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Canterbury Christ Church UniversityFaculty of Health & Wellbeing

Practice Assessment Document

BSc (Hons)Physiotherapy

Level 4 (Placement 1)

1

Student Name:

Number:

Cohort:

CSP Membership number:

Personal tutor:

Visiting Tutor:

Submission Date:

Student’s Name:

Placement Dates: From: To:

Placement Contact Details (Address, telephone and email)

Brief Description of Placement Experience Offered:

Total hours completed:

(37.5 hours per week expected, ½ day study per week is included)

Educator(s) Name(s):(Print)

Designation:

Professional Registration (HCPC) number:

Date of last practice educator update:

Final Grade:Pass

Fail(circle as appropriate)

Practice Educator(s) Signature(s)

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CONTENTSRecord of Signatures.....................................................................................................................4

Mandatory Requirements.............................................................................................................5

Practice Learning Expectations/Guidelines............................................................................6

Placement Orientation................................................................................................................11

Emergency contact details for the student.........................................................................12

Initial Student/Practice Educator Interview.........................................................................14

Assessment of Practice Tool – Part 1.....................................................................................15

Placement Grade Descriptors...................................................................................................16

Assessment of Practice tool – Part 2......................................................................................17

Formative Assessment by Practice Educator(s).................................................................24

Summative Assessment by Practice Educator(s)..............................................................24

Learning Contract/Learning log...............................................................................................25

Supervision Log.............................................................................................................................27

Feedback from Service Users/Carers.....................................................................................32

Feedback from other Professionals........................................................................................42

Reflections.......................................................................................................................................47

Placement Visit from Academic Tutor...................................................................................57

Record of Practice Hours............................................................................................................59

End of placement checklist:......................................................................................................60

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Record of Signatures

This page should contain a record of the signatures and designation of all practitioners who initial and/or sign sections within this documentation.

Full Name (please print) Initials

Signature Designation

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Mandatory Requirements

Each year students complete a range of mandatory requirements to ensure they are suitably prepared and ready for practice. Successful completion of these requirements is recorded on the Faculty placement electronic database. Students are issued with a ‘Readiness for Practice’ certificate, which should be printed and shown to Practice Educators as part of the placement induction process to confirm their status for commencing placement.

Mandatory requirements include: Occupational health clearance (students are cleared initially upon joining

the programme and may be referred for a medical opinion where a change of status is indicated during their studies)

Satisfactory police check via the Disclosure Barring Service (DBS) Moving and Handling Basic Life Support Universal Standard Precautions Safeguarding Information Governance Professional Code of Conduct (CSP, 2011) Health & Care Professions Council (2013), Standards of Proficiency Responding to concerns in practice Placement preparation

Additionally, all students are required to be a member of the Chartered Society, which affords professional indemnity insurance and provides opportunity for access to learning resources relevant to their academic studies and practice learning experiences.

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Practice Learning Expectations/Guidelines

Roles and responsibilities:The student will:

Review and utilise feedback from previous placements to inform their learning and development needs

Take advantage of learning opportunities and review their Learning Contract regularly

Provide evidence of proficiency in relation to the assessment of practice Disclose any special needs or disability in order that reasonable

adjustment can be made by the placement provider Comply with placement policies and procedures Use University procedures to inform of absence Work in a safe manner and within their scope of practice

The Practice Educator will: Verify the evidence demonstrated through the practice assessment

documentation Facilitate learning opportunities and provide constructive feedback on

progress Ensure the student is made aware of the placement policies, procedures

and expectations Ensure the student works safely within their scope of practice Identify a colleague who will take responsibility for the student in his / her

absence and ensure that he / she is aware of the student’s learning needs and that there are effective feedback mechanisms in place

In the absence of the nominated practice educator(s) the student will be supported and supervised by:

The personal tutor will: Provide ongoing support to the student

The academic link for practice will: Monitor student progression Be the contact point for the Practice Educator and student if there are

concerns about the assessment of practice Attend formal meetings with student and Practice Educator Offer advice in writing developmental action plans when concerns are

raised Liaise with personal tutor.

