STUDENT CLINICIAN HANDBOOK
or
BASTYR UNIVERSITY
NATURAL HEALTH CLINIC
2000 - 2001
00-01 Bastyr University Student Clinician Handbook
TABLE OF CONTENTS
....................................................................................................................................................................................... 1
BASTYR UNIVERSITY .................................................................................................................................................. 1
NATURAL HEALTH CLINIC ........................................................................................................................................ 1
WELCOME ...................................................................................................................................................................... 4
AOM DEPARTMENT OVERVIEW .............................................................................................................................. 4
NATUROPATHIC MEDICINE DEPARTMENT OVERVIEW ................................................................................. 4
NATUROPATHIC MEDICINE ...................................................................................................................................... 5
DOCTORATE DEGREE PROGRAM IN NATUROPATHIC MEDICINE .............................................................. 5
AOM MEDICAL STAFF................................................................................................................................................. 6
ND MEDICAL STAFF..................................................................................................................................................... 6
NUTRITION MEDICAL STAFF ................................................................................................................................... 7
CLINIC CONTRACT ...................................................................................................................................................... 7
SECTION I: CLINIC EDUCATION REQUIREMENTS ............................................................................................ 9
NUTRITION PREREQUISITES TO ENTER CLINIC ................................................................................................ 9
ND PREREQUISITES TO ENTER CLINIC.................................................................................................................. 9
AOM
PREREQUISITES TO ENTER CLINIC ..................................................................................................... 9
CLINIC ENTRY COURSES.......................................................................................................................................... 11
ND CLINIC ENTRY I .................................................................................................................................................... 11
AOM CLINIC ENTRY .................................................................................................................................................. 12
ND CLINIC ENTRY II ................................................................................................................................................... 14
SUMMARY OF ND CLINIC REQUIREMENTS ...................................................................................................... 15
MSAOM AND CCHM HERBAL CLINIC REQUIREMENTS................................................................................. 21
NUTRITION SUMMARY OF CLINIC REQUIREMENTS ...................................................................................... 21
ND COUNSELING SHIFT GUIDELINES ................................................................................................................... 23
INTERACTION BETWEEN CLINIC AND COUNSELING CENTER .................................................................... 24
ND PRECEPTORSHIP I, II, III .................................................................................................................................... 26
AOM PRECEPTORSHIP (OPTIONAL) ..................................................................................................................... 27
CLINIC OUTREACH/COMMUNITY EDUCATION ................................................................................................ 29
AOM PROGRAM CHINA EXTERNSHIP .................................................................................................................. 30
AOM PROGRAM CHINA EXTERNSHIP APPLICATION FORM ........................................................................ 31
ABSENCE AND SUBSTITUTION ............................................................................................................................... 35
SUBSTITUTE/EXTRA HOURS ................................................................................................................................... 37
BASTYR UNIVERSITY ................................................................................................................................................ 43
EXAMPLES OF CLINIC EVALUATION FORMS: .................................................................................................................. 47
Clinical Skills ................................................................................................................................................................... 47
AOM PROGRAM OBSERVATION EVALUATION ................................................................................................ 53
AOM PROGRAM INTERNSHIP EVALUATION ..................................................................................................... 55
LOSS OF CREDIT, SUSPENSION, DISMISSAL ....................................................................................................... 58
CLINIC GRIEVANCE POLICY ................................................................................................................................... 61
PROFESSIONAL CONDUCT .................................................................................................................................... 62
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Student/Professional Code of Ethics: ...................................................................................................................... 62
CODE OF ETHICS OF THE ....................................................................................................................................... 63
BASTYR UNIVERSITY NATURAL HEALTH CLINIC ........................................................................................... 63
Introduction............................................................................................................................................................. 63
CLINIC GUIDELINES FOR DRESS, HYGIENE AND GENERAL APPEARANCE................................................ 64
IMMUNIZATION POLICY ..................................................................................................................................... 66
PATIENT VISIT PROCEDURES.......................................................................................................................................... 68
ND/AOM/ NUTRITION CASE MANAGEMENT CONSIDERATIONS ................................................................. 72
PATIENT CHARTS ....................................................................................................................................................... 77
MEDICAL RECORDS ................................................................................................................................................... 79
INSURANCE .................................................................................................................................................................. 79
PAGERS/CELL PHONE USAGE ................................................................................................................................. 80
PATIENT SCHEDULING ............................................................................................................................................. 82
HANDWASHING AND DISINFECTION.................................................................................................................... 86
SENTINEL EVENTS ..................................................................................................................................................... 88
RESIDENCY INFORMATION .................................................................................................................................... 91
PRINCIPLES OF NATUROPATHIC MEDICINE .................................................................................................... 92
PRINCIPLES OF TRADITIONAL CHINESE MEDICINE....................................................................................... 93
ND LEARNING OBJECTIVES FOR SECONDARY CLINICIANS .......................................................................... 95
LEARNING OBJECTIVES FOR PRIMARY CLINCIANS ........................................................................................ 95
AOM CLINICAL TRAINING - LEARNING OBJECTIVES...................................................................................... 96
Observations Objectives.......................................................................................................................................... 96
Internship Objectives .............................................................................................................................................. 96
ND CLINICAL COMPETENCIES ............................................................................................................................... 97
PLEASE NOTE: DISPENSARY SECTION IS UNDERGOING REVISION .......................................................... 116
AOM CLINICAL TRAINING - LEARNING OBJECTIVES ................................................................................... 125
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WELCOME
Welcome to the Bastyr University Natural Health Clinic! You are about to embark on a very
exciting and wonderful part of your training at Bastyr University. The Bastyr University Natural
Health Clinic is expected to provide 36,000 patient visits this year. The services of each program
and the integration between programs offer some of the best natural medicine care anywhere! The
Staff and Medical Staff of the Natural Health clinic are excited about your entry into the clinic and
look forward to your unique and important contributions.
The mission of the Bastyr University Natural Health Clinic is to create an extraordinary
environment committed to excellence in health care and clinical education that assists and
empowers individuals and the community to achieve better health and a higher quality of life.
AOM DEPARTMENT OVERVIEW
Since its establishment in 1988 the Department of Acupuncture and Oriental Medicine (AOM) has had a
strong clinical component at its full-time. A new AOM wing of the Natural Health Clinic opened in 1993 to
provide room for continual growth in the department. In addition, the Chinese Herbal Medicine Dispensary
opened in 1994 to provide the full-time element for the Chinese Herbal Medicine clinical training. In Spring
1999, the AOM clinic was relocated to the third floor of the Natural Health Clinic. The AOM clinic now
has nine acupuncture treatment rooms, several preview/review rooms, a library, and a suite of Medical Staff
offices. The third floor is also home to the CHM dispensary. Students in the AOM programs may also
participate in patient care opportunities at three off-site clinics: Rainier Valley in south Seattle, Highland
park in West Seattle, and King County Medical Clinic in Issaquah.
Unique aspects in the AOM clinic include a strong case management focus implemented as case previews
and reviews, inter-clinic multi-disciplinary referrals (ND, Nutrition, Physical Medicine, Homeopathy, etc.),
and supervision by highly skilled/qualified acupuncturists and Chinese Herbalists in the region.
We hope that your clinical experieince in the AOM department is a rewarding one. We would also
encourage you to consider the following quote from the NEI JUNG as a guide for your medical education
here at Bastyr Natural Health Clinic: “ Alas, The way of healing is so profound. It is deep as the oceans,
and boundless as the skies. How many truly know it? When sages practiced medicine, they were certain to
have understood the laws of nature and principles of disease, to master diagnosis, to have been well learned
in herbal medicine, and to have attained insights into human relationships and individual temperament. As a
result, they delivered their medicine in a thoroughly holistic way.
The key to effective medicine is to determine the cause and rectify the imbalance of the yaun/original qi of
the body. Study the ancient medical classics well. Follow the correct treatment principles and perform your
healing with the utmost care and attention. Conduct yourself with the highest virtue and always have
compassion toward your patients. In this way you will be outstanding in your cures and never cause
malpractice. This is the way of the sage physician.” Welcome to the beginning of your journey.
NATUROPATHIC MEDICINE DEPARTMENT OVERVIEW
The naturopathic clinical program provides training in general naturopathic practice for naturopathic
medical students of Bastyr University. This training comprehensively covers core naturopathic modalities,
including General Medicine, Physical Medicine, Homeopathy, and Psychotherapeutic Counseling.
Naturopathic medical students at Bastyr Clinic progress through their training in observing, supporting, and
then managing roles. Each role assumes increasing responsibility for patient care. Prior to graduating
students are able to safely, competently, and efficiently direct all aspects of patient diagnosis, treatment, and
management in a general care setting. Emerging from naturopathic clinical training, each clinician will
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exemplify the integration of conventional medical knowledge and skills with traditional principles of
healing. At the core of this integration is the self-reflective and self-empowered desire on the part of each
clinician to provide the highest quality of care to each and every one of their patients.
NHC ADMINISTRATION AND STAFF
Following are the key administrators and staff of the NHC:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Jane Guiltinan, ND – Dean of Clinical Affairs
Lise Alschuler, ND - Clinic Medical Director
John Joplin – Clinic Manager
John Hibbs – N.D. Clinic Program Coordinator
Mary Cucco, MS, L.Ac. – A.O.M. Clinic Program Coordinator
Suzanne Myer – Nutrition Clinic Program Coordinator
Susan Sanford - Clinic Registrar (located on main campus)
Terry Courtney, MPH, L.Ac. - AOM Program Chair
Sally Ringdahl, N.D. – Naturopathic Medicine Program Chair
Mark Groven, ND – Physical Medicine Department Chair
Ellen Goldman, ND – Homeopathy Department Chair
Keith Grieneeks, Phd – Counseling Coordinator
Roberta Lord – Clinic Administrative Coordinator
Joseph Yurgevich – Patient Services Manager
Mike Ard-Kelly – Operations Manager
Ann Busch – Dispensary Manager
Matt Ferguson, MS, L.Ac. – Chinese Herbal Medicine Dispensary Manager
Kelly Wright – Products Review Coordinator
Martha Diehl – Preceptor/Off-site clinic Coordinator
Adrienne Kemmish – Lab Manager
Tammi Graves – Marketing Coordinator
Christine Shields – Business Manager
PROGRAMS OF STUDY
Naturopathic Medicine
Doctorate Degree Program in Naturopathic Medicine
Acupuncture and Oriental Medicine
The AOM Program currently runs three clinical programs:
1. Masters of Science in Acupuncture (MSA)
2. Masters of Science in Acupuncture and Oriental Medicine (MSAOM)
3. Chinese Herbal Medicine Certificate in Chinese Herbal Medicine (CCHM)
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Nutrition
The Nutrition Program currently offers two clinical programs:
1. Masters of Science in Nutrition – Counseling track
2. Bachelors of Science – D.P.D.
MEDICAL STAFF BY PROGRAM
AOM MEDICAL STAFF
Following are the AOM Teaching Clinic supervisors. All supervisors are Washington State
licensed acupuncturists:
AOM Core and Full Time Medical Staff:
1. Qiang Cao, ND, L.Ac. - Acupuncture, Chinese Herbal Medicine
2. Terry Courtney, MPH, L.Ac. – Acupuncture - Chair, Acupuncture and Oriental
Medicine Program
3. Wei Yi Ding, RN, L.Ac - Acupuncture, Chinese Herbal Medicine
4. Mary Cucco, MS, L.Ac. – Acupuncture – AOM Clinic Program Coordinator
5. Chongyun Liu, L.Ac. - Acupuncture, Chinese Herbal Medicine
6. Yajuan Wang, L.Ac. – Acupuncture, Chinese Herbal Medicine
7. Ying Wang, L.Ac. - Acupuncture, Chinese Herbal Medicine
AOM Part-time Medical Staff:
1. David Bove, ND, L.Ac. – Acupuncture
2. Chu-Lan Chiong, L.Ac. – Acupuncture
3. Jim Dowling, M.Ac., RN, L.Ac., Acupuncture
4. Matt Ferguson, MS, L.Ac. – Chinese Herbal Medicine
5. Pat Flood, MS, L.Ac., - Acupuncture
6. Susan Heideke, MS, L.Ac. - Acupuncture
7. Kayo King, L.Ac. – Acupuncture
8. Andy McIntyre, MS, L.Ac. – Acupuncture
9. Yuanming Lu, MS, L.Ac. – Acupuncture, Chinese Herbal Medicine
10. Tuan Nguyen, MS, L.Ac. - Acupuncture
11. Joseph Perlmutter, MS, L.Ac. – Acupuncture
12. Michael Pope, MS, L.Ac. - Acupuncture
13. Gwendolyn Rousch, M.Ac., L.Ac. - Acupuncture
14. Kate Yonkers, MS, L.Ac. - Acupuncture
ND MEDICAL STAFF
Following are the clinic supervisors in the naturopathic program. All supervisors are licensed in
Washington State:
ND Core and Full Time Clinic Supervisors
1. Lise Alschuler, ND - Naturopathic Physician
2. Debra Brammer, ND- Naturopathic Physician
3. Ellen Goldman, ND- Naturopathic Physician, Homeopathy
4. Keith Grieneeks, PhD - Counseling
5. Mark Groven, ND - Naturopathic Physician, Physical Medicine
6. Jane Guiltinan, ND- Naturopathic Physician
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7. John Hibbs, ND - Naturopathic Physician
8. Eric Jones, ND - Naturopathic Physician
9. Andrew Parkinson, ND - Naturopathic Physician, Physical Medicine
10. Bill Roedel, PhD - Counseling
11. James Wallace, ND - Naturopathic Physician, Physical Medicine
12. Alan Gaby, MD- Allopathic Physician
Part-time ND Medical Staff
1. Karim Abdullah, ND - Naturopathic Physician
2. David Bove, ND, L.Ac. - Naturopathic Physician
3. Jill Fresonke, ND- Naturopathic Physician
4. Bruce Friend, ND- Naturopathic Physician
5. Marlene Haverty, ND, L.Ac.- Naturopathic Physician
6. Glenn Hoey, ND- Naturopathic Physician
7. Brad Lichtenstein, ND- Naturopathic Physician
8. John Little, ND – Naturopathic Physician
9. Richard Mann, ND - Naturopathic Physician, Homeopathy
10. Jana Nalbandian, ND- Naturopathic Physician
11. Dirk Powell, ND- Naturopathic Physician
12. John Sherman, ND - Naturopathic Physician
13. Kelly Wright, ND - Naturopathic Physician, Dispensary
NUTRITION CLINIC SUPERVISORS
Nutrition Medical Staff
1. Buck Levin, Ph.D., RD- Nutrition
2. Scott Murdoch, Ph.D., RD - Nutrition
3. Suzanne Myer, MS., RD – Nutrition
4. Anne Fittanti, MS, RD - Nutrition
CLINIC CONTRACT
By signing this document I am verifying that I have thoroughly read and familiarized myself with
the Clinic Handbook. I have especially noted the following areas and made note of the differences
in these areas between Academic Classroom Policy and Procedures and Clinic Policy and
Procedures.




CLINIC REGISTRATION PROCESS AND POLICIES
ADD/DROP PROCESS AND DEADLINE POLICIES
PAPERWORK DUE DATES
CLINICAL COMPETENCIES
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
PROFESSIONAL CONDUCT AND CODE OF ETHICS
I will adhere to all confidentiality procedures and policies, knowing that all patient information is
confidential and should never be removed from the clinic or discussed outside of the clinic.
I understand and agree that I am responsible for knowing and understanding all the information
contained within this Clinic Handbook.
signed ___________________________________
dated ______________
GIVE SIGNED COPY TO CLINIC REGISTRAR FOR FILE BEFORE ENTERING CLINIC.
PLEASE KEEP A COPY FOR YOUR RECORDS.
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SECTION I: CLINIC EDUCATION REQUIREMENTS
A. STUDENT CLINICIAN HANDBOOK PURPOSE AND EXPLANATION
This notebook is the required textbook for AOM and ND Clinic Entry Courses, and for Nutritional
Assessment Course. It will be distributed to each student at the beginning of these courses. The Clinic
Handbook is required in clinic for all clinical training programs, as it contains the important
information, policies and protocols that students must know in order to be in the clinic. Students are
responsible for knowing all information contained within the notebook (see contract).
Students keep all completed work and forms, and copies of all clinic related paperwork, in this
workbook. (Originals are to be turned in to Clinic Registrar).
B. PREREQUISITES TO CLINIC ENTRANCE BY PROGRAM
NUTRITION PREREQUISITES TO ENTER CLINIC
Students must complete and achieve competency in all required courses prior to entering clinic.
Students must be in good academic standing.
ND PREREQUISITES TO ENTER CLINIC
1.
Students must complete and achieve competency in all required first and second year classes of the
4-year track or all required classes in the first, second and third years of the 5-year track, prior to
entering clinic. Students must be in good academic standing in order to begin the clinical training
portion of their program.
2.
Students must complete and achieve competency in Clinic Entry I, or equivalent course.
3.
Students must complete and achieve competency in Clinic Entry II, or equivalent course. Clinic
Entry II includes a clinic entrance exam, which the student must pass.
4.
NOTE: All Advanced Standing/Transfer Students must meet all clinical training requirements.
Advanced Standing/Transfer Students must be in good academic standing. Advanced Standing
students will not be granted waivers of any clinical training credits, hours, or other requirements.
Students must have proof of CPR and Advanced First Aid/Emergency Response training, or
equivalent experience. Verification of training must be on file in the Clinic Registrar’s office.
Students must complete a Washington State Patrol criminal background check.
5.
6.
AOM PREREQUISITES TO ENTER CLINIC
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Observation Status:
1.
2.
3.
4.
Students must be matriculated into the AOM program.
Students must complete and demonstrate passing grades in all required first quarter AOM academic
classes.
Students must complete and have a passing grade in Clinic Entry.
Students must complete a Washington State Patrol criminal background check
For Internship Status:
1.
Must have completed 4 observation shifts
2.
Must be matriculated in the MSA or MSAOM degree program and have successfully passed all
required courses in the first 5 quarters of AOM and basic science curriculum and be in good
academic standing.
3.
Must have a current CPR card.
4.
Must have passed the Clean Needle Technique exam and passed the AOM Clinic Entry exam with a
minimum score of 80.
The Clinic Entry Exam may only be attempted once per quarter. If a second
failure occurs, this will require a meeting with the student’s academic advisor in consultation with
the AOM Program Chair. A learning contract will be established which may require a student to
retake a class(s) or other remedial measures. Successful completion of the learning contract must be
accomplished before a retake. A third failure places the student in academic probation, which may
lead up to and include dismissal from the AOM program.
5.
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CLINIC ENTRY COURSES
ND CLINIC ENTRY I
1.
This course is registered and paid for the 1st quarter of the 1st year of the 4 and 5 year track and is to
be completed by the end of Spring Quarter of the first year.
2.
credits: 1.0
3.
hours: 21.5
4.
a.
Course Objectives:
To provide students with a well-rounded experience with the Natural Health Clinic, from a patient’s
perspective. This course is designed as an experiential class for the student. Students can choose
not to receive the recommended treatment. A student can choose to have a wellness program
designed if there are no specific health concerns to be addressed, or if the student prefers not to use
recommended treatments.
b.
To provide the students with exposure to and experience with the medicine they are studying.
c.
To prepare students for Clinic Entry II, the next prerequisite for entry into the clinic after achieving
competency in CE 1.
d.
5.
a.
To complete a study of Medical Terminology with a programmed text.
Course Requirements:
Quarterly and Final all-class meeting
between Students and Instructor.
4.0 hrs
b.
First Office Call:
1.5 hrs
c.
Return Office Call:
1 hr
d.
Physical Medicine: (4 different modalities)
4 hrs
e.
Nutrition Specialty Clinic:
(Nutrition Consultation)
1 hr
f.
Wellness Assessment:
1 hr
g.
Counseling Session:
3 hrs
(includes 2 visits - these will be done at the student counseling center at the main campus)
h.
5 case previews:
2.5 hrs
i.
5 case reviews:
2.5 hrs
j.
Self-Study with Medical Terminology programmed text- open time.
k.
Final exam in medical terminology
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1 hour
6.
7.
Each student will be required to write three papers, discussing their experience in the clinic. These
papers are to be turned in to the CE I Instructor for the course, at the quarterly and final meetings.
Students will receive a CE I tracking sheet that will be a record of the requirements for the class. It
will need to be initialed and dated where appropriate.
8.
The CE I instructor will meet with the class as a whole during scheduled one hour meetings at the
beginning of Fall, Winter and Spring Quarters to answer questions and share information pertinent
to the class.
9.
The class will meet with the Instructor at the end of Spring Quarter for a final discussion group.
Course tracking sheets, student essay, and final examination are due and should be turned in
together at this time.
10.Final exam in medical terminology during finals week of Spring Quarter.
AOM CLINIC ENTRY (NOTE: beginning in Fall 2000 AOM Clinic Entry 1 and Clinic entry 2 are to
be combined.)
1. Prerequisite: AOM Enrollment
2. Credits: 1.0
3. Hours: 1.0/week, 11 total hours
4. Required Text: Student Clinician Clinic Notebook
5. Course Objectives:
a) The student will gain a perspective on clinic purpose and function
b) The role of the observer and intern clinician will be clearly defined
c) The student will be introduced to skills that will allow her/him to become familiar with case
management, including charting.
d) The student will be introduced to the paperwork and paper flow in the clinic.
e) The student will know the role of each person in the clinic structure and how she/he will interact
with these people.
f) The student will learn the clinic policies, procedures, protocols and clinical education
requirements.
g) The student will be exposed to the ethical and moral issues of acupuncture and clinical practice
and how these issues relate to the clinic as a whole and to each person as an individual within the
clinic.
h) The student is encouraged to continue to develop and broaden her/his own personal philosophy
of AOM
i) To provide the students with exposure to and experience with the medicine they are studying.
j) To prepare students for entry into the clinic.
Course Requirements:
1.
a. Course introduced in classroom
2.0 hours
b. First Office Call: Acupuncture
1.5 hours
c. Second Office Call: Chinese Herbal Med.
1.5 hours
d. Return Office Visits 1.o hour each)
2.0 hours
e. 2 case previews
1.0 hours
f. 2 case reviews
1.0 hours
g. End of Quarter Class Session
2.0 hours
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2.
3.
4.
5.
6.
A clinic entry journal is required of all students as well as a summary statement of learning to be
turned in at the final class meeting.
Students will receive a CE tracking sheet that will be record of the requirements for the class. It will
need to be initialed and dated where appropriate a d included in your clinic entry journal.
Students must receive a grade of AC or better to enter the clinic.
This course is designed as an experiential class for the student. A student can choose to have a
wellness program designed if there are no specific health concerns to be addressed.
The required text for this course is, Acupuncture Risk Management, by David Kailin.
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ND CLINIC ENTRY II
1.
Prerequisites:
a. Clinic Entry I
b. The student in the four-year program is required to have completed all first year courses and Fall
and Winter second year classes in order to receive an AC in Clinic Entry II. The student in the
five-year program is required to have completed all 1st and 2nd year courses and all Fall and
Winter 3rd year courses in order to receive an AC in CEII.
2.
Credits: 1.0
3.
Hours: 2.0 hrs/week; 22 total hours
4.
Required Text: Student Clinician Clinic Notebook
5.
Course Objectives:
a.
The student will gain a broader understanding of Naturopathic Medicine as it relates to
clinical practice.
b.
The student will gain a perspective on clinic purpose and function.
c.
The role of the 3rd year student clinician will be clearly defined
d.
The student will be introduced to skills that will allow her/him to become familiar with case
management, including charting, as performed in the Natural Health Clinic.
e.
The student will be introduced to the paperwork and paper flow in the clinic.
f.
The student will know the role of each person in the clinic structure and how she/he will
interact with these people.
g.
The student will learn the clinic policies, procedures, protocols and clinical education
requirements.
h.
The student will be exposed to the ethical and moral issues of medicine and clinical practice
and how these issues relate to the clinic as a whole and to each person as an individual
within the clinic.
The student is encouraged to continue to develop and broaden her/his own personal
philosophy of Naturopathic Medicine.
i.
6. The student will be required to pass a clinic entrance exam in order to receive an AC in Clinic Entry II.
7.
Student must receive a grade of achieved competency in CE II in order to enter the clinic.
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SUMMARY OF ND CLINIC REQUIREMENTS
Following is a summary of the requirements students will need to meet in the Naturopathic Degree Program
order to graduate and be eligible to sit for board examinations:
1.
Total number of shifts:
25
(includes patient care, clinic assistant, preceptorship)
2.
Total number of hours:
1,233
(includes patient care, clinic assistant, preceptorship, interim clinic, clinic grand rounds, and
outreach/community education)
3.
Total number of patient contacts:
350
(includes patients seen in the clinic: in general patient care, homeopathy, counseling and physical
medicine, sub and extra hours, interim clinic, float rooms)
Following is a breakdown of the requirements for shifts, hours and patient contacts:
1.
a.
Shifts:
patient care shifts:
20
(16 general patient care, (includes up to 2 counseling, and may include up to 4 homeopathy), and 4
physical medicine)
b.
clinic assistant rotation/seminar: 2
(1 lab and 1 dispensary)
c.
preceptorship shifts:
3
(to be done in doctors/health care professionals/clinics outside Bastyr Clinic)
2.
a.
Hours:
patient care hours:
880
b.
clinic assistant hours:
88
c.
preceptorship hours:
132
d.
interim clinic hours:
Interim clinic is registered as patient care # 17
80
e.
outreach/community education hours:
ND and dual enrolled students Outreach requirements for graduation:
1) Hours:
20
2) At least 5 hours must be completed by the end of Winter Quarter of the first year in clinic.
