The recording of the heart’s electrical activity through the performance of a 12 lead Electrocardiogram (ECG) is vital in the monitoring, diagnosis, and treatment of various patients. This cardiac assessment tool is only beneficial however, when accurate clinical measurement (analysis and communication) strategies are applied.  This Portfolio assessment requires students to reflect upon their ability to accurately analyse and communicate the outcome of an adult 12 lead Electrocardiogram (ECG) during routine clinical practice.

During clinical practicum, students are requested to collect five (5) ECG traces, with a trace representative from each of the following categories:

1. Sinus rhythm, tachycardia, bradycardia, or arrhythmia
   
2. Atrial fibrillation or ectopy
3. Bundle branch block (LBBB or RBBB) or AV block (1st, 2nd, or 3rd degree)
4. Acute myocardial infarction or ischaemia
5. Artefact anomaly (i.e. electrical, wandering baseline, muscle tremor, lead attachment or calibration error)

(Students who are unable to collect representative cases by week 4 of clinical practicum, should contact their unit coordinator for exemplars.)

Students are then required to complete the 'ECG assessment template' available on the unit Moodle site for Part A and B of this assessment task.

Part A

For ECG traces from categories 1-4, students are required to:

• apply the Step-wise method of interpretation.
• summate key ECG features in preparation for communication of assessment outcome to a nominated clinical supervisor.

For the ECG trace from category 5, students must:

• identify key ECG findings that are associated with the demonstrated artefact.
  
• explain why the artefact anomaly likely occurred.
• postulate how the ECG technician could reduce or eliminate the artefact anomaly during routine practise.

At a mutually convenient time, students are responsible for scheduling a review of the 5 ECG traces analysed in Part A with their nominated clinical supervisor. 

Students are required to document clinical supervisor feedback, noting any errors in clinical measurement (analysis or communication) strategies applied.

Part B

Students are required to reflect on their clinical supervisor feedback, identifying performance strength/weakness, and develop a strategy for skills improvement where applicable.

This assessment is to be undertaken as an individual. As with all other university assessments, colluding with other students on non-group work tasks is considered academic misconduct, and may lead to action being taken the Deputy Dean of Learning and Teaching HMAS.

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

To facilitate unit coordinate review of assessment outcomes, a copy of clinically collected ECG traces must be submitted. 

The ECG assessment template (Part A and B) must be fully completed, including:

• application of the Step-wise method of ECG interpretation to ECGs from categories 1-4, and a summation of the overall impression of the presented ECG recording, as communicated to the nominated clinical supervisor.
• documentation of a proposed rationale for the artefact formation identified in ECG category 5, along with a plausible proposal for reduction or elimination of the artefact.
• summation of supervisor feedback following discussion of ECG outcomes, with clinical supervisor signature verifying discussion.
  
• a student reflection that identifies analysis and communication strength and weaknesses, and provides a sound strategy for skills improvement, where applicable.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

In the event that a student does not achieve a PASS, students will only be given ONE opportunity to revise and resubmit their ECG portfolio.

• Any student who fails the first attempt will be offered additional feedback from the unit coordinator or nominated representative.
• Following additional feedback provision, the ECG portfolio re-submission will be required within 7 days of presentation.

This assessment task will require you to complete three (3) separate quizzes.

Questions posed in each quiz will assess your ability to:

• apply a 'step-wise method' of 12-Lead ECG interpretation.
• interpret the outcome of 12-Lead electrocardiogram (ECG) studies.
• construct links between cardiovascular disease presentation, assessment, and patient outcomes.

You will be allowed two attempts at each quiz. No additional attempts will be provided.

• It is not compulsory to attempt each quiz two times.
• The highest grade you achieve will serve as your final score for that quiz.

The specific dates that each quiz opens, and closes are outlined in the due description. The duration of each quiz is tailored to promote recall of fact, rather than research of answers unknown. There is no time delay between attempts. Once started, each quiz attempt cannot be paused or restarted.

