Faculty of Health
and Social Care
School of Allied Health Professions, Diagnostic Imaging
Clinical Placement Handbook.
Advanced Diagnostic Imaging Studies
Year 3
Name…………………………………
Cohort…………………………………
Placement……………….……………
University of the West of England, Bristol
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1
CLINICAL PLACEMENTS:
Clinical placements are organised by the clinical co-ordinator, who will also
monitor student progress in conjunction with Appraisers and Link tutors.
Academic staff will undertake the role of Link tutors and visit you on clinical
placement. Primarily the role is to provide academic guidance and support for
students ensuring that effective communication links between the University
and Clinical departments are maintained.
PLACEMENT OUTLINE
As part of the Advanced Professional Studies Module, you are once again
required to undertake a clinical placement. This will allow you to consolidate
your knowledge and gain the required clinical experience. This takes the form
of a 14-week clinical block, which begins on 10.9.07 and ends on 14.12.07.
During this placement you will be allocated to the following areas:
-
1 or 2* weeks in Fluoroscopy (to include Digital and Angiography if
available).
-
4 weeks in Accident and Emergency to include all patient groups e.g.
paediatrics, elderly and those with special needs.
-
2 or 3* weeks in General rooms
-
3 weeks on Mobiles / Theatre
-
1 week in CT
-
1 week in chosen “specialist” modality (MRI, RNI or US)
-
1 week in other modalities (1/2 week in each of the non-selected
modalities MRI, RNI, US)
* Extra week at the discretion of the placement and dependent upon which
appraisal is to be undertaken:
 if undertaking fluoroscopy room management appraisal then 2
weeks in fluoroscopy and 2 weeks in General
 if undertaking general room management appraisal then 3 weeks in
general and 1 week in Fluoroscopy
There will also be a 5 week pre-qualifying placement scheduled for 26.5.08 –
27.06.08
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APPRAISAL DETAILS
During the Clinical Placement you MUST complete the following appraisals:
Room Management Session
A Theatre Case
An Accident and Emergency Case
You will be assigned to each of the above specific areas for clinical
experience. The Room Management Session will be negotiated with the
department and will either be in a General or Fluoroscopy room. You can
undertake your appraisal at any time during this period if, after discussion, the
appraiser feels you are ready to do so.
GENERAL APPRAISAL GUIDELINES
Each of the three Year 3 appraisals has very specific guidelines. There will
however, have to be some flexibility to allow for differences in departmental
procedure. These are discussed in more detail under each appraisals specific
heading. There are however, some general guidelines, which apply to all
Year 3 appraisals.
Mock appraisals
The facilitation of mock appraisals is very difficult and would result in
appraiser workload becoming unmanageable. As a compromise, during your
placement in a specific area, you should be allowed to shadow the team
leader in preparation for the actual appraisal. You MUST only attempt the
appraisal at the discretion of the Appraiser, after COMPLETING THE PREREQUISITE OBJECTIVES AND BEING IN THE RELEVANT PLACEMENT
AREA FOR A MINIMUM OF 1 WEEK.
Referral in an appraisal
If you fail at the first opportunity you may only be granted a second
opportunity at the discretion of the award board.
Administration
You will be issued with one form for each appraisal. Further copies are
available on request from the Clinical co-ordinator. The forms are triplicate.
The copies, once completed should be separated,



The White copy is retained by you
The Pink copy is retained by the appraiser
The Yellow copy is forwarded (as soon as possible) to the Clinical Coordinator (Radiography) at the School of Allied Health Professions.
The white copies must be submitted with the completed portfolio at the end of
the placement and they will be returned to you following the assessment of
the portfolio.
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Marking of the Appraisals
The appraisal marking criteria is similar to Year 2 in that there are four levels
of competency for each section e.g.:
0 – Intervention needed due to error/omission
1 – Student needed specific guidance
2 – Student needed minor prompt
3 – Performance adequate
4 – Perfect performance in circumstances
The appraisal can be halted at any point if the student is deemed to be
performing in a dangerous or unprofessional manner.
