Radiographer Training in the Red Dot System - Essay Example

Radiographer Training in the Red Dot System: A Comparison of Articles by SID: ####### Radiographer Training in the Red Dot System: A Comparison of Articles The red dot system is a process whereby a radiographer marks any acute abnormalities he or she sees on a radiograph using a small red sticker (Hargreaves and Mackay 2003: 283). The casualty officer uses these highlights as guideposts in determining the best course of action in treating the patient. Within the Accident and Emergency Departments (A & E) of major hospitals, the task of implementing this informal system of marking fractures or other trauma is often given to radiographers who have not been educated extensively in the process beyond their initial basic training. These medical professionals are in need of further education and, though obviously dedicated, are most often "left with limited local educational support to continue in their clinical role in A & E." (McConnell and Webster 2000: 608) The question has been raised as to the effectiveness of offering a short course of training to these radiographers and, once further instruction has been completed, whether there is a statistically significant improvement in their performance. In the two studies cited above, the authors have undertaken the task of analyzing the skills of radiographers in various hospitals, providing them with a programme of instruction, and then evaluating any significant improvement in their performance. There are three quantifiable categories for this analysis: Sensitivity, which is the ability to spot traumatic abnormalities; Specificity, which is the ability to identify normal skeletal appearance; and Accuracy, which is the overall ability to provide the casualty officer with useful, precise information. The scope of this paper is to critically evaluate and compare the two articles. Stated purposes and objectives The stated purpose and objectives of the two articles are clearly similar; as articulated by Hargreaves and Mackay, the studies are "aimed to investigate whether the introduction of a training programme for radiographers...could increase their ability to exclude fractures within a red dot system." (2003: 283) While both articles undertake and accomplish this task with varying degrees of clarity, the format and layout of the Hargreaves article provides a clearer statement of the intent of the study. The McConnell paper uses a textual abstract to frame the issue and, though sufficient for the purpose of outlining the content of the piece, it infers the objective more obliquely. The reader clearly understands the purpose and objectives only after reading both the abstract and the article. Hargreaves, however, provides a clear statement of the specific purpose at the beginning of the article, making the focus of the piece clearer from the start. This discrepancy can perhaps be accounted for by noting that the earlier article, McConnell, is addressing the somewhat narrower parameter of a "short course of study" within the context of a needs-analysis survey (2000: 608) while Hargreaves, which relies on McConnell as a source in its works cited, undertakes the broader question of generally improving performance through training without the constraints of survey parameters or course length. In terms of clarity, the more recent piece does a better job of stating the purpose and objectives through its format which allows the reader to come into the article knowing exactly what the purpose and objectives are. Results - presentation and ease of interpretation Both articles offer a clear presentation of their conclusions, substantiated by data tables or statistical figures. In their discussion sections, the interpretation of the data is clearly articulated and referenced. Both rely on the combination of narrative and tabular data sets to establish the results of their study. When the text of the discussion is read in conjunction with the data, the reader is able to easily understand the information presented, and the reasoning behind the conclusions made. The layout of both articles facilitates the reader's reference to the data without undue complication, allowing the reader to move between the discussion and tables with ease. Generally, both papers present the material in such a way as to facilitate an easy interpretation of their premise. Conclusion consistency with evidence presentation Both articles present a conclusion that is concise and well-tailored to the data utilized in the studies. Interestingly, there is a minor discrepancy between the conclusions drawn from similar data sets. As discussed in greater detail below in the findings section, both articles reach similar conclusions in regard to the need for further study and the obvious benefit of training radiographers in the finer points of red dot flagging. Yet Hargreaves, whose data shows improvement in the quantifiable categories and whose conclusion avers the "positive effect" of further training on accuracy, states that the results of the study are "not statistically significant." (2003: 288) I found this statement surprising in light of the numerical data. Upon further study, the answer to the apparent contradiction between the statement on statistical significance and the rate of improvement shown may have its explanation in the analytical thresholds used. Hargreaves utilized a paired t-test to measure statistical significance with a 0.05 level of significance applied to all categories. In the McConnell article, the author used a p-value of 0.002 to measure the improvement of specificity and a 0.005 p-value for accuracy. Under a standard statistical analysis grid, the resulting conclusions could be expected to show dramatically different statistical variance simply as a function of the threshold value. It was counter-intuitive for Hargreaves to present evidence that showed considerable improvement in performance and then state that the improvement was statistically insignificant. In terms of test scoring, there were higher levels of accuracy achieved and that progress was easily understood to be a function of the additional training received by the radiographers. Under strict statistical methods, however, McConnell's reliance on dramatically different thresholds would explain the difference in interpretation. Perhaps Hargreaves obviates this question of conclusion consistency with the evidence by following the statement regarding the lack of statistical significance with the words "...there is evidence to suggest that in this context training had an overall positive effect on the accuracy of use of the red dot system by this team of radiographers." (2003: 288) Key words and representation of content Both articles use titles and key words to organize the material presented. In this regard, however, Hargreaves' format stands clearly the winner. Each section has title and, though it may seem obvious, McConnell's failure to place a heading on the introduction is not helpful. Both articles identify the primary sections of method, results, discussion, and conclusion, but Hargreaves uses sub-headings in the results and discussion portions to bring greater clarity to the data-intensive aspects of the paper. In sub-heading the discussion section, Hargreaves enables the reader to easily follow the line of presentation. Each of the quantifiable categories is treated separately, and then follows a helpful discussion of the individual performances in the study. Further, Hargreaves includes a section on literature review, where the question is framed in light of past research. Although McConnell includes references in the introduction, Hargreaves' approach provides a stronger framework for the subsequent narrative and equips the reader to understand both the data and the author's conclusion in a broader context of scientific study. Both authors articulate their findings well and present the