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SUPERVISED HOURS HANDBOOK
SUPERVISED HOURS HANDBOOK
Park City, Utah
From: Pieter Kroon PT, DPT
Re: Supervised Hours Procedures
Hello,
Congratulations on starting the Fellowship portion of the manual therapy program. I hope you will find the experience worthwhile and rewarding, and that it will help you in your development as an expert clinician.
Tim Kruchowsky is the Director of Clinical Education. Questions and concerns related to the supervised hours will be going through him. We do require that you contact him every month while enrolled in the fellowship program. E-mails are the preferred way of communication, but you can always call him when necessary. His phone number is (512) 466-4115, his e-mail address is: [email protected] For all other questions relating to the manual therapy program you can contact me.
You need 440 hours to complete the fellowship portion of the program. For details regarding the hours, please read the enclosed file “Supervised hours”. APTA standards are very strict as far as the duration of fellowship programs is concerned, and extensions are not commonly given. The beginning and start date for the fellowship program are written down in your contract.
As you progress with the supervised hours, make sure to write the hours in your log. For your convenience, templates for contact hours, non-contact hours and clinical hours log are included. Make sure to complete all portions of the form (your name, mentor name, mentor initials etc.). Upon finishing the fellowship program you need to e-mail me the completed hours log. It becomes part of your permanent file.
Prior to the start of the supervised hours, send MTI the first half of the tuition payment. The second half is due upon completion of 220 hours. Send the tuition to the address listed below. It is not necessary to send the check via certified mail.
When you have finished your first 220 hours, you will need to send me the first of two mentor evaluations. Upon completion of the hours, send me the second mentor evaluation as well as the completed supervised hours log.
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Make sure you have your liability insurance taken care of. Prior to starting your hours, email a copy of the policy to MTI and bring a copy to the clinic where you are doing your hours.
If you are doing your hours in a different state than what you are normally working in, make sure to get your licensure taken care of prior to starting your hours. You cannot do your hours if you are not licensed to practice in that particular state. Bring a copy of your license to the clinic you will be doing your hours at.
You will also need to keep track of the patient diagnoses you will be treating during your fellowship hours. I have attached a patient diagnosis chart for you to keep track of this. This chart is a summary of your entire fellowship and does not need to be broken down by the facility you were in.
When doing your live patient exams, make sure to e-mail copies of the write up to your mentor, Tim and Pieter. I need a copy of the write up for your file.
Once you have finished reading the Supervised Hours Handbook, please sign the Acknowledgement Form and email that back to me prior to starting your hours. This will signify that you understand the procedures involved with the Supervised Hours.
Contact me if you have any questions or concerns.
Sincerely,
Pieter Kroon PT, DPTBoard Certified in Orthopedic Physical TherapyFellow, American Academy of Orthopedic Manual Physical Therapists
Program DirectorThe Manual Therapy InstituteP.O. Box 680127Park City, UT 84068(512) [email protected]
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Content
Acknowledgement Form Supervised Hours Handbook 5
Checklist 6
Standards for Supervised Hours 7
Tuition payment 8
Diagnostic Category Chart 9
Fellow Student Mentor Evaluation 11
Contact Hours Log 12
Non-Contact Hours Log 13
Supervised Hours Time Sheet 14
APTA Grievance Policy 15
Live Patient Exam Presentation 17
Assisting in class 23
Poster Presentation 25
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Acknowledgement Form Supervised Hours Handbook
Date: __________________________________________________________
Fellow Student Name: __________________________________________________________
I have read the Supervised Hours Handbook and understand all that is involved in successfully completing the supervised hours portion of the Manual Therapy Institute’s Fellowship Program
Signed: __________________________________________________________
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Upon successful completion of your hours and your live patient exams, I need a fair bit of paperwork from you. The paperwork becomes part of your permanent file, and is required as per APTA standards of Fellowship training. E-mailing the paperwork is much appreciated.
