An analysis of advanced and specialist posts in diagnostic radiography: Do job descriptions describe advanced practice?

Recognition of advanced level practice against multiprofessional capabilities: Experiences of the first radiography applicants

INTRODUCTION

Advanced practice is well established in the health professions with multiprofessional capabilities in place in England. To recognise achievement of these capabilities an ePortfolio (supported) route was initiated in 2022. This study aimed to review the demographics and experiences of radiographers applying for recognition in the first year of operation.

METHODS

The multi method evaluation consisted of quantitative data analysis of information regarding the first three cohorts of radiographers (n = 40) participating in the NHS England (NHSE) scheme. Interviews with 12 participants was undertaken with thematic analysis of the transcripts.

RESULTS

Self-rated scores of expertise were significantly higher by therapeutic radiographers (n = 8) compared to their 32 diagnostic colleagues (t = 5.556; p < 0.01). Radiographers saw the ePortfolio as an opportunity to validate their experience and to evidence parity with other professions. Participants felt the process also enabled critical reflection and gave unseen insight into themselves and their roles. The support of experienced educational supervisors was felt to be vital in this process and for successful completion of portfolio.

CONCLUSIONS

Several radiographers have now achieved the necessary standards to achieve NHSE recognition. The evaluation exposed that most radiographers did not have the relevant evidence to hand and the ongoing collection of evidence around capabilities and impact is critical to evidencing advanced practice capabilities.

IMPLICATIONS FOR PRACTICE

Radiographers are able to achieve the capabilities expected for multiprofessional practice. Cultural change is required to normalise recording of evidence within practice including case-based discussions, clinical supervision and feedback from colleagues and patients. The support of an experienced educational supervisor aided the critical reflection on practice level.

Radiographers' insights on the impact of their potential role in image interpretation within a low resource setting

INTRODUCTION

The global shortage of radiologists has led to a growing concern in medical imaging, prompting the exploration of strategies, such as including radiographers in image interpretation, to mitigate this challenge. However, in low-resource settings, progress in adopting similar approaches has been limited. This study aimed to explore radiographers' perceptions regarding the impact of their potential role in image interpretation within a low-resource setting.

METHODS

The study used a qualitative descriptive design and was conducted at two public referral hospitals. Radiographers with at least one year of experience were purposively sampled and interviewed using a semi-structured interview guide after consenting. Data saturation determined the sample size, and content analysis was applied for data analysis.

RESULTS

Two themes emerged from fourteen interviews conducted with two male and twelve female radiographers. Theme one revealed the potential for enhanced healthcare delivery through improved diagnostic support, bridging radiologist shortages, career development and fulfilment as positive outcomes of role extension. Theme two revealed possible implementation hurdles including radiographer resistance and reluctance, limited training, lack of professional trust, and legal and ethical challenges.

CONCLUSION

Radiographers perceived their potential participation positively, envisioning enhanced healthcare delivery, however, possible challenges like resistance and reluctance of radiographers, limited training, and legal/ethical issues pose hurdles. Addressing these challenges through tailored interventions, including formal education could facilitate successful implementation. Further studies are recommended to explore radiographers' competencies, providing empirical evidence for sustaining and expanding this role extension.

IMPLICATION FOR PRACTICE

The study further supports the integration of radiographers into image interpretation with the potential to enhance healthcare delivery, however, implementation challenges in low-resource settings require careful consideration.

Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution

INTRODUCTION

Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP).

METHODS

From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo).

RESULTS

Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning.

CONCLUSION

Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership.

IMPLICATIONS FOR PRACTICE

This study highlights a policy gap in the education and practice of APs in radiotherapy.

Unveiling the landscape: Investigating education, skills, job description, and challenges in sonography professions and framework development

INTRODUCTION

This paper discusses the current medical sonographer status in the United Arab Emirates (UAE). The paper explores the current education, skills, job description, and challenges towards developing sonography professions and a sonographer framework.

METHODS

The study employed a quantitative descriptive research approach using a cross-sectional study design to collect and analyse data from sonographers in the UAE. Data was collected through a structured survey that included sections addressing demographic information, education, skills, current practices, and challenges.

RESULTS

The data showed a relatively even distribution across different age groups, with a higher proportion falling in the 31-40 age range. Females constitute a slightly higher percentage (55.9 %) than males (44.1 %). The study found that sonographers have the necessary skills and knowledge to interpret the scan results and provide a formal report. A significant percentage of participants taught ultrasound to others and participated in research activities. The survey responses indicate difficulty in reporting sonograms.

