SMRT Signals • February 2017 • Vol.6 Issue 1

INFORMATION FOR YOU:

The JRCERT Accreditation Process: A Site Visitor’s Perspective

  Loraine D Zelna, MS, R.T.(R)(MR)   Bette Schans, PhD, R.T.(R), FASRT

This article is based on content previously published by the American Society of Radiologic Technologists and is used with permission of the ASRT.

To apply for or maintain program accreditation with the Joint Review Committee on Education in Radiologic Technology (JRCERT), radiologic science program faculty must submit a self-study report that documents compliance with the agency’s Standards for an Accredited Educational Program in Radiography, Radiation Therapy, Magnetic Resonance, Medical Dosimetry.1, 2, 3, 4 The JRCERT awards accreditation to programs that demonstrate substantial compliance with the Standards. After JRCERT staff review a program’s self-study report, site visitors conduct a 2-day on-site evaluation to determine whether the program meets the objectives outlined in the standards. Site visitors are peer professionals who have experience developing JRCERT self-study reports and who have hosted site visits at their program locations. This article provides a site visitor’s overview of the JRCERT accreditation process and a typical site visit.

The Self-study Report

Writing a self-study report and preparing for a JRCERT site visit can be a stressful and daunting task for program faculty, particularly while juggling other program responsibilities. The report must document compliance with each objective listed under the 6 standards outlined in the Standards for an Accredited Educational Program, and supporting documentation is required for most of the objectives. It is not a good idea to start the report only a few months before it is due. Collecting information and documentation for the report should be an ongoing process. Having all of the required information on hand makes it easier to assemble the self-study. For objectives that require supporting evidence, be sure to include appropriate documentation that supports the narrative response. For example, if the self-study states that the program’s learning outcomes are published on the program website and in the student handbook or assessment plan, these sources should state the same outcomes. Do not assume that JRCERT staff or the site visitors can determine compliance based on the narrative responses only.

Preparing for the Site Visit

After JRCERT staff members review a program’s self-study report, the staff reaches out to potential site visitors to request their participation in the site visit. Each site-visit team is comprised of a team chair and at least 1 team member. The site visitors might be program directors, clinical coordinators, clinical instructors, or other members of a program’s faculty. Site visitors complete an initial orientation and are required to serve as apprentice site visitors on 3 site visits before achieving full status as a site visitor. All site visitors must attend JRCERT seminars and workshops to stay abreast of standards, accreditation processes, and site visitor responsibilities.

The program director and the site-visit team agree on a date for the site visit, and travel and hotel arrangements are confirmed. The composition of the site-visit team is reviewed with the program and site-visit team to assure there are no conflicts of interest. Team members then complete confidentiality statements. The team chair then works with the program director to develop the site visit agenda. Approximately 2 to 3 months before the on-site evaluation; the site visitors receive the program’s self-study materials, and the peer-review process for accreditation begins.

The site-visit team carefully reviews the self-study materials, including the narrative responses and supporting documentation. The team members collaborate closely during the preliminary review process. If additional or clarifying information is required, the team chair will communicate those needs to the program director. If updates to the original self-study submission are necessary, the program director must submit the updates to the site visitors at least 4 weeks before the on-site visit.

The Site Visit

Upon arriving at the program location, the site visitors compare notes and finalize the 2-day site-visit plan. Often, team members are meeting in person for the first time and must clarify their roles and responsibilities in advance of the on-site evaluation. The JRCERT office staff is available if the site visitors require guidance during the on-site visit. To assess whether the program is operating in compliance with JRCERT standards and objectives, the site visitors verify that the program operations are consistent with the narrative descriptions and supporting documentation in the self-study report. Possible site-visitor evaluation methods might include:

  • Review of published program materials.
  • Review of student academic and clinical records.
  • Review of clinical placement process.
  • Interviews with the program faculty, clinical instructors, and clinical staff.
  • Interviews with students.
  • A tour of program offices and clinical settings.1

The site-visit team, program officials, and institutional administrators begin day 1 of the site visit with an introductory meeting. The site-visit team chair reads the JRCERT confidentiality statement, explains the accreditation cycle, and reviews the site-visit agenda. The team gathers information by reviewing files and conducting interviews with students, faculty, and administration. The team also visits at least 2 clinical settings to assess the clinical component of the program. At the end of the first day, the team starts developing a Report of Site Visit Team Findings and compiles a list of outstanding information. On day 2, the site-visit team concludes interviews and completes the remaining document reviews. Around mid-day, the site visitors convene to complete their report of findings.

The site visit is concluded with an official exit summation meeting, but prior to that, the site visitors meet with the program director to review their findings. This courtesy review helps clear up any misunderstandings that may have developed during the visit and assures the program director that there will be no surprises at the exit summation meeting. The program’s communities of interest, as determined by the program, are invited to attend the exit summation meeting. At the meeting, the site-visit team chair reads the Report of Site Visit Team Findings and explains that the report is not final. The JRCERT staff completes the final review and makes modifications, if necessary, to ensure that the report accurately reflects JRCERT standards. The staff then prepares a package of relevant materials, including the program’s self-study report, the Report of Site Visit Team Findings, and the official Report of Findings, which is sent to the JRCERT Board of Directors for review.

Board Review

The JRCERT Board of Directors oversees the final step in the accreditation review process. The JRCERT Board of Directors is composed of highly qualified individuals nominated by various professional organizations or selected directly by the JRCERT. The board meets monthly to review accreditation recommendations for 20 to 40 radiologic science education programs. Under the leadership of the board chairperson, the board members review, discuss, and determine program accreditation awards. Officials of sponsoring institutions and programs are promptly notified of the accreditation award decision in a letter that specifies the length of the accreditation award. The board may also request program officials to provide a progress report, if necessary, to further assess compliance with specific objectives outlined in the Standards for an Accredited Educational Program.

In summary, the purpose of the peer-reviewed accreditation process is to ensure that radiologic science education programs meet specific quality standards. Experienced with both the self-study report and site visit process, JRCERT site visitors understand that programs can achieve a favorable accreditation award by collecting accurate program information, providing clear and consistent reporting, presenting appropriate evidence, and preparing for the site visit.

Loraine D Zelna, MS, R.T.(R)(MR), is faculty member and chairperson of the medical imaging department for Misericordia University in Dallas, Pennsylvania. She is a member of the JRCERT Board of Directors.

Bette Schans, PhD, R.T.(R), FASRT, is director of assessment of student learning for Colorado Mesa University in Grand Junction, Colorado. She is a member of the JRCERT Board of Directors.

References
  1. The Joint Review Committee on Education in Radiologic Technology. Standards for an Accredited Educational Program in Radiography. http://jrcert.org/sites/jrcert/uploads/documents/2014_Standards/Standards_2014-Radiography.doc. Effective January 1, 2014. Accessed September 22, 2016.
     
  2. The Joint Review Committee on Education in Radiologic Technology. Standards for an Accredited Educational Program in Radiation Therapy. http://jrcert.org/sites/jrcert/uploads/documents/2014_Standards/Standards_2014-Radiation Therapy.doc. Effective January 1, 2014. Accessed September 22, 2016.
     
  3. The Joint Review Committee on Education in Radiologic Technology. Standards for an Accredited Educational Program in Magnetic Resonance. http://jrcert.org/sites/jrcert/uploads/documents/2014_Standards/Standards_2014-Magnetic Resonance.doc. Effective January 1, 2014. Accessed September 22, 2016.
     
  4. The Joint Review Committee on Education in Radiologic Technology. Standards for an Accredited Educational Program in Medical Dosimetry. http://jrcert.org/sites/jrcert/uploads/documents/2014_Standards/Standards_2014-Medical Dosimetry.doc. Effective January 1, 2014. Accessed September 22, 2016.
The Joint Review Committee on Education in Radiologic Technology has published a Site Visit Checklist to assist programs as they prepare for an on-site visit. The checklist is available at: http://www.jrcert.org/sites/jrcert/uploads/documents/Site_Visitors_Resources/JRCERT_checklist_for_programs_preparing_for_site_visit_9-16.pdf
 
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Signals is a publication produced by the International Society for Magnetic Resonance in Medicine for the benefit of the SMRT membership and those individuals and organizations that support the educational programs and professional advancement of the SMRT and its members. The newsletter is the compilation of editor, Julie Strandt-Peay, BSM, RT (R)(MR) FSMRT, the leadership of the SMRT and the staff in the ISMRM Central Office with contributions from members and invited participants.
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