3) At least 10 hours must be completed by the end of Summer Quarter of the second year in clinic.
4) At least 15 hours must be completed by the end of Winter Quarter of the second year in clinic.
5) Any remaining hours must be completed by mid-Spring Quarter of the second year in clinic.
3.
Patient Contacts:
a.
students need 350 patient contacts in the 20 patient care shifts, interim clinic, sub and extra
hours, a minimum of 175 must be primary contacts.
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4.
5.
6.
b.
this averages to 17.5 patients for each of the 20 shifts and would be less when including
patients seen on interim clinic, and during sub and extra hours
c.
this averages to about 1.5 patients for each 4 hour shift
Credits:
a.
patient care shifts:
40 credits
b.
clinic assistant rotations:
4 credits
c.
preceptor shifts:
3 credits
d.
interim clinic:
2 credits
e.
outreach
Hour requirement
The following must occur for completion of the clinical training program:
a.
A grade of AC must be achieved for each clinic shift.
b.
All Clinical Competencies must be signed-off by supervising medical staff.
c.
All Clinical Hours must be completed, all patient contact requirements must be
met, and all required paperwork must be completed and submitted.
A student will not receive their degree until all requirements are met at a level of
achieved competency and the clinic medical staff recommends the student for their ND
degree.
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ND PATIENT CARE (PC) SHIFTS AND CLINIC ASSISTANT (CA) ROTATIONS
1.
Patient Care includes general patient care, physical medicine, homeopathy specialty shift and
counseling specialty shift.
2.
Clinic Assistant includes lab and dispensary.
3.
Required for patient care:
a.
20 patient care shifts
(includes patient care shifts #1-16 one of which is a pre-assigned counseling shift [see
counseling shift guidelines] and physical medicine shifts #1-4)
b.
It is required that each student be enrolled in at least one patient care shift every quarter that
they are clinic eligible with the exception of the summer between their 2nd and 3rd years (on
4 year track) or the summer between their 3rd and 4th years (5 year track). However, failure
to register for a patient care shift during this summer may prohibit completion of all
required clinic shifts by expected graduation date and thus delay graduation.
c.
Off-site clinics, specifically, Community Health Clinic of Redmond, Covenant Shores
Nursing Home, and 45th St. Homeless Youth Clinic may fulfill a student’s patient care
requirements. A student must receive approval from the supervising medical staff and the
Clinic Medical Director in order to be registered for a shift at the 45th St. Homeless Youth
Clinic. The student needs to submit a written request to the Clinic Off-site Coordinator, in
order to be considered for the 45th St. Clinic shift. Deadline for the submission of this
request is posted quarterly.
4.
Required for clinic assistant:
a.
1 lab rotation
5.
b.
1 dispensary rotation
c.
88 hours
Interim clinic requirements: (pt. care 17)
a.
All 80 hours must be done in Patient care or Physical Medicine.
b.
Students will be scheduled for Interim according to the preceding quarter shift schedule, and
responsible for the shifts they were on the same day/time as during the preceding quarter.
c.
6.
No more than 4 shifts can be taken in homeopathy (see additional shift request, #9 below)
a.
Prerequisites must be completed prior to entering a specialty shift. (Homeopathy classes 14).
b.
7.
Students will be automatically registered for PC 17 in Spring Quarter of their graduating
year. An AC for PC 17 depends upon successful completion of all required interim shifts.
Clinic Department Chair/Supervising Medical Staff approval must be granted in order to be
on a specialty shift related to that department
Students need to take 2 physical medicine shifts each year, for a total of 4 shifts. (see additional
shift request, #9 below)
a.
Only 1 physical medicine shift should be taken in any one quarter.
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b.
Prerequisites must be met before taking physical medicine shifts.
8. Students must register for a minimum of 2 shifts and a maximum of 4 shifts per quarter in any quarter in
which they are clinic eligible and enrolled at Bastyr University. At least one of these clinic shifts must
be a patient care shift. Students may not register for more than 2 shifts on any given day.
9. Students wishing to take additional specialty shifts beyond the required or maximum number
(homeopathy, counseling), or extra physical medicine, must have requests to do so approved by clinic
medical staff. Written requests must be submitted to the Clinic Medical Director who will then seek the
approval of the naturopathic medical staff.
10. Minimum and maximum amount of shifts: homeopathy 0- 4, counseling 1 - 2, physical medicine 4 – 6.
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AOM SUMMARY OF CLINIC REQUIREMENTS (MSA AND MSAOM)
Following is a summary of the requirements students will need to meet in order to graduate and be eligible
for NCCAOM diplomat status and Washington State acupuncture licensure (L.Ac.):
Clinic Observation
Clinic pre-requisites:
1. Successful completion of Clinic Entry I.
2. AOM enrollment and good academic standing with passage of all required first quarter classes.
3. Current CPR card
4. Completion of Observation Check-off Form
Credits/Shifts:
Credits: 8 total (1 credit = 22 hours; 2.0 credits per shift)
Shifts: four 2-credit shifts plus 0.5 credits (12 hours) interim clinic
Hours: 188 total hours
AOM Clinic Internship
Internship pre-requisites:
1. Must have successfully completed 4 observation shifts
2. Must be matriculated in the MSA or MSAOM degree program and have successfully completed
the first 5 quarters of AOM and basic science curriculum and be in good academic standing.
3. Must have a current CPR card, must have passed the Clean Needle Technique exam and passed
the AOM Clinic Entry exam with a minimum score of 80.
Acupuncture Intern B and Acupuncture Intern A:
1. Acupuncture Intern B (AIB): after successfully passing the Clinic Intern Entry Exam, the
student will enter internship as an Acupuncture Intern B. During the first 100 patient treatments
supervisors will closely observe and guide the clinician. When the AIB nears his or her 100th
treatment an evaluation is required with the AOM Clinic Program Coordinator.
2. Acupuncture Intern A (AIA): After the AIB successfully completes the first 100 treatments
and had been evaluated, and given recommendation to continue, they may proceed through
internship with more autonomy but continued consultation and assistance of the supervisors.
A minimum total of 300 additional patient treatments are expected of students who have
achieved Acupuncture Intern A status. (a total of 400 patient treatments is required by AOM
Interns)
Credits/Shifts:
1. Credits: MSA: 38 credits/836 hours (1 cr. = 22 hours)
MSAOM: 56 credits/1232 hours (1 cr. = 22 hours)
2. Shifts:
MSA: 14 2-credit shifts plus 1-credit (24 hours) interim clinic for MSA.
MSAOM: 14 2-credit shifts plus 1-credit (24 hours) interim clinic and 8 2-credit Chinese Herbal
Medicine shifts plus a 2-credit dispensary shift and a 2-credit clinic project for MSAOM.
3. Full-time students taking internship are strongly advised to take only 2 internship shifts for
their first quarter. Remaining quarters should average 2-3 shifts per quarter. No less than 2
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shifts and no more than 4 shifts can be taken per any given quarter. Students must register
for clinic shifts during every quarter in which they are clinic eligible and enrolled at Bastyr
University.
4. China Externship Option: Approved sites only. Up to 8 credits of internship may be
registered for in the China externship program. AOM Program Chair will review patient
contacts. China Externship requires application and good academic standing. Third year is
the preferred time for the China Externship.
5. External clinic shift: (formerly Advanced Preceptor) Up to 2 credits of External clinic shift
may be available to students with strong academic standing. As with observation, External
clinic shift hours are 44 per 2 credits. For more information contact Clinic Registrar.
6. Off-Site Clinic Sites: The AOM Clinical program currently offers several clinical training
sites outside of the Natural Health Clinic. These sites include Rainier Park Medical Clinic,
Highpoint Medical Clinic, and Redmond Community Medical Clinic. Observation students
must be in their 3rd observation shift before registering for an off site clinic. Interns in good
academic standing are eligible for registering for off site clinic opportunities. It is strongly
preferable that a student be in at least their 5th intern shift before registering for an off site
clinic. Students with less experience as either an observer or intern must have the written
pre-approval of the supervising medical staff and the AOM Clinic Program Coordinator
before registering for an off-site clinic shift.
Clinic Outreach:
20 hours of clinic outreach is required of all AOM students. (see section on Outreach for description)
AOM Outreach requirements for graduation:
a. Hours: 16
b. At least 4 hours must be completed by the end of Summer Quarter of the second year in clinic.
c. At least 8 hours must be completed by the end of Fall Quarter of the second year in clinic.
d. At least 12 hours must be completed by the end of Winter Quarter of the second year in clinic.
e. Any remaining hours must be completed by mid-Spring Quarter of the second year in clinic.
Specialty Clinics:
At present the NHC runs the following specialty clinics within AOM:
1. Immune Wellness Clinic: A clinic option focusing on HIV and AIDS. Students are asked to
commit to 3 consecutive quarters. There is an emphasis on integrated therapy and education
in the field of AIDS.
2. Herb Clinics: Third year MSAOM or Certificate of Chinese Herbal Medicine students only
are allowed into the Herb Clinic shifts.
3. AOM/ND Integrated Shift: This shift combines AOM clinic with ND clinic under the
supervision of a licensed ND, L.Ac. for students entered in both AOM and ND programs.
Credit will be given for AOM hours and contacts only.
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MSAOM and CCHM Herbal Clinic Requirements
Herbal Clinic Intern:
1.
Credits: 16 credits over no less than one academic year
2.
Shifts: 8 2-credit shifts including interim coverage
Hours: 352
3.
Prerequisites: CH 6803 CHM Clinic 1 (observation) may be taken concurrently
with Materia Medica 1 – 3. Must have completed CH 5411, 6412, 6413
(Materia Medica 1 – 3) prior to starting as an Intern.
Herbal Dispensary:
This two-credit course is designed to teach, in a practical hands-on method, the art and science of preparing
and dispensing Chinese herbs. Students may register for dispensary any time after their Herbal Medicine
Curriculum has begun.
CHM Clinical Project:
Students are required to do a clinical project related to Chinese Herbal Medicine.
(2 credits)
NUTRITION SUMMARY OF CLINIC REQUIREMENTS
Following is a summary of the requirements students will need to meet in order to graduate and be eligible
to sit for board examinations:
1. Total number of shifts: 1 shift for BSDPD students and 3 shifts for MS counseling track
students
2. Total number of hours: 44 hours for 1 shift
3. Total number of patient contacts: MS counseling track students must see 10 patients as a
primary and 15 patients as a secondary. There are no requirements for BSDPD student.
4. Patient Contacts:
Students need patient contacts in the patient care shifts, interim clinic, sub and extra hours,
a minimum of 10 for three shifts must be primary contacts. Minimum of 15 must be
secondary contacts.
5. The following must occur for completion of the clinical training program:
A grade of AC must be achieved for each clinic shift.
All Clinical Competencies must be signed-off by supervising faculty.
All Clinical Hours must be completed, all patient contact requirements must be met,
and all required paperwork must be completed and submitted.
6. A student will not receive their degree until all requirements are met and the clinic faculty
recommends the student for their degree.
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SHIFT GUIDELINES FOR N.D. PATIENT CARE and AOM OBSERVATION AND
INTERN SHIFTS
1. Clinic medical staff will take attendance at case preview and review of each shift.
a. If a student is 15 minutes late for either preview or review, she/he will be marked absent for that 30
minutes, and will need to make up that time.
b. If a student misses case preview, she/he will be marked absent for the entire 4-hour shift, and that
time will need to be made up.
2. Students are responsible for having their Time Sheet at each shift.
a. Four hours is the maximum that can be counted on each shift.
b. Students need to have the supervising doctor/medical staff initial the Time Sheet each week.
3. Students are required to keep a summary of patient contacts from all shifts, interim clinic and sub and
extra time. These are to be recorded on the Summary of Patient Contacts Form, and each patient contact
must be initialed by the supervising doctor/medical staff directly involved with each patient. ND: Must
designate each contact as either Primary (P) or Secondary (S). AOM: Must designate each contact as
either FPI or SPI.
4. Hours lost due to absences, snow days or holidays need to be made up at some point before graduation.
100% of program hour requirements need to be completed.
5. N.D. and AOM: At least 80% attendance is required to receive a grade of IP (in progress) which will
convert after missed hours are made up to achieved competency for each quarterly shift (holidays and
emergency closures excluded). Two excused absences per shift are allowed. Three excused absences for
an IP grade may be allowed under special circumstances at the discretion of the supervisor, otherwise
the student will receive a F grade for the shift. Four or more absences will result in a failure for the
shift, with loss of all hours and patient contacts. An excused absence is an absence for which the student
has properly filled out and returned all required paperwork in a timely manner. Note that an excused
absence requires that a clinician identify and confirm a student substitute. (see absence policies)
6. Unexcused absences are not accepted. One unexcused absence will result in an automatic failure for the
entire quarter’s shift, with loss of all hours and patient contacts. An unexcused absence is defined as
failing to arrive for a scheduled shift, without calling the shift supervisor and clinic administrative
coordinator prior to the start of the shift. Even if the student calls the supervisor prior to the missed
shift, the shift supervisor reserves the right to sanction a student if, in the estimation of the supervisor,
the reason for the student’s absence does not warrant missing the shift. This sanction will include
requiring the student to make up an additional 8 hours to the 4 shift hours missed.
7.
Students must complete chart notes for all patient visits and phone contacts within 24 hours of the
contact. Incomplete charts must be appropriately labeled and notes and treatment plan from the visit
must be in the chart. These charts must remain in the clinic at all times and are left in the supervising
medical staff’s “chart box”. Violation of this policy will result in a clinic sanction, resulting in loss of
that days’ shift hours and patient contacts. Repeated violations of this policy will result in a failure of
the entire quarterly shift. (Including loss of those shift hours, and patient contacts).
8.
Students should become familiar with Section on Lab and the Section on Dispensary in the Clinic
Handbook.
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ND COUNSELING SHIFT GUIDELINES
1. Absences: All absences must be excused. All hours missed must be made up in counseling. This can
be done through 1) interim clinic, or 2) if off-shift counseling privileges are given by the counseling
supervisor, (this is done by seeing a patient in a float room, if available, or during the counseling shift.
A note signed by the counseling shift supervisor signifying approval for off-shift counseling is required
to be in the student’s file at the CR’s office.
2. Substitutes: Substitutes are not used when a clinician is absent from a counseling shift. Absence/sub
paperwork procedure must still be followed, with the exception of leaving the “name of substitute” line
blank.
3. Off-Shift Counseling: Students who have completed a counseling shift may be given off-shift
counseling privileges in order to continue counseling patients they have been working with on the
counseling shift. This would include an allowance to see patients (one per patient care shift) outside of
the counseling shift. Each patient must be assessed by meeting with the counseling supervisor prior to
their first session, (or during the first session). Students must meet with the counseling supervisor
between each patient visit for supervision. A note signed by the counseling shift supervisor signifying
approval for off-shift counseling is required to be in the student’s file at the CR’s office.
4. Interim Shifts: Interim counseling shifts are available to those clinicians currently on a counseling shift,
to those needing to make up any previous counseling absences, or if the need arises, by approval of the
counseling supervisor. Only those who already have taken a counseling shift may sign up for an interim
counseling shift.
5. Second Shift Requests: Students wishing to take a second shift may do so depending upon the
availability of openings. Sign up is through the Clinic Registrar. See Clinic Policy regarding taking
more than the required amount of patient care specialty shifts. No more than 2 counseling shifts may be
taken.
6. Counseling Shift Assignments: Students will be randomly assigned a counseling shift, during their first
clinical year, and must take the shift during the quarter assigned.
All Clinic eligible Naturopathic students will be assigned to counseling shifts during their first
year in clinic.
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INTERACTION BETWEEN CLINIC AND COUNSELING CENTER
1. Counseling Center Student Staff Counselors will not provide counseling services in both locations
(clinic services at the Natural Health Clinic and counseling services in the Campus Wellness Center),
but must only provide counseling at the Campus Wellness Center.
2. This policy is an attempt to safeguard both the student receiving services and the student clinician
providing services from a potential conflict of interest, i.e. harassment, that could result from exposure
in a dual role setting.
3. Only under special circumstances will an exception be granted. The CEI student must submit the
request in writing. The student’s staff counselor must also submit a statement in writing. The requests
will be reviewed by the Counseling Center Director, the Clinic Medical Director, and all appropriate
clinic shift supervisor (i.e. AOM, Counseling, ND, Nutrition, etc.) All involved reviewers must approve
the request.
4. Due to ethical consideration, all student clinicians may not “self-refer” student clients to their own
private practice, outside the NHC.
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INTERIM CLINIC
Interim Clinic differs from regular clinic shifts, occurring at the end of a quarter in order to provide ongoing care for our patients during academic breaks.
You are RESPONSIBLE FOR SHIFT COVERAGE and are required to find substitutes for your interim
shifts if you will not be able to attend.
1. N.D.: Interim clinic Requirements for graduation:
a.
credits: 2
b.
hours: 80
To be completed over the course of all weeks of Interim clinic.
(note: students are automatically registered for Interim Clinic credits (2) during the Spring Quarter
of their fourth year. This will appear on registration form as PC 17)
2.AOM: Interim clinic Requirements for graduation:
Requirements for observation:
a)
credits: 0.5
b)
hours: 12
To be completed over the course of all weeks of Interim clinic.
Requirements for Internship:
a)
credits: 1
b)
hours: 24
To be completed over the course of all weeks of Interim clinic.
(note: students are automatically registered for Interim Clinic credits (2)
3. NUTRITION: Please note that Nutrition students are strongly encouraged to register for interim clinic and
effective within the year, may be required to complete 8 hours (0.5 credit) of Interim.
4.
Interim clinic may be offered during the following times:
a)
Winter break, between Fall and Winter Quarter *(2-3 weeks)
b)
Spring break, between Winter and Spring Quarter* (1 week)
*PLEASE NOTE: Due to Calendar changes, Interim weeks are subject to change without notice. Please be
advised of this possibility and plan to complete this requirement as early as possible during the program.
5. Patients seen during interim clinic on patient care shifts are counted towards the total number of patient
contacts. Students should use the Patient Summary Form to keep a record of the patient contacts. In the
ND program, all 80 hours must be in Patient Care/Physical Medicine.
6. Additional interim hours [above the 80 hours (ND) or 36 hours (AOM) required] can be used to make
up shift hour deficits from the current or past quarters. These hours should be tracked on the Substitute
and Extra Form, and patient contacts on the Summary of Patient Contacts Form.
7. Students will be responsible for interim clinic shifts during the same days/times they were scheduled for
shifts during the preceding quarter. Absence requests must be approved by supervisor and submitted two
weeks prior to the start of the interim period. Additional shifts may be requested and taken during the
interim period, if desired.
8. At the end of each interim clinic, all paper work must be turned in to the Clinic Registrar to receive
credit.
9. Unexcused Absences during Interim Clinic will result in a requirement to make up the 4 hours missed
plus an additional 16 hours for each missed shift. These hours are in addition to the required interim
hours for each program.
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ND PRECEPTORSHIP I, II, III
General Information and Student Responsibilities.
1. Preceptorships give students the opportunity to receive valuable observational and/or hands-on
experiences with practitioners established in private practice or other community settings. All students
in the naturopathic medicine program are required to complete a total of 132 hours of preceptor
experience. Students must precept at a minimum of three sites with a minimum of 20 hours at any one
site. Half of these hours (66) may be done prior to entering the clinic. 88 of your preceptor hours must
be with a ND. The balance may be done with other pre-approved health care practitioners.
2. All preceptor sites must be approved before beginning your experiences. Pre-approved sites are
found in the Preceptor Site Resource Books located in both the clinic and campus libraries. Site
descriptions include the preceptor’s specialties, hours available, student requirements and the types of
opportunities you could expect at the site. Students are always encouraged to develop new sites. If you
would like to suggest a new preceptor site for approval please contact the Preceptor Coordinator.
3. Students are responsible for reviewing site descriptions to ensure they meet the preceptor’s current
requirements (i.e. level of training, dress code, etc.). If you meet these requirements you may contact
the preceptor (or their contact person listed) to request a preceptorship and arrange a schedule.
4. Documentation: Students are responsible for keeping the following written records (contained in this
packet) for each site:
Student Preceptor Plan
Time sheets
Patient Contact sheets
Self-evaluation
Student Evaluation of Preceptor
The preceptor also evaluates the student. This Student Evaluation/Hours Form may be completed with
you, or at a later date and then sent to the Preceptor Coordinator.
All paperwork must be completed, signed, and submitted to the Preceptor Coordinator no later
than a month after the completion of each experience.
5. Registration: Generally, Preceptorships should be registered for in the following sequence:
Preceptorship I: Fall quarter of 4th year on 4 year track, 5th year on 5 year (1 credit )track.
Preceptorship II: Winter quarter of 4th year on 4 year track, 5th year on 5 year (1 credit )
track.
Preceptorship III: Spring quarter of 4th year on 4 year track, 5th year on 5 (1 credit ) year track.
Registration is done on campus, not at the clinic.
6. All completed Preceptorship documentation and grades will be forwarded to the Clinic Registrar for
placement in your student file. Until the completion of your clinical training, a “Y” grade will appear on
your transcript for Preceptorships.
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AOM PRECEPTORSHIP (OPTIONAL)
1. Preceptorship hours consist of observation and hands-on experience at sites outside the Natural Health
Clinic, and replaces Observation IV.
2. Required for preceptorship:
Shifts: 1
a) Hours: 44
b) Credits: 1
c) Paid for Summer of first year.
3. The Preceptor Coordinator and the AOM Clinic Program Coordinator must approve all preceptorship
placements before starting at the site.
4. A Preceptorship Notebook is kept in the clinic listing all of the current preceptor sites. Students are also
encouraged to find their own sites. Once a student wants to begin he/she must contact the Clinic
Preceptor Coordinator.
5. Students are responsible for knowing the information in the preceptor information packet available at
the Natural Health Clinic. Be certain to have all appropriate paperwork filled out and signed.
6. After completing the preceptor shifts, the completed paperwork should be turned in to the AOM Clinic
Program Coordinator for evaluation. A grade will be given for each shift. A copy of the evaluation,
grade and other documentation will be forwarded to the clinic registrar.
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ND & AOM ADVANCED EXTERNAL CLINIC SHIFT (formerly Advanced Preceptor)
1. A N.D. student may only apply for External Clinic shifts after the following are completed:
a. All 132 hours (3 shifts) of preceptorship must be completed, submitted and grade received.
b. Eleven patient care shifts must be completed with a grade of achieved competency in each. (this
does not include Physical Medicine)
2. An AOM student may only apply for External clinic shifts after the following are completed:
a. Observation Requirements must be complete and student in good academic standing.
b. Eight intern shifts must be completed with a grade of achieved competency in each.
3. Both AOM & ND student requests for external clinic shift must be typewritten and submitted to the
respective Clinic Program Coordinator. The request should include:
a. A brief statement as to the reason for the request, number of preceptorship hours already
completed and number of patient care or intern shifts completed.
b. The name of the external clinic site and supervising clinician.
c. The number of hours to be completed (44 hours is equivalent to 1 shift, 88 hours are the
maximum allowable).
d. A letter from the supervising physician or acupuncturist of the external clinic shift must also be
submitted with the request outlining what the student will be doing; assurance that hands-on
experience will be provided is required for approval. If the external clinic shift supervisor is
not already an approved preceptor site, please contact the Preceptor Coordinator for application
materials.
4. 4. The Clinic Program Coordinator will present the student’s request to the clinic medical staff for
consideration of approval through voicemail or at the next scheduled medical staff meeting. The
clinic medical staff will make a decision.
5. If the request is approved, a copy of the request, signed by the Clinic Program Coordinator, will be
sent to the Clinic Registrar. Student will be notified in writing of approval and advised of required
paper work. The student will then meet with the Clinic Registrar to fill out the required paperwork.
6. The total number of external clinic shifts a student can apply for is 2 (88 hrs). All external clinic
shifts must be registered and paid for as a general patient care shift, (2 credits).
7. Students should keep careful records of the patient contacts during an external clinic shift. The
Summary of Patient Contacts Form must be used for this purpose, as well as a time sheet signed by the
supervisor. The number of patient contacts that are counted will depend on the type of experience you
have. This will be reviewed and determined by the Clinic Program Coordinator.
8. After completing the external clinic shift, the completed paper work should be turned in to the Clinic
Registrar for evaluation and determination of the number of patient contacts. The Clinic Registrar will
then forward the paper work to the N.D. or AOM Clinic Program Coordinator for a final grade to be
assigned. This grade will be sent back to the registrar. The student must also give notice of
completion of the experience to the Preceptor Coordinator so that she may send a thank-you note to
the external shift supervisor.
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CLINIC OUTREACH/COMMUNITY EDUCATION
1.
a.
ND and dually enrolled in ND and AOM students’ Outreach requirements for graduation:
hours:
20 total
b.
At least 5 hours must be completed by the end of Winter Quarter of the first year in clinic.
c.
At least 10 hours must be completed by the end of Summer Quarter of the second year in clinic.
d.
At least 15 hours must be completed by the end of Winter Quarter of the second year in clinic.
f. Any remaining hours must be completed by mid-Spring Quarter of the second year in clinic.
2.
AOM Outreach requirements for graduation:
a.
hours: 16 total
b.
At least 4 hours must be completed by the end of Winter Quarter of the first year in clinic.
c.
At least 8 hours must be completed by the end of Summer Quarter of the second year in
clinic.
d.
