The Manual Therapy Institute … · Web viewSTUDENT HANDBOOK. CONTENTS. Acknowledgement Form...
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STUDENT HANDBOOK
Transcript of The Manual Therapy Institute … · Web viewSTUDENT HANDBOOK. CONTENTS. Acknowledgement Form...
STUDENT HANDBOOK
CONTENTS
Acknowledgement Form Student Handbook 4
Introduction 5
Mission Statement 6
Program Goals 7
MTI philosophy 8
Curriculum design
Administrative and Human Resources Issues 10AdmissionGrievance proceduresADA statementDisabilitiesProfessional licensureProfessional liability insuranceIncidents
Treatment during courses 18
CEU’s 18
Dress requirements 18
Attendance 18
Pregnancy and altered hormonal states 18
Disclosure of medical condition and release of liability 18
Copyright 19
Recording 19
Required methods for assessing competencies 20
OSCE guidelines 21
Live patient guidelines 24
Failed exam policy 33
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Postponing exams 34
Academic Integrity 35
Standards for supervised hours 36
Mentoring 43
Cervical Manipulation 46
Tuition and fees 49
Professional behavior 50
Assisting in class 53
Case Study Presentation Template 54
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Acknowledgement Form Student Handbook
Date: _____________________________________________
Student Name: _____________________________________________
I have read the Student Handbook and understand all that is involved in attending successfully completing the Manual Therapy Institute’s Fellowship Program/Certification Program.
Signed: _____________________________________________
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Introduction
The purpose of this handbook is to introduce the philosophy of the Manual Therapy Institute to students in the manual therapy program. It has been developed to familiarize enrolled students with MTI’s policies and procedures.
This handbook is for general information only and is not intended to contain all regulations related to students enrolled in the manual therapy program. MTI reserves the right to withdraw courses at any time, to change fees or tuition, calendar, curriculum, graduation requirements, graduation procedures, and any other requirements affecting students. Changes will become effective as determined by MTI’s Administration and will apply to both prospective students and to those already enrolled.
The Manual Therapy Institute is accredited by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) and approved by the American Academy of Orthopedic Manual Physical Therapists as a Fellowship Program in Orthopedic Manual Physical Therapy.
The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is the credentialing body for the American Physical Therapy Association (APTA) for postprofessional residency and fellowship programs in physical therapy.Credentialing is a process used by the APTA to ensure the quality that participants receive in residency and fellowship programs in physical therapy. It is a voluntary, nongovernmental, peer reviewed process that occurs on a regular basis.
The manual is a dynamic document. Individual policies will be modified or added based on revision of various University, College, or Accrediting Body Policies, or on identified need. Modifications or additions may be brought before the faculty at any time. The Program Director is ultimately responsible for additions, deletions, or modifications to the document and such changes will be reviewed and agreed upon by a majority of the faculty.
The manual in its entirety is reviewed annually by the Program Director. This document was last reviewed on October 1, 2016
Pieter Kroon, PT, DPT Date: 10/1/16Program DirectorThe Manual Therapy Institute P.O. Box 680127
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Park City, UT 84068Mission Statement of the Manual Therapy Institute
The Manual Therapy Institute is dedicated to providing academic and clinical education required to produce master clinical professionals in the field of orthopedic physical therapy. MTI believes that Fellowship training is the best way to achieve the ideal combination of advanced problem solving skills and advanced evaluation/treatment skills. The safety and well being of the public is of utmost importance. The purpose in advanced Fellowship education is to provide the public with physical therapy practitioners that are ready for autonomous practice. Fellow graduates should be able to expertly diagnose musculoskeletal conditions, perform accurate intervention, and provide appropriate referral when necessary. At MTI, we value the contributions of the expert physical therapy community and hence expect our graduates to provide peer education and/or to participate in clinical research.
Mission Statement
The Manual Therapy Institute’s mission is to educate movement experts. To achieve this we believe our graduates need to show mastery of the following 7 domains:
1. Advanced problem solving2. Joint mobilization/manipulation3. Soft tissue mobilization4. Treatment of Adverse Neural Tension5. Evaluation/treatment of muscle imbalance6. Tissue specific exercise prescription7. Patient education
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Goals of the Manual Therapy Institute
1. To educate participants on current best practice of patient management in orthopaedic manual physical therapy using evidence-based patient management strategies.
2. To educate participants on the integration of current best practice for movement disorders of the musculoskeletal and neuromuscular systems into comprehensive patient management programs that include: examination, evaluation, diagnosis, prognosis, intervention, and outcome assessment.
3. To educate participants towards autonomous practice in the treatment of movement disorders of the musculoskeletal and neuromuscular systems using evidence-based physical therapy management strategies.
4. To prepare graduates for life-long learning and contribution to the physical therapy profession through peer teaching and/or clinical research.
5. Standardization of curriculum over multiple sites is a priority. MTI wants to ensure that education standards are the same, no matter where the student takes the course.
To meet these general goals, MTI has established the following objectives:1. Graduates demonstrate advanced clinical decision-making skills through the use of
differential examination, goal setting, and intervention progression with emphasis on evidence based practice in the management of individuals with impairments, functional limitations, and disabilities related to neuromusculoskeletal pathologies.
2. Graduates provide appropriate intervention procedures for the spine and extremities, through the use of high velocity thrust techniques, mobilization of joints, soft tissue, and neural structures, and tissue specific exercises.
3. Graduates are dedicated to providing examinations and interventions that are evidence-based. This motivation is reflected in the performance of clinical research in OMPT.
4. Graduates are effective patient educators and advocates. 5. Graduates are committed to professional and community service and the pursuit of
continuing professional development.6. Graduates serve as role models for the profession by engaging in ethical and legal
practice. Graduates assume leadership positions in physical therapy education, practice, and research.
7. Graduates promote the profession through involvement in the American Physical Therapy Association (APTA) and the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).
8. Workbooks, powerpoint presentations and homestudy courses are established. Input from instructors regarding curriculum development will ne discussed at the Annual Directors Meeting in March and implemented as deemed appropriate.
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MTI Philosophy and Design
The development of the MTI program was based on core commitment to excellence in manual physical therapy training, outcome evaluation, and participation of students. The curriculum is developed from the most recent version of the Description of Advanced Specialist Practice (DASP) issued by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). Further refinement has included development of a formal relationship with Texas State University-San Marcos (Texas State) for shared resources including faculty, space and other educational resources.
The program incorporates current best evidence with a patho-functional morphological model. This model describes how changes in function can lead to restricted movement and complaints of pain. The ability to perform a focused evaluation that identifies the movement dysfunction provides for efficient intervention. For example, it is not the greater trochanteric bursitis that gets treated, but the underlying movement dysfunction that leads to the greater trochanteric bursitis. It is not the rotator cuff tendonopathy that gets treated, but the underlying movement dysfunction that leads to the tendonopathy. The patho-functional morphological model of examination and intervention focuses on the cause of the problem rather than the symptoms and facilitates a comprehensive approach to treatment.
Curriculum Design
The curriculum is designed in a stacked format, which means that each subsequent course builds on the previous courses. Therefore, all courses needed to be taken in the sequence intended. The curriculum includes 16 onsite weekend courses as well as 5 online homestudy courses. Program completion requires a minimum of 17 months, a maximum of 36 months, with 440 supervised clinical hours, 400 of which are spent one-on-one with a mentor. This situation provides fellow students with opportunities to evaluate and treat patients in collaboration with experienced manual therapists.
The clinical instruction component of the curriculum is a strength of this program. Advanced evaluation and treatment skills are emphasized. A sound framework of clinical reasoning and decision-making is utilized as well as significant time in instruction in skilled treatment.
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Curriculum sequence
Administrative and Human Resource Issues
AdmissionMTI offers 2 different programs:
A Certification Program in Orthopedic Manual Physical Therapy A Clinical Fellowship Program in Orthopedic Manual Physical Therapy
Admission requirements for prospective students applying to the Manual Therapy Institute’s orthopedic manual physical therapy fellowship program include the following criteria:
Graduation from an APTA accredited orthopedic residency program.
