Florida International University - Download as DOC

Document Sample
Florida International University - Download as DOC Powered By Docstoc
					                       Florida International University
                        Physical Therapy Department
                              Clinical Education
                                  Fall #4 “B”
                             10-20-08 – 12-09-08

Course Name:   Graduate Clinical Internship IV
Course Number: PHT 6828
Credits: 5
Prerequisites: All didactic and lab courses and internships offered during Fall
               #1, Spring #1 and Summer #1, Fall #2, Spring #2 and Summer

University drop date: The University has established a formal drop date for each
          semester, which serves as the last date that you may “dis-enroll” from
          this course and receive a "DR" grade. It is your obligation to make note
          of that date. Be aware that if you find yourself in "academic trouble" and
          want to avoid a low grade, you may drop this course and receive a "DR"
          grade only if you do the administrative work required to drop this class.

      o Facility Clinical Instructors (CI), facility Center Coordinators of Clinical
          Education (CCCE)

       o   Colleen Rose-St Prix
           MHSA, PT
           Associate Professor Physical Therapy
           Email: stprix@fiu.edu
           Office: HLS-343
           Phone: 348-1943

       o   Steve Bernstein
           PhD, PT
           Clinical Assistant Professor
           Physical Therapy
           Email: bernstes@fiu.edu
           Office: HLS - 245
           Phone: 348-3114

       o   Martha Bloyer
           MSPT, PCS
           Director of Clinical Education (DCE)
           Office: HLS 341
           Office hours: Wednesdays 11:00 am – 2:00 pm
                   Mondays 11:00 – 1:00 pm
           Phone: 305-348-1978
           FAX: 305-348-1979
           E-mail: mbloyer@fiu.edu

           The purpose of physical therapist clinical education is to educate learners
           who, through structured and varied experiences of sufficient excellence and
           breadth and the application of essential knowledge, skills, and behaviors
           under the supervision of competent clinical educators, become competent
           entry-level practitioners.

  Course Description:
        These culminating clinical experiences at the graduate level are supervised,
        full-time, eight week clinical experiences with emphasis on: evidence-based
        practice, clinical decision making, differential diagnosis, administration,
        educational activities, outcomes assessment, and consultation. These
        internships may take place in an acute care setting, orthopedic setting,
        neurorehabilitation setting, pediatric facility or an elected setting. The
        student will also have the opportunity to integrate advanced patient
        management and evaluation skills during this time while working on entry-
        level competencies in physical therapy. The student has completed
        coursework in evaluation techniques and treatment regimens for the
        orthopedic and the neurologically involved patient in both the acute care and
        rehabilitation settings across the lifespan. The ACCE and faculty provide
        consultation and indirect supervision concerning use of the evaluation tool,
        preparation of the students in class and expectations for the clinical

           Tied to this final 8 week internship is a 1 day capstone seminar which
           corresponds with completion of the 7 semester entry level Masters in Physical
           Therapy. The seminar will include full group sessions, smaller breakout
           groups, and patient case study and research project presentations. This
           seminar provides the student with an opportunity for research project
           presentation, "reflective thinking" about the academic and clinical preparation
           program, the opportunity to conduct a self-evaluation and develop a plan for
           professional lifelong learning.

  Student Oriented Objectives:
        The evaluation instrument for Graduate Clinical Internship IV is the Clinical
        Performance Instrument (CPI), 1st Edition, 1997

           Florida International University places great emphasis on the development of
           competent skills in "professional behavior and safety" early in the academic
           curriculum and as a requirement of the first two internships. The
           expectation, for the final two internships, is that the student will continue to
           demonstrate a high level of professional responsibility and achieve "Entry
           Level Performance" on all the skills that they have the opportunity to
           demonstrate in your clinic. Certainly, you are to use the visual analog scale
           to rate the student as you see them in your setting as opposed to marking
           our expectations. The following objectives are a guideline of our
           expectations. Meeting the expected performance is the goal, but not
           necessarily a requirement for passing the internship.

The student must, by the end of the 8-week internship, with at least 90%
       0.0 Practice in a safe manner, which minimizes risk to patient, self and
           others in an out patient orthopedic setting.

