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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.

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 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 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.

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.

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.

As radiation therapy practice evolves with advancing treatment and planning technologies, merging of imaging modalities, changing working models and the advancement to higher education, radiation therapists are frequently finding themselves on the frontline of translating new knowledge into practice. To a large degree, this growing involvement in self-directed original research, with associated dissemination of completed results, has led to an increasing number of therapists being encouraged to pursue an academic path in addition to a clinical career. In Canada, radiation therapists are being appointed as faculty to university departments for the first time. It is heartening that such opportunities are increasing; therapists are able to play a profound role in developing an evidence-based professional body of knowledge while at the same time being recognised for scholarly endeavours. However, despite these many positive steps, barriers and challenges to the development of a scholarly culture for radiation therapists still exist. Part one of this two-part series explores the history of the profession and the subsequent development of a scholarly culture.

Objectives The purpose of this study was to discover and compare radiation therapy patients' and radiation therapists' perceptions of patients' educational topics of interest and methods of information delivery during a course of radiation therapy. Methods Using Likert-type 4-point rating scales, 42 therapists and 183 radiation therapy patients were surveyed to rate the degree of importance of 15 informational items (for example, "What it feels like to have treatment"). In addition, therapists and patients ranked 11 methods of informational delivery (for example, "Watching video tapes") in order of preference. Results Results indicated several differences in therapists' and patients' perceptions of both the educational topics of interest and methods of information delivery. Among other things, patients assigned high importance to after treatment issues ("What happens after radiation therapy is finished") and how radiation therapy works, these areas were not seen as important by the studied therapists. Patients expressed a strong preference for receiving information about radiation therapy from their family doctor (ranked third), therapists ranked this source of information as the least important. Conclusion It is vital to tailor educational interventions according to the patient's preference to optimize both understanding and compliance. This study demonstrated noteworthy differences in several areas between therapists' and patients' perceptions. Recommendations therefore include raising therapist's awareness of topics that are important to patients and meaningful informational delivery methods.

Continuous professional development (CPD) is regarded as an essential component of working life for radiation therapists and is increasingly being used by professional associations to ’prove’ the competence of their members. In the past, CPD activities have primarily been viewed as an individual responsibility, and have focused on maintaining a professional knowledge base and, subsequently, hands-on competency through didactic learning. However, there are drawbacks associated with this model; and concentrating on only one facet of learning ignores other theoretical areas of knowledge acquisition. This article explores several areas of social and organisational theories of learning including social networks, communities of practice, learning organisations, knowledge management, knowledge translation and research utilisation. It is concluded that maintenance of competence after graduation is multilayered and should be viewed in a holistic manner to incorporate some of the relevant elements of the concepts discussed. This article also offers some suggestions for the individual wanting to maximise their educational opportunities beyond traditional models of CPD.

W hile patient use of complementary and alternative medicine (CAM) during cancer treatment is popular, its research is limited. It is anticipated that practices differ considerably amongst practitioners and cancer centres. This study explored current variability in Ontario cancer centres regarding departmental policies and patient education literature for CAM. A semi-structured telephone survey was used to gather data from nine radiation therapy departments across Ontario. One representa- tive was purposefully selected from each centre. Analysis of quantitative data was mainly descriptive and representa- tional, while qualitative data was evaluated using thematic analysis. While six of nine centres had policies on CAM, only two centres considered their policies as sufficient. For patient education litera- ture, five of nine centres had literature on CAM, but only one centre deemed it sufficient. The results demonstrated considerable differences regarding CAM policies and patient education literature in Ontario cancer centres. A common theme was that policies and literature were either too general or absent altogether. A standardized approach would ensure consistent patient teaching on this topic. RESUME

