Revised Date: 7/2/2018
The purpose of the clinical education curriculum is to provide the physical therapy student the opportunity to apply didactic knowledge, develop professional behaviors, and practice hands-on skills. This aspect of the educational experience is essential in developing the practice of physical therapy. Within the clinical setting, the physical therapy student has the opportunity to advance both their integration and application of knowledge, skills, and values.
The clinical education curriculum aims to cultivate graduates that are generalists in the field who are able to restore physical function and performance, prevent physical injury and disease, promote wellness, and advance rehabilitation science. Therefore, clinical education will occur in clinically and geographically diverse settings to afford the student opportunities to experience an interdisciplinary team approach within inpatient medically-complex, elective rehabilitation specialty, and outpatient community-based settings.
Purpose of this Handbook
The Clinical Education Handbook is designed to guide the student, the Site Coordinator of Clinical Education (SCCE), and the Clinical Instructor (CI) through the clinical education curriculum and policies of the University of Maryland School of Medicine (UMSOM) Department of Physical Therapy and Rehabilitation Science’s (PTRS) Doctor of Physical Therapy (DPT) Program. It is the intent of this handbook to improve communication and clarify expectations between PTRS, clinical sites (the facility), and the students regarding policies and procedures surrounding clinical education. The Clinical Education Handbook does not replace the necessary communication between the clinical sites and PTRS. Both the student and the clinical facility will have a copy of the Clinical Education Handbook. It is required that the Clinical Education Handbook be read prior to the student’s arrival at the clinical site and be utilized as a reference during the clinical education experiences. The department reserves the right to update and revise the Clinical Education Handbook. Students will be notified if changes are made. It is the responsibility of the student to check for the most current version.
The student must adhere to any revisions made to the policies and regulations made in the Clinical Education Handbook. The revision date will be posted on the departmental website. The student is required to read the Clinical Education Handbook on at least a yearly basis and review the Clinical Education Handbook prior to each part time and full time clinical experience to familiarize themselves with the stated policies and any potential changes.
PTRS Academic Policy
The UMSOM PTRS DPT Student Handbook describes the DPT Program policies for all enrolled students. The current version of the DPT Student Handbook is available at http://pt.umaryland.edu/Other/Doctor-of-Physical-Therapy-Student-Handbook/. The Clinical Education Handbook is supplemental to the DPT Student Handbook and provides information unique and specific to Clinical Education and to the clinical education blocks.
PTRS reserves the right to update and revise student handbooks. The students must adhere to any revisions made to academic policy. The revision date will be posted on the departmental website.
Integrated Clinical Experience (ICE)
ICEs occur during the Fall and Spring semesters in Year Two of the program. The main purpose of ICE is to introduce the student to the clinical environment and to develop clinical and professional skills. The ICE experiences include clinical patient care under the supervision of a clinical instructor, a Professional Practice Opportunity (PPO), and various professional development activities. The Clinical Skills Assessment is utilized for grading.
Full Time Clinical Experiences
The student will complete three full time clinical experiences in year three of the DPT program. Each clinical experience is eleven (11) weeks in length. Students are required to complete one clinical experience in each of the following categories: medically complex, elective rehabilitation specialty, and community-based. Students will have exposure to patients/clients across the lifespan in a variety of settings. As students progress through each clinical education experience, performance expectations increase from intermediate to entry-level and beyond. Each experience has an assignment associated with it.
Organizational Structure of Clinical Education (ClinEd)
ClinEd is located in Suite 115 of the Allied Health Building and has a general department email address that is available to all those within the office.
Director of Clinical Education (DCE)
The DCE holds a faculty appointment and has administrative, academic, service and scholarship responsibilities consistent with the mission and vision of PTRS. The DCE has the primary role and responsibility to develop, coordinate, administer, and evaluate the clinical education portion of the academic program. The DCE is the faculty member who is responsible for determining student grades for the Clinical Education blocks that occur in the second and third year of the curriculum. The DCE maintains communication with students during their clinical experiences and serves as the liaison between PTRS and the clinical site. The DCE is also responsible for evaluating clinical education sites and facilitating ongoing development of clinical education sites and clinical education faculty.