       1.0 Present her/himself in a professional manner
          2.1. Show responsibility for her/his own learning
          2.2. be punctual and dependable
          2.3 demonstrate initiative

       2.0 Demonstrate professional behavior during interaction with others
          including but not limited to the patient, their family, colleagues and
          support staff

       3.0 Adhere to ethical practice standards as outlined by their profession as
          well as following institutional policies and procedures

       4.0 Adhere to legal practice standards by abiding by pertinent state and
          federal laws and regulations, including those applying to state
          licensure laws

       5.0 Communicate in ways that are congruent with situational needs

       6.0 Produce documentation to support the delivery of physical therapy

       7.0 Adapt the delivery of physical therapy care to reflect respect for and
          sensitivity to individual differences

       8.0 Apply the principles of logic and the scientific method to the practice
          of physical therapy

       9.0 Screen patients using procedures to determine effectiveness of and
          need for physical therapy services prior to continuing with the physical
          therapy examination

       10.0 Perform a physical therapy patient examination on a simple
          orthopedic patient by selecting reliable and valid examination
          methods, taking an accurate and adequate history, attention to the
          chief complaint and prior screening (please refer to Appendix B of the
          CPI to assist with this objective), a minimum of TEN (10) evaluations
          are required

       11.0 Evaluate clinical findings to determine physical therapy diagnoses
          and the outcomes of care delivered to the patients

       12.0 Design a physical therapy plan of care integrating the goals,
          treatments, outcomes, and discharge plans for the patients in the
          practice setting

          13.0 Perform physical therapy interventions in a competent manner
             (please refer to Appendix B of the CPI to assist with this objective)

          14.0 Educate others that are involved in the patients care by using
             relevant and effective teaching methods

          15.0    Participate in activities addressing quality of service delivery

         16.0 Determine the need for consultation services for her/his patients
            and or provide consultation to other disciplines, agencies, schools or

         17.0 Addresses the patients needs for services other than physical therapy

         18.0 Manage her/his time, space, equipment and/or personnel to achieve
            goals of the practice setting

         19.0 Incorporate an understanding of economic factors in the delivery of
            physical therapy services

         20.0 Use support personnel according to legal and ethical guidelines

          21.0 Demonstrate professional/social responsibilities beyond those
             defined by work expectations and job description

         22.0 Implement a self-directed plan for professional development and
            lifelong learning

         23.0 Address primary and secondary prevention, wellness, and health
            promotion needs of individuals, groups, and communities when given
            the opportunity

   Additionally, the student will…
          24.0 Contribute to Physical Therapy scholarly activity by completing a
             patient case study.

          25.0 Educate the Institution’s employees with an agreed upon in-

          26.0 Participate in enhancing the Physical Therapy clinical education
             program by completing assessments of the ACCE, the clinical
             education experience, and the Clinical Instructor.

          27.0 Participate in any pro-bono work offered by the Institution to the
             relevant community while participating in the clinical internship.

          28.0 Assess his/her performance at both mid-term and the end of the 8
             week experience and include a plan for continued learning.

Upon the completion of the Capstone Seminar, the student will…
           29.0 Reflect upon the clinical internship experiences and analyze any
              ethical dilemmas encountered or any medical error experiences.

           30.0 Reflect upon and articulate the adequacy of the professional
              curriculum as preparation for internship, employment and personal
              short-term and long-term professional development needs.

           31.0 Conduct a self-evaluation and develop a plan for studying for the
              licensure exam and for short-term and long-term professional

           32.0 Present or be involved with the presentation of the final “Patient
              Case Study” and be able to field questions regarding the choice of
              treatment, protocols used and discharge planning.

           33.0    Present the results of their Master's Project.

Required Readings
          Clinical Education Policies and Procedures
          Clinical Performance Instrument
          Handout on “Generic Abilities”
          Guide to Physical Therapy Practice
          Texts and notes from all prior didactic and laboratory courses

Supplies Required:
           Lab jacket
           Name tag with University identification
           Clip board
           Stethoscope and sphygmomanometer
           Gait belt

      100% attendance is mandatory during the clinical experience, and students
      will abide by the facility’s schedule. If the student requires 2 or more days off
      during the internship, arrangements must be cleared through the ACCE first.
      Any decisions to allow a student a day off for a special event in exchange for
      an additional or weekend day are at the discretion of the CI. Illness:
      Rescheduling of missed days due to illness is REQUIRED for greater than 2
      days of illness, and recommended for two or less. The final decision is at
      the discretion of the CI. Unresolved absences will result in a failing grade for
      the course. Please be advised that FIU students are working within
      the time frame of the clinic. Students are to abide by the clinics
      work schedule. FIU does not expect the clinic to change schedules
      to accommodate a student's schedule.

