Whilst there are certainly requirements for each of these levels of practice, such as educational qualifications, consideration needs to be given to the transferable skills and attributes which can apply at all levels, or which are developed as we progress.  Moving through this spectrum of practice, the autonomy and responsibility we have in our decision-making increases along with the complexity of the situation and the extension of our scope of practice, as does the sphere of influence that we have on others across education, leadership and research.  But that doesn't necessarily mean that someone working as an assistant practitioner or as a newly qualified radiographer cannot start to develop those KSAs.  Identified within the College of Radiographers Education and Career Framework (ECF)⁵ all levels of practice should embed the four pillars of professional practice (Fig. 2), and this is one place career development can begin.  The four pillars will be discussed in further detail later in this article. 

Fig. 2 The Four Pillars of Practice (scroll to reveal)

When thinking about our personal and professional development the focus should be about developing our KSAs across all the pillars rather than just focusing on just one, commonly the clinical pillar.  In doing so this we can add value to our roles.  As we progressively move through the spectrum, we should be open to any opportunities and experiences that arise.  We can always be on the lookout for these and should get into the habit of recording and developing over time from our day to day experiences. 

Career development in Radiography.

Traditionally, career progression in radiography, may have been seen as climbing the career ladder, aiming to progress through AfC pay bands or by specialising in a particular area of practise. This approach sees radiographers always looking up and waiting for that next opportunity to arise, to climb that next rung on the ladder. This may be alluded to as “waiting for dead man's shoes,” waiting for someone to leave for your opportunity to arise.  But what if we don't get those opportunities, or when they do come along there is a better candidate someone with more of the required skill set? 

In more recent years, portfolio careers have become an alternative approach to career progression.⁶  Developing a portfolio career means rather than everything being a distinct step on the traditional career ladder, all we experience, good or bad, will ultimately develop us as a person and can be applied within our professional practice.  Rather than focusing on planning the next rung of the ladder, we need to reflect on our experiences and gradually build upon these foundations developing ourselves by seeking and engaging in opportunities and activities, taking little steps to build to our next goal. Sometimes these opportunities can be difficult to spot and can feel overwhelming, however as we reflect on ourselves, we can become more open to identifying those opportunities.  Portfolio based career planning views our development more holistically, focusing on evolving us as individuals, developing our KSA’s so that we're progressively growing in our career rather than just purely focusing on that next promotional step.  

Growth-based career planning,⁶ similarly, focuses on considering more than just moving up, but by considering opportunities to move across into roles in other departments, or into other opportunities such as in education, research or leadership. The Kawa method (Kawa is Japanese for river) encourages us to not consider our careers as ladders, but as a river which meanders as it flows along and offers experience opportunities to move forward or in a different direction but also presenting barriers to us moving along the way.  Both methods encourage us to take opportunities presented to us, or that we seek out ourselves, to develop across and not just up.  Understanding the four pillars can help us to appreciate these opportunities more.

 The Four Pillars of Practice

It is often assumed that the four pillars of practice are only relevant to those working at advanced level or beyond, where they must evidence that they are fulfilling all four pillars of practice. As already discussed, and in the ECF,⁵ the four pillars are in fact relevant to all levels of practice.  However, the expectations and the types of activities and roles undertaken at different levels will differ as we move through the spectrum of practice (Fig. 1).  So, what if we could start to build our roles and our skill set around each of these four pillars by undertaking activities relevant to our existing role?  This would support our future development and prepare ourselves for the higher levels of practice we might be aiming for, growth-based career planning.  The remainder of this article aims to demystify the four pillars by identifying what they mean and give examples of types of activity that can be undertaken to develop roles within them.  

Each of the four pillars require KSA’s which will develop and change as our sphere of influence on others grows as we progress through the spectrum of practice.  Focus is often on the clinical pillar, but we typically embed the other pillars within our role without being fully aware that we are.  Some roles, however, might have more of an emphasis on other pillars such as a practice educator with the education pillar or a clinical academic with the research pillar.

Clinical Pillar

In most roles the clinical aspects will form the mainstay.  The clinical responsibilities and activities we undertake will be typically related to our individual scope of practice.  As registrants with the HCPC radiographers have a professional scope of practice, which is our entry scope to the profession.⁷ As you evolve through the spectrum of practice then your individual scope of practice will evolve to redefine the boundaries of your practice. Your scope of practice should be reviewed yearly within performance development reviews (PDRs) to ensure it is relevant and up to date. This is an important element of the governance process; you should not step outside of the boundaries of your scope or what you are trained and competent to do. Working outside the boundaries of your scope of practice will impact your professional indemnity insurance.  Moving through the spectrum of practice from assistant to practitioner, to enhanced, advanced and ultimately consultant invariably relates to us developing into broader or more in-depth clinical roles with increased degrees of autonomy and complexity of decision making related to the patient pathway.  We should consider any opportunities to undertake additional courses, learning or training to help develop in the clinical pillar.

Education Pillar

When considering the education pillar, this is related both to our own learning and CPD but also the learning of others, including patients and carers.  Reflective practice really is a core requirement of our roles, supporting the development of resilience and emotional intelligence as we learn from experiences to improve our practice.  With experience we do this daily, but often we're not very good at recording it.  Our own education is not just about going to study days or undertaking courses.  Any activity or experience we do on a day-to-day basis may be considered a potential learning opportunity, but it needs to be recorded and reflected upon in terms of what happened, what we have learned, and how it will influence our future practice, linking back to what has already been discussed around portfolio careers. Self-directed learning and self-development are a core part of the education pillar, identifying our own learning gaps enables further development in areas that add value to our professional life.  Another key part of the education pillar is to learn how we learn, so that's reflecting upon both the best ways in which we learn ourselves, but also about developing learning environments for others which are effective.  So as part of the development within the education pillar considering how people learn and how we produce a good learning environment can help us to become more proficient in this area.    

