Doctor of Physical Therapy Program Clinical Experience Manual Chatham University does not discriminate on the basis of sex, race, national origin, color, age, sexual orientation or handicap status in its educational programs and policies, co-curricular activities, scholarships and loan programs, and employment practices. Chatham University's Doctor of Physical Therapy degree program is accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association.
Table of Contents I. Doctor of Physical Therapy Program...1 Mission 1 Vision..1 Curricular Philosophy. 1 Program Goals 1 II. Physical Therapy Education & Outcomes.. 2 A. Sample Program of Study. 2 B. Explanation of Problem-Based Learning Model... 3 C. Technical Standards of a Physical Therapy Student. 4 D. Professional Behaviors Continuum.. 6 E. Physical Therapy Program Outcomes...8 III. Physical Therapy Clinical Experience 12 A. Philosophy 12 B. Learning Experience 12 C. Course Descriptions and Objectives. 14 PTH 730 (I-A) & 731(I-B): Clinical Experience I 14 PTH 733: Clinical Experience II. 14 PTH 735: Clinical Experience III... 14 PTH 746: Clinical Experience IV...14 PTH 747: Clinical Experience V. 14 Objectives. 15 D. Guidelines for Educational Presentations. 23 Guidelines for Evidence-Based Content In-Service. 23 Guidelines for Evidence-Based Case Presentation 23 Guidelines for Peer-Reviewed Journal Critique 23 E. Guidelines for Journal...23 IV. Health Policies. 24 Risks...24 Medical Insurance...24 Pre-Clinical Requirements...24 Infection Control...24 Pregnancy......25 Drug Screen Policy...25 Positive UDS Policy....26 V. Clinical Experience Policies and Procedures...27 A. Organizational Structure for Clinical Education Policies and Procedures...27 Confidentiality/Written Permission/Patient Right to Refuse...27 B. Selection of Clinical Sites...27 Student Selection...28 Clinical Site Commitments....28 Contract Policies....28 Complaints Received......28 C. Travel/Living Expenses....29 D. Work Schedule...29 E. Name Tag Use....29 i
F. Absence from Clinical Experience.....29 Student......29 CCCE/CI....29 Return to Clinical Area after Extended Absence....29 Continued Participation in the Clinical Area...29 Readmission to the Clinical Area..30 G. Clinical Education Meetings....30 H. Dress Code....30 I. Cell Phone Policy....30 J. Professional Liability Insurance...30 K. ADA....30 L. Failure of Clinical Experience...31 CCCE/Clinical Instructor s Responsibilities....31 Student Responsibilities....31 University Responsibilities....32 M. Criminal Record Check/Child Abuse Clearance...32 N. Evaluations and Requirements..32 Physical Therapist Clinical Performance Instrument (CPI)...32 Specific Performance Expectation for the Clinical Experience 33 Significant Concerns and Critical Incidents.33 Mid-Term Student Evaluation of a Clinical Experience...33 Physical Therapist Student Evaluation: Clinical Experience and Clinical Instruction..33 Grade Assignment....33 O. Procedure for Analyzing, Resolving, and Documenting Problems during CE..33 P. Honor Code.......34 VI. VII. Resources for Clinical Experience Development and Enhancement...35 Giving and Receiving Feedback...35 Role of the Clinical Instructor...35 Clinical Instructor Privileges......36 Helpful Hints for Clinical Instructor...36 Student Responsibilities...37 Professional Behavior...37 Orientation...37 The Learning Process...37 Helpful Hints for Students...38 Bibliography...39 ii
I. Doctor of Physical Therapy Program Mission: The Chatham University Physical Therapy Program educates Doctors of Physical Therapy who will advance the quality of human life through excellence in clinical practice. The Program prepares professionals to meet the challenges of a dynamic health care environment and supports faculty scholarship that bridges science and practice. Vision: As collaborative leaders in optimizing movement and function, Chatham University Physical Therapy graduates will promote the health and wellness of individuals and society. The Program supports practitioners in achieving best practice through its scholarly inquiry, dissemination, and outreach. Curricular Philosophy: Graduates of the Doctor of Physical Therapy Program are expected to have a professional approach that is compassionate, holistic, and client-centered. The faculty engages students as future colleagues responsible for their learning and already accountable to their future patients/clients. Through peer and faculty evaluation and continuous self-reflection, students internalize constructive feedback and develop their skills. Our graduates will elevate the practice of physical therapy through respect, integrity, critical thinking, translation of evidence, and clinical excellence. This philosophy becomes evident within the curriculum by: Dispensing with student-to-student competition and encouraging collegiality Focusing on respectful communication Yielding ownership for learning and development to the student while providing rich resources to achieve this Providing opportunities for self-evaluation, peer evaluation, and program evaluation Promoting multiculturalism and social justice advocacy for patients/clients and the community Optimizing clinical decision making through an ability to interpret, integrate, and apply knowledge gathered from a variety of sources Prioritizing patient/client preferences as a central factor when planning care Exposing students to gifted clinicians who are passionate about sharing their talents Program Goals: 1. To educate physical therapists who are qualified to practice autonomously in an ethical, legal, safe, caring and effective manner. 2. To offer a program framed in self-directed learning, critical thinking and decision-making, reflective practice, critical evaluation and application of best scientific evidence, and clinical competence in entry level practice. 3. To promote an academic community of students, faculty, and clinical instructors who are committed to clinical excellence, scholarly activity, professional development, and community service that contributes to current societal needs. 4. To develop and support a faculty that is actively engaged in innovative teaching strategies and clinically relevant scholarship. 1
