DEVELOPING WORLD-CLASS PERFORMANCE IN HEALTHCARE SCIENCE

Transcription

1 DEVELOPING WORLD-CLASS PERFORMANCE IN HEALTHCARE SCIENCE A LEARNING GUIDE FOR HEALTHCARE SCIENTISTS THEME PATHWAY Medical Physics Radiotherapy Physics

2 PREFACE Learning Guide version (2011/12) This draft Learning Guide document provides initial information relating to trainees recruited onto the Medical Physics theme that will be following Radiotherapy Physics Pathway and provides information for providers and trainees for the first phase of work based training. Section 4 contains detailed information on content of rotation modules, experiential learning and competences to be completed in the rotational phase of the programme (Year 1). Sections 1-3 contain general information about the programme structure and delivery and also an outline of possible specialist modules for years 2 and 3. Further development work will be undertaken between December 2011 and April 2012 in conjunction with the Professional Bodies to provide detailed modular information for specialist training and assessment. At that point a further updated copy of this Learning Guide will be produced to include detailed information on structure and content of specialist modules for Years 2 and 3 of the programme. The Year 1 Learning Guides will also be reviewed and updated based on experience of their use with trainees.

3 CONTENTS PAGE 1. Introduction 1.1 Learning and development for Healthcare Scientists, overview The aim and content of Healthcare Scientist training Description of Healthcare Science themed pathways The Scope of Practice for Healthcare Scientists Good Scientific and Technical Practice 1.2 How to use this learning guide Providers of the work based learning Healthcare science Trainees 2. Guidance for providers of work based learning 2.1 Programme structure, rotations and specialisms 2.2 Requirements for delivery 3. Guidance for Healthcare Scientist trainees 3.1 The role of the Healthcare Scientist in Radiotherapy Physics Clinical Role Managerial Role Research/training and Education Professional Practice 3.2 About the programme what the trainee will do Induction Rotational Programme Aim of Specialist Training in Radiotherapy Physics 3.3 About the programme- how you will be assessed Assessment Online assessment and personal development management system Progression Rotational Assessment 4. The Healthcare Scientist Programme in Radiotherapy Physics The Learning Framework Learning modules Learning outcomes, recommended clinical practice and assessment, competences, knowledge and skills, and behaviours for each module: Rotations Specialist Professional practice Appendices Good Scientific Practice Scope of Practice for Healthcare Scientists Related STP guidance documents and how to access them Relevant National Occupational Standards (NOS)

4 Reference glossary of terms

5 SECTION 1 Introduction 1.1 Learning and development for Healthcare Scientists The aim of this programme is to develop world class performance in Healthcare Science The Healthcare Scientist Training Programme (STP) in Radiotherapy Physics is designed to provide the Healthcare Scientist (HCS) with strong science-based, clinical training across all aspects of the specialism with an appropriate level of underpinning scientific knowledge to enable them to perform in a range of healthcare settings. The full curricula for can be found on this link This Learning Guide describes the Healthcare Scientist work based training programme in Radiotherapy Physics and should be read in conjunction with the Operational Framework for Modernising Scientific Careers (MSC) (planned for publication in December 2011), the University Handbook from Relevant academic institution (MSc in Clinical Sciences Radiotherapy Physics) and the Online Assessment and Personal Development Management System manual. The training will be delivered both in the work place and in the University and the trainee will also be part of the National School of Healthcare Science for the duration of their training. The National School will oversee the trainee performance using the online assessment function and will actively follow progression of all trainees throughout the programme. The National School will also work with the Strategic Health Authority Modernising Scientific Careers leads to ensure the smooth delivery of the programme. At the end of the programme the successful Trainee will receive an MSc in Medical Physics Radiotherapy Physics and a Certificate of Competence for the work based programme. Description of Healthcare Science themed pathways The Healthcare Science workforce consists of a diversity of specialisms. All involve the application of science, technology, engineering or mathematics to health. Traditionally, these specialisms have been divided into three broad divisional areas: life sciences, physical science and engineering and physiological science. However rapid advances in science and technology and changes in patient needs and service delivery are beginning to blur the lines between these divisions. In recognition of these changes, grouping the more than 45 specialisms into 7 themed pathways is proving to be a helpful way forward: Infection sciences Blood Sciences Cellular Science Neurosensory sciences Cardiovascular, Respiratory and Sleep Sciences Clinical Engineering Medical Physics

