'Beyond Bricks and Mortar - Building Quality Clinical Cancer Services' Symposium 2011

Building Quality Learning & Professional Development Communities - Dr Shane Dempsey

Up to Radiation Oncology

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Senior Lecturer, School of Health Sciences, Faculty of Health, The University of Newcastle

Download powerpoint presentation by Dr Shane Dempsey (PDF 907 KB)

Introduction by Norman Swan:

So the way to attract and recruit, one of the proper ways of improving recruitment and retention, not to mention increasing the safety and quality of what you do, is to provide career development and learning and training environments that work and are of high quality and that's what Shane Dempsey is going to talk to us about. He is the program convenor of three Medical Radiation Science Degrees at the University of Newcastle and chairs the School of Health Sciences Teaching & Learning Committee.
Please welcome Shane.

Dr Shane Dempsey:

Thank you very much. I don't get to watch much news in my family because I've got little kids who want to watch other stuff. And for years when I drive to work I put it on ABC News Radio and this beautiful lyrical voice comes across in a health minute and it's very, very freaky to put a face to that voice that comes out of the radio at me for all these years, because I probably had a different vision in my head.
And listen, the other thing I want to say is I’ve been lucky enough to do some study here, and really I kind of owe a little bit of that to Phillip Yuile, because when I worked for Phillip for a couple of years what he actually showed me was an academic way to do radiotherapy, in a beautiful private practice. Phillip would read journals, integrate that into his practice, talk with me about that stuff, and we really turned our practice around. So a lot of that’s my hard work Phillip, but a lot of it’s your spirit. Okay.

Today I’ve been asked to talk about building quality learning and professional development communities. I got a text off Abel one night that disturbed me watching Masterchef, but anything Abel tells me is pretty good. I actually thought about the things, and I know this is a mini recap of what we did yesterday, but I kind of thought about this, the challenges that we faced yesterday and we heard about - 25% growth in cancer services and regional cancer services, changing technology that absolutely challenges and how to use it and how to use it effectively. And these questions were asked by people from the floor, how do we address training in regards to regional centres, how do we attract staff and overcome the barriers I guess of regional communities, how do we deal safely and quality on ongoing basis?

And then we heard that there were problems in implementing national protocols properly. Someone asked the question at a systems level how do we improve, our patient advocate ask us providing patient centre care and support, that’s the goal. And lastly actually Dr Swan said to us, “How do we actually get rid of regional variation in cancer care?” And then we actually got some answers from the floor and some really beautiful answers I wrote down: "The key to success in achieving quality is staff", that was one of the dominant messages that come to us. Lesson is build the team and look after the team.

And I guess I’m going to say a few things that are going to challenge a few people, and it’s not deliberate, but it’s actually my views as a radiation therapist. The team is sometimes - RO’s, ROMPS, RT’s and oncology nurses, and sometimes the team is a horizontal team. But within all those teams the vertical teams as well. And we hear about RadOncs, MedOncs, Surgical Oncs, Haematologists being the team. We hear about Physicists being the team, the Brachy team, the Treatment team, the Linac team, the QA team, we hear at RT’s, and that’s the pre-treatment, treatment, Sim team, planning team, sub-speciality teams, and oncology nurses have those same teams.

So when we talk about teams, I think that we should really be thinking, when we talk about multidisciplinary teams, we hear a lot about the up and down medical multidiscipline team, there is a vertical and there is a horizontal on all of this which I think we need to keep in mind and address. And the other beautiful thing that rose out of yesterday was the RadOnc Practice Standards and congratulations for those, and I read them yesterday and some of the things that come out to me, the very first Standard on staff talked about "Competence is assured and maintained by staff development". So there’s absolute commitment in that to staff development.

The second dot point Workforce Profile, the rosters and schedules incorporate time for non direct patient activities, teaching, training and education, and the required evidence now is actually going to be record keeping of outcomes or learning, funded time when within working hours for education. So we have the platform here in our regional and normal cancer centres to actually do better training for people.