The Assistant Director of Clinical Education (ADCE)
The ADCE holds a faculty appointment and has administrative, academic, service and scholarship responsibilities consistent with the mission and vision of PTRS. The ADCE is responsible for clinical site communication, both potential and extant, to establish and maintain contracts, and to assist in coordinating student placements in conjunction with the program’s faculty. The ADCE assists with communication with students during their clinical experiences and with the clinical supervisors and staff at partnering facilities. The ADCE also assists with evaluating clinical education sites and facilitating ongoing development of clinical education sites and clinical education faculty.
Administrative Clinical Education Assistant (ACEA)
The ACEA is a staff employee of UMSOM. The primary role of the ACEA is to provide complex administrative support to the Director of Clinical Education within the Doctor of Physical Therapy program. This includes but is not limited to: managingthe clinical education database and software systems, assisting the DCE and ADCE on a daily basis with a variety of tasks, including data entry of the student and clinical instructor information into Web CPI . The ACEA is responsible for collecting and organizing data on each student cohort and clinical site to report to faculty.
Site Coordinator of Clinical Education (SCCE)
The SCCE is an employee of the clinical facility who has specific qualifications and is responsible for coordinating the assignments and activities of the student at the clinical education site. The SCCE is often a physical therapist or physical therapist assistant. In some cases, nonphysical therapist professionals who possess the skills to organize and maintain appropriate clinical education programs will serve as the SCCE. The SCCE should be experienced in clinical education. The SCCE demonstrates knowledge of contemporary issues of clinical practice, management of the clinical education program, educational theory and issues in health care delivery. The SCCE demonstrates ethical and legal behavior and conduct that meets or exceeds the expectations of members of the profession of physical therapy. The SCCE is responsible for assigning and monitoring Clinical Instructors. The SCCE will also communicate with the DCE, CI and Student to assist with problem solving, addressing conflict, and coordinating learning experiences.
Clinical Instructor (CI)
The CI is an employee of the clinical facility and is responsible for direct supervision and mentoring of the student in the clinical setting. The CI demonstrates clinical competence and legal and ethical behavior that meets or exceeds the expectations of members of the profession of physical therapy. The CI demonstrates a desire to work with students by pursuing learning experiences to develop knowledge and skills in clinical teaching. The CI holds a valid license as required by the state in which the individual provides physical therapy services. The CI provides physical therapy services that are consistent with the respective state practice act and interpretive rules and regulations. The CI provides physical therapy services that are consistent with state and federal legislation, including, but not limited to, equal opportunity and affirmative action policies, ADA and informed consent. CIs must have a minimum of one year of full time (or equivalent) post-licensure clinical experience and be effective role models and clinical teachers. For a detailed description of the CI position, refer to the APTA’s online documentation https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BOD/Education/ClinicalInstructors.pdf. CIs are assigned a student by the SCCE. PTRS expects that all clinical education faculty are interested in developing/enhancing clinical teaching.
Responsibilities of the CI include:
Throughout the clinical education curriculum, the student must assume many roles and corresponding responsibilities. In assuming these responsibilities, the student will be held accountable for their own actions at all times. The student is a representative of UMSOM and is responsible to the following entities: the University of Maryland, School of Medicine, PTRS, clinical facility, SCCE/CI, and patient as follows:
Open and Proactive Communication
The DCE, SCCE, CI, and the student are to be in close alliance and communication in achieving the goals of creating an optimal learning experience and ultimately a competent practitioner. To meet these goals, all must communicate with one another in a meaningful and productive manner. If at any time the CI/SCCE has concerns regarding the quality of the student’s performance, it is their responsibility to contact the DCE and jointly determine a plan of action to address the problematic areas. If at any time the student or the CI/SCCE has a concern about the learning or clinical environment at the facility, they must contact the DCE immediately. The CI/SCCE/student is encouraged to contact the DCE at any time during the clinical experience.
