Neurologic Physical Therapy Residency Handbook

Updated October 2014

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Table of Contents

Mission, Goals and Objectives………………………………………………………….….Page 3Faculty Roles and Responsibilities…………………………………………………….…...Page 7Faculty Evaluation………………………………………………………………………....Page 10Patient Confidentiality……………………………………………………………….…….Page 10Mentor/Resident Roles and Responsibilities…………………………………………...….Page 11Facilities……………………………………………………………………………………Page 13Professional Development…………………………………………………………………Page 14Curriculum…………………………………………………………………………………Page 15Resident/ Curricular assessment………………………………………………...…………Page 17Policies……………………………………………………………………………………..Page 18

Admission Criteria…………...…………………………………………………….Page 18Admission Process……………………...………………………………………….Page 18Orientation………………………………………………………………………….Page 19Probationary Period.……………………………………………………………….Page 19Retention/Remediation….………………………………………………………….Page 19Termination……..………………………………………………………………….Page 19Competency Assessment.……………………………………………………….….Page 20Case study………………………….…………………………………………...….Page 21Patient Outcomes……………………….………………………………………….Page 21Anecdotal Record……….………………………………………………………….Page 23

Appendix…………………………………………………………………………………...Page 24Mentor evaluation form……………………………………….………...…….……Page 25Faculty/Program manager evaluation form………………....…………...…………Page 26Residency course evaluation form……………………………………..………..…Page 27Teaching evaluation form……………………………………..………...…………Page 28Non-PT mentor evaluation form………………………………………...…………Page 29Live patient evaluation forms…………………………………………...…………Page 30

Professional Behaviors…………………………………………………………………….Page 37Billing procedures in setting……………………………………………………………… Page 46Goal setting……………………………………………………………………………….. Page 49Calendar…………………………………………………………………………………....Page 50

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A message from Li z Ulanowski, PT, DPT, NCS, Manager of the Physical Therapy Program: It is my genuine pleasure to welcome you to the Physical Therapy Residency Program at Norton Healthcare and Bellarmine University. The program faculty and staff have worked hard to develop a challenging and rewarding educational experience for you. It is our goal to provide you with a stimulating and supportive educational environment that prepares you well for the rigors of advanced physical therapy clinical practice. The faculty of the program is an outstanding collection of clinicians, physicians, administration and academicians with many years of experience. I encourage you to look toward the program faculty and member of our community to help guide your practice to becoming and neurologic certified specialist.

Mission of the NNI Neurologic Physical Therapy (PT) Residency Program in the Norton Neuroscience Institute (NNI):

The Neurologic Physical Therapy Residency Program in the NNI will support the mission of Norton Healthcare by providing high quality health care and education to all those we serve in a manner that responds to the needs of our communities, honors our faith heritage and celebrates our values. This patient-centered program will provide advanced physical therapist clinical training and will promote the application of evidence-based knowledge and skills with emphasis on service and life-long learning. This environment will produce leaders with advanced neurologic rehabilitation training to make a lasting contribution to their local and professional communities. Through this program, residents and staff will educate, advocate, empower and improve the quality of life of our patients, their families, caregivers, and our community.

The Goals of the NNI NPT Residency Program are to:1. Develop advanced practitioners in the field of neurologic physical therapy that meet the needs of patients and

clients, their families, and of society.2. Develop practitioners who are critical consumers of neurologic physical therapy and supporting literature and

who apply the evidence to the development and implementation of patient and client treatment and education programs.

3. Foster and develop laboratory, classroom room and clinical teaching skills in neurologic physical therapy residents.

4. Foster clinical research and inquiry skills in neurologic physical therapy residents to meet the needs of continued evidence based medicine in physical therapy.

5. Enhance resident’s ability to apply advanced knowledge and skill in the examination and treatment during patient care.

6. Provide formative feedback to neurologic physical therapy residents and facilitate guided reflection.7. Promote professionalism, community awareness and leadership roles in neurologic physical therapy residents8. Promote and provide continuing education for community leaders in the field of neurologic physical therapy

to foster best practice habits as well as active participation in clinical research and excellence in teaching skills.

*** Faculty goals mirror the program goals to ensure working towards similar outcome

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Objectives of the NNI NPT Residency Program:

Goal 1: Develop advanced practitioners in the field of neurologic physical therapy that meet the needs of patients and clients, their families, and of society.

The program will provide advanced practice placements in neurologic physical therapy for the resident to work and/or observe to broaden their base of knowledge and skill set.

The program will provide information and education in areas described in the current ABPTS description of specialty practice in neurologic physical therapy.

Create learning experiences for the resident to prepare for the completion of the ABPTS specialist certification examination.

The program will provide clinical experience with advanced mentoring to foster learning with patient/family care.

Goal 2: Develop practitioners who are critical consumers of neurologic physical therapy and supporting literature and who apply the evidence to the development and implementation of patient and client treatment and education programs

The program will offer a variety of research databases to find the highest level of available research for a given topic.

The program will offer a variety of on-site resources to facilitate learning and assist the resident with literature searches for evidence based practice

The program will require the resident to perform regular literature searches as it pertains to patient care and summarize as the basis of clinical practice.

The program will require resident to be involved in journal club monthly to which they will lead and obtain the highest level of knowledge.

The program will offer educational mentoring through evidence based practice and delivery of the highest level of neurologic care.

Goal 3: Foster and develop laboratory, classroom room and clinical teaching skills in neurologic physical therapy residents.

The program will assess classroom evaluations (mentor and students) to ensure the resident is providing optimal teaching in the classroom setting.

The program will provide opportunities for residents to assume leadership positions in clinical, academics and the classroom settings.

The program will require the resident in completing the clinical instructor course through the APTA to enhance their abilities to perform clinical and academic teaching.

Goal 4: Foster clinical research and inquiry skills in neurologic physical therapy residents to meet the needs of continued evidence based medicine in physical therapy.

The program will require resident to write a case study in field of interest with appropriate mentoring available for guidance for highest level of completion.

The program will provide opportunities for resident to be involved in clinical research as available.

Goal 5: Enhance resident’s ability to apply advanced knowledge and skill in the examination and treatment during patient care.

The program will perform ongoing assessments of resident’s performance with systems review, subjective history, objective findings, plan of care and patients expected outcome through formal assessment with clinical experts.

The program will evaluate the organization and implementation of treatment interventions as it correlates to the most current literature.

The program will ensure that the resident will be able to progress and or modify treatment and plan of care as indicated by patient response and patient’s ability to progress.

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The program will expose the resident to a variety of experiences to broaden the knowledge base of the resident for a more comprehensive examination and treatment plan.

Goal 6: Provide formative feedback to neurologic physical therapy residents and facilitate guided reflection. The program manager/mentor will have monthly meeting with resident to enhance reflection. The program will have weekly mentor reflection sheets to enhance discussion and reflection between mentor and

mentee.

Goal 7: Promote professionalism, community responsiveness and leadership roles in neurologic physical therapy residents

The program will provide professional service opportunities for the resident to explore and engage with community and outreach programs.

Ensure that the resident will exhibit specialist level on professional behaviors. The program will promote opportunities for involvement in the Kentucky Physical Therapy

Association and other local agencies to foster leadership.

Goal 8: Promote and provide continuing education for community leaders in the field of neurologic physical therapy to foster best practice habits as well as active participation in clinical research and excellence in teaching skills.

The program will provide didactic coursework for the resident and will open this to local clinicians to promote advanced practice.

The program will provide experiences of clinical mentors to be involved in teaching and research to promote and foster a continuing learning environment.

The resident/graduate of the NNI NPT Residency Program will be to:1. Demonstrate preparation to sit for ABPTS neurologic specialty examination at the end of the program. 2. Promote leadership for the physical therapy community and promote and advocate for the neurologic patient

populations.3. Demonstrate increased confidence in teaching roles for enhancing the consultative services of the physical

therapy profession and or throughout academic institutions. 4. Demonstrate increased confidence and knowledge of basic skills of clinical research and application of evidence

based practice.

Objectives of the NNI Resident in the Program:

Goal 1: Demonstrate preparation to sit for ABPTS neurologic specialty examination at the end of the program. The resident will demonstrate full achievement status for all objectives/goals/outcomes required by the

residency program. The resident will submit a residency portfolio at each quarterly evaluation and at the conclusion of the

residency. This portfolio is the property of the residency program which will include hours and educational experiences.

The resident will complete 2 written exams to demonstrate didactic knowledge of addressed skills and topics throughout the program.

Goal 2: Promote leadership for the physical therapy community and promote and advocate for the neurologic patient populations.

The resident will complete all mentoring hours with faculty at each placement with 150 hours total. The resident will complete all associated observation hours set up by program manager. The resident will pass each clinical rotation as decided by clinical faculty/program manager and performance

rating. The resident will participate and complete and community partner/service project up to 10 hours in area of

interest.

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Goal 3: Demonstrate increased confidence in teaching roles for enhancing the consultative services of the physical therapy profession and or throughout academic institutions.

The resident will participate in all conferences and educational modules. The resident will create and deliver 2 patient case presentations, 10 journal club presentations, 3 physical therapy

in-services, and one presentation at physician rounds. Perform tasks as lab assistant and will put together at least one lecture and lab for Adult Neuro course in spring

semester at Bellarine University.

Goal 4: Demonstrate increased confidence and knowledge of basic skills of clinical research and application of evidence based practice.

Demonstrate that they are critical consumers of neurologic physical therapy and supporting literature and who apply the evidence to the development and implementation of patient and client treatment and education programs which will be recorded in outcome sheets.

The resident will write a minimum of one case study over the year to complete by end of year to be considered as a publishable draft.

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Angela Hardwick, MD

Dee Ann Clark, Director of Hospital Operations & Rehab

Core Faculty Angela Hardwick, MD, Director of Cressman Movement Disorders Program Dee Ann Clark, PT, MBA, HCM, Director of Hospital Operations and Rehabilitation Services Liz Ulanowski, PT, DPT, NCS Neurologic Residency Manager and Clinical Coordinator Megan Danzl, PT, PhD, NCS Education and Research Coordinator at Bellarmine University Beth Quinn, PT, Rehab manager, Outpatient director and mentor facilitator Robin Dixon, PT: Rehab manager, Downtown, inpatient mentor facilitator Melanie Hoehn, PT, Rehab manager OBH, Inpatient mentor facilitator Jennifer Chiles, PT. Inpatient Rehab facilitator at Cardinal Hill Rehabilitation Hospital

MentorsNorton Brownsboro/Downtown: Erica Basile- Skinner, PT, Sarah Bormann, PT, DPTCardinal Rehabilitation Hospital: Jennifer Chiles, PTNorton Outpatient: Liz Ulanowski, PT, DPT, NCS, Laura Miller, PT, DPT, NCS, MSCS, Erin Weigle, PT, DPT, NCSBellarmine University: Megan Danzl, PT, PhD, NCS

Role of Residency Manager, Education/Research, and Clinical Coordinator

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Robin DixonSarah Bormann Norton IP mentor facilitator

Melanie HoehnErica Basile-Skinner OBH mentor facilitator

Liz Ulanowski, Residency Manager,

Clinical Coordinator & OP mentor facilitator

Megan Danzl Education/Research

Coordinator

Michelle GraybealJennifer ChilesCardinal Hill mentor facilitator

Clinical Mentor and Facilitator

Neurologic Resident

Beth QuinnLaura Miller Erin WeigleNorton OP mentor facilitator

Residency Manager/Clinical Coordinator: Liz Ulanowski, PT, DPT, NCSPosition Purpose: Directs, coordinates, and organizes the neurologic physical therapy residency program through the development, evaluation and operation of program activities in partnership with Bellarmine University and Cardinal Hill Rehabilitation Hospital. Essential Duties and Responsibilities of Residency Coordinator

The coordinator, working with faculty and program mentors, will develop, implement and assess program goals and objectives.

The coordinator will be responsible for the development and assessment of all resident experiences, including clinical, research, didactic, community engagement and specialty observation experiences.

The coordinator will be responsible for overseeing and ensuring the availability of advanced resident mentoring at each facility.

The coordinator will meet regularly with the resident, and be available to the resident/faculty for advisory purposes throughout the program.

The coordinator will be responsible for maintaining and providing resources to the resident and faculty throughout the program.

The coordinator will assess residents, faculty and the program with feedback from all shareholders and will continuously monitor and make appropriate changes. .

The coordinator will provide clinical mentoring, and didactic instruction. The coordinator will provide the resident with specific goals and objectives for all learning activities. The coordinator will review the progress and provide formative feedback to the resident throughout the

program. The coordinator will facilitate the preparation of the resident for the ABPTS neurologic certification

examination. The coordinator will maintain appropriate records for each resident and faculty member. The coordinator will ensure that appropriate resources are available to the resident and staff. The coordinator will maintain communication and partnerships with Bellarmine University and Cardinal

Hill and foster relationships to enhance patient care, consultation, and teaching experiences. The coordinator will perform an annual assessment of the residency program and provide this to all

shareholders and APTA on annual update. The coordinator will report directly to the Director of Hospital Operations and Rehabilitation Services.

Research/Education Coordinator: Megan Danzl, PT, PhD, NCSPosition Purpose: Directs, coordinates, and organizes the neurologic physical therapy residency program through assistance of development of the educational and research portions of the program.Essential Duties and Responsibilities of Education/ Research Residency Coordinator

This coordinator will working with faculty and staff to assist resident in research development. This coordinator will be responsible for assisting resident with writing case studies. This coordinator will facilitate relationships with resident and Bellarmine Faculty for mentoring

opportunities in the classroom. This coordinator will assist program manger in implementing teaching and learning opportunities for the

resident. This coordinator will meet regularly with the resident, and be available to the resident/faculty for

advisory purposes throughout the program. This coordinator will be responsible for maintaining and providing resources to the resident and faculty

throughout the program.

Other Duties and Responsibilities

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Angela Hardwick: act as medical liaison to assist with programming and coordinating Norton Neuroscience Institute with residency program. Dee Ann Clark: facilitate residency development and management as it relates to Norton Healthcare and its immediate needs.Laura Miller/Erin Weigle: act to assist resident while in outpatient rehabilitation at Norton Healthcare in daily operations and transition into the clinic.Beth Quinn: act to assist resident while in outpatient at Norton Hospital/NSRC Downtown in daily operations and transition into the clinic as well as supportive during rotation. Robin Dixon: act to assist resident while in inpatient at Norton Hospital/ Downtown in daily operations and transition into the clinic as well as supportive during rotation.Melanie Hoehn: act to assist resident while in inpatient at Norton Hospital/Brownsboro in daily operations and transition into the clinic as well as supportive during rotation.Jennifer Chiles: act to assist resident while in inpatient at Cardinal Hill Rehabilitation Hospital in daily operations and transition into the clinic as well as supportive during rotation.

MentorsErica Basile- Skinner: assist with daily operations and perform or delegate mentoring time each week.Sarah Bormann: assist with daily operations and perform or delegate mentoring time each week.Jennifer Chiles: assist with daily operations and perform or delegate mentoring time each week.Liz Ulanowski: assist with daily operations and perform and or delegate mentoring time each week at Cressman Rehabilitation as well as set up journal clubs, presentations at Norton and Bellarmine and facilitate case study. Laura Miller/ Erin Weigle: assist with daily operations and act as mentor in outpatient rehabilitation at Cressman and NSRCBellarmine Mentor: to mentor resident with lectures/labs led by resident and organization in the classroom as well as assistance with case study.

Faculty evaluation

Faculty of the residency program are employed at Norton Healthcare, Bellarmine University and Cardinal Hill Rehabilitation Hospital. Assessments generated for the residency program will be used for these reviews. The resident and program manager will assess faculty in each area throughout and at the end of each rotation. The program manager will collect these forms and review the feedback to the entire faculty with a yearly summary. If issues with performance arise from the assessment the manager will inform faculty member’s immediate supervisor and work with that member to improve performance. If the performance is consistently under standards then this issue will be discussed and may result in dismissal from participation in the residency program. These assessments will be used as a part of the annual performance assessment review with key accountabilities that include: building trust, communicating with impact, facilitating change, coaching, building effective work teams, leading through mission, vision and values, results and accountability, managing performance, planning and organizing, delegating responsibility and decision making.

See Appendix : faculty evaluation forms

Patient ConfidentialityPatients Rights and Responsibilities

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Policies and Procedures of each clinic*** Please see policies and procedures binder in possession of Residency Manager for full details as well as Nsider which is the web based access to all of these documents

Mentor and Resident Responsibilities

Mentor Attendance learning experiences with documentation

- Friday learning modules (1-2)- Rounds (Monday/Friday Morning at Norton Healthcare/CH rounds)- Journal Club (1x/month)- Continuing education courses as related to adult neurologic care.

Mentoring requirements - Complete at least 3 hours a week of 1:1 observation of patient care (total per year has to be 150

with 100 of direct patient care)- Complete at least 30 minutes a week of 1:1 non-patient care learning (discuss and review

patients, clinical implications, research articles)- Complete rotation objectives and compete all documentation related to examination of resident. - Complete and lead one journal club while resident is present in your clinic.

Meet with Residency Manager to assess resident’s objectives once after each rotation with 1x/month phone calls.

Provide evidence based practice and mentoring. Adhere to APTA code of ethics as well as state and national regulations. Interact and communicate with residency manager about changes and residency goals for continued

evolvement of program.

ResidentProfessional Conduct

The resident is expected to uphold the highest standards of our profession as depicted by the APTA’s code of ethics and Standard of Practice.

The resident will assist in patient-centered program and will provide advanced physical therapist clinical training and will promote the application of evidence-based knowledge and skills with emphasis on service and life-long learning. The resident will be in an environment and lead with advanced neurologic rehabilitation training to make a lasting contribution to their local and professional communities.

Guidelines The residency is an evolving entity and resident will be expected to evolve with the program and adapt

to any changes that need to be made. The resident will be given enough time to complete changes made. The residency program is intended to be a guideline. Resident is encouraged to pursue opportunities for

professional development that interest them The resident is expected to perform in an above and beyond manner. The resident is expected to attend ALL didactic curriculum, teaching labs, case conferences and as able

physician rounds. The resident needs to be prepared with any case presentations, mentoring sessions, reviewing

documentation for educational purposes, literature review with caseload and discussions about advance practice.

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The resident will be responsible for maintaining a portfolio of all documentation, literature reviews, mentoring log time, location/time spent in coursework, as well as patient case load and outcomes used for faculty review.

The resident will meet with the program manager at the end of each month to discuss the program. The resident will bring any concerns or issues to the program manager. The resident will be asked to lead 1-2 modules for educational purposes The resident will be asked to present 1-2 case studies. The resident will have to complete 2 written examinations. The resident will be responsible for supplying each placement with license, CPR card, TB skin test and

Immunization for their records.

Attire Patient care: at Norton Healthcare the resident will be able to dress professionally with use of lab coat

when performing patient care. The resident will have the option of utilizing pewter scrubs for inpatient and black pants with grey polo for outpatient rotation. At Cardinal Hill the resident will be asked to dress in professional attire with the option of buying through their online store polo colors of rehabilitation services (navy, red or gray scrubs or polo’s).

Lab/Teaching: resident will be asked to dress professionally Physician shadowing : resident will be asked to dress professionally with lab coat. Conferences : resident will be asked to dress professionally Scrubs are acceptable with lab coat if going off site and resident will not be expected to change each

setting if multiple in one day.

** Professional attire: shirt and tie for men, slacks or nice shirt for women, appropriate footwear per department policy.

FacilitiesNorton Acute Care Rehabilitation: There are 2 hospitals within the 5 hospital organization that will be discussed as the resident will only be working at these 2. These hospital systems are located in Louisville, KY. Norton Hospital Downtown and Norton Hospital Brownsboro are included in the residency for their extensive

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work with interdisciplinary rehabilitation facilities and evidence based practice. These 2 hospitals consist of 846 beds and a total of 1969 beds throughout the entire system. 231 E.Chestnut St. Louisville, KY 40202/ 4960 Norton Healthcare Blvd. Louisville, KY 40241

Cardinal Hill Rehabilitation Hospital: This is a 232 bed rehabilitation hospital located in Lexington, KY. This extensive rehabilitation hospital consists of stroke, traumatic brain injury, spinal cord injury and general rehabilitation units. Each unit has a specialized gym to meet the needs of the patients, aquatic pool, evaluation clinics as well as outpatient services onsite. 2050 Versailles Road • Lexington, KY

Norton Neuroscience and Spine Outpatient Rehabilitation: Norton Neurosciences & Spine Rehabilitation Center provides rehabilitation services for patients managing a host of neurological and spine conditions, including stroke, brain tumors, brain injuries, spine disorders and injuries, multiple sclerosis and movement disorders like Parkinson’s disease and epilepsy. Through advancing technology with specialized clinics and therapists, LokoMat, GaitRite, Biodex, Therastride body weight support treadmill system this clinic strives to promote evidence based practice for all neurologic conditions with appropriate outcomes and physician collaboration. 315 East Brodaway Ste. 90 Louisville, KY, 40202.

Cressman Rehabilitation Center for Movement Disorders: This center specializes in movement disorders. A small team was put together to serve specifically this community of patients and works closely with physicians for management. The diagnosis include: Parkinson ’s disease, Huntington’s Disease, Dystonia, and Essential Tremor in a multi-disciplinary team. 4960 Norton Healthcare Blvd. Louisville, KY, 40241

Bellarmine University: Bellarmine University hosts The Doctor of Physical Therapy Program that prepares the student for licensure and practice in the field of physical therapy. Students are admitted to the professional program after completing a bachelor’s degree in a major of choice and all program prerequisites. The university awards the Doctor of Physical Therapy (DPT) degree upon completion of the professional curriculum. Bellarmine’s program consists of 12 full time faculty member’s with 8 adjunct faculty and 3 personnel for administrative support. Program faculty mentor and teach diverse learners to practice, serve and lead with integrity, sensitivity and commitment to excellence. 2001 Newburg Road Louisville, KY  40205

Observation work sites:

Kosair Children’s Hospital: 231 East Chestnut Street Louisville, KY 40202University of Kentucky Neurology Clinics: 740 South Limestone Lexington, KY 40508.Wheelchair/Seating Clinic: 315 East Broadway Ste. 90 Louisville, KY 40202Norton Neurology Clinics: TBA***Program manager will assist you with setting up all these observation times.