______ Mentor evaluation form
______ Supervised hours log
______ Tuition for the supervised hours
______ Patients per diagnostic category chart
______ Extremity live patient presentation
______ Spine live patient presentation
______ Extremity live patient exam score sheet (can be obtained from your mentor)
______ Spine live patient exam score sheet (can be obtained from your mentor)
Please send me this checklist as well as the required paperwork. Once I receive this, I will send you your diploma and Fellow application paperwork.
Thanks,
Pieter Kroon PT, DPTProgram DirectorThe Manual Therapy Insititute
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Standards for supervised clinical hours
Two essential components of fellowship training are clinical practice over an extended period of time combined with consistent clinical supervision by the manual therapy instructor(s)/mentor(s).
o 440 hours of on site clinical practice hours must be completed to meet this requirement.
o The hours are completed in a facility that has an orthopedic manual physical therapy instructor available during the entire 440 hours.
Out of the 440 hours, 150 hours have to be so called “contact hours”. This is defined as on-site instructor supervision of the fellow student who is actively engaged in the evaluation and treatment of the patient. These hours are not to be confused with instruction in the theoretical content or supervised learning of manual therapy examination and treatment techniques in class. The supervised patient contact hours must also meet the following standards:
o Each fellow student must maintain a written journal of his/her supervised patient treatments. Forms are established for documenting patient diagnosis, hours of supervision and a summary of clinician performance
o The instructor must be present during the evaluation and/or treatment of the patient.
o A clinical supervision hour may include a brief pre-treatment consult, and written or verbal post recommendations.
o Instructor recommendations may include general comments concerning the evaluation and treatment, appropriateness of said evaluation and treatment, and possible adaptation to the treatment plan.
Out of the 440 hours, 40 hours have to be so called “non patient contact hours” The 40 non patient contact hours may include, but are not limited to:
1. Case presentations - a minimum of 1 case study should be presented by the fellow student during the fellowship period.
2. Case Journal Review - Instructor and fellow student should review the case journal at least weekly during the clinical supervision period.
3. Mock patient practice - opportunities should be available for role playing or mock patient practice during the clinical supervision period.
4. Teaching-assisting at one of the manual therapy courses organized by MTI. A total of 32 hours (2 course weekends) can be officially logged as non-contact hours
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Filling out the hours log is important. It is how you keep track of how many hours you have done in the program. At the end of the program, you need to e mail the log to Pieter Kroon. It becomes part of your file as proof that you have completed the hours. You calculate your 440 hours by adding up the hours in the “clinical practice column”. If you are at the clinic from 8-5, with 1 hour lunch break, you write your start time, ending time for that day and the amount of clinical practice hours (in this case: 8)The amount of contact hours in 1 day is written down in the “patient contact hours” column. The number in this column cannot exceed the amount of clinical practice hours for that day. Once you have reached the required 150 contact hours, it is not necessary to keep track of any further patient contact hours anymore, neither do you have to write them down in your patient diary.
Tuition payment
Tuition for the supervised hours is $6500.00. This is paid in two installments of $3250.00. The first installment is due upon signing the fellowship contract. The second installment is due upon completion of 220 hours.
We have two payment options. You can send a check to MTI (P.O. Box 680127 Park City UT 84068). You can also pay with a credit card. The link for paying with a credit card can be found under the “Courses” tab on the website.
Diagnostic Category Chart
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You will need to keep track of the patient diagnoses you will be treating during your fellowship hours. This ensures that you have adequate exposure to the different diagnostic categories per the Description of Specialty Practice.
I have attached a patient diagnosis chart for you to keep track of this. This chart is a summary of your entire fellowship and does not need to be broken down by the facility you were in.
Each new patient that you see should be counted only once (therefore, if you saw that patient for several subsequent visits, you can only count that person 1 time).
Only the patient’s primary diagnosis may be tracked on the form, not all subsequent diagnoses or areas that you screen.
When calculating the percentages, it would be based on the total number of patient diagnoses you have seen over the course of the program. For example, if you saw 12 foot/ankle patients out of 130 total diagnoses on the chart, then the percentage would be 9%.
Historically, we have found that the cumulative average amount of patients is 155. If you find that you are logging <100, or >200, you are probably doing it incorrectly. You need to then talk to your mentor, or contact the Program Director. It is very important you do this correctly, because the APTA scrutinizes this in detail.
