Supervision and Delegation: PTAs, Aides, Students, and Unlicensed Personnel
What this domain tests
Supervision questions ask who may do what, under whose authority, and with how much oversight. The exam tests the distinction between the PT's non-delegable duties, the PTA's delegated treatment role, the aide's support role, and the student's supervised role. It also tests documentation of supervision and the PT's accountability for delegated care.
Core rules
- PT retains responsibility: the supervising PT is accountable for the care delegated to a PTA. Delegation requires that the task be within the PTA's scope and that the PT provide appropriate supervision.
- What the PT cannot delegate: the initial examination, evaluation, diagnosis, prognosis, and development of the plan of care. The PTA may contribute data but does not perform these.
- PTA supervision: the PTA treats patients under the direction and supervision of a PT. The level of supervision depends on the patient's condition, the complexity of the procedure, and the PT's judgment; the PT must be available and must see the patient as required by the plan of care.
- Aides: may perform non-treatment tasks such as clerical work, equipment preparation, and transporting patients. They may not apply modalities or perform therapeutic procedures, and they may not be used to substitute for a PTA.
- Students: physical therapist and PTA students may perform procedures as part of their supervised educational program. Supervision must meet the educational program's requirements, and the supervising clinician remains responsible for the patient.
- Documentation: delegated care and supervision must be reflected in the record consistent with the plan of care.
Worked example
A PT delegates a gait training session to a PTA and asks an aide to "watch the patient walk" while the PTA documents. Is this acceptable?
Reasoning: gait training is treatment, so it falls to the PT or PTA. An aide may not perform or supervise treatment. "Watching" a patient during gait training is treatment supervision, which the aide cannot provide. Answer: no; the PTA must supervise the gait training, or the PT must be present, and the aide may only assist with non-treatment tasks.
Traps that cost marks
- Letting an aide apply a modality because a PT is "right there." Presence does not create scope.
- Assuming a PTA can perform the initial evaluation when the PT is busy.
- Forgetting that the supervising PT remains accountable even when off-site, if supervision standards are met.
- Treating students as licensed staff; student practice must be tied to the educational program and supervision.
Key points
- PT keeps examination, evaluation, diagnosis, prognosis, and plan of care.
- PTA performs delegated treatment under PT direction and supervision.
- Aides do non-treatment support only; never modalities or treatment.
- Students practice within their supervised educational program.
- The supervising PT is accountable for delegated care.