Establishment of a continuous professional development model for monitoring post-graduate performance of diagnostic radiographers in Hong Kong public hospitals

Abstract

The past decade has seen immense change within the radiography profession internationally, as technical advancements and education and training initiatives have evolved to keep pace with the demands of the clinical environment. In Hong Kong (HK), it is necessary to establish a Continuous Professional Development (CPD) model for radiographers, to objectively monitor and assess the performance of individual radiographers throughout their working lives. Consequently, the current thesis aims: To investigate the need to implement a CPD scheme for Diagnostic Radiographers in HK, which will guide clinical performance and act as a means of monitoring the career progression of individuals within the profession. Information gained in this study will be used to identify the potential for improvement in radiography services and education via the creation of a CPD driven performance model. Objectives The objectives of this study are to: i) investigate and evaluate the current means of assessing clinical performance of Diagnostic Radiographers within the public hospitals in HK; ii) ascertain the views and opinions of relevant stakeholders on specialisation, CPD and role extension of Diagnostic Radiographers in HK; iii) suggest a CPD model for monitoring clinical performance of diagnostic radiographers at all levels of progress within the profession, based on the competencies identified and the consensus views of relevant stakeholders; iv) consult and seek professional views on the CPD model within the clinical environment in HK; v) establish a CPD model, following consultation feedback, for assessing clinical performance of Diagnostic Radiographers in HK that supports professional development. Methods The study used both quantitative and qualitative methods to collect data, by means of questionnaires and semi-structured interviews. The target population included all radiographers and radiologists employed within the HA, all radiography academics, and an Executive Manager (Allied Health) at the HA. For questionnaires, data analysis utilised parametric tests, such as one-way ANOVA and independent t-Test, with Tukey!|s multiple comparison test being used as the post-hoc test. In addition, descriptive statistics were applied for cross-table comparisons and frequency distributions, as appropriate. Qualitative data were analysed, following transcription of tape-recorded interviews, by extracting themes using manifest content analysis. A clinical competency model was devised, based on the findings and following consultation on the model by relevant stakeholders. Results Questionnaires were completed by 171/802 radiographers (21.3%), 10/11 academic radiographers (90.9%), and by 28/122 radiologists (23%). Twenty-four radiographers volunteered to be interviewed. Analysis of questionnaires showed that radio graphers (81.1%) agreed that new graduates were currently prepared for their first clinical post, 74.1% that specialisation should be a postgraduate event, and 80.6% that multi-competent radiographers were a greater asset than single specialty radiographers, and that these findings were consistent with interviewee responses. Radiologists supported the findings on specialisation and multi-competence of radiographers. Radiographers agreed that CPD should be voluntary (84%), that CPD is a good way of keeping up to date (87.7%), and that the HA should have a major role in supporting CPD activities (81.3%). Department Managers (DMs) or senior staff held significantly different views than Radiographer Is and/or us (Rad I/us)] over most issues relating to CPD (p<O.05). Interviewees (95.8%) agreed that a formal CPD scheme must be established. Radiologists unanimously agreed that the radiography profession would benefit from a CPD scheme and that they would support them in carrying out CPD activities. Radiographers (80.6%) agreed that role extension was good for the profession, but that there were too many barriers associated with this (77.6%) or that it required a higher degree of competence (78.3%). Nevertheless, 75.9% indicated that they welcomed the opportunity to extend their roles. Radiologists were generally supportive of role extension for radiographers, but 82.2% felt that there were many barriers. Interviewees clarified that clinical practice standards in radiography were currently monitored by an annual Staff Development Review process in the HA, but only 16.7% felt that this met the needs of both individuals and the service. Academic radiographers tended to remain divided over issues relating to the HA core competency scheme, but 60% felt that the training curriculum did not provide opportunity for demonstration of excellence. However, 90% agreed that the training curriculum was too content-driven and that it was not developmental in nature (6 0%). Summary The current thesis is unique as it is the first study to consider CPD for radiographers in the local context. A CPD model was established based on a thorough review of the literature and the opinions of relevant stakeholders. It is recommended that CPD must be earmarked as the driver for change in the on-going career development and progress of diagnostic radiographers in HK. The current thesis sets out clear criteria for determining specialist status and bridges the link between CPD and expertise. It is recommended that an independent body, appointed by the Radiographers Board and made up of representation from the relevant stakeholders, should initially manage and guide the CPD process for radiographers in HK. This independent body should report to the Board on developments and seek approval for any proposals. The CPD model encourages self-learning, is flexible, encourages excellence and allows individuals to demonstrate reflective skills. It narrows the theory-practice gap by enabling experts to apply their skills and qualities in the context of their practice, while realising the need for academic input and close collaboration between relevant stakeholders.