Radiography School Clinical Handbook
A. WELCOME - Congratulations on your acceptance to our Radiography School. We are happy to have you in our program. You will find your training over the next fifteen months to be very different from any previous college experiences that you may have had. In many other college courses, you learned the material for a test and were able to forget it and move on. Our program is not designed in the same way. Our Radiography Program will begin by teaching you the foundation courses involving Radiographic Physics & Principles, Anatomy & Positioning, and Patient Care. You will then take this didactic information and apply it in the clinical setting. All of the material that will learn must be retained so that you can pass the American Registry of Radiologic Technology (ARRT) certification examination at the conclusion of the program.
B. PACE OF THE PROGRAM - That means that the pace of didactic classroom and the clinical instruction will be fast and will continue for several months. To master the material you will need to continually review and practice your clinical skills. Practicing allows you to retain the information you have learned and to be ready for examinations you need to complete to demonstrate competency. These are essential skills that are needed to be successful in this program because no two patients will ever be alike.
C. OUR ROLE - The Program Faculty is dedicated to providing you with a quality education. Our goal is to produce highly skilled Radiographers who can work in any medical facility, deal with any medical situation that may arise, and provide optimum care for any patient in need. We look forward to the opportunity to work with you over the next four (4) semesters. Good luck and welcome aboard!
II. PROGRAM ATTENDANCE & TRACKING METHODS
A. ATTENDANCE POLICY - A copy of the Attendance Policy is found in your Student Handbook. When questions arise regarding the Attendance Policy, we encourage you to speak to a faculty member to assure that your questions are answered accurately. Personal time off is to be used responsibly. Attendance will be tracked and monitored electronically. Your Clinical Coordinator will show you how to clock in and out using our attendance tracking system (E-Value) to monitor your attendance for clinical days. As a reminder, our program considers you tardy at 8:01AM. You should plan for enough time to park and to report to your designated computer(s) to clock in. If you are sick or have an appointment, you are given personal time off (PTO) to use on clinical days as needed (PTO time is not used for didactic days). However, we strongly encourage you to be responsible with your use of PTO because any number of things can occur over the next four (4) semesters which could quickly deduct from your PTO account.
B. ATTENDANCE RECORDS - The Clinical Instructors (CI) & Clinical Coordinator (CC) are responsible for maintaining your attendance records for the clinical settings throughout the program. Your CC will provide you with a semester report of your PTO time that was used, as well as the number of tardy occurrences and absences. Please contact your CC if you believe a mistake has been made on your attendance report.
C. REQUESTING PTO - The schedule for clinical days is 8:00 AM–4:00 PM (8 hour days). All absences and tardy time will be deducted from your PTO bank. If you are planning to take time off (either planned or unplanned), a PTO slip should be submitted to your CI(s) and an e-mail should be sent to the CC. If you are planning on only taking a portion of the day off, you must identify when you will be arriving and/or leaving. The CI(s) and the CC must be notified of your PTO request no later than 4:00 PM the day before you will be using it. If they are notified after 4:00 PM the day before, the PTO will count as an absence as well as being deducted from your PTO bank. The e-mail to your CC must include:
1. the date you are taking PTO
2. the time period (amount of hours) for that PTO
3. the CI that also contacted regarding your PTO request
III. PROFESSIONAL CONDUCT & PERFORMANCE
A. It is our responsibility as educators to mold you into a highly-skilled, competent Radiographer. In doing so, our faculty has created a list of clinical guidelines to help you understand what we expect of you when you are assigned to the clinical setting. You are expected to follow the ARRT’s Standards of Ethics (which will be discussed in detail at the beginning of the program). Your professionalism and conduct will be continually evaluated throughout the program by faculty and staff. This is a simple overview of the program’s professional conduct and performance standards to instruct you as to what we consider to be acceptable and unacceptable behavior.
