R.T.s Struggle With Inconsistent Applications Training

Applications training is one of the hobgoblins of radiology departments — and with good reason. Too many hospitals dedicated to obtaining state-of-the-art equipment for patient care are falling short in meeting the training needs of the technologists who operate the equipment. The result inevitably is compromised patient care, lost hospital revenue, higher manufacturer-absorbed costs for repeat training and trouble-shooting and, naturally, a department full of frustrated R.T.s. Why are so many radiology departments struggling with these problems? The answers seem to be almost universal, but some technologists and industry experts say it’s high time more hospitals took an active role in developing new solutions.

A Tale of Two Technologists

The degree to which the problem of inconsistent applications training affects radiology departments seems to depend on whom you ask — and for whom they work.

Take, for example, Roddy Williams’ experience. As the chief radiation therapist of the county-owned, partially state-funded University of New Mexico Hospital Cancer Center in Albuquerque, Williams and his four-therapist department recently were faced with the challenge of learning how to operate a newly installed, state-of-the-art 3D virtual cancer treatment system. It was, he says, a textbook example of how applications training works at many hospitals.

“We got through it by the seat of our pants,” he said. “It was all trial and error. We just didn’t have the staff to be trained all at once.”

An applications specialist from vendor Picker-Marconi came to the hospital and trained Williams alone for three days. Other therapists, who had differing schedules, continued to see patients at the usual rate. Once the specialist left, Williams trained the others on the equipment, which was the first digital system in their previously all-analog department. The system also was integrated with a CT scanner, with which none of the therapists had any experience.

After training, more difficulties ensued. When software problems cropped up, for example, there was no one to tell the radiation therapy team a software error was to blame rather than human error. A number of trouble-shooting calls had to be placed to the vendor until the problem was resolved. In hindsight, the applications specialist should have been scheduled for at least two weeks, Williams said. The problem, he emphasized, was that no one — including hospital administrators — could anticipate what the training needs would be for this unprecedented project, and there just wasn’t time to figure it out. In fact, there wasn’t much of a general training plan in place at all.

In marked contrast is the daily reality of Master Sergeant Dave Powell, R.T.(R)(MR), a supervisor in the radiology department at Wilford Hall Medical Center, Lackland Air Force Base in Texas. With 11 years in the profession, both in and out of the military, he has seen the significant differences between the way most civilian and Air Force departments operate.

For starters, Air Force sites normally close or reduce patient care during vendor-supplied applications training, he said. “By slowing the tempo, we are able to discuss and document items that are unique to the to the new piece of equipment,” he said. “It also allows us to bring shift workers into the training setting and ensure all of our technologists receive the same level of training. Allowing the day shift to sit through applications and then pass the information to shift workers is rarely effective.”

These planning measures are an extension of the Air Force’s standardized training programs, which includes the Career Field Education and Training Program (CFETP). Updated every two to three years, the document contains detailed competency requirements for all diagnostic imaging modalities and is designed to span a technologist’s ever-increasing skills throughout an entire career. Air Force technologists that cannot complete any of the required tasks are retrained in that specific requirement, Powell said.

The document must apply to every Air Force technologist, and so it has no equipment-specific guidelines, Powell said. However, equipment-specific applications training provided by the equipment manufacturer always is incorporated into the competency requirements for specific Air Force units. This unit-specific training is further developed and documented by a lead technologist after the equipment has been in use for a few months, which ensures continuity in the imaging service as personnel are reassigned or separate from the armed forces, he said.

In all, the Air Force’s approach is a far cry from what goes on in many civilian radiology departments. What’s more, Powell said, it’s working.

The Story Behind the Story

Why do some radiology departments seem to have it together while others continue to struggle? The answer lies partly in the reasons why the Air Force has been able to implement long-range training systems while most civilian departments continue to fly blind. As might be surmised from the real-life examples above, the eternal but elusive culprits of time, money and labor resources are to blame, and they are linked inseparably in a vicious cycle.

Take the matter of money, for starters. How a hospital generates its revenue has everything to do with how easy it is to create more time for training, according to a number of industry experts. Privately owned hospitals depend on patient load to meet their bottom line. Institutions like the University of New Mexico that are partially publicly funded are somewhat better off. However, some of that funding pays for indigent care. Military units, in contrast, have full governmental backing, no matter what their patient load.

It’s a frustrating disparity for technologists, applications trainers and vendors alike.

“Most hospitals are in such a position now that once the system is ready, they need to make money off of it immediately,” Barbara Black, an applications manager with Toshiba Medical Systems, said. “Quality training time is harder to come by.”

Dave Powell agrees. Yet insofar as the factors underlying most civilian hospitals financial needs can’t be changed, he sees many of the policy decisions for addressing them as shortsighted.