II. Physical Therapy Education & Outcomes A. Sample Program of Study Term Credits Course Number Course Title Dates Term 1 Fall Term 2 Spring Term 3 Summer Term 4 Fall Term 5 Spring Term 6 Summer Term 7 Fall 4/2 BIO 502/502L Human Gross Anatomy 2 PTH 700 Introduction to Clinical Skills 3 BIO 504 Human Physiology 3 PTH 741 Principles of Practice I: Introduction to PT Practice 14 Total Credits For Semester 3/1 BIO 506/506L Principles of Neuroscience/Lab 7 PTH 701 Foundations of Movement Science I 3 PTH 704 Fundamentals of Exercise Physiology 14 Total Credits For Semester 12 PTH 703 Management of Musculoskeletal System Dysfunction 3 PTH 742 Principles of Practice II: Communication and Ethics 3 PTH 730 Clinical Experience I A for 4 weeks 18 Total Credits For Semester 4 PTH 731 Clinical Experience I-B for 6 weeks 1 PTH 743 Principles of Practice III: Integration of Psychosocial Issues and Social Responsibility 7 PTH 707 Management of Cardiovascular & Pulmonary System Dysfunction 3 PTH 702 Foundations of Movement Science II 3 PTH 722 Research I 18 Total Credits For Semester 9 PTH 709 Management of Neuromuscular System Dysfunction 4 PTH 708 Management of Pediatric Neuromuscular System Dysfunction 1 PTH 744 Principles of Practice IV: Service Learning 14 Total Credits For Semester 7 PTH 733 Clinical Experience II for 10 weeks 3 PTH 745 Principles of Practice V: Health Care Delivery, Management, and Policy 2 PTH 724 Research II 3 PTH 713 Management of Multi-System Dysfunction 15 Total Credits For Semester 12 PTH 735 Clinical Experience V for (16 weeks) ; or 6 6 PTH 746 PTH 747 Clinical Experience III for 8 weeks Clinical Experience IV for 8 weeks 2 PTH 748 Principles of Practice VI: Art and Science of Physical Therapy Practice 14 Total Credits For Semester 107 Total Credits For Entire Curriculum Actual dates to begin and end courses may vary from this schedule. We will inform students of any such changes in sufficient time for student to alter their plans/schedules. Curriculum courses and sequences are subject to change. 2
B. Explanation of Problem-Based Learning Model Developed by Howard Barrows and associates at McMaster University for medical education, problem-based learning (PBL) has been implemented in a number of health care professional educational programs. Problem-based learning is a rigorous, highly structured teaching methodology which places the student in a position of active responsibility for learning and mastering content. In a group of peers, the student learns new material by confronting and solving problems in the form of a clinical patient case. Students work in tutorial groups (8-10 students) in which a faculty member serves as a tutorial facilitator. Rather than listening to a lecture on a given topic (teacher-centered learning), students are presented with a patient case which typically integrates previously learned information with a great deal of new content. The group must come to consensus about what they would need to know in order to manage the patient case. They do this by developing learning issues or topics which represent questions about the case. Sample learning issues might be: What impairments typically occur following a middle cerebral artery stroke? What is the anatomy and function of the lymphatic system? How does the patient s weakness relate to his gait dysfunction? What is the relationship between prolonged sitting and low back pain? On an individual basis, students then research the topics by using textbooks, review articles, peer-reviewed research, and electronic data bases. Later in the week, students regroup to discuss their findings and apply them to the patient case at hand. Rather than lecturing, the faculty member facilitates discussion and asks questions to ascertain that students are learning the material to the appropriate breadth and depth required of an entry level physical therapist. Chatham University s physical therapy program employs a modified problem-based learning format in its clinical arts and sciences course work. Five to 12 carefully crafted cases are the anchors around which other content is taught. The curriculum includes extensive laboratory experiences as well as special topic seminars which complement and reinforce content learned in PBL sessions. Other courses at Chatham, including the basic science courses, are taught in a more traditional, lecture-based format. What are the benefits of PBL? An ability to apply information to real-world situations Research indicates that PBL embodies a learning approach that effectively helps students to develop scientific thinking about patients problems and to acquire both basic science and clinical information in a manner that ensures retention and transfer [of learning] to the real-life task of the clinician. (Barrows) Recent studies indicate that graduates of problembased health care educational programs perform well (most studies indicate better than students from more traditional educational programs) on board exams and exhibit secure clinical learning and reasoning skills to the betterment of their patients. Problem-solving skills Since the acquisition of new material revolves around a patient case, students constantly learn and apply information in the context of solving a patient problem. For example, students might be required to answer the following questions posed by the tutor: based on the pathophysiology of his disease process, what precautions would be important when treating this patient? How would you handle the patient s emotional affect in order to accomplish your treatment? How might the patient s medications influence the outcome of today s intervention? What tests and measures might be appropriate for the patient given their current status? 3
