APTA Clinical Performance Instruments for PT

Evaluation
Student: Emma Polski
Clinical Staff: Andrews Havens
Site: Corewell Health Outpatient (Spectrum) Greenville
Evaluation Name: PTH 634 Summer 2023 Class of 2025
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1.   Professional Practice – Safety

Self Mid-Term — Emma Polski
1. Able to monitor patient response to treatment and pivot / adjust the plan as needed for patient safety 2.
Capable of maintaining 50% of a full-time PT's caseload 3. Maintains a safe working environment with
consistently using a gait belt and proper guarding while monitoring patient safety for elderly populations,
complex conditions, balance training, etc. 4. Requests PT assistance when necessary, when patient
response is indicating a red flag behavior

Self Final — Emma Polski
1. I am able to see simple cases independently without CI intervention. 2. I am aware of patient non-
verbal response to treatment and I make sure to follow up and ask for patient feedback, especially on
their thoughts and feelings for a particular treatment. 3. I am consistently using a gait belt for populations
that present as a fall risk. 4. Proper guarding and attention on patient presentation. 5. Confident and
consistent with independent balance training.

CI Mid-Term — Andrews Havens
Emma demonstrates strong competence in day to day safety measures including hand hygene, gait belt
appropriatness, and use of patient identifiers especially with non familar patients0 with high consistency
and low supervision. While providing her a more experimental approach in terms of hands on treatment
such as assisted stretching or joint mobilization, she does require cueing up to 50% of the time for use of
safe body mechanics of her self both for clinician protection as well hand placement for ease of
procedural application. Emma asks clarifying questions appropriately and demonstrates a nack for
seeking patient feedback in her treatment with minimal prompting.

CI Final — Andrews Havens Emma has consistently practiced in a safe manner for both herself and patient's. She is sensitive and
empathetic to patient's psychological state and or changes throughout session. She is able to adjust
intervention application or force for 90+% of patients without CI intervention and when it has been
required, she is very receptive to feedback and implements changes promptly.

B AB I AI E BE
Self +1
Safety
CI +3

2.   Professional Practice – Professional Behavior

Self Mid-Term — Emma Polski
A. Student follows dress code each day, abiding by clinic expectations B. provides empathy, compassion,
and a caring attitude towards all patients C. Maintains a positive attitude with all patients, families, and
colleagues D. Seeks feedback from CI on performances and intervention plans E. Arrives early and is
punctual, prepared, and motivated for treatments F. Manages conflict with patients in a calm and
understanding manner

Self Final — Emma Polski
1. I demonstrate initiative, arriving early and finishing all necessary work before leaving. 2. I follow up
on my word to patients- I am dependable and am true to word. 3. I exhibit compassion and empathy to all
patients, and provide a comforting hand when needed. 4. I pivot based on patient presentation, ensuring
they are comfortable and feel safe. 5. I seek feedback from my CI, other therapists, and patients on my
performance.

CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Professional Self
Behavior CI
3.   Professional Practice – Accountability
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Accountability
CI
4.   Professional Practice – Communication
Self Mid-Term — Emma Polski
From day one, Emma has demonstrated a strong and consistent initiative regarding timelyness of arrival,
prepardness and offers assistance whenever she sees an opportunity. There are absolutely no concerns
regarding her desire to learn, professional yet down to earth approach with her CI, support staff and
patient interactions. She has naturally fit into to the clinic culture and appears to easily interact with staff
that are in differeing stages of life professionally and personally. Emma has both sought and received
constructive criticism and praise in professional manners and does actively seek to correct errors if not in
the moment, at the next avaialble opportunity. There has not been any need from my end to facilitate
these behaviors and Emma appears to naturally be near entry level in this regard.
Emma has continued to demonstrate a very strong and consistent initiative and timeliness. She is very
dependable. Emma is very good at seeing the patients as distinct individuals and makes eye contact,
incorporates patient's desires and goals into the treatment plan. She has gained experience with patient
redirection with subject manner discussion when patient's have initiated controversial conversation and
managed and deflected to help reduce patient agitation well. She required minimal intervention from CI
for the situation.
I AI E BE
+1
-2
A. Actively aware of insurance policies and how to adjust a POC based on patient presentation and
needs. B. Actively abides by HIPAA for each patient, maintaining confidentiality and being self-aware of
discussing patients with CI in front of other patients. C. Actively aware of rules for student treatment
based on insurances and checks with CI. D. Accepts responsibility for errors made with patients,
apologizes, and ensures to correct them
1. The patient comes first at all times, putting their needs above my own. 2. I accept responsibility for
information missed during an evaluation, and for treatment ideas that patients do not respond positively
to. 3. I am aware of insurances, visit authorizations, and other financial aspects of the patient. 4. I actively
abide by HIPAA and make sure to not discuss patient information in front of other patients / outside of
the clinic. 5. I am an advocate for the profession and do my best to explain why physical therapy is great
for the patient.
Emma's caring demeanor shines through with all patient interactions to date. She has a natural ability to
relate to a large range of individuals from 11 to 90 + and discern patient needs verbally or behaviorally.
Emma is receptive to in the moment feedback and does adjust her plan or treatment appropriately with
minimal direct guidance 90+% of the time. She has been able to provide patient privacy and modesty
with all encounters to date 100% of the time with out direction from myself. We have discussed how
fiscal demands can impact a plan of care, especially if anticipated need is expected to be of longer term.
She has demonstrated understanding of outpatient OSHA and HIPPA related concerns and has not
required any corrective feed back in these areas.
Emma continues to do a very good job placing the patinets' needs above hers throughout her interactions.
SHe has started to recognize economic limitations in patient participation in therapy and addressed this
more recently without prompting during an evaluation and adjusted her plan of care to meet the patient's
needs. Emma has no difficulty maintaining patient confidentiality and will make a great addition to the
PT profession.
I AI E BE
+1
+1
A. Selects the most appropriate person to communicate with, such as patients with caregivers present or
spouses that handle care. B. Listens actively to patients needs and is able to adapt based on their
presentation or feelings that day C. Maintains good non-verbal communication with strong eye contact

Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Communication
CI
5.   Professional Practice – Cultural Competence
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Cultural Self
Competence CI
and showing empathy/consideration with patients D. Engages in ongoing dialogue with CI and other PTs
in clinic E. Adjusts language based on target audience, such as communicating with pediatric patients vs
elderly F. Seeks feedback from CI and other PTs on notes that they read G. Actively aware of non-verbal
patient communication via facial expressions or body response, such as when they are wincing or tensing
up in response to treatment
1. I go out of my way to maintain eye contact with the patient and ensure that they know I am actively
listening to them. 2. I am able to interrupt the patient, politely, and encourage them along with their
treatment. 3. I am able to change my communication voice based on patient presentation and age. 4. I am
hyper-aware of non-verbal cues from patients and make sure to respond to them. 5. I communicate with
body language that shows I am an active listener to make the patient feel comfortable. 6. I seek feedback
on my communication through treatment notes.
Emma has done a good job with in the moment verbal communication with my self. She utilizes
appropriate professional and lay person language as situations demand. As this is her first rotation and
has not yet completed significant training beyond orthopedic studies, I have refrained from requesting her
to take on a supervisory role of PTA's within our clinic. She does demonstrate a good raporte and
interaction style with clinical staff that is very natural and open without need of prompting from her CI.
She does at times require assistance with patient interactions in terms of anatomical or condition based
education in terms of analogies to assist in better patient understanding 50% of the time.
Emma continues to do a very good job with written, verbal and non verbal communication with my self.
We have started to transition into more formal communication with additional staff varied from
informing next treatment provider of updates. We are starting to work with communication between
treatment staff and support staff with 50% guidance and prompting
I AI E BE
+1
0
1. I am aware of the cultural populations I do not have experience with. 2. I am non-judgemental with
patients of all presentations. 3. I am able to communicate in a sensitive manner with cultural minorities. I
do not have much experience with different cultures.
1. As I gain more experience, I am more aware and have a better understanding of different cultures and
how they affect treatment. 2. I am able to push "biased" presentations out of my mind and focus on
treating the patient. 3. I provide quality care to all, including those who make inappropriate comments or
those who are quick to snap due to pain. 4. I am able to discuss beliefs with patients and use their beliefs
to relate therapy in a way they might better understand.
The facility of which Emma is completing her rotation is a rural midwestern hospital based outpatient
facility. Demographics of the region are highly caucasian with minimal percentage of ethnic diversity.
There have been instamnces where Emma has been able to gain experience with patients of varying
cognitition levels, health status', gender orientations and life spans and throughout all exposures she has
demonstrated a natural empathy and does not appear to project personal belief's or biases. Supervision
requried for this category is up to 25% required direction from the CI mostly in terms of prior to pateint
planning. We have had conversations regarding providing respect in regards to patient's who are pursuing
gender nsitions or identification challenges of which my philosophy is to treat all others the way you
want to be treated yourself.
Minimal change in comments from mid term. Emma continues to treat all people respectfully and takes
care to elicit patient participation in designing goals for treatment. She has had a large variety of age
ranges from 12- 99. She does not present any biases and
I AI E BE
+2
0
6.   Professional Practice – Professional Development
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Professional Self
Development CI
7.   Patient Management – Clinical Reasoning
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
1. I am able to identify my weaknesses in clinical performance based on knowledge I have not yet
learned in didactic. 2. I actively seek guidance for populations outside of my knowledge. 3. I do not
actively participate in PD or outside learning experiences, outside of my curriculum so that is something
I could work on.
1. I completed an in-serivce presentation, furthering my knowledge on a topic and confidently presenting
it to the other therapists and professionals in the clinic. 2. I actively seek guidance and feedback from my
CI, other therapists in the clinic, and also the patients with how my performance has been. 3. I accept
responsibility for shortcomings and I work towards bettering them. 4. I reflect with my CI on my growth
and where I still feel I am lacking. 5. I have consistently completed weekly goals, long term goals,
reflective journals, and conversations with my CI about expectations for the coming week. 6. I have
referenced protocols from didactic to introduce new ideas to treat patients.
Emma performs daily self reflection and seeks feedback from CI and patients regularly. This is
completed with 90 independence consistently. We have had initial discussions regarding in facility in-
service with plan to have a lunch and learn completed the final week of her rotation. Emma has had the
opportunity to shadow a local orthopedic surgeon for half a day with plans for surgical observation up
coming.
Emma continues to complete her self reflections and weekly goal setting. SHe does not require
prompting for this and she maintains her self discipline on her own. She has completed an in house in-
service focused on her interest of hippotherapy that was both interesting as well as backed with some low
level evidence as overall strong evidence is lacking in this area of therapy. She has completed a surgical
observation with opportunity to observe two arthroscopic shoulder procedures and one open wrist ORIF
I AI E BE
+2
+1
1. I am able to rationalize my reasoning for altering treatment plans based on patient presentation. 2. I am
able to utilize information from initial evaluations, outside EMRs, and patient information to make the
best clinical decision for a patient. 3. I actively assess intervention tolerance and adjust appropriately
based on patient. 4. I actively invite the patient to participate in their plan of care, not only including goal
setting but also daily care. 5. I recognize my limits of knowledge and actively seek CI help outside of
that.
1. I have an answer for the exercises and the treatments that I have chosen and can verbally explain to the
patient. 2. I make ethical decisions based on patient presentation and compliance. 3. I use the patient's
belief on their injury and on pain to guide my treatment choices. 4. I use current data and clinical
evidence to guide my treatment. 5. I am able to make clinical decisions in uncomfortable situations, or
when a patient is emotionally heightened. 6. I recognize my own limits, and seek my CI for help outside
of my knowledge.
Emma demonstrates consistent ability to review pertinent EMR notes from various providers to help
glean information regarding PT chief complaint. She has discussed evidence for orthopedic special tests
to rule in/out conditions to assist with evaluation process. She does require less than 25% guidance with
appropriateness of testing at times vs testing every possibility. This has lead to discussion regarding
hypothesis formation base on historical intake and test selection geared towards proving or disproving
the working hypothesis. Emma does require some prompting to wrap up evaluations with patient
centered goals to bring the whole person into account 25% or less percent of the time.
Emma has had the opportunity to assess a few non surgical peripheral joint cases and one that sticks out
was referred for specifically right shoulder pain. During the subjective intake, it became apparent that the
patient's chief complaint was not that of shoulder pain, but of facial, neck and suprascapular tingling. She
was able to pivot in mind set and shifted her examination to that of an indepth cervical assessment vs
planned shoulder evaluation. She presented good confidence and completed this evaluation with 95%
independence of the CI. Emmma demonstrates a strong desire to succeed and as she gains experience

