Search

Lesbian, gay, bisexual, transgender, queer and two-spirit plus (LGBTQ2S+) people have distinct healthcare needs that may be unaddressed in many undergraduate healthcare curricula. The Radiation Therapy Program (RADTH) at the University of Alberta underwent a review of the three-year didactic curriculum using an online survey. The survey sought to ascertain if, where and how topics related to LGBTQ2S + healthcare are taught. Results indicated that out of 10 RADTH program faculty respondents, three teach related topics. The total time dedicated within the three-year curriculum was approximately three and a half hours. Other findings showed that faculty are interested in receiving more education in this area and would favour discussions about how to incorporate these themes into appropriate courses. This preliminary investigation demonstrated that there has been some initial work in this area, but there is more to be done.

The submission, revision and post-publication process is an often-underappreciated aspect of the manuscript writing journey. It can be quite challenging to navigate journal submission systems, understand the complexities of responding to reviewer feedback, and figuring out how to promote your work post-publication. Part one of this series discussed how to begin your research and write up the results for submission [1]. This second part highlights the rewards and challenges involved in the publication of your work.

Introduction Several studies have demonstrated the psychological impact of the COVID‐19 pandemic on health care providers. However, there is little known about how the COVID‐19 pandemic has impacted radiation therapists (RTs) in Norway or Canada. The aim of this investigation was to study the psychological impact of working during the COVID‐19 pandemic among RTs in Canada and Norway. Methods Online surveys were administered to a convenience sample of RTs and RT department managers. Approximately 2000 and 300 RTs were invited to participate from Canada and Norway, respectively. The RT survey collected information on demographics, work‐related stressors, psychological impact, quality of life, and workplace support programmes. The RT manager survey collected information on departmental changes, patient volumes, staff shortages and redeployment, personal protective equipment, and infection control measures. Descriptive analysis, group comparisons and logistic regression were used to examine the impact of COVID‐19 on RTs in the two countries, while open‐ended questions were examined through thematic analysis. Results Work‐related stress and anxiety were prevalent among Canadian (n = 155) and Norwegian RTs (n = 124), with Canadian RTs reporting higher levels. Fear of transmission, changes in PPE usage, and changes in staffing were reported as the most frequent work‐related stressors. Themes related to working during the pandemic included: generalised anxiety; physical, emotional and cognitive symptoms of stress; and loneliness, as well as negative impact on health and quality of relationships. Survey findings from RT department managers in Canada (n = 12) and Norway (n = 13) suggest that the pandemic had an organisational impact on RT departments due to implemented infection control measures and changes in staffing. Conclusion The COVID‐19 pandemic has led to similar stressors amongst Canadian and Norwegian RTs but relatively higher levels of psychological impact among Canadian RTs. Findings demonstrate the importance of mental health support programmes in the workplace to mitigate the psychological impact of the COVID‐19 pandemic on RTs., The overall aim of this investigation was to study the psychological impact of working during the COVID‐19 pandemic among RTs in Canada and Norway. Work‐related stress and anxiety were prevalent among Canadian and Norwegian RTs, with Canadian RTs reporting higher levels. Fear of transmission, changes in PPE usage, and changes in staffing were reported as the most frequent work‐related stressors. The findings suggest that the COVID‐19 pandemic has led to similar stressors amongst Canadian and Norwegian RTs but relatively higher levels of psychological impact among Canadian RTs.

