clinical education - santa rosa junior collegexho/clinical/clinical education.pdf · clinical...

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Clinical Education The SRJC Radiologic Technology Program is accredited by the Joint Review Committee on Education in Radiologic Technology - 20 N. Wacker Dr. # 900 Chicago IL 60606 - Phone: 312-704-5300, approved by the State of California Department of Health Services, leads to an Associate of Science degree. Concurrent to the didactic education, the training includes operation of x-ray and computer equipment, performance of radiographic procedures, exposing and processing radiographs, experience in other advanced imaging modalities, and radiation protection. This clinical training of is required in hospitals and radiology departments affiliated with Santa Rosa Junior College. Our clinical education centers include: Eleven Eleven Radiology Clinical Instructors: Barbara Southard, R.T. 1111 Sonoma Avenue Sterling Torres, R.T. Santa Rosa, CA 95405 707-545-1111 Healdsburg General Hospital Clinical Instructor: Michael Gray, R.T. 1375 University Avenue Healdsburg, CA 95448 707-431-6410 Kaiser Permanente Hospital Clinical Instructor: Dan Gomez, R.T. 401 Bicentennial Way Santa Rosa, 95401 70-571-4574 Kaiser Permanente Hospital Clinical Instructor: Michael Britz, R.T. 99 Monticello Road San Rafael, CA 415-444-2383 Kaiser Permanente Hospital Clinical Instructor: Pamela Jarvinen, R.T. 3285 Claremont Way Napa, 94558 707-258-4902 Marin General Hospital Clinical Instructor: Jeff Westerberg, R.T. 250 Bon Air Road Greenbrae, CA 94904 415-925-7310 Memorial Hospital Clinical Instructors: John McCollister, R.T. 1165 Montgomery Drive Robin Langhofer, R.T. Santa Rosa, CA 95405 707-525-5295 Novato Community Hospital Clinical Instructor: Gina Derenzo, R.T.

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1625 Hill Road Novato, CA 94947 415-899-9540 Palm Drive Hospital Clinical Instructor: Lisa Surdyka, R.T. Healdsburg Avenue Sebastopol, CA 95472 707-829-4360 Petaluma Valley Hospital Clinical Instructors: Craig Cozad, R.T. 400 N. McDowell Boulevard Bud Lockwood, R.T. Petaluma, CA 94952 707-778-2555 Queen of the Valley Hospital Clinical Instructor: Lynn Mullins, R.T. 1000 Trancas Drive Napa, CA 94558 707-257-4064 St. Helena Hospital Clinical Instructor: Chuck Adams, R.T. 650 Sanitarium Road Deer Park, CA 94576 707-963-6570 Santa Rosa Diagnostic Center Clinical Instructor: Judy Harper, R.T. 121 Sotoyome Street Santa Rosa, 95405 707-546-4062 Sonoma Valley Hospital Clinical Instructor: Curtis Tam, R.T. 347 Andrieux Street Sonoma, CA 95476 707-935-5234 Sutter Lakeside Hospital Clinical Instructor: Don Pifer, R.T. 5176 Hill Road East Lakeport, CA 95453 707-262-5031 Sutter Medical Center Clinical Instructors: Rita Robinson, R.T. 3325 Chanate Road Anna James, R.T. Santa Rosa, CA 95404 707-576-4470 Ukiah Valley Medical Center Clinical Instructor: James Rus, R.T. 175 Hospital Drive Ukiah, CA 95482 707-462-3111 x1420 Warrack Hospital Clinical Instructor: Ken Lenatti, R.T. 2449 Summerfield Road Santa Rosa, CA 95404 707-523-7153

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CLINICAL EXPERIENCE GUIDELINES

A. DUTIES OF A STUDENT RADIOLOGIC TECHNOLOGIST

During the time the student is assigned to clinical training she/he may be expected to participate not only in radiographic procedures but film file, darkroom, patient transport and other office procedures as long as their clinical education is not being compromised.

B. CLINICAL ROTATIONS

The clinical coordinator, with the approval of the program director, is responsible for arranging the diagnostic clinical education rotations.

Personal vacations are to be scheduled only during times when classes are not in session.

C. CLINICAL SCHEDULING

1. Clinical scheduling - Clinical scheduling of the student is up to the discretion

of either the clinical instructor and/or chief technologist of respective assigned department.

All students may be assigned to day, evening, or weekend shifts as long as proper supervision is maintained; equitable rotation schedules, in cases of multiple students, is provided and appropriate variety of radiographic examinations are observed. Students are not allowed to work graveyard shifts or on-call.

All weekend clinical hours must be arranged with the clinical coordinator. Any unassigned clinical hours will not be acceptable.

2. Classroom attendance - unless otherwise notified, students shall attend class at

the college as designated in your specific class schedule. 3. Special Rotation - Students will be rotated through one of the following

imaging modalities per semester/session: Angiography and Computerized Tomography. The duration of each ancillary rotation shall be three weeks.

The clinical coordinator will be responsible for arranging these special rotations.

D. CLINICAL HOURS

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Clinical hours shall not be compensated. Students will not be in clinical assignment when the college campus is closed due to holidays. The missing hours shall be made up before the semester ends.

A certain number of clinical hours are required for each semester beginning with the first semester of the first year. The total weekly clinical hours and didactic shall not exceed 40 hours.

Students are required to keep a record of clinical hours that are accrued on a weekly basis. This time sheet must be validated by the clinical instructor or his/her designee. The total approved overtime hours will be at the discretion of the program director.

These time sheets must be turned in to the clinical coordinator every eight weeks. The accumulated time will be calculated and a print-out will be posted to provide a record for the students regarding the accumulation of laboratory/clinical hours and specific rotations. Late time sheets will warrant loss of credit.

E. OVERTIME CLINICAL HOURS

Special circumstances, which may cause students to work over an eight hour period, must be documented and approved by the clinical instructor. This document must be turned in with the time sheet. Students shall NEVER put in more than 40 hours per week (didactic and practical included).

Clinical hours must be completed within each semester, no exceptions will be made.

F. CLINICAL EXPERIENCE OBJECTIVES

Categories of importance include:

RADIATION PROTECTION

Given a requisition for a radiographic study, the student will demonstrate accuracy in practicing radiation protection for the patient, personnel, and guests by:

• Closing doors during procedures and exposures. • Always shielding patients. • Consideration of patient's pregnancy status; follows department

protocol. • Collimating at least to film size, and or part size. • Protecting himself/herself and others from irradiation by wearing

aprons, gloves, and film badge. • Keeping repeats to a minimum. All repeat films must be assisted by

an R.T.

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• Demonstrates basic knowledge of biological effects of radiation. EQUIPMENT

During a radiographic study, the student will be able to demonstrate knowledge, understanding, and dexterity in the proper use of equipment to the satisfaction of evaluation guidelines. The following functions will be observed:

• Competency and proficiency with equipment including new equipment

by using previous education and experience. • Safety precautions including keeping room furnishings and accessories

properly placed and safely positioned. • Effective manipulation of control panel. • Consideration of tube rating charts and heat units.

PUNCTUALITY AND DEPENDABILITY

Upon assignment to a given hospital, the student will attend their clinical education location, which varies each semester.

• Punctuality in reporting to and preparing the room for patients, at the

start of shift. • Minimum time lost due to absence. • Consideration of others by taking proper length of time for coffee and

lunch breaks according to department policy. • Demonstrates flexibility in taking breaks and lunches. • Communicates whereabouts appropriately. • Properly notifying the department in the event of absence or tardiness.

