Healthcare Science Practitioner Training Programme Training Manual 2011/12 Physical Sciences and Biomedical Engineering: Medical Physics Technology

Transcription

1 Healthcare Science Practitioner Training Programme Training Manual 2011/12 Physical Sciences and Biomedical Engineering: Medical Physics Technology Specialisms: Radiotherapy Physics Radiation Physics Nuclear Medicine

2 CONTENTS Page No Section 1.0 Healthcare Practitioner Training Programme in Medical Physics Technology 1.1 Introduction Role of a Healthcare Science Practitioner Good Technical Practice Overall Aim of the Training Programme 4 Section 2.0 Programme Overview 2.1 Generic Modules Division Modules Specialist Modules 6 Section 3.0 Work-based Training Modules 3.1 Introduction Year Year 2 and 3 for Radiotherapy Physics Year 2 and 3 for Radiation Physics Year 2 and 3 for Nuclear Medicine 17 Section 4.0 Assessment 4.1 Assessment Competency Log Book Generic Module Division /Theme Modules Radiotherapy Physics Radiation Physics Nuclear Medicine 51 Appendices Appendix 1 Direct Observation of Practical/Procedural Skills Template 75 Appendix 2 Case Based Discussion Template 77 2

3 Section 1.0 Healthcare Science Practitioner Training Programme (PTP) in Medical Physics Technology 1.1 Introduction This manual provides an overview of the integrated 3-year BSc (Hons) in Healthcare Science and a more detail description of the structure and function of the workbased learning outcomes that form an integral part of the training programme for Healthcare Science Practitioners (HCSP) in Medical Physics Technology specialising in Radiotherapy Physics, Radiation Physics and Nuclear Medicine. This training manual must be used in conjunction with the course handbook provided by the Higher Education Institution with whom each student is registered. The BSc (Hons) programme has been developed to provide the knowledge, skills and experience that underpins the role and function a Healthcare Science Practitioner is expected to successfully perform at the end the programme. The concept of this programme is shown in the diagram below. PRACTITIONER TRAINING PROGRAMME [PTP] Medical Physics BSc (Hons) in Healthcare Science (Specialism) Academic Workplace-based Year 3 Application to Practice Year 2 Tec hniques & Methodologies Specialism: one of: Radiotherapy Physics Radiation Physics Nuclear Medicine Increasing specialisation & supporting science Academic learning to support workpl ace skills development Clinical Experience (25 weeks) and Research Project Cl inical Experience (15 weeks) Increasing experiential learning Year 1 Scientific Basics Divisional Focus Medical Physics Introductory Block across Heal thcare Science Work placements (10 weeks) 5 3

4 1.2 Role of a Healthcare Science Practitioner A Healthcare Science Practitioner (HCSP) will have the necessary expertise in applied scientific techniques underpinned by theoretical knowledge within a division or related specialism and will work in a range of healthcare settings: with a defined technologically based role in the delivery and technical reporting of quality assured tests, investigations and interventions on patients, samples or equipment; in a number of specialisms, HCSP will provide therapeutic interventions, some of which may be specialist. 1.3 Good Technical Practice Good Technical Practice sets out, for the profession and the public, the standards of behaviour and practice that must be achieved and maintained as a Healthcare Science Practitioner. One of the ways to help set the benchmark for professionals and their practice is to use the standards of professional regulators. This curriculum therefore: broadly uses the generic Health Professions Council (HPC) Standards of Proficiency and HPC Standards of Conduct, Performance and Ethics, but contextualises these for Healthcare Science. The Domains of Good Technical Practice are; 1. Professional 2. Scientific 3. Clinical 4. Technical 5. Investigation and reporting 6. Quality 7. Working with colleagues 8. Research and development 9. Probity 10. Leadership 11. Training and developing Others 1.4 Overall Aim of the Training Programme The overall aim of this HCSP training and education programme is to prepare the student to fulfil the function of a HCSP working in a clinical healthcare setting in Radiotherapy Physics, Radiation Physics and Nuclear Medicine and the programme has been designed to have a strong patient and clinical focus. 4

