Answer

1.0 Introduction

            Every health student needs a clinical placement at some point in their education as it exposes them to real life situations which enable them to employ their acquired theoretical knowledge which developing their clinical and technical skills (Oetker-Black et al., 2014). At the end of their placement, students need to reflect so that they can see how they have progressed and benefited from the placement. The most commonly used reflection mode is by writing reflective journals. This is the best approach as it enables students to actively synthesis their experience, hence engaging in a self-reflection that can be used for future reference and practice (van Horn & Freed, 2008). This paper features a reflective journal of a radiation therapy student who was placed at Peter MacCallum Cancer Centre for two weeks. It features an identification of the role of the student in the team, as well as an analysis of the student’s strengths and development needs. The student’s learning experience will also be discussed.

2.0 Reflective Practice

            Student radiation therapists need reflective practice as it improves their learning experience. This is because the approach makes use of practice to understand cause and motivation with the intention of resulting to personal and professional development (Williams et al., 2002). Reflective practice encourages students to become more aware of their actions and habits, while also considering steps that they can take to improve on them.

            Personally, I believe that reflection is the evaluation of a specific situation, which includes considering why I took specific actions and looking for better ways that the situation could have been handled. This enables a professional to consciously choose the right actions in future to result in better patient outcomes. Some individuals may argue that reflection is all about being in an unpleasant situation, hence triggering subconscious behaviors. On the contrary, it is best to engage in a reflective practice where one spends a sufficient amount of time analyzing the situation and actions which were taken, before identifying recommendations for the future (Charuai, 2015). This is the only way through which a professional is led to commit to self development as they get to learn from it.

            Gibbs Reflective Cycle will be used as the model for this reflective journal. It was chosen because it gives room for thorough analysis of a situation by following a more natural pattern of event occurrences. This model flows smoothly and features questions that are clear and easy to comprehend.

3.0 Students Role in the Team

            In my first week of placement, I was situated in the treatment team. Here, my main role was not that complex. It consisted of observing, introducing myself to everyone, calling patients in, telling them to get changed and wait in the sub-room, taking them into the treatment room, asking them for their details before getting the treatment, laying out linen sheets on the couch, helping with simple set ups for breast patients, head and neck patients and pelvis patients. The team that I worked with was the P2 team, mainly for treating DIBH (Deep Inspiration Breath Hold) patients and prostate patients. The team members helped me a lot as they tried to explain everything to me that I didn’t know. For the first 3 days, my role didn’t vary much as I still didn’t know how to work properly within the clinical environment. The team members helped me to adapt effectively by offering guidance when needed (Tucker et al., 2003).

For the last 2 days of the first week of placement, I noticed that things changed since I started feeling more useful within the team. I had gained a number of skills and knowledge regarding radiotherapy treatment which enabled me to chip in and help the members a lot more. I also noticed that I had acquired more confidence in talking with patients and knowing how to start conversations with them (Reid-Searl & Dwyer, 2005). I also felt more comfortable and at ease which enabled me to familiarize myself with everything and know which equipments are being used for what kind of treatment.

I started the placement by just introducing myself to all patients and staffs, observing treatments and putting linen sheets on couch. But within a few days, I noticed that I had adapted quickly to setting up the couch and equipments for breast patients’ treatment, pelvis patients’ treatment and head and neck patients’ treatment. My team could see that I am capable of setting up the bed and equipments for treatment with so much ease. As the time progressed, my role also developed within the team. In the beginning, I only helped with small things like introducing myself to patients, opening field lights, setting the gantry back to 0^o after treatment is done, bringing out the panels if there is KV imaging, putting linen on the bed and taking them off and cleaning off all equipments with wet wipes after treatment is done.

As I help out with treatment each day, taking patients in and out, I feel more confident as I have developed my communication skills and know how to converse with them appropriately. I also do a lot more set ups before patients enter the treatment room and whilst they’re on the bed, I felt more productive and like I have a purpose in the team.

In the second week of placement, I was in the planning team. My main role here was to observe staffs doing the different planning, contouring organs for different plans, comparing the plans to see which one is better by avoiding most hot spots and try adding in wedges and use different ways to see the different doses. In planning, I was able to do SXRT (Superficial X-Ray Treatment) and CT (Computed Tomography). These were similar to treatment that I had in the first week but they were easier, because there were less set ups and equipments being used. As I already had acquired some experience from treatment, I was able to do simple set ups easily and read the patients information to do the set ups. I also did more observation and asked staffs more questions (“Implementation of a peer-support”, 2009). In CT, I didn’t do much because the staff mainly makes the mask and vac body for the patients and write the set-ups for the treatment staffs. All I did in there was assisting them whenever they ask me to.