INTERPERSONAL INTERACTIONS

During the clinical assignment, the student will demonstrate positive relationships in dealing with co-workers, the public, and other hospital staff. Areas of special importance include:

• Tact and courtesy with coworkers. • Taking initiative and help other staff members. • Cooperation with staff technologist, demonstrates team approach. • Acceptance of constructive criticism. • Welcome instructions and direction. • Personal appearance is neat and clean; adheres to dress code. • Exhibition of professionalism under job stress. • Personal problems do not affect job performance. • Demonstration of enthusiasm and interest in his/her job. • Contribution to a pleasant working environment.

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CLINICAL PERFORMANCE

The student's clinical performance will be observed and satisfactory ratings must be achieved in each of the following areas:

• Marks all radiographs according to department standard. • Plans and organizes work efficiently - has foresight, makes sure all

supplies needed for exam are set up before exam begins. • Work pattern during exam is organized and efficient. • Perseveres and follows through on exams - releases patient when

procedure is completed - does not leave an exam in progress except with the technologist's permission for another patient's safety.

• Is alert and interested in what is happening in room - asks pertinent questions.

• Is willing to start exams on own, demonstrates self-confidence. • Reads and understands the requisition. • Judges new or changing situations and makes reasonable decisions -

doesn't move a patient with a possible C-spine fracture - but sits or lays down a patient that is weak or faint, etc.

• Maintains a neat, clean, well-stocked room. (e.g., changes pillow cases, cleans table and chest unit frequently, and stocks supplies in cabinets.)

• Is able to follow instructions and is effective, dependable and reliable. • Demonstrates the ability to problem solves: Able to recognize and

compensate for multiple variables (e.g., changes in patient position, distance, tube angle, technical factors, anticipates radiologist's needs.)

• Is aware of own weaknesses and strives to improve. • Makes effective use of free time. • Demonstrates adequate speed to keep up with patient flow. • Demonstrates versatility of skills and ability to handle a wide variety

of situations. • Never repeat a radiograph without the assistance of qualified

radiologic technologist.

TECHNICAL FACTORS

During radiographic procedures, the student will be observed in the selection of proper technical factors for routine examinations of the average as well as the unusual patient. This includes:

• Setting the control panel accurately for an exposure, setting right kV

and mAs per technique chart - selects correct tube, bucky, and focal spot size.

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• Evaluating patients in determining exposure factors - ability to deviate from an average technique to compensate for a larger or smaller person, body habitus and pathology.

• Checks control panel before exposing. • Identifying technical error - grid lines/cut-off, under/over exposure,

motion gross/slight, artifacts, buttons, hairclips, etc.; is part completely on film (no cut bases, etc.) - body rotation, (is part completely AP/PA, Lat, etc.).

• Being able to convert phototiming to manual technique. • Understanding how various mA, kV, time and distance factors, Heel

effect, and focal spot size affect the radiographic image. • Correcting technical error once identified. • Converting a technique - in case of patient motion, can reduce time

and go up in kV to come up with good radiograph, etc. - go from a par to fast screen, or Rare Earth system.

• Maintaining quality radiographs - doesn't let film "slide through". • Keeping repeats to a minimum. • Demonstrates understanding of phototiming. • Instructing patient in short and concise language, which they can

understand. • Verifies if patients understand the instructions.

POSITIONING

During radiographic procedures, the student will be observed in the selection of proper technical factors for routine examinations of the average as well as the unusual patient. This include:

• Knows department routines. • Knows specific centering for each part radiographed - including

angulation of the x-ray tube and body part. • Positions the patient carefully and accurately, uses proper

immobilization. • Identifies basic anatomy, can critique films, for positioning and

pathology. Can correct positioning errors. • After achieving competency, progresses toward minimal supervision

and greater independence and confidence in positioning and shows pride in work - does not have to be supervised constantly; doesn't always ask, "Can you check this?" unless appropriate.

• Works at an efficient pace; keeps up with patient flow. • Takes initiative to improvise in a given situation to obtain desired

results. • Handles patients gently when positioning, gives precise instruction.

PATIENT CARE AND PROCEDURES

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During a radiographic study, the student will demonstrate knowledge and understanding of various patient care procedures. Areas of importance are:

• Identifying patient properly and using his/her name during procedure. • Maintains patient's modesty and comfort. • Being empathetic towards patients. • Recognizing patient truly as a person, offering emotional support. • Explains the exam clearly and concisely to the patient. • Using a safe approach in transfer of patients. • Taking vital signs in conjunction with radiographic procedure. • Proper handling of a patient with IVs and catheters. • Assisting the physician during an emergency and non-emergency

situation. • Applying surgical and medical asepsis in drawing up syringes and

working around a sterile set-up, etc. • Knowing when and how to apply various isolation techniques.

G. STUDENT EVALUATION OF CLINICAL EXPERIENCE

At the end of each clinical course the student is required to complete an evaluation of their respective clinical experiences. The evaluation is anonymous and is an opportunity for the student to make an assessment on her/his clinical experiences. Through candid evaluations, the faculty can identify the strengths and weaknesses of a particular clinical education setting and utilize this information for continuing program evaluation and improvement. Another area where this information is useful is in matching student's clinical experience weaknesses with those clinical education settings that can better remediate by providing clinical experiences that address a student's weaknesses.

H. MISCELLANEOUS

When not busy, there will be no loitering. Use idle time for studying. Now is the time to ask those questions or issues that remain unclear to you.

I. BREAKS AND LUNCH PERIODS

Generally, there will be morning, lunch, and afternoon breaks. You must take these breaks, but do observe the departmental policy regarding breaks and lunch periods, and do not take excess advantage of the coffee break. Lunch breaks are not to be counted as hours towards clinical experience and should not be included in the daily total clinical hours.

J. PERSONAL PHONE CALLS

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No personal phone calls should be received while in the clinical area except for emergencies. Departmental telephones may not be used for personal calls. Locate the public telephone for your use.

K. GUIDELINES FOR FILM CRITIQUE - (on campus laboratory or at

clinical site) In order to promote critical thinking and problem solving skills, the following outline exercise is to be used by students and instructors when preparing a film critique presentation.

Each student may be responsible for preparing and presenting a five to ten minute film critique on assigned topics once during each of the practical finals (RT 61A, 61B, 61C). The college instructor will prepare a minimum of seven presentations per semester, dividing the film critique sessions into 20-30 minute segments to include all of the students. Questions will be asked of the students, as group participation is expected. Criteria for Development of Film Critique:

Knowledge of Examination

• Patient prep required for examination. • How is this study scheduled within the typical hospital? • Cost of the examination (approximate). • Anatomy seen on the films. • Difficulty for the R.T. in performing the exam. • Difficulty for the patient to tolerate the exam. • Is there any special equipment used in this exam?

Demonstrate devices used.

Knowledge of Contrast Media Used

• If contrast is not used, could it ever be used? If so, when?

• Contrast media used by this hospital. • How much contrast is used? • Indications and contraindications for contrast medium to be used. • Drugs used to treat any adverse reactions; usual dose required. • Differences between exams done with and without contrast medium.

Collimation

• Discuss methods of beam restriction. • Were extension cones, diaphragms, flared cones used?

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• Was collimation adequate on this film?

Technical Factors and Accessories

• Discuss mA, kV, and time, and their influence on the film quality. • Discuss the phototiming to achieve the same exposure results. • If phototiming was used, discuss the standard technical factors. • Discuss the necessary technique change required if one were to change

from bucky to tabletop or vice versa. • Discuss necessary change in grid ratio, etc., if film were to be done

portably (or vice versa, if original film was done portably). • What was the grid ratio used in the table, stationary grid, etc.? • What type of film-screen combination was used for this exam? • If a wedge filter was used, what effect does it have on the radiograph? • Discuss the proper phase of respiration and the resultant effect on the

technical factors chosen; effect on patient dose. • Are there any artifacts present? (Motion, static, grid lines, grid cut-off,

etc.) • Is a marker present? Has it been used properly? • "Troubleshoot" the film. What should be done to make it perfect? • Can any special techniques be used to enhance the outcome of this

exam? Air gap? Reduced SID to increase magnification selectively? Breathing technique? Small focal spot? Graded screen speeds or grid ratios?