The DCE will be available for communication or a physical site visit (when practically possible) while the student is on a clinical experience. Purposes of these visits are to:
The DCE will also monitor student learning within the clinical setting via the required weekly assessment forms and the mid-term and final CPI. If necessary, additional monitoring will occur.
Housing and Transportation
It is the responsibility of the student to secure and finance transportation and appropriate living arrangements during all clinical experiences. When indicated in the clinic files, housing or assistance to obtain housing may be provided by the facility; some sites provide housing at no expense to the student or at a modest cost.
Please refer to the Potential Hazards section of the PTRS DPT Student Handbook.
As a professional, the student is responsible to supply their own tools of the trade which include items from the PTRS PT kit and other writing/organizational materials requested by the clinic.
Refer to Section II of the PTRS DPT Student Handbook.
The student is expected to be prompt and to work the assigned regular working hours of the CI (this does not include CI vacation days). On occasion, the student may need to stay beyond typical hours to complete patient care and/or documentation. Holidays will be determined by the schedule of the clinical facility and not by the University’s schedule. The student must abide by the policies and procedures of the hospital/department concerning breaks during working hours.
To meet the requirements of the University for passing the clinical experience, the student is expected to work a minimum of 40 hours per week as outlined in the syllabus. In special cases, a clinical site may deem 35 hours per week equivalent to a full time 40 hour work week. Students are required to accurately document their weekly hours in CORE ELMS. Failure to provide accurate documentation of worked hours will be considered a violation of the honor code.
Excused Absence Policies for Clinical Experiences
To pass a clinical experience, each student must complete the minimum number of hours as specified in the syllabus. To maintain normal academic progression and anticipated graduation date, the required clinical hours should be completed between the start date and the end date of the semester in which the student is registered for the clinical experience. If clinical hours cannot be completed during the semester, the student may fall behind in academic progression and graduation. The program does not guarantee make-up days can be scheduled to avoid progression and graduation delays.
The clinical site, not the PTRS program, determines how many UMB students can rotate at a site at any time, how many hours per day clinical site preceptors are available to supervise students, and how many days a week a student may be present at the site. Reasonable cooperation with clinical site requirements helps to ensure good relations and is a factor in ensuring the program has an adequate number of sites for PTRS students, given the competitive environment for placements.
To allow all students the opportunity to have a reasonable number of excused absences (refer to PTRS DPT Student Handbook for description of excused absences), the following guidelines apply:
The maximum number of excused absences per student per full time clinical experience that usually can be accommodated by the program is two days. The program will make reasonable efforts to arrange make-up days for a student, up to the maximum number of days of absence permitted. However, it may not be possible for PTRS to accommodate all excused days without progression delays. The DCE reserves the right to require an alternate assignment of the student to ensure mastery of the content as part of the make-up plan.
Absences exceeding the maximum number permitted may unreasonably interfere with the student’s continuity of experiential learning. A student may request additional absences but there is no assurance make-up days will be possible or pedagogically advisable. A student may be directed to seek academic advising and consider other options, e.g. withdrawal from the clinical experience or to request a grade of Incomplete.
Students who know in advance when they will be absent are required to submit an absence request in CORE ELMS. Under some circumstances, an advanced request may allow a student to complete a make-up day in advance of the excused absence, which may reduce the risk that the student will fail to complete the required clinical hours during the semester.
In the event the student misses a clinic day secondary to the clinic closing or the clinic’s inability to provide CI coverage, the student may be required to make-up the missed time. If the facility cannot accommodate missed time, the student may be required to complete missed time at another facility or complete an alternative assignment at the discretion of the DCE to ensure the student’s mastery of the content objectives.
Decisions about scheduling and placement are made at the discretion of the program and are subject to the PTRS Essential Requirements for Admission, Academic Advancement and Graduation and requirements of the clinical site.