Purpose The safe delivery of radiation therapy is dependent in part on the provision and organization of oncology professionals. General recommendations for staffing of radiation oncologists, medical physicists, and radiation therapists have been published, but most of these provide little detail, especially in the case of radiation therapists (RTs). In Canada, there are no guidelines or national standards for the staffing of RTs, and there is a paucity of Canadian data on the existing staffing levels of RTs and the models used to establish these levels. This project sought to identify and compare the staffing models used for Canadian RTs, and the staffing levels and workload resulting from these models. Methods and Materials In January 2016, a survey was sent to managers of the 46 radiation treatment centres in Canada. This survey sought information on a range of staffing and practice variables for the fiscal year 2014/2015. Respondents were requested to provide the staffing model used for RTs at each centre and enough additional information to calculate the staffing levels and workload resulting from their staffing model. The survey included further variables that had the potential to influence staffing levels and workload, and centres were compared to establish if these variables did indeed impact staffing. Results Of the 46 centres contacted, 37 centres responded, representing an 80.4% response rate. Survey results showed there are a variety of ways used to determine staffing across the country. Twenty of the 37 responding centres include some type of workload measurement in their staffing model, whereas 17 centres base staffing solely on historic levels or operating funds. There is a great deal of variation in the staffing levels and workload of RTs in Canada, with staff at some centres planning and treating twice the number of patients as RTs at other centres. Radiation therapist staffing levels at most radiation treatment centres in Canada are below the level recommended in recent publications. Differences in staffing levels or workload could not be accounted for by treatment complexity, number of specialty programs, use of relief staff, or number of RTs working in specialty nontreatment roles. Conclusions A high degree of variability in staffing levels and workload exists for RTs in Canada, which is not explained by differences in patterns of practice. It is likely that workload for RTs exceed safe levels at some Canadian centres. It is recommended that treatment centres use an up-to-date staffing model for RTs and continue to review staffing levels at regular intervals.

Writing and submitting a paper can be a daunting prospect, especially the first time. One of the more challenging aspects is knowing how to begin. Countless projects in the workplace never make it past local dissemination or conference presentation. This informal guide will help you take that next step and begin the peer-reviewed publication journey.

Purpose Radiation therapy has changed rapidly over the past decade due to the application of technological advances. A survey was conducted of radiation treatment centres in Canada to establish current patterns of practice across the country. Areas of inquiry included treatment techniques and image verification, as well as roles and responsibilities of radiation therapists (RTs). Methods and Materials In January 2016, a survey was sent to managers of the 46 radiation treatment centres in Canada. This survey sought information on a range of staffing and practice variables for the fiscal year 2014/2015. Results Of the 46 centres contacted, 37 centres responded, representing an 80.4% response rate. Survey results showed that the use of volumetric arc therapy and intensity-modulated radiation therapy is common across Canada for several anatomic sites, as well as the use of daily pretreatment image verification. A high degree of variability exists for imaging modality (two dimensional vs. three dimensional) for some sites, including brain, head and neck, and lung. RTs' responsibilities have expanded uniformly across the country, with RTs involved in organ-at-risk contouring and on-treatment image approval at the majority of centres. Despite this role expansion, specialty roles in areas of quality and applications expertise are still rare. Conclusions Radiation therapy in Canada has transitioned to high-technology treatment techniques with relative consistency across the country. There is, however, variation in the imaging modality used for daily verification. Canada may benefit from consensus guidelines on the application of three-dimensional imaging for treatment verification. While RTs have expanded their responsibilities, role definition for RTs working in supervisory or supporting positions has not kept pace at many centres and it is unclear if RTs are supported in their expanded accountabilities.

Introduction/Background Healthcare programs have proven the benefits of standardized patients in educational activities, but limited scholarship exists on the involvement of cancer survivors in radiation therapy education. This innovative approach to simulation-based education in radiation therapy is the first to integrate cancer survivors as standardized patients in a high-fidelity environment. This research aims to examine the impact of cancer survivors on the students’ learning during their simulation course. Methods This qualitative research used a phenomenological approach to gather data and analyze the students’ view of their interactions with cancer survivors in the simulation course. The researchers conducted three focus group discussions with five of the eight radiation therapy students using a set of preformulated questions. Results The collected data were comparatively analyzed, and the research team identified four main themes: experience, teaching/coaching, patient-centeredness and gratitude. These represented the students’ perspective on their experiences and the unique learning opportunities provided by the cancer survivors. Findings/Discussion The simulation activities with the cancer survivors provided a safe and realistic experience for the students. This research highlighted the influence of the cancer survivors’ oncology journey on the skills development of the radiation therapy students. Conclusion The students benefited from the authentic patient perspective of the cancer survivors which helped build their confidence and develop their skills prior to clinical placement. This research demonstrated that incorporating cancer survivors as standardized patients in radiation therapy simulation education has added significant value to the students’ learning.

