EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Clinical Internship I (PHTH 581) consists of a full time experience in a clinical setting for 5
(five) weeks during summer session of the first year of the DPT Program. The primary
purposes are to provide patient centered care by demonstrating examination, evaluation
and intervention skills learned in the first academic year, professional behaviors and
professional interactions with patients and health care professionals in the clinical
environment.
The list below includes the skills taught in the Program during the first year. You need
opportunities to practice these basic skills with patients with supervision and feedback from
your CI(s). Remember, you have not had all of your academics in neuromuscular,
cardiopulmonary or musculoskeletal systems beyond the basic skills listed; therefore, you
are not prepared to perform all examination techniques or to complete evaluations
independently.
Self-assessment will include the use of the weekly planning forms for weeks 1 – 4 and
completion of the Clinical Performance Instrument (CPI) during week 5. The CI(s) will
evaluate you using the same forms and the CPI.
The student will:
Demonstrate patient safety, appropriate universal precautions and sterile technique.
Assess cardiovascular/pulmonary tests and measures: heart rate, pulse oximetry,
respiratory rate, blood pressure and visual signs (SOB, paleness, nausea, diaphoresis).
Perform musculoskeletal system tests and measures: MMTing, palpation, ROM,
goniometry.
Review pertinent medical records.
Conduct a patient interview.
Perform sensory integrity tests and measures.
Write a legible progress note with correct format, abbreviations and content.
Write measurable functional goals that are time referenced with expected outcomes.
Perform posture and gait analysis.
Perform transfer training.
Actively participate in, plan and advance treatment interventions.
Apply superficial and deep heat and cold modalities.
Perform massage.
Perform electrical stimulation for pain management and motor control.
Perform extremity mobilizations (shoulder, fingers, knee and ankle).
Participate in discharge planning.
These weekly planning forms for students and for CIs can be completed in hard copy format or
downloaded from the website. www.ewu.edu/pt Go to clinical education to current students
or to clinical faculty.
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EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Week #1
Comments (done, in process,
progressing, needs work)
Orientation to facility and staff
Discuss learning style
Discuss expectations
Actively participate in patient exam, interventions and
documentation
Demonstrate safety with patient care
Demonstrate professional interactions with patients and staff
Choose one assignment for completion during week 2
Write specific goals for next week
My assessment of my performance this week is:
My goals for week 2 are:
My chosen assignment for week 2 is #
. (Refer to Assignment List for number).
My CI is using these strategies that facilitate my learning:
My self-assessment was reviewed by my CI.
3/15/2010
Date
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EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Week 2
Comments (done, in process,
progressing, needs work)
Actively participate in patient exam, interventions and
documentation
Demonstrate safety with patient care
Demonstrate professional interactions with patients and staff
Review week 2 goals: met or not met and why
Assignment for week 2 completed?
Write specific goals for week 3
Choose one assignment for completion during week 3
My assessment of my performance this week is:
My goals for week 3 are:
My chosen assignment for week 3 is #
. (Refer to Assignment List for number).
I am working on my own time to improve my competency in the basic skills by:
My self-assessment was reviewed by my CI.
3/15/2010
Date
Page 3
EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Week #3
Comments (done, in process,
progressing, needs work)
Actively participate in patient exam, interventions and
documentation
Demonstrate safety with patient care
Demonstrate professional interactions with patients and staff
Review week 3 goals: met or not met and why
Assignment for week 3 completed?
Write specific goals for week 4
Choose one assignment for completion during week 4
My assessment of my performance this week is:
My goals for week 4 are:
My chosen assignment for week 4 is #
. (Refer to Assignment List for number).
My CI can see that I am applying the feedback given to me during these activities:
My self-assessment was reviewed by my CI.
3/15/2010
Date
Page 4
EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Week #4
Comments (done, in process,
progressing, needs work)
Actively participate in patient exam, interventions and
documentation
Demonstrate safety with patient care
Demonstrate professional interactions with patients and staff
Review week 4 goals: met or not met and why
Assignment for week 4 completed?
Write specific goals for week 5
Begin working on CPI for completion during week 5
My assessment of my performance this week is:
My goals for week 5 are:
My CI can help me meet my goals by:
My self-assessment was reviewed by my CI.
3/15/2010
Date
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EWU Department of Physical Therapy
Student Weekly Planning Form for PHTH 581
Assignment list:
Choose one of these assignments or one that your CI requests.
1. Complete a structured observation with another healthcare professional. Download the
structured observation form from the EWU PT Clinical Education website to use as a
guide. Submit the form to the DCE with your final documentation.
2. During week 1 or 2, create a list of how you will demonstrate initiative during this
internship. Give the list to your CI. During the final week, assess how you actually
demonstrated initiative.
3. Compare and contrast the plan of care for two patients with similar diagnoses. Within
one minute, verbally report your findings to your CI.
4. Identify the resources that a patient needs for return to work/school/play. Share your
list with the patient and get his/her feedback.
5. Identify the barriers to a patient’s return to work/school/play. Discuss the list with your
CI.
6. During week one write measurable functional short term and long term goals for a
patient. Give your goals to your CI. During week four or five, write measurable
functional short term and long term goals for a patient with a similar diagnosis. Ask
your CI for your week 1 goals. Compare/contrast them with the week 4 or 5 goals.
Identify the components of goal writing that show improvement.
7. Take vital signs on 5 different patients. Compare the results and identify normal vs.
pathology.
8. Choose an exercise program that you are doing with a patient. Write a modification for
the exercise program to make it less challenging and more challenging.
9. Choose an exercise program that you are doing with a patient. Write down how you
would modify the exercise program if the patient had an additional comorbidity
(diabetes, CVA, cognitive deficit, etc.).
10. Verbally describe to your CI in a concise manner the resources that you used to make a
clinical decision.
11. Find two research articles for your CI that are relevant to the management of patients
you are seeing.
12. Explain the impact of a patient’s medication on your intervention or on the patient’s
response to your intervention to your CI in a concise manner.
13. After interviewing a patient, consider if you asked the patient all of the necessary
questions. Write down any additional questions you might ask during the next visit.
14. Tell your CI what you did today that made you feel like a physical therapist?
15. Assess how your non-verbal communication during a patient treatment helped or
hindered the session. Discuss your observation with your CI and describe what you will
do differently during the next treatment session.
www.ewu.edu/pt
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