Review of the Professional Development Year

Transcription

1 2009 Review of the Professional Development Year A Discussion Paper National Professional Development Programme Review Australian Institute of Radiography February 2009

2 Acknowledgement The contributions of the medical imaging and radiation therapy professionals who have provided their perspectives and opinions during the initial stages of the National Professional Development Programme Review are gratefully acknowledged. Contact information Enquiries concerning this report and its reproduction should be directed to: National Profession Development Programme Review Australian Institute of Radiography PO Box 1169 Collingwood Vic 3066 Telephone: Internet: Disclaimer The material in this document is provided in good faith to assist in promoting professional discussion. Some of the source material relies upon information collated and provided by third party entities and the Australian Institute of Radiography cannot warrant that this information is current, correct or free from error. 2

3 Table of Contents Acknowledgement... 2 Contact information... 2 Disclaimer... 2 Glossary Background Purpose of this Discussion Paper Typical key milestones of the PDY Purpose of the PDY Postgraduate supervised practice: current practice... 9 Medical radiations professions... 9 Australian allied health professions Duration of the PDY Professional clinical experiences during the PDY Assessment during the PDY Moderation of the PDY assessment Supervision of the PDY and requirements for clinical centres Administration Expectations for the Graduate Practitioner Submissions and discussion forums Submissions Discussion forums Discussion questions References

4 Glossary Accredited Programme An accredited programme is an academic programme which has been reviewed and accepted by the PAEB and has met certain requirements as defined by the profession within the Educational Policies (2005) of the AIR. Accredited Practitioner An Accredited Practitioner is a graduate practitioner who has achieved a level of competence commensurate with the Competency Based Standards for the Accredited Practitioner (2005) to enable them to accept the responsibilities of practicing independently and be capable of performing the expected role of a practitioner in a sole practitioner situation. An accredited practitioner has either successfully completed the PDY/IMP and received the Validated Statement of Accreditation, graduated from an AIR accredited programme which satisfies the requirement for the issuing of a Validated Statement of Accreditation, or in the case of an overseas qualified practitioner, has been assessed by the AIR as being equivalent to an AIR accredited practitioner. Graduate Practitioner A Graduate Practitioner is a graduate from an AIR accredited Medical Radiation Science programme whom, upon completion of such a programme, would receive the Provisional Statement of Accreditation of the AIR. The graduate practitioner is required to successfully complete the Professional Development Year (PDY) / Intern Model Programme (IMP) of the AIR to gain recognition as an accredited practitioner. Medical Radiation Science (MRS) Medical Radiation Science is the collective term that includes the practice of Nuclear Medicine Technology, Radiation Therapy, Radiography/Medical Imaging and Sonography. For the purposes of this document the term MRS shall only include Radiation Therapy and Radiography. Radiation Therapist (RT) Radiation Therapists are health care professionals primarily concerned with the design and implementation of radiation treatment and issues of care and wellbeing of people diagnosed with cancer and other conditions. The name Radiation Therapist used within this document refers to those professionals that may have been referred to in the past both within Australia and internationally, as Therapeutic Radiographer, Radiation Therapy Technologist, Medical Radiation Science Professional, and Therapy Radiographer. Radiographer (R) Radiographers are health care professionals who provide and interpret a range of medical imaging examinations for diagnosis and management of medical conditions. Radiographers are responsible for optimising diagnostic quality whilst maintaining radiation safety. The name Radiographer used within this document refers to those professionals that may be called within Australia and internationally, Radiographer, Diagnostic Radiographer, Medical Imaging Technologist, Medical Radiation Science Professional and Medical Imaging Scientist. 4

5 1. Background In 1986 RMIT introduced the first Australian degree-level radiation therapy and medical imaging programmes. Other universities followed suit over the subsequent decade and by 1995 the Australian Institute of Radiography (AIR) required that all medical imaging and radiation therapy programmes in Australia must be at the level of Bachelor degree. The higher academic requirements associated with the degree-level programmes made it impossible for students to complete the minimum 2600 hours of clinical practice required by the AIR to attain a Statement of Accreditation (1). At the AIR Annual General Meeting of 1991 it was determined that graduates of Australian radiation therapy and medical imaging programmes, so as to supplement their academic credentials for the practice environment, would be required to complete a period of supervised postgraduate professional practice in order to be considered eligible for a Statement of Accreditation (2). This period of supervised practice was developed into the Professional Development Year (PDY) and was implemented for graduates in The PDY aims to develop clinical proficiency in new graduates by providing mediated entry to practice (3). Graduates of accredited Australian programmes undertake the PDY as 48 fulltime equivalent weeks of professional clinical practice. During this time it is expected that graduate practitioners will perform a range of clinical procedures. Appropriate clinical professionals provide supervision as the graduate practitioner progresses toward independent practice. Performance is evaluated at the mid- and end-points of the PDY. The Professional Accreditation & Education Board (PAEB) surveyed Australian radiographers and radiation therapists in 2001 to examine experiences relating to the PDY (4). The survey results indicated that there was a degree of confusion and dissatisfaction with the PDY programme. Options and recommendations for eligibility requirements for the Validated Statement of Accreditation (5) and the future of the PDY programme (6) were prepared by the PAEB in 2006 and 2007 respectively. Following an external review of these options and recommendations in 2008 (7), the Board of Directors (BoD) of the AIR has implemented the National Professional Development Programme Review. 5

