National Forum on ChangingEntry-to-Practice Requirements

Professional Panel

Canadian Association of Medical Radiation Technologists (CAMRT)

Claire Hatch Roberta McCammond

Richard Lauzon Debbie Bolger-Ingimundson

Ottawa April 2003

Addressing three questions today:

• Plans to change entry requirements?

• Rationale for the change?

• Challenges and issues identified by CAMRT in achieving its plans?

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.

CAMRT National / Provincial Federation Structure

Association

Individual Members

Association

Individual Members

Association

Individual Members

Federation

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

Budget Invested in Education Programs, 2002

• Education (total):$742, 759

• Certification:$290,000

• Continuing education: $275,000

CAMRT Budget 2002$2,190,770

9%

23%16%

19%

33%

Administration

Communications

Education

Finance

Member Services

Plans to change entry requirements?

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

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.”

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

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)

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)

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)

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.

Rationale for the change?

• Environmental forecast

• The changing workplace

• Emerging independent roles for MRTs

• Benefits to:– Patients

– Technologists

– Management

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

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.

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

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

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

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

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

Degree-entry as a Benefitto Technologists

• Maximizes application of education and experience to benefit patients

• Enhanced roles promotes > job satisfaction

• Greater job flexibility, natl. / intl. mobility

• More competitive for managerial positions

• Offers broader career ladder: specialization, education, management, research

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

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.

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

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

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