Department of Speech-Language Pathology Clinical Education ...€¦ · of clinical practice and research; and (f) clinical skills appropriate to entry-level professi onal practice

FACULTY OF MEDICINE, UNIVERSITY OF TORONTO Rehabilitation Sciences Building, 160‐500 University Ave., Toronto, ON, M5G 1V7 Tel: +1 416 978‐6882 Fax: +1 416 978‐1596 www.slp.utoronto.ca

Clinical Education Guide Department of Speech-Language Pathology

INTRODUCTION 1 PRACTICUM OBJECTIVES 2 Placement Calendar 2 COURSEWORK AND EXPECTATIONS 3 SLP 1500Y 3 SLP 1507H 4 SLP 1508Y 5 SLP 2500Y 6 SLP 1532H 7 ROLES AND RESPONSIBILITIES 8 The Coordinators of Clinical Education 8 The Site Coordinator 9 Clinical Educators 10 Clinical Sites 11 Student Role 12 PLACEMENT PROCESS 13 Placement development and assignment process 13 Before placement begins ‐ student responsibilities 13 Planning the Placement - helpful documents 14

EVALUATION 15 Formative Assessment 15 Summative Assessment 15 If Problems Arise 16 Mid‐term and Final Evaluations FAQs 17 Evaluation of Clinical Faculty Teaching 17 GUIDELINES, POLICIES AND PROCEDURES 18 Counting Clinical Hours 18 General Guidelines Concerning Clinical Activities 18 General Guidelines Appendix A from CASLPA 19 Tips for Counting VOICE and FLUENCY 20 Summary of Clinical Practice Hours Form 20 Reporting Total Hours 20 EMBEDDED PLACEMENT ACTIVITIES 21 Teaching Clinics 21 Guided Observations 22 Interprofessional Education 22 Research to Practice 23 PLACEMENT POLICIES 24 Health Policies 24 Health Forms 24 Illness and Absence 24 CPR Certification 25 Mask Fit Testing 25 Workplace Hazardous Materials Information System 25 Police Record Check/ Criminal Reference Check 25‐26 Use of Social Insurance Number 26 Student Identification Badges 26 INSURANCE 27 INTERNATIONAL PLACEMENT OPPORTUNITIES 28‐29

REQUESTS FROM OTHER PROGRAMS 28 PROFESSIONAL STANDARDS 30 Department of Speech‐Language Pathology 30 University of Toronto 30 CASLPO 31 CASLPA 31 Ministry of Health and Long‐term Care 31 STUDENT SUPPORT SERVICES 32 ADDITIONAL STUDENT RESOURCES 32‐33 M.H.SC. GRADUATION AND REGISTRATION 33 CONTACT INFORMATION 34 APPENDICES

INTRODUCTION

Thank you for your interest in clinical education at the University of Toronto Department of Speech-Language Pathology! At U of T, clinical education is strongly linked to the academic portions of the curriculum. Student competencies are systematically developed across the curriculum, with particular emphasis on research evidence as the foundation for professional practice. During placements, students develop reflective practice skills through activities such as Learning Conferences and Teaching Clinics, in which students evaluate and develop clinical and professional skills in a supportive learning environment. Clear internship expectations ensure consistent development of professional competencies for all students. Clinical courses provide an opportunity for students to apply academic learning in the clinical practice setting and to develop clinical skills. At U of T, clinical placements follow related academic work. All placements occur in actual clinical settings, rather than in clinical laboratories or “in-house” clinics, thus preparing graduates well for professional life. Four separate placement units allow students to experience a range of clinical settings. Performance expectations build from one placement to the next, increasing in the amount of clinical work expected and broadening the role the student clinician takes. The eight curriculum learning objectives of the M.H.Sc. program are integrated into the placement courses:

1. Entry-level competence in the assessment, treatment, and management of individuals with a variety of communication and swallowing disorders as defined, for example, by the CASLPA Foundations of Practice document;

2. Ability to locate, evaluate, and use a variety of resources to solve problems encountered in the practice of speech-language pathology;

3. Ability to communicate effectively with clients, families, and colleagues in both oral and written modes; 4. Knowledge of and compliance with ethical and legal standards governing professional practice; 5. Attitudes of respect for and attention to the needs and abilities of all clients, families, and colleagues,

including those from varied cultural and linguistic backgrounds; 6. Skill in the critical evaluation of research findings and their appropriate application to clinical practice; 7. Ability and motivation to pursue life-long learning within the profession; and 8. Skills and abilities needed to work effectively in inter-professional teams.

Welcome to Clinical Education in the Department of Speech – Language Pathology at U of T

<<<Back Table of Contents

1

PRACTICUM OBJECTIVES:

The general objectives of the practicum courses are to assist the student in development of:

(a) humane, objective and supportive attitudes toward individuals with communication handicaps and their families;

(b) assessment and interpretation skills; (c) rational and flexible treatment and management programs; (d) a sense of responsibility to society in making available professional expertise for the prevention,

identification, and remediation of communication disorders; (e) critical and evaluative attitudes which will permit ongoing change and improvement of all aspects

of clinical practice and research; and (f) clinical skills appropriate to entry-level professional practice in speech-language pathology, such

as those outlined in the 2004 CASLPA document Assessing and Certifying Clinical Competency: Foundations of Clinical Practice for Audiology and Speech-Language Pathology.

Placement Calendar As part of the M.H.Sc. degree program in Speech-Language Pathology, each student must successfully complete five clinical practicum courses:

UNIT NUMBER DURATION COURSE CODE and

TITLE DESCRIPTION DATE YEAR

UNIT 3 2 MONTHS SLP 1500Y: Internship Developmental Placement March to April YEAR I

UNIT 5 1 MONTH SLP 1507H:Clinical

Laboratory in Speech-Language Pathology

Placement in one or more clinical areas studied to date (AAC, Fluency, Voice, Aural Rehabilitation, Audiology)

July or August YEAR I

UNIT 7 2 MONTHS

SLP 1508Y: Advanced Clinical

Laboratory in Speech-Language Pathology

Neuro/Stucturally Related Placement

January to February

YEAR II

UNIT 9 2 ½ MONTHS SLP 2500Y: Advanced Internship

General Speech-Language Pathology May to July YEAR

II

UNITS

1 - 9

Completed across all

program units

SLP 1532H: Clinical Laboratory in

Hearing Disorders

Hearing Disorders in SLP Practice

Throughout program

YEARS I & II


2

COURSEWORK AND EXPECTATIONS At The University of Toronto, clinical placements are closely aligned with academic work. For four separate full-time clinical placement periods, students first complete academic learning in specific clinical areas, then enter full-time clinical placements in related clinical settings. Student Preparation YEAR 1 Unit 1 (Year 1: September – December) SLP 1502Y – Anatomy and Embryology SLP 1505Y – Child Language I SLP 1514Y – Applied Audiology SLP 1520H – Principles of Clinical Practice SLP 1522Y – Speech Physiology and Acoustics Unit 2 (Year 1: January – February) SLP 1503Y – Articulation and Related Disorders SLP 1506H – Child Language II SLP 1521H – Augmentative and Alternative Communication

Practicum Course Unit 3 (Year 1: March - April) SLP 1500Y – Internship This is the first clinical placement, which occurs six months into the program. It is a developmental placement covering the areas of child language, articulation/phonology and fluency. Course Objectives: The purpose of this course is to introduce a student to the clinical practice of speech-language pathology with children and their families. By the end of this practicum, a student must be able to:

(a) demonstrate theoretical knowledge in relation to the understanding of normal, delayed and disordered communication processes and their management

(b) display an understanding of objectives, outcomes, ethics and commitment in client care (c) show attitudes of self-awareness, curiosity, innovation, sensitivity and respect for diversity necessary to

the professional in this discipline (d) evidence an understanding of the multiple roles of a speech- language pathologist in clinical practice,

including working in teams (e) develop ongoing effective communication with clinical educator(s) (f) apply all of the above to one or more communication disorder areas

Full Course Outline (Click link or see Appendix A1.0) Recommended Course Schedule (Click link or see Appendix A2.0)


3

Student Preparation Unit 4 (Year 1: May – June) SLP 1529H – Fluency Disorders SLP 1530H – Voice Disorders SLP 1516H – Aural Rehabilitation

Practicum Course Unit 5 (Year 1: July and/or August) SLP 1507H - Clinical Laboratory in Speech-Language Pathology The purpose of this course is to expand clinical experiences leading to the further development of professional skills in practice areas studied to date, including developmental language disorders, articulation/phonological disorders, fluency disorders, voice disorders, augmentative and alternative communication (AAC) and hearing disorders. May be comprised of 2 part-time placements (including a hearing disorders-related experience) or one full-time placement. Course Objectives: The purpose of this course is to expand clinical experiences leading to the further development of professional skills in speech-language pathology with individuals with fluency and/or voice disorders and their families. By the end of this course, a student must be able to do the following at the supervised clinical practice level:

(a) demonstrate theoretical knowledge in relation to the understanding of normal, delayed and/or disordered communication processes and their management;

(b) interpret assessment information and collaborate with clients/families in making appropriate management decisions;

(c) plan long term and short term goals; (d) consider a discharge plan or options; (e) implement appropriate goal-directed procedures; (f) report findings, objectives, and progress in written and oral formats to clients, family members, significant

others, and/or other professionals; (g) demonstrate the development of self-evaluation skills; and (h) demonstrate the development of clinical reasoning and problem-solving strategies.

Full Course Outline (Click link or see Appendix A1.2) Recommended Course Schedule (Click link or see Appendix A2.1)

4<<<Back Table of Contents

4

Student Preparation YEAR 2 Unit 6 (Year 2: September – December) SLP 1525H - Structurally Related Disorders SLP 1533Y - Aphasia SLP 1534Y - Motor Speech Disorders SLP 1536H - Swallowing Disorders SLP 1538H - Neurocognitive Communication

Practicum Course Unit 7 (Year 2: January and February) SLP 1508Y – Advanced Clinical Laboratory in Speech-Language Pathology This is a neurogenic and structurally related disorders placement, so hours will likely be accrued in acquired language, motor speech, swallowing, voice and/or articulation. Course Objectives: The purpose of this course is to continue to expand clinical experiences leading to the further development of professional skills in speech-language pathology with individuals with neurogenic and/or structurally related disorders and their families. By the end of this course, a student must be able to do the following at the supervised clinical practice level in an efficient and effective manner:


(b) differentiate between a variety of communication and/or swallowing disorders; interpret assessment information and collaborate with clients/families/other professionals in making appropriate management decisions;

(b) design, implement and evaluate appropriate management; (e) report findings, objectives, and progress in written and oral formats to clients, family members,

significant others and/or other professionals; (f) demonstrate the continued development of self-evaluation skills; (g) demonstrate the development of complex, ongoing clinical reasoning skills and problem-solving

strategies; (h) demonstrate reflective practice in all areas of professional and clinical behaviour; (i) demonstrate understanding of the scope of practice of speech-language pathology in relation to

other professions and participate as an effective member of the interprofessional team; and (j) gain exposure to the concepts of best practice, evidence-based practice and outcome evaluation

using a variety of resources Full Course Outline (Click link or see Appendix A1.3) Recommended Course Schedule (Click link or see Appendix A2.3)


5

Student Preparation Unit 8 (Year 2: March - April) SLP 1527 H – Physical Analysis of Speech SLP 1528Y - Research in SLP SLP 1535Y – Advanced Principles of Clinical Practice

Practicum Course Unit 9 (Year 2: May – Mid-July) SLP 2500Y – Advanced Internship This is the final unit in the curriculum. Hours may be accrued in this placement in any area to ensure that CASLPO/A requirements are met. This is a ten-week full-time placement. Students are ready to practice following successful completion of this placement and graduate in November. Course Objectives: The purpose of this course is to develop a student's clinical competence to meet entry-level professional standards. By the end of the internship, a student must be able to do the following at the supervised clinical practice level in an efficient and effective manner:

(a) organize a coherent, integrated approach to client management (e.g., assessment, intervention,

counselling, reporting, discharge planning) utilizing best practice, evidence-based practice and outcome evaluation in collaboration with clients/families/other professionals;

(b) counsel client and/or significant others appropriately and competently; (c) communicate complete, pertinent, and accurate information in both written and oral forms to clients,

family members, significant others and/or other professionals; (d) prioritize responsibilities realistically and allocate time accordingly; (e) manag e a 75% caseload for at least the final four weeks of the internship; (f) follow the administrative standards for the clinical facility independently (e.g., setting up files, closing files,

workload measurement, quality assurance/improvement, knowledge of authority); (g) set realistic goals for self-improvement and recognize and develop personal strengths; and (h) seek out, understand, and support the mandates and operation of the department/program/facility. (i) demonstrate the continued development of self-evaluation skills; (j) demonstrate continued development of complex, ongoing clinical reasoning skills and problem-solving

strategies; (k) demonstrate continued reflective practice in all areas of professional and clinical behaviour; and (l) continue to demonstrate understanding of the scope of practice of speech language pathology in

relation to other professions and participate as an effective member of the interprofessional team. Full Course Outline (Click link or see Appendix A1.4) Recommended Course Schedule (Click link or see Appendix A2.4)


6

Student Preparation Students prepare for this course in year one by taking: Unit 1: SLP 1514Y – Applied Audiology and Unit 4: SLP 1516H – Aural Rehabilitation

Practicum Course SLP 1532H – Clinical Laboratory in Hearing Disorders (Practical experience will be acquired through hearing disorder related experience in Units 3, 5, 7 & 9). Course Objectives: In this course, the student will apply knowledge regarding the ramifications of hearing loss (its nature, degree, age of onset, and progression), as related to a number of factors: its effect on the individual and significant others, personally, socially, educationally (where applicable), and vocationally (where applicable),other existing physical, psychological, and environmental conditions, comprehension, production and use of language in oral, signed and/or written modalities. The student will demonstrate knowledge and skills in the following areas:

(a) performance of valid puretone screening and/or audiograms (b) interpretation of audiologic results accurately (c) consultation with audiologists, physicians, and related support services as appropriate (d) application of hearing status information to speech-language pathology practice (e) use of compensatory mechanisms or strategies to enhance communication in the presence

of hearing disorders (f) use, care and maintenance of hearing aids, cochlear implant devices, assistive listening

devices and amplification systems (g) development of client self advocacy skills (supportive counselling)

Full Course Outline (Click link or see Appendix A1.5) To see how it all fits together, see the Curriculum Map (Click link or see Appendix A3.0) For a reminder of when placement documentation is due, see the Record Keeping Summary Table (Click link or see Appendix A4.0)


7

ROLES AND RESPONSIBILITIES There are many individuals with varying roles involved in the clinical education enterprise:

The Coordinators of Clinical Education The Coordinators of Clinical Education for the department serve as the primary channel of communication between clinical teaching centres affiliated with the University and the Department of Speech-Language Pathology, and act as a liaison between the course instructor, the clinical educator, and the student

The Coordinator of Clinical Education undertakes the following activities and functions: (a) initiates or responds to contact with potential clinical teaching sites; (b) visits potential sites and clinical educators and provides information to the University on a site's potential as

a teaching site; (c) makes arrangements with sites for student placements; (d) makes arrangements with students for clinical placements; (e) co-ordinates records of student clinical experiences; (f) serves as primary liaison person for clinical educators wishing to discuss any aspect of students clinical

placement with the University; (g) serves as primary liaison person for any student wishing to discuss matters concerning clinical placement

with the University; (h) plays a major role in ensuring that each student in the program receives wide ranging clinical experience

in accordance with the student's ongoing professional development.

The Site Coordinator The Site Coordinator is designated by a placement site and acts as the administrative liaison between the Department of Speech-Language Pathology and Clinical Educators.

The Site Coordinator undertakes the following activities and functions: (a) disseminates information sent by the department to SLP colleagues relating to clinical education and

professional education opportunities, etc.; (b) supports the process of clinical education by facilitating the development of related knowledge and skills

among SLP colleagues; (c) arranges offers of student placements by liaising with colleagues and facilitating related decisions and

administration; (d) facilitates communication of placement offers to the university; (e) facilitates exchange of information between the placement site and the university relating to student

placements, including pre-placement administrative requirements; (f) ensures a placement agreement is signed and current; (g) ensures students receive an orientation to the placement site and placement expectations.


8

Clinical Educators A clinical educator is a certified speech-language pathologist, audiologist or other qualified professional, as deemed appropriate, who provides and oversees suitable learning experiences for a student during a clinical practicum course. Potential clinical educators who intend to take a primary role in supervision must have worked in the field at least 2 years. Clinicians in their second year of practice who wish to participate as clinical educators with the support and mentorship of a more experienced peer are encouraged to do so (with the knowledge of the coordinator of clinical education at the university). The potential clinical educator should provide names of qualified speech-language pathologists who would be able to provide supervision in the event of illness or absence.

Potential clinical educators are encouraged to be registered with OSLA or certified with CASLPA and, if practicing in Ontario, must be registered with the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO). The department endorses the following practices for clinical teaching and learning:

(a) Primary Clinical Educators (CEs) have a minimum of 2 years (or equivalent) clinical experience (b) CEs will explore each student's theoretical background for working with the clients allocated. (c) CEs will be familiar with and follow the Department of Speech-Language Pathology Clinical Education

Guide. (d) CEs will be familiar with and follow expectations described in course outlines. (e) The CE will outline for each student the major philosophies and procedures current at the clinical site so

that students will gain knowledge of a variety of approaches to clinical administration. Students should be aware of referral systems, reporting responsibilities and the place of the speech clinic in the overall structure of the institution.

(f) The CE will require the student to adhere to the norms of professional interaction used in that particular treatment centre.

(g) The CE will encourage students to evaluate critically both procedures and philosophy in treatment. The clinical educator will outline, where appropriate, possibilities for applied research.

(h) The CE may require the student to pursue specific background preparation when working with certain types of disorders through assignment of readings or advance preparation for test administration. In giving such assignments the educator should try to assign work which can be integrated realistically within the overall studies for which the student is responsible.

(i) CEs are invited and urged to contact the Coordinator of Clinical Education concerning any aspect of student placement and experience which requires clarification or discussion.

Wondering about ways to get started with clinical education? Consider being a Teaching Clinic facilitator. In your second year of practice? Consider pairing up with a more senior clinical educator who can take the primary role.

Clinical Faculty Clinical educators are considered to be clinical faculty and their contributions are deeply appreciated by students and academic faculty! Without our partners in clinical education, we would not be able to offer this program! We encourage CE's to obtain “status only appointments” to the University in recognition of their contributions. For more information about status only appointments please visit: http://www.rehab.utoronto.ca/StatusOnly/


9

Clinical Sites The clinical experiences must be completed at a clinical site that has been formally approved by the Department of Speech-Language Pathology.

Guidelines for Designation as a Clinical Site: (a) Clinical sites will identify facilities for student activities, including provisions for observation, work space,

audio or visual equipment, etc; (b) Clinical sites will be asked to periodically document and update all professionals who would be

involved in the clinical training, their qualifications, and years of experience. Additionally, the potential site will identify any specialty areas served, the primary model of service delivery, and other specialized experiences available within the clinic;

(c) Clinical sites must be able to document approval, in principle, by the administration of the clinic to have the site involved in clinical education and the implied time and other commitments required by clinical educators;

(d) Clinical sites may be asked to document clinical tools, including those used for diagnostic purposes and for treatment, which are routinely used by the clinical site;

(e) Because staff and resources of clinical sites change from time to time, where possible, clinical sites will be visited periodically by a coordinator of clinical education. The purpose of this visit is primarily to gain first-hand knowledge of the facilities and of the clinical education capacity, and also for promotion of professional development in the area of clinical education;

(f) Any clinical sites that will offer a student a placement and where billing for service is used, must explain in some detail how billing is done, and the implications for billing of students' time.

We couldn’t do it without you, Thank you!

Our innovative curriculum was developed in close consultation with the clinical community. Implementation depends upon on-going close partnership with our clinical educator community. Thank you for providing these valuable learning experiences for our future colleagues. We couldn’t do it without you!


10

Student Role Students in clinical placements have multiple roles. They are learners, benefitting from experience in actual clinical placements to translate academic learning into clinical practice skills. Learning may be accomplished through observing, modeling observed clinical skills, sharing clinical tasks with a student peer or clinical colleague, conducting simulated clinical activities, planning and implementing assessments or interventions with clients, writing reports, participating in clinical team meetings, preparing and presenting continuing education sessions, or (in the final placement) participating on committees or workgroups, to name just some examples. Through guided self-assessment, they learn and demonstrate self-assessment skills that will support continuous learning throughout their career. Formative and summative evaluations of clinical and professional performance also guide the learner. They are managers/administrators. Students are responsible for knowing the learning expectations of a clinical course, and helping to ensure that the placement experience aligns with the expectations. They must track clinical hours obtained while on clinical placement, and manage related forms and signatures. They must ensure that the performance evaluation material reaches the intended university repetitive by the due date and according to instructions (e.g., in a signed sealed envelope). They must gather evidence to show to the university that the course Minimum Expectations have been met, and submit this evidence to the university according to instructions provided. They are current and future clinical colleagues. They collaborate with clinical educators and share responsibility for developing a positive learning environment and supportive communication. Students promote best practice in clinical settings by sharing and applying current knowledge learned in the academic setting. Through research-to-practice assignments and reflective learning activities, they assess the clinical environment and address issues that face our profession.

They are prepared! All students have prepared health/immunization records that can be requested by clinical sites as required

by site policy. All students have completed mask-fit testing. A record is kept in the student’s possession. All students have been advised to complete a Police Record Check. These records are retained in the

student’s possession and can be viewed upon request as per clinical site policy. All students have U of T name tags which can be used at clinical sites. All students have done academic coursework related to their upcoming placements!


11

PLACEMENT PROCESS

The process for developing the needed number of quality clinical placements and assigning these to students is complex, involving numerous stakeholders: students, clinical educators, clinical sites, university instructors, and university staff. Every effort is made to ensure that the process is respectful of the separate and varied needs of all parties.

A priority outcome of the placement process is to enable students to meet CASLPA/O requirements upon graduation. The curriculum has been designed to ensure that students obtain a broad range of clinical experiences. It may not be possible to arrange the needed number of quality clinical placements in the timeframe required within the Toronto area placement region (Oakville – Oshawa – Barrie, inclusive). As a result, each student should expect to receive at least one placement outside of this region. Although efforts are made to place students in their preferred facilities and geographical areas, it is not always possible to do this.

The Coordinator of Clinical Education (Course Instructor) is responsible for coordinating and liaising with all placement sites. As part of this process, clinical sites are evaluated to determine suitability for clinical placements. No student may undertake to make her/his own arrangements for a clinical placement with a facility or an individual therapist. Any such arrangements will not be honoured. Students are encouraged to discuss potential new placement sites with a Coordinator of Clinical Education.

Students are assigned their placement sites through a computer-assisted process, which takes into account students’ placement preferences. The Department of Speech Language Pathology reserves the right to place students in specific facilities/areas of therapy in order to meet individual students’ learning needs and provide students with a balanced clinical education program.

The students are responsible for planning and financing travel/accommodation or other costs related to assigned placements.

PLACEMENT DEVELOPMENT AND ASSIGNMENT PROCESS

1. Placement Sites are contacted in the summer with requests for placements 2. Students are surveyed for preferred site/setting/geographical location;

information is utilized in development of placement offers 3. Students NEVER contact clinical sites about placement opportunities 4. Offers received automatically go into a computerized database 5. A report of offers received is made available on-line for students to review 6. Students and Clinical Coordinator meet to discuss offered placements 7. Student submits 10 placement preferences from the report of offers received (on-line) 8. Students requesting out of catchment are pre -matched where possible 9. Lottery for highly sought after out-of-catchment placements is completed prior to computerized match for

remaining placements 10. Student preferences relating to remaining placement offers are input into the computerized database 11. Computerized match by lottery is completed 12. U of T sends out confirmation letter (email) to sites, students; whenever possible, this is done 6 to 8 weeks

ahead of the start of placement. 13. Pre placement meeting occurs between students and clinical coordinator and course expectations are

reviewed 14. Students review assigned placement offer and follow any instructions indicated by site

The Coordinators of Clinical Education consult regularly with student class representatives regarding the process and challenges that arise relating to the placement process.


12

BEFORE PLACEMENT BEGINS - Student Responsibilities Once students have received their placement assignments, they will review the description of the clinical placement provided by the site to the university and follow any site-specific instructions. Students will contact the site coordinator (or CE if indicated in the placement description) to discuss any pre-placement preparation or administrative tasks, such as:

o Student’s personal contact information o Police Record Check requirements o Mask Fit Testing requirements o Proof of Immunization requirements o Travel requirements o ID Badge requirements o Password assignment o Required Reading o Dress Code / Footwear Requirements o Orientation session or related material (pre-placement?) o Where and when to be on the first day o CV (if required)

PLANNING THE PLACEMENT - HELPFUL DOCUMENTS These documents are provided to assist both clinical educators and students with pre-placement planning and preparation. Internship Practicum Contract(s) This form is used to develop the agreement between the student and the clinical educator about various aspects of the placement; it is returned to U of T by the end of the second week and reviewed by the course instructor. Experience has shown that including as much detail here as possible will help ensure that expectations are explicit and avoid confusion or misunderstanding. Consider incorporating goals arising from the student’s prior placement, when applicable.

One Site- If the student is attending a single site for a placement unit, use this form: One Site Contract(Click link or see Appendix B1.0) Two Sites- If the student is attending two sites for a placement unit, use this form: Note: Information on expectations will be shared across both sites. Two Site Contract (Click link or see Appendix B1.1) Background Questionnaire (OPTIONAL) This can be used as a "get to know you" when the student and the CE meet for the first time. Questionnaire (Click link or see Appendix B1.2) Student Clinical Placement Goals This is used to guide a student to reflect on learning and future goals at the end of each placement. A CE reviews it with the student and signs it. It is to be taken to the next placement where it can be used to guide development of the Practicum Contract. Student Placement Goals (Click link or see Appendix B1.3)


13

EVALUATION: A primary responsibility for the CE is to provide opportunities for formative assessment, as well as to complete a formal summative assessment used for grading purposes by the university.

Formative Assessment Formative assessment refers to ongoing feedback about performance, and should include a balance of areas of good performance and areas that would benefit from further attention. Feedback Log (OPTIONAL) This word document can be used to give daily written feedback (double click on the check boxes to select and print or print and fill in by hand). Both CEs and students retain a copy. Its use is optional. If not used, then some other form of written feedback should be provided on a regular basis (more frequent for earlier placements than for later placements). It is best for the CE to retain a copy of written feedback provided to the students to refer to during mid-term and final evaluations to support ratings and comments. Feedback Log (Click link or see Appendix C1.0) Learning Conference – (for Units 5, 7, 9) This guided self-assessment supports a student to develop self-assessment skills important for life-long learning. A half-hour (max.) learning conference is arranged as per the course outlines. The student will prepare a self-assessment for discussion and record minutes of feedback received. Learning Conference Click here or see Appendix C1.1)

Summative Assessment: The evaluation process for both the midterm and final evaluation is composed of two parts:

(a) ratings (b) summary comments

Note: a formal mid-term evaluation is NOT required in Unit 5 (Clinical Laboratory in SLP). Computerized evaluations for the midterm and final evaluation are used. The evaluations are completed using red-on-white computer bubble sheets. The student completes the first part of the evaluation, which includes all identifying information. The clinical educator(s) complete the portion of the evaluation forms pertaining to the student’s clinical skills and professional behaviour observed during the placement.

Mid-term Formative Performance Evaluation (Units 3, 7 and 9): Mid-way through the placement, the student will be given a formative evaluation by the clinical educator using The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills (Please note that Summary

comments must accompany each evaluation form). This evaluation, though formalized, is not factored into the final grade. The clinical educator will review and discuss the results of these evaluations with the student, then submit them to the Course Instructor/Coordinator of Clinical Education.

TIP: Both the mid‐

term (when

applicable) AND

the final evaluation

must be

accompanied by

signed and dated

summary

comments forms.

These comments

need not be

lengthy but rather

should highlight

strengths and

areas for

development and

offer an overall

impression

consistent with the

ratings provided.

Did you remember…? to include summary comments?


14

The clinical educator must inform the Course Instructor/Coordinator of Clinical Education in the event that the student is in jeopardy of failing at this point in the placement. Written notification of this will then be given to the student (See “If Problems Arise” below). Final Summative Performance Evaluation (All placements: Units 3, 5, 7 and 9): Again, the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills will be used for these evaluations (Summary Comments must accompany each evaluation form). The Clinical Educator will review and discuss the final performance reports (The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills, and Summary Comments) with the student, prior to submitting them to the Course Instructor/Coordinator of Clinical Education. The Course Instructor will determine a final grade. A student who fails the internship must leave the program. The Examinations Committee may, however, review the student’s record to determine if extraordinary circumstances are present and will take any appropriate action (see Student Handbook, Course Regulations).

An inherent part of clinical skills is appropriate record-keeping. Accordingly, a student must complete all record-keeping tasks, as outlined on the form entitled Record-Keeping Summary Table, by the due date indicated. One-third of a grade will be lost for each day late.

Evaluation Forms Clinical Educators will receive a package from the university containing the needed evaluation forms. Evaluation Instruction Forms for Students (Click on the link or see Appendices C2.0 and C2.1) Evaluation Instruction Forms for Clinical Educators(Click on the link or see Appendices C3.0 to C3.3) Summary Comments Form (Click on the link or see Appendix C4.0

If Problems Arise: A student is encouraged to bring any concerns regarding a practicum experience (e.g., course, clinical facility, Clinical Educator) to the attention of the Course Instructor/Coordinator of Clinical Education as soon as they arise. The Course Instructor/Coordinator of Clinical Education will help to problem-solve and to facilitate discussion and resolution of such concerns with the clinical educator, as required. On occasion, a student may experience difficulty in meeting the learning and performance expectations for a practicum course. In such cases, the clinical educator must notify the Course Instructor / Coordinator of Clinical Education as soon as concerns arise, even if a mid-term evaluation has not yet occurred. If a student is not demonstrating acceptable performance in either professional behaviour and/or clinical skills, based on the assessment of the Course Instructor/Coordinator of Clinical Education, written notice must be given to the student and a specific written plan for developing these skills must be negotiated cooperatively by the Course Instructor/Coordinator of Clinical Education, the clinical educator, and the student. This plan will include:

(1) clear identification of problems in learning and teaching;

(2) specification of learning objectives to be achieved and behaviour changes expected;

(3) any necessary actions, procedures, or modifications required to the clinical practicum, and

(4) a time schedule and procedures for evaluating the outcome of the plan. The Course Instructor/Coordinator of Clinical Education will document the plan and provide a copy to the student

Did you remember…? to sign the evaluation forms and have the students sign?