At least 12 hours must be completed by the end of Winter Quarter of the second year in
clinic.
e.
Any remaining hours must be completed by mid-Spring Quarter of the second year in clinic.
3. Education Form, and signed off by the clinic registrar for credit, and turned in with each quarter’s
quarterly paperwork.
4. Failure to complete or turn in paperwork for outreach hours according to the above stated schedule will
prevent the student from registering for the subsequent quarter’s clinic shifts until the required outreach
hours are completed.
5. The purpose of this requirement is to provide the student clinician with the opportunity for public
speaking, preparation for a public talk, and learning skills for practice building.
6. Another purpose is to let the community know about Bastyr University’s clinic and the health care
services provided to the public. This again can serve as a model for students in their own private practice
after graduation.
7. Students may give presentations to parent groups, daycare centers, retirement homes and other
organizations and groups. Outreach event notices are posted in the south resource room, student lounge,
AOM area, and the main campus clinic info. Bulletin board, as they occur. See the Clinic Registrar when
interested in a posted event.
8. If students create opportunities to speak to groups in the community, desire to teach classes at the clinic,
or to offer a support group, please submit a written request to the Clinic Registrar for approval, prior to
the event. The Clinic Registrar will then coordinate with the Medical Director and/or residents on the
details for implementation.
9. There may be several wellness clinics offered throughout the year in which students can participate for
outreach credit.
10. The Clinic Registrar and Clinic Marketing coordinate clinic outreach opportunities. The Clinic
Registrar coordinates student outreach hour credits.
11. If students have any questions regarding this requirement please contact, the Clinic Registrar, or the
Medical Director
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AOM PROGRAM CHINA EXTERNSHIP
If applying, please complete the application that follows, and return to the AOM Program Chair.
A.
1.
2.
3.
4.
Requirements
You must be in good academic standing
Third year status, after 8 internship shifts of experience
All Bastyr University fees paid to date
Approved by AOM Medical Staff
B.
1.
FINANCIAL PROJECTIONS- see department for current price estimates
Bastyr clinic credit, per credit – 50% clinic tuition credit.
C.
1.
2.
CREDIT/PATIENT CONTACT SPECIFICATIONS
Students may apply for up to 8 Bastyr Intern Credits
Similar to preceptorship, credits are figured as 1 credit per 44 hours, as such 1 full time week of
China Clinics average about 44 hours
Only patient contacts that involve diagnosis and treatment of sufficient length under proper
supervision may be considered for credit.
Documentation of all contacts considered for credit must be presented to the AOM Program Chair
upon return, for review and approval.
3.
4.
D.
1.
EVALUATION/DOCUMENTATION
Students must keep documentation on all contacts to be considered for credit. As well all clinic
hours must be kept and signed off with patient contacts by the supervising acupuncturist.
2. An evaluation form will be sent to each site for completion by each supervisor.
3. Students must complete an evaluation form for each major supervisor at each China site.
4. All documents must be turned in to the AOM Department Chair upon return and a grading interview
will be scheduled as well.
E. APPROVED SITES FOR CHINA
Chengdu: Chengdu University of TCM
Shanghai: University of TCM
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AOM PROGRAM CHINA EXTERNSHIP APPLICATION FORM
Name:
Address:
Phone:
Emergency Contact
(while in China):
Phone:
E-MAIL: _
1.
2.
3.
4.
DESIRED QUARTER FOR CHINA EXTERNSHIP:
_____________________________________________________________________
Please supply the following information:
Copy of latest Clinic Requirement Summary sheet from Clinic Registrar. Number of credits you
expect to take in China
Passport number and date of expiration
A short description of the experience you are hoping for and why you want to go.
How do you plan to pay for this experience?
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STUDENT ACADEMIC ADVISING/ ND AND AOM
1. The following is required for student advising with a medical staff advisor:
a. Each student clinician is required to meet with her/his medical staff advisor 2 times/year,
preferably in the Fall and Spring. Students are encouraged to meet with their advisor as often as
needed.
b. Each student clinician will be assigned to a medical staff advisor. If for any reason that
assignment needs to be changed, please see the main campus registrar’s office.
c. AOM students may still be assigned a campus advisor during their 2nd year.
d. There is a 1(one) page advising form that the student should fill out, and bring with her/him to
the advising session. The advisor will write her/his comments on the form, sign and date it, and
put the form in the student’s file in the Registrar’s office.
e. It is the student’s responsibility to contact her/his advisor and make an appointment.
f. The advising sessions are a time for students to share any concerns, problems, complaints,
suggestions or issues that are important to her/him. Advisors are to review a student’s academic
program and keep them on track with their course/clinical requirements.
g. If a student fails to meet her/his requirement of 2 advising sessions/year, prohibition of
enrollment in following quarter shifts or, if graduating, failure to graduate until the advising
sessions are completed will occur. (A clinic year is from the beginning of Summer Quarter to
the end of Spring Quarter, so a determination for advising will be made for the year at the end of
Spring Quarter.)
2. At least two advising sessions are required with the Clinic Registrar before graduation.
a. It is recommended that students meet with the Clinic Registrar near the beginning of their
clinical experience in order to clarify and understand the clinic education requirements, and how
their progress is tracked each quarter.
b. Each quarter the Clinic Registrar’s office will provide to each student a summary of her/his
completed requirements.
c. Additional advising sessions are recommended in order to stay current with completed and
remaining outstanding requirements.
d. It is required for graduating students to meet with the Clinic Registrar in their last quarter in
order to be on-track to graduate.
3.
4.
The acupuncture Intern B (AIB) must meet with the AOM Clinic Program Coordinator or
faculty designee, upon completion of all Clinical Competency Two Objectives to determine
advancement to Acupuncture Intern A (AIA).
a. These competencies include the AIB performing a minimum of 20 first patient interactions
(FPI) and 80 subsequent patient interactions, (SPI) over a minimum of 3 academic quarters and
5 clinic shifts.
There is no advising requirement for Nutrition students.
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STUDENT REGISTRATION FOR CLINIC SHIFTS
1. The Clinic Registrar coordinates registration for clinic shifts.
2. Registration for each quarter will take place approximately 6 to 7 weeks prior to the start of the
following quarter. This timing was chosen so as to avoid midterms and still allow enough time for
patient scheduling for the subsequent quarters.
3. The class schedule for the following quarter should be published before clinic registration occurs.
Classroom and clinic schedules are coordinated to eliminate conflicts, as much as possible, and
provide adequate choices of shifts for students. Clinic registration is performed using information
from each student’s completed academic registration for required and elective classes.
4. N.D.: The goal is to have a primary and secondary student clinician in each room in general patient
care, homeopathy and counseling, and to have 3-4 primary and 3-4 secondary student clinicians on
each physical medicine shift. Each student must complete a 4-hour observation in the dispensary.
There may be occasions when there will be three student clinicians assigned to each patient care room
as a health care team, normally consisting of one primary and two secondary clinicians.
5. A.O.M.: The goal is to have an AIA (primary) and an observation student or AIB clinician in each
room in acupuncture patient care.
6. NUTRITION: The goal is to have a primary and secondary student clinician in each room in patient
care.
7. All student clinician pairings are subject to the final approval of the Medical Director/Clinic Program
Coordinators.
8. Clinic shifts are assigned in random order, according to the track to which the student is assigned for
their didactic classes. Priority is given to dual program or graduating clinicians, with the exception of
counseling shifts when priority is given to ND students during their first clinical year.
9. A student enrolled in the University who is clinic shift eligible must enroll in clinic shifts every
quarter with the exception of their first summer eligible quarter. PLEASE NOTE: registration during
the first eligible Summer quarter is strongly encouraged in order to keep shift completion on track and
in-line with expected program completion and graduation. See catalog for recommended shift
schedules by program.
10. Each ND and AOM student must register for a minimum of two shifts, but no more than four shifts
per quarter, without approval of the Clinic Medical Director. Each N.D. student must register for at
least one patient care shift per quarter. Each NUTRITION student must register for at least one patient
care shift per quarter but no more than two shifts per quarter, without the approval of the Nutrition
CPC and Nutrition Faculty. No student may do more than two shifts per day.
11. At the end of registration, when all the students have been assigned shifts, there will be a short period
of time when changes can be made, (approx. 2 weeks). Students are to only make changes that are
absolutely necessary.
12. The add-drop period for the clinic shifts is different than it is for academic classes, and will be set by
the clinic registrar. It is approximately a two-week period following the quarterly registration.
PLEASE NOTE: As the clinic schedule is used to schedule patients coming to the Natural Health
clinic and off-site shifts, it is imperative that it be placed in the appointment book at the clinic at least
6 weeks prior to the beginning of the following quarter. Patients often must be able to schedule
months in advance. Delays of access to scheduling causes difficulty in continuity of patient care and
potentially may affect patient contacts for students. Please be aware of the reason for the restriction
of the clinic add-drop deadline. Absolutely no changes (this includes adds, drops and switches) will be
allowed on the clinic schedule after the change deadline.
13. A student may only withdraw from clinic if they have a verifiable emergency. They must obtain a
letter signed by the clinic medical director approving this withdrawal.
14. Interim Clinic registration information: refer to section on Interim.
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15. In order to register for clinic shifts, students must first register with the academic registrar on the main
campus.
CLINIC ATTENDANCE POLICY
All medical staff will take attendance, both at case preview and case review.
1. It is the responsibility of the Clinic Medical Director, the program CPC’s, and the Assistant
Patient Services Manager to make changes in the scheduling of student clinician shifts.
Students can not mark themselves in or out in the patient schedule book at the front desk.
Students must fill out a request for an absence form, have it signed by the supervising medical
staff from whose shift the student will be absent and turn it in to the Clinic Administrative
Coordinator. It is the student’s responsibility to be certain to include the name of another
student who will cover the shift in their absence. Unapproved changes in the schedule book will
result in loss of clinic hours. Please note: The term shift may refer to either the QUARTERLY
shift, which is a 4-hour block (daily shift) that meets weekly for the 11 weeks of a quarter, or
may refer to the shift of 4-hours that occurs on a particular day.
2. All student clinicians will be required to attend at least 80% of each assigned quarterly shift,
including clinic assistant, observation, intern and patient care shifts, in order to receive a grade
of achieved competency for the quarterly shift. Holidays and emergency closures do count
towards or against the total quarter’s attendance. A student must attend at least 9 daily
shifts for each quarterly shift in order to obtain a grade for that shift. A student who does not
attend at least 80% of the quarterly shift (2 excused absences) will normally receive a failure for
that quarterly shift, lose all hours and patient contacts, and the entire quarterly shift would need
to be taken again. Exceptional circumstances resulting in a third absence may be approved at
the discretion of the supervisor. Four or more absences will result in an automatic failure for
the shift. Please note that 100% of your required clinical hours must be completed before
recommendation for graduation.
3. An unexcused absence will automatically result in a failure for the involved quarterly shift with
a loss of hours and patient contacts. The entire quarter shift will need to be taken again. An
unexcused absence is defined as failing to arrive for an entire scheduled clinic shift without
calling prior to the start of the shift. Even if the student calls the supervisor prior to a missed
shift, the shift supervisor reserves the right to sanction a student for the day’s shift if, in the
estimation of the supervisor, the reason for the student’s absence does not warrant missing the
shift. This sanction will require the student to make up an additional 8 hours as well as the 4
shift hours missed.
4. Incomplete grades can only be given, in case of illness and personal emergency. Students must
request an Incomplete grade, and receive approval of their supervisor. It is up to the discretion
of each supervising medical staff member whether or not to grant an incomplete grade.
5. In cases of emergency, every effort should be made to contact the Clinic Administrative
Coordinator and supervising medical staff . The clinic has 24-hour/day coverage for messages,
so if a student contacts the clinic off-hours, leave a message at the Clinic Administrative
Coordinator’s voice mail extension 206-834-4106. The student should contact the front desk
only to have their call/message routed to their supervisor. Once the supervisor has “approved”
the absence, the supervisor will notify the front desk staff about the absence. On Saturdays and
evenings, the student should leave a message with the Clinic Administrative Coordinator and
contact their supervisor. Upon returning, contact the Clinic Administrative Coordinator.
6. If a student knows she/he will not be able to come to her/his scheduled shift during the first
week of a quarter because of being out of town or other unusual circumstance, fill out an
absence/sub form and contact the Clinic Assistant prior to the date of absence. A student will
automatically be given a grade of failure and dropped from the shift if no arrangements are
made with the Clinic Administrative Coordinator by the second week of the quarter.
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ABSENCE AND SUBSTITUTION
1. It is the responsibility of every student clinician to inform both their assigned supervisor and the Clinic
Administrative Coordinator of any absence from clinic, prior to that absence.
2. Please comply with the following procedures: (a sample form is included for your familiarity)
a) Fill out the bottom portion of the form. (fill out a separate form for each shift you will miss)
b) Notify the supervisor of each shift that you will miss and have her/him sign the appropriate space
below.
c) Turn this form in to the Clinic Administrative Coordinator for approval.
3. Primary student ND clinicians and AOM interns must obtain a substitute. It is the responsibility of the
student to contact their patients who are coming in specifically to see them, and ask the patients to
contact the front desk if they wish to reschedule. Patient phone numbers can be retrieved from the front
desk. Also, notify the secondary student clinician or observer clinician that you will not be on shift.
4. Secondary student clinicians must also obtain a substitute. They must also notify the primary student
clinician that they will not be on shift.
5. Please do all of these in advance of the shift(s) you will be absent.
6. If ill or in an emergency situation, call in to your supervisor and to Clinic Administrative Coordinator
(206-834-4106) prior to the start of shift. Call the main clinic number: 206-834-4100. Ask to have your
supervisor paged. If they are unavailable, leave a message in their voicemail. Primary student
clinicians must speak with the supervising medical staff to make decisions regarding patients scheduled
for the day of absence.
7. The Clinic Administrative Coordinator will notify the front desk staff, who in turn will make the
changes in the schedule book. Students should not write in or make changes in the schedule book.
8. Failure to follow this procedure will result in loss of clinic credit, hours and/or patient contacts.
9. Student who are more than 30 minutes late to their assigned shift will receive a clinic sanction for the
day.(see section regarding sanctions).
10. Students who are absent more than 2 days or three with the supervisor’s pre-approval , on any one shift
during a quarter (holidays excluded) will:
a. Lose all clinic credits/hours/patient contacts for the entire quarter shift involved, and
receive a grade of F.
b. The quarterly shift will need to be taken again in its entirety.
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BASTYR
UNIVERSITY
NATURAL HEALTH CLINIC
ABSENCE/SUBSTITUTE FORM - STUDENT CLINICIAN
It is the responsibility of every student clinician to inform both their assigned supervising
doctor/medical staff and the Clinic Administrative Coordinator (CAC) of any absence from clinic.
Please follow the procedures outlined below:
1. Fill out the bottom portion of this form. (Fill out a separate form for each shift you
will be absent.)
2. Notify your supervising doctor/medical staff of each shift you will miss, and have
him/her sign the appropriate space below.
3. Turn this form in to the Clinic Administrative Coordinator – at the NHC, for
approval.
4. Primary student clinicians must get a substitute.
5. Secondary student clinicians must get a substitute.
6. Please do all of this in advance of the shift(s) you will be absent. Preferably at least
one week prior. (If you are ill or have an emergency situation, call in to the Medical
Staff/CAC/CMD or leave message on phone machine.)
7. The Medical Staff/CAC/CMD will notify the front desk staff who, in turn, will make
the changes in the schedule book. Students should not write in or make changes in
the schedule book.
8. An unexcused absence will result in an automatic failure for the quarter.
NAME OF STUDENT: _________________________________ ID #:________________
TODAY’S DATE:__________
DATE OF EXPECTED ABSENCE: ___________________
SHIFT: (circle) morning afternoon evening
CIRCLE APPROPRIATE ONE:
NATUROPATHIC GENERAL PATIENT CARE
LAB
DISPENSARY
COUNSELING
NUTRITION
REASON FOR ABSENCE:
HOMEOPATHY
PHYSICAL MEDICINE
ACUPUNCTURE/ORIENTAL MEDICINE/CHM
NAME OF STUDENT SUBSTITUTE: __________________________________________________________
SUPERVISING DOCTOR/MEDICAL STAFF SIGNATURE:__________________________________
CONFIRMATION OF SUBSTITUTE SIGNATURE________________________________________________
Clinic Admin. Coord.
ACAD: 3/98:STABSENCE
Date
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Asst. Patient Svcs Mgr
Date
SUBSTITUTE/EXTRA HOURS
1. Students receive full credit for all hours that they substitute for other students or come in on
a float room basis, which must be pre-approved by the supervising medical staff and
scheduled, if available. Float rooms are on a space-available basis. Any patient scheduled
in float room must be pre-approved by the supervisor for that shift. There can not be more
than 2 float room patients during any given shift. Once written and signed approval from
the supervisor is granted, the student must present this note to the Assistant Patient Services
Manager before the float patient can be scheduled.
2. These substitute/extra hours can be used to make up shift hour deficits.
3. Students should record the substitute/extra time on the reverse side of the Time Sheet under
the section for Substitute/Extra hours. No more than 4 hours can be recorded for any 1
shift.
4. The supervising medical staff on shift must sign off the hours that day.
5. All patients seen during the substitute/extra hours count towards the total patient contact
requirement for N.D. students of 350 patients. All patients seen while substituting count
towards the total patient contact requirement for AOM students of 400 patients. These
patient contacts need to be recorded on the Summary of Patient Contacts Form.
7. Hours that accumulate in the Substitute/Extra “bank” cannot be used to construct a shift.
These hours can only be used to make-up shift hour deficits, or can be stored for future
needs.
8. Sub & Extra hours are automatically shifted into areas showing a deficit of hours by the
office of the Clinic Registrar, when the quarterly update is done. N.D. students should
specify if the sub & extra hours are for patient care or clinic assistant.
9. Students may use Interim shift hours to make up missed shifts during the preceding
quarter(s). To do so, those hours must be recorded on the Time Sheet on the reverse side, in
the SUB hours section, not on the Interim Sheet.
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PERFORMANCE EVALUATIONS
1. In order to enter the clinical training program, students (including Advanced Standing/Transfer
students) are required to receive an AC in all clinic entry courses. Taking and passing a clinic
entrance exam is required to receive an AC in CE II. (AOM and ND programs)
2. Evaluation of performance is an essential part of each student’s training. Performance
evaluation is done in the following way:
a)
Each quarter, the supervising doctor/acupuncturist medical staff on each shift will
evaluate students. This evaluation consists of an objective and a subjective section.
One of the following grades can be given on each shift:
W - withdraw
IP - in progress
F - failure
I - incomplete
PC - partial competency
AC - achieved competency
b)
Each supervising doctor/medical staff has a daily evaluation checklist that coincides
with the evaluation form at the end of the quarter. Students can receive daily
feedback on their performance. Students are encouraged to follow-up with
supervisors and/or advisors regarding any issues identified on daily feedback.
c) If a student is not achieving competency, it is the responsibility of the supervisor to notify
the student in writing. The deficiencies in performance must be clearly and
specifically noted and specific recommendations for correcting the deficiencies
must also be specified. This notification should be given with adequate time left in
the quarter for the student to correct the deficiencies. In general, notification within
the 4th – 8th weeks of each quarter will be considered sufficient. A student may still
receive a failure after the 8th week, without having received prior written
notification if the deficiencies of performance or behavior began after the 8t h week.
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SANCTIONS
a. If a student does not adequately perform one or more of any of the critical shift competencies on
any given day, or does not achieve competency on any two or more of the non-critical
competencies, the supervisor has the right to issue a sanction to the student. This sanction will
normally be preceded with a written warning to the student by the supervisor. A second similar
poor performance will result in a written sanction. A sanction results in the loss of all of the
daily shift hours and patient contacts for the shift under review.
b. Two sanctions on the same shift will automatically result in failure grade for that entire shift
with the loss of all patient contacts and hours obtained on that shift.
c. A student will be issued a sanction when found to violate any of the policies of the clinic
namely, but not exclusively
 breaching patient confidentiality
 removing any patient-identifying information from the clinic
 acting in an unprofessional or disrespectful manner at any time, including off-shift, the student
may be issued a sanction.
The severity of the sanction will depend on the severity of the offense and may range from loss of 4
hours and patient contacts from one of the student’s shifts to suspension from the clinic. The involved
supervisor and the Clinic Medical Director will determine the type of sanction. (see further sections
for more details)
d.
Sanctions are not grades and therefore are not subject to appeal under the appeal of grade
policy. A student may issue a grievance according to the grievance procedure as outlined in
the student handbook.
e.
COMPETENCIES: in addition to, and separate from achieving competencies for all clinic
shifts, students are required to competently perform the skills outlined in the list of Clinical
Competencies. It is the student’s responsibility to complete these competencies according to
the timeline outlined in the Competency Section. Clinical supervisors must sign off on these
competencies, and paperwork documenting satisfactory completion of competencies must be
turned in to the Clinic Registrar as each is completed. Please note: Medical Staff signatures
on clinical competencies does not assure AC grades on clinic shifts, nor does it imply AC
level work on any aspect of clinic shifts.
f.
In order to graduate, a student must competently meet all clinic requirements and be
recommended for graduation by the Clinic Medical Director and those medical staff who
have supervised the student’s clinical education.
Please note: completion of clinic requirements does not necessarily guarantee clinic medical
staff’s recommendation for awarding of degree.
g. Please see student handbook section on grading policy for more details.
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GRADING
1.
Grading in the clinic is based on an achieved competency system. Each student must receive a
grade of achieved competency in order to get credit for a shift and move on to the next shift.
a. Clinic, as part of academics, uses the same grading system as established for the
didactic part of academics. This is a competency based grading system.
b. The achieved competency grading system is not the same as the pass/fail grading
system. Be certain to understand this difference, essentially a grade of AC means that
all clinical skills for each level have been successfully mastered, as appropriate to the
student’s current status in the clinic.
c. The clinical skills a student must demonstrate mastery of are listed on the Primary and
Secondary/Observing student evaluation forms, located in the medical staff offices.
The medical staff is responsible for evaluating a student for competency on each of the
clinical categories on the evaluation form. The student’s current status in clinic is taken
into account when medical staff are evaluating a student’s competency. The level of
skills that must be demonstrated to achieve competency progressively increase as the
student progresses through her/his clinical rotation. These increasing performance
expectations are generally defined in the clinical competency section of the Clinic
Handbook. Please note that competency based grades are not based on an averaging of
clinical skills, rather that each one of the clinical categories has been successfully
mastered at the appropriate level as assessed by the supervising medical staff.
Additionally, there are certain critical clinical skills that must be competently
demonstrated in order to achieve an AC grade. Any one of these critical clinical skills
that is not demonstrated successfully over the course of the shift as assessed by the
supervising medical staff will result in an F grade. PC grades may be given if one of the
non-critical clinical skills is not demonstrated successfully. More than one of the noncritical, yet essential clinical skills not competently demonstrated over the course of the
shift will result in an F grade.
2.
In the event of a dually supervised shift, the senior supervising medical staff person on each
shift grades students each quarter.
Currently, the clinic medical staff uses a comprehensive evaluation form for each department of
the clinic. There are a number of criteria that are used to evaluate the student’s performance
and competency on each clinic shift.
a. Each week the supervising medical staff will evaluate the students on her/his shift.
Utilizing the criteria from the performance evaluations, written feedback may be given
to students on a weekly basis. Students are encouraged to follow up regarding the
feedback with the supervisor and/or advisor.
b. At the end of the quarter, all this information will be used to fill out the quarterly
performance evaluation form. This quarterly evaluation also has a subjective section to
be filled out by the supervising medical staff.
3.
c.
A student can receive a quarterly grade of:
W - withdraw
IP - in progress
F - failure
I - incomplete
PC - partial competency
AC - achieved competency
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4.
5.
6.
Here is a brief summary of what each grade means:
a. Withdraw: A student officially withdraws by notification to the Clinic Registrar, who
will then notify the registrar. Withdrawal requests are for emergency purposes only and
must be done no later than the end of the eighth week of the quarter the shift is taken. A
letter from the department chair explaining the reason and giving approval for the
withdrawal is required. Note: When a shift is officially dropped by a student after the
deadline, the result will be a loss of all clinic credits/hours/patient contacts for the entire
quarter shift involved.
b. In Progress (IP): A student has Achieved Competency but doesn’t have enough patient
contacts or hours on a quarterly shift (greater than 80% but less than 100% hours but
still AC level work). Once 100% of hours and/or patient contact requirements are met,
the grade will be changed to an AC.
c. Failure: A student fails to satisfactorily demonstrate competency as appropriate for
current clinic status for any of the critical clinical categories or more than one of the
non-critical clinical categories listed on the evaluation form. There is a loss of all clinic
credits, hours and patient contacts for the shift. The shift must be made up in its
entirety, in the Bastyr Natural Health Clinic. The student will be on Academic
Probation. One (1) unexcused absence will result in an automatic failure. See absence
policy. Two (2) quarterly shift failures in the same year automatically places the student
on academic probation. In addition, the clinic medical director, CPC and program chair
(if applicable) will make a recommendation to the EVP regarding possible dismissal
from the University. In the even that the student is not dismissed, a learning contract
will developed for the student. They must successfully meet the requirements of the
learning contract in order to avoid dismissal.
d. Incomplete: In order to receive an Incomplete (“I”) grade for a clinic shift, a student
must contact the Clinic Registrar and shift supervisor. Students receive incomplete only
for medical or other verifiable emergencies. An Incomplete is given only when the
student is doing satisfactory work, but cannot complete the requirement because of a
serious illness or personal emergency. An Incomplete is not given if a student is failing
a class or clinic shift. All Incomplete grades must be successfully completed by the end
of the third week of the following quarter, or they will convert to an F. Students must
provide a doctor’s letter stating that they are ill and/or written documentation of
personal emergency.
e. Partial Competency: The critical clinical categories were demonstrated successfully,
however one of the non-critical clinical categories was not competently demonstrated,
appropriate to student’s current clinic status. The supervisor who gave the PC will
submit written requirements to the student all of which the student must satisfactorily
complete in order to change the PC to an AC. The student must complete the
requirements necessary to bring the PC grade to an AC grade by the end of the
following quarter.
f. Achieved Competency: The successful demonstration of mastery of all the clinical
categories listed on the evaluation form, appropriate to the student’s current status in
the clinic.
