Diagnostic radiography students' perceptions of working in the clinical environment: A focus on emotional challenges

Facilitating student engagement and initiative-taking with workplace learning challenges: The change laboratory methodology

INTRODUCTION

Workplace-based learning (WBL) or Work-integrated learning (WIL) is an important pedagogy that prepares students for the world of work. However, students may experience challenges during their work practice, inhibiting their learning. Through reflecting on their WBL experiences and understanding the historical and systemic nature of challenges they experience, students may be able to take the initiative in raising and potentially addressing some of these challenges. This sort of reflection and initiative-taking can be facilitated by engaging students outside the workplace in a series of structured workshops collectively called a 'change laboratory' (CL). This paper reports on the students' engagement in a CL and assesses the potential of the CL in promoting students' initiative-taking in WBL.

METHODS

Eight structured CL workshop sessions were held with seventeen final-year Bachelor of Radiography Degree students who voluntarily participated in the CL sessions after ethics approval was obtained.

RESULTS

Alongside other challenges, qualified radiographers were sometimes dismissive and unsupportive of students' WBL. To address these and other difficulties, students suggested an improved WBL system focusing on teamwork between students and qualified radiographers to facilitate patient-centred care and student learning.

CONCLUSION

CL is proposed as a valuable tool for students learning about and taking initiative in addressing WBL challenges.

IMPLICATION FOR PRACTICE

The research is expected to open new avenues for improving radiography students' WBL experiences at this specific university.

Radiography students' resilience: The impact of interpersonal interactions in the clinical environment

INTRODUCTION

Many diagnostic radiography programs prescribe work placement early in the degree. In these programs first year students become actively involved with the workflow of clinical facilities, under the supervision of qualified diagnostic radiographers. In the clinical environment students are confronted with diverse interpersonal interactions, but little is known about the impact of these relations on the resilience of first year radiography students commencing clinical placement. The aim of this paper is, therefore, to present findings from a study that explored and identified how interactions, as they relate to the clinical environment, affect first-year radiography students' resilience.

METHODS

Qualitative data were collected through focus groups (FGs), guided by a semi-structured interview schedule. First-year radiography students were purposively selected, using the inclusion criteria, and recruited through advertising the study on the learning management system (LMS). Voluntary participation, a confidentiality agreement, and informed consent were required prior to the focus group. Thematic analysis was performed, and after five focus groups, the researcher was confident that data saturation had been reached.

FINDINGS

Twenty-one students participated in five focus groups. The key findings on interpersonal interactions, as they relate to the clinical environment, were identified as (i) student-patient relations, (ii) student-qualified radiographer relations, (iii) student-lecturer relations, and (iv) student-student relations. Student-patient relations seemed difficult at times; however, viewing encounters from a patient perspective helped students reframe negative experiences into positive perspectives. Furthermore, the findings relating to student-qualified radiographer relations and student-lecturer relations indicated that encouraging and respectful relationships greatly contribute to building students' resilience.

CONCLUSION

This research shows that empathetic interpersonal interactions and protected time with peers and lecturers in the clinical environment serve as enablers of resilience in diagnostic radiography students. Negative interpersonal encounters adversely affected students' resilience, whereas positive interactions contributed to improved student resilience.

IMPLICATIONS FOR PRACTICE

The study highlights the diverse clinical interactions that have a significant impact on radiography students' resilience. It suggests resilience-enhancing strategies to better manage interpersonal interactions in the clinical environment thereby improving students' confidence and communication skills.

Pass/fail grading in radiography clinical assessments: Insights from clinical practice educators

INTRODUCTION

Direct observation clinical assessments are used to verify student competence in Radiography. Guidance on grading these assessments is lacking. While pass/fail grading is increasingly adopted in medical education, its application in radiography clinical education remains unexplored.

METHODS

This cross-sectional, case design study explored Clinical Practice Educators' (CPEs) perceptions and experiences of implementing a pass/fail grading system in radiography clinical assessments. A total of 30 CPEs affiliated with undergraduate and graduate entry radiography in a single Irish university were recruited. Six semi-structured focus groups (n = 5 per group) were used to collect data. Deductive thematic analysis was applied.

RESULTS

Findings are presented under four main themes: (i) Benefits of pass/fail grading in radiography clinical assessments (ii) Drawbacks of pass/fail grading in radiography clinical assessments (iii) Impact of grading approach on students and (iv) Recommendations to enhance the implementation of pass/fail grading in radiography clinical assessment. Perceived benefits of pass/fail grading compared to letter grading include enhanced grading consistency, reduced examiner bias, and increased efficiency. Pass/fail grading was valued for its fairness and potential to reduce student stress, fostering a collaborative learning environment. It was also considered more congruent with the competency-based nature of radiography practice. However, concerns were raised regarding its limitations, including insufficient differentiation between student performance levels, challenges in tracking progress, and diminished engagement with feedback. Strategies such as structured feedback practices, and enhanced training for CPEs were recommended to address these challenges.

CONCLUSION

The study offers valuable insights into the perceived advantages and limitations of pass/fail grading compared to traditional letter grading in radiography clinical assessments.

