advanced placement track radiography program...

Advanced Placement Track Radiography Program (APTR) Clinical Handbook

Edition 4/23/2014

TABLE OF CONTENTS page

4 Mission Statement and Goals

5 Introduction

6 Required Documents

6 Rationale

6 Clinical Education Philosophy

7 Glossary of Terms

8 Advanced Radiography Key Names & Numbers

9 Clinical Education Objectives

10 Supervision of Students

11 Clinical Education Policies

13 Student Responsibilities and Competencies

14 Achieving Competency

15 Criteria for Clinical Competency Evaluation

17 Affective Skills Competency

18 Student Insurance and Injuries

18 Student Pregnancy Policy

19 Harassment Policy

21 Student Disciplinary Actions and Procedures

22 Appeal Procedure

23 Student Holidays and Vacations

24 Terminal Objectives and Competencies

25 Instruction to Achieve Student Competency

26 Instructional Methods

27 Clinical Externship Grading

TABLE OF APPENDICES page

29 Index of Appendices

30 Appendix A: Rotation Schedule

31 Appendix B: ARRT Required Competencies

35 Appendix C: Externship Time Sheet

36 Appendix D: Clinical Competency Evaluation

45 Appendix E: Technical and Professional Evaluation

49 Appendix F: Pregnancy Disclosure

56 Appendix G: Clinical Exam and Repeat Log

57 Appendix H: Student Evaluation of Clinical Experiences

58 Appendix I: Acknowledgment of Understanding

MISSION STATEMENT & GOALS Pima Medical Institute Mission Statement To improve the quality of people’s lives by providing the best value in medical career education. Radiography Program Mission Statement It is the mission of our program to graduate students with the entry-level employment skills required of a Radiologic Technologist. Students will graduate to be successful radiographers who can safely and competently perform radiographic exams as specified by ARRT guidelines. Radiography Program Goals Goal 1: Students will demonstrate clinical competence. Goal 2: Students will demonstrate critical thinking skills. Goal 3: Students will demonstrate effective communication skills. Goal 4: Students will grow and develop professionally. Goal 5: Supply Entry-level radiographers to the healthcare community.

4 APTR Clinical Handbook

INTRODUCTION The Radiography program at Pima Medical Institute (PMI) has developed this Clinical Handbook to provide students with the high level of training necessary for the field of Radiologic Technology. In order to provide a sound foundation for further advancement, the program emphasizes not only how procedures are done, but why procedures need to be done a certain way. This document is specific to the Advanced Placement Track Radiography (APTR) online program, and its purpose is to provide students, clinical education sites, and PMI faculty with a clear road map for student success during the clinical phase of the program. It outlines the program objectives for didactic, clinical psychomotor skills and affective skills and establishes the standards a student must meet to successfully complete a clinical externship. It is important to note that in order to participate in clinical externship, certain requirements must be met. The student must have: Successfully completed all semester I, II and III courses. Completed a criminal background check that meets program requirements. Submitted all required forms and records for externship and submitted these

documents to the appropriate personnel.


REQUIRED DOCUMENTS Students must provide documentation of the following items prior to starting clinical rotations: Current CPR certification Negative TB test within the past 12 months Two MMR (Measles, Mumps, Rubella) vaccinations or blood titer Three Hepatitis B vaccinations or blood titer (waivers will not be accepted) Two-dose Varicella (chicken pox) vaccination or blood titer Tetanus, Diphtheria, Pertussis (Tdap) vaccination Annual influenza vaccination Background check Drug screen (must be completed no more than 30 days prior to starting externship)

Some sites may have additional requirements. The student must abide by all the requirements requested by a site. All documents will be obtained at the student’s expense and must be received prior to the start of externship. Upload all required documents into the Advanced Radiography Clinical Externship course.

APTR Clinical Handbook

RATIONALE Students need clinical education to achieve competency of radiographic examinations

required to be performed by an entry level radiographer. Clinical education provides an opportunity for the students to apply their didactic education

to a practical situation. Clinical education is an integral part of the curriculum requirements of the Joint Review

Committee on Education in Radiologic Technology (JRCERT) as published in its “Standards for an Accredited Educational Program in Radiography”, effective January 1, 2014.

Most licensing boards require clinical education for all Radiologic Technology training programs.

The clinical setting reinforces psychomotor skills and affective domain skills through modeling by professional Radiologic Technologists.

CLINICAL EDUCATION PHILOSOPHY Clinical education is skills oriented instruction. For students, the ability to make the transition from classroom to clinical facility will vary considerably. Some students will make the transition easily and excel quickly. The goal is to allow students ample opportunities to master the skills needed to become competent.

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GLOSSARY OF TERMS To ensure consistency throughout this document, the following terms and definitions are used based on the JRCERT Glossary of Terms in its Standards for an Accredited Educational Program in Radiography, implemented in January 2014. Affiliation Agreement – A formal written understanding between an institution sponsoring the program and an independent clinical education center. American Registry of Radiologic Technologists Certification or Equivalent - Certification by the American Registry of Radiologic Technologists or unrestricted state license to operate radiation producing equipment. Assessment – The systematic collection, review and use of information to improve student learning, educational, educational quality and program effectiveness. Assessment Plan – Provides direction for actions, and is a way to determine progress. At a minimum, an assessment plan should include goals, evaluation criteria, benchmarks, outcomes and a plan of action. Clinical Director/Coordinator – A full time member of the sponsoring institution’s faculty and is required if the program has 6 or more educational settings and/or more than 30 students. The clinical director/coordinator will oversee the students’ clinical education under the direction of the program director. Clinical Education Setting - A facility recognized by the JRCERT as meeting appropriate qualifications for delivering clinical education and evaluation of clinical competency. A minimum of one clinical instructor/supervisor is designated at each site. Clinical Instructor – One full time clinical instructor is required for every 10 students involved in the competency achievement process. The clinical instructor is knowledgeable of program goals, understands the clinical objectives and clinical evaluation system, provides students with clinical instruction/supervision, evaluates students’ competence and maintains current knowledge of program policies, procedures and student progress. This position is filled by a qualified practitioner upon mutual agreement by the program faculty and clinical education center’s staff. The clinical instructor performs these tasks under the direction of the clinical director. Direct Supervision – Student supervision by a qualified practitioner, who reviews the procedure in relation to the student’s achievement, evaluates the condition of the patient in relation to the student’s ability, is present during the procedure and reviews and approves the procedure. A qualified practitioner is present during student performance of a repeat of any unsatisfactory radiography. Indirect Supervision – Supervision by a qualified practitioner is immediately available to assist students regardless of the level of student achievement. Immediately available is interpreted as the physical presence of a qualified practitioner adjacent to the room or location where a radiographic procedure is being performed. This availability should be applied to all areas where ionizing radiation equipment is in use. Master Plan of Education – Documentation of the entire course of study that includes at a minimum, didactic and clinical curricula, program policies and procedures and strategies for assessing program effectiveness. Qualified Practitioner – A radiographer who possesses American Registry of Radiologic Technologists certification and/or an unrestricted state license.

APTR Clinical Handbook 7

ADVANCED RADIOGRAPHY KEY NAMES & NUMBERS Students are assigned to a specific clinical education site, and an approved clinical instructor who is employed by the facility will supervise the student’s activities and serve as the primary source of communication during the clinical education component of the program. Immediate discussion may take place by calling or e mailing any of the persons listed below.

Chalonda Jones-Thomas Advanced Radiography Online Director (520) 245-0869 [email protected] Shandea Dashiell Radiography Program Director (520) 881-1284 [email protected]

Steve Forshier Advanced Radiography Online Clinical Director (480) 248-4796 Toll Free: (888)287-1618 [email protected]


mailto:[email protected]



CLINICAL EDUCATION OBJECTIVES To develop the psychomotor and affective skills required of a Radiographer, a student must observe and participate in a clinical setting. Therefore, it is necessary that the students have the opportunity to participate in a wide variety of imaging examinations. A “hands on” approach in the clinical setting is one of our program’s objectives. During the clinical portion of the program, the student is expected to transfer didactic information to a clinical situation. Additionally, the students should be able to perform all aspects of duties performed within a diagnostic medical imaging department. Although all aspects of clinical education offer valuable learning experiences, the following policies should be enforced. Students are not to replace paid personnel. Excessive clinical time should not be spent on non-radiographic duties and tasks. Students must be supervised by qualified practitioners while performing

radiographic examinations. (See page four for the definition of qualified practitioner.)

Students shall never be required to exceed a 40-hour week between classroom and clinical education.

To qualify for graduation, a student must have completed all the mandatory competencies and 15 of the elective competencies as required by the ARRT and described later in this document.


SUPERVISION OF STUDENTS Students must be supervised at all times while in the clinical setting. There are two types of supervision required for students. The type of supervision the student receives will be determined by the student’s competency and skill level. The two types of supervision as mandated and defined by JRCERT are: Direct Supervision – This type of supervision requires that a technologist be present with the student in the examination room when an examination is being performed. Actions by the student without the technologist’s supervision are prohibited. Direct supervision of students is required for those examinations in which the student has yet to prove competent, i.e. hasn’t received a competency. Direct supervision is also required for all repeat radiographs. Indirect Supervision – This type of supervision requires that a qualified practitioner be available to the student if the need arises. Available means that there is a qualified practitioner in the department or within the area (i.e. hearing distance if the student asks for help), but not necessarily in the examination room with the student. All images taken by the student must be checked and approved by the supervising technologists. If repeats are necessary, the corrective action necessary should be discussed with the student and the repeat examination will require direct supervision.