Professional Development

Faculty and Teaching Assistance Development

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The faculty development center is present on Bellarmine’s campus to assist faculty and staff with issues to improve experiences that result in improved satisfaction from teaching well as will be used as needed. Our residency program will assign a Master Teacher to each resident that is composed of an experienced professor in our field to mentor the resident through their teaching experiences. This will consist of weekly meetings with mentor and resident as well as monthly review and reflection meetings with mentor, program manager and resident.

Norton Healthcare Weekly resident module forums (KPTA approval for CEU and provided by Norton University) Monthly Journal Club (led by resident and/or mentor) Rehabilitation In-services (topics may include: community resources, neurology lunch and learns,

Bioness updates and EMG throughout all settings) Research library for assistance in literature reviews (Anne Schaap is rehabilitation librarian for Norton

Healthcare) Norton University has modules available for further educational topics that resident can utilize for no

charge where interested. Refer to residency calendar for weekly modules hosted by neurologic residency program.

Bellarmine University Each educational module available will be communicated to the resident via program manager and will

continue to assemble a working calendar document. The resident will have faculty identification and can access library and resources available through

Bellarmine. The resident will also have access to recreation centers.

Reflection journaling Bi-weekly reflection journal sent to program manager on a situation that caused you to reflect on you as

the resident handled the situation, how you could have handled it better or a challenging situation.

Tracking Patient care logs- review at middle and end of rotation Mentoring logs- review at middle and end of rotation Feedback – for each rotation Diagnosis of patients chart- for each rotation

Residency Curriculum Schedule2013-2014 Neurologic Residency (for specifics refer to calendar): always subject to change

Winter/Spring (January-April) – Acute Care Rotation

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Mentor Facilitator: Sarah Bormann and Erica Basile-Skinner Clinical Practice: Downtown Norton Hospital and Norton Brownsboro Hospital

o 3 hours 1:1 mentoringo 26 hours non-mentored (65%) a week

Learning Experienceso Teaching- PT 630 (Rehabilitation Techniques) and PT 645 (Adult Neuro)- 13 weeks (100 hours)o Research (TBA; case study)o Rounds (1-2 x/ week)o Friday Coursework

Spring (May-July) - Inpatient Rehab Rotation Mentor Facilitator: Jennifer Chiles Clinical Practice: Cardinal Hill Rehabilitation Hospital in Lexington KY

o 3 hours 1:1 mentoringo 26 hours non-mentored (65%) a week

Learning Experienceso Tuesday Webinars (10 total; 2 hours each)o University of Kentucky physician observation clinics (~50 hours)o Cardinal Hill Outpatient Vestibular with Laura Carter- 20 hours (total)o Friday Coursework o Case Studyo Community Service (ex. HD exercise class)o Apply for specialty exam

Spring/Summer/Fall (August-January) – Outpatient Rehab Rotation Mentor Facilitator: Liz Ulanowski, Laura Miller and Erin Weigle Clinical Practice: Downtown Norton Neuroscience and Spine Center and Cressman Center for

movement disorderso 3 hours 1:1 mentoringo 26 hours non-mentored (65%)o Kosiar Children’s Hospital- 20-40 hours (total)o Wheelchair Clinic- 20 hours (total)

Learning Experienceso Research (TBA; case study)o Rounds (1-2 x/ week)o Friday Coursework o Tuesday Webinars continued (10 total; 2 hours each)o Physician/Clinic Shadowing at Norton Healthcare (~50 hours)o Community Service (ex. HD exercise class)o Case Study/ Home Study

Exit interview

Instructional/Clinic Hours

Components Hours based on 50 weeks

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1:1 mentored practice 3/week 150Non-mentored practice 26/week 1300Kosair Hospital 40Observation in MD/WC Clinics 2/week 100Research 30Observation of Surgery 10Neurologic Teaching Assistant at BU

4x/week (13 weeks) 100

Didactic Coursework 1/week 88Journal Club 1/month 10Neuro-MD Rounds 1-2/week 102TBI observation (low sensory) 20Community Outreach 1x/week 10Vestibular Rehabilitation 40 Total 2000

Resident/Curriculum AssessmentAt a minimum, evaluation of both academic and clinical curriculum will be performed on a quarterly

basis with utilization of evaluation forms and outcome measures. The resident and clinical mentors will meet on

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a weekly basis (as needed) to evaluate program and site objectives. There will be one to two meetings with the resident, mentor and the residency manager to set up goals and objectives and then review and discuss progress of goals, live patient exams and mentor sessions. Minutes will be completed for all meetings and filed as well as informal e-mails and communications with the resident and faculty. These communications will be available on a secure website (http://nortonneuroresidency.wikispaces.com/) that only resident and faculty members can access. Initial- Rotation Meeting: (3 total)

**Purpose: set up rotation expectations, goals and objectives for resident and mentor Resident Clinical Mentor Program Manager

Mid-Rotation Meeting: (3 total)** Purpose: Evaluate progress of goals and objectives set for residency and site as well as develop

additional goals as needed or remediate as needed. Resident Clinical Mentor Program Manager Education/Research Coordinator

End Rotation Meeting (3 total)**Purpose: Evaluate goals and goal attainment for each site and overall resident outcomes. Resident

prepared with feedback per each site. (live patient exam performed prior) Resident Clinical Mentor (Rehab Manager at site) Program Manager Education/Research Coordinator

Exit Interview (1 total)** Purpose: for resident to discuss with human resources their insight to the program and to have an

impartial party discuss strengths and weaknesses of program. Resident Human Resources representative

Annual Meeting of Faculty (1 total)**Purpose: to evaluate goals of residency and resident outcomes and utilize resident feedback to modify

program (all faculty invited) Clinical Mentors Program Manager Director of Hospital Operations Education/Research Coordinator

The following are forms for the Resident to complete during and after for assessment of the program. See Appendix for forms: these will appear on survey monkey

1. Resident ratings of faculty, mentors, program manager, learning modules and self in the program: by the end of each clinical rotation.

2. Results of written (2) and practical exams (3) within the program: at the end of each clinical rotation.

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3. Results of professional behaviors and APTA clinical self assessment tool: by end of the residency program.

4. Completion and or publication of case study: by end of residency program5. Completion and results of specialization exam: when becomes available.6. Graduate self assessment tool: 6-12 months post- graduation.7. Employer assessment tool: 6-12 months post- graduation.

Policies Specific to the Resident

Admission CriteriaMinimum Requirements

Current PT license to practice (state of Kentucky required by beginning of residency)

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Comply with all Norton Healthcare employment requirements. Graduate from a CAPTE accredited physical therapy program.

Admission Processa. Submit application form to:

Elizabeth Ulanowski, PT, DPT, NCS Manager, Neurologic Residency Program Norton Neurosciences & Spine Rehab Center 315 East Broadway Ste 90 Louisville KY 40202

1 page essay explaining why you want to participate in the residency program and incorporate 3-5 year career goals

Minimum of 3 Letter of Recommendation (preferably 1 academic, 1 clinical and one other)

Resume or Curriculum Vitae Description of clinical experiences (affiliations if student and or work

experience) Application fee of $25.00. All materials must be completed by September 1st.

b. Completion of online application for physical therapist for Norton Healthcarec. Applications are accepted year round with deadline the first of September each year with the

decision being made within 30-45 days after this. d. Interviews and applications are reviewed such as: The Neurolgoic Residency Manager will

receive all applications and distribute them to faculty of the program. The faculty will then rank applicants using the same tool. The Neurolgoic Residency Manager will then gather results and offer interview based on availability via person or phone. Following interviews, residents will be chosen.

e. Those applicants that are requesting disability have to request so in writing to the program at the time of their application.

f. Norton Healthcare will have the right not to go through any applications that are no complete.g. A final decision on the resident of choice will be made within 30-45 days of September 1st

where the applicants will be notified by phone and mail.h. It is the policy of Norton Healthcare and of this program recruit admits and retain participants in

a non-discriminatory manor. i. The resident will inform the residency coordinator within 30 days of acceptance or decline

verbally and in written form. j. The resident must complete the residency within a 14 month period.k. Retention will be maintained by proper orientation and clear communication throughout the

curriculum as well as ongoing processes in place to continue to monitor grading procedures to intervene as needed. Please see Grievance policy, remediation, and dismissal.

OrientationThe resident will participate in system orientation on the first day of their employment. At this orientation they will be issued a parking pass (no cost to resident). Residents advised to bring their license plate number, make, model and year of vehicle with them for registration purposes. In the table below is the mandatory orientation site and times to attend. Description Date Begin End LocationOrientation, System

January 0800 0430 Cramner Hall: Pavilion

Orientation, Site 1st week at each rotation

0800 0500 Acute, Rehab and OP centers

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The resident will indicate acceptance of the position by returning a signed copy of intent to Liz Ulanowski and a signed offer letter to Human Resources within 3 days of offer.

-Benefits: as a part-time employee and rehab member the resident may receive benefits provided by Norton Healthcare

-Malpractice Insurance: Through the APTA, HealthCare providers Service Organization, and Norton Healthcare

-Health Insurance Coverage: eligible for dental, vision, flexible spending accounts and medical plan of their choice.

Probationary Period As an employee of Norton Healthcare, residents are deemed competent to perform duties associated with practicing as a physical therapist. Competency will be determined within 60 days of hire and this is considered the probationary period. Once competency has been determined the probationary period ends. Residents accepted to this program must show academic abilities to perform post-professional education.

Retention and RemediationRetention involves meeting staff requirements of the physical therapist position at 65%. The resident

will receive feedback related to this position. Ninety days and one year in position the resident will receive performance feedback. The resident will receive mentored clinical time. During this clinical time the resident will be evaluated above and beyond their role as a staff therapist on knowledge and skills. The resident pass each examination, write a case study, participate in all curricular events, adequate feedback scores from Bellarmine, Cardinal Hill and Norton Healthcare staff. In the event the resident does not perform these duties then a plan for remediate will be developed by the program manager and the resident.

TerminationEach of the following may result in immediate termination of the resident position:

Failure to abide by Kentucky Physical Therapy Practice Act. Failure to obtain Licensure in the State of Kentucky. Found to be incompetent in clinical skills during the probationary period. Failure to abide by the American Physical Therapy Association’s Code of Ethics/conduct. Failure to abide by Norton Healthcare’s, or any subsequent facilities that the resident is working,

policies and regulations or the polices and procedures of the residency program. Allows and creates an unsafe working environment for co-workers and/or patients. If the resident does not achieve satisfactory scores for academic achievement. (clinical rotations and

didactic coursework) Receives consistently low scores (below entry level) on assessment of Professional Behaviors. Unable to effectively complete (at discretion of Program Manager) the items outlined such as teaching

responsibilities, community outreach, and case study and/or research obligations. The resident will be terminated and unable to complete any coursework, patient care and will not be awarded a diploma from the program for eligibility to sit for the specialty exam.

