FINAL ND Module 09-10.pdf - AaronsWorld.com

TABLE OF CONTENTS
MISSION STATEMENT .......................................................................................................... 2
DEPARTMENT OVERVIEW: NATUROPATHIC MEDICINE .................................................. 2
INTERIM CLINIC..................................................................................................................... 5
GRADUATION REQUIREMENTS .......................................................................................... 6
REGISTRATION FOR CLINIC SHIFTS .................................................................................. 8
COUNSELING SHIFT GUIDELINES FOR ND STUDENTS.................................................. 13
PRECEPTORSHIP PROGRAM ............................................................................................ 15
RESIDENCY PROGRAM...................................................................................................... 19
ACADEMIC ADVISING......................................................................................................... 24
CHARTING/MEDICAL RECORDS ....................................................................................... 25
INTERVIEW GUIDELINES.................................................................................................... 28
GRADING.............................................................................................................................. 29
LEARNING OBJECTIVES FOR SECONDARY CLINICIANS .............................................. 30
LEARNING OBJECTIVES FOR PRIMARY CLINICIANS..................................................... 34
PHYSICAL EXAM GUIDELINES .......................................................................................... 40
UNIVERSITY GLOBAL COMPETENCIES ........................................................................... 44
PRINCIPLES OF NATUROPATHIC MEDICINE ................................................................... 45
THERAPEUTIC ORDER ....................................................................................................... 45
CLINICAL COMPETENCIES ................................................................................................ 46
SPECIAL PROCEDURES/PROTOCOLS ............................................................................. 54
ND COUNSELING CLINICAL COMPETENCIES ................................................................. 61
LABORATORY PROTOCOLS.............................................................................................. 74
APPENDICES ....................................................................................................................... 77
ND PHYSICAL EXAM GUIDELINES FOR CLINICAL COMPETENCIES ............................ 80
1

Mission Statement of the School of Naturopathic Medicine
We educate future naturopathic physicians who care for the health and well-being of their communities
and advance our profession.
Vision Statement of the School of Naturopathic Medicine
The School of Naturopathic Medicine will be a leading academic center for inspired and scholarly
learning in the cultivation of naturopathic doctors. We will accomplish this through education, research,
professional leadership, community and clinical services that bridge the worlds of science, nature and
spirit.
DEPARTMENT OVERVIEW: NATUROPATHIC MEDICINE
The naturopathic clinical program provides training in general naturopathic practice for naturopathic
medical students of Bastyr University. Naturopathic medical students at the Bastyr Center for Natural
Health progress through their training in observing, supporting, and then managing roles. Each role
assumes increasing responsibility for provision of patient care. Prior to graduation, students are able to
safely, competently, and efficiently direct all aspects of patient diagnosis, treatment and management
in a general care setting. This training includes integration of philosophy into practice and treatment
modalities including physical medicine, homeopathy, botanical medicine, nutrition and counseling.
Emerging from naturopathic clinical training, each clinician will exemplify the integration of
traditional naturopathic philosophy and principles of healing with conventional medical knowledge
and skills. At the core of this integration is the self-reflective approach to life-long learning that allows
clinicians to provide the highest quality of care.
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PROCEDURAL SECTION
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CLINICAL REQUIREMENTS
ATTENDANCE REQUIREMENTS
Student clinicians are required to attend at least 80 percent of each assigned quarterly shift in order to
receive a grade of achieved competency for the quarterly shift. Exceptional circumstances resulting in
additional absence for educational purposes may be approved at the discretion of the supervisor.
The supervisor is not required to grant exception to the policy, and will determine permission based on
student participation and performance on the shift. The hours for ALL absences must be made up.
Holidays and emergency closures do not count against the total quarter’s attendance, but the
missed hours must still be made up. A student must demonstrate competence in their weekly
performance in order to obtain a passing grade. A student missing more than the number of approved
absences for the quarterly weekly shifts will receive a grade of failure for the quarter. A grade of
failure for a quarterly shift means the student will lose all hours and patient contacts for that shift, and
the entire quarterly shift will need to be repeated. Please note that 100 percent of students’ required
clinical hours must be completed before recommendation for graduation.
Students who arrive more than 30 minutes late for their assigned shift will receive a written warning
for a first event and need to make up missed time. Students will receive a clinic sanction for a second
event in the same quarter. (For more information, please see the sanctions section.)
EXCUSED ABSENCES
It is the responsibility of every student clinician to inform their assigned supervisor of any absence
from the center prior to that absence. Notification of a supervisor of an absence after a daily shift has
begun may result in the absence being designated an unexcused absence.
For planned absences:
1. Fill out the bottom portion of the form titled “absence/substitution form—student clinician.” A
separate form must be completed for each shift you will miss. A sample of this form is included in
the appendix.
2. Have the supervisor sign in the appropriate space.
3. Primary ND clinicians must secure a substitute to cover their shift and the substitute must sign
the form as well.
4. Student substitutes on counseling shifts is at the discretion of the supervisor. Students must
check with the supervisor in advance of the projected absence, and the need to arrange a substitute
5. Primary clinicians are also responsible for contacting the patients who are coming in specifically
to see them. Patient phone numbers can be obtained by requesting the patient’s chart. If the phone
number listed is incorrect, clinicians may check with the front desk for phone numbers listed in the
computer. Ask patients to contact the front desk if they wish to reschedule their appointments.
Primary clinicians must also notify the secondary/observation clinicians of their absence.
6. Secondary/observation clinicians must also secure a substitute to cover shifts, if possible, and the
substitute must sign the form. In addition, secondary clinicians must notify the primary student
clinician on their shift of their absence.
7. Once the form is completed, submit it to the faculty administrative assistant in S206. The form
will be retained through the quarter for future reference. Students should provide an email or
written copy of the absence form to their substitute clinician before turning in the form.
8. Students who are unable to attend their scheduled shifts during the first week of a quarter must
complete and turn in a form prior to the date of the absence. A student will automatically be given
a grade of failure and dropped from the shift if no arrangements are made with the supervisor by
the second week of the quarter.
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UNEXCUSED ABSENCES
An unexcused absence occurs when a student fails to notify the shift supervisor of their absence prior
to the start of the shift. This includes the circumstance of a substitute clinician who signs to cover a
shift and does not show up for the shift.
The first unexcused absence during a term will result in the student clinician being required to
complete makeup hours for the missed shift (4 hours) with the additional sanction of a penalty of two
makeup shifts (8 hours) for a total of 12 hours.
A second unexcused absence will result in an F grade for the quarter shift and the loss of all hours and
contacts earned during the quarter. If the absent student is a substitute clinician, they may be
subject to a higher hourly penalty for not showing up for the shift.
Supervising clinical faculty members may, at their discretion, accept notification of an absence after
the start of the clinic shift in the event of an emergency. The student will need to provide
documentation. Even if the student calls the supervising clinical faculty member immediately prior to
the missed shift, the supervisor reserves the right to define the missed shift as unexcused absence and
assign sanctions.
Midwifery students must have a substitute available on an “immediate-notice” basis for all shifts
missed due to their attendance at a birth. Sanctions will be assigned for any shifts missed for a birth
without appropriate back-up in place.
INCLEMENT WEATHER POLICY-See global handbook
INTERIM CLINIC
Interim clinic is the time during which the clinic operates and no academic courses are offered.
Students will be responsible for interim clinic shifts during the same days/times they were scheduled
for shifts during the preceding quarter. Absence requests must be approved by the student’s supervisor
and submitted two weeks prior to the start of the interim period. Interim clinic occurs at the end of each
quarter, allowing the center to provide on-going care to patients during academic breaks.
Students are RESPONSIBLE FOR SHIFT COVERAGE for their interim shifts and are
required to find substitutes as indicated in the attendance policy.
ND interim clinic requirements for graduation:
Credits: 2 Hours: 44
Hours are to be completed over the course of all weeks of interim clinic. The last opportunity that
June graduates have for obtaining interim clinic hours is at the end of winter quarter, during
spring break.
Note: Students are automatically registered for interim clinic credits (2) during the spring quarter of
their fourth year. This will appear on the registration form as interim patient care.
Interim clinic is currently offered during the following times:
• Winter break, between fall and winter quarter, for 2-3 weeks
• Spring break, between winter and spring quarter, for 1 week
Interim clinic time sheets are tracked on a separate form than regular patient care hours. Patients seen
during interim clinic on patient care shifts are counted in the summary total of patient contacts.
Students should use the “patient summary” form to keep a record of the patient contacts.
Additional interim hours (above 44) can be used to make up shift hour deficits from current or past
quarters. These hours should be tracked on the interim shift form, and patient contacts on the summary
of patient contacts form. At the end of each interim clinic period, all paperwork must be turned in to
the clinic registration staff to receive credit for the work performed. Hours above the required 44 will
automatically be added to your sub and extra hour’s bank.
Any unexcused absence during interim clinic will result in the assignment of sanctions, to include a
requirement to make up the four hours missed plus an additional 8 hours of clinic shifts for each
missed shift for a total of 12 hours. These hours are in addition to the required interim hours for
each program.
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ND/AOM dual-track students need to complete 44 hours of ND interim clinic and 36 hours of AOM
interim clinic.
PLEASE NOTE: Due to calendar changes, interim weeks are subject to change without notice.
Please be advised of this possibility.
GRADUATION REQUIREMENTS
Before graduation, students must:
•Have all clinical competencies completed and documented. Students will not graduate until all
requirements have been met and the clinical faculty has recommended the student for graduation.
•Complete all clinical hours, all patient contact requirements, and submit all required paperwork.
•Pass a standardized “clinic exit examination” or OSCE. This exam will be offered before spring
quarter during a student’s final year in clinic. Students will be given the opportunity to remediate
this exam one time if they fail to pass. If they fail the exam a second time, the student will be
referred to the student progress committee. The exam is offered once a year at a designated time
between clinical quarters or during winter quarter. The student must participate in the exam at this
time in order to graduate.
The following is a summary of specific requirements that need to be met in order to graduate and be
eligible to take board examination:
SUMMARY:
Total number of shifts: 21 clinic shifts
Total number of hours: 1,224.5 (includes patient care, 132 hours preceptor, and interim clinic)
Total number of patient contacts: 350
Pass OSCE Exam: 1
GRADUATION ROTATION/SHIFT REQUIREMENTS
Total number of rotations/shifts:
•21 clinic rotations/shifts which includes 17 general patient care and 4 Physical medicine
shifts. General patient care shifts include one mandatory counseling shift. A student may
include one additional counseling shift and/or up to four homeopathy shifts as long as they
exhibit competence in their general patient care shifts.
•3 Clinical Laboratory Diagnosis with Labs
•3 Preceptor Rotations/Shifts
•44 hours of Interim patient care-currently available only during winter and spring breaks.
Required for clinical laboratory diagnosis:
•One lab rotation (3 quarters of lab portion of the Clinical Lab Diagnosis course)
•99 hours, including class
•This lab rotation occurs on campus
Interim clinic requirements:
•All 44 hours must be completed in patient care and/or physical medicine
•Interim clinic is part of your quarterly shift requirement. Students must attend the same
weekly shifts as scheduled the preceding quarter. Unapproved absences during interim will
result in a requirement to make up the four hours missed plus an additional 8 hours of clinic
shift time in addition to the interim hours requirement. A second violation results in failure of
the quarterly shift with loss of all hours and contacts.
• Students are required to complete the interim hours before the spring quarter of their
graduating year. There is no interim clinic between spring and summer quarter.
•An AC for interim depends upon successful completion of all required interim hourly shifts.
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2. HOUR REQUIREMENTS
Clinic Entry I and II 25.5
Patient care hours 924
Lab rotation 99
Preceptor hours 132
Interim clinic hours 44
Total Hours 1,224.5
3. CREDIT REQUIREMENTS
Clinic entry I and II 2
Patient care shifts 42
Clinical lab diagnosis 9 (including class)
Preceptor shifts 3
Interim clinic 2
4. PATIENT CONTACTS REQUIRED
Total number of patient contacts: 350
This includes patients seen in the 21 patient care shifts (homeopathy, counseling, physical medicine,
substitute and extra hours, and interim). A minimum of 175 must be primary contacts. This does not
include patient contacts gained in preceptor. This averages 16.7 patients for each shift.
MEDICAL RECORDS
Filing Forms in the Medical Record (Proper Placement) Patient records are divided into four
sections: Front-Left; Front-Right; Back-Left; & Back-Right. Location for each form is below.
Front-Left (from bottom to top)
(Referrals)
Authorization to Bill Third-Party Payer
Acknowledgement of Receipt for Notice of Privacy Practices
(Any specialty consent forms or authorization forms)
Consent for Treatment
Observation and Imaging Consent Form
Patient Information Form (PIF)
Patient Profile
Pediatric/Adult Health Data Sheet
Supplement and Medication List
Patient Visit Summary
Patient Intra-Clinic Referral Form
Front-Right (Forms in this section are always filed in chronological order with most recent
documentation on top. Documentation for the same DOS should be filed with progress notes on
the top and copies of prescriptions, herbal formulas and treatment plans on the bottom.)
Initial Consultation and Interview Form
Progress Notes for FOC and ROC visits
Prescriptions and Herbal Formulas (copies)
Treatment Plans and Instructions (copies)
(other reference information given to patient-noted by name on treatment plan)
Referral Letters/Other Correspondence
Diet Diaries (and other information, except outside hardcopy medical records provided by patient)
Back-Left (from bottom to top)
Notices of Disclosures
Labs and Referred Procedures (most recent on top)
Back-Right (in chronological order with most recently received information on top)
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Copies of Authorization Forms for Releases Processed
Copies of authorization forms for pending incoming record requests
Outside Medical Records (copies of records received from other practitioners)
REGISTRAR
REGISTRATION FOR CLINIC SHIFTS - GENERAL NFORMATION
1. To register for clinic shifts, students must first register with the academic registration staff.
2. After viewing the faculty schedule, all students will submit to clinic registration staff their
requests for supervisors and shift times for the upcoming year before the registration deadline.
These requests must align with the student’s assigned academic track and course schedule.
3. The clinic registration staff coordinates registration for clinic shifts. They attempt to meet
students’ requests when scheduling shifts but this cannot be guaranteed.
4. Student clinician pairings are subject to final approval of the program and associate dean(s).
5. The completed schedule is approved by the clinic associate dean for naturopathic medicine.
Changes to the student's schedule after the registration date will only be allowed documented
family or medical emergencies. Documentation is required.
6. No student in any program may have more than two shifts in one day. Shift times may not
overlap with other shifts or courses. An adequate amount of time must be maintained for travel
between the clinic, campus and external site locations.
7. It is important to note that the assigned academic track for students and assigned clinic shifts
for all students are not amenable to changes necessitated by other considerations such as outside
employment schedules, child care schedules, etc. It is, therefore, incumbent upon every student to
make whatever arrangements are necessary in order to accommodate his or her assigned academic
and clinic schedules.
8. Students may only withdraw from the clinic if they have a verifiable emergency. They must
obtain a letter signed by the program dean or their designate approving this withdrawal.
9. Information on interim clinic registration is in the interim clinic section of this handbook.
10. Students may register for clinic elective shifts or observation shifts in other programs, on a
space available basis.
ADDITIONAL INFORMATION FOR ND REGISTRATION
The goal is to have a primary and secondary student clinician in each room in general patient care,
homeopathy and counseling; and to have three to four primary and three to four secondary student
clinicians on each physical medicine shift. There may be co-primary clinicians assigned together.
Note: Co-primary designation does not imply that both clinicians function in the role of primary for
each patient. Students may never share primary patient contacts. Co-primaries alternate taking the role
of primary and secondary clinicians.
Students will have the opportunity to add elective shifts, trade comparable shifts with fellow clinicians,
or drop shifts with a financial penalty, after the initial shift assignment process is completed. More
information is distributed by the registrar’s office prior to the shift change period.
In general, each ND student will be registered for a minimum of two shifts and a maximum of four
shifts per quarter. The only exception to this rule is ND students in their first year at the clinic. They
will have one to two shifts per quarter, with a maximum of six total shifts in that year. Each ND
student will be registered for at least one patient care shift per quarter, which could include one
counseling shift during that year. It is highly recommended that students have at least two shifts in
general patient care before shifting into the primary role.
Primary student clinicians who are also on-call as midwifery interns must be paired with a co-primary
on all ND shifts or have a back-up on immediate call. The co-primary must be informed in advance
and accept the responsibility for last minute coverage if the midwifery intern is called out on a birth
before the midwifery student will be allowed an approved absence for the birth.
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APPOINTMENTS WITH THE CLINIC REGISTRATION STAFF
At least one advising session is required with the clinic registration staff before graduation. It is
recommended that students meet with the clinic registration staff near the beginning of their clinical
experience in order to clarify and understand the clinic education requirements, and to understand how
their progress is tracked each quarter. Each quarter the clinic registration office will provide all
students with a summary of their completed requirements. It is the student’s responsibility to check
the summary for accuracy on a quarterly basis. Additional advising sessions are recommended in
order to stay current with completed and remaining outstanding requirements. Graduating students
are required to meet with the clinic registration staff early in their last year to verify they are on
track for graduation.
Homeopathy:
•Up to 4 general patient care shifts may be taken in homeopathy.
•Homeopathy may also be taken as elective audit shifts and shift requirements must be
followed elective or audit shifts. Additional shifts must be approved by the homeopathy chair.
•Prerequisites must be completed prior to entering a homeopathy shift. Homeopathy classes
1-3 are required prerequisites, and Homeopathy 4 is highly recommended.
•All students who are registered for a homeopathy shift are required to be registered and
participate in Homeopathy Grand Rounds. Other students may enroll in Grand Rounds with
approval of the instructor. Grand Rounds hours do not count as clinical patient care hours.
Physical Medicine Requirements:
•Students must take two physical medicine shifts each year for two clinical years, for a total
of 4 shifts. (see additional shift request info below)
•Only one physical medicine shift should be taken in any quarter.
Registration Requirements by Quarter:
Students must be registered for a minimum of one shift, and a maximum of four shifts, in any quarter
in which they are clinic eligible and enrolled at Bastyr University. Students in their first year of clinic
are allowed to take only six shifts in that year. For an outline of shift assignment per quarter see the
shift requirement chart following. At least one of the assigned quarterly clinic shifts must be a patient
care shift. Students may not be registered for more than two shifts in one day. Students wishing to take
more than four shifts per quarter must submit a written request to the clinical associate dean prior to
registration. Failure to follow recommended shift registration will delay graduation date.
Registration in Additional Shifts:
Students wishing to take additional shifts beyond the maximum number (homeopathy, counseling,
patient care or physical medicine) must submit requests to the clinic registrar and clinical associate
dean at least one month in advance of registration.
EXTERNAL SITE ROTATIONS/SHIFTS
External site clinics fulfill clinic requirements. External sites currently include: Ballard Senior Center,
Consejo Center, Country Doctor, Mary’s Place, Providence Marianwood Senior Center, 45 th St.
Homeless Youth Clinic, Cascade Natural Medicine, West Seattle Teen Clinic, Shoreline Senior Center,
Snohomish Valley Senior Center, Carolyn Downs Clinic and YWCA Women’s Wellness Center.
These sites may change from time to time as the external site program is expanded or modified.
Students are required to take at least one external clinic shift during their clinical training. Clinical
faculty reserve the right to restrict the number of external shifts in which a student participates, if
student progress is in question.
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CLINIC AUDIT OR ELECTIVE SHIFTS
If positions are available, students may take additional clinic shifts as clinical elective or as elective
audit shifts. The clinic registrar should be contacted for information regarding the availability of these
shifts. If you take the shift for elective credit, then the first 36 hours of the shift go towards fulfilling
the elective requirement and may not be used as sub hours. You must complete 36 hours to get an AC
for the shift/class. Any hours over 36 may be used as sub hours. Shifts taken as an elective audit do
not qualify for financial aid but all hours may be used as sub hours. Students are held to the same
standards in attendance and performance as all other shifts.
SHIFT REQUIREMENTS – QUARTERLY BREAKDOWN
For 4-year track and 5-year track option A:
Year/Quarter
Number of Clinic Shifts
Year 3 of 4 or Year 4 of 5:
Summer 1 or 2
Fall 1 or 2
Winter 1 or 2
Spring 1 or 2
Note: no more than 6 shifts total in the first year of any ND track
Year 4 of 4 or Year 5 of 5:
Summer 3-4
Fall 3-4
Winter 3-4
Spring 3-4
For 5-year track, option B: You may choose to begin clinic in summer quarter. This is
recommended for dual track students in Acupuncture or midwifery. If you begin clinic in the fall, you
will become a primary the following year in the fall.
Year/Quarter
Number of Clinic Shifts
Year 3 of 5:
Summer 0
Fall 1-2
Winter 1-2
Spring 1-2
Note: no more than 6 shifts total in the first year of any ND track
Year 4 of 5:
Summer 1-2
Fall 1-2
Winter 1-2
Spring 1-2
Year 5 of 5:
Summer 3-4
Fall 2-3
Winter 2-3
Spring 2-3
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MIDWIFERY
All midwifery student clinicians who are also on-call as midwifery interns must be paired with a coprimary
on all ND shifts. The co-primary must be informed in advance and accept the responsibility
for last minute coverage if the midwifery intern is called out on a birth. If no co-primary is assigned,
the student must have student back up for immediate on-call coverage of their clinical shifts. Only two
daily clinic shifts per quarter may be missed on a quarterly shift. The supervisor has the right to
authorize a third excused absence if individual circumstances warrant that absence. The supervisor is
not obligated to authorize a third absence from a quarterly shift.
If a midwifery student does not have substitution coverage and misses a shift to fulfill duties in the
midwifery program, the hours missed will be counted as an unexcused absence and the student will
incur all sanctions noted in the attendance section of this book. In addition, the chair of the midwifery
department will be notified, and further sanctions may occur in that department.
Midwifery students may use documented hours obtained in the clinical pre-and post-partum exam care
of their birthing clients as sub and extra hours to cover their clinic absences due to births. As these
hours are not used in the midwifery department for credit, this policy does not allow double credit for
the work. These hours do not include birthing hours. No more than 120 hours may be used during a
student’s entire clinical training. The hours must be documented and signed by the midwife preceptor.
These hours must then be co-signed by the associate clinical dean and submitted to the registrar’s
office. No hours will be accepted without the co-signature.
Clinical Training Eligibility
•Naturopathic medicine students must complete and achieve competency in all required Classes
prior to entering clinic. This includes all classes in the 1 st and 2 nd year if on the 4-year track. It
includes all classes of the first 3 years of the 5A track, and first 2 years of the 5B track. Students
must be in good academic standing in order to begin the clinical training portion of the program.
Questions about didactic prerequisites for clinical ND training should be addressed to the
registrar’s office on campus.
•Students need to complete all pre-clinic requirements including: background check; TB test
series; and other immunizations as required by elected external site clinics.
•Students must complete and achieve competency in Clinic Entry II and in the clinic entrance
exam.
•All advanced standing/transfer students must meet all clinical training requirements and be in
good academic standing. Advanced standing students will not be granted waivers of any clinical
training credits, hours or other requirements.
•Students must complete the Medical Procedures Course or have proof of completion of an
equivalent that includes current requirements for professional rescuer’s level CPR training.
Questions about what constitutes an eligible equivalent experience should be addressed to the
Associate Dean or Associate Clinical Dean by email.
•A copy of the current CPR/first aid card, or written approval to substitute equivalent experience
for the course, must be turned in to the clinic registration office on campus.
Please note: Bastyr Center for Natural Health requires that all supervisors and student clinicians be
recertified each year at the level stated above, even when the card issued by the certifying agency
states that the card is valid for a period longer than a year.
•Students must complete a Washington State Patrol (WSP) criminal background check. There is
no charge for this service. Forms will be distributed to all students enrolled in Clinic Entry II.
Forms are also available in the registrar’s office. Questions about the WSP background check
should be addressed to the registrar’s office on campus.
•TB screening and hepatitis immunization forms/waivers will be distributed during the
Physical/Clinical Diagnosis 3 Lab course or in CE II. Students must have completed TB screening.
You must have received the immunization series or signed a waiver for hepatitis B immunization.
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Questions regarding TB screening and hepatitis immunization should be directed to the Associate
Clinical Dean at BCNH.
•A signed clinic contract (appendix 1 of the Student Clinician Handbook global module) must be
turned in to your Clinic Entry II instructor.
•All ND students must complete 20 hours of preceptor observation experience prior to the start
of their first quarter in the clinic. Preceptor packets with full instructions are available from the
preceptor coordinator’s office at the BCNH, or the wall display outside of the registrar’s office on
campus. Questions about Preceptor shifts should be addressed to the preceptor coordinator at the
clinic.
•All ND students must be enrolled in at least one patient care shift during all quarters in which
they are clinic eligible through graduation unless they are on a leave of absence. Exceptions to this
quarterly clinic attendance requirement are reserved for extenuating circumstances. Students who
do not register for clinic every quarter will delay the date of their graduation.
To apply for a leave of absence from the university, contact the registrar’s office.
Clinic registration forms will be placed in the main campus student mailboxes of all students eligible to
enter clinic. The forms must be turned in to the registrar’s office by the deadline listed on the form. If
you are clinic eligible and do not receive a clinic registration form, contact the clinic registration office
immediately.
CLINIC ENTRY COURSES
ND CLINIC ENTRY I
This course is registered and paid for the first quarter of the first year of the four- and five-year track
and is to be completed by the end of spring quarter of the first year.
Credits: 1.0
Hours: 14.5
Course Objectives:
•To provide students with a well-rounded experience as a patient at Bastyr Center for
Natural Health. This course is designed as an experiential class. Students may choose not to
receive the recommended treatment. A student may choose to have a wellness program
designed if they have no specific health concerns.
•To provide students with experience in the medicine they are studying.
•To prepare students for Clinic Entry II, the next prerequisite for entry into the clinic after
achieving competency in CE 1.
•To expose students to basic medical terminology.
Course Requirements:
Attendance at all class meetings: one per quarter and one finals week of the last quarter: 4.0 hr
•First office call: 1.5 hr
•Return office call: 1.0 h
•A return office call in any clinic department: 2.0 hr
•3 counseling sessions at the campus student counseling center: 3.0 hr
•3 case previews: 1.5 hr
•3 case reviews: 1.5 hr
Each student is required to write several short evaluative papers discussing their clinic experience.
These papers are to be turned in to the CE I instructor at the class meetings.
Students will receive a CE I tracking sheet to record the requirements as they are met. It needs to be
initialed and dated at each visit.
The class will meet with the instructor at the end of spring quarter for a final discussion group. Course
tracking sheets and clinic evaluation papers are at this time.
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ND CLINIC ENTRY II
Prerequisites:
•ND Clinic Entry I
•All students must have completed the entire body of course work through the winter quarter
when they become clinic eligible to enroll in Clinic Entry II.
Credits: 1.0
Hours: 3 hrs/week x 3 weeks; 9 hrs + 2 hr exam = 11 total hours
Required Text: Student Clinician Handbook, Global and ND modules
Course Objectives:
•Students will gain a broader understanding of naturopathic medicine as it relates to clinical
practice.
•Students will gain a perspective on clinic purpose, administration and function at BCNH.
•The role of the student clinician will be clearly defined.
•Students will be introduced to skills that will allow them to become familiar with case
management and charting, as performed at Bastyr Center for Natural Health.
•Students will know the role of each person in the clinic structure.
•Students will learn the clinic policies, procedures, and clinical education requirements.
•Students will be exposed to the ethical and moral issues of medicine and clinical practice
and how these issues relate to the clinical experience.
•Students are encouraged to develop and broaden their own personal philosophy of
naturopathic medicine.
Students will be required to pass a clinic entrance practical exam in order to receive an AC in Clinic
Entry II. This exam is structured to allow the student to demonstrate competence in physical exam,
differential diagnosis, laboratory diagnosing, charting, and communication skills.
Students must receive a grade of achieved competency in CE II in order to enter the clinic.
Students must purchase required medical equipment for use in their clinical education.
COUNSELING REQUIREMENTS
COUNSELING SHIFT GUIDELINES FOR ND STUDENTS
Absences: Clinic attendance policies must be followed on all counseling shifts. Students must
complete a Student Clinician Absence/Substitute Form when they will miss a shift. (See counseling
substitute policy below) All missed counseling shift hours must be made up to receive credit. Students
are encouraged to make up these hours on a counseling shift, but hours can be made up on any regular
clinic shift. The requirement for student substitutes on counseling shifts is at the discretion of the
supervisor. Substitutes may be necessary if two or more other students from the same shift have
already obtained permission to be absent for the same day. Students must check with the supervisor in
advance for approval of the projected absence, and the potential need to arrange for a substitute
External Counseling Shifts: When available, these shifts can be elected by student clinicians who
have finished their first counseling shift at BCNH.
Interim Shifts: Interim counseling shifts are required for those clinicians currently on a counseling
shift. They are also available to those needing to make up any previous counseling absences.
Second Shift Requests: Students wishing to take a second shift may do so depending upon the
availability of openings. Students should sign up through the registrar’s office. Counseling Shift
Assignments: Students will be randomly assigned a counseling shift, during their first clinical year,
and must take the shift during the quarter assigned.
Interaction Between BCNH and Student Counseling Center on Campus: Students as clients
should have the choice of seeing a counselor at either the Student Counseling Center on Campus or at
BCNH, but not both.
13