CLINICAL EDUCATION POLICIES 1. Upon beginning a rotation, students will be oriented to the institution’s policies and procedures.

Students will comply with all the rules and regulations of the clinical education center. Failure to comply with the rules and regulations of the health care facility will result in disciplinary action taken against the student.

2. Students will be well-groomed at all times, and professionally attired in the uniform which the clinical site deems appropriate.

3. Students must wear a name badge. Some clinical education centers will issue the students an institutional badge to be worn while assigned to that site. If the student isn’t issued an institutional badge, they must wear the PMI name badge. Failure to wear a name badge which identifies the student as a student is considered non-compliant with clinical education policies. Details regarding how to obtain a PMI name badge can be found within the Externship course.

4. PMI will issue students a dosimeter, a radiation monitoring device. This device is to be worn by students at all times while in the clinical setting. It should be positioned outside the apron at the level of the collar. The dosimeter will be mailed directly to the student. Upon completion of extern, students will be responsible for returning the device, along with the control badge, to Landauer. Students will be charged a $20.00 fee for unreturned dosimeters and will not be granted a diploma until this payment has been made. The student will receive a final dosimetry report from PMI.

5. Students are responsible for their own image identification markers. Details regarding how to order markers can be found within the Externship course.

6. Attendance to the assigned clinical education center is mandatory. Students will attend all scheduled clinical education experiences provided to them (refer to Appendix A, Rotation Schedule). If a student is to be absent, he/she is required to phone the clinical site and inform the clinical instructor of the impending absence or tardiness. Notification of absences must be done before the scheduled shift start time. Students are also required to notify the Clinical Director of any absences.

7. The student is not to receive personal telephone calls while at his/her clinical extern site. Students should advise friends and family that calls should be limited to emergencies only. Mobile phones should be switched off completely and stored out of sight.


CLINICAL EDUCATION POLICIES ► Continued from previous page

8. Each week, the student will maintain a detailed time sheet. At the end of the clinical week, the preceptor must sign the bottom of the time sheet with a full signature. The student must then upload the time sheet into the Advanced Radiography Clinical Externship course every week.

9. The student must also upload any competencies achieved during the week. Falsifying time sheets or other extern records is cause for immediate termination from the program.

10. All repeat radiographs require direct supervision (refer to Appendix G, Exam/Repeat Log). Radiation protection is a serious and responsible component of the PMI Radiography Program and every imaging department/facility nationwide. In order to continuously enforce and assure that students follow radiation protection policies and procedures, students are required to have the direct supervision of a qualified technologist whenever repeating images during an exam (JRCERT Standard 4, Objective 4.6). Students are also required to keep track of their repeat exams using the program Clinical Exam and Repeat Log located in Appendix G. Students are required to log in, to the best of their ability, repeats that must be conducted, and obtain the initials of the qualified technologist that supervised the repeat. This Repeat Log will then be uploaded into the Advanced Radiography Clinical Externship course at the end of each clinical extern week. Failure to follow this policy and failure to turn in the Repeat Log will result in a 5 point deduction from the Technical and Professional Evaluation score for each instance. Repeat images contribute greatly to excessive and unnecessary radiation exposure. It is not appropriate to keep repeating images until the “finished product” is adequate, and this policy will assure that repeats are directly supervised and kept under control.

11. Prior to attending their clinical rotation, students have taken didactic courses that include the utilization of imaging equipment, accessories, optimal exposure factors, and proper patient positioning to minimize radiation exposure to patients, selves, and others. These practices assure radiation exposures are kept as low as reasonably achievable (ALARA).

12. Students are not allowed to hold image receptors during any radiographic procedure. Students

are not allowed to hold or restrain a patient during a radiologic examination when ionizing radiation is being utilized. This policy assures the health and safety of students, and guards them from unnecessary exposure to ionizing radiation. This policy also promotes the health, safety, and optimal use of radiation for students, patients, and the general public.


CLINICAL EDUCATION POLICIES 13.► Continued from previous page

14. Many patients referred for x-ray examination, including infants, the elderly, and the incapacitated, are not physically able to support themselves. Mechanical immobilization devices should be available for such patients. Otherwise, a relative or friend who accompanies the patient should be asked to hold. As a last resort, other hospital employees such as nurses and orderlies may be used occasionally to hold patients.

15. When it is necessary to have another person hold the patient, protective apparel must be provided to that person. An apron and gloves are necessary, and the holder should be positioned and instructed carefully, so that he or she is not exposed to the useful beam. Because the holder is often the mother of a child patient, be sure to ask whether she could be pregnant.

16. Upon completion of extern, students must evaluate their clinical experience (refer to Appendix I, Evaluation of Clinical Experience).

Tip for Success: Keep this handbook with you while at your extern site so that all forms are readily available and competency information can be easily updated.


STUDENT RESPONSIBILITIES & COMPETENCIES Radiography students are required to conduct themselves in a professional and caring manner at all times while attending clinical externship. Student interactions with patients, technologists, physicians and other students are to be governed by the HIPAA regulations and the Code of Ethics of the ASRT. Students have been taught ethical conduct, HIPAA policies and professionalism in class before starting clinical externship. It is the student’s responsibility to attend all assigned clinical experiences. Students who are going to be absent on any scheduled day of their clinical externship must telephone their clinical preceptor and clinical director to inform them of the absence. Notice is to be received before the scheduled beginning of shift.

ACHIEVING COMPETENCY The purpose of clinical education is to enable students to achieve competency and proficiency of a wide variety of examinations performed on a wide variety of patients. Demonstration of clinical competence means that the clinical director or designee has observed the candidate performing the procedure, and that the candidate performed the procedure independently, consistently, and effectively. Mandatory Demonstrated Competencies The following procedures/activities are required by the ARRT: • 6 mandatory general patient care activities. • 31 mandatory imaging procedures. • 15 elective imaging procedures to be selected from a list of 35 procedures. • 1 elective imaging procedure from the head section. • 2 elective imaging procedures from the fluoroscopy studies section – 1 must be either an UGI or a Barium Enema. Documentation The following pages identify specific clinical competency requirements. Students are to utilize these pages to record completion of the requirements. To document that the didactic and clinical requirements have been satisfied, candidates must have the program director (and authorized faculty member if required) sign the Endorsement Section of the Application for Certification included in the ARRT Certification Handbook. The student is provided with the competency forms and is responsible for giving these forms to a qualified practitioner for evaluation. The completed forms will be scanned and uploaded into the Advanced Radiography Clinical Externship course every week along with the time sheets. A running count of hours and competencies will be available to students within the externship course.


CRITERIA FOR CLINICAL COMPETENCY EVALUATION A. Evaluation of Requisition

Student will: 1. Identify the

procedure(s) to be performed, patient's name, age, location and mode of transportation.

2. Acknowledge any pathological conditions 3. Acquire appropriate clinical patient history

B. Physical Facilities Readiness Student will:

1. Verify that equipment is operational. 2. Provide a clean and orderly work area. 3. Obtain appropriate supplies for examination.

C. Patient Care Student will:

1. Select the correct patient. 2. Introduce himself/herself to patient and briefly explain the procedure. 3. Request last menstrual period date of female patients between the ages of 12-60. 4. Transport patient to appropriate imaging area. 5. Verify if patient is properly prepared for the exam. 6. Identify, when appropriate, that there are no contraindications for performing

procedure. 7. Provide safe storage for patient's belongings. 8. Provide appropriate assistance to radiographic table based on patient's condition. 9. Maintain patient dignity and modesty through proper gowning and covering for

the patient. 10. Talk to patient in a concerned, professional manner. 11. Apply universal precautions as established by the Centers for Disease Control. 12. Provide proper instructions for moving and breathing. 13. Check patient's condition at regular intervals. 14. Provide for patient security if the patient is left alone in the x-ray room.

D. Equipment Operation Student will:

1. Maneuver the x-ray tube and bucky utilizing appropriate controls and locks. 2. Select the proper image, image holder, grid, etc.


CRITERIA FOR CLINICAL COMPETENCY EVALUATION ► Continued from previous page

3. Select appropriate SID. 4. Manipulate image receptor as appropriate for accurate imaging. 5. Measure the patient if applicable. 6. Use immobilization devices as needed. 7. Use technique chart correctly. 8. Select correct exposure factors. 9. Use equipment so as not to exceed recommended safety guidelines.

E. Positioning Skills Student will:

1. Correctly position the patient. 2. Align center of part to be demonstrated to the center of the image. 3. Set the correct tube angle. 4. Set the correct SID.

F. Anatomical Part(s) Included Radiograph(s) demonstrates:

1. Part shown in proper position. 2. Adequate detail (no motion visible).

Student will: 1. Identify anatomical structures.

G. Proper Alignment Radiograph(s) demonstrates:

1. Image centered. 2. Part centered. 3. Tube centered. 4. Patient aligned correctly.

H. Radiographic Exposure & Technique Radiograph(s) demonstrates:

1. Technique chart was used correctly, as evidenced by. 2. Proper contrast and density. 3. Compensation of exposure factors for pathology. 4. Correct exposure factors used to produce diagnostic image. 5. Correct image, screen, grid, SID and OID.

