Development of an inventory of biomedical imaging Physics learning outcomes for MRI radiographers in Malta

Abstract

The purpose of this study was to develop an inventory of biomedical imaging physics knowledge and skills learning outcomes for MRI radiographers in Malta using a multistakeholder, consensus based approach. The study adopted a sequential mixed methods approach, through five main steps: In step 1, a set of semi-structured interviews followed by a Delphi process were used to forecast the MRI service portfolio for Malta for the year 2020. A multi-stakeholder expert group agreed that the current MRI service catalogue should be maintained (median = 6.0 on a six-point level of agreement Likert scale, interquartile range (IQR) as a measure of level of consensus ≤ 1.0), whilst introducing specific new services such as guided breast biopsies (median = 6.0, IQR = 1.0), tractography (median = 5.0, IQR = 1.0) and oncology planning (median = 5.0, IQR = 1.0). A median ≥5 signified a high level of agreement with the Delphi statements whilst an IQR ≤ 1.0 signified a high level of consensus among the participants on that particular level of agreement. In step 2, a Nominal Group Technique was used to optimise the MRI care pathway used in Malta and identify the quality criteria at each stage. The care pathway was again evaluated by a multistakeholder group of participants and suggested improvements to the care pathway ranked in order of importance. The participants attached the highest importance (> 70 on a level of importance scale of 0 - 100) to benchmarking, defining quality criteria, setting a safety checklist and MR education for referrers. The introduction of a radiographer technical report and documentation of patient pain levels prior to MRI were novel themes proposed by the participants. In step 3 a cross sectional qualitative documentary survey of MRI competence profiles and qualification and certification frameworks in 6 major English speaking countries was carried out with an emphasis on the identification of elements of good practice. New Zealand, Canada, United States and United Kingdom have well established national competence profiles. New Zealand and Canada are in the process of updating their competence profiles. In the majority of countries, the competence profiles are used by educational institutions as a basis for developing MRI course learning outcomes. In New Zealand, Canada and United Stated the competence profile is used by the registration body to design the board registration examination. In Step 4 an MRI competence profile was developed specifically for Maltese MRI radiographers based on the results of steps 1 to 3 and validated with a multistakeholder Delphi group. A high level of agreement and consensus (median ≥ 5.0, IQR ≤ 1.0) was obtained for 37 of the 43 competence statements categorized under 7 key activities namely image acquisition, education, risk management, service unit management, facility management, quality assurance and research in the first Delphi round. In the second Delphi round three further competence statements achieved the desired levels of agreement and consensus, whilst three statements retained a low level of consensus (IQR = 1.5). Further analysis showed that absence of consensus for these three competences was the result of a difference in opinion between radiographers and radiologists. In the final step 5, an inventory of biomedical imaging physics knowledge and skill learning outcomes required by MRI radiographers to deliver the competence profile was developed via a document analysis of textbooks and the research literature. This was subsequently validated by a multi-stakeholder expert group. An inventory of 324 physics learning outcomes closely integrated with the competence profile was validated using a dichotomous agree/do not agree level of agreement scale and a level of consensus ≥70%. The inventory of biomedical imaging physics learning outcomes for MRI radiographers developed and validated in this thesis is the first that has been based on a formal comprehensive research process in Malta and probably worldwide. The research process used in the development of the learning outcomes is sufficiently generic to be easily adapted to the development of physics learning outcomes for other radiography and radiology specialties and possibly other health care professions.