CQUniversity Unit Profile.

This assessment task requires the student to demonstrate aptitude and overall practical competence in completing an echocardiogram to a ‘Novice’ level. 

This task will be assessed by the student’s Clinical Supervisor, or a nominated delegate sonographer, using the practical assessment marking tool provided on the unit Moodle site. Students are required to provide a printed copy of this marking tool to their Clinical Supervisor at the commencement of placement.

Students are encouraged to:

• Read the marking sheet carefully, to ensure that they understand the criteria against which their sonographic skill and relevant theoretical knowledge will be evaluated.
• Discuss the best time to complete this assessment with their Clinical Supervisor, to ensure minimal departmental disruption and sufficient time for task completion.
• Seek detailed feedback from their supervisor post assessment to enable identification of areas requiring improvement.

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. 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.

Should a student fail this assessment, only one re-attempt will be permitted.

Students that fail the first attempt at this assessment, will be provided with detailed feedback regarding performance and areas requiring improvement. The student will be required to develop a strategy to improve their performance, and discuss this strategy with both their assessor and Unit Coordinator. Both attempts must be completed prior to the completion of the clinical placement block.

In the absence of an approved extension, students cannot complete this assessment at a later time, and will receive a fail grade for the assessment.

Students are advised to refer to the Assessment Policy and Procedure (Higher Education Coursework) document for additional university guidelines regarding assessments.

Clinical Supervisors are required to grade their student using criterion provided. Criterion should be considered in the context of the required competency level that students must demonstrate by the end of the clinical practicum block. For ECHO13007, this is 'Novice' level.

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

• Pre-examination tasks and instrumentation (including patient identification checks, consent and appropriate professional communication).
• Scanning technique (including two-dimensional, colour and spectral Doppler optimisation, and appropriate exam extension or modification).
• Measurement technique.
• Documentation (digital image storage and labelling).
• Post-examination tasks (including worksheet completion and interpretation).
• Additional tasks (incorporating ergonomics, manual handling techniques, infection control, ethical and legal requirements).

The Clinical Supervisor is required to evaluate multiple questions under each criterion grouping on the Practical Marking Tool. The Clinical Supervisor will grade each criterion question with a score out of 3:

• A score of 0 indicates the criterion is not demonstrated or not applicable.
• A score of 1 indicates the student requires frequent direction and advice.
• A score of 2 indicates the student requires some direction and advice.
• A score of 3 indicates independent practice, requiring direction or prompting only on complex or unusual cases.

To achieve a practical competency level of ‘Novice’, the student must attain a score of 1 or higher against ALL listed criteria.

The first attempt must be completed in the 12th week of the 16 week placement, and the second attempt (if required) must be conducted before the end of the 16 week clinical placement.

The final PASS/FAIL grade for this assessment will be at the discretion of the Unit Coordinator.

Clinical sites mention professional behaviour, particularly team work and empathy, as paramount in their decision to employ a sonographer. This assessment considers the ability of the student 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 collective feedback will 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.

There are three main sections to the GAPA form:

Section 1: Applied Knowledge

Section 2: Psychomotor skills and Standard of Work

Section 3: Professionalism

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 mid placement GAPA is formative. At the mid placement GAPA, the student should be given sufficient feedback to improve their behavioural performance as required. Any significant issues should be brought to the attention of the Unit Coordinator following the mid placement GAPA (or earlier if required). 

The end-of-placement GAPA assessment is summative. For any behaviour that the student scores well on at the mid-placement assessment, it is expected they will continue to meet that level of performance or surpass it for the rest of the placement.

Clinical supervisors are urged to contact the Unit Coordinator immediately for guidance if:

• Student behaviour is identified as ‘inappropriate and beyond acceptable risk’ to clinical site staff, patients and/or reputation.
• Student skill progression is deemed insufficient despite documented constructive feedback, support, and intervention.

