GENESEE COMMUNITY COLLEGE

 

RESPIRATORY CARE PROGRAM

 

 

 

 

 

CLINICAL GUIDE

 

 

 

TABLE OF CONTENTS

 

Introduction                                                                                                                              3

Mission and Goals                                                                                                                    3

            Program Goals                                                                                                 3

Conduct and Ethics                                                                                                                   3

Integration of the Clinical Component of the Curriculum                                                 4

Teaching and Learning Strategies                                                                                              5

Evaluation                                                                                                                                 6

            Philosophy and Rationale                                                                                              6         

            Bases for Implementation                                                                                              6

            Integration with the Evaluation System within the Curriculum                              6

Clinical Education                                                                                                                     7

Statement of Purpose                                                                                                                7

Rationale for Course Sequence                                                                                     8

Assignment to Clinical Sites                                                                                                       8

Clinical Attendance                                                                                                                   8

Procedure of Notification of Illness or Lateness                                                             9

Dress Code                                                                                                                              9

Clinical Attire                                                                                                                            9

            Violation of Dress Code                                                                                               10

Clinical Practicums                                                                                                                    10

Clinical Logbook                                                                                                                      10

Case Studies                                                                                                                            11       

Reporting Off                                                                                                                           11

Clinical Incidents                                                                                                                       11

Student Evaluation                                                                                                                    12

Clinical Proficiency Evaluations                                                                                     12

Guidelines and Instructions for Standardizing Rating Procedures                                     12

Common Rating Errors                                                                                                 13

Task Performance Rating Scales                                                                                               15

Cognitive Activities                                                                                                                   16

 

 

GENESEE COMMUNITY COLLEGE

RESPIRATORY CARE PROGRAM

CLINICAL GUIDE

 

 

INTRODUCTION

 

            The goal of this document is to disseminate information about the clinical education aspect of the Genesee Community College (GCC) Respiratory Care Program, as well as attempt to act as a standardized reference for its clinical affiliates.  The information and policies within it are intended to promote fairness to students enrolled in the division as well as a sense of humanness in the application of the policies.  Before presenting any further information, it is important for the reader to familiarize himself/herself to the mission and goals of the GCC Respiratory Care Program.  The first part of the document begins with the mission and goals of the GCC Respiratory Care Program.  The document continues to describe how didactic, laboratory, and clinical course work are integrated into a vertical and horizontal building block.  The third portion of the document provides a greater amount of information in regard to the clinical education experience at Genesee Community College Respiratory Care Program. Prior to disseminating any further information, the mission and goals of the program, as well as a conduct statement is presented.

 

MISSION AND GOALS

 

            The primary mission of the Respiratory Care Program is to educate advanced respiratory care practitioners who have the knowledge, skills, and attitudes needed to provide safe and effective cardiopulmonary care.  The program also seeks to develop practitioners capable of proving service to the community, as well as the profession of respiratory care at the local, state, and national level.

 

Program Goals:

 

1.         Graduates of the program will demonstrate that they possess the psychomotor skills       required of an advanced respiratory care practitioner.

 

2.         Graduates of the program will demonstrate that they have the cognitive skills required of             an advanced respiratory care practitioner.

 

3.         Graduates of the program will exhibit behaviors that are consistent with attitudes            expected of an advanced respiratory care practitioner.

 

CONDUCT AND ETHICS

 

            Each student is expected to conduct himself at all time in a dignified manner - a manner which conforms to the ethics of the College and the profession as a health care practitioner.  Irresponsible, unprofessional, or unethical behavior as determined by the instructor or failure to do what is asked by a clinical preceptor/instructor may result in dismissal from the program.  All hospital regulations are to be followed by students during assignments at clinical facilities.  The Respiratory Care Program will not condone cheating in any form.  Any instance cheating will be dealt with in a strict manner, including being dismissed from the program.

 

INTEGRATION OF THE CLINICAL COMPONENT OF THE CURRICULUM

 

            Integrating didactic and clinical curricular elements and providing for sequence and continuity of students' learning activities requires careful organization of the clinical experience and appropriate utilization of the Respiratory Care learning laboratory as an integral element in the overall curricular design.  A concurrent patterning of didactic/clinical organization (in which a portion of each week is devoted to didactic instruction matched with a related clinical component) with a full time clinical assignment during the second year employed at the Genesee Community College (GCC) Respiratory Care Program.  This organization serves the multiple purposes of frequent practice and reinforcement for skills development and mastery; maintaining and promoting the students' interest in learning; and providing for the integration, continuity and sequence among and within the curricular components.  These components, in turn, are organized into identifiable, but nonexclusive clinical stages; orientation and observation (initial exposure), learning and reinforcement of basic modalities, application of advanced modalities and supervised work experience, and finally, advanced clinical areas and subspecialties in a minimally supervised setting.

