|Year : 2022 | Volume
| Issue : 4 | Page : 409-411
Audit methodology for medical physics clinical training programs
Arun Chougule1, Gourav Kumar Jain2
1 Swasthya Kalyan Group, Jaipur, Rajasthan, India; Chairman, IOMP Accreditation Board, Fairmount House, YORK, UK
2 Department of Radiological Physics, SMS Medical College and Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||10-Jan-2023|
Prof. Arun Chougule
Swasthya Kalyan Group, Sitapura, Jaipur - 302 022, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chougule A, Jain GK. Audit methodology for medical physics clinical training programs. J Med Phys 2022;47:409-11
Author: The IAEA officer responsible for this publication was Giorgia Loreti of the Division of Human Health.
Edition: First Edition
Publisher: International Atomic Energy Agency
Place: Vienna, Austria
IAEA Training Course Series No.: 74 (IAEA-TCS-74)
Publication Type: Educational and Professional
Publication Section: Quality Assurance Section, Division of Human Health, International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria. Email: [email protected]
Year of Publication: 2022
Number of Chapters: 8
ISSN: 1018–5518 (print)
Clinically qualified medical physicists (CQMPs) working in the clinical environment are health professionals as per the International Labor Organization and the World Health Organization classification. They contribute to the safety, quality, and effectiveness of the diagnosis and treatment of patients in radiation medicine. The course of medical physicist education should have a well-structured curriculum, supervised clinical training programs (CTP), and thereafter certification to produce CQMPs. The medical physics training programs are often lacking formal structured CTP and this is detrimental to the recognition of CQMPs.
In the past decade, International Atomic Energy Agency (IAEA) has received an increasing number of requests from IAEA member states on guidance for the establishment of medical physics education programs. Furthermore, the need for this document is identified by the IAEA from a series of reviews conducted interregionally under the technical cooperation program. The aim of this publication is to describe a standardized methodology for auditing medical physics CTP. This publication provides information of major components that supports best practices in the CTP of medical physicists. The audit methodology of this publication covers all the specialties of medical physics (e.g., diagnostic radiology, nuclear medicine, and radiation oncology) and all types of CTP. The IAEA officer responsible for this publication is Giorgia Loreti of the Division of Human Health.
This IAEA publication is a complete and resourceful document with plenty of information provided for audit methodology for medical physics CTPs. The IAEA publication has been divided into eight sections to deal with various aspects of audit methodology for medical physics CTP. Twelve appendixes are provided with various templates, checklists, and forms to serve the purpose of the publication with ease of use and better understanding of audit methodology. This publication is a very useful document not only for IAEA member states but also regulators, accreditation boards, medical physics training institutions, and various medical physics professionals involved in CTPs of medical physics.
| Section 1: Introduction|| |
The introduction section is divided into four subsections background, objective, scope, and structure. Background represented the education pathways through which CQMPs acquire knowledge, competency, and formal recognition. Illustration in the form of [Figure 1] is reproduced for ease of understanding for readers for the recommendations on minimum requirements for the academic education and clinical training of CQMPs. The importance of structured and supervised CTP and certification are described in the background with citations of references concerned with the subject. The primary objective of this publication is to promote the quality improvement of CTPs, irrespective of their content, structure, and medical physics specialty. Part of this methodology may also be used for self-assessment, in preparation for an audit, or as a practice to support the monitoring of the quality of a CTP. The scope of this publication is to identify the existence of structured procedures (independently of their type) and their implementation according to best practices within a CTP, with the aim of providing peer review and feedback for improvement. Structured CTPs in medical physics that undergo regular peer review are rare globally and therefore benchmarking to international best practices is challenging. Consequently, this publication also serves the purpose of providing guidance and support in harmonization.