If any difficulties arise, in the first instance the student and practice educator should try to resolve these together. In the event that this is not successful, please contact the academic placement team (Contact details page 10).In exceptional circumstances, it may be necessary to withdraw the student from the placement immediately. The academic link/placement lead will be involved in this process and keep both the student and practice educator(s) fully informed of the process and any action required in line with University guidelines.

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Assessment of practice (pages 15-23)

Placement is assessed using a criteria based grid. It is designed to assess the student’s ability to demonstrate their understanding, skills and values commensurate with the stage of training. It outlines the criteria that are required to be achieved.

All of the criteria have been mapped to academic modules and HCPC Standards of proficiency (2013). These must be passed before a student can progress to the next stage of the programme.

Failure of part 1 of the assessment of practice tool at any time during the placement means that the student will fail placement and may result in a referral to the University Fitness to Practise panel. Where this occurs the student will be required to repeat the whole placement block. If, at the summative assessment at the end of the placement, a student fails in one or more of the proficiencies in part 2 of the assessment of practice tool, they will also be deemed to have failed placement and will be required to repeat the whole placement block.

The formative assessment should be completed mid way through the placement and is assessed using the relevant number placement descriptor (page 16). The formative assessment should provide a clear picture of strengths and areas of development in relation to the criteria. The summative assessment is completed at the end of the placement, again using the placement descriptors. It is considered good practice for this to be completed a few days prior to the end of the placement so that the student has time to reflect upon the feedback and seek further clarification if necessary. The summative assessment should provide a summary of overall achievements along with constructive feedback to inform future practice.

Both formatively and summatively students are expected to prepare and record specific evidence for the criteria in advance of the report being given by the practice educator(s).Each criteria should be signed/initialled (not ticked) by the named practice educator(s).

Academic Module

Whilst the placement criteria are mapped against learning outcomes for the relevant academic year, the Practice Placement Education 1 module specifically aims to:

Help the student prepare for and undertake their first placement. They will draw on, develop and reflect on personal and professional development, particularly in relation to interpersonal skills, using theory, knowledge and skills from other modules and apply these in a practice setting under the supervision of appropriately qualified staff. This is to enable them to gain an understanding of how physiotherapy ‘fits’ into the wider healthcare context, with understanding gained in a clinical environment through observation and clinician-led participation of the role of other professionals who can meet additional needs of service users.

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Learning Outcomes:1. Work safely under supervision to begin to identify people’s needs and

safely apply physiotherapy knowledge, skills and principles.2. Demonstrate through discussion and reflections knowledge of the roles of

healthcare professionals within a multidisciplinary team and the factors that inform and affect interactions with service users, carers and members of the multidisciplinary team

3. Recognise and explore the physical, psychological and social needs of service users

4. Recognise relevant information involved in efficient record keeping and the relevance to fulfilling the HCPC and CSP codes of professional conduct.

Learning Objective/Learning logs (page 25)

The learning objectives should be jointly negotiated by the student and practice educator(s) and are used to inform how specifically the placement proficiencies will be demonstrated and the level of achievement that is required. Learning objectives help the students structure their time during placement and assist in maximising learning opportunities in an individual and meaningful way. These should be routinely reviewed and recorded on the learning log as part of formal supervision. Learning objectives should be completed by the student in collaboration with the practice educator(s) and may be hand written (in black ink) or typed with attention to presentation, spelling, grammar etc.Learning objectives should be written in SMART format (specific, measurable, achievable, realistic, timed) with an initial and ongoing action plan to detail how the objective is to be achieved. There should be one learning objective per page.

New learning objectives can be added as the placement progresses and as existing objectives are completed.

Supervision: (page 27)

Appropriate supervision of students commensurate with the stage of training is vital and may include both formal and informal supervision opportunities. Weekly formal supervision is recommended and a contemporaneous summary should be recorded by the student using the supervision forms. These may be hand written (in black ink) or typed. These should be signed by both student and practice educator(s) to confirm accuracy and agree any actions. The practice educator(s) may wish to retain a copy. Agreed dates for formal supervision sessions:-(to be completed at induction session)

Week 1 Week 2 Week 3 Week 4

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Week 5

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Feedback from service users/carers (page 32)

Students will work with individuals and groups of people and their carers during their placement experiences. Feedback from them is therefore important to inform the professional development of the student and this should be routinely sought and recorded throughout placement (HCPC, 2017).