In the event of illness, injury or family emergency, the student is responsible for contacting the DCE and CI/SCCE immediately and will maintain contact on a daily basis with the DCE and CI/SCCE throughout the absence. At the time of the event, the student must 1) call the facility to inform the CI/SCCE of their absence, 2) immediately following the phone call, the student must send an email to the CI/SCCE, referencing the prior phone call regarding their absence, and email@example.com must be copied on that email. Failure to follow this policy will result in the absence being considered an unexcused absence. If a student’s illness-related absence extends longer than three days, the student is required to submit a doctor’s note to the DCE and clinical site. If accommodations are necessary, the student must consult directly with the Director of Student Affairs.
Request for Time Off
Students are not permitted to request schedule changes or days off from their CI/SCCE, even if they intend to make up the time, without prior written approval of the DCE. To request a clinic schedule change or to accommodate a known event, the student must provide a written request with supporting documentation (when appropriate) to the DCE. Based on the merits of the request, the DCE may grant the student a change in clinic schedule, if the clinic is able to accommodate the altered schedule. It is expected that all missed clinic time will be made up and, the DCE in coordination with the CI/SCCE and student, will formulate a plan to that effect. In the event that a student does not request prior approval from the DCE, the absence or shift in clinical schedule will be consider an unexcused absence.
In the event of severely inclement weather (e.g. blizzard, hurricane, tornado) or other states of emergency, the student should ensure their personal safety first. The student is not part of the employed facility and is not expected to respond in these types of events. If an absence occurs due to inclement weather, the student must 1) call the facility to inform the CI/SCCE of their absence, 2) immediately following the phone call, the student must send an email to the CI/SCCE, referencing the prior phone call regarding their absence, and firstname.lastname@example.org must be copied on that email. Failure to follow this policy will result in an unexcused absence.
If there is an unusual event or accident/injury with patients, employees, other students, visitors, or the student, the CI/SCCE and the DCE must be notified as soon as possible. At the time of the event, the student must immediately follow up with an email to the CI/SCCE, referencing the event and copy email@example.com on the email. The student must fill out a University of Maryland School of Medicine incident report and PTRS is required to notify the liability insurance carrier for PTRS. The facility may also require an incident report.
Documentation and Charting
Documentation needs to be timely, accurate, thorough, and concise. Each facility will have standards for documentation to which the student must adhere. For full time clinical education experiences, it is recommended that the student become acquainted with the facility’s documentation style and system. The following are general documentation guidelines:
Clinical Affiliation Agreements
All facilities must have a clinical affiliation agreement. Please see policy for Developing New Clinical Facilities.
Student Information Shared with the Facility
In initial confirmation with the facility, the DCE shares the student’s name, class year, and general clinical interests (as known), as well as academic objectives and curricular plan for the student’s clinical experience.
Students with approved accommodations through the Office of Educational Support and Disability Services will inform the DCE and their clinical facility liaison of any accommodations that will impact their performance in the clinical setting. The student is required to provide the DCE with their accommodation paperwork prior to contacting their site. The student will share accommodation information with their clinical site liaison upon initial contact. If a clinical site is unable to meet the approved accommodations for the student, an alternative clinical placement will be provided for the student. If necessary, the student and SCCE may communicate earlier than usual in order to prepare for meeting such accommodations.
The student is responsible for sharing all information related to health records, immunizations, and any additional testing required by the clinical facility with the SCCE/CI. PTRS provides a mechanism for storing and sharing this information within CORE ELMS. Some sites may require that this information be shared in a different manner and sites may have a set of requirements for the student that differs from the standard requirements laid out in CORE ELMS. Details on those sites are made available in CORE ELMS as Clinical Education is made aware of them.
The University discloses education records without a student's prior written consent under the FERPA exception for disclosure to school officials with legitimate educational interests. A school official is a person employed by the University in an administrative, supervisory, academic or research, or support staff position (including law enforcement unit personnel and health staff); a clinical instructor or preceptor employed by a facility with whom the University has contracted as its agent to provide a clinical training experience for the institutions students instead of using University employees or officials, a person serving on the Board of Trustees; or a student serving on an official committee, such as a disciplinary, student progress, or grievance committee, or assisting another school official in performing his or her tasks.