Positioning

• Discuss routine projections done for this examination. • Ask students to demonstrate the anatomy best seen on each position. • Give alternative views, which are done for each examination and

discuss why they may be necessary. • Locate the anatomy best seen on each projection. • Discuss the "tricks of the trade" used to make the exam easier. • Is the centering correct?

Why is the Film Taken?

• Review the radiologist's report and compare it with the clinical chart

information (if available) to establish how the radiograph enters into the total patient care.

• Stress patient care and other related information, which might make results different.

• Discuss any other variables, which might have altered the way in which the exam was performed.

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• Discuss any isolation or sterile techniques, which might be considered due to the patient's condition.

Radiation Protection Practice

• Discuss the rules regarding beam limitation. • Discuss the use of gonadal shielding as it relates to the exam. • Discuss the necessity to request from the patient whether she may be

pregnant. What is the procedure to follow if the patient answers "yes" or is unsure?

• Discuss the minimum legal distance from the anode to the patient's skin for the examination.

• What is the radiation dose administered to the patient during this exam?

• What is the effect of the kV and mAs used regarding the patient's dose? Especially the effect of optimum kV techniques versus low kV or variable kV techniques.

CLINICAL RADIATION PROTECTION RULES

A. POLICY AND PROCEDURE

The following safety rules have been established for the protection of the patient, other personnel, and you from ionizing radiation during your radiology observation and clinical education. These rules are a combination of State and Federal regulations and/or laws and additional guidelines in the use of ionizing radiation. These rules are mandatory, and any exception must be reported to the chief technologist and program director immediately.

1. Regarding monitoring devices:

a. A monitoring device, properly placed, must be worn at ALL times during both the observation and clinical education phases.

b. When protective aprons are used, the film badge must be placed outside the apron, at the collar level.

c. Monitoring devices shall be turned in to the program director by the 5th of every other month. NO EXCEPTION.

2. When an X-ray exposure is about to be made, you MUST:

a. Leave the room, or b. Get behind the lead shield, or c. Be otherwise suitably protected for surgery, portable, or fluoroscopic

work.

3. Specifically, you MUST NOT hold or support a patient during exposure.

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4. You may not observe the patient during exposure from an adjacent room or

hall unless through a lead-glass protective window. You must NOT "peak" around a door or through a crack between door and wall.

5. When sitting down to rest in the hall, do not sit in direct line with the tube or

radiographic table even if it is then not being used.

6. During an exposure or procedure do not place yourself in direct line with the central ray, even though you are wearing a lead apron.

7. Under no circumstances will you permit yourself or any other human being to

serve as "patients" for test exposures or experimentation.

8. If, during fluoroscopic procedures, you remain in the radiographic room the following will prevail: a. A lead apron must be worn at all times or you must remain behind an

adequate lead protective screen and not in direct path with either tube or patient.

b. The monitoring device must be worn outside the lead apron at the collar level.

c. You must stand as far from the patient and tube as possible, consistent with the conduct of the examination.

d. Whenever practical, stand behind the radiologist. e. You must wear lead gloves and thyroid shield if you are in proximity

to the patient (less than six feet). 9. With permission of the clinical instructor, you may make test exposures on

inanimate objects. In so doing, all radiation safety rules must be followed as well as tube safety factors, etc.

10. When observing radiographic procedures in surgery and bedside portables:

a. A lead apron must be worn b. A monitoring device must be worn outside of the lead apron. c. Stand as far from the patient and tube as practical while observing the

patient d. Stand so that the central ray is pointing away from your body. e. Observe all regulations, which apply to work in surgery, such as

preserving sterile fields, wearing surgical garments, etc. The staff technologist will provide details.

f. In addition, when observing, you must step outside the room if you cannot stand at least 10 feet from the patient or stand behind the staff technologist during the exposure.

11. Permission to make actual exposures on patients shall be determined by all of

the following:

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a. The opinion of the radiologist/chief technologist/clinical instructor. b. The opinion of the program director/clinical coordinator/clinical

supervisor. c. Your own feeling of security and proven competence.

12. If you are in doubt about practical procedures or practices regarding radiation

protection, contact your clinical instructor and/or clinical coordinator for clarification or instructions.

B. PREGNANT STUDENT

All pregnant students shall observe the pregnancy policy as adopted by the Santa Rosa Junior College in accordance with the regulations of the National Council on Radiation Protection (see Special Policy).

STUDENT SUPERVISION

A. POLICY ON SUPERVISION OF RADIOLOGIC TECHNOLOGY STUDENTS

1. Students must have adequate and proper supervision during all clinical assignments. Students must perform all medical imaging procedures under the direct supervision of a qualified radiologic technologist until students achieve competency. The following conditions constitute direct supervision:

a. A qualified registered radiologic technologist reviews the procedure in

relation to the student=s achievement and evaluates the condition of the patient in relation to the student=s knowledge.

b. A qualified radiologic technologist is present during the conduct of the

procedure.

c. A qualified radiologic technologist reviews and approves the procedure and its radiographs.

d. A qualified radiologic technologist is present during student performance of any repeat of any unsatisfactory radiograph.

Students shall not take the responsibility or the place of qualified staff. However, after demonstrating competency, students may be permitted to perform procedures under indirect supervision.

2. Once competency proven students should performed procedures under indirect supervision, which is defined as the supervision provided by a qualified radiologic technologist immediately available to assist students

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regardless of the level of student achievement. Immediately available is interpreted as the presence of qualified radiologic technologist adjacent to the room or location where a radiographic procedure is being performed. This availability applies to all areas where ionizing radiation equipment is in use.

3. Students are not allowed to perform independently those exams they have not

gained competency in. They must be properly supervised until they gain competency in exams to be checked off.

4. The student will be under direct supervision when working in the Operating

Room, Angiographic facilities, CT, or with traumatic spine patients in the Emergency Room, during 100 percent of their clinical training.

B. POLICY ON FLUOROSCOPY BY RADIOLOGIC TECHNOLOGY STUDENTS

1. Students must adhere to the regulations established by the Department

of Health Services (sec. 30450, Title 17, Chpt. 5, Subchpt. 4.5) concerning the use of fluoroscopic equipment by radiologic technologists.

2. Students may not expose a patient to X-rays in the fluoroscopic mode

for any reason or circumstance without proper supervision.

3. Students may select exposure factors and set up fluoroscopic exam prior to the exposure. They may not adjust or select exposure factors, (i.e., gain control or phototimer sensitivity) or moving the fluoroscopic tube while it is emitting X-rays.

4. WE HIGHLY RECOMMEND THAT NO PREGNANT STUDENT

SHOULD BE PERMITTED TO WORK IN ANY FLUOROSCOPIC ENVIRONMENT. IT IS HIGHLY RECOMMENDED THAT STUDENTS USE GOOD PRACTICES OF RADIATION PROTECTION WHEN PERFORMING PORTABLE RADIOGRAPHIC CASES.

Clinical Instructors RECOMMENDED RESPONSIBILITIES FOR CLINICAL INSTRUCTORS

Responsibilities related to orientation:

1. Have written departmental policies available for students.

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2. Conduct orientation sessions with incoming students.

3. Have up-to-date routines as guidelines for all radiographic procedures,

including projections for each procedure.

4. Have a system of technique guides for students--orient students to type of processing, screens, tubes, bucky grid ratios and speeds, calibrations of machines.

