A virtual radiation therapy workflow training simulation

AimSimulation forms an increasingly vital component of clinical skills development in a wide range of professional disciplines. Simulation of clinical techniques and equipment is designed to better prepare students for placement by providing an opportunity to learn technical skills in a “safe” academic environment. In radiotherapy training over the last decade or so this has predominantly comprised treatment planning software and small ancillary equipment such as mould room apparatus. Recent virtual reality developments have dramatically changed this approach. Innovative new simulation applications and file processing and interrogation software have helped to fill in the gaps to provide a streamlined virtual workflow solution. This paper outlines the innovations that have enabled this, along with an evaluation of the impact on students and educators.MethodVirtual reality software and workflow applications have been developed to enable the following steps of radiation therapy to be simulated in an academic environment: CT scanning using a 3D virtual CT scanner simulation; batch CT duplication; treatment planning; 3D plan evaluation using a virtual linear accelerator; quantitative plan assessment, patient setup with lasers; and image guided radiotherapy software.ResultsEvaluation of the impact of the virtual reality workflow system highlighted substantial time saving for academic staff as well as positive feedback from students relating to preparation for clinical placements. Students valued practice in the “safe” environment and the opportunity to understand the clinical workflow ahead of clinical department experience.ConclusionSimulation of most of the radiation therapy workflow and tasks is feasible using a raft of virtual reality simulation applications and supporting software. Benefits of this approach include time-saving, embedding of a case-study based approach, increased student confidence, and optimal use of the clinical environment. Ongoing work seeks to determine the impact of simulation on clinical skills.     

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

IntroductionThe 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.MethodsA 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.ResultsParticipants 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.ConclusionUndertaking the clinical reasoning module successfully increased students’ confidence and provided opportunities to develop appropriate communication skills for placement.Implications for practiceIncreased levels of confidence and positive reinforcement from RTTs should positively impact students’ knowledge and skills, and provide introspection for improvement for future placements.     

Clinical placement challenges associated with radiography education in a low-resource setting: A qualitative exploration of the Ethiopian landscape

IntroductionClinical placements (CP) are of paramount importance in the learning and the acquisition of key competencies in terms of knowledge, skill and professional attributes required for clinical radiography practice. This study explored the challenges faced by radiography students and educators in relation to clinical placement and training in Ethiopia.MethodsA qualitative approach using focus group discussion and interviews were used to explore the experiences of students and educators, respectively, pertaining to challenges encountered in relation to the clinical placement of students across four university affiliated hospitals. Data obtained was analysed using a structured three step framework and the coding approach employed in a thematic analysis.ResultsParticipants comprise of third- and fourth-year undergraduate radiography students (n = 14) and educators [academic faculty (n = 7) and clinical practice educators (n = 8)]. Four main themes were identified, which relate to deficiencies of an existing training curriculum and its implementation strategies, inadequate resource and infrastructure within the CP environments and absence of advanced training opportunities.ConclusionThis research showed that there are many and varied challenges encountered by both students and educators in relation to CP and training of radiography students in Ethiopia. These challenges could potentially affect the future performance of students/practitioners and/or the appropriate application of the core clinical radiography skills and competencies in the world of work.Implications for practiceClinical radiography training in resource-limited settings will require urgent attention and support with modern infrastructure including simulation to augment their clinical development to acceptable standards.     

Virtual reality versus conventional clinical role-play for radiographic positioning training: A students' perception study

IntroductionSimulated learning environments (SLEs) are commonly utilised by educational institutions. The aim of this study was to assess if students perceptions varied relating to the effectiveness of either a virtual reality (VR) simulation or traditional clinical role-play scenario in developing radiographic hand positioning skills.MethodsA split-cohort study was performed with Year 1 Undergraduate Radiography students (n = 76). Students were randomly assigned to undertake training for radiographic hand positioning tasks using either the CETSOL VR Clinic software (Group 1) or traditional clinical role-play (Group 2). Following completion of their positioning training, students’ perceived impact of the SLE on developing practical and technical skills were assessed using a 5-point Likert scale questionnaire and free text option.ResultsQuantitative student perception scores indicated no significant difference between the two simulation modalities, the mean agreement scores (combined strongly agree + agree) for Groups 1 and 2 were 74.8% and 83.8%, respectively, where χ2 (4, n = 66) = 9.5, p-value = 0.394. Key themes expressed by students following a thematic analysis were “engagement with the learning environment, positioning practice and comparability to clinical practice.ConclusionThe perceptions of novice students in training for radiographic hand positioning tasks, using either a VR SLE or clinical role-play scenario, did not differ. There was a strong similarity in common themes, however, a key point of difference identified was the benefit of repetition afforded by the VR simulation, in contrast to the need for more time using traditional role-play in a constrained laboratory setting.Implications for practiceThe lack of difference in student perceptions between VR and clinical role-play training, could offer a different approach to clinical training which is easily accessible and allows users to correct mistakes at their own pace.     

