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Challenges of Training and Clinical Skill Acquisition in Radiography Education: Perceptions of Students in Resource-Poor Southeastern Nigeria

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Challenges of Training and Clinical Skill Acquisition in Radiography Education: Perceptions of Students in Resource-Poor Southeastern Nigeria NOVEMBER 2016 | volume 54 number 2 THE SOUTH AFRICAN RADIOGRAPHER peer reviewed ORIGINAL ARTICLE Challenges of training and clinical skill acquisition in radiography education: perceptions of students in resource-poor southeastern Nigeria CC Ohagwu1 BSc, MSc, PhD (UNN) | K Ochie2 DCR (Lond), PGD, MSc, PhD (UNN) | CU Eze3 BSc, MSc (UNN), MHPM (UNIBEN) | JC Eze1 BSc, MSc, PhD (UNN) | EE Ezugwu1 BSc, MSc (UNN) | M Barde4 BSc (UNIMAID) | JK Umeano1 BSc (NAU) 1Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University Nnewi Campus, Anambra State, Nigeria. 2Department of Radiography and Radiological Sciences, University of Nigeria Campus, Enugu State, Nigeria. 3Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, College of Medicine, University of Lagos, Nigeria. 4Department of Radiography, Bayero University, Kano, Kano State, Nigeria. Abstract Purpose: To investigate the factors that contribute to the challenges of training and clinical skill acquisition in undergraduate radiography education in southeastern Nigeria. Methods: A cross-sectional prospective study, which targeted radiography undergraduates in the clinical classes in two universi- ties in southeastern Nigeria, was conducted. A 23-item self-completion questionnaire, designed in line with the objectives of the study, was used for data collection. Results: The majority of the factors identified were strongly rated to contribute to the challenges of training except for unavail- ability of published programme curriculum. Multinomial logistic regression showed that the age of the students did not influence the rating of factors (p>0.05). Gender influenced the rating of high academic workload and tight scheduling of lectures and published programme curriculum is not interest-stimulating enough (p=0.008). The factor's rating by the males was higher than the females (3.23 ± 0.91 vs 3.00 ± 0.86. The institutions, where the students are domiciled, influenced their ratings of congested and not conducive classrooms (p<0.0001), and shortage of ICT facilities and e-learning packages (p=0.009). The students’ level of study influenced the rating of 7 of the 18 factors investigated. Conclusion: The challenges facing training and clinical skill acquisition of radiographers in southeastern Nigeria have been highlighted in this study. The challenges identified include inadequate infrastructure, difficult logistics, inadequate teaching aids, negative attitudes of trainers, and poor training methods. Keywords training; clinical skill acquisition; challenges; radiography Introduction process from novice to expert radiogra- tocol was approved by the Research Ethics pher, and begins in the first year of study. Committee of Faculty of Health Sciences High quality training of a radiography It includes theoretical classroom learning, and Technology, Nnamdi Azikiwe Univer- student is desirable for the delivery of simulations in the skills laboratories, and sity Nnewi campus. optimal radiological services and patient hospital-based practice under the guid- care. During training, students acquire ance of clinical tutors. Radiography clini- The study was conducted among students theoretical academic knowledge, clinical cal tutors act as preceptors to students and at the University of Nigeria (UNN), Enugu skills and the professional behaviour ex- play a very important role in training. campus, and the Nnamdi Azikiwe Uni- pected of radiographers. In clinical train- versity (NAU), Nnewi campus. Both in- ing, time is devoted to ensuring gaining of The southeastern Nigeria university train- stitutions offer academic programmes in sufficient clinical skills to enable students ing is faced with numerous challenges radiography and radiological sciences at to become competent radiographers upon which could negatively affect the compe- undergraduate and postgraduate levels. graduation. tence of student radiographers who gradu- A sample of potential respondents was ate from the programme. This study aimed drawn from the population of students A clinical skill is any specialised action of at investigating the factors that contribute who had commenced clinical posting at a healthcare worker in care of a patient to the challenges students face in training both institutions using Yaro Yamane’s for- that affects the clinical outcome.