It is everyone's responsibility to support the learning of others, as stated within our professional scope of practice with the HCPC.⁷ We have a responsibility to help to teach and improve the knowledge of others, whether that is potentially undergraduate students, our peers, across the multi professional team, or patients and carers.  Health literacy, promotion and patient education now forms a core part of the role of the radiographer’s professional scope of practice too and can have a significant impact on person-centred care.

Many of us undertake mentorship or supervision activities of some type and as a part of that, developing other people’s understanding is considered a core part.  As we ‘move up’ the educational pillar we start to identify our sphere of influence changes from an individual, or within our own department, to potentially outside departments in the wider multidisciplinary team and across organisations. Typically, those people working at higher levels of practise have a broader sphere of influence in terms of the education they provide, for example consultant radiographers teaching in a university setting. 

Leadership Pillar

It is important to recognise that leadership and management are not necessarily the same thing, we can be a leader without necessarily having management responsibilities.  We will all have a degree of responsibility for undertaking specific tasks and processes, and commonly we will also have influence over other people undertaking those tasks and processes which can be defined as a form of leadership.  Being a role model, a mentor, or supervisor for someone to ensure that activities and processes are followed effectively and efficiently can also be considered part of the leadership pillar.  

One of the key aspects around this pillar of practice is that it aims to improve the delivery of the services we provide.  So, within our roles, what opportunities are there for us to use initiative to develop service and help to improve the practices that we undertake?  Again, as we move through the spectrum of practice the types of activity that we have responsibility for and who we have responsibility for will become more complex but that does not necessarily mean we can't have leadership activities and roles in the other levels of practice.  Operational leadership, the day-to-day management of activities might be considered within the remit of spectrum of practice towards the left, whilst those working at higher levels might engage more in strategic leadership with longer-term planning.

Research Pillar

The final pillar is perhaps the one that is perceived as the most challenging and, in many ways is perhaps the one pillar that is most misunderstood. The research pillar is not solely about producing primary research and publishing randomised controlled trials in a peer reviewed journal.  Research is about evidence development and integration into practice, a contribution to knowledge. 

So, we can sometimes refer to research with a big ‘R’ but also research with a little ‘r’ and which encompasses all facets of evidence generation and use.  Activities can aim to increase our understanding and application of knowledge, and this might include things like audit and service evaluation, whether leading or simply participating.  Even just engaging with the evidence base will help with this pillar and all our practice should be evidence-based and informed so that means that really, we should all be reading and engaging with the evidence that's out there.  But it is not sufficient just to read as we need to appraise it, to understand it, and to think about how it might apply to our own practice. Can we be doing things differently; can we be doing things better?  So, a big part of engaging with the research pillar is not necessarily actually doing any research, it is engaging in what research and evidence is out there and thinking about how it applies to our role.

The other part of the pillar certainly can be getting involved in the development of new evidence and contribution to knowledge and again, that does not have to be getting involved in big research trials or studies it can be helping on an audit within a department or helping to do a service evaluation to assess how good the service we're actually providing is.  Once again the level of practice in which you work will help determine the type of research activities that you potentially might get engaged with.  

The research pillar, whilst often considered the most challenging, can potentially be one of the easiest to engage with.  Maybe once a month sit down and one read one research article that's relevant to you and your practice and consider (reflect and record) how that evidence is incorporated into your own practice, is there anything that potentially could change?  Potentially this is the first step to then actively engaging in evidence development and contribution to new knowledge.

Summary

On reflection of the four pillars of practice what we might have identified is that there is quite a lot of overlap between them. Education, for example, is related directly to clinical, as you need to learn to be able to undertake new clinical skills effectively.  Similarly, leadership and service improvement are directly linked to engagement with research evidence by thinking about whether what we are doing is the best it can be. How can we improve it and what do we need to know to be able to improve it?  Additionally the expectations within each pillar change as we move through levels of practice, Figure 3 gives an example of how the pillars might be considered for someone working at practitioner level.

Fig. 3. The four pillars explained⁸ (scroll to reveal)

It is imperative to recognise the need to document and evidence the activities we undertake.  For those registered with the HCPC there is already a requirement to maintain a portfolio of CPD, but similarly now in advanced roles the necessity to evidence the four pillars is expected and such evidence can be used in appraisals and in job applications.  Whilst several barriers to undertaking the CPD and taking on new activity are cited, it needs to be recognised it is a necessity and should be part of standard practice.⁹

Within our own roles we need to think about how activities that we engage in and do on a day-to-day basis might link with the four pillars of practice.  Can we identify some small changes that might help to develop our KSAs in one the pillars?  This might help in terms of developing our current role but also in terms of the future.  By undertaking any activities or experiences that are available to us can develop our own careers and put us in a better position for the future in a growth-based way.  Take opportunities as they present themselves and don't necessarily wait for things to be put on a plate because you may go hungry.

The WE-SEARCH and CHEERS projects were funded by NHS England (NHSE) and is part of a
commissioned programme of work led by the Society of Radiographers

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