6 2. Purpose of this Discussion Paper This Discussion Paper aims to review the PDY programme as it is implemented at a national level. The requirements for the graduate practitioner, the supervisor, clinical centres and those currently responsible for administration of the PDY programme are reviewed. Redevelopment of the PDY programme requires careful consideration of many factors including structure, experiences, supervision, administration, assessment and quality assurance. These factors must be considered in the Australian context where the programme must effectively cater for both radiation therapy and medical imaging professions, for private and public sectors, for urban, rural and remote locations, and for diverse regulatory environments. Administrative efficiency and cost efficiency are relevant considerations. Relevant stakeholders may include, but are not limited to, medical imaging and radiation therapy professionals, academic professionals, providers of educational programmes, employers, regulatory authorities, Commonwealth and State Government, consumers, industrial organisations, medical imaging and radiation therapy students, other health professionals and their professional associations. The perspectives and opinions of members of the Australian Institute of Radiography are particularly valuable. The relative merits of options for a new or revised professional development programme must be considered and debated. It is important to identify what might facilitate successful implementation and what may be obstructive. This Paper poses a number of questions to ascertain this information and to assist in understanding the needs of all stakeholders. The questions in this Paper will form the basis of discussion forums in 2009 to further explore perspectives and opinions. 6

7 3. Typical key milestones lestones of the PDY PA E B m a n a g e s P DY p r o g r a m m e State PAEC co-ordinates ordinates clinical centre accreditation for the PDY Employers determine capacity to host graduate practitioners undertaking the PDY and advertise positions Students apply for PDY positions and employers complete selection G r a d u a t e p r a c t i t i o n e r r e c e ive s P r o v i s i o n a l S t a t e m e n t o f Accreditation G r a d u a t e p r a c t i t i o n e r c o m m e n c e s P DY I n t e r i m a s s e s s m e n t r e p o r t c o m p l e t e d ( 2 4 f u l l t i m e e q u iv a l e n t weeks completed) Fina l a ssessment rep ort comp l eted ( 48 f u l l t ime equ iva l ent weeks completed) F i n a l a s s e s s m e n t r e p o r t r e v i e w e d b y S t a t e PA E C a n d a r e c o m m e n d a t i o n m a d e r e g a r d i n g e l i g i b i l i t y f o r a Va l i d a t e d Statement of Accreditation 7

8 4. Purpose of the PDY The PDY is described by the AIR as a mediated entry to the profession, allowing the development of clinical proficiency based on skills and knowledge acquired during the undergraduate program (3). At the time the PDY programme was initially developed, this mediated entry was considered necessary due primarily to the reduction in clinical practice experienced by graduates of degree-level programmes compared with diploma-level graduates (5, 6). Mediated entry is one component of occupational induction and professional socialisation, allowing the beginner to progress from simple to more demanding tasks, and from lesser to greater responsibility, under the supervision of recognised others (8). The AIR Educational Policies (2005) suggest that mediated entry incorporates gradual introduction of clinical experiences, performance assessment and supervision (3). The PDY is predicated on the idea that the graduate practitioner requires the guidance of more experienced practitioners during the first year of professional practice following graduation. The structure and context of the PDY is intended to ensure that the graduate practitioner develops the necessary confidence, skills and understanding of the Accredited Practitioner role (3). Additionally, the PDY programme aims to prevent graduate practitioners from being placed in sole practice situations (3). Such situations are not considered as an appropriate learning environment that supports beginning practitioners in developing skills and competencies (3). Discussion questions 1. How effectively does the current PDY programme meet the purposes of mediated entry to the profession and protection of graduate practitioners from sole practice situations? 2. From the perspective of the profession, what should be the explicit purpose of the PDY programme? 3. From the perspective of the graduate practitioner, what should be the explicit purpose of the PDY programme? 8

