Mercer County Community College Physical Therapist Assistant Program PTA 224 PTA Clinical Education I Clinical Performance Instrument Student/learner Dates of Clinical Experience Name of Clinical Site: Address: Clinical Education Site Information: Telephone: Fax: Clinical Instructor s Name: Center Coordinator of Clinical Education s Name: Holly Beinert Academic Coordinator of Clinical Education 609-570-3478 BeinertH@mccc.edu Mercer County Community College/P.O.Box 17202 /Trenton/NJ/08690 **The students are required to hand deliver either the original (or a copy) of this Clinical Performance Instrument to the ACCE upon return to the college.** 1
Course Description: This is the first clinical experience within the Physical Therapist Assistant Program curriculum. Student/learners will be investing 40 hours per week for 4 weeks in a physical therapy clinical setting within the local geographic area. It is designed to provide the student/learner with an opportunity to experience the clinical environment and apply foundational classroom material in a practicing clinical environment. Additionally, student/learners are expected to perform physical therapy techniques as deemed appropriate by the clinical instructor (CI). Course Outline: Week 1 Orientation and integration to the clinical setting: The student/learner is expected to observe the physical therapy department and personnel utilization until the student/learner and the clinical instructor (CI) determine that the student/learner is sufficiently acclimated to this setting. The CI will be interacting with the student/learner and working with him or her to set up observations as needed. The student/learner needs to initiate interaction with patients, and seek out the components of departmental organization and documentation style. During this week the student/learner should gain an understanding of the role and responsibilities of all staff in the PT department. An introduction to who handles patient scheduling and how effectiveness is maximized via appropriate scheduling should also occur during the first week. Weeks 2-4 Integration into the clinical setting: Once the student/learner has been oriented to the department, the Clinical Instructor can begin to have the student work on the course goal objectives listed below. This can begin during week one at the Clinical Instructor s discretion. Course Goal: At a minimum, each student/learner will achieve the following goal by the end of this first clinical affiliation (Clinical Affiliation I): By the end of the first clinical affiliation, the student/learner will treat a non-complex patient one-onone from start to finish with distant supervision in an appropriate time frame, which includes the following: a. performing a chart review to identify relevant data pertinent to the treatment session b. bringing the patient into the clinic, gathering subjective information, and completing the entire treatment session in a safe, effective and competent manner. c. writing an accurate SOAP note in a timely manner (which is to be handed in by the end of the treatment day, at the latest) d. identifying the appropriate billing codes that correspond with the interventions provided (the students does not necessarily need to identify the # of units per code, but should be able to identify which CPT codes are appropriate) e. providing a clinically meaningful verbal report to the supervising CI or PT regarding the patient. ================================================================ Email beinerth@mccc.edu if at any time the student/learner is considered unsafe with patients 2
What has the student/learner learned so far within the PTA curriculum? Pre-requisite courses Student/learners have successfully completed all pre-requisite courses including PTA 101: Introduction to PTA and PTA 105: Kinesiology. Professional Phase Courses Semester Course Psychomotor Skills (Hands On Skills) Tested to Competency Content Not Tested to Competency Summer PTA 112: Pathology PTA 106: Therapeutic Measurement Fall PTA 210: PTA Techniques PTA 211: Physical Agents PTA 226: PTA Seminar I -Goniometry -Manual muscle testing -Vital signs -Aseptic technique -Wound measurement -Patient positioning and draping -Body mechanics -Bed mobility -Transfers -Wheelchair mobility -Choosing and measuring assistive devices -Gait training on level and elevated surfaces using assistive devices, gait belt and proper guarding -Soft tissue massage -Scar massage -Hot packs -Paraffin -Therapeutic ultrasound -Neuromuscular e-stim -Interferential e-stim -Documentation - -Diseases and disorders by system -Postural assessment -Wheelchair components and fit -Normal and abnormal gait -Trigger point release -Deep friction massage -Edema management -CPM machines -Intermittent Compression -Lymphedema -Chest PT -Radiography -Pharmacology -Lab Tests and medical equipment -Cold packs -Mechanical traction -Hydrotherapy -Therapeutic use of light - -HIPAA -Insurances -Billing and Reimbursement -Regulatory Bodies -Cultural Competence -Communication -Psychosocial Aspects of Disability This section has been provided to inform the Clinical Instructor of the didactic material that the student/learner has already covered within the PTA curriculum. If the Clinical Instructor chooses to instruct the student/learner in skills not included in this list or the PTA 224 course objectives, the Clinical Instructor is then responsible for teaching the student/learner the new skill and ensuring the student/learner s competency and safety with that skill prior to patient care. 3