For every treatment category where there is limited patient exposure (<5% of the total amount of patients), make sure the mentor provides extra learning opportunities in those categories, as to ensure adequate exposure. This can be in the form of extra practice sessions, shadowing of a specialist (i.e. MD, CHT), case study presentations etc. These extra learning opportunities need to be documented at the bottom of the form.
When you are done with your hours, send the completed chart back to me. The APTA wants this information as part of our annual report.
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For EVERY fellow listed as GRADUATED in Section II, please provide their completed diagnostic category chart. Please summarize the number of patients/clients (not number of visits) by diagnostic categories evaluated, treated, and/or managed by the residents/fellows during the entire course of the residency or fellowship program. Do not provide data on patient/clients seen by all staff in the clinic.
Diagnostic Categories for Orthopaedic Manual Physical Therapy Fellowship Programs
DIAGNOSTIC GROUP OR CATEGORY
NUMBER OF PATIENTS/CLIENTS TREATED BY THE FELLOW AS PART OF THE PROGRAM
% OF TOTAL PATIENTS/CLIENTS TREATED BY THE FELLOW
Cranial/Mandibular Cervical Spine Thoracic Spine/Ribs Lumbar Spine Pelvic Girdle/Sacroiliac/Coccyx/Abdomen
Shoulder/Shoulder Girdle Arm/Elbow Wrist/Hand Hip Thigh/Knee Leg/Ankle/Foot
Total 100%
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Fellow’s Evaluation of Clinical Faculty
Please fill out the following evaluation of your mentor’s performance during your fellowship training. Thank you for your time.
Mentor: ________________________________________
Evaluation of mentor related to: Superb
Good Average
BelowAverage
Poor
Competence and manual skills.
Interaction with patients.
Interaction with you.
Ability to teach psychomotor and manual skills.
Ability to teach and relate content.
Promotion of your professional development.
Promotion of critical thinking and differential diagnosis.Promotion and integration of evidence based practice concepts.
Additional comments:
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Diagnosis: _______________________________ Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Narrative comments to include: pre treatment consult, examination and treatment consult, written or verbal summary/post recommendations.
Diagnosis: _______________________________ Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Narrative comments to include: pre treatment consult, examination and treatment consult, written or verbal summary/post recommendations.
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Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Write down the content of this non-contact hour, which may include: case presentations, journal review, tutorial, mock patient practice etc.
Date: _________________________
Mentor: _______________________________ Mentor initials: ____________
Write down the content of this non-contact hour, which may include: case presentations, journal review, tutorial, mock patient practice etc..
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Fellow Student: _________________________ Mentor: _________________________
Date MentorInitials
Timein
Time out Contact Hours
Non-Contact Hours
Total Clinical Hours
This PageNumber:
TOTAL This Page
GRAND TOTAL(All Pages Combined)
Total Required Hours 150 40 440
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Live Patient Exams
Here are a few tips for consideration with the documentation of your live patient exams.
Use outcome measures. This is standard and expected with any and all clinical reports. No case report will be considered in a professional forum without use of standardized outcome measures (commonly used measures include ODI, NDI, HOS, LEFS, SPADI, DASH). The Patient Specific Functional Scale (PSFS) is a reliable, valid and commonly used measure and is great because it uses the patient's self-selected activities to measure change. The GROC is also an excellent tool. However, remember the GROC measures patient's perceived overall improvement and not pain/function specific to the region. A rule of thumb for use outcome measure is to include, when able, both a region-specific measure and/or PSFS and a GROC.
Asterisk or comparable signs are generally those movements, tests, positions that reproduce the patient's symptoms. These are extremely important and sought during examination because they make for excellent means to quickly re-assess and quantify changes (even if it means merely a NPRS rating). Select one or two asterisk or comparable signs that can be incorporated into every treatment. These are generally used at beginning of treatment (to assess inter-treatment change) and after intervention during a treatment session (to assess intra-treatment change). Remember to quantify response.