Course Evaluation and Grading Scale:
      Clinical Internship IV will be graded on a pass/fail basis. For a passing
      (“P”) grade, the student must adhere to the following criteria.
     The student should be at or above the percentages listed on the above skills
     to receive the minimum criteria required to receive a passing grade for the
     fourth and final clinical internship. Lower markings on the visual analog scale
     along with critical comments will warrant in-depth review of the student’s
     performance, and may result in required additional didactic work and/or
     require additional clinical time for the student to pass (receive a grade of “P”
     for) the clinical internship. Failure of (receiving a grade of “F” for) the clinical
     internship may also result. The student will also need to be an active
     participant in the scheduled Capstone Seminar.

     Unprofessional (i.e., not punctual, not dependable), unsafe, or unethical
     behavior during the clinical experience will result in a failing (“F”) grade for
     Clinical Internship II, regardless of adherence to other criteria.

     The ACCE and/or the faculty liaison will give the final grade based on the
     criteria mentioned above and the comments, documentation and midterm
     meetings with the Student's Clinical Instructor and student as well as the
     assignments that follow.


     1. Provide the Institution with the following documents.
                Failure to provide evidence of the following when requested by
        the facility will result in a delay of starting the clinical affiliation. The
        student will be asked to go home and obtain these documents; a delay in
        producing them could result in a failing grade (“F”) for the clinical
        internship, regardless of performance.

               a)      Current CPR certification
               b)      Annual TB screening, PPD (or more recent if required by
               c)      Current vaccinations for Hepatitis B (or declination form
                       filled out and signed), Measles-Mumps-Rubella (current
                       MMR) Varricella (Chickenpox), and Diphtheria-Tetanus
                       (current DpT or DT)
               d)      Personal health/medical insurance

     2. Perform a self-evaluation at mid-term and final.
        This can be done in the student’s personal copy of the CPI. The student
        will need to include specific examples in the comment areas. This must
        be completed before meeting with the CI. CI’s should NOT have to
        prompt students to complete the self-eval, but should give students a
        specific date for midterm.

     3. Complete and e-mail or fax to the DCE or faculty liaison the First week
        Information (form attached) on or before the first Friday of the
        clinical internship.

           4. Students are required to complete a detailed case study on one patient
              during PHT 6828. The student will be given a detailed form to follow for
              this case study (attached). This case study should be emailed,
              faxed or mailed to the Academic Liaison no later than the end of
              the sixth week.
               If the student will be using videotape or slides of the evaluation or a
                  treatment session of this patient, informed consent from the patient
                  and approval of the CI is necessary.
               Research and documentation required for this project, which is above
                  and beyond the requirements of the facility, should be completed by
                  the student during their downtime or after hours and should not
                  impact regular clinical activities. The CI is NOT required to coordinate
                  this project, but must be consulted prior to any interaction with the
               The clinical instructor is NOT expected to correct, grade, or review
                   this case study.

           5. Educate the Institution’s employees with an agreed upon in-service.
              This in-service should be completed following the facilities guidelines
              (timeframes, audience, etc.). Some facilities may opt to use community
              service or education to employees in place of this presentation. The
              student is responsible for sending a copy of the outline, any handouts or
              Power Point Presentation along with a copy of the “Evaluation of Oral
              Performance” (forms will be provided) to the DCE. Topics for this
              presentation must be identified by mid-term. Access to in-service topics
              given during the preceding year will prevent duplication. (Please note:
              you are responsible for doing two different in-services during your 4
              mandatory clinical internships.)

           6. Complete the APTA’s “Physical Therapist Student Evaluation:
              Clinical Experience and Clinical Instructor” form provided. The
              student and the CI must sign the report indicating that it has been read.