Course Objectives: Following the successful completion of this course, the student/learner will possess skills in the following domains to: Cognitive/Knowledge 1. can answer questions regarding and verbalize adequate knowledge of foundational anatomy 2. can answer questions regarding and verbalize adequate knowledge of patient assessment techniques 3. can answer questions regarding and verbalize adequate knowledge of treatment intervention techniques 4. can answer questions regarding and verbalize adequate knowledge of treatment modalities 5. verbally identify methods of maximizing patient safety during treatment 6. verbalize an understanding of the interventions provided by reporting why interventions are chosen, how they are properly performed, when it would be appropriate to use them and when it would not be appropriate to use them 7. approaches the CI with observations regarding which interventions should be progressed with a patient, why progression is indicated and how the progression should take place 8. prepare a written case study as per instructions provided Psychomotor 1. ensure patient safety by the use of universal precautions, proper body mechanics, proper guarding techniques, maintaining a safe environment, and utilizing proper intervention techniques 2. competently and safely perform manual muscle tests (MMT), range of motion (ROM) using a goniometer, and vital signs measurements on patients 3. performs physical therapy interventions in a competent and safe manner including therapeutic exercise, therapeutic activities, neuromuscular re-education, gait training, stair training, transfers, bed mobility, and modalities as appropriate for the clinical site 4. recognize when an intervention should not be provided due to changes in the patient s status and report this back to the supervising PT 5. review patient data prior to treatment interventions, demonstrating the ability to identify data which is pertinent and its importance for that patient 6. document all relevant information in SOAP note format in a method that is accurate, concise, legible, grammatically correct and timely 7. identify accurate billing codes (CPT codes) in a timely manner 8. instruct a patient in a therapeutic exercise program that is new to the patient 9. recognize individual and cultural differences and respond appropriately in all aspects of physical therapy services 10. take appropriate action in an emergency situation (or discuss the steps to take during an emergency situation) 11. recognize when the performance of an intervention is beyond the scope of practice for a PTA student/learner 12. demonstrate an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions 13. maintain patient confidentiality, dignity, and modesty in the clinical environment 14. establish realistic weekly goals in an effort to improve clinical skills 15. arrive prepared to the midterm and final assessment meetings with a fully filled out Self- Performance Evaluation 4
Course Objectives continued: Affective 1. demonstrates initiative by arriving early each day and arriving prepared 2. exhibit conduct that reflects practice standards that are legal, ethical, and safe 3. interact and communicate appropriately verbally and non-verbally with the patient, the physical therapist (PT), health care delivery personnel and others in an effective, appropriate and respectful manner 4. develop a strategy for maintaining an open line of communication with the supervising PT to discuss patient and practice concerns 5. demonstrates time management skills 6. uses downtime appropriately and professionally 7. accept feedback without becoming angry or defensive and use it to strengthen future performance as a PTA in the clinical setting ================================================================ Email beinerth@mccc.edu if at any time the student/learner is considered unsafe with patients 5
Using this Clinical Performance Instrument: The Physical Therapist Assistant Program at Mercer County Community College uses its own Clinical Performance Instrument (CPI) for the assessment of student/learner performance in the clinical setting. For Clinical Instructors who are familiar with the APTA s CPI, that document does not change from clinical to clinical. What changes with regards to the APTA s CPI is the expectation of where the students performance should be at the end of each clinical affiliation. Unlike the APTA CPI, our CPIs are different for each of the three clinical affiliations and the goals reflect the exact expectations of student/learner performance for each of the three clinical affiliations. The goals change and become more complex as the student/learners progress through the clinical education component of the program. It is expected that the student/learners meet all goals by the end of the clinical affiliation. However, just as with the APTA CPI, expectations are not always met. The PTA Program at Mercer does not utilize a pass/fail approach to clinical education and it is the Academic Coordinator of