Working Together-Learning Together - Essay Example

An investigation of the support newly qualified radiographers receive towards developing their CPD (continue professional development) in United Kingdom Introduction: The last two decades have seen marked changes in the role of radiographers. Their demand in health care services has increased immensely. They are the link between patient and doctor so besides updated technical skills they require interpersonal and team work skills also. The heavy pressure due to workload has been further aggravated by shortages of competent people and there always is long queue for them to deal with. Moreover, the patient's waiting time has also increased. The efforts of radiographers are used up in providing services to the patients. While the desire and opportunity to develop learning and reflection from the practice take a back seat (Brown 2009). SOR (Society of Radiographers) clearly found that unlike CPD resource support to other health care workers, radiographers are not placed well. Hence post registration skill development has remained little, if any. But the role extension has been taken as common practice during the duration of service so radiographers too have moved up to clinical practice and higher academics and research (Henwood 2003). However, if the radiographers plan to remain in practice, then also CPD helps in achieving supervisory and/or specialist positions. Achieving higher positions is a biggest incentive for a radiographer to undertake CPD even if he has to arrange for it on his own. Due to work pressures however employers are reluctant to release staff for CPD (Brown, 2009). The radiography is considered a career with monotony and routine work, heavy workload with little credit and family consideration by the school students (Coombs et al, 2003). Moreover lack of clarity of a programme makes radiographer reluctant to go for it. The present article attempts to critically evaluate the various CPD options available to radiographers for job satisfaction and career advancement. Necessity of CPD for Radiographers: It has been clearly indicated by Department of Health (as cited in O'Donoghue, 2006, p92) allied health services personnel must regularly update their knowledge through CPD. Its working together-learning together document emphasised the need stating it necessary for improved patient care and better opportunities for professionals. The e-earning is preferred by higher education funding in UK since professionals can update knowledge without loss of time. The Society of Radiographers (SOR) has emphasised need for CPD, despite initial apprehension about its effectiveness. It has stated that radiographers "must maintain and strive to improve their professional knowledge and competence'... Every patient is entitled to be cared for by radiographers with relevant and up-to-date skills and expertise. Therefore all radiographers must undertake lifelong learning and will keep a record of their ongoing development activities... The Society and college considers that CPD, lifelong learning, periodic appraisal and revalidation must be compulsory to ensure and maintain competence, as well as enabling radiographers to gain knowledge and competencies outside their scope of practice" (SOR 2009, p1). The radiographers' professional and other bodies thought of CPD when some efforts by NHS to appoint non-medical consultants did not succeed fully as there was lack of appropriately qualified and experienced consultants. Moreover, the clinical and educational pathways to prepare potential consultants are also ill defined (Hardy & Snaith, 2007). The study necessitates upgrading the basic training in radiography to make subsequent CPD effective. Cherry and Duxbury (1998) have felt that in spite of training at higher educational institutions i.e universities, the radiographers are equipped only with basic competences. The half life of this knowledge is only 2-5 years so it can not provide the competency for life time. It is more so in these times considering the rapid technology changes. Introduction of CPD is a very good action to support radiographers adapt to changing roles and increasing technological demands. The College of Radiographers (COR) introduced voluntary CPD for radiographers in 1997. The basic aim of such a step was to protect practitioners from public questioning and litigations. The code of conduct for radiographers including COR, also revised CPD stating that the radiographers must identify deficits of knowledge and competence and keep on improving their skills. To support CPD in UK, personal development manager software was launched in 1997. Later on a simplified version of the software was widely used to give a boost to support of CPD besides increasing awareness about the programme (Henwood, 2003). Despite support from the Radiographers' bodies there has been but little effort to provide structured CPD programming incorporating opinion and requirements of radiographers, their job satisfaction and patient satisfaction with current radiography services. The role expansion involves much more than improved technical skills. Effect of CPD on radiographers' practice Dixon (as cited in Dearnley p17) felt a clear change in the attitude of radiographers who had learned a new technique of breast biopsy. It was a role extension for them since such a duty is performed by the doctors only. The radiographer was responsible and accountable for competency as per code of professional conduct. The trained radiographers found that the learning was a dynamic and interactive change and not just a passive reaction to their changing professional environment. The learning leading to expansion of expertise enhanced confidence and self esteem, given a feeling of empowerment and brought respect from other team members for their contribution. The routine radiographer job on the other hand has imprecise medico-legal responsibilities and limitation of expertise (Forsyth & Robertson, 