How can we think outside the box when we value colouring within the lines?

I haven’t put fingers to keyboard to write a blog for some time but the anticipation of a new academic year always makes me stop and reflect on what went well, or not so well, in the last year and where I can make efforts to improve. It is also a time to reflect on what I want students to achieve, clinically and academically, and what behaviours, learning and attributes might warrant marks of distinction, merit, pass or fail and determine a successful radiography career. For me, this always brings about a tension. How can I encourage students to positively challenge professional doctrine and expand the evidence base underpinning radiographic practice in the academic setting while simultaneously expect them to embrace working as part of a team within the clinical setting, following established protocols and practices?

As an academic, I want students to view the profession from a wider perspective, to think outside the box, to recognise where improvements can be made and be creative in developing solutions to the service delivery challenges we hear about daily. Yet at the same time, as a profession, we appear to value those students who fit in well with the clinical team and departmental culture, who get on with the job and support the established work flow. In effect, we value students who replicate our image of what a ‘good’ radiographer should be and mould them to the boundaries of this interpretation. Like a child learning to colour, we want them to respect the lines and colour within them [yellow circle – Figure 1]. But if we make this our professional learning focus, are we erasing the passion for change, for challenge, for seeing and doing things differently that one can argue is required to meet the expectation of advanced and consultant clinical practice? In these roles, questioning and evaluating practice, implementing new ways of working and inspiring people to move forward in their thinking are essential attributes. But how do we value and nurture these attributes in our students and newly qualified radiographers within the clinical environment?

Figure 1: Do you promote colouring within the lines?
outside the box
We have known for some time that there is little correlation between the level of academic award achieved (1st class honours, lower second class honours etc.) and employment offers or promotion. Indeed most students report that few employers are interested in, or take account of, degree status. Certainly there is no requirement to attain a 1st/2:1 degree to enter the workforce. Neither is there any expectation that a good honours degree will identify you to be fast-tracked to senior positions and/or further training as is often the case in other non-healthcare professions (although this is anecdotal and maybe someone, somewhere has evidence to contradict this perception). Indeed I have sat in meetings with senior clinicians from across nursing and allied health professions who have openly stated that they do not want junior staff who will ask questions, challenge common practices or disrupt departmental thinking (key skills developed in undergraduate education and displayed by many of the top students). Instead they want healthcare workers who will follow protocols, do as asked and help the wheels of an overstretched, under-resourced health service keep turning.

So it appears there may be a mis-match between professional aspirations for advanced and consultant practice, which require the ability to use higher level cognition and outside the box thinking as valued by academia, and employer expectations of a ‘good’ radiographer appointee. It might also be that our unconscious bias in defining what ‘good’ looks like could also influence internal and external promotion. This has certainly been considered within the context of gender and race but do we also have a professional bias? Do we subconsciously appoint and promote those who display radiographer qualities we see as positive while discriminating against others we might consider to be agitators, those who might challenge practice or don’t meet the cultural expectations of the department?

As always, I have no answers to provide and this blog reflects my own thinking and general observations that some might say are not unique to radiography. But, with advanced and consultant practice within the nursing and allied health professions approaching 20 years since inception, and evidence that the lack of expansion of these roles is, in part, the result of the limited breadth of skills of potential candidates [1-5], I do think we need to ask ourselves whether, by valuing and nurturing the skills and attributes that promote ‘getting the job done’ within the constraints of departmental operational processes (the lines), we are inadvertently suppressing, and some might say destroying, the passion for thinking outside the box, for providing creative, left-field solutions and visioning a future beyond what is today.

1. Henwood S, Booth L, Miller PK. Reflections on the role of consultant radiographers in the UK: the perceived impact on practice and factors that support and hinder the role. Radiography 2016; 22(1):44e9.

2. McSherry R, Mudd D, Campbell S. Evaluating the perceived role of the nurse consultant through the lived experience of healthcare professionals. J Clin Nurs 2007; 16:2066e80.

3. Graham IW, Wallace S. Supporting the role of the nurse consultant e an exercise in leadership development via an interactive learning opportunity. Nurse Educ Today 2005; 25:87e94.

4. Ford P. Guest Editorial: consultant radiographers – does the profession want them? Radiography 2010; 16(1):5e7.

5. Young S, Nixon E, Hinge D, McFadyen J, Wright V, Lambert P, et al. Action learning: a tool for the development of strategic skills for Nurse Consultants? J Nurs Manag 2010; 18:105e10.

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