Quantify, quantify, quantify. If an examination finding is worth noting/documenting - it should be quantified. That includes ROM (standard goniometer for peripheral joints and bubble inclinometer for spine), MMT grades, NPRS for pain provocation, NPRS, + location + sensitizing maneuver for neurodynamic assessment. Guaranteed - this will be the first question asked of an author/presenter if not used: "How did you measure patient response to change?" Percentages and estimates are nails in the coffin.
The final live patient write-up now needs to be of such quality, that with minor editing, it is good enough to be submitted for publication in a peer-reviewed journal. The current format for the live patient write-up template is already set up with this in mind. Documentation of evidence based treatment interventions is required for each chosen treatment technique and citation in AMA format is required (AMA Manual of Style, 9th edition: http://www.amamanualofstyle.com/). When faced with a circumstance where evidence is not currently available, please provide sound problem solving and reasoning as to why such a method was chosen. Make it clear that advanced clinical reasoning is what dictates the intervention.
In addition, we require that the live patient presentation will be written up in a poster presentation template. This will need to be of such quality that it can be presented at a State or National conference. The template we would like you to use
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is attached, as well as 4 examples of what a good poster presentation should look like.
A poster presentation is a report or research that allows for researches and their professional colleagues to exchange ideas in a conference setting. The poster should contain the major elements of the case study in a clear, brief series of statements including title, purpose, hypothesis or specific aims, method, results and discussion, and conclusions.
The poster should be self explanatory, but “telegraphic” in style: that is, content should include key word and phrases and not necessarily complete sentences. Tables, graphs or pictures should summarize and illustrate important findings or unique aspects of the case study. The most effective posters do not contain so much written material that the observer gets lost, but should be complete enough to allow the observer to understand the full intent of the study.
In preparing your poster, use the template that we provided for you, which shows the arrangement of text and figures. The content elements can be moved about the template to find the best arrangement for the logical flow of information. Ordinarily, the eye follows from left to right, as in reading. The introductory materials should be placed at the top left and the conclusion at the bottom right. Methods and results should be displayed prominently in the center.
An effective poster should be legible and uncluttered. The size and type of text should be readable from 4 ft away. The visual aspect of the poster should remain foremost in it preparation, providing an interesting and attractive presentation.
The poster presentation format requires a more concise presentation of the case study. Summarize the treatments. Add a “discussion” panel where you summarize how you treated this particular patient, and why it was or was not successful. We recommend your poster has a graph, or photo vs. lots of words or references.
The template for the write up is designed with this in mind, and additionally you have to summarize your case presentation in a Poster Presentation format as well. This means you have to submit both the write up and the Poster Presentation template when doing your spine live patient examination.
A Poster Presentation does NOT have to be submitted for the extremity live patient examination
We highly recommend that you consider presenting your live patient case at one of these conferences, because Tim and I feel strongly that our students are some of the best and brightest out there and we would love for you to be recognized as such among your peers.
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Again – we hope you will consider formalizing documentation for your future patients. The purpose of structuring the documentation for the mid-term and final live patient exams is twofold: 1) provide a standardized format for all fellow students to use, and 2) provide a means to train the clinician in the clinical decision-making process. The intent is that each and every patient should be examined and treated with this format in mind (assess, diagnose, measure, intervene, re-assess). My personal opinion is that every MTI graduate has at least 1-2 patients every week, if not every day, that would make great case studies; their clinical reasoning skills are keenly developed and their hands are trained to see and treat findings at an elevated level. That is why clinical practice gets so much fun after completing the program!
Reference: Portney L and Watkins M. Foundations of Clinical Research: Application to Practice, 3r edition. Upper Saddle River NJ: Pearson Prentice Hall; 2008
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Case study presentation
Patient’s primary complaint
Assessment/working hypothesis
Severity Irritability Nature
MildModerate Severe
Mild ModerateSevere
MusculoskeletalNon-musculoskeletalBoth
List the pertinent subjective and objective findings that shore up your assessmentSubjective
Objective
List the asterisk signs by which you gauge the efficacy of your treatment (pre-and post treatment)
Intervention
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What was your first choice of treatment and why? Please provide a brief justification. Cite supportive evidence from the literature where appropriate
What is your second choice of treatment and why? Support your answer as above
From initial evaluation up to now, list treatments and responses (immediate and on follow up)Visit # Technique or exercise
(level/direction/grade/reps/timePatient response after intervention ORPresentation on follow up exam
S
O
S
O
S
O
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S
O
S
O
Assisting in class
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As part of doing your hours, you can be a Teaching Assistant for the courses. We allow 2 weekend courses (32 hours) for this, and they count as non-contact hours.
