A UK survey exploring the assistant practitioner role across diagnostic imaging: current practice, relationships and challenges to progression

Developing CT workforce competencies: What knowledge and skills should we expect of an early career radiographer?

INTRODUCTION

Individual professions seek to define their professional practice through competencies which describe the behaviours and technical attributes to perform effectively within role. Professional body and regulatory frameworks define universal standards for radiography but there is limited evidence of the technical competencies expected of the workforce in Computed Tomography (CT). This study aimed to address this gap by agreeing the essential competencies for the early career radiography workforce who have CT as part of their clinical responsibilities. This is the first step in developing a competency framework for CT across all radiography expertise levels.

METHODS

A modified e-Delphi study was used to identify and gain agreement on essential practice competencies for this group. Structured surveys over two rounds were completed by an expert panel with CT knowledge and experience. Participants were asked to rate the essentiality of competencies for the novice CT workforce. Structured feedback was provided between surveys for consensus building, defined by the content validity ratio (CVR).

RESULTS

Survey responses were received from 34 participants across different diagnostic imaging roles and settings. A total of 56 competency statements were agreed as essential for the early career CT workforce, including some appropriate to assistant radiographer practitioner roles. Competencies could be divided into those that were relevant to diagnostic radiography but could be applied to the CT setting (n = 32) and technical attributes unique to the CT context (n = 24).

CONCLUSION

CT competencies for this group centre around understanding technical concepts of image formation and image quality optimisation; patient preparation and contrast media administration.

IMPLICATIONS FOR PRACTICE

The competencies presented in this research represent the agreed minimum standards for the workforce in CT. Further work is required to validate competencies in practice.

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.

The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review

The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.

Exploring the role of medical imaging assistants in Australian medical imaging departments: A mixed-methods study

INTRODUCTION

Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform.

METHOD

A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation.

RESULTS

Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role.

CONCLUSIONS

Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.

Career intentions, their influences and motivational factors in diagnostic radiography: A survey of undergraduate students

INTRODUCTION

The choice of career and speciality can be a complex process. It is unclear what influences career decisions within undergraduate radiographers and whether the curriculum provides sufficient support.

METHODS

An online cross-sectional survey was undertaken. All undergraduate diagnostic radiography students within one UK higher education institution were invited to participate. Questions were related to anticipated career choice, motivational factors and influences.

RESULTS

The response rate was 67.6% (90/133). The most popular specialist area for career preference was general radiography. The top three motivational factors were work life balance, career development and job satisfaction. The most influential factors on career choice were clinical placements, radiographers on placements and formal teaching. Career guidance was predominantly sourced from the personal academic tutor and was informed by role models.

CONCLUSION

Radiography academic teams and clinical placement providers must work together to ensure that students have access to high quality placements across specialities. The experiences received during undergraduate training are important in specialty choice.

IMPLICATIONS FOR PRACTICE

Career guidance is essential and should begin as early as possible. Clinical and academic radiographers need to appreciate the influence they have on students future career plans.

Substitution, delegation or addition? A discussion of workforce skill mix in computed tomography

AbstractA letter to the Editor in response to the recently published article by Cartwright et al. (AHR, https://doi.org/10.1071/AH20118) on the implication of workforce models on efficiency and staff well-being in a computed tomography department.

There's nothing plain about projection radiography! A discussion paper

OBJECTIVES

Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers' professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field.

KEY FINDINGS

Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%).

CONCLUSION

By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession.

IMPLICATIONS FOR PRACTICE

Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

Impact of the COVID-19 pandemic on radiography practice: findings from a UK radiography workforce survey

OBJECTIVES

Radiographers are key patient-facing healthcare professionals involved in many aspects of patient care. The working patterns and professional practice of the radiography workforce (RW) has been altered during the COVID-19 pandemic. This survey aimed to assess the impact of the pandemic on radiography practice in the United Kingdom (UK).

METHODS

An online cross-sectional survey of the UK RW was performed (March 25th to April 26th, 2020). The survey sought information regarding 1. Demographics 2. Impact of the pandemic on professional practice 3. Infection prevention/control and 4. COVID-19 related stress. Data collected was analysed using the Statistical Package for Social Sciences (v.26).

RESULTS

A total of 522 responses were received, comprising n = 412 (78.9%) diagnostic and n = 110 (21.1%) therapeutic RW categories from across the UK. 12.5% (65/522) of the respondents were redeployed. Redeployment did not appear to contribute (p = 0.31) to work-related stress. However, fear of contracting the infection and perceived inadequate personal protective equipment (PPE) were identified as key contributors to stress during the study period. Compared to the therapeutic RW, a significantly higher proportion of the diagnostic RW identified fear of being infected as a major stressor (166/412 (40.3%) vs 30/110 (27.3%), p = 0.01).

CONCLUSION

This survey has demonstrated changes to clinical practice, in particular to working patterns, service delivery and infection prevention and control were key contributors to workplace-related stress during the pandemic.

ADVANCES IN KNOWLEDGE

Timely and adequate staff training and availability of PPE as well as psychosocial support during future pandemics would enhance quality patient and staff safety.

The role of the advanced clinical practitioner in breast diagnosis: A systematic review of the literature

INTRODUCTION

Increasing prevalence in breast cancers, workforce shortages and technological advancements have increased the need to further develop advanced practice in breast diagnosis. The Advanced Clinical Practitioner training programme has been introduced to support this need. The aim of this work was to systematically review studies that explore advanced practice in mammography to assess the potential impact of the introduction of a specific Advanced Clinical Practitioner training programme in breast diagnosis within the UK.

METHODS

A systematic PRISMA review of the literature published between 1999 and January 2020 was carried out. A total of 17 studies were included in the review.

RESULTS

Four themes were identified in the literature in relation to advanced practice in breast imaging: multidisciplinary practice; roles and responsibilities associated with advanced practice; development and progression; embedding and sustaining advanced practice. It was evident across all themes that advanced practice is vital in supporting better care for patients attending breast imaging in light of workforce shortages. Although advanced practice and its benefits are well established in breast imaging, persistent barriers were acknowledged such as role ambiguity, recruitment issues, lack of support from some radiologists and poor funding.

CONCLUSION

Findings suggest that introducing a more formalised pathway to advanced practice into breast imaging through the implementation of a specific Advanced Clinical Practitioner apprenticeship training programme may overcome many of the challenges evidenced in this review.

IMPLICATIONS FOR PRACTICE

The findings of this review will help inform the development of the Advanced Clinical Practitioner apprenticeship programme specific to breast diagnosis.