12/11/2017. Objectives. Minimum Required Skills of Physical Therapist Graduates at Entry Level

Transcription

1 Break Out of Your Silo: Collaborations to Achieve Core Competencies Kim Levenhagen PT, DPT, WCC Saint Louis University Sara Alhajeri MPT, GCS Caitlin Rosentreter, DPT Barnes Jewish Hospital, Saint Louis, Missouri Objectives By the end of this educational session the participant will: Recall the Core Competencies for Entry- Level Practice in Acute Care Physical Therapy, the APTA Core Values and behaviors identified in the evidence that reflect acute care practice. Identify methods to integrate acute care practice behaviors into the didactic curriculum. Determine methods for various clinical education models to increase numbers of students in the acute care setting. Create a win/win scenario to maximize excellence and professional duty among students and physical therapists/physical therapists assistants. Minimum Required Skills of Physical Therapist Graduates at Entry Level Screening Systems review for referral Recognize scope of limitations Examination/Re-examination Medical Records Imaging Lab Values Medications Home environment Each system Integration Evaluation Clinical reasoning and evidence Diagnosis Identify and prioritize impairments and activity limitations, participation restrictions Prognosis Recognizing barriers Plan of Care Goal setting Coordination of care Discharge 1

2 Minimum Required Skills of Physical Therapist Graduates at Entry Level Interventions Airway clearance Assistive devices Movement (gait, functional mobility) Safety Collaboration Communication across settings Outcome Assessments Education Patients/families Colleagues Practice Management Billing Documentation Direction and supervision HIPPA/Patient rights Professionalism Consultation Evidence Based Practice Minimum Required Skills of Physical Therapist Assistant Graduates at Entry Level Plan of Care Review Review of physical therapy documents Identification of role in patient care Identification of items to be communicated to the physical therapist Identify when the directed intervention are either beyond the scope of work or personal scope of work of the PTA Provision of Procedural Interventions Patient Instruction Application of principles of learning Use of variety of teaching strategies Clarity in instructions Assessment of patient response Patient Progression Competent patient progression Communication of patient information Clinical problem solving Minimum Required Skills of Physical Therapist Assistant Graduates at Entry Level Data Collection Competent date collection Interview skills Accurate and timely Clinical problem solving Ability to modify techniques Documentation and communication Documentation Select relevant information Accuracy Ability to adapt Safety, CPR and Emergency Procedures Reads and understands the healthcare literature Educate colleagues and other health care professional about the role, responsibilities and academic preparation and scope of work of the PTA Ensure ongoing communication with the physical therapist for optimal patient care. 2

3 A Normative Model of Physical Therapist Professional Education: Version 2004 Consistently define and describe entry-level physical therapist professional education that is reflective of a contemporary and forward looking perspective of practice, is responsive to physical therapy practice and the health care environment, and that incorporates the elements for the profession's vision. Guide to Physical Therapist Practice Core competencies for area of practice Movement System Core Competencies for Entry Level Practice in Acute Care Physical Therapy (2015) Clinical decision making Communication Safety Patient management Discharge planning Kristin Greenwood, PT, DPT, EdD, MS, GCS Chair Eric Stewart, PT, DPT Erin Milton, PT, DPT, NCS Melissa Hake, PT, DScPT Lauren Mitchell, PT, DPT Babette Sanders, PT, DPT, MS, FAPTA 3

4 Core Competencies for Entry Level Practice for Physical Therapist Assistants in Acute Care Settings (2017) Communication Safety Patient Management Medical review and documentation Contributions to discharge recommendations Jeremy Foster, LPTA Chair Michele Biernacki, PTA, ACCE Holly Clynch, PT, DPT, MA, GCS Chrissy LaMastus, MPT, BSN, RN Amanda Rausch, PTA Christina Schiel, PT, DPT Deanna Smith, PT Movement System (APTA 2017) PTs provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. PTs examine and evaluate the movement system (including diagnosis and prognosis) to provide a customized and integrated plan of care to achieve the individual's goal-directed outcomes. PTs maximize an individual's ability to engage with and respond to his or her environment using movement-related interventions to optimize functional capacity and performance. What do the students say? What I learned in the classroom is not real life Line management Ventilators Complex patients on paper not the same as the hospital Clinical reasoning is not always black/white Difficult to apply classroom knowledge to patients in the clinic Some clinicals too short Not enough acute care choices May not have a rotation in level 1 trauma center Some time since my acute care rotation and starting my job 4