Each quiz will be marked out of 30 marks. You will have 30 minutes to complete each quiz.

• The number of marks allocated for each question will be indicated within the quiz.
• Question marks are allocated based on the accuracy, depth, and breadth of required responses.

This assessment is open book. You may benefit from having normal Electrocardiographic reference ranges and a calculator available when attempting the quiz.

The topic focus for each quiz is listed below:

• Quiz 1 - Arrhythmias
• Quiz 2 - Heart block
• Quiz 3 - Myocardial infarction
  

Students are reminded that IT support from the university Information and Technology Division (TASAC) is only available during AEST business hours.

This assessment is to be undertaken as an individual. As with all other university assessments, colluding with other students on non-group work tasks is considered academic misconduct, and may lead to action being taken the Deputy Dean of Learning and Teaching HMAS.

Please note that the quizzes must be completed before the due date listed.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a mark of zero (or Fail).

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

Question responses will be assessed according to the:

• use of appropriate terminology and descriptors.
• student’s ability to appropriately interpret 12-Lead electrocardiogram (ECG) studies, including application of the stepwise interrogation method.
• student's ability to succinctly respond with accurate answers, constructing links between cardiovascular disease presentation, assessment, and patient outcomes.

A 12-lead Electrocardiogram (ECG) is one of the simplest and fastest tests used by clinicians to evaluate cardiac abnormalities.

The systemic approach and application of positioning the 12-lead ECG is universal. This helps to ensure that, when a person's ECGs are compared, any changes on the ECG are due to cardiac injury. The analysis of ECG signals recorded from misplaced electrodes can lead to misinterpretation or even to significant diagnostic errors.

The objective of this assessment task is to demonstrate competency in independently performing a 12-Lead ECG in line with safe practice principles.

Students are responsible for scheduling their practical assessment with their clinical supervisor, at a mutually convenient time.

This assessment task must be attempted prior to the completion of the clinical placement block. It is recommended that the first attempt takes place prior to the 7th week of the practicum, to allow time for re-attempt if required.

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

You will be assessed using the Standard 12-Lead ECG 'Assessment of Readiness for Clinical' (ARC) tool. You will be required to demonstrate an 'advanced beginner level' of practical competency.

Each item in the ARC tool in BOLD must be passed, and an 'advanced beginner level' of practical competency must be demonstrated to PASS this assessment task overall.

This practical assessment must be completed within the set time frame given (20 minutes).

You will be assessed on correct ECG performance technique including:

• appropriate skin preparation
• correct rib palpation and anatomical landmark identification
• correct lead placement
• correct leads attached to correct electrodes
• ECG recorded at 25 mm/s with appropriate gain and calibration
• generation of artefact free ECG trace
• application of basic troubleshooting if required
• appropriate hygienic practice
• maintenance of patient comfort and modesty

Should a student fail the first attempt at this assessment task, only one re-attempt will be permitted.

The student will be required to develop a strategy to improve their performance. Any student who fails the first attempt is encouraged to seek additional counsel from the unit coordinator prior to re-attempt.

In preparation for clinical placement, simulation scanning laboratories offer a safe environment where students can learn and practice, without the pressure of real-world performance. This assessment task will evaluate your adaptation of practical simulation scanning skills and safe practice to clinical practice.

This practical assessment requires:

1. Demonstration of safe practice including hand hygiene and scanning ergonomics.

2. Acquisition of standard imaging windows with correct:

• probe manipulation.
• image plane identification.
• identification of key anatomical landmarks.

Students are responsible for scheduling their practical assessment with their clinical supervisor, at a mutually convenient time.

This assessment task must be attempted prior to the completion of the clinical placement block. It is recommended that the first attempt takes place prior to the 7th week of the practicum, to allow time for re-attempt if required.

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

Students will be assessed using the Echocardiographic Practical Assessment 'Assessment of Readiness for Clinical' (ARC) tool. The ARC tool can be found on the unit Moodle site.

