Keywords

1 Introduction and Historical Background

1.1 Establishment of the Joint ICTP—University of Trieste Master of Advanced Studies in Medical Physics Supported by IAEA

The Master of Advanced Studies in Medical Physics (MMP) programme has been established in 2013 thanks to an agreement between the Abdus Salam International Centre for Theoretical Physics (ICTP) and the Trieste University and the contribution of the Trieste University Hospital. The ICTP, a United Nations Educational, Scientific and Cultural Organization (UNESCO) and IAEA institution, has been for more than 50 years a driving force behind global efforts to advance scientific expertise worldwide.

In January 2018 the MMP began its 5th cycle, composed by 19 students from 17 different countries. The international and unique profile of the programme is better understood knowing that the 87 students of the 5 cycles come from 48 different countries, 22 from Africa, 13 from Asia and the Pacific, 5 from Europe and 8 from Latin America and the Caribbean.

Implementation of the MMP programme requires significant financial resources and thus the financial support of different stakeholders has been crucial; these include: American Cancer Society (ACS), European Federation of Organisations For Medical Physics (EFOMP), ICTP, International Organization for Medical Physics (IOMP), Kuwait Foundation for the Advancement of Sciences (KFAS), The World Academy of Sciences (TWAS), Secretaría de Educaciόn Superior, Ciencia, Tecnología e Innovaciόn of Ecuador (SENESCYT), but mainly the IAEA, through the work of the Dosimetry and Medical Radiation Physics Section (DMRP) [1], Division of Human Health (NAHU) and the IAEA Technical Cooperation Programme.

1.2 The MMP Structure

The two-year programme is designed to provide promising graduates in physics or in related fields with one year of postgraduate academic education and one year of clinical training. The clinical training network comprises 19 medical physics departments: 18 Italian and one Croatian. The residency focuses on a specific area of medical physics: medical physics for diagnostic imaging or medical physics for radiation therapy, with elements in cross cutting fields. The programme and the assessment methodology of the acquired competencies constitute the resident’s portfolio, derived adapting the IAEA [2,3,4,5,6]—including AFRA [7,8,9]—guidelines. At the end of the programme, the resident defends a thesis on a specific activity developed during the clinical training.

The programme has received accreditation in 2016 by the IOMP [10]. Thanks to the collaboration with the International Medical Physics Certification Board (IMPCB) [11], from December 2018 selected graduates can undertake the IMPCB certification exams at the ICTP.

2 Materials and Methods

2.1 The Survey

The survey was developed exclusively online and consisted of 27 main questions. It was circulated through email and social media from April 2017 until May 2017, with a peak of received answers in April (68%).

2.2 Sample

22 among the graduates of 2 cycles answered to the survey, 85% of the whole graduates at the time of the survey. 55% of respondents are graduates of the year 2015, 45% of 2016. 50% and 27% were sponsored respectively by ICTP and IAEA, one participant by KFAS and the other students participated at their own expenses or supported by their countries.

The provenance of the graduates that answered to the survey includes 17 countries in 4 Regions, with a maximum of participants (41%) coming from Africa (7 countries), 27% of participants from Asia and the Pacific (5 countries), 23% from Latin America and the Caribbean (3 countries) and 9% from Europe (2 countries). This reflects the scope of the MMP: offer the programme in priority to candidates from Regions where there is lack of opportunities to acquire the necessary competencies to become clinical medical physicists.

3 Results

3.1 Impact Evaluation

To analyse the impact of the MMP, four indicators have been considered:

  1. (1)

    rate of graduates returning to their home country (which can be considered the best-case scenario),

  2. (2)

    rate of graduates returning to a different country, but in the same Region the participant originated from,

  3. (3)

    rate of graduates working as clinical medical physicists and

  4. (4)

    rate of graduates working in a non-clinical environment, but in an area related to medical physics.

Rate of graduates returning to their home country or Region. One of the main risks connected to the provision of such education and training during a 2 years programme abroad is that it can result in brain drain. The data from the survey show that this phenomenon is minimal within the analysed sample (91% of the participants went back to their home country). Only 9% (2 graduates, both from the Middle East) remained in Italy, both enrolled in a Ph.D. in Radiotherapy Medical Physics. According to these data, across 2 cycles of the MMP, countries were consistently returned trained professionals able to contribute to work in the clinic, thus supporting and develo** the national and regional medical physics activities.

Rate of graduates working in clinical medical physics or related areas. To fulfil its main purpose, the MMP should provide professionals that can work in the field of their specialization and support clinical activities.

It is often the case that candidates that apply to the MMP programme already have some experience working in medical physics at the time of the application. Among the respondents of the survey 77% were workers before the MMP. After the MMP 73% of participants were workers, 14% unemployed and 14% students. A follow up done in fall 2017 showed that the situation of unemployment had changed: only 1 unemployed, 82% workers.

