Instructor Monitoring Form Instructor / Candidate Information:Name of Instructor / Candidate:* Instructor / Candidate Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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* MM slash DD slash YYYY Type of Course Monitored:*--Select Course--Heartsaver (HS)Basic Life Support (BLS)Advanced Cardiac Life Support (ACLS)Pediatric Advanced Life Support (PALS)Instructor CourseBEACON BLS Instructor RenewalBEACON ALS Instructor RenewalDisciplines Renewed BLS ACLS PALS Instructor Course Discipline:*Heartsaver (HS)Basic Life Support (BLS)Advanced Cardiac Life Support (ACLS)Pediatric Advanced Life Support (PALS)Course Location:* Monitoring Type:*--Select--Initial MonitoringRenewal MonitoringInstructor Transferring In - Code One to be Primary TCInstructor Transferring In - Code One to be Secondary TCRemote Video MonitoringTraining Center Faculty (Instructor Course)Certification Expiration Date:* MM slash DD slash YYYY 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 MonitoringRemote 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 SkillsDefinition (Goal): Maintains proficiency in provider-level cognitive and psychomotor skills; fulfills requirements for initial or renewal instructor certificationa. 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.DateCourseLocation 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 DeliveryDefinition (Goal): Presents AHA course content as intended by using AHA course curricula and materialsa. 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 RemediationDefinition (Goal): Measures students’ skills and knowledge against performance guidelines and provides remediation when needed to consolidate learninga. 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 ProfessionalismDefinition (Goal): Maintains a high standard of ethics and professionalism when representing the AHAa. 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 AdministrationDefinition (Goal): Successfully manages available resources, including time, materials, space, and budget, to deliver high quality training in accordance with AHA guidelinesa. 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:NotesRecommend 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:
