The Profession
Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

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Purpose

Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile.

Methods and Materials

A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile.

Results

Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items).

Conclusions

We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.

Introduction

Medical imaging plays a fundamental role in the practice of radiation oncology (RO). It is critical for accurate staging, target and organ-at-risk delineation, and image guidance for radiation treatment. Technological advances in imaging science have always provoked radical changes in nearly every aspect of RO 1, 2, 3. Radiation oncologists currently have new imaging techniques and tools at their disposal that combine anatomic and functional imaging for staging, planning, treatment delivery, and follow-up (4). Advances in imaging have allowed for more conformal radiation treatments and have facilitated dose escalation while maintaining a favorable impact on normal tissue tolerances (5). The effective use of multiple imaging modalities has resulted in significant improvements in patient outcomes 6, 7.

New knowledge, skills, and attitudes are needed to optimize the application of medical imaging in modern RO practice (8). Elsewhere, we define “imaging literacy” in RO as being competent in a diverse set of skills including image acquisition, image optimization, and application to patient specific situations (9). While some residency programs are beginning to understand the need for including comprehensive imaging components in their curricula 10, 11, there are no accepted competency profiles that fully address the training needs of RO residents and practicing physicians (12). A review of international requirements for RO 13, 14, 15, along with a review of published literature 16, 17, 18, further emphasizes a widening gap between the need for updated imaging competency among radiation oncologists and the lack of appropriate educational guidelines.

The CanMEDS medical education framework defines the national postgraduate medical education standards in Canada (19). This framework articulates an educational taxonomy of competency groupings that, taken together, guide the essential abilities that physicians require (20). Individual competency items are formed from the best available evidence. These essential “key” competencies are broad abilities that form the grounding on which program-level objectives may be built. Subordinate abilities, referred to as “enabling” competencies, are the specific “ingredient” abilities (knowledge, skills, and attitudes) required to attain each key competency. The viability of any new competency framework depends on the completeness, accuracy, and applicability of both key and enabling competencies to the practice setting. The purpose of this study was to develop a viable entry-to-practice competency profile in imaging literacy for RO based on international consensus.

Section snippets

Competency list generation

From September 2012 to December 2012, a review of the published literature, published objectives of training, and program-specific curricula was conducted to generate an inclusive preliminary list of potential imaging competency items. Most of these sources were readily available to investigators through academic departments or online through professional organizations such as the Royal College of Physicians and Surgeons of Canada and the American Board of Radiology. Permission was requested

Competency list refinement

An initial list of 263 potential enabling competency items was compiled from 14 sources including University of Toronto, Department of Radiation Oncology Medical Physics Residency Program (24); imaging sub-module, Ryerson University Introduction to Imaging Course (25); Royal College of Physicians and Surgeons of Canada Objective of Training for Radiation Oncology (26); Royal Australian and New Zealand College of Radiologists (13); Royal College of Physicians and Surgeons of Canada, Objective of

Discussion

The practice of RO is changing. Advances in imaging technology have impacted all aspects of RO practice including diagnosis, treatment planning, treatment delivery, and follow-up. These changes have improved clinical outcomes and have facilitated the use of new techniques such as stereotactic body radiation therapy 3, 33. RO training programs have struggled to keep curricular content relevant for modern clinical practice (12). This is in part due to a lack of consensus guidelines on the level

Conclusions

The competency profile described in this study represents an international consensus on the items which can inform RO training requirements. Future work should address novel methods to deliver and assess these competencies.

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    Conflict of interest: Dr Giuliani has received travel funding from Elekta Inc.

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