Radiologist support for RA education.

With the addition of the radiologist assistant (RA) to the radiology work force, a small number of colleges and universities have opened RA educational programs. The Massachusetts College of Pharmacy and Health Sciences (MCPHS) is considering joining that group and recognizes that radiologists are crucial to the endeavor. Thus, MCPHS conducted a survey of the 328 radiologists practicing in Massachusetts and the 99 radiologists practicing in New Hampshire--the 2 states in which MCPHS has campuses--to confirm local need for an RA program and determine the level of radiologists' interest in participating in a local RA program.

A 4-page survey questionnaire and cover letter were sent by mail. For comparison purposes, the first part of the survey included items from a similar survey of radiologists in Arkansas. (1) This portion of the survey asked radiologists about:

* The number of years in practice.

* The type of practice setting.

* The number of radiologists in the practice group.

* Whether they thought a master's level program was needed.

* Whether they would participate in the program in a faculty role.

* Whether they would serve as a preceptor or clinical mentor for RA interns.

* Whether they would be interested in hiring RA graduates.

* Whether they would offer financial support to radiographers from their practice to attend the program.

* How they thought the program should be structured and delivered.

* What practice responsibilities would he assigned to any RAs hired by their practice.

This study was limited by the small, geographically narrow sample and a very low response rate of 8.3% (7.7% for Massachusetts and 10.1% for New Hampshire). Because of the low response rate, there may have been a response bias. Also, the results cannot be generalized to the rest of the country. Nonetheless, we believe the data could be interesting to others considering starting RA programs and to radiographers who would like to know more about how radiologists plan to use RAs.

The results for the questions common to both the current MCPHS survey and the Arkansas survey are presented in Tables 1 and 2.

The second section of the survey contained additional items pertaining to program structure and delivery and specific to radiologists in Massachusetts and New Hampshire. The general consensus of radiologists who responded was that the RA program, if implemented, should be offered with both full-time and part-time options and that the program should be delivered as a combination of on-campus and online courses or on-campus courses only. None of the radiologists who responded to the survey supported a fully online program. They also indicated that, although it was preferable that RA students complete radiologist-directed clinical preceptorships with 3 to 5 radiologists rather than a mentorship with a single radiologist, both options should be available.

When asked what advanced practice responsibilities would be assigned to an RA in their practice, 23 radiologists responded. Their verbatim comments are presented in Box 1.

Discussion

Those who responded to the current survey were quite positive both in terms of the need for an RA program and their willingness to participate as a classroom instructor, clinical preceptor or advisory committee member. The respondents also indicated interest in hiring RAs for their practices, with several willing to financially support radiographers from their practices in completing an RA education.

It is interesting to note the similarities and differences in the results of this study and the Arkansas study. Radiologists responding to the Arkansas survey had practiced for an average of 15 years in practices of 5 or fewer radiologists and were most often employed in rural general practices. Massachusetts radiologists responding to the current study had an average length of practice of 15.3 years, but worked in practices averaging 28.5 radiologists and were most often employed in an academic setting. New Hampshire radiologists had an average length of practice of 21.3 years, worked in practices averaging 12.5 radiologists and worked predominately in urban general-practice settings.

In Arkansas, only 45% of responding radiologists expressed interest in contributing to RA education; how ever, in Massachusetts and New Hampshire radiologists in academic centers and urban general practices were much more willing (66.7% and 90%, respectively) to participate in RA education. (It should be noted that the Arkansas study was published in 2004, before the first classes of RAs graduated, while the Massachusetts and New Hampshire study was completed in 2006, after RAs began entering the work force.) Massachusetts and New Hampshire radiologists in rural general practices were similar to their counterparts in Arkansas, with only 50% interested in contributing to the RA educational process.