6 For Radiotherapy Physics the indicative content of the 3 years is shown below. The rotational periods will consist of the disciplines from physics theme. The order, and to some extent, the duration of the rotations may vary according to local availability. Radiotherapy Physics Broadly, the scheme of the STP includes workplace-based training in 4 specialist physics rotations over the first period of training. Each period of training will last for approximately 3 months depending on local arrangements and taking into account any periods of Annual leave. At some point during the specialist training period there will be a 4-6 week elective period arranged by your local department but this may not always follow directly on from the initial rotational period. The aim of the elective period is to allow the trainees to experience other clinical departments, possibly in a different theme that has relevance to Radiotherapy Physics. The remaining time will be spent on specialist Radiotherapy Physics training. This workplace-based component complements and utilises the parallel academic programme of training, which results in a Masters degree in Clinical Science Radiotherapy Physics

7 The Scope of Practice of a Healthcare Scientist (HCS) Healthcare Scientists in Radiotherapy Physics will have clinical and specialist expertise underpinned by theoretical knowledge and experience in the specialism, and by broader knowledge and experience within the healthcare themes. They will undertake complex scientific and clinical roles, defining and choosing investigative and clinical options, making key judgements about complex facts and clinical situations that require expert advice. They will work directly with medical colleagues, within the multidisciplinary team. They will be involved, often in lead roles, in innovation and improvement, Radiotherapy Physics research and development and education and training. Some will pursue explicit academic career pathways, which combine clinical practice and activity in research, innovation and education. Good Scientific Practice Good Scientific Practice [GSP] sets out the principles and values on which good practice within Healthcare Science is founded. It makes explicit, for Healthcare Scientists in Radiotherapy Physics, the public and healthcare providers, the standards of behaviour and practice that must be achieved and maintained in the delivery of work activities and clinical care. GSP is designed to contextualise the standards of practice and proficiency set down by the Health Professions Council (HPC) in a way that is accessible to the profession and the public. It therefore uses as its basis the HPC Standards of Proficiency and HPC Standards of Conduct, Performance and Ethics, which have been further elaborated for Healthcare Scientists in Good Scientific Practice, details of which can be found in the Appendices to this Guide.

8 1.2 How to use this learning guide Providers of work based-learning Section 2 provides an initial reference tool to assist providers with the provision of the training programme. Use of this reference tool will facilitate planning for the delivery of the programme, including the management of the required rotational experience within, or external to the main provider. Following review of this reference tool, providers should ensure that they obtain and are fully familiar with details in several specialist areas of training, e.g. requirements for training workplace based trainers assessment processes quality assurance and monitoring requirements the providers role in supporting equivalence programmes for individual trainees This information will be available in the Operational Framework for Education and Training in Healthcare Science, due to be published in December 2011 Section 3 contains an overview of the Radiotherapy Physics programme and its delivery.. Section 4 contains detail on the work based learning outcomes, suggested clinical experience, competences, knowledge base and outcome performance measures (assessment criteria) and associated behaviours for each module associated with the Radiotherapy Physics programme. Appendices provide further reference materials related to development and assessment in skills, behaviours and expectations of Healthcare Scientists Healthcare Science Trainees Section 3 contains an overview of the Radiotherapy Physics programme and its delivery. Section 4 is the Learning Framework, which provides the training details of the programme. This is presented in a modular format and represents, as measures of successful completion of the programme and its learning outcomes the; clinical experience/assessment criteria for development of competence with recommended assessment tools/methods/criteria competences associated with successful work performance associated knowledge the trainee will be able to apply skills and behaviours associated with effective performance Appendices provide further reference materials related to development and assessment in skills, behaviours and expectations of Healthcare Scientists. Other reference materials are available through the Learning and Development Manager at the providing institution/location e.g. assessment of training details, equivalence (of prior learning and experience) processes, and monitoring and quality assurance of training programmes. It is anticipated that this information will be available, by December 2011 in the Operational Framework for Education and Training in Healthcare Science.

9 SECTION 2 Guidance for providers of work based learning in Radiotherapy Physics 2.1 Programme structure and rotations Programme Structure The work-based element of the Healthcare Scientist Training Programme (STP) in Radiotherapy Physics takes place over the three years of the Programme. It commences with 4 rotations taken from those shown in the Radiotherapy Physics Theme diagram; one of these rotational placements will be in Radiotherapy Physics and will form the introduction to the specialist modules in Radiotherapy Physics. The timings of these modules will depend of local availability and will be organised locally in conjunction with your Strategic Health Authority Modernising Scientific Careers Leads. In the second phase of the workplace based training trainees specialise in Radiotherapy Physics based in the host Trust. The Healthcare Scientist training programme also includes a specific research module, which will be a combination of training in research methodology and a research project carried out in conjunction with the academic provider. The Professional Practice element of the curriculum underpins both the academic and the workplace training and is based on Good Scientific Practice (see Appendices). This Guide describes in detail for trainees and providers the workplace training for the 4 rotational placements and for the specialist programme in Radiotherapy Physics, in particular the curriculum content of the work based training, the details of the assessment programme and the e- portfolio structure. It is the role of the providers of work based training to take responsibility for organising their own delivery timetables, in conjunction with the academic providers. It is important to recognise that in the delivery of these new training programmes trainees are essentially supernumerary to service provision and will need identified and protected time to undertake their academic studies. However an equally important part of this programme is clinical competence, wherever possible and under appropriate supervision trainees should be involved directly in clinical and department practice. Each trainee should be assigned a trainer for the duration of the programme. Throughout the early implementation of these new training programmes the National School of Healthcare Science will provide a national co-ordinating function to support departments in delivery. Assistance will be available in terms of organising specialist rotations that might need national coordination, successful implementation of the assessment tool and the provision of a train the trainer programme. The National School of Healthcare Science will