So we’ve shifted the responsibility here, all of that documentation shifted the responsibility from individuals to take on their own responsibility for learning to sites actually providing it. Employers now have an obligation to provide support for staff to continue their learning, they must make it happen according to the Standard, you must make it happen for your staff according to the Standard. None of this is new, in health, in allied health, in regional health, this message has been out there for a long time, Straub in 2004, a physiotherapist working out of Darwin, in 2004 he went there to start a service and at 2004 we might have thought "Yeah, as if radiation therapy would ever get to a remote location like that", but it is. In writing about rural health professionals, he said, that "all health professionals are represented on programs and policy groups”. These were three recommendations that come out of his study to be addressed, that all health professionals are represented on those program and policy groups.

So the whole team is represented, the vertical team is represented. The horizontal team is represented. Programs are required that address the issue of support, and here we don’t mean academic support, here we mean the living support in regional communities, programs that are at an institutional level that bring people into those places and support them across a time period. And then employees ensure that health professionals have access to same discipline support, and this is a tricky one, because this really challenges - if I’m a radiation therapist in a small group of people in a remote and rural location, my same discipline support is going to be an awful long way in other centres who are doing different things that I should be allowed to learn of. So these aren’t new things, but so we’ve gone from staff are great, we now have a responsibility to help them out, who is the team, but how do we do this? How do we provide access to same discipline education and support? How do we provide for learning across the discipline borders, and where is it appropriate?

And then there’s this competing interest, you know, I have I personally have interest in stuff in the world. I kind of like clinical trials, I like auditing stuff, I like doing some planning, I have some personal interest, but there’s also situational interest needs where the centre needs some learning from the staff. So there is a competing need in staff development to allow them to grow what’s their personal interest, and there’s also a need for situational interest coming into those learning needs. And then who really are the experts on the topic that can bring new perspectives to that learning and actually to the department?

So we’ve got to this point that we’ve identified now that we’ve got to provide some. And what I want to do is just take a little bit of the stuff that I have to deal with all the time at university as a lecturer and academic and how do I incorporate, how do I address the learning styles? Because we work in an area now that learning is very different, it’s not like it was, it’s not out of the textbooks, it’s not in classrooms any longer, there are no pillars of knowledge and authority to pass down all the information to the department, industry requires a team approach, knowledge and skills owned by a team that make the industry outcomes robust against workplace changes. We have people leaving the team, we have people coming into the team, we can’t have in the workplace environment any more that a large loss is a deficit to the team, the team has to have all the knowledges.

The most desirable attributes of staff are those related to social confidence, so this comes out of data from the Business Higher Education Roundtable that’s held bi-annually in Australia, and business including the hospitality and the health business and industry sit down with higher education and the government and they map the next 10 years of what they need as graduates, they map the next 10 years for what they need as attributes for learning. And since 1990 the number one attribute they wanted in people is social competence, team work, communication and leadership. The ability to work truly as part of a team in all the other aspects. So in addressing a learning style we’ve got to acknowledge it’s a whole team has to own the learning, and that we have to allow social competence or social developments of learning to take place.

And I’m going to refer to this Gen X and Gen Y effect, and I think they cop a beating, ‘cause they actually think a lot of this is baby boomer stuff as well, but there’s a blurring these days of our social spaces where we have fun with our social work spaces and our social learning spaces. At university the blurring is immense. If we ask students these days at the beginning of a course, list the 10 things you’d like to happen in this course, we will always get, to have fun, to engage, to be involved and meet other students. There’s not a course at the university now that doesn’t run out of a Facebook page, so they can socially integrate. There’s not a course that doesn’t have a blackboard site where they socially communicate. And we actually at university have to engage them in learning, that’s our strong one.

So if we think about the learning styles that we might want to incorporate, we’ve actually got to probably allow for our learning to be deregulated from the formal environment that some of us went through to a very flexible, social learning space, where there is a bit of blurring between having fun and learning something.

So how can we do that then? And my proposition really is about learning communities, and this is where we engage whole groups of people in a community of practice, you’re probably more familiar with that, but a learning community where everyone regardless of site or location of standing, can enter that learning community and participate freely and equally. And I’m going to give you some examples of the learning spaces that I deal with all the time and the learning communities.