Feedback from other professionals: (page 42)

Students are required to demonstrate their ability to effectively communicate and work with other professionals and the wider team (HCPC, 2014). It is therefore important for them and their practice educator(s) to receive feedback on time spent with, and interactions with, a range of professionals and for students to reflect upon these experiences. Routinely during placement this feedback and reflections should be recorded as part of the overall evidence of achievement for placement.

Reflections: (page 47)

Students should select significant learning events during the placement to provide evidence towards the placement proficiencies. Students should reflect on new knowledge, skills and understanding and make links to relevant theory. Students are also expected to explore each reflection in relation to specific aspects of the Chartered Society of Physiotherapists Code of Conduct (2011), the Physiotherapy Framework (CSP, 2011) and the Health & Care Professions Council Standards of Proficiency for Physiotherapists (2013). These written reflections are used by the practice educator(s) to inform ongoing discussions with the student and the assessment of the student before the end of the placement. Therefore, the practice educator(s) should read, review and sign all reflections.Reflections may be hand written (in black ink) or typed, should be 500 words maximum, with appropriate attention to presentation, spelling, grammar and referencing.

Record of Hours: (page 59)

Students should work 37½ hours per week of placement and for this placement should accrue approximately 187.5 hours (a full-time week is considered equivalent to 37.5 hours per week, across variable working hour structures depending on local patterns of working). Students should have 3.75 hours per full-time working week as study leave and may if they wish, and after negotiation with the practice area, take this time as 7.5 hours every two weeks. Study time is included in the overall hours for the placement. Hours should be recorded on a weekly basis and verified by the practice educator.

Submission of the Practice Assessment documentation:

The submission of the Practice Assessment Document is required at the end of each placement and will be submitted as part of placement de-briefing. Incomplete, late or non-submission of the Practice Assessment Document may delay the student’s progression through the next exam board and subsequent progression through the programme. It is the student’s responsibility to ensure the Placement Assessment Document is fully completed and submitted on time.

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Placement support: (page 57)

Students and practice educators will be visited by a member of the academic team during the placement. Practice educators will be contacted in advance to arrange a mutually convenient time. The purpose of the visit is to:

provide support for the student and Practice Educator if required gain an interim report from the Practice Educator on the student’s

progress ensure the student is on target to meet placement requirements evaluate the quality of the student’s learning experience monitor and guide the student’s personal and professional progress become more familiar with the placement and facilities for learning act as an advocate for the student to maximise learning opportunities

Contact details:

Practice Learning Unit:Placement Administrator (Physiotherapy)Telephone: Email:

Placement Lead (Physiotherapy)Telephone:Email: Electronic copies of this placement documentation, the placement handbook and other placement related resources can be accessed at: http://www.canterbury.ac.uk/health-and-wellbeing/practice-learning-unit/practice-learning-unit.aspx

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http://www.canterbury.ac.uk/health-and-wellbeing/practice-learning-unit/practice-learning-unit.aspx

http://www.canterbury.ac.uk/health-and-wellbeing/practice-learning-unit/practice-learning-unit.aspx

Placement Orientation (to be completed in each placement area on the first day)

Standards of Education and Training Number 5 (HCPC, 2017)Area 1 Area 2 (if applicable)

This list is for guidance. Please add/amend as necessary/appropriate to the setting

Practice Educator initial/ date

Student initial/date

Practice educator initial/date

Student initial/ date

Layout of the placement environment identifying key locations and resourcesIdentification of office and other work spaces that are available for student to use Introduction to key personnel

Procedure for summoning help in the event of an emergencyLocal fire policy

Resuscitation policy and procedures explained

Moving and handling of people and equipment policy and procedures explained and demonstration completed prior to usePolicy regarding safeguarding explained

