Abstract
Selection of suitable students into graduate medical and specialist health professional courses can be difficult. Historically, selection of students was primarily based on prior academic performance. Recently, however, more emphasis has been placed on considering broader academic backgrounds and personal characteristics and attitudes of students, but no reliable measurement tool is available to predict student success and satisfaction with their choice of profession. The aim of this study was to survey practising radiation therapists in Australia to seek their opinions regarding suitable selection criteria for graduate entry radiation therapy (RT) students in order to optimize selection procedures for future applicants. Four hundred questionnaires were sent to nine RT centres in three states within Australia. All nine clinics participated in the survey and 189 questionnaires were returned. Results show that the majority of radiation therapists place a high level of importance upon a sound knowledge of physics and mathematics, as well as life experience, and agree that a visit to an RT clinic plus an interview comprise important components of the selection process. Humanities, psychology and a psychometric test were not viewed as essential entry requirements. Experienced radiation therapists placed less value on academic performance in the primary degree and were more likely to include an interview as a selection criterion than junior practitioners. Empathy for patients was identified as the most important personal attribute. It is thus recommended that not only cognitive but also personal skills be evaluated during the selection of prospective radiation therapists.
Introduction
Radiation therapy (RT) demands high levels of technical knowledge, particularly in physics and mathematics, coupled with a desire and ability to work with seriously ill patients and their families within a multidisciplinary team. On the basis of the current national shortage of radiation therapists in Australia (Baume, Citation2002), Monash University recently developed the ‘Master of Radiation Therapy’. This course was designed to allow graduates from a range of academic backgrounds to study radiation therapy. Students are fully accredited by the Australian Institute of Radiography (AIR) upon completion of the two-year course (six semesters). Given the range of technical and cognitive skills, as well as the emotionally demanding nature of this profession, it is imperative that only dedicated and well-informed students are enrolled into the course. This will facilitate low student attrition throughout the course and ensure that graduates maintain a successful and fulfilling working life. Successful entry into the course is currently based on secondary academic achievement, primary tertiary degree (at least one semester of physics), a visit to a radiation therapy clinic and an interview. However, little information is available in the literature that permits accurate prediction of a student's suitability for and success in radiation therapy. As with medicine and other allied health professions, personal qualities and previous life experiences that drive the motivation of these students to study radiation therapy are considered important criteria in shaping competent future professionals. These may even be more important than academic success in high school or academic success during the primary degree (Sefton, Citation2004; Wilkinson et al., Citation2004; Elliot & Epstein, Citation2005). Furthermore, it has been argued that widening access to graduate medical and other health courses may achieve a greater social and cultural diversity of students and allow entry into the profession to more mature students with broad backgrounds who may be better able to fulfil the emotional and general demands of the profession (Powis et al., Citation2004). While some research into attributes of prospective graduate medical students has been carried out, there is no information available on academic and personal attributes of graduates wishing to embark on a career in radiation therapy. Hence, we undertook this study in order to survey practising radiation therapists and collect information on criteria (academic and personal) that are considered important prerequisites for the competent practice of the profession.
Materials and methods
Questionnaire
A survey questionnaire was developed for this project. The questionnaire was divided into four sections. The first section collected demographic information on the responders (gender, professional qualifications attained, years of experience, current professional role). The second section asked the respondents to rate on a five-point Likert scale (not sure, not important, somewhat important, important and very important) how important specific academic subjects are as prerequisites for RT (biomedical science, physics, mathematics, psychology, humanities/arts). In the third section, the questionnaire addressed personal attributes that are deemed necessary in order to be a successful and competent professional. Respondents were asked to list as many attributes as they liked. Finally, the questionnaire asked respondents to rate a number of selection criteria for students wanting to enter RT on a five-point Likert scale (as above). Selection criteria included: excellence at high school, excellence at tertiary course, interview, a visit to a radiation therapy clinic, life experience, prior understanding of RT and the use of a psychometric test.
