Informing radiography curriculum development: the views of UK radiology service managers concerning the ‘fitness for purpose’ of recent diagnostic radiography graduates

Recent years have seen significant changes in the way medical imaging services are delivered, rapid changes in technology and big increases in the number and ranges of examinations undertaken. Given these changes the study aimed to critically evaluate the fitness for purpose of newly qualified diagnostic radiography. The study employed a grounded theory approach to analyse the interviews of 20 radiology managers from a range of medical imaging providers across the UK. Four key themes emerged from the analysis. These were: curriculum content and structure review; diversification in the role of the radiographer; professionalism and coping and the reformation of career structures. The results indicate the role of the radiographer is now quite nebulous and challenge radiology managers and educators to design curricula and career structures which are better matched the role of the radiographer in the very rapidly changing technological, organisational and social contexts of modern society

Soft skills and hard lessons: the future of radiography education in the UK

The diagnostic radiography BSc curriculum has not seen fundamental changes in recent years with the focus of study predominantly centred around the development of competencies within projection/plain radiography accompanied by a limited experience in a range of other imaging modalities. The operation of a modern imaging department now involves the utilisation of a wide variety of imaging modalities many of which have seen large increases in their workload. The study reports of the findings generated from 20 semi-structured interviews undertaken with radiology service managers from across the United Kingdom. An interview schedule was generated which was developed to elucidate: recent changes in working practices within imaging departments; additional training which needs to be provided for recent graduates and the skills required for the future workforce. The results were analysed using a Straussian Grounded Theory approach in which responses were coded and then grouped using thematic analysis. Results showed the current model of education only partly supports the needs of the modern workforce imaging with specific concerns raised regarding the communication skills, professionalism and clinical skills of newly qualified graduates. Managers foresee the continuing development of the four tier structure; further increases in the workload associated with all modalities and the increasing need for ‘specialisation’ at an earlier stage the career of the Radiographer. Projection imaging, mobile and theatre work will continue to play a central part within the imaging department and should be a primary consideration of the development of future curricula though not all graduates may utilise these skills

Patient obesity and the practical experience of the plain radiography professional: on everyday ethics, patient positioning and infelicitous equipment

Patient obesity is increasingly placing significant and multifaceted strain upon medical imaging departments, and professionals, in (particularly Western) healthcare systems. The majority of obesity-related studies in radiology are, however, primarily focused only upon the technical business of collecting diagnostically-efficacious images. This study, using Interpretative Phenomenological Analysis (IPA), qualitatively explores the everyday clinical experiences of eight expert UK diagnosticians working in plain radiography. Focus herein falls particularly upon (a) problems with patient positioning during examination, and (b) challenges arising around available equipment. In line with extant research, participants reported that difficulties with positioning obese patients could have negative impacts on image quality, and that insufficient table weight limits and widths, and inadequate detector sizes, can adversely affect examination. They also raised some more novel issues, such as how the impact of available gown sizes upon a patient’s sense of dignity can cause practical and ethical dilemmas for a clinician in situ. The issue of how one might ‘train’ experience in positioning patients without bony landmarks as a reference point was also made salient, with strong implications for undergraduate radiography curricula. It is finally highlighted how the participating radiographers themselves seldom conceptualised any given problem as a purely ‘technical’ one, instead recurrently recognising the interlinking of material, socio-economic and moral matters in real healthcare contexts. By better understanding such nuance and complexity as lived by real radiographers, it is contended, a more context-sensitive and flexible path to effective training and guideline-production can be mapped

Charting the practical dimensions of understaffing from a managerial perspective: the everyday shape of the UK’s sonographer shortage

Introduction: Across the last two decades, ultrasound services in many healthcare sectors have become increasingly pressurised as a consequence of upsurging demand and difficulties in recruiting viable clinicians. Indeed by 2013, the UK government's Migration Advisory Committee had listed sonography as an official ‘shortage specialty’. Comparatively little research has to date, however, explored the impacts of this situation upon the departments themselves, and the individuals working therein. The core purpose of this study is, thus, to lend qualitative depth to current understandings of the frontline situation in the UK's ultrasound units, many of which are understaffed, from the perspective of their managers. Methods: Using a thematic analysis informed by a Straussian model of Grounded Theory, N=20 extended accounts provided by ultrasound department leads in public (n=18) and private (n=2) units were explored. Results: Four global themes emerged from the analysis of which the first two (the broadly sociological matters) are described in this paper. Theme 1 addresses how a lack of staff in the broader ultrasound economy has created a troublesome migratory system in contemporary UK ultrasound. Theme 2 addresses how this economy works chiefly to the advantage of the most junior and the most senior clinicians, often leaving mid-career professionals in the borderline impossible situation of having to concurrently occupy both junior and senior roles. Conclusions: The findings ideally open up debate on some key practical contingencies of the UK’s sonographer shortage, and reflect upon literature regarding the nuanced aspects of a shifting healthcare workplace constitution