Students cannot receive counseling from their current clinical supervisors.
Neither staff nor student trainees are allowed to self-refer to their private practices. Referrals may be
made to other clinicians in the community.
PRECEPTORSHIP
Advanced Preceptor Shift in Lieu of Patient Care Shift
A student may request an advanced preceptor shift in place of a regularly scheduled patient care shift if
they have met the requirements below:
• All 132 hours (3 credits) of the required preceptor hours must be completed, submitted and on
the student transcript.
• Eleven patient care shifts must be completed with a grade of achieved competency for each.
Physical medicine shifts cannot be included in this count.
• The student must be in good academic standing
• The site must be pre-approved through the preceptor coordinator.
• The site must offer hands-on patient care experience that is comparable to what would be
obtained in the Bastyr Natural Health Clinic.
The site must provide evaluation on standard clinic evaluation forms.
All student requests for advanced preceptor shifts must be typewritten and submitted to the Associate
Clinical Dean. Email submission is acceptable. The request must include:
• Your purpose in requesting the shift that defines the skills or knowledge you will obtain at the
designated site.
• Information stating that all requirements listed above are met.
• The name, address and contact information of the external clinic site and supervising clinician
or program manager.
• The number of hours to be completed. Each shift must be equivalent to 44 hours.
• Each advanced preceptor shift must be requested independently.
• A maximum of two shifts is allowed. They may be taken at one facility and with one
supervisor or at two sites with two supervisors.
• A letter from the supervising physician that outlines the nature and extent of hands-on
experience and skills the student will obtain. It should also outline the number of contact hours,
estimated number of patients, and a description of the active supervision and management the
student will receive from the supervisor.
All the above elements must be present for the site to qualify as an advanced preceptor site. The
Associate Clinical Dean will review the student’s request with clinical faculty. The student will be
notified of the outcome in writing or by email.
If the site is approved, the associate clinical dean will notify the clinic registrar. The student will be
advised and must complete the required paperwork.
All external clinic shifts must be registered and paid for as a general patient care shift (2 credits per
shift/44 hours). Hours completed above the 44 hours cannot be used as substitution or extra hours.
Students must keep careful records of the patient contacts during the external shift. The summary of
patient contacts and hours form must be completed by the preceptor and submitted to the clinic
registrar at the end of the shift for grading. The associate dean and preceptor program coordinator
should be notified at the end of the shift so that a thank you note may be sent to the preceptor.
14

PRECEPTOR
BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
STUDENT PACKET
Preceptorships provide students with the opportunity to observe established health care practitioners in
their private practice or other community settings. These experiences offer many benefits to
complement the clinical training received on patient care shifts. By preceptoring, students are able to
observe a variety of physician-patient communication styles, therapeutic modalities and clinical
conditions, as well as day-to-day business practices. Additionally, many preceptors offer advanced
students hands-on experience with their patients.
ND Preceptorship graduation requirements are as follows:
1. A total of 132 hours (3 credits) of documented preceptorship experience.
2. At least 88 preceptorship hours must be spent with an ND.
3. You may have up to 44 hours credited with non-ND practitioners.
4. You must precept at a minimum of 3 different sites/locations.
5. A minimum of 20 hours are required at any given site.
6. You may precept with more than one pre-approved preceptor at one site/location as long you
earn at least 20 hours AND you go to at least 3 different sites overall.
7. You must complete 20 hours prior to beginning clinic shifts.
8. Pre-clinic training preceptorships are limited to 40 credited hours.
Finding and Setting up Preceptorships:
There are many practitioners who have already volunteered to be preceptors for Bastyr ND students,
and students are always encouraged to develop new sites. We have NDs, MDs, chiropractors,
acupuncturists, homeopaths, osteopaths, nurse practitioners and more. You may precept in the Seattle
area and/or in other states, provinces and countries. You may precept during the school year and/or
during official school breaks.
There are different ways to learn about ND preceptorship opportunities. Many students hear about
preceptors from other students, a wonderful natural referral system! You are also invited to contact the
ND Preceptor Coordinator for suggestions and information about site placements as well as other aspects
of the preceptorship program. There is also a Preceptor Information Site available on the Bastyr
Intranet at the Center and Campus, which you can access through Internet Explorer at
http://precept/. Here you can browse and search for pre-approved preceptors by different criteria,
including name, credentials (e.g. ND, LAc, MD etc), specialties, location, and student class level
accepted.
Before contacting a preceptor, review their information page for any special requirements and
opportunities, as well as the appropriate contact person for requesting a preceptorship. Keep in mind
that, although approved preceptors have volunteered to precept Bastyr ND students, they are not
required to accept a certain number of students. Unless noted otherwise, the student is responsible for
arranging a schedule that works for both you and your preceptor. It is wise to plan ahead and be as
flexible as possible with your schedule.
If you know of a practitioner who you think has accepted students in the past but do not find him/her
listed on the Information Site, please contact the ND Preceptor Coordinator. If you would like to suggest
a new preceptor, you may either contact the ND Preceptor Coordinator or give a Preceptor Application
packet directly to the prospective practitioner. Application packets are available outside the ND
Preceptorship office at the clinic and outside the Registrar’s office on campus. Please note that ALL
NEW PRECEPTORS (practitioners) MUST BE APPROVED BEFORE YOU BEGIN YOUR PRECEPTORSHIP in
order to receive credit and insure professional liability coverage. Also, please note that individual
practitioners are approved as preceptors so this does not necessarily mean that all practitioners at a
particular clinic/site participate in our program. If in doubt, please check with the ND Preceptor
Coordinator before starting a preceptorship.
Paperwork and Documentation:
The Student Packet contains the following forms: ND Student’s Preceptorship Evaluation, ND Student’s
Clinical Timesheet and ND Student’s Patient Contacts. You must submit a full packet for each
preceptorship that you complete. For your benefit, you should complete the learning objective portion
of the ND Student’s Preceptorship Evaluation prior to starting your experience. However, this form is
15

not submitted until you finish your preceptorship and complete the remaining evaluation portion. All
forms are submitted at the same time ---- at the end of your preceptorship.
Please keep track of your hours and patient contacts on the forms provided. Your preceptor needs to
initial each day’s hours and patient contacts as well as sign the timesheet. When you finish a
preceptorship, double check that you and the preceptor have signed and dated all forms, make copies of
all forms for your own records and submit originals to the ND Preceptorship office. Please submit
completed packets within a month of completion. DO not wait until just before graduation to submit
your forms or your graduation date could be delayed. You can drop off packets, or send them through
interdepartmental mail or the regular mail to the address below. After your paperwork is processed, you
will receive, in your student mailbox, a printout of your total hours and patient contacts to date. This
information is forwarded to the Registrar to be added to your transcript.
The university has a blood born pathogen exposure incident policy in place in the unlikely event of
your exposure to a blood born pathogen while at a preceptor site. Please note that the policy is in
effect whether you are precepting in the Seattle metro area or another state, country or province.
Some sites may have their own policy in place, and if so, you should follow their policy and check in
with the blood born pathogen officer or counselor for follow up as soon as you return to the university.
A counselor may be reached 24 hours a day by calling the resident on call at (206) 200-7067. All
information on an incident or exposure is completely confidential and will not affect your standing in
the program.
All of our preceptors have graciously opened up their practice to help students get a broader view of the practice of medicine. Be sure to
acknowledge your preceptor’s time and generosity!
For more information, please contact:
Martha Diehl, ND Preceptor Coordinator
Office of Graduate and Community Medicine
Room 326
Bastyr Center for Natural Health
1307 N 45th Street
Seattle, WA 98103
Phone 206.834.4103
FAX 206.834.4107
mdiehl@bastyr.edu
revised 8/1/05
Additional Student Packets and Preceptor Applications are available outside the Registrar’s office on campus
and outside the ND Preceptorship office at the clinic.
16

BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
ND Student’s Preceptorship Evaluation
Name of Student: _____________________________________________________________________
Telephone Number: _______________________ Anticipated Graduation (Quarter/Year): ____________
Current Class Level (e.g. 2nd/4th): ____________Clinic Entry Date (Quarter/Year):__________________
Name of Preceptor: ___________________________________________ Title (e.g. ND, MD): _________
Clinic/Site Name: _____________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________
Dates of Preceptorship: ________________________________________________________________
Learning Objectives for this Preceptor Site: _________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________
Using the following scale, how would you rate your experience with this Preceptor?
5. Excellent
4. Above Average
3. Average
2. Below average
1. Poor
N/A Not Applicable
A. Mentoring style 5 4 3 2 1 N/A
B. Informative/ability to explain procedures 5 4 3 2 1 N/A
C. Patient rapport/support 5 4 3 2 1 N/A
D. Clinical Skill 5 4 3 2 1 N/A
E. Time Management 5 4 3 2 1 N/A
F. Receptivity to new ideas 5 4 3 2 1 N/A
G. Integration of ND philosophy into practice 5 4 3 2 1 N/A
~ Continued on reverse ~
Type of Experience: _______ Shadow/Observe _______ Limited Hands-On _______Hands-On
Please briefly describe your experience with the preceptor’s teaching style, kinds of patients seen in practice,
modalities used, etc:
Did the experience meet your learning objectives?
Would you recommend this preceptor to other students? Why or why not?
Total number of hours: ________ Total patient contacts: ________
Student’s Signature: ________________________________________________ Date: _____________
ND Preceptor Coordinator’s Signature: __________________________________ Date: _____________
revised 8/1/05
17

BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
ND Student’s Clinical Time Sheet
(Be sure to total your hours and patient contacts and have your preceptor initial and sign where applicable on
both sides of this form.)
Student: ___________________________________________________________________________
Preceptor: ________________________________________________________Title: ______________
Date In Out Total Hours Total Patients Preceptor’s Initials
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
___________ _____ _____ _________ __________ ______________
Total: _________ __________
Optional Comments by Preceptor: ________________________________________________
____________________________________________________________________________
_________________________________________________________________________________
_______________________________________________________________________
____________________________________________________________________________
Preceptor’s Signature: ___________________________________________ Date: ________________
ND Preceptor Coordinator’s Signature: _______________________________ Date: _______________
revised 8/1/05
~Student Patient Contact Form on reverse~
BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
ND Student’s Preceptorship Patient Contacts
Documentation of ALL Patient Contacts is required for credit. Please document your level of participation (Observed,
Assisted, or Performed) under headings in each SOAP (Subjective, Objective, Assessment, and Plan) column.
Do NOT list any patient names or initials.
Student: ____________________________________________________________________________
Preceptor: _______________________________________________________ Title: ______________
Preceptor’s Initials
Date Medical Assessment S O A P
revised 8/1/05
18

RESIDENCY PROGRAM
Bastyr University is a CNME recognized sponsor of postgraduate medical education. This recognition
has provided the university with the authority to grow its residency program by increasing the number
of affiliate residency training sites. The residency program at the Bastyr Center for Natural Health
(BCNH) is a CNME approved program. Through the residencies at BCNH and its affiliate programs,
the university is able to offer both first-year and second-year residency training opportunities. The
Bastyr University residencies are highly competitive and attract graduates from other educational
institutions as well as from Bastyr.
The residency program at BCNH is a closely supervised mentorship program. Each resident evolves
from an observational role into an independent practitioner over the course of the year. This
progression is monitored and facilitated by a faculty mentor and by the Director of Graduate and
Community Medicine. A second year of naturopathic residency consists of greater clinical autonomy
with continued skill development. All residents have opportunities to do rotations in other local clinics
and medical centers.
The BCNH residency program is designed to provide an opportunity for naturopathic medical school
graduates to strengthen their skills as a naturopathic physician. The program will provide residents the
opportunity to enhance their knowledge and skills in general medicine, application of naturopathic
philosophy, teaching, and practice management. The residency has specific knowledge, skill, and
professional competencies that are consistent with the progressive level of training throughout the
course of the residency.
GOALS OF THE BCNH RESIDENCY PROGRAM
1. To develop ethical naturopathic physicians who are highly competent in the practice of general
naturopathic medicine, and in the management of emergent health conditions.
2. To develop skilled clinical educators in the natural health sciences that integrate mind, body,
spirit, and nature.
3. To teach our residents core skills essential to leadership roles in a wide range of health care
systems.
4. To maintain an emotionally supportive environment, encourage intellectual debate, and foster
life-long professional development.
5. To give our residents the opportunity to provide high quality naturopathic care to the people of
our community, regardless of socioeconomic status.
6. To develop collegial relationships with other members of the clinical staff in order to enhance
the quality of medical care to our community.
7. To foster advanced communication skills with healthcare providers outside the Bastyr Center
for Natural Health.
Moreover, one of the long-term goals of the university is to provide residency opportunities for every
naturopathic graduate. As a CNME recognized sponsor, the university continues to develop training
opportunities through affiliations with established institutions and clinics. The current affiliate
residency sites are CNME approved that base their training on the supervised mentorship model as
well. These affiliate sites range in size from small private clinic-based programs to hospital-based
residencies. Each program has an affiliate residency director who is responsible for ensuring the
quality of the clinical training. Though semi-autonomous, these programs regularly communicate with
the Director of Graduate and Community Medicine to ensure compliance with the CNME training
standards. The goals of each affiliate program are described in each site-specific residency training
manual.
19

ONCOLOGY/CANCER
NATUROPATHIC TREATMENT OF MALIGNANCY
Chapter 18.57 or 18.71 RCW of the naturopathic licensing law states:
“The practice of naturopathy includes manual manipulation (mechanotherapy), the prescription,
administration, dispensing, and use, except for the treatment of malignancies or neoplastic disease, of
nutrition and food science, physical modalities, homeopathy, certain medicines of mineral, animal, and
botanical origin, hygiene and immunization, common diagnostic procedures, and suggestion; however,
nothing in this chapter shall prohibit consultation and treatment of a patient in concert with a
practitioner licensed under chapter 18.57 or 18.71 RCW.”
Upon review by Bastyr University law firm, the statutory limitation in this aspect of our law is that a
ND may not "treat malignancies” except “in concert with” an MD or DO. Therefore, if an ND is
providing care to a cancer patient for any purpose other than treatment of his or her malignancy, there
is no unusual limitation to the ND’s scope of practice.
However, when a ND is providing curative treatment for the malignancy, the ND is within his or her
scope only if the curative treatments are “in concert with” an MD or DO. There is no formal guidance
on what it means to be acting “in concert with” an MD or DO from either the courts or the department
of health. Mr. Burgon has advised us in this regard as follows.
At a minimum, the ND must be confident that she or he is fully aware of the MD’s prescribed
course of treatment. This is likely to require interaction with the MD or DO in order to obtain
the necessary medical records or other direct knowledge of the patient’s treatment.
In light of this interpretation, we have revised the informed consent form for the treatment of
malignancies (see appendix). It is your responsibility to ensure that any patient for whom you are
treating malignancy, the symptoms thereof, or the side effects of their conventional treatment for their
malignancy, sign this consent form prior to your treatment.
In order to treat patients with malignancy, naturopathic providers must:
Have full awareness of the patient treatment as recommended by their MD or DO documented
in the patient’s medical record. It may also be listed as a documented conversation held with
the patient’s MD or DO.
As long as a patient is under the care of an MD or DO for their malignancy, naturopathic providers
may treat this patient’s malignancy. If a patient has refused the treatment recommended by an MD or
DO, naturopathic providers must document the voluntary informed refusal of that treatment.
Naturopathic providers must then continue to adhere to the above stated communication guidelines in
the care of this patient.
• Regularly inform the patient’s MD or DO of the treatment being provided to the patient.
• It is important to note that the ND does not have to be subservient to the MD’s direction. The
ND must only provide treatment that is in harmony with the medical regimen and must inform the
MD of the treatment being provided.
And, to summarize your role:
We provide treatment that is in harmony with the patient’s conventional treatment (to the best of
the medical profession’s current state of knowledge).
20