Did you remember…? to allow the student to make a copy of the evaluation?


15

and the clinical educator. The Course Instructor/Coordinator of Clinical Education will also assist the student and the clinical educator in implementing the plan and in evaluating its success. If the student does not meet the learning objectives outlined in such a plan, a grade of failure (FZ) will be assigned for the practicum course by the Course Instructor. This grade is the equivalent of a failure in an academic course and is subject to the regulations and appeal procedures described in the SGS Calendar and the Student Handbook.

Mid-term and Final Evaluations FAQs What do the numbers on the scale mean? Much poorer than expected: Does not perform skill, even with extensive direction and/or demonstration from Clinical Educator. Needs Further Development: Performs adequately only with continued intervention from the Clinical Educator. Generalization/consistency is not evident. As expected at end of placement (Good Performance): Performs adequately with some guidance and input from the Clinical Educator. Generalization/consistency is adequate. Outstanding: Displays superior performance with minimal guidance and input from the Clinical Educator. Generalization/ consistency is excellent How is “growth” reflected in the evaluations? As per the instructions, “Typically, the student’s performance on the midterm evaluation will be lower on the scale than for the final evaluation, indicating a growth in skills over the placement term.” This means that the student is to be evaluated, both at midterm and at final such that “as expected” is interpreted to mean as expected at the end of the placement. At mid-term, the student may be performing “as expected” (at the end of placement) already for some items, in which case ratings of 5 are appropriate. Typically a profile will emerge of areas of relative strength and areas for development in the final portion of the placement. At the final evaluation, more items will likely achieve a rating of 5 or better. What is “good” performance? A student demonstrates good performance at the end of placement if meeting the expectations described in the course outline while performing adequately with some guidance and input from the CE and when generalization/consistency is considered to be adequate. This corresponds to a rating of “5”on the evaluation. When does a student obtain a rating of “6” or “7"? Ratings of 6 and 7 are reserved for truly outstanding performance – minimal guidance and input is required and generalization /consistency is excellent while achieving the expectations of the course outline. The comments accompanying the rating form must support these ratings. When students demonstrate professional skills that meet the high standards of the profession, is this rated as “5”? As “7”? The level of CE input is important to consider for both clinical and professional skills when determining a rating. Certainly we expect our students to demonstrate professionalism according to the high standards of our profession and typically our students meet these standards, but in rating student achievement, it is helpful to consider the degree to which the student requires guidance or input to do so.


16

Evaluation of Clinical Faculty Teaching At the end of the placement, each student will provide feedback about his or her clinical education experience, addressing the following topic areas using a rating scale as indicated below. Areas of teaching not addressed in the placement are left blank. After 3 or more evaluations are gathered, the results are compiled into a report and sent to the participating clinical educator. This is done to attempt to preserve some degree of anonymity, as well as encourage honest feedback for the university and CEs, who are encouraged to contact us in the meanwhile for support and ideas as they develop their clinical education skills! 1 The first question asks that the student indicate the amount of contact they had with the clinical faculty member (1 poor, 2 Fair and 3 Good) For Items 2 -19 the following rating scale is used 1 = Poor, needs much attention, 2 = Fair, needs some attention, 3 = Good, satisfactory, 4 = Very good, consistently better than average, 5 = Excellent, exemplary teaching General Evaluation: The students are asked based on all of their experiences with the clinician to provide their view of the clinician’s performance using the above rating scale 2 Established clear expectations. 3 Responsive to your learning style. 4 Incorporated your learning agenda and objectives. 5 Was readily accessible, given workplace limitations. 6 Demonstrated enthusiasm for teaching. 7 Demonstrated a caring attitude for clients and families. 8 Demonstrated sensitivity to the needs of students and staff. 9 Took time for questions and discussion. 10 Asked questions that stimulated problem solving. 11 Answered questions clearly. 12 Explained her/his rationale for actions and decisions. 13 Acknowledged when she/he did not know information and suggested alternative sources to obtain

information. 14 Maintained an atmosphere that encouraged differing points of view (i.e., open to ideas, suggestions and constructive feedback). 15 Provided regular, specific, constructive feedback. 16 Promoted self-assessment and self-responsibility for learning. 17 Shared her/his relevant knowledge and experience. 18 Was an effective role model. 19 Overall, I would rate this experience as ….. Evaluation of Quality of Teaching The students are asked to provide their view of the clinician’s quality of teaching in the following content areas. If the content area was not dealt with an N/A should appear on the clinician's report 20 Assessment. 21 Oral and Written Reporting. 22 Developing and Planning. 23 Intervention. 24 Counselling and Interviewing. 25 Evaluation and Problem-Solving. 26 Ethical Issues. 27 Administration. 28 Prevention and Screening Issues. 29 Family and Community Issues. 30 Research in Speech-Language Pathology and/or Audiology. Students may also make additional comments or suggestions.


17

GUIDELINES, POLICIES AND PROCEDURES

Counting Clinical Hours Proof of completion of a minimum of 350 hours experience is required for registration with CASLPA and/or provincial regulatory bodies and professional associations in Canada, as well as for international regulatory agencies in Australia, the United Kingdom, the United States. The student is required to keep accurate records of clinical hours as per university guidelines. Over the course of the two year MHSc program students will engage in clinical activities in a variety of disorder areas that will be counted as clinical hours. This will primarily occur during clinical placements, however all students will also accrue hours during academic course work. The academic hours are tracked by the student independently of the hours obtained on clinical placements. In each clinical placement the student will complete forms provided by the University to show the clinical hours obtained at each site. This form is to be signed by a Clinical Educator. At the end of the two- year program, the student will complete a form to record clinical hours obtained during academic course work and a final hours calculation form with the totals of all of the hours accrued in the program. This final document can then be used for post program registration/application purposes as arranged by the administrative assistant to clinical education and the student.

General Guidelines Concerning Clinical Activities: In clinical practicum courses, students will be involved in various clinical activities as appropriate to their level of experience and the clinical setting. The following definitions of clinical activities are based on the 2004 revised CASLPA guidelines for clinical hours and have been modified to reflect the expectations of the program. I. Clinical Readiness Activities

(a) Review of client files. (b) Observation - Student observes clinical educator or other speech-language pathologist, audiologist or other qualified professional, as appropriate, carry out clinical sessions with client(s). The clinical educator will expect the student to: write brief observation notes and/or record data concerning the client's communication behaviours and the techniques used by the clinical educator when interviewing, assessing, treating, or counselling clients and their families; contribute relevant comments and questions to discussion with the clinical educator following observation.

II. Clinical Experience (Hours: Minimum of 350 total; of those minimum of 300 in A & B; maximum of 50 hours in C) (a) Client Specific Service

1. Screening, Identification, Assessment 2. Intervention, Therapy, Management 3. Interviewing 4. Counselling


18

(b) Client Related Service

1. Case Conference, Rounds, Team Meetings 2. Consultation with other professionals, support personnel 3. Clinical Educator Discussion (client related)

(c) Clinical/Professional Activities 1. Simulated Clinical Activities 2. Promotion 3. Presentations e.g., workshops, in-services 4. Interprofessional Activities 5. Program Development 6. Planning / Analysis 7. Other

III. Other Clinical Practice Activities

(a) Planning and Analysis Activities - Student engages in independent planning for the assessment and/or treatment of a client and/or student analyses information obtained during such activities. (b) Oral and Written Reporting and Record-Keeping - Student composes, produces, and corrects written reports of student-provided clinical services and maintains clinical records such as file notes and institutional statistics. (c) Material Development - Student prepares special materials for use in assessment and treatment. (d) Clinical Education Conferencing - Student engages in student-focused discussion with clinical educator pertaining to planning and execution of the clinical teaching process such as contracting, scheduling, performance evaluation, and orientation.

IV. Related Activities

(a) Orientation to Facility. (b) Continuing Education activities, e.g., rounds, in-service training sessions, conferences. (c) Professional Activities, e.g., department meetings, public relations. (d) Presentations.

General Guidelines Appendix A from CASLPA Expanded information regarding CASLPA Clinical Hours Requirements for Certification CASLPA Clinical Hours Requirement (Click here or see appendix E1.1)


Tips for Counting VOICE and FLUENCY Hours (U of T Department of Speech-Language Pathology) These tips will help students to accurately capture minimum required clinical hours under the appropriate categories for voice and fluency. In each placement, think broadly to try to accurately capture any and all voice and fluency hours possible. Those students who receive placement assignments focusing on fluency should have no problems obtaining CASLPA/O targeted hours for fluency. It may also be possible to get some voice hours. While in a fluency placement, it is important that all the voice hours are captured that are possible. For example, if teaching EASY ONSET is a goal of intervention, then designate part of a session as VOICE hours. Count in 15 minute units. A one hour session might be…

.75 fluency (stretched syllables, counselling)

.25 voice (breathy/easy onsets) So, for instance, in a 45 minute session, .5 hours may be designated as fluency and .25 hours may be designated as voice. Similarly, more voice hours may be captured when providing service to those with motor speech disorders if you target respiration/posture, phonation or intonation in any way. Students who receive placement assignments focusing on voice should have no problems obtaining your CASLPA/O targeted hours for voice. While in a voice placement, obtaining fluency time units may not be possible. However, in other placements, students can capture fluency hours in a variety of ways. For example, when training control of prosody or pacing in motor speech disorders, students can count a portion of a session (perhaps .25 hours) as FLUENCY hours. At some sites that service a general caseload, it may be possible to request a fluency client. Students are asked to contact the Coordinators of Clinical Education with their questions or concerns about obtaining the required hours.

Summary of Clinical Practice Hours Form A student will complete this form once for each clinical placement to track their hours for CASLPA/O. It is critical that students complete this form in its entirety for each placement with careful attention to detail. This will support the student to accurately compile total clinical hours accrued at the end of the professional program for submission to professional and regulatory agencies. Summary of Clinical Practice Hours (Click here or see Appendix E1.2)

Reporting total hours to professional and regulatory agencies At the end of the final placement, students will be guided to complete a summary report of all clinical hours accrued throughout their M.H.Sc. program. This will include some clinical hours completed during academic coursework in addition to all clinical hours accrued during clinical placements. http:/clinical education website/ hours finalization guide


kristina

Sticky Note

coming soon!!

EMBEDDED PLACEMENT ACTIVITIES Clinical learning experiences which are embedded into many of the clinical placements include Teaching Clinics, Guided Observations, Interprofessional Education activities, and Research-to-Practice assignments.

Teaching Clinics In each 8- or 10-week placement, students attend the university for three full days of learning designed to support the development of clinical reasoning and self-assessment skills pertaining to their placement experience. For the morning session, groups of four or five students are assigned to a facilitator (SLP clinicians from our clinical community). The students each present short video clips or detailed prepared scripts describing a clinical experience. They will consider and discuss confirming and developmental aspects of the experience with their peers and the clinical educator facilitator.

Facilitators come from several areas of the community: Private Practice clinicians who are unable to take a student full time but who want to participate in clinical education; status-only clinicians as part of their teaching responsibilities; returning clinicians who enjoy this aspect of teaching and new SLPs as an introduction to clinical education before they taking a student for a clinical placement.

Agenda Morning Session (9:00 – 12:00) Small Group Reflective Teaching Clinic: Individual case presentations with discussion and feedback. Afternoon Education Session The afternoon content is tailored to the particular Unit.

Alternative Assignments Teaching Clinics are mandatory, however students who are participating in placements at a distance from the university or who are unable to attend Teaching Clinics due to extraordinary circumstances (such as illness) are required to complete an alternative assignment, which can be found on the departmental course website.

Where possible, the university will arrange for students in distance placements to participate in Teaching Clinics, or a portion thereof, using video-conferencing or web-based communications technology. Students who are able to attend the morning session of the teaching clinic via the internet are only required to complete the afternoon assignment.

Typically, if a Teaching Clinic day falls on a statutory holiday, the Teaching Clinic is cancelled.

Teaching Clinic Format (Click here or see Appendix D1.0) Release of Video or Audio Recordings for Teaching Purposes (Click here or see Appendix D1.1) Instructions for preparation of video tape (Click here or see Appendix D1.2)

Teaching Clinics Fridays: 9:00 a.m. – 12:00 noon @ U of T Units 3, 7 and 9 (not 5) Weeks 3, 5, 7 for each unit Schedule Jan/Feb Unit 7 (Year 2 – neurogenic and structurally-related disorders) 10 Clinical Educators required; ideally for all 3 sessions Mar/Apr Unit 3 (Year 1 – paediatric; introduction to clinical practice) 10 Clinical Educators required; ideally for all three sessions May/June Unit 9 (Year 2 – final placement) 10 Clinical Educators required; ideally for all 3 sessions


Guided Observations Unit 3 Guided Observations – Students can use this form to gather observational information for Minimum Expectation #1 - Guided Observation. Please note that for Unit 3, use of the first 2 pages of this form is REQUIRED. Use of pages 3-8 is optional.

The expectation in Unit 7 is that the student will provide evidence of guided observations using their notes as indicated in the course outline. The forms below are provided as a reminder of forms students have used in the past. Students are to use judgement as to the suitability of these forms. Students can use these as a resource to plan questions that will guide observations.

Guided Observation Form-Child(Click here or see Appendix D2.0) Developmental Observation Form- Adult (Click here or see Appendix D2.1)

Interprofessional Education What is Interprofessional Education? Interprofessional education (IPE) for students occurs when individuals from at least 2 different roles or professions learn about, from and with each other to collaborate effectively as team members in working towards best outcomes.

What is an interprofessional education activity? Consider using this checklist to support students’ involvement in clinical IPE activities.

1. Are 2 or more professions involved? 2. Does significant interactivity between participants occur? 3. Are there opportunities to learn about, from and with one another? 4. Are interprofessional teaching/learning moments addressed? (e.g. Is learning about how team

members work together discussed?)

What does the University of Toronto IPE curriculum mean for students in clinical settings? As part of the U of T IPE curriculum, students are expected to address competencies for IPE through participating in specific learning activities in clinical settings. Currently, this includes a structured (student team) IPE placement or participation in specific flexible activities. In Unit 7 Flexible Interprofessional activities have been built in to the placement unit. The following documents describe the flexible IPE activities required in Unit 7 Activity 1(Click here or see Appendix D3.0) Activity 2 (Click here or see Appendix D3.1) Activity 3 (Click here or see Appendix D3.2) The following form can be completed and submitted as evidence of having completed the 3 IPE Minimum Expectations for Unit 7. Completion Form (Click here or see Appendix D3.4)


Research to Practice The course assignments described here is part of a sequence of learning activities across the curriculum that are intended to develop the attitudes and skills students will need to effectively use research to guide their practice. CEs are asked to read the student’s report and provide a few comments using the form indicated below. All reports will be reviewed and marked by the faculty advisor for this project, taking into account the comments and feedback provided by clinical educators

Unit 3- Consumer Satisfaction Assignment The Consumer Satisfaction Research to Practice assignment is completed in Unit 3. A description of this assignment and the documents that relating to this assignment can be found in the appendices:

1. Information Letter for Students and Clinical Educators (Click here or see Appendix D4.0) 2. Agreement by the Clinical Educator Regarding Consumer Satisfaction Assignment(Click here or see

Appendix D4.1) 3. Guidelines on which survey to choose(Click here or see Appendix D4.2) 4. Survey Package(Click here or see Appendix D4.3)

The only component that is specific for CEs is the Clinical Educator’s feedback form, which is accessed and submitted online at: http://www.ot.utoronto.ca/SLPResearchToPractice/unit3consumerfeedback.php . At the end of the practicum, CEs select the student’s name from the dropdown menu, type your qualitative feedback on this form and then press submit. This form will only accessed by the instructor responsible for the Research to Practice assignment (Rosemary Martino) as well as the student. We also require CEs to sign the Clinical Educator agreement form at the completion of the assignment. The students will include this in the submission of their assignment.

Unit 7- Treatment Outcomes Assignment Treatment Outcomes is the focus of the Research to Practice assignment that our students complete in Unit 7. Pertinent documents for this assignment can be found in the appendices

5. Neurogenic and Structural Disorders Internship: Information and Instructions for Students and Clinical Educators (Click here or see Appendix D4.4)

6. Information Letter(adult)(Click here or see Appendix D4.5) 7. Information Letter(parent/guardian)(Click here or see Appendix D4.6) 8. Clinical Educator and Student Agreement/Consent Form (Click here or see Appendix D4.7) 9. ASHA NOMs Package(Click here or see Appendix D4.8)

The only component that requires independent completion by the CE is the Clinical Educator’s feedback form. This feedback form is accessed and submitted online at: http://www.ot.utoronto.ca/SLPResearchToPractice/unit7outcomesfeedback.php At the end of the practicum, after receiving a final copy of the assignment from the student, The CE selects the student’s name from the drop down menu, enters CE identification information and then selects the appropriate feedback comments that pertain to the student’s paper. Any other comments are optional. This form will only be accessed by the instructor responsible for the Research to Practice assignment (Rosemary Martino) as well as the student. We also require CEs to sign the Clinical Educator agreement form at the completion of the assignment. The students will include this in the submission of their assignment. For this assignment, the students ARE required to consent the clients in the same fashion as they would for any clinical assessment (as outlined by CASLPO’s Obtaining Informed Consent guidelines). After the student has explained the nature of the assignment/assessment and verbal consent has been obtained, this consent can then be documented in the client’s chart/file as a progress note.


Placement Policies

Health Policies Health Requirements and Proof of Immunization Students entering the M.H.Sc. program are expected to be in a state of health that allows them to participate fully in academic and clinical programs, and pose no risk to themselves or others. After admission, but prior to registration within the program, students must submit to the Administrative Assistant of Clinical Education medical certification stating that they have been immunized against polio, diphtheria, tetanus, rubella, measles, mumps, chicken pox, and hepatitis B, and are free of tuberculosis. Proof of Hep B immunity by blood titre test is required. Tuberculosis certification must be by skin test or chest X-ray. If a skin test yields a positive result, a follow-up chest X-ray is required which must be dated no earlier than one year prior to beginning the program and must be repeated annually. In addition, many clinical sites are requiring annual flu shots, which can be obtained at no charge from any doctor’s office. The Health Form is collected by the Departmental Office in order for the University to establish that each student has fulfilled the University’s requirements as well as the standards set forward by the Public Hospitals Act, Section 4.2, Ontario Regulation. The facilities rely on us to maintain these records and ensure student compliance with these standards. The forms are not collected for the purposes of storing for student use. Students must make a copy of the completed health form and supporting documentation BEFORE it is submitting them to the Office, as students will be required to provide it to placement sites multiple times throughout the program. There is an administrative fee for obtaining a copy of the record once it has been submitted to the University. Failure to fulfill any of the immunization requirements could result in the student being suspended from participating in clinical placements. Certain sites may require a proof of immunization. Students are responsible for following directions particular to the placement site. Instruction Form(Click here or see Appendix F1.0) Year 1 Health Form(Click here or see Appendix F1.1) Year 2 Health Form(Click here or see Appendix F1.2) Illness or Absence During Clinical Placements Clinical placements are considered to be a vital component of the M.H.Sc. program and represent the minimum number of supervised hours needed for the student to achieve competent professional skills. Accordingly it is expected that students attend all scheduled clinical placements, regardless of whether a student has completed required CASLPA hours and course minimum expectations. In the event that total absences exceed five percent of total scheduled clinic time, a supplemental placement must be completed within the grading period according to SGS guidelines. In the event the student cannot complete this requirement by the final grading period, the student will apply to the Graduate Coordinator for an extension. Extension will be given for one term. A student cannot apply for more than one extension.

See Student Support Services-(Accessibility, Accommodations and Course Exemptions) for more information


http://speechpath1.med.utoronto.ca/students/degree/exemptions.htm

Cardiopulmunary Resuscitation (CPR) Certification Department of Speech-Language Pathology students are not required to provide a copy of a valid certificate in CPR at the Basic Rescuer (C) level. This level includes one-person and two-person CPR with infants, children and adults. However please be prepared that some placement sites may require certification. The student is responsible for the expense of these courses. Placement sites accept CPR certification from most agencies in Canada. Some of the most popular courses among students are fun by the following agencies:

• The Canadian Red Cross: http://www.redcross.ca • Heart and Stroke Foundation: http://www.heartandstroke.ca • Lifesaving Society: http://www.lifesaving.ca • St. John’s Ambulance: http://www.sja.ca

Mask Fit Testing The Ministry of Health has developed directives for health care professionals to wear an approved respirator/mask when droplet protection (as in the case of SARS) is required. In order to protect the health and safety of health care students, the use of N95 respirators may be required if there is evidence of potential exposure to airborne infectious agents, chemicals, etc. Please note, as part of a student’s clinical/fieldwork education criteria, mask fit testing and an education session is mandatory for all students. The Rehabilitation Sciences Sector has arranged mask fit testing for all students. All students will receive a memorandum from the Rehabilitation Sector office in reference to the education session and mask fit-testing. Students will receive documents regarding the policies and procedures for completing the education session and mask fit testing. In addition, all students will receive notification regarding the date, time and room number of the education session and mask fit testing at 500 University Avenue. No additional fees are required. Important Notice: Failure to attend the scheduled date and time of the education session and mask fit-testing will result in the student taking full responsibility for making alternative mask fit-testing arrangements and paying the required mask fit-testing fee at a private clinic (approximately $30).

Workplace Hazardous Materials Information System Workplace Hazardous Materials Information System (WHMIS) is a comprehensive national system for safe management of hazardous chemicals which is legislated by both the federal and provincial jurisdictions. The ultimate goal is to create a safer workplace by providing workers with the knowledge and tools to enable them to worksafely. Students will be introduced to WHMIS prior to fieldwork placement in addition to being oriented to site-specific WHMIS procedures and resources while on placement. Students are required to complete the following online tutorial prior to the start of their first placement: Workplace Hazardous Materials Information System available at (http://www.ehs.utoronto.ca/Resources/whmis.htm#INTRO).

Police Record Check/ Criminal Reference Check There are two kinds of Police record checks: a criminal record check and a vulnerable sector screening. All M.H.Sc. students are asked to undergo a Vulnerable Sector Screening - Police Record Check. These checks are needed because students will be involved in observation activities and clinical placement activities (e.g., school boards, social service sites) at clinical sites that require them. Please note that failure to pass a criminal record check may result in a student being unable to participate in observation activities related to academic courses, or the necessity for a delayed or alternate placement assignment. Note: We are asking students to undergo the screening to prepare the students in the event that a clinical site requires this information. We (the department) are NOT asking to see the results. Students DO NOT hand in Police


record check results to the department. Students are asked to keep copies of the record check results and have them available in the event a clinical site requires the results. Due to the length of time required to complete the record check we ask students to begin this process as soon as they are contacted by the department with the appropriate instructions. Metro Toronto Residents If the postal code of your residence begins with "M" you must obtain a "Consent to Disclosure of Personal Information" form from the departments Business Officer (Mark Melchior in Room 1056); if the Business officer is not available, forms may also be obtained from Admin Assistant for Clinical Education (Kristina Smith in Room 1052) or the Student Affairs Assistant (Mabel Lau in Room 1064). Once complete, the student must submit the form to the Toronto Police Service Headquarters located at 40 college street, Toronto. Please note that a fee of $15 plus applicable taxes apply, it is recommended that you pay either by cash or by credit card as any personal cheques need to be certified. for more information please see the Metro Toronto Website: http://www.torontopolice.on.ca/prcp/ Residents in Other Areas Residents in other areas please consult your local police department to determine what is involved in obtaining this check. Use of Social Insurance Number Some students may have placements where videofluorosopic swallow studies are performed. In order to monitor potential radiation exposure, the placement site will provide dosimeters to students for the duration of the placement. In this case, students will be asked to provide their Social Insurance Numbers at the placement site to register with the National Dose Registry (NDR) and obtain dosimeters. Student Identification Badges Students are issued id badges with their pictures in the first year of the program. Students are required to wear the identification badge issued by the University at all times while at a placement site for a clinical placement site. In the event that a badge is lost, the student is to contact the Business Officer (Mark Melchior in Room 1056); in the Department of Speech-Language Pathology at the University of Toronto for a replacement.


Insurance Placement sites are asked to sign a declaration of understanding, a Rehabilitation Sciences Sector form, which describes insurance coverage relating to student placement and which only needs to be filled in once for all three Departments (OT, PT and SLP).

Letter to Placement Employer with WSIB coverage OR

Letter to placement employer without WSIB coverage (Private Insurance)

At the beginning of the program all students are asked to sign a similar form. No further insurance forms are required. Note: A student participating in out - of - province placements is automatically covered by Private Insurance.

WSIB Letter (Click here or see Appendix H1.0) Private Insurance Letter(Click here or see Appendix H1.2) Student Declaration Letter (Click here or see Appendix H1.3)

In The Event of an Accident or Injury In the event of an accident or injury, ensure that first aid is given immediately, and transportation is provided to a hospital, doctor’s office, or the student’s home if necessary. The Ministry of Training, Colleges and Universities ensures that students on work placements receive WSIB for placement employers who have WSIB coverage and private insurance for employers who are not covered by WSIB for injuries or disease incurred while fulfilling the requirements of their placement. Note: If a student must make a claim, contact the University to receive the appropriate paperwork. All sites fill in this letter

Letter of Authorization to Represent Employer (Click here or see Appendix H2.0) Sites with WSIB fill in this report with student:

U of T accident report (Click here or see Appendix H2.1) Sites with Private insurance fill in this report with student:

ACE INA accident report(Click here or see Appendix H2.2) Fax the completed forms ASAP to the: WSIB Administrator Fax: (416) 971-3052


STUDENT PARTICIPATION IN INTERNATIONAL PLACEMENTS

Criteria and Planning Steps for International Placements Process and Timeline The following process and timelines will be utilized for determining a student’s eligibility for international clinical placements. Late September/Early October – Initial Meeting The Director of the International Centre for Disability and Rehabilitation (ICDR) and the Coordinator of Clinical Education, Department of Speech-Language Pathology will meet with all MHSc students interested in doing an international clinical placement to discuss opportunities, student criteria and process, and to answer any questions. October 31 – Application Deadline MHSc students will send an email to notify the Coordinator of Clinical Education, Department of Speech-Language Pathology, of their wish to be considered for an international placement. Required supporting documentation: Curriculum Vitae Personal Statement - to include information on why they are interested in having the placement, where they would prefer to go, their life and travel experiences that are relevant and their expectations for the placement (max two pages, must be double spaced). Late November – Interviews Students will be interviewed by a committee consisting of the Director of the International Centre for Disability and Rehabilitation, the Coordinator of Clinical Education, Department of Speech-Language Pathology and a speech-language pathology graduate who has previously completed an international clinical placement. The interview will be approximately 20 minutes long and will consist of questions relevant to international placements. Candidates will be assessed using a 7-point Likert scale: Criteria

At least B+ performance on previous clinical placements (quantitative and qualitative assessment)

At least B+ performance on previous academic coursework High level of maturity as assessed by interview and observed throughout the professional

degree program Appropriate personal characteristics, including assertiveness, confidence, cultural sensitivity,

preparedness, etc. Previous international travel experience Dedicated attendance/involvement in ICDR activities such as the Speaker Series, biannual

symposium and working groups Good health Placement opportunities provide a match between hours needed (overall and specific

categories) and those that can be provided December – Notification Students will be notified of their recommendation for a potential international clinical placement. It should be noted that even though a student is recommended, this is not a guarantee that an international placement will be available. December – June Students will be notified of their placement match as soon as possible. Placement Preparation

Students will complete the Travel Abroad Check List at http://www.utoronto.ca/safety.abroad/


http://www.utoronto.ca/safety.abroad/

Students will complete the Acknowledgement of Responsibility and Liability Waiver and

provide the SLP department with copies for our departmental files http://www.utoronto.ca/safety.abroad/

.

Students will participate in the Safety Abroad program in the Faculty of Medicine http://www.utoronto.ca/safety.abroad/

Students will have one group and one individual meeting with the Coordinator of Clinical Education

and/or the Director of ICDR to discuss cultural and travel issues and questions. During Placement

Students will communicate via email with the Coordinator of Clinical Education on a routine basis (frequency to be determined prior to departure)

Where possible, web-based technology will be utilized to permit the student to participate in Teaching Clinics (procedures to be determined prior to departure).

For those portions of Teaching Clinics the student is unable to participate in, alternate assignments will be completed (to be determined prior to departure).

Post-Placement Students who complete an international placement will be required to fulfill the following additional minimum expectations:

1. A project, as determined jointly by the clinical educator(s) and student(s), to focus on giving a useful

resource to the site and staff; 2. A written report of their experience – maximum 3 pages (must be double spaced); 3. Recommendations for future clinical placements at that site; 4. Students may also be asked to make a verbal presentation of their experience to a group of

students and/or faculty, and/or to be involved in the process of selecting future students for potential international clinical placements.

It is the intention of this process to ensure that student candidates have the knowledge, skills, attitudes and behaviours, along with the appropriate supports necessary to participate and be successful in an international clinical placement.

Requests for placements from other programs The department receives many requests for placements in the Toronto area from programs across Canada and the United States, as well as international programs. As a service to the community, the Coordinators of Clinical Education may arrange placements for students enrolled in programs of speech-language pathology that offer recognized degrees for CASLPO registration and/or CASLPA membership. Placement requests are considered using the following order of priority: 1. Students in Ontario programs; 2. Other students in Canadian programs; 3. Canadian students in non-Canadian programs. Note: A charge for this service may be levied.


http://www.utoronto.ca/safety.abroad/

PROFESSIONAL STANDARDS

Department of Speech-Language Pathology Vision All people will have the communication skills and swallowing abilities to participate optimally in society. Mission To prepare and support professional and scientific leaders within an internationally recognized university environment that prizes excellence in research, teaching and clinical practice equally. Values The Department of Speech-Language Pathology is fully committed to:

Excellence and innovation in research, teaching and clinical education; Seamless melding of our scientific foundation with our clinical roots; Unimpeachable ethical conduct and full accountability in all educational, scientific and professional

endeavours; Advocacy for the rights and needs of persons with communication and swallowing disabilities, their families,

caregivers and the professionals who serve them; Diversity and equity in the classroom, the research laboratory and the work place; A positive, caring study and work environment that allows students, faculty and staff to reach their fullest

potentials; and Close, meaningful and respectful partnerships with other professionals, persons with communication and

swallowing disabilities and members of the community-at-large.

