charge for CIs.
- 56 -
Clinical Education Resources A variety of clinical internship resources are available on the EWU Clinical Education website at www.ewu.edu/pt .
* Mission and Philosophy of the Physical Therapy Program * Clinical Education Philosophy * Clinical Education Handbook * Course Descriptions * Quarter by quarter curriculum class list * List of textbooks used in the curriculum * Essential Functions * Minimum Required Skills of Physical Therapists Graduates at Entry- level. * Minimum Performance Standards * Guide to the Site Selections Process * Specific site objectives for clinical settings * Mentoring Strategies for Facilitating Learning * Time Management Barriers and Strategies * Structured Observation * Strategies for Sharing Expectations with Students * Action Plans * Professional Behaviors * Behavioral Objectives * Student Project Ideas * Clinical Site Information Form * Clinical Contracts/Agreements * Student Supervisory guidelines * Physical Therapist Student Evaluation of the Clinical Experience and Clinical
Instructor * Clinical Education References * APTA CCCE Reference Manual * APTA Credentialing Course Registration Forms
• Advanced - Dossier • Beginner - Dossier
- 57 -
Chapter 7
Evaluation and Self-Assessment
DCE Assessment The EWU Department of Physical Therapy protocol for faculty assessment is followed when the students are in the didactic component of the curriculum. Students complete an evaluation of the DCE and 700 series in the Spring of their third year.
The SCCE and CI are also asked routinely to assess the DCE. The SCCE and CI Evaluation of the DCE form is sent to each SCCE and/or CI by the Chair of the Department with a stamped envelope addressed to the Chair. The SCCE and/or CI is asked to complete the form and return it back to the Chair.
Clinical Experience and Instruction Evaluation The CI is evaluated by the student at final using the Clinical Evaluation Software tool. The SCCE and/or CI may make a copy of the completed form.
This assessment is available for the DCE to view and release with personal information redacted for other EWU students to view. The DCE will follow up with the clinical site/SCCE/CI should significant discrepancies arise between the two student assessment documents.
The DCE evaluates clinical internship facilities using numerous sources of information. Evaluation is done during clinical visit visits and/or phone visits, in review of the Student Evaluation of the Clinical Experience and Clinical Instruction and in review of student and faculty comments during any phase of the Program. For the many clinical internship facilities that are shared with other programs, the DCE may also consult with the Fieldwork Coordinator from the Department of Occupational Therapy and the Off-site Internship Coordinator for Communication Disorders, as well as the DCEs/ACCEs in the Northwest Intermountain Consortium (NIC). They may request input from faculty or the Clinical Education Advisory Committee. The DCE looks for threads and commonalities for quality of learning opportunities available to students.
- 58 -
Sites that do not consistently meet the expectations for quality learning experiences are removed from the list of clinical internship facilities. A description of quality learning experiences is in the SCCE Reference Manual that is available on the APTA website.
The DCE evaluates SCCEs and CIs using numerous sources of information. Evaluation is done during clinical visit visits and/or phone visits, in review of the Student Evaluation of the Clinical Experience and Clinical Instruction and in review of student and faculty comments during any phase of the Program. A description of quality clinical instruction is in the SCCE Reference Manual that is available on the APTA website. This Manual is recommended for self-assessment. In addition, SCCEs and CIs are consistently informed of professional development opportunities and encouraged to attain Clinical Instructor Credentialing through the APTA programs. CIs who consistently fail to meet the expectations are no longer used.
The site visit is an opportunity for sharing information with the SCCE, CI, DCE and student. We feel that close ties between the University and the affiliating clinical centers are vital to successful clinical education. Good communication, on-site visits and personal acquaintance with the staff and programs of each facility improve the chances of appropriate placements and facilitate problem solving when difficulties arise. Site visits are scheduled by the DCE for various reasons and can be made during times when no student is present.
Site visits are scheduled by the DCE for various reasons:
1) new clinical internship sites 2) when requested by a student, SCCE or CI 3) when the faculty or the DCE have concerns about a student’s clinical
performance 4) routinely during internships to monitor student progress 5) to share information with SCCE, CI
During a routine site visit, the DCE will meet with the CI and the student. Topics of discussion include professional behaviors, patient variety, the evaluation tool, supervision, time management, academic preparation, goals, evaluations, documentation and concerns.
The SCCE, CI or the student may request to meet with the DCE privately.
- 59 -
Student Evaluation Procedure The student is evaluated using the Performance Assessment System (PAS) or similar performance assessment tool during all clinical internships in accordance with the course syllabus. The web based PAS requires SCCEs, CIs and students to review the training manuals prior to getting access to the document for student evaluation.
In addition other assessment tools maybe used as needed:
• APTA Core Values • APTA Standards of Practice • Essential Functions • Professional Behaviors • Incident reports • Minimum Performance Standards • Specific site objectives/expectations • State practice act • Verbal and written feedback from other healthcare professionals, patients and families/caregivers at the internship site • EWU Student Code of Conduct
Clinical Internship Awards The Department of Physical Therapy offers two clinical internship awards that are initiated and decided upon by students. Students may nominate clinical internship sites and/or clinical instructors that they consider to be outstanding during any time in the Program and for any internship. Awards will be given at the end of spring quarter each year.
