Smith Tony, Fisher Karin
UDRH, University of Newcastle, Tamworth, New South Wales, Australia.
Rural Remote Health. 2011;11(2):1560. Epub 2011 Mar 22.
In rural and remote parts of New South Wales (NSW) Australia, GPs and registered nurses who have completed a short course in basic radiography perform X-ray examinations when or where a radiographer is not available. This is a form of 'skills transfer'. They are licensed under the NSW Radiation Control Act 1990 to perform a limited range of examination types, providing a valuable service that prevents rural and remote residents from having to travel to access services. The aim of this survey was to gather background information about the NSW remote X-ray operators and investigate their self-perceived need for continuing education.
A questionnaire was mailed to all 131 remote X-ray operators in NSW, with reminder letters sent 6 weeks later. The questionnaire consisted of 30 close-ended and 3 open-ended questions. Among the questions, respondents were asked to rate their self-perceived competency in 12 examinations covered by their licence, and to indicate how well they understood and how challenging they found certain aspects of radiographic practice.
The response rate of 63% was returned by nurses (74%), GPs (24%) and 2 physiotherapists. The majority (80%) performed radiography in towns of 3000 people or less. Together with other remote operator colleagues, 58% said that they performed an average of 2 to 10 examinations per week. Most thought their radiography was 'Good but not excellent' (48%) or 'Satisfactory most of the time' (41%). For 2 of the examinations (ankle and wrist) more than 90% of the respondents felt competent. For another 6 examinations less than 80% felt competent. Only 23% felt they could perform a chest X-ray on a premature baby. The most challenging aspects for respondents were dealing with paediatric and difficult patients; and the highest level of understanding was in 'Radiation protection'. Nineteen percent 'Never' did continuing education in radiography and radiology and 35% 'Rarely' did so. The GPs did more continuing education than others, and 80% felt a need for continuing education in this field. Approximately half (51%) said they had 'regular' contact with a radiographer and 32% 'sometimes' had contact. Seventy percent said this was 'Extremely' helpful. Approximately one-third (34%) received feedback about their radiography 'Regularly', most (44%) from a local radiographer. Preferred methods of continuing education were: face-to-face training; working alongside a radiographer; reviewing or auditing of their radiographs; and distance or online education. The support needed to undertake radiography continuing education was: time off from regular duties, transport and accommodation, and the support of management.
The survey results strongly suggest a need for continuing education in radiography and radiology for NSW remote X-ray operators. The GP respondents appeared to have different needs from the nurses and physiotherapists. Recognising their special circumstances and the isolation under which they work, ongoing educational support, as well as the opportunity to benchmark their practice against more mainstream services, should be embedded in the system. There is an opportunity to develop a best practice model for supporting and re-credentialing limited X-ray licence holders and to create a national benchmark. A well planned strategy may have relevance in other practice settings where skills transfer may be practised now or in the future.
在澳大利亚新南威尔士州（NSW）的农村和偏远地区，完成基础放射摄影短期课程的全科医生（GP）和注册护士在没有放射技师的情况下进行X光检查。这是一种“技能转移”形式。他们根据1990年新南威尔士州《辐射控制法》获得许可，可进行有限范围的检查类型，提供了一项宝贵服务，使农村和偏远地区居民无需长途跋涉去获取服务。本次调查的目的是收集有关新南威尔士州远程X光操作员的背景信息，并调查他们自我认知的继续教育需求。
向新南威尔士州所有131名远程X光操作员邮寄了一份问卷，并在6周后发送了提醒信。问卷包括30个封闭式问题和3个开放式问题。在这些问题中，要求受访者对其执照涵盖的12项检查中的自我认知能力进行评分，并指出他们对放射摄影实践某些方面的理解程度以及认为这些方面的挑战性如何。
护士（74%）、全科医生（24%）和2名物理治疗师的回复率为63%。大多数人（80%）在人口为3000人或更少的城镇进行放射摄影。与其他远程操作员同事一起，58%的人表示他们平均每周进行2至10次检查。大多数人认为他们的放射摄影“良好但不优秀”（48%）或“大部分时间令人满意”（41%）。对于其中两项检查（脚踝和手腕），超过90%的受访者认为自己有能力。对于另外六项检查，不到80%的人认为自己有能力。只有23%的人觉得自己可以为早产儿进行胸部X光检查。对受访者来说最具挑战性的方面是应对儿科和困难患者；理解程度最高的是“辐射防护”。19%的人“从未”接受过放射摄影和放射学方面的继续教育，35%的人“很少”接受。全科医生比其他人接受的继续教育更多，80%的人认为在该领域有继续教育的需求。大约一半（51%）的人表示他们与放射技师有“定期”联系，32%的人“有时”有联系。70%的人表示这“极其”有帮助。大约三分之一（34%）的人“定期”收到关于他们放射摄影的反馈，大多数（44%）来自当地放射技师。继续教育的首选方法是：面对面培训；与放射技师一起工作；审查或审核他们的X光片；以及远程或在线教育。进行放射摄影继续教育所需的支持是：从日常工作中抽出时间、交通和住宿，以及管理层的支持。
调查结果强烈表明新南威尔士州远程X光操作员需要进行放射摄影和放射学方面的继续教育。全科医生受访者的需求似乎与护士和物理治疗师不同。认识到他们的特殊情况以及工作中的孤立状态，持续的教育支持以及将他们的实践与更主流服务进行对标比较的机会应纳入该体系。有机会为支持和重新认证有限X光执照持有者制定最佳实践模式，并创建一个全国性基准。一个精心规划的策略可能适用于其他现在或未来可能实行技能转移的实践环境。