MHSc Course Regulations http://speechpath1.med.utoronto.ca/students/degree/regulation.htm

University of Toronto U of T professional standards http://www.pgme.utoronto.ca/Assets/PGME+Digital+Assets/policies/Professional+Practice+Behaviour.pdf Code of Behaviour on Academic Matters http://www.governingcouncil.utoronto.ca/policies/behaveac.htm How to avoid plagiarism: www.writing.utoronto.ca Freedom of Information and Protection of Privacy Act http://www.fippa.utoronto.ca/Page4.aspx


CASLPO Code of Ethics http://www.caslpo.com/PracticeStandards/CodeOfEthics/tabid/102/Default.aspx Preferred Practice Guidelines http://www.caslpo.com/PracticeStandards/PreferredPracticeGuidelines/tabid/162/Default.aspx Guidelines for Supervision http://www.caslpo.com/Portals/0/positionstatements/mpssuperofaudslp.pdf Infection Prevention & Control Guidelines for Speech-Language Pathology 2010 http://www.caslpo.com/Portals/0/positionstatements/Infection%20Prevention%20control%20GuidelinesSLP%20FINAL%20Feb%202010.pdf Infection Prevention & Control Guidelines for Audiology 2010 http://www.caslpo.com/Portals/0/positionstatements/Infection%20prevention%20control%20Guidelines%20Audiology%20FINAL%20Feb%202010.pdf

CASLPA Code of Ethics http://www.caslpa.ca/english/resources/ethics.asp

Ministry of Health and Long-term Care Hand washing module http://www.health.gov.on.ca/english/providers/program/pubhealth/handwashing/flash/handhygiene.html


STUDENT SUPPORT SERVICES Faculty Advisors | Student-Faculty Liaison Committees | If you have a problem... | M.H.Sc. Financial Aid | M.Sc./Ph.D. Financial Aid | Housing | University Health Services http://speechpath1.med.utoronto.ca/students/stdserv.htm M.H.Sc. Accessibility, Accommodations & Course Exemptions http://speechpath1.med.utoronto.ca/students/degree/exemptions.htm Partial Funding Reimbursement Requests Funding has been received from the Ministry of Training for Colleges and Universities to support the expansion of clinical education activities – including student placements. Students who experience extraordinary financial hardship as a result of a placement assignment may be eligible for some financial reimbursement of placement-related expenses. Funding is limited; therefore expenses can only be partially reimbursed. The amount of reimbursement provided to each eligible applicant will depend upon the number of requests made and will be proportional to the amount of expenses incurred. Please note:

*Expenses will only be partly covered. *A cheque will not be processed without supporting receipts. *Only amounts over $300 will be considered.

Eligible Expenses: Accommodation: When placements outside of the catchment area require accommodation-related expense to the student. - Travel: For any placements (in or out-of-catchment) which require significant travel expense (e.g., car rental necessary) related to placement activities (e.g., car is required to travel between schools). Application Deadlines: YEAR 2 STUDENTS: June 30th with supporting receipts YEAR 1 STUDENTS: June 30th for the application, Sept 15th for the supporting receipts If eligible, please fill in and submit the following application: Request for Partial Reimbursement Application(Click here or see Appendix G1.0) Travel Journal(Click here or see Appendix G1.1)

Additional Student Resources Website Blackboard (Portal) https://portal.utoronto.ca/webapps/portal/frameset.jsp As with academic courses, Blackboard is used on Portal for course management for clinical placements and related communication with students. On Blackboard, students can access resource materials, links to online resources, information about teaching Clinics, and other material that the course instructor may post from time to time. Students are responsible for checking Blackboard on a regular basis. Department Student Handbook September 2011 (note may change in January) http://speechpath1.med.utoronto.ca/students.htm


Photocopying The Rehabilitation Sciences Sector provides access to all rehab students to a photocopier in the Student Lounge located on the 2nd floor, room 254. Students have 24/7 access to the photocopier. Students can also top up their T-Card in the student lounge. To make copies, you must swipe your T-Card (also known as U of T library Card). The rate will be 8 cents per copy. Please visit http://www.utoronto.ca/tcard for more information on how to top up your T-Card. If you have any questions about the photocopier or problems with the photocopier, please contact Sector Receptionist at 416-946-8554 or stop by room 160. Alternatively students can use Kinko’s for photocopying located across the street (505 University Avenue). All clinical education Items are to be photocopied prior to their submission to the department. The department does not provide photocopying services to students. Clinical Resource and Teaching Laboratory The Clinic Resource Teaching Lab (CRTL) is located in Room 414 and is a group work / departmental study room, Case Study Rooms Case Study Rooms are located on the second floor. Included are 222, 224, 238, 240, 251, 255. The primary purpose for these rooms is for teaching and clinical teaching; however students may use these rooms for quiet study when they are not being used for teaching purposes. Clinical Resources and Tests Clinical Resources and tests are available for students to use for teaching and learning purposes. To access and/or return these materials students must be in touch with the student rep assigned to their year.

M.H.Sc. Graduation and Registration

All students will follow the same process and timeline outlined in the student handbook regardless of the registration they choose or when they decide to register. http://speechpath1.med.utoronto.ca/students/degree/caslporegistrat.htm



Contact Information Placement Administration: Consult the Administrative Officer of Clinical Education for items pertaining to administration of placement paperwork, Health Forms, Police Record Check, when and how to hand things in etc Kristina Smith Ph: (416) 978 - 6882 Email: [email protected] Office Hours: Typically 9am - 5pm September – July; 9am - 4:30pm July and August Not available on Tuesday afternoons for clinical education matters! Coordinator of Clinical Education, Instructors: Consult the course instructor on items pertaining to academic issues as they pertain to the placement course, concerns regarding how the placement is going, illness or absence, calculating hours etc. Units 3 & 5: Marieke Favrod Ph: (416) 978 - 6332 Email: [email protected] Units 7 & 9: Lynn Ellwood Ph: (416) 946 - 8723 Email: [email protected]



APPENDICES

Clinical Education Guide Department of Speech-Language Pathology

APPENDICES

Appendix A – Coursework and Expectations Course Outlines A1.0 SLP 1500Y – Internship A1.1 SLP 1507H - Clinical Laboratory in Speech-Language Pathology A1.2 SLP 1508Y – Advanced Clinical Laboratory in Speech-Language Pathology A1.3 SLP 2500Y – Advanced Internship A1.4 SLP 1532H – Clinical Laboratory in Hearing Disorders Recommended Course Schedule A2.0 Recommended Schedule - SLP 1500Y – Internship A2.1 Recommended Schedule - SLP 1507H - Clinical Laboratory in Speech-Language Pathology A2.2 Recommended Schedule - SLP 1508Y – Advanced Clinical Laboratory in Speech-Language Pathology A2.3 Recommended Schedule - SLP 2500Y – Advanced Internship A3.0 MHSC Curriculum Map A4.0 Record Keeping Summary Table

Appendix B - Planning Documents B1.0 Internship Practicum Contract – One Site B1.1 Internship Practicum Contract – Two Sites B1.2 Background Questionnaire B1.3 Student Goals Form

Appendix C - Evaluation Forms Summative Feedback C1.0 Feedback Log C1.1 Learning Conference Form Student Evaluation Instruction Forms C2.0 Evaluation of Clinical Skills Instruction Form C2.1 Evaluation of Professional Behaviour Instruction Form Evaluation Instruction Forms for Clinical Educators C 3.0 Evaluation of Clinical Skills Instruction Form Unit 3 7 9 C 3.1 Evaluation of Professional Behaviour Instruction Form Unit 3 7 9 C 3.2 Evaluation of Clinical Skills Instruction Form Unit 5 C 3.3 Evaluation of Professional Behaviour Instruction Form Unit 5 C 4.0 Summary Comments Form

Appendix D - Embedded Placement Activities Teaching Clinics D 1.0 Teaching Clinic Format D 1.1 Release of Video Recordings or Audio Recordings for Teaching Purposes D 1.2 Instructions for preparation of video tapes

39

D 2.1 Developmental Observation Form - Adult Interprofessional Education D 3.0 Activity 1 D 3.1 Activity 2 D 3.2 Activity 3 D 3.3 Completion Form

Research to Practice Unit 3 – Consumer Satisfaction Assignment D 4.0 Information Letter for Students and Clinical Educators D 4.1 Agreement by the Clinical Educator Regarding Consumer Satisfaction Assignment Appendix D 4.2 Guidelines on which survey to choose D 4.3 Survey Package Appendix Unit 7 – Treatment Outcomes Assignment D4.4 Information and Instructions for Students and Clinical Educators D4.5 Information Letter (adult) D4.6 Information Letter (parent/guardian) D4.7 Clinical Educator and Student Agreement/Consent Form D4.8 ASHA NOMs Package

Appendix E - Hours Calculation Activities E 1.1 CASLPA Clinical Hours Requirements for Certification E 1.2 Summary of Clinical Practice Hours (Unit tracking tables)

Appendix F - Health Forms F 1.1 Instruction Forms F 1.2 Year 1 Health Form F 1.3 Year 2 Health Form

Appendix G - Student Support Services G 1.0 Partial Funding Reimbursement Forms G1.1 Travel Journal

Appendix H - Insurance – Accident or Injury while on placement Declaration forms H 1.1 Declaration of Understanding - WSIB H 1.2 Declaration of Understanding – Private Insurance H 1.3 Declaration of Understanding - Student In the event of an injury H 2.0 Letter of Authorization to Represent Employer H 2.1 U of T accident report H 2.2 ACE INA accident report

40

Appendix A ‐ Course Work Expectations Course Outlines MHSC Curriculum MapRecord Keeping Summary Table

41 <<<Back

Table of Contents

UNIVERSITY OF TORONTO Department of Speech-Language Pathology FACULTY OF MEDICINE REHABILITATION SCIENCES BUILDING 160 - 500 University Avenue Toronto, ON M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

COURSE OUTLINE SLP 1500Y - INTERNSHIP

UNIT 3

Course Instructor: Marieke M. Favrod, MClSc Time & Place: Full-time; eight (8) consecutive weeks at a clinical teaching facility under the supervision of a

Clinical Educator, as assigned by the Coordinator of Clinical Education SLP 1500Y – Internship comprises Unit 3 in the curriculum and is subsequent to Unit 1 and 2 containing the following coursework: Unit 1

• SLP 1502Y – Anatomy and Embryology • SLP 1505Y – Child Language I • SLP 1514Y – Applied Audiology • SLP 1520H – Principles of Clinical Practice • SLP 1522Y – Speech Physiology and Acoustics

Unit 2

• SLP 1503Y – Articulation and Related Disorders • SLP 1506H – Child Language II • SLP 1529H – Fluency

Course Objectives:

The purpose of this course is to introduce a student to the clinical practice of speech-language pathology with children and their families. By the end of this practicum, a student must be able to:

(a) demonstrate theoretical knowledge in relation to the understanding of normal, delayed and disordered communication processes and their management;

(b) display an understanding of objectives, outcomes, ethics and commitment in client care; (c) show attitudes of self-awareness, curiosity, innovation, sensitivity and respect for diversity necessary to

the professional in this discipline; (d) evidence an understanding of the multiple roles of a speech-language pathologist in clinical practice,

including working in teams; (e) develop ongoing effective communication with clinical educator(s); and (f) apply all of the above to one or more communication disorder areas.

Required Reading: 1) General Guidelines for Clinical Activities in Practicum Courses (See Clinical Education Guide for the Department of

Speech-Language Pathology, University of Toronto). 2) SLP 1500Y – Internship - Recommended Course Schedule (See Clinical Education Guide for the Department of

Speech-Language Pathology, University of Toronto). 3) Developmental Internship Consumer Satisfaction Assignment (Provided to the student by the Research-to-practice

Faculty Advisor)

Evaluation:

This is a pass/fail full-credit course. To achieve a passing grade, all of the following conditions must be met:

1) Minimum Expectations

Student submits evidence which clearly demonstrates that all Minimum Expectations described in this course outline have been met. Evidence submitted is to be selected and compiled by the student and must specifically indicate how the student has met each expectation.

If a student’s submission does not clearly show that Minimum Expectations have been met, the student will be asked to revise and re-submit the evidence. Failure to demonstrate that each and every one of the Minimum Expectations have been met will result in a FAIL for the course.

2) The Evaluation of Professional Behaviour

A student must perform satisfactorily* in each of three areas at the end of placement: Ethical Behaviour, Interpersonal Skills and Professional Qualities.

Failure to show satisfactory performance in ANY one or more of these three areas will result in a FAIL for the course.

3) The Evaluation of Clinical Skills

A student must perform satisfactorily* in each of six areas at the end of placement: Assessment, Reporting, Developing and Planning, Intervention, Counselling and Interviewing, Self-Evaluation and Problem-Solving.

Failure to show satisfactory performance in ANY one or more of these six areas will result in a FAIL for the course.

*Satisfactory performance means that for most behaviours that are evaluated in an identified area (such as Assessment), a student is expected to perform adequately with some guidance and input from the clinical educator, where generalization/consistency is considered by the clinical educator to be adequate. It is understood that the clinical educator will only evaluate student performance on those items for which there was opportunity to observe the student in clinical practice.

Clinical Activities:

• Under usual circumstances, a student will participate in all types of clinical activities, as outlined and defined in the document General Guidelines for Clinical Activities in Practicum Courses.

• A student in this internship will spend 16-20 hours per week with clients, either in observation (General Guideline IB) or supervised client activities (General Guidelines IIABC).

• A recommended weekly schedule for these activities is available for reference in the Clinical Education Guide.

• A Clinical Educator will gradually introduce a student to a variety of clients and clinical activities in the following sequence: observation, shared clinical practice, and supervised clinical practice.

• The Clinical Educator will observe at least 50% of sessions classified as supervised clinical practice. Normally, observation will be 100% at the beginning of supervised practice and will be gradually decreased as the student's skills develop.

• The Clinical Educator will meet daily with the student to give feedback and review all written treatment plans, progress notes and reports.

• By the end of this initial internship, each student will earn a total of 60-90 clinical hours (General Guidelines IIABC).

The focus of this initial internship is the development of a solid clinical base of knowledge through ample preparation, follow-up, self-assessment, and discussion time. Therefore, a student will spend approximately half of the internship time in such activities. The majority of this time will be spent in those activities outlined in categories I and III of the General Guidelines. (review of client files; planning and analysis activities; oral and written reporting and record keeping; material development; supervision conferencing). When possible, a student in this internship will also be exposed to related clinical activities, as outlined in category IV of the General Guidelines.

Minimum Expectations: At a minimum, a student must successfully complete the following activities in supervised clinical practice during the internship: Expectation Specifics 1) Three (3) Guided Observations (minimum)

• One (1) of a child who is developing typically • Two (2) of children with communication needs For each observation, the student will complete the observation form and use it as a basis for discussion with and feedback from the clinical educator. These observations should be scheduled by the student and the CE during the development of the internship contract.

2) Three – Four (3-4) Common Tests/Tools

• Determine the common tests/tools for the site and learn how to administer and interpret them

3) Three (3) Full Communication Assessments

At least one (1) assessment of a child for whom English is not the first language To include: • developing an assessment plan • taking a case history • testing (informal/formal) • interpretation of findings • writing of reports and recommendations If this is not possible, the student will develop an amendment to a management approach with a client on her existing caseload, assuming English is not the first language and highlighting changes required

4) Three (3) Written Treatment Progress Reports

• Utilizing the format appropriate to the internship facility

5)Teaching Clinics Participate in Teaching Clinics for the full day on the Friday of Weeks 3, 5 and 7 of this course: • Morning sessions: Present a case scenario to peers in a small group

(with supporting videotapes or other materials) to promote development of clinical reasoning skills.

• Participate in afternoon workshops as arranged by the course instructor (for example, on the topic of Behaviour Management)

6) Consumer Satisfaction Assignment (Research-To-Practice Objective)

• Write a proposal to collect consumer satisfaction data within this clinical setting

• Report is reviewed by the CE, who will provide brief written comments • All documentation will be reviewed by the Faculty Advisor for this

assignment, who will provide feedback on the quality of the report. A passing grade must be attained on this assignment. If a passing grade is not achieved, the student will be directed to revise and resubmit. At the discretion of the Faculty Advisor, if the revised report does not receive a passing grade, additional remedial work may be required.

The student is required to submit evidence for achievement of these minimum expectations at the end of this course along with other documentation. Hearing Disorders Assignment:

This is a pass/fail assignment required for SLP 1532H Clinical Laboratory in Hearing Disorders, which the student is required to complete:

Identify up to 3 SLP-specific clinical practices in this setting that address hearing loss (e.g., case history taking, hearing screening, individual education plans, referral procedures, etc.) and one resource or service available (e.g., audiology, ENT, Cert. AVT, classroom amplification, etc.). Describe how these practices were incorporated into your clinical practice (or, if not observable, then formulate recommendations suitable for this setting).

(max. 2 pages, double spaced – pass/fail).

The student will submit the assignment to the SLP 1532H course instructor at the end of placement. Mid-term Formative Performance Evaluation: Mid-way through the placement, the student will be given a formative evaluation by the clinical educator using The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills (Please note that Summary

comments must accompany each evaluation form). This evaluation, though formalized, is not factored into the final grade (pass/fail). The clinical educator will review and discuss the results of these evaluations with the student, then submit them to the Course Instructor/Coordinator of Clinical Education. The clinical educator must inform the Course Instructor/Coordinator of Clinical Education in the event that the student is in jeopardy of failing at this point in the placement. Written notification of this will then be given to the student (See “If Problems Arise” below). Final Summative Performance Evaluation: Again, the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills will be used for these evaluations (Summary Comments must accompany each evaluation form). The Clinical Educator will review and discuss the final performance reports (The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills, and Summary Comments) with the student, prior to submitting them to the Course Instructor/Coordinator of Clinical Education. The Course Instructor will grade the initial internship on a Pass/Fail basis. A student who fails the internship must leave the program. The Examinations Committee may, however, review the student’s record to determine if extraordinary circumstances are present and will take any appropriate action (see Student Handbook, Course Regulations).

An inherent part of clinical skills is appropriate record-keeping. Accordingly, a student must complete all record-keeping tasks, as outlined on the form entitled Record-Keeping Summary Table, by the due date indicated. One-third of a grade will be lost for each day late. If Problems Arise: A student is encouraged to bring any concerns regarding a practicum experience (e.g., course, clinical facility, Clinical Educator) to the attention of the Course Instructor/Coordinator of Clinical Education as soon as they arise. The Course Instructor/Coordinator of Clinical Education will help to problem-solve and to facilitate discussion and resolution of such concerns with the clinical educator, as required. On occasion, a student may experience difficulty in meeting the learning and performance expectations for a practicum course. In such cases, the clinical educator must notify the Course Instructor / Coordinator of Clinical Education as soon as concerns arise, even if a mid-term evaluation has not yet occurred. If a student is not demonstrating acceptable performance in either professional behaviour and/or clinical skills, based on the assessment of the Course Instructor/Coordinator of Clinical Education, written notice must be given to the student and a specific written plan for developing these skills must be negotiated cooperatively by the Course Instructor/Coordinator of Clinical Education, the clinical educator, and the student. This plan will include:




(4) a time schedule and procedures for evaluating the outcome of the plan. The Course Instructor/Coordinator of Clinical Education will document the plan and provide a copy to the student and the clinical educator. The Course Instructor/Coordinator of Clinical Education will also assist the student and the clinical educator in implementing the plan and in evaluating its success. If the student does not meet the learning objectives outlined in such a plan, a grade of failure (FZ) will be assigned for the practicum course by the Course Instructor. This grade is the equivalent of a failure in an academic course and is subject to the regulations and appeal procedures described in the SGS Calendar and the Student Handbook.

Rev 25/08/11


COURSE OUTLINE

SLP 1507H - CLINICAL LABORATORY IN SPEECH-LANGUAGE PATHOLOGY

UNIT 5

Course Instructor: Marieke M. Favrod, MClSc Time and Place: Full-time four (4) consecutive weeks, or equivalent (e.g., part-time over a longer

period or 2 part-time placements put together to comprise one full-time placement), at clinical teaching facilities under the supervision of clinical educators, as assigned by the Coordinator of Clinical Education.

Course Objectives: The purpose of this course is to expand clinical experiences leading to the further development of professional skills in practice areas studied to date, including developmental language disorders, articulation/phonological disorders, fluency disorders, voice disorders, augmentative and alternative communication (AAC) and hearing disorders. By the end of this course, a student must be able to do the following at the supervised clinical practice level:


(b) interpret assessment information and collaborate with clients/families in making appropriate management decisions;

(c) plan long term and short term goals; (d) consider a discharge plan or options; (e) implement appropriate goal-directed procedures; (f) report findings, objectives, and progress in written and oral formats to clients, family members,

significant others, and/or other professionals; (g) demonstrate the development of self-evaluation skills; and (h) demonstrate the development of clinical reasoning and problem-solving strategies.

Required Reading:

1) General Guidelines for Clinical Activities in Practicum Courses (See Clinical Education Guide for the Department of Speech-Language Pathology, University of Toronto).

2) SLP 1507H – Clinical Laboratory in SLP - Recommended Course Schedule (See Clinical Education Guide for the Department of Speech-Language Pathology, University of Toronto).

Evaluation:

This is a graded half-credit course. To achieve a passing grade, all of the following conditions must be met: 1) Minimum

Expectations (Pass/Fail)

Student submits evidence which clearly demonstrates that all Minimum Expectations described in this course outline have been met. Evidence submitted is to be selected and compiled by the student and must specifically indicate how the student has met each expectation. If a student’s submission does not clearly show that Minimum Expectations have been met, the student will be asked to revise and re-submit the evidence. Failure to demonstrate that each and every one of the Minimum Expectations have been met will result in a FAIL for the course.

2) The Evaluation of Professional Behaviour

(50%)

A student must perform satisfactorily* in each of three areas at the end of placement: Ethical Behaviour, Interpersonal Skills, and Professional Qualities. All items rated will be averaged to obtain the overall rating for this section of the final evaluation. Failure to show satisfactory performance in ANY one or more of these three areas will result in a FAIL for the course, even if the overall average rating is a passing score.

3) The Evaluation of Clinical Skills

(50%)

A student must perform satisfactorily* in each of six areas at the end of placement: Assessment, Reporting, Developing and Planning, Intervention, Counselling and Interviewing, Self-Evaluation and Problem-Solving. All items rated will be averaged to obtain the overall rating for this section of the final evaluation. Failure to show satisfactory performance in ANY one or more of these six areas will result in a FAIL for the course, even if the overall average rating is a passing score.

*Satisfactory performance (minimum B- level) means that for most behaviours that are evaluated in an identified area (such as Assessment), a student is expected to perform adequately with some guidance and input from the clinical educator, where generalization/consistency is considered by the clinical educator to be adequate. It is understood that the clinical educator will only evaluate student performance on those items for which there was opportunity to observe the student in clinical practice, thus a given category may not have a related . The Course Instructor will grade the course according to the grading scheme of the School of Graduate Studies such that an average score of “5” corresponds to “Good” performance (grade letter “B”). Clinical Activities: • Under usual circumstances, a student will participate in all types of clinical activities, as outlined and defined in

the document General Guidelines for Clinical Activities in Practicum Courses. • A student in this course will spend a minimum of 50% of the total time with clients, either in observation

(General Guideline IB) or supervised client activities (General Guidelines IIABC), with the remaining time spent primarily in activities outlined in sections I and III of the General Guidelines.

• A student may spend a small amount of time in activities described in section IV. • A recommended weekly schedule for these activities is available for reference in the Clinical Education

Guide. • A clinical educator will introduce clients in the following sequence: observation, shared clinical practice

and supervised clinical practice. The student should proceed fairly quickly through this sequence. • For the majority of this experience, a student will function at the supervised clinical practice level with

the clinical educator monitoring the student’s performance by: (a) reviewing written assessment and treatment plans and progress notes; (b) providing specific feedback to the student each day - critical due to the condensed nature of this

placement (see Daily Feedback Log); and (c) observing a student's clinical practice activities at least 50% of the time with observation normally

being 100% initially and gradually decreasing, at the discretion of the clinical educator who is ultimately responsible for the client’s welfare.

• Students are required to complete assessment and lesson plans for all sessions, which are reviewed by the clinical educator(s). In addition, the clinical educator(s) can consider the use of regular journaling as a requirement for students to document their observations and progress.

• Each student will earn a minimum of 30 clinical hours.

Minimum Expectations:

At a minimum, a student must successfully complete the following activities in supervised clinical practice during the internship:

Expectation Specifics 1) Communication

Enhancing Techniques Successfully model/utilize communication strategies which enhance

communication. 2) Assistive devices,

instrumentation or intervention approaches unique to the treatment setting or client population

Demonstrate familiarity with and successful application of one or more of the following: devices (e.g.., hearing aids, other assistive listening devices, sensory

aids, AAC devices) other instrumentation (e.g., audiometer, bio-feedback) unique approaches (e.g., music therapy, pet therapy, parent

education program) 3) Counselling

Identify opportunities for counselling Describe preparation for counselling, and implementation of

counselling on one occasion Write a 1-2 paragraph reflection about your learning

4) Two (2) Written Reports Assessment, treatment, progress or discharge reports, utilizing the format appropriate to the internship facility

The student is required to submit evidence for achievement of these minimum expectations at the end of this course along with other documentation. AUDIOLOGY PLACEMENTS: Where possible, please plan for the students to complete: 1) Audiological Assessments

Five unmasked audiograms including air conduction, bone conduction, speech reception thresholds and speech recognition testing

d/or Depending upon the placement setting, other methods of audiological assessment

may be considered appropriate (such as central auditory processing or infant hearing screening etc.) at the discretion of the course instructor

2) Acoustic Immitance

Understand and interpret acoustic Immitance measurements

3) Quality of Life Tool

Demonstrate familiarity with a Quality of Life tool appropriate to this setting

Students will retain evidence of having completed these learning activities for later submission in relation to the course entitled SLP 1532H Clinical Laboratory in Hearing Disorders. Mid-term Formative Performance Evaluation: No formal evaluation by the clinical educator is required at mid-term. The student will complete a self-assessment using the Learning Conference Form, meet with the clinical education for discussion, and minute key points from the discussion on the form. Both the student and the CE are encouraged to reference the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills which will later be used for the final evaluation of student performance. Both the student and the clinical educator will sign the form. The student will submit the form to the university, which is due one week post-meeting date. The clinical educator must inform the Course Instructor/Coordinator of Clinical Education in the event that the student is in jeopardy of failing by the mid-point of in the placement. Written notification of this will then be given to the student (See “If Problems Arise” below).

Final Summative Performance Evaluation: Please note, due to the condensed nature of the Unit 5 placements, a shortened version of the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills will be used for these evaluations (Summary Comments which support the ratings must accompany each evaluation form). Each student will be given a summative evaluation at the end of placement by the clinical educator using the The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills (Please note that Summary Comments must accompany each evaluation form). The clinical educator will review and discuss the results of these evaluations with the student, then submit them to the Course Instructor/Coordinator of Clinical Education. The Course Instructor will determine a final grade for each student, based on the numerical ratings of each behaviour and the supporting Summary Comments forms. A student who fails the internship must leave the program. The Examinations Committee may, however, review the student’s record to determine if extraordinary circumstances are present and will take any appropriate action (see Student Handbook, Course Regulations). An inherent part of clinical skills is appropriate record-keeping. Accordingly, a student must complete all record-keeping tasks, as outlined on the form entitled Record-Keeping Summary Table, by the due date indicated on the course outline. One-third of a grade will be lost for each day late. If Problems Arise: A student is encouraged to bring any concerns regarding a practicum experience (e.g., course, clinical facility, Clinical Educator) to the attention of the Course Instructor/Coordinator of Clinical Education as soon as they arise. The Course Instructor/Coordinator of Clinical Education will help to problem-solve and to facilitate discussion and resolution of such concerns with the clinical educator, as required. On occasion, a student may experience difficulty in meeting the learning and performance expectations for a practicum course. In such cases, the clinical educator must notify the Course Instructor / Coordinator of Clinical Education as soon as concerns arise, even if a mid-term evaluation has not yet occurred. If a student is not demonstrating acceptable performance in either professional behaviour and/or clinical skills, based on the assessment of the Course Instructor/Coordinator of Clinical Education, written notice must be given to the student and a specific written plan for developing these skills must be negotiated cooperatively by the Course Instructor/Coordinator of Clinical Education, the clinical educator, and the student. This plan will include:





Rev 25/08/11

1

COURSE OUTLINE SLP 1508Y - ADVANCED CLINICAL LABORATORY IN SPEECH-LANGUAGE PATHOLOGY

Unit 7

Course Instructor: Lynn Ellwood, M.H.Sc. Time & Place: Full-time; eight (8) consecutive weeks at clinical teaching facilities under the supervision of

clinical educators, as assigned by the Coordinator of Clinical Education

Course Objectives:

The purpose of this course is to continue to expand clinical experiences leading to the further development of professional skills in speech-language pathology with individuals with neurogenic and/or structurally related disorders and their families. By the end of this course, a student must be able to do the following at the supervised clinical practice level in an efficient and effective manner:


(b) differentiate between a variety of communication and/or swallowing disorders; (c) interpret assessment information and collaborate with clients/families/other professionals in making

appropriate management decisions; (d) design, implement and evaluate appropriate management; (e) report findings, objectives, and progress in written and oral formats to clients, family members, significant

others and/or other professionals; (f) demonstrate the continued development of self-evaluation skills; (g) demonstrate the development of complex, ongoing clinical reasoning skills and problem-solving strategies; (h) demonstrate reflective practice in all areas of professional and clinical behaviour; (i) demonstrate understanding of the scope of practice of speech-language pathology in relation to other

professions and participate as an effective member of the interprofessional team; and (j) gain exposure to the concepts of best practice, evidence-based practice and outcome evaluation using a

variety of resources.

Required Reading: 1) General Guidelines for Clinical Activities in Practicum Courses (See Clinical Education Guide for the

Department of Speech-Language Pathology, University of Toronto). 2) SLP 1508Y – Advanced Clinical Laboratory in SLP - Recommended Course Schedule (See Clinical Education

Guide for the Department of Speech-Language Pathology, University of Toronto). 3) Neurogenic and Structural Disorders Internship Treatment Outcomes Assignment (Provided to the student by

the Research-to-practice Faculty Advisor) Evaluation: This is a graded full-credit course. To achieve a passing grade, all of the following conditions must be met: 1) Minimum Expectations (Pass/Fail)


REHABILITATION SCIENCES Department of Speech-Language Pathology CENTRE FOR FUNCTION AND WELL BEING

FACULTY OF MEDICINE UNIVERSITY OF TORONTO 500 University Ave, #160 Toronto, ON M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

2

2) Research-to-Practice Assignment; Treatment Outcomes (15%)

• Collect and interpret pre- and post-treatment outcome data for two (2) clients utilizing two different outcome measures; one of which is the functional communication measures from the ASHA National Outcomes Measurement System

• Student writes a brief report which is reviewed by the CE, who will provide brief written comments

• All documentation reviewed by Faculty Advisor for this assignment, who will determine a grade

3) The Evaluation of Professional Behaviour (42.5%)


4)The Evaluation of Clinical Skills (42.5%)


*Satisfactory performance (minimum B- level) means that for most behaviours that are evaluated in an identified area (such as Assessment), a student is expected to perform adequately with some guidance and input from the clinical educator, where generalization/consistency is considered by the clinical educator to be adequate. It is understood that the clinical educator will only evaluate student performance on those items for which there was opportunity to observe the student in clinical practice. The Course Instructor will grade the course according to the grading scheme of the School of Graduate Studies such that an average score of “5” corresponds to “Good” performance (grade letter “B”). General Guidelines concerning Clinical Activities:


• A student in this course will spend 20-25 hours per week with clients, either in observation (General Guideline IB) or supervised client activities (General Guidelines IIABC), with the remaining time spent primarily in activities outlined in sections I and III of the General Guidelines.

