Involving stakeholders in the design of a radiography programme is a key expectation set by both the Health and Care Professions Council¹ and the College of Radiographers². Effective stakeholder engagement ensures that radiography education remains dynamic, relevant, and capable of meeting the evolving needs of the services we provide. Additionally, encouraging patient, public and practitioner partnerships is considered good practice³. Stakeholders, including learners, academic educators, clinical practitioners, practice educators, professional bodies and employers, bring diverse perspectives and ideas. Engaging these stakeholder groups helps identify the necessary skills and knowledge, ensuring that the curriculum aligns with current professional standards and future trends, thereby enhancing graduates' employability.

Collaboration with practice educators in programme design has been valuable in bringing together unique viewpoints and ideas based on supporting student radiographers in the past. Collaborative efforts during programme design increased efficiency and sped up the overall process of designing and developing diagnostic radiography programmes. There was the shared purpose of providing learners with relevant and up-to-date training that prepares them to make meaningful contributions to the radiography workforce.

By adopting a collaborative approach, we ensured that the curriculum is not only academically rigorous but also meets the practical demands of the profession. The diversity led to innovative solutions, creative problem-solving, and shared decision-making, especially regarding managing placement capacity. This process fostered a sense of ownership among all participants, with the goal of a more impactful educational experience for the learners.

Methods

Early contact was made with all practice partners to introduce the programme plans and invite their contribution; however, no formal research method was deployed. It emerged retrospectively that our journey of working together reflected the Experience-Based Co-Design (EBCD) approach as activities and collective experiences aligned with its principles⁴. EBCD is a collaborative approach that involves educators, learners, and other stakeholders working together to design and improve educational services and experiences. Communication and collaboration were on an ongoing, healthy cycle from inception to approval. 

The EBCD strategy aimed to improve the learner and staff experience in diagnostic radiography by considering the key imperatives pertinent to radiography and medical imaging priorities in the Buckinghamshire, Oxfordshire, Berkshire and North West London regions. EBCD is particularly effective in education because it values the experiences and insights of those directly involved in the learning process, leading to more relevant and impactful improvements. 

Co-designing our radiography curriculum began by identifying and engaging practice educators as clinical education experts and therefore a key stakeholder group was formed. Their input was crucial for understanding the current needs and future trends in radiography and ultimately creating a curriculum that is relevant, effective, and responsive to the needs of the services within the localities they are required to meet. 

The process began with an initial scoping analysis for the needs of the programme and involved collecting detailed insights from all involved through a 360-degree feedback approach. This often included personal narratives capturing the experiences of the practice educators in supporting learners from a range of higher education institutions within their clinical departments. These insights were then critically reflected upon to identify common themes and areas for consideration during the curriculum design period. Once the initial drafts of programme documentation were developed; workshops and meetings were convened where stakeholders met together to discuss and brainstorm ideas. These sessions were designed to foster open communication and ensure that all voices were heard. Practice educators worked together to agree the core competencies and unique selling points of the curriculum. 

Based on the insights gathered, a draft curriculum was co-created. This included the course structure, content, learning and teaching methods, and assessment strategies with underpinning pedagogical frameworks. The draft documentation was reviewed and refined through multiple iterations, incorporating feedback from stakeholders at each stage. By conducting a thorough needs assessment, gaps in the current curriculum and areas that required enhancement were identified. This was achieved through various communication methods, including meetings, emails and written feedback.  

In their evaluation of the programme content, the practice educators suggested items for inclusion based on current/future practice from a clinical and research perspective including priorities for service provision within their Trusts. Successful prototypes of the assessment documentation were implemented, and their impact was continuously evaluated. This iterative process helped refine the solutions and ensured they met the needs of all stakeholders. Once finalised, the curriculum was implemented, however, a continuous evaluation was conducted to monitor its impact and effectiveness, ensuring it remained relevant and up-to-date with advancements in the field.

The values of collaboration

The themes that emerged from the shared collaborative relationship between the academic and practice educators are given in Figure 1 below.

Ownership and Feedback 

Co-creation from the onset was the key focus of the collaboration where joint decision-making and working together derived from the idea that all stakeholders are impacted by the course design and thus were empowered to influence and engage with its design early on⁵. Importantly, the beneficial outcome of such a collaboration as contributors was given paramount importance. Different stakeholders, all with the end goal in mind, bought individual experiences to shape its design.

This participatory involvement started from a mutual acknowledgment of everyone's wishes, accepted pressure of individual Trusts, placement limitations, and the expertise of those involved. The academic course lead outlined the role that practice educators played in the design and emphasised the importance of open honest feedback as part of the process during each stage- curriculum development, reviewing assessment plans, placement structure, and participation in the approvals process with the university and Professional, Statutory and Regulatory Bodies (PSRB). Informed feedback helped ensure the programme was practically grounded and a curriculum that addresses the competencies required in real-world clinical settings, was achieved⁶.

