Imaging Professionals’ Training, Competency, and its Value in Practical Relevance By Maryam Akhlaghi Togiimoana Amituanai Chelsea Foutz Ashtyn Meibos Anna Pruna-Collins Marcie Sheffield Mapu Talo Leeann Todd A thesis submitted to the School of Radiologic Sciences in collaboration with a research agenda team In partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN RADIOLOGIC SCIENCES (MSRS) WEBER STATE UNIVERSITY Ogden, Utah August 14, 2024 2 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Maryam Akhlaghi Togiimoana Amituanai Chelsea Foutz Ashtyn Meibos Anna Pruna-Collins Marcie Sheffield Mapu Talo Leeann Todd This thesis has been read by each member of the following supervisory committee and by majority vote found to be satisfactory. ______________________________ Dr. Tanya Nolan, EdD Chair, School of Radiologic Sciences ______________________________ Dr. Robert Walker, PhD Director of MSRS ______________________________ Dr. Laurie Coburn, EdD Director of MSRS RA ______________________________ Chris Steelman, MS Director of MSRS Cardiac Specialist 3 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL RESEARCH AGENDA STUDENT APPROVAL of a thesis submitted by Maryam Akhlaghi Togiimoana Amituanai Chelsea Foutz Ashtyn Meibos Anna Pruna-Collins Marcie Sheffield Mapu Talo Leeann Todd This thesis has been read by each member of the student research agenda committee and by majority vote found to be satisfactory. Date August 14, 2024 ______________________ ____________________________________ Maryam Akhlaghi August 14, 2024 ______________________ ____________________________________ Togiimoana Amituanai August 14, 2024 ______________________ ____________________________________ Chelsea Foutz August 14, 2024 ______________________ ____________________________________ Ashtyn Meibos August 14, 2024 ______________________ ____________________________________ Anna Pruna-Collins August 14, 2024 ______________________ ____________________________________ Marcie Sheffield 4 August 14, 2024 ______________________ ____________________________________ Mapu Talo August 14, 2024 ______________________ ____________________________________ Leeann Todd 5 Acknowledgements Amazing people all along our journey have been paramount in this study’s work. Without the love, support, and faith of family and friends it would not have been possible. We would like to recognize our professors Dr. Tanya Nolan and Dr. Taylor Ward for their superlative guidance and unwavering support. Their exceptional mentorship and relentless ministration has been pivotal and will remain with us to fall back upon as we move forward in our careers. 6 Abstract The purpose of this study is to understand the most effective and relevant training and learning methods to support radiologic technologists from significant challenges and to aim at the overall goal and that is to improve patient care, maintain relevance, and ensure competence of radiologic technologists by using time and resources effectively. Radiology technologies and industries are moving at such a rapid pace that training in radiology is a very significant challenge. Furthermore, the workload, minimal time to rest, and irregular breaks continue to affect rapidly growing rates of radiologic technologist burnouts. This quantitative study investigated the most effective and relevant training models to support radiologic technologists and their competence to ensure the highest standard of patient care that can be provided. A total of 100 quantitative surveys were completed and analyzed. The responses from these surveys were measured on a Likert scale to explore the relationship between training methods (online, virtual, face-to-face) and professional competence. Participants included both students and certified imaging professionals and had to be at least 18 years of age and no more than 70 years of age who live within the United States or its territories and are employed within a medical facility as an imaging professional. The findings of this study will benefit the radiologic technologist, the medical imaging facility, and the patients through the improvement and the quality of care. The most utilized training model for competency was online training, followed by face-to-face, and virtual training. According to the surveyors, the highest frequency amongst imaging professionals was online training (M = 53.70), followed by face-to-face (M = 42.38), then virtual (M = 31.97). Furthermore, the most valued training model for competency is face-to-face followed by 7 online training, then virtual training. Face-to-face had a substantial value at over 72% with the online and virtual training barely even reaching 15%. The significance of this study is to help ensure that training remains relevant and responsive to radiologic technologists and the needs of all imaging professionals within the healthcare field. 8 Table of Contents Chapter 1: Introduction ....................................................................................................1 Background ...............................................................................................................1 Statement of the Problem ...........................................................................................2 Purpose of the Study ..................................................................................................3 Research Questions ....................................................................................................3 Nature of the Study ....................................................................................................4 Significance of the Study ...........................................................................................5 Definition of Key Terms ............................................................................................5 Chapter 2: Literature Review ...........................................................................................8 Background ...............................................................................................................8 Standards of Competence ......................................................................................... 10 Professional Behaviors ............................................................................................. 13 Attitude.................................................................................................................... 14 Ethics....................................................................................................................... 17 Teamwork ............................................................................................................... 18 Professional Skills ................................................................................................... 19 Knowledge .............................................................................................................. 19 Continual Learning .................................................................................................. 20 Application of Knowledge ....................................................................................... 21 Training ................................................................................................................... 22 Learning Styles ........................................................................................................ 22 Training Delivery .................................................................................................... 24 Student Training ...................................................................................................... 24 Online, Web-Based, and Modular Training .............................................................. 25 Face-to-Face Training Framework ........................................................................... 25 Relationship-Based Training Framework ................................................................. 26 Summary ................................................................................................................. 27 Chapter 3: Research Method .......................................................................................... 30 Research Methods and Design(s) ............................................................................. 32 Population and Sample ............................................................................................ 32 Materials/Instruments .............................................................................................. 33 Operational Definition of Variables ........................................................................ 34 Data Collection, Processing, and Analysis ............................................................... 38 Assumptions ............................................................................................................ 41 Limitations .............................................................................................................. 42 Delimitations ........................................................................................................... 43 Ethical Assurances ................................................................................................... 44 Summary ................................................................................................................. 44 Chapter 4: Findings ....................................................................................................... 46 Results ..................................................................................................................... 46 9 Evaluation of Findings ............................................................................................. 50 Summary ................................................................................................................. 52 Chapter 5: Implications, Recommendations, and Conclusions ........................................ 53 Implications ............................................................................................................. 53 Recommendations.................................................................................................... 55 Conclusions ............................................................................................................. 58 References ..................................................................................................................... 59 Appendices .................................................................................................................... 62 Appendix A: Survey ...................................................................................................... 62 Appendix B: Tables ....................................................................................................... 68 Appendix C: Figures ...................................................................................................... 69 10 List of Tables Table 1. Descriptive Statistics by Competency………………………………..………………47 Table 2. Correlation Statistics…..………………………………………………………...…….49 Table 3. Descriptive Statistics of Utilized Training Models………….………………..………………………………………………………………....49 Table 4. Descriptive Statistics of Valued Training Models……..……………………...……50 11 List of Figures Figure 1. Distribution of Mean Likert Scores of Professional Skills…………………….47 Figure 2. Distribution of Mean Likert Scores of Professional Behaviors…………………48 1 Chapter 1: Introduction Innovation, experience, and training play a significant role in quality patient care, organizational efficiency, and professional competency among imaging professionals. “Rapidly changing economics and technology are pushing organizations to enter a race for relevance in regards to market, competition, and corporate survival“(Gore, 2020; Ogura et al., 2018). However, best practices to support creative innovation and professional competency leading to competitive advantages and improved patient outcomes in this current environment are not fully explored, assessed, nor understood. Exploring diverse training models aimed at fostering innovation and advanced competency among professionals enhances team collaboration, critical thinking, problem solving, creativity, motivation, and attitudes. This, in turn, contributes to an overall improvement in medical practice and patient care. Background Radiology technologies and industries are moving at such a rapid pace that training in radiology is a very significant challenge. Furthermore, the workload, minimal time to rest, and irregular breaks continue to affect rapidly growing rates of radiologic technologist burnouts. The overall goal is to maintain relevance, improve patient care, and ensure competence of radiologic technologists by using time and resources effectively. According to Colibri Healthcare (2022a, 2022b), investing time, effort, and patience in staff training is crucial in the healthcare industry. With effective and established training programs, a company can improve retention, increase staff morale, and create a positive, motivated, and competent workforce. This, in turn, leads to higher 2 employee satisfaction, which improves patient satisfaction and the overall profitability of the practice. Statement of the Problem Healthcare leadership must find ways to provide their employees with meaningful ways to preserve and grow their competence and maintain relevance and quality in patient care. New technologies, such as artificial intelligence (AI), have shown promise in aiding in professionals’ continuing education. However, AI also poses a threat with its potential to become a competitor with human understanding and practice. New competition requires healthcare workers to be creative, adaptive, and flexible. Unfortunately, the current environment may not foster these ideals. Post-pandemic, many facilities are chronically understaffed and overworked. Most radiologic technologists are asked to work additional hours and cross-train into multiple modalities. Some technologists find themselves in positions where they are asked to cross-train in another modality before they feel competent in their primary specialty. Time is a scarce resource, and a lack of time makes it difficult for employees to incorporate learning modules, in-person clinical training, and other methods of education into their demanding schedule. The problem is there is insufficient research to establish if there is a correlation between different training models and delivery provided to employees and relevant competence. Additional research must be conducted to determine if such correlations exist. 