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 sections 1a and 1b of this assessment task.

1a

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.

For all ECG traces, students must complete a comprehensive measurement assessment, demonstrating correct measurement units and listing corresponding normal reference values.  Rationale must be provided for any abnormal measurement findings or measurements not performed.

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.

1b

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.

To facilitate Unit Coordinator review of assessment outcomes, a copy of clinically collected ECG traces must be submitted. All ECG's must be submitted as colour and as clear as possible to allow analysis of ECG's. If your clinical placement site does not have the capability of scanning high quality documents, there are multiple smart phone scanning apps that can be downloaded and used. ECG's can be uploaded separately if required.

The ECG assessment template (Part 1a and 1b) 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 various forms of electrocardiogram (ECG) studies. For example 12-Lead, 3-Lead and 1-Lead ECG strips.
• construct links between cardiovascular disease presentation, assessment, and patient outcomes.

You will be allowed two attempts at each quiz during the time period each quiz is open.  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

Quiz opening and closure dates are linked to the academic calendar. Some students may be on clinical placement during these times.

To offer attempt flexibility, quizzes are open across weekends and after hours. However, students are reminded that IT support from the university Information and Technology Division (TASAC) is only available during AEST business hours. 

• If attempt issues occur outside of business hours, students should immediately email the Unit Coordinator documenting difficulties. 
• Advice should include date and time of incident and screen shot from PC display if error evident. 
• Incidents will be considered on a case by case basis.  There is no guarantee extra quiz attempts will be offered.  

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.

Question responses will be assessed according to the:

• use of appropriate terminology and descriptors.
• student’s ability to appropriately interpret 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.

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).

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

You will be assessed by your Clinical Supervisor using the Standard 12-Lead ECG 'Assessment of Readiness for Clinical' (ARC) tool.  The ARC tool can be found on the unit Moodle site.

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

You will be assessed on correct ECG performance technique including:

• patient interaction including ID checks and obtaining consent prior to starting test
• 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

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.

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

• Any student who fails the first attempt is encouraged to seek additional counsel from the Unit Coordinator prior to re-attempt.
• The student will be required to consider feedback and develop a strategy to improve their performance.

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.

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

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.

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

• Any student who fails the first attempt is encouraged to seek additional counsel from the Unit Coordinator prior to re-attempt.
• The student will be required to consider feedback and develop a strategy to improve their performance.

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/patients. 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: Applied knowledge
• Section 2: Psychomotor Skills and Standard of Work
• Section 3: Professionalism

In each section there are multiple performance cues 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 and attributes. Your assessor is also encouraged to provide comments to expand on the scoring feedback. This assessment occurs TWICE during the placement. Students are responsible for scheduling their GAPA assessments with their Clinical Supervisor, at a mutually convenient time.

The first occurs at the mid-placement point, at the end of Placement Week 4.

The mid-placement GAPA assessment is formative, meaning it is a progress check designed to provide you and your Unit Coordinator with documented feedback. You are expected to use 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 of placement 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.

If at least 50% of the performance descriptors are not met in the mid placement GAPA, a student will be regarded as a 'Student at Risk' of failing the clinical unit overall.

A student at risk:

• will be required to meet with the Unit Coordinator to discuss behavioural deficits, or to engage in email correspondence to the same effect
• must consider feedback and implement strategies for improvement
• will again be assessed a short time after an unsatisfactory mid placement GAPA, at a time requested by the Clinical Supervisor and/or Unit Coordinator
• will be awarded a fail grade for ECHO12005 Cardiac Clinical Unit 2, if unsatisfactory scores are achieved in the second 'final' GAPA, or improvements in performance are inadequate despite feedback provision.

A university representative will call or visit the clinical site during this process.

The second and final GAPA assessment must occur during Week 8, the final week of placement.

The final GAPA assessment is summative. By the end of the 8-week clinical practicum block, students must demonstrate ALL criteria descriptors at a NOVICE (Level 1) competency level.

(As this placement is the first of four in the CV69 course offering, you should use feedback in this end-of-placement assessment to inform your plans for improvement in your subsequent placements.)

Occasionally student behaviour is beyond acceptable risk to clinical sites. Clinical Supervisors must 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 who fail a clinical placement unit will be required to meet with the Head of Course to discuss the instigation of an individual learning contract, with a view to remedying your skills, technical issues and/or behavioural issues.

A learning contract:

• is individualised to the student, year level and situation at hand
• will detail individual learning objectives which must be achieved within a given time-frame
• will identify available learning resources and support strategies
• may mandate student attendance at practical labs for tuition
• may include progress checks (practical and/or theoretical tests) to ascertain improvement and maintenance of currency.

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

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.

By the end of the 8-week clinical practicum block, students must demonstrate ALL criteria descriptors listed on the marking tool at a NOVICE (Level 1) competency level.

‘Novice’ students are at the first level of skill acquisition.

• Students remember, understand, and recall theoretical concepts but may not associate these concepts to clinical context.
• Direct supervision and clear instruction is usually required, and students are often unaware of their own limitations.
• Students are relatively unfamiliar with professional standards and may not communicate effectively in the clinical environment.

Students at a ‘Novice’ level:

• Demonstrate awareness of listed behavioural attribute and its importance in practice.
• Frequently require supervision and assistance to perform tasks.

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.

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 Log Book 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 log book must be signed by your Clinical 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 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 Supervisor, appropriately qualified medical practitioner, or the cardiac sonographer delegated by the Clinical Supervisor.
• Ensure documentation is submitted by the due date.

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.

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 will be required to submit the Clinical Attendance Log book in two parts, to enable check of attendance compliance mid-practicum.

7a. A mid-placement Clinical Attendance Log Book following the completion of 4-weeks of clinical placement.

7b. The end of placement final Clinical Attendance Log Book following the completion of the 8-week clinical placement block. (This submission documents the final 4-weeks of clinical placement.)

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 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 Supervisor, appropriately qualified medical practitioner, or the cardiac sonographer delegated by the Clinical Supervisor.
• Ensure documentation is submitted by the due date.

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.