For this clinical placement you must complete a practical assessment measuring your overall aptitude and competence in completing an Echocardiogram. You must achieve a level of 'Beginner' competence - student completes the scan satisfactorily and requires direction most (60% or less) of the time, as detailed in the assessment criteria.

This task will be assessed by your Clinical Supervisor, or a delegate sonographer using the Practical Assessment Marking Tool. A downloadable copy of the Practical Assessment Marking Tool can be found on the Moodle site. Please print the Practical Assessment Marking Tool and read it carefully so you understand the criteria against which your sonographic skill, and relevant theoretical knowledge, will be evaluated. Please provide a printed copy to your Clinical Supervisor at the commencement of your placement.

This assessment task must be attempted prior to the completion of the students clinical placement block. You are only permitted two attempts to complete this assessment task. It is recommended that the first attempt takes place in the 14th week of the 16-week placement. Should you fail the first attempt at this assessment task, you will be provided with detailed feedback regarding your performance and areas requiring improvement. You will be required to develop a strategy to improve your performance. Guidance will be provided by both your Clinical Supervisor and the Unit Coordinator. Your Clinical Supervisor must complete and sign the assessment form before you submit it through the assessment block in the unit Moodle site. A completed practical marking tool with feedback, should be submitted to Moodle for each assessment attempt.

This is PASS/FAIL assessment. Failure to successfully complete this assessment will result in failure of the unit overall. 

The Practical Assessment Marking Tool lists the criteria against which your sonographic skill, and relevant theoretical knowledge, will be evaluated. This form can be found on the unit Moodle site.

Criteria can be grouped into several main categories. These include:

• Pre-examination tasks and instrumentation (including patient identification checks, consent and appropriate professional communication)
• Scanning technique (including two-dimensional, colour and spectral Doppler optimisation, and appropriate exam extension or modification)
• Measurement technique
• Documentation (digital image storage and labelling)
• Post-examination tasks (including worksheet completion and interpretation)
• Additional tasks (incorporating ergonomics, manual handling techniques, infection control, ethical and legal requirements)

The Clinical Supervisor or delegate may pose questions at scan conclusion to clarify understanding of any of the assessment criterion.

The Clinical Supervisor is required to evaluate multiple questions under each criterion grouping on the Practical Marking Tool. The Clinical Supervisor will grade each criterion question with a score out of 4. A score of 1 indicates that the student needs constant direction and advice, whilst a score of 4 indicates largely independent practice, requiring direction or prompting only on complex or unusual cases.

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.

Clinical sites mention professional behaviour, particularly team work and empathy, as paramount in their decision to employ a 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 echocardiography 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 scan type or patient case. The observations and feedback are then used to complete the Global Assessment of Professional Attributes (GAPA) form provided.

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

A downloadable copy of the GAPA form can be found on the unit Moodle site.

This placement represents the students first dedicated echocardiography placement. Prior to this scanning placement, students have demonstrated professional and technical scanning competency in a simulated environment on normal, photogenic peers. The GAPA 'Overall technical knowledge, skills and behavioural attributes' critiques need to be evaluated within the context of the practical competency level that the students must attain at the end of each clinical practicum. These applicable competency levels are defined within the practical assessment marking tool associated with each clinical placement (ie. ASAR described competency level of 'Beginner - ECHO13007', 'Advanced Beginner - ECHO 20004', and finally 'Competent - ECHO20005').

Occasionally student behaviour is beyond acceptable risk to clinical sites. Clinical Supervisors will 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 a FAIL grade, and/or the site feedback indicates that they can no longer host you due to the risk incurred, then this fail grade in your GAPA assessment, will constitute a fail of ECHO13007. Where such risk exists, your placement will terminate immediately.

Clinical sites may prematurely terminate a clinical placement if student skill progression is deemed insufficient despite documented constructive feedback, significant support and intervention. Prior to confirmation of clinical placement termination, extensive consultation in conjunction with both the university designated Unit Coordinator and student involved would occur. 

• In each section of the GAPA, there are multiple observable behaviours that a student is required to demonstrate throughout placement.