5. Encourage an environment of acceptance--so that students feel like part of the

department.

6. Assign lockers and parking stickers, if available.

7. Demonstrate equipment unfamiliar to students.

8. Insure that student gets an overall experience in the department during the initial part of his rotation,

9. Communicate to staff at what level students can perform, and the objectives

for rotation--those skills that they need to learn; that they have not had any clinical experience to date.

Responsibilities Directly Related to Instruction:

1. Evaluate clinical performance of each student, in consultation with other staff.

2. Assign students to their area of activity.

3. Identify weaknesses of students in terms of skill and personal interactions, counsel student accordingly, and tailor his assignments to help overcome skill deficiencies.

4. Conduct periodic film critiques.

5. Reinforce routines and policies throughout the rotation.

6. Motivate students' learning.

7. Share with students new ideas, procedures, and articles.

Responsibilities related to Record Keeping:

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1. Maintain record of student assignments.

2. Maintain record of student's evaluation of clinical performance.

3. Generate and maintain record of any unusual happenings, such as lateness, disagreeable behavior, or negligent performance.

4. Maintain record of film critiques.

Responsibilities Related To Student Counseling:

1. Recommend students for a three-way conference.

2. Evaluate, in consultation with the department manager, if a student dismissal is warranted.

3. Be aware and listen to student problems--act as liaison between students and

hospital staff.

4. Relate issues to college instructors in a timely manner.

5. Direct and assist students in case of accident or injury.

7. Insure that students are relieved for lunches, breaks, and campus work.

Responsibilities Related to Accreditation:

1. Help college instructors complete appropriate forms.

2. Act as a representative during accreditation visits.

3. Become familiar with the JRCERT standards, and insure their implementation in the institution.

General Responsibilities:

1. Attend biannual clinical instructor's meetings.

2. Aid in student recruitment.

Clinical Coordinators

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Joanne Robertson, 527-4920, e-mail: [email protected]

Linda Rarey, 527-4945, e-mail: [email protected] Tim Hetzer Clinical Competency Handbook

mailto:[email protected]

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SRJC

RADIOLOGIC TECHNOLOGY PROGRAM

CLINICAL

COMPETENCY HANDBOOK

Clinical Competency

Handbook

Student:

Class of:

Linda Rarey, M.A., R.T.(R), C.N.M.T. Instructor/Clinical Coordinator

&

The Faculty of the

Radiologic Technology Program Santa Rosa Junior College

Revised November, 1998

TABLE OF CONTENTS Introduction ___________________________________________________________ 1 Definitions ____________________________________________________________ 1 Student Requirements for Clinical Experience________________________________ 2 Curriculum Schedule ____________________________________________________ 3 Breakdown of Required Clinical Hours _____________________________________ 4 Clinical Experience Grading Procedures ____________________________________ 5

CLINICAL EVALUATIONS _________________________________________________ 5 CLINICAL COMPETENCIES _______________________________________________ 5 TIME SHEETS ____________________________________________________________ 5

Grading Scale __________________________________________________________ 6 Clinical Evaluation Criteria_______________________________________________ 6 Mid-Assessments _______________________________________________________ 6 Clinical Competency Criteria______________________________________________ 7

HOW TO COMPLETE THE COMPETENCIES ________________________________ 7 STUDENT SUPERVISION POLICY __________________________________________ 7

Schedule of Competency Evaluations Demonstrated on Patients _________________ 8 Exceeding the Minimum Assignment _______________________________________ 8 Guidelines for Competency Evaluations _____________________________________ 9 Mandatory Competency Evaluations_______________________________________ 14

EXTREMITIES_________________________________________________________________ 15 THORAX _____________________________________________________________________ 17 SPINE & PELVIS_______________________________________________________________ 18 ABDOMEN & GI TRACT ________________________________________________________ 19 HEAD & NECK ________________________________________________________________ 20 MOBILE & SURGICAL _________________________________________________________ 21 OTHER EXAMS _______________________________________________________________ 22

Elective Competency Evaluations _________________________________________ 24 EXTREMITIES_________________________________________________________________ 25 THORAX _____________________________________________________________________ 26 HEAD & NECK ________________________________________________________________ 27 SPINE & PELVIS_______________________________________________________________ 27 OTHER EXAMS _______________________________________________________________ 28

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Introduction

It is the intent of this handbook to provide the format for evaluating student progress and competency in the clinical setting. Students, clinical instructors, school faculty and college officials keep an ongoing accurate picture of the student’s clinical progress through recorded performance evaluations. This assures that the student will not perform exams on patients without direct supervision before they are proved competent in that exam. Feedback from the students and their instructors in the clinical settings is solicited and is essential in making this a reliable tool in the evaluation process. This evaluative tool helps in assessing the student’s skill performance while the clinical evaluation form evaluates the student’s overall performance in the Radiology Department. We aim to promote a high degree of competency, professionalism and self-motivation in each participant in this program.

Definitions

Clinical Coordinator: a college faculty member who oversees the clinical education of students in the Radiologic Technology Program. Clinical Coordinators make regular visits to Clinical Education Centers to meet with the students and Clinical Instructors. Clinical Education Center: a Medical Imaging Department approved by the Joint Review Committee on Education in Radiologic Technology (JRCERT) and affiliated with Santa Rosa Junior College. Registered students in the program can only be assigned to Clinical Education Centers for their clinical experience. Clinical Instructor: a registered radiologic technologist assigned to supervise, guide and evaluate the Radiologic Technology Program students assigned to their department. Clinical Instructors are employees of the Clinical Education Centers and are assigned the position of Clinical Instructor by their employers.

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Student Requirements for Clinical Experience

1. You must contact your Clinical Instructor at least 2 weeks before each semester begins. You need to schedule a time for orientation and a time to set up your schedule.

2. You bring a completed self-evaluation form to your clinical instructor on the first clinical day. This tells the department what you have completed and where you need the most experience.

3. Complete, with the help of your Clinical Instructor, a semester schedule of your days and hours. A copy of this schedule must be posted in the department and a copy must be given to your campus Clinical Coordinator.

4. The hourly assignment, as printed in the college catalogue each semester, must be met weekly. Any deviation from your assigned weekly schedule must first be cleared with your Clinical Instructor and Clinical Coordinator.

5. Preserve professional relations at all times at your clinical site. Always call your Clinical Instructor before your scheduled time if you will be late or absent. You are expected to be there on the days and times you are scheduled.

6. Maintain the student dress code as it is outlined in your Student Handbook at all clinical sites.

7. Due dates for the completion of Mid-assessments, Clinical Evaluations, time sheets and Competency Handbook are printed on your roster each semester. Forms should be turned in on campus within one week after they are signed. Forms are available in the R.T. Skills Lab and in C.H.E.C.

Due Dates Time Sheets: Every 8 weeks Mid-assessments: 4 weeks before Clinical Evaluation Clinical Evaluation: Every 8 weeks Special Procedures Evaluations: End of special rotation Competency Handbook: End of each semester

8. There is a 3-week required Special Procedure rotation is in Angiography. This is assigned during the fall or spring semesters of your senior year. Some time may be lost during your special rotation due to equipment down time, low census or patient cancellation. When permitted, you may go back to your regular site during the days that there are no special procedures scheduled. Additional time in a special rotation may be arranged with your Clinical Instructor and Clinical Coordinator.

9. You have the option of choosing an additional 3-week Special Procedure rotation in CT and/or MRI. Videotapes V-43, V-44, V-45, & V-46 must be viewed in C.H.E.C. in preparation for the CT or MRI rotation. Provide verification of video viewing to your Clinical Coordinator prior to your CT or MRI rotation. In addition, your CT or MRI Clinical Instructor may provide reading material for you to help familiarize you with the modality.