B. Clinical Guidelines
1. Included below is a list of guidelines to be followed while in the clinical setting. The Clinical Education Centers (CEC) have the right to develop additional or modify the following guidelines for their facility.
a. Unless there is an emergency, department telephones are not to be used for personal business.
b. Use of personal computers (laptops or tablets) or personal cell phones (calls or text messages) are not permitted during your clinical assignment. Your CI(s) will identify if, when, and where you may use your cell phone.
c. Any incident which involves: a patient, a guest, or you must be reported immediately to the clinical instructor and/or supervisor. Immediate attention must be given to the patient. After the patient’s needs have been attended to, the CI(s) or their designee will assist you in completing all necessary forms about the incident.
d. You should never leave your clinical assignment without permission from your CI(s) or their designee.
e. You shall return on time from their assigned lunch break.
f. With the exception of staff lounge areas, eating, drinking, or chewing gum in the clinical setting is prohibited.
g. You must direct all patient complaints to the department coordinator or supervisor. The patient’s complaints will be investigated and referred to the appropriate sources.
h. Private conversations should be avoided in the patient’s presence or within hearing range of patients or visitors.
i. No patient should ever be left unattended for any unreasonable period of time (whether lying on an examination table or sitting in a room). Protective immobilization devices (safety straps, restraints, side rails, etc.) are to be utilized with patients whose conditions require the use of these precautions.
j. Check your patient’s name band and chart a minimum of three (3) times before doing any procedure to ensure that you have the correct patient.
k. The clinical setting is for you to gain experience in the performance of all radiologic procedures. When no patient procedures are being performed in the department, you should spend that downtime with your classmates practicing positioning, studying your positioning notes, or learning to operate the x-ray equipment (e.g. general radiographic equipment, fluoroscopic equipment, and C-arm equipment). Additionally, it is your responsibility to ensure that the procedure rooms are adequately stocked with linens and other supplies as necessary. Clinical time spent in any other manner will be deemed inappropriate and will result in a corrective action(s). Each case will be discussed and action taken on a case by case basis.
l. Injecting patients with a contrast media for certain examinations is part of the requirements for Radiologic Technologists. You will receive training on the proper method of injecting patients. However, most of the clinical sites will not allow students to inject contrast medias. Follow the regulations of your specific clinical education center (CEC) pertaining to injecting patients with contrast media. If your CEC does allow you to inject a contrast media a registered technologist, registered nurse, and/or medical physician must be present in the room observing you while you perform the injection. This requirement is in effect for the entire length of the program. Under no circumstances are you allowed to inject any other medication besides contrast media’s.
m. Patient confidentiality must be maintained at all times. The patient’s Protected Health Information (PHI) should only be discussed with other medical personnel who are directly involved with the procedure. The University of Akron’s Radiography School follows the terms set forth in the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
IV. CORRECTIVE ACTIONS
A. The Student Handbook you received contains a complete listing of the policies adopted by the Radiography School. Any violations of the Conduct & Performance Policy’s contained in the Student Handbook and/or the Clinical Guidelines identified in this Clinical Objectives Handbook, will result in corrective action. A summary of the steps associated with corrective action are as follows:
1. First (1st) Offense: Documented Verbal Counseling and/or Written Counseling
2. Second (2nd) Offense: Written Warning & points deducted from your clinical grade
3. Third (3rd) Offense: Final Warning & points deducted from your clinical grade
4. Fourth (4th) Offense: Dismissal from the program
V. CRITICAL ERROR PROTOCOL
A. Your patient’s safety and the importance of performing radiographic procedures with minimal radiation exposure are of paramount concern. A critical error is defined as something that falls outside normal performance that may indicate a negative outcome. In this regard, the following protocol has been established for preventing a critical error or when a critical error has already occurred. Examples of critical errors include, but are not limited to:
1. Performing an imaging examination on the wrong patient
2. Placing the wrong name on an imaging examination or specimen
3. Performing the wrong examination on a patient
4. Placing the wrong marker/annotation/left-right procedure description on an image
5. Failing to send images to PACS for interpretation
6. Other errors determined to have the potential to directly affect the patient’s treatment status
B. CONSEQUENCES - Some errors are considered to be more serious than others. If a Critical Error is prevented or actually takes place, your clinical setting will complete all necessary paperwork documenting the error. The paperwork must be completed in a timely manner and forwarded to all appropriate parties for review (e.g. nursing administration, risk management, etc.). As a member of the University of Akron’s Radiography School you are covered for professional liability as long as you are performing within your scope of practice. In every situation the program faculty will also conduct an investigation to access the severity and/or frequency of the critical error(s) to determine the appropriate level of corrective action. The levels of corrective action will be followed for the duration of the Radiography Program (see Corrective Action levels listed above):
1. First Critical Error - you will receive a documented counseling with no impact on your clinical grade
2. Second Critical Error - you will receive a written warning. This will result in your clinical grade for the semester being lowered one (1) step (example: if you had earned a final grade of a B for the semester, then your final grade would be a B-)
3. Third Critical Error - you will receive a final warning with your clinical grade for that semester being lowered one (1) step
4. Fourth Critical Error - you will be dismissed from the program
C. STUDENT INCIDENT FORM – This preventive action form is used anytime you are stopped from making a critical error that would have jeopardized the patient’s care or safety (if the critical error had been completed it would have resulted in a hospital incident report). This form is additionally used when you have been injured (e.g. fall, needle stick, etc.). Please note that your clinical setting may also require a hospital incident form to be completed. It also may be part of the clinical setting’s protocol to have you evaluated by a medical physician.