Adopting Review,Reflect and Re-focus [Triple R] sessions to support pre-registration therapeutic radiography students post clinical placement

IntroductionEducation and training strategies in Therapeutic Radiography are challenged in recruiting and retaining students in the profession. Clinical oncology centres are often viewed as stressful environments for students due to rapid advances in technology and reported bullying and harassment. Educators continue to work with clinical partners in developing strategies to promote resilience and reduce negative attitudes. The overall aim of this project was to explore the use of Triple R sessions as a new method of student reflection.MethodsThe Review, Reflect and Re-focus (Triple R) sessions were designed to enable students to learn from their clinical experiences and; apply their understanding and positivity when they return to clinical placement. Eleven sessions were completed across 7 student cohorts in one academic year. Qualitative data was collected from feedback forms, as well as academic field notes, and analysed thematically.ResultsTwo main themes focused on: (1) staff interactions and (2) student expectations. Results showed that Triple R sessions were helpful in drawing out the experiences of students in a positive way to reflect on their own development. The sessions enabled critical self-analysis and improved problem-solving skills, particularly evident during peer discussions.ConclusionTriple R sessions explored the influence of a positive approach on students' perceptions of their overall placement. Evaluation of the data indicated that, following academic and peer discussion, students' perceptions tended to be a more positive overall view of their placement.Implications for practiceTriple R sessions can be used in academic and clinical environments to enable positive student interactions.     

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

IntroductionRadiation 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.MethodsAn 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.ResultsFour 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.ConclusionThis 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 practiceWhile 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.     

Radiographers' and students' experiences of undergraduate radiotherapy practice placement in the United Kingdom

IntroductionA three-phased, mixed-methods study was conducted to explore the experiences of undergraduate radiotherapy students and their supervising practice educators within U.K. radiotherapy practice placement.MethodsQualitative data were gathered from focus groups/interviews with volunteer participants to elicit in-depth perceptions about experiences of practice placement. Data were transcribed, verbatim, and manually coded and analysed by the researcher using the applied research methodology of framework analysis, enabling the investigation of the a priori theme ‘practice placement model’, and recommendations were made for improvement.ResultsTwo radiotherapy placement models are confirmed, i.e. the single student model, and the paired student model, and advantages and disadvantages are identified for each. Study findings suggest that neither radiotherapy model is superior to the other in terms of placement education and experience. Previous and current experience of either model appears to bias students and practice educators towards that model, despite recognition of its disadvantages.ConclusionThe experiences of students and practice educators using the radiotherapy models are consistent with the experiences of other AHPs and nursing using similar practice placement models. It is recommended that all students should have access to peer-assisted learning on placement to improve critical thinking skills, to enable time for reflection, and to consolidate learning.     

First year student radiographers’ perceptions of a one-week simulation-based education package designed to increase clinical placement capacity

IntroductionThe radiography workforce is short-staffed and under increasing pressure to meet service pressures. Combined with the impact of Covid-19, where student face-to-face clinical time was abruptly halted for safety, there is cause to change the pedagogical approach to teaching diagnostic radiography to students, increasing capacity and ensuring the continuance of qualifying radiographers to support the profession. This paper shares the perceptions of first year student radiographers on a one-week simulation-based education package designed to replace one week of clinical placement experience.MethodsTwo cohorts of first-year radiography students engaged in a one-week simulation-based education package. Simulations increased in complexity throughout the week and included conventional imaging techniques, mobile and theatre radiography, and cross-sectional imaging. Thirty-six students consented to the thematic analysis of their reflective blogs.ResultsFive themes emerged from the data: feeling anxious, understanding and skill development, building confidence, communication, and patient-centred care.ConclusionThe simulation package had a positive impact on students learning, no matter the stage at which it was incorporated into their clinical placement block. Students engaged well with the activities and saw value in the experience. The findings indicate that the simulation-based education package is a suitable replacement for one week of clinical placement, supporting skills development in students and providing increased placement capacity.Implications for practiceA successful, engaging simulation-based education package is presented, which first year student radiographers perceived as a suitable replacement for one-week of clinical placement. Further research into the acceptability of use of simulation-based education packages in second- and third-year student radiographers would be a useful next step.     

