Role of workplace based assessment of radiographers in informing curriculum development practices: a plain X- ray film technical sufficiency exemplar using 2010 post- registration radiographers.

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Sichone, James Maimbo
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The University of Zambia.
It has been established that a curriculum requires periodic reviews to ensure concordance with contemporary demands for training. Erratic review of the diploma radiography curriculum presents a probable risk that a curriculum and workplace requirement mismatch may exist for radiographers trained in Zambia. The inconsistent review is set against a background where rapid technological and professional developments have occurred. Such a mismatch can bring about doubts in the fitness for the practice of these radiographers, which may culminant in poor patient management outcomes due to misdiagnosis resulting from poor radiography services. To establish concordance between curriculum output and clinical practice requirement, curriculum developers need to take into consideration the performance of graduates of such curriculum. However, an actual assessment of the graduates in a clinical setting post qualification is not routinely undertaken. The question set out to be answered centred on how Work-placed based Assessment (WBA) can be used to improve radiography curriculum development practices. The main objective was to analyse the extent to which radiographers who graduated after 2010 are meeting the job requirements and to evaluate their competency levels in plain x-ray technical sufficiency assessment using a cross-sectional study design. A sequential explanatory mixed-method design was used. The process utilised a multistage approach with each phase seeking to answer a specific research question. The qualitative stage had two phases which sought to obtain consensus on the job role/competence of a Zambia radiographer. This first aspect of the study utilised a Delphi approach and focus group discussions (FGDs). The quantitative stage used information from the earlier phases. A cross-sectional design was employed in this stage of the study. Assessment of competency was based on technical evaluation of five (5) chest X-rays for anatomical coverage, patient positioning, exposure, contrast, sharpness, image annotation and radiation protection. A total of 31 participants participated in the self-assessment and WBA conducted in four teaching hospitals. The last phase was a desk review which utilised the output from the first three phases to evaluate the 2004 radiography curriculum. The initial two phases resulted in the identification of eight (8) competence categories for the Zambian radiographers. There was a significant variation with regard to the self-assessment across the different assessment categories (p<0.0001) with significance set at 0.05. In terms of aggregated self-assessment scores, the mean score out of 35 was 26.77 (SD 4.18). In the WBA, only eight (8) (26%) of the participants were assessed as competent. A regression model revealed that sex and rating of self-perception were the only predictor variables of overall competence. Review of the curriculum showed that objectives dedicated to image quality were less than 3% of the total learning outcomes. The study was able to demonstrate that WBA can be a useful tool in generating information that can help to guide curriculum development and review practices for the radiography training in Zambia. Furthermore, the 2004 TEVETA diploma radiography curriculum was deficient in outcome specifications that relate to technical competency. Having a curriculum that responds to societal requirements make graduates of such programmes more suitable for contemporary practice and hence better delivery of medical imaging services in Zambia. Further interrogation of other training factors associated with reduced competence levels is required to improve outputs of radiography training programmes. The curriculum review process, as conducted by TEVETA, can be strengthened by assessment of already qualified radiographers. A model has been proposed to enhance the curriculum review process. This has been termed ‘Three pillar information gathering framework for curriculum evaluation’. It is recommended that this framework should be integrated into the process of curriculum review in radiography training.
Thesis of Doctor of Philosophy in Health Professions Education.