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Curriculum Schedule FALL SEMESTER

Juniors (RT64, RT61A) Seniors (RT63B) Interns (RT67L)

August Positioning I: Chest Patient care: Transfers, medical asepsis

Tube Circuitry National Exam Review

September Positioning I: Abdomen Patient care: Surgical asepsis, isolation

X-ray Production Physics Fluoroscopy

National Exam Review

October Positioning I: Upper Extremities Patient care: Vital signs, drug preps, injections

Radiation Physics and Protection Fluoroscopy

Graduation

November Positioning I: Lower Extremities Patient care: B.E., cleansing enemas, catheterization

Advanced Radiation Protection Fluoroscopy

December Positioning I: Hips & Pelvis Patient care: Drainage tubes

Advanced Radiation Protection/ Fluoro

Clinical Course (RT61AL) Clinical Course (RT63BL)

SPRING SEMESTER Juniors (RT61B, RT63A) Seniors (RT65, RT66)

January Radiographic Techniques Positioning II: GI System

Pathology Special Procedures

February Radiographic Techniques Positioning II: GU System


March Film & Processing Positioning: Contrast Media & Vertebral Column


April Grids & Screens Positioning II: Vertebral Column


May Radiographic Quality & Q/A Positioning II: Ribs, Sternum, & Mammography


Clinical Course (RT61BL) Clinical Course (RT62BL)

SUMMER SEMESTER Seniors (RT61C) Interns (RT62B) June Skull, Facial Bones, Optic

Foramina, Mandible & Sinuses State Exam Review

July Skull, Facial Bones, Optic

Foramina, Mandible & Sinuses State Exam Review

Clinical Course (RT61CL) Clinical Course (RT66L) The program didactic curriculum is designed in close sequence with the clinical competency evaluations that are expected of students throughout their clinical experience.

4

Breakdown of Required Clinical Hours Semester Course

Number Clinical Hours

Semester Cum. Hrs.

Rotation No. of Weeks

1st Fall

RT61AL

8 X 11

88

88

#1

11

1st Spring

RT61BL

16 X 16

256

344

#2

16

1st Summer

RT61CL

32 X 8

256

600

#3

8

2nd Fall

RT62A

30 X 16

480

1,080

#4

16

2nd Spring

RT62BL

27 X 16

432

1,512

#5

16

2nd Summer

RT66L

32 X 8

256

1768

#6

8

3rd Fall

RT67L

38 X 5

190

1958 Total Hrs.

#7

5

Minimum requirements (including 40 hours of angio): 1850 hours

Elective rotations available: CT – 90 hours, MRI – 90 hours, mammo – 40 hours Notes: 1. Students are permitted to bank and roll over to the next semester up to an additional

10% of each semester’s total assigned hours for personal leave. 2. Students are not limited as to the number of additional hours of clinical experience

they may have providing the weekly hours never exceed 40 (including didactic). If additional clinical experience is warranted or desired, students may remain in clinical sites during any hours agreed to by the clinical instructor up to 40 hours per week including classroom time. (No more than 10% of each semester’s total assigned hours are rolled over to the next semester to count towards personal leave.)

3. Student requesting weekend or evening clinical experience must submit the Request for Special Assignment to Evenings and Weekends for approval.

5

Clinical Experience Grading Procedures Grading for clinical experience is based on overall student progress and performance in the clinical area. In addition, 3 tenths of the grade is based on the successful completion of a minimum number of competency exams during the 1st - 6th semesters of the program.

CLINICAL EVALUATIONS It is the responsibility of each student to submit a Clinical Evaluation form to his/her clinical instructor every 8 weeks of each semester. This completed and signed evaluation form must be delivered to the program clinical coordinator on campus within 1 week of the due date. The average of the scores received each semester on the Clinical Evaluations makes up 7 tenths of the entire Clinical Experience grade; the successfully completed Clinical Competencies (see below) make up the remaining 3 tenths of the clinical experience grade. During the final Intern clinical experience course, RT 67L, there are no Clinical Competencies assigned. Students are graded at the discretion of the classroom instructor based on the Clinical Evaluation, class attendance and other assignments.

CLINICAL COMPETENCIES Students are required to complete an assigned number of Mandatory Competency Evaluations on patients in the clinical setting each semester. (See page 8.) Until a competency exam has been successfully completed and signed off by the clinical instructor or authorized technologist, the student may not perform that exam without direct supervision. Students will begin their Elective and Mandatory Competencies during the 1st semester. Some of the Elective and Mandatory Competencies will be signed off in the RT Skills Labs. All of the Mandatory Competency Evaluations and at least 10 of the Elective Competency Evaluations must be signed off before a student can graduate.

GRADING COMPETENCIES Competency Evaluations are a part of the Clinical Experience grade. The Clinical Competency Handbook with the assigned number of competency exams completed and signed off is due at the end of each semester. The score for competencies is the percent of assigned Competency Evaluations successfully completed each semester. The successful completion of the assigned number results in a score of 100%. (For example, 5 competencies completed out of the 7 assigned in the 1st Spring Semester of the program would give a competency score of 71%.) The Competency Evaluations score makes up 3 tenths of the Clinical Experience grade until all assigned Competencies have been completed.

TIME SHEETS Students must turn in a completed and signed time sheet every 8 weeks. All assigned hours must be completed each semester. Students who do not turn in their time sheets before the last day of the semester will be penalized with a10% reduction in their clinical experience course grade. Failure to complete the required number of clinical hours in a semester can result in an “F” in the clinical experience course.

6

Grading Scale The following grading scale applies to all clinical experience courses.

95 - 100% = A 85 - 94% = B 75 - 84% = C 70 - 74% = D Below 70% = F

All Radiologic Technology courses must be completed with a grade of “C” or better.

Clinical Evaluation Criteria It is vital to each student’s progress that they are evaluated within their effective domain. The overall performance and professional behavior of each student is evaluated regularly in the clinical setting. Students are evaluated at the clinical site by their Clinical Instructor every 8 weeks. The evaluations are filled out on the appropriate Junior or Senior Clinical Evaluation Form, which is scored on a scale of zero to 100 points.

Mid-Assessments In order to support the ongoing progress of students in the clinical setting we require that the clinical instructors fill out a mid-assessment several weeks prior to each written Clinical Evaluation form. This serves to keep the students fully informed as to how they are fitting in to the clinical setting and how their overall performance and professional behavior are being evaluated. It gives each student a written assessment of their performance prior to their written graded evaluation. When a student appears to be failing to meet the performance criteria in any area a written assessment describing the area of deficiency must be prepared for the student. This procedure is designed to allow students an opportunity to correct performance problems before their grading period is completed. The required mid-assessment does not count towards the semester grade in clinical experience. It is intended as a progress report to promote continuous communication and dialogue between students, clinical instructors and college faculty.

7

Clinical Competency Criteria One of the ways that the student’s clinical on-the-job performance is assessed is through the performance of Clinical Competencies. These are competency evaluations of the student’s performance on 46 mandatory exams and at least 10 (out of 24) elective exams. A minimum of 35 of the mandatory exams must be performed on patients in the clinical setting. Students must successfully complete the competency evaluation of each exam before they may perform that exam without the direct supervision of a certified radiologic technologist. However, any repeat radiograph must be performed under the direct supervision of a radiographer.

