Department of Nursing, Health and Professional Practice

1

Department of Nursing, Health and Professional Practice

MSc Advanced Clinical Practice

Work Place Learning for

Advanced Clinical Practice Handbook

March 2021

Cohort

2

CONTENTS

CONTENTS Introduction 3 About the Work Place Practice Profile 5 Capability profile assessment 9 Domain1: Clinical Practice Domain 2: Leadership and Management Domain 3: Education Domain 4: Research Demonstration of Practice form (DOP) 17 Mini Clinical Evaluation of Practice form 19 Physical Examination proforma 21 Logging Practice Hours Form 35 Patient Questionnaire 38-39 Learning Contract 41 Practice review summaries 44 Learning in Practice Log 51 Appendix 1: Learning in Practice Flow Chart 52 Appendix 2: Example Capability Profile 55 Appendix 3: Example Logging Practice Hours Form 57 Appendix 4: Example Learning Contract 59 Appendix 5: Example Learning in Practice Log 62

3

Introducing the Work Place Learning Documents for Advanced Clinical Practice The recent Health Education England (2017) review defines advanced clinical practice as: ‘Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence. Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes.’ HEE (2017, p8) The MSc Advanced Clinical Practice at the University of Cumbria enables you to develop competence and confidence so that you are fit for purpose, fit for role and fit for award. Work place learning in practice is integral to achieving this and fitness for purpose and fitness for role is assessed by your facilitator in the practice environment. This Work place Learning for Advanced Clinical Practice Handbook has been prepared to provide a framework to help direct this process. When completed, these documents will provide a record of your learning in practice and achievement as an advanced clinical practitioner. The evidence will be used to demonstrate that you have met the requirements of the programme, which you are required to pass for successful completion of your programme of study. The Work Place Learning for Advanced Clinical Practice Document incorporates:

Pillars of Practice Capability profile (compulsory)

Physical assessment proformas which inform Demonstration of Practice (DOPs) (compulsory)

Mini-CEP (Clinical Evaluation of Practice) (compulsory)

Practice Review Summary Records (compulsory)

Log of minimum 500 Practice Hours (compulsory)

Learning Contracts (optional)

Learning in Practice log or diary (optional) A flow chart is included to help you use these documents at appropriate time points (Appendix 1). We do recommend that you commit 5 hours per week to learning in practice (with 1.5 hours dedicated to working with your facilitator or their deputy), focusing initially on health assessment / differential diagnosis and progressing your development in clinical decision making, and the demonstration of the advanced practitioner role, as this has been defined by the domains and associated capabilities in this profile. You will undertake two qualificatory practice modules: the first unit sub divided into 6 stages which supports your experiences in clinical practice and the second a series of summative qualificatory OSCEs (Objective Structured Clinical Examinations). Whilst non-credit bearing, these both have to be completed successfully alongside the academic

4

modules during the first two years of the MSc Programme. Successful completion will be noted on your University Transcript. If you fail the Qualificatory Practice Units (after all attempts have been exhausted) you will not be awarded the RCN award and your award will be a PGDip Healthcare which will reflect the academic attainment achieved. Information supporting the way you will use the 5 hours in practice is available to you in the Module Handbook and the Programme Specification. They are also available in the Facilitator Handbook. The learning outcomes for the programme are in the Programme Handbook. These outcomes can be used to further guide you and your facilitator. If you have any queries, please do not hesitate to contact your Personal Tutor (PT). For general queries and administrative matters please initially contact our Student and Academic Administration Services (SAAS) via [email protected] Prior to explaining how your development in practice is assessed, you are reminded that the University of Cumbria is not responsible for arranging placements within which your practice learning takes place. You will have already completed a Learning Environment Pre-course Assessment Tool (LEPAT). The University of Cumbria will expect you and your employer to have suitable arrangements for you to learn with appropriate supervision within an appropriate contract of employment and indemnity. If and when you need to negotiate an alternative placement to enhance your learning, the University of Cumbria expects you to ensure that necessary arrangements are in place. The same expectation applies in respect of securing an honorary contract. It is expected that you will uphold the standards of your professional code of conduct and work within the policies and procedures of your employer or clinical placement at all times. The programme team is committed to monitoring the quality of placement learning. To this effect, on an annual basis you will be required to complete an evaluation of your practice based learning experience. Individual student evaluations are summarized and used to provide feedback to practice settings in order that best practice as it concerns learning in practice is recognised and disseminated. Kathy Haigh Programme Leader: MSc Advanced Clinical Practice Tel: 01524 590800 ext 2241 07581592554 [email protected]

mailto:[email protected]

mailto:[email protected]

5

Workplace Learning for Advanced Clinical Practice Capability Profile The capability profile is organized under four domain headings (Pillars of Practice). These headings are taken from the Multi-professional framework for advanced clinical practice in England (Health Education England, 2017) whose 38 statements define the scope, level and capabilities of practitioners working at an advanced level. You need to become familiar with the capabilities and the domains to which they belong. The statements are generalised which means that you and your facilitator are required to interpret them for your practice area and your role. Over the course of years 1 and 2, you are likely to develop greater depth of knowledge and skills and therefore your interpretation of the capabilities within the domains may change, or you may select different evidence as you progress. This is to be expected, and it demonstrates your progression, even within a capability you feel you have met at the start of the programme. Everything you learn and do on the programme in years 1 and 2 relates to the domains, and you are supported in the process of generating the evidence needed to meet the minimum standards, through your practice and the associated theoretical development within the academic modules. Students practising in Scotland or Wales will be able to demonstrate equivalent capability across their national standards as they are essentially similar across all key domains of practice. However, students are advised to keep records of meeting capabilities using their own national guidance. For this programme the Health Education England (2017) documentation is used. When you look at the Capability Profile you will see that three assessment points are indicated:

1. Initial: Following the course induction you will undertake a self-assessment which will be discussed and completed by early May with your facilitator. This is your baseline.

2. Mid-point: This is your mid-point assessment and should be completed by end of February before entering your second year of the programme

3. Final: This is the final assessment to be completed at the early January in year 2 prior to

the OSCE in September. At the Initial Baseline, a self-assessment is conducted. You need to look at all the capability statements and decide whether you achieve them or not. Remember that this is a work in progress until the end of year 2. At this stage the purpose is primarily as a self-assessment and a guide to direct your learning in practice. Record your assessment by placing a tick or a cross in the relevant box (see example in Appendix 2). If there are gaps in your capability, it would be expected. You just need to work out how and when you plan address these gaps. It is also expected that even if you deem yourself to be meeting the standard at this stage (i.e. you are able to tick the capability statement) you will develop further knowledge and skills in the area, or a new and different area of practice, over the course of the two years. One purpose of this early self-assessment is to generate discussion with your facilitator, and to show your progression over time. We expect you to show your assessment to your facilitator to use as a tool for both of you, and to guide your subsequent learning plan. You and your facilitator should sign off each of the domains. Your capability profile is a working document; use it to keep track of your progress. A review of

