Advanced radiotherapy techniques such as image-guided adaptive brachytherapy for cervical cancer improve local tumour control and reduce treatment toxicity. This benefit is critically dependent on radiotherapy targeting or “contouring” by oncologists. Numerous studies have shown considerable inter-observer contouring variation across all tumour sites, often measured in centimetres, suggesting that current methods of teaching contouring are ineffective. Moreover, assessing contouring competency is currently a subjective, time-consuming and onerous process.
The aim of this programme of research is to investigate the assessment and teaching of radiotherapy contouring within an educational design research framework. The thesis reviews the limitations and challenges of current strategies to improve radiotherapy contouring and how insights from the educational literature such as cognitive load theory, deliberate practice theory, and best practices in assessment and feedback can inform and improve contouring assessment and teaching. Real-world data from two studies of online assessment and education for radiotherapy contouring, within an international clinical trial of advanced radiotherapy techniques for locally advanced cervical cancer, were analysed to substantiate the limitations of current approaches within a clinical trial setting.
The thesis describes a novel low-fidelity radiotherapy contouring simulation tool developed to address some of the issues identified in the clinical studies. A detailed useability study was carried out in a small group of oncologists, which also yielded interesting insights into their clinical reasoning and self-regulation processes. The simulation was then used in three pilot studies of different types of learners (trainees and experts) and programmes (one-off workshops and longitudinal programmes) to explore its acceptability, useability and effectiveness.
The thesis concludes by discussing possible approaches for the next iteration of software development and educational research, which could lead to meaningful change in the teaching and assessment of radiotherapy contouring
