Evaluation by:

Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (STOEHR, Scott)

Students (Johnson, Cinira)
4/7/2014
4/7/2014 12:30:39 PM CT

Select the external beam photon planning competency from the drop down menu
below:

First Rotation Palliative

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

Ci did a very good job on the plan is understanding dosimetry well

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:10:14 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (BACKUS, Jennifer)

Students (Johnson, Cinira)
4/7/2014
4/7/2014 3:26:48 PM CT

Select the external beam photon planning competency from the drop down menu
below:

True Vocal Cord

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]

Enters in correct parameters for patient chart. - Satisfactory [2 pts]

Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:10:37 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (RYAN, Nicole)

Students (Johnson, Cinira)
4/8/2014
CT

Select the external beam photon planning competency from the drop down menu
below:

No response

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - No response

Loads the patient imaging studies into the planning computer. - No response
Contours the appropriate anatomy on the image data set. - No response
Successfully places the isocenter using simulation data. - No response
Correctly generates plan using blocks, wedges, fields, segmented fields. - No response
Generates plan with appropriate weighting. - No response
Generates plan with appropriate energies. - No response
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - No response
Accurately generates an individual DVH or composite DVH (for correct # of fractions). - No
response
Communicates effectively with physician for plan review and makes changes as requested.
- No response
Exports/Prints appropriate plan data. - No response
Performs hand verification calculations for plan MU settings using data/calc books. - No
response
Enters in correct parameters for patient chart. - No response
Performs pretreatment checks/calculations. - No response
Observes patient treatment. - No response

Overall rating:

No response

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Responses as of 12/4/2014 8:10:51 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (RYAN, Nicole)

Students (Johnson, Cinira)
4/18/2014
4/22/2014 12:09:36 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Para-aortic or Nodal Irradiation

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. N/A (Additional Comment: Hand calcs were not necessary for this treatment plan) [0 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - N/A (Additional Comment: She has observed many
treatments of this type) [0 pts]
MEAN: 1.73 (out of possible 2), % SCORE: 86.7%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 93.3%

(Each main question equally weighted)

Responses as of 12/4/2014 8:11:04 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (STOEHR, Scott)

Students (Johnson, Cinira)
4/22/2014
4/22/2014 3:23:07 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Intact Breast Tangentials

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

Cinira is competent with intact tangential breast planning and interacts well with our two
breast radiation physicians

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:11:18 PM CT

Evaluation by: Clinical Instructors (BACKUS, Jennifer)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 4/28/2014
Survey Completed: 4/28/2014 10:34:44 AM CT

Select the external beam photon planning competency from the drop down menu
below:

Other

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]

Successfully places the isocenter using simulation data. - Satisfactory [2 pts]

Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

The competency was an orbits plan.

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:11:31 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (RYAN, Nicole)

Students (Johnson, Cinira)
5/28/2014
7/7/2014 2:30:38 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Second Rotation Palliative

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. N/A (Additional Comment: hand calcs were not necessary) [0 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - N/A (Additional Comment: observation was not
necessary) [0 pts]
MEAN: 1.73 (out of possible 2), % SCORE: 86.7%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 93.3%

(Each main question equally weighted)

Responses as of 12/4/2014 8:11:45 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (STOEHR, Scott)

Students (Johnson, Cinira)
6/2/2014
7/7/2014 12:38:11 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Third Rotation Palliative

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:11:56 PM CT

Evaluation by: Clinical Instructors (RYAN, Nicole)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 6/11/2014
Survey Completed: 7/7/2014 2:28:49 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Off-Axis Prescription Point

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]

Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. N/A (Additional Comment: hand calcs were not necessary) [0 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - N/A (Additional Comment: observation was not
necessary) [0 pts]
MEAN: 1.73 (out of possible 2), % SCORE: 86.7%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

overall the plan was done well. Discussion of field energy was necessary, but the off axis
calc-point concept was correct

Mean percentage score for all rating scale questions: 93.3%

(Each main question equally weighted)

Responses as of 12/4/2014 8:12:07 PM CT

Evaluation by: Clinical Instructors (STOEHR, Scott)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 6/17/2014
Survey Completed: 6/18/2014 8:01:12 AM CT

Select the external beam photon planning competency from the drop down menu
below:

Breast or Chestwall with SC and PAB

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory (Additional Comment: Ci
does a very good job with this) [2 pts]
Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:12:18 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (STOEHR, Scott)

Students (Johnson, Cinira)
6/18/2014
7/7/2014 12:41:01 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Chestwall Tangentials (Bolus:Non-Bolus Weighting)

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]

Observes patient treatment. - Satisfactory

[2 pts]

MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:12:30 PM CT

Evaluation by: Clinical Instructors (BACKUS, Jennifer)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 6/23/2014
Survey Completed: 7/7/2014 12:35:30 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Esophagus

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

Nice plan 3D conformal

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Evaluation by: Clinical Instructors (RYAN, Nicole)

Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 6/23/2014
Survey Completed: 7/7/2014 2:24:58 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Abdomen - 3 or 4 field

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. Satisfactory (Additional Comment: Some of the field blocking needed to be edited) [2
pts]
Generates plan with appropriate weighting. - Satisfactory (Additional Comment: Some of
the field weighting needed to be edited) [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. N/A (Additional Comment: hand calc were not necessary) [0 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - N/A (Additional Comment: observing the treatment was not
necessary) [0 pts]
MEAN: 1.73 (out of possible 2), % SCORE: 86.7%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

Some editing of the plan by the dosimetrist was necessary before showing the physician,
but otherwise the plan was done well.

Mean percentage score for all rating scale questions: 93.3%

(Each main question equally weighted)

Responses as of 12/4/2014 8:12:55 PM

Responses as of 12/4/2014 8:12:42 PM CT
Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (BACKUS, Jennifer)

Students (Johnson, Cinira)
6/26/2014
6/26/2014 4:14:25 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Pelvis - 4 field

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]

Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:13:07 PM CT

Evaluation by: Clinical Instructors (STOEHR, Scott)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 7/28/2014
Survey Completed: 8/4/2014 4:43:57 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Lymphoma

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:13:26 PM CT

Evaluation by:
Evaluation of:
Evaluation Period:
Survey Completed:

Clinical Instructors (BACKUS, Jennifer)

Students (Johnson, Cinira)
8/4/2014
8/4/2014 12:35:09 PM CT

Select the external beam photon planning competency from the drop down menu
below:

Thoracic (Conformal)

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]
Exports/Prints appropriate plan data. - Satisfactory [2 pts]
Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]

MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:13:45 PM CT

Evaluation by: Clinical Instructors (STOEHR, Scott)
Evaluation of: Students (Johnson, Cinira)
Evaluation Period: 9/15/2014
Survey Completed: 9/30/2014 11:45:37 AM CT

Select the external beam photon planning competency from the drop down menu
below:

Limb Sarcoma

Please assign each task a score of Satisfactory or Unsatisfactory.

Unsatisfactory in any essential task constitutes competency failure.
The student will repeat the competency at a later date.

Discusses the plan prescription with the physician. - Satisfactory [2 pts]

Loads the patient imaging studies into the planning computer. - Satisfactory [2 pts]
Contours the appropriate anatomy on the image data set. - Satisfactory [2 pts]
Successfully places the isocenter using simulation data. - Satisfactory [2 pts]
Correctly generates plan using blocks, wedges, fields, segmented fields. - Satisfactory [2
pts]
Generates plan with appropriate weighting. - Satisfactory [2 pts]
Generates plan with appropriate energies. - Satisfactory [2 pts]
Accurately calculates daily isocenter dose for each treatment field using prescription % and
weighting. - Satisfactory [2 pts]
Accurately generates an individual DVH or composite DVH (for correct # of fractions). Satisfactory [2 pts]
Communicates effectively with physician for plan review and makes changes as requested.
- Satisfactory [2 pts]

Exports/Prints appropriate plan data. - Satisfactory [2 pts]

Performs hand verification calculations for plan MU settings using data/calc books. Satisfactory [2 pts]
Enters in correct parameters for patient chart. - Satisfactory [2 pts]
Performs pretreatment checks/calculations. - Satisfactory [2 pts]
Observes patient treatment. - Satisfactory [2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Overall rating:

Pass

[2 pts]
MEAN: 2.00 (out of possible 2), % SCORE: 100.0%

Additional Comments:

[If "Other" Competency, please specify type here]

No response

Mean percentage score for all rating scale questions: 100.0%

(Each main question equally weighted)

Responses as of 12/4/2014 8:13:59 PM CT