2007). Dearnley (2009) reports that they received good response from their studies on new learning by nurses. Thus different learners in different training set ups reflected same outcome of CPD. They all had assimilated their personal and professional development with ease and what is more, they adjusted well to new roles. Brown (2009) also found that CPD is unequivocally recognised as effective. The individual learns new techniques and specialist competences that help in work. A radiographer can become an expert in mammography, ultrasonography, skeletal reporting etc to widen his expertise. Mackay (2006) observed that after a short course, Red Dot scheme, Radiographers had developed the ability and sensitivity to detect abnormal radiographs of trauma patients. The learning thus occurred. However, six months post training the ability not only decreased, it actually worsened than was before they did the course. Mackay reports that this post course decline was not unusual since other workers had also noted such a trend. It may have been due to the course since student became conditioned to look for abnormal rather than normal features. . The study emphasises a need for structured CPD programmes with reflective and evidence based learning. Generally the outcome of training is tested by simply examining as to how well candidate has learned the new techniques rather it should focus on how did the learner accommodated it with his earlier knowledge. Support to radiographers for CPD: SOR, in a joint statement with health and social care bodies, has made it essential for employers to support and provide resources to staff for CPD. The joint statement also emphasised that these support and resources be made available equally to all professionals irrespective of their work patterns. The employers must ensure to allot 45 hrs in a year as protected time for CPD. They must implement knowledge and skills framework of NHS which emphasises continuous skills and competence development. It makes CPD necessary as the best way to comply with KSF (CPD joint statement 2009). Henwood (2003 ) indicated that CPD is most effective when it is individual centred. Thus the individual need to have initiative and determination to continue to develop skills. The radiographer is reluctant to opt for a CPD since he has to choose from some available courses designed by people in universities or such other institutions and barely address his deficit of knowledge. He/she should also be adequately supported by employers, managers and professional bodies. Besides peer guidance also plays a role in positive and mutually beneficial learning. Jenkins & Humphris (2006) have analysed the role of various factors facilitating effective CPD for a professional. They said that organisations are focused on good performance, competitive yet economic services. The success of an organisation depends on adapting to change and continuous renewal of competences of its staff. After all the organisation learns from its workers. So it is better to allow them CPD rather than some training now and then. The organisation should encourage questioning, awareness of new things in the field and provide strategic support to its professionals. The role extension is normal but prior to that there is need for sufficient theoretical, clinical and other competency based training and its reflection shown by improvement in practice and confidence. It was very strongly felt that the employer should implement CPD and allow radiographers to progress in career ladder otherwise, as many youngsters felt, they would not be stagnant and rather move out to research, teaching or medical sales (Radiographyworkforce 2002). This task can be accomplished by incorporating following, according Jenkins & Humphris (2006): Performance appraisal: Almost all organizations have performance appraisal for telling professional about their limitations and strengths. The candidates requirements to CPD can be used to provide him appropriate training according to KSF of NHS. Mentoring: it is basically advising and counseling to a new entrant by his more experienced colleague. It gives a long term learning advantage rather than merely a short term skill development. A mentor encourages discussion and goal achievement and lays foundation for independent learning. Clinical supervision: A new allied health professional learns the evidence based approach to work through his her colleagues. A review of students/new radiographers assessment at their workplace revealed that new entrants were not paid sufficient attention and time or focus by peer or doctors. Quite a few felt that "asking questions was a nuisance" and "they just don't have the time" (Radiographyworkforce 2002 ). In fact such is not the case always. The new entrant in the profession has advantages of being trained in newest technology and he/she is most sought after by his/her senior colleagues for support in developing new skills. The new one is also eager to share her knowledge with other staff. This makes peer learning one of the most successful way to develop practice Clinical supervision helps in improved patient care as the professional exchanges practice methods and develop reflective learning. Jenkins & Humphris (2006) elaborated their recommendations by including following points which are of importance to new radiographers: Peer review: The professional with same level, expertise, experience can work together on clinical episode. They discuss their clinical reasoning of that episode. Both of them gain from such exercise. Portfolio-keeping: SOR encourages radiographers to prepare a portfolio of their learning. The current learning evidences are entered in it and planning for future learning is pointed out. The portfolio is an evaluative and reflective method of support to a professional and encourages self directed learning. The evidences of CPD, as included in the portfolio, may be produced as and when asked for. Institutions also need to update their CPD