STUDENT ACADEMIC ISSUE RESOLUTION POLICY
When a student has an academic-related issue and is seeking a venue in which to formally address this
issue, it is the responsibility of the student to initiate the process outlined below in a step-by-step
manner. Examples of academic related issues may include grade disputes, interpersonal
communication difficulties with faculty or supervisors or deans or difficulties complying with program
or department policies or procedures. Students are recommended to meet with the Vice President of
Student Affairs to receive assistance in preparing for the meeting and for creating a written request for
resolution. The student is also welcomed to request the support of the VPSA during all meetings and
steps in the process. If the student suspects the issue may involve sexual harassment, the student is
encouraged to review the Sexual Harassment Policy in the student handbook.
In the event that a faculty member does not respond to a student request to arrange an informal
meeting, or if a student does not receive a response from the lead faculty, chair or dean within the
prescribed time line, the student may progress to the next step in the process. Documentation must be
provided to show that the time lines were not met.
Step 1
The first step in resolving an academic related issue is for the student to arrange a formal meeting with
the faculty regarding the issue of concern. A simple resolution to the issue may occur after this
meeting. Once the issue is raised by the student, the faculty member and the student should meet so
the issue is resolved within five days. If the issue occurs at a break where clinic is not in session the
issue should be resolved by the 5 th working day after classes/clinic resumes. If it is a grade dispute, the
student must raise the issue by 5 PM of the Friday of the first week of the following quarter, including
summer quarter. All discussions and issues occurring during the formal meeting will be documented
by the faculty member.
Step 2
If the issue is not resolved between the student and faculty member, the next step is for the student to
submit a written request to the department chair, lead faculty or associate dean supervising the faculty
member. The letter should state the issue of concern and the student’s recommendation for resolution
of the issue. After receiving the documentation, the supervisor will meet with the student and faculty
in question. The department chair, lead faculty or associate dean will analyze the information and
inform the student and faculty member in writing within 5 working days of the meeting. If the issue
comes forward the week prior to a break or holiday, the issue should be resolved by the 5 th day after
classes/clinic resume. All discussions will be documented by the chair/lead/associate dean.
Step 3
If the issue is not resolved according to step 2 within the 5 working days, the student will submit a
written request to the Dean that clearly outlines the issue and recommends resolution for the issue.
The Dean will review the documentation from step 1 and step 2, the Dean will meet with the student
faculty member and chair/lead/associate dean. The Dean will render a decision and inform the
participants in writing within 5 working days of the meeting. In the event that an issue is presented
during the week prior to a holiday or break, the issue should be resolved within 5 days after
classes/clinic resume. In the case of a grade dispute, the decision of the Dean is binding and not
subject to further appeal. All discussion and decisions rendered will be documented by the Dean. If
the Dean is the instructor, the student should go directly to step 4.
Step 4
As previously stated grades are not subject to further appeal unless the dean is the instructor. If the
student does not agree with the decision of the dean regarding other issues they may submit a written
request to the office of the Vice President for Academic Affairs/Provost that clearly states the issue and
recommends a resolution of the issue. The VPAA or their designee will review the documentation
received from the step 1-3 proceedings, request a meeting if it seems warranted, and will render a
decision within 10 working days of receipt of the request. The decision of the VPAA is final and
21

inding and not subject to further appeal. All discussions and decisions rendered will be documented
by the VPAA or their designee.
In the case of a grade dispute a student who remediates a PC grade to an AC status may still appeal the
original grade. Students must initiate grade appeals with the program or department providing the
course. The prefix designation of the course number signifies the department/program offering the
course. Questions of judgment concerning course content, instructional method and appropriateness of
performance standards are not subject to appeal.
For further information, see the university student handbook.
22

CLINICAL SECTION
23

ACADEMIC ADVISING
APPOINTMENTS WITH CLINICAL FACULTY ADVISORS
Each student clinician will be assigned to a clinical faculty advisor. You may find out who you are
assigned to through the registrar’s office or by checking with the clinic faculty assistant. If the student
desires to change that assignment, contact the main campus registrar’s office. Advising sessions are an
opportunity for students to share any suggestions or issues and to practice skills and review
competencies. Appointments may be made with your advisor in person or by email. Advisors are a
resource to mentor students and supervise mini exam competencies. If a student is at risk of failure,
they are required to meet with their advisor on a regular basis as outlined in their learning contract. It
is the student’s responsibility to contact the advisor and make an appointment. All the faculty members
have posted office hours for student drop in visits, or will make appointments with students through
email. The faculty assistant can also assist students in making appointments with faculty or with the
associate clinical dean.
CODE OF CONDUCT
Student clinicians are expected to function within the code of conduct expected of a professional
physician. This includes awareness and integration of the standards of the profession, and honesty in
their behavior and interactions with staff, patients, supervisors and colleagues. Clinicians will
integrate integrity and responsibility in their interactions and uphold those standards with their
supervisors and other clinicians. The practitioner will also disclose all potential conflicts of interest or
potential for secondary gain that may arise during practice and patient treatment. A patient may not be
referred to an outside resource that may provide benefit to the clinician or practitioner. Failure to abide
by these standards will lead to sanction or even to dismissal.
DOCUMENTATION
TIME SHEETS
•Students are responsible for having their time sheets at each shift.
•Four hours is the maximum number of hours that may be counted for each shift, unless
otherwise noted.
•Students need to have the supervising faculty member initial the time sheet each week.
•Any time missed on a shift due to absence, tardiness, or holiday will result in an IP grade
for the shift. These hours will be made up with substitution or extra interim shift hours.
Time Sheets must be turned in to the supervising faculty by the last day of each quarter. If a
student does not submit their time sheet, the registrar will send a request to the student. If there is
no response within a week, the Associate Clinical Dean or their designate will be notified. The AD
or their designate will investigate whether the time sheet is held by the faculty or student. If the
student has not submitted their time sheet and does not respond to the AD the registrar’s office will
record an N (no Grade) grade. The financial Aid office will be notified in order to calculate
whether this affects the status of the student’s financial aid. The student is required to meet with
the AD or their designate to change the grade from N to IP or AC. If the student is found to be
negligent in their responsibility a fee may be charged.
HAND WASHING/SANITATION
The student applies proper awareness and observance of public health and sanitation rules by washing
their hands, cleaning the tables and equipment before and after each exam and shift. The equipment
may include lights, gynecological lights, tables, mirrors, and personal medical equipment including
their stethoscope. Proper hand washing includes washing for 20 seconds, rinsing and drying the hands
thoroughly. There are hand sanitation stations throughout the clinic that may be used up to two times
before washing with water.
24

HOURS/PATIENT CONTACTS
Students are required to keep a summary of patient contacts from all shifts, interim clinic, substitution,
and extra time. These are to be recorded on the “summary of patient contacts” form, and each patient
contact must be initialed by the supervising faculty member. Students must designate each contact as
either primary (P) or secondary (S) and use a separate form for each shift.
IMMUNIZATIONS-SEE THE GLOBAL HANDBOOK FOR POLICIES, REQUIREMENTS
AND PROCEDURES
Charting/Medical Records
PROCEDURES
All chart entries must be made in black ink on the appropriate form. Computerized chart notes must be
completed on clinic read-only templates installed on clinic library computers or on your PC. Charting
may not be stored on personal computers or PDA’s unless it is completely de-identified. This
policy is to protect the confidentiality of patient medical records in compliance with HIPPA privacy
guidelines.
All charting corrections or changes made by a student or supervising faculty in a chart on the day of
the original entry are to be made as follows:
1. Draw one line through the entry to be changed.
2. Write the new entry beside the old entry.
3. Initial the change.
4. Please refer to the medical abbreviations list in the appendix of the global module for
approved medical abbreviations in charting.
For all chart changes made in a chart after the day of the original entry by the supervising faculty:
1. Draw one line through the entry to be changed.
2. Write the new entry beside the old entry.
3. Initial and date the change.
4. No changes can be made after the provider has signed the chart. Any additions or changes to
the charting must be made on a new page and signed by the supervising faculty and inserted
into the charting with appropriate referencing to the original chart notes.
No patient may be treated without the following:
1. A “consent to treatment” form signed by the patient or the patient’s designated signatory.
2. A completed patient intake form and patient billing/insurance form.
CHARTING/MEDICAL RECORD KEEPING
FORMAT
We utilize the SOAP format for all charting in the clinic.
Each chart should have a subjective (S), Objective (O), Assessment (A), Plan (P), Future Plan (FP) and
Impression (I). Note that within the SOAP format, there are variable styles of charting.
1. Subjective (S): This section includes what the patient tells you about their health and symptoms.
In the large category, this is the history of the present illness (HPI).
a. It includes the chief complaint (ex: my stomach hurts), and the seven attributes of that complaint.
The attributes include: location, quality, quantity or severity, timing (onset, duration and
frequency), setting, aggravating and alleviating factors and associated manifestations.
(Ex: the pain began yesterday and was 3/10 in intensity, now it is 7/10. The pain is dull, aching and
fluctuates in intensity. I took Pepto Bismol and felt better for a while and then I vomited and
had diarrhea two times. I got back from Mexico four days ago. I was traveling in the country
25

and ate at local restaurants and stands. I did not have access to bottled water, but I have an old
filter I used to use when I went camping.) .
It should include the attributes for every complaint a patient presents with in the clinic. Ex: I have a
stomach ache, a headache and diarrhea. My knee also hurts when I walk down stairs. These
extra complaints would be noted as Complaints #2, 3, and 4. If associated with the chief
complaint, example: diarrhea, it may be noted with all its attributes on the associated symptom
portion of the related complaint.
b. It also includes the past medical history, family history, allergies, lifestyle, social history, current
medications (correctly spelled), current supplement and over the counter drug use and a review
of systems. Please see Bates for details regarding professional charting the patient history.
2. Objective (O): This section includes the information you gather using your senses-what you see,
hear, smell and feel while conducting a physical examination of the patient. It is completed using
clinical language. Terms must be spelled correctly.
3. Assessment (A): The assessment is one of the most important aspects of the chart. All active
diagnoses, with a correct ICD-9 code for each, must be recorded in the assessment section. They
must correspond with the diagnoses that are recorded on the superbill.
Clinicians may consider their diagnosis likely but not certain, in which case they should precede
the stated diagnosis with an indicative term such as “working” diagnosis, “presumptive” or
“probable” diagnosis. In this event, the Assessment would also include rule/out(s) or a differential
diagnosis. For example: “Probable Diagnosis: Atypical Migraine Headache, Rule/Out increased
intra-ocular pressure.” Record your diagnostic rationale after each diagnosis or tentative diagnosis.
Every rule/out diagnosis requires a corresponding action in the treatment plan. Differential
diagnoses may or may not require action on the treatment plan. Finally, all active or resolved
diagnoses and problems are recorded and tracked on the patient’s “health data sheet,” which
appears on the left side of the front section of the patient’s chart. They are also included in the
assessment section and noted as resolved.
4. Problems: At BCNH, we follow a system that includes a problem list. It is described by Rakel
in Essentials of Family Practice. A problem is defined as “anything that requires diagnosis or
management or that interferes with quality of life as perceived by the patient. It is any physiologic,
pathologic, psychological, or social item of concern to either the patient or the physician.” Rakel
delineates further that a problem can be anatomic (hernia), physiologic (undiagnosed jaundice), a
specific diagnosis, a sign, a symptom, economic (financial stress), social (family discord),
psychiatric, a physical handicap, an abnormal lab or imaging finding, or a risk factor (personal or
family). Note that “problem” is a more inclusive term than “diagnosis.”
A diagnosis communicates the provider’s certainty of the existence of a specific disease entity. A
problem can be a diagnosis, or it can be a variety of assessments in progress, some requiring
further evaluation.
a. If the purpose of the charted visit was to follow-up on a previously listed problem from a
problem list, and the problem has resolved by inclusion in another diagnosis, or by cure or
disappearance, this should be noted in your assessment
b. Assessment: (Rationale or ddx)
Diagnoses: GERD—Rationale: secondary to suspected food intolerance and possible weak
sphincter muscle tone and reduced HCl/pepsin production
Problems: headache—ddx: a typical migraine, chronic sinus infection, eyestrain
5. Impression (I): After you indicate your active diagnoses and problems, you may then, give your
impression of the patient. Remember to write this section professionally and respectfully. Nothing
should be included in this section that you would not directly tell your patient. This includes the
naturopathic diagnosis and the principles utilized in the case.
6. Plan (P): All actions recommended or prescribed at the present patient visit must be noted in the
plan section of the patient’s chart. This will include instructions for diet or lifestyle modification or
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intervention; any medication (herbal/botanical, homeopathic, nutraceutical, or prescription
medication) with complete and correct name of product, key ingredients(s) and amount(s) as
appropriate, number of units, dose and instructions, duration of dosing, and important side effects
about which the patient was informed and what they were instructed to do if they occur; therapeutic
application or self-treatment (with detailed instructions); referrals for treatment; consultation with
specialist(s); and laboratory testing or imaging. Remember that the plan must contain an action
corresponding to every problem, diagnosis, or rule/out evaluated or managed at that visit; even if
the action is simply to watch and wait (do nothing).
a. As students create and record this plan, they should consider the hierarchy of therapeutics
(therapeutic order) and naturopathic principles, and how these principles guide the plan.
b. If care to be offered in the future has been decided on, it is charted as “future plan.” This
includes all of the future planned actions for the clinician and their team, including any
intended follow-up, when the team will next see the patient in the clinic, any planned phone
calls to the patient, referral, research activities and coordination of care.
c. This is where you include the determinants of health to validate your choice of treatment and
your future plan.
7. The supplement and medication list needs to be updated at each patient visit. If a patient
discontinues a medication/supplement, it should be noted in the medication/supplement sheet on
the left of the chart.
a. Spelling must be accurate.
b. All paperwork must be filled out in its entirety before turning the medical record in to
supervisors for their signature. This includes the patient’s name, date, supervisor’s full name
and student’s full name on every page, a copy of the treatment plan, patient visit summary with
correct ICD-9 code/s used that day, medication/supplement sheet filled out with dosing
schedule, doctor’s name, self-prescribed medication, adult health data sheet or pediatric health
data sheet completed or brought up to date, and drug allergies. Treatment plans in the chart
must include dosages in terms of metric measurement (mg/grams), not just “3 caps TID”,
unless it is a combination product.
c. Do not leave any preparation notes in the medical record.
d. All of the documentation must be completed within the borders of the note page. Any
information outside of the borders (i.e., the dark thick line) may not copy when medical
records are requested from another provider.
e. All ND student clinicians must complete chart notes for all patient visits and phone contacts
within 1 hour of the contact. Incomplete charts must be appropriately labeled and notes and
treatment plan from the visit must be in the chart. Once the chart is signed and completed, the
student fills out a chart action review form for their supervising faculty member, and leaves it
in the supervising clinical faculty’s mailbox.
f. Violation of these policies will result in a clinic sanction, resulting in loss of that day's shift
hours and patient contacts. Repeated violations of this policy will result in a failure of the
entire quarterly shift including loss of those shift hours and patient contacts. Students who
commit repeated violations may be considered as candidates for expulsion from the program.
The medical record is a legal document.
8. Charts need to be legible, clear and concise. If your handwriting is illegible you should complete
your charting by typing or computer. You must follow the patient confidentiality guidelines as
required by HIPPA when you utilize the clinic format for computerized chart notes.
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PATIENT INTERVIEW GUIDELINES
PRIMARY CLINICIAN
The primary student needs to direct the interview. While it is important to hear the patient’s story, it is
inefficient to let the patient run the interview. If a patient is not answering your questions, politely
redirect them. This may mean that you do this several times during an interview.
Remember that FOCs should actually take no more than 75 minutes and ROCs should take only 45
minutes. The interview portion of an FOC should generally be no longer than 30 minutes and for
ROCs no more than 10-15 minutes. This leaves time to perform PE, formulate your diagnosis and
treatment plan, discuss the treatment plan with your supervisor and to present it to the patient.
Time management is one of the most important tools for managing a successful practice. It may not be
possible to obtain all of the patient information in one visit. If the patient has a complicated history, let
them know that another visit may be required in order to complete all the information. Their main
complaint or urgent problems must be addressed in the first visit.
Never discuss any treatment with a patient during the interview without consulting the
supervising clinical faculty member. To do so is to practice medicine without a license and infraction
of this policy is taken seriously as a matter of public safety and respect for the supervisor’s ability to
practice medicine. Students who violate this policy are subject to sanctions. Repeated violation of this
policy will result in failure of the shift and consideration for expulsion by the Academic Progress
Committee.
SECONDARY ND CLINICIAN
The role of the secondary clinician during the interview is to support and learn from the primary
clinician. You may ask questions when it is appropriate and help to fill in gaps that may have been
overlooked by the primary. The expectation is that the secondary clinician assists the primary in
maintaining the interview without disrupting the flow of the interview.
It is also a secondary responsibility to help keep the interview on track. Remember that an FOC lasts
75 minutes and an ROC is no longer than 45 minutes. This means that the interview portion of an FOC
should last no longer than 30 minutes and in an ROC no more than 10-15 minutes. Assist the primary
in leaving time to perform PE, formulate a diagnosis and treatment plan, discuss the treatment plan
with the supervisor and present the plan to the patient.
Never discuss any treatment with a patient during the interview without consulting the primary and
supervising faculty member. See the section above regarding sanctions.
Secondary clinicians are responsible for completion of the patients’ paperwork. This includes the
superbill, treatment plan and dispensary sheet. Please obtain blank copies of these forms before the
shift so they are available. Each should be filled out completely and accurately. Treatment plans must
be legible, with the provider’s full name. It must include a rationale for each treatment recommended
to maximize patient compliance. You may request assistance in completing paperwork from other team
members in order to maximize time management for the visit.
MEDICAL RECORD KEEPING RESPONSIBILITIES - PRIMARY CLINICIANS
Primary student clinicians are responsible for ensuring that all medical records are completed in
accordance with clinic policy and that all forms are filed properly in the chart when generated. All
corresponding recording must be completed by the primary student clinician within 1 hour and should
be signed by the supervising physician within 2 hours after each patient shift. The supervisor will
notify the student by note or email of any charting deficits. The supervisor will discuss the issues and
assist the primary clinician with necessary information to ensure immediate correction. Clinicians who
fail to correct such deficits in charting practices will be warned in writing of the deadline for the
expected changes. If the chart is not corrected within that time, the student is eligible to receive a clinic
sanction.
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SCOPE OF PRACTICE OF A CLINICIAN
The student must recognize at all times that they are practicing under the license of a supervisor. This
means that any advice or recommendation made to a patient without the prior approval of a supervisor
is practicing medicine without a license. By utilizing this behavior in the clinic, the student is placing
themselves at risk for sanctions, up to and including dismissal.
Students may not prescribe treatment that benefits their own business interests or refer a patient to their
private practice or business. This constitutes a conflict of interest and is not tolerated by BCNH.
GRADING HANDBOOK FOR CLINICIANS
Grading criteria for primary and secondary clinicians in naturopathic medicine are outlined in this
section. Achieved competency is reached by incorporating all skills into each shift. Secondary
clinicians are evaluated as early secondary and late secondary clinicians. Primary Clinicians are
evaluated as early, middle and late primary clinicians. An early primary is a clinician who has been a
primary in patient care for 0-2 quarters, usually corresponding to patient care shifts 5-8. A mid-primary
clinician is enrolled in patient care shifts 9-12 and a late primary is enrolled in shifts 13-17.
Naturally, an early primary clinician will demonstrate less skill in all areas than a late primary, and the
grading system takes this into account. Please see the table below for a visual of the grading system
used at the clinic and the performance differences between the grades of AC, PC and F.
Clinic
Grade Earned
Level AC PC F
Early
Primary
All skills w/coaching
on at least 80% of cases
All skills w/coaching on at
least 70-79% of cases
All skills w/coaching on
less than 70% of cases
All skills w/ minimal All skills w/ minimal All skills w/ minimal
Mid
coaching on at least 80% coaching on at least coaching on less than 70%
Primary
of cases
70-79% of cases
of cases
Late
Primary
Early
Secondary
Late
Secondary
All skills w/out coaching
on at least 80% of cases
All skills w/ assistance on
at least 80% of cases
All skills w/out assistance
on at least 80% of cases
All skills w/out coaching
on at least 70-79% of
cases
All skills w/ assistance on
at least 70-79% of cases
All skills w/out assistance
on at least 70-79% of
cases
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All skills w/out coaching on
less than 70% of cases
All skills w/ assistance on
less than 70% of cases
All skills w/out assistance
on less than 70% of cases
The student must receive an AC grade to obtain credit for each of the quarterly shifts. The skills
necessary to demonstrate competence are raised each quarter to ensure that students attain all necessary
basic skills to be a safe and effective naturopathic physician. If a student is performing under the level
of competence, a letter will be sent to them that indicates the area(s) of deficiency and makes
recommendations for improving their performance. If the student cannot raise their level of
performance by the end of the quarter a grade of PC or F will be given.
When a student receives a PC grade for a quarterly shift, the student must follow all recommendations
listed by the supervisor to change the PC to an AC by the fifth week of the following quarter. This
policy differs from the time line of didactic courses. If the student cannot rectify those inadequacies,
the grade will change to an F, and the student will lose credit for all hours and patient contacts.
When a student receives an F grade for the quarterly shift, they will lose all patient contacts and hours
attained during the quarter. The entire shift must be repeated, and the date of graduation will be set

