Professionalism and non-technical skills in Radiology in the UK: a review of the national curriculum
Daley et al. BMC Res Notes
Professionalism and non-technical skills in Radiology in the UK: a review of the national curriculum
F. Daley 0 3
D. Bister 2
S. Markless 1
P. Set 0 3
0 Department of Radiology, Addenbrooke's University Hospital , Addenbrooke's , Cambridge University Hospital , Box 219, Hills Road, Cambridge CB2 0QQ , UK
1 King's Learning Institute , Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London SE1 9NN , UK
2 Guy's Hospital , Great Maze Pond, London SE1 9RT , UK
3 Department of Radiology, Addenbrooke's University Hospital , Addenbrooke's , Cambridge University Hospital , Box 219, Hills Road, Cambridge CB2 0QQ , UK
Objective: To drive quality and safe clinical practice, professional values and non-technical skills need to be explicit in all postgraduate medical curricula and appropriate assessment tools should be available for teachers to apply. We interrogate a national Radiology curriculum for content on professionalism and assessment tools, comparing it with the Royal College of Physicians' 2005 document. Results: We found that whilst the knowledge for practising with professional values is embedded in the curriculum, the skills that have to be acquired have not been comprehensively developed. This is reflected in the restricted assessment tools that are mapped to each generic area. The terminology used in the Radiology curriculum was varied and the most frequently used descriptor for professionalism or behaviours pertaining to non-technical aspects was Good Medical Practice; a term used by our regulator, the General Medical Council, and to which our curriculum is mapped. If terminology is to be standardized in Britain collaboration with our regulator is key. We need standardized terminology to permit effective research and sharing of best practice. The Radiology curriculum encompasses all the values set out in the seminal document produced by the Royal College of Physicians in 2005, Doctors in society: medical professionalism in a changing world.
Professionalism; Radiology; Postgraduate curriculum; Education; Patient Safety
It is recognized that graduate medical education poses
unique challenge for the delivery of safe patient care [
In this cohort distinctive features of errors in judgement
and team-working led to 70% of malpractice claims [
In the UK, the cost of errors is significant [
work in teams and between professional disciplines
nontechnical skills (NTS) are paramount in enhancing safe
practice. All trainees need generic skills of decision
making, team-working, resource management and leadership
]. Yet Greig et al. [
] found a lack of specific detail on
learning objectives or assessment recommendation for
NTS in many UK curricula.
Radiology is central to the management of patient care
in modern medicine, it is a specialty which interacts with
many specialties in primary and secondary care. The
radiologist is increasingly part of the investigating team
and problems often arise from poor communication
rather than technical skill. There is scope for loss of
information at every interaction and problems of this nature
can lead to significant medical errors [
]. There is limited
literature on professionalism or NTS in Radiology; that
from North America reflects on definitions [
] and ‘how I
do it’ [
] principles and cannot be easily translated to the
UK given the major organizational differences between
the two health care systems.
The wider literature on professionalism in medicine
wrestles with definitions and the importance of
practising with professional values with limited number of
studies on how to implement [
] the teaching of these generic
skills. Our study looks in depth at a national Radiology
curriculum’s content for professionalism and identifies
areas for curriculum development.
According to a seminal document produced by the
Royal College of Physicians in 2005 (RCP 2005), Doctors
in society: medical professionalism in a changing world,
professionalism comprises a set of values, behaviours
and relationships that underpin the trust the public has
in doctors. This includes integrity, compassion,
altruism, continuous improvement, excellence, and working
in partnership with members of the wider healthcare
]. The King’s Fund On being a doctor: redefining
medical professionalism for better patient care, suggests
it is the ability to apply a body of specialist knowledge
and skills along with a high degree of self-regulation and
observation of explicit standards and ethical codes [
Definitions of professionalism are manifold, and while
there have been many attempts to standardize a
definition, there has been no universal agreement [
reason why it may be so difficult to place within a
curriculum as reported by Greig et al. [
]. The values of
professionalism are those soft skills sometimes termed
non-technical skills. The anaesthetists are at the forefront
of training in non-technical skills or aspects of
If medical curricula were able to make specific
professional values more explicit it will become easier to embed
into clinical practice: trainees will be able to learn about
them, practise them and improve on them in the
workplace; teachers will be fully aware of them in order that
they can act as mentors and assess their tutees.
To embed professionalism in the Radiology curriculum
we need a clear definition. What it is to be professional,
needs to be reflected in terms specific enough to permit
assessment of the same.