Simulation for Teaching and Assessment of Nodule Perception on Chest Radiography in Nonradiology Health Care Trainees

PurposeSimulation has been used as an educational and assessment tool in several fields, generally involving training of physical skills. To date, simulation has found limited application in teaching and assessment of skills related to image perception and interpretation. The goal of this pilot study was to evaluate the feasibility of simulation as a tool for teaching and assessment of skills related to perception of nodules on chest radiography.MethodsThis study received an exemption from the institutional review board. Subjects consisted of nonradiology health care trainees. Subjects underwent training and assessment of pulmonary nodule identification skills on chest radiographs at simulated radiology workstations. Subject performance was quantified by changes in area under the localization receiver operating characteristic curve. At the conclusion of the study, all subjects were given a questionnaire with five questions comparing learning at a simulated workstation with training using conventional materials. Statistical significance for questionnaire responses was tested using the Wilcoxon signed rank test.ResultsSubjects demonstrated statistically significant improvement in nodule identification after training at a simulated radiology workstation (change in area under the curve, 0.1079; P = .015). Subjects indicated that training on simulated radiology workstations was preferable to conventional training methods for all questions; P values for all questions were less than .01.ConclusionsSimulation may be a useful tool for teaching and assessment of skills related to medical image perception and interpretation. Further study is needed to determine which skills and trainee populations may be most amenable to training and assessment using simulation.     

The Integration of Active Learning Teaching Strategies Into a Radiology Rotation for Medical Students Improves Radiological Interpretation Skills and Attitudes Toward Radiology

PurposeIn recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes toward radiology, as well as impact on departmental efficiency.MethodsThis was a prospective cohort study involving fourth year medical students completing a 1-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes toward radiology.ResultsA total of 105 students enrolled in the study. The mean postrotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% vs 62%; P < 0.001). The integrated rotation freed up 7 hours of radiologists’ time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology.ConclusionsThe integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' postrotation radiological competency and attitudes toward radiology.     

Students' perceptions of a near-peer Objective Structured Clinical Examination (OSCE) in medical imaging

IntroductionNear-peer learning, where peers from more senior year levels teach more junior peers is a popular teaching strategy in healthcare education. There is an emerging trend to utilise this teaching strategy in preparing students for Objective Structured Clinical Examinations (OSCEs) in the form of near-peer led formative OSCEs (NP-OSCE). However, there is little exploration of this teaching strategy in medical imaging education, nor how students perceive NP-OSCEs as beneficial to their learning. This study addresses this gap.MethodsUsing a students as partners inquiry approach, 47 near-peer learners' (NPLs) and 6 near-peer teachers' (NPTs) perceptions of participating in a NP-OSCE were examined using an anonymous self-report questionnaire.ResultsNPLs reported that participating in the immersive NP-OSCE helped their performance in the summative OSCE by helping with their preparedness; including understanding expectations, experiencing emotions and being able to identify gaps in their knowledge and skills, which they then used to direct their revision in a manner that demonstrated the development of skills in evaluative judgement. There were mixed findings regarding the impact the NP-OSCE had on NPLs' levels of anxiety. NPTs also found the NP-OSCE beneficial for identifying gaps in their own knowledge and skills, yet found taking on the role of an examiner challenging.ConclusionStudents perceive NP-OSCEs as a valuable learning activity that helps them prepare for their OSCEs by providing a student perspective of an authentic immersive learning experience. NP-OSCEs enable students to focus their revision and develop skills in evaluative judgement.Implications for practiceEducators should consider including NP-OSCEs in their medical imaging curriculum as students perceive it as a valuable learning experience that assists them to prepare for their OSCE.     

How do the attitudes of therapeutic radiographers affect students’ learning during practice placement?

