The use of the UCLan Mountain Medicine and other Masters programmes as a recruitment tool for healthcare organisations with difficulties in recruitment and retention.

INTRODUCTION: A variety of incentives are used to stimulate recruitment to remote and rural locations. In this presentation, we share experiences at the University of Central Lancashire of forming partnerships with National Health Service (NHS) organisations to offer investment in careers as a recruitment and retention tool. METHODS: Qualitative structured interviews. RESULTS: NHS organisations priorities were to find cost-effective and successful strategies to recruit and retain workers. Many had tried financial incentives, including 'golden handshakes' and 'golden handcuffs' but found them ineffective or unaffordable. Prospective employee priorities were multifactorial, including a desire for flexibility, manageable workload and the ability to develop their personal and career interests. Whilst rates of pay were important, one-off lump sum payments were viewed as having lower value. DISCUSSION: This partnership approach has helped us develop MSc programmes that fit with the needs of their services and innovatively support their recruitment aims. We have also given voice to the needs of our learners, for example by encouraging job planning approaches that facilitate the prolonged blocks of leave required for acclimatisation of practitioners of Mountain Medicine to travel to high altitude. When explored, advertised one-off lump sum payments amounts were perceived as being misleading due to tax deductions, diminishing their utility as a 'feel good' factor in retention. Conversely, gradual investment over time, using academic study as an enabler for flexible job planning combined with a feeling that their employer supported some of their drivers and values contributed to a greater sense of commitment by employees.

Developing a Robotic and Autonomic Medical Evacuation (RAS MEDEVAC) capability for remote and rural populations.

INTRODUCTION: The inherent clinical risks associated with remote and rural environments are potentially mitigated by timely air ambulance transfer, yet this involves other costs, operational constraints and limitations. The development of a RAS MEDEVAC capability may present the opportunity to enhance clinical transfers and outcomes across remote and rural areas as well as more conventional civilian and military environments.Methods The authors propose a multi-phase approach to assist RAS MEDEVAC capability development.Results RAS MEDEVAC capability development could be enhanced by a step-wise approach that: (a) incorporates a clear understanding of related clinical (including aviation medicine), vehicle and interface principles; (b) understands opportunities and limitations of related technology advancements; and (c) develops a new glossary and taxonomy to describe echelons of care and phases of medical transfer.Discussion RAS MEDEVAC presents the opportunity to exploit a number of potential capability characteristics - speed, flexibility, safety (including sparing/avoidance of human escorts), persistence, availability, reliability, expendability and acceptability. The application of a staged, multi-phase approach could allow for a structured review of relevant clinical, technical, interface and human factors that would be matched to product availability to inform future capability development. Particular consideration will need to be played to balancing new concepts of risk as well as considering ethical and legal factors.

US Radiation Oncologists (Re)Defined: An American Society for Radiation Oncology Scope of Practice Study.

PURPOSE: To assess US radiation oncologists' views on practice scope and the ideal role of the radiation oncologist (RO), the American Society for Radiation Oncology (ASTRO) conducted a scope of practice survey. METHODS AND MATERIALS: In spring 2019, ASTRO distributed an online survey to 3822 US RO members. The survey generated 984 complete responses (26% response rate) for analysis. Face validity testing confirmed respondents were representative of ASTRO's RO membership. RESULTS: Nearly all respondents agreed that "ROs should be leaders in oncologic care." Respondents indicated the ideal approach to patient care was to provide "an independent opinion on radiation therapy and other treatment options" (82.5%) or "an independent opinion on radiation therapy but not outside of it" (16.1%), with only 1.4% favoring provision of "radiation therapy at the request of the referring physician" as the ideal approach. Actual practice fully matched the ideal approach in 18.2% of respondents. For the remaining majority, actual practice did not always match the ideal and comprised a mix of approaches that included providing radiation at the referring physician's request 24.0% of the time on average. Reasons for the mismatch included fear of alienating referring physicians and concern for offering an unwelcome opinion. One-fifth of respondents expressed a desire to expand the scope of service though interspecialty politics and insufficient training were potential barriers. Respondents interested in expanding scope of practice were on average earlier in their career (average years in practice 13.3) than those who were not interested (average years in practice 17.2, P < .001). Radiopharmaceuticals administration, medical marijuana and anticancer medications prescribing, and RO inpatient service represented areas of interest for expansion but also knowledge gaps. CONCLUSIONS: These results provide insight regarding US ROs' scope of practice and attitudes on the ideal role of the RO. For most ROs, to provide an independent opinion on treatment options represented the ideal approach to care, but barriers such as concern of alienating referring physicians prevented many from fully adhering to their ideal in practice. Actual practice commonly comprised a mixed approach, including the least favored scenario of delivering radiation at the referring physician's request one-quarter of the time, highlighting the influence of interspecialty politics on practice behavior. Advocacy for open communication and meaningful interdisciplinary collaboration presents an actionable solution toward a more balanced relationship with other specialties as ROs strive to better fulfill the vision of being leaders in oncologic care and being our best for our patients. The study also identified interest in expanding into nontraditional domains that offer opportunities to address unmet needs in the cancer patient's journey and elevate radiation oncology within the increasingly value-based US health care system.