B AB
Clinical Self
Reasoning CI
8.   Patient Management – Screening
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Screening
CI
9.   Patient Management – Examination
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
throughout her remaining clinicals, I expect her self confidence to grow
I AI E BE
+1
+2
1. Before initial evaluations, I review history and try to screen the patient. 2. I am able to perform tests
learned during didactic, and have similar scores as my CI when performing the same tests and
measurements. 3. I focus on patient comfort and safety when performing tests. Things to work on: 1. I
need to be more concise in choosing screening tests and measurements.
1. I am able to more efficiently complete an initial evaluation and use my findings to guide treatment. 2. I
can recognize the answers to questions in an evaluation as a guide to direct me towards a hypothesis. 3. I
am able to ask appropriate follow-up questions when needed, and use patient non-verbal cues as my
guide. 4. I consistently review patient history to ensure that the treatment is the best possible course for
them. 5. I can take data findings from an evaluation and use them to justify why the patient will need PT.
6. I was able to go outside of my comfort zone and complete a subjective history with follow up from a
patient for a vestibular disorder, which I have not learned in school yet, just through observation. * All
orthopedic based, have not done neuro didactic yet.
At this time there have not been opportunities for outside referral based upon systems review or severely
abnormal vital screening. Emma is in tune to listening to patient chief complaint and addressing
additional concerns as they arise. She does well with collaborating discussion regarding findings that are
borderline need of referral. She does this with 50% efficiency and direction at this time.
The main medical screening we perform in an out-patient setting is a vital response screening. BP, HR,
Sa02. We have had a one case where history or patient presentation indicated need for screening as well
as clinical decision regarding keep refer, hold refer or advise immediate medical evaluation. With our
discussions Emma has indicated knowledge of abnormal values and has been able to talk through
appropriate levels with 25% guidance for contacting PCP and for awareness as well as advice vs
hypothetical values coupled with potential presentations where EMS would be the appropriate course of
action. The specific case noted above resulted in persistently elevated systolic BP in the 160, with
variable diastolic response from 100 down to 80 with rest. No apparent distress or outward signs or
subjective complaints, however coupled with recent patient hospitalization with BP response noted,
appropriate course of action was a verbal contact to PCP for advice.
I AI E BE
+3
+3
1. I am able to conduct orthopedic tests and measurements semi-confidently. 2. I am becoming more
comfortable with progress notes, re-assessing patient values. 3. I am able to perform simple evaluations,
with minor input from CI. 4. I address my limitations in neurological examinations, due to lack of
didactic knowledge. 5. I am confident with patient subjective / history section, and am able to follow up
on hints of information given up by patient.
1. I am able to obtain an accurate history from a patient and use that information to guide my treatment.
2. I take the time before an initial evaluation to review patient history (if in their chart), post-op reports,
protocols, and imaging done prior. 3. I perform a quick but accurate systems review, including sensory
and muscular. 4. I am able to take non-verbal cues from patients regarding pain and other discomfort
during an examination. 5. I am confidently able to complete tests and measures that are inside of the
orthopedic zone. 6. I use clinically-relevant testing and compare values efficiently.
Emma has a natural flow with her history taking with a good flow from MOE to current state. She is able
to redirect and keep patient's on task in order to keep this portion of the evaluation efficient with less than

