Training activity information
Details
Use patient dose audit data to establish or review local diagnostic reference levels and compare them to national diagnostic reference levels
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Legislation and guidance on diagnostic reference levels
- Methods for setting local and national diagnostic reference levels
- Data collection for patient dose audits
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like?
- How would you define success for this specific task of using patient dose audit data to establish or review local Diagnostic Reference Levels (DRLs)?
- What specific steps will you take to ensure your analysis is accurate and that your comparison to national DRLs (e.g., from NRPB or PHE) is precise?
- How will you ensure that the recommendations for practice improvement you formulate are strictly evidence-based?
- Have you discussed the specific data sources, departmental methodologies for DRL calculation, and the required report format with your Training Officer to gain clarity on expectations?
- What is your prior experience of this activity?
- What do you already know about data analysis, auditing, and the role of DRLs in patient dose optimisation as outlined in the module’s indicative content?
- What is your prior experience in working with large datasets or using statistical tools and software for data processing?
- How familiar are you with UK radiation safety legislation, such as IRMER or IRR, and how they specifically relate to auditing and patient protection?
- What specific challenges do you anticipate—such as issues with data integrity, access difficulties, or complex statistical discrepancies—and how do you plan to troubleshoot them?
- Do you clearly recognise the scope of your own practice, and do you know when to seek advice from a medical physicist, data analyst, or your Training Officer for complex statistical or legislative interpretations?
- How do you honestly feel about embarking on this activity, and do you feel prepared to manage and interpret the substantial volume of data required?
- What do you anticipate you will learn from the experience?
- What specific skills—such as data extraction, clinical statistical analysis, or technical report writing—do you hope to develop or refine through this activity?
- How do you anticipate this experience will improve your ability to critically assess compliance against national legislation?
- What specific insights do you hope to gain regarding the practical application of patient dose audit data in optimising radiation protection?
- How will this activity deepen your understanding of the challenges and complexities of establishing DRLs and their direct impact on clinical practice and patient safety?
- What additional considerations do you need to make?
- Reflecting on previous data analysis or audit tasks, what areas for improvement (such as data validation or the clarity of your findings) have you identified?
- What important information regarding specific imaging modalities, clinical protocols, and national guidance must you consider before you begin?
- Which departmental policies regarding dose management or local audit cycles do you need to review to ensure your work is aligned with organisational requirements?
- How will you ensure you have identified all the necessary sources of patient dose data and confirmed your methods for accessing them securely?
In action
- Are you encountering unexpected issues with accessing or extracting patient dose data, such as data integrity problems, incomplete records, or difficulties with the data retrieval system?
- Are there unforeseen challenges during the statistical analysis of the audit data, such as outliers, skewed distributions, or complexities requiring advanced statistical methods?
- Does the comparison between local and national Diagnostic Reference Levels (DRLs) reveal discrepancies that are significantly larger or smaller than expected, prompting immediate questions about local protocols or national standards?
- During discussions with clinical staff about audit findings or DRL changes, do they raise unexpected questions or resistance that require immediate adaptation of your communication or explanation?
- Have you dealt with similar data quality issues or analytical challenges in previous audits or data-related tasks?
- How does the current DRL audit differ from previous experiences with audit methodologies or legislative compliance reviews?
- Are you adapting your data collection, cleaning, or analysis approach in real-time to address unexpected data issues?
- Are you seeking immediate clarification or advice from a medical physicist or your Training Officer regarding data anomalies or complex statistical interpretations of the DRLs?
- Is the unexpected development affecting your ability to undertake the activity independently? For instance, do you require immediate support to resolve a technical issue with data processing or to interpret a complex legislative nuance related to DRLs?
- Are you finding it difficult to adapt to the unexpected data challenge or the questions from clinical staff? Is it affecting your confidence in the accuracy of the audit findings or your ability to establish/review DRLs?
- Despite the unexpected elements, are you feeling positive you can reach a successful conclusion, ensuring accurate DRL establishment/review and effective recommendations?
- Are you ensuring that the audit methodology and your recommendations for DRLs remain compliant with relevant legislation (e.g., IRMER, IRR) and employer’s procedures, even when facing unexpected data or analytical challenges?
