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Preamble

This resource manual is a supporting document to the MScPT Program Handbook and is

intended to provide guidance and information about the Clinical Education curriculum to

students and clinical instructors. It outlines expectations of the School of Physiotherapy for

students completing structured clinical placements under the supervision of licensed

physiotherapists who volunteer their time and expertise in training students at their clinical

work places in the community.

Each student is responsible for reviewing the manual and is expected to abide by the policies

and procedures outlined in this document. These policies have been prepared with direction

from Dalhousie University, Faculty of Health, the Practice Education Committee (PEC), Clinical

Education Committee and National Association of Clinical Education Program (NACEP).

Clinical placements are academic courses. All placements must be successfully completed in

accordance with the School of Physiotherapy academic regulations in order to ensure

program progression and timely graduation in the MScPT coursework.

Dalhousie`s Clinical Education Team

Academic Coordinator for Clinical Education (ACCE)

Daphne Pereira daphne@dal.ca

Academic Clinical Education Assistant

Charlene Joseph-Dunbar Charlene.Joseph-Dunbar@dal.ca

Instructor Member

Nancy Walker Nancy.walker@dal.ca

The oversight of clinical education is managed by Interim Director Dr. Lynn Shaw and Associate

Director Dr. Derek Rutherford.

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Table of Contents Preamble ......................................................................................................................................... 1

Table of Contents ............................................................................................................................2

SECTION I – Clinical Education Program for Students ...................................................................4

Curriculum Overview............................................................................................................ 4

Year 1 .................................................................................................................................. 4

Year 2 .................................................................................................................................. 5

Clinical Placement Dates ...................................................................................................... 7

Assessment of Clinical Performance (ACP) ............................................................................ 8

Portfolio ............................................................................................................................ 11

Clinical Remediation .......................................................................................................... 13

Clinical Education Process ............................................................................................................ 15

Application for Placements................................................................................................. 16

Assigning Placements ......................................................................................................... 20

Troubleshooting Prior to Placement ................................................................................... 25

Leave Requests / Missed Clinical Time ................................................................................ 25

Preparation for Placements ................................................................................................ 29

Communication with Clinical Facilities ................................................................................ 30

During a Placement ............................................................................................................ 31

International Placements ................................................................................................... 35

SECTION II – Clinical Education Program for Clinical Educators .................................................. 39

Principles of Planning an Effective Clinical Learning Experience ........................................... 39

The Planning Process .......................................................................................................... 39

Supervising Therapist/CI Preparation ................................................................................. 40

Learning Objectives ............................................................................................................ 41

Examples of Student Clinical Objectives .............................................................................. 46

Guidelines for Student Presentation ................................................................................... 50

Receiving and Giving Feedback ........................................................................................... 52

SECTION III – Dalhousie, Faculty of Health, Placement Policies .................................................. 61

RISK MANAGEMENT – Student Health and Security on Placements ..................................... 61

Guidelines for Personal Safety in Clinical Placements .......................................................... 66

Policy Regarding Student Disclosure of Health Information ................................................. 68

Patient Privacy and Confidentiality ..................................................................................... 69

Use of Social Media & Electronic Communication ............................................................... 69

Conduct Guidelines for Clinical Practice .............................................................................. 70

Suspension or Dismissal from a Programme on the Grounds of Professional Unsuitability ... 72

Strike Situation Policy ........................................................................................................ 75

Pandemic Policy ................................................................................................................. 75

APPENDICES ................................................................................................................................. 77

Appendix A – Roles and Responsibilities of the Team ................................................................. 77

Roles & Responsibilities of the Physiotherapy Student ........................................................ 77

Roles & Responsibilities of the Supervising Therapist /Clinical Instructor (CI) ...................... 78

Roles & Responsibilities of the Centre Coordinator of Clinical Education (CCCE) .................. 80

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Roles & Responsibilities of the Provincial Clinical Education Coordinator (PCCE).................. 81

Roles & Responsibilities of the Dalhousie Academic Clinical Education Assistant (ACEA) ...... 83

Roles & Responsibilities of the Dalhousie Academic Clinical Education Coordinator (ACCE) . 84

Appendix B – Compliance with Clinical Placements ............................................................. 87

Appendix C – Clinical Course Objectives .............................................................................. 88

(PHYT 5500, 5501, 5502, 6501, 6502 and 6503) ................................................................... 88

Appendix D – Checklists for Cardiorespiratory, Musculoskeletal and Neurotherapeutics ..... 99

CARDIORESPIRATORY COMPETENCIES RECORD .................................................................. 99

MUSCULOSKELETAL COMPETENCIES RECORD ....................................................................105

CLINICAL NEUROTHERAPEUTICS: EXPERIENCES RECORD (CHECKLIST) .................................112

Appendix E- Assessment of Clinical Performance (ACP) ......................................................117

Appendix F: ACP Grading Resource ....................................................................................133

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SECTION I – Clinical Education Program for Students

The MScPT curriculum prepares the student to be an autonomous health professional in an interdisciplinary health-care setting. Emphasis is placed on a collaborative, reasoned and evidence- based approach to practice, which manifests the integration of scientific knowledge, physiotherapy skills, and professional attitudes. The curriculum is delivered in an environment of inquiry that fosters reflective practice, confidence in problem-solving, a social conscience, and patient/family-centered communication essential to becoming effective physiotherapists in an ever-changing and complex health care system. Clinical education is a significant element of the MScPT program, as it prepares the student to integrate their academic learnings within a clinical context, while being mentored by physiotherapists in the clinical environment. To gain the required clinical education experience, the MScPT program offers 6 unique clinical education experiences. Year 1 and year 2, each contain 3 placement experiences. Students’ are required to create and manage their own portfolio to record their progress in performing required activities during the placement. The Clinical Instructor is asked to complete the evaluation form (ACP) on HSPnet.

The first year consists of courses targeting the theoretical and practical application of physiotherapy in cardiorespiratory and musculoskeletal practice. One 2-week and two 6-week clinical placements complete each academic module. The main purpose of the clinical placement is to provide the student with an opportunity, to apply and practice the assessment and treatment skills acquired during the academic term. The Students’ Portfolio is used to record their progress in performing required activities during the placement. The Clinical Instructor, along with the student, will complete the evaluation form (ACP) in HSPnet at mid-term and at the end of the placement.

CLINICAL COURSES PHYT 5500 : Clinical Orientation (1CR) 75 hours The main purpose of the placement is to introduce students to basic clinical skills and build confidence through clinical experience early in the program. The placement is intended to familiarize students to a clinical environment, prepare students for subsequent placements and enhance the student’s appreciation of the relevance of content delivered during the academic coursework.

Curriculum Overview

Year 1

5

PHYT 5501 : Clinical Placement (Cardiorespiratory) (3CR) 225hours The clinical component of the program provides the opportunity to integrate and apply academic learnings to the clinical environment leading to the development of clinical competence in Cardiorespiratory practice. Each student is required to complete the equivalent of 225 hours in cardiorespiratory related practice to gain an understanding of the scope and role of cardiorespiratory physiotherapy practice in tertiary, community and primary healthcare environments. PHYT 5502 : Clinical Placement (Musculoskeletal) (3CR) 225 hours The clinical component of the program provides the opportunity to integrate and apply academic learnings to the clinical environment leading to the development of clinical competence in Musculoskeletal practice. Each student is required to complete the equivalent of 225 hours in musculoskeletal practice with exposure to a variety of practice setting in physiotherapy. It is expected that the student will gain an understanding of the scope and role of musculoskeletal physiotherapy practice in tertiary, community and primary healthcare environments. The second year consists of courses dealing with neurosciences, and integrated practice across settings and age groups. The main purpose of these placements is for students to continue to practice and develop clinical problem solving and apply evidence-based practice skills acquired during the academic term.

This clinical placement period will allow for the integration of information into a physiotherapy practice area that would allow the student to assess and treat patients with multiple health problems, chronic diseases and co-morbidities.

The placements may provide the student with an opportunity to learn consultation and advocacy skills, to engage in program development and evaluation, and to educate others on the role of physiotherapy. Through working independently and advocating for their professional role, students will learn the necessary professionals skills to enter the profession.

CLINICAL COURSES:

PHYT 6501 : Clinical Placement (Neurotherapeutics) (3CR) The clinical component of the program provides opportunities to integrate and apply of academic learnings to the clinical environment and develop competence in Neurotherapeutics practice. Each student is required to complete the equivalent of 225 hours in full time clinical practice with exposure to a variety of neurotherapeutic practice areas in physiotherapy, gaining an understanding of the scope and role of Neurotherapeutics physiotherapy practice in tertiary, community and primary healthcare environments.

Year 2

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PHYT 6502 : Clinical Placement (Integrated Practice) (3CR) The clinical component of the program provides the opportunity to apply academic learning to the clinical environment leading to the development of clinical competence. The student will gain understanding of the theoretical and practical application of physiotherapy in complex conditions in all practice areas, building upon the previous clinical knowledge and experience in cardiorespiratory, musculoskeletal and Neurotherapeutics. Moreover, it allows the student to assess and treat patients with more complex condition, crhonic disease, multiple problems and co-morbidities. This may include the areas such as geriatrics (e.g.,long-term care and day-hospital), paediatrics, private practice, industry, community practice (e.g., home care; school-based consultation), innovative practice (e.g., family practice clinics) and/or any area that enhances previous clinical and academic experience. PHYT 6503 : Senior Clinical Placement (3CR)

The clinical component of the program provides for the integration and application of learning in current academic studies to the clinical environment leading to the development of clinical competence. The purpose of the placement is to provide the student with an opportunity to learn consultation skills, to engage in program development and evaluation, and to educate others about the role of physiotherapy. Through working independently and advocating for their professional role, students learn skills that will serve them well as they enter the profession.

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School of Physiotherapy Clinical Placement Calendar 2020-2021

Note: Due to the uncertainty of events pertaining to ongoing academic responses to COVID -19, the school reserves the right to modify the schedule. Any modifications to this schedule will be communicated to our stakeholders and input from the student and clinical perspective will be considered.

Clinical Course and Type Placement duration Dates (2021)

Cohort and Numbers

PHYT 5501*(Cardiorespiratory) or PHYT 5502* (Musculoskeletal) or PHYT 6501 (Neurotherapeutics) 6 weeks January 4 - February 12 Year 2 (66)

PHYT 5501*(Cardiorespiratory) or PHYT 5502* (Musculoskeletal) or PHYT 6501 (Neurotherapeutics) 6 weeks February 15 - March 26 Year 2 (66)

PHYT 5500 (Orientation Placement) 2 weeks February 22 - March 5 Year 1 (62)

PHYT 5501*(Cardiorespiratory) or PHYT 5502* (Musculoskeletal) or PHYT 6501 (Neurotherapeutics) 6 weeks March 29 - May 7 Year 2 (66)

PHYT 5501 (Cardiorespiratory) or PHYT 5502 (Musculoskeletal) 6 weeks May 31 - July 9 Year 1 (62) PHYT 5501 (Cardiorespiratory) or PHYT 5502 (Musculoskeletal) 6weeks July 12 - August 20 Year 1 (62)

PHYT 5501 (Cardiorespiratory) or PHYT 5502 (Musculoskeletal) 6 weeks

August 23 – October 2 (Optional placement block to offset pressures on clinical sites in summer) Year 1 (62)

PHYT 6502 (Integrated placement) 5 weeks July 19 - August 20 Year 2 (66) PHYT 6503 (Senior Placement) 5 weeks October 11 - November 12 Year 2 (66) * rescheduled due to COVID cancellations in Spring /Summer of 2020 Note: Flexible placement blocks are scheduled for Year 2 Winter term and Year 1 Summer Term. This is to allow for accommodation of offers from specific practice areas as they become available at clinical sites.

Clinical Placement Dates

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The Canadian Physiotherapy Assessment of Clinical Performance ((ACP) is a valid, reliable and practical online tool to assess Physiotherapy students in clinical education. There are a total of 21 rating scales and 9 comment boxes in this assessment form. The ACP is based on the Competency Profile for Physiotherapists in Canada (2017). This is a foundational document that describes the essential competencies (i.e. the knowledge, skills and attitudes) required by physiotherapists in Canada at the beginning of and throughout their career. Instructions to complete the tool: Students and clinical instructors are encouraged to access the online education module to help prepare you to complete this form and submit it at midterm and final points of the clinical education experience. If you have any questions about completing this student assessment form, please do not hesitate to contact the Academic Coordinator of Clinical Education at daphne@dal.ca

The distribution and management is the responsibility of the Clinical Education Assistant.

The results are then analyzed by the ACCE, and appropriate feedback is given to the students. It is hoped that such a process will enhance the student's learning experience.

Please see the Appendix for more information pertaining to the ACPext. Criteria for Awarding Credit with Distinction:

The Assessment of Clinical Performance (ACP) was developed to measure basic competence. Each performance criteria progressively describes a level of performance which cumulates in a standard expected of a new graduate. In certain situations a student may exceed the course objectives and expectations outlined in the ACP. In this instance, it is appropriate to recognize the student’s outstanding performance within the clinical environment. The Clinical Instructor will award a ‘credit with distinction’ used in conjunction with the sample behaviors and performance dimensions outlined in the ACP. The student should demonstrate superior performance in a consistent manner to warrant such a rating.

Assessment of Clinical Performance (ACP)

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Progression over Clinical Placements Beginner to Entry Level

Rating Scale and Anchor Descriptors*

Beginner Advanced Beginner

Intermediate Advanced Intermediate

Entry Level

Beyond Entry level

○ ○ ○ ○ ○ ○ ○ ○

*Use of the Rating Scale Anchors and Descriptors adapted and revised from the PT CPI |Web (Alexandria, VA: American Physical Therapy Association; 2006) is by nonexclusive license from the American Physical Therapy Association

Rating Scale and Anchor Descriptors* Beginner Performance: • The student requires close supervision 90-100% of the time managing patients with constant monitoring even with patients with simple conditions • The student requires frequent cueing and feedback • Performance is inconsistent and clinical reasoning is performed at a very basic level • The student is not able to carry a caseload Advanced Beginner Performance: • The student requires clinical supervision 75% to 90% of the time managing patients with simple conditions and 100% of the time managing patients with complex conditions • The student demonstrates consistency in developing proficiency with simple tasks (eg. chart review, goniometry, muscle testing and simple interventions) • The student initiates, but is inconsistent with comprehensive assessments, interventions, and clinical reasoning • The student will begin to share a caseload with the clinical instructor

Expectations

E

Expected for PHYT 5500 &

5501

Expected for PHYT

5502

Expected for PHYT 6501 (Intermediate)

Expected for PHYT

6502

Expected for PHYT 6503

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Intermediate Performance: • The student requires clinical supervision less than 50% of the time managing patients with simple conditions and 75% of the time managing patients with complex conditions • The student is proficient with simple tasks and is developing the ability to consistently perform comprehensive assessments, interventions, and clinical reasoning. • The student is capable of maintaining ~ 50% of a full-time physical therapist’s caseload Advanced Intermediate Performance: • The student requires clinical supervision less than 25% of the time managing new patients or patients with complex conditions and is independent managing patients with simple conditions • The student is consistent and proficient in simple tasks and requires only occasional cueing for comprehensive assessments, interventions, and clinical reasoning. • The student is capable of maintaining ~75% of a full-time physical therapist’s caseload Entry Level Performance: • The student requires infrequent clinical supervision managing patients with simple conditions and minimal guidance/supervision for patients with complex conditions • The student consistently performs comprehensive assessments, interventions and clinical reasoning in simple and complex situations • The student consults with others and resolves unfamiliar or ambiguous situations • The student is capable of maintaining at minimum 75% of a full-time physical therapist’s caseload in a cost-effective manner Beyond Entry Level Performance: • The student is capable of maintaining 100% of a full-time physical therapist’s caseload without clinical supervision or guidance, managing patients with simple or complex conditions, and, is able to function in unfamiliar or ambiguous situations In addition, the student demonstrates at least one of the criteria listed below: • The student is consistently proficient at comprehensive assessments, interventions and clinical reasoning • The student willingly assumes a leadership role for managing patients with more complex conditions or difficult situations • The student is capable of supervising others • The student is capable of serving as a consultant or resource for others • The student actively contributes to the enhancement of the clinical facility or service with an expansive view of physical therapy practice and the profession * Use of the Rating Scale Anchors and Descriptors adapted and revised from the PT CPI |Web (Alexandria, VA: American Physical Therapy Association;2006) is by nonexclusive license from the American Physical Therapy Association.

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Clinical education placements are considered to be courses and as such the student is expected to complete 1-2 hours studying and preparing in the evenings. Students are required to create and manage their portfolio (e.g., completion of reflections, learning plan and clinical log which may take 1-2 hours per day). The portfolio consists of weekly learning plan/objectives, competency records, clinical reflection exercises and any presentations, projects, Inter Professional education experiences and the midterm and final ACP. It is designed to encourage reflective practice that will: a) Assist students and clinical instructors when planning clinical activities; and b) Assist the Academic Clinical Coordinator and the student in planning future clinical placements Students are required to keep the information up-to-date and take responsibility for setting their own learning objectives (in consultation with the Clinical Instructor). The portfolio must be taken to clinics and to interviews with the Academic Coordinator of Clinical Education. The portfolio must be signed by the clinical instructor and the student. Student Evaluation of the Clinical Placement (SECP)

The National Association for Clinical Education in Physiotherapy (NACEP) feedback survey is set up in HSPnet. The Clinical Education Assistant distributes this SECP form to the students via HSPnet. At the end of each placement, the students are supposed to offer their opinions on the placement to their Cis. The student complete the form online and submit it on HSPnet. The feedback is then reviewed by the ACCE, and necessary suggestions and inputs are offered to the clinical sites. Inter Professional Education (IPE) By the end of their program of study students in all entry-to-practice graduate programs in the Faculty of Health are required to have completed a total number of different, meaningful and relevant interprofessional collaborative learning experiences (as determined and approved by each student's School/College). This would be equal to two times the number of years or part years of study in the program. At least one of these experiences will be in a practice setting.

Portfolio

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Summary of required placement documents

Document Type Format Due by Review with CI Frequency

Complete ALL modules of the preceptor education program

Online https://preceptor.ca/

Submit completion

certificate 2 weeks

before start date

Before FIRST placement

Preplacement Letter of Introduction Sample template available on

COURSE Brightspace

Send intro letter and

SPP 2 weeks before

start date

placement start date

Review SPP

with CI Day 1-3

of placement

Before EACH

placement Student Placement Profile (SPP)

Week 1 - 6 Learning Objectives Template on Brightspace Every Friday Yes weekly

Competencies Record (CR, MSK & Neuro checklist) Checklists available on Brightspace

Final day of placement

Yes ongoing

Week 3 Assessment of Clinical Performance (ACP) –Student self assessment

HSPnet Student account log in Friday of Week 3 Yes Mid placement

Assessment of Clinical Performance (ACP) – CI HSPnet CI account log in Yes

Week 6 Assessment of Clinical Performance (ACP) –

Student self assessment

HSPnet Student account log in Friday of Week 6 Yes End placement

Assessment of Clinical Performance (ACP) – CI HSPnet CI account log in Yes

Final week/day Student Evaluation of Clinical Placement (SECP) HSPnet Student account log in Final day of placement

Yes After EACH placement

Submit placement reflection/report and IPE form Brightspace Yes

Postplacement Ensure documents are submitted by deadline Brightspace

File and manage portfolio documents Individual portfolio reviews with ACCE post placement PHYT6501

Consider publishing your experience in the schools newsletter

Email Communications Officer

Consider nominating your CI for an award

Email Clinical Education Asst

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STUDENT ASSIGNMENTS/PRESENTATIONS: The School of Physiotherapy does NOT expect the student to complete a formal assignment (e.g., a written essay or report or an in-service presentation) during the placement, unless specifically negotiated in the pre-placement planning. The focus of the placement should be direct client care wherever possible. Students take longer than the experienced therapists to plan assessments and treatments and to complete charting requirements. In order to maximize client contact time, most students spend some evenings working on these activities, and additional written assignments may inappropriately burden the student and compromise the learning experience. If a Clinical Educator and the student determine that completion of a project or presentation would add to the learning experience, the project should:

• Complement clinical activities.

• Assist the student to achieve the clinical placement objectives for the placement.

• Not demand more than 5% of the student’s time during working hours. (Time to prepare presentations should be provided during working hours). Any questions regarding the appropriateness of a project/presentation should be addressed to the ACCE.

MScPT STUDENT OBSERVATION OF SURGERIES: Observation of surgeries is not a requirement of the MScPT clinical placement curriculum. At some clinical placement sites these student experiences are scheduled in-house without additional HSPnet data input required from Dalhousie. If you–as the Clinical Educator–feel it will add value to student learning while aligning with the learning objectives for the placement please feel free to arrange something for and with your student.

Any incomplete or failed academic work must be completed before entering the placement. The ACCE will work with both faculty and student to allow time for remediation and re-examination before the placement period.

Clinical Remediation

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School of Physiotherapy Clinical Placement Failure Policy Pending Failure: If by the mid-term clinical evaluation it appears that a student has the potential of failing the entire placement, the Clinical Instructor (CI) or designate will inform the student that s/he is a "potential failure". The CI must also inform the Provincial Coordinator of Clinical Education (PCCE) and the School of Physiotherapy Academic Coordinator of Clinical Education (ACCE) (or designate) immediately. The student is encouraged, and has the right, to contact the ACCE at any time that problems are identified on a placement (e.g., own performance, relationship with clinical supervisor, quality of placement, etc.)

Reasons for Failure:

• If the student is unable to meet the evaluation objectives of the clinical placement

• If the student is deemed unsafe in the clinical environment by the CI and confirmed by the ACCE

• If the student self-withdraws from the clinical placement without prior consultation with the CI, PCCE and the ACCE (AND APPROVAL OF THE ACCE AND GRADUATE COORDINATOR).

Steps taken:

The purpose is to provide the student with the opportunity to remediate performance and avoid failure. In the event that a student is having significant difficulty or may possibly fail a clinical placement, the ACCE is contacted immediately and the following is done: - CI/CCCE (CENTER COORDINATOR OF CLINICAL EDUCATION), PCCE and/or - student contact the ACCE. - CI provides student with documentation of behaviors that indicate potential failure (in

consultation with the CCCE). - PCCE OR ACCE meets with student, CI, and CCCE as deemed necessary, to identify problems.

Specific objectives and strategies to address these areas are outlined by the PCCE, CCCE and/or CI, taking into consideration the general objectives of the clinical placement, performance standards and the student's specific learning objectives.

- ACCE maintains weekly contact with the PCCE, CI, the CCCE and student to monitor the student's performance.

- PCCE, ACCE OR DESIGNATE may attend the mid-term, final and any interim evaluations as necessary.

If the failure is identified by the CI at a time that is too late to implement remedial strategies, the CI will document:

• Reasons that precluded the therapist from noting the problems earlier in the clinical placement; and/or

• New behaviors/problems that indicated failure late in the clinical placement.

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Failure: The final decision to fail the student is made by the Clinical Instructor in conjunction with the. Academic Coordinator for Clinical Education. The student has the right to submit an appeal to the Graduate Program Committee. The first time a student fails a clinical placement, the grade to be submitted will be an Incomplete (INC).The student will have the opportunity to repeat the clinical placement at a time coordinated by the School of Physiotherapy Academic Coordinator of Clinical Education (ACCE).

If the student successfully passes the repeat placement, a grade of Pass will be submitted.

If the student fails the repeat placement, a grade of F will be submitted, and the student will automatically be withdrawn from the Program by the Faculty of Graduate Studies. The student may appeal for immediate re-instatement, and if successful, will be given an opportunity to complete the failed placement one more time. If the repeat of the failed clinical placement is successful, a grade of Pass will be submitted. If the student fails the placement, a grade of F will be submitted, and being a second failing grade, will result in final dismissal from the Program. If the student passes the repeat placement, s/he will be informed that any subsequent failure of a clinical placement will result in final dismissal from the Program. Withdrawals Related to Clinical Placements: A student may request withdrawal from a clinical placement for religious, compassionate or health reasons. Students requesting withdrawal after the first two weeks of placement will require approval of the ACCE and the Graduate Program Coordinator. It is the student’s responsibility to submit the request in writing to the ACCE and include a medical certificate with the request if it is based on health reasons. Each request will be taken into consideration by the ACCE and Graduate Program Coordinator.

Clinical Education Process The Clinical Education Team is responsible for arranging all clinical placements. No student may undertake to make their own arrangements with the clinical facilities.

Students will be placed where it is necessary to meet the needs of the student's clinical education requirements based on the National Physiotherapy Entry-to-Practice Curriculum Guidelines.

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The administrative processes outlined below have been carefully developed over time by the

program, school, Faculty, Practise Education Committee and NACEP with input from students

and clinicians, to provide the best possible infrastructure to support the clinical education

curriculum. Inherent in this process is the ongoing support of all stakeholders, including those

in the professional community (CCCE, CI, agency staff), the public, and the academic

community (ACCE, faculty, administration). Students are therefore required to adhere to this

process.