CI Final — Andrews Havens
B AB
Self
Examination
CI
10.   Patient Management – Evaluation
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Evaluation
CI
11.   Patient Management – Diagnosis and Prognosis
Self Mid-Term — Emma Polski
Self Final — Emma Polski
25% input. Emma demonstrates good knowledge of orthopedic special tests, however does require some
cuing "25-50%" with interpretation as exposure with true positive tests versus her experience testing
"health individuals" Emma does well with muscle testing in terms of standardized positioning and
requires infrequent cuing for resistance and supportive hand positions, but when patient testing requires
non-standard positioning, she does require cues to problem solve best available options and document
accordingly.
Emma has progressed with her consistency with application of musculoskeletal tests and measures. She
has gained confidence with shoulder and low back conditions in terms of confidence and exposure with
deciphering between overlapping conditions such as impingement vs early onset adhesive capsulitis. She
is now requiring no more than 25% total with interpretation of patient presentation with ortho. Based on
her trending when she does gain the didactic background for neuro and other specialties, I expect her to
progress in a similar manner.
I AI E BE
+3
+1
1. I am able to make a clinical judgement for treatment based off of the information I gathered from the
patient. 2. I am able to incorporate co-morbidities, and recognize limitations that will be a barrier to
treatment. This is a difficult question, because I have only completed the orthopedic portion of my
didactic. I am exposed to evaluations such as lymphedema, vestibular, and other neurological conditions
that I have not completed in school yet.
1. I make sure
Emma demonstrates a good ability to take pertinent subjective information and coordinate with objective
findings for orthopedic conditions with good consistency and less than 25% CI intervention. She is able
to derive appropriate initiate orthopedic focused activity that is appropriate for more acute and chronic
presentations. She arrives at clinical decision points with appropriately efficacity and minimal
intervention for ortho situations. For non ortho conditions such as CVA, lymphedema, vestibular, Emma
has not yet had classroom course work for basic conditions, tests/measures at this time. She does require
direction 50-75% of the time for these situations, however I feel this is due to the order of coursework
more than it is a deficit for Emma.
Emma continues to require less than 25% cuing for content organization for her subjective intake. She
has improved with her ability to select appropriate tests and measures based on subjective reports and is
starting to taylor her objective examination to test her suspicions from the historical report. She is
applying tests for shoulder in a consistent appropriate manner. She is consistently screening adjacent
regions for potential involvement (neck vs shoulder example) and has on one occasion found that the
documented referral diagnosis was very likely due to a cervical problem. For full case load she is up to
50% of my case load overall and up to 85% of my orthopedic case load.
I AI E BE
+1
+2
1. Able to think outside of the box and consider all possible causes of the reason for treatment. 2. Uses
data to develop a plan of care, including how frequent / how long care should continue. 3. Able to see
progress and determine a patient is ready for discharge or if they need to continue to reach their goals.
1. My CI consistently challenges me to think of differential diagnosis, or different co-morbidities that
MAY impact the patient's impairments. 2. I reach a PT diagnosis based on information and examination
and include the limitations that are important to the patient. 3. I use data to develop a plan of care,
including duration. 4. I am able to create realistic goals based on patient function and preference.

CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Diagnosis and Self
Prognosis CI
12.   Patient Management – Plan of Care
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Plan of Care
CI
13.   Patient Management – Procedural Interventions
Self Mid-Term — Emma Polski
Self Final — Emma Polski
Emma has demonstrated good understanding and discussion regarding discerning between primary issues
regarding impairments of contractility and extensibility vs derangement. Focus has been on identification
of primary impairments of function vs anatomical medical diagnoses. She is accurate in identification of
musculoskeletal impairments with less than 25% guidance of CI, however requires guidance 50-75% for
integumentary, vestibular and neurologic impairments at this time. Emma does a good job with review of
systems and identification of co morbidities and potential impacts of anticipated recovery of function.
Emma is now requiring no more than 25% total with interpretation of patient presentation with ortho.
Based on her trending when she does gain the didactic background for neuro and other specialties, I
expect her to progress in a similar manner. We continue to have discussions and trouble shoot prioritizing
most likely diagnosis and secondary and tirtary as appropriate. She continues to require 50-70% guidance
for non musculoskeletal conditions likely due to lack of didatic preperation.
I AI E BE
+2
-1
1. Able to efficiently create goals based on patient presentation, their activities of daily living, and their
priorities 2. Consistently creates plan with patient to ensure the best possible participation and results 3.
Able to monitor plan and change as needed based on patient results 4. Actively update HEP and plan of
care on a day-to-day basis for certain patients.
1. The duration of treatment and the planned interventions is centered around the patient, with an open
mind of a switch in presentation or differential diagnoses that may be the root of the problem. 2. HEP are
completed during the treatment session, and the explanation and reasoning is directed towards patient
function. 3. HEP are updated frequently with changing presentation. 4.
Once Emma has collected required subjective and objective information, she demonstrates a strong
ability to synthesize the information and establish specific measurable goals for both short and long term
duration that meet demands of demonstrating skill in determination as well as patient centered focus with
less than 25% assistance. She consistently incorporates aspects of patient's desires from directly stated or
inferred desires and formulates goals around these areas.
Emma continues to work with the patients to set goals that are both patient centered and measurable.
Emma has gained confidence in implementing Corewell's specific outcome measures for total joints (6
min walk, TUG, SCT as well as AROM knee extension/flexion and PROM knee extension and hip
extension focus points. She is alert to hip precautions for anterior and posterior approaches and voices
understanding of the rationale to be able to reinforce to patients. Emma does a good job questioning
rationale for established patient programs and justifying her own reasoning for types of activities for
corrective exercise with little prompting. Guidance required continues to be in the less than 25% range
for moderate to low complexity cases with prompting more to remember to review with pertinent family
members involved in the patients care when indicated.
I AI E BE
+1
-1
1. Able to prescribe and/or implement interventions based on patient presentation 2. Provides rationale in
documentation for reasoning for intervention choices 3. Able to adjust interventions based on patient
presentation and/or other comorbidities.
1. Able to efficiently complete an initial eval, progress note, or daily treatment with a flow and
consistency that is comfortable to the patient. 2. I provide rational to the patient as to "why" we are doing
what we are doing. 3. I can use different strategies to promote patient involvement, and center their
treatment around what is important to them. 4. I can accurately identify barriers that may interrupt
 procedure and find a way to pivot around them.

CI Mid-Term — Andrews Havens
Emma has been exposed to a range of manually facilitated techniques from effleurage MLD to
moderately aggressive tissue mobilization, spinal mobilization shy of manipulative thrust, strain counter
strain and IASTM techniques. She is open to application via discussion regarding technique concept and
exploration with guidance regarding application of force, load or direction with appropriate feedback
requests. She appears to think functionally regarding exercise prescription in regard to the functional goal
or desired activity of the patient and is developing a strong back log of force alternatives to progress or
regress exercise performance based on observed or reported feedback of the patient. She initially
performed the first few weeks under 75%+ guidance and especially with orthopedic cases has improved
quickly to 25% or less guidance required.