ORProspective MTI fellowship students who have not previously completed an accredited orthopedic residency program must meet ALL of the following criteria in order to be considered for admission into the orthopaedic manual physical therapy fellowship program:
Successful completion of the first year of MTI’s program in orthopedicmanual physical therapy, which includes five courses (120 hours)
A comprehensive written examination score of 80% or higher.
Successful performance on an OSCE format practical exam with a score of 80% or higher.
Interview with the Program Director, Director of Clinical Education, andteaching faculty as indicated
Perform direct patient care for 50% or more of normal daily practice.
Successful demonstration of professional abilities during the first year of the certification program.
Supervised Hours440 hours
Eligible to start with passing grade on mid term written and practical exams
To be completed within36 months from time of mid term exams
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All students complete the first year of the program, which consists of foundation courses in orthopaedic physical therapy. Upon successful completion of the first year of the program, students may continue in the certification program or apply for entrance into the fellowship program. Students who have successfully completed a residency program are exempt from the first year of the MTI program.
These first year courses serve to ensure that students who have not completed an orthopedic residency program matriculate in to the fellowship program with the requisite knowledge and experience to succeed.
Students, who wish to enroll in the fellowship program, and have met all the requirements listed above, have the possibility to do so up until completion of the Advanced Extremities I course. After this point students are not allowed to enroll anymore.Students who have met all the requirements listed above, and who want to enroll in the fellowship program, then will need to contact the Program Director with an established plan in place in regards to finances, time off from work to complete the hours, the expected timeframe of completion of the hours, and who their mentor will be for the supervised hours. At that time, a fellowship contract will be sent to the student for their signature, and they will be officially enrolled in the fellowship program
They will need to contact the Program Director with an established plan in place in regards to finances, time off from work to complete the hours, the expected timeframe of completion of the hours, and who their mentor will be for the supervised hours.
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The first year curriculum is outlined below. These hours do not count as part of the fellowship curriculum hours:
Course Title Total Hours in the Program
Foundations 32
Introduction to Evaluation and Treatment of the Lumbar Spine
32
Introduction to Evaluation and Treatment of the Cervical Spine
24
Introduction to Evaluation and Treatment of the Extremities
24
Introduction to Evaluation and Treatment of the Thoracic Spine
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Exams 4
Total hours 124
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Students who continue on in the certificate track, will follow the curriculum outlined below:
Course Title Total Hours in the Program
Integrated treatment concepts 8
Evaluation and treatment of Adverse Neural Tension 8
Joint Manipulations 16
Advanced Thoracic Spine 8
Advanced Lumbar Spine 40
Advanced Cervical Spine 40
Advanced Extremities 40
TMJ 6
Medical Exercise Therapy 16
Ethics and Medical Legal Issues 4
Exams 5
Total hours 191
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Students who matriculate into the fellowship-training track will follow a different curriculum upon successful completion of the first year of requisite course.
The orthopedic manual physical therapy fellowship curriculum is outlined below:
Course Title Total hours in the program
Pain Science 8
Advanced Lumbar Spine 40
Advanced Cervical Spine 40
Advanced Thoracic Spine 8
Integrated Treatment Concepts 8
Medical Exercise Therapy 16
Spine Manipulations 8
Extremity Manipulations 8
Introduction to Adverse Neural Tension 8
Gross Anatomy 16
Advanced Extremities 40
EBP 12
Clinical Pharmacology 12
Clinical Radiology 12
Ethics/Medical Legal Issues 4
Differential Diagnosis 6
Advances in orthopedic surgery and regenerative medicine 4
TMJ 6
Directed Projects (including, but not limited to EBP, Radiology, Pharmacology, Differential Diagnosis). Awarded hours with documentation of work
120
Grand Rounds (varies per clinical setting) 30
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Clinical Mentoring1:1 clinical supervision/instruction from clinical faculty while treating patients
130
1:1 patient/client related planning/discussion/review of diagnostic test, evaluation, plan of care etc.
40
Clinical Practice with mentor accessible onsite 270
Fellow Project: case study presentation suitable for journal submission, based on final live patient exam
120
Exams 40
Total hours in Program 1006
Grievance procedure
There is a specified process for a fellow student who desires to lodge a formal grievance in regards to any grading, performance evaluation, treatment or any other pertinent issue related to progression in the course. In order to be considered formal, a grievance must be submitted in writing. The written grievance must be submitted within 5 days of the episode to be considered, should detail the complaint, and express potential ideas for reconciliation of the issue.
The first step of the process is presentation of the grievance to the fellow advisor, who will review the complaint, meet with the fellow student, and determine if resolution can be achieved at this level.
If a successful resolution is not reached at the first level, the grievance will proceed to the grievance committee level where a full review will occur and a determination of resolution will be achieved. Resolution requires majority rule of the committee.
If a successful resolution is not achieved at the level of the grievance committee, the last and final step of the grievance process is submission to the program director for evaluation and consideration. The program director will have final authority to determine the resolution after full presentation of the case and actions that proceeded submission at this level.
Resolution can range from but is not limited to grade challenge and change, re-testing, remediation followed by re-testing, or upholding of the original assessment.
Director of Clinical Education Tim Kruchowsky PT, DPT, OCS, FAAOMPT
Grievance committee Stacy Fancher MSPT, FAAOMPT; Brenda Boucher PT, PhD, OCS, CHT, FAAOMPT
Program Director Pieter Kroon PT, DPT, OCS, FAAOMPT
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A fellow student who desires to lodge a formal grievance against MTI as a program may submit a complaint to the APTA according to the APTA’s grievance policy
PROCEDURE FOR HANDLING COMPLAINTS AGAINST A CREDENTIALED PROGRAM
1. Any person (Complainant) may submit a complaint about a credentialed postprofessional residency or fellowship program (Program) to the American Physical Therapy Associations’ (APTA) American Board of Physical Therapy Residency and Fellowship Education (Board), in care of the APTA’s Department of Residency/Fellowship & Specialist Certification.
2. Upon receipt of a complaint, APTA staff from the Department of Residency/Fellowship & Specialist Certification will forward a copy of the Postprofessional Residency & Fellowship Program Requirements as part of the ABPTRFE policies and procedures manual, Procedures for Handling Complaints about a Credentialed Residency or Fellowship Program, and a Complaint Form to the Complainant.
3. A Complainant must complete and sign a Complaint Form and submit it to APTA Department of Residency/Fellowship & Specialist Certification. By submitting a Complaint Form, the Complainant confirms that he/she is willing to have the Complaint Form known to the Program and agrees that the Complaint Form may be shared with the Program.
4. APTA staff will review all Complaint Forms to determine if the Complaint Form relates to matters within the scope of the Postprofessional Residency & Fellowship Program Requirements (Requirements) or Residency/Fellowship Program Agreement (Agreement).
a. If the Complaint Form does NOT relate to matters within the scope of the Requirements or Agreement, staff will so advise the Complainant, and the Complaint Form will not be sent to the Board.
b. If the Complaint Form DOES relate to matters within the scope of the Requirements or Agreement, staff will so advise the Complainant, and staff will send the Complaint Form (with all attachments, including supporting documentation) to the Board for review.
5. The Board will review the Complaint Form to determine whether the allegations, if true, would justify action by the Board.a. If the Board determines that the allegations, if true, would NOT justify action by the Board, it will so advise the Complainant, and the matter will be closed.b. If the Board determines that the allegations, if true, WOULD justify action by the Board, it will send the Complaint Form (with all attachments, including supporting documentation) to the Program for response, and it will request any additional information it deems relevant to determining whether the Program is in compliance with the Requirements or Agreement.
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6. The Program will be responsible for responding to the Complaint Form and any associated request for information within 45 days, or such other period as the Board may specify.
7. The Board (and APTA staff) will share with the Program only the Complaint Form and supporting documentation. APTA staff will not provide the Program any initial letter(s) of complaint (except to the extent such material may be part of the supporting documentation submitted by the Complainant).
8. APTA staff will provide the Program’s response to the Complaint Form and any associated request for information to the entire Board for review.
9. Within 45 days of receipt of the Program’s response, the Board will:a. Determine the Program is Out of Compliance and: i. Withdraw the credentialed status of the Program, orii. Request additional evidence to show compliance with designated requirements at the next annual review or as designated by the Board; orb. Determine the Program is in Compliance and: i. Take no action, orii. Request additional evidence to show continued compliance at the next annual review.
