Special Requests for Absence from a Clinical Placement

The School of Rehabilitation Science emphasizes the development of high standards related to professional conduct, in conjunction with a program of study in basic, applied and clinical sciences. This is to ensure that graduates are capable of working safely and effectively as physiotherapists and to prepare students for employment expectations on graduation.

In clinical practice courses, the professional behavior expected requires a very high attendance standard. In setting this standard, the School of Rehabilitation Science considers the expectations of the clinical facilities as well as the responsibility and accountability of the student to the clinical facility, the caseload assigned and, ultimately, to the patients receiving service in the clinical facility.

It is imperative that each student complete a required minimum number of hours of clinical education in the MPT program, which includes the established parameters for diversity of clinical experiences. All absences from clinical practice courses require serious consideration in relation to professional responsibility and consequences. All absences from clinical practice courses are carefully monitored for the cumulative amount of time absent, the reasons for absence from clinical duties, and time worked in lieu of approved absences as ‘make-up’ time.

These absence guidelines are designed to emphasize: a. obligations to patients and b. maximizing the experience gained in clinical facilities. Only illness and compassionate leave can be considered as reasons for absence without prior approval. For the MPT clinical education component, requests for approval of absence for other reasons are normally not granted.  However, when granted in special circumstances, such absence requires make-up time.

During a clinical placement the student's priority must be clinical work. In situations where this priority focus and time commitment may be compromised, (i.e.) participation in a non-clinical event, particularly if absence time is greater than what can reasonably be made-up in the placement), the student should apply to postpone one or more clinical placements. The School of Rehabilitation Science does not permit full time clinical courses to be scheduled in shorter segments with time off requiring discontinuity of the placement. Each case will be considered related to its individual circumstances. Some possible reasons to request postponement may include, but not an all-inclusive list:  health care needs, conflict with a training program for a high level sports competition and other personal needs.

Students should be aware that postponing/deferring or repeating clinical placements will often result in a delayed convocation date as there is normally no available time within the MPT to make up significant lost clinical placement time.

These guidelines related to absences from clinical practice course time, and the official application for absence form, can be found in the Student Handbook and in the School of Rehabilitation Science, Master of Physical Therapy web site at https://medicine.usask.ca/policies/special-requests-for-absence-from-a-clinical-placement.php.

The following outlines detailed guidelines and procedures for special requests for absence from clinical practicum course time.

Permission for Absence from Clinical Duties

Only illness and compassionate leave (bereavement) are considered reasons for absence without prior approval. In the event of absence due to illness or other circumstances beyond the student's control, the student will notify the clinical facility as soon as possible to allow time for alternate arrangements to cover the caseload.

Medical, dental, or other non-emergency appointments (ie: job interviews) should not interfere with clinical commitments. If this is unavoidable, the student should:

• first request permission for a special absence from the Clinical Coordinators at the School of Rehabilitation Sciences, Master of Physical Therapy program;
• confirm approval for absence in advance;
• discuss this with the Clinical Instructor once approved; or make alternative arrangements.

Normally any missed time will have to be made up. If the time away is anticipated to be

 quite brief, (i.e.) Less than 2 hrs.) initial discussion with the Clinical Instructor is appropriate.

If the student is absent from clinical practice course time, except for medical or compassionate reasons, without the prior approval from the clinical instructor and the School of Rehabilitation Science, the Director/Manager (or designee) of the clinical facility may refuse to allow the student to continue the clinical placement. This decision will be thoroughly investigated, but normally the decision of the clinical facility will be honored by the School of Rehabilitation Science. An unauthorized absence from clinical practice is considered unprofessional conduct and will be noted on the student's permanent file.

Special requests for absence from a clinical placement for personal reasons may be granted with prior approval as per policy defined below. The student will be required to ‘make-up’ all time ‘in lieu of clinical time granted for personal absences. 

1. Type Of Request For Absence Which May Be Considered

1. When the PCE, Written component is scheduled for a weekend day, on special request, students will be allowed a maximum of one day (7.5 hrs) away from a clinical placement for travel to/from the exam, ONLY IF THE TIME REQUIRED FOR TRAVEL TO THE EXAM LOCATION IS GREATER THAN 4 HOURS. For travel time requirements of less than 4 hours duration, special requests may be considered if undue hardship related to travel is anticipated. This special request must be submitted well in advance of the PCE.
2. When the PCE, Written Component, is scheduled for a weekday students will be allowed time off to write the exam and travel as per criteria above. 
   
   The student should plan the date for taking the PCE well in advance. This allows time for planning alternate caseload management in the student’s absence. Under the above circumstances, additional clinical practicum make-up time in lieu of one day travel time for the PCE will not be required, unless the student has already accumulated maximum absence hours from clinical practice courses.

• It is felt that attending the course will be a direct, clinically beneficial, learning experience for the student given the relevance to the current placement and the current clinical caseload management.
• The clinical instructor and facility are agreeable.
• The time off is not going to be unacceptably disruptive to patient treatment.
• The Clinical Instructor elects to have the student accompany her/him to educational opportunities if they are directly beneficial to the student's understanding of the current clinical caseload.