3 Purpose of the Study The purpose of this quantitative study is to understand the most effective and relevant training models to support radiologic technologists and their competence in an ever-changing and innovative profession. In this study, a survey was distributed to radiologic technologists across the United States, including American Samoa, to gain an accurate understanding of the practical relevance of training for radiologic technologists and imaging professionals. The motivation of this study is to inform the assessment of training and/or continued education such as, quarterly learning modules, weekly staff meetings, physician lectures, on-the-job training, and structured education. Research Questions This quantitative study was formulated to correlate between current training models for imaging professionals and their perceived professional competency. It is understood that forms of training will vary, but may include quarterly learning modules, regular staff meetings, team-building exercises, lifesaving training such as CPR, guidance from physicians, and standardized education modules. Currently, the delivery of these trainings is standardized between online, virtual, and face-to-face models. The following research questions explore current levels of perceived competency based on models of training delivery in correlation to their relevance and value. Q1. Among imaging professionals, what level of competency is self-reported by working professionals? H0. Professionals within the current healthcare environment will report neither higher nor lower levels of aggregate competency. 4 H1 . Imaging professionals working in the current healthcare environment a will report lower aggregate scores of competencies. Q2. What relationship, if any, is found between imaging professionals’ training over the past year and their self-reported competency? H0. There is no relationship between imaging professionals’ training and self-reported competence. H1 . There is a positive correlation between interactive delivery and a frequency of training and perceived competence. Q3. Which training model is utilized at the highest frequency and valued most by imaging professionals for competency? H0. No training model is utilized at higher frequency or perceived of higher value. H1 . Interactive and connecting training models are perceived with higher a value, but these models are utilized less often due to limitations in time and resources. Nature of the Study The purpose of this quantitative study is to inform health care organizations about correlations found between imaging professionals’ competency and educational training. In the radiology field throughout the healthcare world the overall importance of competency and training of staff has a large influence on the productivity of the entire department. For the sample of our research, we will invite imaging professionals who 5 are hands-on with patients working either in radiologic technology or in some aspect of radiological sciences who live within the United States or its territories. Data for the study will be gathered through a survey instrument, with a minimum of 100 volunteers required to assure statistical power. The purpose of this data will be to measure competency, as indicated by several sub-variables, and determine which type of training correlates positively or negatively with competency within an appropriate effective size. Significance of the Study The findings of this study will benefit the radiologic technologist, the medical imaging facility, and the patients through the improvement and the quality of care to be rendered. The increased demand for radiologic technologists with didactic training background justifies the need for more specific competency training approaches within the plethora of imaging modalities. Another important factor that justifies the need for this study is the rapid advancements and innovation of imaging modalities to improve patient outcomes. The study will help uncover critical areas in the competency training process that can be utilized for improvement of skills and performance of the radiologic technologist. Definition of Key Terms Training: Training is a systematic and multifaceted process aimed at enhancing the knowledge, skills, and overall proficiency of individuals within the technologist domain. It involves a combination of structured educational initiatives, collaborative activities, and specialized instructions to equip employees with the necessary 6 competencies. This overarching approach contains various elements, including quarterly learning modules, regular staff meetings, team-building exercises, lifesaving training such as CPR, guidance from physicians, and standardized education modules. Together, these components contribute to a holistic development of employee training within the technologist field. Competency. Competency within radiologic technologist training entails the mastery of specific skills and knowledge relevant to the field to be applied effectively in practical scenarios. Explored within this context, competency encapsulates the overall proficiency and capability of individuals within the radiologic technologist domain, representing a blend of knowledge, skills, and aptitudes essential for effective task performance. This multifaceted concept includes various sub variables crucial for comprehensive competency development: 1. Professionalism: Integral to competency is professionalism, encompassing ethics, attitude, and teamwork. Ethical conduct lays the foundation for principled practice, guiding radiologic technologists to uphold moral standards. A positive attitude fosters resilience and adaptability, while effective teamwork facilitates collaborative problemsolving. 2. Critical Thinking: Fundamental aspect of competency is critical thinking, manifested in problem-solving abilities. Imaging professionals must possess the capacity to analyze complex issues, evaluate potential solutions, and make informed decisions. Cultivating critical thinking skills enables radiologic technologists to navigate dynamic challenges and innovate within their field. 7 3. Practice: Practice plays a pivotal role in competency development, encompassing skill refinement and familiarity with departmental workflows. Through hands-on experience and exposure to real-world scenarios, radiologic technologists hone their abilities and gain practical insights into their professional environment. Practice-oriented training enhances adaptability and proficiency, ensuring imaging professionals are well-prepared for the demands of their role. This exploration into competency within the realm of imaging professionals seeks to unveil the nuanced facets that shape and define proficiency in the professional landscape. 8 Chapter 2: Literature Review A correlation between imaging professionals’ training and competency combined with its value in practical relevance contributes to steady and organized management, supervisory quality control, and time management of an organization. Additionally, innovation, experience, and training play a significant role in quality patient care, organizational efficiency, and professional competency. “Rapidly changing economics and technology are pushing organizations to enter a race for relevance in regard to market, competition, and corporate survival” (Gore, 2020; Ogura et al., 2018). However, best practices to support creative innovation and professional competency leading to competitive advantages and improved patient outcomes in this current environment are not fully explored, assessed, nor understood. Exploring diverse training models aimed at fostering innovation and advanced competency among professionals enhances team collaboration, critical thinking, problem solving, creativity, motivation, and attitudes. This, in turn, contributes to an overall improvement in medical practice and patient care. Background All imaging professionals require a high level of competency in order to be successful. Competence is the expertise that technologists bring to patient care ensuring both patient safety and the responsible use of imaging technologies. Competency measures a broad range of skills and expertise that an imaging professional obtains such as: patient and colleague communication, performing radiologic examinations, prioritization, and innovative critical thinking. In radiologic sciences professions, 9 competency is gained through academic and clinical experiences delivered via a variety of methods including virtual simulation, hands-on experience, or classroom learning. Through this training period, imaging professionals are encouraged to participate in problem solving and critical thinking. Lawal et al. (2020) stated,“ Critical thinking in medical imaging requires the use of ethically sound professional reasoning in making justifiable decisions in relation to examinations, diagnosis, and management of the patient.” Thus, competency is defined by practical knowledge, skills and behaviors altruistic to both the healthcare team and the patient. As an example, radiographers are responsible for the administration of ionizing radiation for diagnostic, therapeutic or research purposes. Radiographers perform a full scope of radiographic and fluoroscopic procedures that create images needed for diagnosis at the request of a physician to be interpreted by a licensed practitioner. To ensure good quality, radiographers must demonstrate an understanding of human anatomy, physiology, pathology and medical terminology complemented by interprofessional skills that support both colleague and patient interactions and services (ASRT, 2019). Because medical imaging competency changes rapidly, competency must be continually assessed and improved upon to meet the demands of the professional environment. According to ASRT, “the medical imaging and radiation therapy professional and any individual who is legally authorized to perform medical imaging must be educationally prepared and clinically competent as a prerequisite to professional practice. The individual should, consistent with all applicable legal requirements and restrictions, exercise individual thought, judgment and discretion in the performance of 10 the procedure. Federal and state statutes, regulations, accreditation standards and institutional policies could dictate practice parameters and may supersede these standards.” (ASRT, 2019) The Joint Commission for accredited labs and institutions, requires competency be documented as “observable and measurable…skills, abilities and personal attributes that constitute an employee’s performance” (ASRT, 2019). Healthcare organizations often require employee orientation to include a review of accreditation standards. Surveys following accreditation review assure that the standard, regulatory, and evidence-based guidelines are both known and expectedly followed. Standards for Competence The term competence is used by employers and management as a measure of practical skills, abilities, experience, and knowledge a professional possesses. A study by Julé et al (2017) proposed a precise definition for competence by stating “a competency is defined as the knowledge or skill required to carry an activity out, not the activity itself” (p. 3). However, what affects or influences the knowledge and skills to perform competently is multifaceted and complex. A domain of competency may include a broad range of categories attributed to overarching skills, experience, and knowledge. In the same study by Julé et al (2017), researchers proposed a competency framework consisting of 50 characteristics grouped into five categories including “Ethics, Quality and Risk Management; Study and Site(s) Management; Research Operations; Scientific Thinking; and Professional Skills” (p. 3). Minimum qualifications to practice within a professional imaging modality may vary based on certification, licensure, and organizational policies. Professional 11 certification distinguishes individuals who have been qualified through academic and clinical pathways and deemed competent to promote high standards of patient care (ARRT, 2024). The American Registry of Radiologic Technologists (ARRT) website states that a credentialed technologist has “met rigorous professional standards” and their proof of certification, “tells employers that [the registrant is] committed to providing high quality patient care.” However, the ARRT also clearly indicates that credentialing is not a national requirement or a mandatory license. Licensure is the legal right to practice or serve in a patient care role as approved by state government legislation. Individual states decide upon the minimum requirements for working imaging professionals. This means that individuals may or may not be required to earn a recognized professional credential based on state practice and policy. As a result, in several states, the healthcare facility requirements for employment may be more stringent than their state’s requirements for practice. Furthermore, under economic stress and critical shortages, rules and regulations may be stretched uncomfortably thin in regards to what education is sufficient and who should perform these skills within a medical profession. According to Fleishon (2022), in any industry, the ability to deliver goods and services is dependent on its workforce. Especially during the ongoing COVID-19 pandemic, workforce issues have