Probation PeriodIf the resident fails to comply with duties outlined for the completion of the residency or if the faculty does not believe that the resident is performing to an adequate level the resident may be placed on probation. This period will consist of 60-90 days at any time during the program. There will be weekly meetings with mentor and

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program manager during this period. A plan will be outline to increase performance that is agreed on by all faculty and current resident.

*** All Norton Healthcare polices and procedures are reviewed during new hire orientation.

Competency AssessmentMeasurement Who will grade Due

Live Patient Exams1. Patient Examination2. Treatment techniques

Clinical Faculty Beginning at end of each rotation and continuing through the end. If necessary may not be remediated immediately.

Professional Behaviors assessment

Resident and Clinical Faculty Beginning of residency and continuing through the end where resident fills it out each rotation to review

Student Ratings Students The end of each class that is taught by the resident

Observation of resident with students

Academic Faculty Mentor The end of each class that is taught by the resident

Observation of resident with patients

Clinical Faculty Beginning at end of first rotation with formal evaluation tools and continuing through the end

Patient Outcome Summary( kept by resident with excel)

Clinical Faculty Beginning at end of first rotation then continue to review at end of each rotation.

Self- Assessment Tool for Neurologic Physical Therapy

Resident Beginning of residency, halfway through and last month of program.

Case Study completion (2) Academic and Clinical Faculty Midterm and last month of residency program

In-services to peer groups (i.e journal club/case conferences/grand rounds)

Peers (PT,OT, SLP, physicians), Academic and Clinical Faculty

End of each group activity with evaluation form.

Completion of Monthly Journal Club

Program Manager Monthly

Completion of all hours required Program Manager Monthly meetings with residentMultiple Choice Comprehensive Exams (2)

Academic and Clinical Faculty At 6 months then 12 months with at least 75% to pass. Will have 2 weeks to re-take if needed.

Case StudyThe resident will complete 1 case study for presentation and 1 for full write up with presentation by the end of the year with progression towards submitting for publication.

Some types of patient cases that are good for case study are: Cases for which new treatment protocol s that the resident learned or heard about that are likely to be

more effective that traditional practice.

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Cases for diagnoses not typically seen by PT, but that the resident can demonstrate strong impact from his or her treatment.

Cases involving more than one problem where there might be competing influences where creativity is required to solve problem.

Residents are advised to write up early outline of each case report to use this to ensure all data collection and for review with research coordinator. Residents are also advised to refer to case studies found in APTA journals and How to Write a Case Study to assist with their organization found at: www.atpa.org

Remediation: Remediation will be required if submission of case study is determined inadequate per faculty feedback. The resident will be assigned an advisor for revision and resubmission. If it is deemed that the residents 2nd draft is unsatisfactory, then the resident will be dismissed from the program. Unsatisfactory is defined as resident’s case study is unable or inadequate to continue working with mentor towards submission for publication.

Multiple Choice ExamsThere are 2 multiple choice exams throughout the residency program that will focus on clinical placements as well as curriculum topics. Each exam will be 75-100 questions in length at 6 months and 12 months. The resident must obtain a score of >75% to pass this exam. If the resident is unable to achieve 75% on the exam the resident will have 2 weeks to re-take the examination 1 time and pass or the resident will be terminated from program.

Grievance PolicyIf there is a grievance placed against the resident by a patient, mentor or supervisor this process will follow Norton Healthcare’s policy and procedure. (Please see insite for full details)If the resident wants to file a grievance a series of measures will be taken to ensure full confidence and resolution. This formal process will first need to begin with resident creating in letter format the grievance in sealed envelope and present to program manager. The program manager will then pass along to grievance committee (core faculty) without communication with resident. This process will begin with the committee, who are unaffiliated with the program, where they will address the issue the resident has presented. (Please see resident policy and procedure binder for full details)

Patient Outcome MeasuresThe resident will utilize a variety of outcomes that he or she deem appropriate for their patient caseload but are encouraged to utilize each of the following in each setting:

Acute Care: TUG, 10MWT, modified BERG and modified sit and reach testInpatient Acute Rehab: BERG, 10 MWT, TUG, 2 or 6 min walk test and FIMOutpatient Rehab: GaitRite, Biodex, BERG, DGI, 10 MWT, TUG (with variation as well), 2 or 6 min walk test, DHI, Tinetti, Community balance and mobility scale, HiMat and functional gait assessment.**Residents are encouraged to use questionnaires to assess quality of life progression with treatment and use other outcomes as see fit.

Remediation: resident will be asked to re-do this report if average amount of change is less than acceptable and the program manager and mentor will attempt to increased caseload to re-do this outcome summary.

ExpensesThe resident will be paid at 65% FTE at $30.45 a hour. The resident will be responsible for traveling costs and housing. The resident is guaranteed 26 hours a week but can make more if more patient care is performed.

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Remediation/Termination General Guidelines 1. Academic- Resident able to re-take each exam, within 2 weeks, 1 time if score does not reflect

expectation of 75%. If not achieved a second time, the resident will be terminated.2. Academic- Resident able to turn in 2 drafts of case study to advisor before determining if remediation

required and satisfactory progress. 3. If resident is in academic probation as it relates to item 1 and 2 then they will receive academic

counseling as chosen by resident.4. If resident fails to achieve the expectation of 75% on exams and satisfactory results from case study, the

will be dismissed from the program without awarded graduation. 5. Clinical- if the resident fails to complete expectations of live patient exams by the end of the residency

an additional 4-8 weeks may be granted to attain satisfactory assessments.6. If the resident requires remediation based on clinical performance here as represented with live patient

evaluations or safety concerns an action plan will be developed to improve these skills as identified as problematic. If the resident is unable to improve skills identified in the time frame outlined with faculty in remediation plan the termination policy will apply. The resident will be allowed ample time to improve skills as long as patient safety and outcomes are not jeopardized the resident can continue to work toward satisfactory results.

7. If the resident fails more than one clinical rotation termination will be indicated. 8. Residency program will use anecdotal record to document any concerns or issues that require

remediation.

Anecdotal Record

Resident name_________________________Date___________________

Evaluator/Observer______________________

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Setting (place, person involved, clinical issues, etc.)

Resident action/behavior:

Evaluator interpretation:

________________________________________________Resident Signature

________________________________________________Evaluator Signature

Resident Comments:

Strategies to correct and prevent this occurrence in the future:

Appendix: Evaluation Forms

Faculty/Mentor evaluation is as follows: Self evaluation: faculty member or mentor to reflect on the past year experiences and rate themselves

and their involvement. Mentor: filled out by manager Program manager evaluation: filled out by faculty

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Exit Interview with resident and faculty: this is an opportunity that the resident as well as rest of faculty will have to discuss each of their roles and reflect on their experiences over the year. This is also a time for peer to peer observations.

Observation: performed by program manager to ensure level of mentoring and coursework is available for the resident.

All employees of the facilities participating in this clinical residency are evaluated on an annual basis as employees of their respected place of work by their rehab manager.

All forms will be reviewed by program manager and changes made appropriately to program and given constructive feedback to faculty and mentors.

Resident Evaluation forms found in this handbook 1. Mentor Evaluation form (filled out by resident on wikipage in survey monkey form)2. Faculty/Program Manager Evaluation form (filled out by resident on wikipage in survey monkey form)3. Residency Course Evaluation form (filled out by resident and faculty on wikipage in survey monkey form)4. Teaching Evaluation form (filled out by resident on wikipage in survey monkey form)5. Non-PT Mentor Evaluation form (filled out by resident on wikipage in survey monkey form)6. Live patient evaluation forms (filled out by mentor: for treatment session and evaluation)

After each evaluation form is filled out this will give the program manager an opportunity to discuss and any constructive feedback will be given to the appropriate parties.

1. Mentor Evaluation Form Resident _______________________ Mentor __________________________5- Not Observed 4-Excellent 3- Good 2-Fair 1- Poor

The objectives of clinical mentor practice were clearly communicated 1 2 3 4 5The objectives of clinical mentor practice were reviewed and altered to account for resident input

1 2 3 4 5

The mentor was easy to approach and talk with and provided clear communication

1 2 3 4 5

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The mentor was accessible when needed and made sure to set aside time to meet with the resident

1 2 3 4 5

The mentor clearly explained roles and responsibilities clearly of the resident

1 2 3 4 5

The mentor was able to meet with the resident regularly to discuss progress

1 2 3 4 5

The mentor was able to give regular and constructive feedback/criticism as well as receive constructive feedback/criticism.

1 2 3 4 5

The mentor was able to facilitate professional growth opportunities within the clinic/institution

1 2 3 4 5

The mentor was able to facilitate professional growth opportunities outside of the clinic/institution

1 2 3 4 5

The mentor was effective in assisting you with networking in and out of the clinic

1 2 3 4 5

The mentor was able to exhibit integrity with relationships with their patients, during mentor sessions and with other employees.

1 2 3 4 5

The mentor facilitated patient-therapist and therapist-resident relationships

1 2 3 4 5

The mentor clearly explained roles and responsibilities clearly of the resident

1 2 3 4 5

The mentor serves as a positive role model in physical therapy practice

1 2 3 4 5

The mentor was able to facilitate and integrate different learning styles into learning opportunities

1 2 3 4 5

The mentor encouraged the resident to self-assess 1 2 3 4 5As a mentor I am please with they style of mentoring and the relationship met my expectations

1 2 3 4 5

The mentor was able to effectively communicate any concerns and positives to the resident in the formal evaluation process.

1 2 3 4 5

The goals and objectives were reviewed at the end of the allotted time and discussed plan of action.

1 2 3 4 5

Please add any additional comments and please comment on non-observable:

2. Program Manager/Faculty Evaluation Form Resident _______________________ Faculty __________________________5- Not Observed 4-Excellent 3- Good 2-Fair 1- Poor

The objectives of residency faculty practice were clearly communicated

1 2 3 4 5

The objectives of residency faculty practice were reviewed and altered to account for resident input

1 2 3 4 5

The residency faculty was easy to approach and talk with and 1 2 3 4 5

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provided clear communicationThe residency faculty was accessible when needed and made sure to set aside time to meet with the resident

1 2 3 4 5

The residency faculty clearly explained roles and responsibilities clearly of the resident

1 2 3 4 5

The residency faculty was able to meet with the resident regularly to discuss progress

1 2 3 4 5

The residency faculty was able to give regular and constructive feedback/criticism as well as receive constructive feedback/criticism.

1 2 3 4 5

The residency faculty was able to facilitate professional growth opportunities within the clinic/institution

1 2 3 4 5

The residency faculty was able to facilitate professional growth opportunities outside of the clinic/institution

1 2 3 4 5

The residency faculty was effective in assisting you with networking in and out of the clinic

1 2 3 4 5

The residency faculty was able to exhibit integrity with relationships with their patients, during mentor sessions and with other employees.