HOW TO COMPLETE THE COMPETENCIES Precompetence: When a student feels capable of doing one of the exams independently, with a minimum of errors, he or she should approach the Clinical Instructor, or their designee, and request to be observed during that exam for a Clinical Competency Evaluation. Only the Clinical Instructor or their designees may evaluate competency exams. Competency exams evaluated by other technologists will not be accepted. When the student demonstrates competency by successfully completing all aspects of the exam as outlined in the competency book, with no more than 2 minor corrections, then the exam may be signed off as completed. If a student fails to successfully complete an exam for the clinical competency evaluation then he or she must review and practice that exam further under the supervision of a technologist. When the student is ready to be evaluated again, the above procedure should be repeated. A student may not perform an exam without direct supervision until he or she has passed the competency evaluation for that exam.

STUDENT SUPERVISION POLICY Students must be under the direct supervision of a qualified radiologic technologist during every exam until that student has successfully completed and been signed off on the exam in their Clinical Competency Handbook. Once an exam has been signed off the student may perform that exam under indirect supervision. A technologist must always be immediately available. No x-ray may be repeated without the direct supervision of a technologist.

8

Schedule of Competency Evaluations Demonstrated on Patients

POSITIONING COURSES COLLEGE

SEMESTER ASSIGNED COMPETENCIES

RT61A chest, abdomen,

extremities, hips, pelvis, shoulders

1st Fall

2 Mandatory Competencies:

Chest and Abdomen

RT61B GB, UGI, BE, spine, ribs,

IVP, cystogram

1st Spring

5 Mandatory Competencies & 2 Elective Competencies:

GI or BE, Spine,ΨΨΨΨ and any other exams* R61C

Skull, facial bones, mandible, sinuses

1st Summer

5 Mandatory Competencies (5 Mandatory are completed in RT61C)

2 Elective Competencies: Any exams *

2nd Fall

11 Mandatory Competencies 2 Elective Competencies

GI or BEΨΨΨΨ and any other exams R66

Special Procedures

2nd Spring 11 Mandatory Competencies

2 Elective Competencies Myelogram and any other exams

2nd Summer 5 Mandatory Competencies 2 Elective Competencies

3rd Fall All Competencies Completed

*Only exams, which have been covered in positioning class. ΨΨΨΨStudents may petition to replace the assigned exam with another exam (i.e. an extremity instead of a GI or BE); however, the assigned exam must be completed the following semester.

Exceeding the Minimum Assignment

Students are not limited to the assigned number of competencies each semester. Students may have as many exams checked off each semester as their personal level of progress allows. The extra competencies checked off are not carried over to fulfill requirements of subsequent semesters. Competencies are 30% of the clinical grade each semester. Students who have completed all of the assigned Competency Evaluations will be graded entirely on their Clinical Evaluations.

9

Guidelines for Competency Evaluations

EVALUATING PERFORMANCE

EVALUATE REQUISITION Student must be able to:

a) Select correct patient. a) Read and evaluate requisition. b) Assess patient condition. c) Review previous films if available d) Determine if any condition or pathology requires adapting standard

positioning. e) Determine if any condition or pathology requires adapting standard

radiographic techniques.

ROOM PREPARATION Student must:

a) Prepare room for patient safety and comfort. b) Organize equipment and accessories needed for exam. c) Clean room when exam is completed.

PATIENT CARE Student must:

a) Give proper explanation of examination. b) Assist patient throughout exam while maintaining modesty. c) Obtain adequate history prior to beginning exam. d) Obtain all appropriate previous history of allergies and reaction to contrast

media before beginning an invasive study. e) Monitor and communicate with patient throughout exam.

USE OF EQUIPMENT Student must be able to:

a) Put overhead tube into proper detent at the correct SID and centered to bucky as applicable.

b) Turn tube from horizontal to vertical and vice versa. c) Move bucky tray and utilize locks. d) Secure tube locks. e) Insert and remove cassettes from appropriate holders, slots or bucky. f) Fill syringes using aseptic technique when needed. g) Operate mobile unit. h) Select proper cassette size. i) Select proper grid when needed. j) Set up and manipulate fluoro unit.

10

POSITIONING SKILLS Student must be able to:

a) Center part to cassette. b) Center central ray to the cassette. c) Angle central ray to the center of the cassette, if necessary. d) Oblique patient correctly, if required. e) Restrict collimation to the part of interest.

RADIATION PROTECTION Student must be able to:

a) Cone or collimate to the part of interest or to the film size. b) Use gonadal shielding when appropriate. c) Demonstrate appropriate use of protective apparel. d) Wear personnel radiation monitoring device on collar at all times. e) Inquire about pregnancy of all women of childbearing age. f) Practice good radiation protection by making optimum use of time distance

and shielding. g) Demonstrate awareness of the principles of ALARA at all times. h) Give precise instructions to patient. i) Communicate with staff and patient in an effective manner.

IMAGE PROCESSING Student must be able to

a) Process film properly. b) Use care and safety around the processor. c) Use care and safety inside the darkroom.

EVALUATING IMAGES

ANATOMICAL PARTS Images should show:

a) Correct alignment of anatomical parts b) No patient motion c) Image well-centered d) Correct angle of central ray

FILM DENSITY AND CONTRAST Images should show correct selection of:

a) kVp and mAs. b) Collimation or cone. c) Grid or non-grid technique. d) Phototiming or manual technique

11

ANATOMICAL ALIGNMENT Images should show

a) Part centered to film. b) Parts aligned correctly.

IMAGE IDENTIFICATION Image should show:

a) Identification on the film with appropriate markers. b) Film flashed with the correct patient ID. c) Lead markers in the appropriate place.

RADIATION PROTECTION Image should show:

a) Optimal contrast b) Optimal density c) Visible collimation d) Gonadal shielding as appropriate.

13

MANDATORY COMPETENCY EVALUATIONS

Patients Number

Completed

Simulated Number

Completed

Date

Clinical Coordinator’s

Initials

Fall

Spring

Summer

Fall

Spring

Summer

14

Mandatory Competency Evaluations

The Mandatory Competency Evaluations are divided into six major categories, which cover a total of 46 radiographic examinations. A minimum of 35 of these exams must be completed on patients in the clinical setting. Eleven exams may be completed using a phantom or simulated in the clinical or lab setting. The Mandatory Competency Evaluations must be completed according to the schedule: 2 the first Fall Semester, 5 the first Spring Semester, 5 the first summer; 11 for the 2nd Fall Semester; 11 the 2nd Spring Semester; and 5 the 2nd summer. More than the assigned number of Mandatory Competency Evaluations may be completed on patients in any given semester, but the minimum number must be done each semester until all 46 Mandatory Competency Exams are completed. Exams must be covered in the classroom before they can be checked off in the handbook. Each exam performed on a patient in the clinical setting must be performed under the direct supervision of a qualified technologist until the student successfully completes the competency evaluation for that exam. When an exam has been signed off in the handbook it may then be performed with indirect supervision, but a technologist must always be immediately available.

More than two “2’s for any one exam requires re-evaluation of that entire exam. A “1” in any evaluation area requires repeating the entire evaluation for that exam.

15

EXTREMITIES AREA OF EVALUATION: FINGER HAND WRIST FOREARM ELBOW HUMERUS

PATIENT OR SIMULATED?