Introduction Social media has emerged as a powerful platform for engagement and learning. There is a growing trend toward the use of social media among health care professionals and professional groups to disseminate and discuss knowledge. Twitter is one tool that may enhance continuing professional development (CPD) for the medical radiation technologist. To evaluate the potential benefits of Twitter to CPD among medical radiation technologists, this study explored the integration of Bloom's taxonomy with Twitter-based professional activities. Approach In 2015, the Medical Radiation Journal Club ( https://medradjclub.wordpress.com/ ) commenced a monthly Twitter-based journal club for medical radiation professionals. This study investigates the application of Bloom's taxonomy of the Twitter-based journal club for CPD purposes. Outcome The Twitter-based journal club provides a valuable platform for CPD. The combination of journal articles, supplementary reading, online blog, and the one-hour Twitter discussion engages all levels of Bloom's taxonomy; remember, understand, apply, analyze, evaluate, and create. A deeper insight revealed that the Twitter journal club provides an authentic learning environment suitable for CPD in which participants consume, collaborate, and produce. Conclusions This evaluation demonstrated that the Twitter journal club can provide an authentic learning environment with all the cognitive dimensions afforded in a formal classroom or face-to-face journal club. Indeed, in some ways, these cognitive dimensions are enhanced in the Twittersphere.

The term “patient experience” is currently ubiquitous in health care. Many facilities are striving to improve care by examining how patients interact with and view their organization and the health care professionals who work within it. Although there is a great deal of literature on patient centered care, patient engagement and patient experience in health care generally, there is little focused literature on how this is related to patient experience in medical imaging and radiation therapy. This review article examines the underpinning concepts of patient experience and the factors that contribute to a positive patient experience. These include good communication, care for the patient as an individual, and emotional support. Patients experiencing care in medical imaging and radiation therapy departments have broadly similar expectations, although this can be challenging to provide in a technologically focused, time-limited environment.

A literature review can be an informative, critical, and useful synthesis of a particular topic. It can identify what is known (and unknown) in the subject area, identify areas of controversy or debate, and help formulate questions that need further research. There are several commonly used formats for literature reviews, including systematic reviews conducted as primary research projects; reviews written as an introduction and foundation for a research study, such as a thesis or dissertation; and reviews as secondary data analysis research projects. Regardless of the type, a good review is characterized by the author's efforts to evaluate and critically analyze the relevant work in the field. Published reviews can be invaluable, because they collect and disseminate evidence from diverse sources and disciplines to inform professional practice on a particular topic. This directed reading will introduce the learner to the process of conducting and writing their own literature review.

