Learning by doing : radiographers' knowledge and learning strategies in the digitized healthcare environment

Abstract: The aim of this thesis was to inform the field of radiography of changes related to the digital image production process, by understanding how radiographers perform tasks and apply knowledge as well as learning strategies in work practice. The method of this study adopts a qualitative ethnographic approach, using participant observation of and semi-structured interviews with radiographers at six Swedish hospitals. In total, 37 radiographers were interviewed, 25 of whom were observed. The interviewees were divided into two categories, novice radiographers working one year or less, and experienced radiographers working five years or more. The thesis classified the radiographers’ work as the: 1) Planning phase, 2) Performance phase, and 3) Evaluation phase. Blackler’s theory of knowledge components was applied to identify properties of knowledge. The results illustrated that the introduction of PACS did not simply entail the transfer of data and information from the analogue to the digital world, but also new activities, new ways of communicating, new responsibilities, new decision–making routines, new image processing and new technological knowledge for the radiographers. The thesis also illustrated that the radiographers applied their knowledge in different ways. Some radiographers applied their knowledge in a more reflective way, while some more routinely. They used embrained knowledge when planning X-ray examinations in a static or flexible way, and when viewing film/images they checked or analyzed them. Encoded knowledge was required for using various kinds of documentation in a reflective or a critical reflective way. Embodied knowledge was called for when action had to be taken in an automatic or problem-solving way. Further on, results showed the differences between novice and experienced radiographers’ learning strategies. Novice radiographers applied the following learning strategies together with critical thinking in the planning and evaluation phase: Memorization combined with logical reasoning and inquisitiveness, open-minded and focused observations, selective reading, and information-seeking. They communicated through active and attentive listening, asking questions, receiving information and feedback, discussing problems, and speaking aloud to themselves. In the performance phase they applied doing combined with flexibility, repetition combined with perseverance, and finally, imitation. Experienced radiographers applied the following learning strategies together with critical thinking in the planning and evaluation phase: Memorization combined with logical reasoning, prediction and contextual perspective, reflective discrimination on focused observations, selective and validated reading, and information-seeking. They communicated through listening in an analytical and critical way, answering questions and providing feedback, and discussing problems. In the performance phase they applied: Visualization combined with intellectual integrity, doing combined with creativity, repetition combined with perseverance and finally, experimentation combined with confidence and intuition. The conclusion of the research showed that the role of the radiographer and knowledge requirements have changed in four principal areas: 1) Communication in work, 2) Image processing, 3) Image quality assurance, including sending patients home, and 4) Decision making. The radiographers used embrained, encoded and embodied knowledge, and they applied knowledge in different levels as routine actors or reflective actors. The difference between routine, novice radiographers and reflective, experienced radiographers respectively was the way in which they applied their knowledge and learning strategies combined with critical thinking. It was important to identify the differences in how radiographers applied knowledge and learning strategies, because this may yield possibilities for fostering the transition from novice to experienced radiographers. The more reflective profile has become even more important in the digital environment as work is more independent and offers greater responsibilities. Consequently, radiographers’ tasks have become more demanding and highly scientific.