Clinical Internship/Fieldwork Site Award: The purpose of this award is to acknowledge a clinical internship/fieldwork site that provides students with exemplary clinical experiences and demonstrates the following criteria:
• Staff that are actively involved in the profession at the state and/or national level. • An adequate student manual and orientation. • Practice that is evidence based, ethical and legal.
- 60 -
• Staff that are friendly, enjoy students, mentor with skill, share their patients willing and are experts in clinical practice.
• An appropriately varied caseload and pace of scheduling patients.
Clinical Instructor/Clinical Educator Award: The purpose of this award is to acknowledge a clinical instructor/clinical educator who made significant contributions to clinical education through teaching/mentoring excellence, clinical expertise and role modeling of professionalism and demonstrates the following criteria:
• Enthusiasm for students and clinical education. • Excellent teaching and mentoring skills. • Clinical skills at the master clinician level. • Leadership in the profession. • Ethical practice.
61
Eastern Washington University Department of Physical Therapy
Essential Functions for Admission, Promotion, and Graduation
Introduction Eastern Washington University, Department of Physical Therapy, endeavors to select applicants who have the ability to become competent physical therapists. As an accredited physical therapy program, the Department of Physical Therapy adheres to the standards and guidelines of the Commission on Accreditation for Physical Therapy Education of the American Physical Therapy Association. Admission and retention decisions are based not only on prior satisfactory academic achievement, but also on non-academic factors that serve to insure that the candidate can complete the essential functions of the program required for graduation.
In November, 1999, the Eastern Washington University, Department of Physical Therapy, adopted the following essential functions for admission, promotion and graduation for its entry-level professional program. Physical therapy is an intellectually, physically, and psychologically demanding profession. It is during the rigorous two and a half year curriculum that the student begins to develop the qualities needed to practice physical therapy. Students acquire the foundation of knowledge, attitudes, skills and behaviors needed throughout the physical therapist’s professional career. Those abilities that physical therapists must possess to practice safely are reflected in the essential functions that follow.
Candidates for the degree must be able to meet these minimum standards, with or without reasonable accommodation, for successful completion of degree requirements (see Section III).
Essential Functions
A. Observation Observation requires the functional use of vision, hearing and somatic sensations. A student must be able to observe lectures, laboratory dissection of cadavers, lecture and laboratory demonstrations, and observe microscopic
62
studies of tissues. The student must be able to observe a patient accurately, observe digital and waveform readings and other graphic images to determine a patient’s condition. Examples in which these observational skills are required include: palpation of peripheral pulses, bony prominences and ligamentous structures, visual and tactile evaluation for areas of inflammation, and visual and tactile assessment of the presence and degree of edema.
B. Communication Communication includes: speech, language, reading, writing and computer literacy. Students must be able to communicate effectively and sensitively with patients to elicit information regarding mood and activities, as well as perceive non-verbal communications. Students must also be able to communicate effectively and efficiently with other members of the health care community to convey information essential for safe and effective care.
C. Motor Students must possess sufficient motor function to elicit information from the patient examination, by palpation, auscultation, tapping, and other evaluation maneuvers. Students must be able to execute movements required to provide general and therapeutic care, such as positioning large or immobile patients, gait training using therapeutic aids and orthotics, positioning and performing manual mobilization techniques, performing non-surgical wound debridement, and placing electromyographic electrodes. These skills require coordination of both gross and fine muscular movement, equilibrium, and the integrated use of touch and vision.
D. Intellectual- conceptual, integrative and quantitative abilities To effectively solve problems, students must be able to measure, calculate, reason, analyze, integrate and synthesize information in a timely fashion. For example, the student must be able to synthesize knowledge and integrate the relevant aspects of a patient’s history and examination findings to develop an effective treatment program. In addition, students must be able to
63
comprehend three dimensional relationships and to understand spatial relationships of anatomical structures.
Behavioral and Social Attributes A student must possess the psychological ability required for the full utilization of their intellectual abilities, for the exercise of good judgment, for the prompt completion of all responsibilities inherent to diagnosis and care of patients, and for the development of mature, sensitive, and effective relationships with patients. Students must be able to tolerate physically and mentally taxing workloads and function effectively under stress. They must be able to adapt to a changing environment, display flexibility and learn to function in the face of uncertainties inherent in the clinical problems of patients. As a component of their education, students must demonstrate ethical behavior.
F. Curriculum Requirements In addition to the abilities specified above, students must be able to successfully complete, with or without reasonable accommodation, all required components of the curriculum.
G. Tests and Evaluations In order to evaluate competence, the Physical Therapy Program employs periodic examinations, both written and practical, as an essential component of the curriculum. Successful completion of these examinations is required of all students as a condition for continued progress through the curriculum.
H. Clinical Assessments Demonstration of clinical competence is fundamental to the career of the student. The process of evaluation of the clinical performance of the student is an integral and essential component of the curriculum. Although reasonable accommodation will be made, participation in clinical experiences and the evaluation of that participation is required. The Performance Assessment System (PAS) is the evaluation tool currently used.
64
Reasonable Accommodation Persons with disabilities are an integral part of the Eastern Washington University community, and the provision of equal access to programs, services and activities through reasonable accommodation is a campus-wide responsibility and commitment. In accord with the Americans with Disabilities Act of 1990; the Washington State Law Against Discrimination, RCW 49.60; and Section 504 of the 1973 Rehabilitation Act which prohibits discrimination against individuals on the basis of disability, Eastern Washington University shall provide reasonable accommodation for individuals with disabilities and is committed to ensuring that discrimination against disability does not occur.