A grade needs to reflect what a student earns for a particular quarter without any contingencies.
There are to be no contingencies that carry over into the next quarter. The student will receive a
performance evaluation for her/his performance each quarter.
At Mid- Quarter of each quarter there is a clinic medical staff-grading meeting.
a. The purpose of this confidential meeting is to go over the objective and subjective
evaluations of students in order to identify the strengths, weaknesses, and areas of
concern and recommendations. All of these concerns are discussed in order to find
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b.
c.
ways to appropriately evaluate students and to strategize ways to improve the student’s
chances of success in their clinical training.
This information is recorded by the Clinic Registrar and is kept confidential in her/his
office
Any students who need follow-up from this meeting will be identified and
communicated to from either their clinic supervisor, their advisor, the Clinic Medical
Director or CR. The Clinic Registrar will give a written summary of the comments
from the meeting to either the supervisor or the advisor, if needed. The supervisor or
the advisor may set up a meeting with the student to discuss the issues and strategies
raised.
7.
Students who are at risk for failing the shift must be notified in writing by their supervising
medical staff before the end of the quarter, unless this risk is not evident until the end of the
quarter. A copy of this letter will also be given to the Clinic Medical Director, the Program
Chair (of the program applicable to the student) and to the Clinic Registrar (for student’s clinic
file).
a. A student should be given sufficient notice so that she/he may have time to improve in
the areas of concern. In general, notification within the 4th to 8th week of each quarter
will be considered sufficient notice.
b. Each area of concern must be identified, and clear guidelines need to be given as to
how to improve and what is expected in order to achieve competency.
c. Students must meet with their supervisor and/or advisor if they receive notice of risk of
failing a shift. It is solely the student’s responsibility to arrange this meeting.
d. A copy of this letter should be given to the Clinic Registrar (for student’s clinic file)
8.
Grades are kept in the student’s files in the Clinic Registrar’s office. If a student has a question
about her/his grades, please make an appointment with the Clinic Registrar to review the grades.
These files are confidential.
If a student wishes to file a grievance or appeal a clinic grade, they must follow the University’s
academic grievance and appeal of grade procedure as outlined in the Student Handbook.
9.
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Bastyr University
Policy/Procedure # 98-C17
POLICY/Procedure
Approved by AVP ________________________
Effective Date: 9/98
Revised: 3/00
Academic Sanctions
NOTE: All F’s and PC’s are cumulative in single and dual curriculum programs.
Electives are not factored into the sanctions process, but students must be aware that F grades will
affect GPA’s, which may in turn affect a student’s standing.
For students in the Spirituality, Health, & Medicine Certificate Program, the levels of sanction are
outlined in the program syllabi.
Academic Warning
A student who receives two grades of PC or one F is automatically placed on academic warning.
Students who receive a PC or F in a clinic shift, see Student Clinician Handbook.
Academic Probation
Following are some scenarios, but not all that would put a student on Academic Probation:
 Fail two courses or shifts
 Receive three or more PC grades
 BS students whose GPA falls under 2.0
 MS students whose GPA falls under 3.0
 If a student is on probation for two consecutive quarters due to an F in courses offered on an annual
basis, sanction status remains constant until those grades are remediated unless new PC or F is earned.
It is recommended that first year ND students placed on Academic Probation be placed on the 5-year track.
Applied Behavioral Science students on Academic Probation are required to have a learning contract.
Academic Final Probation
Students who attain any of the following will be placed on Academic Final Probation:
 An additional PC or F is earned while on Academic Probation
 3 or more F’s and/or 4 or more PCs cumulatively
 2 or more F’s received in one quarter
Final Probation requires a Learning Contract, dual-track students must drop a program, and a 5-year track is
required for ND students.
This category does not apply to Applied Behavioral Science students.
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Restricted Status
Students who fail to satisfy the requirements of their learning contract are placed on Restricted Status and
may be subject to dismissal.
Students may only take courses needing remediation.
The length of Restricted Status varies from one quarter through one year.
Students who have been on Restricted Status are required to meet with their program chair/lead (LIOS) to
review the continuation of their learning contract at least two weeks prior to the start of the quarter of their
return to the university.
If a student does not maintain satisfactory academic progress during the academic year of readmission, the
student meets with the AVP or his designee, who then decides the student’s academic status.
Academic Dismissal
Students who attain any of the following may be dismissed:
 Fail a required course for a second time or a second clinic shift are subject to dismissal at the discretion
of the EVP (after consultation with the Clinic Medical Director)
 Failure to complete the requirements of a Learning Contract.
NOTE: Academic dishonesty or other code of conduct violations that disrupt the orderly activity of the
university may result in immediate restriction by the AVP and could lead to dismissal. Please refer to the
Student Handbook.
Academic Dismissal from the university is the termination of a student’s status, with loss of all rights and
privileges.
Academic Dismissal is an action of the EVP, in accordance with the section on Judicial Process in the
Student Handbook.
Academic Dismissal must be preceded by at least one written warning, notifying the student of the problem
area(s) and providing an adequate time period for response and/or improvement before taking action.
Academic probation is one such warning.
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Academic Policy/Procedure
#98-C17
Levels of Sanctions
I
Good Standing
III
II
Probation
Academic
Warning
If probation is earned
for 2 consecutive
quarters
If Clinic, See
Clinic STUDENT
CLINICIAN
HANDBOOK
2 F’s in same
required course or
any 2 Clinic Shifts
2 F’s in one
quarter
Student can only
take courses
needing
remediation
Learning Contract
Established
Satisfy Learning Contract
NO
III or IV
Yes
Second F, same
required course
2 F’s and/or 3 PC’s
< 2.0 BS GPA
< 3.0 MS GPA
3 or > F’s
4 or > PC’s
II
Yes I
Dismissal
Restricted Status
Final Probation
1 F and/or 2 PC’s
IV
Revert to Appropriate
level
IV
Yes - II
IV
Yes - II
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I - 1st year ND students, recommend 5 year track. Applied Behavioral Science
students on probation are required to have a learning contract
II - Learning Contract, 5 year track required; drop one program if on dual track.
Final probation does not apply to Applied Behavioral Science students.
III - Restricted Status may be converted to Final Probation by AVP
IV - Also includes cheating, practice without license, or other academic
dishonesties determined by EVP
NOTE: All F’s and PC’s are cumulative in single and dual curriculum programs.
Electives are not factored into the sanction’s process, but students must be
aware that F grades will affect GPA, which may in turn affect a student’s
standing.
For students in the Spirituality, Health, & Medicine Certificate Program,
the levels of sanction are outlined in the program syllabi.
Addendum: Clinic Academic Status Policy
In general, students must be in good academic standing to begin or to continue their clinical training.
Students who are placed on restricted status are ineligible to register for clinical training shifts until their
academic standing is remedied.
Students who receive 2 (two) F’s for the same clinical training shift, or any two clinical training shifts
will be subject to dismissal as per Academic Sanction Policy. (See preceding section)
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Examples of clinic evaluation forms:
BASTYR
UNIVERSITY
NATURAL HEALTH CLINIC
STUDENT DAILY SHIFT CHECK-OFF EVALUATION FORM - PATIENT CARE
STUDENT NAME: _______________________________________________ DATE: ______________
QUARTER/YEAR: ________________________________ SHIFT: _____________________________
NUMBER OF PATIENTS SEEN ON SHIFT: _________________
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2
= adequate (AC)
3
= good (AC)
4
= excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories appropriate
to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more noncritical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing
requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Clinical Skills
1.
Initiative, motivation and responsibility: __________
2.
Communication skills and rapport with patients: ___________
3.
Interviewing skills (S): __________
4.
Physical exam skills (O): _________
5.
Differential diagnosis/assessment skills (A): __________
6.
Knowledge of naturopathic therapeutics and their proper application (P):
_______________
7.
Patient/case preparation and follow-up: _____________
8.
Familiarity with clinic policies and procedures and efficiency in following them:
_________
9.
Listening skills: __________
10.
Time management skills: ____________
11.
Proper use of lab, diagnostic studies, etc.: _____________
12.
Ability to make an appropriate referral when needed and ability to write up referral:
__________
13.
Charting technique (completeness and clarity): ______________
14.
Participation and input in case discussions on shift, case preview and case review:
___________
Please turn over and continue.
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Summary Comments: This space for comments/suggestions/recommendations and /or to explain
and clarify ratings above:
Supervising Medical Staff Signature: _________________________________________date:
___________
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BASTYR
UNIVERSITY
NATURAL HEALTH CLINIC
SECONDARY STUDENT EVALUATION FORM - PATIENT CARE
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
3
= adequate (AC)
3
= good (AC)
4
= excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories appropriate
to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more noncritical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing
requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS * skills identified with an asterisk are critical clinical skills, others are essential
skills.
*1.
Initiative and responsibility in role as a secondary student clinician:
*2.
Cooperation with clinic supervisors and staff:
*3.
Familiarity with clinic policies and procedures and efficiency in following them:
*4.
Physical exam skills:
*5.
Application of academic learning to clinic training:
*6.
General overview of case management:
*7.
Listening skills:
8.
Communication skills and rapport with peers and supervisors:
9.
Time management skills:
10.
Motivation and initiative in learning clinical skills:
11.
Participation and input in case discussions on shift:
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Student’s overall level based on the number of quarters in the clinic: (there are 8 total quarters):
(please circle the one that is most appropriate)
1
2
3
4
5
6
7
8
Summary Comments: (please write comments to explain and/or clarify your ratings above.
Please Indicate Grade For This Quarter: (circle one)
failure (F)
in-progress (IP)
Supervisor’s Signature:
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partial competency (PC)
achieved competency (AC)
Date: _____________
BASTYR
UNIVERSITY
NATURAL HEALTH CLINIC
PRIMARY STUDENT EVALUATION FORM - PATIENT CARE
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:_______
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
4
= adequate (AC)
3
= good (AC)
4
= excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories appropriate
to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more noncritical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing
requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual for details.
CLINICAL SKILLS * skills identified with an asterisk are critical clinical skills, others are
essential skills.
1. *
Initiative and responsibility in patient care:
2. *
Communication skills and rapport with patients:
3. *
Interviewing skills:
4. *
Physical exam skills:
5. *
Overall case management skills:
6.
Charting technique (completeness & clarity):
7.
Application of academic learning to clinic training and patient care:
8.
Differential diagnosis/assessment skills:
9.
Knowledge of Naturopathic therapeutics and their proper application:
10. *
Patient follow-up care:
11. Listening skills:
12. Time management skills:
13. Cooperation with clinic supervisors and staff:
14. Communication skills with peers and supervising doctors:
15. Motivation and initiative in learning clinical skills:
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16. Familiarity with clinic policies and procedures and efficiency in following them:
Student’s overall level is based on the number of quarters in the clinic: (there are 8 total quarters):
(please circle the one that is most appropriate)
1
2
3
4
5
6
7
8
Summary Comments: (please write comments to explain and/or clarify your ratings above)
Please Indicate Grade For This Quarter: (circle one)
failure (F)
in-progress (IP)
partial competency (PC)
Supervisor’s Signature:
Date:
BASTYR
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achieved competency (AC)
UNIVERSITY
NATURAL HEALTH CLINIC
AOM PROGRAM OBSERVATION EVALUATION
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:
The number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
5
= adequate (AC)
3
= good (AC)
4
= excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories appropriate
to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more noncritical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing
requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual for details.
Rate each of the following categories and give an overview rating at the end.
1. Initiative and responsibility in role as Observation Clinician: _______
2. Cooperation with clinic supervisors and staff:
_______
3. Communication skills with peers and supervisors:
_______
4. Familiarity with Clinic Policies and procedures and efficiency in following them:_______
5. Interviewing skills: _______
6. Time Management Skills: _______
7. Charting technique (completeness & clarity):
_______
8. OM Inspection skill and interpretation of tongue diagnosis: _______
9. OM Auscultation and Olfaction skill: _______
10. OM Inquiry skill: _______
11. OM Palpation skill and interpretation of pulse diagnosis: _______
12. Application of academic learning to clinic training: _______
13. Eight Principles diagnosis skill: _______
14. Zang-Fu Patterns diagnosis and differention skills:
_______
15. General overview of case management: _______
16. Motivation and initiative in learning clinical skills:
_______
Overall Rating of Clinic Work and Performance for this Quarter:
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_______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student must
demonstrate competency ( a 2 or more) on all skills above as well as the overall rating relative to
their current level in the clinic. Please refer to the appropriate clinic competencies for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above
ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)
in progress (IP)
partial competency (PC)
Supervisor’s signature____________________________________________
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achieved competency (AC)
date: _______________________________
BASTYR
UNIVERSITY
NATURAL HEALTH CLINIC
AOM PROGRAM INTERNSHIP EVALUATION
STUDENT NAME:
QUARTER/YEAR:
SHIFTS:
Approximate number of patient visits you supervised this student this quarter:
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2
= adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories
appropriate to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill
is assessed as unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two
or more non-critical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a
letter detailing requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual for
details.
Rate each of the following categories and give an overview rating at the end.
1. *Initiative and responsibility in role as Intern Clinician: _______
2. Cooperation with clinic supervisors and staff:
_______
3. Communication skills with peers and supervisors:
_______
4. *Communication skills and rapport with patients:
_______
5. *Interviewing skills:
_______
6. Time Management Skills:
_______
7. Charting technique (completeness & clarity):
8. *OM Four Exams skills:
_______
_______
9. *OM Eight Principles Skills:
_______
10. *Application of acupuncture points location: ___________
11. Accuracy of acupuncture points location:
12. Needling techniques:
_______
13. Moxibustion techniques:
_______
14. Cupping and other techniques:
15. Clean needle technique:
_______
_______
_______
16. Knowledge of Oriental Medicine therapeutics and their proper application:________
17. *Patient follow-up care: ________
18. Familiarity with clinic policies and procedures and efficiency in following them: _______
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19. Appropriate application of Western assessment techniques: ________
20. Appropriate referral or consideration for referral: ______
Overall Rating of Clinic Work and Performance for this Quarter: _______
NOTE: This is not an average of the above categories. To receive AC for a shift, a student must
demonstrate competency ( a 2 or more) on all skills above as well as the overall rating relative to their
current level in the clinic. Please refer to the appropriate clinic competencies for reference.
SUMMARY COMMENTS: (please write any comments to explain and/or clarify above ratings)
Please indicate grade for this Quarter: (circle one)
Failure (F)
in progress (IP)
partial competency (PC)
achieved competency (AC)
Supervisor’s signature ______________________________________ date: ____________________________
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BASTYR UNIVERSITY
NATURAL HEALTH CLINIC
CHM INTERNSHIP/OBSERVATION EVALUATION FORM
STUDENT NAME:
QUARTER/YEAR:
RATING SCALE:
SHIFTS:
NA = not applicable
1 = unsatisfactory (F)
6
= adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2,3 or 4 on scale above) in all the clinical categories appropriate
to her/his status in clinic. A PC grade is given if all critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale at left). An F grade is given if one or more critical clinical skill is assessed as unsatisfactory, or if two or more noncritical clinical skills are assessed as unsatisfactory at a level appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing
requirements for changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading
Rate each of the following categories, and then give an overall rating.
1. *Interest and responsibility in patient care: __________
2. *Cooperation with clinic supervisors and other clinicians: _________
3. Communication skills with peers and supervisors: __________
4. *Communication skill and rapport with patient: __________
5. *Interviewing skills: __________
6. *Diagnostic skills and case management: __________
7. Charting technique (completeness, clarify and signature): __________
8. Time management skills: __________
9. *Familiarity with Chinese herbs and basic formulas: __________
10. Knowledge of Chinese Herbal Medicine therapeutics and their proper application:
__________
11. *Written clarity of prescriptions and any necessary instructions for packaging herbs:
__________
12. Clear explanation of cooking instructions: __________
13. *Follow up care with patients: __________
(please turn over and continue)
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Summary Comments: (please write comments to explain and/or clarify your ratings above.)
Please Indicate Grade For This Quarter: (circle one)
Failure (F)
In progress (IP)
Partial Competency (PC)
Supervisor’s signature:
LOSS OF CREDIT, SUSPENSION, DISMISSAL
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Achieved competency (AC)
Date: _________________
There are specific actions and behaviors that can result in partial loss of credit, failure (F) for an entire
shift, suspension and/or dismissal from the clinic.
A. Clinic sanctions result from violation of clinic policy or procedure as determined by the student’s
clinic supervisor or any other clinic supervisor if the event occurs outside of a shift or off-site. A
supervisor may choose to issue a warning to the student in lieu of a sanction, but upon repeated
violation, a sanction will be issued. A Clinic Sanction results in the loss of four (4) clinic contact
hours, and all patient contacts received during those hours. The hours and contacts must be made up.
A written notification of clinic sanction must be given to the student by the clinic supervisor, with a
copy to the clinic Medical Director and the Clinic Registrar for the student’s file. If a student receives
two (2) clinic sanctions on one clinic shift, this will result in a failure (F) grade for that entire
quarterly shift. The shift will need to be repeated in its entirety. No credits, hours, or patient contacts
will be given for the failed shift.
The following violations may result in a clinic sanction:
1. Failure to follow the clinic absence/substitution policy. (Except for UNEXCUSED
ABSENCES- see section P. Absence and Substitution).
2. Failure to follow the clinic protocols, policies and procedures as described in the Student
Clinician Handbook
3. Failure to follow the instructions or recommendations of the supervising
doctor/physician.
4. Causing intentional harm to a clinic patient, neglect of a patient’s care and safety or any
form of verbal abuse.
5. Inappropriate behavior and unethical conduct with medical staff, staff, patients or
students.
6. Failure to follow the phone contact policies and procedures.
7. Failure to follow Clinic Handbook charting policies and procedures.
B. The following violations will result in loss of clinic credit, suspension, and/or dismissal, depending
on the circumstances and severity of the violation. In the case where suspension or dismissal may be
appropriate, the Clinic Medical Director will make a recommendation to the Academic Vice
President according to the circumstances of each incident.
1.
2.
3.
4.
Dishonest conduct.
Practicing medicine without a license.
Violation of the NHC Code of Ethics.
Breach of patient confidentiality which includes the removal of any identifying patient
material from the clinic.
5. Failure to convert an Incomplete or Partial Competency for a clinic shift to Achieved
Competency within 1 quarter will result in:
a) A Failure for the shift in question, with loss of all hours and patient contacts. The shift
will need to be repeated in its entirety.
b) It is the student’s responsibility to complete the requirements, and take care of the paper
work. Contact the CR.
1. Please note: This is not subject to the grade appeal process. If a student has a concern,
please refer to the grievance policy.
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THE BASTYR UNIVERSITY NATURAL HEALTH CLINIC POLICY ON
CONFIDENTIALITY.
There are several components to this policy, all of which are listed below. Please familiarize yourselves
with these policies. A breach in confidentiality is considered a very serious offense and may result in a
failure event for the student(s) involved.
1.
All patient records and identifying information must remain in the clinic at all times. These
records must not be left unattended in non-designated chart areas. Patient records can never
leave the clinic except under the lawful practices of the medical records coordinator.
2.
Patients and their medical care can only be discussed in a manner which omits any identifying
information about the patient such as name, specific occupation, address, identifying
relationship, or identifying act.
3.
Under no circumstances can a Bastyr or LIOS student-patient, be discussed during case review.
During preview, only the clinicians who are seeing a student-patient may discuss that studentpatient privately with their supervisor.
4.
Students must refrain from speaking of student-patient visits while on campus, or in public.
5.
Significant others, children, parents, siblings, etc. of Bastyr students may be discussed during
preview and review, however absolutely no identifying information can be shared about this
patient. Additionally, a supervising medical staff may decide at their discretion, that a certain
staff member is not appropriate to be discussed for a particular shift.
6.
Bastyr campus staff may be discussed during preview and review, however, absolutely no
identifying information can be shared about this patient. Bastyr clinic staff may not be discussed
during review, and may only be discussed privately with the supervisor during preview.
7.
Patient contact record sheets must only list the initial of the patients’ first name, and may never
contain identifying information.
Confidentiality is of paramount importance to safety and well being of each patient. This is a critical
component of the professional code of ethics for all health professions.
Thank you for your diligent adherence to patient confidentiality at the Bastyr Natural Health Clinic.
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CLINIC GRIEVANCE POLICY
This policy is designed to establish a method whereby students, medical staff, residents and other staff
can voice their concerns and feelings about policies, procedures or other concerns in a way that they will
be heard, and the concern can be dealt with in a fair manner.
1. If a student has a concern about something that happens while on a patient care shift, first discuss the
matter in private with the supervising medical staff. If it is not resolved, the student must meet with
their advisor. If it is still not resolved, then they should type a letter about the issue to the Clinic
Medical Director and set up a meeting to discuss it with the Medical Director.
2. If a student has a concern about something that happens while on a clinic assistant rotation in the lab
or the dispensary, first discuss the matter in private with the supervisor. If it is not resolved, they
must meet with their advisor. If still not resolved, then they should type a letter about it to the Clinic
Program Coordinator and set up a meeting to discuss it with the Clinic Program Coordinator.
3. If a student has a concern about something that happens while on an external clinic shift or
preceptorship, first discuss the matter in private with the supervisor. If it is not resolved, they must
meet with their advisor. If still not resolved, then they should type a letter about it to the Medical
Director and set up a meeting to discuss it with the Medical Director.
3. If a student has a concern about a policy or procedures, or clinic operations in general, please type a
letter about it to the appropriate Clinic Program Coordinator and set up an appointment to discuss it
with the Clinic Program Coordinator. If still not resolved, then they should forward their letter along
with a explanation from the CPC to the Medical Director and set up a meeting to discuss it with the
Medical Director.
4. If a student has a concern about hours, number of shifts, credits, registration, clinic grades or
attendance please see the Clinic Registrar.
5. If a student has a concern about the preceptor program, this should be addressed to the Preceptor
Coordinator.
5. If a medical staff member, resident or medical staff person has a concern about anything or anyone in
the clinic, please type a brief letter to the Medical Director and then make an appointment to see the
Medical Director.
6. If any issue or concern can not be satisfactorily resolved by a meeting with the Clinic Program
Coordinator, Preceptor Coordinator and/or Clinic Registrar, then the original letter and subsequent
written reviews of the issue from the Clinic Program Coordinator, Preceptor Coordinator and/or
Clinic Registrar will go to the Medical Director.
7. If the issue cannot be satisfactorily resolved by the Clinic Medical Director, all written materials
along with a written letter from the Medical Director will go to the Dean of Clinical Affairs for
review.
8. If any issue or concern can not be satisfactorily resolved by a meeting with the Dean of Clinical
Affairs, then the issue and all accompanying materials will go to the Executive Vice President for
final guidance and resolution.
Please refer to the Student Handbook for other information regarding grievances, sanction and
appeals policies.
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PROFESSIONAL CONDUCT
This is the Code of Conduct for all members of the Bastyr University community. Please see Student
Handbook and Medical Staff Handbook.
The rights and privileges exercised by any person are always a function of their relationships with others.
Loss of privileges, specified disciplinary requirements or separation from Bastyr University may be
imposed on anyone whose conduct on or off campus adversely affects the Bastyr University community,
particularly when it shows failure to accept responsibility for the welfare of other persons. Fundamental
kinds of misconduct, which may lead to suspension or dismissal, are:
1. Physical and/or verbal abuse, intimidation or harassment of another person or group.
2. Racist and/or sexist remarks and/or behavior towards another person or group.
3. Deliberate or careless endangerment; tampering with safety alarms or equipment; violation of
specific safety regulations; and failure to render reasonable cooperation in an emergency.
4. Obstruction or forcible disruptions of regular Bastyr University activities, including teaching,
research, administration, clinic services, discipline, organized events and operation and maintenance
of facilities.
5. Interference with the free speech and movement of any academic and/or community members.
6. Dishonesty, including provision of false information, alteration or misuse of documents, plagiarism
and other academic cheating, impersonation, misrepresentation or fraud.
7. Theft, abuse or unauthorized use of personal or Bastyr University property.
8. Use of illicit drugs or being on the premises in a drug or alcohol -intoxicated state.
Student/Professional Code of Ethics:
No Bastyr University student will practice any form of medicine (outside of supervised work in the
Bastyr University Natural Health Clinic or approved supervised preceptorships) for which s/he does not
hold a professional license. Failure to observe this rule may result in immediate dismissal.
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CODE OF ETHICS OF THE BASTYR UNIVERSITY NATURAL HEALTH CLINIC
Introduction
The purpose of the Code of Ethics is to provide a framework within which all students and staff at the
University’s Natural Health Clinic can learn and work in a safe, nurturing and supportive environment.
Ethical behavior is critical to the quality of interactions among individuals and groups within the
University and Clinic. They also reflect on the quality of health care given to the patients at the Clinic.
We are all striving for excellence, as individuals, and as an institution, and this Code of Ethics gives us
guidance in seeking that excellence.
1) The Natural Health Care Practitioner’s primary purpose is to restore, maintain and optimize health in
human beings.
2) The Natural Health Care Practitioner acts to restore, maintain, and optimize health by providing
individualized care, according to his/her ability and judgment.
3) The Natural Health Care Practitioner shall endeavor to first, do no harm and to provide the most
effective health care available with the least risk to his/her patients at all times.
4) The Natural Health Care Practitioner shall recognize, respect and promote the healing power of
nature inherent in each human being.
5) The Natural Health Care Practitioner shall strive to identify and remove the causes of illness, rather
than to merely eliminate or suppress symptoms.
6) The Natural Health Care Practitioner shall educate her/his patients, inspire rational hope and
encourage self-responsibility for health.
7) The Natural Health Care Practitioner shall treat each person by considering all individual health
factors and influences.
8) The Natural Health Care Practitioner shall promote personal well-being and the prevention of disease
for the individual, each community and our world.
9) The Natural Health Care Practitioner shall acknowledge the worth and dignity of every person.
10) The Natural Health Care Practitioner shall safeguard the patient’s right to privacy and only disclose
confidential information when either authorized by the patient or mandated by law.
11) The Natural Health Care Practitioner shall act judiciously to protect the patient and the public when
health care quality and safety are adversely affected by incompetent or unethical practice by any
person.
12) The Natural Health Care Practitioner shall maintain competence in her/his field and strive for
professional excellence through assessment of personal strengths, limitations and effectiveness and
by advancement of professional knowledge.
13) The Natural Health Care Practitioner shall conduct his/her practice and professional activities with
honesty, integrity and responsibility for individual judgments and actions.
14) The Natural Health Care Practitioner shall respect all ethical, qualified health care practitioners and
cooperate with other health professionals to promote health for the individual, the public and the
global community.
15) The Natural Health Care Practitioner shall strive to exemplify personal well-being, ethical character
and trustworthiness as a health care professional.
(Adapted from the American Association of
Naturopathic Physicians Code of Ethics)
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CLINIC GUIDELINES FOR DRESS, HYGIENE AND GENERAL APPEARANCE
1. The purpose of the dress code is to help develop and convey a sense of professionalism and to support
an attitude of respect toward patients, the clinic and our medicine. All medical and clinic staff, and
students working when the clinic is open need to comply with the dress code. If one is not on duty, but
stopping by the clinic and not dressed professionally, please make a point of not lingering where
patients are present.
2. The dress code requires clean, neatly pressed clothing, in good condition, presenting a professional
attitude about the role that you are performing. Clothes should be dressy rather than casual and not
revealing. Open-toed sandals or shoes are not permitted in the clinic, in compliance with Department
of Health regulations.
3. Clothing considered too casual for the clinic includes denim material of any color, jeans style pants,
athletic footwear, slipper-type footwear, deck shoes without socks, T-shirts, polo shirts, tank tops,
spaghetti strap sundresses and shirts, sweat shirts, sweat pants, and shorts. Undergarments should
not show through clothing. If belt loops are present, a belt or suspenders are required.
4. Men are required to wear a shirt and tie with the following exceptions only: turtlenecks, sweaters
with a turtleneck top, mandarin collared dress shirts, dress shirts designed to be worn without a tie,
and medical smocks/surgical scrubs during Physical Medicine shifts.
5. Women are required to wear an appropriate top (sweater, blouse, shirt) and bottom (dress slacks,
pants, skirts, dressy culottes, or dresses). Skirts, dresses and culottes must be of modest length.
Clothing should never be tight fitting or revealing. An appropriate top of modest length must cover
tights and leggings. Medical smocks/surgical scrubs are allowable during Physical Medicine shifts.
6. All clinicians in the acupuncture department must wear a white lab coat of knee length with lapels
over their clothing. This coat must be clean and pressed at all times. The student is responsible for
his or her own lab coat and its care (washing and pressing). It is not permissible to borrow another
clinician’s lab coat without permission.
7. It is preferable that clinicians have no visible piercings or tattoos. However if they do, they must be
minimal and tasteful. Many patients may find them offensive. Please be aware of this.
8. Please be aware of breath and body odors when at the clinic. Please do not wear strong smelling
scents, or perfumes in the clinic. Keep hair, beard, and fingernails clean and neatly trimmed. Tie or
pin back long hair. Hair should not be shocking or outrageous in style or color.
9. Be sure to wash your hands between patients.
10. Please wear your student clinician name tags while on duty. Failure to do so
will be considered a violation of dress code.
11. Everyone in the clinic is required to follow the guidelines for Universal Precautions for Infectious
Diseases, Safety Standards, and Sterile Technique Standards. Please review these guidelines which
are located in the Lab. In addition, OSHA mandated education will be required annually in regard to
Blood Borne Pathogens. The Clinic Infection Control Representative will inform you of the
requirements and provide opportunities for compliance.
12. NAMETAGS are required while on duty in the clinic and/or at Outreach Events. The dress code
must be followed when representing the Natural Health Clinic or Bastyr University at Outreach
events. Nametags should be ordered in clinic entry class.
13. No foods or strong-smelling beverages are to be eaten or drunk in the exam rooms.
It is up to each individual to follow this code and take care of ones’ self. It is uncomfortable and
unnecessary for others in clinic to have to remind individuals of the dress code. Continued and/or
flagrant disrespect for each other and for patients by not following this dress code will be dealt with on a
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case-by-case basis by the clinical medical staff and Medical Director. Violations of the dress code may
result in the following:
 For the first offense the student will get a written warning. Any medical staff supervisor can write
this warning to a student. A copy of this warning will be given to the student’s supervisor if a
different supervisor wrote it.
 For the second offense, the student will be sent home for the shift, and the student will be issued a
sanction. The student will lose all hours and patient contacts for that day’s shift.
 For the third offense, the student will be sent home for the quarter, fail the shift, and the entire shift
will need to be made up.
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IMMUNIZATION POLICY
PURPOSE:
To protect the health and safety of employees and students who may be exposed to certain biohazardous
agents in the campus and clinic-working environment.
TB SCREENING:
All medical staff, students and staff who work or take shifts in the Natural Health Clinic are required to
be tested for TB annually and provide documentation to the Safety Officer. There are no waivers of this
policy. Employees who do not comply with this policy will be prohibited from working at the clinic.
Students who do not comply will not be allowed to take clinic shifts, or register for clinic shifts.
Bastyr University agrees to pay for:
 100% of the cost of tuberculosis screening for all staff and medical staff, per OSHA/WISHA
regulations.
 50% of the cost of tuberculosis screening for students (up to the amount charged by the King County
Department of Health).
HEPATITIS B IMMUNIZATIONS:
The following occupational positions and student clinicians have been designated as “exposed
individuals” and are required to either take the Hepatitis B immunization series, provide
documentation that they have had such immunizations in the past ten (10) years, or sign a waiver
refusing the immunizations, along with a release of liability form.
 All ND & AOM students and clinical medical staff
 All clinic laboratory and operation staff
 All employees at the main campus in the following capacities:
- instructor of any class, first aid officer, or any other person whose job may include tasks
involving possible exposure to body fluids/tissues
NOTE: It is not the University’s position to deny anyone from being immunized. Each person has the
opportunity to provide for his or her own immunization. If an employee believes that he/she is at
risk, but is not on the list of at-risk personnel s/he can appeal that decision to the Campus Safety
Officer.
Bastyr University agrees to pay for:
 100% of the cost of the immunization series for all staff and medical staff, per
OSHA/WISHA regulations.
 50% of the cost of the immunization series for students (up to the amount charges by the
King County Department of Health).
ALL OTHER REQUIRED IMMUNIZATIONS:
For off-site clinic shifts or preceptor sites which require MMR immunization (measles, mumps, and
rubella) or any other kind of immunization or proof of immunity:
The student is required to pay for:
All costs involved in testing for anti-body levels, if they choose to check for immunity, as well as costs
for immunizations.
This policy will become fully implemented at the start of Summer Quarter 2000. In succeeding years, the
waiver, commencement of the immunization series, and tuberculosis screening shall occur before the first
day of work for all medical staff and staff and before ND & AOM students enter the clinic, and with the
start of Fall Quarter each year for entering ND & AOM students. Screenings shall occur at the campus
and clinic. However, the student may need to receive certain immunizations and screenings off-site on
occasion.
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BASTYR UNIVERSITY
NATURAL HEALTH CLINIC
BASTYR UNIVERSITY NATURAL HEALTH CLINIC
SECTION II.
CLINICAL PROCEDURES, POLICIES AND PROTOCOLS
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PATIENT VISIT PROCEDURE
Patient visit procedures
I. Supervising (Attending) Medical Staff: Supervisor must personally see each patient, in the exam
room, at some time during each clinic visit. The supervising (attending) medical staff is responsible
for both the quality of care provided to each patient and the quality of supervision given to the student
clinicians. Overall case management is the responsibility of the supervising physician. Specifically,
the supervising medical staff is responsible to:
a. Preview each case with the students during case preview in order to establish a framework from
which the students can proceed. Please follow case preview guidelines.
b. Teach the students how to proceed through the standard SOAP format in case taking and
management.
c. Suggest and/or approve a diagnostic strategy, being certain that the assessment is established
before the plan is discussed and/or implemented. The primary student clinician should present a
differential diagnosis with reasons to support and/or rule out each differential diagnosis. The
supervising medical staff makes the final decision on the diagnosis.
d. Decide whether or how much of the case discussion should take place in front of the patient or in
a private area. When the supervising physician is discussing the case with the student clinicians
outside the patient’s room, be as timely as possible and don’t leave the patient alone for an
unreasonable amount of time.
e. See to it that appropriate referrals take place, either in-house or to an outside doctor or facility.
There is a referral directory in the clinic medical staff office with a comprehensive listing of
referrals. There is also a referral protocol that student clinicians and supervising medical staff
should follow.
f. Suggest and/or approve the plan of treatment, be sure the patient plan and instruction sheets
given to the patient are filled out correctly, sign the superbill, and sign or initial other appropriate
forms such as the dispensary order form, lab requisition form and/or record release form.
g. Go door to door 15 minutes before case review and insure that student clinicians are progressing
towards completion of the visit.
h. Approve and/or amend case notes and sign them once the chart is completed and signed by the
student clinician. Charts should be signed within 72 hours of visit.
i. Initial the patient summary line on the inside cover of the chart for each date that a patient is
seen.
j. Indicate the approved number of refills for any dispensary items on the dispensary order form.
k. Make sure the superbill is filled out completely: patient name (last name in capital letters), date,
circle appropriate visit code, diagnosis and diagnostic or procedure lab tests, and sign it.
l. Attend and direct case review at the end of the shift as explained in the “Guidelines for Student
Clinician-Clinic Doctors General Clinic Interaction.”
m. Initial the student’s summary of patient contact form and time sheet when it is completed by the
student at the end of the shift.
n. Delegate responsibility to the primary student clinician as soon and as much as possible based on
competence and evaluations.
o. Give appropriate feedback to students each week regarding their case management, using the
student daily evaluation form as a guideline. It is strongly encouraged to give each primary
student weekly written evaluations.
p. Take attendance on each shift.
q. Supervisor must be present in the exam room during all male/female genital exams or treatments
that expose these areas. Supervisors must ensure accuracy of all abnormal physical exam
findings.
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r.
Supervisor needs to take an active role in communicating difficult or potentially life-threatening
news to a patient and should not delegate this task to the student clinicians.
ND/AOM Primary/Intern Student Clinician
The primary student intern is responsible for presenting her/his cases in case preview and review,
directing the patient interview, taking the case notes and assessing the patient both subjectively and
objectively. After collecting this information, the student meets with the supervising doctor to
discuss the diagnostic strategy and, once a diagnosis is reached, establish the plan. The primary
student intern is encouraged to think through and develop her/his own strategy and management of
the case. The supervising medical staff makes the final decisions. Specifically, the primary student
intern:
a. Previews the case with the attending acupuncturist and secondary student clinician during case
preview before initiating contact with the patient.
b. It is the responsibility of the primary intern to physically check the reception area for the first 15
minutes of a scheduled appointment in the event of a late patient. If a patient arrives more than 20
minutes late for their appointment, the receptionist will page the supervisor. The supervisor will
determine the viability of starting the appointment or the need to reschedule the appointment.
c. Meets the patient in the reception area and shows the patient to the exam room. She/he should
explain to a new patient how our clinic operates and how patient visits are conducted, and tell the
patient how many supervisors and/or observers will be attending the visit. (From this point onward,
the patient is not to be left unattended, except for the purpose of providing privacy during disrobing
and dressing again in connection with a physical exam, or when the student clinicians and
supervisor discuss the case in private consultation.) Make sure to tell all patients to wait until the
clinician returns before getting up onto the exam/massage table. Additionally, do not leave patients
with limited physical or mental capacities unattended for more than brief periods of time.
d. Takes case notes in black pen only, neatly and in an organized manner, following the standard SOAP
formats. An S, O, A or P should be written in for each appropriate section on Progress Form.
e. Carries out supervisor’s instructions with respect to interviewing the patient, performing a physical
exam, diagnostic studies, and making referrals and treatment plans.
f. Familiarizes the secondary student clinician with her/his style of case management, and
directs/supports the secondary student clinician’s role as an observer and facilitator.
g. Signs the chart when it is completed, (charts must be completed within 24 hours of the patient visit),
fills in the summary of patient contact Health Data and Medication List forms on the inside cover of
the chart, makes certain that the superbill is filled in correctly and signed by the supervising doctor
and obtains the supervisor’s signature on the case notes.
h. Is responsible for recommending that the patient is rescheduled at a time that the supervisor and, if
possible, the primary and/or secondary student clinicians are present. The supervisor, with the
knowledge and consent of the patient must approve exceptions.
i. Is responsible for follow-up telephone contact with the patient, and phoning the patient when there is
a cancellation or no-show on a scheduled visit, with the goal of finding out why the patient was
unable to come in, the state of their health and to reschedule an appointment. Limit the length of all
phone calls to/from patients to no more than 3 minutes. All phone contacts need to be pre-approved
by the supervising medical staff. Be certain to record any phone contact information in the patient
chart, and have it signed by the supervising medical staff . (Patients appreciate your personal care
and interest you show in their health care.)
j. At the end of the shift, is responsible for having the time sheet and summary of patient contacts
signed off by the supervisor/medical staff.
k. Personally locate and inform the supervising medical staff if they do not respond in a timely fashion.
l. Remember to close the blinds when a patient is told to undress and put on a gown during a physical
exam or in certain treatments, and during evening clinic shifts.
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m. Become familiar with clinic resources, such as patient protocols, therapeutic notebooks, forms, etc.
n. Only practice modalities in which coursework has been completed, and which your supervisor has
approved (i.e., utilizing cranial sacral therapy should only occur on shifts when the supervisor is also
proficient).
CHARTING GUIDELINES
(SECTION UNDER REVISION)
INTERVIEW GUIDELINES
(SECTION UNDER REVISION)
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PATIENT VISIT PROCEDURE
ND/AOM Secondary/Observer Student Clinician
The secondary student clinician has an observer/facilitator role. It is her/his responsibility to discuss
with the primary student intern on each shift exactly what role she/he is to take during the patient visit.
Specifically, the secondary student clinician:
a. Becomes familiar with each case on each shift before case preview.
b. Makes certain that the exam room is in order and that all the necessary supplies are in the room.
There is a list of supplies for each room in the cabinet above the sink. Insures that the paging
telephone volume is at an audible level.
c. Attends case preview to provide input on each case with the primary student intern and supervising
medical staff.
d. Oversees the dispensary care, entering all dispensary items on the dispensary requisition form on a
one-item-per-line basis. She/he then obtains all appropriate supervisor’s initials on the card, seeing
that the date, item and refill section are complete. This student also takes the form to the appropriate
dispensary.
e. At the conclusion to the office visit, accompanies the patient to the front desk to have the return
office visit scheduled, and check out. The student does not need to wait with the patient.
f. Instructs the patient that they will have to collect and pay for their dispensary items separately from
the visit fees. The student should also direct the patient to the dispensary.
g. Makes certain that the room is in order and the supplies that were used replaced at the end of the
shift.
h. Attends case review during the last half-hour of the shift.
i. At the end of the shift, is responsible for having the time sheet and summary of patient contacts
signed off by the supervising acupuncturist/medical staff.
j. Anticipates the paper work that will be needed on a shift and have it ready: release of records, diet
diary, clinic referral form, etc.
k. Completes all information on the Records Release Form, has patient sign and date the form and has
the name of the requesting primary intern on the form.
l. Personally takes the patient’s chart to the reception desk of a different department if the patient is
subsequently scheduled for a visit in that department.
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ND/AOM/ NUTRITION CASE MANAGEMENT CONSIDERATIONS
1. Case Taking and Charting
a. Case management should be designed by using the standard SOAP approach to taking and
charting cases. Each section, the S. O. A. and P. should be clearly designated in the chart for
each patient visit. The primary student clinician is responsible for signing the chart before
giving it to the supervising medical staff for review and signature. Each chart should be left
in the supervisor’s chart area with a chart tag affixed inside, to left of chart.
b. These areas are designated as:
1) Subjective
2) Objective
3) Assessment
4) Plan
c. Refer to handout section on case management.
2. Time Management
a. Student clinicians are responsible for beginning and ending patient visits on time.
b. A Comprehensive FOC is 1.5 hours, of which 1.25 hours is for the patient visit and 15
minutes is for completing the chart and preparing for the next patient. You should manage
your time appropriately. Homeopathy FOC’s are 2 hours. Nutrition FOC’s are 1 hour.
c. An acute FOC is 1.0 hours, of which .75 hours is for patient visit, and 15 minutes is for
completing the chart and preparing for the next patient.
d. A regular ROC is 1 hour, of which .75 hours is for the patient visit and 15 minutes is for
completing the chart and preparing for the next patient.
e. An Acute ROC is for 30 minutes. The purpose of this visit is for follow-up on 1 acute health
concern.
f. A Consultation, “Introduction Visit” is for 20 minutes. The purpose of this visit is to answer
patient questions and provide general information. No diagnosis or treatment is to be given.
g. As each patient visit is completed, the exam room is to be disinfected, organized, and made
ready for the next patient.
h. Time should be managed so that the student clinicians are done and are ready for case review
for the last 30 minutes of the shift.
i. Students cannot determine the length of a visit. This is the responsibility of the supervising
doctor. When a patient schedules and is seen for a visit, the length of the visit should not be
changed without the supervisor’s consent.
3. Check-out and Payment for Services
a. When the patient visit is completed, the primary or secondary student clinician must
accompany the patient to the front desk in order that the patient may reschedule and checkout. Be sure to hand the front desk staff the completed and signed superbill. The supervising
physician is responsible for filling out the superbill accurately and completely, with all
diagnostic, treatment code numbers as appropriate. Students should not linger at the front
desk and only wait there if assistance is required for patients with a special scheduling need.
b. All patients must check out at the front desk before leaving the clinic. Secondary clinicians
are responsible for notifying the front desk of any late patient checkouts.
c. All payment arrangements, or discounts on services must be arranged by the patient services
department prior to the patient visit.
d. Be familiar with the scope of clinic services.
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ND, AOM AND NUTRITION CASE PREVIEW PROTOCOL
The following are recommendations to make case preview a better learning and teaching experience:
1. Case preview is the first 30 minutes of each 4-hour shift.
2. Start promptly. Clinic supervising medical staff is responsible for starting and ending case
preview on time. Clinic supervisors should be familiar with the day’s cases.
3. Students should be prepared to start on time with all of their cases reviewed beforehand. All lab
work and medical records should be in the chart ready to be discussed.
4. Each student team from each room presents a brief identification of their patients scheduled on
the shift, with their chief complaints.
a. Patient age, sex and race if relevant.
b. Chief complaint(s).
5. Then, going one room at a time, the primary student clinician should present the reason or
purpose of the days’ visit for each of the patients in their room. The clinician should include
other relevant information on each case, namely age of patient, sex, race and chief complaints.
a. If this is a ROC, a short summary should be presented of past data pertinent to understanding
the differential diagnosis, and the response of the patient to the treatment. Also note future
plans. A discussion of that day’s plan should be presented.
b. If this is an FOC, a discussion of the complaint listed should occur that includes possible
diagnosis, confirmatory exams, and therapeutic ideas.
6.
7.
7.
9.
10.
All the other student clinicians should be attentive to each case, in order to learn from it and
offer any input they might have.
By the end of case preview, all the cases will have been discussed as a group, and the
students prepared to start the first scheduled patient’s care.
If students are more than 15 minutes late for case preview without prior arrangement or an
emergency, there will be no credit given for case preview, and the 30 minutes time will need
to be made up at a future date. Shift supervisor will mark absent on the CP (case preview)
section of the attendance sheet for that shift.
This is valuable time that should be used to prepare and educate the supervising
physician/medical staff and student clinicians for the shift’s patients.
Finish case preview with the group after 25 minutes, to allow 5 minutes for students to get
ready to start on time with their patients, and time to discuss cases on an individual basis if
needed.
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ND, NUTRITION AND AOM CASE REVIEW PROTOCOL
YOUR CASE PRESENTATION MUST BE CONCISE AND TO THE POINT. THIS
SHOULD BE DONE IN 6 TO 7 MINUTES.
1. Clinic supervising physicians/medical staff is responsible for starting and ending case review on
time.
2. Case review is the last 30 minutes of the 4-hour shift.
3. Any student more than 15 minutes late for case review will not receive credit for case review.
(You must get approval from the supervising physician/medical staff in order to get credit under
special circumstances.) The 30 minutes will need to be made up to receive credit.
4. At the beginning, student clinicians from each room will report briefly on each patient
identifying the chief complaints and the diagnosis.
5. Supervising physicians/medical staff will then choose the best teaching cases and have the
student clinicians present each case with the following format: (NOTE: Students are encouraged
to present their cases from memory without reading excessively from the patient’s chart.)
SUBJECTIVE
1.
2.
3.
4.
Patient information
Introductory comment
Chief complaint(s) and its (their) duration
HPI- present a succinct version of the HPI
5.
6.
7.
8.
 pertinent positive findings from appropriate ROS section(s)
 pertinent risk factors and family history
PMH - give only pertinent information
Allergies - all allergies including drug reactions (include type of reaction)
Medications - all present medicines, dosages and indications for taking
Lifestyle - pertinent information on work, school, home environment,
sleep, exercise, diet, relationships, habits
ROS - state only pertinent positives (other than those mentioned in HPI)
9.
OBJECTIVE
Physical Examination
1. Introductory sentence - describe appearance and condition
2. Vital signs
3. Pertinent positive findings - describe findings
Laboratory Tests and Diagnostic Studies
1. State pertinent positives and significant findings
2. State pertinent negatives if they are significant
3. State significant past results, if available
ASSESSMENT
1. Problem list - compile and present a comprehensive list for the differential diagnosis
a. give reasons and findings that support or rule out each ddx
2. Diagnosis - state your diagnosis (may have more than one) NUTRITION: State your assessment.
3. Impression - after you indicate your diagnosis, you may then, in your own words, give your
impression of the patient
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PLAN
1. State your treatment plan according to each diagnosis NUTRITION: State your recommendations
for each assessment.
2. State the reasons supporting each treatment in the plan (rationale) (Include a discussion about
naturopathic or Eastern Medicine, philosophy and, for ND’s: the therapeutic order.)
3. Indicate laboratory tests and/or diagnostic studies you plan to order
Follow-up Plan
1. Indicate when you will next see the patient in the clinic/office
2. Indicate any planned phone call follow-up
3. List any short-term or long-term goals that you have for the patient
OUTCOME
1. State what you believe the outcome will be according to the diagnosis and treatment
2. Indicate the time frame for the treatment plan
3. If this is a case you have been following and you are able to make a conclusion of the efficacy of
the treatment, indicate this here as well
REMEMBER TO BE CLEAR, CONCISE AND COHERENT
ALWAYS KEEP IN MIND THE NATUROPATHIC PRINCIPLES OF TREATMENT AND/OR
PRINCIPLES OF TRADTIONAL CHINESE MEDICINE
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PATIENT RECORDS AND RELATED FORMS
Following is a list of forms that you should become familiar with and use in the clinic. If you have
questions about these forms, please contact the Clinic Registrar or Medical Director
1.
2.
3.
4.
Comprehensive FOC Case History Interview Form
Progress Notes Form
Physical Exam Form
Patient Summary Form in Chart
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Medication Log form
Patient Information Form
Adult Health Data Form
Pediatric Health Data Form
Dispensary Order Form
Lab Requisition Forms (In-House and Reference Lab)
Patient Plans and Instructions Form
Summary of Patient Contacts Form
Reportable Disease Form
Preceptor Program Forms
Clinic Outreach/Community Education Form
Interim Hour Form
Substitute/Absence Form
Advising Form
Medical Staff/Medical Staff Evaluation Scantron Card/Form
Referral Letter Samples
Request for Patient Records Form
Diet Diary Form
Student Report to Medical Director Form
Patient Profile Form
Consultation Interview Form
Time Sheets
Life Contract
Naturopathic Welcome Information
Observation Consent Form
Informed Consent 1 and 2
New Patient Information Form
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PATIENT CHARTS
PATIENT CHARTS ARE TO REMAIN IN THE CLINIC AT ALL TIMES. UNDER NO
CIRCUMSTANCES ARE PATIENT CHARTS EVER TO LEAVE THE CLINIC.
