Instructor Monitoring Form

"*" indicates required fields

Instructor / Candidate Information:

Name of Instructor / Candidate:*

Training Site Affiliation*

Enter Training Site candidate is affiliated with or has approval for affiliation. If affiliating as a new training site put NEW prior to the training site name. If transferring to another Training Center, put TRANSFER OUT.

Instructor / Candidate Address:*

Street Address Address Line 2 City State ZIP Code

Instructor / Candidate Email:*

A copy of the completed monitor form will be emailed to the Instructor / Candidate.

Instructor / Candidate AHA ID:*

Obtain from the American Heart Association Instructor Network at https://ahainstructornetwork.americanheart.org

Reviewer / Training Center Faculty Information:

Name of Reviewer / Training Center Faculty:*

Reviewer Status:*

AHA Instructor / Course Coordinator

Training Center Faculty

Training Center Coordinator

Reviewer / Training Center Faculty Email:*

A copy of the completed monitor form will be emailed to the Reviewer / Training Center Faculty.

Monitoring Session Information:

Monitoring Date*

Type of Course Monitored:*

Disciplines Renewed

BLS

ACLS

PALS

Instructor Course Discipline:*

Course Location:*

Monitoring Type:*

Certification Expiration Date:*

Reviewer / Training Center Faculty (TCF) will use this form to assess the competencies of instructor candidates and renewing instructors. For each competency, there are several indicators or behaviors that the instructor may exhibit to demonstrate competency.

Remote Monitoring

Remote Monitoring Checklist

Professional environment

Instructor professional appearance

Adequate manikins

Use of current DVD

Students have workbooks

Link to Video:

1. ECC/AHA Cognitive and Psychomotor Skills

Definition (Goal): Maintains proficiency in provider-level cognitive and psychomotor skills; fulfills requirements for initial or renewal instructor certification

a. Demonstrates proficiency in provider-level skills:*

Conduct a provider skills test for the Instructor / Candidate utilizing the skills checklist for the course being monitored.

Successful

Needs Remediation

Provider Written Exam Score:

b. Teaches at least the minimum number of classes per cycle*

The AHA requires instructors teach at least four (4) courses per two (2) year certification period. List the date, course type (HS, BLS, ACLS, PALS), and location of four courses instructor in the past two years.

Date

Course

Location

c. Is aligned on the Instructor Network*

Successful

Needs Remediation

If Instructor / Candidate has an instructor number, then they are aligned on the AHA Instructor Network.

d. Completes the required provider and instructor updates.*

Successful

Needs Remediation

If Instructor / Candidate has an instructor number, then they have completed their instructor updates.

e. Achieves satisfactory rating during instructor monitoring*

Successful

Needs Remediation

2. Course Delivery

Definition (Goal): Presents AHA course content as intended by using AHA course curricula and materials

a. Delivers content that is consistent with Lesson Maps and agenda*

Successful

Needs Remediation

b. Uses videos, checklists, equipment, and other tools as directed in the Instructor Manual*

Successful

Needs Remediation

c. Allows adequate time for content delivery, skills practice, and debriefing*

Successful

Needs Remediation

d. Promotes retention by reinforcing key points*

Successful

Needs Remediation

e. Delivers course in a safe and nonthreatening manner*

Successful

Needs Remediation

f. Uses student and faculty feedback to improve teaching performance*

Successful

Needs Remediation

Not Observed

g. Provides precourse instructions and resources to students before the course*

Successful

Needs Remediation

Not Observed

h. Ensures equipment is in working order and available in sufficient quantity as recommended*

Successful

Needs Remediation

Not Observed

i. Relates course material to practical events*

Successful

Needs Remediation

Not Observed

j. Effectively operates technology used in the course*

Successful

Needs Remediation

Not Observed

k. Adapts terminology appropriate to location, audience, and culture*

Successful

Needs Remediation

Not Observed

l. Accommodates students who have disabilities and other special needs*

Successful

Needs Remediation

Not Observed

m. Provides timely and appropriate feedback to students*

Successful

Needs Remediation

Not Observed

n. Uses principles of effective team dynamics during small group activities*

Successful

Needs Remediation

Not Observed

o. Secures and protects testing materials*

Successful

Needs Remediation

Not Observed

p. Decontaminates/cleans equipment according to manufacturer's instructions*

Successful

Needs Remediation

Not Observed

Testing and Remediation

Definition (Goal): Measures students’ skills and knowledge against performance guidelines and provides remediation when needed to consolidate learning

a. Tests students by using AHA course materials according to instructions in the Instructor Manual*

Successful

Needs Remediation

b. Provides feedback to students in a private and confidential manner (observation and review of students’ course evaluation forms)*

Successful

Needs Remediation

c. Remediates by directing students to reference material and by providing additional practice opportunities*

Successful

Needs Remediation

d. Retests students when indicated*

Successful

Needs Remediation

Not Observed

e. Facilitates debriefings after scenarios to improve individual and team performance*

Successful

Needs Remediation

Not Observed

Professionalism

Definition (Goal): Maintains a high standard of ethics and professionalism when representing the AHA

a. Endorses the ECC Leadership Code Of Conduct*

All persons in AHA ECC leadership and Instructor roles are expected to conduct themselves with honesty, integrity, and a commitment to the goals of the AHA and the ECC program. This code is intended to provide standards of professional conduct. The scope of the standards implied in this code includes activities directly related to the discharge of ECC leadership functions, such as committee activities and assignments, as well as actions performed with other AHA programs or activities, such as ECC classes and activities related to AHA affiliate programs. Furthermore, AHA Instructors and faculty have a special responsibility to maintain neutrality while serving in leadership and educational roles.

Successful

Needs Remediation

b. Acknowledges the AHA Statement of Conflict of Interest*

The American Heart Association has established a Conflict of Interest policy that applies to all ECC leaders. Throughout the course of performing duties associated with the ECC leadership role, all ECC leaders must comply with these policies.

Successful

Needs Remediation

c. Demonstrates professional behavior in physical presentation and teaching, including enthusiasm, honesty, integrity, commitment, compassion, and respect*

Successful

Needs Remediation

d. Follows HIPAA, FERPA, and/or local guidelines maintaining confidentiality*

Successful

Needs Remediation

e. Recognizes and appropriately responds to ethical issues encountered in training*

Successful

Needs Remediation

Not Observed

f. Appropriately manages conflicts of interest*

Successful

Needs Remediation

Not Observed

g. Maintains student confidentiality when appropriate (observation and review of students’ course evaluation forms)*

Successful

Needs Remediation

Not Observed

Program Administration

Definition (Goal): Successfully manages available resources, including time, materials, space, and budget, to deliver high quality training in accordance with AHA guidelines

a. Completes postcourse records, including an accurate roster, grade report, and summary evaluation*

Successful

Needs Remediation

b. Complies with the current, appropriate version of the Program Administration Manual (PAM)*

Successful

Needs Remediation

Not Observed

c. Ensures that AHA course completion cards are issued in a timely manner*

Successful

Needs Remediation

Not Observed

Notes / Recommendations:

Notes

Recommend Instructor Status:*

Based upon your observations from this monitoring session only, do you recommend that the Instructor / Candidate be issued an American Heart Association Instructor certification card?

Yes – Issue Instructor Certification Immediately

Yes – Issue Instructor Certification Upon Expiration

Yes – Instructor is Utilizing Code One as Secondary TC; Primary TC will Issue Instructor Card

No – Needs Remediation, Further Monitoring

Remediation Plan:

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