Caruana Carmel Final Results of the

Report
Final Results of the ‘European
Guidelines on Medical Physics Expert'
Project
Carmel J. Caruana
EFOMP Past-Chair, Education and Training
EFOMP representative on European Guidelines on the Medical Physics
Expert, MEDRAPET and EUTEMPE-RX projects
Medical Physics Department, Fac. of Health Sciences, University of Malta
[email protected]
• Methodology
• European Qualifications Framework (EQF)
• Summary of results
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–
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Definition of an MPE
Mission statement of the MPE
Definitions of key activities of the MPE
Qualification framework for the MPE: Need for early
specialization
– Inventory of learning outcomes for the MPE
– Recommendations for recognition
– Staffing levels for MP and MPE
• What next? The EUTEMPE Project
2
Methodology
• Comprehensive debate among the members of
the consortium taking into account:
– European documentation (directives, qualification
frameworks)
– The results of a survey on the MPE in Europe
– The previous EFOMP qualification framework for
MPs/MPEs (Policy Statement 12, 2009)
– MP/MPE qualifications frameworks in various states
– Work of specific workgroups set up by the consortium
– Results of a European workshop (Seville). Invitees
included representatives of European national Medical
Physics organizations and other stakeholders e.g., EC,
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IAEA, ESR, EANM, ESTRO, EFRS, WHO …
European Qualifications
Framework (EQF)
• European Qualification Framework European Parliament and Council 2008/C
111/01
• Educational levels: levels 1 to 8, 8 is the
highest level, definitions of each level
• Curricula: Learning outcomes to be
expressed in terms of: knowledge, skills and
competences (KSC). The term ‘competence’
refers to ‘responsibility and autonomy’
4
Definition of EQF Level 8
Knowledge at the most advanced frontier of a field of
work and at the interface between fields, the most
advanced and specialised skills and techniques,
including synthesis and evaluation, required to solve
critical problems in research / innovation and to
extend / redefine existing professional practice,
demonstrate substantial authority, innovation,
autonomy, professional integrity and sustained
commitment to the development of new ideas or
processes at the forefront of work contexts including
research (EQF)
5
Definition of MPE
• Legal definition: 2013/59/Euratom: Medical physics expert means an
individual or, if provided for in national legislation, a group of
individuals, having the knowledge, training and experience to act or
give advice on matters relating to radiation physics applied to medical
exposure, whose competence in this respect is recognized by the
competent authority
• Guideline definition: An MPE is an MP who has achieved EQF Level 8
in one or more of the following specialties of Medical Physics:
– Diagnostic and Interventional Radiology
– Nuclear Medicine
– Radiation Oncology
• ‘Group of individuals’: Given the ongoing rapid advances in technology
it is becoming increasingly difficult for an individual to be MPE in all
three specialties. Hence individual MPEs are increasingly being
replaced by groups of MPEs in different specialties of Medical Physics
which together provide a full MPE service.
6
Mission Statement
“Medical Physics Experts will contribute to maintaining and
improving the quality, safety and cost-effectiveness of
healthcare services through patient-oriented activities
requiring expert action, involvement or advice regarding the
specification, selection, acceptance testing, commissioning,
quality assurance/control and optimised clinical use of
medical radiological devices and regarding patient risks
from associated ionising radiations including radiation
protection, installation design and surveillance, and the
prevention of unintended or accidental exposures; all
activities will be based on current best evidence or own
scientific research when the available evidence is not
sufficient. The scope includes risks to volunteers in
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biomedical research, carers and comforters”
11 Key Activities for MPs/MPEs
(derived from revised 2013/59/Euratom, survey, workshop)
•
•
•
•
•
•
•
•
•
•
•
Scientific Problem Solving Service,
Dosimetry Measurements (ionising radiation and other physical agents as
appropriate)
Patient Safety / Risk Management (including volunteers in biomedical
research, carers, comforters and persons subjected to non-medical imaging
exposures),
Occupational and Public Safety / Risk Management (when there is an impact
on medical exposure or own safety),
Clinical Medical Device Management (particularly specification, selection,
acceptance testing, commissioning and quality assurance including quality
control),
Clinical Involvement,
Development of Service Quality and Cost-Effectiveness,
Expert Consultancy,
Education of Healthcare Professionals (including Medical Physics trainees),
Health Technology Assessment (HTA) and
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Innovation.