And the first one really is the University of Newcastle, RT Learning Committee. About 30 clinical sites nationally around Australia participate in our program. We have about 25 clinical places – centres in New South Wales if you include private and public, we constantly - we regularly deal with about five or 10 outside, so we have 30 clinical centres. And it might feel sometimes to people that that’s only about taking our students, so you get staff, but in fact I’ll tell you about some developments.

And the first one there is the development of the RT Ed positions in New South Wales. How that came about was Jenny Cox from Sydney University and myself wrote to New South Wales Health and said, “One of the problems we have in getting students better teaching is that the work of RTs is clinical, it’s not teaching, we need some clinical teachers in centres”. New South Wales Health funded three positions across New South Wales as a trial for three years. Eighteen months into that trial we wrote to them and said the success of it, and out of that came the payment of an RT clinical educator in every university that was initially in every clinical centre in New South Wales, that was initially responsible to the university, but eventually rolled funding into the clinical centres.

So it was a two way provision of support and learning, I absolutely get great support from my learning communities, but we will talk, I will provide them information, so this is a great learning community.

Another learning community that’s been setup with the fantastic help of DoHA or DET, or DEET, whatever you want to call it over those years, is the Australian RT Clinical Universities Group. We - just so you understand there were five universities at the time who used to deal with student placement, and we were all pretty suspicious of each other, we kept out of each others’ way. I placed in New South Wales, QUT placed in Brisbane, RMIT placed in Victoria, South Australia and then we all fought over the scraps, which were Perth and Tasmania, you know, we all fired over that, and occasionally we’d leak into each others’ spaces. We had different paperwork, we had different assessment strategies, and the Federal Government noticed that, and so they brought us together, and they probably really brought us together around the early 2000’s, after we’d already been involved at Newcastle with them in strengthening a whole bunch of stuff.

They sat us down and they said, “This is your opportunity to talk to us and to do things together”, and with a little bit of suspicion across the room, you know, we gave out a word and then we’d look to see how everyone reacted. What eventually we did is formed a fantastic collaboration where these are the things that have come out of it: funding for student placements to regional centres. The reason why the Waggas, the Townsville, the Hobart, Launceston, the Perths, why Canberra gets the students these days is that DoHA funds the university. And originally we wrote our own agreements, and eventually that was a waste of time, so we shared the agreement, we wrote one agreement and we emailed it to each other and we just put in the same submissions. We then actually increased our people in our programs, and what we found is we didn’t have enough simulation labs at uni, what I mean simulation is radiation therapy setup labs or simulation labs, planning labs, not simulation radiotherapy simulation.

And so again a joint initiative, a joint funding from five universities to DoHA, and we all received a pile of money to put in 20 piece, 20 Eclipse systems at the universities or 20 Pinnacles or whatever one they were using, fantastic joint initiative. The development of a national RT student evaluation form - one of the barriers to doing better was that actually whenever one of our students went interstate, they copped a different form, and a different student at a different stage to be evaluated differently. So one of the bits of feedback we worked on is a funding application which Eileen from the Uni of South Australia took the lead on and actually wrote on our behalf, and we got funding to develop a research based project which looked at two rounds at DELPHI which looked at a pilot process in two different states of Australia, and we rolled out a national student evaluation tool, and national RT educated training packages.

Our most recent success which Meg Chiswell from RMIT took on the role, the other roles up there were mine, and Eileen’s had a go and Meg’s had a go as we passed the rope around, and this is a brilliant one, is that DoHA have now funded five virtual linacs. And if you’re not sure what the virtual linac is, it’s actually a 3 x 4 metre screen with rear projection projectors behind it, and the companies, whether it’s Varian, and Siemens or Elekta handed over their software, and you put the projector on, you use your little iPad which has all the software of the linac on it, you walk into an area which has overhead tracking, you put on your 3D glasses like you’re going to the movies, and the linac appears in front of you in the wall in the room like a hologram. And it does everything, it does everything the linac does except turn on and treat a patient. You can actually bring the patient in the room, there’s cupboards, you can lay them on the bed, you can set them up, you can check ODI’s, FSD’s, you can turn the gantry, you can watch the beam. If you walk around to their feet, you can take the skin off, you can see it in CT, MR, PET cross section, you can QA on it. In the UK, in the USA and in Europe, they use VERT as their verification tool in radiation therapy departments. They send their plan to VERT and verify their patients on VERT before they go to treatment. We've got VERT, five VERTs, five million bucks. Fabulous. Out of that though we have to develop a VERT a community of practice, and some of you already would have received the emails from some of us to the chiefs actually telling you that our big target group is a community of practice involving all you guys to utilise VERT. VERT is available for you at those universities nationally from next year.