• A small amount of time will also be spent in activities described in IV. • A recommended weekly schedule for these activities is available for reference in the Clinical Education Guide. • A clinical educator will introduce clients in the following sequence: observation, shared clinical practice and

supervised clinical practice. The student should proceed fairly quickly through this sequence. For the majority of this experience, a student will function at the supervised clinical practice level with the clinical educator monitoring the student’s performance by: (a) reviewing written assessment and treatment plans and progress notes; (b) providing specific feedback to the student each day, utilizing the Feedback Log, if desired; and (c) observing a student's clinical practice activities at least 50% of the time with observation normally being 100%

initially and gradually decreasing, at the discretion of the clinical educator who is ultimately responsible for the client’s welfare.

• In this course, each student will earn 90 - 150 clinical hours (General Guideline IIABC), in order to meet the 350 hour minimum clinical requirement for CASLPA and CASLPO certification.

Minimum Expectations: At a minimum, a student must successfully complete the following activities in supervised clinical practice during the internship:

Expectation Specifics 1) Learning Conferences • Complete Learning Conference form in advance of meeting with clinical

educator at the end of Weeks 2 and 6. • Discuss and determine own strengths, areas for development and an action

plan with the clinical educator in a formal half-hour (max.) meeting.

3

Expectation Specifics 2) Two (2) Guided Observations (minimum)

• For each observation, the student will take notes and use them as a basis for discussion with and feedback from the clinical educator. These observations should be scheduled by the student and the CE during the development of the internship contract



4) Three (3) Full Assessments

To include: • developing an assessment plan • taking a case history • testing (informal/formal) • interpretation of findings • writing of reports and recommendations

5) Management Approach for Three (3) Clients (minimum)

• At least one (1) of which should be for a client for whom English is not the first language; if possible

• If this is not possible, the student will develop an amendment to a management approach with a client on her existing caseload, assuming English is not the first language and highlighting changes required

Develop and implement a management approach based on assessment and information gathering, as required, to include:

• Mutual goal-setting • Therapeutic procedures • Counselling • Outcome evaluation • Discharge planning • Demonstration of application of theoretical knowledge

6) Four (4) Written Reports • Any type of report utilizing the format appropriate to the internship facility 7) One (1) Case Presentation • May be at rounds, case conferences or department meetings 8)Teaching Clinics Participate in Teaching Clinics for the full day on the Friday of Weeks 3, 5 and 7:

• Morning sessions: Present a case scenario to peers in a small group (with supporting videotapes or other materials) to promote development of clinical reasoning skills.


9) IPE Activity 1* • Participation in Inter-professional Team Education 10) IPE Activity 2* • Interview and Shadow Two (2) other Health Professionals 11) IPE Activity 2* • Participate in Team Meetings *IPE Curriculum: Flexible IPE Component In A Clinical Setting These learning activities should be scheduled by the student and the CE during the development of the internship contract. Description of activities available to students on Blackboard. Those students involved in a formal IPE placement in this placement unit will meet these expectations through their participation in that formal IPE placement experience. The student is required to submit evidence for achievement of these minimum expectations at the end of this course along with other documentation.

Hearing Disorders Assignment:


Identify a client on your SLP caseload with hearing loss and describe how your approach to either assessment or treatment was impacted as a result of the hearing loss (include mention of enhancing communication strategies). If this is not possible, develop an amendment to an assessment plan or management approach for a client on your existing caseload, assuming the client has an acquired moderate to severe binaural sensory-neural hearing loss and wears at least one hearing aid (max. 2 pages, double spaced – pass/fail). The student will submit the assignment to the SLP 1532H course instructor at the end of placement.

4

Mid-term Formative Performance Evaluation:

Mid-way through the placement, the student will be given a formative evaluation by the clinical educator using The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills (Please note that Summary comments must accompany each evaluation form). This evaluation, though formalized, is not factored into the final grade. The clinical educator will review and discuss the results of these evaluations with the student, then submit them to the Course Instructor/Coordinator of Clinical Education.

The clinical educator must inform the Course Instructor/Coordinator of Clinical Education in the event that the student is in jeopardy of failing at this point in the placement. Written notification of this will then be given to the student (See “If Problems Arise” below). Final Summative Performance Evaluation:

Again, the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills will be used for these evaluations (Summary Comments must accompany each evaluation form).

The Clinical Educator will review and discuss the final performance reports (The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills, and Summary Comments) with the student, prior to submitting them to the Course Instructor/Coordinator of Clinical Education.

The Course Instructor will determine a final grade. A student who fails the internship must leave the program. The Examinations Committee may, however, review the student’s record to determine if extraordinary circumstances are present and will take any appropriate action (see Student Handbook, Course Regulations).

An inherent part of clinical skills is appropriate record-keeping. Accordingly, a student must complete all record-keeping tasks, as outlined on the form entitled Record-Keeping Summary Table, by the due date indicated. One-third of a grade will be lost for each day late. If Problems Arise:

A student is encouraged to bring any concerns regarding a practicum experience (e.g., course, clinical facility, Clinical Educator) to the attention of the Course Instructor/Coordinator of Clinical Education as soon as they arise. The Course Instructor/Coordinator of Clinical Education will help to problem-solve and to facilitate discussion and resolution of such concerns with the clinical educator, as required.

On occasion, a student may experience difficulty in meeting the learning and performance expectations for a practicum course. In such cases, the clinical educator must notify the Course Instructor / Coordinator of Clinical Education as soon as concerns arise, even if a mid-term evaluation has not yet occurred. If a student is not demonstrating acceptable performance in either professional behaviour and/or clinical skills, based on the assessment of the Course Instructor/Coordinator of Clinical Education, written notice must be given to the student and a specific written plan for developing these skills must be negotiated cooperatively by the Course Instructor/Coordinator of Clinical Education, the clinical educator, and the student. This plan will include:





Revised 25/08/11

COURSE OUTLINE SLP 2500Y - ADVANCED INTERNSHIP

Unit 9

Course Instructor: Lynn Ellwood, M.H.Sc. Time & Place: Full-time; ten (10) consecutive weeks at clinical teaching facilities under the supervision of clinical

educators, as assigned by the Coordinator of Clinical Education Course Objectives: The purpose of this course is to develop a student's clinical competence to meet entry-level professional standards. By the end of the internship, a student must be able to do the following at the supervised clinical practice level in an efficient and effective manner:

(a) organize a coherent, integrated approach to client management (e.g., assessment, intervention,

counselling, reporting, discharge planning) utilizing best practice, evidence-based practice and outcome evaluation in collaboration with clients/families/other professionals;

(b) counsel client and/or significant others appropriately and competently; (c) communicate complete, pertinent, and accurate information in both written and oral forms to clients,

family members, significant others and/or other professionals; (d) prioritize responsibilities realistically and allocate time accordingly; (e) manage a 75% caseload for at least the final four weeks of the internship; (f) follow the administrative standards for the clinical facility independently (e.g., setting up files, closing

files, workload measurement, quality assurance/improvement, knowledge of authority); (g) set realistic goals for self-improvement and recognize and develop personal strengths; and (h) seek out, understand, and support the mandates and operation of the department/program/facility. (i) demonstrate the continued development of self-evaluation skills; (j) demonstrate continued development of complex, ongoing clinical reasoning skills and problem-solving

strategies; (k) demonstrate continued reflective practice in all areas of professional and clinical

behaviour; and (l) continue to demonstrate understanding of the scope of practice of speech-language pathology in

relation to other professions and participate as an effective member of the interprofessional team. Required Reading:

1) General Guidelines for Clinical Activities in Practicum Courses (See Clinical Education Guide for the

Department of Speech-Language Pathology, University of Toronto). 2) SLP 2500Y – Advanced Internship - Recommended Course Schedule - (See Clinical Education Guide for the

Department of Speech-Language Pathology, University of Toronto). Evaluation: This is a graded full-credit course. To achieve a passing grade, all of the following conditions must be met:

1) Minimum Expectations (Pass/Fail)



2) The Evaluation of Professional Behaviour (50%)


3)The Evaluation of Clinical Skills (50%)


*Satisfactory performance (minimum B- level) means that for most behaviours that are evaluated in an identified area (such as Assessment), a student is expected to perform adequately with some guidance and input from the clinical educator, where generalization/consistency is considered by the clinical educator to be adequate. It is understood that the clinical educator will only evaluate student performance on those items for which there was opportunity to observe the student in clinical practice. The Course Instructor will grade the course according to the grading scheme of the School of Graduate Studies such that an average score of “5” corresponds to “Good” performance (grade letter “B”). General Guidelines concerning Clinical Activities:


• A student in this course will spend 20-25 hours per week participating in activities with or for clients, either in observation (General Guideline IB) or supervised client activities (General Guidelines IIABC, which include client-specific, client-related activities, and clinical/professional activities) with the remaining time spent in activities outlined in sections I (Clinical Readiness Activities), III (Other Clinical Practice Activities, such as record-keeping) and IV (Related Activities, such as orientation to the facility) of the General Guidelines.

• A weekly schedule for supervised client activities is included in this document. • As this is the final practicum placement, a student will be involved in all aspects of the clinical setting to

ensure a comprehensive understanding of the speech-language pathologist's roles. • A clinical educator will introduce clients in the following sequence: observation, shared clinical practice and

supervised clinical practice. The student should proceed quickly through this sequence. • For the majority of this experience, a student will function at the supervised clinical practice level with the

clinical educator monitoring the student’s performance by: (a) reviewing written assessment and treatment plans and progress notes; (b) providing specific confirming and developmental feedback to the student at least three times a week and (c) observing a student's clinical practice activities at least 25% of the time with observation normally being

100% initially and gradually decreasing, at the discretion of the clinical educator who is ultimately responsible for the client’s welfare.

• In this course, each student will earn 150 - 250 clinical hours (General Guideline IIABC), in order to meet the 350 hour minimum clinical requirement for CASLPA and CASLPO certification.

Minimum Expectations: At a minimum, a student must successfully complete the following activities in supervised clinical practice during the internship:

Expectation Specifics 1) Learning Conferences • Discuss and determine own strengths, areas for development and an action

plan with the clinical educator in a formal half-hour conference at the end of Week 3 and 8

2) One (1) Interaction (minimum) with Another Health Care Professional

• Around a client or a professional issue For each interaction, the student will discuss with the clinical educator:

What was the goal of the interaction? What did you learn from this interaction that you can apply to your

clinical practice? This interaction should be scheduled by the student and the CE during the development of the internship contract.



4) Three (3) Full Assessments

To include: • developing an assessment plan • taking a case history • testing (informal/formal) • interpretation of findings • writing of reports and recommendations

5) Management Approach for Three (3) Clients (minimum)

• At least one (1) of which should be for a client for whom English is not the first language; if possible

• If this is not possible, the student will develop an amendment to a management approach with a client on her existing caseload, assuming English is not the first language and highlighting changes required

Develop and implement a management approach based on assessment and information gathering, as required, to include:

• Mutual goal-setting • Therapeutic procedures • Counselling • Outcome evaluation • Discharge planning • Demonstration of application of theoretical knowledge

6) Four (4) Written Reports

• Any type of report utilizing the format appropriate to the internship facility

7) One (1) Formal Presentation

• May be at formal rounds, department meetings, workshop or in-service

8) Manage 75% of caseload

• For the final four weeks of the placement

9)Teaching Clinics Participate in Teaching Clinics for the full day on the Friday of Weeks 3, 5 and 7 of this course: • Morning sessions: Present a case scenario to peers in a small group

(with supporting videotapes or other materials) to promote development of clinical reasoning skills.


The student is required to submit evidence for achievement of these minimum expectations at the end of this course along with other documentation. Hearing Disorders Assignment:


Identify a client on your SLP caseload with hearing loss and describe how your approach to either assessment or treatment was impacted as a result of the hearing loss (include mention of enhancing communication strategies). If this is not possible, develop an amendment to an assessment plan or management approach for a client on your existing caseload, assuming the client has an acquired moderate to severe binaural sensory-neural hearing loss and wears at least one hearing aid (max. 2 pages, double spaced – pass/fail).

The student will submit the assignment to the SLP 1532H course instructor at the end of placement.

Mid-term Formative Performance Evaluation:

Mid-way through the placement, the student will be given a formative evaluation by the clinical educator using The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills (Please note that Summary comments must accompany each evaluation form). This evaluation, though formalized, is not factored into the final grade (pass/fail). The clinical educator will review and discuss the results of these evaluations with the student, then submit them to the Course Instructor/Coordinator of Clinical Education.

The clinical educator must inform the Course Instructor/Coordinator of Clinical Education in the event that the student is in jeopardy of failing at this point in the placement. Written notification of this will then be given to the student (See “If Problems Arise” below). Final Summative Performance Evaluation:

Again, the Evaluation of Professional Behaviour and the Evaluation of Clinical Skills will be used for these evaluations (Summary Comments must accompany each evaluation form).

The Clinical Educator will review and discuss the final performance reports (The Evaluation of Professional Behaviour and The Evaluation of Clinical Skills, and Summary Comments) with the student, prior to submitting them to the Course Instructor/Coordinator of Clinical Education.

The Course Instructor will determine a final grade. A student who fails the internship must leave the program. The Examinations Committee may, however, review the student’s record to determine if extraordinary circumstances are present and will take any appropriate action (see Student Handbook, Course Regulations).

An inherent part of clinical skills is appropriate record-keeping. Accordingly, a student must complete all record-keeping tasks, as outlined on the form entitled Record-Keeping Summary Table, by the due date indicated. One-third of a grade will be lost for each day late. If Problems Arise:

A student is encouraged to bring any concerns regarding a practicum experience (e.g., course, clinical facility, Clinical Educator) to the attention of the Course Instructor/Coordinator of Clinical Education as soon as they arise. The Course Instructor/Coordinator of Clinical Education will help to problem-solve and to facilitate discussion and resolution of such concerns with the clinical educator, as required.

On occasion, a student may experience difficulty in meeting the learning and performance expectations for a practicum course. In such cases, the clinical educator must notify the Course Instructor / Coordinator of Clinical Education as soon as concerns arise, even if a mid-term evaluation has not yet occurred. If a student is not demonstrating acceptable performance in either professional behaviour and/or clinical skills, based on the assessment of the Course Instructor/Coordinator of Clinical Education, written notice must be given to the student and a specific written plan for developing these skills must be negotiated cooperatively by the Course Instructor/Coordinator of Clinical Education, the clinical educator, and the student. This plan will include:





Revised 25/08/11

REHABILITATION SCIENCES Department of Speech-Language Pathology CENTRE FOR FUNCTION AND WELL-BEING FACULTY OF MEDICINE UNIVERSITY OF TORONTO #160-500 University Ave, Toronto, ON M5G 1V7 Phone: (416) 978-2770 Fax: (416) 978-1596

COURSE OUTLINE

SLP 1532H

CLINICAL LABORATORY IN HEARING DISORDERS

Department of Speech-Language Pathology University of Toronto

Course Instructor: Lynn Ellwood, M.H.Sc. Time & Place: Practical experience will be acquired through hearing disorder related experience in Units 3, 5, 7, & 9. Overall Course Objectives: In this course, the student will apply knowledge regarding the ramifications of hearing loss (its nature, degree, age of onset, and progression), as related to a number of factors:

• its effect on the individual and significant others, personally, socially, educationally (where applicable), and vocationally (where applicable)

• other existing physical, psychological, and environmental conditions • comprehension, production and use of language in oral, signed and/or written modalities

The student will demonstrate knowledge and skills in the following areas:

• performance of valid puretone screening and/or audiograms and/or other methods of audiological assessment

• interpretation of audiologic results accurately • consultation with audiologists, physicians, and related support services as appropriate • application of hearing status information to speech-language pathology practice • use of compensatory mechanisms or strategies to enhance communication in the presence

of hearing disorders • use, care and maintenance of assistive listening devices such as hearing aids, cochlear

implant devices and amplification systems • development of client self advocacy skills (supportive counselling)

Evaluation: This is a pass/fail half-credit course. Credit will be attributed once the learning expectations and associated evidence have been approved by the course instructor following the final placement unit. Assignments: Four assignments must be completed and a passing grade achieved for each assignment. A failing grade on any assignment will result in a request for the student to re-write and re-submit the assignment. If more than one assignment is failed on the first submission, or a resubmitted assignment is not passed, the student will be required to complete a one-week remedial hearing disorder clinical placement experience.

1) In Unit 3: Identify up to 3 SLP-specific clinical practices in this setting that address hearing loss (e.g., case history taking, hearing screening, individual education plans, referral procedures, etc.) and one resource or service available (e.g., audiology, ENT, Cert. AVT, classroom amplification, etc.). Describe how these practices were incorporated into your clinical practice (or, if not observable, then formulate recommendations suitable for this setting). (max. 2 pages, double spaced – pass/fail). NOTE: For the following 2 assignments, at least one must be completed with respect to an actual client with hearing loss on your SLP clinical caseload. 2) In Unit 7: Identify a client on your SLP caseload with hearing loss and describe how your approach to either assessment or treatment was impacted as a result of the hearing loss (include mention of enhancing communication strategies). If this is not possible, develop an amendment to an assessment plan or management approach for a client on your existing caseload, assuming the client has an acquired moderate to severe binaural sensory-neural hearing loss and wears at least one hearing aid (max. 2 pages, double spaced – pass/fail). 3) In Unit 9: Identify a client on your SLP caseload with hearing loss and describe how your approach to either assessment or treatment was impacted as a result of the hearing loss (include mention of enhancing communication strategies). If this is not possible, develop an amendment to an assessment plan or management approach for a client on your existing caseload, assuming the client has an acquired moderate to severe binaural sensory-neural hearing loss and wears at least one hearing aid. (max. 2 pages, double spaced – pass/fail) 4) Course capstone minimum expectations: The student must successfully complete the following activities (see chart below) in supervised academic or clinical settings over the course of the 2-year program. The student is required to submit evidence for achievement of these minimum expectations at the end of Unit 9.

Expectation Specifics 1) Audiological Assessments

• Five unmasked audiograms including air conduction, bone conduction, speech reception thresholds and speech recognition testing

and/or • Depending upon the placement setting, other methods of audiological

assessment may be considered appropriate (such as central auditory processing or infant hearing screening etc.) at the discretion of the course instructor

2) Acoustic Immitance • Understand and interpret acoustic immitance measurements

3) Assistive Devices

• Demonstrate understanding and use of assistive listening devices (e.g., care and maintenance of hearing aids, cochlear implant devices, assistive listening devices and amplification systems).

4) One (1) Counselling Session addressing

hearing status

• Plan and conduct at least one counselling session with a client with a hearing disorder. Describe your preparation and planning in a brief reflection (1-2 pages double-spaced).

5) Quality of Life Tool • Identify a Quality of Life tool related to hearing loss appropriate to one of your clinical placement practice settings and briefly describe how it is applicable to the clients in that setting (max. one page double spaced).

SLP 1500Y – Internship – Recommended Course Schedule: The following schedule outlines minimum expectations concerning activities appropriate to the initial internship. In particular, it provides minimum expectations concerning a student's involvement in observation (General guideline IB), shared clinical practice (General guideline IIABC), and supervised clinical practice (General guidelines II ABC), within the total of 16-20 hours per week recommended for such activities. Students are required to complete assessment and lesson plans for all sessions, which are reviewed by the clinical educator(s). In addition, the clinical educator(s) should consider the use of regular journalling as a requirement for students to document their observations and progress.

Weekly list

Activities

Specifics

Completion Date

Week1

Practicum Contract CEs and student negotiate utilizing guided questions (focusing on relevant background, experiences, concerns and goals)and form provided

End of Week 1

Orientation Student should have orientation and introduction to site and other staff, including service delivery model and rationale for it

End of Week 1

Observation Student observes Clients/CE at least 10 hours/week

End of Week 1

Shared Clinical Practice

Student engages in at least 4 hours/week

End of Week 1

Consumer Satisfaction Assignment

Student consults with CE re: consumer satisfaction practices at the site and the student obtains CE signature on ASHA agreement forms

End of WEEK 1

Guided Observations

Initiate as indicated above under Minimum Expectations

Week 4

Common Tests/Tools

Initiate as indicated above under Minimum Expectations

Week 8

Full Communication Assessments

Initiate, as appropriate, as indicated above under Minimum Expectations

Week 8

Week list

Activities

Specifics

Completion Date

Weeks 2 to 3

Practicum Contract CE and Student submit to Course Instructor/Clinical Coordinator

Due End of Week 2


Week 2 and 3



Week 2 and 3

Supervised Clinical Practice


Week 2 and 3

Teaching Clinic Full-day Friday meeting of all students at Week 3

U of T (Includes student meeting with course instructor/Coordinator of Clinical Education or designate)

Guided Observations

Initiate/continue as indicated above under Minimum Expectations

Week 4


Student begins writing proposal paper Week 8

Common Tests/Tools


Week 8


Initiate/continue, as appropriate, as indicated above under Minimum Expectations

Week 8

Week list

Activities

Specifics

Completion Date

Weeks 4 to 6

Midterm Evaluation Conference

CE and Student hold conference and complete midterm evaluation

Preferably Week 4, but no later than the middle of Week 5

Midterm Evaluation CE submits mid-term performance reports (Evaluation of Professional Behaviour and Evaluation of Clinical Skills) to Course Instructor/Clinical Coordinator

End of Week 5


Week 4,5,6



Week 4,5,6



Week 4,5,6

Teaching Clinic Full-day Friday meeting of all students at U of T

Week 5

Guided Observations

Conclude as indicated above under Minimum Expectations

Week 4

Common Tests/Tools


Week 8


Initiate/continue, as appropriate, as indicated above under Minimum Expectations

Week 8

Written Treatment Progress Reports

Initiate, as appropriate, as indicated above under Minimum Expectations

Week 8

kristina

Typewritten Text

SLP 1500Y – Internship – Recommended Course Schedule (cont):

Weekly list

Activities

Specifics

Completion Date

Weeks 7 to 8


Student engages in at least 12 hours/week • To include some parent counselling

Week 7 and 8


Week 7

Common Tests/Tools

Conclude, as indicated above under Minimum Expectations

Week 8


Conclude, as appropriate, as indicated above under Minimum Expectations

Week 8

Written Treatment Progress Reports

Conclude, as indicated above under Minimum Expectations

Week 8


Student submits assignment to CE for review CE submits on line feedback

Week 8

Unit 3 Hearing Disorders Assignment

Student completes assignment Week 8

Final Evaluation Conference

CE and Student hold conference and complete final evaluation

Week 8

Record-Keeping Summary Table

Student completes other record-keeping tasks as outlined on table

Week 8

Weekly list

Activities

Specifics

Completion Date

One week post

Evaluation CE submits final performance reports (Evaluation of Professional Behaviour and Evaluation of Clinical Skills) to U of T

One week post placement

Unit 3 Hearing Disorder Assignment

Student submits separately to U of T One week post placement

Minimum Expectation Evidence

Student compiles evidence in binder and submits to U of T



Student submits completed record-keeping tasks as outlined on table (see also checklist on blackboard)


kristina

Typewritten Text

SLP 1500Y – Internship – Recommended Course Schedule (cont):

SLP 1507H – Clinical Laboratory in SLP - Recommended Course Schedule: The following schedule outlines minimum expectations concerning activities appropriate to this course. In particular, it provides minimum expectations concerning a student's involvement in observation (General guideline IB), shared clinical practice (General guideline IIABC), and supervised clinical practice (General guidelines II ABC), within the minimum of 50% of the total time for the placement recommended for such activities. Where a placement by necessity has an altered timeline (e.g., 6 or 8 weeks), related deadlines and expectations outlined below are to be extended accordingly. Students are required to complete assessment and lesson plans for all sessions, which are reviewed by the clinical educator(s). In addition, the clinical educator(s) should consider the use of regular journaling as a requirement for students to document their observations and progress.

Weekly list

Activities Specifics

Completion Date

Week1

Practicum Contract

CEs and student negotiate utilizing guided questions (focusing on relevant background, experiences, concerns and goals) and form provided

End of Day 1

Student submits to Course Instructor/Clinical Coordinator

Due End of Week 1


End of Day 1

Observation, Shared and Supervised Clinical Practice:

Student spends a minimum of 50% of the total time in the placement in observation, shared and supervised clinical practice.

Specifically, a minimum of: 25% must be spent in observation of clients/CE

and 25% must be spent in shared clinical practice

Enhancing Techniques

Initiate as per Minimum Expectations Week 4

Counselling Session

Initiate, as appropriate, as per Minimum Expectations Week 4

Written Reports Initiate, as appropriate, as per Minimum Expectations Week 4

Weekly list

Activities Specifics Completion Date

Weeks 2 to 3

Learning Conference

Complete conference. End of Week 2

Student submits completed Learning Conference Form to Course Instructor/Clinical Coordinator

Due End of Week 3

Observation, Shared and Supervised Clinical Practice:

• Student spends a minimum of 50% of the total time in the placement in observation, shared and supervised clinical practice.

• Specifically: o Observation and shared clinical

practice should be engaged in as requested/needed

o A minimum of 25% must be spent in supervised clinical practice

Week 2 and 3


Continue as per Minimum Expectations Week 4

Counselling Session

Initiate, as appropriate, as per Minimum Expectations Week 4

Written Reports Initiate, as appropriate, as per Minimum Expectations Week 4

Weekly list


Completion Date

Week 4 Observation, Shared and Supervised Clinical Practice:

• Student spends a minimum of 50% of the total time in the placement in observation, shared and supervised clinical practice.

• Specifically: o A minimum of 50% must be spent in

supervised clinical practice

Week 4


Continue as per Minimum Expectations Week 4

Counselling Session

Complete, as per Minimum Expectations Week 4

Written Reports Complete, as per Minimum Expectations Week 4


CE and Student hold conference and complete evaluations

Week 4

Weekly list


Completion Date

One week post-placement

Evaluation CE submits final performance reports (Evaluation of Professional Behaviour and Evaluation of Clinical Skills) to Course Instructor/Clinical Coordinator






Student completes other record-keeping tasks as outlined on table and submits separately to U of T (also see checklist on Blackboard).


kristina

Typewritten Text

SLP 1507H – Clinical Laboratory in SLP - Recommended Course Schedule (cont):

kristina

Typewritten Text

SLP 1508Y – Advanced Clinical Laboratory in SLP - Recommended Course Schedule: The following schedule outlines minimum expectations concerning activities appropriate during this course. In particular, it provides minimum expectations concerning a student's involvement in observation (General Guideline IB), shared clinical practice (General Guideline IIABC) and supervised clinical practice (General Guideline IIABC) within the total of 20 – 25 hours per week recommended for such activities. Students are required to complete assessment and treatment plans for all sessions, which are reviewed by the clinical educator(s). In addition, the clinical educator(s) should consider the use of regular journaling as a requirement for students to document their observations and progress.

Weekly

list

Activities

Specifics

Completion Date

Week 1

Practicum Contract CEs and student negotiate utilizing guided questions (focusing on relevant background, experiences, concerns and goals) and form provided

End of Week 1


End of Week 1

OBSERVATION Student observes Clients/CE at least 5 hours/week

END OF WEEK 1


Student engages in at least 5 hours/week END OF WEEK 1


Student engages in at least 8 hours/week END OF WEEK 1

Guided Observations

Initiate and conclude as per Minimum Expectations Week 1

Observation of Another Health Care Professional


Common Tests/Tools


Full Assessments Initiate, as appropriate, as per Minimum Expectations Week 8 Management Approach


Written Reports Initiate as per Minimum Expectations Week 8 Inter-professional Team Education


Weekly list

Activities

Specifics

Completion Date

Weeks 2 to 3


End of Week 2

OBSERVATION Student observes Clients/CE as needed/requested

WEEK 2 AND 3


Student engages in at least 2 ½ hours/week WEEK 2 AND 3



WEEK 2 AND 3

Learning Conference

Complete first conference as per Minimum Expectations

END OF WEEK 2


Week 3

Observation of Another Health Care Professional

Initiate as per Minimum Expectations

Week 4

Common Tests/Tools

Initiate/continue as per Minimum Expectations Week 8

Full Assessments Initiate/continue, as appropriate, as per Minimum Expectations

Week 8

Management Approach


Week 8

Written Reports Initiate as per Minimum Expectations

Week 8

Case Presentation Initiate as per Minimum Expectations

Week 8

Treatment Outcomes Assignment


Week 8

Hearing Disorders Assignment

Initiate; identify client as able

Week 8

Weekly list

Activities

Specifics

Completion Date

Weeks 4 to 6


CE and Student hold conference Preferably Week 4, but no later than the middle of Week 5


End of Week 5


WEEK 4, 5, 6


Student engages in as needed/requested WEEK 4, 5, 6



WEEK 4, 5, 6

Learning Conference

Complete first conference as per Minimum Expectations

END OF WEEK 6

Teaching Clinic Full-day Friday meeting of all students at U of T Week 5 Observation of Another Health Care Professional

Conclude as per Minimum Expectations Week 4

Common Tests/Tools

Initiate/continue as per Minimum Expectations Week 8


Week 8

Management Approach


Week 8

Written Reports Initiate, as appropriate, as per Minimum Expectations Week 8 Case Presentation Initiate as per

Minimum Expectations Week 8



Week 8


Initiate/continue, as appropriate Week 8

kristina

Typewritten Text

SLP 1508Y – Advanced Clinical Laboratory in SLP - Recommended Course Schedule (cont):

Weekly list

Activities

Specifics

Completion Date

Weeks 7 to 8


WEEK 7 AND 8


Student engages in as needed/requested WEEK 7 AND 8


Student engages in at least 20 hours/week WEEK 7 AND 8


Week 7

Common Tests/Tools

Conclude, as per Minimum Expectations Week 8

Full Assessments Conclude, as appropriate, as per Minimum Expectations

Week 8

Management Approach


Written Reports Conclude, as per Minimum Expectations Week 8 Case Presentation Conclude as per Minimum Expectations Week 8 Treatment Outcomes Assignment

Student analyses and interprets treatment outcome data and submits corresponding assignment

Week 8


Conclude, as per SLP 1532H course outline. Week 8


CE and Student hold conference Week 8

Weekly list

Activities

Specifics

Completion Date


Evaluation CE submits final performance reports (Evaluation of Professional Behaviour and Evaluation of Clinical Skills) to Course Instructor/Clinical Coordinator



Student completes other record-keeping tasks as outlined on table



CE makes comments and submits One week post placement

kristina

Typewritten Text

SLP 1508Y – Advanced Clinical Laboratory in SLP - Recommended Course Schedule (cont):

SLP 2500Y – Advanced Internship - Recommended Course Schedule: The following schedule outlines Minimum Expectations concerning activities appropriate during this course. In particular, it provides Minimum Expectations concerning a student's involvement in observation (General Guideline IB), shared clinical practice (General Guideline IIABC) and supervised clinical practice (General Guideline IIABC) within the total of 20 – 25 hours per week recommended for such activities. Students are required to complete assessment and treatment plans for all sessions, which are reviewed by the clinical educator(s). In addition, the clinical educator(s) should consider the use of regular journalling as a requirement for students to document their observations and progress.