Researchisoneoftheprimaryhallmarksofaprofession.Medicalradiationtechnologists(MRTs)arepartofa‘‘neophyteacademicprofession’’ [1] that has seen a relatively slow uptake of researchandscholarlyenquiry[2].Withtheshifttobaccalaureateeduca-tion (and beyond) and the gradual increase in MRTs obtainingacademic appointments, more practitioners are becomingresearch-active.Our knowledgebaseisstill heavilyreliant, how-ever,onworkdonebyotherprofessionssuchasmedicine,phys-ics,andnursing[2].Thereareimportantprofession-specificgapsthat need to be filled to inform practice, policy, and educationwhich should be addressed by MRTs to establish a unique anddistinct paradigm for our professional research.When we do conduct research, we tend to focus on quanti-tativeresearch that ‘‘reduce(s)experience towell-defined varia-bles.for investigation’’ [3] or work that uses experimentaldesigns, involves statistical analysis and deals with numbers asdata. Our publications reflect this, for example only about5%ofsubmissionstotheJournalofMedicalImagingandRadi-ation Sciences (JMIRS) in the last 8 years have been nonquanti-tative (qualitative)papers. Qualitativeresearch is not driven bynumbers; it involves examining the reality of individuals, theirperceptions, and understanding of events or phenomena pri-marily using interviews, focus groups, and observation.Therearelikelyafewreasonsforthelackofqualitativeworkin our profession, probably the most significant being that thescientific (quantitative) approach is the dominant paradigmand gold-standard in medical research, and as such holds themost value in imaging and radiation therapy departments.Our practice has been convincingly described as being placedfirmly within ‘‘a biomedical model of health in a market-orientedservice,drivenbyquantitativeoutcomes’’[4].Further-more,itiseasier(relativelyspeaking)tobepartoftheteaminaphysician-drivenclinicaltrialorassistinamedicalphysicspro-jectthantobeinvolvedinaqualitativeinitiativethatoftenfallsinto the domain of social work, nursing, or psychology.As a further potential barrier, for a novice researcher, theapproaches and methodologies of qualitative research can bea whole new language. Many MRTs have done statisticscourses and may vaguely remember the difference betweencausation and correlation. How many of us are comfortablewith the concepts and lexicon of qualitative research such asthe differences between Husserlian and Heideggerian phe-nomenology? I am obviously exaggerating to make a point,but the roots of qualitative research lie in the traditions ofthe social sciences. Those of us in the applied health sciences,without a background in anthropology, sociology, or psycho-logy have struggled to learn the rules and jargon of anapproach that sometimes seems to be situated ‘‘inaccessiblyhigh up in the misty mountains of academic discourse’’ [5].It has not helped in the uptake of qualitative research that,until fairly recently, it has often been measured against quan-titative research and been found wanting. The two approacheswere traditionally posited as being diametrically opposed. Inhealth care, the subjectivity and descriptive nature of thedata often sat uneasily with more quantitative researchers[6]. In the 1970s and 1980s, we had quantitative researchersin one corner, discussing predetermined hypotheses andgeneralizability, occasionally taking pot shots at qualitative re-searchers’ ‘‘touchy-feely’’ methods. In the other corner, thequalitative researchers were defensively asserting that a so-called scientific approach is inherently flawed when dealingwith subjective human beings [7] and waiting for theoriesand ideas to mysteriously ‘‘emerge’’ from their post-positivistic data. At the end of the 1980s, the two forms finallycame to a sometimes shaky rapprochement, and at the begin-ning of the 1990s, the mixed methods movement was born.Mixed methods, using and blending the best elements ofboth approaches, has become far more common and is appro-priate for many of our practice-driven questions.Alongwiththeemergingacceptanceoftherolesandvalueofboth types of research, there has been a growing understandingthatthereisadisparitybetweentheaimsofthetraditionalqual-itative approaches grounded in the social sciences (primarilyethnography, grounded theory, and phenomenology) and thegoals of clinical health care researchers such as MRTs that may

Introduction The medical radiation sciences' (MRS) MedRadJournalClub attracts a global group of participants to monthly sessions to discuss selected journal articles. The September 2017 session explored the experiences of MRS professionals working with lesbian, gay, bisexual, and transgender (LGBT) patients. The aim of the chat was to establish staff educational preparation, how participants’ organizations approached the issue, and what participants would do differently at work or at home in relation to this patient population after the chat. Method Data were extracted using the Twitter advanced search function with #MedRadJClub from the 19th to 23rd September 2017. The data were reviewed and categorized for themes. Tweets related to shared LGBT resources were captured, verified, and counted separately. Results 44 participants took part in the September Twitter chat. After data cleaning, 127 tweets were included for analysis with a further 16 tweets sharing LGBT resources. Almost all of the participants disclosed that they had no undergraduate education or workplace training in the care of LGBT patients. Workplaces of a limited few participants had specific approaches to improve experiences for this patient population. Many participants were eager to advocate for changes in their workplaces after the Twitter chat. Conclusion There is still work to be carried out to educate MRS professionals to enhance their LGBT patients’ experience and improve workplaces. Positive changes in education and a more inclusive clinical environment will ultimately improve care for LGBT patients.