Determining what is reasonable accommodation for students in the Eastern Washington University Physical Therapy Program is an interactive process which the student should initiate with the Chair of the Physical Therapy Program, the student’s physical therapy advisor, and the Disability Support Services Office.
Professional Behaviors for the 21st Century
Definitions of Behavioral Criteria Levels
Beginning Level – behaviors consistent with a learner in the beginning of the professional phase of physical therapy education and before the first significant internship
Intermediate Level – behaviors consistent with a learner after the first significant internship
65
Entry Level – behaviors consistent with a learner who has completed all didactic work and is able to independently manage a caseload with consultation as needed from clinical instructors, co-workers and other health care professionals
Post-Entry Level – behaviors consistent with an autonomous practitioner beyond entry level
Background Information In 1991 the faculty of the University of Wisconsin-Madison, Physical Therapy Educational Program identified the original Physical Therapy - Specific Generic Abilities. Since that time these abilities have been used by academic programs to facilitate the development, measurement and assessment of professional behaviors of students during both the didactic and clinical phases of the programs of study.
Since the initial study was conducted, the profession of Physical Therapy and the curricula of the educational programs have undergone significant changes that mirror the changes in healthcare and the academy. These changes include managed care, expansion in the scope of physical therapist practice, increased patient direct access to physical therapists, evidenced-based practice, clinical specialization in physical therapy and the American Physical Therapy Association’s Vision 2020 supporting doctors of physical therapy.
Today’s physical therapy practitioner functions on a more autonomous level in the delivery of patient care which places a higher demand for professional development on the new graduates of the physical therapy educational programs. Most recently (2008-2009), the research team of Warren May, PT, MPH, Laurie Kontney PT, DPT, MS and Z. Annette Iglarsh, PT, PhD, MBA completed a research project that built on the work of other researchers to analyze the PT-Specific Generic Abilities in relation to the changing landscape of physical therapist practice and in relation to generational differences of the “Millennial” or “Y” Generation (born 1980-2000). These are the graduates of the classes of 2004 and beyond who will shape clinical practice in the 21st century.
The research project was twofold and consisted of 1) a research survey which identified and rank ordered professional behaviors expected of the newly licensed physical therapist upon employment (2008); and 2) 10 small work groups that took the 10 identified behaviors (statistically determined) and wrote/revised behavior
66
definitions, behavioral criteria and placement within developmental levels (Beginning, Intermediate, Entry Level and Post Entry Level) (2009). Interestingly the 10 statistically significant behaviors identified were identical to the original 10 Generic Abilities, however, the rank orders of the behaviors changed. Participants in the research survey included Center Coordinators of Clinical Education (CCCE’s) and Clinical Instructors (CI’s) from all regions of the United States. Participants in the small work groups included Directors of Clinical Education (DCE’s), Academic Faculty, CCCE’s and CI’s from all regions of the United States.
This resulting document, Professional Behaviors, is the culmination of this research project. The definitions of each professional behavior have been revised along with the behavioral criteria for each developmental level. The ‘developing level’ was changed to the ‘intermediate level’ and the title of the document has been changed from Generic Abilities to Professional Behaviors. The title of this important document was changed to differentiate it from the original Generic Abilities and to better reflect the intent of assessing professional behaviors deemed critical for professional growth and development in physical therapy education and practice.
Preamble In addition to a core of cognitive knowledge and psychomotor skills, it has been recognized by educators and practicing professionals that a repertoire of behaviors is required for success in any given profession (Alverno College Faculty, Assessment at Alverno, 1979). The identified repertoire of behaviors that constitute professional behavior reflect the values of any given profession and, at the same time, cross disciplinary lines (May et. al., 1991). Visualizing cognitive knowledge, psychomotor skills and a repertoire of behaviors as the legs of a three-legged stool serves to emphasize the importance of each. Remove one leg and the stool loses its stability and makes it very difficult to support professional growth, development, and ultimately, professional success. (May et. al., Opportunity Favors the Prepared: A Guide to Facilitating the Development of Professional Behavior, 2002)
The intent of the Professional Behaviors Assessment Tool is to identify and describe the repertoire of professional behaviors deemed necessary for success in the practice of physical therapy. This Professional Behaviors Assessment Tool is
67
intended to represent and be applied to student growth and development in the classroom and the clinic. It also contains behavioral criteria for the practicing clinician. Each Professional Behavior is defined and then broken down into developmental levels with each level containing behavioral criteria that describe behaviors that represent possession of the Professional Behavior they represent. Each developmental level builds on the previous level such that the tool represents growth over time in physical therapy education and practice.
It is critical that students, academic and clinical faculty utilize the Professional Behaviors Assessment Tool in the context of physical therapy and not life experiences. For example, a learner may possess strong communication skills in the context of student life and work situations, however, may be in the process of developing their physical therapy communication skills, those necessary to be successful as a professional in a greater health care context. One does not necessarily translate to the other, and thus must be used in the appropriate context to be effective.
Opportunities to reflect on each Professional Behavior through self-assessment, and through peer and instructor assessment is critical for progress toward entry level performance in the classroom and clinic. A learner does not need to possess each behavioral criteria identified at each level within the tool, however, should demonstrate, and be able to provide examples of the majority in order to move from one level to the next. Likewise, the behavioral criteria are examples of behaviors one might demonstrate, however are not exhaustive. Academic and clinical facilities may decide to add or delete behavioral criteria based on the needs of their specific setting. Formal opportunities to reflect and discuss with an academic and/or clinical instructor is key to the tool’s use, and ultimately professional growth of the learner. The Professional Behaviors Assessment Tool allows the learner to build and strengthen their third leg with skills in the affective domain to augment the cognitive and psychomotor domains.
