The lessons learned working in diagnostic and therapeutic radiography departments through the COVID-19 pandemic in Northern Ireland, UK. What can we do differently the next time?

INTRODUCTION: Following the emergence of the COVID-19 pandemic in January 2020, a radical restructure of NHS services occurred, prioritising the acute needs of infected patients. This included suspending routine procedures, leading to an inevitable resurgence in the future, placing increased demands on the NHS, including diagnostic and therapeutic radiographers. With radiography departments already experiencing staff shortages due to COVID-19 related illnesses and vulnerable staff shielding, there is a need to implement plans within radiography departments to ensure their sustainability in the future. METHODS: A mixed methods study was undertaken in Northern Ireland, involving distribution of a survey to diagnostic and therapeutic radiographers alongside conducting interviews with radiography department managers. RESULTS: 106 radiographers completed the survey, with 9 radiography managers and 2 band eight superintendents participating in interviews. Over 60% of participants felt that morale declined in their departments, with the majority feeling that the pandemic had a negative impact on their physical or mental health and wellbeing. Managers felt that to improve staff morale and motivation, incentives need to be offered including remuneration, flexible working and support for professional development. CONCLUSION: Whilst predicting when the next wave of a COVID-19 variant or the next pandemic will occur is impossible, preparation and planning will help manage the situation better. This requires identifying clinical areas for expansion/retraction and having access to additional staff to meet the demands on the service to ensure all patients receive care not just those acutely ill. IMPLICATIONS FOR PRACTICE: This study has identified key lessons learned from the pandemic within the radiography departments. This will enable preparation and strategic planning for future pandemics.

The impact of COVID-19 on the mental health of radiography staff and managers in Northern Ireland, UK: The radiography managers' perspective.

INTRODUCTION: Increasing evidence suggests that the COVID-19 pandemic has influenced the mental health of health professionals, including radiographers. Less is known about the effect of the pandemic on the mental health of radiography managers. Radiography managers have led their teams through the pandemic, making unpopular decisions to safeguard staff and patients. This study explores radiography managers' perceptions regarding the impact of the COVID-19 pandemic on the mental health of themselves and their staff. METHODS: Ethical approval was obtained from the NHS Research Ethics Committee (ID 287032). Eleven interviews were conducted with therapeutic and diagnostic radiography managers between March-April 2021. Written information was also included from a paediatric diagnostic radiography manager. Data was analysed independently by 2 researchers using thematic analysis. RESULTS: Three central themes emerged: 1) Factors perceived to have negatively influenced mental health, which included changing PPE guidance, restructuring of work conditions, social isolation, challenges to patient care and lack of quality vacation leave. 2) Factors perceived to have positively influenced mental health, which included witnessing staff resilience and team camaraderie. 3) Support provided for mental health. CONCLUSION: Managers felt that they had implemented appropriate strategies to support their staff throughout the first year of the pandemic and expressed feeling responsible for the wellbeing of their staff. Strong empathy was evident towards staff and their experiences. Despite the availability of mental health support services, managers felt that resources were underutilised by radiography teams. IMPLICATIONS FOR PRACTICE: Managers should be proactive in communicating their appreciation for their staff in an era where remote working can add to disconnect between staff and management. Mental health support services should be promoted and continually reviewed, to ensure that appropriate support services are maintained.

A North American Collaboration Integrating Digital Pathology into Residency Curriculum: Steps towards Global Training in the Digital Age

Background: Digital pathology is emerging as a critical tool in daily practice as highlighted by the SARS-CoV-2 pandemic. Pathology residents must gain adequate exposure to this technology as they approach independent practice. In this feasibility study, Canadian residents worked remotely with a United States (US)-based laboratory to help them prepare for careers in the digital age. Design: As part of their Canadian-based genitourinary (GU) pathology rotation, three 3rd-year Anatomical Pathology residents engaged in longitudinal screening and drafting of reports for digitally scanned US-based prostate biopsy cases prepared by a US laboratory specializing in digital pathology technology. Each trainee screened routine US-based digital case work as part of their curriculum and had access to artificial intelligence (AI) diagnostic software (Figure 1) during their case analyses. Residents also completed a digital pre- and post-test to assess diagnostic accuracy and time spent per core. Neither AI nor immunostains were permitted during the pre- and post-test sessions. Diagnoses were considered correct when no major discrepancies existed between resident and approved report. Results: Residents each screened and reported 10 digital prostate biopsy cases in addition to routine GU workload (Table 1). The digital pathology software allowed trainees to annotate specific histologic features and leave notes as required which could be subsequently reviewed remotely by supervisors. Feedback was provided by three anatomical pathologists, one practicing at the residents' home institution and the other two practicing at the US-based laboratory. Sign out session format varied but included video meetings with screen sharing, text messaging, phone calls, and/or email messages. Residents scored 76.67% (SD 5.7%) on the pre-test and 96.67% (SD 5.7%) on the post-test with respect to diagnostic accuracy;the average time per core decreased over the course of the rotation (Table 1). Conclusions: In this feasibility study, Canadian residents used a US-based digital pathology platform to remotely preview routine prostate biopsy casework. The residents gained exposure to digital pathology technology, including AI. Over the course of their rotations, all residents improved. These findings provide a framework for future global pathology education outreach.

Impact of COVID-19 on service delivery in radiology and radiotherapy.

INTRODUCTION: The COVID-19 pandemic has had a profound impact on radiography services globally. The reshaping of service delivery continues to impact patient management and the experience of the radiography workforce should be evaluated to determine how effective service delivery can be maintained in the ongoing and post-pandemic world. METHODS: A mixed methods approach was adopted. Questionnaires, designed using Qualtrics (Qualtrics, Provo, UT) online survey software, were used to survey radiographers throughout Northern Ireland (NI). Semi-structured interviews were conducted with radiography service managers in the NHS and private sector in NI. All interviews were digitally recorded, transcribed and coded independently by 2 researchers. RESULTS: A total of 106 Radiographers completed the online survey i.e. 82 Diagnostic and 24 Therapeutic. Variations were reported regarding staff concern for contracting COVID-19 and passing it on. Clinical workload was reported to fluctuate during the early period of the pandemic, however, both diagnostic and therapeutic radiographers reported workloads which were higher than normal at the time of the data collection. Nine service managers participated in the interviews plus two band 8 superintendent radiographers. Staff faced many challenges whilst delivering services due to COVID-19. The two most frequently cited challenges included issues related to (i) Implementation of PPE and (ii) Changes to work practices. CONCLUSION: A pre-prepared pandemic plan should be established and stress tested for the future. The plan should be devised in consultation with both the public and private sector to determine the very best use of resources. IMPLICATIONS FOR PRACTICE: The radiography workforce has worked continuously throughout the pandemic and needs to be supported to deal with the potential increase in demand for services in the post-pandemic world.

A narrative review exploring the professional practice training requirement of therapeutic radiographers undertaking effective remote/telephone review clinics in place of face-to-face radiographer-led review clinics during the COVID-19 pandemic

Background and purpose: The COVID-19 pandemic has led to the introduction of alternative on-treatment and post-treatment radiographer-led review clinics in an attempt to protect patients, staff and the public. Pre-COVID, patient reviews were routinely undertaken face-to-face, led by therapeutic review radiographers with advanced practice qualifications and skills in radiotherapy symptom management, triage, referral and support services. During the COVID-19 pandemic, an alternative option has been to follow-up in the form of telephone reviews to reduce face-to-face exposure whilst continuing to manage patient radiotherapy treatment-related toxicities. The aim of the narrative review is to explore the subject of telephone reviews and how therapeutic review radiographers might need to adapt communication skills so that they can continue to effectively assess and manage radiotherapy patient treatment reactions remotely. Method and discussion: A narrative review was conducted using the SCOPUS database and 28 publications were included from 2013 to 2021. The review highlights a paucity of literature exploring specific telephone training for radiographers and other allied healthcare professionals. Experiences within medical and nursing programmes demonstrate that development and integration of training in this area is critical in preparing for patient interaction via telephone. Conclusion and implications for practice: Multiple teaching modalities including simulation are ideal for teaching telephone-specific skills and content, demonstrating improvement in student knowledge, competence and confidence. Less is known regarding whether this knowledge translates to an improved patient experience. Enhancements in education and training, guided by the Health and Care Professions Council, may be warranted to ensure that patients continue to receive the optimal quality of care in a world where remote reviews are likely to become commonplace. Patient-reported outcome measures might be utilized for future training evaluations to ensure that effective patient care is being maintained.