           7. Participate in any pro-bono work offered by the Institution to the relevant
              community while participating in the clinical internship.

           All paper work is required no late than the last day of the clinical experience.
           If preferred by the facility’s clinical educators, these forms may be mailed by
           the facility to the school, addressed to the faculty member involved in your
           clinical experience. Failure to return all forms on or before the date above
           will result in an “F” Fail grade and could bar graduation.

All students are expected to exhibit consistent, professional conduct in the classroom,
clinic and laboratory settings. The Generic Abilities, Developing Level Criteria, will guide
the students’ conduct. Any student wishing to discuss these aspects of professional
conduct is encouraged to dialogue with the course instructor.

Disability Services
If a student has a disability and needs assistance, please notify the Instructor and/or

contact the Office of Disability Services for Students http://drc.fiu.edu/ to make
arrangements for the appropriate modification and/or assistance.

Religious Holidays
Any student may request to be excused from a scheduled day in the clinic to observe a
religious holiday of his/her faith. The student must notify the Clinical Instructor and
arrange to take make up the day at another time.

                          CODE OF ACADEMIC INTEGRITY

This Code of Academic Integrity was adopted by the Student Government Association on
November 28, 2001 and reflects the values articulated in the Student Code of Standards.
Florida International University is a community dedicated to generating and imparting
knowledge through excellent teaching and research, the rigorous and respectful
exchange of ideas, and community service. All students should respect the right of
others to have an equitable opportunity to learn and honestly to demonstrate the quality
of their learning. Therefore, all students are expected to adhere to a standard of
academic conduct, which demonstrates respect for themselves, their fellow students,
and the educational mission of Florida International University.


As a student of this university:

      I will be honest in my academic endeavors.
      I will not represent someone else’s work as my own.
      I will not cheat, nor will I aid in another’s cheating.

All students are deemed by the University to understand that if they are found
responsible for academic misconduct, they will be subject to the Academic Misconduct
procedures and sanctions, as outlined in the Student Handbook.

                             FALL 2008

Requirement                                    Date Due                Date Sent
Current CPR certification                      Before 8/01/2008

Annual TB screening                            Before 8/01/2008

Current vaccinations for Hep B, MMR,           Before 8/01/2008
Varicella and DPT

OSHA and AIDS certification                    Before 8/01/2008

First Week Information                         On or before 10-24-08

In-Service Documents                           On or before 12-10-08
      Title page with name, title of
       presentation, date, facility            Please note: Your
      Outline of Presentation                 topic should be
      Handouts                                decided at or before
      List of references                      mid-term
      Attendance Form
      Summary of In-service Evaluation
       Form (Do not send copies of the
       Attendee Rating Forms)

Case Study                                     On or before 12-10-08
      Typed paper
      CI signature for approval
      References
      Your response to pt., treatments,

Clinical Performance Instrument (CPI)          On or before 12-10-08
(with CPI cover page)

Physical Therapist Student Evaluation:       On or before 12-10-08
Clinical Experience and Clinical Instruction
   This is REALLY important. Please take
   the time to thoroughly and honestly fill
   it out.
Evaluation Of Academic Supervision             On or before 12-10-08
During Clinical Internship

                                                                                      Form A

                       PHYSICAL THERAPY
                    INTERNSHIP #4 (PHT 6828)

DATE: ________________________



SUBJECT: Clinical Internship #4 @

My CI for this clinical experience is: ____________________________________

My hours of work are:

To contact my CI, the best times and numbers are:

      Time: __________________________________________

      Phone: _________________________________________

To contact me, the best times and numbers are:

      During work hours, time: _______________________

                           Phone: _______________________

      During the evening, time: _______________________

                           Phone: _______________________

                 E-mail address: _______________________

Other comments:

FAX (305-348-1979) or e-mail this information no later than the first Friday of the
                      MS in Physical Therapy Curriculum