6

your progression where your facilitator will discuss any further capabilities that can be signed off, and also plan your learning going into the next stage. At the Mid-point review you and your facilitator again engage in a joint process assessing whether you have achieved each capability statement. Once again the boxes are only ‘ticked’ or ‘crossed’ but you are both expected to sign off each of the domains. Again, it is unlikely that you will have achieved all capabilities at this stage. It is an opportunity to review your progress and update your plans to address the gaps. Your capability profile will demonstrate the development of your abilities / confidence over time. Therefore if a capability was claimed on initial assessment, for example, it will need to be claimed again at mid-point and final reviews. At the Final review, all capability statements must be achieved and there must be evidence to support the claim. Each capability achieved should be initialled by you and your facilitator. When all capabilities in one domain are achieved, the domain should be signed off by student and facilitator. As you progress through the programme, you will be preparing evidence to support your claim for each capability. There are many types of evidence that you can produce. You will be given more guidance for the preparation of suitable evidence. It is imperative that you do not at any time breach confidentiality (see the relevant Appendix in your Programme Handbook). Your progress with the capabilities will be discussed during Practice Reviews with your Facilitator and also with your Personal Tutor.

Physical Examination proformas: These proformas can be used as an aide memoire whilst you are learning and should be used by your facilitator or their deputy to support your examination skills development. These are the minimum standard you are expected to be able to demonstrate and will form the basis upon which your Demonstration of Practice (DOPs) will be assessed. You should be learning the examinations throughout the first year as guided within the Qualificatory Practice Unit and will be asked at the practice reviews how your skills are developing. You may find that you progress quickly and are competent in undertaking many of the physical examinations within your first year. It is important that you are assessed as competent by the completion of year 2 of the QPU. A successfully achieved DOPs form for each physical examination must be completed and signed by your facilitator or their deputy prior to your OSCEs and be presented with the rest of the completed Workplace Learning in Advanced Clinical Practice documentation. This demonstrates that you are competent in the full range of physical examinations you are likely to meet in practice.

Log of Clinical Practice Hours The Log of Practice Hours form presents a means to account for your learning experiences in practice over your first and second year of study. You may if you wish develop your own system to account for your learning time but we do advise that you evidence your learning and clinical experience as it will support your discussions with your facilitator and act as evidence that you meet your capability profile. You are required to record a minimum of 500 hours within the first 2 years, this equates to 5 hours per week in your advanced clinical practice role as this will help to illustrate the breadth and variety of clinical experience and patient presentations, highlight where there are

7

gaps and help you instigate an action plan to address this. You would not be penalised for recording more! We cannot emphasize enough that there is no substitute for clinical experience and if you are not able to log regular practice hours, this could have a detrimental impact on your learning and clinical skills that regular exposure to a wide range of conditions, presentations and their clinical management provides. You may need to have a discussion with your manager as well as your facilitator, and it is also your responsibility to keep your personal tutor informed of any problems as they occur. We do not expect to encounter major problems that we are unaware of at the practice review stage. As well as logging actual time, you should provide brief details of the learning situations, environments or experiences themselves. Each entry should be initialled off by your facilitator or the person facilitating that learning experience. You should keep a separate log of the hours spent with your facilitator. It is recommended that your facilitator (or their designated deputy) provide an average of 1.5 hours per week in direct support of your learning. This time can be spent in any ways deemed appropriate for your development. They are likely to begin with direct teaching and tutorials, but they will also include supervised practice, discussions, assessment and negotiations about meeting the capabilities outlined in the document. The log will be reviewed by your PT at the end of each stage, to explore how you are gaining a wide range of clinical experience. An example of how to complete your learning hours log is included (Appendix 3). Patient Questionnaire One of the best ways to inform personal practice is through feedback from patients in your care. As part of your learning in practice, you will undertake a patient questionnaire at five points during the QPU which will provide good evidence of your development and progress over time and will be discussed during your practice review with your PT. The first will be completed by you before practice review 2, with a minimum of three before each of the following practice reviews by the end of year 2. This will provide you with a minimum of 15 patient questionnaires to provide feedback on your practice and will also provide excellent evidence for professional revalidation. Of course, this is the minimum and you would not be penalised for undertaking more.

Learning Contract Regular assessment of your progress in practice will help you identify capabilities that are difficult for you to achieve. This is where a learning contract drawn up with your facilitator may prove useful. A learning contract is a structured way of addressing a learning need. You should use a learning contract as evidence that you are planning how you will achieve your learning needs. Using a learning contract will help you and your facilitator plan and evaluate your progress in particularly significant areas of learning. You don’t have to identify all your learning needs within learning contracts. Students often start with history taking and physical examination skills; they are the building blocks of your developing role. An example learning contract is provided (Appendix 4). If you don’t like its format you can create your own. Guidance on how to develop and use learning contracts will be available from the programme team. It is important that both your facilitator and personal tutor know what your learning needs are. So show them the contract. It could be that you are being unrealistic in what you want to achieve right now. They can guide you.

8

Practice Reviews The practice review is designed to facilitate your learning in practice over time and provides documentary evidence of your progress. The practice reviews are carried out at six specified time points for your programme. These are compulsory elements of the QPU, and must be completed by the date specified by the programme team. Three of the practice reviews also coincide with your initial, mid-point and final capability assessment. Practice review 1 – May Year 1 Following the course induction, you should arrange to meet with your facilitator to complete the first practice review and discuss your initial capability self-assessment. This forms your baseline from which you can plan how you will develop your practice. There are prompts on the practice review record to help you and your facilitator to focus on your current practice and how this can be developed. Both you and your facilitator will then sign the Practice Review Summary record. You will be given dates and times of appointments that are available with your PT. These will be conducted over the phone and include further discussion of your progress to date and your initial capability review. Once this has been has completed, the review summary record made by your PT will be sent to you by email for your records. You then need to keep copies of these reviews to be submitted as part of your evidence for meeting the required work place learning for the QPU. Practice review 2 - October Year 1 This is a review with your facilitator and PT where your ongoing progress can be documented and further learning needs identified. For example, your progress with your DOPs and preparation to undertake your 2 Mini-CEPS by the end of year 1. You should complete the 2nd practice review documentation as before and keep with your work place learning records. Practice review 3 – February Year 1 This review takes place towards the end of Year 1 and also includes the Mid-point Capability document assessment with your facilitator. You should also have completed your 2 Mini-CEP assessments at this point. There is further discussion with your PT and the 3rd practice review documentation completed and signed by yourself, your facilitator and your PT. Keep these records safe as they are a record of your progress and submitted as part of the QPU. Practice reviews 4 and 5 - Year 2 These reviews is undertaken in June and October (respectively) with your facilitator as you settle into and progress through your second year on programme. There is further telephone review with your PT and completion of the 4th and 5th Practice review summary records. Your discussions at 5th practice review may, for example, include your preparation for completion of the final 2 Mini-CEPs as well as progress made in completing all the physical examination DOPS forms.

