Massachusetts college of pharmacy & health sciences radiation therapy program school of Medical Imaging & Therapeutics Contact Information


CLINICAL COMPETENCY EVALUATION – All procedures



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CLINICAL COMPETENCY EVALUATION – All procedures



Student/Affiliate Information:

Student Name: _____________________________________________________

Clinical Affiliate: ___________________________________________________

Date of Evaluation: __________________________________________________

Circle Appropriate Rotation: RTT 201C: RTT 202C: RTT 203C: RTT 304C: RTT 305C

Clinical Instructor: __________________________________________________

Treatment Unit: _____________________Tx Energy_______________________

Patient Parameters: (Check all that apply)

Cooperative ________ Difficult ________

In-Patient ________ Out-Patient ________

Mentally Alert ________ Confused ________



Treatment Parameters: (Give a brief explanation as to why this treatment is Simple, Intermediate, or Complex.)

Simple ________ Field Shaping ________

Intermediate ________ Wedges ________

Complex ________ IMRT ________


Explanation: ______________________________________________________

Diagnosis: ________________________________________________________



CLINICAL COMPETENCY EVALUATION ***TREATMENT PROCEDURE***___________

Psychomotor Domain

Task

Pass

Fail

  1. Identify & assist correct patient into treatment room







  1. Verify Treatment Parameters










  1. Verify treatment prescription & review chart and orders







  1. Set up Treatment Unit

    • Set controls for prescribed dose & follow “Time-Out” procedure & verify against R&V

    • Treatment parameters correctly reproduced under direct supervision







  1. Patient Positioning

    • Follow set-up notes and position patient accurately using positioning mold or immobilization devices when specified

    • Check field placement & make adjustments

    • Level patient

    • Set correct field size

    • Set field light to area marked (including “flash”)

    • Set correct machine parameters:

      • SSD or SAD

      • Table height (CV, CL)

      • Gantry angle

      • Collimator angle

      • Table angle (kick)







  1. Monitoring Patient

    • Maintain continual observation of patient and physical contact with controls during treatment







  1. Documentation

    • Record the following data in the treatment chart according to department procedure:

      • Initials of student and therapists performing treatment

      • Date

      • Elapsed Days (if applicable)

      • MU’s (monitor units)

      • Daily dose for each portal treated

      • Total dose for each portal treated

      • Combined field dose (if applicable)

      • Total critical organ dose (if applicable)

    • Any changes in treatment set-up or dose

    • Check for any treatment delivery errors

    • Verify entry with therapist whose initials appear in the chart for this treatment








Interpersonal Domain

Task

Pass

Fail

  1. Sensitivity and Compassion

    • Addresses patient’s physical and emotional well-being

    • Responses appropriately to patient questions and concerns

    • Provides culturally competent care







  1. Personal Interactions

    • Interacts with Radiation Therapy Team in a positive and productive manner







  1. Maintains high ethical standards







  1. Correlation of Theory and Technique

    • Theory – Didactic knowledge

    • Technique – Application of knowledge through neuromuscular application

    • Utilizes Critical Thinking Skills






Comments: ________________________________________________________


__________________________________________________________________

The Clinical Instructor/Supervisor has reviewed the results of this Competency Evaluation with me:


Student: _______________________________________ Date: _______________
Clinical Instructor/Supervisor:__________________________________________

8/11





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