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INFORMATION FOR YOU: JRCERT Accreditation Standards: Focus on Safety |
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Jason W. Stephenson, M.D. serves on the JRCERT Board of Directors and is Assistant Professor, Associate Residency Program Director, and Director of Medical Student Education at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. This article is based on content previously published by the American Society of Radiologic Technologists and is used with permission of the ASRT. |
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Each student is entitled to a safe environment in which to learn. The Joint Review Committee on Education in Radiologic Technology (JRCERT) is committed to ensuring that radiology, radiation therapy, magnetic resonance and medical dosimetry training programs are safe for students and patients. While all JRCERT standards are intended to be straightforward, differences in interpretation of language in standard elements and changes in the scope of training can lead to gaps in compliance. This article reviews selected elements within Standard 4, which is intended to support the maintenance of “policies and procedures that promote the health, safety, and optimal use of radiation for students, patients, and the general public” and highlights common compliance pitfalls related to these elements. Standard 4, Objective 4.1 Assures the radiation safety of students through the implementation of published policies and procedures that are in compliance with Nuclear Regulatory Commission regulations and state laws as applicable.1-4 It is critical that educational program policies and procedures be well documented and shared with appropriate communities of interest. An effective way for programs to maintain compliance with this objective is to share the information on the program’s public website. Dose monitoring is a well-documented and well-understood part of occupational safety maintenance. In keeping with this, students are required to wear dosimetry badges at all times during their training. If students are employed by the medical center as technologist assistants, they are expected to wear a separate badge for that activity. The educational program should monitor student exposure closely, including ongoing review of student dosimetry data. These results should be shared with the student on a quarterly basis, at minimum, regardless of the reported dose levels. Optimally, the distribution of these results and confirmation that students have reviewed them should be documented by program administration. Common pitfalls encountered in relation to this standard include insufficient dosimetry data management or distribution. Standard 4, Objective 4.2 Has a published pregnancy policy that is consistent with applicable federal regulations and state laws, made known to accepted and enrolled female students, and contains the following elements:
The majority of programs demonstrate understanding of the importance of having a published policy that appropriately addresses radiation safety practices for pregnant students. The most commonly encountered problem relating to this standard is the failure to delineate or communicate the procedures for the withdrawal of a pregnancy declaration or the failure to stipulate that the withdrawal of a pregnancy declaration must be in writing. Standard 4, Objective 4.3 Assures that students employ proper radiation safety practices. 1-4 Several aspects of this standard present common pitfalls for educational programs during the accreditation process, including policies relating to keeping radiation exposures as low as reasonably achievable (ALARA), using radiation safe practices in the acquisition of radiographs, and providing adequate safety training and safety screening. Students are prohibited from holding image receptors during image acquisition and strongly discouraged from holding patients during image acquisition. Adherence to these safety practices will limit the student’s occupational radiation dose and encourage use of patient immobilization devices during imaging examinations. Because of the unique risks posed to healthcare providers and patients in relation to MR imaging, students who are in the MRI environment during their training at any time must receive MR imaging safety training. This training, whether part of orientation activities or the formal training curriculum, must occur before the student starts an MR imaging rotation. Further, it is strongly advised that each educational program require students to complete an MR imaging safety screening form before the start of their clinical rotations. This documentation, kept in the student’s file, should be updated yearly, or whenever a student’s responses to any of the screening questions change. Common issues encountered in relation to this standard include failure to emphasize that students must not hold image receptors, failure to provide MR imaging safety training before students start MR imaging rotations, or failure to document the presence or distribution of any of the above requirements. Standard 4, Objective 4.8 (Objective 4.6 for Radiation Therapy; Objective 4.7 for Magnetic Resonance and Medical Dosimetry) Assures that students are oriented to clinical setting policies and procedures in regard to health and safety. 1-4 Students must be familiar with each clinical setting’s safety policies to ensure they are equipped with sufficient knowledge to protect patients and themselves. This requirement ensures student compliance with all relevant local policies on safety. To ensure that students achieve this level of understanding, a clinical setting must offer a dedicated orientation, along with appropriate corresponding documentation, before a student begins a rotation at that location. Documentation While it is important to ensure the presence of safety policies and accurately convey them to students and faculty, it is equally important to document that students have received this information. One way to provide documentation is to have students sign an attestation form confirming that they received and understand this necessary information. During the site visit process, site visitors will discuss these policies with students to gauge their level of understanding; therefore, it is also important for programs to confirm students’ ongoing understanding of these policies. Conclusion Ensuring a safe training environment for students is a shared goal of program directors, program faculty and staff, home institutions, healthcare facilities, and the JRCERT. Every objective included in JRCERT Standard 4 serves to ensure that this goal is reflected in reality for all accredited educational programs. To that end, care must be taken to ensure that the safety measures in place are effective and well documented.
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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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