When provided with a student’s education records for legitimate educational reasons, Clinical Instructors, or Clinical Education Supervisors shall be under the direct control and authority of the Program with regard to the use, maintenance and disclosure of such records and identifiable information from such records.
Block grades are assigned by the DCE. The DCE will utilize feedback provided by the CI in determining the block grade. The student must pass the specific criteria outlined for the Clinical Skills Assessment/Clinical Performance Instrument in order to pass the block.
Refer to DPT Student Handbook - Section III regarding policies regarding passing criteria for written assignments, PBAs, and projects.
If a student does not achieve the passing standard on the Clinical Skills Assessment (CSA), Clinical Performance Instrument (CPI), or assignment, the student will be given an Interim Block Notice (IBN) by the block leader. The IBN will contain information related to the academic deficit and the student is strongly encouraged to meet with the DCE for direct feedback on areas needing improvement. The Director Student Affairs also receives a copy of the IBN. The Director or DCE may employ the Academic Advancement Committee (AAC) to assist in making recommendations to facilitate student success.
Deductions for failure to meet written assignment expectations are as follows:
Deductions for any unexcused absence of a mandatory event are as follows:
Deductions for any unexcused clinical absence are as follows:
If the SCCE/CI/DCE has concerns regarding the student’s progress, the student may be referred to the AAC for review and recommendation and/or placed on a learning contract to assist the student and CI to outline key steps to mark successful progression in the clinical experience.
Prior to receiving a final grade, each student must complete a Block Evaluation and Clinical Experience Site Evaluation for all Clinical Education Blocks.
Integrated Clinical Experiences (ICE)
The grade for ICE experience blocks is a combination of clinical performance, quality of completed assignments, participation in mandatory events and labs, and ethical and professional behavior. The student is responsible for their own academic work and progress. Grades will be determined based on the course rubric.
Passing level for the Clinical Skills Assessment for each ICE is outlined in the course syllabus and rubric.
Full Time Clinical Experiences
The grade for Full Time Clinical Experience blocks is a combination of clinical performance, quality of completed assignments, participation in mandatory events and ethical and professional behavior. The student is responsible for their own academic work and progress. Grades will be determined based on the course rubric.
Clinical Performance Parameters for Full Time Clinical Experiences
The APTA’s web-based Physical Therapist Clinical Performance Instrument (webCPI/CPI) tool will be utilized to assess clinical performance parameters. This parameter is graded Pass/Fail. Both the CI and the student will complete individual copies of the CPI for formal review at both midterm and final. Students are expected to achieve at least the established minimum consistent performance level on each individual competency. In addition, both written and verbal feedback from the SCCE, CI(s) and/or the student at the facility, as well as other data garnered by the DCE weighs in the block grade decision.
The DCE evaluates that by the end of the final clinical experience the student has received an entry level score on all criteria on the webCPI. The CPI comments, as well as communication with SCCEs/CIs, students and core faculty will be taken into consideration in evaluating the student’s readiness for graduation.
Upon removal from the facility, the DCE will assess the student’s learning needs. Based on the results of this assessment, the DCE may direct the student to the Director of Student Affairs and/or the AAC for academic advisement.
Removal from a clinical site may result in failure of the clinical experience.
Refer to the DPT Student Handbook - Section IV.
In addition, students are expected to meet professional behavior guidelines outlined for their specific clinical site.
If a student receives a PVN during a Clinical Education Block, there will be a 5% point deduction from the student’s final grade in that block.
The students must follow the Protected Health Information (PHI) Standards regarding information about patients and their families. This information is strictly confidential. It should not be shared with friends, family, or other health care providers except in need-to-know situations, such as emergencies. Each student is responsible for clarifying each clinical facility’s regulations on confidentiality and information sharing. Each clinical facility is responsible for informing the student of specific confidentiality and/or HIPAA regulations upon orientation to the facility. Any assignments from the clinical experience must be de-identified of all personal information prior to submission to PTRS. Patients also have the right to refuse treatment by a student at any time.
