Exploring current undergraduate student perspectives on the introduction of the degree apprenticeship scheme in diagnostic radiography – a single institution study

IntroductionThe first degree apprenticeship programme in diagnostic radiography was launched in March 2020. This route into radiography runs in parallel with ‘conventional’ pre-registration programmes where students apply to a higher education institution (HEI) and undertake discrete clinical placements. The aim of this study was to explore the perspectives of pre-registration students on the diagnostic radiographer degree apprenticeship route.MethodsA qualitative approach (online questionnaire) gathered attitudes and opinions of pre-registration students from a single HEI, regarding the degree apprenticeship programme. Participants were pre-registration medical imaging students from all stages of the programme (n = 204). Braun and Clarks's thematic analysis was employed for data analysis.ResultsA response rate of 21% (n = 44) was recorded. Four themes emerged from data analysis: (1) misunderstandings surrounding the degree apprenticeship, (2) financial implications and (3) practical experience associated with both degree courses and (4) the experience the pre-registration degree has to offer.ConclusionThere was an apparent lack of understanding regarding the degree apprenticeship leading students to misinterpret aspects of the course. Additionally, students highlighted the earning aspect of the apprenticeship to be an advantage in comparison to student debts associated with the traditional pre-registration programmes. Furthermore, students emphasised the advantage of the clinical focus practice associated with the degree apprenticeship. Nevertheless, students who have selected the HEI route still value what the traditional pre-registration degree offers.Implications for practiceAs degree apprenticeship programmes become widely available, a greater awareness should, therefore, follow. In the interim, there is scope for HEIs to seek to raise awareness of degree apprenticeship provision. HEIs should seek to allay any concerns and highlight the benefits of having this alternative route into the profession.     

Qualitative content analysis of image interpretation education in UK pre-registration diagnostic radiography programmes

IntroductionImage interpretation is a required capability for all UK pre-registration programmes in diagnostic radiography to meet the needs of graduate practice. It also provides a potential educational foundation for future advanced clinical practice. The aim of this study was to explore how image interpretation education is designed, delivered, and assessed within contemporary UK pre-registration diagnostic radiography programmes.MethodsQualitative content analysis of open-source image interpretation curriculum data extracted from UK Higher Education Institute (HEI) websites.ResultsExtracted search data was initially coded and three overarching themes emerged, image interpretation education vision, operationalisation, and delivery and assessment.ConclusionThis study identified significant heterogeneity in all aspects of UK pre-registration image interpretation education which may suggest an equal heterogeneity can be expected in the image interpretation knowledge, skill, confidence between newly registered practitioners.Implications for practiceThere may be a need for clearer expectations on HEIs by professional and regulatory bodies to ensure consistency in pre-registration image interpretation education.     

The use of simulation and moulage in undergraduate diagnostic radiography education: A burns scenario

IntroductionThere is a national drive to increase allied health professions simulation training. However, there is a paucity of literature within diagnostic radiography in relation to clinical simulation. No research could be found regarding the impact of simulation in radiography with complex clinical burns scenarios.This research aims to explore the perceptions of radiography undergraduate students regarding their preparedness for the complex care requirements in imaging examinations of clinical burns cases using a mixed methods approach.MethodA small-scale simulation-based teaching session was developed in a Scottish HEI, using role play and moulage to create realism. Twenty-eight undergraduate student radiographers participated in the scenario. Students completed pre and post-scenario questionnaires using Likert scale and free response data. Focus groups were undertaken three months after the simulation to obtain rich qualitative data. Common themes were identified via a process of initial coding and a 6-phase thematic analysis.ResultsThematic analysis demonstrated a marked increased perception of preparedness post-scenario; students felt more prepared to undertake their role in the imaging of complex care patients (Likert scoring increased with both mode and median post-scenario). Common themes that were identified were patient centeredness, realism and learning.ConclusionWithin this limited pilot project, the use of simulation was an effective means of preparing students to understand their role within the complex care setting (with respect to the traumatic realism of burns) in preparedness for professional practice. Additionally, students related to the practical understanding of the complexity of human factors that exist within clinical practice.     