VI. CLINICAL EDUCATION
A. The purpose of this section of the handbook is to explain the process in which you will learn the information to be applied in the clinical setting. Program faculty and Staff Radiographers will be evaluating your competency and proficiency throughout the program:
1. Room Competencies - these are performed by the CI(s) at the clinical settings and are a method of documenting that you are proficient with the radiologic equipment at that clinical site.
2. Anatomy and Positioning class - these classes are taught by the Program Director (PD) and will include an overview of the skeletal structures, positioning of those body parts, and their associated pathology. At our bi-weekly faculty meetings, the PD communicates with the other program faculty of the progress with each class. An examination will be given after completing each A&P packet.
3. Positioning Labs - these examinations (procedures) are taught by the CC and/or the CI(s) covering primarily the positioning material over the same anatomical parts that were covered in the A&P classes. The faculty member may use another student or a phantom (artificial body) while conducting this learning activity and you are expected to take notes. You will need two (2) books for the positioning labs; the A&P textbook and the A&P pocket guide. The following is a brief list of content covered in each positioning lab:
a. Positioning landmarks
b. Positioning of the patient and the body part
c. Central ray positioning
d. Image criteria that should be demonstrated on each radiographic image
e. Patient care during the procedure
f. Radiation protection (for both you and the patient)
g. Critical thinking exercises to help develop your independent judgment and discretion
4. Clinical Practice (may either be scheduled or completed during down time) - after completing the positioning lab, you are to utilize your downtime to practice your positioning skills and the manipulation of the equipment with your classmates. You should choose a partner and practice your clinical setting’s examination protocols. Your CI(s) will provide you with all of the protocols for that clinical setting and explain their expectations regarding your practice time.
5. Simulation on that clinical simulation - Simulations are conducted after you have had a chance to practice on your classmates. A simulation is your opportunity to demonstrate your knowledge of the exams that were presented in the positioning lab. You will be expected to perform that particular radiographic examination on a classmate (without actually exposing them) as if you were carrying out the examination, from start to finish, on an actual patient. CI(s) will document your performance and determine whether you passed or failed the simulation. A simulation will result in a failure if you:
a. make mistakes in protocol (performing an incorrect view/projection)
b. make mistakes in positioning (not locating the appropriate landmarks or centering in the wrong location)
c. orient the image receptor incorrectly compared to the body part
d. select the incorrect image receptor for that particular examination
e. The process to rectify a failed simulation is that you should:
(1) find downtime to perform additional practice
(2) after practicing, attempt the simulation again
(3) The program faculty will document your performance. If you pass the re-simulation, then you will move on to work with patients. However, if you should continue to fail the simulation, the process will be need to be repeated until you pass.
f. When you has successfully completed the simulation process you may perform that exam under direct supervision with actual patients. You are encouraged to practice exams with your classmates or on actual patients under direct supervision before you attempt to test-out (except for exams in which the Clinical Instructor deems rare).