The questionnaires were sent to nine RT centres in Australia, five in Victoria, one each in Western Australia and Queensland and two in Tasmania. These nine clinics participate in the clinical supervision of our students and are informed about the graduate entry course. All centres agreed to take part in the survey. Each centre was asked to provide an approximate number of radiation therapists currently practising at the centre. Due to changing numbers of full-time, part-time and casual staff over the course of this project, exact numbers could not be established. Hence, each centre received about 10–15 additional questionnaires above the numbers estimated. All participating radiation therapists were asked to complete the questionnaire, place it in a sealed envelope and drop it into a collection box located at each clinic. The boxes were collected by one of the investigators during clinical visits or returned by mail. Only de-identified information was collected. Approval for this survey was given by the Standing Committee on Ethics in Research involving Humans at Monash University, as well as all institutional ethics committees associated with the nine clinics.
Statistical analysis
Differences in proportion of respondents’ rating for each criterion were analysed using a chi-squared test. Where frequencies of individual criteria to be analysed fell below 10, a Fisher's Exact Probability test was used instead. Significance was afforded when p < 0.05. All analyses were carried out using SPSS (version 12.0, Chicago, USA).
Results
A total of 189 questionnaires were returned from nine RT centres approached to participate (47.3%). The demographic characteristics of the 189 respondents are given in . Forty-five (23.8%) respondents were males and 136 (71.9%) had more than five years experience as radiation therapists. The majority had only undergraduate education (139; 73.5%). Seventy-five (40.1%) were employed in managerial positions.
Table 1. Demographic characteristics of survey participants (Total n = 189)
gives the scores obtained for the importance of a number of selection criteria for graduate RT students. Both secondary and tertiary performance was scored highly by the majority of respondents, as was ability in physics and mathematics. Almost half of the respondents valued prior knowledge in biomedical science, while subjects such as humanities/arts and psychology were viewed as less important prerequisites by most of the respondents. An interview plus a visit to an RT clinic were identified as the most important components of the selection process. Use of a psychometric test was not favoured by the majority of radiation therapists surveyed.
Table 2. Importance of subjects/criteria for the selection of graduate entry radiation therapy students according to practising radiation therapists
When the data were split into least and most experienced radiation therapists, significant differences were detected in two criteria (). Excellence in tertiary education was viewed as less important by experienced radiation therapists than by junior radiation therapists (59.6% vs. 77% respectively, p = 0.05), whilst the use of an interview during the selection process was scored as important or very important by more of the experienced than the junior practitioners (94.1% vs. 61.6% respectively, p = 0.002). Mathematical skills were valued more highly by the experienced practitioners but the difference between experienced and junior staff did not reach statistical significance (69.1% vs. 38.5%, p = 0.1).
Table 3. Criteria rated as important or very important by practising radiation therapists in the selection of graduate radiation therapy students, according to professional experience (total n = 189)
When asked what subjects/skills required more in-depth education prior to a career in RT, 43 respondents identified several areas of study (). Thirteen respondents wanted to see more education in imaging anatomy, while 10 and eight respondents felt that students needed more knowledge in communication and English-language skills respectively. Other subjects identified included physiology, pathology and IT skills.
Table 4. Subjects perceived by practising radiation therapists (RT) as requiring more in-depth education of RT students (total n [survey respondents] = 43)
lists the most commonly stated personal attributes of a competent radiation therapist. Empathy for the patient was considered the most important characteristic (selected by 123 [67.5%] of all respondents). Further important attributes included good communication skills, ability to work in a team and being able to integrate technical/scientific concepts (49.5%, 45.6% and 23.6% respectively).