Awareness of placement policies e.g. taking messages, lone worker, accident procedure, Health and Safety, Infection Control guidelines, confidentiality, uniformRecord keeping policy and Information Governance requirements explained

Confirmation of work patterns/study time and lunch/break arrangementsArrangements for supervision & study time determined and bookedNotification of sickness procedures

Mail systems

Team meetings/handovers etc

Telephone/bleep/private calls

Access to IT and password

Library, text books, national/local policy documents identifiedReadiness for Practice Certificate seen and checkedStudent Emergency contact details shared (page 12)

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Other induction requirements – please detail

Emergency contact details for the student

This page can be removed from the Practice Assessment documentation and allows the student if they wish to share with their practice educator their personal contact details and information on who to contact in case of an emergency. Where this page is removed and given to the practice educator(s) it is their responsibility to maintain confidentiality of this at all times, shared with others only on a need to know basis and to ensure it is confidentially disposed of immediately at the end of the placement.Student Name

Placement dates

Address during placement

Telephone number (s)

Emergency contact name/relationship/numbers

Details of others who may need to be contacted (eg. schools, nurseries)

Personal Tutor at University:

Any other relevant information (eg. medical conditions)

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This page is intentionally blank

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Initial Student/Practice Educator Interview (discussed within first few days of placement and used to inform learning contract)

Previous placement settings/types of experiences

Student to identify personal and professional strengths

Student to identify learning and development needs (to consider previous placement experiences and/or previous work roles etc)

Identification of any academic requirements during placement, including any dates when required to return to University

Identification and discussion of special or particular support needs including where relevant, the Placement Learning Support Plan.

Agreed initial learning (to be formulated into learning objectives)

Student Signature: Date:

Practice Educator Signature: Date

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Assessment of Practice Tool – Part 1

Failure at any time during the placement in any of the criteria below means that the student will fail placement. In any instance of unsatisfactory performance, the practice educator should contact the University immediately.

Criteria Pass(Practice educator initials/date)

Fail(Practice educator initials/date)

Demonstrates safe practice

Identifies and implements the CSP Code of Professional Values & Behaviour and the HCPC standards of conduct, performance and ethics within the practice settingImplements health & safety regulations as per the practice setting requirements

Complies with organisational and administrative procedures appropriate to the practice setting

For any failed criteria, please outline the reasons why in the box below:

Reason(s) for failure:

Signature of practice educator:

Signature of student:

Date:

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Placement Grade Descriptors

The following descriptors are to be use to inform student self-evaluation of performance and the practice educator(s) formative and summative assessments.

PASS

Excellent 1 The student consistently performed this criterion to an exceptionally high standard once established in the placement. Required minimal ongoing guidance and supervision.

Very Good 2 The student performed this criterion to a very good standard at the mid-point discussion. For the summative assessment they sustained this throughout the placement. Required moderate guidance and minimal supervision.

Good 3 The student progressed to perform this criterion to a good standard at/from the mid-point discussion onwards. Required moderate ongoing guidance and supervision to achieve this.

Sound 4 The student progressed to perform this criterion to an acceptable standard at/from the mid-point discussion throughout most of the placement. Required moderate ongoing guidance and supervision to achieve this.

Satisfactory

5 The student performs this criterion to the minimum acceptable standard at/from the mid-point discussion onwards. Required moderate to high levels of guidance and supervision to achieve this.

FAIL F Performed this criterion at an unacceptable or unsafe standard at/from the mid-point discussion onwards, despite high levels of supervision. Cannot be left unsupervised unless given high levels of specific instruction.

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Assessment of Practice tool – Part 2

The following descriptors are to be used to inform student self-evaluation of performance and the practice educator(s) formative and summative assessments.

