School of Physical Therapy. Clinical Education Program Manual

Transcription

1 School of Physical Therapy Clinical Education Program Manual We welcome your partnership in providing effective clinical experiences for the future leaders within the physical therapy profession. This manual will provide you with information to enhance your clinical education program and our partnership such as guidelines regarding clinical rotation descriptions, clinical teaching resources and policies that guide the clinical education program at Regis. We are excited to share with you the benefits of the Regis Clinical Education Scholar Program such as online library access and other professional development opportunities. We hope this manual will be helpful in facilitating communication and uniting the efforts of the clinical facility, the students and the School of Physical Therapy to create a superior clinical experience that is rewarding for all individuals involved. Thank you for mentoring tomorrow s physical therapy leaders!

2 Table of Contents Click on topic to navigate What is Regis? 3 Mission Curriculum Curriculum By Semester... 4 Clinical Education Course Descriptions and Selection.5 Clinical Education Course Policies...7 Student Assessment and Evaluation... 8 Planning and Organization Tools 9 Clinical Education Scholar Program (CESP) Appendix A- Regis CE I Assessment...11 Appendix B- Incident Report..16 Appendix C- Student Reflection and Feedback Form.18 Appendix D- Daily Caseload Management Form..21 Appendix E- Individual Patient Tracking Form.23 Appendix F- Student Final Evaluation of Clinical Instruction and Site.26

3 REGIS SCHOOL OF PHYSICAL THERAPY Mission Statement The School of Physical Therapy is dedicated to providing value-centered education within the Jesuit Catholic tradition. The professional education is extensive in depth and breadth and promotes current best practice across settings. The program is designed to prepare graduates as leaders in the profession who bridge theory and practice in a dynamic healthcare environment. Special attention is placed on developing an appreciation of the uniqueness of the individual and recognition of how this uniqueness influences health and wellness of diverse populations. Emphasis is placed on developing advocates for the public welfare and common good by changing self-centeredness and other values that compromise a sense of community. Graduates are challenged to integrate Jesuit values with future personal and professional pursuits. Graduates practice autonomously, ethically, and legally as primary care providers. As professionals, graduates are decision-makers and critical thinkers who have a clear understanding of the value of lifelong learning and contributing to the body of knowledge of physical therapy The School of Physical Therapy is housed within the Rueckert Hartman College of Health Professions within the University. Regis is a Catholic Jesuit University that strives to educate men and women of all ages to take leadership roles necessary for professional excellence and contributions to the improvement and transformation of a changing society. We encourage the continual search for truth, values, and a just experience. Throughout this process, we examine and attempt to answer the question: How ought we to live? Curriculum The central concept of the curriculum is movement theory that is presented through a systems approach expressed across a lifespan. There are longitudinal threads weaved throughout the curriculum to develop skills in critical inquiry, writing, teaching/learning, mission and service learning and leadership. 3

4 Regis University Professional Doctor of Physical Therapy Curriculum Yr SEMESTER I (Fall) SEMESTER II (Spring) SEMESTER III (Summer) I COURSE SEM HRS COURSE SEM HRS COURSE SEM HRS DPT 701 Human Anatomy and Histology DPT 703 Biomechanics/Kinesiology- Extremities DPT 708 Management Applications of Physiology: MAP I DPT 770 Professional Issues/Case Management I DPT 776 Critical Inquiry DPT 704 Neuroscience DPT 705 Biomechanics/Kinesiology-Spine DPT 706 Movement Science DPT 710A Pharmacology DPT 730 PT Examination DPT 732 Management Applications of Physiology: MAP I DPT 707 Kinesiology II DPT 714 Psychosocial Aspects of Healthcare DPT 719 Exercise Foundations DPT 733 Musculoskeletal Management I DPT 771 Professional Issues/Case Management II DPT 790 EBP 1 Total 16 Total 16 Total 15 Yr SEMESTER IV (Fall) SEMESTER V (Spring) SEMESTER VI (Summer) II DPT 710B Pharmacology DPT 712 Diagnostic Imaging and Procedures DPT 734 Musculoskeletal Management II DPT 736 Neurological Management I DPT 750 Clinical Education I DPT 772 Professional Issues/Case & Practice Management III DPT 735 Musculoskeletal Management III DPT 737 Neurological Management II DPT 738 Management Applications of Physiology: MAP III DPT 773 Professional Issues/Case Management IV DPT 791 EBP II HCE 709 Heath Care Ethics for Physical Therapists/IHCE 709 Interdisciplinary Ethics DPT 715 Health Care Policy DPT 731 Differential Diagnosis DPT 739 Exercise Application DPT 751 Clinical Education II DPT 774 Professional Issues/Case Management V Total 13 Total 18 Total 11 Yr SEMESTER VII (Fall) SEMESTER VIII (Spring) III DPT 716 Business Management DPT 740 PT Management across the lifespan DPT 752 Clinical Education III DPT 775 Professional Issues/Case Management VI DPT 780E-W Topics in Physical Therapy DPT 781E-W Topics in Physical Therapy DPT 792 EBP III DPT 799 Comprehensive Exam DPT 753 Clinical Education IV DPT 793 EBP IV DPT 796 Physical Therapy Capstone Total 13 Total 8 TOTAL 110