I. Image Identification and/or Other Identifications Radiograph(s) demonstrates:

1. Right and left markers properly displayed (free of pertinent anatomy). 2. Accessory markers visible, if required (minute, hour, directional, etc.). 3. Patient information and date displayed.


CRITERIA FOR CLINICAL COMPETENCY EVALUATION ► Continued from previous page

J. Provide Evidence of Radiation Protection

Student will: 1. Collimate to part. 2. Use gonad shields, if appropriate. 3. Demonstrate use of lead aprons, gloves and lead blockers, if appropriate. 4. Select proper exposure factors. 5. Adjust exposure factors for motion, pathology or patient size when appropriate.

Radiograph(s) demonstrates: 1. Evidence of collimation. 2. Gonad shields in place, if required. 3. Student will verify all repeats and must be performed under direct supervision

AFFECTIVE SKILLS COMPETENCY Students will be evaluated on their professional conduct and affective behaviors (refer to Appendix E, Technical and Professional Evaluation). These evaluations, completed by the preceptor at the clinical education settings, will be completed both at the midpoint and the conclusion of extern. The preceptor may use feedback from other qualified practitioners who have worked with the student. The score on this form will make up part of the student’s clinical externship grade. The preceptor will complete and review this document with the student, to assess student progress in achieving appropriate effective behaviors, critical thinking, problem-solving, and communication skills. The student will upload this document into the extern course in Blackboard.


STUDENT INSURANCE & INJURIES Students without private medical insurance or other form of medical insurance such as Medicaid, Access, or any other program may be provided a limited amount of insurance. The insurance only applies to injuries sustained during scheduled clinical externship hours. The insurance excludes coverage for injury incurred while traveling to and from the externship site. Students are strongly encouraged to seek their own medical and accident coverage from private or public sources. Personal health insurance is the responsibility of the student. In the event a student is injured during scheduled externship hours, the student must report the injury to APTR faculty and an Incident Report signed by the student must be filed with the school within 24 hours of the incident. When the injured student arrives at the medical treatment facility, if the student has his own medical coverage, he must provide that information to the facility for billing purposes. The school’s insurance company will not pay claims for students who have any form of medical coverage.

STUDENT PREGNANCY POLICY As stated in the Pima Medical Institute Academic and Student Handbook, disclosure of pregnancy is voluntary and at the sole discretion of the female student. When a student does disclose pregnancy to the program, the student will be provided relevant reading material and the Clinical Director will immediately order a second radiation monitor specifically to monitor fetal doses. The student may elect to proceed on in the program, performing the normal didactic and clinical assignments. Reading material and disclosure forms are included in Appendix F, Pregnancy Disclosure.


HARASSMENT POLICY Title IX of the Education Amendments of 1972 prohibits discrimination in any education program or activity receiving federal financial assistance because of an individual's gender. In accordance with Title IX, Pima Medical Institute Radiography Program has a strict policy prohibiting discrimination based on race, color, religion, national origin, age, disability, marital status, and gender. This policy includes a prohibition against sexual harassment. Each and every incident of discrimination or harassment, including sexual harassment, should be reported in accordance with this policy. PROHIBITION AGAINST HARASSMENT Discrimination or harassment, including sexual harassment, of any member of the

Radiography Program student body by anyone including another member of the Radiography Program student body will not be tolerated. There is a distinction between harassment and the need for normal evaluation of a student’s academic or professional behavior performance. Harassment does NOT include reprimands for violating PMI Radiography Program policies, reminders for academic improvement or challenges to critical thinking or radiography judgments. It is the responsibility of all Radiography Program employees to evaluate the academic and professional performance of each student and to determine his or her readiness to attend a clinical rotation.

If a student believes that he or she has been discriminated against or harassed, the student should immediately report such conduct in accordance with this policy.

Sexual harassment is defined generally as including unwelcomed sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when: submission to such conduct is either an explicit or implicit term or condition of an

individual's education; a student's reaction to the conduct is used as a basis for making academic decisions affecting

that student; or the conduct has the purpose or effect of substantially interfering with an individuals'

academic performance or creating an intimidating, hostile, or offensive educational environment.

Report an incident of sexual harassment whether carried out by a PMI employee, clinical site employee, another student, or any third party, to one of the following persons: Instructor Program Director or Clinical Director of the Advanced Radiography Program Online Director


HARASSMENT POLICY ► Continued from previous page If you believe that you cannot report an incident of sexual harassment to one of the persons listed above because that person has caused the incident(s), acquiesced to the incident(s), or you otherwise believe that the person will not address the incident(s), you should report it to one of the other persons. Each person to whom a report may be made has the obligation and authority to investigate and act on the report regardless of who is accused. The person to whom the incident of sexual harassment is reported, as well as the Radiography Program Director (unless he or she is accused of the harassing conduct) shall have the authority to investigate the charges of sexual harassment. Hereafter, the persons conducting the investigation will be referred to as the Investigators. The Investigators may ask the charging party to provide them with a written statement of the offending actions or activities. The Investigators may also ask the charging party to present any witnesses or evidence which the charging party has of the harassing conduct. The Investigators will strive to complete the investigation within ten (10) days of the complaint. However, in the event that the investigation of the complaint is complex or the nature of the harassment is severe or widespread; such ten (10) day period may be extended at the sole discretion of the Investigators. The Radiography Program may take action as it deems appropriate in order to prevent the recurrence of any sexual harassment or to correct the effects on the charging party and others. The action taken by the Radiography Program may include subjecting the harassing party to disciplinary action up to and including termination of employment or dismissal from the Radiography Program. The Radiography Program will not tolerate retaliation against any student who complains of sexual harassment or who provides in good faith information in connection with any complaint or investigation. Any employee who retaliates against any student in violation of this policy will be subject to disciplinary action up to and including termination and any student who retaliates against another student in violation of this policy will be subject to disciplinary action up to and including dismissal from the Radiography Program.


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STUDENT DISCIPLINARY ACTIONS & PROCEDURES While students are assigned to a clinical education facility, they are to adhere to the rules and regulations of the institution. However, since they are PMI students and not paid employees of the clinical education center, the required corrective actions for any infractions of the rules are the responsibility of PMI faculty. The corrective action will be initiated when inappropriate behavior or an infraction of policies outlined in this manual are noted. Initiation of corrective action will be at the discretion of PMI faculty. Corrective actions may be taken for repeated tardiness and/or absences and substandard performance in the clinical or didactic portion of the program. Corrective action will follow this sequence: Upon notification of substandard or inappropriate behavior, a conference call will be scheduled with the student to discuss the nature of the problem. The discussion will be documented with a description of the behavior and also methods to improve the behavior as well as a timeline to demonstrate improvement. Failure to correct the behavior within the allotted time may result in the student’s termination from the Radiography program. A student may be removed from a clinical education site for reasonable cause. If it is due to inappropriate behavior on the student’s part (as opposed to irreconcilable differences) the student will only have one more opportunity for clinical placement. The student may have to wait until the next rotation cycle to attend the new site. If asked to be removed from a second clinical site, the student may be terminated from the Radiography program. Due to the limited availability of clinical externship sites, there is no guarantee a student removed from a site will be immediately placed into another facility. The student may be immediately terminated from the Radiography program for demonstrating any of the following: Unethical or unprofessional conduct Carelessness or negligence in the safety of the patient and/or personnel.


APPEAL PROCEDURE The process for a student who has a grievance related to his/her status at Pima Medical Institute during the clinical portion of the training is as follows: Contact the APTR Online Clinical Director and arrange to present the problem, if the

situation is unresolved, present the problem to the APTR Online Director.

If this is still unresolved, present the problem in writing to the Online Education Director.

If the Online Education Director cannot resolve the issue, the student should present the situation in writing to the Operations Manager. The Operations Manager will contact the student within one week of receiving the correspondence to set an appointment for a conference call. The presence of other concerned parties at this conference call is at the discretion of the Operations Manager. The appointment will be arranged within one week of the initial call to the student. The student will receive the decision resulting from the meeting within two weeks of the conference call.

If the issue isn’t resolved by the Operations Manager, the student may request a hearing consisting of program representatives, institution representatives, and student representatives. This committee will hear the student’s grievance within three weeks of the post marked date on the response from the Operations Manager. The committee will reach a consensus on appropriate action.

If the student is still unsatisfied, he may seek any outside intervention he wishes.


STUDENT HOLIDAYS & VACATIONS

PMI Radiography students should plan trips and vacations during the program’s assigned semester breaks and holidays. All plans for travel or holidays should be made according to the following: There is a two week break between each semester. (Refer to your schedule for

semester start and end dates.) The student may not substitute another week in place of the scheduled week off.

The students receive two full weeks off during December. This time begins after the last Friday prior to December 25th and ends on the first Monday after two full weeks have passed.

Students may be absent from their clinical site 6% (8 hours) of the scheduled externship/clinical hours each semester. The Absences must be excused and requested by the student and approved by the Clinical Director.