ack at least one quarter. During the repeat shift, the student will be graded at the same level as the
failed shift. Failure of a clinic shift places the student on academic probation and a learning contract is
developed with the assistance of the associate clinical dean. Failure of two clinic shifts automatically
places the student on final probation status and they must meet with the associate clinical dean and
with the naturopathic medicine academic progress committee to determine whether they may remain in
the program.
LEARNING OBJECTIVES FOR SECONDARY CLINICIANS
During their careers at Bastyr Center for Natural Health, all clinicians must demonstrate competence in
numerous clinical skills. We track this expanding expertise by a system of skills/performance
evaluations to be completed sequentially by term. Below is a time line for all ND student clinicians.
The clinic supervisor, advisor or resident will sign for the competencies they have observed.
Secondary Quarter/Shift 1
Development and Application of Communication Skills
Knowledge and utilization of all aspects of clinic operational procedures
Incorporates Professional Attitudes and Behaviors
Knowledge and Practice of Physical Exam Skills
Development of Charting Skills
Building Knowledge of Treatment Modalities and Application
Secondary Quarter/Shift 2
All the preceding skills and:
Responsibility and Participation in active patient care
Present cases at preview and review-Professional Communication Skills
Further development of Charting Skills
Further develop knowledge of Treatment Modalities
Application of treatment skills
Secondary Quarters/Shifts 3 & 4
All the preceding skills and:
Application of Interview and communication skill
Charting Skills applied at Early Primary Level
Physical Exam Skills intact and ready for assuming primary role
Contribute actively to diagnostic and therapeutic work-up of patient cases
Interactive application of treatment skills
Begin limited primary work with supervision
Secondary competency achievement on general naturopathic medicine shifts is noted on a tracking
form which is included for in the appendix of this notebook. There are separate competency tracking
forms for homeopathy shifts, counseling shifts and physical medicine shifts. Each secondary clinician
will complete one form for each general naturopathic patient care shift they have each quarter. If you
have no patient care shifts in a quarter you do not complete a form. The forms are turned in to the
clinic program supervisor when they are completed. They must be on record with the clinic registration
staff before you may advance to primary status. Please see the Associate Clinical Dean with questions
regarding this policy
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SECONDARY SKILLS
1. Professional Skills
A. Initiative and Responsibility in Role as Secondary Clinician
B. Communication Skills with supervising physician, peers and staff
C. Communication skills with patients
2. Clinical Skills
A. Physical Exam Skills
B. Integration of Didactic Knowledge into the Clinical Setting
C. Medical Record Keeping Skills
D. Participation in Case Discussion
PROFESSIONAL SKILLS-Secondary Clinician
These are skills that are necessary in creating rapport with patients, supervisors and colleagues
throughout your professional life. The grading in this category is oriented to provide optimal flow to
patient care. The skills themselves are necessary adjuncts to success in the professional world.
Initiative and Responsibility in Role-Secondary Clinician
This skill is necessary in the clinic for student education and quality of patient care. Grading for this
criterion includes, but is not limited to:
• The student studies and prepares for shifts by reading patient charts and researching
complaints and conditions, reviewing the pathophysiology of disease processes, biochemistry
of illness and treatments, differential diagnosis, and treatment for the complaints, conditions
and diagnoses of the patients.
• The student demonstrates self-motivation in pursuing knowledge to enhance patient care and
their own education.
• The student demonstrates familiarity with cases and can present the cases seen that day in
case preview and review when requested to do so by their supervisor.
• The student utilizes clinical resources to enhance their skill and knowledge during down time
on the shifts by pursuing self study, practicing physical exam skills and studying treatment
modalities.
There is no remediation or PC grade available for this skill.
This skill is a necessary attribute for a practicing physician as our skill set is never mastered.
Continual study is a necessity for a safe and viable practitioner.
Communication Skills with Supervising Faculty, Peers and Staff-Secondary Clinician
• The student exhibits an understanding and mastery of professional communication in their
verbal, non-verbal and written communication.
• The student assists the supervisor and their peers in processing paperwork and enhancing the
effectiveness and timeliness of the patient visit.
• The student elicits feedback on their performance from the supervisor and their peer clinicians.
• The student exhibits professionalism and collegiality in all their interactions with clinic staff,
peers and supervisor.
• The student incorporates clinical policies and procedures smoothly into the patient care and
learning process.
Communication Skills with Patients-Secondary Clinician
• The student participates in the patient visit in a professional manner that enhances, and does
not impede the visit progress.
• The student actively follows the case taking and inserts appropriate questions at indicated
times during the visit.
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• The student notes requests by the patient during the visit and informs the primary and
supervisor so that those needs may be addressed.
• The student observes the patient during the interview and reports pertinent observations to the
primary and supervisor.
• The student demonstrates communication skills that emphasize patient needs and are
culturally and socially sensitive to patient gender, lifestyle, culture, race and socioeconomic
status.
Remediation of this skill may include, but is not limited to, auditing portions of counseling courses,
pursuing skills workshops in counseling or communication skills, tutoring on communication skills
and diversity training through the school tutoring center or an outside resource.
Communication skills are one of the most important attributes of a successful physician and are
a necessary ingredient for smooth flow and optimal function of a multidisciplinary teaching
clinic.
CLINICAL SKILLS-Secondary Clinician
Physical Exam Skills
The student is adept in taking the vital signs of each patient on each visit in a timely manner, using
the appropriate equipment accurately.
• The student reports abnormal vital signs to the supervisor and ensures that the information is
recorded appropriately in the patient chart.
• The student demonstrates proper technique and knowledge of exams when asked to repeat
physical exams during the patient visit and when achieving their competency sign-off
requirements.
• The student demonstrates their ability to integrate the information obtained in physical exam
into the differential diagnosis and treatment plan for each patient as a part of the clinical team.
• The student is prepared to participate in exams by bringing their diagnostic equipment in good
working order to each daily shift.
The student applies proper awareness and observance of public health and sanitation rules by
washing their hands, cleaning the tables and equipment after each exam and shift. The equipment
may include lights, gynecological lights, tables, mirrors, and personal medical equipment including
their stethoscope. Proper hand washing includes washing for 20 seconds, rinsing and drying the
hands thoroughly.
Remediation for this skill in the event a student receives a PC includes demonstration of appropriate
technique in performing physical exam competencies and in obtaining vital signs and accurate charting
of information in a patient chart. If PC is given because of damage or lack of equipment the student
must demonstrate that their equipment is in good working order.
It is mandatory that a safe and successful physician exhibit excellent physical exam skills and an
understanding of how information obtained in a physical exam contributes to the development of
a differential diagnosis and treatment plan for each patient.
Integration of Didactic Knowledge Into the Clinical Setting-Secondary Clinician
• The student demonstrates understanding and integration of pathophysiology, anatomy, and
biochemistry as they relate to patient complaints and diagnosis during case discussion, case
preview and case review.
• The student demonstrates evidence of case preparation by including knowledge obtained
through research into case discussion.
• The student suggests appropriate lab or diagnostic testing during case discussions and can
explain the procedures and purpose of testing to the patient if asked to do so.
• The student exhibits their grasp of knowledge in case discussions, case preview and case
review.
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A PC grade in this skill is rectified by the student completing an assignment of three case analyses with
supervisor or their agent. The cases will include the following components:
• Identify the chief complaint and seven attributes and how the review of systems is integrated
into the development of a differential diagnosis.
• Describe objective findings utilizing appropriate terminology.
• Formulate and defend a differential diagnosis and how testing is integrated into the
confirmation process.
This skill is mandatory for both the success of the physician and to guard public safety.
Medical Record Keeping Skills (Charting)-Secondary Clinician
• The student charts vital signs appropriately in the medical record
• The student demonstrates mastery of the SOAP charting format by presenting cases in Case
Preview and Review in that form when called upon to do so.
• The student demonstrates their competence in medical record keeping by recording findings
during physical exam when asked to do so by the primary clinician.
• The student demonstrates a grasp of medical record keeping requirements as outlined in this
handbook when submitting required charting for competency evaluation.
A PC in this category is rectified by presenting two completed return office call records and first office
call record that complies with clinic medical record keeping guidelines.
Clinical record keeping skills are mandatory for the successful physician for ethical and legal
reasons. The record is a physician’s and a patient’s protection as it documents patient- physician
interactions.
Participation in Case Discussion-Secondary Clinician
• The student demonstrates competence in explaining the principles of naturopathic medicine
and how they apply to each case when presenting in case preview and review.
• The student demonstrates competence in discussing the Therapeutic Order and how they
apply in each case during case preview and review when asked to do so by the supervising
physician or peers.
• The student demonstrates their ability to present cases within the SOAP format during case
preview and review discussion when called upon to do so by the supervisor.
• The student demonstrates the integration of didactic knowledge into each patient interaction
during case discussions.
• The student exhibits a willing participation in case discussion during shift and during case
preview and review.
A PC in this skill is remediated by practicing case presentation and analysis under the supervision
of the supervising faculty or the associate clinical dean. Large gaps in knowledge may require
attendance of a portion of didactic classes pertaining to the area of weak knowledge or the addition
of a case analysis and management course.
The ability to synthesis patient data and discuss reasoning for your clinical choices is a
primary skill of a safe and effective physician.
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GRADING CRITERIA PRIMARY CLINICIANS
• An AC grade is given when students have successfully demonstrated competence in all the
clinical categories relevant to their clinical status.
• A PC grade is given if one non-critical skill is assessed as inadequate.
• An F grade is given if critical clinical skills are assessed as unsatisfactory.
• If a PC grade is given, a letter detailing requirements for changing the PC grade to an AC will
accompany the grade. Refer to the clinic SOP and grading section in the global manual for
details.
If an F grade is given, a letter detailing the reasoning for the grade will follow assignment of
the grade. Refer to the clinic grading section and policy sections in the global and ND manuals
for details.
LEARNING OBJECTIVES FOR PRIMARY CLINICIANS
Early Primary
• Practice application and integrate skill in the interview, PE, development of differential
diagnosis, and medical charting of patients seen in clinical rotations.
• Formulate basic treatment plans utilizing nutrition, homeopathy, counseling, botanical
medicine and/or physical medicine that are pertinent to the patient.
• Demonstrate skills in application and explanation of diagnosis and treatment to the
supervising physician and to the patient
• Develop confidence in personal skill development
• Demonstrate integration of lifelong learning skills
• Enhance communication skills and professional demeanor
• Integrate communication skills with empathy and unconditional regard into the patient
encounter.
Integrate the principles of naturopathic medicine and therapeutic order into discussion and decision
making.
Mid level Primary
All of the above skills and:
• Apply scientific research in communication of etiology (cause), diagnosis and treatment of
disease
• Demonstrate effective time management into the patient interview
• Integrate evaluation of the vis into the assessment, diagnosis, and treatment of each patient.
• Mastery in application of assessment skills utilizing the determinants of health, therapeutic
order and the principles of naturopathic medicine into patient evaluation and treatment.
• Integrate wellness and prevention in evaluation and management.
Advanced Primary
All the preceding skills and:
• Master effective patient management skills that utilize the principles of naturopathic medicine
and the therapeutic order in individualized assessment, treatment and management.
• Integrate self-confidence into your role as a clinician.
• Demonstrate the ability to function independently, developing treatment plans and case
management with minimal assistance from the supervisor.
PRIMARY SKILLS
1. Professional Skills
A. Communication with Patient
B. Communication with Supervisor, Staff and Colleagues
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C. Motivation, Initiative and Responsibility in the Patient Care Setting
D. Teamwork-Incorporation of Policies and Procedures
2. Clinical Skills
A. Interview Skills
B. Physical Exam Skills
C. Overall Case Management
D. Medical Record Keeping (Charting)
E. Incorporation of Academic and Didactic Knowledge into Clinical Practice
F. Application of Naturopathic Therapeutics
PROFESSIONAL SKILLS-Primary Clinician
These skills are necessary in creating rapport with patients, supervisors and colleagues throughout your
professional life. The skills are necessary adjuncts to success in the professional world.
Communication with Patients-Primary Clinician
• The student speaks clearly to the patient and establishes patient rapport.
• The student uses language and terminology in order to improve patient knowledge and
understanding of their health and illness.
• The student communicates specific patient care recommendations as authorized by the
supervising physician accurately to the patient and does not volunteer or direct additional
treatment to the patient without physician authorization.
• The student demonstrates good listening skills during the patient interview by including all
patient concerns in the charting and case discussion.
• The student demonstrates empathy with the patient during the interview and exam. For
example, this may be done by emphasizing respect, and an understanding of the patient’s
circumstances into the conversation in a non-judgmental and accepting manner.
• The student conducts themselves in an open, non-judgmental way to all information disclosed
by the patient.
• The student ensures that all the needs of the patient have been elicited before the end of the
visit.
• The student demonstrates communication skills that emphasize patient needs and are
culturally and socially sensitive to patient gender, lifestyle, culture, race and socioeconomic
status.
Remediation of this skill may include, but is not limited to, auditing portions of counseling courses,
pursuing skills workshops in counseling or communication skills, tutoring on communication skills
and diversity training through the school tutoring center or an outside resource. The student will
demonstrate these skills in at least four of five interviews.
Communication skills are one of the most important attributes of a successful physician and are
a necessary ingredient for smooth flow and optimal function of a multidisciplinary teaching
clinic.
Communication with Supervisors, Staff, and Colleagues-Primary Clinician
• The student demonstrates respect and collegiality in their communications and interactions
with supervisors, staff and colleagues.
• The student demonstrates the ability to work as part of the team to optimize patient care.
• The student demonstrates an articulate and summarized presentation of cases in preview and
review.
• The student demonstrates the ability to summarize the patient’s case to the supervisor in a
complete, coherent and concise manner.
• The student responds to supervisor’s requests or assignments in a timely and professional
manner.
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• The student follows the attendance policy and is responsible and thorough in communication
regarding absences and its impact on patient care.
• The student communicates specific patient care recommendations as authorized by the
supervising physician accurately to the patient and does not volunteer or direct additional
treatment to the patient without physician authorization.
There is no PC in this category. If a student demonstrates a deliberate lack of cooperation and
professionalism with others that results in delay, confusion, error, omission, conflict or creates extra
work in patient management and/or jeopardizes patient rapport, further sanctions will be given on the
first offense. The sanctions will be appropriate to the violation and may include a warning letter, a
failure event or referral to the appropriate progress committee as decided by the supervisor. Additional
episodes during the remainder of the clinical training will result in failure of the quarterly shift in
which the episode occurs and potential dismissal from the program.
Motivation and Initiative in Learning-Primary Clinician
• The student demonstrates initiative and responsibility in aspects of patient care including, but
not limited to - researching conditions, treatments, and disease processes and integrates this
information into case discussion, preview and review.
• The student demonstrate initiative and responsibility in the time management areas of patient
care including, but not limited to – attendance, and appropriate time management for each visit.
• The student reads patient charts, reviews diagnostic testing and is prepared for patient visits,
contributing the information to case preview, review and discussion.
• The student conducts research into etiology and treatment and integrates that information into
case discussion and management, preview and review.
• The student has integrates the information obtained from the chart on past treatment and
outcomes and incorporates that information into patient management.
• The student reviews incoming medical records and integrates the information into case
discussion by the next patient visit.
• The student utilizes down time on the shift to improve clinical knowledge and skills by
practicing physical exams, hands on treatment, research, treatment modalities and/or
pathophysiology without supervisor stimulus.
• The student sits in on case discussions of other primary clinicians using the time to learn and
contribute to the group education.
The student is respectful of their role and the roles of other members of the team, and supports
them in the fulfillment of their duties.
To rectify a PC in this category, the student must be observed on each shift actively pursuing
improvement of their clinical skills for an equal number of hours that were not well spent on their
clinical shift. They will turn in two case studies they have evaluated. The supervisor in question has the
option of creating a different process for rectification of this skill as meets the needs of the student in
question. Other supervisors may be the monitors of this activity.
This skill is mandatory for a practicing physician. Self-motivation and life-long learning are
hallmarks of a competent and safe practitioner.
Incorporation of Clinic Policies and Procedures-Teamwork-Primary Clinician
• The student will demonstrate competence in this area by adhering to all clinic and university
policies outlined in the clinic student handbooks and catalogues.
• The student will follow the attendance and substitution policy of the clinic.
• The student focuses on utilizing regulations and teamwork to enhance the quality of the
patient visit and to ensure patient safety.
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The student will demonstrate professional code of conduct and ethics in the manner they conduct
their practice and professional activities. This will include honesty, integrity and responsibility for
individual judgments and actions. The practitioner will disclose all potential conflicts of interest
that may arise during patient treatment.
To rectify a PC in this area, the student must score 80% or more on a quiz that will cover the policies
and procedures outlined in the clinic student handbook. No further violations of policy or procedure
may occur during the duration of clinical training. As noted in the handbook, certain violations are
subject to immediate failure or dismissal from the clinical training program and the university.
CLINICAL SKILLS-Primary Clinician
Interview Skills
• The student obtains a thorough case history on the initial office visit as outlined in this manual
and in “A Guide to Physical Examination and History Taking” by Bates, that includes, but is
not limited to:
HPI-History of the Present Illness
Past Medical History
Family History
Psychosocial and Lifestyle History
Pertinent Review of Systems
Current Medication and Supplement dosing
• The student demonstrates integrates special interview techniques in gynecology, drug and alcohol
dependence, STD risk profile, psychological risk and history, etc.
• The student can ascertain the present risk to safety of the patient and others when it is indicated to
do so.
• The student integrates pertinent positive and pertinent negative information obtained during the
interview to focus questioning toward development of a diagnostic and treatment plan.
• The student assimilates the written and verbal information gathered during the patient visit into
their differential during the visit to maximize use of the allotted visit time.
• The student obtains this information during the interview in a respectful and non-judgmental
manner.
To rectify a PC grade, the student will participate in three mock interviews to demonstrate the above
skills. The conditions utilized in the interview will be taken from the condition list in the clinic
notebook. The student must demonstrate these skills successfully in two of the three cases if an early to
mid-primary and in all cases if a mid to late primary.
Physical Examination Skills-Primary Clinician
• The student competently performs an exam within accepted performance guidelines on
request of the supervisor, or as indicated by patient chief complaint, within a reasonable time
frame.
• The student has all equipment in working order.
• The student notifies the supervisor of all positive findings so they may be reviewed during the
patient visit by the supervisor. Failure to do so makes the clinician eligible for sanctions.
• The student performs all exams as required and adapts to individual patient circumstances and
comfort.
• The student has appropriate faculty supervision before performing any breast exam or male or
female genital exam. Failure to obtain supervision for genitourinary examinations will result in
sanctions being applied to the student.
The student applies proper awareness and observance of public health and sanitation rules by
washing their hands, cleaning the tables and equipment after each exam and shift. The equipment
may include lights, gynecological lights, tables, mirrors, and personal medical equipment including
37

their stethoscope. Proper hand washing includes washing for 20 seconds, rinsing and drying the
hands thoroughly.
To rectify a PC the student must perform three exams, reflecting the appropriate skill level, during
interim or substitute shifts. The student must pay for the services of a model to perform the exams. In
some circumstances the student may use the male and female pelvic models to practice these skills if
authorized by a resident or physician.
Overall Case Management-Primary Clinician
• The student reveals integration of information and knowledge in their management of
treatment by monitoring patient progress and suggests alterations to the plan when
circumstances indicate change is due.
• The student integrates clinical application of patient management techniques by following up
on referrals, diagnostic testing, and recommending change to the plan as indicated by patient
progress and/or test outcome with faculty supervision and authorization.
• The student follows up with authorized phone calls to the patient when indicated by the
supervisor to do so.
• The student integrates individual pathophysiology and lifestyle factors into their consideration
of treatment changes.
• The student continues to research and integrate new information into the treatment plan as
indicated necessary by patient progress.
• The student monitors patient progress and stimulates change or referral when patients do not
respond to treatment in a timely manner.
• The student must demonstrate the ability to take an appropriate history, perform the
appropriate physical exam(s), meet with supervisor for case discussion, make an assessment
and diagnosis, create a treatment plan, and successfully communicate that information to the
patient within the allotted period of time.
• The student presents the clinical cases in the prescribed format at case preview and review
and actively participates in discussion of cases managed by other students.
• The student integrates the principles of naturopathic medicine and the therapeutic order into
their case management and can discuss how they impact the management of the case.
The student demonstrates an understanding and application of ethical behavior in the management
of patient care.
To rectify a PC grade, the student will present treatment plans for three FOC cases as assigned by the
supervising faculty or their designate. They will adapt those treatment plans through two ROC visits.
The plans will be graded for complexity and knowledge based on the current educational status of the
student.
Medical Record Keeping (Charting)-Primary Clinician
• The student must complete the medical record within 24 hours of the patient visit unless
exception is granted by the supervisor. Corrections or changes made to the chart must be
completed within 24 hours unless exception is granted by the supervisor.
• Record notes with basic case information, including assessment and plan, are to be left in an
incomplete chart.
• NO MEDICAL RECORD IS TO LEAVE CLINIC PREMISES. SANCTIONS WILL BE
INVOKED WITH VIOLATION OF THIS POLICY.
• The medical record is to be completed in the accepted clinic SOAP format as defined in the
earlier section of this handbook. The pages are to be properly organized in the record folder.
• The student will write in black ink only and handwriting must be legible or typed charting
notes utilized.
38