The year 3 appraisals do not contain a formalised discussion element
however; it is envisaged that the appraiser will have to question you during
the appraisal so that they can award the appropriate mark to each section. It
may even be necessary to question you after the appraisal has finished in
order to clarify some issues.
At this level it has been agreed that there should be some element of negative
marking. It is with this in mind that the forms have been designed so that if
omitted, the areas of practice, which should be “second nature”, can be
penalised. This will mean that if you fail to carry out one of the elements
included in the first section of the appraisal you will either incur an automatic
failure or a deduction in marks depending on the nature of the omission.
The pass mark for year 3 appraisals is 70%.
Clinical Objectives
In order to gain an integrated approach to the appraisals pre-requisite
objectives have been linked to the appraisals as in year 1 and 2.
Appraisal
A&E Trauma
Case
Room Management
Session
Theatre Case
Pre-requisite
objectives
A&E
General & Fluoroscopy/
angiography
Mobile and Theatre
Minimum time
required in
placement area
1 week
1 week
1 week
You must also produce evidence (e.g. logbook entries) to show that you have
completed sufficient relevant examinations before the appraisal is carried out.
A table outlining the minimum unassisted examination numbers required by
the end of the 3rd year placement is included in the front of the logbook.
Failure to record / achieve these numbers may result in a referral in the
portfolio component and the academic award board will decide if you are
granted a second opportunity.
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You are allowed to submit only 1 draft copy of each of your objectives to gain
feedback prior to final submission.
Clinical Portfolio
For a pass to be achieved, the student must demonstrate satisfactory
progress. In the event of an area being identified as “BELOW REQUIRED
STANDARD FOR THIS STAGE OF TRAINING.” and scored as a 1, an
ACTION PLAN needs to be produced. There is the option to use an action
plan at any stage of the 14 weeks if the assessor feels that the student is not
performing at the required level for that week.
The Action Plan

This plan will be a negotiated between the student and the clinical
supervisor and will aim to redress the identified shortcoming.

If this is not achieved within the agreed time frame, the link lecturer will
intervene.
SPECIFIC APPRAISAL GUIDELINES
Room Management Session
This appraisal has been designed to test your management skills. The
rationale behind its design was to investigate how well the student would cope
with the day to day running of a General or Fluoroscopy Room rather than
one isolated case.
It is envisaged that you will co-ordinate the running of the room in question for
either a morning or an afternoon session. The length of time each individual
student will be under appraisal conditions will vary. However, the session
time should be between 2-3 hours to allow for sufficient variety in workload
and departmental procedures.
The idea is that you will take over the role of team leader for a General or
Fluoroscopy Room. You will liaise with staff and manage the workload and
the staff working in the room, to ensure the smooth running of the room. You
will be required to make decisions and liaise with staff whilst following normal
working procedures.
The guidelines as to what type of room should be used will be deliberately
vague to allow for departmental variation. It is envisaged that a variety of
general radiography or a fluoroscopy session will be undertaken within the
room in question, and that there be a minimum of 2 staff working there, (1 of
these staff can be the student). You should undertake the examinations of
some but not all of the patients that are imaged during the session.
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Assessment Forms
The front sheet of this appraisal form (L3/Man/1) records the general
particulars for the appraisal and the pre-requisite objectives.
Form L3/Man/2 deals with questions that relate to the patients, which you
personally image during the session. Failure to carry out any of these tasks
will result in an automatic failure.
Form L3/Man/3 is specific to the sessional appraisal and should be marked as
outlined in the marking of appraisals section ie 0-4 depending on overall
sessional performance.
L3/Man/4 is a feedback and final mark form. This is similar to those used in
year 1 and 2 appraisals, and allows the appraiser and student to comment on
the session.
L3/Man/5 allows the student to reflect and comment on the session similar to
those used in year 1 and 2.
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Clinical Appraisal Level Three- Room Management Session
Name of Hospital…………………………………………………………………….
Name of Appraiser .……………………………..Signature………………………
Name of Student………………………………….Signature……………………..
Please indicate room: General / Fluoroscopy (Delete as appropriate)
------------------------------------------------------------------------------------------------------------
Do not proceed with the appraisal if the following pre-requisites
have not been met.
Has the student spent a minimum of one week in the area prior to
this appraisal?