curricula to make these more of learner focused. Often the faculty and student aspirations differ. Ng et al (2008) reviewed results of questionnaire survey to find out skills requirement by radiographers. They were trying to convince the health care community about usefulness of CPD as new radiographers should not only have theoretical knowledge; they should have a good hand at practice too which includes good communication, interpersonal relations and application of skills. The radiography students preferred annual rather than semester system. In their survey the academicians had high expectations while students were realistic in their development since the latter take time to perfect the skills needed. In the end the researchers decided that students would voluntarily select the activity and reflect on it while the faculty members would provide the support. The study indicates that during basic qualification itself, the students can be trained to serve the community immediately on appointment without much lag. The inconsistent CPD approach has resulted in low pay, less opportunities and responsibilities. The respondents felt that there was very little resource moreover when radiographers wished to go for self-funded CPD, there was inability to grant time for that.(radiology work force). However the change is taking place in employers' attitude and institutions are also coming up with flexible CPD training material to be used by a learner as per his convenience. Initiatives by departments of radiology and oncology in universities are also coming forward to help CPD learning as discussed next. The CPD anywhere run by Sheffield Hallam University has many variations to suit the learner. Its virtual learning environment (VLE) is e-learning package for self-teaching. Besides, online tutors are also made available by the university. For the organisations, the university offers custom made programmes according to the local needs. The new radiographer should ideally plan his/her career in advance. In the health care sector, the specialization begins at post graduate level. The undergraduate are taught and trained to work successfully as a general practitioners. It is advised that young radiographers must go for post graduate qualifications after putting a few years as general practitioners. They must consider their interest and requirements for multitasking personnel in the field. The latter is considered an asset for medical fields (White and Mckay 2004 ). Preferences and attitudes towards CPD According to Henwood et al (2004) a reluctant attitude towards CPD is coupled with barriers which individuals have complained about explain relatively low rates of participation in CPD. The study pointed out that attendance and participants' involvement in both formal and informal activities was not encouraging. Castle et al (1998) identified three major issues concerning CPD: funding/resources, lack of uniformity in curricula and the relationship to practice. The latter raised further issues for consideration including the accreditation of practice, the development of reflective practice and the moves towards research-based and evidence-based practice. Castle's work points out that much more clarity and focused research of expected outcome of CPD is required to make it effective and encourage employers to provide support. . It is evident that there is a lack of awareness as to what constitutes CPD. Poor staffing or lack of employer support causes programmes run poorly and there is no recording of the CPD activities so no review is made. As a result the desired improvement becomes difficult Henwood et al (2004). Many researchers have thus studied point of view of the radiographers regarding the CPD which ideally should have been done earlier. Marshall et al (2006) carried out a useful study of CPD concept and its requirement for radiographers. It was considered very important particularly by the younger radiographers which was a reflection of international trend showing role expansion and higher competence of radiographers. They found 7 h. per month, on an average, a good time spent on CPD. Radiographers preferred mixture of papers, internet and e-learning in their native language, if available, otherwise most of them had chosen English as second language. The choices of CPD were reflection of subjects with constantly advancing technology. CT and MRI were chosen a most favoured followed by digital imaging and trauma. Radiographers were clearly taking the evolving role seriously and CPD was a way to upgrade practice for that. Henwood and Taket (2008) worked to bring about a strategy for a meaningful CPD for radiographers. They wanted to know whether CPD affects practice positively or not They found that CPD was not uniform for all radiographers, it was individual centered and a dynamic process. The researcher found that even prior to participation facilitation and external influences which mainly are the employers support, encouragement and resources provided played a positive role in this individual centred CPD. It is taken as a step to climb up the career ladder though the researchers felt that it should equally be taken for improvement in current practice. Conclusion: The discussion has pointed out some positive and negative aspects of CPD options currently available for radiographers. The encouragement for CPD is essential but structured programmes taking knowledge deficit, job satisfaction and patient satisfaction by radiography services along with newer technology are few. Moreover the assessment of CPD should incorporate not only the competence in new technology being taught but also the overall knowledge in that area. It should possibly begin with a refresher programme. It is also felt that basic radiography courses should also prepare future radiographers with specialisations in different radiographic fields. To prepare for role expansion the new radiographers need to be aware of: 1. The guidelines and rules of SOR, NHS and other health care bodies regarding CPD. These bodies also give directions to employer for providing resources and encourage staff for CPD. 2. For a new radiographer the peer learning is a good option since mutual exchange of expertise helps both reflect on their respective practice. The mentoring helps a new entrant to adjust within the community. 