Students will be required to demonstrate professional behaviour consistent with safe practice including:

• performance of appropriate hand hygiene
• application of knowledge of infection control practices at the patient bedside
• implementation of ergonomic adjustments during routine clinical scanning

Under clinical supervisor instruction, students will be required to demonstrate basic knowledge of ultrasound scanning and window acquisition including:

• obtaining on-axis orthogonal views
• identifying sector orientation
• manipulating the transducer
• using appropriate terminology

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 Sonography 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 with you in the clinical setting, 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 which can be found on the unit Moodle site.

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.

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 must occur during Week 8, the final week of placement.

The final GAPA assessment is summative, in that its 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.

Students are responsible for scheduling their practical assessment with their clinical supervisor, at a mutually convenient time.

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

Students will be assessed using the Global Assessment of Professional Attributes (GAPA) marking tool. The marking tool can be found on the unit Moodle site.

The Clinical Case Log Book is a document designed to track clinical experience.

Whilst on clinical placement, you are required to maintain a record of ALL clinical cases that you observe, participate in or perform.

It is recommended that:

• the Clinical Case Logbook is completed at the end of each clinical day.
• students analyse this record at regular intervals to assist in the formulation of learning goals that will support the achievement of unit outcomes.

The Clinical Case Log Book summates clinical case exposure into two tables (non-echo and echo activities), documenting the weekly cumulative case volume under descriptive category titles.

• Echocardiography cases will be categorised under the following titles: Transthoracic (TTE), Transoesophageal (TOE), Stress echo (SE), Dobutamine echo (DSE), and other.
• Other cardiac measurement modality cases will be categorised under the following titles: ECG, Exercise stress testing (EST), Holter monitoring, Blood pressure monitoring (BP), Cath lab, Electrophysiology studies (EP), Cardiac rhythm management procedures / Pacemaker checks (CRM), and other.

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

Maintenance of a Clinical Case Log Book helps to ensure that:

• an acceptable volume of clinical work is achieved
• exposure to a reasonable case variety is achieved to support development of key practical skills

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

In order to achieve an overall grade of PASS for this assessment task, students must:

• Observe, participate in, or perform a minimum of 20 echocardiography cases, from any category during clinical placement.
• Ensure log book is signed by your clinical site supervisor, appropriately qualified medical practitioner, or the cardiac sonographer delegated by the clinical supervisor.
• Ensure documentation is submitted by the due date.

The ECHO12005 clinical practicum experience is 8-weeks in duration. Students are expected to undertake clinical placement in a full time capacity, working 40 hours per week equivalent.

During this 8-week (320 hour) clinical practicum, students must:

• achieve a minimum of 80 hours (2 weeks x 40 hours) of direct echocardiography observance/participation approved by an ASAR registered Clinical Supervisor or appropriately qualified medical practitioner.
• complete an additional 240 hours (6 weeks x 40 hours) of multimodality exposure within the cardiac department.

As students are experiencing the ‘real’ work life of an Echocardiographer / Cardiac physiologist, they may be required to work outside of a nine to five, Monday to Friday roster and travel to various site locations.

Students may be requested to submit an 'interim log book' demonstrating hours of attendance completed at any time throughout placement, to check documentation and attendance compliance.

Once students have completed the minimum number of hours, they are required to continue attending placement until the placement’s prescribed finish date unless an alteration to the standard placement block has been approved by the Head of Course and the Clinical Supervisor.

Students are advised to refer to the 'Bachelor of Echocardiographic and Cardiac Physiology / Graduate Diploma of Echocardiography - Clinical Placement Attendance Guidelines' document for additional information. This document is available through the Work Integrated Learning - Sonia Online site, and the ECHO12005 Moodle site.

All hours worked must be entered into the Clinical Attendance Log Book. This form must be signed by the Clinical Supervisor, or a sonographer delegated this task by the Clinical Supervisor.

• The Clinical Attendance Log Book form is available on the Moodle site.
• Students are advised to print this form and read it carefully so they understand the criteria against which their clinical attendance will be evaluated.