Radiography students achieving competencies through structured interprofessional education

IntroductionInterprofessional education (IPE) takes place when representatives of at least two professions work and learn together, about and from each other to provide optimal healthcare. For the successful implementation of an IPE programme, conceptualisation, planning, and operationalisation and coordination among the various professions is crucial, to assist students to obtain the desired competencies of such a programme. The purpose is to investigate if a structured IPE programme assisted radiography students to achieve competencies.MethodsAn online questionnaire was compiled from literature and completed by radiography students who participated in a structured, three-week-long IPE programme. The questionnaire was mainly quantitative (using a Likert scale), though it also consisted of qualitative elements (open-ended questions). A Fischer’s Exact test was used to compare the responses of three different year groups.ResultsFeedback from the radiography students (n=63) indicated that they achieved this IPE programme’s specific competencies: role clarification, interprofessional communication, teamwork, person-centered care and values and ethics. There was good correlation between the feedback from all three year groups. The feedback on the open-ended questions correlated with the quantitative feedback, though some students felt excluded, as there was little reference to their particular profession in the simulation session of the IPE programme.ConclusionThe results of the study indicate that radiography students achieved the prescribed competencies of a structured IPE programme. The results provide insight into ways to improve the IPE programme. A recommendation emanating from the results of this study is that, to improve the experience of all healthcare professions students, structured IPE programmes have to promote inclusive teaching and learning.Implications for practiceRadiography students that participate in a structured IPE programme develop competencies necessary for effective collaborative clinical practice.     

Radiographer interpretation of trauma radiographs: Issues for radiography education providers

BackgroundThe role of radiographers with respect to image interpretation within clinical practice is well recognised. It is the expectation of the professional, regulatory and academic bodies that upon qualification, radiographers will possess image interpretation skills. Additionally, The College of Radiographers has asserted that its aspiration is for all radiographers to be able to provide an immediate written interpretation on skeletal trauma radiographs by 2010. This paper explores the readiness of radiography education programmes in the UK to deliver this expectation.MethodA postal questionnaire was distributed to 25 Higher Education Institutions in the UK (including Northern Ireland) that provided pre-registration radiography education as identified from the Society & College of Radiographers register. Information was sought relating to the type of image interpretation education delivered at pre- and post-registration levels; the anatomical range of image interpretation education; and education delivery styles.ResultsA total of 19 responses (n = 19/25; 76.0%) were received. Image interpretation education was included as part of all radiographer pre-registration programmes and offered at post-registration level at 12 academic centres (n = 12/19; 63.2%). The anatomical areas and educational delivery methods varied across institutions.ConclusionRadiography education providers have embraced the need for image interpretation education within both pre- and post-registration radiography programmes. As a result, UK education programmes are able to meet the 2010 College of Radiographers aspiration.     

Patient centred care in diagnostic radiography (Part 2): A qualitative study of the perceptions of service users and service deliverers

IntroductionThere is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services in order to develop measurable indicators of PCC.MethodsThis project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level.ResultsFour focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered.ConclusionIt is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice.Implications for practiceSeveral service improvements and audit tools are offered to support the increased delivery of PCC.     

Evidence-based radiography: A new methodology or the systematisation of an old practice?

IntroductionEvidence based radiography (EBR) is the logical development of evidence based practice applied to radiography. The aim of this study was to investigate the opinion of a cohort of Portuguese radiographers in Southern Portugal working in public hospitals regarding evidence based practice (EBP), namely about the levels of knowledge about EBR, how they access information and how they use it within daily practice.MethodsA self-administered questionnaire was applied to a sample of 40 radiographers in the Portuguese region of Algarve. This questionnaire was validated for Portuguese speakers using the translation-retranslation method.ResultsThe final response rate was 69% (40/58). Results suggest that most radiographers trained EBR during their undergraduate training. Although, no statistically significant correlations were found in the practice of EBR against participant gender, age, training, career level, reading papers and workplace. The most frequent reason to read papers is the “interest” to do so, and national professional journals are read more often. It was found that radiographers that read scientific papers more frequently know more about research (p = 0.005), understand the importance of research for the professional activity (p = 0.023), and know more on how to conduct research papers (p = 0.034).ConclusionEBR within radiography is not yet well established, and radiographers' have varying viewpoints. Radiographers that read scientific papers more frequently understand better the philosophy behind this concept but it is very important to deepen the knowledge on this area.Implications for practiceWhen practicing radiography based on the best available scientific knowledge, professionals are ensuring the best for patients and for profession. To achieve this, and before taking any action, it is important to evaluate the current situation, and this research presents a way to do so.     

Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics

IntroductionAwareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics.MethodsThis paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compares these to the perspectives of service users, clinical radiographers and radiography managers reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches.ResultsResponse rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC.ConclusionThere is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer's perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency, it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice.Implications for practiceA package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC.     

There's nothing plain about projection radiography! A discussion paper

ObjectivesUnlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field.Key findingsDanish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%).ConclusionBy changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession.Implications for practiceRegardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.     

Unprofessional practice and student professionalism dilemmas: What can radiography learn from the other health professions?

ObjectiveProfessionalism in radiography is a complex, multidimensional concept seldom investigated. During clinical placements, students may observe or be involved in unprofessional practice/professionalism lapses which result in professionalism dilemmas. Establishing what constitutes a professionalism dilemma and what action to take may be challenging for students and also practitioners. This is due to unclear reporting pathways and fear of retribution, both deterrents to raising concerns. The aim of this integrative literature review was to investigate how and why professionalism dilemmas occur. In addition, to explore the types of dilemma students experience during clinical placement and to contextualise and reflect on these findings within radiography. Ovid MEDLINE, PubMed, Google Scholar and the grey literature were reviewed, analysed and themed.Key findingsTwenty-eight papers (published between 2004 and 2020) were analysed and summarised. Four themes emerged, and were discussed within the radiography context; the nature of professionalism lapses (mistreatment, verbal abuse, exclusion and intimidation), reasons for professionalism lapses (burnout and poor role modelling), student response at the time of the professionalism dilemma (accept, resist or report) and long-term impacts on students (moral/emotional distress, professional development and choice of career).ConclusionProfessionalism dilemmas are not reported in the radiography literature but are cited in radiology and other health professions studies. Student experiences of such dilemmas can be profound and long lasting. Thus, research is required to investigate specifically the professional dilemmas experienced by radiography students in the unique environment in which they develop their clinical skills.Implications for practiceThe literature review findings can be used to support the development of strategies to enhance future teaching and modelling of professionalism and develop related research in radiography.     

Bourdieu’s field theory applied to the story of the UK radiography profession: A discussion paper

ObjectivesThere are many suggestions offered within the literature to decide if a job type is a profession, some using tick box type trait and characteristics analyses to compare the actions and qualities of individuals to a predefined list. However, there is no specific way to resolve what makes or defines a profession. Writers in many disciplines, including radiography, have used these different models, sometimes with conflicting results. This paper explores the use of Bourdieu’s replacement of the concept of profession with that of a ‘field’, meaning a network of occupants with common attributes, in this case radiographers, in an attempt to resolve this issue.FindingsIn the UK, radiography practitioners and professional bodies generally use the term profession to describe radiography, and this paper explores a defence of the term for radiography. Using Bourdieu’s field theory not only helps define a profession, but also explains the difficulties at the boundaries of professions, and the work needed to protect a profession as a credible entity.ConclusionThis paper supports the argument that radiography is a profession when using Bourdieu’s field theory. Radiography continues to work to maintain its status by increasing its symbolic capital by increasing the research output and evidence base of the profession and through role extension.Implications for practiceRadiographers can perhaps be assured that radiography is a profession when using Bourdieu’s field theory. This paper shows how theoretical frameworks and concepts from outside radiography can be used to support new ways of thinking within the profession.     