10. With respect to any Complaint Form sent to the Program for response, the Board will notify the Program and the Complainant of its decision
IncidentsIn case an incident occurs as a result of a technique or examination during the course, an incident report must be filled out that day and given to one of the faculty members. Incidents include any unusual occurrence that could present a liability to the Manual Therapy Institute. Incident reports can be obtained from the instructors at the course.
ADA StatementStudents having special needs/disabilities that require accommodations for the successful completion of the program must notify the Program Director not later than 4 weeks before the start of the program. Failure to do so in a timely manner may result in accommodation not being made as necessary.
DisabilitiesThe student is responsible for any disability that he/she may have and should exercise at all times the right not to have a certain joint examined or treated. The student also has the right not to have a particular therapist practice on him/her if the student so wishes. Please communicate such feelings to the instructor who will handle those concerns in private. Keep in mind that all courses are learning classes and therefore the therapist s attending are presumably not skilled at what they are practicing. If the student has a disability, it is his/her choice whether it is examined, and or practiced on during the course.
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Professional licensureSince you will be treating patients as part of your supervised hours, the student is require to obtain licensure in the state where the hours are taking place.
Professional liability insuranceIt is the student’s responsibility to obtain individual professional liability insurance when starting the supervised hours. Proof of insurance needs to be sent to MTI’s office prior to starting your hours.
Treatment during coursesTreatment at courses is not allowed except in the sense of correcting aspects of a dysfunction that are part of the instructed lab session (such as mobilizing a facet restriction). Faculty is not permitted to treat either during or after class hours. However, if they are demonstrating a routine treatment or an examination, a student with a clinical problem may be used as a model, but this is not considered a treatment
CEU’sMTI will provide CEU’s during the program sufficient to satisfy State Board requirements to maintain licensure. If you misplace your certificates, you can obtain duplicates from MTI for a fee of $25
Dress requirementsIt will be necessary to expose each joint fully with the exception of the hip and pelvic girdle in which case the student is encouraged to wear light clothing. For shoulder, cervicothoracic and thoracic spine, women should wear a halter-top or a bra. Avoid a one-piece swimsuit as this invariably restricts viewing the spine. Please bring enough clothing to be comfortable, as it is impossible to regulate the temperature to everybody’s wishes.
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Attendance
Attendance at all lecture and lab sessions is expected. It will be difficult to make up any missed sessions, but if you are ill or otherwise not able to attend, you are expected to notify the instructor prior to the session. Failure to do so may result in the absence being considered unexcused.
The current excused attendance policy covers typical life events and emergencies (e.g. illness of student, illness or death of immediate family member, military deployment of an immediate family member) If a student anticipates an important life event other than the typical or emergency situations listed, he or she should notify the course instructor as soon as possible to discuss whether altered class expectations are possible.
Should a student miss class, it is the student’s responsibility to obtain the missed information and meet with classmates to discuss/practice missed material. Responsibility for make up of missed work is the responsibility of the student.
A class missed needs to be made up in the next year of the program. Be aware that the next program might not be close to your residence. Additional travel costs for a make up class are for the therapist. A class not taken and made up may cause final examination to be delayed or withheld.
Pregnancy and other altered hormonal statesThe student must exercise discretion. Thrust techniques on the hips, for instance, should not be practiced on pregnant individuals due to forces that may be transmitted to the pelvis. Pelvic techniques should not be practiced on pregnant women either.
Disclosure of Medical Condition and Release of LiabilityAll students in the program must be responsible for their welfare and the welfare of others during the courses. Given that in these classes a learning situation exists, it happens that faculty cannot watch each and every single practice of technique. Even if they should manage to do so, this would not insure against faulty application of the technique. Before starting the manual therapy program, the student will be required to sign the “Disclosure of Medical Condition and Release of Liability” form. If you choose not to do so that is perfectly acceptable with the Institute, but you cannot take part in any practical sessions, nor must you do any of the activities that might be requested by the instructor. Please appreciate that even in the best run and most closely supervised environment accidents can happen. The Manual Therapy Institute cannot continue it’s course offerings if suits are brought against us.
It is also quite likely that if you have a mechanical problem it could become aggravated by activities in the class unless you take the precaution to exclude yourself from such activities.
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Access to Copyrighted Materials.
Purpose: Protection of the rights of intellectual property
MTI will make available to its Students certain of its educational materials for use by the students during the scope of the Student’s engagement in the Fellowship Program. The educational materials made available by MTI is herein referred to as the “Copyrighted Materials.” MTI has registered ownership of the copyright in all Copyright Materials. The Student agrees to make every effort to assure that the Copyrighted Materials are used only in accordance with the policies established by MTI. Such covenants are referred to as the “Covenants About Use of Copyrighted Materials”. The Student’s right to use the Copyrighted Materials shall terminate automatically and without notice at the termination of the Certification Program or Fellowship Program.
At no time shall Student disclose to any person, firm, partnership, venture, or corporation, any of the writings constituting Copyrighted Material or relating to methods or systems used by MTI in or about its business. Student expressly covenants and agrees that upon termination of the Manual Therapy Program, he will surrender to MTI all papers, documents, writings, and other property coming into his possession by or through the Manual Therapy Program to the extent that such and same relates to the information referred to above, including the Copyrighted Materials. All such materials will at all times remain the property of MTI.
Excerpts and links may be used, provided that full and clear credit is given to The Manual Therapy Institute with appropriate and specific direction to the original content.
In the event of a breach by Student of the Covenants About Use of Copyrighted Materials, Student agrees that MTI shall have the option to bring an action against Student to enjoin him from the activities causing the breach. In addition to such suit for equitable relief, MTI shall be entitled to seek compensatory and other damages caused by the breach of the Covenants About Use of Copyrighted Materials.
It is the student’s responsibility to download the appropriate course material prior to attending the designated course. When the course material is misplaced, notify Pieter Kroon via email and pay a fee to re-access the course material.
Recording
Purpose: Protection of the rights of intellectual property.
Policy: Audio- and video recording is not permitted. The purpose for this policy is twofold:1. Protection of the rights of intellectual property of the Manual Therapy Institute. 2. Videotaping of the class detracts from the student’s ability to pay full attention to the material presented.
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Required methods for assessing competencies
The examination procedures to assess knowledge and skills in manual therapy will meet the standards of the AAOMPT. The fellow student must demonstrate competency in: A multiple choice quiz examination (5 questions) prior to each course, for a total of 17 A written exam at the end of each of the 5 home study courses A comprehensive written examination in multiple choice format at the end of the first
year A comprehensive written examination in multiple choice format at the end of the
program A practical exam in OSCE format at the end of the first year of the program and at the
end of the program Ongoing informal assessment of clinical competence during clinical supervision with
patients present. Formal examination and intervention of a patient in a clinical setting with examiners
present. One patient with extremity emphasis, one patient with spine emphasis. One evaluation, two-three follow up visits.
Oral defense: Each fellow student must be able to orally defend his/her examination and intervention decision following each patient examination. The on-site patient examinations will last approximately 1 hour each.
Generic abilities. Assessment of generic abilities typically occurs three times throughout the program.
Passing grade for the written examination
The overall score of the written quizzes given prior to each course, and the quizzes taken with the home study courses, will count for 20% of the overall written grade.
The score of the mid term written exam at the end of the first year will count for 30% of the overall written grade.
The score of the written exam at the end of the program will count for 50% of the overall written grade. This exam must be passed at 80% in order to successfully complete the program.
For students wanting to start the fellowship program at the end of the first year, the composite score on the midterm written exam must be 80% or higher. When the student cannot get a score of 80% or higher, despite retaking it, they can continue with the certification program, but will not be allowed to start with the fellowship program.
A passing grade is 80%, which is conform the Standards of Texas State University Graduate School.
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OSCE guidelines
Testing procedures for assessing the resident’s clinical reasoning skills and psychomotor skills outside the clinical setting are done in the form of an OSCE (Objective Structured Clinical Exam) format. The OSCE is widely used in curricula involving the assessment of practical skills (Guidelines for curriculum development for postprofessional residencies in orthopedic physical therapy and orthopedic manual physical therapy). Many other manual therapy fellowship programs use a similar format to assess the fellow student practical skills. The handling skills are demonstrated on a faculty member, a more senior fellow student or another “live” model. Our guidelines for the OSCE exam are as follows:
Purpose: To determine the fellow student’s level of competency by testing his/her knowledge base and psychomotor skills through oral and practical examination.