5 Clinical Sequence: Fall Semester 16 weeks Spring Semester 16 weeks Summer Semester 13 weeks Year 1 On Campus Year 2 6 weeks CE I Year 3 12 weeks CE III 12 weeks CE IV 8 weeks CE II Clinical Education Rotation Descriptions and Expectations Clinical Education I (6 weeks from late August to early October) At this point in the curriculum, the students have completed one year of academic preparation. The students have been instructed in lower extremity management. They are able to take subjective histories, complete documentation, perform manual muscle tests, apply goniometry skills, perform transfer and gait training with assistive devices, and utilize modalities. In addition, their coursework has included posture and gait analysis, initiation of therapeutic exercise strategies, cardiopulmonary management, and motor control/motor learning. We have created a CE I Student Assessment Tool that will be used instead of the CPI. The tool is designed to help you and the student focus on the basic skill acquisition that is fundamental to this first clinical experience such as subjective exam, basic examination, gait and movement analysis, mobility training and beginner clinical reasoning and evaluation skills. Clinical Education II (8 weeks throughout May and June) Prior to CE II, students have completed two years of academic preparation that includes all patient management courses across all practice settings. At the end of this rotation, the expectation is for the student to be capable of managing 50% of the patient caseload. Depending on patient complexity and the uniqueness of the clinic setting, students generally will require CI supervision 50%-75% of the time. 5

6 Clinical Education III (12 weeks from mid-october through December) These students have successfully completed the didactic portion of our program. By the end of this 12- week rotation, students should be capable of maintaining 75% or greater of a full-time entry level physical therapist s caseload at your facility. Clinical Education IV (12 weeks from mid-january to early April) These students have successfully completed the didactic portion of our program. By the end of this final 12-week terminal internship, the student should be capable of maintaining a full-time entry level physical therapist s caseload at your facility. Combined Clinical Education III and IV (6 months from mid-october to early April with a 2-week break within internship) The 6 month terminal internship combines the goals of CE III and IV. The rationale for a longer experience is that students can participate more fully in aspects of site management in addition to patient care. Examples of additional experiences might include: assisting in mentoring early rotation students, completion of special projects for business management or peer review, gaining exposure to selected patient management skills beyond entry level CPI criteria. Students are coached to give back to the clinical site and are interviewed by the site prior to placement to ensure a good match. THE CLINICAL ROTATION SELECTION PROCESS: Description of Clinical Rotation Types and Experiences Each student will complete four clinical rotations unless the last rotation is a 6-month, combined CE III/IV experience. Students will complete a minimum of one rural and one out of state rotation. During CE II, III and IV or combined CE III/IV, students must complete rotations in one inpatient and one outpatient clinical setting. Alternative Experiences As part of completing DPT 752 (Clinical Education III) and DPT 753 (Clinical Education IV), students may participate in one alternative experience that ranges in duration from 1 to 4 weeks. Examples of these alternative experiences include but are not limited to: clinical experiences in Ethiopia, Nicaragua, or Peru; observation in a pediatric gait lab; shadowing an orthotist; internship at the APTA National headquarters in Alexandria, VA; or observation/patient care in a niche practice of physical therapy (e.g., oncology, cardiac rehabilitation, women s health, pediatrics, veterinary care, hippotherapy, etc.). Clinical faculty can determine if having a student with a shorter clinical experience works well for their clinical site and student learning objectives. If your student has been accepted to one of these alternative experiences, the clinical education team will confirm that this is acceptable. 6

