Disparities in radiography education have been well-documented, with many studies highlighting the varying quality of radiography programmes across different universities^1,2,3,4. While a common education policy is generally followed in European countries (such as the European Qualifications Framework or the Bologna process), significant differences in educational programmes and professional issues still exist, including in radiography^5,2. These variations are even more evident at the global level⁶.

The lack of standardization in radiography education leads to unequal access to resources since different countries will give different priorities to the training of these professionals. 

Radiography is a critical field in the healthcare sector that relies heavily on access to resources (human and material) to provide effective training for future professionals. However, the distribution of these resources, including human capital, equipment, clinical placements, specialized techniques, teaching spaces, simulation equipment, and access to research equipment or data, is often unequal across different universities teaching radiography and across countries. This inequality in resource allocation can affect the quality of radiography education and, ultimately, the competence of the radiography workforce.

Several factors contribute to the inequality in education resources, including variations in national health policies, disparities in funding allocations, and differences in the prioritization of radiography education within the broader healthcare system^3,7. 

This article will focus on the unequal access to human resources in radiography education, emphasising the importance of universities having access to “experts” to prepare the future workforce for the multitude of modalities and techniques performed in modern radiography. It will also explore how the ECHOES platform can help address expertise gaps in radiography education (and research) worldwide.

For clarity, in the context of this article, an “expert” is someone who achieves a high level of mastery in a particular discipline (or a sub-field), often evidenced by credentials or significant contributions to the field. Their expertise is applied to solve complex problems, guide decision-making, or innovate within their domain. They maintain up-to-date knowledge and contribute to advancing expertise through research, mentorship, or leadership roles⁸.

Commentary on expertise disparities across universities teaching Radiography worldwide

The factors limiting the availability of expertise in radiography education worldwide differ from university to university. These may include a relatively small pool of experts accessible by the university, a lack of access to modern clinical settings, a lack of investment in the profession (and their education) that leads to financial inability to hire experts, and an inability to tap into the clinical expertise of radiographers in the clinical setting, among others. As such, this article challenges the readers to identify which issues discussed below resonate most with their local context.

Please note that this commentary includes published evidence and the authors’ own professional experience as a radiotherapy radiographer, academic, researcher in radiography education, and member of the ECHOES project.

Small workforce = small pool of experts

The radiography workforce has historically been a relatively small profession, naturally leading to a small pool of experts, of whom even fewer take on teaching roles. The challenges facing the academic radiography workforce were previously documented, particularly in recruiting and retaining the best educators⁹. The shortage of qualified radiography educators can exacerbate the inequality in resource distribution, as some universities may struggle to attract and retain the talent needed to provide high-quality training. 

This problem seems to be exacerbated in many European educational programmes where multiple radiography specialisms (radiotherapy, nuclear medicine, and medical imaging) are taught in one programme. In these cases, there may be even less opportunity for these academics to develop areas of expertise because there are often fewer academics in each specialism. During my PhD research, a participant stated that only one academic was employed to cover all radiotherapy-related topics in their educational programme¹⁰. This required the academic to have an overall knowledge of all topics but hindered them from developing an area of expertise.

Academic and research tradition

McNulty et al. (2015) showed that only 22% of universities participating in their study required that academic staff hold a Doctorate (PhD) or equivalent¹. Hopefully, this has improved in the 10 years since this publication. However, it shows that tradition has seen radiographers as a professionalising career. Even though a PhD may not be an automatic indicator of expertise, it often reflects the deep subject matter knowledge and research experience that can enhance the quality of radiography education. Additionally, radiographers can become experts through other pathways (discussed later).

This tradition can also be seen in research, where radiography was, for many years, a “consumer of research rather than a producer”¹¹. However, this tradition seems to be changing with increased publications and citations reported¹². As such, radiographers now create the evidence that supports their practice, which is key to calling ourselves a “profession”¹¹.

However, this is not happening everywhere. In many countries worldwide, the concept of radiographers leading research remains an aspiration rather than a reality. To my knowledge, no radiographers are employed as full-time researchers in clinical departments in Portugal and Malta, highlighting that radiography research is not a priority - keeping with old traditions.

The exchange of research experts may be key to equipping radiographers with the necessary skills and organising interventions that will start changing the traditions in these countries.

Limited access to advanced modalities and techniques

Differences in the availability of radiotherapy and medical imaging equipment exist across countries and regions^13,7. These disparities in access to clinical resources impact the modalities and techniques that radiography students are exposed to during their training and the expertise developed by the academics teaching those courses.

