Abstract
In 2008 in Croatia, the provision of education for radiation therapists (RTTs) was very limited. There was no concept of a standardised formal education and continuous education opportunities were also very limited. In 2008, Croatia was invited to join the first iteration of the 'Best Practice in Radiation Oncology-a project to train the RTT trainers' initiative. This was the starting point of significant positive change in the education of RTTs in Croatia and thereby, the provision of quality care to patients. The project also resulted in a close collaboration in the development of educational opportunities for all radiation oncology professionals- radiation oncologists, medical physicists and RTTs, together with national bodies and universities.
Keywords: Radiotherapy, Competencies, Regional projects, Study programmes
The practice of RTTs in Croatia has gone through many changes over the last decade. These changes are obvious when it is observed how the standard of patient treatment and care has evolved over this decade and particularly in the context of the role and status of radiotherapy in healthcare today.
In 2008 in Croatia, there was no clear pathway for professional development and continuous education and there was certainly no concept of a specialised educational programme for RTTs.
From 2008 onward RTTs in Croatia have been active participants in several projects conducted by ESTRO and IAEA. Our first experience was in 2008 when a group of RTTs participated in the ESTRO/IAEA project Best Practice in Radiation Oncology – A Course to Train Radiation Therapist Trainers (TTT) –RER6019. Two further projects followed: Improving Radiotherapy Services through Strenghtened Knowledge of Radiation Oncologists and Radiation Therapists – RER6029 and Strengthening Knowledge of Radiation Therapy Professionals – RER6033. The aim of these programmes was raising the awareness of the need for specific education of RTTs (Radiation TherapisTs). However in Croatia, as in some of the other participating countries, bringing the idea of improved education to fruition encountered many difficulties. These included a lack of guidelines for improving basic clinical practice and establishing continuous professional development programmes at national level, both of which needed to be addressed.
Many efforts were made involving participants of the projects and the national bodies who had supported the iniative. Croatia's National Society for Radiation Technologists was the first to embrace the initiative, followed by the Croatian Chamber of Health Professionals and the State Office for Radiological and Nuclear Safety.
In 2009 the University of Applied Health Sciences in Zagreb and the University Department of Health Studies, University of Split, joined the project and offered their support for a two year period.
The education of RTTs in Croatia is carried out by three educational bodies, as a single, integrated program for Radiation Therapists combining Radiology, Radiotherapy and Nuclear Medicine. The graduates are awarded a BSc. in Radiation Technology. Throughout the projects outlined above, a considerable number of courses, workshops and symposia have been organised and delivered successfully and defined changes have been achieved with respect to the formal educational system.
In the period 2008–2011 four courses were developed and delivered by RTTs who had attended the first ‘Train the Trainer’ programme. Over this period the number of participants, as well as the participation from the various State institutions and educational bodies, increased with each course that was organised. The TTT group cooperated closely with their mentors, but they also collaborated closely with other teams from different countries involved in this project, and the enthusiasm for this approach to education grew rapidly.
At the end of the first year this approach evolved to become an educational pilot project, that involved not only RTTs, but also physicists and radiation oncologists who joined with us, having been impressed by the first course delivered. We agreed on the general theme and title: A course/workshop on Quality Assurance in Radiation Technology (QART) to cover all aspects of radiation therapy that needed further education, development or research with the final goal of raising awareness for the need to continuously improve clinical practice in Radiation Oncology.
Many issues were addressed as part of this process, and many of them became local initiatives undertaken by the National Society, the Chamber and official educational bodies to be resolved following recommendations through the TTT project.
In 2012 and 2013 two meetings took place in collaboration with the Croatian Chamber of Health Professionals covering the important task of defining the competencies and skills of RTTs, trying to harmonise them with the European Core Curriculum for RTTs from ESTRO.
From 2014 to date, various events and actions encompassing activities from the National Society, Chamber and Universities have taken place in an attempt to finally resolve the professional issues of RTTs.
One of the most exciting and beneficial results of national and international courses that were delivered as part of the TTT programme is the collaboration and interlinking between countries involved. This finally gave birth to SEETRO – South and East Europe Technology in Radiation Oncology, an international professional platform for National Societies who wish to work together and exchange experiences and knowledge gained through the ‘Train the Trainer’ project. To date it has resulted in three very successful Congresses held in Belgrade (2013-Serbia), Zagreb (2015-Croatia) and Sofia (2017-Bulgaria). The 4th SEETRO Congress is scheduled for October 2019 in Ljubljana, Slovenia.
Over many years of work and involvement it became clear that educational programmes and qualifications in Croatia were insufficient for the fields of specific competencies such as radiation therapy. In continuing collaboration with ESTRO and IAEA a new specialised programme for the education of RTTs has been proposed by Croatia's educational institutions. This initiative is being promoted by the Department of Health Studies at the University of Split, but Universities in Zagreb and Rijeka have also recognised its importance and the need to adapt existing education programmes for RTTs.
Looking back at the period from the first ‘Train the Trainer’ project in 2008 to the current time, it would be fair to conclude that this project had a very positive impact for both professionals and the profession of RTTs.