Postsecondary Articulation:
Implementing AAI in a Community College-Based
Radiologic Technology Program

Merritt College in Oakland, California, is a community college within the Peralta Community College District. Its Program of Radiologic Technology is a 24-month program designed to prepare students for careers in diagnostic medical imaging, particularly x-ray technology. The program provides concurrent classroom study at Merritt College and clinical education at various East Bay hospitals that leads to the Associate of Science (AS) degree in Radiologic Technology. The program is accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT), a branch of the Committee on Allied Health Education and Accreditation (CAHEA).

Students successfully completing the requirements of the Merritt College Program of Radiologic Technology are eligible to take the national examination by the American Registry of Radiologic Technologists (ARRT) and the certification examination for radiologic technologists (CRT), which are administered by the State of California, Department of Health Services Radiologic Health Branch. Passing these examinations permits technologists to perform diagnostic radiologic examinations in a wide variety of clinical settings. Radiologic technologists perform duties in the operating rooms, emergency rooms, in acute care nursing units, and in medical imaging departments of hospitals, as well as at outpatient clinics and physicians' offices.

As an instructor in the Merritt College Program of Radiologic Technology, I teach a variety of classroom subjects, including Radiation Biology and Applied Radiographic Physics. I am also responsible for the clinical instruction and evaluation of approximately 32 second-year students in their assigned hospital training sites throughout the East Bay area.

When I began teaching at Merritt College two-and-one-half years ago, I was also assigned the responsibility of developing and coordinating a Tech Prep program with the Oakland Technical High School Health and Bioscience Academy. At this point in time we are close to completing an articulation agreement between the Program of Radiologic Technology and the Health Academy. This agreement will allow Health Academy students to complete prerequisites for the program (Anatomy and Physiology, English Composition, Elementary Algebra, and an introductory course in radiologic technology) during their junior and senior years in high school. In addition, they will have the opportunity to receive competitive program selection points for completing internships in diagnostic medical imaging departments in partner industry hospitals such as Highland Hospital and Kaiser Permanente in Oakland. This agreement will greatly shorten the time it normally takes students to be prepared for entry into the Radiologic Technology program. Work is currently in progress for similar agreements between the Health Academy and other Allied Health programs at Merritt College. Vista Community College in Berkeley (another college within the Peralta Community College District) has been working toward a Tech Prep program between Oakland Tech's Bioscience Academy and Vista's Biotechnology Technician degree and certificate programs.

Oakland public schools have traditionally been plagued with high dropout rates, with few graduates going on to two- or four-year colleges or to occupational training programs. The city of Oakland also has extremely high unemployment rates. Tech Prep partnerships, when fully in place, will hopefully provide students with knowledge of career options and pathways to facilitate attainment of their goals. An important role of Tech Prep is to provide high school students with a "foot in the door" to the community college before they leave high school. By allowing students to take community college courses on the college campuses during their senior year of high school, we hope to help them become accustomed to a college environment and be less intimidated by it. Many of Oakland's high school students will be the first in their families to continue their education past high school, and we firmly believe that if students can begin making that transition before they "fall through the cracks," we may hook them and assist them in their progress of pursuing productive career goals.

The AAI Project

Becoming a Tech Prep partner with Oakland Technical High School Health and Bioscience Academy has allowed me to work closely with Patricia Clark and some of the other faculty members at the high school over the past two years. As a result, I was invited to participate in the Joyce Foundation All Aspects of the Industry Partnership.

My first glance at the AAI framework left me with doubt and confusion as to how on earth it could be applied to the health care industry, and in particular to an accreditation-driven curriculum such as a Radiologic Technology program. With the exploration and guidance provided at the Cambridge and Berkeley workshops, along with the support of the sponsoring institutions during the course of the project, I was able to better understand and begin to implement the framework on a small scale in several of the courses and clinical rotations that I teach. Through working with the team participants from Oakland Tech, we were all able to assist each other in our understanding of the project and its implications for us individually and as a whole.