Placement organization by the clinical education team is a lengthy process involving:

• requesting placement offers from clinical facilities at the start of the academic year

• confirming offer details and loading information into the HSPnet database*

• making offers available for students to review and select placement requests • reviewing students’ request of their placement choice(s)

• assignment of placements and release of information to class

• informing facilities of student allocations

• ensuring Affiliation Agreements are in place

• preparing the student placement evaluation packages for distribution to clinical instructors.

PLACEMENT REQUESTS TO CLINICAL FACILITIES:

Placement offers are requested from all clinical facilities in the Dalhousie catchment area of the

Atlantic Canadian provinces in a Call for Offers send out in September at the start of the

academic year, with follow-up prior to each placement session. Receipt of placement offers

from facilities is requested at least 8-10 weeks ahead of placement start date and is essential

to avoid overall delays in the process. Timelines must be adhered to as far as possible in order

to complete placement allocations in a reasonable length of time, avoiding delays in

communication with placement sites and difficulties in students arranging travel and

accommodations.

Placements require a signed affiliation agreement which outlines the roles, responsibilities, and legal accountabilities between the health care facility and educational institution. As per policy, an agreement must be in place before submitting a request.

The Physiotherapy Program is acutely aware of the present economic and management

constraints on sites and practicing health care professionals. These pressures, combined with

the early deadline dates for submitting offers to the School, tend to lead to a hesitation to offer

student placements.

Application for Placements

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Clinicians are reminded that graduate students must be trained in a diverse settings providing a

wide scope of practice areas to ensure the future of the physiotherapy profession. We suggest

that each practicing clinician consider supervising students for two placements per year. We

also remind students to remember this when they graduate and are in the position of being able

to offer placements themselves.

CATCHMENT AREAS:

This process is different for in-catchment, out-of-catchment (other Universities across Canada),

and International placements. The catchment area for Dalhousie School of Physiotherapy extends to the entire region of Atlantic Canada. Students can expect to be

placed anywhere within the area offering a clinical placement.

IN-CATCHMENT AREA REQUESTS: The clinical education team will inform students when in-catchment area offers are ready for selection by students. Placement offers may be viewed and five preferences selected on the placement management services database HSPnet. Requests must be submitted by the

deadline assigned. Students must use all 5 choices when applying for in- catchment

placements. Requests will not be considered if all choices are made at one facility or in one city (i.e. Halifax/St. John`s/Fredericton) unless the student has an approved accommodation request from Accessibility Center.

Until placement assignments are finalized, DO NOT commit to employment, social occasions,

extracurricular courses or travel during designated placement blocks.

You may not be granted more than 3 musculoskeletal placements (outpatient orthopaedics, amputees, rheumatology, private practice orthopaedics, sports physiotherapy, inpatient orthopaedics) out of the total of 5 placements you undertake at Dalhousie so please do not request a 4th placement in the musculoskeletal area unless you have met all the competencies for the cardiorespiratory/vascular and neuromuscular practice areas.

REQUESTS FOR ACCOMMODATIONS: It is the student’s responsibility to make a request for accommodation in accordance with the

Dalhousie University policy www.studentaccessibility.dal.ca/policy. The request for

Please remember:

Any initial contact with a facility including questions about the availability of placements or alterations in the assignment of clinical placements must be administered by the ACCE. Under no circumstances may the student contact a facility directly in order to inquire about placements, obtain or alter a placement.

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accommodation must be made in advance of the start of the field placement so that a decision

can be made as to what is needed and available and proper supports can be accessed. We

strongly advise any student who might need accommodation and/or advising should contact

these services as early as possible.

Except in rare circumstances, there should be no “after-the-fact” accommodation and these

situations will be considered on a case-by-case basis. The University will consider a request for

accommodation made by a third party (physician, family member, caregiver, advocate or other

representative) only where the student has provided prior written consent. The Faculty of

Health at Dalhousie recommends that students who have health concerns that have the

potential to compromise client, student and/or agency personnel safety to follow the policy

detailed at:

• https://www.dal.ca/faculty/health/current-students/student-policies-and-procedures.html

• https://www.dal.ca/campus_life/academic-support/accessibility/accommodations-.html

The School cannot and will not contact sites to arrange for placement accommodations without explicit student permission. If a student does not request the School to communicate with the site on his/her behalf for accommodations, it will be the student’s responsibility to liaise with the site regarding requested accommodations. Please note that not all sites will be able to provide all accommodations related to individual student need; a change of placement site may be required if the site is unable to provide the required accommodations in their specific clinical setting.

Please note that due to our dependence on a fluctuating Clinical Environment, the School of Physiotherapy cannot guarantee that all students will be placed according to their choice during each placement period

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Special considerations for placement in a particular location must be discussed with the Accessibility Center and decisions made by the Center will be communicated to the ACCE. Recommending special consideration is the prerogative of the Advisor at the Accesibility Center.

Please refer to Appendix A – Compliance with Clinical Placements

ARRANGING TRAVEL AND LIVING ACCOMMODATION FOR PLACEMENTS: Refer to the Faculty of Health policy on placements outside Halifax

UNAVOIDABLE PLACEMENT CHANGES: When sites offer student placements, there is a professional commitment to provide these learning opportunities. On rare occasions, a confirmed placement may be cancelled by a clinical facility. Discussion with the ACCE may facilitate the provision of a suitable option at the same facility. However, if this is not possible it is the responsibility of the Centre Clinical Coordinator in conjunction with the ACCE to find an alternative placement.

PLACEMENTS IN PRIVATE PRACTICE:

No more than two placements, including the final, may be completed under the supervision of private practitioners (i.e., at a private facility/site or through a private business in the community).

All travel and accommodations costs for EACH placement is the responsibility of the student. Students must be proactive in budgeting for these costs. It is expected that students make appropriate enquiries and arrangements for travelling to their placement locations (e.g. researching trip time, checking bus schedules, enquiring about parking options, etc.)

STUDENTS REQUESTING FOR SPECIAL CONSIDERATION APART FROM THOSE APPROVED BY ASSESSIBILITY SERVICE WILL NOT BE CONSIDERED

• house or apartment in Halifax so unable to afford paying additional rent for accommodation while on placement in another city

• don’t have a car or transportation • partner is here and do not want to leave him/her • students who have part-time jobs • caring for pets

• students on sports teams

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There are occasions where an in-catchment private practice may request for a specific student,

e.g. one who may have done volunteer work at their clinic. This is acceptable ONLY:

1. If the placement is congruent with the student’s learning needs and a potential conflict

of interest will not arise.

2. If this is a new site that may not otherwise take a student.

3. On the condition the therapists know it is an exception.

4. If the site agrees to accept other students in the future as assigned by the School.

All placement offers are entered into the HSPnet database and made available for students.

PLACEMENTS TYPES AND REQUIREMENTS: As an integral part of the Master of Physiotherapy Program, there are six clinical education placements that students must complete in order to graduate. These placements are facilitated by our Clinical Educators and take place at approved Clinical Education Sites in Atlantic Canada (ALL areas in the province of Nova Scotia, Newfoundland and Labrador, Prince Edward Island and New Brunswick). Students will be exposed to a variety of clinical settings, practice areas and patient populations as part of the clinical education curriculum. Students are assigned to specific sites, however are able to express preferences as to their top choices through the HSPnet system. Every student is required to complete a minimum of 100 hours in each of the following practice areas in musculoskeletal, cardiorespiratory/cardiovascular and neurotherapeutics. This will be monitored through HSPnet and the clinical portfolio logging system on Brightspace.

CONFLICT OF INTEREST AT PLACEMENT SITE:

Students are required to inform the ACCE when assigned to a facility where a conflict of interest may occur, e.g.:

1. A close friend, relative or significant other is the assigned clinical instructor that would be responsible for the students clinical instruction and/or evaluation.

2. The student has worked directly with the physiotherapy site/clinic and personnel as a volunteer, employee or client.

3. A close friend, relative or significant other works at or is a patient at the facility, and this could interfere with the learning experience or place the student in a conflict of interest situation.

4. The student has signed an employment contract with the clinical site or organization.

Assigning Placements

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OUTSIDE METRO PLACEMENTS:

A minimum of two out of six clinical placements will take place Outside the metro regions.

GEOGRAPHIC LOCATION FOR PLACEMENTS:

New Brunswick

Communities in the metropolitan area Rural Communities

Fredericton Moncton Miramichi Saint John Dieppe Grand Bay

Oromocto Sackville Waterville Cartlet County Bathurst

Students should be prepared to travel daily to any of these locations during placement periods.

Nova Scotia Communities in the metropolitan area Rural Communities

HRM Bedford Dartmouth Cole Harbor Lower Sackville Wolfville Antigonish New Minas Lower Sackville Kentville Bridgewater Chester St. Margaret’s Bay

Truro Cape Breton Sydney Lunenburg New Glasgow Shelburne Windsor Yarmouth

Students should be prepared to travel daily to any of these locations during placement periods.

Newfoundland and Labrador

Communities in the metropolitan area Rural communities

St. John`s Torbay Topsail Portugal Cove

Marystown Carbonear Bay Roberts Victoria

The final ACP Evaluation must be completed prior to any commitment or offer of employment at Clinical Placement site or within its organization.

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Paradise Mount Pearl Conception Bay Kelligrews Goulds Holyrood

Old Perlican Placentia Clarenville Burin Grand Bank Bonavista Whitbourn Gander Grand Falls Baie Verte Notre Dame Bay Corner Brooke Port-aux-Basque Deer Lake Stephenville Bay St George Bonne Bay St. Anthony Labrador City Goose Bay

Students should be prepared to travel daily to any of these locations during placement periods.

Prince Edward Island

Communities in the metropolitan area Rural Communities

Summerside (Prince County Hospital and a few private clinics) Charlottetown Cornwall Stratford (Queen Elizabeth Hospital, and many private clinics)

Rural: O'Leary Community Hospital Kings County Hospital in Alberton and a private PT clinics in Alberton and Kensington Souris Hospital Kings County Memorial Hospital (KCMH) in Montague Private PT clinics in Morell and Montague. Remote: O'Leary Alberton Montague.

Students should be prepared to travel daily to any of these locations during placement periods.

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PLACEMENT PREFERENCE SELECTION:

USING HSPnet:

HSPnet is a comprehensive, web-enabled Practice Education Management System for the health sciences which assists the clinical education team in managing clinical placements for our students. Each student is assigned a temporary password (by HSPnet directly, via email) giving them access to the system. The student can then follow first-time sign in instructions and change the password. The Clinical Education Assistant sends out an information sheet and instructions on how to use HSPnet before the start of Clinical orientation placements. For each of the SIX clinical placements, students will see a listing of available offers for that placement period and have the opportunity to input preference selections in HSPnet during a specified three-day time period. Students are notified of this time period by the Clinical Education Assistant.

Students use an HSPnet listing of facility offers to enter five preferences, in order of preference. The match is computer generated and is done randomly. It is expected that students will be placed throughout the Atlantic region, and that a broad range of clinical sites and experiences will be undertaken

Students make choices by viewing a listing of available placements and marking placements of most interest as 'Save to Choices.’ Five choices can be saved and ranked from 1-5.

Another important feature within HSPnet is the ‘Show Classmate Statistics.’ Clicking on this

feature shows the number of classmates with the exact placement in the same rank, as well as the number of classmates who have saved the placement for their top five choices. If, for example, 20 people have saved a certain placement to their top five choices, a student might wish to select another preference that fewer classmates have selected, in order to have a better chance at being placed at that site. If there is more than one offer at a clinical site, students may select the same site more than once provided they choose different clinical. The computer matches students to placements based on preferences, however it is unlikely that there will be a “perfect match” for all students, and some students may be randomly matched to any available site. Assignment to sites may be made by computer or by the School. Students must attend the site to which they been assigned. Refer to the Faculty of Health policy on placements outside Halifax

Please note that students indicate PREFERENCES only. We cannot guarantee that students will receive any of their preferred sites during the program a placement based on preferences.

All students should choose placements in a minimum of two placement categories for their first five placements.

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STEPS IN THE MATCHING PROCESS:

1. Students select their 5 placement preferences

2. Initial matching will be done for students who have priority needs e.g.: for certain

locations (as approved by Accessibility Centre) or for essential placements such as

Cardiorespiratory and Neurology 3. The match for all other students will then be completed.

Criteria for placement assignment are: the setting of placement needed by each student, the

location requested, and the availability of placement type and setting for each placement

session. If all criteria are equal, placements are assigned randomly for those placements

requested by more than one student. Placements requested by only one student can also be

easily allocated. For placements requested by more than one student the ACCE will match the

placement to the student requiring a particular clinical experience. If a particular group of

students are equal in terms of portfolio, then the ACCE will manually perform a lottery draw by

writing and pulling a name. Placements are not assigned in alphabetical order of student

names.

INFORMING STUDENTS AND ACCEPTANCE OF PLACEMENT ASSIGNMENTS: The clinical education team will inform students of their placement assignments as soon as

possible after the matching process has concluded, usually 4-6 weeks prior to placement (if

able to). Please be prepared for delays, usually due to delays in receiving placement offers or

confirmation from clinical facilities. Students will be asked to sign their acceptance of placements, at which time the School will

inform facilities of student allocations and mail the evaluation materials to the facility. ONLY

THEN should students contact their assigned facility.

Students NOTE: Your confirmation that you have accepted a placement and the notification to facilities of students assigned to that site means that you have entered into a contract that cannot be broken except for extenuating circumstances.

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It is important for all stakeholders in clinical education to recognize the reality of changing clinical environments, practice trends, and changing student situations. The University does not have control over these situations, which, in some circumstances may result in last minute changes with respect to student placements. The ACCE’s attempts to find solutions to problems as they arise. The following is a brief list of some possible problems and their follow up:

a) A shortage of numbers or types of placements:

• a final round of requests are sent out to ALL Dal catchment area clinicians requesting for additional offers.

• clinicians are encouraged to consider alternate models of supervision (ie. 2:1 two students with one therapist or group supervision models) as possible.

• new clinical sites in the Dal catchment area are sought out. • innovative placement types are considered and developed as appropriate.

b) Cancellation of a placement by the site: • all attempts will be made by the ACCE to secure a replacement placement in the same

timeframe however, it may not be in the same geographic location or in the same practice area.

• travel and accommodation payments cannot be refunded, so it is highly recommended that these be paid out only once a placement is confirmed.

c) Two students each receive a placement the other would prefer: • an early request (3-5 days after being assigned) to switch placements may be made in

writing to the ACCE prior to the cut-off for initial acceptance and if it is appropriate for both students’ clinical and academic history.

d) A student request for an out-of-catchment placement is rejected/denied: • the student will be placed by the ACCE in a placement within the catchment area

(contingent on availability of sufficient numbers and appropriate types of placements) • NOTE: that there is no second opportunity at this time to request for a new out-of-

catchment placement. DO NOT commit to employment, social occasions or travel during designated placement blocks. Placements are equivalent to employment and requesting vacation days or leave is not appropriate during the relatively short 6-week period of the placement. The only legitimate reasons for leave are illness, bereavement and extenuating circumstance. Extenuating circumstances refers to a personal circumstance beyond the student’s control that has a direct impact on the student’s ability to meet essential academic requirements or standards in a course(s). Extenuating circumstances include but are not limited to a sudden or acute physical or mental illness, serious injury to self or significant others, bereavement, a

Troubleshooting Prior to Placement

Leave Requests / Missed Clinical Time

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traumatic event, or other serious personal/ family crisis. This may include extenuating circumstances that last for a period of a) up to 48 hours, or b) more than 48 hours and up to 3 months. Requests for leaves that are not valid include, but are not necessarily limited to: • Attending a wedding • Attending a family event • Personal travel • Leisure pursuits • Caring for an animal Leave during a clinical placement will NOT be granted for vacation, family weddings, or other “predictable” life events, which must be scheduled during non-placement time. If the student requires time off during a placement, the student may have to defer the placement until a later time (and delay graduation).

The student must inform the Academic Coordinator of Clinical Education of all placement time loss (other than one day of sick time) with an explanation of why time was lost. All time lost must be recorded on the student evaluation.

When time loss during a placement has been approved in advance of the placement, the student must inform the clinical site of these arrangements (including the reason for the absence) in the introductory letter before the placement. The site is welcome to contact the school for clarification of absences.

When time loss during one placement period exceeds 2 days in total prior to graduation students must make up the time lost which is in excess of the allowed amount; this may result in delayed graduation. Students may make a request to the site to allow time to be made up on a weekend or extended working hours within the designated placement time period; however it is entirely up to the site whether this request can be accommodated. Sites are not required to give a reason for refusal of student requests for additional hours. If the site is unable to provide the student with extra hours, the department will schedule additional hours in a future placement, and this will likely delay graduation. Illness or Accident: Clinical Placement hours are one of the most valuable learning experiences during the MScPT program. As such, it is expected that students make every effort to attend the required placement dates and hours, However, It is recognized that students sometimes get sick during placement, and students must not attend a placement when their own personal health status would place the student, patients or clients, or other staff at the clinical site at risk.

The student must notify the Clinical Site regarding absence due to illness or accident as soon as possible. A medical certificate signed and dated by a physician may be required from the student for

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time loss that exceeds two consecutive days, or two separate absences, during a placement. Students must be prepared to submit a medical certificate immediately, if/when requested to do so, either by the site or by the University. Return to work following illness or accident: Physiotherapy is a physically and mentally demanding profession. Following prolonged medical leave (i.e., greater than three weeks) students must provide a letter from their physician which clearly states the student is fit to resume their studies−including clinical placement−before the student is allowed back into a clinical or other work site. This policy is for the safety of the student and their patients/clients. Medical Appointments: All non-emergency appointments should be made around a students’ academic schedule rather than during placement hours. If unavoidable, appointments should be made early or late in the day to minimize time lost on the placement. The Clinical Educator should be notified of the appointment as soon as possible, and if known in advance, on the first day of the placement. The Clinical Site may decide how much, if any, time should be made up during the placement. Compassionate Leave: Leave may be granted for compassionate reasons. Such requests should be directed immediately to the ACCE who will make the necessary decision. Educational Leave: Students may request permission from the Department to attend educational events during placements. Examples of events which may be approved include: CPA Congress; WCPT; other courses which are a “once in a lifetime” opportunity. Students will not be granted permission to attend events which are regularly scheduled or which are at a post-graduate level, or which are unrelated to the clinical practice area of the current placement. Permission will be granted for a maximum of two such events during the course of the student’s clinical education during the MScPT program, with a maximum time loss of 30 hours. Time lost for approved educational events must be made up prior to graduation. Clinical Educator’s Days Off: Students must be assigned an alternate supervisor when their Clinical Educator is on a day off. Alternative student arrangements could include observing other health care professionals, completing off-site visits or completing a specific project or literature search. Clinical activities are preferred whenever possible.

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Leave for Athletic Activities: Students anticipating selection for a Dalhousie or national team event must inform the ACCE (in writing or by email) of possible conflicts with placement scheduling at least three months in advance. Students are expected to collaborate in effectively planning for completion of the clinical placement requirements. Where time loss is involved, the ACCE will arrange for the student to make up the time prior to graduation; however graduation may be delayed if time loss is extensive. Job Action: Time lost due to union job action will NOT affect the student’s promotion from one year to the next. If time lost exceeds 55 hours, the student may be required to make up the learning experience. Every effort will be made to provide supplementary placements, or additional clinical time, prior to the student’s anticipated date of graduation.

According to union regulations, students MAY NOT cross the picket line even when their Clinical

Educator is at work, as only essential services are being provided (which does not include student instruction/supervision).During a job action, it is the student’s responsibility to liaise with the facility and receive instructions from the Centre Coordinator. Conferences:

The School encourages students to attend the Canadian Physiotherapy Association (CPA) convention (especially the student components of the program). Any students wishing time off placement to participate in this meeting should discuss their request with the ACCE before finalizing the placement concerned. A decision will be made in concert with the CI at the agency/facility in question. If more than 2 days will be missed from placement, the time must be made up before successful completion of the placement. Permission can be withdrawn if the student is not performing to standard during the placement in question Courses:

The Clinical education courses are just that – courses. Time off should not be requested to attend other extracurricular or post-graduate courses. Occasionally, a course that is relevant to the placement may be scheduled concurrently. A student may attend such courses with the approval of BOTH the CI and ACCE. Permission can be withdrawn if the student is not performing to standard during the placement in question.

The Physiotherapy Competency Examination:

If a student is registered to sit the exam during the course of a final year placement, one day prior to or after the exam date may be permitted for travel purposes to/from the exam

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location. For specific dates refer to the web-site of the Canadian Alliance of Physiotherapy Regulators www.alliancept.org Studying for the PCE must NOT affect required work during a placement.

In the event that the student requires leave from the clinic, arrangements must be made at the beginning of the placement with the Facility Clinical Coordinator.

If a student misses more than two days of clinical time in a single placement, the student will be subject to remediation. The method of remediation will be determined by the student, clinical instructor (CI), and facility clinical coordinator (CCCE). Examples of remediation could include:

• Making up the time working on a weekend if suitable to the site and meets the goals of the placement

• Completing a project for the site • Presentation for the site by the student

The student and the CCCE should inform the Academic Clinical Coordinator (ACCE) of placement time loss.The student must notify the CCCE about absence due to illness or accident as soon as possible.A medical certificate will be required from the student for time loss of two days or more.

• Students requesting fro time off due to religious reasons must declare their intentions in the letter before the placement starts and must make up the time by:

• Participating in weekend work if appropriate to the placement • Stay longer to complete all tasks • Complete and an assigned project or inservice presentation

Both students and clinical instructors are prepared for clinical placements through clinical

education preparation sessions: for students at the School during the academic block prior to a

placement and, for clinicians, through workshops, online programs preceptor courses and in-

services held at Dalhousie or on-site in the clinical facility.

Essential policies and procedures that must be complied with and completed in a timely fashion

include licensing regulations in certain provinces, immunizations, CPR and First Aid training and

mask fit testing. It is the responsibility of each student to maintain a portfolio of their required

documents and bring them to the institution where they will complete their placements.

Failure to do so may result in cancellation of the placement.

Preparation for Placements

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STUDENT PREPARATION SESSIONS:

Clinical education sessions are scheduled during the term prior to placement to inform students

about the clinical placement process, policies and procedures and to discuss clinical education

issues such as: curriculum content, supervision in physiotherapy practice, models of

supervision, ethics in clinical practice, conflict management, learning objectives and clinical

placement performance evaluation and self- evaluation. Information on these topics is also

presented in course PHYT 5101 Introduction to PT. Sessions are also scheduled prior to and

subsequent to placements to provide a forum for student questions, a debrief on the

placement(s), information on upcoming placement processes, objectives, and performance

expectations as students’ progress to entry-level practice.

It is required that students attend ALL scheduled sessions to avoid missing important information.

COMPLETION OF MANDATORY PRE-PLACEMENT TASKS: Before you commence your placement levels there are several mandatory tasks you need to complete; these form part of the requirements for passing your clinical education courses. Credit for these courses will not be granted if these tasks are incomplete. Preceptor Education Program Modules: Prior to the start of the first placement, students are required to complete all modules from the online Preceptor Education Program (PEP) modules www.preceptor.ca and upload the certificate of completion on Brightspace. Review of Relevant Clinical Material: Students are responsible for reviewing clinical material relevant to the assigned area of practice prior to the placement (e.g., course notes, relevant literature).

Please see Apprendix C for a summary of documents pre, during and post placement.

Introductory Letter: Students are required to write an introductory letter BEFORE commencing EACH placement. The letter summarizes their past clinical or other relevant experiences, and identifies personal strengths, areas for improvement, areas in which further expertise is required, and specific

Communication with Clinical Facilities

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interests related to an individual placement. Information included in the letter should be based on that found in PEP Module 1. The contact details are provided to the students by the Clinical Education Assistant upon confirmation of placements.The student may request information about living accommodation, transportation or anything pertinent to the placement. Complete the Student Placement Profile (SPP) and send with your letter of introduction.

STUDENT RESPONSIBILITY: The student, during the placement: ✓ Assumes primary responsibility for meeting the learning objectives. Draft objectives must be developed by the student prior to the placement and discussed with the site in the first week of the placement. The finalized objectives will be jointly agreed between clinical instructor and student. ✓ Fulfills expectations regarding attendance and policies as agreed upon between the academic program and the facility. ✓ Notifies the ACCE of time lost during a placement. ✓ Notifies the ACCE of any work-related injury, which occurs during a placement. ✓ Informs the ACCE of potential failure or any learning or performance difficulties during the placement. ✓ Provides the Clinical Instructor with a written evaluation of the clinical education experience at mid-placement and at the end of the placement using the form provided.

STUDENT WORKING HOURS: Students must complete 225 hours of clinical time per placement. This can be scheduled in whatever way the clinical site finds most convenient. Student work hours may include extended hours (e.g., 10-hour shift), evenings and weekends. The student should be informed of non-standard shifts before the placement begins. If the Clinical Educator has days off during the placement, alternative arrangements should be made for the student (e.g., working under the supervision of another Physical Therapist,

During a Placement

This letter must be emailed to the Clinical Instructor and Site Coordinator at least TWO weeks prior to the start of placement.

NOTE: Students are responsible for ensuring understanding of the requirements outlined in this manual and those outlined by the clinical site following a placement match.

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observing another health care professional, participating in off-site visits, etc.). Students will take time for lunch and coffee breaks consistent with the Clinical Site practice. It is important to remember that learning is tiring, so students should be encouraged to take appropriate rest breaks (e.g., morning and afternoon 15- minute breaks, 30-minute lunch break). Students cannot “bank” extra time spent on placements for future use (i.e., more than 225 hours, or during volunteer activities). Students may NOT ask for time off except for illness or compassionate reasons. Dress Code: During the academic program, students will be working in a number of diverse clinical education settings in which they will be expected to dress professionally and in accordance with the dress code guidelines established by the School of Physiotherapy. The clinical sites reserve the right to require the student to conform to their specific dress code if significantly different from the School of Physiotherapy dress code guidelines. Students should seek advice about the appropriateness of the Physiotherapy program guidelines from the ACCE or the Clinical Educator on the first day of each placement. Students should not be required to purchase items of clothing specific to a Clinical Site’s uniform, unless the student is in a country where they must respect and abide by the cultural requirements.

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Dalhousie School of Physiotherapy DRESS CODE GUIDELINES

CLOTHING

• Pants, in good condition, no holes or frayed bottoms o No blue jeans, faded denim of any colour, sweat pants, leggings or spandex • Tops long enough to tuck into slacks or shorts and with sleeves (short or long rolled up) • No graphic tees

• Sweaters and cardigans, preferably removed for patient care • Skirts are not appropriate in most direct patient care areas FOOTWEAR • Clean footwear in good repair

• Flat shoes/clogs with an enclosed toe and heel. No sandals. • Non-slip and non-marking soles

• Runners (if clean and in good condition) o In some areas, runners leave marks on the floor and may not be acceptable

• Socks or panty-hose with shoes

SCENTS

• Absolutely NO perfume, cologne, aftershave or strongly scented personal products

ACCESSORIES

• Only minimal jewelry is allowed

• Smooth surface rings only

• No neck pendants or multiple chains

• No facial jewelry

• Small discreet earrings

• Wrist watch (should be removed for patient care) GENERAL APPEARANCE

• Conservative make-up only • Clean and well-groomed hair

• Long hair worn off the collar

• Neat and well-trimmed beards

• Short and well-trimmed nails

• NO nail polish

EXCEPTIONS

• A scrub/coat worn over street clothes is acceptable in some clinical areas if the student is not providing direct patient care

• Some specialized clinical areas (e.g., Burn Unit, ICU, or Emergency) may have other clothing requirements. These are generally provided by the site/area. Students in such areas must comply with these requirements.

OUT-OF-CATCHMENT (OOC) PLACEMENT REQUESTS:

Placements outside the catchment area is currently suspended.

Dalhousie Physiotherapy students are not required to complete a clinical placement outside the Atlantic Canadian provinces. Placements in other provinces are controlled by PT programs in that province (just as Dal controls placement allocation in Atlantic Canada to allow home students to have first opportunity).

If a student is interested in an OOC placement, s/he may make a request for PHYT 6502 and/or PHYT 6503. Students will not be placed out-of-province at any time if the student has encountered difficulty during previous placements (i.e., previous weak performance or other issues which affect the student’s ability to perform successfully) or during the academic part of the program.

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To request an OOC placement, students must complete the OOC Expression of Interest form as forwarded by the ACCE and pay an administrative fee of $50 to the the School of Physiotherapy. Normally an administration fee is also charged by the provincial university for processing a request (you will be charged whether or not the placement request is successful). If an OOC placement is arranged for a student, it is mandatory that the student attend the OOC as it will become the assigned placement.

The ACCE submits Dal students’ requests for out-of-catchment placements to the other

universities and in turn receives requests from other programs. Each PT Program offers

available placements to their own students first and any remaining placements are offered to

out-of-catchment students. Each university (including Dal) holds its available catchment

placements as long as possible to ensure their own

students are placed. Students who have applied for out-of-catchment will not be matched with

in-catchment placements unless the placement start date is less than two weeks away. If the

placement start date is less than two weeks away, the ACCE will retract the OOC request and

offer the student the options from the remaining in-catchment offers.

Remember that only one catchment area may be requested per session and only one request

may be made to another University catchment area per year.

CLINICAL PLACEMENT FEES FOR OOC PLACEMENTS:

Students are responsible for any applicable fees to the out-of-catchment university, to the

provincial licensing body or placement facility. Fees for each placement request are required

for the universities.

Fees are non-refundable, meaning that if a placement cannot be found, the fee may not be

refunded. Every effort will be made to place students and we will be advised if it is likely that

placements will not be available at a particular time.

Students must NOT approach facilities in other provinces or ACCEs at other universities to request placement.

Students are responsible for all costs associated with OOC placements, including travel, accommodation and any applicable fees. No stipends or other funding is available for these placements.

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All international exchange programs are currently cancelled https://www.dal.ca/campus_life/ile.html

RATIONALE AND BACKGROUND: The School of Physiotherapy at Dalhousie University is proud to be among the few Canadian Universities with an established international placement option for MSc.PT students. An International placement is an optional way to achieve course credit for ONE of the required placements in the MSc.PT programs. It is recognized that International Placements provide students with a unique educational opportunity to develop clinical skills, while also combining learning in the areas of global health and cultural diversity. A reciprocity also exists for Dalhousie University, whereby our MSc PT students act as ambassadors for our programming and support Canadian values internationally. The safety of all students on an international clinical placement is of paramount importance and the University has a responsibility to help manage the risks associated with such International placements.

This document sets out the necessary steps that must be followed by Dalhousie University and the School of Physiotherapy to demonstrate due diligence prior to making a decision in regard to a student participating in an International placement opportunity.

ELIGIBILITY CRITERIA: To be considered for a placement outside of Canada, a student must be approved by the International Placement Committee in the Physiotherapy program. This Committee comprises of the Academic Coordinator of Clinical Education, Chair of the Graduate Program Committee and current Course Manager/Coordinator. Conditions for eligibility are as follows:

a) A student must be in the final year of the MScPT program and be willing to accept the International offer for PHYT6502 or PHYT 6503 (June-August).

b) The student must maintain a minimum overall grade point average of 80%, without exception. This standing must be maintained until the commencement of the International Placement.

c) Satisfactory academic performance (minimum average of B+ or 75%). d) Successful completion of previous placements (no significant weaknesses or concerns

on previous placements). e) Strong interpersonal skills, including tact and diplomacy, and well developed judgment

skills (as documented on previous performance evaluations and observed by faculty). f) An awareness of potential cultural differences in the proposed host country.

International Placements

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g) The student should accept full financial responsibility for ALL COSTS associated with the international placement, e.g., travel, accommodation, visa, medical insurance, immunizations, etc.

h) The student must be willing to accept a placement in Atlantic Canada as arranged by the ACCE in the event of cancellation of the international placement.

PLACEMENT LOCATION: International placements are currently limited to the following sites where the Faculty of Health has a current Student Placement Agreement.

• Amar Seva Sangam, Tenkasi, India https://www.amarseva.org/index.php

• Glasgow Caledonian University, Scotland https://www.gcu.ac.uk

• University College Dublin, Ireland www.ucd.ie

• Oslomet University, Norway https://www.oslomet.no/en/english The site in India is in partnership with Physiotherapists and Occupational therapists who travel there as volunteers. There are no guarantees that a placement in any of the above locations will be available when requested, as there are various factors to consider. The School will inform students of all available options for the eligible timeframe.

Given the complexity of arranging University and clinical site legal agreements to support international student placements, students are not permitted to seek their own locations for international clinical education. Under no circumstances will a student be permitted to participate in a placement in a country deemed a “Level 3 (Avoid non-essential travel) or Level 4 (Avoid all travel)” by Global Affairs Canada.

Accommodations: The School of Physiotherapy cannot guarantee the cooperation of foreign institutions should students require accommodations while on an International Placement. Although we can assist in communicating needs to international institutions, not all countries possess human rights legislation that would compel an institution to provide appropriate accommodations, including accommodations for human rights related grounds such as disability or faith requirements, etc.

Please note: A student will not be granted more than ONE international placement throughout the MScPT Program

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APPLICATION PROCEDURE: Planning for your global health clinical placement requires a lot of preparation. 1. Expression of Interest: To request an international placement at a site with a current Dal Clinical Placement Agreement, students must first complete the International Placement Expression of Interest form (emailed to the class) and return it to the ACCE at least eight months prior to the placement requested. The student is required to pay a non-refundable $150.00 International Placement Administrative fee to the School of Physiotherapy. The fee is due upon application of request. 2. Letters of Reference: A letter of intent and two references (one from a clinical instructor/preceptor and one from a faculty member) refer to Appendix

There must be favorable consensus from both the respective academic and clinical faculty that the student demonstrates professional behaviour in both academic and clinical situations (e.g., independence, maturity).

3. Student Interviews: Once an international placement expression of interest has been received, interviews will be scheduled for all interested applicants to better understand student motivation and previous experience with international travel. These will also allow faculty to determine suitability of students to the different organizations/sites.

4. Mandatory DAL Global Health Office Requirements: All students participating in international placements must complete pre-departure training, curriculum developed to help you prepare no matter where you are travel on your placements. The Global Health Office provides specialized pre-departure training for OT/PT students in the fall.

1. Complete Dal Student Safety Abroad program requirements: Apply to the Global Health Office

Deadline for submission of documents (expression of interest and references) is at minimum six months prior to the placement.

Once approved for an international placement, a student must complete several requirements at least six weeks prior to the placement

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2. Complete the on-line modules 3. Attend a mandatory in-person orientation session at Dal and submit the completion

certificate on Brightspace. 4. Sign on to the Student Safety Abroad Registry 5. The pre-departure planning checklist must be completed and submitted to the ACCE

prior to the start of placement.

For “Level 2” countries [“Exercise high degree of caution”, according to Global Affairs Canada] students will be required to travel in pairs and the International Placement Committee must approve the country and/or region of interest.

STUDENT RESPONSIBILITIES FOR INTERNATIONAL PLACEMENTS: The student is responsible for the determination and fulfillment of all requirements necessary for entry in the country of placement, for example:

• A visa • Medical assessment (if required) • Immunizations required by the site (the student must check with the site to ensure that

s/he meets all immunization requirements, and obtain proof of such (e.g., letter from Dal Student Health Services)

• Medical and liability insurance • A student must ensure sufficient personal insurance is in place (MSI and extended

health/travel insurance). • It is recommended that flights should be purchased with flight cancellation insurance.

ACADEMIC REQUIREMENTS DURING and FOLLOWING PLACEMENT:

1. Weekly submission of documents on Brightspace: placement objectives, checklists of clinical skills, IPHE and reflection documents.

2. Mid-term and Final ACP submission on HSPnet. Student evaluation of clinical placement.

3. Skype conversation with ACCE or designate at mid-placement (Week 3) 4. Placement debrief by writing a report to publish in the School Newsletter

The student MUST complete the pre-departure orientation and ALL required documentation & processes as prescribed by the Global Health Office, Dalhousie University. If INCOMPLETE, the student will NOT be allowed to attend International Placement.

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dd

SECTION II – Clinical Education Program for Clinical Educators

The plan for a clinical learning experience must integrate progressive levels of responsibility and specific competency-based content areas.

The instructional design process incorporates four key elements: - Identify expectations and objectives

- Establish an evaluation for achievement of objectives

- Design learning activities to meet objectives - Evaluate effectiveness of learning experience and revise as necessary

1. Identify expectations and objectives of the learning experience.

• The process of establishing realistic expectations and objectives involves identifying what you want the learner to demonstrate, with which patients and with how much independence.

2. Establish means to evaluate the achievement of these objectives. • To identify the means to evaluate achievement of the objective, we must answer the question,

“How will it look, sound, feel if the learner is achieving this objective?”

3. Design learning activities to meet the objectives.

• There are three principles to follow in the design of learning activities:

• Assess learner readiness for the required level of responsibility.

• Select appropriate patients, complexity of tasks, and support required. • Identify a progression of learner performance in these activities.

4. Evaluate the effectiveness of the learning experience and revise as necessary

• This evaluation requires the learner and supervising therapist/CI to assess learner performance in achieving the objectives based on mutually agreed upon criteria. Specific and targeted feedback is essential for learner development.

• The revision of the learning experience might involve adding supplementary experiences, including more instructor observation and feedback or identifying materials for learner self-study.

Principles of Planning an Effective Clinical Learning Experience

The Planning Process

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BEFORE THE STUDENT COMES:

1. Familiarize yourself with the Clinical Education Resource Manual made available on the School website.

2. Familiarize yourself with the student evaluation form (ACPext) and complete the on- line training.

3. Reflect on student placement objectives, considering the level of the student and the opportunities your service and caseload have to offer.

4. Review the Student Placement Profile (SPP) and student letter of introduction.

PLANNING FOR STUDENT PLACEMENT:

• Hours of work • Arrival time

• What to do in case of illness Uniforms and name tags must be worn Case topic/presentation • Subject and time of presentation is to be decided by the end of the first week Confidentiality

• Charting Statistics/recording • Review of Department/clinic organizational structure and services offered Department policies,

eg. patient scheduling, use of escorts, occupational health Department maintenance

• Safety and appearance • Security of equipment and personal belongings Safety and Emergency Procedures

• Locations of and use of phones, including phone numbers for fire, security, police and medical emergencies

• Locations of and use of fire extinguishers and exits

• Incident reporting • Blood/body fluid precautions Resources/Library/Equipment manuals Review of student’s

Portfolio • Previous experience

• Learning objectives

• Discussion of clinical teaching techniques, and methods of supervision and providing feedback

• Communication strategies for problem-solving

• Establish regular meeting times

• Tour of Department/orientation to equipment and staff.

WHEN THE STUDENT ARRlVES:

1. Orient the student to the placement, including but not limited to policies and procedures, introduction to team members, assessment and recording methods, equipment use and cleaning.

Supervising Therapist/CI Preparation

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2. Discuss with the student, the available learning experiences and schedule for the same (e.g., rounds, in-services, resource people, observations of surgery, patient education and/or treatment classes, library facilities).

3. Review the student’s Portfolio noting previous experience and discuss strengths and objectives for placement.

4. Discuss various clinical teaching and supervision methods with the student. Evaluate the amount of supervision and teaching methods frequently during the placement.

5. Establish regular times for discussion. Give feedback and address potential problems early.

6. Within a week of starling the placement, the students should present their learning objectives for discussion and approval.

7. At midterm, review the students learning objectives and modify as necessary. 8. Provide the student with a verbal and written performance evaluation at midterm and at the

end of the rotation. Students should also provided you with an ACP self-evaluation which should reviewed with you at midterm and final.

9. Value the student’s opinion and prior experience. Identify the student’s performance problems and develop and implement strategies. Keep the CCCE abreast of any issues

10. Review the students Portfolio at the end of the placement. Identify the student’s strengths and outline learning objectives for future placements.

CLINICAL TEACHING TIPS:

1. Use slow times for instruction.

2. Have students prepare ahead for clinical activities. 3. Save time by having students self-evaluate their readiness to progress with a more advanced

clinical skill. 4. Have students keep a list of questions for daily discussion.

5. Emphasize the development of basic clinical skills - e.g. assessment, handling, interviewing and communication skills, treatment skills, The Clinical instructor’s role is to assist students in applying the academic content learned to date to the clinical situation. It is not the Clinical Instructor’s responsibility to teach the students high level clinical skills which are normally acquired through years of experience and continuing postgraduate education.

6. Be a supporter - help students be successful.

7. When assessing students’ readiness to perform a skill, ask questions to assess students’ baseline knowledge observe ask students for self-assessments of their performance

8. Start with less complex patients and progress to more complex ones. Progress the caseload at a rate that is acceptable to you and the student as recommended on www.preceptor.ca

After orientation to the clinical facility, each student is expected to develop learning objectives. The objectives should be developed by both student and supervising therapist and may be changed at any

point during the placement.

Learning Objectives

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The CI should assist the student in refining the objectives and ensure that the patients and resources are available to meet them.

Each objective must be specific, measurable, acheiable, realistic, and time sensitive (SMART). The

clinical activity checklist is NOT considered the learning objective document.

An objective is defined as a clear and concise statement of what the student is expected to be able to do after instruction is completed.

The 3 domains of learning which should be considered when writing the objectives include:

1. Performance - the skill or behaviour to be learned.

2. Condition - the condition(s) under which the student must perform.

3. Standard - the minimum level of performance the student must achieve

1. The performance statement describes the exact skill or behaviour that the student must be able to perform after completion of instruction.

In order to do this effectively, a performance statement must have the following qualities:

• correct (be specific)

• complete (be detailled)

• clear (easily understood)

• contain only one action verb (the exact action or behaviour to be measured)

• have only one interpretation (i.e. means the same thing to everyone who reads it).

2. The condition statement describes the circumstance(s) under which the student is expected

to perform. With this statement, you will specify what learning resources, strategies, or support will be provided or not to the student in order to accomplish each objective. The

critieria upon which the student's performance will be evaluated and who will perform the evaluation will also be outlined.

3. The standard states the minimum performance level the student must achieve by the end of the learning. The standard provides the basis for measuring the performance to determine

if the student has met the objective.

Three basic criteria can be user to measure performance:

Quality - how well a task was done based on accuracy of the task. For example, you can indicate if the performance is expected to be error free or if some error/omission are tolerated and if so what kind

are and which ones are not (e.g., safety threats)

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Quantity- the number of times the student must perform the task. For example, you can indicate the number of back assessements that need to be performed or wheelchair transfers.

Time -Completion of a task or skill within some minimum acceptable time. For example, you can

require the students to complete documentation on daily caseload within a day for progress notes

and two days for an initial complex assessement.

STEPS TO FOLLOW WHEN DEVELOPING LEARNING OBJECTIVES:

1. Identify what you need to learn in order to successfully complete the placement. This should also be based on areas that have been identified as needing improvement.

2. Specify your learning objectives. State what you need to learn in terms of a behavioral outcome. Remember to include the three domains of learning in these objectives.

3. Specify learning resources and strategies that the student will use in order to accomplish each

objective.

4. Specify the method of evaluation. Indicate how the student's performance will be evaluated and who will perform the evaluation.

5. Specify criteria for evaluation, i.e., standard of achievement. Specify what criteria will be used to judge the accomplishment of the objectives.

6. Review your learning objectives. Review each step in developing your objectives to ensure that

they are understandable, realistic and that they describe what you want to learn.

7. To check that all the components have been considered, try breaking the objective down into the following format:

Given ... (the conditions ... the student will be able to ... (the performance) ... to the extent that ... (the standards) ... as evaluated by ... (the evaluation).

DEVELOPING OBJECTIVES:

Definition

A learning objective (or contract) is a document, drawn up by a student which specifies what the student will learn, how this will be accomplished, within what period of time, and what the criteria of evaluation will be. The objectives and their outcomes form part of the evaluation process and are taken into consideration when decisions about overall performance are being made.

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Advantages Many advantages have been cited by students and Clinical Instructors in structuring the learning environment at the outset. Several of these advantages are listed below.

1. As learning objectives are self-determined, the student becomes an active participant in the learning process. This provides motivation. Since learning is self-directed, the retention of information is enhanced through personal interest. Rewards are internal and specific to the student with the desire to learn focused towards personal and professional growth.

2. The Clinical Instructor's attention focuses on student learning and on the student's strengths and weaknesses. Learning objectives provide direction to the placement.

3. Learning objectives enable the Clinical Instructor to structure feedback directly to the student. Feedback is based upon the identified learning goals established by the student.

4. The relationship and communication between the Clinical Instructor and the student is enhanced because they have a personal agreement for learning which is discussed at the beginning of the placement.

5. Students acquire the ability to evaluate their own strengths and weaknesses, to determine their learning needs, and to learn to meet those needs.

Introduction: Every student, after a period of orientation to the clinical facility and specific placement (3-4 days), is expected to develop learning objectives. It is recommended that only 1-3 objectives be identified and focused on by the student.

Additional objectives may be developed following the mid-term evaluation incorporating the identified areas needing improvement.

The Clinical Instructor assists the student in refining the objectives, specifically to ensure the requested time commitment of the tutor is realistic. The objectives should be referred to throughout the placement, particularly at mid-term and final evaluation, by both the student and the Clinical Instructor and may be renegotiated at any point during the placement if necessary.

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Every student assumes responsibility for the learning objectives and initiative for achieving the objectives.

A. Cognitive:

1. The student will be able to list from memory the origin and insertion of the muscle groups surrounding the shoulder joint.

Standard: The student's answer is 100% correct.

2. Without assistance, the student will be able to explain to the patient why, when ambulating with crutches, it is important to avoid weight bearing through the axilla. Standard: The student gives an explanation which is appropriate to the patient's level of understanding.

3. After observing the supervising physiotherapist on two occasions, the student will be able to question the patient regarding his medical history. Standard: Student obtains a complete medical history.

4. Without assistance, the student will be able to justify his choice of electrical modality used to

treat the patient with low back pain. Standard: The student can compare the effects of electrical modalities and state why each will meet the goals of treatment.

5. Following consultation with the supervising therapist, the student will be able to organize his

clinical time so that all patients are treated on a daily basis. Standard: Student's caseload is organized so that all patients receive daily treatment.

6. Without assistance, the student will be able to summarize his assessment findings of the hemiplegic patient for the weekly team meeting.

Standard: The student covers all of the appropriate components of the hemiplegic assessment within the allotted time frame when presenting at the team meeting.

7. Given an outline of the charting guidelines of the facility, the student will be able to document his assessment findings.

Standard: The student follows the charting guidelines of the facility.

a. Psychomotor:

1. After watching the supervising therapist once, the student will be able to position the

hemiplegic patient so that the synergistic patterns are inhibited.

Standard: The student correctly positions the hemiplegic patient.

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2. Without assistance, the student will be able to mobilize the affected upper extremity of a patient with a fractured humerus in a "safe" and pain free manner.

Standard: The student demonstrates correct handling techniques.

b. Affective:

1. During the final week of his rotation (i.e., given three weeks of experience on the rotation), the

student will be able to challenge the excuses of the uncooperative patient.

Standard: The student is able to achieve the co-operation of the patient.

2. Without prompting from the supervising physiotherapist, the student will demonstrate interest by volunteering to spend some of his free time researching the literature pertinent to a particular problem.

Standard:The student volunteers the information which he has found to his supervising physiotherapist.

3. The student will be able to discuss with the patient's physician the rationale behind a treatment

technique which the student believes is contraindicated and in fact dangerous for his patient. Standard: The student demonstrates professional behaviour while communicating with the M.D. who responds in a positive manner toward the student.

Goal: To demonstrate professional behaviour.

Objectives Criteria

Demonstrates professional behaviour. ✓ Maintains confidentiality in a clinical setting

✓ Seeks advice and assistance when necessary

✓ Adheres to the Professional Code of Ethics ✓ Adheres to policies and procedures

✓ Demonstrates responsibility and reliability

Demonstrates self directed learning

✓ Performs accurate self evaluation ✓ Gives and receives constructive feedback

✓ Initiates interaction with supervisor

✓ Identifies and responds to learning needs

✓ Selects appropriate teaching resources

Examples of Student Clinical Objectives

1. Professional Behaviour

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Goal: To demonstrate personal and patient safety

Objectives Criteria

Identifies safety risks

✓ Describes safety risks clearly and concisely

✓ Incorporates safety precautions

✓ Complies with facility safety policies in the work place policies and procedures ✓ Demonstrates proper body mechanics

✓ Practices electro-mechanical safety

✓ Practices infection control

✓ Aware of workplace hazardous materials handling procedures

Intervenes in an unsafe situation

✓ Reacts to unsafe situations ✓ Completes incident reports clearly and concisely

✓ Recommends ways to reduce safety risks

Goal: To gather clinical data related to the patient's condition

Objectives Criteria

Obtains data from patient's health ✓ Collects relevant and accurate data within a reasonable time frame

✓ Obtains subjective data from the chart ✓ Chooses the proper environment in patient and/or family interview which to conduct the interview

✓ Collects relevant and accurate data within a reasonable time frame

Chooses patient evaluation ✓ Chooses procedures that are based on the patient’s diagnosis, age, personality

and disability Performs the physical examination

✓ Performs procedures safely accurately and in an organized manner

✓ Considers the patient's comfort and dignity

2. Safety

3. Patient Evaluation

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Goal: To interpret evaluation findings and plan a treatment program

Objectives Criteria:

Determines the underlying pathology

✓ Relates the theory and its relevance to the evaluation findings

✓ Determines if physiotherapy intervention is indicated

Identifies the patient's problems

✓ Generates a complete problem list in order of priority

✓ Supports the problem list with subjective and objective data

Establishes short and long term goals ✓ Establishes goals that are realistic, measurable and achievable within a predetermined time

period ✓ Bases goals on the problem list

✓ Considers the patient's goals and family situation

Selects a treatment plan ✓ Bases the treatment plan on patient goals, background knowledge and the literature

✓ Considers the indications and contra-indications ✓ Selects the sequence, duration and frequency of treatment

✓ Chooses procedures based on the underlying pathology and the patient’s status

✓ Identifies the need for intervention by other members of the health care team ✓ Prepares a discharge plan

✓ Designs a discharge plan that meet the patient’s needs

Goal: To implement the treatment program accurately and effectively

Objectives Criteria:

Explains the treatment plan to the patient ✓ Explains the indications and contra-patient indications of treatment

✓ Obtains the patient's consent

✓ Gives clear instructions based on the patient's cognitive level

4. Interpretation & Program Planning

5. Program Implementation

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Carries out the treatment plan ✓ Selects the space and equipment required to do the treatment

✓ Selects the sequence, duration and frequency of treatment

✓ Chooses procedures based on the patient's ability, age, diagnosis and personality

✓ Applies the treatment safely and accurately

Goal: To determine the effectiveness of the treatment

Objectives Criteria:

Evaluates the treatment

✓ Observes changes in the patient's status

✓ Compares the treatment outcome with the patient's goals

✓ Evaluates the progress of the treatment

Progresses or modifies treatment ✓ Progresses or modifies the treatment according to the patient's status and accounts

for the changes made ✓ Modifies treatment goals according to the patient's progress

✓ Stops the treatment when warranted

Prepares the discharge plan

✓ Writes a discharge plan for the patient ✓ Communicates the discharge plan to all concerned

Goal: To demonstrate effective communication skills

Objectives Criteria:

Communicates with the patient ✓ Observes and interprets non-verbal messages

✓ Uses effective interviewing techniques ✓ Listens to patient and family concerns

Establishes a therapeutic relationship ✓ Motivates and encourages the patient with the patient-Demonstrates empathy and concern

✓ Gains the patient's trust and cooperation

6. Program Evaluation

7. Communication

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Communicates with the health care ✓ Participates in conferences and team rounds

✓ Exchanges relevant information with team members

✓ Refers patients to other team members

Establishes a therapeutic relationship ✓ Motivates and encourages the patient

✓ Demonstrates empathy and concern

✓ Gains the patient's trust and cooperation with the patient

Establishes professional relationships ✓ Offers support and assistance to co-workers in the workplace

✓ Demonstrates collaborative behaviour

Goal: To complete all documentation

Objectives Criteria: Records the patient's assessment

✓ Follows the facility and school and discharge plan charting guidelines

✓ Records clearly and legibly ✓ Records statistics daily

✓ Follows the physiotherapy workload measurement system ✓ Follows facility statistics guidelines

✓ Corresponds with the health care team

✓ Provides relevant documentation to team members ✓ Sends progress reports and discharge summaries to the referring physician

Purpose:

To give the student assistance in developing skills in the presentation of clinical and theoretical material.

No numerical value is placed on the presentation, however, the Student Presentation Evaluation Form could be completed and given to the student for constructive feedback following each presentation.

Objective:

8. Documentation

Guidelines for Student Presentation

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1. To provide experience in the verbal presentation of information in a clear and concise manner.

2. To effectively use audio-visual aids, treatment technique demonstrations, etc., to enhance

the presentation.

3. To demonstrate the information-gathering and decision-making process that is an integral

part of physiotherapy intervention.

4. To integrate the presentation with a wider knowledge of the involved condition.

5. To stimulate and participate in discussion of the physiotherapy treatment approach.

Format for Case Presentation:

1. Condition/Topic Introduction Brief summary of condition to be discussed.

2. History Includes patient's age, sex, occupation, residence, presenting problem(s), history of present problem, relevant social history, activity level, past medical history including any previous physiotherapy intervention.

3. Medical Treatment

Medications - note present medications. 4. Tests

Include any relevant tests and results, ex. X-ray, C.T. scan. 5. Assessment

Detailed and concise, applicable to presenting problem(s).

6. Analysis i.e., impression and problem list. Problem list must develop from the information gathered during the history and assessment.

7. Physiotherapy Intervention Include long and short term goals

Management should relate to the problem list. Include any activities which require co-ordination with other health care team members.

8. Progress and Modification

Include patient response, education of care-givers, home exercise programs and discharge planning (as applicable).

9. Question Period Topic Presentation:

-Topic chosen should be of clinical relevance to the practice of physiotherapy. -Students should choose a topic that is relevant to the rotation they are on and their caseload.

-Presentation should include the application of Physiotherapy treatment to the condition.

-Time should be allotted for questions at the end of the presentation.

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Format Variations:

The emphasis which is placed on a specific portion of the case presentation and the timing of the presentation may vary between institutions and rotations. The student may choose to do a topic presentation instead of a case presentation. It is recommended that the student gain experience in presenting both types of format. The time frame will be determined by the specific institution, normally ranging from 15 to 30 minutes.

Evaluation:

No numerical value is placed on the presentation, however, the student Presentation Evaluation Form could be completed and given to the student for constructive feedback following each presentation.

PROVIDING CONSTRUCTIVE FEEDBACK:

Feedback is most useful when it is:

1. Specific - provide examples

2. Positive 3. Useful – Comments that can be acted upon in a realistic time frame.

4. Feedback should be directed towards behaviour you can do something about.

5. Supportive

6. Given privately

7. Based on first-hand information and is clear on the facts 8. Fair

9. Honest

10. Immediate - this makes the feedback more meaningful and relevant to the situation

11. Focused on behaviour - be descriptive when providing feedback e.g. “Keep your back straight and your knees bent when lifting a patient” vs. “That was lousy lift”

Feedback is least useful when it is:

1. Global - general, non-specific feedback usually raises people’s defenses and is of very 2. little use

3. Negative - with no ideas for changing the behaviour

4. Impossible to change the situation 5. Judgmenta

6. Given in front of Others

7. Hearsay or speculative

Receiving and Giving Feedback

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8. Based on only one incident 9. Used to protect feelings or egos

10. Delayed

11. A personality attack

PRACTICAL TIPS:

Timing:

The receiver should be ready for feedback otherwise it is subject to misinterpretation.

e.g. don’t start criticizing on the first day. Take some time to get to know the person. Establish that trusting relationship first.

Amount:

Never give too much feedback since it is impossible to think and act about how one can alter behaviour if one is given too many facts to consider. e.g. Ask the student if you are overloading them with feedback or information. If necessary, have the student make a list of things requiring action and assist the student in prioritizing those essential elements in need of immediate remedy.

Paraphrase:

Always give the receiver of the feedback an opportunity to paraphrase or comment on the feedback in order to ensure they understood the purpose of your statement(s). This ensures that both parties agree with the terms of the feedback.

Ask:

Ask the student if they want feedback and encourage them to ask for it they feel they require guidance. e.g. Student to clinical instructor: “I thought I did that subjective assessment rather well for my second

time but still feel I am having difficulty keeping the patient on track...do you have any ideas? SHARING Invite the student to share reactions to your feedback so you can determine whether the information is helpful to the student. Use the feedback from the student to enhance the specific learning relationship.

ENCOURAGING PROBLEM SOLVING ACTIVITIES BY THE STUDENT:

In certain situations, a student may exhibit difficulty in attempting to resolve a clinical problem. The

clinical instructor can be a great help in aiding the student to identify more solid clinical reasoning skills.

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A typical problem-solving model usually encompasses the following steps: 1. I = identify the problem What is the nature of the patients complaint?

2. D = Define and represent the problem What questions need to be asked to more

a. specifically to identify the problem?

3. E = Explore possible strategies Once the problem is represented as a ‘clinical diagnosis

or problem’, what tools are within the physical therapist’s arsenal to remedy the problem?

4. A = Act on the strategies. Implement a treatment protocol based on planned short and

long term goals. These goals must be realistic and based upon the history of the disease process, the normal physiological healing times and the therapeutic benefits of the

physical therapy interventions. 5. L = Look back and evaluate the effects of your activities Reassess the problem and

re-define it at regular intervals. Adjust the treatment approach if short term goals are not being realized.

(Ref: Bransford, JD, Stein, BS. The ldeal Problem Solver. New York. WH Freeman Co., 11 - 32, 1984)

The following profile can also be used to demonstrate the differences between problem solving and non-problem solving behaviours and can be used to assist the student in structuring their approach to clinical problem resolution.

PROBLEM SOLVER / NON-PROBLEM SOLVER

PROBLEM PRESENTED:

Recognized problem immediately/ Not recognized as a problem

PROBLEM DEFINED: Translates, interprets data Told a problem exists Establishes scope of problem/

Difficulty seeing scope of problem

Disregards data or judges that it is unimportant

PROBLEM ANALYZED: Breaks down problem into small components Judges problem before collecting

Determines relationship between components data Determines desired outcomes

Feels receptive and open/ Closed to new relationships Feels closed and defenseless

DATA COLLECTED:

Identifies specific data needed Identifies data needed in general

Selects methods to collect data terms Uses effective collection techniques Looks to standard methods, little (e.g. evaluation techniques)

selection involved

Uses creative abilities/

May or may not be effective in performing techniques Little creativity or originality

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SOLUTION DEVELOPED:

Develops solution based on data/

Disregards data collected and problem components Looks toward “textbook” solutions

Identifies solutions general and nonspecific

SOLUTION IMPLEMENTED:

Applies solution effectively Solution implemented correctly/

Able to modify and adapt solutions but little modification is made to new data. Unable to make direct connection between solution and problem

OUTCOME RE-EVALUATED:

Relates actual outcome to desired outcome/

Unable to relate actual outcome to desired outcome

Must be told what aspects have been solved and which need further work.

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TROUBLESHOOTERS’ GUIDE TO TUTORING STUDENTS

Positive tutoring requires on-going analysis. The following guidelines, although not inclusive, may provide insight into some common problems, their causes and possible strategies for management. Professional behaviour Problems Strategy Punctuality Home situation Draw out possible Other course/commitments reasons for lateness. Lacks organizational skills Contract arrangements, Working hours not clarificed at be flexible if possible. Outset Use direct, open questions to address the problem, eg. “is there a problem with a 0900 hour start time?

Inappropriate Behaviour Masking lack of confidence or Immediate feedback, be over-confidence direct, e.g. “Mr. Jones Imitating tutor or previous role seemed ill at ease during model the treatment. Did you notice this too? Sets a good example of professionalism. Clinical Management Shyness, lacks self-esteeem Display enthusiasm for Lack of initiative subject. Student intimidated by supervising Discuss supervisory style therapist, environment at outset Difficulty transplanting theoretical Define expectations to practical applications clearly Uncomfortable with criticism Give positive feedback to Desired behavior Be direct, e.g. “Do you Find the ICU intimidating? Can we discuss some solutions?

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Professional behaviour Problems Strategy Unsafe with patients Overconfident Give immediate feedback Nervousness Offer further Poor awareness of the opportunities for the Seriousness of safety issues student to demonstrate Lack of insight, critical safe applications. Analysis and judgement Encourage self-evaluation e.g. “How did you feel about the transfer with Mr. Jones?” Intervene to Prevent incidents, Increase supervision. Be sure students fills in incident reports and required documentation. Notify University Lack of Preparation Other obligations, school, Discuss openly, ask family, social, health, questions to determine Material not covered in knowledge base Curriculum Set realistic expectations Lack of interest in subject Attend Clinical Education workshop Read course outlines Display enthusiasm for subject Student Runs Overtime Unrealistic expectations of Appropriate caseloads student Review objectives Poor organizational skills, e.g. Stress “gate keeping” unable to control interview skills, systematic approach Inadequate Problem- Poor theoretical background Assessment/treatment Solving Skills Inexperience at problem-solving Confirm appropriate e.g. zeros in without defining the knowledge base boundaries Allow plenty of opportunity to practice problem-solving Break problems into small steps

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Professional behaviour Problems Strategy

Student Evaluation

Difficulty evaluating the student objectively

Not enough observational time by tutor Tutor taking over, therefore not allowing student participation

Multiple observations in repeated settings Increase observational time Support from administration to allow observational time Allow student to perform skills Avoid intervening Use multiple raters define expectations clearly

Poor Clinical Skills Difficulty integrating theoretical to practical skills previous placement inadequate to prepare student lack of experience, e.g. missed placement

Demonstrate and observe review previous clinical experience break down objectives into achievable components

Defensive Behavioiur by student Lack of Knowledge False confidence

Difficulty accepting responsibility for actions intimidation by supervising Therapist Mark oriented

Assess student’s knowledge base Encourse self-evaluation, e.g. “How did you feel about…? Integrate self-evaluation into plan for new strategies Immediate specific feedback Clarify expectations mutally Avoid threatening situations Give encouragement and positive feedback

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Professional behaviour Problems Strategy

Student wanting to be “spoon fed”

Poor theoretical or practical knowledge Laziness, poor preparation, manipulator Feels tutor is expert Does not want to reveal weakness

Request preparation and presentations in non- threatening manner Clearly define your expectations of student and your teaching style Tutor should not “flaunt” his/her experience

Personality Conflict

Conflict in learning/ Teaching styles Differences in Confidence levels Between supervising therapist/student Prejudice; Poor communication

Define conflict causing situation (e.g. I feel uncomfortable when you interrupt me in the middle of a treatment session) Contract Objectives Review objectives frequently Involve CCCE &ACCE

Resent placement

Preference for another facility or geographic location Low interest level in subject area Negative expectations Via “grapevine”

Encourage mature students Stress positive aspects of experience Integrate these benefits into objective setting process initiate open dialogue concerning reality of situation (ongoing.

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CLINICAL EDUCATION AWARD:

Intent: To recognize a facility or an individual physiotherapist within the Atlantic Provinces who

demonstrates excellence in, or makes an outstanding contribution to, the clinical education of students

over an extended period of time.

This award may be given on an annual basis. Criteria could include:

1. The development, implementation, and evaluation of an innovative supervision model.

2. The design and implementation of student in-services/teaching sessions

3. Consistent acceptance of more than the recommended minimum number of students per

year (2 per therapist)

4. A high level of student satisfaction based on evaluation information from the Clinical

Placement Feedback Form.

5. The recognition of leadership abilities in the area of clinical education.

6. Nominations may be submitted by students, Clinical Supervisors, Facility Coordinators, Provincial Coordinators or the Academic Clinical Coordinator.

7. The responsibility for the selection of the award will be with the Clinical Education Committee and the ACCE.

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SECTION III – Dalhousie, Faculty of Health, Placement Policies Refer Dalhousie Faculty of Health student policies and procedures

IMMUNIZATION REQUIREMENTS:

The clinical and placement requirements are detailed in the School’s Supplementary Application form, and applicants must sign a Statement of Compliance in regard to these requirements. One of the requirements, upon being granted admission, is pre- placement immunization as indicated in the School of Physiotherapy “Occupational Health and Infectious Diseases: Preclinical Placement Requirements for Health Care Worker Students”. (Appendix D) To ensure safety and the safety of the individuals who will be entrusted to their care, physiotherapy students must maintain immunity against vaccine-preventable diseases. Before commencing your clinical placement, all students must provide evidence of immunization for:

• Diphtheria-tetanus • Measles (Rubeola) • Mumps (2 doses of vaccine) • Rubella • Hepatitis B • Varicella, and • Tuberculosis skin test

When you begin your program, you will be asked to provide serology information for

• Immune status for Hepatitis B • Measles (Rubeola) • Rubella • Varicella-Zoster

All Year I students are required to have a 2 step Mantoux test for tuberculosis administered in the fall prior to clinical visits and placements. We understand it is difficult to obtain this immunization and testing in your home community, so TB and HEP B testing and immunization may be arranged through Dalhousie University. Students, who have previously had a 2-step test, are required to obtain a current 1-step-test.

RISK MANAGEMENT – Student Health and Security on Placements

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CPR:

Students are required to show evidence of a current/non expired Standard First Aid/CPR Level C Certificate before entering the first Clinical Placement. Students are required to keep it valid throughout the programme. Students should be prepared to show a copy of the current certification to clinical sites. Proof of re-certification must also be provided to the School and the Clinical Placement Facility.

CRIMINAL RECORDS CHECK:

Upon admission, students are required to submit a criminal records check, including a Vulnerable Sector Survey. Some health authorities may require an additional criminal records check for a placement in one of their facilities. In addition, some provincial regulatory bodies may require a satisfactory record check as a condition of professional licensure. It is the student’s responsibility to have such procedures completed. Multiple checks may be required throughout the program, and all costs associated with obtaining the checks will be borne by the student. Because many placement sites will require a check that is less than one year old, it is best to wait until at least July before obtaining one. All students are required to have a new criminal record check completed for second year and at the request of a clinical site.

UNCLEAR OR FAILED Dalhousie University’s Faculty of Health does not require Criminal Record Checks or other screening procedures (e.g., Vulnerable Sector Screen) as a condition of admission into its program. However, students should be aware that practicum sites/facilities often require such checks and may not accept students with unclear criminal record checks, criminal records, or who have failed vulnerable sector searches or child abuse registry searches. Students who are unable to complete a practicum placement due to failure to meet the record check or screening requirements of the site/facility on the basis of the information provided, may fail the practicum placement, and as a result, may not be eligible for the progression through the program or graduation of the program.

It is the responsibility of each student to maintain their health records and to take a copy to the institution where they will complete their placements. Placements will be cancelled if the student does not produce the documentation by the dates requested by the program. Failure to produce proof of immunization may delay or prevent you from graduating from your program.

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PLACEMENT WAIVERS/STUDENT ACKNOWLEDGEMENT FORM: School of Physiotherapy signs and affiliation agreement with each practicum placement site/facility outlining the roles and responsibilities for both parties. Prior to starting a practicum placement, each student will be required to read and sign a Student Acknowledgement form. The document describes the student’s responsibilities during the placement and other important information. Students will arrange to meet with the Clinical Education Assistant to sign the Student Acknowledgement Form prior to the commencement of EACH practicum placement.

DSU HEALTH COVERAGE:

The DSU Health Coverage covers emergency medical services up to $10,000.00 for 60 consecutive days and extended health coverage up to $5,000. It does not cover the long- term effects of blood borne diseases. Therefore, concerned students may wish to take out extended health insurance while on clinical placement. Students who opt out of the DSU Health Insurance plan must have alternative coverage.

INSURANCE COVERAGE:

The University carries insurance which provides for liability coverage for third party personal injury and property damage which has been caused by University employees in the course of their employment at the University or by students registered at Dalhousie University in respect of any activity related to the discipline in which they are registered, in furtherance of their education or training in such discipline, whether conducted on or off campus. This insurance coverage provides for a limited liability of $20,000.00 and is subject to certain stated exceptions therein.

The University also carries insurance, which provides coverage for any error or omission in the rendering or failure to render professional services to a third party. The insurance policy covers employees of Dalhousie University acting in the course of their employment and also covers any person while registered as a student at Dalhousie University in respect of any activity to the discipline in which the student is so registered in the furtherance of his or her education or training in such discipline whether conducted on or off campus. The limit of liability under this insurance policy is $18,000.00 and the policy contains stated exceptions therein. Further information relating to the above noted insurance can be provided on request.

In several provinces, students on clinical or fieldwork placements are covered by provincial workers’ compensation legislation. In general, workers’ compensation law says that if an individual is unable to work because of a workplace accident, that person will receive money to compensate him or her for lost income. For students in universities in other provinces, this

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means that if they become disabled while they’re on a clinical/fieldwork placement, and are permanently prevented from working in the area that they’re training for, the workers’ compensation scheme will provide them with money calculated based on an assessment of how much they would have otherwise made in the profession. Unfortunately, this is not the case for Nova Scotia university students who go on placement, outside Ontario, BC, NB. Because of this, the University advises students to obtain disability insurance. The purpose of disability insurance is to provide a sum of money to a student in case they become disabled as a result of an accident that happens while they are on a placement. This insurance may be in the form of a calculation of lost future income or it may involve a one-time lump sum payment. You should make the decision of how much insurance you purchase and how it will be calculated in consultation with your insurance company/broker. The cost of such insurance would be the responsibility of the student and must be secured in advance of the start of the rotation. In some situations some sites may ask for proof of such insurance before accepting a student at their site. Dalhousie University submitted purchasing documents to purchase Accidental Death and Dismemberment (AD&D) and Permanent Total Disability (PTD) insurance coverage for our students in clinical placements in New Brunswick, British Columbia, Alberta and Ontario. This insurance will be provided by a private third party carrier and will be effective September 1, 2012. Coverage is for accidents that occur while students are on clinical placements.

INSURANCE RE: TRAVEL DURING PLACEMENTS: Disability Insurance: Dalhousie has purchased occupational accident coverage for all students in all faculties that participate in unpaid placements, except placements in those provinces that have mandatory workers compensation coverage. We have tried to align this coverage with worker’s compensation coverage as closely as possible. If a student is injured while participating in an unpaid placement, the student should follow the normal placement site protocol but also contact their Academic Coordinator of Clinical Education at the earliest opportunity so the insurer can be notified. Students still need to maintain their DSU Health Insurance or equivalent health plan coverage, as the disability insurance does not include health insurance. Please note: The occupational disability insurance coverage does not apply to international placements. Students Travelling in Vehicles during Practicum:

Students or clinical educators who use their own vehicle while travelling to or from a clinical education activity or event should be aware that there is no automobile coverage provided

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under Dalhousie’s automobile policy. If a clinical educator or student were driving a student or clinical educator somewhere while on a clinical placement, the d river’s automobile insurance policy would be the policy that would respond to an accident claim. They should notify their broker/insurer to make sure they have adequate coverage. Dalhousie University recommends that anyone using their own vehicle for University business/study carry a minimum liability of $2 million on their automobile policy. It should be noted that the occupational disability insurance would not apply if a student was injured while commuting to or from his or her clinical placement. The occupational disability insurance would only apply in a motor vehicle accident where the student was travelling as part of their clinical placement experience.

INSURANCE FOR VOLUNTEER ACTIVITIES: School of Physiotherapy’s Insurance covers volunteers while performing volunteer duties as assigned in clinical/professional activities during a clinical placement, provided that the volunteer is under the supervision of the Clinical Instructor (or supervising therapist). Volunteers are NOT automatically covered by the School’s Insurance for volunteer activities at other times during the MScPT program. This means that if a student decided to volunteer at an event, or acts as a volunteer with a team, the student does not automatically have insurance coverage provided by the School of Physiotherapy. The School will only approve activities which are relevant to the profession of Physiotherapy and which are carried out under the supervision of a licensed physiotherapist who is supervising the volunteer student on placement and is willing to take overall responsibility for the volunteer. The types of events which may be approved include:

• Volunteering in the medical or treatment tents at community sporting events • Volunteering with a sports team

Activities where the volunteer is being paid will not be covered. Shadowing physiotherapists in the community will also not be covered.

SUPERVISION:

As the CI is ultimately responsible for the patient client, it is the full responsibility of the CI (or appropriate designate) to be readily available to the student during placement working hours. Communication by telephone or pager is acceptable in a large institution. The CI should not be off site without appointing an appropriate designate.

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The Faculty of Health places a high value on the personal safety of students in the Faculty. All safety issues warrant attention and action. The following guidelines are designed to provide guidance to students, faculty and clinical sites regarding student safety issues. For the purposes of these policies, being "at risk" refers to risk related to personal safety and is not applicable to students who are "at risk" of failing their clinical experience because of a lack of knowledge, attitudes and/or skills. The following guidelines apply on the University campus and in all clinical related activities including traveling safely to and from sites. Faculty, agency fieldwork instructors/clinical educators and students are all expected to share responsibility for assuring safe teaching/learning environments. Each School/ College is responsible for:

1. having procedures for educating students to manage "at risk" situations. These procedures will emphasize the safety knowledge of students to be acquired in the academic setting prior to embarking on clinical experiences. These procedures will try to ensure that students are fully informed of any reasonable risk situations prior to the placement. In addition, each clinical site will agree to be responsible for orienting students to site-specific risks and safety procedures which will be part of the students' initial orientation.

2. having procedures to deal with risk situations if they occur. Possible outcomes could

include either the student remaining at the present placement or the student moving to an alternate clinical site. In cases where students may need to change placements, reasonable and timely effort will be made to arrange an alternate clinical placement for the student. Every effort will be made to enable the student to complete the necessary placement in a timely fashion.

If an "at risk" situation has occurred, the School/College will follow up with the agency after the immediate matter has been resolved to assist with remedial measures for future planning.

March 20, 1996 Approved by Faculty Council, April, 1996

Guidelines for Personal Safety in Clinical Placements

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Students who perceive their safety is "at risk" in a clinical placement are encouraged to seek immediate guidance regarding this situation from one of the individuals below. Academic/Faculty Advisor Advisor to Students with Disabilities, Dalhousie University Black Student Advisor, Dalhousie University Employment Equity Office, Dalhousie University Native Student Counselor, Dalhousie University Ombudsperson, Dalhousie University Sexual Harassment Officer, Dalhousie University

March 20, 1996

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Medical Conditions and Prior Disclosure:

1. Policy

The following policy was ratified by Faculty Council in the Faculty of Health in May 1995.

Students registered in this Faculty are encouraged to inform both the School/College and the clinical learning sites if they have a health concern that has the potential to compromise client, student, and/or agency personnel safety. For the purpose of this policy, the term health concern refers to any cognitive, affective, and/or physical health problem, injury, or condition that may place the student and/or others at risk and/or inhibit the student's learning ability and performance.

GUIDELINES FOR DISCLOSURE OF HEALTH INFORMATION

1. The student has the right to decide if disclosure of health information is appropriate. The method, timing and extent of the disclosure is at the student's discretion (for consultation options, see below). Early disclosure of the following information regarding the health concern may be helpful to the students in the academic and/or clinical sites. To disclose this information:

• clearly describe the nature of the health concern and the potential limitations with regard to the learning tasks expected in either the academic or clinical site. Appropriate verification of the information may be required.

• list any adaptations, modifications and/or safety procedures that may be required in planning the student's learning experiences in either setting.

• provide clear and appropriate advice regarding the management of this health concern. 2. If the disclosure of health information in clinical and/or academic site produces difficulties, students are encouraged to report these difficulties immediately to the appropriate person(s) within both the clinical site and/or within their educational program. Discrimination in any form will not be tolerated.

Students are advised to make the initial contact with the person with whom they are most comfortable from the lists below. These individuals would be available for consultation/advocacy.

• Academic/Faculty Advisor • School Clinical Coordinator/ACCE • Director of the School • Dean of the Faculty of Health • Advisor to Students with Disabilities, Dalhousie University

Policy Regarding Student Disclosure of Health Information

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• Dalhousie/King's Association of Students with Disabilities • Human Rights Commission • Preceptor • Clinical Site Director • Provincial Clinical Coordinator

March 20, 1996

jj Student access to patient and client information is a privilege, not a right. Hence, one of the most basic, yet important, part of Clinical (and therefore student) performance involves the issue of client/patient privacy and confidentiality. Adherence to appropriate policies and procedures related to patient’s privacy and confidentiality is an essential element of professionalism, and hence a graduation requirement: violation or breach of privacy/confidentiality policies and guidelines will be taken extremely seriously and will result in disciplinary action – like immediate dismissal from the placement, legal action by the placement site and others, and possible expulsion from the Dalhousie University’s School of Physiotherapy.

Use of Technology: The capacity to record, store and transmit information in electronic format brings new responsibilities to those working in healthcare with respect to privacy of patient information. Significant educational benefits can be derived from this technology but students must be aware of potential problems and liabilities associated with its use. Material that identifies patients, institutions, health care providers, or colleagues and is intentionally or unintentionally placed in the public domain may constitute a breach of standards of professionalism and confidentiality. Respect of patient information extends to the use of the internet at any time – whether in a private or public forum. Use of the internet includes posting on blogs and public media sites, mailing lists, video sites, electronic networks, instant messaging (IM) sites and e-mail. Clinical Educators and students, at the beginning of a placement, are expected to discuss the appropriate use of cell phones, computers, internet, and networking sites and review related site policies. Students should NEVER post anything about patients, the site or Clinical Educators. Cellphones and Social Media: Students are expected to follow the Dalhousie University Faculty of Health Guidelines for the Student Use of Social Media and Electronic Communication in Practice Education Settings during

Patient Privacy and Confidentiality

Use of Social Media & Electronic Communication

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all practicum placements. Students are expected to review the document prior to beginning each practicum placement.

Appropriate use of cellphones and social media forms part of the professional behaviour requirements for graduation. Students found violating these policies will be subject to discipline.

1. Wear appropriate uniform including name tag. Makeup and jewelry must be discreet, maintaining a professional appearance.

2. Be prompt for lectures, in-services, rounds and other appointments/ activities.

3. Ensure that the supervising therapist/CI is always aware of your activities and

whereabouts while at the placement.

4. If you are ill and unable to attend your placement, call the Physiotherapy Department before your usual arrival time, and inform them of the patients for whom you are responsible.

5. All information regarding patients is strictly confidential. Each student must read and

conform to each hospital's policy regarding confidentiality.

6. Do not remove any records or patient information from the facility. Permission must be sought when borrowing reference material.

7. Address patients and hospital staff by their surname unless requested to do otherwise.

CLINICAL SUPERVISION BY A RELATIVE: Students of the Dalhousie School of Physiotherapy may not be supervised in any clinical placement by a relative. A relative is defined as any family member including those through marriage - parents, siblings, spouse, in-laws, aunts, uncles and first cousins. Rationale: To avoid a conflict of interest and potential bias by the supervising physiotherapist/CI in the evaluation process.

Conduct Guidelines for Clinical Practice

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PROFESSIONAL BEHAVIOUR POLICIES: https://cdn.dal.ca/content/dam/dalhousie/pdf/healthprofessions/Current%20Students%20-%20Policies%20and%20Procedures/Suspension%20or%20Dismissal%20due%20to%20Professional%20Unsuitability%20March%202018.pdf Guidelines for Professional Conduct: Everyone at Dalhousie is expected to treat others with dignity and respect. The Code of Student Conduct allows Dalhousie to take disciplinary action if students don’t follow this community expectation. When appropriate, violations of the code can be resolved in a reasonable and informal manner. If an informal resolution can’t be reached, or would be inappropriate, procedures exist for formal dispute resolution. Dalhousie recognizes its students as independent adults and the Code exists to maintain a minimum standard of behaviour that’s deemed acceptable by our community. The Code is very broad and encompasses many types of behaviour. Students who are submitting a complaint or who have had a complaint made against them should be aware of their rights and responsibilities. Students are also responsible for following all civil and criminal laws in Nova Scotia, violations of which are explicitly violations of the code and can also result in penalty from Dalhousie University. Additional information related to the Code of Student Conduct can be found at: https://cdn.dal.ca/content/dam/dalhousie/pdf/dept/university_secretariat/policy-repository/CodeofStudentConduct-SenateApproved2018-05-22(inclNov27-17amndmts).pdf The following are some of the offences found in the Code of Student Conduct:

• Offences against persons (e.g. assault, sexual harassment, threats, endangering health and safety, discrimination, intimidation)

• Offences involving property (e.g. theft, misuse, damage) • Unauthorized use of university facilities, equipment or services • Alcohol and drug use (i.e. not abiding by Campus Alcohol Policies or the use, possession

and/or sale of drugs)

Unprofessional Conduct: Students in the Dalhousie School of Physiotherapy who violate any of the above guidelines will face disciplinary action which may include withdrawal from the program. Students may also be

Clinical Educators/Instructors are also required to abide by these standards.

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required to withdraw from the program when ethical, medical, or other reasons interfere with satisfactory practice in their respective disciplines. Such decisions are made by the Department Head, who will collect relevant information from the student and the source(s) of complaint(s) before initiating remedial activities or requesting withdrawal from the program. Students who feel they have experienced harassment or unfair treatment during the clinical education portion of the MScPT program should contact the ACCE. If students feel their concern is not adequately addressed by the ACCE they are encouraged to contact the Department Head and to familiarize themselves with the Faculty of Health equity policies.

The Faculty of Health, acting through its Committees on Studies at the School/College and Faculty levels, and in consultation with the Directors and Dean, may suspend or terminate a student from a programme if the student is judged to be unsuitable for the profession in which s/he is studying. Because of the nature of the study and practice of the various health professions, which places care givers in a position of special trust, certain impairments or some types of conduct unbecoming to a member of a health profession may be grounds for suspension or dismissal. The following list includes examples of behaviours that might indicate unsuitability for the various health professions. The nature of these behaviours is such that, should any of them ever be repeated, grievous harm could be caused to clients. This list should not be considered to be all inclusive:

1. a criminal act (e.g., assault, sexual assault, fraud, and drug trafficking) which according to established Faculty processes was determined to be of such a nature as to bring disrepute to the profession, or by which in the opinion of the Faculty, the student demonstrated poor judgment, lack of integrity or (other) unsuitability for the profession; or evidence that, on the balance of probability, the student had committed such an act;

2. being under the influence of alcohol or drugs while participating in client care, any other professional activity, or any activity related to the practice of the health profession;

3. in accordance with provisions of the Nova Scotia Human Rights Act, the occurrence of a health condition that impairs essential performance required for the health profession;

4. unethical behaviour as specified by the code of ethics/standard of practice of the health profession.

Suspension or Dismissal from a Programme on the Grounds of Professional Unsuitability

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The students situation will be considered with discretion throughout the investigation of the allegation of unsuitability and these deliberations shall determine whether suspension, dismissal or neither is recommended. The principles of natural justice and due process will be observed in all investigations. Any member of the University community can bring to the attention of the Director behaviours that are deemed unsuitable. These behaviours will be investigated and allegations heard. Appeals will follow the appeal procedure for academic matters within the Faculty of Health Professions notwithstanding that the criteria are different. At the University level, appeals will require formation of an ad hoc Senate Committee.

Bullying and Harassment:

Dalhousie University is an inclusive and respectful community, and therefore bullying and harassment is not tolerated. Bullying behaviour may be treated as a violation of the Code of Student Conduct or Hazing Policy, as deemed appropriate. Taken from the Report of the Nova Scotia Task Force on Bullying and Cyberbullying, the university defines bullying as, “a repeated behaviour that is intended to cause, or should be known to cause, fear, intimidation, humiliation, distress or other forms of harm to another person’s body, feelings, self-esteem, reputation or property.” Bullying can be direct or indirect and can take place by written, verbal, physical or electronic means, or any other form of expression. Cyberbullying (also referred to as electronic bullying) is a form of bullying that occurs through the use of technology. This can include the use of a computer or other electronic devices, social networks, text messaging, instant messaging, websites, email or other electronic means. A person participates in bullying if he or she directly carries out the behaviour or assists or encourages the behaviour in any way. If you need help: There are many resources available on campus to assist you if you find yourself being bullied or harassed. If you live in residence, you can speak with your RA or Residence Life Manager. All students can contact Human Rights and Equity Services or social.worker@dal.ca. In an emergency, contact Dalhousie Security at 902-494-4109. Discrimination and Harassment in Placements: As per Dalhousie University’s Statement on Prohibited Discrimination and Personal Harassment Policy, the University is committed to safeguarding its students against all forms of prohibited

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discrimination and harassment in the course of work or study or participation in University-sponsored organizations, activities, and programs, including during practicum placements. The University operates in accordance with the Nova Scotia Human Rights Act which prohibits discrimination based on a number of grounds or characteristics including, but not limited to, age, race, sex, colour, religion, physical or mental disability, sexual orientation, gender identity or expression, and ethnic, national or indigenous origin. The University’s Personal Harassment Policy prohibits harassment including, but not limited to, abusive or demeaning treatment that is unwelcome, unwanted, intimidating, hostile, and/or threatening (e.g., name calling, insults, inappropriate jokes, threats, shouting, derogatory remarks, spreading malicious rumours). Please see the Statement of Prohibited Discrimination or Personal Harassment Policy for detailed information. Information for Students: When discrimination or harassment occurs while a student is completing a practicum placement, the University has a responsibility to ensure the issue is addressed. If a student is experiencing discrimination or harassment within a practicum placement, it is important that they seek help. The University cannot provide support if they are not aware of the issue. If the student feels comfortable and safe doing so, they are certainly welcome to address the issue directly (e.g., tell the person directly such behaviour is inappropriate or unwanted) within the practicum setting. The student is also encouraged to discuss the issue with their clinical educator, as practicum placement organizations and agencies often have their own policies and procedures in place for dealing with issues of discrimination and harassment. Furthermore, students are encouraged to reach out to their School’s Academic Coordinator of Clinical Education, the University’s Human Rights & Equity Services or Student Health & Wellness Centre, the University Ombudsperson, or Good 2 Talk Post-Secondary Student helpline (1-833-292-3698; available 24/7/365/) to discuss issues with discrimination or harassment in practicum placements and receive support. Information for Clinical Educators: When issues related to discrimination or harassment in practicum placements arise, the clinical educator may be the first to respond. Practicum placement organizations and agencies often have their own policies and procedures in place for dealing with issues of discrimination and harassment. Clinical educators are encouraged to follow those policies and procedures and seek support from their manager(s) or Human Resources department as necessary. If a clinical educator witnesses an act of discrimination or harassment against a practicum student or the student discloses such issues to the clinical educator, the clinical educator is expected to take steps to stop the inappropriate or discriminatory behaviour (e.g., educate the individual making discriminatory remarks/displaying harassing behaviour, take disciplinary action by reporting such behaviour as per the organization’s policies and procedures). Clinical educators are encouraged to respond to a practicum student with compassion and patience, listen

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actively, offer support and reassurance, document the meeting, suggest resources (e.g., direct student to University services such as those listed in the paragraph above), and explain options (e.g., informal option: clinical educator will speak with the person who engaged in the inappropriate behaviour directly and indicate that such behaviour will not be tolerated, formal option: file a complaint with the organization/agency or the province’s Human Rights Commission). It is important that if a student raises issues about discrimination or harassment in the practicum setting that their concerns are not minimized or ignored.

In the event of a strike situation, the Facility Clinical Coordinator or the Director will provide direction to the student regarding attendance in the clinic. In making this decision, the facility should consider the following:

1. the student's personal safety, i.e., students crossing picket lines; 2. the opportunity to meet rotation objectives, e.g., the availability of appropriate

caseload; and the availability of appropriate supervision 3. If the strike necessitates the student missing a period of time exceeding three (3) days,

the Provincial Coordinator and the Academic Clinical Coordinator at Dalhousie should be contacted for direction.

GUIDELINES FOR STUDENTS ON CLINICAL PLACEMENT DURING A PANDEMIC: The guidelines for students during a pandemic are based on the principles that student safety and the integrity of the learning experience are paramount during a pandemic, as at any other time during the clinical learning experience. Should a pandemic occur whilst students are on placement in a clinical setting, the following guidelines will be followed:

1. Students will continue to attend the clinical site while it is safe to do so and continues to be a positive learning experience for the student. This includes the need for adequate and appropriate supervision, and the provision of an appropriate caseload. If a positive learning experience cannot be provided by the site, students will be reassigned to other sites or clinical areas (e.g., a private clinic rather than a public facility experience).

2. Students must follow the infection control policies of the facility at all times during a pandemic. If the facility requires students to be vaccinated the student must comply with this requirement or be reassigned to an alternate site. (Students will be Fit Tested for N-95 masks by the university prior to commencing placements in the clinical setting.)

Strike Situation Policy

Pandemic Policy

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3. Students should not be exposed to patients/clients/residents with pandemic diseases unless under strictly controlled conditions and as part of their usual placement activities (i.e., part of their regular caseload). Full protective clothing and any required training related to infection control must be provided by the site.

Students attending academic classes at Dalhousie during a pandemic will not be redeployed into the clinical setting as part of their studies or for credit. If students wish to act as lay volunteers during a pandemic this should be done on their own time unless directed otherwise by the Department.

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Appendix A – Roles and Responsibilities of the Team

The Physiotherapy Student is responsible for actively applying the professional knowledge and skills learned in the classroom setting to the clinic situation. In addition, the student is responsible for augmenting his or her knowledge and skills and for developing professional attitudes for the practice of Physiotherapy.

RESPONSIBILITIES: Communication:

• Provide the supervising therapist/CI with background information on past rotations and clinical learning experiences and complete the Student Placement Profile.

• Provide the supervising therapist/CI at the start of the rotation with personal learning objectives for the rotation. Review and revise these weekly.

• Establish with the supervising therapist/CI overall objectives for the rotation and the method of evaluation to be used.

• Communicate to the supervising therapist/CI and clinical coordinator any problems encountered during the placement.

• Notify the supervising therapist and clinical coordinator in advance about arriving late or being absent from the workplace and make arrangements for their patient caseload.

Management/Administration:

• Select from the list of available placements the ones preferred and inform the

University Clinical Coordinator. • Contact the facility in writing or by phone to introduce oneself, to finalize their rotation

and arrange a time to be at the facility. • Arrange living accommodations.

Maintenance/Support:

APPENDICES

Roles & Responsibilities of the Physiotherapy Student

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• Follow the policies and procedures of the placement facility and respective physiotherapy department.

• Carry out all duties and projects assigned by the supervising therapist. • Complete the physiotherapy student portfolio as instructed and forward to the

supervising therapist/CI at the beginning of the next rotation.

Clinical Education:

• Discuss their clinical performance with the supervising therapist/CI on an ongoing

basis. • Augment knowledge and skills by reading, questioning and observing. • Prepare and present one case presentation, topic presentation or special project

during each placement as requested.

Evaluation:

• Discuss the Assessment of Clinical Performance (ACP) with the supervising therapist/CI

at midterm and at the end of the rotation. • Complete and discuss the Student Evaluation of the Clinical Placement Form with the

supervising therapist/CI and Facility Clinical Coordinator at midterm and at the end of the rotation.

Professional:

• Act in a professional manner. • Maintain the confidentiality of the patient. • Continually be aware of the safety of the patient and oneself.

Notify the supervising therapist/CI about any area of difficulty during the placement.

The supervising therapist/CI is a facility clinician directly responsible for teaching and evaluating students placed on their rotation. This person reports to the Facility Clinical Coordinator or Director.

RESPONSIBILITIES: Communication:

• Consult with the Facility Clinical Coordinator to clarify the School's clinical education

program, its goals and objectives, and the performance level of each student.

Roles & Responsibilities of the Supervising Therapist / Clinical Instructor (CI)

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• Set rotation learning objectives with each student.

Management/Administration:

• Attend and participate in meetings and workshops related to the clinical education

program.

Maintenance/Support:

• Guide the student's actions during the placement. • Familiarize oneself with the entrance performance level of the student and

expected level of performance by the end of the placement. • Promote quality patient care during the student's clinical placement through

supervision and student monitoring.

Clinical Education:

• Promote student clinical learning in the following ways:

o develop open communication with each student at the commencement of the placement;

o define clinical goals and learning objectives with the student at the beginning and during each placement;

o discuss the methods of teaching and supervision with the student; o utilize a variety of teaching methods and learning experiences with the

students; o provide a varied caseload; o keep current with clinical practice techniques.

• Promote professional and personal development of students in the clinical setting by:

o guiding in the problem-solving process; o assisting in the development of self-evaluation skills; o encouraging independence, confidence and self-directed learning strategies; o promoting professional and ethical behavior; o act as a role model of professional behavior.

Evaluation:

• Provide continual feedback to students during the placement to obtain maximum student performance and progress.

• Evaluate the student's performance by completing and discussing with the student the Assessment of Clinical Performance (ACP) at mid-term and final.

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• Provide constructive comments and suggestions about the program to the Facility or Provincial Clinical Coordinator

The Centre Coordinator of Clinical Education (CCCE) is the staff member of a facility, affiliated with the School of Physiotherapy, responsible for the Physiotherapy Clinical Education Program. These responsibilities include the organization and monitoring of all clinical placements in their facility. The coordinator may be the director of the department. If not, any decisions relating to clinical education may also need the approval of the director.

RESPONSIBILITIES:

Communication:

• Liaise with the Provincial Clinical Coordinator (PCCE) and Dalhousie Clinical Coordinator

(ACCE) on matters concerning the clinical education program. • Provide the Dalhousie Clinical Coordinator and the Provincial Clinical Coordinator with

information about the facility's resources and ability to meet the clinical education needs defined by the curriculum.

• Circulate the School goals and objectives to all supervising therapists/clinical instructors at the facility.

• Identify clinical needs and areas of concern in clinical education on behalf of the students.

• Identify and address problems encountered during the clinical period and communicate with the Provincial Clinical Coordinator or Dalhousie Clinical Coordinator.

• Clarify expectations between the student and the supervising therapist/clinical instructor and between the therapist and the school.

Management/Administration:

• Organize student placements and rotations in the facility. • Identify placements in the facility and complete the placement requests. • Send a completed list of offered placements and placement periods to the Provincial or

Dalhousie Clinical Coordinator. • Provide any available information on accommodation that may be required for students

during their placements. • Maintain an updated list of all student placements and a summary of placement

evaluations. • Maintain and update the facility clinical education manual.

Roles & Responsibilities of the Centre Coordinator of Clinical Education (CCCE)

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Maintenance and Support:

• Attend and participate in clinical education workshops. • Encourage supervising therapists/clinical instructors to attend the clinical

education workshops. • Encourage the development of therapists' clinical teaching skills. • Act as a resource for supervising therapists/clinical instructors and students.

Clinical Education:

• Coordinate student learning experiences in the clinical setting by: ▪ determining areas for student placements; ▪ selecting supervising therapists/clinical instructors; ▪ scheduling special clinical education sessions -

rounds, operative procedures, special lectures, demonstrations;

▪ orienting students to the facility's policies and procedures; ▪ encouraging growth of ethical and professional behavior.

• Monitor student progress throughout the placement. • Participate in clinical teaching duties.

Evaluation:

• Send copies of the student evaluation to the Dalhousie ACCE immediately upon

completion of the placement.

• Send copies of placement evaluations to the Provincial Clinical Coordinator as necessary.

• Identify the strengths and weaknesses of the clinical education program overall and recommend suggestions to the School and facility representatives.

The Provincial Clinical Coordinator (PCCE), through affiliation with the School of Physiotherapy, is the provincial designate and is responsible for the physiotherapy clinical education program within the province. These responsibilities include the organization, coordination and monitoring of all clinical placements. Additionally, the Coordinator participates in the Admissions Program. The Provincial Clinical Coordinator reports to the Dalhousie Academic Coordinator of Clinical Education (ACCE) on clinical education matters.

Roles & Responsibilities of the Provincial Clinical Education Coordinator (PCCE)

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RESPONSIBILITIES:

Communication:

1. Liaise with the Dalhousie ACCE, the Chair of the Admissions Committee, the Chair of the

Clinical Education Committee and the Director of the School of Physiotherapy. 2. Provide all facilities with clear guidelines regarding program implementation and

clinical visits. 3. Liaise with all Universities' physiotherapy programs. 4. Coordinate the clinical education program throughout the province. 5. Provide all students with all necessary clinical education information. 6. Provide all interested students with provincial employment and financial

assistance information. 7. Identify and take initiative in resolving any problems related to student

placements.

Management/Administration:

1. Identify facilities that can offer clinical placements. 2. Prepare a budget for the student clinical program, where appropriate. 3. Participate in clinical education planning with the Clinical Education Committee by

attending a minimum of one meeting per year and monitoring minutes and reports. 4. Provide the necessary reports to the School and other agencies. 5. Implement student placements in accordance with the University program schedule. 6. Send a list of supervising therapists, students, placement periods and facilities to the

Registrar of the provincial licensing body. 7. Participate in the admissions process at Dalhousie University by:

• providing admission information to candidates; • arranging interview sessions for provincial candidates; • being a member of the interviewing team; • being a member of the Admissions Committee.

8. Perform physiotherapy recruitment tasks.

Maintenance/Support:

Coordinate and participate in clinical education workshops.

Clinical Education:

• Monitor students at Facilities on a regular basis to maintain continuity between academics and clinical education.

• Participate in clinical teaching duties.

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Evaluation:

• Provide feedback to the Dalhousie Clinical Education Coordinator annually regarding student evaluations.

• Provide feedback to the Dalhousie Clinical Education Coordinator annually, regarding the student readiness for clinical practice.

• Identify strengths and weaknesses of the overall clinical education program and suggest solutions to government, school or facility representatives.

The Dalhousie Academic Clinical Education Assistant is responsible for administrative matters related to the Dalhousie Physiotherapy Clinical Education Program and reports to the ACCE. Responsibilities include ensuring students have met the clinical requirements of Dalhousie University’s Faculty of Health before they enter any clinical site visits or undertake any clinical placements, distribution of forms and course materials, providing administrative support for the ACCE, Clinical Instructors and students to ensure the efficient delivery of clinical education to Dalhousie physiotherapy students.

RESPONSIBILITIES:

Communication:

1. Inform student of the preplacement requirements for the school and the health authorities.

2. Provide Administrative support to the Clinical Education Committee. 3. Liaise with students, clinical coordinators, clinical instructors and administrators regarding

issues related to the delivery of clinical education. 4. Act as a resource in clinical education. 5. Assist the Provincial Coordinators, the facility clinical coordinators or directors with all

placement information regarding student objectives and evaluation procedures. 6. Liaise with the Atlantic regional facilities concerning clinical affiliation agreements with

Dalhousie University. 7. Set up and provide Administrative support for Clinical Education teleconferences.

Management/Administration:

1. Manage the Call for Offers system and responses in the HSPnet database. 2. Manage the placement cycle records in HSPnet and Dalhousie file systems. 3. Maintain current student records in HSPnet.

Roles & Responsibilities of the Dalhousie Academic Clinical Education Assistant (ACEA)

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4. Oversee the establishment and execution of affiliation agreements with the School of Physiotherapy’s clinical partners.

5. Ensure students have met the pre-placement requirements for clinical placement and confirm their compliance to the school’s clinical partners.

6. Provide the terms of students' insurance coverage for clinical placements to the facilities.

7. Maintain documentation for NACEP and International placements for both incoming and out of catchment students and for Dalhousie students doing out of catchment placements.

Maintenance/Support:

1. Provide administrative support to clinical education meetings and workshops. 2. Distribute placement materials to Clinical Instructors. 3. Monitor student placement evaluation reports and surveys.

Clinical Education:

1. Inform students of their clinical responsibilities before and during clinical

placements. 2. Ensure students have signed Student Placement Agreements to cover their placements and

that the agreements are fully executed. These agreements are an Appendix to the Affiliation Agreements.

3. Assist in the assignment of students to placements. 4. Ensure placement course materials are available to students in Brightspace.

Evaluation:

1. Ensure students and Clinical Instructors have access to the ACP via HSPnet. 2. Monitor completion of ACP’s by Clinical Instructors and students. 3. Use collected data to help determine Clinical Education Award winners.

The Dalhousie Academic Clinical Coordinator (ACCE) is responsible for all matters related to the Dalhousie Physiotherapy Clinical Education Program and reports to the Director and Faculty of the Whole Committee. Responsibilities include the coordination of the clinical teaching requirements, placing physiotherapy students in the Atlantic region, across Canada, and in international placements, overall planning and the successful integration of both the theoretical and practical components of the physiotherapy school curriculum.

Roles & Responsibilities of the Dalhousie Academic Clinical Education Coordinator (ACCE)

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RESPONSIBILITIES:

Communication: 1. Liaise directly with Provincial Coordinators on clinical education matters. 2. Act as a resource in clinical education. 3. Provide Provincial Coordinators, facility clinical coordinators or directors with all

placement information regarding student academic background, objectives and evaluation procedures.

4. Keep faculty informed of clinical education developments in the Atlantic region and liaise with other involved personnel.

5. Act as the Chairperson of the Clinical Education Committee. Management/Administration:

1. In cooperation with the Provincial Coordinators and facility clinical coordinators or directors, determine the availability of clinical placements at each Atlantic facility at least three months in advance.

2. Maintain current descriptions of Atlantic region facilities involved in student clinical education.

3. Send final placement lists to the Provincial Coordinators and facility clinical coordinators at least four - six weeks in advance.

4. Provide the Provincial Coordinators with the opportunity to participate in the clinical education planning with the Clinical Education Committee at least once a year.

5. Provide the terms of students' insurance coverage for clinical placements to the facilities.

6. Assist with the appointment of a Facility Clinical Coordinator, when requested. 7. Liaise with the Atlantic regional facilities concerning clinical affiliation agreements with

Dalhousie University. 8. Identify and develop additional clinical placements across the region. 9. Provide strategic planning, problem identification and problem solving in the student

clinical education program. 10. Investigate the various clinical education procedures.

Maintenance/Support: 1. Coordinate provincial workshops. 2. Develop supervision and evaluation procedures for students across the Atlantic region. 3. Monitor facility and student activities through communication with the Provincial

Coordinators, facility coordinators and visiting students at the various facilities.

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Clinical Education: 1. Inform students of their clinical responsibilities before and during clinical

placements. 2. Inform students of their responsibility to respect University and Facility

agreements. 3. Explain the purpose and the completion of the physiotherapy student manuals. 4. Participate in clinical teaching.

Evaluation: 1. Evaluate clinical education program requirements and objectives.

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Appendix B – Compliance with Clinical Placements

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PHYT 5500 Clinical Orientation Objectives

Appendix C – Clinical Course Objectives

(PHYT 5500, 5501, 5502, 6501, 6502 and 6503)

To introduce the students to the profession of physiotherapy and physiotherapy practice in Canada.

This introduction will include the physiotherapist/patient relationship in a clinical setting, principles

of physiotherapy practice, professional practice behaviours and life-long learning. Expected Learning Outcomes and Specific Knowledge-Based and Behavioural-Based Objectives At the completion of this course, students should be able to:

1. Demonstrate professional and ethical attitudes and behaviors at all times.

2. Demonstrate safe practices that minimizes risk to patients, self and others.

3. Develop fundamental skills in self-assessment and reflection.

4. Participate in a peer-assisted learning environment.

5. Practice basic clinical skills as outlined in the evaluation form (Appendix A)

6. Comply with legal and regulatory requirement and

7. Act with professional integrity.

Specific Basic Clinical Objectives

1. Conduct patient interviews.

2. Assist physiotherapist with positioning, transfers and ambulation as needed.

3. Ensure safe handling techniques.

4. Perform basic assessment skills like goniometry and manual muscle testing.

5. Auscultate chest and perform vital signs.

6. Identify commonly used medical equipment according to the environment.

7. Safe management of lines and tubes.

8. Discuss and identify red flags.

Key Learning Objectives:

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Students are expected to integrate the learning objectives and the course work to date, into this placement. The expectations for student performance in subsequent placements build on and add to the expectations in this placement. It is expected that the student would meet the following basic competencies (adapted from Competency Profile for Physiotherapists in Canada (2017) by the end of this placement. Professionalism: 1. Maintains confidentiality and privacy of client information and records.

2. Complies with federal, provincial/territorial and regulatory legislation and requirements.

3. Behaves with honesty, respect for others and in a manner that values diversity.

4. Accepts accountability for decisions and actions.

Communication Skills: 1. Speaks clearly and concisely, listens actively and responds appropriately.

2. Writes in a clear, concise, legible and organized fashion.

3. Ensures communication is timely and delivered in an empathetic and respectful manner.

4. Uses electronic technologies appropriately and responsibly.

Collaboration Skills: 1. Promotes an integrated approach to client services and engages client as a team member

2. Recognizes and respects the roles of others, interacts in a manner that promotes inclusion.

3. Contributes to effective teamwork and being respectful of all members.

4. Responds constructively to conflict resolution when needed.

Management Skills: 1. Complies with organizational policies, procedures and directives.

2. Utilizes available resources efficiently and manages own time effectively.

3. Adheres to individual, team and system-level safety practices.

4. Applies best practice for infection control, maintains a clean and organized work environment.

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Clinical Skills:

1. Supports a client-centered approach by respecting client’s uniqueness, diversity and autonomy,

by building rapport and trust, by ensuring ongoing informed consent and actively involving

client in decision-making.

2. Interview client to obtain relevant information about health conditions, personal and

environmental factors. Determine client’s expectations and its relevance to physiotherapy.

3. Identify client-specific precautions, contraindications and risks.

4. With guidance, interpret assessment findings and apply under supervision assessment and

intervention procedures in a manner that enhances client safety and comfort.

Leadership & Scholarly Skills:

1. Promotes a culture of client-centeredness.

2. Fosters client engagement in finding solutions to address health needs.

3. Maintains awareness of emerging technologies.

4. Integrates self-reflection and external feedback to enhance learning activities.

PHYT 5501 Cardiorespiratory Placement Objectives

Relative to Management of Patients with Cardiorespiratory Limiters to Functional Performance:

1. Interpret the following clinical data at a basic level: pulmonary function tests,

arterial blood gases, pulse oxymetry, electrocardiograms, hemodynamic variables, chest x-rays, blood glucose, lipid profile, diet and activity history, anthropometrics, blood parameters (Hb, WBC, RBC), body temperature.

2. Discuss commonly used medical equipment (humidification devices, medication

delivery devices, oxygen delivery systems and devices, mechanical ventilators, CPAP and BiPAP systems, chest drainage systems, arterial and venous lines and monitors, artificial airways, suction equipment) in terms of therapeutic rationale and any special considerations the equipment imposes on physiotherapy management.

3. Perform a thorough objective physiotherapy cardiovascular/respiratory

examination including inspection, palpation, percussion, auscultation, screening

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for and assessment of risk factors for CR dysfunction, functional mobility and activity or movement tolerance. Incorporate other necessary tests as appropriate to patient and evaluation setting.

4. Determine and justify a differential diagnosis based on subjective and

objective evaluation findings, laboratory tests and knowledge of cardiorespiratory pathophysiology.

5. Apply entry-level cardiopulmonary physiotherapy treatment techniques safely and effectively: • Therapeutic Positioning (implies understanding of mechanics of respiration

relative to body position; principles of V/Q matching and airway clearance; body mechanics, transfers, functional ROM and muscle strength assessment).

• Assisted Airway Clearance: postural drainage and percussion, vibration, shaking, humidification and medication delivery devices, PEP devices (flutter, Acapella, PEP mask or mouthpieces), deep breathing, huffing, breath stacking and cough facilitation techniques, relaxation strategies and positions.

• Patient Mobilization and Monitoring: (implies use of bed exercises and movement in and out of bed, ambulatory aids as appropriate, energy conservation techniques, as well as measurement of level of patient tolerance

• i.e. HR, BP, RR , ECG, SaO2, pain scale, RPE, dyspnea scale). • Suctioning, bagging, instillations (requires use of sterile vs. clean

procedures including gowning, masking, gloving, handwashing, etc). • Peak flow monitoring, symptoms diary, and action plan review for patients

with asthma and COPD.

• Use of target heart rate, dyspnea and RPE scales, blood pressure, angina scale, METs charts in prescribing safe activity levels for “at risk”.

• Use of appropriate strength and endurance testing, training techniques and outcome measurements (includes inspiratory muscle testing and training, upper and lower extremity exercise training, bike and walk tests, oximetry, use of supplementary oxygen.

• Motivational interviewing and patient and family education as appropriate to age, practice setting, etc.

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Relative to Management of Patients with Musculoskeletal Limiters to Functional Performance:

1. Demonstrate basic knowledge and skills in the examination, evaluation, and treatment of common musculoskeletal impairments of MSK tissues (i.e. muscle, connective tissue, nerve, bone), where impairments include illness, injury, trauma, overuse, postural, genetic, developmental, and post-surgical issues.

2. Apply knowledge of anatomy, pathology and histo-pathology of MSK tissues through the stages of healing.

3. Demonstrate the ability to generalize therapeutic principles discussed in Module 5 to other, less common MSK conditions.

4. Interpret and critically review the MSK literature while incorporating the concepts to the examination, evaluation, and treatment of common MSK impairments.

5. Demonstrate the ability to apply prospective clinical reasoning using a two stage hypo-deductive reasoning model where a probing subjective history and patient observation skills are used to develop differential diagnoses (Stage 1) and MSK examination and reasoning skills are used to confirm or disprove these diagnoses (Stage 2).

6. Based on Stage 1 clinical reasoning results: rationalize the selection of and demonstrate the safe performance of appropriate MSK assessment skills, and be able to accurately interpret examination data, including: postural evaluation, palpation of articular & soft tissue structures, upper and lower quadrant scan exams, selective tissue tension testing, ligament stress tests, assessment of ROM and strength, selected passive accessory mobility tests, integumentary system (e.g. skin, hair, nails), proprioception, balance and gait analysis.

7. Determine a primary differential diagnosis at the level of impairment that takes into account stage of healing, nature of the pain, tissue / system pathology, level of irritability and considers both patho-anatomic and patho- mechanical causes of MSK dysfunction. • Identify concerns at the levels of activity and participation.

• Discuss how to identify danger signs and common syndromes of non-musculoskeletal origin ('red flags').

8. Understand the basic concepts of various common medical & surgical investigations in MSK impairments as they relate to the physiotherapy primary differential diagnosis.

9. Demonstrate the ability to rationalize and design an MSK intervention plan for common MSK dysfunctions that includes (i) specific, measurable, achievable, realistic, and time-based (SMART) functional goals developed in collaboration with the patient / client, (ii) SMART impairment goals that support each functional goal, (iii) appropriate interventions to achieve these goals, and (iv) appropriate outcome measures to evaluate treatment effects.

10. Demonstrate the ability to implement a comprehensive, reasoned intervention plan that

PHYT 5502 Musculoskeletal Placement Objectives

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is matched to both patient / client needs and the SMART goals (functional, impairment), is safe, cost effective and efficient, and includes re- assessment criteria with subsequent treatment modifications, and discharge criteria. • Address concerns at the levels of impairment, activity and participation • Integrate the multiple determinants of health which influence patient prognosis. • Demonstrate safe, ethical practice, skill and competence in common MSK

interventions including soft tissue techniques, therapeutic exercise, manual therapy, devices /aids/ tape, gait and posture re- education, functional training, basic adaptations to home, work, and sport techniques or environments, and patient education.

• Demonstrate the ability to document relevant aspects of the assessment, evaluation and intervention processes, including informed consent, standardized assessment forms, clinical reasoning, SOAP notes, and communications to patients / clinicians.

11. Demonstrate communication and interpersonal skills conducive to effective interaction with patients / clients (and their social support group), peer clinicians, support personnel, and other various health care providers. • Understand the process and rationalization of referring patients/clients to other health

care providers and/or community/government agencies for treatment and/or support while respecting the patient’s / client’s right to confidentiality.

• Discuss the causes of conflicting needs between health care providers, insurers and patients / clients.

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PHYT 6501 Neurotherapeutic Placement Objective

Relative to Management of Patients with Neuromusculoskeletal Limiters to Functional Performance: Indicator conditions covered in the neurotherapeutics curriculum include stroke, spinal cord injuries, Guillian Barré Syndrome, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, traumatic brain injuries, Parkinson Disease, and CNS tumors. Other conditions not directly addressed in the curriculum such as post-polio syndrome and Friedreich’s ataxia are referred to as transfer- of-learning conditions.

Specific Behavioural Objectives

1. Upon successful completion of the clinical component, the student will be able to:

2. Collect pertinent information from the patient‘s health record regarding relevant personal and environmental contextual factors, and the health condition, which will compliment the physical evaluation findings of a physiotherapy assessment.

3. Conduct a focused patient/family interview that will compliment information obtained from the health record review. This information, together with the physical examination findings and current evidence from the literature, will inform prognosis, patient-centred goals and the physiotherapy intervention plan.

4. Conduct a multi-system physical examination of relevant impairment, activity-level, and participation-level attributes, demonstrating knowledge and skills consistent with (i) selection of appropriate outcome measures, (ii) performance of safe and accurate assessment procedures, and (iii) awareness of contraindications for various assessment techniques. It is expected that students carry out evaluation and treatment only after the patient gives explicit informed consent.

5. Determine whether physiotherapy intervention is warranted based on assessment findings and the available clinical data.

6. If physiotherapy is deemed appropriate, create a list of principal physiotherapy concerns.

7. Set, in concert with the patient, patient’s family or caregiver, appropriate physiotherapy-related goals that are specific, measurable, attainable, functionally relevant and time based (ie SMART).

8. As the basis for intervention planning, ascertain the degree to which neurologic, cardiorespiratory and musculoskeletal dysfunctions impede achievement of patient/family-centered goals.

9. Use the evaluation findings and the identified goals to formulate a reasoned plan for management which:

• corresponds directly with the concerns identified

• is within the scope of physiotherapy practice

• reflects the unique nature of the individual case

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• is based on current and objective evidence

• respects the individual’s personal dignity, religious and cultural beliefs

• integrates problem solving & a reasoned approach to physiotherapy management

1. identifies needs of the patient that require referral for further consultation or for other resources that will aid recoverySet therapeutic targets indicating the magnitude of change in outcome measures needed for successful attainment of goals.

2. Practice a problem-solving approach to justify the assessment and treatment methods chosen. Discuss the current literature in terms of evidence-informed physiotherapy practice.

3. Identify aspects of the intervention plan that can be delegated safely and effectively to physiotherapy support workers.

4. Document assessment findings in a clear and concise manner such that the management plan and the patient’s physiotherapy-related goals are apparent to all members of the health care team.

5. Communicate and discuss effectively the assessment findings with appropriate professionals and agencies while respecting the patient’s right to confidentiality.

6. Participate actively in team/committee planning.

7. Determine when consultation with family members and/or other members of the health care team will optimize the patient’s progress.

8. Demonstrate strategies to enhance patient’s self efficacy in addressing personal needs, engaging in active health practices and achieving personal health-related goals.

9. Demonstrate self-directed learning and appropriate professional and ethical attitudes and behaviors. Demonstrate sensitivity and understanding by becoming aware of the influence of the social determinants of health (e.g., physical, social, emotional and spiritual elements) on the patient’s/family’s situation.

10. Evaluate each patient’s response to treatment in order to determine progress, evaluate effectiveness of the intervention plan, and modify intervention as needed.

11. Understand the roles of health care team members by engaging in learning opportunities, e.g. attending home visits with occupational therapists, observing surgical procedures, assisting in occupational therapy assessment and/or treatment sessions, etc.

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PHYT 6502 Integrated Placement Objective

Relative to Management of Patients with Mixed and Complex Conditions:

Overall Placement objective: This clinical placement period will allow for the integration of information and evidence from all courses in year 1 and year 2 into a physiotherapy practice area. One six-week clinical placement is undertaken at the end of a 13-week academic module - “Integrated Physiotherapy Practice for the Entry-Level Clinician.” The main purpose of this clinical placement is to provide the student with an opportunity to practice clinical problem solving and evidence-based practice incorporating the evaluation and treatment skills acquired during the academic term. This clinical placement period will allow for the integration of information and evidence from all courses in year 1 and year 2 into a physiotherapy practice area that would allow the student to assess and treat patients with multiple problems and co-morbidities. This will include the areas of geriatrics, paediatrics, private practice, industry, community practice, innovative practice and/or any area that enhances previous clinical and academic experience. Indicator Conditions covered in the integrated practice curriculum run from the elite athlete to the frail elderly and includes vestibular conditions, burns, amputees, cancer, HIV/Aids, women’s health, high risk infants, autism, rheumatologic conditions, diabetes, congestive heart failure and organ transplants, progressive neuromuscular disorders and palliative care.

Specific Behavioral Objectives: 1. Upon successful completion of the clinical placement, the student will be able to: 2. Collect pertinent information from the patient‘s health record regarding relevant personal and

environmental contextual factors, and the health condition, which will compliment the physical evaluation findings of a physiotherapy assessment.

3. Conduct a focused patient/family interview that will compliment information obtained from the health record review. This information, together with the physical examination findings and current evidence from the literature, will inform prognosis, patient-centred goals and the physiotherapy intervention plan.

4. Conduct a multi-system physical examination of relevant impairment, activity-level, and participation-level attributes, demonstrating knowledge and skills consistent with (i) selection of appropriate outcome measures, (ii) performance of safe and accurate assessment procedures, and (iii) awareness of contraindications for various assessment techniques. It is expected that students carry out evaluation and treatment only after the patient gives explicit informed consent.

5. Determine whether physiotherapy intervention is warranted based on assessment findings and the available clinical data.

6. If physiotherapy is deemed appropriate, create a list of principal physiotherapy concerns. 7. Set, in collaboration with the patient, patient’s family or caregiver, appropriate physiotherapy-

related goals that are specific, measurable, attainable, functionally relevant and time based (i.e. SMART).

8. As the basis for intervention planning, ascertain the degree to which neurologic, cardiorespiratory and musculoskeletal dysfunctions impede achievement of patient/family-centered goals.

9. Use the evaluation findings and the identified goals to formulate a reasoned plan for management which:

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• corresponds directly with the concerns identified • is within the scope of physiotherapy practice • reflects the unique nature of the individual case • is based on current and objective evidence • respects the individual’s personal dignity, religious and cultural beliefs • integrates problem solving & a reasoned approach to physiotherapy management • identifies needs of the patient that require referral for further consultation or for other

resources that will aid recovery 10. Set therapeutic targets indicating the magnitude of change in outcome measures needed for

successful attainment of goals. 11. Practice a problem-solving approach to justify the assessment and treatment methods chosen.

Discuss the current literature in terms of evidence-informed physiotherapy practice. 12. Identify aspects of the intervention plan that can be delegated safely and effectively to

physiotherapy support workers. 13. Document assessment findings in a clear and concise manner such that the management plan

and the patient’s physiotherapy-related goals are apparent to all members of the health care team.

14. Communicate and discuss the assessment findings with appropriate professionals and agencies while respecting the patient’s right to confidentiality.

15. Participate actively in team/committee planning. 16. Determine when consultation with family members and/or other members of the health care

team will optimize the patient’s progress. 17. Demonstrate strategies to enhance patient’s self efficacy in addressing personal needs,

engaging in active health practices and achieving personal health-related goals. 18. Demonstrate self-directed learning and appropriate professional and ethical attitudes and

behaviours. Demonstrate sensitivity and understanding by becoming aware of the influence of the social determinants of health (e.g., physical, social, emotional and spiritual elements) on the patient’s/family’s situation.

19. Evaluate each patient’s response to treatment in order to determine progress, evaluate effectiveness of the intervention plan, and modify intervention as needed.

20. Understand the roles of health care team members by engaging in learning opportunities, e.g. attending home visits with occupational therapists, observing surgical procedures, assisting in occupational therapy assessment and/or treatment sessions, etc.

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PHYT 6503 Senior Placement Objectives The senior five-week clinical placement is undertaken at the end of the program. The main purpose of this placement is to continue to provide the student with an opportunity to practice clinical problem solving and evidence-based practice incorporating the assessment and treatment skills acquired during the academic program. This placement may provide the student with an opportunity to learn consultation skills, to engage in program development and evaluation, and to educate others about the role of physiotherapy. Through working independently and advocating for their professional role, students learn skills that will serve them well as they enter the profession. Examples of liaisons to supplement the students’ clinical experiences could be:

• Heart & Stroke Association/Lung Association • Injury prevention • Chronic Disease Management • Administrative Internships working with PT Managers • Research • Pain Management • Outreach Geriatrics/ Community Outreach Teams/Home Care Schools • Workers Compensation Board • International Medicine Projects • Primary Health Care:

▪ e.g. NB community health centres or regional boards ▪ Community capacity building ▪ Education programs/ergonomic activities

• Health & Wellness • Health policy development • Building a Better Tomorrow • Workplace wellness/Occupational Health & Safety • Falls prevention • Obesity Clinics

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Appendix D – Checklists for Cardiorespiratory, Musculoskeletal and Neurotherapeutics

CARDIORESPIRATORY COMPETENCIES RECORD

A CHECKLIST OF KEY CARDIORESPIRATORY INTERVENTIONS FOR ENTRY-LEVEL PHYSICAL

THERAPY STUDENTS – SHORT FORM

The objectives of the CR checklist are:

1. to ensure that PT students gain experience with essential clinical skills, attitudes, behaviours

and clinical reasoning within CR in order to obtain the minimum entry-level cardio-respiratory

competencies prior to graduation;

2. to provide clinical supervisors with guidance as to the practice settings and clinical situations in

which competence may be assessed; and

3. to highlight for students, clinical instructors and facilities that any clinical setting has the

potential to assist students in acquiring CR competencies.

IMPORTANT NOTICE TO STUDENTS

The checklist is a guide for tracking PT student CR experiences. The checklist should be used to

guide/maximize a student’s CR clinical experience. A student is unlikely to obtain exposure and/or clinical

experience in all of the areas listed prior to graduation.

The checklist is NOT meant to be used as an evaluation tool or a measure of a student’s CR clinical

competence.

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ASSESSMENT TECHNIQUES Cardiorespiratory History/Lab Results: The student will demonstrate knowledge of relevant history and lab

results such as those listed below and incorporate them into assessment and treatment planning, in keeping with

the practices of the clinical setting.

Completed Comments

1. Chart review

2. Arterial Blood Gas interpretation

3. Pulmonary Function Test interpretation

4. Results of cardiac/pulmonary diagnostic tests

5. Awareness of CR precautions/contraindications for

treatment

6. Collection of radiographic information

7. Significant Blood work findings

8. Pharmacological implications of medications taken

Other (specify):

Subjective: The student will demonstrate knowledge and/or use of a variety of subjective assessment tools such

as those listed below, in keeping with the practices of the clinical setting.

Completed Comments

1. CR complaints (SOB, orthopnea, cough, angina)

2. Pain/discomfort (angina, surgical pain, MSK)

3. Use of patient self-report measures (may include:

VAS pain scale, Quality of Life measures, Borg

Rating of Perceived Exertion)

4. Patient history, (with focus on respiratory issues

such as smoking, activity history)

5. Recent Activity History

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Completed Comments

Other (specify):

Objective Inspection/Observation: The student will demonstrate knowledge and/or use of a variety of objective

assessment measures such as those listed below, in keeping with the practices of the clinical setting.

Completed Comments

1. Lines and Tubes (understand implications)

2. Understand the implications of and Perform

Vital Signs (HR, BP, SpO2 , RR, Temp)

3. Fluid Balance (understand implications)

4. Jugular venous pressure (distention), peripheries,

abdomen; understand implications

Observed/

Discussed

Performed

on Patient

Comments

1. Chest Assessment (IPPA)

• Inspection (cyanosis etc.)