5 Student Feedback Regarding Preparedness I did not feel under prepared for this experience in the sense that we had not learned certain material yet. However, I did have to look a few things up that we had already learned just for a quick refresher! Finding different motivation techniques to encourage patients to participate in therapy when they refuse. One suggestion would be to team up with the OT program for a lab and co treat a patient so students can learn how to work together efficiently, while also playing a balancing act seeing how both therapies overlap yet do not cross boundaries. I felt unprepared for ventilator management, IV/leads management, walking patients with multiple medical devices (IV poles, etc.), pharmacology and its implications for PT, discharge disposition. Reviewing the Evidence (Baybar 2003) Case study presentation Group discussion Patients in class Patients in clinic Problem solving videotape Jette 2007 Reviewing the Evidence Knowledge Clinical skills Safety Clinical decision making Self directed learning Interpersonal communication Professional demeanor Masley 2011 Continual Dynamic Assessment Complex Communication to gain information Collection and analysis of medical information Communication to provide information Application of specialized physical therapy knowledge 5

6 Foundational Sciences Nationwide Acute Care Physical Therapist Practice Analysis Identifies Knowledge, Skills and Behaviors that Reflect Acute Care Practice (Gorman 2010) Clinical diagnostic procedures Leadership Risk management Professional development Social responsibility Examination/Evaluation Diagnosis/Prognosis Intervention Outcomes Bridging the Gap Weaving inpatient care into the curriculum Pathology clinical examples Basic Procedure Multisystem Management Labs Integrative clinical experiences Seminars Acute Care Threaded Throughout Curriculum PY 1 Survey of Disease, Lab Studies/ Imaging, Basic Procedures, Pharmacology Integrative Project Patients in lab Assist devices PY 2 Multisystem Management, Cardiopulmonary, Neuro, Patient Management, Communication Patients in lab ICE Integrative Project Sim Lab Collaboration with nursing PY 3 Seminars, Patient Management, Business Administration, Interprofessional Team Seminar, Clinicals Complex evaluation in clinic Cases w/ IP therapists Collaboration w/ PTA Program Interprofessional interactions 6

7 Project: Survey of Disease, Pharmacology and Lab Studies/Imaging Example of Lab: Integrative Clinical Experience Chart Review Subjective Interview Objective Examination Cognition Gross muscle screen Dermatome/Light touch Vital signs Balance (sitting/standing) Outcome measures Movement assessment (bed mobility, sit to stand to sit, ambulation) Example of Lab: Integrative Clinical Experience Assessment Identify impairments and activity limitation and participation restrictions. State why patient requires skilled physical therapy. Describe intervention or education provided during this treatment session. Plan Determine frequency for therapy sessions during hospital stay. Document 3 short term goals for the patient (met by discharge). Establish a discharge plan. 7

8 Example of Lab Integrative Clinical Experience Discuss 3 relevant findings from the chart review with anticipated presentation (signs and symptoms and implications with examination. At least one must include an abnormal lab value. Given the patient s findings today, name 2 interventions and 2 followup examinations you want to perform on the next visit. Include clinical implications for 3 pharmacological agents the patient is currently taking in the hospital. Explain your clinical reasoning for your discharge recommendation. Discuss how CI adapted the examination secondary to current and past medical history. Collaborative Learning in Nursing Sim Lab This was a good learning experience for me because I now know that I need to make my SBAR statement more clear and concise in An interprofessional experience the future. I especially want to improve upon my "assessment through structured communication portion" of the SBAR in establishing why the patient might be tools such as SBAR provide context experiencing various symptoms. for application in an acute care It was good to have nursing there and interact with them as well but I environment. found it difficult to cut off my interview and quickly gather my thoughts to give the SBAR to the nurse in front of the patient. A HFHS patient scenario with emerging data provided a safe environment for learning. Overall, I liked to experience and I have a better idea of what kinds of communication skills and inpatient skills I can improve upon in the future. The experience was unique and not one that we usually get to receive in school so I really liked to opportunity to see my strengths and weaknesses in that situation. This was a great experience. It was very helpful to be able to collaborate with the nurse following the interview. It was a good way to get out first time jitters with experiences like this. I was prepared with a lot of questions to complete a full interview but due to the significant changes in BP and heart rate and presents of redness, swelling, and tenderness in her L calf I had to stop short. 8