IMPLICATIONS FOR PRACTICE

Findings are particularly relevant for academic institutions contemplating the adoption of pass/fail grading systems for radiography clinical assessments.

Radiography students' learning of plain X-ray examinations in clinical practice: An ethnographic study

INTRODUCTION

Learning of plain x-ray examinations in clinical practice is the core element of becoming a professional in diagnostic radiography. Learning in clinical practice is situated in an authentic socio-cultural context promoting students' learning from legitimate peripheral participation to full participation. The purpose of this study was to describe and understand radiography students' learning of plain X-ray examinations in clinical practice.

METHODS

The data consisted of observations, learning diaries and interviews of 17 radiography students and the researcher's own field notes regarding students' clinical practice of plain X-ray examinations. Learning was studied from the perspective of interpretive ethnography. Data were analyzed by the constant comparative method.

RESULTS

In clinical practice, radiography students' learning was governed by a learning culture requiring the ability to interpret and adapt to the prevailing learning styles of the clinical practice contexts. The learning styles were: 1) learning towards expertise through collaboration, 2) learning actively through student's solo work and 3) learning by working in the background and following instructions. In these learning styles, the extent and depth of the learning content, patient care and imaging varied. Learning methods, learning in cooperation, students' solo working and learning under radiographers' changeable guidance differed as well. Students' learning was impacted by the factors radiographer's supervision and student's learning space. According to students' own evaluation, the learning outcomes regarding theory-practice connection were achieved to a variable extent.

CONCLUSION

Learning culture provided variable opportunities for the socio-cultural context to promote students' learning in clinical practice. The results can be applied when developing and implementing radiography students' clinical practice. Further research could focus on strengthening the curriculum towards cooperative learning.

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.

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences

INTRODUCTION

Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients.

METHODS

UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed.

RESULTS

43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence.

CONCLUSION

Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers.

IMPLICATIONS FOR PRACTICE

To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

The perceptions and experiences of final year undergraduate diagnostic imaging students when facilitating peer-assisted learning within the simulated learning environment

INTRODUCTION

The persistent shortage of radiographers in the UK has prompted the exploration of innovative education models to enhance practice-based learning. Peer-Assisted Learning (PAL) has been advocated as a viable method to increase clinical training capacity, yet its application in Diagnostic Imaging is constrained by regulations on ionising radiation. This study investigates the perceptions and experiences of final-year undergraduate Diagnostic Imaging students facilitating PAL within a simulated learning environment.

METHODS

Final-year students were recruited via convenience sampling to act as mentors in simulated role-play activities. Data was collected through semi-structured interviews with three student mentors following the simulation. Thematic analysis of interview transcripts identified key themes related to the research question.

RESULTS

The analysis revealed four main themes: RELATIONSHIPS: Students valued the peer-to-peer teaching dynamic and the psychological safety provided by the simulation, which fostered reciprocal learning and enhanced inter-student relationships.

LEARNING ENVIRONMENT

The informal, responsive nature of the simulation was perceived as beneficial for encouraging participation and allowing students to learn from mistakes without real-world consequences.

LEARNING DESIGN

The timing of the simulation was noted as effective, aligning with academic learning. Feedback delivery and mentor preparation were also discussed, with disagreement on the value of the latter noted.

CONFIDENCE

Students reported increased confidence in their clinical and mentorship abilities.

CONCLUSION

The findings support existing literature on the benefits of PAL and simulation-based education (SBE), highlighting the positive impact on psychological safety, inter-student relationships, and confidence. However, the lack of formal training for mentors suggest areas for further research.

IMPLICATIONS FOR PRACTICE

The study underscores the potential for integrating PAL and SBE in radiography education to enhance readiness for clinical practice and foster effective peer mentoring.

Radiography community involvement in the professional socialisation of diagnostic radiography students

INTRODUCTION

Professional socialisation entails acquisition and internalisation of knowledge, skills, and values necessary to become members of a chosen profession. In the healthcare professions, the process is initiated during undergraduate academic and clinical learning, with clinical learning considered as more significant. This suggests that clinical radiographers play a key role in socialising students into the radiography profession. Based on communities of practice, a theory of social learning, professional socialisation of diagnostic radiography students would involve different members of the radiography community. Limited knowledge exists on the professional socialisation of diagnostic radiography students.

AIM

This study aimed to explore how diagnostic radiography students are socialised in the clinical environment with a focus on the role of communities of practice.

METHODS

Qualitative, exploratory, and descriptive research was conducted. Data was collected through unstructured interviews and focus groups. Interview recordings were verbatim transcribed, and framework analysis was used to analyse data.

FINDINGS

Data analysis resulted in the identification of a key theme, radiography community involvement, with four subthemes: shared responsibility for learning and teaching, critical reflection and lifelong learning, interpersonal skills, and empathy and consideration for students.

CONCLUSION

Effective professional socialisation of diagnostic radiography students is essential to develop radiography knowledge, skills, and values. The findings presented in this paper highlight the importance of the radiography community involvement in the professional socialisation of students because the various members of this community have valuable knowledge to share and a role to play.

