“Stranded on an Island: The Challenges of Practicing Medical Dosimetry in a Small Clinic”

Pt. 1: Training and Continuing Education

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The most recent estimate of Radiation Oncology departments in the U.S. is around 2,200.  A mixture of free-standing clinics; small, medium, and large hospital-based departments, including satellite clinics comprise the landscape of available treatment possibilities for patients. Furthermore, a variety of policies and attitudes towards paying for continuing education and trainings exist, depending on available funds or staff availability.  Regardless, there is an ever increasing environment of reduced reimbursements for procedures, along with consequential strangle-holds on department budgets. All too often, the first thing to be removed is employer funding for educational opportunities. This usually leads to staff members paying for CE’s and certification maintenance out of their own pocket.

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In a larger or multi-institutional system, staff members sometimes have the ability to pool knowledge and training. For example, if Suzie went to the most recent vendor meeting, she may have scribbled down notes that could be shared with her colleagues.  However, the solo Dosimetrist in a smaller facility struggles to have access to similar information.  These smaller and non-hospital based clinics make up over half of all radiation oncology departments in the US.  Many of us have experienced the following:  the administrator discusses the obvious current state of the market, setting the stage for a comment such as “ASTRO is off the budget, and oh by the way, you will now be responsible for paying for your AAMD membership.”

Meanwhile, we are tasked with producing the next treatment plan in the queue, and the physicist informs us that the latest version of our planning software is due for an upgrade. We are handed the release notes and are tasked with the responsibility of becoming “experts” on all of the wonderful new features available in the latest release.  This scenario, coupled with the fact that educational opportunities are severely limited leads to frustration and skepticism on our ability to optimize the machine in front of us.  Ironically, even if funds for training magically appeared, there are typically some great lessons on the physics of the new features, descriptions on how to access them in the system, or at best a basic understanding of the possibilities.  However, what about practical planning information on how to use these features to show significant improvements in quality or efficiency of our treatment plans?  A recent performance report on vendor training rated customer satisfaction at only a 30% positive response with the ability or availability of opportunities to implement and train the end-user on new technologies.

For many of us working in smaller clinics, there can be definite challenges when it comes to accessing current or relevant information…making us feel as if we are stranded on an island.  One option is posting specific questions on list servers or emailing professional contacts. Will the information we receive be accurate (not to mention relevant)?  Through the plan challenge process, the clinicians at ROR have heard and shared experiences highlighting those struggles with many of our peers.  Beyond that, we have hosted webinars, presentations, and personalized follow-up educational tips and tricks for best practices.  In this spirit of learning, we have developed ROQS.  Aside from the library of information and personalized feedback, ROQS is simply that lifeline that can readily connect you with a support group of peers and expertise. Best of all, it is not a “bank-breaker.” So if you’re ready to get off of that “lonely island” (not the Adam Samberg one), shoot us a signal flare!

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