The Electrocardiogram (ECG) is an important non-invasive test used for interpretation of the cardiac rhythm, conduction system abnormalities, and the detection of myocardial ischaemia. A systematic approach to ECG interpretation is necessary to avoid overlooking any abnormalities. The objective of this assessment task is to reinforce the framework for a systematic analysis of an adult 12 lead ECG.

There are two components to this assessment:

Part A

You are required to collect five (5) ECG traces demonstrating the following:

1. Sinus rhythm
2. Atrial fibrilation
3. Bundle branch block (LBBB or RBBB)
4. AV block (1st, 2nd or 3rd degree)
5. Acute myocardial infarction or ischaemia

Part B

Apply the Step-wise Method of ECG interpretation to the collected traces.

Use the Assessment 1 Portfolio Template provided on the unit Moodle site to complete this assessment task.

Ensure saved, scanned, or photographed ECG traces are both de-identified and legible for the assessor to review. If traces contain any patient identifying details or are illegible you will receive a mark of zero.

Part A

Traces will be assessed as follows:

• Quality of trace (artefact free, correct lead attachment)
• ECG traces must be de-identified

Part B

Interpretation will be assessed as follows:

• Calculates and explains ventricular rate
• Identifies and describes heart rhythm
• Describes the cardiac axis
• Identifies and describes the type of block
• Calculates and describes corrected QT interval
• Identifies ventricular hypertrophy if present
• Identifies and describes the location of ischaemia and or infarction if present
• Comments on overall impression of ECG
• Documents normative reference values for ECG intervals
• References normative values using Vancouver style referencing

Please also see the Assessment 1 Marking Rubric and the Assessment Video provided on the unit Moodle site

Part A - ECG

The Electrocardiogram (ECG) is an important non-invasive test used for interpretation of the cardiac rhythm, conduction system abnormalities, and the detection of myocardial ischaemia. A systematic approach to ECG recording is necessary to avoid overlooking any abnormalities. The objective of this assessment task is to reinforce the framework for performing and recording an adult 12 lead ECG.

You are required to demonstrate you understand how to perform and record a standard adult resting 12 lead electrocardiogram.

Part B - Basic Echo

As part of your basic echo knowledge, relative to your level of experience, you must understand ultrasound scanning planes and directions, and orthogonal views and sector orientation.

You will be asked to demonstrate the correct placement of the ultrasound probe to obtain one of the three orthogonal views from the parasternal or apical acoustic windows (chosen at random by your clinical supervisor). From this same acoustic window you will then be required to move the transducer in two different directions relating to that plane.

From an alternative parasternal or apical image, provided by your clinical supervisor, will then be asked to correctly identify the displayed orthogonal plane and sector orientation.

Part A - ECG
The marking criteria used for this assessment is detailed on the 12 lead ECG marking Rubric available HERE

Part B - Basic Echo
The marking criteria used for this assessment is detailed on the Practical Assessment Echocardiography Marking Rubric available HERE

Clinical placement occurs in the professional workplace. As a clinical student you are provided access to that workplace on the condition that you demonstrate behaviours and attributes of a healthcare professional and present a positive image to the clinical facility's staff and clients. As a student in the Medical Sonographer profession in Australia, you are also required to be working toward consistent compliance with the Code of Conduct for Accredited Medical Sonographers.

Clinical sites mention professional behaviour, particularly team work and empathy, as paramount in their decision to employ a cardiac sonographer. This assessment considers your ability to communicate professionally with a diverse cultural audience of patients, staff and the general public, demonstrate professional respect for all, and function as a reliable, well organised member of the health team.

Your clinical supervisor, or delegate, will be working in the echo lab with you, directly observing your day-to-day performance. These observations and collected feedback relate to your demonstrated knowledge, skills and behaviours over a span of time, not limited to a particular cardiac modality, scan type or patient case. The observations and feedback are then used to complete the Global Assessment of Professional Attributes (GAPA) form provided (see below).

There are three main sections to the GAPA form:

• Section 1: initiative and communication
• Section 2: responsibility and demeanour
• Section 3: overall technical knowledge and skill

In each section there are multiple observable behaviours that you are required to demonstrate throughout your placement. Your assessor will score your performance based on how frequently and to what extent you demonstrate each of the listed behaviours. Your assessor is also encouraged to provide comments to expand on the scoring feedback. This assessment occurs TWICE during the placement.

The first occurs at the mid-placement point, at the end of Placement Week 4. Please submit to Moodle by Monday November 26th, 2018 @ 4pm AEST. If your placement week 4 falls on a different date- please submit by the first Monday of week 5. The mid-point GAPA assessment is formative, meaning its function is to provide you and your unit coordinator with formal documented feedback on your performance, but there are no minimum required scores related to your final grade. You are expected to use that feedback to reflect on your performance, develop an action plan to address any areas of performance that are not yet at the target level for this placement, and use the remaining weeks to achieve those targets. For any behaviour that you score well on at the mid-placement assessment, it is expected that you will continue to meet that level of performance or surpass it for the rest of the placement. It is recommended that you print a few copies of the GAPA for your supervisor at the start of your placement.

The second and final GAPA assessment occurs toward the end of Week 8, the final week of the placement. Please upload and submit by Wednesday 2 January 2019 @ 9am AEST or the first working day following the completion of your Clinical Placement. The final GAPA assessment is summative, in that it's primary use is to evaluate and document your performance relative to the stated performance targets. The minimum required scores are listed on the GAPA document. Your final overall grade in this assessment depends on where you stand relative to those performance targets. As this placement is the first of four in the course, you should use this end-of-placement assessment as formative as well, to inform your plans for improvement in your subsequent placements.