In Arkansas 46% of responding radiologists indicated interest in hiring RAs for their practice, with the greatest interest (68%) from those in rural practice. In Massachusetts 78.3% indicated interest in hiring RAs, with the greatest interest exhibited by those working in academic centers. In New Hampshire 80% indicated interest in hiring RAs, with the greatest interest shown by those working in general-practice urban settings.

Several of the RA programs implemented to date, including the graduate program of the University of Arkansas for Medical Sciences (UAMS), consist of online didactic instruction and local clinical education. Thus, these programs can draw students from a national pool of radiographers. The length of required residency on campus varies by institution, with most RA programs requiring some campus-based activities every semester. Students at UAMS have a minimum requirement of only 2 visits during the entire program.

If MCPHS decides to implement an RA program, it plans to explore a model similar to the one used by UAMS. However, further investigation is necessary before MCPHS would implement this type of distance education format, given responding radiologists' preference for a predominantly face-to-face instructional format. We do not know if this perspective would be the same as that of nonresponding radiologists. However, it is encouraging that a flexible online program with minimal campus-based requirements has been successfully implemented in Arkansas. *

Box 1

Radiologists' Verbatim Responses About RA Responsibilities in Their Practice

1. Fluoroscopy, patient assessment prior to imaging-guided procedures (biopsy and drainage), covering contrast injections for CT and MRI

2. Various access procedures (PICC lines, removal of pats and lines); assist at arterial and venous procedures; assist at biopsies and fluid drainage procedures; fluoroscopy

3. Use in MRI, use in neuroradiology procedures

4. Fluoroscopy, needle-based interventions; spinal; pain management

5. Patient scheduling/database management/contact with patient and referring physician; research coordinator; assisting with routine procedures; presenting work at meetings; marketing practice; writing papers (with mentoring)

6. Section head

7. Many; mostly assisting dictation of clinical cases, preview transcriptions

8. Fluoroscopy; checking ultrasounds; procedures

9. Thoracocentesis, paracentesis, pick lines, reporting ultrasound (if sonographer), getting patient consent for procedures, reporting DEXA scans

10. Fluoroscopy, working with patients in CT and MRI, postprocessing data

11. Fluoroscopy, thorocentesis, paracentesis

12. Arthrography, VCUG, paracentesis, fluoroscopy

13. Fluoroscopy

14. Assist ordering physicians in selecting appropriate studies, triage requests for procedures, fluoroscopy and basic procedures (thoracentesis, arthrography, etc.)

15. Duties within IR would include patient workups, consults, postprocedural follow-up (in- and outpatient); quality assurance, research assistance

16. Fluoroscopy, CT including HDC, IVP

17. Consenting patients for procedures, relaying biopsy reports

18. Fluoroscopy (limited), assisting in procedures, interviewing patients, follow-up care, second reading mammography

19. Protocol design and management for CT & MRI, triage function of requests, sedation protocols management and delivery

20. Basic interventional procedures (thorocentesis, paracentesis), fluoroscopy, QA programs

21. Fluoroscopy, contrast injections, patient assessments, QA

22. Fluoroscopy, liver biopsies

23. Fluoroscopy, quality control management

References

(1) Ludwig R. Assessing interest for a radiologist assistant program. Radiol Technol. 2004;76 (1):73-74.

James D. Blagg Jr, Ph.D., R.T.(R), FASAHP, is a professor of health sciences at the Massachusetts College of Pharmacy and Health Sciences in Worcester. Cy Whaley, Ed.D., M.P.H., R.T.(R), is dean of the school of radiologic sciences at the Massachusetts College of Pharmacy and Health Sciences. David Gilmore, M.S., R.T.(R)(N), CNMT, is an assistant professor of radiologic sciences at the Massachusetts College of Pharmacy and Health Sciences. Rebecca Ludwig, Ph.D., R.T.(R)(QM), FAEIRS, is interim chairman and associate professor in the department of imaging and radiation sciences at the University of Arkansas for Medical Sciences in Little Rock. Table 1 Respondents' Characteristics by State Characteristic Massachu- New Arkansas