In preparation for graduation, this practical assessment requires you to demonstrate the ability to competently carry out all tasks associated with a normal echocardiographic ultrasound examination, with minimal (20% or less) intervention or guidance. This is deemed equivalent to a 'competent' level of proficiency.

This task will be assessed by your clinical supervisor, or a delegate sonographer using the Practical Assessment Marking sheet. A downloadable copy of the Practical Assessment Marking Sheet can be found on the Moodle site.

Please print the Practical Assessment Marking Sheet 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 sheet with feedback,  should be submitted to Moodle for each assessment attempt.

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

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

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

• Pre-examination tasks (including patient ID checks, consent and appropriate professional communication)
• Scanning technique (including 2D, 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 to the student either prior, during or after 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 Sheet.  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.   

Students commence each clinical practicum unit having successfully demonstrated the 'behavioural attributes of overall technical knowledge and skill' consistent with the competency level of the previous requisite unit. The GAPA 'Overall technical knowledge and skill 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 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 of ECHO20005. Where such risk exists your placement will terminate immediately.

It is difficult to place such students in the clinical environment again. Your continued progress within the Echocardiography course may be at risk.

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:

• Initiative and communication
• Responsibility and demeanour
• 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 occurs at the mid-placement point, at the end of 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 ECHO20005 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 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 after just one GAPA, 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 ECHO20005 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.

The ‘Clinical Case Log Book’ is a document designed to track clinical experience. This log book documents all observed, partially or fully completed echocardiography cases that a student is exposed during clinical placement.

The clinical case log 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 should be kept in excel format and submitted electronically at the end of clinical placement. The Clinical Case Log Book entries should be sighted weekly by the supervising ASAR accredited sonographer or appropriately qualified medical practitioner. 

The clinical 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 partially or fully complete a minimum of 320 echocardiograms.

Students will be required to submit 4 case studies over the duration of their 16 week clinical placement. Each echocardiographic study must have been partially or fully completed by the submitting student themselves. Submissions can be staggered and completed in any order, but at least two cases must be submitted by the end of week 8, or mid clinical placement.

One case study should be submitted from each of the following categories:

1. Ventricular function assessment including comprehensive systolic and diastolic evaluation
2. Aortic stenosis, mitral stenosis or prosthetic valvular replacement assessment, incorporating application of PEDOF probe
3. Valvular regurgitation assessment of at least moderate severity
4. Congenital anomaly

NB. Students who do not encounter a congenital echocardiographic case within their facility by week 10 of placement, will be provided with a case for evaluation by the unit coordinator.

The purpose of these case study submissions is to:

• Provide the unit coordinator with an opportunity to critically evaluate and moderate student technical performance on cases that they have performed as part of their clinical workload
• Facilitate the continued development of student clinical reasoning and to ensure exposure to a variety of clinical cases
• Encourage student reflection and self improvement, of both technical and research skills, pathology knowledge and assessment strategies

Each case study should include:

• identification of the clinical indications for the examination performed
• identification of expected echo findings based on clinical indications
• identification of any patient care considerations
• a brief discussion of the relevance of any previous imaging or medical tests which may be accessible
• identification of variations in scanning protocol which were necessitated and why
• identification of any scan or measurement limitations encountered
• a description of findings and categorisation of lesion severity against established guidelines
• a brief discussion of the case anomaly, pathophysiology and etiology
• a discussion of additional investigations indicated and how this could influence management (eg. transoesophageal echocardiography, left or right heart catheterisation/angiography, MRI, CTCA), likely disease progression and patient management

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

Any supervisor assistance must be clearly identified within the case study report.

The echocardiographic cases presented must be accompanied by the submission of de-identified DICOM images. The DICOM images can be submitted on a USB to the unit coordinator. A mail address will be made available on the unit Moodle site. Alternatively the files can be uploaded and shared via a google drive folder link. Time and date, as well as technical information must be retained on the images.

Case study submissions will be critiqued using a marking rubric available on the unit Moodle site. This rubric will evaluate:

• the diagnostic quality of the examination performed, in particular, the scan technique and protocol adopted by the student
• image optimisation and image selection representative of pathology
• measurement technique
• the student's self critique of examination quality
• discussion of findings and anomaly presented with reference to relevant literature and use of appropriate references
• appropriate use of terminology, and presentation style consistent with that of a scientific discussion

Case study should be concise and succinctly presented.

Word count limit 1200-1500 words.

This is a PASS/FAIL submission. A PASS will be awarded if:

• conclusions drawn are appropriate and consistent with images and information acquired
• student self critique is appropriate
• information presented within the case study is consistent with current guidelines and is appropriately referenced
• presentation standard adopts an appropriate scientific narrative

Submissions not up to standard, will be returned to the student with appropriate feedback. A re-submission will be required within one week of receiving feedback.

