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+
Clinical Supervisor Workshop
PT afternoon session
+ Agenda
Clinical policies & resources
How to use the Assessment of Clinical Performance (ACP)
Case studies Clinical reasoning Problem learner
Program updates
+ Specific questions YOU would like
to have answers to?
+
Clinical education policies & resources
+ Graduate Profile
A clinician who is: Competent in all essential competencies Self-directed Empathetic, promotes health and the profession
With practice, the therapist will be: Client centered Evidence-based using resources effectively
Clinical Courses (curriculum details slides )
Fall Winter Summer
U1 Courses U1 Courses Off
U2 Courses U2 Courses Off
U3 & QY Courses U3 & QY Courses Clinical I Clinical II 7 wks 7 wks
M1 Courses Begin Research
Project
Clinical III – 8 wks M1 Courses
Research Project M2
Project submission
Clinical IV - 8 weeks
Graduates are ready to work in November
2016 Placement dates
Clinical 1 7 weeks
April 25th to June 10th
Clinical 2 7 weeks
June 13th to July 29th *or any 7 week period up to August 26th
Clinical 3 8 weeks
January 4th to February 26th
Clinical 4 8 weeks
September 6th to October 28th
+ Student’s clinical requirements 1025 hours required nationally *McGill students get 1050
80% of hours supervised by a PT
100 hours minimum in each of: Neuro, Cardioresp and Musculoskeletal
Require experience in a mixed patient population and across different practice settings: acute care
rehabilitation/long-term care/community
ambulatory care – private and public out-pt settings
+ Trends in student placement requests Increased requests for public ortho-in/ortho-out and neuro
rehab in clinical 1 & 2
Increased requests for ortho private in clinical 4
Need for pelvic floor rehab in clinical 3 & 4
Need for pediatrics in clinical 3 & 4
Increased interest for oncology, vestibular, chronic pain
Increased need for rehab, community, CLSC settings across all placements
Achieving cardioresp experience for all students remains a challenge
Use of cardioresp checklist
+ Increased need for accommodations - Policy for clinical placements*
The student must communicate this need with the Program Director or Academic Coordinator of Clinical Education at least 4 months prior to the clinical placement start date.
A meeting will take place between the student, faculty member, OSD (Office for Students with Disabilities) advisor and a representative from the clinical setting.
In order to properly plan and implement the clinical placement, the student will need to sign a consent form for relevant information to be communicated with the clinical site.
*Prior to the start of a clinical placement, the Academic Coordinator of Clinical Education will meet with the student to determine whether/how/when relevant information should be disclosed by the student to the clinical site. This meeting will also be required if a student is registered with OSD but does not request accommodations during a clinical placement.
+
Policies: Frequently Asked Questions?
Policies & Procedures FAQs How many days can a student miss? What are immediate causes of concern? What happens if I fail a student? Do I have to check the FAIL box? What do students have to prepare before they start a
clinical rotation? What happens if a student is injured during a rotation? What do I do if I think my student is in trouble? What is the “blue” clinical experience booklet that
students ask me to sign? What can I let the student do on their own? Can I keep a copy of the student’s ACP for job interviews?
13
+
Other FAQs?
14
+
Clinical course pre-requisites
Students must successfully complete: PDSB Workshop CPR/First Aid Immunization Mask fitting Self-declaration affidavit criminal background
Vulnerable screening police check if requested by site
Policies & Procedures
Policies & Procedures
Students MUST successfully complete:
CPR/First Aid: Valid certificate over the 3 years of the pgm. CPR/AED Level HCP course, or equivalent (AED = Automated
External Defribillator; HCP = Health Care Provider in order to enter a clinical setting
Immunization: Ask to see their immunization card or record from the
McGill Student Health Service. (514) 398-6017
ATTENDANCE: Must complete a minimum of 1025 hrs in total. Students
have 30 wks ie: 1050 hrs in clinic.
If sick more than 1 day, needs to be justified by a doctor’s note.
Time must be made up for missed days if > 1 per placement period (statutory holidays not included)
If the supervisor is absent , arrangements must be made from the site for the student to be supervised or time to be made up.
