Investigating Australian Radiographers - Research Paper Example

?Investigating Australian Radiographer’s Perceptions on Advanced Practice With Emphasis on Image Interpretation and Involved Training Introduction With the continuous advancement in medical imaging leading to the wide diversity and increase in the number of diagnostic procedures (Australian Institute of Radiography 2009), radiologists and physicians are faced with greater responsibilities and increased workloads. In addition, in many developed countries, the ageing population is likely to contribute to the increase in the number of patients in the future, coupled by the impending retirement of old health professionals (Smith and Baird 2007). In response to this, there have been calls for role expansion in the field of radiology to include non-physician allied health practitioners, especially radiographers in performing tasks that extend beyond their usual scope of practice in radiology (Snaith and Lancaster 2006). With advanced radiographic practice, radiographers are allowed not only to acquire medical images but to perform skills formerly restricted to other specialists, such as image interpretation (Hardy and others 2008, e16) and clinical assessment. It was said that the main benefit of this system is to free physicians and other highly-trained specialists to concentrate on their essential function – that is, to diagnose and to treat (Australian Institute of Radiography 2009). United Kingdom leads the development in advanced radiographic practice (Cowling 2008), with the radiographer’s roles changing towards diagnosis and even radiation therapy over the last twenty years (Australian Institute of Radiography 2009). However, several countries still have not fully accepted advanced practice. In Australia, while there have been attempts to implement role expansion, advanced practice has not been officially established (Burrow and others 2006). This is despite the fact that the country has shortage of radiologists attributed to reduced working hours and small staff growth rate increase (Smith and Baird 2008). Several reasons were identified for this uncertainty in Australia including resistance from the medical workforce and radiographer education, thereby affecting radiographer’s perception towards advanced practice. Given the situation, it is necessary to explore the aspects of advanced practice in Australia since resistance to it may lead to reduced standards and recognition of the profession of the radiographers (Cowling 2008). United Kingdom vs. Australia: A Comparison The demand for radiologists due to the increasing population has been regarded as the major factor that drives the need for advanced radiographic practice worldwide. Between United Kingdom and Australia, the number of patients per radiologist is greater for the latter (Smith and Baird 2007, 629). However, when it comes to the number of examinations per year, reports show that United Kingdom has more compared to Australia (Smith and Baird 2007, 629). While imbalance between supply and demand exists in these two countries, each adapted a different approach in carrying out advanced practice. According to Cowling (2008, e29), advanced radiographic practice worldwide can be classified at several levels. United Kingdom belongs to the first level which is characterized by the presence of driving forces such as government intervention, research, graduate programs and professional organizations that lead to implementation of advanced practice in the field (Cowling 2008, e29). On the other hand, Australia only belongs to the second level, in which despite the presence of the same driving forces, implementation has not been carried out to remarkable levels (Cowling 2008, e29). In United Kingdom, government policy has been directed towards enhancing the National Health Service; thus, contributing to the advancement of radiographers’ roles and practice (Australian Institute of Radiography 2009, 28). In fact, the government has increased funds for the National Health Service (Smith and Baird 2007, 630), allotting budget and facilitating decision making towards the welfare of the patient (Australian Institute of Radiography 2009, 29). Due to the government’s support, post-graduate education in radiography have been made available in many universities across the country. As a result, many radiographers in United Kingdom are now reporting not just chest x-rays but also musculoskeletal and abdominal x-rays (Smith and Baird 2007, 630). Further development includes the founding of Special Interest Group in Radiographer Reporting which is geared towards development of new standards of practice (Australian Institute of Radiography 2009, 24). This development gave rise to professional organizations like UK Advanced Practitioners that regulates the profession in the country. On the contrary, Australia stays behind United Kingdom as little progress has occurred in officially recognizing advanced radiographic practice (Smith and Baird 2007, 630). This is despite the fact that undergraduate degrees in radiology incorporate knowledge and skills in determining pathology in radiographs as part of their curriculum (Smith and others 2008, e21). Moreover, just like