In the planning team placement, there was not much to do and my main goal was to communicate well and professionally with staff and patients. Therefore, within the last two days of my planning week, I did more treatment. During these last two days, I felt comfortable and more confident as I now know what I am doing and have gained more knowledge. I felt like I progressed so much and felt like I was an important member of the team (“Health Diagnosing”, 2010). I was not just in the P2 but was everywhere helping here and there. I was learning everything I could in the last 2 days. I got an opportunity to help with every treatment and also experienced the Varian Linac Machine in P6 where we do not have to position and move the patient to the lasers, instead the bed moved itself to move the patient to the correct position and line up with the lasers. Therefore, I had an opportunity of experiencing treatment for different patients with different machines, and learnt a lot. However, I never got the chance of experiencing treatment for pediatric patients. I felt like I was contributing and being productive to the team and no longer being in the way or just standing there observing as was the case when I started my placement. I was able to participate in the whole set up for the treatment and help assist radiation therapists in anything I could. This has made me more assertive and I am now willing to learn more and give anything a try.

4.0 Strengths and Development Needs

After my first week of placement, I received feedback from the staffs and got assessed on my performance. The result was not that great as my communication skills had not reached the satisfactory stage yet. So I reflected on what I did and how I performed in my clinical practice by writing up an action plan, and also identified my strengths and areas in need of development. My strengths included demonstrating good listening skills, showing respectful attitude to staff and patients, and striving to increase my knowledge and understanding (Huber et al., 2016). However, I noticed that some of my strengths still needed improvement. During my first week of placement, areas that needed improvement included communicating well with patients by showing empathy towards them, applying my knowledge into clinical practice at hand, developing my confidence and getting used to the many equipments being used (Price, Buch & Hagerty, 2015).

Before our clinical practice, we had to come up with 3 main goals to achieve at the end. But as this was my first placement, I didn’t know what to expect thus coming up with any goals I wanted to achieve on my placement was difficult. So my main goals were simply about team skills and communication with staff and students. However, after my first week of placement, I was able to identify my strengths and areas that needed development, and what goals I have achieved from the placement so far. Whatever goals I had not achieved in the first week, was forwarded to the second week of placement. The first goal was to focus on my communication and interact effectively with patients and staffs in a professional manner, and to provide quality care towards patients. To achieve this goal, I was supposed to introduce myself and ask patients for their details.  I was also supposed to get the patients from the waiting room into the treatment room as much as possible, and try to converse with them in the process. The second goal was to gain confidence and basic knowledge and understanding of the set-ups for different treatment and familiarize myself with the equipments being used. To achieve this goal, I had to familiarize myself with the treatment room and equipments being used for the different treatments. I also had to practice reading the set up on my free time so that I would be swift in making the set up before the patients came in. Lastly, as the other staff members were working out the shifts for patients and gantry angles, I was to ensure that I actively participated. This would help me to practice working them out more quickly and effectively. The third goal is being able to read the plans and contour the OARs properly. To achieve this, I had to practice contouring OARs for different plans. I had to learn more about it so I could know what to contour for the specific areas that needed to be treated. I also had to take the chance to observe plans made by the staffs and educators, and ask questions where needed. I had to join Chart round meetings and listen effectively to the discussions. During free time, I also had to practice adding wedges and bolus to plan to help avoid hot spots and reduce doses where needed.

Even though I have achieved some of the goals, there are still some factors that need to be improved and worked on more for the next placement. This includes my communication skills and confidence. I am confident that I have learnt a lot and gained more knowledge, but not so much in applying the knowledge well into a clinical placement setting. Therefore I need to achieve this in order to be a good radiation therapist in the future.

My struggle with communication with patients is due to being shy, and this shows lack of confidence. I know that communication is an important skill to have in this health profession, but I am lacking skills in this area since I am a very shy person and I do not know how to communicate appropriately with the elderly patients. This is something I need to work on and strive for in my next placement.

During my second week of placement, I felt like I could communicate better and handle patients more effectively. This is because I felt more confident and comfortable in the radiation therapy clinical setting. My confidence has improved due to increased knowledge and time spent in the clinical setting with patients. Another strength I have is learning from my mistakes, so whatever I did wrong in the past, I would ask radiation therapists staffs for the correct answer and fix my mistakes and learn from it. Although I have improved over time, I still have areas that need improvements. I have to learn and grow from these situations. I found that in difficult situations such as complicated set-ups or challenging patients, I still lack confidence and communication. I tend to find myself confused as I end up not knowing what I am supposed to do. I end up feeling out of place and not part of the team as I would just stand back and observe the situation. As a result, I need to learn to adapt to difficult and challenging situations, this can also be my goal for my next placement.

