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.

Creating a sense of professional belonging and value

Understanding the needs of the hybrid nuclear medicine practitioner, in terms of their need for on-going training, knowledge, skills enhancement and optimisation of technology has been integral to my doctoral research.  However, recently I have begun to understand the additional need to ensure practitioners and patients are included in the creation / development of new treatment pathways. 

Has technology begun to remove the personal nature / approach within nuclear medicine?  Creating physical barriers in the form of control rooms (image below), intercoms, cctv and an array of computer workstations potentially retracts the practitioner from the patient and how is autonomous practice / decision making take place?

 

 

There is a need to ensure the hybrid workforce understand the new clinical environments they find themselves in and value themselves as a profession.  Also, how do you fit the humanistic aspects of work into a technologically focused environment?  For example, hybrid nuclear medicine practitioners are seeing patients earlier in the cancer treatment cycle and this requires a greater understanding of where that patient is in terms of the support required, which aspect of the Kubler Ross cycle are they currently in and how can the practitioner ensure they obtain information in the form of functional and anatomical information coupled with appropriate patient preparation.

 

 

These themes have begun to arise from my research and allowed me to have greater insight into the complex emerging culture within hybrid imaging.  

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. 

Technology Determinism

The introduction of new technology within nuclear medicine appears to have shifted the traditional positioning of the nuclear medicine practitioner.  There is a need for careful consideration around the appropriate use of new technology, in order to aid patient diagnosis and potential subsequent monitoring of treatment response.

How does a workforce, which now works with hybrid imaging technology ensure they are able to control the daily workflow within the department?  Given the automated aspects of patient worklists and seemless connectivity associated with acquiring and processing data, the professional group need to ensure their involvement in the acquisition of clinical information is central to the patient's journey.  The use of technology needs to complement the role of the healthcare practitioner, rather than replace it.

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. 

Impact of hybrid imaging on patient management

The use of a hybrid imaging technique such as SPECT/CT or PET/CT may bring advantages to the overall patient management that may have not been initially forcasted.  From working alongside clinical nuclear medicine practitioners, there is a degree of 'incidental findings' that may occur within a hybrid imaging procedures.  Questions that immediately come to mind in this situation:

1) What are the ethics and clinical protocol/s associated with this sort of situation?
2) How are nuclear medicine practitioners trained to spot the incidental findings?
3) Can autonomous practice be adopted by practitioners, to enable them to fully utilise the diagnostic capabilities of hybrid imaging (e.g. Intravenous Contrast injection)?


There is also the matter of reporting the resultant images and ensuring the data sets acquired match highlight any additional information. 

Early adoption theory

I have begun to explore the role of 'technology ownership' within a community, such as nuclear medicine / hybrid imaging.  The introduction of new technology, such as hybrid imaging components and software has resulted in a potential shift in the ownership of such technology. 

Who actually owns this new technology and who are the early adopters? 

Early adoption theory (Rogers, 1971) highlights the percentage of people who readily accept new technology and those who 'lag'.  This is often referred to as 'cultural lag' and may demonstrate itself in varying degrees across the workforce and at a variable pace across different clinical environments