 

            We should define the following terms, Clinical Observation, Supervised and Minimally Supervised.   By clinical observation, we mean that the student is shadowing a therapist, and observe a procedure; the student does not perform any diagnostic or therapeutic regimen which they have not passed their laboratory.   We refer to two types of supervision, e.g. supervise and minimally supervised.  By supervised work experience we mean that the student performs the procedure under the personal guidance of a faculty instructor or preceptor.  This takes place only after the student has (1) performed the procedure in the lab, and has achieved proficiency in the laboratory setting.  The student then practices in a supervised work experience (close supervision) until either ready, or scheduled to be checked off in the clinical environment.  Once the student has successfully completed their proficiency examination, they may then perform the procedure under minimal supervision.  In performance under minimal supervision, we mean that the student is supervised by a clinical preceptor and/or faculty instructor who is within the same clinical area as the student when the student performs the procedure under minimally supervised conditions.  The progression from observation to supervised; to minimally supervise is illustrated and correlated to course work below.

 

            SEMESTER               COURSE #                 CLINICAL PHASE

            Summer I                     RCP 106                      Orientation/Observation

                                                                                    Basic Modalities - Introduction,

                                                                                    Learning and Reinforcement

                                                                                    (Supervised Work Experience)

                                                                                    Basic Modalities - Reinforcement

                                                                                   

            Fall I                            RCP 215                      Advanced Modalities -

                                                                                    Learning and Reinforcement

                                                                                    Subspecialty Rotations

                                                                                    (Supervised Work Experience)

 

            Spring II                       RCP 206                      Advanced Clinical Areas/Subspecialties

                                                                                    (Minimally Supervised Work Experience)

 

 

TEACHING AND LEARNING STRATEGIES

 

            The teaching and learning strategies employed in the clinical practice of the Respiratory Care Program represent the logical extension of the clinical mastery sequence noted previously.  The basic premise underlying the selection and utilization of the clinical resources of the Program is the belief that the clinical affiliate(s) will proved (a) student experience, and (b) opportunities for developing the higher level cognitive and performance skills requisite to assuming the role of the entry-level respiratory therapist.

 

            The nature and the type of learning strategies employed in the clinical setting are contingent upon the particular phase (or particular clinical practice) of clinical education that the student is assigned):

 

PHASE OF CLINICAL EDUCTION                       TEACHING/LEARNING STRATEGIES

1.  Learning/Reinforcement                                           -demonstrations as necessitated

     (Basic Modalities)                                                    -clinical conferences as needed

                                                                                    -supervised procedural application and practice                                                                         -medical lectures (incidental and scheduled)

                                                                                    -basic therapeutic modalities with

                                                                                                competency evaluations

                                                                                    -clinical log

                                                                                    -formative and summative evaluations

 

2.  Reinforcement/Advanced Modalities                        -advanced therapeutics with competency

                                                                                                evaluations

                                                                                    -case studies

                                                                                    -case presentations

                                                                                    -medical lectures (incidental and scheduled)

                                                                                    -introduction to the ICUs

                                                                                    -OR, PFT, Sleep rotations

                                                                                    -maintenance of clinical log

 

4.  Advanced Clinical Areas/Subspecialties                   -minimally supervised ICU

     (Minimal Supervision)                                              -intubation

                                                                                    -management and education

                                                                                    -neonatal intensive care

                                                                                    -pulmonary rehabilitation, hyperbaric &

                                                                                                care rotations

                                                                                    -medical lectures (incidental and scheduled)

                                                                                    -case studies and presentations

                                                                                    -maintenance of clinical log

 

EVALUATION

 

Philosophy and Rationale

            The clinical evaluation methodology employed at the GCC Respiratory Care Program to assess the students' procedural proficiency and behavior has been formulated to reflect a competency-based, student centered philosophy of the Program.  The faculty maintains that it is only through the implementation of reliable and valid measures of students' clinical performance and proficiency that the ultimate goal of the program of learning, i.e. the training and provision of competent clinical practitioners capable of successfully assuming the roles and functions requisite to the delivery of quality respiratory care can be realistically achieved.

