Saint Louis University
Program in Physical Therapy
Clinical Education Handbook
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Disclaimer
This handbook is intended for all students, clinical faculty members (Center
Coordinators of Clinical Education and Clinical Instructors), faculty, and the members of
the Clinical Education Team enrolled in or affiliated with the Saint Louis University
Program in Physical Therapy. All policies and procedures outlined in the Clinical
Education Handbook are in accordance with the Student Handbook for each graduating
class, Program in Physical Therapy Faculty Handbook, Associated Faculty Handbook,
and Saint Louis University Affiliation Agreement.
Policies and procedures may be updated on an annual basis. Updated policies will be
forwarded to students, clinical faculty, and Clinical Education Team member.
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Saint Louis University
Program in Physical Therapy
Clinical Education Handbook
Table of Contents
General Information & Policies
Philosophy of Clinical Education
Clinical Education Terms
Clinical Assignment Criteria and Process
Clinical Education Timelines
Cancellation of a Clinical Assignment
Assessment of the Clinical Education Curricular Component
Program Complaint Policy
Web-Based Clinical Education Sites
Patient Right of Refusal
Contacting the Clinical Education Team
Team Coverage in Absence of Director of Clinical Education (DCE)
Midterm Call Policy for Phase II & III Rotations
Student Policies
Overall Expectations for Students
Attendance & Absence Policies for Class and Clinic Components
Cancellation for Clinical Education Classes or Clinical Time
Student Clinical Requirements
Reviewing Clinical Assessment of Student Performance
Progression in Clinical Education Courses Policy
Housing & Transportation for Clinical Experiences
Dress Regulations for Clinical Settings
Alcohol & Drug Policy
Completing an Incident Report
Clinical Faculty Policies
Minimum Qualifications for Clinical Instructors
Responsibilities of Clinical Faculty during Clinical Experiences
Reviewing Student Assessment of Clinical Experience and Clinical Instructors
Clinical Requirement/Request Forms
Student Notification of Possible Health Risks Related to Clinical Practice
Student Health Record Instructions
Personal Health History
Physical Examination
2 Step TB Skin Test Immunity Report
Vaccination Report
Refusal for Hepatitis B Vaccine Form
Health Insurance Report
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Healthcare Professional Vaccination Recommendations
Request for Student Accommodations during Clinical Experiences
HIPAA & OSHA Training
Annual Student Statement & Policy Reviews
Appendices
Appendix A: Position and Committee Descriptions
Clinical Faculty: Clinical Instructor & Center Coordinator of Clinical Education
Director of Clinical Education
Clinical Education Advisor
Affiliations Coordinator
Clinical Education Program Coordinator
Compliance Officer
Clinical Education Advisory Committee
Doisy College of Health Sciences Affiliations Committee
Appendix B: Clinical Education Timelines
Students
Clinical Faculty
Director of Clinical Education
Clinical Education Advisor
Clinical Education Program Coordinator
Appendix C: Request for Student Accommodation Forms
Disabilities Accommodation Form
Notification of Accommodations
Appendix D: Annual Statement and Policy Documents
Confidentiality Statement
Letter of Indemnity
Release of Student Information to Clinical Sites
Doisy College of Health Sciences Policy and Procedure Following a Confirmed
Affirmative Criminal Background Check
Doisy College of Health Sciences Drug Screening Policy
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GENERAL INFORMATION &
POLICIES
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Philosophy of Clinical Education
The goal of clinical education is to integrate didactic material with clinical practice
in the development of an entry-level physical therapist. Students are assisted in the
transition from the novice to an entry-level physical therapist by the Clinical Education
Team. The Clinical Education Team, along with clinical faculty (Center Coordinators of
Clinical Education and Clinical Instructors) guides the student in a series of courses with
both didactic and clinical components. These courses are designed to produce a
graduate who is capable of thinking critically and acting in a manner that demonstrates
commitment to the belief that patients possess physical, spiritual, and intellectual needs.
The clinical courses prepare the student to practice across the lifespan and with a wide
range of patient conditions. To this end, tasks and assignments in the classroom and
clinic will require the practice of self-assessment, the use of critical thinking skills, and
holistic exploration of the patient and themselves.
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Clinical Education Terms
Acadaware: The database that maintains information for each student enrolled in
clinical education courses and for each clinical site. This database provides a webbased portal which allows students to access their information and clinical site
information 24 hours a day. The Acadaware web address is:
https://portal.acadaware.com/
Academic Software Plus: The company that supports the PT CPI Web and CSIF.
American Physical Therapy Association (APTA): The primary professional
organization representing physical therapists and physical therapists assistants.
APTA Clinical Performance Instrument (CPI): The standard evaluation tool created
by the APTA and used to assess student performance in the clinic. This tool is used
during Phase II and III.
APTA Clinical Site Information Form (CSIF): (Pronounced "Sif") A form completed by
the Center Coordinator of Clinical Education or a student assigned to a particular site.
The CSIF provides information about the clinical site such as typical patient population,
information about the CI's, and information regarding student requirements and
amenities (e.g. housing, hours, dress code). The CPI web portal now allows for the
CSIF to be uploaded for centralized distribution to all affiliated clinical sites.
Cancellations: The termination of a clinical due to one of the following reasons: site
cancels the commitment or student does not successfully complete all course work prior
to start of clinical experience. A cancellation due to the site will be reassigned to another
site with as similar a patient population as possible. In the event a new clinical
assignment cannot be confirmed, the student may be delayed in starting the clinical
experience. A cancellation due to the student not successfully completing all previous
course work will be rescheduled for the clinical experience based on his or her new
academic plan.
Center Coordinator of Clinical Education (CCCE): The staff member at the clinical
site responsible for coordinating clinical affiliations with academic programs. The CCCE
may or may not be a physical therapist. See Appendix A for full description of
responsibilities.
Clinical Education Advisor (CEA): The faculty member who assists in preparing a
student for each clinical experience and monitors the student’s progress during the
clinical experience. Each student will be assigned to a different CEA for each clinical
education course. See Appendix A for full description of responsibilities.
Clinical Education Program Coordinator (CEPC): The program administrative
assistant charged with the completion of all administrative tasks associated with the
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clinical education curricular component. See Appendix A for full description of
responsibilities.
Clinical Education Team: The Director of Clinical Education, CEAs, and CEPC who
are responsible for the clinical component for the Program in Physical Therapy.
Clinical Faculty: A licensed physical therapist who provides supervision for physical
therapy students during clinical experiences. See Appendix A for full description of
responsibilities.
Clinical Instructor (CI): The physical therapist directly responsible for the supervision
and evaluation of the student during the clinical component of clinical education
courses. See Appendix A for full description of responsibilities.
Clinical Education Budget: In order to encourage access to a wide depth and variety
of clinical education sites, students should plan for a clinical education expense budget
for expected travel out of area and short term housing. Such expenses are expected
within clinical education and are the responsibility of the student.
Clinical Education Courses: Clinical education courses include both a
didactic/classroom and clinical component. One faculty member on the Clinical
Education Team is the course coordinator for the didactic/classroom component. The
Director of Clinical Education is the coordinator for the clinical component.
 Skill Practicum (SP): part-time experience of 48 hours over 12 weeks during the
spring semester of Senior Year at a local clinical site
 Clinical Rotation I (CRI): full time 10 week experience at the end of the spring
semester of Professional Year I and into the summer semester of Professional
Year II at one clinical site either locally or away from the St. Louis area
 Clinical Rotation II (CRII): full time 10 week experience during the summer
semester and prior to the start of the fall semester for Professional Year II at one
clinical site either locally or away from the St. Louis area
 Clinical Internship A (CIA): full time 10 week experience during the spring
semester of Professional Year II at one clinical site either locally or away from the
St. Louis area
 Clinical Internship B (CIB): full time 10 week experiences during the spring
semester of Professional Year II at one clinical site either locally or away from the
St. Louis area
Clinical Education Phases: The clinical component of the curriculum is divided into
three distinct phases based on clinical course the student is enrolled in:
 Phase I: Skills Practicum (Senior Year Spring Semester)
 Phase II: Clinical Rotation I and Clinical Rotation II (Profession Year I Spring
semester and Professional Year II Summer and Fall semesters)
 Phase III: Clinical Internship A & B (Professional Year II Spring Semester)
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Clinic Ownership: The type of management for OP centers. The following are the
primary ownership categories:
 Hospital Based: Clinic is owned and managed by a hospital or hospital system
 Physical Therapist: Clinic is owned by one or more physical therapists or
combination of other rehabilitation professionals (i.e. Occupational Therapist or
Speech Therapist)
 Corporate: Clinic is owned and managed by a for-profit company
 Physician: Clinic is owned by one or more physicians. SLU does not affiliate with
clinical sites that are predominately physician owned.
Commitment: The timeslot for a student affiliation offered by a clinical site.
Compliance Office: Saint Louis University department responsible for the performance
of student criminal background checks required for clinical education. This office is
located in DuBourg Hall is part of the Office of the Registrar.
Condition Categories: Three broad areas of patient diagnoses students are expected
to experience across all clinical assignments in pediatric, adult, or geriatric populations.
 Medically Complex: Patients with several co-morbidities that influence the
amount and intensity of physical therapy provided.
 Neurological: Patients with primary impairments related to a genetic disorder,
disease, or injury within the nervous system
 Musculoskeletal: Patients with primary impairments related to a genetic disorder,
disease, or injury to the musculoskeletal system
Director of Clinical Education (DCE): The faculty member responsible for
coordinating clinical component for the Program in Physical Therapy. The DCE also
serve as a Clinical Education Advisor and a Course Coordinator. See Appendix A for full
description of responsibilities.
First Come, First Serve (FCFS): Indicating a commitment from a clinical site that must
be confirmed as soon as possible that a student from the academic program is
interested in a clinical assignment at that location. These do not count as preassignments (see definition of pre-assignment).
Inpatient (IP): A clinical setting in which patients remain 24 hours a day for medical
care but not including the patient’s home. The following terms relate to specific types of
settings:
 Hospital: patients admitted for scheduled medical procedures, a decline in
medical status, or for an emergency medical situation
 Rehabilitation (Rehab): located either inside of a hospital or as a free-standing
facility for the provision of on-going rehabilitative services for patients who are
medically stable but not prepared for final discharge home and who can tolerate
3 or more hours of daily rehabilitation
 Skilled Nursing Facility (SNF): located either inside of a hospital or as a freestanding facility for the provision of on-going rehabilitative services who are
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medically stable but not prepared for final discharge and who cannot tolerate 3 or
more hours of daily rehabilitation
Extended Care Facility (ECF): located either inside of a hospital or as a freestanding facility for the provision of on-going rehabilitative services who are
medically stable but not prepared for final discharge and who cannot tolerate 3 or
more hours of daily rehabilitation
Long Term Care Facility (LTC): located either inside of a hospital or as a freestanding facility for the provision of on-going rehabilitative services who are
medically stable but not prepared for final discharge and who cannot tolerate 3 or
more hours of daily rehabilitation
Local Clinical Site: A site within 45 miles of Saint Louis University.
Outpatient (OP): A clinical setting in which the patient travels to for rehabilitation
services or a setting the PT travels to for treatment once the patient is medically stable
for discharge from an IP facility. The following terms relate to specific types of settings:
 Day Rehabilitation: Facility in which patients attend rehabilitation services for
longer than 1 hour each day and typically working with more than one discipline.
 School Based: PT services provided to children from pre—school through high
school in the child’s school
 Home Health: PT services provided in the patient’s home
 Industrial: PT services provided in a work setting or a free-standing setting to
treat work-related injuries and screen new employees for physical capacity to
complete prescribed work tasks
PT CPI Web: Web portal to access CPI assessment tools and completed CSIFs.
Students and clinical faculty may only access this site following the completion of the
mandatory training through the APTA Learning Center. The web address is:
https://cpi2.amsapps.com/user_session/new
Pre-Assignment: A commitment from a clinical site that requires students to submit
applications, complete interviews, or demonstrate a strong interest in the specific
practice area of the clinic. Students may only receive one pre-assignment for any Phase
II or III rotation unless no other student in his or her class is interested in a particular
location.
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Clinical Assignment Criteria and Process
Decisions regarding the assignment of students to clinical experiences are
performed in consideration of the following criteria:

Phase I
o DPT 484 Skills Practicum: Minimum 44 hours experience in any clinical
setting within the Greater St. Louis metropolitan area.

Phase II* – Two diverse clinical settings (medically complex, neurological or
orthopedic) including one inpatient and one outpatient setting. The courses are
both listed across 2 semesters as “A” and “B”.
o DPT 580 Clinical Rotation IA (Professional Year I Spring)
o DPT 581 Clinical Rotation IB (Professional Year II Summer)
o DPT 582 Clinical Rotation IIA (Professional Year II Summer)
o DPT 583 Clinical Rotation IIB (Professional Year II Fall)

