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

Download 2.08 Mb.
Size2.08 Mb.
1   ...   37   38   39   40   41   42   43   44   45

Clinical Intent

The student and the clinical staff will review patient census and create a clinical plan for clinical competency objectives.

1. The student will be required to fill out a clinical intent form during the FIRST week of clinical.

2. The student will fax the completed clinical intent form to the Clinical Coordinator

3. The intent form should be posted at the treatment unit and reviewed with the therapy staff.

4. A new Clinical Intent form will need to be filled out for each treatment rotation.
Clinical Competency Intent Form


STUDENT: ____________________________________________________________

CLINICAL SITE:________________________________________________________

TREATMENT UNIT: ____________________________________________________

RTT 201C, 202C, 203C, 304C 305C (CIRCLE ONE) DATE: ___________________

* A new clinical intent form must be filled out for each treatment or simulator rotation. Copy of this intent form will be reviewed with the staff, faxed to the Clinical Coordinator and posted on the treatment unit for the entire rotation. Any revisions to the original Clinical Intent will need to be faxed to the Clinical Coordinator.
This is to clarify what I need to accomplish during my ___ week rotation.
I intend to complete the following competency evaluations.






Schedule of mid and final evaluation due dates:
Clinical Evaluation by Clinical Supervisor – Mid Eval (1/2 way through each tx unit rotation / Due: ­­­­­­­­_________________________

Clinical Evaluation by Clinical Supervisor – Final Eval (end of each tx unit rotation / Due:__________________________

*Student is required to evaluate the clinical site & instructors by the end of the clinical rotation.
At any point in the rotation, the Program Director, Clinical Coordinator, clinical supervisors and the student may meet to review what progress has been made and what areas need to be improved.

Student’s Signature: ___________________________________________________

Clinical Supervisor(s) Signature(s): __________________________________

Revised 8/09

Clinical Infraction Policy:

Infractions of the policies of the Radiation Therapy Program are determined by the clinical staff and/or the Clinical Coordinator. Designated clinical supervisors are expected to be forthcoming with any information regarding student clinical infractions. If the clinical supervisor prefers, the Clinical Coordinator will write up the clinical infraction and address the issue with the student.
1. A Clinical Infraction form will be written up and reviewed with the student by the person issuing the written warning.

2. The policy(ies), incident(s), and consequences of the infraction will be noted on the document and the student will be asked to sign it along with the person issuing the clinical infraction.

3. A student signature indicates only that a warning has been received. If the student feels that extenuating circumstances should be considered in regard to the identified infraction(s), then the student should submit the information to the Clinical Coordinator & Program Director in writing.

4. The Clinical Infraction will need to be reported by the clinical supervisor to the Clinical Coordinator who will address this with the student.

5. Receiving three or more clinical infractions in a clinical internship will result in a drop of one letter grade for that clinical internship.

6. The 4th clinical infraction will result in an additional drop in one letter grade.

7. The 5th clinical infraction will result in an additional drop in one letter grade.

8. Multiple Clinical Infractions will lead to either clinical probation or the student failing that clinical rotation.

Revised 1/07, 2/09, 6/09, Reviewed 8/11

Clinical Infraction Form

Policy(ies) Cited:

MCPHS Clinical Coordinator notified Yes No


________________________________ _________________________

Staff Therapist/ Clinical Supervisor Name of Clinical Site


Susan MacIsaac, B.S.N., R.T.(T).

Clinical Coordinator

(optional – not needed if therapist signed)



(A signature indicates only that a warning has been received)
Comments Staff/Faculty:

Student Comments:
Revised 8/10, 8/11

Massachusetts College of Pharmacy and Health Sciences

School of Medical Imaging & Therapeutics

Clinical Incident Documentation Form

This form serves as documentation of a clinical incident involving a radiation therapy student in the clinical education site. Upon completion of this form the original is placed in student’s file at the clinical site and a copy is sent to the Radiation Therapy Program Director at MCPHS. Students must also follow the specific policies and procedures of the clinical site regarding incident reports.

Name of Student:______________________________________________________

Date and Time of Incident:______________________________________________

Clinical Site:__________________________________________________________

MCPHS Notified: Yes Date and Time Reported___________________ NO____

Brief Description of Incident (may use other side):__________________________

Action Taken (If any):____________________________________________________

Signature of Student:________________________________Date_________________
Signature of Clinical Supervisor:______________________Date_________________

Share with your friends:
1   ...   37   38   39   40   41   42   43   44   45

The database is protected by copyright © 2020
send message

    Main page