Formative Assessment

Formative assessment

(Descriptor number)

CommentsStudent strengths/areas for development

Module reference

Preparation for Treatment Student

Educator

1 APD1ACR1

With informed consent obtain relevant information from all available sources prior to patient contact

2 PP1ACR1

Use appropriate questioning techniques & respond accordingly including confirmation of patient’s main problems and meeting patient individual needs

3 PP1ACR1

Demonstrate observational skills4 APH1

PS1Demonstrate palpation, measurement techniques where appropriateImplementation of Treatment

5 PS1 Adopt a systematic approach to treatment6 PS1

ACR1Safe & effective implementation & justification of basic therapeutic skills e.g. equipment and techniques

7 HWB1 Educate the service user appropriately8 ACR1 Monitor progressions of treatment9 ACR1 Recognise where treatments may need to be

modified if goals are not met10

HWB1APD1

Recognise when help from health care professionals and peers is required in patient management

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(Descriptor number)


Module Reference

Recording Information Student

Educator

11

PP1ACR1

Keep accurate and concise records as required by the placement

12

PP1ACR1

Student fulfils the requirements of ‘shared responsibility’ in terms of countersigning patients’ documentation

13

PP1APD1

Maintain confidentiality and security of written and verbal information acquired in a professional capacity adhering to information governance

Personal & Professional Development14

APD1 Demonstrates reliability & conscientiousness

15

APD1 Begin to recognise own strengths & areas for development

16

APD1 Receives, accepts & acts upon valid & constructive feedback from staff/service users appropriately

17

APD1 Demonstrates interpersonal skills & ability to adapt behaviour appropriately

18

PP1HWB1

Demonstrates consideration for the comfort of service users/significant others

19

PP1 Identify an awareness of the physical, psychological & social needs of individuals within the environment e.g. serviced users, carers and health care workers

20

APD1PP1

recognise, respect and actively support diversity, expertise and experience of individuals, carers and colleagues

20


(Descriptor number)


Module Reference

Personal & Professional Development Student

Educator

21

APD1 Directs own learning through negotiation & implementation of learning contract

22

APD1HWB1

Shares knowledge & skills appropriately

23

APD1PP1

Identifies and works within key legislation, policies and procedures and begins to recognise the implications for practice

Overall Comments

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Summative Assessment

Summativeassessment

(Descriptor number)


Module reference Preparation for Treatment Studen

tEducator

1 APD1ACR1

With informed consent obtain relevant information from all available sources prior to patient contact

2 PP1ACR1

Use appropriate questioning techniques & respond accordingly including confirmation of patient’s main problems and meeting patient individual needs

3 PP1ACR1

Demonstrate observational skills

4 APH1PS1

Demonstrate palpation, measurement techniques where appropriateImplementation of Treatment

5 PS1 Adopt a systematic approach to treatment6 PS1

ACR1Safe & effective implementation & justification of basic therapeutic skills e.g. equipment and techniques

7 HWB1 Educate the service user appropriately8 ACR1 Monitor progressions of treatment9 ACR1 Recognise where treatments may need to `

modified if goals are not met10

HWB1APD1

Recognise when help from health care professionals and peers is required in patient management

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Summative assessment

(Descriptor number)


Module reference Recording Information Studen

tEducator

11

PP1ACR1

Keep accurate and concise records as required by the placement

12

PP1ACR1

Student fulfils the requirements of ‘shared responsibility’ in terms of countersigning patients’ documentation

13

PP1APD1

Maintain confidentiality and security of written and verbal information acquired in a professional capacity adhering to information governance

Personal & Professional Development14

APD1 Demonstrates reliability & conscientiousness

15

APD1 Begin to recognise own strengths & areas for development

16

APD1 Receives, accepts & acts upon valid & constructive feedback from staff/service users appropriately

17

APD1 Demonstrates interpersonal skills & ability to adapt behaviour appropriately

18

PP1HWB1

Demonstrates consideration for the comfort of service users/significant others

19

PP1 Identify an awareness of the physical, psychological & social needs of individuals within the environment e.g. serviced users, carers and health care workers

20

APD1PP1

recognise, respect and actively support diversity, expertise and experience of individuals, cares and colleagues

23

Summativeassessment

(Descriptor number)


Module Reference

Personal & Professional Development Student

Educator

21

APD1 Directs own learning through negotiation & implementation of learning contract

22

APD1HWB1

Shares knowledge & skills appropriately

23

APD1PP1

Identifies and works within key legislation, policies and procedures and begins to recognise the implications for practice

Overall Comments

24

Safety and Professional conduct

Students should at all times adhere to:

Chartered Society of Physiotherapists Code of Ethics and Professional Conduct (2011)

Health & Care Professions Council Standards of Conduct, Performance and Proficiency (2013)

Local/organisational policies and procedures Faculty of Health and Wellbeing Practice Learning guidelines

At no point should student or others’ safety, health or well-being be put at risk.