CI Final — Andrews Havens
The large majority of the intervention implementation has been via therapeutic exercise, therapeutic
activity or neuromuscular re-education. Emma has gained good experience with initiating, progressing
and modifying specific tasks and seeking patient feed back for ease or challenge of performance. She is
able to complete a full treatment session with orthopedic focused patient's with less than 25% assistance
of the CI and confidently

B AB I AI E BE

Procedural Self +1
Interventions CI 0

14.   Patient Management – Educational Interventions

Self Mid-Term — Emma Polski
1. Able to learn the patient's learning style and implement the best way to educate them 2. Able to
accurately identify a patients barriers to learning (I.e- make their HEP bigger for patients with bad
eyesight). 3. Educate patients on how to best perform their treatment at home, including outside
resources or household items to help them meet their goals 4. Able to change language and tone of voice
based on patient's cognitive state

Self Final — Emma Polski
1. I can identify how best the patient learns and document it so they can receive the best care possible
going forward from all providers. 2. I can identify barriers to learning, and how to get around them or
how to communicate with the patient's spokesperson. 3. I bring in family members and others close to the
patient to make sure they are involved in the patient's care. 4. I provide consistent education on the
importance of exercising and completing their therapy. 5. I make sure I understand the patient resources
before recommending objects.

CI Mid-Term — Andrews Havens
Emma does a good job with explanation on the fly. Meaning that while instructing, implementing and
correcting exercise performance she is consistently explaining the why and rationale for the activities she
is requesting. She does a good job with interacting with patient's with a range of educational knowledge
and can recognize and flip between a more medical explanation vs more layman terminology and or
analogies for improved patient understanding. At times she does require assistance with education of
conditions or concerns that are more outside of her current academic exposure (neuro/lymph/vestibular),
however she does appear to be picking up quickly in these areas as well. I have no concerns in this area,
especially as her base knowledge continues to develop.

CI Final — Andrews Havens Emma continues to demonstrate a strong emphasis on explaining the purpose/rationale of exercises and
assisting patient's in recognizing their constraints to determine safe performance parameters. Emma does
need periodic prompting less than 25% to keep patient's active and participating during exercises vs a lot
of discussion without active participation.

B AB I AI E BE

Educational Self +1
Interventions CI +2

15.   Patient Management – Documentation

Self Mid-Term — Emma Polski 1. Able to finish a daily treatment note throughout treatment while still paying close attention to patient.
2. Able to pick important information from patient conversation to include in appropriate sections. 3.

Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Self
Documentation
CI
16.   Patient Management – Outcomes Assessment
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Outcomes Self
Assessment CI
17.   Patient Management – Financial Resources
Provides clinical reasoning to justify treatment for patient. 4. Avoids excessive use of abbreviations and
other confusing language for 3rd party payers that are involved in reading the documentation. 5.
Accurately documents the daily session, using patient quotes and response to treatment to paint a picture.
1. I am able to finish a daily note before a patient leaves their session. 2. I can complete a progress note
in 8 minutes following a patient leaving, if I can sit in quiet and complete the note . 3. I am accurate and
efficient at capturing the patient's language and documenting their state of mind. 4. I document my
clinical decision making and make sure to rationalize in the assessment 5. I avoid excessive abbreviations
and am repetitive with what side of the body I am treating. 6. I use objective and subjective data to
rationalize why the patient needs to continue, including their own personal goals.
With treatment notes especially, Emma demonstrates a good ear for gleaning relevant information from
patient's in regard to their concern or referred condition. She is able to stay up with documentation for the
large majority of treatment case load with very little prompting at this time. We do need to work toward
and discuss more Indepth manners which demonstrate justification of skill so that documentation is as
justifiable as possible and discuss more patient centered wording in regard to assessments.
Emma continues to demonstrate good efficiency with keeping up with clinical documentation. She
naturally selects pertinent information for documentation regarding focus of treatment, response and
anticipated progression/modification. Emma does a good job with involving the patient in the end of
session summary, and collaborating with patients vs dictating the plan for next visit. She requires 25%
assistance with refining the assessments for evaluations and progress notes to include pertinent
information for physician awareness.
I AI E BE
+1
0
1. Able to assess the patient's response to treatment, whether during visit or at next visit, and adjust plan
accordingly 2. Consistently able to evaluate goals and if they are met or not 3. Actively invites patient to
give input in the quality of their care
* Disclaimer: I was not allowed access to FOTO, where the outcome measures are reported before an
evaluation / progress note. 1. I have become familiar with outcome measures and the importance of them
in planning a patient's care. 2. I can select appropriate outcome measures based on the presentation. 3. I
am sufficient at re-testing to see if goals have been met based performance and patient subjective.
Our facility has started to wean away from individual paper based outcome tools and has transitioned to a
computerized FOTO based outcome management system. This system is pre selected for patient's based
upon referral diagnosis and preselects and selects progressive questions per condition to statistically
determine reported and adjusted outcome scoring compared to national data bases of like minded
condition. We do continue to utilize more objective tools such as 6 MWT, TUG, BERG, ect for more
evidence based safety and performance determinations of which she does select appropriate testing for
age based or condition based completion based up reported significance of use with less than 25%
guidance.
Emma is doing a good job at recognizing when and what type of clinician-initiated outcome tools are
indicated as well as recognizing the MCID and in cases of fall risk, what cut off scoring is fall risk
determination. Emma does not require significant guidance in this regard. Emma does a very good job
reviewing specifically with the patient.
I AI E BE
+1
+1
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Financial Self
Resources CI
18.   Patient Management – Direction and Supervision of Personnel
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
B AB
Supervision of Self
Personnel CI
19.   Summative Comments / Caseload / Days Absent
1. Able to accurately write down billing charges for CI to submit with submission of notes. 2. I actively
promote PT to all of those that I meet. Not familiar/able to submit billing, communicate with insurances,
or familiar with billing codes.
1. I am able to recognize when a patient is supposed to have a progress note based on insurance,
especially if it is a patient I see frequently. 2. I have become more accurate with the billing charges, and
they are always completed day off. 3. I adhere to guidelines and rules of insurances and consider patient
financial situation. 4. I advocate for the profession and why investing in your health is important. 5. I
educate on preventative maintenance and how that can financially benefit a patient
Following evaluations, Emma has taken initiative to search for noted insurance coverage impacts in
regards to co-payments or deductibles. She takes this into consideration when recommending a frequency
and duration for a plan of care for her patient's. She does still continue to require periodic prompting less
than 25% of the time to discuss this with patients as part of her evaluation summary at the end of the
sessions. From prior experience working in a physical therapy facility as a PSR type position, she has
valuable insite into how insurance can impact desire, participation and attendance with physical therapy
recommended programing.
Emma has continued to have some exposure in regards to the financial aspect of therapy. The case I am
thinking is a patient who has 24 visits per Calander year limitation. She was referred for outpatient
therapy 2 months status post a hip replacement and during the course of her rehab, her left knee started to
become aggravated. There are concerns regarding potential OA, but no current imaging was present to
confirm likely-hood of OA. Emma still requires promting up to 25% of the time for discussion of these
scenarios with the patient.
I AI E BE
+5
-2
1. I am able to time manage efficiently, by documenting while providing patient treatment 2. Able to
justify my clinical findings and reasonings and collaborate with other PT/PTA's who see the patient next.
3. I show respect and gratitude for other professionals. **As a student, it is not my jurisdiction to
supervise other colleagues.
1. I am able to time manage well, and document while providing treatment. 2. I ask for help when needed
from my CI or therapy techs, whether to help cleaning a table or grabbing a tool without disrupting
patient care. 3. I am respectful and friendly with all other professionals in the area. 4. I thank the support
staff frequently for all that they do. AS a student, I do not have jurisdiction over anyone else.
Emma has had the opportunity to both seek input as well as provide initial direction for desired plan of
care and activity progression for a few of the patients she has evaluated. She has worked on a smooth
hand off between PT and PTA and building patient confidence with a different clinician. She does require
some prompting 25% at this time. She demonstrates a natural interaction style that is both laid back and
professional and her interpersonal skills are a natural fit in this setting.
I have geared this rotation more on the foundational exposure to patient care and evaluation. She
continues to seek feedback from support treatment staff as indicated when provider is in the building.
Emma fits into a team approach to patient care very well and is not threatened and very willing to seek
feed back and provide input.
I AI E BE
+5
-2
Areas of Strength
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
Areas for Further Development
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
Caseload/Other Comments
1) What is the full caseload at your clinical site for a new graduate?
2) Considering the rating anchors, what percent of a new graduate caseload is the student capable of managing at this
time?
Self Mid-Term — Emma Polski
Self Final — Emma Polski
CI Mid-Term — Andrews Havens
CI Final — Andrews Havens
Recommendations
1. Patient communication / interactions 2. Adaptability 3. Compassion towards others
1. Communication 2. Education towards patient 3. Adaptability 4. Able to show compassion towards the
patient 5. Time management skills 6. Documenting my skill
Strong interpersonal skills with patients, support staff and additional co workers. Very strong desire to
learn as well as "get her hands dirty" and try techniques that are not familiar to her. Emma has a natural
ability to interact with patients of all levels and life spaces. Emma also has a strong ability to t
Strengths for Emma continue to be what was listed at the mid term below as well as her compassion and
empathy. She continues to relate well with patient's of a large range of life spaces as well as educational
and socioeconomic back grounds. Ethnic exposure is limited in this geographic region, but based on
demonstrated behaviors, I would not anticipate any conflicts.
1. Conciseness on objective data 2. Confidence in new knowledge
1. Creating a flow for my objective examinations 2. Furthering my education in certain topics 3.
Continuing to update my special test toolbox
Further time spent with developing a frame work for spine based evaluation and treatment over the
remaining 3 weeks. Will need to gain more experience with ortho evaluations that are non acutely post
operative so that she has the exposure to appropriate special test application and interpretation. (based on
CI case load at this time)
1) Developing a strong route routine for both the subjective and objective aspects of the evaluations. This
will allow her to rule in/out and more efficiently hone in on the patient's problem. 2) Continue to develop
self confidence when patient facing. An outward projection of certainty can have a calming influence on
anxious/fearful or nervous individuals even if there is uncertainty involved. 3) Do not be afraid to
acknowledge when you may not have the answer. There will always be something that is either new or
you just plane forget. In the case of a patient's concern, if you cannot answer it, let them know that either
you will find the answer or point them to a person who would be able to assist.
1. The full caseload is 12-14 cases in a 10+ hour day 2. I would be able to handle 75% of ortho cases.
This clinic is a mix of orthopedics, vestibular, lymphedema, and other various complex conditions. This
is a split clinic. I feel confident to handle 75% of ortho patients, but the answer varies due to the
population at this clinic.
I have taken 75% of my CI's caseload, but he has specialities in lymphedema and vestibular therapy that I
am not able to take over.
A full case load at our facility is 12-14 patient's in a 10+ hour day. This facility is a rural general clinic
and as such providers are expected to be able to treat a wide range of orthopedic, neurologic conditions.
More specialty cases such as vestibular, lymphatic and women's health do require a more advanced
training or certification and are available for clinic pursuit as desired. Emma is managing in the
orthopedic arena very close to a full case load for treatments and is 75% for peripheral joint ortho
evaluations. At this time exposure for a steady ortho case has been partially limited as my schedule has
included a significant case load for lymphatic and vestibular cases.
See mid term for clinical site break down. For orthopedic conditions Emma is performing at 90% case
load in this final week. She continues to require guidance for non orthopedic cases (vestibular and
lymphedema and neurologic evaluations), however with established TBI or CVA patient's she is
becoming more comfortable with implementation of treatment modalities with 30% or less guidance.
Self Mid-Term — Emma Polski Consider reviewing biomechanics and kinsesiology anatomy. Continue to work on special tests to
become more comfortable with evaluations.

