This assessment task requires the student to demonstrate aptitude and overall practical competence in completing an echocardiogram to the level of ‘Advanced Beginner’. A student of advanced beginner competence can complete an echocardiographic scan satisfactorily, as detailed in the assessment criteria and marking tool, requiring direction <40% of the time.

This task will be assessed by the student’s Clinical Supervisor, or a delegate sonographer, using the Practical Assessment Marking tool provided on the university Moodle site. Students are required to provide a printed copy of this marking sheet to their Clinical Supervisor at the commencement of placement.

Students are encouraged to:

• Read the marking sheet carefully, to ensure that they understand the criteria against which their sonographic skill and relevant theoretical knowledge will be evaluated.

• Discuss the best time to complete this assessment with their clinical supervisor, to ensure minimal departmental disruption and sufficient time for task completion.

• Seek detailed feedback from their supervisor post assessment to enable identification of areas requiring improvement.

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

• Students that fail the first attempt at this assessment, should discuss their strategy for performance improvement with both their assessor and Unit Coordinator.

• Both attempts must be completed prior to the completion of the clinical placement block.

In the absence of an approved extension, students cannot complete this assessment at a later time, and will receive a mark of zero (or fail) for the assessment, if not completed it by the scheduled date and time applicable to their placement allocation.

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

Clinical supervisors are required to grade their student using criterion provided to evaluate how independent he or she is upon supervisor direction and support. 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 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.

This assessment must be conducted before the end of the 16 week clinical placement. As the student is permitted two attempts to complete this assessment, it is recommended that the first attempt takes place in the 14th week of the 16 week placement.

Clinical sites mention professional behaviour, particularly team work and empathy, as paramount in their decision to employ a sonographer. This assessment considers the ability of the student 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.

The Clinical Supervisor, or delegate, will be working in the echocardiography lab with the student, directly observing day-to-day performance. These observations and collective feedback will relate to the student's demonstration of 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.

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 the student is required to demonstrate throughout the placement. The assessor will score the performance of the student based on how frequently, and to what extent, each of the listed behaviours are demonstrated. The assessor is also encouraged to provide comments to expand on the scoring feedback.

This assessment is performed TWICE during the placement – at the midpoint (week 8) and at the completion (week 16).

The student is expected to use feedback provided after the first GAPA to:

• Reflect on their performance.
• Develop an action plan to address any areas of performance that are not yet at the target level for this placement.
• Use the remaining weeks to achieve those targets.

The end-of-placement GAPA assessment is summative. For any behaviour that the student scores well on at the mid-placement assessment, it is expected they will continue to meet that level of performance or surpass it for the rest of the placement.

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 the placement). If the outcome of this GAPA is a FAIL grade, and/or the site feedback indicates that they can no longer host the student due to the risk incurred, then this FAIL grade in the GAPA assessment, will constitute a fail of ECHO20004. Where such risk exists, clinical 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. Premature clinical placement termination due to poor skill progression would constitute a FAIL for ECHO20004.

The nominated assessor will score the student's clinical performance based on how frequently and to what extent each of the listed behaviours in section 1, 2 and 3 of the GAPA marking tool are demonstrated.

• 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.

If minimum scores in the mid-placement GAPA are not met, a 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 ECHO20004 and provide formative feedback via email. The student is required to respond to this email to show they understand the implications of this information.
• The student must reflect on their performance and the feedback provided, and 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 student’s progress will be completed a short time after the mid placement GAPA, at any time as requested by your Clinical Supervisor or Unit Coordinator.

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.

Unsatisfactory scores obtained at the second GAPA attempt, will result in a FAIL grade for ECHO20004 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 your 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.

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.

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.

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.

Outside of Clinical Placement hours

Outside of hours placement may only be used in the event of illness or injury and may not be utilised for personal leave requests.

• In the event of illness and injury, 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 either the student’s insurance, or employment, must be entered onto the outside clinical placement attendance form.

At the end of the scheduled placement, if a student has not met the 100% attendance requirement AND does not have documented justifiable grounds for the absence, they will score a 'FAIL' for this assessment item. If there are documented justifiable grounds for absenteeism, the student will be provided additional scheduled time to make up the time they 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).

To be awarded a PASS, all documentation must be completed and submitted by the corresponding due date and time.

The Clinical Logbook will be reviewed to ensure:

• The minimum number of clinical placement hours have been completed.
• The logbook documentation has been verified as accurate by the nominated ASAR registered clinical supervisor.

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 Log Book helps to ensure that:

a) an acceptable volume of clinical work is achieved

b) exposure to a reasonable case variety is achieved

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.

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. It is recommended that 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, a student must aim to observe or partially or fully complete a minimum of 320 echocardiograms (minimum of 4 echocardiograms per day). Students are advised to ensure they are gaining experience under each of the different categories.

The Logbook must be signed by the Clinical Supervisor or echocardiographer delegated by the Clinical Supervisor.

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

• Accurately record all studies in the Clinical Case Logbook.
• Ensure documentation is complete.
• Submit the requested documentation via Moodle by the published due dates.

Students are required to submit two (2) case studies during this clinical placement. The images of the case study must be partially or fully completed by the submitting student and any images obtained by the Clinical Supervisor must be clearly identified on the images submitted.