The Unit Coordinator may request performance of a GAPA assessment at any time during a student placement. If the outcome of this GAPA is unsatisfactory, and/or the site feedback indicates that they can no longer host the student due to the risk incurred or lack of skill progression, this singular GAPA result may result in a FAIL grade and clinical placement termination immediately (prior to student completion of the allocated practicum block).

To PASS this assessment:

Students must satisfactorily demonstrate ALL criteria descriptors by the end of placement, in accordance with the competency level of a 'Novice'.

The assessor is also encouraged to provide comments to expand on the scoring feedback.

If minimum scores in the mid-placement GAPA are not met, a student will be regarded as a 'Student at Risk' of failing the clinical unit overall.

• The Unit Coordinator will contact the student to advise of the risk of failing ECHO13007 and provide formative feedback via email. The student is required to respond to this email to show they understand the implications of this information.
• The student must reflect on their performance and the feedback provided, and 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 student’s progress will be completed a short time after the mid placement GAPA, at any time as requested by the Clinical Supervisor or Unit Coordinator. 

If behavioural attributes within any section of the GAPA are deemed a 'patient safety risk', student placement may be cancelled immediately, prior to completion of the allocated clinical placement block. 

Unsatisfactory scores obtained at the second GAPA attempt, will result in a FAIL grade for ECHO13007 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 remedy 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 the student's progress. This will likely involve attendance at on campus scanning skills labs for tuition and assessment.

It is expected that students attend 100% of the time during clinical placement to achieve the minimum required hours of direct echocardiography observance/participation or related activities. All hours of attendance must be 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 the Clinical Supervisor, or a sonographer delegated this task by the Clinical Supervisor, and submitted monthly. The Clinical Attendance Forms are available in the assessment block in the unit Moodle site. Please print these forms and read carefully to understand the criteria against which clinical attendance will be evaluated.

Students must not organise holidays, recreational leave or personal appointments during clinical placement periods, in the absence of prior written approval.

Students must 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. For all absences due to illness, students must provide the Clinical Supervisor and Unit Coordinator with a medical certificate or statutory declaration.

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, please refer to the Clinical Placement Attendance Guidelines available through SONIA or the unit Moodle site.

Students who are absent from clinical placement due to illness or injury must phone their Clinical Supervisor and email their Unit Coordinator PRIOR to the scheduled start time for that day. Any clinical placement hours missed due to illness or 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 Forms 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.

Outside Clinical Placement Hours:

Outside of hours placement may only be used in the event of illness or injury and may not be utilised for personal leave requests.

In the event of illness and injury, 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.

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 clinical placement attendance form.

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 forms.
• Ensure the documentation is complete.
• Upload each completed assessment form into the unit Moodle site by the due date.

At the end of the scheduled placement block, if a student has not met the 100% attendance requirement AND has documented justifiable grounds for absenteeism, the student will be provided additional scheduled time to make up the time missed. This scheduled make-up time may not immediately follow the scheduled placement block, and/or may not be at the same placement site, depending on clinical availability. At the end of the scheduled placement block, if a student has not met the 100% attendance requirement AND does not have documented justifiable grounds for the absence, the student may score a 'FAIL' for this assessment item.

The Clinical Case Logbook is a document designed to track clinical experience. This logbook documents all observed, partially or fully completed echocardiography cases that a student is exposed to during clinical placement. The Clinical Case Logbook will also incorporate details of case exposure obtained during any hours of attendance submitted from 'outside of clinical placement'.

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. The 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.

Maintenance of a Clinical Case Logbook helps to ensure that:

a) an acceptable volume of clinical work is achieved

b) exposure to a reasonable case variety is achieved, and

c) key practical skills are developing.

The Clinical Case Logbook entries must be signed by the Clinical Supervisor or appropriately qualified medical practitioner.

The Clinical Case Logbook serves as a record of the depth and breadth of experience a student has attained during placement. It demonstrates the degree of progression of skill development within and across examination types. Students should analyse this record at regular intervals to assist in the formulation of learning goals that will support achievement of the unit outcomes.