Have the pre-requisite clinical objectives been completed and
signed off? (The completed objectives should be initialled by the
appraiser to indicate this has been checked.)
------------------------------------------------------------------------------------------------------------
Session details
Date…………………………………..
Number of patients during assessment session……………………
Range of type of patient………………………………………………
Range of examinations performed by student………………………
Number of staff in the room………………………………………
Time period under assessment……………………………………
Time started……………………………….. Time finished……………
NB The appraisal can be halted and an automatic failure recorded if: a) The appraiser deems that the student is committing a dangerous act.
b) If the answer to any question marked * in section 2 is “NO”
YES=1 mark
Please indicate: - 1st opportunity / 2nd opportunity
L3/Man/1
White copy to student, yellow copy to UWE, pink copy to appraiser.
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Section 1
Prior to the session to what level did the student:0
1
2
3
4
a) Prepare the room / area?
b) Prepare the radiographic equipment?
c) Prepare the emergency equipment?
d) Ensure sufficient supply of consumables
e) Carry out forward planning of the session
TOTAL
Section 2
Did the student carry out the following checks on the patients they
imaged in the session?
YES=1 mark
NO=Automatic failure
YES
NO
i)*The student considered the possibility of patient
pregnancy (Female patients only).
ii)*The student checked that the request form was
completed in accordance with departmental protocol (E.g.
verified by signature)
iii)*The student obtained a positive identity check
iv)*The student justified the examination with regards to
IRMER.
v)*The student correctly identified which projections they
will take.
vi)*The student considered viewing previous radiographs or
reports (even when films/reports are not available).
SUB-TOTAL
L3/Man/2
White copy to student, yellow copy to UWE, pink copy to appraiser.
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MARKING GUIDE 0. intervention needed due to omission/error
1. Student needed specific guidance
2. Student needed minor prompt
3. Performance adequate
4. perfect performance in the circumstances
Section 3
During the session
To what level did the student :-
0
1
2
3
4
0
1
2
3
4
Manage the transport of patients
Prioritise duties to be performed
Delegate duties to be performed
Liaise/communicate with other staff
Ensure radiation protection measures were carried
out for staff/patients.
Deal with any difficulties
Manage their time
Manage the workload of other staff
Anticipate any difficulties/problems
Ensure that exposure factors were recorded and
monitored
Ensure a high standard of patient care
Know how to correct any errors to obtain diagnostic
radiographs
TOTAL
Section 4
After the examinations
To what level did the student :Ensure patients aftercare
Ensure that the patients knew how to get their
results.
Manage patient transport
Organise collation of films and carry out correct
procedure for film reporting
Ensure the room and equipment was cleaned in
accordance with infection control protocols.
TOTAL
L3/Man/3 White copy to student, yellow copy to UWE, pink copy to appraiser.
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APPRAISAL SCORE
PASS MARK = 70% = 66/94
Section number
1
2
20
6
3
4
SCORE
48
20
TOTAL SCORE
APPRAISAL
SCORE %
[Total / 94 X 100]
94
Evaluation and Feedback
Appraiser’s feedback on student’s overall performance (including
areas for development and relevant details of patient condition)
Appraiser’s signature……………………Date………………………
Appraiser’s name……………………………………………………..
L3/Man4 White copy to student, yellow copy to UWE, pink copy to appraiser.
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Student’s comments and reflection on appraisal performance
Student’s signature… ……………………………. Date…………….
L3/Man/5
White copy to student, yellow copy to UWE, pink copy to appraiser.
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Theatre Case
The rationale behind this appraisal is to assess your performance as a
radiographer undertaking a theatre case.
You will be required to make decisions and liaise with other theatre staff whilst
following normal working procedures.
Obviously this appraisal will be very difficult to standardise throughout the
region, however, it is envisaged that the case will relate to an operation done
in an operating theatre under sterile conditions, requiring screening using an
Image Intensifier. Examples of suitable cases include: Dynamic Hip Screw,
operative cholecystography, any plate/pinning procedure.
.