Policies & Procedures
Policy on Student athletes’ ATTENDANCE Required to attend all scheduled clinical days, not
permitted any absences. HOWEVER Arrangements can be made to make up hours lost due to
competitions, needs to be discussed with the ACCEs. Note that this policy applies to all students
Policies & Procedures
+ Policy & procedure - attendance
Students are allowed up to three days for approved planned absences related to PT activities, such as a national physiotherapy exam or a presentation at an international, national, or provincial PT conference or research colloquium.
DRESS CODE According to site policies ID tag worn at all times.
WORK INJURY Covered by CSST & McGill Liability Insurance 1) Student must notify the supervisor 2) Fill an Accident/Incident Report Form 3) Call the Academic Coordinator of Clinical Education
Adriana Venturini 514-398-5541 [email protected] Crystal Garnett 514-398-4400 ext.09678 [email protected] Martha Visintin – not yet
Policies & Procedures
+ Intervention process to optimize clinical placement
Weeks 1-2 Clinical instructor should be able to determine whether student is
functioning at expected level or having major difficulties
If issues are identified discuss with student and/or Centre Coordinator of Clinical Education/ACCE
We can provide strategies or meet with the student as needed.
Weeks 3-4 Evaluate change that has occurred
Adjust accordingly – lower expectations if needed
At mid-term, clearly communicate the projected outcome of the placement
Keep ACCE posted, we can support both the clinical instructor and/or the student.
+ Intervention process to optimize clinical placement
Weeks 5-6 If difficulties persist, select the key areas for improvement, set clear
objectives.
Re-assess weekly, provide clear feedback
Decide whether placement level expectations are being met
Keep ACCE posted, we can still assist in achieving objectives
Weeks 7-8 Student should be aware of the likely outcome of the placement
Students are encouraged to remain in a placement until the end
Encourage student to keep learning from the current situation.
ACCE will debrief with the student and clinical instructor after a challenging placement.
+
Resources for clinical educators You are part of a community of clinical educators You are not alone
+ Resources for clinical educators to support student learning Annually: Full day workshop on becoming a clinical educator Interactive on-line supervisory modules Workshops on « Searching for the Evidence » Spring Clinical Day (AM: education session, awards , PM:
program-specific meetings) Access to McGill’s Faculty of Medicine Faculty Development
Workshops http://www.mcgill.ca/medicinefacdev/
On demand: Educational workshops on-site: focussed topics of your choice Site visits to review teaching programs Clinical coordinators available for counseling to educators and
students. Conflicts are resolved by site visits/mediation and/or follow-up as indicated.
+ Other Supervisor Benefits
Faculty lectureship (nil-salary) appointment Access to Library ressources
Site stipends
Certificates for continuing education hours
Clinical Advisory Committee membership
Awards (long-term service, retirement, clinical educator award of excellence)
Support: The Academic Coordinators of Clinical Education: Mid-term emails for follow-up (as possible)
Always available for help via email or telephone (responses within 24-48 hours)
Administrative coordinator available for documents and assistance [email protected] 514-398-1293
Online Modules
www.mcgill.ca/spot/clinicaleducation/supervision University of British Columbia E-tips Online
www.practiceeducation.ca
Western University https://owl.uwo.ca/portal/site/!pep Université d’Ottawa (en français) http://www.cnfs.ca/formations/lart-superviser-les-stagiaires-ateliers-en-ligne
University of British Columbia E-tips Online 8 Module topics:
Setting the stage for clinical teaching
Learning in the practice education setting
Teaching skills in practice education
Fostering clinical reasoning
Giving feedback
The evaluation process
Supporting the struggling student
Strategies for resolving conflict
University of British Columbia E-tips Online
Useful resource to enhance your practice education skills.
Modules are btw 15-30 mins long. Can be accessed anytime at no cost.