Self Final — Emma Polski Continue to work on becoming more comfortable with evaluations.

CI Mid-Term — Andrews Havens Continuing to stay up to date on functional anatomy and keep applying her kinesiology understanding to
exercise prescription. Would recommend that rotation occurred following academic course work for
other than orthopedic conditions due to variety of cases at this facility.

CI Final — Andrews Havens Continue to stay driven and try and take some case examples from your rotation and apply their
presentations to what you study via Neuro, Developmental or Pediatric course work in the future. Try
and find your area of joy. There are many different avenues you could pursue in PT, but if you find what
you love, you will never truly have a job, but instead a calling.

Mid-Term Days Absent Student: 0 days

CI: 0 days

Final Days Absent Student: 0 days

CI: 0 days

Reason for Absence

Self Mid-Term — Emma Polski No absent days

Self Final — Emma Polski No absent days

CI Mid-Term — Andrews Havens n/a

CI Final — Andrews Havens
No absences. Emma has been more than prompt, always early and readily prepared for each day of the
rotation. I have no concerns regarding her punctuality nor dedication to learn and the profession overall.
* I do wish to clarify grading on the CPI. After discussion with the site visit coordinator, I did realize that
I may have rated Emma higher overall on the mid term than what was expected for her progress within
the program. With that in mind, I attempted to show progress between mid term and final CPI ratings and
I do feel that she has progressed greatly. If orthopedic case load was only taken into account i feel her
scoring would be accurate, however when considering the non orthopedic case load, overall I feel she
would fall between the intermediate and advanced intermediate categories. She is well on her way to
becoming an excellent clinician.

Evaluation Sign Off Dates/Times

Self Mid-Term

[CI] Andrews Havens - 06/02/23 01:46 PM

[Student] Emma Polski - 06/02/23 01:46 PM

Self Final

[CI] Andrews Havens - 06/23/23 07:47 AM

[Student] Emma Polski - 06/20/23 07:49 AM

CI Mid-Term

[Student] Emma Polski - 06/02/23 01:46 PM

[CI] Andrews Havens - 06/02/23 01:45 PM
[CI] Andrews Havens - 06/02/23 11:41 AM

CI Final

[Student] Emma Polski - 06/23/23 07:47 AM

[CI] Andrews Havens - 06/23/23 07:46 AM
 [CI] Andrews Havens - 06/20/23 07:47 AM

Post-Assessment Comments
Please review this Mid-Term evaluation:

Save Comments
Please review this Final evaluation:

Save Comments
Final comments by Andrews Havens - 06/23/23 07:48 AM
Emma will do well in this profession. It was a pleasure to assist her through her learning experience.