Synthesis and interpretation and Links to empirical data
A total of twenty participants were recruited from both UG and GEM programs and all recruited participants had undertaken a minimum three clinical placement experiences. Table 2 summarises the demographic data for each focus group. The groups were relatively homogenous demographically with some minor differentiation in relation to the highest level of qualification attained however each student had a different placement mapping and therefore their clinical placement experiences throughout the course of the degree may have differed significantly. There were a range of genders and cultures represented within the study.
Three overarching themes were developed during data analysis: “Education”, “Culture and Responsibility” and “Hopes, Fears, and Barriers”.
This theme looked at education as the starting point of all practitioners’ journey with EBP. It explored students’ fundamental understanding of EBP as a concept. It discussed the importance of pedagogy in building EBP skills, comparing the training versus education model. It delved into concepts of lifelong learning, critical thinking and looked strongly at challenging previously held knowledge and existing assumptions. Further to this, it examined the perceived shortfalls of the education that these students have received. Table 3 provides a summary of quotes representing this theme.
Participants within both focus groups had a consistently narrow definition of EBP that does not align with the more generally accepted definitions. They defined EBP as simply applying research-backed evidence in the clinical setting and most strongly equated their own learnings from university with EBP. Participants widely agreed that there was a strong tendency for clinicians within medical imaging to place higher value on the clinical expertise of practitioners than that of research-based evidence and articulated that they perceived this value to be misplaced. Those participants that did discuss clinical expertise as an asset were quickly shut down by their peers within the focus group. No participants articulated a link between clinical expertise and EBP, preferring to explore them as separate concepts.
Many participants perceived that the pedagogical approaches adopted in their academic subjects did not set them up well for implementing EBP in practice nor did they feel it encouraged them towards becoming evidence-based practitioners upon graduation. The perceived didactic teaching approach was viewed negatively by participants and there was a feeling of their potential being limited by this style of teaching. Participants identified the development of critical thinking, learning to assess the quality of research and adapting this research to the clinical environment as fundamentally important to their education however felt that this wasn’t well developed in their academic or clinical education. They described a disconnect between the way in which learning occurred during their academic subjects and the development of the skills required to practice in an evidence-based manner.
There was a wide sense of disempowerment that was apparent and consistent across both focus groups when it came to their ability to implement EBP on clinical placement. Participants reported a strong link between the attitudes of their clinical educators and their ability to implement EBP during placement experiences. Participants felt that their ability to implement EBP on placement had a substantial impact on their ability to learn and develop their skills.
Culture and Responsibility
This theme explored participants’ perceptions of where responsibility lies for implementing EBP in the clinical setting and reflected on the existing cultures. In order to categorise this further and provide additional structure for analysis this theme was broken down into three sub-themes “Individual” “Organisational” and “Professional”. Table 4 provides a summary of quotes representing this theme.
Within this sub-theme participants discussed the role that the profession more broadly has on the implementation of EBP. There was a strong sense of hierarchy when it came to the implementation of EBP in the experiences that participants had encountered. Research backed up by a strongly “scientific” or quantitative foundation was viewed as more important, particularly in relation to radiation dose reduction and paediatric patients. In contrast traditionally qualitative fields were viewed as less important with participants discussing elements such as communication as being a skill that can’t be improved with further research.
Professional stagnancy received significant attention and participants kept returning to this throughout the discussion. The concept of practitioners continuing to practice in the way in which they were taught was strong and participants noted the ways in which this limits both individual professional development and the advancement of the profession.
The barriers to EBP discussed by participants at an organisational level are quite consistent with the barriers reported in other literature. Participants explored both their positive and negative encounters during clinical placement experiences and noted factors that they believed to influence the evidence-based tendencies within departments and wider organisations. There is a very strong sense that for an organisation to have a culture that prioritises EBP, senior management must be proactive and evidence-based themselves and create structural efforts to support the culture within the department. Participants perceived those organisations that are strong in terms of implementing EBP had a significant advantage over competitors that did not, linking this to cost and efficiency savings.
Participants also described the impact that social forces can have on an individuals’ ability to implement EBP. This was again noted in both positive and negative scenarios where participants discussed examples of feeling pressured to implement practice that was not evidence based to conform to the standards of the organisation and alternatively where they were encouraged to explore and implement EBP on their placements.
There was much debate and little consensus in terms of the ability of the individual to implement EBP in the scenario where an organisation does not prioritise this action. Participants noted a differentiation in the ability of students versus practitioners to implement EBP. Some participants percieved that once the supervision requirements of being a student were lifted and they had the ability to practice independently that they would have more agency to make their own decisions in relation to implementing EBP; other students felt that they were still limited by the organisational priorities in this respect and that barriers such as time and resources made implementing EBP a continual challenge for individual practitioners.
Participants noted that individuals who are evidence-based in their practice have a competitive advantage when compared with their peers who are not. They felt that individuals who are more evidence-based in their practice were more sought-after employees, were likely to find desirable employment more readily and be able to advance more quickly and work in the areas that they want.
Hopes, Fears, and Barriers
This theme explored the participants’ hopes and fears: they see themselves as the future of the profession and hope to lead it in a more positive direction however they fear becoming a part of "a cycle of defensiveness about knowledge" (FG2) that they see within the profession. Participants agreed that EBP is fundamentally important to both themselves as professionals and their patients and described a sense of responsibility around implementation and a frustration at the barriers that prevent them from doing so. There was agreement about the early years in the profession being crucial for their development as evidence-based practitioners and they discussed their fears around these formative years, describing a sense of worry around the type of organisation they gain employment at.
Participants passionately articulated their desire to influence change in the profession. They discussed this particularly in relation to professional stagnancy and their view that the culture within the profession needs to change. There was a strong sense of urgency that surrounded this discussion and a sense of impatience from the participants who wanted to see immediate change.
Participants discussed several barriers to their ability to implement EBP on placement which were consistent with the barriers reported in the literature that are faced by professionals within the field of medical imaging. They reported feelings of medical dominance when practicing clinically, time and resource pressure and strong social forces that limited their ability to implement EBP.