Outline IV 1

Radiation therapists’ perspectives about barriers to continuing education in medical

dosimetry.
April Hardman, BS, RT(R)(N)(CNMT); Jessica Pagan, BS; RaeLyn Iacobo, MSHS, RT(R)(T)
(MR)(CT), Nishele Lenards, PhD, CMD, RT(R)(T), FAAMD; Ashley Hunzeker, MS, CMD;
Sabrina Zeiler, MS, CMD, RT(T)
Medical Dosimetry Program at University of Wisconsin, La Crosse, WI

I. Abstract 
A. PI: Historically, the traditional route to becoming a medical dosimetrist has been
to complete on-the-job training (OJT) with the option to sit for the Medical
Dosimetry Certification Board exam (MDCB).
B. Keywords: medical dosimetrist, radiation therapist, external barrier, internal
barrier, education
II. Introduction 
A. PI: Over the last few decades, the field of radiation oncology has progressed
rapidly. Increasing in both complexity and precision, these technological
advancements have enhanced the treatment planning process but not without
added responsibilities of the radiation oncology team. (References:
Robinson,1 Cagle,2) 
B. PII: Historically, the traditional route to become a medical dosimetrist has been to
complete on-the-job training (OJT) with the option to sit for the Medical
Dosimetry Certification Board exam (MDCB). The prerequisites to sit for the
MDCB exam required either a minimum of 3 years of OJT or the completion of a
formal medical dosimetry program.3 (References: Pursey,3 AAMD,4) 
C. PIII: The AAMD 2020 Workforce Study predicts that the number of qualified
medical dosimetrists will not fulfill the workforce demand unless the number of
students graduating accredited programs doubles.4 (References: AAMD,4) 
D. PIV: Barriers to post-secondary and higher education is extensively researched in
several fields, but not medical dosimetry. There are several barriers that could
impact the number of students attending post-primary or higher education
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pathways including low socio-economic status and ethnic minority backgrounds.7

(Vandelannote,5 Smith,6 Sabio,7) 
i. Problem: The problem is that barriers for radiation therapists to pursue an
education in medical dosimetry may have a significant impact on future
workforce demands.    
ii. Purpose: The purpose of this study is to identify barriers to pursing an
education in medical dosimetry from the perspectives of radiation
therapists.  
iii. Research Questions: Research questions used to guide the study were
(Q1) what are the external barriers and, (Q2) internal barriers to pursing an
education in medical dosimetry for radiation therapists? 
III. Materials and Methods 
A. PI: Survey Selection
i. 7-question survey using Qualtrics
a. Results were auto-generated
b. < 4 minutes to complete
ii. Participants were emailed
B. PII: Study Design (Seekhle,8)  
i. Frist 2 questions
a. Assessing the participants’ interest in continuing education in
medical dosimetry
ii. Next Section
a. External Barriers
b. Internal Barriers
c. Ranking of barriers
iii. Final Question
a. Demographics on experience level in radiation therapy
C. PIII: Study Validation and Participant Selection Description (Leon,9)
i. Validity
ii. Respondent population 
a. Radiation therapist (entry level)  
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b. Radiation therapist (5+ years of experience) 

IV. PIV: Data Collection 
A. Online survey distributed to 10,000 radiation therapy students and registered
radiation therapists through ASRT membership database 
B. Implied consent
C. Survey window (September 15, 2015 – October 1, 2021)
V. PV: Statistical Analysis  
A. Researchers used a survey with a mixed method approach
i. Multiple-choice questions measured a Likert Scale for order and ranking
B. Qualtrics used for descriptive statistics and thematic analysis for the open-ended
responses  
VI. Results  
A. PI: General result information  
i. Number of responses (650/10,000)  
a. Response rate of 6.5%
b. 408/650 did experience barriers to continuing education in medical
dosimetry (Table 1)
c. 245/650 did not have an interest in continuing education in medical
dosimetry
ii. Demographic information (Table 2)
a. 68.1%, 278/408 had 5+ years of experience
b. 31.9%, 130/408 had <5 years of experience
B. PII: (Research Question 1) What are the external barriers to pursing an education
in medical dosimetry for radiation therapists? (Figure 1)  
i. Top 3 common for Radiation therapists 
a. 59.8%, 244/408 – lack of flexibility in school enrollment status
b. 55.6% (217/408) – loss of employment (income and benefits)
c. 53.2% (143/408) – lack of financial support (scholarships, loans)
C. PIV: (Research Question 2) What are the internal barriers to pursing an education
in medical dosimetry for radiation therapists? (Figure 2) 
i. Top 3 common internal barriers for radiation therapists
 Outline IV 4