1. When a chart is removed from the front desk area, an out card must be filled out and put in the
chart’s place. Do not refile charts that have been removed from the files. Place the charts in the
chart return box, if completed and signed, and the front desk staff will refile them. If incomplete or
needing supervisor signatures, attach an Incomplete chart tag inside the front cover and place in
supervisors chart box. All charts must be completed within 24 hours of the contact. Supervisors
must sign these within another 48 hours. Please refer to the guidelines around front desk function
and student’s responsibilities when interacting with the front desk. (See chart guidelines at front
desk for more information.)
a. If a student clinician removes a chart from the Bastyr University Natural Health Clinic premises,
on first offense, it will result in: (1) A failure in clinic for one entire quarter shift, including loss
of hours and patient contacts.
b. If a physician/medical staff or staff member removes a chart from the Bastyr University Natural
Health Clinic premises their job security will be placed in jeopardy.
c.. If a student clinician removes a chart from the Bastyr University Natural Health Clinic premises, on
second offense, it will result in:
(1) A second clinic shift failure and immediate clinic suspension.
2. There are several basic components to each patient’s chart, (and correct placement in chart):
b. Patient in-take form (last page on inside front cover)
c. Case history/physical exam/assessment/plan forms (filed in chronological order, most recent on
top)
d. Progress notes (filed in chronological order)
e. Copy of plans and instructions to patients (filed with notes from that day’s visit)
f. Lab reports (back section, on left)
g. Previous medical records and copies of release forms.(back section on right)
h. Patient summary sheet (first page on inside front cover)
i.
Adult or Pediatric health data form (inside front cover)
j. Statement and Insurance Form (superbill - placed inside of chart prior to each visit)
k. Patient information form (inside left front cover directly beneath medication log form)
l. Medication Log form (inside left front cover, on top of Patient information form)
3. Each component of the chart is the responsibility of one or more members of the patient-care team:
supervising physician/medical staff, primary student clinician, secondary student clinician. The
responsibility of keeping the charts in order belongs to the primary student clinician:
a. The patient summary sheet will be fixed as the first page on the left inside cover of the chart.
The sheet will contain an entry for each visit that should be filled out correctly and initialed by
the supervising physician/medical staff.
b. Lab reports are to be 2-hole punched at the top and inserted into the back section of the chart, on
the left.
c. The patient intake form will be 2-hole punched at the top and inserted as the last page in the front
section of the chart under the patient summary sheet.
d. The FOC forms will be 2-hole punched at the top and inserted in the front section of the chart,
opposite the intake form.
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e.
f.
g.
h.
The Adult Health Data form will be 2-hole punched and placed inside left cover.
The Patient Information form will be 2-hole punched and placed inside left cover.
The Medication form will be 2-hole punched and placed on top of the Patient information form.
Progress notes for each succeeding ROC will be 2 hole punched at the top
and inserted on
top of the previous visit notes.
i. Previous medical records should be 2 hole punched at the top and inserted in the back section of
the chart opposite the lab reports in order received.
j. Notes/letters from referral physicians should be 2 hole punched at the top and inserted as they are
received as previous medical records and behind FOC forms.
k. All charts must be completed by the primary student clinician in 24 hours and signed by the
supervising physician within 72 hours after the patient contact.
Charting concerns and/or deficits identified should be discussed by the supervising physician/medical
staff and student, and corrected immediately. If this doesn’t resolve the problem, the student will be
warned in writing of the problem and asked to correct it within a defined time limit. If chart is not
corrected within that time, the student will receive a clinic sanction.
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MEDICAL RECORDS
All medical records requested and/or received must be processed via the medical records department.
1. Please tell patients, who want records of their charts sent to another health care practitioner, or to
themselves, that the patient must complete a Release of Information Form. Only information that
originated at Bastyr University Natural Health Clinic will be released and only with signed
authorization. There may be a charge for patients wanting records for personal use or to hand-carry to
another provider. There is always a charge to send patient information to parties not directly
involved in patient care.
2. Copies of information from other health facilities will not be released to patients. They may contact
the facility where the information originated.
3. Copies sent to another clinic/health care practitioners are sent at no charge, as professional courtesy.
A patient who wants information for personal use, or to hand carry to another provider will be given
15 pages at no charge. Copies in excess of 15 pages will be charged at the full rate. All copies sent to
parties not directly involved in patient care will be charged at the full rate.
4. Medical Records Personnel should be given completed authorizations for processing. The form must
be signed and dated by the patient, include the outside facilities address, patient date of birth, and
patient’s daytime phone number. The student clinician should tell the patient that it will take 7 – 10
business days to process the request. Outside release forms must include special authorization for
information related to sexually transmitted diseases, HIV and AIDS, substance abuse or mental
health and counseling.
5. When medical records personnel receive information, that information is placed in the chart and they
are placed in requesting provider’s box.
6. Medical record personnel must process all outgoing requests and incoming records. This includes all
records received by FAX. Medical Records must also process any information mailed directly to the
NHC providers.
7. If a patient is being seen simultaneously by different providers, it is permissible for the Bastyr
supervisor/student team to include copies of relevant labs or progress notes with written referral
letters with a summary of treatment letters to these other providers. It is also permissible for these
providers to share information from the patient records with one another as part of consultation
conversations.
INSURANCE
UNDER REVISION John Hibbs to write this
NOTE: INSURANCE BILLING POLICIES MAY CHANGE IN 2000-2001.
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PAGERS/CELL PHONE USAGE
All pagers and cell phones must be on vibratory alert mode while in the clinic. Furthermore, it is not
permissible to answer these calls in a room with a patient during a patient visit. Urgent calls may be
answered outside of patient care rooms.
CLINIC TELEPHONE PAGING SYSTEM
While paging may be disruptive to a patient visit, it is critical that student clinicians and supervisors be
able to hear pages at all times. All telephone pages require immediate attention; some pages are of an
emergency or urgent nature. From this point forward, it will be the responsibility of the observing or
secondary student in each room to make sure that the volume of the telephones is at an audible level.
Failure to comply may result in a failure event for that student.
Please know that we are in a process of developing a triage system for paging calls. This process should
result in fewer and only essential pages.
If you have any questions about this policy or telephone operation, please contact your shift supervisor.
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BASTYR UNIVERSITY NATURAL HEALTH CLINIC
SECTION III: PATIENT MANAGEMENT POLICIES
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PATIENT SCHEDULING
Student clinicians are encouraged to contact and bring in your own patients through outreach/community
education, public talks, participating in wellness clinics and health fairs, and talking to your friends. You
can also go back through past clinic patient files and call patients. Please see the Medical Director first.
1. Fourth year (or 5th year) N.D. and third year AOM student clinicians, as you begin to enter the Spring
Quarter, and are on schedule to graduate, need to begin the process of providing a smooth transition
of transferring the primary responsibility of care for your patients to the third year student clinicians.
You are required to notify your patients, your supervising physicians, and the student clinicians you
are referring the patient to about this transition, and to note this transfer in the patient chart. This
transition will take place by graduation, so that all patients will continue with the same supervising
physician/medical staff and new fourth year student as the primary student clinician. Once you
graduate, you will not be able to see patients in the capacity of a student any longer - and until you
are licensed as a physician (ND) or as an acupuncturist with NCCA certification (AOM) you are not
able to practice medicine. You must graduate and pass the board exams, and obtain your license in
order to see patients.
2. The front desk has a system of scheduling FOC’s that is fair for everyone. Student clincians may not
make any requests to restrict FOC’s in their rooms.
3. If arranging an appointment for a patient, students need to have the patient call in to schedule an
appointment. Students must never schedule appointments, or ever write or erase in the appointment
book. It is fine to tentatively arrange with a patient when to come in, but the patient must be the one
to actually contact the front desk to schedule the appointment.
4. You must have your patients scheduled on regular clinic shift time.
ND/AOM/NUTRITION PATIENTS REFERRED TO CLINIC
1. ND: Patients directly referred by another physician or supervising Medical Staff for lab tests,
physical medicine treatment or dispensary items may be seen and/or treated without the usual FOC
work-up. A chart should be made up with a note/short summary of the complaint/care from the
referring physician and what type of treatment she/he wants for her/his patient in physical medicine.
If a patient does not bring the appropriate written and signed information from the referring
physician, please telephone the referring physician for authorization.
2. ND & AOM: A thank you letter should be composed, typed and sent to any referring physician in
appreciation for sending her/his patient to us.
3. ND & AOM: A letter summarizing the patient’s visit and/or treatments should be sent to a referring
physician after an appropriate number of visits, typically three visits, or after pertinent diagnostic or
therapeutic outcomes are achieved.
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ND PATIENT REFERRALS TO OUTSIDE PHYSICIANS/HEALTH CARE
PROVIDERS
1. There is a referral notebook of Bastyr University Natural Health Clinic approved doctors, clinics,
hospitals and other health care professionals, located in the medical staff office and another one at
the front desk. The supervising medical staff must approve all referrals, after consulting the patient.
2. It is recommended that the supervising physician/medical staff either type a letter or call and
personally talk to the physician or other health care professional about the patient and set up the
appointment. This task may be delegated to the primary clinician, if appropriate.
3. If a letter is written, it should include the patient’s identifying information, the presenting complaints
and other relevant subjective information, any objective findings, the assessment or rule outs
(differential diagnosis), the reason for the referral and what tests or diagnostic procedures to perform.
State whether or not the physician/health care practitioner should institute treatment as she/he sees
appropriate, or whether she/he should consult back with the supervising medical staff. This letter
needs to be signed by the physician/health care practitioner, photocopied and the original sent with
the patient and the copy placed in the chart.
4. You may use one of the form letters located in the patient resource file or you may compose your
own letter. Please use official clinic stationary for these letters.
AOM / NUTRITION PATIENT REFERRALS TO OUTSIDE PHYSICIANS/HEALTH
CARE PROVIDERS
1. There is a Rolodex card file of Bastyr University Natural Health Clinic approved doctors, clinics,
hospitals and other health care professionals, located in the medical staff offices. The supervising
medical staff must approve all referrals, after consulting the patient.
2. It is recommended that the supervising medical staff call and personally talk to the acupuncturist or
other health care professional about the patient and set up the appointment.
3. A brief referral letter should be typewritten by the primary or secondary student clinician to either
send with the patient to the acupuncturist/health care practitioner, or get mailed. This letter should
include the patient’s identifying information, the presenting complaints and other relevant subjective
information, any objective findings, the assessment or rule outs (differential diagnosis), the reason
for the referral and what tests or diagnostic procedures to perform. State whether or not the
acupuncturist/health care practitioner should institute treatment as she/he sees appropriate, or
whether she/he should consult back with the supervisor first. This letter needs to be signed by the
acupuncturist/health care practitioner, photocopied and the original sent with the patient and the copy
placed in the chart.
See the referral etiquette form on how a letter should be composed.
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EXAMPLE: LETTER OF REFERRAL
(Print on Clinic letterhead)
Date___________________
Dear___________________,
We are referring ______________________ to you for further evaluation of:
Pertinent History:
Pertinent PE/Lab:
Diagnosis:
Tx to Date:
____Please evaluate and help treat the problem as indicated.
____A brief written or verbal report on findings and recommendations would be appreciated.
____Please provide periodic status reports on patient if she/he remains under your care.
Enclosed are the following reports to help relay work-up of problem(s) to date:
_____chart notes
____lab
____X-ray/reports
____other
Thank you so much for your help in the care of this patient. If further information is needed,
please call. Feel free to use our fax if desired, (206) 632-8034.
Sincerely,
_______________,ND/L.Ac./ RD
______________, Student Clinician
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Appointment on
_____date
@________time
Example #2 Referral Letter
(Clinic letterhead)
TO:
______________________________________DATE________________
REFERENCE:
PATIENT REFERRAL NOTE FOR:
PATIENT’S NAME
DATE OF BIRTH
I have referred this patient to you for the following problem:
CLINICAL
SUMMARY___________________________________________________________________
_______
THANK YOU FOR SEEING THIS PATIENT. I LOOK FORWARD TO YOUR FINDINGS.
_____________________(ND/ L.Ac./RD) ________________________Student Clinician
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ND/AOM/ NUTRITION TELEPHONE CONTACT
1.
Please observe the following rules for phone contact:
a. The clinic phones are for clinic business only.
b. All calls to patients must be pre-approved by the supervising physician/medical staff.
c. If the patient’s residence is long distance, you must obtain permission to call from a
supervisor and use a medical staff phone.
d. Calls to/from patients should be limited to 3 minutes. If the call is longer than this, consider
scheduling the patient for an office call, or consultation. A phone contact should not replace
an office visit.
e. You are legally responsible for phone advice. A note in the chart must be made with the
date, reason for the call and any pertinent information or advice. You and the supervising
physician/medical staff should then sign this. Do not offer any new treatment advice or
change any treatment plan without the approval of the supervising medical staff.
f. There is a student phone in the lounge that should be used for local, personal calls.
g. Students should never give home phone numbers to patients. Any business that you need to
discuss with a patient should take place at the clinic in person or by phone.
HANDWASHING AND DISINFECTION
All students are required to wash hands with soap and warm H20 before and after every patient visit.
Disinfection of surfaces (exam tables, sink and countertop, lamp, etc.) must be performed between each
patient visit. Refer to infection control manual located in lab for details.
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ND AND AOM CLEAN NEEDLE TECHNIQUE AND BIOHAZARD WASTE
HANDLING
You are responsible for knowing the OSHA guidelines for bloodborne pathogens. You are required to
view a training video and sign a document acknowledging that you understand these guidelines annually.
Please follow the clinic policies for handling biohazard materials by placing disposables in the biohazard
bags located in each exam room. Reusable instruments should be taken immediately to the supply room
for cleaning and sterilization. Biohazard materials include all supplies and instruments that have come
into contact with patient body fluids, such as blood, urine, vaginal secretions, saliva, etc. See the Safety
Manual in the laboratory or ask the current infection control representative for details.
Acupuncture Needle Policy
1. An acupuncture needle count will be made prior to any treatment and initialed by the intern before
insertion. Any needles added or removed during the treatment must be recorded. After removal of
all needles a final count must be made and initialed by the intern(s) and by the supervisor. This
information must be recorded on the chart notes for every visit.
2. Any lost needle must be brought to the attention of the supervisor. A continued lost needle will
result in a flagged garbage to be deposited in the bloodborne pathogens “box” and laundry from the
room will be flagged. A special notice will be placed on the door alerting the janitorial crew to the
lost needle in the room. On rare occurrences it is possible a patient will take a needle home that
dropped into a pants cuff or elsewhere in clothing. A decision may be made to call a patient and alert
them to this possibility.
3. “Lost needle” incidents will be recorded by the supervisor and brought to the attention of the Clinic
Program Coordinator immediately. The Clinic Program Coordinator will record the incident and
send a copy to the Clinic Registrar to be placed in the student’s record. Any pattern of continual
occurrences of lost needles will result in clinical sanctions. If the needle is found related to a specific
room or shift this could result in clinical sanctions for the clinicians in that room.
4. All private practice acupuncturists working out of the NHC will be alerted to this policy and the
clinic’s concern. If needles are found related to private practice the Clinic Medical Director must be
notified so proper feedback may be initiated. Needles from private practice will be taken as seriously
as those found in the teaching clinic.
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SENTINEL EVENTS
PROCEDURE : REPORTING AN OCCUPATIONAL ACCIDENT/ILLNESS EVENT
It is understood that this procedure is for any occupational injury or illness occurring on the Clinic premises or caused by
the working environment.
I.
II.
III.
IV.
V.
In case of illness
A.
Notify supervisor
1.
Supervisor shall complete the ‘Occupational Illness/Injury Report Form’ with employee
2.
Employee shall be seen by a provider of their choice (i.e.: at the Clinic or elsewhere)
B.
Supervisor shall immediately forward paperwork to the Clinic Safety Coordinator
C.
Safety Coordinator will forward paperwork to Human Resources Department within 24 hours of the incident
and continue the evaluation process (see sec. V. B.)
In case of accident
A.
Notify employee/student’s supervisor
1.
Supervisor shall immediately contact nearest available N.D. provider and then contact the front desk
2.
Provider is responsible for physical assessment of any injury and shall approve moving the injured
person only if safe to do so
3.
Front desk is responsible for the following:
a.
Furnish ‘Occupational Illness/Injury Report Form’ to provider/supervisor
b.
Arrange for an exam room
c.
Contact appropriate emergency responders per provider’s instructions
4.
Supervisor and provider will begin appropriate paperwork with employee as soon as possible,
following the injury
B.
Supervisor will forward paperwork to the Clinic Safety Coordinator within 24 hours of the incident
C.
Safety Coordinator will continue evaluation process (see sec. V. B).
Emergency transport of patient will be 911 vehicle
In case of a sentinel event
A.
Sentinel event is defined as an unexpected occurrence involving death or physical or psychological injury, or
the risk thereof. Such events are called “sentinel” because they signal the need for immediate investigation and
response.
B.
Front desk is notified and is responsible for the following:
1.
Page senior N.D. provider to the site using the in-house emergency contact schedule
2.
Arrange for exam room
3.
Furnish ‘Occupational Illness/Injury Report Form’ to provider/supervisor
4.
Contact appropriate emergency responder per instructions from provider
C.
The following administrators must be notified immediately
1.
Dean of Clinical Services
2.
Clinic Medical Director
3.
Clinic Manager
4.
Clinic Safety Coordinator
Paperwork requirements
A.
Supervisor or provider must complete the ‘Occupational Injury/Illness Incident Report Form’, to include
B.
1.
Date, time and place of incident
2.
Complete detailed description of incident, including any object(s) or machinery involved
3.
Nature of incident
4.
Indicate basic cause and any contributing cause(s)
Safety Coordinator completes investigation of events
1.
Conducts interviews with all persons directly involved
2.
Presents evaluation to Clinic Safety Committee which is responsible for the following:
a.
Review evaluation
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b.
c.
C.
D.
Develop action plans and establish time lines for completion, including but not limited to
i.)
Documentation of response to the incident
ii.)
Identification of deficiencies
iii.)
Suggestions for improvement(s) to the response
Write recommendation(s) and send to
i.)
Supervisor/provider who was directly involved
ii.)
Clinic Program Coordinator
iii.)
Clinic Medical Director
iv.)
Clinic Manager
v.)
Dean of Clinical Services
OSHA 200 Log and Summary Form is required to be completed for each event, and is the responsibility of the
Safety Coordinator.
Copies of all paperwork will be forwarded to Bastyr University Health and Safety Office on the main campus
PROCEDURE: REPORTING A VISITOR/PATIENT ACCIDENT/ILLNESS EVENT
It is understood that this protocol is to be for any injury or illness occurring on the Clinic premises or as a result of a product
purchased from the Naturopathic Dispensary or the Oriental Medicine Dispensary
I.
In case of illness/accident on the premises of the Clinic
A.
Front desk is notified and is responsible for the following:
1.
Page senior N.D. provider to the site using the in-house emergency contact schedule
2.
Arrange for exam room
3.
Furnish ‘Patient/Visitor Incident Report Form’ to the provider of record
B.
Provider of record completes top portion of form and forwards paperwork to the Clinic Safety
Coordinator within 24 hours of the incident
C
.Safety Coordinator/Risk Management Officer is responsible for contacting the University’s liability company
D.
Safety Coordinator shall copy all paperwork to the Clinic Medical Director and Manager within 24 hours
II
Emergency transport of patient will be 911 vehicle
III.
In case of injury from or adverse reaction to any product purchased from the Clinic
A.
Dispensary staff notifies supervisor to discuss event with patient
1.
Supervisor determines extent of problem
2.
Refers patient to provider if necessary to discuss specific nature of problem
B.
Dispensary staff and/or supervisor completes top portion of ‘Patient/Visitor Incident Report Form’, and
forwards paperwork to Clinic Safety Coordinator within 24 hours of the incident
IV.
In case of a sentinel event
A.
Sentinel event is defined as an unexpected occurrence involving death or physical or psychological injury, or
the risk thereof. Such events are called “sentinel” because they signal the need for immediate investigation and
response.
B.
Front desk is notified and is responsible for the following:
1.
Page senior N.D. provider to the site using the in-house emergency contact schedule
2.
Arrange for exam room
3.
Furnish ‘Patient/Visitor Incident Report Form’ to provider of record
4.
Call appropriate emergency responder per provider instructions
C.
The following administrators must be notified immediately
1.
Dean of Clinical Services
2.
Clinic Medical Director
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3.
4.
V.
Clinic Manager
Clinic Safety Coordinator
Paperwork requirements
A.
Supervisor or provider must complete the top portion of the ‘Injury/Illness Incident Report Form’, to include
B.
1.
Date, time and place of incident
2.
Complete detailed description of incident, including any object(s) or machinery involved
3.
Nature of incident
4.
Indicate basic cause and any contributing cause(s)
Safety Coordinator completes investigation of events
1.
Conducts interviews with all persons directly involved
2.
Presents evaluation to Clinic Safety Committee which is responsible for the following:
a.
Review evaluation
b.
Develop action plans and establish time lines for completion, including but not limited to
c.
3.
i.)
Documentation of response to the incident
ii.)
Identification of deficiencies
iii.)
Suggestions for improvement(s) to the response
Write recommendation(s) and send to
i.)
Supervisor/provider who was directly involved
ii.)
Clinic Program Coordinator
iii.)
Clinic Medical Director
iv.)
Clinic Manager
v.)
Dean of Clinical Services
Follow-up by Safety Coordinator, as recommended by the Committee
C.
Clinic Medical Director shall contact patient as deemed necessary to ensure patient satisfaction
D.
Copies of all paperwork will be forwarded to Bastyr University Health and Safety Office on main campus
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RESIDENCY INFORMATION
Each year Bastyr University conducts a process to select first and second year ND and AOM clinical residents for training
positions in the Natural Health Clinic of Bastyr University (NHC). The numbers of desired first and second year residents vary
with the annual budget and the needs of the NHC.
Packets containing job description, application process description and application materials are posted at BU and at the other
ND medical schools, and acupuncture schools in North America.
Applicants must send, before the published deadline unless specific allowance is approved in writing, a current resume,
medical school academic transcripts, letters of recommendation and a completed application. This includes, but is not limited
to essay responses to medical and case management questions. A personal interview is required for hiring and not guaranteed
to each applicant. The applicants send applications to the Department of Human Resources, Bastyr University, where they are
held until complete, then forwarded to the resident hiring committee at the NHC. The Resident Selection Committee evaluates
each application in writing and recommends personal interviews for selected applicants. Applicants not being asked to
interviews will be so notified in writing. Selected applicants will be contacted by phone to schedule interview times. A
calendar deadline for application and approximate schedule for interviews will be posted with applications.
Personal interviews will be conducted by a Resident Selection Committee as a whole, each lasting about 20 minutes. The
Committee contains several full-time clinical medical staff and representatives from the part-time clinical medical staff group
and the third year ND or 2nd year AOM class. Applicants are asked interview questions from a list pre-established by the
Committee, and are given an opportunity to ask the Committee questions.
After all interviews are completed, the Committee meets as a whole to discuss and rank the applicants. In addition to the
criteria listed in the application packet on a page titled “General Residency Expectations”, applicants are evaluated according
to the following criteria (from Resident Selection Evaluation Form): clinical skills, communication/interpersonal skills,
organizational/planning skills, supervising/teaching skills, knowledge of therapeutics, creativity/imagination/vision,
confidence/self-esteem/self care, and goals. The Committee functions on a discussion/consensus basis, selects a group of first
and second year residents from the interviewees and identifies a group of alternates. In the event that a consensual process
fails, the Medical Director will make final decisions. All interviewees are contacted in writing post-interview. Candidates
selected to be residents must respond in writing to the Committee by the published date.
Residency Announcements from Bastyr University, and other sites/locations will be posted as received.
MISCELLANEOUS
1. Parking: Students must use on street parking. The Wallingford Plaza (NHC building) parking lot is reserved for patient
parking. Your car will be towed if you violate this rule. It is suggested that student clinicians attempt to carpool, use Metro,
or bicycle if possible.
2. Copy Machine
The copy machines are for clinic business only. Personal copies, including copying of class notes need to be made outside
of the clinic.
3. Announcements and Communications
Announcements and other communications are placed in the student mailboxes in the lounge. General clinic information is
posted in the student resource room. Phone messages are posted on the bulletin board in the hallway outside the Clinic
Administrative assistant’s office. Outreach opportunities are posted in the south resource room.
STUDENT CLINICIANS MUST CHECK THEIR MAILBOXES AND THE STUDENT PHONE
MESSAGE BOARD EACH TIME THEY ARE IN THE CLINIC. STUDENT CLINICIANS ARE
RESPONSIBLE FOR KNOWING AND RESPONDING TO ALL INFORMATION IN THEIR
MAILBOXES AND ON THE MESSAGE BOARD, AS APPROPRIATE.
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PRINCIPLES OF NATUROPATHIC MEDICINE
The Healing Power of Nature Vis Medicatrix Naturae
Naturopathic medicine recognizes an inherent ability in the body which is ordered and intelligent. Naturopathic
physicians act to identify and remove obstacles to recovery and to facilitate and augment this healing ability.
Identify and Treat the Causes Tolle Causam
The naturopathic physician seeks to identify and remove the underlying causes of illness, rather than to eliminate or
merely suppress symptoms.