Developed by an inter-disciplinary team of health care professionals based on feedback from over 400 health care preceptors
Clinical Education Portal
SPOT website: www.mcgill.ca/spot Clinical education website Clinical education portal
Enter offers of availability year round Track assignment of student to an offer Future plans: access feedback from students submit student evaluations
+
Assessment of Clinical Performance (ACP) refer to: -ACP ou ERC pdf -example student behaviours for non-expert roles (draft document)
+ Objectives of Clinical Evaluation
Evaluate the student's performance
Monitor the student's competency development
Ensure the student is qualified to enter professional practice
+ Canadian Physiotherapy Assessment of Clinical Performance (ACP) Evaluation du rendement clinique (ERC)
Now in use for all cohorts
EXCEPT a few students Jan-Feb 2016
Online education module
http://app1.rehab.utoronto.ca/ACP/story.html (EN)
http://app1.rehab.utoronto.ca/ERC/story.html (FR)
Electronic (pdf fillable form)
+ Features 21 key competencies, based on 7 roles from the Essential
Competency Profile for Physical Therapists
10 point rating scale
Anchor descriptors
Comment boxes
Recommendation
+ Roles
1.0 Expert Focus on Assessment Focus on analysis Focus on intervention
2.0 Communicator
3.0 Collaborator
4.0 Manager
5.0 Advocate
6.0 Scholarly practitioner
7.0 Professional
Key competency: 4.3 from manager role
+ Anchor descriptors
Intermediate Performance
• The student requires clinical supervision less than 50% of the time managing patients with simple conditions and 75% of the time managing patients with complex conditions
• The student is proficient with simple tasks and is developing the ability to consistently perform comprehensive assessments, interventions, and clinical reasoning.
• The student is capable of maintaining ~ 50% of a full-time physical therapist’s caseload
Advanced Intermediate Performance
• The student requires clinical supervision less than 25% of the time managing new patients or patients with complex conditions and is independent managing patients with simple conditions
• The student is consistent and proficient in simple tasks and requires only occasional cueing for comprehensive assessments, interventions, and clinical reasoning.
• The student is capable of maintaining ~75% of a full-time physical therapist’s caseload
Used throughout the continuum
Every key competency contributes to the overall assessment of clinical competence.
All key competencies should be rated based on observation of student performance relative to entry-level.
The Assessment of Clinical Performance (ACP)
As you use the instrument in your clinical setting it would be helpful to discuss and reach agreement on how the example behaviors would be demonstrated at entry-level by students in your clinical setting.
Good idea to:
Each academic institution is responsible for determining minimum performance expectations for successful completion of each clinical experience.
Clinical Educator/Mentors are not responsible for assigning grades to students.
But it is essential for them to rate student performance based on their direct observations of student performance.
1. Quality of intervention 2. Supervision/Guidance required 3. Consistency of performance 4. Complexity of tasks/environment 5. Efficiency of performance.
Used to guide your evaluation and feedback comments.
The Five Clinical Performance Dimensions
1. Quality*: refers to the degree of knowledge & skill proficiency
demonstrated.
should progress from demonstration of limited skill to a highly skilled performance
2. Supervision/guidance* : level & extent of assistance required
by the student to achieve entry-level performance.
the degree of supervision/guidance is expected to progress from 100% supervision to to independent performance with consultation*
may vary with the complexity of the patient or environment.
Performance Dimensions
3. Consistency* : frequency of occurrences of desired behaviors
related to the performance criterion.
quality performance is expected to progress from infrequently to routinely.
4. Complexity*: the number and difficulty of elements that must
be considered relative to the task, patient, and/or environment.
Progression in complexity of tasks, patient management, and the environment should increase, with fewer elements being controlled by the Clinical Educator/Mentor.
Performance Dimensions
5. Efficiency* : the ability to perform in a cost-effective, organized and timely manner.
Progression from a high expenditure of time and effort to
economical and timely performance.
Performance Dimensions
Rating of Performance Dimensions Performance Dimensions Level
I Level
II Level
III Level
IV
Quality of interventions 25% 50% 75% 100% Supervision/Guidance required
100%-75%
75%- 50%
50%- 25%
<25%
Consistency of performance
25% 50% 75% 100%
Complexity of task/envt 25% 50% 75% 100%
Efficiency of performance 25% 50% 75% 100%
+
Placement expectations
refer to: clinical documents for supervisors
By the end of the First Clinical Practicum, the average student can start to share a caseload with the clinical instructor.
At this stage the student requires close clinical supervision and manages patients with simple conditions with 75% to 90% supervision & constant feedback
At this level, performance may be inconsistent & clinical reasoning* is performed in an inefficient manner. Performance reflects little or no experience.
