Radionuclide Therapies —
Training activity: 3

Details

Provide radionuclide therapy patients with radiation protection instructions and, where relevant, perform monitoring to determine their discharge and radiation restrictions including:

• Inpatient therapies
• Outpatient therapies

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

• Choice of appropriate monitor
• Calculating effective half-life, discharge from hospital and duration of radiation restrictions
• Local and national radiation legislation
• Patient’s home/work circumstances
• Tailoring advice to individual circumstances
• Communication with patients
• Patient centred care and support
• Carers and comforters

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?
  • What is your understanding of what constitutes successfully providing clear, accurate, and understandable radiation protection instructions, and how will you ensure that your monitoring measurements correctly determine a patient’s discharge eligibility in compliance with regulatory limits?
  • Have you discussed the specific expectations for this particular patient scenario—whether they are an inpatient or outpatient—with your training officer?
• What is your prior experience of this activity?
  • Thinking about your prior experience, how has observing or practicing the explanation of complex radiation risks prepared you for this task, and how familiar are you with performing the specific radiation monitoring required for therapy patients?
  • What possible challenges do you anticipate—such as patient anxiety, language barriers, complex home circumstances, or background radiation issues—and how have you planned to handle these in the moment?
  • Do you clearly recognise your scope of practice, specifically knowing when you must seek advice or help from a supervisor, medical physics expert, or nursing staff regarding complex questions or unclear monitoring results?
  • How do you feel about embarking on this specific training activity?
• What do you anticipate you will learn from the experience?
  • What specific skills do you want to develop through this activity, such as improving your communication of sensitive information, tailoring advice to an individual’s life, or refining your dose rate monitoring technique?
  • What specific insights do you hope to gain, such as understanding common patient concerns or the practicalities of linking administered activity and patient factors to final discharge criteria?
• What additional considerations do you need to make?
  • Have you consulted actions identified from your previous experiences of observing patient communication or monitoring tasks to ensure you are focusing on areas you previously noted for improvement?
  • Have you reviewed all important information required before you begin, including the patient’s therapy details, standard protection instructions, regulatory discharge limits, and the relevant departmental SOPs?

In action

• Are you noticing anything surprising or different from what you anticipate during the process of giving instructions, performing monitoring, or determining discharge?
  • Are you encountering situations such as:
    • Patient difficulty understanding or complying with instructions
    • Monitoring readings (e.g., dose rate) that are higher or lower than expected or near a discharge limit
    • Challenges related to the patient’s social situation impacting their ability to follow restrictions (e.g., living with children or pregnant individuals)
    • Equipment malfunction during monitoring
    • Unexpected questions or concerns from the patient or their family/carers
  • How does this experience compare with previous experiences of similar activities?
• How is this impacting your actions? For example, are you responding to the situation appropriately?
  • Are you adapting or changing your approach to explaining, monitoring, or calculating? Is it affecting your ability to undertake the activity independently?
  • Consider the steps you are taking in the moment, such as:
    • Are you rephrasing instructions or using different communication techniques?
    • Are you repeating monitoring measurements or checking equipment?
    • Are you consulting guidelines for discharge criteria or specific restriction scenarios?
    • Are you seeking advice from a supervisor, Radiation Protection Adviser (RPA), or other healthcare professional?
  • How are you feeling in this moment? For example, are you finding it difficult to adapt? Is it affecting your confidence? Are you feeling positive you can reach a successful conclusion?
• How is any unexpected development being resolved as you progress during the activity?
  • How are you working within your scope of practice? Are you successfully managing the situation within your authority, or do you need to escalate or seek input from someone with greater expertise or authority (e.g., to make a final discharge decision)?
  • What are you learning in this moment as a result of any unexpected development? For example, are you learning a more effective way to communicate complex restrictions or the specific protocol for dealing with a borderline monitoring result?

On action

• Begin by summarising the key points of the experience of providing instructions, performing monitoring, and determining discharge/restrictions.
  • Describe the specific steps you undertook, including the communication process and using monitoring equipment.
  • Consider specific events, actions, or interactions that felt important during the activity, including your own feelings during the experience. This might include challenges in explaining complex restrictions, patient understanding or compliance, or issues with the monitoring process.
  • Include any ‘reflect-in-action’ moments, where you adapted to the situation as it unfolded. Recall anything that felt surprising or different from what you anticipated (e.g., unexpected monitoring results, a patient’s living situation impacting restrictions), and how you reacted to that unexpected development in the moment.
• Identify what learning you can take from this experience. For example, what did you learn about effective communication of radiation risks and restrictions, applying discharge criteria based on monitoring results, or tailoring advice to individual patient circumstances?
  • What strengths did you demonstrate during the activity? Were you effective in communicating clearly, performing accurate monitoring, or applying guidelines correctly?
  • What skills and/or knowledge gaps were evident? Was there anything you were unsure about regarding specific restrictions, monitoring techniques, or interpreting results for discharge?
  • Compare this experience against previous engagement with similar activities (if any). Have any previously identified actions for development been achieved? Has your practice improved in providing instructions or performing monitoring for discharge?
  • Identify any challenges you experienced and how you reacted to these. Did these challenges affect your ability to deal with the situation? Were you able to overcome the challenges?
  • Identify anything significant about the activity. Did you need to seek advice or clarification from a supervisor or colleague regarding patient instructions, monitoring, or discharge decisions? Or did you need to escalate something to ensure you were working within your scope of practice?
• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt. This includes learning from any feedback you have received.
  • What will you do differently next time you provide radiation protection instructions or perform monitoring for patient discharge?
  • Will you change your communication style or monitoring approach?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, particularly regarding handling unexpected monitoring results or patient questions about restrictions?
  • Do you need to practise any aspect of the activity further?
  • Are there specific skills related to communication, monitoring, or applying discharge criteria you want to develop further, drawing upon this experience?

Beyond action

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (providing patients with radiation protection instructions and performing monitoring for discharge)?

When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to explaining complex restrictions clearly, addressing patient concerns, performing monitoring measurements correctly, or applying discharge criteria?

Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity?

Are you ready to demonstrate this new learning confidently and consistently when performing this task?

Have you engaged in professional storytelling or discussed your experiences of instructing and monitoring patients for discharge with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient communication regarding restrictions or the practicalities of monitoring for discharge?

• Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? For example, how does your improved communication and monitoring skill prepare you for an OCE like ‘Explain radiation precautions to a patient having radionuclide therapy’ or a DOPS related to patient monitoring?

How has your practice related to instructing patients and monitoring for discharge developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in handling different patient needs or interpreting monitoring results?

Based on your experiences, how has your ability to recognise when something related to patient instructions, monitoring results, or discharge criteria is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., RPA, medical staff, supervisor) you need to seek advice or clarification?

Relevant learning outcomes

#	Outcome
# 2	Outcome Identify and explain the post-therapy behavioural radiation restrictions including the effective communication of risk to patients and personnel.
# 4	Outcome Perform monitoring measurements to determine a radionuclide therapy patient’s point of release and follow appropriate decontamination procedures.