Students must be supervised by a licensed physical therapist any time the student is providing direct (hands-on) patient care. Each state has different licensure laws governing the practice of Physical Therapy, and may provide more stringent guidelines than those outlined here. In such cases, state law supersedes Division or University governance, and must be adhered to by all parties. In addition, certain payers (e.g. Medicare) may have specific restrictions regarding student supervision.
- Whenever a student is providing direct patient care, the student must have the direct supervision of a licensed physical therapist.
- Direct patient care means care that involves hands-on examination; developing an evaluation, diagnosis/prognosis, or treatment plan; hands-on intervention; or providing patient/family instruction.
- Direct supervision means that the supervising physical therapist is physically present and immediately available for direction and supervision. The supervising physical therapist will have direct contact with the patient during each visit. (APTA, House of Delegates 06-00-18-30)
- A patient visit is defined as all encounters with a patient in a 24 hour period (APTA, Guide to Physical Therapist Practice)
At no time may a student provide direct patient care without a physical therapist on the premises.
- The supervising physical therapist shall determine the intensity of supervision needed, based on:
- The needs and the acuity of the patient(s) involved.
- The level of training of the student.
- The physical therapist's judgment of the student's ability to provide safe and effective care, based on direct observation and assessment of the student's knowledge, clinical skills, and interpersonal skills.
According to APTA policy, it is always the physical therapist's responsibility to decide what care may be delegated, and how much supervision is required, when delegating such care to others (APTA House of Delegates 06-00-16-27).
The supervising therapist may decide that the student can:
- Observe only
- Participate in portions of the care with direct, constant supervision and feedback
- Provide a complete examination or intervention with constant supervision (the therapist is always within sight of the student and patient)
- Provide examination or intervention with the supervising therapist readily available for questions or guidance; the physical therapist consults with the patient and student at each visit.
- All patient care documentation written by the student must be reviewed and cosigned by the supervising physical therapist.
- Students may be assigned to provide patient care in conjunction with, or delegate care to, a physical therapist assistant (PTA). Such learning opportunities are important for the student to learn how the PTA is involved in the management of care. If the student is assigned to work with/delegate to a PTA, supervision by a licensed physical therapist must be provided as outlined in items #1, #2, and #3 above.
- Students may be assigned to work with other PT students, or with PTA students. In such cases, the students should be supervised as outlined in items #1, #2, #3, and #4 above.
- If a student is providing instruction to PTs, other health care providers, or community groups, the supervising physical therapist must (at a minimum) review the content and organization of the session prior to delivery. The supervising therapist may, as outlined in #2 above, deem that the student needs direct supervision and provide such if needed.
- Students may be assigned to observe other health care providers as part of the educational experience. Such experiences are valuable opportunities for the student to learn the scope and roles of other professions. Other providers the student might observe include, but aren't limited to, physical therapist assistants, occupational therapists, occupational therapist assistants, speech therapists, physicians, social workers, nurses, etc. If the student is only observing these other providers (i.e. NOT providing patient care as outlined in #1 above), direct supervision of the physical therapist is not required.