Level 1 - Beginner to advanced beginner
By the end of the 2nd Clinical Practicum, the average student is expected to carry a ~50% of the patient load of a PT from admission to discharge.
A student who requires clinical supervision <50% of the time managing patients with simple conditions, and 75% of the time managing patients with complex conditions.
At this level, the student demonstrates consistency in developing proficiency with simple tasks (e.g.: medical record review, goniometry, muscle testing, and simple interventions), but is unable to perform highly skilled examinations, interventions, and clinical reasoning skills.
Level 2 – Advanced beginner to Intermediate
An average student requires clinical supervision less than 25% of the time managing patients with simple conditions, and 50% of the time managing patients with complex conditions.
At this level, the student is proficient with simple tasks and is developing the ability to consistently perform highly skilled examinations, clinical reasoning and interventions.
The student is capable of maintaining 75% of a full-time physical therapist’s caseload.
Level 3 – Intermediate to advanced Intermediate
A student is independent managing pts with simple conditions & requires cueing in < 25% of the time managing new pts or pts with complex conditions.
At this level, the student is consistently proficient and highly skilled in simple and complex tasks for highly skilled examinations, interventions, and clinical reasoning. Student consults with others and resolves unfamiliar or ambiguous situations.
The student is capable of maintaining at least 75% of a full-time physical therapist’s caseload in a cost effective manner.
Level 4 – Adv. Intermediate to Entry to Practice
A student who requires minimal clinical supervision or guidance in managing patients with simple or highly complex conditions, and is able to function in unfamiliar or ambiguous situations.
At this level, the student is consistently proficient at
highly skilled examinations, interventions, and clinical reasoning, and is a capable of serving as a consultant or resource for others.
With Distinction*
The student is capable of maintaining the expected
physical therapist’s caseload or more (according to level & seeks to assist others where needed.
The student is capable of supervising others. The student willingly assumes a leadership role* for
managing pts with more difficult or complex conditions.
Actively contributes to the enhancement of the clinical facility with an expansive view of PT practice & the profession.
With distinction*
Checking this box indicates that the student’s performance on this competency is unacceptable for this clinical experience.
If checked, written comments need to substantiate the concern, additional documentation such as a critical incident form and learning contract are required with a
Must inform the ACCE
Provides an early warning system to identify student performance problems thereby enabling the CI, student, and ACCE to determine a mechanism for remediation, if appropriate.
Significant Concerns Box
✓
+ Comments section for feedback
To confirm strengths
To learn about areas for improvement
To identify barriers to achieving goals
To encourage alternative behaviours & actions
To provide motivation for change.
+ Student Feedback
Students want to know…
How am I doing?
How can I improve?
What does my supervisor think of my work?
Gaiptman & Anthony, 1993, Kadushin (1992)
Supervisees reported receiving far too little direct feedback, especially feedback that was
critical
+ Fostering Self Critique
What they want to work on
What they need to work
Climate and opportunities for self-critique
+ Students in difficulty – problem learner What to do?
Define the problem and gather your data
Determine the impact on the supervisor, the student, the system and the patient
How will you address it? How will you involve the student?
Who should be involved in the intervention?
What is your time frame?
Explain the difficulties
Define clear expectations of performance
Involvement of ACCE to support the supervisor or the student
Ensure Confidentiality
Failure of a stage student allowed ONE remedial placement
Should be flagged early and given fair chance to remediate (unless safety issue)
Reason’s for failure: Safety, not achieving requirements, lack of awareness of weaknesses, lack of initiative to change/improve
Failures
Pass/fail decision-making
Identify gaps & communicate to student, CCCE and ACCE
Set specific objectives, plan in place to achieve them, evaluate
Objectives met = pass
Objectives not met = fail
Roles
Clinical supervisor: closest to the situation; makes the decision as to how important the gaps are.
CCCE: support the clinical supervisor throughout the process.
ACCE: guide the decision-making/supports the student/clinical supervisor
If going into extra time need to know if passing or failing
If passing, extra time is to consolidate
If failing, extra time is because there is a potential for achieving criteria in 2-4 extra weeks
Used to provide a global perspective of the student’s performance across all key competencies at midterm and final evaluations.
Provide a section for the rater to comment on the overall strengths, areas requiring further development, other general comments, and any specific recommendations with respect to the learner’s needs, interests, planning, or performance.