9 WHAT IS YOUR PRIMARY CLINICAL EDUCATION CHALLENGE? Capacity vs Quality Capacity or Quality OUR SILOS Professor Clinician Clinical Instructor SCCE ADDRESSING QUALITY: FROM THE CLINICAL SITE PERSPECTIVE ORIENTATION & COMMUNICATION 9

10 HOW DO WE MANAGE ALL OF THIS ORIENTATION? IT TAKES A VILLAGE 32 Structure similar to employee orientation Components of Our Student Orientation Program 10

11 EXAMPLES OF ASSIGNED STUDENT PROJECTS Bring Evidence To Staff Case Studies and Journal Clubs Analyze Evidence for Outcomes Measures Create/Update Patient Handouts Update Existing Documents With Current Norms Create Videos - For Student Orientation, Transfer Training, etc Update Student Orientation Materials Archive Students Projects For Future Use FEEDBACK FROM SLU STUDENTS The student program at Barnes (Jewish Hospital) is great! They are very open to teaching you as much as possible and exposing you to the way the hospital system operates. Doing the case study/inservice was helpful to learn more about inpatient PT and different interventions to provide. All of the training and orientation was very helpful for succeeding on this clinical. I thought the student program was structured very well. I learned so much on this rotation and was able to get a great understanding of what PT's role is in acute care. 35 ADDRESSING QUALITY: FROM THE ACADEMIC PERSPECTIVE 36 11

12 ADDRESSING CAPACITY: FROM THE ACADEMIC PERSPECTIVE ADDRESSING CAPACITY FROM THE CLINICAL SITE PERSPECTIVE SCCE COMMUNICATION WITH CLINICAL INSTRUCTORS 12

13 Lifelong Learners Experts Role Models Culture Student New Employee Clinical Instructor Role Model CLINICAL EDUCATION MODELS 1 Student: 1 Instructor 1 Student: 2 Instructors 2 Students: 1 Instructor 13

14 CLINICAL EDUCATION MODELS 1 Student: 1 Instructor PT or PTA Student ICE CLINICAL EDUCATION MODELS 1 Student: 2 Instructors Full Time Student Shared Between 2 Part Time Therapists Split Clinical Between 2 Full Time Therapists CLINICAL EDUCATION MODELS 2 Students: 1 Instructor 2 PT/PTA Students PT Student/ PTA Student Student Labs PT Student/ Student Labs PT Student/ ICE Student 14

15 POLICIES AND REGULATIONS: STUDENT SUPERVISION 2:1 CLINICAL MODEL Barriers Student Instructor Quality of Clinical Treat Together Comparison to Student Too Much Time Students at Different Levels Decrease Productivity at Beginning Divided CI Attention Increased Stress Generalized Feedback 2 CPI!! 2x Documentation Review 2:1 CLINICAL MODEL Benefits Student Instructor Increased Collaboration Security Foster Independence Lifelong Learner Increased Productivity Less Stress Improve Knowledge Get Comfortable with Uncomfortable Experience Larger Caseload Expert 15

16 Increased Collaboration Education PT Student PTA Student Direction and Supervision PT STUDENT & PTA STUDENT: INSTRUCTOR MODEL Scope of Practice Teamwork Increased Communication 49 INSTRUCTOR ROLE MODEL Specialty Sections and Special Interest Groups (Education Section of APTA) Education Leadership Conference American Council of Academic Physical Therapy (ACAPT) Literature Review/EBP Online Links: Balance Testing, Stroke Education, ECG Knowledge, etc RESOURCES TO EXPLORE APTA Learning Center AcuTEACH Forum in AACPT 16