Background Canadian radiation therapy departments usually have flat organizational structures, with relatively few administrative/managerial levels. The "unit supervisor" level is a typical job role that provides direct supervision of one or more treatment units with a mixture of clinical and administrative duties. Methods At the British Columbia Cancer Agency, the unit supervisor role was recently evaluated. One approach used as part of the evaluative process was a series of telephone interviews to examine similar roles across Canada (n = 9). Results Data indicated that departmental administrative tasks seem to be increasing significantly, and there is a move toward the addition of more administrative "middle" roles across the country to deal with these. Unit supervisor roles are subsequently becoming less clinical, but there is an emerging tension with moving away from solely clinical responsibilities and assuming more administrative work. Conclusions The historic unit supervisor role was part of the team and did little administrative work. This model is becoming difficult to sustain, and tensions can arise in this new environment when using old organizational models. Focused departmental clinical expertise is important; however, balancing clinical and administrative expectations within the unit supervisor role can be problematic. Role expectations need to be examined, clarified, and communicated within departments. If unit supervisor roles are deemed clinical experts, then clinical time needs to be protected for expertise to be sustained.

This paper provides an overview of qualitative research and highlights the benefits of a qualitative approach to research in the radiation sciences milieu. Qualitative research methodologies can be used independently of, or to enhance, quantitative approaches. We draw attention to the process of generating a qualitative research question. In addition, we provide an overview of the purpose, benefits and drawbacks of the four main qualitative research methodologies: interviews, focus groups, observation studies and chart (document review), for you to consider for your next research endeavour.

This research project analyses how Ontario therapists currently define advanced practice and identifies some of the issues involved. Twenty-two qualitative semi-structured interviews were conducted at four Ontario cancer centres with a group of therapists, managers and educators. The resulting data were analyzed for emergent themes, which were subsequently presented as three overarching themes. The themes that emerged were “What is Advanced Practice?”, “Scope of Practice Issues” and “Professional Image”. Therapists offered many current and potential examples of advanced practice and were cognizant of how evolving roles may impact both their profession and their collaborative relationships with other disciplines. Recommendations arising from this study include the need for a consistent advanced practice framework with underpinning professional development and the need to nurture and support growing professional confidence. Reimbursement issues should also be addressed and there is a pressing requirement for subsequent evaluation of the impact of new roles in all domains (especially patient outcomes).

Roles for radiation therapists are currently in a period of rapid global change. Technological advancement,increased entry-level education and the growing specialisation and professionalisation of many non-physicianclinician groups are all significant drivers for change. There has been considerable interest in the Province ofOntario in “advanced practice” roles for therapists. This literature review identifies some of the backgroundissues involved from a local and global perspective. Keywords Role extension; role development; international; radiotherapy INTRODUCTION There is no doubt that radiation therapists todayare pushing the boundaries of their profession. Ina few years we have seen technological advancesin treatment machines leading to conformal,intensity modulated and high-dose treatment.A therapist working in planning may need skillsin computerised tomography (CT) such as cross-sectional anatomy to delineate critical structures,positron emission tomography (PET) imaging forco-registered CT-PET planning and even ultra-sonography for departments performing prostateimplants.Patient care roles (such as weekly reviewclinics, specialist patient education positions andpalliative care) as well as research skills are alsobecoming increasingly important.There is also an increasing demand for therapists’professional skills.As cancer incidence grows

A semi-structured telephone survey was used to gather data on skin care practices from twenty-six radiotherapy departments across Canada. Questions were asked about the department's recommendations on washing the irradiated area (with or without soap), using deodorant (if the axilla is in or near the treatment fields), use of creams or other products on the skin and the management of dry and moist desquamation. The results demonstrated considerable practice differences across Canada. The survey results were discussed in regards to recent evidence from the literature. A non-restrictive washing policy is encouraged, along with the use of mild hydrophilic cream to moisturise irradiated skin. The use of deodorant is also advocated if the skin is intact. Approaches for the active management of skin reactions are also discussed.