41% of the respondents were working in the clinic as medical physicists before enrolling in the MMP. The role of the MMP programme in these cases is to expand the professional competence of participants. After the programme, the results showed that 55% of respondents worked in the clinic and 86% have activities related to medical physics, versus 50% before the MMP.

Areas of activity. The most frequent area of activity was diagnostic radiology (10 respondents), followed by radiotherapy (9 respondents). Respondents could select more than one answer to this question. The results showed that half of the respondents worked in several areas at the same time. This is understandable, considering that in countries without an established clinical medical physics department, the few available medical physicists will have to cover the whole spectrum of applications of radiation in medicine.

3.2 Local Title Registration and Certification

Programmes of higher education in the European Higher Education Area (EHEA) are offered at three levels or cycles: undergraduate, graduate and postgraduate. The Trieste MMP is a third-cycle program (“Master of Second level” in the Italian system). One of the questions of the survey aimed at exploring how the MMP diploma was recognized in their home countries. Most graduates (59%) underwent the process with different results. Most of the survey’s respondents that underwent the process of title recognition were already working in medical physics or related fields (71%) before entering the MMP. In general, in most countries of the graduates of the MMP there is little or no established path to become a clinical medical physicist, which is one of the reasons why these participants were considered for the Trieste MMP in the first place.

For the graduates that attempted the local registration of the title, the local recognition appeared not to be an issue in most cases (62% of participants that underwent the process) and the equivalence proposed has been in each case an M.Sc (Ecuador, Ghana, Nicaragua, Nepal, Togo, Sudan). Although, as explained previously, the title has a different meaning in the Italian system. 38% of the graduates that underwent the process faced difficulties in the process of local recognition of the title (Guatemala, Iran, Montenegro, Morocco and Qatar). In the case of Morocco, no equivalence was proposed. For example, in Guatemala and Qatar, the equivalence proposed was respectively of a Master’s Programme (6–7 years of University) and a “diploma” (2–3 years Master’s).

3.3 Professional Development and Support to Local Medical Physics

The formal recognition of the profession of clinical medical physicist is a challenge internationally. From the survey it emerges that 36% of the respondents report one medical physics national professional society, active in their country and 18% more than one. With the aim of supporting the recognition of the profession of clinical medical physicist, a national professional certification should be considered. Certification demonstrates the ability of the resident to be an independent medical physics practitioner or Clinically Qualified Medical Physicist (CQMP). Certification is normally awarded by a national body. Respondents of the survey for the most part (91%) declared not to have a national board for certification and, among those, answers were mostly positive (90%) to the possibility of taking part in an international certification process.

According to internationally recognized guidelines [2] certification should be followed by registration as a CQMP and the maintenance of registration achieved through Continuing Professional Development (CPD). This is the case for the two respondents that report having a national certification board. In some cases, CPD can be a national requirement, independent from the process of certification retention (59% of respondents). Among all the respondents that participate in a CPD programme 55% have plans to participate in educational activities as participants, while 32% as lecturers. 18% of respondents ignore whether there are requirements in their country for medical physicists to participate in a CPD.

3.4 Participants Feedback

The survey also contained specific questions to evaluate the MMP and its impact on the participant’s career. Most respondents declared that the MMP had helped them improve their career (59% highest appreciation mark). It was specified that the MMP helped increase the participant’s competence level in medical physics (77% highest marks). The self-assessment of the capacity of performing medical physics procedures after the MMP was of score 4 over 5 for 68% of participants and the highest for the remaining. The lectures and materials, assignments and activities part of the MMP were rated relevant (86%) to the participant’s current careers and the quality of the clinical training excellent (36%) and good (50%). Most respondents (82%) declared that they are still using documents collected during the clinical training (for example QC protocols), generally to develop updated protocols in their hospital 59%.

Furthermore, most participants (95%) keep in touch with the colleagues of the hospital where the clinical training took place, for example to discuss professional issues (55%) and develop research projects jointly (41%). The opportunity of maintaining and enlarging a network of peers for knowledge exchange and research purposes is an added value of the MMP.

4 Conclusions and Future Directions

The MMP offers to its participants a highly appreciated academic programme and one year of structured clinical training, thanks to its hospital network. The programme has proven to participate to provide the needed competencies to the participants, that in most cases regress to their home countries and Regions (91% of the graduates responding to the survey). The MMP programme has received the international IOMP Accreditation in 2016 and, since 2017, with the collaboration of IMPCB offers graduates that fulfil the needed requisites, the opportunity of undertaking examinations to achieve international certification.

Since the 2015–16 cycle, the MMP has received an increasing support from the IAEA, both technical for the selection of candidates and financial with the largest number of awarded fellowships. The MMP is continuing in the upcoming year and there are plans to extend the same survey to the new graduates of 2017.