Initial Impact and Operational Responses to the COVID-19 Pandemic by American Radiation Oncology Practices.

PURPOSE: In February 2020, the COVID-19 pandemic reached the United States. The impact of the pandemic on the US radiation oncology field remains unknown. The American Society for Radiation Oncology surveyed US radiation oncology practice leaders to gauge initial impact and immediate operational responses to the pandemic. METHODS AND MATERIALS: From April 16 to April 30, 2020, the American Society for Radiation Oncology surveyed US radiation oncology practice leaders by email to gauge initial impact and immediate operational responses to the COVID-19 pandemic. RESULTS: Two hundred twenty-two (43%) of 517 leaders responded from community and academic practices (62% and 34%, respectively), hospital-based and free-standing centers (69% and 29%), and metro and rural locations (88% and 12%). Practices reported treating an average of 1086 patients per year in 2019 (range, 0-7900) with an average daily treatment volume of 70 patients (range, 5-400). All practices reported uninterrupted operation. On average, practices were treating 68% of their typical volume (range, 10%-95%), with 92% implementing planned treatment postponement for lower risk patients. An estimated revenue decrease of 20% or more was experienced by 71% of practices. Confirmed COVID-19 patient cases were treated by 39% of practices. Seventy percent experienced staff shortages. Almost all (98%) practices implemented formal operational procedures to protect patients and staff, although personal protective equipment/infection control supply shortages were reported by 78% of practices. Seventy-four percent used telemedicine for virtual follow-up surveillance, and 15% leveraged telemedicine for on-treatment assessment. CONCLUSIONS: The clinical and financial impacts of the COVID-19 pandemic on US radiation oncology were deep and broad. Despite reported shortages in personal protective equipment, declines in revenue, and reduced patient volumes, practices adapted quickly by refining standard processes of care, implementing recommended safety measures, and employing telemedicine to facilitate treatment continuity. Patients with higher risk disease experienced uninterrupted access to care. We plan to continue regular surveying across the lifespan of the pandemic to document the geographic and temporal impact of COVID-19 on the field and its patients.

The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study.