Semester 1 Fall : (15 Credits)
PHT 5174     Analysis of Movement and Function                      3 Credits
PHT 5174L    Analysis of Movement and Function Lab                  1 Credits
PHT 5523     Dimensions of Professional Practice Seminar I          3 Credits
PHT 5205     Clinical Skills Lecture                                3 Credits
PHT 5205L    Clinical Skills Lab                                    1 Credits
ZOO 5371     Applied Musculoskeletal Systems                        3 Credits
ZOO 5371L    Applied Musculoskeletal Systems Lab                    1 Credits
Semester 1 Spring: (12 Credits)
PHT 5027     Clinical Education Seminar                             1 Credits
PHT 5180     Musculoskeletal Diagnosis and Management I             3 Credits
PHT 5180L    Musculoskeletal Diagnosis and Management I Lab         1 Credits
PHT 5524     Dimensions of Professional Practice Seminar II         3 Credits
PHT 6341     Diagnosis and Management of Disease                    3 Credits
PHT 6341L    Diagnosis and Management of Disease Lab.               1 Credits
Semester 1 Summer A: (8 Credits)
PHT 5181     Musculoskeletal Diagnosis and Management II            3 Credits
PHT 5181L    Musculoskeletal Diagnosis and Management II Lab        1 Credits
PHT 5505C    Physical Therapy Constructs of Health                  3 Credits
PHT 5960     Comprehensive Exam 1                                   1 Credits
Semester 1 Summer B: (3 Credits)
PHT 5805     Clinical Internship                                    3 Credits
Semester 2 Fall: (12 Credits)
PHT 5182     Musculoskeletal Diagnosis and Management III           3 Credits
PHT 5182L    Musculoskeletal Diagnosis and Management III Lab       2 Credits
PHT 5525     Dimensions of Professional Practice Seminar III        3 Credits
PHT 6163     Neurological Diagnosis and Management I                3 Credits
PHT 6163L    Neurological Diagnosis and Management I Lab            1 Credits
Semester 2 Spring: (11 Credits)
PHT 6164     Neurological Diagnosis and Management II               3 Credits
PHT 6164L    Neurological Diagnosis and Management II Lab           1 Credits
PHT 6381     Diagnosis and Management of Cardiopulmonary Systems 3 Credits
             Diagnosis and Management of Cardiopulmonary Systems
PHT 6381L                                                           1 Credits
PHT 6817     Clinical Internship II                                 3 Credits
Semester 2 Summer C: (11 Credits)
PHT 6169     Neurological Diagnosis and Management III              3 Credits
PHT 6169L    Neurological Diagnosis and Management III Lab          1 Credits
             Dimensions of Professional Practice Seminar IV (comp
PHT 6526                                                            3 Credits
PHT 6961     Comprehensive Exam 2                                   1 Credits
PHT 6970/1 Master’s Project or Thesis                               3 Credits
Semester 3 Fall: (13 Credits)
PHT 6827     Clinical Internship III                              5 Credits
PHT 6828     Clinical Internship IV                               5 Credits
PHT 6970/1 Master’s Project or Thesis                             3 Credits
             TOTAL CREDITS                                        85 Credits
                                            CPI Cover Sheet
                                            Physical Therapy
                                        Internship #4: PHT 6828
Internship dates: _______________________ (8 weeks)

                                                            Behaviors           Expected     Earned
                                                                              (Scale: 0cm-
                                                                               10cm) = 0 -
1. Practices in a safe manner that minimizes risk to patient, self, and      100%
2. Presents self in a professional manner.                                   100%
3. Demonstrates professional behavior during interactions with others.       100%
4. Adheres to ethical practice standards.                                    100%
5. Adheres to legal practice standards.                                      100%
6. Communicates in ways that are congruent with situational needs.           100%
7. Produces documentation to support the delivery of PT services.            90-100%
8. Adapts to the delivery of PT care to reflect respect/sensitivity to       100%
9. Applies principles of logic & scientific method to the practice of PT.    90- 100%
10. Screens patients using procedures to determine need/effectiveness        90- 100%
for PT.
11. Performs a physical therapy patient examination.                         90-100%
12. Evaluates clinical findings to determine PT diagnoses & outcomes         90-100%
of care.
13. Designs a PT POC that integrates goals, treatment, outcomes & d/c        90-100%
14. Performs physical therapy interventions in a competent manner.           90-100%
15. Educates others using relevant and effective teaching methods.           100%
16. Participates in activities addressing quality of service delivery.       80-100%
17. Provides consultation to individuals, businesses, schools, gov't         80-100%
agencies, etc.
18. Addresses patient needs for services other than physical therapy as      80-100%
19. Manages resources to achieve goals of the practice setting.              90- 100%
20. Incorporates an understanding of economic factors in the delivery of     90%
21. Uses support personnel according to legal standards and ethical          100%
22. Demonstrates that a PT has other responsibilities beyond job             100%
23. Implements a self-directed plan for professional develop./lifelong       100%
24. Addresses primary/secondary prevention, wellness, health                 80-100%
promotion needs.
                                                                    Total:   92.9-100%