10 continue to function with a high level over sight of all the Radiotherapy Physics trainees and co-ordinate mid term and final work based assessments in collaboration with the professional body. The National School of Healthcare Science will also liaise with the relevant academic institution to ensure the timely delivery of the academic programme Requirements for delivery Quality Objectives and Measures for providers of Work based training All training departments are responsible for the delivery of the work based training quality standards detailed in the Learning and Development Agreement (LDA) issued by their local Strategic Health Authority Modernising Scientific Careers Leads. This section provides a reference tool for work based training providers to assist with decision-making to deliver the full content of this training programme. Providers may need to include plans for working with other approved providers in order to meet the rotation and elective components, although the host provider continues to hold the responsibility for the overall quality of training provision for trainees, by regular contact e.g., weekly catch up sessions. The table below draws providers attention to some of the challenging issues that must be addressed in the Radiotherapy Physics training programme.

11 RESOURCE OBJECTIVES Staff resources Quality objective The delivery and assessment of the Radiotherapy Physics Healthcare Science programme requires an appropriate programme faculty across each component of the programme, all of whom have undertaken appropriate training for the role Physical Resources The provider will ensure that sufficient physical resources are available, operational and approved for the required training Rotations The range of clinical services to be available in each rotational site can be found by reference to the rotational modules in section 4 Electives The provider will ensure that sufficient resources and locations are available for the elective component for 4-6 weeks Specialist Radiotherapy Physics training The provider will ensure that sufficient physical resources are available for specialist training in Radiotherapy Physics Requirements Trainers are appropriately trained and qualified in training and assessment Trainers are vocationally competent to train and assess trainees in the learning outcomes of the curriculum. Trainers are given sufficient time to effectively fulfil all aspects of the role and ensure the quality of the programme There are sufficient physical resources to ensure that trainees can undertake the required rotations. This may require arrangements with other providing institutions with responsibility for ensuring quality and consistency of provision remaining with the originating provider Available resources for electives in any Healthcare Science specialism or related clinical service Available resources for single specialism training in Radiotherapy Physics including the research module

12 SECTION 3 Guidance for Healthcare Scientist trainees in Radiotherapy Physics 3.1 The role of the Healthcare Scientist in Radiotherapy Physics Healthcare Scientists in Radiotherapy Physics fulfil all elements of the generic Scope of Practice for the specialism. They must use knowledge and experience across a wide range of clinical pathways in Radiotherapy Physics services. The Healthcare Scientist working in Radiotherapy Physics, for a range of treatments, will be able to demonstrate: A critical understanding of the treatment planning process, including the ability to develop site specific treatment planning protocols, plan and check complex treatment plans, perform treatment dose calculations, outline anatomy and clinical target volumes and advise on individual patient treatments. A critical understanding of the dosimetry framework, including the ability to undertake definitive calibrations on, commission and quality assure radiotherapy equipment An understanding of brachtherapy treatments, including the ability to plan, prepare and administer sealed source treatments An understanding of the radiation protection framework in Radiotherapy, including the ability to develop room designs and procedural controls The following roles will be developed throughout the training programme by a combination of work based competences, underpinning academic knowledge and clinical experience. They are not exhaustive, but are indicative of the multi-layered role of the Healthcare Scientist in Radiotherapy Physics. Clinical Role Plan radiotherapy treatments and offer advice on planning options and management Assure the optimal performance and accuracy of radiotherapy treatment machines Recognise the role and importance of the multidisciplinary team environment for optimum patient care. Managerial Role Provide an appropriate, modern range of services in a patient focussed environment

13 Understand the legal framework for testing including ethical, legal and social implications Conduct clinical audit Research/Training and Education Participate in relevant collaborative research Contribute to evidence based good practice guidelines Research the application of scientific investigation to one or more clinical situations in Radiotherapy Physics Lead, develop or participate in training and education of Healthcare Scientists in Radiotherapy Physics Professional Practice Be a role model in excellent professional behaviours and practice as described by Good Scientific Practice