Phase III* – Two diverse** clinical settings including one inpatient and one
outpatient setting. The settings should complete a balance of clinical settings
experienced during Phase II.
o DPT 584 Clinical Internship A
o DPT 585 Clinical Internship B
*Students may participate in only one full time pediatric rotation during either Phase II or
Phase III.
**The DCE is responsible for ensuring each student is assigned to two diverse clinical
settings and obtain additional commitments for the rotation in the event this does not
occur during assignment process.
Phase I
DPT 484 Skills Practicum (SP)
 Students submit information to the “Clinical Education Information” Google Doc
with clinical interests and special considerations (i.e. participation on
intercollegiate team, limited/no access to a car) during the fall semester of senior
year
 DCE completes the initial assignments based on site availability and information
provided by students on through the Google Doc
 Members of the Clinical Education Team review the assignments and provide
feedback
 DCE adjusts clinical assignments based on feedback from the Clinical Education
Team
 Final assignments are entered into Acadaware sent to students via SLU e-mail
as well as being posted on the Blackboard Clin – PA page by the end of the
senior fall semester
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Phase II
 Students update the “Clinical Education Information” Google Doc with clinical
interests and special considerations (i.e. financial constraints, family obligations)
prior to the deadline for submitting choices in Acadaware for CRI and CRII.
 Students submit up to 10 choices from the available commitments for both
Phase II rotations into Acadaware.
 Student choices are considered but are not a guarantee of the assignments.
 The matching program in Acadaware is run for initial assignments.
 The DCE reviews the initial assignments to ensure equity in process (i.e. that
each student does receive at least one of their choices for a Phase II
assignment) including a review of sites not utilized during initial matching.
 The DCE and members of the Clinical Education Team review assignments and
make changes determined to be in the best interest of the student in terms of
setting and patient condition mix.
 Final assignments will be released through Acadaware, sent to students via SLU
e-mail and posted on the Blackboard page for the clinical education course the
students are enrolled in at the time of assignment.
 See the “Student Clinical Education Timeline” in Appendix B for the estimated
time of Phase II assignments.
Phase III
 Students update the “Clinical Education Information” Google Doc with clinical
interests and special considerations (i.e. financial constraints, family obligations)
prior to the deadline for submitting choices in Acadaware for CIA and CIB.
 Students submit up to 10 choices from the available commitments for both
Phase III rotation into Acadaware.
 Student choices are considered but are not a guarantee of the assignments.
 The matching program in Acadaware is run for initial assignments.
 The DCE reviews the initial assignments to ensure equity in process (i.e. that
each student does receive at least one of their choices for a Phase III
assignment) including a review of sites not utilized during initial matching.
 The DCE and members of the Clinical Education Team review assignments and
make changes determined to be in the best interest of the student in terms of
setting and patient condition mix.
 Final assignments will be released through Acadaware, sent to students via SLU
e-mail and posted on the Blackboard page for the clinical education course the
students are enrolled in at the time of assignment.
 See the “Student Clinical Education Timeline” in Appendix B for the estimated
time of Phase III assignments.
 Clinical commitments that remain open following the assignment of the A and B
rotations will be posted on the Blackboard page of the clinical education course
the students are currently enrolled. Students will have one week from the posting
to request switching a clinical assignment for an open commitment or switching
assignments with a classmate. Following this one week period, all assignments
are final.
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Clinical Education Timelines
The clinical education timelines (see Appendices B) begin in June and ending in May of
each year. Each timeline is representative of a particular individual or group: students,
clinical faculty, DCE, CEA, or CEPC. Each timeline is organized by months (rows) and
phases or year in the Professional Phase of the program (columns). Tasks related to
the classroom and clinic components for each phase are included. Students should
refer to clinical education syllabi for specific assignment dates. The timelines are
estimations of when tasks related to clinical education will be completed and are meant
to provide general direction on timing of events.
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Cancellation of a Clinical Assignment
Prior to the Start of the Clinical Assignment
Based on Academic Standing
 Students may not begin a full time clinical experience if they do not successfully
pass all academic courses preceding the clinical course or if the student’s
semester or cumulative grade point average (GPA) results in dismissal from the
program.
 The student is notified by the course coordinator first regarding his/her final
course grade or the Assistant Program Director in the event of a GPA concern.
 Following this notification, the student is contacted by the Director of Clinical
Education (DCE) or a designated Clinical Education Advisor (CEA) in the
absence of the DCE.
 During the contact by the DCE/CEA the following information is conveyed to the
student:
o The student may not begin the pending clinical experience due to an
unsatisfactory academic course grade preceding the start of the clinical
assignment or may be delayed in the case of an unsatisfactory GPA.
o If the student has not started the clinical yet, the DCE/CEA will
immediately contact the CCCE or CI to inform them the student will not be
completing the clinical rotation or may be delayed in starting as scheduled
due to a change in his/her academic schedule.
o If the clinical rotation begins prior to posting of final grades, the DCE/CEA
will immediately contact the CCCE or CI to inform them the program is
removing the student from the clinical rotation due to a change in his/her
academic schedule.
 The student is expected to return to the site to recover any
belongings and ensure all tasks from the previous day are
completed.
 The database is updated to note the clinical experience was cancelled by the
program.
 Progression procedures established by the Program in Physical Therapy will be
followed (See Program in Physical Therapy Academic Eligibility and/or
Professional Behavior documents in the Student Handbook).
Based on Clinical Site Request
 Clinical faculty at a site may determine a clinical commitment should be canceled
prior to the start of the rotation for any of the following reasons:
o Insufficient staffing
o Change in patient population
o Managerial/administrative changes
o Over commitment of clinical education assignments
o Relocation of facility
Clinical faculty are not obligated to assist in the reassignment of students or
continue with the commitment if it is not believed to be in the best interest of
patients, staff, or students.
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Cancellation or Removal of a Student during a Clinical Experience
Decline in Quality of Clinical Experience
 A student may be removed from a clinical site if it is determined that the quality of
the clinical experience does not meet the Program in Physical Therapy
standards.
 Prior to the student’s removal the following steps will be taken:
o The Clinical Education Team member informed of the student’s concerns
notifies the DCE.
o When possible, the DCE meets with all Clinical Education Team members
(or those available) to discuss the student’s concerns.
o The DCE or the student’s CEA communicate with the student regarding
possible options and the level of learning that is occurring at the site on his
or her part.
o The DCE or the student’s CEA communicate with a clinical faculty
member (CCCE or CI) at the site to discuss student’s concerns.
 The clinical faculty member is offered the opportunity to address
the concerns.
o The DCE notifies the Assistant Program Director of the possibility a
student may be removed from a clinical experience and possible solutions.
o The DCE investigates possible alternative clinical assignments that will
provide the student with a comparable experience (based on patient
conditions, setting, location, and range of lifespan)
 If the members of the Clinical Education Team and the student agree the clinical
experience is not providing a quality learning environment and the clinical faculty
at the site makes no significant improvements:
o The DCE notifies the student and the CCCE or the CI of the termination of
the experience.
o The DCE schedules a meeting with the student (either in person or via
telephone) to discuss plan for reassignment.
o The student resumes his or her clinical experience at the new site as soon
as possible based on travel/housing requirements and the schedule of
clinical faculty at the new site.
o The DCE arranges assessment times for the student following their
transfer to a new setting.
o The DCE is responsible for additional discussions with the CCCE of the
original site regarding future expectations for continued affiliation with the
program
 If the members of the Clinical Education Team and student agree the clinical
experience is improving in quality, the student remains at the clinical site for the
completion of the experience.
Request from Clinical Faculty
 A clinical faculty member (CCCE or CI) may request the termination of a
student’s clinical experience for several reasons:
o Unexpected change in staffing
o Unexpected change in patient load
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o Poor performance of the student
In the event of the first two reasons listed above, the DCE discusses possible
solutions that would allow the student to remain in the setting.
o If the suggestions are deemed reasonable by the clinical faculty, the
student may remain at the site.
o If the suggestions are not deemed reasonable by the clinical faculty, the
DCE works with the student to make alternative arrangements for
alternate clinical placement.
In the event the request is based on the student’s poor performance, the
following steps are taken:
o The Clinical Education Team member notified of the request attempts to
provide possible suggestions for improving the student’s performance
during the initial conversation.
o The DCE is notified of the clinical faculty concerns.
o The student is notified by the DCE or the student’s CEA of the concerns
raised by the clinical faculty.
o A learning contract is drafted by the DCE (in consultation with the
student’s CEA) including specific expectations for behavior changes with
time frames and is submitted to the clinical faculty and student for review.
Signatures of all parties are requested if the learning contract is accepted.
In the event the CCCE or CI requests immediate removal of the student, the DCE
takes the following steps:
o All members of the Clinical Education Team and the Assistant Program
Director will be notified.
o The DCE notifies the student of the termination of the clinical experience
and schedules a meeting with the student as soon as possible.
 The meeting will focus on the areas the clinical faculty identifies as
significant concerns and a plan for a remediation contract to outline
specific conditions to be met prior to reassignment in the clinic.
o The DCE identifies and confirms a new clinical site for the student upon
the successful completion of the remediation contract.
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Assessment of the Clinical Education Curricular Component
Assessment of all aspects of the clinical education curricular component is performed
frequently during the year. The following is a list of the data sources for each of the
components of the clinical education curriculum
Affiliations Coordinator
 Director of Clinical Education: formative feedback regarding new site
development
Clinical Education Curriculum
 Clinical education faculty: evaluation performed every 3 years
 Core program faculty: feedback provided during faculty meetings and faculty
retreats regarding the curriculum and progress of students on clinical
experiences
 Program Advisory Council: feedback from stake holders external to the
program regarding trends in clinical practice
 Students: course evaluations for each clinical education course
Director of Clinical Education
 Program Director of in Physical Therapy
o Annual faculty review
o Six month faculty review
o APTA 360 Degree Director of Clinical Education Assessment perform
every 3 years
 Clinical education faculty
o Evaluation at the conclusion of Phase III clinical rotations
o Formative feedback provided outside of contexts listed above (i.e.
midterm calls during full time clinical experiences)
o APTA 360 Degree Director of Clinical Education Assessment
performed every 3 years
 Clinical Education Team
o Informal feedback regarding performance as DCE during team
meetings and during individual meetings
o APTA 360 Degree Director of Clinical Education Assessment
performed every 3 years
 Core program faculty:
o Annual assessment during the spring faculty retreat
o APTA 360 Degree Director of Clinical Education Assessment
performed every 3 years
 Students:
o Course evaluations for each clinical education course
o APTA 360 Degree Director of Clinical Education Assessment
performed every 3 years
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Clinical Education Advisors
 Director of Clinical Education: formative feedback provided to Clinical
Education Advisors on communication with students and documentation of
student meetings
 Students: course evaluations for clinical education courses
Clinical Education Program Coordinator
 Director of Clinical Education: annual review of performance as directly
relates to tasks for clinical education
 Students: course evaluations for clinical education courses
 Lead Administrative Assistant: formative feedback on performance as a staff
member in the program
Clinical Education Course Coordinators
 Director of Clinical Education: formative feedback on the progression of the
clinical education curriculum across all courses
 Students: course evaluations for clinical education courses
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Program Complaint Policy
This policy for addressing program complaints excludes complaints for which there is an
established University, College, or Program policy or procedure, such as grade appeals,
academic dismissal appeals, or allegations of racial, sexual, or gender harassment.
These matters are covered in the Physical Therapy Student Handbook, the University
Student Conduct Policies, or through the Office of Diversity and Affirmative Action.
An individual who has a concern/complaint following an experience/encounter with any
student, faculty, or staff member is welcome to communicate their complaint. Program
complaints are recognized as an opportunity for program improvement and should be
expressed with this end in mind. A complainant can choose to communicate a
complaint either informally or formally.
If the complainant chooses, the complaint can be communicated informally by
contacting the party(s) involved (e.g. course coordinator, faculty member, Program
Director, Director of Clinical Education, student) to discuss the issue. In this case, there
is no documentation of the complaint.
If the complainant prefers, a formal written complaint can be filed with the Program
Director. Such a complaint must be communicated in writing and be signed. The
complaint should state with specificity the facts giving rise to the complaint, the names
of persons who have knowledge of the events surrounding the complaint, and the relief
sought. It should be signed by the person filing the complaint. All parties to the process
will seek to maintain the confidentiality of the process; however, it is recognized that
circumstance may compel further disclosure to other persons, particularly if the facts
implicate possible violations of law, University policy, or foreseeable risk of harm to any
person. The Program Director will maintain a file of all written Program Complaints for a
period of five (5) years.
Complaints should be addressed to:
Saint Louis University
Program in Physical Therapy
3437 Caroline Mall
Saint Louis, MO 63128
ATTN: Program Director
The Program Director will address the issue with the involved party within 10 working
days of receipt of the letter and will seek resolution of the issue. The resolution action
will be communicated to all parties in writing.
Should the complainant not be satisfied with the resolution of the issue at the Program
level, or if the complaint involves the Program Director, the complaint can be made to
the Dean of the Doisy College of Health Sciences. As appropriate, the Program
Director will forward a written summary of the situation to date.
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The written complaint shall be filed with the Dean within ten (10) working days of receipt
of the complaint resolution letter from the Program Director, or, if the complaint is
regarding the Program Director, within ten (10) days of the experience/encounter. Upon
receipt of the complaint, the Dean shall evaluate the merits of the complaint and identify
a course of action. A letter summarizing the Dean’s action shall be filed with the
complaint letter in the Program Complaint file.
Should the complainant not be satisfied with the resolution of the issue at the College
level, the complaint can be made to the Vice President of Academic Affairs. The Vice
President of Academic Affairs shall evaluate the merits of the complaint and identify a
course of action. A letter summarizing the Vice President’s action shall be filed with the
complaint letter in the Program Complaint file.
Revised 06/2009
Revised 06/2012
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Web-Based Clinical Education Sites
Students, clinical faculty, and Clinical Education Team may access information related
to the clinical education team through several web-based sites.
SLU Clinical Education Web Page (Students, Clinical Faculty, and Clinical
Education Team):
The SLU Clinical Education Web Page provides information to all individuals involved in
clinical education. All policies, procedures, and documents are retained on this website
including materials for each clinical education course. The web page address is:
https://sites.google.com/a/slu.edu/saint-louis-university-program-in-physical-therapyclinical-education/
Acadaware (Students & Clinical Education Team):
Acadaware is the database that maintains information for each student enrolled in
clinical education courses and for each clinical site. This database provides a webbased portal which allows students to access their information and clinical site
information 24 hours a day. The Acadaware web address is:
https://portal.acadaware.com/ Students will receive a username and password by e-mail
from Acadaware. Students are responsible for maintaining their username and
password throughout the professional phase of the program.
Students are responsible for utilizing Acadaware for the following tasks:
 Updating information regarding program or clinical site requirements by dates
and uploaded documents (i.e. PPD results, drug screen)
 Browse associated sites to submit preferences for upcoming clinical rotations
and to obtain contact information and site specific requirement information
 Preparation of Student Information Form (both General Info and Student
Overview) prior to each clinical rotation
Submission of a midterm and final assessment of a clinical site and clinical instructor
Blackboard Learn (Students & Clinical Education Team):
Blackboard Learn or Blackboard is an e-Education platform designed to enable
educational innovations by supporting course information. Students will submit most
assignments (i.e. reflections and clinical logs) or complete quizzes related to clinical
education. This is also where the Clinical Education Handbook will reside for student
access.
Clinical Performance Instrument (Students, Clinical Faculty & Clinical Education
Team):
The Clinical Performance Instrument (CPI) was developed by the APTA and is
supported by Academic Software Plus. The CPI is the assessment instrument used by
Saint Louis University for all full time clinical rotations. All users, including students,
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clinical faculty, and members of the Clinical Education Team, must complete mandatory
training through the APTA Learning Center prior to gaining access to the CPI. Both
students and clinical instructors will complete a midterm and final assessment within the
CPI. Students and clinical instructors are “paired” upon the finalization of each clinical
assignment. The web address for the CPI is:
https://cpi2.amsapps.com/user_session/new
Clinical Site Information Form (Students, Clinical Faculty & Clinical Education
Team):
The Clinical Site Information Form (CSIF) should be uploaded to the CPI site by CCCEs
(https://cpi2.amsapps.com/user_session/new) for centralized access by students at
affiliated academic programs. CCCEs will receive an annual reminder e-mail from
Academic Software Plus to update information contained in the CSIF. A CCCE may
also grant a student assigned to his/her clinical site access to upload the information for
the CSIF. The CCCE has final authority to review information uploaded by a student
prior to releasing to students and academic faculty with access to the CPI.
Academic programs must maintain updated information on any clinical affiliate to ensure
students have ample information regarding possible clinical assignments and to comply
with accreditation requirements. Clinical faculty may contact the DCE or CEPC at Saint
Louis University regarding any questions about uploading CSIF.
22
Patient Right of Refusal
Students must identify themselves as a physical therapist student prior to the initiation
of treatment for all patients. In the event that a patient refuses treatment by a physical
therapist student, the clinical instructor must be notified and the patient reassigned to a
physical therapist for continued treatment.
23
Contacting the Clinical Education Team
Any student, Center Coordinator of Clinical Education (CCCE), or Clinical Instructor (CI)
may call the Clinical Education Team or the Program in Physical Therapy for any of the
following reasons:
1.
to report student illness or absence (it is the student's responsibility to inform the
school),
2.
to confirm policies/procedures of the clinical education program with a member of
the Clinical Education Team,
3.
to ask for any forms or information that the site did not receive,
4.
to discuss with the DCE or the student’s CEA any concerns that arise during a
clinical assignment,
5.
to clarify information regarding program curriculum,
6.
to discuss any other matter with a member of the Clinical Education Team
regarding clinical education, the curriculum at Saint Louis University, CPI, and/or
policies and procedures related to clinical education.
Telephone Contact:
The Clinical Education Team telephone number is (314) 977-8511. The Clinical
Education Program Coordinator (CEPC) is responsible for checking this line for
messages in the morning and throughout the day as well as answering any calls on this
line during the day. In the event the CEPC must leave his/her desk or is away from the
office, this phone line should be forwarded to either the front desk line (314-977-8505)
or to the DCE line (314-977-8539) as appropriate. If a member of the Clinical Education
Team is not available, please leave a message regarding the problem on the
clinical education voice mail system and a team member or will return the call as
soon as possible.
Students and clinical faculty may use the emergency contact number (314-541-6021)
after 6:00 p.m., on weekends, or holidays to speak with the DCE for urgent situations or
concerns.
E-mail Contact:
The Clinical Education Team e-mail address is slu_pt_clin_ed@slu.edu. The CEPC is
responsible for checking this address in the morning and throughout the day for
messages. The CEPC will forward messages to other members of the Clinical
Education Team as is appropriate based on the information in the subject line and email. If the CEPC is away from the office, the DCE will assume the responsibility for
checking this address or the acting DCE for the day in the event the DCE is also away
from the office.
24
Fax Number
The Clinical Education Team fax number is (314) 977-8513. The CEPC is responsible
for checking the fax during the day for any clinical education documents and distributing
them as appropriate to CEAs, entering the information in to the database, or filing the
document. In the event the CEPC is away from the office, the DCE will check the fax
machine for any clinical education documents or the acting DCE if the DCE is also away
from the office.
25
Team Coverage in Absence of Director of Clinical Education (DCE)