If minimum scores in the mid-placement GAPA are not met, you will be regarded as a 'Student at Risk'. The unit coordinator will contact you to advise you of the risk of failing ECHO12005 and provide formative feedback. You must respond to this email to show you understand the implications of this information and give details of your plans for immediate improvement. A phone call or clinical visit will follow. Review of your progress will be completed a short time after the mid placement GAPA, at a time requested by your supervisor or unit coordinator. Unsatisfactory scores at this second GAPA will result in a fail grade for ECHO12005.

You will meet with the Head of Course to discuss the instigation of an individual learning contract for you with a view to remedying your skills, technical issues and/or behavioural issues. It will provide you with details of individual learning goals which must be achieved within a given time-frame. The learning contract will detail learning objectives, available learning resources, strategies and methods which will be used to assess your progress. Each learning contract is individualised to the student, year level and situation at hand, but will likely involve practical labs for tuition and assessment on a regular basis, and a theoretical test to ascertain currency.

Occasionally student behaviour is beyond acceptable risk to clinical sites. Clinical supervisors contact CQUniversity academics immediately when this occurs. A GAPA assessment is requested at this time (which could be at any time during your placement). If the outcome of this GAPA is unsatisfactory, and/or the site feedback indicates that they can no longer host you due to the risk incurred, then this one GAPA alone, or site refusal to host, will constitute a FAIL. Where such risk exists, your placement will terminate immediately. It is difficult to place such students in the clinical environment again and hence your continued progress within the echocardiography course may be at risk.

The final GAPA at the completion of this placement, is a PASS/FAIL assessment item. To PASS, the student must receive an overall score of 16 marks or more, from a potential of 32 marks, and additionally is not permitted any scores of 0.

A copy of the GAPA marking sheet is available HERE

While you are on clinical placement you will need to maintain a record of ALL the clinical cases that you observe, participate in or perform. It is recommended to fill out the Clinical Case Logbook at the end of each clinical day.

The logbook serves as a record of the depth and breadth of experience you attained during the placement. It demonstrates the degree of progression of your skill development within and across examination type. You should analyse this record at regular intervals to assist in the formulation of learning goals that will support your achievement of the unit outcomes.

Each echocardiography case will be categorised into one of the following areas: adult, stress/dobutamine, congenital, TOE, and paediatric. During this placement, you must observe, participate in or perform a minimum of 20 echocardiography cases, from any category.

Cases from other cardiac measurement modalities will be categorised into one of the following areas: ECG, stress testing, Holter, cath lab, EP, CRM, and other.

Each week of the logbook must be signed by your clinical site supervisor, appropriately qualified medical practitioner, or a cardiac sonographer delegated by the clinical supervisor.

If your clinical placement dates have been negotiated outside of the standard placement calendar, please contact the unit coordinator to arrange your due date

To PASS this assessment, an appropriately completed and verified Clinical Logbook document must be submitted by the due date

The Clinical Logbook document is available HERE

At all times in clinical practice, the patient’s health care should be the number one priority. The purpose of this assessment is to orientate yourself with the clinical setting, become aware of changing patient needs which exist in this setting, and to enable you to develop patient care strategies of your own.

In this case study you are to reflect on your observations of, or participation with, qualified staff modifying examinations for different patient requirements during your placement. These modifications may be due to variations in patient age, mobility or pathology as examples.

Other aspects you may wish to discuss could include maintaining patient modesty, describing strategies for dealing with patient queries, variation in communication, providing reassurance and displaying care and compassion, eliminating risk of injury, and infection control.

You are to formulate a written essay of these reflections for submission.

• A logical and well thought out reflection of your experiences
• Free from spelling and grammatical errors
• Observing and identifying differing patient requirements and sonographer response to these
• Your expressive language indicates empathy, as well as maintenance of appropriate standards and protocols
• Inclusive of a title page which contains your name, student number, unit code, year of study, placement site and word count
• Inclusive of a reference list (if required) will form the final page of your submission
• Submitted as a word document so marker feedback can be easily incorporated
• 500 words in length (+/- 10%)

Please also see the Assessment 5 Marking Rubric provided on the unit Moodle site.

The Australian Sonographer Accreditation Registry (ASAR) requires you to complete 2000 hours of echocardiography placement throughout your course. This clinical placement unit incorporates 2 weeks (80 hours) of dedicated echocardiographic experience towards that total.

While you are on clinical placement you must maintain a record of your hours of attendance.

It is recommended to fill out the Clinical Attendance Form at the end of each clinical day, and have it signed each week.

You are required to work full-time for 8 weeks to achieve a minimum of 320 hours (8 x 40 hours) of clinical experience. However please note that ASAR accreditation requirements stipulate a total of 2000 hours spent in clinical placement dedicated to echocardiography specifically. Hence for this placement a minimum of 2 weeks (80 hours) must be dedicated to echocardiographic examinations only.

To PASS this assessment, an appropriately completed and verified clinical attendance form must be submitted by the due date.

Please access the Clinical Attendance Form HERE

Note: You can submit 'outside clinical placement' log books if applicable. Details of this are in the Outside Clinical Placement Record Keeping tab on the unit Moodle site.
Your attendance must be verified (signed) by an ASAR accredited sonographer or appropriately qualified medical practitioner and details of either your insurance, or employment, must be entered in the outside clinical placement logbook.