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



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RADIATION THERAPY PROGRAM

Clinical Competency Evaluation   Simulation - Second Clinical Year, (304C, 305C)

Student Name:_____________________ Date:___________


Evaluated by:__________________________ Clinical Site & Treatment Unit:_________
Student grades are dependent upon submission of evaluation by:_______
This evaluation is to be filled out and reviewed with the student during the last week of their clinical rotation. Please use the following criteria to identify performance on the individual objectives:
M-meets expectations I-needs improvement US – is unsatisfactory
OVERALL performance in each area is to be ranked using the following scale:

outstanding above average average below average unsatisfactory
Ratings of outstanding or unsatisfactory must be accompanied by explanation.

______________________________________________________________________________



PROFESSIONALISM

Development of professional behaviors will be demonstrated by:





M

I


US

Professional appearance-compliance with dress code

  1. wears personal radiation monitor at all times

  2. is prepared with ruler, pens, etc.










Cooperates with radiation therapists










Interacts courteously with other medical personnel










Uses appropriate language (i.e. no profanity)










Avoids personal telephone calls










Maintains patient confidentiality










Follows chain of command when addressing conflicts










Demonstration of professional behavior is:
outstanding above average average below average unsatisfactory

COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________



____________________________________________________________________________________________________________________________________________________________


COMMUNICATION WITH STAFF

Student shall demonstrate staff communication skills by:





M

I


US

Relaying messages promptly










Respecting the professional and technical knowledge/skills of radiation therapists interacting courteously and following directions










Seeks staff assessment of progress










Acts on staff assessment and suggestions for improvement










Demonstration of student’s staff communication skills:

outstanding above average average below average unsatisfactory


COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
COMMUNICATION WITH PATIENTS AND THEIR FAMILIES



M

I

US

Maintains friendly, supportive manner with patients and families










Addresses patients formally until patient invites familiarity










Introduces self to patients










Converses with patients and/or families










Strives to put patients at ease










Adjusts voice volume to patient’s hearing ability










Uses discretion when communicating (e.g., information, sympathy)










Answers patient questions, when capable, in the presence of clinical staff










Refers ALL questions to clinical staff










Demonstration of student’s patient and family communication is:

outstanding above average average below average unsatisfactory


COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
MOTIVATION

The student will display intellectual curiosity by:






M

I


US

Reporting to clinical assignment at assigned time










Concentrating on learning rather than social climate










Reviewing clinical rotation objectives with clinical staff










Assisting in all aspects of radiation therapist's role










Seeking clinical knowledge/skill experiences during slow periods










Becoming familiar with patient diagnosis, history and area of treatment










Demonstrating initiative in performing clinical skills










Accepting assigned clinical skill tasks










Demonstrating self-direction in attaining new skills










Utilizing clinical time to complete clinical assignments










Demonstration of motivation is:

outstanding above average average below average unsatisfactory


COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
TEAMWORK

Student will participate as a member of the treatment team by:






M

I


US

Assuming clinical duties at assigned time










Notifying staff prior to absence/tardiness










Informing staff of whereabouts at all times during assigned hours










Maintaining cleanliness and orderliness in the treatment room










Assisting with all simulation










Recognizing supervisory role of clinical staff










Overall performance as a member of the treatment team is:

outstanding above average average below average unsatisfactory


COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
PATIENT CARE

Student shall demonstrate concern and skill in patient care by:






M

I

US

Putting patients' needs FIRST










Maintaining patient confidentiality










Demonstrating empathetic understanding of patients’ emotional/physical needs










Demonstrating respect for patient modesty/dignity










Demonstrating proper patient identification










Assisting patients to and from treatment room










Handling wheelchairs and stretchers safely

a. accurately assessing and providing patient assistance












Accurately assessing need for and providing patient assistance










Overall demonstration of patient care skills is:

outstanding above average average below average unsatisfactory


COMMENTS:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
TECHNICAL AREA

Student will be able to:






M

I

US

Identify type of equipment and/or radiation utilized










Identify procedures followed in a medical or fire emergency










Turn processor ON & OFF (if applicable)










Review patient charts and/or sim instructions prior to simulation










Prepare simulation room prior to patient arrival










Prepare for special procedures (catheters, contrast, etc.)










Prepare injectables (contrast, medications, etc.) using aseptic technique










Interpret treatment prescriptions










Safely assists with patient transfer










Maintain patient modesty










Maintain patient comfort while producing a reproducible set-up position










Consistently demonstrate accuracy and attention to detail










Safely operate simulator controls










Safely and correctly utilize treatment accessories










Fill out patient set-up sheet or electronic instructions for pt. set up










Operate fluoroscopy independently (if applicable)










Determine when a grid should be used (if applicable)










Determine selection of kV, mA and time to obtain a quality radiograph (if applicable)










Contour a patient without assistance (if applicable)










Take compensator measurements (if applicable)










Explain procedure and put permanent marks on patients










Label/identify patient immobilization equipment










Perform calculations (including blocked fields, extended distance, gaps, etc.) (if applicable)










Prepare front sheets (if applicable), or EMR demographic information










Develop and label radiographs (if applicable)










Label/identify DRR’s, pt. record









Student will independently simulate 7 of the following areas based on simulation procedures that were not completed during the previous simulator rotation. Revised 8/04, 8/09




Area:

Breast

Head and Neck

Brain

Chest

Abdomen

Pelvis

Skeletal


Overall demonstration of technical skill is:

outstanding above average average below average unsatisfactory


COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Overall assessment of clinical performance:
Areas Needing Improvement:
Clinical Supervisor(s):_________________________________ Date: __________________
Student:____________________________________________ Date: ___________________

(Signature indicates only that evaluation has been reviewed.)


Student comments: (Please attach additional sheet if necessary)




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