Mercer County Community College Physical Therapist Assistant Program Learner PTA 235 PTA Clinical Education II Clinical Performance Instrument Dates of Clinical Experience Name of Clinical Site: Address: Clinical Education Site Information: Telephone: Fax: Clinical Instructor s Name: Clinical Instructor s License #: Center Coordinator of Clinical Education s Name: Holly Kaiser Academic Coordinator of Clinical Education 609-570-3478 KaiserH@mccc.edu Mercer County Community College / 1200 Old Trenton Road / West Windsor / NJ / 08550 **The learners 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 second clinical experience within the Physical Therapist Assistant Program curriculum. Learners will be investing 40 hours per week for 5 weeks in a physical therapy clinical setting within the local geographic area. Learners will have the opportunity to practice and apply skills learned in other classes. Learners will also have the opportunity to become integrated into a physical therapy department by working with a clinical instructor. Course Outline: Week 1 Orientation and integration to the clinical setting: The learner is expected to observe the physical therapy department and personnel utilization until the learner and the clinical instructor (CI) determine that the learner is sufficiently acclimated to this setting. The CI will be interacting with the learner and working with him or her to set up observations as needed. The learner needs to initiate interaction with patients, and seek out the components of departmental organization and documentation style. During this week the 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 2-5 Integration into the clinical setting: Once the learner has been oriented to the department, the Clinical Instructor can begin to have the learner work on the course goal objectives listed below. The learner can be expected to perform the following activities within the department: MMT, ROM, vital signs, measurement for assistive devices, gait training, transfers, massage, wound care dressing, hydrotherapy, physical agents, bed mobility, therapeutic exercise, and treatment documentation. This is not an all-inclusive list and providing opportunities for learners to reach their highest potential is encouraged. Additional experience with techniques is encouraged, as deemed appropriate by the CI and the learner. ================================================================ Email Kaiserh@mccc.edu if at any time the learner is considered unsafe with patients 2
Course Goals: At a minimum, each learner will achieve the following goals by the end of the second clinical affiliation (Clinical Affiliation II): 1. By the end of the second clinical affiliation, the learner will treat a complex (or lower functioning) patient one-on-one 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 learner 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. 2. By the end of the second clinical affiliation, the learner will treat multiple non-complex patients from start to finish at the same time, with distant supervision in an appropriate timeframe, which includes the following: a. performing chart reviews to identify relevant data pertinent to the treatment session for the patients b. bringing the patients into the clinic, gathering subjective information, and completing the entire treatment sessions in a safe, effective and competent manner. c. managing his/her time effectively to minimize having patients wait and maximize the session for all patients 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) for each patient d. identifying the appropriate billing codes that correspond with the interventions provided (the learner 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 patients What has the learner learned so far within the PTA curriculum? This section has been provided to inform the Clinical Instructor of the didactic material that the learner has already covered within the PTA curriculum. If the Clinical Instructor chooses to instruct the learner in skills not included in this list or the PTA 235 course objectives, the Clinical Instructor is then responsible for teaching the learner the new skill and ensuring the learner s competency and safety with that skill prior to patient care. Pre-requisite courses Learners have successfully completed all pre-requisite courses including PTA 101: Introduction to PTA and PTA 105: Kinesiology. 3
Professional Phase Courses Semester Course Psychomotor Skills (Hands On Skills) Tested to Competency Content Not Tested to Competency Summer PTA 112: Pathology PTA 107: 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 201: Therapeutic Exercise 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 -Therapeutic exercise - -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 4
Course Objectives: Following the successful completion of this course, the 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. approach the CI with observations regarding which interventions should be progressed with a patient, why progression is indicated and how the progression should take place 3. verbalize an understanding of how each PT intervention provided relates to the patient s functional goals 4. observe an initial PT examination performed by a physical therapist, and participate in the development of an initial treatment session for that patient 5. describe the sequence from the initial examination of a patient forward 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. identify situations in which patient assessment is indicated and then competently and safely perform manual muscle tests (MMT), range of motion (ROM) using a goniometer, and vital signs measurements on patients 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. 