• The Clinical Case Logbook is to be submitted monthly during the clinical placement block (starting from Monday of Week 5).
• The Clinical Case Logbook cover page must be signed by the Clinical Supervisor or echocardiographer delegated by the Clinical Supervisor for each submission.

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

• Accurately record all studies in the Clinical Case Logbook.
• Ensure documentation is complete.
• Submit the requested documentation via Moodle by the published due dates.

It is recommended that students observe, partially or fully complete a minimum of 320 echocardiograms during this clinical placement (average of 4 scans per day). Students should regularly assess case log progress; if a student is unable to achieve the minimum number of scans, the student should contact the Unit Coordinator.

• Students will complete a case study based on a clinical study in which they have performed during clinical placement.
• The majority of case study images must be completed by the student and any images obtained by the Clinical Supervisor must be clearly identified.
• Students are required to present their case study to the Unit Coordinator 2 weeks prior to the due date.

The case study presentation is mandatory, however it is formative and students will not be assessed on presentation skill and ability. Case study presentations must be completed 2 weeks prior to the submission date via Zoom, please contact the unit Coordinator to schedule a suitable time. The purpose of the case study presentation prior to submission is to allow for provision of feedback to enable any refinements to be made, as well as to ensure DICOM images are accessible and appropriate.

Students need to read the article ‘Using a clinical decision-making framework to foster sonographer student learning in the clinical setting’ by Thoirs and Sim prior to completing this case study. The case study should be written in the framework style as described in the article. The published article and framework template are available on the unit Moodle site.

According to Thoirs and Sim (2016), clinical reasoning or clinical decision making, occurs during clinical placement when students use critical thinking based on prior theoretical knowledge relative to a specific situation or patient. A clinical decision-making framework may help students to apply theoretical knowledge in the clinical setting. This framework helps students to identify and prioritise learning, promote self-reflection and future decision making and facilitate diagnostic thought processes.

Students must use the clinical decision-making framework to evaluate the following:

• Encounter: Did the encounter data include cultural considerations, protocols around patient and echocardiographer safety, the consent process and pre-test history? Was there an established purpose of the examination?
• Hypothesis generation: When generating a hypothesis, were possible pathophysiology relevant to the echocardiogram examination, possible associated conditions, complications or mimics of the suspected condition included? What was the most likely condition suggested by the pre-encounter data? What are the associated conditions? Which structures are most likely involved?
• Assessment: Did the echocardiographic assessment include a contextual analysis of echocardiographic information obtained? What protocol, image optimisation techniques, possible modifications were required due to patient presentation or echocardiogram findings? Did it include the additional data?
• Evaluation: Did the echocardiographic examination answer the clinical question? What is the most likely diagnosis? Is a differential diagnosis possible? Did the diagnosis include normal and abnormal appearances, applicable reference measurements, and future pathways for the patient with this diagnosed condition?
• Reflection: Did reflection of the clinical decision-making process include a critical and reflective analysis of approach? What was done well or lacking during the exam? If gaps in knowledge were identified, what is the appropriate action plan in the future?

The anonymised provisional or final echocardiographic report must be included as an appendix to the case study. The echocardiographic case study presented must be accompanied by the submission of de-identified DICOM images. 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.

Word count: 1500-2000 words. Excess words will not be assessed. Word count does not include headings or references, but does include diagram explanations and labelling.

Referencing: Vancouver. Minimum 8 peer reviewed journal articles or relevant text books must be cited. Literature titles must be current (<5 years of age), except seminal works.

Students are developing aptitude and overall practical competencies consistent with that of a 'Novice' in ECHO13007.

To PASS this assessment:

• Students must successfully demonstrate ALL criteria descriptors as specified on the marking rubric.
• BOTH components must be passed to pass the case study overall.

A detailed marking rubric is available on the unit Moodle site.

Case studies submitted without accompanying DICOM images will not be marked.

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 only (imaging component and/or written component as required). Any re-submission attempt is required within two (2) weeks of receiving feedback.