When to assess competency.

According to the American Registry of Radiologic Technologists, the purpose of the clinical competency requirement is to verify that the student technologist has demonstrated proficiency in specified procedures in the clinical setting. The student technologist must perform the procedure independently, effectively and consistently during formal training. But who decides when it is time to "comp" on an examination?

In 1979, the year I graduated from radiography school, there were no competency-based programs. We reported to our clinical setting, observed the technologists and jumped right in. Most of us did not have direct supervision during our training. We were schooled under the philosophy of "see one, do one, teach one." Those were the days when every patient came to the hospital and walked out with a radiograph. We never thought about how many times we needed to see an exam before we felt confident to pass a competency requirement. We never worried about getting our competencies finished in time to graduate.

I now watch students scrambling through departments, focused on completing competencies that are performed so infrequently it becomes impossible to comp them. Students post their names and the exams they require in every area of the radiology department, hoping when a patient comes in needing that exam someone will call them. Other exams might never be performed because the required competencies do not exist at a student's hospital and will have to be simulated. I ask myself, "Is it really the same?" Students are so focused on completing their competencies that I often wonder if they truly feel comfortable performing the exam.

Another problem I have observed is that there is no consistency as to when a student is allowed to perform a competency requirement. Many schools determine which exams need to be completed by the end of each clinical rotation but do not specify how many times a student must see the exam before attempting to pass the competency. Other schools allow clinical instructors to make that decision. The instructors then pass decision-making authority along to the technologists who are working with the students. One technologist is easier on students than another and decides that observing a procedure once is enough. Another technologist, however, might decide that 4 or 5 observations are necessary before allowing the student to attempt a competency. Unfortunately, the examination may not be performed again during the student's rotation, so the window of opportunity is missed.

I am not swing that all schools fail to set rules or that all clinical settings are alike. There are some schools that maintain strict protocols. Students must review procedures first in the classroom setting, pass a quiz and then are allowed to attempt the competency. It is difficult for hospitals with student technologists from multiple schools to keep each school's standards straight. After a while, I believe they require all students to conform to a single standard.

So what is the magic number or the deciding factor? Is it the number of times a student observes a procedure or the student's ability to catch on and feel comfortable with the exam? I truly believe there probably is no right or wrong answer. Performing clinical competencies should be allowed when the student feels comfortable enough to try. When the student is comfortable he or she will perform better and more naturally; the procedure will not seem so mechanical. It is difficult to set an arbitrary number and not judge each student's individual abilities. I believe students should be allowed to attempt a competency when they feel they are ready. If they do not pass, that becomes part of their learning curve. Allowing students the opportunity to try is what learning is all about.

Lisa Fanning, M.Ed., R.T.(R)(CT), is clinical coordinator of the radiography program and an assistant professor at the Massachusetts College of Pharmacy and Health Sciences in Boston.