Characteristics of an ideal practice educator: Perspectives from undergraduate students in diagnostic radiography,nuclear medicine,nutrition and dietetics,occupational therapy,physiotherapy and radiation therapy

BackgroundPractice education is a core component of undergraduate health programs, with the characteristics of the practice educator reported to have an influence on student experience during practical. This study analyses Australian student perceptions from six allied health professional undergraduate programs, to identify the characteristics of the ideal practice educator leading to successful placement experiences.MethodsAn existing survey developed for medical students was modified to incorporate both quantitative and qualitative responses. Participants included all students enrolled in six undergraduate health professions in the School of Health Sciences at the University of Newcastle, Australia (n = 1485). Students were invited to complete the survey via hard copy or online.ResultsThere was a 54% response rate. The most valued characteristics were non-judgemental, clarity and feedback. The three least valued characteristics were scholarly activity, role model and practices evidence base practice. Students identified the importance of their relationship (respectful, inspirational and supportive) with the practice educator as being fundamental to a productive placement.ConclusionThe characteristics identified by respondents were common to all six professions, with little differences between gender, year of program or number of placements completed. This study suggests that the attitude of the practice educator towards the student is one of the key factors that underpin the success of practice experience across allied health professions.     

Patient centred care in diagnostic radiography (Part 1): Perceptions of service users and service deliverers

IntroductionThere is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography.MethodsA multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately.ResultsSurvey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident.ConclusionIt is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC.Implications for practiceFurther work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.     

A literature review exploring the perceived impact,challenges and barriers of advanced and consultant practice in therapeutic radiography

ObjectivesThis review seeks to explore the perceived impact, challenges and barriers of advanced and consultant radiographer roles on staff, patients and healthcare. A systematic approach was used to search for and identify suitable literature for review. All appropriate literature was critically appraised and analysed qualitatively by thematic analysis. The results were integrated to give an overall evaluation of the impact of advanced and consultant practice within Therapeutic Radiography.Key findingsThe literature found eleven studies that met the inclusion criteria and after critical appraisal, all were included in the analysis. Five key themes emerged from the analysis which is in keeping with the literature: education, quality of working life, patient care, benefit to healthcare and implementation obstacles.ConclusionMost advanced and consultant radiographers felt unprepared for these roles and the education requirements were varied and misunderstood. It was well documented that the advanced and consultant radiographer found great satisfaction from these roles and felt that it benefitted the patients as well as themselves and their career. Advanced and consultant roles benefitted patients by streamlining pathways and increasing satisfaction and there was a clear benefit to healthcare due to time and cost savings. The implementation obstacles focused around a lack of understanding and support from colleagues. There is a positive impact from advanced and consultant roles in therapeutic radiography to patients, staff and the healthcare system.Implications for practiceThere are challenges with respect to educational requirements, implementation obstacles and understanding of these roles which need to be addressed. There needs to be more education about the benefits of these roles so that they are encouraged and the staff are supported     

Do general radiographic examinations resemble a person-centred environment?

Aim and objectiveIt is argued whether general radiographic examinations adhere to a person-centred approach within the direct digital radiography (DDR) environment. General radiographic examinations continue to increase and constitute approximately 90% of all examinations undertaken in the clinical environment. This study explored the potential impact patients experience whilst undergoing general imaging examinations.MethodAn ethnographic methodology provided insight of two general radiography environments in the United Kingdom (UK) using participant observation and semi-structured interviews.FindingsThe findings highlighted an ‘in and out’ culture whereby patients are ‘hurried’ and ‘rushed’ out of X-ray rooms in response to increasing time pressures experienced by diagnostic radiographers. In addition, this study challenged that patients may begin to rank ‘speed’ and ‘waiting times’ above other elements of radiographic care thus presenting new challenges for radiographers within the clinical environment.ConclusionIt is asserted that radiographers should remain holistic healthcare professionals and not begin to resemble operators on the production line. Further, it challenges whether patients are beginning to rank aspects of radiographic care within contemporary practices.Advances in knowledgeFew studies have explored the radiographer–patient relationship within the DDR environment, yet this study provides insight of person-centred practices within contemporary practices.