in United Kingdom, several universities in Australia also cater post-graduate courses on image interpretation and reporting (Smith and others 2008, e21). Nevertheless, while there are courses being offered in image interpretation for radiographers in Australia, there is no existing policy that will legally allow the practice within the country (Cowling 2008, e31). Unlike in United Kingdom, there is lack of government intervention in Australia to support the practice. As a matter of fact, in a survey conducted by Australian Institute of Radiography in 2005, more than half of the respondents are performing unofficial interpretation of medical images (Smith and others 2008, e21). Meanwhile, for the past twenty years, image interpretation by radiographers has been more valued in the rural areas of Australia which are seldom visited by radiologists (Smith and others 2008, e21). On the other hand, in the urban area, radiographers also perform image interpretation when a radiologist is not around (Smith and others 2008, e21). This situation proves the necessity of extended skills for radiographers in Australia; yet, regulation and acceptance of this system remain to be far from reach. Resistance from the Medical Workforce Despite several studies justifying the importance of advanced radiographic practice, such system was not spared from resistance from the medical workforce who used to exclusively perform the new roles given to radiographers. In his response to one published journal supporting advanced radiographic practice Peereboom (2008, 317) disagreed with the idea that it is reasonable to substitute radiologists and physicians with radiographers just because of the increased demand and low number of radiologists. According to him, such reason is very superficial and does not consider the error rate that goes with radiographers interpreting medical images. Peereboom (2008, 317) cited a parallel report on physiotherapists replacing orthopaedic surgeons in managing orthopaedic clinics wherein it was found that over a quarter of the patients who visited these clinics were improperly treated. However, in a commentary by Nuss (2007, 472), it was pointed out that radiographers have been interpreting images for more than two decades already even before the emergence of a separate medical specialty in radiology. In fact, in rural areas, radiographers are the ones calling the attention of physicians upon finding an abnormal feature in a film (Nuss 2007, 472); therefore, the experience of radiographers is not comparable with that of the physiotherapists that Peerebroom has cited especially when it comes to the chance of committing an error in image interpretation. According to Nuss (2007, 472), radiography is all about image interpretation, which is a skill that radiographers are faced to at work each day. Nonetheless, while Peereboom acknowledged the fact that radiographers are, to some extent, qualified to read images based on their education and training background, he believed that their interpretative skills cannot be equated to that of radiologists and other specialized physicians. He argued that the training given to radiographers is simply not as extensive. In addition, another finding in the abovementioned report cited is that a percentage of these physiotherapists do not practice referral to surgeons anymore (Peereboom 2008, 317). This information implies that if the role of radiographers will be extended to at least, image interpretation, then they may put diagnosis and even management into their hands, relegating highly-skilled physicians in the background. Much has been said that it might even soon destroy the medical specialty of radiology (Australian Institute of Radiography 2009, 34). Peereboom (2008, 317) believe that it is unjust to put their duties as physicians to care for patients in the hands of other professionals who are not adequately equipped with training and education. Uncertainty in Australia While the system being adapted in United Kingdom seems to be promising with studies showing that there is very little difference between the accuracy of reporting of trained radiographers and highly-specialized radiologists (Smith and Baird 2007, 630), it was said that it is unreasonable to simply pattern the advanced practice approach of Australia to that of UK. This is because the challenges that Australia is faced to with regards to healthcare is different from those of United Kingdom especially as far as population is concerned (Australian Institute of Radiography 2009). Despite the larger number of patients in Australia, the number of radiologists is still relatively greater compared to United Kingdom, which is perhaps the reason why role boundaries remain inflexible (Smith and others 2008, e23). Moreover, given this situation in Australia, radiographers are faced with uncertainties with regards to adapting advanced practice approach. Several studies have explored different perceptions of radiographers towards performing new roles. The inadequacy of formal standardization of roles in Australia (Burrow and others 2006, 50) led to reluctance among radiographers. In a study conducted by Williamson and Mundy (2010, 43), it was found that radiographers in Australia