Some universities may have limited access to more advanced equipment, such as PET/CT scanners or MRI machines, or fewer opportunities for their students to gain experience with cutting-edge techniques like 4D imaging or proton therapy. Constraints on access to these resources inhibit academics' ability to stay up-to-date on the latest advancements and provide comprehensive training to their students.

Due to the lack of these modalities, some radiography programmes may focus more on standard modalities (such as planar X-ray or linear accelerator EBRT), limiting the breadth of expertise available to students. Students trained in such resource-limited settings may also face challenges transitioning to clinical environments with more advanced technology, potentially hindering their ability to provide high-quality patient care. 

Nowadays, graduates move between regions and countries more often, especially across Europe, due to policies favouring free movement and the current lack of workforce in high-income countries that promote this movement further¹⁰. Therefore, radiographers must have well-rounded training irrespective of where they train so they do not compromise patient safety when movement occurs.

Exchanging expertise between universities where these advanced resources are available would be invaluable in improving the radiography profession worldwide. 

Geographical disparities in access to expertise

Small and low-income countries have less access to specialised clinical areas, leading to a lack of expertise in academic teaching. 

Azzopardi-Muscat et al. (2014) showed that a lack of expertise in certain areas of healthcare in Malta led to the inability to train healthcare professionals in some areas of specialisation¹⁴. A practical example is that, in Malta, many specialised radiotherapy treatments are unavailable (e.g. Total Body Irradiation, Proton Therapy, Brachytherapy, Paediatric Radiotherapy), and patients are sent abroad for treatment. As a result, local radiography students do not have practical training (only theoretical) in these areas. This was also observed during my PhD research that, within the same country, some universities (for example, those linked to radiotherapy departments) offer more exposure to radiotherapy techniques than universities that do not have access to these¹⁰. 

A similar situation is seen in low-income countries where new equipment and techniques are not yet implemented due to a lack of investment, limiting the experiences of radiography students. Additionally, the inequity of expertise in academia is exacerbated by the brain drain from economically disadvantaged regions to countries that offer better opportunities¹⁵. This phenomenon further limits the educational resources available for training the next generation of healthcare providers.

In my professional experience, I also observed pools of expertise scattered geographically. Universities and hospitals may be able to access specific equipment and experts but lack access to other areas of expertise. This expertise is transmitted to healthcare students locally but is not always disseminated internationally. As such, universities with access to different expertise could collaborate and exchange these to benefit radiography students in both institutions.

Clinical experts are often not involved in training

Despite substantial expertise in Medical Imaging, Nuclear Medicine, Oncology, and Radiotherapy within clinical departments, this valuable knowledge and experience does not always reach radiography students. There are several potential reasons for this disconnect.

One factor may be the bureaucratic red tape or budgetary constraints that can hinder the direct engagement of these clinical experts with educational institutions. Additionally, these experts may sometimes remain "invisible" to decision-makers within academic settings unless they are already part of the professional network of the institution. Furthermore, clinical experts may have heavy workloads and limited time to devote to teaching responsibilities or lack formal pedagogy training, making them hesitant to take on educational roles. As a result, these clinicians with specialized expertise may not be invited to share their knowledge and insights with the next generation of radiography students.

Universities and educational providers should make concerted efforts to identify and connect with the clinical experts in their local and international networks and address the barriers they face. This could involve streamlining administrative processes, allocating dedicated funding, forging collaborations between academic and clinical settings, or training them in pedagogy. By facilitating the involvement of these expert clinicians, radiography students will access a broader range of specialized knowledge and practical skills, ultimately enhancing the quality and relevance of their education.

One solution is sharing expertise between universities and/or clinical settings at both national and international levels. Despite this obvious solution, finding experts in the areas needed was often limited to personal networks, which often excluded niche areas. As such, an international consortium was set up to develop the ECHOES platform.

The ECHOES platform

ECHOES is a European-funded project with 17 partners (Figure 1) that aims to develop a digital platform for sharing healthcare education and research expertise, including radiography. The platform allows healthcare professionals, researchers, and academics to register their areas of expertise, and they can then be contacted to collaborate in education, research, and/or clinical practice. 

Figure 1

The ECHOES platform is supported by AI. Healthcare professionals, academics, and researchers can easily register their areas of specialisation based on a quick CV screening. At the same time, AI is also used to find experts registered in the database. The institution looking for expertise can find relevant information the experts share about their expertise and contact them to collaborate.