17 BREAK DOWN THE SILO: IMPROVING CAPACITY AND QUALITY Academic Wins Increasing student placements Advancing current practice: Awareness of current trends in clinical practice Building relationships with facilities/sites (Recruiting lab assistants/adjunct faculty) Preparing students for entry level practice/normative Model Improving application of curriculum content because of hands on experience Refining students inter-professional communication Clinic Wins Teaching opportunities for staff Advancing current practice: In-service on topics relevant to your practice (Student or faculty) Building relationships with academic institutions (Opportunities: lab assistant, list for CEUs) Increasing efficiency of new hire for orientation and productivity when previously a student at that site Completing projects: Students can do these too Improving employee retention (Educated decision when applying for position) REFERENCES APTA A Normative Model of Physical Therapist Professional Education: Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; Available at: Accessed 11/1/17. APTA Professionalism in Physical Therapy: Core Values BOD P [AMENDED BOD ] sionalismcorevalues.pdf Accessed on 3/6/2017. Core Competencies for Entry-Level Practice in Acute Care Physical Therapy. APTA Academy of Acute Care Physical Therapy Minimum Skills Task Force; Gorman SL, Wruble Hakim E, Johnson W, et al. Nationwide acute care physical therapist practice analysis identifies knowledge, skills, and behaviors that reflect acute care practice. Phys Ther. 2010; 90 (10): Doi: /ptj Masley PM, Havrilko CL, Mahnensmith MR, et al. Physical therapist practice in the acute care seting: A qualitative study. Phys Ther. 2011; 91(6), Doi: /ptj Delany C, Bragge P. A study of physiotherapy students' and clinical educators' perceptions of learning and teaching. Med Teach Sep;31(9):e REFERENCES Dunfee HJ. Clinical Education: Past, Present, and Future. Journal of Physical Therapy Education. 2008;22(3):3 6. Plack Margaret M. The Learning Triad: Potential Barriers and Supports to Learning in the Physical Therapy Clinical Environment. J of Physical Therapy Education. 2008;22(3):7 18. Rosenwax L, Gribble, N, Margaria, H. GRACE: An Innovative Program of Clinical Education in Allied Health. Journal of Allied Health. 2010;39(1):e11 e16. Giberson Tomas R, Black Beth, Pinkerton, Eric. The Impact of Student Clinical Instructor Fit and Student Organization Fit on Physical Therapist Clinical Education: Experience Outcome. Journal of Physical Therapy Education. 2008;22(1): Smith PM, Seeley J. A review of the evidence for the maximization of clinical placement opportunities through interprofessional collaboration. J Interprof Care Nov;24(6): Jette D, Brown R, Collette N, Friant W, Graves L. Physical Therapists Management of Patients in the Acute Care Setting: An Observational Study. Phys Ther. 2009;89(11): APTA student supervision chart Accessed 11/27/17. 17

18 REFERENCES Jette D, Bertoni A, Coots R, Johnson H, McLaughlin C, Weisbach. Clinical Instructors Perceptions of Behaviors That Comprise Entry Level Clinical Performance in Physical Therapist Students: A Qualitative Study. Phys Ther. 2007; 87: Silberman N, Panzarella K, Melzer B. Using Human Simulation to Prepare Physical Therapy Students for Acute Care Clinical Practice. Journal of Allied Health. 2013; 42(1): Pabian P, Dyson J, Levine C. Physical Therapist Productivity Using a Collaborative Clinical Education Model Within an Acute Care Setting: A Longitudinal Study. Journal of Physical Therapy Education. 2017;31(2): Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013;93: REFERENCES McCallum CA, Mosher PD, Jacobson PJ, Gallivan SP, Giuffre SM. Quality in physical therapist clinical education: A systematic review. Physical Therapy. 2013;93(10):1-18. Ladychewsky RK, Bird N, Finney J. The impact on departmental productivity during physical therapy student placements: An investigation of outpatient physical therapy services. Physiotherapy Canada. 1994;46(89-93). Currens JB, Bithell CP. The 2:1 clinical placement model- Perceptions of clinical educators Innovative Clinical Internship Model in the US Army-Baylor Doctoral Program in Physical Therapy. US Army Medical Department Journal. 2014: Jelley W, Larocque N, Patterson S. Interdisciplinary clinical education for physiotherapists and physiotherapist assistants.: a pilot study. Physiotherapy Canada. 2010;62(1): Triggs-Nemshick M, Shepard KF. Physical therapy clinical education in a 2:1 student instructor education model. Physical Therapy. 1996;76(9): O Connor A, Cahill M, McKay E. Revisiting 1:1 and 2:1 clinical placement models: student and clinical educator perspectives. Aust Occup Ther J. 2012;59(4):