• The student will use the current accepted forms for each visit and note the patient name, date
of birth, and date of visit on each page.
• If more than one page is used to record a ROC, each page will be numbered.
• The supporting record pages including the visit summary sheet, medication list, and patient
health profile sheet are to be brought up to date for each visit.
• Accepted medical terminology as noted in the global edition of the handbook, including
abbreviations, is to be used in record keeping.
• Spelling and grammar are correct and appropriate, including names of medication.
• Treatment section of the medical record should be completed, including the formula for any
tincture or tea prescribed. It is not appropriate to refer readers to the treatment plan or previous
visit notes for this information.
• Patient treatment plan should include the rationale for each recommendation and how long it
should be continued. They should also include any previously prescribed medication that is to
be continued as well as any that are to be discontinued. Each treatment plan should stand alone.
To rectify a PC grade the student must complete three medical records appropriately. The records must
be completed on substitution or interim shifts.
Incorporation of Academic and Didactic Knowledge in the Clinical Setting-Primary Clinician
• The student must demonstrate integration of didactic knowledge as they relate to patient
complaints and diagnosis during case discussion, case preview and review.
• The student must demonstrate the ability to triage acute patients in the clinical setting.
• The student must regularly demonstrate evidence of case preparation by including their
pertinent research into case discussions.
• The student must integrate laboratory and diagnostic testing and the impact of the results of
that testing on diagnosis and treatment of the patient.
• The student must demonstrate integration of their knowledge of the psychological aspects of
patient complaints, diagnoses and methods of intervention.
The student must integrate the principles of naturopathic medicine and therapeutic order into
case discussions and management.
To rectify a PC the student must demonstrate the above skills on two to four cases as indicated by the
supervisor that are included on the required conditions list, to supervising faculty or their designate.
Application of Naturopathic Therapeutics-Primary Clinician
• The student exhibits a growing depth and breadth of knowledge in all aspects of naturopathic
therapeutics.
• The student prepares and presents therapeutic options for each case and can discuss rationale,
strategy and therapeutic goal during presentation in case discussion and case preview.
• The student demonstrates the ability to apply therapies appropriate to each patient’s
circumstances.
• The student is able to prepare a pertinent treatment plan in an acute situation within the given
time constraints.
• The student is familiar with the contents of supplement formulas prescribed for the patient.
• The student is a safe practitioner and exhibits understanding of actual and potential
interactions between medications, supplements, food, nutrients and botanical medicines.
• The student is able to identify all of the treatment modalities that may be appropriate for
treatment of the individual patient condition and can discuss the rationale and any indicated
safety concerns for the use of each modality.
• The student is able to recommend effective and safe doses of supplements, botanicals and
homeopathic remedies.
39

• The student incorporates the use of the naturopathic principles and the therapeutic order into
the treatment plan and can document their action over time.
To rectify a PC grade, the student will be assigned five cases from the supervisor’s caseload and be
required to formulate specific alternative treatment plants for the given conditions. These treatments
will be reviewed and discussed with the supervisor. The skills indicated above must be demonstrated in
at least four of the cases.
SANCTIONS/FAILURE EVENTS
If a student does not adequately perform one or more of any of the critical shift competencies on any
given day or does not achieve competency on any two or more of the non-critical competencies, the
supervisor has the right to issue a sanction to the student. A written warning may precede this sanction,
though that depends on the nature of the event. A second incident must result in a written sanction. A
written sanction results in the loss of all of the daily shift hours and patient contacts for the shift under
review, and may include additional penalties. Two sanctions on the same shift will automatically result
in a failure grade for that entire shift with the loss of all patient contacts and hours earned on that shift.
This means the student must pay for and retake an entire shift.
Students will be issued a sanction when they are found to have violated any of the policies of the clinic,
including, but not limited to:
• Breaching patient confidentiality.
• Removing any patient ID information from the clinic.
• Acting in an unprofessional or disrespectful manner to patients, staff, faculty and peers at any
time, including when present in the clinic and not on shift.
• Failing to comply with Blood Borne Pathogen and other safety policies and procedures.
Practicing medicine without a license.
The severity of the sanction will depend on the severity of the offense and may range from loss of
clinical hours and patient contacts to suspension from the clinic or school. The involved supervisor and
the program dean, or their designate, will determine the type of sanction.
Sanctions are not grades and therefore are not subject to appeal under the appeal of grade policy. A
student may issue a grievance according to the grievance procedure as outlined in the student
handbook.
PHYSICAL EXAM GUIDELINES
Clinicians are expected to know all physical exams. The Physical/Clinical Diagnosis class teaches
clinicians to perform a thorough PE. Even if clinicians haven’t performed this type of exam recently,
they must be adept in performance of each exam at all times, so constant practice is recommended.
Vitals must be taken at each visit, including physical medicine shifts. Vitals include height and weight.
Clinicians must have their equipment in working order for each shift. It should be checked the day
before to ensure that everything works well, batteries are recharged, etc.
A doctor must be present in the room during breast and genitourinary exams of both male and
female patients. This is to guard the safety of the patient, protect the clinic, clinician and supervisor
legally and to ensure accurate performance and education.
Alert the supervisor of all questionable or abnormal findings obtained during the physical examination.
The attending physician must recheck all positive findings. Failure to notify the physician of
abnormal findings obtained during a physical exam so they can verify those findings makes the
student eligible for sanctions. Repeated failure to notify the supervisor of positive findings will
result in sanctions that may include failure of the shift.
40

Contract for Blood Borne Pathogen and Injection Safety
This contract is to be signed by each student after they have received the blood
borne pathogen and injection safety review update. All students at any clinical site
associated with Bastyr University must have a signed copy of this contract on file
with the safety office to continue their clinical education.
I have participated in the biohazard and blood borne pathogen safety review. I agree to
follow the biohazard and blood borne pathogen safety procedures at all times and
recognize that failure to do so will result in sanctions being imposed upon me.
Student Name (print) ________________________________
Signature _________________________________ Date _____________________
Return this completed form to:
Bastyr Center for Natural Health
Faculty Administrative Assistant
Room S206
41

SAFETY
Please review the general clinic safety section in the Global Module Handbook for the clinic policies and
regulations.
In the event a blood borne pathogen accident or incident occurs and you or the patient may have been
exposed, immediately notify your supervisor, who will ensure the health and safety of all involved in the
incident. Please follow the BBP incident procedure outlined elsewhere in this handbook.
The following two charts are a review of the Blood Borne Pathogen safety policy and procedures. Please
note that deliberate failure to comply with Blood Borne Pathogen safety policies and procedures may
result in a sanction.
Blood Glucose Check Procedure:
1. Assemble equipment next to patient. Place sharps container no more than ½ step away from
injection area.
2. Wash and glove hands.
3. Insert testing strip into glucometer. There must be a flashing drop of blood on the
glucometer screen in order to proceed with test.
4. Swab lateral part of patient’s 4th fingertip with alcohol.
5. Using lancet, prick swabbed area.
6. Immediately, put lancet into sharps container.
7. Touch and hold the drop of blood to the edge of the “Comfort Curve” on the testing strip.
8. Apply a cotton ball and/or band aid to bleeding site.
9. After reading blood glucose level, immediately put testing strip and soiled cotton ball into
biohazard container.
10. Clean up after yourself and put equipment away.
11. Wash hands.
12. Document procedure and test results.
42

L/B
HOW TO: INJECTIONS AND FINGERPRICKS
EQUIPMENT NEEDED:
1. SHARPS CONTAINER
2. SUPERVISOR
3. GLOVES
4. Band aid
5. Cotton balls
6. Alcohol
7. a. Syringe and needle (B12/Complex injection) OR
b. Lancet (blood glucose check)
9. a. Bottle of B12 and/or B complex OR
b. Glucometer kit (blood glucose check)
IF YOU ARE MISSING ANY ITEMS ON THIS LIST,
YOU MAY NOT PROCEED!!
B12/B Complex Injection Procedure:
1. Assemble equipment next to patient. Place sharps container no more than ½ step away from
injection area.
2. Check vial for expiration date.
3. Wash and glove hands.
4. Expose injection site.
5. Palpate lateral aspect of tissue between greater trochanter and PSIS, feeling for muscular tissue
with minimal adipose tissue and no bone palpable.
6. Swab area with alcohol.
7. Swab top of vial(s) with alcohol.
8. Push appropriate amount of air into vial (Ex: 1:1 ratio air:vitamin in multi dose vial; 1:2 ratio
air:vitamin in single dose vial).
9. Draw up appropriate amount of B12 or B complex.
10. Withdraw needle from vial.
11. Repeat steps 7-9 if also using B complex.
12. Flick syringe to allow bubbles to escape.
13. With a flick of the wrist, inject needle into swabbed area, pull back to ensure no blood/not in a
vein. If no blood retracts, inject at a moderate rate. Use distraction by scratching area local to
injection with gloved finger.
14. Continue to depress plunger, needle will automatically retract.
15. Immediately put syringe into sharps container.
16. Apply cotton ball and/or band aid to injection site as needed.
17. Clean up after yourself and put supplies away.
18. Wash hands.
19. Document injection.
(Ex: 1 cc B12 and 1 cc B complex injected IM R gluteal m. Lot #: ___; Expiration date: ___. Pt
tolerated injection well, or describe any problems that occurred during the injection).
43

COMPETENCIES
Students at Bastyr Center for Natural Health will demonstrate competence in the clinical skills required
for proficiency in their chosen degree.
UNIVERSITY GLOBAL COMPETENCIES
Communications skills
Students at BCNH will develop writing and speaking skills that will enable them to communicate in a
professional, appropriate and effective manner to colleagues, other health care providers, patients, and the
public. Students will be able to actively listen to their patients, colleagues, other health care providers and
the public and to integrate this information into their case management. Students will develop their
clinical intuition. Students will develop literacy in medical and professional information.
Critical Thinking
Students at BCNH will demonstrate the ability to think critically illustrating their knowledge,
comprehension, application, analysis, synthesis and evaluation of information.
Professional Behavior
Students at BCNH will conduct themselves professionally and responsibly with regards to medical ethics,
compassionate behavior, cross-cultural differences, respectful communication and personal health and
wellness.
CLINIC QUALITIES
Heritage
Students at BCNH will develop an understanding and acknowledgement of the rich heritage inherent in
naturopathic medicine as well as all other forms of medicine. Students will appreciate the philosophy and
essence of holism that naturopathic medicine embodies.
Integration
Students at BCNH will develop the skills and professional competence necessary to demonstrate
integration between disciplines, modalities and philosophies.
Career Management
Students at BCNH will develop competence relating to professional responsibilities, career and business
management. The students will participate in their professional community.
44

PRINCIPLES OF NATUROPATHIC MEDICINE
The Healing Power of Nature [Vis Medicatrix Naturae] Naturopathic medicine recognizes an inherent
ability in the body which is ordered and intelligent. Naturopathic physicians act to identify and remove
obstacles to recovery and to facilitate and augment this healing ability.
Identify and Treat the Causes [Tolle Causam] The naturopathic physician seeks to identify and remove
the underlying causes of illness, rather than to eliminate or merely suppress symptoms.
First Do No Harm [Primum Non Nocere] Naturopathic medicine follows three principles to avoid
harming the patient:
1. utilize methods and medicinal substances which minimize the risk of harmful side effects
2. avoid, when possible, the harmful suppression of symptoms
3. acknowledge and respect the individual’s healing process, using the least force necessary to
diagnose and treat illness.
Doctor as Teacher [Docere] Naturopathic physicians educate the patient and encourage selfresponsibility
for health. They also acknowledge the therapeutic value inherent in the doctor - patient
relationship.
Treat the Whole Person Naturopathic physicians treat each individual by taking into account physical,
mental, emotional, genetic, environmental, social and other factors that affect health. Since total health
also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal
spiritual path.
Prevention Naturopathic physicians emphasize the prevention of disease, assessing the risk factors and
hereditary susceptibility to disease and making appropriate interventions to prevent illness. Naturopathic
medicine strives to create a healthy world in which humanity may thrive.
Wellness Naturopathic medicine seeks to establish and maintain optimum health and balance; wellness is
a state of being healthy, characterized by a balance in emotion, thought and action. Wellness is inherent in
everyone, no matter what disease(s) is/are being experienced. If wellness is recognized and experienced
by an individual, they will more quickly heal a given disease than direct treatment of the disease alone.
(This principle was adopted by Bastyr University and added to the six principles.)
THERAPEUTIC ORDER
The therapeutic order is used to assist developing clinicians to focus their treatment method using the
lowest possible force to assist patients in regaining their health. The treatment chosen is one that best
addresses the needs of the patient at one moment in time. The force of the chosen treatment may decrease
as patients regain their health.
Determinants of Health
Assess/Stimulate the Healing Power of Nature
Tonify Systems
Correct Structural Integrity
Symptom Based Naturopathic Treatment
Symptom Based Synthetic Treatment
Higher Force Interventions
45

CLINICAL COMPETENCIES
During clinical training at the Bastyr Center for Natural Health, naturopathic medicine students are
required to demonstrate competence in numerous clinical skills. Those skills begin with the secondary
skills and advance to the primary skills, each building upon the next. Skill competence is tracked on the
following sheets. These requirements are not linked to the clinic shift grades. They are a separate
requirement, and a signed competency does not assure a grade of AC on any clinic shift.
Patient care, counseling, homeopathy, and physical medicine all have specific forms to help document
that skill development. Supervising faculty will evaluate and confirm your competence on a quarterly
basis. Each quarter the sheet is signed by your supervising physician. Keep a copy for yourself and turn
the original in to the clinic registration staff to prove completion of the competencies. Following you will
find the clinical competencies for secondary clinicians and primary clinicians and the timelines we
suggest you follow in order to complete them in time for graduation.
All secondary competencies must be signed before a clinician may advance to primary status.
All primary competencies must be signed before a primary may graduate.
Tracking Clinical Competencies
Each quarter you receive an updates from the registrars office that notes competencies you have
completed. Check that each quarter to ensure that you are being credited appropriately.
Tracking for Secondary Clinicians Clinical competencies (3 or 4) Patient Care
Clinical competencies -Physical Medicine
Clinical competencies - Counseling
Clinical competencies - Dispensary
Tracking for Primary Clinicians (On your quarterly updates from the registrar)
Clinical competencies - Patient Care
Clinical competency - Counseling
Clinical competency - Physical Medicine
Elective competency – Homeopathy
Clinical competencies – Conditions
Clinical competencies - Physical Examination
Clinical competency – OSCE examination
46

SECONDARY
COMPETENCIES
PATIENT CARE 1 PATIENT CARE 2 PATIENT CARE 3
Dispensary
competency (3) Have supervisor initial when Completed------- -------------------------
Build patient
treatment notebookelectronic
or written (3)
FOC charting One Chart Two Charts Two Charts
ROC charting Two Charts Three Charts Three Charts
HEENT exam
(perform 1)
Respiratory Exam
(perform 1)
Cardiac Exam
(perform 1)
Neuro Exam
(perform 1)
Abdominal Exam
(perform 1)
Musculoskeletal
Exam (1)
Update CPR (annually)
47

STUDENT EVALUATION -- PRIMARY ND PATIENT CARE COMPETENCY Grade each category as: AC /
PC / F
STUDENT’S NAME: DATE: / / QUARTER: F W SP SU
(Please Print)
(Circle or Bold)
DAY: M T W TH F S SHIFT: 1.0 1.1 2.0 2.1 3.0 3.1 Offsite:
(Circle or Bold) (Circle or Bold) (Name Of External Site)
I. PROFESSIONAL SKILLS
A. COMMUNICATION SKILLS
1. Demonstrates empathy to the patient and speaks clearly to effectively establish
rapport
2. Uses appropriate language and terminology to teach patient about their health
(Docere)
3. Effectively communicates treatment recommendations to the patient as directed by
the supervisor
4. Demonstrates listening skills and includes all the patient concerns in charting and
discussion
5. Conducts self in an open and non-judgmental manner in obtaining and
communicating information
6. Demonstrates professionalism, respect and collegiality in all interactions with
supervisor, staff and peers
7. Demonstrates the ability to articulate and summarize case presentations using
accurate medical terminology
B. MOTIVATION AND INITIATIVE SKILLS
1. Demonstrates self-initiative and responsibility in all aspects of patient care
2. Integrates their research and all information in the patient chart before each visit
3. Tracks and follows through on all laboratory and diagnostic testing that is ordered
4. Reviews charts and all requested medical records and assimilates that information
into diagnosis and treatment
5. Utilizes down time on rotations to improve clinical knowledge and skills
6. Demonstrates initiative and responsibility in time management in all areas of
patient care
C. INCORPORATION OF CLINIC POLICIES AND PROCEDURES
1. Adheres to policies to enhance patient experience and student education
49
2. Utilizes regulations and teamwork to ensure patient safety
II. CLINICAL SKILLS
A. INTERVIEW SKILLS
1. Obtains a thorough case history during initial and return office visit
2. Demonstrates the ability to perform special interview techniques as needed
3. Demonstrates the ability to obtain information to ascertain the patient’s risk and/or
safety
4. Demonstrates the ability to effectively assimilate the written and verbal information
obtained in the visit to develop a plan
5. Demonstrates the ability to obtain all necessary information in a respectful and timely
manner
B. PHYSICAL EXAM SKILLS (FIRST DO NO HARM & FIND THE CAUSE)
1. Demonstrates the ability to perform a competent exam as indicated by needs of
patient within a reasonable time
2. Has all equipment in working order and equipment necessary on hand in the room
prior to the visit
3. Notifies a supervisor of all positive and pertinent negative findings in a timely
manner so they may be reviewed
4. Competently performs all exams as needed for the visit adapting to individual patient
need and comfort level
5. Has appropriate faculty supervision before performing any male or female exam
C. OVERALL CASE MANAGEMENT SKILLS (TREAT THE WHOLE PERSON)
1. Demonstrates understanding of treatment goals and monitors patient progress
2. Indicates competence in following through on referrals and laboratory and diagnostic
testing
3. Integrates pertinent pathophysiology in their consideration of treatment choice and

change
4. Continues to research and integrate new information into the treatment plan
C. OVERALL CASE MANAGEMENT SKILLS (TREAT THE WHOLE PERSON)
(CONTINUED)
5. Monitors patient progress and recommends to supervisor changes or referrals when patients do
not progress as expected
6. Demonstrates the ability to perform all aspects of a visit with in the allotted time frame
7. Meets with the supervising physician as needed to monitor progress and provide
optimal medical care
8. Integrates principles of naturopathic medicine and the Therapeutic Order into the
development, application and management of treatment
D. CHARTING SKILLS
1. Completes charting following clinic guidelines within the allotted time frame
2. Charting is completed using the accepted SOAP format
3. Charting is demonstrated as professional by incorporating appropriate information,
language, spelling and grammar
E. INCORPORATING ACADEMIC AND DIDACTIC KNOWLEDGE INTO
CLINICAL SETTING
1. Regularly demonstrates understanding of pathophysiology, anatomy, biochemistry and
physical diagnosis and integrates this into case discussion, preview and review and
evaluation and management of the patient
E. INCORPORATING ACADEMIC AND DIDACTIC KNOWLEDGE INTO
CLINICAL SETTING (CONTINUED)
2. Regularly demonstrates the ability to triage patient complaints correctly identifying and
prioritizing problems and actions
3. Regularly demonstrates case preparation by familiarity with medical record and by
including research into discussions accurately for each patient
4. Demonstrates skill by accurately ordering appropriate laboratory and diagnostic testing
and incorporating results to monitor patient progress
5. The student demonstrates integration of the psychological and spiritual aspects of
patient care into case management
F. APPLICATION OF NATUROPATHIC THERAPEUTICS
1. Demonstrates expanding depth and breadth of knowledge of therapeutics throughout
the quarter
2. Prepares and presents therapeutic options in a timely manner and can effectively
discuss rationale and strategy for each
3. Demonstrates safety an knowledge in their choice of treatment, prescribed dosage and
duration of treatment
4. Demonstrates the integration of naturopathic principles and therapeutic order into each
plan
5. Integrates naturopathic principles, philosophy and Therapeutic Order into evaluation,
management and treatment of each patient
COMMENTS: (*FACULTY – please attach a separate sheet with the student’s information at the top if you choose to make additional comments beyond this space.)
SUPERVISOR’S NAME:
(PLEASE PRINT)
SUPERVISOR’S SIGNATURE:
50

ND PRIMARY CLINICAL COMPETENCIES
Student Name:
Competency
1. Recertified CPR status (current
CPR) each year. Must present card to
supervisor.
2. Communicates knowledge of risk
and safety in prescription of injections
and demonstrates safety and
competence in provision of
intramuscular injection &/or IV
therapy &/or Minor office procedures.
3. Has demonstrated competence in
writing referral letters to other
physician/specialists.
4. Has demonstrated skill & ability in
writing treatment summary letters for
physicians or chart summary.
5. Discuss birth control options,
efficacy and safety with patient
including protection from STDs.
6. Effectively utilizes and integrates
multiple methodologies and/or
modalities within patient management.
7. Acts within ethical parameters (see
the ethics benchmark).
8. Demonstrates CPT and ICD-9
coding knowledge in billing and
charting.
9. Integrates quality of service into
case discussion with patients.
10. Effectively applies homeopathic
prescribing into the treatment of
patients.
11. Creates and prescribes effective
botanical formulas into the treatment
of patients.
Quarter/Year:
Quarter 4/5 Quarter 6/7 Quarter 8
Supervisor
Sig/Date
Comments
Supervisor
Sig/Date
Comments
Supervisor
Sig/Date
Comments
51

ND PRIMARY CLINICAL COMPETENCIES - CONDITIONS
A thorough knowledge of the etiology, assessment or diagnosis, management and treatment of each of
the following categories of disease or conditions must be demonstrated by each student. For credit the
student should have seen the patient for an initial and at least 1 follow up visit.
Acute conditions do not require a follow-up in person, but may be made by telephone. The student
must also present standard and naturopathic treatment options, risks and benefits
Student Name:
Quarter/Year:
Supervisor Competency - may include but is not limited to the listed diagnoses.
Initial/Date If line follows a category, must present at least two cases.
Cardiovascular disease: (HTN, hypercholesterolemia, coronary artery disease, angina, etc.)
Dysglycemia: (diabetes-NIDDM or IDDM, or hypoglycemia)
Upper gastrointestinal disorder: (GER, GERD, PUD, dyspepsia)
Lower gastrointestinal disorder: (IBD, IBS, Crohn’s, UC, Celiac, constipation, diarrhea)
(2 nd -Upper or lower)
Hepatobiliary disease: (cholelithiasis, hepatitis, metabolic liver disease)
Cancer prevention and/or treatment
Skin diseases: (eczema, psoriasis, exanthums, acne, etc...)
Hematological disorders: (anemia, leukemia, dyscrasias, etc…)
Osteoporosis or osteopenia
Female gynecological conditions: (FBD, menopausal management, PMS, polycystic
ovary disease, dysmenorrhea, endometriosis, management of abnormal pap smear,
etc.)
Male genitourinary conditions: (prostate disorder, epididymitis, varicocele, etc...)
Acute Respiratory Tract Disorder: (otitis media, pharyngitis, bronchitis, etc…)
Chronic Respiratory Tract Disorder: (chronic bronchitis, asthma, emphysema, chronic
sinusitis, allergies, etc…)
Nutritional deficiencies or inadequacies
Acute Urinary tract and/or kidney disorders: (UTI, pyelonephritis, glomerulonephritis,
etc.)
Mental/emotional illness
Nervous system disorder: (insomnia, dizziness, seizure, paresthesia, etc…)
HIV: (opportunistic infections associated with HIV+, HIV risk assessment)
Endocrine disorders
Auto-immune Disease: (RA, SLE, Hashimoto’s, etc…)
Musculoskeletal conditions - acute
Musculoskeletal conditions - chronic
52

