Insights into Diagnostic Radiography students' perception of clinical stressors

Understanding the current situation of challenging clinical interactions for medical radiation undergraduates: An integrative literature review

OBJECTIVES

The objectives of this review were to identify the causes, types, and effects of clinical interactions that medical radiation students (MRS) consider as challenging and assess available support and coping strategies during these challenging interactions. The overarching aim is to understand the current situation of challenging clinical interactions (CCIs) for MRS during clinical placement (CP).

KEY FINDINGS

A comprehensive literature search on PubMed, Scopus, Web of Science, Ovid Medline, CINAHL, ERIC, OpenDissertation, and ProQuest Digital databases for studies published from 2005 to 2024 found 133 studies, with 11 meeting the inclusion criteria. Most of the studies (n = 8) recruited medical imaging students with no study found for nuclear medicine undergraduates. The main cause of CCIs identified thematically was inadequate support and preparation, while three themes were identified for the types of CCIs: students' self-perceived challenges, clinical scenarios and situations, and unacceptable behaviours. Similarly, three themes were identified regarding the effects of CCIs: attitudinal changes, long-lasting effects, and professional identity development. The identified coping and support strategies were support from supervisors, educators, and students.

CONCLUSION

Compared to nursing and medicine, the issue of CCIs has received little research interest in medical radiation education. This could result in increased attrition, while its potential to impede students' professional capability development cannot be underestimated. These CCIs and their effects need to be studied thoroughly with all stakeholders.

IMPLICATION FOR PRACTICE

To enable MRS to achieve their clinical learning objectives, a major goal in the future will be to assess the effectiveness of the support and coping strategies available to all MRS during CCIs and to ensure the development of effective support strategies.

ePortfolios: Enhancing confidence in student radiographers' communication of radiographic anatomy and pathology. A cross-sectional study

INTRODUCTION

In 2020, the Medical Radiation Practice Board of Australia made several revisions to its professional capabilities. To address this, medical radiation practitioners, including diagnostic radiographers, are required to escalate urgent findings in all radiographic settings. However, the confidence of radiographers in articulating descriptions of radiographic findings varies despite this requirement. This cross-sectional study explores how the implementation of eportfolio affects student self-perceived confidence in identifying and describing radiographic findings in both an academic and a clinical setting.

METHODS

A Qualtrics survey was distributed to second-year radiography students who had used eportfolios. The survey comprised of four questions using a Likert-scale and one open-ended question. Quantitative data were analysed using the Wilcoxon signed-rank test and qualitative data was thematically assessed.

RESULTS

Overall, 55 of 65 radiographic students (85%) completed the survey. Confidence (strongly agree and agree) decreased from 89% to 74% between academic and clinical environments when identifying abnormalities, and 89% to 73% when describing findings. This finding highlights the challenges students face when in the clinical environment. Wilcoxon signed rank test analysed a statistically significant relation between the two environments (P < 0.05). However, the relationship between identifying and describing skills was not statistically significant (P > 0.05). Following a review of the qualitative data, three recurring themes were identified among responses.

CONCLUSION

ePortfolios assist in improving confidence in identification and description of radiographic abnormalities, particularly in an academic setting. The clinical environment presents unique challenges which may limit student clinical performance; however, this requires further investigation.

The effect of non-immersive virtual reality radiographic positioning simulation on first-year radiography students' image evaluation performance

INTRODUCTION

Optimal radiographic image quality is critical because it affects the accuracy of the reporter's interpretation. Radiographers have an ethical obligation to obtain quality diagnostic images while protecting patients from unnecessary radiation, including minimizing rejected and repeated images. Repeated imaging due to positioning errors have increased in recent years.

METHODS

This study evaluated the effectiveness of non-immersive virtual reality (VR) simulation on first-year students' evaluation of positioning errors on resultant knee and lumbar spine images. Crossover intervention design was used to deliver radiographic image evaluation instruction through traditional lecture and guided simulation using non-immersive VR to 33 first-year radiography students at a single academic institution located across four geographic program locations. Pre- and post-test knowledge assessments examined participants' ability to recognize positioning errors on multiple-choice and essay questions.

RESULTS

Raw mean scores increased on multiple choice questions across the entire cohort for the knee (M = 0.82, SD = 3.38) and lumbar spine (M = 2.91, SD = 3.69) but there was no significant difference in performance by instructional method (p = 0.60). Essay questions reported very minimal to no raw mean score increases for the knee (M = 0.27, SD = 2.78) and lumbar spine (M = 0.00, SD = 2.55), with no significant difference in performance by instructional method (p = 0.72).