Two examiners will be present. Examiners are on faculty of the Manual Therapy Institute.
The OSCE is a multi station test, which tests the resident in the following areas: Cervical spine Thoracic spine and ribs Lumbar spine and pelvis Upper extremity Lower extremity
Each station challenges the fellow student to answer one oral question and perform two practical demonstrations of an examination or treatment technique: Each station shall be designed as one of the five areas above. Six 3 by 5 cards will be randomly placed face down at each station. Each card will have
3 questions. The first one will be oral; the other two are practical. The candidate shall proceed to the first station and select a card. The candidate will read the first oral question aloud and proceed to answer it. Upon
completion of the first question, the candidate should then read the 2nd question, indicating that they are finished with the first question and then answer the 2nd question.
After answering the oral question on the card, the resident shall proceed to the treatment table, read the practical questions and demonstrate the appropriate techniques on a live model.
The card for the first station is handed to one of the examiners and the candidate proceeds to the 2nd station.
The above procedure is repeated for each station until the candidate completes all 5 stations.During this practical exam, the resident is judged on the following criteria: patient positioning, therapist positioning, safety issues, localization, stabilization, amplitude velocity, and direction.Scoring criteria are conforming to what has been taught in the classroom. Grades are on a pass/fail basis. A passing grade is 80%, which is conform the Standards of Texas State University Graduate School.
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Passing grade for the OSCE examination
Per station, the maximum amount of points that can be scored is 100.
An overall score of 80% for the 5 stations combined is considered a passing grade. This is 80 points per station, or 400 points combined.
The resident will still pass if 2 stations are below 80%, but not below 70%. In this case, the overall score still needs to be 80% or better.
The resident will not pass if 3 stations are below 80%, no matter what the composite score.
If the student scores one station below 70%, he/she fails the exam.
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ORAL AND PRACTICAL SCORING SUMMARY
Examinee______________________ Examiner______________________ Date__________
Cervical Lumbar Thoracic UE LE
Oral (10pts) ____ ____ ____ ____ ____
Diagnostic test (10 pts) ____ ____ ____ ____ ____
Technique #1Appropriate? (if not: -20 pts) ____ ____ ____ ____ ____
Patient position (2 pts) ____ ____ ____ ____ ____
Therapist position (2 pts) ____ ____ ____ ____ ____
Localization (10 pts) ____ ____ ____ ____ ____
Restriction barrier (13 pts) ____ ____ ____ ____ ____
Velocity (13 pts) ____ ____ ____ ____ ____
Total #1 ____ ____ ____ ____ ____
Technique #2Appropriate? (if not: -20 pts) ____ ____ ____ ____ ____
Patient positioning (2 pts) ____ ____ ____ ____ ____
Therapist position (2 pts) ____ ____ ____ ____ ____
Localization (10 pts) ____ ____ ____ ____ ____
Restriction barrier (13 pts) ____ ____ ____ ____ ____
Velocity (13 pts) ____ ____ ____ ____ ____
Total #2 ____ ____ ____ ____ ____
Grand total ____ ____ ____ ____ ____
PASS ____________ FAIL ______________
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Live patient guidelines
The fellow student must present a patient who has undergone a comprehensive musculoskeletal assessment and has been seen a minimum of 2 follow up visits. In addition the fellow student must:
Properly inform the patient ahead of time that a team of therapists will be observing their reassessment at a specific time. Explain that only what is done in the course of a normal re assessment will be demonstrated to the team.
Provide a typed comprehensive narrative summary of the initial evaluation along with a typed progress note summary. A detailed progress note must be written for each visit for patients seen 3 visits or less. Patients who are seen more than 3 times should have a detailed progress note done after every 3rd visit and their final visit. Include an up to date treatment plan.
The exam shall take place at the facility in which the patient is being treated to avoid any uncomfortable feelings on the part of the patient and avoid any liability in the event there is any kind of mishap on the patient’s way to another facility. The fellow student will be given the time of the live patient examination at least 5 days in advance to help prepare the patient’s schedule for the examination. The patient should be present 15 minutes prior to the patient examination. The fellow student should be present 30 minutes before the start of the exam. The fellow student must turn in a typed narrative summary before 4 PM the day before the exam is scheduled. Copies need to be distributed to the Program Director, the Director of Clinical Education and the Mentor. The fellow student keeps the original for reference during the exam.
The Director of Clinical Education serves as the external examiner for each live patient exam. The Director of Clinical Education and the examiner discuss the Live Patient Examination write up the day before the presentation. Upon finishing the presentation, the Director of Clinical Education and the examiner discuss the presentation. Priorities to work on are identified and suggested strategies discussed. The examiner and Director of Clinical Education both need to agree on Pass/Fail. In case they have divided opinions, the Program Director is brought in as a second external examiner, and his vote will be the tiebreaker for Pass/Fail.
The final live patient write-up now needs to be of such quality, that with minor editing, it is good enough to be submitted for publication in a peer-reviewed journal. The current format for the live patient write-up template is already set up with this in mind. Documentation of evidence based treatment interventions is required for each chosen treatment technique and citation in AMA format is required (AMA Manual of Style, 9th edition: http://www.amamanualofstyle.com/). When faced with a circumstance where evidence is not currently available, please provide sound problem solving and reasoning as to why such a method was chosen. Make it clear that advanced clinical reasoning is what dictates the intervention.
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In addition, we require that the live patient presentation will be written up in a poster presentation template. This will need to be of such quality that it can be presented at a State or National conference. The template we would like you to use is attached to this email. The poster presentation format requires a more concise presentation of the case study. Summarize the treatments. Add a “discussion” panel where you summarize how you treated this particular patient, and why it was or was not successful. We recommend your poster has a graph, or photo vs. lots of words or references.
We highly recommend that you consider presenting your live patient case at one of these conferences, because Tim and I feel strongly that our students are some of the best and brightest out there and we would love for you to be recognized as such among your peers.
Format of the exam
The examiners review the narrative summary The Fellow in Training gives an oral overview of the case presentation. The examiners may ask the resident clarifying questions pertinent to the case
presentation. The patient is brought in and introduced to the examiners. The Fellow in Training at
this point should be prepared to:1. Demonstrate relevant examination techniques on the patient including manual
therapy examination techniques.2. Point out any structural deviations if present as well as relating the present
structural findings to the initial findings.3. Correlate any radiological findings to the patient’s biomechanical status.4. Any other relevant information or demonstration pertinent to the case.
The patient is then excused and thanked for their time and cooperation. The examiners may ask questions relevant to the patient presentation at this time
and the Fellow in Training may be asked to demonstrate treatment techniques on a model.
The live patient exam is concluded and the Fellow in Training is excused.
Competence
During the live patient exam and oral defense, the Fellow in Training must demonstrate competence in the following area:1. The appropriate completion of a medical screen to rule out non-musculoskeletal origins
of the patient’s complaints and/or the relevance of existent conditions that may contribute to or impact the management of a patient’s primary musculoskeletal condition.
2. Clearly identify and articulate orally and in writing the patient’s local and referred symptoms.
3. Effectively question the patient in a manner that reflects understanding of indications and contraindications to manipulation.
4. Rule out central nervous system involvement.
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5. Associate and disassociate local and referred symptoms in peripheral vs. spinal problems.
6. Examine physiological and accessory movements of vertebral a peripheral joints and determine positive signs.
7. Analyze and identify relationship between hypermobile and hypomobile segments and patient’s signs and symptoms.
8. With skill and accuracy, be able to perform neurodynamic testing.9. Analyze and identify the relationship between impaired neurodynamics and the
patient’s sign and symptoms.10. Analyze and identify the relationship between muscleimbalance and the patient’s
signs and symptoms11. Examine pain sensitive structures within the vertebral canal and intervertebral
foramen.12. Interpret examination in relation to history, severity, irritability, nature and stage of
the condition. 13. The ability to make an appropriate physical therapy diagnosis.14. Identify and justify the length and type of treatment and anticipated benefits of
treatment.15. Discussion, with the patient, of prognosis based on clinician experience, current best
evidence and patient values.16. With skill and accuracy, be able to perform mobilization and manipulation for
peripheral and spinal joints. The fellow student’s competence in this area is graded on the following: appropriateness of technique, patient positioning, therapist positioning, localization, ability to locate restriction barrier and velocity.