In addition, the students will be off on the following holidays:

Martin Luther King, Jr. Day Memorial Day

Independence Day Labor Day

Thanksgiving Day and the Friday after Thanksgiving


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TERMINAL OBJECTIVES & COMPETENCIES In addition to the mandatory clinical competency requirements, both general and radiographic, the terminal competencies reflect the minimum skills required of a successful entry-level radiographer. The ARRT mandatory clinical requirements can be found preceding the competency form in this manual. Acquisition of these skills or objectives may be documented by either formative (quizzes) or summative (final examinations, competencies required for graduation) evaluation tools. These evaluation instruments should serve as reliable indicators of the effectiveness of instruction and course design. TO GRADUATE FROM THE RADIOGRAPHY PROGRAM, THE STUDENT MUST DEMONSTRATE THE FOLLOWING TERMINAL COMPETENCIES: Use written and verbal medical communication Demonstrate knowledge of human structure, function and pathology Anticipate and provide basic patient care and comfort Apply principles of proper body mechanics Perform basic mathematical functions Operate radiographic imaging equipment Position the patient and imaging system to perform radiographic examinations and procedures Modify standard procedures to accommodate for patient condition and other variables Process radiographs Retrieve images produced by computerized radiography and/or fluoroscopy Determine exposure factors to obtain diagnostic quality radiographs utilizing the principles of

ALARA Adapt exposure factors for various patient conditions, equipment accessories and contrast media

to maintain appropriate radiographic quality Practice radiation protection for the patient, self and others Recognize emergency patient conditions and initiate first aid and basic life support procedures Evaluate radiographic images for appropriate positioning and image quality Identify the need for oxygen and initiate the oxygen treatment at the physician’s request Demonstrate the ability to inject contrast media into a vein using standard universal precautions Assess patient’s change in condition and obtain vital signs and recognize normal and abnormal

values Recognize adverse reactions to contrast media and the common medications used to treat

anaphylaxis


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TERMINAL OBJECTIVES & COMPETENCIES ► Continued from previous page Evaluate the performance of radiographic systems, know the safe limits of equipment operation

and report malfunctions to the proper authority Demonstrate knowledge and skills relating to quality assurance Exercise independent judgment and discretion in the technical performance of medical imaging

procedures Practice proper infection control techniques for both direct and indirect means of transmission Adapt and apply learned skills and knowledge to the situation presented when doing radiographic

exams in surgery Practice proper sterile technique while in the surgical suite Recognize and practice proper conduct in accordance with ARRT’s Rules and Regulations and

the Standard of Practice Practice patient confidentiality as required by HIPAA


INSTRUCTION TO ACHIEVE STUDENT COMPETENCY Achieving and perfecting desired technical skills is the goal of clinical education. Because of PMI’s responsibility to students, patients and personnel of the clinical education center, this manual should present a straightforward and logical process to train the student.


INSTRUCTIONAL METHODS Orientation – the clinical education center will provide an orientation for the student which will

include the policies and procedures of the institution and department.

Reception, filing and darkroom – Student will rotate through these areas, but the clinical education center should not place too much emphasis on these non-radiographic duties.

Examinations – The majority of the student’s clinical time should be devoted to learning and mastering radiographic examinations. The student should be assigned to a room or technologist. The student should observe the technologist perform the examination. After observing the examination, the student may assist the technologist in performing the exam and add assistance steps until he/she is able to perform the exam with direct supervision.

Although all students learn at various rates, we encourage students to perform examinations and related tasks as soon as possible. When students achieve competency of an exam, repetition of the exam will further increase the student’s skill and confidence level. Students require immediate feedback on tasks performed correctly or incorrectly. The feedback may be given while reviewing images with the student immediately after the examination. Without feedback, the performance of the examination loses much of its educational value to the student. When the student is confident about performing a specific examination, the student should ask a registered radiographer to evaluate the student for “competency”. This includes an evaluation of both the procedure as well as the resultant images. The evaluating radiographer will then fill out a competency form according to the level of student performance. The student will scan and upload these competencies into the Advanced Radiography Clinical Externship course weekly. The student’s clinical grades are based in part on the number of earned competencies per semester. The student’s grades are not adversely affected, however, by not passing an attempted competency. All competencies which are unsuccessfully attempted by students may be re-attempted by the student. Students will be graded on their affective skills with the Technical and Professional Evaluation forms. These will be completed at the midpoint and end of each semester.


CLINICAL EXTERNSHIP GRADING An evaluation of a student’s performance—both behavioral and technical—is performed by the clinical preceptor(s). The clinical grade for the course is based on a percentage and compilation of the different types of evaluations conducted per semester. The weighting of these areas for the final clinic grade is as follows: Other factors calculated into the final grade: Unexcused absences (7 point deduction from the final clinical grade for EVERY UNEXCUSED

ABSENCE). All unexcused and excused absences (over programmatic excused) must be made up within a week after clinical ends. See Holidays and Vacation section of the handbook to verify programmatic excused absences.

Non compliance in turning in weekly repeat logs. Five (5) points taken from the Technical and Performance Evaluation for each occurrence of non-compliance (#10 of Clinical Education Policy).

Weighting for Final Clinic Grade Category Percentage of Grade

Quantity (number) of competency achieved 10% Quality of individual competencies achieved 40%

Midterm Technical and Professional Evaluation 25% Final Technical and Professional Evaluation 25%

TOTAL 100%

NOTE: The student cannot graduate from the APTR program unless all of the ARRT requirements are met as described in this handbook.


CLINICAL EXTERNSHIP GRADING ► Continued from previous page Candidates must demonstrate competency in 37 mandatory (M) procedures which include all six general patient care activities. Procedures should be performed on patients; however, up to eight mandatory procedures may be simulated if demonstration on patients is not feasible. Candidates must demonstrate competence in 15 of the 35 elective (E) procedures. Candidates must select one elective procedure from the head section. Candidates must select either an Upper GI or Barium Enema, plus one other elective from the fluoroscopy section. Elective procedures should be performed on patients; however, electives may be simulated if demonstration on patients is not feasible. Institutional protocol will determine the positions or projections used for each procedure. Demonstration of competence includes requisition evaluation, patient assessment, room preparation, patient management, equipment operation, technique selection, positioning skills, radiation safety, image processing, and image evaluation.

29

Description Due

A Rotation Schedule Form Due every week

B Clinical Education Competency Record This is a list of procedures required by the ARRT. It is also used for you to document your competencies. Keep a copy of this in your binder. Once you’ve demonstrated competency in all required ARRT procedures, you will then upload this into the Advanced Radiography Clinical Externship course. Do not upload until complete!

Due at the end of your extern

C Externship Timesheet Complete and upload this into the Advanced Radiography Clinical Externship course.

Due every week

D Clinical Competency Evaluation Form & Criteria Use this form to document your ARRT procedures. You will need to have your clinical instructor make copies of this form. As you complete your required procedures, upload this into the Advanced Radiography Clinical Externship course and keep copies for yourself in your binder. You must complete one of these forms for every ARRT procedure you complete.

Due every week

E Technical and Professional Evaluation This form will be utilized by your clinical instructor at the midpoint of your extern, and again at the end of your extern. Please provide your clinical instructor with a copy of this form.

Due at the midpoint and at the end of your extern

F Pregnancy Disclosure Form Use this form to voluntarily declare pregnancy and notify the school of how you wish to proceed.

Due if you wish to declare pregnancy

G Exam/Repeat Log Due every week

H Evaluation of Clinical Experience Form Due at completion of extern

I Acknowledgement of Understanding Complete and upload this into the Advanced Radiography Clinical Externship course.

Due at the beginning of your clinical extern

Index of Appendices

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Week 1 Week 2 Week 3

Hospital Shift Times M T W TH F S S M T W TH F S S M T W TH F S S

Diagnostic

ED / Urgent Care

Fluoro

Ortho

Surgery

Portables

Clinic / Out Patient Shift Times M T W TH F S S M T W TH F S S M T W TH F S S

Diagnostic

Fluoro

Orthopedics

Ambulatory Surgery

Week 4 Week 5 Week 6

Hospital Shift Times M T W TH F S S M T W TH F S S M T W TH F S S

Diagnostic

ED / Urgent Care

Fluoro

Ortho

Surgery

Portables

Clinic / Out Patient Shift Times M T W TH F S S M T W TH F S S M T W TH F S S

Diagnostic

Fluoro

Orthopedics

Ambulatory Surgery

Pima Medical Institute Advanced Placement Track Radiography Program

Rotation Schedule Form Student Name ________________________________ Clinical Site __________________________________

Start Date ___________________________________ End Date ____________________________________

Appendix A: Rotation Schedule Form

Clinical Instructor Signature __________________________________________________________________

Instructions: Place a check mark in the corresponding area(s) of rotation.

PIMA MEDICAL INSTITUTE ADVANCED PLACEMENT TRACK RADIOGRAPHY PROGRAM

CLINICAL EDUCATION COMPETENCY RECORD

The following pages identify specific clinical competency requirements. Candidates may wish to use these pages, or their equivalent, to record completion of the requirements. To document that the didactic and clinical

requirements have been satisfied, candidates must have the program director (and authorized faculty member if required) sign the ENDORSEMENT SECTION of the Application for Certification included in the

Certification Handbook.

The clinical competency requirements include the six general patient care activities listed below and a subset of the 66 imaging procedures identified on subsequent pages. Demonstration of

competence should include variations in patient characteristics (e.g., age, gender, medical condition).