been front and center with employee shortages impacting service industries particularly hard. Radiology has not been immune to these shortages. Due to a variety of factors, many unique to our profession, professionals are 12 feeling the pressure to provide more services with less resources to accommodate the demands whether competent or not (Fleishon, 2022). Greiner & Knebel (2004) distinctly highlighted 5 core competencies for all health clinicians, regardless of their discipline. These five competencies are meant to be a core of fundamental requirements, but they are not intended as an exhaustive list. The committee recognizes that there are many other competencies that health professionals should possess, and each profession will have its own way of operationalizing such competencies in practice. • Provide patient-centered care—identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, educate patients; share decision making and management; continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health. • Work in interdisciplinary teams—cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. • Employ evidence-based practice—integrate best research with clinical expertise and patient values for optimum care and participate in learning and research activities to the extent feasible. • Apply quality improvement—identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms 13 of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality. • Utilize informatics—communicate, manage knowledge, mitigate error, and support decision making using information technology. In efforts to explain and understand competency for the purposes of this study, the research team has chosen to focus on two main aspects of professional competency in radiologic sciences. These include (1) professional behavior inclusive of attitudes, ethics, and teamwork and (2) professional skills encompassing knowledge, learning, and application. Professional Behaviors Professional behavior is defined by the attitudes, values, and commitments that guide a professional’s actions (Theall & Graham, 2017). In the context of radiologic technologists, professional behaviors are integral to ensuring high standards of patient care, safety, and diagnostic accuracy. These behaviors include a steadfast commitment to continual learning, adherence to ethical standards, and the ability to apply specialized knowledge in practical settings. Professionalism allows for radiologic technologists to obtain behaviors and attitudes that are ethically and legally sound, thereby creating a safe environment for both technologists and patients (Haynes & Despino, 2021). Without the additional implementations of professional behaviors, a radiology department is susceptible to an environment that include “apathy, resistance to change, lack of professional recognition from other healthcare professionals, and lacking 14 autonomy because the functions of the profession revolve around supporting the medical profession” (Haynes & Despino, 2021; Sim & Radloff, 2008; Yielder & Davis, 2009). Attitude Attitude plays a crucial role in the delivery of high-quality patient care by radiologic technologists. Positive attitudes towards patients, characterized by empathy and respect, significantly contribute to improved patient satisfaction. Healthcare providers who exhibit positive attitudes and empathy in patient interactions achieve higher patient trust and satisfaction (Steele et al., 2015). This highlights the impact of positive interpersonal interactions on the quality of care. A positive attitude towards professional development is essential in supporting ongoing competency among radiologic technologists. Continuous education and skill enhancement enable technologists to stay abreast of technological advancements and evidence-based practices. According to Herrmann & Arnold (2013) ongoing professional development not only enhances technical proficiency, but it also promotes critical thinking and problem-solving skills. Technologists who embrace a proactive attitude towards learning are better equipped to navigate complex clinical scenarios and contribute to improved patient care outcomes through enhanced diagnostic accuracy and treatment efficacy. A positive attitude is also crucial to enhance communication. Effective communication between radiologic technologists and patients is essential for explaining procedures, addressing concerns, and ensuring patient comfort. Technologists who prioritize clear and compassionate communication can reduce patient anxiety, enhance cooperation, and improve overall patient experiences (Hensley 2022). This finding 15 emphasizes the importance of fostering strong communication skills alongside technical proficiency in radiologic technology education and practice. Positive attitudes towards patient safety and advocacy reflect a deep commitment to the core values of healthcare. Radiologic technologists must often navigate complex patient scenarios where an empathetic and proactive attitude can significantly impact patient outcomes. Studies show that technologists who prioritize patient comfort and safety, and who communicate effectively about procedures, contribute to reduced patient anxiety and improved cooperation during imaging processes (Beyer & Diedericks, 2010). This focus on patient-centered care underscores the importance of a positive and reassuring attitude in achieving optimal clinical results. Finally, a positive attitude towards interdepartmental collaboration enhances the overall efficiency and quality of healthcare delivery. Radiologic technologists often need to work closely with other healthcare professionals, including physicians, nurses, and administrative staff. A cooperative and respectful attitude towards colleagues in other departments can lead to more effective communication, quicker problem-solving, and better-coordinated care. Radiologic technologists who actively engage in interdepartmental collaboration report higher job satisfaction and perceive their work environment as more supportive and efficient (Alumutery, A. et al. 2022). This collaborative spirit ultimately benefits patient care by fostering a more cohesive and responsive healthcare team. Overall, attitudes towards professional identity and role perception within the healthcare system can influence job satisfaction and retention among radiologic technologists. A study by Borbon al. (2005) found that technologists who view their 16 roles as integral to the patient care continuum are more likely to report higher job satisfaction and professional fulfillment. This positive self-perception encourages a greater commitment to the profession and enhances overall morale within radiology departments. By fostering a strong professional identity, technologists contribute to a more motivated and cohesive workforce, ultimately benefiting patient care quality and departmental efficiency. A medical professional’s attitude significantly impacts the effectiveness of training models and the perceived competency of radiologic technologists. Technologists with a growth mindset and a proactive approach to their professional development are more likely to engage in interactive and frequent training sessions, which are correlated with higher self-reported competency levels (Martell, B. 2010). This relationship underscores the importance of fostering constructive, productive, and efficacious attitudes to maximize the benefits of professional development opportunities, thereby ensuring that technologists are well-equipped to provide highquality patient care. The development and cultivation of positive attitudes in radiologic technology extends beyond patient care to encompass professional development, communication, patient advocacy, interdepartmental collaboration, and professional identity. By fostering empathy, continuous learning, clear communication, a cooperative approach to interdepartmental work, and a proactive approach to patient safety, radiologic technologists enhance patient satisfaction, improve diagnostic accuracy, and contribute to a more effective and efficient healthcare environment. These enabling attitudes and resulting behaviors are essential for advancing the field of radiologic technology and 17 ensuring the highest standards of patient care. Moreover, these attitudes are closely linked with ethical behavior, forming a foundation of trustworthy and effective healthcare practice. Ethics Ethical behavior is foundational to the practice of radiologic technology. Adherence to ethical standards ensures that patient rights are respected, and that care is delivered in a manner that upholds the dignity and confidentiality of patients. Andersson et al. (2022) emphasize that ethical dilemmas are common among healthcare professionals, necessitating strong ethical principles to navigate these challenges effectively. The ARRT (2024) Standards of Ethics is one of the profession’s governing documents and includes the Code of Ethics. In accordance with this standard, ethical behavior ensures quality patient care, appropriate use of equipment, patient confidentiality, informed consent, non-discriminatory practices, and ongoing professional development. The Rules of Ethics are enforceable and guard against fraud or deceptive practices, unprofessional conduct, technical incompetence, judicial determination, improper management of patient records, and violations of Federal Law. Radiologic technologists who demonstrate high ethical standards are more likely to gain the trust of patients and colleagues, which in turn, facilitate better teamwork and improved patient care outcomes. This underscores the need for comprehensive ethics training in the professional development of all healthcare professionals (Andersson et al., 2022) because this knowledge and understanding leads to practice, collaboration, and communication based on the same professional values. 18 Teamwork Teamwork is essential in healthcare settings, including radiology departments, for ensuring comprehensive patient care and efficient workflow. Effective teamwork and communication among healthcare professionals are crucial for the accurate and timely delivery of diagnostic services. Rosen et al. (2018) highlight that teams characterized by open communication, mutual respect, and collaborative problem-solving exhibited better patient outcomes and reduced instances of adverse events. In radiologic settings, teamwork involves coordinating with physicians, nurses, and other healthcare staff to ensure that diagnostic imaging is performed accurately and efficiently. Rosen et al. (2018) found that workers who excelled in teamwork were better at managing complex cases and ensuring patient safety. This emphasizes the importance of fostering a collaborative environment through team-building activities and communication training. Teamwork also enables healthcare professionals to leverage each other's strengths and perspectives, leading to comprehensive and well-rounded patient assessments and treatment plans. By pooling their knowledge and resources, teams can brainstorm innovative solutions, adapt quickly to changing patient needs, and address complex medical challenges more effectively. Focusing on attitudes, ethics, and teamwork ensures high standards of patient care and professional competency among radiologic technologists. Positive attitudes support empathetic patient interactions, ethical behavior upholds the dignity and rights of patients, and effective teamwork ensures coordinated and efficient care delivery. Integrating these characteristics into professional development programs can lead to 19 better patient outcomes, enhanced safety, and effective collaborative work environments. Professional Skills Professional skills for radiologic technologists encompass specialized knowledge, continual learning, and the application of this knowledge in real-time situations, all of which are crucial for their self-reported competency. Radiologic technologists play a pivotal role in healthcare, blending profound knowledge with specialized skills in medical imaging technology. Knowledge The journey of a radiologic technologist begins with rigorous education encompassing anatomy, physiology, radiographic positioning, and radiation safety (Julé et al., 2017). This foundational fundamental didactic knowledge is critical for producing high-quality diagnostic images and ensuring patient safety. It forms the bedrock upon which they build their expertise in utilizing X-rays, MRI, CT scans, and other imaging modalities to diagnose and treat medical conditions. Understanding and mastering this theoretical knowledge are essential for technologists to perform their duties effectively and safely. For example, a thorough grasp of anatomy and physiology allows technologists to accurately position patients and optimize image quality, while knowledge of radiation safety protects both patients and healthcare workers from unnecessary exposure (Fleishon, 2022). In addition to didactic knowledge, radiologic technologists must possess organizational knowledge, which involves understanding how to navigate and adhere to protocols and procedures within a healthcare setting. This includes familiarity with 20 patient scheduling, data management, and compliance with healthcare regulations and standards. Organizational knowledge ensures the smooth operation of imaging departments and contributes to the overall efficiency and effectiveness of healthcare delivery. It also involves the ability to work within multidisciplinary teams in healthcare, coordinating with other professionals to provide the best patient care (Rosen et al., 2018). For instance, effective data management skills ensure that patient records are accurately maintained and easily accessible, while knowledge of healthcare regulations ensures compliance with legal and ethical standards. Continual Learning Continual learning is intrinsic to the profession because of the rapid rate of technological, equipment, and protocol advancements. For example, with the advent of AI technologies, imaging professionals