National Forum on Changing Entry-to-Practice Requirements Professional Panel

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National Forum on ChangingEntry-to-Practice
RequirementsProfessional Panel

• Canadian Association of Medical Radiation
  Technologists (CAMRT)
• Claire Hatch Roberta McCammond
• Richard Lauzon Debbie Bolger-Ingimundson
• Ottawa April 2003

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Addressing three questions today

• Plans to change entry requirements?
• Rationale for the change?
• Challenges and issues identified by CAMRT in
  achieving its plans?

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CAMRT Mission Statement

• The CAMRT fosters excellence in patient care by
  providing medical radiation technologists with
  standards of practice and opportunities for
  continuing professional development, by advancing
  the profession, and by establishing effective
  partnerships with related health professionals.

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CAMRT National / Provincial Federation Structure
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CAMRT History

• 1942 Canadian Society of Radiological Technicians
  established
• 1943 Ad hoc Committee on university education
• 1945 New curriculum created and certification
  exams set
• 1955 Separate certification exam for radiation
  therapy
• 1964 First Fellowship examinations held
• 1966 First nuclear medicine certification
  examination
• 1968 Adoption of Alberta AC program nationwide
• 1974 Ad hoc Committee re Radiologist Assistant
  program
• 1987 BS (Health Studies) collaboration with WMU
• 1996 Magnetic Resonance discipline established
• 2001 AIT Labour Mobility Mutual Recognition
  Agreement

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Budget Invested in Education Programs, 2002

• Education (total) 742, 759
• Certification 290,000
• Continuing education 275,000

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Plans to change entry requirements?

• Degree motion and provincial implementation
• Degree chronology
• Program status to date

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1995 MOTION - 53rd AGM CAMRTDegree as
Entry-to-Practice Requirement

• That CAMRT support the proposal for a degree as
  the entry-level requirement for medical radiation
  technologists as of the year 2005.
• In response to questions, President Brodie
  stated since education falls within provincial
  jurisdictions, implementation of a degree program
  would be the responsibility of each province.

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CAMRT Degree Chronology

• 1943 CSRT/CAMRT Degree activity
• 1994 Strategic objective re feasibility study
  for degree
• 1995 Degree motion passed / Provincial
  implementation
• 1997 Report Degree Initiatives A blueprint for
  action
• 1998 Report Degree Education Facts and Fiction
• 1998 First sitting of CAMRT competency-based
  exams
• 2001 Degree Addendum additional degree models
• 2001 Rationale for deadline extensions accepted
  by BoD
• 2002 Validations completed of competency profiles

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Degree Initiative Status to Date Nuclear Medicine

• 5 programs nationwide
• 3 have degree operational (ON, NS, NB)
• 2 offer a diploma exit option (NS, NB)
• 1 has no diploma exit option (ON)
• 1 fully developed, approaching the government
  approval process (BC)
• 1 diploma program in place (QC)

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Degree Initiative Status to Date Radiation
Therapy

• 11 programs nationwide
• 4 fully developed degree programs, awaiting
  provincial government support (AB, SK, MB, NB)
• 3 programs favor degree, will be working towards
  implementation (QC)
• 1 approved degree, moving to implementation (BC)
• 1 fully integrated degree, no diploma exit option
  (ON)
• Serves three provinces (ON, NF, NS)

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Degree Initiative Status to Date Radiological
Technology

• 21 programs
• 7 have degree operational with diploma exit
  option
• (ON, NB, NS, PE, NF)
• 5 under active development (BC, SK, MB, ON)
• 4 programs favor degree, working towards (QC)
• 2 investigating degree-completion model (AB, ON)
• 1 moving to full degree implementation (ON)
• 1 fully integrated program no diploma exit (ON)

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Degree Initiative Status to Date Magnetic
Resonance

• Currently a post-certification, second discipline
  
• 4 programs nationally (BC, AB, MB, ON)
• 2 offer distance ed option (BC, ON)
• 1 is a full time program (MB)
• 1 currently inactive and undergoing redesign (AB)
• Once MR education programs are developed as
  post-secondary programs, it is expected they will
  be degree level programs.

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Rationale for the change?