14 3.2 About the programme what the trainee will do The following pages provide a broad overview of the role and functions related to the specialist Radiotherapy Physics and rotational components of the work based part of this programme. The detailed performance measures are included in Section 4, which serves as the basis for programme design, delivery and assessment Induction Each time a trainee begins workplace-based training in a new clinical or department environment, an induction will be provided and will include. Local hospital induction local policies Review of local service and functioning of the department and any related operations Review of clinical users of the department service Review and more detailed description of health and safety, pertinent to the modules and to the local department. Basic knowledge about the function, operation of equipment appropriate to the section(s) of the department in which the trainee will be working

15 Healthcare Scientist Rotational Programme The aim of the rotational programme is to introduce the breadth of underpinning knowledge necessary to fulfil the role of a Healthcare Scientist in Radiotherapy Physics. Within the Radiotherapy Physics Programme the following rotational placements operate. The following provides a broad outline of the aims of each rotation. Detailed learning outcomes, workplace competences and knowledge specification are included in the Learning Framework in section 4. The corresponding academic components of these modules are being delivered by Relevant academic institution using a blended learning approach described in the Handbook for the MSc. Rotational Placements in Radiotherapy Physics Radiotherapy Physics Radiation Safety Imaging with non ionising radiation Imaging with ionising radiation Aim Trainees will gain an understanding of relevant legislation around radiation protection applied to radiotherapy, gain understanding of dosimetry, Dosimetry Codes of Practice, treatment machines and treatment planning. On completion of this module the trainee will be able to plan treatment and operate a range of treatment equipment under supervision and, through application of knowledge and understanding, select and use relevant measurement devices to undertake basic measurements on treatment machines. On completion of this module, the trainee will have undertaken a range of assessments, measurements and tests based on understanding of the requirements, standards and policy for radiation safety. They will have participated in a range of radiation measurement and audit activities and contributed to quality assurance, the optimisation of practices and the design of new facilities. To introduce the trainee to a range of equipment and techniques used in ultrasound, Magnetic Resonance Imaging and non- imaging techniques and an understanding of the effects of image acquisition parameters On completion of this module the trainee will have a basic knowledge of the major applications of ultrasound Magnetic Resonance Imaging and non-imaging techniques and their use as applied to a range of common investigations. They will understand and be able to assist with risk management and to work safely within Non-ionising Radiation environments. They will be able to apply learning to imaging and non-imaging equipment performance and increase their understanding of new and emerging developments in this field. To introduce the trainee to a range of equipment and techniques used in Nuclear Medicine and Diagnostic Radiology and understand the effects of image acquisition parameters and post processing. On completion of this module the trainee will be able to operate a range of equipment for equipment performance evaluation, patient dose measurement and clinical imaging.

16 Aims of Specialist training in Radiotherapy Physics The Healthcare Scientist Programme in Radiotherapy Physics provides workplace-based training to complement the academic learning programme provided through the MSc in Clinical Science (Radiotherapy Physics). Clinical Module Dosimetry and treatment equipment Treatment planning Brachytherapy Computing related to radiotherapy Research project in Radiotherapy Physics Aim To gain the analytical skills required to support the service to ensure accurate treatment delivery To become competent in performing and assuring all aspects of the planning process To understand the role of Brachytherapy as part of Radiotherapy Treatments and to be able to perform routine tests of equipment and develop patient dose prescriptions To understand the role of Information and Communication Technology (ICT) in contemporary radiotherapy, discuss its needs with IT professionals from inside and outside the hospital organisation and to be able to safely perform data transfer between computer systems associated with the design, management, delivery and quality assurance of highly complex radiotherapy. The overall aim of this module, building on the Research Methods module is for the trainee to undertake research that shows originality in the application of knowledge, together with a practical understanding of how established techniques of research and enquiry are used to create and interpret new information in a specialism of Healthcare Science. During Years 2 and 3 the trainee will undertake a creative piece of research involving the application of scientific investigation to one or more clinical situations. The trainee will also be expected to complete either one [single] large research project or three shorter health services research projects to gain an understanding of the health services contexts within which clinical research is undertaken. Whichever is chosen they should include: Evidence-based practice Clinical audit Supporting service users

17 Trainees will complete a research project in Radiotherapy Physics to show originality in the application of knowledge, together with a practical understanding of how established techniques of research and enquiry are used to create and interpret new information in Radiotherapy Physics. The research project will be carried out in conjunction with the relevant academic institution. The generic Professional Practice module underpins training and performance across the whole programme.

