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 wears personal radiation monitor at all times 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

____________________________________________________________________________________________________________________________________________________________

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

	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

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

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

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

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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