Research skills As Chatham physical therapy students are learning how to ask questions through the PBL process, they also learn to research the answers. Our students become quite skillful at database searching, critiquing journal articles, and synthesizing information from a variety of sources. Communication skills Since group members are dependent on each other for enriching discussion and subsequent learning, each student must participate in PBL sessions, whether by volunteering information, asking questions, seeking clarification, confirming the thoughts of a peer, or relating information to the patient case. Inherent in the PBL process, Chatham students learn how to function as individual members of a team, conferring for the greater good (learning the material/treating the patient). Students also have an opportunity to evaluate the participation skills of their classmates (preparation, clinical reasoning, quality of learning resources, team skills, respective listening) and themselves, in written and oral formats. This teaches critical reflection and the skills of providing/receiving constructive criticism. References: Enarson C. Cariaga-Lo L. Influence of curriculum type on student performance in the United States Medical Licensing Step 1 and Step 2 Exams: problem based learning vs. lecture-based curriculum. Medical Education. 35: 1050-55, 2001 Lycke KH. Inside PBL groups: observations, confirmation and challenges. Education for Health. 15(3): 326-334, 2002. Wood EJ. Problem-based learning: exploiting knowledge of how people learn to promote effective learning. BEE-j Volume3: May 2004 http://bio.ltsn.ac.uk/journal/vol3/beej-3-5.htm Koh GC-H. Khoo HE. Wong ML. Koh D. The effects of problem-based learning during medical school on physician competency: a systematic review. CMAJ 2008;178(1):34-41 Barrett M. Moore S. eds. New Approaches to Problem-Based Learning. New York: Routledge, 2011 Yaqinuddin A. Kvietys P. Ganguly P. et al. PBL performance correlates with content acquisition assessment: a study in a hybrid PBL program at Alfaisal University. Medical Teacher 2012;34:83 Karantzas GC. Avery MR. Macfarlane S. et al. Enhancing critical analysis and problem-solving skills in undergraduate psychology: an evaluation of a collaborative learning and problem-based learning approach. Australian J Psych 2013;65:38-45 C. Technical Standards of a Physical Therapy Student All candidates must meet health and technical standards for admission to and participation in the physical therapy educational program at Chatham University. The professional doctoral degree denotes that the holder's educational program has prepared that individual for entry into practice. Thus, graduates must have the knowledge, abilities, and essential physical skills to function in a wide variety of clinical situations while providing a broad spectrum of patient care. A candidate for the physical therapy degree program must have abilities and skills in five essential areas: observation; communication; motor function; intellectual capacities related to conceptual, integrative and quantitative abilities; and behavior and personal attributes. Technical support can compensate for some disabilities in certain areas, but a candidate must perform in a prudent and reasonable independent manner. Use of a trained intermediate suggests that someone else s power of selection and observation impacts a candidate s judgment. 4
Observation: The candidate must exhibit the ability to observe demonstrations and experiments in the foundational sciences including, but not limited to, anatomical structures and muscular, nervous, cardiovascular, pulmonary and integument tissue in normal and pathologic states. A candidate must exhibit the ability to observe a patient/client accurately at a distance and close at hand. A candidate must exhibit the ability to visualize measuring devices including, but not limited to, a goniometer, a tape measure, a volumeter, dials on evaluation and therapeutic equipment. Observation requires the functional use of the sense of vision, hearing, and bodily sensations. For example, the sense of smell enhances observation. Communication: A candidate must exhibit the ability to speak, hear, and observe patients to elicit information; to describe changes in mood, activity and posture; and to perceive nonverbal communications. The candidate must exhibit the ability to communicate effectively and sensitively with patients/care givers. The candidate must exhibit the ability to communicate effectively in teaching patients or their family members or both patients and family members. Communication includes reading and writing in addition to speech. The candidate must exhibit the ability to communicate effectively and efficiently in oral and written form with all members of the health care team. Motor Function: A candidate must have sufficient motor function to obtain information from patients by palpation, mobilization, auscultation, percussion, and other diagnostic and intervention maneuvers as appropriate. A candidate must exhibit the motor function to assist with intervention and functional activities. A candidate must exhibit the ability to carry out motor movements reasonably required to provide safe, general care and emergency intervention to patients. Safe, general care includes the ability to move with speed to render assistance in case of a fall. Examples of emergency intervention reasonably required include cardiopulmonary resuscitation and the application of pressure to stop bleeding. Such actions require coordination of both gross and fine motor movements, equilibrium and functional use of the senses of touch and vision. Intellectual: Conceptual, integrative and quantitative abilities include measurement, calculation, reasoning, analysis, and synthesis. Problem-solving (which leads to competent clinical decision making), the critical skill required of physical therapists, includes all of these intellectual abilities. Candidates must also exhibit the ability to comprehend three-dimensional relationships and to understand spatial relationships of structures. Behavior and Personal Attributes: Candidates must exhibit the emotional health needed for full use of their intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities related to the assessment and management of patients, and the development of mature, sensitive, and effective relationships with patients. Candidates must exhibit the ability to make sound ethical and legally correct decisions. Candidates must exhibit the ability to tolerate physically taxing workloads and to function effectively under stress. Candidates must exhibit the ability to adapt to changing environments, display flexibility, and to learn to function in the face of uncertainties inherent in management of the clinical problems of many patients. Compassion, integrity, concern for others, interpersonal skills, interest and motivation describe the personal qualities that the program will assess during the admission and educational process. 5