Clinical Education (ACCE) at Mercer who is ultimately responsible for the academic grade. It is in the student/learner s best interest to provide accurate and honest feedback during the midterm assessment, so that the student/learner has the opportunity to demonstrate improvement prior to the final assessment. While some skills will be progressed and continue in future clinical affiliations (i.e. documentation, billing, communication, etc), others are specific to certain PT settings. This may be the only clinical affiliation the student/learner will have in this particular PT setting. Therefore, student/learners should become competent in the foundational skills that are unique to this setting. For instance, there are certain exercises and manual techniques that are typical of an outpatient setting. In the subacute setting, there are transfers that may be foundational to that setting. In the acute care setting, reading and interpreting lab results may be foundational to that setting. When assessing student/learner performance, please make a mark along the 0-10 line which indicates to the best of your ability, the current performance level of the student/learner. Please differentiate the midterm assessment from the final assessment by utilizing M and F as indicators. Additional Learning Experiences are Encouraged: There are many aspects of clinical practice in addition to direct patient care. The PTA program highly encourages student/learners to observe and practice additional areas of clinical practice when provided the opportunity. These additional experiences may include but are not limited to billing and coding, scheduling, quality assurance review, ordering supplies, vendor relationships, grand rounds, in-services and productivity standards. 6
C1. The student/learner can answer questions regarding and verbalize adequate knowledge of foundational anatomy. C2. The student/learner can answer questions regarding and verbalize adequate knowledge of patient assessment techniques. (This includes ROM, MMT, vital signs, etc) 7
C3. The student/learner can answer questions regarding and verbalize adequate knowledge of treatment intervention techniques. (This includes bed mobility, transfers, gait training, stair training, therapeutic exercise, therapeutic activities, NMRE, manual therapy, etc) C4. The student/learner can answer questions regarding and verbalize adequate knowledge of treatment modalities. (This includes moist hot packs, cold packs, paraffin, electric stimulation, ultrasound, laser, diathermy, etc) 8
C5. The student/learner can verbally identify methods of maximizing patient safety during treatment. C6. The student/learner can verbalize an understanding of the interventions provided by reporting why interventions are chosen, how they are properly performed, when it would be appropriate to use them and when it would not be appropriate to use them. 9
C7. The student/learner approaches the CI with observations regarding which interventions should be progressed with a patient, why progression is indicated and how the progression should take place. P1. The student/learner ensures patient safety by the use of universal precautions, proper body mechanics, proper guarding techniques, maintaining a safe environment, and utilizing proper intervention techniques. 10
P2. The student/learner competently and safely performs manual muscle tests (MMT), range of motion (ROM) using a goniometer, and vital signs measurements on patients. P3. The student/learner performs physical therapy interventions in a competent and safe manner including therapeutic exercise, therapeutic activities, neuromuscular re-education, gait training, stair training, transfers, bed mobility, and modalities as appropriate for the clinical site. 11
P4. The student/learner recognize when an intervention should not be provided due to changes in the patient s status and report this back to the supervising PT. P5. The student/learner reviews patient data prior to treatment interventions, demonstrating the ability to identify data which is pertinent and its importance for that patient. 12
P6. The student/learner documents all relevant information in SOAP note format in a method that is accurate, concise, legible, grammatically correct and timely. P7. The student/learner identifies accurate billing codes (CPT codes) in a timely manner. (It is not a requirement that the student/learner identify the # of units per CPT code, but it is expected that the student/learner understands which CPT codes cover the specific interventions provided.) 13
P8. The student/learner can instruct a patient in a therapeutic exercise program for the first time. (It is much easier for a student/learner to supervise a patient in a therapeutic exercise program when the patient had been doing it for 2 weeks prior to the student s arrival. Being able to demonstrate and verbalize a therapeutic exercise program typical and appropriate for the setting to a patient who has not yet performed them, provides feedback regarding the student/learners true ability to instruct therex.) P9. The student/learner recognizes individual and cultural differences and responds appropriately in all aspects of physical therapy services. 14