18 3.3 About the Programme - how you will be assessed Assessment There will be continuous assessment during the work based training using a series of validated workplace based assessment tools. Trainees will be expected to keep a record of all assessments and competences in their e-training portfolio. The overall workplace based assessment programme comprises a number of assessment tools. Case based discussion (CbD) o This tool is designed to demonstrate the trainee s knowledge and understanding of any aspect of an output for which they have been wholly or partially responsible. This can range from discussion of the science behind the output to ethical and communication issues arising in context. Direct observation of practical skills o This tool records an observation of a skill or procedure. Feedback is given and learning needs identified. Each discipline will have a core list of skills with documentation of what is expected at the relevant stage of training Multi-source feedback o The tool enables feedback to be given to trainees by different colleagues who work with them. The trainee and trainer nominate a range of colleagues who will be invited in accordance with agreed guidelines for who is eligible. o Research has shown that 8-10 raters are necessary to achieve reliability. o The trainee also rates him/herself. o This tool is also entirely on-line and there is no local paperwork. A report is generated which should be discussed with the trainee by a trainer who has been trained in giving feedback. The report is placed in the online training portfolio. Observation of clinical events (based on Mini-Cex) o A clinical event is defined as any occasion when the trainee/student is present with a patient as part of the clinical team. This is true for all patientfacing occasions whether the trainee only observes, or speaks to, touches, positions or examines a patient. o The tool records aspects of the trainee s communication and clinical skills as relevant. It also records professionalism

19 The assessment programme is an integral part of the curriculum. The curriculum in turn is based on Good Scientific Practice. This linkage is crucial to standard setting and to support review of the satisfactory progression of trainees through the programme. The assessment tools taken together therefore provide evidence/information about the trainee s ability in relation to all aspects of the curriculum. The evidence provided by the work based assessments taken together provides evidence/ information about the trainee s ability, demonstrated in the workplace, in relation to all aspects of the curriculum. Assessment Tool DOPS MiniCex CbD MSF Purpose Observation Observation Conversation/ discussion Review by others/colleagues Observe and assess the conduct of a practical procedure Observe and assess a clinical encounter Discuss an outcome/ output from workplace activity using a record, result, Professionalism Interpersonal skills/team working Communication Takes place Process Reviewed and documented with feedback in the moment/ as it is happening Process Reviewed and documented with feedback in the moment/ as it is happening Outcome/output Discussing, explaining, justifying aspects of the report/record/result. Including aspects of professionalism Reflecting on comments of others within the framework of constructive feedback There is a requirement for each trainee to engage with the assessment process and to complete a minimum numbers of the different types of assessments within each module; these will be detailed in the assessment manual and on the tool.

20 Online assessment and personal development management system An online assessment and personal development management system provides an electronic medium for completion and logging of all of the personal assessments related to the work based elements for the Modernising Scientific Careers (MSC) training programmes and is available for the work based elements of the programme. The electronic portfolio provides support to the trainees with their continuous professional development throughout the training programme and provides a mechanism through which their development and progress can be monitored and managed. Progression Maintaining the electronic portfolio is an integral part of the workplace based programme and its maintenance by the trainees is essential for progression. Trainees are responsible for maintaining their portfolio and keeping keep a record of all assessments and competences and information relating to their progression through the programme up to date. The National School of Healthcare Science will use the assessment tool to consider the trainee s progression at any time within the programme and to provide feedback around areas of development. The successful completion of the online assessments will form the main body of evidence for the School and the Professional bodies to award the Certificate of Competence. Rotation Assessment During the rotational periods there should be one DOP and one CBD completed for each rotation. The clinical experiential learning should be recorded on the online tool as reflective learning and will form an important part of your portfolio. The trainees must complete all competences by the end of the rotation.

21 SECTION 4 The Learning Framework The following section provides the framework for the design, delivery and assessment of learning and performance outcomes and associated knowledge and skills. The framework provides a specification for each rotation and then for the specialist component of the programme All of the underpinning academic knowledge will be taught as part of the Masters programme delivered by the academic provider RADIOTHERAPY PHYSICS

22 Rotational Modules MODULE TITLE RADIOTHERAPY PHYSICS COMPONENT ROTATION AIM SCOPE Trainees will gain an understanding of relevant legislation around radiation protection applied to radiotherapy, gain understanding of dosimetry, Codes of Practice, treatment machines and treatment planning. On completion of this module the trainee will be able to plan treatment and operate a range of treatment equipment under supervision and, through application of knowledge and understanding, select and use relevant measurement devices to undertake basic measurements on treatment machines. LEARNING OUTCOMES On successful completion of this module the trainee will achieve the following work based learning outcomes; Radiation Protection applied to Radiotherapy 1. Understand IRR99 2. Understand IR(ME)R 3. Handle sealed sources safely 4. Perform a radiation survey Dosimetry & Treatment Equipment 1. Operate treatment equipment safely (under supervision) 2. Select and use relevant measurement devices 3. Undertake basic measurements on the treatment machines 4. Understand the relevant Dosimetry Chains and Codes of Practice 5. Understand the Quality Control of treatment machines Treatment Planning 1. Understanding the international, national and local guidelines in treatment planning 2. Discuss the relative merits of treating with photon, or electrons in clinical situations 3. Understanding of the treatment planning process from immobilisation to start of treatment 4. Produce and critically appraise routine MV photon treatment plans. 5. Acquire a working knowledge of relative dosimetry and the calculation of monitor units for photons and electrons. 6. Quality assure treatment planning systems