Anytime the DCE is absent from campus and unavailable readily by e-mail or
telephone, a Clinical Education Advisor (CEA) or other faculty member will be
designated as the “Interim DCE”
A schedule for “Interim DCE” will be created by the Clinical Education Program
Coordinator (CEPC) and distributed to all members of the Clinical Education
Team, the Program Chair, the Program Assistant Chair, and the Program Lead
Administrative Assistant
The CEPC will screen clinical education telephone calls and mail distributed to
the DCE in order to inform the “Interim DCE” of any potential situations requiring
immediate attention.
The Interim DCE will communicate with the other members of the Clinical
Education Team regarding any situations to ensure follow-up is completed.
The following are situations in which an action must take place by the “Interim
DCE”
o Cancellation of a clinical assignment that would otherwise delay the start
of the student’s experience if held until the return of the DCE;
o Contact by a clinical site regarding the unacceptable performance of a
student during a clinical experience;
o New requirement by a clinical site that must be shared with a student in a
timely fashion (i.e. a student must complete a criminal background prior
the start of the clinical rotation and the DCE will not return prior to the
clinical start date);
o Contact by a student regarding an emergency situation during a clinical
experience as related to patient care, his/her performance, or level of
supervision by the clinical instructor; or
o Any situation deemed an immediate emergency that requires attention
prior to the return of the DCE.
26
Midterm Call Policy for Phase II and III Rotations
A certain number of students will be required to complete a midterm call for both clinical
experiences in Phase II and III. Midterm calls may be performed with students and
clinical instructor(s) (CI) for one or more of the following reasons:






Student’s prior experience on a clinical rotation
Clinical site/instructor’s prior experience with SLU
New clinical site/CI
Identification of concerns on midterm Clinical Performance Instrument or CPI
(e.g. discrepancies, performance rated below midterm standards, limited
comments offered by CI on the CPI)
Student requests a midterm call
CI requests a midterm call
Students will be notified if they are required to complete a midterm prior to the start of
each clinical experience unless the call is deemed necessary following the review of the
student’s midterm assessment.




Each student will schedule a time and date for the midterm call through his or her
Clinical Education Advisor ‘s (CEA) MT call schedule (accessible through Google
Doc via link sent to SLU e-mail account).
Students will call the Clinical Education Telephone Line (314-977-8511) to reach
his or her CEA for the midterm call
All midterms MUST be completed by the end of the midterm week of the clinical
rotation (see course syllabus for specific dates).
o If the student anticipates this will not be possible, he or she must notify his
or her CEA of any delay.
Prior to calling the student’s CEA, the student must review the assessment
completed by the CI(s) and the student’s self-assessment on the CPI.
o If any CPI criteria are below the minimum rating for midterm of clinical
component, the student may be required to write objectives for
improvement on one or more of these criteria. See the appropriate course
syllabus for midterm minimum ratings.
27
STUDENT POLICIES
28
Overall Expectations for Students
The Clinical Education Team expects professional behavior by all students during both
the didactic and clinical portion of this course. Professional behavior includes but is not





Active attention to class and clinic experiences
Engagement in all opportunities available to assist students in their development as
physical therapist
Respectful communication toward members of the Clinical Education Team, clinical
faculty, and classmates in the classroom, and by electronic communication
Timely responses to all electronic communication by members of the Clinical
Education Team, clinical faculty, and classmates
Submission of all required documents by the prescribed deadlines
29
Attendance & Absence Policies for Class and Clinic Components
Class Component:
 The student will attend all scheduled clinical education classes.
 The student is expected to arrive promptly for all clinical education classes.
 The student will notify the appropriate Director of Clinical Education directly
regarding absence from a class. Excused absences include but may not be
limited to personal illness or death in the immediate family. Absences for other
reasons may not be excused.
 A student with an excused absence will be required, at the discretion of the
Course Coordinator, to make-up the class by attending a make-up class and/or
completing an assignment on the material covered.
Clinic Component:
 The student is assigned to one facility for each clinical assignment. The student
will be punctual in arriving and remain for the time scheduled or until dismissed
by the Center Coordinator of Clinical education (CCCE) or Clinical Instructor(s)
(CI).
 If it is necessary to remain in the department after hours to complete patient care
or other responsibilities, the student will remain until all tasks are completed.
 The student will notify his or her CI(s) at the clinical site AND contact the Clinical
Education Program Coordinator (CEPC) at either (314) 977-8511 or
slu_pt_clin_ed@slu.edu regarding absences from the clinic.
o Excused absences include but may not be limited to personal illness or
death in the immediate family.
o Absences for other reasons may not be excused.
o An unexcused absence from the clinic may result in the student receiving
a Professional Warning.
o The student must contact the CEPC if he/she will not be in the clinic on a
regularly scheduled day due to an unusual clinical situation (e.g. inclement
weather, clinic, clinic power failure).
 In the event a student must request a day out of the clinic for a significant event
such as a family wedding, the student must complete the “Clinical Absence
Request Form” at least 1 week prior to the absence.
o The form must be faxed or scanned and submitted electronically for
review by the Director of Clinical Education (DCE).
o The form must include the signature of the student’s CI.
 A student with an unexcused absence will be required to make up time at the
discretion of the student’s Clinical Education Advisor (CEA), the DCE, the CCCE,
and the CI.
 The student is required to plan for the coverage of patient care and other
professional responsibilities if absence from the department is foreseen.
 The student is expected to be present in the clinic except for the above
exceptions. Any additional absences or time off from the clinic must be
30
rescheduled at the discretion of the student’s CEA, the DCE, the CCCE, and the
CI.
31
Cancellation for Clinical Education Classes or Clinical Time

Please refer to the policy in the Student Handbook regarding class cancellation
with regard to the didactic component of all clinical education courses.

The clinical component of all clinical education courses will not be cancelled in
the event of inclement weather unless the clinical instructor initiates the
cancellation with the student. A student enrolled in Phase I is expected to be in
the clinic on all scheduled days unless otherwise directed by his/her clinical
instructor (CI) or the Center Coordinator of Clinical Education (CCCE).

A student enrolled in Phase II and Phase III of the clinical education curriculum is
expected to be in the clinic on all days in which his/her clinical instructor is
scheduled to work. Students are expected to be in attendance in the clinic on
days when Saint Louis University is closed due to holidays or inclement weather
unless otherwise directed by their clinical instructors.
32
Student Clinical Requirements
Students must ensure they are in compliance with all program and clinical site
requirements by reviewing information in Acadaware and confirming with their CEA
and/or the DCE.
Requirement
Personal Health History
Physical Exam
Program
Completed prior to SP
Completed prior to SP
Documentation of vaccination
or immunity to Measles,
Mumps, and Ruebella (MMR);
Tetanus, Diphtheria, and
Pertussis (TDP)
Documentation of vaccination
or immunity to Varicella
(Chicken Pox)
Documentation of current
personal health insurance
Completed prior to SP
Completed prior to SP
Updated annually or
whenever individual health
insurance changes
Current negative PPD test or if 2-Step completed prior to
PPD converted to +, negative SP; annual PPD completed
chest X-ray and annual
in subsequent years
completion of Review of
Symptoms
Documentation of completed
Completed prior to SP
Hepatitis B vaccine, a lab
report of immunity to Hepatitis
B or the Refusal for Hepatitis
B Vaccine Form
Proof of current CPR
Re-certified as needed to
certification (written and inremain current
person skill test) for infants,
children, and adults
Proof of current Basic First Aid Re-certified as needed to
Certification (in-person or onremain current
line course)
Completion of electronic Letter Updated annually
of Indemnity
Proof of HIPAA Training
Completed prior to SP
Proof of OSHA Bloodborne
Pathogen Training
Completed prior to SP
33
Clinical Site*
N/A
May be required within
1 year of clinical
assignment
May require titers to
confirm immunity
May require titer to
confirm immunity
Proof of current
personal health
insurance
May require results of a
PPD test within a
certain time frame prior
to start of clinical
assignment
May require titer to
confirm immunity
Certification through a
specific agency may be
required
Certification through a
specific agency may
required
Updated annually
May be required to
complete site specific
HIPAA training
May be required to
complete site specific
OSHA training
Requirement
Proof of Criminal and
Caregiver Background Check
Program
Completed prior to SP
Proof of a Negative Drug Test
Not required by program
Clinical Site*
May be required within
a specific time frame
prior to the start of the
clinical assignment
May be required with a
specific time frame
prior to the start of the
clinical assignment
*Students are always responsible for reviewing all requirements for a clinical site in
Acadaware AT LEAST 6 weeks prior to the start of the clinical experience
Failure to comply with the program and clinical site requirements will result in the delay
of the student beginning the clinical component of each clinical education course.
The student must complete the following tasks prior to the start of the clinical
component for each clinical education course:
 Submission of updated information for the Student Information Form – General
and Student Overview in Acadaware
 Schedule and attend a meeting with his or her CEA to review the above
documents and ensure all requirements are up to date
 Submission of the Policy Signature Form denoting acceptance of all policies
affiliated with this course
 Completion of the annual Letter of Indemnity
34
Reviewing Clinical Assessment of Student Performance
Phase I
 Students are assessed on the clinical component of DPT 484 Skills Practicum on
the tool “Clinical Instructor Assessment of Student Performance” by the clinical
instructor(s) (CI)
 Students receive one of three ratings for “Overall Student Performance”
o Satisfactory
o Needs Improvement
o Unsatisfactory
 Each student’s Clinical Education Advisor (CEA) reviews the assessment for
congruency between the comments of the CI and the rating.
o If the student's performance is rated UNSATISFACTORY, a remediation
contract is developed to assist in remediation of the student's areas
needing improvement from the student's final clinical evaluation.


o If the student’s performance is rated NEEDS IMPROVEMENT, the DCE
and the student’s CEA will determine future actions.
 If the DCE and CEA recommend additional activities for clinical
skills development, a mastery assurance contract will be generated.
The student will have the opportunity to accept or decline the
activities recommended.
 If the DCE and the CEA require additional activities for clinical skills
development, a remediation contract will be generated.
o If the student’s performance is rated as SATISFACTORY by the CEA, no
additional action is required
If the DCE and the student’s CEA determine the comments on the “Clinical
Instructor Assessment of Student Performance” do not support a “Satisfactory”
rating, the student may be subject to the above conditions for the rating of either
“Needs Improvement” or “Unsatisfactory”.
A Student Counseling Form is generated by the student’s CEA in the event of
receiving either a “Needs Improvement” or “Unsatisfactory” rating and is
forwarded to all members of the Clinical Education Team, the Assistant Program
Director, and the student’s faculty mentor
Phase II & III
 Students are assessed on the clinical component of DPT 580 - 585 on the tool
Clinical Performance Instrument (CPI) by the CI(s)
 The CPI is completed both at midterm and final as formative assessment and
summative feedback of clinical performance.
o Midterm
 The CEA reviews the midterm CPI completed by the CI(s) to
determine if the student is meeting the minimum midterm criteria
outlined in each clinical education course’s policies.
 If the student meets the minimum midterm criteria, no further action
is required by the CEA.
35

If the student does not meet the minimum midterm standard for a
particular criterion on the CPI, the student is contacted via e-mail or
telephone to discuss the specific areas of concern.
 If not directed to write an objective for this criteria during the
midterm call (see Procedures for Midterm Calls), the student
is directed to write an objective for each area of concern and
submit to his/her CEA.
 A Student Counseling Form is generated regarding the
student contact.
o A copy is forwarded to the student’s faculty mentor
 The DCE is notified regarding the student’s progress at
midterm.
o Final
 The CEA reviews the final CPI completed by the CI(s) to determine
if the student is meeting the minimum final criteria outlined in each
clinical education course’s policies.
 If the student meets the minimum final criteria, no further action is
required by the CEA.
 If the CEA identifies an area in which the student is passing
with some concern, the DCE is notified.
o The CEA meets with the student and a Student
Counseling Form is completed to identify a
“conditional pass” for the clinical rotation.
o Specific expectations for upcoming performance in
this area are outlined in the Student Counseling Form.
o Failure to meet these expectations on the next clinical
experience result in the failure of the current clinical
experience.
 If the student does not meet the minimum final criteria, the CEA
requests the DCE or a second CEA to review the entire final CPI
completed by the CI(s).
 If both individuals reach the same conclusion regarding the
student’s failure to meet minimum passing criteria, the
experience is graded as a “Fail”.
 If both individuals reach different conclusions regarding the
student’s grade
o The individuals meet to discuss the findings.
 A review by a third CEA is performed if agreement is not reached
by the first two DCE and CEA.
36
Progression in Clinical Education Courses Policy
Students must pass both the didactic and clinical component of each clinical education
course to progress to the next clinical education experience. The student will receive an
“Incomplete” in a clinical education course that is not passed until remediation work is
successfully completed.
At the finish of the clinical rotation, if the student falls below the criteria listed in clinical
education course syllabus:
 An individual remediation contract will be developed to identify the student’s
areas needing improvement based on the final assessment.
o Remediation could include but is not limited to review of coursework,
counseling, additional clinical time, and/or other assignments.
o The remediation contract will clearly state the conditions for satisfactory
completion of remediation.
o The DCE, the student’s CEA, and the Assistant Program Director must
approve the contract. Other members of the Clinical Education Team will
provide assistance in the contract development as needed.
o The student will receive an “Incomplete” in the clinical education course until
remediation work is successfully completed.
 Additional clinical rotation
o Once all the conditions listed in the remediation contract are completed
satisfactorily, the student will be assigned an additional clinical rotation at a
site to be determined by the Clinical Education Team.
o The timing of this clinical rotation will be determined mutually by the student,
the DCE, and the CCCE of the facility.
o The student’s progression in the remaining clinical education courses will be
deferred until remediation is satisfactorily completed