First Do No Harm Primum Non Nocere
Naturopathic Medicine follows three principles to avoid harming the patient: 1) utilize methods and medicinal
substances which minimize the risk of harmful side-effects; 2) avoid, when possible, the harmful suppression of
symptoms; 3) acknowledge and respect the individual’s healing process, using the least force necessary to diagnose
and treat illness.
Doctor as Teacher Docere
Naturopathic physicians educate the patient and encourage self-responsibility for health. They also acknowledge the
therapeutic value inherent in the doctor - patient relationship.
Treat the Whole Person
Naturopathic physicians treat each individual by taking into account physical, mental, emotional, genetic,
environmental, social and other factors. Since total health also includes spiritual health, naturopathic physicians
encourage individuals to pursue their personal spiritual path.
Prevention
Naturopathic physicians emphasize the prevention of disease, assessing the risk factors and hereditary susceptibility
to disease and making appropriate interventions to prevent illness. Naturopathic Medicine strives to create a healthy
world in which humanity may thrive.
Wellness
Naturopathic medicine seeks to establish and maintain optimum health and balance, Wellness is a state of being
healthy, characterized by positive emotion, thought and action. Wellness is inherent in everyone, no matter what
dis-ease(s) is/are being experienced. If Wellness is really recognized and experienced by an individual, it will more
quickly heal a given dis-ease than direct treatment of the dis-ease alone. (This principle was adopted by Bastyr
University and added to the six principles)
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Principles of Traditional Chinese Medicine
Traditional Chinese Medicine is based on the theory that patterns of energy (Qi) flow through the body, interconnect
individuals internal and external environments, and are effected by the larger universe. Individuals and their energy
are effected by external extremes called the six exogenous pathogenic influences, which are wind, cold, damp,
dryness, summer heat, and fire as well as the seven emotions which are joy, anger, melancholy, worry, grief, fear and
fright. Additional factors that contribute to the onset of disease are overworking, improper diet, lack of physical
exercise, traumatic injury, phlegm fluid accumulation, stagnant blood, and insect or animal bites.
Illness and disease are represented as disharmonies between the extremes (yin and yang, interior or exterior, cold or
hot, excess or deficiency). When yin and yang are in proper dynamic relationship, an individual will be able to adapt
to the environment in a way, which is not only free from disease, (either active or subclinical) but also in a way that
promotes growth and an individual perception of wellness. In this sense, the root cause for the occurrence and
development of disease can be understood as the imbalance of yin and yang. An individual will be able to withstand
the assaults of the six exogenous pathogenic influences, seven emotions and other factors discussed above as long as
yin and yang are in dynamic equilibrium.
Thousands of years of clinical experience and scholarly research and discussions have lead to a complex and detailed
accumulation of medical theories involving the human body and its physiological functions. The broad categories of
these theories are the organ systems (zang fu); vital substances (qi, blood, and body fluids, jing); and meridians and
collaterals. The meridians and collaterals are pathways in which the qi and blood of the human body are circulated.
There are twelve regular meridians, eight extra meridians, twelve divergent channels, twelve tendomuscular regions,
twelve cutaneous regions, as well as fifteen collaterals. They form the network that connects interior organs, tissues,
and physiological processes into an organic whole. Acupuncture and moxibustion techniques are employed along
these pathways in order to restore the dynamic equilibrium of yin and yang of individuals. Other techniques used to
restore balance to the individual are herbal medicine, cupping, tui na, dietary advice and qi gong.
The first tenets of TCM evolved and proliferated through out the world and over many centuries. This has lead to the
development of many subsystems, which are loosely described as Asian or Eastern medicine. As a matter of fact, the
refinement of TCM was also initiated in Europe as well as Asian countries and most recently in the United States.
Despite the many adaptations that have evolved over the centuries, the core principles remain the same in all medical
systems derived from TCM. One of the primary principles in TCM is that human life is expressed as a mixture of the
influence of heaven (yang/energy) and earth (yin/matter) in dynamic equilibrium.
A person who practices TCM must therefor be dedicated to life-long learning, rooted in both a material (scientific)
understanding of life and a more energetic (esoteric) realization of all possibilities.
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Bastyr University Natural Health Clinic
SECTION IV: CLINICAL COMPETENCIES
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ND LEARNING OBJECTIVES FOR SECONDARY CLINICIANS
Timelines and Objectives
Each student clinician during his/her career at the Natural Health Clinic demonstrates competency at numerous clinical skills.
One way of keeping track of the progressively expanding expertise of a student clinician is by a system of skills/performance
evaluations designed to be completed sequentially by term. The following is a time line for all ND student clinicians. After
each term is completed, the student will receive written feedback or will meet with their clinic supervisor to discuss how well
they have completed their shift competencies, develop strategies for meeting the student’s needs in the following quarter and
review their progress. The clinic supervisor will sign off for the competencies they have observed.
Quarter 1
1. Active observation during patient visits.
2. Familiarity with all aspects of clinic operation.
Quarter 2
3. Review and practice of history and PE skills.
4. Present cases at preview and review.
Quarter 3
5. Chart properly and completely in the SOAP format.
6. Contribute actively to diagnostic and therapeutic work-up of patient cases.
LEARNING OBJECTIVES FOR PRIMARY CLINCIANS
Quarter 4 and 5
 Expand knowledge and skills in the interview, PE, differential diagnosis, treatment and charting.
 To formulate basic plans utilizing nutrition, homeopathy, counseling, botanical medicine and physical medicine and
explain the rationale for each item in plan to the supervising physician and the patient.
Quarter 6
 Suggest probable etiologies underlying a particular diagnosis.
 To demonstrate and communicate a preventive view of health assessment to a patient.
Quarter 7 and 8
 To demonstrate good overall patient management ability.
 To develop holistic therapeutic plans and long term case management plans.
 To develop the ability to function independently during follow up visits, developing treatment plans with minimal
assistance from the supervising doctor.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Timelines and Objectives
Each student clinician during his/her career at the Natural Health Clinic demonstrates competency at numerous clinical skills.
One way of keeping track of the progressively expanding expertise of a student clinician is by a system of skills/performance
evaluations designed to be completed sequentially by tern. Here is a time line for all AOM student clinicians. After each term
is completed, the student will receive written feedback or will meet with their clinic supervisor to discuss how well they have
completed their shift competencies, develop strategies for meeting the student’s needs in the following quarter and review their
progress. The clinic supervisor will sign off for the competencies they have observed.
There are separate competencies for each observation and clinic intern shift. In general, the information tracked by the CR
regarding patient numbers, shifts, interim and preceptor hours is not included in these competencies. Students will continue to
meet with the CR and receive written feedback detailing their progress. The purpose of these Learning Objectives is to
evaluate the clinician’s performance of skills required of acupuncturists, including medical interviewing, physical exams,
diagnosis, referral and assessment, therapeutics and communication skills. Clinicians are encouraged to complete
competencies and have them signed off as the term proceeds. Although not all of any term’s check-offs must necessarily to be
completed in the term, students will be given a grade of Partial Competency if they drop substantially behind the baseline for
their year or quarter.
During a student’s clinical education the following must be completed:
Observations Objectives
a) Clean Needle Technique (NCCA) Exam
b) Clinical Competency One
c) Clinical Intern Exam
i)
Written
ii)
Practical
d) Preceptorship
Internship Objectives
a) Acupuncture Intern B Completion
b) Clinical Competency Two-Six
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ND CLINICAL COMPETENCIES
During your clinical training at the Natural Health Clinic of Bastyr University, you are required to demonstrate competency
with numerous clinical skills. Those skills begin with the secondary skills and advance to the primary skills, each building
upon the next.
Each department in the clinic has its own competencies. The competencies are listed on the sheets following this introduction.
You must have each sheet signed off by your supervising physician, keep a copy for yourself and turn the original in to the
clinic registrar to prove completion. Following, you will find the clinical competencies for secondary clinicians and primary
clinicians and the timelines we suggest you follow to complete then in time for graduation.
All secondary competencies must be signed off before a clinician may advance to primary status. All primary competencies
must be signed off before a primary may graduate.
All primary clinicians must demonstrate competency in performing all physical exams and in diagnosis and treatment of a list
of conditions. Following this condition you will find a sign off sheet for the exams, lists of steps to be included in the exams
and the sign off sheet for the conditions.
Please note that these competencies are not linked to the clinic shift grades. They are a separate requirement, and a signed-off
competency does not assure a grade of AC on any clinic shift.
1.
2.
Secondary Clinicians:
Clinical Competencies for Secondary Clinicians
a. Clinical competencies, quarters 1-3, secondary clinicians
b. Clinical competency # 3 – Physical Medicine
c. Clinical competency # 5 – Counseling
d. Clinical competency # 6 – Laboratory
e. Clinical competency # 7 – Dispensary
Clinical Competencies for Primary Clinicians
a. Clinical competencies, quarters 4-8 primary clinicians
b. Clinical competencies, Conditions
c. Clinical competencies, Examinations
d. Clinical competency #4 - Physical Medicine
e. Elective competencies – Homeopathy
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Primary Competencies (CLINICAL COMPTENCY #1)
QUARTER 6,7
QUARTER 4,5
Competency
Medical Staff
supervisor
signature, date
Comments
Medical Staff supervisor
signature, date
QUARTER 8
Comments
Medical Staff supervisor
signature, date
#1. Has demonstrated the ability
to chart competently and
completely the patient's history
with adequate communication
skills and thoroughness, to use
the appropriate forms for FOC and
in-house referrals and to put these
in the proper order in the chart.
#2. Demonstrates the ability to do
a whole person analysis for health
and risk factors. (More than 1
patient may be used.)
#3. Is able to establish and
maintain rapport and
communicate professionally with
patients as observed by
supervising doctor.
#4. Demonstrates the capacity to
prioritize patient's health concerns
and to discuss general treatment
strategies with the patient and
supervising doctor.
#5. Demonstrates the capacity to
do appropriate lifestyle counseling
including Safer Sex.
#6. Recertify CPR status.
#7. Has presented a case in case
review following the
SOAP/outcome format.
#8. Has demonstrated good time
management skills, completing a
ROC in45 minutes and a FOC in
75 minutes.
QUARTER 6,7
QUARTER 4,5
Competency
Medical Staff
supervisor
signature, date
00-01 Bastyr University Student Clinician Handbook
Comments
Medical Staff
supervisor
signature, date
QUARTER 8
Comments
Medical Staff supervisor
signature, date
Comments
#9. Has demonstrated B-12
injection
#10. Has demonstrated
successful ability to write a referral
letter to another physician.
#11. Has shown initiative in
seeing the need to call a patient to
check-in, after receiving
permission from the supervising
doctor.
#12. Has completed transfer of
assigned patients to secondary
student clinicians during the last
patient care shift.
#13. Has completed 1 chart
summary for a clinic patient with
multiple visits (>10) over at least a
one year period of time.
#14. Has fit either cervical cap or
diaphragm on a patient or student
model.
#15. Has demonstrated initiative
in researching patient cases.
#16. Demonstrate competency in
interpreting findings from
laboratory, radiographic, and other
diagnostic tests.
#17. Demonstrate initiative and
competency in determining
relevant additional diagnostic
testing.
#18. Demonstrate competency in
assessing the probable etiology/
processes underlying the
diagnosis.
QUARTER 4,5
SECONDARY COMPETENCIES (CLINICAL COMPETENCY #2)
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QUARTER 6,7
QUARTER 8
Competency
Medical Staff
supervisor
signature, date
Comments
Medical Staff
supervisor
signature, date
Comments
Medical Staff supervisor
signature, date
#1. Is familiar with and adheres to clinic
policy, procedure and flow. Knows
procedure for biohazard disposal,
speculums, cervical cap, diaphragm, ear
lavage equipment.
#2. Demonstrates ability to anticipate
needed paper work and have it completed
and ready: lab forms for PAPs, lab
requisition forms, release of records form,
diet diaries, and be able to find specific
protocols for patients upon request.
#3. Has demonstrated the ability to be part
of a health-care team by actively
observing and participating in patient care
and follow-up, specifically contributing to
the therapeutic protocol being developed
by the supervisor and primary clinician,
and contributing to the differential
diagnosis or problem list in case
discussion.
#4. Has demonstrated the ability to
properly fill out the dispensary Plan and
Instruction sheet during discussion with
the supervising doctor and primary
clinician.
#5. Has ensured that the exam room is
adequately stocked with items needed
during the shift.
#6. Has a current CPR card.
QUARTER 1
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QUARTER
2
QUARTER 3
Comments
Competency
Medical Staff
supervisor
signature, date
Comments
Medical Staff
supervisor
signature, date
Comments
Medical Staff
supervisor signature,
date
#7. Is familiar with emergency procedures
manual and knows the location of the
emergency box and oxygen tank and how
to use the contents.
#8. Demonstrates the ability to present the
appropriate information at case preview
and case review.
#9. Able to assess and identify pertinent
and relevant patient findings and life style
modifications.
#10. Demonstrates communication skills
which emphasize patient needs and are
sensitive to patient lifestyle, gender,
culture and socioeconomic status.
#11. Reads charts and prepares for
patients visits prior to case preview.
#12. Demonstrates the ability to chart 2
complete patient visits in SOAP format
#13. Is able to explain lab requirements to
a patient, including the purpose of the test
specimen collection technique, any
dietary, modifications required, anticipated
length of time before results are available
and billing specifications.
QUARTER 1
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QUARTER 2
QUARTER 3
Comments
ND CLINICAL COMPETENCIES
PRIMARY CLINICAL COMPETENCIES - CONDITIONS
Categories of disease/conditions for which holistic therapeutic plans are to be developed (beginning with
clinical competency four). The therapeutic plan should include at least 1 follow up visit as well as future
plan indicating long term management goals.
Doctor’s Initials/Date
_________Cardiovascular disease- (HTN, hypercholesteolemia, coronary artery disease, angina, etc.)
_________Dysglycemia - (diabetes or hypoglycemia)
_________Food Allergies
_________Intestinal disorder - (IBD, IBS, Crohn’s, ulcerative colitis, constipation/diarrhea)
_________Peptic Ulcer Disease
_________Gallstones
_________Cancer prevention protocol
_________Skin diseases
_________Arthritis or myalgia (long term)
_________Anemia
_________Osteoporosis
Gynecological conditions - FBD, menopausal management/PMS or dysmenorrhea,
endometriosis, polycystic ovary disease, management of abnormal pap smear
Acute Respiratory Tract Disorder (otitis media, strep throat)
Chronic Upper Respiratory Tract Disorder
Asthma
Nutritional deficiencies
Urinary tract problems or vaginitis, kidney stones
______ Mental/Emotional illness
______Nervous system disorder - (insomnia, dizziness, seizure)
______Opportunistic infections associated with HIV+, also HIV risk assessment
______Endocrine imbalance or hepatic conditioning
______Musculoskeletal conditions (acute)
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ND CLINICAL COMPETENCIES
CHECK-OFF OF PHYSICAL EXAMS TO BE PERFORMED BY CLINICIANS
List of Physical Exams to be Performed by Clinicians
Doctor’s signature/Date
____________Gynecological Exam - breast (in 10 minutes)
____________Gynecological Exam - pelvic (in 20 minutes)
____________Male Reproductive Exam including prostate (in 20 minutes)
____________Well Child Check-up including developmental mile-stone
assessment (in 20 minutes)
____________Complete 72- step exam (in 30 minutes)
____________HEENT Exam
____________Abdominal Exam
____________Respiratory Exam
____________Cardiovascular Exam
____________Musculoskeletal Exam
____________Neurological Exam
The steps of each exam are listed in Physical Exam Outline. The exams are to be performed from
memory and observed in full by the supervising doctor. Clinicians are encouraged to complete
their exams well in advance of their last patient care shift. A copy of this page is given to the
Clinic Registrar upon completion.
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ND CLINICAL COMPETENCY THREE
Physical Medicine One (Secondary Clinician Objectives)
Student Name:
Quarter/Year:
Clinical Competencies:
1. Demonstrate ability to perform various hydrotherapy treatments
2. Demonstrate ability to perform various physiotherapy treatments
3. Demonstrate soft tissue assessment and treatments
Initials/Date
I.
Objective
HYDROTHERAPY TREATMENT
1.
Constitutional Hydrotherapy
_________a. technique
_________b. major indications
_________c. contraindications
2.
Hyperthermia
_________a. technique
_________b. major indications
_________c. contraindications
3.
Wet Sheet Pack
_________a. technique
_________b. major indications
_________c. contraindications
4.
Colon Irrigation
_________a. technique
_________b. major indications
_________c. contraindications
5.
Local Contrast
_________a. technique
_________b. major indications
_________c. contraindications
II.
PHYSIOTHERAPY
1.
Diathermy
_________a. technique
_________b. major indications
_________c. contraindications
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ND CLINICAL COMPETENCY THREE
Physical Medicine (Third Year Objectives)(Continued)
Student Name:
Quarter/Year:
Initials/Date
Objective
2. Ultrasound
_________a. technique
_________b. major indications
_________c. contraindications
3. Low Volt EMS
_________a. technique
_________b. major indications
_________c. contraindications
4. Interferential
_________a. technique
_________b. major indications
_________c. contraindications
5. Galvanic/Iontophoresis
_________a. technique
_________b. major indications
_________c. contraindications
III. SOFT TISSUE ASSESSMENT
________1.
________2.
Tissue Texture Evaluation
Muscle Tension Evaluation
IV. SOFT TISSUE TREATMENT
1. Local Tissue Release Techniques
_______a.
NMT
_______b.
Swedish massage techniques
_______c.
cross fiber
2. Muscle Energy Stretching
_______a.
lower extremity/low back
_______b.
upper extremity/neck/shoulders
ND CLINICAL COMPETENCY FOUR
Physical Medicine Two (Primary Clinician Objectives)
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Student Name:
Quarter/Year:
Clinical Competencies:
1.
2.
3.
4.
To demonstrate use of orthopedic tests
To demonstrate use of neurological tests
To demonstrate ability to assess joint dysfunction due to fixation
To demonstrate ability to reach a working diagnosis, prescribe and administer appropriate treatment
including hydrotherapy, physiotherapy, soft tissue and joint manipulation, nutrition, botanicals and
homeopathy.
Initials/Date
Objective
1. Orthopedic Assessment
_______ a.
knee
_______b.
hip
_______c.
SI/low back
_______d.
shoulder
_______e.
neck/thoracic outlet
2. Neurologic Assessment
_______a.
reflexes
_______b.
Romberg
_______c.
Babinski
_______d.
muscle strength
_______e.
sensation
3. Joint Fixation Assessment
_______a.
static palpation
_______b.
motion palpation
_______c.
contraindications to joint manipulation
4. Appropriate Physical Medicine Prescription/Treatment
_______a.
nutritional support
_______b.
botanical/homeopathic
_______c.
hydrotherapy
_______d.
physiotherapy
_______e.
soft tissue manipulation
_______f.
joint manipulation set up
_______g.
joint manipulation
ND CLINICAL COMPETENCY 10
Clinical Competency - Specialty
Homeopathy (Optional—ONLY FOR HOMEOPATHY CLINICIANS)
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Student Name:
Quarter/Year:
Initials/Date
I. Requirements
A. To register in homeopathy shift as secondary
1.
Complete Homeopathy IV or equivalent
B. To become Primary
1.
Satisfactorily participate/fulfill responsibilities as secondary (as
below)on(2)shifts
2.
Complete and turn in written analysis on two cases
3.
Act as primary on two first office calls which includes taking the
case, analyzing the case and writing up the chart. Detailed below.
4.
Be available for case discussion with supervising doctor
II. Responsibilities
A. Secondary Student Clinician
1. Same as general Patient Care shift
__________a. Adequate attendance as described in STUDENT CLINICIAN HANDBOOK
__________b. Keep track of patient contacts
__________c. Is responsible for all paper work, dispensary form, consent form, treatment plans, etc.
__________d. Cooperate with primary clinician and supervising doctor
__________e. Participate in the taking of the case-demonstrate active listening & appropriate
questioning.
__________f. Participate in case preview/review- come prepared to review by reading patients charts.
2. Unique to Homeopathy Specialty Shift
Write down case with appropriate homeopathic underlining, observations, etc. on all patient visits
Study case alone or with primary and be prepared to discuss case analysis with supervising doctor in case
pre/review.
Try to be in attendance on case discussion with supervising doctor (recommended - not required)
ND CLINICAL COMPETENCY 10
Clinical Competency - Specialty
Homeopathy (Optional—ONLY FOR HOMEOPATHY CLINICIANS)
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Student Name:
Quarter/Year:
B. Primary Student Clinician:
1. Same as general Patient Care shift
Initials/Date
__________ a. Attendance, charting, responsibility for patient, adequate number of patient visits seen,
___________ b. Keep track of patient contacts
___________c. Cooperate with secondary clinician and supervising doctor
___________d. Participate in case preview/review
___________ e. Adequate charting of patient visit in a timely fashion. (24 hour turn around time)
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ND CLINICAL COMPETENCY 10
Clinical Competency - Specialty
Homeopathy
Student Name:
Quarter/Year:
Initials/Date
III. Goals and objectives - students in the Homeopathy Specialty Shift will gain
A.
B.
C.
D.
E.
experience, increase competence, demonstrate skills in the following ways:
Communication skills
1.
Explaining homeopathy treatment to the patient in clear, understandable terms
2.
Instructing the patient in how to take the remedy appropriately and what to expect from
their treatment
3.
Discuss with the patient what we expect from them in terms of life-style habits, making
follow-up appointments, when they can phone The Natural Health Clinic, etc.
4.
Display open, and cooperative communications with peers and with supervising doctor
Case taking skills
1.
Establish adequate rapport with patient
2.
Demonstrate proper use of open ended and confirmatory questions, listening skills and
full homeopathic case taking plus review of systems, past medical history, family medical
history, etc.
3.
Be able to take a full case in a reasonable amount of time
4.
Demonstrate good charting skills, including underlining and completeness of information,
that is readable and relevant
Case assessment and analysis skills
1.
Medical differential diagnosis
a.
Proper lab and other testing to confirm
b.
Proper physical examinations
2.
Recognize acute vs. chronic prescribing
3.
Identification of patient’s complaints, in a homeopathic perspective
- center of gravity, etiology, general, particular and mental/emotional symptoms
4.
Demonstrate adequate knowledge and use of the repertory as it applies to the patient’s
symptoms
5.
Demonstrate systematic thought process of homeopathic assessments - essence, keynote,
totality, etiology, reliable symptoms, etc.
6.
Show adequate knowledge of comparative materia medica and
confirmatory, illuminating, keynote symptoms, etc., and arrive at a remedy selection
7.
Give rationale for potency selection
8.
Give some evaluation of prognosis of treatment
Follow-up case skills
1.
Show initiative and persistence in following up
2.
Take follow-up case appropriately
3.
Evaluate the action of the remedy within appropriate timelines
4.
Determine next action to be taken
Additional goals/concerns:
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ND CLINICAL COMPETENCIES
Clinical Competency Five
Counseling
Student Name:
Quarter/Year:
DURING THE FIRST AND SUBSEQUENT SHIFTS THE STUDENT WILL MEET THE
FOLLOWING COMPETENCIES WHEN POSSIBLE:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Establish rapport, demonstrate counseling characteristics, (congruence, empathy, positive regard)
and communication skills (paraphrasing, clarifying, reflecting, summarizing) in the counseling
session.
Engage his/her healer/physician within during the counseling session.
Clinically assess patient’s Jungian Typology and use this assessment to inform the selection of
counseling interventions.
Recognize indicators of mood, anxiety, eating disorders, alcoholism, and somatization problems
in patients and assess according to the Prime M.
Establish a continuing relationship with patients beyond the first interview, carry a case load,
chart, develop and follow a treatment plan.
Recognize and maintain professional limitations and boundaries, creating a safe therapeutic
environment for patient and physician.
Assess, stabilize, treat and/or refer a suicidal patient.
Demonstrate the ability to refer out to appropriate mental health providers and write a referral
letter.
Incorporate the Principles of Naturopathic Medicine into the Counseling Relationship, and Case
Management (The Healing Power of Nature, First Do No Harm, Find the Cause, Treat the Whole
Person, Preventative Medicine, Wellness and Doctor as Teacher).
A. Demonstrate the ability to wait, understand and empathize prior to implementing an
intervention, and if an intervention is necessary, to select one that is least invasive.
B. Demonstrate the ability to separate symptoms from cause.
C. Recognize the person beyond the disease and support all aspects of the patient’s life
within the counseling relationship and treatment planning.
D. View the patient from an over-all perspective and assess what could help prevent further
disease and strengthen Health.
E. Demonstrate an ability to establish a wellness alliance, wellness consultation and to
stimulate wellness throughout the healing process.
F. Educate the patient concerning the healing process, their place in that process, how to
promote healing and to take responsibility for their own health.
10.
Assess personal/professional limits and ask for help when needed.
ADDICTIONS AND DISORDERS
In addition to the above competencies, students taking their first shift during the Fall of the 3rd year in the
4th year track or the 4th year of the 5 year track, will meet the following competencies when presented:
11. Diagnose chemical dependency, assess the appropriate level of treatment and develop a treatment
plan which aligns with the principles and scope of the naturopathic model.
12. Diagnose eating disorders, assess the appropriate level of treatment and develop a treatment plan
which aligns with the principles and scope of naturopathic medicine.
PSYCHOLOGICAL ASSESSMENT
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In addition to the above competencies, students taking their first shift during the Winter quarter of the 3 rd
year in the 4 year track or 4th year of the 5 year track, will meet the following competencies when
presented:
13. Recognize psychotic and characteristically disturbed patients, determine when counseling would be
effective, whether counseling in each case lies within scope of naturopathic medicine, and make an
appropriate psychological or psychiatric referral.