Comments should be based on the student’s performance relative to stated objectives* for the clinical experience.
Summative Comments
+ Outcome of placement - recommendation
Please check one of the following boxes with your recommendation regarding the student’s overall performance. This recommendation, along with the completed ACP, will be taken into account by the university faculty when assigning the final grade for the course.
Credit with exceptional performance - student's overall performance is exceptional and exceeds expectations for a student at that experience level
Credit – student’s performance meets expectations for a student at that experience level
Credit with reservation – student’s performance is borderline, demonstrating areas of weakness that may require remediation
No Credit – student consistently performs below the expected level and/or demonstrates significant deficits in professionalism, communication, safety or clinical reasoning
+ En francais…
Veuillez cocher une des boites suivantes afin d’émettre votre recommandation concernant la performance globale de l’étudiant en stage. Cette recommandation, conjointement avec l’ensemble des informations consignées dans l’ACP, sera considérée par l’Université afin d’établir le résultat final du stage.
Réussite avec distinction – La performance globale de l’étudiant est exceptionnelle et dépasse les attentes pour un étudiant à ce niveau de stage
Réussite – La performance de l’étudiant correspond aux attentes pour un étudiant à ce niveau de stage
Réussite minimale – la performance de l’étudiant est à la limite inférieure des attentes pour un étudiant à ce niveau de stage et il démontre certaines lacunes qui pourraient nécessiter un suivi particulier
Échec – la performance de l’étudiant est constamment en deçà des attentes pour un étudiant à ce niveau de stage et/ou il démontre des lacunes importantes au niveau du professionnalisme, de la communication, de la sécurité ou du raisonnement clinique
+ A few words on grading…
Refer to document for clinical supervisors
+ Tips for Evaluation
Before Meeting Ask student to engage in self evaluation in order to
share perspectives
While Meeting Give balanced feedback Be specific, give examples, use action verbs Discuss differences in evaluation At midterm, set objectives for rest of placement At final, indicate whether performance expectations
were met and identify areas for future improvement Student’s and supervisor’s signature Provide a copy of the CPI to the student
Identify and communicate concerns early on
+ Any strategies you would recommend?
Schedule time for midterm evaluation upon arrival
Obtain feedback from other staff members
Include specific areas for improvement and clear expectations
Discuss in the midterm and final evaluation meeting the rationale behind the comments
Clarify by providing examples to support the feedback
Maintain positive approach to evaluation - provide areas of improvement balanced with areas of strength
Keep the areas for improvement to a reasonable amount so student can focus on these
Set aside time each week to discuss the placement overall
Recognize that each placement is unique
Allow time for the student to adjust
Useful tips for using the ACP
Refer to useful info using ACP
+ Questions on the ACP?
Is there anything you are still not certain about?
Anything we did not cover?
End of placement
Send student self-assessment & clinical supervisor’s ACP to SPOT. Use submit button on the pdf fillable Email attaching the ACP as a pdf file Surface mail – try to avoid
We recommend that the student get a copy of the supervisor’s ACP to improve for future placements. Cc the student on the email
Student completes the evaluation of placement on-line and prints a copy for the clinical site.
Should present placement evaluation to site after final evaluation is discussed.
+ Student Clinical Experience Booklet
Includes: • Learning Outcomes • Learning Contract • Info on site, setting, special
activities, project, etc • Clinical Experiences • Major/Minor Incident Report • Journal • and more…
Student Clinical Experience Booklet
Used for 2 year-period Following completion of the final rotation Original brought to ACCE Copy kept by student
Complete the appropriate student experience sheets.