| Section 2: The Audit Methodology|| |
The audit methodology section is divided into three subsections: CTP in medical physics, roles and responsibilities in the audit process, and audit of the CTP. The primary aim of an audit is to support improvements based on recommendations. In addition, the audit process provides accreditation, designation of CTP as a recognized training center at the national or interregional level, and expansion or restructuring of an existing CTP. Competency in CTP in medical physics often lacks due to reasons such as unavailability of infrastructure, equipment, and/or procedures (such as brachytherapy service) and clinical supervisor(s). Moreover, structured hands-on training activities for residents are unavailable due to collaboration among universities and hospitals. The audit is a voluntary peer-review process for improvements in the competency of CTP in medical physics. The audit requestor is generally in charge/head of the CTP. The audit coordinator is the person who receives the audit request and organizes the audit. Sometimes, it can be an independent authority such as IAEA. The auditees are the recipient of outcomes of the audit, generally head and clinical training supervisors of CTP. Different roles in the audit process are summarized in [Table 1]. This section also describes the roles and responsibilities of various persons involved in the audit process.
| Section 3: Audit Structure|| |
The audit structure section is classified into four major parts, namely request for an audit, contextualization of the CTP, details of the CTP, and monitoring of the CTP. The complete audit methodology is presented in [Figure 2]. This section provides a number of documentation required for the audit of CTP. These documents mainly include curriculum, details of supervisors, resources, medical physics specialty, number of residents, link to academic programs, etc., More importantly, the audit structure includes strengths, weaknesses, opportunities, and threats analysis table filled in by the head of the CTP for analysis. This section also provides typical documentation in various areas for supporting audit requests and these are provided in [Table 2] of the report. Further, the insight into the basic components of evaluation performed by auditors is explained meticulously. The salient elements for evaluation are academic programs linked to the CTP such as the memorandum of understanding, structure, hospital support of the CTP, availability of equipment and procedures, organograms of the departments, adequacy of radiation protection services, infrastructure for conducting research, availability of support in professional ethics support in the hospital and sustainability of the CTP in the form of connection to a national context with respect to the needs of the Ministry of Health; quality management to produce a health workforce with appropriate and adequate competencies; recognition of the profession and financial sustainability.
The publication represented the fact that the number of residents should not exceed the number of CQMP in the department; however, this may vary as per local needs including department workload. Moreover, there is a clear reference to a ratio of residents to supervisors of 2:1. Consequently, a variability that takes into account the local conditions is expected; however, overloading supervisors may impact the quality, effectiveness, and sustainability of clinical training. Therefore, sustainability of the supervision of residents is generally ensured through (a) limiting the number of residents per supervisor and (b) allocating dedicated time to the supervisor for such tasks. Further, the auditors also assess the standardization of the final examination process (es). The monitoring of CTP is conducted using documented absorption of former residents as CQMP in hospitals and systematic feedback mechanisms from residents and supervisors for guiding toward corrective measures, involvement in audits or accreditation.
| Section 4: Audit Communication Management Strategy|| |
This section discusses about the audit communication strategies of the audit coordinator (whose role is comparable to the one of a project manager). The audit communication strategy may be in form of table, a short text, or a combination of both. The strategy typically includes purpose, in brief, a list of involved stakeholders with contact details; roles and responsibilities with respect to communication; a list of communications methods, tools, and software such as electronic mail, meetings, videoconference tools, and presentations; structure of the reports and their level of confidentiality; timing and main deadlines for communication and reporting to happen; point of contact for each of the audit's phases; handling communication and confidential issues during the audit or any unexpected issues.
| Section 5: Desk-based Audit|| |
Desk-based audit section is divided into two subsections outcome and report. This section describes how the desk-based audit is conducted independently by the external auditors and what information is collected in a desk-based audit. The information of self-assessment collected in template can be provided by the audit requester voluntarily for desk-based audit. Desk-based audit report emphasizes on strengths of CTP, areas of improvement, and practical recommendations on how to apply corrective measures. In general, on-site audits are conducted after the completion of desk-based audits based on a scoring scale. Various templates are provided for auditors in the audit process for CTP, residents, clinical supervisors, and involvement of hospital staff.
