Lived experiences of first-year radiation therapy students communicating with patients and radiation therapists - A qualitative review using interpretative phenomenological analysis.

INTRODUCTION: Radiation therapists must possess adaptable communication skills to manage patient-centred care and provide required technical information. Adaptive communication is also an expectation of undergraduate students to gain registration in Australia. The University Of Newcastle's Clinical Reasoning Module (CRM) prepares first-year radiation therapy students for clinical interactions. This research aims to reveal the lived experience of students after completing their first clinical placement. METHODS: An interpretative phenomenological analysis (IPA) approach was the chosen methodology. Audio-recorded semi-structured interviews were conducted with first-year students who had completed the CRM and attended their first placement. Two independent reviewers analysed each data set separately before discussing and agreeing on, and arranging themes into clusters to reveal substantive and sub-themes. RESULTS: Four students were interviewed. Five substantive themes were revealed; 'making sense of the CRM', 'the inner self',' the art of communication', 'the student as a learner' and 'clinical work'. Students' varied clinical experiences were evident, and the interviews allowed a de-brief mechanism. Students related the CRM to the clinical environment and revealed unexpected reactions and emotional responses during their placement. Examples include disclosing the reluctance of patients to interact and talking about dying, which became their new normal. CONCLUSION: This review allowed an opportunity to inquire into the lived experiences of radiation therapy students navigating their way through the clinical environment. Differences between student's emotional intelligence and level of communication reflected their ability to make sense of their experiences in the clinical setting. IMPLICATIONS FOR PRACTICE: While students appeared satisfied with the CRM in preparing them for clinical placement, providing regular de-brief sessions and reviewing clinical practice guidelines to better prepare for psycho-social issues encountered is recommended for overall student well-being.

Effect of communication skills training on radiation therapy student's confidence and interactions during their first clinical placement.

INTRODUCTION: The University of Newcastle, Radiation Therapy degree (RT) includes a clinical reasoning module that provides students with the opportunity to learn and practice communication skills before their first clinical placement. This study investigates students' perceptions of how well the module prepared them for placement and explores students' perceptions of their communication experiences during placement. METHODS: A single survey was administered to students four months following placement (six months after delivery of module), and included a request for perceptions pre-module, post-module and pre and post placement via an online survey comprising 46 closed, Likert scale and open-response questions. Assessment of changes in student confidence, the value of preparation for placement and perceptions concerning interpersonal skills with patients and radiation therapists (RTTs) were examined. Survey data was analysed quantitatively (counts, Fisher's exact) assessing statistical differences in confidence and Weighted Sum Average (WSA) of Likert scales. Qualitative findings were supported by written comments. RESULTS: Participants reported increasing confidence levels between pre-module (WSA - 1.13), and post-module (2.88), which was statistically significant (p = 0.039) and between pre-placement (2.0) and after placement (3.38), in their ability to communicate with patients. Similar changes in confidence were noted with interactions with RTTs (WSA scores 1.0, 2.13, 1.75, 3.25 resp). Students reported communication strategies prepared them well for patient interactions. Positive reinforcement from RTTs was acknowledged as creating immediate support of their current patient skills. CONCLUSION: Undertaking the clinical reasoning module successfully increased students' confidence and provided opportunities to develop appropriate communication skills for placement. IMPLICATIONS FOR PRACTICE: Increased levels of confidence and positive reinforcement from RTTs should positively impact students' knowledge and skills, and provide introspection for improvement for future placements.

Radiation therapist health literacy training: A qualitative study exploring perceived barriers and attitudes.

INTRODUCTION: Health literacy (HL) is a universal issue in healthcare. While difficult to assess an individual's HL status, the onus is on the health provider to empower patients to seek understanding of health information provided to them. Universal HL training techniques include implementing plain language and the teach-back method. The research aims to explore the perceptions of Australian radiation therapists (RTTs) learning and implementation of these tools with patients. METHODS: RTTs attended two communication and HL workshops one week apart. Participants completed three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) and a workshop evaluation was administered after the second workshop. Participants had the opportunity to provide written comments on all surveys and the evaluation form. A thematic analysis was performed on the written comments by two independent researchers. RESULTS: Five themes were revealed after the thematic analysis of the surveys. These themes were: improved patient understanding, impact on professional credibility, practice and timing of using methods, appearing to be condescending to educated patients and increased patient anxiety. The workshop evaluation assessment indicated the success of and improvement for future workshops and revealed seven themes. These were: learning from others, providing a safe environment to share experiences, to be open to learning new methods, more time for learning, role-play aversion, group sizing and thinking beyond the workshops. CONCLUSION: While strong evidence of using HL tools for improved patient understanding exists, this qualitative review revealed unexpected barriers with implementing both the plain language and teach-back method. IMPLICATIONS FOR PRACTICE: Barriers revealed during HL training could have patient flow on effects when checking for understanding. These challenges need further exploration, to inform all health professionals.

Radiation therapist health literacy training: Does learning alternate communication methods translate into improved confidence in patient interactions?

INTRODUCTION: Low health literacy can inhibit patients' understanding of radiation therapy (RT) procedures. An objective of this research was to develop training to educate Australian radiation therapists (RTTs) about tools that support low health literacy patients, namely plain language and the Teach Back method (TBM). Perceptions, clinical use of these tools and confidence levels (pre and post training) in occupational scenarios were evaluated. METHODS: RTTs attended two workshops one week apart. Three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) were completed. Quantitative analysis included weighted sum averages of confidence levels and chi-square analysis. RESULTS: At baseline, 56% of participants had heard of 'health literacy', 93% 'plain language', while 26% knew about TBM. Confidence levels increased after the workshops, with improvement of confidence demonstrating significance (p < 0.05) in 3/7 scenarios. The use of 'plain language' assessed on the third survey during every interaction was higher than that anticipated by participants on the second survey (46% vs 39%), while the TBM was utilised less (0% vs 23%). CONCLUSION: Radiation therapists' confidence and use of alternative tools to improve patient understanding improved after attending training. IMPLICATIONS FOR PRACTICE: Ongoing encouragement using alternate communication methods are recommended to assist with strengthening patient outcomes.

Communication: Preparing undergraduate radiation therapy students for initial clinical patient interactions.

INTRODUCTION: Radiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations. METHODS: The module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively. RESULTS: Four hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions. CONCLUSION: Overall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.

Implementation of an image-guided radiation therapy program: Lessons learnt and future challenges.

The aim of this paper is to detail the experience obtained in implementing an image-guided radiation therapy program at the Northern Sydney Cancer Centre. This required retrofitting a Varian Clinac 21EX with an on-board imager. The commissioning and quality assurance procedures, organisation of a multidisciplinary image guided radiation therapy group, and the development of clinical protocols for orthogonal kV and cone beam computed tomography implementation are described. Reassessment of the image-guided radiation therapy program has continued as new equipment and software versions were made available in the department.

An Australian model for professional standards.

This article describes the qualitative research methodologies used to develop entry-level standards documents for the four medical radiations science professions in Australia. This Australian model features a mix of complementary research tools to validate the range and level of the professional standards. In addition to methodology, this article also describes the beneficial role played by these standards and the possibility of using the development method in other countries.