The ECHOES platform also includes a video-conferencing functionality, allowing virtual collaboration, teaching, research and mentorship. So, even if an expert is physically located far away, they can still engage with the institution or individuals in need. This provides an environment and financially sustainable alternative to physical exchanges. In the future, the project also aims to engage the experts on this platform to create and share content on specialized topics, which can further support the training of future healthcare professionals.

The ECHOES website (www.echoesplatform.eu) is online and fully functioning. However, new features will be added gradually based on users’ feedback, such as online activities, including videos, webinars, and Q&A sessions.

We invite all radiographers to register on the platform so we can grow a community where your clinical expertise, which is often invisible to people outside your network, is shared with more people through teaching and research projects.

Academics and researchers are also key experts and are strongly encouraged to register their expertise with the world healthcare community.

You can also register as a “user” if you wish to connect with the experts or attend the training webinars organised on the platform rather than share your expertise.

There are also plans to grow the platform into a training hub, with online webinars delivered by verified experts registered on the platform. This hub aims to close training gaps identified in the ECHOES research work packages.

To receive updates about ECHOES, please follow our social media:

www.linkedin.com/company/echoes-platform 

www.twitter.com/ECHOES_platform

www.facebook.com/ECHOESplatform  

How do academics, researchers, and healthcare professionals benefit from using the ECHOES?

The ECHOES platform provides an exciting opportunity to "make the invisible experts visible," as one participant in the last ECHOES workshop noted. Often, educational institutions overlook the wealth of expertise held by clinical radiographers, who possess invaluable knowledge and practical skills that could greatly benefit the training of future generations of radiographers. 

The ECHOES platform aims to address this oversight by showcasing the expertise of these clinical practitioners and facilitating greater collaboration between the academic and clinical realms. This will enhance the quality and relevance of radiography education and give clinicians an additional sense of professional recognition and fulfilment.

Furthermore, the ECHOES platform offers tremendous opportunities for academics and researchers to collaborate fruitfully with these clinical experts. They can develop innovative educational resources and curricula and conduct joint research projects, enriching radiography education and research.

For academics and researchers, the ECHOES platform also presents a valuable avenue for disseminating their expertise beyond their local institutions. Many have dedicated years to teaching and researching specific areas of radiography, accumulating a wealth of knowledge that deserves to be shared. The ECHOES platform enables them to grow their professional networks, engage in diverse research initiatives, and expand the reach and impact of their work worldwide.

How do universities, hospitals, and research centres benefit from using the ECHOES platform? 

Through the ECHOES platform, universities training radiographers can connect with experts worldwide to supplement their in-house expertise, providing students with access to a broader range of specialized knowledge. This can help address the disparities in resource access, ensuring a more equitable and high-quality radiography education for students across different institutions and countries. For example, a university with limited expertise in a particular modality (e.g. U/S or Adaptive Radiotherapy) could utilize the ECHOES platform to connect with an expert from another institution to deliver guest lectures or contribute to course development. 

Another practical difficulty experienced by universities is finding external examiners for MSc and PhD students who often research niche areas. The ECHOES platform can help universities identify and connect with the most relevant external experts to serve as examiners and provide constructive feedback to the students. The same applies to finding co-supervisors for specific areas not available locally.

These engagements can occur through posts as casual lecturers or visiting lecturers. Universities can also organise bilateral agreements of expertise exchanges in a quid pro quo manner. Within ERASMUS+ countries, universities can invite experts through teaching exchange programmes, which cover all the costs of this exchange.

Conclusion

The ECHOES platform presents an exciting opportunity to enhance radiography education and research worldwide by bridging the gap between academia and clinical practice and empowering universities to enrich their programs with diverse global expertise.

Clinicians, researchers, and educators can now share their specialized knowledge and skills globally. This will elevate the quality and relevance of radiography training while simultaneously providing greater fulfilment for those contributing their expertise. 

Universities, radiography departments, and research centres can use the ECHOES platform to facilitate finding people to complement their in-house expertise. Be it to cover a specific topic, examine students or programmes, or collaborate on joint research initiatives, among many other joint activities that require a unique area of knowledge or skill. 

Don't miss out on this transformative platform—register today to unlock a world of collaborative possibilities that will shape the future of radiography education.

Acknowledgements

Funded by the European Union. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or European Union Programmes Agency (EUPA). Neither the European Union nor the granting authority can be held responsible for them.

Anyone from around the world can register on the platform. This includes "experts" (people who can help close gaps in knowledge, practice, teaching or research in health) and other users (people who want to either network with experts or attend the webinars). This is also not limited to radiographers but is open to all healthcare professions.

The platform is now online at www.echoesplatform.eu, where people can register directly.

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