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

Objectives: There is a growing trend towards the use of online journal clubs amongst healthcare professionals as a means of sharing knowledge, discussing evidence in an accessible form of continued professional development (CPD). In March 2015, the Medical Radiation Journal Club was founded to run monthly Twitter-based journal critique and discussion. The Twitter journal club is aimed at all medical radiation professionals. The hour-long meetings are based on a key selected theme relevant to all medical radiation technologists, with one key study chosen from the literature and supplemented by suggested reading. The objective of this study was to examine the progression and development of this initiative over the initial 12 months. Methods: #Tweets including the journal club hashtag (#medradjclub) were analysed for each session through third party services, Symplur (www.symplur.com) and Keyhole (www.keyhole.com). Available information included total tweet count, total participants, total impressions and country of tweet origin. Results: Provisional analysis indicates that there is a core group of consistent participants, with others joining for topics relevant to their area of practice. The initial trend is for relatively consistent volumes of tweets and impressions across the chats. The Twitter journal club has a global reach, typically 500+ tweets per hour and a total reach in the order of 1000000 per session. Conclusions: Online journal clubs provide a forum for promotion of evidence based practice, academic debate and professional networking, free from traditional physical boundaries. Analysis of the first twelve months of #MedRadJclub demonstrates consistent participation and global reach, and is an accessible, interactive platform for discussion of research and practice in this field. The Twitter journal club is consistent with globalisation and internationalisation strategies amongst the medical radiation technology professions.

Background The process of radiation therapy planning and delivery is increasing in complexity, and errors that occur can have serious repercussions for patients. Many radiation therapy departments use incident learning systems (ILSs) to report, analyze, and learn from errors. The success of an ILS relies on a nonpunitive workplace culture in which practitioners are comfortable reporting errors. This study examines the error reporting culture of radiation therapists and dosimetrists in Canada and the United States. Methods A survey assessing perceptions regarding communication among staff, comfort in error reporting, and associated obstacles was mailed to a national sample of 1,500 radiation therapists and 528 dosimetrists in the United States. A similar survey was sent electronically to 1,500 Canadian radiation therapists, and the results from both surveys were compared and summarized using descriptive statistics. Results The quality of communication between radiation therapists and physicians, physicists, and administrators is good in both countries, but there are differences between the three groups, with administrators ranked lowest. There was better perceived communication between radiation therapists, physicians, and physicists in the US cohort. Both cohorts felt they had opportunities to speak to physicians, physicists, and administrators, but the US cohort felt they had better opportunities than the Canadians. Most respondents felt there was a system for reporting errors in their departments, but this was higher in the Canadian group (88% in the United States, 98% in Canada). The majority of respondents felt that they were encouraged and felt comfortable to report errors in the clinic, and this result was significantly higher in the Canadian group. The majority of respondents felt that they had not been reprimanded for reporting an error; more people reported knowing of other staff being reprimanded rather than themselves. The largest obstacles to error reporting in both cohorts were fear of reprimand, poor communication, and hierarchy. Conclusions The majority of staff in both countries feel that communication in their department is good and that there are adequate systems for error reporting. However, a number of respondents felt that they, or a colleague, had been reprimanded in the past, and there are still perceived barriers to the use of an ILS. There is still work to do on improving positive perceptions of error reporting and departmental communication.

The principal goal of interprofessional education (IPE) is to cultivate collaborative practice for providing patient centered care. Introduction to Radiation Therapy (IRT) is a course designed to introduce radiation oncology residents to the radiation treatment process and the interprofessional nature of the radiation oncology environment. Each resident is paired with a radiation therapy student during the clinical portion of the IRT course. The intent behind the pairing is to facilitate opportunities for IPE and to establish a professional relationship for interprofessional collaboration in the future. The overall outcome of the IPE experience has been positive and beneficial to both groups. Results of the survey examining the residents' and the radiation therapy students' perception of their IPE experience within the IRT course showed that they were able to gain insight into each other's role, as well as learn with and from each other. However, the timing of the IPE experience had some impact on the participants' ability to reflect on their own practice and share it meaningfully.

Preceptorship is a time-limited, education-focused model for teaching and learning within a clinical environment that uses clinical staff as role models. Its primary goal is to assist new staff and students to adapt to their roles, develop clinical skills and socialize the novice to a department or institution. It has been widely used within the allied health professions; however, very little is known of its practice within the medical radiation sciences. The purpose of this paper was to review the literature available regarding the practice of preceptorship within the medical radiation sciences as well as provide a general overview of the key components to consider in any application of preceptorship. Key findings have been categorized into the following components: evolving definitions of preceptorship, purpose of preceptorship, benefits, roles within preceptorship, qualities of a good preceptor, drawbacks, structured and self-directed preceptorship programs.

This paper examines the impact of a nine-week overseas clinical placement at a Canadian teaching hospital on second-year radiation therapy students from Trinidad and Tobago. The placement allowed the students to accumulate specific technical competencies and experience other aspects of Canadian radiation therapy professionalism such as patient education and assessment, quality assurance and academic activities. The evaluation of the visit examined the students' perceptions of their experience utilizing a focus group as well as comments and reflections gathered during the placement. The results showed that the students noted many differences-both positive and negative in nature. These could be subdivided into several areas categorised broadly as "technical," "organizational" and "teaching." All students achieved the objectives of their visit, that is, the competencies and assignments set by the program. In addition, the focus group and reflections indicated that significant transformation had occurred in the area of professionalism. It was also established that the host hospital had benefited from the placement and lessons learned from the experience will allow improvements in both staff and student preparation for next time.

One of the well-established hallmarks of a profession is its ability to generate research to expand its unique professional knowledge base. Health care professionals in today's rapidly evolving, highly technological work environment also need the skills to use research findings in their practice. Practitioners, therefore, need to have the knowledge and skills to competently engage in research activities. There have been a number of studies investigating how health care professionals perceive their role in regards to research. However, little is known about how nuclear medicine (NM) students perceive research and if they see themselves playing a role in the future research in their field. Objectives: To determine the attitudes and perceptions of NM students toward conducting research and to explore factors that influence NM students' perceptions of conducting research. Methods: Seventy surveys were sent out via e-mail to NM students studying at the University of Toronto and Michener Institute joint degree-diploma program in Medical Radiation Sciences; 21 completed surveys were collected. Results: The majority of students reported having no intention of engaging in research in the future. General disinterest in research was the most common reason stated for not engaging in research. Discussion: Though the results of this preliminary study cannot be generalized to all NM students, it does reveal a negative attitude toward conducting research among the NM students surveyed. It has also been shown that general disinterest in research seems to be one of the most important barriers for students. Further studies with more in-depth analysis and a larger sample size are necessary to determine whether students feel they have a role to play in the future research in the NM field and to further explore barriers to research participation.

To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy? Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners. Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings. Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.

131 Background: Due to the rising incidence of cancer, increasing complexity of cancer treatment and growing resource constraints, there is demand for innovative interprofessional models of care. Cancer Care Ontario (CCO), in collaboration with Ontario’s Ministry of Health and Long-Term Care, launched the Clinical Specialist Radiation Therapist (CSRT) project to investigate a new advanced practice (AP) radiation therapy (RT) role. Methods: A series of pilot phases commenced in 2004. A system wide implementation phase began in 2010. The overall goal of the project was to enable CSRTs to assume responsibility for certain key radiation medicine activities, optimize RT team functioning, and improve quality of care. This was to be achieved by applying advanced clinical, technical and professional RT competencies. A project team coordinated assessment of new position proposals, implementation activities, and data collection. Work towards formalizing the role is being conducted through partnerships with cancer centre administrations and the national professional association for RTs. Results: Currently there are 17 CSRTs in 6 of 14 Ontario cancer centres, practicing in palliative and disease-site specific positions. The provincial total will be 24 CSRTs in 10 centres by Fall 2014. Data show a major impact on patient throughput and wait times, with significant increased capacity in some clinics. CSRTs’ impact within their departments is being evaluated with regards to: 1) capacity building, 2) quality of care, and 3) knowledge translation (KT). In terms of role formalization, 6 positions are now considered permanent within their centres and the first iteration of a national certification process is anticipated for fall 2014. Conclusions: The CSRT project is aligned with CCO's priorities of improving Ontario’s cancer system performance by implementing innovative models of care and providing high quality care. This jurisdictional implementation project has demonstrated that an AP RT role can be successful in addressing system pressures and improving quality of care and innovation in Radiation Medicine. Further work is necessary to develop and formalize this AP role and leverage learnings for national implementation and future models of care work.