Bridge over troubled water: The experience of Turkey in providing high-quality nationwide radiotherapy service

Transcription

1 SESSION 13A Access to high quality care: challenges and possible solutions Bridge over troubled water: The experience of Turkey in providing high-quality nationwide radiotherapy service Yavuz ANACAK Ege University School of Medicine Izmir - Turkey

2 Turkey: Main indicators of an upper-middle income country

3 History of Radiotherapy in Turkey The medical use of radiation arrived to Turkish soil very early 1897: One year after the Roentgen s discovery locally produced x-ray tubes were used for diagnostic purposes in Medical School of Istanbul 1897: Earliest use of x-rays to detect bullets and schrapnels in war wounds Nevsali Afiyet, page 226, 1897

4 History of Radiotherapy in Turkey 1898 the first radiology book in Turkish was published Röntgen Şu â âtı ve Tatbikat-ı Tıbbiye ve Cerrahiyesi, 76 pages, 1898

5 History of Radiotherapy in Turkey Turkey is among the first countries in the World having a radiotherapy service! Prof.Cemil Topuzlu published his experience with radiotherapy on 30 patients in 1 January 1904 at Gazette Medicale d'orient

6 History of Radiotherapy in Turkey Republic of Turkey 1930s - The rise of Nazism, German intellectuals and scientists seek refuge in Turkey University reform Einstein letter to Ataturk Paul Hindemith Carl Ebert Rudolf Belling Clemens Holzmeister Ernst Reuter Alexander Rüstow

7 Prof.Friedrich Dessauer in Turkey Prof. Dessauer was a physicist, a philosopher, a socially engaged entrepreneur, a journalist and a member of the parliament. He was imprisoned by the Nazis when they came to power for his opposition to Hitler. He was released at request of the Turkish government, who invited him to the University of Istanbul, where he was made chair of the Radiology Institute. Dessauer is the father of the «Modern Radiotherapy» in Turkey

8 Çapa Institute of Radiology and Biophysics Today s «Istanbul University Oncology Institute» The institute became one of the leading cancer institutes worldwide, where new equipment used and new techniques were developed, such as rotational chair technique for TBI

9 Radiation Oncology in Turkey Period of stagnation followed by booming Very few improvements until 1990s Radiotherapy was limited to 6-7 major towns Only cobalts, 1-2 linacs, 2-3 brachy systems Less than 30 radiation oncologists, less than 20 physicists No standartization for education, training and practice Open-economy Booming of radiation oncology Public and private investments Radiotherapy departments in almost all cities Modern linacs replaced cobalts completely İncrease in the number of staff Projects on standartization of education, training and practice National cancer control plan Turkish Society for Radiation Oncology

10 Radiotherapy Centers Public university Min.of Health Private centers & universities 135 radiotherapy centres in 40 towns More centers in planning & construction

11 Teletherapy Machines Heterogenous distribution throughout the country 54 centers operate with single machine Fragmentation of the services High-tech machines with inadequate staffing Replacement of the aging machines is a problem Maintenance quality is not good

12 Radiation Oncology Manpower new cancers/year needs radiotherapy Goksel F et al. Asian Pacific Journal of Cancer Prevention, Vol 12, 2011 IAEA guidelines for infrastructure and manpower

13 Radiation Oncology Manpower Lievens Y et al. Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey. RadiotherOncol (2014),

14 Projection to 2023 (Centennial of the Republic) 2023 Population Population ,8% Cancer incidence (1.000) 3-3,2 New cancers/year Need for radiotherapy From the report: Restructuring the Oncology Services in Turkey Staffing needs in 2023 RO: MP: radiation oncologists and medical physicists should be trained until 2023

15 Aproaching shortage of radiation oncologists More than 100 radiation oncologists will retire in 10 years!

16 Radiation Oncology Training Radiation oncologist 5 year training in university centers Core curriculum is prepared, but not officially endorsed yet Quality is variable among centers Medical physicist 2 years MSc degree is required - B.Sc degree is prerequisite No core curriculum yet Quality is variable among centers RTT 2 year associate s degree no further training available No core curriculum Quality is variable among centers

17 Turkish Radiation Oncology Society (TROD) 800 members Radiation Oncology core curriculum V.2.0. updated June 2013 Resident s log-book Courses National Congress Educational grants Board certification Competence triangle of TUKMOS based on 7 main fields of competence

18 Turkish Radiation Oncology Society (TROD) Training Courses 6 week-end and 3 pre-congress courses in 2017 Hands on e-contouring-astro Basic Radiation Physics Radioimmunotherapy Clinical Radiobiology Treatment Planning & Plan Evaluation Lung cancer Post-ASTRO meeting

19 Turkish Radiation Oncology Society (TROD) National Radiation Oncology Congress Every second year 13th UROK will be in pre-congress courses 10 teaching sessions Panels & sessions on education and training National Cancer Congress in-between TROD is a partner together with medical oncology and pediatric oncology

20 Turkish Radiation Oncology Society (TROD) Annually 1 year eduation abroad for 3 young members ( euro/each) 3 months eduation abroad for 4 young members (3.750 euro/each) grants for ESTRO courses

21 Turkish Radiation Oncology Society (TROD) Proficiency exams What do we evaluate? Competence which yields on Cognitive domain (How?)Exam blueprint, web based question bank, 100 MCQs, quality review, Nedelsky standard setting Skills / attidute domain (How?)Exam blueprint, question templates, 10 stations OSCE (150 mins), Modified Angoff standard setting (expert consensus on minimum acceptable level for each station)

22 Turkish Radiation Oncology Society (TROD) Practical Exam Objective Structured Clinical Examination-OSCE

23 Objective Structured Clinical Examination-OSCE 15 minutes duration for each station

24 Objective Structured Clinical Examination-OSCE Starting nervous moments Critical reading an article

25 Objective Structured Clinical Examination-OSCE Room for patient communication Outside

26 Objective Structured Clinical Examination-OSCE Big brother is listening And watching you

27 Objective Structured Clinical Examination-OSCE From one station To another

28 Objective Structured Clinical Examination-OSCE Contouring Plan evaluation

29 Objective Structured Clinical Examination-OSCE Teachers smiling 2.5 hours passes quickly

30 Objective Structured Clinical Examination-OSCE It s over everybody seems relaxed

31 Objective Structured Clinical Examination-OSCE Candidates discuss the exam with teachers

32 Objective Structured Clinical Examination-OSCE Teachers evaluate

33 Objective Structured Clinical Examination-OSCE Happy end. Not for everybody

34 Results

35 Conclusions Athough Turkey has a long history of radiotherapy, services still has the problems common to middle-income countries Problems in manpower - availability and training Problems in countrywide distribution of infrastructure Infrastructure and quality of radiotherapy is improving Guidelines and minimum requirements for manpower and infrastructures should be prepared Training should be standartised TROD is a major player especially in training Planning of future is required current national cncer control plan of the MoH needs revision

36 Thank you for your attention!