D. Professional Behaviors Continuum *This is utilized to aid students in identifying strengths and weaknesses in professional behavior and the affective domain. Faculty advisors and students work together to develop strategies aimed at addressing areas of concern. 1. Critical Thinking Beginning Level* Raises relevant questions; Considers all available information; Articulates ideas; Understands the scientific method; States the results of scientific literature but has not developed the consistent ability to critically appraise findings (i.e. methodology and conclusion); Recognizes holes in knowledge base; Demonstrates acceptance of limited knowledge and experience Entry Level* Distinguishes relevant from irrelevant patient data; Readily formulates and critiques alternative hypotheses and ideas; Infers applicability of information across populations; Exhibits openness to contradictory ideas; Identifies appropriate measures and determines effectiveness of applied solutions efficiently; Justifies solutions selected 2. Communication Demonstrates understanding of the English language (verbal and written): uses correct grammar, accurate spelling and expression, legible handwriting; Recognizes impact of non-verbal communication in self and others; Recognizes the verbal and nonverbal characteristics that portray confidence; Utilizes electronic communication appropriately Demonstrates the ability to maintain appropriate control of the communication exchange with individuals and groups; Presents persuasive and explanatory verbal, written or electronic messages with logical organization and sequencing; Maintains open and constructive communication; Utilizes communication technology effectively and efficiently 3. Problem Solving Recognizes problems; States problems clearly; Describes known solutions to problems; Identifies resources needed to develop solutions; Uses technology to search for and locate resources; Identifies possible solutions and probable outcomes Independently locates, prioritizes and uses resources to solve problems; Accepts responsibility for implementing solutions; Implements solutions; Reassesses solutions; Evaluates outcomes; Modifies solutions based on the outcome and current evidence; Evaluates generalizability of current evidence to a particular problem 4. Interpersonal Skills Maintains professional demeanor in all interactions; Demonstrates interest in patients as individuals; Communicates with others in a respectful and confident manner; Respects differences in personality, lifestyle and learning styles during interactions with all persons; Maintains confidentiality in all interactions; Recognizes the emotions and bias that one brings to all professional interactions Demonstrates active listening skills and reflects back to original concern to determine course of action; Responds effectively to unexpected situations; Demonstrates ability to build partnerships; Applies conflict management strategies; Recognizes the impact of non-verbal communication and emotional responses and modifies own behaviors based on them 5. Responsibility Demonstrates punctuality; Provides a safe and secure environment for patients; Assumes responsibility for actions; Follows through on commitments; Articulates limitations and readiness to learn; Abides by all policies of academic program and clinical facility Educates patients as consumers of health care services; Encourages patient accountability; Directs patients to other health care professionals as needed; Acts as a patient advocate; Promotes evidence-based practice in health care settings; Accepts responsibility for implementing solutions; Demonstrates accountability for all decisions and behaviors in academic and clinical settings 6. Professionalism Abides by all aspects of the academic program honor code and the APTA Code of Ethics; Demonstrates awareness of state licensure regulations; Projects professional image; Attends professional meetings; Demonstrates cultural/generational awareness, ethical values, respect, and continuous regard for all classmates, academic and clinical faculty/staff, patients, families, and other healthcare providers Demonstrates understanding of scope of practice; Provides patient/family centered care as evidenced by provision of patient/family education, seeking patient input and informed consent and maintenance of patient dignity; Seeks excellence in practice by participation in professional organizations and attendance at professional development; Utilizes evidence to guide decision making; Demonstrates leadership in collaboration with both individuals and groups 6
Beginning Level* Entry Level* 7. Use of Constructive Feedback Demonstrates active listening skills; Assesses own performance; Actively seeks feedback from appropriate sources; Demonstrates receptive behavior and positive attitude toward feedback; Incorporates specific feedback into behaviors; Maintains two-way communication without defensiveness Independently engages in a continual process of self-evaluation of skills, knowledge and abilities; Seeks feedback from patients/clients and peers/mentors; Readily integrates feedback provided from a variety of sources to improve skills, knowledge and abilities; Uses multiple approaches when responding to feedback; Reconciles differences with sensitivity; Modifies feedback given to patients/clients according to their learning styles 8. Effective Use of Time and Resource Comes prepared for the day s activities/responsibilities; Identifies resource limitations (i.e. information, time, experience); Determines when and how much help/assistance is needed; Accesses current evidence in a timely manner; Verbalizes productivity standards and identifies barriers to meeting productivity standards; Self-identifies and initiates learning opportunities during unscheduled time Uses current best evidence; Collaborates with members of the team to maximize the impact of treatment; Has the ability to set boundaries, negotiate, compromise, and set realistic expectations; Gathers data and effectively interprets and assimilates determine plan of care; Utilizes community resources in D/C planning; Adjusts plans as patient needs and circumstances dictate; Meets productivity standards while providing quality care 9. Stress Management Recognizes own stressors; Recognizes distress or problems in others; Seeks assistance as needed; Maintains professional demeanor in all situations...demonstrates appropriate affective responses in all situations; Responds calmly to urgent situations with reflection and debriefing as needed; Prioritizes multiple