Creighton University
Department of Occupational Therapy
Professional Rotation Manual
TABLE OF CONTENTS
Introduction...................................................................................................3
Preparation for Professional Rotation ........................................................5
Clinical Education Seminar I and II ..........................................................5
Identification of Site Environment ...........................................................5
Clinical Affiliation Agreement for Professional Rotations ........................5
Placement Process .............................................................................. 5-6
Placement Sequence ...............................................................................6
Contacting Professional Rotation Site mentors ........................................6
International Professional Rotations .......................................................7
Identification of Roles...............................................................................9
Clinical Education Advisor ...............................................................9
Site Mentor ......................................................................................9
Faculty Mentor .................................................................................9
Faculty Communication Liaison………………………………………. 9
Professional Rotation Experience ..............................................................9
Policies and Requirements for Participation ...........................................10
Policies and requirements for Participation ............................................10
Absence Policy ......................................................................................10
Dates and Hours of the professional practice experience ......................10
Professional Competence/Attitude and Behaviors ................................11
Evaluations and Grading........................................................................11
APPENDIX - FORMS
A. OTD Program Educational Objectives ..............................................12
B. Professional Rotation Proposal .................................................. 14-16
C. Site Confirmation Form ............................................................... 17-18
D. Clinical Affiliation Agreement .................................................... 19-24
E. Student Professional Rotation Learning Log(SPRLL)……………25-26
F. Student Self-Evaluation ……………………………………………. 27-28
G. Student Evaluation of Site ........................................................ 29-31
H. Student Evaluation of Site Mentor ............................................. 32-33
I. Site Mentor-Evaluation of Student .............................................. 34-36
J. International Professional Rotation Learning Contract …… .. … ..37-38
K. Faculty Mentor Agreement ………………………………………….39-40
L. Verification of Receiving/Reviewing Professional Rotation Manual. 41
All documents represented in this manual are subject to change, the most current
documents are located on the fieldwork website at:
https://spahp.creighton.edu/departments-offices/occupational-therapy/clinical-education-department
Professional Rotation Manual
Updated 6/2015
2
Introduction
Each student is required to complete a Professional Rotation as part of the experiential component of
the OTD program. Professional Rotations in the OTD program offer students the opportunity to extend
and refine knowledge acquired in the curriculum and utilize it meaningfully as a means of critically
analyzing occupational therapy practice. Using the OTD curriculum design framework, students will
articulate a rationale for professional rotation site choice(s) that considers: (a) their own occupational
interests and needs; (b) the opportunities, limitations, requirements and needs of particular practice
environments; and (c) the potential contribution a professional prepared with an OTD degree might make
to such environments. Emphasis will be placed on understanding the personal, communal and
institutional/societal dimensions of professional development and on the appreciation of the critical
balance between these three dimensions.
The placement process for participation in experience and outcome objectives is dramatically different
than Level II fieldwork experiences. Students continue their personal inquiry toward professional
development during a two-semester trajectory process to construct their Professional Rotation. During
the trajectory process students consider various options of types of practice environment(s) and gather
data in order to select an environment for their Professional Rotation. The selected practice environment
will serve as the basis for locating specific site options for the student’s Professional Rotation and for
designing a personal development plan in preparation for the rotation. Students may choose to focus
on one or more of the following areas for the professional rotation:
1.
2.
3.
4.
5.
6.
7.
8.
Clinical practice skills,
Research skills,
Administration,
Leadership,
Program and policy development,
Advocacy,
Education/Academia,
or Theory Development
The professional rotation manual has been prepared to help the student understand the policies,
procedures and guidelines pertaining to the professional rotation portion of your doctoral education. The
policies and guidelines for students enrolled in the Occupational Therapy Program described in this
manual have been approved by the Dean of the School of Pharmacy and Health Professions, the
Occupational Therapy Program Director and Faculty, and with the assistance of the Occupational
Therapy Department Curriculum Committee. The Academic Clinical Education Coordinator will be
available to clarify any information. The Assistant Coordinator will assist with questions regarding facility
information files. Communication is essential for a successful collaborative effort in developing
Professional Rotations. Students meet with the Academic Clinical Education Coordinator throughout
the trajectory courses (OTD 460460 Clinical Education Seminar I Clinical Education Seminar I and OTD
461461 Clinical Education Seminar IIClinical Education Seminar I) for questions, guidance, suggestions,
and support. Questions are always welcomed.
The University reserves the right to change and to make exceptions to the provisions of this
Manual at any time and to apply any change or to make an exception applicable to any student
without regard to date of admission application or date of enrollment. This Manual is neither a
contract nor an offer to enter into a contract.
Professional Rotation Manual
Updated 6/2015
3
Instructor of Record for the Professional Trajectory and Professional Rotation
courses:
Andrea Thinnes, OTD, OTR/L
Director, Clinical Education Office
Academic Clinical Education Coordinator
Assistant Professor of Occupational Therapy
Boyne 103E (402) 280-5929 email: andreathinnes@creighton.edu
Anna Domina, OTD, OTR/L
Academic Clinical Education Coordinator
Assistant Professor of Occupational Therapy
Boyne 103F 402-280-3407 email: annadomina@creighton.edu
Angela Patterson, OTR/L
Academic Clinical Education Coordinator
Adjunct Instructor of Occupational Therapy
Boyne 115F 402-280-5980 email: angelapatterson@creighton.edu
Michelle de la Garza, OTD, OTR/L
Academic Clinical Education Coordinator
Assistant Professor of Occupational Therapy
Boyne 103B 402-280-3426 email: michellemesser@creighton.edu
Clinical Education Office Support:
Mary Pat Wearne
Clinical Education Administrative Assistant
Boyne 103C O: (402) 280-5631 F: (402) 280-5692 email: mpwearne@creighton.edu
Professional Rotation Manual
Updated 6/2015
4
Preparation for Professional Rotation
Clinical Education Seminar I and II (OTD 460 and OTD 461)
Students receive instruction for preparation of their Professional Rotation in OTD 460 and OTD
461 Clinical Education Seminar I and II. These classes provide resources that assist students in
identifying their strengths, resources, needs and aspirations in preparation for developing their
Professional Rotation experience.
Drawing on the understanding of occupation, professional practice, and professional identity and
leadership from field and classroom experiences, students develop learning objectives and
activities to support a personal trajectory toward transformation of practice. These objectives will
be carried out during the Professional Rotation course.
Assignments will be constructed to enable students to prepare themselves to enter the
environment they have identified to meet their learning objectives. Assignment descriptions are
located in the OTD 460, OTD 461 and OTD 600 course syllabi. Professional rotation sites may
also assign additional assignments to students during the professional rotation.
Previous Work Experience
Prior fieldwork, continuing education, or work experience may not be substituted for any part of
the professional rotation experience.
