AHPT 870: Clinical Experience II
Prerequisites: Successful completion of all prior coursework or with permission from
the department.
Credit Hours: (9)
Instructional Method: Internship.
Detailed Description of Course
Clinical Experience II is the second of a series of three clinical experiences. It
requires a full time commitment each week over the course of the clinical experience.
The outcome of the clinical education process is based on the hierarchical pattern.
Each clinical experience builds from previous didactic knowledge and clinical rotation
experience by developing the student's clinical knowledge, critical thinking skills,
and practical application skills. The focus of this experience includes complex patient
examination, evidence based care and treatment, use of critical thinking and clinical
reasoning skills, professional behaviors and adult learning, as well as decision-making
for medically complex patients. Students will have the opportunity to practice the
skills they have learned in supervised clinical settings including any previous setting
not yet experienced within nursing homes, inpatient rehabilitation facilities, and
outpatient rehabilitation clinical sites as well as opportunity to participate in
supervised practice in acute or home health settings.
Detailed Description of Conduct of Course
Students will actively participate in hands-on methods and techniques related to patient/client
management including examination, evaluation, diagnosis, prognosis, interventions
and outcomes measurement. Students will collaborate with a Clinical Instructor in
all aspects of patient care under the direct supervision of the licensed physical
therapist and Clinical Instructor. Students will complete initial evaluations on department
forms or through electronic documentation. Students will develop and present a written
exercise program for patient/family/parents for the patient on which the student performed
an initial examination and developed a PT diagnosis. Students will present a specific
case study to clinicians and therapy team based on physical therapy care provided
and supported by evidence of best current evidence and practice during this clinical
internship. Student will submit a written report of a case study presentation to the
Director of Clinical Education (DCE). Students will write a letter of medical necessity
to an insurance company or federal agency either to argue for continuation of services
or the need for equipment or adaptive equipment for a patient. The student is expected
to provide evidence to support why these services or equipment are necessary. Student
will participate in on-line discussion board with University faculty and peers weekly.
Goals and Objectives of this course will require
Professional Behaviors and Attitudes
Students will:
1) Perform at entry level on Generic Abilities Self-Assessment;
2) Exhibit professional behaviors in interactions with patients, families, caregivers,
other health providers, students, and third party payers;.
3) Utilize discretion in maintaining a balance between professional and personal interactions;
4) Demonstrate collegial interactions and relationships with the Clinical Instructor
(CI)., DCE., and other members of the rehabilitation team, doctors, and other health
care professionals;
5) Demonstrate professional and ethical behavior in all interactions;
6) Maintain a position and attitude that will provide optimal support in all areas
of the clinic operations.
Written and Oral Communication and Interpersonal Relationships
Students will:
1) Communicate with patients, clients, peers, supervisors, and other health care providers
in a respectful manner;
2) Communicate self-reflection assessment including personal strengths and weaknesses
with peers, supervisors, the Clinical Instructor, Director of Clinical Education and
academic faculty;
3) Observe and professionally critique the performance of a physical therapist in
the clinical setting;
4) Communicate appropriately with awareness of socioeconomic, psychosocial, ethnic,
and cultural diversity;
5) Demonstrate empathy and interest in patients and others as individuals;
6) Recognize, interpret, and respond to an individual's body language consistent with
professional guidelines;
7) Demonstrate good listening skills with patients, professional staff, families,
program faculty, and peers
8) Communicate with sensitivity and respect to differences in culture, race, color,
gender, age, national or ethnic groups, sexual orientation, and disability or health
status;
9) Function as a liaison between patients, families and community services;
10) Complete all documentation appropriate for patient, administrative, and educational
purposes in a thorough, accurate and timely manner in accordance with the policies
of the facility;
11) Select and include appropriate and pertinent information from the patient examination
in the medical record;
12) Demonstrate professional and technically correct written communication skills;
13) Explain assessment measures and treatments to patients, families, rehab team members,
and peers at a level of communication effective for the situation;
14) Act as an advocate for patients;
15) Write appropriate long term and short term goals based on analysis of the interaction
of a patient's problems with multi-systems disorders and resources available.
Legal and Ethical Standards of Physical Therapy Practice Management
Students will:
1) Demonstrate an application of the APTA's "Standards of Practice";
2) Practice physical therapy within all ethical and legal practice boundaries, including
all federal, state, and institutional regulations and fiscal management;
3) Adhere to departmental policies and procedures;
4) Abide by APTA's "Guide to Professional Conduct";
5) Practice ethical decision-making and abide by the APTA's "Code of Ethics";
6) Accept responsibility for personal actions when placed in moral and ethical dilemmas
which may arise in the practice of physical therapy;
7) Create cost-effective patient care plan including writing a letter of medical necessity,
outcome assessment, and health and wellness promotion upon patient care discharge;
8) Demonstrate working knowledge of roles and responsibilities of practitioners and
support staff within the healthcare system;
9) Delegate and supervise PTAs, rehab assistants, and administrative staff to meet
patient goals and outcomes effectively;
10) Demonstrate working knowledge of reimbursement guidelines and practices of physical
therapy including coding and application of ICD-9 codes through utilization and claims
review;
11) Manage resources to achieve patient outcomes expected.
Observe and Perform Safety Precautions
Students will:
1) Display consistent use of universal precautions;
2) Perform consistently safe and appropriate supervision, guarding, and patient transfer
techniques;
3) Utilize good body mechanics for self and others when working with patients;
4) Demonstrate safe patient protocol and request appropriate assistance when necessary;
5) Maintain a safe working environment;
6) Provide a safe and secure environment for the patient;
7) Administer safe and effective treatments modifying plans as needed to meet patient
needs.
Accurately Perform Examination Techniques, Appropriate and Specific to Meet Patient
Needs, Determine PT Diagnoses, and Patient Outcome Prognoses
Students will:
1) Select appropriate methods, including history, systems review, and selected tests
and measures in order to determine the patient’s degree of dysfunction, impairment
or disability;
2) Perform and record accurately the following assessment dependent upon the particular
practice setting and patient needs assessment: a. aerobic capacity and endurance;
b. anthropometric measurements; c. arousal, attention, and cognition; d. assistive
devices assessment; e. circulation (arterial, venous, lymphatic) including vital signs,
f. peripheral and cranial nerve integrity; g. environmental, home, and work (Job/School/Play)
barriers including architectural /environmental barriers assessment; h. ergonomics
and body mechanics; i. gait, locomotion, and balance including wheel chair measurement;
j. integumentary integrity including edema assessment, skin and wound examination;
k. joint integrity and mobility including proprioception, goniometric and arthrokinematic
assessment; l. motor function (Motor Control and Motor Learning) including reflex
assessment and gross sensory testing; m. muscle performance (including strength, power,
and endurance) including manual muscle testing; n. neuromotor development and sensory
integration; o. orthotic, protective, and supportive devices assessments; p. pain
assessment; q. postural assessment; r. prosthetic requirements assessment; s. range
of motion including muscle length and flexibility testing; t. reflex integrity; u.
self-care and home management (including activities of daily living [ADL] and instrumental
activities of daily living [IADL]) assessment; v. sensory integrity; w. ventilation
and respiration/gas exchange; x. work (Job/School/Play), community, and leisure integration
or reintegration (including IADL);
3) Based on patient presentation and current evidence, create a physical therapy plan
of care that is safe, effective, and patient/client-centered;
4) Apply the diagnostic process consistent with practice policies and procedures synthesizing
data to complete a physical therapy examination, evaluation, diagnosis, prognosis,
intervention, and assessment of functional outcomes based on a patient's medical need
and current evidence-based practice.