14. Demonstrate ability to conduct an assessment interview and make an appropriate diagnosis using the
DSM IV.
RELATIONSHIP AND FAMILY COUNSELING
In addition to the above competencies, students taking their first shift in the Spring quarter of the 3 rd year
on the 4 year track, or 4th year of the 5 year track, will meet the following competencies when presented:
15. Assess, establish a wellness alliance, educate, renew, and restore partnership with a couple.
16. Establish a continuing relationship with a couple, chart, develop and follow a treatment plan.
17. Assess family functioning, apply holistic parenting techniques and make wellness oriented family
interventions.
SEXUALITY AND SEX THERAPY
Those students who are taking or who have taken “Sexuality and Sex Therapy” will also be responsible
for the following competencies when presented:
18. Assess sexual dysfunction’s and treat or refer according to the treatment scope of naturopathic
practice.
19. Demonstrate understanding and acceptance of sexual preference and gender orientation.
20. Demonstrate comfort and confidence when discussing sexual issues with patients.
DEATH AND DYING: COUNSELING THE TERMINALLY ILL AND THEIR FAMILIES
Those students whoa re taking or who have taken “Death and Dying: Counseling the Terminally Ill and
Their Families” will also be responsible for the following competencies when presented:
21. Identify psychological issues, stages and tasks for patients and families facing terminal illness.
22. Identify/ develop/ strengthen effective coping skills and styles for patients and families to face death
and survive loss.
SECOND COUNSELING SHIFT
Students taking a second counseling shift will have completed all six critical counseling psychology
courses. Students will meet the preceding competencies 1-17 to an even greater extent and will meet the
following competency:
23. Present a case they have worked with using a professional format.
SECOND COUNSELING SHIFT IN THE IMMUNE CLINIC
Students will have completed all six critical counseling psychology courses and will meet the preceding
competency plus the following competencies when presented:
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24. Demonstrate an understanding of the psychological needs of HIV+ patients and the ability to counsel
them.
25. Co-facilitate a group addressing the specific psychological needs of patients affected by HIV+.
Signature of supervisor___________________________________date_________________
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ND CLINICAL COMPETENCIES
Clinical Competency Six
Laboratory
StudentName:__________________________________________________Quarter/Year:_____
I.
Processing
_____________________A.
_____________________B.
_____________________ C.
Clinic protocol
Specimen handling requirements
1. Routine tests
2. Special tests
Lab safety
1. Universal precautions
2. Biosafety training for the Clinic
II.
Phlebotomy
_____________________A.
Addressing patient needs
_____________________B.
Knowledge of correct tube(s) per test(s)
_____________________C.
Performing venipuncture
_____________________1.
Fingerstick technique
_____________________2.
Vacutainer system
_____________________3.
Syringe system
_____________________4.
Butterfly needle technique
_____________________5.
Common problems/solutions
III. Microscope
_____________________A. Handling and appropriate use
IV. Hematology (Manual procedures)
_____________________1.
Hematocrit, spun
_____________________2.
ESR
_____________________3.
Blood smear evaluation
V. Urinalysis
_____________________ A. Collection requirements
_____________________ B. Macroscopic exam
_____________________1.
Color, character
_____________________2.
Dipstick reactions
_____________________ C. Microscopic exam
_____________________1.
Observe and evaluate @ 10x
_____________________2.
Observe and evaluate @ 40x
_____________________3.
Urine pregnancy tests and serum hCG levels
_____________________ D. Confirmatory tests
VI. Microbiology
_____________________A.
Specimen collection/handling and patient instruction
_____________________B.
Identify key pathogens associated with the following:
_____________________1.
Throat/nasopharyngeal
_____________________2.
Sputum
_____________________3.
Skin
_____________________4.
Urine
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ND CLINICAL COMPETENCIES
Clinical Competency Six
Laboratory
5. Urogenital
_____________________A.
Male
_____________________B.
Female
_____________________1.
Stool/rectal
_____________________C.
Routine screening tests
1. Microscopic exams
_____________________A . Direct mount
_____________________1.
Scabies/fleas
_____________________2.
Pinworm prep
_____________________3.
Post-coital sperm evaluation
_____________________4.
Fern test
_____________________B.
Wet mount
_____________________1.
Saline
_____________________a)
Vag/os
_____________________b)
Stool
_____________________2.
KOH/fungal elements
_____________________C.
Gram’s stain evaluations
_____________________3.
Nasal smear interpretation
_____________________4.
Occult blood
_____________________5.
Quick antigen tests for Group A strep
_____________________7.
TB : discussion
_____________________8.
Viral herpes culture
VII.Chemistry
_____________________A.
Appropriate use of the glucometer
_____________________B.
General functions : discuss lab diagnosis approach
for the following:
1. Infectious diseases
_____________________a.
Respiratory
_____________________b.
GI
_____________________c.
GU
_____________________d.
HIV
2. Metabolic problems
_____________________a.
Acidosis/alkalosis
_____________________b.
Diabetes/hypoglycemia
3. Adrenal problems
_____________________a.
Insufficiency
_____________________b.
Hypersecretion
4. Thyroid problems
_____________________a.
Hypothyroid
_____________________b.
Hyperthyroid
_____________________1. Anemias
_____________________2. Liver abnormalities
_____________________3. Others
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VIII.
Serology/Immunology
A.
Kit tests
_____________________1.
C-RP
_____________________2.
Mono screen/RA testing
_____________________3.
ANA testing and special tests interpretation
B.
Allergy testing
_____________________1.
Skin scratch testing
_____________________2.
RAST/ELISA testing
_____________________3.
Serum IgE and IgG4
IX.
Case Presentation
_____________________
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ND CLINICAL COMPETENCIES
Clinical Competency Seven
Dispensary
Student Name:
Quarter/Year:
PLEASE NOTE: DISPENSARY SECTION IS UNDERGOING REVISION
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ND CLINICAL COMPETENCIES
PHYSICAL EXAM OUTLINE
1. Female Reproductive Exam
Breast Exam
Observe - pigmentation, retraction, asymmetry, nipple discharge
Palpate - masses, nipple discharge, pain
Nodes - axillary, clavicular
Pelvic Exam
Observe - ext. genitalia - hair, skin, labia, perineum
Palpate - nodes, inguinal
BSU glands
Cystocele/Rectocele
Speculum exam - inspect vagina, cervix, samples
Bimanual exam - uterus, adnexae
Rectal/vaginal
Anus/rectum - inspect, palpate, stool guiac
2.
Male Reproductive Exam
Penis/Scrotum Exam
Observe - lesion, discharge, asymmetry
Palpate - masses, discharge, pain
Nodes - inguinal
Hernia Inspection and Palpation
Prostate Exam
Palpate - enlargement, masses, pain asymmetry
Anus/Rectal Exam
Observe - hemorrhoids, other lesions
Palpate - masses
Stool guiac
3.
Well Child Exam
Denver Developmental Screening Test
Measurements
Height - chart on graph
Weight - chart on graph
Head circumference - to 12 mos. - chart on graph
Blood Pressure - begin at 3 years
Pulse
Respiratory rate
Temperature
Observe skin
Well Child Exam , continued
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HEENT Exam
Observe
Inspect
Palpate
Chest Exam
Observe
Inspect
Palpate
Thorax/back and front
Breast
Lung - auscultate
Heart - auscultate
Abdominal Exam
Observe
Auscultate
Percuss
Palpate
Liver
Stomach
Spleen
Kidneys
Intestines
Aorta
Inguinal nodes
Genitalia and Rectal Exam
Observe
Inspect
Palpate - scrotum, penis, anus
Musculoskeletal Exam
Observe - posture, form, gain, movements, tone
Palpate - back, extremities, joints
Neurological Exam
Infantile reflexes
Test for
Cranial nerves
Motor function
Sensory function
DTR’s
Cognitive function
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ND CLINICAL COMPETENCIES
PHYSICAL EXAM OUTLINE
72 Step Screening Physical Exam
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Wash hands
Inspect general appearance
Take oral temperature
Palpate, count and compare radial pulses
Count respiratory rate
Measure blood pressure
Inspect hands, nails, skin, joints, palms
Inspect, palpate, flex and extend forearms and arms
Inspect face and head
Test visual acuity
Check visual fields
Test ocular movements
Inspect conjunctiva, sclera, cornea
Test pupillary reactions to light and accommodation
Ophthalmoscopy
Examine external ears
Otoscopy
Examine nose
Wrinkle forehead
Palpate masseters with teeth clenched
Show teeth
Protrude tongue
Inspect lips, gums, teeth, tongue, buccal mucosa
Inspect pharynx and have patient phonate
Test range of motion of neck
Shrug shoulders
Extend arms over head
Palpate neck for nodes
Palpate thyroid
Inspect and percuss spine and renal angles
Examine chest: symmetry and expansion
Percuss posterior and lateral chest
Auscultate posterior and lateral chest
Percuss anterior lung fields
Auscultate anterior lung fields
Palpate breasts
Palpate axillary nodes
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PHYSICAL EXAM OUTLINE
72 Step Screening Physical Exam (Continued)
38. Inspect neck veins
39. Test hepatojugular reflux
40. Palpate carotids
41. Inspect precordium
42. Palpate precordium
43. Percuss cardiac border
44. Auscultate heart
45. Auscultate carotids
46. Auscultate midepigastrium
47. Auscultate femoral areas
48. Inspect abdomen
49. Palpate abdomen
50. Palpate bimanually for liver
51. Palpate bimanually for spleen
52. Palpate inguinal nodes
53. Palpate femoral pulses
54. Palpate for femoral hernia
55. Inspect, palpate, flex and extend feet legs
56. Test for pretibial edema
57. Palpate dorsalis pedis and posterior tibial pulses
58. Test plantar reflexes
59. Test knee and ankle reflexes
60. Test biceps and triceps reflexes
61. Test rapid alternating movements
62. Test finger to nose
63. Test heel to shin
64. Test light touch and pinprick on limbs
65. Test position sense in feet
66. Test vibration sense in feet
67. Hold arms extended
68. Romberg test
69. Check gait
70. Walk on toes
71. Pelvic examination
72. Rectal examination
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ND CLINICAL COMPETENCIES
PHYSICAL EXAM OUTLINE
HEENT Exam
Head
Examine
Inspect
Hair
Scalp
Skull
Face
Skin
Eyes
Acuity
Visual fields
Observe - position, alignment, eyelids, lacrimal ducts, conjunctiva, sclera
Examine - cornea, lens, pupil
EOM
Ophthalmoscopic exam - lens, retina, disc, cup, vessels
Ears
Inspect auricle - lesions
Otoscopic exam - external canal, TM
Acuity - gross, Weber, Rinne
Nose
Inspect external and internal nose - lesions, mucosa condition
Sinus palpation
Mouth/Pharynx
Examine
Inspect
Lips
Buccal mucosa
Gums
Teeth
Roof
Tongue
Pharynx
Neck
Examine
Inspect
Palpate
Symmetry, enlargement
Nodes - auricular, tonsillar, submaxillary, submental, cervical,
Trachea - symmetry
Thyroid - masses, enlargement
Carotids/Jugulars - pulsations
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supraclavicular, suboccipital
ND CLINICAL COMPETENCIES
PHYSICAL EXAM OUTLINE
Abdominal Exam
Observe - skin, umbilicus, contour, peristalsis, pulsations
Auscultate - bowel sounds, bruits
Percuss
Palpate - light, deep
Liver
Stomach
Spleen
Kidneys
Intestines
Special techniques - as appropriate
Murphy’s
McBurney’s
Respiratory Exam
Observe - color, fingernails, respiratory distress
Respiratory rate
Posterior Chest
Inspect - asymmetry
Palpate - masses, pain
Fremitus - dullness, resonance
Respiratory expansion
Percuss - dullness, resonance
Auscultate - breath sounds, adventitious sounds, transmitted voice
Anterior Chest
Inspect - asymmetry
Palpate - masses, pain
Fremitus - dullness, resonance
Respiratory expansion
Percuss - dullness, resonance
Ausculate - breath sounds, adventitious sounds, transmitted voice
Cardiovascular Exam
Pulses - radial, pedal
Blood Pressure
JVP
Abdominojugular Test
Inspect - apical impulse, edema
Palpate - size, location, apical impule
Auscultate - rate, rhythm, extra sounds, bruits (in all three positions: recumbant 30 degrees, left
lateral decubitus, leaning foreard)
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PHYSICAL EXAM OUTLINE
Musculoskeletal Exam
Inspect
Palpate
Strength and ROM - passive, active, resisted
TMJ
Cervical spine
Hands, wrists, fingers
Elbows
Shoulder
Hips
Knees
Ankles
Feet, toes
Spine
Neurological Exam
Mental Status and Speech Exam
Cranial Nerve Exam
Smell (1)
Visual acuity, fields (2)
Pupillary rxns (2,3)
EOM (3,4,6)
Corneal reflex, jaw movement (5)
Facial movement (7)
Hearing (8)
Swallowing, rise of palate (9.10)
Voice (10)
Speech (5,7,10.12)
Shoulder shrug (11)
Tongue movement (12)
Motor Nerve Exam
Observe gait, heel-toe, hop, bend
Romberg
Extend, elevate arms - hold
Grip strength
Observe for bulk, tone, involuntary movements
Test for Muscle Strength
Compare, flex, extend joints against resistance
fingers
wrists
elbows
shoulders
neck
hips
Neurological Exam (Continued)
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knees
ankles
feet
toes
Rapid Alternating Motion - upper and lower extremities
Point-to-Point Testing - upper and lower extremities
Deep Tendon Reflex Exam
Grade, compare
Biceps
Triceps
Brachioradialis
Abdominal
Quadriceps
Achilles
Plantar
Sensory Exam
Test/compare pain in hands and feet
Test/compare vibration sense in hands and feet
Test/compare light touch in arms and legs
Test/compare stereognosis in hands
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency One
Observation I, II, and III
Student Name:
Quarter/Year:
Learning Objectives:
1. Active observation in patient visits
2. Familiarity with all aspects of clinic operation
3. Review and practice of the four exams
Initials/Date


OBJECTIVE
1. Is familiar with and adheres to clinic policy, procedure and flow. Knows procedure for
biohazard disposal and CNT.
2. Demonstrates ability to anticipate needed paperwork and have it completed and ready.
3. Has demonstrated the ability to be part of a health care team by actively observing and
participating in patient care and follow-up, specifically contributing to the therapeutic protocol
being developed by the supervisor and primary clinician. Actively contributing to the diagnosis
and case discussions must also be demonstrated.
4. Has demonstrated the ability to properly fill our the dispensary Plan and Instruction Sheet during
discussion with Shift Supervisor and primary clinician.
5. Has ensured that the exam room is adequately stocked with items needed during the shift.
6. Has a current CPR card.
7. Has passed the NCCA Clean Needle Technique course.
8. Has watched the Blood Borne Pathogen Video, and is familiar with OSHA requirements.
9. Is familiar with emergency procedures.
10. Has discussed the above guidelines and met with clinic supervisor to review and set goals.
11. Additional goals and concerns:
Passes written Clinic Intern Entry Exam
Demonstrates proper understanding of basic skills and techniques during practical portion.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Two
Internship I, II, III, IV and V
Student Name:
Quarter/Year:
Learning Objectives:
1. Demonstrates self reliance and thoroughness in performing the four exams.
2. Chart properly and completely in the SOAP format.
3. Contribute actively to the diagnostic and therapeutic work up of a client.
4. Demonstrate competence performing critical technique skills.
Initials/Date
OBJECTIVE
1. Demonstrates the ability to chart 2 complete patient
histories.
2. Demonstrates the ability to safely and effectively
perform and record the 4 exams.
3. Has contributed to case discussions, pattern
differentiation, diagnosis and therapeutic plan.
4. Continues to facilitate good time management by
anticipating needed paperwork and ensuring adequate room stock.
5. Demonstrates the ability to choose correct needle gauges and sizes most appropriate for the
particular patient, condition and therapeutic goal.
6. Demonstrates the ability to perform all of the following techniques in a safe and competent
manner:
a) Needle insertion with tube
b) Needle withdrawal
c) Six methods of attaining Qi
d) Reinforcing
e) Reducing
f) Fixed cupping
g) Running cupping
h) Indirect moxibustion
i) Rice grain direct moxibustion
j) Warm needle
k) 5-Needle Auricular
l) Tui-Na
m) Needle Aishi point
n) Selection, set up and proper placement and monitoring of electroacupuncture
7. Has discussed the above guidelines and met with clinical supervisor to review and set goals for
quarter.
8. Additional Goals and Concerns:
a) The Acupuncture Intern B (AIB) will perform a minimum of 100 total treatments, including a
minimum of 20 first patient interactions (FPI) and 80 subsequent patient interactions (SPI) over a
minimum a 3 academic quarters and 5 clinic shifts.
b) The AIB will meet with the AOM Clinic Director upon completion of all Clinical Competency Two
Objectives to determine advancement to Acupuncture Intern A (AIA).
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Three
Internship VI, VII, VIII
Student Name:
Quarter/Year:
Learning Objectives:
1. To expand knowledge and skills in pattern differentiation, diagnosis, 4 exams, charting
of therapeutic plan and rationale.
2. Be able to formulate treatment programs using Acupuncture, nutrition, Tui Na, Qi Gong,
and Auriculotherapy.
3. To demonstrate and communicate a preventive view of health assessment to a patient
using TCM concepts.
4. To assume the role of Acupuncture Intern A.
Initials/Date
OBJECTIVE
1. Has demonstrated the ability to chart competently and completely the patient’s history with
adequate communication skills and thoroughness. Can use the appropriate forms for FOC, inhouse referrals, return visits and is able to put these in the proper order in the chart.
2. Demonstrates the ability to perform the following exams within the time allotted.
a) 4 Exams (FOC in 30 minutes
b) Front Mu and Back Shu analysis in 15 minutes (or equivalent exam per supervisor)
c) Auricular Point assessment in 10 minutes
3. Has formulated a treatment plan including the use of:
a) Acupuncture
b) Nutrition (TCM focus)
c) Tui Na
d) Qi Gong
e) Auriculotherapy
4. Has discussed the above guidelines and met with clinic supervisor to review and set goals.
5. Additional goals/concerns
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Four
Internship IX, X, XI
Student Name:
Quarter/Year:
Learning Objectives:
1. To improve interviewing and communication skills.
2. To integrate a wellness approach in the context of TCM
3. To be able to develop a treatment plan for 6 cases with follow-up/outcome from the list
of conditions shown in Clinical Competency Seven.
Initials/Date
OBJECTIVE
1. Is able to establish and maintain rapport and
communicate professionally with patients as observed
by clinic supervisor.
2. Demonstrates the capacity to prioritize patient’s health concerns and discuss general treatment
strategies with the patient and clinic supervisor.
3. Has demonstrated the ability to perform and complete all techniques listed in Clinical
competency Two.
4. Re-certify CPR status.
5. Has formulated a treatment plan including the use of:
a) Acupuncture
b) Nutrition (TCM focus)
c) Tui Na
d) Qi Gong
e) Auriculotherapy
For six conditions listed in Clinical Competency Seven
And has done a follow up series for each of these cases (3 treatment minimum) and can report on
outcome.
Case A:
Case B:
Case C:
Case D:
6. Has presented a case in case review following the
SOAP/outcome format.
7. Has discussed the above guidelines and met with clinic supervisor to review and set goals.
8. Additional goals/concerns:
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Five
Internship XII and XIII
Student Name:
Quarter/Year:
Learning Objectives:
1. To achieve competency in all basic acupuncture skills.
2. Demonstrate basic skills in pattern discrimination and diagnosis.
3. To demonstrate a basic use of TCM therapeutics.
4. To demonstrate good overall patient management ability.
Initials/Date
OBJECTIVE
1. Has continued to demonstrate the ability to perform
competently all acupuncture techniques listed in
Clinical Competency Two.
2. Has demonstrated good time management skills
completing SPI in 60 minutes and FPI in 90 minutes.
3. Demonstrates the ability to gather pertinent
information, perform the 4 exams, synthesize a
diagnosis and devise, implement and monitor a
treatment plan for patients. The clinic supervisor will
have worked with the clinician on 5 different cases.
Case A:
Case B:
Case C:
Case D:
Case E:
4. Demonstrates the ability to recognize and implement (with follow-up) 5 cases for referral.
5. Has discussed the above guidelines and met with clinic supervisor to review and set goals.
6. Additional goals/concerns.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Six
Internship XIV
Student Name:
Quarter/Year:
Learning Objectives:
1. To consolidate clinical skills
2. Demonstrate basic skills in pattern discrimination and diagnosis.
3. To demonstrate a basic use of TCM therapeutics.
4. To demonstrate good overall patient management ability.
Initials/Date
OBJECTIVE
1.
2.
3.
4.
Has demonstrated the ability to perform and evaluate all remaining examinations.
Has continued to demonstrate good time management in all situations including acute illness.
Has demonstrated successful ability to write a referral letter to another practitioner.
Has shown initiative in seeing the need to call a patient to follow up/check in, after receiving
permission from the clinic supervisor.
5. Demonstrates continued expansion of abilities with regard to gathering information, synthesizing
a diagnosis, and has developed treatment plans for 5 different cases. Has seen these patients
since the initial protocol, made adjustments as needed, and has discussed long term goals with
the patient and clinic supervisor.
Case A:
Case B:
Case C:
Case D:
Case E:
6. Demonstrates good therapeutic integration as evidenced by therapeutic plans that consistently
integrate different TCM modalities and reflect some aspect of wellness care.
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AOM CLINICAL TRAINING - LEARNING OBJECTIVES
Clinical Competency Seven
Categories of Disease/Conditions for Therapeutic Plans
Student Name:
Quarter/Year:
Categories of Western disease/conditions for which TCM therapeutic plans are to be developed
(Competency Four). The plan should include at least one series of three return visits as well as a plan for
long-term management if appropriate. Students should attempt to see the full list of disease/conditions
signing off as they proceed.
Initials/Date
Cough and Asthma _________
Insomnia_________
Headache _________
Common Skin Disorder _________
Low Back Pain _________
Anxiety/Stress _________
Nicotine Addiction _________
Fatigue _________
Cold/Flu _________
Sinusitis/Rhinitis _________
Diarrhea _________
Constipation _________
HIV/AIDS _________
Obesity/Eating Disorder _________
Arthritis _________
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NUTRITION - CLINICAL COMPETENCIES
During your clinical training at the Natural Health Clinic of Bastyr University, you are required to
demonstrate competency with numerous clinical skills. Below are the general learning objectives for
secondary and primary Nutrition Clinicians.
LEARNING OBJECTIVES FOR SECONDARY CLINICIANS
Quarter 1
1. Active observation during patient visits.
2. Familiarity with all aspects of clinic operation.
3. Assist in presenting cases at preview and review.
4. Chart properly and completely in SOAP format.
5. Contribute actively to therapeutic work-up of patient cases.
LEARNING OBJECTIVES FOR PRIMARY CLINICIANS
Quarters2 and 3
1. Expand knowledge and skills in the interview and charting.
2. To formulate basic plans utilizing nutrition and explain the rationale for each item in plan to the
supervising medical staff and the patient.
3. To demonstrate and communicate a preventive view of health assessment to a patient.
4. To demonstrate good overall patient management ability.
5. To develop holistic therapeutic plans and long term case management plans.
6. To develop the ability to function independently during follow up visits, developing treatment plans
with minimal assistance from the supervisor.
Each department in the clinic has its own specific competencies. The nutrition clinical competencies are
listed on the form following this section. You must have each form signed off by your supervisor, keep a
copy for yourself and the original is to be turned in to the Clinic Registrar to prove completion.
All primary competencies must be signed off before a primary may graduate.
Please note that these competencies are not linked to the clinic shift grades. They are a separate
requirement, and a signed-off competency does not assure a grade of AC on any clinic shift.
NUTRITION - CLINICAL COMPETENCIES
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PRIMARY CLINICAL COMPETENCIES - CONDITIONS
Categories of disease/conditions for which holistic therapeutic plans are to be developed
(beginning with clinical competency four). The therapeutic plan should include at least 1 follow
up visit as well as future plan indicating long term management goals.
Doctor’s Initials/Date
Cardiovascular disease- (HTN, hypercholesteolemia, coronary artery disease, angina, etc.)
Dysglycemia - (diabetes or hypoglycemia)
Food Allergies
Intestinal disorder - (IBD, IBS, Crohn’s, ulcerative colitis, constipation/diarrhea)
Peptic Ulcer Disease
Gallstones
Cancer prevention protocol
Skin diseases
Arthritis or myalgia (long term)
Anemia
Osteoporosis
Gynecological conditions - FBD, menopausal management/PMS or dysmenorrhea,
endometriosis, polycystic ovary disease, management of abnormal pap smear
Acute Respiratory Tract Disorder (otitis media, strep throat)
Chronic Upper Respiratory Tract Disorder
Asthma
Nutritional deficiencies
Urinary tract problems or vaginitis, kidney stones
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NUTRITION - CLINICAL COMPETENCIES
NUTRITION PRIMARY CLINICAL COMPETENCIES - CONDITIONS
Mental/Emotional illness
Nervous system disorder - (insomnia, dizziness, seizure)
Opportunistic infections associated with HIV+, also HIV risk assessment
Endocrine imbalance or hepatic conditioning
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Bastyr University Natural Health Clinic
SECTION V : STUDENT PAPERWORK
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Index
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