The Situation

In August 2016 the College received a complaint from a patient. Apparently, a student learner was involved in her treatment without her consent. And the clinic where she received treatment was not kept clean.

The student coordinating care had completed a “written exam,” but in the patient’s opinion it was clear this learner, “was not that experienced.” The supervising physiotherapist did not introduce himself at any point during treatment.

The physiotherapist in question told the College he supervised his physiotherapy student for about a month between July and August 2016. During the complainant’s care, he said he was, “available for consultation or to take over at any time.”

In the patient’s complaint, she specified the clinic was “very, very dirty” and “not a clean place at all”. At her first appointment, she noticed sheets were not changed and,“the pillow was on top of the sheet and its cover was not changed either.”

The supervising PT said clinic policy requires sheets and pillowcases to be changed between patients. The student learner admitted sometimes forgetting to do this.

The Rules

Physiotherapists supervising a student assume professional accountability for the learner’s actions. Sure, it’s important to encourage a student’s autonomy, but what level of clinical judgement can they manage? If you’re going to involve a student learner in a patient’s care, it’s your responsibility to obtain consent from the patient. If the patient doesn’t understand how a supervisory relationship works, they won’t feel comfortable discussing concerns or questions with you, the senior professional.

Likewise, if you aren’t around to monitor your student’s progress, you won’t notice they aren’t changing sheets and pillowcases between patients. There’s no disputing this clinic experienced a lapse in infection control practices.

Last but not least, the patient record for this case lacked a clinical impression, an analysis, and a treatment plan with goals and outcome measures. Nevertheless, the supervising physio signed off on his student’s incomplete chart entry.

The Consequences

The supervising PT’s negligence in the areas of consent, record keeping and infection control were enough for him to meet with the Senior Physiotherapist Advisor and write a reflective paper as part of a Specified Continuing Education and Remediation Program (SCERP), to remind him of his professional expectations.

This included:

• A review of the Supervision of Student Learners Standard
• A review of the Essential Competency Profile for Physiotherapists in Canada
• A review of the Infection Control Standard and the Guide
• A review of the Record Keeping Standard and Guide, the Record Keeping Checklist and the Record Keeping Video 

SCERP costs were paid by the physiotherapist.