Identification of Site Environment
During the Clinical Education Seminar I and II courses students will develop their own personal
learning objectives which are consistent with the OTD program’s educational objectives
(Appendix A). Based on the student’s identified learning objectives, they will research and identify
sites whose facilities, expertise and resources have the potential to facilitate the student’s learning
objectives. The student will submit an OTD Professional Rotation Proposal (Appendix B) to the
Clinical Education Advisor with learning objectives and identified sites according to the deadlines
established.
Professional Rotation Clinical Affiliation Agreement
Once the Clinical Education Seminar II Clinical Education Advisor has approved the student’s
learning objectives and the site mentor’s resume or curriculum vitae has been received and
approved, the site must agree to comply with Creighton University’s School of Pharmacy and
Health Professions Clinical Affiliation Agreement. (Appendix D). If the site has an agreement in
place already for Level I and/or Level II students, they may accept professional rotation students
under that same agreement. If the site does not already have a contract in place with Creighton
University, a new contract must be initiated. In the event the site wishes to utilize their own
agreement, the agreement must be approved and signed by the appropriate officials at
Creighton University before a student is allowed to begin the professional rotation experience.
Placement Process
Once the Clinical Education Advisor has approved the student’s learning objectives and potential
sites, the student may contact the site for the purpose of seeking professional rotation placement.
The student will be directed and supported in this placement confirmation by the Clinical
Education Advisor and the Assistant Fieldwork Coordinator. Once verbal confirmation has been
obtained, it is the student’s responsibility to see the Site Confirmation Form (Appendix C) form
and site mentor’s CV or resume is returned via fax, email or regular mail to the Clinical Education
office.
Professional Rotation Manual
Updated 6/2015
5
Placement for Professional Rotations is the responsibility of the Student, the Clinical Education
Advisor Clinical Education Advisor and the Clinical Education Administrative Assistant.
Communication and coordination of efforts is essential. Students are actively involved in
constructing their own Professional Rotation experiences. Students have the opportunity to meet
one on one with the Clinical Education Advisor to clarify the placement process, receive
recommendations regarding focus, mentors, and/or sites throughout the trajectory process. The
most efficient manner of communicating with the Clinical Education Advisor is to make an
individual appointment via Outlook.
A professional rotation placement is guaranteed by the University but the University does not
insure geographic or other preferences. Students are strongly encouraged to plan and discuss
finances, housing possibilities and travel arrangements with their family and significant others
prior to completing the placement process. The Clinical Education Seminar courses will
specifically address the Professional Rotation placement process.
Placement sequence
1. Student constructs learning objectives
2. Clinical Education Advisor approves learning objectives
3. Student identifies a minimum of three (3) potential environments (sites) where learning
objectives might be achieved
4. Clinical Education Advisor approves three (3) sites
5. Student seeks information regarding activities of the sites
6. Student in collaboration with the Clinical Education Advisor contacts site(s) seeking site
placement
7. Student contacts site(s) seeking site mentor’s resume or curriculum vitae.
8. Student submits Final Professional Rotation Proposal to Blueline Course Website
9. Site faxes or emails mentor’s resume or curriculum vitae to Clinical Education Advisor.
10. Site faxes or emails signed Clinical Affiliation Agreement and Site Confirmation Form to
Clinical Education Advisor.
11. Student is considered placed.
Once all the professional rotation placements are completed, a roster is prepared which lists the
facility, address, site mentor name, phone number and dates of placement. The following packet
of materials is then emailed or mailed to each site mentor: course syllabus, the student’s final
professional rotation plan, and evaluation forms. The student must send the site mentor his/her
personal data sheet, student self-assessment of learning and communication styles, and resume
at least one month prior to the professional rotation starting.
Contacting Professional Rotations Site Mentors
Students are to contact potential Site Mentors once directed by the Clinical Education Advisor. In
most cases, the IOR will communicate with the site initially and will work with the student on any
follow up communication necessary.
Students must request a copy of the Site Mentor’s resume or curriculum vitae in order to ensure a
quality learning experience and to demonstrate compliance with ACOTE Standard B.11.3. The
resume or curriculum vitae and site confirmation form must be uploaded to the OTD 461 course
dropbox.
After the site mentor’s resume or curriculum vitae has been approved and the site has sent back
a site confirmation form, students should maintain regular contact necessary to negotiate learning
activities to meet the student’s learning objectives.
At least one month prior to the start date for the scheduled rotation, students should contact their
Site Mentor. Arrangements such as meeting time and place, dress code, parking and expected
Professional Rotation Manual
Updated 6/2015
6
hours and dates for the Professional Rotation should also be confirmed by the student at this time.
Site Mentors will receive a copy of the Professional Rotation syllabus and evaluation forms from
the instructor of record 2 weeks prior to the start date of the professional rotation.
Some sites may require copies of certain documents such as immunization records, CPR
certification, physical examinations, drug testing or criminal history checks, etc. It is the student’s
responsibility to provide any such documentation to the site, and the student incurs the cost of
such documentation and/or any testing the site requires.
International Professional Rotations
International Professional Rotation sites are developed on a case-by-case basis given that:
1. Liability and health insurance are guaranteed by the student,
2. There is no language barrier between the student, site mentor and the population served,
3. The site mentor has expertise in the area the student is focused on,
4. The rights and safety of the student are reasonably assured.
Additional resources regarding International rotations can be found at:





“Working as an Occupational Therapist in Another Country” is one of WFOT’s most frequently
downloaded resources. Resources are listed alphabetically and can be found at:
http://www.wfot.org/ResourceCentre.aspx. If you are undertaking volunteer or paid work in
countries where the profession is just beginning, WFOT is happy to assist with establishing
networks where possible. Please contact WFOT as you plan for your work: admin@wfot.org.au
Use OT Connections to network: http://otconnections.aota.org/
Check out opportunities on: http://www.wfot.org/NewsEvents.aspx
Contact the local OT organization – as a courtesy and for information, to learn about culture,
regulation, needs and issues in the profession:
http://www.wfot.org/Membership/CountryandOrganisationProfiles.aspx
WFOT Alternate Delegate, Anne Jenkins, represents members who reside outside the U.S. and are
working internationally in the AOTA Representative Assembly.
WFOT Announcements & Delegate Update, May/June 2015 http://www.maneyonline.com/loi/otb
Students in the occupational therapy program will follow all policies in Creighton University’s Travel
Policy which can be found at
http://www.creighton.edu/fileadmin/user/InternationalPrograms/docs/Travel_Policy_2-25-1f .
Please note that students traveling abroad are responsible for checking the United States Department of
Homeland Security website to ensure the location of which a Professional Rotation experience will be
completed is safe for American’s to travel.
http://travel.state.gov/content/passports/english/alertswarnings.html. If a location becomes unsafe prior
the student’s planned Professional Rotation experience dates the student will be required to find a
replacement site as they will not be allowed to travel to any unsafe locations. This could delay the start of
the Professional Rotation placement and in turn may delay graduation.