a. 35.0% (143/408) – perception of the level of difficulty of medical

dosimetry education
b. 23.0% (94/408) – lack of confidence in succeeding
c. 21.3% (87/408) – insufficient support from faculty
d. 31.4% (128/408) – respondents identified that they did not have
any internal barriers (Figure 2.)
VII. Discussion  
A. PI: The most significant external barriers identified by participants in this study
suggested that financial reasons were a major factor preventing them from pursing
further education in medical dosimetry. (Velez,10)
B. PII: In addition to the cost of completing the degree, the financial strain of leaving
employment adds to the burden of pursing a medical dosimetry degree. Medical
dosimetry programs that require 1 to 2 years of full-time enrollment recommend
that radiation therapists not retain employment to keep up with curriculum
demands and abide by accreditation standards. PIII: Summary of survey results of
Internal barriers 
C. PIII: Intrinsic barriers are more difficult to modify as they are unique to the
individual, despite commonalities among peers. Intrinsic barriers often need to be
resolved by the individual alone, although support from faculty and peers is
beneficial. (Gorczyca,11)
D. PIV: Overall, the results of this study indicate that external barriers are more
prominent than internal barriers for radiation therapists in their pursuit of an
education in medical dosimetry. The current study results are promising as
external barriers lend easier to modifications on a large scale. (AAMD,4)
VIII. Conclusion  
A. PI: The medical dosimetry field is rapidly evolving, and the need for medical
dosimetrists is expected to increase. Perceived barriers for radiation therapists to
pursue an education in medical dosimetry may have a significant impact on future
workforce demands.
Outline IV 5

i. Problem: Perceived barriers for radiation therapists to pursue an

education in medical dosimetry may have a significant impact on future
workforce demands.
ii. Purpose: To identify barriers to pursuing an education in medical
dosimetry from the perspectives of radiation therapists. 
B. PIII: Limitations 
i. A limitation of this study was the lack of survey respondents.
ii. Future research should be conducted to expand the inclusion criteria to
radiation therapists that are not ASRT members
Outline IV 6

References
1. Robinson GF, Mobile K, Yu Y. The radiation oncology workforce: A focus on medical
dosimetry. Med Dosim. 2014;39(2):197-200. http://doi.org/10.1016/j.meddos.2014.02.001.
2. Cagle S, Sullivan C. The Changing Face of The Medical Dosimetrist: How This Will Affect
Your Department. In: AAMD Annual Meeting; 2015. (PPT Presentation).
https://www.roswellpark.org/sites/default/files/changing-face-medical-dosimetrist.pdf.
3. Pusey D, Smith L, Zeman EM, Adams R. A history and overview of the certification exam
for medical dosimetrists. Med Dosim. 2005;30(2):92-96.
http://doi.org/10.1016/j.meddos.2005.03.001.
4. American Association of Medical Dosimetrists. 2020 AAMD Workforce Study Reports.
Salary and Workforce Surveys - American Association of Medical Dosimetrists.
https://www.medicaldosimetry.org/publications/salary-and-workforce-surveys/. Updated
June 1, 2021. Accessed June 21, 2021.
5. Vandelannote I, Demanet J. Unravelling socioeconomic school composition effects on higher
education enrollment: the role of students’ individual and shared feelings of futility and self-
efficacy. Soc Psychol Educ. 2021;24(1):169-193. https://doi.org/10.1007/s11218-021-09608-
z.
6. Smith AN, Boyd LD, Rogers CM, Le Jeune RC. Self-perceptions of value, barriers, and
motivations for graduate education among dental hygienists. J Dent Educ. 2016;80(9):1033-
1040. http://doi.org/10.1002/j.0022-0337.2016.80.9.tb06185.x.
7. Sabio C. Associate degree nursing students’ perceived barriers to baccalaureate nursing
education and intentions to enroll in a baccalaureate-only nursing environment. Teach Learn
Nurs. 2019;14(1):9-14. http://doi.org/10.1016/j.teln.2018.08.004.
8. Internal and external barriers to effective communication: And how to overcome them!
https://www.seekhle.com/2018/07/barriers-to-effective-communication.html. Updated July 7,
2018. Accessed July 26, 2021.
9. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical
research. J Psychiatr Res. 2011; 45(5):626-629.
http://dx.doi.org/10.1016/j.jpsychires.2010.10. 008.
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10. Velez E, Cominole M, Bentz A. Debt burden after college: the effect of student loan debt on
graduates’ employment, additional schooling, family formation, and home ownership. Educ
Econ. 2018;27(2):186-206. https://doi.org/10.1080/09645292.2018.1541167.
11. Gorczyca C. Factors influencing the pursuit of graduate education in registered nurses:
exploring the motivations and barriers. [Thesis]. Vancouver, Canada: The university of
British Columbia; 2013.
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Appendix A
Survey Introduction 
Dear Radiation Therapists, 

