My First Exam

Transport was a blast. Imagine the largest hospital you've ever seen and you'll get an idea. The place is a maze of corridors. I felt like I was exploring. I don't want to give you the idea that it's cold, far from it; the staff are all caring individuals. But it is a county hospital so it's naturally comprehensive it scope. Radiology alone seems to occupy a city block of area.

We were assigned to shadow a transport staff. I'll call him Tim. Tim made it fun with invites to us to figure out how to get around the hospital. We went up to the Burn Intensive Care Unit (BICU.) We watched several trauma exams. I wish I had the time to fill you in on everything we saw. Suffice to say I feel at home here. It really is my element.

Today was my first exam. I didn't comp. it. But I was basically directed through the whole exam. It was done with a special machine intended for chest images. It's the only direct radiography (DR) machine in whole hospital. The bucky is the image receptor (IR.) The tube moves up and down with the bucky automatically. The definition of such a system is that no cassettes are used. The gonad shield is a lead curtain that closes like a door. The tech dragged me over and stepped me through the entire process. It was a special thrill.

It's late in my day. So I just want to ask for some feedback. I know it's easier just to read this. But, how about telling me what you think. This can't be a one way street. How about a little synergy? Thanks for reading Radiologic Confidential.

First Clinical Day

Today was the first clinical day. I met many dymamic and friendly individuals. The day started with a review of expectations and locations. We talked at length on everything from a bus pass to personal leave. That part of it wasn't every interesting. But what made the it fun was talking with the education coordinator of the hospital.

She's really very much a people person. She arranges education for many hospital staff including doctors. Hearing her talk about her job made me realize how irreplaceable she is. I can't imaging trying find someone to fill her shoes. She coordinates continuing eduction for a lot of the staff.

We met up with the “seniors,” second year students who showed us around to all the x-ray rooms scattered through out the wing. And of course the ER, trauma, CT, and MR.

I simply don't know how to convey my excitement about the placement at this particular hospital. It really looks like a huge extended family. Of course, I could be projecting my expectations. I don't think so. I'm a rather reserved fellow and I was very much made to feel welcome.

I met a few techs. That's kinda where I didn't get an impression. But I'm sure I'll get one tomorrow. I'll be shadowing in transport.

Clinical Starts Monday.

Clinical starts next week at the local trauma center. I'm feeling mixed emotions of elation, because it's finally time, and a sort of fear of how I'll adjust to working in a hospital. We'll be there for two 40-hour weeks starting Monday.

Last week was challenging, more so than I'd have thought going in. We had two exams that were fairly intense. What made them difficult is that we only had one day to study before being tested on some of the material.

I did fine but I should have asked for extra time off work. I need to work on the feeling of diminishing levels of return. Find that perfect balance. I've put a lot of work in these classes. I want to make it clear that being in RT school is more fun then I've had in some time.

We get to work with people of all walks of life. We use equipment in the ways it was intended. I could go on. I know the lines. I've read the ethics. I know how to behave and I have some idea what to expect out of clinical. Wish me luck.

These are some thoughts others have shared regarding clinical success:
Show up, act professionally and within ethical bounds;
Assume abilities of being humble and taking direction;
Asking questions and being assertive;
and learning from past actions.
Ask how you can help.
Keep areas well stocked.

My first Practical

I'm doing well in all my classes. I had a written and practical exam on the same morning. Yike! It felt long. We had a 70 question written test and we identified anatomy on14 radiographs. I felt like a wet rag after that. I did fine though.

For the positioning practical I did a P-A and Lateral Chest, and a supine abdomen (KUB). I did OK on the positioning but I missed an important detail. I forgot the breathings instructions on the lateral chest. Doh!

We reviewed the anatomy of the wrist, and fingers last Tuesday. We'll have a positioning lab on that anatomy on Monday. I start my first clinical on Monday 28.

Acute Abdomen

We've been working on the Acute Abdomen series this week. It started Monday with the positioning lecture and lab. I've had to work very hard.

I find the didactic lessons provide the biggest challenge. I'm a kinesthetic learner. I do well when I can learn experientially. Naturally I do well in labs then. I've been focusing in on the practical and written exams we have next Monday.

I pretty much have nailed the acute abdominal series: PA CXR, AP Upright abdominal, and supine abdomen. They're basic projections but I love 'em! Today I reviewed the anatomy of the bony thorax and the abdomen. Bring on clinical!

I've been hammering out the beginnings a study buddies. I study with a couple of fellow RT students in the cafeteria. We worked on anatomy.

Infection Control

Today was review for me. I've been a care giver for many years. Our nursing class covered infection control.

I got 95% on my first test of the quarter. Ta ta.

Safety and Clinical Assignments.

Today the discussion started with safety. We talked abut fire prevention and what to do in the event of a fire. We also covered proper body mechanics and patient skin care. Other topics were basic patient positions and assessments before moving a patient. Our lab involved patient transfer using a wheel chair or a stretcher.

What follows is a paraphrase of a discussion that occurred later today regarding clinical assignments.

“There's a lot of wonderful people out there. How you present yourself in the beginning is how others will perceive you. You need to help as much as possible. You need to ask, “how can I help.” You're the student and pretty much low man on the totem pole.”

Our program has a better reputation of treating their students better than other programs. Some people will resort to treating students poorly if they were treated poorly. They think of you as a really green student. Many people are reluctant to work with first year students because there's so much for the student to learn. If you go in overly cocky, they won't like that.”

Don't go in thinking, “Oh I know something about this.” Even if you have some experience that's not the way to approach it. You need to let them show you how to do things. There's lots of right ways of doing things. You're going to learn a different way from every tech you deal with.”

That's hard when you're a student that everything isn't consistent. There will be a tech who will say, “No you never put the flasher up in a chest x-ray. Even if what the tech teaches is opposite to what your didactic experience would suggest just go with it. Eventually you'll learn your own way and use the proper principles.”

It's really good learning experience to just get along with whom ever you're assigned to. Most people enjoy working with students. You don't correct the tech by saying, “My instructor told me this way was best.”

There's ways to get along with these people: prepare and clean the room, ask how you can help. Assume a basic good work ethic. When it's slow practice your skills and get to know the rooms and equipment. They'll give you respect if you clean the rooms and equipment. Put films in the bucky use another student for practice if appropriate.”

I would add that I have a sheet that I look at often. It reads in 30 point type: Clinical success: abilities of being humble and taking direction; asking questions, assertiveness and to learn from past actions.

Bony Thorax

True to the schedule, we attacked the bony thorax. What I mean to say is I finally got the chance to do some real positioning. It started with Posterior-Anterior Chest and the corresponding left lateral. The instructor showed us some very bad chest x-rays. Seriously rotated or foreshortened, they were obviously of very little diagnostic value.

I like the very small lab ratio: one instructor to eight students. I really like this aspect of the program. The small ratio really allows for high interaction between the instructor and student.

At the start of second period I began by working the various locks getting used to the tube in that lab.

Our instructor walked in. “Since you're at the tube, P-F, why don't you position for an A-P stretcher chest. I did the well, considering I'd not been able to use my notes. I placed the cassette behind the “patient” and pointed the tube towards the cassette with a SID of 72 inches. I felt pretty good about it. I didn't put the requisite angle on the tube though.

The instructor corrected me. “What you've done is a good start. But you need to provide an angle that matches that of the patients sternum. I learned that an unintentional lordotic projection with out diagnostic value would have resulted.

Mind you, we're so green that every correction is a learning opportunity, And is offered with much patience.

Today we reviewed the anatomy of the bony thorax.