Physical Exam Benchmark Competencies
Each exam is listed in the Physical Exam outline section(see Appendix). The exams are to be
performed from memory and observed in full by the supervising doctor. The exams must be performed
competently. Clinicians are encouraged to complete their exams well in advance of their last patient
care shift. A copy of this page is given to the Clinic registration staff upon completion.
Supervisor
Initial /
Date
Benchmark Primary Physical Exam Competencies
Part of Exit Exam Prior to Graduation (last 4 quarters)
Breast Exam (10 minutes)
Female Gynecological Exam, pelvic (20 minutes)
Male Reproductive Exam (20 minutes)
Well Child Check-up, including developmental mile-stone assessment (20
minutes)
Complete Screening exam (30 minutes)
HEENT Exam (10 minutes)
Abdominal Exam (10 Minutes)
Respiratory Exam (10 Minutes)
Cardiovascular Exam (15 minutes)
Musculoskeletal Exam (20 minutes)
Neurological Exam 15 minutes)
53

SPECIAL PROCEDURES/PROTOCOLS
GYNECOLOGICAL CYTOLOGY SERVICES
Papanicolaou (PAP) staining of endocervical, ectocervical and vaginal smears is an important aspect of
women’s health care. Please see the attached description of the recommended examination in the
physical exam section of this notebook. A separate cytology notebook details the services offered, and
is available from the client services staff. It includes sections on:
•General information
•Specimen collection
•Patient statistical and follow-up reports
•Terminology/classification standards
•Special services
Collection supplies including slides or SurePath/LiquiPap liquid medium, broom or cytobrush,
modified Ayre spatula, and Pap Paks are available at no charge from the laboratory.
PAP PROCEDURAL DIRECTIONS
Almost all cancers of the cervix begin near the squamo-columnar junction. It is imperative, therefore,
that smears be taken from this area. There are two collection media available: Pap Pak and SurePath
Liquid Pap.
Instructions for Using Pap Pak
Prior to obtaining the cervical sample:
•Write the patient’s name in pencil on the frosted end of the glass.
•Have a Pap Pak open.
•Indicate on the request form all pertinent information about the patient such as last menstrual
period, radiation therapy, IUD, clinical cancer, hormone therapy and previous abnormal cytology.
•Excess mucus should be removed from the uterine cervix and vagina before the samples are
taken.
Ectocervical Sample – Using a modified wooden Ayre spatula, obtain a sample from the ectocervix.
Rotate and scrape the external OS. The sample material should be spread evenly along the length of the
slide in a thin layer.
Endocervical Sample – Using a cytobrush, obtain a second sample from the endocervix. Rotate within
the endocervical canal. Please note that a cytobrush should not be used on pregnant patients. Roll the
brush to spread the sample along the length of the slide in an even and thin layer. It is not an issue for
evaluation if you mix the samples from the two areas.
Fix immediately with the fixative from the Pap Pak or a spray.
If hormonal evaluation is needed, an additional smear may be obtained by scraping the lateral vaginal
wall. This sample should be thinly spread on a separate slide and fixed immediately with the fixative
from the Pap Pak or spray. Label slide M.I. (Maturation Index) and note the request on the lab
requisition form.
Water based lubricant can be used on the speculum to enhance patient comfort. It does not obscure
detail.
The use of a cytobrush can significantly improve the collection of endocervical cells at the
squamocolumnar junction. The following cautions govern their use:
•You may want to inform your patients that there may be some minor painless spotting for a day
or two following the PAP test.
•NEVER reuse the cytobrush.
•Insufficient clinical data exists regarding its use on pregnant patients. DO NOT USE on
pregnant patients.
•The cytobrush MUST NOT be used for sampling from the endometrium.
54

Instructions for Using SurePath or LiquiPap
Cervical Sample Collection: Insert the Rovers Cervix-Brush® into the endocervical canal. Apply
gentle pressure until the bristles form against the cervix. Maintaining gentle pressure, hold the stem
between the thumb and forefinger. Rotate the brush a full rotation in a clockwise direction. Placing
your thumb against the back of the brush pad, gently disconnect the entire brush from the stem into the
SurePath® preservative vial. Dispose of the stem. The spiral cytobrush may also be used to gather
endocervical samples. The brush is swished thoroughly through the liquid medium to release cells.
Cap and label vial: Place the cap on the vial and tighten. Label the vial and lab requisition form with
patient name and/or number, physician name and date if desired.
Lubricant: A small amount of water based lubricant may be used on the speculum in this collection
without diminishing the quality of the sample collected.
Exam Components:
Each annual gynecological examination is accompanied by a screening history that should include
evaluation of current health status, lifestyle risk factors, health habits, and family history. The patient
also receives screening exams that include HEENT, neck and lymph, cardiac, respiratory, abdominal
and breast exams. The patient is also evaluated for the need of any additional screening tests indicated
by the patient history.
Other annual or preventive laboratory testing and/or imaging should be ordered at this time.
WASHINGTON BREAST AND CERVICAL HEALTH PLAN
Bastyr Center for Natural Health is a participating site for the Washington Breast and Cervical Health
Plan which offers gynecological exams and mammograms at no cost to underserved women between
the ages of 40 and 64 years of age. The candidates must be screened by Dr. Jennifer Powell in medical
records to ensure they qualify for the program. The program pays for the pap, mammogram and any
care necessary after a positive finding on either exam. Please check with the Associate Clinical Dean
or Dr. Powell to find out more about this program.
55

ND PHYSICAL MEDICINE COMPETENCIES
Mission Statement: To offer specialized care in physical medicine modalities in an atmosphere of
excellence, professionalism and compassion, while simultaneously developing these skills and
attributes in naturopathic medicine student clinicians.
Clinical Competencies:
• Skillful performance of listed hydrotherapy treatments
• Skillful performance of listed physiotherapy treatments
• Skillful performance of soft tissue assessment and integration of findings into treatment
• Demonstrates knowledge and integration of orthopedic tests
• Demonstrate knowledge and integration of neurological tests
• Demonstrate skill in assessment of joint dysfunction due to subluxation/fixation through static and motion palpation
• Demonstrate skill in formulation of a working diagnosis, prescribe and administer diagnostic
testing and appropriate treatment (including hydrotherapy, physiotherapy, soft tissue manipulation,
joint manipulation, nutrition, botanicals and homeopathy)
Student Name:
Supervisor
Initial/Date
HYDROTHERAPY TREATMENTS
56
Quarter/Year:
Constitutional Hydrotherapy
a. application
b. primary indications
c. contraindications
Hyperthermia (including Peat immersions)
a. application
b. primary indications
c. contraindications
Wet Sheet Pack
a. application
b. primary indications
c. contraindications
Colon Hydrotherapy
a. application
b. primary indications
c. contraindications
Local Contrast
a. application
b. primary indications
c. contraindications
Plasters and Poultices (peat, castor oil)
a. application
b. primary indications
c. contraindications
Other Office and Home treatments (heating compress [wet sock], neutral bath,
Epsom salts soak, contrast showers, other contrast applications)
a. applications
b. primary indications
c. contraindications (continued on next page)

Student Name:
Supervisor
Initial/Date
ELECTROTHERAPY TREATMENTS
Diathermy
a. application
b. primary indications
c. contraindications
Ultrasound (including phonophoresis)
a. application
b. primary indications
c. contraindications
Low Volt NEMS
a. application
b. primary indications
c. contraindications
Interferential NMES
a. application
b. primary indications
c. contraindications
DC (Galvanic) Iontophoresis
a. application
b. primary indications
c. contraindications
Low Level Laser Therapy (LLLT)
a. application
b. primary indications
c. contraindications
MANUAL THERAPIES
Soft Tissue Assessment
a. tissue texture evaluation
b. muscle tension evaluation
c. active/passive/resisted joint range of motion
d. Indications for treatment
e. Contraindications of treatment
Local Tissue Release Techniques
a. NMT
b. Swedish massage basic techniques
Muscle Energy (stretching) Technique (MES/MET)
a. lower extremity/low back muscles
b. upper extremity/neck/shoulders muscles
ORTHOPEDIC ASSESMENT
a. knee
• Ant /Post drawer sign (continued on next page)
Quarter/Year:
57

Student Name:
Supervisor
Initial/Date
ORTHOPEDIC ASSESMENT cont’d
• Apley’s compression/distraction tests
• patella femoral grind
• Lachman’s test
• ballotable patella test (major effusion)
• bulge test (minor effusion)
b. hip/pelvis/SI
• trendelenburg
• test for leg length discrepancy
• Patrick (Patrick-FABER) test
• Ely’s test
• Gaenslen’s test
• Hibb’s test
• Ober’s test
• Ortolani click
• pelvic rock test
• Thomas’ test
• Yoeman’s test
c. low back/sciatica
• Lasegue’s test (SLR)
• straight leg raise
• valsalva test
• Bragard’s test
• Bechterew’s test
• Minor’s sign
• Kemp’s test
• Milgram’s test
• Nachlas Test
• Kernig’s test
LBP Malingering Tests
• Hoover’s sign
• Burn’s bench test
d. shoulder
• Apley’s scratch test
• Drop arm test (Codman’s)
• Glenohumoral apprehension test
• impingement test (Neer’s, Hawking-Kennedy)
• Lippman’s test
• Speed’s test
• Yergason’s test
e. neck/TOS testing (continued on next page)
Quarter/Year:
58

Student Name:
Supervisor
Initial/Date
ORTHOPEDIC ASSESMENT cont’d
f. ankle/foot
• vertebral artery test
• cervical spine (foraminal) compression test
• cervical spine (foraminal) distraction test
• Lindner’s test (Brudzinski’s sign)
• Adson’s/reverse Adson’s (thoracic outlet)
• East’s test (Roos’ test) (thoracic outlet)
• Posterior drawer test
• anterior drawer test
• tibial torsion test
• dorsiflexion
• Homan’s sign
59
Quarter/Year:
• Forefoot squeeze test (Morton’s test)
h. elbow/wrist/hand
• Cozen’s test (lateral epicondylitis)
• Mill’s test (lateral epicondylitis)
• Golfer’s elbow test (medial epicondylitis)
• Finkelstein’s test (stenosing tenosynovitis)
• varus/valgus stress tests
• Phalen’s test
• Tinel’s sign
NEUROLOGIC ASSESSMENT
a. DTR’s
b. Romberg
c. Babinski
d. muscle strength testing
e. sensation testing
OSSEOUS MANIPULATION ASSESSMENT
a. static palpation
b. motion palpation
OSSEOUS MANIPULATION TECHNIQUE
(know indications, contraindications, correct manipulation set up, and technique)
a. joint manipulation set up
b. joint manipulation
• cervical spine
• thoracic spine
• ribs
• lumbar spine
• sacrum (SI joints)
PATIENT EDUCATION RE: PREVENTION OF MUSCULOSKELETAL PROBLEMS
a. Prevention (continued on next page)

Student Name:
Supervisor
Initial/Date
ORTHOPEDIC ASSESMENT cont’d
• Activity Modification
• Correct lifting
• Ergonomic work stations
• Functional training
• Postural training
• Rest
Quarter/Year:
60

ND COUNSELING CLINICAL COMPETENCIES
Mission Statement: The mission of the Counseling Department is to train naturopathic medical
students in relationship-centered care and help students achieve personal integration. During their first
rotation the students will meet the following competencies. Any further advanced counseling shifts
will expand these competencies.
BASTYR UNIVERSITY
BASTYR CENTER FOR NATURAL HEALTH
ND COUNSELING: CORE CLINCIAL COMPETENCIES
Student:
Quarter/Year:
Supervisor:
___________________________________
___________________________________
___________________________________
Competence in Basic Counseling Skills
Establish rapport, which includes demonstrating counseling characteristics of:
Congruence
Empathy
Positive regard
Reinforcing individual strengths
Collaboration
Demonstrate communication skills:
Attending Behavior (eye contact, vocal qualities, verbal tracking, body language)
Open and Closed Questions
Encouraging, Paraphrasing, & Summarizing
Reflection of Feeling
Confrontation
Focusing
Interpretation/Reframe
Appropriate Use of Self-Disclosure
Feedback
Offers Appropriate Information/Advice
Directives
Reflection of Meaning
Collaborative Goal Setting
Competence in Psychological Assessment
Conduct and Document Initial Assessment Interview, including:
Psychiatric History
Etiology
Symptom Presentation (Frequency, Intensity, Duration)
Precipitants/Triggers
Diagnostic Impression/Dynamic Formulation
Treatment Plan
Mental Status Exam
Recognize indicators of psychological conditions, assess according to current DSM and naturopathic
perspective, and make appropriate treatment plan.
61

Demonstrate Competency in Assessing the following areas:
Axis I Clinical Syndromes and V Codes
Axis II Personality Disorders
Axis III Related Medical Conditions and Holistic Assessment of Functioning
Axis IV Psychological Stressors
Axis V Global Assessment of Functioning
Demonstrate appropriate charting skills including:
Ongoing treatment/SOAP notes
CPT Codes
Demonstrate the ability to differentiate and articulate symptoms from cause:
Identify stages of change demonstrated by the patient.
Demonstrate the ability to assess and refer for suicidal behavior.
Demonstrate the ability to assess and refer for homicidal behavior.
Demonstrate the ability to assess and refer for domestic violence.
Demonstrate the ability to assess and refer for child/elder abuse.
Competence in Whole Person Healing and Integration of Naturopathic Principles
Discuss and apply counseling principles within the context of Naturopathic Medicine:
1. Vis Medicatrix Naturae (the Healing Power of Nature)
2. Tolle Causum (Treat the Cause)
3. Tolle Totem (Treat the Whole Person)
4. Primum Non Nocere (First Do No Harm)
5. Docere (Doctor as Teacher)
6. Prevention
Articulate spiritual considerations as they relate to patient wellness.
Competence in Professional Consultation and Referrals
Demonstrate the ability to determine when a referral is necessary and to refer out to appropriate mental
health providers.
Identify community and internet resources for providers and for patients.
Competence in Professional Conduct, Ethics, and Legal Matters
Recognize and maintain personal/professional limitations and boundaries.
Demonstrate personal maturity and emotional integration congruent with University policies and
professional standards.
Demonstrate behavior consistent with promoting health and appropriate self-care.
Demonstrate openness to present one’s work for ongoing critique, as well as an ability to hear and
incorporate feedback in clinical supervision and with peers.
Demonstrate time management skills.
Demonstrate ability to obtain and articulate informed consent (including principles of confidentiality).
Competence in Culture and Diversity
Demonstrate awareness of how one’s cultural background and experiences have influenced attitudes,
values, and biases about psychological processes.
Demonstrate awareness of own negative and positive emotional reactions toward other cultural.
groups/areas of diversity that may prove detrimental or challenging to the counseling relationship.
Recognize and use culturally appropriate assessment and intervention strategies.
62

DISPENSARY CLINICAL COMPETENCIES - SECONDARY
The dispensary competency is required during your secondary year of clinical training. You will sign
up for 4 small group discussions during the year. One of those discussions must cover Quality
Assurance Standards. This discussion group will be offered multiple times during the year. Other
topics will be offered in rotation and are based on a systems approach to treatment. You will attend
three other discussion groups during the year on topics of your choice. Only 12-15 students are
allowed per discussion group, and priority is given those who sign up. The competency will be
awarded on the following points.
Attendance
Preparation
Participation in Discussion-the student must participate in active discussions on three
conditions
o The student must be prepared to present information on three products chosen to treat a
condition. The products chosen may include encapsulated products, loose herbs,
tinctures, glycerites, solid extracts, homeopathics, flower remedies, drainage remedies
or topical treatments. Each discussion must include the following information:
•Ingredients
•Mechanism of action
•Desired beneficial effects
•Contraindications, if any
•Undesired effects, if any
•The above information may be applied to any of the following diagnoses or
conditions, though are not limited to these conditions. You may choose other
conditions under the general topic that you are interested in
Cardiovascular disease (hypertension, hyperlipidemia, coronary artery
disease, angina, etc.)
Dysglycemia (DM, IDDM, hypoglycemia
Upper gastrointestinal disorder (GER, GERD, PUD, dyspepsia)
Lower gastrointestinal disorder (IBD, IBS, Crohn’s, UC, Celiac,
constipation, diarrhea, etc…)
Hepatobiliary disease (cholelithiasis, hepatitis, metabolic liver disease, etc.)
Cancer prevention or treatment
Skin diseases (eczema, psoriasis, exanthums, acne, etc…)
Hematological disorders (anemia, leukemia, dyscrasias, etc…)
Bone disorders (osteoporosis, osteomalacia, osteopenia, rickets)
Female gynecological conditions (fibroids, FBD, menopause, PMS,
PCO/PCOS, dysmenorrhea, abnormal pap, etc…)
Male genitourinary conditions (BPH, prostatitis, epididymitis, etc…)
Acute Respiratory Tract disorder
Chronic Respiratory tract disorder
Nutritional deficiency
Acute urinary tract or kidney disorder
Mental or emotional illness
Nervous system disorder (insomnia, dizziness, seizure, paresthesia, etc…)
HIV
Endocrine disorders
Autoimmune conditions
Acute musculoskeletal disorders
Chronic musculoskeletal disorders
63

The project is required to increase knowledge of products available to treat common conditions and to
allow the student practice integrating and communicating their knowledge of botanical, nutritional, and
homeopathic treatment modalities in the clinical setting before they become primary clinicians. The
learning objectives for the project include the following:
1. Integrate mechanism of action, safety and physiology to the choice and application of treatment
to a mock patient pathological condition or case.
2. Create treatment plans that may be applied to patient care in the clinical setting.
3. Articulate and define individual circumstances of treatment application based on the
naturopathic principles and determinants of health.
The competency is presented and managed by a naturopathic physician with years of clinical and
preceptor and teaching experience. You must utilize professional demeanor and communication in all
your interactions with your instructor and each other during these discussions.
When you have completed the competency as outlined, your instructor will sign off a section of the
overall competency. If you do not complete the competency during the discussion to the satisfaction
of the moderator, you may repeat the section without sanction until you attain the competency. You
must complete this entire competency before moving into the primary role.
Quality Assurance Discussion Group 2 Discussion Group 3 Discussion Group 4
Signature/Date Signature/Date Signature/Date Signature/Date
Databases that may be helpful in preparing for your project:
www.naturaldatabase.com
www.naturalstandard.com
www.consumerlab.com
You are welcome to use other resources and share those resources with others in the group.
Kathie Golden, ND
64

HOMEOPATHY CLINICAL COMPETENCIES (OPTIONAL AND ELECTIVE)
Mission Statement: Homeopathy is an integral part of naturopathic medicine and a vital tool used by
naturopathic doctors in healing their patients. Bastyr University is committed to teaching homeopathy
with the highest standards in order to graduate naturopathic doctors who are competent and skilled in
the use of homeopathic medicines. Note that All homeopathic student clinicians are required to
attend a minimum of five sessions of Grand Rounds for each homeopathy shift in order to enhance
their clinical case study and analysis experience in Homeopathy. Primary clinicians are required to
attend Homeopathic Grand Rounds whenever they have a case that needs study and analysis
beyond the homeopathic clinic office call procedure.
REQUIREMENTS TO ENROLL IN OPTIONAL HOMEOPATHY SPECIALTY SHIFTS
Student Name:
Quarter/Year:
Supervisor
Initial/Date
Requirements
To register for a homeopathy shift as a secondary student clinician:
Complete Homeopathy III. Registration in Homeopathy IV is preferred.
Attend Homeopathy Grand Rounds as assigned each quarter
To become primary clinician complete all the following requirements. This may occur
your first quarter in homeopathy:
Fulfill the responsibilities of a secondary clinician.
Complete and turn in written analysis on 2 cases that you have observed.
Act as primary clinician on one office call. Includes taking and analyzing the case, and
writing up the patient’s chart notes.
Be available for case discussion with supervising doctor.
Demonstrate the ability to remain present and receptive to the patient.
HOMEOPATHY CLINICAL COMPETENCIES - SECONDARY
Student Name:
Supervisor
Initial/Date
Requirements
65
Quarter/Year:
The following requirements are the same as for a general Patient Care Shift:
• Attendance is required, as described in the Student Clinician Handbook.
• Ensure appropriate forms are available for signature. (dispensary/consent forms & treatment plans)
• Track patient contacts.
• Professional Cooperation with the colleagues and the supervising doctor.
• Participate in taking the case - demonstrate active listening and appropriate questioning.
• Participate in case preview/review - prepared for preview familiar with patient charts.
The following requirements are unique to a Homeopathy Specialty Shift:
• Take the patient’s case with appropriate homeopathic underlining, observations, etc. on
all patient visits.
• Study the case alone, or with a primary clinician, and be prepared to discuss and analyze
the case with the supervising doctor in case preview/review.
• All homeopathic student clinicians are required to attend a minimum of five
sessions of Grand Rounds per shift. Primary clinicians may be required to attend
additional Grand Rounds when they have a case that needs study and analysis beyond
clinic.
• All homeopathic clinicians should be able to demonstrate adequate knowledge and use
of the repertory and materia medica as it applies to the patient’s symptoms

HOMEOPATHY CLINICAL COMPETENCIES - PRIMARY
Student Name:
Supervisor
Initial/Date
Competency
Quarter/Year:
The following requirements are the same as for a general Patient Care shift:
• Assume responsibility for attendance, charting, and tracking the number of patient
visits according to clinic policy
• Track patient contacts and ensure that you have seen an adequate number of patients.
• Professional cooperation with colleagues and supervising doctor.
• Participate in case preview/review.
• Adequately chart the patient’s visit in a timely fashion (within 24 hours)
Communication skills:
• Explain homeopathy treatment to the patient in clear and understandable terms.
• Instruct patients how to take the medicine appropriately and what to expect from their
treatment.
• Discuss with the patient what we expect from them in terms of life-style habits, making
follow-up appointments, when they can phone the clinic, etc.
• Display open and cooperative communications with peers and with supervising
doctors.
• All students will be held to the highest standards of professional and ethical behavior.
These include: patient confidentiality, personal responsibility, impartiality,
professional accountability and an appropriate understanding and respect of ethical
personal boundaries.
Case taking skills:
• Establish adequate rapport with patient.
• Demonstrate proper use of open ended and confirmatory questions, listening skills and
full homeopathic case taking plus review of systems, past medical history, family
medical history, etc.
• Be able to take a full case in a reasonable amount of time.
• Demonstrate good charting skills, including underlining and completeness of
information that is readable and relevant.
Case assessment and analysis skills:
• Medical differential diagnosis.
• Proper lab and other testing in order to confirm the diagnosis.
• Proper physical examinations.
• Identify acute vs. chronic prescribing.
• Identify the patient’s complaints from a homeopathic perspective. This includes the
chief complaint, the center of gravity, the etiology, the recognition of general,
particular, and mental/emotional symptoms; the differentiation of strange, rare, and
peculiar symptoms from common symptoms; identification of the miasmatic basis of
the patient’s disease, and an assessment of the strength of the patient’s Vital Force.
• Demonstrate an adequate knowledge and use of the repertory and materia medica as it
applies to the patient’s symptoms.
(continued on next page)
67

Student Name:
Supervisor
Initial/Date
Competency
Quarter/Year:
• Demonstrate the systematic thought processes of homeopathic assessments: essence,
keynote, totality, etiology, reliable symptoms, etc.
• Demonstrate adequate knowledge of comparative materia medica, and confirmatory
and keynote symptoms, in order to arrive at the proper selection of the medicine.
• Give rationale for potency selection.
• Give evaluation of prognosis of treatment.
• Document all of the above in chart for each visit.
Follow-up case skills:
• Show initiative and persistence in following up with supervisor and patients.
• Take follow-up case appropriately and comprehensively.
• Evaluate the action of the remedy within appropriate timelines.
• Demonstrate the ability to effectively communicate with other medical
professionals, and to refer to them when appropriate, in order to ensure optimal
patient care.
68

BUSINESS SECTION
69

BILLING
CURRENT PROCEDURAL TERMINOLOGY (CPT)
Bastyr Center for Natural Health uses CPT codes according to the standards agreed upon by CMS and
associated medical groups. The chosen CPT codes reflect the level of service provided during each
patient visit. The supervising clinician is responsible for choosing the correct CPT code for the visit,
and for recording it on the patients billing and lab forms.
Important principles for choosing CPT codes include:
• A new patient is one who has not received any professional services from the clinician or
another clinician of the same specialty who belongs to the same group practice within the past
three years.
• Counseling is defined as a discussion with a patient and/or family concerning diagnostic
results, impressions or recommendations, prognosis, risks evaluation and risk reduction.
PATIENT CARE CPT CODING WORKSHEET
[Used to calculate visit fee - Not to be filed with the Medical Records]
On the following four pages, you will find the BCNH Patient Care CPT Coding Worksheet. It is to be
optionally used by supervisors or student clinicians on shift as a guide to choosing the correct CPT
code for the level of visit complexity, the number of history elements obtained, and the number of
physical exam elements performed. All criteria included in the tables are derived from the
documentation guidelines.
NEW PATIENTS:
Requires all three Key Components – History, Physical Exam and Decision Complexity.
Decision
Code History Physical Exam
Complexity
CC:
99201
1 System/Area
Straight
HPI [1-3]
Focused
[1-5 elements]
Forward
areas
99202 Expanded
Problem Focused
99203
Detailed
99204
Comprehensive
99205
Comprehensive
CC:
HPI [1-2]
ROS [1]
areas
CC:
HPI [4-7]
ROS [2-
9]
PFSH [1]
areas
CC:
HPI [4-7]
ROS [10]
PFSH [3]
CC:
HPI [4-7]
ROS [10]
1+ Systems
[6 elements]
6 Systems/Areas w/2
Elements or 2 Systems/Areas
w/12 Elements
9 Systems/Areas
w/2+ Elements
9 Systems/Areas
w/2+ Elements
Straight
Forward
Low
Moderate
High
Counseling
[Health]
10 minutes
20 minutes
30 minutes
45 minutes
60 minutes
70

RETURN PATIENTS:
Requires 2 of the following 3 Key Components – History, Physical Exam and Decision Complexity.
Decision Counseling
Code History Physical Exam
Complexity [Health]
99212
1 System/Area
Straight
CC: HPI
10 minutes
Focused
[1-5 elements]
Forward
99213 Expanded
Problem Focused
99214
Detailed
99215
Comprehensive
CC:
HPI
ROS [1]
CC:
HPI
ROS [2-9]
PFSH [1]
CC:
HPI
ROS [10]
PFSH [3]
1+ Systems
[6 elements]
6 Systems/Areas w/2
Elements or 2
Systems/Areas w/12
Elements
9 Systems/Areas
w/2+ Elements
Low
Moderate
High
15 minutes
25 minutes
40 minutes
History of Present Illness [HPI]
Includes the Elements Listed Below
Location
Quality
Severity
Duration
Timing
Context
Modifying Factors
Associated Signs and Symptoms
HPI Notes
Brief HPI: The medical record should describe 1-3 elements
of the present illness.
Extended HPI: Description should include at least 4
elements of the HPI or the status of at least 3 chronic or
inactive conditions.
Past Family and/or Social History (PFSH)
Consists of a Review of 3 Areas
Past History: The patients past experiences with
illnesses, operation, injuries, and treatments
Family History: A review of medical events in the
patients family, including diseases which may be
hereditary of place the patient at risk
Social History: An age appropriate review of past
and current activities
PFSH Notes
Pertinent PFSH: At least one specific item
from any of the three history areas must be
documented of a pertinent PFSH.
Complete PFSH: At least one specific item
from each of the three history areas must be
documented.
71

Review of Systems [ROS]
Includes the Systems listed below
Constitutional Symptoms [e.g.
fever, weight loss, etc.]
Eyes
Ears, Nose, Mouth, Throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
Hematological/Lymphatic
Allergic/Immunologic
Other Comments/Additional
Instructions:
ROS Notes
Problem Pertinent ROS: The patient's positive responses and
pertinent negatives for the system related to the problem should
be documented.
Extended ROS: The patients positive responses and pertinent
negatives for 2 – 9 systems should be documented
Complete ROS: At least 10 organ systems must be reviewed.
Those systems with positive or pertinent negative responses
must be individually documented. For the remaining systems, a
notation indicating all other systems are negative is permissible.
In the absence of such a notation, at least 10 systems must be
individually documented.
Notes for Coding
Problem Focused: A limited examination of the affected body
area or segment or organ system. 1-5 elements.
Expanded Problem Focused: A limited examination of the
affected body area or organ system and any other symptomatic
or related body area or organ. 6+ elements.
Detailed: An extended examination of the affected body area of
organ system and any other symptomatic or related body area or
organ system. At least 2 elements from each of the 6 areas or at
least 12 elements in 2+ areas.
Comprehensive: A general multi-system examination of a
single organ system and other symptomatic or related body area
or organ system. All elements in at least 9 areas.
72

FEES AND PAYMENT
•Three components of an office visit are key to determining the level of E/M (Evaluation and
Management) service. They are: History, Examination, and Medical Decision
Making/Complexity of Case as docu.
• The quantity of detail, counted as elements, in areas of History of Present Illness/Chief
Complaint (HPI/CC), Past/Family/Social History (PFSH), Review of Systems (ROS), and
Physical Examination further impacts the level of CPT chosen.
•Time, in reference to a patient visit, equals face-to-face time working with the patient.
•There are five E/M levels of risk and complexity: Minimal, Self-Limited, Low, Moderate,
and High.
• To select a CPT code for a new patient visit, the E/M services provided must meet or
exceed established criteria in all three key components described above. A return office visit
must meet or exceed only two, and one must be the level of medical decision
making/complexity.
• In the case where counseling and/or coordination of care constitutes more than 50 percent
of the clinician/patient and/or family encounter (face-to-face time), then time alone becomes
the determining CPT factor. Quantity of time must be documented.
•The CPT code series most used at Bastyr Center for Natural Health in ND patient care are
Office or Other Outpatient Services (99201-205, 99221-215), Preventive Medicine Services
(99381-387, 99391-397), and Counseling and/or Risk Reduction Intervention (99401-404).
BILLING DOCUMENTATION GUIDELINES (DG)
•Pertinent factors of Complexity of Medical Decision Making including Number of
Diagnoses or Management Options, Amount and/or Complexity of Data to be Reviewed, and
Risk of Significant Complications, Morbidity, and/or Mortality.
•An Encounter Dominated by Counseling or Coordination of Care, particularly the element
of time.
• The correct number of elements of CC, HPI, ROS, PFSH, and Examinations to correspond
with the Complexity of Medical Decision Making and CPT chosen.
INTERNATIONAL CLASSIFICATION OF DISEASES (ICD-9)
• Every condition actively addressed during the patients present clinic visit, and only those
conditions, must be assigned a specific ICD-9 code. All ICD-9 codes pertaining to an individual
patient visit must be recorded in the required locations in the written record, including the
assessment section. However, only four ICD-9 codes should be listed on the billing form.
• All ICD-9 codes must be numbered by priority on each billing form and in the patient chart.
73

LABORATORY PROTOCOLS
HOURS OF OPERATION
Laboratory hours of operation are as follows:
Open: 8:30 a.m. to 8:30 p.m. Monday, Tuesday, and Thursday
8:30 a.m. to 4:30 p.m. Wednesday, Friday
8:30 a.m. to 12:30 p.m. Saturday
Closed: 12:30 until 1:30 on Monday through Friday
5:00 until 5:30 on Monday, Tuesday, Thursday
LABORATORY PROCEDURES
BCNH has an affiliation with Pacific Physicians Laboratory (PPL). With this relationship, there will be
a PPL phlebotomist in the lab area for most hours that the clinic is open for patients. The phlebotomists
are employees of PPL and are here to assist the clinic in the care of our patients. They are not clinic
employees and cannot be used for services outside the lab.
There are two general categories of lab services that we provide: Outside Labs (Reference Laboratory,
including PPL and other labs) and In-House labs (Waived tests). Waived tests are those tests that
physician practitioners are legally able to perform in their offices.
• All outside lab specimens will go through PPL including non-reference labs (Great Smokies,
Immunolabs, etc.). These will all be collected, prepared, and processed by the phlebotomist.
• Waived tests can be performed here in the lab area by physicians with the assistance of
student clinicians, or may be sent out to PPL. When we elect to do a waived test here, it is our
responsibility to make the appropriate diagnosis from the lab result.
• Only physicians can use the microscope to interpret lab results, students and the medical
assistant (MA) can look but CANNOT interpret the results. A physician must record the lab
results on the results sheet.
Waived tests include the following and are to be performed only in the lab area:
• UA-dipstick and micro
• KOH preps
• wet preps
• hematocrit
• rapid strep
• guiac
• fern
• glucometer
• nasal smear
• pregnancy
• pinworm
After your clinical diagnosis class, you should be reasonably comfortable doing dipsticks, wet mounts,
KOH, guiac, rapid strep and PG tests-though only your supervisor can report the results. The
following tests require a higher level of skill and your supervisor may complete them personally or
may choose to send them out: UA-microscopy, nasal smear, hematocrit and fern. There may be
situations where a second opinion is desired. BCNH encourages calling the techs/pathologist at PPL,
rather than relying on specific faculty with lab expertise.
74

When a supervisor needs to do a waived lab test performed in-house, the physician will decide how to
proceed:
• They can collect and prepare the sample themselves, and interpret the result-providing
educational opportunities for their students.
• Or, if the test involves microscopy, they can contact the in-house on-call resident to prepare
and interpret the result. The on-call resident may be covering a shift, and therefore, not always
available. Students may be directed to review the findings for educational purposes.
• In all cases, the lab results must be reviewed and recorded on the results sheet by the
supervising physician, signed by the supervisor, and placed in the patient chart.
In the event that a provider requires an ASAP lab test performed, the phlebotomist can arrange to send
the sample to PPL in a taxi. (As a reminder: ASAP tests, results of which should be available within
one hour, cover a broad range of tests. Results of ASAP tests can offer definitive diagnostic
information and direct specific therapy. STAT tests comprise those procedures for which results are
needed within seconds to minutes. When dealing with life-threatening conditions, these test results
may be essential in guiding therapy in the crucial first few minutes after a clinically unstable patient
arrives in the center.) In the case where a STAT test is required, in all likelihood, the supervisor should
arrange for the patient to be transported by 911 to an emergency department.
Students may, with the permission of their supervisor and under direct supervision from the same,
perform phlebotomy on their patients. All students must adhere to the following guidelines prior to
drawing any samples:
• Notify the phlebotomist first before taking the draw kit
• The phlebotomist must double check the paperwork
• The phlebotomist must double check that the students are drawing the correct samples
• PPL will be billing the patient for the draw fee as they are providing the materials
• The clinic blood borne pathogen safety procedures will be followed at all times. See the
safety section to review those rules.
LAB PAPERWORK
All waived tests that are done in-house must be charged for on the superbill, and there is no need for a
lab requisition form.
All labs to be sent to outside facilities (PPL or otherwise) must be accompanied by a lab requisition
form that is properly filled out in pen. The white copy goes to the phlebotomist in the lab or is placed
in the “Lab Requisitions” file above the phlebotomist’s desk, the yellow copy goes into the chart, and
the pink copy goes to the patient (this is especially important if the patient is going to a different
facility for their draw or if they are returning to BCNH at a later date for their draw). Ensure that all
copies of the form are completed accurately through the three layers of the form.
All Pap and other samples to be sent to pathology require information sections of the lab specimen
identification form be completed by the physician.
LABORATORY WORKFLOW
The lab tech is in the lab during open clinic hours except during the designated lunch and dinner breaks.
All patients needing draws should be scheduled through the front desk to ensure that there is time and
space to see them immediately. Students may draw blood for any tests under the supervision of
supervising faculty. All specimens are to be labeled and placed on the bench with appropriately
completed forms. LABEL: patient last name, first name; date collected; source. Samples collected
from patients in exam/ treatment areas must be handled following blood borne pathogen safety
procedures and transported to the lab in accordance with OSHA guidelines. This includes containing
samples completely and transporting in a gloved hand(s). Every lab procedure that is performed or
sent out must be coded and billed appropriately. Even though the student or provider may draw the
specimen and/or perform a lab test, we must charge for the resources that have been utilized. Any
75

discounts or special rates will be determined by the clinic policies in place and managed through the
phlebotomist or front desk staff. Obtaining and processing of a sample can take up to 30 minutes,
depending on the request. It is during the immediate post-closing time that work already requested is
finished, and the laboratory is cleaned and disinfected for the next day. All lab work is to be brought to
the lab or requested 30 minutes prior to the lab’s posted closing time. Should there be an emergency
that may require the lab to remain open past its closing time, please notify the lab personnel as soon
as possible. Poor time management is no reason for staff to stay later than their posted time.
For patients who need laboratory work during closure hours, please refer them to the front desk for a
lab appointment time.
LABORATORY TEST FEES AND BILLING
Whenever an outside lab is ordered, the patient must be informed that additional fees will be incurred
and that they will be billed for these fees.
Only laboratory personnel will quote test fees with the patient. The supervising physician may research
the cost and give an estimated cost to the patient.
Reference laboratories may have a multi-tiered fee schedule. In such cases, a discussion with
laboratory personnel is required to clarify which schedule to apply. Criteria to determine such an
application include:
•Insurance coverage
•Payment at time of service option
• Payment included with specimen option
• Specific reference laboratory offering the requested test(s)
Laboratory personnel bill patients for laboratory testing. Any tests that are subsequently requested will
be billed to the patient by the testing entity.
LABORATORY TEST RESULTS
Original reports of lab test results will be placed in the ordering physician’s mailbox for review,
response and signature. A copy of the test results will be placed under the physician’s name in the
folding blue file in the faculty assistant’s office for students to review. The physician will route the
reports to the patient’s chart for filing by placing the signed report in the loose paperwork medical
records box hanging on the outside of the chartroom door. Duplicate copies of all lab reports are stored
for two months in the lab.
76

APPENDICES
1. Student Clinician Absence/Substitute Form
2. ND Physical Exam Guidelines for Clinical Competencies
3. Naturopathic Treatment of Malignancy Consent Form
77

Appendix 1
BASTYR CENTER FOR NATURAL HEALTH
Student Clinician Absence / Substitute Form
It is the responsibility of every Student Clinician to inform their assigned Supervisor
of any planned absence from the clinic, and give this form to the Faculty
Administrative Assistant.
Please follow the procedures outlined below:
1. Fill out the bottom portion of this form completely, otherwise it will be
returned to you for further clarification. Fill out a separate form for each shift
and planned absence.
2. Notify the Supervisor of each shift you plan to miss, and have him/her sign
the appropriate space below.
3. Primary and Secondary Student Clinicians must obtain a substitute for each
shift you plan to miss, and have the substitute sign the appropriate space below.
A copy of the completed form or confirmatory email should be sent to the sub by
the absent clinician.
4. Once the form is complete, submit it to the Faculty Administrative Assistant in
room S 206 (second floor). The form is retained on a quarterly basis.
5. All of these procedures must be followed in advance of the planned
absence.
6. If you are suddenly ill or have a personal emergency, you must call your
supervisor and the front desk at the clinic as soon as possible to notify them in
person.
7. An unexcused absence will result in an automatic fail for the quarter.
Name of Student (Please Print): ______________________________________________
Today’s Date: _______________
Date of Absence: ______________
Department (Please Circle):
Acupuncture/Oriental Medicine Dispensary Counseling
Naturopathic Patient Care Homeopathy Nutrition
Physical Medicine
Lab
Shift (Please Circle): Morning Afternoon Evening
Reason for Absence: ____________________________________________________________
Signature of Supervisor: _____________________________________________________
Name of Substitute (Please Print): ___________________________________________
Signature of Substitute: _____________________________________________________
78

Appendix 2
BASTYR CENTER FOR NATURAL HEALTH
STUDENT DAILY SHIFT CHECK-OFF EVALUATION FORM – PATIENT CARE
STUDENT NAME: ______________________________ DATE: _____________
QUARTER/YEAR: ______________ SHIFT: ____________________________
NUMBER OF PATIENTS SEEN ON SHIFT: ____________________________
RATING SCALE:
NA = not applicable
1 = unsatisfactory (F)
2 = adequate (AC)
3 = good (AC)
4 = excellent (AC)
An AC grade is given if the student has successfully demonstrated competency (2, 3 or 4 on scale
above) in all the clinical categories appropriate to her/his status in clinic. A PC grade is given if all
critical clinical skills are successfully demonstrated and one non-critical skill is assessed as
unsatisfactory (1 on scale above). An F grade is given if one or more critical clinical skill is assessed as
unsatisfactory, or if two or more non-critical clinical skills are assessed as unsatisfactory at a level
appropriate to the student’s status in clinic. If a PC grade is given, a letter detailing requirements for
changing the PC to an AC must accompany the grade. See the Clinic Handbook and grading manual
for details.
Supervisor
Initial/Date
Objective
Clinical Skills
Initiative, motivation, responsibility
Communications skills and rapport with patients
Interview skills (S)
Physical exam (O)
Differential diagnosis/assessment skills (A)
Knowledge of naturopathic therapeutics and their proper application
Patient case preparation and follow up
Familiarity with clinic policies and procedures and efficiency in following them
Listening skills
Time management skills
Proper use of lab, diagnostic studies, etc.
Ability to make an appropriate referral when needed and ability to write up referral
Charting technique (completeness and clarity)
Participation and input in case discussions on shift, case preview and case review
Summary comments: This space for comments/suggestions/recommendations and/or
to explain and clarify ratings above. Supervising Clinic
al Faculty must sign & date.
Supervisor’s Signature ________________________________ Date ________________
79

Appendix 3: ND PHYSICAL EXAM GUIDELINES FOR CLINICAL COMPETENCIES
The Abdominal Examination Benchmark
Basics:
The abdominal Examination proceeds through look, listen, then feel. Ensure the following throughout
the examination.
Patient comfort is maximized
Patient is supine, draped and only the abdomen is exposed
Their head is supported by a pillow
Their knees are slightly flexed to relax abdominal muscles
Their hands are on their chest or by their side
Your hands are WARM
Watch the patient’s face throughout the exam for signs of distress
The painful or tender area is examined LAST
A. Inspection:
1. DO: Observe for:
Patient distress (does it hurt the patient to move or cough?
Abdominal distension, if present, is it localized or generalized?
Scars
Masses
Visible organomegaly
2. KNOW:
The abdomen is typically divided into 4 quadrants-R & LLQ, R & LUQ
And additional three middle or central regions-epigastium, peri-umbilical &
hypogastrium/supra-pubic
A localized bulge in the abdominal wall may suggest a hernia
Patients with peritonitis have increased pain with sudden movements of the abdomen,
like coughing, walking, or when bed is bumped
B. Auscultation
1. Do:
Listen in one place with the diaphragm of the stethoscope until you hear bowel sounds.
Listen for bruits in the epigastrium and both upper quadrants
2. KNOW:
Normal bowel sounds rate and sound
In bowel obstruction, bowel sounds may be high pitched and tinkling
In complete obstruction, there may be no bowel sounds, but you may have to listen for 2
minutes to make sure there are no sounds
An isolated systolic bruit heard in the epigastrium can be regularly heard in normal
persons.
C. Percussion
1. DO:
Percuss the abdomen lightly in all four basic quadrants
Percuss, in the mid-clavicular line, the upper liver margin superiorly and the lower liver
margin inferiorly. OR you may palpate the lower liver margin inferiorly.
Measure the distance between the upper liver margin and the lower liver margin in the
mid clavicular line.
If you suspect ascites on the basis of bilateral flank bulging or dullness to percussion,
then also perform one of the following tests:\
80