6. Testing out on a clinical competency - clinical competencies (more commonly called procedural test-outs) are attempted once you has successfully passed the simulation on that particular examination. You will notify your CI(s) or a Staff Radiographer when you are ready to attempt a procedural test-out on an actual patient. These clinical staff will evaluate your performance throughout the exam. Once you has successfully passed a procedural test-out, you are required to enter that exam into the E*Value accounting system for your CI(s) approval. Once a test-out has been confirmed, it will be counted toward the total number of clinical competencies that are required for each semester. If a Staff Radiographer completes the test-out paperwork (as opposed to the CI) then you need to make give the CI(s) the patient’s name so that they can review your images. The CI(s) will review the images and determine whether you successfully passed the procedural test-out. However, a CI may reject the test-out if the images for one of the following reasons:
a. the images were substandard
b. a repeat image had to be done
c. someone had to help you or had to complete the exam
d. you failed to follow the clinical setting’s protocol for that examination
e. Clinical competencies (procedural test-outs) make up five (5) points of your clinical grade and you will need to pass a minimum number of test-outs each semester. If you fail to pass the minimum number of clinical competencies (test-outs), then points will be deducted from your clinical grade. The chart below identifies the minimum number of clinical competencies that must successfully passed each grading period. And you must completed all sixty-two (62) clinical competencies to graduate from the program. We strongly encourage you to complete more clinical competencies every semester so that you will have the opportunity to visit some advanced radiologic modality areas during the last semester of the program (you will not be allowed to visit the advance radiologic modality areas unless your clinical competencies are complete).
f. Failing a clinical competency (test-out) does not in any way affect your clinical grade. However, failed test-outs must be documented as well as those clinical competencies that were successfully passed. When you fail a procedural test-out, you needs to accept the constructive feedback received so that you don’t continue to make the same mistakes again. Continue to practice and re-attempt the test-out when you are ready. If there are reoccurring failures on a particular test-out the CI(s) and/or CC are available to help review the material with you again.
g. As soon as you have successfully passed a clinical competency (procedural test-out) then you will move from direct supervision to indirect supervision on that particular examination. However, regardless of whether you are under direct or indirect supervision, students are strictly prohibited from performing a repeat without direct supervision from a Staff Radiographer. If you are performing an examination under indirect supervision and are told to repeat an image, then you must seek out the help of your CI or a Staff Radiographer. Failure to get a CI or Staff Radiographer to monitor your repeat will result in corrective action and points deducted from your clinical grade. Any attempt to falsify the procedural test-out form will also lead to severe corrective action up to and including dismissal from the program.
Semester Minimum # of clinical competencies required/semester
Summer Semester (Clinical I First Year) 11 (11 total clinical competencies)
Fall Semester (Clinical II Second Year) 17 (28 total clinical competencies)
Spring Semester (Clinical III Second Year) 17 (45 total clinical competencies)
Summer Semester (Clinical IV Second Year) 17 (62 total clinical competencies)
7. Blind competencies - blind competencies are ways for the program faculty to evaluate your knowledge and retention of previous educational material. Since the ARRT certification process is a comprehensive examination it is imperative that you don’t test-out on a radiologic procedure and then simply forget it. With the exception of Clinical I, the CC and/or CI’s will conduct one (1) blind competency/semester with you. You must perform the exam chosen by the program faculty just as if you were attempting a procedural test-out. And the blind competency that is selected will be any procedure that you have been trained on (not necessarily that you have successfully test-out on). The program faculty will also have you critique some radiographic images of that type of examination as part of this process.
8. Affective evaluation forms - these are completed by the CI(s) at the end of each semester and specifically addresses your clinical behavior and professionalism.
9. Student evaluations - these are completed by the Staff Radiographers and the CI(s). Each student is rated based on how well they have achieved the ten (10) performance objectives. Comments will also be made regarding your performance, attitude, and knowledge. Unless the Radiographer requests for their name to be known these comments are kept confidential. Instead of focusing on single positive or negative marks or comments, you should be looking for trends; what do the majority of the evaluations say that you should be improving on. The following point scale is used for the student evaluations:
a. 10 = Excellent Performance
b. 9 = Above Average Performance
c. 8 = Average Performance
d. 7 = Needs Improvement
e. 6 = Poor Performance
f. The points from each evaluation submitted are added up and then averaged together and your clinical grade is based on the following:
(1) Attendance - 5%
(2) Dress Code - 5%
(3) Affective Evaluation - 20%
(4) Blind Competency - 15%
(5) Procedural test-outs - 5%
(6) Student Evaluations - 50%
g. Appointments will be scheduled at the end of each semester to review your didactic grades and your clinical performance; the PD & CC will review didactic grades on a class day while your CC & your CI(s) will review your clinical performance on a clinical day.