NAME: _____________________________
AFFILIATION #: ______________________
FACILITY: ___________________________

                                    PATIENT CASE STUDY

PURPOSE: To provide the student an opportunity to observe a patient holistically by
correlating the patient’s social, occupational, psychological and medical states with the
physical therapy treatments prescribed and administered.

DIRECTIONS: Patients should be chosen who have an active Physical Therapy program
and/or an interesting history. All information regarding other interdisciplinary team members
should be related to the patient’s Physical Therapy treatments. If sections of the outline are
not applicable, proper explanation should be made to indicate that all areas have been

Following is the outline of the case study, please answer all areas. Paper must be type
written and doubled spaced.

I.     Personal Information
       a.    Patient’s initials
       b.     Age
       c.     Sex
       d.     Nationality/Race
       e.     Family size
       f.     Occupation
       g.     Insurance coverage (i.e., Medicare/Medicaid, Workman’s Compensation,
              Private, other)
       h.     Education
       i.     Primary diagnosis
       j.     Secondary diagnosis
       k.     Date of admission
       l.     Date of discharge

II.    Socioeconomic Information
       a.    Home facilities
       b.     Type of community

III.   Psychosocial Information
       a.    Attitude of patient to illness
      b.    Attitude to hospital situation

IV.   Diagnosis
      a.    Give a BRIEF description including classic symptoms
      b.    Patient’s history as relates to diagnosis
      c.    Tests performed and results (i.e., radiographs, lab tests, EMG,
            neurological/orthopedic exams, others)
      d.    Why was P.T. ordered in relation to this diagnosis? (Relate symptoms to P.T.

V.    Physical Therapy Evaluation
      (Please consider the following and remember the specific examples in “parentheses”
      are only some examples and are by no means an exhaustive list.)
      a.     Mental Status
      b.    Vital signs
      c.    Pain (define type, location, when it occurs, what relieves it)
      d.    Sensation
      e.    Cranial nerve function
      f.    ROM (gross evaluation, contractures/limitations due to pain/weakness, etc.)
      g.    Measurements (leg lengths, circumferences)
      h.    MMT (gross evaluation)
      i.    ADL’s (include transfers, bed and w/c mobility)
      j.    Gait assessment (include any asymmetries, pain, any device used, etc.)
      k.    Tone (spasticity, athetosis, ataxia, rigidity, flaccidity, other)
      l.    Reflexes (hyperactive, hypoactive, deep, superficial, specify)
      m.    Respiratory status

VI.   Physical Therapy Treatment Program
      a.    Initial treatment date
      b.    Frequency (qd, bid, etc.)
      c.    Prescribed therapy (physician)
      d.    Briefly outline the specific treatment program plan designed after evaluation by
            the P.T.
      e.    Goals
            1.      Short term
             2.      Long term
       f.    Contraindications
       g.    Precautions
       h.    Explain correlation of treatment given with the assessment of the patient’s
       i.    Note changes during the course of treatment
       j.    Patent’s/family’s response to P.T.
       k.    Equipment/aids needed
       l.    Other hospital/facility departments involved (O.T., R.T., Speech, S.S., Nursing,
       m.    Date P.T. program discontinued
       n.    Home program and follow-up plans

VII.   Comment on your response to the patient, treatment, working with this type of patient,

                            Patient Case Study Project Criteria

___ 2 point: Paper typed and in a narrative format. All areas listed should be addressed.
___ 1 point: CI signature for approval
___ 1 point: References
___ 1 points: Your response to pt., treatments, etc., complete and insightful

                              Department of Physical Therapy

                              In-service Presentation Guidelines

In your professional career, you will be required to present in-services to your colleagues.
Therefore, the purposes of this assignment are to help you become accustomed to public
presentations, to give you an organizational format for presentations to your colleagues, and
to encourage the use of the most recent information on a particular topic.


