Research

UNIVERSITY OF HERTFORDSHIRE RESEARCH PINPOINTS CRITICAL ISSUES IN THE CURRICULUM AND IN THE DEVELOPING ROLE OF THE RADIOGRAPHER

At the end of 1994 the College of Radiographers, in conjunction with the Radiographers Board at the Council of Professions Supplementary to Medicine, issued invitations to tender for a research project into the radiography curriculum. The University of Hertfordshire was successful with its submission, and between August 1995 and December 1996, the Department of Radiography in collaboration with the departments of Psychology and Education carried out a study into the developing role of the radiographer.

The purpose of the research was to gain a strategic view of likely future demands on diagnostic imaging, radiotherapy and oncology and to inform future curriculum development. The research was set against a background of fundamental change within the health and education sectors. Imaging and radiotherapy were continuing to evolve and had been subject to the impact of new technologies and to the organisational and cultural changes within the national health service (NHS). Radiographic education had entered into a new era with the giant leap from the typically small and exclusive monotechnic schools to the more transparent and diverse university sector. This at a time when numbers entering higher education were expanding rapidly; the government was entering into dialogue with higher education on the nature of vocational preparation and the drive towards competence-based education and training.

In order to tackle the issues impacting upon radiography the research was split into four main elements.

1. Content analysis of course documents held by the College of Radiographers revealed the current themes and issues in education.
2. The structured interview was used as the primary tool to survey practitioners. Radiographers, radiographic managers, radiologists, oncologists and medical physicists were interviewed to identify key occupational roles and tasks, and causal factors of role variation. This was supported by a wider questionnaire of radiographers that sought additionally to identify education and training requirements and opportunities for continuing professional development.
3. Action research was designed to explore methods of integrating theory and practice and to develop an assessment procedure to evaluate clinical competence.
4. A survey of educators sought views on a range of issues including curriculum design, structure and content and competency assessment.

Role Developments

It was no surprise that all those interviewed reported an increase in their departmentšs workload that included the amount of administrative work demanded as a result of the NHS reforms. Present and predicted shortage of medical staff was seen as one cause of change within both imaging and oncology. Radiographers were required to do some of the tasks previously performed by radiologists and oncologists. Although benefit was reported for both patients and radiographers there was a view that even though it was more cost effective for radiographers to do these tasks they would never have been able to move into such areas if the medical staff were not over-stretched. Significantly, extra work was resulting in radiographers being asked to take on higher workloads with no extra pay.

The view of one radiologist was typical of the responses:

"The number of examinations are going up all the time, the amount of reporting is going up, so is the amount of administration and management, all these have added a lot of stress, more audit, more formalised training for juniors, everything's increased, without increasing staff significantly"
Diagnostic radiographers who had extended their role gave IV injections, participated in red dot schemes, reporting and conducted barium studies. For radiotherapeutic radiographers extended roles were making decisions about target volumes, performing computer planning, conducting on-treatment (review) clinics, quality assurance and counselling. Role extension was seen favourably by a large proportion of our respondents. It was tempting to conclude that such a ground swell of enthusiasm for change to the radiographer's role would lead inevitably to such changes becoming the norm across Britain in the near future. However, such developments are uneven across Britain, and indeed to talk about role extension as if it described one single situation is misleading and developments at one hospital may not mirror those at a hospital just a mile away. Developments were on an ad hoc basis and to a large extent uncoordinated.

No room for technicians

The concept of imaging technicians or radiotherapy technicians gained little support and any role for an additional grade was seen to be limited. Managers wished to employ multi-skilled radiographers who were versatile and able to perform a wide range of functions. However, those who were in favour of technicians were concerned that adequate training be provided and it was seen by some that it was necessary to introduce imaging technicians in order to allow radiographers time to undertake more complex tasks.

Single modality courses

Any attempt to introduce pre-registration single modality qualifications was viewed with scepticism. The majority view across the diagnostic sample, was that the specialisms (CT, MRI, US and nuclear medicine) should be retained in their separate form as an optional add-on that could be decided upon after initial qualification. Most of the sample were agreed that a firm grounding in the basics of radiography was needed before radiographers tackled specialist areas. Moving towards separate courses would split the profession and destroy the flexibility of the workforce. Irrespective of the question of whether there should be separate and distinct career paths there was agreement that eighteen was too young an age at which to specialise.

Education not meeting the need?

Nearly half of the diagnostic sample surveyed believed that current education and training programmes do not prepare radiographers adequately for their first post. In therapy, only twenty nine percent thought that first post practitioners were not adequately prepared. Many believed that there was too much theory in degree courses and that much of it was irrelevant. Concerns were mainly centred around the perception of a lack of practical experience and many practitioners believed that clinical practice was compromised by the amount of academic material. The view of one manager was fairly typical.
"I think the weaknesses are that they have so many areas to cover and they donšt spend very much time in any one place because radiography has developed so much ... they have to learn about ultrasound, CT, MRI they basically have to learn a lot more and only 50% of the time is given over to practical training so we are a short on that."

While institutions believed that their curriculum provided an integrated learning experience, evidence indicated that students experienced their training as separate and fragmented episodes rather than an integrated whole. If it is the desire to provide a broad academic curricula it must not be at the expense of clinical education. However, it was not conclusive that students spend insufficient time at placements but more that the time is ineffectively managed with over emphasis on areas that detracted from developing skills needed upon qualification.

The future

The sponsors asked that there be a 'speculative but informed consideration' of the 'inter-professional relationships in diagnostic imaging and radiotherapy and oncology services'. It seemed crucial to consider the possibility of future legislation and the consequences for the relationships between radiographers and other professional groups. Of major relevance here will be changes to the Professions Supplementary to Medicine Act; the widespread introduction of continuing professional development and the possible introduction of occupational standards. The final chapter considers these interrelated and complex issues and looked at future scenarios for therapeutic and diagnostic radiographers.
At the time of the research we were not aware of any other work that had attempted to evaluate and reflect on recent developments on a wide scale. We believe the profession has made sound recommendations to guide educational development and it is clear that the profession would do well to reconsider the expectations that it places on education and more importantly on students and new graduates. There must be a realisation that developing first post competencies and preparation for a career based on further development within the workplace are two separate issues that need to be managed carefully in developing future curricula.
The findings of the research are published in a report 'The Developing Role of the Radiographer' - Issues affecting the future curriculum. Prepared by Richard Price, Janet High and Dr. Linda Miller, ISBN 1-898543-26-27. The report costs Ł15 and is available from:
The College of Radiographers, or:
 	The Department of Radiography, 
	University of Hertfordshire, 
	College Lane, 
	Hatfield, 
	Herts, 
	AL10 9AB. 
	Tel: + 44 (0) 1707 284960; 
	Fax: + 44 (0) 1707 284977;


 E mail: 
R.C.Price@herts.ac.uk

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