We all strive to be professional in our roles as medical radiation technologists, but the term “professional” is a contested one. This talk will examine how the concept of “being a professional” has shifted over time, and how various discourses of professionalism manifest in our work and interactions with patients.
1. 2017 W.Q. Stirling Lecture:
Professionals, professionalization
and practice
Delivered at BCAMRT AGC: April 2017
Amanda Bolderston
Radiation Therapy Provincial Professional Practice & Academic
Leader, BC Cancer Agency
2. 1. Definitions
2. Medical Radiation
Technologists (MRTs) and
professionalization
3. Contested territories
4. Professional wisdom
5. The end of the
professional?
6. Conclusion: what next?
3. What does it mean to be professional?
• Is it how you look?
▫ Neat and tidy
▫ Wear appropriate clothes
• Is it how you act?
▫ No cell phones at work
▫ Kind and considerate to
patients
• Is it what you know?
▫ Specialized education
▫ Continuous learning
4. Webster dictionary definition
• Specialized knowledge and often
long and intensive preparation
• Maintaining high standards of
achievement and conduct
• Committing to continued study
• Service to the public
5. Key elements of many definitions
“Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the basis
of a benign moral or cultural code”
Dent and Whitehead, 2002
8. CAMRT definition
• Patient and family centred care
• Interprofessional collaboration
• Commitment to education and life-long learning
• Commitment to the profession
• Acting within legal and ethical boundaries
• Expertise in Medical Imaging and Radiation
Therapy
▫ Quality patient care
▫ A safe environment
Description of practice http://www.camrt.ca/mrt-
profession/description-of-practice-2/
9. Professionalization milestones
• Institutionalized training developed
• Local associations lead to a national association
• The introduction of codes of professional ethics
• Defining entry to practice criteria
• Education shifts to a university, credentials
increase
• Licensing laws and regulation
▫ Policing the boundaries – who gets in, who is out
▫ Public protection
11. Semi-professions
• Also known as:
• Caring professions
• Quasi-professions
• Vocations
• People professions
• Sophisticated knowledge and skills, but often not
regarded as a true profession
• Many emerged to serve an existing profession (e.g.
nursing to medicine)
• Supervised: lack full control over their own work
Hearn, 1982; Adams, 2010
12. Semiprofessions
• Usually lack the right of privileged
communication between client and professional
• Emphasis on practice over theory
• High percentage of women
• Examples include social work, journalism,
librarianship, teaching, nursing, occupational
therapy and medical radiation technology
Hearn, 1982; Adams, 2010
13. Contested territories
• Professions develop
interdependently
• Control of work
brings professions
into conflict
• E.g. radiographer
reporting in the UK
Abbot, 1988
14. Non-physician clinicians scopes
Bolderston, 2004 (adapted from Cooper, 2003)
• Ratio of NPC to
physicians is rising
• Driven by cost and
increase in
interprofessional
practice
• We can add MRT to this
list!
15. “Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the
basis of a benign moral or cultural code”
Dent and Whitehead, 2002
16. What is professional judgement?
Technical + practical wisdom (phronesis)
Theory: body of
knowledge/education
Intuitive: From
experience/tacit
18. Practical and professional wisdom
• Phronesis: from Aristotelian ethics
• Used in the “swampy lowlands” of practice
(Schön, 1983)
• Also: Experiential knowing, craft knowing,
know-how, tacit knowing, personal knowing
(Dreyfus et al, 1984)
“Scientific evidence and knowledge are incapable
of rendering the individual, improvisatory, fluid
and artistic aspects of practice” (Clark, 2011)
19. “Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the basis
of a benign moral or cultural code”
Dent and Whitehead, 2002
20. Professional values
• “Virtues of character”
• Professional morals or codes of ethics
“It is the cultivation of virtues
such as courage, temperance,
justice and wisdom that lie at the
heart of exemplary professional
conduct” (Carr, 2011)
21. Professional values
CMRTO: “The Code of Ethics is intended to help MRTs
choose the right, fair, good and just action”
http://www.cmrto.org/what-we-do/professional-
practice/code-of-ethics/
23. Professional practice: Art & science?
Nursing is an art;
and if it is to be made an art,
it requires as exclusive a devotion,
as hard a preparation,
as any painter's or sculptor's work;
for what is the having to do with
dead canvas or cold marble,
compared with having to do with the
living body - the temple of God's spirit?
It is one of the Fine Arts;
I had almost said
the finest of the Fine Arts
- Florence Nightingale
24. Professional practice: Art &
science?
“The significance of the affective component of the
role, which initially attracted many radiation therapists to the profession, is that it
provides an important source of professional satisfaction and reward …Unfortunately,
our research finds affective behavior greatly under-represented in both educational
program advertisements and job postings”
Ekmekci O, Turley, C. Therapist, 2008, 17(1) p. 11
25. Gender and more
• Classic professions not
available to women
• Now majority of healthcare
workers are women
• Many new professions are
female dominated
• Health professions said to
be feminizing
26. “Being professional”
• Is often (unintentionally) gendered
• The professional is seen as “not just a man but, to
a large extent, a white heterosexual middle-class
man” (Grey, 1998, p. 584)
• Masculine values traditionally
are control, rationality and
competitiveness
28. Professionalism today
“Professionals are still trusted, to the extent that
they have to be, but that trust is increasingly
mitigated through the process of being managed,
inspected and audited by external actors and
systems”
Dent and Whitehead, 2002
29. New public management
• Dominant management theory of last 20 years
• Private sector models and ideas in public sector
(e.g. healthcare)
• Aim is to improve efficiency and “customer service”
with a focus on competition, incentives and
targets
• Tension between humanistic and economic aspects
of workplace
▫ Professions and managers
30. Managers and/or professionals?
Professional groups
▫ Professionals
▫ Collegial
▫ Scope, standard, ethics
▫ Accountable to
individual patient
▫ Autonomous
Healthcare organization
▫ Managers
▫ Hierarchical
▫ Policies, procedures
▫ Accountable to budget,
metrics
▫ Bureaucratic
31. Impacts of NPM
• “We are all managers now”
• New professional language is about:
▫ Being flexible
▫ Patient (client) choice
▫ Being a reflective practitioner
▫ Embracing lifelong learning
▫ Being market-oriented, entrepreneurial
Evetts, 2009
32. UK Francis inquiry
Between 400 and 1,200 patients died as
a result of poor care over the 50 months
between January 2005 and March 2009
at Stafford hospital in the UK Midlands
Guardian, Feb 26th
2013
33. UK Francis inquiry
• Lack of care and compassion mentioned
repeatedly in the report
• “Doing the system’s business, not the patients”
• Focus on meeting externally imposed targets:
managerialism over professionalism?
34. Final thoughts
• The concept of “the professional” is complicated
and contested
• MRTs are part of the general professionalization
movement
• The growing influence of NPM has impacted all
HCPs
• We are a work in progress, in BC and beyond!
35. References
• Abbot, A. D. (1988). The system of professions: An essay on the division of
expert labour. Chicago, IL: University of Chicago Press
• Adams, T. (2010). Gender and Feminization in Health Care Professions.
Sociology Compass, 4(7), 454–465
• Bolderston A. Advanced practice perspectives in radiation therapy. J
Radiother Pract, 4 (2-3), 57 – 65, 2005
• Carr, D. Virtue, Character and Emotion in the People Professions. In
Towards Professional Wisdom: Practical Deliberation in the People
Professions, Bondi L, Carr D, Clark C, Clegg C.
• Dent, M., & Whitehead, S. (2002). Configuring the “new” professional. In
M. Dent & S. Whitehead (Eds.), Managing professional identities:
knowledge, performativities and the “new” professional. London, UK.:
Routledge
36. References
• Dreyfus, H. L., Dreyfus, S. E., & Athanasiou, T. (1986). Mind over machine:
The power of human intuition and expertise in the era of the computer.
New York: Free Press.
• Evetts, J. New Professionalism and New Public Management: Changes,
Continuities and Consequences. Comparative Sociology 8 (2009) 247–266
• Grey, C. (1998). On being a professional in a “Big Six” firm. Accounting,
Organizations and Society, 23, 569–87
• Hearn, J. (1982). Notes on Patriarchy, Professionalization, and the Semi-
Professions. Sociology, 16(2), 184–202.
• Schon, D. A. (1983). The reflective practitioner: How professionals think in
action. New York: Basic Books
Editor's Notes
We all strive to be professional in our roles as medical radiation technologists, but the term “professional” is a contested one. As we approach the reality of a professional regulatory college in BC, this talk will examine how the concept of “being a professional” has shifted over time, and how various discourses of professionalism manifest in our work and interactions with patients.
List three professions (maybe show an image of each) and ask whether participants would see them as professional: priest, nurses, plumber
3 classic professions are law, medicine and the clergy
Stress the point that the public trusts us with certain significant acts like taking care of their money, health etc. as well as the other elements.
John French’s Welch etc.
Usually in reference to research (body of knowledge)
Not autonomous practice – highly constrained by protocols and legislation because of use of ionizing radiation. Professional socialization is conformity and obedience (Wyle, 2009 on leadership, radiographers score lowest w podiatrists).
Could add first degree course, first Masters program…
What don’t we have?
Consistency in training across the country
National regulation
Ekmekci and Turley2 analyzed job advertisements and recruitment material for radiation therapy schools and colleges in the US using content analysis. They found that such public images are overwhelmingly technical in nature (e.g. images of treatment units, planning computers and CT scanners) rather than emphasizing patient care and contact. This is not surprising given that symbols of science are usually deemed more prestigious than symbols of caring or humanism.
Male MRTs – doctor!
“When I saw ‘Operating Theater’ by Malika Favre on the cover, I was struck not only by the beautiful image, but by the depiction of a female surgeon and her team — a sight that is not commonplace,” says Susan Pitt, an endocrine surgeon at the University of Wisconsin. She issued a challenge to her fellow female surgeons: to replicate the image in real life, bringing visibility to the women and other minority groups working in a traditionally white, male-dominated field. Hundreds of surgeons across the world responded to the challenge, taking photographs and sharing them online with the hashtag #ILookLikeASurgeon
Evetts – tensions
Between 400 and 1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire triggered by concern over unusually high death rates. 2013 report by Robert Francis QC. Byword for poor care and targets over people’s needs.
Francis cited a litany of failings in the care of patients. "For many patients the most basic elements of care were neglected," he said. Some patients needing pain relief either got it late or not at all. Others were left unwashed for up to a month. "Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding." Too many patients were sent home before they were ready to go, and ended up back in hospital soon afterwards. "The standards of hygiene were at times awful, with families forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections." Patients' calls for help to use the toilet were ignored, with the result that they were left in soiled sheeting or sitting on commodes for hours "often feeling ashamed and afraid". Misdiagnosis was common.
Chronic staff shortage, poor morale – one reason was the ruling trusts reliance on apparently favourable performance reports by outside bodies not patient and staff feedback, cut staff to save 10m pounds to try to gain foundation trust status.