Table 5. Personal attributes important for the competent practice of radiation therapy (total n [survey respondents] = 182)
Discussion
To our knowledge this is the first study to investigate professional radiation therapists’ evaluation of cognitive and personal characteristics of prospective radiation therapy students. An earlier paper comparing interest patterns between radiographers and radiation therapists identified that both groups are practical and strongly orientated towards science and technology. However, radiation therapists displayed significantly higher interest towards others (Care, Citation1991). This study, however, investigated only small numbers of male practitioners and the criteria used to identify interests were very broad and non-specific. In many ways, radiation therapists require similar academic and personal characteristics to medical practitioners. Both groups need to grasp complex physiological and scientific concepts, and both need to be able to work in a multidisciplinary team while caring for patients through treatment and therapy. The difficulties encountered by medical schools in selecting appropriate students into medical degree programmes are comparable to those of other schools engaged in the training of prospective radiation therapists. The same arguments in favour of graduate medical degrees can hence be put forward for the graduate RT course.
It is generally accepted that selection of medical students onto graduate courses based on academic performance alone, in particular scientific subject selection, is not sufficient to guarantee the production of competent, ethical and compassionate professionals (McManus et al., Citation2003; Powis et al., Citation2004). The rationale in favour of graduate entry into medicine used by universities includes arguments such as increased motivation, better ability to make career choices, broader education and better suitability of ‘older students’ to engage in problem-based learning (PBL) curricula (Powis et al., Citation2004; Sefton, Citation2004). A diverse academic background may even improve a student's performance throughout a medical course. In fact, several studies have shown that graduate medical students who present with a background in both humanities and sciences perform better than those with a pure science background with regard to overall examination results. They are also twice as likely to complete their degrees (Rolfe et al., Citation1995; Albanese et al., Citation2003; Searle & McHarg, Citation2003; Stratton et al., Citation2003; Craig et al., Citation2004). Female students perform better than male students during these years. Female students have also been shown to be more empathetic and possess better developed communication skills than male students (Lumsden et al., Citation2005). However, the results of these studies are limited as most of them followed their students only into the intern year and little information is available on their ‘success’ and competence in the later stages of their career. It is important to gather information on characteristics that shape a competent professional as seen by those working in the profession. Based on such data, selection procedures can be formed that allow these characteristics to be included in the selection process.
According to the opinions of professional radiation therapists, students need to display an aptitude for mathematics and physics. It is interesting that those radiation therapists with the most experience valued mathematical skills more than the most junior practitioners. This results contrast with those obtained for overall tertiary performance where more of the junior practitioners placed high value on the academic outcomes than those practitioners with several years’ experience in the profession. Overall though, both secondary and tertiary performance appears to justify inclusion in the selection of prospective students, as do a visit to an RT clinic and an interview, which was considered a vital part of student assessment. This result underlines another outcome of this survey, namely that a student's empathy for the seriously ill patient is the most highly valued personal attribute. The majority of respondents valued highly characteristics such as communication skills, people skills and working in a team. Several answers included statements such as ‘academic excellence is not important’ and ‘students need to have a desire to work with patients’. Some mentioned that students are too focused on their academic achievements during the course (test scores) rather than on developing their ability to deal with patients and other team members.
Since it is impossible to assess accurately qualities such as ‘empathy’ and ‘desire to work with patients’, we need to find alternative avenues that may help identify a student's personal make-up and inclinations. An interview conducted by experienced professionals seems the optimal strategy to use in this setting. However, the use of an interview to assist selection of graduate students can be problematic and results recorded in the literature have been mixed. One study has demonstrated that an objective structured interview, when used as part of the overall selection process, can have significant predictive validity (Powis et al., Citation1988). This study showed that an interview can predict which students failed to complete the course and which students achieved honours. A similar study at our institution, assessing the California Psychological Inventory as an interview tool among medical students in 1991 and 1992, showed that this test was able to accurately measure personal attributes of medical students (Tutton, Citation1993). However, the studies by both Powis and Tutton analysed undergraduate medical students and the outcomes reported may not apply to mature-age students with prior tertiary degrees. Further, long-term outcomes of these studies are not available.