Professional Rotation Manual
Updated 6/2015
7
Communication will be documented and faxed after any telephone meeting to insure the
accuracy of the language interchange if applicable. Students are required to communicate
weekly with the Faculty International Communication Liaison by mail, fax and/or phone. The
following additional documents are required for students completing an international professional
rotation:



International Professional Liability Insurance certificate submitted to the instructor during
OTD 460 Clinical Education Seminar II
International Professional Rotation Learning Contract (Appendix J)
And the documentation required by Creighton University’s Global Engagement Office
(GEO). Please check the GEO website and speak to one of the coordinators in the office
in order to receive the most up to date information/forms.
All students are required to purchase international professional liability insurance independently
as the Creighton University School of Pharmacy and Health Professions Student Professional
Liability insurance does NOT cover students completing a professional rotation outside of the
United States. Students wishing to complete a professional rotation abroad must supply a copy
of the insurance policy and a receipt of payment to the Clinical Education Advisor. The cost of
the insurance plan on average is approximately $100/month abroad. This is in addition to other
costs incurred with traveling abroad. The company recommended for student professional
liability insurance abroad is:
Academic Group, linked here: http://www.academicins.com/
Students are also required to show proof of immunizations and travel preparations as
appropriate for the country in which they will complete the rotation.
All international forms required by GEO can be found at:
http://www.creighton.edu/internationalprograms/forms/index.php
Students may choose to participate in ILAC, a cultural immersion experience in the
Dominican Republic. This experience, facilitated by a faculty member takes place over 17
days in the beginning of the professional rotation experience. The experience will take
place over set ILAC dates and will change the start and end date of the Professional
Rotation. There are pre-determined learning objectives that all students complete as part
of the ILAC program, it is not necessary for students to create their own independent
objectives. Students commence their experience at the professional rotation site upon
returning from the D.R. Students must follow the application process and be selected to
participate in the D.R. experience.
Professional Rotation Manual
Updated 6/2015
8
Identification of Roles
The requirements of the Professional Rotation experience involve several individuals to guide,
facilitate, and evaluate the student’s performance and outcomes. The roles of the individuals and
the parts they play in orchestrating the rotations are identified as follows:

Clinical Education Advisor - The individual who administer the total Professional Rotation
program and is a Creighton faculty member whose primary concern relates to integrating the
student’s professional rotation experience with the curriculum. In association with the academic
and clinical faculty, the Clinical Education Advisor plans and coordinates the student’s professional
rotation experience and evaluates the student’s progress. The Clinical Education Advisor
approves all student identified learning objectives and site selection to meet those objectives. The
Clinical Education Advisor is responsible for placing the student in an appropriate setting to meet
those objectives, addressing issues relevant to the rotation. The Course Instructor is responsible
for issuing the final grade (Satisfactory/Unsatisfactory) in the course.

Site Mentor - The individual, who, on behalf of the professional rotation site, is responsible
for the direct instruction and supervision of the student in the professional rotation setting. This
individual supervises, directs and facilitates the professional rotation experience. They may be
the clinical supervisor, therapist, faculty member, or political or agency representative who acts on
behalf of the site where the student is assigned for the rotation. The Site Mentor negotiates with
the student the learning activities and tasks to meet the student’s learning objectives and evaluates
the student’s performance during the professional practice experience including performance of
the learning activities.

Faculty Mentor - If the student chooses to complete a manuscript as a piece of evidence
of the professional rotation experience, the student must identify a faculty member to serve as the
manuscript mentor. The Faculty Mentor commits to act as a consultant and agrees to give
formative feedback during the process of working on the manuscript. The Faculty Mentor may, in
conjunction with the student, establish goals, objectives and/or guidelines for submission of drafts
to facilitate the student’s adhering to project requirements and deadlines.

Faculty Communication Liaison – If the student chooses to complete an international
professional rotation, a faculty member must agree to serve as a communication liaison. An
agreement form located on the course website outlines should be signed by both parties and
turned in to the instructor in OTD 461. The faculty member will agree to a time each week during
the international portion of the professional rotation to speak to the student to check in and ensure
the student is doing well.
Professional Rotation Manual
Updated 6/2015
9
Professional Rotation Experience
Students are required to complete a 16 week Professional Rotation for a total of 16 credit
hours in order to fulfill the requirements for the Doctorate in Occupational Therapy.
Rotations are established and arranged based upon specific learning objectives identified
by the student. These learning objectives must be consistent with the OTD Program’s
Educational Objectives (Appendix A).
Students are expected to complete their professional rotation experience participating in
activities intended to meet their individually identified learning objectives. These objectives
are recorded on the Professional Rotation Proposal Form (Appendix B) and are approved
by the Clinical Education Advisor. The Site Mentor will evaluate the student’s performance
based on the Professional Rotation Mentor- Evaluation of Student form (Appendix I).
Class of 2015
Professional Rotation Dates
OPTION 1: (Traditional 16 weeks)
DATES August 17-December 4, 2015
OPTION 2: (ILAC experience + 2nd professional rotation site)
DATES TBD (Dominican Republic)
Start Date TBD - December 4, 2015 (13 weeks)
Professional Rotation Manual
Updated 6/2015
10
Policies & Requirements for Professional Rotation
The policies and guidelines in this manual are supplementary to policies in the Creighton
University Bulletin, School of Pharmacy and Health Professions and the Creighton
University Department of Occupational Therapy Handbook and Fieldwork Manual.
Students are responsible for familiarizing themselves with, and following University, School,
Departmental and Professional Rotation policies.
Specifically, students should be familiar with policies regarding:
Immunizations
Student health insurance
Cardiopulmonary Resuscitation (CPR) Certification
Universal precautions
Drug Testing
Criminal Background checks
HIPPA regulations
Absence Policy
The dates and hours of the rotation must be agreed upon in advance between the Site Mentor,
the Student and the Clinical Education Advisor. These dates should not be changed without first
gaining permission from the Clinical Education Advisor and Site Mentor. The student should
follow the full time schedule of the site mentor. A student does not have any personal/sick days
during the professional rotation experience.
 Creighton University requires that if students requires a personal leave due to (illness or , death
in the family) he/she must negotiate directly with his/her site mentor to make up the time missed
and communicate the agreed upon arrangement with the Clinical Education Advisor.
 If a student becomes ill, he/she MUST contact the Clinical Education Advisor immediately via
email and/or telephone AND request permission from the Site Mentor.
 Requests for vacation time or time off to conduct job interviews ARE NOT APPROPRIATE
during the Professional Rotation experience.
Dates and Hours of the Professional Rotation
Students are expected to complete a full time schedule based on the site mentor’s schedule during
the professional rotation. This schedule would typically be Monday through Friday 8am-4:30 p.m.
