A Review of the Regulatory Framework for the Practice of MRI
Review Context
The MRTB – The primary responsibility of the Board is to protect the health and safety of the public in respect of medical imaging and radiation therapy services – Legislative responsibilities under the Health Practitioners Competence Assurance Act 2003 – Regulate the competence and fitness to practise of individual practitioners
Core Functions • Defining scopes of practice and associated qualifications (sections11 – 13) • Setting competencies/standards of practice (sections 11; 16) • Regular reviews of regulatory mechanisms (section 14) • Registration and issuing practising certificates (sections 15 – 33) • Monitoring ongoing competence (sections 34 – 44) • Managing professional standards notifications (sections 34 – 51; 64 – 71) • Accrediting qualification programmes (section 12) Under the Health Practitioners Competence Assurance Act 2003 4
Principles that Underpin Our Work • Consideration of potential risk of harm or serious harm to the public • We are accountable to the public, Parliament and the Minister of Health • We are accountable to the profession for the efficient use of funds • As an independent regulator our decision making is not determined by external bodies (see notes) • Ensure the most effective, efficient, and consistent regulation of the profession • Ensure our policies and standards are current in the NZ health environment through an ongoing programme of review • Work collaboratively and constructively with key stakeholders
Regulation Workforce Health Regulation Health Outcomes Health Workforce
MRI from an International Aspect
A Stocktake of the Regulation of MRI • MRTB commissioned an independent literature review (Waipiata Consulting) looking at global picture for practice of MRI: – New Zealand compared with 5 other countries with comparable health systems: • Australia • United Kingdom • Canada • South Africa • USA
Terms of Reference • How are MRI practitioners regulated in those countries? • The various training frameworks – Level of study (courses/undergraduate/postgraduate) – Learning hours – Academic and clinical components – Critical subject matter • How is clinical competence assessed? • What competencies are entry-level MRI practitioners expected to have? • How does each country manage the regulation of overseas-trained MRI practitioners?
Australia • Regulation: – No separate registration for practitioners practising MRI • Training in MRI: – MRPBA (Medical Radiation Practice Board of Australia) requires MRI component within undergraduate medical imaging programmes – Legislation does not restrict practice. Practice only limited by what the practitioner is educated for and competent to do – As a minimum would need to have workplace training in MRI and preferably that would include formal study (MRPBA) – Majority of training is postgraduate: AIR (Australian Institute of Radiography) the largest provider – Current registration is a pre-requisite to course entry – MRI certification through AIR
• Workplace Practice: – MRI competencies embedded into the Diagnostic Radiographer standards and professional capabilities – Must apply MRPBA Code of Conduct when practising MRI • Regulation of Overseas-Trained Practitioners: – Overseas-trained practitioners must meet MRPBA professional capabilities and Code of Conduct – Entry via TTMRA or an online examination – “High Risk” countries: examination plus supervised practice
United Kingdom • Regulation: – No separate registration for practitioners practising MRI • Training: – MRI physics and principles taught within undergraduate MI qualifications – No expectation that new Radiographers will practise MRI – Expectation that MRI practitioners will have postgraduate qualification – 8 postgraduate MRI courses 2 ½ -3 days week in MRI dept. with supervisor to monitor clinical practice – – Focus of qualifications is theoretical and technical knowledge – Current registration is a pre-requisite to course entry
• Workplace Practice – “ High trust” model (refer to notes) – Practical training for MRI generally provided in-house within a hospital setting – Majority of employers require some form of postgraduate qualification in MRI but there is no absolute requirement – No prescribed number of hours to be deemed competent in MRI – Clinical component of in-house hospital training is up to the individual department • Regulation of Overseas-Trained Practitioners: – HCPC (Health and Care Professions Council) is the national regulator – Standard process for all international applicants – Employers: Relevant PG qualification and experience. Code of Conduct and working within scope of practice
Canada • Regulation: – Medical imaging regulated in some provinces but not all – CAMRT (Canadian Association of Medical Radiation Technologists) is the national professional association and certifying body for MRT’s – 4 disciplines of MRT practice each with their own entry-level competency profiles: • Magnetic Resonance • Nuclear Medicine • Radiation Therapy • Radiological Technology
• Training: – Approved/accredited MRI qualifications: 6 diplomas and 1 certificate – Entry to all programmes (except one) is post graduate – Current registration is a pre-requisite to course entry – Includes both academic curricula and clinical practicum • Workplace Practice: – Standards of practice determined through regulatory framework • Regulation of Overseas-Trained Practitioners: – Self-Assessment Tools – Voluntary Orientation Course – Clinical Competency Assessment National Certification Exam
USA • Regulation: – 5 disciplines of “radiologic technology” recognised including MRI – ARRT (American Registry of Radiologic Technologists) is the registration body – ASRT (American Society of Radiologic Technologists) is the professional body and provides both a Practice Standard and Curriculum Guidelines for the practice of MRI – Only 3 states regulate MRI Technologists by modality • Training: – 2 pathways for MRI: • Primary Pathway – an accredited educational programme approved by ARRT • Post-Primary Pathway – qualified and registered MRT plus MRI clinical experience requirements plus 16 hours of structured education • 30 ARRT recognised educational programmes in MRI
• Workplace Practice: – Significant variation across states as to employers’ requirements • Registration of Overseas-Trained Practitioners – Certification examinations required in most states
South Africa • Regulation: – Health Professions Council of South Africa (HPCSA) regulates the professions of radiology and clinical technology – Professional Board for Clinical Technology and Radiography (PBCTR) sits within the HPCSA – 3 scopes of practice: • Diagnostic radiography (including MRI) • Nuclear medicine radiography • Radiation therapy – HPCSA regulates radiographers in respect of registration, education and training, professional conduct and ethical behaviour
• Training: – 1 post graduate MRI programme recognised by the PBCTR • 1-year certificate in MRI. 2 x fulltime academic semesters • Requires clinical placement with 600 hours logged in the MRI unit – HPCSA accredits training facilities for clinical experience for undergraduate programmes • Workplace Practice: – Standards of practice determined through regulatory framework • Registration of Overseas-Trained Practitioners: – HPCSA is the national regulator – Standard process for all international applicants
Overseas MRI Practice: An Overview • MRI regulated as a separate modality in some of the countries surveyed while in others it is amalgamated into other regulated scopes • Australia – UK – Canada typically expect MRI practitioners to have a post-graduate qualification. – In the large part assessment of clinical experience sits with the employer • Entry into the majority of MRI courses have a pre-requisite of a medical imaging qualification • All countries surveyed have explicit entry criteria for overseas-trained practitioners
MRI in NZ
New Zealand Regulation: • MRTB regulates practice of MRI as a separate scope of practice • 2 MRI scopes of practice have been defined under the HPCAA: – MRI Technologist – Trainee MRI Technologist Training: – Post graduate diploma studied part-time over a maximum of 4-years (most complete in 2-years) – Clinical placement in MRI unit requirement of the PG Diploma – Includes both academic curriculum and clinical competence assessment – Current registration pre-requisite to registration as a Trainee MRIT
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