 The student will be assigned to one additional clinical assignment
beyond the original assignment for a clinical education course
 The student must satisfactorily complete that experience before
progressing to the next clinical education course or in the case of
CRIVB, graduation.
Failure to successfully fulfill the conditions of the remediation contract will result
in the issuance of a grade of “No Pass” for that particular clinical education
course.
37
Housing & Transportation for Clinical Experiences
Students are responsible for securing housing for any clinical site away from the St.
Louis Metro area or their hometown. In some cases, the Director of Clinical (DCE) or
site clinical faculty can assist students with housing options. It is the responsibility of the
student to review Acadaware for any information regarding housing options and initiate
contact with the appropriate individuals at least 3 months prior to the start of the rotation
when possible.
Students are responsible for their own transportation to/from all clinical experiences.
Whenever possible, students without cars are placed at facilities that are 1) close to
their housing, 2) available via public transportation, 3) on a route so the student could
carpool with other students from Saint Louis University.
The Clinical Education Team encourages students to for carpool when possible. It is up
to the individual students involved to make arrangements for carpools or any other
means of transportation to the clinical site. Students are asked to consider fairness in
carpool situations by sharing the driving responsibilities or cost of gas as well as being
on time for the carpool.
38
Dress Regulations for Clinical Settings
Students are expected to be dressed and groomed appropriately for clinical experiences
by complying with the Clinical Education dress regulations:









Pants must be full length.
Shirts must have short, 3/4, or full length sleeves (no sleeveless or capped
sleeves)
Shoes must be close-toed and close-heeled with a heel no higher than ½
inch.
Socks or nylons must be worn at all times.
Shirts must be tucked in or of sufficient length to cover low back and stomach
while moving.
Shirts must have a collar and must not expose the upper torso.
Clothing should not restrict any movement required during patient care.
The student will wear a lab coat and Saint Louis University issued name tag
unless otherwise directed by the clinical site CCCE or CI.
The student may be required to purchase specific items of clothing to meet a
clinical site’s requirements.
Requirements for lab experiences in the clinic are the same as above except students
are required to wear a Saint Louis University Physical Therapy polo shirt and may not
be required to wear a lab coat.
In addition to dress regulations, students must maintain, short, clean nails (no false nails
or nail jewels), ensure hair will not interfere in patient care, remove facial piercings
beyond two earrings per ear, limit use of perfumes/colognes, and refrain from excessive
jewelry. As possible, tattoos should not be visually evident.
The student may be asked to leave the clinic or lab experience if in violation of dress
regulations; this absence will be considered an unexcused absence. A professional
warning will be issued if a second infraction occurs during clinical experiences.
39
Alcohol and Drug Policy
Saint Louis University Physical Therapy students assigned to clinical education
experiences are bound by the State of Missouri alcohol and drug laws or the state in
which the clinical site is located, Saint Louis University’s Drug and Alcohol Abuse
Prevention Policy, and Saint Louis University Health Professional Letter of Indemnity
Section 2.c (2011-2012). The Drug and Alcohol Abuse Prevention Policy drafted by the
Office of Student Conduct (http://www.slu.edu/x25107.xml) states:
Saint Louis University prohibits the unlawful manufacture,
distribution, sale, possession, or use of illicit drugs or alcohol on its
premises or as part of any University activities. Conduct involving
prescription drugs which have not been prescribed by a physician
will be treated as a violation. This policy supplements and does not
limit rules of conduct pertaining to alcohol or drugs which are
published in other official University publications.
The Office of Student Conduct (http://www.slu.edu/x25107.xml) defines University
activities as:
The term “University activities” includes academic programs
affiliated with the University or in which students have matriculated
for academic credit at Saint Louis University, including study-abroad
programs, overseas, and any on-campus or off-campus event or
function conducted, approved, sponsored, or funded, in whole or in
part, by the University or any officially recognized student
organization.
Therefore, suspected student infringement of drug and/or alcohol policy will be handled
in the following manner.
 A student who is suspected of being under the influence of alcohol or drugs while
in the clinic will be instructed by a representative of the clinical site to call the
Saint Louis University Program in Physical Therapy.
o The student will be required to submit to a drug or alcohol test at the expense
of the student.
 If the student is found to have a negative drug and/or alcohol test, he or she will
be allowed to return to the clinic on the next scheduled day at the discretion of
the DCE.
 If the student is found to have a positive drug and/or alcohol test, he or she will
be subject to the Saint Louis University Drug and Alcohol Abuse Prevention
Policy (http://www.slu.edu/x25107.xml) and the Doisy College of Health Sciences
Drug Policy (see policy distributed in class).
The student will be asked to leave the site if any test results are positive for drugs or
alcohol. He or she will be responsible for the cost of a taxi to his/her local residence.
40
Completing an Incident Report
Students are responsible for completing an incident report for Saint Louis University in
the event a patient is injured under the care of the student, injured while the student is
observing, or when an examination or treatment results in an unexpected outcome. The
following are examples but not a comprehensive list of unexpected outcomes that
warrant the completion of an incident report:



Patient injury as a result of a fall or equipment failure
Assessment or treatment of patient without appropriate
Unusual or unexpected outcome from a examination or treatment treatment such
as changes in the skin, respiration, cardiac, or neurological system.
An incident report is NOT an assignment of guilt but is meant to provide an objective
description of the events immediately preceding and following the unusual or
unexpected encounter. The completion and submission of an incident report by a
student to Saint Louis University is required per the Letter of Indemnity signed annually
to maintain the integrity of the student’s liability insurance through the University.
The following are the steps required to successfully prepare and submit an incident
report:




As soon as possible following the incident, contact a member of the Clinical
Education Team by telephone on the clinical education line (314-977-8511) or on
the after-hours number (314-541-6021).
Locate the “General Liability Form” on the SLU Risk Management and Insurance
webpage (https://www.slu.edu/busfin/departments/risk-management-andinsurance/accident-forms)
Download the General Liability Form and document the incident in objective
terms including events preceding and immediately following the incident. Consult
a member of the Clinical Education Team for assistance as needed.
Return a hard copy of the document by MAIL ONLY to the DCE at:
Program in Physical Therapy
Saint Louis University
c/o Carol Beckel, PT, PhD
3437 Caroline Street
Allied Health Building, Suite 126
St. Louis, MO 63104
41
CLINICAL FACULTY POLICIES
42
Minimum Qualifications for Clinical Instructors
Phase I
 Licensed as a physical therapist in the state where clinical experience will take
place
 Minimum of one year in clinical practice
 Employed by a clinical affiliate with an active affiliation agreement with Saint
Louis University
 Maintains current clinical competence by meeting practice requirements for
employer
Phase II & III
 Licensed as a physical therapist in the state where clinical experience will take
place
 Minimum of one year in clinical practice (two years in clinical practice preferred)
 Employed by a clinical affiliate with an active affiliation agreement with Saint
Louis University
 Maintains current clinical competence by meeting practice requirements for
employer
 Successful completion of the APTA Clinical Performance Instrument Training
Module
43
Responsibilities of Clinical Faculty during Clinical Experiences
Phase I (Skills Practicum):
Before The Student Arrives
 Provide information to the student regarding
 How to reach the facility
 Where to park
 The hours the student will work
 Who to ask for on the first day
 Location of the Physical Therapy Department (if located in a hospital or large
building
 Uniform code/requirements
 Please read assignment information distributed to the CCCE electronically via e-mail
prior to the start of the rotation. If you have any questions regarding how any
information, please contact the Clinical Education Team at 314-977-8511 or
slu_pt_clin_ed@slu.edu.
On The First Day of Skills Practicum
 File the student health information (hand-carried by the student to the clinical site) or
otherwise document student health status.

Orient the student per individual departmental procedure, including an orientation to
the Emergency Procedures of the facility.

Review the Student Self-Assessment Form (hand-carried by the student to the
clinical site or sent electronically by the student) and the Schedule of Physical
Therapy Course Topics and:
o assist the student to set specific and appropriate goals for the specific
clinical site,
o plan with the student what the student will practice while at the clinical
facility.
Throughout Skills Practicum
 Provide close supervision, beginning with demonstration and leading to the student
performance of certain procedures by the student.
On The Final Day of Skills Practicum
 Complete the Clinical Instructor Assessment of Student Performance form and
review it with the student. Both you and the student will sign the form.

Review the Evaluation of Practicum form with the student and sign it.

Make copies of the Clinical Instructor Assessment of Student Performance form and
the Evaluation of Practicum form for your records and for the student's records.
44
Within 3 Working Days of the Last Day of Skills Practicum
It is the preference of the Clinical Education Team that students hand carry all
completed documents to the program. It the clinical instructor prefers to mail final
paperwork, the Clinical Education Team requests this information be returned to the
program within 3 working days of the last day of Skills Practicum.
Phase II and III (Clinical Rotations I/II and Clinical Internships A/B):
Before The Student Arrives
 Provide information to the student regarding
o How to reach the facility
o Where to park
o The hours the student will work
o Who to ask for on the first day
o Location of the Physical Therapy Department (if located in a hospital or large
building) and the exact street address as some facilities have multiple
locations
o Uniform code/requirements


Please read assignment information distributed to the CCCE electronically via e-mail
prior to the start of the rotation. If you have any questions regarding any information,
please contact the Clinical Education Team at 314-977-8511 or
slu_pt_clin_ed@slu.edu
Complete Training for use of CPI if not previously completed. The directions for
accessing the APTA Learning Center for this free training are provided in the
information sent to the CCCE
On The First Day of Clinical Rotation or Clinical Internship
 File the student health information (hand-carried by the student to the clinical
site) or dispose of it per individual departmental procedure.
o A Criminal Background Check report is sent directly to the CCCE if
required by the clinical site.

Orient the student per individual department procedure, including a review of the
Emergency Procedures of the facility.

Review the Student Information Form (hand-carried by the student to the clinical
site or sent electronically to the CI) and
o assist the student with setting specific and appropriate goals for the
specific clinical site,
o plan with the student what he or she will practice while at the clinical
facility.
45
Throughout Clinical Rotation
 Provide appropriate supervision based on the students level of academic
preparation, beginning with demonstration of examinations and treatments to the
student and progressing toward the student participating in all components of PT
practice.

Provide feedback on documentation skills.

Call the Clinical Education Team if you have any questions or concerns with any
aspect of the Clinical Rotation (using the CPI, student behavior, student
progress, etc.).
At Midterm of Clinical Rotations and Clinical Internships
 Complete the CPI on-line and review it with the student. Discuss the ratings and
comments with the student and review/revise the objectives that the clinical
instructor and the student set.

The student may be completing an objectives’ writing assignment based on the
midterm CPI per the program’s requirements.

Review the CPI completed by the student on her/himself.

Review Midterm Experience Evaluation completed by the student.

The student may be assigned to call his or her Clinical Education Advisor (CEA)
after completing the midterm tasks listed above. The student should schedule a
time with his or her CEA for this call. The CEA will speak to the CI following a
conversation with the student.
o If a student is not scheduled to complete a midterm call but the CI would
like to speak to the CEA, he or she may request a call after discussing this
with the student. Please contact the CEA through the clinical education
phone line (314-977-8511) or e-mail address (slu_pt_clin_ed@slu.edu)
On The Final Day of Clinical Rotations and Clinical Internships
 Complete the CPI and review the ratings and comments with the student.

Review the CPI completed by the student on her/himself.

Review Final Experience Evaluation completed by the student.
46
Reviewing Student Assessment of Clinical Experience and Clinical Instructors
Phase I
 Students assess the Phase I clinical experience using the form “Evaluation of
Practicum”.
 Each Clinical Education Advisor (CEA) reviews the “Evaluation of Practicum”
completed by each advisee.
 A CEA notifies the Director of Clinical Education (DCE) if any comments in reference
to the clinical instructor or the clinical experience identify any concerns regarding the
potential quality of the student’s experience.
 Either the CEA or the DCE may request a meeting with the student to discuss their
concerns. A Student Counseling Form is completed to assist in tracking clinical site
concerns and is saved on the DCE U-drive.
 The DCE records any concerns on an Excel spreadsheet on the U-drive for future
discussion with the Clinical Coordinator of Clinical Education (CCCE) at the clinical
site.
Phase II and III
 Students assess Phase II and Phase III clinical experiences using the “Midterm
Experience Form” and “Final Experience Form” in Acadaware.
 Each CEA reviews the information provided at both midterm and final.
 Upon review of the “Final Experience Form” if students respond to any questions as
“slightly satisfied, needs some adjustments” or “not satisfied”, the DCE is notified.
 Either the CEA or the DCE may request a meeting with the student to discuss their
concerns. A Student Counseling Form is completed to assist in tracking clinical site
concerns and is saved on the DCE U-drive.
 The DCE records any concerns on an Excel spreadsheet for future discussion with
the Clinical Coordinator of Clinical Education (CCCE) at the clinical site.
47
CLINICAL REQUIREMENT/REQUEST
FORMS
48
Student Notification of Possible Health Risks Related to Clinical Practice
Students are notified of possible health risks related to clinical practice in the following
manners:



Completion of SLU web based OSHA training regarding blood-borne pathogens
Receipt of latest Center for Disease Control guidelines on appropriate
Immunization of Health-Care Workers during the first summer of the Professional
Phase of the curriculum
Instruction in Universal Precautions in Basic Procedures & Systems Review
49
Saint Louis University
Doisy College of Health Sciences
Program in Physical Therapy
Student Health Record Instructions
A Student Health Record is required for all students enrolled in the Program in Physical
Therapy. This will become part of your confidential health record while enrolled in Saint
Louis University Doisy College of Health Sciences and will be kept on a secure server.
All documents for the health record MUST be uploaded through the Acadaware
database. Documents uploaded through Acadaware will be downloaded by the Clinical
Education Program Coordinator and stored on the secure t-drive. The members of the
Clinical Education Team (Director of Clinical Education, Clinical Education Advisor, and
Clinical Education Program Coordinator), Program Director, and Assistant Program
Director are the only individuals will access to these records. Students have access to
scanners in both the Medical and Pius Libraries.
Students are required to update all documents in Acadaware throughout the
Professional Phase of the program to ensure they are eligible for each clinical rotation.
Instructions for uploading documents through Acadaware are available through the DPT
Clin-PA Blackboard Learn page as a Tegrity Lecture.
ALL documents must be scanned and uploaded through the Acadaware








