In preparation for graduation, this practical assessment requires students 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 the 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. 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 so you understand the criteria against which sonographic skills, and relevant theoretical knowledge, will be evaluated
• Discuss the best time to complete this assessment with the clinical supervisor, to ensure minimal departmental disruption and sufficient time for task completion
• Seek detailed feedback from the clinical supervisor post assessment to enable identification of areas requiring improvement.

Please note the following details:

• In case of receiving a fail only one re-attempt will be permitted
• This assessment task must be completed prior to the completion of the students clinical placement block
• It is recommended that the first attempt takes place on or before the 14th week of placement thus allowing sufficient time for improvement before a second attempt
• Should the student fail the first attempt at this assessment task, they will be provided with detailed feedback regarding performance and areas requiring improvement.

The clinical supervisor must complete and sign the Practical Assessment Marking Sheet before submission through the assessment block in the unit Moodle site. A completed Practical Assessment Marking Sheet, 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. Maintenance of patient confidentiality must be adhered throughout both practical and written components of the case study. 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.

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 the students sonographic skill, and relevant theoretical knowledge, will be evaluated. This sheet can be found on the unit Moodle site. During this clinical placement, students will be scanning real-life patients and will be assessed to a 'Competent' level of proficiency - requiring minimal direction.

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 extensions 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. 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 the 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.

The clinical supervisor, or delegate, will be working in the echocardiography lab with the student, directly observing your day-to-day performance. These observations and collected feedback relate to 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 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. 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 performance
• Develop and action plan to address any areas of performance that are not yet at the target level for this placement.

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 placement). If the outcome of this GAPA is FAIL grade, and/or the site feedback indicates that they can no longer host the student 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 the placement will terminated immediately.

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.

The assessor will score your 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 mid-placement, 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 the student of the risk of failing ECHO20005 and provide formative feedback via email. The student must respond to this email to show you understand the implications of this information.
• The student will be required to reflect on 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.

The second assessment occurs during week 16 of your 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 ECHO20005 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 progress. This will likely involve scanning skills labs for tuition and assessment on a regular basis.

This is a PASS/FAIL assessment and must be submitted by the due date.

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 to 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:

• an acceptable volume of clinical work is achieved
• exposure to a reasonable case variety is achieved
• 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 mid-placement and at the end of clinical placement. The Clinical Case Log Book Cover Page must be signed 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 attained during the placement. It demonstrates the degree of progression of the students 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. Students are advised to ensure they are gaining experience under each of the different categories.

It is recommended that students partially or fully complete a minimum of 320 echocardiograms (average 4 per day). Students should regularly assess case log progress and if are unable to achieve the minimum number of scans should contact the unit coordinator.

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

• Accurately record all studies int he Clinical Case Log Book
• Logbook Cover Page must be signed by the clinical supervisor or a delegate of the clinical supervisor
• Ensure the documentation is complete
• Submit the requested documentation via the unit Moodle site by the published due dates.

The mid term submission must be complete up to the end of week 8 including the Clinical Case Log Book and Logbook Cover Page. The final submission must include the entire clinical placement including the Clinical Case Log Book and Logbook Cover Page.

Students will be required to submit two (2) case studies during this 16 week clinical placement. Each echocardiographic study must have been completed by the submitting student themselves during this clinical placement (a limited number of labelled images may be included by clinical supervisor).

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

1. Aortic stenosis, mitral stenosis or prosthetic valvular replacement assessment, incorporating application of PEDOF probe.
2. Congenital anomaly.

Students who do not encounter a suitable case in clinical practice should contact 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 must include the following:

• Clinical indications for the exam
• Details of expected findings based on clinical indications
• Patient care considerations
• Brief discussion of any previous imaging or medical testing available
• Variations in scanning protocol used
• Identification of study limitations (imaging or measuring)
• Detailed description of study findings and pathology identified, including grading of severity in accordance with ASE guidelines
• Discussion of aetiology and pathophysiology
• Discussion of any appropriate additional investigations indicated (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).

Image Submission

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. 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. 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 patient consent form must be submitted with the case study.

The DICOM images must be submitted to the unit coordinator. Upload and share a google drive folder link. Time and date, as well as technical information should be retained on the images.

Word count:

1200-1500 words. Word count does not include headings or references, but does include diagram explanation and labelling.

Referencing:

Vancouver. Minimum of 5 peer reviewed journal articles/relevant text books must be cited. Literature titles must be current (< 5 years of age), except for seminal works.

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

The rubric will assess the following items:

• Diagnostic quality of the examination performed
• Scan technique and protocol adopted 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 case study must be referenced using Vancouver referencing style. Support material for Vancouver Referencing System is available on the Moodle site.

Students must pass this assessment to pass the course:

• The pass mark for the written component of the case study is 65%.
• The imaging component of the case study is a PASS/FAIL submission. Case studies submitted without accompanying DICOM images will be awarded a FAIL grade.

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.

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. Should the imaging component need to be re-submitted the second submission does not need to be from the same patient.

To pass this assessment you must achieve a minimum of 640 hours (16 X 40 hours) of direct echocardiography observance/participation 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 your clinical supervisor (or a sonographer delegated this task by your clinical supervisor) and submitted fortnightly. The clinical attendance forms are available in the assessment block in the unit Moodle site. Students are advised to print this form and read it carefully so they understand the criteria against which clinical attendance will be evaluated.

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 the unit coordinator prior to the 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.

Any students who are absent from clinical placement due to injury must phone the clinical supervisor and email the unit coordinator prior to the scheduled start time for that day. 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. 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 Clinical Attendance Form 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.

Any days absent from the clinical site must be appropriately documented.

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.

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 of Clinical Placement Attendance Form.

At the end of the scheduled 16 weeks of placement, if a student has not met the 100% attendance requirement AND does have 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 16 week placement, and/or may not be at the same placement site, depending on clinical availability).

At the end of the scheduled 16 week of placement, if a student has not me the 100% attendance requirement AND does NOT have documented justifiable grounds for the absence, they will score a 'FAIL' for this assessment item.

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 form
• Ensure the documentation is complete
• Submit the requested documentation via the Moodle site by the published due dates.

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 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 standardised marking critique for both component (A) and (B). The ARPP tool is available for download on the unit Moodle site.

Component A:

The students will view a series of echocardiographic images from four categories:

1. Ventricular function
2. Valvular disease
3. Congenital Heart disease
4. Other cardiac findings (intra-cardiac or extra-cardiac).

Each series of images will be introduced with a brief patient history and/or referral indications.

• Students will answer a series of questions corresponding the the images shown
• A maximum of 15 minutes will be allocated to each category (total 60 minutes)
• Students will be given the opportunity to go back to previous categories if time permits, but once 60 minutes has passed no additional work will be accepted.

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.

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 provided patient model/s.

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 assessment 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.