• Palpation (chest excursion etc.)

• Percussion (resonance)

• Auscultation (breath sounds,

adventitia)

• Cough (effective, ineffective)

• Sputum (colour, consistency)

2. Mobilization (independent; with assistance or supervision)

• Bed mobility

• Transfers

• Gait/Ambulatory status /Stairs

3. Functional Capacity Measures

may include: 6 MWT, self –

paced walk, shuttle walk)

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Observed/

Discussed

Performed

on Patient

Comments

4. Balance (sitting, standing,

walking)

5. Posture (affecting chest

expansion)

6. Strength/Endurance (sufficient

for safe mobilization)

7. Range of Motion (UE/thoracic

ROM )

Other (specify):

ANALYSIS AND PLANNING The student will learn to collect and analyze assessment findings and apply these to the identification of goals

and the development of treatment plans, in keeping with the practices of the clinical setting.

Completed Comments

Formulate and articulate evaluation findings

Establish short & long-term patient-centered goals

Develop effective treatment plans

TREATMENT TECHNIQUES The student will become knowledgeable about a number of treatment methods, but may only practice some. All

students should endeavour to obtain practice with a variety of treatment techniques, in keeping with the

practices of the clinical setting.

Observed/

Discussed

Performed

on Patient

Comments

1. Mobilization (bed mobility,

transfers, walking, stairs, prescription of

mobility devise)

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Observed/

Discussed

Performed

on Patient

Comments

2. Safe management of tubes & lines

3. Oxygen titration

4. Improved ventilation / breathing

exercises - may include:

(Mobilization; Deep Breathing-TEE;

Facilitated Breathing / Manual Techniques

–rib springing , basal lifts; Volume

Augmentation –sniffing & breath staking

etc.)

5. Secretion mobilization - may

include:

(Mobilization; Active Cycle Breathing

Technique/ Huffing; PD; Percussions –

manual/mechanical; Vibrations;

PEP/Flutter etc.).

6. Secretion clearance – may include:

(Cough, huff, manually assisted cough;

Suctioning – non-intubated; Suctioning –

intubated; Tracheal /stoma cough assist; In-

exsufflation.

7. Managing dyspnea – may include:

(Purse lip breathing, positioning for SOB,

energy conservation, relaxation training

etc.)

8. Implement Exercise Training.

(Prescription of adapted programs for

special CR populations; may include:

104

Observed/

Discussed

Performed

on Patient

Comments

aerobic exercise or resistance exercise

prescription)

9. Thoracic mobility

(AROM, AAROM, PROM)

Other (specify):

COMPLETE THE FOLLOWING TO TRACK YOUR EXPERIENCES: CR Patient Diagnoses seen on Placement (list) Settings / CR Environments (list)

Clinical Instructor (CI) Review: Please review the student checklist outlining the interventions completed during

this placement. Please validate below if the items indicated by the student as completed, observed and/or

performed during this placement are accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is accurate. Check

Here:

Student Review: Please review the checklist outlining the interventions you have completed during this

placement. Please validate below if the items you have indicated as completed, observed and/or performed

during this placement are accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is accurate. Check

Here:

105

MUSCULOSKELETAL COMPETENCIES RECORD

INSTRUCTIONS:

1. Indicate if condition is encountered with a’√’ in the appropriate placement column.

2. Make note of the specifics (for e.g. Supraspinatus or bicipital tendinitis) in the placement-specific section

that follows. P1, P2 etc. refers to patient 1

Condition P1 P2 P3 P4 P5 P6 P7

Musculoskeletal

Spinal disorders

• low back strain / sprain

• postural dysfunction (lordosis, kyphosis, scoliosis)

• disc lesion (with and without neuro signs)

• spondylosis

• spondylolysis

• spondylolisthesis

• spinal stenosis

• instability

Torticollis

Whiplash injury (acceleration/deceleration injury)

TMJ disorders

Hand disorders (dislocations, tendon repairs, Dupuytren’s contracture, etc)

Meniscal injuries (e.g. knee, wrist) / plica syndromes

anterior knee pain/PFPS

Shin splint/periostitis

Foot disorders (e.g. plantar fasciitis)

Sprains: grades 1 → 3 (cervical, knee, ankle)

Strains: grades 1 → 3 (hamstrings, rotator cuff)

Contusions (adductor, quadriceps)

Tendonitis / tendinosis

Tendon repairs

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Condition P1 P2 P3 P4 P5 P6 P7

Post-surgical (hip, knee, ankle, including arthroplasy, rotator cuff – e.g. Bankart)

Overuse injuries (e.g. bursitis, tennis elbow, tenosynovitis – DeQuervains, long finger flexors)

Dislocations (U/E e.g, glenohumeral, A/C, finger and L/E e.g. patellar)

Subluxations (U/E e.g, glenohumeral, A/C, finger and L/E e.g. patellar)

Fractures (spinal, peripheral, stress and internal, external fixation)

Lower motor nerve issues (impingement, injury, entrapment)

Chronic regional pain syndrome (CRPS)

Hypomobility syndromes (e.g. adhesive capsulitis, immobilization in cast)

Hypermobility syndromes / instability / impingement syndromes (knee, shoulder, ankle, spine, wrist)

Arthritic conditions (i.e. seronegative arthropathy e.g. degenerative joint disease)

Rheumatic conditions (i.e. seropositive arthropathy)

Osteoporosis

Bone disorders (i.e. osteomyelitis)

Fibromyalgia

Myositis ossificans

Growth disorders/apophysis (i.e. Osgood Schlatter’s disease, Sever’s disease)

ASSESSMENT PROCEDURES CHECKLIST

INSTRUCTIONS:

1. Indicate if procedure has been performed/observed (P = performed; O = observed).

2. Leave blank if not performed.

3. Comment on the quality of the performance (C = Competent [safe, appropriate, effective, proficient] IP

= in progress [with brief explanation – for e.g. work on efficiency]).

It is important to note clearly any procedures that are performed UNSAFELY.

107

Assessment Procedure

Performed or Observed

Competent or

In Progress

P O C IP Comment

Perform patient interview to obtain relevant subjective data

Assess pain (VAS, McGill Questionnaire, pain scales, etc.)

Read / obtain results of imaging or special tests

Consult with other health care professionals as appropriate

Observe general condition/situation

Assess mental status

Assess posture Assess function (e.g. bed mobility, transfers)

Assess gait

Perform upper and lower quadrant scanning examinations

Assess rheumatic disease activity (active joint count, effusion, etc.)

Assess rheumatic disease joint damage (deformity, laxity, damage)

Assess joint inflammation, effusion

Assess skin condition

Assess circulation (pulse, color, temperature, capillary refill, etc.)

Assess vertebral artery status

Assess stability of spinal joints

• cranio-vertebral

• cervical

• thoracic

• lumbar

• pelvis

Assess spinal joint play (PPIVMs, PAIVMs)

• cranio-vertebral

• cervical

• thoracic

• lumbar

• pelvis (SI jt) (PAMS, not PPIVMS)

Assess active ROM (e.g. goniometer-peripheral; tape measure – spine)

Assess passive ROM (goniometry)

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Assessment Procedure

Performed or Observed

Competent or

In Progress

P O C IP Comment

Assess muscle tone (tension, tone, spasms, spasticity)

Assess muscle length and flexibility, length tension test

Assess joint mechanics (joint play -i.e. PAM, ligament stability)

Assess end feels

Assess muscle performance

• endurance

• strength- isometrics, concentric, eccentric

• power

Perform functional strength tests (i.e. squat, shoulder elevation)

Perform and grade manual muscle tests

Assess deep tendon reflexes (DTR)

Assess myotomes and dermatomes

Assess UMN lesion (i.e. Babinski, Clonus)

Assess balance, proprioception

Assess coordination

Assess sensation to hot/cold, sharp/dull, light touch

Assess need for use of equipment / aids for function (e.g. walking aids, wheelchairs, orthotics)

Neurodynamic testing

Other: (e.g. limb girth, leg length)

•

•

•

•

•

Special tests: (e.g. McMurrays)

•

•

•

•

•

109

INTERVENTION CHECKLIST

INSTRUCTIONS:

Each of the general headings listed below may include a variety of specific treatment procedures. Interpret

these general headings as appropriate to the specialty of the placement.

Intervention Performed or Observed

Comment

P O Passive movements:

• ROM

• prolonged stretching (spinal and peripheral)

• spinal joint mobilization techniques:

- cranio-vertebral

- cervical - thoracic

- lumbar

- pelvis

• peripheral joint mobilization techniques

• neural mobilization techniques

Active movements:

• assisted exercise • free exercise (AROM)

• coordination and agility exercises

• core stability exercises Resisted movements (spinal, peripheral and patterned movement):

• manual

• mechanical

Massage, frictions Positioning of patient (e.g. for optimal or alternate sleep positions)

Postural correction Balance training

Gait training

Use of ambulation aids

Functional training

• transfer and mobility skills

• stairs, inclines, outdoors

• hand function • oral facial function

Adaptation of equipment for therapeutic or recreational purposes

110

Intervention Performed or Observed

Comment

P O

Use of equipment for exercise (slings, springs, pulleys, tubing etc.)

Classes:

• post THR

• back education Hydrotherapy

• WP

• Contrast baths • Pool

Cold packs/hot packs

Wax

Traction (cervical and lumbar):

• manual

• mechanical

Electrotherapy:

• TENS • interferential

• US

• Electrical stimulation • diadynamic

• direct current

Compression garments (i.e. Jobst) Biofeedback

Principles of joint care (Joint protection, energy conservation)

Management of acute and chronic inflammation

Bandaging / taping:

• tensor bandaging

• taping

• anti-embolic stocking

Adaptive equipment:

• collars

• corsets

• splints / slings

• orthotics (e.g. ankle brace, knee brace, AFO,) Prosthetic training

Care of open wounds/sores/burns (including sterile technique)

Discharge planning

Communication , written and verbal with:

• Referring physician

111

Intervention Performed or Observed

Comment

P O

• Surgeon

• Orthotist • OT

• Kinesiologist

• WCB • 3rd party payers

COMPLETE THE FOLLOWING TO TRACK YOUR EXPERIENCES: MSK Patient Diagnoses seen on Placement (list) Settings / MSK Environments (list)

Clinical Instructor (CI) Review: Please review the student checklist outlining the interventions completed during

this placement. Please validate below if the items indicated by the student as completed, observed and/or

performed during this placement are accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is accurate. Check

Here:

Student Review: Please review the checklist outlining the interventions you have completed during this

placement. Please validate below if the items you have indicated as completed, observed and/or performed

during this placement are accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is accurate. Check

Here:

112

CLINICAL NEUROTHERAPEUTICS: EXPERIENCES RECORD (CHECKLIST)

NEUROLOGICAL CONDITIONS

INSTRUCTIONS:

Indicate if condition is encountered with a’√’ in the appropriate placement column.

Make note of the specifics (for e.g. CVA or SCI) in the placement-specific section that follows.

P1, P2 etc. refers to patient 1

Condition P1 P2 P3 P4 P5 P6

Adult

Stroke

Parkinson disease

Multiple sclerosis

Amyotrophic Lateral Sclerosis

Brain injury

Brain tumor

Alzheimer Disease (or other forms of dementia)

SCI • paraplegic

• quadriplegia/tetraplegia

Poly-neuropathies (e.g. GBS, diabetic)

Post Polio Syndrome

Other (specify)

Other (specify)

Pediatric

Myelodysplasia (spina-bifida)

Developmental delay (motor delay)

Traumatic brain injury

Brain tumor

Stroke

CP • hemiplegia

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Condition P1 P2 P3 P4 P5 P6

• diplegia

• quadraplegia/tetraplegia

• other

Neuromuscular diseases (e.g. MD)

SCI • paraplegia

• quadriplegia/tetrapelgia

Other (specify):

ASSESSMENT PROCEDURES AND TOOLS

INSTRUCTIONS:

1. Indicate with an ‘X’ if procedure has been performed/observed (P = performed; O = observed).

Comment with what outcome measures were used.

Leave blank if not performed.

2. Indicate the quality of the performance (C = Competent [safe, appropriate, effective, proficient] IP = in

progress).

Comment with brief explanation (e.g. work on efficiency), and clearly note any procedures that are performed unsafely.

Attribute Being Assessed Examples of Outcome Measurement Tool(s)

Performed or

Observed

Competent or

In Progress

Impairment-Level Attributes P O Comment C IP Comment

Cognition Mini-Mental, GCS

Perception scan

Sensation:

• light touch

scan, dermatomes, S-W filaments

• proprioception scan

• vibration tuning fork

Pain VAS

Range of motion/contractures goniometry

Muscle tone descriptive, MAS, Tardieu, clonus

Reflex activity: reflex hammer

114

Attribute Being Assessed Examples of Outcome Measurement Tool(s)

Performed or

Observed

Competent or

In Progress

Impairment-Level Attributes P O Comment C IP Comment

• DTRs

• develop. reflexes observation

Postural alignment (lying/sitting/standing)

scan

Skin integrity observation

Muscle strength MMT, myotomes, dynanometry, grip

Motor control of UEs/LEs CMSA

Coordination scan

Balance/postural adjustments Berg, CBMS, ABC

Gait pattern observation, Gaitrite, videotape

Cardiovascular endurance 6MWT, RPE

Motor development level (pediatrics)

Other (specify):

Activity & Participation Level Attributes:

Functional mobility NSRC Bed Mobility Scale

FIM: transfers

FIM: stairs

Locomotor FIM, TUG, 10M walk

UE function (reaching, grasping, etc.)

CAHAI

Assessment of overall functional status

Total FIM, Barthel, GMFM, GAS

Other (specify):

INTERVENTIONS

Each of the general headings listed below may include a variety of specific treatment procedures. Interpret headings

as appropriate to neurotherapeutics.

115

Intervention Category Performed or Observed

P O

ROM • positioning

Exercises • passive ranging + stretching

• instruction in self stretches

• mobilizations

Activation techniques

• sensorimotor facilitation

• FES

• mental imagery

Active • assisted exercise

Movement • manual guidance

• active exercises

• coordination exercises

Muscle • PRES with 1RM

Strengthening • wt & pulley/springs/theraband

• functional strengthening

Balance • external perturbations

Training • internal perturbations

Mobility • bed

Training • sit-to-stand

• transfers

• indoor walking

• outdoor walking

• outdoor walking (uneven terrain)

• wheelchair skills

UE training • reaching, grasping, manipulating, transferring

Cardiovascular fitness training

Patient/family education

• ind. exercise program

• group exercise class

Discharge planning • home/school visit

• plan for continuing therapy (e.g. home care, OP, follow-up, home exercise program)

Other (specify) ____________________________

Other (specify) ____________________________

Other (specify) ____________________________

116

CLINICAL INSTRUCTOR (CI) REVIEW:

Please review the student checklist outlining the interventions completed during this placement. Please validate

below if the items indicated by the student as completed, observed and/or performed during this placement are

accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is

accurate. Check (“X”) Here: ___

STUDENT REVIEW:

Please review the checklist outlining the interventions you have completed during this placement. Please validate

below if the items you have indicated as completed, observed and/or performed during this placement are accurate.

I [type name] certify that to the best of my knowledge, the information provided in the above is

accurate. Check (“X”) Here: ___

117

Appendix E- Assessment of Clinical Performance (ACP) Canadian Physiotherapy Assessment of Clinical Performance

Program: Dalhousie University /

Master of Science Physiotherapy

Placement:

Site:

Student: Assessor:

Placement Dates:

Status:

The Canadian Physiotherapy Assessment of Clinical Performance (ACP) tool is the property of the Canadian Council of Physiotherapy University Programs. The information contained herein is confidential in nature and should be returned to the proper academic authority if found.

Background:

There has been an extensive process to develop and test the Canadian Physiotherapy Assessment of

Clinical Performance (ACP) assessment form to assess PT students in clinical education . in

collaboration with. We have consulted the Academic Coordinators/Directors of Clinical Education and

Academic Chairs /Directors at each PT school across Canada , interviewed experts, clinicians, recent

graduates and survey physiotherapists across Canada. We piloted the ACP in 10 schools across

Canada in English and French from March - December 2013. The ACP demonstrated evidence of

internal consistency reliability , construct validity and practicality and we feel we can confidently use

the ACP to assess PT students in clinical education . It is an exciting time for physiotherapy clinical

education in Canada.

The ACP is based on the Canadian Essential Competency Profile for Physiotherapists (ECP). The ECP is

a foundational document that describes the essential competencies (i.e., the knowledge, skills and

attitudes) required by physiotherapists in Canada at the beginning of and throughout their career. It

also provides guidance for physiotherapists to build on their competencies over time. There are three

levels to the ECP: Roles; Key Competencies; Enabling Competencies. The ECP has 7 roles. Each Role is

comprised of Key Competencies (a total of 23) which are further explained by several Enabling

Competencies. The Rating Scale used in this tool has been modified from the Revised PT CPI : Version

2006 with permission from the APTA.

Instructions to complete the tool:

Please access the online education module <https://app.rehab.utoronto.ca/ACP> to help prepare

you to complete this form to assess the student’s performance for the internship . You will be asked

to observe and consider the student’s performance and complete the tool at midterm and final

points of the clinical education experience.

118

The rating scale and anchor descriptions are on page 4 of the assessment form. You will be asked to

consider the rating scale and anchor descriptions while assessing the student at midterm and final

points of the clinical experience. The student must demonstrate all criteria within an anchor to be

scored at that level. For the anchor “Performance with Distinction”, the student must demonstrate

the first criteria and any additional criteria from the list. Please click on the circle/radio button you

feel best describes your student’s performance . Please do not make any extraneous marks on the

rating scale. In addition, there are comment boxes within the assessment form. You are asked to use the

comment boxes to highlight areas of strength and areas for improvement with regards to the

student’s performance using examples from their clinical work .

As you can see in this assessment form, some key competencies have been grouped and other key

competencies have their own rating scale. There are a total of 21 rating scales and 9 comment

boxes in this assessment form. If you have any questions about completing this student assessment form, please do not hesitate to

contact your university Academic Coordinator or Director of Clinical Education or Brenda Mori,

Department of Physical Therapy, University of Toronto. (Brenda.mori@utoronto.ca

<mailto:Brenda.mori@utoronto.ca> ; phone: 416-946-8646) -------------------------------------------------------------------- 1 National Physiotherapy Advisory Group (October 2009). Essential Competency Profile for Physiotherapists in Canada. Toronto:

Canadian Physiotherapy Association.

2 Use of the Rating Scale Anchors and Descriptors adapted and revised from the PT CPI |Web (Alexandria, VA: American

Physical Therapy Association; 2006) is by nonexclusive license from the American Physical Therapy Association .

119

Rating Scale and Anchor Descriptors* Beginner Performance:

• The student requires close supervision 90-100% of the time managing patients with constant

monitoring even with patients with simple conditions

• The student requires frequent cueing and feedback

• Performance is inconsistent and clinical reasoning is performed at a very basic level

• The student is not able to carry a caseload Advanced Beginner Performance:

• The student requires clinical supervision 75% to 90% of the time managing patients with simple

conditions and 100% of the time managing patients with complex conditions

• The student demonstrates consistency in developing proficiency with simple tasks (eg. chart

review, goniometry, muscle testing and simple interventions)

• The student initiates, but is inconsistent with comprehensive assessments, interventions, and clinical reasoning

• The student will begin to share a caseload with the clinical instructor Intermediate Performance:

• The student requires clinical supervision less than 50% of the time managing patients with simple

conditions and 75% of the time managing patients with complex conditions

• The student is proficient with simple tasks and is developing the ability to consistently

perform comprehensive assessments, interventions, and clinical reasoning.

• The student is capable of maintaining ~ 50% of a full-time physical therapist ’s caseload Advanced Intermediate Performance:

• The student requires clinical supervision less than 25% of the time managing new patients or

patients with complex conditions and is independent managing patients with simple conditions

• The student is consistent and proficient in simple tasks and requires only occasional cueing

for comprehensive assessments, interventions, and clinical reasoning

• The student is capable of maintaining ~75% of a full-time physical therapist ’s caseload Entry Level Performance:

• The student requires infrequent clinical supervision managing patients with simple

conditions and minimal guidance/supervision for patients with complex conditions

• The student consistently performs comprehensive assessments , interventions and clinical

reasoning in simple and complex situations

• The student consults with others and resolves unfamiliar or ambiguous situations

• The student is capable of maintaining at minimum 75% of a full-time physical therapist ’s

120

caseload in a cost-effective manner

Performance with Distinction:

• The student is capable of maintaining 100% of a full-time physical therapist ’s caseload without

clinical supervision or guidance, managing patients with simple or complex conditions, and, is

able to function in unfamiliar or ambiguous situations

In addition, the student demonstrates at least one of the criteria listed below:

• The student is consistently proficient at comprehensive assessments , interventions and clinical reasoning

• The student willingly assumes a leadership role for managing patients with more complex conditions or difficult situations

• The student is capable of supervising others

• The student is capable of serving as a consultant or resource for others

• The student actively contributes to the enhancement of the clinical facility or service with an

expansive view of physical therapy practice and the profession

* Use of the Rating Scale Anchors and Descriptors adapted and revised from the PT CPI |Web (Alexandria, VA: American Physical Therapy Association ;

2006) is by nonexclusive license from the American Physical Therapy Association.

121

1.1 Consults with the client to obtain information about his/her health, associated history, previous health interventions, and

associated outcomes.

1.1.1 Collects and reviews background information relevant to the client’s health.

1.1.2 Determines the client’s expectations related to physiotherapy services.

1.1.3 Collects and reviews health information about the client from other sources (e.g., other sources may include previous health records,

other health care practitioners, professional colleagues, or family).

1.1.4 Collects and reviews information related to the client’s prior functional abilities, physical performance, and participation.

1.1.5 Identifies the client’s personal and environmental factors affecting his/her functional abilities, physical performance, and

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

1.2 Collects assessment data relevant to the client ’s needs and physiotherapy practice.

1.2.1 Selects quantitative and qualitative methods and measures based on evidence-informed practice.

1.2.2 Informs the client of the nature and purpose of assessment as well as any associated significant risk.

1.2.3 Safely performs a physiotherapy assessment, taking into account client consent, known indications, guidelines, limitations and risk-

benefit considerations.

1.2.4 Monitors the client’s health status for significant changes during the course of assessment and takes appropriate actions as

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments:

Final Comments: Please check if you have significant concerns with the student’s performance on these items . Midterm Final

1.0 EXPERT – Focus on Assessment As experts in function and mobility, physiotherapists integrate all of the Physiotherapist Roles to lead in the promotion, improvement, and

maintenance of the mobility, health and well-being of Canadians.

122

1.3 Analyzes assessment findings.

1.3.1 Identifies the nature and extent of the client’s impairments, activity limitations, and participation restrictions within the

context of the client’s needs.

1.3.2 Identifies environmental and personal supports and barriers relevant to the client.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

1.4 Establishes a physiotherapy diagnosis and prognosis.

1.4.1 Formulates a physiotherapy diagnosis based on the analysis of client assessment findings.

1.4.2 Identifies the need for and potential value of intervention by a physiotherapist.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

1.5 Develops and recommends an intervention strategy.

1.5.1 Establishes and prioritizes, with the client, expected outcomes based on the assessment findings and evidence-

informed practice.

1.5.2 Recommends a service approach consistent with the client’s needs, goals and all available resources.

1.5.3 Identifies when physiotherapy services are not required or indicated and refers for other services as appropriate.

1.5.4 Establishes goals that are specific, measurable, action oriented, realistic, and time-specific.

1.5.5 Selects interventions that are evidence-informed and consistent with the client’s goals, general health status, functional

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments:

Final Comments: Please check if you have significant concerns with the student’s performance on these items . Midterm Final

1.0 EXPERT – Focus on Analysis As experts in function and mobility, physiotherapists integrate all of the Physiotherapist Roles to lead in the promotion, improvement, and

maintenance of the mobility, health and well-being of Canadians.

123

Midterm Please check if you have significant concerns with the student’s performance on these items . Final

1.6 Implements intervention.

1.6.1 Orients the client to the practice setting and provides information about relevant service/policies (e.g., location, duration, frequency,

cost; introduce client to all staff involved in their care; expected completion of service).

1.6.2 Performs physiotherapy interventions in accordance with client consent and in a safe and effective manner.

1.6.3 Determines the client’s need for supervision and implements appropriate monitoring during specific physiotherapy

interventions.

1.6.4 Educates the client about health promotion, self-management, and relevant services with respect to his/her unique condition.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

1.7 Evaluates the effectiveness of interventions .

1.7.1 Discusses with the client, the nature, purpose and results of ongoing assessment and outcome evaluations.

1.7.2 Monitors client responses and changes in status during the interventions and modifies intervention accordingly.

1.7.3 Evaluates effectiveness of the intervention strategy on an ongoing basis using appropriate outcome measures.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

1.8 Completes physiotherapy services.

1.8.1 Develops, in consultation with the client, a plan for the completion of physiotherapy services.

1.8.2 Assesses client status prior to the completion of physiotherapy service and compares with initial assessment findings.

