Improving Health Through Medical Physics

Medical Physics 3.0 Report

Titania Juang | La Jolla, CA and Erika Chin | Victoria, BC

AAPM Newsletter — Volume 44 No. 4 — July | August 2019

Picture of Titania Juang Titania Juang
Picture of Erika Chin Erika Chin
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The Physicist is IN: Responses from the AAPM Membership

In the past year, the Medical Physics 3.0 (MP3.0) Working Group has put forth a number of strategic goals1 and a framework of "smart" initiatives2 for tackling development, communication, and representation in areas that contribute not only toward a consistent high level of quality in our current clinical practices, but also toward the future growth of medical physics both as an interdisciplinary scientific field and as a profession.

The efforts of these initiatives include the following:

  1. Create and curate resources and tools that medical physicists can readily implement in their everyday practice to improve efficiency and consistency (Unit #40 - Smart Tools).
  2. Define and promote technical, clinical, and leadership competency (Unit #41 - Smart Practitioners).
  3. Apply models of process improvement to clinical practices (Unit #42 - Smart Models of Practice).
  4. Explore new avenues beyond radiation medicine where physics and physicists can contribute to the advancement of medicine and healthcare (Unit #46 - Smart Expansion).
  5. Provide a voice for medical physicists in regulatory bodies with the intent of creating regulations, guidelines, and accreditation criteria that reflect best practices (Unit #39 - Smart Regulations).
  6. Engage with the medical physics community to raise awareness of MP3.0 goals and related resources and opportunities for professional growth, as well as an avenue for active feedback (Unit #44 - Smart Grassrooting).
  7. Advocate for medical physics by creating connections with our partners in healthcare, including administrators, other medical professionals, and patients (Unit #43 - Smart Advocacy).

Work falling under these areas can already be found across our profession, both within AAPM and through independent efforts at individual clinics and institutions. Given the diversity of disciplines and working environments in our field, there are also a variety of opportunities for improving practices, further developing our skill sets, and advancing patient care by looking beyond the traditional role of medical physics.

With this in mind, visitors to the informational Medical Physics 3.0 booth at last year's AAPM Annual Meeting in Nashville, TN, were invited to participate in answering a set of open-ended questions that asked for our membership's experience with and thoughts on four of our initiatives. Over two days, 101 participants provided a wealth of input. Some highlights are summarized below:

Smart Practitioners & Smart Expansion
  • Give an example of when your work or the work of another colleague successfully blended technical physics expertise with clinical knowledge in an innovative fashion resulting in better patient care. Conversely, are there examples of standard of care practices that could be further optimized to improve patient care?
  • Have you or someone you know worked on projects/collaborations in areas beyond your "standard" medical physics training? How did you get involved? What was the best way you found to gain new expertise efficiently? Conversely, are there interesting projects you wish you could work on but feel you lack the expertise?

Responses to these two questions were wide-ranging with many overlaps. Topics included patient safety, dosimetry, implementation of new technology, quality assurance, clinical communications, workflow optimizations, treatment planning and delivery, patient setup, clinical trials, IT support and data science, machine learning, hospital administration, education, and more! However, the critical takeaway was that responses starkly demonstrated the wide variation in practice environments and mindsets in our field – wider than might be expected. What would be considered standard physics duties for one physicist (e.g., clinical workflow optimization) was not for another. It was a reminder for our committee to be continually cognizant of the variation in resources and experiences among AAPM members. These responses also showed that despite all our current online resources, there is still a huge unmet need for efficiently sharing and vetting resources and knowledge.

Smart Tools

In your work, are there any tools you have or wish you had that could improve your efficiency and your enjoyment of your job? Any benchmarking metrics that would help quantify the value of your work to other healthcare stakeholders? Conversely, are there any tools you must use that are frustrating and decrease your efficiency?

While no specific tools were named, the top 4 features physicists wished for were:
  1. Updated and clinically-relevant physics QA tests with tolerances and testing frequencies based on TG-100 risk analysis.
  2. Greater efficiency through equipment, test, and software designs that would allow for multiple tests to be accomplished simultaneously on a single compact and easily transportable system.
  3. Greater automation for treatment planning, QA, plan quality checks, data analysis, and other repetitive tasks.
  4. An electronic whiteboard or dashboard to provide real-time snapshots of the patient workflow to help identify bottlenecks, streamline the patient's treatment path, and better capture everyone's contributions to patient care.