1 2 3 4 5

The residency faculty facilitated patient-therapist and therapist-resident relationships

1 2 3 4 5

The residency faculty clearly explained roles and responsibilities clearly of the resident

1 2 3 4 5

The residency faculty serves as a positive role model in physical therapy practice

1 2 3 4 5

The residency faculty was able to facilitate and integrate different learning styles into learning opportunities

1 2 3 4 5

The residency faculty encouraged the resident to self-assess 1 2 3 4 5As a residency faculty I am please with they style of mentoring and the relationship met my expectations

1 2 3 4 5

The residency faculty was able to effectively communicate any concerns and positives to the resident in the formal evaluation process.

1 2 3 4 5

The goals and objectives were reviewed at the end of the residency with the residency faculty

1 2 3 4 5

Please add any additional comments and please comment on non-observable:

3. Faculty/Course evaluation form

Course Title: Date:Presenter: Location:Program Provider:Course Type:

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We are constantly trying to improve the quality of our continuing education courses. Please take a few minutes at the completion of the program to evaluate this course and presenter. Thank you.

Please circle on of the followingResident PT OT Other (faculty, staff etc)

PLEASE CIRCLE YOUR RESPONSE TO EACH OF THE FOLLOWING:

5- Excellent 4-Good 3- Fair 2-Poor 1- Not oberved

Meeting site was adequate in size, comfortable, and convenient 1 2 3 4 5

Course administration was efficient and friendly 1 2 3 4 5

Course objectives were consistent with the course as advertised 1 2 3 4 5

Course material was up-to-date, well-organized, appeared in a good place in overall curriculum and presented in sufficient depth

1 2 3 4 5

Course will contribute to my understanding and preparation of the NCS exam 1 2 3 4 5

Instructor demonstrated an enthusiastic and comprehensive knowledge of the subject

1 2 3 4 5

Instructor spoke clearly and encouraged questions and participation 1 2 3 4 5

Instructor expanded and challenged my understanding of this topic 1 2 3 4 5

Audio-visual materials used were relevant and of high quality 1 2 3 4 5

Handout materials enhanced course content 1 2 3 4 5

Overall, I would rate this course: 1 2 3 4 5

Overall, I would rate this instructor: 1 2 3 4 5

Comments (positive or negative and not observed):

Other topics and/or speakers you would like offered:

4. RESIDENT RATING OF MENTORING DURING TEACHING IN NEUROLOGIC LABSResident _______________________ Mentor __________________________5- Not Observed 4-Excellent 3- Good 2-Fair 1- Poor

The objectives of mentored laboratory instruction were clearly communicated.

1 2 3 4 5

There was opportunity for resident input into the objectives for mentored laboratory instruction.

1 2 3 4 5

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The mentor provided constructive feedback on resident performance in laboratory teaching.

1 2 3 4 5

The mentor provided timely feedback on resident performance. 1 2 3 4 5The mentor demonstrated skill in active listening. 1 2 3 4 5The mentor provided clear and concise communication. 1 2 3 4 5The mentor taught in an interactive manner that encouraged problem solving.

1 2 3 4 5

The mentor communicated in an open and non-threatening manner. 1 2 3 4 5There was a clear understanding to whom you were directly responsible and accountable.

1 2 3 4 5

The mentor was accessible when needed. 1 2 3 4 5The mentor clearly explained your responsibilities in laboratory teaching.

1 2 3 4 5

The mentor provided responsibilities that were within your scope of knowledge and skills.

1 2 3 4 5

The mentor facilitated teacher-resident-student relationships. 1 2 3 4 5Time was available with your mentor to discuss laboratory teaching techniques.

1 2 3 4 5

The mentor served as a positive role model in the physical therapy education setting.

1 2 3 4 5

The mentor skillfully used the classroom environment for planned and unplanned learning experiences.

1 2 3 4 5

The mentor integrated knowledge of various learning styles into laboratory teaching.

1 2 3 4 5

The mentor made the formal evaluation process constructive. 1 2 3 4 5The mentor encouraged the resident to self-assess. 1 2 3 4 5Please add any additional comments and please comment on non-observable:

5. RESIDENT RATING OF CLINICAL MENTORING (Non-PT)Resident _______________________ Mentor __________________________5- Not Observed 4-Excellent 3- Good 2-Fair 1- Poor

The objectives of mentored clinical experience were clearly communicated.

1 2 3 4 5

There was opportunity for resident input into the objectives for the mentored experience.

1 2 3 4 5

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The mentor provided constructive feedback on resident performance. 1 2 3 4 5The mentor provided timely feedback on resident performance. 1 2 3 4 5The mentor demonstrated skill in active listening. 1 2 3 4 5The mentor provided clear and concise communication. 1 2 3 4 5The mentor taught in an interactive manner that encouraged problem solving.

1 2 3 4 5

The mentor communicated in an open and non-threatening manner. 1 2 3 4 5There was a clear understanding to whom you were directly responsible and accountable.

1 2 3 4 5

The mentor was accessible when needed. 1 2 3 4 5The mentor clearly explained your responsibilities. 1 2 3 4 5The mentor provided responsibilities that were within your scope of knowledge and skills.

1 2 3 4 5

Time was available with your mentor to discuss patient/client management.

1 2 3 4 5

The mentor skillfully used the clinical environment for planned and unplanned learning experiences.

1 2 3 4 5

The mentor integrated knowledge of various learning styles into the clinical experience.

1 2 3 4 5

The mentor made the formal evaluation process constructive. 1 2 3 4 5The mentor encouraged the resident to self-assess. 1 2 3 4 5

Please add any additional comments and please comment on non-observable:

End of rotation feedback questions

What are you goals you would like to focus on in the next rotation?

What would you like to see changed within this last rotation and what worked well?

Please share your portfolio and what items have you included?

What is your status on case study, community project and shadowing hours?

7. Live patient exam

ASSESSMENT OF EXAMINATION (2 per setting for acute care and 1 per setting for inpatient rehab and outpatient rehab):

Resident: _____________________Mentor: __________________ Location:___________________Date: ________________________Rotation: __________________

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NNI Neurologic Physical Therapy (PT) Residency Program in the Norton Neuroscience Institute (NNI):Performance of Patient Examination

Live____ Written____ Video____ Self_____Of scored items:

After 1st rotation resident must have at least 50% above entry levelAfter 2nd rotation resident must have at least 65% above entry level with at least 25% in NCSAfter 3rd rotation resident must have at least 85% above entry level with at least 50% in NCS

Indicate one of the following (resident was assessed):Balance and vestibular disorders Congenital and acquired conditions of childhood Congenital and acquired conditions of adolescence and adulthood Progressive disorders of the central nervous system Acute or chronic peripheral neuropathies Other_____________________

Please place resident on continuum in each sectionThen in comments please indicate areas observed/graded on

____1. 2. 3. 4 ___ Entry level Practice Area NCS Expert

1. Examination a. History 1. 2. 3. 4.

o Able to perform an interview that is patient/client-guided.o Able to integrate knowledge of disease with medical history o Comments:

b. Systems review 1. 2. 3. 4.

o Able to anticipate screening procedures based on identified pathology, previous interventions, patient history, and observation.

o Comments:

c. Test and measures 1. 2. 3. 4.

o Able to appropriately examine communication, cognition, affect, and learning styles. o Able to select and prioritize test and measures based on history, systems review, scientific merit, clinical

utility, and physiologic of fiscal cost to patient relative to criticality of data.o Able to perform kinematic observations of tasks.

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o Able to perform measures such that data is accurate and precise.o Aerobic capacity/endurance (eg timed walk test- 6, 9, 12-minute walk test, Physical Performance

Test, Physiologic Cost Index) o Arousal, attention, and cognition (eg, assessment of factors that influence motivation level

consciousness, orientation, recall)o Assistive and adaptive devices (eg, assessment of appropriateness, use, effect on impairment,

alignment and fit, safety)o Circulation (screens for circulatory abnormalities)o Cranial and peripheral nerve integrity (eg, Hallpike-Dix Maneuver, gaze stability, nural

provocation)o Environmental, home and work (job/school/play) barriers (eg, architectural barriers)o Ergonomics and body mechanicso Gait, locomotion, and balance (eg, analysis with and without assistive or other devices, on

various terrains, in different environments, safety assessment)*o Integumentary integrityo Joint integrity and mobility (eg, mobility assessment of joint hyper-and hypo-mobility to include

passive accessory motions, response to manual provocation)o Motor function*o Muscle performance (including, strength, power, and endurance)o Neuromotor development and sensory integration (eg, assessment of appropriate development,

dexterity, coordination, and integration of somatosensory, visual, and vestibular systems)o Orthotic, protective, and supportive devices (eg, assessment of appropriateness, use, effect on

impairment, alignment and fit, safety) o Pain assessment using questionnaires, behavioral scales, and analog scales.o Posture (eg, body or body segment (s) structure, alignment, changes in different positions, and

body contours)o Prosthetic requirements (eg, assessment of assessment of appropriateness, use, effect on

impairment, alignment and fit, and safety)o Range of motion ( eg, single-joint and multisegmental muscle and length)o Reflex integrity (eg, assessment of normal and pathological reflexes)o Self-care and home managemento Sensory integrity (eg, proprioception, kinesthesia, vibration, and perception of vertical

orientation)o Ventilation and respiration (eg, breathing patterns, chest wall mobility, and perceived exertion)o Work (job, school, play), community, and leisure integration or reintegration (including

instrumental activities of daily living)***Comments:

2. Evaluation 1. 2. 3. 4.

o Able to predict present or potential disability based on impairments, functional limitations, (including results from task or motion analysis) and potential for recovery.

o Able to develop clinical judgments based on data collected from the examination.

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o Able to differentiate impairments/functional limitations that require compensatory movement strategies vs strategies that focus on recovery of normal movement.

o Able to link impairments, functional limitations, and psychosocial factors to the patient/client’s and caregiver’s expressed goals.

o Able to interpret observed movement and function.o Able to integrate instruments, tests, screens, and evaluations used or performed by other health

care professionals.Comments:

3. Diagnosis 1. 2. 3. 4.

o Able to interpret data from the examination to develop differential diagnosis.o Able to differentiate impairments/functional limitations disabilities which are amenable to

intervention.o Able to refer patient/client to other professionals for findings that are outside the scope of the

physical therapist’s knowledge, experience, or expertise.Comments:

4. Prognosis 1. 2. 3. 4.

o Able to predict optimal level of improvement in functiono Able to predict amount of time to achieve optimal level of improvement in function.o Able to collaborate with patient/client and family in setting goals.o Able to develop a plan of care that prioritizes interventions related to the recovery process,

patient/client goals, resources, health and wellness.Comments:

5. Able to conduct patient screening 1. 2. 3. 4.

o Able to identify and describe screening tools appropriate for the population being tested. Choice is based on such factors as the person’s age, cognition, and vocational- avocational activities. It is also based on the purpose of the screen: primary, secondary, or tertiary prevention. The screener must base selection on the sensitivity, specificity, reliability, validity, and test bias of the instrument.

o Able to apply tools in a timely and efficient manner, within the constraints of available equipment and the environment, and with appropriate delegation.