CONCLUSION

Guided simulation instruction was shown to be as effective as traditional lecture. Results also suggest that novice learners better recognize image evaluation errors and corrections from a list of options but have not yet achieved the level of competence needed to independently evaluate radiographic images for diagnostic criteria.

IMPLICATIONS FOR PRACTICE

Non-immersive VR simulation is an effective tool for image evaluation instruction. VR increases access to authentic image evaluation practice by providing a simulated resultant image based off the students' applied positioning skills.

Framework for a radiography student podcast

Podcasts refer to episodes of audio content that are readily available on streaming applications on smartphones or computers. This paper reports on the development of the 'Breathe In Radiography Podcast' series for radiography students and provides suggestions for evaluation. Podcast development followed a structured framework, including identification of podcast topics and expert guests, content development, audio recording, episode upload to host site and distribution. Using a framework was useful to guide development and ensure consistency across podcast episodes. Evaluation through podcast usage data, surveys and focus groups provides a comprehensive strategy to explore radiography students' perception of the newly developed podcast series.

A wellbeing podcast for diagnostic radiography students

INTRODUCTION

Diagnostic radiography students experience challenges during clinical placements, which have the potential to impact students' emotional wellbeing. This study aimed to explore radiography students' perception of the newly developed podcast series as a wellbeing support tool.

METHODS

A mixed methods study was conducted analysing data from listeners, including usage data from the podcast host site, surveys, and focus groups. Usage data was analysed descriptively. A bespoke survey, using a 5-point Likert scale and fixed-response questions was analysed descriptively. Two focus groups consisting of ten participants in total were conducted and data was analysed using thematic analysis.

RESULTS

There were 1201 downloads of the 'Breathe-in Radiography Podcast' series across 20 countries and 17 platforms during the study period. A total of 66 complete survey responses demonstrated an overall positive perception of the podcast series. Five main themes were identified from the focus groups: integrated with other activities, accessed when experiencing emotional challenges, relatability to peers, impact on behaviour and mindset, and future podcast content.

CONCLUSIONS

This study demonstrated students' positive perceptions of a podcast for support during clinical placement. Further studies are needed to maximise the benefits of podcasting to radiography students and to establish a direct effect of podcasts on student wellbeing.

Explaining the practicum experiences of diagnostic radiography undergraduates in Australia and Ethiopia using the theory of human relatedness

INTRODUCTION

Practice learning is critical to the development of clinical skills; hence placements are a major component of all pre-registration radiography programmes. Nonetheless, dissatisfaction with practicum experiences is a common reason why students consider leaving such programmes. Providing effective placements which promote retention may not only require better appreciation of students' clinical reflections, but also a more fundamental understanding of the implicit criteria they use to appraise a practicum. This study applied the theory of human relatedness (THR) to the placement experiences of radiography undergraduates to identify the evaluative mechanisms which may underpin these experiences.

METHODS

A critical realist investigative approach was employed to reanalyse data regarding the practicum experiences of stakeholders involved in undergraduate diagnostic radiography programmes at two universities in Australia and Ethiopia against the eight core THR concepts, namely connectedness, disconnectedness, parallelism, enmeshment, belonging, reciprocity, mutuality, and synchrony.

RESULTS

The findings identified all states of relatedness and processes/social competencies of the THR within the placement experiences of these stakeholders. The degree of positive relatedness a radiography student experiences within a practicum, irrespective of the setting, may affect their clinical performance.

CONCLUSION

The findings support the argument that the THR may reflect an implicit set of criteria stakeholders use to evaluate clinical encounters. Additionally, these results are congruent with earlier investigations regarding the practicum reflections of other undergraduate healthcare students.

IMPLICATIONS FOR PRACTICE

To enhance student placement experiences, it is necessary to recognise the effect a student's sense of relatedness may have on their self-efficacy and proficiency, modifying pre-practicum preparation and assessment arrangements to inhibit disconnectedness and enmeshment, avoid the need for parallelism, and better cultivate connectedness, belonging, reciprocity, mutuality, and synchrony.

Recruitment and retention of radiography clinical practice educators

INTRODUCTION

Clinical Practice Educators (CPEs) play a vital role in radiography education, fostering the development of students' clinical competence and creating positive learning experiences. In recent years, there has been a high turnover and difficulties recruiting radiography CPEs in Ireland. This is the first study to explore issues surrounding recruitment and retention of radiography CPEs.