Only one re-submission opportunity for each case study submission will be provided.

To pass this assessment you must achieve a minimum of 640 hours (16 X 40 hours) of clinical attendance. Any days away from your clinical site must be documented.

Over the course of your 16 week clinical placement all hours worked must be entered into the clinical attendance form. This form must be signed by your clinical supervisor, or a sonographer delegated this task by your clinical supervisor. The clinical attendance 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. If you are away from your clinical institution during placement work hours, you MUST supply a verifiable supporting document indicating why you have not attended. Both your clinical supervisor and the unit coordinator MUST be informed of any absences from your clinical placement. Any absence for part, or all of, a working day must be made up after, or during (e.g Saturday /evenings if available), the clinical placement.

You can supplement any deficit in log book hours with hours accrued from 'outside clinical placement'. You can submit the 'outside clinical placement' attendance form dated between the end of year 4 ECHO20004 clinical placement and the start of year 4 ECHO20005 (second) placement.

Details of this are in the 'Outside Placement Hours' information tab on the unit Moodle site.

Please note: The Logbook must be verified (signed) by an ASAR accredited sonographer or appropriately qualified medical practitioner.

Details of either your insurance, or employment, must be entered in the Outside Clinical Placement Attendance form on your moodle site.

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,
• accurately record your studies in the clinical case log,
• ensure the documentation of each assessment is complete, and
• upload each completed assessment for into the unit Moodle site by the due date.

The objective of this assessment task is to moderate the clinical competence of all students, to ensure safe practice upon graduation. This is the University’s duty of care as required by the Australian Sonography Accreditation Registry. The application of Echocardiography and cardiac physiology knowledge and skills at a graduate level will be assessed using an OSCE format – ‘Objective Structured Clinical Examination’.

The OSCE will consist of two components (A) image interpretation; and (B) echocardiographic scanning. Together these tasks will simulate clinical practice.

Each assessment component will require the student to perform certain clinical tasks. The responses will be observed and documented. Performance will be evaluated using an Assessment of Readiness for Professional Practice (ARPP) tool. The ARPP will detail a standardized marking critique for both component (A) and (B). The ARPP tool is available for download on the unit Moodle site.

Component A:

The image interpretation component will consist of four cases displayed in a PowerPoint format on a computer.

The echocardiographic pathologies presented during this assessment, are covered in detail within the CV69 Bachelor of Echocardiography and cardiac physiology / Graduate diploma of Echocardiography curriculum, and will fall under the following headings:

1. Ventricular function

2. Valvular disease

3. Congenital Heart disease

4. Other cardiac findings (intra-cardiac or extra-cardiac)

• Component (A) has a total possible mark allocation of 100 marks. Each case will be weighted equally, with a maximum of 25 marks available per case.
• Each case will be introduced with a brief patient history and/or referral indications. An examiner will then present a Power point presentation and ask questions corresponding to appropriate slides.
• Students will be given the opportunity to go back to questions regarding particular slides, if time permits during the assessment but once the time is up nothing new can be added to your responses. A maximum of 10 minutes discussion time will be allocated to each case study.

Component B:

The echocardiographic scanning component will consist of a 45-minute scanning session. During this session, students will be asked to perform components of a transthoracic examination on a provided patient model.

Results including feedback and a copy of the completed ARPP tool, will be provided to students following cross campus moderation of interim grades.

This is a PASS/FAIL assessment task.

Component A of this assessment task will critique the student’s ability to demonstrate their Echocardiographic and cardiac physiology knowledge through discussion of topics including:

• Normal and abnormal sonographic appearances
• 2D, colour and Doppler interpretation, including heamodynamic evaluation and severity classification
• Imaging and measurement optimisation, artefacts and caveats
• Pathophysiology of disease process
• Differential diagnoses
• Relevance of findings to referral indications and prognostic significance
• Use of appropriate sonographic terminology

Student responses will be compared against model answers, and marks will be awarded according to the provided ARPP tool.  To achieve competency in component (A) students must:

• Pass each of the four (4) cases, by achieving a minimum grade of 50% for each individual case - (> 12.5/25 marks)
• Achieve a minimum overall grade of 60% for component (A) - (> 60/100 marks)

Component B of this assessment task will critique the student’s ability to demonstrate competent Echocardiographic scanning skills including:

• Image quality comparable to that obtained by an experienced cardiac sonographer on the same day
• Accurate measurement acquisition
• Appropriate exam extension

To achieve competency in component (B), students must:

• Achieve ‘Competent’ against all criteria detailed on the ARPP tool

To pass the OSCE assessment overall, a student must demonstrate competency for both component (A) and (B).

Only ONE opportunity for RESIT will be provided for either component.