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School of Medical Imaging & Therapeutics RADIATION THERAPY PROGRAM 2011-2012 1 MASSACHUSETTS COLLEGE OF PHARMACY & HEALTH SCIENCES RADIATION THERAPY PROGRAM School of Medical Imaging & Therapeutics Contact Information: Massachusetts College of Pharmacy & Health Sciences 179 Longwood Avenue Boston, MA. 02115-5896 Dr. Susan Belinsky Associate Professor of Radiation Therapy Director, Radiation Therapy Program 617-732-2261 Fax 617-732-2075 Sbelinsky@mcphs.edu Susan MacIsaac, R.T.(T), B.S.N. FacultyInstructor & Clinical Coordinator of the Radiation Therapy Program 617-732-2840 Fax 617-732-2075 susan.macisaac@mcphs.edu Frances Keech, MBA, RT(N), FSNMTS Associate Professor of Nuclear Medicine Technology Acting Dean, School of Medical Imaging & Therapeutics 617-732-2928 frances.keech@mcphs.edu 2 Radiation Therapy Program Student Handbook and Clinical Course Guide Table of Contents Contents INTRODUCTION TO CLINICAL COURSE GUIDE ........................................................................................................................ 6 MISSION STATEMENT .................................................................................................................................................................... 7 Program Objectives .............................................................................................................................................................................. 8 Program Curriculum ............................................................................................................................................................................ 8 Admission Technical Standards ........................................................................................................................................................... 9 Post-Baccalaureate Baccalaureate Program ....................................................................................................................................... 10 Terminal Objectives ........................................................................................................................................................................... 11 MCPHS ACADEMIC POLICIES AND PROCEDURES ................................................................................................................. 12 Clinical Rotation Sites ....................................................................................................................................................................... 13 Baystate Medical Center ......................................................................................................................................................... 13 Beth Israel Deaconess Medical Center (East Campus) ........................................................................................................... 13 Brigham & Women’s Hospital/Dana Farber Cancer Institute ............................................................................................... 13 Brigham and Women’s Hospital/ Dana Farber Cancer Institute ............................................................................................. 14 BW/DF Cancer Center @ Milford Regional Hospital............................................................................................................. 14 Cooley-Dickinson Hospital ..................................................................................................................................................... 14 Dana Farber/Brigham and Women’s Hospital @ South Shore Hospital ................................................................................. 15 Commonwealth Atrius Cancer Center ..................................................................................................................................... 16 Lahey Clinic ............................................................................................................................................................................ 16 Lahey Clinic North .................................................................................................................................................................. 16 Massachusetts General / North Shore Center for Outpatient Care .......................................................................................... 17 MetroWest Medical Center ..................................................................................................................................................... 17 Mount Auburn Hospital........................................................................................................................................................... 17 NorthMain Radiation Oncology (formerly Radiation Oncology Associates) ......................................................................... 17 Rhode Island Hospital ............................................................................................................................................................. 18 St. Vincent Hospital Radiation Oncology Center .................................................................................................................... 18 South Suburban Oncology Center (SSOC) ............................................................................................................................. 18 Shields Radiation Oncology Center (SROC) .......................................................................................................................... 19 Winchester Hospital Radiation Center (WHRC) ..................................................................................................................... 19 Clinical Education Goals & Evaluation ............................................................................................................................................. 20 Clinical Internship Rules .................................................................................................................................................................... 21 Infection Control Policies .................................................................................................................................................................. 21 Sickness Policy .................................................................................................................................................................................. 21 Clinical Make-Up Time ..................................................................................................................................................................... 23 Snow Policy ....................................................................................................................................................................................... 23 Continuing Education Requirements ................................................................................................................................................. 23 Clinical Travel & Transportation ....................................................................................................................................................... 23 Bereavement ...................................................................................................................................................................................... 24 Outside Employment.......................................................................................................................................................................... 24 Dress Code ......................................................................................................................................................................................... 24 Procedures in the Event of Injury ....................................................................................................................................................... 26 Ethics And Professional Conduct ....................................................................................................................................................... 26 Mission Statement ............................................................................................................................................................................ 28 Radiation Therapy Program Goals ..................................................................................................................................................... 28 Professional Relationships ................................................................................................................................................................. 31 Grading .............................................................................................................................................................................................. 31 Retention & Dismissal Policy for the RTT Internship ....................................................................................................................... 32 Clinical Probation .............................................................................................................................................................................. 32 Re-Entry Policy .................................................................................................................................................................................. 33 Grievances.......................................................................................................................................................................................... 33 3 Joint Review Committee on Education in Radiologic Technology ................................................................................................... 34 Clinical Procedure Lab Practical Description .................................................................................................................................... 34 Student Responsibilities and Limits of Responsibility ....................................................................................................................... 34 American Society of Radiologic Technologists ................................................................................................................................. 35 CODE OF ETHICS ................................................................................................................................................................. 35 Direct Supervision Policy .................................................................................................................................................................. 38 Time Out Policy ................................................................................................................................................................................. 39 Clinical Competency Schedule 2011-2012 ........................................................................................................................................ 39 CLINICAL POLICIES & FORMS .................................................................................................................................................... 41 CLINICAL COMPETENCY KNOWLEDGE ASSESSMENT ........................................................................................................ 42 Log-In Record Policy ......................................................................................................................................................................... 44 LOG-IN RECORD ............................................................................................................................................................................. 45 CLINICAL PROCEDURE FORM .................................................................................................................................................... 46 ARRT Radiation Therapy Clinical Competency Requirements ......................................................................................................... 47 Second Year Student’s Role & Responsibility................................................................................................................................... 48 Mid-Point Evaluation ......................................................................................................................................................................... 49 MID-ROTATION REVIEW ALL INTERSHIPS ............................................................................................................................ 50 PATIENT CARE ROTATION RTT 201C ........................................................................................................................................ 52 PATIENT CARE ROTATION RTT 202C ........................................................................................................................................ 52 Clinical Competency Evaluation - Patient Care Rotation RTT 201C Clinical Internship ................................................................. 54 Clinical Competency Evaluation - Patient Care Rotation RTT 202C Clinical Internship ................................................................. 56 Oral Assessment Policy ..................................................................................................................................................................... 58 Oral Assessment Questions ................................................................................................................................................................ 59 Simulation & Simulation Observation ............................................................................................................................................... 60 RADIATION THERAPY CLINICAL............................................................................................................................................... 61 SIMULATION COMPETENCY REQUIREMENTS ....................................................................................................................... 61 Simulation Procedures Conventional Simulation & CT Simulation .................................................................................................. 62 SIMULATION OBSERVATION ROTATION: CT SIMULATOR ................................................................................. 63 SIMULATION COMPETENCY: Conventional Simulation Procedure: ________________ .......................................................... 65 SIMULATION COMPETENCY: CT Simulation ............................................................................................................................. 66 Brachytherapy OBSERVATION ROTATION: HDR CT Sim: Brachytherapy ..................................................................... 67 RADIATION THERAPY PROGRAM ............................................................................................................................................. 69 Clinical Competency Evaluation - Simulation - Second Clinical Year, (304C, 305C) .................................................................. 69 Final Semester Evaluation ................................................................................................................................................................. 74 SUPERVISOR EVALUATION OF CLINICAL SKILLS ................................................................................................................ 75 Recompetencies & Unsuccessful Recompentencies .......................................................................................................................... 82 Recompetency Form .......................................................................................................................................................................... 83 Master List of Recompetencies Required .......................................................................................................................................... 84 Clinical Conference Policy ................................................................................................................................................................ 85 Clinical Conference Documentation Form ........................................................................................................................................ 86 Radiation Protection ........................................................................................................................................................................... 87 Treatment Planning DOSIMETRY .................................................................................................................................................. 88 Clinical Competency Evaluation -Treatment Planning ...................................................................................................................... 89 Radiation Safety - Clinical Competency Evaluation .......................................................................................................................... 91 Dosimetry Competency Form ............................................................................................................................................................ 93 Mould Room ...................................................................................................................................................................................... 96 Mould Room Rotation Form .............................................................................................................................................................. 97 COMPETENCY 1: Identify components of a Linear Accelerator ..................................................................................................... 98 COMPETENCY 2: Use of Linear Accelerator Components ........................................................................................................... 100 COMPETENCY 3A: Treatment Unit Orientation & Emergency Procedures (First Clinical Year) ................................................ 102 COMPETENCY 3B: Treatment Unit Orientation & Emergency Procedures (Second Clinical Year) ............................................ 104 COMPETENCY 4: Warm-up Procedures---Clinac 2100 CD ......................................................................................................... 107 COMPETENCY 4: Warm-up Procedures---Varian Brigham 6 ex .................................................................................................. 109 COMPETENCY 4: Warm-up Procedures---Varian 6/100 ............................................................................................................... 111 COMPETENCY 4: Warm-up Procedures--- 21 EX Linear Accelerator.......................................................................................... 113 COMPETENCY 4: Warm-up Procedures---Siemens Primus .......................................................................................................... 115 COMPETENCY 4: Warm-up Procedures---Trilogy ....................................................................................................................... 117 CLINICAL COMPETENCY EVALUATION – All procedures ..................................................................................................... 119 CLINICAL ATTENDANCE/Student Absences .............................................................................................................................. 122 Clinical Education Attendance Record ............................................................................................................................................ 123 Clinical Intent................................................................................................................................................................................... 124 4 Clinical Competency Intent Form ....................................................................................................... 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Clinical Infraction Policy: ................................................................................................................................................................ 126 Clinical Infraction Form................................................................................................................................................................... 127 Clinical Incident Documentation Form ............................................................................................................................................ 128 EXAMPLE OF AN E-JOURNAL ................................................................................................................................................... 129 Warm-up & Warm-up Observation ................................................................................................................................................. 130 Warm-up Observation Form ............................................................................................................................................................ 131 CLINICAL SUPERVISOR AND INSTRUCTOR EVALUATION FORM ................................................................................... 132 MCPHS Pregnancy Declaration ....................................................................................................................................................... 135 ACCEPTANCE OF POLICY FORM 2011-2012............................................................................................................................ 138 ACCEPTANCE OF RT STUDENT HANDBOOK ........................................................................................................................ 138 5 INTRODUCTION TO CLINICAL COURSE GUIDE 2011-2012 The purpose of the Clinical Course Guide is to assist the student in the organization of his/her accomplishments in the clinic. This book will be accessible on-line in the RTT Clinical Internship Blackboard site. All clinical policies and documents are located in this book. Each clinical affiliate site will have a hard copy of this handbook available for your references. The student is responsible for printing out all necessary forms for use in clinical. The student is encouraged to maintain copies of all clinical documents for their personal records, including documentation of work completed and goals met during the two year clinical portion of the Radiation Therapy program. Please note: The policies identified in this guide may be amended upon written communication of such changes to students and faculty. Drafted 6/18/96 Revised 8/99, 8/00, 8/01, 7/02, 8/03, 6/04, 5/05, 8/07, 8,08, 8/09, 8/10, 8/11 6 MISSION STATEMENT SCHOOL OF MEDICAL IMAGING & THERAPEUTICS It is the mission of the School of Medical Imaging & Therapeutics: To offer high quality collaborative programs in partnership with Boston’s renowned medical institutions, and to meet societal needs for qualified and competent radiologic health professionals; To educate and train radiologic health professionals so that they are able to provide expert, reliable, and compassionate health care to their patients; To promote the development of those intellectual skills and professional attitudes and values necessary for continued learning and growth after graduation; To provide a collegial atmosphere that fosters the integration of all students in the College community. This integration promotes interaction between students from different programs, enriches their educational experience, and enhances understanding of the roles and responsibilities of different members of the health care team. 7 Program Objectives RADIATION THERAPY PROGRAM The objectives of the full-time 36-month Radiation Therapy Program within the School of Medical Imaging & Therapeutics of the MCPHS School of Health Sciences are: To prepare the graduate to work effectively in the care and treatment of patients, as a part of a radiation oncology team. To provide the graduate with sufficient command of basic scientific disciplines (anatomy, physics, and oncology) so that competence as a radiation therapist can develop and improve with increasing clinical experience. To provide a theoretical foundation for the development of sound judgment in ethical and professional conduct and decision-making. To develop the graduate’s desire and ability to use scientific procedures for the advancement of radiation therapy. To provide the graduate with an understanding of the profession of radiation therapy, and the avenues for development and growth within it. To develop recognition of continuing education as a requirement maintaining professionalism. Program Curriculum The curriculum of the three-year BS in Medical Imaging & Therapeutics with a major in Radiation Therapy program involves two phases of instruction: classroom instruction and the clinical internship. The degree to which the student's time is devoted to the internship is outlined below: First Year Classroom Instruction - During the first year of instruction students in the Radiation Therapy Program complete general education, basic science and introductory professional courses taught by MCPHS faculty. Clinical Internship - During the first year of instruction, students in the RT Program are required to complete Orientation to Radiologic Sciences, a course that teaches the student specific medical terminology vocabulary and exposes the student to the clinical radiation oncology area in a radiation oncology department within an affiliated clinical institution. The goal of this experience is to familiarize the student with clinical settings in which s(he) will complete their clinical internships during the second and third years of the RT Program. This orientation period takes place at any one of the Program’s affiliated clinical sites under the direct supervision of clinical supervisors. 8 Second Year Classroom Instruction - The second year contains a mix of basic science, introductory, and professional courses. Expert clinicians drawn from MCPHS-affiliated clinical institutions are used to teach the professional courses. Each clinician holds a position as an adjunct faculty member of the College at the academic rank of instructor, Assistant Professor or Associate Professor. Clinical Internship - The internship period during the second year of the RT Program requires each student to spend approximately 720 hours in the affiliated clinical institutions under the direct supervision of a clinical supervisor in a radiation oncology department. These hours are accumulated on a semester-by-semester basis. Third Year Classroom Instruction - All professional courses offered students during the third year of the RT Program are taught by adjunct faculty drawn from MCPHS-affiliated clinical education centers. Clinical Internship - The internship period during the third year of the RT Program requires each student to complete approximately 720 hours of experiential learning in the clinical setting under the direct supervision of a clinical supervisor. A student is assigned to a clinical site based on the judgment of the program director and the needs of the student on a semester-by-semester basis. Based upon the above information, each student should complete approximately 1440 hours of clinical internship over the period of the program. The total number of semester credits earned and required for the BS degree during the three-year period of time is 123/124. (This number of credits is contingent on math [by placement]). Admission Technical Standards The Massachusetts College of Pharmacy and Health Sciences has established the following list of technical standards for the majors of Nuclear Medicine, Radiography and Radiation Therapy. These technical standards conform to the professional technical standards required for the safe and ethical practice of the task/skills associated with clinical nuclear medicine, medical radiography and clinical radiation therapy. Each student, with reasonable accommodation, must be able to demonstrate that he/she is able to: Reach and manipulate equipment to its highest position (6 feet). Communicate in a clear and concise manner with patients of all ages, including obtaining health history and pertinent information. Read and apply appropriate instructions contained in requisitions, notes and patient charts. Transfer patients from wheelchairs and stretchers and help them on/off treatment table. Move a standard wheelchair and/or stretcher from a waiting area to a treatment area. Understand and apply clinical instructions given by department personnel. Visually monitor patients/charts/machine indicator lights in dimly lit conditions. Detect audible alarms and background sounds during procedures to ensure patient/staff safety Demonstrate manual dexterity to perform necessary manipulations such as drawing doses with a syringe, manipulating locks, putting on surgical gloves. Endure an eight-hour day with a minimum of four to six hours of standing or walking. Endure a minimum of two hours of didactic instructions in a classroom environment. 9 Radiation Therapy Majors Only: Demonstrate the ability to lift up to 30 pounds and position beam directional, immobilizing and modifying devices. Post-Baccalaureate Baccalaureate Program Prospective students who hold a baccalaureate or higher degree from a regionally accredited college or university may pursue a Medical Imaging & Therapeutics program in Nuclear Medicine Technology, Radiation Therapy or Radiography. The candidate for the Post-baccalaureate Program in the Medical Imaging & Therapeutics must have completed the following prerequisite college courses with a minimum grade of C: Anatomy and Physiology I and II with lab, College Algebra and Trigonometry (for radiation Therapy and Nuclear Medicine Technology only), Probability and Statistics (for Nuclear Medicine Technology only), (for Radiation Therapy and Nuclear Medicine Technology only), a computer course, Basic Chemistry I and II with lab (for Nuclear Medicine Technology only), 4 credits College Physics (for Nuclear Medicine and Radiation Therapy only), 3 or 4 credits calculus based general physics (MRI only), medical terminology, and Clinical Pathophysiology or equivalent (for Nuclear Medicine Technology only). Accepted MRI and radiation therapy students begin their program in the summer session; nuclear medicine and radiography students begin in the fall session. Note that effective Summer of 2011, the Radiography program will begin in the summer session. Graduates are eligible to apply for certification in their discipline through examination by the American Registry of Radiologic Technologists (ARRT) or by the Nuclear Medicine Technology Certification Board (NMTCB). Certification by the NMTCB is available only to graduates of the Nuclear Medicine Technology program. The Nuclear Medicine Technology program is accredited by the Joint Review Committee on Education in Nuclear Medicine Technology (JRCNMT). The Radiation Therapy and Radiography programs are accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT). The MRI program is recognized by the ARRT through regional accreditation. PLEASE NOTE… Eligibility for the Bachelor of Science in Medical Imaging & Therapeutics with a major in Radiation Therapy is based upon completion of all phases of education. Completion of this JRCERT-accredited program determines the student's eligibility to apply to sit for the American Registry of Radiologic Technologists examination. 