commitments; Reconciles inconsistencies within professional, personal and work/life environments; Demonstrates ability to defuse potential stressors with self and others 10. Commitment to Learning Prioritizes information needs; Analyzes and subdivides large questions into components; Identifies own learning needs based on previous experiences; Welcomes and/or seeks new learning opportunities; Seeks out professional literature; Plans and presents an in-service, research or cases studies Respectfully questions conventional wisdom; Formulates and reevaluates position based on available evidence; Demonstrates confidence in sharing new knowledge with all staff levels; Modifies programs and treatments based on newly-learned skills and considerations; Consults with other health professionals and physical therapists for treatment ideas *Beginning Level behaviors consistent with a learner in the beginning of the professional phase of physical therapy education and before the first significant internship *Entry Level behaviors consistent with a learner who has completed all didactic work and is able to independently manage a caseload with consultation as needed from clinical instructors, co-workers and other health care professionals References: Adapted from: Warren May, PT, MPH, Laurie Kontney PT, DPT, MS and Z. Annette Iglarsh, PT, PhD, MBA: Professional Behaviors for the 21 st Century, 2009-2010 7
E. Physical Therapy Program Outcomes The Physical Therapy Program provides educational experiences that will enable each student to develop the competencies necessary to meet the present and future physical therapy needs of society. The Program's graduates will function autonomously as providers of physical therapy services within the health care environment. Graduates will further their own personal development and that of the profession through participation in clinical, research, educational, professional and community activities. At the completion of the program the graduates will: 1.0 Practice in an ethical, legal, safe, professional and effective manner: 1.1 Select and use examination and intervention strategies based on current scientific theory and evidence. 1.1.1 Integrate scientific theory and evidence with evaluation to provide effective preventative and/or rehabilitative intervention; 1.2 Adhere to the standards of practice for physical therapy; 1.2.1 Provide care that falls within the scope of physical therapy practice; 1.2.1.1 Acknowledge one's limitations in physical therapy practice; 1.2.1.2 Refer to other physical therapists and members of the health care team when indicated. 1.2.2 Demonstrate safety in dealing with another individual's physical, mental and emotional wellbeing; 1.3 Make decisions within the scope of practice of a physical therapist as defined by state laws governing the practice of physical therapy; 1.3.1 Evaluate the effect of federal legislation and policy on the provision of physical therapy services and provide those services within the confines of that legislation; 1.4 Adhere to the Code of Ethics and Guidelines for Professional Conduct of the American Physical Therapy Association; 1.4.1 Respect and value confidentiality in physical therapy practice; 1.5 Act in accordance with APTA core values (accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility) 2.0 Screen individuals to determine the need for habilitation, rehabilitation, referral, and/or care to promote fitness, health and wellness 2.1 Discover the potential for health problems that may require prevention or intervention; 2.1.1 Recognize normal structure and function in multiple systems and across the lifespan 2.1.2 Compare patient presentation to normal structure/function and recognize the potential for abnormalities; 2.2 Determine the need for urgent vs. non-urgent referral 8
2.3 Justify the scope of further physical therapy examination using information from screening 3.0 Effectively examine a patient/client 3.1 Organize information gained through interview or other appropriate methods to establish a pertinent history; 3.2 Plan and perform a systems review based on medical diagnosis and/or patient/client history; 3.3 Plan and perform appropriate test and measures to determine the degree of impairment, activity limitation, and participation restriction; 4.0 Formulate the physical therapy diagnosis 4.1 Systematically organize and evaluate the examination data through the differential diagnosis process; 4.2 Seek from and/or share information with other professionals as needed; 5.0 Design a comprehensive physical therapy plan of care 5.1 Establish the physical therapy prognosis by developing realistic, measurable goals and outcomes, including length of time for goal achievement; 5.1.1 Integrate scientific evidence with examination results to develop goals that correlate with each other and consider economic, social and cultural influences that may affect the outcome; 5.2 Propose evidence-based therapeutic interventions that are consistent with best practice, and 5.2.1 Are based upon the individual's physiologic and psychological status and on cognitive, social and cultural influences; 5.2.2 Consider clinical outcome, cost effectiveness, administrative procedures, personnel and potential for achieving goals; 5.2.3 Represent appropriate duration and intensity; 5.3 Plan programs to promote and maintain health and wellness; 5.4 Collaborate with patients/clients, their families, other health care providers and payers 5.5 Continually evaluate the patient/client's response to the plan of care and modify the plan as necessary 5.6 Integrate primary, secondary, and tertiary prevention into the plan of care 6.0 Manage a comprehensive plan of care 6.1 Prepare the patient/client, area and equipment in a manner that assures the clinician's safety and patient/client's safety, dignity, and privacy, and treatment efficiency; 9
