Overcoming the theory / practice gap

During my research it has become apparent that a gap between theory and practice exists.  This is linked with the need to understand / define the various roles within the hybrid imaging workforce.  Creating an environment whereby a system of work exists permitting the effective use of CT during hybrid imaging examinations is paramount.  This is only one of the integral aspects of working practices within a hybrid imaging environment, however it is crucial to the overall service delivery. 

The image below depicts the range of potential autonomy associated with using CT in a hybrid imaging environment.  There is the consideration of system / software specifications, but one of the most fundamental questions that does not seem to factor during the procurement / installation and subsequent use of a hybrid imaging system is 'how will you use it?'. 

It is pointless having a 64 slice CT unit attached to a gamma camera if all you intend to do is attenuation correction +/- localisation.  Will you use contrast agent? Will you need to specialist software which looks good, but actually it is not required.  Having the appropriate underpinning knowledge and understanding of hybrid imaging practice will always be linked to the relevant theory and principles.   

 

A committed hybrid imaging workforce should be able to flex and adapt as required, exploring new potential patient pathways and establishing their position within inter-disciplinary teams.  This is easier said than done, however we need to think about our community, the 'nuclear medicine fraternity' (image below).  There needs to be an understanding that a new workforce is emerging, those practitioner that do not have a tradition in non-hybrid practice.  This has merits in the form of a greater appreciation of anatomical imaging etc, however how does the nuclear medicine fraternity balance the development needs of the traditional workforce with the emerging workforce?  This equation does not even include the new trainees who may witness / be influenced by the sub-communities within nuclear medicine. 

Becker (1961) explored the notion that our social and technical order now requires us to deliver more and more (patient) services within the environment we work.  The effective delivery of these patient services depends upon esoteric knowledge and skills and it is crucial that trust exists between all practitioners, regardless of the sub-community belonging.     

Knowledge rather than reliance on policies

Despite having an apparent abundance of policies and procedures at their fingertips and visible within the clinical imaging environment, nuclear medicine practitioners often appeared to ask their colleagues for advice or feedback.  This was most noticeable in situations where experienced nuclear medicine practitioners would be approached by staff who were not as familiar with hybrid imaging techniques or technical aspects (e.g. Quality Control checks) and were asking for help / guidance.  Although there was access to a range of policies and other useful documents, the practitioners generally preferred to ask their colleagues and learn from the experience.  This often involved citing previous experiences and / or bringing up example studies to demonstrate particular aspects of image acquisition or processing etc. 

The documents pertaining to hybrid imaging practice were being produced by a mixture of professional disciplines, including hybrid imaging practitioners and clinical scientists.  There also appeared to be a notion of health competition between the professional disciplines in terms of who could produce the most documentation / policies in some incidences.  Why was this the case? This behaviour appeared very 'tribal' in nature, almost mirroring graffiti street tags and highlighting a claim on the technology that was being used. 

Issues however may arise when protocols change or new imaging pathways are introduced.  How is this information disseminated through the hybrid imaging community? This also leads to a potential lack of evidence based knowledge development and practitioners not being able to develop enquiry based learning approaches within the workplace.

Hybrid Practitioner toolkit

It's becoming apparent that a number of nuclear medicine departments are being involved in new patient pathways, as a result of introducing hybrid imaging technology.  Creating a 'practitioner toolkit' enabling the identification of new skills and competencies is essential to future service provision.

There is also a need to include aspects such as research, innovation, mentorship and service improvement within the toolkit as well as being appreciative of the learning requirements of the assistant workforce. 

The toolkit could be developed and aimed at the entire nuclear medicine workforce who are involved specifically in hybrid imaging.  For example, the assistant workforce (titled 'Assistant Practitioners' in the UK) could develop a range of skills and experiences around delivering an effective clinical service, whether this relates to basic counselling  for patients, to undertaking CT based examinations under written protocols and being involved in audits.  The practitioner level is an interesting perspective and would in most cases be specific for each clinical environment, however there is again scope for role development in terms of involvement with multidisciplinary teams, creation of imaging protocols, creation of evidence based practice approaches, processing and reporting.  The scope for the advanced / consultant practitioner also includes aspects such as influencing new income streams / referral streams for emerging patient pathways, clinical research / trials and beyond. 

Undoubtedly there will be competition for 'professional ownership' the relevant skills and knowledge with the hybrid imaging environment and it will be important that nuclear medicine practitioners are not too possessive over traditional roles, but focus on new / emerging roles that will further enhance the profession. 

Creating new identities

The introduction of hybrid imaging technology has undoubtedly begun to create a new society of members, who only have exposure to an environment whereby anatomical and functional imaging within a single environment is a possibility. 

With this notion in mind, there could be potential disengagement from members of the traditional nuclear medicine community as a new culture of roles, identities and relationships begin to emerge.  Symbolic interactionism is a means of understanding the emergence of new societies  or cultures within an organisation, along with the creation of new language, relics and behaviours. 

This is an important aspect of my research, as I need to understand the potential tensions and conflict within the nuclear medicine community as a whole, as the training needs of all practitioners needs to be considered, not just those who appear to be fully engaging with the technological changes.  So there is a collective need to consider the existing (traditional) nuclear medicine community members, who possess a wealth of experience in terms of undertaking physiological examinations and all of the associated factors (e.g. patient preparation, processing); the emerging workforce who typically would include practitioners who may have some experience with traditional nuclear medicine procedures but are more exposed to working practices involving hybrid techniques.  The final group of practitioners are those coming into the nuclear medicine environment for the first time.  This group of practitioners/ trainees may learn common behaviours from both of the aforementioned groups of practitioners, including the use of specific language, rituals and role development.