Introduction Radiation therapy skin reactions are one of the most common side effects and can cause patient distress. In some cases, a severe radiation-induced skin reaction may limit delivered dose and potentially compromise treatment outcomes. There are some established best practices, but approaches and patient advice appear to have changed little over the years and are often based on tradition, not evidence. Canadian radiation therapy departments use different skin care products and approaches, and there has been little previous work to examine national practice patterns. Materials and Methods This study used a 42-item electronic survey based on a questionnaire designed by the UK Society and College of Radiographers. Practice data were collected related to assessment and prophylactics, interventions for prevention and management, and use of tools and guidelines. The final survey version was distributed to an identified radiation therapist-registered nurse dyad at each radiation therapy department in Canada (n = 44). Results Thirty-three departments responded (75% response rate). Results suggest a variation in national management. A number of departments continue to advise patients not to wash or use deodorant/antiperspirant despite having evidence to the contrary. There are also unnecessary restrictions on the use and timing of application of lotions as well as conflicting postradiotherapy skin care instructions regarding sun exposure. Conclusion The study demonstrated variation in practice across Canadian radiation therapy departments. National interprofessional guidelines could improve uptake of best practices. Where there is little evidence, a stress-reduction approach with more collaborative decision-making should be used to minimize patient disruption.

Introduction Online Twitter journal clubs are a recent and popular innovation with the potential to increase research awareness and inform practice. The medical radiation sciences' MedRadJournalClub (MJRC) is a Twitter-based event that attracts a global group of participants at the monthly chats. An analysis of a recent MedRadJournalClub discussion evaluated the perceived benefits and limitations of medical radiation practitioners participating in an online journal club. Methods The February 2017 chat used for analysis was based on the Journal of Medical Imaging and Radiation Sciences article by Currie et al. "Twitter Journal Club in Medical Radiation Science" that examines the educational theory behind learning and evidencing professional development through MRJC and social media. The data consisted of chat tweets which were collated using the Twitter advanced search function using the #medradjclub. An initial reviewed was performed to exclude irrelevant content. A second review was then undertaken to categorize the main theme of the tweet. The data were then subjected to thematic analysis which yielded seven different categories. Results The main benefits included global access due to the online nature of MRJC that has facilitated networking and collaboration. Open access to recently published research was another key benefit. The character limitation of a tweet was the most common constraint, and the dynamic nature of the twitter conversation requires multi-tasking that may be difficult. Conclusion Our analysis indicated that participants use MedRadJournalClub as a source of continuing professional development with some evidence that this is directly informing clinical and educational practice.

Following development of a framework to establish the scope of advanced practice for radiation therapists (APRTs), a Canadian certification process was built. This involved three independently-assessed phases: professional portfolio, case submission, and oral examination. The oral examination was to test the candidate's knowledge and capacity for decision-making. Development and piloting involved 3 elements: 1) content development, including relevant case selection, with accompanying high-fidelity imaging and resources; 2) harnessing of technology and ensuing logistics, given the desire to offer the examination online, maximizing accessibility and minimizing resources; and 3) examiner recruitment and preparation, involving a national call for interprofessional examiners, to assess across the spectrum of competencies. Each element was approached systematically, with modifications made iteratively. Three overarching challenges required ongoing attention and consideration: resource-intensiveness of building and validating cases, ensuring applicability and relevance of case content and "answers" across practice environments, and preparation of non-radiation therapist (oncologist and physicist) examiners regarding APRT standards. The resultant examination model is thought to be a robust assessment tool, well-regarded by candidates and examiners as fair and transparent, and complementary to the other certification phases. A consultatory pilot process supported establishment of a robust framework that is believed to be defensible and preliminarily valid.

The publisher regrets that the table 2 was inadvertently published as an online appendix files instead of regular table in the proof. The table 2 should be as follows. [Table presented]The publisher would like to apologise for any inconvenience caused.