CONCLUSIONS

The study found that sonographers possess the necessary expertise and skills to pass on their knowledge to trainees and colleagues. The participants expressing a desire to increase their knowledge and skills indicate that sonographers recognised that continuous professional development is crucial for staying updated with advancements in the field. The participant's "Advanced Practitioners" title recommendation suggests a desire for professional recognition, career progression, and specialisations in sonography. Effective interdisciplinary collaboration is important for providing quality patient care.

IMPLICATION FOR PRACTICE

The paper emphasises the importance of recognising sonography as a vital healthcare profession. It aims to raise awareness about the crucial role of sonographers in patient care. The study also stresses the need for a well-defined career progression framework to guide professional growth and acknowledgement.

Expectations of radiographer reporting roles: A multimethod evaluation across a single imaging network

INTRODUCTION

Prior studies have demonstrated inconsistent development and utilisation of radiographers in the reporting of radiographs, and there is ongoing consideration of the level at which such radiographers should be educated to and operating at. This study aimed to explore and evaluate expectation and utilisation of radiographers currently, or training in, reporting in projection radiography across one integrated care system (ICS).

METHODS

A multi-method approach was utilised, with document analysis of projection radiography reporting role job descriptions and person specifications and an online survey of managers and clinical leads. A single ICS in the north of England formed the setting for the study.

RESULTS

This study demonstrated variation in implementation and utilisation of the role across trusts within the ICS. Inconsistencies in scope, expected underpinning education and role activity were identified. Radiographers autonomously reporting in projection radiography were titled advanced practitioners, however are not expected to achieve national educational standards for such roles and are not empowered to work at this level of practice by their employers. It was acknowledged that staffing pressures hinder appropriate role utilisation and reporting capacity.

CONCLUSION

Inconsistent development and utilisation of radiographers in such roles may hamper collaboration and service delivery across a network. Identifying variation and working towards role standardisation could promote cross-organisational working and improve career progression opportunities.

IMPLICATIONS FOR PRACTICE

Scoping the reporting radiographer workforce may assist and guide future imaging service and workforce planning.

Scoping of advanced clinical practitioner role implementation using national job advertisements: Document analysis

AIM

The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets.

DESIGN

Documentary analysis of job descriptions (JDs), person specification and advertisements.

DATA SOURCES

England based jobs advertised on NHS jobs website from 22 January to 21 April 2021.

RESULTS

A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted.

CONCLUSION

The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists.

IMPACT

This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs.

REPORTING METHOD

No EQUATOR guideline exists for document analysis.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. The research relates to organizational human resource information only.

Advanced practice roles amongst therapeutic radiographers/radiation therapists: A European survey

INTRODUCTION

Advanced Practice (AP) roles in Radiotherapy (RT) over time are variable, often locally developed and not underpinned by professional standards which leads to conceptual and practical gaps. This study aimed to assess AP roles amongst Therapeutic Radiographers/Radiation Therapists (TR/RTTs) and identify educational gaps for this level across Europe.

METHODS

An anonymous online survey was designed, validated, and distributed across Europe. Convenience sampling was used to recruit advanced TR/RTTs practitioners or TR/RTTs working in AP roles. Descriptive analysis from closed questions and thematic analyses from open questions are reported.

RESULTS

A total of 272 responses were obtained, of which 189 eligible participations were from 21 European countries. 42% of respondents acknowledged additional education required to perform AP, and 25% reported a minimum of five years of RT practice to perform AP roles/tasks. There is a trend to work more on the clinical practice domain with a low percentage of working time allocated to research. Inconsistency was found in job titles, scopes of practice, and educational backgrounds across and even within countries. Education needs regarding knowledge about image-guided and adaptive RT, multimodal imaging and technologies, and advanced treatment planning were found. Training needs on leadership and management skills and clinical site-specific expertise were identified.

CONCLUSION

This study clearly shows a gap in education support, a need for standardisation in job titles and scopes of practice across Europe.

IMPLICATIONS FOR PRACTICE

As the first large-scale assessment of current AP roles and educational support amongst TR/RTTs across Europe, this study recommends the establishment of governance structure and role regulation. It also informs the curricula for master programmes to align the education with current and future practice.

Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review

OBJECTIVE

This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP.

METHODS

PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP.

RESULTS

Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications.

CONCLUSION

This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.

Diagnostic radiographer advanced clinical practice in the United Kingdom - A national cross-sectional survey

Objectives

To survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP).

Methods

174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October-December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included.

Results

A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification.

Conclusions

Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts.

Advances in knowledge

Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards.