+

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

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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 adriana.ventrini@mcgill.ca Crystal Garnett 514-398-4400 ext.09678 crystal.garnett@mcgill.ca 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 clinicaleducation.spot@mcgill.ca 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.