IntroductionPractice placements are essential for radiotherapy students to learn and embed the necessary skills for practice; thus, each placement should afford an optimum learning experience. A key finding from the Phase 3 student arm of recent doctoral research suggests that for some students an optimum learning experience is not guaranteed. Using students' own words, this paper seeks to increase radiographers' awareness of how their behaviours can affect students’ placement learning, and aims to help improve the placement learning experience for both.MethodA three-phase, U.K.-wide, mixed methods study was conducted. In the Phase 3 student arm, qualitative data were gathered via focus groups/interviews from volunteer student radiographers. Data were transcribed, manually coded, and analysed thematically by the Researcher using the applied research methodology Framework Analysis.ResultsThe analysed data were complimentary to radiographers, overall, but common themes were identified criticising certain of their attitudes and behaviours. Students exhibited fragility in response to perceived negative attitudes and behaviours, and failed to develop resilience in response to further similar experiences. This had a negative effect on their placement learning. Positive attitudes from radiographers enhanced students’ placement learning. The placement experiences of radiotherapy students are consistent with those of other AHP and nursing students identified in the literature.ConclusionIncreasing radiographers' awareness of the negative and positive effects of their behaviours and attitudes will help improve students' placement learning experience. Students’ resilience may be improved by teaching them coping strategies to use on placement.Implications for practiceThe retention of radiotherapy students is an urgent concern for the radiotherapy profession therefore it is important to take steps to improve it. Enhancing students’ placement experience may contribute to increased retention.     

The meaning of critical thinking in diagnostic radiography

IntroductionThe development and application of critical thinking skills is a requirement and expectation of higher education and clinical radiographic practice. There is a multitude of generic definitions of critical thinking, however, little is understood about what critical thinking means or how it develops through a course. Diagnostic radiography students struggle with demonstrating this skill to the desired expectation, and, in higher education it is assumed that students have an implicit understanding of what is required in relation to this expectation. This study explores radiography students’ understanding and perceptions of the meaning of critical thinking in diagnostic radiography.MethodsThe research framework sits within the interpretive paradigm and was designed as a longitudinal study conducted over a three-year study period. Semi-structured face-to-face interviews were employed as the means of gathering context-rich information from diagnostic radiography students (n = 13) who were purposively selected to participate in the study.FindingsThree themes were constructed following the analysis and interpretation of the interview data. The themes were logical thinking involving analysis and evaluation, the process of decision-making, and reflection and metacognition.ConclusionAs participants progressed from year one to year three, they recognised that critical thinking comprised not only of cognitive skills but affective skills too. They attributed their developing understanding of the meaning of critical thinking to clinical placement learning, understanding written feedback, and the expectations of professional practice. Based on these findings a definition of critical thinking applicable to diagnostic radiography was developed.Implications for radiography education and practiceUnderstanding the meaning of critical thinking in relation to academic requirements and clinical placement learning is essential for diagnostic radiography students if they are to succeed in both settings.     

A qualitative analysis of radiography students' reflective essays regarding their experience of clinical placement during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic significantly impacted healthcare services and clinical placement for healthcare students. There is a paucity of qualitative research into radiography students’ experiences of clinical placement during the pandemic.MethodStudents in stages three and four of a 4-year BSc Radiography degree in Ireland wrote reflective essays regarding their experience of clinical placement during the COVID-19 healthcare crisis. Permission was granted by 108 radiography students and recent graduates for their reflections to be analysed as part of this study. A thematic approach to data analysis was used, allowing themes to emerge from the reflective essays. Two researchers independently coded each reflective essay using the Braun and Clarke model.ResultsFour themes were highlighted; 1) Challenges associated with undertaking clinical placement during the pandemic, such as reduced patient throughput and PPE-related communication barriers; 2) Benefits of clinical placement during the pandemic, in terms of personal and professional development and completing degree requirements to graduate without delay; 3) Emotional impact and 4) Supporting students in clinical practice. Students recognised their resilience and felt proud of their contribution during this healthcare crisis but feared transmitting COVID-19 to family. Educational and emotional support provided by tutors, clinical staff and the university was deemed essential by students during this placement.ConclusionsDespite the pressure hospitals were under during the pandemic, students had positive clinical placement experiences and perceived these experiences to have contributed to their professional and personal growth.Implications for practiceThis study supports the argument for clinical placements to continue throughout healthcare crisis periods, albeit with additional learning and emotional support in place.Clinical placement experiences during the pandemic prompted a deep sense of pride amongst radiography students in their profession and contributed to the development of professional identity.