Posted: July 1st, 2015

Reflective Report on learning experience through Work-Based Advanced Skills and Innovative Practice (WBASIP)

Reflective Report on learning experience through Work-Based Advanced Skills and Innovative Practice (WBASIP)

 

Introduction

 

Incorporated into numerous occupations during the 1980s, reflective practice – the process for continuously educating ourselves – is regarded as one of the methods that employees can use to better comprehend and improve their professional work (Jasper, 2013). Essentially, this process involves reflecting on our experiences in a way that facilitates taking more informed actions in the future based on this contemplation (Donna Campbell, 2011). Broadly, reflective practice comprises three main aspects – the original experience, reflective processed and action – informally known as ERA (see Appendix 1). In order for the reflective process to happen, all of these factors need to exist together (Jasper, 2013), although if one fails to recognise this, they merely become three unrelated aspects. Education academics have formulated the concept of reflective behaviour as self-discovery (Taylor, 2010), and one expert in this field is Kolb (1984), who formulated a process of experience-based self-discovery that has provided the grounding of numerous approaches for reflective practice in the last twenty years. His work explains the phases of reflection in detail (see Appendix 2) (Jasper, 2013).

 

In the work environment, reflective practice is a vital way for humans to gain knowledge from events and moments in their life. It provides humans the ability to further their understanding and attributes in such a way that can improve their ability to perform well and continue to aid that improvement in their future (Jasper, 2013). This can be highly beneficial in many areas, but a crucial one is health and medical provision. Its use can help narrow the gap between hypotheses and practice, enhance the standard of care provided, and further both individual development and the performance of an individual in their workplace. There is a belief that reflection on the events in people’s lives is the most vital aspect in aiding progression both individually and within the workplace (Mann et al, 2009). In this regard, numerous frameworks of assisting this reflective practice have been produced by experts whose target was to explain how to effectively undergo this reflection. In this paper, I have chosen to utilise the Borton framework, which has been outlined by Jasper (2013) (Appendix 3).

It is very useful in helping people address the three areas of importance – understanding what awareness they have of the relevant issue at that point, how that awareness has been used or how it has impacted their viewpoint, and how to formulate a plan for the future with the aim of being utilised in reality. “What?” is asked to identify the experience and describe it in detail. “So what?” is asked to facilitate the process of analyzing and interpreting the situation. “Now what?” is asked to explore alternatives and to plan the action that will be put into practice (Jasper, 2013).

Therefore, in this report, I intend to provide a true reflection and to critically evaluate the knowledge that I acquire within this module in this reflective report. My reflection will entail a reflection on a reporting radiographer’s role. Finally, I will conclude my reflection report by examining the key learning points and establishing my action plan for future.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reporting Radiographers

What?

This paper will closely look at my experiences at the National Hospital in Glasgow, where I discussed the subject of reporting radiographers with staff members. Radiographer reporting of plain film radiographs is a well-known occupation in Britain, and it is a fresh area to explore and to measure in contrast to the same position in my home nation (Saudi Arabia) (Stephenson et al, 2012). Radiographer reporting has been an accepted occupation in Britain for a long time, as it is a beneficial aspect of medical imaging services. Diagnostic image interpretation and clinical reporting are legally and legitimately within the scope of radiography practice, and this has been the case for a long time (Smith & Baird, 2007).

Brought in during the mid 1990s and backed by regional education programmes, radiographer reporting was not originally wide in its scope, but subsequently, an increase in provision requirements and the number of employees spurred an increase in both the amount of reporting radiographers and the scope of reporting practice. Consequently, many hospitals now combine this duty of reporting radiographic images as part of the work of both radiographers and radiologists. Thus, it is important to me to examine this issue in more detail (Kenny & Andrews, 2007).

 

On one of my placements, I felt it was important to discover the viewpoints of health practitioners, such as radiographers, nurses, healthcare assistants and other staff members who work in this area. My aim was to discern their opinions about the significance of radiographer reporting and in what ways it assists or does not assist them in their field of work. Through doing so, I learned that the participating health practitioners hold a variety of feelings in terms of the utility and implementation of this skill. Respecting the manic nature of their occupation, I chose to interview them at quieter times so that they could provide thorough and reasoned answers.

 

I chose to examine this area by formulating questions for these professionals, who relayed their understanding of radiographer reporters’ roles at their hospital or unit to me. Participants were asked for their advice on how to best improve the delivery of these services by their colleagues and to express their view on training.

