Assessment Plan Template
Program Radiography Certificate Program
Assessment Coordinator for the program George Pales
Department(s) or Interdisciplinary Council Responsible for the Program Health Physics
Five-Year Implementation Dates (2004-2005 to 2009-2010)
Is this program accredited by an external organization? No X Yes, and the organization is Joint Review Committee on Education in Radiologic Technology.
NOTE: The program may submit the most recent self study assessment documents/information in substitution for this plan.
STANDARD ONE: The program, in support of its mission and goals, develops and implements a system of planning and evaluation to determine its effectiveness and uses the results for program improvement.
In support of Standard One the program:
1.1 Has a mission statement that defines its purpose and scope.
Explanation:
The program’s mission statement should be a broad statement of purpose or intent and may range in length from one sentence to a few paragraphs. The program’s mission statement should be consistent with that of its sponsoring institution.
1.2 Has written goals that outline what the program is designed to achieve.
Explanation:
The JRCERT defines goals as tasks or direction statements adopted by a program that include the purpose or intent toward which the program’s efforts are directed. A program’s goals are a more specific expression of the program’s intended student learning outcomes. The goals should be written using behavioral terms and should address the cognitive, affective and psychomotor domains. They must be measurable, preferably through the use of more than one measurement tool.
1.1/1.2 Compliance is Demonstrated by:
Written Program Mission Statement and Goals are demonstrated by the Radiography Policy Manual; “Broadside” (often referred to as “student bulletin” by UNLV); UNLV website; UNLV Radiography Program “Master Plan of Education”; and “student information packet” materials.
See “evidence binder”
1.4 Develops and implements an assessment plan that identifies benchmarks for the measurement of outcomes in relation to its mission statement and goals and includes:
· program completion rate;
· clinical performance and clinical competence;
· problem solving skills and critical thinking;
· communication skills;
· professional development and growth;
· graduate satisfaction; and
· employer satisfaction.
UNLV Radiography Program Statistics 1999-2003
Year starting program / # accepted / # finishing / # finishing & passing boards / # having jobs within 6 mos of finishing1999 / 31 / 26
84% / 24
92% / 26
100%
2000 / 35 / 30*
86% / 28
93% / 30
100%
2001 / 36 / 25*
72% / 25
100% / 28
100%
2002 / 45 / 33*
73% / 31
94%
2003 / 46
*2000 2 finishing the program via “extended program”
*2001 6 finishing the program via “extended program”
*2002 6 dropped/failed; 5 finishing via “extended program”
Clinical performance and competence is evaluated in an “on-going” semester by semester fashion as well as annually by the Clinical Coordinator and Chief Clinical Coordinator at each clinical education site.
Problem solving skills, critical thinking, communication skills as well as professional development and growth are continuously evaluated in each didactic and/or clinical course. Certain aspects in one are much more so than others as per the “Personal and Professional Growth Assessment” of each student twice each semester in clinical.
Overall student and employer satisfaction are evaluated annually via graduate and employer surveys.
See evidence binder
1.5 Documents outcomes consistent with each of the following JRCERT policies:
· over the past five years, credentialing examination pass rate average of not less than 75 percent at first attempt
· over the past five years, job placement rate of not less than 75 percent within six months of graduation
Explanation:
The program should have an ongoing, systematic process to assess its outcomes. The assessment plan should incorporate the program’s goals, supported by specific outcomes. An outcome, as defined by the JRCERT, is the expected end result of student learning. A benchmark must be established for each expected outcome to provide a standard against which the actual outcome can be evaluated. The assessment plan should also identify tools to be used and timeframes for data collection and analysis. The person and/or group responsible for the analysis should be identified.
UNLV Radiography Program Goals are evaluated in an on-going method annually.
Specific Program Goals:
1. Produce students with the technical skills to perform as entry-level radiographers.
2. Graduate students proficient in radiation safety practices.
3. Prepare graduates to administer appropriate patient care techniques.
4. Graduate students who will be successful in passing the American Registry of Radiologic Technologists exam, at a minimum rate of 75% passing.
5. Provide continuing education opportunities for graduate Radiographers.
6. Support faculty research.
Goals 1-6Outcomes / Measurement Tool / Benchmark / Time Frame / Person/Group Responsible
1. Graduates will be clinically competent / Clinical Competency Evaluations / Graduates will have a minimum score of 90% / On-going and at graduation / Program Clinical Coordinator
2. Graduates will be adequately prepared to perform as entry-level practitioners / Employer Surveys / 85% of returned surveys will indicate validity / Annually in December / Advisory Committee to review
3. Graduates will pass the ARRT exam / ARRT board exam results / Minimum of 75% taking the exam will pass on the 1st attempt / Annually in December / Program Faculty
4. Graduates will indicate they were prepared to perform as entry-level practitioners(both technical/radiation safety and patient care aspects) / Graduate Surveys/radiation dose summaries / Minimum of 85% of returned surveys will indicate validity / Annually in December / Didactic and Clinical Faculty to review
5. Provide continuing education opportunities for
graduates / Number of students registered in advanced programs / Former students will be surveyed for continuing educational activities / Annually each fall / Program Faculty
6. Support Faculty Research / Number of research projects completed underway / Survey of faculty members/annual evaluation of faculty / Annually / Dept. Chair and Program Director
See evidence binder
1.7 Analyzes and uses feedback from its communities of interest and outcome for data for continuous improvement of its policies, procedures, and educational offerings.
Explanation:
The program should review actual outcomes in relation to expected outcomes and their benchmarks and input from its communities of interest, analyze this information, and use the results of the analysis to make appropriate changes. Changes should be monitored to determine if the desired effect(s) has been achieved. A comparative analysis of data from one assessment cycle to another should be performed to identify trends in outcomes.
The Program reviews graduate surveys, employer surveys, teacher evaluations, clinical instructor evaluations, clinical site evaluations and advisory committee meeting minutes to ascertain areas for improvement.
Specific areas of improvement undertaken since last site evaluation visit:
-established a clinical site evaluation tool and evaluate sites annually
-established a clinical faculty evaluation tool and evaluate faculty annually
-revised the graduate survey instrument and perform survey annually
-revised the employer survey instrument and perform survey annually
-obtained a “C-arm” fluoro unit to utilize on campus to augment the surgery clinical experiences (feed back on graduate surveys indicated this need)
-obtained a “Panorex” unit for mandible studies (student feedback review indicated many sites utilized “Panorex” units, yet the UNLV campus did NOT have a unit)
-bolstered radiation protection didactic and clinical enforcement of the ALARA Principle due to radiation dose readings (all within federal, state and UNLV dose guidelines, but a bit higher than desired) AND additional radiation safety reviews given both clinically and didactically due to the rapid increase in “digital imaging” with “post image acquisition tweaking of the image” regardless of mAs used
-revised clinical competency evaluation form for each study/exam evaluation to include a new ALARA evaluation due to the rapid proliferation of digital imaging
-expanded the HIPPA student instructions to didactic coursework in RAD 100 (Introduction to Medical Imaging and Radiation Therapy) and RAD 117 (Patient Care
in Medical Imaging and Radiation Therapy). Heavy emphasis on HIPPA is also given during the annual clinical orientation meeting.
See evidence binder
1.8 Periodically evaluates its mission statement, goals, and assessment plan and makes revisions as necessary to achieve continuous quality improvement.
Explanation:
As part of the assessment cycle, the program should review its mission statement and goals to assure that they are appropriate and useful. The assessment plan should be reviewed to assure that assessment measures are adequate and that the assessment process is effective in measuring student learning outcomes.
The Radiography Program revises the mission statement, goals and assessment plan in concert with NASC Accreditation and/or JRCERT evaluation schedules as well as whenever the advisory committee indicates a need. The last MAJOR revision was in 1999. The assessment process was revised extensively during 2003 as per 1.7 above using information from graduate and employer surveys as well as advisory committee input.
STANDARD EIGHT: Program policies and procedures are in compliance with federal and state radiation protection laws.
In support of Standard Eight the program:
8.1 Safeguards the health and safety of students associated with educational activities through the implementation of published policies and procedures that are in compliance with Nuclear Regulatory Commission regulations and state laws as applicable.
Explanation:
The program must maintain and monitor student radiation exposure data. The program must have a protocol for incidents in which dose limits are exceeded. The program is advised that is consistent with Standard Three, Objective 3.3, if exposure reports are publicly posted they must be free of confidential student information.
UNLV Radiography Program students and faculty are monitored at both didactic energized labs and clinical education sites. The Radiation Safety Officer of UNLV and his/her staff perform an annual REQUIRED Radiation Safety Brief for ALL faculty and students that operate ionizing imaging equipment and/or radioactive sources. The university adheres to federal and State of Nevada Administrative Code (Chapter 459) in its radiation safety program. Both the Radiography Program Director and Clinical Coordinator, in concert with the UNLV RSO, monitor the dosimetry readings of any and all faculty and students.
Further: Both the Radiography Program Director and Clinical Coordinator are members of the UNLV Radiation Safety Committee; the UNLV RSO reviews the dosimetry doses and immediately contacts the Radiography Program if any faculty/student doses exceed 10% of the maximum state/federal maximum permissible dose. Thus the doses received, even if deemed above the UNLV maximum level are only at one tenth the MPD for federal and state guidelines.
UNLV Radiation Protection Program policies, Safety Newsletter, and dosimetry samples are available in the evidence binder.
8.3 Assures that students use equipment and accessories, employ techniques, and perform procedures in accordance with accepted equipment use and radiation safety practices to minimize radiation exposure to patients, selves, and others.
Explanation:
Students must understand basic radiation safety practices prior to assignment to the clinical education setting. As students progress in the program, they must become knowledgeable of practices to minimize radiation exposure.
In addition to 8.1 above, the UNLV Radiography students receive radiation protection education in RAD 100, RAD 150/151, RAD 170/171 and the “clinical orientation brief” as well as annual REQUIRED UNLV RSO Radiation Safety Brief PRIOR to any actual clinical radiation exposure to patients. They also must successfully pass RAD 102 (Radiation Safety and Biology).
See evidence binder
8.4 Assures that all radiation therapy procedures are performed under the direct supervision of a qualified practitioner.
N/A No Radiation Therapy Program at this time at UNLV
8.5 Assures that all medical imaging procedures are performed under the direct supervision of a qualified practitioner until a radiography student achieves competency.
Explanation:
The JRCERT defines direct supervision as student supervision by a qualified practitioner who: reviews the procedure in relation to the student’s achievement; evaluates the condition of the patient in relation the student’s knowledge; is present during the conduct of the procedure; and reviews and approves the procedure and/or image. Students must be directly supervised until competency is achieved.
8.6 Assures that all medical imaging procedures are performed under the indirect supervision of a qualified practitioner after a radiography student achieves competency.
Explanation:
For radiography, the JRCERT defines indirect supervision as that supervision provided by a qualified practitioner immediately available to assist students regardless of the level of student achievement. Immediately available is interpreted as the physical presence of a qualified practitioner adjacent to the room or location where a radiographic procedure is being performed. This availability applies to all areas where ionizing radiation equipment is in use.
8.7 Assures that radiography students repeating unsatisfactory radiographs are under the direct supervision of a qualified practitioner.
Explanation:
A qualified practitioner must be present during the conduct of a repeat radiograph.
Direct supervision of students is addressed for the clinical faculty and technologists coming in contact with UNLV Radiography Program students via: UNLV Clinical Faculty Seminars (required to be a “UNLV tester of students”). Students are made aware of direct supervision requirements via the UNLV Radiography Program Policy Manual, The UNLV Radiography Program Competency based clinical binder (required of each student), the UNLV Clinical Orientation of Students MANDATARY session prior to starting clinical rotation and on all “Competency Based Clinical Evaluation Forms”.
See evidence binder
8.8 Maintains documentation that learning environments are in compliance with applicable state and federal radiation safety laws.
Explanation:
Records of compliance (JCAHO, state, or equivalent) must be maintained for clinical education settings and energized laboratories.
All clinical education settings are in JCAHO compliance.
All energized laboratory units are in compliance with State of Nevada guidelines.
See evidence binder for JCAHO certificates and State of Nevada certificates for ionizing x-ray units at UNLV.
Standard Nine: The program and the sponsoring institution have adequate financial resources, demonstrate financial stability, and comply with obligations for Title IV federal funding, if applicable.
In support of Standard Nine, the program:
9.1 Has sufficient on-going financial resources to support the program’s mission and goals.
Explanation:
The sponsoring institution must demonstrate on-going financial commitment to the program and its students by providing adequate human and physical resources.
The Radiography Program is funded by the State of Nevada via the UNLV annual budget. In addition to the Radiography Program’s three budgets, the program is supported by the budgets from the School of Health and Human Science and the Department of Health Physics as needed.
See evidence binder