IMPLICATIONS FOR PRACTICE

The findings can guide development of initiatives to support radiography community members in their role as facilitators of student professional socialisation, which in turn will enable effective professional socialisation for the students.

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.

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.

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.

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.

An exploratory study on recently qualified Australian radiographers' expectations and experiences in emergency and trauma imaging

BACKGROUND

Radiographers provide imaging services in multiple healthcare settings, including emergency and trauma. Transitioning to a qualified radiographer is already a time of vulnerability - with the increasing complexity and unpredictable nature of the emergency and trauma healthcare environment, recently qualified radiographers may experience this environment distinct from other service delivery areas.

OBJECTIVE

The study explored recently qualified radiographers' expectations and experiences in emergency and trauma imaging service delivery.

METHODS

An inductive qualitative phenomenological approach with a purposive sampling technique recruited recently qualified radiographers (n=19) involved in the delivery of emergency and trauma imaging services. Transcribed semi-structured individual interviews were thematically analysed.

RESULTS

Two themes and related categories were identified: 1. The multiplexity of diagnostic emergency and trauma imaging service delivery and 2. Approaching the complex nature of emergency and trauma imaging.

CONCLUSION

The expectations and experiences of emergency and trauma imaging varied, aligned to previous exposure to emergency and trauma imaging. Even though emergency and trauma imaging was challenging, the fast pace, patient dynamics and multidisciplinary deliverance; the experience was considered rewarding and an opportunity to improve skills. Participants coped through debriefing and calming strategies; however, radiology-specific debriefing was recommended to further foster the recently qualified radiographers' well-being.

Like Riding a Roller Coaster: University Teachers' Emotional Experiences Dealing with Student Plagiarism

The topic of research ethics has attracted attention in Chinese higher education, especially with regard to the "crackdown" on plagiarism. Although higher education teachers have implemented various interventions intended to reduce such misconduct, academic malpractice continues to occur. However, few studies have investigated the emotional challenges that these teachers face when dealing with plagiarism and the emotional changes that they experience in the process of addressing such misconduct. To address this research gap, in the current study, interviews, focus group discussions, and teaching journals were employed to investigate the negative emotional experiences of university teachers with student plagiarism in the Chinese context. An inductive thematic analysis was conducted, followed by in-depth analyses. The findings highlighted the fluctuating emotional development of the participating teachers from an ecological perspective, and the influential factors associated with the mitigation of negative emotions for teachers facing challenging situations were examined. The results also highlighted the necessity of taking the initiative to strengthen and normalize academic integrity in tertiary institutions.

Emotional Intelligence and Productive Relationships with Patients and Colleagues

A higher degree of emotional intelligence among health professionals has been shown to result in better patient care and improved wellbeing of the health professional. For nuclear medicine, emotional competence of staff and emotional proficiency of institutions, are important expectations. Nonetheless, there is a paucity of material outlining purposeful honing of emotional intelligence, or the tools for such development, across the literature. While the hidden curriculum provides powerful and authentic educational opportunities, incidental or accidental (organic) capability development does not benefit overall professionalism. Deliberate curricula can be achieved through a scaffold of emotional training and immersion programs that allow the nuclear medicine student or practitioner to recognize and foster emotionally safe environments. This requires careful planning to drive the emotional intelligence pipeline. Central to this is an understanding of learning taxonomies. There remain substantial gaps between the most and least emotionally insightful that could be addressed by rich immersive activities targeting emotional proficiency among students and the graduate workforce.

Insights into Diagnostic Radiography students' perception of clinical stressors

INTRODUCTION

Clinical placements are integral components of Diagnostic Radiography (DR) university training programs, providing students with necessary and unique learning experiences. Educators' understanding of the student experience on placement is growing, and it is important for educators to be attentive to students' reactions to their learning environments and to situations identified to reduce wellbeing. This study aimed to explore DR students' perceptions of challenges experienced during clinical placements and their use of coping strategies.

METHODS

Final year DR Students at the University of Sydney, were invited to participate in an online focus group. Three focus groups were conducted with a total of 13 participants. Participants were asked to narrate situations experienced while on clinical placement that reduced their emotional wellbeing, and coping strategies considered to support emotional wellbeing. An inductive thematic analysis of focus group transcripts was undertaken to identify the main discussion themes.

RESULTS

Three themes were identified regarding situations considered to reduce emotional wellbeing: adapting to the 'reality' of the clinical environment, forming effective relationships, and balancing student role expectations and responsibilities of patient care. Three themes were identified about coping strategies for emotionally challenging situations: support from clinical and academic staff, peer support and personal strategies, and growing knowledge and confidence over time.

CONCLUSION

Students' emotional wellbeing during experiential learning experiences is an underappreciated factor in their transformations into competent diagnostic radiographers. Academic training programs are therefore encouraged to be sensitive to the wellbeing of their trainees, and to take deliberate steps to equip students with the skills to navigate emotions and to normalise emotional responses that may be experienced in the clinical setting.

IMPLICATIONS FOR PRACTICE

Students' experience of challenges in the clinical environment is largely influenced by students' abilities to deal with negative experiences, hence students' concerns require implementation of focused interventions prior to first clinical placement.