68
Professional Behaviors
Critical Thinking The ability to question logically; identify, generate and evaluate elements of logical argument; recognize and differentiate facts, appropriate or faulty inferences, and assumptions; and distinguish relevant from irrelevant information. The ability to appropriately utilize, analyze, and critically evaluate scientific evidence to develop a logical argument, and to identify and determine the impact of bias on the decision making process.
Beginning Level: v Raises relevant questions v Considers all available information v Articulates ideas v Understands the scientific method v States the results of scientific literature but has not developed the consistent
ability to critically appraise findings (i.e. methodology and conclusion) v Recognizes holes in knowledge base v Demonstrates acceptance of limited knowledge and experience
Intermediate Level: v Feels challenged to examine ideas v Critically analyzes the literature and applies it to patient management v Utilizes didactic knowledge, research evidence, and clinical experience to
formulate new ideas v Seeks alternative ideas v Formulates alternative hypotheses v Critiques hypotheses and ideas at a level consistent with knowledge base v Acknowledges presence of contradictions
Entry Level: v Distinguishes relevant from irrelevant patient data v Readily formulates and critiques alternative hypotheses and ideas v Infers applicability of information across populations v Exhibits openness to contradictory ideas v Identifies appropriate measures and determines effectiveness of applied
solutions efficiently v Justifies solutions selected
69
Post-Entry Level: v Develops new knowledge through research, professional writing and/or
professional presentations v Thoroughly critiques hypotheses and ideas often crossing disciplines in
thought process v Weighs information value based on source and level of evidence v Identifies complex patterns of associations v Distinguishes when to think intuitively vs. analytically v Recognizes own biases and suspends judgmental thinking v Challenges others to think critically
Communication The ability to communicate effectively (i.e. verbal, non-verbal, reading, writing, and listening) for varied audiences and purposes.
Beginning Level: v Demonstrates understanding of the English language (verbal and written):
uses correct grammar, accurate spelling and expression, legible handwriting v Recognizes impact of non-verbal communication in self and others v Recognizes the verbal and non-verbal characteristics that portray confidence v Utilizes electronic communication appropriately
Intermediate Level: v Utilizes and modifies communication (verbal, non-verbal, written and
electronic) to meet the needs of different audiences v Restates, reflects and clarifies message(s) v Communicates collaboratively with both individuals and groups v Collects necessary information from all pertinent individuals in the
patient/client management process v Provides effective education (verbal, non-verbal, written and electronic)
70
Entry Level: v Demonstrates the ability to maintain appropriate control of the
communication exchange with individuals and groups v Presents persuasive and explanatory verbal, written or electronic messages
with logical organization and sequencing v Maintains open and constructive communication v Utilizes communication technology effectively and efficiently
Post Entry Level: v Adapts messages to address needs, expectations, and prior knowledge of the
audience to maximize learning v Effectively delivers messages capable of influencing patients, the community
and society v Provides education locally, regionally and/or nationally v Mediates conflict
Problem Solving The ability to recognize and define problems, analyze data, develop and implement solutions, and evaluate outcomes.
Beginning Level: v Recognizes problems v States problems clearly v Describes known solutions to problems v Identifies resources needed to develop solutions v Uses technology to search for and locate resources v Identifies possible solutions and probable outcomes
Intermediate Level: v Prioritizes problems v Identifies contributors to problems v Consults with others to clarify problems v Appropriately seeks input or guidance v Prioritizes resources (analysis and critique of resources) v Considers consequences of possible solutions
71
Entry Level: v Independently locates, prioritizes and uses resources to solve problems v Accepts responsibility for implementing solutions v Implements solutions v Reassesses solutions v Evaluates outcomes v Modifies solutions based on the outcome and current evidence v Evaluates generalizability of current evidence to a particular problem
Post Entry Level: v Weighs advantages and disadvantages of a solution to a problem v Participates in outcome studies v Participates in formal quality assessment in work environment v Seeks solutions to community health-related problems v Considers second and third order effects of solutions chosen
Interpersonal Skills The ability to interact effectively with patients, families, colleagues, other health care professionals, and the community in a culturally aware manner.
Beginning Level: v Maintains professional demeanor in all interactions v Demonstrates interest in patients as individuals v Communicates with others in a respectful and confident manner v Respects differences in personality, lifestyle and learning styles during
interactions with all persons v Maintains confidentiality in all interactions v Recognizes the emotions and bias that one brings to all professional
interactions
Intermediate Level: v Recognizes the non-verbal communication and emotions that others bring to
professional interactions v Establishes trust v Seeks to gain input from others v Respects role of others v Accommodates differences in learning styles as appropriate
72
Entry Level: v Demonstrates active listening skills and reflects back to original concern to
determine course of action v Responds effectively to unexpected situations v Demonstrates ability to build partnerships v Applies conflict management strategies when dealing with challenging
interactions v Recognizes the impact of non-verbal communication and emotional responses
during interactions and modifies own behaviors based on them
Post Entry Level: v Establishes mentor relationships v Recognizes the impact that non-verbal communication and the emotions of
self and others have during interactions and demonstrates the ability to modify the behaviors of self and others during the interaction
Responsibility The ability to be accountable for the outcomes of personal and professional actions and to follow through on commitments that encompass the profession within the scope of work, community and social responsibilities.