10. Master Rubric - this document was created by our program as a tool to measure your progress through the program. Our learning outcomes are listed in the left-hadn column while the program semesters are the headers for each column. Throughout the program, the program faculty will refer to this tool to evaluate your accomplishments and determine the areas in which you need improvement.
11. Imaging Obstacles & Solutions - The Imaging Obstacles and Solutions (IOS) course is a capstone course which takes place during the final semester of the program. This is a critical thinking course where you must utilize all of your radiologic skills to tackle unusual medical situations. Your critical thinking will be assessed in a variety of ways including:
a. IOS written case studies - you will be required to describe in proper medical language how you would resolve an unusual case study.
b. IOS role-playing with a simulated patient/actor - You will be given examples of cases where critical thinking is required and you must demonstrate the steps that you would take to successfully complete the exam.
12. Additional clinical paperwork – You are also required that total number of radiologic examinations that you participated on s performed with their initials (markers) placed on the images. The CI(s) at each clinical setting will provide exam log forms for you to record the exams completed. You are also required to document when a repeat image was performed. This form will be reviewed by your CI(s) to determine whether there are any patterns occurring which may require further instruction. This documentation of repeat images does NOT impact your clinical grade in any manner.
13. Clinical Objectives - this form outlines the program’s expectations for you during every clinical rotation during every semester. The objectives are listed for general diagnostic imaging, the emergency room, trauma, mobile, surgical, and fluoroscopic rotations. The CI(s) at each clinical setting will evaluate whether you have accomplished the objectives listed for each semester. If the CI(s) determines that you have failed in meeting the objectives listed, you will be placed on clinical probation. As the number of clinical objectives increase every semester, you should note that the program faculty and the Staff Radiographers will also expect more from you with each passing semester.
14. Advanced Modality Rotations - these optional (not guaranteed) rotations occur Clinical IV (the fourth semester of the program). If time and clinical site workflow permits and you have met all of the criteria listed below, you will allowed to visit an advanced modality of your choosing which will be scheduled by your CI(s). The criteria for being allowed to visit an advanced modality area include:
a. All sixty-two (62) clinical competencies must be completed
b. You do not have an active plan for improvement in place
c. You are not currently on clinical and/or academic probation
d. You are not in the process of making up clinical time due to an illness/injury
VII. GRADUATION REQUIREMENTS
A. In order to be eligible to take the ARRT certification examination you, must complete various clinical competencies. There are two (2) categories of clinical competencies that you should be watching out for so that you can test-out when the opportunity presents:
1. Mandatory Clinical Competencies - You must successfully pass 100% of these procedural test-outs. There are a few examinations on this list that are challenging to obtain among the various clinical sites because they are rarely seen. When encountering rare examinations it is in your best interest to attempt the test-out.
2. Elective Clinical Competencies - In addition to the mandatory clinical competencies you need to successfully pass fifteen (15) of the elective procedural test-outs. And of these elective exams:
a. one (1) must be from the head section
b. two (2) must be from the fluoroscopy section (one (1) must be an upper GI or a lower GI)
3. All sixty-two (62) total test-outs must be completed by the final Friday of Clinical IV. The Program Director will not be allowed to sign off on your ARRT registry application until ALL of the ARRT required competencies have been completed. Failure to complete the graduation requirements will
a. prevent you from graduating from the program
b. extend your time beyond Clinical IV to complete those competencies
c. stop you from applying and/or taking the ARRT certification examination
d. postpone you from obtaining radiologic employment
VIII. HOW TO BECOME A BETTER STUDENT
A. The intention of this section is to discuss how to make your transition into this program a little easier. The most successful students are those who learn to manage their time wisely with their didactic and clinical assignments. You may find that the study habits you have used in the past may need to be modified to keep up with the volume of material being covered. The key is to know when to ask for help. Your PD, CC, & CI’s are all willing to tutor students because our program faculty truly cares about your success in our program.