 

 

Thus, it is important for me to look closely at these areas, as comprehending them will enable me to attain adequate knowledge of this area and the context of radiography reporting. Therefore, I examined this area fully, which included reading the current literature published, and by doing so, I learned that a conclusive radiology report is the most significant part of the diagnostic imaging process.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

So What?

This part closely examines my understanding of this area in five sections.

1. Diagnostic accuracy

 

Firstly, it is vital for me to comprehend the accuracy of reporting radiographers in their diagnoses. In the previous thirty years, both in Britain and now in a more global way, the job of creating a report has been shared between radiographers and radiologists more frequently than before across the whole range of imaging options (Snaith et al, 2014). While some dissatisfaction may continue to exist between colleagues with relation to sharing the reporting workload (Forsyth & Robertson, 2007), some findings have demonstrated that the role of a reporting radiographer is commensurate to a consultant radiologist, irrespective of the radiographer’s medical area or the scope of practice (Hardy et al, 2008). According to Buskov et al (2013), the sensitivity level for an accurate diagnosis of bone fractures for reporting radiographers was 99%; however, for trainee radiologists, this was lower at 94%. With reporting radiographers, the specificity was 97%, whilst trainee radiologists recorded 99% in this area. The explanation for reporting radiographers achieving higher accuracy in fracture detection compared to trainee radiologists can be attributed to numerous aspects. We must note that the radiography of trauma victims comprises a small area of the tutelage of aspiring radiologists. Instructed mostly as a traineeship, it does not have the equivalent standard of training quality afforded to radiographers or indeed the level of experience of their instructors.

 

It is understandable that there would be some level of over-diagnosing by radiographers recently trained in the area of reporting. Furthermore, these new radiographers’ fairly low false-positive and higher false-negative results possibly reflect their greater belief in their ability when reporting, owing to their previous skills in making judgements in that role. Consequently, they are arguably not expected to point out slight abrasions that are usually seen as medically insignificant (Buskov et al, 2013). Therefore, a large variation was not seen when comparing the two groups. The big advantage that results from this is that radiographers are able to report radiographs of anatomical extremities with great accuracy. By doing so, they provide an accurate and integral service that assists in negating the rising demands of a hospital whilst ensuring that the calibre of the work is not compromised (Buskov et al, 2013, Howard, 2013).

 

2. Scope of reporting

 

The varying viewpoints of hospital employees regarding the application of radiographer reporting skills and the way they are utilised to improve patient care suggest that the creation of a standard system and process in an organisation will involve thoughtful consideration of the scope of this reporting practice (Paterson et al, 2004). Whilst the aforementioned reporting of plain film radiographs by radiographers in Britain has been a practice that has been undertaken for many years and is widely understood, research shows that the way that it is applied differs. The scope of the practice of radiographer reporting roles has never been standardised in the medical profession – rather, it has gradually changed on its own accord to service regional demands, assisted by approved training schemes (Snaith et al, 2014) Paterson et al, 2004).

 

Snaith et al (2014) demonstrated a considerable difference in the reporting radiographer’s role, depending on where the organisation was located. It is of note that the types of educational training offered by the eight universities who provide radiographer reporting programmes vary in terms of anatomical study. Analysing these training programmes closely demonstrates that there are more impressive standards and accuracy for some radiographer reporters when measured against those at other organisations with limited positive results. A Society of Radiographers (2015) paper demonstrated that some universities provide a qualification in appendicular musculoskeletal (MSK) reporting, and possibly, these narrower qualifications can inhibit employees’ reporting skills or the ability to develop and grow in their career. This can jeopardise the possible benefit of these radiographers, especially without more training. Therefore, radiography instructors should aim to explain the influence of particular courses in terms of being able to foster reform and to address far-reaching medical concerns. In the same way, visceral reporting courses are provided at just three universities, showing again how the practice has evolved in different locations. How local practice impacts the flow of education offered is not easy to know and beyond what this paper aims to ascertain (Snaith et al, 2014).

 

 

Had I been aware of the fact that a vast majority of the individual staff members were up to date in their knowledge about course availability and the like, I would have focused more on ensuring that participants were asked for their opinions about the available educational courses and whether or not they thought this was a limitation in terms of the development of skilled radiographer reporters. This would be a factor to consider if I were to carry out more primary research in this area.