9

Practice review 6 – Final review – January end Year 2 This is the final review with your facilitator where you should be able to complete your capability assessment profile to ensure you meet the standards for advanced clinical practice. At this point, you will have completed all the physical examination DOPs forms, logged a minimum of 500 clinical practice hours, the 4 mini-CEPs forms and a minimum of 15 patient questionnaires. The final practice review summary record should be completed and kept with the remaining records of the QPU. These records are important and are submitted to the university as evidence you have met the learning outcomes for HPHA9004.

Learning in Practice Log The Learning in Practice Log is not compulsory, but its completion will help you to ensure that you develop skills across the different elements of the domains and maintain a breadth to your developing capabilities. By using this it may become obvious that you have little experience in one particular area e.g. treating acutely ill individuals or people with a respiratory problem. An example of how to complete this form is in Appendix 5.

Capability Profile Assessment Document The standards of advanced clinical practice described below define the scope and level of practice required of advanced clinical practitioners. They are benchmark statements designed to protect the public and ensure safe care, and have been developed by various stakeholders, including NHS employers, professional organisations, regulatory bodies and educationalists. The capability statements are not specific in that they define a particular methodology or approach to care, but rather, in broad terms, they identify types of activities and skills necessary to practice at an advanced level. With this in mind, it is important to discuss, negotiate and interpret what each statement means in specific practice settings and within different organisations. Specific capabilities are identified within the programme e.g. physical examination, history taking, diagnostic and treatment skills. However, the domains also specify a broad range of advanced clinical practice skills such as leadership, interdisciplinary working, innovation and service redesign and you will be required to develop your knowledge and skills across all domains and produce extensive documentary evidence through the completion of your QPU. The completion of your workplace learning profile at the end of year 2 coincides with the summative sign off with your facilitator, and it is useful to incorporate the two by using your developing profile to generate the discussions needed to complete your assessment with your facilitator. The standards should continue to be a useful framework post qualifying as you supplement this capability statement with additional evidence relevant to your practice as required, and as the role develops over time. This is not required as part of this programme, but it may be a useful way of compiling evidence for your continuing professional development and ultimately for re-validation, where this is necessary. Other summative elements of your Workplace Learning Profile include Demonstration of Practice (DOP) and Mini – Clinical Evaluation of Practice (Mini-CEP) assessments. These are an important part of your profile, contribute to evidence of achievement of your capabilities and alongside critical reflection will support your development over time.

10

Health Education England (2017): Multi-professional framework for advanced clinical practice in England

Domain / Capability Statement Initial Mid point

Final

1.Clinical Practice or X or X Student’s Initials

Facilitator‘s Initials

1.1 Practise in compliance with their respective code of professional conduct and

within their scope of practice, being responsible and accountable for their decisions, actions and omissions at this level of practice.

1.2 Demonstrate a critical understanding of their broadened level of responsibility

and autonomy and the limits of own competence and professional scope of practice, including when working with complexity, risk, uncertainty and incomplete information.

1.3 Act on professional judgement about when to seek help, demonstrating critical

reflection on own practice, self-awareness, emotional intelligence, and openness to change.

1.4 Work in partnership with individuals, families and carers, using a range of

assessment methods as appropriate (e.g. of history-taking; holistic assessment; identifying risk factors; mental health assessments; requesting, undertaking and/or interpreting diagnostic tests; and conducting health needs assessments).

1.5 Demonstrate effective communication skills, supporting people in making

decisions, planning care or seeking to make positive changes, using Health Education England’s framework to promote person-centred approaches in health and care

11

Domain / Capability Statement

Initial Mid point

Final

or X or X Student’s Initials

Facilitator’s Initials

1.6 Use expertise and decision-making skills to inform clinical reasoning

approaches when dealing with differentiated and undifferentiated individual presentations and complex situations, synthesising information from multiple sources to make appropriate, evidence-based judgements and/or diagnoses

1.7 Initiate, evaluate and modify a range of interventions which may include

prescribing medicines, therapies, life style advice and care

1.8 Exercise professional judgement to manage risk appropriately, especially

where there may be complex and unpredictable events and supporting teams to do likewise to ensure safety of individuals, families and carers

1.9 Work collaboratively with an appropriate range of multi-agency and inter-

professional resources, developing, maintaining and evaluating links to manage risk and issues across organisations and settings.

1.10 Act as a clinical role model/advocate for developing and delivering care that

is responsive to changing requirements, informed by an understanding of local population health needs, agencies and networks.

1.11 Evidence the underpinning subject-specific competencies i.e. knowledge,

skills and behaviours relevant to the role setting and scope, and demonstrate application of the capabilities to these, in an approach that is appropriate to the individual role, setting and scope

12


Initial Mid

point Final

2. Leadership and Management



2.1 Pro-actively initiate and develop effective relationships, fostering clarity of roles within teams, to encourage productive working

2.2 Role model the values of their organisation/place of work, demonstrating a person-centred approach to service delivery and development

2.3 Evaluate own practice, and participate in multi-disciplinary service and team evaluation, demonstrating the impact of advanced clinical practice on service function and effectiveness, and quality (i.e. outcomes of care, experience and safety).

2.4 Actively engage in peer review to inform own and other’s practice, formulating and implementing strategies to act on learning and make improvements.

2.5 Lead new practice and service redesign solutions in response to feedback, evaluation and need, working across boundaries and broadening sphere of influence.

2.6 Actively seek feedback and involvement from individuals, families, carers, communities and colleagues in the co-production of service improvements.

13


Initial Mid

point Final



2.7 Critically apply advanced clinical expertise in appropriate faciliatory ways to provide consultancy across professional and service boundaries, influencing clinical practice to enhance quality, reduce unwarranted variation and promote the sharing and adoption of best practice

2.8 Demonstrate team leadership, resilience and determination, managing situations that are unfamiliar, complex or unpredictable and seeking to build confidence in others.

2.9 Continually develop practice in response to changing population health need, engaging in horizon scanning for future developments (e.g. impacts of genomics, new treatments and changing social challenges).

2.10 Demonstrate receptiveness to challenge and preparedness to constructively challenge others, escalating concerns that affect individuals’, families’, carers’, communities’ and colleagues’ safety and well-being when necessary.

2.11 Negotiate an individual scope of practice within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and upholding safety

14


Initial Mid

point Final

3 Education



3.1 Critically assess and address own learning needs, negotiating a personal development plan that reflects the breadth of ongoing professional development across the four pillars of advanced clinical practice

3.2 Engage in self-directed learning, critically reflecting to maximise clinical skills and knowledge, as well as own potential to lead and develop both care and services

3.3 Engage with, appraise and respond to individuals’ motivation, development stage and capacity, working collaboratively to support health literacy and empower individuals to participate in decisions about their care and to maximise their health and well-being

3.4 Advocate for and contribute to a culture of organisational learning to inspire future and existing staff

3.5 Facilitate collaboration of the wider team and support peer review processes to identify individual and team learning

3.6 Identify further developmental needs for the individual and the wider team and supporting them to address these

15


Initial Mid

point Final



3.7 Supporting the wider team to build capacity and capability through work- based and inter-professional learning, and the application of learning to practice

3.8 Act as a role model, educator, supervisor, coach and mentor, seeking to instil and develop the confidence of others

4 Research

4.1 Critically engage in research activity, adhering to good research practice guidance, so that evidence based strategies are developed and applied to enhance quality, safety, productivity and value for money

4.2 Evaluate and audit own and others’ clinical practice, selecting and applying valid, reliable methods, then acting on the findings.