17. With skill and accuracy, be able to perform soft tissue mobilizations. The fellow student’s competence in this area is graded on the following: appropriateness of technique, patient positioning, therapist positioning, localization, depth and direction.
18. With skill and accuracy, be able to treat impaired neurodynamic function. The fellow student’s competence in this area is graded on the following: appropriateness of technique, patient positioning, therapist positioning, localization, ability to locate restriction barrier and direction
19. With skill and accuracy, be able to instruct patient in an appropriate home program.20. Demonstration of use of reliable and valid outcome measures.
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LIVE PATIENT EXAMINATION EXTREMITIES
Fellow student_______________________________________
Examiner _______________________________________
Date _______________________________________
Instructions: The following is the gradesheet and criteria for grading of the mid-term Extremities Live Patient Exam. Each category from evaluation and assessment to intervention is broken down into subcategories. Carefully review each. Points will be added cumulatively to establish the overall grade which must be greater than or equal to 80% of the total possible points. However, several categories have P/F (pass/fail) criteria. These P/F categories are based upon either critical safety or expectations of fellowship level clinical practice. Failure of any one of these P/F categories will lead to failure of the exam regardless of what the total cumulative point percentage may be.
5 = excellent & thorough demonstration of accomplishment4 = good demonstration of accomplishment; fellowship level performance3 = average demonstration of accomplishment2 = below average demonstration of accomplishment1 = minimal accomplishment0 = no accomplishment demonstrated
History (30 points)Obtains accurate description of symptoms ___/5Determines onset of problem ___/5Obtains description of mechanics of injury ___/5Obtains past history of previous episodes and previous Intervention
___/5
Obtains medical hx person and family ___/5Determines appropriate diagnoses to R/I & R/O based on Hx
___/5 P / F
Comments________________________________________________________________________
________________________________________________________________________
Behavior of symptoms (20 points)Determines aggravating and easing factors ___/5Determines pain behavior in 24 hour period ___/5Nocturnal disturbance of sleep patterns ___/5Non-organic symptoms (pain drawing, visual analog pain scale etc.)
___/5
Comments________________________________________________________________________
________________________________________________________________________
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Structural Inspection (20 points)Postural assessment ___/5Recognize acute deformities ___/5Inspection of trophic changes ___/5Inspection of muscle tonal changes ___/5Inspection of skin ___/5
Comments________________________________________________________________________
________________________________________________________________________
Movement Assessment (35 points)Cardinal plane movements (pattern of pain and limitation, range, change in status)
___/5
Passive, nonweight bearing movements(relate to active movements)
___/5
Resisted movements ___/5Joint play testing ___/5Stability testing ___/5Palpation for positional faults, soft tissue restrictions, pain
___/5
Special testing ___/5
Comments_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
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Neurological Screen/Assessment (50 points)Assessing reflex changes, sensory changesmotor changes
___/5
Understands relevance of changes ___/5 P / F
Assessing neural dynamics: ___/5Recognizes Presentations that suggest ANTT ___/5Identifies correct dural and/or peripheral nerve ___/5
Assesses with correct technique: Correct starting position ___/
5Asks re:s/s prior to each component ___/5Takes up each component and maintains ___/5Alters with appropriate distant component ___/5Determines if findings are Relevant ___/5
Vascular (10 points)Assessing thoracic outlet, when applicable ___/5Assessing proximal/distal pulses ___/5
Radiology (10 points)Identifies structures ___/5Correlation to patient status and treatmentplan
___/5
Comments______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Correlation (35 points)Identifies “red flags” & consequences forIntervention
___/5 P / F
Identifies psychosocial issues(“yellow flags”) and consequences for Intervention
___/5
Identifies critical safety issues and consequences for Intervention
___/5 P / F
Identifies Contraindications ___/5 P / FCorrelates Subjective & Objective Findings ___/5Identifies the cause of the problem ___/5Determines appropriate Comparable S/S to monitor Response to Intervention
___/5
TreatmentAppropriateness of Intervention Selection
___/5
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5 – exceptional; no missed components & foresight demonstrated 4 – good; no missed components3 – acceptable; all major components addressed, some minor lacking2 – needs improvement; lacking a few major & minor components1 – multiple major and minor components lacking0 – unacceptable for intended purpose
Joint Mobilization (35 points ea) Mob:_____ Mob:_____ Mob:_____ Mob:_____Appr. Mob. ROM Impairment __/5 P / F __/5 P / F __/5 P / F __/5 P / FCorrect Position & Alignment of Patient __/5 __/5 __/5 __/5Correct Position & Alignment of Clinician __/5 __/5 __/5 __/5Chooses Correct Grade for Purpose __/5 __/5 __/5 __/5Monitors pt Response to Mobilization __/5 __/5 __/5 __/5Measures ROM after Mobilization __/5 __/5 __/5 __/5Performs Appropriate Neuroms Re-ed __/5 __/5 __/5 __/5
Neuromuscular Re-ed: (35 points ea) Ms._____ Ms._____ Ms._____
Ms._____
Correct ms group based on eval criteria P/F
___/5 P/F ___/5 P/F ___/5 P/F ___/5 P/F
Choose Appropriate Technique ___/5 ___/5 ___/5 ___/5Optimal Position of Pt. ___/5 ___/5 ___/5 ___/5Re-ed at End of New ROM ___/5 ___/5 ___/5 ___/5Appropriate Force/Resistance ___/5 ___/5 ___/5 ___/5Time & Repetitions ___/5 ___/5 ___/5 ___/5Avoids Substitutions ___/5 ___/5 ___/5 ___/5
Soft tissue mobilization (10 points)Identifies appropriate tissues to mobilize ___/5Utilizes appropriate technique based upon restriction & phase of healing
___/5
Nerve or Dural Glides: (30 pnts per nerve) Nerve:______ Nerve:_____ Nerve:_____Correct Tensioning Position for Nerve ___/5 ___/5 ___/5Appropriate choice of joint to glide/floss with ___/5 ___/5 ___/5Correct Interpretation of Pt Response ___/5 ___/5 ___/5Quality of instruction (asks re: s/s) ___/5 ___/5 ___/5Correct Prescription Based upon Irritability ___/5 ___/5 ___/5Ensures Correct Form ___/5 ___/5 ___/5
Ther Ex Procedure: (45pnts ea) Tech 1 Tech 2 Tech 3Technique Chosen _______ ______
________
Appropriate & Safe P/ F
__/5 _______ _______
_______
Correct Target Tissue/s Identified __/5 _______ _______
_______
Quality of Instruction __/5 _______ _______
_______
Proper Posture & Form __/5 _______ _______
_______
Recognition of Substitutions __/5 _______ _______
_______
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Correct Prescription for Goals (re-ed, strength, end.) __/5 _______ _______
_______
Correct Prescription based on Tissue __/5 _______ _______
_______
Correct Prescription based on Stage of Healing __/5 _______ _______
_______
Progress or modify Based on Performance __/5 _______ _______
_______
Postural Re-Education (15 points; when applicable)Targets correct ms imbalances ___/5Proper form ___/5Progresses from basic to functional ex
___/5
Home Exercise Program (25 points)Exercises to address ea. Intervention Category
___/5
Approriate Exercises Chosen ___/5Ensures appropriate form ___/5Correct Prescription for ea. Based on Goal ___/5Good pt education – ensures understanding ___/5
Comments________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Follow up treatments (20 points)Assessment for change in signs/symptoms ___/5Assessment for change in function ___/5Modification of interventions accordingto pt’s change in status/response
___/5
Prognosis ___/5
Overall impression: ______/5
5 – Correctly identified the diagnosis with complete and exhaustive information regarding all possible causative factors and secondary factors.4 – Correctly identified the diagnosis with significant information regarding most of the possible causative factors and secondary factors. 3 – Correctly identified the diagnosis with moderate information regarding a few of the possible causative factors and secondary factors.2 – Correctly identified the diagnosis with minimal information regarding possible causative factors and secondary factors.