5 The programme combines and integrates both academic and work-based learning. Within the first year it is expected that the experiential component will start broad with short tasters across Medical Physics Technology with some exposure to other aspects of the patient pathways for example a clinic, patient education programme, medical records and other areas of healthcare science. This will give the student a wide appreciation of the many specialisms within Healthcare Science and a more holistic view of the areas, which contribute to high-quality care. At the end of the programme the student should be able to fulfil the role of a Healthcare Science Practitioner. The diagram below depicts the broad framework around which all BSc (Hons) degree programmes in Healthcare Science being implemented as part of the Modernising Scientific Careers (MSC) Programme are structured. Each of the three divisions within the MSC Programme (Physical Sciences and Biomedical Engineering, Life Sciences and Physiological Sciences) have interpreted and adapted this framework. Further refinement has been undertaken by each Higher Education Institution to develop and deliver BSc (Hons) programmes that enable students to meet the learning outcomes of the course. Year 3 Application to Practice Year 2 Techniques & Methods Year 1 Scientific Basics HIGH LEVEL FRAMEWORK INTEGRATED BSc (Hons) IN HEALTHCARE SCIENCE Professional Practice [10] Generic Curriculum Professional Practice [10] Generic Curriculum Professional Practice [10] Scientific Basis of Healthcare Science Specialism Research Methods [10] [60] Scientific Basis of Healthcare Science - Integrated Module across Body Systems will usually include informatics, maths and statistics [60] Generic Curriculum Specialism Specific Curriculum Scientific Basis of Healthcare Science Practice Based Project [30] Principles of Scientific Measurement [30] [60] Division/Theme Specific Curriculum Scientific Basis of Healthcare Science [50] Work-based Training 25 weeks [20] Work-based Training 15 weeks [10] Specialism Work-based Training 10 weeks Division/Theme Specific Curriculum *46 wks *40 wks *36 wks Generic Modules: Common to all divisions of Healthcare Science Division/Theme Specific Modules: Life Sciences; Physical Sciences and Biomedical Engineering (Medical Physics Technology; Clinical Engineering); Physiological Sciences (Cardiovascular, Respiratory and Sleep Sciences; Neurosensory Sciences) Specialist Modules: Specific to a specialism Section 2 provides an overview of the structure of the Generic, Division and Specialist modules for students following the Medical Physics Technology BSc. 5

6 Section 2.0 Programme Overview 2.1 Generic Modules The 3-year degree has been designed with three key curriculum strands. The Generic Curriculum depicted in blue will be followed by all students undertaking Healthcare Science Practitioner BSc (Hons) degree and has three modules: Year 1, 2 & 3 Year 1 Year 2 Professional Practice Scientific Basis of Healthcare Science Research Methods The professional practice module is a vertical theme running from Year 1 to Year 3. In Year 1 all students will also study the Scientific Basis of Healthcare Science with integrated work-based training and in Year 2 Research Methods. 2.2 Division/Theme Modules This BSc (Hons) programme in Medical Physics Technology has six Division specific modules namely: Year 1 Informatics, Maths and Statistics Year 1 Scientific Basis of Medical Physics including Work-based training Year 2 Medical Imaging Year 2 Radiation Governance Year 2 The Medical Equipment Life Cycle Year 2 Principles of Scientific Measurement 2.3 Specialist Modules The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Radiotherapy Physics specialism and has four modules: Year 3 Cancer, Radiobiology, and Clinical Radiotherapy Physics Year 3 Practice of Radiotherapy Physics Years 2 & 3 Work-based training Year 3 Research Project The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Radiation Physics specialism and has four modules: Year 3 Framework of Radiation Governance and Risk Management Year 3 Practice of Radiation Physics Years 2 & 3 Work-based training Year 3 Research Project 6

7 The specialism specific curriculum, depicted in orange, will be followed by students undertaking the Nuclear Medicine specialism and has four modules: Year 3 Physics and Instrumentation Year 3 Clinical Indication, Pathology and Patient Care Years 2 & 3 Work-based training Year 3 Research Project Further details of the indicative content and high level learning outcomes for each module of the BSc in Healthcare Science (Medical Physics Technology), including the work-based training, will be provided by the Higher Education Institution in the Student Handbook. 7

8 Section 3.0 Work-based Training Modules 3.1 Introduction The BSc (Hons) programme integrates knowledge, skills and experience and a series of work-based placement enables students to gain the skills and attitudes to practice as a Healthcare Science Practitioner. This section describes the learning outcomes across knowledge, skills, experience and professionalism that a student should gain during work-based training. The professional practice module runs vertically throughout the programme and many of the learning outcomes will be achieved in the workplace. Work-based learning should equate to a minimum of 10 weeks in Year 1 and a minimum of a further 40 weeks across Year 2 and 3. The work-based placement in Year 1 exposes the student to the clinical environments across Medical Physics and specifically within the Radiotherapy Physics, Radiation Physics and Nuclear Medicine pathways. It is expected that the student will gain an understanding of how departments function, the range of investigations undertaken, the professional and inter-professional relationships, which exist, and a wider understanding of the NHS. Section 3.2 Division: Theme: Year 1: Physical Sciences and Biomedical Engineering Medical Physics Technology Work-based Training The overall aim of the work-based learning within Year 1 is to provide the student with a broad appreciation of the range of work undertaken within Healthcare Science. Students will begin the process of the development of the skills and attitudes relevant to the Healthcare Science Practitioner building on learning in the academic environment including practical sessions, clinical skills sessions, reflection on development etc. Additionally it should help students learn in the context of practice and real life experience and have a motivational element as they work towards a career in the NHS. This module will provide a foundation from which the student will build their knowledge, skills, experience and attitudes throughout the three year programme of study and transfer these skills to employment in healthcare science. It is expected that this period of initial work-based training will provide the opportunity to begin to integrate and embed many of the professional practice learning outcomes and enable the student to practice safely in the workplace Students will be expected to begin to maintain a portfolio of evidence and achievement in the relevant sections of the Training Manual. 8