By the end of the week of my 2 weeks placement, I felt like I had achieved part of my goals. I had improved in communicating with patients in such a small amount of time. I believe that if I have placements for a longer period of time, my communication skills will improve and accelerate more. I have also familiarized myself with reading the set-ups and setting up equipments for different treatments, especially breast, pelvis and head and neck.

Although I have improved on my communication skills, there are still areas in need of progress. As my next placement will be for a longer period of time, up to 5 weeks, I can strive towards it and build a stronger rapport and converse with patients better. I also need to continue to improve my technical skills by becoming more confident in reading complicated set-ups situations and setting up patients with different treatment types (Clover et al., 2011). I have to try and adapt to working out shifts and gantry angles movements on the spot really fast while treating patients.

5.0 Key Learning Experience

5.1 Descriptions:

On the first week of placement, I had to do treatment. I was with the P2 team which mainly does treatment for DIBH breast patients and prostate patients. It was a completely different environment for me because I never worked in a clinical setting before and everything was new for me, so it was quite overwhelming. I encountered so many elderly patients where I have to converse with them, which was very hard for me because I am a really shy person and I rarely talk with elderly people. I have no idea how to talk or start a conversation with the elderly patients. Elderly patients are quite hard to impress and hard to understand because they will behave the way they want. Some may be really cheerful and nice whilst others are a bit moody and gloomy, which is totally understandable as not everyone is happy to go through treatment because of their illness. First, I just observed all the different patients being treated and soon after I had to take them in from the waiting room and start a conversation with them. That is when I start to notice the different personalities from patients and how I should have a conversation with them depending on the way they act and what they want to talk about (Arraras et al., 2015).

For example, I had the opportunity of dealing with two completely different patients. Mary and John (Alias names). I watched Mary undergo treatment before she was released into the waiting room where I had to engage her in a conversation. I started off jokingly, stating how fast her session was. I did not realize her personality, and I noticed she seemed offended by my words and just shrugged her shoulders and closed her eyes. This was when I realized that she was moody and unhappy. The best approach would have been to approach her calmly and ask her how she is feeling, and if she would like to talk about it (Coyne, 2004). John, on the other hand, seemed jovial and easy to talk to. He actually started the conversation as I escorted him to the couch. He cracked jokes about how I just looked fresh from college, stating how confused I looked. He also threw in a few words of encouragement, talked about his family, and even mentioned how he is not going to give up the fight as his time was not yet here. With this personality, any communication approach will trigger a positive response from the patient.

5.2 Feelings:

At first I was quite scared to make conversations with patients because I did not have the confidence and I did not know how to start a proper conversation. All I did was introduce myself and ask “how are you?” Although sometimes I asked them how they are fairing, they responded irritated and not so happy which made me hesitant to continue with the conversation. It also made me uncomfortable of asking the question again as I was scared of the response I would get. It made me want to just stand there and kept quiet. At times I just faded into the background and only helped out whenever I could. It was quite sad because I did not feel like part of the team and I also felt like I was being unproductive. All I could do was stand there and give a reassuring smile as I was scared of saying or doing something wrong.

So I asked my radiation therapists team staffs to help me converse well with patients. I asked them to teach me their ways of communication with difficult and challenging patients. I started to reflect on myself and what I should do to improve my communication skills with patients, as this is a vital role to have in this healthcare profession (Tzelepis et al., 2014). I observed the way my radiation therapists’ team talked to patients and picked up some ideas on how to socialize well. Hence, the last 2 days for the first week, I pushed myself out of my comfort zone and went forward to try and start conversing with all the patients I had to take in from the waiting room. I did feel uncomfortable and awkward at first but over time, asking the same questions and knowing about their treatment became easier as I knew that I had to be friendly and show empathy towards them if I was to become successful (“Radiation Therapists”, 2006). The elderly patients started to remember my name and would remember who I was. We started building a rapport relationship and I gave all the support that they need.

5.3 Evaluation:

It took me a lot of time to gather the courage to start communicating with the patients. I gathered all my courage in order to overcome my shyness and become an active participant in the interaction with patients. In came to appreciate the fact that as a professional, I needed to improve my communication skills with the patients as it helps improve their outcome. By reflecting on my experience with the patients, I was able to get over this shyness which was preventing me from achieving my set goals. Without effective communication, it would be impossible to know how the patient is doing, if necessary measures are needed after treatment, and what is needed to make them more comfortable as they undergo treatment in future.