2. Amount of Time Granted

1. If more than three days are missed, for any reason, (i.e. illness, bereavement, exceptional other circumstances), in any one clinical placement in PTH 852, 854, 856 or 858, normally the time must be made up by extending a placement (not necessarily the same placement) a minimum of one additional week. The Master of Physical Therapy, (MPT), and program curriculum is based on an approved required number of clinical practice course hours before entry-to-practice at graduation. Total clinical experiential learning hours is an important standard in the program to achieve expected MPT program clinical competencies. More than 3 days of missed time in any one placement is considered a large critical mass of time for that placement and must be adequately replaced, which means an additional week must be added to that placement, or a placement in the future.

5. Missed time (which is not made up during the respective placement) due to unplanned absences, illness, bereavement, or other special circumstances is also tracked as a cumulative amount across all clinical practice courses from CP 2-CP 5. Normally cumulative missed clinical practice course time of 5 days or greater, (i.e. cumulative over multiple placements, which may be one or two days per placement for example) will require make-up time before graduation. If there is a pattern of missed days over a number of clinical placements, (for example significant cumulative sick leave over multiple placements), the requirement to make up extra time will be considered by the School of Rehabilitation Science, MPT program, and final approval may be required from the Academic Affairs Committee.

1. If more than ONE WEEK of full days is missed in any single clinical placement,

• and it appears that the student has not acquired the expected competencies for that placement and setting,

• and/or has not had enough clinical time to experience a reasonably complete clinical caseload for that setting,
• the result is that the student will not pass the placement and normally the ENTIRE PLACEMENT will have to be repeated.

3. Options for 'Make-Up' Time In Lieu Of Time Absent From Clinical Placements

1. The availability of type and amount of make-up time activity varies with each clinical facility.
2. The following are acceptable make-up time options where available:
   • evening and weekend clinical time,
   • extended placement dates,
   • visits to other clinical sites to extend normal clinical hours,
   • visits to observe and/or work with other health professionals (i.e.: covering a sport event under supervision),
   • special project work or an in-service presentation with documented time (verified with an approved signature from a supervisor) for the time spent in productive preparation,
   • assignments,
   • extended hours of a significant critical mass of time (i.e.: at least one hour duration) at the beginning or end of a regular work day,
   • other options may be suggested specific to individual clinical sites
3. In some special circumstances, for short amounts of required make-up time, extended or additional time may be deferred to a subsequent clinical placement.

4. Advance Notice Required For Special Requests For Absence

1. Optimally, as much advance notice as possible is desirable for planning alternative caseload management and scheduling within the clinical placement. It is the student’s responsibility to demonstrate good communication strategies and respect for others’ time with advance planning.
2. When possible the request should be submitted in time to permit:
   • adequate time for consideration of the request by the School and the clinical facility, and
   • final confirmation of approval for absence, sent from the program to the clinical facility before the clinical placement begins. Normally this means that the request should be submitted at least 3 weeks in advance of a clinical placement.

Formal Procedure To Submit A Request

1. A request for a special absence from a clinical placement must be submitted in writing according to the standard template form provided for such requests (see ‘Special Absence Request Form’). Standard request forms are available from the School of Rehabilitation Science, MPT program, website, the specific clinical practice course PAWS site or the General Office of the School. 
2. The written request for special absence must be submitted to General Office of the School of Rehabilitation Science, MPT program, ‘with attention to the Academic Coordinator Clinical Education (ACCE), or, alternatively, the Assistant Clinical Coordinator’. If the request is in keeping with the School of Rehabilitation Science, MPT program, policy, the ACCE or Assistant Clinical Coordinator will consult with the clinical facility to determine if approval can be granted. When a decision has been made the ACCE will ensure that all parties (including the student) have been informed, and that a copy of the completed documentation related to the request for absence is placed in the student’s file. 
3. Once a request is approved the student must contact the clinical facility to plan the type and amount of make-up time. This completed make-up time is verified by the Clinical Instructor to the School of Rehabilitation Science, MPT program via the documentation session for this on the final Assessment of Clinical Performance (ACP).

6. Accountability

1. All requests for special absence from clinical practice course time MUST initially be requested by the student to the Clinical Coordinators at the School of Rehabilitation Science, MPT program. The student must not negotiate such requests with the clinical facility before consulting with the School of Rehabilitation Science, MPT program, Clinical Coordinators. Following approval of special requests for absence, there must be consultation, discussion and collaborative planning between the student and the clinical facility regarding the make-up time. As stated above, the plan for make-up time must be communicated to the ACCE or Assistant Clinical Coordinator. The plan must include:
   • the type of activity
   • anticipated dates and
   • anticipated hours of make-up time.
2. The make-up activity must be done at the clinical site whenever possible. However, this will depend on the type of make-up activity. On occasion, ‘off-site’ make-up time (i.e: literature search time) may be approved by the Clinical Instructor.
3. The Clinical Instructor verifies actual make-up time hours completed. This record is included on the Assessment of Clinical Performance instrument (ACP) and submitted to the MPT program via HSP Net submission of the ACP at the end of the placement.

7. Summary

Clinical practice courses required hours of experiential learning is an important standard for attainment of clinical competencies before graduation. Attendance is closely monitored to insure the requisite amount and diversity of clinical learning is achieved for each student.