9 Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Describe the roles undertaken by a Healthcare Science Practitioner relevant to each area of their placements. 2. Explain the range of technologies and procedures relevant to their placements. 3. Describe the work of the healthcare science workforce and explain how it contributes to the patient pathways relevant to each area of their placement. 4. Explain the need to ensure that the needs and wishes of the patient are central to their care. 5. Explain the importance of developing and maintaining the patient-professional partnership. 6. Explain the procedures relevant to the use of chaperones. 7. Explain the impact of adverse incidents on patients, carers and healthcare professionals. 8. Describe the procedures and need for evaluation of adverse incidents. 9. Recognise the relevance of a Dress Code policy in the modern clinical environment. 10. Recognise the standards of professional behaviour expected of a Healthcare Science Practitioner. 11. Explain why responsibility for infection control is a shared responsibility. 12. Explain the structure of the organisation and inter-relationship of primary care, outpatient and inpatient services. Learning Outcomes: Practical Skills On successful completion of this module the student will demonstrate: 1. Safe working in the clinical environment relevant to each area of their placement. 2. The six stage hand-washing technique. 3. Basic Life Support in accordance with current Resuscitation Council (UK) guidelines. 4. Appropriate professional practice at all times. 5. Effective communication within the work-based environment and clinical team. 6. In accordance with local health and safety regulations, the ability to undertake routine investigations as defined in this training manual. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of this module the student will: 1. Behave in a professional manner in matters of attendance, appearance, maintaining confidentiality and infection control. 2. Respect and understand individuals beliefs and ways of coping with illness. 9

10 3. Value social diversity and its relationship to service provision in healthcare. 4. Demonstrate the ability to work safely within each environment. 5. Demonstrate the ability to treat patients with respect. 6. Communicate effectively with the healthcare environment and clinical team and develop appropriate interpersonal skills. 7. Seek to adapt their communication style to meet the varying needs of different peers, colleagues and patients in different contexts. 8. Adopt a range of techniques to overcome barriers to communication. 9. Develop and maintain professional relationships and effective team working. 10. Discuss and demonstrate safe and effective practice in a healthcare environment. 11. Begin to develop a balance between reflective practice and active exploration in personal learning. 12. Take responsibility for personal learning. Indicative Content and Suggested Experience Observe the work of a range of Healthcare Science departments, technologies and procedures Observe the process for handling work requests from the receipt of the request to completion Observe the patient journey from admission to discharge Gain an understanding of the skills required to work safely in the clinical/laboratory/workshop/radiation environment Record keeping, data protection, confidentiality Gain an appreciation of how the NHS is structured Team working and the role of multi-disciplinary team meetings Meaning and role of professionalism and professions in healthcare Roles of different professional groupings in Healthcare Science Human and social diversity and its implications for relationships, behaviours and service provision in healthcare Types of effective communication in the context of healthcare. Barriers to effective communication and strategies to overcome them Interpersonal skills related to dealing with patients, carers and healthcare professionals The skills needed to work as part of a team Management and evaluation of adverse incidents Data management (paper and electronic) Infection control Basic Life Support Reflective practice and its application 10

11 Section 3.3 Division: Theme: Specialism: Years 2 & 3: Physical Sciences and Biomedical Engineering Medical Physics Technology Radiotherapy Physics Work-based Training [30 Credits] The overall aim of this module is to give the student experience of Radiotherapy Physics that ensures that the student can undertake the full breadth of practice expected of a newly qualified healthcare science practitioner in Radiotherapy Physics. This is delivered through work placements in Years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory. Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in application of the core skills in clinical, patient identification, communication skills and management, and quality assurance. 2. Demonstrate competence for routine tasks and situations in Radiotherapy Physics including treatment planning, dose measurement, quality assurance, calibration and operation of equipment, patient interventions and immobilisation techniques. 3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management, quality assurance. 4. Critically review and evaluate routine tasks in relation to treatment planning, dose measurement, quality assurance, calibration and operation of equipment, and patient interventions. 5. Produce a Professional Portfolio which cumulatively records / provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Produce a range of Radiotherapy dose treatment plans using imaging data, defined treatment parameters, dose calculations and simulation. 2. Undertake processes to assist in the safest and most effective treatment being delivered to the patient. 3. Make safe and appropriate immobilisation devices in accordance with local 11

