Implementing Evidence-Based Practice in Diagnostic Radiography: an Exploration of Education and Culture

Abstract

Evidence-based practice is vital to providing healthcare that is effective, efficient, and patientcentred. Despite its importance, evidence-based practice is poorly implemented in diagnostic radiography, with evidence underutilised by clinicians. In this doctoral thesis I explore two major influences on the implementation of evidence-based practice within diagnostic radiography: education and culture. I advocate for an approach that sets up diagnostic radiography students for success when it comes to the application of evidence in practice, exploring current disciplinary culture, and the intersection of university education and disciplinary culture during clinical placements. In this thesis, I present a literature review and three empirical studies. My narrative review explored the application of knowledge translation techniques in diagnostic radiography and disciplinary culture. In the first of the empirical studies, I conducted focus groups with student participants (N=20) to explore their experiences of evidence-based practice during clinical placement. For the second empirical study, I introduced an applied educational intervention, to enhance students’ knowledge and skills, practices and attitudes and application of evidence-based practice. I evaluated this intervention using a convergent parallel mixed methods design. I employed focus groups (N=12), and pre- and -post intervention surveys (N=23, 18) to assess the effectiveness of the intervention. In the third empirical study, I undertook a national survey of diagnostic radiographers in Australia (N=131) to establish a baseline of their evidence-based practice capabilities. Through my analysis I developed several key findings and a series of practical recommendations that are presented in my thesis. In relation to education, students’ experiences of evidence-based practice during work integrated learning placements were fundamental to setting them up for future clinical practice. It is therefore essential that universities position students for success by ensuring these experiences are positive. This is easier said than done; organisational and professional cultures in clinical settings have a significant impact on both students’ and practitioners’ ability to implement evidence in practice. Therefore, educational efforts in the absence of cultural change are unlikely to be impactful on future clinical practice. Culture is innately shaped by leaders; in my national survey of radiographers, I found that institutional leaders in Australia were no more likely to have positive attitudes towards evidencebased practice than other radiographers. To create the cultural change required, their attitudes must shift through a coordinated and strategic effort at both professional and organisational levels. This culture shift would include more diagnostic radiographers actively engaging with and contributing to iv our profession’s evidence base. Furthermore, radiographers must learn from other disciplines, like implementation science, to ensure the evidence is applied in practice. This thesis argues that the educational foundation of diagnostic radiography students in relation to evidence-based practice is imperative to the application of the practice for graduate clinicians. Substantial thought, research and planning of radiography curricula are crucial to ensure that graduate practitioners are ready to address to challenges of tomorrow. Furthermore, we must prioritise a strategically led cultural shift towards an evidence-based paradigm as the norm for our profession. This will ensure that our clinical practices remain effective and efficient, and ultimately, enhance patient outcomes and professional standards.