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o Able to observe the person’s response, collect data, and assign person to appropriate classification.

o Able to recommend action(s) based on the results. The possible actions include recommending no further intervention, deciding to evaluate, and referring to other providers.

o Able to document and communicate results of screening as needed.Comments:

Scoring is as follows:Entry Level Clinician

· Occasionally  requires 2-5 cues from evaluator to continue task

· Includes important tests and measures but may occasionally fail to select a key test    

· Demonstrates appropriate psychomotor skills but sometimes has difficulty performing complex techniques

· Demonstrates safe techniques but may occasionally need cueing from mentor  

· Knows underlying rationale for selection of tests and measures, but cannot provide evidence behind > 50% of them 

· Manages full caseload but could improve efficiency· Clinical decision making process is mostly appropriate but

occasionally needs cueing from mentor  

Practice Area Clinician (ie, geriatric, neuro, ortho, setting)

· Requires < 2 cues from evaluator· Completes test and measures efficiently· Selects appropriate test and measures and implements in a

safe manner· Able to discuss evidence behind test and measures a

majority of the time· Able to reflect and identify areas of improvement and

strength

Certified Specialist · Requires no cues from evaluator· Completes test and measures efficiently· Discusses specific research to rationalize test and

measures utilized (sensitivity/specificity, clinical prediction rules, NNT, etc)

· Able to reflect and identify areas of improvement and strength as well as strategies to enhance skills

· Utilizes specific knowledge of pathology and/or patient population to modify treatment and/or examination. (i.e. limited mobility expectations of rTSA vs traditional TSA, etc)

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ASSESSMENT OF TREATMENT (2 per setting)

Resident: _____________________Mentor: __________________ Location:___________________Date: ________________________Rotation: __________________

Norton Healthcare Neurologic ResidencyPerformance of Treatment

Live____ Written____ Video____ Self_____Of scored items:

After 1st rotation resident must have at least 50% above entry levelAfter 2nd rotation resident must have at least 65% above entry levelAfter 3rd rotation resident must have at least 85% above entry level with at least 50% in NCS of scored items

Indicate one of the following (resident was assessed on):Balance and vestibular disorders Congenital and acquired conditions of childhood Congenital and acquired conditions of adolescence and adulthood Progressive disorders of the central nervous system Acute or chronic peripheral neuropathies Other________________________Please place resident on continuum in each sectionThen in comments please indicate areas observed/graded on

____1. 2. 3. 4 ___ Entry level Prac Area NCS Expert

1. Intervention a. Coordination, Communication, and Documentation

____1. 2. 3. 4 ___

o Able to integrate communication strategies with therapeutic intervention.o Able to adapt communication to meet the educational and cognitive level of the patient/client and

caregivero Able to ask questions which are helpful in determining patient/client problems.o Able to apply conflict resolution strategies in a timely manner.o Able to effectively adapt communication strategies across the lifespan.

Comments:

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b. Patient/Client-Related Instruction____1. 2. 3. 4 ___

o Able to educate patient/clients on diagnosis, prognosis, treatment, responsibility, and self-management within plan of care.

Comments:

c. Procedural Interventions____1. 2. 3. 4 ___

i. Therapeutic exerciseo Able to perform task-specific training Able to analyze the relationship between biomechanics of therapeutic exercise and functional outcome. Able to anticipate the impact of multisystem impairments on the ability to perform therapeutic exercise.

Able to prescribe a precise exercise program related to functional limitations. Able to interpret, integrate, and correctly apply research findings to therapeutic exercise prescriptions. Able to adapt aerobic conditioning for patients/clients with neurologic dysfunction. Able to integrate physiological findings in the adaptation of therapeutic exercise programs.

ii. Functional training in self-care and home management and in work (job/school/play), community and leisure integration and reintegration

Able to analyze the interaction between multiple system impairments and environment. Able to optimize training despite communication/language, cultural, socioeconomic, and educational

variables. Able to provide assistance and cues which will challenge the patient/client appropriately. Able to select and implement training that enhances abilities for IADLs including:

iii. Manual therapy techniques Able to appropriately prescribe manual therapy in a manual therapy in a neurologic population.

iv. Prescription, application, and as appropriate, fabrication of devices and equipment including assistive, adaptive, orthotic, protective, supportive, or prosthetic

Able to choose appropriate device based on predicted long-term health needs. Able to promote optimal function with least restrictive devices. Able to anticipate the impact of the device across a wide range of functional activities and

social/environmental contexts.v. Integumentary Repair and Protective Techniques

Able to skillfully prevent and manage integumentary impairment. Able to educate neurologic patient/clients about the importance of skin management

Comments

2. Outcomes

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____1. 2. 3. 4 ___

o Able to select appropriate outcome measures and participates in data collection.o Able to analyze and interpret data to modify own future practice.

Comments:

Scoring is as follows:Entry Level Clinician · Occasionally  requires 2-5 cues from evaluator to continue task

· Includes important tests and measures but may occasionally fail to select a key test    

· Demonstrates appropriate psychomotor skills but sometimes has difficulty performing complex techniques

· Demonstrates safe techniques but may occasionally need cueing from mentor  

· Knows underlying rationale for selection of tests and measures, but cannot provide evidence behind > 50% of them 

· Manages full caseload but could improve efficiency· Clinical decision making process is mostly appropriate but

occasionally needs cueing from mentor  

Practice Area Clinician (ie, geriatric, neuro, ortho, setting)

· Requires < 2 cues from evaluator· Completes test and measures efficiently· Selects appropriate test and measures and implements in a safe

manner· Able to discuss evidence behind test and measures a majority of

the time· Able to reflect and identify areas of improvement and strength

Certified Specialist · Requires no cues from evaluator· Completes test and measures efficiently· Discusses specific research to rationalize test and measures

utilized (sensitivity/specificity, clinical prediction rules, NNT, etc)

· Able to reflect and identify areas of improvement and strength as well as strategies to enhance skills

· Utilizes specific knowledge of pathology and/or patient population to modify treatment and/or examination. (i.e. limited mobility expectations of rTSA vs traditional TSA, etc)

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Professional Behaviors for the 21st Century2009-2010

Definitions of Behavioral Criteria Levels

Beginning Level – behaviors consistent with a learner in the beginning of the professional phase of physical therapy education and before the first significant internshipIntermediate Level – behaviors consistent with a learner after the first significant internshipEntry Level – behaviors consistent with a learner who has completed all didactic work and is able to independently manage a caseload with consultation as needed from clinical instructors, co-workers and other health care professionalsPost-Entry Level – behaviors consistent with an autonomous practitioner beyond entry levelSpecialist: behaviors consistent with Patient centered approach, Strong moral commitment to the patient, Collaborative problem-solving approach with the patient, Multi-dimensional knowledge base-patient important source of knowledge, Reflective process- recognize own limitation, Expertise is more of a process or continuum of development- not a static state.

1. (BL) 2. 3. 4. (IL) 5. 6. (EL) 7. (PEL) 8.(Specialist)

Background InformationIn 1991 the faculty of the University of Wisconsin-Madison, Physical Therapy Educational Program identified the original Physical Therapy - Specific Generic Abilities. Since that time these abilities have been used by academic programs to facilitate the development, measurement and assessment of professional behaviors of students during both the didactic and clinical phases of the programs of study.

Since the initial study was conducted, the profession of Physical Therapy and the curricula of the educational programs have undergone significant changes that mirror the changes in healthcare and the academy. These changes include managed care, expansion in the scope of physical therapist practice, increased patient direct access to physical therapists, evidenced-based practice, clinical specialization in physical therapy and the American Physical Therapy Association’s Vision 2020 supporting doctors of physical therapy.

Today’s physical therapy practitioner functions on a more autonomous level in the delivery of patient care which places a higher demand for professional development on the new graduates of the physical therapy educational programs. Most recently (2008-2009), the research team of Warren May, PT, MPH, Laurie Kontney PT, DPT, MS and Z. Annette Iglarsh, PT, PhD, MBA completed a research project that built on the work of other researchers to analyze the PT-Specific Generic Abilities in relation to the changing landscape of physical therapist practice and in relation to generational differences of the “Millennial” or “Y” Generation (born 1980-2000). These are the graduates of the classes of 2004 and beyond who will shape clinical practice in the 21st century.

The research project was twofold and consisted of 1) a research survey which identified and rank ordered professional behaviors expected of the newly licensed physical therapist upon employment (2008); and 2) 10 small work groups that took the 10 identified behaviors (statistically determined) and wrote/revised behavior definitions, behavioral criteria and placement within developmental levels (Beginning, Intermediate, Entry Level and Post Entry Level) (2009). Interestingly the 10 statistically significant behaviors identified were identical to the original 10 Generic Abilities, however, the rank orders of the behaviors changed. Participants in the research survey included Center Coordinators of Clinical Education (CCCE’s) and Clinical Instructors (CI’s) from all regions of the United States. Participants in the small work groups included Directors of Clinical Education (DCE’s), Academic Faculty, CCCE’s and CI’s from all regions of the United States.This resulting document, Professional Behaviors, is the culmination of this research project. The definitions of each professional behavior have been revised along with the behavioral criteria for each developmental level. The ‘developing level’ was changed to the ‘intermediate level’ and the title of the document has been changed from Generic Abilities to Professional Behaviors. The title of this important document was changed to differentiate it from the original Generic Abilities and to better reflect the intent of assessing professional behaviors deemed critical for professional growth and development in physical therapy education and practice.

PreambleIn addition to a core of cognitive knowledge and psychomotor skills, it has been recognized by educators and practicing professionals that a repertoire of behaviors is required for success in any given profession (Alverno College Faculty, Assessment at Alverno, 1979). The identified repertoire of behaviors that constitute professional behavior reflect the values of any given profession and, at the same time, cross disciplinary lines (May et. al., 1991). Visualizing cognitive knowledge, psychomotor skills and a repertoire of behaviors as the legs of a three-legged stool serves to emphasize the importance of each. Remove one leg and the stool loses its stability and makes it very difficult to support professional growth, development, and ultimately, professional success. (May et. al., Opportunity Favors the Prepared: A Guide to Facilitating the Development of Professional Behavior, 2002)

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The intent of the Professional Behaviors Assessment Tool is to identify and describe the repertoire of professional behaviors deemed necessary for success in the practice of physical therapy. This Professional Behaviors Assessment Tool is intended to represent and be applied to student growth and development in the classroom and the clinic. It also contains behavioral criteria for the practicing clinician. Each Professional Behavior is defined and then broken down into developmental levels with each level containing behavioral criteria that describe behaviors that represent possession of the Professional Behavior they represent. Each developmental level builds on the previous level such that the tool represents growth over time in physical therapy education and practice.

It is critical that students, academic and clinical faculty utilize the Professional Behaviors Assessment Tool in the context of physical therapy and not life experiences. For example, a learner may possess strong communication skills in the context of student life and work situations, however, may be in the process of developing their physical therapy communication skills, those necessary to be successful as a professional in a greater health care context. One does not necessarily translate to the other, and thus must be used in the appropriate context to be effective.