Weekly

list

Activities

Specifics

Completion Date

Week 1

Practicum Contract CEs and student negotiate utilizing guided questions (focusing on relevant background, experiences, concerns and goals) and form provided

End of Week 1


End of Week 1

OBSERVATION Student observes Clients/CE at least 5 hours/week

END OF WEEK 1



END OF WEEK 1



END OF WEEK 1

Interaction with another Health Care Professional


Common Tests/Tools Initiate as per Minimum Expectations Week 10 Full Assessments Initiate, as appropriate, as per Minimum

Expectations Week 10

Management Approach


Written Reports Initiate as per Minimum Expectations Week 10 Formal Presentation Initiate as per Minimum Expectations Week 10

Weekly list

Activities

Specifics

Completion Date

Weeks 2 to 3


End of Week 2


WEEK 2 AND 3


Student engages in at least 2 ½ hours/week

WEEK 2 AND 3



WEEK 2 AND 3

Learning Conference Complete first conference as per Minimum Expectations

END OF WEEK 3


Week 3



Common Tests/Tools Initiate/continue as per Minimum Expectations

Week 10


Week 10

Management Approach


Written Reports Initiate as per Minimum Expectations Week 10 Formal Presentation Initiate as per Minimum Expectations Week 10


Initiate; identify client as able.

Week 10

Weekly list

Activities

Specifics

Completion Date

Weeks 4 to 6


CE and Student hold conference Preferably Week 5, but no later than the middle of Week 6


End of Week 6


WEEK 4, 5, 6


Student engages in as needed/requested

WEEK 4, 5, 6



WEEK 4, 5, 6


Week 5



Common Tests/Tools Initiate/continue as per Minimum Expectations

Week 10


Week 10

Management Approach


Week 10

Written Reports Initiate, as appropriate, as per Minimum Expectations

Week 10

Formal Presentation Initiate as per Minimum Expectations Week 10 Hearing Disorders Initiate/continue, as appropriate. Week 10

kristina

Typewritten Text

SLP 2500Y – Advanced Internship - Recommended Course Schedule (cont):

Weekly list

Activities

Specifics

Completion Date

Weeks 7 to 10


WEEK 7 -10


Student engages in as needed/requested

WEEK 7 -10



WEEK 7 -10


Week 7

Learning Conference Complete first conference as per Minimum Expectations

END OF WEEK 8

Common Tests/Tools Conclude, as per Minimum Expectations Week 10 Full Assessments Conclude, as appropriate, as per Minimum

Expectations Week 10

Management Approach


Written Reports Conclude, as per Minimum Expectations Week 10 Formal Presentation Conclude as per Minimum Expectations Week 10 Manage 75% of Caseload

Initiate and conclude as per Minimum Expectations

Week 10

Clinical Laboratory in Hearing Disorders Unit 9 Assignment



Conclude, as per SLP 1532H course outline.

Week 10


CE and Student hold conference Week 10

Weekly list

Activities

Specifics

Completion Date


Completed Evaluation CE submits final performance reports (Evaluation of Professional Behaviour and Evaluation of Clinical Skills) to Course Instructor/Clinical Coordinator





Clinical Laboratory in Hearing Disorders Unit 9 Assignment

Student submits separately to U of T One week post placement


Student completes other record-keeping tasks as outlined on table and submits separately to U of T (see checklist on Blackboard).


kristina

Typewritten Text

SLP 2500Y – Advanced Internship - Recommended Course Schedule (cont):

M.H.Sc. CURRICULUM

YR Sept

Oct

Nov

Dec Jan Feb Mar Apr May June July1 Aug1

1

Unit 1: FOUNDATIONS OF S-LP 15 weeks Anatomy And Embryology Applied Audiology Child Language I Principles Of Clinical Practice Speech Physiology & Acoustics Integrative Learning (IL)

Unit 2: DEVELOP- MENTAL DISORDERS 7 weeks Articulation Child language II Fluency Disorders

IL

Read

ing

Wee

k

Unit 3: INTERNSHIP 1 – DEVELOP- MENTAL DISORDERS 8 weeks

Unit 4: SPEECH & HEARING DISORDERS 7 weeks

Aural Rehab. Augmentative and Alternative Communication Voice

IL

Unit 5: INTERNSHIP 2 – SPEECH & HRG DISORDERS 4 weeks

Unit 5: INTERNSHIP 2–SPEECH & HRG DISORDERS 4 weeks

2

Unit 6: NEUROGENIC & STRUCTURAL DISORDERS 15 weeks Aphasia Motor Speech Disorders Swallowing Structurally Related Disorders Neurocognitive Communication

IL

Unit 7: INTERNSHIP 3 – NEUROGENIC DISORDERS 8 weeks

Re

adin

g W

eek

Unit 8: PRACTICE OF S-LP 7 weeks

Advanced Principles of Clinical Practice Physical Analysis of Speech Disorders Research in Speech-Language Pathology

IL

Unit 9: INTERNSHIP 4 –FINAL INTERSHIP 10 weeks

OFF

1 Most students will complete Internship 2 in either July OR August, but some will have half-time placements in both July AND August.

U of T Department of Speech-Language Pathology RECORD-KEEPING SUMMARY TABLE

All originals to be handed in to U of T (NO COPIES) *

FORM

To be completed by: To be given to:

DEADLINEStudent Clinical Educator Student Clinical Educator U of T*

(1) Student Declaration of Understanding (Unit 3 Only) Copy n/a Original

Due with pre-placement paperwork

(2)

Internship Practicum Contract

Copy

Copy

End of Week 1 in Units 3 7 9 To U of T End of Week 1 in Unit 5 end of day 1 To U of T by end of Week 1

(3)

Midterm Evaluation Copy Copy Must be Completed by:

Unit 3 / 7: Week 4 Unit 5: Week 2 Unit 9: Week 5 & Submitted To U of T by Following Week

a) The Evaluation of

Professional Behaviour Sign

& Sign

Copy

Copy

Summary Comments Sign & Sign Copy Copy

b) The Evaluation of Clinical

Skills Sign

& Sign

Copy

Copy

Summary Comments Sign & Sign Copy Copy (4)

Final Evaluation Copy Copy

Submitted To U of T One week post-practicum

a) The Evaluation of

Professional Behaviour Sign

& Sign

Copy

Copy

Summary Comments Sign & Sign Copy Copy

b) The Evaluation of Clinical

Skills Sign

& Sign

Copy

Copy

Summary Comments Sign & Sign Copy Copy (5) Minimum Expectations One week post-practicum

(6) Student Clinical Placement Goals & Sign Sign

Copy

Last page of minimum Expectations

(7) Summary of Clinical Hours for S-LP (CASLPA/CASLPO) Sign Copy Copy One week post-practicum

(8) Evaluation of Clinical Faculty Teaching Copy One week post-practicum

Documents must be copied by the student and the Clinical Educator for their own files The University of Toronto will NOT provide copies SLP Department Phone: 416-978-2770 Clinical Education Administrative Assistant: 416 978-6882 Fax: 416-978-1596

Appendix B ‐ Planning Documents Internship Practicum Contracts Background Questionnaire Student Goals Form

79

Table of Contents<Back Table of Contents


UNIVERSITY OF TORONTO FACULTY OF MEDICINE Department of Speech-Language Pathology REHABILITATION SCIENCES BUILDING

160- 500 University Avenue, Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

INTERNSHIP PRACTICUM CONTRACT Student Name: Year I Year II

Course Number: Current Date: Clinical Educator(s):

Placement Site Name:

Placement: (complete mailing address)

Schedule: (include beginning and end dates, holidays, etc.)

From: To:

Placement Phone: EXT: Clinical Educator E-mail:

CLINICAL COORDINATORS: Unit 3 and 5: Marieke Favrod, 416 978 - 6332 Unit 7 and 9: Lynn Ellwood, 416 946 - 8723Number of Clock hours student is to spend in facility: ______________

Approximate caseload student is expected to assume: (list case type and approximate number of hours of therapy per week)

Diagnostic responsibilities of student: (list number of assessments and approximate frequency, etc.)

Record Keeping System: (lesson plans, data collection, reports expected, etc.)

Special services student is expected to provide:

staff meeting if yes, when in service readings conferences / workshops other

Additional goals as defined by student:

Additional goals as defined by Clinical Educator:

Responsibilities of Clinical Educator: (orientation, conference time to be spent with students, observation of student therapy, etc.)

The student and the Clinical Educator may agree upon specific duties and responsibilities, however, in cases of disagreement, the contract shall form the basis for decisions regarding the student's obligations to the placement site. The Coordinator of Clinical Education shall act as arbitrator in these decisions. Modifications of the contract shall be made with the permission of the student, Clinical Educator and Coordinator of Clinical Education. Signatures Student (Print Name) Clinical Educator (Print Name) U of T Clinical Coordinator (Print Name)

REHABILITATION SCIENCES BUILDING FACULTY OF MEDICINE

UNIVERSITY OF TORONTO Department of Speech-Language Pathology #160- 500 University Avenue Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

INTERNSHIP PRACTICUM CONTRACT (TWO SITES) Student Name: Year I Year II

Course Number: Placement A Start Date: SITE A SITE B Clinical Educator(s):

Placement Site Name:

Placement: (complete mailing address)

Schedule: (include beginning and end dates, holidays, etc.)

From:

To:

From: To:

Placement Phone: Clinical Educator E-mail:

Number of Clock hours student is to spend in facility:

Approximate caseload student is expected to assume: (list case type and approximate number of hours of therapy per week)

Diagnostic responsibilities of student: (list number of assessments and approximate frequency, etc.)

Record Keeping System: (lesson plans, data collection, reports expected, etc.)

Special services student is expected to provide: A B

staff meeting if yes, when In service readings conferences / workshops other

Additional goals as defined by student:

Additional goals as defined by Clinical Educator:

Responsibilities of Clinical Educator: (orientation, conference time to be spent with students, observation of student therapy, etc.)

The student and the Clinical Educator may agree upon specific duties and responsibilities, however, in cases of disagreement, the contract shall form the basis for decisions regarding the student's obligations to the placement site. The Coordinator of Clinical Education shall act as arbitrator in these decisions. Modifications of the contract shall be made with the permission of the student, Clinical Educator and Coordinator of Clinical Education. Unit 3, 5 Marieke Favrod - 416 978-9332 Unit 7, 9 - Lynn Ellwood 416 946 - 8723 Signatures Student (Print Name) Clinical Educator Site A (Print Name) Clinical Educator Site B (Print Name) U of T Clinical Coordinator (Print Name)

1

REHABILITATION SCIENCES Department of Speech-Language Pathology CENTRE FOR FUNCTION AND WELL-BEING FACULTY OF MEDICINE UNIVERSITY OF TORONTO 500 University Avenue, #160 Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596 E-mail: [email protected]

BACKGROUND QUESTIONNAIRE This questionnaire has been developed to serve as a possible framework for sharing information in the first meeting between the student(s) and clinical educator(s).

CLINICAL EDUCATOR ASKS THE STUDENT

(1) What have you enjoyed most about your studies?

(2) What have you found the most challenging?

(3) List your clinical experiences.

(4) Identify the most positive aspects of those experiences.

(5) What were your most challenging moments during those experiences?

(6) What should I know about your strengths and areas for development that might

influence our plans for your clinical experience at this facility?

(7) What goals and objectives do you have in mind for this placement?

(8) How would you describe your learning style?

(9) Tell me something of your experience or interests that will help me to appreciate your

particular background.

(10) Do you anticipate that there will be any special events in your personal life that may

affect your availability during this placement?

(11) Will you need help with directions?

Please turn over …..

2

STUDENT ASKS THE CLINICAL EDUCATOR

1) What have you enjoyed most about your work?

2) List your clinical experiences.

3) Identify the most positive aspects of your clinical educator experiences.

4) What were your most challenging moments during those experiences?

5) What goals and objectives do you have in mind for this placement?

6) How would you describe your learning style?

7) Tell me something about yourself (e.g., interests, projects, university graduated from) that will

help me to appreciate your particular background.

8) Will there be any special events that may affect your availability during this placement?

R:/forms master file/forms2000/backgound questionnaire

STUDENT CLINICAL PLACEMENT GOALS Department of Speech-Language Pathology

University of Toronto Instructions: This form is to be filled out by the student following the final evaluation for all placement units. It is to be handed in as part of the minimum expectations evidence and then once returned to the student taken to the next clinical placement where it can be used to help complete the Clinical Practicum Contract. After the final placement, these goals can be incorporated into future professional development or mentorship plans. STUDENT NAME:

COURSE NUMBER:

YEAR: Year I Year II

CURRENT DATE:

1. Strengths in present placement as mutually identified by the formal evaluation and

discussion within the clinical placement. (a)

(b)

(c)

2. Goals for future placements as identified by the evaluation and discussions (including

areas which were not covered in any depth, areas of particular interest, etc.) (a)

(b)

(c)

Site Name: __________________________________________________________ CE Signature: _______________________ Std Signature: _________________________

Appendix C ‐ Evaluation Forms

Feedback LogLearning Conference Student Evaluation Instruction Forms Evaluation Instruction Forms for Clinical Educators


FEEDBACK LOG SPEECH/LANGUAGE PATHOLOGY INTERNSHIPS UNIVERSITY OF TORONTO

Student: ________________________ Clinical Educator: ___________________________ Date: ________________________ CLINICAL SKILLS: Assessment Planning/Preparation Appropriate Change Needed Not Applicable Interaction with Client/Family Appropriate Change Needed Not Applicable Interpretation of Results Appropriate Change Needed Not Applicable Reporting Written Appropriate Change Needed Not Applicable Oral Appropriate Change Needed Not Applicable Developing and Planning Background Knowledge Appropriate Change Needed Not Applicable Goals/Program Appropriate Change Needed Not Applicable

Techniques/Materials Appropriate Change Needed Not Applicable

Intervention Planning/Preparation Appropriate Change Needed Not Applicable Interaction with Client/Family Appropriate Change Needed Not Applicable Techniques/Materials Appropriate Change Needed Not Applicable Counseling/Interviewing Planning/Preparation Appropriate Change Needed Not Applicable Interaction with Client/Family Appropriate Change Needed Not Applicable Self-Evaluation/Problem-Solving Objective Evaluation Appropriate Change Needed Not Applicable Implements Changes Appropriate Change Needed Not Applicable PROFESSIONAL BEHAVIOUR: Positive Attitude Appropriate Change Needed Not Applicable

Responsible Appropriate Change Needed Not Applicable Ethical Behaviour Appropriate Change Needed Not Applicable SUMMARY OF CONFIRMING FEEDBACK:

SUMMARY OF DEVELOPMENTAL FEEDBACK:

ACTIONS REQUIRED:

UNIVERSITY OF TORONTO FACULTY OF MEDICINE Department of Speech-Language Pathology REHABILITATION SCIENCES BUILDING 160- 500 University Avenue, Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

LEARNING CONFERENCE MEETING WITH CLINICAL EDUCATOR

Department of Speech-Language Pathology University of Toronto

The student completes this form prior to conference and records comments and discussion with the clinical educator during conference. Student: Date: Course Number and Title: Unit: Dates of Placement: _______________ (___ days per week) Learning Conference (circle): 1st 2nd (Please check course outline Minimum Expectations for specified week to be completed) Clinical Educator: Site: Special Unit: 1. SELF-ASSESSMENT BY STUDENT (a) Five greatest strengths: 1.

2.

3.

4.

5.

Comments/Discussion:

(b) Five areas requiring development: 1.

2.

3.

4.

5.


(c) Background knowledge: Strengths:

Areas for development:

Compared to expected student performance at this level, the background knowledge that I bring to this placement is:

Much Poorer Poorer As Than Expected Than Expected Expected Outstanding

I_______ I _______ I _______ I _______ I _______ I _______I 1 2 3 4 5 6 7


(d) Clinical skills: Compared to expected performance at the end of the placement, my performance in the area of clinical skills is:


I_______ I _______ I _______ I _______ I _______ I _______I 1 2 3 4 5 6 7


(e) Professional behaviour: Compared to expected student performance at the end of the placement, my performance in the area of professional behaviour is:


I_______ I _______ I _______ I _______ I _______ I _______I 1 2 3 4 5 6 7


2. ACTION PLAN FOR REMAINDER OF PRACTICUM

(determined jointly by Student and Clinical Educator) 1.

2.

3.

4.

5.

Name of Student Signature of Student Name of Clinical Educator Signature of Clinical Educator

kristina

Typewritten Text

54

Student Clinician: THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING

THE RED-ON-WHITE COMPUTER FORM.

The Student will complete items A-C and items 1-25. The Clinical Educator must complete item 26 and all subsequent evaluation items.

I. Identifying Information A. Print your name in the upper right corner of the computer form on Side 1. Write the course number and name on the

line marked “Subject”. Write today’s date on the line marked "Date". Example: Carrothers, Emily SLP 1500Y – Internship July 30, 2010 Done

B. Using a #2 (HB) pencil only, write your student number in the vertical column in the upper left corner of the computer sheet on Side 1. Use the boxes provided and fill in only one number per line. You will leave the tenth row blank since each student number is only nine digits. Example: 009411759; 941175934 Done

C. Carefully and completely fill in the appropriate circle to the left of each number. Done

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Now move down to Question #1 on side 1 of the computer form and continue to fill in the following identifying information. 1. Indicate the type of evaluation form.

Evaluation of Clinical Skills Evaluation of Professional Behaviour

2. Indicate the clinical course number.

SLP 1500Y – Internship SLP 1507H – Clinical Laboratory in Speech-Language Pathology SLP 1508Y – Advanced Clinical Laboratory in Speech-Language Pathology SLP 2500Y – Advanced Internship

3. Indicate the type of evaluation. Midterm Final

4. Indicate the year of this evaluation.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 5. Indicate the month of this evaluation. Fill in this line if it is between January and October, otherwise leave it blank

and go to Question #6. Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec)

please see over

EVALUATION OF CLINICAL SKILLS – SPEECH-LANGUAGE PATHOLOGY Instructions for the student

Department of Speech-Language Pathology Faculty of Medicine, University of Toronto

Are you filling in the appropriate circles completely?

6. Indicate the date of this evaluation.

1-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-31

7. Indicate the year the course began.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 8. Indicate the month the course will begin. Fill in this line if it began between January and October, otherwise leave it

blank and go to Question #10. Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec)

9. Indicate the month the course will end. Fill in this line if it will end between January and October, otherwise leave it blank and go to Question #13.

Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec)

10.– 13. Fill in the University of Toronto clinical educator code number. Fill in only one number per line. Fill in 10 for 0. 14. – 17. Fill in the University of Toronto clinical educator code number for the second clinical educator, if appropriate. Fill

in only one number per line. Be sure to start on line 14. Fill in 10 for 0. 18. – 21. Fill in the University of Toronto clinical educator code number for the third clinical educator, if appropriate. Fill

in only one number per line. Be sure to start on line 18. Fill in 10 for 0. 22. – 24. Fill in the University of Toronto code number for your site. Fill in only one number per line. Be sure to start

on line 22. Fill in 10 for 0. Thank you!

Place completed forms back in the placement package with the CE Instruction forms and

pre-addressed envelopes and pass on to your CE when you begin your placement.

The placement package should contain: Course Outlines

1 internship contract 4 bubble sheets and CE instructions

4 Summary Comments forms FAQ sheet

Summary of Clinical Practice Hours in Speech-Language Pathology (CASLPA) and 2 pre-addressed envelopes

Please print all other necessary placement documents (learning conference, goals etc)

from blackboard

Example: Clinical Educator Code Number 27 would be 10, 10, 2, 7… 10. 11. 12. 13.

Example: For the 27th day of the month, fill in.

Check to be sure that the item number and computer form number agree.

7 = 7

Student Clinician: THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING

THE RED-ON-WHITE COMPUTER FORM. The Student will complete items A-C and items 1-25.

The Clinical Educator must complete item 26 and all subsequent evaluation items. Identifying Information A Print your name in the upper right corner of the computer form on Side 1. Write the course number and name on the

line marked “Subject”. Write today’s date on the line marked "Date". Example: Carrothers, Emily SLP 1500Y – Internship July 30, 1999

Done

B. Using a #2 (HB) pencil only, write your student number in the vertical column in the upper left corner of the computer sheet on Side 1. Use the boxes provided and fill in only one number per line. You will leave the tenth row blank since each student number is only nine digits. Example: 009411759; 941175934

Done

C. Carefully and completely fill in the appropriate circle to the left of each number. Done

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Now move down to Question #1 on side 1 of the computer form and continue to fill in the following identifying information. 1. Indicate the type of evaluation form.

Evaluation of Clinical Skills Evaluation of Professional Behaviour

2. Indicate the clinical course number.

SLP 1500Y – Internship SLP 1507H – Clinical Laboratory in Speech-Language Pathology SLP 1508Y – Advanced Clinical Laboratory in Speech-Language Pathology SLP 2500Y – Advanced Internship

3. Indicate the type of evaluation:

Midterm Final 4. Indicate the year of this evaluation.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

5. Indicate the month of this evaluation. Fill in this line if it is between January and October, otherwise leave it blank and go to Question #6. Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec)

please see over

EVALUATION OF PROFESSIONAL BEHAVIOUR Department of Speech-Language Pathology

Faculty of Medicine University of Toronto


6. Indicate the date of this evaluation.

1-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-31

7. Indicate the year the course began.

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

8. Indicate the month the course began. Fill in this line if it began between January and October, otherwise leave it blank and go to Question #10. Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec)

9. Indicate the month the course ended. Fill in this line if it ended between January and October, otherwise leave it

blank and go to Question #13.

Jan Feb Mar Apr May Jun Jul Aug Sep Other (Oct, Nov, Dec) 10. – 13. Fill in the University of Toronto clinical educator code number.

Fill in only one number per line. Fill in 10 for 0.

14. – 17. Fill in the University of Toronto clinical educator code number for the second clinical educator, if appropriate. Fill

in only one number per line. Be sure to start on line 14. Fill in 10 for 0. 18. – 21. Fill in the University of Toronto clinical educator code number for the third clinical educator, if appropriate. Fill

in only one number per line. Be sure to start on line 18. Fill in 10 for 0. 22. – 24. Fill in the University of Toronto code number for your site. Fill in only one number per line. Be sure to start

on line 22. Fill in 10 for 0.

Thank you!

Place completed forms back in the placement package with the CE Instruction forms and pre-addressed envelopes and pass on to your CE when you begin your placement.

The placement package should contain:

Course Outlines 1 internship contract

4 bubble sheets and CE instructions 4 Summary Comments forms

FAQ sheet Summary of Clinical Practice Hours in Speech-Language Pathology (CASLPA)

and 2 pre-addressed envelopes

Please print all other necessary placement documents (learning conference, goals etc) from blackboard

Example: Clinical Educator Code Number 27 would be 10, 10, 2, 7… 10. 11. 12. 13.

Example: For the 27th day of the month, fill in .

Check to be sure that the item number and computer form number agree.

7 = 7


EVALUATION OF CLINICAL SKILLS – SPEECH-LANGUAGE PATHOLOGY

Instructions for the Clinical Educator: THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING


Items 1 - 25 on the bubble sheet have been filled in for you. Please complete item 26 and all subsequent evaluation items that are applicable.

26. Indicate the number of student absences. Fill in 10 if there were NO absences.

1 2 3 4 5 6 7 8 9 0

Reminder: Clinical placements are considered to be a vital component of the program and represent the minimum number of supervised hours needed for the student to achieve competent professional skills. Accordingly it is expected that students attend all scheduled clinical placements. In the event of an absence through illness (or an exceptional personal circumstance) every effort should be made by the student to make up this missed clinic through arrangements with the Clinical Educator. II. Evaluation Do NOT write your responses on this sheet. Continue to fill in the accompanying red-on-white computer

form beginning with #27. Indicate the number which best corresponds to the student’s performance for the items below. If the item is not applicable, leave the line blank. DO NOT use 8, 9 or 10! Typically, the student’s performance on the midterm evaluation will be lower on the scale than for the final evaluation, indicating a growth in skills over the placement term. Much Poorer As Outstanding Poorer Than Expected Than Expected Expected Much poorer than expected: Does not perform skill, even with extensive direction and/or demonstration from

Clinical Educator. Poorer than expected: Performs adequately only with continued intervention from the Clinical Educator.

Generalization/consistency is poor. As expected: Performs adequately with some guidance and input from the Clinical Educator.

Generalization/consistency is adequate. Outstanding: Displays superior performance with minimal guidance and input from the Clinical

Educator. Generalization/ consistency is excellent.


A. Assessment

27. Clinician gathers appropriate information on client. 28. Clinician develops appropriate non-standardized assessment tasks and provides rationale for use.

29. Clinician devises and implements appropriate methods for evaluating results of non-standardized procedures. 30. Clinician uses standardized or appropriate techniques for tests or non-standardized procedures 31. Clinician prepares prior to administering diagnostic tests by being familiar with testing.

32. Prior to test, ensures assistive devices & hearing aids are functioning 33. Able to give instructions for testing 34. Clinician scores diagnostic tests accurately. 35. Clinician is able to make pertinent observations of a client's behaviour during assessment. 36. Clinician recognizes inconsistencies and evaluates results during testing.

37. Clinician interprets results of diagnostic testing accurately. 38. Clinician considers diagnostic testing along with other available information to form a clinical impression. 39. Clinician makes appropriate recommendations and/or referrals based on information obtained from assessment or

treatment. (assessment skills pertaining to audiology only) 40. Able to test puretone thresholds accurately

41. Able to test speech reception threshold and speech recognition accurately

42. Able to record speech reception threshold and speech recognition

43. Recognizes when to use masking: air

44. Recognizes when to use masking: bone

45. Recognizes when to use masking: speech

46. Able to interpret results of tympanometry

Check to be sure that the item number and the computer form number agree. 34 = 34

Much Poorer As Outstanding Poorer Than Expected Than Expected Expected

B. Reporting – Oral and Written 47. Clinician reports complete, pertinent, and accurate information. 48. Clinician is concise, clear and grammatically correct when reporting information.

49. Clinician includes interpretation of test results and observations.

50. Clinician conveys appropriate information to other professionals

51. Clinician develops appropriate therapy goals for the term, based on client’s needs and level of functioning 52. Clinician recommends appropriate approaches/procedures to achieve selected goals. 53. Clinician selects and creates appropriate stimulus materials (age and ability level of client) to achieve goals. 54. Clinician plans strategies for maintaining on-task behaviour (including structuring the therapy environment and setting

behavioural limits). C. Intervention 55. Clinician prepares therapy room appropriately for client and observer. 56. Clinician sequences and times activities within therapy sessions to facilitate client’s success . 57. Clinician gives clear, concise instructions in presenting materials and/or techniques in treatment. 58. Clinician utilizes planned therapy procedures and makes modifications in the intervention strategy such as shifting

materials and/or techniques when client is not understanding or performing the task. 59. Clinician uses feedback and/or reinforcement which is consistent, discriminating, and meaningful to the client. 60. Clinician ensures ongoing evaluation and outcome and records appropriately. 61. Clinician deals effectively with client’s inappropriate behaviours. 62. Clinician maintains on-task behaviour. 63. If mistakes are made in therapy, clinician is able to generate ideas of what might have improved the situation. 64. If mistakes are made in therapy, clinician is able to incorporate clinical educator’s suggestions in future sessions. 65. Clinician involves significant others (family, educators, etc.) in therapy process when appropriate. (Intervention skills pertaining to audiology only) 66. Performs troubleshooting of assistive devices & hearing aids

67. Understands use and care of hearing aid

D. Counselling and Interviewing 68. Clinician prepares for session when necessary by selecting appropriate information/questions. 69. Clinician conveys accurate and appropriate information with honesty and tact.

70. Clinician discriminates when to listen and when to talk

71. Recognizes need for further intervention. 72. .Clinician is ultimately successful in obtaining and giving all relevant information. (Counselling and Interviewing pertaining to audiology only) 73. Clinician demonstrates knowledge of different types and degrees of hearing loss F. Self-Evaluation and Problem Solving 74. Clinician objectively evaluates own clinical performance. 75. Clinician uses evaluation information to plan for next session. 76. Clinician discusses possible improvements for areas of weakness with clinical educator. 77. Clinician implements suggested improvements. 78. Clinician can identify professional development needs. III. Signatures A. Print the date of the evaluation conference on the computer form in the middle of side 2, where indicated. Then sign

your name in ink below on the line. Your signature must not extend beyond the line. Have each clinical educator do the same. Example: July 30, 1999 Janet Andersen Done

B. Have the student sign his/her name in ink on the computer form on the bottom of side 2.

Example: Emily Carrothers Done

IV. Summary Comments In addition to the objective evaluation you have just completed, comments must also be submitted to the Course Instructor/Coordinator of Clinical Education. The comprehensive comments form has been included in the essential documents package. In paragraph form, indicate the student’s strengths and areas for continued development. Please e-mail ([email protected]) or fax (416-978-1596) typed comments to the University. If you prefer, you may


Check to be sure that the item number and computer form number agree. 73 = 73


append a typed sheet with comments to the red-on-white evaluation form. Please sign the comments form in ink, if faxed or appended. Done V. Return Forms to the University Return the red-on-white computer form with the comprehensive comments sheet (e-mailed, faxed or appended) in the pre-addressed envelope you received in the essential documents package by the time specified in the confirmation letter. Please ensure that your signature appears on the sealed flap. If you have mislaid or already used the envelope the address should appear exactly as below.


Rehabilitation Sciences Building 160 - 500 University Avenue

Toronto, ON, M5G 1V7

to the attention of the: Administrative Assistant to Clinical Education and Academic Affairs

IT IS NOT NECESSARY TO RETURN THESE INSTRUCTIONS Done

Thank you!