Patient/Client Management utilizing Evidence-Based Practice
Students will:
1) Assess an individual's safety and fall risk, and develop a program that addresses
safety in indoor and outdoor environments;
2) Identify individuals at risk by assessing health needs and risk factors of individuals
of diverse cultures across the lifespan;
3) Apply theoretical foundations for physical therapy to clinical practice for examination,
evaluation, diagnosis, prognosis, and intervention decisions;
4) Utilize the elements of patient/client management from the Guide to Physical Therapy
Practice; for examination, evaluation, diagnosis, prognosis, intervention and outcomes
for individuals with disabilities across the lifespan;
5) Accurately interpret and apply the results of examination and evaluation procedures
to provide evidenced-based patient care;
6) Develop specific, measureable, achievable, realistic and timely (SMART) goals to
meet patient/client goals and expectations based on available resources;
7) Educate patients about proper exercise and self-care according to the patient’s
demographic, cultural, and medical characteristics;
8) Teach a manual therapy technique to clinical instructor or rehabilitation team
member previously learned within the didactic aspect of the curriculum and apply techniques
to appropriate patient cases;
9) Demonstrate knowledge and use of medical terminology and acceptable medical abbreviations;
10) Show evidence of awareness of precautions, contraindications and indications for
interventions considering anatomy, pathology, and pathophysiology;
11) Determine the type, intensity and time of procedures to effectively treat based
on evidence based practice;
12) Effectively and safely apply under the direct supervision of a physical therapist
modalities and physical agents including but not limited to: a. wound care; b. sterile
technique; c. pressure garments; d. electrical stimulation; e. hydrotherapy; f. massage;
g. paraffin; h. mechanical traction; i. superficial heat; j. cryotherapy; k. ultrasound/phonophoresis;
l. iontophoresis; m. fluidotherapy; n. biofeedback; and o. joint mobilization for
extremities;
13) Monitor the patient responses of interventions and adapt interventions for patients'
safety and best outcomes of patient care;
14) Effectively and safely select, administer and modify the following procedures
to meet patient needs and best outcomes: a. therapeutic exercises; b. manual exercises;
c. mobilization technique; d. range of motion exercises; e. stretching/flexibility
exercises; f. strengthening exercises; g. aerobic exercises; h. PNF; i. Bobath techniques;
j. Brunstrom techniques; k. balance and coordination exercise; l. vestibular exercises;
m. muscle energy techniques;
15) Demonstrate proactive learning by utilizing opportunities to practice alternative
treatments such as but not limited to pain management techniques, shortwave and microwave
diathermy, light therapy, intermittent compression devices, acupressure, acupuncture,
yoga, aquatic therapy, hippotherapy, and virtual reality therapy;
16) Instruct patients and family/guardians how to safely guard patient while performing
activities of daily living;
17) Teach the patient and family/guardians safe transfer techniques, mobility training
with wheelchairs and assistive devices;
18) Instruct patients and family/guardians regarding environmental modifications for
safety;
19) Integrate the principles of research methodology and statistics into the practice
of physical therapy;
20) Apply research using the scientific method to clinical problems solving in physical
therapy practice.
Life Long Learning Behaviors
Students will:
1) Practice under the guidance and direction of a licensed physical therapist representing
the profession of physical therapy in a professional manner;
2) Assume responsibility for personal professional growth and development;
3) Demonstrate the ability to self-direct, self-assess, and self-seek new knowledge
and understanding within the scope of physical therapy practice.
Assessment Measures
Students may be assessed based on daily direct supervision and weekly meetings with
his/her on-site Clinical Instructor. Competency grading may be assessed using the
Clinical Performance Instrument (CPI). The CPI tool uses a Visual Analog Scale (VAS)
measuring from 0-100mm (100%) on the VAS. Assignments may include: participation in
patient examinations and treatments under the supervision of a licensed physical therapist,
written assignments, presentations, and on-line discussion board participation with
University faculty and peers.
Other Course Information
None
Review and Approval
May 9, 2017
February 10, 2014