are unsure with regards to the opportunities available for them to develop and expand their roles. This reluctance is even reinforced by the apparent pressure to acquire specialized education first before performing extended roles, leading to lack of confidence in the part of radiographers. According to a recent report of Australian Institute of Radiography (2009, 46), radiographers are hesitant to perform new roles because they do not think that they have enough abilities to pursue the new roles being assigned to them. Worse, the pressure to acquire education gets in the way of performing daily work by radiographers (Burrow and others 2006, 50). Moreover, another uncertainty in Australia stems from legal issues that result from increased number of responsibilities which, in turn, increases accountability (Burrow and others 2006, 50). In some other countries like United Kingdom, radiographers follow standard protocols such that whatever actions they take are backed up by the hospital (Australian Institute of Radioraphy 2009, 26). Unfortunately, this is not the case in Australia. As a result, radiographers in advanced practice are more at risk for litigation (Australian Institute of Radiography 2009, 26). In a study cited by Burrow and colleagues (2006, 50), it was found that more than half of radiographers studied feel anxious over medico-legal issues which hinder them to pursue advanced practice. Indeed, the negative perceptions towards advanced radiographic practice are inevitable in a country like Australia which has not fully recognized the approach. Nonetheless, it is noteworthy that there is a potential for these perceptions to change. In a study conducted among graduate radiographers, all believe that advanced practice is interesting and valuable (Williamson and Mundy 2010, 43). Majority also expressed increased expectations that advanced practice will develop in the near future. These findings show that given the right opportunities, radiographers in Australia are likely to look forward into accepting advanced practice. In fact, the number of radiographers who are pursuing further education has been increasing in the last five years. For example, the course Advanced Radiographic Pathology which covers lessons extending beyond the traditional knowledge of radiographers have acquired more than a hundred percent increase in enrolments in a span of two years from 2005 to 2007 (Smith and others 2008, e23). This finding further proves the importance being attributed by radiographers into advanced practice. Essential Skills & Knowledge Since the issue of expanding radiographer education has been brought up, the concern now is regarding the skills and knowledge that radiographers essentially have to learn to qualify for advanced practice. When the issue on advanced practice first surfaced, the emphasis was given on image interpretation in general. Yet meaning of ‘interpretation’ is ambiguous for it the work of specialized radiologists is more than just looking at the x-ray film. It sure does require a background in the basic medical sciences especially anatomy, at the very least. Moreover, it is not clear whether interpretation, as a part of radiographers’ advanced roles, include diagnosis, which is entirely a different thing. If it does, then radiographers would have to acquire knowledge on advanced medical courses particularly, gross pathology. Hence, this leads to the issue on the extent of what radiographers really have to know in order to carry out image interpretation. One of the skills currently being proposed to be acquired by radiographers is clinical assessment. According to the College of Radiographers, understanding the clinical context will help radiographers in image interpretation. Even without thorough knowledge on anatomy and gross pathology, information obtained from clinical assessment will guide the radiographers in the interpretation of the images. For instance, in cases when the diseased area was not adequately captured in the x-ray film, radiographers will still be able to make projections and do necessary adjustments to fully visualize the area based on the information solicited from patient history and clinical assessment. In addition, since patient symptoms often change – sometimes as instantly after referral of the physician for imaging – radiographers will be more confident that the patient receive appropriate examination if they have skills in eliciting a clinical history and performing basic physical examination (Snaith and Lancaster 2008, 151). sNonetheless, this is not merely an issue of radiographers’ advancement in their profession but of healthcare delivery to the patients. If radiographers develop these skills, it would enhance delivery of service; thus, favouring patient experience (Snaith and Lancaster 2008, 151). Radiographer Education Education is integral to role progression among radiographers (Cowling 2008, e29). At present, there is a requirement for radiographers in Australia to complete a four-year degree in radiography in a span of twenty years (Hardy and others 2008, e17). However, in undergraduate programs, opportunities in developing skills are often limited. Fortunately, educational programs designed for specific