3. There are number of university departments in UK running CPD courses. These courses are flexible and the learner can choose his/her time, mode and subject. Particularly the VLE courses, these promote e-learning, are popular among busy radiographers. .References Brown, A.2009, 'Professionals under pressure: contextual influences on learning and development of radiographers in England'. Available from: http://www.guidance-research.org/blogs/work-related/entries/9099477010/5619092077/knexfile.2005-02-02.7165417691/attach/revised%20radiogs%20article%20LHSC%20draft2.pdf [5 Feb 2009] Castle, A, Holloway, DG & Rage, AJ 1998, 'A review of issues in continuing professional development in teaching, nursing and radiography', International Journal of Lifelong Education, vol 17, no. 5, pp. 328-341. Cherry , P & Duxbury, A. 1998, Practical radiotherapy physics and equipment, Cambridge University Press Coombs, CR, Park, R, Loan-Clarke, J, Arnold, J, Preston, D et al 2003, Perceptions of radiography and the National Health Service: a qualitative study, Radiography Vol. 9, no. 2, pp.109-122. Forsyth, LJ & Robertson, EM 2007, 'Radiologist perceptions of radiographer role development in Scotland', Radiography, vol. 13, no. 1, pp. 51-55. Hardy, M & Snaith, B 2007, 'How to achieve consultant practitioner status: A discussion paper', Radiography, vol. 13, no. 4, pp. 265-270. Radiograhpyworkforce 2002, 'Comprehensive Review of the Radiography Workforce'. Available from http://www.dhsspsni.gov.uk/radiography_workforce.pdf [ 5 Feb2007] Dearnley, C & Dixon, AM 2008, 'Finding the professional voice: towards a theory of continuing professional development'. University of Bradford http://www.leeds.ac.uk/medicine/meu/lifelong08/papers/Christine_Dearnley.pdf Henwood, SM 2003, Continuing professional development in diagnostic radiography: A grounded theory study, Ph.D. thesis. South Bank University. Henwood, SM, Yeilder, J & Flinton, D 2004, 'Radiographers attitudes to mandatory CPD: a comparative study in the United Kingdom and New Zealand', Radiography, vol.10, no. 4, pp. 251-258. Henwood, SM & Taket, A. 2008, 'A process model in continuing professional development: Exploring diagnostic radiographers' views', Radiography, vol. 14, no 3, pp. 206-215. Jenkins, F & Humphris, P 2006, Developing the allied health professional, Allied Health Professions Federation (Great Britain), Radcliffe Publishing. Joint Position Statement. A joint statement on continuing professional development for health and social care practitioners. Available from http://www.cot.co.uk/public/publications/free/pdf/CPDjointstatement.pdf [ 6 Feb 2009] Mackay, SJ 2006, 'The impact of a short course of study on the performance of radiographers when highlighting fractures on trauma radiographs: "The Red Dot System", British Journal of Radiology, 79, pp. 468-472. Marshall, G, Punys, V & Sykes, A 2006, 'The continuous professional development (CPD) requirements of radiographers in Europe: An initial survey', Radiography , Available from: http://www.henre.co.uk/h2_downloads/cpd%20article.pdf [4 Feb 2009] Ng, C K C, White, P & McKay, J C 2008, 'Establishing a method to support academic and professional competence throughout an undergraduate radiography programme', Radiography , vol. 14, no. 3, pp. 255-264. O'Donoghue, J 2006, Technology Supported Learning and Teaching: A Staff Perspective, Idea Group Inc (IGI), Sheffield Hallam Univ, CPD Anywhere, Faculty of Health and Wellbeing Radiotherapy & Oncology. Available from: http://www.acorrn.org/Education-And-Training/ACORRN-CPD/CPD-Anywhere.aspx [6 Feb 2009] SOR.2009.CPD General information. Available from: http://www.sor.org/public/educpd/gen_info.htm[ 5 Feb 2009] White, P & McKay, JC 2004, 'Review article :The Specialist Radiographer-does the role justify the title' , Radiography, vol.10, no.3, pp. 217-227. References and further reading may be available for this article. To view references and further reading you must purchase this article. C. R. . R. Park, J. Loan-Clarke, J. Arnold, D. Preston, D. Preston, A. J. Wilkinson Analysis of the interview transcripts indicated that radiography as a career choice is perceived as boring and routine, involving high workloads and little recognition from the general public. Working with patients is the source of considerable job satisfaction but is offset by staff shortages, lack of flexibility over working hours and a lack of consideration of family commitments in the NHS. Financial costs are highlighted as dissuading many participants from considering a career as a radiographer in the NHS or returning to work for the NHS Maryann Hardy and Beverly Snaith, radiography, 13 (4), 2007, 265-270. the purpose of non-medical consultants is to promote and develop practice at the clinical, strategic and policy level. One of the reasons for this poor appointment rate is the deficiency in suitably qualified and experienced candidates, a finding acknowledged to be an issue across all the non-medical professions. Further, the development of potential consultant practitioners has been hampered by the lack of clearly defined clinical and educational pathways Lesley J. Forsyth and Elizabeth M. Robertson, (i) Respondents considered increased professional standing of radiographers, best use of manpower resources, reduced pressure on the service and improved recruitment and retention, as positive advantages of radiographer development. (ii) The potential impact on radiology specialist registrar training, lack of clear medico-legal responsibilities and radiographers recognising the limitations of their abilities were identified as the main areas of radiologist anxiety Read More