9 5. Postgraduate supervised practice: current practice In reviewing the PDY, it would be remiss to neglect consideration of the manner in which others manage the initial period of postgraduate professional practice. Valuable insight can be gleaned from programmes in Australia and internationally, for medical radiation sciences and for other non-medicine health professions. Medical radiations professions Depending on the Australian State in which a graduate medical imaging or radiation therapy practitioner undertakes the first year of postgraduate professional practice, they may do so within the PDY programme, the Victorian Intern Model Programme (IMP) or the Queensland Supervised Practice Programme (SPP). The Victorian internship model predates the PDY programme, having been implemented to support the first degree-level graduate practitioners from RMIT in The very broad structures of the PDY, the IMP and the SPP are similar, being based upon 48 fulltime equivalent weeks of supervised professional practice. The IMP and the SPP provide, to a greater or lesser degree, explicit requirements for performance, assessment, supervision and range of clinical experiences (9-12). In the case of the SPP, graduate practitioners are required to participate in professional development activities such as in-service seminars and case study presentations (10, 11). On reviewing the practice of the professional associations for radiation therapy and medical imaging therapy in New Zealand, the UK, Japan, Hong Kong, Norway, Singapore, South Africa, Canada, Ireland and the United States, it is apparent that the Australian approach to managing the first year of postgraduate professional practice is unique. In these other countries, successful completion of an appropriately accredited or certified education programme leads to recognition with the professional association, except in the case of the United States and Canada where graduates must pass a certification examination (13-22). The UK College of Radiographers actively encourages, but does not require, preceptorship for new graduates, allowing structure, duration and format to be determined by individual workplaces or employers (23-25). The general intent of this style of preceptorship is to facilitate the development of independence and 9

10 confidence (25). While preceptorship may be employed as a mechanism or a requirement for entry-level practitioners to progress to a higher level or grading, it is not currently a requirement for recognition by the professional association. Australian allied health professions A recent publication by Services for Australian Rural and Remote Allied Health identified almost seventy professions that might be considered as allied health professions (26). To simplify the current discussion the following Australian professions have been considered: audiology, chiropractic, dentistry, dietetics, exercise physiology, medical physics, nursing, occupational therapy, optometry, orthoptics, orthotics, osteopathy, pharmacy, physiotherapy, podiatry, prosthetics, psychology, speech pathology and veterinary science. Figure 1 provides a summary of the manner in which these professions manage the immediate postgraduate professional practice of new graduates. A review of the practice of the peak professional associations for these professions indicates that only a small number include requirements for graduate practitioners to undertake postgraduate supervised practice (27-43). It is noted that some professional associations possess programmes that provide a pathway to accreditation Pharmacists and psychologists may be required to undertake a period of internship or supervised practice to obtain practitioner registration (37, 44-57), thereby providing eligibility for appropriate recognition by the relevant professional association (37, 40). For pharmacy, the supervised practice period is defined by the relevant State regulatory authority. There is variation between State programmes. In general, graduate pharmacy practitioners must demonstrate 1748 to 2500 hours of clinical practice experience over a minimum 48-week period (45-49, 56, 57). Additionally, postgraduate professional development requirements during this period may include written assignments, practical and online assessment, written examination, training courses, practical demonstration of competencies, participation in educational seminars or project work (45-49, 56, 57). Graduate psychologists may be required to undertake a two-year period of supervised practice where a graduate has undertaken a four-year academic programme rather than a six-year academic programme sequence. The structure, expectations, degree of supervision and assessment for the supervised practice period are determined in an 10

11 individualised plan for each graduate and is approved by the relevant State registration authority (44, 50-55). Dietitians have the option of undertaking the Accredited Practising Dietitian programme. The programme requires completion of continuing professional development requirements during a one-year period and evidence that the candidate had a mentoring partnership with an accredited dietitian during the initial six months (30). This programme does not appear to be designed specifically as a mechanism to manage the first year of postgraduate professional practice albeit that newly graduated dietitians would likely benefit from the programme requirements. Experienced dietitians with more than five years of professional experience in Australia may apply for accreditation without undertaking the formal programme (30). The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) provide medical physicists with the opportunity to undertake the Registrar Training, Education and Accreditation Program (TEAP) as a mechanism to attain accreditation as a medical physics specialist in either radiation oncology medical physics, radiological physics or nuclear medicine physics (58). This programme provides a pathway to the relevant specialty rather than explicitly managing the initial postgraduate professional practice of a medical physicist. The requirements for each discipline vary. The ACPSEM website indicates that the TEAP for Radiological Physics is in discussion with the Professional Standards Board (58). The requirements for radiation oncology medical physics generally take at least five years to complete and include completion of an ACPSEM accredited Master of Science in medical physics (or other approved postgraduate programme), relevant research and development activities, and a clinical training placement comprising a minimum of three years professional practice(58). With the exception of the medical radiations professions, audiology is the only profession where a period of postgraduate supervised practice is required for eligibility for full membership with the professional association. Graduate audiologists are required to complete a clinical internship of one year in order to attain full membership of the Audiological Society of Australia (27). The internship is designed as a practicum with well-defined supervision and structured reflection documented in a mandatory Supervision Diary. Supervision is defined to the point of mandating minimum amounts 11