 

 

 

3. Audit

 

Because the health profession is closely monitored, I discovered that radiographers consistently assist with the reporting workload. They are responsible for explaining what occurs and providing sufficient service (Lumsden & Cosson, 2015). However, requirements for performing audits on reporting radiographers’ abilities are limited. Therefore, regular audits with follow-up reports are needed, even though they are very time-consuming and involve important resources. Audits offer a minor but very relevant snapshot of the work performed and should be conducted every month or every other monthly (Woznitza et al, 2014; Forsyth & Robertson, 2007; Paterson et al, 2004).

 

According to Woznitza et al (2014), auditing has been suggested as a vital tool for ensuring safe practice, and radiographers who are trusted with this task need to display continuous high skill levels that match radiologists at a more senior level.

 

Understandably, my interviews with the employees at this particular organisation revealed that chest radiography is one of the most frequently undertaken radiology tests. Knowing this and applying it to what Woznitza et al suggested (2014), recommended structures under which the auditing could take place by radiographers have been formulated for musculoskeletal (with a minimum 95% accuracy) and ultrasound (also requiring 95% accuracy) tests. It is of note, though, that we do not have an analysis so far to show an understanding of chest radiograph audits by qualified radiographers.

 

 

 

 

Thus, research was undertaken in 2014 with the aim of understanding the adult chest radiograph (CXR) reporting performance of reporting radiographers in medical practice. The study utilised differing auditing methods, with a single radiographer and two radiologists, accompanied by a clinical review of inharmonious cases. A total of one hundred chest radiographs (CXRs) were picked at random from a continuous array of 4800 CXRs that had been previously revealed over the course of nine months at a district general hospital by a radiographer who had received two years of training. The audit showed a high level of accuracy after the radiologists had analysed a random series of ninety-nine chest radiograph reports – all executed under the auspices of a reporting radiographer in medical practice. Just one of these CXRs demonstrated an anomaly that was medically relevant, and the result was reported as standard by one of the two radiologists in question. However, numerous methodological limitations should be taken into consideration when attempting to understand the analysis of this audit. The frequency of a particular disease’s occurrence or selection and spectrum bias (only hospital patients were involved) may have possibly contributed to exaggerated concordance figures. A very large flaw was the sample size, which only constituted 1.5 % of this radiographer’s case load in the audit time frame – 4800 cases. To increases the chances of discovering variations, a minimum of five hundred cases should have been reviewed. Audits are usually adequate in demonstrating the continuing ability – or lack thereof – of a reporting radiographer, but this study was inadequate in terms of discerning an overall standard of competence. Finally, research appears to show that frequent auditing aids and assists safe practice (Woznitza et al, 2014; Forte, 2009).

 

 

 

 

 

 

 

 

 

 

 

4. Cost effectiveness

 

The employees suggested that the need for both emergency department (ED) and radiology services is still increasing throughout Britain (Hardy et al, 2013). An argument could be made that a new opportunity has arrived for merging abilities, and that allowing a reporting radiographer to release patients who arrive at the ED with minor injuries would lessen waiting times from the initial x-ray assessments to release, with no adverse effects on patient outcomes. This indeed could assist in increasing the rate of patient assessment and improve how they are then dealt with (Henderson et al, 2013). It would also be expected that important reforms in service frequency would bring further added improvements in regard to reducing inpatients’ time of stay at the hospital. This would consequently improve cost effectiveness in this area (Hardy et al, 2013).

 

How cost efficiency would be impacted by using radiographer reporters rather than consultant clinicians is an area that could be investigated so as to further the utility of radiographers in medical settings. The cost-effectiveness outcomes can be regarded as being influenced by two factors: the equality of the medical improvements gained and possibly the frequency of unnecessary hospital bed days. There are an insufficient number of beds nationally, and consequently, an increasing number of free beds could enhance patient care and lower expenditures in this area if the length of time that the patient remains in the hospital could be lowered by utilising radiographer reporters. Thus, increasing the knowledge of the financial/economical advantages of the use of radiographer reporters will be vitally useful if Britain decides it wants this particular option to be used more in the future (Hardy et al, 2013).

 

 

 

 

 

 

5. Benefits for staff

One point of my finding that is important to remember is that the radiographers themselves have benefited from this. It has given radiographers greater opportunities of career progression – and many of them have been greatly enthused by this. They express greater career satisfaction and fulfilment after reflecting upon their achievements so far.

 

Other studies have demonstrated that the merging of skills is regarded by radiographers as an opportunity to enhance their career satisfaction. Lumsden and Cosson (2015) reported that 93% of survey participants believed that career satisfaction could be enhanced by expansion of their roles. An equivalent analysis using radiography students examined job expansion and employees, showing that all the participants anticipated that their role as radiographers would expand within a time frame of no later than five years from completing their studies.