Opportunities to reflect on each Professional Behavior through self assessment, and through peer and instructor assessment is critical for progress toward entry level performance in the classroom and clinic. A learner does not need to posses each behavioral criteria identified at each level within the tool, however, should demonstrate, and be able to provide examples of the majority in order to move from one level to the next. Likewise, the behavioral criteria are examples of behaviors one might demonstrate, however are not exhaustive. Academic and clinical facilities may decide to add or delete behavioral criteria based on the needs of their specific setting. Formal opportunities to reflect and discuss with an academic and/or clinical instructor is key to the tool’s use, and ultimately professional growth of the learner. The Professional Behaviors Assessment Tool allows the learner to build and strengthen their third leg with skills in the affective domain to augment the cognitive and psychomotor domains.

In addition to these behaviors being used for traditional physical therapy students Norton Healthcare and Bellarmine University have worked with Laurie Kontney to develop specialist level behaviors to better fit the needs for a residency program and advanced practice. For these needs the Beginning Level and Intermediate Level are described here in the definitions but are not continued throughout the assessment form. This is to assume that the residents accepted in the program are at least at entry level in these behaviors. If the resident is unable to meet criteria for entry level behaviors then the resident will be a candidate for remediation planning. Some behaviors found in specialist level were presented as post-entry level behaviors. For the purpose of the residency program these behaviors deemed appropriate for specialist were re-located to that level with some additional items added to fit the needs of this program.

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Professional Behaviors

1. 2. 3. 4. 5. 6. 7. 8.

1. Critical Thinking - The ability to question logically; identify, generate and evaluate elements of logical argument; recognize and differentiate facts, appropriate or faulty inferences, and assumptions; and distinguish relevant from irrelevant information. The ability to appropriately utilize, analyze, and critically evaluate scientific evidence to develop a logical argument, and to identify and determine the impact of bias on the decision making process.

Entry Level: Distinguishes relevant from irrelevant patient data Readily formulates and critiques alternative hypotheses and ideas Infers applicability of information across populations Exhibits openness to contradictory ideas Identifies appropriate measures and determines effectiveness of applied solutions efficiently Justifies solutions selected

Post-Entry Level:

Identifies complex patterns of associations Distinguishes when to think intuitively vs. analytically Recognizes own biases and suspends judgmental thinking Challenges others to think critically Develops new knowledge through research, professional writing and/or professional presentations and able to apply

throughout settings Thoroughly critiques hypotheses and ideas often crossing disciplines in thought process Weighs information value based on source and level of evidence Identifies complex patterns of associations and able to treat in all situations. Recognizes patterns in patient care and able to accurately communicate prognosis. Challenges others to think critically as related to critical inquiry and research design

Specialist Level: Thoroughly critiques hypotheses and ideas often crossing disciplines in thought process Weighs information value based on source and level of evidence Identifies complex patterns of associations and able to treat in all situations. Recognizes patterns in patient care and able to accurately communicate prognosis. Challenges others to think critically as related to critical inquiry and research design

Comments:

1. 2. 3. 4. 5. 6. 7. 8.

2. Communication - The ability to communicate effectively (i.e. verbal, non-verbal, reading, writing, and listening) for varied audiences and purposes.

Entry Level: Demonstrates the ability to maintain appropriate control of the communication exchange with individuals and groups Presents persuasive and explanatory verbal, written or electronic messages with logical organization and sequencing Maintains open and constructive communication Utilizes communication technology effectively and efficiently

Post Entry Level:

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Adapts messages to address needs, expectations, and prior knowledge of the audience to maximize learning Effectively delivers messages capable of influencing patients, the community and society Provides education locally, regionally and/or nationally Mediates conflict

Specialist Level: Understands scope of physical therapy practice and able to synthesize information and provide consultative services Develops and promotes new programs for health and fitness for the neurologically impaired. Renders opinion about patients with neurological dysfunction to external organizations. Educates physical therapist and other health care professionals about neurologic physical therapy. Adapts messages to address needs, expectations, and prior knowledge of the audience to maximize learning Provides education locally, regionally and/or nationally Communication, including knowledge of empathy, modification strategies, communication with sensory or cognitively

impaired, and listening and observing techniques.

Comments:

1. 2. 3. 4. 5. 6. 7. 8.

3. Problem Solving – The ability to recognize and define problems, analyzes data, develop and implement solutions, and evaluate outcomes.

Entry Level: Independently locates, prioritizes and uses resources to solve problems Accepts responsibility for implementing solutions Implements solutions Reassesses solutions Evaluates outcomes Modifies solutions based on the outcome and current evidence Evaluates generalizability of current evidence to a particular problem

Post Entry Level: Weighs advantages and disadvantages of a solution to a problem Participates in outcome studies Participates in formal quality assessment in work environment Seeks solutions to community health-related problems Considers second and third order effects of solutions chosen

Specialist Level: Predicts present or potential disability bases on impairments, functional limitations, and potential for recovery. Evaluates the effectiveness of new and established examination tools, interventions, and technologies Appropriately applies research information, methods or instruments. Weighs advantages and disadvantages of a solution to a problem

Comments

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1. 2. 3. 4. 5. 6. 7. 8.

4. Interpersonal Skills – The ability to interact effectively with patients, families, colleagues, other health care professionals, and the community in a culturally aware manner.

Entry Level: Demonstrates active listening skills and reflects back to original concern to determine course of action Responds effectively to unexpected situations Demonstrates ability to build partnerships Applies conflict management strategies when dealing with challenging interactions Recognizes the impact of non-verbal communication and emotional responses during interactions and modifies own

behaviors based on them

Post Entry Level: Establishes mentor relationships Recognizes the impact that non-verbal communication and the emotions of self and others have during interactions and

demonstrates the ability to modify the behaviors of self and others during the interaction

Specialist Level: Thrives in mentor relationships Recognizes impact of communication as a resource to other healthcare professionals.

Comments

1. 2. 3. 4. 5. 6. 7. 8.

5. Responsibility – The ability to be accountable for the outcomes of personal and professional actions and to follow through on commitments that encompass the profession within the scope of work, community and social responsibilities.

Entry Level: Educates patients as consumers of health care services Encourages patient accountability Directs patients to other health care professionals as needed Acts as a patient advocate Promotes evidence-based practice in health care settings Accepts responsibility for implementing solutions Demonstrates accountability for all decisions and behaviors in academic and clinical settings

Post Entry Level: Recognizes role as a leader Facilitates program development and modification Promotes clinical training for students Monitors and adapts to changes in the health care system Promotes service to the community

Specialist Level: Recognizes role as a leader in neurologic physical therapy Encourages and displays leadership through teaching, clinic and patient care Promotes clinical training for coworkers and other healthcare professionals (MD’s) Monitors outcomes of patients and tracks changes for reflection and alteration of plan Promotes service to the community to focus on neurologic physical therapy.

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Comments

1. 2. 3. 4. 5. 6. 7. 8.

6. Professionalism – The ability to exhibit appropriate professional conduct and to represent the profession effectively while promoting the growth/development of the Physical Therapy profession.

Entry Level: Demonstrates understanding of scope of practice as evidenced by treatment of patients within scope of practice, referring to

other healthcare professionals as necessary Provides patient/family centered care at all times as evidenced by provision of patient/family education, seeking patient input

and informed consent for all aspects of care and maintenance of patient dignity Seeks excellence in professional practice by participation in professional organizations and attendance at sessions or

participation in activities that further education/professional development Utilizes evidence to guide clinical decision making and the provision of patient care, following guidelines for best practices Discusses role of physical therapy within the healthcare system and in population health Demonstrates leadership in collaboration with both individuals and groups

Post Entry Level: Actively promotes and advocates for the profession Pursues leadership roles Supports research Participates in program development Demonstrates the ability to practice effectively in multiple settings Advocates for the patient, the community and society

Specialist Level: Pursues leadership roles for neurologic physical therapy Initiates and participates in research Participates in education of the community Demonstrates the ability to practice effectively in multiple settings Acts as a clinical instructor Advocates for the patient and how they can integrate in external resources

Comments

1. 2. 3. 4. 5. 6. 7. 8.

7. Use of Constructive Feedback – The ability to seek out and identify quality sources of feedback, reflect on and integrate the feedback, and provide meaningful feedback to others.

Entry Level: Independently engages in a continual process of self evaluation of skills, knowledge and abilities Seeks feedback from patients/clients and peers/mentors Readily integrates feedback provided from a variety of sources to improve skills, knowledge and abilities Uses multiple approaches when responding to feedback Reconciles differences with sensitivity Modifies feedback given to patients/clients according to their learning styles

Post Entry Level: Engages in non-judgmental, constructive problem-solving discussions Acts as conduit for feedback between multiple sources

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Utilizes feedback when analyzing and updating professional goals

Specialist Level: Seeks feedback from a variety of sources to include students/supervisees/peers/supervisors/patients Utilizes feedback when analyzing and updating professional goals Able to apply feedback to multiple situations for continued best practice.

Comments

1. 2. 3. 4. 5. 6. 7. 8.

8. Effective Use of Time and Resources – The ability to manage time and resources effectively to obtain the maximum possible benefit.

Entry Level: Uses current best evidence Collaborates with members of the team to maximize the impact of treatment available Has the ability to set boundaries, negotiate, compromise, and set realistic expectations Gathers data and effectively interprets and assimilates the data to determine plan of care Utilizes community resources in discharge planning Adjusts plans, schedule etc. as patient needs and circumstances dictate Meets productivity standards of facility while providing quality care and completing non-productive work activities

Post Entry Level: Organizes and prioritizes effectively Prioritizes multiple demands and situations that arise on a given day Mentors peers and supervisees in increasing productivity and/or effectiveness without decrement in quality of care

Specialist Level: Advances profession by contributing to the body of knowledge (outcomes, case studies, etc) Applies best evidence considering available resources and constraints Mentors peers and supervisees in increasing productivity and/or effectiveness without decrement in quality of care

Comments

1. 2. 3. 4. 5. 6. 7. 8.

9. Stress Management – The ability to identify sources of stress and to develop and implement effective coping behaviors; this applies for interactions for: self, patient/clients and their families, members of the health care team and in work/life scenarios.

Entry Level: Demonstrates appropriate affective responses in all situations Responds calmly to urgent situations with reflection and debriefing as needed Prioritizes multiple commitments

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Reconciles inconsistencies within professional, personal and work/life environments Demonstrates ability to defuse potential stressors with self and others

Post Entry Level: Recognizes when problems are unsolvable Assists others in recognizing and managing stressors Demonstrates preventative approach to stress management Establishes support networks for self and others

Specialist Level: Able to approach any situation with calm and resolving attitude without disruption. Offers solutions to the reduction of stress Models work/life balance through health/wellness behaviors in professional and personal life Understanding teaching and learning theory to modify communication in the workplace.

Comments

1. 2. 3. 4. 5. 6. 7. 8.

10. Commitment to Learning – The ability to self direct learning to include the identification of needs and sources of learning; and to continually seek and apply new knowledge, behaviors, and skills.