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 6. modify the performance of PT interventions to meet the varying needs of patients 7. 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 8. review patient data prior to treatment interventions, demonstrating the ability to identify data which is pertinent and its importance for that patient 9. document all relevant information in the format used by the PT department, in a method that is accurate, concise, legible, grammatically correct and timely 10. document a progress note or summative weekly note (whichever summative note format is utilized in the clinical setting) 11. identify accurate billing codes (CPT codes) in a timely manner 12. instruct a patient in a therapeutic exercise program for the first time 13. delegate appropriate tasks to support staff as a demonstration of time and resource management 14. contribute to discharge planning with the assistance of a supervising PT 15. recognize individual and cultural differences and respond appropriately in all aspects of physical therapy services 16. take appropriate action in an emergency situation (or discuss the steps to take during an emergency situation) 17. prepare and perform an in-service for colleagues 5
18. recognize when the performance of an intervention is beyond the scope of practice for a PTA learner 19. demonstrate an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions 20. provide patient related instruction to patients, family members, and caregivers to achieve patient outcomes based on the POC established by the PT 21. adjust interventions within the POC established by the PT in response to patient clinical indications and report this to the supervising PT 22. maintain patient confidentiality, dignity, and modesty in the clinical environment 23. establish realistic weekly goals in an effort to improve clinical skills 24. 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 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 Kaiserh@mccc.edu if at any time the learner is considered unsafe with patients 6
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 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 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 learner performance for each of the three clinical affiliations. The goals change and become more complex as the learners progress through the clinical education component of the program. It is expected that the 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 learner s best interest to provide accurate and honest feedback during the midterm assessment, so that the 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 learner will have in this particular PT setting. Therefore, 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 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 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 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, inservices and productivity standards. ================================================================ Email Kaiserh@mccc.edu if at any time the learner is considered unsafe with patients 7
#1. KNOWLEDGE: The learner: (C5) Can describe the sequence of patient care from the initial examination to discharge. Midterm Feedback #1. KNOWLEDGE Final Feedback #2. PATIENT SAFETY: The learner: (P1) Ensures patient safety by utilizing universal precautions, proper body mechanics, proper guarding techniques, maintaining a safe environment, and utilizing proper intervention techniques. Midterm Feedback #2. PATIENT SAFETY Final Feedback 8
#3. TREATMENT INTERVENTIONS: The learner: (C1) 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) 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. (C3) Verbalizes an understanding of how each PT intervention provided relates to the patient s functional goals. (C4) Observes an initial PT examination performed by a physical therapist, and participates in the development of an initial treatment session for that patient. (P5) 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) Modifies the performance of PT interventions to meet the varying needs of patients. (P12) Instructs a patient in an initial therapeutic exercise program. (It is much easier for a learner to supervise a patient in a therapeutic exercise program when the patient had been doing it for 2 weeks prior to the learner 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 learners true ability to instruct therex.) (P21) Adjusts interventions within the POC established by the PT in response to patient clinical indications and reports this to the supervising PT. 9
#3. TREATMENT INTERVENTIONS Midterm Feedback Final Feedback 10
#4. PERFORMANCE: The learner: (P2) Identifies situations in which patient assessment is indicated and then competently and safely performs the assessment (manual muscle tests (MMT), range of motion (ROM) using a goniometer, and vital signs measurements) on patients. (P3) Modifies ROM and MMT techniques based on varying patient circumstances while utilizing sound foundational concepts. (P8) Reviews patient data prior to treatment interventions, demonstrating the ability to identify data which is pertinent and its importance for that patient. (P9) Documents all relevant information in the format used by the PT department, in a method that is accurate, concise, legible, grammatically correct and timely. (P10) Documents a progress note or summative weekly note (whichever summative note format is utilized in the clinical setting). (P11) Identifies accurate billing codes (CPT codes) in a timely manner. (It is not a requirement that the learner identify the # of units per CPT code, but it is expected that the learner understands which CPT codes cover the specific interventions provided.) (P13) Delegates appropriate tasks to support staff as a demonstration of time and resource management. (P14) Contributes to discharge planning with the assistance of a supervising PT. (P16) Takes appropriate action in an emergency situation (or discusses the steps to take during an emergency situation). 11