 

• Therefore, to achieve successful implementation of this framework of reporting radiographers, incentives for all radiology employees are needed to keep them motivated (Henderson et al, 2013). In addition, most of the required continuous professional development (CPD) programmes can be executed within an organisation as long as sufficient planning is afforded for the required Undertakings that ought to be part of this process would include areas such as frequent case conferences, important multidisciplinary medical gatherings, writing groups and detailed journal keeping. Furthermore, outsourced seminars arranged to improve understanding and to enhance abilities in reporting practice are vital (Paterson et al, 2004).

 

 

 

 

 

 

 

 

 

 

 

 

Limitations

 

Upon reflection, I felt that my research into the utility and implementation of radiographer reporters in a clinical scenario was interesting. The suggestions in ‘Skills Mix in Clinical Radiology’ (1999) set out a variety of beneficial outcomes for the reporting radiographer job, and stronger relationships among the members of a radiology unit should be encouraged (Gaarder et al, 2015, Snaith, 2007). Reading about the topic, however, using published researched, has shown that there are many barriers and limitations regarding the expansion of the career. This is because there is a lack of employees who are ideally required to provide error-free provision of the existing services, whilst the newer services are still being formulated. Also, there are too few platforms for improving knowledge and services, as the problems caused by trainee radiographers making errors has contributed to rising expenditures. Thirdly, some feel there is too little funding to sufficiently pay radiographers who have undertaken expanded roles. Traditional views that firmly demarcated professional boundaries are another obstacle. Finally, to implement new reporting radiographer skills, regular audits need to occur (Henderson et al, 2013; Forsyth & Robertson, 2007; Lumsden & Cosson, 2015).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Now what?

 

I discovered that the learning I have obtained about the role of reporting radiographers has great significance for me, particularly as a lecturer in Saudi Arabia, where we do not have this career opportunity. I believe that the experience achieved in this process has been crucial in improving my communication abilities but also in enhancing my aptitude in utilising secondary data collection and analytical skills to collate published information from academic texts. I can use these skills to further supplement the data that I have garnered from my personal research and talks with employees. Furthermore, with regards to Taylor and Dawsonera (2006), my action plan going forward will be to continuously look for and analyse current and recently published text that pertains to this area of reporting radiography. Also, I plan to critically evaluate my observations within the practice. I will consult with those who work in radiology to gain opinions of those who have great knowledge in this area and plan to utilise other people’s experiences to enhance my own skills and abilities.

In the future, I hope to have more opportunities to talk with staff and to gain important data and viewpoints that will educate me in areas of relevance to me. Personally collecting facts and relevant information will assist me in my pursuit of knowledge and awareness. This will mean that I can continuously advance in an academic and professional manner so that I can better provide the services I aim to give students at my university and at the Saudi hospitals where I work. The knowledge and experiences I have gained can be passed on to my students, and in turn, this should improve their studies and understanding for the benefit of everyone.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conclusion

 

Overall, reflective practice is crucial to both individual and career progression, as it offers an opportunity to analyse the experience of practitioners. I am certain that I have improved my skills in terms of completing research of a high standard through collecting data and working hard to gain this data and knowledge. Consequently, I have indeed improved my knowledge. This contemplation was beneficial, as it formed the grounding of a plan of action to examine the abilities of reporting radiographers. The first-hand understanding that I have attained can now form a foundation for analysing further literature in radiology. Furthermore, this reflection has provided me an opportunity to better understand the process of assessing the accuracy of diagnostic testing. Any improvements require resources and hard work to ensure that high standards or applied. Importantly, I now understand more fully the role that radiographers can play in achieving beneficial impacts.

Moreover, I have acquired a stronger interest in reporting radiographers. I will aim to pass on this newly found information to others, including my colleagues in healthcare provision and the students that I teach. It is also good for me to be able to pass on this understanding at staff meetings, seminars or lectures in the hospital that is affiliated with the university where I am based. I hope to utilise all the knowledge and abilities acquired in order to further my career and enhance knowledge for my students. A final point is that I fully understand how vital it is to provide healthy and safe-practice services and how we clinically apply this within the healthcare sector.

 

 

 

 

 

 

 

 

 

 

 

 

 

References

 

 

Buskov, L., Abild, A., Christensen, A., Holm, O., Hansen, C. & Christensen, H. 2013, “Radiographers and trainee radiologists reporting accident radiographs: A comparative plain film-reading performance study”, Clinical Radiology, vol. 68, no. 1, pp. 55–58.