If a student does not fulfill a full-time rotation due to time off requests, they will be subject to a
professional behavior citation and/or a failing grade in the course.
Professional Rotation Manual
Updated 6/2015
11
Professional Competence/Attitudes and Behaviors
Per the contractual clinical affiliation agreement, any student whose professional competence
and/or attitudes and behaviors are deficient or inappropriate so as to warrant removal from the site
prior to the completion of the professional education experience will receive a failing (F) or
unsatisfactory (UN) grade for that experience.
Both the Site Mentor and the
clinicians/administrators of the practice site have the authority to remove students from the practice
site if their professional performance or their behaviors compromise patient safety or are disruptive
to staff and/or clinic operation.
If a student fails the professional rotation experience, a clinical remediation course must be
successfully completed to progress on to the professional rotation. Required courses in which
grades of F or UN are earned must be repeated at the student’s expense in order to graduate.
Students are urged to contact the Clinical Education Advisor at the first sign of difficulty so that
problems can be addressed and resolved in a timely and professional manner.
Evaluation and Grading for the Professional Rotation (OTD 600)
Requirements for successful completion of a Professional Rotation include the following:
1. Satisfactory completion of the 16 week, full-time Professional Rotation experience
2. Satisfactory completion and submission of all learning objectives, learning activities, and
evidence
3. Satisfactory completion of all required assignments
4. Receipt of a satisfactory grade from the Site Mentor on the Site Mentor Evaluation of Student
form
5. Completion of the Student Evaluation of Site form
6. Completion of the Student Evaluation of Site Mentor form
7. Completion of the Student Self-Evaluation form
8. Completion of monthly professional rotation learning logs
Professional Rotation Manual
Updated 6/2015
12
Appendix A
OTD Program Educational Objectives
Upon completion of the OTD program, graduates will be able to:
1. Demonstrate entry-level occupational therapy clinical skills.
2. Develop a new or refine an existing program that enhances occupational therapy practice.
3. Demonstrate positive interpersonal skills and insight into one’s professional behaviors to
accurately appraise one’s professional disposition strengths and areas for improvement.
4. Demonstrate the ability to practice educative roles for clients, peers, students, and others in
community and clinical settings.
5. Influence policy, practice and education by advocating for occupational therapy services for
individuals and populations and for the profession.
6. Demonstrate leadership aptitude and characteristics to assume leadership roles at the local,
national and international levels in occupational therapy, health professions, and the community.
7. Develop essential knowledge and skills to contribute to the advancement of occupational therapy
through scholarly activities.
8. Apply principles and constructs of ethics to individual, institutional and societal issues, and
articulate justifiable resolutions to these issues and act in an ethical manner.
Professional Rotation Manual
Updated 6/2015
13
Appendix B
Professional Rotation Proposal
Professional Rotation Manual
Updated 6/2015
14
Creighton University
School of Pharmacy and Health Professions
Department of Occupational Therapy
PROFESSIONAL ROTATION PROPOSAL
Student Name:
Rotation Focus:
Permanent Address:
Rotation Dates:
City, State, Zip
Phone:
Student Emergency
(
Student Cell Phone:
)
(
)
Contact Name and Phone number:
Professional Mission Statement:
Mentor 1 Name and
Credentials:
Mentor Phone and Email:
Rotation Site Name and
Mailing Address:
Rotation Dates:
Mentor 2 if applicable)
Name and Credentials:
Mentor Phone and Email:
Rotation Site Name and
Mailing Address:
Rotation Dates:
Learning Objective
1.
Proposed Learning Activities
Proposed Evidence
Corresponding to Learning Objective
Show Accomplishment
of Learning Objective
1a.
1a.
1b.
1c.
1d.
1b.
1c.
1d.
Professional Rotation Manual
Updated 6/2015
15
2.
2a,
2b,
2c.
2d.
2a.
2b.
2c.
2d.
3.
3a.
3b,
3c.
3d.
3a.
3b.
3c.
3d.
4.
4a,
4b.
4c.
4d.
4a.
4b.
4c.
4d.
5.
5a,
5b,
5c.
5d.
5a.
5b.
5c.
5d.
If completing a manuscript as a piece of evidence, student must have requested the assistance of an OT Faculty Mentor named below:
Creighton OT Faculty Manuscript Mentor:
________________________________________ _____________
Student Signature
Date
For office use only
___ Site Mentor 1 CV received
___ Site Mentor 2 CV received
___ Faculty Mentor form received
International Student Rotations:
___ File created with office of International Programs
___ International form packet completed
___ Student learning contract completed
Professional Rotation Manual
Updated 6/2015
16
Appendix C
Site Confirmation Form
Professional Rotation Manual
Updated 6/2015
17
Department of Occupational Therapy
PROFESSIONAL ROTATION
SITE CONFIRMATION FORM
FROM:
TO:
STUDENT NAME
Clinical Education Advisor Name
Department of Occupational Therapy
School of Pharmacy and Health Professions
Creighton University
2500 California Plaza, Boyne 103E
Omaha, Nebraska 68178
Fax: 402-280-5692
Site Name _________________________________
Address ____________________________________
City, State, Zip ______________________________
Site Mentor Name: __________________________
Email address: _____________________________
Phone: ( ) ________________________________
Fax: ( )___________________________________
Focus of the Rotation:
Rotation Dates:
Site Mentor:
OTR:

Yes

No
I confirm the placement of the student named above for a professional rotation during the
dates noted.
Date Signed
Site Mentor Signature/Printed Name
Return signed form via fax at (402) 280-5692
Or via mail at address listed above
Professional Rotation Manual
Updated 6/2015
18
Appendix D
Clinical Affiliation Agreement
Professional Rotation Manual
Updated 6/2015
19
AGREEMENT BETWEEN
CREIGHTON UNIVERSITY
AND
___________________________
This agreement is entered into by ___Site Name, City, State___ (“Site”) and Creighton University, a
Nebraska nonprofit corporation located at 2500 California Plaza, Omaha, NE 68178 (“Creighton”).
Creighton desires to provide a professional clinical educational experience program for its students, and has
asked Site to participate in that program in order to provide Creighton’s students an opportunity for clinical
education.
In consideration of the mutual benefits, the parties agree to the following:
I.
GENERAL INFORMATION:
A.
B.
C.
D.
E.
II.
The course of instruction (the “Clinical Program”) will cover a period of time mutually agreed
upon between Site and Creighton. The Clinical Program objectives will be communicated in
writing to the Site’s preceptor by the appropriate Creighton Clinical/Experiential Education
Office when scheduling students.
Except under compelling circumstances agreed to by both parties, the beginning dates and
length of experience will be agreed upon no less than one month before the beginning of the
Clinical Program.
The number of students eligible to participate in the Clinical Program will be mutually
determined by agreement of the parties and may be altered by mutual agreement.
Students are not employees of Site or Creighton and are not eligible for compensation or
benefits from either institution.
