Title: KIN 492 Proposal – Springer Prosthetic and Orthotic Services, Inc.

Student: Jane Doe

Internship Site: Springer Prosthetic and Orthotic Services, Inc.

Site Supervisor: Joseph Smith, Co-Owner, Certified Prosthetist (CP), John Issac, Co-Owner, CP

General Objectives:

1) Acquire skills and understanding relating to the technical aspects of the prosthetic field.

2) Gain perspective on the clinical side of the field, including patient interaction and assessment.

Specific Objectives from General Objective #1 / Implementation Plan / Assessment Plan (I will be assessed on all specific objectives by my supervisor using the scale on page 3 at the midpoint and end of my internship hours)
1a / Learn to fabricate test socket from plaster mold of residual limb. / I will observe Mr. Smith and Mr. Issac, both registered prosthetic technicians, as they fabricate test sockets and prepare them for use by the patient. I will then attempt to fabricate my own test socket and use the verbal feedback provided to me to improve on my ability to fabricate test sockets. / Mr. Smith and Mr. Issac will evaluate me on my ability to fabricate a test socket from the plaster mold of a residual limb (first step draw of plastic).
1b / Gain experience preparing a test socket for static test by the patient using sanding belt, router, and acetone. / Mr. Smith and Mr. Issac will guide me through the proper techniques of using various equipment to complete test sockets. I will ask questions as they arise, and will attempt to prepare my own test socket for static test by the patient using sanding, router, and acetone. / Mr. Smith and Mr. Issac will evaluate me on my ability to prepare a test socket for static test by the patient using sanding, router, and acetone.
1c / Understand how various locking and foot components work and which are used for various prosthetic set ups. / I will assist Mr. Smith and Mr. Issac throughout the fabrication process, not only to learn the established procedure, but also a few ‘tricks of the trade.’ I will also ask questions for clarification, and engage in any processes I am allowed and able. / Mr. Smith and Mr. Issac will evaluate me on my understanding of the various locking and foot components as well as my understanding of which are used for various prosthetic set ups.
1d / Learn how alterations are made to test sockets. / I will observe alterations made to test sockets based on practitioner notes and markings. I will make alterations to test sockets if I am allowed and able. / Mr. Smith and Mr. Issac will evaluate me on my understanding/ability to make alterations for the comfort of a patient.
1e / Learn process of lamination for definitive prostheses. / I will observe Mr. Smith and Mr. Issac as they laminate prostheses and will try it myself once I have progressed enough. / Mr. Smith and Mr. Issac will evaluate me on my ability to laminate and understanding of the lamination process.
1f / Understand how to align prosthesis based on the patient’s comfortable standing position and gait. / I will observe Mr. Smith and Mr. Issac as they construct definitive prostheses based on the test socket, alterations by Mr. Springer, and the wishes of the patient. I will ask questions for clarification. / Mr. Smith and Mr. Issac will evaluate me on my ability and understanding of how to align a prosthesis based on the patient’s comfortable standing position and gait.
Specific Objectives from General Objective #2
2a / Learn how to appropriately and professionally interact with patients. / I will observe practitioner-patient interaction in order to gain appreciation of appropriate interactional techniques. I will ask questions of my supervisors if I am uncertain what is appropriate. / Mr. Smith and Mr. Issac will evaluate me on my ability to professionally and appropriately interact with patients.
2b / Learn procedure and technique for casting residual limb of the patient in a way that will give the socket the best fit. / I will observe Mr. Smith and Mr. Issac as they construct definitive prostheses based on the test socket, alterations by Mr. Springer, and the wishes of the patient. I will not be allowed to cast my own residual limb, so I will be sure to ask lots of questions and take notes on the process. / Mr. Smith and Mr. Issac will evaluate me on knowledge of the procedure and technique to cast a residual limb of a patient that will allow give the socket the best fit.
2c / Understand process of static and dynamic testing of a test socket. / I will observe Mr. Springer as he completes casts of residual limbs and completes static and dynamic tests of the test socket in preparation for the definitive prosthesis. I will take notes and ask lots of questions as information arises. / Mr. Smith and Mr. Issac will evaluate me on my knowledge and understanding of the process of static and dynamic testing of a test socket.
2d / Become proficient at filling out a patient’s chart during an appointment. / I will observe Mr. Smith and Mr. Springer as they are filling out a patients chart during an appointment. I will attempt to fill out my own patient charts at the same time and compare notes with my supervisor to ensure I did it correctly. / Mr. Smith and Mr. Issac will evaluate me on my ability to proficiently fill out a patient’s chart during an appointment.

Other Internship Assessments outside of my personal specific learning objectives:

1. My internship requires that I take a quiz at the beginning of training to ensure I understand the safety issues around fabricating test sockets. The quiz is out of 10 points and I require an 80% to pass and therefore be allowed to handle equipment.

2. My internship site requires that I build a test socket. This test socket will be judged by my supervisor on the quality of the overall work, and informally my supervisor will verbally discuss with me some of the benefits and drawbacks of my technique throughout the semester.

Personal Objectives Scale Supervisor please circle one of the following: Midpoint or Final

Please circle the number that corresponds to your intern’s present ability level, and provide constructive comments as needed/desired. Their rating on this scale will NOT affect their overall grade in this course, but is meant to be used as formative feedback.

Specific Objectives / Unacceptable Performance (1) / Developing Performance (2) / Strong Performance (3) / Model Performance (4) / Supervisor Comments
1a: Test socket-Draw of plastic / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
1b: Test Socket-Preparations, Sanding, Router, Acetone / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
1c: Knowledge of locking and foot components / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
1d: Test Socket- alterations / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
1e: Lamination process / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
1f: Alignment of prostheses based on individual patient / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
2a: Patient Interaction / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
2b: Procedural understanding and technique for casting a residual limb / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
2c: Test socket - Knowledge of static and dynamic testing / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:
2d: Patient charting / 1 / 2 / 3 / 4 / Area for improvement:
Next steps:

Signatures:

[Joseph Springer] ______[John Issac] ______[Jane Doe] ______