7 CLINICAL EDUCATION COURSE POLICIES Compliance All students are required to be compliant in all immunizations, ppd testing, CPR certification, OSHA and HIPAA training. A background check and drug screen is conducted at entrance to the program only. If your site has additional requirements not noted in the affiliation agreement, please communicate those to us and the process/forms you use to meet your institution s requirements so we can better assist you. Dress Code Students are to comply with the dress code of their assigned clinical facility. Clinical Attendance Students are expected to follow the schedule of their Clinical Instructor including weekends and/or holidays. Any clinical absence may jeopardize a student's ability to successfully meet clinical objectives as well as inconvenience the clinical site. If a student will be absent from the clinic during any portion of a clinical rotation, for any reason, they must first discuss the absence with their clinical advisor, receive pre-approval, and discuss arrangements to make up missed days prior to asking permission from their clinical instructor. In the case of emergencies or illness, both the clinical site/ci and Regis clinical advisor must be contacted immediately. Clinical and academic faculty reserve the right to require students to make up any missed clinical times. Students required to make up a clinical absence(s) are required to do so based on clinical faculty availability and convenience. If a student would like to attend an American Physical Therapy Association sponsored meeting (e.g., Annual Meeting or Combined Sections Meeting), a State Chapter meeting, National Student Conclave, or any other type of conference or continuing education event, they must first receive permission from their clinical advisor and must then seek permission of the clinical facility s Coordinator of Clinical Education (CCCE) and Clinical Instructor(s) before making travel arrangements. Students should always be prepared to make up any missed clinical days. Students must also be aware that some clinical facilities may not approve days off for these types of events and plan accordingly. Incident Reports: Students are required to report immediately any errors of omission or commission (incidents) involving a patient to the Clinical Instructor. If required, an incident report must be filled out according to facility policy. The clinical advisor should be called immediately and a Regis University incident report must also be completed. A copy the university incident report must be sent to the clinical advisor within 24 hours. Medicare A and Medicare B Guidelines for student supervision: In order for a PT facility to bill Medicare for physical therapy treatments there are strict guidelines in regards to supervision of student physical therapists. Please refer to the APTA website and D2L for specific material regarding Medicare guidelines involving student physical therapists. Please contact us with any questions. 7

8 An example of wording that some healthcare systems have used regarding these guidelines are: I was present for the entire session, I have assessed the need, made the skilled judgment for the treatment provided and directed the student in the delivery of services. In the EMR chart it states: I directly supervised the student for the entire encounter. Trigger Point Dry Needling: Students are able to participate in trigger point dry needling (TPDN) interventions on patients under the direct supervision of their clinical instructor (CI) in specific state jurisdictions which allow licensed physical therapists to perform this intervention based on their state practice act. The decision to allow students to participate in this intervention technique is at the discretion of those CIs. In compliance with State of Colorado (4CCR ), students in clinical rotations in Colorado can only observe TPDN interventions and cannot perform TPDN on patients. Student Injury: Any student injury should be reported immediately to the CI, CCCE and clinical advisor and addressed according to the Regis University Workers Compensation policy. Students are required to complete the Employer s First Report of Injury and submit it to Regis University Human Resource Department within 24 hours of the incident. Physical Abuse: According to most state laws, students should discuss any suspected physical abuse of children or elders of patients/clients to their CI. If abuse is suspected physical therapists are required to report it under most state laws including Colorado. GENERAL PRINCIPLES OF STUDENT EVALUATION Student clinical performance evaluation should be used as a mechanism for determining strengths and weaknesses of the student, both at midterm and final, as well as assessing the effectiveness of the academic and clinical phases of the curriculum. Ratings should be made on the basis of: systematic and specific observations of the student's behavior the typical frequency of performance rather than on isolated instances as summary of regular feedback given to the student throughout the clinical rotation performance as judged by the stated objectives and the criteria given for each item performed. Regis Clinical Education I Student Assessment Tool The Regis Clinical Education I Student Assessment Tool will be utilized during DPT 750 CE I to assess and guide student learning. Clinical Performance Instrument (CPI) The APTA Clinical Performance Instrument (CPI) Web will be utilized to evaluate the student's performance in the clinic for DPT 751 CE II, DPT 752 CE III and DPT 753 CEIV. The CI and student are expected to document the student's performance using the PT CPI Web at Midterm and Final separately and then discuss the student's performance and upcoming goals together. Clinical Performance Instrument (CPI) Performance training is required for all clinical instructors and students. 8