- Are you recognising when a data anomaly or a question from clinical staff is beyond your current scope of statistical expertise or clinical protocol knowledge and effectively managing this, perhaps by noting it for further consultation?
- What new insights are you gaining into data integrity challenges, the practical application of DRLs in optimising patient protection, or effective strategies for managing complex data analysis or stakeholder discussions in real-time?
On action
- Summarise the key points of the experience of performing the DRL audit.
- Describe the process you followed for collecting and analysing the patient dose audit data, and how you established or reviewed local DRLs.
- Outline the key findings from your comparison of local DRLs to national DRLs.
- Were there specific challenges encountered during data extraction or analysis, such as data integrity issues or outliers?
- Describe any discussions you had with clinical staff about the audit findings or proposed DRL changes. What was their reaction?
- How did you adapt your data collection, cleaning, or analysis approach in real-time to address unexpected data issues or discrepancies?
- Describe any instances where you had to immediately adjust your communication strategy when discussing audit findings or DRL changes with clinical staff who raised unexpected questions or resistance
- What strengths did you demonstrate in performing a comprehensive audit, interpreting complex patient dose data, and formulating clear recommendations for DRLs?
- What skills and/or knowledge gaps were evident in your statistical analysis capabilities, understanding of DRL methodology, or ability to navigate legislative nuances (e.g., IRMER, IRR) during the audit?
- Compare this experience against previous engagement with similar activities.
- Were any previously identified actions for development achieved in your auditing skills, data analysis, or ability to advise on legislative compliance?
- Has your practice improved in identifying and addressing data anomalies or in discussing sensitive audit findings with stakeholders?
- Identify any challenges you experienced and how you reacted to these. Were you able to overcome these challenges to ensure accurate DRL establishment/review and effective recommendations?
- Did you need to seek advice or clarification from a medical physicist or your Training Officer regarding complex statistical interpretations, specific DRL calculations, or implications of legislative requirements (e.g., IRMER, IRR)?
- Did you need to escalate any aspect to ensure that you were working within your scope of practice, particularly if a data anomaly or clinical question exceeded your current expertise?
- Do you feel more confident in your ability to conduct DRL audits and make recommendations after reflecting on this experience?
- Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received.
- What will you do differently next time to improve the efficiency or accuracy of your DRL audits, or to enhance your communication of audit findings and recommendations?
- Has anything changed in terms of what you would do if you were faced with a similar situation again, particularly regarding data management best practices or strategies for engaging clinical staff in discussions about DRL changes?
- Do you need to practise any aspect of the activity further, such as advanced statistical analysis techniques, specific software for data extraction, or methods for presenting audit results persuasively?
Beyond action
- Have you reviewed your actions from your previous reflections for performing patient dose audits and DRL comparisons?
- What specific actions did you identify you needed to take to improve your audit methodology, data analysis techniques, interpretation of DRL discrepancies, or communication of findings (e.g., addressing data integrity issues, handling outliers, discussing DRL changes with clinical staff)?
- Have you completed these identified actions in subsequent DRL audit activities?
- Are you now ready to demonstrate this new learning into your practice consistently when establishing, reviewing, and comparing DRLs?
- Have you engaged in professional storytelling with peers, near peers, or colleagues regarding challenges or insights gained from DRL audits or legislative compliance reviews?
- Has your view of optimal DRL methodologies, strategies for addressing non-compliance, or effective ways to recommend practice improvements changed because of analysing these situations with others?
- How has the mutual exchange of experiences transformed your approach to using dose audit data and formulating advice on legislation compliance?
- How have these cumulative experiences impacted upon your current practice of using patient dose audit data?
- How does the learning from multiple instances of DRL audits and related discussions support you in preparing for observed ‘in-person’ assessments?
- Consider how your practice in performing audits against legislation, making recommendations to improve practice, and formulating advice on compliance has developed and evolved over time across various audit scenarios.
- Are you now more proficient at identifying critical data issues, applying statistical methods, or effectively articulating the implications of DRL findings to clinical staff?
- How has your ability to work within your scope of practice, particularly in recognising when a data anomaly, statistical complexity, or legislative nuance is beyond your expertise, improved over multiple experiences?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Perform audits against legislation and make recommendations to improve practice. |
| # 4 |
Outcome
Formulate advice on compliance with aspects of legislation. |