The main frustrations were outdated tests, cumbersome and buggy software, lack of standardization in tests and reports, lack of metrics to measure physics clinical contributions, and lack of financial resources to acquire tools.

Smart Models of Practice

Think of the best place you've ever worked. What made it great? (E.g. Organization of the group, workload distribution, workflow streamlining, models of leadership, continuing education opportunities, etc.) Conversely, what practice models make your work environment more difficult?

The most commonly cited qualities of the best workplaces fell under the following categories:
  1. Personnel with the right attitude (35%). This included attitudes toward interpersonal interactions that foster a supportive, friendly workplace environment with a sense of genuine community and camaraderie; as well as attitudes toward work and our profession that include a focus on patient care, dedication, and the open-mindedness and motivation needed to promote growth, learning, and adaptation. Knowledge and a diversity of experiences and expertise were also cited as positive traits.
  2. Workplace culture (29%). Characteristics of a good workplace culture included open collaboration, communication, and teamwork; a culture of respect where physicists are treated as equal members of the healthcare team; good rapport with different work groups, such as with therapists, dosimetry, and management; and quality improvement through process improvement and continuing education.
  3. Workplace structure (17%), including good organization with clearly delineated goals and action items, balanced workloads, variety in the work, equal opportunities for all members, and mentorship.
  4. Workplace communication (15%). This was a common thread through many responses that overlapped with personnel and culture. Qualities of communication in the best workplaces included respect for all opinions regardless of seniority, willingness to share thoughts honestly, open communication between different groups, and the ability to bring up issues without fear of retribution.
  5. Management (15%) that is invested in supporting and enabling staff to accomplish their personal and professional goals, such as by providing needed tools and equipment, and by allowing staff the freedom and flexibility to pursue big ideas and test new initiatives.
  6. Good leadership (14%). Characteristics of a good leader fell under two categories: personal traits, such as being empathetic, knowledgeable, supportive, encouraging, and hardworking; and actions, such as creating a collaborative environment, investing in their people and helping them to be their best and succeed, intervening in unhealthy relationships, empowering personnel, and establishing an inclusive environment.
Qualities of a poor workplace environment largely fell under the same categories:
  1. Management (20%). Characteristics of poor management included a lack of oversight, micromanagement and interference with work, practices driven by the bottom line rather than best professional guidelines, uninformed decision-making, and not valuing physics.
  2. Workplace culture (15%). Qualities of a negative workplace culture included a lack of professional respect for others and their contributions, internal competition and distrust, poor teamwork, lack of collaboration, research silos, no mentorship, and a lack of motivation to deviate from existing practices.
  3. Workplace structure (6%). Workplace structure characteristics in poor workplace environments included overloaded schedules, too much time spent manually creating documentation for compliance and billing when the process could be automated, poor definition of duties and how they should be shared, and bottlenecks in decision-making.
  4. Poor leadership (5%), including an inability to interface directly with people.
  5. Poor communication (3%) between physics and other staff.

Putting MedPhys 3.0 into Action

Our newly revamped website outlines the purpose and goals of MP3.0, and provides guidelines for good practices, examples of opportunities for clinical growth, and articles showcasing the goals of MP3.0 in action through medical physics practice outside the box. Videos highlighting the roles of medical physicists in healthcare are posted on the site and freely available for you to share and distribute.

This website will also be the future home for MP3.0's goal of providing resources and links, including digital tools and instructional training material, that will be readily available for use by all medical physicists.

Additionally, an upcoming 3-day Medical Physics 3.0 workshop, where participants will have the opportunity for hands-on experience and implementation, is planned for 2020. Please keep an eye out for the registration announcement in the upcoming year!

Find us at our session at the 2019 AAPM Annual Meeting in San Antonio:

How International Actions Interface and Support Med Phys 3.0

Monday, July 15, 1:45 – 3:45 pm Room 302

1. Redefining and reinvigorating the role of physics in clinical medicine: A Report from the AAPM Medical Physics 3.0 Ad Hoc Committee. Samei, E., et al. Med. Phys., 45: e783-e789 (2018). doi:10.1002/mp.13087
2. MedPhys 3.0 Report: What is it all About? Samei, E. AAPM Newsletter, 43 (4), (2018).

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