Completing Practice Experience Paperwork

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Completing Practice Experience Paperwork

• Saint Louis University
• School of Public Health
• Community Health Practice Experience Program

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Goals of Practice Experience Paperwork

• Document practice experience
• Evaluate students experience based on public
  health competencies
• Give guidance to faculty and future students on
  practice experiences and preceptors

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Steps to Your Practice Experience

• Explore opportunities
• IRB/HIPAA Training
• Meet with potential preceptor(s) and obtain
  description of possible internship(s)
• Obtain approval of practice experience faculty
  advisor before accepting or finalizing plans for
  internship
• Register for CMH 594-01
• Initiate paperwork
• Complete practice experience
• Complete and submit final paperwork

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Web Site for Forms

• Forms for the Practice Experience
• can be downloaded
• from the following page
• on the SPH web site
• http//publichealth.slu.edu/OSD/PracticeExperience
  NewForms.htm

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Student Checklist for Activities (not to be
turned in for student use only)
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List of Required Forms

• Student Self-Evaluation of Experience /
  Competence
• Practice Experience Agreement and Learning Plan
• Practice Experience Timeline
• Guided Progress Reports
• Preceptor Final Practice Experience Evaluation
• Practice Experience Final Poster

FOR MORE INFO...
See Required Forms under MPH Practice
Experience on SPH Website http//publichealth.slu
.edu/OSD/PracticeExperienceNewForms.htm
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Form 1 Student Self-Evaluation of
Experience/Competence

• Part 1 Domains of core public health competence
• Part 2
• Section A Evaluate your experience in ALL
  domains and competencies
• Check under column that best describes your level
  of familiarity with the competency
• Check last column if this is an area you would
  like to gain experience in during your internship
• Section BEvaluate your level of competence
  before beginning the practice experience in ALL
  domains
• Check under column that best describes your
  competence level
• Section CEvaluate your level of competence after
  completing the practice experience in ALL domains
  
• Check under column that best describes your
  competence level

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Student Self-Evaluation Section A
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Student Self-Evaluation Section B
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Form 2 Practice Experience Agreement and
Learning Plan

• Includes
• Brief description of practice experience (or
  attach job description, if provided by preceptor)
  
• Student Self-Evaluation of Experience and
  Competence (Form 1)
• Agreement and Learning plan (Form 2) based on
  competencies you have chosen to focus on for your
  internship
• (use Practice Experience Competency to Activity
  Worksheet ), and specific activities
  for accomplishing your learning plan
• Timeline (Form 3) for practice experience

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Agreement and Learning Plan
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Competency to Activity Worksheet (part of
Agreement Learning Plan)
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Form 3 Practice Experience Timeline

• Two sample timelines provided
• Choose timeline to use based on whether your
  internship is part time or full time
• Open Word document and customize timeline for
  your time frame
• Fill in, at a minimum, approximate dates for the
  following
• Practice experience start and end dates
• General dates for completing each of 10 Progress
  Reports
• Date for mid-point review (you initiate this)
• Date for submitting all final paperwork to
  complete practice experience

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Sample Full Time Timeline
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Part Time Timeline
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Sample Part Time Timeline
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Turn in Initial Paperwork

• Submit initial paperwork (Forms 1, 2 and 3) to
  Practice Experience Coordinator no later than the
  end of the first week of your internship
• Make copies of all paperwork for yourself
• Form 1 (Student Self-Evaluation) will be used
  again for post-internship evaluation
• Form 2 (Agreement Learning Plan) is needed to
  complete Progress Reports
• Form 3 (Timeline) as a reminder of important dates

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Form 4 Guided Progress Report

• Ten (10) of these must be completed during the
  course of the internship (plan times to complete
  them on your timeline)
• These reports are intended as a kind of journal
  an opportunity for you to reflect on your
  experience
• Download Word document and fill in
• Reflect on each competency you are working on at
  least once during the internship
• You may submit the Progress Reports as you write
  them (keep a copy) or turn them in at the end of
  your internship

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Guided Progress Report (example)
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Mid-Point Review

• You are responsible for initiating the mid-point
  review of the practice experience with your
  preceptor and your practice experience faculty
  advisor (and/or practice experience coordinator)
• Plan time to complete this on your timeline
• Review will take about 20-30 minutes and can be
  done in person or by conference call
• Contact all persons involved and coordinate
  possible times
• Midpoint review will be documented by the SPH
  faculty or staff member

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Final Paperwork

• At the end of your practice experience turn in
  the following
• Form 1 Student Self-Evaluation
• Complete Section C post experience evaluation
• Form 4 Ten Guided Progress Reports
• Unless you have been submitting them throughout
  your internship
• Form 5 Preceptor Final Practice Experience
  Evaluation
• Give a paper or electronic copy of this form to
  your preceptor to complete
• Form 6 Practice Experience Final Poster
• Poster is to be all on one PowerPoint slide (see
  example)
• You do not need to print the poster itself just
  turn in the slide
• Download the poster template and fill in with
  content from your internship
• Refer to your Progress Reports for the sections
  on challenges and accomplishments and competencies

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Student Self-Evaluation Post-Practice Experience
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Preceptor Final Practice Experience Evaluation
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Final Poster Template
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Final Poster example
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