4.3 Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin own practice and to inform that of others

4.4 Take a critical approach to identify gaps in the evidence base and its application to practice, alerting appropriate individuals and organisations to these and how they might be addressed in a safe and pragmatic way

16


Initial Mid

point Final



4.5 Actively identify potential need for further research to strengthen evidence for best practice. This may involve acting as an educator, leader, innovator and contributor to research activity and / or seeking out and applying for research funding

4.6 Develop and implement robust governance systems and systematic documentation processes, keeping the need for modifications under critical review

4.7 Disseminate best practice research findings and quality improvement projects through appropriate media and fora (e.g. presentations and peer review research publications).

4.8 Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers

Time 1: Initial Assessment Signatures

Time 2: Midpoint Review Signatures Time 3: Final Review Signatures

Student:

Student: Student:

Facilitator:

Facilitator: Facilitator:

Date: Date: Date:

17

Advanced Clinical Practitioner: Direct Observation of Practice (DOP)

Summative: Routine

Date of Assessment:

Trainee’s Name:

Trainee’s Year:

Assessor’s Name:

Assessor’s Email Address:

Assessor’s Registration Number (e.g. GMC, NMC, GDC):

Assessor’s position: Consultant ☐ SAS ☐ SpR ☐ SHO ☐ GP ☐ ACP ☐ Other ☐

If Other, please specify:

Clinical setting (e.g. A&E, GP, WIC etc): Examination: Type of assessment: Formative / Summative Please score the trainee on the scale shown. Please note that your scoring should reflect the performance of the trainee against which you would reasonably expect at their stage/year of training and level of experience. Please mark ‘Not applicable’ if the domain is not applicable to the procedure:

Under direct supervision/assistance

With limited supervision/assistance

Competent unsupervised & deals with complications

Not applicable

Demonstrates understanding of indications, relevant anatomy, technique of examination:

☐ ☐ ☐ ☐

Obtains informed consent:

☐ ☐ ☐ ☐

Demonstrates appropriate preparation pre-examination:

☐ ☐ ☐ ☐

Technical ability:

☐ ☐ ☐ ☐

Seeks help where appropriate: ☐ ☐ ☐ ☐

Post procedure management: ☐ ☐ ☐ ☐

Communication skills: ☐ ☐ ☐ ☐

Consideration of patient/professionalism: ☐ ☐ ☐ ☐

18

Based on this observation please now rate the level of independent practice the trainee has shown for this procedure:

Unable to perform ☐

Able to perform under direct supervision/assistance ☐

Able to perform the examination with limited supervision/assistance ☐

Competent to perform the examination unsupervised and deal with complications ☐

Which aspects of the encounter were done well?

Suggested areas for improvement :

Agreed action:

Where summative assessment please tick one of the options below:

Has the trainee passed or failed this assessment based on your observation and comments above?

Passed ☐ Failed ☐

19

Advanced Clinical Practitioner: Supervised Learning Event (SLE)

Mini-Clinical Evaluation of Practice

Date of Assessment:

Trainee’s Name:

Assessor’s Name:

Assessor’s Email Address:

Assessor’s Registration Number (e.g. GMC, NMC, GDC):

State the setting for the learning event (e.g. acute admission, ward round, night shift):

Provide a brief summary of the cases observed:

Please comment on what was done well and the areas for improvement within each category. Please note, constructive feedback is required in order for this assessment/learning event to be valid, and aims to identify areas for learning and reflection. Consultation and communication skills:

Physical examination:

Clinical judgement:

20

Organisation/Efficiency:

Please comment on the overall performance of the trainee: What was done well:

What are the suggested areas for development:

Agreed action plan:

Signature Student

Signature Facilitator Date

21

Physical Examination Proformas

Subject Area Page

1. Abdominal assessment 22

2. Cardiovascular assessment 23

3. Ears, Nose, Sinuses and Throat assessment 24

4. Respiratory assessment 25

5. Ankle assessment 26

6. Back and hip assessment 27-28

7. Knee assessment 29

8. Shoulder assessment 30

9. Cranial Nerves assessment 31-32

9. Assessment of the Gross Motor Nervous System and coordination

33

10. Assessment of the Sensory Nervous System and Reflexes

34

22

ABDOMEN (minimum standard required) The student is expected to be able to undertake a full physical assessment and complete each of

the criteria prior to the OSCE (Objective Structured Clinical Examination)

CRITERIA COMPETENT NOT

COMPETENT

1. Warm approach to patient, explains procedure and asks patient to report discomfort

2. Asks patient if they need to empty their bladder

3. Observes face for signs of pain throughout exam

4. Observes general appearance, including skin and nails, inspects mouth and sclera

5. Takes vital signs (or comments that these would be measured)

6. Observes abdomen fully exposed, notes symmetry, distension, contours, scars

7. Observes abdominal movements for aortic pulse

8. Auscultates all 4 quadrants for bowel sounds

9. Auscultates aorta, renal and iliac arteries for bruits

10. Percusses all 4 quadrants with technique that elicits sound –comments on tympany / dullness

11. Palpates abdomen lightly, starts away from pain

12. Palpates abdomen deeply

13. Tests for guarding, rebound tenderness, or cough reflex

14. Assesses liver boundaries with percussion

15. Assesses liver size with palpation

16. Assesses spleen boundaries with percussion

17. Palpates for spleen

18. Palpates kidneys bilaterally

19 Says would Palpate for inguinal nodes

20. Comments that would only perform a PR/PV exam if indicated. Paediatric students may say they would not perform this procedure if so mark for rationale

Facilitator Signature:

Student Signature:

Date:

23

CARDIOVASCULAR (minimum standard required)

The student is expected to be able to undertake a full physical assessment and complete each of


CRITERIA Competent Not

Competent

1. Inspects hands for cyanosis, clubbing, nicotine, Splinter haemorrhages.

2. Positions patient at a 45 d angle

3. Says would measure the blood pressure in both arms

4. Checks the radial, brachial and carotid pulses

5. Describes rhythm, amplitude and contour of the pulse

6. Observes eyes for oedema, corneal arcus, xathanthaloma. Sclera and conjunctiva

7. Inspects mouth and tongue

8. Listens for bruits over carotid artery

9. Identifies highest point of pulsation in the internal jugular vein

10. Inspects and palpates for thrills/ heaves over precordium

11. Palpates apical impulse, listens with bell at apex, rolling patient to the left

12. Listens with stethoscope at 2nd intercostals space at left and right of sternum. Listens through 3, 4, 5, intercostals spaces. Asks patient to hold breath