10 Terminal Objectives All clinical internship courses are intended to prepare the graduate to work safely and competently as a radiation therapist. Prior to graduation, the student must demonstrate the ability to meet the following terminal objectives: Correctly interpret and implement terminology used in treatment prescriptions and take part in the localization, radiographic recording, surface markings and charting of patients Perform calculations and treatment planning arising from the prescription, and undertake the production of immobilization devices Interpret the prescription and planning instructions with regard to patient positioning, beam collimation and modifications, accessory equipment, and shielding Demonstrate appreciation of the importance of monitoring the care and well-being of the patient by: monitoring patient during application of the treatment; providing for the patient’s comfort with appropriate immobilization of the patient; communicating effectively with the patient; and continuously monitoring the control equipment Maintain accurate records of treatment, and write up the treatment record immediately after the application of the treatment. Report and record immediately, in writing, any variation from a prescribed course of treatment – in EVERY instance Be responsible (under guidance of the radiation oncologist) for: advice given to the patient regarding the treatment and its side effects; recognizing significant changes in the patient’s condition, and taking appropriate action; and for providing counsel, care and comfort to patients under great psychological stress Demonstrate safe and competent use and care of highly sophisticated and expensive equipment, including: linear accelerators; simulators and associated computer systems. Also keep patients, staff and public from electrical/mechanical/radiation, and all other, hazards Ensure consistent, satisfactory, and routine performance of equipment maintenance; be able to recognize malfunctions or defects in any/all equipment or accessory devices; take all steps possible to ensure prompt maintenance/repair of defective parts Deliver a prescribed radiation dose to a precisely defined volume Be thoroughly familiar with the physical properties of accessory materials employed in any treatment, and with the mathematic and physical principles governing beam direction devices and beam modifiers Show total familiarity with emergency procedures 11 MCPHS ACADEMIC POLICIES AND PROCEDURES Please refer to MCPHS 2011-2012 Student Handbook for the following: Academic Honesty Absence/Attendance Examination & Grading Good Academic Standing Students’ with Disabilities Immunization Requirements E-Mail Pregnancy Policy HIPAA Student Support Services 12 Clinical education is provided on a 15 week (one semester) rotational basis. RTT 203C Clinical Internship is 40 hours a week for 6 weeks (starts one week prior to summer session I). Clinical hours are typically 8-4:30 pm (MAH & MWMC are 7:30-4:00). Approximately 1360 hours of clinical experience is gained in this Radiation Therapy program. Students are expected to contact the Clinical Supervisor prior to attending the first day of clinical for introductions & confirm your assignment. Clinical Rotation Sites Baystate Medical Center D’Amour Cancer Center 3350 Main Street Springfield, MA Cathy Rousseau, Director Phone: 413-794-9338 Fax: 413-794-9754 Website: http://baystatehealth.com/Baystate I-91 Southbound: Take Exit 11. Take a sharp right off the exit and continue straight down Birnie Avenue. The D'Amour Center for Cancer Care is one block on your right. 1-91 Northbound: Take Exit 10. At the lights turn left onto Main Street. Go straight through the next set of lights. The D'Amour Center for Cancer Care is the second building on the left. Beth Israel Deaconess Medical Center (East Campus) 330 Brookline Ave. Boston, MA 02215 Linac I (617) 667-4696 Linac II (617) 667-8366 Linac III (617) 667-4670 CT-sim (617) 667-9527 conventional sim (617) 667-9529 Chief Therapist: Lyndi Heidt, R.T.(T), 617-667-3546 Website: http://www.bidmc.org/ Radiation Therapy is located in the Finard Basement. At the main entrance, bear left to use the revolving door entrance. After revolving doors, take an immediate left through sliding doors. Walk straight down hallway (past Admitting) and around bend to Finard elevator. Take to the basement. Brigham & Women’s Hospital/Dana Farber Cancer Institute 44 Binney Street Boston, MA 02115 Main number: (617)632-3591 Siemens Primus (617) 632-3236 Varian 10, Novalis TX Chief Therapist: Michelle Physic, R.T.(T). (617) 632-4122 Mphysic@lroc.harvard.edu Website: http://www.dana-farber.org/ 13 Radiation Therapy is located on level one. From main entrance, take elevator to “L2.” Follow signs to Radiation Therapy Brigham and Women’s Hospital/ Dana Farber Cancer Institute 75 Francis Street Boston, MA 02115 Main number: (617)732-6310 Chief Therapist: Todd Vivenzio, R.T.(T) tvivenzio@lroc.harvard.edu Website: http://www.brighamandwomens.org/ Radiation Therapy is located on L-2. From the main entrance, turn right at the information desk and take elevators to L-2. Turn right out of the elevators and go to the end of hallway. From the North - Head South on Route 93. Take exit 26 (Route 28/Route 3 North) toward Storrow Drive. Keep left at the fork in the ramp. Turn slight right onto Route 3 North. Merge onto Storrow Drive west. Take the Fenway/Route 1 South exit (on left). Stay in the left lane as you drive up the ramp. At lights, bear right onto Boylston Street. At third set of lights, bear left onto Brookline Avenue. At fifth set of lights, turn left onto Francis Street. The hospital is one block down on the left. From Logan Airport - Follow signs to Sumner Tunnel. At end of Sumner Tunnel, take immediate right for Storrow Drive. Stay in right lane on the ramp. Take the exit for Storrow Drive. This puts you in the left lane of merging traffic. Move into one of the two right lanes to stay on Storrow Drive. Take the Fenway/Route 1 South exit (on left). Stay in the left lane as you drive up the ramp. At lights, bear right onto Boylston Street. At third set of lights, bear left onto Brookline Avenue. At fifth set of lights, turn left onto Francis Street. The hospital is one block down on the left. From the West - head east on Massachusetts Turnpike. Take Route 128 (I-95) south for approximately one mile. Take Route 9 east for six miles. Take a left onto Brookline Avenue (Brook House Condominiums will be on right). At third set of lights, turn right onto Francis Street. The hospital is one block down on the left. ~or~ Stay on Massachusetts Turnpike east. Take Huntington Avenue/Copley Square/Prudential Center exit, and bear left toward the Prudential. Follow Huntington Avenue west for approximately three miles. Turn right onto Francis Street at Brigham Circle. From the South - Head north on Route 3 (Southeast Expressway). Take Massachusetts Avenue/Roxbury exit. At end of ramp, cross Massachusetts Avenue onto Melnea Cass Boulevard. At the 8th traffic light, take left onto Tremont Street. Take first right onto Ruggles Street. Turn left onto Huntington Avenue at intersection with Ruggles Street. At second set of lights (Brigham Circle), turn right onto Francis Street. Hospital is one block down on right. BW/DF Cancer Center @ Milford Regional Hospital 20 Prospect Street Milford, MA 01757 508-488-3800 Varian Trilogy Chief Therapist: Monica Batchelder, R.T.(T) mbatchelder@lroc.harvard.edu Website: http://www.milfordregional.org/Site/slideshow/index.cfm Cooley-Dickinson Hospital 30 Locust Street Northampton, MA. 01061 413-582-2000 Elekta Synergy Chief Therapist: Craig Hansen R.T.(T). Craig-hansen@cooley-dickinson.org Website: http://www.cooley-dickinson.org/splash.php 14 From Points North 1. Take Interstate 91 south to exit 20. When exiting off of the highway, stay in the right lane. 2. At the first light, take a right turn onto Bridge Road. 3. At the next set of lights, take a left turn onto Jackson Street. 4. At the end of Jackson Street, you will come to a stop sign. 5. Take a right and continue up the hill to the next set of lights. Be sure to stay in the left lane as you approach this intersection. 6. You will make a left turn crossing over Route 9 to enter the Cooley Dickinson Hospital campus. From Points South 1. Take Interstate 91 north to exit 19, Amherst/Northampton. 2. At the end of the ramp go straight. 3. You are now on Damon Road. At the end of Damon Road, you will come to a second set of lights. Go straight through these lights; the road becomes Bridge Road. 4. At the next set of lights, take a left turn onto Jackson Street and follow Jackson Street until you come to a stop sign. 5. At the stop sign take a right and continue up the hill to the next set of lights. Be sure to stay in the left lane as you approach this intersection. 6. You will make a left turn crossing over Route 9 to enter the Cooley Dickinson Hospital campus. From Points East and West 1. Take the Massachusetts Turnpike to exit 4, Interstate 91, North. 2. Follow the directions above, from points south. Dana Farber/Brigham and Women’s Hospital @ South Shore Hospital 101 Columbian Street at Route 18 South Weymouth, Massachusetts 02190 Varian iX main # 781-624-5000 781-624-4712 kscholl@lroc.harvard.edu Website: http://www.southshorehospital.org/cancercenter/index.html South Shore Hospital is easily accessible from Route 3. Northbound on Route 3. Take exit 16 off Route 3 on to Route 18 south (Main Street). At the third traffic light, turn left on to Columbian Street. Take the first left. Parking garage is at the end of the driveway on the right. From North Follow I-93 south to Route 3 south (Braintree/Cape Cod). Take exit 16B off Route 3 on to Route 18 south (Main Street). At the third traffic light, turn left on to Columbian Street. Take the first left. Parking garage is at the end of the driveway on the right. From West Follow the Mass Pike (I-90) to exit 14 (I-95/Route 128 south). When I-95 splits from Route 128, remain on Route 128 south (which is now also I-93 north). When I-93 north splits north, travel on to Route 3 south (Braintree/Cape Cod). Take exit 16B off Route 3 south on to Route 18 south (Main Street). At the third traffic light, turn left on to Columbian Street. Take the first left. Parking garage is at the end of the driveway on the right. From South Follow Route 3 northbound to exit 16. Travel south on Route 18 south (Main Street). At the third traffic light, turn left on to Columbian Street. Take the first left. Parking garage is at the end of the driveway on the right. Follow Route 24 north to I-93 north. Follow to Route 3 south (Braintree/Cape Cod). Take exit 16B off Route 3 on to Route 18 south (Main Street). At the third traffic light, turn left on to Columbian Street. Take the first left. Parking garage is at the end of the driveway on the right. The parking garage is for Cancer Center patients, designated South Shore Hospital physicians, and colleagues. Valet parking is available to all patients and visitors. 15 Commonwealth Atrius Cancer Center 51 Performance Drive East Weymouth, MA 02189-3141 781-682-0510 tel 781-682-0597 fax Varian iX 781-682-0528 Chief Therapist: Anna Marinilli 781-682-0566 Main # (888) 829-8252 amarinili@allianceimaging.com From the North: Take Route 3 South to Exit 16B (Route 18 South). Follow Route 18 up the hill to the first set of lights. Get into left lane and turn left onto Middle Street. Cross the highway and take your first right into Libby Industrial Park. Take first left onto Performance Drive and a right into the parking lot. Enter the building through the Entry One doors. CACC is on the first floor. From the South: Take Route 3 North to Exit 16 (Route 18). At the end of the ramp, take a left onto Route 18 South. Follow up the hill to the first set of lights. Get into left lane and turn left onto Middle Street. Cross the highway and take your first right into Libby Industrial Park. Take first left onto Performance Drive and a right into the parking lot. Enter the building through the Entry One doors. CACC is on the first floor. Lahey Clinic 41 Mall Road Burlington, MA 01805-0001 Clinac IX & Linac 2100 C (781) 744-8780 Chief Therapist: Angela Tambini, R.T.(T) Angela.tambini@lahey.org Website: http://www.lahey.org/ From Boston: Follow Storrow Drive to I 93 North, take Route 128 North to exit 33B. This exit leads onto Cambridge Street. At first set of lights turn left onto Mall Road. Lahey clinic is on the left at the third set of lights. The Radiation Oncology Department is housed separately and it is the next left after the Clinic’s main entrance. Lahey Clinic North 1 Essex Center Drive Peabody, MA. 01960 978-538-4120 Valerie Fitzpatrick, RTT Chief Therapist Valerie_fitzpatrick@lahey.org Website: http://www.lahey.org/ From Route 128 North (toward Gloucester), take Exit 25A (Route 114, Salem). Turn right on ramp Follow shopping center signs to Essex Center Drive From Route 128 South, take Exit 25B (Route 114, Middleton). Take left at second traffic light. Enter shopping center. Take first left and follow to Essex Center Drive. http://www.lahey.org/Medical/RadOncology/Index_RadOncology.asp 16 Massachusetts General / North Shore Center for Outpatient Care 102 Endicott Street Danvers, MA. 01923 (978) 882-6060 Director of Radiation Therapy: Jamie Silva, R.T.(T) 978-882-6011 jsilva1@partners.org Website: www.massgeneralnorthshore.org From Boston: 93N to exit 37A. Merge onto I95 North/MA 128 N toward Peabody. Slight left at MA-128N (signs for MA 128/Gloucester). Take exit 24 for Endicott Street. Left at Endicott St. to 102 Endicott Street MetroWest Medical Center Framingham Union Campus 115 Lincoln Street Framingham, MA 01701 Primus I & II (508) 383-1260 Clinical Manager: Melissa Stegbuchner, R.T.(T) Melissa.stegbuchner@mwmc.com Administrator: Website: http://www.mwmc.com/default From Boston: Follow Rte. 9 to Rte. 126 South, approximately 2 miles to Lincoln Street. Take a right onto Lincoln Street; Visitor Parking is approximately .5 mile on the right, directly across the street from the main hospital. The Cancer Care Center is to the left of the hospital. Enter the main entrance of the Cancer Care Center and take elevator/stairway to lower level. Commuter Rail stops in Framingham about 1/2 mile from the hospital. Mount Auburn Hospital 330 Mount Auburn Street Cambridge, MA 02238 15 MV 617-499-5665 X 5768 Clinical Supervisor: Mary McCullough, R.T.(T) (617) 499-5665 ext. 4291 mmccullo@mah.harvard.edu Website: http://www.mountauburn.caregroup.org/clinicalservices/cancer.htm Radiation Therapy is located on the ground floor of the LINAC Building. The LINAC Building is located next to the Wyman Building. Many busses and subway (red line) run to Harvard Square (#66 from Brigham Circle, #71 from Waterford Square, #73 from Waverly Square), and a bus runs from Harvard Square down Mount Auburn Street. Also an enjoyable 15 – 20 minute walk on a nice day. NorthMain Radiation Oncology (formerly Radiation Oncology Associates) 825 North Main Street Providence, RI 02904 (401)-521-9700 (Fax) 401-331-6718 Chief Therapist: Linda McKnight, R.T.(T)(R) Website: http://nmrad.com From Boston: Take 95 South to the Branch Ave. Exit. At the end of the ramp go left, crossing over 95. At the set of lights, take a left onto N.Main St. Take an immediate right into parking lot. First building at the lights. 17 Rhode Island Hospital 593 Eddy Street Providence, RI 02903 401.444.8311 (Fax) 401-444-5335 Chief Therapist: Stephanie Aschettino, R.T.(T) saschettino@lifespan.org Website: http://www.lifespan.org/partners/rih/ From Boston: Take 95 South to Exit 19. Turn right onto Eddy Street. Ambulatory Patient Care Building (APC). St. Vincent Hospital Radiation Oncology Center Vernon Hill Campus 121 Providence Street Worcester, MA 01604 main # 508-363-7100 Chief Therapist: Tim Betz Timothy.betz@st.vincenthospital.com 508-363-7099 2100CD 508-363-7746 CT Sim 508-363-5263 600C 508-363-7084 Webstie: http://www.stvincenthospital.com/Contact/facilities-directory.aspx From Boston: Rt 9 W to I95 N. Take 95 N to exit 23-24-25 I 90/MA-30 towards the Mass Pike. Take exit 11 for State 122 toward Millbury/Worcester, Left on MA-122 N/Grafton Rd., Left on Massasoit Rd., Left on Heywood St., Left on Massachusetts 122A S/Providence St. to 121 Providence St. Vernon Hill Campus, Radiation Oncology Center. South Suburban Oncology Center (SSOC) Crown Colony Park 700 Congress Street Quincy, MA. 02169 617-376-6400 (Fax) 617-471-6211 Chief Therapist: Theresa Grady, R.T.(T). tgrady@ssocpo.shields.com Administrative Director: Karen Donnellan kdonnell@ssocpo.shields.com Website: www.ssocma.com 18 From Routes 93 or 128: Take Route 3 South (towards Cape Cod) to Exit 18, about 40 yards after the split. Follow the signs for Quincy Adams T Station and Burgin Parkway that is to the left. Going under the highway, staying to the left, and proceed to the next set of lights. Turn left onto Centre Street. Take an immediate left at the set of lights onto Crown Colony Drive. Take the first right onto Congress Street. SSOC is located at 700 Congress Street which is the 4th office building on your right. Shields Radiation Oncology Center (SROC) 89 Forbes Boulevard Mansfield, MA. 02048 508-261-2000 Chief Therapist: Karen Wetterhahn, R.T.(T). karenwet@shcpo.shields.com Website: www.whroc.com From Boston: 93 South to 95 South via exit 1 toward Providence RI, 140 South to exit 7A toward Mansfield. Take Forbes Blvd ramp, slight right turn onto Forbes Blvd. to 89 Forbes Blvd. Winchester Hospital Radiation Center (WHRC) 620 Washington Street Winchester, MA. 01890 781-756-8300 Chief Therapist: Lisa Crouse, R.T.(T) 781-756-8300 site: www.srocmansfield.com From Boston: 93 North. Take the Montvale Ave exit (#36) toward Stoneham/Woburn. Turn left onto Montvale Ave. Left onto Washington Street 19 Clinical Education Goals & Evaluation Goals 1. To provide a wide range of clinical situations that will orient students to applied radiation oncology 2. To provide an adequate background for the study of radiation oncology procedures and for the development of skill in clinical practice 3. To help the students appreciate their role as a member of the treatment team 4. To develop a genuine concern for patients and the ability to respond to this concern 5. To ensure that students reach a safe level of competence in the performance of the calculations for and in the execution of all standard radiation therapy treatment prescriptions 6. To develop attitudes of self criticism and scientific inquiry 7. To develop the ability to use scientific procedures for the advancement of medical radiation therapy 8. To develop understanding of departmental and institutional expectations of the radiation therapist as an employee. Performance Evaluations Two types of evaluations (clinical evaluations and competency evaluations) will be used to determine if clinical performance is satisfactory by the midpoint and end of semester rotation. Clinical Evaluations - Evaluation of achievement of performance and conduct objectives is completed by the clinical supervisor at the completion of each rotation. The purpose of the clinical evaluation is to assess the student's professional conduct and overall performance in patient care and technical skill. During the last week of each clinical rotation the student must have the clinical supervisor(s) complete the appropriate clinical evaluation form. Have a clinical supervisor initial the date they received the form from you. This completed evaluation must be received by the Program Director by 4:00 pm on the last day of that rotation. Competency Evaluations - These evaluations are progressive tests of clinical achievement and are completed by the clinical supervisor. The purpose of the competency evaluation is to assess specific technical skills. It is each student’s responsibility to request time with the clinical supervisor and machine time to perform specific clinical competencies. This time must be convenient for the clinical staff and patient care delivery, and should be scheduled at least 3 days in advance and cannot be left until the day of the rotation. 20 Recompetencies: In addition to the number of treatment competencies each clinical rotation, formal recompetencies will begin in the third year (second clinical year): RTT 304C seven recomps due, & RTT 305C seven recomps due. The student will be required to provide documentation of 14 recompetency procedures out of the required 22 treatment competency procedure required. No more than 7 recompetencies per clinical internship will be accepted and the student is not allowed to “bank” extra recompetency procedures. Clinical Internship Rules Program rules and regulations have been established to provide the student radiation therapist with a realistic guideline for professional behavior development. Rules and regulations are consistent with expectations made of practicing radiation therapists, both as professional members of the health care and treatment team, and as employees of an institution. The professional portion of the Radiation Therapy Program educates and guides the student toward development and implementation of the knowledge, skills and attitudes necessary for assuming the responsibilities of a practicing radiation therapist. The scheduling of clinical assignments will be determined at the discretion of the Clinical Coordinator. Infection Control Policies Students with an infectious illness must notify the Clinical Coordinator, the Program Director, and the assigned clinical supervisor at their clinical assignment that they will be absent. Students are reminded of the compromised status of their patients’ health and immune systems, and should not impose a health hazard on others. Sickness Policy Interns are required to follow the below guidelines regarding sickness. If an intern presents with the following conditions, the Clinical Supervisor may use discretion to send the intern home, or accept the intern into the clinical setting based on the examples below. General Illnesses Fever Too Sick for Clinical Attendance · No patient care until fever is gone. Skin Conditions Hand dermatitis Too Sick for Clinical Attendance · Skin is cracked and bleeding at any time prior to, during or after work shift. · Wound is located on the hands or face and is draining or not healed over, and duties involve patient contact. · Wound is located under clothing but dressings are saturated by the end of the shift and duties involve patient contact. · Generalized rash with an unknown cause. · Small blisters located on hands and face or a large area on body trunk. · Rash appears like tiny broken blood vessels or bruises with mild fever. · Rash has spots or pimples and is accompanied by a fever. · Lesion is located on hands. Open wounds Rash Herpes simplex 21 (cold sores) · Lesions are open and draining. · Lesions are located on face and duties include patient contact in high risk areas. Burns · Burn is located on the face or hands and area is weeping or blistered. Pediculosis (lice) · No work until confirmed that transmission is not possible following appropriate treatment. Impetigo Conjunctivitis · No work until medical treatment started. · No skin to skin contact until resolved. · Excessive tearing with discharge, sensitivity to light, itching, redness, or swelling. No work until discharge/drainage ceases. Upper Respiratory Symptoms Too Sick for Clinical Attendance Cough · Accompanied by a fever. · Has a >2 week duration and accompanied by night sweats, fever, weight loss, hemoptysis or a positive PPD (tuberculosis test). · Severe or persistent coughing spells. Sore throat · Accompanied by fever, white spots on tonsils, swollen glands or skin rash. Strep throat · Following a positive throat culture, need 24 hours of medication and feeling better clinically. Nasal congestion · Nasal secretions are so persistent that hands can not be washed after each tissue use. · Accompanied by a fever, sinus pain and colored discharge. Diphtheria · No work until antimicrobial therapy completed and two cultures at least 24 hours apart are negative. Influenza · Combination of muscle aches, sore throat, cough, mild cough, runny nose, headache, light sensitivity or intestinal symptoms. Upper Respiratory Infection · Requires staying home until symptoms are resolved to prevent spread of disease to immunocompromised patients. Pertussis (Whooping Cough) · Requires staying home and being on medication for 24-48 hours. · May return to clinical assignment with medical permission. Gastrointestinal Symptoms Nausea Vomiting Too Sick for Clinical Attendance · Present with yellowing of the skin or eyes. · Accompanied with other general complaints (e.g. headache, fever, fatigue or yellowing of skin) · Difficulty maintaining hygiene practices or sanitary conditions. · Accompanied by other intestinal symptoms (e.g. increase flatus, nausea, vomiting or other unusual stool characteristics). 22 Diarrhea Convalescent Salmonella · Difficulty in maintaining hygiene practices or sanitary conditions. · An increased number of bowel movements with an acute onset due to an unknown cause (3 loose stools in 24 hour time period). · Accompanied by a fever, headache, or fatigue. · Accompanied by other intestinal symptoms. · No work with high risk, immunocompromised patients until documentation of 2 consecutive negative stool cultures, 24 hours apart. Impairment Too Sick for Clinical Attendance Narcotics If an intern is on narcotic prescription drugs, the intern will not be allowed to participate in clinical activities due to the potential side effects & altered mental status. Intern will not be allowed to return to clinical without medical clearance from a physician & safety concerns are eliminated. Clinical Make-Up Time Students may not be required to do make-ups for lost clinical days on the college's official days off, holidays, or during the exam period. Students will be allowed to attend clinical for make-up hours on the college’s unofficial days off, holidays, or during the exam period if they chose to do so. Faculty may "schedule in" an extra clinical as a make-up during each semester or may require students to complete make-ups after the exam period each semester. Clinical proficiency is based on clinical experience and clinical hours. All unexcused and excused clinical time will need to be made up prior to the end of the semester. Revised 8/10 Snow Policy In the event of school closing due to inclement weather, the student will not be required to attend clinical. The student may use this day as an opportunity to make up clinical hours. Students are required to make up missed clinical days. Clinical proficiency is based on clinical experience and clinical hours. All unexcused and excused clinical time will need to be made up prior to the end of the semester. Revised 8/10 Continuing Education Requirements All students are required to obtain 10 Category A or B continuing education credits in the three final semesters of the second year of the clinical rotations. Please ask the clinical supervisor in your clinical setting when the continuing education conferences are held, and if you may attend. The American Society of Radiologic Technologists offer CEU credits in its publications and on line. The Massachusetts Society of Radiologic Technologists & the New England Society of Radiation Therapists offer several conferences per year. The student must keep documentation and certificates of attendance to be presented upon completion of the clinical internship program. 8/07, Revised 8/10 Clinical Travel & Transportation In order to provide students with exposure to a broad range of patients in a wide variety of practice settings, travel beyond the metropolitan Boston/Massachusetts area may be required. As the program 23 continues to grow and recruit even more clinical sites in both hospital-based and free standing settings, this perimeter could easily expand. The student will be held responsible for transportation to and from all assigned clinical sites and any costs incurred, regardless of their location. In addition, as a general rule, the student is also responsible for any expenses incurred while rotating at the clinical site including food, parking, and any other incidentals. New affiliated clinical sites are added based on program growth and list of clinical affiliates are subject to change at the discretion of program faculty. Revised 8/10, Reviewed 8/11 Bereavement In the event of the death of an immediate family member, an appropriate duration of absence will be determined in consultation with the Program Director. (Usually 3 days). Students are required to make up missed clinical days. Revised 8/09, Reviewed 8/10 "Immediate family" includes a spouse, child, parent, grandparent, brother, sister, son-in-law, daughter-in-law, spouse's parent, and/or a person living within the student's household. Days missed due to an extended absence, or absence for a non-immediate family member, must be made up. Outside Employment This is not to affect attendance or achievement of educational objectives. Students who are employed in a radiation therapy department that is affiliated with the college may be excluded from that site as a clinical rotation at the discretion of the Clinical Coordinator & the Program Director. Students must report to the Clinical Coordinator & the Program Director when they are hired by a designated Clinical Affiliate. Revised 3/04, 8/07, Reviewed 8/10 Dress Code All students must be professionally dressed while in the clinical area. Overall appearance and attire should not be distracting to others (co-workers, patients, visitors, etc.). The following is considered proper dress: Slacks: Clean, neat and pressed. Jeans (or any other color of denim), scrubs or knit pants are not permitted. White Lab Coat: Student issued MCPHS lab coat must be worn at all times, along with MCPHS nametag and film badge. The MCPHS embossed lab is the standard lab coat and will be required of all students, all other lab coats will not be allowed. Shoes: Polished dark-solid colored leather shoes or clogs with heel straps which are neat and clean in appearance are permitted. (Sneakers, sandals, open-toed shoes, strapless clogs, and high heels are not permitted.) Hair: All styles must be kept neat and clean; hair longer than shoulder length must be tied back. 24 Earrings: Small styles only, since large hoops or dangling earrings can get caught on the equipment or pulled on by unsteady patients. Ear stretchers are not allowed and the opening should be covered. No visible tattoos: Visible tattoos must be covered while in clinical, in clinical labs and on clinical site property while attending clinical. No visible body piercing: (nose, lip, belly etc.) Revised 1/04,6/05, 4/10, 8/10, 8/11 Body Piercing: "No other visible piercings are permitted in the clinical setting" Shirts: Should be clean & pressed. No logo shirts, sports shirts or low cut shirts are permitted. Jewelry: Watches and rings are permissible. Costume jewelry is not permitted because it can fall on patients or get caught on equipment. Female Students Skirts must be of reasonable length (not distracting). Slacks should be full-length (no cropped/ capri pants). Colored tops may be paired with slacks or a skirt as long as a lab coat is worn. (No sweatshirts or printed T-shirts). No V-neck shirts or low cut blouses allowed. Stockings/hose should be worn in the clinic at all times. Nail polish permitted in subdued shades only, no chipped nail polish permitted. Nail length should be kept to 1/4", and no acrylic nails allowed for infection control purposes. Male Students Button-down Shirts are required and should be neat, clean and pressed. Ties must be worn at all times. T-shirts are not permitted. Polished dark-solid colored leather shoes may be worn. (Sneakers, sandals, open-toed shoes, strapless clogs are not permitted.) Facial Hair must be kept clean and neatly trimmed. A student, who chooses to grow a beard /moustache/sideburns, etc., should initiate this over a vacation to avoid appearing unkempt in the clinic. "It is mandatory that a professional appearance be maintained! If a student is found to be non-compliant with the dress code, the student will be immediately suspended from clinical assignment. Time lost will need to be made up after conferring with Program Director and Clinical Supervisor." Revised 8/07, 6/08, 8/10,11/10, 8/11 Miscellaneous 25 Students should refrain from chewing gum or eating, unless they are in the lounge or cafeteria areas. Eating or drinking in the clinical area is not permitted. Newspapers, magazines and non-textbooks are not to be taken in to the clinical area. Students are expected to utilize any “down-time” by reviewing patient records, reviewing films, or assisting other radiation therapy teams. Students are not allowed to study for their didactic courses while at clinical unless on a designated break or approved by the radiation therapy team. All cell phones are to be turned off while in clinical and not carried in your clothing or lab coat. You may keep your cell phone in your bag and check it during the lunch break. Revised 8/11 Procedures in the Event of Injury Departmental policies are to be followed at all times in the clinical sites. These policies are written to protect the safety of patients and employees. In the event a student is injured while in a radiation oncology department, the student should observe the following procedures: Notify supervising therapist of the injury, and of the circumstances under which the injury occurred. Also report the injury to the Clinical Coordinator & the Program Director verbally as soon as possible, and in written form utilizing the MCPHS Clinical Incident Report Form. Complete a departmental incident report form for the clinical site in which you are assigned, give a copy of the report to the Clinical Coordinator & the Program Director, and keep a copy for your records. PLEASE NOTE: There are separate Incident Report Forms that will need to be completed for both MCPHS and the clinical sites. If medical attention is required, go to the emergency room at the hospital to which you are assigned for internship. The student is responsible for all costs incurred in the emergency room. (It may be helpful to take a copy of your insurance information with you to the ER.) "NEEDLE STICKS ARE NEVER MINOR”. These must be brought to the attention of your supervising therapist immediately, and an emergency room visit must be made within 24 hours of the injury. Do NOT dismiss a needle stick as unimportant; prompt action should be taken." Ethics And Professional Conduct Ethics (by definition): A pattern of conduct demonstrating adherence to the values and attitudes established to benefit professionals and their relationships with patients, families of patients, coworkers and other medical personnel. Altruism, confidentiality, personal integrity, professional demeanor, attitude and appearance are attributes deemed essential to functioning effectively in the clinical setting. The student is expected to behave in a way that is truthful and honest, accepting responsibility for his/her own actions, and working diligently to correct identified deficiencies. Any behavior or attitudes that call into question the student’s potential capabilities to perform as a radiation therapist will be reviewed and addressed accordingly. Students will be evaluated on their performance in the areas of medical ethics and professional conduct. The main concepts to be addressed include courtesy, respect, integrity, and common sense. 26 As students of the MCPHS Radiation Therapy Program, you will be studying subject areas and learning skills essential to the competent practice of Radiation Therapy. Through your behavior you will also be required to demonstrate an awareness of, and commitment to meeting, the ethical standards integral to the professional practice of a radiation therapist. Whether inside or outside of the hospital, your behavior reflects your level of commitment to professionalism and quality patient care. The development of an ethical, professional demeanor is a critical component of your education. Satisfactory performance in the classroom and technical skills alone is NOT sufficient to ensure continued enrollment in the program. Intrinsic to each individual are attitudes, feelings and beliefs, which motivate behavior. It is only through your words and actions that another person can assess the value and respect that you hold for the radiation therapy profession. As students, your ethical and professional conduct will be evaluated by your actions, and how closely these actions approximate accepted value-oriented behavior. (To help clarify this concept, think about the word dependable. Traits of a dependable individual include punctuality and reliability. For example, a dependable person arrives on time, and does not leave his/her assigned station.) 27 Mission Statement The Radiation Therapy Program provides a high-quality, student learner-centered environment. Students receive state-ofthe-art didactic and clinical experiences enabling them to become competent entry-level professionals in the radiologic sciences. Radiation Therapy Program Goals 1. Program graduates will be competent and qualified entry level radiation therapists. 2. Program graduates will possess necessary skills to effectively communicate. 3. Program graduates apply critical thinking skills required of an entry-level radiation therapist. 4. Program graduates will demonstrate professional and ethical behavior. Various groups of people will witness your professional development. The following list exemplifies several ways that professionalism may manifest. Students should peruse this list to gain insight into commonly accepted practices of professional behavior. 28 Value(s): Efficiency and Competency Behaviors observed by patients: Caring Professional appearance; good hygiene; good posture Attentive expression Proper use of language; avoid slang or profanity Composure (If you feel anxious/unsure, excuse yourself and get assistance. Do not, however, leave patients in your care alone.) Efficient and self-confident movements/body language Explain procedures as you perform them (This reassures patients that you are alert to their needs.) Procedures should be performed in a timely manner, so not to compromise the patients comfort. Use of proper names and titles (Mr./Ms./Dr., etc.) until the patient expresses a desire to be addressed differently. Introduction of any personnel that the patient has not already met Eye contact- actively seek & maintain it when caring for patients Behaviors observed by supervising radiation therapists: Role Responsibility Punctuality and reliable attendance Follow through with assigned tasks on time as per schedule Introduce yourself to all patients & family members Respect the knowledge of therapists and staff Thoroughly understand your role within the department (both the responsibilities & limitations thereof) Honesty & integrity in documentation Revised 03/05, 8/06, 8/09 Self-Direction in Learning Attentiveness to instruction Asking pertinent questions Individual research for solutions to problems (Don’t ask others for all the answers—instead ask for suggestions on research materials.) Teamwork Knowledge of expected duties Performance of duties without constant reminders Recognizing when others need assistance and assisting in other areas—ONLY when it is appropriate to leave your assignment (And obtaining permission prior to leaving an assigned area.) Be courteous and respectful to all team members Effective time management skills (e.g., utilizing a slow period to research clinical topics/read charts/assist others, etc.) Return from all breaks promptly as scheduled Do not leave the treatment area in the middle of a patient procedure 29 Value(s): Do not leave the treatment area or department without notifying the therapist or clinical supervisor Also see Role Responsibility Academic Behaviors: Role Responsibility Self-Directed Learning Confidentiality Competence Prompt, thorough and neat completion of assignments Attendance of classes, labs & other scheduled activities Neat appearance & compliance with dress code (Remember that like patients, instructors are impacted by your appearance Not discussing the patient’s disease with the patient Listen to the patient but not confirming or denying any comments the patient makes of their health Refer the patient and/or family to the radiation oncologist, if the patient and/or family requests additional information Treat patients & their families with the utmost respect & courtesy Integration and application of knowledge (Applying learned material from various courses/clinical experiences to the problem at hand. Application of didactic concepts to your own behavior.) Professional representation of the Radiation Therapy profession (and health care in general) Never divulging patient information to anyone outside of the patient’s healthcare team Avoidance of gossip (by self or others); never discussing negative impressions of patients/peers/physicians, etc. Avoidance of gossip about other therapists or clinical affiliates Remove or obstruct any patient identification on copied patient records. Follow HIPAA Guidelines (see Clinical Coordinator or Frances Keech) Revised 3/04 Keeping patient & departmental information in the Radiation Oncology Department confidential. Confidentiality must be maintained at all times Maintain patient safety. Maintain universal precautions Follow all Doctors orders and treatment prescriptions designated in the patient record. Often measured by education/intelligence in our society Participation in continued education Achievement in maintenance of certification and licensure 30 Professionalism Active involvement in professional societies. All instruction from the physicians need to be recorded and dated. When questions arise, check with the assigned clinical supervisor. Working under supervision at all times. Maintain professional demeanor at all times. Never speak or behave unprofessionally in the presence of patients, their family members, or any member of the radiation therapy team; which includes therapists, physicians, physicists, dosimetrists, nurses, and support personnel. ** The above listed guidelines do not represent an exhaustive list of professional values and associated behaviors. Professionalism as a goal requires good judgment and consistent effort, throughout your education and subsequent career. Reviewed 8/10 Professional Relationships It is essential that students behave professionally when in the clinical setting. Equally important is the maintenance of professional relationships with patients, physicians, co-workers and other medical staff. Students should observe the following guidelines when in a clinic: Grading Clinical grades will be given at the end of each semester and will be part of the students Quality Point Average and their Professional Quality Point Average. Clinical grades will be based on the student meeting specific radiation therapy internship goals and objectives, successfully completing specific clinical competency evaluations for each internship rotation, and on the evaluation of the student’s overall professional standards by the Clinical Supervisor, the Clinical Coordinator, & the Program Director in the areas of: attendance, communication, professionalism, technical skills, cognitive ability, knowledge assessments, oral competencies, industry, attitude, interpersonal interactions, professional judgment & rules and regulations. See the Supervisor Evaluation of Clinical Skills Form. Assessment of Student Competency To pass this course, students are required to achieve a final minimum grade of C (2.0). Obtaining a score of less than a 75% will result in a student’s having to repeat the course, and not being allowed to progress to the next clinical internship. Students should be aware, however, that receiving a grade of less than B (3.0), may jeopardize their professional GPA of a required 2.5, which could also jeopardize progression in the program. 31 The numerical distribution and corresponding letter grade is listed below: 93-100 92-90 89-87 86-83 82-80 79-77 76-75 74-70 69-64 63-60 A AB+ B BC+ C CD F 4.0 3.7 3.3 3.0 2.7 2.3 2.0 1.7 1.0 0.0 Revised 8/10 Retention & Dismissal Policy for the RTT Internship Clinical Probation Removal from a clinical assignment can occur anytime during the rotational period for any of the following reasons but not limited to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Failure to perform clinical tasks with direct supervision Lack of professional ethics and/or conduct Lack of cooperation Inability to accept his/her role as a student Negative attitude toward patients and/or staff Refusal to comply with the professional appearance codes Creating disruptions in the clinical area Failure to satisfactorily complete performance, including competency, evaluations Failure to comply with Program or Affiliate rules and regulations Approaching a clinical staff member with the purpose of debating a grade or evaluation, or in any confrontational manner Falsifying actions, findings, or documentation in clinical settings Presenting fictional patient cases as real or falsely presenting pieces of real patient cases in a single composite case Failure to maintain visual contact with patient and physical contact with console while running the beam Failure to complete clinical objectives in the designated clinical rotation timeline A student removed from a clinical assignment for any of the above will be provided written notification of the cause for removal along with a recommendation to the Academic Standing Committee (ASC) of the College that he or she be placed on Academic Probation. The recommended conditions of the probation will also be transmitted to the Academic Standing Committee in writing with a copy to the student. This notification will be co-signed by the student and the Program Director and placed on file. If the terms of the probation are not met in the specified time, a recommendation for dismissal will be made to the ACS. Revised 8/09, 6/11, 8/11 32 Re-Entry Policy Policy for Content Validation after Non-Progression or Leave of Absence Students who have not been continuously attending courses for a period of one semester or more from an undergraduate SON/SMIT professional course, or who withdraw from a SON/ SMIT program via leave of absence, must validate previous knowledge and skills held prior to program exit before they may reenroll in SON/ SMIT clinical professional courses. Reenrollment is subject to clinical placement availability (Note: there is no guarantee that space will be available at the desired time of return of the student; it may take up to two years for reentry due to lack of clinical placement availability). This policy applies to all undergraduate SON/ SMIT programs. The validation will occur via students’ demonstration of knowledge and skills, i.e., meeting established program clinical competencies, in a selected clinical facility or simulation laboratory. This requires that students notify the program director of desired date of return a minimum of 30 days prior to anticipated return to make arrangements for preparing and performing validation testing. Program faculty will provide guidance as to what content and skills (competencies) need to be reviewed by students prior to the testing, but it is the students’ responsibility to prepare for the validation testing. Students attempting to return from a leave of absence must also have been cleared to return to classes by designated staff in the Academic Resource Center and the Dean of Students (if a medical leave of absence) prior to performing validation testing. The Academic Resource Center will notify the Dean of Nursing/Dean of Radiologic Sciences when the student is eligible to take the validation test. Validation of knowledge will consist of a competency examination. A minimum grade of C on the competency examination is required. Program faculty will determine the content and skills to be included in the validation test. If a student fails the validation test, he/she must enroll in a one-semester Directed Study to remediate prior to reentering the program. This will delay the student’s reentry for at least one semester but likely for one year (or more if there is no clinical space available). The number of semester credits assigned to the Directed Study course will vary (1-3 semester credits) depending upon the number of semesters successfully completed in the program. If the student completed 2 or fewer semesters, one credit will be assigned; if 3-4 semesters, 2 credits; and if more than 4 semesters, 3 credits). Students may take general education courses concurrently with the Directed Study, but may not take any program professional courses until the directed study has been successfully completed. If a student does not pass the Directed Study with a minimum of C on the first attempt, he/she will be dismissed from their respective program. Reviewed 8/10, Revised 8/11 Grievances The Clinical Internship Grievance policy enables students to work with program faculty to resolve problems that may arise at their clinical internship site in a fair and unbiased manner. If a student has a grievance regarding decisions made during the clinical internship an appeal may be made within ten days of the occurrence as outlined below. PROCEDURE The student should first make every effort to resolve the problem/situation through open communication with the Clinical Instructor. 1. If the student is not satisfied the situation has been resolved he/she should present the problem in writing to the Radiation Therapy Clinical Coordinator at MCPHS within three days. 33 2. If the student is not satisfied the situation has been resolved he/she should present the problem in writing to the Radiation Therapy Program Director at MCPHS within three days. 3. After investigating the situation the Radiation Therapy Program Director will respond to the student in writing, within ten days of receiving the student’s original letter. 4. If the student is not satisfied with the Radiation Therapy Program Director’s resolution/response then he/she should present the problem, in writing to the Dean, School of Radiologic Sciences within five days. 5. The Dean, SRS then has ten days to request additional information and must respond to the student’s grievance within 20 days of receiving the student’s original letter. 6. The decision of the Dean, School of Radiologic Sciences is final. 7. If the complaining party has exhausted all College channels for resolution of a program-related problem that represents non-compliance with Accreditation Standards, the student should contact the JRCERT at: Joint Review Committee on Education in Radiologic Technology 20 N. Wacker Drive, Suite 900 Chicago, IL 60606-02901 Phone: (312) 704-5300 e-mail: mail@jrcert.org fax (312) 704-5304 The student may choose to cancel the grievance procedure at any point in the process by notifying the appropriate person, i.e. the Radiation Therapy Program Director, Dean for the School of Health Sciences or the Dean of Students in writing that he/she wishes to cancel the grievance process. Revised 1/04, Reviewed 8/07, 8/09, Reviewed 8/10 Clinical Procedure Lab Practical Description The Clinical Procedure Lab Practical is designed to supplement the Clinical Internship experience. Clinical labs are additional practice sessions designed to complement the skills obtained during the clinical internships & are conducted by licensed radiation therapists staff members. Students will be expected to integrate information learned in the clinical setting and didactic classes at the College with the lab practical procedures. Each treatment procedure learned in the clinical setting will be reviewed and broken down in the Clinical Procedure Lab Practical. Students will be expected to read all related material, review treatment port films/DRRs, and review patient records prior to attending each lab. The lab offers the student an opportunity to learn in a setting without the patient present and is conducted by program adjunct faculty. Labs are scheduled when the treatment units are available The student will be required to complete a clinical lab survey no later than 48 hours after attending each clinical lab. 8/07, Reviewed 8/10 Student Responsibilities and Limits of Responsibility It is the responsibility of the RTT student to: 1. Maintain level of required direct supervision by a registered RTT. Working within your scope as a student and not completing any treatment procedures unsupervised. 34 2. Check prescription daily in the treatment record and conduct a “Time-out” procedure & correct patient identification according to MCPHS program policy. 3. Avoid discussing the health of the patients with the patients themselves. 4. Avoid administering treatments unless specific instructions are given by the radiation oncologist. 5. Keep complete and accurate records of all treatments carried out in the Radiation Oncology Department. 6. Keep complete and accurate records of all clinical documentation. Falsifying documentation may lead to disciplinary action. 7. Do nothing when in doubt about what action to take. When uncertain, question the appropriate staff member, and do not proceed until the orders/set-up has been clarified. 8. Report ALL mistakes to the Therapist Manager immediately. 9. Report any injuries that occur on duty to the Clinical Supervisor, Clinical Coordinator, and the Program Director. 10. Complete an incident report according to policy when involved/witnessing a clinical incident. 11. Have initials in charts co-signed by a therapist. It is the responsibility of the student completing the chart to assure this is done before the chart is filed. 12. Not accept gratuities or "Tips" (monetary compensation) from patients or patient's families. 13. Exercise honesty and integrity in all interactions. 14. Use proper English at all times (absolutely no profanity). 15. Use tact, not temper, when dealing with patients, their families, co-workers, physicians and other medical personnel. 16. Realize that the clinical area is not a place for “goofing off,” gossiping, giggling, etc. The care and comfort of the patient should always be the first priority! 17. Maintain professional relationships at all times with clinical staff and patients. 18. Anticipate the next step in the clinical setting, i.e. identifying patients that are cued in, setting up the treatment room, reviewing the patient record for any daily changes. 19. Make yourself available to clean up the treatment room & equipment, restock the linen, and ask the staff if there are any unfinished tasks to complete 20. Escort patient to their OTV visits, to and from the treatment room or any other department as requested by the staff. 21. Research & study only clinical related information during down time (after all other clinical tasks have been achieved), non RTT class work should not be reviewed during the clinical day. 22. All cell phones are to be turned off while in clinical and not carried in your clothing or lab coat. You may keep your cell phone in your bag and check it during the lunch break. 23. Follow all policies and procedures of the RTT program as outlined in the RTT clinical handbook. 24. Report any abnormal circumstances to the assigned clinical supervisor or radiation oncologist. Revised 8/09, 8/10, 8/11 A copy of the Code of Ethics for Radiologic Technologists is included in this course guide. Familiarize yourself with it, and refer to it as a guide to proper ethical conduct in the Radiation Oncology Department. American Society of Radiologic Technologists CODE OF ETHICS This code shall serve as a guide by which Radiologic Technologists may evaluate their professional conduct as it relates to patients, colleagues, other members of the medical care team, health care consumers and employers. The Code is intended to assist radiologic technologists in maintaining a high level of ethical conduct. 1. The Radiologic Technologist conducts himself/herself in a professional manner, responds to patient needs and supports colleagues and associates in providing quality patient care. 2. The Radiologic Technologist acts to advance the principle objective of the profession to 35 provide services to humanity with full respect for the dignity of mankind. 3. The Radiologic Technologist delivers patient care and service unrestricted by the concerns of personal attributes or the nature of the disease or illness, and without discrimination regardless of sex, race, creed, religion or socioeconomic status. 4. The Radiologic Technologist practices technology founded upon theoretical knowledge and concepts, utilizes equipment and accessories consistent with the purpose for which they have been designed, and employs procedures and techniques appropriately. 5. The Radiologic Technologist assesses situations, exercises care, discretion and judgment, assumes responsibility for professional decisions and acts in the best interest of the patient. 6. The Radiologic Technologist acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment management of the patient, and recognizes that the interpretation and diagnosis are outside the scope of practice of the profession. 7. The Radiologic Technologist utilizes equipment and accessories, employs techniques and procedures, performs services in accordance with an accepted standard of practice, and demonstrates expertise in limiting the radiation exposure to the patient, self and other members of the health care team. 8. The Radiologic Technologist practices ethical conduct appropriate to the profession, and protects the patient's right to quality radiologic care. 9. The Radiologic Technologist respects confidences entrusted in the course of professional practice, respects the patient's right to privacy, and reveals confidential information only as required by law or to protect the welfare of the individual or the community. 10. The Radiologic Technologist continually strives to improve knowledge and skills by participating in educational and professional activities, sharing knowledge with colleagues and investigating new and innovative aspects of professional practice. One means available to improve knowledge and skill is through professional continuing education. CODE OF ETHICS OF RADIATION THERAPISTS The radiation therapist advances the principle objective of the profession to provide services to humanity with full respect for the dignity of mankind.The radiation therapist delivers patient care and service unrestricted by concerns of personal attributes or the nature of the disease or illness, and nondiscriminatory with respect to race, color, creed, sex, age, disability or national origin. The radiation therapist assesses situations; exercises care, discretion and judgment; assumes responsibility for professional decisions; and acts in the best interest of the patient. The radiation therapist adheres to the tenets and domains of the Scope of Practice for Radiation Therapists. 36 The radiation therapist actively engages in lifelong learning to maintain, improve and enhance professional competence and knowledge. General Rules for Completion of Competencies By the end of the first week’s rotation (where applicable) each student will be required to fill out an Intent Form and give a copy to the clinical supervisor that they will be working with and a copy to the Clinical Coordinator & Program Director. A knowledge assessment form must be filled out and given to the clinical supervisor assessing the log-in procedure. Each student is responsible for scheduling time with the clinical supervisors (radiation therapists) to complete their log-in procedures. This should be done after the student has studied and practiced the technique and is able to perform it independently (under staff supervision). The procedure must be performed with 100% accuracy to be counted as a log-in. Immediately following successful completion of a log-in the observing clinical supervisor should co-sign the student’s Log-In Record Book. Before evaluation of any technique, the 2nd Year Student must log-in three set-ups of the same technique (preferably not all on the same patient). The 3rd Year student will be required to log in once before a treatment competency evaluation. The student is then again responsible for scheduling time with a clinical supervisor to perform the specific competency. Satisfactory completion of the competency will include performance of technique with 100% accuracy. Satisfactory demonstration of theoretical comprehension using critical thinking & problem solving skills shall be accomplished through an oral assessment. A comprehensive list of topics for selection during the oral section is included in this section. Revised 6/4, Reviewed 8/11 All competency requirements must be completed for program completion date. Fifteen of the twenty Radiation Therapy Procedures must be demonstrated on patients. Five Radiation Therapy Procedures may be completed under simulated conditions. Seven Simulation Procedures are required. All Simulation Procedures must be demonstrated on patients. **Students are responsible for the maintenance of clinical skills throughout the program. The student enrolled in any clinical internship course must complete all objectives assigned to them for that particular semester or session (see Radiation Therapy Student Handbook/Clinical Course Guide). This policy will be strictly adhered to with the exception of the following instances: Extended Machine Shutdown Personal Emergency Assignment to a Machine that does not fulfill required Competencies needed (in the event of this situation, notify clinical supervisor and /or Program Director). Any Substantiated Situation as approved by the Program Director that prevents you from completion of Clinical Objectives Failure to complete competencies in a timely manner will result in a failure for clinical internship course. 37 Revised 8/04, Reviewed 8/07, 8/11 Direct Supervision Policy As student members of the treatment team, radiation therapy students must follow MCPHS RTT program rules for direct supervision as outlined by the Joint Review Committee on Education in Radiologic Technology (JRCERT). All radiation therapy procedures are performed under direct supervision of a qualified practitioner. Students are never to administer radiation without the direct supervision/approval of a registered, licensed radiation therapist and will be supervised in and out of the treatment room at all times. Radiation therapy procedures requiring direct supervision include brachytherapy, simulation, and treatment. The JRCERT defines direct supervision as 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 knowledge; is present during the conduct of the procedure; and reviews and approves the procedure. JRCERT.org 8.4 12/09 Reviewed 8/11 38 Time Out Policy RIGHT PATIENT – RIGHT PROCEDURE Policy The MCPHS Radiation Therapy program “Time-Out” policy follows the National Patient Safety Goals of The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). All MCPHS students must be supervised by a registered, licensed Radiation Therapist while working with patients in the clinical setting. The purpose of this policy is to establish a safe, accurate, and consistent identification process for verifying the right patient & right procedure in the radiation therapy clinical setting. Procedure 1. 2. 3. 4. 5. 6. 7. 8. 9. This procedure applies to all MCPHS radiation therapy students while working in a clinical educational setting. The student will identify the correct patient by asking their name, & date of birth and/or following the identification policy of the clinical institution (verify digital face photo, scan patient demographic identification card, verify this information from the e-chart navigator page in IMPAC). The Time Out procedure will be completed daily for each patient before initiation of treatment. Students who are at the treatment unit console must do a “Time-out” prior to running the beam. This procedure ensures that you have identified the correct patient, consent, prescription, dose/mu, treatment field, & beam energy prior to the start of treatment for each treatment field. The student is prohibited from turning on the beam without first completing a verbal time-out including the above parameters The student is prohibited from turning on the beam without verifying permission from a registered, licensed Radiation Therapist to beam on. It is the responsibility of the student to ensure that the therapist is standing next to the student within site of the console and monitor while the beam is running. If the clinical staff are not verbally doing a time-out check they will still be expected to have the student verbalize all parameters of the time-out policy/right patient right procedure policy. Clinical Competency Schedule 2011-2012 RTT 201 C 14 weeks T & TH 2 Treatment Competencies 3 Log Ins per Competency 1 Patient Care Rotation 4 simulation observations Daily Conference Attendance 2 X per week Patient Care Assignment Warm-up Observation RTT 202 C 14 weeks T & TH 5 Treatment Competencies 3 Log Ins per Competency Daily Conference Attendance 2 X per week Patient Care Assignment 4 simulation observations Warm-up Observation 39 RTT 203 C 6 weeks M-F (2 weeks sim, 4 weeks tx unit) 5 Treatment Competencies 3 Log Ins per Competency 1 Simulation Procedure (cannot be on phantoms) Minimum 3 X week Conference Attendance Warm ups RTT 304 C 14 weeks M, W,F (10 weeks tx. unit, 4 weeks sim) 5 Treatment Competencies 1 Log In per Competency 3 Simulation Procedures (cannot be on phantoms) 7 Recompetencies Dosimetry Lab (non clinical hours) Daily Conference Attendance Warm ups RTT 305 C 14 weeks M, W,F (10 weeks tx unit, 4 weeks sim) 5 Treatment Competencies 1 Log In per Competency 3 Simulation Procedures (cannot be on phantoms) 7 Recompetencies Dosimetry Lab (non clinical hours) Mould Room Rotation Brachytherapy Rotation Warm ups Daily Conference Attendance Revised 8/11 40 CLINICAL POLICIES & FORMS 41 Massachusetts College of Pharmacy and Health Sciences School of Medical Imaging & Therapeutics Radiation Therapy Program CLINICAL COMPETENCY KNOWLEDGE ASSESSMENT The knowledge assessment must be completed before the log ins are attempted. The descriptions used should be in medical terminology Name:____________________________ Date:_______________ Clinical Site:_______________________ Treatment Unit_______ Set-up Procedure:__________________ 1. Identify the patient’s primary disease and histology (if metastatic disease indicate primary as well as metastatic site) 2. Stage of disease to include staging system used (include reference and rational for stage) 3. Describe the patient position during treatment. List and explain why immobilization, positioning or any accessory devices are used in the treatment set-up. 4. Name the anatomic borders of the treatment field or fields. 5. Identify the critical organs within or adjacent to the treatment field or fields. What are the normal tolerance doses of these organs? Cite reference used for tolerance doses. 42 Student_______________________________ 6. Name the possible acute side effects the patient may experience during treatment. List the instructions and give rational for the recommendations you would give to the patient concerning side effects and skin care. 7. Name the possible long-term (chronic) side effects from treatment. Student Signature:_____________________________ Clinical Supervisor Signature:___________________________ 1/01, rev. 1/03, 8/03, 1/05, 8/07, 8/11 reviewed 8/10, 8/11 43 Log-In Record Policy Policy Prior to attempting a procedure competency, the student must first successfully complete log-ins or practice competencies. Procedure 1. 2. 3. 4. 5. 6. 7. 8. The student will choose three different patients for log-ins The knowledge assessment must be filled out prior to logging in, and signed off by the clinical staff Any registered therapist can assess the student log in procedures (they do not have to be designated clinical supervisor) The procedure must be completed by the student with 100% accuracy The student must set at least the first field size manually The student will do all triangulation and leveling independently Second year students will do 3 log-ins successfully before attempting the treatment competency Third year students will do 1 log-in successfully before attempting the treatment competency Revised 8/99, 3/05, Reviewed 8/10 44 MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES RADIATION THERAPY PROGRAM LOG-IN RECORD STUDENT:____________________________ DATE:_________________ Clinical Site:___________________________ Circle one: RTT 201C, RTT 202C RTT 203C, RTT 304C, RTT 305C TREATMENT TECHNIQUE *one log-in record per treatment technique, i.e. all prostate cases on one form DATE BEAM MODIFIERS SITE HISTOLOGY TX UNIT FILMS/DRR’S REVIEWED STAFF SIGNATURE COMPETENCY EVALUATION(S): DATE/ SIGN PASS YES/ NO COMMENTS YES/ NO ORAL ASSESSMENT: The student will be able to discuss the boost field and all landmarks involved for the procedure they are doing the oral competency on. DATE/ SIGN PASS YES/ NO COMMENTS *include review of boost procedure for primary field *review port films, DRR’s Name the borders of the field Name all critical structures & bony landmarks in this field REVISED: 9/99, 4/01, 5/04, 8/07, Reviewed 8/10 45 MASSACHUSETTS COLLEGE OF PHARMACY & HEALTH SCIENCES CLINICAL PROCEDURE FORM Student Name: Clinical Site: Date: Treatment Unit: Rationale for Exercise: It has been reported by staff therapists, and observed by the Clinical Coordinator that some students are not integrating their theory and didactic course work into the clinical setting. The goal of alternating class schedules with clinical schedules is for the student to apply these concepts to their daily clinical education. While many procedures look similar, there are a wide range of differences: different pathology, critical structures, positioning, side effects, beam parameters, beam modifiers, dose etc. Prior to participating in any & all set up procedure the expectation is that the student will know what they are treating and why. For instance, when asked what we are treating for a patient with a mask, the student would say the metastatic or primary brain disease, or the larynx etc. The incorrect answer is “a head and neck”. Example: when setting up a pelvic field and asked what we are treating, the student would say Prostate, Bladder etc. If it is a metastatic case, the student would know what the primary was & routes of spread etc. Again, the goal being to actually integrate theory and didactic work into the clinical setting. This exercise is to encourage the student to identify basic radiation therapy theory for every patient that they treat, whether comping on the patient or not! ASSIGNMENT: The student will be expected to complete this form for every new start patient treated on their treatment unit. It is the responsibility of the student to incorporate looking in the chart of EMR for every patient before they enter the room. The therapists as clinical instructors should be asking the student these basic questions and not allowing the student to go near a patient if they don’t know what they are doing. The student will copy this form for all procedures & review briefly with the staff at the end of the clinical day. *The student should know that they will always be expected to know this information and will routinely be asked this information even after this assignment. Don’t be a robot, be a critically thinker, your patient depends on it! Primary Disease: Anatomical Site Treated: Stage of Disease: Beam Arrangement: Dose/mu section: Does the patient need films, which ones would you take: What anatomical structures do you plan to review to make sure the film matches the sim film: Why are we using blk/mlc: 46 ARRT Radiation Therapy Clinical Competency Requirements Student Name: _________________________ Radiation Treatment Procedures Brain Mandatory 1. Primary X 2. Metastatic X Elective Date Completed Competence Verified By Head and Neck 3. Laterals Only 4. Multiple Fields* to include Supraclavicular X X Chest 5. AP/PA X 6. Multiple Fields* X Breast 7. Tangentials Only X 8. Tangentials with Supraclavicular X 9. Tangentials with Supraclavicular and Posterior Axilla Boost X 10. Tangentials with Supraclavicular and Internal Mammary X Abdomen 11. AP/PA X 12. Multiple Fields* X 13. Para-Aortic X Pelvis 14. AP/PA X 15. Multiple Field Supine* X 16. Multiple Field Prone* X 17. Inguinal X Skeletal 18. Spine X 19. Extremity X Electron Fields 20. Single 21. Abutting Fields X X *Multiple fields may include IMRT. “The ARRT Radiation Therapy Clinical Competency Requirements are printed by permission of the ARRT. The ARRT Radiation Therapy Clinical Competency Requirements are copyrighted by the ARRT.” Duplication for uses other than as above is subject to express written permission by the ARRT. 47 MASSACHUSETTS COLLEGE OF PHARMACY & HEALTH SCIENCES RADIATION THERAPY PROGRAM Second Year Student’s Role & Responsibility The second year student is considered a “novice” student with different capabilities than the third year students. The following is a guideline for the staff to follow when working with a second year student. Each clinical situation and facility is different as is the capabilities of each student. The staff therapist will need to use their own clinical judgment as to the level of the student and the level of supervision required. This list is a guideline; for more detailed Clinical Internship Rules, refer to the RTT student handbook PATIENT CARE: Introduce self & greet the patients. Escort patients to and from the treatment room Assist patient to and from treatment couch using correct lifting/moving techniques Help maintain patient comfort while maintaining proper patient positioning Explain treatment procedures Set up treatment room prior to procedure and clean room after procedure Relay patient problems & complaints to radiation therapist, nurse or physician TECHNICAL AREA: Explain and demonstrate the use of immobilization devices, blocks & wedges Identify correct patient & Time – Out procedure Assist with patient positioning by: 1. locating skin marks and tattoos 2. instructing patient as to desired position 3. correcting patient alignment Develop and mark portal images Document patient treatment by: 1. recording daily treatment fields and meter doses *all entries to be reviewed an cosigned by staff 2. recording of portal films taken 3. recording any change in treatment parameters Demonstrate operation of pendant and control panel Rotating the gantry from outside the room is not encouraged. I therapist can choose to allow this function with supervision or to save time in the process Running the beam with supervision. Student must have verbal ok from a licensed therapist after checking all control panel settings & parameters before turning the beam on Locate and use emergency shut-offs PROFESSIONAL BEHAVIORS: The ability to report to the assigned area on time. Return from all breaks or rotations promptly as scheduled Dress code compliance Professional attitudes & respect towards staff The ability to accept constructive criticism when necessary Effective communication skills, including proper phone etiquette Honesty & integrity Maintain patient confidentiality Complete and maintain Clinical Attendance Record & have staff sign on a daily basis Reviewed 8/11 48 Mid-Point Evaluation Policy The purpose of the mid point evaluation is to have the therapists identify student’s strengths and weaknesses and give that student sufficient time to improve if needed. The student is responsible for reviewing the midterm evaluation along with course objectives at the beginning of every rotation to ascertain what clinical skills and behaviors will be evaluated by the therapy staff. Procedure 1. 2. 3. 4. 5. 6. It is the student’s responsibility to provide the staff with the document one week prior to the due date. The same mid-evaluation form is used for all clinical internships. It is preferred by the faculty that all staff therapists working with the student on the treatment unit have input in the evaluation of the student. The lead therapist or clinical supervisor is responsible for reviewing the mid-point evaluation with the student. **This document MUST be reviewed with the student**. It is the student’s responsibility to forward this document to the Clinical Coordinator by the due date. A student who debates a grade with the clinical staff will have a clinical infraction and/or program disciplinary actions based on the severity of behaviors Revised 6/10 49 RADIATION THERAPY PROGRAM MID-ROTATION REVIEW ALL INTERSHIPS 201C, 202C, 203C, 304C, 305C Student Name:___________________ _____ Date:___________ Clinical Supervisors and students please note: This review is completed midway through the rotation. Comments and observations are not limited to the sections below. Please discuss all areas of concern with the student & document in the comment section. SOMEALWAYS TIMES NEVER TECHNICAL: 1. Use equipment properly and safely. 2. Interprets set-up information correctly. 3. Displays plan of action in room (i.e. patient flow, knowing their role inside and outside of the treatment room.) 4. Displays ability to make field adjustments as prescribed 5. Displays ability to correctly document in treatment record 6. Able to retain & demonstrate previously learned technical skills BEHAVIORAL: 1. Displays professionalism (ex.: complies with dress code, prepared in room, use of appropriate language) 2. Maintains a professional atmosphere with patients and other members of the patient care team. 3. Accepts responsibility willingly 4. Has displayed attempts to achieve all of his/her required objectives without need for cueing from staff. 5. Accepts criticism well & makes needed improvements C COMMUNICATION and MOTIVATION: 1. Follows chain of command when addressing conflict 2. Fills out and discusses intent form with appropriate staff 3. Seeks staff assessment on their progress and acts upon it 4. Uses time efficiently & seeks out additional work 50 Student____________________________ Comments and Recommendations on How to Improve in Specific Clinical Areas: Please support all noted areas of need for improvement with a narrative in this section. Students Comments: Students this is your time to voice your concerns on your rotation. Note: Do you agree or disagree with your evaluation and why? Clinical Supervisor(s):___________________________ DATE:___________ Student:________________________________________ DATE:___________ 51 Patient Care PATIENT CARE ROTATION RTT 201C Policy The student will follow a patient under treatment from the first week through the last day of treatment. The patient care rotation will provide the radiation therapy student a clinical education experience which will reinforce the objectives achieved in the patient care course (RSC 305 Patient Care in Imaging). Student will demonstrate therapeutic patient communication skills, show empathy and understanding of the patient throughout the radiation therapy process, & gain understanding of patient care issues related to patients receiving radiation therapy. Procedure 1. 2. 3. 4. 5. 6. 7. The student and staff will choose a patient on the treatment schedule who is being simulated during the student’s first week of clinical. The student will monitor the patient’s course of radiation therapy including any changes in treatment plan, side effects, and any psychosocial issues that may arise. The student will be expected to follow the patient each week with the physician & nurse for scheduled & PRN on treatment visits, and all radiation therapy treatments. The student will keep a journal of such visits. The student is responsible for knowing the patient’s daily schedule in the department. The student will research the patient record for information that lead up to the scheduling of the simulation for radiation therapy. The student will submit an outline to the Clinical Coordinator of all pertinent patient information as indicated in the RTT 201C Patient Care Rotation objectives. PATIENT CARE ROTATION RTT 202C Policy The student will build upon Patient Care concepts gained in RSC 305 Patient Care In Imaging and in RTT 201C Clinical Internship patient care rotation. To provide the student with foundation concepts and competencies in assessment and evaluation of the patient for service delivery. Psychological and physical needs and factors affecting treatment outcome will be explored. Routine and emergency care procedures will be reviewed. Procedure 1. 2. 3. The student and staff will schedule observation times with the nurse and physician to review and participate in the following (time can be individual cases, partial or full days). The student must review schedule with the therapists to ensure that important treatment procedures are not missed. The student will participate in 3 different patient consultation visits of varying pathologies 52 4. 5. 6. The student will participate in 3 different patient care on treatment visits of varying pathologies The student will participate in 3 different patient care follow up visits of varying pathologies The student will submit an outline to the Clinical Coordinator of all pertinent patient information as indicated in the RTT 202C Patient Care Rotation objectives. 53 Radiation Therapy Program Clinical Competency Evaluation - Patient Care Rotation RTT 201C Clinical Internship Student:__________________________________ Staff Nurse Evaluator:________________________ Date:_______________________ Clinical Site:__________________ Preceptors are asked to evaluate students’ professional behavior and communication skills by identifying how well the student met expectations of performance in each criterion. Interpersonal Domain: Candidates should demonstrate ongoing sensitivity to and compassion for each patient’s physical and emotional well-being, interact with members of the radiation therapy treatment team in a positive and productive manner, and maintain high ethical standards. Met Not Met Reviews clinical rotation objectives with clinical nursing staff Interacts professionally with patients and family members Introduces self to patients & family Interacts courteously with nurses & other medical personnel Uses appropriate language (proper grammar, no slang, profanity, etc.) Respects the professional knowledge/skills of nurses Demonstrates cultural awareness and competent practice Maintains eye contact, personal space, therapeutic touch with patient Maintains patient confidentiality Maintains patient modesty (draping, gowning, privacy) Seeks clinical knowledge/skill experiences during slow periods Examine different psychological aspects effecting the patient: change in body image, family dynamics, change in role in the family, sexual relations, financial stressors, & mortality concerns Identify patient resources & support services in the department, hospital & community & discuss if they were reviewed with the patient N/A Cognitive Domain: As part of providing treatment, candidates should demonstrate their understanding of concepts related to patient care and reinforce the objectives achieved in the patient care course (RSC 305 Patient Care in Imaging). Met Not Met N/A Understands radiation side effects/complications related to this case & select the appropriate medical intervention Recognizes staging & staging work up for patient case Recognize radiation side effects/complications related to this case & select the appropriate medical intervention Correlates the onset of clinical symptoms with the cumulative dose Identify patient resources & support services in 54 the department, hospital & community & discuss if they were reviewed with the patient Understands Kubler-Ross stages of grieving & application to patient case Understands Maslow’s Hierarchy of Needs & application to patient case Psychomotor Domain: Candidates should demonstrate competence performing activities such as: discussing treatment plan, therapeutic touch, assessing patient’s physical status, documenting patient care, and formulating answers to frequently asked questions. Met Not Met N/A Locates documentation of informed consent Explain the dynamics of communicating with the cancer patient & family Indentify presenting symptoms Differentiate between pathological types of this patient’s disease List interventions/education given to the patient Examine different psychological aspects effecting the patient: change in body image, family dynamics, change in role in the family, sexual relations, financial stressors, & mortality concerns Assess the physical condition of the patient before, during & after treatment delivery Assess the nutritional status of the cancer patient to provide nutritional education or intervention. List nutritional interventions/education Discuss any change in treatment plan applicable to this patient, breaks in treatment, progression of disease Identify patient resources & support services in the department, hospital & community & discuss if they were reviewed with the patient Reviews treatment prescription The following objectives have been met in RSC 305 Patient Care in Imaging Class labs Demonstrates proper body mechanics and patient transferring Demonstrates proper IV insertion technique Demonstrates proper gowning & gloving procedures Demonstrates proper hand washing procedure & infection control Demonstrates proper care & safety of patient with oxygen Staff Nurse evaluator comments: __________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Student comments:_____________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Revised 8/11 55 Radiation Therapy Program Clinical Competency Evaluation - Patient Care Rotation RTT 202C Clinical Internship Student:__________________________________ Staff Nurse Evaluator:________________________ Date:_______________________ Clinical Site:__________________ Preceptors are asked to evaluate students’ professional behavior and communication skills by identifying how well the student met expectations of performance in each criterion. Interpersonal Domain: Candidates should demonstrate ongoing sensitivity to and compassion for each patient’s physical and emotional well-being, interact with members of the radiation therapy treatment team in a positive and productive manner, and maintain high ethical standards. Reviews clinical rotation objectives with clinical nursing staff Interacts professionally with patients and family members Introduces self to patients & family Interacts courteously with nurses & other medical personnel Uses appropriate language (proper grammar, no slang, profanity, etc.) Respects the professional knowledge/skills of nurses Demonstrates cultural awareness and competent practice Maintains eye contact, personal space, therapeutic touch with patient Maintains patient confidentiality Maintains patient modesty (draping, gowning, privacy) Seeks clinical knowledge/skill experiences during slow periods Cognitive Domain: As part of providing treatment, candidates should demonstrate their understanding of concepts related to patient care and reinforce the objectives achieved in the patient care course (RSC 305 Patient Care in Imaging). Understands concepts of proper body mechanics and safe patient transferring Understands radiation side effects and appropriate interventions Understands the goals of patient& staff interaction during OTV, Follow-up visits & consultations Psychomotor Domain: Candidates should demonstrate competence performing activities such as: discussing treatment plan, therapeutic touch, assessing patient’s physical status, documenting patient care, and formulating answers to frequently asked questions. Identifies patient concerns & lists direct patient education or interventions Lists the role responsibilities of the nurse, physician, & radiation therapist Locates documentation of the Patient’s Bill of Rights, distribution to patient Discusses the principle of medication administration with the nurse 56 Provide patient education for medical procedures Recognize radiation side effects and complications and select the appropriate medical intervention Describe the proper care of patients with tubes (IV’s, catheters, drainage) Describe emergency response procedures (department, hospital) Demonstrate the application of the principles of radiation protection during brachytherapy procedures Demonstrate proper use of the principles of patient safety and transfer Demonstrates adherence to patient modesty, draping, privacy Lists challenges in patient communication: Hearing, vision and speech problems, Impaired mental function, Altered states of consciousness, Pediatric and adolescent patients, Geriatric patients, Communicating in stressful circumstances, Cultural diversity, Artificial speech, Transesophageal puncture (TEP), Esophageal speech, Electrolarynx devices Identifies psychological considerations: death and dying, concerns, stages, family coping, quality of life Other common patient concerns: Misconceptions related to radiation, Scheduling, Transportation, Financial, Sexual Identify normal ranges & list signs & symptoms and ramifications of low levels of: (may use documentation from PT Care class) WBC, Hemoglobin, hematocrit, platelets Staff Nurse evaluator comments: __________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Student comments:_____________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Revised 8/11 57 Scheduling of Competency Evaluations Competency evaluations are to be conducted by a clinical supervisor. It is the student’s responsibility to schedule these evaluations with the clinical supervisor. It is also the responsibility of the student to inform the Clinical Coordinator, Program Director when the competency evaluation is scheduled. Oral Assessment Policy Policy The purpose of the oral assessment is to allow students to demonstrate their theoretical understanding of the technique through critical thinking and problem-solving skills, and the disease being treated. It also offers a valuable opportunity for the evaluator to discuss important case issues with the student. This assessment should be looked upon as an additional tool to enhance the learning experience. Procedure 1. 2. 3. 4. 5. 6. 7. 8. 9. The student will be responsible to make copies of any pertinent patient records while following all patient confidentiality procedures The student will set the appointment with the clinical supervisor no later than two weeks after the treatment competency procedure was successfully passed. The student and clinical supervisor can review any questions from the oral competency list. The therapist chooses the questions, not the student During an oral assessment for a primary treatment field, the student will also be expected to review the procedure for that boost field. A second oral assessment will not be required of the student provided they can present documentation of the assessment of a boost procedure. If a student completes a competency on a boost field in a clinical setting that is different from the clinical setting they completed the primary competency, an oral assessment for that boost field including any details that are unique to that facility will be required. The student who does not answer all questions correctly will have an opportunity to submit the answers in writing to the therapist Should the therapist feel that the student is missing too much information, the student will fail the oral competency If the oral competency is failed, the student will need to review all patient case information, relevant oncology, pathology, anatomy and physiology and reschedule the competency. Revised 5/04, reviewed 8/07, 8/10, 8/11 58 Oral Assessment Questions (any of these questions may be selected) Theoretical Understanding of Procedure Following successful performance of competency skills, a student must demonstrate his/her theoretical understanding of: Technique Disease treated Side effects of treatment Equipment used This understanding of these topics should be demonstrated via the student’s oral response to a selection of questions from the list that follows. (The evaluator chooses the questions.) Define the terms used in the chart. What were the presenting symptoms? What diagnostic exams were performed? What is the primary site? Histology? Are there etiologic factors identified in the chart? What etiologic factors are associated with this disease? How does this tumor metastasize? Common sites? What is the stage and grade of this pts disease? What is the plan for treatment? (RT, chemo, surgery…) Identify the treatment technique being used. Describe the treatment technique in detail. Review films/IMAGES: Identify normal anatomy What is being blocked? Compare sim/portal films/IMAGES Identify/explain the fractionation scheme. Comment on choice of treatment energy. Describe the method of MU calculation. Identify beam modifiers, why and how used. Identify critical structures in field and tolerance doses. Identify potential acute effects from these fields. Describe interventions for acute effects. Identify acute effects experienced by patient being treated. Identify potential chronic effects. Describe x-ray or electron production. Identify Dmax/isodose distribution. Describe interlocks and other safety devices of unit. Describe quality assurance checks. Describe film image reproduction. Describe choice of radiographic technique. Competencies will be recorded as PASSED when unsatisfactory answers are corrected in writing. 59 Simulation & Simulation Observation Policy The student will rotate to the CT simulator to gain knowledge regarding the simulation and treatment planning of patient radiation therapy fields. A basic understanding of simulation and treatment localization is necessary for a quality radiation therapy education. MCPHS does not expect a student be passed on a simulation competency unless they can possess fundamental knowledge and can critically think issues related to that procedure. Procedure 1. 2. 3. 4. 5. 6. 7. 8. Students will be introduced to the simulator starting in RTT 203C summer clinical internship. The student will be required to complete a simulation observation form prior to being allowed to comp on a simulation procedure In RTT 203C clinical internship, the student is required to do 1 simulation procedure from the master list of simulations set forth by the ARRT. In RTT 304C, clinical internship, the student is required to do 3 simulation procedures from the master list of simulations set forth by the ARRT. In RTT 305C, clinical internship, the student is required to do 3 simulation procedures from the master list of simulations set forth by the ARRT. The ARRT and MCPHS are aware of the complexities of the simulator and varying units and systems. The ARRT have listed various levels of responsibility allowed of students. It is expected that the candidate will participate with appropriate personnel at one or more of the following levels of responsibility for successfully passing the competency: PERFORM, DISCUSS, REVIEW, OR OBSERVE (LEVEL OF PARTICIPATION MAY DEPEND ON STATE OR INSTITUTIONAL REQUIREMENTS) Simulation responsibilities vary between sites as well with some therapists doing more than others (choosing protocols, placing isocenters, starting IV’s for contrast, etc.) Students are expected to have an understanding of the field they are simulating, areas involved, disease process, areas of concerns, treatment volume, and how this would be treated or planned, exporting information for planning, interpreting CT images, positioning/immobilization, set-up documentation (chart, EMR), consent, tattoos, patient identification photos, explanation of procedure to the patient. 60 RADIATION THERAPY CLINICAL SIMULATION COMPETENCY REQUIREMENTS *Eligibility Requirements Effective January 2005 RADIATION THERAPY SIMULATION PROCEDURES (Conventional or CT) Area: MANDATORY Breast Head and Neck Chest Abdomen Pelvis Skeletal Brain Date Completed Verified by: full signature Candidates must demonstrate competence in treatment simulation for the anatomic regions listed below. Either a conventional simulator, CT simulator, or treatment machine may be used. Mandatory Simulation Procedures. Students must demonstrate competency in all of the mandatory Simulation Procedures. All of the Simulation Procedures must be demonstrated on patients 61 Radiation Therapy Clinical Competency Requirements Simulation Procedures Conventional Simulation & CT Simulation Important: Demonstration of competence includes considerations related to radiation safety, equipment operation, patient and equipment monitoring, patient positioning, treatment volume localization, imaging procedures and processing, record keeping, and patient management and education. Specific requirements for conventional and CT simulation are summarized below. Conventional Simulation CT Simulation Assure that therapist and patient follow ALARA Assure that therapist & patient follow ALARA Operate simulator; check lasers, ODI, field size, etc. Operate CT scanner, perform daily QC as appropriate (lasers, phantom scans, etc.) Explain procedure to patient, prepare supplies Needed for simulation, and monitor equipment during procedure. Explain procedure to patient, prepare supplies needed for simulation, and monitor equipment during procedure. Position and immobilize patient using available tools and instrumentation as required (e.g. lasers, lead markers). Position and immobilize patient using available tools and instrumentation as required (e.g. lasers, fiducial markers). Determine potential treatment fields from simulation films and diagnostic studies. Perform CT scan for region of interest; participate in determining treatment fields (on film or digitally). Obtain contour and measurements used to make treatment plan. Review and discuss CT scan & treatment plan with appropriate personnel. Obtain orthogonal films. Utilize preset protocols or adjust imaging parameters (e.g., slice level, FOV) to obtain image. Process exposed films. Mark isocenter and transmit network images to workstation. Record patient position and other required information (e.g. gantry angles, collimator settings). Record patient position and other required information (e.g., set-up, table position). Demonstrate patient care as situation requires (e.g., skin care, nutrition). Manage patient as situation requires, including monitoring for possible contrast reactions. 62 STUDENT:___________________________ DATE:___________________________ MACHINE___________________________ CLINICAL SITE:__________________ CT SIMULATOR SIMULATION OBSERVATION ROTATION: The student will observe simulation procedures & identify parts of the simulator & related set-up information. CT SIMULATOR Spiral CT – x-ray tube rotates, patient moves through scanner identify parts of the console virtual simulation workstation: CT scanner, target volume definition/treatment planning dose calculation software discuss production of high quality DRR “digitally reproduced radiographs” identify simulator controls patient data entry protocol selection; algorithm selection, slice thickness, scan location Discuss slice interval (spacing) technique Selection; mA, kVp, rotation speed, table movement identify gantry, bore size (70 cm, 90 cm) discuss image reconstruction, reconstruction algorithms low pass convolution filters; high pass convolution filters Axial, coronal, sagittal views Discuss image display; higher the matrix the more improved the spatial resolution locate crash cart, sharps container locate emergency off buttons & CODE team numbers discuss patient positions discuss & identify contrast media identify various types of patient immobilizers & when to use them locate & discuss oxygen system identify patient field locators, tattoos discuss various ways to identify a patient discuss parts of the treatment record (electronic and/or hard copy) identify & discuss fiducials indentify sterilization or cleaning materials discuss billing & coding for procedures √ N/A comments/notes 63 PERFORMANCE: (Choose all which apply) IN PARTICIPATING IN THIS OBSERVATION ROTATION THE STUDENT: √ comments/notes Was enthusiastic and inquisitive Appeared not motivated to learn Asked appropriate questions Was not inquisitive Took notes Behaved professionally to patients and/or staff members Did not behave professionally to patients and/or staff members COMMENTS: Student’s Signature Evaluator’s Signature 8/08 64 STUDENT:___________________________ DATE:__________ SIMULATION COMPETENCY: Conventional Simulation Procedure: ________________ The student will demonstrate competency on this set-up using the following criteria. PERFORMANCE: S 1. PREPARATION OF ROOM a. Prepared the simulation table b. Obtained necessary equipment and accessories to perform set-up c. Obtained all records prior to simulation 2. GREETING AND ASSISTING CORRECT PATIENT a. Escorted patient from waiting room b. Confirmed patient’s identity c. Introduced self by name d. Assisted and/or supports patient to or from wheelchair, stretcher, bed, etc. 3. EXPLAINS PROCEDURE AND CONFIRMS PATIENT’S UNDERSTANDING a. Informed patient of procedure to be performed b. Explained procedure in terms patients can understand c. Asked patient if they have any questions d. Provided answers which are accurate and appropriate to patient’s level of understanding 4. SIMULATION PROCEDURE a. Demonstrated patient safety and comfort during simulation b. Prepared cast or mask according to desired immobilization requirements c. Demonstrated proper use of and operation of simulation equipment: hand pendant, collimator, gantry, table, and control console d. Determined simulation parameters: SSD/SAD, field size and centering, correct radiographic technique, marks patient denoting field size and center e. Assisted radiation oncologist/ therapist in localizing the tumor volume and critical organs using radiographic techniques f. Acquired approval of treatment field indicated on film from radiation oncologist g. Used proper contrast media h. Used markers correctly (on patient and cassette) i. Labeled simulation films correctly (patient’s name, date, field size, SSD/SAD/SFD) j. Prepared patient contour with appropriate measurements 5. TREATMENT RECORDS a. Recorded treatment parameters b. Completed simulation sheet US NA IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully COMMENTS: Student’s Signature Evaluator’s Signature 65 STUDENT:___________________________ DATE:__________________ MACHINE___________________________PROCEDURE________________________________ SIMULATION COMPETENCY: CT Simulation The student will demonstrate competency on this set-up using the following criteria. PERFORMANCE: S 1. PREPARATION OF ROOM a. Prepared the simulation table b. Obtained necessary equipment and accessories to perform set-up c. Obtained all records prior to simulation 2. GREETING AND ASSISTING CORRECT PATIENT a. Escorted patient from waiting room b. Confirmed patient’s identity c. Introduced self by name d. Assisted and/or supports patient to or from wheelchair, stretcher, bed, etc. 3. EXPLAINS PROCEDURE AND CONFIRMS PATIENT’S UNDERSTANDING a. Informed patient of procedure to be performed b. Explained procedure in terms patient can understand c. Asked patient if they have any questions d. Provided answers which are accurate and appropriate to patient’s level of understanding 4. SIMULATION PROCEDURE a. Demonstrated patient safety and comfort during simulation b. Prepared cast or mask according to desired immobilization requirements c. Used proper contrast media (if applicable) d. Demonstrated proper use of and operation of simulation equipment: CT scanner, simulation computer, and CT console area e. Determined simulation parameters: performed proper scans, correctly downloads CT information into dosimetry computer, build model on dosimetry computer f. Observed marking patient according to computer data g. Acquired approval of treatment field indicated on scans from radiation oncologist 5. TREATMENT RECORDS a. Printed out simulation data US NA IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully COMMENTS: Student’s Signature Evaluator’s Signature 2/03 66 Brachytherapy OBSERVATION ROTATION: HDR CT Sim: Brachytherapy The student will observe an HDR/ Brachytherapy procedure and explain to the supervising therapist the concepts involved, and the points detailed below. CT SIMULATOR Review of CT Scanner operations: warm ups , general info Identify parts of the console and sim controls Virtual simulation workstation: CT scanner, target volume definition/treatment planning dose calculation software Review emergency procedures Patient data entry Patient set up for HDR purposes Protocol selection; algorithm selection, slice thickness, scan location Discuss slice interval (spacing) Technique Selection; mA, kVp, rotation speed, table movement Identify gantry, laser systems, localizing process, bore size (70 cm, 90 cm) Discuss image reconstruction, reconstruction algorithms, (ie. Cylinder diameter measurements) Axial, coronal, sagittal views Discuss image display; higher the matrix the more improved the spatial resolution; contrast; Hounsfield Units/ CT numbers √ N/A comments/notes Room & equipment: locate control area, sterilization and scrub areas, treatment room equipment, brachy planning; locate crash cart, sharps container; emergency stops; CODE team numbers and important team numbers inc. radiation safety officer contacts HDR/ AFTERLOADER Explain Afterloader operation for procedures; discuss HDR, LDR and VLDR Review HDR console and operations Discuss Radioisotopes Daily QA – warm ups Emergency procedures and equipment usage, inc. radiation safety personnel Identify various types of patient immobilization, kits, & when to use them Understanding of the case observed (pick 1 or 2 to discuss) Case options: GYN: Cylinders; T & O; T & Ring; T & cylinder Prostate TRUS Others: surface applicators; catheters; vasculars; endobronchs; bile ducts; mammosites; esophageal; Liver- SirSpheres Others: LDR and VLDR cases. (For example, LDR T & O; VLDR seeds case for sarcomas Explain importance of HDR treatment to that patients’ course of treatment, as an alternative therapy Explain your understanding of the emotional aspects of the explained treatment Discuss various ways to identify a patient Explain Safety Pauses: anesthesia cases and outpatients Discuss parts of the treatment record (paper recording; HDR treatment procedures; physics planning concepts) Identify and explain sterilization kits, equipment, and clean up Discuss billing and coding for procedures 67 PERFORMANCE: (Choose all which apply) IN PARTICIPATING IN THIS OBSERVATION ROTATION THE STUDENT: √ comments/notes Was enthusiastic and inquisitive Showed knowledge of Radioisotopes Did not show adequate knowledge of Radioisotopes Showed understanding of the concepts and topics discussed Understood the Cognitive Domain as part of their competency (demonstration of understanding of concepts related to anatomy, physiology, pathology, and dose to critical structures; recognize complications and sideeffects commonly associated with each treatment procedure; and also describe alternative treatment procedures and how those procedures might apply to a given case) Understood the Psychomotor Domain as part of their competency (Demonstrate competence performing activities such as verifying treatment parameters, set-up, patient positioning and immobilization, monitoring the treatment delivery, and documentation) Understood the relevance of the ‘Interpersonal Domain’ for competency assessment (demonstrate ongoing sensitivity to and compassion for each patient’s physical and emotional well-being, interact with the members of the team in a positive and productive manner, and maintain high ethical standards) Appeared not motivated to learn Asked appropriate questions Was not inquisitive Took notes Behaved professionally to patients and/or staff members Did not behave professionally to patients and/or staff members COMMENTS: Student’s Signature Evaluator’s Signature 9/2010 68 RADIATION THERAPY PROGRAM Clinical Competency Evaluation - Simulation - Second Clinical Year, (304C, 305C) Student Name:_____________________ Date:___________ Evaluated by:__________________________ Clinical Site & Treatment Unit:_________ Student grades are dependent upon submission of evaluation by:_______ This evaluation is to be filled out and reviewed with the student during the last week of their clinical rotation. Please use the following criteria to identify performance on the individual objectives: M-meets expectations I-needs improvement US – is unsatisfactory OVERALL performance in each area is to be ranked using the following scale: outstanding above average average below average unsatisfactory Ratings of outstanding or unsatisfactory must be accompanied by explanation. ______________________________________________________________________________ PROFESSIONALISM Development of professional behaviors will be demonstrated by: M I US Professional appearance-compliance with dress code a. wears personal radiation monitor at all times b. is prepared with ruler, pens, etc. Cooperates with radiation therapists Interacts courteously with other medical personnel Uses appropriate language (i.e. no profanity) Avoids personal telephone calls Maintains patient confidentiality Follows chain of command when addressing conflicts Demonstration of professional behavior is: outstanding above average average below average unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ _______________________________________________________________________________________ _____________________________________________________________________ 69 COMMUNICATION WITH STAFF Student shall demonstrate staff communication skills by: M Relaying messages promptly Respecting the professional and technical knowledge/skills of radiation therapists-interacting courteously and following directions Seeks staff assessment of progress Acts on staff assessment and suggestions for improvement Demonstration of student’s staff communication skills: outstanding above average average below average I US unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ COMMUNICATION WITH PATIENTS AND THEIR FAMILIES M Maintains friendly, supportive manner with patients and families Addresses patients formally until patient invites familiarity Introduces self to patients Converses with patients and/or families Strives to put patients at ease Adjusts voice volume to patient’s hearing ability Uses discretion when communicating (e.g., information, sympathy) Answers patient questions, when capable, in the presence of clinical staff Refers ALL questions to clinical staff Demonstration of student’s patient and family communication is: outstanding above average average below average I US unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ MOTIVATION The student will display intellectual curiosity by: M I US Reporting to clinical assignment at assigned time Concentrating on learning rather than social climate Reviewing clinical rotation objectives with clinical staff Assisting in all aspects of radiation therapist's role Seeking clinical knowledge/skill experiences during slow periods Becoming familiar with patient diagnosis, history and area of treatment Demonstrating initiative in performing clinical skills Accepting assigned clinical skill tasks Demonstrating self-direction in attaining new skills Utilizing clinical time to complete clinical assignments 70 Demonstration of motivation is: outstanding above average average below average unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ TEAMWORK Student will participate as a member of the treatment team by: M Assuming clinical duties at assigned time Notifying staff prior to absence/tardiness Informing staff of whereabouts at all times during assigned hours Maintaining cleanliness and orderliness in the treatment room Assisting with all simulation Recognizing supervisory role of clinical staff Overall performance as a member of the treatment team is: outstanding above average average below average I US unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ PATIENT CARE Student shall demonstrate concern and skill in patient care by: M Putting patients' needs FIRST Maintaining patient confidentiality Demonstrating empathetic understanding of patients’ emotional/physical needs Demonstrating respect for patient modesty/dignity Demonstrating proper patient identification Assisting patients to and from treatment room Handling wheelchairs and stretchers safely a. accurately assessing and providing patient assistance Accurately assessing need for and providing patient assistance Overall demonstration of patient care skills is: outstanding above average average below average I US unsatisfactory COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ ___________________________________________________ 71 TECHNICAL AREA Student will be able to: M I US Identify type of equipment and/or radiation utilized Identify procedures followed in a medical or fire emergency Turn processor ON & OFF (if applicable) Review patient charts and/or sim instructions prior to simulation Prepare simulation room prior to patient arrival Prepare for special procedures (catheters, contrast, etc.) Prepare injectables (contrast, medications, etc.) using aseptic technique Interpret treatment prescriptions Safely assists with patient transfer Maintain patient modesty Maintain patient comfort while producing a reproducible set-up position Consistently demonstrate accuracy and attention to detail Safely operate simulator controls Safely and correctly utilize treatment accessories Fill out patient set-up sheet or electronic instructions for pt. set up Operate fluoroscopy independently (if applicable) Determine when a grid should be used (if applicable) Determine selection of kV, mA and time to obtain a quality radiograph (if applicable) Contour a patient without assistance (if applicable) Take compensator measurements (if applicable) Explain procedure and put permanent marks on patients Label/identify patient immobilization equipment Perform calculations (including blocked fields, extended distance, gaps, etc.) (if applicable) Prepare front sheets (if applicable), or EMR demographic information Develop and label radiographs (if applicable) Label/identify DRR’s, pt. record Student will independently simulate 7 of the following areas based on simulation procedures that were not completed during the previous simulator rotation. Revised 8/04, 8/09 Area: Breast Head and Neck Brain Chest Abdomen Pelvis Skeletal Overall demonstration of technical skill is: outstanding above average average below average unsatisfactory 72 COMMENTS:___________________________________________________________________________ _______________________________________________________________________________________ ____________________________________________________________ Overall assessment of clinical performance: Areas Needing Improvement: Clinical Supervisor(s):_________________________________ Date: __________________ Student:____________________________________________ Date: ___________________ (Signature indicates only that evaluation has been reviewed.) Student comments: (Please attach additional sheet if necessary) 73 Final Semester Evaluation Policy The Supervisor’s Evaluation of Clinical Skills final clinical evaluation is a comprehensive assessment of the student’s clinical comprehension, technical skills, patient care skills, and professionalism. The student is responsible for reviewing the final evaluation along with course objectives at the beginning of every rotation to ascertain what clinical skills and behaviors will be evaluated by the therapy staff. Procedure 1. 2. 4. 5. 6. 7. 8. It is the student’s responsibility to provide the staff with the document one week prior to the due date. It is preferred by the faculty that all staff therapists working with the student on the treatment unit have input in the evaluation of the student. The lead therapist or clinical supervisor is responsible for reviewing the final evaluation with the student. It is the student’s responsibility to forward this document to the Clinical Coordinator by the due date. If staff prefers, **This document does NOT have to be reviewed with the student**. The Clinical Coordinator would be happy to review this evaluation with the student. A student who debates a grade with the clinical staff will have a clinical infraction and/or program disciplinary actions based on the severity of behaviors An electronic copy of the final evaluation form should be e-mailed to the Clinical Coordinator by the clinical staff. No final evaluations will be accepted by the Clinical Coordinator from the student directly. Revised 6/10 74 SUPERVISOR EVALUATION OF CLINICAL SKILLS Massachusetts College of Pharmacy and Health Sciences Radiation Therapy Program SUPERVISOR EVALUATION OF CLINICAL SKILLS Student Name: Internship Site: Comprehensive Program Evaluation Protocol Class of 2011, Class of 2012 Clinical Supervisor Name: Date: Clerkship RTT 201C, RTT 202C, RTT 203C, RTT 304C, RTT 305C Internship #: 1 2 3 4 5 Clinical Supervisor Instructions: Please read the narratives associated with each letter grade. After reading the narrative and taking into consideration this student’s performance compared to others at the same stage of training, assign a rank on the scale that best describes the student’s level of performance. SECTION 1: CLINICAL COMPETENCY 1) Written Communications Clinical Competency Intent Form *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Failed to submit Intent Form. Failed to identify goals or relevant information. Frequently needed cueing or discussions around identifying or completing goals. *PLEASE CIRCLE ONE F D C- Entries disorganized, failing to identify goals or relevant information. Fails to review with staff by the end of the first week of clinical. Not initiated by student. *PLEASE CIRCLE ONE C C+ Disorganized with exclusion of relevant data. Goal directed with most relevant information provided. Reviewed by the end of the first week of clinical, not initiated by the student. *PLEASE CIRCLE ONE B- B Organized, concise, goal directed with most relevant information provided. Reviewed by the end of the first week of clinical and initiated by the student. Well organized, concise, goal directed & relevant information. Reviewed by the end of the first week of clinical and initiated by the student. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B+ A- A 2) Warm-up Procedure (Comprehensive and Machine Specific) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Incomplete and inconsistent with major deficiencies in technical quality. Inability to pass after three attempts. *PLEASE CIRCLE ONE F D C- Completed with minor deficiencies in technical quality. Able to pass after 1-3 attempts. *PLEASE CIRCLE ONE C C+ Occasionally incomplete or inconsistent with minor deficiencies in technical quality. Attention to organization and speed indicated. *PLEASE CIRCLE ONE B- B Appropriate skills evaluated. Good organizational flow with an understanding of procedure. Appropriate skills evaluated with description of procedure. Well organized flow and knowledge base. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B+ A- A 3) Written Conference Communications *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY *exclusions due to scheduled log-ins only Fails to submit entries or documentation of conference. Fails to identify topic for review. Less than 25% of conferences attended or failed to attend any conferences. *PLEASE CIRCLE ONE F D C- Entries disorganized with inclusion of extraneous information. Fails to identify topic for review. Less than 50% of conferences attended. *PLEASE CIRCLE ONE C C+ Occasionally disorganized with exclusion of relevant data, some inclusion of extraneous data. Minor revisions indicated. 50– 75% of conferences attended. Organized with inclusion of relevant data and exclusion of extraneous information. Reviewed on date of conference. 75%-90% of conferences attended. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B- B B+ A- Well organized, concise presentation of relevant information. Reviewed on the date of conference. 100% of conferences attended. *PLEASE CIRCLE ONE A 75 STUDENT: _______________________________________ 4) Technical Skills/Clinical Competency Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Procedures accomplished using unsafe technique; consistently fails to organize equipment ahead of time; has not consistently mastered procedures & clinical set ups. Inability to master documentation & in making adjustments in field parameters. *PLEASE CIRCLE ONE F D C- Procedures accomplished using improper technique; fails to organize equipment ahead of time; difficulty in timing & coordination. Major difficulty in mastering procedure & clinical set ups. Major difficulty with documentation & making adjustments in field parameters Procedures generally accomplished using proper technique, but occasionally fails to organize equipment; minor problems with timing and coordination. Some difficulty with documentation & in making adjustments in field parameters. Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure appropriate. Adequate in documentation & in making adjustments in field parameters. Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure precise and without hesitation. Proficient in documentation & in making adjustments in field parameters *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B B+ A- A 5) Technical Skills/Routine Clinical Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Procedures accomplished using unsafe technique; consistently fails to organize equipment ahead of time; has not consistently mastered procedures & clinical set ups. Inability to master documentation & in making adjustments in field parameters. *PLEASE CIRCLE ONE F D C- Procedures accomplished using improper technique; fails to organize equipment ahead of time; difficult timing and coordination, difficulty mastering new skills or procedures. Some difficulty with documentation & in making adjustments in field parameters. Procedures generally accomplished using proper technique, but occasionally fails to organize equipment; minor problems with timing and coordination. Some difficulty with documentation & in making adjustments in field parameters. Procedures performed using proper technique; equipment organized ahead of time; coordination and timing of procedure appropriate. Masters new skills easily. Adequate in documentation & in making adjustments in field parameters. Procedures performed using proper technique; equipment organized ahead of time; coordination and timing precise; masters new skills with great facility. Proficient in documentation & in making adjustments in field parameters. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B B+ A- A 6) Technical Skills/Recompetency Clinical Procedures *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Recompetency procedures accomplished using unsafe technique. Demonstrates failure in maintenance of clinical skills & procedures. Inadequate knowledge & comprehension of concepts required for procedure. *PLEASE CIRCLE ONE F D C- Recompetency procedures accomplished using improper technique. Demonstrates difficulty in maintenance of clinical skills & procedures. Poor knowledge & comprehension of concepts required for procedure. *PLEASE CIRCLE ONE C C+ Recompetency procedures generally accomplished using proper technique, Demonstrates some inconsistency in maintenance of clinical skills & procedures. Fair knowledge & comprehension of concepts required for procedur.e *PLEASE CIRCLE ONE B- Recompetency procedures performed using proper technique; Demonstrates maintenance of clinical skills & procedures; Good knowledge & comprehension of concepts required for procedure. *PLEASE CIRCLE ONE B+ B A- Recompetency procedures performed using proper technique, & with great facility; Demonstrates mastering & maintenance of clinical skills & procedures. Excellent knowledge & comprehension of concepts required for procedure. *PLEASE CIRCLE ONE A 7) DOSIMETRY/TREATMENT PLANNING (To be filled out by dosimetry staff members only) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Great difficulty recalling and comprehending basic treatment planning procedures. Has not mastered new skills or procedures. Needs foundation of knowledge base. Lacks initiative in rotation & education. Difficult recalling and comprehending basic treatment planning procedures. Difficulty mastering new skills or procedures. Needs improved knowledge base. Needs improvement in initiative in rotation & education. Occasional difficulty recalling and comprehending basic treatment planning procedures. Minor difficulty mastering new skills, or documentation. Usually demonstrates initiative in rotation & education. Recalls, comprehends and relates knowledge of basic treatment planning procedures. Masters new skills easily. Proficient in documentation. Demonstrates initiative in rotation & education. Demonstrates advanced comprehension and application of basic treatment planning procedures. Masters new skills with great facility. Proficient in documentation. Excellent initiative in rotation & education. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE F D C- C C+ B- B B+ A- A 76 NAME OF STUDENT: _______________________________________ 8) SIMULATION: Please note: (level of participation may depend on state or institutional requirements) –the following levels of student participation is acceptable: perform, discuss, review, or observe simulation procedure & competency. All simulation procedures must be demonstrated on patients (not on phantoms). Great difficulty recalling and comprehending basic simulation planning procedures. Has not mastered new skills or procedures, use of equipment. Needs foundation of knowledge base. Lacks initiative in rotation & education. *PLEASE CIRCLE ONE F D C- Difficult recalling and comprehending basic simulation planning procedures. Difficulty mastering new skills or procedures, use of equipment. Needs improved knowledge base. Needs improvement in initiative in rotation & education. *PLEASE CIRCLE ONE C C+ Occasional difficulty recalling and comprehending basic simulation planning procedures. Minor difficulty mastering new skills, use of equipment or documentation. Usually demonstrates initiative in rotation & education. Recalls, comprehends and relates knowledge of basic simulation planning procedures. Masters new skills easily. Proficient in use of equipment & documentation. Demonstrates initiative in rotation & education. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B- B B+ A- Demonstrates advanced comprehension and application of basic simulation planning procedures. Masters new skills with great facility. Proficient in use of equipment & documentation. Excellent initiative in rotation & education. *PLEASE CIRCLE ONE A 9) Industry and Attitude towards Work (Self Management) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Inefficient use of time. Wastes time in unproductive activities. Has trouble meeting commitments. Lacks initiative and needs frequent reminders. Lacks initiative in rotation & education. *PLEASE CIRCLE ONE F D C- Generally ineffective use of time. Somewhat productive and usually uses time to meet most commitments. Occasionally takes initiative for extra work. May need reminders. Needs improvement in initiative in rotation & education. *PLEASE CIRCLE ONE C C+ Occasional ineffective use of time. Reasonably productive and uses time to meet most commitments. Usually takes initiative for extra work. Generally does not need reminders. Usually demonstrates initiative in rotation & education. *PLEASE CIRCLE ONE B- B Effective use of time; performs assigned duties and attends to commitments without being reminded. Takes initiative for extra work. Demonstrates initiative in rotation & education. *PLEASE CIRCLE ONE B+ A- Functions efficiently with minimal direction. Performs all duties and seeks additional assignments. Always seeks additional work. Excellent initiative in rotation & education. *PLEASE CIRCLE ONE A 10) Interpersonal Interactions with Patients *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Lacks communication skills; (verbal and nonverbal). Cannot adequately explain things & is not aware of cross cultural situations; often does not listen to patients or is superficial. Lacks empathy and therapeutic skills. *PLEASE CIRCLE ONE F D C- Demonstrates difficulty at times communicating and explaining things, occasionally aware of cross cultural situations; usually listens to patients. Usually empathetic and therapeutic. Attempts to communicate and explains appropriately & generally aware of cross cultural situations. Generally listens to patients. Generally empathetic and therapeutic. Communicates effectively; offers appropriate explanations while being aware of cross cultural situations; listens attentively to patients. Empathetic and therapeutic. Communicates very effectively; makes extra effort to offer explanations while being astuitely aware of cross cultural situations; listens attentively even with difficult patients. Always empathetic and therapeutic. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B B+ A- A SECTION 2: CRITICAL THINKING 1) Knowledge Assessments (Comprehensive and Case Specific due 1 week prior to competency) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Consistently inaccurate or incomplete with major or minor data frequently missing. (Not submitted prior to competency). Needs improvement and/or remediation. Incomplete or inaccurate with important major or minor data frequently missing. Lack of chronology of events (Not always submitted prior to competency). Needs minor improvement. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE F D C- C C+ Occasionally incomplete or inaccurate with minor details missing. Attention to chronology and detail needed. *PLEASE CIRCLE ONE B- B Less complete and accurate with important data on chronology of events included. *PLEASE CIRCLE ONE B+ A- Complete and accurate with important data on chronology of events obtained in efficient, concise fashion. *PLEASE CIRCLE ONE A 77 NAME OF STUDENT: _______________________________________ 2) Oral Competency Communications (Case Discussions) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Case presentations missed or rescheduled frequently due to lack of preparation. Disorganized, poorly integrated and confusing. Unable to explain or summarize. *PLEASE CIRCLE ONE F D C- Case presentations are disorganized, poorly integrated and confusing. Unable to explain or summarize. Competency rescheduled by staff due to student’s lack of knowledge. *PLEASE CIRCLE ONE C C+ Case presentations generally organized but occasionally verbose, incomplete or confusing. Additional data required in order to pass. *PLEASE CIRCLE ONE B- B Case presentations are organized and complete. Able to explain and summarize effectively. Good knowledge base of information. *PLEASE CIRCLE ONE B+ A- Case presentations are complete, concise, orderly and succinct. Able to explain and summarize effectively. Excellent knowledge base of information. *PLEASE CIRCLE ONE A 3) PROBLEM SOLVING & CRITICAL THINKING ABILITY Fundamentals and Application of Knowledge *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Great difficulty recalling and comprehending basic radiation therapy knowledge. Inadequate preparation and/or lack of clinical preparation. Needs foundation of knowledge base. Lacks ability to recall previously learned information. *PLEASE CIRCLE ONE F D C- Difficult recalling and comprehending basic radiation therapy knowledge. Inadequate pre-clinical preparation. Needs improved knowledge base. Needs improvement in ability to recall previously learned information. *PLEASE CIRCLE ONE C C+ Occasional difficulty recalling and comprehending basic radiation therapy knowledge. Usually demonstrates ability to recall previously learned information. *PLEASE CIRCLE ONE B- B Recalls, comprehends and relates knowledge of basic radiation therapy sciences to clinical cases. Demonstrates ability to recall previously learned information. Demonstrates advanced comprehension and application of basic radiation therapy sciences to clinical cases. Excellent demonstration of ability to recall previously learned information. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B+ A- A 4) Clinical Research Assignment OR patient CASE PRESENTATION (THIS IS NOT THE ORAL COMPETENCY) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Disorganized presentation of information & data or no presentation of information submitted. Work not cited or cited and referenced improperly. *PLEASE CIRCLE ONE F D C- Disorganized presentation of information & data. Work cited inconsistently or not in proper format. Occasionally disorganized presentation with most relevant information & data. Work cited and referenced properly. Organized, presentation with inclusion of relevant information & data. All work cited and referenced properly. Well organized, concise presentation of all relevant information & data. All work cited and referenced properly. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B B+ A- A SECTION 3: PROFESSIONALISM 1) Personal Attitudes Attitude Toward Learning (Self-Learning) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Assimilates information passively and indifferently or not at all. Infrequently attends or does not attend lectures or conferences. Lacks knowledge of radiation therapy. Assimilates information passively and indifferently; infrequently attends lectures, conferences. Occasionally lacks knowledge of radiation therapy. Occasionally shows interest, asks questions; occasionally attends lectures and conferences. Generally demonstrates knowledge of radiation therapy. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE F D C- C C+ B- B Expends extra effort to read on problems encountered; asks good questions; attends lectures and conferences; demonstrates knowledge of radiation therapy. Demonstrates independent learning effort; undertakes supplemental readings; is questioning, insightful and enthusiastic. Excellent initiative. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B+ A- A 78 NAME OF STUDENT: _______________________________________ 2) Interpersonal Interactions with Health Professionals *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Fails to cooperate with others; does not recognize own limitations, does not accept & learn from constructive criticism; consistently oversteps boundaries with other health professionals, and fails to respect others' professional roles. *PLEASE CIRCLE ONE F D C- Usually cooperates with other health professionals; occasionally fails to recognize own limitations, needs improvement on accepting & learning from constructive criticism; may occasionally overstep boundaries with other health professionals, or respecting others' professional roles. *PLEASE CIRCLE ONE C C+ Generally cooperates with other health professionals; usually recognizes own limitations, usually accepts & learns from constructive criticism; and generally respects others’ professional roles. Cooperates with other health professionals; recognizes own limitations, accepts & learns from constructive criticism; and respects others' professional roles. Expends extra effort to cooperate with other health professionals; recognizes own limitations, always accepts & learns from constructive criticism; respects and complements others' professional roles. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B- B B+ A- A 3) Professional Judgment *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Unresponsive to criticism; proceeds on own without checking with authority; overestimates abilities; poor judgment. *PLEASE CIRCLE ONE F D C- Occasionally unresponsive or defensive about criticism, usually fails to check with authority before proceeding; occasionally lacks good judgment. Generally responsive to criticism; occasionally fails to check with authority before proceeding; usually demonstrates good judgment. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B Responds readily to criticism; checks routinely before proceeding; seeks assistance when approaching limits of ability; demonstrates appropriate judgment. *PLEASE CIRCLE ONE B+ A- Seeks out feedback on performance from other health professionals; recognizes own limitations; demonstrates good judgment. *PLEASE CIRCLE ONE A 4) Clinical Attendance *Please Note: Students are allowed one excused absence without effecting their grade. **attendance record must be consulted before completing this portion! *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Greater than 4 clinical absences requiring numerous make up day(s). and/or not punctual to clinical and conferences. Exceeded limit of scheduled breaks or lunch hour. Did not call Clinical Supervisor/staff if absent. *PLEASE CIRCLE ONE F D C- Had 3 clinical absences requiring make up day(s). Usually punctual to clinical and conferences with occasional tardiness. Occasionally exceeded limit of scheduled breaks or lunch hour. Often did not call Clinical Supervisor/staff if absent. Had 2 clinical absences requiring make up day(s). Generally punctual to clinical and conferences. Generally did not exceed limit of scheduled breaks or lunch hour. Occasionally called Clinical Supervisor/staff if absent. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B Had 1 clinical absence requiring make up days. Punctual to clinical and conferences. Did not exceed limit of scheduled breaks or lunch hour. Called Clinical Supervisor/staff if absent. Attended all scheduled clinical days. Always punctual to clinical and conferences. Did not exceed limit of scheduled breaks or lunch hour. Called Clinical Supervisor/staff if absent. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B+ A- A 5) Rules & Regulations (Dress code, Ethics & Professional Conduct) *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Often demonstrates inappropriate behavior, not always committed to ethical standards, unprofessional demeanor demonstrated. Dependable and responsible behavior not always demonstrated. *PLEASE CIRCLE ONE F D C- Occasional inappropriate behavior, usually committed to ethical standards, professional demeanor. Generally dependable & responsible behavior. Appropriate behavior, generally committed to ethical standards, professional demeanor, dependable & responsible behavior. Appropriate behavior, demonstrates commitment to ethical standards. Professional demeanor, dependable & responsible behavior. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE C C+ B- B B+ A- Exceptional behavior, always demonstrates commitment to ethical standards. Professional demeanor, dependable & responsible behavior. *PLEASE CIRCLE ONE A 79 NAME OF STUDENT: _______________________________________ 6) Written Communication with Clinical Coordinator (submission of weekly e-journals & submission of all required clinical documentation) To be Evaluated by Clinical Coordinator at MCPHS *PLEASE NOTE THAT A STUDENT DOES NOT HAVE TO MEET ALL DESCRIPTORS PROVIDED FOR A PARTICULAR GRADE TO BE CHOOSEN BUT SHOULD MEET THE MAJORITY OF THE CATEGORY Entries disorganized with inclusion of extraneous information. Fails to submit more than 50% of the time and/or not at all. Not submitted electronically. *PLEASE CIRCLE ONE F D C- Entries disorganized with inclusion of extraneous information. Fails to identify requested information. Not submitted on time at least 50% of time and/or not submitted electronically. *PLEASE CIRCLE ONE C C+ Occasionally disorganized with exclusion of relevant data, some inclusion of extraneous data. Generally submitted electronically and on time. Organized with inclusion of relevant data and exclusion of extraneous information. Generally submitted electronically and on time. Well organized, concise presentation of relevant information. Submitted electronically and on time. *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE *PLEASE CIRCLE ONE B- B B+ A- A 7) Clinical Infraction (written policy infractions submitted by Clinical Supervisor and/or Clinical Coordinator (Check one section only). Four or more clinical infractions will result in a drop of one letter grade for that clinical internship. Four or more Clinical Infractions of the RTT program policies Three Clinical Infractions of the RTT program policies Two Clinical Infractions of the RTT program policies One Clinical Infraction of the RTT program policies No Clinical Infractions of the RTT program policies SECTION 4 1A) Clinical Procedure Lab: Section to be filled out by the Clinical Procedure Lab Adjunct Faculty & Clinical Coordinator only. 2A) Research Assignment: Section to be filled out by the Clinical Coordinator only 3A) Comprehensive Clinical Exam: Section to be filled out by the Clinical Coordinator only *PLEASE CIRCLE ONE F <66 D 66-69 C70-72 *PLEASE CIRCLE ONE C 73-76 C+ 77-79 *PLEASE CIRCLE ONE B80-82 B 83-86 *PLEASE CIRCLE ONE B+ 87-89 A90-92 *PLEASE CIRCLE ONE A 93-100 Please take a minute to add comments. The Clinical Excellence Award is based on overall clinical performance. Evaluator’s General Comments: ELECTRONIC SIGNATURE: (script or typed): Chief Therapist/ Clinical Supervisor’s Signature: DATE: 80 For MCPHS Use Only: SECTION 1 CLINICAL COMPETENCY SECTION 2 CRITICAL THINKING SECTION 3 PROFESSIONALISM SECTION 4 PROCEDURE LABS (201C/202C) RESEARCH ASSIGNMENT 203C, 304C COMPREHENSIVE EXAM 305C 40% Average for Section 1: 30% Average for Section 2: 20% Average for Section 3: 10% The final grade is calculated at the College, please do not tell the student what you think their grade will be. ************************************************************************************************ Please complete this document and make a copy for your records. Send electronically by the final Friday of the internship. Please do not give the evaluation to the student to deliver. Any questions please call Susan MacIsaac at 617-732-2840, or Susan Belinsky, Program Director at 617-732-2261. The Program Director and the Clinical Coordinator reserves the right to review and change content of this form only in the case of major disagreement between MCPHS Program Officials and the Clinical Supervisor. Revised 8/07, 1/08, 6/09, 12/09, 8/10, Reviewed 8/11 81 Recompetencies & Unsuccessful Recompentencies Policy The student is responsible for the maintenance of clinical skills throughout the program in order to achieve the program’s terminal objectives for each student. The student is expected to recall and maintain previously learned treatment procedure skills, and didactic class work, and continue to build upon this foundation of knowledge. The purpose of a Recompetency is for the student to demonstrate continued clinical competency throughout the program of study. Procedure 1. 2. 3. 4. 5. 6. 7. 8. Recompetencies on previously passed competencies are required in RTT 304C & RTT 305C clinical internships (Third year students) The recompetencies procedures are not scheduled in advance The student is not to pick the patient to recomp or pick the time of the recomp 7 recompetencies are due for RTT 304C and 7 recompetencies are due for RTT 304C No more than 7 recompetencies will be accepted for the above clinical internships If a student is ahead in the required number of treatment competencies for a particular clinical internship, they will be required to do recompetencies to total the number of required competencies. Student can recomp on previously passed recompetencies only if the particular treatment unit assigned does not have the cases needed for other recompetencies. Therapists can request a student do a recompetency at any time if they feel the student is lacking skill and knowledge of a particular procedure. Unsuccessful Recompetencies 1. 2. 3. 4. 5. A student who fails a re-competency will need to repeat the entire procedure: including; log in(s), knowledge assessment, oral competency and the re- competency. If an attempted recompetency is assessed by the therapist to be unsatisfactory, a written warning will be issued to the student with input from the clinical staff, Clinical Coordinator, and/or the Program Director. The student will also be required to write a narrative describing the failed recompetency procedure, the reasons for failure and steps that should have been taken in order to be successful. If the student does not follow through with the action plan and does not show improvement in the outlined problem areas, the student will fail the clinical internship for that semester. A student who fails the second recompetency will fail the clinical internship for that semester. 82 Recompetency Form STUDENT:_______________________ CLINICAL SITE_________________ CLINICAL SUPERVISOR:___________________________________ CLINICAL INTERNSHIP (circle one) 203C, 304C, 305C DATE/SEMESTER STUDENT PASSED ORIGINAL COMPETENCY:___________________ DATE OF RECOMPENCY:______________________________________________________ PROCEDURE TYPE: ___________________________________________________________ FIELD & SET UP PARAMETERS:________________________________________________ OVERALL PERFORMANCE IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully Referred to all necessary set up notes, chart, instructions written/electronic CONCEPT COMPREHENSION & ASSESSMENT Comprehension of concepts necessary for completing this task was: (check all that apply) Inadequate for basic concepts, needs remediation or review Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts Able to identify critical structures in field and tolerance doses Able to identify beam modifiers, why and how used Able to identify potential acute effects from these fields TECHNICAL SKILLS OF CLINICAL PROCEDURE Procedure accomplished using unsafe technique; has not mastered procedure & clinical set up or documentation Procedure accomplished using improper technique; difficult timing & coordination, documentation not performed or verified Procedure generally accomplished using proper technique, minor problems with timing and coordination, minor difficulty with documentation Procedure performed using proper technique; coordination & timing of procedure appropriate. Proficient in documentation Procedure performed using proper technique, coordination and timing precise. Proficient in documentation PASS YES/*NO GRADING OF RECOMPETENCY COMMENTS Clinical Supervisor/therapists signature:_________________ (print name below) ___________________ 83 RECOMPETENCY CLINICAL COMPETENCY REQUIREMENTS Master List of Recompetencies Required * THERAPIST’S SIGNATURE IS REQUIRED FOR EACH RECOMETENCY Mandatory BRAIN Comp. 5: Comp. 5a: Primary Metastatic HEAD AND NECK Comp. 6: Comp. 6a: Laterals Only 3 Field & Supraclavicular CHEST Comp. 7: Comp. 7a: AP/PA Obliques BREST Comp. 8: Comp. 8a Comp. 8b Tangentials Advanced Primary Posterior Axillary Boost ABDOMEN Comp. 9: Comp. 9a: Comp. 9b: AP/PA 3 or more fields Para-Aortic PELVIS Comp. 10: Comp. 10a: Comp 10b: Comp. 10c: AP/PA Multiple Field Supine Multiple Field Prone Inguinal SKELETAL Comp. 11: Comp. 11a: Spine Extremity ELECTRON FIELDS Comp. 12: Comp. 12a: Single Abutting Fields LOW VOLUME/HIGH RISK PROCEDURES Comp. 13: Total Body Irradiation Comp. 14: Craniospinal Date Completed Date of Recomp Verified By **Candidates who complete their educational program during 2005 or 2006 may use either the previous (2004) requirements or the current (2005) requirements. Candidates who graduate after December 2006 may no longer use the previous (2004) competency requirements. 84 Clinical Conference Policy Policy The student will attend all scheduled conferences including; chart rounds, M&M rounds, professional case presentations and CEU lectures during the clinical day. Individual case presentations by radiation oncology resident physicians. Discussion centers on diagnosis, natural history of disease, work-up and staging, treatment rationale, placement of radiation portals, and acute and long-term effects of treatment. This conference is the main teaching tool for the instruction of the radiation oncology residents. Procedure 1. The student will be required to attend conferences for educational purposes and fill out a conference documentation form for each date attended. 2. The student will review topics for discussion with the appropriate staff: physicians, residents, physicists, dosimetrists, nursing, or radiation therapists depending on the topic to research 3. The student will be responsible for having the documentation signed by the professional 4. The student will review and save any hand-outs distributed during the conference 5. The student will have the attendance record reflect the missed clinical time to attend conferences 6. Students will be expected to attend conferences that may be held during the lunch hour and are not expected to take an additional hour off from the clinical day. Revised 8/06, 8/09, Revised 8/10 85 School of Medical Imaging & Therapeutics Department of Radiation Therapy Program Clinical Conference Documentation Form STUDENT:________________________ CLINICAL SITE:___________________ NAME OF CONFERENCE/ROUNDS:___________ DATE:____________________________ CLINICAL SUPERVISOR SIGNATURE:_________________________ Topic/patients discussed: Information/Education for review: Students will be expected to attend conferences that may be held during the lunch hour and are not expected to take an additional hour off from the clinical day. *falsifying attendance is a violation of ethics and program policies Revised 8/06, 8/09, 8/11 86 Radiation Protection Radiation Safety Goal The student will gain clinical experience in the practice of radiation protection and brachytherapy procedures through a two week rotation in the radiation safety office. This experience will be gained through observation of and providing assistance to the RSO team. Professional Behaviors Reporting to clinical assignment and assumed clinical duties at assigned time Observing all aspects of Radiation Safety Officer's role Utilizing clinical time to achieve clinical objectives Demonstrating self-direction in completing clinical objectives Knowledge Describe requirements and responsibilities for a RSO List objectives of a radiation protection program and demonstrate ability to document same Interpret personnel monitoring reports State examples of personnel and area radiation monitors Describe the theory and operation, demonstrate use of the following personnel and area monitors: ring badges, film badges, pocket ionization chambers, TLD’s GM counter, cutie pie Identify the applications, advantages and limitations of each of the above devices Identify controlled/uncontrolled areas and acceptable exposure limits for each State national/state radiation limits in controlled/uncontrolled areas State when a radiation survey should be done Identify who should conduct the survey List conditions and locations evaluated in an area survey Identify personnel to be notified in case of isotope loss or damage Describe “RADIATION AREA” signs Appropriate placement of “RADIATION AREA” signs Appropriate storage methods brachytherapy sources Source inventory procedures Maintenance, use and cleaning of brachytherapy applicators Leak testing of brachytherapy sources 87 Treatment Planning DOSIMETRY Policy The student will rotate through the physics/dosimetry departments to gain knowledge regarding the treatment planning of patient radiation therapy fields. A basic understanding of treatment planning concepts are necessary for a quality radiation therapy education. Procedure 1. 2. 3. 4. 5. 6. 7. 8. The student will be required to do a three week dosimetry rotation during RTT 203C Summer clinical internship The student will be required to do a second dosimetry rotation in RTT 305C Spring clinical internship. The student will introduce themselves to the dosimetry staff during the first week of clinical and confirm the dates for the assignment. The student will meet with the dosimetry staff during the first week of clinical to review the competency and evaluation forms for that rotation. If the dosimetry staff is unable to meet with the student during the scheduled weeks, the student and the staff will discuss and agree upon different dates and notify the Clinical Coordinator in writing of those changes. It is the responsibility of the student to forward to the staff the correct evaluation forms and request staff to grade the student performance. The student will submit the dosimetry objective form, and the evaluation form to the Clinical Coordinator when turning in all clinically related documentation. The student will complete objectives for the Mould Room as required by the ARRT during one dosimetry rotation (does not have to be repeated in second dosimetry rotation) Revised 2010 88 RADIATION THERAPY PROGRAM Clinical Competency Evaluation -Treatment Planning Student Name:______________________________ Date:____________________ Evaluated by:_________________________________ Department:______________ This evaluation is to be filled out and reviewed with the student during the last week of their clinical rotation. Preceptors are asked to evaluate students’ professional behavior and communication skills by identifying how well the student met expectations of performance in each criterion. Expectations of performance are: Consistently exceeded (Exc) Consistently met (M) Not consistently met (NC) OVERALL performance in each area is to be ranked using the following scale: outstanding above average average below average unsatisfactory Ratings of outstanding or unsatisfactory must be accompanied by comments. ______________________________________________________________________________ PROFESSIONALISM Students shall demonstrate professional behavior, motivation and intellectual curiosity: Exc M NC Expectations were Professional appearance-complies with dress code a. wears personal radiation monitor at all times Cooperates with dosimetrists Interacts courteously with other medical personnel Uses appropriate language (proper grammar, no slang, profanity, etc.) Maintains patient confidentiality Follows chain of command when addressing conflicts Assuming clinical duties at assigned time Notifying staff prior to absence/tardiness Informing staff of whereabouts at all times during assigned hours Relaying messages promptly Respects the professional knowledge/skills of nurses Seeks staff assessment of progress Acts on staff assessment and suggestions for improvement Concentrates on learning rather than social climate Reviewed rotation objectives with staff Observes all aspects of dosimetrist’s role Demonstrates self-direction in completing clinical objectives Utilizes clinical time to complete clinical assignments 89 Demonstration of professional behavior: outstanding above average Demonstration of motivation: outstanding above average average below average unsatisfactory average below average unsatisfactory Demonstration of staff communication skills: outstanding above average average below average unsatisfactory COMMENTS:_______________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________ Areas of Strength: Areas needing Improvement: Preceptor/Instructor:__________________________________________________ Student:_____________________________________________________________ (Signature indicates only that evaluation has been reviewed.) Student comments: (Please attach additional sheet if necessary.) 90 RADIATION THERAPY PROGRAM Radiation Safety - Clinical Competency Evaluation Student Name:_________________________ Date:__________________________ Evaluated by:__________________________ Evaluation period:________________ Please use the space provided for comments and suggestions for improvement. GOAL: The student will gain clinical experience in the practice of radiation protection and brachytherapy procedures through a rotation in the radiation safety office of an affiliated clinical education center. This experience will be gained through observation of and providing assistance to the RSO team. The student will demonstrate PROFESSIONAL BEHAVIOR by: S US S US S US Report to clinical assignment and assumed clinical duties at assigned time Observing all aspects of RSO’s role Utilizing clinical time to complete clinical objectives Demonstrating self-direction in completing clinical objectives The student will demonstrate KNOWLEDGE of radiation safety procedures by: Describe requirements and responsibilities for a radiation protection officer List objectives of a radiation protection program and demonstrate ability to document same Interpret personnel monitoring reports State examples of personnel and area radiation monitors Describe the theory and operation and demonstrate use of the following personnel and area monitors: ring badges, film badges, pocket ionization GM counter, cutie pie Identify the applications, advantages and limitations of each of the above devices Identify controlled/ uncontrolled areas and acceptable exposure limits for each National/ state radiation limits in controlled/ uncontrolled areas State when a radiation survey should be done Identify who should conduct the survey List conditions and locations evaluated in an area survey Identify personnel to be notified in case of isotope loss or damage Describe “RADIATION AREA” signs The student will observe and assist with/in: Determining the presence of radiation in controlled or uncontrolled areas Area and room surveys during and following brachytherapy procedures 91 Appropriate placement of “RADIATION AREA” signs Appropriate storage methods for brachytherapy sources Source inventory procedures Maintenance, use and cleaning of brachytherapy applicators Leak testing of brachytherapy sources Overall assessment of clinical performance: ______satisfactory ______acceptable with reservation (see notes for improvement) ______satisfactory (documentation of efforts to correct deficiencies attached) Areas of Strength: Areas Needing Improvement: Preceptor/Instructor:__________________________________________________ Student:_________________________________________ (Signature indicates only that evaluation has been reviewed.) Student comments: (Please attach additional sheet if necessary) 92 Massachusetts College of Pharmacy and Health Sciences School of Medical Imaging & Therapeutics Radiation Therapy Program Dosimetry Competency Form Record and Verify Competency The goal is to have a solid working foundation of the tools available in the system Record and Verify System: 1. Enter simulation fields 2. Enter treatment fields 3. Primary dose tracking 4. Secondary dose tracking 5. Troubleshoot dose tracking problems 6. Dose action points a. When to use b. Add dose action point c. Acknowledge dose action point 7. Manually record treatments a. Necessity b. Document reason 8. Treatment calendar a. Create new treatment calendar b. Changing treatment calendar c. Schedule films d. Dose tracking e. Schedule unusually patterned treatments 9. Prescriptions a. Information needed Signatures 1. Images MET UNMET COMMENTS Calculation Competency The goal is to understand factors involved in MU and dose calculations. Students are expected to be proficient in mu calculations for all types of fields. Calculations: 1. Interpolation 2. Single fixed SSD MU calculation a. Extended distance MU calculation b. Mayneord F factor c. Inverse square d. Given dose e. Dose to a point f. Bolus g. Transmission factors 3. SAD MU calculation a. Weighted fields b. Mixed energy fields c. Normalization d. Bolus e. Transmission factors 4. Electron MU calculation a. Extended distance MU calculation b. Bolus c. Cutouts 93 MET UNMET COMMENTS 5. 6. d. Pb shielding on skin Rotational field MU calculation a. understanding the difference when calculating for rotational fields: average TAR and MU/degree Equivalent square a. Unblocked field b. Blocked field c. Clarkson Calculation – When it is used Candidates must demonstrate competence calculating doses for each of the following treatment set-ups 1. Single, Open Field 2. Parallel Opposed Fields with Blocks 3. Geometric Gap 4. Weighted Fields 5. Wedged Fields 6. Computer Generated Isodose Plan 7. Electron Field Treatment Planning Competency The goal is to understand treatment planning techniques, what makes a valid plan vs. a nontreatable plan. Students should understand the effect of beam modifying devices through hands on learning. Students should be able to interpret information in a plan. Treatment Planning: 1. Contours a. Normal tissue b. CTV, GTV, PTV, ITV 2. Beams a. Beam parameters i. Independent jaws ii. Split beam b. Beam modifiers i. Use of MLC vs cerrobend and limitations ii. Use of hard wedges vs EDW and limitations c. Beam weighting 3. Prescription a. Normalization 4. Isodose lines a. Goals 5. Dose a. Target volume b. Normal tissue tolerance 6. 2-D planning 7. 3- D planning a. Breast/CW tangents b. Breast/CW with bolus c. 3 0r 4 field Breast d. Lung e. Pelvis f. Rectum 8. IMRT a. H & N b. Prostate c. Gyn 94 MET UNMET COMMENTS 9. 10. 11. 12. 13. 14. 15. 16. Cumulative plans a. What they are b. When they are needed DVH a. Interpreting the information DRRs a. Generate DRRs b. Generate electron cutouts Documentation Secondary MU calculation Plan check IMRT QA Plan approval a. In planning system b. In record and verify system Mould Room Competency The goal is to learn about different techniques used in patient setup and treatment through actual involvement in the design and creation of blocks, bolus, etc. Blocks, Bolus 1. Create cerrobend Photon and electron blocks in planning system 2. Cut cerrobend photon and electron blocks 3. Aquaphor bolus 4. Superflab 5. Custom bolus 6. Pb shields for electrons 7. Moulds MET UNMET COMMENTS STUDENT: _________________________________ DATE: ____________________________ CLINICAL STAFF:__________________________ TITLE/CREDENTIALS:_______________ CLINICAL SITE:____________________________ CLINICAL ROTATION: (Circle one) RTT 304C, RTT 305C COMMENTS:__________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Created 8/11 95 Mould Room The goal of the mould room rotation is the integration and application, by the second year radiation therapy student, of the theory and skills utilized in the mould room/machine shop. If no mounted blocks are being used in this department, student will schedule a visit with personnel to develop mounted blocks for a “mock or simulated” case. Accomplishment of this goal will be evaluated by the mould room technicians and the completion of the following: a. b. c. d. one custom mounted cerrobend block (from start to finish) one custom electron block bolus (discuss and/or make various depths) compare custom block theory to MLC blocking (parameters, limitations etc.) Students shall demonstrate: a. b. c. d. the ability to report on time to the assigned area professional attitudes and respect for staff constructive use of time to complete objectives understanding and application of safety procedures Revised 8/04, 8/09 96 RADIATION THERAPY PROGRAM Mould Room Rotation Form Student Name:_________________________ Date:_________________________ Evaluated by:__________________________ Evaluation Period:_______________ STUDENT IS ABLE TO: PERFORMANCE: S US 1. Report to mould room assignment and assume mould room duties at assigned time. 2. Utilize time to complete mould room objectives. A. Align a simulator film on the Huestis cutter. B. Set the proper focus tray distance and focus film distance. C. Select correct styrofoam mould. D. Tape the mould to prevent leakage. E. Weight the moulds down on the cooling table. F. Pour cerrobend into mould. G. State time necessary for the block to form. H. Select correct tray to mount block on. I. Set mounting device with correct FFD and align film on the isocenter. J. Slide tray into mounting device to select the screw holes. K. Drill holes in tray and blocks. L. Mount blocks to tray. M. Label block correctly. 3. Construct electron moulds and cutouts 4. Observe the construction of a compensator 5. Dismantle incoming blocks 6. Select/make appropriate size bolus for a patient 97 STUDENT:___________________________ DATE:__________ CLINICAL SITE:______________________ COMPETENCY 1: Identify components of a Linear Accelerator The student will locate and identify the major components and treatment accessories for a linear accelerator. This is to be evaluated in a simulated situation following student orientation. EQUIPMENT UTILIZED: LOCATE AND IDENTIFY: 1. Gantry a. rotation scale b. back stop 2. Collimator a. length and width scale b. field light switch c. room light switch d. plug mounting e. rotation scale f. switch to rotate collimator 3. Treatment Couch a. couch rotation scale b. motion locks c. motion switches—couch and pendant d. mylar-standard and center spine 4. Accessories a. distance and rod holder b. lead blocks c. templated cerrobend blocks d. wedges e. compensators f. breast bridge (if used) g. spirit level h. bolus i. head immobilizer j. calipers k. angle board l. mantle board 5. Other positioning/ immobilization devices a. sponges b. sandbags c. straps d. ropes e. casts 6. Emergency shut-off switches a. inside room b. outside room PERFORMANC: 98 S US NA STUDENT:___________________________ PERFORMANCE: 7. a. b. c. d. e. Console monitor panel wedge panel fault panel arc therapy panel back-up counter IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully COMMENTS: Student’s Signature ____________ Clinical Supervisor’s Signature 8/95 Revised: 9/99 Reviewed: 8/01, 8/07 99 S US NA STUDENT:____________________________ DATE:_____________ CLINICAL SITE:______________________ COMPETENCY 2: Use of Linear Accelerator Components The student will locate and demonstrate the use of the major components and accessories of a standard linear accelerator. This is to be evaluated in a simulated situation after student orientation. DEMONSTRATE USE THE FOLOWING: SAFE HANDLING PROCEDURES: 1. Gantry rotation scale 2. Collimator a. length and width scale b. field light switch c. interlock indicators d. rotation scale e. switch to rotate collimator 3. Treatment Couch a. couch rotation scale b. locks for couch motion c. switches for couch motion 4. Pendant a. motion enable bar b. controls for unit in use 5. Accessories a. distance rod and holder b. lead blocks c. templated cerrobend blocks d. wedges e. compensators f. breast bridge (if used) g. spirit level h. bolus i. calipers j. aquaplast system k. mantle board l. angle boards (lg. & sm.) 6. Other positioning and immobilization devices a. sponges b. sandbags c. straps d. ropes e. casts 7. Locate emergency shut off switches a. inside room b. outside room 8. Demonstrate termination of treatment BEAM a. door b. console switch c. key 100 EQUIPMENT UTILIZED: PERFORMANCE: S US NA STUDENT:____________________________ 9. Console—demonstrate setting each of the following a. monitor panel b. wedge panel c. fault panel d. Arc therapy panel e. back-up timers IN PERFORMING THIS PROCEDURE,THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully Comments: Student’s Signature: ____ Clinical Supervisor’s Signature: 8/95 Revised: 9/99 Reviewed: 8/01, 8/07 101 S US STUDENT:____________________________ DATE:___________ CLINICAL SITE:______________________ COMPETENCY 3A: Treatment Unit Orientation & Emergency Procedures (First Clinical Year) The student will demonstrate competency in emergency procedures and in the identification and use of equipment associated with the assigned treatment unit. This will be accomplished by the end of the second week of each clinical rotation of the first year. This will be assessed with the clinical supervisor for the treatment unit in a simulated situation. PERFORMANCE: PROCEDURE: 1. Locate: a. Emergency shut-off switches in the room b. Emergency shut-off switches outside room (incl. circuit breaker) c. Treatment room code button d. Code cart e. Ambu bags f. Suction machine g. defibrillator h. O2 i. fire extinguishers j. fire alarms k. fire exits l. emergency pendent 2. State the emergency phone numbers: a. medical (cardiac, respiratory, psych) b. fire c. security 3. List information to be provided if emergency number is contacted: a. name, department, position b. nature of emergency c. location 4. Describe departmental emergency procedures: a. code b. fire 5. Identify and demonstrate proper use of the following components: (beginning with third rotation) a. standard block tray holder b. electron cones c. standard and custom compensators d. wedges e. extended range couch motion 6. Locate and demonstrate use of all controls operating (Beginning with third rotation) a. collimator 1. rotation 2. field sizes b. gantry c. couch d. console (including manual setting of back-up timers) 102 S US NA STUDENT:___________________________ IN PERFORMING THIS PROCEDURE,THE STUDENT: (Check those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully Comments: Student’s Signature: Clinical Supervisor’s Signature: 8/95 Revised: 9/99 Reviewed: 8/01, 8/07 103 STUDENT:___________________________ DATE:_____________ CLINICAL SITE:______________________ COMPETENCY 3B: Treatment Unit Orientation & Emergency Procedures (Second Clinical Year) The student will demonstrate competency in emergency procedures and in the identification and use of equipment associated with the assigned treatment unit. This will be accomplished by the end of the first week of each clinical rotation of the second year. This will be assessed with the clinical supervisor for the treatment unit in a simulated situation. CLINICAL ASSIGNMENT: PERFORMANCE: PROCEDURE: 1. Locate: a. Emergency shut-off switches in the room b. Emergency shut-off switches outside room (incl. circuit breaker) c. Treatment room code button d. Code cart e. Ambu bags f. Suction machine g. defibrillator h. O2 i. fire extinguishers j. fire alarms k. fire exits l. emergency pendent 2. State the emergency phone numbers: a. medical (cardiac, respiratory, psych) b. fire c. security 3. List information to be provided if emergency number is contacted: a. name, department, position b. nature of emergency c. location 4. Describe departmental emergency procedures: a. code b. fire 5. Locate and demonstrate use of all controls operating (Beginning with third rotation) a. collimator 1. rotation 2. field sizes b. gantry c. couch d. console (including manual setting of back-up timers) 6. Discuss limitations: a. field size b. SSD c. wedges and compensators 1. field size 2. orientation relative to collimators 3. block trays (if used) 104 S US NA STUDENT:___________________________ 7. Identify and demonstrate proper use of the following components: (beginning with third rotation) a. standard block tray holder (if used) b. electron cones c. standard and custom compensators d. universal wedges e. extended range couch motion f. use of independent collimator settings g. immobilization devices 8. Correctly measure and record beam quality a. state tolerances b. describe procedure followed if not meeting quality standards 9. Discuss how to start the treatment unit if emergency off has been engaged or circuit breaker has been tripped. IN PERFORMING THIS PROCEDURE,THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully DEMONSTRATE USE THE FOLOWING: SAFE HANDLING PROCEDURES: EQUIPMENT UTILIZED: PERFORMANCE: S US 1. Gantry rotation scale 2. Collimator a. length and width scale b. field light switch c. interlock indicators d. rotation scale e. switch to rotate collimator 3. Treatment Couch a. couch rotation scale b. locks for couch motion c. switches for couch motion 4. Pendant a. motion enable bar b. controls for unit in use 5. Accessories a. distance rod and holder b. lead blocks c. templated blocks d. wedges e. compensators f. breast bridge g. spirit level h. bolus i. calipers 105 S US NA j. aquaplast system k. mantle board l. angle boards (if used) 6. Other positioning and immobilization devices a. sponges b. sandbags c. straps d. ropes e. casts 7. Locate emergency shut off switches a. inside room b. outside room 8. Demonstrate termination of treatment BEAM a. door b. console switch c. key 9. Console—demonstrate setting each of the following a. monitor panel b. wedge panel c. fault panel d. Arc therapy panel e. back-up timers IN PERFORMING THIS PROCEDURE,THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully Accomplished in the _______ week of this rotation. Comments: Student’s Signature: Clinical Supervisor’s Signature: 8/95 Revised 9/99, Reviewed 8/01, 8/07 106 S US STUDENT:____________________________ DATE:___________________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures---Clinac 2100 CD The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor. EQUIPMENT UTILIZED: PROCEDURE: 1. With key in standby, turn on console monitor. 2. Perform Varian diagnostic machine check by hitting the F2 function key (BIH10 and BWH15 only). 3. Place key in machine and turn “ON”----time delay appears. 4. Activate MLC by turning on the power coordinator. Turn on MLC computer/Hyperterminal already on 5. Switch the MLC from CLINICAL mode to PARK mode. 6. Select “Morning Checkout” 7. Place the 20x20 electron cone into the collimator. 8. At completion of time delay, select correct number of MU and beam energy for assigned treatment unit, turn key to “ON” and press beam on. 9. Bring up Argus- enter password. Perform Argus check. (Door, warning light etc.) 10. Perform morning dosimeter readings a. Place PROTEA on table, align crosshairs, set correct SSD b. Select and run separately: MU of 6, 9 and 12 MEV energies. Record all five channels after each energy is run. c. Repeat “b” with each photon energy d. Place victoreen on table, Align crosshairs, set SSD e. Enter temp and pressure, check for correct machine and energy. f. Select and fun separately 4,6.9.12.15 MeV’s using Argus g. Repeat with photon energy. 11. Report to physics if readings are outside standard limits 12. Record values in “Morning Checkout” for water pressure, water temperature, and gas pressure. Describe radiation therapist responsibilities when readings are unacceptable. 13. Check jaw sizes. 14. Turn on patient monitoring devices. 15. Run MLC test – field 1 and 2 with film test 16. Check lasers and ODI 17. Explain the flatness and symmetry of the beam you are checking. IN PERFORMING THIS PROCEDURE THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully 107 S US S US STUDENT:___________________________ CONCEPT COMPREHENSION: Comprehension of concepts necessary for completing this task was: (Check one) Inadequate for even basic concepts Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts ADDITIONAL COMMENTS: Student’s Signature: Clinical Supervisor’s Signature: 8/95 Revised: 9/99, 8/01 108 STUDENT:____________________________ DATE:___________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures---Varian Brigham 6 ex The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor and is comfortable with the procedure. EQUIPMENT UTILIZED: PROCEDURE: 1. Turn monitors on by flipping switches (located under open door cabinets) 2. Press F2 on the Clinac console and execute a self-test 3. Insert keys into the Clinac computer and console. Turn Clinac from standby to on. This will initiate the 12-minute time delay 4. Inside room, move Gantry & collimator to zero degrees. Read temp. pressure of room, and water temp, water & gas pressure of Clinac 5. Turn on the MLC computer, IMPAC Computer, and Portal Vision Computer 6. Turn on MLC Contoller when HyperTerminal program is up 7. Program IMPAC once HyperTerminal indicates MLC leafs are moving 8. Ask therapist to log into IMPAC. A new screen should appear showing the leafs in Red moving in/out 9. Log in to the Portal Vision Computer at this time: Username: therapist Password: therapist 10. Ask Therapist to put IMPAC into standby 11. Bring up the “Millennium MLC Workstation”, and park the mlc 12. On Console load “Morning Checkout”, check that Opening Door and turning Key shut machine off. Also test backup counter 13. Exit out of Morning Checkout and record water temperature, water & gass pressure of Clinac 14. Bring up Clinical Mode 15. Setup the Argus system inside room to measure beam output 25 X 25 field size 100 FSD Place lcm build up plate onto tracker 16. Have therapist log into Argus system outside of room. Run 100 MU’s. Measure & record Beam output. Save data and exit 17. Perform IMRT QA test 18. Close MLC program that is in Park and then exit standby in IMPAC S IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully 109 US NA STUDENT:____________________________ CONCEPT COMPREHENSION: Comprehension of concepts necessary for completing this task was: (Check one) Inadequate for even basic concepts Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts ADDITIONAL COMMENTS: Student’s Signature: Clinical Supervisor’s Signature: 8/07 110 STUDENT:____________________________ DATE:___________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures---Varian 6/100 The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor and is comfortable with the procedure. EQUIPMENT UTILIZED: PROCEDURE: 1. Place keys in the machine and turn “on” 2. Identify and rectify any machine interlock 3. Delay light appears, set timer to 9.9 4. When delay light goes off, turn key to “on” 5. Record the following readings in the log book (depending on machine) -Mag filament voltage -gun filament voltage -p.s. current -PFN voltage -beam current -vacuum -beam off, 150 & 300 dose rate -300V -mag. filament -mag. 1 -gun 1 -error -doserate -150 doserate -focus -centering -gantry angle 6. After 999(888) test is completed, set 777, turn beam “on” 7. Perform lamp test reading from inside(outside) the gantry stand. a. air pressure (PSI) b. H2O temperature c. primary and secondary Freon d. explain radiation therapist responsibilities when readings are unacceptable. 8. Check the back-up timer is set at 460 9. Perform a full field check 10. Record and assess beam quality by performing morning dosimeter readings using PROTEA or diode checker 11. Leave room and set 200 monitor units on console. 12. Turn “on” 13. Deliver 200 mu and record the three diode readings 14. Repeat for opposite direction 15. Report to physics if readings are outside standard limits 16. Check jaw sizes---6x6, 15x15, 30x30 17. Turn on patient monitoring devices 111 S US NA STUDENT:___________________________ IN PERFORMING THIS PROCEDURE THE STUDENT: (Choose those which apply) Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully CONCEPT COMPREHENSION: Comprehension of concepts necessary for completing this task was: (Check one) Inadequate for even basic concepts Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts ADDITIONAL COMMENTS: Student’s Signature: Clinical Supervisor’s Signature: 8/95 Revised: 8/99 Reviewed: 8/01 112 STUDENT:____________________________ DATE:___________________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures--- 21 EX Linear Accelerator The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor. EQUIPMENT UTILIZED: PROCEDURE: 1. With key in standby, turn on console monitor. 2. Insert keys (2) located on the ledge of cabinet door in console and Standby/ On switch 3. Turn on HyperTerminal (Black Box) 4. Turn MLC Computer On and Log-in 5. Wait 5 minutes to complete initialization of MLC Leaves-go to “START” and click on “MLX Millennium” to view leaves initializing 6. Bring the gantry up to 0 degrees (failure to do this will cause MLC initialization to fail) 7. Bring up Argus – enter password 8. Perform morning dosimetry readings a. Place victoreen on table, align cross hairs, set SSD b. Enter temp and pressure, check for correct mach and energy c. Select and run separately 4,6,9,12,15 meV’s using Argus d. Repeat with photon energy 6 and 10 Mv 9. Report to physics if readings are outside standard limits 10. Turn IMPAC Monitor On 11. Boot up IMPAC Hard Drive (only after MLC initialization is complete) 12. Log-in to IMPAC from the desktop 13. Park MLC 14. Take the following readings from inside the Gantry Stand: a. Water Pressure – approximately 76 psi b. Water Temperature – approximately 40 degrees c. Gas Pressure – approximately 32 psi 15. MLC Test/ Check lasers and ODI 16. Explain flatness and symmetry of the beam you are checking. IN PERFORMING THIS PROCEDURE THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully 113 S US S US STUDENT:___________________________ CONCEPT COMPREHENSION: Comprehension of concepts necessary for completing this task was: (Check one) Inadequate for even basic concepts Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts ADDITIONAL COMMENTS: Student’s Signature: Clinical Supervisor’s Signature: 9/01, 8/07 114 STUDENT:____________________________ DATE:___________________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures---Siemens Primus The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor. EQUIPMENT UTILIZED: PROCEDURE: 1. Boot-up Windows 2. Place key in stand-by, turn to PGM/RDY (type in date and time). 3. Place the 25x25 electron cone into the collimator 4. Select correct number of MU and beam energy for assigned treatment unit, turn key to “ON” and press beam on. Repeat procedure. 5. Perform morning dosimeter readings a. Set 10 X 10 to check for field size QA b. Place PROTEA on table, align crosshairs, set correct SSD c. Select and run separately MU of 6, 7, 9, 10, 12, 15MeV energies. Record all six channels after each energy is run. d. Repeat “b” with each photon energy (6MV-X and 10MV-X) S US 6. Report to physics if readings are outside standard limits. 7. Record values in “Morning Checkout” for Pulse tank pressure, Pulse tank oil level, SF6 pressure, Water level, Water purity light, Water pressure, Water temperature, Filament hours, HV hours, Meters, Room . temperature, air pressure and relative humidity. Describe radiation therapist responsibilities when readings are unacceptable. 8. Initialize table. 9. Turn on patient monitoring devices. IN PERFORMING THIS PROCEDURE THE STUDENT: Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully 115 S US STUDENT:___________________________ CONCEPT COMPREHENSION: Comprehension of concepts necessary for completing this task was: (Check one) Inadequate for even basic concepts Limited understanding of essential concepts Adequate understanding of basic concepts Above average understanding of basic concepts Comprehensive knowledge of basic and advanced concepts ADDITIONAL COMMENTS: Student’s Signature: Clinical Supervisor’s Signature: 3/00 Reviewed: 8/01 116 STUDENT:____________________________ DATE:___________________ CLINICAL SITE:______________________ COMPETENCY 4: Warm-up Procedures---Trilogy The student will demonstrate the morning warm-up procedure for each treatment unit. To be performed after the student has performed the procedure under the direction of a clinical supervisor. EQUIPMENT UTILIZED: PROCEDURE: S US 1. With key in standby, turn on console monitor 2. Place key in machine and turn “ON”----time delay appears. 3. Activate MLC by turning on the power coordinator. Turn on MLC computer/Hyperterminal already on 4. Turn on 4DCT 5. Hit F1 and select morning checkout 6. Check Lasers and ODI, Set 10x10 field Size 7. Bring Gantry to desired Angle. Check if crosshairs intersect the dosimeter @ the angle. 8. At completion of time delay, select correct number of MU and beam energy for assigned treatment unit, turn key to “ON” and press beam on. 9. 10. Perform morning dosimeter readings a. Bring Gantry to desired Angle. Check if crosshairs intersect the dosimeter @ the angle. b. Select and run separately: MU of 6, 9 and 12 MEV energies. Record all five channels after each energy is run. c. Repeat “b” with each photon energy d. Record dosimeter readings e. Check if readings are within tolerance 11. Report to physics if readings are outside standard limits 12. Record Room temperature, room pressure, check water level, water pressure, water temperature and gas pressure. 13. Adjust gas pressure and water level accordingly 14. Record values in “Morning Checkout” for water pressure, water temperature, and gas pressure. Describe radiation therapist responsibilities when readings are unacceptable. 15. Check jaw sizes. 16. Turn on patient monitoring devices. 17. Explain the flatness and symmetry of the beam you are checking. 18. Warm Up SBRT Cameras a. Set 20x20 field size b. Place SBRT PROTEA on table, set SSD and Align Cross hairs c. Turn on mobile SBRT computer unit d. Check CAX on PROTEA @ 270 and 90 degrees e. Record mag factor @270 degrees from mobile SBRT uit 19. Warm up OBI a. Turn OBI console on and select OBI application b. warm up tube with 20 second exposure 20. Print out necessary forms IN PERFORMING THIS PROCEDURE THE STUDENT: 117 S US Was obviously satisfied with an unsuccessful or incomplete result Was awkward and lacked a coordinated approach to the procedure Proceeded rapidly but exhibited a lack of attention to detail Was slow and deliberate Was well paced and thorough Exhibited dexterity, precision, and coordination Proceeded rapidly and skillfully 6/08 118 MASSACHUSETTS COLLEGE OF PHARMACY & HEALTH SCIENCES RADIATION THERAPY PROGRAM CLINICAL COMPETENCY EVALUATION – All procedures Student/Affiliate Information: Student Name: _____________________________________________________ Clinical Affiliate: ___________________________________________________ Date of Evaluation: __________________________________________________ Circle Appropriate Rotation: RTT 201C: RTT 202C: RTT 203C: RTT 304C: RTT 305C Clinical Instructor: __________________________________________________ Treatment Unit: _____________________Tx Energy_______________________ Patient Parameters: (Check all that apply) Cooperative ________ Difficult ________ In-Patient ________ Out-Patient ________ Mentally Alert ________ Confused ________ Treatment Parameters: (Give a brief explanation as to why this treatment is Simple, Intermediate, or Complex.) Simple ________ Field Shaping ________ Intermediate ________ Wedges ________ Complex ________ IMRT ________ Explanation: ______________________________________________________ Diagnosis: ________________________________________________________ 119 CLINICAL COMPETENCY EVALUATION ***TREATMENT PROCEDURE***___________ Psychomotor Domain Task 1. Identify & assist correct patient into treatment room 2. Verify Treatment Parameters 3. Verify treatment prescription & review chart and orders 4. Set up Treatment Unit o Obtain necessary equipment and accessories for treatment o Correct beam shaping devices inserted properly o Set controls for prescribed dose & follow “Time-Out” procedure & verify against R&V o Treatment parameters correctly reproduced under direct supervision 5. Patient Positioning o Follow set-up notes and position patient accurately using positioning mold or immobilization devices when specified o Check field placement & make adjustments o Level patient o Set correct field size o Set field light to area marked (including “flash”) o Set correct machine parameters: SSD or SAD Table height (CV, CL) Gantry angle Collimator angle Table angle (kick) 6. Monitoring Patient o Maintain continual observation of patient and physical contact with controls during treatment 7. Documentation o Record the following data in the treatment chart according to department procedure: Initials of student and therapists performing treatment 120 Pass Fail Date Elapsed Days (if applicable) MU’s (monitor units) Daily dose for each portal treated Total dose for each portal treated Combined field dose (if applicable) Total critical organ dose (if applicable) o Any changes in treatment set-up or dose o Check for any treatment delivery errors o Verify entry with therapist whose initials appear in the chart for this treatment Interpersonal Domain 1. 2. 3. 4. Task Sensitivity and Compassion o Addresses patient’s physical and emotional well-being o Responses appropriately to patient questions and concerns o Provides culturally competent care Personal Interactions o Interacts with Radiation Therapy Team in a positive and productive manner Maintains high ethical standards o Promotes patient dignity o Maintains patient confidentiality Correlation of Theory and Technique o Theory – Didactic knowledge o Technique – Application of knowledge through neuromuscular application o Utilizes Critical Thinking Skills Pass Fail Comments: ________________________________________________________ __________________________________________________________________ The Clinical Instructor/Supervisor has reviewed the results of this Competency Evaluation with me: Student: _______________________________________ Date: _______________ Clinical Instructor/Supervisor:__________________________________________ 8/11 121 CLINICAL ATTENDANCE/Student Absences As health care professionals you will always be expected to be on time or early for all scheduled work days. Therefore, I expect that you will be present & on time for all classes. Policy Clinical internship will be 8 hours in length with a thirty-minute lunch break. All students will follow the published MCPHS holiday and vacation schedule. Clinical internship is a MCPHS course, therefore, in the case of severe weather attendance will follow the College’s decision for school closing or delayed opening. All unexcused and excused clinical time will need to be made up prior to the end of the semester. Procedure 1. 2. 3. 4. 5. 6. 7. Each semester students are assigned to a clinical internship site by the Clinical Coordinator in accordance with the MCPHS clinical affiliation agreements. Students are expected to arrive at the clinical facility on time and check-in with the clinical site supervisor designee. Students must sign-in and sign-out each day before leaving the clinical site and the clinical supervisor and must sign the attendance record each clinical day. Student’s class, vacation and holiday schedules follow the MCPHS schedule. The Clinical Coordinator will notify the clinical facility when MCPHS classes are from the clinical site(s). In the event MCPHS remains in session and in the absence of the Program Director and Clinical Coordinator, the clinical site instructor should use their own best judgment in releasing the students from their clinical sites during severe weather conditions, or during other emergency situations. The student is expected to attend clinical for the full 8 hours scheduled. If there is reason that the treatment unit is finished for the day, the student must seek other clinical work, and/or treatment unit to attend until the end of the clinical day. **Greater than 4 clinical unexcused absences will result in an “F” for the Clinical Attendance section of the clinical grade – Supervisor’s Evaluation Of Clinical Skills. 8/07, Revised 8/10 122 RADIATION THERAPY PROGRAM Clinical Education Attendance Record Student_________________________________(Date From: - - ) (To - - ) Clinical Education Center:_________________ Record is to be signed and dated at the completion of EACH clinical day Date Time in Time Out Time Comments/ Conference Therapist Therapist Missed Make-up date Attendance signature signature (- time) (+ time) Full Staff Signature mm/dd/yy 8:00 s. 4:30 s. - 8 hours s. macisaac macisaac macisaac Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday *It is the responsibility of the student to maintain accurate clinical attendance records & keep record posted at treatment unit at all times. Copies of this form should be made by the student as needed. *Conference attendance is mandatory for all students except when attempting a log in or patient competency. 123 Clinical Intent Policy The student and the clinical staff will review patient census and create a clinical plan for clinical competency objectives. Procedure 1. The student will be required to fill out a clinical intent form during the FIRST week of clinical. 2. The student will fax the completed clinical intent form to the Clinical Coordinator 3. The intent form should be posted at the treatment unit and reviewed with the therapy staff. 4. A new Clinical Intent form will need to be filled out for each treatment rotation. 124 RADIATION THERAPY PROGRAM Clinical Competency Intent Form PLEASE REVIEW WITH STAFF AND POST BY THE 2nd CLINICAL DAY STUDENT: ____________________________________________________________ CLINICAL SITE:________________________________________________________ TREATMENT UNIT: ____________________________________________________ RTT 201C, 202C, 203C, 304C 305C (CIRCLE ONE) DATE: ___________________ * A new clinical intent form must be filled out for each treatment or simulator rotation. Copy of this intent form will be reviewed with the staff, faxed to the Clinical Coordinator and posted on the treatment unit for the entire rotation. Any revisions to the original Clinical Intent will need to be faxed to the Clinical Coordinator. This is to clarify what I need to accomplish during my ___ week rotation. I intend to complete the following competency evaluations. * * * * * * Schedule of mid and final evaluation due dates: Clinical Evaluation by Clinical Supervisor – Mid Eval (1/2 way through each tx unit rotation / Due: _________________________ Clinical Evaluation by Clinical Supervisor – Final Eval (end of each tx unit rotation / Due:__________________________ *Student is required to evaluate the clinical site & instructors by the end of the clinical rotation. At any point in the rotation, the Program Director, Clinical Coordinator, clinical supervisors and the student may meet to review what progress has been made and what areas need to be improved. Student’s Signature: ___________________________________________________ Clinical Supervisor(s) Signature(s): __________________________________ Revised 8/09 125 Clinical Infraction Policy: Policy Infractions of the policies of the Radiation Therapy Program are determined by the clinical staff and/or the Clinical Coordinator. Designated clinical supervisors are expected to be forthcoming with any information regarding student clinical infractions. If the clinical supervisor prefers, the Clinical Coordinator will write up the clinical infraction and address the issue with the student. Procedure 1. 2. 3. 4. 5. 6. 7. 8. A Clinical Infraction form will be written up and reviewed with the student by the person issuing the written warning. The policy(ies), incident(s), and consequences of the infraction will be noted on the document and the student will be asked to sign it along with the person issuing the clinical infraction. A student signature indicates only that a warning has been received. If the student feels that extenuating circumstances should be considered in regard to the identified infraction(s), then the student should submit the information to the Clinical Coordinator & Program Director in writing. The Clinical Infraction will need to be reported by the clinical supervisor to the Clinical Coordinator who will address this with the student. Receiving three or more clinical infractions in a clinical internship will result in a drop of one letter grade for that clinical internship. The 4th clinical infraction will result in an additional drop in one letter grade. The 5th clinical infraction will result in an additional drop in one letter grade. Multiple Clinical Infractions will lead to either clinical probation or the student failing that clinical rotation. Revised 1/07, 2/09, 6/09, Reviewed 8/11 126 Clinical Infraction Form Date: Student: Policy(ies) Cited: Incident(s): MCPHS Clinical Coordinator notified Yes No Consequences: ________________________________ Staff Therapist/ Clinical Supervisor _________________________ Name of Clinical Site _________________________________ Susan MacIsaac, B.S.N., R.T.(T). Clinical Coordinator (optional – not needed if therapist signed) _________________________________ Student (A signature indicates only that a warning has been received) Comments Staff/Faculty: Student Comments: Revised 8/10, 8/11 127 Massachusetts College of Pharmacy and Health Sciences School of Medical Imaging & Therapeutics Clinical Incident Documentation Form This form serves as documentation of a clinical incident involving a radiation therapy student in the clinical education site. Upon completion of this form the original is placed in student’s file at the clinical site and a copy is sent to the Radiation Therapy Program Director at MCPHS. Students must also follow the specific policies and procedures of the clinical site regarding incident reports. Name of Student:______________________________________________________ Date and Time of Incident:______________________________________________ Clinical Site:__________________________________________________________ MCPHS Notified: Yes Date and Time Reported___________________ NO____ Brief Description of Incident (may use other side):__________________________ Action Taken (If any):____________________________________________________ Signature of Student:________________________________Date_________________ Signature of Clinical Supervisor:______________________Date_________________ 128 EXAMPLE OF AN E-JOURNAL RTT 202C WEEK #1 1/10-1/15/05 Susan MacIsaac BWH 6/100 Mv Have completed this week: Completed & posted clinical intent form Posted Attendance record Attended 2 noon conferences, completed & had signed documentation form Practice warm-ups 3 log – ins: PRIMARY BRAIN, 4 FIELD BREAST, MULTIPLE FIELD SUPINE - PROSTATE Plan to Do: 2 treatment competencies (name them, not numbered) (Multiple field supine, prostate)(multiple field prone - rectum), & oral competencies on both Warm ups on the 6 Mv TOTAL # OF TREATMENT UNIT COMPETENCIES COMPLETED THIS SEMESTER: (DO NOT INCLUDE COMPS 1-4) 7 TOTAL # OF COMPETENCIES COMPLETED TO DATE: 7 of 22 TOTAL # OF RECOMPETENCIES TO DATE (RTT 304 & RTT 305 only): 5 of 22 CONFERENCES ATTENDED (chart rounds, conferences, CEU events): *falsifying attendance is a violation of ethics and program policies Attendance: -1 hour due to leaving early for MD appointment *falsifying attendance record is a violation of ethics and program policies COMMENTS FOR BOTH NARRATIVES ARE REQUIRED: Narrative: 1) General Clinical Comments or Reflections: Narrative: 2) Specific Topic/educational concept that you learned this week. Describe RTT concept, clinical scenario, procedure, disease process or intervention. Staff therapists or interdisciplinary team members involved: (M.D. resident/interns, R.N., dosimetrist, physicist) 129 Warm-up & Warm-up Observation Policy The warm up procedure is an important aspect of quality assurance for the linear accelerator. Students are required to complete competencies of the warm up treatment unit procedures. The student will be required to complete a warm-up competency for each new treatment unit they rotate to. The student will not be expected to complete a warm up competency for any treatment unit they have done a competency on in past clinical sites. Procedure 1. 2. 3. 4. 5. 6. Warm-up Procedures are to be completed for each treatment unit starting in the 3rd clinical internship rotation, RTT 203C. The student will arrive early to study and/or test on the warm-up procedures. Students will schedule with the clinical supervisors, a minimum of three and a maximum of five dates to successfully complete warm-up competency. Warm-ups may be completed at any time during the rotation but dates are to be decided on during the first week of each assignment. The student who successfully completes the warm-up procedure on a treatment unit will not be required to repeat the procedure for the same unit at another clinical rotation (provided it is the same make/model equipment) but will be expected to observe the warm ups and complete a WarmUp Observation form. The student will remain on the treatment unit following warm-up. The student will be dismissed at the completion of an eight hour day (not including lunch break). For example, if warm-up begins at 6:30 am and the student takes a ONE hour lunch break, they may be dismissed at 2:30 pm. Revised 5/04, 6/08 WARM UP OBSERVATION 1. 2. 3. 4. Warm-up observation is required of all students in RTT 201C and RTT 202C clinical internships. Warm-up observation is also required of all students who have previously completed the warm up competency for that particular treatment unit. Students will observe and learn any variations in procedures each facility may have, and discuss any problem scenarios and staff interventions if applicable. The student will submit a record of the treatment unit warm-up observation and discuss any new information that was acquired through troubleshooting. Reviewed 8/10 130 MASSACHUSETTS COLLEGE OF PHARMARCY & HEALTH SCIENCES RADIATION THERAPY DEPARTMENT Warm-up Observation Form STUDENT NAME: CLINICAL SITE: CLINICAL ROTATION: CIRCLE ONE: RTT201C, RTT202C, RTT203C, RTT304C, RTT 305C DATE OF OBSERVATION: NAME/MAKE OF TREATMENT UNIT: THERAPIST’S SIGNATURE: STUDENT SIGNATURE: LIST ANY PROCEDURE VARIATIONS: LIST ANY READINGS OUTSIDE STANDARD LIMITS DATE OF ORIGINAL WARMUP PROCEDURE: LIST/DISCUSS THE TROUBLESHOOTING SCENARIOS 8/07, 8/08 131 CLINICAL SUPERVISOR AND INSTRUCTOR EVALUATION FORM Clinical Site:_______________________________ Clinical Rotation: ________________________ Clinical Supervisor/Chief Therapist_____________ Clinical Instructors/Therapists__________________ At the end of each clinical rotation, the student should answer the following questions, and submit the form to the Program Director. This evaluation provides the student with the opportunity to voice his/her questions or concerns, as well as thoughts about the internship as a whole (e.g., whether or not it was a good learning experience, evaluation of radiation therapists with whom the student worked, complaints or praise, the clinical supervisor was available to you, etc.) The following questions are representative of the question that you will be asked at the end of your rotation. These forms MUST be submitted by the end of the last day of each treatment unit rotation. Forms must be received from you to receive credit for the rotation! Choose the number (1, 2, 3, 4) that you feel is the most appropriate answer: “1” – without exception “2” – consistently “3” – occasionally “4” – does not display 132 The Radiation Therapist displays the following behaviors: Treats the student with patience & respect Provides opportunities & encouragement to perform procedures Explains procedures or suggests alternate resources when necessary Supervises student’s clinical work Assigned tasks related to clinical education Provided the student with an appropriate quantity of tasks 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 As a role model, the therapist: Demonstrated empathy and concern for patient welfare Demonstrated leadership qualities Communicated well with patients Communicated well with students As an evaluator of student performance/progress, the therapist: Informed the student of strength/weaknesses during rotation Provided positive reinforcement along with constructive criticism Promptly notifies student of areas of concern Encourages student participation in decision-making process Fills out evaluations on time Takes time filling out evaluations, and is specific Reviewed the evaluation with the student The Therapist Manager/Chief Therapist displays the following behavior: Oversees the student in the clinical environment by clarifying goals, objectives & expectations Presents clear performance expectations to students at the beginning & throughout the learning experience Addresses problems between clinical instructors & students as necessary Avails/ her/himself to students when needed Conducts periodic reviews of student performance through feedback from clinical instructors Clinical Site Specific: Site provided sufficient opportunity (i.e. patient load) to meet the course & site-specific objectives Resources (equipment, supplies, support services) were readily available on site to complete the rotation objectives Facilities (i.e. parking, cafeteria, personal space, & computer access) were adequate The clinical site served as a positive learning environment I was well received by the health professionals in the site Patient care was delivered according to professional ethics and standards Opportunities for interdisciplinary collaboration were available The preceptor/manager/chief demonstrated professionalism and leadership 133 These are the technical skills I learned/practiced on this rotation: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ _____________ The professional lessons that I learned/practiced on this rotation: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ___________________________________________________________ Additional Comments: ____________________________________ Student Signature (student's name and comments will not be divulged to the clinical site personnel) 134 MCPHS Pregnancy Declaration MCPHS Radiation Safety How to and Declare Your Pregnancy? In order to start this protection program, you must declare your pregnancy with your Instructor. A simple form is provided for you to declare your pregnancy. You must provide your name, a declaration that you are pregnant, the estimated date of conception (only the month and year need be given), and the date that you gave the form to the Instructor. All of this information is noted on the form. You may also write your own letter if you prefer. • You do not need to provide documented medical proof that you are pregnant. • Regulations require that the MCPHS receive the declaration in writing. • Even if you are visibly pregnant, the lower dose limits do not apply until pregnancy is declared in writing. • The choice to declare pregnancy, and thereby work under the lower dose limits is your choice. The College cannot direct you to make this declaration. • If you are planning to become pregnant (but are not yet pregnant), and sign a declaration, the lower limits will not apply until you declare in writing that you are pregnant. • Should you miscarry or discover that you are not pregnant, please notify the Instructor at your earliest opportunity. • After the birth of your child, you must notify the Instructor that you have given birth so that embryo/fetal monitoring can be canceled and your normal exposure limits can be reinstated. • You can revoke your declaration of pregnancy at any time, even if you are still pregnant by contacting the Instructor. Monitoring the Radiation Dose to Your Embryo/Fetus A special monitoring program has been developed to assist you and your Instructor with monitoring your radiation dose: • Once pregnancy is declared, an extra dosimeter or film badge will be provided by the MCPHS’s Radiation Safety Officer to monitor the exposure to your embryo/fetus. • Wear the dosimeter clipped on outer clothing under the lead apron if a lead apron is worn. The dosimeter should be worn at waist level at the location of your embryo/fetus at the part of the body that could receive the highest radiation exposures. This will usually be the front of your body. • A special report will be provided once a month so that both you, and your instructor, can track your monthly doses. Radiation Safety Officer also independently reviews these reports. 135 • If you have any questions about the reports, or how to properly wear the dosimeter, please contact the MCPHS Radiation Safety Officer at 617-732-2861. What are the health risks from radiation exposure to the embryo/fetus? During certain stages of development, the embryo/fetus is believed to be more sensitive to radiation damage than adults. Studies of atomic bomb survivors exposed to acute radiation doses exceeding 20 rads (0.2 Gy) during pregnancy show that children born after receiving these doses have a higher risk of mental retardation. Other studies suggest that an association exists between exposure to diagnostic x-rays before birth and carcinogenic effects in childhood and in adult life. Scientists are uncertain about the magnitude of the risk. Some studies show the embryo/fetus to be more sensitive to radiation-induced cancer than adults, but other studies do not. In recognition of the possibility of increased radiation sensitivity, and because dose to the embryo/fetus is involuntary on the part of the embryo/ fetus, a more restrictive dose limit has been established for the embryo/fetus of a declared pregnant radiation worker. See Regulatory Guide 8.13. "Instruction Concerning Prenatal Radiation Exposure." If an occupationally exposed woman declares her pregnancy in writing, she is subject to the more restrictive dose limits for the embryo/fetus during the remaining of the pregnancy. The dose limit of 500 mrems (5 mSv) for the total gestation period applies to the embryo/fetus and is controlled by restricting the exposure to the declared pregnant woman. Restricting the woman's occupational exposure, if she declares her pregnancy, raises questions about individual privacy rights, equal employment opportunities, and the possible loss of income. Because of these concerns, the declaration of pregnancy by a female radiation worker is voluntary. Also, the declaration of pregnancy can be withdrawn for any reason, for example, if the woman believes that her benefits from receiving the occupational exposure would outweigh the risk to her embryo/fetus from the radiation exposure. CONFIDENTIAL MCPHS VOLUNTARY DECLARATION OF PREGNANCY FOR RADIATION WORKERS I. DECLARATION OF PREGNANCY Name of Individual Social Security Number Date of Conception (Mo/Yr) By providing this information to my immediate supervisor/Instructor, in writing, I am declaring myself to be pregnant as of the approximate date shown above. Under the provisions of 10 CFR Part 20.1208 I understand that my exposure will not be allowed to exceed 5 mSv (500 mRem) during my pregnancy, from occupational exposure to radiation. I understand that this limit includes exposure I have already received. If my estimated exposure since the above approximate date of conception has already exceeded 5 mSv (500 mRem), I understand that I will be limited to no more than 0.5 mSv (50 mRem) for the remainder of my pregnancy. If I should find out that I am not pregnant, or if my pregnancy ends, I will inform my supervisor as soon as practical. Signature of Individual Date Signed II. DESCRIPTION OF CURRENT WORK WITH IONIZING RADIATION 136 Source of Ionizing Radiation (equipment): Isotope: III. RECEIPT OF DECLARATION OF PREGNANCY Name of Supervisor/Instructor I have received notification from the above named woman that she is pregnant. I have explained to her the potential risks from exposure to radiation as provided in Regulatory Guide 8.13, Revision 3. I have evaluated her prior exposure and established appropriate limits to control the dose to the developing embryo/fetus in accordance with limits in 10 CFR part 20.1208. I have explained to her options for reducing her exposure to as low as reasonably achievable (ALARA). Signature of Supervisor/Instructor Date Signed 137 ACCEPTANCE OF POLICY FORM 2011-2012 Name________________________ ACCEPTANCE OF RT STUDENT HANDBOOK I, ______________________________, acknowledge that I have received and am responsible for understanding and complying with the policies stated in the Radiation Therapy Student Handbook. I understand that I may contact Dr. Susan Belinsky at (617) 732-2261 to ask questions regarding the policies contained therein. _________________________________ Student Signature Date ACCEPTANCE OF RT DIRECT SUPERVISION POLICY I, ______________________________, acknowledge that I have received and am responsible for understanding and complying with the policies stated in the Radiation Therapy Student Handbook. I understand that students are never to administer radiation without the direct supervision of a licensed radiation therapist. ACCEPTANCE OF RT PREGNANCY POLICY I, _________________________________________, acknowledge that I have received and am responsible for understanding and complying with the pregnancy policies stated in the Radiation Therapy Student Handbook. I understand that I may contact Dr. Susan Belinsky at (617) 732-2261 to ask questions regarding the policies contained therein. _________________________________________ Student Signature Date ACCEPTANCE OF ACADEMIC HONOR POLICY I,_______________________________________, acknowledge that I have received and am responsible for understanding and complying with the honor system policy stated in the Radiation Therapy Student Handbook. I understand that I may contact Dr. Susan Belinsky at (617) 732-2261 to ask questions regarding the policy contained therein. __________________________________________ Student Signature Date Revised 5/04 ACCEPTANCE OF CLINICAL TRAVEL POLICY I,_________________________________, acknowledge that I have received and am responsible for understanding and complying with the policies stated in the Radiation Therapy Student Handbook. I understand that all travel expenses to and from clinical are my responsibility. __________________________________________ Student Signature Date ACCEPTANCE OF CLINICAL HEALTH CLEARANCE I,_________________________________, acknowledge that I have received and am responsible for understanding and complying with the policies stated in the Radiation Therapy Student Handbook. I understand that all my medical records need to be up to date and that I am responsible for providing this information to FILE MD. ACCEPTANCE OF RE-ENTRY CONTENT VALIDATION POLICY I,_________________________________, acknowledge that I have received and am responsible for understanding and complying with the policies stated in the Radiation Therapy Student Handbook. I understand that I must validate previous knowledge and skills held prior to program exit before reenrollment in SON/SRS clinical professional courses. Revised 8/10 138