Background The "resource therapist" supervisory radiation therapy roles at the British Columbia Cancer Agency were recently evaluated. Methods The process included interviews with resource therapists (n = 22) and an electronic survey of stakeholders including department managers (n = 5) and clinical radiation therapists (RTs) (n = 230). Results Themes from both sets of data included the ability and advisability of maintaining clinical expertise, role clarity and job creep, and the definition of leadership. The resource therapists were balancing an increasingly complex administrative workload that varied between provincial centres. The understanding of the role differed between stakeholders. Only 48% of the RTs agreed that they had a good idea of what resource therapists do and many desired the resource therapists to be more "hands on." Conclusions In agreement with the literature, many resource therapists view themselves as clinicians first and managers second. There is also a marked difference in how the role is viewed between resource therapists and RTs. Role incumbents may benefit from access to more formal preparation, including job shadowing, training, and mentoring. There is also a need to increase understanding of the role across all stakeholder groups.

Aim: The primary objective of the survey was to evaluate clinical skin care practice in radiotherapy departments across the United Kingdom. Methods and sample: A questionnaire containing sixty-one questions grouped into eight themed sections was developed and a link to an on-line survey, using the Survey Monkey™ tool, was e-mailed to all radiotherapy department managers in the United Kingdom (N=67). Each recipient was invited to provide one response per department. Key results: Fifty-four departments responded within the allocated timeframe giving a final response rate of 81%. Products and their use for skin conditions varied and some outdated and unfounded practices were still being used which did not always reflect the current evidence base. The amount of data routinely collected on skin toxicity was limited making it difficult to quantify the extent of skin morbidity following radiotherapy. Conclusion: The survey demonstrated variability in skin care practice in radiotherapy departments across the UK, with limited practice based on evidence or on skin toxicity measurement and monitoring. © 2011 The College of Radiographers.

Proceedings from RTi3 2011: Inquire, Inspire, Innovate Organizing committee: Tara Rosewall, Amanda Bolderston, Annamarie Butler, Lisa DiProspero, Jane Higgins, Lori Holden, Marc Potvin, Aisha Sheikh, Effie Slapnicar and David Wiljer Department of Radiation Oncology, University of Toronto, Ontario, Canada b Princess Margaret Hospital, Toronto, Ontario, Canada Michener Institute for Applied Health Sciences, Toronto, Ontario, Canada Odette Cancer Centre, Toronto, Ontario, Canada

Reflection is a way of evaluating best practice and challenging existing norms, while at the same time, considering one’s personal values and assumptions in our personal and professional lives. However, many health practitioners may lack the skills to do this effectively. Through participation in a series of three workshops, practitioners in the Radiation Medicine Program at Princess Margaret Hospital have learned and acquired new skills to encourage reflection and reflective practice in themselves, their colleagues as well as with their students. A pre- and post-course survey was used to ascertain their level of knowledge of reflection and reflective practice. An additional survey at 3 months assessed the frequency of use and ongoing comfort level with reflective practice. Results of the evaluation indicate that the participants’ knowledge of reflective practice has improved their understanding of reflection in clincal practice. They recognize the importance of reflection and anticipate increasing their use of reflection in/on practice. As well, participants have been able to sustain the positive momentum 3 months after the course was delivered.

Preceptorship is a valuable component of undergraduate radiation therapy education and allows students to develop clinical skills and professional attitudes under the supervision of experienced practitioners. Preceptor preparation in the form of continuing professional development is an important factor for successful preceptorship to occur. This article describes the development and evaluation of a short, flexible blended learning course by a group of Ontario educators. The course was designed to support radiation therapists teaching students from the joint University of Toronto and Michener Institute Medical Radiation Sciences (MRS) program undergoing the clinical practicum component of their 3-year program. The course comprises two workshops and a web-based component. Topics include adult education theories, orienting a student to clinic, feedback, fostering clinical reasoning, conflict resolution, formal evaluation, the MRS program structure/processes and the needs of the student with English as a second language. To date, three cohorts have completed the course (52 learners) from four Ontario radiation therapy departments. Evaluations have been positive, with high participant satisfaction and a noteworthy difference in self-perceived knowledge using the original course objectives between pre- and post-knowledge levels. It is hoped that this course will contribute to the success of the role and provide an opportunity for staff recognition and support.

Introduction Patient satisfaction is an important indicator of quality in health care. Radiotherapy (RT) requires patients to attend daily treatment through outpatient appointments (OPA). Therefore, wait times (WT) for daily RT OPAs can have a significant impact on patient satisfaction. This study aims to quantify WTs associated with daily RT OPAs and investigate the cause of identified delays. Methods A total of 128 outpatients scheduled on eight different linear accelerators for RT were included in this ethics-approved study. Radiation therapists recorded the entry time (time patient entered the treatment room) for each OPA over 10 consecutive treatment days. Where applicable, radiation therapists recorded the cause for appointment delays. Subsequently, WTs were calculated as the difference between the scheduled appointment time and the entry time. Subgroup analysis by time of appointment and anatomical treatment sites was performed. Results Mean WT ± standard deviation (SD) was 7.2 ± 27 min. for 866 OPAs. A total of 382/866 (44%) OPAs were early or on time (-12 ± 21 min.); 484/866 (56%) were delayed (22 ± 20 min.). The delays were primarily attributed to an indirect cause of catching up from previous delayed appointments (73%). The WT was ≤20 min. for 693/866 OPAs (80.0%). The mean WT ± SD was longest for midday appointments (10:30 AM–2:30 PM) at 9.5 ± 29 min. and was statistically significant ( P = .020). The comparison of WTs by treatments sites showed pelvis site (majority prostate cancer patients) experiencing the longest WT ± SD at 11 ± 22 min. ( P 0001), caused by specific radiotherapy treatment protocol. Conclusion Most OPAs (80%) were treated within 20 min. of their scheduled time. Reported delays were influenced by clinic workflow and coordination of multiple appointments throughout the day. The findings of this study will assist in the formulation of strategies to improve efficiency and patient satisfaction.

Aims This study explores radiation therapists' understanding and interpretations of the concept of caring within their profession. Background Health professions' concepts of care have been explored in disciplines such as nursing and medicine. However, there has been little previous attempt to describe what caring means to radiation therapists. Methods A qualitative phenomenological approach was used and 27 radiation therapists were interviewed in four focus groups. Discussions were transcribed and analysis was performed to identify themes from the data. Results Three overarching themes emerged from the data: human connection established between radiation therapists and patients, technical care as the use of technology and procedures in treatment planning and delivery, and the therapist's unique identity as compared to other professions. Conclusions The concept of care was seen by radiation therapists primarily as a supportive relationship with the patient but they were unable to agree if the technical aspects and procedures were considered a part of caring. Further research is needed to further examine the connection between technology and care.

Conference Chairs: Amanda Bolderston*, Tara Rosewall; Organizing committee members: Ruth Barker , Angela Cashell , Kathleen Conway , Lisa DiProspero , Terri Flood , Nicole Harnett , Cate Palmer , Effie Slapnicar , and David Wiljer a,b a University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada b Princess Margaret Hospital, Toronto, Ontario c Odette Cancer Centre/Sunnybrook Health Sciences Centre, Toronto, Ontario d The Michener Institute for Applied Health Sciences, Toronto, Ontario

Proceedings from the 6th annual Toronto Radiation Medicine Conference, Friday, March 6, and Saturday, March 7, 2009 Organizing committee members: Amanda Bolderston (Program Chair), Tara Rosewall (Research Chair), Cathryne Palmer, Nicole Harnett, Lisa DiProspero, Ruth Barker, Angela Cashell , Effie Slapnicar, David Wiljer, and Kathleen Conway a University of Toronto Department of Radiation Oncology, Toronto, Ontario, Canada b The Michener Institute for Applied Health Sciences/University of Toronto, Toronto, Ontario, Canada c Odette Cancer Centre/Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Complementary and alternative medicine (CAM) is increasingly popular among patients receiving radiation therapy. However, there is little empirical evidence relating to the interactions of radiation therapists and their patients regarding the use of CAM during treatment. The study objectives were to quantify how often the issue of CAM use arises in the therapists' daily practice, to explore radiation therapists' knowledge and attitudes about CAM use by their patients, and to identify areas for future education and development for therapists. This article describes a two-centre survey conducted at the Vancouver Cancer Centre in British Columbia and Princess Margaret Hospital in Ontario. The survey used an email survey instrument, “SurveyMonkey,” which was emailed to all therapists working at both centres (n = 230). The survey had a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” There were also associated open-ended questions to allow for individual comments. The total response rate from the two centres was 49%. Results indicated that the topic of CAM does arise, although the frequency of interaction between patient and therapist varies between centres. Therapists reported feeling comfortable with their knowledge of 3 from a list of 27 common CAM therapies. They would recommend/support their patients' use of 11 CAM therapies in total. Therapists and patients use a variety of information sources about CAM, but would welcome more information/education in this area. Overall, therapists felt that the radiation oncologist was the most appropriate person to discuss the use of CAM with patients. Radiation therapists need more information about CAM in the form of continuing education to meet the needs of their patients. Further research is warranted, as this is a very preliminary look at a large and somewhat controversial topic.

Introduction This qualitative study explores the experiences of undergraduate radiation therapy students who have English as a second language (ESL) in the clinical environment, as well as the experiences of staff members who teach these students. Specific study aims were to increase understanding of the issues faced by this subset of students, including identifying potential barriers to clinical learning. Methods and design A qualitative methodology was utilized with focus groups as the data collection tool to gain insights from students/recent graduates whose primary language was not English, as well as from staff members who educate this group of students in the clinical environment. Two focus groups were conducted; Group 1 ( n =6) consisted of ESL graduates/students and Group 2 ( n =5) consisted of radiation therapy staff members and clinical coordinators who are actively involved in the education of ESL students. Comparative data analysis of the transcribed discussions was carried out using content analysis and categorized according to the emergent themes. Results Three overarching themes were identified for both groups, "Communication", "Differences" and "Dealing with it…" The primary barrier for ESL students was seen as proficiency in English, which manifested in a number of ways. This resulted in a lack of confidence and a subsequent sense of alienation. External challenges identified were unfamiliarity with Canadian systems and cultural differences. Support strategies identified included the use of mentorship, professional development and external support for teaching staff and journaling, among others. Conclusions There are identified challenges for ESL students in the clinical environment, thus it is important to provide support for this population to improve learning outcomes. Recommendations for practice, arising from the study as well as the available literature included: allowing extra time, assisting with improving English proficiency, improving confidence, different learning approaches and ensuring the message is clear.

Part two of this two-part series presents the results of a departmental initiative implemented in 2003 at a large urban cancer centre, Princess Margaret Hospital (PMH) in Toronto, Ontario, Canada. This new model for radiation therapists was called Advanced Integrated Practice (AIP) and was developed, in part, to encourage and promote scholarship within radiation therapy. The AIP model incorporated integrated clinical specialty roles designed to blend exemplary clinical practice with focused academic activities. This paper discusses an evaluation of the AIP model undertaken to obtain a formal measure of how the model had evolved, how the radiation therapists and other stakeholders were responding to the new model, whether the initial outcomes were realized and to create plans for further development of the design. The evaluation utilized a mixture of traditional qualitative research methodologies such as focus groups, quantitative surveys and a variety of other available measurable outcomes. Outcomes from the model included increased opportunities for diverse roles that incorporated an element of academic practice and augmented career choice and scope for radiation therapists. In addition, academic output and research work also increased within the department. Lessons learned from the implementation and evaluation of the model are shared, and the authors offer some suggestions to increase scholarly activity within the profession.