EVALUATION OF PROFESSIONAL BEHAVIOUR – SPEECH-LANGUAGE PATHOLOGY

Instructions for the Clinical Educator:

THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING THE RED-ON-WHITE COMPUTER FORM.

Items 1 - 25 on the bubble sheet have been filled in for you.

Please complete item 26 and all subsequent evaluation items that are applicable. 26. Indicate the number of student absences. Fill in 10 if there were no absences.

1 2 3 4 5 6 7 8 9 0 II. Evaluation

The profession of speech-language pathology sets standards for the behaviour of its practising members. Each speech-language pathologist is expected to "act with integrity, accountability, and judgement in the best interests of the client, society, and the profession.1" Student speech-language pathologists at the University of Toronto are expected to conduct themselves in accordance with accepted standards of professional behaviour, such as those outlined in the Canon of Ethics of the Canadian Association of Speech-Language Pathologists and Audiologists. A student clinician must also adhere to the Code of Behaviour on Academic Matters and the Code of Student Conduct, as outlined in the Calendar of the School of Graduate Studies at the University of Toronto. Violation of the standards of conduct outlined in any of these documents will be sufficient cause for dismissal from the program.

Behaviour inconsistent with being a speech-language pathologist is viewed as a demonstration of lack of suitability for the profession and constitutes sufficient grounds for failure of a clinical practicum course and required withdrawal from the graduate program. The professional behaviour of student clinicians will be evaluated in three areas that are of paramount importance to the successful practice of speech-language pathology. These areas are Ethical Behaviour, Interpersonal Skills and Professional Qualities. 1 Canon of Ethics, Canadian Association of Speech-Language Pathologists and Audiologists. Do NOT write your responses on this sheet. Continue to fill in the accompanying red-on-white computer

form beginning with #27. Indicate the number which best corresponds to the student’s performance for the items below. If the item is not applicable, leave the line blank. DO NOT use 8, 9 or 10! Typically, the student’s performance on the midterm evaluation will be lower on the scale than for the final evaluation, indicating a growth in skills over the placement term.

Much Poorer As Outstanding Poorer Than Expected Than Expected Expected Much poorer than expected: Does not perform skill, even with extensive direction and/or demonstration

from Clinical Educator. Poorer than expected: Performs adequately only with continued intervention from the Clinical Educator.



Educator. Generalization/ consistency is excellent. A. Ethical Behaviour

27. Clinician displays ethical behaviour consistent with standards set by the profession of speech-language pathology

and the School of Graduate Studies at the University of Toronto. B. Interpersonal Skills 28. Clinician relates comfortably to client.

29. Clinician focuses on needs of client rather than on own concerns. 30. Clinician interacts in mature manner, displaying confidence. 31. Clinician assumes appropriate responsibility for initiating discussion in supervisory conferences. 32. Clinician reacts appropriately when conflicting information/viewpoints are presented by not being defensive.

33. Clinician reacts appropriately when conflicting information/viewpoints are presented and modifies teir original

position. 34. Clinician presents positive and enthusiastic attitude towards clinical and supervisory processes. 35. Clinician views practicum experience as an opportunity to learn.


36. Clinician demonstrates awareness of group dynamics and facilitates interaction among clients. 37. Clinician exercises self-control in emotionally charged situations. C. Professional Qualities 38. Clinician is reliable and accepts responsibility. 39. Clinician is punctual (written work, conferences, therapy sessions). 40. Clinician respects confidentiality. 41. Clinician uses socially acceptable voice, speech and language. 42. Clinician’s personal appearance is appropriate for clinical setting and maintaining credibility. 43. Clinician appears to recognize own professional limitations and stays within boundaries of training. 44. Clinician schedules clinical activities appropriately. 45. Clinician notifies clients/clinical educator/other professionals of schedule changes. 46. Clinician demonstrates respect for various cultural norms, value systems, ethics, and moral standards in interaction

with colleagues and clients. 47. Clinician works productively with colleagues and other helpers within the clinical setting. 48. Clinician displays concern for the needs of the clients and their families beyond those of a communication nature. 49. Clinician adheres to policies and procedures of clinical facility. III. Signatures A. Print the date of the evaluation conference on the computer form in the middle of side 2, where indicated. Then sign

your name in ink below on the line. Your signature must not extend beyond the line. Have each clinical educator do the same. Example: July 30, 2007 Janet Andersen

Done B. Have the student sign his/her name in ink on the computer form on the bottom of side 2.

Example: Emily Carrothers July 30, 2007 Done

IV. Summary Comments In addition to the objective evaluation you have just completed, comprehensive comments must also be submitted to the Course Instructor/Coordinator of Clinical Education. In paragraph form, indicate the student’s strengths and areas for continued development. Please e-mail ([email protected]) or fax (416-978-1596) typed comments to the University. If you prefer, you may append a typed sheet with comments to the red-on-white evaluation form. Please sign the comments form in ink, if faxed or appended.

Are you filling? in the appropriate circles completely?


III. Return Forms to the University Return the red-on-white computer form with the comprehensive comments sheet (e-mailed, faxed or appended) in the pre-addressed envelope you received in the essential documents package by the time specified in the confirmation letter. Please ensure that your signature appears on the sealed flap. If you have mislaid or already used the pre- addressed envelope the address should appear exactly as below.






Thank you!

UNIVERSITY OF TORONTO FACULTY OF MEDICINE Department of Speech-Language Pathology REHABILITATION SCIENCES BUILDING 160 - 500 University Avenue, Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596

EVALUATION OF CLINICAL SKILLS – SPEECH-LANGUAGE PATHOLOGY

Instructions for the Clinical Educator: THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING


Items 1 - 25 on the bubble sheet have been filled in for you. Please complete item 26 and all subsequent evaluation items that are applicable.

25. Indicate the number of student absences. Fill in 10 if there were NO absences.

1 2 3 4 5 6 7 8 9 0

Reminder: Clinical placements are considered to be a vital component of the program and represent the minimum number of supervised hours needed for the student to achieve competent professional skills. Accordingly it is expected that students attend all scheduled clinical placements. In the event of an absence through illness (or an exceptional personal circumstance) every effort should be made by the student to make up this missed clinic through arrangements with the Clinical Educator. II. Evaluation Do NOT write your responses on this sheet. Continue to fill in the accompanying red-on-white computer

form beginning with #27. Indicate the number which best corresponds to the student’s performance for the items below. If the item is not applicable, leave the line blank. DO NOT use 8, 9 or 10! Typically, the student’s performance on the midterm evaluation will be lower on the scale than for the final evaluation, indicating a growth in skills over the placement term. Much Poorer As Outstanding Poorer Than Expected Than Expected Expected Much poorer than expected: Does not perform skill, even with extensive direction and/or demonstration from

Clinical Educator. Poorer than expected: Performs adequately only with continued intervention from the Clinical Educator.



Educator. Generalization/ consistency is excellent.


A. Assessment

26. Clinician gathers appropriate information on client. 27. Clinician knows when to administer standardized and/or non-standardized assessments. 28. Clinician presents appropriate rationale for selection of standardized assessment procedures. 29. Clinician develops appropriate non-standardized assessment tasks and provides rationale for use. 30. Clinician devises and implements appropriate methods for evaluating results of non-standardized procedures. 31. Clinician uses standardized or appropriate techniques for tests or non-standardized procedures 32. Clinician prepares prior to administering diagnostic tests by being familiar with testing.

33. Prior to test, ensures assistive devices & hearing aids are functioning 34. Able to give instructions for testing 35. Clinician scores diagnostic tests accurately. 36. Clinician is able to make pertinent observations of a client's behaviour during assessment. 37. Clinician recognizes inconsistencies and evaluates results during testing.

38. Clinician interprets results of diagnostic testing accurately. 39. Clinician determines nature and extent of deficits within specific areas. 40. Clinician considers diagnostic testing along with other available information to form a clinical impression. 41. Clinician continues to assess client throughout the course of therapy using observational recording, standardized and

non-standardized measurement procedures and techniques. 42. Clinician makes appropriate recommendations and/or referrals based on information obtained from assessment or

treatment. (assessment skills pertaining to audiology only) 43. Able to test puretone thresholds accurately

44. Able to test speech reception threshold and speech recognition accurately

45. Able to record speech reception threshold and speech recognition

46. Recognizes when to use masking: air

47. Recognizes when to use masking: bone

48. Recognizes when to use masking: speech

49. Able to interpret results of tympanometry



B. Reporting – Oral and Written 50. Clinician reports complete, pertinent, and accurate information. 51. Clinician is concise, clear and grammatically correct when reporting information. 52. Clinician includes interpretation of test results and observations.

53. Clinician conveys appropriate information to other professionals

54. Meets deadlines for reports

C. Developing and Planning

55. Clinician applies academic information to the clinical process

56. Clinician develops appropriate therapy goals for the term, based on client’s needs and level of functioning 57. Clinician recommends appropriate approaches/procedures to achieve selected goals. 58. Clinician selects and creates appropriate stimulus materials (age and ability level of client) to achieve goals. 59. Clinician plans strategies for maintaining on-task behaviour (including structuring the therapy environment and setting

behavioural limits).

D. Intervention 60. Given the long term goals selected, clinician develops appropriate short term goals.

61. Clinician prepares therapy room appropriately for client and observer. 62. Clinician sequences and times activities within therapy sessions to facilitate client’s success . 63. Clinician gives clear, concise instructions in presenting materials and/or techniques in treatment. 64. Clinician modifies level of language according to needs of client and significant others. 65. Clinician utilizes planned therapy procedures and makes modifications in the intervention strategy such as shifting

materials and/or techniques when client is not understanding or performing the task. 66. Clinician uses feedback and/or reinforcement which is consistent, discriminating, and meaningful to the client. 67. Clinician ensures ongoing evaluation and outcome and records appropriately. 68. Clinician deals effectively with client’s inappropriate behaviours 69. Clinician maintains on-task behaviour. 70. If mistakes are made in therapy, clinician is able to generate ideas of what might have improved the situation. 71. If mistakes are made in therapy, clinician is able to incorporate clinical educator’s suggestions in future sessions.


Are you filling in the appropriate

circles completely?

72. Clinician involves significant others (family, educators, etc.) in therapy process when appropriate. (Intervention skills pertaining to audiology only) 73. Performs troubleshooting of assistive devices & hearing aids

74. Understands use and care of hearing aid

E. Counselling and Interviewing 75. Clinician determines when counselling/interviewing is required.

76. Clinician prepares for session when necessary by selecting appropriate information/questions. 77. Clinician conveys accurate and appropriate information with honesty and tact.

78. Clinician discriminates when to listen and when to talk

79. Recognizes need for further intervention.

80. Clinician is ultimately successful in obtaining and giving all relevant information.

81. Clinician reacts appropriately when conflicting information/viewpoints are presented by the client, by seeking

additional information

82. Clinician reacts appropriately when conflicting information/viewpoints are presented by not being defensive.

83. Clinician reacts appropriately when conflicting information/viewpoints are presented by maintaining original position when appropriate.

(Counselling and Interviewing pertaining to audiology only) 84. Clinician demonstrates knowledge of different types and degrees of hearing loss F. Self-Evaluation and Problem Solving 85. Clinician objectively evaluates own clinical performance. 86. Clinician uses evaluation information to plan for next session. 87. Clinician discusses possible improvements for areas of weakness with clinical educator. 88. Clinician implements suggested improvements. 89. Clinician can identify professional development needs.


Check to be sure that the item number and computer form number agree. 73 = 73


III. Signatures A. Print the date of the evaluation conference on the computer form in the middle of side 2, where indicated. Then sign

your name in ink below on the line. Your signature must not extend beyond the line. Have each clinical educator do the same. Example: July 30, 1999 Janet Andersen Done

B. Have the student sign his/her name in ink on the computer form on the bottom of side 2.

Example: Emily Carrothers Done

IV. Summary Comments In addition to the objective evaluation you have just completed, comments must also be submitted to the Course Instructor/Coordinator of Clinical Education. The comprehensive comments form has been included in the essential documents package. In paragraph form, indicate the student’s strengths and areas for continued development. Please e-mail ([email protected]) or fax 416-978-1596) typed comments to the University. If you prefer, you may append a typed sheet with comments to the red-on-white evaluation form. Please sign the comments form in ink, if faxed or appended. Done V. Return Forms to the University Return the red-on-white computer form with the comprehensive comments sheet (e-mailed, faxed or appended) in the pre-addressed envelope you received in the essential documents package by the time specified in the confirmation letter. Please ensure that your signature appears on the sealed flap. If you have mislaid or already used the preaddressed envelope, the address should appear exactly as below.






Thank you!


EVALUATION OF PROFESSIONAL BEHAVIOUR – SPEECH-LANGUAGE PATHOLOGY

Instructions for the Clinical Educator:

THANK YOU FOR NOT HOLE PUNCHING, STAPLING OR FOLDING THE RED-ON-WHITE COMPUTER FORM.

Items 1 - 25 on the bubble sheet have been filled in for you.

Please complete item 26 and all subsequent evaluation items that are applicable. 25. Indicate the number of student absences. Fill in 10 if there were no absences.

1 2 3 4 5 6 7 8 9 0 II. Evaluation

The profession of speech-language pathology sets standards for the behaviour of its practising members. Each speech-language pathologist is expected to "act with integrity, accountability, and judgement in the best interests of the client, society, and the profession.1" Student speech-language pathologists at the University of Toronto are expected to conduct themselves in accordance with accepted standards of professional behaviour, such as those outlined in the Canon of Ethics of the Canadian Association of Speech-Language Pathologists and Audiologists. A student clinician must also adhere to the Code of Behaviour on Academic Matters and the Code of Student Conduct, as outlined in the Calendar of the School of Graduate Studies at the University of Toronto. Violation of the standards of conduct outlined in any of these documents will be sufficient cause for dismissal from the program.

Behaviour inconsistent with being a speech-language pathologist is viewed as a demonstration of lack of suitability for the profession and constitutes sufficient grounds for failure of a clinical practicum course and required withdrawal from the graduate program. The professional behaviour of student clinicians will be evaluated in three areas that are of paramount importance to the successful practice of speech-language pathology. These areas are Ethical Behaviour, Interpersonal Skills and Professional Qualities. 1 Canon of Ethics, Canadian Association of Speech-Language Pathologists and Audiologists. Do NOT write your responses on this sheet. Continue to fill in the accompanying red-on-white computer

form beginning with #27. Indicate the number which best corresponds to the student’s performance for the items below. If the item is not applicable, leave the line blank. DO NOT use 8, 9 or 10! Typically, the student’s performance on the midterm evaluation will be lower on the scale than for the final evaluation, indicating a growth in skills over the placement term.

Much Poorer As Outstanding Poorer Than Expected Than Expected Expected Much poorer than expected: Does not perform skill, even with extensive direction and/or demonstration

from Clinical Educator. Poorer than expected: Performs adequately only with continued intervention from the Clinical Educator.



Educator. Generalization/ consistency is excellent. A. Ethical Behaviour

26. Clinician displays ethical behaviour consistent with standards set by the profession of speech-language pathology

and the School of Graduate Studies at the University of Toronto. B. Interpersonal Skills 27. Clinician relates comfortably to client.

28. Clinician focuses on needs of client rather than on own concerns. 29. Clinician interacts in mature manner, displaying confidence. 30. Clinician assumes appropriate responsibility for initiating discussion in supervisory conferences. 31. Responds to feedback in a mature fashion. 32. Clinician reacts appropriately when conflicting information/viewpoints are presented by clinical educator. 33. Clinician presents positive and enthusiastic attitude towards clinical and supervisory processes. 34. Clinician views practicum experience as an opportunity to learn.


35. Clinician demonstrates awareness of group dynamics and facilitates interaction among clients. 36. Clinician exercises self-control in emotionally charged situations. C. Professional Qualities 37. Clinician is reliable and accepts responsibility. 38. Clinician is punctual (written work, conferences, therapy sessions). 39. Clinician respects confidentiality. 40. Clinician uses socially acceptable voice, speech and language. 41. Clinician’s personal appearance is appropriate for clinical setting and maintaining credibility. 42. Clinician appears to recognize own professional limitations and stays within boundaries of training. 43. Clinician conveys information with honesty and tact. 44. Clinician schedules clinical activities appropriately. 45. Clinician notifies clients/clinical educator/other professionals of schedule changes. 46. Clinician demonstrates respect for various cultural norms, value systems, ethics, and moral standards in interaction

with colleagues and clients. 47. Clinician works productively with colleagues and other helpers within the clinical setting. 48. Clinician displays concern for the needs of the clients and their families beyond those of a communication nature. 49. Clinician adheres to policies and procedures of clinical facility.

Are you filling? in the appropriate circles completely?


III. Signatures A. Print the date of the evaluation conference on the computer form in the middle of side 2, where indicated. Then sign

your name in ink below on the line. Your signature must not extend beyond the line. Have each clinical educator do the same. Example: July 30, 2007 Janet Andersen

Done B. Have the student sign his/her name in ink on the computer form on the bottom of side 2.

Example: Emily Carrothers July 30, 2007 Done

IV. Summary Comments In addition to the objective evaluation you have just completed, comprehensive comments must also be submitted to the Course Instructor/Coordinator of Clinical Education. In paragraph form, indicate the student’s strengths and areas for continued development. Please e-mail ([email protected]) or fax (416-978-1596) typed comments to the University. If you prefer, you may append a typed sheet with comments to the red-on-white evaluation form. Please sign the comments form in ink, if faxed or appended. III. Return Forms to the University Return the red-on-white computer form with the comprehensive comments sheet (e-mailed, faxed or appended) in the pre-addressed envelope you received in the essential documents package by the time specified in the confirmation letter. Please ensure that your signature appears on the sealed flap. If you have mislaid or already used the envelope the address should appear exactly as below.






Thank you!


SUMMARY COMMENTS

STUDENT NAME:

COURSE NUMBER:

YEAR: Year I Year II UNIT NUMBER: CURRENT DATE:

_______________________

EVALUATION: Mid Term Final

Professional Skills

Clinical Skills

CLINICAL EDUCATOR NAME (S):

PLACEMENT SITE NAME:

CE PHONE NUMBER(S):

PLACEMENT DATES:

TO: FROM:

COMMENTS [Please print or type comments below. Use back of sheet to provide more detail if desired.]

______________________________ ____________________________________ Signature of Clinical Educator Signature of Student

Please turn over for additional writing space

Rev.2006

Appendix D ‐ Embedded Placement Activities Teaching Clinics Teaching Clinic Format Release of Video Recordings or Audio Recordings for Teaching Purposes Instructions for preparation of video tapes Developmental Observation Unit 3 and Unit 7 Assignment Developmental Observation Form-Child Developmental Observation Form- Adult Interprofessional Education Unit 7 Assignment

Activity 1 Activity 2 Activity 3 Completion Form

Research to Practice Unit 3 – Consumer Satisfaction Assignment

Information Letter for Students and Clinical Educators Agreement by the Clinical Educator Regarding Consumer Satisfaction Assignment Appendix Guidelines on which survey to choose Survey Package Appendix

Unit 7 – Treatment Outcomes Assignment

Neurogenic and Structural Disorders Internship: Information and Instructions for Students and Clinical Educators

Information Letter (adult) Information Letter (parent/guardian) Clinical Educator and Student Agreement/Consent Form ASHA NOMs Package


123

Small Group Teaching Clinic Ground Rules

1) Each demonstration clinician must bring the required videclip along with a brief case history of the client, including initials, age, “diagnosis”/strengths and areas for development and the goals/objectives focused upon to share with each member of the group.

2) Analysis and discussion throughout the teaching clinic must be directed to the

clinical behaviour of the demonstration clinician, not to that individual as a person.

3) Observer feedback must be specific and should have a rationale and some

evidence to support it.

4) All comments made during the teaching clinic remain in the room in which they are made.

5) Participants should ensure turn-taking among themselves.

6) The Group Monitor monitors the time for each section of the clinic.

7) The teaching clinic is not focused on evaluation (and will not be used to support

any evaluations), but on a positive learning environment which is supportive of skill development. As such, positive language is encouraged to set the tone and promote this rule.

Goals of the Small Group Teaching Clinics

1. Skill development in a positive learning environment through a structured,

collaborative group clinical education method.

2. Specifically, development of:

• Observational skills • Skills of balanced, constructive analysis of clinical behaviour, both of self and

of others • Skills in giving and receiving feedback • Problem-solving/clinical reasoning skills

3. Model the clinical education model utilized in placements

4. Develop confidence in clinical judgements

5. Increase knowledge beyond the student’s own clinical experience.

Roles

1. Clinical Educator Facilitator

• Monitors and encourages the Teaching Clinic ground rules • Guides participants to fulfill responsibilities • Stimulates discussion and interaction among the peers • Leadership role may be adopted by others as comfort and skill grow

2. Demonstration Clinician

• Brings videotape of session to Teaching Clinic for group observation and

discussion

3. Peers

• Observe videotape of session, collecting salient information and forming impressions

• Provides feedback to the demonstration clinician • Assist in problem-solving/clinical reasoning around strategies for future

sessions

4. Group Monitor

• Observes the group process and provides feedback on roles and responsibilities • Determines if ground rules are followed

Small Group Teaching Clinic Format Introduction/Review

• Review of last session, as appropriate, including sharing of outcomes of strategies

• Group monitor reviews ground rules with specific feedback, as required, from previous session

Focus/Planning

• Demonstration clinician presents brief case history, objectives/goals • Informative phase, therefore, not typically given feedback • Request by demonstration clinician of collection of specific types of information • CE Facilitator may help with the above

Observation

• Observe 2 – 3 minute videoclip • Tape can be stopped at any time to be reviewed or to ask questions

Problem-Solving/Strategy Development

• Self-analysis from demonstration clinician • Analysis of data collected, if any, from peers • Comment/feedback/viewpoints stated with rationale from peers • Balanced/constructive feedback given and rules of effective feedback followed • Problem-solve/clinically reason strategies for future clinical use • CE Facilitator guides and facilitates, doesn’t monopolize • Equal turn-taking expected among team members

Resolution

• Demonstration clinician and group determine which strategies she may wish to pursue (not coercive)

Integration/Review

• Group discusses what they’ve learned from the process • Group monitor reports on effectiveness of group interactions in terms of all

participants and observance of ground rules

The focus for this portion of the Teaching Clinic is on: * accurate observation * analysis * problem-solving/clinical reasoning skills in a group format to augment the individual clinical education you obtain with your clinical educator(s) in your placement. This is a structured method that allows you to critically examine clinical behaviour and to develop YOUR CLINICAL SKILLS and the process of clinical interaction. These may include: * planning skills * explanation/modelling/prompting/cueing of assessment/therapy procedures * arrangement and use of therapy materials/equipment * match of materials/procedures to age/interest/ability of client * judgement of adequacy of client's responses * type and schedule of reinforcement * provision of specific/accurate feedback to client * collecting accurate data during session * consideration of response rate * utilization of time * ability to make on-line modifications to meet client's needs * provision of appropriate home activities * goal selection * task selection * treatment strategies * content and manner of verbalizations * balance of client/clinician talking time * clinician's nonverbal behaviour * demonstration of empathy and respect * maintenance of client attention/interest * inclusion of client in planning/evaluation This allows you to further develop your self-evaluation skills and allows you to modify your behaviour.

REHABILITATION SCIENCES Department of Speech-Language Pathology FACULTY OF MEDICINE UNIVERSITY OF TORONTO #160-500 University Ave, Toronto, ON M5G 1V7 Phone: (416) 978-2770 Fax: (416) 978-1596

Release of Video Recordings or Audio Recordings for Teaching Purposes

Information Page

The Master of Health Science program in the Department of Speech-Language Pathology involves learning activities, which utilize video and audio recordings to promote student learning of clinical skills. Specifically these include:

1) Teaching Clinics

Recordings of the students’ interactions with clients offer invaluable opportunities for review, evaluation and feedback. The focus is on creating a positive learning environment through out the program with peers and course instructors using objective recordings to support clinical skill development. 2) Teaching Portfolio

Student must compile a portfolio of evidence to demonstrate her/his achievement of the curriculum objectives as a requisite of graduation. Video and audio recordings highlighting clinical skills from internships or assignments may be included as a form of evidence. The portfolio is assessed by faculty to determine entry-level competence to practice. 3) Clinical Portfolio The student may then choose to share portions of the above portfolio in job interviews and with her/his mentor from the College of Audiologists and Speech-Language Pathologists post-graduation, who will assist the new practitioner in the development of further clinical competency on the job.

4) Lectures

As part of various academic lectures, professors may include video and/or audio clips as illustrations of various clinical presentations of clientele and/or clinical skills and techniques used in client interactions.

REHABILITATION SCIENCES Department of Speech-Language Pathology FACULTY OF MEDICINE UNIVERSITY OF TORONTO #160-500 University Ave, Toronto, ON M5G 1V7 Phone: (416) 978-2770 Fax: (416) 978-1596

RELEASE OF VIDEO RECORDINGS OR AUDIO RECORDINGS FOR TEACHING PURPOSES

I have read the information page regarding the use of video and audio recordings and have been given a copy of the information page for my records. I have had the opportunity to ask any questions regarding it and have been given satisfactory answers.

I consent to the release of video recordings

audio recordings

of _________________________________________ to the University of Toronto, (Name of Client) Department of Speech-Language Pathology, for

Teaching Clinics – the student will share the recording(s) with other students /clinicians/faculty to promote student learning of clinical skills

Teaching Portfolio – the student will share the recording(s) with other students/clinicians/faculty to demonstrate evidence of achievement of curriculum objectives at the conclusion of the Masters program. Clinical Portfolio – the student will share the recording(s) in job interviews and with her/his mentor from the College of Audiologists and Speech-Language Pathologists’. Lectures – course instructors will play the recordings in their lectures as part of the program’s academic teaching.

For Teaching Clinics, Teaching Portfolios or Clinical Portfolios, it is understood by all parties that this recording will be maintained in the student’s possession in a secure location and erased or destroyed within one year post-graduation from the M.H.Sc. program at the University of Toronto, ______________________ 20_____ or alternatively until ______________________. Where the recording is being used for lecture purposes, the recording will be kept in an encrypted format in a secure location within the Department of Speech-Language Pathology or on a secure

A copy of this form is given to the client or client’s guardian or power of attorney, the placement site-coordinator, the Department of Speech-Language Pathology of the University of Toronto and the student, as involved. Should there be a breach in confidentiality of information, the client or client’s guardian or power of attorney will be notified of the breach and the circumstances of the breach and the appropriate and necessary actions.

server only accessible to authorized faculty of the Department of Speech-Language Pathology at the University of Toronto for an undefined period of time unless otherwise stated. It is understood by all parties that the student and the Department of Speech-Language Pathology will inform others that these recordings are confidential and will not be shared outside the situations as specified above. In situations where the client in the recordings is a registered client with a health care facility or provider, the practitioner providing the direct client care is the health care custodian of the client information being released for the above purposes. Any party in this agreement may revoke this authorization in writing at any time, except where action has been taken on this authorization. It is a condition precedent to this release that the student and the University honour the following wishes:

_______________________________________________________________________

_______________________________________________________________________ _______________________________________________________________________

The undersigned is the client referred to above; or if the client is at least 16 years of age, a person who is at least 16 years of age that the client has authorized in writing to act on his/her behalf; or if the client is less than 16 years of age, a parent of the child or a children's aid society or another person who is lawfully entitled to give consent in the place of the parent. Signature: ________________________________

Relationship to Client: ________________________________

Witnessed By: ________________________________

Date: ________________________________

Clinical Site: ________________________________

Clinical Educator: ________________________________

Signature of Clinical Educator: ________________________________

Unit/Course: ________________________________

Instructions for Teaching Clinic Videotape Preparation

Teaching Clinics are designed to prepare you for eventual independent reflective evidence-based practice. Use of video-recording is unparalleled as a tool for developing the related skills. Every effort must be made during your practicum to obtain video samples of your clinical practice for reflection together with peers (reminder: a consent form must be used). What’s the best way to get a video-recording? Do I have to tape the whole session? What if a client is reluctant? Should I show one clip or two?

Train the view of the camera on YOU. Where possible, also include the client so

that you may examine client reactions and responses. This is important of you want to examine clinical skills such as timing and type of reinforcement.

A client who is reluctant to be taped may be willing if left out of the visual field of

the recording. Ask. It’s ok if you tape yourself and not the client; In this case the client will be heard, but not seen. This works particularly well if you want to examine how you deliver instructions for a therapy task, explain about giving a test, etc.

It may not be necessary to videotape an entire session. Ask the client if it is ok if

you tape yourself explaining test results, or just one of the therapy tasks, for instance.

For your first teaching clinic, it’s best to show one clip for areas of strength and

another clip for areas for development. After that, it’s fine to use the same clip for both purposes.

What do I do if I cannot obtain consent for videotaping?

Notify the Coordinator of Clinical Education immediately, including an explanation of the reason as well as your alternate plan. You have several options:

o Obtain an audio-recording of your work with a client. Bring the materials

used during the taped session for the peer group to see. Perhaps take a picture of the room set-up to show the group.

o Video-tape a role-play. Ask your CE, a fellow student, or another friendly

volunteer to act as the client. Demonstrate giving a test, explaining and implementing a treatment task, explaining test results or a treatment plan, etc. Use a scenario similar to your placement experiences.

o Prepare a “script”. Give a sequential description with lots of details of how the

session went, perhaps in the form of a screenplay! Bring materials to show or demonstrate as part of your description. Please submit a copy of what you prepare to the group facilitator. Bring copies for your peers, as well.

Enjoy!

Teaching Clinics

1. Cameras 2. Portable DVD players 3. Teaching Clinic Days

Cameras Four cameras are available for sign-out. The cameras record in the following 8cm disc formats that allow the DVD’s to be played back on the new players directly: DVD-R This format will allow you to record onto a new disc without the need for formatting it. Before playing your disc using the portable player you will be required to finalize the disc. You will not be able to record on it again once it is finalized. DVD+RW This format requires you to format new discs before recording. Before playing your disc using the portable player you will be required to finalize the disc. You will be able to record again on the same disc once it has been unfinalized. DVD-RW (VF) This format requires you to format new discs before recording. Before playing your disc using the portable player you will be required to finalize the disc. You will be able to record again on the same disc once it has been unfinalized. If you will be recording using your own camera - please be sure it is in one of the above formats if you wish to bring in a disk only. The cameras also record in the DVD-RAM and DVD-RW(VR). These formats allow you edit your recordings however you will not be able to play the discs on the portable players. You can hook up the camera to the player for viewing. Individuals signing out cameras will be responsible for the replacement of any loss or damage to the camera and any of its accessories. All pick-up and drop off of cameras should be made in person when possible. If not the student will be responsible from the time the camera is left in a designated place for them to pick up; if the camera goes missing before it is picked it up the individual will still be held responsible. Portable DVD players The department has purchased ten portable DVD players. As mentioned above, the players are compatible with 8cm DVD-R, DVD+RW, and DVD-RW (VF) formats. The players are also able to play 12cm DVD’s as well. The players have A/V in capabilities also in order to play from other devices using the standard Red, Yellow and white video cables. If you are bringing in your own camera for input into the players, be sure to bring the proper cables.