are facing new methods of image capture, postprocessing, and diagnoses. All imaging professionals must stay abreast of advancing and adapting knowledge and skills through ongoing education and professional development. Engaging in workshops, seminars, and continuing education courses, as well as participating in professional organizations and keeping up with industry journals, is essential for staying current with new procedures and updated safety protocols. This aptitude for continual learning enables technologists to adapt to innovations and maintain the highest standards of care, ensuring they can meet the evolving demands of the healthcare industry. Indeed, staying updated on the latest techniques or new radiologic software allows technologists to improve diagnostic accuracy and enhance patient care. 21 Application of Knowledge Beyond theoretical understanding, radiologic technologists apply their knowledge in clinical settings with precision and compassion. They collaborate closely with physicians and healthcare teams to capture clear and accurate images that are crucial for diagnosing illnesses and planning treatments. Their role extends beyond technical proficiency; they must ensure patient comfort, safety, and confidentiality throughout the imaging process. Effective communication and empathy are essential to reassure and support patients undergoing often unfamiliar procedures. This practical application of knowledge is where didactic, organizational, and continual learning skills converge, demonstrating the technologists’ comprehensive competency. For instance, a technologist might adjust imaging techniques based on a patient’s specific condition while explaining the process to alleviate any anxiety the patient might have. Through their dedication to learning and application, radiologic technologists contribute significantly to the healthcare system's ability to deliver accurate and timely diagnosis. Their in-depth expertise in medical imaging techniques, coupled with their commitment to continual learning, ensures that they can provide the highest quality care. Understanding these elements helps to evaluate the self-reported competency among imaging professionals, examine the impact of recent training on their competency, and determine the most valued and frequently utilized training models in the field. Thus, it is the challenge of all training designs and delivery to enhance competency and its various aspects. 22 Training Training is an essential part of the work environment, and it is beneficial for both new employees as well as current and/or veteran employees. In their study, Safdar et al. (2014) found that the training of junior doctors and undergraduate medical students ensured that they did not miss critical findings while reviewing images. Thus, training is a means of quality control and assessment of radiologic practices and procedures resulting in current, safe and proficient protocols and processes. Training can be a quick, short-term practice that involves gaining knowledge, updating skills, and refreshing information related to the workflow of a department or it can be implemented as an ongoing program that is assessed and evaluated monthly, quarterly, or yearly. Training encompasses two essential categories, learning styles and delivery methods. Both categories must be considered before implementing training for the workplace. Learning Styles Learning styles differ from person to person as well as the type of information that is being delivered. The theory that learning styles play a substantial role in the effectiveness of training is open to debate given that supportive research evidence is lacking. Therefore, the consideration of individual “learning styles” in radiology technologists’ training cannot be recommended since proper research studies are needed (Newton & Salvi, 2020; Cuevas, 2015). A study conducted by Edwards et al. (2019) wanted “to identify if any benefit exists to matching course/program delivery style with student preferred learning style in a physical therapy course/program” and the conclusion was: 23 The results showed that there was no relationship between total score on the Perceived Learning Style Inventory and academic performance. The current study builds on prior research that suggested matching teaching and learning styles was not beneficial. Despite these findings, there is a lot of documented theory support. Problembased learning has encouraged radiographers to use and develop skills necessary to become independent learners and critical thinkers (Lawal et al., 2020). “The process of critical thinking involves the application of both cognitive and affective skills in order to provide not just a logical thought pattern but also an empathetic approach to patientcentered care and management in radiography practice” (Lawal et al., 2020). These skills are applicable in each setting of radiology and are needed when imaging professionals are faced with difficult situations such as trauma patients, uncooperative patients, complicated exams, and etc. The implementation of active learning techniques can be used as successful methods for improving students’ knowledge, understanding, and application of information” (Harris & Welch-Bacon, 2019). Active learning aids the development of competency by promoting independent thought processes, communication, and teamwork skills that can transfer into the real world setting of radiology (Harris & Welch-Bacon, 2019). Though thought may be needed in coordinating the “how”, active learning techniques can be used in all delivery methods. Without the use of active learning and competency- based education healthcare providers, such as RT’s, would not have the competency skills to enhance their clinical performance (Imanipour et al., 2021). In addition to lower clinical performance “the lack of clinical skills and 24 competencies leads to high turnover rates, decreased job satisfaction, increased presenteeism, decreased patient safety and increased medical errors” (Imanipour et al., 2021). Hence, training requires a multi-faceted approach to attack all levels of competency. As a result, in addition to learning styles, it may be beneficial for an assessment to be made as to what delivery method is the most effective for the staff. Learning in the workplace requires consideration of the context and material of what is being taught and who is receiving that lesson, which would promote the idea of using preferred learning styles along with appropriate delivery methods (Bound & Garrick, 2000 and Cronin 2014). In radiology specifically, professionals receive an onslaught of training and knowledge throughout their career due to updated research, guidelines and protocol. To successfully implement training, the goal is to create a well-rounded basis for knowledge in a department and apply methods based on unique staff learning needs. Overall, the scope of delivery includes online, virtual and face-to-face components. Training Delivery The breadth of training within an imaging department includes quarterly learning modules, JCAHO, team bonding, weekly and quarterly staff meetings, modality huddles, CPR training, physician lectures, and standardizing education across the board. Standardizing education can be broken down into standardized learning and structured learning, performed in both the classroom and conference settings. The overall effect is both related to competency and competitive edge. The following paragraphs provide definitions and examples of some common training methods and measures utilized across professional organizations and throughout the career of an imaging professional. 25 Student Training (Structured/Hospital Based, Cross Training) Student training can be done in both a structured classroom setting or a hospital and/or through on–the-job training. Clinical education and cross training methods are key to a professional’s success and rely upon hands on and experiential learning. Not all knowledge and skills can be learned within the confines of a classroom. Thus, the passing down of knowledge from one more knowledgeable professional to another is highly important. Most hospital-based or clinical training echoes organizational values, beliefs, and practices that support their mission and strategic goals. Online, Web-Based, and Modular Training Online or web-based training is widely understood as the act of learning through the use of electronic means to enhance understanding, improve skills, or to gain experience within the multitudes of radiology modalities. Often, this type of learning is asynchronous and is accessed when the learner chooses to learn. According to Abraham et al. (2022), the global pandemic catapulted medical and imaging education into the online realm which initiated the need for educators to create effective ways to provide teaching methods for medical imaging students. Regardless of this delivery transition, medical imaging educators remained responsible for helping learners become critical thinkers capable of clinical reasoning skills which is a hallmark of the competent medical professional. Because of the rapid transition to online learning during the pandemic, there were and continue to be concerns about the retention and transfer of learning from online training settings to the clinical setting, making it necessary to identify the imaging students’ knowledge gaps and correct them through remediation programs and/or training. As best practice, Abraham et al. (2022) found a blended 26 approach, combining traditional teaching and online learning, resulted in learners who had higher skill competencies and retention. Face-to-Face Training Framework. In examining the theoretical framework of face-to-face training, there is a rich history and contemporary research to understand its impact on imaging professional competency. Face-to-face training encompasses scenarios like structured education of technologists (Farajolahi, et al., 2015) and on-site training sessions, including team huddles, emphasizes direct interpersonal interactions (Whittington, et al., 2020). Pal’s et al. (2018) work emphasized the effectiveness of direct, in-person interactions, exemplified by structured education and onsite training sessions. However, conflicting findings from Almeida (2022) introduce considerations such as logistical challenges and pandemic implications, particularly in the context of the impact that COVID-19 had on face-to-face meetings. This recognition of external factors adds complexity to the intellectual discourse, requiring a thorough examination of contextual influences on the outcomes of face-to-face training and its implications for imaging professional competency. Relationship-Based Training Framework. Transitioning to the realm of relationship-based training, we explore the theoretical foundations that highlight collaboration between radiologists and technologists. This dynamic partnership, representing a relationship-based approach to training, exemplifies the interpersonal dimensions crucial for imaging professional competency (Ong et al. 2017). Team-building activities emerge as integral components of this framework, fostering effective communication and teamwork among 27 professionals (Whittington, 2020). Recent research, as seen in Implementation of a Point-of-a-Care Radiologic-Technologist Communication Tool in a Quality Assurance Program (Ong et al, 2017), uncovers emerging trends at the intersection of technology and relationship-based approaches, contributing to the ongoing dialogue concerning competency development. As organizations navigate the intricacies of relationship-based training, a tapestry of emerging horizons unfolds. The theoretical foundations supporting collaboration between radiologists and technologists illuminate a pathway toward enriched imaging professional competency (Ong, 2017). This dynamic partnership signifies more than a training approach; it symbolizes a transformative journey where effective communication and teamwork exemplified through team-building activities (Slatter, 2019), become the keystones to success. Recent research, embodied in the works of Ong et al. (2017), uncovers novel trends at the nexus of technology and relationship-based approaches, injecting vitality into ongoing deliberations on competency development. Our exploration of face-to-face and relationship-based training unveils the intricate dynamics shaping imaging professional competency. From the effectiveness of direct interactions of face-to-face training to the transformative dimensions of collaboration in relationship-based approaches, these insights set the stage for a comprehensive understanding of training methodologies. The evolving landscape of competency development remains at the forefront of our study. Summary Competency in radiologic technology encompasses various elements, including professional behaviors, attitudes, ethics, and skills. Competence is defined by a 28 combination of practical skills, experience, and knowledge. Julé et al. (2017) suggest that competency is about the knowledge or skill required for an activity rather than the activity itself. This multifaceted nature includes overarching skills, experience, and knowledge. Greiner & Knebel (2004) outline five core competencies for all health clinicians: providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. These competencies form the foundation but are not exhaustive, as each profession will have specific ways of operationalizing these competencies in practice. Professional behavior in radiologic technology involves attitudes, ethics, and teamwork. Professional behaviors are crucial for maintaining high standards of patient care, safety, and diagnostic accuracy (Haynes & Despino, 2021). A lack of professionalism can lead to issues like apathy and resistance to change, negatively impacting the radiology department (Sim & Radloff, 2008; Yielder & Davis, 2009). First, attitudes significantly affect patient care quality. Positive attitudes towards patients, professional development, communication, patient safety, and interdepartmental collaboration enhance patient satisfaction, diagnostic accuracy, and job satisfaction (Steele et al., 2015; Herrman & Arnold, 2013; Beyer & Diedericks, 2010; Alumutery et al., 2022; Borbon et al., 2005). Positive attitudes also facilitate effective communication, reduce patient anxiety, and improve cooperation (Hensley, 2022). Second, ethics are foundational to radiologic practice, ensuring respect for patient rights, dignity, and confidentiality. The ARRT (2024) Standards of Ethics provide guidelines for ethical behavior, including quality patient care and appropriate equipment use, and protect against unprofessional conduct and fraud (Andersson et al., 2022). 