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Student Advocacy – A Team Approach
2 0 0 5 W E L C H MEMORIAL LECTURE
4UVEFOU"EWPDBDZo"5FBN"QQSPBDI Valerie Palm, RTR, ACR, FCAMRT Presenter of the 2005 Welch Memorial Lecture at the Delta Prince Edward Hotel in Charlottetown, PEI. President Gallagher, Colleagues, Friends, and invited guests: Well over a year ago, Claire Hatch invited me to present the Welch Memorial Lecture in 2005, I was momentarily lost for words. I accepted, but after we finished the call I began wondering what I had gotten myself into, and instantly wished I had paid heed to my husbandʼs bid that I learn to say NO. A few weeks later the formal letter arrived. My thoughts flew to all the letters I had sent confirming someone to this very same thing: I now offer an apology to all of you. When I first began volunteering in association activities, I had great fun helping to plan and organize local educational sessions in the Okanogan. This is where the snowball began rolling. Here I am, with over 3 decades of experience in our professional organizations. It is gratifying to know that my contributions over the years are being acknowledged with such a distinct honor. I am proud and humbled to be taking on this role today. I did look at the list of the many Welch Memorial Award recipients. I read all the previous lectures I could get my hands on. All the presentations demonstrated eloquence and boldly conveyed noble statements. I have listened to many of my mentors deliver the Welch Memorial address and I recall the many times I hoped that I would never have to make a decision to accept such a verdict – and what could I possibly have to say in such a venue to fill the designated time? So, why does the CAMRT continue the time-honored tradition of the Welch Memorial Lecture? To give people anxiety attacks in preparation for the presentation? I think not. Herbert M. Welch was a founding member of our professional organization, a CAMRT President and a pioneer in many clinical practices during the First World War. He died before I was born - yet his legacy of leadership lives on with us more than 5 decades later. The historical background of our association reflects his sustained engagement in promoting professional identity. The outline provided by CAMRT states that: “the award is extended to a person who most closely emulates these same selfless qualities as displayed by the late Herbert M. Welch”. I have and continue to be a pro-active voice for the advancement of the profession, but I donʼt consider my contributions to be unselfish as I have reaped many benefits and gained so many cherished friends.
There are many key individuals that have influenced specific areas of my professional life. I thank each of them for sharing their wisdom and guiding me through some challenging phases of professional growth. With a short walk down memory lane I would like to share some of my initial contacts with the profession. The very first was during the BCIT entrance interview with Pat Rogers (now Pat Noel). Miss Rogers taught radiographic procedures. I was a blushing 17 year old when I started the program at BCIT and Pat was telling us: “for the best rib images” we had to move “pendulous” breasts out of the way. I thought I would likely die of embarrassment asking a patient to do that. Now, doing a mammogram for a patient seems like a very normal part of a technologistʼs contact with a patient. During a BCIT “field trip” to Vancouver General, I had to do an IVP evaluation with Shirley Hundvik. So, there I was shaking in my stiff duty shoes and starched white dress uniform. I kept catching my Blue & Gold striped “nursing” cap on the collimator. After a few “time-outs” in the control booth to catch my breath, I managed to successfully finish the evaluation. But, I looked like a disheveled basket case at the end, with cap askew and beads of perspiration running down my temples. Shirley has since become one of my important colleagues and dear friends. Near the end of my final year practicum in Kelowna, BC, Art Cliffe asked me how I was going to make a difference in my chosen career? It wasnʼt until I was about five years into my career that I reflected on his question to me. In the early 80ʼs, I began a serious look at my future directions. Active participation in my professional association seemed like a good start. So, I got my dues up to date – yes, I was on the “delinquent list” for a short spell in the early years of my work life – but thatʼs a story for another time. The BCAMRT offered a wealth of opportunity to meet new people, with common interests, working for a common good. But, I was not yet clear on how I would make a difference. Special people along the way showed me skills I could not have readily gained elsewhere. In particular, organizational skills and the importance of accurate and complete documentation became second nature. I was reminded that I would only get out of the work what I put into it. I watched other very active members, with amazing and sustained energy and commitment, regularly prepare education programs for members. Still others modeled
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advocacy for advancing our professional identity with the public and, of course, to our patients. I was continually reminded that without some fun along the way, what would be the point of it all? My CAMRT life has been an amazing journey thus far. I have had the benefit of working with many wonderful people from coast to coast, all doing their part to make a difference in our profession. There are so many people that have added to my enjoyment and are the reason that I continue active participation in our association. Early on, there were a few people who saw potential in me and had enough faith in my abilities to encourage me to seek work on the CAMRT Advanced Certification Committee. That experience significantly altered my view of our profession. When my focus in education moved from education committee work to employment at the BCIT, little did I know that Art Cliffeʼs question to me – “how will you make a difference?” was being answered. I found a niche in education that I am committed to and thrive on. Many amazing people have influenced my growth as an instructor. In particular, my colleagues on the BCIT team. Our Program Head, Mary Filippelli offers outstanding leadership as we develop a comprehensive and collaborative program with our clinical partners. Mary encourages individuality as we attain our common goals. I watch Dori Kaplun wave her magically creative wand to energize the learning process. I hear Euclid Seeram continually ask “whereʼs the research on that?” Rita McLaughlin demonstrates unfaltering integrity when we try to quiz her for “insider” information on COE happenings. Jennifer Talman, from the physics department, somehow makes the subject interesting, applicable and fun. Elaine Fraser, from the nursing department, endorses care for the entire patient and boldly guides our students to take full ownership of the patientʼs needs while in our care. And the program is only complete with the dedication of the clinical instructors at all of our affiliated sites. I am blessed to be rubbing elbows with this caliber of co-worker. I learn every day. And I am privileged to work in such a cohesive team environment as we “ride the waves of change”. While my colleagues do influence my practices, it is the studentʼs quest for excellence that drives my desire to be the best that I can be. We have been doing our best with the resources available to keep up with the technological advances in teaching tools. The BCIT proudly went live with a PACS that ties all the campus imaging departments together. This has great potential to show all students all the modalities. In fact, we are in the planning stages of placing medical laboratory images and anatomy slides on the server to create a more comprehensive
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teaching tool. Our medical radiography students are linked to the program via a complex website where we offer many services such as on-line practice examinations, engage in online image review and the next phase will include audio links for virtual classrooms with the students out at clinical as they prepare for the CAMRT certification process. There has been a careful approach to this work to ensure proper encryption and confidentiality protection. I am excited to be here and welcome the opportunity to share our work at the BCIT towards building self-direction and clinical autonomy for our students. I hope that some of what I share will bring you to reflect on your current practices when working with student technologists. I also hope that you will find my comments applicable to your local student programs whatever the discipline. I continue to learn from the students and during my research discussions with them, I was reminded of some key points to make in this presentation regarding their needs during clinical practice. My thoughts appear to tie in with the conference theme – “Your Link to Lifelong Learning”. The students begin their life long journey to move through the transition from newcomer to old-timer. This initial step in the learning journey is a critical piece in building our community of practice. I know I love teaching; I enjoy working with adults that intentionally choose to be in this realm of study. I also know that, as instructors, weʼre not supposed to have favorites, but every now and then there is a group of students that quickly create a group dynamic that embraces respect and diversity and they take care of each other through immense challenges. In that setting, I am given a space that I feel safe in, that is, safe to tell my stories. We laugh a lot, cry a little and persevere the rigorous schedule of learning. All instructors appreciate when camaraderie and cohesiveness is extended to classmates and instructors. Even when equipment fails in the labs, when there are labor disputes, when the thought of another exam is too much to bear, students tend to accept the role of student with grace. They innately rise to the task and show immense professional growth. Early in my teaching role, I was given some advice “relax and remember, you know more than them”. I could never quite wrap myself around that one. I know I am a subject specialist, but I also know that every student brings a wealth of life experience and other sources of learning that can only enrich the learning environment. In a large class setting these elements can sometimes be difficult to tap into. However, in the small group work and the essential one-on-one sessions, I gain an immense understanding of who the student is, and I always appreciate what I learn. I know that I strive to make connections and make sense of the material and the educational processes. I always look for ways to make meaning in the content in hopes that
the learner will move from memorization to inherent understanding. I know that sometimes my introductory and closing stories donʼt make sense until days later. But for me, that reflects back that the necessary “ah-ha” in the learning process is eventually occurring.
Newly graduated students tend to grumble at the knowledge that they will unfortunately have to balance the scale and return the favor. As a life-long student, I know I will be paying back for years to come!
I also strive to be clear and consistent and the student pretty much knows my expectations. I work hard to make decisions fairly. Equity is a deep-seated piece of my world and perhaps that stems from my mother. With four children, Mom had the responsibility to attend to and keep all of us in check. Equity was important to her, to the point that she counted out potato chips!
Our program is striving for a cohesive team approach with the students at the center of our focus. The BCIT Medical Radiography Program is based at the institute and holds strong partnerships with many hospital imaging departments throughout the province. The program is well balanced with the students regularly shifting between didactic and clinical settings. Once in the clinical environment, the student relies on the wisdom of many different sectors of the imaging community.
The apple hasnʼt fallen too far from the tree. Although I donʼt count potato chips, I believe in fair and equitable management of all situations. My hope is that you take this on as a point of view in your approach to situations that you will face every day. Look for the reasonable solution.
Linking the influence of instructors to the studentʼs learning experience.
When I began my graduate work at Simon Fraser University, the chief professor described that we were embarking on a journey and that the success of the journey depended on the choices made at each crossroad. The studentsʼ journey in radiation sciences essentially begins when the various instructors review the paper application and recognize potential. We are getting to know them before we meet them. With the rigorous selection process completed, the final preparations to welcome the “wannabes” to the program are underway. Oprah recently discussed the concept that “it takes a village to raise a child…”. The same applies in preparing our students for the certification process, which is a significant crossroad for them. There is a strong community of practice in our disciplines to support the student to develop the requisite skills and judgment. Consider all the people that connect with the student on their journey: lectures, lab simulations, debates on theory, hospital site practicumʼs, home study, personal care, stress relieving activities, pent up energy burning activities like co-ed flag football, part-time jobs and all the other elements that propel the student through the rigorous didactic and clinical assignments. Consider the village that helps the student on their journey to become a graduate technologist or therapist. On another note, we are now seeing several students following in their parentsʼ footsteps. This is a good indicator that we are promoting our profession in a positive light and it is seen as a worthwhile and interesting occupation. Students usually recognize that their family and friends have been diligent to keep them, and everyone around them, on track to graduation. It is at that point that the families can step back from their duty.
The focus of todayʼs presentation is on the linking between the instructors and staff technologists and some of their influences on the studentʼs learning experience. Being a student is not an easy path to choose, and depending on their length of time away from “the books”, it can be that much more challenging. They respond to countless questions on every nuance of the subjects presented. We intentionally probe thought processes, checking and re-checking comprehension and re-checking them again to prepare them for the CAMRT certification examinations. At the institute, we intentionally set up opportunities for experimentation and development of individual work within a unified team environment. For the students this experimental mode continues into the clinical setting – albeit a closely supervised trial process where the clinical instructors and staff technologists watch for errors and intervene as necessary. It is the style of that intervention that the studentʼs voice the greatest concerns with. Generally, students have permission to make some mistakes and hopefully learn from them. Once graduated, this shifts to very little tolerance for mistakes. My SFU research work launched a quest to understand the struggle that student technologists experience when they move from school to the clinical practice setting. This image depicts the borders and boundaries of the various communities the students move in and out of on a regular basis. At clinical, we work to evolve skills from assisted to independent performance thus forging pathways between school and clinical. When students leave the school setting and enter the clinical practicum there is a sense of newfound freedom from the confines of the classrooms and living out of a locker. And trivial reading seems a good option for a change of pace. But, in reality, students move into another controlled and confined space. The apron strings are short at first, ensuring safe practice, before the lines are lengthened for them to engage in more independent clinical practice.
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In our program, the students choose two or three different clinical facilities to attend during their educational program. We encourage the students to sample a variety of hospitals, small and large, city and community based, with film and digital archive. When the students arrive at a new clinical site, they are inherently anxious. They are the “new kid on the block” and desperately want to make a good “first impression” and also get into the workflow pattern to rack up the cases they need to build competence in their clinical objectives. Lave & Wenger have done extensive research on situational learning and the impact on learning related to the noviceʼs placement in a community of practice. Their educational theories are directly applicable to our clinical practicum. The student progresses through skill building exercises alongside the experts. As “newcomers” moving towards full and legitimate participation in the radiological community, they have distinct needs along their learning path. Moving to a full member or “old-timer” status includes adoption of, and blending with, the socio-cultural practices and the technical expertise in any given department. From the studentʼs perspective, there are obstacles in reaching their clinical learning objectives. For example: -
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Hierarchy – Because of a studentʼs seemingly subordinate position, staff technologists can choose to take advantage of the students. I often remind my colleagues that the students are not their slaves or gophers! Students need to be part of the process of developing clinical autonomy in our profession. They cannot achieve clinical autonomy when they are denied the opportunity to think their way out of a situation. While the hierarchy and paternalistic traditions are ever present – they are evolving. Attitude – The students look to the staff technologists, the frontline caregivers, to be exemplary role models in their patient management, their peer interactions and most importantly their approach to students. They have excellent recall of their early clinical experiences and make choices for their own practice based on these experiences.
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Harsh Words – Students are continually looking for suitable role models to guide their practice. Harsh words cause the student to look elsewhere for guidance or avoid the technologist altogether – this can be difficult in a small department and has negative results towards team building.
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Degrees of Reprimand – Some “infractions” rightfully have a greater chastisement attached than others, however, some staff deliver differing levels of reprimand for the same infraction. The students commented that they are only students - not children. As adult learners, they respond best to respectful interactions.
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Do you want to be remembered as the technologist they vow never to be like or the one they most want to emulate? In the matter of a few days, there is a shift in expectations. They move from full time student, to a graduate, to a working person with inherent responsibilities. Think about the paradigm shift – as a student thereʼs an expectation that the student will receive advice and actually show an interest in the advice. New graduates will now be giving that advice and expecting it to be received well. I do not support the “do as I say model” of education and neither should you. Be the requisite professional – advocate the role model of “do as I do”.
Colliding Directives Students work with a variety of staff and learn something new each time. Trying different “tricks” in this experimental mode is important as they develop their own style and approach to any given patient scenario. The student is typically trying to manage the case in a reasonable way and at the same time trying to recall and include the specific preferences of the technologist they are working with at that moment. There are a variety of ways to achieve the same end result, which is – giving the patient optimum care while obtaining a diagnostic image or accurate dose. Just the fact that there are a variety of methods being shown to the student identifies that the community of practice embraces individuality within the team environment. My way is the only way The students need credit for their initiative to sort it out for themselves and fill their bag of “tricks” with the ones that work best for them. Staff technologists should not be insulted or be too harsh when a student chooses not to adopt a particular technique in their process of developing their individual skills. Variances There are typically variables between sites as radiologists and other specialistʼs preferences dictate the common practices. The school focuses to develop fundamental knowledge and skills for any clinical setting. Those skills then require modifications to adapt to a particular situation. It is very frustrating for students and demeaning to instructors when a staff technologist says “forget everything you learned at school – we will set you straight here.” The college or university components exist to keep the education at a consistent and professional level. Students unanimously prefer suggestions for improving their practice over dictated doʼs and donʼts.
Cloning Ourselves So we need to perhaps ask ourselves if we are attempting to clone ourselves or do we need to adopt an attitude of building for the future of our profession. A personal goal in my teaching practices is a promise to myself to always “paint myself” into the picture. I spend a lot of energy ensuring I connect the academic content to some sense of realistic importance. However, there is a fine line between role modeling and demanding that they “do as I do”. I am certainly proud of my work, but if I could change anything in our profession, it would be that our students had more knowledge, more skills, more strength to hold an influential position in the health care team - just plain more! So how do we achieve that?
Clinical Decisions When our students arrive at clinical, they know the basics but they are looking for guidance to manage the cases and this is certainly true for situations that are more difficult. Students learn minimal adaptation skills if the staff technologist “takes over” the case. With the critical funding issues in Canadian Health Care, there are more acute care situations – many hospital and bed closures have generated a trend that those patients in hospital are more sick and need higher-level care than a decade ago. More home care and day care is in place to address health care funding and resource use. For the most part, it keeps the average patient closer to home and leaves the acute care facilities for the more seriously ill. Hence on average, when a student gets (for example) to image a wrist on an in-patient, it is typically more challenging and needs significant modification than in the average ambulant patient situation. We talk about this in class and prepare them as best we can. But truly there is nothing like “being there” to bring the notion of adaptation clear in the studentʼs mind. The students continue to meet challenges as they adapt to patient limitations. For the MRT, this work with students can be an exhausting process. I know there are many days when I go home mentally drained after a hectic and challenging day with the students. I might complain about my fatigue. But I donʼt complain about the students, they are my reason for being.
Uninvited Intervention Students describe that those staff technologists that are clearly confident in their own practice are sooner confident in the studentʼs work. I intentionally placed a line on the floor in these pictures to demonstrate that instructors and staff need to keep their distance and wait for the students to indicate need for assistance. When I first began teaching, I had to clasp my hands together to keep from interfering in the studentʼs work.
When the staff technologist does have to intervene, it needs to be done in a professional way. Remember the patient is likely hearing the exchange and doesnʼt need to hear a student being chastised or demeaned for a mistake in the learning process. The students related the multitude of times when a staff technologist would intervene without prompting. This undermines the studentʼs ability to problem solve and build adaptation skills. Certainly there can be a fine line to ensure patient safety, but the uninvited intervention on a routine case is a major frustration for the students. Afterwards they think to themselves “I would have had it in another second or two.” Patience during the learning curve is essential for both students and staff. Students usually like to be questioned as long as they are posed in a positive way and not intended to demean them or to blatantly point out their failures. I like giving out beef sandwiches – the complaint or “beef” is couched or balanced with some soft kudosʼ and compliments. As a student, I was often told that I needed to receive constructive criticism better. I have since recognized that there wasnʼt all that much construction happening in those instances. If anything, more destruction, and retrospectively, I can justify that my responses were reasonable at the time for the situation. I now have a definition of constructive criticism that I live by to remind me of my preferred approach to deliver any observation or suggestion to students and peers. It is called – “the art of evaluation to promote improvement”.
Dependant to Independent Perhaps the greatest frustration described by the students was the ability to achieve an “unassisted case” for their workbook record. Depending on the case, the student will have done enough of a particular type of case to be able to move through it with reasonable competence. But, like staff, students have those “bad hair” days and cannot seem to do anything right. The staff technologists need to be gentle and supportive as these students move in and out of competence depending on a variety of circumstances. If the student perceives negative attitudes from the staff on a prior case, it will seem immense during a subsequent case, thereby impeding their demonstration of the skills that are very often nearly fine-tuned. Some staff technologists in some facilities are of the understanding that if the student did not do absolutely every bit of the case, without staff intervention, then the case would not be credited to their unassisted work. We are working with the staff to clarify the parameters of unassisted work, that is, if their intervention or adjustments do not change the overall outcomes then it is considered unassisted. In the meantime, the student is sometimes losing cases if the staff tightens the collimation a millimeter or adjusts the patientʼs pillow.
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Patience With the Learning Curve Another perspective raised by students is that sometimes the staff make significant changes to the set up and in the studentʼs mind, these changes are often the cause for the need of a repeat. This would be completely reasonable to the students if the staff took ownership of making the adjustments that caused the need for a repeat. Instead, the students are held accountable for the errors that they had little to do with. The students describe a concern that if they are performing cases that they are quite familiar with, they actually feel the need to slow down and do it absolutely perfectly to prevent any negative judgment. They also described the sense of feeling safer doing the more unfamiliar, knowing that the mistakes will have less impact on their performance assessment than on a case that “should” be done well. Eventually the students will earn the right of passage to full and independent practitioners.
The BCIT Team Approach As part of the quality assurance plan, the didactic and clinical instructors from all partnered facilities meet regularly to review, revise and implement changes to the existing program. At the time of the scheduled meetings, the institute program staff also hosts seminars and workshops on specific and timely topics to assist the instructors in their role of mentoring the students in both classroom and clinical practice. Recent sessions have challenged the participants to consider their approaches in a variety of clinical teaching situations. For one session, several video clips were produced of various student/instructor scenarios for discussion. By identifying the problems and developing possible solutions, the instructors in both realms (didactic and clinical) can reflect on their practice. Other topics in these workshops addressed the Clinical Instructor as Coach and Conflict Resolution.
Clinical Staff In-Services One of the ways we have addressed the issue of clinical site staff not being familiar with the curriculum content and the stage of learning that any given student is at, is to hold inservice sessions with the staff prior to a new group of students arriving. During these sessions we outline what they have been taught, what the clinical expectations are and clarify the various methods implemented to assess their progress on the specific objectives for that clinical rotation. This is augmented with written documentation to reach staff unable to attend the sessions.
Planning Employment During clinical experiences, the students consider their postgraduate employment. In a time when recruitment is very competitive, the new graduates can pick and choose based on their experiences to date and from the shared stories from their peers. Todayʼs student is an informed consumer, and among other things, needs to see evidence of supported
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opportunities for professional development before they sign onto the payroll. The existing staff technologists are the frontline caregivers and they are also the frontline recruitment officers. What are you doing to entice the new grad to seek employment in your department? I know the intensive pace that the students manage over the years of a program, and even though graduation is an immense milestone, we are never done. As we move through the phases of our career, it is clearly understood that there are a multitude of choices to be made and opportunities abound. It is important that we choose carefully which doors we close. Interests will change. Some make the leap to ultrasound. Others have pursued MR, PET, dosimetry. Others travel and offer their skills to the international community. Yet others find supervisory & management roles appealing. Research is a crucial and viable option in our ever-changing modalities and practices. And there will be a few others who will recognize the satisfaction in working with students and pursue teaching. My students have been my child substitutes, so as a pseudoparent this would certainly satisfy me! Whatever you choose, be proactive! Radiation science technology is an ever-expanding environment. We are a multi-discipline enterprise. The CSI series has opened our minds to the science of forensic investigations. Itʼs not for everyone, but I recommend that you take on the responsibility of learning about the other radiation science technologies. Itʼs fascinating and the best part, your patients will benefit from the comprehensive approach to their care. Also, please look beyond the walls of radiation and imaging departments. Attend the hospital in-service sessions, go to rounds, take every opportunity to learn something new about the actions of other health care providers. You will have more knowledge to correlate the clinical information with the work that you are doing. Be curious. If something doesnʼt quite ring clear, pursue the unknown. In particular, track your patientʼs outcomes to appreciate your role in their wellness. I guarantee it will enhance your daily work experience and keep you excited to go to work every day. The patient is our reason to be. They are the driving force in our role in the health care team. While I tend to spend more time in the classroom, I have the perfect balance in teaching assignments that takes me from the lecture room into lab simulation, to on-line support for our senior students and the best piece, out into the clinical setting. With this balance, instructors can keep the learning relative to the
current industry needs. I always find immense gratification interacting with and attending to each patientʼs needs. I want to share a piece of a message I recently presented to the BCAMRT graduating classes. Perhaps it is a good reminder to all of us. “Your formal education cannot end at the diploma. Start the next phase of your continuing education soon. While the current job market is ready for all of you to be gainfully employed immediately, do not rest on your new status. Keep yourself primed for those opportunities. A lack of self directed continuing education will close doors before you ever get a chance to consider them. Keep yourself ready for advancement. Donʼt wait for the employer to suggest that you take some courses nor should you insist that they support you financially to advance your education. Yes, they will benefit from your enhanced knowledge base, but you will benefit more. You will enjoy your work more, and most importantly, other members of the health care team will respect you as effective contributors in decisions made. Part of this Commencement Ceremony is the “Pinning Ceremony”. I am reminded of the story of when my dad pinned my mother in high school. It was a symbolic event evoking a promise that evolved into a lifetime commitment. The BCAMRT, your professional association, holds this Commencement and Pinning Ceremony to welcome you into their ranks with a promise and commitment to provide opportunity for your professional development. As a former BCAMRT and CAMRT President, I have had the privilege of pinning several graduates and proudly welcomed them into the ranks. This celebration includes a clear message to you that the BCAMRT and the CAMRT have space for you. There is a reciprocal expectation that you find a path to contribute to your professional organization. It is not a strange or obscure “council of bureaucrats”. The people making decisions for the profession come from the front line radiation workers – you. Our responsibility to professional development resides within us and can be accomplished by us. This is a simple model of autonomy. We certainly look beyond our walls to ensure our professional development agrees with current practice, but we must promote ourselves. Consider how you can contribute to the various initiatives of your professional organizations. Attend those regional seminars, find your way to the conferences, and support the foundation events to raise money for professional development bursaries. And meet some great people along the way! A close connection will reap many benefits. I can attest to this. I have spent the majority of my three decade-plus career engaged in professional association activities – all of them as a volunteer. I know I am an exception to the rule. For most of my professional career I have volunteered on various committees, been a member of various boards, participated in special projects and always supported the goals of the associations.
I admit there were times when I wondered about the amount of time I was spending, but two things kept the drive alive, making a dent in the perspective of others about our unique and important place in health care and the many wonderful people I have met along the way. I have made long time friends and professional connections with colleagues across the country and around the world. This would not have happened without the commitment to professional volunteer work. It has been a rewarding relationship that I would recommend to everyone. For a successful and rewarding career, embrace the standards of practice and strive for more knowledge, work towards perfection in clinical practice, build effective communication skills and practice with your own personal integrity and accountability at stake. Consider your future, make informed choices, walk your own path with confidence – take on a reasonable level of individualism as you evolve to be an integrated member of the health care team. My pride and admiration for the graduates is profoundly satisfying, I hope that each of you find an exciting path for your next phase of this journey – you are now part of the village to raise the next ones to sit in those seats.” From this message two things ring for me… Student Membership and the Degree Initiative. During my tenure on the CAMRT Board, I was an active proponent to the establishment of a student category at the CAMRT level. Since that time, I can see that the work continues on this initiative, I do hope this can come to be. Typically, the students currently view the CAMRT as a distant, scary and exclusive entity complete with barriers. Part of my overall goal is to show the students that WE, the CAMRT, are not a bunch of buzzards, but a gracious and welcoming partner in their aspiration to be fully qualified members. This is the year – 2005 – that the CAMRT membership declared that all programs will have baccalaureate degree education to access the CAMRT Certification Examination. Amendments to that goal have been made to capture the challenges facing various jurisdictions. I still believe it is the right place to be headed. Just last week a new diploma grad contacted me to sort out her options to obtain a degree. She is interested in working her way around the world and recognizes she needs to be more qualified to do that. While I hate to lose her to the rest of the world, I know she will be back in due time. She will bring back with her a wealth of experience and education to offer to her workplace, wherever that will be. But even closer to home, the demands on technologists and therapists to contribute to health care decisions will become more commonplace. We just need to be recognized that our voice, and our collective voice, comes from a valid position.
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There will be opponents to any decision. This one may feel a tad threatening to those long since graduated technologists wondering what the new students are going to be challenging them with. Just remember, that you have the years of experience and knowledge that they donʼt – share your wisdom and ask some questions for yourself. Our community will only get better by connecting to the people in our environment and putting our heads together to make a difference. I refer to Alain Crompʼs 2001 Welch Address where he clearly appealed to all of us that professional development is essential and constant renewal is fundamental to our practice. Other opponents will contest that we donʼt need a degree to do our job. Perhaps that is true, but consider the quality of that job and the quality of your enjoyment of that job, by having a wider scope of skills and thinking processes. According to the Canadian Oxford Dictionary, a job is a paid position of employment while a profession is a vocation that involves some branch of advanced learning or science. A professional is defined as one highly skilled and engaged with commitment to a profession. I am a professional! At any given moment, I am doing a good job of the task at hand, but the job is only a small element of my overall profession. Depending on the curriculum design, degree graduates will be more ready for many aspects of the workplace – although a few older students do struggle - the newbies typically come with computer savvy. A degree program can make room for the essential telemedicine education needed to survive in the current workplace. Degree education promotes a multifunctional foundation, the student is focused to a career path, better able to take on responsibility, not just the “button pusher” but a critical thinker able to problem solve. Letʼs not create this situation … ʻnurse – get on the internet – go to SURGERY DOT COM…. scroll down and click on the “Are you totally lost?” icon…ʼ. With my focus on student advocacy, I worry that our future degree students will be treated differently when they arrive at clinical. I worry that with more academic education, there may be a false impression that the student is therefore more ready to take on the clinical practice. I caution you that the students will still be intimidated, still need to find their way in the new environment, still be looking to you to be their role model. They are still students – not perfect out of the gates – they need you to mould them to perfection – just like you have always done.
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Key Points So regardless of what education doctrine you may have embraced or come from, I would like to leave you with some key thoughts: • Students are developing individual style and need reasonable space to do so; •
Education doctrines vary and technologists that have themselves trained in a different program are not always open to learning the nuances of the program they are now working within. The staff in-services do help in this regard;
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The students are keen to get to the same outcomes as the staff radiographers, that is, provide optimum patient care delivery with diagnostic images and accurate therapy treatments;
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Most staff are caring and considerate. While my comments today may come across that all staff are less than supportive, I remind you that the purpose of this presentation was to invite you to reflect on your practice and to reinforce the need of students to “fit in” during their move from apprentice to expert.
During his last Presidential address Herbert Welch hoped that in some small measure he had “…endeavored to help some of our younger members along the road towards the goal for which they are aiming…” I share his hope. Delivering the Welch Memorial Lecture is for me a personal milestone! I offer humble gratitude to the CAMRT Board of Directors for this honor and the opportunity to share my passion for our students! I must thank my partner, Michael Stockwell for indulging my distractions to attend to my passion of teaching and volunteerism!
4UVEFOU"EWPDBDZo"5FBN"QQSPBDI Valerie Palm, RTR, ACR, FCAMRT Presenter of the 2005 Welch Memorial Lecture at the Delta Prince Edward Hotel in Charlottetown, PEI. President Gallagher, Colleagues, Friends, and invited guests: Well over a year ago, Claire Hatch invited me to present the Welch Memorial Lecture in 2005, I was momentarily lost for words. I accepted, but after we finished the call I began wondering what I had gotten myself into, and instantly wished I had paid heed to my husbandʼs bid that I learn to say NO. A few weeks later the formal letter arrived. My thoughts flew to all the letters I had sent confirming someone to this very same thing: I now offer an apology to all of you. When I first began volunteering in association activities, I had great fun helping to plan and organize local educational sessions in the Okanogan. This is where the snowball began rolling. Here I am, with over 3 decades of experience in our professional organizations. It is gratifying to know that my contributions over the years are being acknowledged with such a distinct honor. I am proud and humbled to be taking on this role today. I did look at the list of the many Welch Memorial Award recipients. I read all the previous lectures I could get my hands on. All the presentations demonstrated eloquence and boldly conveyed noble statements. I have listened to many of my mentors deliver the Welch Memorial address and I recall the many times I hoped that I would never have to make a decision to accept such a verdict – and what could I possibly have to say in such a venue to fill the designated time? So, why does the CAMRT continue the time-honored tradition of the Welch Memorial Lecture? To give people anxiety attacks in preparation for the presentation? I think not. Herbert M. Welch was a founding member of our professional organization, a CAMRT President and a pioneer in many clinical practices during the First World War. He died before I was born - yet his legacy of leadership lives on with us more than 5 decades later. The historical background of our association reflects his sustained engagement in promoting professional identity. The outline provided by CAMRT states that: “the award is extended to a person who most closely emulates these same selfless qualities as displayed by the late Herbert M. Welch”. I have and continue to be a pro-active voice for the advancement of the profession, but I donʼt consider my contributions to be unselfish as I have reaped many benefits and gained so many cherished friends.
There are many key individuals that have influenced specific areas of my professional life. I thank each of them for sharing their wisdom and guiding me through some challenging phases of professional growth. With a short walk down memory lane I would like to share some of my initial contacts with the profession. The very first was during the BCIT entrance interview with Pat Rogers (now Pat Noel). Miss Rogers taught radiographic procedures. I was a blushing 17 year old when I started the program at BCIT and Pat was telling us: “for the best rib images” we had to move “pendulous” breasts out of the way. I thought I would likely die of embarrassment asking a patient to do that. Now, doing a mammogram for a patient seems like a very normal part of a technologistʼs contact with a patient. During a BCIT “field trip” to Vancouver General, I had to do an IVP evaluation with Shirley Hundvik. So, there I was shaking in my stiff duty shoes and starched white dress uniform. I kept catching my Blue & Gold striped “nursing” cap on the collimator. After a few “time-outs” in the control booth to catch my breath, I managed to successfully finish the evaluation. But, I looked like a disheveled basket case at the end, with cap askew and beads of perspiration running down my temples. Shirley has since become one of my important colleagues and dear friends. Near the end of my final year practicum in Kelowna, BC, Art Cliffe asked me how I was going to make a difference in my chosen career? It wasnʼt until I was about five years into my career that I reflected on his question to me. In the early 80ʼs, I began a serious look at my future directions. Active participation in my professional association seemed like a good start. So, I got my dues up to date – yes, I was on the “delinquent list” for a short spell in the early years of my work life – but thatʼs a story for another time. The BCAMRT offered a wealth of opportunity to meet new people, with common interests, working for a common good. But, I was not yet clear on how I would make a difference. Special people along the way showed me skills I could not have readily gained elsewhere. In particular, organizational skills and the importance of accurate and complete documentation became second nature. I was reminded that I would only get out of the work what I put into it. I watched other very active members, with amazing and sustained energy and commitment, regularly prepare education programs for members. Still others modeled
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advocacy for advancing our professional identity with the public and, of course, to our patients. I was continually reminded that without some fun along the way, what would be the point of it all? My CAMRT life has been an amazing journey thus far. I have had the benefit of working with many wonderful people from coast to coast, all doing their part to make a difference in our profession. There are so many people that have added to my enjoyment and are the reason that I continue active participation in our association. Early on, there were a few people who saw potential in me and had enough faith in my abilities to encourage me to seek work on the CAMRT Advanced Certification Committee. That experience significantly altered my view of our profession. When my focus in education moved from education committee work to employment at the BCIT, little did I know that Art Cliffeʼs question to me – “how will you make a difference?” was being answered. I found a niche in education that I am committed to and thrive on. Many amazing people have influenced my growth as an instructor. In particular, my colleagues on the BCIT team. Our Program Head, Mary Filippelli offers outstanding leadership as we develop a comprehensive and collaborative program with our clinical partners. Mary encourages individuality as we attain our common goals. I watch Dori Kaplun wave her magically creative wand to energize the learning process. I hear Euclid Seeram continually ask “whereʼs the research on that?” Rita McLaughlin demonstrates unfaltering integrity when we try to quiz her for “insider” information on COE happenings. Jennifer Talman, from the physics department, somehow makes the subject interesting, applicable and fun. Elaine Fraser, from the nursing department, endorses care for the entire patient and boldly guides our students to take full ownership of the patientʼs needs while in our care. And the program is only complete with the dedication of the clinical instructors at all of our affiliated sites. I am blessed to be rubbing elbows with this caliber of co-worker. I learn every day. And I am privileged to work in such a cohesive team environment as we “ride the waves of change”. While my colleagues do influence my practices, it is the studentʼs quest for excellence that drives my desire to be the best that I can be. We have been doing our best with the resources available to keep up with the technological advances in teaching tools. The BCIT proudly went live with a PACS that ties all the campus imaging departments together. This has great potential to show all students all the modalities. In fact, we are in the planning stages of placing medical laboratory images and anatomy slides on the server to create a more comprehensive
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teaching tool. Our medical radiography students are linked to the program via a complex website where we offer many services such as on-line practice examinations, engage in online image review and the next phase will include audio links for virtual classrooms with the students out at clinical as they prepare for the CAMRT certification process. There has been a careful approach to this work to ensure proper encryption and confidentiality protection. I am excited to be here and welcome the opportunity to share our work at the BCIT towards building self-direction and clinical autonomy for our students. I hope that some of what I share will bring you to reflect on your current practices when working with student technologists. I also hope that you will find my comments applicable to your local student programs whatever the discipline. I continue to learn from the students and during my research discussions with them, I was reminded of some key points to make in this presentation regarding their needs during clinical practice. My thoughts appear to tie in with the conference theme – “Your Link to Lifelong Learning”. The students begin their life long journey to move through the transition from newcomer to old-timer. This initial step in the learning journey is a critical piece in building our community of practice. I know I love teaching; I enjoy working with adults that intentionally choose to be in this realm of study. I also know that, as instructors, weʼre not supposed to have favorites, but every now and then there is a group of students that quickly create a group dynamic that embraces respect and diversity and they take care of each other through immense challenges. In that setting, I am given a space that I feel safe in, that is, safe to tell my stories. We laugh a lot, cry a little and persevere the rigorous schedule of learning. All instructors appreciate when camaraderie and cohesiveness is extended to classmates and instructors. Even when equipment fails in the labs, when there are labor disputes, when the thought of another exam is too much to bear, students tend to accept the role of student with grace. They innately rise to the task and show immense professional growth. Early in my teaching role, I was given some advice “relax and remember, you know more than them”. I could never quite wrap myself around that one. I know I am a subject specialist, but I also know that every student brings a wealth of life experience and other sources of learning that can only enrich the learning environment. In a large class setting these elements can sometimes be difficult to tap into. However, in the small group work and the essential one-on-one sessions, I gain an immense understanding of who the student is, and I always appreciate what I learn. I know that I strive to make connections and make sense of the material and the educational processes. I always look for ways to make meaning in the content in hopes that
the learner will move from memorization to inherent understanding. I know that sometimes my introductory and closing stories donʼt make sense until days later. But for me, that reflects back that the necessary “ah-ha” in the learning process is eventually occurring.
Newly graduated students tend to grumble at the knowledge that they will unfortunately have to balance the scale and return the favor. As a life-long student, I know I will be paying back for years to come!
I also strive to be clear and consistent and the student pretty much knows my expectations. I work hard to make decisions fairly. Equity is a deep-seated piece of my world and perhaps that stems from my mother. With four children, Mom had the responsibility to attend to and keep all of us in check. Equity was important to her, to the point that she counted out potato chips!
Our program is striving for a cohesive team approach with the students at the center of our focus. The BCIT Medical Radiography Program is based at the institute and holds strong partnerships with many hospital imaging departments throughout the province. The program is well balanced with the students regularly shifting between didactic and clinical settings. Once in the clinical environment, the student relies on the wisdom of many different sectors of the imaging community.
The apple hasnʼt fallen too far from the tree. Although I donʼt count potato chips, I believe in fair and equitable management of all situations. My hope is that you take this on as a point of view in your approach to situations that you will face every day. Look for the reasonable solution.
Linking the influence of instructors to the studentʼs learning experience.
When I began my graduate work at Simon Fraser University, the chief professor described that we were embarking on a journey and that the success of the journey depended on the choices made at each crossroad. The studentsʼ journey in radiation sciences essentially begins when the various instructors review the paper application and recognize potential. We are getting to know them before we meet them. With the rigorous selection process completed, the final preparations to welcome the “wannabes” to the program are underway. Oprah recently discussed the concept that “it takes a village to raise a child…”. The same applies in preparing our students for the certification process, which is a significant crossroad for them. There is a strong community of practice in our disciplines to support the student to develop the requisite skills and judgment. Consider all the people that connect with the student on their journey: lectures, lab simulations, debates on theory, hospital site practicumʼs, home study, personal care, stress relieving activities, pent up energy burning activities like co-ed flag football, part-time jobs and all the other elements that propel the student through the rigorous didactic and clinical assignments. Consider the village that helps the student on their journey to become a graduate technologist or therapist. On another note, we are now seeing several students following in their parentsʼ footsteps. This is a good indicator that we are promoting our profession in a positive light and it is seen as a worthwhile and interesting occupation. Students usually recognize that their family and friends have been diligent to keep them, and everyone around them, on track to graduation. It is at that point that the families can step back from their duty.
The focus of todayʼs presentation is on the linking between the instructors and staff technologists and some of their influences on the studentʼs learning experience. Being a student is not an easy path to choose, and depending on their length of time away from “the books”, it can be that much more challenging. They respond to countless questions on every nuance of the subjects presented. We intentionally probe thought processes, checking and re-checking comprehension and re-checking them again to prepare them for the CAMRT certification examinations. At the institute, we intentionally set up opportunities for experimentation and development of individual work within a unified team environment. For the students this experimental mode continues into the clinical setting – albeit a closely supervised trial process where the clinical instructors and staff technologists watch for errors and intervene as necessary. It is the style of that intervention that the studentʼs voice the greatest concerns with. Generally, students have permission to make some mistakes and hopefully learn from them. Once graduated, this shifts to very little tolerance for mistakes. My SFU research work launched a quest to understand the struggle that student technologists experience when they move from school to the clinical practice setting. This image depicts the borders and boundaries of the various communities the students move in and out of on a regular basis. At clinical, we work to evolve skills from assisted to independent performance thus forging pathways between school and clinical. When students leave the school setting and enter the clinical practicum there is a sense of newfound freedom from the confines of the classrooms and living out of a locker. And trivial reading seems a good option for a change of pace. But, in reality, students move into another controlled and confined space. The apron strings are short at first, ensuring safe practice, before the lines are lengthened for them to engage in more independent clinical practice.
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In our program, the students choose two or three different clinical facilities to attend during their educational program. We encourage the students to sample a variety of hospitals, small and large, city and community based, with film and digital archive. When the students arrive at a new clinical site, they are inherently anxious. They are the “new kid on the block” and desperately want to make a good “first impression” and also get into the workflow pattern to rack up the cases they need to build competence in their clinical objectives. Lave & Wenger have done extensive research on situational learning and the impact on learning related to the noviceʼs placement in a community of practice. Their educational theories are directly applicable to our clinical practicum. The student progresses through skill building exercises alongside the experts. As “newcomers” moving towards full and legitimate participation in the radiological community, they have distinct needs along their learning path. Moving to a full member or “old-timer” status includes adoption of, and blending with, the socio-cultural practices and the technical expertise in any given department. From the studentʼs perspective, there are obstacles in reaching their clinical learning objectives. For example: -
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Hierarchy – Because of a studentʼs seemingly subordinate position, staff technologists can choose to take advantage of the students. I often remind my colleagues that the students are not their slaves or gophers! Students need to be part of the process of developing clinical autonomy in our profession. They cannot achieve clinical autonomy when they are denied the opportunity to think their way out of a situation. While the hierarchy and paternalistic traditions are ever present – they are evolving. Attitude – The students look to the staff technologists, the frontline caregivers, to be exemplary role models in their patient management, their peer interactions and most importantly their approach to students. They have excellent recall of their early clinical experiences and make choices for their own practice based on these experiences.
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Harsh Words – Students are continually looking for suitable role models to guide their practice. Harsh words cause the student to look elsewhere for guidance or avoid the technologist altogether – this can be difficult in a small department and has negative results towards team building.
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Degrees of Reprimand – Some “infractions” rightfully have a greater chastisement attached than others, however, some staff deliver differing levels of reprimand for the same infraction. The students commented that they are only students - not children. As adult learners, they respond best to respectful interactions.
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Do you want to be remembered as the technologist they vow never to be like or the one they most want to emulate? In the matter of a few days, there is a shift in expectations. They move from full time student, to a graduate, to a working person with inherent responsibilities. Think about the paradigm shift – as a student thereʼs an expectation that the student will receive advice and actually show an interest in the advice. New graduates will now be giving that advice and expecting it to be received well. I do not support the “do as I say model” of education and neither should you. Be the requisite professional – advocate the role model of “do as I do”.
Colliding Directives Students work with a variety of staff and learn something new each time. Trying different “tricks” in this experimental mode is important as they develop their own style and approach to any given patient scenario. The student is typically trying to manage the case in a reasonable way and at the same time trying to recall and include the specific preferences of the technologist they are working with at that moment. There are a variety of ways to achieve the same end result, which is – giving the patient optimum care while obtaining a diagnostic image or accurate dose. Just the fact that there are a variety of methods being shown to the student identifies that the community of practice embraces individuality within the team environment. My way is the only way The students need credit for their initiative to sort it out for themselves and fill their bag of “tricks” with the ones that work best for them. Staff technologists should not be insulted or be too harsh when a student chooses not to adopt a particular technique in their process of developing their individual skills. Variances There are typically variables between sites as radiologists and other specialistʼs preferences dictate the common practices. The school focuses to develop fundamental knowledge and skills for any clinical setting. Those skills then require modifications to adapt to a particular situation. It is very frustrating for students and demeaning to instructors when a staff technologist says “forget everything you learned at school – we will set you straight here.” The college or university components exist to keep the education at a consistent and professional level. Students unanimously prefer suggestions for improving their practice over dictated doʼs and donʼts.
Cloning Ourselves So we need to perhaps ask ourselves if we are attempting to clone ourselves or do we need to adopt an attitude of building for the future of our profession. A personal goal in my teaching practices is a promise to myself to always “paint myself” into the picture. I spend a lot of energy ensuring I connect the academic content to some sense of realistic importance. However, there is a fine line between role modeling and demanding that they “do as I do”. I am certainly proud of my work, but if I could change anything in our profession, it would be that our students had more knowledge, more skills, more strength to hold an influential position in the health care team - just plain more! So how do we achieve that?
Clinical Decisions When our students arrive at clinical, they know the basics but they are looking for guidance to manage the cases and this is certainly true for situations that are more difficult. Students learn minimal adaptation skills if the staff technologist “takes over” the case. With the critical funding issues in Canadian Health Care, there are more acute care situations – many hospital and bed closures have generated a trend that those patients in hospital are more sick and need higher-level care than a decade ago. More home care and day care is in place to address health care funding and resource use. For the most part, it keeps the average patient closer to home and leaves the acute care facilities for the more seriously ill. Hence on average, when a student gets (for example) to image a wrist on an in-patient, it is typically more challenging and needs significant modification than in the average ambulant patient situation. We talk about this in class and prepare them as best we can. But truly there is nothing like “being there” to bring the notion of adaptation clear in the studentʼs mind. The students continue to meet challenges as they adapt to patient limitations. For the MRT, this work with students can be an exhausting process. I know there are many days when I go home mentally drained after a hectic and challenging day with the students. I might complain about my fatigue. But I donʼt complain about the students, they are my reason for being.
Uninvited Intervention Students describe that those staff technologists that are clearly confident in their own practice are sooner confident in the studentʼs work. I intentionally placed a line on the floor in these pictures to demonstrate that instructors and staff need to keep their distance and wait for the students to indicate need for assistance. When I first began teaching, I had to clasp my hands together to keep from interfering in the studentʼs work.
When the staff technologist does have to intervene, it needs to be done in a professional way. Remember the patient is likely hearing the exchange and doesnʼt need to hear a student being chastised or demeaned for a mistake in the learning process. The students related the multitude of times when a staff technologist would intervene without prompting. This undermines the studentʼs ability to problem solve and build adaptation skills. Certainly there can be a fine line to ensure patient safety, but the uninvited intervention on a routine case is a major frustration for the students. Afterwards they think to themselves “I would have had it in another second or two.” Patience during the learning curve is essential for both students and staff. Students usually like to be questioned as long as they are posed in a positive way and not intended to demean them or to blatantly point out their failures. I like giving out beef sandwiches – the complaint or “beef” is couched or balanced with some soft kudosʼ and compliments. As a student, I was often told that I needed to receive constructive criticism better. I have since recognized that there wasnʼt all that much construction happening in those instances. If anything, more destruction, and retrospectively, I can justify that my responses were reasonable at the time for the situation. I now have a definition of constructive criticism that I live by to remind me of my preferred approach to deliver any observation or suggestion to students and peers. It is called – “the art of evaluation to promote improvement”.
Dependant to Independent Perhaps the greatest frustration described by the students was the ability to achieve an “unassisted case” for their workbook record. Depending on the case, the student will have done enough of a particular type of case to be able to move through it with reasonable competence. But, like staff, students have those “bad hair” days and cannot seem to do anything right. The staff technologists need to be gentle and supportive as these students move in and out of competence depending on a variety of circumstances. If the student perceives negative attitudes from the staff on a prior case, it will seem immense during a subsequent case, thereby impeding their demonstration of the skills that are very often nearly fine-tuned. Some staff technologists in some facilities are of the understanding that if the student did not do absolutely every bit of the case, without staff intervention, then the case would not be credited to their unassisted work. We are working with the staff to clarify the parameters of unassisted work, that is, if their intervention or adjustments do not change the overall outcomes then it is considered unassisted. In the meantime, the student is sometimes losing cases if the staff tightens the collimation a millimeter or adjusts the patientʼs pillow.
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Patience With the Learning Curve Another perspective raised by students is that sometimes the staff make significant changes to the set up and in the studentʼs mind, these changes are often the cause for the need of a repeat. This would be completely reasonable to the students if the staff took ownership of making the adjustments that caused the need for a repeat. Instead, the students are held accountable for the errors that they had little to do with. The students describe a concern that if they are performing cases that they are quite familiar with, they actually feel the need to slow down and do it absolutely perfectly to prevent any negative judgment. They also described the sense of feeling safer doing the more unfamiliar, knowing that the mistakes will have less impact on their performance assessment than on a case that “should” be done well. Eventually the students will earn the right of passage to full and independent practitioners.
The BCIT Team Approach As part of the quality assurance plan, the didactic and clinical instructors from all partnered facilities meet regularly to review, revise and implement changes to the existing program. At the time of the scheduled meetings, the institute program staff also hosts seminars and workshops on specific and timely topics to assist the instructors in their role of mentoring the students in both classroom and clinical practice. Recent sessions have challenged the participants to consider their approaches in a variety of clinical teaching situations. For one session, several video clips were produced of various student/instructor scenarios for discussion. By identifying the problems and developing possible solutions, the instructors in both realms (didactic and clinical) can reflect on their practice. Other topics in these workshops addressed the Clinical Instructor as Coach and Conflict Resolution.
Clinical Staff In-Services One of the ways we have addressed the issue of clinical site staff not being familiar with the curriculum content and the stage of learning that any given student is at, is to hold inservice sessions with the staff prior to a new group of students arriving. During these sessions we outline what they have been taught, what the clinical expectations are and clarify the various methods implemented to assess their progress on the specific objectives for that clinical rotation. This is augmented with written documentation to reach staff unable to attend the sessions.
Planning Employment During clinical experiences, the students consider their postgraduate employment. In a time when recruitment is very competitive, the new graduates can pick and choose based on their experiences to date and from the shared stories from their peers. Todayʼs student is an informed consumer, and among other things, needs to see evidence of supported
• Fall 2005 | The Canadian Journal of Medical Radiation Technology | Automne 2005
opportunities for professional development before they sign onto the payroll. The existing staff technologists are the frontline caregivers and they are also the frontline recruitment officers. What are you doing to entice the new grad to seek employment in your department? I know the intensive pace that the students manage over the years of a program, and even though graduation is an immense milestone, we are never done. As we move through the phases of our career, it is clearly understood that there are a multitude of choices to be made and opportunities abound. It is important that we choose carefully which doors we close. Interests will change. Some make the leap to ultrasound. Others have pursued MR, PET, dosimetry. Others travel and offer their skills to the international community. Yet others find supervisory & management roles appealing. Research is a crucial and viable option in our ever-changing modalities and practices. And there will be a few others who will recognize the satisfaction in working with students and pursue teaching. My students have been my child substitutes, so as a pseudoparent this would certainly satisfy me! Whatever you choose, be proactive! Radiation science technology is an ever-expanding environment. We are a multi-discipline enterprise. The CSI series has opened our minds to the science of forensic investigations. Itʼs not for everyone, but I recommend that you take on the responsibility of learning about the other radiation science technologies. Itʼs fascinating and the best part, your patients will benefit from the comprehensive approach to their care. Also, please look beyond the walls of radiation and imaging departments. Attend the hospital in-service sessions, go to rounds, take every opportunity to learn something new about the actions of other health care providers. You will have more knowledge to correlate the clinical information with the work that you are doing. Be curious. If something doesnʼt quite ring clear, pursue the unknown. In particular, track your patientʼs outcomes to appreciate your role in their wellness. I guarantee it will enhance your daily work experience and keep you excited to go to work every day. The patient is our reason to be. They are the driving force in our role in the health care team. While I tend to spend more time in the classroom, I have the perfect balance in teaching assignments that takes me from the lecture room into lab simulation, to on-line support for our senior students and the best piece, out into the clinical setting. With this balance, instructors can keep the learning relative to the
current industry needs. I always find immense gratification interacting with and attending to each patientʼs needs. I want to share a piece of a message I recently presented to the BCAMRT graduating classes. Perhaps it is a good reminder to all of us. “Your formal education cannot end at the diploma. Start the next phase of your continuing education soon. While the current job market is ready for all of you to be gainfully employed immediately, do not rest on your new status. Keep yourself primed for those opportunities. A lack of self directed continuing education will close doors before you ever get a chance to consider them. Keep yourself ready for advancement. Donʼt wait for the employer to suggest that you take some courses nor should you insist that they support you financially to advance your education. Yes, they will benefit from your enhanced knowledge base, but you will benefit more. You will enjoy your work more, and most importantly, other members of the health care team will respect you as effective contributors in decisions made. Part of this Commencement Ceremony is the “Pinning Ceremony”. I am reminded of the story of when my dad pinned my mother in high school. It was a symbolic event evoking a promise that evolved into a lifetime commitment. The BCAMRT, your professional association, holds this Commencement and Pinning Ceremony to welcome you into their ranks with a promise and commitment to provide opportunity for your professional development. As a former BCAMRT and CAMRT President, I have had the privilege of pinning several graduates and proudly welcomed them into the ranks. This celebration includes a clear message to you that the BCAMRT and the CAMRT have space for you. There is a reciprocal expectation that you find a path to contribute to your professional organization. It is not a strange or obscure “council of bureaucrats”. The people making decisions for the profession come from the front line radiation workers – you. Our responsibility to professional development resides within us and can be accomplished by us. This is a simple model of autonomy. We certainly look beyond our walls to ensure our professional development agrees with current practice, but we must promote ourselves. Consider how you can contribute to the various initiatives of your professional organizations. Attend those regional seminars, find your way to the conferences, and support the foundation events to raise money for professional development bursaries. And meet some great people along the way! A close connection will reap many benefits. I can attest to this. I have spent the majority of my three decade-plus career engaged in professional association activities – all of them as a volunteer. I know I am an exception to the rule. For most of my professional career I have volunteered on various committees, been a member of various boards, participated in special projects and always supported the goals of the associations.
I admit there were times when I wondered about the amount of time I was spending, but two things kept the drive alive, making a dent in the perspective of others about our unique and important place in health care and the many wonderful people I have met along the way. I have made long time friends and professional connections with colleagues across the country and around the world. This would not have happened without the commitment to professional volunteer work. It has been a rewarding relationship that I would recommend to everyone. For a successful and rewarding career, embrace the standards of practice and strive for more knowledge, work towards perfection in clinical practice, build effective communication skills and practice with your own personal integrity and accountability at stake. Consider your future, make informed choices, walk your own path with confidence – take on a reasonable level of individualism as you evolve to be an integrated member of the health care team. My pride and admiration for the graduates is profoundly satisfying, I hope that each of you find an exciting path for your next phase of this journey – you are now part of the village to raise the next ones to sit in those seats.” From this message two things ring for me… Student Membership and the Degree Initiative. During my tenure on the CAMRT Board, I was an active proponent to the establishment of a student category at the CAMRT level. Since that time, I can see that the work continues on this initiative, I do hope this can come to be. Typically, the students currently view the CAMRT as a distant, scary and exclusive entity complete with barriers. Part of my overall goal is to show the students that WE, the CAMRT, are not a bunch of buzzards, but a gracious and welcoming partner in their aspiration to be fully qualified members. This is the year – 2005 – that the CAMRT membership declared that all programs will have baccalaureate degree education to access the CAMRT Certification Examination. Amendments to that goal have been made to capture the challenges facing various jurisdictions. I still believe it is the right place to be headed. Just last week a new diploma grad contacted me to sort out her options to obtain a degree. She is interested in working her way around the world and recognizes she needs to be more qualified to do that. While I hate to lose her to the rest of the world, I know she will be back in due time. She will bring back with her a wealth of experience and education to offer to her workplace, wherever that will be. But even closer to home, the demands on technologists and therapists to contribute to health care decisions will become more commonplace. We just need to be recognized that our voice, and our collective voice, comes from a valid position.
Fall 2005 | The Canadian Journal of Medical Radiation Technology | Automne 2005 •
There will be opponents to any decision. This one may feel a tad threatening to those long since graduated technologists wondering what the new students are going to be challenging them with. Just remember, that you have the years of experience and knowledge that they donʼt – share your wisdom and ask some questions for yourself. Our community will only get better by connecting to the people in our environment and putting our heads together to make a difference. I refer to Alain Crompʼs 2001 Welch Address where he clearly appealed to all of us that professional development is essential and constant renewal is fundamental to our practice. Other opponents will contest that we donʼt need a degree to do our job. Perhaps that is true, but consider the quality of that job and the quality of your enjoyment of that job, by having a wider scope of skills and thinking processes. According to the Canadian Oxford Dictionary, a job is a paid position of employment while a profession is a vocation that involves some branch of advanced learning or science. A professional is defined as one highly skilled and engaged with commitment to a profession. I am a professional! At any given moment, I am doing a good job of the task at hand, but the job is only a small element of my overall profession. Depending on the curriculum design, degree graduates will be more ready for many aspects of the workplace – although a few older students do struggle - the newbies typically come with computer savvy. A degree program can make room for the essential telemedicine education needed to survive in the current workplace. Degree education promotes a multifunctional foundation, the student is focused to a career path, better able to take on responsibility, not just the “button pusher” but a critical thinker able to problem solve. Letʼs not create this situation … ʻnurse – get on the internet – go to SURGERY DOT COM…. scroll down and click on the “Are you totally lost?” icon…ʼ. With my focus on student advocacy, I worry that our future degree students will be treated differently when they arrive at clinical. I worry that with more academic education, there may be a false impression that the student is therefore more ready to take on the clinical practice. I caution you that the students will still be intimidated, still need to find their way in the new environment, still be looking to you to be their role model. They are still students – not perfect out of the gates – they need you to mould them to perfection – just like you have always done.
• Fall 2005 | The Canadian Journal of Medical Radiation Technology | Automne 2005
Key Points So regardless of what education doctrine you may have embraced or come from, I would like to leave you with some key thoughts: • Students are developing individual style and need reasonable space to do so; •
Education doctrines vary and technologists that have themselves trained in a different program are not always open to learning the nuances of the program they are now working within. The staff in-services do help in this regard;
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The students are keen to get to the same outcomes as the staff radiographers, that is, provide optimum patient care delivery with diagnostic images and accurate therapy treatments;
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Most staff are caring and considerate. While my comments today may come across that all staff are less than supportive, I remind you that the purpose of this presentation was to invite you to reflect on your practice and to reinforce the need of students to “fit in” during their move from apprentice to expert.
During his last Presidential address Herbert Welch hoped that in some small measure he had “…endeavored to help some of our younger members along the road towards the goal for which they are aiming…” I share his hope. Delivering the Welch Memorial Lecture is for me a personal milestone! I offer humble gratitude to the CAMRT Board of Directors for this honor and the opportunity to share my passion for our students! I must thank my partner, Michael Stockwell for indulging my distractions to attend to my passion of teaching and volunteerism!