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1 – Correctly identifies the diagnosis, but unable to provide information regarding causative factors and secondary factors.0 – Unable to correctly identify the diagnosis.
Priorities to work on
Suggested strategies
Comments:
GRADE: PASS FAIL
Signature examiner ___________________________________________
Correct Diagnosis
ID Causative Factors
ID Secondary Considerations
Explains Regional Interdependence
5 Yes Complete & exhaustive identification of possible causative factors
Complete & exhaustive identification of secondary considerations
Connections to regional interdependence clearly understood and specifically stated
4 Yes Most possible causative factors identified
Most secondary considerations identified
Most connections to regional interdependence understood and clearly stated
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3 Yes Identifies about half of the possible causative factors
Identifies about half of the possible secondary considerations
Moderate understanding of regional interdependence but unable to identify all factors
2 Yes A few possible causative factors identified
A few secondary considerations identified
Moderate to minimal understanding of regional interdependence
1 Yes Unable to identify possible causative factors
Unable to identify secondary considerations
Minimal to no understanding of regional interdependence
0 No Unable to identify causative factors
Unable to identify secondary considerations
No understanding of regional interdependence
GradesAll tests (written exam, OSCE and live patient) are on pass/fail basis. To graduate from the program, the student must pass all components.
Failed exams
The policy on retaking failed exams is similar to failed exam policies found in university graduate school programs. A passing score for each written exams is 80 (not including course quizzes). The practical exams and live patient exams are scored on a pass/fail basis. Fellow students failing an exam are allowed to retake them at the next available opportunity.
If the fellow student is unable to demonstrate competency as defined by the passing scores on the specific exams, the student will be counseled by providing them with a breakdown of the exam results and guiding further study and preparation for retest.
Remediation methods may include, but are not limited to, retaking of specific classes of the core curriculum, additional hours spent with a mentor or completion of specific assignments.
If the student is not able to pass the first year written- or practical exam after the second try, despite remediation, the student will be ineligible to enter the fellowship program.
If the student is not able to pass the final written- or practical exam after the second try, despite remediation, the student will be ineligible to:
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1. Complete the fellowship program2. Graduate from the certification program
The written retake exam can be done in proctored format. The student will identify a proctor. The exam will be sent to the proctor. Upon completion, the proctor will send the entire exam back to the Program Director for grading.
The OSCE retake exams are scheduled with the Program Director and are up to the discretion of the faculty and Program Director. They will be done on course weekends, which might mean that the student will have to travel to the location where the courses are taught. The OSCE retake exams will be administered by MTI teaching faculty. The student is not eligible for graduation until passing performance on the retest exam has been achieved. The fellow student will have to retake the exam within 3 months.
Postponing exams
Due to the volume of students enrolled in our program and the amount of time and energy it takes to organize a final exam, as well as honor code considerations, it is very challenging for us to reschedule final exams. With that said, we do accommodate our students as we want you to succeed but re-scheduling the exam has an associated $100 additional fee.
Postponing the exam might mean you have to travel to a different course location to take the exam.
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Academic Integrity
Purpose: In recognition that health care professionals must be held to the highest standards of ethics and responsibility, honesty and academic integrity are a fundamental requirement of the program.
Policy: Lapses in academic integrity are not tolerated in the program and all cases will be vigorously investigated. Students who do not adhere to these standards will face dismissal from the program.
Procedure:Person Responsible
Action
Faculty members 1) Notify students of expectations for honesty and academic integrity.
2) Design evaluative tools such that opportunities for cheating are minimized.
3) When assigning and grading assignments, require proper citation of all materials used and proper references.
4) In the event cheating, plagiarism, or similar acts are suspected, take immediate action.
Students 1) Adhere to the expectations for academic integrity at all times.
2) The following rules apply to examinations: Test is not to leave the room Once an exam is turned in, it may not be retrieved by
the student Book bags / backpacks etc. should be closed and tucked
securely away 3) Students may be permitted to take an exam at a time other
than the scheduled time in special circumstances including personal illness or emergency. The Program Director will determine a method and
date in consideration of the specific situation.4) Follow guidelines for proper reference and citation for all
written work.
Standards for supervised clinical hours
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Two essential components of fellowship training are clinical practice over an extended period of time combined with consistent clinical supervision by the manual therapy instructor(s)/mentor(s).
o 440 hours of on site clinical practice hours must be completed to meet this requirement.
o The hours are completed in a facility that has an orthopedic manual physical therapy instructor available during the entire 440 hours.
o A minimum of 90% of the caseload should involve orthopedic patients. The instructor: resident ratio should not exceed 1:6. The instructor is available to
provide feedback to individuals or groups of residents while the resident is involved in ongoing patient care.
It is not necessary to complete the 440 hours in 1 block. However, the 440 supervised hours must be completed within 36 months from the start of the program.
Requirements for 1:1 supervision of fellow students: The clinical supervision requirement is defined as on-site instructor supervision of the fellow student who is actively engaged in the evaluation and treatment of the orthopedic patient. Fellow students are to receive 150 hours of 1:1 (fellow student: instructor ratio) supervised patient contact hours and a minimum of 40 hours of tutorial/case presentation with clinical instructor present. These hours are not to be confused with instruction in the theoretical content or supervised learning of manual therapy examination and treatment techniques in class.
o The 40 non patient contact hours may include, but are not limited to:1. Case presentations - a minimum of 1 case study should be presented by
the fellow student.2. Case Journal Review - Instructor and fellow student should review the
case journal at least weekly during the clinical supervision period.3. Mock patient practice - opportunities should be available for role playing
or mock patient practice during the clinical supervision period.4. Teaching-assisting at one of the manual therapy courses organized by
MTI. A total of 32 hours (2 course weekends) can be officially logged as non-contact hours.
The supervised patient contact hours must also meet the following standards:o Each fellow student must maintain a written journal of 150 hours of
supervised patient treatments. Forms are established for documenting patient diagnosis, hours of supervision and a summary of clinician performance
o The instructor must be present during the evaluation and/or treatment of these patients.
o A clinical supervision hour may include a brief pre-treatment consult, and written or verbal post recommendations.
o Instructor recommendations may include general comments concerning the evaluation and treatment, appropriateness of said evaluation and treatment, and possible adaptation to the treatment plan.
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MTI will arrange for its fellow students to work in one or more clinic and to participate in the institutional services provided by such organization. We refer to each of these organizations as "the Facility." Although we communicate our roster of fellow students to the Facility, we establish the contractual arrangements directly with its fellows and independently from the Facility. However, as a condition to our Fellowship program at the Facility, each Facility has asked to reserve the right for the Facility to reject any one of MTI's fellow students. That is, the Facility may, for its own reasons, refuse to allow any one of MTI's fellow students to use the institutional setting provided by the Facility or to work at the Facility. These decisions are made by the Facility and are beyond MTI's control. Accordingly, if the Facility objects to a fellow, and other reasonable accommodations cannot be made, MTI cannot provide the Fellowship program to the fellow and must have a way to terminate its contractual obligation to the fellow. In the case that a Facility rejects a Fellow, the Fellow will go through a remediation process and MTI will take the necessary steps, within reason, to ensure that the Fellow is able to complete the hours at a different Facility.
The termination provisions allow either the fellow or MTI to terminate the fellow's participation in the Fellowship program. The terminating party must give one month's notice of termination to the other party. The termination provisions also remind the fellow that termination of the contract between the fellow and MTI may occur as a result of the unilateral rejection of the fellow by the Facility.
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Supervised Hours Log
Fellow Student:_________________________ Mentor:_____________________________
Date MentorInitials
Timein
Time out Contact Hours
Non-Contact Hours
Total Clinical Hours
This PageNumber:
TOTAL This Page
GRAND TOTAL(All Pages Combined)
Total Required Hours 150 40 440
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Diagnosis: _______________________________ Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Narrative comments to include: pre treatment consult, examination and treatment consult, written or verbal summary/post recommendations.
Diagnosis: _______________________________ Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Narrative comments to include: pre treatment consult, examination and treatment consult, written or verbal summary/post recommendations.