12 protocols. 4. Participate in the preparation and delivery of Brachytherapy treatment procedures. 5. Undertake quality control procedures for Radiotherapy Systems. 6. Demonstrate the ability use a wide range of dosimeters for a variety of dose measurements types in accordance with established procedures. 7. Apply a professional approach to all activities undertaken within the radiotherapy department. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of the module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt communication style and language to meet needs of listeners. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on professional duty of care. 7. Reflect and review own practice to continuously improve personal performance. 8. Consistently operate within sphere of personal competence and level of authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seeks accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operates with work of multi disciplinary teams. 14. Act in a calm and reassuring manner. Indicative Content Isodose charts and how they are used Percentage Depth Doses and Tissue Maximum Ratios Factors affect the dose distribution along the central axis of the beam Back-scatter Build-up Effect Field sizes are defined Output factors and normalisation Calculation of equivalent squares Older methods of volume transfer onto planning outline (e.g. orthogonal film mark-up) Other imaging modalities used in Planning Target Volume (PTV) localisation. Possible pros and cons of using a single outline to generate a treatment plan Planning algorithms used by the Treatment Planning System (TPS) 12

13 Benefits of using a 3 Dimensional Treatment Planning System that uses Computerised Tomography (CT) electron densities Need and techniques used to limit the dose to sensitive structures, e.g. rectum, eyes, brain stem etc Concepts of International Commission on Radiological Units (ICRU) Guidance and the concept of margin growing Department checking procedure following local protocols Advanced planning techniques Dose volume histograms and their production Dosimetric characteristics of photon, electron and orthovoltage beams Variety of impression materials and immobilisation devises on the market and the pros and cons of their use Requirements for electron mark-ups Effect of field sizes and stand off corrections Variety of impression materials and immobilisation devises on the market and the pros and cons of their use Health and safety aspects of brachytherapy Modalities that have taken over from Low Dose Rate Brachytherapy (LDR) for example High Dose Rate Brachytherapy (HDR) and Pulsed Dose Rate (PDR) Brachytherapy Range of treatment sites where brachytherapy can be utilised All sources used by the department and is aware of why different sources/isotopes are used for different procedures including; Type of emitted radiation o Half life of isotope o Energy Record keeping for a given procedure using radioactive sources used clinically Attendance and knowledge of theatre and knows how to make sources available for use The clinician s role and the certification needed to practice. Brachytherapy for gynaecological malignancies Algorithm used to produce brachytherapy treatment plans, showing an understanding of units of measurement Different brachytherapy systems used nationally Clinical and special waste and equipment, including radiation risks Effective audit trail and work towards continuous improvement Rationale for Quality Assurance in Radiotherapy Departmental protocol in completing radiation dosimetry checks on linac (photons and electrons) Procedure for reporting equipment which is out of specified tolerance limits Appropriate equipment for Quality Control explaining how the instrument works o Ionisation chamber o Farmer dosimeter o Well chambers Variations in temperature and pressure affect machine output How and why Quality Control frequency differs for different machines National codes of practice and guidelines 13

14 Use of Thermoluminescent dosimeters (TLD) and semiconductor dosimetry systems in: o Personal and patient monitoring as appropriate locally o Use of the department s chosen personal/patient dosimetry system to calculate dose o Systems for personnel monitoring o Action levels and tolerances o Principles of portal dosimetry Need for plan verification. Clinical use of a variety of verification techniques Newer verification technologies (e.g. Image Guided Radiation Therapy (IGRT), Tomotherapy) and impact of these technologies on the patient experience and clinical workload Fundamentals of random and systematic errors Appropriate use of 2 dimensional, 3 dimensional, kilo-voltage (kv) and Mega-voltage (MV) imaging techniques Concomitant dose requirements for the different imaging processes Radiation protection legislation o Ionising Radiation Regulations 1999 o Ionising Radiation (Medical Exposure) Regulations 2000 o Environmental Permitting Regulations 2010 o MARS o Control of Substances Hazardous to Health o Health and Safety Radiotherapy related information technology in particular: o Hospital Information Systems o Oncology Information Systems o Radiology Information Systems and their role in Radiotherapy o Digital Imaging and Communications in Medicine (DICOM) Quality systems o ISO9000 o Quality Assurance in Radiotherapy (QART) o Error reporting o Audit Quality Assurance processes for a range of radiotherapy equipment following standard departmental protocols. 14