29 Third, teamwork is essential in healthcare, especially in radiology. Effective teamwork improves patient outcomes and ensures accurate, timely diagnostic services. Teams that communicate openly and solve problems collaboratively are more successful (Rosen et al., 2018). Last, professional skills in radiology include specialized knowledge, continual learning, and practical application. Technologists must understand anatomy, physiology, and safety protocols to produce high-quality images and ensure patient safety. Ongoing education and adaptation to technological advancements are crucial for maintaining competency (Herrmann & Arnold, 2013; Imanipour et al., 2021). Training methods are diverse, including online, face-to-face, and blended approaches. Training ensures up-to-date knowledge and skills, enhancing competency and addressing knowledge gaps (Safar et al., 2014; Abraham et al., 2022). Face-to-face training, though challenged by external factors like the COVID-19 pandemic, remains vital for direct interaction and team building (Farajolahi et al., 2015; Almeida, 2022). Relationshipbased training emphasizes collaboration between radiologists and technologists, enhancing communication and teamwork (Ong et al., 2017; Slatter, 2019). Each professional’s learning style impacts training effectiveness, but evidence suggests that matching learning styles with training delivery has limited benefits (Edwards et al., 2019). Active learning and problem-based learning foster critical thinking and practical skills essential for radiologic technology (Lawal et al., 2020; Harris & Welch-Bacon, 2019). Integrating attitudes, ethics, teamwork, and professional skills into training frameworks enhances radiologic technologists' competency, improving patient care and operational efficiency. Comprehensive training that incorporates face-to-face, online, 30 and relationship-based approaches prepares technologists for the evolving demands of healthcare. 31 Chapter 3: Research Method Innovation, experience, and training play a significant role in quality patient care, organizational efficiency, and professional competency among imaging professionals. However, best practices to support creative innovation and professional competency leading to competitive advantages and improved patient outcomes in this current environment are not fully explored, assessed, nor understood. Exploring diverse training models aimed at fostering innovation and advanced competency among professionals enhances team collaboration, critical thinking, problem solving, creativity, motivation, and attitudes. This, in turn, contributes to an overall improvement in medical practice and patient care. To assess the advantages and understand healthcare crew of diverse creative and diverse training in innovation and professional competencies, a quantitative survey was utilized to answer the following research questions: Q1. Among imaging professionals, what level of competency is self-reported by working professionals? H0. Professionals within the current healthcare environment will report neither higher nor lower levels of aggregate competencies. H1 . Imaging professionals working in the current healthcare environment a will report lower aggregate scores of competency. Q2. What relationship, if any, is found between imaging professionals’ training over the past year and their self-reported competency? H0. There is no relationship between imaging professionals’ training and self-reported competence. 32 H1 . There is a positive correlation between interactive delivery and a frequency of training and perceived competence. Q3. Which training model is utilized at the highest frequency and valued most by imaging professionals for competency? H0. No training model is utilized at higher frequency or perceived of higher value. H1 . Interactive and connecting training models are perceived with higher a value, but these models are utilized less often due to limitations in time and resources. Overall, the survey is aimed to estimate the current state of radiologic technologists’ training and competency. The survey and research questions scale are designed for quantitative hypotheses and analysis. The null hypotheses will be accepted or denied based on a one-way ANOVA and correlation analysis. Imaging professionals of differing background, age, and experience will be invited to the survey and will respond to questions using a Likert scale, multiple choice, sliding bar, and open-ended format. From this data, it is determined to have an overall impression of current perceptions in professional training and competency. 33 Research Methods and Design(s) The research design was chosen because this type of method is generalizable to a larger audience. Furthermore, quantitative data is essential for statistical testing and confirmation of our theories and assumptions. Our quantitative method includes a short survey created to assess variables of competency and training. Because diagnostic imaging has become the fastest growing sector in the medical field, it has taken on a central role in medical training. Thus, outcomes of the survey and associated statistical analyses maximize cost-effective training aimed at overall competency and quality patient care. Population and Sample The target population of the study was a broad range of radiologic imaging professionals who have received any training relating to their profession. This included radiologic imaging professionals currently working in radiologic modalities including bone densitometry, cardiac interventional, cardiovascular interventional, computed tomography, magnetic resonance, mammography, medical dosimetry, nuclear medicine, radiation therapy, radiography, sonography, and/or vascular interventional as well as students pursuing an education in radiology. Participants had to be at least 18 years of age and no more than 70 years of age who live within the United States or its territories and are employed within a medical facility as an imaging professional. A total of 101 participants were included and would consist of both students and certified imaging professionals. Ideally the study would have included more participants to be more representative of the population and minimize sampling error, however the study was 34 limited by both time and resources, therefore only 100 participants were included. All participants volunteered and were recruited using a convenience sampling approach and were recruited through professional relationships and professional organizations of which the researchers belonged to. Participants were contacted via email, text message, and through various social media platforms. Materials/Instruments Background and foundational information were gathered by the research team via internet searches of published scholarly articles. The purpose of this research was to better understand the literature already studied and published to ensure that the research being conducted would be helpful and not repetitive. The Literature gathered was solely based on healthcare and medical experiences and feedback from medical professionals on training efficiency and its relation to competence. Survey questions were discussed amongst the research team to ensure adequate and appropriate questions were being asked. This process started with a large bank of questions that was then narrowed down to a specific set of questions that were appropriate to gather the essential data. Within these categories a variety of questions are presented that all pertain to their category. This allows for clear and organized data results. Four main survey categories were created: demographic, professional training, professional competency, and professional knowledge, learning and skills. Within these categories a variety of questions are presented that all pertain to their category. There are eight demographic questions, five professional training questions, ten professional behavior questions and ten questions regarding professional knowledge, learning and skills, equating to thirty-three survey questions. Examples of questions include How 35 many total years have you worked within the field of Medical Imaging? In which modality do you primarily work? In which type of facility are you employed? If virtual training is defined as digital training with live instructor contact or communication, over the past year, what percentage of training did you receive that was delivered in a virtual format? (Google Meet, ZOOM, etc.), I can persevere despite work challenges, my coworkers know they can rely on me during a busy or stressful day to do my best and get the job done, I understand how to acquire diagnostic images within my profession, I am prepared and can foresee when patients and/or physicians may require assistance during procedures. See Appendix A for the full set of survey questions. Each of these categories will be measured based on participant responses. Demographic questions are provided in a multiple answer format to show differences in experiences and perspectives based on region/demographics. Training and competency questions will be coded on a Likert scale ranging from 1 to 5 with higher scores indicating a stronger level of agreement to the survey question. Reliability and validity of the survey will be based on the performance of the survey and how well it is understood amongst the participants. Operational Definition of Variables Variables pertaining to competency and training pertinent to this study and its measures are listed below: “Professional training” constructs are defined as the delivery in which the professional training was gained (including schooling, organizational training, and continuing 36 education). Listed are the operational definitions of the survey questions’ recorded data pertaining to professional training according to the measured variable: 1. Scalar variables were measured using levels on a Likert sliding scale and recorded as numerical answers: a. Online training defined as digital training without live instructor contact or communication: 0-100% representing the percentage of training delivery type utilized over the past year b. Virtual training defined as digital training with live instructor contact or communication (Google Meet, ZOOM, etc): 0-100%, representing the percentage of training delivery type utilized over the past year c. Face-to-face training defined as being in person at having a physical location and having a live instructor (Classroom, Conference, Coaching, Mentoring, etc): 0100%, representing the percentage of training delivery type utilized over the past year d. Perceived impact training had on the individual’s overall competency: sliding bar scale of 1 (not at all) to 10 (highly impacted) 2. Nominal categorical variables: a. Format of the preferred method to acquire training i. Categories recorded: 37 1. Online 2. Virtual 3. Face-to-face b. Format of the perceived most effective training delivery defined as the most effective training as it affects overall professional competency i. Categories recorded: 1. Online 2. Virtual 3. Face-to-face c. Frequency the individual engaged in training activities i. Categories recorded: 1. Daily 2. Weekly 3. Monthly 4. 4 times per year 5. 2 times per year 6. Once per year 7. Never 8. Other (Define) 3. Qualitative open ended question: How would you improve the training of imaging professionals in today’s healthcare environment? 38 “Professional Competency” constructs are defined as professional behaviors that guide a professional’s actions and include attitudes, knowledge, and skills (Theall & Graham, 2017) and require learning, understanding, and application of professional knowledge and skills. This was measured within the survey questions as Scalar variables measured using levels on a 1-5 Likert scale indicating the strength of agreeability; 1 indicating strongly disagree and 5 as strongly agree. The reverse scores were accounted for using an asterisk for identification. Listed are the operational definitions of the survey questions’ recorded data pertaining to professional competency: 1. “Professional Behaviors” encompasses the sub-variables Attitude, Ethics, and Teamwork. a. Attitude is described as feelings of persevering despite work challenges, of having negative feelings within the workplace, of having confidence in the ability to do the job well, and of having the resources necessary to be successful. b. Ethics is described as being how the surveyor sees the importance of following every hospital protocol, ensuring every patient has appropriate care, and deals with others honestly and fairly. c. Teamwork is described as perceptions of self-reliability to get the job done, perceived active communication with others within and outside of the department, and feelings of being part of a team. 2. “Professional knowledge, learning, and skills” encompasses the subvariables Knowledge, Learning, Application. 