Due to their compact size and portability, the DVD players will not be set up in the PBL rooms in the morning before the teaching clinics take place. One person from each group will be selected ahead of time and they will receive the DVD player directly from either the Business Manager or the Admin Assistant for Clinical Education. On the morning of the teaching clinics, the players will be available for pick-up outside the PBL rooms on the second floor. Once the teaching clinic is finished that person is responsible for packing it and its components and returning them to either the Business Manager or the Admin Assistant for Clinical education. The players must not be left in the rooms un-attended. The players are available for sign out but must remain in the building and must be returned in person to the Business Manager. Individuals signing out DVD players will be responsible for replacement in the case of any loss or damage to the camera and any of its accessories Teaching Clinic Days

Please read the following instructions carefully.

On the morning of the teaching clinics the 1st person on the group list will go to Room 1052 at 8:45 am to collect the DVD player and a box of markers from the Administrative Assistant to Clinical Education.

You will need to present your student card and to sign out the DVD player.

You will return the DVD player and the box with the markers and eraser to Room 1052 immediately after the teaching clinic morning (at 12:00 pm).

If the first person on the list is absent for whatever reason the second person on the list would pick up and return the DVD player.

This package is intended for student use in gathering observational information on children. Pages 1 and 2 should be completed for all observations and pages 3 to 6 should be completed as required. An appendix defining some of the terminology is included at the end of this package. An asterisk * indicates that key terms for this section are defined in the appendix.

SLP 1500Y Developmental Observation Form

Date: Clinician(s): Name of child/initials: Age: Situation: Group composition/size: Language requirements for situation (e.g. single word responses, discourse level): Interactive/Play requirements for situation (e.g. constructive/pretend play): Attention requirements for situation (e.g. length of time between turns, length of time per activity): Other relevant information:

REHABILITATION SCIENCES Department of Speech-Language Pathology CENTRE FOR FUNCTION AND WELL-BEING FACULTY OF MEDICINE UNIVERSITY OF TORONTO 500 University Avenue, #160 Toronto, Ontario, M5G 1V7 Phone: (416) 978-6882 Fax: (416) 978-1596 E-mail: [email protected]

Summary

Note the child’s strengths and areas requiring further development along the following dimensions:

Area Comments Age approp. (Y/N)

More info rq’d (Y/N)

Receptive Language

Expressive Language

Pragmatics

Speech Production (incl. oral motor and artic skills)

Voice/ Resonance

Fluency

Attention

Behaviour

Other (e.g. play skills, cognition, motor skills etc.)

What did the child understand ?(give examples) Complexity Level Examples Contextual cues available Prelinguistic/ Nonverbal

Single Words

Comments

Commands (1 step - multiple step)

Questions

Discourse/ Narrative

Other

How did the child play? * Type of play Examples Solitary

Parallel

Cooperative

What levels of play did the child exhibit? * Level of play ExamplesSensorimotor

Constructive

Symbolic

(*see Appendix)

How did the child communicate? (circle as many as apply) gestures

signs

Augmentative & Alternative Communication (AAC)

single sounds

consonant-vowel combinations

1 word phrases

2 words phrases

3 - 5 word phrases

sentences

discourse/ extended conversation

What sounds did the child produce? (circle sounds heard) manner

place

stop nasal fricative affricate liquid/glide

bilabial p /p/ b /b/ m /m/ w /w/

labio-dental f /f/ v /v/ l /l/

dental th // th /ð/

alveolar t /t/ d /d/ n /n/ s /s/ z /z/

palatal sh // zh

/�/

ch /t/

j /�/

y /j/

velar k /k/ g /g/ ng /ŋ/

other h /h/ r /r/

vowel sounds

consonant clusters

phonological processes present

For what purposes did the child communicate? * Purpose Nonverbal (e.g. crying, eye

contact, gestures) Verbal

Commenting

Social Routine (e.g. open and/or close social interactions, polite markers)

Calling attention (e.g. to self, others, objects, events)

Requesting (e.g. direct, indirect)

Obtaining information (e.g. questions)

Providing information/ explanations (e.g. responses to questions)

Regulating others (e.g. command, protest, gain assistance)

Describing a past event/ Retelling a story

Conversational Skills * Purpose Nonverbal Verbal Joint attention ( e.g. acts used to direct another’s attention to share focus)

Turn-Taking ( e.g. attending, waiting, responding, initiating)

Topic Manipulation/ Maintenance

Conversational Repair (e.g. requesting clarification, responding to requests for

clarification) How did the communication partner(s): Adults Peers Maintain attention

Monitor comprehension

Manage behaviour

Repair breakdowns in communication (e.g.cueing)

Provide feedback (e.g. use of reinforcement)

Facilitate interactions

What were effective strategies supporting the child’s communication?

Used by communication partner: Used by child: What ineffective strategies were used? By communication partner: By child:

Appendix Types of Play (page 3)

Symbolic Play Make believe or dramatic play in which child uses objects to stand for /represent an

absent object Constructive Play Systematic manipulation of materials to create a product (e.g. building a tower of blocks) Sensorimotor Play Rough and tumble play involving body movements (e.g. running, jumping, climbing,

balancing, filling and emptying) Adapted from summary by Wetherby, 2000

Types of Social Play (page 3)

Onlooker Watching, observing others but not participating Solitary Play Plays alongside other children with different toys Parallel Play Independent play beside other children, using similar toys Associative Play Child plays with other children in a common activity but each child acts on their own

interests Cooperative Play Child plays with other children, working towards a common goal Adapted from summary by Wetherby, 2000

Prelinguistic/ Nonverbal Comprehension Levels (page 3) Comprehension of nonverbal cues Use of other’s gestures, facial expression and directed eye gaze to

respond Comprehension of situational cues Use of immediate environment and knowledge of what to do with

objects to respond (e.g. cup with juice—drink) Comprehension of paralinguistic cues Use of intonation to determine response (e.g. loud voice means

“angry”) Adapted from summary by Wetherby, 2000 Communicative Intentions (page 5) Comment Intent is for no apparent interpersonal communication; not evoked by a question; not

directed to another person; no behaviour or reaction expected by the speaker. Examples: label, practice, self directing, repeat Social Routine Intent is to open, maintain, or close social interactions by using routine or stereotypical

expressions. Examples: open, close, politeness marker Call Attention Intent is to gain another’s attention, to call attention to next utterance, or direct attention

to another area. Examples: summon, to self, to object, to others, to event Request Object Intent is to obtain an object. Examples: direct, indirect

Regulate Others Intent is to control the listener’s behaviour. The focus of interest is an action (vs. an

object). Examples: command, protest, suggest, gain assistance, negotiate/collaborate, warn Obtain Information Intent is to obtain new knowledge from the listenter Examples: yes/no question, seek clarification, wh-question, seek confirmation Inform Others Intent is to provide information Examples: answer, describe, label, disagree, joke, justify Adapted from: Parks, G.R. (1987). A format for analyzing expressive language. The Clinical Connection, Winter 1987, 12-13. Conversational Skills (page 5) Skill Requirements Turn Taking attending to speaker, waiting for turn, responding, initiating Topic Manipulation/Maintenance initiating, adding information, responding, asking appropriate questions Conversational Repair requesting clarification, responding to requests for clarification Adapted from Brinton, B. & Fujiki, M. (1989). Converstational Management with Language Impaired Children: Pragmatic Assessment and Intervention, Rockville: Aspen

UNIVERSITY OF TORONTO, DEPARTMENT OF SPEECH-LANGUAGE PATHOLOGY GUIDED OBSERVATION FORM SLP 1520H Principles of Clinical Practice STUDENT: DATE OF VISIT: SITE: Name of Site_________________________________________________________

Name of Clinician Observed: ____________________________________________ CLIENT: Initials of Client Observed:_______________________________________________

Age of Client: ________

Reason for Referral: ___________________________________________________ 1. Brief description of disorder for which client was referred. 2. Type of session observed (i.e. assessment, therapy, interview/counselling, consultation). 3. Who participated in the session? 4. Set-up of room. 5. Materials/equipment used.

Guided Observation Form – SLP 1520H Principles of Clinical Practice Page 2

ASSESSMENT 1. What procedures were used (e.g. standardized tests, informal measures, observation of

parent-child interaction, etc.)? 2. What was the clinician's rationale for the selection of the evaluation procedures? 3. How did the clinician -

a) introduce or present the evaluation procedure?

b) elicit the response?

c) give reinforcement?

d) record the response/result? 4. How was attention maintained? 5. What behaviours did the clinician attempt to modify? Which strategies were used most/least

effectively? 6. How was verbal/non-verbal information given by the clinician to maximize understanding by

client? (discuss rate, pitch, placement of materials, etc.) 7. What strategies did the clinician use to elicit a representative sample of the client's

spontaneous speech? 8. What was the clinician's interpretation of the results? 9. Did the clinician and client discuss the results and recommendations? How did the clinician

present these? 10. How did the client respond to hearing the results of the assessment and the

recommendations? What questions or comments did she/he have?

Guided Observation Form – SLP 1520H Principles of Clinical Practice Page 3

TREATMENT 1. What were the long- and short-term goals for the client? What were the goals of this

session? Were the tasks designed to help the client achieve one major goal or several goals?

2. What were the therapy tasks? How did the clinician present the task(s)? What strategies

were used to help the client understand what was expected? How was verbal/non-verbal information given by clinician to maximize understanding by client (discuss rate, pitch, placement of materials, etc.)?

3. If this was a natural language stimulation activity, what did the clinician do to facilitate or

stimulate certain responses? 4. If this was a group session, how did the clinician facilitate interaction among clients? 5. What types of prompts or cues were used? How effective were they? 6. Discuss what the clinician did following the client's utterance or response. What types of

feedback were used? What effect did they have on the client's subsequent performance? 7. Was the clinician using any strategies to encourage self-evaluation? 8. How was reinforcement given? Did this change over the session? If so, how? 9. How well did the client perform? What could have contributed to this? What types of errors

were made? What changes were made to the task to increase/decrease success rate for the client (i.e. sub- and superstepping)?

10. Was the clinician keeping data on the client's performance? How was this done? 11. How long did each activity last? 12. How was attention maintained? 13. What behaviours did the clinician attempt to modify? Which strategies were used most/least

effectively? 14. Were home activities given for additional practice? If so, describe these. 15. Were the objectives of the session met? What indicators during this session would be

helpful in determining tasks/goals for future sessions?

Guided Observation Form - SLP 1520H Principles of Clinical Practice Page 4

INTERVIEW/COUNSELLING 1. How did the clinician begin the interview? 2. What information did the clinician gather? What did the clinician do to gather information?

What type of information did the clinician record and how was this done? 3. How did the client react to the questions asked? 4. What did the clinician do (verbally and nonverbally) to encourage the client to continue

talking? 5. If the client wandered off-topic, how did the clinician draw him/her back to the topic? 6. How did the clinician demonstrate empathy for the client? 7. If this was a counselling session dealing with the client's feelings about an issue, how did the

clinician respond to the client's statements? How did he/she handle sensitive issues? 8. Did the clinician provide information during the session? What strategies were used by the

clinician to make the information clear to the client (e.g. use of examples, simplified terminology, explanation of more difficult terminology)? How did the client respond to the information? Did the clinician check to see that the information was understood?

9. How did the clinician end the interview? Did she/he summarize information, discuss what

would happen next?

Guided Observation Form - SLP 1520H Principles of Clinical Practice Page 5 CONSULTATION (With Clients, Parents, Spouses, Teachers, etc.) 1. Briefly describe the information being presented. 2. Did the clinician demonstrate strategies, techniques, etc.? 3. Did the clinician solicit the client's or caregiver's input in selecting goals? 4. How did the clinician solicit opinions, feedback, information from the other participant in the

consultation? 5. How did the two participants collaborate? 6. How did the clinician determine what the other participant had understood? 7. How did the other participant respond to the information? 8. What action plan for follow up, if any, was developed?

Guided Observation Form - SLP 1520H Principles of Clinical Practice Page 6 CONCLUSION 1. List 3 things which surprised or interested you about this session. 2. List three things that you learned. 3. Do you have any questions which were unanswered or which you would like to discuss in

class? COMMENTS C:\slp1520\gobform.doc

Page 1 of 2 April 16, 2010

IPE Component in a Clinical Placement - Flexible Activity 1: Participation in Interprofessional Team Education

Description: In this experience, you (student) will have the opportunity to learn about, from and with colleagues (e.g. staff/students from other professions). Examples of educational sessions that may be appropriate include: interprofessional lunch and learn sessions, journal club discussions, patient/client team-based case discussions, and interprofessional grand rounds. Given the diversity of the sessions possible, the opportunities to address the objectives below may vary accordingly. An interprofessional team education session should include:

Involvement of 2 or more professions Significant interactivity between participants Opportunities to learn about, from and with one another Interprofessional teaching/learning moments are discussed/addressed

Learning Objectives:

• consider how to contribute to advancing effective interprofessional team function through a variety of strategies including, but not limited to:

o reflection o identification of factors that may contribute to or hinder team collaboration,

including power and hierarchy o assuming diverse roles in an interprofessional group and support others in their

roles • reflect on how to establish and maintain effective interprofessional working relationship

partnerships with others (e.g. team members) to support achievement of common goals Structure: A minimum of 1 hour participation in interprofessional (IP) team education is suggested in addition to written reflection and discussion (reflection could be with supervisor, or organization’s clinical IPE leader).You may wish to consider completing this activity near the beginning of the student placement to build on learning throughout.

Things to consider before you begin: • The pre and post-session questions on page 2 are a suggested guide and may be

modified. • This activity does not have to be completed in one day. • Review the learning objectives (above) interview and reflection questions (page 2) and

modify as appropriate. Discuss these with your supervisor, along with any potential challenges you see arising.

• Record your pre-session reflections (questions provided on page 2) and share these with your clinical supervisor.

• Ensure that the session leaders are in agreement with your (student’s) participation.


Pre Session Reflections It is recommended that students record for discussion with supervisor:

1. What is the purpose of the education session? 2. What do you hope to learn through participating in the education session:

o About the topic? o About the team/other team members?

Post Session Reflections: After completing this activity, consider the questions below in a written reflection (one page suggested).

1. Who was involved? (e.g. patient/client, team members, other health care staff, community members)

2. How was the patient/client’s voice/goals addressed? 3. What was the value for you in learning in a group with other professionals? What

were the benefits of and challenges to learning together in this experience? 4. How has this experience caused you to reflect on your professional role with

patient/clients and on teams? 5. In reflecting on this session, what do you think may enable additional

interprofessional education or learning about, from and with each other? 6. What have you learned about this experience? How will you apply what you learned

today in the future?

Debrief Clinician Instructions:

• Ensure that the student discusses their reflections, either with you, another health care provider, and/or the clinical IPE Leader in the organization.

• Consider what surprised you in reviewing the reflections, what resonated with you and how can you continue to guide and support this student’s reflections and interprofessional education.

***Please note that a Supervisor/Staff IPE Tip Sheet for clinicians is available.


IPE Component in a Clinical Placement: Flexible Activity 2: Interviewing/Shadowing a Team Member

Description: Through interviewing and shadowing, you (student) will have the opportunity to learn about, from and with other team members such as patients/clients, family members or other healthcare professionals. Learning Objectives:

• describe own role, responsibilities, values and scope of practice effectively to a patient/client and how other professions are involved in patient/client/family care

• establish an effective working relationship with a patient/client • based on patient/client/family needs, consider that preferred practice is interprofessional

collaboration • be prepared to explain the concept of a team • perform as an effective team member by:

- sharing information effectively - listening attentively - using understandable communications - reflecting on own learning needs in relation to team function - responding to feedback from others

Structure: Suggested time to complete this activity is 4 hours total with at least two team members in different roles (e.g. pharmacist, nurse, patient/client). The interviewing/shadowing may be completed individually or on a group basis (e.g. 3 students could interview and shadow an occupational therapist at the same time if appropriate). Things to consider before you begin:

• Ensure that confidentiality and consent are addressed. • The questions are a suggested guide and may be modified. • The order and timing of the activity can be adapted (e.g. shadow first & interview second;

interview 1hour & shadow 3 hours). • Review the learning objectives, interview questions and reflection questions; modify as

appropriate. Discuss this with your supervisor and any potential challenges that you see. • You may wish to conduct additional research on the professions you will be observing

(e.g. review the professional association websites) or the patient/client (e.g. review chart).

How do you select the team members?

• List all of the members on this team and reflect on your knowledge about their roles. • Discuss this list with your supervisor and together select at least 2 team members to

interview and shadow. • You may want to select the 2 that you know the least about or one you know the least

about and one with whom you will collaborate regularly. • The clinical supervisor/student should explain the purpose of the activity to the team

members and obtain consent. The supervisor must obtain consent from the patient/client. • Interviewing/shadowing a patient/client can be a very rewarding and interesting

experience as it will enable you to learn about their collaboration from their perspective.


Interviewing Experience (suggest 1 hour per team member) Suggested Questions - Health Care Professionals

A) Learning about you and your role: 1. How did you decide to enter your profession? 2. How would you describe your scope of practice and is this a typical role for your

profession? On this team, what does your assessment & intervention usually involve?

3. What are the biggest challenges in enacting your role? 4. I would like to practice explaining my role (student’s professional role) to other

team members. Please provide me with feedback on the following description of my role…

5. I am also learning how to describe other team members’ roles. Knowing what I now know, here is how I would describe your role. What feedback do you have for my description of your role?

B) Learning about collaboration on this team:

1. How and when do you assess, plan and provide intervention collaboratively with others on this team? (e.g. in what types of situations).

2. Who do you collaborate most closely with on this team? Why? Can you provide a specific example/patient/client story to illustrate?

3. How do you in your professional role usually interact with mine on this team? What goals might we share?

4. How do you contribute to effective decision making on this team? 5. How do you work to establish and maintain relationships on this team?

Suggested Questions - Patients/Family Members

A) Learning about you:

1. What brought you to this team? 2. What difficulties and changes have you noticed in yourself recently? 3. What strengths/resources do you use that help you? 4. What are your hopes and plans for the future? 5. Is there anything else you would like me to know about you?

B) Learning about collaboration on this team:

1. Please tell me about your involvement with this team. Who do you consider a part of your team here and outside of here? How would you describe your role as part of the team?

2. I am a student in ______________ (profession). Have you met an individual from my profession previously? What would you like to know about my profession?

3. Who on the team do you work with most closely? Can you provide a specific example?

4. How would you describe the teamwork here? (e.g. Does the work seem coordinated? Do the team members seem to be communicating well with each other?)


Shadowing Experience (suggest 1 hour per team member) Shadow health care professionals interacting with patients/clients/family members. For patient/client shadows, shadow the patient/client as he/she interacts with other team members.

1. How did the professional interact with the patient/client/family member? 2. How did the actual shadowing compare with your expectations and assumptions?

Reflection: After completing this activity, consider the questions below in a written reflection. (one page suggested).

1. What did you learn about the roles on this team that you did not know previously? 2. What are the similarities & differences between the roles (including yours)? 3. What else do you want to learn about the team and its members? What new learning

objectives have now emerged for you? 4. How was the patient’s voice/goals expressed? 5. How will this experience influence your role as a professional and team member?

Debrief Clinical supervisor Instructions:

• Ensure that the student discusses their reflections, either with you, another health care provider, and/or the clinical IPE Leader in the organization.

• Consider what surprised you in reviewing the reflections, what resonated with you and how can you can continue to guide and support this student’s reflections and interprofessional education.

***Please note that a Supervisor/Staff IPE Tip Sheet is available.


IPE Component in a Clinical Placement - Flexible Activity 3: Participation in Team Meetings

Description: In this experience, you (student) will participate in a minimum of 2 team meetings in which at least 2 team members are involved (ideally with the same team). Examples of team meetings include: patient/client rounds, discharge planning meetings, and patient/client/family meetings. Learning Objectives:

• develop awareness of and contribute to continual improvement of interprofessional team dynamics and group processes through effective interprofessional communication

• advance effective interprofessional team function through identification of factors that contribute to or hinder team collaboration and addressing conflict

• work collaboratively with others to assess, plan and/or provide intervention to optimize patient/client outcomes and quality of care

• perform as an effective team member by promoting effective decision making and displaying flexibility and adaptability

Structure: • Suggested time to complete this activity is 2 hours plus time for written reflection and

discussion with clinical supervisor; however, this may vary based on your setting.

Things to consider before you begin: • Review the objectives for this activity and add additional ones that may be important for

you. Share with your supervisor. • The clinical supervisor will select a minimum of 2 team interactions/meetings and ensure

that the team is clear about the purpose of this activity and your role.

Pre-Meeting Questions

• Consider the following and discuss with your supervisor: 1. What supports will you need to perform as an effective interprofessional team

member and how you should prepare for collaborating in team meetings? 2. What do you expect will happen through collaborating? (e.g. what type of

information do you expect you will receive, what information will they expect from you?)

3. What do you expect will happen when you participate in and observe the team meetings? (e.g. how will the team function, what will support the team to reach its goals)


Post-Meeting Reflection: After completing this activity, consider the questions below in a written reflection (one page suggested).

Description of Team Meetings: 1. Briefly describe the team experiences (why/what was the reason for the meeting,

what tasks were completed, were objectives for the meetings met, etc.) 2. Who was involved? (e.g. patient/client, team members, other health care staff,

community members). Who wasn’t there and how was information from that person/profession shared? (e.g. how was the patient’s voice expressed)

3. How did the team conduct the meetings? (Including what ‘group roles’ were evident such as chair, facilitator, mediator, clarifier, etc.) Describe how you think the team facilitated the need for all members to have opportunities for active participation.

4. Describe your role in the meetings as a team member. How did you display flexibility and adaptability? How did you promote effective decision making?

Reflections on Team Collaboration: 1. How would you describe the relationship (anticipated or actual) between how the

team functions in these meetings and the impact on patient/client care and team member satisfaction?

2. Describe the group process or how the team interacted. (For example, consider how team members behaved, communicated, solved problems, made decisions, provided and responded to feedback, addressed conflict, etc.)

3. What structures or supports impacted team collaboration? (e.g. attendance at meetings, having a clear and agreed upon meeting agenda, etc.)

4. What did you learn that you can apply to your own practice in your role? What learning will you take as a team member in the future?

Debriefing Supervisor Instructions: Review the student’s recorded reflections with the student. Consider what surprised you in reviewing the reflections, what resonated with you and how can you continue to guide and support this student’s reflections and interprofessional education. ***Please note that a Supervisor/Staff IPE Tips Sheet for clinicians is available.

IPE COMPONENT IN A CLINICAL PLACEMENT Site Completion Form

Student Information (Please print clearly) Name: _____________________________

Student Number: _____________________________

Program: _____________________________

Year of Program: _____________________________ Placement Information Site Name: _____________________________________________________

Clinical Educator/Preceptor: _______________________________ Type of IPE Component in a Clinical Placement (Please check all that apply)

Structured Model: Date Complete: Structured IPE Placement __________

(i.e., Weekly tutorial meetings with IP student teams & shared IPE student presentation)

Flexible Model: Date Complete: Flexible Activity 1: Participation in Interprofessional Team Education

__________

Flexible Activity 2: Interviewing / Shadowing a Team Member __________

Flexible Activity 3: Participation in a Team Meeting __________ I hereby certify that the above named University of Toronto student has completed the indicated activity(ies) related to the IPE Component in a Clinical Placement of the UT IPE Curriculum/Program.

Signature of Educator/ Signature of Student: Preceptor: ____________________ ____________________

Date: _________ Date: _________ IMPORTANT: Once complete, please return form to your program office.

Appendix E ‐ Hours Calculation Activities CASLPA Clinical Hours Requirements for CertificationSummary of Clinical Practice Hours (Unit tracking tables)


163

CASLPA CLINICAL HOURS REQUIREMENTS FOR CERTIFICATION

SPEECH-LANGUAGE PATHOLOGY

CLINICAL ACTIVITIES I. CLINICAL OBSERVATION

(No specific hours requirement) Observation is intended to serve as an important preparatory experience prior to direct clinical practicum experience in a specific clinical area. Observation forms part of a continuum moving from observation with no active involvement, to active or guided observation where the student clinician participates at some level, to shared supervised clinical activity, and finally to solo supervised clinical activity. Observation experiences should be provided by or under the direct supervision of a qualified audiologist of speech-language pathologist. The student clinician is an observer, not an active participant. Actual observations or videotapes may be used. While there is no specific clinical hours requirement for observation, it is strongly recommended that it be incorporated as part of the students’ clinical education experience.

II. CLINICAL EXPERIENCE

350 Clock Hours:

• Minimum of 300 clinical hours in Specific Client Services and Related Client Service.

• Maximum of 50 clinical hours in Clinical/Professional Activities. In the following, the “client” is identified as the individual presenting with a speech, language, and/or hearing disorder; “family member” is defined as any family member or care giver (e.g. parent, grandparent, child, sibling, spouse, legal guardian, foster parent, attendant, etc.). Student clinicians may obtain supervised clinical experience working on their own, or working with other professionals and/or student clinicians. Solo vs. shared participation is not distinguished in the accumulation of clock hours. However, it is assumed that the majority of clinical experiences are obtained by students working independently under supervision. A. CLIENT SPECIFIC SERVICES

a. Screening, Identification, Assessment b. Intervention, Therapy, Management c. Interviewing d. Counseling

“Client Specific Service” refers to clinical activities where the client or family member is present and the focus of the clinical activity. Screening should not comprise the majority of hours obtained in the area of evaluation.

B. CLIENT RELATED SERVICE

a. Case Conference, Rounds, Team Meetings b. Consultation with other professionals, support personnel c. Supervisor-Case Discussion

“Client Related Service” refers to clinical activities related to a specific client. The client or family is not necessarily present. Service involves face-to-face contact with those – other than family members – involved in a specific client’s care. Case conference, rounds, team meetings, and

CASLPA clinical hours requirements for certification – Speech-Language Pathology

Page 2 of 4

consultation refer to presentation or exchange of information related to a specific client in a one-to-one or group situation. Supervisor-case discussion refers to discussion between student clinician and clinical supervisor of clinical activities related to a specific client.

C. CLINICAL/PROFESSIONAL ACTIVITIES (Of the 350 total hours required, a maximum of 50

clinical hours may be in this area) a. Simulated Clinical Activities b. Promotion c. Presentations (e.g. Workshops, In-Service) d. Interprofessional Activities e. Program Development f. Planning/Analysis g. Other – e.g. special project approved by Clinical Education Coordinator

“Clinical/Professional Activities” includes activities that are clinically relevant and meaningful learning experiences, but not necessarily related to a specific client. “Promotion” and “Presentation” refer to those activities related to increasing awareness of and providing information about communication disorders and the professions. These activities are not directed toward specific clients. Clock hours include time spent in front of the group only, and do not include hours involved in preparation. “Interprofessional Activities” refer to time spent with allied professionals intended to increase the awareness of scope of practice of those individuals and enhance understanding of collegial relationships. “Program Development” and “Planning and Analysis” activities refer to complex activities and do not include general therapy preparation, materials development, or follow up.

Note:

Ancillary clinical activities, such as report writing, record keeping, materials development, and planning for sessions are not considered clock hours and may not be counted. It is acknowledged that these essential activities comprise an indirect component of specific client service. Time spent in supervisory conferences in which the supervisee’s clinical skill development is the focus of discussion is not counted.

SPEECH-LANGUAGE PATHOLOGY - CLINICAL AREAS LANGUAGE (70 Hours Minimum)

DEVELOPMENTAL (40 Hours Minimum) Delays or disorders in the areas of morpho-syntax, semantics, pragmatics and discourse in oral, graphic and/or manual modalities. Includes work with any individual who has a developmental language delay or disorder including the following special populations: Specific Language Impairment, Autism Spectrum Disorders, Cognitive Impairment, Hearing Impairment, Cerebral Palsy.

ACQUIRED (30 Hours Minimum) Neurogenic disorders of comprehension and/or expression in oral, graphic and/or manual modalities resulting from traumatic brain injury, cerebral vascular accident, neoplasm, dementia, or other progressive neurological conditions.

DYSPHAGIA (10 Hours Minimum) Disorders of swallowing and oral function for feeding.


Page 3 of 4

ARTICULATION/PHONOLOGY (20 Hours Minimum) Delays or disorders of speech sound production and/or phonological awareness. MOTOR SPEECH / FLUENCY/ VOICE/RESONANCE (40 Hours Minimum)

MOTOR SPEECH (10 Hours Minimum) Disorders of speech resulting from apraxia and dysarthria. Includes regular examination or oral peripheral structures for speech production. FLUENCY (10 Hours Minimum) Disordered repetition of speech sounds, syllables, words and/or phrases, problems with speech rate; problems with pacing/juncture between syllable/word boundaries. VOICE/RESONANCE (10 Hours Minimum) Abnormalities in vocal quality, pitch, loudness, and/or resonance resulting from neurologic, organic, functional, or hyperfunctional causes. Includes the production of voicing post-laryngectomy (e.g. use of electro larynx, T-E puncture, esophageal speech).