 

Bases for Implementation

            The policies and procedures upon which the evaluation system is built are consistent with the philosophy, goals, and grading policies of the College and are based upon the principle of equivalent clinical experience within the curriculum.  The criteria utilized to assess the learning outcomes have been derived from the current delineation of the roles and functions of the entry-level respiratory therapist.

 

Integration of the Evaluation System within the Curriculum

            The evaluation feedback system has been designed to provide documentation, assessment, feedback and remediation which are relevant to the four key phases of the students' clinical education.  The various evaluation approaches and assessment/documentation tolls utilized are summarily described, according to the clinical phase in which they are employed.

 

            Through out these clinical rotations, each student is assigned a preceptor (faculty or clinical staff member) under whose guidance they first observe, and then perform, the regular daily activities of the staff and services and functions of the applicable department.  During this initial learning and reinforcement phase of the clinical education, the clinical mastery sequence is actually initiated.  Competence is assessed first in the College laboratory by discrete skills evaluations utilizing a "workbook" mastery of skills and observation.  A checklist/rating scale approach may also be utilized as these are contained within the utilized clinical performance rating scales.  All performance elements, whether performed in the College laboratory or in the clinical affiliate site, are maintained on file at the College during the students’ enrollment in the program.

 

            Depending upon the student's performance of the skill and comprehension of the procedure, a status recommendation is made by the evaluator and recorded on the performance rating scale.  Additional assessment of the student's clinical performance made by clinical preceptors during the learning and reinforcement phase, as well as the advanced/subspecialty modalities (supervised work phase), as well as the advanced clinical areas/subspecialty (minimally supervised work experience) include formative and summative evaluations.  An assessment of the students' clinical logbook at the end of the semester is made by the Director of Clinical Education (DCE).

 

            Entry into the advanced modalities (supervised work) experience of the clinical education phase is contingent upon the student's successful demonstration of proficiencies in all requisite skills and procedures.  It is during this phase that a majority of the actual clinical evaluations take place.  The same form utilized for evaluation of procedural proficiency is employed for the clinical evaluations.  For each assigned rotation during the clinical course work, students must satisfactorily complete all proficiencies applicable to that rotation and demonstrate a satisfactory or better rating on the formative/summative evaluation sheet.  In subspecialty rotations, the students will have to provide a written product (case study), as well as the student logbook, to be assessed for satisfactory completion of the rotation.  Progress to subsequent rotations is dependent upon the status report made by the applicable clinical preceptor in conjunction with the Respiratory Care Program Faculty:  DCE and Program Director (PD).

 

            Entry into the application and work experience phase (supervised working and minimal supervision) of the clinical education is contingent upon the student's successful demonstration of proficiency in all skills and procedures.  This requires documentation of the student's logbook which summarizes on a daily basis, procedures performed, pertinent observations, and physician contact.  In the final clinical practicum, the students work under minimum supervision in intensive care areas as long as the clinical preceptor, in conjunction with the student and DCE, substantiate the student as competent and ready.

 

            For each assigned rotation during each clinical practicum, students must satisfactorily complete all proficiency evaluations applicable for the rotation and demonstrate a satisfactory or better formative and summative evaluation.  Progress to subsequent rotations is dependent upon the status report made by the applicable clinical preceptor in conjunction with the formal and/or informal discussions with the Clinical Preceptors, DCE and PD.

 

            Documentation of student experience is accomplished by a student-maintained logbook which summarizes, on a daily basis, procedures performed; pertinent observations and physician contact.  This represents an in-depth study into areas which the student has expressed particular interest.  Additional participation in any in-depth specialty is not required for graduation.  Upon completion of all clinical rotations, a composite student clinical performance rating scale will be inserted in the program folder.

 

CLINICAL EDUCATION

 

            Clinical Respiratory Care Courses provide the student with an opportunity to apply knowledge and skills of various procedures and techniques gained in the classroom and laboratory in the patient care setting.  To assure the safe and effective patient health care delivery students are required to demonstrate 100 percent pre-clinical proficiency to be eligible for clinical practice.  All students are required to demonstrate 100 percent clinical skill proficiency.  As a means to assure safe and effective health care delivery, the proficiency assurance steps illustrated below are strictly enforced

STATEMENT OF PURPOSE

 

            The philosophy of a controlled clinical practice supports the concept that the clinical experience is a whole series of experiences which have to be integrated with didactic and laboratory aspects of the GCC Respiratory Care Program.  It is not just a block of time set aside for the neophyte student to practice skills at random.  It is an opportunity to assimilate knowledge of the discipline gained through classroom and laboratory instruction, and utilize it in a practical setting.

