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.

This assessment task is linked to the National Competency Standards for Entry Level Sonographers in Australia.

This assessment task provides students with an opportunity to contribute to workplace health and safety and quality assurance programs, through the completion of a small part of a clinical audit.

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 readings available through the ereading list, 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 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.

Portfolios that do not achieve a PASS grade will be returned to the student with appropriate feedback. Students are permitted one re-submission opportunity. Re-submission attempts are required within two (2) weeks of receiving feedback.

Student sonographers must demonstrate behaviours and attributes of a healthcare professional. This assessment considers the student's 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 day- to-day performance. These observations and collected feedback 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 provided.

This assessment is performed TWICE during unit enrolment- at mid term (week 6) and at end of term (week 12). The GAPA Assessments are to be performed concurrently with the Practical Assessments.

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

• Reflect on performance
• Develop an action plan to address any areas of performance that are not yet at the target level for this placement

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 consistently in their practice. 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.

Upon completion of ECHO28006, the 'Overall Technical Knowledge and Skill' scores of the enrolled student must be consistent with graduate competency level.

The nominated assessor will score 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 the student does not demonstrate this behavioural attribute, or demonstrates it in an unacceptable manner
• A score of 1 indicates the student demonstrates this behavioural attribute, but needs some improvement
• A score of 2 indicates the student consistently demonstrates this behavioural 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-term GAPA are not met, the student will be regarded as a 'Student at Risk' of failing the unit overall.

• The unit coordinator will contact the student to advise of the risk of failing ECHO28006 and provide formative feedback via email. The student must respond to this email to show understanding of 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 clinical practice, and use the remaining weeks to achieve those targets.
• Review of the student's progress will be completed a short time after the mid-term GAPA, at any time as requested by the clinical supervisor or unit coordinator.

The final GAPA assessment is summative. For any behaviour that you score well on at the mid-term assessment, it is expected that you will continue to meet that level of performance or surpass it for the rest of the term.

Unsatisfactory scores obtained at the second GAPA attempt will result in a FAIL grade for ECHO28006 overall.

Failure to successfully complete this assessment task may delay graduation and result in implementation of a learning contract prior to re-attempt. This contract will likely mandate additional clinical attendance.

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- graduate' level of proficiency.

This assessment is performed TWICE during unit enrolment- at mid term (week 6) and at end of term (week 12). The Practical Assessments are to be performed concurrently with the GAPA assessments.

Should the student fail the first attempt at this assessment task, they will be provided with detailed feedback regarding performance and areas requiring improvement.

Students are encouraged to:

• Read the marking sheet carefully, to 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

Each submission of this assessment task has two components:

1. Clinical supervisor practical assessment

• This task will be assessed by the clinical supervisor, or delegate sonographer
• The clinical supervisor, or delegate, must complete and sign the Practical Assessment Marking Sheet before submission through the unit Moodle site
• 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

2. University moderation of practical assessment

• Each submission will be critiqued, to CQUniversity standards
• The final PASS/FAIL grade of this assessment will be at the discretion of the unit coordinator

Each 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 to 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 Practical Assessment Marking Sheet lists the criteria against which the student's sonographic skill, and relevant theoretical knowledge, will be evaluated. Students 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, while a score of 4 indicates largely independent practice, requiring direction or prompting only on complex or unusual cases.

This is a PASS/FAIL assessment.

Failure to successfully complete this assessment task may delay graduation and result in implementation of a learning contract prior to re-attempt. This contract will likely mandate additional clinical attendance.

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). An exemplar 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. Each case will fall under the following categories:

1. Ventricular function

2. Valvular disease

3. Congenital heart disease

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

Each case will be introduced with a brief patient history and/or referral indications.

• Students will answer a series of questions corresponding to 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 CV74 Graduate Diploma of Cardiac Ultrasound 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.

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 spectral Doppler interpretation, including heamodynamic evaluation and severity classification
• Imaging and measurement optimisation, artefacts and caveats
• Pathophysiology of disease processes
• 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. 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.

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

Student performance will be graded as ‘Competent’ or ‘Not yet competent’, against criteria detailed on the ARPP tool. 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).

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

Only ONE opportunity for RE-SIT will be provided for either component of this assessment task.

Failure to successfully complete this assessment task may delay graduation and result in implementation of a learning contract prior to re-attempt. This contract will likely mandate additional clinical attendance.

An example ARPP tool and OSCE assessment can be found on the Moodle site.