12 of time where the supervisor provides at-elbow supervision, the proportion of work directly reviewed by the supervisor, and the points during the internship where these minimum requirements change to facilitate the graduate practitioner s progression toward independent practice. Other requirements of the internship include, variously, preparation of learning agreements, reflective writing and maintenance of a professional portfolio (27). 12

13 Figure 1: Management of immediate postgraduate practice - Australian allied health professions Health Profession Peak professional association Management of immediate postgraduate professional practice? Supervised practice requirement Other requirements during period of supervised practice? Audiology Audiological Society of Australia Inc Yes, as a requirement for full membership. Chiropractic Chiropractors' Association of Australia (National) Limited No Dentistry Australian Dental Association No Dietetics Dietitians Association of Australia No. Offers optional accreditation programme. Australian Association for Exercise and Exercise physiology Sports Science No 1 year Learning agreements, reflective writing, professional portfolio. Medical physics The Australasian College of Physical Scientists and Engineers in Medicine No. Offers accreditation programme for medical physics specialties. Nursing Royal College of Nursing Australia No Occupational Australian Association of Occupational No therapy Therapists Optometry Optometrists Association of Australia No Orthoptics Australian Orthotic & Prosthetic Association No Orthotics Australian Orthotic & Prosthetic Association No Osteopathy Australian Osteopathic Association No Pharmacy Pharmaceutical Society of Australia Yes, as a requirement for State registration. Physiotherapy Australian Physiotherapy Association No Podiatry Australasian Podiatry Council No Prosthetics Australian Orthotic & Prosthetic Association No Psychology The Australian Psychology Society Ltd Yes, as a requirement for State registration. Speech pathology Speech Pathology Australia No Variable to 2500 hours. 2 years, either as an individually approved programme or in conjunction with an approved postgraduate degree. Variable. May include written assignments, practical and online assessment, written examination, training courses, practical demonstration of competencies, participation in educational seminars or project work As individually agreed or as required for postgraduate programme. Veterinary science Australian Veterinary Association No

14 6. Duration of the PDY The PDY incorporates 48 fulltime equivalent weeks of professional clinical practice and must be completed within three years of graduation (3). The period of 48 weeks provides the graduate practitioner with the opportunity for leave while still allowing the PDY to be completed in a single year. It is unclear how it was determined that the period of supervised postgraduate practice should be one year, nor the rationale for stipulating three years as the nominated period for completion. Where the PDY is undertaken in a part-time capacity, there is no specified minimum requirement of working hours per week provided the programme is completed within the stipulated three-year timeframe. Anecdotally, it has been suggested that variation in local employment conditions results in considerable variation and inequity in the number of contact hours undertaken by graduates in the PDY programme. Examination of the debate about the relationship between hours of clinical practice experience and competence is beyond the scope of this Paper. It is, however, important to note that the stipulated 48 fulltime equivalent weeks may represent contact hours ranging from 1680 hours in the case of a 35-hour working week to 1824 where the national standard 38-hour working week applies. Options for the duration of the PDY programme include: All graduate practitioners required to complete 48 fulltime equivalent weeks, maintaining the status quo. All graduate practitioners required to complete a fixed period of supervised practice. Graduate practitioners required to undertake a period of supervised practice within a defined minimum and maximum limit of hours or weeks. All graduate practitioners must complete the minimum period. Subject to satisfactory assessment, graduate practitioners may subsequently complete the period of supervised practice at any time prior to the defined maximum limit. Graduate practitioners required to complete a period of supervised practice mutually agreed with their employer and approved by the AIR. Other option.