Entry Level: Respectfully questions conventional wisdom Formulates and re-evaluates position based on available evidence Demonstrates confidence in sharing new knowledge with all staff levels Modifies programs and treatments based on newly-learned skills and considerations Consults with other health professionals and physical therapists for treatment ideas

Post Entry Level: Acts as a mentor for other physical therapists Continues to seek and review relevant literature Works towards clinical specialty certifications Seeks specialty training Is committed to understanding the PT’s role in the health care environment today (i.e. wellness clinics, massage therapy,

holistic medicine) Pursues participation in clinical education as an educational opportunity

Specialist Level: Acts as a mentor not only to other PT’s, but to other health professionals Utilizes mentors who have knowledge available to them in practice area Advancing in specialist training and certification Is committed to understanding the PT’s role in the health care environment today (i.e. wellness clinics, massage therapy,

holistic medicine) and advancing relationships in the community in which they serve. Pursues participation in clinical education as an educational opportunity

Comments

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Based on my generic abilities: I am setting the following goals:

To accomplish these goals I plan to take the following actions:

Mentor/Faculty comments

Mentor/Faculty/Resident comparison

Resident Signature:__________________________________________________

Faculty/Mentor Signature:_____________________________________________

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Acute Care Billing for Physical and Occupational Therapy: NortonBilling Instructions: Physical and occupational therapy services are billed using CPT codes, and these codes are either procedure- or time-based codes. For services described by a procedure-based code, the therapy provider will enter “1” unit- in EPIC, you will simply click “yes”. Only one unit of a procedure-based code can be billed during a session. For services described by a time-based code, the therapy provider will use the “8-Minute Rule” to determine how many units of a CPT code should be billed. If the duration of a single modality or procedure is greater than or equal to 8 minutes and less than 23 minutes, then one unit will be billed. If the duration of a single modality or procedure is greater than or equal to 23 minutes and less than 38 minutes, then 2 units will be billed. If two separate modalities or procedures are completed during a session, then time spent performing each intervention will determine the units. For example, the duration of a therapy session is 35 minutes; 10 minutes was spent on Ther Ex and 25 minutes was spent on Functional Therapeutic Activities. 1 unit of Ther Ex and 2 units of FTA will be billed. The total number of units billed will be determined by the duration of treatment within each CPT code, not necessarily the total treatment time. Recording Time: To help ensure billing integrity, it is highly recommended that you record your treatment in/out time as well as time spent performing each procedure. Therapy billing must be consistent regardless of the patient’s insurance and it should accurately reflect the time spent with the patient.Evaluations: Although the CPT codes for PT and OT evaluations and re-evaluations are procedure-based, our productivity standards do not weigh specific codes with a different time-standard. For our internal productivity standards, we will treat eval and re-eval charges as a time-based code and charge the remainder of the time as treatment. Co-treatments: If two rehab disciplines are evaluating or treating a patient at the same time, both disciplines may bill for services rendered as long as it is skilled therapy and there is clear documentation supporting the need for services to be provided together. A PA charge may be used if a portion of the time spent by a therapist was not skilled services. For example, a PT and OT may co-evaluate a patient. If the PT proceeds with gait training and the OT assists with the IV pole and lines, then the PT would bill a PA for the time the OT is assisting. Students and Observation Patients: Therapy services that are provided to Medicare patients in an inpatient hospital setting are billed to Medicare Part A, with the exception of patients that are admitted under an “Observation Status”, or Obs. Obs patients are typically admitted for only 24-48 hours, and services rendered during an Obs admission are billed to Medicare Part B. Because Medicare Part B limits reimbursement when students evaluate/treat, students will not evaluate or treat observation patients unless the following requirements are met:

The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner.

Medicare Part A does not have the same restrictions for students; therefore we will allow students to eval/treat to Part A Medicare patients.

Procedure Assist Charges- Procedure Assist (PA) charges are used to account for the time spent when a rehab tech is assisting a therapist during a treatment. If a rehab tech is not available and the therapy provider chooses to use another therapist to assist (essentially using a therapist as a tech), then the treating therapist will bill a PA. The therapist that assisted will not enter any charges; however they may write a PA charge on their charge sheet with a note clarifying who they assisted and count that unit towards their daily unit tally.

Reference: Code Manager 2012, Q3.

Outpatient Billing for Physical and Occupational Therapy: NortonBilling Instructions: Physical and occupational therapy services are billed using CPT codes, and these codes are either procedure- or time-based codes. For services described by a procedure-based code, the therapy provider will enter “1” unit- in EPIC, you will simply click “yes”. Only one unit of a procedure-based code can be billed during a session. For services described by a time-based code, the therapy provider will use the “8-Minute Rule” to determine how many units of a CPT code should be billed. If the duration of a single modality or procedure is greater than or equal to 8 minutes and less than 23 minutes, then one unit will be billed. If the duration of a single modality or procedure is greater than or equal to 23 minutes and less than 38 minutes, then 2 units will be billed. If two separate modalities or procedures are completed during a session, then time spent performing each intervention will determine the units but total time needs to be taken into account and cannot bill past total time. For example, the duration of a therapy session is 35 minutes; 10 minutes was spent on Ther Ex and 25 minutes was spent on Functional Therapeutic Activities. 1 unit of Ther Ex and 1 units of FTA will be billed. The total number of units billed will be determined by the duration of treatment within each CPT code and total treatment time.

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Recording Time: To help ensure billing integrity, it is highly recommended that you record your treatment in/out time as well as time spent performing each procedure. Therapy billing must be consistent regardless of the patient’s insurance and it should accurately reflect the time spent with the patient.Evaluations: Although the CPT codes for PT and OT evaluations and re-evaluations are procedure-based, our productivity standards do not weigh specific codes with a different time-standard. If treatment is given on that day you may charge treatment codes.Students and Observation Patients: Therapy services that are provided to Medicare patients in an inpatient hospital setting are billed to Medicare Part B limits reimbursement when students evaluate/treat, students will not evaluate or treat observation patients unless the following requirements are met:

The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner.

Medicare Part A does not have the same restrictions for students; therefore we will allow students to eval/treat to Part A Medicare patients.

Procedure Assist Charges- Procedure Assist (PA) charges are used to account for the time spent when a rehab tech is assisting a therapist during a treatment. If a rehab tech is not available and the therapy provider chooses to use another therapist to assist (essentially using a therapist as a tech), then the treating therapist will bill a PA. The therapist that assisted will not enter any charges; however they may write a PA charge on their charge sheet with a note clarifying who they assisted and count that unit towards their daily unit tally.

Acute Rehab for Physical and Occupational Therapy: please see Cardinal Hill policy and procedures upon arrival at site

Acts same as OP where total time needs to be assessed

CPT Code Table: CPT Codes, Flowsheet Name, Charge Description, and Timed v. ProcedureEvaluation Codes

97001 PT Evaluation

PT Evaluation Procedure

97002 PT Re-eval

PT Re-evaluation Procedure

97003 OT Evaluation

OT Evaluation Procedure

97004 OT Re-evaluation

OT Re-evaluation Procedure

Therapeutic Procedures (A manner of effecting change through the application of clinical skills and/or services that attempt to improve function. Therapist is required to have direct (one-on-one) contact with the patient.)

97110

Ther Ex Therapeutic exercises to develop strength and endurance, ROM and flexibility

Timed

97112

Neuromuscular Reeducation (NMR)

Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities

Timed

97116

Gait Training Gait training (including stair climbing) Timed

97124

Massage Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

Timed

97530

Functional Therapeutic Activities

Therapeutic activities- use of dynamic activities to improve func. performance

Timed

97535

Patient/Family TrainingSelf-Care/Home Mgmt Training

Self-care and home management training (eg activities of daily living and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology and adaptive equipment)

Timed

97537

Community/work Reintegration Training

Community/work reintegration training (eg shopping, transportation, money mgmt, vocational activities, work task analysis, use of assistive technology device/adaptive equipment)

Timed

9713 CPM Initial/Daily Unlisted therapeutic procedure (NHC built) Timed

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9 Check9714

0Manual Therapy Manual therapy techniques (eg, mobilization/ manipulation,

manual lymphatic drainage, manual traction)Timed

97542

Wheelchair Management

Wheelchair management (eg assessment, fitting, training) Timed

97799

Procedure Assist (PA)

Unlisted physical medicine/rehabilitation serviceUsing the assistance of tech or other therapist (NHC built)

Timed

95992

Canalith repositioning

Canalith repositioning procedure (eg Epley, Semont maneuver), per day

Procedure

Modalities (Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.)

97010

Hot Pack/Cryotherapy

Application of a modality to 1 or more areas; hot or cold packs

Procedure

97012

Traction mechanical Traction mechanical Procedure

97014

E-stim Unattended Electrical Stimulation (unattended) Procedure

97018

Paraffin Bath Paraffin bath Procedure

97032

E-stim Attended TENS Initial

Application of a modality to 1 or more areas with constant attendance;

Timed

97033

Iontophoresis Iontophoresis Timed

97034

Contrast Bath Contrast Bath Timed

97035

Ultrasound Ultrasound Timed

64550

TENS Treatment Check

Timed

Active Wound Care Management (Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. Provider is required to have direct (one-on-one) patient contact.)

97597

Wound Care <20 sq cm

Debridement (eg high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (eg fibrin, devitalized epidermis and/or dermis, exudates, debris) including topical application, wound assessment, use of a whirlpool, when performed and instructions for ongoing care;

Procedure

97598

Wound Care >20 cm Debridement, each additional 20 sq cm Procedure

97022

Whirlpool (modality) Whirlpool Procedure

Orthotic Management and Prosthetic Management9776

0Splint Ortho Fit/Fab Orthotic(s) management and training (including assessment

and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk

Timed

97761

Prosthetic Training Prosthetic training, upper and/or lower extremity(s) Timed

97762

Splint Ortho Check Checkout for orthotic/prosthetic use, established patient Timed

Additional Tests and Measurements9775

0Physical Performance Test

Physical performance test or measurement (eg musculoskeletal, functional capacity) with written report

Timed

95831

Manual Muscle Test Extremity/Trunk

Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk

Timed

95932

Manual muscle Test Hand/Report

Muscle testing, manual (separate procedure) with report: hand, w/ or w/out comparison to normal side

Timed

95851

ROM Measurement Extremity/Trunk W/ Report

Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)

Timed

95852

ROM Measurement Hand With Report

Range of motion measurements and report (separate procedure); hand, w/ or w/out comparison to normal side

Timed

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Ideas for goal setting in each rotationThis is to be used as a guide for ideas but encouraged to modify to your own personal strengths/weakness and goals

Acute Care Consider length of stay in acute setting Be prepared to decide post acute needs on evaluation Focus on the smaller functions (goals) that need to be achieved to get to the next level Be ready to consider all factors (social, emotional, physical, cognitive, etc) quickly to make

appropriate goals in this setting Appropriate outcome use

Inpatient Rehab Time efficiency Most useful treatment for setting Discharge plans Goal writing Appropriate outcome use

Outpatient Rehab Treatment progression Referral to other services Discharge plans/HEP planning for long term use Goal writing Appropriate outcome use Medication management

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Mentoring log

Week of Pt relatedDescription and hours

TeachingDescription and hours

MDDescription and hours

OtherDescription and hours

Weekly total

Patient: End of Rotation SummaryPractice Pattern Diagnosis # of patients5A5B5C5D5E5F5G5H5I

Total # of patients

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