title: Self-reported competency and continuing education needs of limited licence remote X-ray operators in New South Wales, Australia.
abstract: BACKGROUND
  In rural and remote parts of New South Wales (NSW) Australia, GPs and registered nurses who have completed a short course in basic radiography perform X-ray examinations when or where a radiographer is not available. This is a form of 'skills transfer'. They are licensed under the NSW Radiation Control Act 1990 to perform a limited range of examination types, providing a valuable service that prevents rural and remote residents from having to travel to access services. The aim of this survey was to gather background information about the NSW remote X-ray operators and investigate their self-perceived need for continuing education.
  
  
  METHODS
  A questionnaire was mailed to all 131 remote X-ray operators in NSW, with reminder letters sent 6 weeks later. The questionnaire consisted of 30 close-ended and 3 open-ended questions. Among the questions, respondents were asked to rate their self-perceived competency in 12 examinations covered by their licence, and to indicate how well they understood and how challenging they found certain aspects of radiographic practice.
  
  
  RESULTS
  The response rate of 63% was returned by nurses (74%), GPs (24%) and 2 physiotherapists. The majority (80%) performed radiography in towns of 3000 people or less. Together with other remote operator colleagues, 58% said that they performed an average of 2 to 10 examinations per week. Most thought their radiography was 'Good but not excellent' (48%) or 'Satisfactory most of the time' (41%). For 2 of the examinations (ankle and wrist) more than 90% of the respondents felt competent. For another 6 examinations less than 80% felt competent. Only 23% felt they could perform a chest X-ray on a premature baby. The most challenging aspects for respondents were dealing with paediatric and difficult patients; and the highest level of understanding was in 'Radiation protection'. Nineteen percent 'Never' did continuing education in radiography and radiology and 35% 'Rarely' did so. The GPs did more continuing education than others, and 80% felt a need for continuing education in this field. Approximately half (51%) said they had 'regular' contact with a radiographer and 32% 'sometimes' had contact. Seventy percent said this was 'Extremely' helpful. Approximately one-third (34%) received feedback about their radiography 'Regularly', most (44%) from a local radiographer. Preferred methods of continuing education were: face-to-face training; working alongside a radiographer; reviewing or auditing of their radiographs; and distance or online education. The support needed to undertake radiography continuing education was: time off from regular duties, transport and accommodation, and the support of management.
  
  
  CONCLUSIONS
  The survey results strongly suggest a need for continuing education in radiography and radiology for NSW remote X-ray operators. The GP respondents appeared to have different needs from the nurses and physiotherapists. Recognising their special circumstances and the isolation under which they work, ongoing educational support, as well as the opportunity to benchmark their practice against more mainstream services, should be embedded in the system. There is an opportunity to develop a best practice model for supporting and re-credentialing limited X-ray licence holders and to create a national benchmark. A well planned strategy may have relevance in other practice settings where skills transfer may be practised now or in the future.
authors: UDRH, University of Newcastle, Tamworth, New South Wales, Australia.
authors: Tony
authors: T
authors: Smith
authors: Karin
authors: K
authors: Fisher
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004496:Education, Continuing; D006801:Humans; D008004:Licensure; D009517:New South Wales; D024802:Nurse's Role; D011859:Radiography; D011871:Radiology / Q000193:education*; D019035:Rural Health Services; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D000078329:Workforce