Enhanced practice: A strategy to resolve the inconsistencies in advanced practice implementation

Has the skills mix promise been broken? A scoping review of the deployment of the support and assistant workforce within diagnostic imaging in the UK

INTRODUCTION

In the UK the development of skill mix in radiography at the end of the 20th century formalised the assistant practitioner role, separating it from the support worker function. The key aim was to increase imaging capacity whilst enabling opportunities for career progression within both the support and radiography workforce. There has been limited examination of these support and assistive roles and this review aims to explore the current evidence.

METHODS

This scoping review used a systematic search strategy and interrogated MEDLINE, CINAHL, Scopus and Google Scholar. Primary research articles published in the English-language referring to studies conducted in the UK on assistant or support roles in radiography were sought. The sourced data was uploaded to a web-based review platform for screening.

RESULTS

The literature search identified only 11 articles which met the search criteria, of which only one referred to the support worker role. Adopting a primarily qualitative approach the quality of the articles varied. Thematic analysis was undertaken using a priori themes role purpose, outcomes, aspirations and capacity building.

CONCLUSION

There is limited research evidence of capacity generation with most presenting individual perspectives. Job satisfaction and career aspirations within the support and assistive workforce are evident but there is still confusion over scope of practice and supervision.

IMPLICATIONS FOR PRACTICE

The support and assistive workforce are a key part of the diagnostic imaging workforce but limited research evidence examining these roles has been published. Further research exploring the impact of skill mix changes across all levels and imaging professions is required.

What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers

INTRODUCTION

Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice.

METHODS

A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice.

RESULTS

261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles.

CONCLUSION

Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training.

IMPLICATIONS FOR PRACTICE

Role development. Education changes for therapeutic radiographers.

Vetting of medical imaging referrals: A scoping review of the radiographers' role

INTRODUCTION

Vetting and treatment verification, are now an expectation of threshold radiography competencies at qualification. Radiographer-led vetting contributes to the expedition of patients' treatment and management. However, the current state and the role of the radiographer in vetting medical imaging referrals remains unclear. This review aims to explore the current state and associated challenges to a radiographer-led vetting and offer directions for future research by addressing knowledge gaps.

METHOD

The Arksey and O'Malley methodological framework was employed for this review. This includes a comprehensive search using key terms relating to radiographer-led vetting across relevant databases: Medline, PubMed, AMED and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles were screened for eligibility and information extracted and analysed descriptively to map the available evidence.

RESULTS

1149 studies were identified with 12 articles included for this review after duplicates were removed. The findings indicate existence of some radiographer-led vetting activities in practice; however, the scope of this practice is associated with a large variance across settings. Key challenges relating to radiographer-led vetting include referral selectivity, medical professional dominance, and lack of clinical indication on referrals.

CONCLUSION

Radiographers vet various categories of referrals depending on jurisdictional policies and more clarity in regulation, advanced practice training and change in workplace culture is needed to support radiographer-led vetting.

IMPLICATION FOR PRACTICE

Radiographer-led vetting should be championed across settings through formalised training to widen the scope of advance practice and career progression pathways for radiographers as a means of ensuring optimal use of resources.

A pilot study to assess radiographer preliminary clinical evaluation (PCE) introduced for emergency department adult appendicular X-ray examinations: Comparison of trained and untrained radiographers

INTRODUCTION

Radiographers are transitioning from using "Red Dot" annotations to flag abnormal emergency X-ray images, to providing written preliminary clinical evaluation (PCE) diagnostic comments. This study explored the impact of local training on radiographers' PCE participation and accuracy performance during a trial period.

METHODS

Ten radiographers provided PCE comments for adult appendicular trauma X-ray examinations performed in the Emergency Department of an English public hospital over a 19 week trial period. Five senior radiographers who had received local PCE training and five more recently qualified radiographers, without this local training, participated in the trial. PCE participation rates were recorded and the PCE comments were scored for accuracy compared to the formal radiology report.