39 a. Knowledge is described as feelings of understanding how to acquire professional images, of having equipment and technique familiarity, and of having the knowledge to teach/train new students. b. Learning is described as feelings of enjoyment in learning, perceived difficulties learning via critical feedback, and perception of self-competence/proficiency. c. Application is described using feelings of ease working around different patient conditions, of having skills necessary to be successful in any healthcare organization, of being capable of working independently, of being prepared and able to assist during procedures. Data Collection, Processing, and Analysis Effective data collection for this study involved the collaborative development of a survey instrument by the research team, aimed at gathering insights from approximately 100 healthcare professionals, predominantly radiologic technologists. The survey, comprising structured questions across various formats, was designed to capture both quantitative and qualitative data crucial to understanding technologists’ perceptions and practices in radiologic technology. The survey questionnaire was strategically distributed to a diverse sample of radiologic technologists across the United States and its territories. Distribution channels included email invitations, text messages, the GroupMe App, and multiple social media platforms. This approach ensured broad 40 participation and representation within the profession. The survey instrument itself consisted of 25 questions: 15 Likert-scale questions: These measured attitudes and perceptions on a scale from Strongly Disagree to Strongly Agree, providing nuanced insights into technologists’ views. 5 multiple-choice questions: These gathered demographic information such as age, years of experience, and primary modality of work, offering contextual data for analysis. Open-ended questions: These prompts allowed participants to provide detailed qualitative insights, enriching the understanding of their experiences and perspectives within the field. The survey data collected relies on the background and foundational information gathered by the research team via searches of scholarly articles. Effective training for new technologists in data collection, processing, and analysis is essential for leveraging the full potential of modern technological advancements. A comprehensive training program should encompass the foundational principles of accurate data collection methods, ensuring data integrity, and reliability. Additionally, it should provide in-depth knowledge of data processing techniques, including data cleaning, transformation, and integration, to prepare raw data for meaningful analysis. 1. Quantitative: Quantitative data collected from Likert-scale and multiplechoice questions were meticulously processed and analyzed using ANOVA (Analysis of Variance) in SPSS (Statistical Package for the Social Sciences). 41 ANOVA was chosen to assess differences in self-reported competency levels across various demographic factors and training models, aligning with hypotheses derived from scholarly literature and preliminary research findings. In the training process through quantitative analysis, a meticulous analysis strategy is employed to rigorously test each hypothesis. Initially, the research team carefully formulates clear and precise hypotheses based on the research questions and objectives. These hypotheses serve as the foundation for the subsequent analytical steps. Describe the analysis strategy used to test each hypothesis. The discussion must be sufficiently detailed so that the appropriateness of the statistical tests chosen is evident (i.e., the statistical tests are appropriate to respond to the hypotheses and the variable constructs meet the assumptions of the statistical tests). 2. Qualitative: Qualitative insights from open-ended survey responses were not directly analyzed using ANOVA, but instead were subjected to thematic analysis to identify recurring themes and patterns using qualitative data analysis techniques. This process was facilitated using qualitative analysis software to ensure systematic coding and interpretation of qualitative data. By integrating ANOVA for quantitative analysis and thematic analysis for qualitative insights, this study ensures a comprehensive approach to understanding and addressing issues within radiologic technology. The systematic handling of data collection, processing, and analysis underscores 42 the study’s methodological rigor and contributes valuable findings to enhance practices within the healthcare field. 3. Mixed Method: all processes involved show the data collection, analysis and processing. Assumptions Assumptions are realistic expectations which can be believed to be true. It can provide a basis to develop theories and research which can influence the development and implantation of a research process. So therefore, these following assumptions were made in consideration for this survey. 1. Participants should be mentally competent to respond to the survey questions/instrument. 2. The target population should be represented adequately. 3. The participants should read the questions carefully to understand what the questions are asking. 4. The answers to the questions should be truthful. 5. All survey questions should be answered to ensure accurate data. To ensure the validity of the survey, steps were taken so that the assumptions could be made. A sample size of the target population included 100 participants with ages ranging from 18 to (include age range and mean/standard deviation). Only the 43 target population was invited to participate, and this is so that all data is valid. The survey questions covered the different areas that were relevant to training, development and competency. Any survey that was incomplete was not used. This is so that data is clean and accurate. All participants had to provide informed consent to participate in this survey. All participants were expected to answer honestly and are a representative group of individuals whom we hope to understand or study. Limitations This survey has potential limitations. One of these limitations is the sample size of the target population. Even though the desired number of participants was achieved, the amount did not represent the total number of radiological technologists working in the radiology field in the country. The survey instrument covers all geographical areas and demographics of the participants eligible to partake in the survey. This is important so that all data received from the survey is not biased. Convenience sampling is a less robust method for validity but is limited by time and resources. The researchers believe that the sample size was adequate and would also include minimal sampling errors. Time also limits such a survey due to some of the participants' workload. Some participants will not have the time to answer all questions completely which can lead to incomplete surveys and wrong answers. Delimitations Delimitations are factors that can restrict the questions that the researcher can answer or draw from the data findings. Delimitation is based on the intentional choices and design of the survey. One clear delimitation factor is the target population. A total 44 of 100 participants took part in the survey. Another delimiting factor is the scope of the survey. Depending on the answers given in the surveys, some of the participants will not be eligible to participate. Some surveys will not be used due to their being incomplete. Informed consent should be given before a participant can answer the questions in the survey. Ethical Assurances This research will comply with the highest standards for conducting ethical research, ensuring the protection of participants' rights and confidentiality. Prior to any data collection, approval from the Institutional Review Board (IRB) will be sought to ensure that the study meets ethical guidelines. In the final dissertation, it will be stated that IRB approval was obtained before any data collection was conducted. Participants will be fully informed about the purpose of the study, the procedures involved, their right to withdraw at any time, and how their data will be used. This information will be provided through an informed consent form that participants must read and agree to before participating in the study. The consent form will be designed to be clear and easily understandable, ensuring that participants can make an informed decision about their involvement. There are minimal risks in taking part in the anonymous survey, one of which may be that some participants may be uncomfortable answering questions about their own competency. To protect the confidentiality of participants, several measures will be put in place. All data collected will be stored in a password-protected database using Qualtrics, a secure online survey platform. Access to this database will be restricted to authorized research team members only. We will not collect any personally identifiable information 45 such as names, addresses, or social security numbers. The most detailed information gathered will be geographic regions, which will be sufficiently broad to prevent identification of individual participants. Additionally, all data will be anonymized to ensure that individual responses cannot be traced back to specific participants. This means that no direct identifiers will be stored alongside the survey responses. Data collected during the study will be retained for a period of no longer than two years after the completion of the research. After this period, all data will be securely destroyed to ensure that no information remains. Before the study begins, formal approval will be obtained from the IRB, ensuring that the research design, informed consent procedures, and confidentiality measures meet all ethical requirements. Appendices included in this thesis will provide additional documentation as needed, such as the informed consent form and details about the data protection measures. By adhering to these ethical standards, the research will ensure the protection of participants' rights and the integrity of the research process. Summary The study examines the training and competency of radiologic technologists through a survey of 100 participants across the U.S and territories. It explores the relationship between training methods (online, virtual, face-to-face) and professional competence. The sample includes both students and certified professionals recruited via convenience sampling. Data is collected using an online survey covering demographics, training, competency, and knowledge, with responses measured on a Likert scale and 46 securely stored in Qualtrics. "Professional training" is categorized by delivery method, and "professional competency" includes attitudes, ethics, teamwork, knowledge, learning, and application. Assumptions include participants' competency and truthful responses, while limitations involve sample size and potential biases. Ethical standards are maintained through IRB approval, informed consent, confidentiality measures, and data anonymization. 47 Chapter 4: Findings The purpose of this quantitative study is to describe perceived competence among imaging professionals and explore relationships between training models and levels of competence in an ever-changing and innovative profession. The following research questions were generated and utilized to create a survey for employed imaging professionals between the ages of 18 and 70 years. All data was acquired over a three month period and analyzed through the Statistical Package for the Social Sciences (SPSS) software. The following paragraphs will review each research question and provide the data generated and analyzed to respond to each question. The motivation of this study is to inform the assessment of training and/or continued education such as, quarterly learning modules, weekly staff meetings, physician lectures, on-the-job training, and structured education. Results The first research question explored the level of competency that was selfreported among working imaging professionals. Using a Likert scale from 1 to 5, imaging professionals self-reported their level of competency in regard to professional skills (M = 4.45, SD = 0.415) higher than their professional behaviors (M = 4.28, SD = 0.413). See Table 1 for descriptive statistics by group. Self-reported competency of professional skills was negatively skewed (skew = -1.54, SEskew = 0.25) and leptokurtic (kurtosis = 3.63, SEkurtosis = 0.50) while self-reported competency of professional behaviors was also negatively skewed (skew = -0.71, SEskew = 0.25) and leptokurtic (kurtosis = 1.82, SEkurtosis = 0.49). See Figures 1 and 2 for distribution of means by group. 48 Table 1 Descriptive Statistics by Competency N M SD Professional Skills 92 4.45 0.415 Professional Behaviors 94 4.28 0.413 Total 186 4.37 0.414 Figure 1 Distribution of Mean Likert Scores of Professional Skills 49 Figure 2 Distribution of Mean Likert Scores of Professional Behaviors The second research question explored what relationship, if any, was found between imaging professionals’ training over the past year and their self-reported competency. We performed a bivariate correlation to determine if there was a positive correlation between imaging professionals’ training over the past year and their selfreported competency in professional skills and professional behaviors. There was no significant correlation between the frequency of training activities and professional skills (r = -0.077, p = 0.48), between frequency of training activities and professional behaviors (r = -0.021, p = 0.85), or between impact of training on competency and professional behaviors (r = 0.38, p = 0.73). There was however a low but significant correlation between impact of training on competency and professional skills (r = 0.25, p = 0.026). See table 2 for correlation statistics. About 6% of the variance in 50 professional skills can be explained by the impact of training on competency (r = 0.25, r2 = 0.062). Table 2 Correlation Statistics Parameters Professional Skills Professional Behaviors r p r2 r Frequency of Training -0.077 0.48 0.0059 -0.021 0.85 0.00044 Impact of Training on Competency 0.25 0.026 0.062 0.38 0.73 p r2: Pearson correlation The third research question explored which training model was utilized at the highest frequency and valued most by imaging professionals for competency. The training model utilized at the highest frequency amongst imaging professionals was online training (M = 53.70), followed by face-to-face (M = 42.38), then virtual (M = 31.97). See table 3 for descriptive statistics of utilized training models. Table 3 Descriptive Statistics of Utilized Training Models Training Model N M SD Online 86 53.70 31.80 Virtual 77 31.97 27.29 Face-to-Face 81 42.38 34.08 r2 0.144 51 The training model valued most by imaging professionals for competency is face-to-face (frequency = 66, percent = 72.5%), followed by online (frequency = 17, percent = 18.7%), then virtual (frequency = 6, percent = 6.6%). See table 4 for descriptive statistics of valued training models. Table 4 Descriptive Statistics of Valued Training Models Training Model Frequency Percent Online 17 18.7 Virtual 6 6.6 Face-to-Face 66 72.5 Other 2 2.2 Total 91 100 Evaluation of Findings Q1. Among imaging professionals, what level of competency is self-reported by working professionals? Among imaging professionals, high levels of competency were reported in regard to professional skills and behavior. The scoring value range is from 1 (low rating) to 5 (high rating); professional skills had a mean value of 4.45 which is higher than the mean value of 4.28 for professional behaviors. Imaging professionals reported higher competency in professional skills than in professional behaviors. This indicates a strong self-perception of technical abilities among imaging professionals. The vast majority of the survey 52 participants reported being competent, most were on the mid or high end of the scale with very few participants on the low or no competence end of the scale, this caused the data to be leptokurtic and negatively skewed. Q2. What relationship, if any, are found between imaging professionals’ training over the past year and their self-reported competency? The relationships that were investigated for correlations were frequency of training activities and professional skills, frequency of training activities and professional behaviors, the impact of training on professional skills, and the impact of training on professional behaviors. Only one of the relationships was statistically significant, there was a small effect between the impact of training and professional skills. 94% of that correlation is not explained by their relationship. Q3. Which training model is utilized at the highest frequency and valued most by imaging professionals for competency? The most utilized training model for competency was online training, followed by face-to-face, and virtual training. The training model utilized at the highest frequency amongst imaging professionals was online training (M = 53.70), followed by face-to-face (M = 42.38), then virtual (M = 31.97). 53 The most valued training model for competency is face-to-face followed by online training, then virtual training. Face-to-face had a substantial value at over 72% with the online and virtual training barely even reaching 15%. Summary In a study of imaging professionals' self-reported competency, participants rated their professional skills higher (mean=4.45) than their professional behaviors (mean=4.28), reflecting strong self-perception of technical abilities. Most participants scored on the mid to high end of the competency scale, with the data showing leptokurtic and negatively skewed distribution. The investigation of training impacts revealed a statistically significant, though small, effect of training on professional skills, indicating that while training does influence competency, it explains only a minor portion of the variance. Regarding training models, online training was the most frequently utilized, while face-to-face training was deemed the most valuable by a substantial margin. These findings highlight that while online training is prevalent, faceto-face interactions are highly valued for competency development. The study contributes incrementally to the understanding of training effectiveness in imaging professions, underscoring the need for balanced training approaches that leverage the benefits of face-to-face engagement while accommodating the convenience of online methods. This insight is valuable for both academic and corporate leadership in refining training strategies to enhance professional development within the field. 54 Chapter 5: Implications, Recommendations, and Conclusions The results of this study highlight significant insights into the competency levels of imaging professionals and the impact of various training models. The findings suggest that imaging professionals report higher competency in professional skills compared to professional behaviors, indicating a strong self-perception of technical abilities among these professionals. This disparity suggests that while imaging professionals are confident in their technical skills, there may be areas for improvement in professional behaviors, which include attitudes, ethics, and teamwork. The study also revealed a positive correlation between the impact of training on competency and professional skills, though the relationship was not strongly significant. This suggests that while training does enhance professional skills, other factors may also play a crucial role. Moreover, the study found that online training is the most frequently utilized training model, followed by face-to-face and virtual training. However, face-toface training was valued the most for competency, indicating that direct, interpersonal interactions are crucial for effective training in this field. Imaging professionals reported high levels of competency in both professional skills and behaviors, with mean values of 4.45 and 4.28, respectively, on a 5-point scale. Professional skills were rated higher than professional behaviors, emphasizing a need for training programs to address the development of professional behaviors. The selfreported competency of professional behaviors was also negatively skewed, indicating a disparity between skills and behaviors. The training model valued most by imaging professionals for competency was face-to-face training, with a frequency of 66 and a percentage of 72.5%. This was 55 followed by online training (frequency of 17, 18.7%) and virtual training (frequency of 6, 6.6%). Face-to-face training was not only the most valued but also the most effective, with a substantial preference over online and virtual training models. Additionally, the most utilized training model for competency was online training, followed by face-toface, and virtual training. Among imaging professionals, the highest frequency of training was reported in online training (M = 53.70), followed by face-to-face (M = 42.38), and then virtual training (M = 31.97). These findings align with the existing literature, which emphasizes the importance of comprehensive and diverse training models in fostering innovation, critical thinking, and professional competency among imaging professionals. The role of continuous education, hands-on experience, and ethical practice are underscored as essential components for achieving high standards of patient care and professional development. This study's findings offer several important implications for the training of imaging professionals. The first research question explored the self-reported competency levels among imaging professionals, revealing high competency in professional skills and behavior. This underscores the critical role of targeted training programs in enhancing specific competencies. However, potential limitations such as sample size and self-report bias might have influenced the results, highlighting the need for more extensive and objective assessments in future research. The results align with the literature that emphasizes the importance of continuous professional development and its positive impact on patient care and departmental efficiency. 56 These findings contribute to the existing literature by providing empirical evidence on the preferred training models among imaging professionals, demonstrating that face-to-face training is the most valued, followed by online and virtual training. This preference suggests that direct interpersonal interactions and hands-on experiences are crucial for effective competency development. The study’s results can be applied to real-world settings by encouraging the integration of face-to-face components in training programs, even when leveraging online and virtual training modalities. The practical utility of these findings is significant for designing and implementing training programs that foster innovation, critical thinking, and problemsolving skills. By applying conceptual frameworks that support active learning and engagement, training programs can be tailored to meet the specific needs of imaging professionals, thereby enhancing their competency and ultimately improving patient care outcomes. These implications extend to broader social contexts, emphasizing the importance of effective training in maintaining high standards of healthcare delivery. Recommendations Based on the findings, several recommendations can be made for the practical application and future research. First, training programs for imaging professionals should prioritize face-to-face interactions to maximize competency development. Incorporating hands-on experiences and direct interpersonal communication within training modules can significantly enhance learning outcomes. Additionally, blended learning approaches that combine face-to-face, online, and virtual training elements can provide a comprehensive and flexible training solution. While this study utilized a mixed-methods approach, future research could 57 benefit from a more balanced integration of qualitative and quantitative data. This could include in-depth interviews, focus groups, and case studies to complement survey data and provide a richer understanding of training experiences and outcomes. Future research should address the limitations of this study by expanding the sample size and employing more objective measures of competency. Longitudinal studies could provide deeper insights into the long-term effects of different training models on professional development. Exploring the impact of technological advancements, such as simulation-based training and AI-driven educational tools, could also offer new avenues for enhancing training effectiveness. Investigating the impact of continuous professional education and certification programs on competency would provide valuable insights. This could include studying the effects of mandatory continuing education requirements and the role of professional organizations in supporting lifelong learning. Additionally, future studies should examine the effectiveness of comprehensive ethics training programs and their impact on professional behavior. This could include exploring different ethical frameworks and their applicability to the radiologic technology profession. Furthermore, it is recommended that institutions implement continuous feedback mechanisms to regularly assess and refine training programs. This can help ensure that training remains relevant and responsive to the evolving needs of imaging professionals and the healthcare environment. Encouraging collaborative research across institutions and countries could provide a broader perspective on training models and their effectiveness. This collaboration could lead to the development of standardized training guidelines and best practices that can be adopted globally. 58 Conclusions Overall, this study highlights the critical importance of effective training models for imaging professionals. The findings suggest that face-to-face training is highly valued and effective in enhancing professional competency, followed by online and virtual training models. The study’s contributions to the field are significant, providing a basis for developing training programs that meet the evolving needs of healthcare professionals. Despite the study’s limitations, it offers valuable insights and sets the stage for future research to further explore and refine training methodologies, ensuring that imaging professionals are well-equipped to provide high-quality patient care. 59 References Abraham, R., M., Enoch, L., C., Singaram, V., S. (2022). A comparative analysis of the impact of online, blended, and face-to-face learning on medical students’ clinical competency in the affective, cognitive, and psychomotor domains. BMC Medical Education, 22(1), 735. https://doi.org/10.1186/s12909-022-03777-x Almeida, A., Silva, C., Vicente, B, & Abrantes, A. (2022). The paradigm in medical imaging education and training in europe. International Journal of Information and Education Technology, 12(4), 326 - 327. https://www.semanticscholar.org/reader/041634b289f8c465552b9171c73b4d34f b65262d Alumutery, A., Abdullah, O., Almutairi, F., Almutairi, N., Alyami,S., Aldajani,F., Alsubaiei, N., Alharbi, A., Abdulwahab, A., Moafa, T., Alzuraia, A., Al-Shahrani, S., & Aldawi, S. (2022). Collaborative approach: Nurses and radiologic technologists working together in x-ray departments. a new appraisal. Journal of Namibian Studies : History Politics Culture, 32(1), 809- 824. https://namibian-studies.com/index.php/JNS/article/view/6400 Andersson, H., Svensson, A., Frank, C. , Rantala, A., Holmberg, M., & Bremer, A. (2022). Ethics education to support ethical competence learning in healthcare: An integrative systematic review. BMC Med Ethics, 23(29), 2-26 https://doi.org/10.1186/s12910-022-00766-z ASRT Interpreting Joint Commission Standards: FAQs. https://www.jointcommission.org/standards/standard-faqs/ ARRT Certification & Registration - ARRT. (n.d.). https://www.arrt.org/pages/about-the-profession/arrt-certification-andregistration Beyer, L. and Diedericks, P. (2010). The attitudes of radiographers towards patients in government hospitals in Bloemfontein. The South African Radiographer, 48(2), 22-27. https://hdl.handle.net/10520/EJC98849 Borbon, M., Galang, K. O., Montoya, A., & Moran, K. (2005). The relationship between management support system and the job satisfaction among radiologic technologists of De La Salle University Medical Center (Publication No. 238) [Bachelor of Science in Radiologic Technology Thesis, De La Salle University Medical Center]. Geen Prints. https://greenprints.dlshsi.edu.ph/bsrt/238/ Boud, D., Garrick, J., and Greenfield, K. (2000). Understanding Learning at Work. Wiley Online Library. https://doi.org/10.1002/pfi.4140391013. Colibri Healthcare. (2022a). Empowering content from thriving practices. Organization solutions. https://www.colibrihealthcare.com/organizations/ 60 Colibri Healthcare. (2022b). Strengthening healthcare one professional at a time. Professional Solutions. https://www.colibrihealthcare.com/practitioners/ Cronin, C. (2014). Workplace learning - a healthcare perspective. Education + Training, 56 (4), 329-342. https://doi.org/10.1108/ET-03-2013-0039/full/html Cuevas, J. (2015). Is learning styles-based instruction effective? A comprehensive analysis of recent research on learning styles. Theory & Research in Education, 13(3), 308–333. http://doi.org/10.1177/1477878515606621 Edwards, D. J., Kupczynski, L., & Groff, S. L. (2019). Learning styles in problem-based learning environments impacts on student achievement and professional preparation in university level physical therapy courses. International Journal of Higher Education, 8(3), 206. https://doi.org/10.5430/ijhe.v8n3p206 Farajolahi A., Ghojazzageh, M., Movaffagi, A., Alikhah, H., & Naghavi-Behzad, M. (2015). Association of academic education and practical capacities of radiology technologists. J Anal Res Clin Med, 3(1), 57-62. https://doi.org/10.15171/jarcm.2015.004 Fleishon, H. (2022). American college of radiology bulletin. The Radiology Labor Shortage. https://www.acr.org/Practice-Management-QualityInformatics/ACR-Bulletin/Articles/March-2022/The-Radiology-Labor-Shortage Gore, J. (2020). Artificial intelligence in medical imaging. Magnetic Resonance Imaging, 68, A1-A4. http://doi.org/10.1016/j.mri.2019.12.006 Greiner, A & Knebel, E. (2004). Health professions education: A bridge to quality. Journal for Healthcare Quality, 26(1) 54. https://doi.org/10.17226/10681 Harris, N., & Welch-Bacon, C. (2019). Developing cognitive skills through active learning: A systematic review of health care professions. Athletic Training Education Journal, 14(2), 135-148. https://doi.org/10.4085/1402135 Haynes, W., & Despino, A. (2021). Teaching Professionalism in Radiologic Technology. CINAHL. https://web-p-ebscohostcom.hal.weber.edu/ehost/detail/detail?vid=0&sid=5bdbe7a7-ebf0-4ea6-931f72b1f1a58684%40redis&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin 20&AN=153551260 Hensley, C. (2022). Developing effective communication skills in radiology students. Radiologic Technology, 23(6), 577-581. http://www.radiologictechnology.org/content/93/6/577.extract 61 Herrmann, T., & Arnold, A. (2013). What are critical thinking and problem solving strategies? Introduction to Radiographic Sciences and Patient Care (5th ed., 33-41. https://books.google.com/books?hl=en&lr=&id=vVxPAQAAQBAJ&oi=fnd&pg =PA33&dq=%22What+are+Critical+Thinking+and+Problem+Solving%22&ots =FGpIFBGX4S&sig=09g90bkweiRagP9_tHD8YC8jtKE#v=onepage&q=%22W hat%20are%20Critical%20Thinking%20and%20Problem%20Solving%22&f=fal se Imanipour, M., Ebadi, A., Ziarat, H., & Mohammadi, M. (2021). The effect of competency-based education on clinical performance of health care providers: A systematic review and meta-analysis. International Journal of Nursing Practice, 28(1), e13003. https://doi.org/10.1111/ijn.13003 Julé, A., Furtado, T., Boggs, L., Van Loggerenberg, F., Ewing, V., Vahedi, M., Launois, P., & Lang, T. (2017). Developing a globally applicable evidenceinformed competency framework to support capacity strengthening in clinical research. BMJ Global Health, 2(3), e000229. https://doi.org/10.1136/bmjgh2016-000229 Lawal, O., Ramlaul, A., & Murphy, F. (2020). Problem based learning in radiography education: A narrative review. Radiography, 27(2), 727-732. https://doi.org/10.1016/j.radi.2020.11.001 Newton, P. M. & Salvi, A. (2020). How common is belief in the learning styles neuromyth, and does it matter? A pragmatic systematic review. Frontiers in Education, 5(602451), 1-14. http://doi.org/10.3389/feduc.2020.602451 Ogura, A., Hayashi, N., Negishi, T., Watanabe, H. May (2018). Effectiveness of an e-learning platform for image interpretation education of medical staff and students. Journal of digital imaging, 31, 622-627. https://doi.org/10.1007/s10278-018-0095-6 Ong, L., Elnajjar, P., Nyman, G., Mair, T., Juluru, K. (2017). Implementation of a point-of-a-care radiologic-technologist communication tool in a quality assurance program. American Journal of Roentgenology, 209(4), 809-815. . https://doi.org/10.2214/AJR.16.17517 Pal, S., Ikeda, D., Jessinger, R., Mickelson, L., Chen, C., & Larson, D. (2018). Improving performance of mammographic breast positioning in an academic radiology practice. American Journal of Roentgenology, 210(4), 807-815. https://doi.org/10.2214/AJR.17.18212 Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries safer, high-quality care. American Psychologist, 73(4), 433-450. http://doi.org/10.1037/amp0000298 62 Safdar, S., Zafar, A., N., & Zafar, S. (2014). Evaluation of use of e-learning in undergraduate radiology education: a review. European Journal of Radiology, 83(12), 2277- 2287. https://doi.org/10.1016/j.ejrad.2014.08.017 Sim, J., & Radloff, A. (2008). Enhancing reflective practice through online learning: impact on clinical practice. Biomedical imaging and intervention journal, 4(1), e8. https://doi.org/10.2349/biij.4.1.e8 Slatter, M., Morrison, T., & Steele, D. (2019). The impact of interventional radiology mock code blue drills on team vitality. Journal of Radiology Nursing, 38(2), 98-103. https://doi.org/10.1016/j.jradnu.2019.01.007 Steele, Joseph R., A. Kyle Jones, Ryan K. Clarke, Stowe Shoemaker, (2015) Health care delivery meets hospitality: A pilot study in radiology. Journal of the American College of Radiology, 12(6), 587-593. https://doi.org/10.1016/j.jacr.2014.10.008 Theall, M. & Graham, D. (2017). Using John M. Keller’s MVP model in teaching professional values and behaviors. New Directions for Teaching & Learning, 2017(152), 53-66. http://doi:10.1002/tl.20268 Yielder, J., & Davis, M. (2009). Where radiographers fear to tread: Resistance and apathy in radiography practice. Radiography Online. https://www.radiographyonline.com/article/S1078-8174(09)00061-3/abstract Whittington, K., Walker, J., & Hirsch, B. (2020). Promoting interdisciplinary communication as a vital function of effective teamwork to positively impact patient outcomes, satisfaction, and employee engagement. Journal of Medical Imaging and Radiation Sciences, 51(4), 107-111. https://doi.org/10.1016/j.jmir.2020.07.002 63 Appendices DEMOGRAPHICS 1. What is your age? a. 18-27 b. 28-37 c. 38-47 d. 48-57 e. 58 years and older f. Prefer not to say 2. How many total years have you worked within the field of Medical Imaging? a. 0-4 b. 5-10 c. 11-15 d. 16-20 e. 21-25 f. 25+ 3. In which modality do you primarily work? a. Bone Densitometry b. Cardiac Interventional c. Cardiovascular Interventional d. Computed Tomography e. Magnetic Resonance f. Mammography g. Medical Dosimetry h. Nuclear Medicine i. Radiation Therapy j. Radiography k. Sonography l. Vascular Interventional m. Other 4. How many hours per week do you work? a. PRN b. Less than 20 c. 20-40 hours d. 40 + hours 5. What type of shift do you work? a. Business Hours/Daytime 64 b. Evening Shifts c. Swing Shifts (In-between Hours) d. Graveyard/Overnight e. Locum Tenens/PRN 6. In which type of facility are you employed? a. Armed forces b. Clinic/Outpatient Facility c. Rural Hospital 1-25 beds d. Small Hospital 25-100 beds e. Medium Hospital 100-499 beds f. Large Hospital >500 beds g. Imaging Center h. Locum Tenens, PRN, or Travel Technologist i. Mobile Unit j. Physician Office k. Temporary Service l. Home Health m. Remote Technologist n. Other 7. What is your ethnic background? a. White / Caucasian b. Asian - Eastern c. Asian - Indian d. Hispanic e. African-American f. Native-American g. Mixed race h. Other (with a blank entry field for the participant to self-identify) i. I prefer not to say 8. In which geographic region of the United States are you currently employed? a. Alaska b. Midwest c. Northwest d. North Central e. Northeast f. Pacific Islands g. South Central h. Southeast MEASURE OF VARIABLES PROFESSIONAL COMPETENCY 65 The following questions measure how you feel about your current professional competency. This will include your professional behaviors, attitudes, knowledge, and skills. Professional Behaviors (Attitude, Ethics, Teamwork) Professional behavior is defined by the attitudes, values, and commitments that guide a professional’s actions (Theall & Graham, 2017). Please respond to each statement on how you would rate your level of professional behavior on a Likert scale from Strongly Disagree (1) to Strongly Agree (5) 1. I can persevere despite work challenges. (A) 2. I do not see the importance of following every hospital protocol. (E)* 3. Regardless of my circumstances or the patient’s background, I ensure every patient receives appropriate care. (E) 4. My co-workers know they can rely on me during a busy or stressful day to do my best and get the job done. (T) 5. I feel overwhelmed, angry, and disappointed within my workplace. (A)* 6. I actively communicate with my organizational leadership, peers, and co-workers within and outside of my department. (T) 7. I am confident in my ability to do the job well. (A) 8. I do not have the resources that I need to be successful (A)* 9. I deal with others honestly and fairly (E) 10. I don’t feel that I am a part of a team (T)* For rating this scale, all sub-variables are marked for the following: Attitude (A), Ethics (E), and Teamwork (T). All reverse scored answers are marked with an asterisk*. Professional Skills: Knowledge, Learning, and Application Professional competency requires learning, understanding, and application of professional knowledge and skills. Please respond to each statement on how you would rate your level of professional knowledge and skills on a Likert scale from Strongly Disagree (1) to Strongly Agree (5) 1. I understand how to acquire diagnostic images within my profession. (K) 2. I don’t enjoy learning new protocols, equipment, and/or procedures. (L)* 3. I can easily work around different patient conditions to provide diagnostic images . (A) 66 4. I don’t always know how to use my equipment or change my techniques to improve diagnostic images. (K)* 5. It’s difficult for me to learn from critical feedback. (L)* 6. I have the knowledge to teach and train newer technologists and students. (K) 7. I feel that I have a lot to learn in my profession before I will be competent or proficient (L)* 8. I have the skills I need to be successful in any healthcare organization. (A) 9. I can work independently (A) 10. I am prepared and can foresee when patients and/or physicians may require assistance during procedures (A) For rating this scale, all sub-variables are marked for the following: Knowledge (K), Learning (L), Application (A). All reverse scored answers are marked with an asterisk*. References Theall M, Graham DD. Using John M. Keller’s MVP Model in Teaching Professional Values and Behaviors. New Directions for Teaching & Learning. 2017;2017(152):53-66. doi:10.1002/tl.20268 PROFESSIONAL TRAINING Professional training is created to enhance professional competency. The following questions refer to the delivery in which you gain your professional training (including your schooling, organizational training, and continuing education). 1. If online training is defined as digital training without live instructor contact or communication, over the past year, what percentage of training did you receive that was delivered online (modules, videos, etc)? (Sliding bar 0 – 100%) 2. If virtual training is defined as digital training with live instructor contact or communication, over the past year, what percentage of training did you receive that was delivered in a virtual format? (Google Meet, ZOOM, etc) (Sliding bar 0 – 100%) 3. If face to face training is defined as being in person at a physical location and having a live instructor, over the past year, what percentage of training did you receive that was delivered in a face-to-face format? (Classroom, Conference, Coaching, Mentoring, etc) 67 (Sliding bar 0 – 100%) 4. Over the past year, how frequently did you engage in training activities? a. b. c. d. e. f. g. h. Daily Weekly Monthly 4 times per year 2 times per year Once per year Never Other (Define) 5. Over the past year, please rate how much you feel your training impacted your overall competency. (Sliding bar: 1 Not at all to 10 Highly impacted) 6. In which format (online, virtual, or face to face) do you prefer to acquire training? a. Online b. Virtual c. Face-to-face 7. Which type of training delivery has been most effective in helping you develop your professional competency? a. Online b. Virtual c. Face-to-face Open Ended: 8. How would you improve the training of imaging professionals in today’s healthcare environment? 68 Appendix B: Tables Table 1 Descriptive Statistics by Competency N M SD Professional Skills 92 4.45 0.415 Professional Behaviors 94 4.28 0.413 Total 186 4.37 0.414 Table 2 Correlation Statistics Parameters Professional Skills Professional Behaviors r p r2 r Frequency of Training -0.077 0.48 0.0059 -0.021 0.85 0.00044 Impact of Training on Competency 0.25 0.026 0.062 0.38 0.73 r2: Pearson correlation Table 3 Descriptive Statistics of Utilized Training Models Training Model N M SD Face-to-Face 86 53.70 31.80 Virtual 77 31.97 27.29 p r2 0.144 69 Online 81 42.38 34.08 Table 4 Descriptive Statistics of Valued Training Models Training Model Frequency Percent Online 17 18.7 Virtual 6 6.6 Face-to-Face 66 72.5 Other 2 2.2 Total 91 100 70 Appendix C: Figures Figure 1 Distribution of Mean Likert Scores of Professional Skills 71 Figure 2 Distribution of Mean Likert Scores of Professional Behaviors