9 Final Grading All clinical experiences, which include DPT 750 (CE I), DPT 751 (CE II), DPT 752 (CE III) and DPT 753 (CE IV), will be graded on a Pass/Fail basis. The expectations for satisfactory performance on the CEI Student Assessment Tool and Clinical Performance Instrument (CPI) are specifically outlined in each clinical education syllabus. Please evaluate/document the student s performance objectively. Academic faculty determine the final course grade (pass/fail) based upon the CPI and other required work. Planning Your Student s Clinical Experience Successful clinical experiences don t just happen. Pre-planning and open communication are critical elements. In addition to the overview below, refer to appendices for specific techniques/ideas to support your clinical teaching. Pre-arrival: 1. Communicate with the student and Regis regarding additional requirements not covered in the affiliation agreement. 2. First day need to know info to student: dress code, parking, meals, housing, typical caseload/diagnoses, hours, CI contact information. 3. Regis students will contact their CI 4-6 weeks prior to the rotation with their goals. First 1-2 days (see sample orientation checklist, appendix 1. Discussion of site expectations/need to know facility procedures 2. Review of student goals, what can be achieved at your site 3. Review of student s preferred learning style 4. Agreement on how feedback will be provided (frequency, where, when) Ongoing 1. Schedule time to meet at least weekly to review progress, weekly goals 2. Create and maintain an open, collegial environment 3. Facilitate clinical reasoning 4. Adapt experiences to the student s level of performance 5. Role model importance of ongoing professional development/lifelong learning The clinical education team is here to assist you in developing your clinical curriculum, mentoring clinical instructors and in facilitating a successful student experience. Additional resources: APTA: including the Reference Manual for Center Coordinators of Clinical Education under Educator Development heading. Regis School of PT: J of Physical Therapy Education: 9

10 Appendices: The appendices also include a sample of Clinical Education Resources available to clinical instructors and students. Student and Clinical Advisor have access to these and additional resources in a Word version. Please contact the CE team for resources for individual situations. Student Reflection and Feedback Form Required form for students to set goals and provide experience feedback Daily Caseload Management Form to help students get their caseload organized Individual Patient Tracking Form - to monitor patient progress over time Student Final Evaluation of Clinical Instruction and Site completed and shared with CI at end of rotation Regis University Clinical Education Scholar Program (CESP) Program Highlights The CESP is designed specifically for clinical instructors (CI) and Center Coordinator of Clinical Education (CCCE) who enjoy mentoring students while striving for excellence in clinical care. Clinical experiences play an integral part in developing students of physical therapy to become independent thinkers and autonomous practitioners. As a CI or CCCE you are a leader and a catalyst in promoting essential skill sets and critical reasoning in the clinical setting. We value your time and expertise and recognize that resources for your growth in evidenced-based practice and in clinical teaching should be readily available to you. We have upgraded the cost-free CESP to include two levels that will better serve the needs of our clinical faculty. Why become a Regis Clinical Education Scholar? Level 1: Mentor one Regis student/year 24/7 online access to Regis library databases Advances effectiveness and efficiency in your clinical teaching through online resources Fosters a stronger academic/clinical partnership Level 2: Mentor two Regis students/year 24/7 online access to Regis Library databases Advances effectiveness and efficiency in your clinical teaching through online resources APTA CI Credentialing Courses Tuition benefits for post-professional coursework such as the Manual Therapy Fellowship Program Fosters a stronger academic/clinical partnership To apply to the CESP program go to regis.edu/clinicalscholar for an application. 10