RESULTS

There were 796 eligible examinations, of which 528 (66%) had PCE comments. PCE participation was significantly higher (p < 0.001) for the radiographer group who received the training (80%, 253/316) compared to the untrained group (57%, 275/480). Similar levels of PCE accuracy (90% vs. 89%), sensitivity (86% vs. 82%) and specificity (91% vs. 93%) were found for the trained and untrained cohorts respectively, with no statistically significance difference between these scores.

CONCLUSION

Local PCE training was associated with more frequent PCE participation but did not appear to influence PCE accuracy. The accuracy results suggest that radiographers are well equipped to provide PCE comments for adult appendicular X-ray examinations.

IMPLICATIONS FOR PRACTICE

Local PCE training is likely to be important for consistent PCE scheme participation. Both experienced and recently qualified radiographers appear well equipped to provide accurate PCE for adult appendicular trauma X-ray examinations.

Difficulties associated with Reporting Radiographer working practices - A narrative evidence synthesis

OBJECTIVES

This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on working practices affecting trainees and qualified Reporting Radiographers.

KEY FINDINGS

Fourteen studies informed the themes of this article, they were published between 2014 and 2021. Delays to commencement of reporting roles and variance in performance monitoring was common. Lack of formalisation, overly restrictive and out of date scopes of practice were also found. Whilst, staffing shortages contributed to underutilisation. Failure to utilise skills was most prevalent in cross sectional imaging modalities. Considerable variance in practice was also found between centres. Meanwhile, Reporting Radiographer involvement in professional development, education and research is far from universal and often dependant on individuals sacrificing their own time.

CONCLUSION

Governance in many centres would benefit from renewal and standardisation, particularly relating to scopes of practice and performance monitoring audits. Measures are also required to encourage compliance with guidance, address staffing issues and reduce variation between centres. Failure to address these issues has the potential to impair collaboration, delay patient care and increase economic inefficiencies whilst negatively impacting satisfaction for service users and staff. Lack of involvement in professional development, education and research suggests Reporting Radiographers are not accomplishing their full potential, educating the next generation of the reporting workforce and driving evidence-based change for further development of the specialism.

IMPLICATIONS FOR PRACTICE

Better use of the existing workforce is essential to increase productivity, value, and security of Reporting Radiographer services, which are essential to improve patient outcomes and efficiency.

Radiographers' self-perceived competencies after attending postgraduate courses in CT and MRI

INTRODUCTION

Postgraduate education in computed tomography (CT) and magnetic resonance imaging (MRI) varies globally. Multiple factors affect the development of associated core skills and competencies for these specialist roles. Previous research has highlighted that different teaching standards and methods may influence radiographers' confidence and competencies. Nonetheless, there is limited knowledge of skill development and capabilities in post-registration roles. Hence, the aim of this research was to explore radiographers' self-perceived competencies before, during and after successful completion of postgraduate study.

METHODS

Radiographers enrolled on the CT and MRI courses voluntarily completed questionnaires at three time points. As part of the last survey, questions were added to evaluate their perceptions of the courses' impact on their clinical and professional practice. Descriptive statistics, Wilcoxon matched pairs signed rank and Friedman tests, were performed to analyse results across the different time points.

RESULTS

53 students completed the baseline survey, with initial perceived areas of weakness being lack of knowledge relating to CT or MR technology, cross-sectional anatomy and pathology. Follow up surveys, highlighted a significant increase in self-described competence in technical knowledge, literature appraisal and image viewing skills. As a result of completing the course, students described favourable changes to their departmental practices and their own continuing professional development (CPD). Challenges detailed included but not limited to lack of study time provided by employers, and the demands of balancing studies and work commitments.

CONCLUSION

Postgraduate education has value and positively impacts radiographers and their clinical departments. The courses enabled the radiographers, including those experienced in CT and or MRI to develop skills they could translate into clinical practice, thereby contributing towards service delivery.

IMPLICATIONS FOR PRACTICE

Post graduate education has the potential to enhance self-perceived competency in aspects of CT and MRI practice.