Beginning Level: v Demonstrates punctuality v Provides a safe and secure environment for patients v Assumes responsibility for actions v Follows through on commitments v Articulates limitations and readiness to learn v Abides by all policies of academic program and clinical facility
73
Intermediate Level: v Displays awareness of and sensitivity to diverse populations v Completes projects without prompting v Delegates tasks as needed v Collaborates with team members, patients and families v Provides evidence-based patient care
Entry Level: v Educates patients as consumers of health care services v Encourages patient accountability v Directs patients to other health care professionals as needed v Acts as a patient advocate v Promotes evidence-based practice in health care settings v Accepts responsibility for implementing solutions v Demonstrates accountability for all decisions and behaviors in academic and
clinical settings
Post Entry Level: v Recognizes role as a leader v Encourages and displays leadership v Facilitates program development and modification v Promotes clinical training for students and coworkers v Monitors and adapts to changes in the health care system v Promotes service to the community
Professionalism The ability to exhibit appropriate professional conduct and to represent the profession effectively while promoting the growth/development of the Physical Therapy profession.
Beginning Level: v Abides by all aspects of the academic program honor code and the APTA Code
of Ethics v Demonstrates awareness of state licensure regulations v Projects professional image v Attends professional meetings
74
v Demonstrates cultural/generational awareness, ethical values, respect, and continuous regard for all classmates, academic and clinical faculty/staff, patients, families, and other healthcare providers
Intermediate Level: v Identifies positive professional role models within the academic and clinical
settings v Acts on moral commitment during all academic and clinical activities v Identifies when the input of classmates, co-workers and other healthcare
professionals will result in optimal outcome and acts accordingly to attain such input and share decision making
v Discusses societal expectations of the profession
Entry Level: v Demonstrates understanding of scope of practice as evidenced by treatment
of patients within scope of practice, referring to other healthcare professionals as necessary
v Provides patient/family centered care at all times as evidenced by provision of patient/family education, seeking patient input and informed consent for all aspects of care and maintenance of patient dignity
v Seeks excellence in professional practice by participation in professional organizations and attendance at sessions or participation in activities that further education/professional development
v Utilizes evidence to guide clinical decision making and the provision of patient care, following guidelines for best practices
v Discusses role of physical therapy within the healthcare system and in population health
v Demonstrates leadership in collaboration with both individuals and groups
75
Post Entry Level: v Actively promotes and advocates for the profession v Pursues leadership roles v Supports research v Participates in program development v Participates in education of the community v Demonstrates the ability to practice effectively in multiple settings v Acts as a clinical instructor v Advocates for the patient, the community and society
Use of Constructive Feedback The ability to seek out and identify quality sources of feedback, reflect on and integrate the feedback, and provide meaningful feedback to others.
Beginning Level: v Demonstrates active listening skills v Assesses own performance v Actively seeks feedback from appropriate sources v Demonstrates receptive behavior and positive attitude toward feedback v Incorporates specific feedback into behaviors v Maintains two-way communication without defensiveness
Intermediate Level: v Critiques own performance accurately v Responds effectively to constructive feedback v Utilizes feedback when establishing professional and patient related goals v Develops and implements a plan of action in response to feedback v Provides constructive and timely feedback
Entry Level: v Independently engages in a continual process of self-evaluation of skills,
knowledge and abilities v Seeks feedback from patients/clients and peers/mentors
76
v Readily integrates feedback provided from a variety of sources to improve skills, knowledge and abilities
v Uses multiple approaches when responding to feedback v Reconciles differences with sensitivity v Modifies feedback given to patients/clients according to their learning styles
Post Entry Level: v Engages in non-judgmental, constructive problem-solving discussions v Acts as conduit for feedback between multiple sources v Seeks feedback from a variety of sources to include
students/supervisees/peers/supervisors/patients v Utilizes feedback when analyzing and updating professional goals
Effective Use of Time and Resources The ability to manage time and resources effectively to obtain the maximum possible benefit.
Beginning Level: v Comes prepared for the day’s activities/responsibilities v Identifies resource limitations (i.e. information, time, experience) v Determines when and how much help/assistance is needed v Accesses current evidence in a timely manner v Verbalizes productivity standards and identifies barriers to meeting
productivity standards v Self-identifies and initiates learning opportunities during unscheduled time
77
Intermediate Level: v Utilizes effective methods of searching for evidence for practice decisions v Recognizes own resource contributions v Shares knowledge and collaborates with staff to utilize best current evidence v Discusses and implements strategies for meeting productivity standards v Identifies need for and seeks referrals to other disciplines
Entry Level: v Uses current best evidence v Collaborates with members of the team to maximize the impact of treatment
available v Has the ability to set boundaries, negotiate, compromise, and set realistic
expectations v Gathers data and effectively interprets and assimilates the data to determine
plan of care v Utilizes community resources in discharge planning v Adjusts plans, schedule etc. as patient needs and circumstances dictate v Meets productivity standards of facility while providing quality care and
completing non-productive work activities
Post Entry Level: v Advances profession by contributing to the body of knowledge (outcomes, case
studies, etc) v Applies best evidence considering available resources and constraints v Organizes and prioritizes effectively v Prioritizes multiple demands and situations that arise on a given day v Mentors peers and supervisees in increasing productivity and/or effectiveness
without decrement in quality of care
Stress Management – The ability to identify sources of stress and to develop and implement effective coping behaviors; this applies for interactions for: self, patient/clients and their families, members of the health care team and in work/life scenarios.