15 Section 3.4 Division: Theme: Specialism: Years 2 & 3: Physical Sciences and Biomedical Engineering Medical Physics Technology Radiation Physics Work-based Training [30 Credits] The overall aim of this module is to give the student experience of Radiation Physics that ensures that the student can undertake the full breadth of practice expected of a newly qualified healthcare science practitioner in Radiation Physics. This is delivered through work placements in years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory. Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in application, of the core skills in communication skills and management, and quality assurance. 2. Demonstrate competence for routine tasks and situations in Radiation Physics including dose measurement, quality assurance, calibration and operation of equipment that uses ionising and non-ionising radiation. 3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, communication skills, management and quality assurance. 4. Critically review and evaluate routine tasks in relation to legislative compliance, dose measurement, equipment evaluation and commissioning, quality assurance and the calibration and operation of equipment that uses ionising and non-ionising radiation. 5. Produce a Professional Portfolio, which cumulatively records and provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Perform a full range equipment life cycle procedures as an equipment user. 2. Measure and record levels of radiation. 3. Calibrate a range of radiation measuring devices. 4. Safely use and transport radioactive sources. 5. Perform a range of tasks in the personal dosimetry service. 6. Perform commissioning and routine Quality Assurance tests on a range of ionising and non-ionising equipment. 15

16 7. Participate in patient dosimetry procedures for both ionising and non-ionising applications. 8. Perform Radiation Surveys for ionising and non-ionising installations. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of the module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt communication style and language to meet needs of listeners. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on professional duty of care. 7. Reflect and review own practice to continuously improve personal performance. 8. Consistently operate within sphere of personal competence and level of authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seek accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with work of multi disciplinary teams. 14. Act with a calm and reassuring manner. Indicative Content Work safely in all radiation areas Undertake an assessment of image quality Participate in the evaluation of a range of new equipment, including X-ray and Ultrasound Participate in the acceptance testing and commissioning of a range of new equipment including X-ray and Ultrasound Measure and report image quality Promote safe and effective working practices in areas which may be affected by ionising and non-ionising radiation Optimise practices involving radiation Quality assure and calibrate a range of equipment and radiation sources, including X-ray, Laser, UltraViolet and Ultrasound Audit areas where ionising and non-ionising radiation is used Investigate and report on legislative aspects of use of ionising and non-ionising radiation at a departmental level Co-ordinate storage, disposal and transfer of radioactive substances Collect, monitor and record radioactive waste Monitor and decontaminate areas where radioactive materials have been used Audit and report environmental radiation monitoring results 16

17 Audit and report staff dosimetry and workplace monitoring results Provide a personnel monitoring service for staff working in radiation areas Measure or calculate radiation doses to members of the public Measure and report patient radiation dose Measure and record levels and characteristics of radiation Section 3.5 Division: Theme: Specialism: Years 2 & 3: Physical Sciences and Biomedical Engineering Medical Physics Technology Nuclear Medicine Work-based Training [30 Credits] The overall aim of this module is to give the student experience of Nuclear Medicine that ensures that the student can undertake the full breadth of practice expected of a newly qualified Healthcare Science Practitioner in Nuclear Medicine. This is delivered through work placements in years 2 and 3 of the degree course. Important Note: Work-based training does not have to be confined only to the work-base but elements may be taught in other environments, e.g. a clinical skills laboratory, simulation centre or science laboratory. Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in application, of the core skills in clinical, patient identification, communication skills and management, and quality assurance. 2. Demonstrate competence for routine tasks / situations in Nuclear Medicine including imaging, non-imaging and therapeutic interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of equipment. 3. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management, quality assurance. 4. Critically review and evaluate routine tasks in relation to imaging, non-imaging and therapeutic patient interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of equipment. 5. Produce a Professional Portfolio which cumulatively records / provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Demonstrate competence for routine tasks and situations in Nuclear Medicine including imaging, non-imaging and therapeutic patient interventions, preparation of radiopharmaceuticals, quality assurance, and the operation of 17

18 equipment. 2. Demonstrate the ability to work safely within the legislative and policy framework around the safe use of ionising radiation within a hospital environment. 3. Be able to use a dose calibrator in the preparation and measurement of radioactivity. 4. Perform a full range equipment life cycle procedures as an equipment user. 5. Be able to set up, optimise and operate imaging equipment safely so as to be able to produce the highest quality results for interpretation across a range of nuclear medicine investigations. 6. Be able to perform all aspects of the preparation required including providing relevant information and instructions to the patient/carer to ensure the Nuclear Medicine Investigations and Treatment is successful. 7. Be able to administer Radiopharmaceuticals whilst observing all safety, control of infection and radiation protection governance requirements. 8. Be able to perform full range of common Acquisition and Recording techniques used when carrying out Diagnostic Imaging procedures. 9. Be able to perform a range of Nuclear Medicine Therapy procedures used in the clinical treatment pathway of patients. 10. Be able to work in a Radio-pharmacy safely and within the legislative and statutory framework to prepare and dispense radiopharmaceuticals for use in the diagnosis or treatment of patients. 11. Be able to apply quality control procedures within the Radiopharmacy to establish and maintain a safe environment, which meets all legislative and medicine inspectorate requirements. 12. Demonstrate the ability to perform In-Vitro procedures in Nuclear Medicine. 13. Demonstrate the ability to perform Tracer Methodology procedures in Nuclear Medicine investigations. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of the module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt communication style and language to meet needs of listeners. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on professional duty of care. 7. Reflect and review own practice to continuously improve personal performance. 8. Consistently operate within sphere of personal competence and level of authority. 9. Manage personal workload and objectives to achieve quality of care. 10. Actively seek accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with work of multi disciplinary teams. 18

19 14. Act in a calm and reassuring manner. Indicative Content Anatomy and Physiology which needs to be considered in the planning and interpretation of radionuclide tests Immunology Infection o Acute, chronic, pus, abscess, differential diagnosis between abscess, cyst and tumour Neoplastic disease o Tumours, primary and secondary, (metastases), benign and malignant tumours, assessing the extent of malignant involvement Nursing and Emergency Procedures Administration of Radioactivity Adverse Incident Reporting Procedures Radiation Protection for Nuclear Medicine Radiopharmaceuticals used in Nuclear Medicine o The design of the radiopharmacy o Good Manufacturing Practice o The types of preparation o Sterilisation techniques o The operation of the radiopharmacy o Maintaining and monitoring the pharmaceutical environment o Waste disposal Radiochemistry and Quality Control o The chemistry of technetium o Radiochemical techniques o Production of radiopharmaceuticals o Labelling of blood products o Selection of appropriate radiopharmaceutical Perception of the Image In Vivo Non-imaging Techniques Techniques requiring the Assay of Radioactive Samples The Application of Nuclear Medicine in Diagnosis. For radionuclide tests in common use this should include knowledge of: - o The radiopharmaceutical used, activity administered and route of administration, half life, beta energy o The preparation of the patient o The views/samples which must be obtained, dynamic protocols o The use of any special data handling techniques or display mode o Any special features of the study o Possible artefacts o Setting up the equipment energy windows, collimation etc. o The clinical context in which radionuclide tests may be of value, and the influence of the test results on patient management. 19

20 o The radiation dose to the patient and the risks and benefits of the particular radionuclide test to a particular patient. o New developments in Nuclear Medicine, and the changing role of Nuclear Medicine in the diagnosis and treatment of disease and the relevant imaging modalities used in reaching a diagnosis Nuclear Medicine services applied to: o Skeletal Imaging o Central Nervous System o The Endocrine System o The Cardiovascular System o The Respiratory System o The Renal Tract o The Gastrointestinal System Therapeutic Applications of Radionuclides in Nuclear Medicine 20

21 Section 4.0 Assessment 4.1 Assessment The responsibility for designing and assessing student learning lies with the Higher Education Institution and will be explained in the Course Handbook. However, there will also be continuous assessment across the 3-year training period in the work-base, using a series of Directly Observed Procedures / Direct Observation of Practical Skills (DOPs), Case Based Discussions (CbDs) and Mini Clinical Examinations (mini-cex). Examples of CbDs, DOPS and mini-cex can be found in Appendix 1 and 2. Direct Observation of Practical Skills (DOPS) is the observation and evaluation of a procedural/technical or practical skill performed by a student in a live environment. Case Based Discussions (CbDs) are designed to provide structured teaching and feedback in a particular area of clinical or technical practice by evaluating decision making and the interpretation and application of evidence. They also enable the discussion of the context, professional, ethical and governance framework of practice, and in all instances, they allow students to discuss why they acted as they did. CbDs are used throughout training and should encourage a reflective approach to learning. Mini Clinical Examinations (mini-cex) are a short snapshot of practitioner/patient interaction. They are designed to assess the clinical skills, attitudes and behaviours of students essential to providing high quality care. All DOPS, CbDs and mini-cex have the potential to be completed electronically and analysed on a central database. Each student will be required to complete a portfolio in which a record of these will be kept, further detail can be found overleaf. The table below indicates the suggested number of formal work-based assessments that should be completed by the student in Year 1, Year 2 and Year 3. Year 1 Year 2 Year 3 2 DOPS 1 CBD Competencies 4 DOPS 1 CBD 1 Mini-Cex Competencies 4 DOPS 2 CBD 2 Mini-Cex Competencies It is the responsibility of the student to maintain their own portfolio and ensure all assessments are completed on time. 21