1.     Select a topic of your choice. The topic must meet your Clinical Instructor’s approval.
       Your topic should be chosen before the mid-term visit / phone call by the ACCE.

2.     Two in-services are required for FIU. You must complete these
       in-services by the end of the 4th clinical internship. The actual presentation should
       be a minimum of 30 minutes in length.

3.     Prior to your in-service, prepare the following items:

       A.    An outline of your presentation.

       B.    Handouts (copies of your own handouts or articles).

       C.    A list of the references that you used to prepare the in-service presentation.
             The list should include a minimum of five current references. Use the APA or
             AMA style manual.

       D.    Copies of the ATTENDANCE RATING FORM for each member of your audience.

4.    After your in-service presentation, have each staff member of the Facility sign the
      "ATTENDANCE FORM" and complete the "ATTENDEE RATING FORM". Prepare a summary of
      the forms with suggestions for change should you present the topic again and complete the
      Your clinical instructor should sign this form.

5.    You are required to use a minimum of two different teaching techniques that are
      appropriate (i.e. discussion, lecture, demonstration, etc.). You are encouraged to use
      audiovisual equipment and handouts for your presentation.

6.    At the completion of your affiliation, turn in the following items:

       A.     Title page with your name, title of presentation, date, facility

   B.    The outline of your presentation.

   C.    Any handouts that you distributed.

   D.    The list of references.

   E.    The Summary of the In-service Evaluation form.

   F.    The Attendance form.

7. The items that you turn in must be TYPED AND DOUBLE-SPACED.

                           Department of Physical Therapy

                          IN-SERVICE ATTENDANCE FORM

Presenter’s Name____________________________Date_______________



                 NAME                               TITLE

                             Department of Physical Therapy
                                 Attendee Rating Form

Presenter’s Name ____________________________ Date______________

Topic ______________________________Facility_____________________


The topic was introduced in a clear manner.
               5           4            3            2         1
           Agree                                             Disagree

The material was presented in a logical order.
             5            4              3           2          1
          Agree                                              Disagree

The presentation was well paced within the time available.
             5            4             3             2         1
         Agree                                               Disagree


The objectives were clearly stated.
             5             4            3            2          1
          Agree                                              Disagree

The objectives were addressed during the presentation.
             5            4            3            2           1
          Agree                                              Disagree

The topic covered was appropriate for the facility.
             5           4              3               2          1
          Agree                                                 Disagree

Teaching Methods:

More than one teaching method was used.

          5                4             3              2          1
        Agree                                                   Disagree

Adequate time was provided for me to make comments and ask questions.

           5               4             3              2          1
        Agree                                                   Disagree

The in-service ended with a summary of information presented.

           5               4             3              2          1
        Agree                                                   Disagree

General Comments:

The overall presentation was

      Excellent            Good          Fair           Poor       Waste Of Time

The things I liked best about this presentation were:

This presentation could have been improved by:

                                                                                             Form G

                               Department of Physical Therapy

Presenter’s Name____________________________ Date_______________
Topic________________________________ Facility_________________

Please indicate the total number of responses you received in each of the indicated categories. (5 =
Strongly Agree, 1 = Strongly Disagree)

    Introduction                      _5     _4      _3     _2      _1
    Order                             _5     _4      _3     _2      _1
    Pace                              _5     _4      _3     _2      _1

    Clarity                           _5     _4      _3     _2      _1
    Continuity                        _5     _4      _3     _2      _1
    Appropriateness                   _5     _4      _3     _2      _1

     Variety                          _5     _4      _3     _2      _1
     Adequate time                    _5     _4      _3     _2      _1
     Summary                          _5     _4      _3     _2      _1

     Overall Excellent              Good          Fair     Poor          Waste of Time

What did your audience consider the best points of your presentation?

What did your audience consider the weak points of your presentation?

Summarize all comments and discuss how you would modify / change / improve your presentation of
this topic in the future.

___________________________                        _________________
Student’s Signature                                      Date

___________________________                        _________________
Clinical Instructor’s Signature                          Date


Shared By: