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Clinical Instructor - Level II Staff Technologists
Rotation Evaluations & Supervision
Please click on the modules below to read the inservice. At the end of the last module is the link to follow to the assessment.
Glossary of Terms:
The Importance of the Rotation Evaluation
The student should begin the clinical rotation by inquiring of the Clinical Instructor what behaviors he/she believes demonstrates each component of the evaluation. For example: you might respond that being dependable means the student is punctual, is always with you when any activity is going on and provides assistance to you without being asked. Each Clinical Instructor has their own interpretation of dependable so it's important that the student is aware of your expectations.
When the clinical instructor completes the evaluation at the end of the rotation, it is important to take the time to read each question and then to check the option that truly describes the student's performance.
The grading of the evaluation is designed as follows:
During the first year of education, most students would be expected to earn a high B to low B if performing to expectations. Very few students would be expected to earn all A's until the middle to end of the second year.
This evaluation is instrumental in allowing students to see where they need improvement and in which areas they excel at. If they are not informed via this evaluation that they are not strong in an area they will not know. Therefore, the student will not believe improvement is necessary. This gives the student a false sense of their abilities. There should always be areas identified where the student can strive to improve performance.
The evaluation tells RT faculty how the clinical staff perceives the student's performance. With consistent, thoughtful evaluation completion, RT faculty can guide the student on methods to improve performance.
The rotation evaluation is typically worth 25% of the clinical course grade.
Expectations of New Second Year Students
JRCERT: Joint Review Committee on Education in Radiologic Technology (RT Education's accrediting organization)
Year One Student: September through August of the first year enrolled in the program.
Year Two Student: September through August (graduation) of the second year enrolled in the program.
Direct Supervision: At minimum, direct supervision is used:
Indirect Supervision: Indirect Supervision may be used:
Competency: Performance in a manner that satisfies the demands of a situation. Effective interaction with the environment.
Proficiency: The quality of having great skill and competence. Skillfulness and command of fundamentals resulting from practice and familiarity.
Year One Student: September through August of the first year enrolled in the program.
Year Two Student: September through August (graduation) of the second year enrolled in the program.
Direct Supervision: At minimum, direct supervision is used:
- when the student has not yet successfully completed a competency test on the particular exam being performed,
- whenever a repeat radiograph is being performed,
- for all portable and operating room procedures,
- when a student is in the first year of the program before and after successful completion of a competency test.
Indirect Supervision: Indirect Supervision may be used:
- only after the student has successfully completed a competency test on the particular examination,
- only during the second year of the program. The supervising technologist must be immediately available to assist the student regardless of the level of student achievement. (In an adjacent room or location where radiographic procedure is being performed.)
Competency: Performance in a manner that satisfies the demands of a situation. Effective interaction with the environment.
Proficiency: The quality of having great skill and competence. Skillfulness and command of fundamentals resulting from practice and familiarity.
The Importance of the Rotation Evaluation
The student should begin the clinical rotation by inquiring of the Clinical Instructor what behaviors he/she believes demonstrates each component of the evaluation. For example: you might respond that being dependable means the student is punctual, is always with you when any activity is going on and provides assistance to you without being asked. Each Clinical Instructor has their own interpretation of dependable so it's important that the student is aware of your expectations.
When the clinical instructor completes the evaluation at the end of the rotation, it is important to take the time to read each question and then to check the option that truly describes the student's performance.
The grading of the evaluation is designed as follows:
- Scores of mostly A (Always) + some U (Usually) typically earns the student a grade of 'A'.
- Scores of fairly evenly mixed A + U earns the students a mid B to a high B grade.
- Scores of mostly U's earns the student a C to low B grade.
- Scores of S (Sometimes) earns the student a lower C grade.
During the first year of education, most students would be expected to earn a high B to low B if performing to expectations. Very few students would be expected to earn all A's until the middle to end of the second year.
This evaluation is instrumental in allowing students to see where they need improvement and in which areas they excel at. If they are not informed via this evaluation that they are not strong in an area they will not know. Therefore, the student will not believe improvement is necessary. This gives the student a false sense of their abilities. There should always be areas identified where the student can strive to improve performance.
The evaluation tells RT faculty how the clinical staff perceives the student's performance. With consistent, thoughtful evaluation completion, RT faculty can guide the student on methods to improve performance.
The rotation evaluation is typically worth 25% of the clinical course grade.
Expectations of New Second Year Students
There is a very distinct difference in our perception of the skills of a first year radiography student versus the skills of a second year student. We all expect that the first year student will need direct supervisions, but what about the second year student?
To begin, all students need either direct or indirect supervision. First year students require direct supervision at all times. Second year students require direct supervision for any procedure for which they have not yet documented competency. They also require direct supervision for all portables and all OR procedures regardless of whether or not competency has been demonstrated.
Why a first year needs direct supervision is fairly obvious. Competency by no means indicates proficiency. It certainly does not mean that a first year student knows exactly what to do with a patient whose condition varies greatly from average. Also patients today are often much sicker than 10 years ago. Most students are unsure of what to do if an urgent or emergent situation occurs, regardless of what they were taught in the classroom. For these reasons and more, first year students need direct supervision.
Performance under Indirect supervision is a bit trickier. The student may have demonstrated competency but by no means are they proficient, even in chest radiography (incidentally the most frequently repeated radiographic exam is the chest x-ray). Even second year students have not yet encountered enough challenging patients to exhibit proficiency. Sometimes there is a tendency to expect them to be able to run an x-ray room the minute they transition from first to second year students.
Some students excel in the clinical area and are capable, to a certain extent, of running a general room, under indirect supervision. These students do typically quite well with patients who are "average"; average size, average ability to cooperate, and no known pathology requiring position or technique adjustment or pathology that requires little to no adjustments. However they have most likely not had enough experience with "non-average" patients to wither make the proper adjustments or handle a difficult situation appropriately.