GENERAL PATIENT CARE DATE

COMPLETED COMPETENCE VERIFIED BY

1. CPR

2. Vital signs (blood pressure, pulse, respiration, temperature)

3. Sterile and aseptic technique

4. Venipuncture

5. Transfer of patient

6. Care of patient medical equipment (e.g. oxygen tank, IV tubing

Appendix B: ARRT Competencies 1 of 4

Note: The ARRT requirements specify that certain clinical procedures may be simulated. Simulations must meet the following criteria: (a) the student is required to competently demonstrate skills as similar as circumstances permit to the cognitive, psychomotor, and affective skills required in the clinical setting; (b) the program director is confident that the skills required to competently perform the simulated task will generalize or transfer to the clinical setting, and, if applicable, the student will evaluate related images. Examples of acceptable simulation include: demonstrating CPR on a mannequin, positioning a fellow student for a projection without actually activating the x-ray beam, and performing venipuncture by demonstrating aseptic technique on another person, but then inserting the needle into an artificial forearm or grapefruit.

1. General Patient Care Requirement: Candidates must demonstrate competence in all six patient care activities listed below. The activities should be performed on patients; however, simulation is acceptable (see footnote) if state or institutional regulations prohibit candidates from performing the procedures on patients.

IMAGING PROCEDURE MANDATORY/

ELECTIVE DATE

COMPLETED PATIENT/

SIMULATED COMPETENCE VERIFIED BY

CHEST AND THORAX

1 Chest Routine M

2 Chest AP (Wheelchair or Stretcher M 3 Ribs M

4 Chest lateral decubitus E

5 Sternum E

6 Upper Airway (Soft-Tissue Neck) E

UPPER EXTREMITY 7 Thumb or finger M

8 Hand M

9 Wrist M

10 Forearm M

11 Elbow M

12 Humerus M

13 Shoulder M

14 Trauma: Shoulder (Scapular “Y”, Transthoracic or Axillary) *

M

15 Clavicle E

16 Scapula E

17 AC Joints E

18 Trauma: Upper Extremity (Non Shoulder)*

M


2. Imaging Procedures Requirement: Candidates must demonstrate competence in all 37 (which includes the 6 general patient care competencies) identified as mandatory (M). Procedures should be performed on patients; however, up to eight mandatory procedures may be simulated (see previous page) if demonstration on patients is not feasible. Candidates must demonstrate competence in 15 of the 35 elective (E) procedures. Candidates must select one elective procedure from the head section. Candidates must select either Upper GI or Barium Enema from the fluoroscopy section. Elective procedures should be performed on patients; however, electives may be simulated (see previous page) if demonstration on patients is not feasible. Institutional protocol will determine the positions or projections used for each procedure. Demonstration of competence includes requisition evaluation, patient assessment, room preparation, patient management, equipment operation, technique selection, positioning skills, radiation safety, image processing, and image evaluation.

* Trauma is considered a serious injury or shock to the body. Modifications may include variations in positioning, minimal movement of the body part, etc.

Appendix B: ARRT Competencies

RADIOLOGIC PROCEDURE MANDATORY/

ELECTIVE DATE PATIENT/

SIMULATED VERIFIED BY LOWER EXTREMITY

19 Toes E

20 Foot M

21 Ankle M

22 Knee M

23 Tibia-Fibula M

24 Femur M

25 Trauma: Lower Extremity * M

26 Patella E

27 Calcaneus (Os Calcis) E

HEAD – Candidates must select at least one elective procedure from this section 28 Skull E

29 Paranasal Sinuses E

30 Facial Bones E

31 Orbits E

32 Zygomatic Arches E

33 Nasal Bones E

34 Mandible (Panorex acceptable) E

SPINE AND PELVIS

35 Cervical Spine M

36 Trauma: Cervical Spine (Cross Table Lateral) *

E

37 Thoracic Spine M

38 Lumbar Spine M

39 Pelvis M

40 Hip M

41 Cross Table Lateral Hip M

42 Sacrum and/or Coccyx E

43 Scoliosis Series E

44 Sacroiliac Joints E

ABDOMEN

45 Abdomen Supine (KUB) M

46 Abdomen Upright M

47 Abdomen Decubitus E

48 Intravenous Urography E

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* Trauma is considered a serious injury or shock to the body. Modifications may include variations in positioning, minimal movement of the body part, etc.


IMAGING PROCEDURE MANDATORY/

ELECTIVE DATE PATIENT/

SIMULATED VERIFIED BY

FLUOROSCOPY STUDIES – Candidates must select either Upper GI or Barium Enema plus one other elective procedure from this section

49 Upper GI Series (Single or Double Contrast)

E

50 Barium Enema (Single or Double Contrast) E

51 Small Bowel Series E

52 Esophagus E

53 Cystography/Cystourethrography E

54 ERCP E

55 Myelography E

56 Arthrography E

SURGICAL STUDIES

57 C-Arm Procedure (Orthopedic) M

58 C-Arm Procedure (Non-Orthopedic) E

MOBILE STUDIES

59 Chest M

60 Abdomen M

61 Orthopedic M

PEDIATRICS (Age 6 or younger)

62 Chest Routine M

63 Upper Extremity E

64 Lower Extremity E

65 Abdomen E

66 Mobile Study E

Appendix C: Externship Timesheet


EXTERNSHIP TIMESHEET

Instructions: Write in your daily and weekly hours and have your preceptor sign and date your timesheet. It is your responsibility to upload the timesheet. Keep copies of all time sheets for verification. Timesheets are due no later than Monday of the following week by 12:00 noon. The minimum hours required for the externship must be documented using timesheets or you will fail the course. Upload your timesheet every week!

Student Name

Externship Site Phone #

Day Date Time In Time Out Lunch

Time In Lunch Time Out Total Hrs/

Day

Monday ____/____/____

Tuesday ____/____/____

Wednesday ____/____/____

Thursday ____/____/____

Friday ____/____/____

Saturday ____/____/____

Sunday ____/____/____

TOTAL HOURS (PER WEEK)

Day Date Time In Time Out Lunch

Time In Lunch Time Out Total Hrs/

Day

Monday ____/____/____

Tuesday ____/____/____

Wednesday ____/____/____

Thursday ____/____/____

Friday ____/____/____

Saturday ____/____/____

Sunday ____/____/____

TOTAL HOURS (PER WEEK)

Preceptor Signature Date

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CLINICAL COMPETENCY EVALUATION FORM

Student:_________________________________Procedure:___________________________ TYPE OF EVALUATION MANDATORY ELECTIVE PATIENT SIMULATED ADULT PEDIATRIC This form has been designed for evaluating a maximum of three position/projections per radiographic procedure (i.e. Chest: PA, Lateral). The evaluator will write the number of points earned by the student in each area (0 – 3 in each cell). Failure to successfully complete any position/projection will require the student to repeat that position/projection later. Point Scale: 0 = unacceptable performance 1 = below expectations, improvement needed 2 = meets expectations, satisfactory performance 3 = exceeds expectations, outstanding performance

TASK EVALUATED PROJECTION 1 PROJECTION 2 PROJECTION 3

Evaluation of Requisition

Readiness of Facility

Patient Care

Equipment Operation

Positioning Skills

Anatomic Parts Included

Proper Beam Alignment

Exposure & Technique

Image Identification

Evidence of Shielding/Collimation

Total Points 23 points or more per projection is required to pass this competency

Appendix D: Clinical Competency Evaluation Form

Evaluator Signature:_________________________________________________ Date:_____________________ Student Signature:__________________________________________________ Date:_____________________ Clinical Education Setting: ______________________________________________________________________


CRITERIA FOR CLINICAL COMPETENCY EVALUATION Clinical faculty will assess the student's competency using the following criteria. A. Evaluation of Requisition

Student will: 1. Identify procedure(s) to be performed 2. Identify the patient's name and age 3. Identify patient location and mode of transportation 4. Acknowledge any pathological conditions 5. Acquire appropriate clinical patient history

B. Physical Facilities Readiness

Student will: 1. Verify that equipment is operational 2. Provide a clean and orderly work area 3. Obtain appropriate supplies for examination

C. Patient Care

Student will: 1. Select the correct patient 2. Introduce himself/herself to patient and briefly explain the procedure 3. Request last menstrual period date of female patients between the ages of 12-60 4. Transport patient to appropriate imaging area 5. Verify if patient is properly prepared for the exam 6. Identify, when appropriate, that there are no contraindications for performing procedure 7. Provide safe storage for patient's belongings 8. Provide appropriate assistance to radiographic table based on patient's condition 9. Maintain patient dignity and modesty through proper gowning and covering for the patient 10. Talk to patient in a concerned, professional manner 11. Apply universal precautions as established by the Centers for Disease Control 12. Provide proper instructions for moving and breathing 13. Check patient's condition at regular intervals 14. Provide for patient security if the patient is left alone in the x-ray room

D. Equipment Operation

Student will: 1. Maneuver the x-ray tube and bucky utilizing appropriate controls and locks 2. Select the proper image, image holder, grid, etc. 3. Select appropriate SID 4. Manipulate image receptor as appropriate for accurate imaging 5. Measure the patient if applicable 6. Use immobilization devices, as needed 7. Use technique chart correctly 8. Select correct exposure factors 9. Use equipment so as not to exceed recommended safety guidelines

E. Positioning Skills

Student will: 1. Correctly, position the patient 2. Align center of part to be demonstrated to the center of the image 3. Set the correct tube angle 4. Set the correct SID

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E. Positioning Skills Student will:

1. Correctly, position the patient 2. Align center of part to be demonstrated to the center of the image 3. Set the correct tube angle 4. Set the correct SID

F. Anatomical Part(s) Included

Radiograph(s) demonstrates: 1. Part shown in proper position 2. Adequate detail (no motion visible)

Student will: 3. Identify anatomical structures

G. Proper Alignment

Radiograph(s) demonstrates: 1. image centered 2. Part centered 3. Tube centered 4. Patient aligned correctly

H. Radiographic Exposure &Technique

Radiograph(s) demonstrates: 1. Technique chart was used correctly, as evidenced by 2. Proper contrast and density 3. Compensation of exposure factors for pathology 4. Correct exposure factors used to produce diagnostic image 5. Correct image, screen, grid, SID and OID

I. Image Identification and/or Other Identifications

Radiograph(s) demonstrates: 1. Right and left markers properly displayed (free of pertinent anatomy) 2. Accessory markers visible, if required (minute, hour, directional, etc.) 3. Patient information and date displayed

J. Provide Evidence of Radiation Protection

Student will: 1. Collimate to part 2. Use gonad shields, if appropriate 3. Demonstrate use of lead aprons, gloves and lead blockers, if appropriate 4. Select proper exposure factors 5. Adjust exposure factors for motion, pathology or patient size when appropriate

Radiograph(s) demonstrates: 1.Evidence of collimation 2.Gonad shields in place, if required

Student will verify all repeats. All repeats must be performed under direct supervision.