78
Beginning Level: v Recognizes own stressors v Recognizes distress or problems in others v Seeks assistance as needed v Maintains professional demeanor in all situations
Intermediate Level: v Actively employs stress management techniques v Reconciles inconsistencies in the educational process v Maintains balance between professional and personal life v Accepts constructive feedback and clarifies expectations v Establishes outlets to cope with stressors
Entry Level: v Demonstrates appropriate affective responses in all situations v Responds calmly to urgent situations with reflection and debriefing as needed v Prioritizes multiple commitments v Reconciles inconsistencies within professional, personal and work/life
environments v Demonstrates ability to defuse potential stressors with self and others
Post Entry Level: v Recognizes when problems are unsolvable v Assists others in recognizing and managing stressors v Demonstrates preventative approach to stress management v Establishes support networks for self and others v Offers solutions to the reduction of stress v Models work/life balance through health/wellness behaviors in professional
and personal life
79
Commitment to Learning The ability to self-direct learning to include the identification of needs and sources of learning; and to continually seek and apply new knowledge, behaviors, and skills.
Beginning Level: v Prioritizes information needs v Analyzes and subdivides large questions into components v Identifies own learning needs based on previous experiences v Welcomes and/or seeks new learning opportunities v Seeks out professional literature v Plans and presents an in-service, research or cases studies
Intermediate Level: v Researches and studies areas where own knowledge base is lacking in order
to augment learning and practice v Applies new information and re-evaluates performance v Accepts that there may be more than one answer to a problem v Recognizes the need to and is able to verify solutions to problems v Reads articles critically and understands limits of application to professional
practice
Entry Level: v Respectfully questions conventional wisdom v Formulates and re-evaluates position based on available evidence v Demonstrates confidence in sharing new knowledge with all staff levels v Modifies programs and treatments based on newly-learned skills and
considerations v Consults with other health professionals and physical therapists for
treatment ideas
Post Entry Level: v Acts as a mentor not only to other PT’s, but to other health professionals v Utilizes mentors who have knowledge available to them v Continues to seek and review relevant literature
80
v Works towards clinical specialty certifications v Seeks specialty training v Is committed to understanding the PT’s role in the health care environment
today (i.e. wellness clinics, massage therapy, holistic medicine) v Pursues participation in clinical education as an educational opportunity
Behavioral Objectives
Components A. Who: audience for whom the objective is intended.
“The physical therapist student will...”
B. What: specific observable actions/behaviors that the learner is to perform or exhibit.
Use taxonomy.
C. “Givens” or conditions: relevant factors affecting the actual performance.
1. in the classroom, lab or clinical setting...
2. upon completion of the assignment or learning task...
3. after reviewing instruction...
4. following a lecture, demonstration or discussion...
5. with(out) the use of notes, text, lab manuals...
6. when provided with certain materials or equipment...
7. given a case study, diagram,, clinical problem...
8. on a model, classmate, patient...
D. Criterion for success: level of achievement indicating acceptable performance.
1. to a degree of accuracy, e.g. 90% or + or - 1 s.d.
2. to a stated proportion, e.g. within 2 mm of mercury
3. within a given time period
4. within a given number of trials
81
5. to a standard of clinical acceptability
6. to be verified by an external agency, panel, person
7. according to criteria set forth in a lab manual, standard operating policy, skill analysis, or other document
8. to the satisfaction of the instructor
E. Examples:
1.Given a sphygmomanometer and stethoscope, the physical therapist student will measure the blood pressure of a patient to within 5mm Hg of the values obtained by the instructor with measurements completed within 2 minutes.
2.Following treatment, the patient will transfer safely from a wheelchair to a bed with a side rail, 100% of the time.
LEVEL ONE Domain: Cognitive - knowledge: The remembering of previously learned material.
Domain: Affective - receiving: getting, holding, and directing the student’s or patient’s attention.
Domain: Psychomotor - perception: using sense organs to obtain cues that guide motor activity.
Cognitive Affective Psychomotor Knowledge Receiving Perception cite label ask choose define list choose describe describe match describe detect eliminate name eliminate differentiate express request express distinguish identify state identify identify itemize locate inspect name itemize reply isolate
82
request relate (tell) select separate
LEVEL TWO Domain: Cognitive - comprehension: grasping the meaning of the material
Domain: Affective - responding: active participation and reaction by the student
Domain: Psychomotor - set: mental, physical, and emotional readiness to act.
Cognitive Affective Psychomotor Comprehension Responding Set
classify explain answer label begin collect generalize assist perform display compile inspect collect present explain convert paraphrase comply repeat institute defend record conform report respond document repeat discuss respond show estimate restate examine restate start inspect
LEVEL THREE Domain: Cognitive - application: using learned material in new and concrete situations.
Domain: Affective - valuing: displaying consistent behavior which makes a student’s values clearly identifiable.
Domain: Psychomotor - guided response: early stages of learning a complex skill.
