RTT advanced practice and how it can change the future of radiotherapy.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

Overcoming uncertainty: A framework to guide the implementation of Australian radiation therapy advanced practitioners.

INTRODUCTION: The implementation of radiation therapy advanced practice in Australia has not yet been broadly realised. With anticipated growing demands on cancer services, it is imperative to understand why this is the case, and to strategise a way forward. As a result, we explored the factors influencing the implementation of advanced practitioner radiation therapists (APRT) in Australia. The research outcome was a complex process of Navigating Uncertainty, which described the contextual, social and personal factors surrounding implementation successes and challenges. Further synthesis of the findings was undertaken to highlight the fundamental features influencing this process, with the intention to provide a useful understanding for practitioners seeking APRT implementation. METHODS: Data were collected through national online focus groups and case studies with 53 participants. Analysis identified a constructivist grounded theory process of Navigating Uncertainty. Further analysis of the categories and properties of the process was undertaken to synthesise findings at a higher level of abstraction. RESULTS: Four overarching and intertwined factors were influencing the implementation of APRT. Uncertainty occurred when practitioners attempted to conceptualise and assimilate the new role into the workplace. Power was apparent in the advocacy and legitimisation of the APRT by centre leaders. Value was vital to achieving purposeful outcomes. Identity was evident in the personal transition of the APRT, and in the boundary work with others. CONCLUSION: Recognising and negotiating uncertainty, power, value and identity is essential for APRT implementation strategies to succeed. A framework to guide practitioners towards the implementation of APRT has been described that embodies these factors.

An Environmental Scan of Advanced Practice Radiation Therapy in the United States: A PESTEL Analysis.

PURPOSE: In 2021, the Advanced Practice Radiation Therapy Working Group (APRTWG) was established in the United States as a grassroots alliance of multidisciplinary radiation oncology professionals-radiation therapists, physicians, dosimetrists, and administrators-located across the country, interested in studying and establishing the Advanced Practice Radiation Therapist (APRT) level of practice in the United States. The APRT model has shown success in the United Kingdom, Canada, Australia, Singapore, and other countries, documenting the value of the APRT to the quality and advancement of clinical care. In the United States, the APRTWG seeks to coordinate activities, align resources, and drive the national agenda to collectively develop and define novel models of care using APRT in line with the evolving needs of patients and the radiation therapy profession. This environmental scan aims to examine the context of radiation oncology medical practice in the United States to inform pathways ahead for a proposed APRT model through a Political, Economic, Social, Technological, Environmental, and Legal (PESTEL) analysis. METHODS AND MATERIALS: A literature search was conducted to understand the chronological timeline of the development of APRT during the past 25 years. Items that included the activities, scope of practice, and implementation of APRT nationally and internationally were identified. Papers describing advanced practitioner roles that are commonly found in the multidisciplinary team in radiation oncology both in the United States and internationally, such as physician assistants and nurse practitioners, were excluded. RESULTS: Despite the environmental scan outcome, it is acknowledged that data collation and analysis was not as robust as that anticipated by undertaking a systematic review. Papers were identified by the lead author that aligned with each of the PESTEL factors. Defined broadly, a new care model can adjust how health services are delivered by incorporating best practices in patient care for a specific population, person, or patient cohort. As patients enter different stages of their disease, the purpose of a new model is to provide individuals with the right care, at the right time, by the right team, in the right place. It is clear that the opportunity for positive change and impact on the current state of practice in radiation oncology exists. CONCLUSION: The environmental scan findings demonstrate the complexities associated with implementing APRT in the United States, with multifactorial political, environmental, societal, technological, economic, and legal aspects to consider. The APRTWG will continue to lead and participate in such activities to demonstrate and identify APRT role opportunities in the United States and drive the nationwide implementation of the APRT level of practice in this country.

An intentional approach to the development and implementation of meaningful assessment in advanced radiation therapy practice curricula.

Creating meaningful assessment for advanced radiation therapy practice training programs is a challenge. This is because it requires a balance of formative and summative assessments, which meet the academic and professional needs of the practitioner, as well as the requirements of local service delivery, educational and professional standards. This paper discusses educational strategies and models used to integrate assessment into theoretical and clinical curricula, allowing practitioners to demonstrate higher order cognitive knowledge, advanced level clinical performance and attitudes/values associated with advanced practice. The discussion draws upon concepts of constructive alignment and programmatic approaches to assessment, which use Bloom's taxonomy, Benner's beginner to competent model of skill development, and Miller's pyramid of clinical competence. These models are analysed with respect to an advanced practice program in adaptive radiation therapy to provide context.