METHOD

A cross-sectional, mixed-method study was conducted to gain a better understanding of the issues surrounding recruitment and retention of radiography CPEs. Current and former CPEs affiliated with undergraduate radiography training in Ireland were recruited. CPEs completed an online questionnaire detailing demographics and career background. Online semi-structured focus groups were conducted with current CPEs and interviews with former CPEs.

RESULTS

Nineteen current CPEs completed the questionnaire and participated in focus groups (95% response rate). Ten CPEs who had resigned within the last five years were interviewed. The main motivators for CPEs were an interest in teaching, inspiration from role models, personal learning goals and the appeal of part-time employment. Job satisfaction was influenced by efficacy in the role, professional growth, autonomy, and relationships with stakeholders. The main disincentives were the CPE grade not being commensurate with work involved, lack of protected time and lack of support from colleagues. A variety of reasons for resignation were provided, many of which related to grading of the CPE post and lack of career progression opportunities in the role.

CONCLUSION

The findings outline the key motivators for radiography CPEs and disincentives relative to recruitment and retention of radiography CPEs in Ireland.

IMPLICATIONS FOR PRACTICE

By understanding the disincentives relative to CPE recruitment and retention, along with the motivators, employers can devise initiatives that reduce turnover and increase CPE retention.

Supporting radiography clinical placements in Ireland during the COVID-19 pandemic: The practice educators perspective

INTRODUCTION

The COVID-19 pandemic has significantly impacted healthcare services and the clinical learning environment. Several studies have investigated radiography students' experiences of clinical placement during the pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) perspective. CPEs play a pivotal role in supporting clinical education.

METHOD

A qualitative study was conducted using a purposeful sample of twenty-two CPEs, each working in a different Irish hospital. Four semi-structured focus groups were used to gather data. To maintain reasonable homogeneity, CPEs who were new to the role (n = 8) were assigned a separate focus group from experienced CPEs (n = 14). Inductive thematic analysis was applied.

RESULTS

CPEs experienced role expansion, particularly in managerial and administrative aspects of the role. They described arranging COVID-19 vaccinations locally for radiography students and the complexities of student rostering during the pandemic. CPEs perceived the pandemic to have impacted students' emotional wellbeing with 'high anxiety levels' and 'loneliness' being reported. They also perceived issues with clinical readiness and the student transition to clinical practice. Many challenges were faced by CPEs including arranging clinical recovery time for numerous students when sites were already at full capacity, fewer learning opportunities due to decreased patient throughput and range of imaging examinations, social distancing constraints, resistance from staff to student placements, and a shortage of staff for student supervision. Flexibility, communication, and multi-level support helped CPEs to fulfil their role.

CONCLUSION

The results provide insight into how CPEs supported radiography clinical placements during the pandemic and into the challenges faced by CPEs in their role. CPEs supported student placement through multi-level communication, teamwork, flexibility, and student advocacy.

IMPLICATIONS FOR PRACTICE

This will aid understanding of the support mechanisms needed by CPEs to provide quality clinical placements.

Clinical placement challenges associated with radiography education in a low-resource setting: A qualitative exploration of the Ethiopian landscape

INTRODUCTION

Clinical placements (CP) are of paramount importance in the learning and the acquisition of key competencies in terms of knowledge, skill and professional attributes required for clinical radiography practice. This study explored the challenges faced by radiography students and educators in relation to clinical placement and training in Ethiopia.

METHODS

A qualitative approach using focus group discussion and interviews were used to explore the experiences of students and educators, respectively, pertaining to challenges encountered in relation to the clinical placement of students across four university affiliated hospitals. Data obtained was analysed using a structured three step framework and the coding approach employed in a thematic analysis.

RESULTS

Participants comprise of third- and fourth-year undergraduate radiography students (n = 14) and educators [academic faculty (n = 7) and clinical practice educators (n = 8)]. Four main themes were identified, which relate to deficiencies of an existing training curriculum and its implementation strategies, inadequate resource and infrastructure within the CP environments and absence of advanced training opportunities.

CONCLUSION

This research showed that there are many and varied challenges encountered by both students and educators in relation to CP and training of radiography students in Ethiopia. These challenges could potentially affect the future performance of students/practitioners and/or the appropriate application of the core clinical radiography skills and competencies in the world of work.

IMPLICATIONS FOR PRACTICE

Clinical radiography training in resource-limited settings will require urgent attention and support with modern infrastructure including simulation to augment their clinical development to acceptable standards.