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4 of 9

TASK PRECEPTOR EVALUATION (Initial below)

Met *Not Met

Perform CPR

Demonstrate the proper techniques utilized for CPR

Provided preceptor with a copy of current CPR certification card


ARRT GENERAL PATIENT CARE COMPETENCIES

CPR

STUDENT ______________________________________ CLINICAL SITE ___________________________________


* If a competency is initialed as Not Met, it MUST be repeated to pass competency.

Evaluator Signature: Date:

Student Signature: Date:

5 of 9


Met *Not Met

Obtain a respiration rate

Demonstrate the proper technique for obtaining and recording a respiration rate

Measure a patient’s respiration by observing the patient’s chest or abdomen for a 60-second period

Record the number of respirations per minute

Count obtained is _______ . Is this within a normal range? ___YES ___ NO

Obtain a pulse rate

Demonstrate the proper technique for obtaining and recording a respiration rate

Measure a patient’s pulse rate at the radial artery near the wrist for 60-second period

Record the patient’s pulse rate per minute

Count obtained is _______ . Is this within a normal range? ___YES ___ NO

Obtain a blood pressure

Demonstrate the proper technique for obtaining and recording a blood pressure

Obtain a sphygmomanometer and stethoscope

Place the cuff of the sphygmomanometer on the patient’s upper arm midway between the elbow and shoulder

Inflate the cuff above the systolic pressure to stop blood flow to the arm

With the stethoscope in place over the brachial artery in the antecubital fossa of the elbow, slowly release the cuff of the sphygmomanometer and listen for pulse tones Record the systolic reading _________ Record the diastolic reading _________ Record the blood pressure obtained using proper nomenclature ______________ Is this within normal range? ____YES ____NO



VITAL SIGNS






6 of 9


Met *Not Met

Open a sterile package onto a table

Demonstrate the proper technique for opening a sterile package onto a table

Place package on table with top flap of wrapper set to open away from yourself

Open top flap and lay flat on far surface of table (by reaching around, not over)

Use right hand to open right-side flap, and left hand to open left-side flap and lay flat

Open fourth flap by using turned-down corner and lay flat

Open a sterile package in air and deposit onto sterile field Demonstrate the proper technique for opening a sterile package and deposit content onto sterile field

Hold package with top flat of wrapper set to open towards yourself

Peel top flap back and drop contents onto sterile field without contamination

Donning sterile gloves (open method)

Demonstrate the proper technique for donning sterile gloves

Open outer dust cover and open sterile packaging

Open sterile flaps using proper technique

Don first glove using proper sterile technique to maintain glove sterility

Don second glove using proper sterile technique to maintain glove sterility

Sterile gowning (self-gowning)

Demonstrate proper technique for sterile self-gowning

Properly pick up gown by its folded edges

Grasp gown at its neckband, hold at arms length, and unfold it

While facing inside of gown, properly insert arms into both sleeves

Direct an assistant to help you with “spin” technique or faster back of gown

Don sterile gloves without contamination



STERILE & ASEPTIC TECHNIQUE






7 of 9


Met *Not Met

Perform venipuncture

Demonstrate the proper techniques utilized for venipuncture

Assemble all needed supplies

Introduce yourself to the patient

Check the patient’s identification and explain the procedure

Apply tourniquet above the site suing sufficient tension to impede blood flow

Use techniques to distend veins, if necessary

Perform hand hygiene and put on disposable gloves

Choose appropriate site for venipuncture and cleanse with an alcohol pad using a circular motion, starting in the center and moving out

Stabilize vein

Hold needle by pinching wings, bevel upward, at a 10 - 15 degree angle and gently advance into vein; blood "flash" indicates needle is correctly positioned

Remove tourniquet

Secure the needle with tape without covering the site

Carefully remove the needle while applying pressure to the site with gauze

Dispose of equipment properly and wash hands

Document information (time, date, site, gauge)



VENIPUNCTURE






8 of 9


Met *Not Met Perform a wheelchair transfer Demonstrate the steps required for a wheelchair transfer

Introduce yourself to the patient Check the patient’s identification and explain the procedure Place wheelchair next to table Lock wheels Lift footrests Stand with one foot between the patient’s feet

Maintain good posture while helping patient up

Once standing, turn and pivot patient to the table Support patient’s shoulders while raising legs Ease patient to supine position

Perform a gurney with sheet transfer Demonstrate the steps required for a gurney with sheet transfer

Introduce yourself Check patient ID Place sheet under patient using log-roll technique Place gurney next to bed and lock wheels One person pulls the patient from the gurney side Unlock wheels and place side-rails up for transport Maintain good posture while sliding patient over

Perform a two/three person lift wheelchair transfer Demonstrate the steps required for a two/three person lift wheelchair transfer

Introduce yourself Check patient ID Lock wheels Lift footrests Primary stands behind patient, arms through axillae Secondary kneels cradling thighs and legs (Inst.) Primary gives lift instruction; both lift together Patient placed gently on table



TRANSFER OF PATIENT






9 of 9


Met *Not Met

Proper use of oxygen delivery devices

Demonstrate proper use of oxygen delivery devices

Obtain required equipment

Explain the procedure to the patient

Adjust device to ordered level

Correctly apply device to patient

Confirm oxygen level as appropriate

Peripheral venous lines

Demonstrate proper technique for handling a central venous while performing an examination

Demonstrate proper placement of IV line on IV pole

Demonstrate how you would manipulate an IV line to perform an upright chest radiograph



CARE OF PATIENT MEDICAL EQUIPMENT






Appendix E: Technical and Professional Evaluation 1 of 2

IMPORTANT, PLEASE READ: Please evaluate the student’s technical and professional skills below. Please remember that students are in different semesters. As you complete this form, take into consideration the student’s level of education. Use the guidelines below for rating student performance. The highest score possible is 5. This does not indicate perfection; it means that the student performed the task or exhibited the behavior consistently. 5 = The student exhibits the behavior consistently; rarely is there a need for guidance, direction or improvement. 4 = The student almost always exhibits the behavior; minimal guidance and improvement needed. 3 = The student is generally consistent in the exhibition of this behavior; student requires moderate guidance and direction. 2 = The student is inconsistent in the exhibition of this behavior; student requires substantial guidance and direction. 1 = The student exhibits this behavior only when guidance and direction are provided. 0 = The student is unable to perform the task, even when guidance and direction are provided. N/A = Not applicable and/or unable to evaluate the behavior.

CRITIAL THINKING POINTS Can correctly modify positioning techniques/methods for challenging exams and patients Critiques the quality of completed radiographs, and correctly identifies and makes the required adjustments. Can correctly adjust technical factors (mAs, kVp, etc) for various patients’ body size, age, pathology. ORGANIZATIONAL FACTORS POINTS Prepares the radiographic room prior to patient arrival. Places proper anatomical markers and patient ID information on the image. Sets appropriate technical factors. Follows department examination protocol. The student receives appropriate supervision when repeating radiographs Is actively involved in the performance of radiographic examinations Radiographic examinations are performed in an organized manner Assists others as needed. Can complete exam in timely manner RADIATION PROTECTION AND SAFETY POINTS Performs radiographic examinations with appropriate supervision Follows proper extern site protocol in regards to verifying possibility of pregnancy, and acts accordingly Shields patients when appropriate. Collimates to the area of interest. Uses appropriate radiation safety methods for self and others. Escorts patients without accident or injury. Positions patients and equipment without causing further injury to the patient EQUIPMENT MANIPULATION POINTS Uses appropriate tube, table, and bucky locks. Is able to set specified technical factors for routine radiography and/ or fluoroscopy. Prepares and uses equipment appropriately. Process radiographs properly.

For any scores of three or less, please provide constructive comments in the space provided.