At the end of the scheduled placement, if you have not met the 100% attendance requirement AND you have documented 'justifiable grounds' for your absenteeism, you will be provided additional scheduled time to make up the time you have missed. This scheduled make-up time may not immediately follow the scheduled placement, and/or may not be at the same placement site, depending on clinical availability.

At the end of the scheduled placement, if you have not met the 100% attendance requirement AND you 'do not have documented justifiable grounds' for the absence, you will score a 'FAIL' for this assessment item.

Leave arrangements:

Students must not organise holidays, recreational leave or personal appointments during clinical placement periods.

• Students are to notify the clinical placement site prior to their scheduled start time if they will be late arriving to the clinical placement site for any individual day throughout the clinical placement.
• Students who are absent from clinical placement due to sickness must phone their Clinical Supervisor and email their Unit Coordinator prior to their scheduled start time for that day.

For all absences, students must provide the Clinical Supervisor and Unit Coordinator with a medical certificate or statutory declaration. Any clinical placement hours lost to sickness must be made up.

Injury:

Students who are absent from clinical placement due to injury must phone their Clinical Supervisor and email their Unit Coordinator prior to their scheduled start time for that day.

• Any injury that occurs while on placement must be reported immediately to your Clinical Supervisor and Unit Coordinator.
• Medical clearance may be required before returning to placement.
• For more information on this, including fitness to practice, please refer to the Clinical Placement Attendance Guidelines on the unit Moodle site.

Any clinical placement hours missed due to injury must be made up.

Public holidays/university vacation periods:

Public holidays recognised by CQUniversity are outlined on the academic calendar.

• When a public holiday falls during a clinical placement block, public holiday dates can be entered as 8 hours for each day into the Attendance Log Book and hours are not required to be made up.
• If a designated University student vacation period coincides with the clinical placement period, students are expected to attend during this time.
• Students are advised that attendance at clinical placement takes precedence over any personal work commitments as related to absenteeism.

Any days absent from the clinical site must be appropriately documented.

COVID-19 disruptions:

Practicum non-attendance due to adherence to government or departmental COVID-19 health and safety directives should be noted in Attendance Log Book by acronym 'CD'.

• Requirement for make-up of days absent due to COVID-19 disruptions (CD), will be evaluated on a case-to-case basis.

On occasion, student clinical placements may be suspended due to COVID-19 government / LGA directives.

• During such times, students with coexistent employment may be able to continue site attendance under scope of practice as an 'essential healthcare worker'.
• Such an arrangement is governed by student-employer contractual arrangements and separate to university clinical placement arrangements.
• Hours of employment completed during these times can be documented on the 'outside clinical placement attendance form', provided experience matches placement learning objectives.

Outside of Clinical Placement hours:

Students are able to record clinical attendance hours completed 'outside' of clinical placement arrangements. These 'outside' attendance hours can be used to supplement those in your assessed Clinical Attendance Log Book in the event of sickness or injury, but may not be utilised for personal leave requests.

• Students are permitted to supplement up to 25% of required unit hours from outside of clinical placement.
• These hours must be documented within three (3) months prior to unit enrolment for approval by the Unit Coordinator.
• Supplementary hours outside of clinical placement must be verified (signed) by an ASAR accredited sonographer or appropriately qualified medical practitioner.

Details of student insurance or employment, must also be documented on the 'outside clinical placement attendance form' where practical experience is obtained outside of the university scheduled clinical placement block.

Students are advised to refer to the 'Assessment Policy and Procedure (Higher Education Coursework)' document for additional university guidelines regarding assessments.

In the absence of an approved extension, given there is no opportunity to apply a late penalty, any submission that is late will be awarded a FAIL.

In order to achieve an overall grade of PASS for this assessment task, students must:

• Document completion of the minimum number of hours of clinical practicum.
• Ensure log book is signed by your clinical site supervisor, appropriately qualified medical practitioner, or the cardiac sonographer delegated by the clinical supervisor.
• Ensure documentation is submitted by the due date.