6.2 Effectively and efficiently perform interventions customized to the patient/client's status; 6.3 Accurately interpret and respond to changes in the patient/client s physiologic and psychological states; 6.4 Provide patient/client and caregiver instruction based on proposed outcomes and patient goals; 6.5 Respond appropriately to an emergency situation in any practice setting; 6.6 Interact with patients/clients and families in a manner which provides appropriate psychosocial support; 6.6.1 Provide culturally congruent care by adapting exam, plan of care and interventions based on an understanding of individual differences 6.6.2 Evaluate and respond appropriately to the stress patients/clients and families may experience as well as the mechanisms they may employ to cope with those stresses; 6.7 Direct and appropriately supervise the physical therapist assistant and other support personnel; 6.8 Utilize resources in a fiscally responsible manner; 6.9 Contribute to discharge planning and follow-up care including interfacing with community resources; 6.10 Participate in inter-professional teams where appropriate 7.0 Demonstrate effective written, oral, and nonverbal communication with patients/ clients and their caregivers, colleagues, other health providers, payers, and the public; 7.1 Complete thorough and accurate documentation consistent with practice setting guidelines; 7.2 Promote effective interpersonal relationships in all aspects of professional practice; 7.2.1 Effectively function as a member of the inter-professional health care team or other working group. 7.2.2 Provide and receive constructive feedback to/from colleagues and patients/clients. 8.0 Apply principles of management in the provision of physical therapy to individuals, organizations, and communities; 8.1 Demonstrate effective leadership and supervisory techniques; 8.2 Explain the impact of external agencies or departments on a physical therapy service and respond to those agencies or department with appropriate actions; 8.3 Demonstrate good management practices in the daily operation of a physical therapy service; 8.4 Effectively market physical therapy services to appropriate consumer groups; 8.5 Design and implement cost effective physical therapy services; 8.5.1 Participate in budgeting, billing, and reimbursement activities; 8.6 Use current information management technologies in the delivery of physical therapy services; 10
8.7 Participate in continuous quality improvement programs; 9.0 Apply concepts of teaching and learning theories in designing, implementing, and evaluating learning experiences used in the education of patients/client, students, colleagues, and the community; 9.1 Defend the pervasive nature of education in the practice of physical therapy; 9.2 Develop clear, concise and appropriate learning objectives for: Patient/client education; student clinical experiences; in-service education; community education; 9.3 Design, select, and implement appropriate teaching methods and learning activities to accomplish stated learning objectives; 9.4 Design and select appropriate methods to evaluate the effectiveness of learning experiences; 10.0 Apply the principles of evidence-based practice to collaborative clinical decision making 10.1 Assess the need to respond to clinical uncertainties (related to examination, evaluation, diagnosis, prognosis, and intervention) by formulating an answerable question; 10.2 Efficiently search and locate scientific evidence; 10.3 Critically evaluate the validity and clinical utility of scientific evidence; 10.4 Consider individual clinical and patient/client circumstances; 10.5 Perform standardized outcome measurement and evaluation; 11.0 Develop personal and professional self-assessment skills and formulate/implement a career development plan; 11.1 Accept that being a professional is a continuing process and assume the responsibility for one's personal and professional development 11.2 Participate in and defend the role of professional associations; 11.3 Acknowledge the boundaries of an entry-level educational program and pursue a variety of resources to expand those boundaries in future professional development. 11.4 Serve as consultants to individuals, colleagues in physical therapy, other health professionals, organizations, and the community; 11.4.1 Distinguish issues and problems in physical therapy and health care and propose potential solutions; 11.5 Participate in service to the local, national, and international community beyond one's role as a health care professional 11
III. Physical Therapy Clinical Experience A. Philosophy As an experiential learning process, clinical education represents an integral part of the total physical therapy curriculum. Attainment of competencies as a physical therapist depends upon integration of didactic and clinical learning experiences. While didactic education provides a basis for the development of appropriate problem solving abilities and a knowledge base, clinical education provides an opportunity for refinement of the knowledge, skills, and attitudes that characterize a competent, entry level practitioner. Clinical education requires mutual endeavors by the academic faculty, the clinical faculty, and the student to achieve the common goal of clinical competence. The academic faculty holds primary responsibility for preparing the student didactically and coordinating placement of the student in appropriate clinical facilities. The clinical faculty provides appropriate learning experiences and evaluates the student's performance. Responsibilities of the student include recognition and communication of the student's own abilities and limitations according to academic level, previous clinical experiences, and personal attributes. Involved individuals must effectively communicate to attain the overall goal of clinical competence. The physical therapy program recognizes three phases of clinical experience education: 1. The first clinical experience provides students with an opportunity to transfer knowledge and skills of the musculoskeletal system from a simulated, didactic setting to a realistic, outpatient clinical setting. Active participation in patient/client care allows the student to develop responsiveness to musculoskeletal physical therapy problems by applying and enhancing evaluation, treatment, follow up, and communication competencies and skills. 2. The second clinical experience provides students with an opportunity to transfer knowledge and skill of cardiopulmonary, neuromuscular, and multi-systems across the lifespan. Students additionally have the opportunity to work with patients in the acute and sub-acute phases of illness. Guided problem solving enables the student to creatively adapt solutions to simple or complex physical therapy problems across a variety of settings to include acute, sub-acute, inpatient rehabilitation, long-term care and outpatient care across the lifespan. * 3. The final phase of clinical education provides the student with the opportunity to further refine clinical skills in practice settings that complement the first and second phases of clinical education.*. During this clinical experience the student will continue to develop competency in his/her entry-level professional physical therapy skills in preparation for licensure. *Please Note: An inpatient experience is required during the second or third phase of clinical experience. B. Learning Experience Physical therapy education has traditionally been centered around clinical experience. It has evolved from almost exclusive clinical training in early hospital-based programs to the current combination of didactic and clinical education. In a competency-based education system the outcomes or objectives can be used for planning a student s program and evaluating the clinical performance. The objectives can be further defined by the clinical instructors, based on the needs, requirements and resources of the facility and the student. The outcomes can be used to determine a student's starting level and to identify areas of deficiency which become the foci for subsequent learning. In summary, outcomes provide a system for planning learning experiences and for assessing performance based on a student s needs, expectations, and abilities in specific areas. 12
To provide a good clinical experience, much thought and planning should precede the arrival of a student and continue throughout the student's experience. Criteria for a good clinical learning experience include, but are not limited to, the following: The clinical environment should provide an atmosphere which: Encourages people to be active (rather than passive) learners. Promote self-discovery of the personal meaning of ideas. Emphasizes the subjective nature of learning (recognizes individual contributions). Allows people the right to make mistakes. Recognizes difference as good and desirable. Tolerates ambiguity and permits confrontation. Emphasizes cooperative or self-evaluation. Encourages openness of self (rather than concealment). Encourages people to trust in themselves as well as external sources. Makes people feel accepted and respected. The clinical experience should be practical in terms of space, equipment, time and personnel available. The learning experience should be appropriate to the student's level of attainment and predispositions. The well-planned learning experience should help fulfill more than one objective. The clinical experience should use a problem solving approach--think, analyze and solve--develop concepts (i.e., do not continually "spoon-feed" information to the student). The clinical experience should be built around pre-established objectives. The clinical experience should provide for increased complexity in the student-patient involvement throughout the curriculum. The clinical experience should include exposure to real life situations to allow practice in communication, documentation, problem-solving, inter-departmental relations, and medical-legal aspects of patient care with patients with a variety of disabilities and of various ages. The students should have exposure to multiple settings including: an outpatient orthopedic setting, an acute care setting, a rehab and/or skilled nursing setting, and an area of particular interest which may include a pediatric setting. The students should have experience in dealing with different levels of health care workers (physicians to aides) within physical therapy and the facility. References: Rammel, Martha L., Influence of the Organizational Environment on Clinical Education, 1980, unpublished. APTA, Handbook for Physical Therapy Teachers, 1967, New York, pp. 197-199. 13
C. Course Descriptions and Objectives PTH 730 (I-A) & 731(I-B): Clinical Experience I 7 credits Course Description: This ten (10) week, full-time experience is scheduled at the completion of musculoskeletal system coursework. Students will be placed in outpatient facilities or general hospitals with an expectation that students, under the supervision of a licensed physical therapist, will primarily evaluate and treat patients with musculoskeletal conditions. An in-service education program or case study presentation is a requirement of this clinical experience. Prerequisite(s): Satisfactory completion of all previous academic requirements. PTH 733: Clinical Experience II 7credits Course Description: This ten (10) week full-time experience is scheduled at the completion of study of didactic and laboratory course work. Students will generally be placed in acute care, acute rehabilitation, skilled nursing, pediatric, sub-acute, outpatient, or home health settings. Students will, under the supervision of a licensed physical therapist, primarily evaluate and treat patients with cardio/pulmonary and neurological conditions across the lifespan. A critique and presentation of a peer-reviewed journal article is a requirement of this clinical experience. Prerequisite(s): Satisfactory completion of all previous academic requirements. PTH 735: Clinical Experience V 12 credits Course Description: A sixteen (16) week full-time experience completed at the conclusion of Clinical Experience II during the final term of the Doctor of Physical Therapy Program. The student is assigned to an area of academic need and/or interest. During this experience the student will continue to develop competency in his/her entry-level professional physical therapy skills, under the supervision of a licensed physical therapist. An alternative to this course is the combination of PTH 746 Clinical Experience IV (8 weeks) and PTH 747 Clinical Experience V (8 weeks). Prerequisite(s): Satisfactory completion of all previous academic requirements. PTH 746: Clinical Experience III 6 credits Course Description: An eight (8) week, full-time experience in combination with PTH 747 Clinical Experience V (eight weeks) completed at the conclusion of Clinical Experience II during the final term of the Doctor of Physical Therapy Program. During this experience, the student will continue to develop competency in his or her entry-level professional physical therapy skills, under the supervision of a licensed physical therapist. An alternative to this course in combination with PTH 747 Clinical Experience V is PTH 735 Clinical Experience III (16 weeks). Prerequisite(s): Satisfactory completion of all previous academic requirements. PTH 747: Clinical Experience IV 6 credits Course Description: An eight (8) week, full-time experience in combination with PTH 746 Clinical Experience IV (eight weeks) completed at the conclusion of Clinical Experience II during the final term of the Doctor of Physical Therapy Program. During this experience, the student will continue to develop competency in his or her entry-level professional physical therapy skills, under the supervision of a licensed physical therapist. An alternative to this course in combination with PTH 746 Clinical Experience IV is PTH 735 Clinical Experience III (16 weeks). Prerequisite(s): Satisfactory completion of all previous academic requirements. 14