The views of UK radiology service managers concerning professionalism: on the ability of newly qualified radiographers to cope with working in contemporary clinical contexts

These findings have emerged from a broader project which mapped the views of UK radiology service managers concerning the fitness for purpose of recent radiography graduates. The data revealed very emotive responses which generated a meta theme related to professionalism and coping skills. The core questions asked were: How ‘fit for purpose’ are radiography graduates? Are current curricula aligning with the needs of service? How should curricula evolve in the future

Managing the initial transition from student to professional radiographer: Making induction and preceptorship count

Background: Today, increased marketisation of the higher education (HE) and heath sectors requires that students in allied healthcare disciplines make an almost instantaneous shift upon qualification from a consumer identity to that of service provider, with a range of sharp corollary impacts upon their senses of self and accountability (Sloane and Miller, 2017). In these terms, how the earliest days of post-qualification employment are managed can have profound and long-lasting consequences. In this paper, emergent of a broader study funded by the College of Radiographers Industrial Partnership Scheme, findings around this initial transition period in diagnostic radiography are investigated. Methods: With institutional ethical approval, N=20 (f=13, m=7) junior diagnostic radiographers working across the UK were recruited for extended, semi-structured telephone interviews. Verbatim transcripts were analysed using Straussian Grounded Theory (Waring et al., 2018). Results: Participants reported a range of nuanced positive experiences of individually-tailored induction and preceptorship, which had smoothed the pathway into practice in both the short and longer terms; they helped rapidly align personal identities/expectations with that of a “real radiographer.” While actively negative (often generic) experiences were reported to have stymied this process, an overall absence of induction/preceptorship was received more variably. While some participants felt undermined, others claimed that it had boosted their resilience and made them more ready for the challenges ahead. Conclusion: Findings echo the concerns of Yale (2019), regarding personal tutoring in HE; it may be the case that no transition-management is better for new radiographers’ adjustment than something too generic and/or inflexible

Personnel flux and workplace anxiety: personal and interpersonal consequences of understaffing in UK ultrasound departments

Introduction: By 2013, the UK government’s Migration Advisory Committee had determined sonography to be a formal shortage specialty, and understaffing remains a key concern for research in the domain. This paper, emergent of a qualitative study funded by Health Education North West, explores unit managers’ perspectives on the present state of UK ultrasound. The focus herein falls upon the personal and interpersonal consequences of this circumstance for individuals working in specific understaffed departments. Methods: A thematic analysis informed by a Straussian model of Grounded Theory was utilised; N=20 extended accounts provided by ultrasound department leads in public (n=18) and private (n=2) units were collected and analysed accordingly. Results: The global themes addressed herein describe (a) how both inter-departmental movement of senior sonographers and early retirement, within a nationally understaffed picture, impacts upon local knowledge economies, and (b) how such staffing instabilities can undermine the day-to-day confidence of managerial staff and practicing sonographers alike. Conclusions: It is personnel flux, rather than simple short-staffing, that is reported to cause the greatest social-psychological problems for both managers and sonographers. The issues raised herein require further examination from the perspective of sonographers themselves, in order to corroborate the views of the managers interviewed

“Looking back at my student years now…”: Recently-qualified radiographers’ retroactive understandings of key resilience sources

Background: The rapid evolution of healthcare provision models in the UK has left many Higher Education curricula in the medical imaging sciences struggling to fully equip their graduates for engagement with the vagaries of full clinical practice upon qualification (Sloane and Miller, 2017). Emerging from a national study of the practical experiences of recently-qualified diagnostic radiographers, however, this paper addresses key aspects of the participants’ undergraduate experience that had directly informed their subsequent resilience in the workplace. Methods: With institutional ethical approval, N=20 diagnostic radiographers of one to two years post-graduation experience, working across the UK, sat for extended, semi-structured telephone interviews. Verbatim transcripts were analysed using Straussian Grounded Theory (Miller et al., 2019). Results: Participants accounted that they had sourced resilience from many aspects of their undergraduate experience. Four issues, however, were recurrent in nearly all interviews. 1. Positive clinical experiences during placement routinely reassured participants they were ultimately “up to the job.” 2. “Errors without insults” during placement were taken to be highly constructive development experiences. 3. Strong link-tutoring provided intellectual reinforcement of practical and social skills during placement. 4. Academic content that unambiguously elucidated its functional value was essential in providing confidence in procedural knowledge. Conclusion: Observably, the strongest sources of resilience for participants with respect to their subsequent clinical practice were themselves practical in nature. While some found no difficulty in extracting confidence from more theoretical aspects of curricula, those aspects were still most successful when actively framed in the most practical terms possible