Assessment Forms
The front sheet of this appraisal form (L3/Theatre/1) records the general
particulars for the appraisal and the pre-requisite objectives. The “Bail Option”
is there to allow the clinical assessor to take over the procedure from you if
they consider it necessary as a result of factors outside your control. You will
not be penalised if this happens.
Form L3/Theatre/2 relate to the general elements of the appraisal including
preparation of the equipment and patient prior to imaging. It also has the
mandatory questions, which carry an automatic failure if the tasks are not
completed correctly. This is similar to those in the 1st and 2nd years.
Form L3/Theatre/3 allows the appraiser to rate your performance in section 3
during the operation. Sterile conditions relate to the observation and
maintenance of any sterile field determined by the surgeon or other theatre
staff and your ability to manoeuvre radiographic equipment safely in that
environment. The marks awarded follow the format outlined in the “marking of
appraisal guidelines”.
Form L3/Theatre/4, section 4, allows for the assessment of your actions after
the operation. The final marking grid is also on this page
L3/Theatre/5. This is similar to those used in year 1 and 2 appraisals, and
allows the appraiser and the student to comment on the session. The
appraiser is encouraged to feedback on the quality of the resultant images.
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Clinical Appraisal Level Three – Theatre case
NB. This assessment must be conducted on a single theatre case, which
is performed under sterile conditions using an Image Intensifier
Name of Hospital……………………………………………………………………
Name of Appraiser………………………………Signature……………………….
Name of Student…………………………………Signature……………………….
Do not proceed with the appraisal if the following pre-requisites have not been
met
Has the student spent a minimum of one week (or equivalent) in theatre
prior to this appraisal?
Have the pre-requisite clinical objectives been completed and signed
off? (The completed objectives should be initialled by the appraiser to
indicate this has been checked)
Case Details
Date…………………………………
Patient’s clinical history………………………………………………………………
Type of operation to be performed..………………………………………………..
Number of staff present in theatre………………………………………………….
Time period under assessment……………………………………………………..
Time started……………………Time finished……………………………………..
NB The appraisal can be halted and an automatic failure recorded if:
a) The appraiser deems that the student is committing a dangerous act
b) If the answer to any section marked * in section 2 is “No”
BAIL OPTION. Should the appraiser deem it necessary to take over from the
student due to factors outside student’s control, the student will not be
penalised in any way.
Please indicate:- 1st opportunity / 2nd opportunity
L3/Theatre/1 White copy to student, yellow copy to UWE, pink copy to
appraiser
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0.
1.
2.
3.
4.
MARKING GUIDEIntervention needed due to omission/error
Student needed specific guidance
Student needed minor prompt
Performance adequate
Perfect performance in the circumstances
Section 1
Prior to entering the theatre to what level did the student: 0
1
2
3
4
a) Verbalise the procedure (what was going to happen)
b) Discuss radiation protection for staff and patient
c) Dress appropriately for theatre
d) Visually check the equipment for cleanliness
Total
Section 2
Did the student carry out the following checks on the patient?
Yes = 1 mark
No = *Automatic failure
Yes
No
a)* The student considered the possibility of patient
pregnancy (Female patients only)
b)* The student checked that the request form was
completed in accordance with departmental protocol
c)* The student obtained a positive identity check
d)* The student justified the examination with regards to
IR(Me)R
e)* The student considered viewing previous radiographs or
reports
f)* The student correctly identified how the Image Intensifier
will be set up and what projections will be needed
L3/Theatre/2 White copy to student, yellow copy to UWE,
pink copy to appraiser
SUB-TOTAL
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0.
1.
2.
3.
4.
