A program to train medical physicists for direct patient care responsibilities

Abstract Objectives To develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities. Materials and Methods The training program was designed in collaboration with the faculty at the UC San Diego School of Medicine and incorporates training techniques that have been shown to be effective in improving communication skills. The program emphasizes experiential, practice‐based learning over didactic presentations. Results The training program is comprised of 5 components: 1) a 1‐day Clinician‐Patient Communication Workshop run by the UC San Diego School of Medicine, 2) Communication Strategies for Radiation Oncology, which consists of two, 2‐hour sessions designed to provide trainees with patient communication skills that are specific to patient interactions in radiation oncology, 3) Simulated Patient Interactions, in which trainees perform mock physicist‐patient consults with trained patient actors, 4) Faculty‐Observed Patient Consults, and 5) a Case‐Based Treatment Toxicity Course. A competency assessment mechanism was also developed to provide a clear set of objectives and to guide trainer feedback. [Correction added after first online publication on November 7, 2018: The phrase ", which consists of two, 2‐hour" was added above.] Conclusions The training program that we have developed incorporates an array of established education techniques and provides a comprehensive, accessible, means of improving medical physicists’ patient communication skills.

As technical experts, medical physicists are uniquely positioned to be able to guide patients through the treatment process, to address questions about treatment delivery and imaging modalities, as well as to discuss concerns about radiation safety. In contrast to the extensive training received by physicians, 8,9 there are no comparable resources for medical physicists. 10,11 Moreover, we are not aware of any independent training programs that are specifically designed to teach medical physicists to communicate effectively with patients.
Here, we describe a training program that was developed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities.

| STRUCTURE OF THE TRAINING PROGRAM
The training program incorporates established techniques for improving patient communication skills. It emphasizes experiential, practice-based learning over didactic presentations and includes roleplaying and Simulated Patient interactions. [12][13][14][15] The five steps are described below.

| Clinician-Patient Communication Workshop
The medical physics training program utilizes a Physician Assessment and Clinical Education Workshop which is a 1-day event offered through the UC San Diego School of Medicine. It is designed specifically to improve physician-patient communication and employs a structured approach to training communication skills based on four main conceptsengagement, empathy, education, and enlistment. 16

| Communication Strategies for Radiation
Oncology This course consists of a series of two, 2-hour sessions designed to provide trainees with patient communication skills that are specific to patient interactions in radiation oncology. The sessions combine brief lectures with moderated, practice-based group interactions.
Topics covered are: 1. The essential components of a physicist-patient consult.
2. How to introduce yourself to a patient.
3. Review of a list of common questions from patients. 4. Strategies for answering patient questions effectively.
5. Re-enactments of positive and negative physicist-patient interactions followed by group discussion. 6. A one-on-one role-playing exercise where each physicist plays the role of a patient during an encounter with a medical physicist.  the medical physicist mentor prior to, and immediately after, the consult to discuss the interaction.

| Case-Based Treatment Toxicity Course
Medical faculty in our department run a case-based course that describes common treatment toxicities. Classes occur once per month over the course of a year and cover common toxicities for breast, genitourinary, gynecological, brain, pediatrics, lymphoma, head and neck, gastrointestinal, and lung cases. Toxicity presentation, progression, and likelihood of resolution are discussed. Medical physicist trainees take this course for the purpose of equipping them with the knowledge to better prepare for understanding likely medical questions from patients and to help them effectively communicate toxicity concerns to the attending radiation oncologist.

| COMPETENCY ASSESSMENT
A series of clinical communication competencies, shown in Table 1, were developed to reflect the primary goals of patient interactions. was developed for this assessment, defined as follows: 1. Trainee did not attempt to display the specific competency.
2. Trainee attempted to display the specific competency but missed some key elements.
3. Trainee displayed mastery of the specific competency.
Trainees are deemed competent to perform physicist-patient consults on their own when they score a three in all competency categories.

CONF LICT OF I NTEREST
The authors have no other relevant conflicts of interest to disclose.