 

Campbell, D. 2011, Reflective practice for healthcare professionals, 3rd edn, Sage Publications, Ottawa.

 

Forsyth, L.J. & Robertson, E.M. 2007, “Radiologist perceptions of radiographer role development in Scotland”, Radiography, vol. 13, no. 1, pp. 51–55.

 

Forte, D. 2009, “Effective practice in health and social care”, Journal of Interprofessional Care, vol. 23, no. 2, pp. 208–208.

 

Gaarder, M., Seierstad, T., Soreng, R., Drolsum, A., Begum, K. & Dormagen, J.B. 2015, “Standardized cine-loop documentation in renal ultrasound facilitates skill-mix between radiographer and radiologist”, Acta Radiologica (Stockholm, Sweden: 1987), vol. 56, no. 3, pp. 368–373.

 

Hardy, M., Legg, J., Smith, T., Ween, B., Williams, I. & Motto, J. 2008, “The concept of advanced radiographic practice: An international perspective”, Radiography, vol. 14, pp. e15–e19.

 

Hardy, M., Hutton, J. & Snaith, B. 2013, “Is a radiographer led immediate reporting service for emergency department referrals a cost effective initiative?” Radiography, vol. 19, no. 1, pp. 23–27.

 

 

Henderson, D., Gray, W.K. & Booth, L. 2013, “Assessment of a reporting radiographer-led discharge system for minor injuries: A prospective audit over 2 years”, Emergency Medicine Journal, vol. 30, no. 4, pp. 298–302.

 

Howard, M.L. 2013, “An exploratory study of radiographer’s perceptions of radiographer commenting on musculoskeletal trauma images in rural community based hospitals”, Radiography, vol. 19, no. 2, pp. 137–141.

 

Jasper, M. 2013, Beginning reflective practice: Melanie jasper, Cengage Learning, Andover.

 

Kenny, L.M. & Andrews, M.W. 2007, “Addressing radiology workforce issues”, Medical Journal of Australia, vol. 186, no. 12, pp. 615–6.

 

Lumsden, L. & Cosson, P. 2015, “Attitudes of radiographers to radiographer-led discharge: A survey”, Radiography, vol. 21, no. 1, pp. 61–67.

 

Mann, K., Gordon, J. & MacLeod, A. 2009, “Reflection and reflective practice in health professions education: A systematic review”, Advances in Health Sciences Education: Theory and Practice, vol. 14, no. 4, pp. 595–621.

 

Paterson, A.M., Price, R.C., Thomas, A. & Nuttall, L. 2004, “Reporting by radiographers: A policy and practice guide”, Radiography, vol. 10, no. 3, pp. 205–212.

 

Smith, T.N. & Baird, M. 2007, “Radiographers’ role in radiological reporting: A model to support future demand”, Medical Journal of Australia, vol. 186, no. 12, pp. 629–31.

 

 

Snaith, B., Hardy, M. & Lewis, E.F. 2014, “Radiographer reporting in the UK: A longitudinal analysis”, Radiography.

 

Snaith, B.A. 2007, “Radiographer-led discharge in accident and emergency – the results of a pilot project”, Radiography, vol. 13, no. 1, pp. 13–17.

 

Society of Radiographers. 2015, Radiographers’ scope of practice in medical image interpretation. [online] Available at: http://www.sor.org/learning/document-library/medical-image-interpretation-radiographers-definitive-guidance/radiographers-scope-practice-medical [Accessed 10 Apr. 2015].

 

Stephenson, P., Hannah, A., Jones, H., Edwards, R., Harrington, K., Baker, S., et al. 2012, “An evidence based protocol for peer review of radiographer musculoskeletal plain film reporting”, Radiography, vol. 18, no. 3, pp. 172–178.

 

Taylor, B.J. & Dawsonera 2006, Reflective practice: A guide for nurses and midwives [electronic resource], Open University Press, Philadelphia, Pa.

 

Taylor, B.J. 2010, Reflective practice for healthcare professionals: A practical guide, Open University Press, Philadelphia, Pa.

 

Woznitza, N., Piper, K., Burke, S., Patel, K., Amin, S., Grayson, K., et al. 2014, “Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme”, Radiography, vol. 20, no. 3, pp. 223.

 

 

 

 

 

 

 

 

Appendix 1: The ERA cycle of reflective practice.

From Jasper (2013).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 2: Kolb’s experiential learning cycle (1984).

From Jasper (2013).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 3: A framework for reflective practice (Rolfe et al, 2001).

From Jasper (2013).