Applied Health Physical Therapy 890

AHPT 890:  Clinical Internship III
Prerequisite: Successful completion of all course content areas taught in the third year of the doctor of physical therapy program or permission of the Department.
Credit Hours: (10)

Clinical Internship III is the last of a series of three internships. This internship is the finale of clinical internships and of didactic curriculum. It requires 40 hours per week for 12 weeks. The focus of this internship is to assimilate didactic knowledge of professional behaviors and decision-making for medically complex patients. Students will have the opportunity to enhance the skills they have learned in the classroom and supervised clinical settings in a practice area relevant to that of a licensed physical therapist. At the conclusion of this course, students will be expected to have entry-level skills as practitioners of physical therapy.

Detailed Description of Course

Clinical Internship III is the last of a series of three internships. This internship requires 40 hours per week for 12 weeks. The learning goals of this clinical education experience are based on the hierarchical series of courses in the program. Each clinical internship builds on previous clinical internship experience(s) developing the student's clinical knowledge, critical thinking skills, and practical skills. As students’ progress through the clinical internships, the focus is on the complex patient’s examination, evidence-based care and treatment, use of critical thinking and clinical reasoning skills in order to meet entry level demands of practice. The focus of this internship is to progress professional behaviors and adult learning and 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 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 electronic documentation. Student will develop and present a written exercise program for patient/family/parents for the patient 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 and current evidence and practice during this clinical internship. Student will submit a written case report of 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 for either argument for continuation of services, or need for equipment or adaptive equipment for a patient. The student is expected to provide evidence of support to 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 may require students to:

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 Clinical Instructor, Director of Clinical Education, 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, 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 plans, outcome assessments, and health and wellness promotion upon patient care discharges;
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) Perform multiple chart reviews to assess accuracy in following reimbursement guidelines and practices of physical therapy including coding and application of ICD-9 codes;
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 when working with patients;
4) Demonstrate the 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) Develop and implement culturally sensitive and evidence-based comprehensive care plans;
2) Identify individuals at risk by assessing health needs and risk factors of individuals of diverse cultures across the lifespan;
3) Apply theoretical foundation 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 techniques; 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


Review and Approval

February 10, 2014