Qualification Framework for the Medical Physics Expert (MPE) in Europe
MPE: “An individual having the knowledge, training and experience to act or give advice on matters relating to radiation
physics applied to medical exposure, whose competence to act is recognized by the Competent Authorities” (Recast BSS)
The Qualifications Framework is based on the European Qualifications Framework (EQF). In the EQF Learning Outcomes
are defined in terms of Knowledge, Skills, Competences (KSC) (European Parliament and Council 2008/C 111/01)
EDUCATION
CLINICAL TRAINING
EQF Level 6
EQF Level 7
(e.g., Bachelor
with 180 - 240
ECTS)
(i)
(e.g., Master
with 90 - 120
ECTS)
(iii)
Physics
or
equivalent
(ii)
Medical
Physics*
or
equivalent
(iv)
ADVANCED EXPERIENCE
and CPD
Clinical Certification as
Medical Physicist in a
given specialty
EQF Level 8 in
Medical Physics Specialty
(v)
(vii)
Structured accredited
clinical training residency
in the specialty of
Medical Physics in which
the candidate seeks
clinical certification. The
duration should be
typically two full-time
year
equivalents**
Structured accredited
advanced experience and
CPD in the specialty of
Medical Physics in which
the candidate seeks
certification as MPE. The
duration would be an
additional minimum of
two full-time year
equivalents***
(vi)
RECOGNITION
By Competent
Authority as MPE in
Medical Physics
specialty
(ix)
RE-CERTIFICATION
5 year CPD cycle
(x)
(viii)
* Should include as a minimum the educational components of the Core KSC of Medical Physics and the educational components of the KSC of
the specialty of Medical Physics (i.e., Diagnostic & Interventional Radiology or Nuclear Medicine or Radiation Oncology) for which the candidate
seeks clinical certification. When this element of specialization is not included it must be included in the residency.
** The EQF level of the residency is intermediate between EQF levels 7 and 8.
*** In states where the MPE is required to be certified in more than one specialty of Medical Physics the number of years would need to be
extended such that the MPE will achieve level 8 in each specialty.
KSC Inventory: Methodology
• We analyzed the duties of the MPE in the recast
BSS
• Three expert groups (one in each of the three
Specialties i.e., Diagnostic & Interventional
radiology, Nuclear Medicine, Radiation
Oncology) independently produced inventories
of KSC for their respective areas.
• A coordinator was responsible for integrating the
three inventories into a single coherent
document and to ensure that the final document
is in agreement with good curricular practice and
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the recommendations of the EQF.
INVENTORY of
900 KSC
Most
comprehensive
inventory
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KSC Specific to D&IR
Knowledge
Comprehensive Scientific Problem Solving Service
1.
2.
3.
4.
5.
List statutory and institutional requirements for
1.
Medical Physics Services in Diagnostic and
Interventional Radiology with respect to
Comprehensive Physics Problem Solving
Service.
List the common imaging modalities (projection
x-ray imaging, fluoroscopy, CT, CBCT, MRI,
ultrasound) and explain their function as
instruments for the measurement, mapping and
imaging of the spatial distribution of different
2.
physical variables within the human body.
Discuss the advantages and disadvantages of
imaging as a means of displaying spatially
dependent signals and variables.
Explain in detail the principles of image quality 3.
measurement: linear systems theory, types of
contrast (subject, image and display),
unsharpness (LSR, PSF, LSF, MTF), lag, noise
(including sources, noise power spectra, effect of
lag on noise, noise propagation in image
subtraction), SNR ….
Explain inverse problem mathematical
techniques used in image reconstruction….
Skills
For each modality, operate
1.
imaging devices at the level
necessary for giving advice on
optimization of imaging
protocols, quality control,
image quality manipulation, and
carry out research when the
available evidence for advice is
not sufficient.
For each modality predict the
effect on image quality and
diagnostic accuracy when
2.
changing scanning and
reconstruction parameters.
Manipulate acquisition
parameters for all forms of
projection x-ray imaging
devices (e.g., kV, filtration,
mAs, sensitivity (‘speed’),
collimation, magnification, SID,
SSD, frame rate, screening time,
manual/AED modes,
compression), explain the effect
on image quality and relevant
patient dose quantities …
Competence
Take responsibility for
statutory and
institutional
requirements for
Medical Physics
Services in Diagnostic
and Interventional
Radiology with respect
to Comprehensive
Physics Problem Solving
Service.
Carry out or supervise as
appropriate the
measurement of physical
quantities relevant to the
effective, safe and
economical use of
medical devices /
ionising radiations
(includ. other physical
agents as approp.) in
Diagnostic and
Interventional
Radiology…
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Recommendations on
Recognition of MPE
•
•
•
•
•
•
•
Each Member State should consider designating, through a legal instrument, a
Competent Authority specifically for the recognition of the MPE.
Recognition should be achieved by registration. It is highly recommended that a
professional register should be kept by an official authority (e.g. Ministry of Health or
Radiation Protection Authority). This task could also be delegated to a professional
body such as professional medical physics societies if an official mandate is given.
The Competent Authority designated for the recognition of the MPE, should use the
Qualifications Framework and KSC of the MPE specified in the present document, for
the recognition of the MPE to Level 8 of the EQF.
The educational establishments of each Member State involved in medical physics
education and training should use the KSCs of the present guidelines.
To allow the mobility of the MPE between Member States, it is recommended that the
education and training of each MPE be recorded in a document that can be used as
proof of the recognised competence.
MPE education and training requires formal steps that should be implemented by the
competent authorities as recommended in the Qualification and Curriculum
Frameworks to be found in this document.
It is highly recommended that MPE recognition should be overseen by a joint board of
experts from the various stakeholders (i.e. Ministry of Education, Ministry of Health, 13
Radiation Protection Authorities and Professional Societies, as appropriate).
Staffing Levels
• To ensure adequate protection of the patient it is essential to have
the appropriate number of MPEs and supporting staff
• Need a certain number of Whole Time Equivalents (WTE) of medical
physicists (MPS) out of which a certain number are MPE
• The number of MPS and MPE required will depend upon the number
and type of equipment and their complexity together with the amount
of patient activity
• Minimum number of MPS and MPE required
• Calculation of number of MPS/MPE based on factors depending on:
– Type of devices
– Number of patients
– Type of services
– Other activities e.g., research
• Excel worksheet for automatic calculation
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Equipment Factors
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What Next? EUTEMPE-RX
• We urgently need an agreed programme of education
and training that would lead an MP to MPE in each
specialty as specified in the ‘Guidelines on the MPE’
document and to level 8 of the EQF.
• EUTEMPE-RX (EUropean Training and Education for
Medical Physics Experts - Diagnostic and Interventional
Radiology) - new EC funded project is setting up such a
programme for MPEs in D&IR (to be followed by others
in NM and RO) www.eutempe-rx.eu
• First Module: Development of the profession and the
challenges for the MPE (D&IR) in Europe.
Prague 9 – 13 February 2015
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Module MPE01: Development of the profession and the challenges for the MPE (D&IR) in Europe
Aims: This module aims to help the future MPE (Diagnostic and Interventional Radiology) acquire the knowledge, skills
and competences necessary to exercise a leadership role within the profession in his own country and in Europe. The
content of the module would address the development of the role of the MPE in D&IR in its entirety and would inform
and provide a framework for discussions for all the other modules. In the face-to-face phase participants will have the
opportunity to discuss the major issues directly with the present European leaders of the profession. The participants
would also be updated with the latest EU directives, guidelines and activities impacting the role to ensure they are at
the forefront of these developments.
Learning Outcomes:
MPE01.01
MPE01.02
MPE01.03
MPE01.04
MPE01.05
MPE01.06
MPE01.07
MPE01.08
MPE01.09
MPE01.10
MPE01.11
MPE01.12
MPE01.13
Take responsibility for researching, evaluating, leading, and offering vision for the professional development of the role of
the MPE (D&IR,) in the ambit of European and national legislation and a holistic vision of healthcare.
Implement and evaluate strategic solutions to the challenges facing the MPE (D&IR) in own country and Europe.
Evaluate the various models of management suitable for a Medical Physics Service including the issue of staffing levels.
Take responsibility for researching, evaluating, leading, and offering vision for the development of the role of the MPE
(D&IR) in advancing service quality and clinical governance in D&IR.
Take responsibility for ethical issues in the area of radiation protection in D&IR and apply them in practice.
Discuss the role of the MPE (D&IR) in health technology assessment (HTA), innovation and expert consultancy.
Research, develop and lead the development of the role of the MPE (D&IR) in the education and training of medical physics
trainees and other healthcare professionals.
Manage inter-professional issues in D&IR.
Manage priorities regarding radiation protection research and medical physics input to clinical research projects needing the
support of MPEs.
Implement safety culture in their management practice.
Participate in networks for research and development at the European level.
Take responsibility for the role of the MPE (D&IR) in accidental and unintended medical exposures in D&IR and radiation
accidents.
Interpret the significance of liaising with the Radiation Protection Expert
Date and Location of Face-to-Face Component: Prague 9 – 13 February 2015
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References
European Commission
RP174 European Guidelines on the Medical Physics
Expert
http://ec.europa.eu/energy/nuclear/radiation_protection/
doc/publication/174.pdf
Phys Med. 2014 Sep;30(6):598-603
European Federation of Organisations for Medical
Physics (EFOMP) Policy Statement 12.1:
Recommendations on Medical Physics Education and
Training in Europe 2014.
Caruana CJ, Christofides S, Hartmann GH
Carmel J. Caruana, Medical Physics, Faculty of HealthSciences, University of Malta
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I would love him more
if he’s an MPE of
course!
Thank you
for your
attention!
19

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