15 Discussion questions 4. Should all graduate practitioners be required to undertake a period of supervised practice of equal duration? 5. What should be the defined minimum period of supervised practice applicable for all graduate practitioners? 6. What are the advantages and disadvantages of nominating a one-year period for the PDY? 7. What are the advantages, disadvantages and risks of reducing the minimum period of supervised practice to less than one year? 8. What are the advantages, disadvantages and risks of increasing the minimum period of supervised practice to more than one year? 9. What are the advantages, disadvantages and risks of allowing for individualised or customised periods of supervised practice? 10. How appropriate and important is the current requirement to complete the PDY within three years of graduation? 15

16 7. Professional clinical experiences during the PDY During the PDY, graduate practitioners are expected to engage in a range of professional clinical experiences. The amount of experience in any specific area is not nominated except to indicate that rostered periods should facilitate the development of skills consistent with professional expectations for the accredited practitioner (3). The Educational Policies (2005) stipulate that the expected professional clinical experiences for medical imaging include radiographic examinations of the skeletal, alimentary, genitourinary and respiratory systems in a context where there is no medical urgency. Where such procedures are available, experience in common operative and ward-based procedures are desirable. The requirements for professional clinical experience are further expressed in the medical imaging PDY report document, which indicates that graduate practitioners must demonstrate ability in six of the following areas: radiography of the thoracic anatomy (including ribs), radiography of abdominal anatomy, radiography of the cranium/spinal column/pelvis, radiography of upper & lower limbs, fluoroscopic procedures, minor contrast procedures, theatre and mobile radiography, angiography, or computed tomography (59). The requirement for professional clinical experiences in radiation therapy includes a responsible role in simulation, planning, treatment, quality assurance & quality control, in routine radiation therapy procedures (3). This is further described in the radiation therapy PDY report document as ability in all of the following areas: interpret treatment prescriptions, simulation, planning procedures, 16

17 computer planning, treatment delivery, manufacture of treatment accessories, and quality assurance and quality control (60). There are a number of criticisms that might be levelled at these requirements for professional clinical experience. A number of the areas listed may continue to represent core routine procedures encountered by beginning medical imaging and radiation therapy practitioners, but it could be argued that contemporary practice dictates that other modalities or experiences should be included, or that some of those listed are increasingly obsolete. Further, the descriptors for the clinical experience areas are vague and, at times, highly subjective. Reference to CBS assists little in determining precisely what each experience should entail and the degree of engagement expected. It is unclear, for example, what precisely ability in computed tomography might entail: should this include all anatomical areas; should this incorporate procedures such as CT angiography; should all contrast procedures be included? An example from radiation therapy might be ability in computer planning : should this include all anatomical areas; should this incorporate a range of techniques from simple to complex; should procedures such as image fusion be included? Finally, these experiences focus on technical clinical experiences with no mention of other clinical experiences that contribute to professional practice, for example, participation in clinical research. Discussion questions 11. What clinical experience areas relevant to contemporary medical imaging practice should be included in the PDY programme? Which of these should be mandatory? 12. What clinical experience areas relevant to contemporary radiation therapy practice should be included in the PDY programme? Which of these should be mandatory? 17

18 13. What are the implications if mandatory elements are unavailable to a graduate practitioner at a particular clinical centre? How should this be managed and who should be responsible? 14. Other than technical elements of professional practice, what other clinical or professional experiences should be included in the PDY programme? 15. What representation would be appropriate in a working party formed to define professional clinical experience areas for medical imaging and radiation therapy? 18

19 8. Assessment during the PDY A large number of scholarly publications are dedicated to assessment, examining a very wide range of perspectives and aspects of assessment. Development of the assessment structure for the PDY should be informed by assessment perspectives that relate to assessment of learning and performance assessment. Assessment may have a wide range of purposes depending on, amongst other factors, the context and content. Some purposes of assessment include support of learning, certification, review of an individual, review of a programme, selection, motivation and diagnosis. The key point is that there is no single purpose of assessment. At least three categories of assessment purpose have been identified: assessment for judgement, assessment for decision and assessment for impact (61). Assessment for judgement relates to technical aims of assessment and is exemplified in the assignment of a grade to a particular piece of work. Assessment for decision relates to the use of assessment to facilitate a decision or action, for example the use of a PDY report to recommend that a graduate practitioner receives a Validated Statement of Accreditation. Assessment for impact relates to the intended or actual impacts of implementing the assessment process, for example the use of assessment to maintain motivation or to encourage debate. The purpose of assessment has implications for the assessment design. The PDY programme requires that an assessment report is completed at two points. The interim report is completed after 24 fulltime equivalent weeks and intends to provide an indication of the progress of the graduate and addresses possible areas where additional attention may be required (3). The final report is completed at the conclusion of the period of supervised practice. The final report is used by the State Professional Accreditation & Education Committee (PAEC) to determine whether a graduate practitioner should be recommended for the Validated Statement of Accreditation. The assessment reports applicable to the PDY are available at: Medical imaging Radiation therapy 19