The case studies must be from each of the following categories:

1. Ventricular function

2. Valve regurgitation

The purpose of these case studies is to:

• Provide the Unit Coordinator with an opportunity to evaluate student technical performance
• Facilitate the continuing development of student clinical reasoning to ensure exposure to a variety of cases
• Encourage reflection and self improvement of technical and research skills and assessment strategies

Each case study must include the following:

• Clinical indications for the examination
• Details of expected echo findings based on clinical indications
• Patient care considerations
• Brief discussion of any previous imaging or medical testing available
• Explanation of any variations in scanning protocol used
• Identification of study limitations (imaging or measuring)
• Detailed description of study findings and pathologies identified, including grading of severity in accordance with ASE guidelines
• Discussion of aetiology and pathophysiology
• Discussion of any appropriate additional investigations (eg transoesophageal echocardiography, left or right heart catheterisation/angiography, MRI, CTCA) including how this could influence patient management
• Brief explanation of likely or expected disease progression and patient management (including any follow up if available)

The anonymised provisional or final echocardiographic report should be included as an appendix to the case study.

Image submission:

The echocardiographic case study presented must be accompanied by the submission of de-identified digital images in DICOM format.

• All clinical information must be de-identified to protect patient privacy and confidentiality.
• Maintenance of patient confidentiality must be adhered throughout both practical and written components of the case study.

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.
• This patient consent from must to be submitted with the case study.

Word count:

1200-1500 words. Word count does not include headings or references, but does include diagram explanations and labelling. Marks will be deducted if the word count is under/over the word limit as per the marking rubric.

Referencing:

Vancouver. Minimum 8 peer reviewed journal articles/relevant text books must be cited. Literature titles must be current (<5 years of age), except seminal works. Support material for the Vancouver Referencing System is available on the Moodle site.

Note: This assessment is to be undertaken as an individual. 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.

Case study submissions will be evaluated using the marking rubric available on the Moodle site.

The rubric will assess the following items:

• Diagnostic quality of the examination
• Scan technique and study protocol applied by student
• Image optimisation and appropriate image selection to assess presenting pathology
• Measurement technique
• Self critique of examination by student
• Discussion of findings and pathology presented with reference to relevant literature and current guidelines
• Appropriate use of terminology throughout
• Presentation style consistent with scientific discussion

The word count for the written component is strictly 1200-1500 words. Marks will be deducted if the word count is under/over the word limit as per the marking rubric.

To PASS this assessment:

• Students must achieve a minimum mark of 60% for the written component of the case study.

• The imaging component of the case study is a PASS/FAIL submission. Case studies submitted without accompanying DICOM images will not be marked.

Case studies that do not achieve a pass grade will be returned to the student with appropriate feedback. Students are permitted one re-submission opportunity for each case study (imaging component and/or written component as required). Any re-submission attempt is required within two (2) weeks of receiving feedback.

Undertaking a clinical audit, as part of a quality management process, occurs in all imaging practices on a cyclical basis. In this assessment, students will complete a small part of a clinical audit. Successful completion of this assessment is a course requirement of the Australian Sonographers Accreditation Registry (ASAR).

Students will prepare a 2000 word (+/- 10%) report about quality management in a cardiac imaging workplace. This will include:

• Identifying adverse events
• Identifying contributing factors, near misses or potential adverse events
• Suggesting recommendations for quality improvement

This assessment task involves completing a series of tasks:

1. Context and adverse risk identification:

• Discuss five adverse events and identify contributing factors.
• Choose one event to create an Ishikawa ‘fish’ diagram of contributory factors.

2. Organisational Culture:

• Expand on one adverse event from an organisational culture perspective.
• Utilise an ‘iceberg’ model to demonstrate visible and background cultural understandings.

3. Detailed risk analysis:

• Choose a risk factor relevant to a cardiac imaging environment, describing the potential impact of the risk from an OHS perspective.
• Use the risk matrix, risk table and likelihood rating tables provided on Moodle to calculate a consequence rating.
• Demonstrate risk reduction due to control methods by using the residual risk table provided on Moodle.

4. Quality management:

• Describe an everyday workplace event for a medical imaging organisation and five clinical indicators that could be used to monitor quality of structures, processes and outcomes involved in this event.

5. Safety Culture:

• Use a Manchester Patient Safety Framework Evaluation Sheet, in partnership with a work colleague, to evaluate the patient safety culture in your clinical workplace.

Explanations of terminology and quality practice concepts may be found in your prescribed text, lecture material and resources provided on the unit Moodle site.

Your final report will include:

• Cover page
• Contents page
• Data presented in figures, tables or diagrams
• Discussion of results (or further action) for some tasks
• Short directive paragraphs and objective language

Your Portfolio will be assessed on the following criteria:

• Production of a complete, informative quality management portfolio
• Correct use of terminology and concepts for quality practice
• Relevancy and prioritisation of content
• Informed rationale for choices made
• Information supported by relevant and recent references with correct citation consistently used
• Correct labelling and citation of legible diagrams, tables and graphics
• Critical analysis, and application of relevant theory to data collected
• Application of concepts to analysis of events, observations and data
• Proposal of relevant and feasible plans for improvement
• Accurate completion of quality improvement tools
• Logical and neat presentation, including use of appropriate use of titles, headings and sub-headings
• Correct grammar and spelling
• Adherence to the word limit
• Use of footers with student name, student number, assessment name and page number on each page
• Legible 12pt font throughout

A detailed marking rubric is available on the unit Moodle site.