PIMA MEDICAL INSTITUTE ADVANCED PLACEMENT TRACK RADIOGRAPHY PROGRAM TECHNICAL AND PROFESSIONAL MID-TERM EVALUATION

STUDENT ______________________________________ C.I. ___________________________________ DATE ____________

CLINICAL EDUCATION SETTING ________________________________________ SEMESTER. #______4_____

Send at 3 weeks


PATIENT CARE POINTS Identifies patients using appropriate means (at least two forms of ID) Assists patient as needed (i.e. clothing changes, bedpans, etc.) Obtains relevant patient medical history Provides patient education as needed. Communicates with patients using an appropriate vocal tone and loudness. Maintains professional contact with the patient throughout the examination. Assesses the patient’s condition as appropriate. Assists with the preparation and administration of contrast media. Follows department protocol in handling infectious patients. Is knowledgeable of, and conforms to HIPAA regulations PEER INTERACTIONS POINTS Work area conversations are professional and courteous. Uses proper telephone etiquette. Maintains a positive attitude and is supportive of fellow students. Doesn’t participate in, or initiate inappropriate behavior or discussions INITIATIVE/DEPENDABILITY POINTS Completes assigned tasks. Seeks instruction/guidance when necessary. Performs non patient tasks on own initiative. Does not leave assigned area Seeks opportunities for clinic practice. Utilizes clinic time productively. APPEARANCE POINTS Conforms to uniform code specified by PMI. Uniforms, shoes, etc. are neat and clean. Conforms to OSHA guidelines concerning infection control (handwashing, wearing of artificial finger nails etc.) PROBLEM SOLVING * The term “problem could represent any situation where the student is faced with a challenge, thinks of a solution, and successfully achieves resolution. An example could be how the student deals with a change in a patient’s condition/attitude, or perhaps how they work to resolve a personality conflict with another member of the healthcare team. A problem could also be technical in nature. Recognizes and evaluates problems, and takes initiative to actively participate Creates solutions to the problem. Compares various solutions and Selects the most logical solution. Critiques and analyzes the results of an action and modifies future behavior accordingly.

COMMENTS

Total points Possible points 240

Grade CLINICAL INSTRUCTOR SIGNATURE ______________________________________


IMPORTANT, PLEASE READ: Please evaluate the student’s technical and professional skills below. Please remember that students are in different semesters. As you complete this form, take into consideration the student’s level of education. Use the guidelines below for rating student performance. The highest score possible is 5. This does not indicate perfection; it means that the student performed the task or exhibited the behavior consistently. 5 = The student exhibits the behavior consistently; rarely is there a need for guidance, direction or improvement. 4 = The student almost always exhibits the behavior; minimal guidance and improvement needed. 3 = The student is generally consistent in the exhibition of this behavior; student requires moderate guidance and direction. 2 = The student is inconsistent in the exhibition of this behavior; student requires substantial guidance and direction. 1 = The student exhibits this behavior only when guidance and direction are provided. 0 = The student is unable to perform the task, even when guidance and direction are provided. N/A = Not applicable and/or unable to evaluate the behavior.

CRITIAL THINKING POINTS Can correctly modify positioning techniques/methods for challenging exams and patients Critiques the quality of completed radiographs, and correctly identifies and makes the required adjustments. Can correctly adjust technical factors (mAs, kVp, etc) for various patients’ body size, age, pathology. ORGANIZATIONAL FACTORS POINTS Prepares the radiographic room prior to patient arrival. Places proper anatomical markers and patient ID information on the image. Sets appropriate technical factors. Follows department examination protocol. The student receives appropriate supervision when repeating radiographs Is actively involved in the performance of radiographic examinations Radiographic examinations are performed in an organized manner Assists others as needed. Can complete exam in timely manner RADIATION PROTECTION AND SAFETY POINTS Performs radiographic examinations with appropriate supervision Follows proper extern site protocol in regards to verifying possibility of pregnancy, and acts accordingly Shields patients when appropriate. Collimates to the area of interest. Uses appropriate radiation safety methods for self and others. Escorts patients without accident or injury. Positions patients and equipment without causing further injury to the patient EQUIPMENT MANIPULATION POINTS Uses appropriate tube, table, and bucky locks. Is able to set specified technical factors for routine radiography and/ or fluoroscopy. Prepares and uses equipment appropriately. Process radiographs properly.

For any scores of three or less, please provide constructive comments in the space provided.


TECHNICAL AND PROFESSIONAL FINAL EVALUATION

STUDENT ______________________________________ C.I. ___________________________________ DATE ____________

CLINICAL EDUCATION SETTING ________________________________________ SEMESTER. #_____4______

Send at END


PATIENT CARE POINTS Identifies patients using appropriate means (at least two forms of ID) Assists patient as needed (i.e. clothing changes, bedpans, etc.) Obtains relevant patient medical history Provides patient education as needed. Communicates with patients using an appropriate vocal tone and loudness. Maintains professional contact with the patient throughout the examination. Assesses the patient’s condition as appropriate. Assists with the preparation and administration of contrast media. Follows department protocol in handling infectious patients. Is knowledgeable of, and conforms to HIPAA regulations PEER INTERACTIONS POINTS Work area conversations are professional and courteous. Uses proper telephone etiquette. Maintains a positive attitude and is supportive of fellow students. Doesn’t participate in, or initiate inappropriate behavior or discussions INITIATIVE/DEPENDABILITY POINTS Completes assigned tasks. Seeks instruction/guidance when necessary. Performs non patient tasks on own initiative. Does not leave assigned area Seeks opportunities for clinic practice. Utilizes clinic time productively. APPEARANCE POINTS Conforms to uniform code specified by PMI. Uniforms, shoes, etc. are neat and clean. Conforms to OSHA guidelines concerning infection control (handwashing, wearing of artificial finger nails etc.) PROBLEM SOLVING * The term “problem could represent any situation where the student is faced with a challenge, thinks of a solution, and successfully achieves resolution. An example could be how the student deals with a change in a patient’s condition/attitude, or perhaps how they work to resolve a personality conflict with another member of the healthcare team. A problem could also be technical in nature. Recognizes and evaluates problems, and takes initiative to actively participate Creates solutions to the problem. Compares various solutions and Selects the most logical solution. Critiques and analyzes the results of an action and modifies future behavior accordingly.

COMMENTS

Total points Possible points 240

Grade CLINICAL INSTRUCTOR SIGNATURE ______________________________________


RADIATION RISK DURING PREGNANCY Patient Holding Many patients referred for x-ray examination, including infants, the elderly, and the incapacitated, are not physically able to support themselves. Mechanical immobilization devices should be available for such patients. Otherwise, a relative or friend who accompanies the patient should be asked to hold. As a last resort, other hospital employees such as nurses and orderlies may be used occasionally to hold patients. Radiology staff/students should never hold patients. When it is necessary to have another person hold the patient, protective apparel must be provided to that person. An apron and gloves are necessary, and the holder should be positioned and instructed carefully, so that he or she is not exposed to the useful beam. Because the holder is often the mother of a child patient, be sure to ask whether she could be pregnant. The Pregnant Student When a student becomes pregnant, she should notify her Clinical Coordinator. The pregnancy then is declared, and the DL becomes 0.5 mSv/mo (50 mrem/mo). The Clinical Coordinator will then review her previous radiation exposure history because this facilitates decisions regarding what protective actions are necessary. The DL for the fetus is 5 mSv (500 mrem) for the period of pregnancy –a dose level that most radiologic technologists/students will not reach regardless of pregnancy. Although some may receive doses that exceed 5 mSv/yr (500 mrem/yr), most receive less than 1 mSr/r (100 mrem/yr). This usually is indicated with the personnel monitoring device positioned at the collar above the protective apron. Exposure at the waist under the protective apron normally does not exceed 10% of these values; therefore, under normal conditions, specific protective action is not necessary. Most lead protective aprons are 0.5 mm lead equivalent. These provide approximately 90% attenuation at 75 kVp, which is sufficient. One millimeter lead equivalent protective aprons are available, but such thickness is not necessary, particularly in view of the additional weight of the apron. Back problems during pregnancy constitute a greater hazard than radiation exposure. The length of the apron need not extend below the knees, but wrap-around aprons are preferred during pregnancy. If necessary, a special effort should be made to provide an apron of proper size because of its weight. The pregnant radiologic student will be provided with a second personnel monitoring device. An additional radiation monitor should be positioned under the protective apron at waist level. The exposure reported on this second monitor will be maintained on a separate record and identified as exposure to the fetus. Experience with the use of an additional monitor shows consistently that exposures to the fetus are zero. Suppose, for instance, that a pregnant radiologic technologist/student wearing a single radiation monitor at collar level receives 1 mSv (100 mrem) during the 9-month period. The dose at waist level under a protective apron would be less than 10% of the collar dose, or 0.1 mSv (10 mrem). This is the dose to the monitor; the dose to the fetus is near zero. Attenuation by maternal tissues overlying the fetus reduces the dose to the fetus to approximately 30% of the abdominal skin dose, or 50 µSv (3 mrem). Consequently, when normal protective measures are taken, it is nearly impossible for a radiologic technologist/student even to approach the fetal DL of 5 mSv (500 mrem).