Upon graduation, you are more than welcome to audit future courses. In return, we ask you that you will be functioning as a TA for those courses.
As an MTI-registered lab assistant, you will be required to agree to comply with ALL of the following points:
1. Maintain a current physical therapy license, and submit a current copy to the Site coordinator when required.
2. Maintain current personal malpractice insurance. 3. Seek permission of the Program Director in a timely fashion.4. Be on time. Class starts at 8AM sharp.5. Be prepared to perform in the lab assistant function by reviewing the course,
course notes and theory for the course level on which you will assist.6. Come prepared to actively assist the students and the Instructor7. Passive auditing of the entire class by the lab assistant is not permitted.8. Come prepared to be a model and have techniques demonstrated on you and
inform the Instructor(s) of any physical limitations or precautions prior to being a demonstration model.
9. Provide assistance to students during lab time (i.e. moving among the tables, checking hand placements, body mechanics or technique, answering student questions regarding theory, technique and clinical reasoning, etc).
10. Refer questions to the instructor if unaware of proper technique or correct answer.
11. Pose only legitimate or useful questions during class in an effort to help the students’ understanding or to elucidate a point being made.
12. In the lab sessions or breaks, refer ONLY to theory or techniques that have been introduced and taught during the course, unless specifically requested to demonstrate a technique variation by the Instructor. (Despite your expertise, this is not the place to demonstrate your variation of a technique, nor treat a course participant.)
13. Treatment of course participant’s pain or dysfunctions during the course or during the breaks is NOT permitted. If the student has a problem or develops a problem during the class, the Course Instructor must be informed and will manage the situation.
14. Approach each student as one would a patient and be alert for contraindications to techniques as well as increasing sensitivity of areas to repeated assessment or treatment.
15. Assess the students’ difficulties with comprehension or psychomotor skills and endeavor to facilitate the learning.
16. Maintain confidentiality of the course participants’ personal and health information (per HIPAA guidelines).
17. Assist in room set up and break down, setting out break snacks and clean up and other lab assistant duties as needed or requested by the site coordinator
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or Instructor.
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The Poster Presentation
For your final live patient presentation we want you to present both a write up and a poster presentation of the case. The write up of the final case needs to be of such quality that with minor editing it can be submitted for presentation as a case study in a peer reviewed journal. The poster presentation needs to be of such quality that it can be presented at a State or National Conference. You will be graded on both the final write up/presentation and the poster presentation.
A poster presentation is a report or research that allows for researches and their professional colleagues to exchange ideas in a conference setting. The poster should contain the major elements of the case study in a clear, brief series of statements including title, purpose, hypothesis or specific aims, method, results and discussion, and conclusions.
The poster should be self explanatory, but “telegraphic” in style: that is, content should include key word and phrases and not necessarily complete sentences. Tables, graphs, or pictures should summarize and illustrate important findings or unique aspects of the case study. The most effective posters do not contain so much written material that the observer gets lost, but should be complete enough to allow the observer to understand the full intent of the study.
In preparing your poster, use the template that we provided for you, which shows the arrangement of text and figures. The content elements can be moved about the template to find the best arrangement for the logical flow of information. Ordinarily, the eye follows from left to right, as in reading. The introductory materials should be placed at the top left and the conclusion at the bottom right. Methods and results should be displayed prominently in the center.
An effective poster should be legible and uncluttered. The size and type of text should be readable from 4 ft away. The visual aspect of the poster should remain foremost in it preparation, providing an interesting and attractive presentation.
References need to be written according to the AMA Manual of Style.
Reference: Portney L and Watkins M. Foundations of Clinical Research: Application to Practice, 3r edition. Upper Saddle River NJ: Pearson Prentice Hall; 2008
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