Neither Site nor Creighton will discriminate against any employee or student on the basis of
race, national origin, religion, creed, sex, sexual orientation, age, or marital, veteran or disability
status. Both parties agree to comply with the Family Educational Rights and Privacy Act of
1974, as amended, and regulations promulgated thereunder, governing the privacy of student
records.
RESPONSIBILITIES OF CREIGHTON:
A. Creighton shall provide and maintain the records and reports required by Site for conducting
clinical learning experiences of its students under this Agreement. Creighton assumes
responsibility for assigning grades for the clinical education experience.
B. Creighton shall obtain or require its students to maintain professional liability insurance
coverage in the amount of $1,000,000 per medical incident/$3,000,000 aggregate to cover the
liability of the student.
C. Creighton shall obtain or require its students to purchase additional international professional
liability insurance coverage when any portion of a clinical experience will be completed outside
of the United States.
D. Creighton shall require its students to comply with Site policies and procedures while
participating in the Clinical Program at Site, including Site’s policies and procedures governing
patient confidentiality. As a part of this agreement, Creighton shall require students to submit
to the appropriate Clinical/Experiential Education Office a signed Student Clinical
Participation and Confidentiality Agreement. An example of this agreement is attached as
Exhibit A.
Professional Rotation Manual
Updated 6/2015
20
E.
Creighton acknowledges that it shall submit a signed attestation form for each student
participating in the Clinical Program at Site. An example of this attestation form is attached as
Exhibit B.,
F. Creighton will conduct a background check on each student prior to participating at Site.
Creighton will only send students on rotation whose background checks have no positive
findings or whose results have been pre-approved by Site. Creighton’s background check will
include the following items:
1. Social Security number verification
2. Criminal search (5 years)
3. Violent Sexual Offender & Predator registry
4. HHS/OIG/GSA
5. Any other items requested in writing by Site upon signing of this Agreement.
G. Creighton shall defend, indemnify and hold Site harmless from and against any and all liability,
loss, expense (including reasonable attorneys; fees), or claims for injury or damages arising out
of the performance of this Agreement but only in proportion to and to the extent such liability,
loss, expense, attorneys’ fees, or claims for injury or damages are caused by or result from the
negligent or intentional acts or omissions of School, its officers, agents, students, or employees.
H. Creighton will assign to Site only those students who have satisfactorily completed the
prerequisite didactic portion of the curriculum unless remediation-related clinical education
services have been specifically negotiated with Site.
I. Creighton will enforce rules and regulations governing students that are mutually agreed upon
between Site and Creighton.
III.
RESPONSIBILITIES OF SITE:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Site will participate in directing and implementing the Clinical Program.
Site reserves the right to limit the number of students it receives. Site, in conjunction with
Creighton, will determine the dates for student participation in the program.
If Site accepts a student, Site shall provide instruction and professional experience in
accordance with Clinical Program objectives (Section I. A) and any specific Clinical Program
goals developed and agreed upon by the parties.
Site shall provide and maintain records and reports required by Creighton for conducting the
educational program and provide an evaluation to Creighton on forms provided by Creighton.
Site shall be under no obligation to maintain any facilities for the Clinical Program other than
those which Site ordinarily maintains in the course of its business.
Site shall provide available time, when possible, to clinical instructors for attending clinical
supervisory meetings and conferences called by Creighton as part of the educational program.
Site will inform participating students on pertinent policies and procedures at Site.
Site will encourage students in Creighton’s Clinical Program to attend the Site’s professional
meetings, and shall allow such students access to journals, books, and periodicals contained in
Site’s library, if any, provided, that no student shall be permitted to take outside of the premises
any such journals, books, or periodicals from the library unless approved by Site.
No student shall be entitled to any stipend from Site by reason of this Agreement or by reason
of such student's participation in the Clinical Program. Students may not accept stipends from
Site if prohibited by accreditation standards.
Site shall defend, indemnify and hold Creighton harmless from and against any and all liability,
loss, expense (including reasonable attorneys; fees), or claims for injury or damages arising out
of the performance of this Agreement but only in proportion to and to the extent such liability,
loss, expense, attorneys’ fees, or claims for injury or damages are caused by or result from the
negligent or intentional acts or omissions of Site, its officers, agents, or employees. This
Professional Rotation Manual
Updated 6/2015
21
K.
L.
indemnification provision is not intended to and shall not change the obligations of any
insurance company under any insurance policy maintained by a party.
Site retains the right to terminate any student's participation in the Clinical Program where it
reasonably believes doing so is necessary to protect the health, safety and welfare of Site, its
patients, employees or visitors. Site shall immediately notify the Director of the
Clinical/Experiential Education Office (identified in the mailing address provided at on the
signature page of this Agreement) of any such termination of a student. The Director of the
Clinical/Experiential Education Office will notify any Creighton faculty serving as Instructor
of Record for the terminated student’s clinical education rotation.
Students who become ill while at Site will be provided initial medical or emergency treatment
at Student’s cost.
IV.
Either party may terminate this Agreement upon sixty (60) days advance written notice to the other
party.
V.
Any revision or modification of the Agreement shall be in writing, and shall be signed by both
parties.
VI.
This agreement shall be effective as of the 1st day of __________, 2015.
SITE NAME
CREIGHTON UNIVERSITY
By:_______________________________________
By:____________________________________
Print Name:
Print Title:
Date:______________________________________
Victoria F. Roche, Ph.D.
Senior Associate Dean
School of Pharmacy and Health Professions
Date:___________________________________
By:____________________________________
Andrea M. Thinnes, OTD, OTR/L
Director of Clinical Education
Date:___________________________________
Site Mailing Address:
Creighton Mailing Address:
ADD INFO
Creighton University
School of Pharmacy and Health Professions
Department of Occupational Therapy
Clinical Education Office
2500 California Plaza
Omaha, NE 68178
Professional Rotation Manual
Updated 6/2015
22
EXHIBIT A
STUDENT CLINICAL PARTICIPATION AND CONFIDENTIALITY AGREEMENT
SITE is committed to quality health care and confidentiality for its patients. As a student of another
institution assigned to a clinical experience at SITE, the undersigned is required to agree to the terms of this
Agreement. Please review and ask questions if you have any.
“Confidential Information” is any patient, physician, employee, and SITE business information obtained
during the course of work or association with SITE.
I agree to treat all Confidential Information as strictly confidential and will not reveal or discuss
Confidential Information with anyone who does not have a legitimate medical and/or business reason to
know the information. I understand that I am permitted to access Confidential Information only to the extent
necessary for patient care and to perform my duties while assigned to SITE. I will not disclose identifiable
Confidential Information (e.g., name, date of birth) if the identity of the individual can be removed. I
understand that I am a member of SITE’s workforce for purposes of complying with the Health Insurance
Portability and Accountability Act of 1996, and its applicable privacy and security regulations, and agree
to follow SITE’s policies regarding HIPAA while participating in this Clinical Program at SITE.