A breach of any of the above could override achievement of any of the learning outcomes and could result in a referral to the Faculty Fitness for Practice panel and/or a fail of placement overall.

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Formative Assessment by Practice Educator(s)

Is student progressing satisfactorily? Yes No

If no, practice educator(s) to inform student and University immediately to ensure appropriate support can be offered.

Additional comments:

Practice Educator(s) signature:

Student Signature:

Date:

Date:

Summative Assessment by Practice Educator(s)

I confirm that (insert student’s name) HAS/HAS NOT (delete as necessary) provided sufficient evidence to demonstrate that the requirements for the placement have been achieved and that they have PASSED/FAILED (delete as necessary) the summative assessment.

Additional comments:

Practice Educator(s) signature:

Student signature

Date:

Date:

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Learning Contract/Learning log (to be reviewed and updated weekly during formal supervision)

Learning Objective (To be written in SMART format, one per page) No:

Date Agreed: Educator signature: Student Signature:

Date Completed: Educator signature: Student Signature:

Learning LogDate

Action Plan Evaluation of progress Evidence of achievement

Dat Action plan Evaluation of progress Evidence of 27

e Achievement

Supervision Log

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This record should be used to record general progress and/or to identify areas of need. It is especially important that areas of concern are clearly documented. Practice educators may wish to retain a copy for their own records.

Week 1: Date: Duration of session:

Attendees:

Agenda (to include review/updating of learning objectives, review of service user feedback, review of feedback from other professionals)

Summary of Discussion:

Agreed Actions/Priorities:

Practice educator(s) signature: Date:


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Week 2 Date: Duration of session:

Attendees:







30

Attendees:






31


Attendees:







32

Attendees:






33

Feedback from Service Users/Carers

Practice Educators/students should obtain consent from service users/carers who should feel able to decline to participate.Service users/carers do not need to provide their name or any other personal details.

We would like to receive your views about the way the student physiotherapist has worked with you.

Your feedback will help the student physiotherapist’s learning The feedback you give will not affect your care

Student’s Name:

Circle if you are: The Patient/Service user A carer/relative

How well did the student physiotherapist…..

Very Well Well Not sure Not well… listen to you?

…talk to you?

….understand the way you

felt?

Show respect for you?

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What did the student physiotherapist do well?

How could the student physiotherapist improve? What could they do differently next time?

Student reflection on feedback given and own action plan.

Practice Educator(s) signature: Date:



35




Student’s Name:




…talk to you?


felt?



36






Practice Educators/students should obtain consent from service users/carers who should feel able to decline to participate.

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Service users/carers do not need to provide their name or any other personal details.



Student’s Name:




…talk to you?


felt?



38







39



Student’s Name:




…talk to you?


felt?



40








41


Student’s Name:




…talk to you?


felt?




42




Feedback from other Professionals

We would like to receive your views about the way the student physiotherapist has worked with you. This feedback will help the student’s learning.

Student’s name:

Name/profession: Date: Time spent with you:

Signature:

What did the student do well?

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Student’s name:


Signature:


44







Student’s name:


Signature:


45







Student’s name:


Signature:


46







Student’s name:


Signature:


How could the student physiotherapist improve? What could they do differently

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next time?