As medical dosimetry graduate students at the University of Wisconsin La Crosse, we invite you
to complete this survey regarding barriers to continuing education in Medical Dosimetry from
the perspective of radiation therapists. We are reaching out to you because you have been
identified as a radiation therapist or are currently enrolled in a radiation therapy program.
Barriers for radiation therapists to pursue an education in medical dosimetry may
significantly impact future workforce demands. The researchers of this study aim
to identify barriers that contribute to radiation therapists not enrolling in medical dosimetry
programs.   

This survey is composed of 7 questions. Completing this survey should take < 4 minutes. The
survey is anonymous, and your identity will remain confidential. Your participation is
completely voluntary. Clicking on the survey link implies consent to participate in the study. 

If you have any questions or concerns, please contact our research advisor, Nishele Lenards,
at nlenards@uwlax.edu. 

This survey is best suited for completion on a desktop, as some of the questions may not be
mobile friendly. Please click here; or copy and paste this URL into your internet
browser:https://uwlax.ca1.qualtrics.com/jfe/form/SV_ai99mueJRqHakAu 

We thank you in advance for your participation.   

If you decide to participate in this survey, please submit the survey before (deadline date).   

Thank you,   
 
RaeLyn Debner (debner4390@uwlax.edu)   
April Hardman (hardman5150@uwlax.edu)   
Jessica Pagan (pagan7749@uwlax.edu)   
 
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Appendix B

Questions and Answers to Barriers of Radiation Therapists to pursuing education in Medical

Dosimetry. We greatly appreciate your participation in this survey. This survey should take <4
minutes to complete.
Survey Questions   
1. How likely are you considering furthering your education in a medical
dosimetry program?      
a. Extremely Likely   (skips to #3)  
b. Likely    (skips to #3) 
c. Undecided    (skips to #3) 
d. Unlikely (skips to #2) 
e. Very Unlikely (skips to #2) 
2. Based on your prior answer, is your decision to not further education in medical
dosimetry due to challenges or barriers you may have encountered?  
a. Yes (skip to #3) 
b. No (this choice will auto exit survey with a custom message: “Thank you
for participating in the survey. There are no additional questions applicable to
you”) 

(Q1) What are the external barriers to pursing an education in medical dosimetry for
radiation therapists?  
3. External barriers correspond to limitations outside of us, including people and
environment around us. Please identify the external barriers that would prevent you from
going to medical dosimetry school.  
 Lack of clinical sites in preferred location    
 Lack of familiarity in the program applications    
 Lack of financial support (e.g. scholarships, loans)  
 Loss of employment (income and benefits)    
 Length of most medical dosimetry programs    
 Lack of patient interaction    
 Ergonomic: too much sitting    
 Difficulty of the board exam  
 Lack of flexibility in school enrollment status (part-time options) 
 Lack of flexible schooling format (hybrid or online options) 
 Personal responsibilities    
 Job responsibilities in medical dosimetry  
 Other (please specify) [text entry box]  
 There are no external barriers (skip to question #5) 
4.  If applicable, please rank your prior choices of external barriers from most significant (1)
to least significant.  (Use the drag and drop feature to order your choices) 
(This question will carry forward their choices from #3 and allow them to order only those
they selected in #3.) 

(Q2) What are the internal barriers to pursing an education in medical dosimetry for
radiation therapists? 
Outline IV 10

5.  Internal barriers correspond to limitations inside of us, including: our thinking,

attitude, perceptions, and communication. Please identify the internal barriers that would
prevent you from going to medical dosimetry school. 
 Lack of confidence in succeeding   
 Preference to obtain more work experience.    
 Perception about the difficulty level of medical dosimetry education    
 Perception that the job will be boring     
 Perception that I am not in an ideal age range 
 Perception that there would be insufficient support from faculty 
 Perception that job will be stressful 
 Other (please specify) [text entry box] 
 There are no internal barriers (skip to question #7) 
6. If applicable, please rank your prior choices of internal barriers from most significant (1)
to least significant.  (Use the drag and drop feature to order your choices) 
(This question will carry forward their choices from #5 and allow them to order only those
they selected in #5.) 
7.  Demographics: How many years of Radiation Therapy Experience do you have? (post-
graduation)    
a. 0-5    
b. 5+