13. Listens for rate, rhythm, S1, S2, splitting, S3 and/or S4. Extra heart sounds.

14. Checks femoral, popliteal, post tibial and dorsal pedis pulses

15. Either says or does – listens to posterior chest for signs of heart failure

16. Inspects ankles, sacrum for oedema


Student Signature:

Date:

24

EARS, NOSE, SINUSES AND THROAT (minimum standard required)



CRITERIA Competent Not Competent

1. Warm open approach, explains procedure and asks patient to report any discomfort

2. Says would observe pulse and temperature

3. Inspects external pinna bilaterally

4. Palpates external pinna and tragus bilaterally to elicit pain, or to identify masses

5. Palpates mastoid bones bilaterally

6. Observes canal and TM bilaterally with safe auroscope technique e.g. Right hand, Right Ear.

7. Names landmarks. i.e. light reflex, umbo, malleus, pars tensa

8. Inspects both nostrils and lower/middle turbinates, evaluates patency of the nares

9. Palpates frontal and maxillary sinuses for tenderness, pain, swelling, asks patient to lean forward, assessing level of sinus discomfort

10. Inspects mouth, comments on condition of teeth and gums/ buccal mucosa/under tongue

11. Observes tonsils, uvula and posterior wall of pharynx

12. Names all lymph nodes – pre-auricular, post-auricular, tonsillar, sub-mandibular, sub-mental, supra-clavicular, anterior cervical, posterior cervical and occipital

13. Palpates using correct technique, in correct position saying what they are feeling for- enlarged, tender, non-tender shotty, discrete nodes, mobile, fixed


Student Signature:

Date:

25

RESPIRATORY (minimum standard required)




competent

1. General approach to the patient. Introduction, warmth, eye contact.

2. Checks hands and fingers for, nicotine staining, clubbing, capillary refill, warmth/cold, tremor

3. Says would monitor vital signs including temperature

4. States monitoring respiratory rate, pattern and respiratory movements e.g. use of accessory muscles

5. Inspects face and states: Observing for Pursed Lip Breathing, Observes tongue for central cyanosis/ general condition

6. Palpates lymph nodes, Supraclavicular, Axillary

7. Palpates trachea for possible mediastinal shift

8.Inspects the chest fully exposed and states observing for: overall shape / size, Symmetry / spinal deformities, both anterior / posterior

9. Chest expansion, uses hands on the anterior or posterior chest

10. Palpates - anterior and posterior chest comparing sides, checks for fremitus comparing sides

11. Percussion: anterior and posterior chest compares both sides of chest during examination

12. Auscultation: performed both anteriorly and posteriorly Compares both sides of chest during examination

13. Indicates assessment for normal and abnormal chest sounds such as wheezes & crackles. pleural rubs.


Student Signature:

Date:

26

ANKLE (minimum standard required)

The student is expected to be able to undertake a full physical assessment and complete each of the criteria prior to the OSCE (Objective Structured Clinical Examination)

MARKING CRITERIA Competent Not Competent

1. Assesses gait

2. Instructs patient to indicate point of maximum pain, and inform of any tenderness during assessment.

3. Inspects and compares Ankle, Heel, Dorsal and Plantar aspects of foot, toes. Observes for Injury, swelling, redness and deformity

4. Palpates anterior and posterior aspects of medial and lateral malleolus

5. Compresses Calcaneum. Palpates achilles tendon

6. Compresses metatarsals, carries out individual palpation of metatarsals. Palpates toes.

7. Identifies and palpates Cuboid and Navicular bones

8. Notes tenderness, asymmetry, temperature, paraesthesia throughout palpation.

9. Assesses passive range of movement - Dorsiflexion and Plantar flexion, Inversion and Eversion.

10. Assess active range of movement Dorsiflexion and Plantar Flexion, Inversion and Eversion.

11. Tests muscle strength through resisted range of movement

12. States would assess Knee and Hip


Student Signature:

Date:

27

BACK AND HIP (minimum standard required)




1. Says would ask expose relevant body parts respecting patient’s dignity at all times

2. HIPS - Inspects the hips anteriorly and posteriorly whilst patient stands. Notes any asymmetry in iliac crest height. width of base (heel to heel measurement should be 5-10cm). Asks patient to walk across the room inspecting gait

3. With patient supine, palpates hips and pelvis noting any instability, tenderness or crepitus. Compares leg length with patient lying down, says would measure (iliac crest to medial mal). Notes any abnormal leg rotation.

4. Examines hips range of motion by SLR (hip flexion – up to 90°°). Flexion with knee flexed – up to 120°)

5. Hyperextension with straight leg (either lying or standing up to 30°).

6. Abduction (up to 45°), Adduction (up to30°)

Internal rotation (up to 40°), external rotation (up to 45°)

7. Resisted movement to evaluate muscle strength flexion & extension (with knee flexed). Abduction and adduction

8. May suggest special procedures such as Thomas test for flexion contracture of the hip and Trendelenburg test to detect weak hip abductor muscles.

9. BACK – Inspects spinal profiles when upright and bending down – notes curves / symmetry when upright (kyphosis, lordosis, scoliosis).

10. Palpates spinal process for warmth & tenderness. S I joints

11. Percusses spinal processes to identify tenderness

28


12. Palpates paravertebral muscles

13. Tests range of movement (flexion, extension, lateral bending, rotation).

14. Check straight leg raising (passive & active) L4, L5 S1 nerve root irritation / lumbar disk herniation

15. Extra tests such as dorsiflexion of foot (braggard stretch test – L4, L5, S1 lumbar disk herniation, nerve root irritation), Femoral stretch test – L1, L2, L3 nerve root inflammation). Sitting knee extension test for sciatic nerve tenderness

16. Assess patella and tendo-achilles reflexes


Student Signature:

Date:

29

KNEE (minimum standard required)



Competent

1. Asks about site of pain prior to examination

2. Compares alignment and contours of knees

3. Looks for muscle wasting, scars, bruising, redness

4. Looks for signs of swelling around knee joint

5. Checks tightening of quadriceps

6. Asks patient to walk across room if they can

7. Checks active range of movement of both knees including straight leg raise

8. Checks passive range of movement of both knees

9. Says would examine both knees and would begin with non affected knee

10. Checks for heat/inflammation over knee

11. Palpates patella, patellofemoral joint and popliteal fossa

12. Palpates medial & lateral collateral ligaments

13. Palpates medial & lateral joint line with knee in 30 degree bend

14. Performs ballottement and bulge test

15. Adduction stress test (medial collateral)

16. Adduction stress test (lateral collateral)

17. Anterior draw sign (anterior cruciate)

18. Posterior draw sign (posterior cruciate)

19. States McMurry’s sign (90 flexion, rotation of tibia) or Apley grinding & distraction test are no longer recommended in practice

20. Rotation of foot

21. Says would also examine hip and ankle


Student Signature:

Date:

30

SHOULDER (minimum standard required)



Competent

1. Assesses patients posture anterior / posterior, comparing both sides.

2. Observes patient’s face during movements for signs of pain

3. Observes for swelling, redness, bruising, scars or deformity.

4. Feels for areas of heat / crepitus / swelling / bony tenderness. Comments that would palpate the following areas;

Cervical spine.