“Most civilian agencies that I have been associated with refuse to sacrifice throughput for training,” he said, describing how his own former civilian employers scheduled vendor-directed applications training during a full patient schedule. Under these conditions, technologists often focused only on completing the daily schedule so they could go home rather than learning the new equipment, he said. “The theory is that you learn while you earn. In my experience, this has proven to be a mistake.”

What results instead is a situation much like the one Roddy Williams faced — one with little continuity in training after the vendor leaves, he said. To deal with the resulting problems, “[employers often] advertise for a technologist with experience on ‘Brand X, Model X,’” rather than expending more time and effort on training existing staff, he said. “It’s simply easier than training someone new.”

Likewise, many institutions that find it impossible to train all their technologists at the same time continue to rely on the kind of technologist-to-technologist method that Williams experienced. What some administrators haven’t calculated is what the consequences of taking matters into their own hands could be.

According to the preliminary findings of a recent study of onsite applications training of magnetic resonance technologists, 45 percent of the technologists who had followed hospital personnel-directed — identified as “customer-directed” — training instead of an equipment vendor-prescribed curriculum did not have the skills necessary to operate the equipment independently after the initial training. The study was conducted by ASRT and its Education and Research Foundation in conjunction with GE Medical Systems (GEMS).

Behind these problems, however, is the deeper issue of labor shortages, according to all parties involved. In Williams’ department, for example, six or seven therapists will eventually be needed to keep operations running smoothly on the new virtual cancer treatment system, he said. Yet, he doesn’t anticipate seeing any new faces in his four-person department any time soon.

Enter the phenomenon of cross-training. As fewer technologists are available to operate an ever-increasing variety of equipment, more of them are being cross-trained on different systems than ever before, according to Toshiba’s Barbara Black. Trainees sometimes rotate through various training sessions to the extent that no one is designated as an expert on any one system. “You get a lot a people who know the system, but just barely,” Black said.

As one CT technologist who preferred to remain anonymous said of what she described as her typical experience in cross-training on various applications at one hospital, “The underlying theory there was ‘See one, do one, teach one.’”

“Even though today’s equipment needs fewer people, its more complex,” Black added. “The problem is that physicians and administrators often feel that if you’re a technologist, no matter what company’s equipment is involved, you should know how to use it. That’s just not realistic. Management and physicians don’t always appreciate the time that needs to be taken to learn.”

How to Find a Happy Ending

So what can be done to address complaints of inadequate training time? Vendors are taking matters into their own hands.

Toshiba and other companies have created new training programs that seek to eliminate technologists’ chief problems — lack of time and the distractions created by patient load — by bringing the training in-house.

Courses in the Toshiba program, called the ExACT program, are held at Toshiba’s International Training Academy in Irvine, Calif. The company offers vouchers to hospitals to subsidize the cost of sending technologists.

The program, which was developed after the company realized it wasn’t having much success in trying to dictate hospitals’ training requirements, has had a “pretty good” success rate thus far, according to Barbara Black. The company has tracked fewer callbacks from hospitals whose technologists have undergone the training, and the same institutions have been shown to be able to start patient studies faster — thus leading to faster revenue generation, she said. Classes in CT, MR and vascular studies currently are offered, with more trainers available in the classroom than normally would be offered on-site, and classes even have waiting lists.

The advantages seem clear. But the problem is still in getting hospitals suffering from the labor crunch to send their staff in the first place, she said.

Meanwhile, some other companies continue to offer onsite training, but with a twist. Kodak Eastman’s long-standing approach, for example, encourages hospitals to take responsibility for the type and quality of training their technologists receive, according to Gary Stevens, a current professional services regional manager and former applications trainer for Eastman Kodak.

Hospitals seeking applications training with Kodak Eastman are required to submit a Request for Proposal, in which they detail their current equipment, staff and procedures; what their ultimate goals are in each of those arenas; and what they think they would need to attain them. Once the company formulates a proposal, the customer is encouraged to talk to more than one vendor. If the customer chooses Eastman Kodak, training hours are consequently agreed upon and included in the terms and conditions of the work contract, Stevens said.

Although it’s not a formal part of the Eastman Kodak process, the most important thing hospitals that anticipate training needs but aren’t experienced in handling them can do is to initiate a peer review, contacting other hospitals to see how they have handled the process, Stevens said.

“There’s no need for each hospital to reinvent the wheel,” he said.

Ultimately, though, the success of any undertaking in applications training is dependent on one factor that can’t be changed — only managed differently.

“In my opinion, the single most important aspect of training is time,” Powell said. “Facilities that fail to provide adequate time for training will surely fail in deploying new equipment.”

Indeed, some say, if more time and attention were brought to the issue, nothing less than the industry, the profession and patient care could be transformed.

“Productivity and efficiency would dramatically improve,” Eastman Kodak’s Stevens says. “The thing to remember is that this needs to be an ongoing effort. Staff leaves. New people come in. Hospitals need an annual plan for training, just like CPR. People need enough time to learn theory, not just application.”


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