23 CLINICAL EXPERIENTIAL LEARNING The recommended examples of clinical experiential learning for this module are Conduct a radiation survey including environmental monitoring and instantaneous dose Audit an example of departmental local rules Use of strontium-90 test source to check instrument constancy Audit of QS procedure Perform output measurements Assist with routine quality assurance Measure beam parameters and characteristics Produce a range of routine MV photon treatment plans Observe the patient pathway from immobilisation to start of treatment Extract relevant geometric and dosimetric clinical data from the treatment planning system for treatment and verification Undertake validation calculations on routine treatment plans produced using data charts Observe treatments of superficial lesions and calculate treatment parameters Perform quality assurance checks on treatment planning systems Observe MV photon treatment All of these experiences should be recorded in your e-portfolio as reflective learning and discussions with your training officers. The following section provides detail of expected achievements in both practical and knowledge based learning outcomes for this module. Required achievements are cross-referenced to the above Learning Outcomes to ensure application of competence across all activities within this module and thus maintain an integrated and holistic approach to development and assessment. Requirements for Professional Practice are contextualised to ensure the application and assessment of broad descriptors contained within Good Scientific Practice.

24 KEY LEARNING OUTCOMES Radiation Protection applied to Radiotherapy COMPETENCES Explain the role of Local Rules, their linkage to the legislation and their relevance in the local department. Explain the concept of justification for medical radiation exposures Identify the Duty Holders under IR(ME)R and defined roles under IRR99, within the department. Assist with the safe handling and operation of small sealed sources in the department including the performance of strontium-90 consistency checks on dosimetry equipment Perform a radiation protection room survey and discuss the results. Perform a radiation risk assessment and discuss the results KNOWLEDGE AND UNDERSTANDING Relevant National Legislation and associated guidance Required structure of Local Rules Basic awareness of the Quality System and an understanding of it relationship to Legislation Knowledge of the local Duty Holders and their roles and responsibilities Programme of personnel and environmental monitoring The sources of radiation and construction of radiotherapy equipment Performance characteristics and suitability of area survey monitoring equipment Principles of radiation protection and their application in context The ALARP principle Structure and requirements of a risk assessment Importance of engineering controls for risk management

25 KEY LEARNING OUTCOMES Dosimetry and Treatment Equipment COMPETENCES Operate treatment equipment safely and evaluate the operation of the interlocks. Select an appropriate dosemeter and measure standard output including assessment of the constancy and leakage of the measurement system and its significance. Relate standard output measurement to the relevance Code of Practice (MV/kV electron) Measure a beam profile at the depth of maximum dose and reference depth and calculate the field size, penumbra, flatness and symmetry. Explain the differences and relate to the beam specification. Critically evaluate the function of the ionisation chamber in the Linear Accelerator and its importance for correct treatment delivery. KNOWLEDGE AND UNDERSTANDING Basic principles of Linear Accelerators and their operation Range and type of instruments for measurement and how to select to meet identified need Capabilities and limitations of such devices At least one Code of Practice and its application/relevance The dosimetric chain relating the output to the primary standards Beam characteristics The function of relevant components of the Linear Accelerator

26 Determine the HVL by measuring an attenuation curve in an appropriate material for a kilovoltage machine. Relate this to the treatment parameters and evaluate the appropriateness of the tolerances. Assist with routine QC on External Beam Radiotherapy equipment (including items such as light to radiation, Quality Index) and evaluate the appropriateness of action / tolerance levels kv beam production, filtration and energy Beam characteristics The need and importance of QC of treatment equipment How action levels are used to ensure equipment remains in tolerance and relate to the patient dose Relevant IPEM reports

27 KEY LEARNING OUTCOMES Treatment Planning COMPETENCES Determine how the legislation and guidance particular to treatment planning e.g. data protection, patient confidentiality, and IR(ME)R fit in with local practice. Follow in detail the patient pathway from imaging to treatment. Identify the principles for ensuring accurate treatment e.g. markers; verification Assess available immobilisation techniques and identify treatment sites which would most benefit Import images for treatment planning purposes. Evaluate the interactions between data systems and be able to critically assess the essential information e.g. image QA; slice requirements etc. Generate outlines for anatomical structures and geometrical volumes to aid planning based on CT data sets KNOWLEDGE AND UNDERSTANDING How to identify and comply with relevant international and national recommendations, IR(ME)R, Caldecott principles, ICRU guidelines Use of imaging data for the treatment planning process Relevant departmental protocols and policies and their application with respect to dose prescription Local protocols for data entry, utilisation and transfer Basic understanding of sectional anatomy

