For this clinical placement students must complete a practical assessment measuring their overall aptitude and competence in completing an echocardiogram. Students must achieve a level of 'beginner' competence - student completes the scan satisfactorily and requires direction 60% (or less) of the time, as detailed in the assessment criteria.

This task will be assessed by the 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 to understand the criteria against which sonographic skill, and relevant theoretical knowledge, will be evaluated. Please provide a printed copy to the Clinical Supervisor at the commencement of placement.

This assessment task must be attempted prior to the completion of the students clinical placement block. It is recommended that the first attempt takes place in the 14th week of the 16 week placement. Should a student fail the first attempt at this assessment task, only one re-attempt will be permitted. The student will be provided with detailed feedback regarding performance and areas requiring improvement. The student will be required to develop a strategy to improve their performance. Guidance will be provided by both the Clinical Supervisor and the Unit Coordinator. The Clinical Supervisor must complete and sign the assessment form before the student submits 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.

The submission must be accompanied by de-identified DICOM images of the echocardiogram performed. All clinical information must be de-identified to protect patient privacy and confidentiality. Relevant details for submission of DICOM images can be located on the Moodle site. If all attempts to de-identify the echocardiography images have failed, the student must request permission from the patient to provide their images to CQUniversity for educational purposes. The patient must provide written consent by completing the form provided on the unit Moodle site. The DICOM images must be submitted to the unit coordinator via a Google drive folder link.

This is a PASS/FAIL assessment and must be submitted by the due date. Failure to successfully complete this assessment will result in failure of the unit overall.

The Practical Assessment Marking Tool lists the criteria against which 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.

The final PASS/FAIL grade for this assessment will be at the discretion of the Unit Coordinator.

Clinical placement occurs in the professional workplace. Clinical students are provided access to that workplace on the condition that they 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 a students 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.

A Clinical Supervisor, or delegate, will be working in the echocardiography lab with the student, directly observing day-to-day performance. These observations and collected feedback relate to 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, echogenic 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. 

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 placement). If the outcome of this GAPA is a FAIL grade, and/or the site feedback indicates that they can no longer host a student due to the risk incurred, then this fail grade in the GAPA assessment, will constitute a fail of ECHO13007. Where such risk exists, 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

The assessor will score a students clinical performance based on how frequently and to what extent the student demonstrates 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.

The 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, the student will be regarded as a 'Student at Risk' of failing the clinical unit overall.

• The Unit Coordinator will contact the student to advise of the risk of failing ECHO13007 and provide formative feedback via email. The student must respond to this email to show they understand the implications of this information.
• The student will be required to reflect on their 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 the students progress will be completed a short time after the mid placement GAPA, at any time as requested by the 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 clinical placement. The end-of-placement GAPA assessment is summative. For any behaviour that a student scores well on at the mid-placement assessment, it is expected that the student 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 the student to meet with the Head of Course to discuss the instigation of an individual learning contract with a view to remedying 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 the students progress. This will likely involve scanning skills labs for tuition and assessment on a regular basis.

It is expected that students attend 100% of the time during the 16 week clinical placement to achieve the minimum 640 hours (16 X 40 hours) of direct echocardiography observance/participation or related activities approved by an ASAR registered Clinical Supervisor or appropriately qualified medical practitioner.

All hours worked must be entered into the Clinical Attendance Forms. These forms must be signed by the Clinical Supervisor, or a sonographer delegated this task by the Clinical Supervisor and submitted fortnightly. The Clinical Attendance Forms are available in the assessment block in the unit Moodle site. Please print these forms and read carefully to understand the criteria against which 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. For all absences due to illness, students must provide the Clinical Supervisor and Unit Coordinator with a medical certificate or statutory declaration.

Any injury that occurs while on placement must be reported immediately to the 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.

Students who are absent from clinical placement due to illness or injury must phone their Clinical Supervisor and email their Unit Coordinator prior to the scheduled start time for that day. Any clinical placement hours missed due to illness or 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 illness 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 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 to 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. The 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, a student must:

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

At the end of the scheduled 16 weeks of placement, if a student has not met the 100% attendance requirement AND has documented justifiable grounds for absenteeism, the student will be provided additional scheduled time to make up the time 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 a student has not met the 100% attendance requirement AND does not have documented justifiable grounds for the absence, the student 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 a student has attained during placement. It demonstrates the degree of progression of skill development within and across examination types. Students should analyse this record at regular intervals to assist in the formulation of learning goals that will support achievement of the unit outcomes.

During this clinical placement, students should aim to observe or partially or fully complete a minimum of 320 echocardiograms.

*This number is a recommendation only as considerations have been made to accommodate the impact of COVID19 on placement sites*

The Clinical Case Logbook is to be submitted twice during the clinical placement block (mid-placement and end of placement).

Students will complete a case study based on a clinical study in which they 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.

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.

Students must 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 must 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 or relevant text books must be cited. Literature titles must be current (<5 years of age), except seminal works.

Students will be assessed on the 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 pass grade is 50%. Any submissions made after the due date will be subject to a late submission penalty of 5% per day (or part there of). This penalty will be applied to the written component.

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.