22 4.2 Competency Log Book The competencies form the foundation of the work-based training programme and they are an important part of the portfolio and the student s record of competence. Competencies are transferable across learning outcomes and do not need to be undertaken twice where they are repeated. Reference should be made to the point at which this competency has been completed. Competencies are cumulative and as such not all competencies have to be completed within the relevant module. All competencies should be completed by the end of the training programme. This manual provides examples of areas of application or evidence required to demonstrate competence. Students are expected to utilise different tools, resource and media within the local laboratory to demonstrate each area of competence. Some competencies are exit competencies. These are described as such in the recognition that they require longer time and experience to acquire and therefore cannot be limited to one specific module or individual learning outcome. 22

23 Section 4.3 Generic Module Year 1: Work-based Training Learning Outcome 1 Performs the generic skills, demonstrates adherence to health and safety, professional behaviour and the knowledge and understanding defined in the work-based module for Year 1. Competency Reviewer Date Comments/Evidence The student will be able to: Demonstrate the six stage handwashing technique. Demonstrate basic life support skills. Demonstrate effective communication skills within the healthcare environment. Demonstrate safe working practice in the workplace. Demonstrate the standards of dress and professional behaviour required in the workplace. 23

24 Section 4.4 Division: Theme: Year 1: Physical Sciences and Biomedical Engineering Medical Physics Technology Work-based Training Learning Outcome 2 Demonstrate the ability to observe, assist and perform under direct supervision, some basic routine procedures whilst working in accordance with local rules and safety regulations. Competency Reviewer Date Comments/Evidence The student will be able to: Assist in the preparation of Nuclear Medicine equipment prior to a scanning procedure. Observe and assist in routine Nuclear Medicine scans. Perform basic contamination monitoring. Perform basic radiation dose measurements. Observe and assist in measuring the performance characteristics of an X-ray tube. Observe and assist in the production of a radiotherapy treatment plan. Observe and assist in the production of an immobilisation device. 24

25 Section 4.5 Division: Theme: Specialism: Years 2 & 3: Physical Sciences and Biomedical Engineering Medical Physics Technology Radiotherapy Physics Work-based Training Learning Outcome 3 Demonstrate the ability to perform a full range equipment life cycle procedures as an equipment user. Competency Reviewer Date Comments/Evidence The student will be able to: Critically appraise equipment, accessories or consumables as to whether they are fit for purpose. Participate in the procurement of equipment, accessories or consumables. Perform visual inspection of equipment prior to use to ensure it is safe to use. Perform risk assessments on equipment and its use. Operate the equipment inventory system (written or electronic) in order to save or retrieve equipment information. 25

26 Identify equipment inventory information such as serial numbers model numbers etc. Identify the cleaning / decontamination process for a range of equipment within the specialist area and then applies these processes to clean the equipment. Identify the maintenance requirements of a range of equipment used in the department and perform user maintenance. Follow the procedure to obtain local or manufacturer assistance in maintenance or repair. Perform user decontamination procedures on a range of equipment of equipment. Demonstrate the process for the disposal of equipment, accessories and consumables in a safe and appropriate manner. 26

27 Learning Outcome 4 Dose planning and virtual simulation: Demonstrate the ability to produce a range of Radiotherapy dose treatment plans using imaging data, defined treatment parameters, dose calculations and simulation processes to assist in the safest and most effective treatment being delivered to the patient. Competency Reviewer Date Comments/Evidence The student will be able to: Manually add opposed fields dose distribution. Calculate monitor units from the treatment prescription for the opposed field s distribution. Identify and contour organs at risk and taking into account their dose tolerance limits. Demonstrate competence in using department s treatment planning system. Produce and critically evaluate an opposed field pelvis plan including sparing organ at risk following local protocols. Produce and critically evaluate a multi field treatment plan for a bladder or prostrate patient including sparing organ at risk following local protocols. Produce and critically evaluate an opposed fields plan for a larynx including sparing organ at risk following local protocols. 27

28 Produce and critically evaluate a Breast/Chest wall plan including sparing organ at risk following local protocols. Check Planning Target Volume margins against clinical protocols as per diagnosis. Demonstrate the ability to define treatment field parameters for simple treatment techniques using virtual simulation software. Demonstrate the ability to define appropriate isocentre. Demonstrate the ability to conform treatment fields using multi-leaf collimators etc. 28

29 Learning Outcome 5 Mould room: Demonstrate the ability to make safe and appropriate immobilisation devices in accordance with local protocols. Competency Reviewer Date Comments/Evidence The student will be able to: Prepare the clinical area for the procedure. Check the patients identity and that the request is appropriate to the clinical history provided. Empathise with the patient and assess their ability to undergo the procedure specified by the request. Prepare the patient according to the radiotherapy request form. Give instructions and explain the procedure to the patient and other relevant persons. Complete the necessary documents for set-up reproduction. Use hand and machine tools safely and effectively during procedures associated with the mould room. Demonstrate good health and safety practice when performing mould room procedure. Position the patient as appropriate to the procedure. Take the relevant measurements and impressions. 29

