Presentation on theme: "1 November 7, 2014 Chicago, Illinois. CE Documentation Process Attendance Sheets Completion of session Certificates Emailed to participants 2."— Presentation transcript:
1 November 7, 2014 Chicago, Illinois
CE Documentation Process Attendance Sheets Completion of session Certificates ed to participants 2
3 The JRCERT promotes excellence in education and elevates quality and safety of patient care through the accreditation of educational programs in radiography, radiation therapy, magnetic resonance, and medical dosimetry.
4 Debra J. Poelhuis, M.S., R.T.(R)(M) Chair Laura S. Aaron, Ph.D., R.T.(R)(M)(QM), FASRT 1 st Vice Chair Stephanie Eatmon, Ed.D., R.T.(R)(T), FASRT 2 nd Vice Chair Darcy Wolfman, M.D. Secretary/Treasurer
5 Laura Borghardt, M.S., CMD Susan R. Hatfield, Ph.D. Tricia Leggett, D.H.Ed., R.T.(R),(QM) Jason L. Scott, M.B.A., R.T.(R)(MR), CRA, FAHRA
Leslie F. Winter CEO Jay Hicks Associate Director Kelly Ebert Assistant Director
Barbara Burnham Special Projects Coordinator Tom Brown Accreditation Specialist Traci Lang Accreditation Specialist Jacqueline Kralik Accreditation Specialist
8 Radiography 618 Radiation Therapy 74 Magnetic Resonance 6 Medical Dosimetry 17
9 Total Considerations Interim Reports Initial -6 Progress Reports - 24 Continuing - 77 Other – 83
10 8 Year – 52 Probation – 9 5 Year – 11 2 Year – 1 3 Year –3 Involuntary Withdraw – 3
Learning Modules JRCERT Accreditation (Student Focused) JRCERT Accreditation (Student Focused) Interim Report Modules Interim Report Modules Outcomes Assessment Outcomes Assessment Understanding of Program Effectiveness Data Understanding of Program Effectiveness Data
12 Standards JRCERT professional staff Broadcast s JRCERT Policies and Procedures
All accreditation related forms can be found under Program & Faculty on Web site (www.jrcert.org)www.jrcert.org Self-Studies & Interim Reports should be sent to the office on USB flashdrive 13
1 year from projected Site visit date, program will receive “Greetings letter” Self-study submission due in 6 months Site visit within 6 months of Self-study review Site Visit Team report submitted to the JRCERT following site visit 16
JRCERT Report of Findings within 3 months via Program response to the JRCERT within 6-8 weeks Board of Directors Meeting Accreditation award letter Progress Report or Interim Report – if applicable 17
18 Demonstration of compliance with standards & objectives Self- evaluation of program Identification of strengths and weaknesses Plan for addressing identified issues
Involve communities of interest Develop plan for self-study process Involve someone unfamiliar with your program for clarity Be concise but complete Use samples for exhibits – recommended organization of the report 20
Assume the JRCERT already has material or documents Send Paper Documents! ◦ If your agency will not allow a USB Flash drive to be mailed – contact the office. 21
For each Objective: Explanation Required program response Possible site visitor evaluation methods 22
Assurance ◦ Objective 1.6: Submit section of Student Handbook to confirm program has a grievance policy. Narrative ◦ Objective 1.5: Describe how the program assures security and confidentiality of student records, etc. Assurance and Narrative ◦ Objective 4.2: Submit section of Student Handbook that contains the pregnancy policy and describe how the policy is made known to students. 23
24 StrengthsConcerns Plan for Addressing Concern(s) ProgressConstraints
Dates are determined after the Self-Study is reviewed Site Visit Scheduling Form Program notified by JRCERT Accreditation Services Coordinator 27
28 Validate Application material Self-study Report Evaluate Program’s personnel, facilities and resources in support of its mission and goals Assess Relationship between program efforts and requirements of objectives
29 Minimum of 2 Conflict of interest Geographic considerations Sponsorship considerations Apprentice participation
Team chair contacts program director to establish agenda Communications shift from Professional Staff to Team Chair Following visit, communication shifts back to the JRCERT office 30
Two (2) days Tour sponsoring institution (classrooms, learning resources, etc) Visit selected clinical sites Interviews with administration, faculty, clinical instructors, and students 31
The Official Report is based on: 34 Self Study Report Report of Site Visit Team Findings Staff review of relevant materials Official Report
The JRCERT is a step in the grievance policy.
37 Based on the documentation submitted by the program and the findings of the site visit team, the program appears to be in substantial compliance, at the time of the site visit, with Objectives 1.1, 1.2, 1.3, 1.4, 1.5, and 1.6. The program is not in compliance with Objective 1.7. The program is not in compliance with the following: Objective 1.7 – Assures that students are made aware of the JRCERT Standards for an Accredited Educational Program in Radiography and the avenue to pursue allegations of non-compliance with the Standards.
38 Narrative Describe the procedures for making the students aware of the JRCERT contact information and the Standards. Assurance Provide updated policy and assurance that students have been made aware of the update.
Be concise, but complete Provide narrative and documentation Evidence of implementation is important Response is submitted to Must be signed by the CEO or President **Direct questions to JRCERT Professional Staff member that developed the ROF. 39
Previous ROF Current ROF Current Award Letter Program’s response to current ROF Staff recommendation 40
Based on review of program package Determined by Board of Directors Types: ◦ Initial – 18 months minimum/3 year maximum ◦ Continuing: 8 years 5 years with/without progress report 3 years with/without progress report probation 41
Program Length 2 year or longer 1 year Compliance Timeframe 24 months 18 months Failure to demonstrate compliance, or identify mitigating circumstances within the specified time period, will result in Involuntary Withdrawal of Accreditation.
Make the connection between initial recommendation and narrative in Report of Findings Understand first response was inadequate in some way Contact professional staff for clarification Be clear Provide documentation; evidence of implementation important 44
Required of programs with maximum accreditation award includes – basic program information elements of Standards One, Two, Four, Five, and Six Board of Directors’ Accreditation action – 8-year award maintained or award reduced and review process expedited 46
50 Describe how students, clinical instructors, and clinical staff are made aware of the supervision requirements. Describe how the program’s supervision requirements are monitored and enforced in the clinical education setting. Provide representative samples of instruments (e.g., clinical evaluations, student surveys) that document the monitoring and enforcement of supervision policies. Provide copies of memos to students, clinical instructors, and clinical staff; and/or meeting minutes that document discussion of the supervision requirements.
51 Provide Representative Samples – Completed or Blank copies are acceptable. Document…Document…Document.
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53 for supporting excellence in education and quality patient care through programmatic accreditation.