 

            While evaluation of the student practitioner is addressed mainly in observable performances of respiratory therapy diagnostic and therapeutic modalities, the use of interpersonal skills between student and patient and/or student and staff, should be evaluated with no less weight than that of performance competencies.  Currently, behavioral and attitudinal evaluations of the students are done by formative and summative program evaluations as well as by anecdotal conversations with staff members who act as clinical preceptors. 

 

            What the faculty of the Program (in conjunction with clinical faculty and staff) attempt to do is build a series of experiences which will lead the allied health student to a firm understanding of the role and responsibilities of a competent Respiratory Care Practitioner.

 

RATIONALE FOR COURSE SEQUENCE

 

            The sequencing of courses in the curriculum is based on continuity, or "building-block" approach.  This allows the students' knowledge and skills to be progressively deepened and broadened throughout the program.  Furthermore, this sequence provides integration of the different curriculum areas so that necessary science theories are introduced before respiratory therapy didactic materials that use them; respiratory care didactics are presented prior to practice with equipment; and equipment lab is mastered before the application into the clinical setting.

 

            This order of instruction allows potential feedback mechanisms to assess its perceived effectiveness in producing expected outcomes.  Performance results from the NBRC's credentialing exam taken by graduates of the program provide information on the didactic portions while a program constructed employer evaluation questionnaire will return useful information to the motor skills and affective portion of the curriculum.  These provide specific feedback for internal components of the program.

 

ASSIGNMENT TO CLINICAL SITES

           

            The program contracts with various hospitals to provide clinical experiences.  Student assignment to various hospitals is based on size of department, number of students who can be assigned, amount of supervision necessary, and learning needs of the students.  Students must be prepared for clinical assignments on all clinical shifts (days, evenings and occasional nights and weekends).  Should clinical rotations other than days be scheduled, the amount of time that students will be assigned will be equally distributed among the students.  If assignment to a hospital presents a serious problem because of distance, the student should consult with the Director of Clinical Education for possible reassignment. 

 

CLINICAL ATTENDANCE

 

            Each student, unless excused, must attend clinic each term.  Students may not leave the hospital before the end of their assigned shift except for extenuating circumstances.  Incidents of lateness greater than 10 minutes without notification within the assigned time will be cause for dismissal on the date of the occurrence.  Any clinical time missed can only be made up at approved clinical sites.  Any absent days must be made-up at the end the term of the occurrence.  Arrangements for such must be coordinated through and approved by the current hospital and the DCE.

 

            The student will arrive at all scheduled clinical sessions on time (five minutes before the assigned time).  The student will never be absent from scheduled clinical sessions without prior notification to the DCE and clinical affiliate.  Only prior verbal notification (by phone or in person) will be accepted except in emergency situations.  The DCE can be reached by phone at 585-345-6860 or a message must be left on voice mail.  Student will submit requests for excused absences a minimum of 48 hours in advance.  Two unexcused absences will result in disciplinary action.

 

            The student will be signed in and out on the appropriate attendance record by clinical faculty.  Failure to do so will be considered an unexcused clinical absence.  Failure to have any attendance days signed off when submitting the clinical log book will result in a five (5) point deduction the first time, and five (5) points every time afterwards.

 

PROCEDURE OF NOTIFICATION OF ILLNESS OR LATENESS

 

1.         Call the hospital/clinic before assignments are made if possible.

2.         Speak with shift supervisor and identify the person with whom you will be leaving the     message, and note the time of your call.

3.         Identify yourself and tell them that you are a GCC student.

4.         Inform them that you will be late or absent.

5.         Call the DCE at 585-345-6860.  You will get the voice mail of the program.  Leave a   message which includes the items 1-4 above.

 

DRESS CODE

 

            The student is required to adhere to the dress code for the Respiratory Care Program.  Faculty members will enforce the dress code in the clinical experience.  The only exception is students assigned to a clinical care area when another form of dress is specified or approved (i.e., OR).  The student is responsible for the cost of the uniform and name tag, as well as other costs associated with their clinical education.

 

CLINICAL ATTIRE

 

A.        For Females and Males:

1.         Navy colored scrubs.

2.         White tennis shoes or sneakers.

3.         Button white quarter length laboratory coat.  Lab coasts should not have extra buttons on the                              sleeves, cuffs, back or sides which may catch on IV tubing or other hospital equipment.

