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Background: Trends in New Zealand (NZ) medical students’ health and the influence of a wellbeing curricula are unknown. Methods: The author’s collected self-report data from NZ medical students on ‘Graduation Day’ from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between ‘cohorts’ of students receiving different exposures to a wellbeing curriculum, and correlations between students’ own lifestyle practices and their frequency of talking with patients about those topics. Results: Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients. Conclusions: NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students’ self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

To understand the medical student perspective and experiences of academic difficulty and remediation in years' 2-6 at The University of Auckland (UoA), Aotearoa New Zealand, who were admitted via the Indigenous Māori and Pacific Admission Scheme (MAPAS) and international student pathways.A qualitative study which undertook one-on-one, semi-structured interviews using case study as the research method within Kaupapa Māori and Pacific research frameworks. Two student groups were interviewed during 2017: MAPAS and international medical students. An email invitation was sent to all students, inviting those who had failed a year, or at least one examination, assessment, module or domain in UoA Medical Programme during 2014-2016 to participate in the study. Interview transcripts were thematically analysed with an inductive approach.Fourteen medical students at UoA were included in the study, with ten from MAPAS and four from the international student admission pathway. There were six major themes identified. Three themes related to academic difficulty: the set curriculum, the hidden clinical curriculum and life complexities. Three related to the student perspectives of remediation: the impact of MAPAS support, enhanced resilience (particularly the MAPAS cohort) and stigmatisation from failing.This study has investigated the MAPAS and international medical student experience of academic difficulty and remediation at UoA. The student dialogue offered a rich insight to deepen our understanding into the remediation process to ensure it is not only culturally safe but also fit for purpose. Tertiary institutions that offer undergraduate medical education can (and should) better support their at-risk medical student cohorts.

Introduction This study investigated the learning styles and personality preferences of undergraduate Bachelor of Radiation Therapy (BRT) students at the University of Otago, Wellington in New Zealand from 2014 to 2018. The implications of these findings for radiation therapy education and the profession were also explored. Methods All students enrolled in the first year of the BRT degree during this time were invited to participate in the research. The test tool was the Paragon Learning Style Inventory (PLSI), which is a standardised questionnaire adapted from the Myers Briggs Type Indicator (MBTI). All students who participated in the workshops consented for their data to be used for this project. Results The BRT student participants (n = 130) were more likely to have a preference for Introversion and/or Judging in their personality and learning style profiles, relative to the population norms. No statistically significant preferences were present in the Thinking/Feeling, or Sensing/Intuition dichotomies relative to the norms given with respect to published MBTI data. Conclusion The study has indicated that the students currently studying radiation therapy at the University of Otago exhibit learning style and personality preferences that are well suited to radiation therapy clinical practice. However, some deficits could compromise a balanced professional profile, teamwork and future professional development. Implications for practice RT students are likely to show particular characteristics when stressed, anxious or fatigued that may compromise classroom and clinical dynamics. The integration of peer group supervision to the BRT has the potential to help students reflect on their feelings, develop solutions and improve their clinical practice.

Medical students are exposed to multiple factors during their academic and clinical study that have been shown to contribute to high levels of depression, anxiety, and stress. The purpose of this article was to explore the issue of depression in the medical student population, including prevalence, causes, and key issues, along with suggestions for early identification and support from one medical school in New Zealand. After establishing that the prevalence of depression is higher for medical students than the general population, the key issues explored include assessment used in the program, characteristics of the student population (such as Type A personality and perfectionism), resilience, selection procedures, students' motivation, and the nature of the clinical environment. This review includes several recommendations to improve students' psychological health such as positioning well-being within an overarching comprehensive workplace wellness model and integrating peer and faculty-led support into the day-to-day running of the institution. It also highlights the advantages of the addition of a well-being curriculum, as skills to prevent and manage distress and depression are relevant in supporting the competencies required by medical practitioners. It concludes that medical schools need wide-ranging strategies to address the complexities associated with the particular student population attracted to medicine and calls for educators to act, by noticing opportunities where they can introduce such initiatives into their medical programs.

This study investigated the learning styles and personality type of undergraduate radiation therapy students at the University of Otago, Wellington (UOW) in New Zealand (NZ) to ascertain whether there is a pattern evidenced for this group and how that might compare with NZ medical imaging students. All students enrolled in the first year of the Bachelor of Radiation Therapy degree from 2014 to 2016 at the UOW were invited to participate in this research. The test tool was the Paragon Learning Style Inventory (PLSI), which is a standardised questionnaire adapted from the Myers-Briggs Type Indicator (MBTI). All students who participated in the workshops consented for their data to be used for this project. The current study is longitudinal, and will continue for five years in total. The initial findings indicate that the cohorts of RT students exhibit personality and learning style preferences similar in Introversion/Extraversion and Thinking/Feeling to the proportion expected in the normal population. However, the Sensing/Intuition and Judging/Perceiving dichotomies show some similarities to the medical imaging students studied, who fell considerably outside that expected in the normal population. Overall, the dominant preference combinations identified, although different in degree, were similar to those of medical imaging students. The continuation of the radiation therapy study is important to ascertain more fully whether the results are particular to these cohorts of students or are trending towards showing a pattern of personality and learning style within the profession.

The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was developed in 1998 using the true score theory to measure students' deep approaches (DA) and surface approaches (SA) to learning. Using Rasch analyses, this study aimed to 1) validate the R-SPQ-2F's two-factor structure, and 2) explore whether the full scale (FS), after reverse scoring responses to SA items, could measure learning approach as a uni-dimensional construct. University students (N = 327) completed an online version of the R-SPQ-2F. The researchers validated the R-SPQ-2F by showing that items on the three rating scales (DA, SA, and FS) had acceptable fit; both DA and FS, but not SA, showed acceptable targeting function; and all three scales had acceptable reliabilities (0.74 - 0.79). The DA and SA scales, not the FS, satisfied the unidimensionality requirement, supporting the claim that student approaches to learning are represented by DA and SA as separate constructs.

We set out to explore the question, what ethical challenges do medical students identify when asked to perform or observe a sensitive examination, given a historical background relevant to this context.Thematic analysis of 21 Ethics Reports from 9 female and 12 male students.Overall 14 students undertook a sensitive examination without the patient's consent; three did not carry out a sensitive examination because of a lack of consent; and two students (or their senior colleagues) gained the patient's written consent for the student to undertake the examination. One patient refused the student's request for consent to perform a digital rectal examination; and in the final case, verbal consent was given by the patient for the student to observe a bimanual examination only. Three interrelated core themes arose from thematic analysis of the research question: systemic constraints on getting consent; internal conflicts of interest; and, power and hierarchy.A number of senior medical students at our institution disclosed observing or performing sensitive examinations on patients without the patients' knowledge or consent.

The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change.A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 2013 and 2014, combined with thematic qualitative analysis of educator perspectives derived by interview on factors underlying remediation and the quality of that currently provided by the faculty.17.7% of all students required some form of remedial assistance and 93% of all students offered remediation passed their year of study. Multivariate analysis showed international students (OR 4.59 95% CI 2.62-7.98) and students admitted via the Māori and Pacific Admission Scheme (OR 3.43 2.29-5.15) were significantly more likely to require remediation. Male students were also slightly more likely than their female classmates to require assistance. No effect was observed for rural origin students, completion of a prior degree or completion of clinical placement in a peripheral hospital. Knowledge application and information synthesis were the most frequently identified underlying problems. Most faculty believed remediation was successful, however, flexibility in the programme structure, improved diagnostics and improved access to dedicated teaching staff were cited as areas for improvement.Remediation is required by nearly a fifth of University of Auckland medical students, with MAPAS and international students being particularly vulnerable groups. Remediation is largely successful, however, interventions addressing reasoning and knowledge application may improve its effectiveness.

IntroductionThis article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). MethodsThe study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. ResultsFindings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. ConclusionsThe authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommendmore » (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board.« less

INTRODUCTIONThe ability to reflect – reflection – taking time to stop, think and evaluate is an important professional skill to develop. AIMTo evaluate a compulsory reflective group activity to determine whether compulsory participation enabled students to constructively share emotional clinical experiences and develop ethical and professional behaviour. METHODSThis was a case study with mixed methodology. Participants were Years 5 and 6 medical students at the University of Auckland, New Zealand. Data collection included pre- and post-reflective group questionnaires with Year 5 and 6 students, questionnaires with general practice academic facilitators, and audiotapes of the reflection group discussions. RESULTSStudents shared emotional experiences that were organised into three themes: (i) witnessing unprofessional behaviour; (ii) meeting difficult clinical scenarios for the first time; and (iii) the hierarchy of medicine. They reported positive learning experiences relevant to their future practice and valued the opportunity to share their experiences safely. Facilitators thought the groups provided unique educational opportunities that students appreciated. Eighty-two percent of participants would like to repeat the activity during their medical school training. CONCLUSIONSelf-reflection is an essential condition for professionalism. Use of reflective groups can help students become ethical and professional doctors.

This article explores the literature available in the field of medical education on the topic of clinical assessment, in order to suggest different ways of assessing clinical experience that may not have been considered within undergraduate radiography programmes. The medical literature is contrasted with the clinical assessment currently being used in a medical imaging programme in New Zealand, with the aim of offering suggestions that may benefit the assessment of the clinical and professional elements of radiography programmes more generally. The authors conclude that ideally students need to be assessed in the clinical domain by multiple assessors, with varied assessment methods used repeatedly over a period of time and with the provision of frequent and constructive feedback. Various methods of clinical assessment are suggested and it is emphasised that the methods selected need to be valid, reliable and psychometrically supported. This encourages an evidence-based practice approach that is supportive of on-going programme development and change.

In the June 2014 issue of the Journal of Medical Radiation Sciences, an article by Neep et al.1 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,2 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,3 who compared the confidence and accuracy of nurse practitioners, junior doctors and radiographers reporting trauma radiographs. They found that radiographers reported lower confidence, even though they had the highest average score and were the only group whose level of confidence correlated with their accuracy. As has been identified previously,4–7 there is a culture of subservience and apathy prevalent in the profession, largely due to the background of medical dominance that has persisted since the early 1900s when a hierarchal system was created within radiology departments, bringing about the limitation of the radiographer's role.8,9 Lewis et al.6 maintain that radiographers report feelings of intimidation, under-appreciation and worthlessness, that they feel ‘overlooked’, and these factors have translated into the ‘just the radiographer’ syndrome. While this article was written 8 years ago, this form of identity based on an inferiority complex can still be evidenced in attitudes towards advanced practice, for example, as seen in qualitative comments elicited in the recent medical imaging research for the NZIMRT.7 It could be postulated that this may be one of the factors lying behind the lack of confidence of participants describing (as opposed to detecting) abnormalities that characterised the findings of Neep et al.1 It has also been suggested4,5 that radiographers have been socialised into a culture of compliance in order to be accepted as members of the broader radiology team. Conformity and compliance generally lead to conventional behaviour and are not conducive to innovation, risk-taking and improvement. This form of workplace culture does not support high levels of job satisfaction, self-esteem or confidence. Does this mean that given the opportunity to develop and advance, there is likely to be a backlash of resistance? Does this perhaps relate to why radiographers and radiation therapists in Australia and New Zealand have been slow to embrace the changes necessary to support career progression? If professional identity is formed around being ‘just the radiographer’, then how can a practitioner dare to stand up and offer an opinion that may be taken seriously by medical staff and other health professionals? Unfortunately, remaining restricted in a role undermines motivation and encourages ‘mindless’ practice.4 This professional culture does not encourage critically reflective practice,5 teamwork or the ability to effect needed change. Apathy also has an effect on a practitioner's willingness to engage in the life-long learning (including research) required to fully engage as a professional. Neep et al.'s article suggests that the participants in the research study were willing to consider a short 2-day (or equivalent) course of targeted image interpretation training to enable them to take on a radiographer commenting role. At the same time it was suggested that the more formal postgraduate requirements for image reporting may be found ‘inaccessible due to large time requirements and a substantial financial commitment’.1 While there was a strong theme evident in the New Zealand role development research10 that indicated a desire for change that would enhance their professional status, there were many participants who expressed resistance to engaging in further study or taking on additional responsibilities. It is a case of the philosophical ‘chicken-and-egg’ problem – if radiographers and radiation therapists engage in further education their confidence will improve and they will feel able to take on extended roles that befit their knowledge and skills. How can they be empowered to adopt an active approach to their future, which means being willing to put in the time, energy and financial commitment to lead change, even where the future is still unknown? To ensure the future of the profession, it is time for radiographers and radiation therapists in both countries to stand up and insist on being seen, respected and having a profile as health professionals rather than being conceptualised as ‘allied health technicians’ (to this end it is unfortunate that in New Zealand the term ‘technologist’ is still used, along with the message this sends). Medical imaging and radiation therapy are rapidly developing professions that need motivated and active practitioners if reciprocity with our international colleagues and with other health professions is to be upheld. Neep et al.'s article is a timely reminder that while progress is being made, some radiographers and radiation therapists are still finding a move outside their comfort zone challenging, despite the large body of evidence that they are capable of making that change. At the same time, there are many practitioners in both countries who indicate willingness to champion local change. Our professional bodies (AIR and NZIMRT) need to find ways to encourage and engage these practitioners, both to create change in the professional culture and to progress an advanced practitioner framework.

Introduction: This paper reports the first phase of a two-phase longitudinal study which explored the attitudes of radiographers in two countries (UK and New Zealand) towards CPD, before and after the introduction of a mandatory CPD policy. In addition, this paper outlines in brief the planned phase two of the project, which will be undertaken to assess whether attitudes change over time, following the introduced mandate. Methods: 1739 radiographers across both countries were approached via a survey using a written questionnaire with quantitative and qualitative components endorsed by the relevant professional body in each country (Society of Radiographers and the New Zealand Institute of Medical Radiation Technologists). The questionnaire was statistically analysed using t-tests. In addition, the qualitative components were analysed thematically, to add depth and explanations to the findings. This paper presents the results, focusing especially on the qualitative data in order to fully explore the attitudes demonstrated. Results: The results of the study showed that a degree of apathy surrounded CPD participation, despite the professional expectation that staff be CPD active. On an individual level, radiographers self reported a low level, or a complete lack of formal recording of CPD. A number of barriers were identified, which were perceived by participants to restrict their CPD activity, including, of particular note, poor staffing levels and lack of employer support. Radiographers in both countries appeared to have a narrow understanding of what is perceived to constitute CPD, with an apparent focus on formal, attendance-based activities. Less formal, on-the-job activities were not always considered as CPD by participants in this study. Conclusion: This study outlined a range of factors which impact on attitudes towards CPD, with many similarities in findings across both countries represented. A lack of intrinsic motivation was demonstrated, which is perceived to hamper active participation in CPD. There was a desire for personal benefit from CPD participation to be evident, in order to motivate individuals to get actively involved. The complexity of the current working environment was outlined, with acknowledgement that the mandatory policy towards CPD is not the only factor affecting participation. While further research will be required to examine the impact of all the variables affecting CPD, the results of this study may allow individuals and managers to begin to interact with CPD participation in order to attempt to increase the level and effectiveness of learning in practice.

The vast majority of radiography research is subject to critique and evaluation from peers in order to justify the method and the outcome of the study. Within the quantitative domain, which the majority of medical imaging publications tend to fall into, there are prescribed methods for establishing scientific rigour and quality in order to critique a study. However, researchers within the qualitative paradigm, which is a developing area of radiog- raphy research, are often unclear about the most appropriate methods to measure the rigour (standards and quality) of a research study. This article considers the issues related to rigour, reliability and validity within qualitative research. The concepts of reliability and validity are briefly discussed within traditional positivism and then the attempts to use these terms as a measure of quality within qualitative research are explored. Alternative methods for research rigour in interpretive research (meanings and emotions) are suggested in order to compliment the existing radiography framework that exists for qualitative studies. The authors propose the use of an established model that is adapted to reflect the iterative process of qualitative research. Although a mechanistic approach to estab- lishing rigour is rejected by many qualitative researchers, it is argued that a guide for novice researchers within a developing research base such as radiography is appropriate in order to

This article explores some of the key issues that characterise the culture of the radiography profession as experienced and reported in the United Kingdom, New Zealand and Australia. It raises many questions for professionals concerned about the future of the profession to consider, arguing that if these issues remain unchallenged they may limit both ongoing professional development of individuals and the profession as a whole.

This paper describes the evolution and current status of advanced practice in medical imaging and radiation therapy in the Oceania region. To date development has been slow, largely ad hoc and based on local needs. Most advanced practice is informal or is regarded as part of the core skills of some individual practitioners. However, recently, there have been signs of change taking place, with a more coordinated and collaborative approach to role development becoming evident. In Australia, although a number of reports and papers have discussed extended clinical roles, especially for diagnostic Radiographers, no concrete action has yet taken place in either discipline. Stakeholders apparently agree that existing extended roles should be formalised, however, and that continuing education must underpin future role extension initiatives. A three-level professional structure, including an advanced practitioner level, has been accepted by the New Zealand Institute of Medical Radiation Technology (NZIMRT), with the support of the District Health Boards of New Zealand (DHBNZ). Implementation is expected to begin before the end of 2008. Meanwhile, recognition of the serious lack of Radiologists in Western Pacific Island Nations led to the training of some Radiographers in radiological interpretation of images between 2004 and 2006. The aim was to up-skill the Radiographers so that they could more reliably flag abnormalities to doctors, a model that may be applicable elsewhere. It is argued that future practice models must include advanced practice roles in order to safely meet the growing demand for medical radiation services. Local factors, such as the structure of the health care system and the depth of engagement of the key stakeholders in planning and implementation, however, are expected to influence the evolution of new clinical practice models in the region.

Background Progress Tests (PTs) draw on a common question bank to assess all students in a programme against graduate outcomes. Theoretically PTs drive deep approaches to learning and reduce assessment-related stress. In 2013, PTs were introduced to two year groups of medical students (Years 2 and 4), whereas students in Years 3 and 5 were taking traditional high-stakes assessments. Staged introduction of PTs into our medical curriculum provided a time-limited opportunity for a comparative study. The main purpose of the current study was to compare the impact of PTs on undergraduate medical students’ approaches to learning and perceived stress with that of traditional high-stakes assessments. We also aimed to investigate the associations between approaches to learning, stress and PT scores. Methods Undergraduate medical students (N = 333 and N = 298 at Time 1 and Time 2 respectively) answered the Revised Study Process Questionnaire (R-SPQ-2F) and the Perceived Stress Scale (PSS) at two time points to evaluate change over time. The R-SPQ-2F generated a surface approach and a deep approach score; the PSS generated an overall perceived stress score. Results We found no significant differences between the two groups in approaches to learning at either time point, and no significant changes in approaches to learning over time in either cohort. Levels of stress increased significantly at the end of the year (Time 2) for students in the traditional assessment cohort, but not in the PT cohort. In the PT cohort, surface approach to learning, but not stress, was a significant negative predictor of students’ PT scores. Conclusions While confirming an association between surface approaches to learning and lower PT scores, we failed to demonstrate an effect of PTs on approaches to learning. However, a reduction in assessment-associated stress is an important finding.

Re: Yielder J, Young A, Park S, Coleman K. Establishing advanced practice for medical imaging in New Zealand. J Med Radiat Sci 2014;61(1):14–21 Thank you for providing the opportunity to reply to Mr Hayes’ Letter to the Editor, written with respect to our article ‘Establishing advanced practice for medical imaging in New Zealand’. We would like to raise a number of points in response: The two first authors for the parallel medical imaging and radiation therapy articles have been appointed to the NZIMRT advanced practice working parties since 2005. The current research has built on this work. The original research (2005–2008) included surveys of all stakeholders. The second stage was a qualitative study that did not seek to be representative of the medical imaging profession. Its purpose was to qualitatively explore and ‘flesh out’ potential profiles, from experienced MRTs working in specialty areas. The profiles used generic criteria established in the first stage of the research that were formally accepted by the NZIMRT in 2009, in addition to asking respondents to comment on further specialist‐focused skills. The study was not seeking support for advanced practice per se, but to establish what an advanced practice profile may potentially ‘look like’. The recommendation is that one advanced scope of practice is established, consisting of the generic criteria plus specialist skills that would be department‐dependent and negotiated for an individual AP position. This recommendation was based on the small numbers of MRTs likely to seek advanced practitioner status. No profiles have been recommended from this exploratory research, so although the findings about profiles were interesting, Mr Hayes’ concerns regarding over‐claiming results are redundant. It was not the intention of the article to advocate that the University of Auckland is the only provider capable of establishing postgraduate courses for advanced practice in medical imaging. Any institution that has the ability to offer master's programmes to support MRT advanced practice would be an option, noting that any provider will need to consider student numbers for viability. The point was being made that the University of Auckland and University of Otago are currently able to offer education to support advanced practice, contextualised specifically to the profession. We were drawing the readers’ attention to the understanding that advanced practice is more than a collection of specialist skills – these are important, as are the generic criteria. A master's qualification to support advanced practice needs to include both. It is hoped that now that the AIR has called for nominations for an advanced practice pathway, that New Zealand MRTs will support initiatives to move advanced practice ahead in a similar, and timely, fashion. Interested MRTs, including Mr Hayes, need to register their willingness to be actively involved. It would be most detrimental to the profession in New Zealand to be left behind in this initiative.

This article examines the concept of professional leadership in medical imaging. It explores the context of power issues in which such leadership is located, the differences between leadership and management, the qualities needed for effective leadership and how an individual's psychology may affect it. The article concludes that in the current climate of change and development, the medical imaging profession needs strong and appropriate leadership to profile the profession effectively and to lead it through to a more autonomous future.

Purpose: In 2001 an evaluative study was conducted involving an oral positioning aid (the E-Z-Em Mouthpiece). Manufacturer opinion suggested that the device may enhance safe and demonstrative practice in the radiographic and radiological components of case examinations involving acute trauma to the upper cervical spine. The study was conducted at Auckland Public and Starship Children's Hospitals, New Zealand with prior approval from Auckland Health Research Human Subjects Ethics Committee.Literature review confirms that the atlanto-axial compartment of the cervical spine is most commonly involved in acute cervical spine injury. Consequently difficulty experienced in achieving adequate and optimal radiographic demonstration of the osseous and articular structures of this complex region is well reported.Methods: The study adopted applied programme evaluation – methodology. The evaluation was conducted within a time frame stipulated by the ethics approval. All participating subjects presented with a case history of trauma to the cervical spine referred for initial radiological assessment from either accident and emergency or admission departments. Radiographers who performed the examinations were requested to use the positioning device. When the examination was concluded, questionnaire participation was requested to provide reports from each examination. These reports were then subjected to analysis.Results: Seventy-five patients participated in the study. Thirty-three questionnaires were completed (a respondent rate of 44%). Responses tended to endorse provision of the device for optional use within current examination practice. Factors influencing optional use of the device were difficulties associated with subject type, the position of external immobilising collars, peripheral injuries sustained by the patient and difficulty experienced with those subjects who had suffered multiple injuries with associated head injury.Conclusions: This study supports provision for the availability and optional use of this product in certain cases, supporting the manufacturer's assessment of its capability to enhance aspects of image quality and assist subject immobilisation.

The nature of professional expertise has been widely debated in the literature. However it has been examined primarily from a dichotomy of perspectives – either from an experiential or a cognitive focus, without the attempt to integrate these, and other aspects of expertise into an integrated and coherent model. This article series explicates the nature of professional expertise specifically in the field of medical imaging. It represents a section of the outcomes of a larger study which formulated and illustrated an integrated model of professional expertise also applicable to other professions. It has been written in two parts, Part I of which overviews the study and presents two of the five aspects of expertise identified. Part II presents the other three aspects.The study used data gathered from interviews and critical incident recording from expert medical imaging practitioners in Auckland, New Zealand, over an extended time frame.Findings showed that while expertise is situated in the context of practice, it incorporates several dimensions working together in an integrated, seamless fashion through the medium of the individual practitioner. The participants identified and illustrated that expertise in medical imaging is a synthesis of a particular knowledge base, the cognitive processes, personality and internal processes of the practitioner. It manifests through, and builds on, interpersonal relationships with patients and other professionals, and is expressed through the actual doing of professional practice. It is through the reflexive examination of practice and management of change that professionals may transform these integrated aspects into the qualitative state of expertise.

the nature of professional expertise has been widely debated in the literature. however it has been examined primarily from a dichotomy of perspectives – either from an experiential or a cognitive focus, without the attempt to integrate these, and other aspects of expertise into an integrated and coherent model. this article series explicates the nature of professional expertise specifically in the field of medical imaging. it represents a section of the outcomes of a larger study which formulated and illustrated an integrated model of professional expertise also applicable to other professions. it has been written in two parts, part i of which overviews the study and presents two of the five aspects of expertise identified. part ii presents the other three aspects.the study used data gathered from interviews and critical incident recording from expert medical imaging practitioners in auckland, new zealand, over an extended time frame.findings showed that while expertise is situated in the context of practice, it incorporates several dimensions working together in an integrated, seamless fashion through the medium of the individual practitioner. the participants identified and illustrated that expertise in medical imaging is a synthesis of a particular knowledge base, the cognitive processes, personality and internal processes of the practitioner. it manifests through, and builds on, interpersonal relationships with patients and other professionals, and is expressed through the actual doing of professional practice. it is through the reflexive examination of practice and management of change that professionals may transform these integrated aspects into the qualitative state of expertise.

This study explores the attitudes of radiographers in two countries (UK and New Zealand) to mandatory CPD prior to a mandatory CPD policy being implemented. Postal questionnaires were sent to 1739 radiographers (250 in the UK and 1489 in New Zealand), in collaboration with the respective professional bodies in both countries. The study showed that there is a general ambivalent attitude towards CPD and there are a number of barriers which individuals identify to explain relatively low rates of participation in CPD. The study also showed that there is a very restricted view of what constitutes CPD around attendance at study days and formal activities and subsequently less formal activities are not being recognised and valued. The lack of recording of CPD activity was highlighted along with problems related to poor staffing levels and in places, lack of employer support. The study will be repeated and attitudes compared two years following the implementation of the mandatory CPD policy in both countries.

This paper proposes a model of leadership within tertiary education based on research into expertise and institutional distinctiveness. It builds on two contrasting styles of institutional development. Firstly, in the traditional university (higher education) sector, promotion to senior management positions has tended to be based on academic prowess, largely relating to research capability. The result is senior academic leaders who may not be well suited to line or operational management. By contrast, in the traditional polytechnic (vocational education and training) sector, promotion to leadership positions has tended to be based more on perceived managerial qualities, and the resultant leaders may be more inclined to be good managers without displaying overt academic leadership. A model of shared academic management and leadership focused on departmental/school level, based on research into the nature of professional expertise, is therefore proposed which brings together the strengths of both of the abo...

Medical Imaging students work under the close supervision of qualified Medical Radiation Technologists (MRTs), or Radiographers. In the New Zealand setting, some MRTs are formally appointed as clinical tutors by an educational institution providing medical imaging education, while others are senior staff who have supervision and some aspects of assessment incorporated within their job role. This article proposes a model of clinical supervision that supports and extends medical imaging students at their clinical placement.The model includes discussion relating to modes, scope, boundaries and relationships within clinical supervision, and also outlines important aspects within the actual process of supervision. This includes teaching, assessment and feedback.The model maintains the importance of critical analysis, clinical reasoning and reflection within the supervision relationship. It focuses on a form of professional practice and teaching which encourages the development of professional, adaptable MRTs, who have the ability to incorporate principles and theories into their practice.

The introduction of a new domain of learning for Personal and Professional Skills in the medical program at the University of Auckland in New Zealand has involved the compilation of a portfolio for assessment. This departure from the traditional assessment methods predominantly used in the past has been challenging to design, introduce, and maintain as a relevant and authentic assessment method. We present the portfolio format along with the process for its introduction and appraise the challenges, strengths, and limitations of the approach within the context of the current literature. We then outline a cyclical model of evaluation used to monitor and fine-tune the portfolio tasks and implementation process, in response to student and assessor feedback. The portfolios have illustrated the level of insight, maturity, and synthesis of personal and professional qualities that students are capable of achieving. The Auckland medical program strives to foster these qualities in its students, and the portfolio provides an opportunity for students to demonstrate their reflective abilities. Moreover, the creation of a Personal and Professional Skills domain with the portfolio as its key assessment emphasizes the importance of reflective practice and personal and professional development and gives a clear message that these are fundamental longitudinal elements of the program.