After observing how others communicated with the patients, I was able to employ these in the second week of placement (Liénard et al., 2010). It turned out better for me, as I also felt more comfortable around the patients. It made me more active within the team as I could carry on with my roles much more effectively compared to when I was shy and hiding in the back. I could talk freely with the staff and ask questions without worrying that they will shrug it off. With time, I had acquired more communication skills which enabled me to be at ease with a patient I was meeting for the first time (Bambini, Washburn & Perkins, 2009). I became more confident, and could offer recommendations to the patient without breaking a sweat.

5.4 Analysis:

            From my experience dealing with these patients, I realized that I had difficulties mainly in effective communication and confidence. My shyness was preventing me from effectively communicating with the patients, which is a rather important aspect if I am to become successful in my career. Confident students are expected to become increasingly effective and innovative in their roles. As such, I have to try and make sure that I become more confident as I study and even in my future placement. Panduragan et al. (2011) conducted a study whose findings indicated that most students are not completely confident in a clinical setting, more especially when they are expected to provide and manage care.

This study notes that the main cause of distress in patients is the fear of errors. Although majority was not feeling confident, they were still willing to provide holistic care (Panduragan et al., 2011). In addition, the study places great emphasis on the importance of clinical placements with long durations in a specific area and the resulting impact on a student’s clinical decision-making ability (Panduragan et al., 2011). This study relates directly to my situation as my lack of confidence does not affect my willingness to offer holistic care. However, it is evident that I need a longer placement that will give a better opportunity for handling my areas that require improvements.

5.5 Conclusion:

Looking back at my past 2 weeks of placement, there are still some areas in need of improvement as I feel like I could have handled them better. But because everything was so new to me and I have to learn to adapt to the environment and clinical setting in such a short amount of time, I feel like I have learnt a lot. I have gained more knowledge and increased my confidence and communication skills as well. To do better at my next placement, I have learnt that I should always introduce myself to everyone instead of having my radiation therapists’ team introduce me to some patients. I plan to always try to converse with patients as much as possible as this will distract the patient from their treatment and make them feel more at ease (Schneider-Kolsky, Wright & Baird, 2006). They will start to trust me more and need the support offered. By communicating with them, I will be building a strong rapport with them.

5.6 Action Plan:

The main goal of my action plan is to be able to communicate appropriately and effectively with patients and staffs. To achieve this, there are specific strategies which I must employ. I intend to ask each and every patient for their details and acknowledge their answers. I will be introducing myself to everyone. I plan to interact with patients more often and show empathy towards them. I will always be there to help patients get off the bed when treatment is done. I will be more active in interacting with staffs by asking any questions. I plan to learn how to start small talks with patients by asking them how they have been. If one has difficulty laying on their back or getting up, I will help them get off the bed. If the patient complains of feeling cold, I will ask them nicely if they need a blanket. Lastly, I will be active in bringing patients from waiting room to sub-waiting room and then to the treatment room.

During the first week of placement, I was in treatment, helping patients and communicating with them. However, I did not pass the satisfactory stage in my communication skills as I still lacked confidence and showed little interaction with the patients. As this was a ‘hurdle’ requirement which means I have to pass this assessment, my clinical educator gave me another option to continue treatment on the last 2 days of placement in order to help me gain that satisfactory pass in communication skills. With that, I had to come up with an action plan to help assist me in my communication with patients and staffs and my clinical staff have to check if I had passed everything.

As a result, I have learnt to gain confidence in talking with patients as I know this is an important skill to have as a radiation therapist. Without this skill, I know I will not go very far in this career. I have learnt to give the best possible patient centered care through effective communication.

6.0 Conclusion

            Through reflective practice, I have been able to use my clinical experience to encourage growth of my skills, behavior and attitudes as it relates to my profession (Cohen, 2001). I have learnt to recognize my strengths and weaknesses, and also how to identify possible actions that will trigger improvements. I have identified specific areas of improvement that I will work on in my future placement which is expected to be a bit long. The exposure to real life situations has enabled me to realize what my role will be when I finally graduate and get employed to work as a radiation therapist. With the use of Gibbs reflective cycle and the contrasting relating literature, I was able to reflect on my experience with the elderly radiation patients. This reflection enabled me to realize the reasons behind my shyness and lack of confidence. It has also assisted in the identification of ways through which I can improve my confidence and communication. It is evident that I have improved my skill and knowledge as a result of using this reflective journal.