20 Graduate practitioners undertaking the PDY are assessed by their supervisor in relation to their clinical skills abilities and their professional attributes. The clinical experience areas defined for each of medical imaging and radiation therapy are listed in section 7 of this Paper. The professional attributes are the same for both disciplines and include: Demonstrates a professional approach to patient care. Communication and interaction with patients and staff. Conforms to professional code of practice. Ability to work independently (59, 60). The PDY assessment report requires that clinical supervisors assign numerical ratings to the various assessment categories. These numerical ratings reference a qualitative evaluation descriptor and do not result in any type of overall grade or ranking except in the context that a report is deemed satisfactory or not. The PDY programme relies upon the judgment, fairness and integrity of the clinical supervisor to assign an evaluation rating for each relevant category. In the absence of clear guidelines and explicit detail, clinical supervisors must interpret the assessment category, determine relevant assessment criteria, measure the degree of performance against their expectations and assign an appropriate evaluation rating. It is likely that, for many, this is an intuitive rather than explicit process. The PDY programme assessment requirements have been criticised for numerous reasons (4-7, 62). Some of the key concerns are very briefly summarised in the remainder of this section. Competence is poorly defined in the PDY programme Notions of competence are complex. Traditional views of competence as the application of knowledge and skills to specific tasks in the workplace have been discredited and it is arguable that professional practice demands more contemporary, integrated conceptualisations of competence as complex combinations of skill, knowledge, attitudes, context, professional judgement, clinical reasoning, reflection, values and performance (7, 63-65). The way in which the AIR chooses to define competence is not detailed in either the Educational Policies (2005) or the CBS. The nature of these 20

21 documents and the PDY assessment reports suggest a reductionist approach to conceptualising competence, with primary focus on technical knowledge and ability. Clinical experience expectations lack clarity and are inadequate Notwithstanding the arguments for or against particular concepts of competence, the clinical experience expectations described in the Educational Policies (2005) might be considered to inadequately reflect the range of experiences available and necessary to contemporary professional clinical practice. Further, the clinical experiences identified are not described in detail and are open to individual interpretation. For example, what precisely is expected of ability in radiography of abdominal anatomy? What are the specific expectations for aspects of the radiographic procedure such as interpretation of the request, accuracy of positioning, appropriateness of exposure factors, interpretation and critique of images, consideration and determination of alternative techniques or safe practice? The vague categories for expected clinical experience areas and lack of description contributes to perceptions of variability in PDY experience and assessment (5-7). Professional attribute expectations lack clarity and are inadequate While defining the clinical experience expectations, the Educational Policies (2005) do not describe, except in a very brief reference, the professional attributes that are expected to be demonstrated by a graduate practitioner during or upon completion of the PDY programme. The CBS define aspects of professional practice relating to autonomy, accountability, collaboration, professional relationships, communication, patient advocacy, ethical practice, patient welfare, cultural sensitivity, empathy, research, lifelong learning, clinical management, and others. Despite this, the PDY assessment reports require evaluation of only a very limited number of these areas. Like the clinical experience expectations, the professional attributes are described in vague terms and are open to interpretation. Performance expectations are inadequately defined The vague nature of the clinical experience and professional attribute expectations is exacerbated by a lack of clarity about performance expectations. While it may be considered implicit, it is not stipulated in either the assessment reports or the 21

22 Educational Policies (2005) as to what is considered an acceptable or unacceptable report. Rather, it is simply indicated that satisfactory assessment is required for the recommendation for the Validated Statement of Accreditation. It might be presumed that graduate practitioners must achieve competent or satisfactory ratings in all required categories in order for their report to be considered satisfactory, but this is not explicit. This prompts consideration of what must be demonstrated, how frequently, in what manner and within what context in order that performance might be deemed as satisfactory. These aspects are not explicated in the Educational Policies (2005), nor do the CBS indicate how the defined CBS outcomes align with the PDY assessment method. As a result, expectations for performance are open to individual interpretation contributing to inconsistency (5-7). PDY assessment cycle is too infrequent The interim report is the only formally defined point at which a graduate practitioner receives feedback and performance evaluation prior to the completion of the PDY period. The Educational Policies (2005) do not require or recommend that supervisors provide more regular formal or informal guidance or feedback, despite the PDY programme being predicated on the graduate practitioner s need for mediated entry and guidance from more experienced medical radiations professionals. It has been argued that there is a need to provide feedback more frequently during the PDY period (7) to reinforce areas of strength and to act upon areas requiring development. Options for assessment in the PDY programme include (note that options are not necessarily mutually exclusive): Maintain the existing format of interim and final assessment reports with development of the assessment and performance criteria. Introduce additional assessment points so that assessment reports are completed every three months. Incorporate mechanism for regular feedback between assessment points. 22