The GAPA is used to assess behavioural attributes including:

    Section 1: Initiative and communication

    Section 2: Responsibility and demeanour

    Section 3: Technical knowledge and skill application

Your assessor will score your clinical performance based on how frequently and to what extent you demonstrate each of the listed behaviours. The Clinical Supervisor will allocate a score of 0,1 or 2.

• A score of 0 indicates that the student does not demonstrate this behavioural attribute, or demonstrates it in an unacceptable manner.
• A score of 1 indicates that the student demonstrates this behaviour attribute, but needs some improvement.
• A score of 2 indicates that the student consistently demonstrates this behaviour attribute (>70% of the time) to a high level.

Your assessor is also encouraged to provide comments to expand on the scoring feedback.

This assessment occurs twice during the placement. The first GAPA occurs at the mid-placement point, during Week 8.

If minimum scores in the mid-placement GAPA are not met, you will be regarded as a 'Student at Risk' of failing the clinical unit overall.

• The Unit Coordinator will contact you to advise you of the risk of failing ECHO13007 and provide formative feedback via email. You must respond to this email to show you understand the implications of this information.
• You will be required to reflect on your performance and the feedback provided, and to 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.
• Review of your progress will be completed a short time after the mid placement GAPA, at any time as requested by your Clinical Supervisor or Unit Coordinator.

Note: If behavioural attributes within any section of the GAPA are deemed a 'patient safety risk', student placement may be cancelled immediately, prior to completion of the allocated clinical placement block.

The second assessment occurs during week 16 of your clinical placement. The end-of-placement GAPA assessment is summative. 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.

Unsatisfactory scores obtained at the second GAPA attempt, will result in a FAIL grade for ECHO13007 overall.

Failure of this clinical unit will require you to meet with the Head of Course to discuss the instigation of an individual learning contract for you with a view to remedying your scanning skills, technical issues and/or behavioural issues. The learning contract will detail learning objectives, available learning resources, strategies and methods which will be used to assess your progress. This will likely involve scanning skills labs for tuition and assessment on a regular basis.

Hours of Attendance Logbook:
It is expected that you attend 100% of the time during your 16 week clinical placement to achieve the minimum 640 hours (16 X 40 hours) of direct echocardiography observance/ participation or related activities approved by your ASAR registered Clinical Supervisor or appropriately qualified medical practitioner. All hours worked must be entered into the Clinical Attendance Logbook form. This form must be signed by your Clinical Supervisor, or a sonographer delegated this task by your Clinical Supervisor. The Clinical Attendance Logbook form is available in the assessment block in the unit Moodle site. Please print this form and read it carefully so you understand the criteria against which your clinical attendance will be evaluated. 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.

 
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 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 Logbook 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 must be aware that the attendance of clinical placement takes precedence over any personal work commitments as related to absenteeism.

Hours Outside of Clinical Placement
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. Outside of hours placement may only be used in the event of sickness or injury and may not be utilised for personal leave requests. Please note: supplementary hours outside of clinical placement must be verified (signed) by an ASAR accredited sonographer or appropriately qualified medical practitioner. Details of either your insurance, or employment, must be entered onto the outside clinical placement attendance form.

Clinical Case Logbook:
The Clinical Case Logbook is a document designed to track clinical experience. This logbook documents all observed, partially or fully completed echocardiography cases that a student is exposed during clinical placement. The Clinical Case Logbook will also incorporate details of case exposure obtained during any hours of attendance submitted from 'outside of clinical placement'.

Maintenance of a Clinical Case Logbook helps to ensure that:
a) an acceptable volume of clinical work is achieved

b) exposure to a reasonable case variety is achieved, and

c) key practical skills are developing.

The Clinical Case Logbook incorporates the following data:
1. Cover page(s) which present two tables summating the weekly cumulative case volume under descriptive headings. Summative tally is based on the actual scan findings, NOT the referral indications.
2. The date of each examination.
3. Allocation of a unique identifier for each patient to ensure anonymity.
4. Referral indications
5. Type of echocardiogram performed (i.e. Adult, Paediatric, Stress/Dobutamine, TOE)
6. Student level of scan participation (Observed, partially, or fully completed examination)
7. Case Findings

The Clinical Case Logbook entries must be signed by the Clinical Supervisor or appropriately qualified medical practitioner.