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Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Write down the content of this non-contact hour, which may include: case presentations, journal review, tutorial, mock patient practice etc.
Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Write down the content of this non-contact hour, which may include: case presentations, journal review, tutorial, mock patient practice etc..
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Patient per Diagnostic Category Chart
You will also need to keep track of the patient diagnoses you will be treating during your fellowship hours.
I have attached a patient diagnosis chart for you to keep track of this. This chart is a summary of your entire fellowship and does not need to be broken down by the facility you were in.
Each new patient that you see should be counted only once (therefore, if you saw that patient for several subsequent visits, you can only count that person 1 time).
When calculating the percentages, it would be based off of the total number of patient diagnoses you have seen over the course of the program. For example, if you saw 12 foot/ankle patients out of 130 total diagnoses on the chart, then the percentage would be 9%.
Historically, we have found that the cumulative average amount of patients per diagnostic category is 155. If you find that you are logging <100, or >200, you are probably doing it incorrectly. You need to then talk to your mentor, or contact the Program Director
When you are done with your hours, send the completed chart back to me. The APTA wants this information as part of our annual report.
For EVERY fellow listed as GRADUATED in Section II, please provide their completed diagnostic category chart. Please summarize the number of patients/clients (not number of
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visits) by diagnostic categories evaluated, treated, and/or managed by the residents/fellows during the entire course of the residency or fellowship program. Do not provide data on patient/clients seen by all staff in the clinic.
Diagnostic Categories for Orthopaedic Manual Physical Therapy Fellowship Programs
DIAGNOSTIC GROUP OR CATEGORY
NUMBER OF PATIENTS/CLIENTS TREATED BY THE FELLOW AS PART OF THE PROGRAM
% OF TOTAL PATIENTS/CLIENTS TREATED BY THE FELLOW
Cranial/Mandibular Cervical Spine Thoracic Spine/Ribs Lumbar Spine Pelvic Girdle/Sacroiliac/Coccyx/Abdomen
Shoulder/Shoulder Girdle Arm/Elbow Wrist/Hand Hip Thigh/Knee Leg/Ankle/Foot
Total 100%
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Clinical mentoring: the core of clinical fellowship education
When experts are asked how they arrived at their level of performance, they often discuss their mentors. Similarly, the therapist who pursues residency education frequently seeks the opportunity to receive ongoing clinical supervision and mentoring from highly skilled practitioners, acknowledging :I want to be able to do that or to solve those kind of complex problems”. This is part of their internal drive and motivation. The clinical mentoring experience is at the core of fellowship education and is a major factor that governs the success of a program in meeting its goals and objectives.Many factors contribute to the success of the mentoring experience:
The program’s philosophy toward clinical mentorship The allocation of sufficient resources for seeking qualified faculty and facilitating
their ongoing mentoring skills The communication between the fellowship program director, fellow and faculty, so
that the mentoring experience is continually linked to the academic components of the program and is tailored to the fellow’s changing performance.
Within clinical education, the terms preceptorship or mentorship tend to be used interchangeably. However, as described in the educational literature, these are distinctly different experiences. The chart below compares the characteristics of a preceptorship with those of a mentorship.
Preceptorship Random matching of the preceptor with the trainee A structured program for learning is in place with identified performance outcomes The preceptor guides the trainee primarily in practice development and clinical
competence The individuality of the trainee is emphasized and the dynamics of learning are
interactive and unpredictable Assistance in socialization is related more specifically to the clinical environment The preceptor/trainee relationship is of shorter duration (less than 1 year)
Classic mentorship A natural, self-chosen relationship, one that is self selected An informal, undefined program The mentor serves as a wise, reliable counselor and is concerned with professional
development in terms of broader career issues The mentor widens the protégé’s professional network and makes social and
professional introductions The mentor/protégé relationship is long term, usually several years. Has a natural beginning and end that is mutually determined
At the heart of mentorship is collaboration and reflective practice. Reflective practice is not just “critical thinking” but rather the deliberate and systematic use of reflection as a learning tool in professional practice. The 2 key concepts here are reflection and deliberation. Reflection is the thinking about the action both during and after the events.
This thinking is critical and evaluative: “What could I have done?” “What should I do now?” Mentors help facilitate this process. A second element is deliberation: “What ought I to do now for the good of the patient?” This includes the moral dimension and the use of practical reasoning and wisdom.
Research on expert practice in physical therapy also shows that listening to the patient is a central component of expert practice. The patient is a valued and trusted source of knowledge. Experts focus on knowing the patient’s valued activities and goals, how movement problems may interfere with those activities, and what kind of support systems they have in place. Furthermore, experts focus on collaboratively solving the problems rather than laying blame, or judging or labeling a patient. If the therapist is having a difficult time finding a successful intervention, often it is because he/she needs to learn or to find out more. Advocacy is a responsibility taken seriously by experts, as they believe they have the obligation to insist on the best possible care for their patients.
What mentors provide to fellows
Mentors support, challenge and provide vision. Assisting a fellow to learn how to assess or critique his/her own clinical performance is essential and a foundational component of the reflective process. Fellows must then be able to use different strategies for thinking more deeply about their clinical reasoning. Mentors have a good grasp of clinical knowledge attained through reflection of their experience. They challenge fellows with questions to facilitate growth and development of the fellow’s clinical knowledge. The mentor also provides vision-asking the fellow “Who do you want to become?” “What will your contribution to the profession be?” This requires the ability to see the broader view beyond the application of technique or specific knowledge of the patient to the political, social, cultural, moral and organizational issues that affect professional practice and patient outcome. MTI strives for an educational environment that creates a mentoring experience. The role modeling of professional behaviors and a lifelong commitment to learning is a key component of the OMPT DACP.
Factors to consider in providing clinical supervision to experienced therapists
Fellowship programs usually attract physical therapists with a broad range of clinical experiences and ages. Providing clinical supervision to experienced therapists poses unique challenges that differ significantly from those involved in supervising entry-level practitioners.
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Experienced practitioners May possess a definite a professional identity accompanied by pride in past clinical
performance Have developed practice patterns (clinical reasoning and handling skills) that may
need to be challenged or may need to be unlearned in order to achieve a higher level of practice
Are highly motivated to learn and grow but may experience feelings of ambivalence about moving out of their “comfort zone”
What fellows seek in the clinical supervision experience
Fellows want to: Increase their clinical and academic knowledge and ability to apply it Observe their fellowship faculty in action and absorb how they do what they do Receive constructive and timely feedback with strategies for change Be connected to the profession beyond the confines of the clinic
Teaching characteristics faculty bring to the clinical supervision experience
Being an expert practitioner does not necessarily mean that the clinician has equivalent skills in clinical supervision. One of the greater challenges MTI faces in building the fellowship program is how to build an atmosphere of collaboration. Some of the characteristics of residency faculty that contribute to a collaborative atmosphere during supervision are listed below. Collaborative faculty is:
Accessible Responsive to the learning needs of the resident Comfortable with self Respectful and non-judgmental Nurturing yet able to set limits and communicate concerns Forthcoming if personality conflicts arise Timely with written and verbal feedback. Willing to acknowledge when unable to solve a patient problem or when they have
made a mistake Able to use a fellow’s experience effectively to advance the fellow’s individual
performance Receptive to the opinions and rationale of the fellow if different from their own
From: Guidelines for curriculum development for postprofessional residencies in orthopedic physical therapy and orthopedic manual physical therapy. Published by the Orthopedic Section of the APTA and the American Academy of Orthopedic Manual Physical Therapists, 2001.
Policy on the Practice of Cervical Manipulations
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Preamble
Students at MTI are initially taught mobilization techniques which are then progressively developed into manipulative techniques. Manipulative techniques involve the application of a high speed, small amplitude thrust beyond the physiological passive range of a joint. They are often referred to as high velocity thrusts (HVT) and are frequently associated with a ‘popping sound’ (otherwise known as a ‘cavitation’). The graduated increase in the forces applied to the spine is seen as an important safety aspect of this process.
However, there are potential dangers associated with the use of manual therapy techniques and recognized contraindications to their use, in particular with respect to HVT techniques.