4.         Name pin must be worn above the left top pocket and state the following:  (a) Student's             Name; (b) Student Respiratory Therapist; (c) Respiratory Care Program; (d) and Genesee             Community College.  The name tag should be blue with white lettering.  For example:

                        JONATHAN DOE (or JOANNA DOE)

                        Student Respiratory Therapist

                        Respiratory Care Program

                        Genesee Community College

 

B.        Personal Appearance (Males):

1.         Good personal hygiene.

2.         Beard and mustache must be kept groomed.

3.         Hair style - hair should be kept neat and in moderation at all times.  If hair length should             exceed shoulder length, it must be confined while in the clinical area to prevent     contamination and to promote safety.  Hair may not be braided during attendance at the            clinical site.  Because of clinical sit policy males may not wear earring in their clinical             rotations.

4.         Fingernails must be kept clean and trimmed to a moderate length.

5.         White laboratory jacket or coast appearance must be clean, free of wrinkles and presentable.    Insignia/labels other than professional are unacceptable.

6.         Shoes must be clean and polished where applicable.

7.         No cologne or after shave may be worn.

 

C.        Personal Appearance (Females):

1.         Good personal hygiene.

2.         Hair style - hair should be kept neat and in moderation at all times.  If hair length should             exceed shoulder length, it must be confined while in the clinical area to prevent     contamination and to promote safety.  Hair may not be braided during attendance at the            clinical site.  Dangling earrings may not be worn.  Earring size may not be greater than the            diameter of a quarter (25 cent coin), and only one pair may be worn at a time.

3.         Fingernails must be kept clean and trimmed to a moderate length.

4.         White laboratory jacket or coast appearance must be clean, free of wrinkles and presentable.    Insignia/labels other than professional are unacceptable.

5.         Shoes must be clean and polished where applicable.

6.         No perfume may be worn.

 

Violation of Dress Code

            Students reporting to the clinical area wearing improper uniforms will be sent home to change to the proper uniform.  Time lost in this manner shall be considered as an absent day and must be made up.

 

CLINICAL PRACTICUMS

 

            To insure the success of the clinical practicum, it is important that everyone have an in-depth understanding of the practicum.  The objective of a controlled clinical practicum is characterized by the gradually expanding role of the student as a practitioner, capable of assuming responsibility in a community hospital, medical center, cardiac and/or pulmonary diagnostic clinic, HMO, and pulmonary rehab and home care setting.

 

            The sequence of clinical practice is divided into three discrete stages, each designated as a clinical practicum within the curriculum.  The first clinical rotation reflects didactic and laboratory instruction in the first semester, as well as new knowledge gained in the second respiratory care course and laboratory practice.

 

CLINICAL LOGBOOK

 

            The student will maintain a daily cumulative log of clinical practicum experiences in his/her Clinical Notebook.  The student is responsible for the accuracy of the log, and will bring it to all clinical sessions (when changing locations, be sure to take it with you) for inspection by the DCE, Program Director, or Clinical Preceptors.

            a.         5 points will be subtracted for the first time the student does not bring the book; an                    additional 10 points will be subtracted for each time afterwards.

            b.         2 points will be subtracted for clinical notebooks which are not up-to-date when                                    submitted.

            c.         3 points will be subtracted for each time the clinical notebook is not submitted on the                 required day.

 

CASE STUDIES 

 

            Case studies are a significant part of the student's learning experience.  Respiratory care case studies are on a selected disease state and are a part of the learning experience to develop student growth in the application and management of clinical data.  The number of case studies required per semester will vary in each of the clinical courses.  The number required will be delineated in each course syllabus.  Each case study is expected to demonstrate the student possessing appropriate competencies in communication, critical thinking, and knowledge.  Case studies must by typed and be consistent with the approved format and the objectives met in the case presentations.

 

            The student will use correct spelling, legible handwriting, and appropriated medical terminology when assigned written reports such as clinical worksheets, medical record entries, and departmental records; print written assignments when unable to demonstrate legible penmanship; submit original work assignments using the assigned guidelines.

 

REPORTING OFF

 

            The Student will remain in assigned clinical area at all times unless a change is approved by the DCE or program faculty.  Before taking breaks or lunch, the student will:

            a.         notify, in person, the clinical evaluator or preceptor.  Thirty minutes is allotted for                       lunch; a maximum of two 15 minute breaks will be allotted per daily rotation.

            b.         secures the signature of the clinical evaluator or preceptor for the day's activities in                     the attendance log and on the daily report form.

            c.         report status of all patients and equipment assigned to his or her assigned clinical                                    faculty.

 

            Student are never to leave their assignments for the day until they have given report to their clinical preceptor, the day shift supervisor, or the designated staff person who is responsible for the patient(s).  STUDENTS ARE ALLOWED ONE HOUR AT THE CLINCIAL SITE’S MEDICAL LIBRARY PER 4 WEEKS OF ROTATION.

 

CLINICAL INCIDENTS

 

            An incident occurring which affects patients or staff well being or patient's prescribed care will be reported to the clinical instructor immediately.  A hospital incident report will be completed according to the policy of the institution.  A duplicate of the hospital incident report as well as a memorandum of explanation from the clinical instructor will be place in the student's file and the clinical coordinator and division director will be notified immediately.  Incidents involving gross errors in judgment and or practice will constitute grounds for dismissal from the program.

 

            The student will immediately report any and all incidents which might affect the well being of the patients he/she is assigned.  Failure to do so will result in dismissal from the clinical session.

 

STUDENT EVALUATION

 

            Students' level of competence in the course will be determined by their performance in meeting the course requirements.  The student will conduct his/her behavior according to the AARC Code of Ethics and the Respiratory Care Program Handbook, and deviation from these policies and procedures will affect the student's evaluation.

 

CLINICAL PROFICIENCY EVALUATIONS

 

            Clinical practicums are structured so that students have an opportunity to observe, assist, and perform advanced assessment, diagnostic, and therapeutic skills in a clinical setting.  Once laboratory mastery is demonstrated, the student is assigned patients to practice and refine required skills under the supervision of clinical faculty.

 

            The integration of the didactic, laboratory and clinical aspects of the program is evident when considering the sequence that the student must learn, practice, and perform identified clinical proficiencies prior to achieving the ability to perform minimally supervised clinical practice.  Within this integration, the student learns competencies in the classroom and practices them in the laboratory.  Students must then pass a clinical proficiency check-off prior to moving on to practice this skill in the clinical setting under supervision of the Clinical Preceptors or institutional preceptor. 

 

GUIDELINES AND INSTRUCTIONS FOR STANDARDIZING RATING PROCEDURES

 

1.         Where will evaluation performance take place?

            Clinical appraisal must be conducted in an environment that represents conditions encountered in practice.  Identification of the specific location for the performance should be made on the basis of patient accessibility and availability.  Reliable evaluation may be conducted in a variety of settings.  However, to ensure equivalent conditions for all evaluations, the side, once selected, must be kept uniform (e.g. if oxygen rounds are evaluated on a patient floor, each student should have their evaluation done in such an environment instead of an ICU).  Performances evaluated under unlike conditions cannot be considered equivalent.  For example, the intensive care environment might expose the practitioner to distractions not encountered on the open ward.  Therefore, if the latter is chosen as the evaluation site, al practitioners considered in the same sample must be evaluated in the same manner unless there are extenuating circumstances (all extenuating circumstances must be noted on Performance Rating Scale).  If conditions cannot be kept uniform, notation of variations must be recorded and considered in scoring.

2.         What sample should be used?

            The sample population must be uniform.  The decision to use actual or simulated, alert or comatose, lucid or disorientated, critical or prophylactic patients should be made before an evaluation and should remain uniform for all clinicians being evaluated.

3.         What instructions should the clinician receive?

            The clinician must be informed at the time and place of the evaluation as determined by the rater.  He should be also told that he may not solicit information from the rater before or during the evaluation.  The clinician will be instructed to perform the procedure in the usual manner.

 

 

 

4.         What background information should the clinician receive?

            The clinician will be informed of the procedure for which he will be evaluated.  The evaluation process should be explained and all questions about the evaluation procedure (not the therapeutic procedure being evaluated) should be answered before the evaluation begins.

5.         What equipment should be given to the clinician?

            Because the assembly and handling of equipment and materials are integral components of most respiratory therapy performances, variations in accessibility, and the conditions of specific brand characteristics of equipment can significantly affect the outcome of the clinician's performance.  Therefore, whenever possible, evaluations should be administered with identical equipment.  If selection and procurement of equipment are considered part of the performance, all materials need to be uniformly available.  If materials have been collected and packaged before the evaluation, these pre-assembled units should be equally accessible to all persons evaluated.