30 Manufacture immobilisation devices to meet the specification required to deliver treatment. Select the appropriate thickness of lead shielding. Produce a lead mask or cut-out that meets the department s quality standard. Produce a tissue equivalent substance (bolus) to meet the treatment specification requirements. 30

31 Learning Outcome 6 Brachytherapy: Demonstrate the ability to participate in the preparation and delivery of Brachytherapy treatment procedures. Competency Reviewer Date Comments/Evidence The student will be able to: Check and calculate the activity of sealed sources. Perform standard sealed source calculations using the department s planning programmes. (e.g. standard High Dose Rate Brachytherapy insertion) Explain the principles of prostate brachytherapy and observation of the procedure. Discuss and apply understanding of volume coverage and treatment plan analysis. Clean and sterilise applicators after use in accordance with departmental rules. Produce brachytherapy treatment plans. Perform routine quality control of any brachytherapy equipment. 31

32 Learning Outcome 7 Quality Control of Radiotherapy: Demonstrate the ability to undertake quality control procedures for Radiotherapy Systems. Competency Reviewer Date Comments/Evidence The student will be able to: Perform routine quality control programme of orthovoltage treatment units. Perform under supervision, routine quality control programme of megavoltage units. Follow departmental protocol in completing radiation dosimetry checks on linac (photons and electrons). Perform, under supervision, quality control procedures for other radiotherapy treatment units. (eg High Dose Rate Brachytherapy, Tomotherapy units). Perform routine strontium testing of therapy level dosimeters. Perform routine output measurements of treatment units. (Orthovoltage in air measurements, MegaVoltage X- ray and electron measurements). Perform under supervision routine quality control programme of Computed Tomography and simulators. Perform under supervision routine quality control programme of treatment planning systems. 32

33 Learning Outcome 8 Dose Measurement: Demonstrate the ability to use a range of dosimeters for a variety of dose measurements types in accordance with established procedures. Competency Reviewer Date Comments/Evidence The student will be able to: Describe the use of Thermoluminescent Dosimeters (TLD) and semiconductor dosimetry systems in: personal and patient monitoring according to local protocols. Prepare Thermoluminescent Dosimeters for patient monitoring according to local protocols. Explain the principles portal dosimetry. 33

34 Learning Outcome 9 Image Guidance: Demonstrate the ability to use image guidance to check and modify treatment plans following local protocols. Competency Reviewer Date Comments/Evidence The student will be able to: Explain the justification of departmental localisation tolerances. Check verification images against planning Digitally Reconstructed Radiographs following local protocols under supervision. Produce Digitally Reconstructed Radiographs encompassing relevant anatomy to assist the image matching process. Apply the limitations of cone beam soft tissue matching analysis. Explain the appropriate use of different Fiducial markers for a number of treatment sites. Assess criteria required for rescanning, replanning and reimaging patients in according to local protocols or tolerances. 34

35 Learning Outcome 10 Radiotherapy Practice: Demonstrate the ability to apply a professional approach to all activities undertaken within the radiotherapy department. Competency Reviewer Date Comments/Evidence The student will be able to: Comply with all data protection requirements when creating, storing and maintaining valid patient records. Use computer systems, verification systems and network systems within the radiotherapy department following any local rules. Work within the legislative frameworks, radiology protection, health and safety standards and clinical governance. Work within the Quality Assurance systems as applied to radiotherapy and audit. Comply with the rules relating to Health and Safety, including manual handling. Communicate with patients and colleagues. Make radiotherapy judgements and decisions to support effective healthcare delivery. Practice safely and to the highest professional standards. 35

36 Participate as an effective member of the Multidisciplinary Team (MDT) dealing with the delivery of radiotherapy based treatments. 36

37 Section 4.6 Division: Theme: Specialism: Years 2 &3: Physical Science and Biomedical Engineering Medical Physics Technology Radiation Physics Work-based Training Learning Outcome 3 Demonstrate the ability to perform a full range equipment life cycle procedures as an equipment user. Competency Reviewer Date Comments/Evidence The student will be able to: Critically appraise equipment, accessories or consumables as to whether they are fit for purpose. Participate in the procurement of equipment, accessories or consumables. Perform a visual inspection of equipment prior to use to ensure it is safe to use. Perform risk assessments on the equipment and its use. Operate the equipment inventory system (written or electronic) in order to save or retrieve equipment information. Identify equipment inventory information such as serial numbers model numbers etc. 37