1.8.3 Discontinues physiotherapy intervention as planned or upon the client’s request.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments: Final Comments:

1.0 EXPERT – Focus on Intervention As experts in function and mobility, physiotherapists integrate all of the Physiotherapist Roles to lead in the promotion, improvement, and

maintenance of the mobility, health and well-being of Canadians.

124

Midterm Please check if you have significant concerns with the student’s performance on these items . Final

2.1 Develops, builds, and maintains rapport, trust, and ethical professional relationships through effective communication .

2.1.1 Demonstrates sensitivity to the uniqueness of others.

2.1.2 Listens effectively and facilitates discussion to ensure reciprocal exchange of information.

2.1.3 Demonstrates an awareness of self behaviours and the responses of others and adapts communications appropriately.

2.1.4 Respects confidentiality, privacy and autonomy.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

2.2 Elicits, analyzes, records, applies, conveys and shares information.

2.2.1 Seeks out and gathers information from clients and others to assist in shared and informed decision-making.

2.2.2 Encourages and asks clarifying questions.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

2.3 Employs effective and appropriate verbal , non-verbal, written, and electronic communications.

2.3.1 Produces and maintains legible, accurate, and appropriate records, in keeping with regulatory requirements (e.g., may

be written or electronic and relate to clients or equipment).

2.3.2 Effectively presents information about client care and physiotherapy service delivery.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments:

Final Comments:

2.0 COMMUNICATOR Physiotherapists use effective communication to develop professional relationships with clients, families, care providers, and other

stakeholders.

125

Midterm Please check if you have significant concerns with the student’s performance in this role . Final

3.1 Establishes and maintains interprofessional relationships, which foster effective client-centered collaboration.

3.1.1 Demonstrates an understanding of and respects the roles, responsibilities and differing perspectives of team members.

3.1.2 Integrates knowledge and understanding of the physiotherapist role and the roles of others in providing client-centred care.

3.1.3 Consults and shares relevant information with clients, other health professionals, and all relevant individuals or groups in a timely

manner.

3.1.4 Promotes active and informed shared decision making.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

3.2 Collaborates with others to prevent, manage and resolve conflict.

3.2.1 Identifies the issues that may contribute to the development of conflict between the physiotherapist and client or between team

members (e.g., recognizes that one’s own beliefs, perceptions, and values may contribute to interprofessional tension).

3.2.2 Addresses conflicts in a timely manner.

3.2.3 Demonstrates a respectful attitude towards other colleagues and members of an interprofessional team.

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments:

Final Comments:

3.0 COLLABORATOR

Physiotherapists work collaboratively and effectively to promote interprofessional practice and achieve optimal client care.

126

4.1 Manages individual practice effectively .

4.1.1 Understands the structure, funding and function of the health system as it relates to physiotherapy practice.

4.1.2 Provides services considering client needs and allocation of available human, physical and financial resources.

4.1.3 Sets priorities and manages time for provision of client services and general physiotherapy practice delivery.

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mediate

Final

4.2 Manages and supervises personnel involved in the delivery of physiotherapy services.

4.2.1 Assesses, orients, and provides ongoing feedback and continuing education to personnel involved in the delivery of

physiotherapy services.

4.2.2 Assigns tasks to, and monitors, personnel acting within established regulatory guidelines. (Note: If this is not applicable, please state why in the comment box. This is the only item that

does not require a rating in the ACP.)

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Final

4.3 Participates in activities that contribute to safe and effective physiotherapy practice .

4.3.1 Anticipates, recognizes, and prevents hazards in the physical environment (e.g., infection prevention and control; hazardous

waste; electrical safety; equipment).

4.3.2 Delivers physiotherapy services in a safe physical environment for self, other team members, and staff.

4.3.3 Promotes client safety in the selection and application of assessment, intervention and evaluation measures.

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Midterm Comments:

Final Comments:

4.0 MANAGER Physiotherapists manage time, resources, and priorities at all levels for individual practice and to ensure sustainable physiotherapy practice

overall.

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5.1 Works collaboratively to identify , respond to and promote the health needs and concerns of individual clients, populations, and

communities.

5.1.1 Collaborates with clients and other care providers to understand, identify and promote the health and physiotherapy needs and

concerns of clients/client populations.

5.1.2 Speaks out on health issues identified by clients and, together with other health care providers/team members, empowers client’s to

speak on their own behalf.

5.1.3 Understands the limits and opportunities within the practice setting to address health issues, and works collaboratively to

develop strategies to optimize client care (e.g., Supports clients to access timely and affordable service; assists clients to navigate and

coordinate the health care system).

5.1.4 Identifies the determinants of health of clients/client populations and understands factors that act as barriers to accessing services

and resources.

5.1.5 Describes the role of the physiotherapy profession in advocating for health and safety.

5.1.6 Uses opportunities to communicate the role and benefits of physiotherapy to enhance individual and community health

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Final

Midterm Comments:

Final Comments:

Please check if you have significant concerns with the student’s performance in this role . Midterm Final

5.0 ADVOCATE Physiotherapists responsibly use their knowledge and expertise to promote the health and well-being of individual clients, communities,

populations and the profession.

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6.1 Uses a reflective approach to practice.

6.1.1 Utilizes self-evaluation and feedback from clients and other providers to reflect upon actions and decisions to continuously improve

knowledge and skills.

6.1.2 Uses a problem-solving approach to make decisions and take action.

6.1.3 Recognizes and takes into account how own background, education, experiences, perspectives, values and beliefs impact on decision-

making.

6.2 Incorporates lifelong learning and experiences into best practice.

6.2.1 Engages in professional development and lifelong learning activities (e.g., actively participates in the acquisition of new knowledge

and skills; integrates new knowledge, skills and behaviours into practice).

6.2.2 Incorporates own experiences, education, research, and best available resources to plan and deliver physiotherapy services.

6.3 Engages in scholarly inquiry.

6.3.1 Uses the principles of research, research ethics, and research methods to advance practice (e.g., critically appraises literature;

conducts a systematic search for evidence).

6.3.2 Engages in activities that support clinical research (e.g., collecting and/or analysing data; integrating and/or disseminating

Beginner Advanced Inter- Advanced Entry With

Beginner mediate Inter- Level Distinction

Midterm

mediate

Final

Midterm Comments: Final Comments:

Please check if you have significant concerns with the student’s performance in this role . Midterm Final

6.0 SCHOLARLY PRACTITIONER Physiotherapists are committed to ongoing learning for the purpose of improving client outcomes through seeking, creating, applying,

disseminating, and translating knowledge to physiotherapy practice.

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7.1 Conducts self within legal/ethical requirements.

7.1.1 Provides services within physiotherapy scope of practice and personal competence.

7.1.2 Maintains a professional therapeutic relationship with clients (e.g., maintains professional boundaries, integrity and acts in the best

interest of the client).

7.1.3 Provides services upholding professional ethical values (e.g., adheres to professional codes of ethics and standards of practice

when making decisions with client).

7.1.4 Informs the client regarding all uses of collected personal and health data and obtains client consent.

7.1.5 Maintains client confidentiality/privacy as required by applicable legislation.

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7.2 Respects the individuality and autonomy of the client.

7.2.1 Demonstrates sensitivity to and respect for each client’s rights, dignity, and uniqueness.

7.2.2 Treats the client with respect and empowers the client in expressing individual needs.

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7.3 Contributes to the development of the physiotherapy profession.

7.3.1 Contributes to the learning of others (e.g., supports student clinical education; supports colleagues through feedback, mentorship,

and knowledge transfer).

7.3.2 Engages in activities that support the development of the profession of physiotherapy (e.g., participates in in-service

presentations, local and national conferences, professional committees, and public education of

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Final

Midterm Comments: Final Comments:

Please check if you have significant concerns with the student’s performance in this role . Midterm Final

7.0 PROFESSIONAL Physiotherapists are committed to the best interests of clients and society through ethical practice, support of profession-led regulation,

and high personal standards of behaviour.

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MIDTERM ASSESSMENT Areas

of Strength:

Areas for Improvement:

Other Comments:

SUMMATIVE COMMENTS

FINAL ASSESSMENT

Areas of Strength:

Areas for

Improvement: Other

Comments:

Please select one of the following boxes with your recommendation regarding the student’s overall performance .

This recommendation, along with the completed ACP, will be taken into account by the university faculty when assigning the final

grade for the course.

Midterm: Final: Definitions:

Credit - student’s performance meets expectations for a student at that experience level

Credit with exceptional performance - student's overall performance is exceptional and exceeds expectations for a student at that

experience level

Credit with reservation - student’s performance is borderline , demonstrating areas of weakness that may require remediation

No Credit - student consistently performs below the expected level and/or demonstrates significant deficits in professionalism,

communication, safety or clinical reasoning

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Demographic Information

Clinical placement hours: Please consider the time the student was at your facility.

How many weeks was this clinical placement?

Placement Week: 0.00

How many hours were worked per week at your setting? Hours Per Week: 0.00

Hours absent:

Hours Absent: 0.00

Make-up time completed in lieu of hours missed:

Make-up Hours: 0.00

Extra hours worked:

Extra Hours Worked: 0.00

Practice Setting: Please enter a percentage for each practice setting. Total response must add to 100%.

Acute care hospital: 0.00

Rehabilitation hospital/facility: 0.00

Long term care facility: 0.00

Community care/Home care: 0.00

Ambulatory (out-patient) Care - Public sector: 0.00

Ambulatory (out-patient) Care - Private sector: 0.00

Other (please specify): 0 0.00

Area of practice: Please enter a percentage for each area of practice. Total response must add to 100%. Cardiopulmonary: 0.00

Musculoskeletal/orthopaedics: 0.00

Neurology/Neurosciences: 0.00

Non-patient care internship (e.g., Administration, Research): 0.00

Please indicate if this placement included opportunities to work with the following specialty areas of practice (check all that apply):

Women’s health (including pelvic floor rehabilitation)

Pain

Oncology

Burns/wound care

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Rheumatology

Hand therapy/plastic surgery

Vestibular

Sports

Other (please specify)

Patient Age Group: Please enter a percentage for each patient age group. Total response must add to 100%.

0-17 years: 0.00

18-64 years: 0.00

65 years and older: 0.00

ADDITIONAL REQUIREMENTS may be completed during the clinical placement .

If this is applicable, please indicate the additional requirements and comment on the topic, and quality of performance.

Presentation

Reflective assignment

Article Review

Other (please specify): ADDITIONAL REQUIREMENTS:

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Appendix F: ACP Grading Resource This resource document was developed as a supplement to facilitate completion of the ACP. This resource

is an addendum to the ACP online module which is the most comprehensive resource for

instructions on how to interpret and complete the ACP. https://app.rehab.utoronto.ca/ACP Frequently Asked Questions What do you mean by entry level performance on the rating scale?

Rating a student at entry level signifies that the student can carry, at minimum, 75% of a typical caseload for

your service/area/clinic within the scheduled day and requires guidance only in situations where there are

multiple factors and complexities. The student is able to safely and effectively manage situations that are new

and/or ambiguous. The student is also observed to safely and effectively demonstrate entry-level performance

for all key competencies while carrying 75% (or greater) of a typical caseload. During the most senior level

internships, students are expected to attain “Entry Level Performance” on the ACP in each of the seven (7) roles.

How does “Entry Level Performance” on the rating scale apply to roles other than Expert?

Some CIs have observed, “My student is on his/her first internship and is seeing ~4 patients a day. He/she

communicates and collaborates very well with patients and colleagues. Why can’t I rate this student at

entry level?”

The reason this student would not be scored at entry level is because the CI has observed the student’s

performance with a reduced caseload only. While the CI might wish to extrapolate how the student might

perform if he/she were carrying a full caseload, there are added complexities and efficiencies that would also be

expected with managing an increased caseload. The demands if a junior student were to manage an entry-level

caseload may impact performance in all roles. In using the ACP, CIs are required to rate actual observation of

student performance without extrapolation or projection of anticipated performance in the context of higher

demands. CIs are able to use the comment boxes to expand on student strengths, including examples of

behaviours that CIs have observed. An ACP scoring guide matrix has been developed to provide examples of sample student behaviours for each

item at each anchored level of the ACP rating scale. The scoring guide matrix contains examples only, and

should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their

own context.

What’s the difference between distinction and exceptional? The far right-hand anchor of the ACP rating scale for

each key competency indicates “with distinction”. This “with distinction” rating is applied only to a student who

is managing a full (100%) caseload and takes on a leadership role, or can supervise others, or manages multi-

factorial, complex situations; and therefore the service/unit where the student is working is enhanced by the

student’s contribution to that service/unit. The ACP scoring guide matrix provides some examples of

performance with distinction that will help guide you in rating your student. The rating scale anchor “with

distinction” is the highest rating on the rating scale and is

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intended to reflect student clinical performance beyond entry level expectations. At the end of the ACP, clinical instructors are asked to make a recommendation regarding the student’s overall

performance which will be reviewed by the university when assigning the student’s final grade. The highest

recommended grading by the CI on the student’s overall performance would be “Credit with exceptional

performance”. This descriptor may be applied to any student who surpasses the CI’s expectations of a student

at his/her experience level. The student may be completing his/her first internship, and if the student has

performed very well (for example, carrying a caseload greater than expected or continually “going above and

beyond” for his/her patients) then the CI could recommend “Credit with exceptional performance” even with

rating scale scores at "Advanced Beginner" level. The student does not have to be rated “with distinction” on

the rating scale in order to receive a summative overall recommendation of credit with exceptional performance.

The “With Distinction” rating should be reserved only for those students who exceed entry level performance.

Safety is really important to me in how the student provides care. Where do I capture safety in the ACP? In the

ACP, the student’s ability to provide safe care is principally captured under the Manager role in item 4.3

“Participates in activities that contribute to safe and effective physiotherapy practice”. This includes that the

student is able to provide safe and effective care with respect to the physical environment, self and other team

members, patient care and participates in quality improvement and client safety initiatives. However, for

specific safety elements of patient assessment and intervention,

see enabling competencies under the Expert role, specifically 1.2.3 and 1.6.2, respectively. How do I capture the student’s ability to provide education to patients and others? The student's ability to

educate patients and others can be captured under the Communication role in item 2.1 “Develops, builds, and

maintains rapport, trust, and ethical professional relationships through effective communication.” This key

competency encompasses the student’s ability to demonstrate sensitivity while exchanging information,

respecting confidentiality and privacy, and also ensuring an awareness of their own behaviours. Alternatively, it

can be captured under the Expert role in enabling competency

1.6.4 if the education the student is providing relates to health promotion or patient self-management.

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

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Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Communi- cator 2.1

Requires cueing to maintain eye contact, and/or actively listen to patients.

Effectively communicates with others once the student has taken time to plan the interaction with guidance and support.

Builds and maintains rapport in predictable encounters with patients, families and others in the health care facility.

Uses appropriate verbal and non-verbal communication by adapting the communication style based on the needs of the receiver. Effectively establishes rapport and trusting relationships.

Uses appropriate verbal and non-verbal communication when establishing relationships to demonstrate sensitivity and respect in complex and/or challenging situations.

Mentors and coaches others about how to most effectively establish rapport with patients and team members.

Communi- cator 2.2

Requires probes and guidance to gather and share information about patients with CI or the team.

Initiates the exchange of information but requires cueing to focus on the most relevant and concise information.

Reports appropriate basic/essential information (e.g. at patient care rounds) for straightforward cases. Seeks out and clarifies information with the team.

Participates in the exchange of information about the caseload but is occasionally missing minor details and takes slightly more time.

Participates in the exchange of information about the caseload independently in complex and/or challenging information sharing situations.

Shares information in a confident, relevant and appropriate manner with professionals external to the clinical facility or patients/ families in delicate or challenging situations.

Communi- cator 2.3

Requires frequent corrections; notes are completed in draft before being transcribed into the patient care record.

Completes a chart review for a straightforward patient with few minor errors. Patient notes for routine situations include required information.

Consistently documents care for straightforward cases and situations.

Creates and maintains records for complex patient care situations with minimal errors and minimal cueing.

Effectively and efficiently creates and maintains concise and comprehensive notes without errors for all patients and situations.

Independently constructs detailed and appropriate reports (e.g., for third-party payers).

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

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Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Collaborator 3.1

Requires guidance in identifying the most appropriate team members for collaboration with respect to patient care.

Describes the roles, responsibilities and perspectives of team members.

Actively seeks and shares information but requires cueing to effectively participate in shared decision-making processes.

Actively participates in discussions (e.g., at patient care rounds) but requires guidance to contribute to important decisions about patient care.

Effectively participates in and facilitates exchange of information between patients, families and team members (e.g., in a family- team meeting).

Effectively optimizes collaborative patient care when there are contentious issues: e.g., a challenging family- team meeting.

Collaborator 3.2

Requires cueing to identify when there are conflicting priorities and values.

Identifies competing priorities or conflicting value systems; may need assistance to identify possible solutions.

With the CI, recognizes and discusses competing priorities with patient care or team dynamics; however, may need assistance to determine the best solution.

With prompting, the student can rehearse a discussion with their CI in preparation for a discussion with a team member regarding a conflict (e.g., scheduling).

Can politely and respectfully discuss with the patient, or others involved in their care when misunderstandings arise and collaboratively seeks a solution (e.g., if the patient is consistently late or non- adherent).

Recognizes and manages conflict in a thoughtful, productive, and collaborative manner.

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

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Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Manager 4.1 Has difficulty managing own time in carrying out client services. The student is unsure of how to prioritize patients or required tasks. May not always be punctual and dependable.

Consistently is punctual. Starting to understand time management and patient prioritization principles. Shares caseload with CI and may be managing 20- 25% of caseload with up to 90% supervision.

Understands various models of PT service delivery. Able to effectively manage time with up to a 50% caseload with between 50 and 75% supervision. Is able to prioritize patients to be seen each day. Takes initiative to screen patients and plan for new assessments.

Effectively manages time with up to a 75% caseload and coordinates with other staff as needed. Appropriately allocates time for patient care considering patient and health system resources. Liaises with external agencies (funders or insurers).

Manages all aspects of a required caseload (minimum 75%) including screening, assessment, treatment, discharge planning and follow up. Takes initiative and prioritizes independently when planning and coordinating the day and with other staff/health care providers.

Independently performs all tasks associated with managing 100% of full time experienced PT caseload. PT practice is proficient, and student shows innovation in managing individual practice and understanding of the health care system.

Manager 4.2 Does not consider assignment of tasks to support personnel.

Is aware of roles of support personnel, and may begin to determine which tasks would be appropriate for assignment.

Assigns simple tasks to support personnel. Needs reminders to follow-up and ensure that assigned tasks are completed.

Assigns appropriate tasks to support personnel with appropriate assessment and follow up.

Assigns appropriate tasks to support personnel and takes responsibility for assessment and follow up. Is accountable for all actions.

Is fully capable of supervising support level staff. Is accountable for all actions and can effectively troubleshoot matters with support personnel.

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

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Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Manager 4.3 Requires constant monitoring to attend to routine safety matters in the physical environment (e.g. frequently forgets brakes on wheelchair, doesn’t wash hands consistently).

Is aware of maintaining a safe work environment. Requires some cueing to prevent hazards. May have minor patient safety infractions that are addressed and not repeated.

Usually delivers patient care in a careful and safe manner. Observes health and safety regulations in professional dress and footwear. May have minor lapses in safety in complex situations that are not repeated.

Consistently maintains a safe work environment for patients, self and other staff. Provides patient care safely for both patients and self.

Anticipates hazards and maintains a safe work environment. Is cognizant of and actively promotes patient safety.

Independently takes on new initiatives to improve service delivery or patient care from a quality improvement perspective.

Advocate 5.1

Has difficulty identifying advocacy opportunities; unable to initiate advocacy actions without support.

Identifies advocacy opportunities with respect to individual clients (e.g., delaying discharge) or the profession, identifying the actions as distinct from usual team communication and collaboration. Requires some cueing to channel advocacy efforts appropriately.

Initiates advocacy strategies that are beyond the standard communicator and collaborator roles; Advocacy is typically focused on individual clients or the profession.

Demonstrates initiative in advocating on behalf of individual clients or the profession: e.g., advocating for a patient to receive services from another profession or community resource.

Confidently initiates and executes advocacy for individual clients or the profession. Insight into opportunities to advocate for health of client populations or communities is well developed (even if little or no opportunity to execute strategies).

Initiates insightful advocacy strategies on behalf of client populations or communities that demonstrate an advanced understanding of social determinants of health, health system issues, health promotion or related concepts.

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

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Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Scholarly Practitioner 6.1, 6.2 and 6.3

Requires direction to self- reflect, seek out relevant new knowledge and evidence to practice existing or new clinical skills. May demonstrate some defensiveness to constructive feedback.

Beginning to incorporate feedback and reflect on performance as well as to seek out new knowledge, skills and evidence. Requires cueing to integrate new knowledge, skills and evidence into practice.

Often applies principles of research and engages in literature searches. Draws on own experiences to inform the delivery of PT services.

Demonstrates self- awareness and insightful intention toward self- improvement.

Actively and independently seeks out new knowledge and skills. Incorporates the feedback of others and own beliefs and values to improve own practice.

Consistently reflects on performance and actively seeks out new knowledge and skill to consistently improve practice. Consistently uses best practices to deliver PT services and advance their practice.

Actively seeks out new knowledge and skills, readily shares new found knowledge with peers/co-workers. Critically questions current practice and seeks out evidence to support better ways of delivering PT services.

Professional 7.1

Requires cueing to ensure all legal requirements (e.g., consent, privacy) are met and professional boundaries are not crossed.

Shows awareness of relevant ethics, laws and professional standards and achieves adherence in straightforward situations. May have minor infractions that are addressed and not repeated.

Maintains professional conduct and ethical standards in straightforward situations; identifies potential breaches of professionalism although may require assistance in troubleshooting.

Independently assures that consent is obtained and privacy maintained in accordance with law. Maintains professional conduct and ethical standards in straightforward situations.

Independently takes action to ensure all legal requirements and professional practice standards are met in a responsible and accountable manner.

Able to identify, discuss and resolve challenging ethical and/or professional dilemmas.

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ACP Grading Resource (Version 2016-04-18) The scoring guide matrix contains examples only, and should not be viewed as comprehensive criteria. CIs may adapt the guiding examples to be suitable for their own context.

ACP Grading Resource Consider the student’s performance across these dimensions: QUALITY OF CARE SUPERVISION/GUIDANCE REQUIRED CONSISTENCY OF PERFORMANCE COMPLEXITY OF TASKS EFFICIENCY OF PERFORMANCE

Some Example Student Behaviours

Role

Beginner Requires almost constant supervision and very frequent guidance and cueing…”

Advanced Beginner “Starting to be independent with simple patients for a small caseload and requiring frequent cueing/guidance… “

Intermediate “For ~50% of a caseload, relatively independent with simple patients, but more guidance in complex situations…”

Advanced Intermediate “For a caseload of 50- 75%, proficient in simple tasks and requires only occasional cueing for patients with complex conditions…

Entry Level “Manages a minimum of a 75% caseload, with consistency, comprehensiveness and efficiency…”

With Distinction “Exceeds entry level performance by carrying a full caseload and …”

Professional 7.2

Requires cueing to appropriately express respect for individuality and autonomy of clients, including respect for professional appearance and any applicable dress codes. May demonstrate discomfort when interacting with a person who is different or from another culture.

Consistently dresses appropriately. Beginning to express outward action for respecting each client’s individuality and autonomy in straightforward situations (e.g., may develop a PT plan without always considering beliefs and practices related to health and healing for that unique person/culture).

Identifies situations that require insightful sensitivity, but may need assistance for how to convey respect to clients appropriately and completely.

Independently assures that clients' rights, dignity and uniqueness are respected in straightforward situations. Requires guidance to explore solutions for culturally complex situations (e.g., respecting religious or cultural values that may require significant adaptations to care).

Independently takes action to ensure an environment of cultural safety. Ensures clients have their individuality and autonomy respected, and clients of all cultures are empowered to express their needs.

Takes leadership and demonstrates exemplary conduct in situations requiring insight, sensitivity and/or cultural competence. Demonstrates high regard for the need to develop practices that enhance culturally competent care. Professional

7.3

Conveys enthusiasm for the physiotherapy profession and the learning of others; requires direction to make meaningful contributions.

Demonstrates awareness of issues in the physiotherapy profession, but may require guidance to contribute in local learning opportunities (e.g., in-services, or peer-assisted learning with other students)

Engages in actions that support the profession or others' learning (e.g., contributions to discussion or presentation at in- services, helping other students learn).

Independently follows through on readily available opportunities to develop the physiotherapy profession through discussion, teaching or mentorship of others.

Independently initiates action to promote or advance the physiotherapy profession through discussion with, or teaching of others.

Takes a lead role in activities that develop the profession, and/or provides mentorship to others.