Navigating uncertainty: The implementation of Australian radiation therapy advanced practitioners.

Radiation therapy advanced practice has been implemented in several international jurisdictions; however, it is yet to be systematically integrated into Australian radiation oncology centres. This paper presents the outcomes of a doctoral research study to explore the factors that may be influencing the implementation of radiation therapy advanced practice in Australia. Using a constructivist grounded theory methodological approach to guide procedures, data collection occurred via 6 nationally facilitated online (video mediated) focus groups, and during interviews and observations at 5 purposively selected clinical case study locations. Data analysis led to the development of a grounded theory 'navigating uncertainty' to describe the process influencing the implementation of radiation therapy advanced practice in Australia. Navigating uncertainty is explained by three inter-related contextual processes of conceptualising radiation therapy advanced practice, integrating radiation therapy advanced practice, and becoming the radiation therapy advanced practitioner. The research suggests that the process of actively finding a way to accommodate uncertainty is necessary for advanced practice implementation objectives to be realised.

"Why have you done it that way?" Educator perceptions of student-initiated conversations about perceived deviations from evidence-based clinical practice.

Students on clinical placement may encounter practice that deviates from what they perceive to be evidence-based. However, queries by students about the evidence-base of their clinical educators decision-making and practice can be a challenging conversation to initiate. It is unclear how these conversations occur, and what impact engaging in these challenging conversations may have on practice, the learning experience, and the relationship with the educator. This study sought to explore clinical educators' experiences of student-initiated discussions that question the evidence-base of their clinical practice. And to identify their preferred approaches for students to initiate these conversations. Individual interviews were conducted with 23 clinical educators from five professions at three different hospitals in Victoria, Australia. Semi-structured interviewing techniques were employed to identify participants' context and experiences. Participants described student-initiated conversations about deviations from evidence-based practice as challenging encounters with potential for positive or negative impact on clinical educators, students and patients. They noted that the perceived appropriateness of the discussion could be influenced by the method utilised by students to initiate the conversation. Elements identified by clinical educators as barriers or enablers to support students to appropriately initiate conversations about clinical practice may be utilised by education and health providers to enhance opportunities for learning conversations to occur.

Using Online Meeting Software to Facilitate Geographically Dispersed Focus Groups for Health Workforce Research.

Focus groups as a data collection method in qualitative research have been used for several decades with great effect. Recent developments in online mechanisms for communication have prompted several researchers to explore alternate means of facilitating focus group participation. However, much of the online focus group literature has explored the use of text-based communication; there are few reports on the application of real-time online video-enabled software. In this article, we seek to inform the growing use of online-meeting software-mediated focus groups by reporting and analyzing its application within the context of a health workforce study among geographically dispersed radiation therapy professionals.

Use of Online Media for Professional Development Amongst Medical Radiation Practitioners in Australia and Canada.

Online media allows access to professional development (PD) regardless of geographical location and has the potential to provide equitable, immediate and quality PD. Online media includes online information and social media. The purpose of this mixed methods research study was to investigate the perceptions and use of online media for PD amongst medical radiation practitioners within Australia and Canada. An online survey was circulated to members of the Canadian Association of Medical Radiation Technologists (CAMRT) and the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT). The survey collected data within three domains: current use, satisfaction of use, and future use. A four point Likert scale was used for both satisfaction with the online platform and frequency of use. Two hundred and thirty-nine responses were collected. Results indicated that the online mechanisms most frequently used by respondents for PD were Google, self-directed learning, and intranet. A correlating degree of satisfaction was indicated with the use of these platforms. The least used online media for PD were social media platforms including health related blogs, LinkedIn, Twitter, health related and professional applications, Facebook, and online journal clubs. Online media is well suited to PD for medical radiation practitioners. The platforms that are preferred offer speed and ease of access regardless of geographical location or occupation. Whilst inherent risks and instances of unprofessional online behaviour are acknowledged, Australian and Canadian practitioners are keen to learn what social media PD opportunities exist. Findings indicate that radiation therapists are more receptive to explore new social media platforms and tools than are radiographers. There is an opportunity to incorporate formal PD for medical radiation practitioners within recognised social media platforms.