Educating for the future: Bookending evidence-based practice.

The role of a modern radiographer is complex; radiographers are expected to be technically skilled, professional, ethical and have honed their radiation safety and risk management skills.1Medical Radiation Practice Board of AustraliaProfessional capabilities for medical radiation practice.2020Google Scholar Additionally, they need to excel in communication and collaboration.1Medical Radiation Practice Board of AustraliaProfessional capabilities for medical radiation practice.2020Google Scholar In each interaction, radiographers apply clinical reasoning, balancing patient needs, clinical expertise, empirical evidence, and practical aspects. This is the very definition of evidence-based practice (EBP).2Sackett D.L. Rosenberg W.M.C. Gray J.A.M. Haynes R.B. Richardson W.S. Evidence based medicine: what it is and what it isn't.BMJ (Clinical research ed.). 1996; 312: 71-72https://doi.org/10.1136/bmj.312.7023.71Crossref PubMed Google Scholar Radiographers tend to have positive attitudes towards EBP, however, in busy clinical environments with competing priorities, conducting, or even consuming current research is challenging, and so they are rarely able to prioritise EBP. Radiographers traditionally act as consumers of research,3Higgins R. Robinson L. Hogg P. Unlocking student research potential: toward a research culture in radiography undergraduate learning curricular.J Med Imag Radiat Sci. 2015; 46: S6-S9https://doi.org/10.1016/j.jmir.2015.06.009Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar and often have low confidence in both their research and EBP skills.4Chau M. Brown E. Beldham-Collins R. Anderson N. Research demographics of Australian medical radiation practitioners.J Med Imag Radiat Sci. 2022; 53: 591-598https://doi.org/10.1016/j.jmir.2022.07.009Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 5Upton D. Upton P. Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom.J Allied Health. 2006; 35: 127-133PubMed Google Scholar, 6Dennett A.M. Cauchi T. Harding K.E. Kelly P. Ashby G. Taylor N.F. Research interest, experience and confidence of allied health professionals working in medical imaging: a cross-sectional survey.J Med Radiat Sci. 2021; 68: 121-130https://doi.org/10.1002/jmrs.432Crossref PubMed Scopus (8) Google Scholar Additionally, radiographers do not usually base their clinical decision-making on empirical evidence.7Ahonen S.-M. Liikanen E. Radiographers' preconditions for evidence-based radiography.Radiography. 2010; 16: 217-222https://doi.org/10.1016/j.radi.2010.01.005Abstract Full Text Full Text PDF Scopus (21) Google Scholar Instead, they tend to rely more heavily on their clinical expertise and are more likely to change techniques based on the advice of a colleague.5Upton D. Upton P. Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom.J Allied Health. 2006; 35: 127-133PubMed Google Scholar,8Rawle M. Pighills A. Mendez D. Dobeli K. Radiographic technique modification and evidence-based practice: a qualitative study.J Med Radiat Sci. 2023; 70: 56-63https://doi.org/10.1002/jmrs.616Crossref PubMed Scopus (1) Google Scholar Clinical expertise is one of the pillars of EBP, however, an issue arises when that expertise or advice from colleagues is not based on evidence. Rawle and colleagues (2023) noted that radiographers often assume that historical practices are evidence-based, even when they are not, and that technological advancements play a significant role in driving changes in practice.8Rawle M. Pighills A. Mendez D. Dobeli K. Radiographic technique modification and evidence-based practice: a qualitative study.J Med Radiat Sci. 2023; 70: 56-63https://doi.org/10.1002/jmrs.616Crossref PubMed Scopus (1) Google Scholar While technological advancements may drive change, it has been noted that improvements in technology do not always translate into improvements in patient care.9Munn Z. McArthur A. Mander G.T.W. Steffensen C.J. Jordan Z. The only constant in radiography is change: a discussion and primer on change in medical imaging to achieve evidence-based practice.Radiography (London, England). 1995; 26: S3-S7https://doi.org/10.1016/j.radi.2020.07.001Abstract Full Text Full Text PDF Scopus (7) Google Scholar Over time, radiography has developed a culture that tends to be forgiving of practices that are not evidence-based. This culture is deeply complex and rooted in a history of medical dominance that still pervades today. Within radiography, there are ongoing debates surrounding identity, self-esteem and professionalisation.10Lewis S. Heard R. Robinson J. White K. Poulos A. The ethical commitment of Australian radiographers: does medical dominance create an influence?.Radiography. 2008; 14: 90-97https://doi.org/10.1016/j.radi.2007.01.004Abstract Full Text Full Text PDF Scopus (42) Google Scholar, 11Yielder J. Davis M. Where radiographers fear to tread: resistance and apathy in radiography practice.Radiography (London, England). 2009; 15 (1995): 345-350https://doi.org/10.1016/j.radi.2009.07.002Abstract Full Text Full Text PDF Scopus (38) Google Scholar, 12Sim J. Radloff A. Profession and professionalisation in medical radiation science as an emergent profession.Radiography. 2009; 15: 203-208https://doi.org/10.1016/j.radi.2008.05.001Abstract Full Text Full Text PDF Scopus (49) Google Scholar Historically radiographers have been described as having low self-esteem and a lack of professional autonomy, viewing themselves as “just the radiographer”.10Lewis S. Heard R. Robinson J. White K. Poulos A. The ethical commitment of Australian radiographers: does medical dominance create an influence?.Radiography. 2008; 14: 90-97https://doi.org/10.1016/j.radi.2007.01.004Abstract Full Text Full Text PDF Scopus (42) Google Scholar, 11Yielder J. Davis M. Where radiographers fear to tread: resistance and apathy in radiography practice.Radiography (London, England). 2009; 15 (1995): 345-350https://doi.org/10.1016/j.radi.2009.07.002Abstract Full Text Full Text PDF Scopus (38) Google Scholar, 12Sim J. Radloff A. Profession and professionalisation in medical radiation science as an emergent profession.Radiography. 2009; 15: 203-208https://doi.org/10.1016/j.radi.2008.05.001Abstract Full Text Full Text PDF Scopus (49) Google Scholar Whilst Munn (2020) describes these views as unhelpful and potentially damaging,13Munn Z. Why isn't there an evidence-based radiography? Reflections and a call to action.Radiography (London, England). 2020; vol. 26 (1995): S14-S16https://doi.org/10.1016/j.radi.2020.05.005Abstract Full Text Full Text PDF Scopus (11) Google Scholar we believe that acknowledging the past and learning from it is important. Our history and culture cannot be ignored; however, they need not define our future as a profession. As Munn suggests, “there is great potential for medical imaging and radiography to embrace EBP and a culture of research”.13Munn Z. Why isn't there an evidence-based radiography? Reflections and a call to action.Radiography (London, England). 2020; vol. 26 (1995): S14-S16https://doi.org/10.1016/j.radi.2020.05.005Abstract Full Text Full Text PDF Scopus (11) Google Scholar Most of us are aware of the five-step model of EBP as set out in the Sicily statement i.e “Ask, search, appraise, apply evaluate”.14Dawes M. Summerskill W. Glasziou P. Cartabellotta A. Martin J. Hopayian K. et al.Sicily statement on evidence-based practice.BMC Med Educ. 2005; 5: 1https://doi.org/10.1186/1472-6920-5-1Crossref PubMed Scopus (556) Google Scholar We utilise this model to varying degrees in both clinical practice and education. In the context of education, the best way to teach EBP is by ensuring that all five steps are well integrated and constructively aligned throughout the coursework and clinical curriculum.15Thomas A. Saroyan A. Dauphinee W.D. Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions.Adv Health Sci Educ Theo Prac. 2011; 16: 253-276https://doi.org/10.1007/s10459-010-9251-6Crossref PubMed Scopus (68) Google Scholar However, could there be more to consider? Now, nearly twenty years on from the development of the Sicily statement, we are in the position to ask, could we do more for EBP? Melnyk et al. (2010) introduced two additional steps to the EBP cycle that bookend the five steps outlined in the Sicily statement. Melnyk et al.’s model is displayed in Fig. 1. The proposed model suggests that the prequel to the Sicily statement is cultivating a spirit of enquiry.16Melnyk B.M. Fineout-Overholt E. Stillwell S.B. Williamson K.M. Evidence-based practice: step by step: the seven steps of evidence-based practice.Am J Nurs. 2010; 110: 51-53https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Crossref PubMed Scopus (201) Google Scholar This emphasises the role of culture in the effective implementation of EBP. As educators, if we can nurture, not only the necessary skills for EBP, but also a genuine desire and commitment to lifelong learning in the next generation of professionals, we can contribute to the cultural shift that is required. It has been observed that high intrinsic motivation is a key predictor of the application of EBP, and faculty members can foster this motivation by exemplifying the concept in their own practice.17Amit-Aharon A. Melnikov S. Warshawski S. The effect of evidence-based practice perception, information literacy self-efficacy, and academic motivation on nursing students' future implementation of evidence-based practice.J Prof Nurs. 2020; 36: 497-502https://doi.org/10.1016/j.profnurs.2020.04.001Crossref PubMed Scopus (11) Google Scholar Additionally, Melnyk et al. (2010) propose that dissemination should form an integral part of the EBP process. As educators, it is imperative that we equip students with robust skills beyond those required to practice clinically. This includes providing them with opportunities to develop their ability to write and present effectively, as well as preparing them for the reality of teamwork. The transition from technical on-the-job training to formal university education in radiography has played a significant role in facilitating this shift.18Malamateniou C. Radiography and research: a United Kingdom perspective.Eur J Radiogr. 2009; 1: 2-6https://doi.org/10.1016/j.ejradi.2008.12.003Crossref Scopus (27) Google Scholar,19Di Michele L. Thomson K. McEntee M.F. Kenny B. Reed W. Knowledge translation: radiographers compared to other healthcare professionals.Radiography (London, England). 2020; 26 (1995): S27-S32https://doi.org/10.1016/j.radi.2020.06.007Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar We must acknowledge that as a discipline, we have relied on empirical evidence generated by other disciplines for too long. While this evidence should not be overlooked, depending on it has led to a situation where the research questions explored do not always align with the clinical questions most relevant to radiographers. By establishing our own evidence base, our discipline becomes more equipped to adopt evidence as it is more directly applicable. This is essential to the continued advancement of the profession and will further enhance the EBP culture within radiography. While there is some debate about the importance of embedding research skills in undergraduate curriculum,20England A. McNulty J.P. Inclusion of evidence and research in European radiography curricula.Radiography (London, England). 2020; 26 (1995): S45-S48https://doi.org/10.1016/j.radi.2020.04.018Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar we passionately believe that providing education in this area is vital for the continued development and professionalisation of our discipline. As our discipline continues to evolve and the role of radiographers becomes increasingly complex, it is the job of educators to prepare our students for success. This responsibility presents us with an opportunity to shape the future of radiography. We must cultivate a passion for lifelong learning and a commitment to evidence-based practice in our future professionals, whilst equipping them with the necessary skills to implement and disseminate their findings. In doing so, we elevate the field of radiography. Our role as educators goes beyond simply imparting skills and knowledge; we can inspire, nurturing the spirit of enquiry in our students. We have the privilege of shaping the future of our profession, let us use this privilege to advance evidence-based radiography. During the preparation of this work the author(s) used ChatGTP in order to review for clarity and proofread the article. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.