Charting the practical dimensions of understaffing from a managerial perspective: everyday consequences of the UK’s sonographer shortage

Background: The Society and College of Radiographers reports that by 2014, 18.1% of UK ultrasound vacancies remained unfilled, a substantial rise from the 10.9% reported in 2011, and the 10.1% reported in 2009.[1,2] Indeed by 2013, the UK government’s Migration Advisory Committee had listed sonography as an official ‘shortage specialty’.[3,4] The research reported herein is designed to lend qualitative depth to our current understanding of the “coal-face” situation in the UK’s ultrasound units from the perspective of their managers. Methods: Using a Straussian model of Grounded Theory,[5,6] extended accounts provided by N=20 ultrasound department leads in public (n=17) and private (n=3) units were analysed. Results: Three global themes emerged from the analysis. The first addresses how a lack of staff in the broader economy has created a migratory system that works chiefly to the advantage of the most junior and the most senior clinicians, often leaving mid-career professionals in a borderline impossible situation. The second highlights how the knowledge economy in many departments is being stymied by early retirement and late-career migration, rendering questions about how advanced expertise in ultrasound might be obtained and sustained by the remaining experienced clinicians. The third underscores how it is often workplace instability, rather than simple short staffing, that is most damaging to staff morale, planning capacity and clinical self-efficacy. Conclusions: This work ideally opens up debates on some largely undiscussed practical contingencies of the sonographer shortage, and can help ground future deductive research in the real-world experience of key actors. References 1. Society and College of Radiographers. Sonographer workforce survey analysis. SCoR; 2014. 2. Society and College of Radiographers. Developing and growing the sonographer workforce: Education and training needs. SCoR; 2009. 3. Migration Advisory Committee. Skilled shortage sensible: Full review of the recommended shortage occupation lists for the UK and Scotland, a sunset clause and the creative occupations. 2013. 4. Parker PC, Harrison G. Educating the future sonographic workforce: Membership survey report from the British Medical Ultrasound Society. Ultrasound 2015;23:231-241. 5. Sloane C, Miller PK. Informing radiography curriculum development: The views of UK radiology service managers concerning the ‘fitness for purpose’ of recent diagnostic radiography graduates. Radiography 2017;23:S16-S22. 6. Charmaz, K., Grounded Theory, in: Smith, J.A., ed., Qualitative Psychology: A Practical Guide to Methods, Sage, London, 2008, 81-110

Constructing the “ideal” first-post sonographer: mapping the views of ultrasound department leads in the UK

Background: The findings reported in this presentation emerge from a broader project investigating the future of Ultrasound education in the UK. Specifically addressed herein is the way in which the employers of prospective first-post sonographers assembled the attributes and aptitudes that would constitute an “ideal” person for such a role. Method: In line with the conventional methods of Straussian Grounded Theory, N=20 Ultrasound Department leads in the North West of England, working within NHS Trusts (N=17) and independent provision (N=3), were interviewed. All interviews were semi-structured, conducted and recorded by telephone and transcribed verbatim. Results: Participants cited “acquired” capacities such as advanced communication skills, good time management and the ability to work autonomously as essential in a first post-sonographer. They also argued that certain “inherent” personality traits should be sought out as part of a selection process; these attributes included patience, amicability, empathy, caring and a tendency towards perfectionism. Although academic aptitude was deemed important, the ability to be non-judgmental was deemed more so. Conclusion: In discussing the ideal attributes of a workplace sonographer, it became clear that the participants had a clear sense of which were desirable and undesirable. However, and in a more novel vein, it was equally clear that they also held strong and relatively consistent views on which kinds of personal attribute were static (i.e. immanent qualities of a prospective employee) and which were malleable (i.e. could be altered/improved with on-the-job training). This, it is contended, has significant import for educators and trainees alike