 

6.         Who should do the rating?

            The rater should be a content expert trained in observation and the use of the evaluation instruments and should be responsible for the direct supervision of the clinician if possible.

 

7.         What information should the rater receive?

            The clinician should be introduced the rater before evaluation, away from the evaluation site.  The rater should be told to provide feedback to the clinician after the procedure is rated.  The rater should stop the procedure only if a clear and immediate danger exists to the patient because of the clinician's actions.  Raters should prepare narrative critiques immediately after observing a procedure in an area convenient to the evaluation site and as free of distractions as possible.  Raters should not at any time collaborate with other raters if more than one rater is simultaneously evaluating. 

 

8.         How many times should the clinician exhibit the performance?

            Draining inferences from a single incident and failing to consider contraindication data can lead to faulty conclusions.  Behaviors result from many influences, and observations must take context into account.  A single behavior may have two or more antecedents.  The tendency to generalize from too limited a sample of behaviors is a common pitfall.  Therefore, the student clinician should be evaluated on different occasions and on separate days (if possible).  No evaluation on the same student clinician should be conducted with the same patient.

 

COMMON RATING ERRORS

 

            There are times during clinical evaluation of the student clinician that outside those outside factors may influence the way that they are evaluated.  Some rating errors occur so frequently that special efforts must be made to counteract them.  Each rater may have some tendency toward one or more of the errors.  We highlight a number of these tendencies below so that the rater may make a conscious effort to eliminate them:

 

A.        HALO EFFECT        

            The halo effect occurs when the rater's general impression of a student influences the rating of a specific performance.  Some factors that may produce the halo effect are:

1.         Manner-a rater may be favorably influenced by a student who is friendly, deferential, or             cooperative and, as a result of these characteristics, may tend to rate the performance of a    task more highly than otherwise.  On the other hand, ratings may be low because a rater is     unfavorably influenced by a student's challenging, questioning, or rude or boorish manner.

 2.        Appearance-a student who is neat, well-groomed, or attractive may receive higher ratings,         while a student who is untidy, poorly groomed, or unattractive may receive lower ratings,      even though these characteristics have nothing to do with the way in which the task is            performed.

3.         Previous Encounters-in general, an instructor will tend to overrate the performance of his            own students, perhaps because the instructor feels the ratings reflect his own success as a        teacher.  However, previous knowledge of a student can also be detrimental if the instructor   has formed a poor impression of the student's abilities or for any other reason has an    unfavorable attitude toward the student.  An instructor may make allowances for a "good"          student who performs a skill poorly, or may give credit to the "poor" student who performs   the skill well.

4.         Colleagues Opinions of the Student-a rater may be unduly influenced by what his colleagues       think of a student.  If a fellow instructor comments favorably or unfavorably about a student, or if a student has an outstandingly good or poor record, the ratings are likely to reflect this          opinion or record.

5.         Influence of the First Part of the Task-a rater may form a judgment of the student by the way     he performs the first steps of the task and then may rate the rest of the task accordingly.  A   slow or hesitant beginning may unnecessarily handicap the student, while an efficient   beginning may give an undue advantage.

 

The halo effect results in a tendency for all ratings of a student to be similar, thus obscuring the actual strengths and weaknesses of their performance.

 

B.        CENTRAL TENDENCY ERROR

            Central tendency error results when a rater is reluctant to use the ratings at either extreme on the scale.  A rater who is not experienced in rating or who feels uncertain about the task to be performed often rates all student performance in or near the center of the scale.  In this case, all ratings are about the same; about average.

 

C.        GENEROSITY ERROR

            Generosity error occurs when a rater tends to use only the high end of the scale.  The rater either explicitly or implicitly makes allowances for poor performances-because students cannot really be expected to perform with expertise-or gives them higher ratings than they deserve.  The distribution of these ratings is clustered above the center point and all ratings show up as above the average of above the center point on the scale.

 

D.        SEVERITY ERROR

            Severity error occurs when a rat assumes that students cannot be expected to perform very well.  Such a rater uses only the lower or negative end of the scale.  The ratings all tend to cluster below the center point.

 

E.         LOGICAL ERROR

            Logical error occurs if a rater thinks of a certain characteristics as related.  The most common example of this error is the mistaken idea that intelligence and performance are equivalent.