I will abide by all SITE policies and procedures regarding Confidential Information.
If I am given any access security codes or passwords, I agree to use them solely to perform my duties and
will not breach the security of the information systems or premises. I will not use or disclose or misuse
security codes or passwords. I will not misuse or attempt to alter SITE information systems in any way. I
understand that SITE reserves the right to audit, investigate, monitor, access, review and disclose
information obtained through the information systems at any time, with or without advance notice to me
and with or without my knowledge. I understand I will be held accountable for my work and any changes
made under my password and security codes. I understand that I am responsible for the accuracy of
information submitted under my passwords and security codes.
I am expected to be covered by my own health insurance at all times, including hospitalization insurance.
Should I seek routine or emergency medical care, I understand that I will be responsible for the cost of such
care.
I am not and will not be an employee of SITE by virtue of my participation in this Clinical Program at Site
and shall not be entitled to compensation or employee benefits of any kind, including but not limited to
health insurance, workers’ compensation insurance or unemployment benefits.
I understand that violations of SITE policy may subject me to immediate termination of my assignment at
SITE, as well as civil sanctions and/or criminal penalties.
My signature acknowledges that I have read and understand this Agreement.
_________________________
Student Name (print)
_________________________
Student Signature
_________________________
Date
_________________________
SITE
This Exhibit is made a part of the Agreement to which it is attached.
Professional Rotation Manual
Updated 6/2015
23
EXHIBIT B - HEALTH STATUS/CLINICAL PROGRAM TRAINING ATTESTATION FORM
1. I verify the following information for the required health screenings, immunizations or
documented health status and will provide documentation upon request.
a. Tuberculosis screening within the past 12 months (negative PPD skin test or a chest x-ray and
health care provider review if a previous positive PPD reaction): April 2009
b. Measles, mumps, and rubella (MMR) immunity (positive antibody titers or 2 doses of MMR):
DATES
c. Diphtheria, pertussis, and tetanus immunity (Tdap, Adacel, or Boostrix): DATE
d. Polio immunity (3-dose series or positive antibody titer): DATE
e. Varicella immunity (positive history of chickenpox and positive antibody titer or Varicella
immunization): DATES
f. Hepatitis B immunity (3-dose series and positive antibody titer): DATES
I verify that I have CPR for Healthcare Providers certification with an expiration date of ______:
2. Creighton provides the following required program instruction to all students. I verify that I have
received instruction in all areas
 CPR for Healthcare Providers
 Confidentiality (Patient Rights)
 Dress Code
 Universal Precautions, including needle safety
 HIPAA training
I agree to abide by all policies and procedures of the sites hosting my rotations/clinical experiences.
My signature acknowledges that the information I have provided is complete and accurate and that I
authorize the above information to be disclosed to preceptors/sites prior to rotations/clinical experiences.
_________________________________
Student Name (print)
_________________________________
Student Signature
_______________________
Date
This Exhibit is made a part of the Agreement to which it is attached.
Professional Rotation Manual
Updated 6/2015
24
Appendix E
Student Professional Rotation Learning Log
Professional Rotation Manual
Updated 6/2015
25
Student Professional Rotation Learning Log (Monthly Progress Report) Form
This document is to be completed electronically and turned into the Blueline dropbox. . If you have permission
granted from your site mentor and the IOR to work off site on a learning activity, this must be detailed in the chart
below.
Student Name: ____________________________________ Site Name: __________________________
Progress for the Month of: ____________________________
1. Please fill out grid below with information regarding progress on each learning objective.
Learning
Objective
#
Date
Clock hours
spent
Learning activity
Location (i.e. on site, library, if other,
please state where)
*No more than 20% of the time logged in
each SPRLL may take place off site
ACOTE Standard C.2.3
2. Please describe/summarize the progress you are making on each learning objective. Progress can include plans you
have established that will assist you in meeting the learning objectives (meetings arranged, presentations arranged,
etc). If you have not made progress toward a learning objective please document “none at this time” and your plans
for the next month.
Student Signature: __________________________________________ Date: _________________
Site Mentor Signature: _______________________________________ Date: _________________
Site mentor must sign form before it is uploaded to Blueline dropbox. Please plan ahead in collecting the signature in order to
comply with course due dates.
Professional Rotation Manual
Updated 6/2015
26
Appendix F
Student Self-Evaluation
Professional Rotation Manual
Updated 6/2015
27
OTD 600
PROFESSIONAL ROTATION
EVALUATION
Student SELF Evaluation
OTD Curricular Model
INSTRUCTIONS: The student will complete this evaluation form. Both the mentor and student will review the
evaluation collectively and sign that they agree on the evaluation. The student will then submit the form to the
Instructor of Record for OTD 600 Professional Rotation according to the course due dates located in the course
syllabus.
Student Name:___________________________
Mentor Name:___________________________
Rotation Site:_____________________________
Dates of Rotation: __________to___________
Focus of Rotation: _________________________________________________________________
Please answer the questions below and provide any relevant comments related to the Professional Rotation.
Aspect of experience
1. I was able to meet all my planned learning objectives during this
Rotation.
Comments:
YES
NO
2. I was able to apply didactic concepts from the OTD Curriculum
during my Rotation.
Comments:
3. My mentor guided me appropriately during this Rotation.
Comments:
4. Professional growth occurred for me during this Rotation.
Comments:
5. I spent the planned time of this Rotation as outlined in my
Professional Rotation Plans.
Comments:
6. I felt challenged during this Rotation.
Comments:
7. Reflection on Professional Rotation Experience and Student Demonstration of Ignatian Value(s)
Please describe at least one example during your professional rotation experience in which you were able to
demonstrate a specific Ignatian value and the mission of Creighton University. The table below is for your
reference.
Comments:
Professional Rotation Manual
Updated 6/2015
28
Ignatian Value
Cura Personalis
Magis
For the Greater Glory of God
Men and Women For and
With Others
Finding God in All Things
A Faith That Does Justice
Behaviors exhibited by a student
 Willingness to engage in an encounter with a client and reflect that said
client affected his/her life
 Therapeutic use of self
 Considerate and shows care for the whole person in how they interact with,
provide intervention for, and educate a client
 Going above and beyond in day to day tasks for which one is responsible
 Take thoughtful consideration of and acts on the most/best compassionate
choice(s) for the client
 Acknowledgement of one’s skills and gifts and gives glory to God for those
gifts
 Reflective capacity and self-awareness to recognize limitations and ask for
help
 Ability to receive and accept constructive feedback from fieldwork educator
and peers
 Exhibits personal vulnerability in order to excel and learn from others and
self
 Ability to pause in the midst of daily routines and shift gears based on new
information received
 Provide client with most meaningful, honest and respectful care
 Seek out motivating factors from client and plan interventions based on
meaning
 Sees the “bigger picture” and bigger “systems” at work with special attention
to health disparities, culture, and client’s access to healthcare
 Equipped as change agents, striving for progress in OT profession, health
care system, and supportive legislation
8. Overall, this Rotation met or exceeded my expectations.
Comments:
Mentor Signature:________________________________________ Date:________________
Student Signature:________________________________________
Date:________________
Professional Rotation Manual
Updated 6/2015
29
Appendix G
Student Evaluation of the Site
Professional Rotation Manual
Updated 6/2015
30
OTD 600
PROFESSIONAL DOCTORATE ROTATION
Student Evaluation of Site
Curriculum Model
Student Name: _____________________________ Mentor Name:_________________________
Rotation Site: ____________________________Dates of Rotation: ________to__________
Focus of Rotation: __________________________________________________________
Student's Comments
Living Accommodations during rotation: (approx. cost/mo. other helpful details)
______________________________________________________________________________________
______________________________________________________________________________________
Public Transportation in the area:
______________________________________________________________________________________
______________________________________________________________________________________
Before beginning a rotation at this site study/read/prepare by:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
The most rewarding part of this rotation was:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
The most challenging part of this rotation was:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Professional Rotation Manual
Updated 6/2015
31
ACADEMIC PREPARATION
Rate the relevance and adequacy of your academic coursework relative to the needs of your professional rotation,
circling the appropriate number.
OTD 302 Occupations and Occupational Therapy
OTD 306 Health Conditions
OTD 314 Occupations and Health: Pop. & Persp.
OTD 316 Prof Practice and Ethical Formation Sem.
OTD 341 Neuroanatomy
OTD 300 Research Proposal
OTD 317 Occupational Therapy in Mental Health
OTD 318 Level IA Fieldwork: Mental Health
OTD 324 Applied Kinesiology
OTD 339 Clinical Anatomy
OTD 340 Clinical Anatomy Lab
OTD 355 Physical Rehabilitation I: Evaluation
OTD 333 Upper Extremity Eval. and Intervention
OTD 356 Phys. Rehab. II: Neurorehabilitation
OTD 390 Level IB Fieldwork: Phys.Rehabilitation
Adequacy for Placement
Low
High
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Relevance for Placement
Low
High
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
OTD 400 Research Project Implementation I
OTD 403 Neuro-Occupation
OTD 423 Occupational Therapy with Older Adults
OTD 433 Upper Extremity Eval. and Intervention II
OTD 435 Occ. Therapy with Children and Youth I
OTD 442 Critical Analysis of Occ.Therapy Practice
OTD 460 Clinical Education Seminar I
OTD 490 Level IC Fieldwork: Peds/other setting
OTD 401 Research Project Implementation II
OTD 406 Management and Program Development
OTD 417 Disability and Healthcare Policy
OTD 436 Occ.Therapy with Children and Youth II
OTD 457 Phys. Rehab. III: Intervention /Outcomes
OTD 461 Clinical Education Seminar II
OTD 491 Level ID Fieldwork: Peds/other setting
OTD 481 Level IIA Fieldwork
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
OTD 564 Prof. Identity, Ethics, Ignatian Tradition
OTD 574 Professional Competency
OTD 571 Level IIB Fieldwork
OTD 600 Professional Rotation
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
What courses or experiences contributed the most to your success on your professional rotation?
___________________________________________________________________________
What changes would you recommend in your academic program relative to the needs of your experience?
_______________________________________________________________________________________
_______________________________________________________________________
Rotation Mentor Signature: _______________________________Date: _______________
Student Signature: _____________________________________ Date: ______________
Professional Rotation Manual
Updated 6/2015
32
Appendix H
Student Evaluation of the Site Mentor
Professional Rotation Manual
Updated 6/2015
33
OTD 600
PROFESSIONAL ROTATION
Student Evaluation of the Site Mentor
OTD Curriculum Model
Please indicate the number that is descriptive of your site mentor. Please fill out a separate copy for each site mentor if you
had more than one.
1=Strongly Disagree, 2=Disagree, 3=No opinion, 4=Agree, 5=Strongly Agree
1
2
3
4
5
Provided ongoing feedback in a timely manner
Reviewed written work in a timely manner
Made specific suggestions to student to improve performance
Provided clear performance expectations
Sequenced learning experiences to grade progression
Used a variety of instructional strategies
Identified resources to promote student development
Presented clear explanations
Facilitated student’s clinical reasoning
Supervision changed as rotation progressed
Provided a positive role model of professional behavior in practice
Frequency of face to face meetings/types of meetings with mentor:
______________________________________________________________________________________________________
____________________________________________________________________
General comments on mentorship:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________
_______________________________
Student’s Signature
_______________________________
Student’s Name (please print)
_______________________________________
Mentor’s Signature
_______________________________________
Mentor’s Name and Credentials (please print)
Date: __________________________
Professional Rotation Manual
Updated 6/2015
34
Appendix I
Mentor - Evaluation of the Student
Professional Rotation Manual
Updated 6/2015
35
Department of Occupational Therapy
2500 California Plaza, Omaha, NE 68178
Phone (402) 280-5929
Fax (402) 280-5692
PROFESSIONAL ROTATION
Site Mentor Evaluation of the Student
OTD Curricular Model
INSTRUCTIONS: The Professional Rotation Mentor will complete the Final Evaluation Form. Both the mentor and
student will review the evaluation collectively and sign that they agree on the evaluation. The student will then submit
the form to the Instructor of Record for OTD 600 Professional Rotation according to the course due dates located in the
course syllabus.
A. Name of Student
Name of Professional Rotation Mentor
B. TO THE MENTOR: Graduates of Creighton University’s School of Pharmacy and Health Professions are expected to pursue careers in
practice, education, and research where they will serve as role models and leaders of the profession. Your assessment of their performance
and potential during the Professional Rotation ensures that students have met the OTD curricular objectives and are ready to act as role
models and leaders in the profession. Please carefully assess the student in the following areas. Compare this student to others you have
known who have similar levels of experience or education.
Top 5%
Excellent
Top 10%
Above
Average
Top 40%
Average
Lower
60%
Below
Average
Unable to
Judge
COMMUNICATION SKILLS: Command of oral and written language, clarity,
coherence and facility of expression.
MOTIVATION FOR THE PROFESSION: Solid commitment based on mature
values and a realistic view of the profession.
CLINICAL SKILLS: Exhibits a minimum of entry-level clinical skills, clinical
reasoning skills appropriate, represents profession appropriately.
MATURITY: Self-control, unselfishness, realistic self-appraisal, ability to cope
with life situations.
RELIABILITY: Honesty, trustworthiness, conscientiousness.
PERSEVERANCE: Steadfastness in purpose, disciplined work habits, stamina
and endurance.
INTERPERSONAL RELATIONS: Effective response and sensitivity to the
feelings and needs of others, compassion, empathetic.