Fluid Wave:
Have the patient place the edge of their own hand on their anteriofr abdominal
wall to dampen false positive soft tissue waves
Lightly place your right hand on the right lateral side of the patient’s abdomen.
With the fingertips of your left hand, briskly tap the left lateral side of the
patient’s abdomen
In the presence of ascites, you will feel a tap against your right hand as the fluid
wave generated by your left hand travels through the ascites
Shifting dullness:
In the presence of ascites, air filled bowel loops float above the ascites fluid
In the supine patient, percuss the bowel bluid level on the patient’s lateral
abdominal wall (percussing from anterior to posterior) noting where the
percussion note changes from tympanitic (bowel loops anteriorly) to dull
(ascetic fluid posteriorly). Make a small mark with your pen to delineate this
line.
Have the patient assume a partial decubitus position angled towards you.
Again percuss the lateral abdominal wall and see if the bowel bluid interace
level has changed. If it has, it suggests that there is freely moving fluid (ascites)
within the abdomen.
2. KNOW:
The normal abdomen should have both tympanitic areas (gas filled bowel) and
dull areas (fluid filled bowel).
A protuberant abdomen that is diffusely tmpanitic suggests intestinal obstruction.
Localized percussion tenderness suggests peritoneal inflammation
The causes of ascites include liver disease, renal disease, inflammation, and
decreased intravascular oncotic pressure.
The determination of a given patient’s liver span varies between observers. The
more consistent you are in using the same method with every patient you
evaluate, the less variable your own examination becomes in assessing liver size.
Current references list different normal liver spans in the mid clavicular line as
follows:
Bates’ Guide to Physical Examination and History Taking: 6-12 cm
Evidence-Based Physical Diagnosis: 6-15 cm
Physical Diagnosis Secrets: less than 12-13 cm
D. Palpation
1. DO:
a. Palpate all four quadrants superficially once, then palpate them more deeply
b. Palpate the lower liver edge in the RUQ
Technique: Place your left hand behind the patient, along and just below their
11 th -12 th ribs
Ask the patient to relax, and press your left hand forward as they exhale
Place your right hand on the patient’s right abdomen in the mid clavicular line
Begin your palpation well below the lower border of liver dullness as
determined by percussion
Ask the patient to breath inward as you feel for their liver edge coming down to
meet your right fingertips
Repeat several times as necessary, keeping your left hand in the same place, but
adjusting your right hand’s position until the edge is palpated. Note whether it
is tender to the patient and the characteristics edge: soft, smooth, hard, nodular
c. Palpate for an enlarged spleen in the LUQ by using a similar technique except reach
across the patient with your left had, supporting and pressing forward with your left
81

hand on the patient’s left lower rib cage and adjacent soft tissues. Attempt to
palpate the spleen with your right hand in the LUQ
d. Assess the abdominal aorta for enlargement in people over 50 years of age or with
risk factors for cardiovascular disease
Technique:
Press inward in the epigastric region slightly left of the midline to identify aortic
pulsations
Now place your hands on either side of the aorta, and press inwards, attempting to
determine the width of the palpated pulsations being transmitted through overlying
tissue
Remember that you are feeling pulsations through multiple overlying tissues, so
even the normal adult aorta (less than 2.5-3.0 cm diameter) will feel wider than it is.
An aorta more than 5 cm diameter on ultrasound needs a vascular surgery consult
e. Elicit Murphy’s sign, McBurney’s sign and Rosvig’s sign if indicated by tenderness
on palpation
2. KNOW:
Definition and medical meaning of:
Peritonitis
Tenderness
Guarding
Rebound
Rigidity
McBurney’s Point
Murphy’s sign
82

Cardiac Exam Benchmark
Basics:
Places table in appropriate position for exam
The student explains benefit of examining in each of three positions.
A. Inspect & Palpate
DO: Demonstrates inspection
Palpates precordial region for lifts/heaves and thrills in appropriate regions
Palpates the PMI (point of maximal impulse) at the cardiac apex
2. Know
Definitions:
Heave or Lift (defines perimeters and location)
Thrill (defines perimeters and location)
Normal PMI (defines perimeters and location)
B. Auscultate
1. DO: Listen at four basic locations using the diaphragm of the stethoscope. At each
location, auscultate the normal heart sounds (S1, S2). At each location listen carefully for
murmurs and rubs.
Aortic area (R 2 nd ICS, upper right sternal border)
Pulmonic area (L 2 nd ICS, upper left sternal border)
At the pulmonic area, listen for the physiologic split of S2
Tricuspid area (l 5 th ICS, lower left sternal border)
Cardiac apex (mitral valve area)
Use the bell of the stethoscope and auscultate for S3 or S4
2. DO: If a murmur is heard, grade the murmur
3. KNOW: The physiologic actions that create S1 and S2
The normal S1-S2 sounds and where they are best heard
Difference between a physiologic and pathological split sound
Definition of a rub, where it is best heard
Definition of an S3, where it is best heard
Definition of an S4, where it is best heard
Definition of the five characteristics of a murmur and the location of the classic
murmurs
C. Assess Neck Veins and Determine JVP
1. Do:
Position and light the patient to visualize the neck and veins
Determine the JVP
2. The definition of the normal JVP
D. Palpate & Auscultate Carotid Arteries
1. Do:
Palpate each artery with appropriate technique
Auscultate each artery
2. Know:
Definition and location of murmurs heard in the Carotid Arteries
Definition, health considerations and location of bruit
E. Palpate Peripheral Arteries
1. Do: Palpate peripheral arteries with appropriate technique
2. Know:
Health considerations of absent pulses
83

Ethics Benchmark
As professionals, there are specific expectations regarding ethical knowledge and behavior.
Overall, we expect students will be able to:
Recognize ethical issues when they arrive in clinical practice
Reason through ethical dilemmas
Understand their responsibility to act (guiding principles of the profession)
Respond in ethically appropriate ways (carry out the appropriate action)
A. Ethics Knowledge: the student is familiar with ethics concepts presented in the first two years
(pre-clinical) of medical school, including:
1. Ethical issues in the physician-patient relationship.
a. Informed consent
i. Right to refuse
ii. Decision making capacity
iii. Surrogate decision makers
b. Confidentiality
c. Truth telling
2. Ethical issues at the end of life
a. DNR orders
b. Futility
c. Withholding and withdrawing treatment
B. Ethics Tools: the discipline of ethics relies on specific methods as tools to reason through
dilemmas and guide behavior in practice. Students will be familiar with:
1. Ethical principles that guide health care professionals, including students in training, in
appropriate care for patients in the clinical setting.
a. Respect for person (autonomy): respect for autonomy and self-determination
b. Nonmaleficence (first, do no harm): prevent harm, or minimize harm.
c. Beneficence: be of benefit to patients
d. Justice: Treat patients with integrity and fairness
2. A case-based method to work through ethical dilemmas. The student will be able to:
a. Describe core topic information in a case. Core topics are present in every clinical
encounter.
Medical considerations
Patient preferences
Quality of life
Contextual feature such as the family, the law, clinic policy, third party payers
and cultural traditions
b. Identify core issue or dilemma in case
c. Find relevant resources such as books, current articles, consultants
d. Propose and justify a course of action
C. Ethical Behaviors: recognizing ethical issues and knowing what is appropriate is only part
of what is expected of medical professionals and physicians in training. You must also be
able to act appropriately. This includes:
a. Understand and maintain professional boundaries with patients
b. Maintain patient confidentiality
c. Admit mistakes, lack of knowledge, errors, and omissions, and seek to correct them.
84

Head & Neck Examination Benchmarks
I. Basics
a. The head and neck examination is usually performed in the seated patient. Parts of the
neck examination and palpation of the thyroid gland may be performed with the
examiner standing behind the patient.
b. The cranial nerve examination may occur at the time of the head & neck examination or
separately as part of the Neurological examination. For the purposes of competency
examination, the cranial nerve exam is performed with the neurological examination.
II.
III.
IV.
Initial Inspection
a. DO:
i. Inspect the size and shape of the head
ii. Look for symmetry, masses and signs of trauma.
iii. Note any difficulty with breathing or speech.
b. KNOW - (the following terms):
i. Normocephalic: a normal sized and shaped calvaium
ii. Stridor: noise with breathing that is high-pitched, fine, and originates at the
level of the glottis or subglottis
iii. Hoarseness: arises from swelling or masses on the true or false vocal cords
Face
a. DO:
i. Inspect for symmetry and lesions.
ii. Palpate bony prominences, parotid glands, and temporomandibular joints (TMJ).
iii. Percuss the paranasal sinuses in the following areas for tenderness: above the
eyes (frontal), between the eyes (ethmoid), over the malar eminences (maxillary).
b. KNOW:
i. An acute facial fracture may result in point tenderness, step-offs, edema,
crepitus, and/or facial numbness.
Ears
a. DO:
i. Inspect the auricle and mastoid.
ii. Palpate the pinna and tragus for tenderness.
iii. With the otoscope examine the external auditory calans (EAC), tympanic
membranes (TMs), and note any middle ear structures visualized through the
TMs.
iv. Assess hearing one ear at a time with a tuning fork (512 Hz), ticking watch, or
light finger rubbing.
v. If hearing is asymmetrical or otherwise clinically deficient, perform the Weber
and Rinne Tests assessing for sensorineural or conductive hearing loss:
1. Weber’s Test: A 512 Hz vibrating tuning fork is placed on the patient’s
forehead, nasal bridge, or upper teeth and the patient is asked where the
sound is heard best. Normally the sound should be heard equally well in
each ear. If the sound is heard asymmetrically, it means one of two
things:
a. KNOW: there is sensorineural loss on the side with the
decreased sound OR there is conductive hearing loss on the side
with the increased sound
2. Rinne’s Test: the vibrating tuning fork is placed on the mastoid process.
It is then held just lateral to the ear and the patient is asked which
position produced the loudest sound. A positive Rinne’s test is a normal
test: Air conduction85
is greater than bone conduction.

The Neurological Exam Benchmark
Basics:
Parts of the Neurological Examination may be interspersed, depending on timing, exposure and
clinician preference with other segments of the health examination (E.g., cranial nerve exam at the
time of the HEENT exam, strength with the MS exam). The complete neurological benchmark must
be completed for competency to be awarded.
A. Basic Mental Status
1. Do: An assessment of:
Level of Consciousness
Orientation to person, place and time (Day, date, month and year)
Memory: short term (Three-word recall tests - items after 5 minutes)
long term (health history)
Language & Speech
2. Know: The following level of consciousness terms:
a. Alert
b. Lethargic
c. Stuporous
d. Comatose
3. Know: The following language/speech terms
a. Aphasia
b. Dysphonia
c. Dysarthria
B. Cranial Nerves II-XII
DO:
1. CNI – Olfactory – smell with alternate nostrils – coffee, mint, lemon etc…
2. CNII: visual acuity, visual fields, papillary reaction & Fundi
3. CNIII, IV & VI: ocular alignment, lid pupillary reaction & extra ocular movements
4. CN V: facial sensation (3 distributions – forehead, cheek, lateral jaw) & muscles of
mastication
5. CN VII: muscles of facial expression
6. CN VIII: hearing, nystagmus & balance
7. CN IX & X: palateal rise to phonation & coordinated swallowing
8. CN XI: sternocleidomastoid & upper trapezius strength
9. CN XII: tongue size and movement
KNOW:
a. The parasympathetic nervous system and the sympathetic nervous system
involvement in function of each nerve
b. Know which muscles and movements are controlled by CN III, IV & VI
10. Motor Function
DO:
a. Assess the following for each major muscle group of the upper and lower
extremities
i. Muscle bulk
ii. Muscle tone
iii. Strength (Myotomes)
Upper extremities: Deltoids, biceps, triceps, wrist flexors, wrist extensors,
hand grip, interossei muscles
Lower extremities: Hip flexors, hip extensors, quadriceps, hamstrings, ankle
dorsiflexors, ankle plantar flexors
86

The Pelvic Examination Benchmark
I. Basics & Preparation
Encourage your patient to void prior to this examination.
Wash your hands before the exam, and wear gloves on both hands, as indicated below.
Be attentive and ensure your patient’s comfort and modesty with draping and exposure.
Have appropriate supplies readily at hand: speculum, light source, cotton swabs, water soluble
lubricant, culture equipment (GC, Chlamydia, HSV) and for sampling the vaginal pool (swab in
test tube and carrier), and pap supplies (pap pak and liquid-pap supplies)
1. Have the patient disrobe, either completely or to socks, as indicated by physician choice.
The gown should close in the front or back, indicated by physician preference.
2. Assist the patient onto the table and adjust the pillow and stirrups to fit the patient’s body
size and positional comfort. Then perform any exam preceding the pelvic examination.
Keep movements smooth and gentle.
3. Give as much control as possible to the patient. Instruct her to let you know if you are
inadvertently hurting her, or causing discomfort. Provide reasonable explanations of your
movements and intentions as you proceed through the exam.
II. Examination-DO
1. Vulva & Introitus
A. Inspect:
1.Hair pattern over lower abdomen, groin and mons pubis.
2.Skin changes or concerning nevi
3.labia majora and minora
4.size of clitoris
5.inspect perineal region for lesions or scars
6.inspect the perianal region for external hemorrhoids or fissures
B. Palpate:
1.SBU-Skene’s gland, Bartholin’s gland, periurethral gland
2.Introitus-check for hymen
3.Check for location of cervix
4.Evaluate for pelvic floor relaxation-cystocele, rectocele and cervical descent or
prolapse
2. Speculum Examination-DO
A. Choose an appropriately sized speculum, and lubricated with a small amount of
lubricant (water based only).
B. Gently insert the speculum with the blades of the speculum oriented transversely and
the gyn light turned on.
C. Insert the speculum smoothly with the pressure downwards to avoid the sensitive
urethral area
D. Pass the speculum along the axis of the vagina, and gently rotate the speculum as it is
being moved inward so that the blades become horizontal in orientation.
E. Adjust the speculum and light as needed to visualize the cervix.
F. Examine the cervix:
1.Note the shape of the os, squamocolumnar junction, and any apparent lesions.
2.Obtain cultures from the endocervical region for GC and Chlamydia (leave swabs in
place for 30 seconds before withdrawing).
3.Obtain the Papanicolaou (Pap) smear.
a.Pap Slide-Spatula-Place longer end of spatula into cervical os and scrape 360
degree circle, then spread cells from blade to slide along one side of the slide.
Brush-then insert the brush inside the endocervix and turn 360 degrees. Wipe
the brush by rolling it down the slide. Drop on or spray with fixative.
87

Respiratory Clinical Benchmark Exam
Basics:
Table and patient are placed in the appropriate position for each section of the exam.
The student can explain the reason for position changes during the respiratory exam.
A. Inspection Posterior Chest:
a. DO: inspect for signs of respiratory distress
Inspect lips for color and nails for color and shape
Inspect the posterior thorax and lungs with patient arms crossed anteriorly over the
chest and hands placed on the opposite shoulder or arm
Listen to the patient’s breathing for wheezing or stridor
Inspect the neck for contraction of the sternocleidomastoid contraction or other use of
accessory muscles
Inspect the shape and movement of the chest for unbalanced movement or deformity
b. KNOW: Normal resting respiratory range for adult and child
Meaning of cyanosis and clubbing of the nails
Meaning of wheezing and stridor and accessory muscle use
Retraction of the interspaces indicates severe asthma, COPD or upper airway
obstruction
B. Palpation Posterior Chest:
a. DO: Palpate for tenderness, masses and fremitus
Test for chest expansion
i. Technique: Place thumbs at the level of the 10 th rib with fingers lateral
and parallel to the rib cage. Slide hands medially until there is a loose
fold of skin between thumbs and spine on each side. Have the patient
inhale deeply and observe the area between the thumbs for symmetry of
movement to evaluate for underlying fibrosis, pleural effusion, lobar
pneumonia, and unilateral bronchial obstruction.
Test for tactile fremitus
i. Technique: Using the ball or ulnar surface of the palm, palpate for
vibrations in the 8 points (4 on each side) on the posterior thorax for
symmetry, increase, decrease or absent sounds.
b. KNOW: Causes of unilateral decrease or delay in expansion
i. chronic fibrosis of lung or pleura, pleural effusion, lobar pneumonia,
bronchial obstruction
C. Percussion Posterior Chest:
a. DO: Percuss the posterior chest, in 14 points (7 on each side) as for auscultation, for
intensity, pitch and duration. (for technique, refer to “Guide for Physical Examination
and History Taking by Bates”). Evaluate each sound for dullness and hyper resonance.
b. KNOW: notes and characteristics of each note
i. Definitions:
1. Hyper resonance
2. dullness
D. Auscultation Posterior Chest:
a. Do: Auscultate the 14 points previously percussed differentiating for intensity, pitch,
and duration of inspiration and expiration and for adventitious sounds.
b. Know: Identification of vesicular, bronchovesicular, bronchial and tracheal
sounds.
Meaning of adventitious sounds including crackles (rales), wheezes and rhonchi and
how to utilize characteristics to focus diagnosis or rule out of pathology.
88

E. Examine, Palpate, Percuss and Auscultate the Anterior chest demonstrating respect for
anatomical differences of male and female patients.
Know: Techniques for clinical assessment of pulmonary function including vital
capacity, spirometry and imaging.
F: Perform special maneuvers-whispered pectoriloquy, egophony and bronchophony
Know: indications of positive results from special maneuvers.
G: Pearls:
Normal resting respiratory rate in an adult is 14-20 resps/minute
Cyanosis indicates hypoxia. It is most apparent in the lips and nails
Stridor is a high-pitched wheeze that is a sign of obstruction or secretions in the larynx
or trachea
Wheeze indicates constriction of the bronchioles
Crackles suggest lung pathology including pneumonia, fibrosis, early CHF or of the
airways as in bronchitis or bronchiectasis
Clearing of crackles, wheezes or rhonchi after coughing or percussion indicates
bronchitis or atelectasis.
89

Multi-System Screening Examination
Patient Seated
1. Check height and weight
2. Wash hands
3. Inspect general appearance
4. Check oral temperature
5. Palpate, compare, count radial pulse
6. Count respiratory rate
7. Measure blood pressure
8. Inspect skin and nails
9. Inspect and palpate the hair, scalp, skull and face
10. Inspect eyes (position alignment, lids, conjunctiva, sclera)
11. Inspect cornea, lens, PERRLA, corneal reflections
12. Funduscopic exam
13. Inspect and palpate external ears
14. Otoscopic exam
15. Inspect nose and palpate sinuses
16. Inspect lips, tongue, teeth, buccal and labial mucosa, pharynx
17. Palpate tongue, buccal and labial mucosa, palate, floor of mouth
18. Inspect neck (trachea, veins)
19. Inspect and palpate thyroid
20. Inspect and palpate posterior chest
21. Percuss posterior and lateral chest
22. Auscultate posterior and lateral chest
Patient Supine
23. Inspect and palpate the precordium (measure PMI)
24. Percuss cardiac border
25. Auscultate heart
26. Auscultate carotid arteries
27. Auscultate abdomen, mid-epigastrium and femoral areas
28. Palpate tibial and pedal pulses
29. Check for pedal, tibial and pre-tibial edema
30. Inspect and percuss abdomen
31. Palpate abdomen
32. Palpate bimanually for liver
33. Palpate bimanually for spleen
34. Palpate for cervical nodes
35. Palpate axillary and epitrochlear nodes
36. Palpate femoral nodes
37. Inspect and palpate joints
38. Test ROM of lower extremity
91

Patient Seated
39. Test ROM of upper extremity
40. Inspect and percuss spine and renal angles
41. Test ROM of cervical spine
42. Test ROM of lumbar spine
43. Check visual acuity (CN II)
44. Test EOM (CN III, IV, VI)
45. Check strength of temporalis and masseter (CN V)
46. Check facial muscles (CN VII)
47. Check auditory acuity (CN VIII)
48. Check phonation, uvula, tongue (CN IX, X, XII)
49. Check strength of SCM and trapezius (CN XI)
50. Check DTR at biceps, triceps, patellar, achilles (C 6 / 7 / 8 ) (L 3 / 4 ) (S 1 )
51. Check sensory with sharp and light touch on face and extremities
Patient Standing
52. Check gait
53. Assess judgment and insight
54. Assess orientation to person, place, and time
55. Assess recent and remote memory
56. Assess mood
Equipment Needed for this Exam
Thermometer
Blood Pressure Cuff
Rosenbaum Card
Pen Light
Ophthalmoscope
Otoscope
Nasal Speculum
Tongue Blade
Gloves
Stethoscope
Cotton-Tipped Applicator
Reflex Hammer
92

Appendix 4
Naturopathic Treatment of Malignancy Consent Form
In accordance with the Washington state licensing law of naturopathy, naturopathic doctors may treat
malignancy only in concert with an M.D. or D.O.
I, ______________________, request naturopathic care at the Bastyr Center for Natural Health.
(patient’s name)
An oncologist has diagnosed me with _________________________ cancer.
(type of cancer)
I am currently under the care of Dr. _____________________________ (M.D. or D.O.) for my cancer.
(name of doctor)
I understand that Washington law requires that any naturopathic care that I receive at the Bastyr Center for
Natural Health for the treatment of cancer be rendered in concert with a medical or osteopathic doctor. My
signature below attests to my understanding of this important relationship between my health care
professionals and my commitment to cooperate with my care providers in this collaborative treatment.
Date
Patient’s Name (Print)
Guardian’s Name (Print)
Patient’s Signature
Guardian’s Signature
93

INDEX
A
absence · 4, 12, 33, 36, 78
see unexcused
B
blood borne pathogen · 41
C
CPT codes · 70
E
external sites · 9
F
failure · 4, 24, 27, 30, 36
L
laboratory · 74
I
P
patient contacts · 4, 5, 6, 7, 25
Q
quarterly breakdown · 10
S
sanction · 40
substitute · 4, 5, 13, 78
T
time sheets · 5, 24
U
unexcused absence · 5
W
warning · 4, 36, 40
interim · 5
94