| Section 6: On-Site Audit|| |
The on-site audit section is classified into four major parts, namely principles and preparation, structure of the on-site visit, on-site audit specificities, and confidentiality. The end objective of the on-site audit is to drive quality improvement of the CTP. The success of the on-site audit lies in the availability and cooperation of members of the staff and the main stakeholders of the CTP during the on-site audit process. Further, the auditors should be facilitated to the activities, infrastructure, and documentation. Appendixes VII–X are provided to plan for structure and harmonize the on-site audit. In this section, it is discussed how the on-site audit team is constituted and the methodology to conduct on-site audit investigation by validation of information provided during desk-based audit to present the final report.
This section has also mentioned about the entrance briefing which includes a direct meeting between the local staff and auditors to brief about the organizational chart, some historical description, and statistics on the outcomes of CTP and its future extension plan by the head of the CTP. The auditors assess through direct close observation, investigations, and interviews primarily about the clinical training environment in alignment with curriculum and adequacy of infrastructure. The on-site audit process ends with an exit interview which is a meeting involving hospital management, head, supervisors, residents, and the auditors. The auditors briefly quote about the general impression of the audit, highlighting the summarized key strengths and weaknesses identified. Time is also allocated for questions and discussion by all involved persons. During this meeting, feedback from auditees is also invited for improvements in future audit visits. Apart from the recommendation shared during the exit interview, all the key information during the on-site audit is confidential and only communicated to the audit coordinator for further reviewing and communicating results to the relevant parties involved.
| Section 7: Final Audit Report|| |
The section deals with basic elements which are included to prepare the final report by each audit expert. The report should include a brief description of audit activities and agenda; list of people met and their roles; description of the facility including infrastructure and workload, etc.; degree of cooperation from the institution; finding and results from on-site audit, highlighting the deviation with the desk-based audit; list of strengths and recommendations for improvements of the CTP; appendixes and evidence where relevant. Annexure XII is also provided for further guidance to prepare the final audit report.
| Section 8: Audit Follow-Up|| |
The section is short and concise to emphasize the need and importance of audit follow-up. An audit follow-up is a helpful tool for the continuous quality improvement of a CTP. A paper-based follow-up can be done in case of limited and significant findings observed during the on-site audit that have a major impact on the quality of CTP. The timeframe for submission of a follow-up response should not exceed 3 months. The audit follow-up is also requested when there is a change in the infrastructure, new equipment, new clinical procedures, and expansion of the CTP.
Audit forms, checklists, and templates related to CTP are provided in the appendixes appropriately. The sample forms, checklists, and templates are very useful and ready to use in the audit of CTP. Sample forms are provided for audit requests and letters of acceptance of the audit. Checklists are provided for documentation in support of an audit request, CTP, residents, staff, and supervisors. Templates are provided for contextualization, details, monitoring of the CTP, conclusion of a desk-based audit, and conclusion of an on-site audit.
In the end, a comprehensive list of references is appended to support the information provided in the publication. The IAEA officer responsible for this publication is Giorgia Loreti of the Quality Assurance Section, Division of Human Health, IAEA. At last, the list of contributors is provided who are involved in drafting and review of the publication. The contributors to the drafting and review of this IAEA publication are Khelassi Toutaoui N (Algeria), Loreti G (IAEA), Mofta B (Saudi Arabia), Padovani R (ICTP), Perkins A (Australia), Sanz DE (Argentina), Silveira TB (Brasil), van der Merwe D (IAEA), and Vynckier S (Belgium). The contributors are properly acknowledged and their efforts reflect in the quality content of this publication. This publication is addressed to all professionals involved in establishing, delivering, or leading a CTP in medical physics, as well as to the residents, for clarifying standards and managing expectations. We recommend this IAEA publication is a must-read document for auditors, auditees, accreditors, regulators, and educators in this profession for its implementation in member states.