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5. CHAPTER FIVE

5.1 Formulating recommendations - The dissemination workshop

When the findings and analysis from all participants is brought together the following seven, substantive themes emerge:

  1. Managing placement capacity
  2. Ensuring effective partnership working with the HEI
  3. Promoting security and belonging
  4. Selection and preparation of students
  5. Student support and assessment  
  6. Creating a stronger learning culture in departments
  7. Managing staff and student expectations

All 58 Radiotherapy Service Managers and their education leads, together with HEI programme leaders in England, were invited to a dissemination workshop to discuss the project’s interim conclusions and to take part in the formulation of recommendations.  The workshop was held in London on 24th September 2012 and facilitated by the Project Manager and other Steering Group members.

In total, 52 people attended the workshop. Thirty centres were represented, either by the RSM, the centre education lead or both.  Eleven radiotherapy centres declined the invitation and the remaining 17 did not respond despite several invitations and reminders.  Eight of the 10 HEIs were represented, either by the programme leader or a centre-based practice educator.  One university representative was prevented from attending on the day and one declined the invitation. (See Appendix 5 for details of attendance).

5.2 Workshop programme

Following a presentation and plenary discussion of the project objectives and audit findings, participants were allocated to specific groups to discuss the emerging themes and propose concrete recommendations. There were 8 tables comprising a mix of managers, education leads and university representatives. Each table was allocated a theme together with the key findings that contributed to it and asked the question, ‘What shall we do about…?’ These key findings are described in 5.3.1 – 5.3.7 below. Theme 1, Managing placement capacity, was discussed by 2 tables.

5.3 Themes and key findings

5.3.1 Managing placement capacity

The ratio of commissioned numbers to placement providers is skewed and there is overcrowding, with most having 2 students on each treatment unit frequently. If retention improves, this will be very challenging for placements to accommodate unless it is addressed. Placement plans vary widely and are often perceived to be designed to suit the needs of the HEI rather than the centres. The length of each placement is also variable as is the timing of the first placement. What are the principles that should govern placement capacity?

5.3.2 Ensuring academic and clinical integration through effective partnerships

Partnerships with HEIs are mainly described as positive and constructive. However, some departments expressed the view that it felt like ‘working for, not with, the university’ and there is some perception that the academic aspect of the programme is privileged by HEIs. Conversely, HEIs believe that relationships are equitable although they also think that departments do not always appreciate the university processes and procedures that govern students’ registration.  Given that students will exploit any perceived weaknesses, what more might be done to improve the quality of partnerships?

5.3.3. Promoting security and belonging

Research (and our own experience) tells us that a sense of security and belonging is important to individuals’ wellbeing. Promoting it may improve retention. The project findings demonstrate that students are perceived to need more time and pastoral support than the current workload and staffing levels permit. There is also confusion in some minds that creating a good, supportive clinical learning environment is in opposition to enabling students to take responsibility for their own learning, leading to charges of spoon-feeding.  It is admitted that not all staff are committed to student education and some are hostile. This tends to be ‘known about’ and managed by avoidance rather than challenge. How do we ensure students feel that they belong?

5.3.4 Selection and preparation of students

Attrition is high because the wrong people are selected! Interviewing practices are highly variable, their value in assessing suitability is doubtful and the level of involvement by clinical staff could be improved. There may be an opportunity to involve service users and existing students. There appears to be a problem with prior visits due to Trust governance policies and even a half day clinical visit before an offer is made may not include time on a treatment unit. The significance of VERT™ to skills development prior to first placement is acknowledged and there is comprehensive attention to ‘soft skills’ in pre-clinical modules.  Timing of first placement is variable and there is no evidence that early or later placements impact on retention. The use of a ‘suitability’ placement, early in the first year, was discussed. How do we get and retain the right people?

5.3.5 Student support and assessment

Mentoring practices are very variable and inconsistent among HEIs. Mentoring and clinical assessment are viewed as separate functions, with mentoring having a more supportive element and perhaps occurring remotely from the treatment unit. Is this correct for radiotherapy? There is a need to recognise and respond to the changed profile of pre-registration students who often have more complex personal lives and are likely to express their needs more vociferously. How can personalised learning be introduced into radiotherapy education? Employment of dedicated, funded Practice Educators to support student experience appears very significant – and their absence has a noticeable effect. Should the profession adopt minimum standards for mentoring and assessment?