MARKING GUIDEIntervention needed due to omission/error
Student needed specific guidance
Student needed minor prompt
Performance adequate
Perfect performance in the circumstances
Section 3
During the operation: To what level did the student
0
1
2
3
4
Set up the equipment with consideration to health
and safety
Liaise/communicate with theatre staff
Observe theatre etiquette
Understand the Surgeon’s requirements
Observe and maintain sterile conditions
Ensure radiation protection measures were carried
out for staff and the patient
Centre to the area of interest (e.g. hip)
Collimate the beam appropriately
Manipulate the image intensifier to obtain the
required projections
Use Intensifier controls to optimise the image
including the use of pulsed/continuous or manual
exposure
Anticipate and resolve any difficulties/problems
Ensure that exposure factors were monitored
TOTAL
L3/Theatre/3 White copy to student, yellow copy to UWE, pink copy to
appraiser
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Section 4
After the Operation
To what level did the student
0
1
2
3
4
Organise collation of images and carry out correct
procedure for image recording
Ensure that final images are correctly annotated
Ensure that exposure factors were recorded and
documentation correctly completed
Ensure that the equipment was cleaned in
accordance with infection control protocols
Ensure that all equipment was returned to it’s correct
place of storage
Ensure that final images are made available for
reporting/surgeon’s review in accordance with local
protocols
TOTAL
APPRAISAL SCORE
PASS MARK = 70% = 66/94
Section number
1
2
3
4
Score
16
Total score
6
48
24
94
APPRAISAL
SCORE%
[Total / 94 x 100]
L3/Theatre/4 White copy to student, yellow copy to UWE, pink copy to
appraiser
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Evaluation and Feedback
Appraiser’s feedback on student’s overall performance (including areas for
development, theatre technique and quality of images produced)
Appraiser’s Signature……………………Date………………………..
Appraiser’s name……………………………………………………..
Student’s comments (including student’s impression of their performance)
Student’s Signature………………………Date………………….
L3/Theatre/5 White copy to student, yellow copy to UWE, pink copy to appraiser
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Accident and Emergency Case
The rationale behind this appraisal is to assess your management of an
accident and emergency case. Obviously this appraisal will be very difficult to
standardise throughout the region, however, it is envisaged that certain
criteria for patient selection should be adhered to. These will include: i.
The patient should have a minimum of TWO sites of injury.
Ideally one of the sites of injury should require the application of
a horizontal beam technique. The examination should however
include the necessity for some adaptation in routine radiographic
positioning and or manual handling techniques.
It is not envisaged that you should attempt the case totally unaided. You will
be allowed to ask for assistance but should demonstrate some degree of
forward planning and be able to discuss the rationale behind your actions and
decisions. (This will have the effect that in some sections it will be very
difficult for you to obtain a perfect score of 4).
Assessment Forms
The front sheet of this appraisal form (L3/A&E/1) records the general
particulars for the appraisal and the pre-requisite objectives.
Form L3/A&E/2 relate to the general elements of the appraisal including
preparation of the room and patient prior to imaging. It also has the mandatory
questions, which carry an automatic failure if the tasks are not completed
correctly. This is similar to those in the 1st and 2nd years.
Form L3/A&E/3 allows the appraiser to rate your performance in section 3
during the examination. Whereas section 4 rates the practical skills necessary
for image production. The marks awarded follow the format outlined in the
“marking of appraisal guidelines”.
Form L3/A&E/4 section 5 allows for the evaluation of the resultant radiographs
by the student. Section 6 then follows which allows the appraiser to give a
score of 0-10 on your overall ability to recognise whether the images
produced were of a diagnostic quality or needed repeating. Section 7
considers your actions post imaging. The final marking grid is also on this
page.
L3/A&E /5. This is similar to those used in year 1 and 2 appraisals, and allows
the appraiser and the student to comment on the session. The appraiser is
encouraged to feedback on the quality of the resultant images.
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Clinical Appraisal Level Three- Trauma case
Name of Hospital……………………………………………………….
Name of Appraiser .……………………………..Signature………..………………
Name of Student…………………………………Signature………………………..
------------------------------------------------------------------------------------------------------------
Do not proceed with the appraisal if the following pre-requisites
have not been met.
Has the student spent a minimum of one week in A&E prior
to this appraisal?
Have the pre-requisite clinical objectives been completed
and signed off? (The completed objectives should be initialled
by the appraiser to indicate this has been checked.)
------------------------------------------------------------------------------------------------------------
Case details
Date…………………………………..
Patients clinical history………………….………………………………………….
Location of patient eg Resus / x ray room/ other (please specify) ………….…
Examinations performed by the student on the patient…..…………….………...
Number of staff assisting with trauma case…………………………..……………
Time period under assessment……………………………………….…………..…
Time started……………………….. Time finished……………………………….
