Mercer County Community College Physical Therapist Assistant Program PTA 240 PTA Clinical Education III 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 full time clinical affiliation takes place at the conclusion of all of the technique and procedure related courses for the PTA student. Student/learners will be investing 40 hours per week for 6 weeks in a physical therapy clinical setting within the local geographic area. Students will be expected to perform all activities in the clinic that would normally be delegated to a physical therapist assistant in that facility. Students will be expected to provide an In-Service presentation to colleagues at the clinical site. Course Outline: Week 1: Days 1 & 2 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. Week 1: Day 3 through the end of Week 6 Integration into the clinical setting: The student is expected to perform all duties that would normally be expected of a PTA at entry level. The student is also expected to participate in departmental in-service presentations. The student is also required to present an in-service to the department. Course Goal: At a minimum, each student/learner will achieve the following goal by the end of the final clinical affiliation (Clinical Affiliation III): 1. By the end of the final clinical affiliation, the student/learner will handle a patient case load equivalent to that of an entry-level PTA in that particular setting, which includes both direct patient care and non-patient care responsibilities. What is entry-level? According to the APTA s Normative Model of PTA Education (Version 2007), entry level is a level of practice characterized by little or no experience as a credentialed, working PTA. Entry-level is also the initial point of entry into the health system working under the supervision and direction of a physical therapist, and characterized by successful completion of an accredited PTA program and the acquisition of the appropriate credential (i.e. license) to function as a PTA. Think about the clinical level in which you were practicing when you started your first job. It is probably very different from the level you are practicing today. Student/learners are expected to perform at entry-level upon completion of this clinical affiliation, not at the level of experienced clinician. ================================================================ Call 609-570- 3478 if at any time the student/learner is considered unsafe with patients 2
Course Objectives: Following the successful completion of this course, the student/learner will possess skills in the following domains to: Cognitive/Knowledge 1. 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 be inappropriate to use them 2. outline potential patient progression sequences within a specified Plan of Care and be able to explain why progression is indicated 3. design a therapeutic exercise program to address the short and long term goals identified within the evaluation of a patient and consistent with the identified plan of care 4. describe physical therapy as a component of the rehabilitation of patients, recognizing other components which encompass the big picture 5. complete a case study as per instructions provided Psychomotor 1. ensure patient safety by utilizing universal precautions, proper body mechanics, proper guarding techniques, maintaining a safe environment, and utilizing proper intervention techniques 2. indicate when a patient should be re-evaluated by a physical therapist or when the patient should receive a progress note, and complete said progress note (or weekly summative note) 3. modify ROM and MMT techniques based on varying patient circumstances while utilizing sound foundational concepts 4. interpret the results of changes in the patient s objective measures and identify its impact on the treatment plan 5. perform 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 6. independently operate physical therapy equipment and modalities within the department 7. modify the performance of PT interventions to meet the varying needs of patients 8. recognize when an intervention should not be provided due to changes in the patient s status and report this back to the supervising CI or PT 9. review patient data prior to treatment interventions, demonstrating the ability to identify data which is pertinent and its importance for that patient 10. document all relevant information in the format used by the PT department, in a method that is accurate, concise, legible, grammatically correct and timely 11. coordinate the physical therapy care for more than one patient at a time 12. identify accurate billing codes (CPT codes) and the number of units for each patient treatment session in a timely manner 13. instruct a patient in a therapeutic exercise program for the first time 14. delegate appropriate tasks to support staff as a demonstration of time and resource management 15. contribute to discharge planning with the assistance of a supervising PT 16. demonstrate time management skills by managing his/her daily schedule to maximize efficiency 17. recognize individual and cultural differences and respond appropriately in all aspects of physical therapy services 3
18. take appropriate action in an emergency situation (or discuss the steps to take during an emergency situation) 19. prepare and perform an in-service for colleagues 20. demonstrate an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions 21. provide patient related instruction to patients, family members, and caregivers to achieve patient outcomes based on the POC established by the PT 22. adjust interventions within the POC established by the PT in response to patient clinical indications and report this to the supervising PT 23. maintain patient confidentiality, dignity, and modesty in the clinical environment 24. establish realistic weekly goals in an effort to improve clinical skills 25. arrive prepared to the midterm and final assessment meetings with a fully filled out Self- Performance Evaluation Affective 1. demonstrates initiative by arriving early each day and arriving prepared 2. exhibit support and understanding for patients who may be having psychological difficulty in dealing with their diagnosis or treatment and discuss these patients with the clinical instructor 3. exhibit conduct that reflects practice standards that are legal, ethical, and safe 4. 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 5. develop a strategy for maintaining an open line of communication with the supervising PT to discuss patient and practice concerns 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 8. devote time to the reading of professional literature What has the student/learner learned so far within the PTA curriculum? 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. Pre-requisite courses Student/learners have successfully completed all pre-requisite courses including PTA 101: Introduction to PTA and PTA 105: Kinesiology. 4
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 -Goniometry -Manual muscle testing - -Diseases and disorders by system -Postural assessment Fall PTA 210: PTA Techniques Spring PTA 211: Physical Agents PTA 226: PTA Seminar I PTA 205: Motor Development PTA 213: PTA Clinic PTA 216: Orthopedics PTA 236: PTA Seminar II -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 -total hip and total knee replacements -residual limb wrapping after amputation -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 - -Motor development -Motor Learning & motor control -Reflexes -General Treatment Approaches -Adaptive equipment and patient handling -Development and aging -Amputation -Prosthetics and orthotics -CVA, SCI, TBI & other neurologic disroders -ADA accessibility issues -Postural re-education interventions -Outcome measurement tools -Orthopedic conditions and treatment organized by joint/body segment -Special tests -Patient evaluation process -Learning styles -Teaching and learning -Reading professional literature -Home care equipment -Observation of inpatient rehab and prosthetics fabrication 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 student/learners 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 and in-services. ================================================================ Call 609-570- 3478 if at any time the student/learner is considered unsafe with patients 6
C1. The student/learner verbalizes 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 be inappropriate to use them. C2. The student/learner outlines potential patient progression sequences within a specified Plan of Care and is able to explain why progression is indicated. 7
C3. The student/learner designs a therapeutic exercise program to address the short and long term goals identified within the evaluation of a patient and consistent with the identified plan of care. C4. The student/learner describes physical therapy as a component of the rehabilitation of patients, recognizing other components which encompass the big picture. 8
P1. The student/learner ensures patient safety by utilizing universal precautions, proper body mechanics, proper guarding techniques, maintaining a safe environment, and utilizing proper intervention techniques. P2. The student/learner indicates when a patient should be re-evaluated by a physical therapist or when the patient should receive a progress note, and completes the progress note required (or weekly summative note). 9
P3. The student/learner modifies ROM and MMT techniques based on varying patient circumstances while utilizing sound foundational concepts. P4. The student/learner interprets the results of changes in the patient s objective measures and identifies its impact on the treatment plan. 10
P5. 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. P6. The student/learner independently operates physical therapy equipment and modalities within the department. 11
P7. The student/learner modifies the performance of PT interventions to meet the varying needs of patients. P8. The student/learner recognizes when an intervention should not be provided due to changes in the patient s status and reports this back to the supervising CI or PT. 12
P9. 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. P10. The student/learner documents all relevant information in the format used by the PT department, in a method that is accurate, concise, legible, grammatically correct and timely. 13
P11. The student/learner coordinates the physical therapy care for more than one patient at a time. P12. The student/learner identifies accurate billing codes (CPT codes) and the number of units for each patient treatment session in a timely manner. 14
P13. The student/learner instructs a patient in a therapeutic exercise program for the first time. P14. The student/learner delegates appropriate tasks to support staff as a demonstration of time and resource management. 15
P15. The student/learner contributes to discharge planning with the assistance of a supervising PT. P16. The student/learner demonstrates time management skills by managing his/her daily schedule to maximize efficiency. 16
P17. The student/learner recognizes individual and cultural differences and responds appropriately in all aspects of physical therapy services. P18. The student/learner takes appropriate action in an emergency situation (or discusses the steps to take during an emergency situation). 17
P20. The student/learner demonstrates an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions. P21. The student/learner provides patient related instruction to patients, family members, and caregivers to achieve patient outcomes based on the POC established by the PT. 18
P22. The student/learner adjusts interventions within the POC established by the PT in response to patient clinical indications and reports this to the supervising PT. P23. The student/learner maintains patient confidentiality, dignity, and modesty in the clinical environment. 19
P24. 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.) 20
A2. The student/learner exhibits support and understanding for patients who may be having psychological difficulty in dealing with their diagnosis or treatment and discusses these patients with the clinical instructor. A3. 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, recognizes when the performance of an intervention is beyond the scope of practice for a PTA student/learner, etc) 21
A4. 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) A5. 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.) 22
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. 23
A8. The student/learner devotes time to the reading of professional literature. Course Goal: At a minimum, each student/learner will achieve the following goal by the end of the final clinical affiliation (Clinical Affiliation III): 1. By the end of the final clinical affiliation, the student/learner will handle a patient case load equivalent to that of an entry-level PTA in that particular setting, which includes both direct patient care and non-patient care responsibilities. **If the student/learner is marked at <5/10 for 9 items, please call the ACCE so that a visit or phone call can be scheduled to maximize the resources available to help the student succeed. 24
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 Do you feel that the student/learner was academically prepared to meet your expectations for a PTA student/learner experiencing a final clinical affiliation? YES / NO Please Comment: Midterm Comments: Midterm Evaluation Signatures: Student/learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 25
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 Did the student provide an in-service for the PT department? Yes / No Final Comments: Final Evaluation Signatures: Student/learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 26
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