Breach of patient confidentiality is a federal offense and may be subject to penalty under law. Breach of patient or facility confidentiality will result in immediate removal from facility and referral to the Director of Student Affairs and the Academic Advancement Committee for review.
Due to the facility complexity and rigor, some facilities have greater expectations of performance and productivity and require advanced student skills. Examples include:
Clinical assignments are subject to change for various reasons, including changes in clinical staffing, suspension of student programming, and the facility closure. If a clinical site is cancelled, the student will be reassigned by the DCE. If the student’s ability to attend clinic is hampered, the student must notify the Clinical Education office as soon as the issue is identified.
The facility SCCE is responsible for CI selection. Upon signing the Affiliation Agreement, a link to the Clinical Education handbook that outlines CI qualifications is provided to the facility. Each CI completes an online demographic survey. If the CI does not meet the PTRS qualifications, another CI will be selected by the SCCE or the student will be reassigned to another facility.
Students are NOT permitted to contact clinical education sites to establish contracts or request clinical placements. All contract initiation and clinical placements requests are solely managed by the PTRS clinical education office.
ICE Site Assignments
Students are randomized for ICE placements; however, final placement is based on DCE decision. Every endeavor is made to procure two different setting types during ICE for all students. Student interest outlined in the Clinical Interest Form is taken into consideration.
Full Time Clinical Experience Site Assignment Process
Each student submits a form that includes clinical interests, potential conflicts of interest, and specific clinical sites/locations of interest. The PTRS Clinical Education office compiles a list of available clinical placement sites based on the request for site forms received from clinical facilities. Each student submits a form ranking their top preferences based on the list of available clinical sites. Students are randomized by CORE ELMS for clinical site assignment based on the submitted rankings for sites that do not require an advanced interview or application process. The DCE reserves the right to adjust clinical site assignment as needed based on facility and student needs. Finalized placement decisions are made available in CORE ELMS. Students will be randomized for clinical site assignment for each clinical experience.
Defined as patients with a recent or ongoing medical condition with additional >1 chronic diagnoses (requiring frequent monitoring of physiological stability) in the inpatient setting.
Conflict of Interest and Site Selection
During the site selection process, the student must provide possible conflicts of interest on the clinical interest form. If at any time the student feels that there are additional potential conflicts of interest, it is the student’s responsibility to make this known to the DCE. Failure to do so may result in cancellation or removal from the experience and/or disciplinary action. The DCE has final authority regarding any potential conflicts between students and clinical facilities.
Student declination of a confirmed site
Once a student is confirmed at a clinic site and that information is made available to the student in CORE ELMS, the student may decline placement at the site by completing the Site Declination Form. By doing so, the student agrees to the following:
Immediately following posting of the site assignments, student names will be sent to the facilities for confirmation of UMB slot availability. Students will be given an assignment to contact their clinical site ~8-10 weeks prior to the start of the clinical experience. If a student contacts their site prior to the date provided by ClinEd, the student will forfeit their placement at this clinical site. If this occurs, site recruitment, rescheduling, and placement of a new clinical experience will only occur after the remainder of the class is scheduled, confirmed, and assured initiation of their clinical experience assignments; therefore, PTRS cannot guarantee that the student will graduate on time.
Policy for Developing New Clinical Sites
New clinical sites will be established at the discretion of the DCE. The primary goals of the DCE is to establish relationships with sites that demonstrate excellence in clinical care and a commitment to clinical education.
Students are NOT permitted to contact clinical education sites to establish contracts or request clinical placements. All contract initiation and clinical placements requests are solely managed by the PTRS clinical education office. If the student is interested in a facility that PTRS does not currently have a contract with, the student should contact ClinEd as early as possible to discuss their interests. In addition, there is a Site/Contract Lead Form available in CORE ELMS to provide information about possible contracts. ClinEd cannot guarantee a contract will be established or that the student will be placed at this facility if a contracted is generated.