Please complete the Personal Health History form yourself.
Have a physician complete the Physical Examination form. Note: Be sure both
pages are completed and the signature is included. If the physician chooses to
use his/her own form be sure that the form addresses all the areas on included on
our form.
Have your physician fill out and sign the Vaccination Report. Your physician MAY
provide a different record of your immunizations as long as all those listed on the
Vaccination Report from SLU are listed.
Students must submit documentation of a completed 2-step TB test including the
results of TWO separate skin tests.
If you have not started and are planning to start, or have started the Hepatitis B
vaccination series, you only need to fill out the Hep B Vaccination form for the
vaccinations you have already received by the date this information is due. Please
submit documentation as you receive further vaccinations.
Fill out the Refusal of Hepatitis B Vaccine form if you choose not to receive the
vaccination series for Hepatitis B. This may prohibit students from being
assigned to clinical education sites that require this vaccination.
Complete the Health Insurance Report form, including a copy of the front and back
of your insurance card.
Retain the electronic copies of all health records for submission to future clinical
instructors upon demand.
50
Saint Louis University
Program in Physical Therapy
PERSONAL HEALTH HISTORY
TO BE COMPLETED BY STUDENT
Name _____________________________________________________
Date ______________________________________________________
(Last)
(First)
(Middle)
Banner ID # _________________________________
Age ________________________________________
Place of Birth ____________________________________
Date of Birth _____________________________________
If there is a family history of any of the following disease(s) please check:
____ Diabetes ____ Cancer ___ Seizures ___ Heart trouble
___ High blood pressure ___ Blood disease
Describe any serious illness, injury, or operation you have had (in chronologic order)
giving nature of condition, hospital name and location, date and any persistent after
effects:
______________________________________________________________________
______________________________________________________________________
Are you sensitive/allergic to any medication or other substance?
______________________________________________________________________
Please list any medications or special forms of therapy you use
regularly:______________________________________________________________
______________________________________________________________________
51
Give date of last immunization against: Diphtheria _______________
Tetanus toxoid ____________ Smallpox _______________ Polio _______________
Are you now being treated for any conditions? Yes ____ No ____ if so, what?
______________________________________________________________________
______________________________________________________________________
Describe any condition or diagnosis which may require accommodations during clinical
experiences due to a physical, psychological or learning disability:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________________
Student Name (PLEASE PRINT)
_______________________________________________
Student's Signature
_______________________________________________
Date
52
Saint Louis University
Program in Physical Therapy
PHYSICAL EXAMINATION
TO BE COMPLETED BY PHYSICIAN:
STUDENT'S NAME ________________________________
DATE ______________________
Sex
Height
Weight
Pulse
Blood Pressure
Has student been your patient: ___ > 1 year ___ < 1 year ___ this is first visit
History: Are you aware of any serious illnesses or injuries? If so please describe,
otherwise mark n/a:
______________________________________________________________________
_____________________________________________________________________
______________________________________________________________________
Are there abnormalities of the following system? Describe fully. Use additional sheet if
necessary.
NO|YES
NO|YES
1. SHEENT
___|___ 5. Genitourinary
___|___
2. Respiratory
___|___ 6. Musculoskeletal
___|___
3. Cardiovascular
___|___ 7. Metabolic/Endocrine
___|___
4. Gastrointestinal
___|___ 8. Neurological
___|___
If yes, please
describe:______________________________________________________________
______________________________________________________________________
To your knowledge is this person now under treatment for any medical or psychological
condition?
Yes _____ No _____If yes, please comment:
53
______________________________________________________________________
Students enrolled in the physical therapy program participate in a variety of physical,
psychological, and cognitive activities, exercises and other physical therapy treatments
as part of the academic program and are active in clinical work. Does this individual
have restrictions or precautions for participation in clinical experiences related to
physical, psychological, or cognitive activities? ________ If so, please describe.
______________________________________________________________________
______________________________________________________________________
___________________________________________
Physician’s Signature
___________________________________________
Physician's Name (PLEASE PRINT)
Date_______________________________________
54
Saint Louis University
Program in Physical Therapy
2 Step TB Skin Test Immunity Report
Student Name (PLEASE PRINT)__________________________________________
PLEASE NOTE: THIS TEST CANNOT BE THE SELF-READ "TINE" TEST. IT MUST
BE AN INTRADURAL TYPE TEST.
TUBERCULIN SKIN TEST TYPE: _____________________
STEP 1:
Date Given: ___________________
Date Read: ____________________ Reaction: _________________
____________________________________________ _______________________
Nurse's or Physician's Signature
Date
STEP 2: (THIS TEST MUST BE GIVEN AT LEAST 2 WEEKS AFTER THE FIRST
TEST.)
Date Given: ___________________
Date Read: ____________________ Reaction: _________________
____________________________________________ _______________________
Nurse's or Physician's Signature
Date
Physician or Clinic Address:________________________________________
_______________________________________________________
Physician or Clinic Phone Number: __________________________________
55
Saint Louis University
Program in Physical Therapy
VACCINATION REPORT
Student Name (PLEASE PRINT)
________________________________________________
MMRV VACCINATION
If the individual named above received the MMRV (Measles, Mumps, Rubella, and
Varicella) vaccine, please fill out the top box and leave the remainder of the form blank.
If the individual named above did not receive the MMRV vaccine, please leave the top
box blank and fill information regarding individual immunizations.
MMRV VACCINATION: Must have both doses.
Date First Dose
Date Second Dose
(must be at least 28 days after first
dose)
MEASLES
________
Documented Measles Vaccination
__________________________________
Vaccine
_________________
Date
MUMPS
________
Documented Mumps Vaccination
__________________________________
Vaccine
_________________
Date
VARICELLA
_________ Documented Varicella Vaccination
__________________________________
Vaccine
56
__________________
Date
________
Documented Illness
__________________________________
Date of illness
__________________
Date
RUBELLA IMMUNITY REPORT: Check the one that is proof. A history of disease is
not acceptable.
________
Documented Rubella Vaccination
__________________________________
Vaccine
________
_________________
Date
Documented Rubella Immunity: Laboratory evidence of immunity will be
accepted as follows: Serology by HAI to measles of 1:16, or positive
immunofluorescence to Measles Virion of 1:8 or higher.
Test Type
Date
Reaction
Test Type
Date
Test Results
HEPATITIS B VACCINATION
Date First Dose
Date Second Dose
Date Third Dose
TDAP VACCINATION (Tetanus, diphtheria, pertussis)
_______________________
Date of Last Dose
Physician's
Signature:
Date:
57
Print Physician's
Name:
Address:
Phone
Number:
58
Saint Louis University
Program in Physical Therapy
REFUSAL FOR HEPATITIS B VACCINE
I understand that due to my occupation’s exposure to blood or other potentially
infectious materials I may be at risk of acquiring Hepatitis B Virus (HBV) infection. I
decline getting the Hepatitis B Vaccination at this time. I understand that by declining
this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.
__________________________
Signature of Person Refusing
Vaccine
________
Date
59
__________________________
Signature of Witness to Refusal
________
Date
Saint Louis University
Program in Physical Therapy
HEALTH INSURANCE REPORT
Student’s Name (PLEASE PRINT):
______________________________________________
Last Name
First Name
Please SCAN a copy of the front and back of your insurance card. If you do not have
an insurance card, please explain how you would be identified as being insured if you
were taken to the Emergency Room.
60
61
Request for Student Accommodations during Clinical Experiences
The following steps are required to secure accommodations for a disability during
clinical experiences:
 A student must submit appropriate documentation to the University Office of
Disability Services regarding the existence of a disability.
 The Director of Clinical Education (DCE) receives confirmation from the Disability
Services Officer regarding the student’s request for accommodations
 The DCE meets with the student to discuss the application of accommodations
during an upcoming clinical experience.
o The DCE completes the “Disabilities Accommodation Form” (See
Appendix C) following this meeting to established accommodations for
clinical settings.
 A “Notification of Accommodations” form (See Appendix C) is completed by the
DCE for each clinical rotation in which the student is requesting accommodations
and submitted to the student for review.
 Upon the student’s approval, the DCE contacts the Center Coordinator of Clinical
Education (CCCE) or the clinical instructor (CI) to discuss the request for
accommodations.
 If the CCCE or the CI accepts the terms of the accommodation request:
o Two copies of the “Notification of Accommodations” form are printed and
signed by the DCE.
o Both copies are mailed to the CCCE or the CI, signed, and a single copy
is returned to the DCE.
o The signed copy is retained in the office of the DCE.
 If the CCCE or the CI are unable to fulfill the terms of the accommodation
request:
o The DCE works with the student to secure another clinical location and the
process for accommodation is repeated.
 Upon the completion of the clinical experience, the DCE meets with the student
to discuss the effectiveness of the accommodations.
 This procedure is repeated for each clinical experience that a student requests
accommodations.
62
HIPAA & OSHA Training
All students must complete on-line training on the Health Insurance Portability &
Accountability Act (HIPAA) Privacy Regulations and Occupational Health & Safety
(OSHA) guidelines for health care workers. Student will review the material in both online programs and complete assessments. Students must pass the assessments for
both programs with at least 75%. Students will retake the assessments until 75% pass
rate is reached. Students must submit an electronic copy of certificates of completion for
both programs to slu_pt_clin_ed@slu.edu and record this information in Acadaware
under “Requirement Documents”.
HIPAA & OSHA training through Saint Louis University must be completed during the
fall semester of their Senior Year. Subsequent training by clinical sites the students are
assigned may be required.
63
Annual Student Statement & Policy Reviews
Students must acknowledge several specific policies on an annual basis regarding the
clinical education portion of the Program in Physical Therapy. These policies include the
following:
 Confidentiality Statement – statement regarding the confidentiality of all patient
information and images completed in Professional Residency Courses

Letter of Indemnity – statement information students of liability coverage during
clinical experiences

Release of Student Information to Clinical Sites – release that students
acknowledge the necessity of information regarding health forms, criminal
background checks, and drug screens will be released to staff at clinical sites
they are assigned to meet the requirements of participation at these locations

The Doisy College of Health Sciences Policy and Procedure following a
confirmed Criminal Background Check – policy and procedure for assigning
student with confirmed criminal background checks to clinical sites who are
enrolled in the Doisy College of Health Sciences.

The Doisy College of Health Sciences Drug Screening Policy – policy on positive
drug screens for students enrolled in the Doisy College of Health Sciences
Students will receive hard copies of the above statements and policies on an annual
basis in a clinical education meeting or course. Students must return a signed copy of
each during either a Professional Residency class or a Clinical Education class or
meeting. An electronic copy of all of the above statements and policies are located in
Appendix D.
64
Appendices
65
Appendix A: Position and Committee Descriptions
Clinical Faculty: Clinical Instructor & Center Coordinator of
Clinical Education
Job Summary:
Clinical Faculty are licensed physical therapist who supervise physical therapist
students during part-time and full-time clinical experiences. Clinical faculty are
charged for the assessment of the student performance in the practice of
physical therapy using the assessment tool required by the academic program.
Clinical faculty are also responsible for communicating any concerns regarding
student performance to academic faculty during the progression of the clinical
experience.
Specific Responsibilities and Duties:
Center Coordinator of Clinical Education (CCCE): The CCCE is the liaison
between clinical faculty at a clinical setting and the academic faculty. The
following is a list of possible responsibilities of the CCCE though these may vary
from setting to setting:
 Submission of annual commitments to academic programs for future
student assignments
 Updating the Clinical Site Information Form through the CPI Web portal
 Communication with students prior to the start of clinical experiences to
inform student of his/her clinical instructor, confirm start time, work hours,
information about type of patient care, exact location of clinical site, and
site specific requirements
 Orientation of students at the start of clinical experiences
 Consultation with clinical instructor regarding student progress
 Review of midterm and final assessment of student performance
 Consultation with student regarding any concerns about clinical
experience
 Consultation with academic faculty regarding student progress or
concerns with academic program
Clinical Instructor (CI): The CI is the individual responsible for the supervision
and assessment of students during clinical experiences. The following is a list of
possible responsibilities of the CI though these may vary from setting to setting:
 Communication with students prior to the start of clinical experiences to
confirm start time, work hours, information about type of patient care,
exact location of clinical site, and site specific requirements
 Orientation of students at the start of clinical experiences
 Completion of student assessment at both the midterm and final of a
clinical experience
 Communication with the CCCE regarding concerns with student progress
during a clinical experience
 Communication with academic faculty regarding student progress
66

Communication regarding concerns or recommendations for the academic
program
67
Director of Clinical Education
Job Summary:
The Director of Clinical Education (DCE) is responsible for the progression of students
during the clinical component of the curriculum and oversees the activities of the Clinical
Education Team. The DCE serves as a liaison between the University and clinical
affiliates. Clinical education tasks are assigned to members of the clinical education
team by the DCE.
Specific Responsibilities and Duties:
Department
 Attend and participate in activities sponsored by the Central Academic
Coordinators of Clinical Education Consortium
 Serve on the College Affiliations Committee
 Serve as liaison with Risk Management Specialist regarding incident reports
 Provide updates to the Assistant Chair for the Program in Physical Therapy
 Produce the Clinical Education Yearly Report
 Provide feedback to Curriculum Committee re: strengths and areas needing
improvement across the curriculum
 Liaison with the University Compliance Committee
 Liaison with clinical education faculty
 Chair of the Clinical Education Advisory Committee
 Member of the Program Advisory Committee
 Plan clinical faculty development activities (i.e. Clinical Educator Weekend, CI
and Advanced CI Credentialing Courses)
 Prepare required documentation for CAPTE
Clinical Education Team
 Coordinates tasks with the Clinical Education Advisors
 Oversee tasks of the Clinical Education Program Coordinator
 Collaborate with of the Affiliations Coordinator to ensure adequate clinical
affiliations for the successful completion of clinical experiences and retention of
clinical sites
 Collaborate with Clinical Education Team members in development of clinical
education courses
 Elicitation of feedback from Clinical Education Team members and students
regarding clinical experience and clinical instruction
Course Coordinator
 The DCE will be the course coordinator for the didactic component of all clinical
education courses.
 The DCE will collaboration with the CEPC in preparing course material and
request CEAs to provide appropriate lectures.
68
Student
 Review and update clinical education policies and procedures for all levels
 Coordinate information for students with temporary and/or permanent disabilities
and arrange for appropriate clinical assignments
 Coordinate clinical assignments for all phases in the clinical education
component of the program
 Supervise remediation contracts for students failing clinical experiences
 Collaborate with Clinical Education Advisors in the development of learning
contracts for clinical component of course
 Assist clinical education course coordinators for the development of remediation
of didactic component of courses
 Review of clinical education requirements
Clinical Site
 Provide feedback to clinical instructors concerning their effectiveness with clinical
education activities
 Provide learning opportunities for clinical sites upon request
69
Clinical Education Advisor
Job Summary:
Clinical Education Advisors (CEAs) are faculty members assigned student clinical
education advisees who are enrolled at the Senior, Professional Year I, and
Professional Year II levels. Advisees are assigned to CEAs by the Director of Clinical
Education (DCE). CEAs are assigned a different group of advisees each semester
throughout Phase I and II. CEAs will maintain the same advisees during the final
rotation in Phase II & Phase III unless otherwise designated by the DCE. Contact with
advisees occurs through small groups, electronic correspondence, telephone contact,
and individual meetings. The CEA is responsible for determining the student’s final
grade following each clinical experience. In the event the CEA identifies specific
concerns at any time during the semester related to the student or the clinical site
he/she will consult with the DCE. If areas of concern arise regarding a student’s clinical
performance, the CEA will work with the DCE to develop a mastery assurance for
recommended tasks or a remediation contract for required tasks to successfully
complete the course. CEAs will communicate with the other members of the Clinical
Education Team at regularly scheduled meetings and as needed between team
meetings. The Clinical Education Team consists of the DCE, CEAs, Affiliations
Coordinator, and Clinical Education Program Coordinator (CEPC).
Specific Responsibilities and Duties (see attached time breakdown):
Team Responsibilities for CEA
 Provide DCE with feedback on the goals and outcomes of clinical education
program
 Attend weekly Clinical Education Team Meetings
 Provide vacation coverage for DCE
 Provide vacation coverage for other CEAs and clinical education course
coordinators
 Attend clinical education continuing education courses at local, regional, and
national meetings
Course Lecturer
 CEAs will provide lectures in clinical education course at the request of the DCE
Individual Student Contact
 Phase I: Skills Practicum
o Review student self-assessment and provide written feedback
o Review electronically submitted reflections on clinical experiences
o Review general comments on first 2 reflections during small group
meetings and provide written feedback on the final reflection
o Review PICO statements submitted by students
o Review Clinical Experience Logs during first small group meeting Review
final clinical paperwork:
 clinical instructor assessment
70

 student assessment of clinical site
 clinical experience log
o Discuss specific information related to clinical assignments
o Coach students having issues while in the clinic and follow-up as
necessary
o Collaborate with the DCE on mastery assurance or remediation contracts
for any advisees demonstrating unsatisfactory performance on the clinical
component of the course
Phase II and III: Clinical Rotation I & II and Clinical Internships A & B
o Meet with students for individual meetings to update health information
and review self-assessments (including learning style, preferred format of
feedback, strengths, areas for improvement, objectives)
o Review the clinical instructor Clinical Performance Instrument (CPI) and
the student self-assessment on the CPI at midterm
 Review midterm call form
 Contact student if new objectives need to be written and review
submitted objectives
o Review of students’ final paperwork for each clinical experience:
 CPI completed by clinical instructor
 Student self-assessment on CPI
 APTA Physical Therapist Student Evaluation: Clinical Experience
and Clinical Instruction
o Collaborate with the DCE on mastery assurance or remediation contracts
for any advisees demonstrating unsatisfactory performance on the clinical
component of the course
Midterm Calls
 Identify advisees on each Phase II and III assignment who must complete a
midterm call
 Coordinate a time for the call with advisees and their CIs during the midterm
week of each Phase II and III rotations.
 Notify the DCE if a time cannot be coordinated between the CEA, student, and CI
 Complete midterm call form and notify team of completion of call
 Discuss specific concerns with the DCE; notify the student’s faculty mentor
 Review student objectives submitted for any factor below midterm requirement:
o Provide student with feedback
o Enter the objectives onto the midterm CPI assessment in the “Midterm
Comment” box.
 Review all advisees’ CPI midterm assessments and contact additional students
for MT calls if their assessments do not meet the midterm criteria
 Educate clinical faculty on teaching strategies, procedures for completing the
assessment tool (CPI), and information on the program curriculum
Student Group Discussions
 Facilitate group meetings with advisees during Skills Practicum to discuss
experiences in a clinical setting
71



Identify any areas of concern raised by students during small group session or in
students’ written reflections
Follow up with students
Informs Clinical Education Team members of areas of concerns
72
Clinical Education Individual Student Instruction and Evaluation
Course
Activity
Time
Skills Practicum
Read and respond to self¼ hr./student
assessment
Read on-line reflections and
½ hr./student
rd
respond in writing to 3
reflection
Facilitates Small Group
2.5 hrs./group
Meetings and review
assignments (Clinical
Experience Log & PICO
Statement)
Read student evaluations,
½ hr./student
site evaluations, and Clinical
Experience Log
Clinical Rotation I
Meet with students re:
1 hr./student
(A & B)
objectives
Mid-term call
1/3 hr./student x # of
students
Read midterm CI CPI, and
½ hr./student
student CPI, Midterm
Experience Form
Review final CI CPI and
½ hr./student
student CPI; Final
Experience Form
Clinical Rotation II Mid-term call
1/3 hr./student x #
(A & B)
students
Read midterm CI CPI, and
½ hr./student
student CPI, Midterm
Experience Form
Review final CI CPI and
½ hr./student
student CPI; Final
Experience Form
Clinical Internship Meet with students re:
1 hr./student
A
objectives
Mid-term call
1/3 hr./student x #
students
Read midterm CI CPI, and
1/2 hr./student
student CPI, Midterm
Experience Form
Review final CI CPI and
½ hr./student
student CPI; Final
Experience Form
Clinical Internship Mid-term call
1/3 hr./student x #
B
students
Read midterm CI CPI, and
1/2 hr./student hrs./CEA
73
student CPI, Midterm
Experience Form
Review final CI CPI and
student CPI; Final
Experience Form
74
1/2 hr./student
Affiliations Coordinator
Job Summary:
The Affiliations Coordinator (AC) is a member of the Clinical Education Team
responsible for the development of new clinical affiliations and the maintenance of
current clinical affiliations. The AC collaborates with the Director of Clinical Education
and the Clinical Education Program Coordinator regarding the development of new
clinical affiliations.
Specific Responsibilities and Duties
 Collaborate with the Director of Clinical Education (DCE) regarding future clinical
affiliate needs
 Collaborate with the DCE on the retention of quality clinical education sites
 Prioritize possible new clinical affiliates recommended by faculty and students for
possible development
 Review the Doisy College of Health Sciences Clinical Affiliation database for
possible new sites already under contract with Saint Louis University (SLU)
 Review new clinical affiliate information (i.e. websites, brochures, Clinical Site
Information Forms) for compatibility with SLU Program in Physical Therapy
 Perform on-site or telephone interviews with the Center Coordinator of Clinical
Education for all new clinical affiliates
 Communicate with the College Clinic Coordinator to secure new contracts and to
request contract updates for existing clinical affiliates
 Review the list of clinical assignments for each clinical experience to assure a
current contract is in place
 Communicate with the Clinical Education Program Coordinator regarding the
uploading of new clinical affiliates into the clinical education database
 Provide updates with regard to new clinical affiliate development during Clinical
Education Team meetings, Program faculty meetings, and for the annual Clinical
Education Yearly Report
 Schedule site visits with existing clinical affiliates
75
Clinical Education Program Coordinator
Job Summary:
The Clinical Education Program Coordinator (CEPC) is the staff member responsible for
all support required in the clinical education component of the curriculum. The CEPC
assists the DCE, the CEAs, clinical education course coordinators, and students in all
three phases of clinical education.
Specific Responsibilities and Duties:
 Support of the faculty on the Clinical Education Team
 Maintaining the clinical education database, clinical education files, and
clinical education Blackboard courses
 Organizing and preparing for clinical education events
 Support for the web-based Clinical Performance Instrument
 Supervision of student workers assisting with clinical education tasks
 Management of clinical education mailings
 Communication with faculty, students, and clinicians
 Elicitation and categorization of feedback from students and clinical
facilities for use by the curriculum committee
76
Compliance Officer
Job Summary:
The Compliance Officer is a University position charged with the responsibility of
performing all Criminal Background Checks for students enrolled in Saint Louis
University. The Office of Compliance is within the Registrar’s Office.
Specific Responsibilities/Duties:




Performance of FBI and MO criminal background checks (CBC) via digital
fingerprints
Performance of all caregiver background checks (both federal and state level)
Transfer of CBC results to academic program faculty/staff contact
Consultation with students in the event of any affirmative findings on CBC or
caregiver background checks
77
Clinical Education Advisory Committee
Composition:
 Director of Clinical Education (chairperson/facilitator)
 Faculty members of Clinical Education Team
 Invited clinicians from varied physical therapy settings
Function:
 Review and make recommendations concerning clinical education program and
related policies and procedures
 Identify educational needs of clinical faculty
 Assist in assessing curriculum needs of students based on performance in the
clinic
 Act as a focus group for research topics
 Provide insight on the current clinical climate from a variety of clinical settings
Meeting Procedures
 Minutes recorded by the chairperson or designated faculty member
o Minutes distributed to all members via e-mail
o Reviewed and accepted at subsequent meeting
 Agenda drafted by chairperson with input from all members of committee
o Agenda distributed to all members via e-mail prior to meeting
 Committee members reminded of upcoming meeting approximately 1 week prior
to meeting via e-mail by the Clinical Education Program Coordinator
 Meeting schedule agreed upon with all members prior to the conclusion of
meeting
 All members invited to attend on-site or via Fuze Box audio/video conferencing
program
Meetings: One meeting in both the fall and spring semester
78
Doisy College of Health Sciences Affiliations Committee
Composition: Faculty or staff from each program in Doisy College of Health Sciences
responsible for overseeing the clinical component of their program curriculum.
Representatives from the Office of the Dean include the College Clinic Coordinator and
an Assistant or Associate Dean charged as the liaison to this committee.
Function: Discuss current trends in clinical education including requirements from sites,
internal management of requirements, and affiliation agreements
Meeting Procedures: The positions of Chair and Secretary for this committee are filled
on a rotating assignment across all programs. The Chair establishes an agenda for the
meetings and distributes ahead of time. External members of the SLU community
involved in clinical education (i.e. representatives from the Office of General Counsel or
the University Compliance Officer) are invited to meetings when the members request
clarification on processes.
Meetings: This committee meets monthly from August to May.
79
Appendix B: Clinical Education Timelines
Students
Month
June
July
August
September
Phase I
Meet with DCE
twice as a class
No tasks
Schedule
necessary
appointments to
complete clinical
education
requirements
Phase II
CRI Ends
Phase III
Submit choices for CIA and CIB
CRII Starts and
Exchange process for CIA and CIB
MT assessment
Review CRI and
No tasks
CRII commitments
PYI fall semester
CRII Continues
PYII summer
semester
Meet with DCE as
a class
Submit CRI and
CRII choices PYI
fall semester
Classroom component for Phase III begins and
meet with CEA (continues through November)
Submit
information
regarding Phase I
assignment
consideration to
Google Doc
Review site requirements in Acadaware for
CRII Ends PYII fall Phase III assignments
semester
80
Appendix B: Clinical Education Timelines
Students
Month
October
November
December
January
Phase I
Meet with DCE as
a class
Electronically
submit all required
clinical education
forms to
Acadaware
Meet with DCE as
a class
Complete CPI
Training
Review site
requirements in
Acadaware for
Phase I
assignment
Classroom
component for
Phase I begins
Complete Student
Information Form
in Acadaware
Phase II
Phase II
Exchange
Process
Phase III
Classroom component for Phase III continues
No tasks
Phase III classroom component ends
No tasks
Submit updated forms to Acadaware prior to
start of CIA and CIB
Begin contacting CIA and CIB sites to confirm
and address housing if necessary
Classroom
CIA begins
component for
Phase II begins
Meet with CEA
(continues through
March)
Review site
requirements in
Acadaware for
Phase II
assignments
81
Appendix B: Clinical Education Timelines
Students
Month
February
Phase I
Start of Phase I
clinical component
(continues through
May)
Phase II
Begin contacting
Phase II sites to
confirm and
address housing if
necessary
March
Continue
classroom and
clinic components
for Phase I
April
Continue Phase I
classroom and
clinic components
Complete Phase I
final tasks
Continue Phase II Complete CIA final tasks
classroom
component and
CIB begins
upload any new
documents to
Acadaware
CRI Begins
Complete CIB midterm tasks
May
Complete CRI
midterm tasks
82
Phase III
Notify DCE of interest in any pre-assignments
for Phase III rotations in spring semester of PYI
Complete CIA midterm tasks
Complete CIB final tasks
Clinical Faculty
Month
June
Phase I
No tasks
Phase II
Complete CRI CPI No tasks
Final assessment
Confirm name of
CI for CRII
July
No tasks
CRII Begins
August
No tasks
Complete the CRII No tasks
midterm
assessment
Complete the CRII No tasks
final assessment
November
Return
commitments for
Phase I spring
part-time rotation
Return
commitments for
Phase I spring
part-time rotation
No tasks
December
No tasks
September
October
Phase III
Confirm CIA and CIB assignments
No tasks
No tasks
No tasks
No tasks
No tasks
No tasks
83
Clinical Faculty
Month
January
Phase I
No tasks
Phase II
No tasks
Phase III
CIA Begins
February
Start of Phase
part time
experiences
No tasks
No tasks
Complete CIA midterm assessment of student
No tasks
Complete CIA final assessment of student.
March
Review annual
commitment
request for
Phase II and III
rotations
CIB Begins
April
Return
commitments for
Phase II and III
rotations
Complete Phase I
final paperwork
CRI Begins
Complete CIB midterm assessment of student
May
Complete Phase I
final paperwork
Complete CRI
midterm
assessment
Complete CIB final assessment of student
84
Director of Clinical Education
Month
June
July
August
Phase I
Meet with Senior
Class twice
No tasks
Prepare Phase III
Recruitment Letter
Phase II
Consult on CRI
final assessments
Enter CRI grades
Consult on CRII
MT assessments
Release Phase II
commitments
Phase III
Release Phase III commitments
Classroom component for Phase III continues
Manage Phase III exchange process
Classroom component for Phase III begins
September
Meet with Senior
Class
Consult on CRII
final assignments
Enter CRII grades
October
Recruit additional
commitments for
Phase I
Review health
forms
Complete Phase II Classroom component for Phase III continues
assignments
November
December
January
Review list of
Phase I
commitments and
finalize
assignments
Notify students of
Phase I
assignments
No tasks
Prepare Phase II
assignment letter
Classroom component for Phase III ends
No tasks
No tasks
No tasks
Prepare Phase III pre-assignment list
CIA Begins
85
Month
February
Phase I
No tasks
Phase II
No tasks
Phase III
Consult on CIA MT assessments
March
No tasks
No tasks
Consult on CIA Final assessments
CIB begins
Consult on CIB MT assessments
April
No tasks
No Tasks
May
Enter final grades
Consult on CRI
MT assessments
Consult on CIB Final assessment
Enter CIA and CIB Grades
86
Clinical Education Advisor
Month
June
Phase I
No tasks
Phase II
Review CRI Final
assessments
No tasks
July
No tasks
No tasks
Review Phase III assignments
August
No tasks
Review CRII MT
assessments
No tasks
September
No tasks
Phase III CEIMs
October
No tasks
Review CRII Final
assessments
Review Phase II
assignments
No tasks
No tasks
No tasks
No tasks
No tasks
Phase II CEIMs
Complete CIA MT assessments & calls
Phase II CEIMs
Review CIA final assessments
November
December
January
February
March
484 CC –
coordinate with
CEPC
484 - Review SP
assignments
No tasks
484 - Review
CEAs selfassessment
484 - Small group
meeting
484 - Read
reflection
484 - Read
reflection
Phase III
87
Phase III CEIMs continue
Phase III CEIMs continue
April
May
Small group
meeting; read
reflection and
respond
Review Phase I
final PW and
submit grade to
CC
CRI Begins
Review CIB MT assessments and calls
Review CRI MT &
assessments
Review CIB final assessments
88
Clinical Education Program Coordinator
Month
June
July
August
Phase I
Prepare Class Sign - Rosters
– Class Packet will be
Available to Blackboard Learn
– Make class available to
Blackboard Learn – Give
Students access to
Acadaware to upload health
forms
No Tasks
Email Recruitment Mailing for
Phase I
Give Class access to HIPAA
and OSHA Training online
Phase II
Finalize CRII
CI/Student pairs in
CPI
Review Phase II
commitments
w/DCE
Pull Phase II
preferences from
Acadaware portal to
backdoor of
database
89
Phase III
Review Phase III
Commitments w/
DCE
General Tasks
Obtain an electronic
copy of Certificate
of Insurance.
CIB Send out
CEUs
Update Clin Ed
Website
Pull Phase III
preferences from
Acadaware portal to
backdoor of
database
All Phases – Obtain
Letter of Indemnity
from DCHS and
Coordinate PPD
tests with Student
Health and DCHS.
Coordinate with
Phase III CC and
prepare course
packet
Update Clin Ed
Website
All Phases – Assist
with PPD testing in
DCHS
Update Clin Ed
Send out Phase III
Website
first mailing
confirming
Send out CI
assignment with site credentialing
announcement to
CCCEs and CIs
Clinical Education Program Coordinator
Month
Phase I
September Enter SP commitments for
Phase I
October
November
Phase II
Send out Phase II
student packets to
sites
Download health form data
from Acadware and enter in
SP commitments
No tasks
Order Senior Nametags
No tasks
Enter in class points
and download
health docs from
Acadaware for
Phase III
Prepare Phase III
and send out 2nd
assignment mailing.
Generate Commitment List
December
Prepare and email Phase I
assignment packets
Phase III
Enter in Phase III
class points
Send out Phase II
first mailing to
clinical sites
Match Phase III
students/CIs in CPI
Coordinate w/ CC and
prepare Phase I course
packet
January
Prepare sign-in sheets &
enter class points
General Tasks
All Phases –
Schedule 2nd PPD &
Flu Vaccine in
DCHS
Update Clin Ed
Website
Update Clin Ed
Website
Assist with CI
credentialing course
Order Christmas
Cards
Update Clin Ed
Website
Send out Christmas
Cards
Update Clin Ed
Website
Coordinate with
Phase II CC and
prepare course
packet
90
Prepare Phase III
pre-assignment list
CIA Confirm
CI/Student match in
CPI
Collect data for
Annual
Accreditation Report
Update Clin Ed
Website
Clinical Education Program Coordinator
Month
February
Phase I
Enter Phase I class points
Phase II
Enter in Phase II
class points
Phase III
Match CIB
student/CI in CPI
Prepare CRII and
send assignment
packets
March
Enter Phase I class points
Enter Phase II in
class points
Send CIA CEUs to
CIs
Match CRII
student/CIs in CPI
April
May
Enter Phase I class points
Enter Phase I class points
and send CEUs to CIs
Enter Phase II class
points
Distribute CRII
commitment list to
sites
No tasks
91
General Tasks
Prepare annual
recruitment packet
Update Clin Ed
Website – Start 360
Degree prep (Every
3 years)
Distribute annual
commitment
recruitment packet
Send out 360
Degree Survey
(Every 3 years)
No Tasks
Send CIB CEUs to
CIs
Update Clin Ed
Website
Enter commitments
from annual
recruitment
Update Clin Ed
Website
Enter commitments
from annual
recruitment
Update Clin Ed
Website
Collect data for
annual clinical
education report
Appendix C: Request for Student Accommodation Forms
Disabilities Accommodation Form
Program in Physical Therapy
Saint Louis University
Student Name:
Medical Diagnosis (optional):
Restrictions:
Accommodations Needed for Clinical Experiences:
I give my permission for the Program in Physical Therapy at Saint Louis University to
release the above information to my clinical instructors regarding accommodations
needed for clinical experiences.
__________________________________________________
92
NAME
(DATE)
Notification of Accommodations
Program in Physical Therapy
Saint Louis University
This information is confidential only to be released to those individuals directly involved
with the educational experiences of this student.
Clinical Supervisor:
Facility:
Date:
Student Name:
Accommodations:
_________________________
Carol Beckel, PT, PhD
Director of Clinical Education
__________________________
<CCCE Name>
Center Coordinator of Clinical
Education
93
Appendix D: Annual Statement and Policy Documents
Confidentiality Statement
Saint Louis University
Program in Physical Therapy
Student Confidentiality Agreement
I have been asked by the Program in Physical Therapy at Saint Louis University to abide by the
Generic Abilities as they relate to maintaining the confidentiality of all information. I understand that
the Program in Physical Therapy reminds its students of their confidentiality obligation on a periodic
basis to help ensure compliance.
I agree to maintain confidentiality of all information, data and the like in electronic, paper, or verbal
form that is considered by the Program in Physical Therapy to be private and confidential which
includes, but is not limited to, information contained within individual file folders located in the file
cabinet of the Department’s reception area, test/quiz scores, laboratory practical results, health
information, criminal background checks, and transcripts. I agree not to reveal, disclose or otherwise
allow any other person(s) to gain access, directly or indirectly, to confidential information.
I understand that I will be subject to disciplinary action if I violate this Confidentiality Agreement.
Disciplinary action may include dismissal from the Program to Physical Therapy. By my signature
below, I commit to maintaining confidentiality.
Print Name
SLU ID Number:
Freshman
Signature:
Date:
Sophomore
Signature:
Date:
Junior
Signature:
Date:
Senior
Signature:
Date:
94
T: PT Share/Program Committee /Student Affairs/STUDENT CONFIDENTIALITY AGREEMENT 11-8-07
Letter of Indemnity
1
SAINT LOUIS UNIVERSITY
HEALTH PROFESSIONAL LETTER OF INDEMNITY
July 1, 2013 – June 30, 2014
1. NATURE AND EXTENT OF PROTECTION
a. This protection is a voluntary undertaking by Saint Louis University, subject to the terms and
limits set forth herein, to pay on behalf of those protected, all sums those protected may become
legally obligated to pay as compensatory damages because of injury or death to any person arising
out of the rendering of, or failure to render, health care services. The “sums” referred to in the
preceding sentence shall include payment of judgments, settlements, attorneys’ fees, investigative
fees, witness fees and other similar litigation expenses.
b. Health professional liability protection is afforded to Saint Louis University employees and duly
registered students of Saint Louis University at the Saint Louis University Medical Center for
occurrences during the performance of health care related duties for, or under the auspices or
direction of Saint Louis University, or during the performance by them of other health care activities
with the permission or approval of Saint Louis University by and through the Dean of the School of
Medicine or his/her designee.
i. As used herein, the term “employee” refers to full-time and part-time salaried faculty members of
the various departments and schools of the Saint Louis University Medical Center, voluntary faculty
members when serving under the direction and authorization of the appropriate dean, and any other
person employed by Saint Louis University to render or assist in health care.
ii. As used herein, the term “student” means students at the Saint Louis University Medical Center
and includes residents, interns, medical students, graduate students, fellows, undergraduate students
or any other person in student status as designated in writing by the Dean of the School of Medicine
of Saint Louis University or his/her designee.
iii. The sole person authorized to grant the “permission or approval” referred to in Paragraph b is the
Dean of the School of Medicine of Saint Louis University or his/her designee and the “permission or
approval” shall be stated in writing except when the health care services of the employee or student
are those customarily or regularly engaged in by persons employed or enrolled in Saint Louis
University at the Saint Louis University Medical Center.
00022282-1 Page 2 of 6
95
c. Protection is afforded to each protected individual for professional services rendered as emergency
aid in a “Good Samaritan” capacity.
d. Protection is provided under this agreement to any person performing volunteer health services
without remuneration, on or off the University’s premises, only if their participation has been
approved in advance and in writing by the Dean of the School of Medicine of Saint Louis University,
or his/her designee, upon recommendation of the appropriate Department Chairperson.
e. Full-time faculty members on sabbatical or other leave shall be covered only if they are receiving
University salary during the period of leave, and only if their participation in providing health
services has been approved in advance and in writing by the Dean of the School of Medicine of Saint
Louis University, or his/her designee, and only if no remuneration other than salary from Saint Louis
University is received by the faculty member for the performance of health care services.
f. The protection provided hereunder shall be applicable only with respect to health care services
rendered by the person seeking protection while such person is acting as an employee, student or
protected person within the meaning of this document and during the time this document is effective,
and only to the extent provided by this document. If these conditions are met, the protection here
rendered is effective regardless of the status of the person seeking protection at the time a claim is
asserted or any loss is settled or paid.
g. Persons covered under this agreement may carry, or be entitled to the benefit of, other liability
coverage. When there is other indemnity or insurance covering professional liability which would be
available to the person seeking to be protected hereunder if this document and its protection did not
exist, then the protection provided hereunder, including the defense of claims and suits against
protected employees or students, shall be limited to the excess over and above such other indemnity
or insurance and shall be void and inapplicable to the extent of such other indemnity protection or
insurance. This is true regardless of any “other insurance” or similar language in such other
indemnity or insurance agreements. For the protection of this document to be applicable as excess
protection, the person covered by other indemnity or policy of insurance shall take all necessary
measures to enforce the coverage provided by such other sources. If for any reason the protection
here provided be deemed or held to be on a contributing basis with other indemnity, protection or
insurance, such contribution shall be on an equal basis with such other protection, and shall in no
event be based on any ratio involving policy, coverage or indemnity limits.
00022282-1 Page 3 of 6
96
2. EXCLUSIONS
This protection does not apply:
a. To bodily injury and/or psychological injury to any employee of Saint Louis University arising out
of, and in the course and scope of, his/her employment by Saint Louis University;
b. To any obligation for which Saint Louis University or any insurance company as insurer of the
person affected may be held liable under any Workers’ Compensation, unemployment compensation,
disability benefits law, or under any similar law;
c. To injury or damage resulting from the acts or omissions of an employee or student while
intoxicated, under the improper influence of drugs or narcotics, or engaged in a criminal act, or to
harm willfully or intentionally caused, provided that this exclusion shall not be a bar to protection for
any other employee or student against whom a claim is made as the result of such acts or omissions,
unless said other employee or student participating in the providing of health services knew or should
reasonably have been expected to know that the services performed, or to be performed, by another
person providing services, were subject to the terms of this exclusion;
d. To property damage to property owned, occupied or used by, rented to, or in the care, custody or
control of, or over which physical control is being exercised for any purpose, by Saint Louis
University, its employees or students;
e. To any employment relationship with an employer other than Saint Louis University or any selfemployment situation furnishing health care services, unless the protection of this document has been
extended in writing, in advance, by the Dean of the School of Medicine of Saint Louis University or
his/her designee;
f. To any injury, claim, expense, demand, settlement, suit, judgment or damages involving undue
familiarity, sexual intimacy, sexual misconduct or assault concomitant therewith;
g. To statutory or other fines;
h. To injury or damage resulting from acts or omissions of any employee or student that are contrary
to law;
i. To injury or damage resulting from acts or omissions of any employee or student that exceed or go
beyond the scope of the written permission or approval previously granted by the Dean of the School
of Medicine of Saint Louis University, or his/her designee, unless such acts or omissions
00022282-1 Page 4 of 6
97
occur during the providing of emergency aid in a “Good Samaritan” capacity.
j. To claims or suits that are not promptly disclosed and reported in the manner provided in Section 3
of this document;
k. To any claim, suit, liability, expenses, demands, settlements or judgments for which coverage has
been contractually assumed by another insurance plan or an entity other than Saint Louis University.
3. PROTECTED PERSONS’ DUTIES IN THE EVENT OF OCCURRENCE, CLAIM OR
SUIT
a. Upon becoming aware of any actual or alleged injury or incident with the potential for later giving
rise to a claim, or upon receipt of a notice of a claim or suit to which this protection applies, the
involved employee or student must notify the Associate General Counsel of the actual or alleged
injury or incident, including particulars sufficient to identify the protected person and any reasonably
obtainable information with respect to the time, place and circumstances thereof, and the names and
addresses of the injured person and of any available witnesses. These notices may be provided either
by accessing the online incident reporting link at slucareincident.slu.edu, by calling in to the incident
reporting line at 314-977-8778, or by hand-delivering said notification to the Associate General
Counsel in the General Counsel’s Medical Center Office at 3556 Caroline Mall, Caroline Building,
Room C-307. Such notices shall be made or delivered within 48 hours of the involved employee or
student becoming aware of the incident, injury or claim. These notices are prepared in anticipation of
litigation, for the use of our attorneys, and are intended to be privileged attorney-client
communication prepared for the purpose of seeking legal advice. If any other policy of insurance or
other indemnification is applicable to any of the persons providing health care who were involved in
the reported incident, the report should indicate the name of the provider of other coverage, their
address and the amount of coverage.
4. ASSIGNMENT OF PROTECTION
a. The interest hereunder of a protected person is not assignable. If the protected person should die or
be adjudged incompetent, this coverage will inure to the benefit of the protected person’s legal
representative with respect to liability previously incurred and covered by this document.
5. DEFENSE AND SETTLEMENT OF CLAIMS AND SUITS
a. Saint Louis University shall, through counsel and personnel of its choice, defend claims and suits
against the protected person, even if one or more of the allegations of the claim or suit are
groundless, false or fraudulent.
00022282-1 Page 5 of 6
98
b. Saint Louis University and its attorneys may offer counsel with respect to claims for punitive or
exemplary damages without voiding other provisions of this document and without incurring liability
to pay any judgment or claim for or on account of punitive or exemplary damages.
c. As a condition of coverage under this agreement, all protected persons hereby assign their right to
waive any conflicts of interest, with respect to the retention of counsel, to Saint Louis University.
This assignment shall become null and void to the extent a claim involves allegations outside the
scope of protection provided hereunder.
d. Saint Louis University may settle any claim or suit brought against any protected person, as it
deems proper. Any protected person may be consulted prior to settlement to determine their views
concerning compromise. However, Saint Louis University, through its authorized representatives,
shall ultimately determine whether settlement shall occur and at what amount and the decision shall
be final.
e. All protected persons, as a condition for the protection afforded, shall be required to cooperate
fully with Saint Louis University and its designated counsel and personnel in processing and
defending any claims or suits directed against any protected person or against Saint Louis University
as a result of the activity of the protected person.
6. EFFECTIVE DATES
a. Subject to all terms and conditions contained herein, this Letter of Indemnity covers protected
persons for claims or suits arising from health care services rendered July 1, 2013 through June 30,
2014 irrespective of the date a claim for damages or lawsuit is first presented to the protected person
or Saint Louis University. Claims and suits presented February 28, 1998 and after, but related to
health care services rendered prior to February 28, 1998, will be governed by the Letter of Indemnity
in effect at the time of the subject health care service.
7. LIMIT OF FINANCIAL LIABILITY
a. The extent of protection provided by Saint Louis University for any one occurrence is $2,000,000,
inclusive of allocated claims adjustment expenses and irrespective of the number of protected
persons potentially liable for any one occurrence. This $2,000,000 per occurrence limit is applicable
to each and every occurrence during the effective period, regardless of the number of occurrences or
the aggregate amount of claims paid during the effective period.
b. In addition to the levels of protection provided by this Letter of Indemnity, Saint Louis University
has purchased, on behalf of the institution and on
00022282-1 Page 6 of 6
99
behalf of all protected persons, excess professional liability insurance having a combined aggregate
limit of $25,000,000 for the effective period. Any coverage provided by the excess insurance policies
described above is subject to each policy’s respective terms and conditions.
8. AMENDMENT AND MODIFICATION
a. The terms of this document can be amended or modified by Saint Louis University as it deems
necessary and changes shall be expressed in writing. Such changes shall be sent to Saint Louis
University employees and duly registered students of Saint Louis University at the Saint Louis
University Medical Center. Such changes shall be prospective only, unless otherwise expressly
provided in writing. Only the Dean of the School of Medicine of Saint Louis University or his/her
designee has the authority to grant exceptions to the terms of this document, and any exceptions
granted must be in writing.
9. TERMINATION
a. This voluntary protection program outlined herein will remain in force through June 30, 2014. It
may, at the option of Saint Louis University, be terminated and replaced, in whole or in part, by a
modified or different voluntary protection program or a policy or policies of insurance or reinsurance
with limits of liability as selected by the University.
b. This voluntary protection program may be terminated by Saint Louis University at its discretion
upon thirty (30) days notice to those protected hereunder.
July 1, 2013
Philip O. Alderson, MD
Dean, School of Medicine
100
Release of Student Information to Clinical Sites
Program in Physical Therapy
Saint Louis University
I am scheduled for clinical experiences outside of Saint Louis University. The
institutions where I am scheduled to complete my clinical rotations require that Saint
Louis University Program in Physical Therapy release my phone number, social security
number, immunization and PPD records, the results of my criminal background check,
documentation of my HIPAA and OSHA education attendance before I begin clinical
training.
Therefore, I authorize Saint Louis University Program in Physical Therapy to release my
phone number, social security number, immunization and PPD records, background
check, and attendance records for HIPAA and OSHA education to the institutions where
I am scheduled for clinical training.
This permission extends for the duration of my enrollment as a student at Saint Louis
University Program in Physical Therapy. I understand that I may withdraw this
permission by notifying the Director of Clinical Education in writing. However,
withdrawal of this authorization will not affect information that has already been
released.
I understand that withdrawing my permission may prevent my placement at outside
clinical sites and prevent my Program in Physical Therapy program completion.
I understand that the information disclosed pursuant to this authorization, may be
subject to re-disclosure by the recipient institutions and may no longer be protected by
federal regulations.
101
The Doisy College of Health Sciences
Policy and Procedure Following a Confirmed Affirmative Criminal Background Check
Purpose:
The Doisy College of Health Sciences is affiliated with a variety of organizations that provide
our students with learning experiences in actual practice settings. Students and faculty are bound
by certain requirements mandated by these affiliate facilities and their accrediting bodies to
maintain these collaborative arrangements. This policy is implemented to meet the criminal
background check requirement.
Definitions:
The following definitions are presented for the purpose of this document:
Learning Experiences: This term is used in reference to all coursework that occurs
in a practice setting (inclusive of, but not limited to: clinical rotation, clinical practicum,
fieldwork experience, experiential learning, supervised practice; or professional practice)
through the application of knowledge and skills in actual patient/client-centered situations
in a health care facility, community based facility, or school environment.
Criminal Background Check (“CBC”): A background check search of an individual’s personal
record through Federal and State law enforcement databases to identify individuals who have
committed serious crimes.
Individuals with a criminal history would then be identified and determined whether or not they
are disqualified from employment, educational, practicum, clinical and volunteer placement by
law because their presence would create an unacceptable risk to patients, residents, students,
affiliate organizations, and staff.
Affirmative Criminal Background Check: Any confirmed finding of a prior charge and/or
conviction on a CBC, or more stringent criteria as may be required by an affiliate facility, that
may preclude a student’s participation at an affiliate facility.
An exhaustive list of disqualifying crimes does not exist at this time. The following are
examples of criminal offenses that would prohibit learning experiences at some facilities and
might impede curricular completion: (terms are those used in Missouri criminal codes http://www.moga.mo.gov/STATUTES/STATUTES.HTM)