My University of Newcastle Health Workforce Australia learning community can provide support at eight regional RT centres, as you probably all know. Last year Health Workforce Australia announced a big round of funding, rural and regional. I identified some - I asked everyone who wanted to be involved. Some regional centres including Townsville, North Coast Cancer Institute Lismore, Port, Coffs, Canberra, Hobart, Launceston and Charley’s got on board and we’ve actually got about $850,000 worth of HWA money to support them in terms of staff training and infrastructure development, so they can do more for training for themselves. Increased training opportunities for students, but also increased work responsibilities for staff and a new place to go, two way provision of resources, it’s like a learning community. So for me learning communities cross borders, we learn from each other and we borrow and make use of experts.

But how do we work in the 21st century? How do we actually do this, and this is the challenge for some of you, e-communication and information portals, that’s what it’s all about. It’s not about anything else anymore, you’ve got to be involved. In my email in 2003, I did a presentation the other day, I looked. I got 100 emails in the first two weeks of April in 2003. In 2010 I got 290 in the same period, but in 2010 the software I’m using lets me have folders. In those folders are a couple of hundred emails that don’t sit in my community folder. So I’m probably up around the 500 emails per fortnight. So the traffic has changed. The way I do my business has changed. And I know these are kitsch things that we go, "This has got nothing to do with radiation therapy", Facebook 2010 stats 750 million users, 50% daily logon.

Sitting yesterday over there I did see some people under the table with their phones ensuring they got their Facebook entry at the cancer conference watching Norman Swan. Cool, you know, on their Facebook right? With social plug-ins and what we call about these social plug-ins is you visit a website and on that website you can find the link to your Facebook. University of Newcastle, every university has these social plug-ins, society pages have them, your societies will probably have them soon. Active users on Facebook and it’s a platform for information dissemination and training of your staff. Twitter, when we think about Twitter, we don’t think of it in its right terms, it’s a real time information network that connects you to the latest information okay, about what you want. So if you’re plugged into the right information, you can actually get a Twitter to your phone saying, the latest publication from the British Journal’s out, there’s an online tutorial webinar coming this week, students get tweets now from the university going, "Your assignment is due next Tuesday", okay.

Does anyone know who has the most people attached to their Twitter account? Who's the person who has the greatest number of followers? No, it’s, what’s his name, Kutcher, Ashton Kutcher, I was going to say, Ashton Kutcher has the biggest amount last year of people following his tweets right. But tweet can be used for good, not just evil okay, that’s the message from tweet, okay.

So now the question is we’ve come the journey, we’ve realised that staff are important, we realise we learn in different ways, we realise we have to be dynamic, so now we’re going to try to ensure there’s quality across regional Australia, we need to adapt, you need to adapt, you need to get out of what you’re doing.

I want to tell you about this product called Illuminate. Illuminate is a web conferencing teaching and learning video system, that allows for multi point audio, multi point video, interactive whiteboard, application and desktop sharing. It allows you to hand over to your desktop to people who login on a URL. It’s firewall proof, it gets through. So I’ve got two fabulous, three fabulous people in the room this week, Paul and Charlene, where are they, from Geelong? You guys Illuminated a couple of weeks ago, the experience? Very good. These two guys – these two guys – these two guys entered a classroom with 30 of my final year students doing advanced and future practice, I’ll show you what the topic is, it's Advance and Future RT methods, there’s a whole range of things that the students have to engage in social learning spaces about.