Appendix F: Pregnancy Disclosure 1 of 6

Management Principles It should be clear that the probability of a harmful effect after any occupational radiation exposure in diagnostic imaging is highly unlikely. A biologic response is expected very rarely and has not been observed in radiologic personnel for the past 50 years or so. Nevertheless, it is essential for the Program Director to incorporate three steps into the program: training and instruction of proper radiation protection guidelines and procedures, and the availability of counseling during pregnancy. The initial step in any administrative protocol involving pregnant students involves orientation and training. During these discussions, all female students who declare pregnancy will be instructed as to their responsibility regarding pregnancy and radiation. Each student will be provided with a copy of the appropriate materials regarding radiation safety during pregnancy. This material might include a one-page summary of doses, responses, and proper radiation control working habits. The material to be covered in counseling sessions is outlined in Table 40-8. Although it is good to review doses and responses, it is probably more appropriate to emphasize radiation control procedures. These, of course, affect the radiation safety of all students—not only pregnant students.

TABLE 40-8 Pregnancy in Diagnostic Radiology HUMAN RESPONSE TO LOW-LEVEL EXPOSURE Life span shortening Cataracts Leukemia Cancer Genetic effects Death from all causes

10 days/rad None below 200 rad 10 cases/106 /rad/yr 2 cases/104/rad Doubling dose = 50 rad 2 deaths/104/rad

EFFECTS OF IRRADIATION IN UTERO 1 to 14 days 2 to 10 weeks 2nd to 3rd trimester 0 to 9 months

Spontaneous abortion: 25% natural incident; 0.1% increase/10 rad Congenital abnormalities: 5% natural incidence; 1% increase/10 rad Cell depletion: no effect at <50 rad Latent malignancy: 4:10,000 natural incidence; 6:10,000/rad Genetic effects: 10% natural incidence; 5 x 10-7 mutations/rad

PROTECTIVE MEASURES FOR THE PREGNANT RADIOLOGIC TECHNOLOGIST Two occupational radiation monitors Dose limit: 5 mSv/9 mo, 0.5 mSv/mo

A review of personnel monitoring records is particularly important. The quarterly report will be initialed by each student, and the Clinical Coordinator will ensure that students understand the nature and magnitude of their annual exposure. Through such training, students will realize that their occupational exposure is minimal—usually at less than 10% of the DL.


Counseling During Pregnancy. The Clinical Coordinator takes the next action when the student declares her pregnancy. First, the Clinical Coordinator will counsel the student after reviewing her radiation exposure history and considering any future modifications to her schedule that may be appropriate. Under no circumstance should termination or an involuntary leave of absence occur as a consequence of pregnancy. In all likelihood, a review of the student’s previous radiation exposure history will show a low exposure profile. Those who wear the radiation monitor positioned at the collar, as recommended, and who are heavily involved in fluoroscopy, may receive an exposure greater than 5 mSv/yr (500 mrem/yr). Such students, however, are protected by lead aprons, so that exposure to the trunk of the body normally would not exceed 500 µSv (50 mrem/yr). During this review of occupational radiation exposure, it is appropriate to emphasize that the DL during pregnancy is 5 mSv (500 mrem) and 0.5 mSv/mo (50 mrem/mo). Furthermore, it should be shown that this DL refers to the fetus and not to the student. The level of 5 mSv (500 mrem) to the fetus during gestation is considered an absolutely safe radiation exposure level. In view of this discussion, the Clinical Coordinator will point out to the student that an alteration in her work schedule normally is not required. Finally, the student will be required to read and sign a form to indicate that she has been instructed in the area of radiation protection, and that she understands that the level of risk associated with her exposure to radiation in the clinical setting is much less than that experienced by nearly all occupational groups. An important point to be made by signing this document is to attest the fact that the student voluntarily declared her pregnancy to the Clinical Coordinator, received counseling regarding radiation protection, reviewed the student’s radiation dose history, and received a fetal monitor. Summary DLs are prescribed by the NCRP for various organs, the whole body, and various working conditions; so that the lifetime risk of each year’s occupational exposure does not exceed 10-4 per year. The NCRP recommends a cumulative whole-body DL of 1- mSv times age in years. The DL during pregnancy is 5 mSv. In diagnostic imaging, however, it is seldom necessary to exceed 1/10 the appropriate DL. Occupational radiation exposure is measured in milliseiverts (millirems), and the description of such exposure is effective dose (E). Effective dose accounts for type of radiation and the relative radiosensitivity of tissues and organs. Although the dose limit of occupational workers is 50 mSv/yr, most radiologic personnel receive less than 0.5 mSv/yr. Radiologists may receive a higher dose if engaged in a heavy fluoroscopy schedule. Note: information provided in this document is courtesy of Radiologic Science for Technologists, Bushong, 10th ed. , Mosby Elsevier 2012.



ACKNOWLEDGMENT OF RADIATION RISK DURING PREGNANCY

I, _______________________________________, do acknowledge that I have received

counseling from ____________________________________ regarding my responsibilities during my

pregnancy.

It is clear to me that there is a small probability that duties assigned to me during my

clinical externship will in any way adversely affect my pregnancy. The reading material that has been

made available to me demonstrates that the additional risk during my pregnancy is much less than that

for most occupational groups. I further understand that, although I may be assigned to low-exposure

duties and provided with a second radiation monitor, these are simply added precautions and do not in

any way convey that any assignment in the clinical department is especially hazardous during pregnancy.


Clinical Director Signature Student Signature

Date Date


PREGNANCY DISCLOSURE FORM I, ______________________________, student of the Pima Medical Institute's Advanced Placement Track Radiography program declare my pregnancy on _________________________________. I have received and read information on the risks of radiation during pregnancy and I have chosen the following option that I initialed below: ________ OPTION #1: I have voluntarily declared my pregnancy and have chosen to proceed in the program. I understand I will be provided with a second radiation monitor that needs to be changed monthly and assigned to low exposure areas which may extend my clinical externship due to not being exposed to these areas to obtain competencies. ________ OPTION #2: I have voluntarily declared my pregnancy and have chosen to proceed in the program. I understand I will be provided with a second radiation monitor that needs to be changed monthly and I have chosen not to be assigned to low exposure areas. ________ OPTION #3: I wish to temporarily withdraw from the program. I realize that I may re-enter the program after delivery. If I have any further questions, I can contact the Program Director, APTR Director or APTR Clinical Director. If you have any questions about your pregnancy, please contact your physician before choosing from these options. Shandea Dashiell – Radiography Program Director - (520)881-1284 – [email protected] Chalonda Jones-Thomas – APTR Director – (520)245-0869 – [email protected] Steve Forshier – APTR Clinical Director – (480)248-4796 – [email protected] ------------------------------------------------------------------------------------------------------------------------------- By signing this form, I acknowledge that I understand the options I have available and am declaring my pregnancy to school officials.


Student Signature Date






PREGNANCY POLICY ACKNOWLEDGMENT FORM

STUDENT INFORMATION Name: Address: City: State: Zip Code:

Female students enrolling in the Radiography Program are not required to report their pregnancy to any PMI school official. Information regarding pregnancy can be found in the Student Regulations section of the Pima Medical Institute Catalog and in the Radiography Program Pregnancy Policy. Students may seek additional information regarding the effects of radiation and pregnancy, radiation effects to the fetus, or as it relates to the demands of the Radiography Program by contacting their personal physician and the Radiography Program Director. Signing below indicates that you have been informed and received a copy of the PMI Radiography Program Pregnancy Policy. Additional information, reading materials and forms may be requested from the Radiography Program Director at any time.

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Student Evaluation of Clinical Experiences

Please circle the rating which best describes your clinical experience. Comments and explanations are encouraged.

Rating Scale: 4 = Excellent … 1 = unsatisfactory

1. Do you believe that all students are scheduled to have equal opportunity to complete their clinical objectives?

6 5 4 3 2 1

2. Did you always know whom you are responsible to and/or who you go to ask questions? 6 5 4 3 2 1

3. Do you feel clinical assignments are made primarily for their educational value? 6 5 4 3 2 1

4. Was the Pima Clinical Director available to assist instructional staff and students with problems?

6 5 4 3 2 1

5. Did the Clinical Instructor relate well to other departmental and hospital personnel? 6 5 4 3 2 1

6. Did the Clinical Instructor demonstrate enthusiasm for teaching while allowing students to participate in the assigned clinical activities?

6 5 4 3 2 1

7. Did the Clinical Instructor demonstrate proficiency in the clinical, technical, and procedural aspects of your clinical education?

6 5 4 3 2 1

8. Was the Clinical Instructor knowledgeable of the medical resources available? 6 5 4 3 2 1

9. Did you receive an informative and complete orientation of the hospital? 6 5 4 3 2 1

10. Do you feel that you were exposed to a wide variety of clinical experiences? 6 5 4 3 2 1

11. Did you feel comfortable asking questions? 6 5 4 3 2 1

12. Was the Clinical Instructor available to complete competency forms in a timely manner? 6 5 4 3 2 1

13. Do you feel there is adequate communication between Pima and the clinical education setting?

6 5 4 3 2 1

Comments and explanations:

Clinical Education Setting Date

Appendix H: Evaluation of Clinical Experience Form 1 of 1


Acknowledgment of Understanding

Student Signature Date

Appendix I: Acknowledgment of Understanding 1 of 1

I, ________________________________________________have read the policies and

procedures outlined in the APTR Clinical Handbook for Pima Medical Institute, Tucson

Campus. I agree to abide by and follow the aforementioned policies and procedures. I

understand that if I require clarification on any portion of this handbook it is my

responsibility to seek out a Radiography faculty member. I understand that failure to

follow the policies and procedures as outlined in this handbook may result in

disciplinary action or termination from the program.

Please print your full name