PURPOSE: The aim of this study is to report the American Society for Radiation Oncology 2017 radiation oncologist (RO) workforce survey results; identify demographic, technology utilization, and employment trends; and assess the profession's ability to meet patients' needs, offer job satisfaction, and attract high-caliber trainees. METHODS: In spring 2017, the American Society for Radiation Oncology distributed an online survey to 3856 US RO members. The questionnaire was patterned after the 2012 workforce survey for trend analysis. The 31% response rate yielded 1174 individual responses (726 practices) for analysis. RESULTS: ROs' mean age was 50.9 years. Compared to 2012, female representation (28.9%) increased and white representation (69.8%) dropped. The proportion in rural practice (12.6%) decreased, whereas the number of suburban ROs (40.6%) increased and urban ROs (46.8%) remained high. Most ROs worked full-time, averaging 51.4 h/wk. Stereotactic body radiation therapy, cone beam computed tomography, and magnetic resonance/positron emission tomography-computed tomography fusion utilization increased, whereas low-dose-rate brachytherapy decreased by >15 percentage points. Hypofractionation utilization was 95.3% and was highest in academic/university systems and lowest in private solo practices (P < .001). More respondents were concerned about an RO oversupply rather than shortage. ROs reported 250 consults (median) and 20 on-treatment patients (median) in 2016 and greater time allocation to electronic health record management compared with 3 years earlier. Approximately 15% of ROs reported job vacancies, which were more prevalent in urban practices and academic/university systems. ROs were employed by academic/university systems, private practices, and nonacademic hospitals in a respective ratio of 2:2:1. Comparison with 2012 survey findings showed a shift from private practice toward academic/university systems and nonacademic hospitals. Compensation was predominantly productivity-based at private practices and a fixed salary or a base salary at academic/university systems and nonacademic hospitals. Practice merger/buyout was the lead reason for ROs to change employers. CONCLUSIONS: Since 2012, race and gender gaps narrowed, but geographic disparities persisted, with ROs gravitating toward resource-rich suburban and urban locations over rural practices. The workforce has shifted from predominantly private practice to more equal balance with academic/university systems. These findings reflect the current US RO landscape and serve to underscore the need for collective action to ensure equitable RO care for all patients.

Trends in relative weight over 1 year in low-income urban youth.

OBJECTIVES: Recent cross-sectional data indicate the rates of childhood obesity are plateauing. Few large-scale longitudinal data sets exist, particularly in low-income and minority youth. The purpose of this study was to describe longitudinal changes in relative weight among a large sample of low-income, minority youth over 1 year. METHODS: Participants were students from 56 schools in urban, low-income environments. There were 17,727 first- to sixth-graders (64% African-American, 52% male) assessed at baseline, and 13,305 youth (75.1%) were reassessed 1 year later at follow-up. Measured height and weight were used to assess categorical (overweight, obesity, severe obesity) and continuous (BMI, percentile, z-score) measures of relative weight. RESULTS: Longitudinal data showed that over 1 year, BMI percentile (95% CI.64--0.32, P<0.001) and BMI z-score (95% CI: -0.02--0.01, P<0.001) were significantly lower compared to baseline. The prevalence of overweight and obesity was stable over 1 year. Most (86.0%) youth remained in the same weight category as baseline, 6.8% improved weight category, and 7.2% worsened weight category over 1 year. CONCLUSIONS: These longitudinal data indicate that the relative weight of low-income, urban youth is showing signs of a small improvement over a 1-year follow-up period. The rates of childhood obesity, however, remain remarkably high and require continued, creative public health efforts.

Breakfast patterns among low-income, ethnically-diverse 4th-6th grade children in an urban area.

BACKGROUND: Increasing school breakfast participation has been advocated as a method to prevent childhood obesity. However, little is known about children's breakfast patterns outside of school (e.g., home, corner store). Policies that increase school breakfast participation without an understanding of children's breakfast habits outside of school may result in children consuming multiple breakfasts and may undermine efforts to prevent obesity. The aim of the current study was to describe morning food and drink consumption patterns among low-income, urban children and their associations with relative weight. METHODS: A cross-sectional analysis was conducted of data obtained from 651 4th-6th graders (51.7% female, 61.2% African American, 10.7 years) in 2012. Students completed surveys at school that included all foods eaten and their locations that morning. Height and weight were measured by trained research staff. RESULTS: On the day surveyed, 12.4% of youth reported not eating breakfast, 49.8% reported eating one breakfast, 25.5% reported eating two breakfasts, and 12.3% reported eating three or more breakfasts. The number of breakfasts consumed and BMI percentile showed a significant curvilinear relationship, with higher mean BMI percentiles observed among children who did not consume any breakfast and those who consumed ≥ 3 breakfasts. Sixth graders were significantly less likely to have consumed breakfast compared to younger children. A greater proportion of obese youth had no breakfast (18.0%) compared to healthy weight (10.1%) and overweight youth (10.7%, p = .01). CONCLUSIONS: When promoting school breakfast, policies will need to be mindful of both over- and under-consumption to effectively address childhood obesity and food insecurity. CLINICAL TRIAL REGISTRATION: NCT01924130 from http://clinicaltrials.gov/.