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In radiotherapy, the focus for RTTs will shift from performing tasks to controlling equipment and more individualized decision making to optimize patients' treatment. To guarantee qualitative professionals, more efficient training methods are required. Job Instruction (based on Toyota’s lean principles) can help to improve the learning curve by explicating implicit knowledge. The aim of the current study is to develop a new training method and to evaluate this in a pilot study for training RTTs in treatment planning (TP) of lung cancer.

Six RTT-trainees followed a new training method, developed according to the Job Instruction method and applied to treatment planning of lung cancer. First, expert RTT explicated the most critical points for quality in the treatment plan (TP). For every point a what, how and why were determined and translated in a practical tool. An educational database was set up for trainees to use this tool to make a lung cancer TP in a safe environment separated from the clinic. Each trainee defined their thinking steps and trained coaches provide feedback on the outcomes of TP and decision making to increase personal learning. All was included in a learning development system, to visualize the trainee’s development pathway. After completing 3 TPs with increasing difficulty, a test was completed. To improve the learning curve further, the trainees participated in peer sessions to enhance interpersonal reflection. Group variance on and medians in DVH parameters of TPs of the trainees were compared to six experienced RTTs after individual training completion of trainees (T0); after peer reflection (T1); and after six months (T2). Throughput time for training was also evaluated.

At T0, the variance in DVH parameters between the trainees was smaller than between experienced RTTs, e.g. spinal cord D0.03cc, see figure 1. However, the medians of heart Dmean, heart V30Gy, and esophagus Dmean were lower for experienced RTTs than for trainees. At T1, the difference in medians between the groups disappeared and variance remained small for both groups. At T2, the variance and difference in medians sustained and had improved further for the trainees (Lungs-GTV Dmean, esophagus D0.03cc). The average throughput time for a trainee to become fully competent for complex TP decreased from about one year to three months, see table 1.

Training based on Job Instruction elements and combining individual feedback with peer reflection presented positive results for a pilot of TP training. Although developing training materials was labor intensive, the reduction of throughput time for students to become competent for complex TP of lung to only three months was a striking benefit. In addition, interpersonal variance decreased resulting in sustainably higher plan quality. This structured training method improves training efficiency in situations with complex decision-making and can be used in continues education setting to maintain competences.