EMOTIONAL STABILITY: Performance under pressure, absence of tension
symptoms, mood stability.
INTELLECTUAL ABILITY: Facility in understanding new ideas, perception of
relationships between concepts, insight.
RESOURCEFULNESS: Adaptability to new situations, effective use of available
resources, originality.
JUDGMENT: Ability to analyze a situation and make an appropriate decision,
common sense.
EDUCATION: Ability to accurately and effectively educate a variety of
populations including clients, family members, peers, other health care
professionals, and others in clinical and community settings.
ADVOCACY: Demonstrates care and concern for others by advocating for
individuals, groups, and populations related to OT practice.
LEADERSHIP: Exhibits the ability and desire to assume leadership roles
SCHOLARSHIP: Demonstrates essential knowledge and skills to contribute to
the advancement of occupational therapy through scholarly activities
CRITICAL SELF REFLECTION: Awareness and action related to personal
challenges allowing for personal growth, engages in ongoing reflection and
modifies behavior due to reflective experiences
Professional Rotation Manual
Updated 6/2015
36
C. Reflection on Professional Rotation Experience and Student Demonstration of Ignatian Value(s)
Now that you have had a chance to review the curriculum and Ignatian values, please take a moment to provide important feedback on the
questions below. For assistance in completing this part, we’ve created a table with a few examples of how Ignatian values may be
demonstrated in a clinical setting. The student may not be completely competent in a given behavior example, but the fieldwork educator
can remark on how the student has excelled and/or progressed in any of the given values listed below.
Ignatian Value
Cura Personalis
Magis
For the Greater Glory of God
Men and Women For and With
Others
Finding God in All Things
A Faith That Does Justice
Behaviors exhibited by a student
 Willingness to engage in an encounter with a client and reflect that said client affected his/her
life
 Therapeutic use of self
 Considerate and shows care for the whole person in how they interact with, provide intervention
for, and educate a client
 Going above and beyond in day to day tasks for which one is responsible
 Take thoughtful consideration of and acts on the most/best compassionate choice(s) for the
client
 Acknowledgement of one’s skills and gifts and gives glory to God for those gifts
 Reflective capacity and self-awareness to recognize limitations and ask for help
 Ability to receive and accept constructive feedback from fieldwork educator and peers
 Exhibits personal vulnerability in order to excel and learn from others and self
 Ability to pause in the midst of daily routines and shift gears based on new information received
 Provide client with most meaningful, honest and respectful care
 Seek out motivating factors from client and plan interventions based on meaning
 Sees the “bigger picture” and bigger “systems” at work with special attention to health
disparities, culture, and client’s access to healthcare
 Equipped as change agents, striving for progress in OT profession, health care system, and
supportive legislation
For Professional Rotation Site Mentor(s) to Complete:
As a site mentor, in your understanding of Ignatian Values at this time, please describe how you have seen the student demonstrate at
least one Ignatian Value during this professional rotation experience.
D. We are interested in obtaining an accurate profile of the student’s capacity for the profession. Please note student strengths as well as areas
for growth.
Professional Rotation Manual
Updated 6/2015
37
Strengths:
Areas for Growth:
E. As a Professional Rotation Mentor, you work closely with a student in an area of professional interest. Many students seek Professional
Rotation Mentors as guides in a professional area of practice. Based on your expertise and interactions with the student during the
Professional Rotation, please indicate a satisfactory or unsatisfactory completion of the professional rotation experience for this student in
Creighton University’s Doctor of Occupational Therapy program:
Satisfactory Performance
Unsatisfactory Performance
If you desire, please make any additional comments here :
Student’s Signature
Date
Site Mentor’s Signature
Date
Please print name
I am an
Occupational Therapist
Phone:
________
Other
E:mail: _________________________________________________________
School of Pharmacy and Health Professions ● Department of Occupational Therapy
Clinical Education Office
Andrea Thinnes, OTD, OTR/L; andreathinnes@creighton.edu
P: 402-280-5929; F: 402-280-5692
Creighton University ● 2500 California Plaza ● Omaha, NE 68178
Professional Rotation Manual
Updated 6/2015
38
Appendix J
International Professional Rotation Learning Contract
Professional Rotation Manual
Updated 6/2015
39
International Professional Rotation
Learning Contract
Date
RE: Student’s Name
International Professional Rotation
The following conditions are recommended to facilitate an optimal professional rotation for you,
as well as establish a method of consistent communication between you and Creighton
University.
The following items have been discussed and agreed upon on __________________, date.
__________________________, occupational therapy student, , and
_______________________________, the faculty communication liaison, have agreed to the
objectives outlined below:


Communication via email or telephone conversation with the faculty communication
liaison will take place a minimum of one time per week at an agreed upon time
An evening phone number of the student must be provided prior to leaving the United
States
Evening phone number: _______________________________________________

A day time phone number and on site supervisor contact information (at the facility) must
be provided prior to leaving the United States
Day time phone number and contact name at site:
_________________________________________________________________________
_________________________________________________________________________

An emergency contact name and phone number of 2 other personal relations family
members in the United States that reside in different households
Contact 1 Name/Phone:
____________________________________________________________________________
____________________________________________________________________________
Contact 2 Name/Phone:
____________________________________________________________________________
____________________________________________________________________________
Cc: Student, Global Engagement Office, Students’ faculty communication liaison,
Student Advisor
Professional Rotation Manual
Updated 6/2015
40
Appendix K
Faculty Manuscript Mentor Agreement
Professional Rotation Manual
Updated 6/2015
41
Department of Occupational Therapy
OTD PROFESSIONAL ROTATION
Faculty Manuscript Mentor
Agreement Form
I. For the student:
I understand that it is my responsibility to contact and secure the signature of a faculty mentor for my
professional rotation manuscript. I agree to negotiate with my mentor regarding the topic, content and
organization of the manuscript and to submit drafts on a timely basis as required by the mentor.
Signature of student:
Date:
Educational Objective this project will address:
II. For the Faculty Mentor:
My signature on this form indicates my willingness to serve as a mentor for the professional rotation
manuscript as specified above. I agree to review all drafts which are submitted by the student in a timely
manner and provide constructive feedback on the topic, content and organization of the project. I further
agree to serve as one of the graders for the professional rotation manuscript.
Signature of Faculty Mentor:
Date:
Timeline for submission of drafts:
Professional Rotation Manual
Updated 6/2015
42
Appendix L
Verification of Receiving/Reviewing
Professional Rotation Manual
I, ______________________________________, acknowledge that I have
(student name)
received and completely reviewed the professional rotation manual and take personal
responsibility for the information contained in it.
One question I have regarding what I read in the manual is: (each student is required to
generate one question from reading the manual).
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Student Signature:________________________________
Date:__________________________________________
Professional Rotation Manual
Updated 6/2015
43