material in a straightforward manner, but by the frequent use of sub-headings and the inclusion of a literature review, Hargreaves makes it easier to understand the internal logic and structure of the material. This method presents the findings in such a way that the conclusions are more fully understood. Overall Presentation and Style As previously stated, I found that the overall presentation and style of the Hargreaves article assisted the reader in an easier assimilation of the information. That is not to say, however, that the McConnell paper is poorly written or that Hargreaves' piece is any more persuasive. McConnell's research is actually more credible. This is due to two key distinctions that can be drawn between the studies themselves. First, McConnell performed a needs analysis survey of 280 radiology departments across all health regions in the UK (2000: 609). This real-world approach, contrasted against Hargreaves' more academic style, put the whole study into a context of addressing specific needs in specific places. When framed in this way, there was more of a sense of urgency to McConnell's article because it was presented as an attempt to address an on-going problem. While it is easy to intellectually acknowledge that radiographers need more training in the red dot system, discussing that need within the scope of actual survey results validates the study in a way that mere theoretical analysis cannot. The second reason that McConnell's study is more reliable comes from the size of the sample used. Hargreaves studies seven radiographers where McConnell's sample group is 22 radiographers. The fact that three times more individuals participated in McConnell's study makes the data more significant. In fact, and as discussed in the concluding remarks of this paper, Hargreaves' points out that one reason they found no statistical significance may be due to the small sample size used (2003: 286). In terms of style, both authors demonstrate the ability to communicate technical information in a way that is easily understood. Both articulate the methodology and data well, with the advantage going to Hargreaves for the formatting style previously discussed. Comparison of articles, complementary findings Despite the minor differences previously noted, both studies confirmed the logical expectation that more training for radiographers will result in a higher degree of accuracy. The only anomaly in the improved performance data was the second assessment period in the McConnell study. Where Hargreaves implemented two assessments, McConnell used three. Both tested the samples prior to the additional instruction, and both tested after the training. Hargreaves' methodology was rather straightforward: test the sample group, train them, and then test them again afterward. McConnell tested prior to training, tested again on the last day of training, and then followed up six to ten weeks after the instruction. The anomaly occurred in McConnell's testing on the last day of training where there was a "marked increase in the number of false positive scores..." (2000: 610) This increase in sensitivity was not present in the subsequent assessment weeks later and McConnell notes that the second assessment data "may have skewed the significance of the results" as well as stating that a more accurate representation "may be taken from a comparison of the first and third assessments only." (2000: 610) Further, both studies call for additional research into the efficacy of the training before, in Hargreaves' words, "these results can be used with confidence in other contexts." (2003: 288) Again, this conclusion is not surprising. The sample sizes of both studies are insufficient to draw sweeping conclusions on the rate of improvement while affirming the notion that training is beneficial. Overall, both studies come to the same conclusion and their findings are complementary. Improvement of clinical knowledge The review and analysis of these articles enhanced and improved my clinical knowledge in three ways. First, I have a better understanding of system implementation in the clinical environment. These studies focused on radiologists working in the A & E Departments of working hospitals. Most of the hospitals surveyed by McConnell used a red dot system (2000: 609). They employ this system because it is helpful to radiologists when radiographers are able to flag trauma. The implementation of this process is beneficial to the efficiency of these departments. Second, while predictable, the conclusion that training enhances performance is a constant indicator of the importance of systematic, on-going instruction. In spite of disparities in time on the job and experience with using the red dot system within the sample population, both groups showed marked improvement in their professional skills as a direct result of training, whether it was a two-day workshop or a 10 week programme. The value of continuing education cannot be over-stressed. Finally, the significance of research methodology was emphasized to me. The presence of statistical anomalies within McConnell's study demonstrated the importance of timing and control when gathering this type of data and the issue of sample size underscored the significance of proper methodology when drawing conclusions that can be accurately projected onto other groups. Overall evaluation Both studies had strengths and weaknesses. I thought that Hargreaves' use of an articulated protocol allowed more control of the process. The radiographers knew exactly what was expected of them, e.g., what specific traumas to red dot and those on which not to use the system (2003: 289). Even though the sample size was smaller, specifying the protocol allowed researchers to have confidence that the study would be taking place within strict practical guidelines. Although neither study used a large population, giving rise to the mutual call for more research, McConnell's sample size was significantly larger. This fact lends more credibility to the conclusions drawn, but does not permit full confidence in the results. Both studies confirmed that there is benefit to additional training and demonstrated this fact very well. The inability to rely upon the quantifiable impact of such training, however, is problematic and does not allow a researcher to broadly apply the conclusions. Although there was no mention made regarding the importance of the length of the training programme, this is an obvious area for future investigation. In comparing the articles, we have simply analyzed a training program. In fact, the differences between these studies' use of training was demonstrable: a two day workshop in one, a ten week course of study in the other. Echoing the authors, there is a need for additional research, particularly where the control elements of future studies are more similar in terms of sample size, statistical thresholds, protocols, and training regimen. Both articles presented and articulated the data well. The overall organization of Hargreaves' paper was better, but McConnell did an adequate job of conveying the information. The fact that both studies, in spite of different structures and the separation of several years, came to the same basic conclusion is significant. Even with the caveat that more research is needed, these studies are indicative of the benefits of education. In spite of the methodological differences, they both end up at the same place: A & E departmental operations are best served when the personnel have received specific training within their discipline. References Hargreaves, J., Mackay, S. (2003) "The Accuracy of the Red Dot System: Can it Improve with Training". Radiography 9, 283-289 McConnell, J. R., Webster, A. J. (2000) "Improving Radiographer Highlighting of Trauma Films in the Accident and Emergency Department with a Short Course of Study-an Evaluation." The British Journal of Radiology 73, 608-612 Read More