Imaging & Oncology - Society of Radiographers

“Preceptorship, CPD and clinical supervision are the architecture
of a mature learning culture beyond registration”
therapy and social work, would not permit a student to be placed in setting
without a suitably qualified fieldwork educator or practice teacher.
Perceptions of bullying and marginalisation – managing
expectations
As might be expected, the statement in the audit tool: ‘All practitioners
are committed to having students and promoting their wellbeing’,
scored positively with a mean average of 1.6. Yet, despite this, the
comments revealed ambivalence and contradiction. One manager
stated that some staff see this as an optional extra and highlighted the
culture change needed, while another suggested that there is scope for
improvement. In one case the manager stated that supporting student
learning and development is included in Personal Development Review
objectives. This issue was probed during visits and there was general
acknowledgement that, while many staff enjoy having students and
recognise their professional responsibility in this regard, there are staff
who do not value having students, are perceived as difficult to work with
and who students avoid.
Students were clear that they believe that there is a causal link
between student attrition and the experience of bullying behaviours in
radiotherapy centres. This is a topic that provokes defensive responses
from practitioners who charge students with over-reacting and not being
able to accept the discipline of the radiotherapy team delivering complex
treatments under considerable pressure on Linear Accelerators (LAs).
In addition, there is evidence of cultural differences in how students are
perceived and whether their expectations are legitimate and deserve to
be met. A clear distinction was apparent within the data between those
staff who empathise with students who are learning in a complex and
difficult clinical environment and those who believe that students expect
to be ‘spoon-fed’ and fail to grasp that patient care is at the heart of the
radiotherapy service and not them.
The term ‘LA fodder’ was used by some to describe the work of Band 5
practitioners and it was suggested that students’ expectations needed to
change to be brought into line with this (derogatory) view. The Francis
Report 10 is clear about the harsh and uncaring cultures in too many
healthcare organisations. The Report casts it as a ‘top down’ problem, with
managers who are under pressure to meet performance management
targets, creating a similar ethos among those they are responsible for, that
reaches right down the organisation to the lowest and arguably the most
vulnerable levels, ie student practitioners.
There is no doubt that, in 21st century Britain where a rights-based culture
prevails, individuals prioritise their perceived entitlements. In the case of
student radiographers this needs to be acknowledged as translating to a
personalised learning approach, which takes account of them as individuals
deserving of respect and having differing learning needs. They themselves
expressed a desire for honesty and openness. For students to feel a sense
of significance and achievement, it cannot simply be a question of treating
all students as if they were inferior clones of one another who should be
able to discern what they should be doing and how to behave, or take the
consequences.
Preceptorship, clinical supervision and continuing
professional development (CPD)
The audit tool asked specifically whether clinical supervision as
recommended by the College of Radiographers’ guidance document 17 was
embedded within radiotherapy centres. This is a system of professional
support that has been widely adopted among health and social care
professions to give practitioners the opportunity to engage safely in
reflective practice as a means of coping with the daily stresses of clinical
practice and to assist in developing their careers. The mean average score
for this statement was 2.22, indicating that clinical supervision is not viewed
as a positive system for staff support and development, and interviews
confirmed that it has not been implemented widely.
During visits, staff were also asked about structured preceptorship
programmes for newly qualified radiographers and it was clear that this
too is variable, as is the opportunity for all practitioners to engage with
CPD activities. There is a perception that funding for CPD for radiographers
is lacking and arrangements within Trusts for accessing the non-medical
education and training budget were often not clear. The concept of personal
professional development review planning as part of the managerial
{ 10 } IMAGING & ONCOLOGY 2013