Reflections

Reflection 1 (link to a proficiency) Date:

Chosen Evidence:

48

Developmental Needs:

Relevance/links to academic modules:

Links to HCPC Standards of Proficiency (HCPC, 2013)

Links to Physiotherapy framework (CSP, 2011)

Practice Educator(s) Signature:


49

Chosen Evidence:


50



Links to Physiotherapy Framework (CSP, 2011)



Chosen Evidence:

51


52






Chosen Evidence:

53


54






Chosen Evidence:

55


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Placement Visit from Academic Tutor This form is completed by the visiting tutor. The practice educator(s) may also wish to retain a copy for their own records.

Student Name & Cohort: Practice Educator(s) Name:

Placement Address:

Telephone number:Dates of placement: Visiting tutor:

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Number of weeks: Date of visit:EVALUATION OF STUDENT’S PROGRESS (Please comment in each section)

Learning Contract: Has the learning contract been jointly negotiated and signed? Are objectives appropriate to the level of the student and relate to the placement proficiencies? Are they regularly updated? Is the evidence of achievement being recorded? Are they in SMART format? Is there a sufficient range of learning opportunities available to the student?

Supervision: Are weekly supervision logs being maintained? Is there evidence of formal and informal supervision opportunities? Is supervision supportive and provide constructive feedback? Does the student feel they are receiving appropriate supervision? Is there recorded evidence of service user and other professionals’ feedback?

Assessment of Practice: Has the formative report been given? Are strategies in place to address any areas of concern? Is the student on target to achieve the proficiencies for this placement?

Written reflections: Are written reflections being completed? Are they shared with and read by the practice educator(s)? Are links being made to HCPC Standards of Proficiency, CSP Code of Ethics and academic modules? How could they be enhanced?

General: Is alternative support identified in case of the practice educator’s absence? Has induction checklist been completed? Does the student feel valued in the practice setting? Are there concerns about the professional conduct of the student? Are there any safeguarding, whistleblowing or SUI to be aware of? Are there any service changes/developments the University should be aware of?

Has the student had any absences from placement? Yes/No (If yes please determine reason and detail expected impact on achieving the placement requirements)

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Does the student have a Placement Learning Support Plan (PLSP)? Yes/No (If yes please comment on reasonable adjustments that are in place and if they are meeting the needs of the student – discuss and document further adjustments if necessary)

Has the practice educator(s) attended an educator training session within the last 12 months? Yes/No (If not please check they are familiar with all requirements of them and recommend booking a training session)

Any cause for concern? Yes/No (If yes please document and liaise with placement lead as soon as possible to discuss)

Is a further visit/contact required? Yes/No (If yes please liaise with placement lead as soon as possible to discuss)

AGREED ACTIONS:

Academic tutor signature:Practice educator(s) signature:Student signature: Date:

Record of Practice HoursThis sheet should be used to monitor hours throughout the placement. Please ensure that all hours and any absences are accurately recorded and weekly totals initialled by practice educator(s). Please note that lunch breaks are not included as placement hours. Students are expected to complete 37.5 hours each week of placement.

Total hours at end of the placement should be logged on the separate ‘Overall Record of Hours’ sheet.

Date Hours InitialsMonTuesWedsThursFriSat

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SunWeekly total

MonTuesWedsThursFriSatSun

Weekly total


Weekly total


Weekly total


Weekly total

TOTAL HOURS THIS PLACEMENT:

End of placement checklist

Student and practice educator(s) details recorded on pages 1 & 2

Sample signature completed for practice educator(s) on page 4

Formative assessment initialled and scored by practice educator(s) for each criteria (pages 17- 19)

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Summative assessment (Pass/Fail) initialled and scored by practice educator(s) for each criteria (pages 20-22)Practice educator(s) feedback on assessment of practice tool completed and signed page 24pOverall pass or fail deleted as appropriate on page 24

Hours/absences recorded on page 59

Overall hours recorded onto student record of hours sheet (for passed placements only)Emergency contact detail form returned to student or confidentially destroyed page 12All learning objectives/learning logs signed by student and practice educator(s) and filed in date orderAll supervision logs signed by student and practice educator(s) and filed in date orderService user/carer feedback forms signed by student and practice educator(s) and filed in date orderFeedback forms from other professionals signed by student and practice educator and filed in date order

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