[1] Radi- and clinical skill acquisition in undergrad- mula[2] as below: ography students, like students in other uate radiography education in southeast- health disciplines, acquire clinical skills ern Nigeria. n = N ÷ N + 1e2 through formal instructions and practice. Where; In Nigeria, clinical skill acquisition in ra- Subjects and methods diography begins in the third year of study n = desired sample size; in a five-year programme. It enables stu- A cross-sectional prospective study, which N = total number of students that have dents to learn skills necessary to become targeted radiography undergraduates who commenced hospital posting in both uni- competent radiographers. Training is a had commenced their clinical posting, versities; term used to describe the transformation was conducted. The study design and pro- e = the level of precision at 0.05 level of www.sorsa.org.za 7 THE SOUTH AFRICAN RADIOGRAPHER volume 54 number 2 | NOVEMBER 2016 significance; and version 19.0 (SPSS Inc., Chicago, Illinois). mean rating was unavailability of pub- 1 = constant. Responses to items 5 to 22 on the ques- lished programme curriculum. Its mean tionnaire were assigned numerical values rating was 2.25 ± 0.92. The ratings for At the time of the study, a total of 468 stu- to indicate their magnitude and direction other factor show they were fairly strongly dents had commenced clinical posting in for objective quantitative analysis. Strong- noticed by students as shown in Table 2. both universities. Substituting this number ly disagree = 1, disagree = 2, agree = 3, Table 3 shows the ratings of the factors for N in the equation resulted in sample of and strongly agree = 4. Frequency distri- contributing to challenges of training and 216 respondents, as indicated below. butions were obtained for items 1 to 3. clinical skill acquisition, according to n = 468 ÷ 468 + 1 x 0.052 = 216 Descriptive statistics, namely minimum, gender and training institution. Table 4 maximum, mean, and standard devia- shows the ratings of the factors that con- However, data were collected from 234 re- tion, were obtained for items 4 to 22. The tribute to challenges of training and clini- spondents to increase the precision of the particpants’ suggestions on improvement cal skill acquisition, according to level of study. The data collection instrument was a of clinical training of radiography stu- study of the partcipants. self-designed 23-item self-completion and dents were subjected to content analysis semi-structured questionnaire designed in Multinomial logistic regression shows using suitable themes and reported in a line with the objectives of the study. The that particpants’ age had no influence on frequency table. Multinomial logistic re- main author designed the questionnaire. the rating of the factors that contribute to gression was used to analyse the effect He identified the challenges using his challenges (p > 0.05). Gender influenced of demographic variables on the ratings clinical hospital-based experiences, and the rating of high academic workload and of the factors identified in terms of their as a clinical tutor of students on clinical tight scheduling of lectures, as well as contribution to challenges of training and posting, for example. The questionnaire published programme curriculum is not was critically reviewed and approved as clinical skill acquisition. Tests were two- interest-stimulating enough (p = 0.008) as being adequate for the study by the entire tailed with statistical significance consid- shown in Table 5: males gave higher rat- research team. The questionnaire sought ered at p < 0.05. ings than females (3.26 ± 0.81 vs 3.22 ± demographic information, and data on 0.92 and 3.23 ± 0.91 vs 3.00 ± 0.86 as challenges of training and clinical skill ac- Results shown in Table 3). The training institutions quisition in radiography. The respondents’ A total of 234 undergraduate radiography where the students’ trainings were domi- suggestions, on how the challenges could students, who had commenced clinical ciled significantly influenced their ratings be reduced, were also sought. postings participated in the study. Their of “congested and not conducive class- A pilot study was conducted to test the re- ages ranged from 19 to 40 years (mean rooms” (p < 0.0001), “there is acute short- liability of the questionnaire. Ten students 23.4 ± 2.5). Their demographics are age of visual teaching aids” (p = 0.004) and from each respective university (n=20) shown in Table 1. Their ratings of the fac- “shortage of ICT facilities and e-learning were randomly chosen. Coded copies of tors that contribute to challenges of train- packages” (p = 0.009) as shown in Table the questionnaire were administered di- ing and clinical skill acquisition are shown 5. Participants from Nnamdi Azikiwe Uni- rectly to them. Each code was tagged to a in Table 2. The mean ratings for more than versity rated the factors higher than re- particular respondent. The completed pi- half of the factors were greater than 3.0 on spondents from University of Nigeria (3.53 loted questionnaires were returned to the a 4-point scale. The factor with the least ± 0.65 vs 2.56 ± 0.98 for “congested and researchers.
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