UNIVERSITY of ARKANSAS for MEDICAL SCIENCES
COLLEGE OF HEALTH RELATED PROFESSIONS - DEPARTMENT of RADIOLOGIC TECHNOLOGY
DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM
Student Competency Evaluation 2002 All rights reserved.

Student: _______________________________________________________________Date:________________________

Exam Performed: ______________________________________________   Instructor:____________________________

Patient File #: ______________________________Location:__________________________________________________

The student will not be expected to perform a sonographic examination until he/she has received appropriate instruction for that examination.
Check off each area as it is performed. The student should make a copy of the completed form and return the original to the UAMS DMS Faculty.

Difficulty of Case: 1 = Easy 3 = Medium 5 = Difficult

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Patient size: 1 = Thin, 3 = Medium, 5 = Obese

 

 

 

 

 

Patient cooperation: 1 = Very, 3 = Medium, 5 = Uncooperative

 

 

 

 

 

Patient anatomy: 1 = Normal Anatomy, 3 = Some Variation, 5 = Major Anomalies

 

 

 

 

 

TASKS: Rate the Student’s Performance: 
1 = Poor 3 = Acceptable
5 = Excellent

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1. Room properly prepared before bringing in the patient.

 

 

 

 

 

2. Patient properly identified and student identified him/herself to patient.

 

 

 

 

 

3. Correct transducer selected for the examination.

 

 

 

 

 

4. Patient information correctly entered before starting examination.

 

 

 

 

 

5. Proper patient history obtained.

 

 

 

 

 

6. Patient informed of the nature of the procedure.

 

 

 

 

 

7. Patient in correct position for the procedure.

 

 

 

 

 

8. Correct gain and machine settings used.

 

 

 

 

 

9. Correct focal range(s) and fields of view selected.

 

 

 

 

 

10. Images labeled correctly.

 

 

 

 

 

11. Correct image planes obtained.

 

 

 

 

 

12. Sufficient images recorded to demonstrate appropriate anatomy.

 

 

 

 

 

13. Correct use of pre-& post-processing controls.

 

 

 

 

 

14. Correct sonographic diagnosis/differentials/pathology proposed.

 

 

 

 

 

15. All measurements taken accurately and properly.

 

 

 

 

 

16. Images properly recorded and processed.

 

 

 

 

 

17. Exam completed in a timely fashion.

 

 

 

 

 

18. Paper work completed according to the laboratory’s routine.

 

 

 

 

 

19. Case discussed properly with the instructor/physician.

 

 

 

 

 

20. Patient properly released when the examination is completed.

 

 

 

 

 

Totals (Sum)

 

 

 

 

 

Scanning Time: Start: ____________________ Finish: ____________________ Total minutes: ___________
Student’s Observations:

 

Instructor’s Comments:

 

Student’s Signature:__________________________________   Instructor’s Signature:___________________________________

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