• Environmental forecast
• The changing workplace
• Emerging independent roles for MRTs
• Benefits to
• Patients
• Technologists
• Management

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Environmental Forecast

• Changing demographics and pattern of disease
• Revolutionary advances in MRT technologies
• Substantial decline among medical specialists
• Increased Canadian capacity for telemedicine
• Changing practice patterns of radiologists
• Increasing use of high tech diagnostic procedures
• Increased time for sophisticated MRT protocols
• Less time and for professional development

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The Changing Workplace 20 Years Ago

• Film/Screen Technology
• No post-processing capabilities
• CT brand new, MR and PET in infancy, Fusion
  Imaging still theoretical
• Cross sectional anatomy not taught, little formal
  emphasis on pathology, patient care,
  communication, ethics, legislation, etc.

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The Changing Workplace Today

• Film/Screen PLUS Digital Imaging Modalities,
  hugely expanded scope of post-processing
  capabilities
• Advent of spiral and multi-slice CT, MR, MRA,
  PET, SPECT, 3D imaging, BMD and screening
  mammography, integrated computerized planning in
  radiation therapy and CT Sim/MR Sim and Fusion
  Imaging
• Emphasis on interpersonal communication skills,
  patient education and participation with health
  care team
• Widespread use of radio-pharmaceuticals in NM

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The Changing Workplace All modalities

• Significantly expanded equipment capability
• new and more interventionalist approaches to
  disease detection
• greater numbers and types of examinations
  performed
• Greater emphasis on computer application and
  usage
• demands a solid understanding of computer
  principles for optimization of the functions and
  applications
• requires an entirely new knowledge/skill set
• Patient demographic shift
• an older, population means increased demand for
  diagnostic and treatment procedures
• Scarce health care means working smarter with
  less
• Expanded roles, more delegated physician functions

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The Changing Workplace All modalities

• Injection of contrast media
• increased responsibility for patient care and
  monitoring
• Patient and staff education
• Increased awareness of multicultural diversity
  and the need for effective communication and
  problem solving
• Quality Assurance/ Quality Control now integral
  to all departments

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Emerging Independent Rolesfor MRTs

• Upper and lower gastro-intestinal imaging
• Bone mineral densitometry
• Mammography screening
• Patient education cancers, osteoporosis, etc.
• Screening clinic management
• Telemedicine / teleradiology, PACS admin.
• Research and evaluation studies

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Degree-entry as a Benefitto Patients

• More comprehensive skill set
• Improved basis to solve problems, appraise
  solutions, make decisions
• Enhanced sensitivity to socio-cultural
  determinants of care
• Better verbal and written reporting skills
• More efficient service delivery

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Degree-entry as a Benefitto Technologists

• Maximizes application of education and experience
  to benefit patients
• Enhanced roles promotes gt job satisfaction
• Greater job flexibility, natl. / intl. mobility
• More competitive for managerial positions
• Offers broader career ladder specialization,
  education, management, research

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Degree-entry as a Benefitto Management

• Access to broader range of competencies
• Pool of MRT research talent available
• Improved supervisor skill sets
• More autonomous technologists
• Reduced cost for selected MRT procedures
• Better decision-making skills reduces risk of
  liability

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Degree Status in Other Countries

• United Kingdom / Rep. of Ireland 1989
• Australia / New Zealand 1995
• Hong Kong 1992
• Netherlands 1990s
• United States of America 1980s
• Israel 1993
• Norway 1990s
• Denmark late 1990s
• Post-graduate training avail.

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Challenges and issues in achieving CAMRT degree
plans?

• Lack of / soft government support
• Personnel shortages
• Dual exit / two-tiered system
• Agreement on Internal Trade / MRA
• Extension delays implementation
• Community college / university concerns
• Perceived subsequent wage impact

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CAMRT Actions to Address the Challenges

• Created two committees to assist provinces and to
  facilitate the implementation of degree programs
• In response to AB, CAMRT expanded the number of
  models eligible for degree status
• At BC, AB and ON request, CAMRT extended the date
  for examination access (reasonable progress)
• Willingness by provincial associations and CAMRT
  to dialogue on any degree implementation issue

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Degree-entry as Change

• There is nothing more difficult to carry out nor
  more doubtful of success, nor more dangerous to
  handle than to initiate a new order of things.
  For the reformer has enemies in all who profit by
  the old order and only lukewarm defenders in all
  those who would profit by the new order.
• Machiavelli, c. 1520