We set out to interrogate the Royal College of
Radiologists (RCR) curriculum [
] against the RCP 2005
document on professionalism because the values of
professionalism defined in the latter underpins those
recently termed NTS used by the anaesthetists [
The Royal College of Physicians’ 2005 document (RCP
2005), Doctors in society: medical professionalism in a
changing world, sought to conceptualise medical
professionalism and define it using a range of evidence and is
considered to have done so very effectively by the
regulator, General Medical Council (GMC).
We evaluate the following research questions:
1. Does the 2015 Radiology curriculum match up with
the robust definition of professionalism set out in the
RCP 2005 document?
2. Is it explicit in the behaviours that are required to be
3. What are the methods of assessments for
Using qualitative case study methodology [
] in the
context of UK Radiology training we examined the two
important documents outlined above. The method used
is document analysis to identify emerging themes in both
]. The two documents were treated as
data sets, which were read and re-read multiple times to
identify the values of professionalism and the term
‘professionalism’ by a method called constant comparison
]. The data from the two large documents was
analysed inductively for emerging themes, similarities
In addition, quantitative analysis was made for the
descriptors of non-technical skills and values of
professionalism as used in the current medical literature to
triangulate with the qualitative inductive analysis [
The Radiology curriculum is constantly updated, for the
purpose of this study we used the most recent
curriculum dated November 2015.
Compared to previous curricula the 2015 curriculum
is clear and explicit about professionalism in Radiology
training. In the introduction it sets out that ‘satisfactory
performance in professional practice will be expected
throughout..’ and that ‘performance to be judged will be
the basis of much of the assessments of generic skills and
competences such as good medical practice, clinical care,
professionalism and leadership.’
In Section 2.4 Generic content under ‘behaviours in
the work place’ professionalism is defined as ‘to practise
radiology employing values, behaviours and relationships
that underpins the trust the public has in doctors and in
accordance with the current GMC Good Medical Practice
(GMP) guidance’ [
]. This definition resonates with that
provided by the RCP 2005 document and encompasses
the GMC guidance.
The curriculum also defines the knowledge required for
professionalism as ‘concepts of modern medical
professionalism, the relevance of professional bodies and when
to seek support’.
Skills of professionalism set out in the curriculum are
the values defined in the RCP 2005 document of
practising ‘with integrity, compassion, altruism, continuous
improvement, excellence, working in partnership with
members of the wider health care team’. The curriculum
goes beyond these values and adds ‘humility, insight,
respect for cultural and ethnic diversity and regard for the
principle of equity’.
In professional behaviours the curriculum
emphasizes the practice of patient-centred care, prudent and
equitable use of healthcare resources. It is explicit that
the trainee should practise with honesty and sensitivity,
be able to cope with uncertainty and have the ability to
accept and act positively on appropriate feedback. There
is resonance with the RCP 2005 document on
The curriculum expands and prescribes under three
further sections on (i) working with colleagues, (ii)
relations and communications with patients and (iii)
personal qualities, the importance of explicit knowledge,
skills and behaviours for training and assessments.
Overarching themes of effective communication, development
of clinical teams underpinned by the values of the
medical profession as outlined in the RCP 2005 document and
respect for patients and colleagues emerged.
Throughout the text of the document, the curriculum
echoes the RCP 2005 document. It tells us that ‘good
communication is an essential component’, we should have ‘a
sense of team-working within all spheres of practice’ and
‘a professional attitude to all aspects of clinical practice,
which places good conduct at its centre’. It goes further in
saying we should be maintaining individual skills,
knowledge and values throughout our career with ‘a desire to
commit to the dynamic nature of radiological practice’.
There is clear explicit connection and mapping to the
four domains of GMP throughout the curriculum.
Of the 193 pages of curriculum 5 (2.6%) were dedicated
to professionalism and non-technical skills in
Radiology. We report on the number of times descriptors of
professionalism or professional values appeared in the
document within the brackets following each descriptor
as follows. The words- professionalism (6), professional
values (2), integrity (5), compassion (2), altruism (2),
continuous improvement (2), humility (1), excellence (3),
respect for others (2), ‘regard for principle of equity’ (3),
insight (5), Good Medical Practice GMP (96), leadership
(35), resource management (14), team working (6),
decision making (8) situational awareness (0), human factors
(1), non-technical skills (0) and reflective approach (27).
The quantitative analysis triangulated well with the
qualitative analysis through multiple readings and
inductive analysis for themes as described.
The curriculum indicated that these professional
behaviours were to be assessed by work-based assessments in
the National Health Service (NHS) ePortfolio. There are
five methods for assessment of professional or
non-technical skills namely, mini-IPX (mini-imaging
interpretation exercise), Rad-DOPS (Radiology-direct observation
of procedural skills), MDTA (Multi-disciplinary team
Assessment), MSF (multi source feedback) and Audit
The mini-IPX has 11 areas for assessment of which
three are non-technical and they relate to
i. Interaction with patient/staff
iii. Overall clinical judgement
The Rad-DOPS has 13 areas for assessment of which
three are non-technical and they relate to
i. Communication with patient/staff
iii. Explain procedure/risk/informed consent
The MDTA has eight areas of assessment of which five
are non-technical and they relate to
i. Communication of information/ideas
ii. Collaborative approach/team working
iii. Time management/organizing effectively
iv. Self awareness
v. Leadership of team
The MSF has ten areas of assessment and all pertain to
values of professionalism or NTS, these include
communication, attitude, team working, reliability/punctuality,
leadership, honesty and overall professional competence.
The Audit assessment can be used to demonstrate use
of health care resource.
The mini-IPX and Rad-DOPS are elementary for
assessment of professionalism or NTS, they are designed
to assess technical skills with soft skills in the context of
communicating with staff/patients.
The MSF is the only true assessment tool for values of
professionalism and it is undertaken once a year.
Contrary to Greig’s et al. [
] findings we found that the
RCR curriculum is explicit about what professionalism
means in training and that the themes matched those of
the RCP 2005 document. In addition the curriculum is
mapped to the GMC guidance of good medical practice.
This is a good starting point, however whilst the
knowledge for practising with professional values is embedded
in the curriculum the skills that have to be acquired have
not been comprehensively developed. This is reflected in
the restricted assessment tools that are mapped to each
generic area. Unlike the assessment tools for
anaesthetists in training [
] our tools are limited. More research
is needed to refine assessment tools for non-technical
skills in Radiology.
One study which attempted to make these values more
explicit found that by outlining certain behaviours that
are expected, and by motivating positive department
behaviour with assessment by colleagues, patients and
referring physicians, professionalism can be successfully
implemented. These values ranged from the assessment
of simple introductions to the ability to prioritize patients
over other tasks, facilitating patient care by helping
physicians with imaging and setting a realistic tone when
talking to referring clinicians [
]. This is a significant
finding for educators in developing and delivering the
It is interesting to note that if we were to search for
descriptors such as non-technical skills (0), situational
awareness (0) or human factors (1) without multiple
reading of the entire document we may not have come
to the conclusion that the RCR curriculum is explicit in
these skills. Fundamentally the descriptors for NTS are
the values of professionalism. Another important finding
is that the curriculum descriptor for professional values
or NTS was ‘good medical practice’, this was the most
frequently used term. We need to standardize terminology
as suggested by Greig et al. [
]. NTS is more than
professionalism and for progress to be made in assessment
of the same, we propose that undergraduate and
postgraduate medical curricula should be reviewed in light of
recent literature. If educators can agree on standardized
terminology this would make research and sharing of
best practice more effective.
Our study is limited by the interrogation of the singular
UK Radiology curriculum however the themes identified
may be generalised to other curricula and used to inform
further curricular development.
NHS: National Health Service; NTS: non-technical skills; RCR: Royal College of
Radiologists; RCP: Royal College of Physicians; GMC: General Medical Council;
UK: United Kingdom; GMP: Good Medical Practice; Rad-DOPS:
Radiologydirect observation of procedural skills; MDTA: Multi-disciplinary team
Assessment; MSF: multi source feedback; Mini-IPX: mini-imaging interpretation
FD contributed to acquisition and analysis of data and drafted the
manuscript. PS contributed to conception and design and revising it critically for
important intellectual content. DB and SM contributed to conception and
design and revising it critically for important intellectual content. FD, PS, DB
and SM gave final approval of the version to be published and agreed to be
accountable for all aspects of the work. All authors read and approved the
We would like to thank Dr. M Alexander, Head of School of Radiology, East
of England Deanery for his unwavering support to all aspects of curriculum
development and delivery and this study.
The authors declare that they have no competing interests.
Availability of data and materials
The datasets for analysis are derived from two public documents and these
are referenced as number [
] and [
] in the reference section.
Consent for publication
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