Offenses against the Person (murder, manslaughter, assault, harassment, kidnapping,
child abduction, elder abuse, invasion of privacy)
Sexual Offenses (rape, child molestation, sexual misconduct)
Robbery, Arson, Burglary, and Related Offenses (robbery, arson, tampering, property
damage, trespass).
Background Information:
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A majority of the Doisy College of Health Science’s learning experience facilities mandate that
CBC’s be performed on all persons having any opportunity for patient/client interaction. This
includes employees and volunteers, as well as students. A CBC revealing a charge and/or
conviction for certain crimes could result in a ban from participation in learning experiences and
thus prevent graduation. Therefore, every student in the Doisy College of Health Sciences whose
academic program requires her/him to participate in learning experiences in an affiliate facility
will be required to undergo the level of CBC required by their major department and/or the
affiliate facility.
The Office of Clinical Education Compliance has a detailed policy that outlines the procedure for
obtaining a CBC through the University. Please refer to the Office of Clinical Education
Compliance (34-977-6636 or http://www.slu.edu/office-of-the-university-registrarhome/background-checks#Students) or your department for a copy of this policy.
The timing of a CBC will be in concert with the student’s program/department or affiliate facility
policies. A single negative check does NOT preclude the requirement of additional checks at a
future time. Students should be aware that any affirmative results from a CBC could
restrict ability to participate in a learning experience and therefore restrict ability to
complete degree requirements. In addition, the lack of an acceptable report on a CBC could
bar the student from sitting for licensure examinations and thus from practice in certain
professions.
In the event that a student’s CBC is reported “affirmatively” the student will have the
opportunity to contest the report by requesting an additional CBC at the student’s expense. In
the event that an Affirmative CBC is confirmed, the compliance officer will notify the
designated University department official.
Procedure:
Obtain a signed release from each student for the department to send CBC information
to appropriate clinical sites regardless of findings.
In the event of a confirmed Affirmative CBC, the following procedure will be enforced:
1. The program/department designee will receive a report from the University Compliance
Officer. The program/department designee will then notify the department chair or the
program director.
2. The program/department designee will send a summary letter titled “Conduct &
Investigations Form (Appendix A) to the appropriate affiliates outlining the findings of the
criminal background check.
3. If a student is reported to have an Affirmative CBC, program/department designee must take
the opportunity at that point to counsel the student on the meaning of an Affirmative CBC
(this may result in a delay or failure to complete remaining learning experiences and
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ultimately the program of study) and how it will impact current and future progression in the
respective program as well as their future professional practice.
4. If the student would like to proceed with the learning experience it is the student’s
responsibility to contact the affiliate facility and make it aware of the confirmed
Affirmative CBC charges.
a. The student needs to inform the affiliate facility of the case #, the date of the
incident, and any details pertinent to the charge.
5. Official CBC reports to affiliate facilities will only be released through Saint Louis
University’s Office of the Registrar-Office of Clinical Education Compliance. The affiliate
facilities have the ultimate right of acceptance or refusal of the student.
6. If the affiliate facility states they will except the student for the scheduled learning
experience, the affiliate facility needs to provide the appropriate DCHS program/department
with the following information on the affiliate facility’s letter head:
a. A statement stating they know that a background check on “student name” has
yielded adverse findings. The affiliate facility needs to specifically state the
charge(s) and that it has been made aware of the charge(s) by the student.
b. The letter needs to state the case # and date of charge and or conviction.
c. A statement stating they will allow “student name” to complete the learning
experience at the specific affiliate facility.
d. The affiliate facility needs to identify the specific learning experiences the
student will be allowed to participate in at its site.
7. If a student is accepted by the initial affiliate facility regardless of the confirmed Affirmative
CBC, the student may participate in the scheduled learning experience at the affiliate facility.
Each subsequent affiliate facility, with the requirement that a student is to provide a CBC,
however, will also have the right of refusal. If a student is refused by a proposed affiliate
facility he/she should be aware that he/she will not be allowed to complete the assigned
learning experience at that affiliate facility.
8. The program/department designee will notify the student that an affiliate facility has refused
a student placement due to a confirmed Affirmative CBC. In the event that a student is
unable to complete the program/department required learning experiences at any of the
DCHS affiliate facilities, the student’s case would then go through the specific
program/department review process.
9. If a student did not disclose a criminal history on his/her application for the CBC, and is
found to have such a record, the appropriate program/department designee will be notified of
the falsification by the University Compliance Officer in the Office of Clinical Education
Compliance. If the inconsistency is due to a prior charge and/or conviction that should have
been removed from the student’s record (and the student can produce documentation
confirming it should have been removed from the record prior to the CBC), no further action
will be taken. If, however, it is found that the falsification was deliberate and intentional,
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the student’s case will be reviewed by their program/department and based on the
program/department according to the policy and procedure manual.
Appendix A
Office of Clinical Education Compliance
Conduct & Investigations Verification Form
The Missouri Revised Statute Section 660.315 and the Missouri Department of Elementary and
Secondary Education (DESE) require institutions prior to hiring, placements for practicum,
clinical and or volunteer; identify individuals who have committed serious crimes that would
disqualify them from working with patients, residents and or students. Saint Louis University
adhering to the Missouri State Statute and DESE guidelines requires each student to obtain a
Missouri Highway Patrol and Federal Bureau of Investigations (FBI) Fingerprint Background
Check. The results of the fingerprint background check are sent directly to the University.
The following student, ____________________________, had a FBI and Missouri Highway
Patrol Fingerprint Background Check on _______________. The results of the check are as
follows:
__ No open criminal records reported from Missouri Highway Patrol.
__ Criminal history record reported by Missouri Highway Patrol.
__ No open criminal records reported from FBI.
__ Criminal history record reported by FBI.
__ No open criminal records reported from EDL.
__ Criminal history record reported from EDL.
For certification and/or employment purposes, the fingerprint results are valid for twelve
months from the date of this letter. Please be advised that pursuant to §43.540, RSMo Supp.
2008, you may only use these results for “… determining the suitability of an applicant or a
volunteer. The information shall be confidential and any person who discloses the information
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beyond the scope allowed in this section is guilty of a class A misdemeanor.” Do not copy or
share these results with other employers.
(Your Name)
(Department)
If you have any questions please contact Felicia C. Echols, Saint Louis University Coordinator of
Clinical Education Compliance – Office of the Registrar, at 314-977-6636.
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The Doisy College of Health Sciences
Drug Screening Policy
The Doisy College of Health Sciences is committed to maintaining a safe, healthful, and efficient learning
environment, which enhances the welfare of our employees, students, patients, and visitors. We therefore
strictly prohibit the use of illegal substances by our students. This concurs with the Saint Louis
University Office of Student Conduct Drug and Alcohol Abuse Prevention Policy
(http://www.slu.edu/x25107.xml).
While Saint Louis University does not require drug testing of their students, an increasing number of our
affiliate facilities do as a matter of individual institutional policy. Therefore, in accord with the
University’s position on drug abuse and as a direct result of institutional policies of our affiliate facilities,
many Doisy College of Health Sciences students learning experience placement requires students to
undergo drug screening prior to being assigned to their learning experience(s). Unless a student’s
learning experience placement facility requires other procedures to be followed, the procedures set forth
in this policy will apply.
If the affiliate facility requires that the University assure students have satisfactorily passed a drug screen,
these screening procedures will be performed by Saint Louis University’s Student Health and Counseling
Service. Students will be responsible for any charges related to the drug screen.
A single negative drug screen does not preclude the requirement of additional screens for future
learning experience placements. The need for additional drug screens will be based on affiliate facility
requirements.
The current procedure for Doisy College of Health Sciences students needing to obtain a drug screen is as
follows:
1.
Students will fill out an authorization form at the program/department level for the
release of student information. This will include the release of their name and
program/department to Student Health and Counseling Services for drug screening and
the release of screen results to their department/program designee and to the affiliate
facility if requested.
2.
Students must go to Student Health and Counseling Services at Marchetti Towers (East)
with their Saint Louis University picture identification badge. Initial screening tests will
be performed on site.
3.
Students complete required student health paper work and provide a urine sample on site
for testing. If confirmatory testing is not required (i.e. the sample is clearly negative in
the screening procedure), a negative report will be sent to the appropriate
program/department designee.
4.
If confirmatory laboratory testing is required (i.e. the test site requires additional
clarification), the sample is sent to an independent external laboratory. This will require
additional time to obtain the results and may require that the student be contacted for
additional information by Student Health and Counseling Services charged with
interpreting the confirmatory test. This may require students to produce documentation
of prescription medication that could influence the test results. Students are not required
to disclose information related to prescribed medicine to their
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program/department/college faculty or staff. The student must respond to Student
Health and Counseling Services within 7 days or the test may be reported as
positive. The lab confirmatory test will have an additional charge. If this confirmatory
test is reported to the program/department as negative no further action is required.
5.
If the lab confirmatory test is positive the program/department designee will receive a
copy of the report. A student’s learning experience placement could be delayed or
canceled following a positive drug screen, as well as being subject to
program/department review.
6.
Any student dismissed as a result of this policy has a right to appeal. The appeal will
follow the guidelines and procedures outlined by the University and the student’s
respective program/department.
7.
For additional information on the drug screening policy and how it is applied to your
program of study please contact the faculty member in your program/department that
coordinates learning experiences.
________________________________
Student Signature
________________________________
Student Name – Printed
________________________________
Date
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