And these two guys from Geelong got online as experts in the field, no longer did I have to go on there and try to convince them I knew something about VMAT. Real people use the real technology and a world class centre got on board with students, and for an hour their heads were on the video, 30 students were in their bedrooms, lounge rooms and the library, wherever they logged on with their headsets, and listened to these two guys present. Colin Hornby from Peter Mac followed them I think the next week, and he looked at another version of IMRT. Is Colin here? Oh he might be in the next room. Another version - he logged on. We actually have functional imaging experts in magnetic resonance spectroscopy. The University of Newcastle is becoming a leader in this field, we’ve appointed a Professor of Imaging from Harvard is coming over, her world is the world of bio chemical imaging. ROMPS are involved for bio optimisation, this is a fabulous program.

In 2012 we’re going to run it out across Australia for our clinical partners to be involved. And what I’m going to propose right now, is probably I've talked to a few people that in 2012 we develop something like this, an RT community of learning colloquium for a want of a better name, it’s a community based blackboard, Illuminate site, it’ll allow for discussion forums, webinars, what’s new, what’s being done, resources is the best practice of our most innovative cities. Experts available for advice and opinion that'll interface with Facebook and Twitter, so it’ll keep you guys online, and you guys will help run it through our portal, and we can share across those boundaries, it’s no longer the lunch room, tea room.

In summary, learning communities allow for exchange of information, social constructive learning where we can debate and collaborate, socially professional engaging and fun, authority that challenge as the authority and mastership of who owns the knowledge, helps build quality cancer services.

Finally I just want to show you this pushbike okay. This is a great pushbike, this is an Italian pushbike called a Fondriest, and I love it, its monocoque frame, ‘cause it’s my pushbike. And I only bought it a couple of weeks ago, I haven't had time to ride it too many times, so I just thought I'd have a (inaudible)

(laughing and applause)
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Norman Swan:

Now my colleague who's an expert in social media tells me it’s Lady Gaga who's actually got the biggest Twitter following. I actually just went on, started Twitter about February, it’s amazing actually, you know. When you don’t use it for social and use it for information, utterly incredible, yeah. I strongly recommend it. So all this is nice, again the warm and fuzzies, does their formal knowledge improve?

Dr Shane Dempsey:

Does knowledge improve? I think what we could do is run an evaluation of it.

Norman Swan:

You’re about to avoid – you’re about to avoid this question aren’t you?

Dr Shane Dempsey:

No, no. I’m one of these academics and I’m supposed to say yes, we’ll actually run a formal evaluation on this and dah dah dah. Does it improve it? It provides access for people in remote locations to talk to people in other locations. And a positive benefit might be to verify what you’re doing is in fact right, it might just be to chat to other people online, but will it improve what they’re doing, if you’re using it correctly, if you’re gaining the right information, attending the right sessions, you can only improve your knowledge base, your skill base. That last product Illuminate, gobsmackingly good. Watch out for it it’s coming your way.

Norman Swan:

But that’s much more like formal education.

Dr Shane Dempsey:

Yeah. Oh very relaxed, in your bedroom laying with a Pina Colada or a cigarette and ...

Norman Swan:

But there’s no point to this, there’s surely no point to this unless your formal knowledge improves, that you can apply to daily practice.

Dr Shane Dempsey:

No. I think some of the things that you read about rural practice is isolation. There’s an isolationism about being an awful long way from other people, and some of these technologies are just to make sure people who feel like - part of it, is to make sure people who feel isolated, stay connected and feel connected with the world around them, and it’s not passing them by. And one of the biggest reasons why you can’t retain staff in rural places, whether it’s medicine or nursing or physio and now radiation therapy, is they feel in the big smoke the world is passing them by professionally. And if we can draw the link that it’s not happening, that you’re on top of it as well, and you can leave the city folk, the hub and spoke let’s turn it around a little bit. I think we can do that.

Norman Swan:

Are many people here on Twitter? You’re missing out.

Dr Shane Dempsey:

I was on Abel’s Twitter account, and he kept twittering me, so I disabled him. Dis-Abeled him!

Norman Swan:

Unfollow as they say. Any questions or comments for Shane? Shane that was a great presentation, thank you very much indeed.

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