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RULE §114.30Professional Clinical Residency Requirements

(a) The department will accept a professional clinical residency having standards that are equivalent to or exceed NCOPE standards and those set forth in the Act and this chapter, at the time the residency was being completed.

(b) The Texas licensure requirements in this section apply only to residencies and residency programs fulfilled or conducted in Texas.

(c) Professional clinical residency programs must meet or exceed current NCOPE standards.

(d) The resident's involvement in patient care must meet or exceed current NCOPE standards.

(e) A clinical resident must be directly involved in providing patient care, under the supervision of a Texas licensed practitioner whose license is in the same discipline in which the professional clinical residency is being completed.

(f) Notwithstanding the supervision requirements in this section, the department may establish procedures, processes, and mechanisms for the monitoring and reporting of the supervision requirements.

(g) A professional clinical residency must provide the residents with a written description of the educational program, including the scope and duration of assignments to other facilities if part of the residency. The written description of the program must demonstrate equivalency to NCOPE requirements and must include:

  (1) the term of residency;

  (2) job description;

  (3) pertinent policies and procedures;

  (4) safety requirements;

  (5) patient confidentiality;

  (6) liability and malpractice insurance;

  (7) expectations;

  (8) limitations and restrictions of residency;

  (9) the name of the practitioner who is designated as the residency program director; and

  (10) the requirement under the Act to hold a current student registration during the term of the residency.

(h) Facility requirements. A facility offering a professional clinical residency program must:

  (1) be accredited by the department unless the facility is one to which the accreditation requirement does not apply in accordance with §605.260(e) of the Act;

  (2) have the resources and adequate facilities for residents to fulfill their education and patient care responsibilities;

  (3) have resources and adequate facilities for residents to develop proficiency in laboratory skills in prosthetic and orthotic fabrication; and

  (4) meet current NCOPE requirements.

(i) Responsibilities of the residency program director.

  (1) Each residency program director must meet the current NCOPE requirements.

  (2) The prosthetic and orthotic supervising licensee-to-resident ratio shall not exceed one Texas licensed practitioner to two residents.

  (3) The program director shall maintain documentation of residents' agreements.

  (4) The program director shall ensure that residents hold a current student registration during the term of the residency.

  (5) The program director shall supervise residents during patient care.

    (A) Direct supervision of the following is required:

      (i) critical care events;

      (ii) the fitting and delivery process; and

      (iii) ancillary patient care services.

    (B) The supervising practitioner shall review and sign off on patient care notes made by the clinical resident, and review all clinical records, within ten working days.

    (C) Indirect supervision of clinical procedures, except critical care events, is permitted.

    (D) Supervision shall be provided by a practitioner licensed in Texas in the discipline being taught.

    (E) Overall assurance of quality patient care is the ultimate responsibility of the supervising practitioner.

  (6) Evaluation of a resident's ability to assume graded and increasing responsibility for patient care must be completed quarterly. This determination is the residency program director's responsibility, in consultation with members of the teaching staff. The facility administration shall assure that, through the residency program director and staff, each program:

    (A) evaluates the knowledge, skills and professional growth of its residents, at least quarterly;

    (B) provides to residents a written assessment of their performance quarterly; and

    (C) maintains written evaluations on department-approved forms, as part of the performance record for each resident. The performance record of each resident shall be available to that resident.

(j) Resident responsibilities and qualifications.

  (1) The resident shall participate in safe, effective and compassionate patient care under supervision commensurate with his or her level of advancement and responsibility.

  (2) The resident must hold a student registration issued under the Act.

  (3) After completing the clinical residency, a registered student may continue to work as a resident under supervision in accordance with the applicable requirements of §114.30.

(k) Residency objectives.

  (1) Clinical assessment. Upon completion of a residency, a person must be proficient in current NCOPE requirements, including clinical assessment skills for an individual requiring prosthetic or orthotic services as demonstrated by the ability to:

    (A) obtain a history of the patient to determine the need for a specific device by interviewing the patient, and others, if necessary, and/or by reviewing available records;

    (B) observe gait, coordination, present device if available and other physical characteristics to supplement patient history and physical examination;

    (C) examine the patient to determine skin condition, joint range of motion and muscle strength;

    (D) assess the specific needs of individual patients by integrating the information obtained from history, examination and observation;

    (E) discuss with the patient his or her needs and expectations;

    (F) provide information to the patient, family and involved health professionals regarding a device's potential advantages and disadvantages to assure understanding of the treatment plan and cooperation of the individuals involved;

    (G) develop a treatment protocol for patients by review of data obtained to determine a specific device recommendation and plan for its use; and

    (H) obtain and accurately record appropriate measurements and other data from the patient to design the recommended device.

  (2) Patient management. Upon completion of a residency, a person must be proficient in patient management skills under current NCOPE requirements for prosthetic or orthotic patients as displayed by the ability to:

    (A) measure a patient by using proper instruments and tests. Compile data to be used in device design and fabrication;

    (B) manipulate the patient's limbs to provide correction, position or deformation to obtain the most appropriate information;

    (C) replicate the patient's body or limbs to obtain an accurate anatomical impression to be used in fabricating a prosthesis or orthosis;

    (D) achieve optimum comfort, function and cosmesis by using proper fitting techniques;

    (E) visually evaluate if a patient's gait has achieved optimum prosthetic or orthotic function;

    (F) achieve optimum alignment and function of a patient's prosthesis or orthosis by evaluating the sagittal, transverse and coronal planes;

    (G) maintain proper documentation of the patient's treatment history through established recordkeeping techniques; and

    (H) provide ongoing patient care to assure continued proper fit and function of the prosthesis or orthosis.

(l) Completion of residency. The residency program director shall certify that a resident has successfully completed the residency only if the residency was conducted in accordance with this section.

Source Note: The provisions of this §114.30 adopted to be effective October 1, 2016, 41 TexReg 4467; amended to be effective September 1, 2018, 43 TexReg 5362

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