OBJECTIVES FOR ALL CLINICAL EXPERIENCES ONLY DIFFER IN SECTION 3.0, 4.0, 5.0, 6.0 & 7.3 AS NOTED BELOW Objectives: Upon completion on of this course the student will: 1.0 Practice in an ethical, legal, safe, professional and effective manner: 1.1 Select and use examination and intervention strategies based on current scientific theory and evidence. 1.1.1 Integrate scientific theory and evidence with evaluation to provide effective preventative and/or rehabilitative intervention; 1.2 Adhere to the standards of practice for physical therapy; 1.2.1 Provide care that falls within the scope of physical therapy practice; 1.2.1.1 Acknowledge one's limitations in physical therapy practice; 1.2.1.2 Refer to other physical therapists and members of the health care team when indicated. 1.2.2 Demonstrate safety in dealing with another individual's physical, mental and emotional wellbeing; 1.2.2.1 Observe proper safety techniques and precautions; 1.2.2.2 Follow safety and health regulations; 1.2.2.3 Demonstrate knowledge of contraindications and precautions in patient treatment; 1.2.2.4 Demonstrate awareness of physiological and psychological changes and adjust treatment accordingly; 1.2.2.5 Ask for assistance when needed; 1.2.3 Adhere to clinical site s institutional policy and procedures; 1.2.4 Identify situations in which ethical questions are present; 1.2.5 Report violations of ethical practice; 1.3 Make decisions within the scope of practice of a physical therapist as defined by state laws governing the practice of physical therapy; 1.3.1 Evaluate the effect of federal legislation and policy on the provision of physical therapy services and provide those services within the confines of that legislation; 15
1.3.2 Recognize and report appropriately legal questions or violations of laws; 1.3.3 Seek advice and/or interpretation in application of rules, regulations, and laws; 1.4 Adhere to the Code of Ethics and Guidelines for Professional Conduct of the American Physical Therapy Association; 1.4.1 Respect and value confidentiality in physical therapy practice; 1.5 Demonstrate professional behavior; 1.5.1 Demonstrate dependability and flexibility; 1.5.2 Assume responsibility for own behavior 1.5.3 Present self in professional manner; 1.5.4 Complete work schedule in timely manner; 1.6 Demonstrate cooperative attitude with others; 1.6.1 Accept constructive criticism in positive manner; 1.6.2 Recognize and respect practice domains of other professionals; 1.6.3 Demonstrate ability to resolve conflict resolution and negotiation 1.6.4 Assume responsibility for decisions made when conflict in ethical and legal situations; 2.0 Screen individuals to determine the need for physical therapy and/or referral to other health care professionals; 2.1 Discover potential health problems; 2.1.1 Discuss normal structure and function throughout the life cycle; 2.1.2 Discover areas of abnormal structure and function and areas where a potential for such abnormality exists; 2.1.3 Evaluate patient/client problems that may require referral in addition to physical therapy intervention; 3.0 Effectively examine a patient 3.1 Organize information gained through interview or other appropriate methods to establish a pertinent history; 3.2 Plan and perform a systems review based on medical diagnosis and/or patient history; 16
PTH 730&731: Clinical Experience I: Musculoskeletal PTH 733: Clinical Experience II: Musculoskeletal, Cardiopulmonary, Neuromuscular, Integumentary PTH 735: Clinical Experience V: (all of the above as applicable) PTH 746: Clinical Experience III: (all of the above as applicable) PTH 747: Clinical Experience IV: (all of the above as applicable) 3.3 Plan and perform appropriate test and measures to determine the degree of impairment, activity limitation, and participation restriction; (As per level of experience noted in 3.2) 4.0 Formulate the physical therapy diagnosis (As per level of experience noted in 3.2) 4.1 Systematically organize and evaluate the examination data through the differential diagnosis process; 4.1.1 Predict initially and on a continuing basis a patient s need for physical therapy intervention and the potential of the patient to respond to specific physical therapeutic intervention; 4.1.2 Specify the nature of the problem in physical therapy terms; 4.1.3 Explain underlying pathological process or mechanism of injury involved in the disease or disability; 4.1.4 Determine general extent of the problem (i.e. acute vs. chronic, systemic vs. local, structural vs. functional prognosis); 4.1.5 Explain nature of problem, underlying pathology or mechanism of injury to patient and/or family/caregiver at their level of understanding; 4.2 Seek from and/or share information with other professionals as needed; 5.0 Design a comprehensive physical therapy plan of care (As per level of experience noted in 3.2) 5.1 Establish the physical therapy prognosis by developing realistic, measurable goals and outcomes, including length of time for goal achievement; 5.1.1 Integrate scientific evidence with examination results to develop goals that correlate with each other and consider economic, social and cultural influences that may affect the outcome; 5.2 Propose evidence-based therapeutic interventions that are consistent with best practice, and 5.2.1 Are based upon the individual's physiologic and psychological status and on cognitive, social and cultural influences; 5.2.2 Consider clinical outcome, cost effectiveness, administrative procedures, personnel and potential for achieving goals; 5.2.3 Represent appropriate duration and intensity; 17