Summative Professional Assessment Flashcards
1 Practice safely and effectively to the appropriate standard for the level of a band 5 newly qualified radiographer
Assessor must ask the student:
What is your understanding of “scope of practice” and how will you ensure your practice is safe and effective??
Scope of practice, is linked to what HCPC standards have been set and these can update and change over time, but its basically everything I have been trained to do. So this means doing things i’ve been trained to do, so e.g if im not signed off on a piece of equipment, don’t use it, so acting within local policies and protocols. Seek senior support on anything Im not sure of. Also seek out CPD opportunities to ensure I keep up with changing standards and the evidence base behind things.
To ensure my practice is safe and effective, first I would only act within my scope of practice, and speak to seniors if I need help and guidance around a topic. for example cannulation, I wouldn’t do that without appropriate training.
To ensure its safe, I act within IMMER and IRR so ALARP and making sure that requests are justified and if i’m unsure about requests, speaking to someone senior or speaking to the referrer about the request so I can understand the logic behind it. so e.g a doctor requesting a lateral foot, even though it’s not usual to do I remember the dr saying they think there an avulsion fracture in the top of the foot because of swelling, so in order to visualise it well a lateral is needed, and the doc was right there was.
Ensure to ensure safety, is safeguarding since we have a duty of care to patients. so if a patient tells me something concerning, alerting the safeguarding team about that and the referrer.
To ensure its effective, this is like clinical prioritisation, so e.g x-raying the ?NOF before ?# of the wrist, because I know the NOF has high mortality rate.
Appropriate documentation so again the safeguarding thing, I would write a witness statement about what was said to me. or even put a note on sol if a patient is verbally abusive so other staff are made aware.
Speaking to other staff so e.g if I see an NG tube not in the stomach, so its in the lung, I would phone the ward and let them know, just so they don’t use the NG.
Adapting to patients needs is a requirement of the Equality Act 2010, for example, if a patient needs to pray at a certain time, schedule appointment around that.
2 Practice within legal and ethical boundaries
Assessor must ask the student:
What are the legal and ethical boundaries of radiographic practice?
IMMER and IRR so this means justify if a request is valid or if a different procedure is better for the patient, e.g back problems might be best to go MRI.
This also means ALARP, so e.g if its a child, make sure the exposures are lowered for them.
This brings in about non-maleficence and beneficence, as we do a risk vs benefit when it comes to checking whether the patient needs the x-ray or not.
but this also means we have to gain informed consent since we are using ionising radiation and patients need to be aware of the risk.
In chances where the patient cant give consent e.g they are unconscious, a radiologist would give consent for the patient since its deemed in the patients best interest, but this is for a consultant and radiologist to decide, not me the radiographer.
In other cases, its checking for pregnancy when doing abdominal x-rays, because of the risk to the foetus, but there are cases where you have to x-ray or even CT scan a patient during pregnancy but the radiologist will make this decision and we can discuss any concerns around that with the radiologist.
Also the Equality Act, and respecting patients decisions to upload justice, for example, this means maintaining dignity inline with inclusive pregnancy policy, so e.g if there is a patient who is trans, asking them if there is a chance of pregnancy in a respectful way and also ensuring that I use the correct pronouns.
We have a duty of care to patients and safeguarding so e.g if I saw a nightstick fracture I would go through local safeguarding policies and speak to seniors for help in these cases.
Also Data Protection Act, so I wouldn’t do anything that puts patient’s data at risk, so leaving patient details up on a portable machine for example.
Duty of condour so e.g if I x-rayed the wrong side I would admit my mistake to the patient and would document it and then regain consent to x-ray the correct side.
3 Maintain high standards of professional conduct
Assessor must ask the student:
As a qualified radiographer, how will you maintain your fitness to practice?
Adherence to HCPC standards, and also doing CPD which is a requirement of the HCPC.
way to do this, is attending the yearly reviews and getting feedback so this can give me action points to work on.
You can also get feedback from patients, e.g if a patient thought I had a lack of understanding of a topic, e.g gender inclusive I would get this as a learning point as something to work on.
Also from peers, e.g if someone says my scapula images are not good, I could do some training or CPD around that since I don’t do them often.
Its about identifying areas where I may lack understanding and ensuring I improve my skills in the best interest of the patient.
also attending yearly meetings about my practice to ensure I am meeting standards.
also means that if anything affects my mental health which is affecting my ability to work I let my line manager try to organise keeping myself safe and patients safe.
Also equipment refresher training, I remember an audit that said those who didn’t do the refresher training had higher radiation incidents
Taking part in audits and listening to them forgien body marker example
Any changes to policy and law so e.g inclusive pregnancy policy
4 Exercise autonomous professional judgement
Assessor must ask the student:
As a qualified practitioner, you will be required to justify all your decisions. Discuss why this is the case
Because I am autonomous in my practice, I need to ensure my decisions are justified so that I can explain them and give the reasoning behind it if asked. Sometimes I will have to justify the decisions to patients, so going back to the MRI example, if I cancelled the patient I would explain why I did and how I am acting in their best interest.
And also explaining this to the referrer and documenting it as its a legal requirement.
Another example is x-raying a child and changing the exposure to suit the patient, but the patient won’t stay still and is having a bad time. I wouldn’t x-ray that child and I wouldnt do anything to restrain the child, if the kid is moving the image won’t be diagnostic so there’s no point in doing it. So if possible I would tell the parent to schedule or come back in a couple hours when the child has calmed down.
I would let the refer know and document in case they are waiting for the patient. or is it’s not possible I would document, its about working ethically and legally in the best interest of my patients.
5 Be aware of the impact of culture, equality and diversity
Assessor must ask the student:
Can you discuss examples of where you have had to adapt the way you work in order to meet the needs of different groups and individuals?
One example, if when getting patients changed for their x-rays, I explain clearly that they can keep their hijab on to respect their belief. So I would explain that it’s just the bra that needs removing and any jewellery.
I did have a case when getting a patient changed for MRI scan, and we put them in the gowns, I told them to keep the hijab on and I respectfully asked if I could check if there is metal clips on the hijab, so out of the way of other patients to respect their privacy, in case the hijab fell or something when I checked.
Another times I have changed when I would take breaks so that co-workers would have time to go pray, and ensure there is enough staff in the department.
Once I had a patient ask if they can pray before their chest x-ray for good luck as they were extremely stressed and I gave them time to do this.
Another example is the inclusive pregnancy policy and being fair to all patients. For example, I had to ask for pregnancy status for a trans patient who identifies as male. I asked and also asked what their pronouns were (he/him) to ensure that I respected the patient.
Being aware how these things affect patients as not respecting their needs, will make them lose trust in health professionals.
Deaf patient and running behind the screen and speaking to them and not the translator
6 Practice in a non-discriminatory manner
Assessor must ask the student:
What would you do if you were the only radiographer available and you were asked to image a prisoner who, from recent high profile media reports, you know is a convicted murderer?
I would first do my normal checks so e.g is the request all justified etc, and then I would set up room as usual.
I would call the patient in and since they are a prisoner, im guessing they will have guards with them.
If I noticed anyone recording in the waiting room, I would tell them to stop because local policy says to not be recording in the waiting room and I may even set up the privacy screens, if I felt the need to. (I might set up the privacy screen before hand if Im made aware of the patient before and if I have time/chance to.
Once I have the patient in the room, I would do my normal ID checks, check they are happy to have the x-ray and x-ray them. I would ensure the guards are behind the lead screen also.
then I would send the patient back to the waiting room with the privacy screens if needed. Send the images off correctly labelled etc and process as normal.
If anyone tried asking me about it I would just state that the data protection act means I cant speak about it and carry on as normal. This is very imporant in cases where other staff might ask so I would explain that if they need access to the details, they need to speak to IT oor the line manager and not me.
7 Understand the importance of and be able to maintain confidentiality
Assessor must ask the student:
You are working at the weekend and a member of staff from another department comes to you and asks you to access an imaging report for a patient as the staff member does not have access to view the report themselves. What would you do?
Acting within the Data Protection Act, if the staff member doesn’t have access they dont need access usually. I would establish who the staff member is and ask if they are taking care of the patient. I would tell them they need to speak to the line manager.
If its like sending to another hospital they should have access via PACS or send via the portal thing, but I will say I can’t discuss it.
8 Communicate effectively
Assessor must ask the student:
How do you modify your communication to address and take account of individual service users?
Having a open stance
So I would modify my communication to meet the needs of individuals so for example for children, I would sound happy and cheery and call the x-ray tube, a camera to make it less scary and lead down/kneen so I am making direct eye contact with the kid. This can help them fell less scare and more happy to do the x-ray. But also speaking to the parent about what I plan on doing and if the parent needs to stay with them, asking if the parent is happy and no chance of pregnancy.
Another example is dementia patients, so it’s best to ask one question at a time for ID rather than going quickly. and not moving around the x-ray tube at the same time so they can hear me clearly. I may use gestures to convey information such as breathing in when I want them to breathe in for a chest x-ray.
If a patient is upset I may use touch such as holding the patient’s hand or shoulder to show empathy, to comfort the patient.
using crystal clear language to explanation everything to get informed consent.
also with language barriers I would get a translator involved to help so that the patient knows what is happening to gain that informed consent.
Another example is speaking to adult patients with autism, I would explain things clearly and encourage them to ask questions if they are confused etc, but I wouldn’t necessarily maintain eye contact with them as it can make some people uneasy. but I would explain everything to the patient and have them involved and also explain to the carer but wouldn’t expect the carer to like “translate” to the patient. So i would advocate for the patient’s individuality in that sense.
You know i adapt to the patients needs with the Equality Act in mind so I know I am giving equal opportunity and not assuming that a patient cant understand me.
9 Work appropriately with others
Assessor must ask the student:
Can you explain why working in a multidisciplinary team is important to empower service users?
Because there will be many people who have different skill sets who can help the patient in different ways.
For example, lets say there is a patient for a contrast CT and the patient is unsure if they are allergic, I would check the patients notes and call the nurses on the ward. If the nurses are unsure, then I would consult the duty radiologist and they would make the decision whether to continue. Throughout this I would ask the patient what they would like to do and whether they are happy for the contrast to be given.
It might involve having the radiologist or the referrer explaining to the patient why it is in their best interest but giving the patient the informed decision on whether they want to have that contrast or not.
If I just said right im not doing the scan then without getting other professionals involved to help the patient come to an informed decision about the contrast then I have taken that choice away from the patient without giving them chance to decide.
Another example is intervention, so let’s say the patient comes down from the ward, their consent forms are filled in but the patient says they don’t understand what they are having. I would explain to the patient the procedure but I would like the consultant who is doing the procedure know so they can gain informed consent. I would let the patient know about the radiation risk etc and again gain that informed consent.
Everyone has their own skills and knowledge and can help the patient make informed decisions about their care.
10 Able to maintain records appropriately
Assessor must ask the student:
In your practice, how and why do you ensure that the records you keep are accurate and appropriate?
mistakes I promptly fix them. so e.g if I labelled the wrong side I would fix it.
Follow consistency, and if I find anything critical I would report it as soon as possible e.g NG tube is in the lungs.
Following confidentiality policies etc, so only sending images via established routes through PACS to other hospitals.
Continued training so if policies change I know what has changed so I can follow it. If i’m unsure ask for advice.
Following GPPR principles and that only minimum data needs to be recorded so e.g if a patient is verbally aggressive I could put a note saying they are verbally aggressive for future staff to be aware, however, I wouldn’t need to write down the specific things said unless it was something that was to be DEXTA.
And also in that regard following safeguarding so if I have to share it, its sharing with only those who need to know and documenting and doing a witness statement also.
Keeping it update.
and also in line with IR(ME)R recording patient dose and also IRR recording staff who were there for interventional procedures for record keeping.
11 Able to reflect on and review practice
Assessor should look at student’s clinical handbook to review their weekly feedback sheets for weekly evidence of reflective practice. To meet the requirements of “meets expectation”, the student must have a consistent approach to undertaking reflection and action planning
In addition the Assessor must ask the student:
What is the value of reflective practice?
It’s a HCPC requirement to do CPD and reflective practice.
It gets you to critically think about your actions to improve your patient care, and identify ways to improve.
I personally find it useful for my mental health, looking back on situations and thinking about what went well so I don’t feel completely negatively about situations. or it helps you realise that a situation is out of your control, so for example, I have done reflectives on when patients have crashed and that I did what I could for the level of knowledge and skill I have in those situations.
So it gives you that self-awareness in order to continuously improve, you can identify problems and make a plan to get better.
For example, i’ve done reflectives on when I’ve had patients crash and its allowed me to look back and say I did what I could do in regards to the amount of experience and knowledge I had as a student and to move forward i’ve said I want to learn the equipment in the crash cart so I can be more helpful in those situations.
12 Able to assure the quality of their practice.
Assessor must ask the student:
As a qualified practitioner, how will you engage in evidence based practice?
So I will use my knowledge and keep up to date with any changes e.g if IMMER or IRR got changed I would do a training course to ensure I would understand any changes.
Work within the NICE guidelines so e.g for stroke you want to do the CT head within a hours as we know quality of life is reduced after this time period.
Another example, is x-ray requests for lower back pain, should be sent to MRI instead because x-ray is not sensitive for conditions like slipped disc so in order to follow guidelines, I wouldn’t do the x-ray and phone the referrer and let them know.
Being involved in audits within the hospital, for example, I remember watching a radiologists presenting an audit they did about foreign body markers and about how radiographers were not using them which made it more difficult to interpret the images. They showed examples, so it was a good lesson to remind me to always use foreign body markers.
Also doing refresher training on equipment, I remember hearing about an audit that found that those who don’t do their competency training have more radiation incidents.
Also CPD is a HCPC requirement.
13 Apply their knowledge base to their practice.
Assessor must ask the student:
As a qualified practitioner, how will your knowledge base influence your practice?
My knowledge base will influence everything I do, so e.g knowing my anatomy, so I can get good quality images that are centred correctly.
Pathology e.g pnuemothorax I would report.
Clinical prioritisation e.g sepsis/NOF
Also following the principles of IM(ME)R and IRR so using ALARP, to keep exposures so so using my knowledge about collimation so e.g for a wrist you only need to include a 3rd proximal radius and ulna, no more than that and distally, the metacarpal heads.
This also comes into using my physics knowledge to ensure good images so e.g being the IR closer to reduce magnification.
working within my scope of practice and keeping up with mandatory training such as patient handling and the refresher training in order to be safe and competent. Asking for help from a senior when i’m unsure.
Working autonomously to do the right examination for the right patient, so working within NICE guidelines.
Following Data Protections Act and principles and local policies to ensure all data is only sent to those who need it and via the safe established routes.
Equality Act so working holistically ensuring that all my patients get the care they need whilst meeting their other needs so e.g keeping hijab on when possible.
working within the mental capacity act also to ensure I am getting informed consent from all patients and preventing deprivation of liberties.
And doing CPD to help me keep my knowledge base up to date to do best practice.