TASK PERFORMANCE RATING SCALES

 

            It is assumed that the student will work diligently in both the laboratory and clinical setting to gain practice and proficiency in the required tasks.  You should utilize the available free laboratory time, textbooks, and wealth of resources that you have for study and reference.  You should work closely under the supervision of the College Instructor, or clinical preceptor until your assigned evaluation time, or at the time you request a clinical evaluation.  You are never to perform clinical tasks without the knowledge of the Clinical Preceptor.  As you progress in the program, you will also progress form an individual who requires a large amount of supervision to one who requires minimal supervision.

            The following should act as a guideline for formal clinical evaluations:

 

Before the formal evaluation sessions, you should:

1.         Review all task performance steps and element,

2.         Clarify any points of confusion with the clinical evaluator,

3.         Practice the performance elements during clinical sessions with the clinical evaluator until            you feel confident you can perform these procedures perfectly and without assistance        (verbal and otherwise) and then ask to be evaluated.

4.         If you do not feel ready for your evaluation, you should either (a) go back to the lab and            practice during open lab time, or (b) schedule a meeting prior to the evaluation day with the   clinical evaluator to discuss how you can prepare yourself.  Regardless, the student is       expected to be an active participant in the clinical learning experience.  This does not only      mean to actively seek knowledge and experience, but in advising the College Instructor and/or Clinical Preceptor of areas which require further assistance. 

5.         Review the didactic and laboratory information as they apply to the procedure and         consolidate them with performance elements.  Should any type and/or amount of assistance     be provided during the evaluation, it will be noted in your evaluation.

6.         The emphasis during the proficiency evaluation is primarily on the performance aspects of           the clinical procedures.  A number of elements relate to the manner in which you interact     with the patients and/or other health professionals.  While the evaluation instrument relates    more to what you do rather than what you say, this is not to say that it is not important to be             able to explain what you are performing to the evaluator.  In addition, the student will be             expected to answer questions about the procedure, the patient, the pathophysiology, as well      as correlate signs, symptoms laboratory and other diagnostic/therapeutic tests (see Cognitive         Activities).  Be aware that you will be expected to be able to answer any questions           which refer to didactic, laboratory, and clinical course work previously passed, as well     as demonstrate the ability to identify appropriate sources and answer questions which   may not have been part of previous course work.

7.         You should review all pertinent information before beginning the proficiency.  You may have difficulty successfully completing a procedure due to circumstances rather than your   skills (e.g. inappropriate settings, uncooperative patient, etc.).  Your evaluator's judgment           regarding the surrounding circumstances will be taken into consideration in determining the             appropriate ratings for your evaluation.

8.         Since you are in the medical field and any mistakes you make can affect the well being of           the patient, it is expected that you perform with 100% accuracy.  Any minor deviations          from the procedure that is delineated in the clinical proficiency check-offs will be     determined by the evaluator.  Major deviations will result in the evaluator stopping the           evaluation.  That is why you must review the clinical materials and practice tasks prior    to being evaluated.

9.         It may not be possible for the student to demonstrate mastery of all clinical procedures   during your clinical rotation.  For example, there may not be any patients on a particular         therapy or some necessary equipment may not be readily available.  Therefore, it will        sometimes be necessary for the clinical check-off to be simulated, along with a thorough             oral examination to ascertain the competency of the student.  At the same time, the clinical          evaluator should try to be flexible when unscheduled opportunities arise for learning experiences or check-offs.  Every opportunity should be made to accommodate those     situations as long as it does not interfere with the overall clinical learning experience.

10.       The student will be responsible for ensuring that all clinical practicum activities are checked         off on the individual Summary Performance Record in the Student Clinical Notebook.          Activities may be checked as completed or mastered only by approved clinical evaluators    and are subject to weekly formative evaluations by the DCE.

11.       It is the responsibility of the student is rated on each of the task twice, according to the   above criteria.  The clinical book must be kept securely by each student, and periodically    submitted to the student's designated advisor/reviewer in the program.  Notes will then be     forwarded to the Director of Clinical Education.  The DCE, in consultation with the student's             advisor/reviewer, will be responsible for determining clinical grades in accordance with the         criteria listed in the clinical course syllabus.

12.       Students will present all suggestions, unusual requests or grievances related to clinical     assignments to the DCE.

 

COGNITIVE ACTIVIES

 

            Cognitive activities are a part of the clinical experience and evaluation.  Students are asked questions to which their responses act as an indicator to the breadth and depth of knowledge; they are also an acknowledged part of proficiency check-offs.  Cognitive activities include formal questions about daily activities, patient pathology, or any aspect of respiratory care.  Questions may be administered orally and/or in written form at the discretion of the clinical preceptor.