28 Design treatment plans for 2 to 4 field treatments for a range of sites in accordance with ICRU Guidance and local clinical protocols (explain choice of modality/energy, beam arrangement, and compensation). Appraise treatment plans, making use of dose volume information and dose constraints for organs at risk and the target volume How to prepare the relevant patient data and patient treatment related data in a form appropriate for calculation. The underlying principles of creating a treatment plan and the manipulation of treatment parameters to achieve an acceptable relative dose distribution How to record all calculations, calculation results and treatment instructions according to departmental protocols to provide sufficient detail for the method and results to be verified sufficiently to satisfy an independent check and for the results to be used for treatment. The radiobiology behind choice of fractionation regimes Criteria for acceptable dose to the planning target volume and maximum allowed dose to organs at risk dependent on disease site Perform manual calculations for basic treatment techniques taking into account field size, wedge factor, change of FSD, off-axis etc. Perform and discuss routine quality assurance checks on the treatment planning/vsim system and the radiotherapy network. Capabilities and limitations of treatment machines, associated equi0pment Use of calculation data and charts Range and extent of independent checks required National or international guidelines according to local practice e.g.; IPEM81

29 Associated Behaviours and Professional Practice - Learning outcomes The Healthcare Scientist operates to high standards of professionalism and demonstrates essential behaviours and personal qualities These are specified within Good Scientific Practice and map to the professional standards needed for registration with the appropriate regulatory bodies. These include areas such as communication and Health and Safety that complement and test application of the academic learning. These qualities need to be assessed throughout the work based assessment programme and will be demonstrated using appropriate assessment tools (DOPs and CBDs). Appendix 1 contains the summary of these professional learning outcomes The key professional learning outcomes for this module are contextualised below. Communicate complex and technical information including to those with limited technical knowledge in terms that facilitate understanding of issues Ensure validation of data, through use of appropriate sources of information including relevant databases and consultation with senior colleagues Evaluate data from a range of analysis, information and personal support sources to assist with judgements and decisions on interpretation, extended testing, reporting and communicating results Make use of suitable range of diagnostic, investigative and/or monitoring procedures when undertaking investigations Produce a range of written reports in accordance with personal level/sphere of responsibility Use the appropriate range of IT platforms and software to ensure effective and comprehensive data collection and analysis Audit scientific practice within all areas of practice associated with investigations to ensure application of ethical and governance regulations Accept the responsibilities of the role of the Healthcare Scientist in relation to other health care professionals and with empathy and sensitivity to patients, carers and families, where relevant Prioritise and organise workload and duties with due regard for urgency, patient care, safe practice and the optimisation of departmental workload. Work effectively and efficiently within a multi-disciplinary team with due regard for the needs, wishes, dignity and privacy of patients and their families Present Quality Assurance data in compliance with principles of internal Quality Control and external Quality Assurance

30 SECTION 4 The Learning Framework The following section provides the framework for the design, delivery and assessment of learning and performance outcomes and associated knowledge and skills. The framework provides a specification for each rotation and then for the specialist component of the programme All of the underpinning academic knowledge will be taught as part of the Masters programme delivered by the academic provider Rotational Modules RADIATION SAFETY PHYSICS

31 Rotation Module MODULE TITLE Radiation Safety Physics COMPONENT Rotation AIM SCOPE This module includes seven components covering policy, practice and application across Radiation Safety On completion of this module, the trainee will have undertaken a range of assessments, measurements and tests based on understanding of the requirements, standards and policy for radiation safety. They will have participated in a range of radiation measurement and audit activities and contributed to quality assurance, the optimisation of practices and the design of new facilities. LEARNING OUTCOMES On successful completion of this module the trainee will achieve the following work based learning outcomes; New Facilities 1. Assess the risks associated with planned new facilities or services involving radiation. 2. Specify design features for new facilities or services involving the use of radiation. 3. Specify radiation protection and control features required for new facilities involving the use of radiation Facility Safety Assessment 1. Measure and record levels and characteristics of radiation. 2. Assess acceptability of installation by performing critical examination. 3. Calibrate and test equipment that measures radiation Radiation Safety Audits 1. Audit areas where radiation is used. 2. Understand the framework for audit of radiation dose to patients. 3. Understand the framework for monitoring radiation dose to staff. Optimisation 1. Assess, audit and interpret patient radiation dose. 2. Measure and record levels and characteristics of radiation 3. Understand the principles for optimisation of practices involving radiation Measure Radiation Levels 1. Measure and record levels and characteristics of radiation. 2. Select and use appropriate instruments and test equipment that measure radiation

32 Contingency Plans 1. Be aware of response to radiation emergencies. 2. Understand and discuss procedures and policies for the management and control of incidents involving radiation. 3. Support safe and effective working practices in areas which may be affected by radiation Policy and Procedures 1. Be familiar with the broad requirements of IRR1999 and other relevant safety legislation 2. Understand and discuss organisational policies for radiation protection. 3. Understand and discuss procedures for management and control of radiation 4. Understand and discuss procedures for control of equipment generating radiation and of the radiation emitted.