B. While our program is college-based, we have many benefits of a hospital-based structure. Some college-based Radiography programs spend time in the classroom teaching the skills that you won’t apply until the following semester or even the following year in the clinical setting. Our program structure is different in that you will be taught program content and for you to be able to apply that knowledge immediately at your clinical setting. However, that also makes this program is very demanding in that you must retain everything you have learned, perfect your clinical skills, and juggle all of your other responsibilities outside of the program during the next fifteen (15) months. This program can also be challenging because you must take responsibility for their education. You will hear many of the staff and faculty members refer to this program as a fifteen (15) month job interview. The Staff Radiographers and the Radiology management team at every clinical setting are observing your performance as well as how you interact with patients and staff. They are paying attention to your attendance patterns, your work ethic, as well as your patient care and your communication skills. The main differences between a regular college course and this college-based program is:
1. You must master the clinical competencies AND retain them - exams that were successfully tested out or learned at the beginning of the program must be performed with the same ease throughout the program. Much of the information obtained during the program is considered fundamental and will be used not just through your education, but throughout your career. And all of the material that you will be learning will be on your national registry certification examination. It is your responsibility to review this material and retain it throughout the program.
2. The program faculty is constantly tracking your performance - Our program faculty will be constantly looking at your strengths, weaknesses, and progress every semester. These are discussed at the end-of-semester evaluations where students are also given the opportunity to ask for additional help or review of the protocols learned (keep in mind that this is not the only time that you can request assistance; you can ask for assistance at any time during the program). Again, you need to communicate your needs so that our program faculty know how to help you be successful.
3. Our program expects students to follow an attendance policy similar to that of an employee - Our program expects you to follow and abide by the attendance policy. Excellent attendance records and dependability are what employers are looking for. This means that you must be in the clinical setting as much as possible to practice, improve, and “fine-tune” your clinical skills. Always remember that every patient is different which means that you can’t do things the same way all of the time; you must learn to adapt and apply critical thinking skills to obtain optimum radiographic images.
C. Here are a few suggestions on ways that you can succeed in the program:
1. PRACTICE, PRACTICE, and more PRACTICE!!!
2. Don’t postpone asking for help. If you are struggling, ask for help sooner than later.
3. Keep up with your reading assignments and studying. If you maintain a regular schedule for studying, you will keep up. Some students choose to arrive early for class or stay afterwards to study independently or with a small group of students. Pre-class and post-class tutoring is available for you.
4. If you are employed, try to reduce your work hours down to around twenty (20) hours/week. This is especially important for the first couple of months of the program to see how you adapt to the program’s schedule.
5. Make optimum use of your free time. Everyone needs to refresh and regroup.
6. If you have prior healthcare experience, temporarily forget what you have learned until you know what you can and cannot do.
7. Evaluate and optimize your study habits. Do you prefer to study alone or in groups? What is the best environment to study in? Identify how you learn best. When reviewing for a test do you tend to memorize facts or do you focus more on the theory?
8. Share what you have learned with your classmates. The best way to learn something is to explain the material to another classmate. If you can explain it, you know it.
9. Review on a regular basis. Up to 80% of what you have learned is forgotten in twenty-four (24) hours if it is not reviewed. This is why studying/practicing over several sessions is more effective than “cramming” the night before.
10. Identify your stresses and find ways to deal with them. Students become stressed at different stages in the program. For many students, the first two (2) semesters of the program are the worst because you will feel so helpless; you won’t know what you can do, what you can’t do, or when to do or not do something. But this a normal part of learning any new skill.
11. Eat well and get plenty of sleep. Typically, when students become stressed, they will get sick.
IX. APPENDIX OF CLINICAL FORMS
A. Exam Log
B. Procedural Simulation
C. Procedural Test-Out
D. Procedural Test-Out (Surgery)
E. Clinical Objectives
F. Clinical Grade Sheet
G. Student Evaluation
H. Master Rubric
I. Affective Evaluation
J. Blind Competency
K. Image Critique Evaluation
L. ARRT Clinical Competency List
M. Student Incident
N. Personal Time Off (PTO) Report (sample)
Last Revision Date: April/2018
Last Review Date: April/2018