professional groups are now open for radiographers (Snaith and Lancaster 2008, 151). In this case, they can complete the program in order to develop skills such as clinical assessment. Nevertheless, in order for radiography to be recognized as a specialty in itself, an official university-based qualification seems necessary (Hardy and others 2008, e17). In fact, those countries which do not require education prior to practice do not recognize radiography as a skilled profession. Snaith and Lancaster (2008, 152) believe that the real opportunity for radiographers lie within postgraduate programs. Nuss (2007, 472) also support this notion by saying that while radiographers actually practice image interpretation as a part of their work, there is still a need for formal post-graduate education in order to formalize and further develop their skills (Nuss 2007, 472). This will not only further extend their roles but also will make them gain enough credentials to be recognized as a separate but allied medical professional. As such, it is expected that those radiographers who would perform advanced practice acquire qualifications that are above entry-level. Meanwhile, advanced practice does not only call for theoretical but for practical components of knowledge as well (Hardy and others 2008, e17). This entails that radiographers also need to experience practicing what they learned based on the theories presented to them. It is believed that critical thinking will facilitate the process of practical application. Snaith and Lancaster (2008, 151) seem to support problem-based learning which are now being practiced in different medical staff programs. They also emphasized the importance of assessing the competency of radiographers. This can be done by objective and structured observation of practice (Snaith and Lancaster 2008, 152). Since the roles of radiographers will be advancing, it is necessary that their abilities will match those of the specialized medical practitioners that they will be sharing skills and knowledge with (Snaith and Lancaster 2008, 152). Moreover, in order to ensure that the newly acquired skills of radiographers do not fall beyond quality, Snaith and Lancaster (2008, 152) calls for a performance review to be done not just as in single occurrence but in progressive manner. They believe that through continuous review of performance, the competence of radiographers involved in advanced practice will be retained (Snaith and Lancaster 2008, 152). Also, it is essential that radiographers will be given opportunities to be exposed to and to perform clinical assessment (Snaith and Lancaster 2008, 152). In addition, according to Hardy and colleagues (2008, e18), involvement in research is crucial in developing the ability of evaluating and interpreting medical images, which constitute the essential aspects of critical thinking. By conducting research, radiographers become more involved in clinical practice, thereby, enhancing their roles (Hardy and others 2008, e18). In addition, it is also suggested that mentoring programs be held such that radiographers performing advanced practice would also contribute to educating their peers and patients (Hardy and others 2008, e17). In this manner, not only are they helping in the training of fellow radiographers but they are also able to evaluate themselves whether they indeed learned something from advanced practice. Conclusion Advanced practice roles in image interpretation have been slowly developing in Australia unlike in United Kingdom for several reasons. The most obvious reason is that the healthcare systems of these two countries operate in a different manner. Primarily, the number of radiologists and other specialists remain to be greater in Australia compared to United Kingdom. Nevertheless, given the expected demand for healthcare services, demarcated roles in healthcare service delivery still persistent in Australia may be unsustainable in the long run. The imbalance of demand for and supply of radiologists is inevitable. As Nuss (2007, 317) argues, no physician will stay in the middle of the night just to supervise and report findings of radiographs but the radiographers will be there to do the job. Without a doubt, the idea of advanced radiographer practice will evolve over time amidst the continuous significant advancement in technology. However, given the qualms against this idea, it seems necessary for healthcare delivery sector to formulate a clear definition of the roles expected among radiographers on the basis of advanced practice in the Australian context. Recognition and enhanced training would improve perceptions of radiographers towards the profession, thereby, enhancing the quality of services. Nevertheless, whatever path the Australian health delivery system would take, the welfare of the patients receiving care should be given the utmost importance. Bibliography Australian Institute of Radiography. 2009. “Discussion paper: A model of advanced practice in diagnostic imaging and radiation therapy in Australia.” Report of the Advanced Practice Working Group (APWG) to the Board of Directors of the Australian Institute of Radiography (AIR): 1-94. 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