(P20) Provides patient related instruction to patients, family members, and caregivers to achieve patient outcomes based on the POC established by the PT. (P23) Establishes realistic weekly goals in an effort to improve clinical skills. (It is expected that the 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.) (A5) Demonstrates time management skills. (This includes completing written documentation in a timely manner, improving on the length of time that is takes to review a patient chart, treating a complex patient one-on-one in an appropriate length of time for the setting, and treating multiple non-complex patients at the same time.) Midterm Feedback #4. PERFORMANCE Final Feedback 12
#5. RECOGNITION & AWARENESS: The learner: (P4) Interprets the results of changes in the patient s objective measures and identifies its impact on the treatment plan. (P7) 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. (P15) Recognizes individual and cultural differences and responds appropriately in all aspects of physical therapy services. (P18) Recognizes when the performance of an intervention is beyond the scope of practice for a PTA learner. (P19) Demonstrates an awareness of one s own limits by asking for assistance when necessary and asking appropriate questions. #5. RECOGNITION & AWARENESS Midterm Feedback Final Feedback 13
#6. PROFESSIONALISM: The learner: (P22) Maintains patient confidentiality, dignity, and modesty in the clinical environment. (A1) Demonstrates initiative by arriving early each day and arriving prepared. (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.) (A2) 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) 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) (A4) Develops a strategy for maintaining an open line of communication with the supervising PT to discuss patient and practice concerns. (When a learner has questions, it is expected that the learner will take the initiative to look up or think about the answer to the question. The learner should then present both the question and their answer to the CI, with their rationale. The CI can give the learner feedback and a rationale at that point. This is an opportunity for the learner to demonstrate initiative, responsibility for their own learning, and critical thinking skills.) (A6) Uses downtime appropriately and professionally. (Occasionally a patient will cancel or no show. The 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) Accepts feedback without becoming angry or defensive and uses it to strengthen future performance as a PTA in the clinical setting. 14
Midterm Feedback #6. PROFESSIONALISM Final Feedback 15
Course Goals: At a minimum, each learner will achieve the following goals by the end of the second clinical affiliation (Clinical Affiliation II): 1. By the end of the second clinical affiliation, the learner will treat a complex (or lower functioning) patient one-on-one 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 learner 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. Midterm Feedback Course Goal #1 Final Feedback 16
Course Goals: At a minimum, each learner will achieve the following goals by the end of the second clinical affiliation (Clinical Affiliation II): 2. By the end of the second clinical affiliation, the learner will treat multiple non-complex patients from start to finish at the same time, with distant supervision in an appropriate timeframe, which includes the following: a. performing chart reviews to identify relevant data pertinent to the treatment session for the patients b. bringing the patients into the clinic, gathering subjective information, and completing the entire treatment sessions in a safe, effective and competent manner. c. managing his/her time effectively to minimize having patients wait and maximize the session for all patients 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) for each patient d. identifying the appropriate billing codes that correspond with the interventions provided (the learner 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 patients Midterm Feedback Course Goal #2 Final Feedback **If the 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 learner succeed. 17
Midterm Evaluation Findings Strengths at Midterm: Challenges at Midterm: Did the learner bring a completed Self Performance Evaluation Instrument in preparation for the midterm meeting? Please circle: YES NO Do you feel that the learner was academically prepared to meet your expectations for a PTA learner experiencing a second clinical affiliation? YES / NO Please Comment: Midterm Comments: Midterm Evaluation Signatures: Learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 18
Final Evaluation Findings Strengths at Final Areas for continued improvement Did the learner bring a completed Self Performance Evaluation Instrument in preparation for the final meeting? Please circle: YES / NO Did the learner provide an in-service for the PT department? Yes / No Final Comments: Final Evaluation Signatures: Learner Clinical Instructor Name (Print) Date Clinical Instructor Signature/Date 19
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