OTHER Includes clinical caseloads not included above (e.g. trach-ventilator dependent clients). Hours must be approved by Clinical Education Coordinator. It is recognized that work with a client may fall within more than one clinical disorder area. For example, when working with a client who requires the use of an AAC system, hours may be counted under the category of Developmental Language, or Acquired Language (depending on etiology) and may also fall under the category of Motor Speech. Hours should be divided between categories according to the amount of time spent on each. Questions about recording of hours with varied caseloads should be directed to the Academic Clinical Education Coordinator. MINOR AREA HOURS (20 Hours Minimum) Preamble: Requirements for minor area hours were reduced from 35 to 20 hours. The rationale for this was overwhelming agreement from all groups that these hours requirements be reduced. ASHA recently reduced minor area requirements to 20. The College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) currently requires 35 hours in the minor area. However, CASLPO has agreed to pursue an amendment to the legislation to reduce this requirement to 20 hours. Expectations for students gaining clinical experience in the minor area focus on gaining an overall understanding and appreciation of the minor area as opposed to developing independence in specific skills. This would include, for example, being able to interpret assessment results, knowing when to refer, understanding how to adjust communication for a client who has a communication disorder in the minor area of hearing, speech, or language. The majority of minor area hours should be supervised by a clinician certified in that area. Audiologists and Speech-Language Pathologists can supervise screenings related to the minor area (i.e. SLPs can supervise hearing screenings; Audiologists can supervise speech and language screenings). Certified


Page 4 of 4

Auditory-Verbal Therapists, and Auditory Oral Rehabilitation Specialists in the Province of Quebec may supervise minor area hours in the area of aural rehabilitation for both audiology and speech-language pathology students. OTHER DISTRIBUTIONAL CONSIDERATIONS The following tables present minimum requirements for distribution of clinical hours according to Client/Patient Age and Nature of Clinical Activity:

AGE

SLP AUDIOLOGY

CHILD 50 Hours 50 Hours

ADULT 50 Hours 50 Hours

CHILD: Refers to clients from 0-18 years (i.e. includes pre-school, school-age, and adolescent) ADULT: Refers to clients over 18 years (i.e. includes adult and geriatric populations)

ASSESSMENT / IDENTIFICATION

SLP AUDIOLOGY

TOTAL 100 Hours 100 Hours



TREATMENT / MANAGEMENT

SLP AUDIOLOGY

TOTAL 100 Hours 100 Hours



ASSESSMENT/IDENTIFICATION: Includes Screening, Interviewing, Counseling and all clinical activities described in CLIENT RELATED SERVICES regarding Assessment/Identification. TREATMENT/MANAGEMENT: Includes Counseling, Interviewing and all clinical activities described in CLIENT RELATED SERVICE regarding Treatment/Management. Note: The 350 hours of CLINICAL ACTIVITIES should contain the above distribution.

SPEECH-LANGUAGE PATHOLOGY

SUMMARY OF CLINICAL PRACTICE HOURS

TOTAL HOURS OF CLIENT RELATED ACTIVIVITIES (hours to be rounded up to nearest quarter hour)

STUDENT NAME:______________________________ SITE NAME:_______________________________ PLACEMENT DATES: _______________________UNIT:_____________

ASSESSMENT/ IDENTIFICATION (Ax)

TREATMENT/ MANAGEMENT (Tx)

Client Specific Services

Client Related Services

Client Specific Services

Client Related Services

Clinical/Professional Activities

Sub-Total Hours

Total All Age

Min. Req. Hours

AGE GROUP:

C = Child

A = Adult

C

LANGUAGE Developmental

A

40

C

LANGUAGE Acquired

A

30

C DYSPHAGIA

A

10

C

ARTICULATION/ PHONOLOGY

A

20

C MOTOR SPEECH

A

10

C FLUENCY

A

10

C VOICE/RESONANCE

A

10

40

C

OTHER – approval needed Clinical Education Coordinator

A

C AUDIOLOGY-MINOR

A

20

Ax Minimum Required Tx Minimum Required Maximum: 50 Hours

TOTAL HOURS

C/20

C/20

C

50

TOTAL HOURS

A/20

A/20

A

50

TOTAL CLIENT HOURS

ASSESSMENT HOURS (Min. Required = 100) :

TREATMENT HOURS (Min. Required = 100):

GRAND TOTAL:

350 2010

_______________________________________________ ____________________________________________________________ ________________________________

Signature (Student) Signature (Clinical Educator) Date

kristina

Typewritten Text

CLINICAL/ PROF HOURS:

Appendix F ‐ Health Forms Instruction Forms Year 1 Health Form Year 2 Health Form


171

REHABILITATION SCIENCES

INSTRUCTIONS ON COMPLETING HEALTH FORMS

Documentary proof of current immunization against specific diseases must be provided to the Clinical Education Office by Registration Day. Please read the below information and instructions on health form requirements and completion below. It is strongly recommended that you bring this information with you when visiting your physician. The Health Form is collected by the Departmental Office in order for the University to establish that each student has fulfilled the University’s requirements as well as the standards set forward by the Public Hospitals Act, Section 4.2, Ontario Regulation. The facilities rely on us to maintain these records and ensure student compliance with these standards. The forms are not collected for the purposes of storing for student use. Please remember to make a copy of your completed health form and supporting documentation BEFORE it is submitted to the Office, as you will be required to provide it to placement sites multiple times throughout the program. There is an administrative fee for obtaining a copy of the record once it has been submitted to the University1

.

Failure to fulfill any of the immunization requirements could result in the student being suspended from participating in clinical placements.

CONTACT INFORMATION Requirements: 1) All personal information (name, date of birth, telephone, etc.) requested on the form. SPECIAL CONSIDERATIONS Requirements: 1) A brief summary by the student of any difficulties (medical, psychological, learning) which may affect the student’s education in the program or in a fieldwork setting. This information will be kept strictly confidential by the Departmental Office and Student Services. The university may request further information from the student. MANTOUX TUBERCULIN TEST Requirements: 1) Date and result of step 1 of the two-step test. 2) Date and result of step 2 of the two-step test. A two-step Mantoux TB test within one year prior to registration is required. The date and result of both steps must be completed by the physician/nurse. A one-step Mantoux test within one year prior to registration is ONLY ACCEPTABLE IF a two-step test was done more than one year but within two years prior to registration. The date and result of both steps of the prior two-step test as well as the date and result of the one-step test must be completed by the physician/nurse. You must have the 2-step Mantoux regardless of your BCG vaccination history (unless you have previously documented positive TB skin test results). BCG vaccination is a very controversial subject. The effectiveness of BCG vaccination varies and any protective effects of BCG vaccination wear off with time. The use of BCG vaccination has not been in practice since the 1970’s in Canada. Section 4: CHEST X-RAY CHEST X-RAY

What is a Two-Step Mantoux Test? Some people with latent TB or past infection may have a negative reaction years after the infection. The initial skin test may stimulate or “boost” the body’s ability to react to tuberculin causing subsequent tests to be misinterpreted as a new infection. Two-step testing reduces the likelihood that a boosted reaction is later interpreted as a new infection.

Step 1: A standard dose of if tuberculin is injected into the skin. The result is read at your return to the doctor 48 – 72 hours later. If this first test is positive, a chest x-ray is required.

Step 2: If the first test is negative, a second test is performed 1 – 3 weeks after the first injection. The result is read at your return to the doctor 48 – 72 hours later. A positive second test indicates past TB infection and a chest x-ray is required.

10 mm or above in duration will be considered as positive.

Requirements: 3) Chest x-ray results if step 1 or 2 of two-step Mantoux test is positive. A chest x-ray is required (to determine whether the infection is active) only if there is a positive TB test result. The date and result of the chest x-ray must be completed by the physician/nurse. You cannot provide chest x-ray results as an alternative to TB skin test results. TB skin testing is used to detect latent TB infection, and the chest x-ray is effective in detecting active TB disease. Therefore, you should have the 2-step Mantoux, and if it is positive, provide the chest x-ray results. Students who test positive for latent or active infection must contact University of Toronto Health Services for counseling on treatment before they can continue classes. HEPATITIS B Requirements: 1) Date of injection 1 (MINIMUM requirement by registration) 2) Date of injection 2 (according to schedule) 3) Date of injection 3 (according to schedule) 4) Immunity test results (according to schedule) within 10 years of registration OR 1) Immunity test results within 10 years of registration if childhood records of vaccination are not available. The Hepatitis B vaccination and/or immunity test results within 10 years of registration are required. For students who have never received the full set of injections, at least the initial injection is required by registration, subsequent injections are required according to the vaccination schedule. The dates of each of the three injections of the vaccination and the results of the immunity test OR the results of the immunity test alone (only if primary vaccination dates are unavailable) must be completed by the physician/nurse. Students who are non-immune must be screened for surface antigen (HBsAg) to determine if the virus is present. If the HBsAg result is negative, the student must undergo re-vaccination. If the HBsAg result is positive, further testing for e-antigen (HBeAg) is required to determine if the virus is active and the student is infectious or a carrier of the virus. Students who are HBsAg or HBeAG positive must consult with the Fieldwork Coordinators to determine how their medical status will impact fieldwork placements. MEASLES, MUMPS, RUBELLA AND CHICKEN POX Requirements 1) Measles, Mumps, Rubella: Results of immunity test/titre 2) Chicken Pox: Results of immunity test or date of childhood infection OR 1) Dates of vaccination Vaccination against measles, mumps and rubella is required. The dates of vaccination (usually done during childhood) OR the titre results showing immunity must be completed by the physician/nurse. Vaccination or date of childhood infection for chicken pox is also required. The dates of vaccination or childhood infection OR the titre results showing immunity must be completed by the physician/nurse.

What is Involved in the Hepatitis B vaccination?

The Hepatitis B vaccination is a series of 3 injections as well as an antibody test to confirm immunity. In Canada, the vaccination is usually administered during childhood. The schedule for the 3 injections and immunity test is typically is as follows: 1st injection 2nd injection – 1 month after the 1st injection 3rd injection – 5 months after the 2nd injection Immunity test – 1 to 6 months after the 3rd injection

In the event that a student’s current physician does not have access to childhood records, results of a recent (within 10 years prior to registration) immunity test alone are acceptable. Students who were not vaccinated during childhood must have at least the initial injection by registration, and provide documentation to the fieldwork office from their physician/nurse according to the schedule above.

DIPHTHERIA / TETANUS AND POLIO Requirements 1) Date of last primary vaccination or last booster injection, within 10 years of registration. Vaccination against diphtheria, tetanus and polio is required. The date of the primary vaccination or the last booster injection, within ten years prior to registration, must be completed by the physician/nurse.

INFLUENZA RECORD The Influenza vaccine is recommended in both years of the program. The Influenza vaccine is mandatory at some institutions; therefore, if you do not receive the vaccination, you may be denied access to the clinical site. ACELLULAR PERTUSSIS REQUIREMENTS (A single dose of Acellular Pertussis in the form of a Tdap (Adacel vaccine) if not previously received as an adult or adolescent, in place of one Td booster.) INTERNATIONAL PLACEMENTS Rehabilitation Science Students undertaking International Clinical Placements will require additional assessment and a travel medicine consultation should take place at least eight weeks before the placement. Additional Immunizations may be necessary depending on the location of the placement.

Completed health form must be returned to the Departmental Clinical Education Assistant in person at 500 University Ave. or by mail to: Department of Occupational Science and Therapy, OR Department of Physical Therapy, OR Department of Speech-Language Pathology Rehabilitation Sciences Building University of Toronto 160 – 500 University Ave. Toronto, ON M5G 1V6

DEPARTMENT CONTACTS – for questions or additional information Occ. Sci. & Occ. Therapy [email protected] 416-978-8234 Physical Therapy [email protected] 416-946-3793 Speech-Language Pathology [email protected] 416-978-6882

Do I need to have a polio booster?

The primary series of vaccinations for Polio is usually administered during childhood. Among the general population in Canada, adults are not routinely given the booster shot. HOWEVER, during fieldwork placements students will be working in health care facilities which may put them at risk of coming into contact with patients who may be carrying the polio germ. For this reason, a booster shot is required within the last 10 years.

mailto:[email protected]�



Health Form 2010

REHABILITATION SCIENCES HEALTH FORM Year 1

Department: OSOT PT SLP

IMPORTANT NOTE: Please keep copies of this form once completed as you will be required to provide it to clinical facilities on request during clinical placements. Once submitted to the department, there is an administrative fee for copies of this record. This form and the immunization record on page 2 must be completed and submitted to the Departmental Office by Registration Day. Please see the attached “Instructions on Completing Health Forms” for detailed information on requirements. We encourage students to bring these instructions with them to their physician/nurse in case they require clarification. Students are required to be immunized against the diseases listed on page 2 of this form before they enter a clinical setting. These requirements must be fulfilled in order to meet the Health Standards set forth in the Public Hospitals Act, Section 4.2, Ontario Regulation 518/88. Contact Information: To be completed by the student: Name: Student Number:

Date of Birth: Year of Graduation:

Address: Telephone: Email Address:

Ontario Health Card Number: Out of Province Insurance (Name of Provider):

Next of Kin for Emergency: Relationship:

Address: Home Telephone: Home Email: Work Telephone: Work Email:

Special Considerations Are there any difficulties (physical, psychological, learning) which may affect your education as a Rehabilitation Science student in the classroom or the clinical education setting? Please describe so that we can work together to plan strategies to enhance your learning: Allergies Do you have any allergies? If yes, please list and state how they are managed.

I give my consent that the information on this form may be shared with university/hospital/teaching/administrative staff and clinical placement facilities upon request in appropriate cases. Date: Signature of Student

For inquiries, please contact: Occ. Sci. & Occ. Therapy [email protected] 416-978-8234 Physical Therapy [email protected] 416-946-3793 Speech-Language Pathology [email protected] 416-978-6882




Health Form 2010

REHABILITATION SCIENCES IMMUNIZATION RECORD Year 1

Department: OSOT PT SLP

NAME _________________________________________ DATE ___________________________ LAST FIRST TO THE PHYSICIAN: Students are required to be immunized against the following diseases before they enter the clinical setting. These requirements must be fulfilled in order to meet Health Standards set forth in the Public Hospitals Act, Section 4.2, Ontario Regulation 518/88. PLEASE COMPLETE ALL SECTIONS BEFORE RETURNING THE FORM: TUBERCULIN TEST: Incoming students in the first year of Test 1 Test 2 the program must have a two-step Mantoux skin test after June 1 and by Registration Day. Date: ___________ ____________ Result: ___________ ____________ CHEST X-RAY: Required within the current calendar year if new TB test result is positive. For students who have previously tested positive for TB, if your last skin test results were positive and the chest x-ray was normal, X-Ray Date: __________________ a note from your doctor stating such is required. Chest x-rays are not required with each subsequent TB test. Students who have a chest x-ray compatible with old or active Result: ___________________ TB, or are anti-Hbs negative after vaccination, must meet with the Director or Academic Coordinator of Clinical Education, before continuing in the program. Students who, after immunization, are anti-HBs negative will be counseled and tested for HB-Ag.

IMMUNIZATION Please check (). HEPATITIS B [ ] Immunization Date 1st ___________ 2nd ____________ 3rd____________ [ ] Screening [ ] Yes [ ] No Result _________________ [ ] Known History [ ] Yes [ ] No Date __________________ MEASLES [ ] Immunization Date _________________________________ [ ] Laboratory evidence of immunity Date _________________________________ [ ] No evidence of immunity Vaccination Date: _________________________________ MUMPS [ ] Immunization Date _________________________________ [ ] Laboratory evidence of immunity Date _________________________________ [ ] No evidence of immunity Vaccination Date: _________________________________ RUBELLA [ ] Immunization Date __________________________________ [ ] Laboratory evidence of immunity Date __________________________________ [ ] No evidence of immunity Vaccination Date: _ ________________________________ CHICKEN POX [ ] Known History [ ] Laboratory evidence of immunity Date __________________________________________ [ ] No evidence of immunity DIPHTHERIA/TETANUS Date of Most Recent Booster _______________________________ POLIO Date of Most Recent Booster _______________________________ DIPTHERIA / TETANUS AND POLIO BOOSTERS ARE REQUIRED EVERY TEN YEARS.

Health Form 2010

INFLUENZA RECORD The Influenza vaccine is recommended in both years of the program. The Influenza vaccine is mandatory at some institutions; therefore, if you do not receive the vaccination, you may be denied access to the clinical site. INFLUENZA VACCINE: (TYPE) Date:

ADMINISTERED BY: (print)

SIGNATURE:

ACELLULAR PERTUSSIS ACELLULAR PERTUSSIS: (A single dose of Acellular Pertussis in the form of a Tdap (Adacel vaccine) if not previously received as an adult or adolescent, in place of one Td booster.)

Date Received: I, ________________________________ (please print) certify that the above-named student has had the immunizations noted above. Date: __________________________ Signature: ____________________________________, M.D Address: ______________________________________________________________________________ Phone: _________________________ Fax: _____________________ Email: Please SCAN and KEEP A COPY of this form and return the original to the Clinical Education Assistant Office when you have received a flu shot, with the vaccination certificate attached. (This form can be signed in lieu of a certificate if there is none available where the shot is administered.)

FOR OFFICE USE ONLY

Date of Review __________________________ Signature ______________________________

179

REHABILITATION SCIENCES HEALTH FORM Year 2

Department: OS&OT PT SLP

IMPORTANT NOTE: Please keep copies of this form once completed as you will be required to provide it to clinical facilities on request during clinical placements. Once submitted to the department, there is an administrative fee for copies of this record. This form and the immunization record on page 2 must be completed and submitted to the Departmental Office by Registration Day. Please see the attached “Instructions on Completing Health Forms” for detailed information on requirements. We encourage students to bring these instructions with them to their physician/nurse in case they require clarification. Students are required to be immunized against the diseases listed on page 2 of this form before they enter a clinical setting. These requirements must be fulfilled in order to meet the Health Standards set forth in the Public Hospitals Act, Section 4.2, Ontario Regulation 518/88. Contact Information: To be completed by the student: Name: Student Number:

Date of Birth: Year of Graduation:

Address: Telephone: Email Address:

Ontario Health Card Number: Out of Province Insurance (Name of Provider):

Next of Kin for Emergency: Relationship:

Address: Home Telephone: Home Email: Work Telephone: Work Email:

Special Considerations Are there any difficulties (physical, psychological, learning) which may affect your education as a Rehabilitation Science student in the classroom or the clinical education setting? Please describe so that we can work together to plan strategies to enhance your learning: Allergies Do you have any allergies? If yes, please list and state how they are managed.

I give my consent that the information on this form may be shared with university/hospital/teaching/administrative staff and clinical placement facilities upon request in appropriate cases. Date: Signature of Student

For inquiries, please contact: Occ. Sci. & Occ. Therapy [email protected] 416-978-8234 Physical Therapy [email protected] 416-946-3793 Speech-Language Pathology [email protected] 416-978-6882




REHABILITATION SCIENCES IMMUNIZATION RECORD Year 2

Department: OS&OT PT SLP

NAME _________________________________________ DATE ___________________________ LAST FIRST TO THE PHYSICIAN: Returning Year 2 students must have a standard one-step Mantoux skin test after June 1 and by Registration Day. These requirements must be fulfilled in order to meet Health Standards set forth in the Public Hospitals Act, Section 4.2, Ontario Regulation 518/88. TUBERCULIN TEST: One-step Mantoux Test Date:_____________________ Result:____________________ CHEST X-RAY: Required within the current calendar year if new TB test result is positive. For students who have previously tested positive for TB, if your last skin test results were positive and the chest x-ray was normal, X-Ray Date: __________________ a note from your doctor stating such is required. Chest x-rays are not required with each subsequent TB test. Students who have a chest x-ray compatible with old or active Result: ___________________ TB, or are anti-Hbs negative after vaccination, must meet with the Director or Academic Coordinator of Clinical Education, before continuing in the program. Students who, after immunization, are anti-HBs negative will be counseled and tested for HBs-Ag. Form completed by (please print) : _______________________________________________ Date: __________________________ Signature: ____________________________________, M.D Address: ______________________________________________________________________________ Phone: _________________________ Fax: _____________________ Email: TO THE STUDENT: SCAN and KEEP A COPY of this form; Submit original to the Fieldwork/ Clinical Education Assistant Office upon completion. INFLUENZA RECORD The Influenza vaccine is recommended in both years of the program. The Influenza vaccine is mandatory at some institutions; therefore, if you do not receive the vaccination, you may be denied access to the clinical site. INFLUENZA VACCINE: (TYPE) Date:

ADMINISTERED BY: (print)

SIGNATURE:

TO THE STUDENT: Once vaccination is completed, please submit a vaccination certificate attached to a copy of this form. This form can be signed in lieu of a certificate if there is none available where the shot is administered. Reminder: SCAN and KEEP A COPY of this form and return the form with original signature to the Fieldwork/Clinical Education Assistant Office

FOR OFFICE USE ONLY

Date of Review __________________________ Signature __________________________________

Appendix G ‐ Student Support Services Partial Funding Reimbursement Forms

UNIVERSITY OF TORONTOEXPENSE REPORT / ACCOUNTABLE ADVANCE SETTLEMENT (Revised 9-July-2010) ACCOUNTING INFORMATION

To be completed by Claimant TO BE COMPLETED BY BUSINESS OFFICER

Purpose: Business Area:Personnel Number Period of Note: Enter purpose code

Travel 1. To request reimbursement in other than in empty slot inLast Name Initial Canadian funds, indicate currency and do not account number. 0 EMPLOYEE FIELD TRIP Company Code:

convert expenses to Canadian funds. If purpose is other 1 EMPLOYEE CONFERENCE

Address Canadian Funds than those listed 2 STUDENT FIELD TRIP

U.S. Funds below, please 3 STUDENT CONFERENCE Document Number:

Other ________________________ enter the applicable 4 VISITOR

Location and Description: 2. Original receipts are required. account number.

COST INTERNAL COMMITMENT

CTR ORDER FUND C/F CTR ITEM

AIRFARE: Travel within Canada 8 4 0 1 0 ERDepartment Contact Travel to USA from Ontario 8 4 0 1 0 EE

All other Airfare 8 4 0 1 0 E0Department ACCOM.: In Ontario 8 4 0 2 0 ER

In Other Provinces 8 4 0 2 0 EETelephone Fax OUTSIDE CANADA 8 4 0 2 0 E0

ALLOWANCE: Per Diem: in Canada 8 4 0 3 0 EAPer Diem: International 8 4 0 3 0 E0

Date Prepared KMS X 47 cents/km 8 4 0 4 0 EARAIL/BUS: Travel within Canada 8 4 0 5 0 ER

I have read the University's regulation on reimbursements Travel outside Canada 8 4 0 5 0 E0of expenses and confirm that I am in compliance. CAR RENTAL: In Ontario 8 4 0 6 0 ERSignature of Claimant: In Other Provinces 8 4 0 6 0 EE

OUTSIDE CANADA 8 4 0 6 0 E0MEALS: In Ontario 8 4 0 7 0 ER

In Other Provinces 8 4 0 7 0 EEPrint Name Title OUTSIDE CANADA 8 4 0 7 0 E0

Authorized Approval: TAXI: In Ontario 8 4 5 0 0 0 ERIn Other Provinces 8 4 5 0 0 0 EEOUTSIDE CANADA 8 4 5 0 0 0 E0

OTHER:

Print Name Title

Copies for Accountable Advance Settlements:Financial Services (1)Originating Department (1)

TOTAL EXPENSES - LESS: ACCOUNTABLE ADVANCE

REIMBURSEMENT REQUIRED

OR REPAYMENT -$

ACCOUNT NUMBER

FUNDS MANAGEMENT

TAX CODEEXPENSE CATEGORIES AMOUNT

GENERAL LEDGER COST CTR ACCTG

or

kristina

Typewritten Text

to clear this form go to Form and choose clear form

TRAVEL JOURNAL To be submitted when requesting consideration for travel reimbursement

Date of Travel Departure (home, site, school…) Destination Mileage in Kilometers

Date of Travel Departure (home, site, school…) Destination Mileage in Kilometers

Appendix H ‐ Insurance Declaration forms Declaration of Understanding - WSIB Declaration of Understanding – Private Insurance Declaration of Understanding - Student In the event of an injury Letter of Authorization to Represent Employer U of T accident report ACE INA accident report

FACULTY OF MEDICINE Rehabilitation Sciences Building, 160-500 University Ave., Toronto, ON, M5G 1V7 Canada

Tel: +1 416 978-6882 Fax: +1 416 978-1596 www.slp.utoronto.ca

Letter to Placement Employers – clinical sites with WSIB coverage

Pilot Project Process for workplace Safety and Insurance Board coverage:

The University of Toronto health science program is collaborating with the Ministry of Training, Colleges and Universities (MTCU) to pilot a new streamlined process for students registered in school sanctioned unpaid clinical placements.

The process during the pilot project links student WSIB coverage with current registration in health science programs participating in the pilot project.

The requirement to complete the MTCU Work/Education Placement Agreement/Post Secondary form for each student placement is waived.

In the event of a workplace injury or disease, the WSIB Form 7 Employer’s Report of Injury/Disease and the MTCU Letter of Authorization to Represent Placement Employer is completed by the Training Agency (University of Toronto) and submitted to WSIB within 3 business days.

Declaration

By signature of an authorized representative here under we confirm our commitment to immediately report any workplace injuries or disease to the student’s college or university.

Signature: __________________________ Title: __________________________

Organization: ________________________ Date: __________________________

Distribution

A copy with the original signature is to be returned to the University of Toronto Department of Speech-Language Pathology and a copy is to be kept by the placement employer.

FACULTY OF MEDICINE Rehabilitation Sciences Building, 160-500 University Ave., Toronto, ON, M5G 1V7 Canada

Tel: +1 416 978-6882 Fax: +1 416 978-1596 www.slp.utoronto.ca

Letter to Placement Employers – clinical sites without WSIB coverage

Pilot Project Process for workplace safety private insurance coverage:

The University of Toronto health science program is collaborating with the Ministry of Training, College and Universities (MTCU) to pilot a new streamlined process for students registered in school sanctioned unpaid clinical placements.

The process during the pilot project links student private insurance coverage with current registration in health science programs participating in the pilot project.

The requirement to complete the MTCU Work/Education Placement Agreement/Post Secondary form for each student placement is waived. Training Agencies are required to complete the private insurance statistics form at the beginning of the year.

In the event of a workplace injury or disease, the placement employer must immediately submit the Ace INA Accident Medical Claim Form to the Training Agency. The Training Agency is then required to review and submit the Accident Medical Claim Form within 30 days from the date of the injury or disease.

Declaration

By signature of an authorized representative here under we confirm our commitment to report any workplace injuries or disease to the student’s college or university.

Signature: _________________________________ Title: __________________________

Organization: _______________________________ Date: __________________________

Distribution

A copy with the original signature is to be returned to the University of Toronto, Department of Speech-Language Pathology and a copy is to be kept by the placement employer.

Student Declaration of Understanding

Workplace Safety and Insurance Board or Private Insurance Coverage

Unpaid Student Trainees in Clinical Placements

Student coverage while on placement

Students of health sciences programs as identified by their university or college are eligible for Workplace Safety Insurance Board (WSIB) coverage of claims while on unpaid placements as required by their program of study. Private insurance will be provided should the unpaid placement required by their program of study take place with an employer who is not covered by WSIB.

Ministry of Training, Colleges and Universities ensures that students on work placements receive WSIB for placement employers who have WSIB coverage and private insurance for employers who are not covered by WSIB for injuries or disease incurred while fulfilling the requirements of their placement.

Declaration

I have read and understand that WSIB or private insurance coverage will be provided through the Ministry of Training, Colleges and Universities while I am on training placements as arranged by the university or college as a requirement of my program of study.

I understand the implications and have had any questions answered to my satisfaction.

I agree to immediately report any placement related injury or disease to the placement employer.

Release of Information

I understand that my personal information will be released to the placement employer in the event of a workplace injury or disease at the placement employer’s workplace during an unpaid placement.

I understand that the Ministry of Training, Colleges and Universities, the college or university and placement employer will be required to release relevant personal information with each other and to the WSIB or a private insurance company.

Student name (print):________________________ Student signature: _________________

Program/School: Department of Speech-Language Pathology, U of T Date: _____________

Ministry of Training, Colleges and Universities

Ministère de la Formation et des Collèges et Universités

Mowat Block 900 Bay St. Toronto ON M7A 1L2

édifice Mowat 900, rue Bay Toronto ON M7A 1L2

Letter of Authorization to Represent Employer

This section to be completed by Training Agency Please be advised that the following Training Agency will serve as the Employer’s representative in matters pertaining to WSIB in this work related injury. Training Agency __________________________________________________ Address _________________________________________________________ City, Province ____________________________________________________ Postal Code __________________ Firm # _____________________________ Contact Person ______________________ Telephone # __________________ This section to be completed by Placement Employer _______________________________, unpaid training participant is claiming that he/she (Training Participant’s Name) suffered a work related injury on _____________ while on work placement with our (Date) company. Company Name _________________________________________________ Address ________________________________________________________ City, Province ___________________________________________________ Postal Code ___________________ Firm # ___________________________ Contact Person __________________ Telephone Number ________________ _____________________________________ _______________________ Placement Employer’s Authorization Signature Date To be attached to Form 7 and sent to WSIB.

UNIVERSITY OF TORONTO

Students on Unpaid Work Placements Accident Report Submit completed form within 24 hours to: Health & Well-Being Programs & Services Fax: 416/971.3052 A Accident Type: ο No Injury ο First Aid ο Health Care ο Lost Time ο Critical Injury ο Occupational Disease B Student (Training Participant) Injured: Last Name: First Name: Sex: M or F Home Address: Postal Code: DOB: (dmy): Social Insurance Number: Placement start date: (dmy) Home Phone: Program enrolled in: Depart/Faculty/Address: C Reporting: Date and time of injury: (dmy) Date reported: (dmy) To whom was injury reported: (name/title) If injury not reported immediately – state reason: Was medical attention sought? ο Yes ο No If yes provide name/address of attending physician D Accident/Occupational Disease Details – State exactly (continue on back or attach letter if required) 1. What happened to cause the injury? 2. Explain what the training participant was doing and the effort involved? 3. Describe the injury, part of body involved and specify left or right side. 4. Identify the size, weight, and type of equipment or materials involved. 5. Where did the accident occur? (location, building, room #) 6. What conditions attributed to the accident and what steps have been taken to prevent recurrence? 7. Name and work address of any witnesses who were aware of the accident. E Please answer all questions – Explain yes answers on back 1. Did the accident occur outside of Ontario? If yes, state where. ο Yes ο No 2. Was anyone not in the University’s employ responsible? ο Yes ο No 3. Do you have any reason to doubt the history of the injury? ο Yes ο No 4. Was employee doing work other than for the university? ο Yes ο No 5. Was there serious and wilful misconduct involved? ο Yes ο No 6. Do you know if employee had a similar previous disability? ο Yes ο No F Complete if any Lost Time from Work Date and time last worked: (dmy) Date returned: (dmy) G To be Signed by Placement Employer Name and address of placement employer: Completed by: (please print) Signature: Date: Phone:

ACE INA Insurance130 King Street West

12th FloorToronto, Ontario

M5X 1A6

SGC 102845

Accident ReportStatement of Work Placement Employer and Training Agency

Name of Work Placement Employer

Name of Training Participant

Date Work Commenced 20

Is the Training Participant covered by the Workplace Safety Insurance Board Coverage? Yes No

Date last worked 20

Reason Training Participant ceased work

Description of accident:

Witness to accident:

If Training Participant has returned to work, give date of return 20

Describe exact duties of Training Participant prior to the date of accident or attach copy of job description

If Training Participant has returned to work, have you modified the duties due to the accident? Yes NoIf “Yes”, please describe

Date 20

Name of Work Placement Employer’s Authorized Representative Signature(Please print)

Name of Training Agency’s Authorized Representative Signature(Please Print)

By

By