23 Introduce assessment requirements other than clinical reports. Options might include, amongst others, assignments, online assessments, written or online examinations, case study presentations, paper presentations, postgraduate study, project work, professional portfolio or reflective writing. Other option Discussion questions 16. What purpose should be served by assessment of the PDY other than determining whether a graduate practitioner should be recommended for a Validated Statement of Accreditation? 17. What professional attributes should be evaluated or assessed? 18. Excepting assessment reports, what other elements should be included in assessment of the PDY? What are the advantages and disadvantages of including these elements? 19. How frequently should formal assessment occur during the PDY? 20. How frequently should formal feedback occur during the PDY? 21. What representation would be appropriate in a working party formed to define assessment requirements and tools for the PDY? Moderation of the PDY assessment Moderation can be employed as a process for accountability or as a formal or informal means to confirm that assessments for a particular individual or for groups are valid. Used effectively, moderation provides a degree of external control and consistency. Moderation may be used as a process for improvement, as a mechanism to assist assessors to develop the appropriate skills in assessment to allow them to make consistent and comparable assessment decisions over time. In this way, moderation provides an opportunity for professional development. 23

24 The need for moderation for the assessment of the PDY is somewhat contentious. If one considers assessment from the positivist perspective, it is conceived that objective assessment is possible and that there would exist a single, correct assessment result (66-69). The poststructuralist perspective views assessment as constructed within communities of practice and is, therefore, relative, provisional, subjective, contingent and variable (66, 69, 70), implying that there might be different assessment result in different contexts and circumstances. Of course, these are not the only theoretical approaches to assessment, but the positivist and poststructuralist perspectives are likely to represent two extremes across the range of perspectives as to the need or otherwise for moderation of assessment. PDY assessment does not result in a grading or rank. The assessment reports are employed to formulate a recommendation for or against eligibility for the Validated Statement of Accreditation. It has been suggested that moderation of the PDY is necessary (7) but perhaps this should be considered within the implementation of broader quality control and quality assurance measures for the programme. There is no established process for moderation of PDY assessments and in the absence of explicit detail about the assessment categories and performance expectations, it is difficult to conceptualise how moderation could be effectively employed. In reviewing the assessment process and tools for the PDY programme, it will be important to consider the role of moderation and, more generally, quality processes that support consistency and equity. 24

25 9. Supervision of the PDY and requirements for clinical centres The PDY may only be undertaken at a clinical centre accredited by the relevant State PAEC. To be eligible for accreditation, clinical centres must provide the range of experience such that the graduate practitioner will reach the level of accredited practitioner at the satisfactory completion of the PDY (3). Essentially, this means that radiation therapy facilities must provide, at a minimum, exposure to simulation, planning and treatment procedures. The precise nature of these procedures is not described: it is not defined, for example, whether graduate practitioners are expected to undertake experience in 2D or 3D planning or both, or whether simulation should include conventional or virtual simulation or some combination. Medical imaging centres must provide opportunities to undertake at least six of the nine procedures outlined as clinical experience areas, with no single experience area mandated. To be eligible for accreditation, clinical centres must meet a minimum staffing complement of one AIR accredited medical imaging practitioner or two AIR accredited radiation therapists per graduate practitioner (3). The intention of this minimum staffing ratio appears to be to ensure that graduate practitioners are not employed in sole practice situations or in situations where supervision is provided by medical radiations professionals without relevant professional accreditation. It has been contended that, in some circumstances, these minimum staffing requirements are inadequate to ensure that graduate practitioners are provided with adequate supervision (7). The AIR stipulates that an appropriate clinical supervisor is an individual who holds a Statement of Accreditation, or its equivalent, issued by the AIR and who conforms to the AIR Guidelines for Professional Conduct (3). Supervisors are expected to provide the graduate practitioner with supervision, guidance and mentoring (3). With the exception of the completion of the interim and final PDY assessment reports, there is no further explanation as to what the supervision, guidance or mentoring might entail. It has been suggested that the structure and quality of supervision varies significantly (6, 7). Immediate supervision is required until the mid-point of the PDY, after which time some aspects of professional practice may be undertaken with indirect supervision, accessible on-site, subject to the completion of an interim assessment report and approval from the graduate practitioner s employer (3). 25

26 Medical radiations professionals who supervise the PDY receive no formal training from the AIR to ensure consistency and equity (7). There is no expectation that supervisors will actively engage with graduate practitioners to assist them in integrating theory and practice (62) although it might be argued that this might be an implicit aspect of the aforementioned guidance and mentoring. Discussion questions 22. What should be the minimum staffing complement for an accredited clinical centre? 23. What factors other than supervision and range of clinical experiences should be considered for clinical centre accreditation? 24. How closely and in what manner should graduate practitioners be supervised and how should this change during the PDY? 25. What support do clinical supervisors require? 26. What training should be provided to clinical supervisors? Should this training be provided by the AIR? 27. Should the AIR implement a recognised supervisor programme? 26