Students also acquire clinical skills at different rates. Some students become quite comfortable in the clinical setting in the first year and are therefore much more able to learn and put into practice the concepts they learn in academics and the observations they make in the clinical setting.
Other students take quite a long time to reach a level of comfort in the clinical setting. They take much longer to put into practice the information they are absorbing, and really that 's ok. Some students simply require more observation time before trying a procedure on their own. What we are all striving for is a student who leaves the program with the skills necessary to be a confident, motivated, dependable, and professional entry-level radiographer. The pace at which they acquire these skills is somewhat irrelevant as long as they continue to demonstrate improvement and have acquired the skills prior to graduation.
New second year students should be closely observed for clinical ability and confidence before allowing them to perform under indirect supervision. Each Clinical Instructor needs to be comfortable in making this judgment call- that means knowing how the student handles patients, how confident they are in setting technical factors, and in making adjustments to positioning and techniques based on patient situations.
Technique choice brings us a bit off the subject for a moment. Competency (after the first clinical course) should mean that the student knows an average technique to use and how to set it. As part of the radiographic procedures course, the student learns the optimal kVp to use for the associated body part. Choosing mAs is a bit trickier. The students begin to learn how mAs affects the image during the first radiographic imaging course, offered in the first spring semester. Too often, during a competency test, the Clinical Instructor is kind enough to set technique while the student positions the patient. This does not help the student in any way to become competent, let alone proficient. When they begin performing procedure under indirect supervision they must know standard techniques or at least where to find them (on a wall chart, etc.). However, it should be expected that students need assistance adjusting technique in some cases. Indirect Supervision means the technologists are immediately available to assist the student when necessary.
Do you remember the first time you encountered an emergency situation with a patient? Your patient had a contrast reaction, or maybe had a syncopal episode while under your care? Did you experience that adrenaline rush? Those heart palpitations? That feeling of being very unsure of what to do first? This is another reason that supervision (direct or indirect) is so crucial for the student. You may have memorized what to do from the patient care course, but when it happened to you, the first few times, you probably experienced feeling of uncertainty. It is critical to patient safety, and hospital liability, that a technologist be immediately available to assist the student.
To begin, all students need either direct or indirect supervision. First year students require direct supervision at all times. Second year students require direct supervision for any procedure for which they have not yet documented competency. They also require direct supervision for all portables and all OR procedures regardless of whether or not competency has been demonstrated.
Why a first year needs direct supervision is fairly obvious. Competency by no means indicates proficiency. It certainly does not mean that a first year student knows exactly what to do with a patient whose condition varies greatly from average. Also patients today are often much sicker than 10 years ago. Most students are unsure of what to do if an urgent or emergent situation occurs, regardless of what they were taught in the classroom. For these reasons and more, first year students need direct supervision.
Performance under Indirect supervision is a bit trickier. The student may have demonstrated competency but by no means are they proficient, even in chest radiography (incidentally the most frequently repeated radiographic exam is the chest x-ray). Even second year students have not yet encountered enough challenging patients to exhibit proficiency. Sometimes there is a tendency to expect them to be able to run an x-ray room the minute they transition from first to second year students.
Some students excel in the clinical area and are capable, to a certain extent, of running a general room, under indirect supervision. These students do typically quite well with patients who are "average"; average size, average ability to cooperate, and no known pathology requiring position or technique adjustment or pathology that requires little to no adjustments. However they have most likely not had enough experience with "non-average" patients to wither make the proper adjustments or handle a difficult situation appropriately.
Students also acquire clinical skills at different rates. Some students become quite comfortable in the clinical setting in the first year and are therefore much more able to learn and put into practice the concepts they learn in academics and the observations they make in the clinical setting.
Other students take quite a long time to reach a level of comfort in the clinical setting. They take much longer to put into practice the information they are absorbing, and really that 's ok. Some students simply require more observation time before trying a procedure on their own. What we are all striving for is a student who leaves the program with the skills necessary to be a confident, motivated, dependable, and professional entry-level radiographer. The pace at which they acquire these skills is somewhat irrelevant as long as they continue to demonstrate improvement and have acquired the skills prior to graduation.
New second year students should be closely observed for clinical ability and confidence before allowing them to perform under indirect supervision. Each Clinical Instructor needs to be comfortable in making this judgment call- that means knowing how the student handles patients, how confident they are in setting technical factors, and in making adjustments to positioning and techniques based on patient situations.
Technique choice brings us a bit off the subject for a moment. Competency (after the first clinical course) should mean that the student knows an average technique to use and how to set it. As part of the radiographic procedures course, the student learns the optimal kVp to use for the associated body part. Choosing mAs is a bit trickier. The students begin to learn how mAs affects the image during the first radiographic imaging course, offered in the first spring semester. Too often, during a competency test, the Clinical Instructor is kind enough to set technique while the student positions the patient. This does not help the student in any way to become competent, let alone proficient. When they begin performing procedure under indirect supervision they must know standard techniques or at least where to find them (on a wall chart, etc.). However, it should be expected that students need assistance adjusting technique in some cases. Indirect Supervision means the technologists are immediately available to assist the student when necessary.
Do you remember the first time you encountered an emergency situation with a patient? Your patient had a contrast reaction, or maybe had a syncopal episode while under your care? Did you experience that adrenaline rush? Those heart palpitations? That feeling of being very unsure of what to do first? This is another reason that supervision (direct or indirect) is so crucial for the student. You may have memorized what to do from the patient care course, but when it happened to you, the first few times, you probably experienced feeling of uncertainty. It is critical to patient safety, and hospital liability, that a technologist be immediately available to assist the student.
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