P10. The student/learner takes appropriate action in an emergency situation (or discusses the steps to take during an emergency situation). P11. The student/learner recognizes when the performance of an intervention is beyond the scope of practice for a PTA student/learner. 15
P12. The student/learner demonstrates an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions. P13. The student/learner maintains patient confidentiality, dignity, and modesty in the clinical environment. 16
P14. The student/learner establishes realistic weekly goals in an effort to improve clinical skills. (It is expected that the student/learner utilize the Weekly Summary sheet by taking the initiative to fill out the left column, identifying their challenges and improvements as well as appropriate goals for the coming week and asking for feedback and input from the CI.) A1. The student/learner demonstrates initiative by arriving early each day and arriving prepared. (Student/learners are aware that they should be arriving 10-15 minutes prior to the start of the schedule, so that they can take their coats off, put their lunch away and review the schedule. This enables them to be ready to treat a patient at the start time.) 17
A2. The student/learner exhibits conduct that reflects practice standards that are legal, ethical, and safe. (i.e. Obeys statutory and regulatory rules that govern the practice of physical therapy) A3. The student/learner interacts and communicates appropriately verbally and non-verbally with the patient, the physical therapist (PT), health care delivery personnel and others in an effective, appropriate and respectful manner. (This includes verbal and non-verbal communication, appropriate use of medical terminology vs. layman s terminology, personal appearance, body language, eye contact, etc) 18
A4. The student/learner develops a strategy for maintaining an open line of communication with the supervising PT to discuss patient and practice concerns. (When a student/learner has questions, it is expected that the student/learner will take the initiative to look up or think about the answer to the question. The student should then present both the question and their answer to the CI, with their rationale. The CI can give the student feedback and a rationale at that point. This is an opportunity for the student/learner to demonstrate initiative, responsibility for their own learning, and critical thinking skills.) A5. The student/learner demonstrates time management skills. (This includes providing SOAP notes in a timely manner, improving on the length of time that is takes to review a patient chart, and treating a patient one on one in an appropriate length of time for the setting.) 19
A6. The student/learner uses downtime appropriately and professionally. (Occasionally a patient will cancel or no show. The student/learner is expected to utilizes this time appropriately. Examples would be following another clinician, reading PT literature, preparing a case study, working on SOAP notes, reviewing patient charts, etc.) A7. The student/learner accepts feedback without becoming angry or defensive and uses it to strengthen future performance as a PTA in the clinical setting. 20
Course Goal: At a minimum, each student/learner will achieve the following goal by the end of this first clinical affiliation (Clinical Affiliation I): By the end of the first clinical affiliation, the student/learner will treat a non-complex patient one-onone from start to finish with distant supervision in an appropriate time frame, which includes the following: a. performing a chart review to identify relevant data pertinent to the treatment session b. bringing the patient into the clinic, gathering subjective information, and completing the entire treatment session in a safe, effective and competent manner. c. writing an accurate SOAP note in a timely manner (which is to be handed in by the end of the treatment day, at the latest) d. identifying the appropriate billing codes that correspond with the interventions provided (the students does not necessarily need to identify the # of units per code, but should be able to identify which CPT codes are appropriate) e. providing a clinically meaningful verbal report to the supervising CI or PT regarding the patient. **If the student/learner is marked at <5/10 for 9 items, please email the ACCE so that a visit or phone call can be scheduled to maximize the resources available to help the student succeed. 21
Midterm Evaluation Findings Strengths at Midterm: Challenges at Midterm: Did the student bring a completed Self Performance Evaluation Instrument in preparation for the midterm meeting? Please circle: YES NO Midterm Comments: Midterm Evaluation Signatures: Student/learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 22
Final Evaluation Findings Strengths at Final Areas for continued improvement Did the student bring a completed Self Performance Evaluation Instrument in preparation for the final meeting? Please circle: YES / NO Do you feel that the student/learner was academically prepared to meet your expectations for a PTA student/learner experiencing a first clinical affiliation? YES / NO Please Comment: Final Comments: Final Evaluation Signatures: Student/learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 23
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