83
Cognitive Affective Psychomotor Application Valuing Guided Response
Adjust manipulate advise formulate bandage/administer massage apply implement handle apply mobilize check initiate investigate arrange modify choose institute specify change operate clarify investigate transfer check participate complete justify turn clarify perform derive mobilize complete position describe participate compute predict designate propose demonstrate present determine quantify discover refer differentiate rank examine schedule distinguish rate experiment solve draw recommend handle suggest evaluate record implement transfer explain refer investigate translate extract report schedule select
LEVEL FOUR Domain: Cognitive - analysis: breaking down material into its component parts.
Domain: Affective - organization: comparing, relating, and synthesizing values.
Domain: Psychomotor - mechanism: performance acts where the learned response is habitual and the movements can be performed with proficiency.
Cognitive Affective Psychomotor Analysis Organization Mechanism
analyze illustrate adjust modify bandage assess manage alter negotiate handle assign negotiate analyze organize investigate choose outline arrange prepare specify diagram rank combine relate transfer derive rate compare simplify turn determine relate consult supervise designate select criticize synthesize differentiate separate defend teach
84
discuss simplify develop terminate distinguish specify document draw (conclusions) experiment evaluate terminate judge extract test manage
LEVEL FIVE Domain: Cognitive - synthesis: putting parts together to form a new whole.
Domain: Affective - characterization by a value: behavior is typical or characteristic of that person.
Domain: Psychomotor - complex overt response: skillful performance involving complex movement pattern.
Cognitive Affective Psychomotor Synthesis Characterization Complex Behavior
advise manage act adjust articulate modify communicate administer categorize negotiate direct apply combine organize discriminate bandage communicate originate display handle compose plan instruct investigate consult practice practice speak coordinate propose propose specify correlate quantify question test create rearrange revise transfer design recommend serve turn develop reconstruct solve devise reorganize establish revise extrapolate summarize formulate supervise generate teach instruct write
85
LEVEL SIX Domain: Cognitive - evaluation: judging the value of material for a given purpose.
Domain: Psychomotor - adaptation: modifying well-developed skills to fit a certain requirement of to meet a problem situation.
Cognitive Psychomotor Evaluation Adaptation
appraise adapt compare alter conclude change consult develop contrast massage criticize mobilize direct position discriminate rearrange interpret reorganize justify revise support schedule
LEVEL SEVEN Domain: Psychomotor - origination: creation of new movement patterns to fit a particular situation or problem.
Psychomotor Origination
arrange combine communicate compose construct design instruct manage originate teach
86
Directions for Creating an Action Plan Students will work with a faculty member to create a plan of action to address behavioral criteria that need to be demonstrated appropriately in the Program. As stated by May, Straker, and Foord (Facilitation Development of Professional Student Behaviors in Physical Therapy Education, 1997), students frequently require assistance in taking ownership of the identified problem and development of a formal plan to address the issue(s) needing remediation is helpful. A formal plan facilitates the student’s understanding of the expectations. Although development of a plan is a collaborative effort with a faculty member, it is the student’s responsibility to compose the plan.
The Action Plan consists of the following components: • Problem list – behaviors (from the list of behavioral criteria or the Clinical
Performance Instrument or similar performance assessment tool) that the student is not demonstrating
• SMART learning objectives – specific, measurable, achievable, results oriented, time bounded
• Specific activities to achieve the objectives • Outcome measurement – what the student and faculty (or CI) will see, hear
or feel that will verify the achievement of the objectives. This is what the student will do on a consistent basis that demonstrates competency.
To develop the plan of action, the faculty member and the student discuss the problem list and come to agreement on the primary issue(s) of concern. If there are multiple issues, more than one Action Plan may be required. The Action Plan is then written initially by the student and submitted in a draft form to the faculty member. The learning objective must be specific, measurable, achievable, results oriented and time bounded. The specific activities are identified by the student as opportunities to increase skill, attitude, or behavior and may include such items as review of texts, practice with others to promote skill acquisition, strategies to increase knowledge or awareness, discussion, consultation with faculty or classmates, chart review, etc. The number of activities may be determined by the student but should include a sufficient quantity to increase the chances of success. The outcome measurement is what the student will demonstrate to show competency in the problem behavior. The faculty member reads the Action Plan draft, provides feedback, and returns it to the student for revision. This process may continue until the Action Plan is clear,
87
concise and addresses the issue(s) thoroughly. Once the Action Plan has been approved, both the faculty member and the student sign it. Copies are made for each. The student then proceeds with the Action Plan, asking for assistance if appropriate, using the strategies and specific activities. Once the student has demonstrated the behavior consistently per the outcome, signatures are obtained and the Plan is complete. Copies with signatures are provided to the faculty member and the student. Consequences in the event of unsuccessful completion of an Action Plan should be discussed with the student during the initial meeting with the faculty member. These consequences should be clear and documented with signature by the student and the faculty member.
88
Sample Plan of Action Form Faculty member signature: Sally Smith, DPT
Student signature: John Doe
Date of start of plan: October 27, 2012
Problem
Specific Activities
(The student will fill in this section. Add activities that will facilitate achievement
of the outcome)
Outcome Measurement (what student, faculty, CI will see, hear or feel to verify accomplishment)
Inappropriate and inadequate modification of manual muscle tests for patients
• review my manual muscle testing notes from class
• review my manual muscle testing techniques using my textbook
• practice manual muscle testing techniques for the extremity joints with a classmate
• practice modifying manual muscle testing techniques for the extremity joints on a classmate using case studies
• discuss the modifications and rationale with my CI
• observe 2 PTs in the facility do manual muscle testing on patients
• discuss the modifications made with the 2 PTs at a convenient time within 2 days of the observation
I will demonstrate appropriate modifications of manual muscle testing techniques on 3 patients with extremity joint dysfunction within the next 10 days of the internship.