NB The appraisal can be halted and an automatic failure recorded if: a) The appraiser deems that the student is committing a dangerous act.
b) If the answer to any question marked * in section 2 is “NO”
Please indicate: - 1st opportunity / 2nd opportunity
L3/A&E/1 White copy to student, yellow copy to UWE, pink copy to appraiser.
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MARKING GUIDE 0. intervention needed due to omission/error
1. Student needed specific guidance
2. Student needed minor prompt
3. Performance adequate
4. perfect performance in the circumstances
Section1
Prior to imaging the patient to what level did the student: 0
1
2
3
4
a) Prepare of the room / area?
b) Prepare the radiographic equipment?
c) Prepare the emergency equipment?
d) Check the patient’s clinical history?
e) Ensure that the patient had been prepared for
imaging?
f) Discuss the forward planning of the case?
TOTAL
Section 2
Did the student carry out the following checks on the patient?
YES=1 mark
NO= * Automatic failure
YES
NO
i)*The student considered the possibility of patient
pregnancy (Female patients only).
ii)*The student checked that the request form was
completed in accordance with departmental protocol (e.g.
verified by signature)
iii)* The student obtained a positive identity check
iv)*The student justified the examination (IRMER).
v)* The student considered viewing previous radiographs
or reports (even when films/reports are not available).
vi)*The student correctly identified which projections they
will take
L3/A&E/2
SUB-TOTAL
White copy to student, yellow copy to UWE, pink copy to appraiser.
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Section 3
During the imaging of the patient: To what level did the student
0
1
2
3
4
Manage the transport of the patient, if necessary.
Prioritise duties in relation to the patient’s condition.
Delegate duties to be performed
Liaise/communicate with other staff
Co-ordinate any patient transfer manoeuvres
Ensure radiation protection measures were carried
out for staff/patients.
Identify and deal with any difficulties
Manage their time
Anticipate and resolve difficulties or problems
Ensure that exposure factors were recorded and
monitored
Ensure a high standard of patient care throughout
The examination
Know how to correct any errors to obtain diagnostic
radiographs
TOTAL
Section 4 (score 0-4 for each image produced)
During the imaging of the patient to what level did the student: Image
1
Image
2
Image
3
Image
4
Image
5
Know the correct projection.
Accurately locate centring point
Collimate the beam adequately
Correctly place markers and
legends
Correctly adjust all console settings
Give clear instructions to patient on
breathing etc
Manipulate the equipment
Total marks
Average projection mark
= total marks / number images
L3/A&E/3
White copy to student, yellow copy to UWE, pink copy to appraiser.
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Image
6
Section 5 (score 0-4 for each image produced)
During the checking of the images: Image
1
To what level did the student
Image
2
Image
3
Image
4
Image
5
Image
6
Identify the patient (anatomical/
personal)
Identify the area under examination
Identify the projection
Evaluate the image quality
(contrast etc)
Anatomically evaluate image
Identify existing pathology or normal
variants
Recognise film faults and artefacts
Total marks
Average projection mark
= total marks / number images
Section 6
Did the student recognise the diagnostic quality of the resultant
images?
MARK
(The appraiser should allocate an overall score of 0-10.)
Section 7
After the examination:To what level did the student
0
1
2
3
4
Organise collation of films and carry out correct
procedure for film reporting
Ensure the room was cleaned in accordance with
infection control protocols.
Ensure the patient receives the correct aftercare
Total marks
APPRAISAL SCORE
PASS MARK = 70% = 110/156
Section number
1
2
3
4
5
6
48
28
28
7
SCORE
24
6
10
12
TOTAL
APPRAISAL
SCORE %
156
[Total /156 X 100]
L3/A&E/4
White copy to student, yellow copy to UWE, pink copy to appraiser.
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Evaluation and Feedback
Appraiser’s feedback on student’s overall performance (including
areas for development , relevant details of patient condition and
quality of images produced)
Appraiser’s signature…………………………..Date…………………
Appraiser’s name……………………………………………………….
Student’s comments (Including students impression of their
performance,)
Student’s signature… ……………………………………….
Date……………………
L3/A&E/5 White copy to student, yellow copy to UWE, pink copy to appraiser.
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