27 10. Administration The PAEC in each State operates in the capacity of a subcommittee of the PAEB (3). Among other responsibilities, the PAEC implements and administers the PDY programme within the State of jurisdiction (3). At a practical level, this involves accreditation of clinical centres, verification of PDY reports, monitoring the PDY programme and acting appropriately in response to deviations and issues (3, 5, 6). Such responsibilities represent a significant workload, particularly where distances are great, where remoteness is a consideration, or where there are many graduate practitioners or accredited clinical centres. The PAEC in each State is composed of volunteer members who generously contribute to this professional service in their own time. In most States of Australia, the PAEC receives little or no support from the AIR to manage the workload (7). PAEC volunteers are not required to undertake, nor does the AIR provide, formal training or credentialing associated with the PDY programme or its administration (7). Administration of the PDY programme by the State PAEC provides advantages that include: Members of the State PAEC are likely to possess greater knowledge about the local context and practice environment. Members of the State PAEC are likely to have established or have stronger relationships with professionals at local clinical centres. Use of volunteers allows for cost-effective administration and minimises costs for graduate practitioners. Administration of the PDY programme by the State PAEC presents disadvantages that include: Dependence on volunteers is fraught as there is no guarantee of commitment, either in terms of continuity or the level of commitment each individual might be prepared to volunteer. The workload is large. This can prove overwhelming especially when the State PAEC comprises only a small number of volunteers. 27

28 Decentralised administration inevitably leads to variation and inconsistency. This is exacerbated by the absence of explicit, structured guidelines for the PDY and dedicated training in administration of the programme. Options for administration of the PDY programme include: Centralised administration of PDY reporting and clinical centre accreditation by the AIR Secretariat with reference to the BoD, PAEB or State PAEC by exception. Centralised administration of PDY reporting by the AIR Secretariat with reference to the BoD, PAEB or State PAEC by exception. Clinical centre accreditation managed by the State PAEC. Decentralised administration by the State PAEC. Other process. Discussion questions 28. What process should be adopted to administer the PDY programme? 29. What training or support is required by volunteers of the State PAEC? 30. Increased cost is likely to be associated with centralised administration. Who should bear this cost? 28

29 11. Expectations for the Graduate Practitioner The AIR defines an Accredited Practitioner as one who has:...achieved a level of competence to enable them to accept the responsibilities of practising independently and be capable of performing the expected role of a practitioner in a sole practitioner situation. An accredited practitioner has either successfully completed the PDY/IMP and received the Statement of Accreditation, graduated from an AIR accredited course which satisfies the requirement for the issuing of a Statement of Accreditation, or in the case of an overseas qualified practitioner who has been assessed by the AIR as being equivalent to an AIR accredited practitioner (3). The AIR has defined and detailed expectations for the accredited practitioner in the CBS. The CBS include standards relating to knowledge and understanding, critical thinking and evaluation, professional and ethical practice, care and clinical management, and lifelong learning (71). The AIR defines a Graduate Practitioner as: a graduate from an AIR accredited Medical Radiation Science course whom, upon completion of such course, would receive the Statement of Provisional Accreditation of the AIR. The graduate practitioner is required to successfully complete the Professional Development Year (PDY)/Intern Model Program (IMP) of the AIR to gain recognition as an accredited practitioner (3). There are currently no AIR defined competency based standards or similar for the graduate practitioner. No formal documentation of the profession s expectations for graduates abilities, attributes and understanding exist. Medical radiations professionals who design, develop or teach educational programmes must make educated judgments and determinations relevant for their own programme and context. This presents a challenge as, consequently, graduate practitioners exit university programmes with varying levels of knowledge, ability and experience. Undoubtedly, one would expect to see some variation among individual graduates for numerous reasons, but it does not seem unreasonable to expect that all graduates should possess defined core knowledge, skills and experiences as the result of successful completion of 29

30 an academic programme accredited by the professional body. Without clearly defined expectations for graduate knowledge, ability, attitudes and attributes, it is both possible and probable that some graduates may enter the PDY programme inadequately prepared to engage in professional clinical practice at the intended level. It has been noted that some clinical centres have extended their clinical education programmes, through choice or necessity, to become very structured extensions of the undergraduate program (6). Discussion questions 31. Is it necessary or desirable for the AIR to define the professional expectations for graduate practitioners? 32. What is the appropriate format for defining the expectations for graduate practitioners? What are the advantages and disadvantages of using the same format as for the Competency Based Standards for the Accredited Practitioner (2005)? 33. What representation would be appropriate in a working party formed to define the professional expectations for graduate practitioners? 30