5.3.6 Creating a stronger learning culture in departments

Preceptorship for newly qualified radiographers is not embedded and, in some cases, is non-existent. Clinical supervision as defined and advised by the College of Radiographers12 does not occur, although one department has instituted peer action learning sets as a result of a Trust stress audit.  Most departments are committed to continuing professional development (CPD) for qualified staff, although funding is difficult.

Where the profession’s career progression framework (‘the four-tier structure’) has or is being implemented, together with formalized preceptorship, this could be interpreted as a commitment to creating a learning and development culture among all staff and it appears that this ‘trickles down’ to students (and assistant practitioners). The commitment of managers is essential – some good leadership was evident. What can we do to support the development of a learning culture?

5.3.7 Managing student and staff expectations

The project findings suggest that there is a mismatch in expectations in relation to what the job is and what students’ experiences will be initially and a need for honesty and clear induction. Some staff believe that students should conform to their own idea of student behaviour, which were formed years previously when hierarchies were stronger and individualism not such a strong feature of life.  This impacts on how they feel about having students and how they treat them when they are in placement. How can we manage students’ expectations so that they are more realistic and how should we support, develop and manage staff to improve their commitment to student education?

5.4 Summary and draft recommendations

In the final plenary session, participants were invited to agree or disagree with each table’s proposals by holding up a green or red card, and this was noted on the responses. Subsequently, the proposed recommendations were transcribed verbatim and then summarised. This summary of the workshop’s proposals was sent to all participants, together with those RSMs and HEI programme leaders who had not attended, for validation and comment prior to compiling a first draft of the recommendations. There was little feedback but what there was was supportive of the summary (see Appendix 6).  

The next step was to further consolidate the emerging themes in 5.1 above into four main areas. Fifteen draft recommendations were developed to take forward to the final stage of the project, the student voice conference:

5.4.1 Managing placement capacity and ensuring integration through effective partnerships

  1. Development of strategic partnerships with commissioners (LETBs, SHAs, local partnership groups) to influence and manage the ratio of student numbers to placement availability and make the case for practice educator roles in every department. A more sophisticated metric is needed - not based only on the number of linear accelerators in the centre.
  2. Formalisation of local partnerships between each HEI and its placement providers through a local Service Level Agreement (SLA) that places duties and expectations on each partner ie operational issues related to placing students equitably, ensuring access to an appropriate range of experiences to achieve outcomes and minimising overlaps and placement sharing. A model agreement needs to be developed or sourced. 

5.4.2 Selection and preparation

  1. Selection of students needs to be more robust in terms of criteria for judging suitability for radiotherapy.
  2. Interviewing all students is best practice, and, where it occurs, clinical input to this process is essential. It is accepted that research about the value of interviewing is equivocal.
  3. Opportunities for student and service user involvement in selection should be explored. 
  4. A clinical visit report prior to offer should be mandatory.
  5. Psychometric testing and values assessment should be investigated.
  6. The profession needs to be more confident about its importance, complexity and what it can offer to prospective students.

5.4.3 Managing staff and student expectations and promoting security and belonging

  1. There should be more honesty about what the Band 5 job is and greater input from service. Students need to understand their position and role in the department. There is already some good practice, eg student focus groups, question and answer books, and it should be identified and disseminated.
  2. Strongly-held differences of view about the timing of the first placement are not evidence- based in relation to student retention. However, an early, developmental first placement could be devised to assess students’ individual responses to initial placement experience and develop personalised support mechanisms.
  3. Clinical staff responsibilities in respect of student education should be explicit in Personal development reviews (PDRs) and monitored.
  4. Clinical staff must be enabled through training and development to manage the diverse needs of today’s students so that a culture of high challenge and high support develops.

5.4.4 Student support and assessment and creating a stronger learning culture in RT centres   

  1. Centre plans should contain explicit objectives / action plans in relation to workforce planning and the profile of staff. As a minimum, they should include a commitment to enabling staff learning and development at all levels and, ideally, demonstrate that the department is working towards the profession’s career framework.
  2. Minimum standards of education and training for those mentoring and assessing students and other learners should be developed.
  3. The feasibility of developing standards of practice for therapeutic radiography should be investigated.

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