One can argue that age per se at entry into a course may affect the performance of graduate students since maturity and life experience can positively affect selection and performance during the course and may also facilitate the timely development of effective clinical skills. Evidence to support such arguments was provided by a recent study headed by Wilkinson et al. (Citation2004), who surveyed 587 undergraduate and graduate medical students at Christchurch School of Medicine and Health Sciences. The aim was to assess whether a prior degree or age at entry was significant in terms of overall success. Results have shown that having a prior degree is positively associated with being an achiever, being assertive, cooperative, motivated and goal orientated. However, all of these associations were confounded by age at entry to the medical course. This is interesting, as all of the qualities that contribute to a student's success appear to relate to age per se, and not to prior degree or type of degree. So, could life experience itself be a contributing factor, rather than the primary degree obtained? Should mature-age students, then, be allowed entry, even if they have not attained prior tertiary qualifications? And what is the optimal age range for potential applicants? Is there a maximal age beyond which learning styles become resistant to change and a smooth integration into clinical environments becomes problematic? Such questions remain unanswered and require further research. The use of a ‘Personal Qualities Assessment’ tool, which measures a combination of cognitive abilities, personality traits and moral/ethical reasoning, has shown promise in facilitating selection of medical students (Lumsden et al., Citation2005). However, more long-term research is needed into this test, especially among graduate medical students, before it can find broad use among a range of universities. It remains untested among radiation therapy students.
Finally, it is important to mention that students mature as they progress through a course regardless of their maturity or age at entry to the course. The process of studying and engaging with professionals and patients awakens and develops inherent attributes that are needed during professional practice. This process is further stimulated by courses that are embedded in a reflective practice paradigm, in contrast to the more traditional ‘technoist’ approach to teaching and learning, which does not touch on psychosocial elements of the profession but remains focused solely on the technical details of delivering therapy. Hence, by interacting with patients and becoming engaged in PBL and case-based learning, students can enhance their personal development, attitudes and values, including communication skills and empathy (Holm & Aspegren, Citation1999). The ‘novice-to-expert model’ of teaching further allows students to interact with experienced practitioners and to develop their factual knowledge base into a more holistic approach to patient care, integrating patients’ well-being and suffering. Hence, a course appropriately designed to incorporate PBL, coupled with immediate exposure to the clinical environment and patients, will facilitate the appropriate development of maturity and empathy necessary for practice. As such, the initial selection process should also assess a student's potential to further develop personal attributes.
In conclusion, the study has highlighted that selection procedures for graduate radiation therapy students have to be multi-focal, including traditional assessment of academic performance in secondary and tertiary institutions, as well as an interview to assess intrinsic qualities and motivational factors of applicants. Before admission of students, it is highly recommended to arrange a visit to a clinic, possibly linked to a period of work experience where not only can the student experience the day-to-day life in a RT clinic, but where experienced radiation therapists can observe and assess a student's suitability and desire to embark on this profession.
Additional information
Notes on contributors
Michal Schneider-Kolsky
MICHAL SCHNEIDER-KOLSKY, PhD, is senior lecturer and head of research at the Department of Medical Imaging & Radiation Sciences at Monash University. Research interests include: musculoskeletal imaging of sports injuries, bioeffects of doppler ultrasound during pregnancy and postgraduate education of health professionals, especially implementation of evidence-based practice and research in clinical practice.
Caroline Wright
CAROLINE WRIGHT, radiation therapist, is Convenor of the Master of Radiation Therapy at the Department of Medical Imaging & Radiation Sciences, Monash University. Research interests include the notion of fitness to practice and the implementation of evidence-based practice in radiation therapy.
Marilyn Baird
MARILYN BAIRD, PhD, is an Associate Professor and Head of the Department of Medical Imaging & Radiation Sciences at Monash University. Her research interests include development of optimal educational and assessment tools for radiography and radiation therapy students, in particular student-orientated learning using online resources and role extension of radiographers.
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