For the safety of students and patients, the following policy will be followed with respect to the application of mobilization and manipulative techniques taught at the Manual Therapy Institute
Policy
Students must screen for the presence of contraindications to manipulation Students must read and understand ‘Contraindications to Manipulation’
and “Pre Manipulative Screening” & its associated references. Students will assess for potential vertebro-basilar insufficiency (VBI) and/or upper
cervical ligament stability by following the ‘VBI and upper cervical stability protocol” on each and every occasion before practicing any cervical techniques.
Students have the right to withdraw from practicing manual therapy if they feel unsafe or have conditions that may preclude them from practicing safely, without prejudice or bias.
Students must sign a copy of the Manual Therapy Institute consent form attached acknowledging that they have read, understood and will comply with this policy.
In rare circumstances students may have an adverse reaction to a manual test or procedure. In such an event, the following policy must be followed:
The student who has the adverse reaction and/or other student’s involved will report to the lecturer the nature and extent of the problem either at the time of the incident or as soon as is possible in the event of a delayed reaction.
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Spinal Manipulation Screening Form
Date:Patient Name:Student Name:
SUBJECTIVE OBJECTIVEY N √ box if no symptoms of VBI
provoked√
History of Trauma?Sustained End Range Cervical Rotation
Previous VBI Symptoms or History? Pre-Manipulative Position in Supine
Differential diagnosis ?Vestibular System
(Quick Movement of the Head)
Y N Y NDysphagia NauseaDysarthria NystagmusDrop Attacks Numbness
&/orTingling of lips ortongue
DizzinessDiplopia
SUBJECTIVE OBJECTIVEPositive Negative Positive Negative
DiscussedRisks/Benefits of manipulation Yes NoPatient questions Yes No
Informed Consent Given by Patient Yes No
Instability TestingAlar Ligaments Positive/NegativeTransverse Ligament Positive/Negative
General HealthAny musculoskeletal or general medical problem(s) or condition(s)? Yes/NoIf yes, please detail...
Student DeclarationI have undergone the above screening procedures today and agree with the findings as detailed above. I consent to the application of manipulative techniques to my spine. I have also signed the Spinal Manipulation Consent Form
Signed
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Spinal Manipulation Consent From
I voluntarily consent to participate in the practice of spinal manipulative techniques during the manual therapy program taught by the Manual Therapy Institute.
I have read and understand the ‘Policy on the Practice of Manipulative Techniques’ the ‘Contraindications to Manipulation’ and the “VBI and Upper Cervical Instability Screening Protocol"
I understand that I have the right to refuse to have manipulative procedures applied to me at anytime.
Name
Signature
Date
Witness Name
Signature
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Tuition and Fees
Tuition course work (includes weekend courses, workbooks $8,100.00homestudy courses, manipulation DVD and exams)
Tuition supervised hours $6,500.00
Replacement CEU certificate $25
Retake written exam $100
Retake OSCE $250
Postponing written/practical exam $100
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Professional Behavior
Purpose: To enhance professionalism within the Program and the Profession.
Policy: Professionalism is an integral part of PT that is to be exemplified by both students and faculty. Students and faculty are expected to adhere to the APTA Code of Ethics and Standards of Practice and all Program policies related to professional behavior.
Students are expected to attend and participate in all scheduled lecture and laboratory sessions. Participation in class discussion, lecture, and laboratory is vital in order for students to develop basic examination knowledge and skill. Examples of appropriate professional behaviors for the course include the following: treats all individuals with respect, arrives on time and prepared for class/laboratory sessions, demonstrates consistent attention and focus, changes laboratory partners often, works well with others, asks questions, leads discussion when asked, helps others with practice and discussion, volunteers for demonstrations, and comes to instructors for help when needed. Please see the Student Handbook for further information regarding professional behavior within the Department. If you are unable to attend a class, please notify the instructor prior to that class meeting. If you are absent, it is your responsibility to obtain information from the missed session.
Professional Behavior Expectations
Student arrives on time to class and laboratory, demonstrates consistent attention and focus, changes laboratory partners often, works well and respectfully with others, asks questions and engages in class, leads discussion when asked, helps others with practice and discussion, volunteers for demonstrations, follows policies regarding appropriate dress for both laboratory as well as guest speakers, comes to instructors for help when needed in a timely and professional manner.
If a course instructor deems a student’s behavior to be egregiously inappropriate, the student may be required to meet with his or her advisor, the course instructor, and any other faculty deemed appropriate to review the Generic Abilities requirements and formulate a corrective action plan prior to returning to class. At this point it is possible for the outcome to include the student being placed on professional probation. Refer to attached Professional Behaviors Policy and Procedures for details.
Behavior Deemed Inappropriate for Successful Course Completion
Examples of behaviors that will not be tolerated include, but are not limited to: repetitively interrupting or speaking out of turn, refusing to defer to instructor direction, using an inappropriate or accusatory tone of voice, cursing, using inappropriate body language (ie rolling eyes, huffing, refusing to make eye contact, placing hands on hips).
If the course instructor deems a student’s behavior to be egregiously inappropriate, the student will be required to meet with the course instructor, and any other faculty deemed
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appropriate to review the Generic Abilities requirements and formulate a corrective action plan prior to returning to class. At this point it is possible for the outcome to include the student being placed upon professional probation, or dismissal from the program.
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Assisting in class
As part of doing your hours, you can be a Teaching Assistant for the courses. We allow 2 weekend courses (32 hours) for this, and they count as non-contact hours.
Upon graduation, you are more than welcome to audit future courses. In return, we ask you that you will be functioning as a TA for those courses.
As an MTI-registered lab assistant, you will be required to agree to comply with ALL of the following points:
1. Maintain a current physical therapy license, and submit a current copy to the Site coordinator when required.
2. Maintain current personal malpractice insurance. 3. Seek permission of the Program Director in a timely fashion.4. Be prepared to perform in the lab assistant function by reviewing the course, course
notes and theory for the course level on which you will assist.5. Come prepared to actively assist the students and the Instructor6. Passive auditing of the entire class by the lab assistant is not permitted.7. Come prepared to be a model and have techniques demonstrated on you and inform
the Instructor(s) of any physical limitations or precautions prior to being a demonstration model.
8. Provide assistance to students during lab time (i.e. moving among the tables, checking hand placements, body mechanics or technique, answering student questions regarding theory, technique and clinical reasoning, etc).
9. Refer questions to the instructor if unaware of proper technique or correct answer.10. Pose only legitimate or useful questions during class in an effort to help the
students’ understanding or to elucidate a point being made.11. In the lab sessions or breaks, refer ONLY to theory or techniques that have been
introduced and taught during the course, unless specifically requested to demonstrate a technique variation by the Instructor. (Despite your expertise, this is not the place to demonstrate your variation of a technique, nor treat a course participant.)
12. Treatment of course participant’s pain or dysfunctions during the course or during the breaks is NOT permitted. If the student has a problem or develops a problem during the class, the Course Instructor must be informed and will manage the situation.
13. Approach each student as one would a patient and be alert for contraindications to techniques as well as increasing sensitivity of areas to repeated assessment or treatment.
14. Assess the students’ difficulties with comprehension or psychomotor skills and endeavor to facilitate the learning.
15. Maintain confidentiality of the course participants’ personal and health information (per HIPAA guidelines).
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16. Assist in room set up and break down, setting out break snacks and clean up and other lab assistant duties as needed or requested by the site coordinator or Instructor.
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Case Study Presentation Template
Case study presentation
Patient’s primary complaint
Assessment/working hypothesis
Severity Irritability Nature
MildModerate Severe
Mild ModerateSevere
MusculoskeletalNon-musculoskeletalBoth
List the pertinent subjective and objective findings that shore up your assessmentSubjective
Objective
List the asterisk signs by which you gauge the efficacy of your treatment (pre-and post treatment)
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Intervention
What was your first choice of treatment and why? Please provide a brief justification. Cite supportive evidence from the literature where appropriate
What is your second choice of treatment and why? Support your answer as above
From initial evaluation up to now, list treatments and responses (immediate and on follow up)
Visit # Technique or exercise(level/direction/grade/reps/time
Patient response after intervention ORPresentation on follow up exam
S
O
S
O
S
O
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S
O
S
O
57
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