Barriers To Implementing AAI in Rad Tech Programs

At first, all of us tended to focus on perceived barriers, of which there are many! The following were comments I made or heard my colleagues make in response to AAI:

We barely have time to teach the essentials in a two-year period as it is!!! Add MORE to current curriculum???

We don't know very much about those "other aspects" outside our realm ourselves!!! How can we teach about them competently to our students???

It seems so forced to try to cram each of the "all aspects" into each course!!!

Everyone in those other departments at the hospitals are so territorial!!! They guard their areas of expertise like mother hens!!! They're unwilling to share their knowledge and skills because they think we want their jobs!!!

We have too much to do as it is!!!

After calmly examining the AAI model and exploring its meaning for the health care industry with my team, I was able to identify some specific applications for the "sub-industry" of medical imaging:

Planning

• Personnel scheduling according to patient load at various times of the day (based on previous statistics)
• Patient scheduling of exams based on interacting effects of medications/contrast media/radio pharmaceuticals "on board"
• Purchasing of capital equipment based on present and future demands
• Purchasing/ordering of department supplies based on previously documented patterns of use
• Hiring of personnel in specific areas based on present and future needs and technological advances

• Cross-training technologists in different specialty areas to fill present and future demands ("the Multiskilled Worker")
• Worker involvement in decisions are possible to a certain extent but difficult because of the hierarchical nature of the health care industry
• Scheduling, supervising, and evaluating of employees

• Justifying of expenditures based on patient load/population and technological standards
• Financing of capital equipment, supplies, personnel, training, and continuing education for technologists in a constantly evolving field

• Equipment operation and maintenance
• Radiation Physics and Biology
• Radiographic Positioning, other "core" courses

• Advantages and disadvantages of union vs. non-union radiology departments

• Health care reform
• Access to health care
• Community problems such as teen pregnancy, substance addicted newborns, substance addicted adults and children, violence, and joblessness and how they all affect health care, its quality, and its availability in a community
• Social and economic principles at work that greatly affect the health care delivery system and underlie technology

• Body substance precautions
• Hazardous materials safety training
• Proper body mechanics when moving patients
• Radiation safety for workers and patients
• Hospital emergency; disaster plans

• Ethics
• Medicolegal issues

Through working with the project to understand and implement AAI, I was able to come up with some solutions for implementation that were fairly simple and could be accomplished with a minimum of disruption in the structure of our program.

Solutions To Implementing AAI in Radiological Technology Programs

• It is actually easier than it initially appears to infuse AAI into the existing structure without completely disrupting our curriculum. We are already doing an excellent job of including MANY of the aspects now. In addition, exploring some of the more difficult aspects in the form of student projects is one of the easiest and least painful ways of complying with the Perkins Act mandate.
• The fact that we are not experts ourselves at AAI can also be solved by having the students explore the program through projects and share their information with the class. They are a tremendous link to industry, providing up-to-the minute information in technological advances.
• Time is on our side! We have two years to include AAI, and some courses naturally lend themselves to some aspects, others to different aspects. As long as our students are gaining understanding and experience in AAI by program completion, we are in compliance.
• Start SMALL!!! Begin with projects on a small scale and build. Small projects, each addressing only one or two aspects at a time, may be more effective than trying to cover AAI in a single larger project.
• The health care industry is evolving into a broader-based, multiskilled worker model. As this happens, programs that have a strong AAI base will naturally progress along with the industry (with some guidance and structure on the part of the educators).

Benefits of Implementing AAI

• Students who understand the "whole picture" and their role in it are more efficient, understand patient and work flow, and make better health care team members.
• As educators, we can learn as much from our students and other health care workers as they can learn from us.
• Our students have clearer career paths and are open to a greater number of possibilities.
• Our students are more flexible, adaptable, and multiskilled, which are essential characteristics for an effective workforce of the future.

• Have students research and develop a Medical Imaging department budget.
• Take one topic relating to Medical Imaging and explore AAI by using the AAI "web."
• Have students develop and produce a product that can be used by the hospital, department, or patient (e.g., translate information brochures into another language, and so on).
• Project for cost savings within a Medical Imaging department.