DATE:

Evaluation of Requisition Room Preparation Patient Care Use of equipment Positioning Skills Radiation Protection Image Processing IMAGES SHOW CORRECT: Anatomical Parts

Film Density & Contrast Anatomical Alignment Image Identification Radiation Protection

EXAMINATION PASSED (Evaluator’s Signature)


Instructions The evaluator will mark each area according to the following scale: 3 = Acceptable 2 = Requires minor improvement 1 = Unacceptable


16

EXTREMITIES AREA OF EVALUATION: SHOULDER TRAUMA

SHOULDER FOOT ANKLE TIB/FIB KNEE FEMUR


DATE:

Evaluation of Requisition Room Preparation Patient Care Use of equipment Positioning Skills Radiation Protection Image Processing IMAGES SHOW CORRECT:

Anatomical Parts


EXAMINATION PASSED: (Evaluator’s Signature)




17

THORAX AREA OF EVALUATION: CHEST

routine CHEST

decubitus CHEST

≤≤≤≤ 6 years CHEST

wheelchair CHEST

stretcher RIBS


DATE:







18

SPINE & PELVIS AREA OF EVALUATION: C-SPINE C-SPINE

trauma T-SPINE L-SPINE PELVIS HIP HIP

trauma

AFFILIATION CODE:

DATE:







19

ABDOMEN & GI TRACT AREA OF EVALUATION: ESOPHAGUS

STUDY ABDOMEN supine and

upright

ABDOMEN decubitus

UGI SMALL BOWEL BE double contrast


DATE:







20

HEAD & NECK AREA OF EVALUATION: SKULL FACIAL BONES MANDIBLE NASAL BONES ORBITS SINUSES


DATE:






More than two “2’s for any one exam requires re-evaluation of that entire exam. A “1” in any evaluation area requires repeating the entire evaluation for that exam. 21

MOBILE & SURGICAL AREA OF EVALUATION: PORTABLE

CHEST PORTABLE ABDOMEN

PORTABLE ORTHOPEDICS

OPERATIVE CHOLANGIO-

GRAM

RETROGRADE UROGRAM

C-ARM surgical


DATE:






More than two “2’s for any one exam requires re-evaluation of that entire exam. A “1” in any evaluation area requires repeating the entire evaluation for that exam. 22

OTHER EXAMS AREA OF EVALUATION: INTRAVENOUS

UROGRAM MYELOGRAM


DATE:

Evaluation of Requisition

Room Preparation

Patient Care

Use of equipment

Positioning Skills

Radiation Protection

Image Processing

IMAGES SHOW CORRECT: Anatomical Parts

Film Density & Contrast

Anatomical Alignment

Image Identification

Radiation Protection EXAMINATION PASSED: (Evaluator’s Signature)



23

Patients Number

Completed

Simulated Number

Completed

Date

Clinical Coordinator’s

Initials

Spring

Summer

Fall

Spring

Summer

ELECTIVE COMPETENCY EVALUATIONS

24

Elective Competency Evaluations The Elective Competency Evaluations are divided into six major categories, which cover a total of 24 radiographic examinations. The Elective Clinical Competency Evaluations may be completed in the clinical setting on patients, or in the clinical setting or lab setting with a phantom or simulated with another student. Students must demonstrate competency on a minimum of ten of the 24 Elective Clinical Competencies. A minimum of 2 must be completed during each semester starting with the first Spring and ending with the last summer session of training. Each exam performed on a patient in the clinical setting must be performed under the direct supervision of a qualified technologist until the student successfully competes the competency evaluation for that exam.


25

EXTREMITIES AREA OF EVALUATION: TOES OS CALCIS PATELLA AC JOINTS EXTREMITY

age 6 or younger

SOFT TISSUE EXTREMITY

LONG BONE MEASUREMENT


DATE:




ELECTIVE COMPETENCY EVALUATIONS Instructions The evaluator will mark each area according to the following scale: 3 = Acceptable

2 = Requires minor improvement 1 = Unacceptable


26

THORAX GI TRACT

AREA OF EVALUATION: SCAPULA CLAVICLE CHEST oblique or apical

lordotic

STERNUM ERCP


DATE:




ELECTIVE COMPETENCY EVALUATIONS Instructions The evaluator will mark each area according to the following scale: 3 = Acceptable

2 = Requires minor improvement 1 = Unacceptable


27

HEAD & NECK SPINE & PELVIS AREA OF EVALUATION: ZYGOMATIC

ARCHES LARYNX (SOFT TISSUE NECK)

COCCYX AND/ OR SACRUM

SI JOINTS SCOLIOSIS SERIES


DATE:




ELECTIVE COMPETENCY EVALUATIONS Instructions The evaluator will mark each area according to the following scale: 3 = Acceptable 2 = Requires minor improvement

1 = Unacceptable


28

OTHER EXAMS AREA OF EVALUATION: TOMOGRAMS CYSTOGRAM VOIDING

CYSTOGRAM RETROGRADE

URETHROGRAM VENOGRAM


DATE:




ELECTIVE COMPETENCY EVALUATIONS Instructions The evaluator will mark each area according to the following scale: 3 = Acceptable 2 = Requires minor improvement

1 = Unacceptable

Mandatory Competency Evaluations Check (!!!!) when completed in Competency Evaluation Handbook Juniors: 1st Fall Semester 2 Mandatory Competencies:

"#CHEST routine "#ABDOMEN supine

and upright Juniors: 1st Spring Semester 5 Mandatory Competencies Must complete GI or BE and any 4 of the following exams

"#UGI "#BE double contrast "#FINGER "#HAND "#WRIST "#FOREARM "#ELBOW "#HUMERUS "#SHOULDER "#TRAUMA SHOULDER "#FOOT "#ANKLE "#TIB/FIB "#KNEE "#FEMUR "#CHEST decubitus "#CHEST 6 years or

younger "#CHEST wheelchair "#CHEST stretcher "#RIBS "#C-SPINE "#C-SPINE trauma "#T-SPINE "#L-SPINE "#PELVIS

"#HIP "#HIP trauma "#ESOPHAGUS STUDY "#ABDOMEN decubitus "#SMALL BOWEL

Seniors: 1st Summer 5 Mandatory Competencies Skull, Mandible & Orbits are done in class. Complete sinuses, facial bones or nasal bones and one of the other following exams.

"#SKULL "#FACIAL BONES "#MANDIBLE "#NASAL BONES "#ORBITS "#SINUSES "#PORTABLE CHEST "#PORTABLE ABDOMEN "#PORTABLE ORTHOPEDICS "#OPERATIVE

CHOLANGIOGRAM "#RETROGRADE UROGRAM "#C-ARM surgical "#INTRAVENOUS UROGRAM "#MYELOGRAM

Seniors: Fall, Spring & Summer 11 Competencies in fall, 11 in spring, 5 in summer. All of the Mandatory Competencies must be completed by the end of the last summer rotation.

Elective Competency Evaluations Check (!!!!) when completed in Competency Evaluation Handbook

A minimum of 2 Elective Competency Evaluations are assigned every semester after the first Junior Fall semester until 10 have been completed. A total of 10 are required. Elective exams may be simulated or completed on a patient. It is preferable to do competency evaluations on a patient when possible.

"#TOES "#OS CALCIS "#PATELLA "#AC JOINTS "#EXTREMITY, age 6 or

younger "#SOFT TISSUE

EXTREMITY "#EXTREMITY, trauma "#LONG BONE

MEASUREMENT "#SCAPULA "#CLAVICLE "#CHEST oblique or apical

lordotic "#STERNUM "#ZYGOMATIC ARCHES "#LARYNX (SOFT TISSUE

NECK) "#COCCYX AND/ OR

SACRUM "#SI JOINTS "#SCOLIOSIS SERIES "#TOMOGRAMS "#CYSTOGRAM "#VOIDING CYSTOGRAM "#RETROGRADE

URETHROGRAM "#VENOGRAM "#ERCP

___________________________________________ Signature of Program Official Clinical Evaluation Criteria CRITERIA FOR STUDENT CLINICAL EVALUATIONS JUNIOR STUDENTS (FIRST FALL & SPRING SEMESTER)

APPLICATION OF KNOWLEDGE & PROGRESS:

* Understand most requisitions. * By the end of the Spring semester - convert a technique in case of

patient motion by changing time and mA or kV, or by converting to faster screens.

* By the end of the Spring semester - properly apply phototiming for automatic exposure.

