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.
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PROFESSIONALISM
Development of professional behaviors will be demonstrated by:
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Professional appearance-compliance with dress code
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wears personal radiation monitor at all times
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is prepared with ruler, pens, etc.
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Cooperates with radiation therapists
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Interacts courteously with other medical personnel
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Uses appropriate language (i.e. no profanity)
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Avoids personal telephone calls
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Maintains patient confidentiality
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Follows chain of command when addressing conflicts
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Demonstration of professional behavior is:
outstanding above average average below average unsatisfactory
COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
COMMUNICATION WITH STAFF
Student shall demonstrate staff communication skills by:
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Relaying messages promptly
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Respecting the professional and technical knowledge/skills of radiation therapists interacting courteously and following directions
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Seeks staff assessment of progress
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Acts on staff assessment and suggestions for improvement
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Demonstration of student’s staff communication skills:
outstanding above average average below average unsatisfactory
COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
COMMUNICATION WITH PATIENTS AND THEIR FAMILIES
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Maintains friendly, supportive manner with patients and families
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Addresses patients formally until patient invites familiarity
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Introduces self to patients
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Converses with patients and/or families
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Strives to put patients at ease
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Adjusts voice volume to patient’s hearing ability
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Uses discretion when communicating (e.g., information, sympathy)
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Answers patient questions, when capable, in the presence of clinical staff
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Refers ALL questions to clinical staff
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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:
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Reporting to clinical assignment at assigned time
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Concentrating on learning rather than social climate
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Reviewing clinical rotation objectives with clinical staff
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Assisting in all aspects of radiation therapist's role
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Seeking clinical knowledge/skill experiences during slow periods
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Becoming familiar with patient diagnosis, history and area of treatment
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Demonstrating initiative in performing clinical skills
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Accepting assigned clinical skill tasks
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Demonstrating self-direction in attaining new skills
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Utilizing clinical time to complete clinical assignments
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Demonstration of motivation is:
outstanding above average average below average unsatisfactory
COMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
TEAMWORK
Student will participate as a member of the treatment team by:
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Assuming clinical duties at assigned time
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Notifying staff prior to absence/tardiness
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Informing staff of whereabouts at all times during assigned hours
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Maintaining cleanliness and orderliness in the treatment room
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Assisting with all simulation
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Recognizing supervisory role of clinical staff
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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:
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Putting patients' needs FIRST
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Maintaining patient confidentiality
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Demonstrating empathetic understanding of patients’ emotional/physical needs
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Demonstrating respect for patient modesty/dignity
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Demonstrating proper patient identification
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Assisting patients to and from treatment room
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Handling wheelchairs and stretchers safely
a. accurately assessing and providing patient assistance
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Accurately assessing need for and providing patient assistance
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Overall demonstration of patient care skills is:
outstanding above average average below average unsatisfactory
COMMENTS:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
TECHNICAL AREA
Student will be able to:
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Identify type of equipment and/or radiation utilized
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Identify procedures followed in a medical or fire emergency
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Turn processor ON & OFF (if applicable)
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Review patient charts and/or sim instructions prior to simulation
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Prepare simulation room prior to patient arrival
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Prepare for special procedures (catheters, contrast, etc.)
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Prepare injectables (contrast, medications, etc.) using aseptic technique
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Interpret treatment prescriptions
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Safely assists with patient transfer
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Maintain patient modesty
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Maintain patient comfort while producing a reproducible set-up position
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Consistently demonstrate accuracy and attention to detail
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Safely operate simulator controls
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Safely and correctly utilize treatment accessories
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Fill out patient set-up sheet or electronic instructions for pt. set up
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Operate fluoroscopy independently (if applicable)
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Determine when a grid should be used (if applicable)
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Determine selection of kV, mA and time to obtain a quality radiograph (if applicable)
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Contour a patient without assistance (if applicable)
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Take compensator measurements (if applicable)
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Explain procedure and put permanent marks on patients
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Label/identify patient immobilization equipment
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Perform calculations (including blocked fields, extended distance, gaps, etc.) (if applicable)
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Prepare front sheets (if applicable), or EMR demographic information
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Develop and label radiographs (if applicable)
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Label/identify DRR’s, pt. record
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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:
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Breast
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Head and Neck
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Brain
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Chest
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Abdomen
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Pelvis
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Skeletal
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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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