Creating our future: conformity or change?

In the June 2014 issue of the Journal of Medical Radiation Sciences, an article by Neep et al. is on the subject of ‘frontline radiographer commenting’, in the context of abnormalities of the musculoskeletal system due to trauma. I would like to use this article as a timely catalyst to debate some of the issues that the profession is currently facing. In this editorial the term ‘radiographer’ will be used to represent the diagnostic sector of the profession, while noting that in New Zealand medical imaging technologist is the term designated by the Medical Radiation Technologists Board (MRTB). Medical imaging and radiation therapy in both New Zealand and Australia have been exploring for some years the possibility of changing roles and career progression frameworks in line with international developments. These developments have seen radiographers and radiation therapists extending their practice both within their own scopes of practice (role expansion) and into areas previously designated as roles of doctors or other health professionals (role extension). These developments have been in part to reflect the changing nature of health provision, with an advanced practice framework having the potential to be of real benefit to patients, and in part to enable professional development for an important and highly skilled sector of the health workforce. This change has been particularly apparent in the United Kingdom over the past two decades, a significant length of time that has allowed for acceptance, consolidation and research to be undertaken to support their initiatives. This is not yet the case in Australia or New Zealand, where progress has been slower and has yet to achieve a level of acceptance. In New Zealand progress has been made based on research conducted initially between 2005 and 2008, investigating role development and a possible career structure. The recommendations from this research were formally accepted by the New Zealand Institute of Medical Radiation Technology (NZIMRT) in 2009 and led to further research conducted between 2010 and 2013, developing profiles and criteria for the formulation of advanced scopes of practice towards the establishment of an advanced practitioner role. The registration board in New Zealand, the MRTB, currently has the development of an advanced scope of practice under consideration as it progresses with reformulation of all the scopes of practice for the profession. In Australia, a proposed pathway to advanced practice has been distributed to members of the Australian Institute of Radiography (AIR) for consultation (see http://www.air.asn.au/advanced.php) and it’s roll out is expected to commence in the near future. It was based on a report released by Professor Ian Freckleton SC and the Inter-professional Advisory Team in April 2012. To this end, the AIR has recently released a call for applications for advanced practitioner accreditation via the champion pathway. In this context, Neep et al.’s article explores radiographer perceptions of their readiness to detect and comment on abnormalities of the axial and appendicular skeleton following trauma, as well as their preferences for two alternative forms of delivery of image interpretation education. It has been well documented, as described in both Neep et al.’s article and the commentary also included in this issue by Woznitza, that radiographers are capable of high levels of sensitivity and specificity in the reporting of radiographs, not to mention the many other forms of role extension that have been incorporated in advanced practitioner roles in the United Kingdom. Given that there is a solid evidence base to support role extension and the formulation of advanced practitioner roles, the lack of confidence shown by radiographers about their abilities and their reluctance to actually describe what they have detected, raises some professionally focused questions for debate. Woznitza’s commentary reports the findings of Coleman and Piper, who compared the confidence and accuracy of