PHTH 7810: Clinical Internship I

Course Syllabus

Course Description

One, full-time clinical internship, ten (10) weeks in length. Students practice patient management skills in the clinical environment under the direct supervision of an experienced physical therapist. Students perform patient examination/measurement techniques, evaluate and interpret examination results, determine a physical therapy diagnosis and prognosis, design and implement a thorough plan of care, and evaluate patient outcomes. The student will also practice and progressively develop a variety of skills critical for developing appropriate professionalism. Students should refer to the online course site for ongoing course updates and assignments.

Time Frame

10 weeks full-time, for a total of 400 clinical hours; adjustable time frame at the sole discretion of the Clinical Instructor in consultation with the Director of Clinical Education.

Credit Hours

9

Prerequisite(s)

Successful completion of all didactic coursework-to-date (Year 1) in the Department of Physical Therapy, including: Clinical Experience I (PhTh 6800, part-time clinical exposure – 48hr equivalent); Beginning level Professional Behaviors; and, good standing in the Department of Physical Therapy.

*All students are to provide a copy of their Student Information (General Information & Student Overview via Acadaware) AND their Self-Evaluation to the coordinator and on-site clinical instructor prior to the start of the internship. The Student Information outlines the student’s previous experience and specific internship goals. The Self-Evaluation depicts a student’s self-assessment of each of the CPI performance criterion, tests and measures, and interventions. See the program site for specific curriculum and course information.

Course Coordinator and Instructors

• • Reva Rauk, PT, PhD, MMSc, NCS
  • Director of Clinical Education (DCE) & Assistant Professor (Clinical)
  • 801-581-8665 / 435-901-4803
  •  
• • Brad Jensen, DPT
  • Assigned Clinical Instructor (CI)
  • 801-557-2966
  •  
• • Amy Versteeg, PTA
  • Center Coordinator of Clinical Education (CCCE)
  •  

Student Course Expectations / Objectives

Throughout the internship the student will:

1. Abide by the University of Utah Department of Physical Therapy Student Code of Responsibilities. (See Student Handbook)
2. Demonstrate appropriate professional behaviors and skills in all clinical education scenarios (see APTA Clinical Performance Instrument - CPI)
3. Achieve appropriate level of student performance on CPI evaluation
4. Complete all assignments: **Incomplete grades will be given if not all assignments are in by AUGUST 7!
   
   1. Midterm and Final Self-Assessment with the PT CPI Web: review/compare with the CI’s and/or the CCCE’s evaluation of student performance.
      
      1. Student Intern’s self-assessment – with electronic “sign off”
      2. CI’s evaluation of the student – with electronic “sign off”
         *NOTE: To successfully complete the internship, all evaluations must be “signed-off” by both student & CI! Student & CI MUST “sign-off” on each evaluation in order for the DCE to view & review the evaluation.
   2. Student Evaluation of the Clinical Site: complete near the end of the internship via the Acadaware website (www.acadaware.com).
   3. Canvas Assignments: (Click on assignment links for further info, directions, and assignment examples on the online course site).
      
      1. Submit Site, CI, Student & Schedule information.
      2. Confirm (with Assistance to DCE - Kristin) the midterm on-site or telephone visit.
      3. Minimum of TWO (2) guided reflective journals (additional journaling is highly encouraged) utilizing the Reflective Practitioner (Schön) and Mindful Practice (Epstein). Students are encouraged to share reflective journals with their CIs.
      4. Evidenced-Based Case Report (see criteria posted on Canvas)
      5. A formal In-Service and/or a Project for the site, presented to the clinical faculty/staff.
         
         1. In-service option: complete an evidenced-based educational presentation based on a clinical question from the internship, AND/OR
         2. Project option: complete an evidenced-based project for the site. This should be a site-identified need and will result in a usable product (e.g., wheelchair medical necessity letter template, home exercise program for a specific diagnosis, standardized test collection for a specific diagnosis, etc)
            

            Assignments**	Due
            CI & Schedule Information	Week 1	1
            Reflective Journal 1	Week 2	10
            CONFIRM Midterm On-Site or Telephone Visit	Week 2-4	1
            MIDTERM CPI Signed-Off by BOTH CI AND STUDENT	Week 5	PT CPI Web
            DRAFT Case Report – Submitted to Peer	Week 5	5
            DRAFT Case Report - Peer Critique	Week 6	10
            FINAL Case Report	Week 8	10
            Reflective Journal 2	Week 9	10
            In-service or Project Presentation Completed	Week 10	10
            Student Evaluation of Clinical Site (Acadaware Site: www.acadaware.com)	Week 10	1 Acadaware
            FINAL CPI Signed-Off by BOTH CI AND Student	Week 10	PT CTI Web
            ** Assignments WILL be returned to you if not completed to expectation (see individual criteria).

5. Notes to clinical instructors and students:
   
   1. Students have been instructed on the use of the electronic CPI. They should be able to answer questions regarding implementation, but please feel free to contact the Director of Clinical Education for any clarifications regarding use of the assessment tool.
   2. It is the student’s responsibility to be pro-active in pursuing appropriate clinical learning experiences, pursuing practice opportunities for appropriate skills, and self-initiating the scheduling of student evaluation sessions with the clinical instructor.
   3. These beginning 2nd year (1st internship) DPT students should demonstrate solid performance of basic clinical skills. If there are ANY concerns whatsoever about the student’s performance in any of the CPI skills or any other skill the CI or the CCCE feel the student should be demonstrating, please communicate any concerns to the Director of Clinical Education as soon as possible.
   4. Students are advised NOT to attempt part-time or full-time employment during these full-time clinical internships.

Required Text

• McEwen, Irene, PT, PhD (2009). Writing Case Reports: A How -To Manual for Clinicians (3rd ed.). Alexandria, VA: APTA. [Available through APTA $49.95 student member price]; ISBN: 978-1-931369-62-6.

Recommended Readings

• Educating the Reflective Practitioner, Schon, Donald A., Part 1, pp. 3-40 (on Canvas)
• Mindful Practice, Epstein, JAMA; 282(9): 833-839 (on Canvas)

Evaluation of Student’s Clinical Performance

The University of Utah, Department of Physical Therapy utilizes the APTA Clinical Performance Instrument (CPI) in the evaluation of student performance in the clinic. The evaluation should be reviewed early in the experience, with formal evaluations of the student schedule at least at midterm and near the end of the experience (final).

*The midterm evaluation is completed in weeks 4-5 of the internship; the final evaluation is completed in week 10 of the internship. Interns submit the self-assessment & discuss at the same time as the instructor evaluations – see instruments for further instructions. The DCE is to be kept apprised of the student’s progress and status.

If ANY concerns arise about the student’s performance in any of the criteria please communicate your concerns to the Director of Clinical Education immediately via (435) 901-4803. Addressing these concerns early is prudent and in the best interest of all parties.

If you have any questions about the PT CPI Web training, rating scale, or how to access the site, please contact Kristin Augustine at (801) 585-1462, kristin.augustine@hsc.utah.edu, or Reva Rauk at (435) 901-4803, reva.rauk@hsc.utah.edu. We appreciate the time and energy you invest in educating the next generation of physical therapists!

CPI Web Performance Criteria

Red Flag Items - The Performance Criteria 1-4 & 7 of the CPI are foundational elements of clinical practice, and therefore the student must achieve appropriate performance of each skill by the end of the internship (students are NOT expected to be at entry-level, but “appropriate” for a 2nd year student during a 1st clinical internship). Although effective student performance of these items is essential, these red flag items do not stand alone in the evaluation of student performance. Each skill is critical to the overall assessment of a student’s clinical competence. Students who demonstrate difficulty with any red flag performance criteria require:

• Immediate attention!
• Documentation describing performance deficiency
• Call to the DCE! - ** Any concerns with student performance in ANY of the Red Flag criteria should be communicated with the student and the DCE immediately via 435-901-4803 and/or reva.rauk@hsc.utah.edu for appropriate interventions.
• Development of a plan with the student, clinical site, and academic program to address and improve performance.

Student Performance Rating and Expectations

Student performance ratings must be completed at midterm and near the completion of the internship (final). Ratings are based on six defined anchors with five distinct categories and specific criteria within each category. The scale is designed to reflect a continuum of performance ranging from “Beginning Performance” to “Beyond Entry-Level Performance.” In other words, a rating is given to identify, in your professional opinion, at what capacity the student is performing within your specific clinical setting based on the defined categories.

Lack of appropriate progress is more concerning and should be immediately communicated with the DCE for appropriate interventions. The CI should check the Significant Concerns Box when the student’s performance does not meet the CI’s expectations and the observed deficits place the student AT RISK for not completing the experience successfully. If a student is unsure as to the expected performance level, it is the student’s responsibility to make an appropriate and timely inquiry. Once concerns are brought to the attention of the intern (written and/or verbal), students’ are expected to be responsive. Do not hesitate to utilize the evaluation instruments more frequently if desired. The Weekly Feedback form, Critical Incident Report form and Anecdotal Record form are available within the PT CPI Web. The Professional Behaviors Assessment and APTA Professional Core Values Assessment are also available from the students or the DCE to further diagnose and remediate issues in professional behavior.

The Department of Physical Therapy expects the 1st Internship student may achieve a rating between Beginning and Intermediate performance (intervals 1-2), in ALL 18 performance criteria by the END of the internship.

Lack of appropriate progress is more concerning and should be immediately communicated with the DCE for appropriate interventions. The CI should check the Significant Concerns Box when the student’s performance does not meet the CI’s expectations and the observed deficits place the student AT RISK for not completing the experience successfully. If a student is unsure as to the expected performance level, it is the student’s responsibility to make an appropriate and timely inquiry. Once concerns are brought to the attention of the intern (written and/or verbal), students’ are expected to be responsive. Do not hesitate to utilize the evaluation instruments more frequently if desired. The Weekly Feedback form, Critical Incident Report form and Anecdotal Record form are available within the PT CPI Web. The Professional Behaviors Assessment and APTA Professional Core Values Assessment are also available from the students or the DCE to further diagnose and remediate issues in professional behavior.

Grades

The internship is Credit/No Credit

All assignments must be completed and student interns must achieve appropriate performance ratings throughout the internship to be successful and achieve passing credit. Final determination of internship grades is at the discretion of the DCE in consultation with clinical instructors, clinical coordinators of clinical education, academic faculty and the Department Chair. It’s important to remember the CI does not assign/determine the Pass/Fail course grade. Refer to the Department of Physical Therapy Student Handbook and Clinical Education manual for further information on program progression standards.

Additional Information

Examples of Clinical Training Agreement language of which students must be aware:

“The Facility may immediately remove from the premises any student who poses an immediate threat or danger to personnel or to the quality of medical services or for unprofessional behavior.”

“It is mutually understood and agreed between the parties that the Hospital or the Educational Institution may withdraw any student from the program at any time if the qualifications, performance, or actions of such individual is unsatisfactory or if an individual is disruptive or otherwise interferes with desirable work relationships within the Hospital. If in the opinion of the Hospital or its agents, the health of the student may be detrimental to the health of the Hospital’s patients or employees, the Hospital may remove that student. The above action may be exercised summarily and without recourse.”

APTA Credential Clinical Education Program

The University of Utah highly recommends all Clinical Instructors and Clinical Coordinators of Clinical Education complete the APTA Credentialed Clinical Instructor Education Programs and achieve credentialing. The programs are offered a minimum of annually through the Department.

• Basic Credentialed Clinical Instructor Program
• Advanced Credentialed Clinical Instructor Program

For further information contact the DCE, Reva Rauk, PT, PhD, MMSc, NCS, via reva.rauk@hsc.utah.edu or 801-581-8665, or Kristin Augustine, Assistant to the DCE, at 801-585-1462. 

STATEMENT OF EQUAL ACCESS

The University of Utah and the Department of Physical Therapy seeks to provide equal access to its programs, services, and activities for people with disabilities. If you will need accommodations in the class, reasonable prior notice needs to be given to the Center for Disability Services, 162 Olpin Union Building, 581-5020 (V/TDD). CDS will work with you and the instructor to make arrangements for accommodations. All written information in this course can be made available in alternative format with prior notification to the Center for Disability Services.

ADDRESSING SEXUAL MISCONDUCT

Title IX makes it clear that violence and harassment based on sex and gender (which includes sexual orientation and gender identity/expression) is a Civil Rights offense subject to the same kinds of accountability and the same kinds of support applied to offenses against other protected categories such as race, national origin, color, religion, age, status of a person with a disability, veteran’s status, or genetic information. If you or someone you know has been harassed or assaulted, you are encouraged to report it to the Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action, 135 Park Building, 801-581-8365, or the Office of the Dean of Students, 270 Union Building, (801) 581-7066. For support and confidential consultation, contact the Center for Student Wellness, 426 SSB, (801) 581-7776. To report to the police, contact the Department of Public Safety, 801- 581-2677(COPS).

THE CODE OF STUDENTS RIGHTS & RESPONSIBILITIES

The code is provided in detail on the University of Utah web page. The code specifies student rights as well as conduct involving cheating, plagiarism, collusion, fraud, theft, etc.