Completed sheets must be reviewed and signed by the supervising therapist. Don’t forget the cardiorespiratory checklist
+ Small Group Exercise: Scoring Practice Using the ACP
+ Vicky – Level 1 student
Rotation: In-patient Ortho
Observed and assisted her supervisor perform a Berg Balance test > 5 times but still takes a long time to complete the test and tends to omit parts of the test
Requires help to analyze the results and generate treatment goals
Open to feedback and self-identifies the areas of improvements and potential tools to help her
+ Rosie – Level 2 student
Rotation: Acute care setting (Medicine) – Adult & Geriatrics
Communicates easily with the team members In team meetings, she actively participates by commenting
on the activities her clients are doing When doing initial interviews, she has difficulty to speak
loud enough and uses a lot of “technical terminology”
Her progress notes are very detailed, but somewhat repetitive
Responsible for making her own schedule Overwhelmed by her large caseload and difficulty to
complete documentation on time and to prepare her interventions in advance
+ Mark – Level 4 student
Rotation: Out-Patient Ortho Private
Effectively performs manual therapy assessment and treatment technique
Takes too long to complete the initial evaluation
Requires a lot of guidance to decide on which assessment techniques to use (tends to do too much)
Difficulty with analysis of objective information and clinical reasoning
Lacks confidence
+
Learn from common mistakes
+ Case studies – bring examples of challenging clinical supervision situations Describe the situation
Describe the student profile
Discuss strategies with your group
Refer to: Clinical Reasoning Difficulties guide Problem Learner handout
+
MSc A (PT) Curriculum
Masters PT Program
2 Entry points into the program
U1 U2 U3/QY M1 M2
B.Sc in Rehabilitation Science (major PT) Master of Science Applied in PT
CEGEP students
(45)
QY=Students
with a previous Bachelor degree
(30)
75 Graduates
Duration of the program
From CEGEP
3 years with 2 summers off
+1.5 years no summers off
4.5 years
With a previous degree 26 months non-stop (starting fall term)
PT U1 Curriculm
Fall Winter Anatomy - Limbs/back Visceral Anatomy
Mammalian Physiology 1
Mammalian Physiology 2
PT Seminars Introduction to Biomechanics in Rehabilitation Sciences
2 complementary courses Introduction to Professional Practice 1 complementary course
PT U2 Curriculum
Fall Winter Neuroanatomy (brain and spinal cord)
Musculoskeletal Biomechanics
Neurophysiology Research methods
Clinical Exercise Physiology
Introduction to PT Practice
2 complementary courses 2 complementary courses
PT U3 Curriculm
Fall Winter PT Orthopedic Management Integrated Orthopedic
Management
PT Neuro Rehabilitation Integrated Neuro Rehabilitation
Foundations of Professional Practice
Cardiorespiratory rehabilitation
Roles in InterProfessional Teams (inter professional education seminar)
Communication in InterProfessional Teams (interprofessional education seminar)
PT M1 Curriculum Summer
Clinical Practicum I & Clinical Practicum II
Fall Winter Introduction to Pediatric Physical Therapy
Clinical Practicum III New: Patient-centered collaborative care (Interprofessional education seminar)
Advanced Research methods Advanced educational & management strategies
Differential Diagnosis and management
Promoting Healthy Behavior
Integrated Clinical Exercise Rehabilitation (new)
Integrated Pain management
1 Professional complementary 1 Professional complementary
*Professional complementary courses Fall: Advanced cardiorespiratory rehabilitation* Motor control Pelvic floor rehabilitation Cancer rehabilitation Perception & action Winter: Advanced manual therapy Sport physiotherapy Advanced Practice in Stroke Rehabilitation Physical Therapy in Pediatrics
PT M2 Curriculm
Summer Fall
Work on Master’s Research Project
Clinical Practicum IV
Presentation and submission of Master’s Research Project
Graduation with M.Sc (Applied) degree 58 credits
http://www.mcgill.ca/spot/programs/pt/curriculum
+ Shadowing
Wednesday February 3rd afternoon
U1 students from new program (BSc. Rehab Science) paired with M1 winter students “a day in the life of a M1 student”
to provide the M1 student with a sense of mentorship
+ Calendar of Events
Jan 4th - Feb 26th Clinical Practicum 3
Jan – Feb 2016 Searching the Web Workshop Supporting Evidence-Based Practice for a Busy Clinician
February 3rd , 2016 First-Year Shadowing Day (PM)
Apr 25th – June 10th Clinical Practicum 1
June 8th , 2016 Spring Clinical Day
June 13th - July 29th Clinical Practicum 2
Sept 6th - Oct 28th Clinical Practicum 4
+ Thank you for your participation today!
Any questions?
Please complete the workshop evaluation that can be found at the end of your booklet.
Your feedback will help us to improve our workshops and meet your needs.