89
A “Smart” Objective is:
1. Specific At completion of the time frame: 2. Measurable 3. Achievable Date 4. Results centered 5. Time bounded From: Facilitation Development of Professional Student Behaviors in Physical Therapy Education May, Straker, Foord, 1997 CI
90
Plan of Action Form Faculty member or CI signature:
Student signature:
Date of start of plan:
Problem Specific Activities
(The student will fill in this section. Add activities that will facilitate achievement of the outcome)
Outcome Measurement (what student, faculty, CI will see, hear or feel to verify accomplishment)
91
A “Smart” Objective is:
6. Specific At completion of the time frame: 7. Measurable 8. Achievable Date 9. Results centered 10. Time bounded From: Facilitation Development of Professional Student Behaviors in Physical Therapy Education May, Straker, Foord, 1997 CI
92
Clinical Internship/Fieldwork Site Award The purpose of this award is to acknowledge a clinical internship/fieldwork site that provides students with exemplary clinical experiences.
Eligibility: A clinical site that demonstrates the following criteria:
• Staff that are actively involved in the profession at the state and/or national level.
• An adequate student manual and orientation. • Practice that is evidence based, ethical and legal. • Staff that are friendly, enjoy students, mentor with skill, share their patients
willing and are experts in clinical practice. • An appropriately varied caseload and pace of scheduling patients.
Procedure:
• A clinical site may be nominated by any student at any level of the Program during or after a clinical internship experience of any length.
• The student will write a letter addressing the eligibility requirements. The letter must be submitted electronically to the Director of Clinical Education by May 10th.
• All nominations will be submitted to the DCE during spring quarter of each year. If more than 3 nominations for the award is received, a volunteer committee will be assembled composed of both 1st and 2nd year students. The committee will review the nominations and determine the final award selections. Clinical sites may be nominated and awarded multiple times.
Nature of award:
• The clinical internship site will receive a certificate appropriate for hanging in the clinic.
• The clinical internship site name will be added to a plaque in the Program office.
Clinical Instructor/Clinical Educator Award The purpose of this award is to acknowledge a clinical instructor/clinical educator who made significant contributions to clinical education through
93
teaching/mentoring excellence, clinical expertise and role modeling of professionalism.
Eligibility: A clinical instructor/clinical educator who demonstrates the following criteria:
• Enthusiasm for students and clinical education. • Excellent teaching and mentoring skills. • Clinical skills at the master clinician level. • Leadership in the profession. • Ethical practice.
Procedure:
• A clinical site may be nominated by any student at any level of the Program during or after a clinical internship experience of any length.
• The student will write a letter addressing the eligibility requirements. The letter must be submitted electronically to the Director of Clinical Education by May 10th.
• All nominations will be submitted to the DCE during spring quarter of each year. If more than 3 nominations for the award is received, a volunteer committee will be assembled composed of both 1st and 2nd year students. The committee will review the nominations and determine the final award selections. Clinical sites may be nominated and awarded multiple times.
Nature of award:
• The clinical instructor/clinical educator will receive a certificate appropriate for hanging in the clinic.
• The clinical instructor/clinical educator name will be added to a plaque in the Program office.
94
Eastern Washington University – Department of Physical Therapy
STUDENT AGREEMENT OF UNDERSTANDING
CLINICAL EDUCATION AND SELECTION PROCESS
Initial/Date
__________ I understand that the primary objective of the selections process is to provide high quality clinical education opportunities for each student. Special and confidential needs of individual students may require individual consideration.
__________ I have had the opportunity to ask questions about the Program’s expectations regarding clinical selections.
__________ I will comply with variable clinical schedule hours.
__________ I give permission for EWU Department of Physical Therapy Clinical Education to send, via email, personal/protected information to clinical internship sites once placed to fulfill on-boarding requirements of the site.
__________ I understand that I am expected to have access to personal transportation during clinical education periods and that most clinical education sites are not accessible via public transportation.
• I understand the Program may not be able to accommodate my preferences of specific clinical site placements for all clinical courses.
95
• I understand that I may have a long or inconvenient commute to a clinical site.
• I understand that it is likely that I will relocate outside the Spokane area for at least one of my clinical education experiences, and that some students may relocate more than once.
• I understand that I may need to relocate to areas where I may not have family or friends.
• I understand that I will likely have additional travel and relocation housing expenses during clinical education courses.
• I understand that I may need to be paying rent at two locations during clinical education periods, and that I may not be able to maintain part-time employment during clinical education courses.
__________ I understand that I will likely incur additional expenses to satisfy on-boarding requirements. This may include any or all of the following:
• Vaccinations • Titers • Drug Screens • Additional background checks • Other internship site specific requirements
__________ I understand that it is my responsibility to inform the DCE in writing, in a timely manner, if I have concerns:
• about my ability to meet the expectations described in the Guide to the Clinical Selections Process and expectations outlined above.
• About my ability to meet the Essential Functions for admission, promotion and graduation as stated in the Student Handbook.
Student Name (Print) Student Signature