Clinical Attendance:

In order to achieve an overall grade of 'Pass' in this assessment task, you must:

• Meet the minimum number of hours required on the attendance form
• Ensure the documentation the assessment is complete
• Upload each completed assessment for into the unit Moodle site by the due date

At the end of the scheduled 16 weeks of 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 16 week placement, and / or may not be at the same placement site, depending on clinical availability). At the end of the scheduled 16 weeks of 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.

Clinical Case Logbook:

The Clinical Case 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 types. 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. During this clinical placement, a student must observe or partially or fully complete a minimum of 320 echocardiograms.

You will complete a case study based on a clinical study in which you have taken part in during this clinical placement. Read the article ‘Using a clinical decision-making framework to foster sonographer student learning in the clinical setting’ by Thoirs and Sim prior to completing this case study.This article is available on the unit Moodle site. 

According to Thoirs and Sim (2016), clinical reasoning or clinical decision making, occurs in the clinical placement when students use critical thinking based on prior theoretical knowledge relative to a specific situation or patient. A clinical decision-making framework may help students to apply theoretical knowledge in the clinical setting. This framework helps students to identify and prioritise learning, promote self-reflection and future decision making and facilitate diagnostic thought processes.

The described published article and framework template are available on the unit Moodle site. The case study should be written in the framework style as described in the article.

Use the clinical decision-making framework to evaluate the following:

• Encounter: did the encounter data include cultural considerations, protocols around patient and echocardiographer safety, the consent process, pre-test history. Was there an established purpose of the examination?
• Hypothesis generation: when generating a hypothesis, were possible pathophysiology relevant to the echocardiogram examination, possible associated conditions, complications or mimics of the suspected condition included? What was the most likely condition suggested by the pre-encounter data? What are the associated conditions? Which structures are most likely involved?
• Assessment: did the echocardiographic assessment include a contextual analysis of echocardiographic information obtained? What protocol, image optimisation techniques, possible modifications were required due to patient presentation or echocardiogram findings? Did it include the additional data?
• Evaluation: Did the echocardiographic examination answer the clinical question? What is the most likely diagnosis? Is a differential diagnosis possible? Did the diagnosis include normal and abnormal appearances, applicable reference measurements, and future pathways for the patient with this diagnosed condition?
• Reflection: Did reflection of the clinical decision-making process include a critical and reflective analysis of approach? What was done well or lacking during the exam? If gaps in knowledge were identified, what is the appropriate action plan in the future?

Image submission: The anonymised provisional or final echocardiographic report should be included as an appendix to the case study. The echocardiographic case study presented must be accompanied by the submission of de-identified DICOM images. The DICOM images can be submitted to the Unit Coordinator. Upload and share via a google drive folder link. Time and date, as well as technical information must be retained on the images.

Word count: 1500-2000 words. Excess words will not be assessed. Word count does not include headings or references, but does include diagram explanations and labelling.

Referencing: Vancouver. Minimum 8 peer reviewed journal articles must be cited. Literature titles must be current (<5 years of age), except seminal works.

You will be assessed on your ability to:

• Produce a scholarly case study
• Provide clear and concise de-identified information regarding the patient encounter
• Demonstrate a high degree of comprehension associated with the condition provided in the hypothesis
• Provide a contextual analysis of the examination and information obtained
• Evaluation of data obtained is analytical and logically structured
• Comprehensive reflective analysis of what the sonographer did well or could be improved

A copy of the marking rubric can be found on the unit Moodle site. This is a PASS/FAIL assessment. The minimum passing grade is 50%.

In the event that the first submission does not meet the minimum requirements as per the marking rubric, the student will be provided with feedback and guidance by the Unit Coordinator. The student will then have an opportunity to revise and resubmit the case study within one week of receiving feedback.