11 Appendix A Regis CE I Assessment Form 11

12 Regis University School of Physical Therapy DPT 770 Clinical Education I Assessment Instructions: The student and clinical instructor (CI) will complete the following assessment at midterm and final based on t he expectations that are defined in each portion of the assessment. Upload to D2L at Midterm and Final. KEY: (++) Exceeds expectations (+) Meets expectations (*) Below Expectations (NA) Not Applicable Student Name: Site Name: Primary CI: PATIENT MANAGEMENT Expectation: Student performs identified skills in a safe manner on simple patients with no more than moderate supervision EXAMINATION Extracts pertinent information from chart review Obtains accurate patient history Identifies patient identified problems Generates ideas for an initial and alternative hypothesis Performs appropriate system review Selects tests and measures to confirm or disconfirm hypothesis Provides rationale for monitoring physiology EVALUATION Interpret findings from the evaluation Rule in or rule out hypothesis DIAGNOSIS/PROGNOSIS Identifies impairments in body structure and function, activity limitations, and participation restrictions Establishes a PT diagnosis Estimates expected outcomes PROBLEM LIST AND GOALS Identifies patient identified problems (PIP) and anticipated non patient identified problems (NPIP) Generates short and long term goals INTERVENTIONS Selects and safely performs PT interventions based on goals Determines duration and frequency of treatment Modifies plan of care based on patient safety, response and resources Incorporates patient/family education into treatment Engages in discharge planning Student Clinical Instructor MT F MT F Comments

13 PSYCHOMOTOR SKILLS Expectations: Complete the following skills with minimal assistance using clear communication, efficient sequencing, good body mechanics, and proper use of equipment/lines Vital Signs Patient Scan Observation: posture, skin Integrity, functional movement assessment Spine and Extremity Mobility Assessment: AROM, PROM, PROM w/ over pressure Strength and Nerve Root Level Assessment: Goniometry Manual Muscle Testing Muscle Length Testing Joint Play Assessment: extremities, spinal PA glides, cervical upper ligaments Neurological Exam Sensory exam: dermatomes, sharp/dull, light touch, proprioception Muscle tone Reflexes: DTRs, cutaneous Motor Screen: coordination Cranial Nerves Mini-Mental State Balance Testing Static postural assessment Dynamic balance strategies (anticipatory and reactive) Bed Mobility Transfers Gait Training (Assistive Device Adjustment and Instruction, appropriate use of gait belt and weight bearing status) Gait Analysis Outcome Measures (such as Timed up and Go, Forward Reach Test, etc.) Basic therapeutic exercise instruction Physical Agents: modalities Student Clinical Instructor MT F MT F Comments

14 DOCUMENTATION Expectations: Completes quality documentation for simple patients with moderate assistance from CI Student Clinical Instructor KEY: (++) Exceeds expectations (+) Meets expectations (*) Below Expectations MT F MT F Supports rationale for skilled PT care Documents accurately, concisely and (if applicable) legibly Contains relevant information to replicate treatment Documents all aspects of patient management including assessment of patient progress Completes documentation in a timely manner Comments PROFESSIONAL BEHAVIORS Expectations: The student will consistently demonstrate the following behaviors at a level expected of a 2 nd year DPT student Student Clinical Instructor KEY: (++) Exceeds expectations (+) Meets expectations (*) Below Expectations MT F MT F Actively seeks new information and skills Receptive to and incorporates constructive feedback Manages time effectively Talks out loud to reveal clinical thought process Initiates Interprofessional communication Communicates in a professional manner, verbally and nonverbally Actively listens to patients and colleagues Adapts communication to others culture and language Communicates in a clear and concise manner Comments MIDTERM REVIEW: Opportunities for Growth: Student: CI: Areas of Strength: Student: CI:

15 CI and Student Midterm Goals: Learning Plan for Weeks 4 through 6 FINAL REVIEW: Opportunities for Growth: Student: CI: Areas of Strength: Student: CI: Midterm Signatures (electronic permissible): Student signature: Primary CI Printed Name: Additional CI Printed Name: Signature: Signature: Final Signatures: Student: Primary CI Printed Name: Additional CI Printed Name: Signature: Signature:

16 Appendix B Incident Report 16

17 RHCHP INCIDENT REPORT/ACCIDENT FORM NOT WORKERS COMPENSATION Date & Time of Incident Date: Time: STUDENT INFORMATION Name Phone # Clinic Name School (N, Ph, PT) Description of Incident (Who, What, Where, When, Why) ACTION TAKEN TO PREVENT FUTURE OCCURRENCE: Completed by Date Signature

18 Appendix C Student Reflection and Feedback Form 18

19 Student Reflection and Feedback Form Student: Clinical Instructor: CCCE: Week # I. Patient Encounters- Patient experiences I had this week that were most meaningful to my learning: II. Best Practice- I incorporated these strategies and/or evidence into my clinical practice this week: III. Areas Improved Over this past week, I have improved in the following areas: IV. Areas for Future Growth Identified areas I will continue to develop during this clinical affiliation V. Goals for Next Week Measureable goals for the next week to address the targeted areas of future growth, including specific action steps that will be taken in order to attain this goal. 1. Goal: Action Steps: 2. Goal: Action Steps: 3. Goal:

20 Action Steps: VI. Feedback for my Clinical Instructor Identify beneficial ways your CI has facilitated your learning and what changes could be made in teaching and / or communication to support a more optimal clinical learning environment. VII. Things that will facilitate my learning: More supervision (interaction with me and patient during treatment session) Less supervision to allow me to experience more independently More positive feedback More constructive feedback More feedback during treatment session Feedback after the treatment session More time for my CI to explain things to me Additional learning experiences such as: Other: VIII. Changes that could be made that would improve my learning experience for the remainder of this clinical are: IX. Ways I would like to contribute to the clinic by the end of the clinical rotation are: X. Clinical Instructor to complete: My student is progressing appropriately in the following areas: My student needs assistance/supervision or improvement the following areas: Student Signature: CCCE/CI Signature:

21 Appendix D Daily Caseload Management Form 21

22 Daily Patient Follow Up Visit Flow Sheet Pt 1 st name Dx Key findings from eval Current Rx Retest (info needed to guide rx) Manual Rx or other Ex Pt Ed What if better? What if worse?

23 Appendix E Individual Patient Tracking Form 23

24 Pt Initials Dx: Plan Days/Week: # of Weeks: Key Evaluation Findings: Therapy Goals: Outcome Measures: # Visits Authorized: Date: Score: Visit count: Objective Measures and Treatments: Visit # Subjective: Tests Manual Tx Neuro Re-Ed Tx Ther Ex Education Assessment: Plan: If Better, If Worse

25 Objective Measures and Treatments: Visit # Subjective: Tests Manual Neuro Re-Ed Ther Ex Education Assessment: Plan: If Better, If Worse

26 Appendix F Student Final Evaluation of Clinical Instruction and Site 26

27 Student Final Evaluation of Clinical Instruction and Site Student Name: Clinical Site Name: Section 1 (student completes) Using a 1-5 scale, rate the level of clinical instruction provided during your clinical experience 1=strongly disagree 2=disagree 3=neutral 4=agree 5=strongly agree Clinical Instruction Rating Scale (1-5) My clinical instructor (CI) was approachable My CI listened to my feedback on mentoring to enhance my learning My CI challenged me to set weekly goals to improve my clinical skills My CI stimulated my critical thinking/ reasoning skills My CI allowed me to share best practices to improve patient management My CI demonstrated professional responsibility to all patients My CI demonstrated professional accountability to the PT profession Additional comments: Section 2 (student completes) Using a 1-5 scale, rate the statements related to your clinical experience 1=strongly disagree 2=disagree 3=neutral 4=agree 5=strongly agree Clinical Site/Environment Rating Scale (1-5) I received a timely comprehensive orientation of my clinical site I felt welcomed and part of the clinical team throughout my rotation My site provided education and role modeled appropriate billing practices I observed consistent use of current best practice/ evidence in patient care Physical Therapists and assistants adhered to the APTA core values Additional comments: Section 3 (CI completes) Student inservice and/or other project Yes No My student provided an informative inservice to staff As an alternative to an inservice, my student completed a clinical project Cl Signature: Date Student Signature: Date