33 The following section provides detail of expected achievements in both practical and knowledge based learning outcomes for this module. Required achievements are cross-referenced to the above Learning Outcomes to ensure application of competence across all activities within this module and thus maintain an integrated and holistic approach to development and assessment. CLINICAL EXPERIENTIAL LEARNING The recommended examples of clinical experiential learning for this module are: Risk assessment of radiation facilities Design of radiation facilities Assess the safety of radiation facilities and conduct of critical examinations Undertake patient dose surveys Measure radiation levels Assist with safety audits Apply local rules to an area of work For ionising and Non-Ionising radiation settings: review and discuss the procedural framework against legislative requirements Participate in or review the investigation of a radiation incident Review and participate in the exercise of a contingency plan All of these experiences should be recorded in your e-portfolio as reflective learning and discussions with your training officers. Requirements for Professional Practice are contextualised to ensure the application and assessment of broad descriptors contained within Good Scientific Practice.

34 KEY LEARNING OUTCOMES New Facilities COMPETENCES Undertake risk assessment for a radiation facility. Undertake room design from first principles for a diagnostic X-ray facility and surgical Laser facility Specify the design and control features for each of the facilities. In conjunction with the user develop the Local Rules procedures for the new facilities. KNOWLEDGE AND UNDERSTANDING Methods of risk assessment. Sources of and extent of hazards. Hazards and their significance Properties of the radiation source Methods of control of radiation levels in the facility Design constraints and how to meet them by calculation and prediction Shielding materials and construction Safety mechanisms and warning systems Planning and design for radiation safety Routine work undertaken within the facility Application of relevant requirements of IRR1999 and CAORaW Factors influencing safe use of the intended radiation sources and their relative significance

35 KEY LEARNING OUTCOMES Facility Safety Assessment COMPETENCES Describe the radiation characteristics of the equipment within the facility. Compare the design features and control systems of a facility with the specified design KNOWLEDGE AND UNDERSTANDING Characteristics of the radiation source Radiation intensity Interpretation of design specification documents Practical assessment of physical design features and control systems Obtain measurements required and the safety features to be tested as part of the critical examination Measurement of radiation levels and characteristics Functional testing of control features and their failure modes Compare the results of the critical examination with relevant legislation, standards and guidance. Report findings of the critical examination and make recommendations for improvements. Apply legislation and guidance relevant to new facilities Interpretation of compliance with legislation and guidance Reasonable foreseeable incidents and their likelihood Confirm acceptability of radiation levels within the defined area or distance from the source. Confirm that warning devices, interlocks and safety cut-off mechanisms are fully operational. Design constraints and controlled area definitions Methods of exposure control and their effectiveness

36 KEY LEARNING OUTCOMES Radiation Safety Audits COMPETENCES Assess audit reports, actions plans and outcomes against legislative requirements. Prepare and apply an audit based on legislative requirements Participate in an audit of an area where radiation is used. Undertake a simple audit according to local standard operating procedures. Report findings; specify degree of compliance, recommendations for further action and date of follow up review. KNOWLEDGE AND UNDERSTANDING The role of audit in assuring compliance with requirements for radiation safety Objective assessment of legislative requirements The role of service documentation in compliance with radiation safety Analysis of compliance and interpretation of legislation Reporting of findings commensurate with the intended audience Principles of assurance and continuous improvement

37 KEY LEARNING OUTCOMES Optimisation COMPETENCES Plan measurements to assess patient dose quality on a plain X-ray or fluoroscopy room. Undertake measurements to assess patient dose in a plain X-ray or fluoroscopy room. KNOWLEDGE AND UNDERSTANDING Current practices within the service involving the use of radiation Means of measuring, calculating and estimating representative doses to patients The relevant dose quantities Patient factors affecting dose Link between radiation doses and diagnostic outcomes Limitations of measurement devices used Review the outcome of image quality and patient dose measurements and recommend optimisation strategies. The influence of dose on image quality and options for clinical assessment Acceptable range of doses to patients Factors affecting radiation doses received by a range of patient groups The requirements of the relevant radiation legislation or guidance Current developments relating to reduction of dose/exposure