* By the end of the Spring semester - identify most technical errors on a film.

* Know specific centering for each part to be radiographed in most routine exams.

* Demonstrate increased confidence and independence. * Show pride in work.

PATIENT CARE:

* Maintain patient modesty and comfort. * Show empathy towards patients. * Properly handle patients with IV and catheters. * Explain exams clearly and concisely to patients. * Use a safe approach in transferring patients.

PROFESSIONAL JUDGMENT:

* Show courtesy to coworkers. * Project professionalism under job stress. * Contribute to a pleasant working environment.

* Cooperate with technologists and demonstrate a team approach. * Adapt to new or changing situations and make reasonable decisions. * Evaluate patients in determining exposure factors according to body

habitus. * Demonstrate versatility of skills and the ability to handle a wide

variety of situations. * Determine when an exam requires skill beyond his/her level of

understanding and asks for assistance when appropriate.

USE AND CARE OF EQUIPMENT:

* Show competency and proficiency with equipment by using previous

education and experience. * Use safety precautions including keeping room furnishings and

accessories properly placed and safely positioned. * Demonstrate careful manipulation of control panel. * Observe limits of tube-rating charts and heat units.

RADIOGRAPHIC QUALITY & FILM CRITIQUE:

* Mark radiographs correctly according to department standards. * Retain positioning of all routine exams. * Retain positioning and routines for most special procedures with the

exception of Angiography. * Set the control panel accurately for all procedures. * Insure quality radiographs - doesn't let poor films "slide through". * Identify and correct technique errors. * Identify anatomy seen on the films. * Recognize causes of artifacts and their prevention. * Troubleshoot sub optimal radiographs.

RADIATION PROTECTION:

* Close all doors before any exam. * Use shielding on patients when possible. * Use proper radiation protection for self and others. * Collimate to at least film size. * Show consideration of patient pregnancy status. * Keep repeats to a minimum.

ORGANIZATION & QUANTITY OF WORK:

* Maintain a neat, clean, well-stocked room. (e.g., changes pillow cases, cleans table and chest unit frequently, and stocks supplies in cabinet.)

* Plan and organize work efficiently - anticipate, make sure all supplies needed for exam are set up before exam begins.

* Work pattern during exam is organized and efficient. * Work at an efficient pace to keep up with patient flow. * Keep repeats to a minimum.

INITIATIVE:

* Remain alert and interested in the procedures - asks pertinent questions.

* Makes effective use of idle time. * Remain proactive in exam performance. * Take initiative to improvise in a given situation to obtain desired

results. * Demonstrate enthusiasm and interest in his/her job.

CONSTRUCTIVE CRITICISM:

* Accept constructive criticism in a positive manner. * Be receptive to instruction and direction. * Acknowledge areas of weaknesses and strives to improve.

DRESS CODE:

* Report to clinical site in appropriate uniform. * Clothing under lab coat is neat and clean - loud colored clothing or

monogrammed T-shirts are not permitted. * Shoes must not be running shoe type, sandals, or clogs. * Identification badge, arm patch, and personnel monitoring device are

worn on the uniform at all times. * Good grooming includes neat, clean hair - long hair drawn back; small

earrings, and no body odor or strong cologne.

PUNCTUALITY & ATTENDANCE:

* Be punctual in reporting to and preparing the room for patients at the

start of shift. * Show consideration for others by taking proper length of time for

coffee and lunch breaks. * Properly notifies the department in the event of tardiness.

* Communicates whereabouts appropriately. * Properly notifies department in the event of absence. * Demonstrate flexibility in taking breaks and lunches.

CRITERIA FOR STUDENT CLINICAL EVALUATIONS SENIOR STUDENTS


* Read and understand the requisition. * Adapt exposure factors in case of patient motion by changing time and

mA or kV, or by converting to faster screens. * Correctly apply phototiming for automatic exposure. * Identify technical errors on a radiograph and its correction. * Know specific centering for each part to be radiographed. * Progress toward minimal supervision. * Demonstrate increased confidence and independence. * Demonstrate effective work.

PATIENT CARE:



* Show courtesy to coworkers. * Project professionalism under job stress. * Contribute to a pleasant working environment. * Cooperate with technologists and demonstrate a team approach. * Adapt to new or changing situations and make reasonable decisions. * Evaluate patients in determining exposure factors according to body









* Mark radiographs correctly according to department standards. * Retain positioning of all routine exams. * Retain positioning and routines for most special procedures with the

exception of Angiography. * Set the control panel accurately for all procedures. * Insure quality radiographs - doesn't let poor films "slide through". * Identify and correct technique errors. * Identify anatomy seen on the films. * Recognize causes of artifacts and their prevention. * Troubleshoot suboptimal radiographs.




* Maintain a neat, clean, well-stocked room. (e.g., changes pillow cases,

cleans table and chest unit frequently, and stocks supplies in cabinet.) * Plan and organize work efficiently - anticipate, make sure all supplies

needed for exam are set up before exam begins. * Work pattern during exam is organized and efficient. * Work at an efficient pace to keep up with patient flow. * Keep repeats to a minimum.

INITIATIVE:

* Remain alert and interested in the procedures - asks pertinent

questions. * Makes effective use of idle time. * Remain proactive in exam performance. * Take initiative to improvise in a given situation to obtain desired



* Accept constructive criticism in a positive manner. * Be receptive to instruction and direction. * Acknowledge areas of weaknesses and strives to improve.

DRESS CODE:








coffee and lunch breaks. * Properly notifies the department in the event of tardiness. * Communicates whereabouts appropriately. * Properly notifies department in the event of absence. * Demonstrate flexibility in taking breaks and lunches.

CRITERIA FOR STUDENT CLINICAL EVALUATIONS INTERN STUDENTS


* Read and understand the requisition. * Adapt exposure factors in case of patient motion by changing time and

mA or kV, or by converting to faster screens. * Correctly apply phototiming for automatic exposure. * Identify technical errors on a radiograph and its correction. * Know specific centering for each part to be radiographed. * Progress toward minimal supervision. * Demonstrate increased confidence and independence. * Demonstrate effective work.

PATIENT CARE:



* Show courtesy to coworkers. * Project professionalism under job stress. * Contribute to a pleasant working environment. * Cooperate with technologists and demonstrate a team approach. * Adapt to new or changing situations and make reasonable decisions. * Evaluate patients in determining exposure factors according to body









* Mark radiographs correctly according to department standards.

* Retain positioning of all routine exams. * Retain positioning and routines for most special procedures with the

exception of Angiography. * Set the control panel accurately for all procedures. * Insure quality radiographs - doesn't let poor films "slide through". * Identify and correct technique errors. * Identify anatomy seen on the films. * Recognize causes of artifacts and their prevention. * Troubleshoot suboptimal radiographs.




* Maintain a neat, clean, well-stocked room. (e.g., changes pillow cases,

cleans table and chest unit frequently, and stocks supplies in cabinet.) * Plan and organize work efficiently - anticipate, make sure all supplies

needed for exam are set up before exam begins. * Work pattern during exam is organized and efficient. * Work at an efficient pace to keep up with patient flow. * Keep repeats to a minimum.

INITIATIVE:

* Remain alert and interested in the procedures - asks pertinent questions.

* Makes effective use of idle time. * Remain proactive in exam performance. * Take initiative to improvise in a given situation to obtain desired



* Accept constructive criticism in a positive manner.

* Be receptive to instruction and direction. * Acknowledge areas of weaknesses and strives to improve.

DRESS CODE:








coffee and lunch breaks. * Properly notifies the department in the event of tardiness. * Communicates whereabouts appropriately. * Properly notifies department in the event of absence. * Demonstrate flexibility in taking breaks and lunches.

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