Toronto 2018

canada city cityscape downtown

The LTWRAP conference held October 20-21st 2018 brought together some of the leading lights in radiographer advanced practice. The event was supported by CAMRT, and held at the Michener Institute in Toronto. Cate Palmer (Director, Medical Radiation Sciences Program at the University of Toronto) chaired the conference, which was planned by a local organising committee (Jean Nash, Yasmin Allidina, Susan Weltz, Kitty Chan, Laura D’Alimonte and Mark Given).

Dr. Rachel Harris (Professional and Educational Officer, Society and College of Radiographers, UK) started us off with a summary of how we got here. The first LTWRAP conference (held in 2016 at Sheffield Hallam University in the UK) originated from a Twitter chat, and there was a lot of avid tweeting in evidence at the second one. Rachel reminded us that expert clinical practice is “a given” for an advanced practitioner (APs), but education, leadership and research are what makes APs “movers and shakers”. She spoke from the heart about her recent experience with breast cancer, and ended by stressing that however far we go, we need to remember that the patient is at the heart of the work we do and we should “treat patients as people, not bodies”.

During the two-day conference four keynote speakers discussed the state of play in their country:

Canada: Nicole Harnett (Director of the Accelerated Education Program, Radiation Medicine Program) described the Clinical Specialist Radiation Therapist (CSRT) project in Ontario, and the subsequent Canadian Association of Medical Radiation Technologists’ AP certification process. Her recent publication details some of the impact of the CSRTs working in areas like palliative care, brachytherapy and breast treatment. For example, CSRTs can add 20% net new patients to the system, and task delegation from radiation oncologists (ROs) can save 15-24 hours per month of RO time.

UK: Dr. Johnathan McConnell (Consultant Radiographer, National Health Service, UK) discussed the UK’s consultant radiographer (medical radiation technologist) role. The role should include the four core domains (expert clinical practice, professional leadership and consultancy, education and professional development and practice and service development – research and evaluation) but there is no particular time allotment for non-clinical practice domains (so sometimes non-clinical work like research may be prioritised less). Clinical academic roles can mitigate this but they aren’t common. A lack of research activity and a small number of radiographers holding doctorates are possible barriers to consultant practice. Johnathan contended that regardless of proportions of the domains involved in a role, passion for the job is vital.

Australia: Mary Job (Advanced Practice Radiation Therapist, Princess Alexandra Raymond Terrace) described her role as one of Australia’s first five accredited APs. She stressed that there needs to be more investment in AP roles, and the implementation should be evidence based. Her own role is in palliative care and involves strong advocacy for both radiotherapy and AP. She showed the impact of territoriality and professional resistance on AP roles with the recent contentious RANZCR statement on radiographer reporting that stated the association did not support extending radiographer roles in this area.

USA: Vicki Sanders (President, Society of Radiology Physician Extenders) discussed the role of the Radiologist Assistant (RA). The RA is a “mid-level provider” role with practice standard oversight from the American Society of Radiologic Technologists. They can perform certain invasive and non-invasive radiologic procedures, administer medications and report initial observations to the radiologist. However, recognition and funding of the RA role is an issue in the US, since it is currently not recognised under the social security act where other similar roles, such as Physician Assistants, are.

There were many excellent oral presentations, three of my favourites are highlighted below but abstracts for the full conference have been published in JMIRS (September 2018. Vol.49; No.3S).

Kristie Matthews: Kristie described her doctoral work examining the barriers to AP in Australia. She is using a qualitative grounded theory approach and has found that issues of identity and self-concept can have a significant impact on the uptake and sustainability of new AP roles. Her work suggests that expectations around the changing identity of the new AP need to be managed and standard for all stakeholders or the role may not be sustained.

Grace Lee: Grace neatly summarised the impact a CSRT (or AP) can have on a program. She works in the Princess Margaret Cancer Centre’s breast rapid access radiotherapy clinic (QuickStart). The new model of care incorporating a CSRT (performing target delineation, expediting appointments, reviewing patients and managing side effects) has reduced wait times dramatically for breast treatment, patients in the program receive radiotherapy on average 11 days sooner than standard patients.

James Harcus: James demonstrated a novel way of educating radiographers to advance their clinical skills. The Clinical Academy for Radiographer Reporting program (CARR) is an intensive 9 month course at the University of Bradford (UK) that educates medical imaging practitioners to report musculoskeletal images. The program also encourages attendees to develop an appreciation of the other pillars of AP (expert clinical practice, professional leadership and consultancy, education training and development and practice and service development, research and evaluation).

Several workshops were also held at the conference on the following subjects:

  • Technologist peer review for image quality improvement in general radiogaphy
  • An introduction to image interpretation of the appendicular skeleton
  • Recognizing advanced practice
  • Leadership skills

Some highlights from the panel discussions were:

  • AP roles work synergistically with other professions, there shouldn’t be a competition – radiographers have a unique skill set.
  • All four of the so-called “pillars” of AP are important (and Australia has seven!) – but clinical excellence seems to be the most referenced. The focus on each of them can vary from day to day and role to role but fulfilling them all is important.
  • Research is important! We could call it evidence-based practice but its key to improving patient care.

The main conference themes that emerged were impact and evidence. Demonstrating the impact of AP roles and publishing the evidence. Building connections across the world to make the evidence stronger. Learning from each other to see what impact different roles in different areas can have. These weren’t the official themes, but they came across loud and clear.

The conference closed with thanks to Cate Palmer and the local organising committee. Cate announced that LTWRAP 2020 will be held in Australia.

More conference highlights can be viewed with the Wakelet Twitter summary.

Contributed by: Amanda Bolderston RTT, FCAMRT, University of Alberta

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