Anterior structures – SC joint, AC joint, Clavicle, Corocoid process, upper humerus, Scapula

5. Assesses active range of movement at GH joint. Abduction/ adduction / internal & external rotation/ medial/ lateral rotation

6. Assesses active range of movement in neck - flexion/ extension/ lateral flexion/ rotation

7. Assesses passive range of movement at GH joint. Abduction/ adduction/ internal & external rotation/ medial/ lateral rotation

8. Assesses passive range of movement in neck – flexion/extension/lateral flexion/ rotation.

9. Assesses resisted range of movement in GH joint

10. Check for sensory deficits - C4,5,6

11. Compares both sides.

12. Performs special tests for painful arc. (Asks patient to abduct arm – will experience pain between 80 – 120 deg. Beyond this the pain will subside.)


Student Signature:

Date:

31

CRANIAL NERVES (minimum standard required) The student is expected to be able to undertake a full physical assessment and complete each of


CRITERIA Competent Not competent

1. Explains to patient various examinations throughout

2. Cranial nerve i – Olfactory • Asks patient to close eyes and occlude nostril. • Tests with two aromas. Repeats on other

nostril

3. Cranial nerve ii – Optic • Visual acuity (snellen chart). • Visual fields (confrontation). • Says fundoscopy would be performed to

complete examination.

4. Cranial nerves iii, iv & vi – Oculomotor, Trochlear, Abducens

• Size and shape of pupil • Pupillary light reflex (direct and consensual) • Extraocular movements in the 6 cardinal

directions of gaze

5. Cranial nerve v – Trigeminal Inspects for muscle atrophy and tremors.

• Motor – test muscles of mastication • Sensory –corneal reflex, light touch, pain,

temperature.

6. Cranial nerve vii – Facial – Observes face for asymmetry Asks patient to:

• Raise both eyebrows • Frown

To keep both eyes tightly shut against resistance

• Show upper and lower teeth • Smile • Puff out both cheeks

7. Cranial nerve viii – Acoustic Cochlea Hearing Weber test Rinne test Vestibular Asks patient to stand with eyes closed for minimum of 30 seconds, ensures feet are together Asks patient to march on spot with eyes closed

32

CRITERIA Competent Not competent

8. Cranial Nerve ix & x - Glossopharyngeal and Vagus

• Listens to patients voice - Is it hoarse or nasal? • Elicits history of swallowing problems • Observe movement of soft palate • Test gag reflex

9. Cranial nerve xi – Spinal Accessory • Observes for atrophy/fasciculations of

trapezius muscles. • Tests strength by asking patient to shrug both

shoulders upward against hands • Asks patient to turn head to the side against

hand.

10. Cranial nerve xii – Hypoglossal • Listens to articulation of voice • Inspects the tongue, observes for

atrophy/fasciculations • With tongue protruding observes for midline

deviation/asymmetry • Palpates for strength as patient sticks tongue

into cheek


Student Signature:

Date:

33

GROSS MOTOR AND COORDINATION (minimum standard required) The student is expected to be able to undertake a full physical assessment and complete each of



1. Observes body position

2. Observes for involuntary movements. E.g. tremors, tics, fasciculation’s

3. Tests cranial nerves 5, 7,11 and 12

4. Observes muscle bulk, comparing size and contours. Pays particular attention to hands, shoulders and thighs

5. Tests muscle tone by flexing and extending patient’s fingers, wrist, elbow, knee and ankle

6. Test muscle strength through active and passive movements

7. Biceps/ triceps - asks patient to push and pull against hand

8. Radial nerve – asks patient to make a fist and resist it being pulled down

9. Tests grip by asking patient to squeeze students fingers and not let them go

10. Tests finger abduction

11. Tests opposition of thumb

12. Trunk – flexion, extension, lateral bending of spine Thoracic expansion

13. Tests flexion, extension, adduction, abduction of hip

14. Tests flexion and extension of knee

15. Tests dorsiflexion and plantar flexion at the ankle

Coordination

16. Asks patient to perform rapid alternating movements of hands, thumb and finger, legs

17. Asks the patient to carry out point to point movements of arms and legs

18. Observes gait while patient walks normally, heel to toe, on toes then heels

19. Asks patient to hop and do shallow knee bends

20. Asks patient to perform Romberg test

21. Tests for pronator drift


Student Signature:

Date:

34

SENSORY NERVOUS SYSTEM AND REFLEXES (minimum standard required) The student is expected to be able to undertake a full physical assessment and complete each of



Competent

1. Says that sensory testing needs to be carried out efficiently before the patient fatigues. Otherwise unreliable results would be produced

2. Informs the patient that they will be testing random areas of the body for sharp and soft touch. (soft and rough for paediatrics) Demonstrates sharp and soft before commencing examination.

3. Compares symmetrical areas on two sides of the body, including arms, legs and trunk. Uses a random method so patient does not respond to a repetitive rhythm. Ensures patient’s eyes are closed.

Suggested pattern

4. Both shoulders – C4

5. Inner and outer aspects of the forearms – C6 and T1

6. Thumbs and little fingers – C6 and C8

7. Fronts of both thighs – L2

8. Medial and lateral aspects of both calves – L4 and L5

9. Little toes – S1

10. Says would test medial aspect of both buttocks – S3

11. Tests position sense of big toe and index finger

12. Tests vibration sense of big toe

13. Says that would go on to test for temperature sensation if reduced sensation was identified

14. Reflexes – observe for correct handling of reflex hammer. Mark on technique – (reflexes will alter with continual examination). Use alternative sides

15. Triceps

16. Biceps

17. Brachioradial

18. Patellar

19. Achilles

20. Abdomen

21. Plantar

22. Comments on reflex grading e.g. 0 – no response – 5 – hyperactive.


Student Signature:

Date:

35

Logging Practice Hours Form

We recommend that all learning hours are documented as this provides useful evidence of your range of experience in practice and will assist you in identifying areas where you would benefit from either wider clinical experience of clinical presentations / conditions or perhaps how you could enhance your learning around a particular topic. You should undertake a minimum of 5 hours of clinical experience per week to ensure that you gain enough relevant experience to embed your skills and learning into practice. 1.5 of these hours should be working with your facilitator. Time spent with your facilitator (or deputy) is best recorded on a separate log. You need to briefly specify the nature of the learning experience, for example ‘knee examination’ ‘history taking’ , not just attending clinic or ward round as this will illustrate your range of experience in a far better light and aid discussion with your facilitator at review.

36

LOGGING PRACTICE HOURS FORM

Student Name ………………………………….. Facilitators Name……………………………………

Cohort/ Site………………………………………. Total Practice Hours……………………………….. DATE HOURS Description of area of experience Facilitator

Initials Student Initials

Student Name Total practice hours

37

LOGGING FACILITATIOR PRACTICE HOURS

DATE HOURS Description of area of experience Facilitator


Student Name Total practice hours

38

Patient Questionnaire

Thank you for agreeing to complete this questionnaire which asks you to consider the consultation you have just had with the Advanced Practitioner trainee and asks you to place an X in the box for your preferred answer. Please be assured that the information you provide is confidential and is to be used in order to inform the trainee’s practice and enable him/her to consider areas for improvement for the future.

1. Do you understand the role of an Advanced Clinical Practitioner?

Yes No

2. Have you seen this Advanced Clinical Practitioner before for any health problems?

Yes No

3. Would you if possible, request to see this practitioner again if you suffered any further health problems?

Yes No

4. How would you rate the practitioner at each of the following?

Very Poor. / Poor / Adequate / good /very good Giving you enough time Asking about your symptoms..... Listening to you Explaining tests and treatments Involving you in decisions about your care Treating you with care and concern Taking your problems seriously

5. Q24In these discussions…

Did the practitioner take notice of your views about how to deal with your health problem?

Yes No

39

6. Did you feel the practitioner listened fully to your concerns about your health problem?

Yes No

6. Did the practitioner give you information about the things you might do to deal with your health problem?

7.

Yes No

8. Did you and the practitioner agree about how best to manage your health problem?

Yes No

9. Did the practitioner give you any written information about the discussions you had about managing your health problem?

Yes No

9. Did you have confidence and trust in the practitioner you saw?

Yes, definitely Yes, to some extent No, not at all Don’t know/can’t say

10.

11. In general, how satisfied are you with the care you have received today? Very satisfied Fairly satisfied Neither satisfied nor dissatisfied Fairly dissatisfied Very dissatisfied

Q28

Thank you again for completing this questionnaire.

40

Learning Contracts

41

Contract Number: 1 23456789101112


LEARNING CONTRACT

Student's Name: Practice Facilitator: Personal Tutor: Learning Contract Start Date: Learning Contract Completion Date: To be completed at the start of the Learning Contract Domain(s) of capability: Part A: What have I achieved to date that will support my development in this area of capability?

Part B: What do I need to achieve in order to be able to demonstrate my capability?

Student's Signature: Facilitator's Signature: Personal Tutor's Signature: Date: Date: Date:

42

ACTION PLAN:

Resources needed to meet the action plan:

Evidence generated which supports claim that capability has been achieved:

Signature of Student: ………………………………..………. Date: …………………………………………………………..

Signature of Facilitator: ……………………………..………… Date: …………………………………………..………………..

Signature of PT: ………………………………… Date: …………………………………………….……………...

43

Practice Review Summary Records

44

Practice Review Summary Record


1st Practice Review Summary Record

Student:

Facilitator:

Personal Tutor:

Practice Review No: One

Date:

Suggested areas for discussion with student and conferring with facilitator

Student progress to date/ issues in

practice? Hours logged in practice

Facilitator role/ preparation/ needs/ issues?

Baseline Capability Profile undertaken with

Facilitator. Areas of concern, gaps in knowledge, strengths

Gaining range of experience in own practice

and in other settings?

Learning Contracts? Any action plan devised?

Physical Examination DOPs

Links with own area of work if practice

experience takes place in a different setting?

Student signature Date

Facilitator Signature Date

PT signature Date

45



2nd Practice Review Summary Record

Student:

Facilitator:

Personal Tutor:

Practice Review No: Two

Date:







Learning Contracts? Any action plan devised?

Physical Examination DOPs progress

1st Mini-CEP preparation and completion

Patient questionnaire completed



PT signature Date

46



3rd Practice Review Summary Record

Student:

Facilitator:

Personal Tutor:

Practice Review No: Three

Date:





Mid-point Capability Profile review

undertaken with Facilitator) highlight areas of concern, gaps in knowledge, strengths



Patient questionnaires

Physical Examination DOPs completed

1st and 2nd Mini-CEP completed

Plans if progressing to 2nd year or exiting

programme



PT signature Date

47



4th Practice Review Summary Record

Student:

Facilitator:

Personal Tutor:

Practice Review No: Four

Date:


Student progress to date

- Protected clinical time? Hours logged

- Range of conditions and systems covered?

- Range of experiences attained?

- Experience gained in other areas?

Facilitator needs/issues

Evidence of learning

- Preparation for Mini-CEPs

- Physical Examination DOPs progress

- Patient questionnaires

Role envisaged once the course is

completed?



PT signature Date

48



5th Practice Review Summary Record Student:

Facilitator:

Personal Tutor:

Practice Review No: Five

Date:

Suggested areas for discussion with student conferring with facilitator


- Protected clinical time? Hours logged

- Range of conditions and systems covered?

- Range of experiences attained?

- Experience gained in other areas?

Facilitator needs/issues

Evidence of learning

- Preparation / completion final 2 Mini-CEPs

- Physical Examination DOPs progress

- Patient questionnaires

Role envisaged once the course is

completed?



PT signature Date

49



Final Practice Review Summary Record Student: Facilitator:

Personal Tutor:

Practice Review No: Final Date:

Suggested areas for discussion with student and conferring facilitator


Patient questionnaires Minimum 500 hours Logged

Readiness for forthcoming OSCE

Facilitator needs/issues / Letter from Facilitator

Final Capability profile review and completion with facilitator

All physical skills DOPs completed?

Remaining 2 Mini-CEP’s completed? Envisaged changes in role if progressing into year

3 or exiting the programme



PT signature Date

50

Learning in Practice Log

This is a suggested method of recording events which you may refer back to in discussing your clinical learning needs. It is not a requirement of the programme and it does not need to be submitted for assessment, it is purely for your personal use. It is useful to record significant events, meetings, or just to reflect on your effectiveness in practice, remember that you can learn as much from unsuccessful interactions as well as successful ones. You may wish to colour code your notes to associate an event with a specific examination, and you can supplement your record with a reflective diary. You can vary the way in which you record events, remember this is not a record of achievement but a method of helping to track your progress, and prompt you memory of significant milestones which will support your reflections when reviewing progression.

51


Date Health

Issue/Presenting Problem: Summarize

and Code1

Colour Code2

History Physical Exam

Lab work with interpretation

Creates problem

list

Makes Differential diagnosis

Plans mgt

Teaching Referral F/U

1 Health Issue/Presenting Problem Code: Well person interaction (WPI); acutely ill presentation (AIP); chronic health problem (CHP); other (O) 2 Colour Code : Head and Neck (orange); Special Senses (plum); ENT (pink); Respiratory (blue); CVS (red); Gastrointestinal (brown); Renal (yellow); Reproductive (bright green); Neuro (grey); Musculoskeletal (purple); Endocrine (green); Lymphatic (teal); Mental Health and Well being (turquoise)

52

APPENDIX 1

Learning in Advanced Clinical Practice Flow Chart

Learning Environment in Pre-course Assessment Tool

Student: Undertakes self-assessment of capability Identifies learning needs Begin Log of Hours

Facilitator Personal Academic

Tutor

Student

Student and Facilitator: Sign off completed self-assessment in Capability Profile Begin Physical Exam Practice Conduct Time 1 Practice Review Summary Recommend record Log of Hours

Student and PT: Conduct 1st Practice Review Summary

Student working with capability profile completes: Logging practice hours

Patient questionnaires (6 in total by this point) 2 mini-CEPs by this point

Facilitator: Invited to contact student PT regarding student’s progress

At midpoint the Student and Facilitator: Conduct 3rd Practice Review Summary Mid-point Capability Assessment Continue with Physical Assessment Practice DOPs forms

In

itia

l P

racti

ce

re

vie

w:

Ma

y y

ea

r1

Mid

po

int:

Fe

bru

ary

en

d Y

ea

r 1

By end of Mid-point review the Student and PT:

Conduct 3rd Practice Review Summary

Student, facilitator and PT conduct 2nd practice review October year 1

Learning in Advanced Clinical Practice Flow Chart

54

Student completes:

Logging Practice Hours (recommended)

Patient questionnaires (further 9 by this point)

Final 2 Mini-CEPs by this point

Facilitator:

Invited to contact student’s PT regarding student’s progress

Facilitator communicates with student’s PT to:

Confirm all capabilities achieved

Anticipated readiness for OSCE

By end of the 6th Semester the Student and Facilitator:

Complete capability assessment

Complete QPU DOPs and Mini-CEP

Completed all patient questionnaires

Conduct Time 6 Final Practice Review Summary

Student, facilitator and PT will undertake:

Practice review 4 in June Year 2 Practice review 5 in October Year 2

En

d R

evie

w

Ja

nu

ary

Yea

r 2

55

APPENDIX 2

Example how to complete the capability profile

56

Capability statement

Domain 1: Clinical Practice Initial Mid

point Final

√ or X √ or X Student Facilitator

1.1 Practise in compliance with their respective code of professional conduct and within their scope of practice, being responsible and accountable for their decisions, actions and omissions at this level of practice

X √ NJP CC

1.2 Demonstrate a critical understanding of their broadened level of responsibility and autonomy and the limits of own competence and professional scope of practice, including when working with complexity, risk, uncertainty and incomplete information.

X X NJP CC

1.3 Act on professional judgement about when to seek help, demonstrating critical reflection on own practice, self-awareness, emotional intelligence, and openness to change.

X X NJP CC

√ √ NJP CC

X √ NJP CC

X √ NJP CC

X √ NJP CC

X √ NJP CC

X X NJP CC

X X NJP CC

57

APPENDIX 3

Example of How to Complete Logging Practice Hours Form

58

LOGGING PRACTICE HOURS FORM

Student Name …A. Student……… Facilitators Name……A Practitioner…………....…

Cohort/ Site… March …………….…… Total Practice Hours………….…. DATE HOURS Description of area of experience Facilitator


22.4.19

7

Observation – focusing on history

taking

AJP AAS

1.05.19

6

Visit to eye clinic, basic eye

examination and vision testing

PPM AAS

9.05.19

8

ENT physical examinations in

same day appointment session

AJP AAS

Student Name A. Student Total practice hours 21

59

APPENDIX 4

Example of how to complete the Learning Contract

60

Contract Number: 1 23456789101112 University of Cumbria

LEARNING CONTRACT

Student's Name: A Student

Practice Facilitator: A Facilitator

Personal Academic Tutor: A Tutor Learning Contract Start Date: 1.05.19 Learning Contract Completion Date: 30.08.19 To be completed at the start of the Learning Contract Domain(s) of capability: Clinical practice Part A: What have I achieved to date that will support my development in this area of capability?

Experience over 20 years talking with patients, eliciting information necessary to the provision of nursing care. Experienced in being able to recognize a sick patient from a well one. Modules about to be commenced will be learning more about A&P and pathophysiology of some systems in the body and how to assess them.

Part B: What do I need to achieve in order to be able to demonstrate my capability?

Domain 1- obtains a comprehensive problem-focused health history from the patient or carer. Student's Signature: Facilitator's Signature: Personal Tutor's Signature:

A Student A Facilitator A Tutor Date: 1.05.19 Date: 1.05.19 Date: 05.05.19

61

ACTION PLAN:

Resources needed to meet the action plan:

Evidence generated which supports claim that capability has been achieved:

Domain 1 Want to be able to take 5 comprehensive histories and 5 focused histories from patients presenting in the acute setting. Plan to have a range of presenting problems within the 10 cases, but may need to be flexible here depending on what is happening in practice.

Work alongside either my facilitator or the staff grade for the next 10 Monday afternoons in the assessment unit. Need to put together a brief explanation of my role as a learner so that patients, their families and my colleagues know that I am a student NP, what I’m doing and how I am being supervised by my medical colleagues. Negotiate to spend two Monday mornings in A&E working alongside experienced Nurse Practitioner.

10 histories - 5 comprehensive; 5 focused

1 reflective account of my progress to date, taking into account experience in the assessment unit and in A&E. 1 witness testimony from my facilitator [or the staff grade] Aim to complete by (date). Review with facilitator to develop action plan identifying what I need to do next.

Signature of Student: ………………………………………. Date: ………………………………………………………….

Signature of Facilitator: ………………………………………. Date: …………………………………………………………….

Signature of PT: ………………………..…………………. Date: ………………………………………………………….

62

APPENDIX 5

Example how to complete the Learning in Practice Log

63


Date Health Issue/Presenting

Problem: Summarize and Code1

Colour Code2

History Physical Exam

Lab work with

interpretation

Creates Problem

list

Makes Differential diagnosis

Plans mgt

Teaching Referral F/U

28.09.18 Abdominal pain

AIP

Brown √ √

10.10.18 Fractured ulna

WPI

Purple √ √ √

22.3.19 Loss of

consciousness AIP

Orange √ √ √ √ √

17.5.19 MI AIP

Red √ √ √ √ √ √ √

9.8.19 High blood sugar

CHP

Green √ √ √ √ √ √ √ √ √

1 Health Issue/Presenting Problem Code: Well person interaction (WPI); acutely ill presentation (AIP); chronic health problem (CHP); other (O) 2 Colour Code : Head and Neck (orange); Special Senses (plum); ENT (pink); Respiratory (blue); CVS (red); Gastrointestinal (brown); Renal (yellow); Reproductive (bright green); Neuro (grey); Musculoskeletal (purple); Endocrine (green); Lymphatic (teal); Mental Health and Well being (turquoise)