Active participatory involvement in co-creating the curriculum needed careful consideration. The academic course lead acted as facilitator and provided leadership and structure to ensure the group worked amicably together, met objectives, often within short time frames and regularly set the scene for the group objectives⁶.

Numerous methods were used to bring together the different ideas from the collaboration, from rich but productive discussions, online workshops, curriculum review and mapping, to the use of feedback loops between academic and clinical educators and setting up online workspaces to allow tracked reviews of documentation. 

Insights from practice educators as critical friends were highly encouraged. Specific contributions include a review of module documentation, creation of hands-on clinical skills assessments, and review of the admissions interview process, ensuring there was an alignment of academic objectives with clinical needs. The practice placement portfolio, for example contained assessments designed in collaboration with practice partners which was impactful in meeting the new HCPC Standards of Proficiency¹ for MRI and PET, in particular. 

The involvement also enabled practice partners to consider areas of practice that learners struggle with, for example, remembering a suitable mnemonic to guide the development of their image evaluation skills. This allowed the creative integration of clinical expertise and the opportunity to use the training materials as a platform for testing materials that the practice educators had designed.

The benefits of collaboration were felt at all stages of the project leading to the mutual appreciation of effort that allowed for bridging the relationship between academic and practice teams.

Stakeholders represented the full spectrum of radiographic practice and clinical settings, ensuring systemic design of the co-creation model and consistency across settings⁶. The programme benefitted from the diversity of input from experts within trauma radiography, CT, MRI, PET, image reporting in a range of study routes, e.g. MSc (pre-reg), BSc and Apprenticeships. Acknowledging the difficulties in maintaining consistency between the academic and clinical components of the programme was important, particularly when learners rotate through multiple practice placements. 

Feedback from all stakeholders provided a unified voice that focused on improved learner outcomes, the learning experience, what clinical competency, confidence and resilience would look like, and how to develop critical thinking skills to strengthen the learner's preparedness for the workforce. We started with the end goal in mind to improve the retention of learners and provide the opportunity to grow the local workforce with recruitment of locally based learners who were more likely to remain in the area after qualifying. 

Some logistical and organisational challenges arose and were only natural when working with a variety of stakeholders with different priorities. Some of these were timelines, competing commitments, placement requirements, and of course the biggest challenge of all, placement capacity. Again, in keeping the end goal in mind, all stakeholders were keen to ensure that placement capacity was managed to ensure a good and equitable learning experience for all learners within the placement setting. Placement capacity is an ongoing deliberation since placements are limited and departments often train learners from multiple higher education institutions. 

In linking with the clinical practice educators, the academic course lead created a shared sense of “growing our own” local workforce from the beginning of the programme design. This created a tangible feeling of having the opportunity to positively contribute directly to the quality of the local workforce and therefore gave the group a sense of shared ideals, aspirations and ownership. This became a remarkable incentive for the ‘Why’ we should collaborate as there was a clear common purpose⁷.  The shared ambition was also underpinned by wider nationally driven incentives from NHS England in seeking to increase the size of the AHP workforce. This gave the team a feeling of positively contributing to a larger purpose⁸.

360-degree feedback 

A 360-degree feedback approach was used as part of the design tool; a method of appraisal where feedback from a variety of sources was used to shape the content. This approach provided a comprehensive, holistic view of the strengths and areas for improvement in the programme. The feedback was from multiple sources, which validated its reliability and improved consistency, so the academic course lead felt more empowered to act upon the feedback⁹. 

360-degree feedback was a powerful tool for fostering communication and improving outcomes between the stakeholders. However, to be successful, it required careful planning and clear communication from the academic course lead, and a supportive culture that valued feedback and continuous improvement. Clear goals were established for the feedback process, and knowing the purpose helped design the approach more effectively¹⁰.

There were regular follow-ups arranged, allowing re-assessment of essential documentation, tracking progress, and encouraged continued development of the programme. File sharing software and networking platforms allowed better connections and more efficient communication between the academic and clinical teams. These platforms allowed the feedback to be collated in a structured and efficient way, making the process smoother and more transparent¹¹.

It is worth acknowledging some of the challenges of the 360-degree feedback approach, that were observed in this collaboration. It was important to focus on feedback that was objective and constructive. Several critical discussions were held where considerable amounts of information were offered by all stakeholders and the academic course lead acted to manage and prioritise the large volume of information the discussions generated, handling any conflicting feedback diplomatically and practically⁹.

Through this collaboration the academic course lead created a safe space for practice educators, to feel empowered to provide honest, constructive feedback. The use of this approach encouraged cohesive team camaraderie ensuring candid, honest communication through transparency and trust. 

Communication and Transparency 

In the interest of transparency, our collaborative group harnessed an open and honest platform of conversation from the very beginning. The rawness of the current reality needed to be addressed before any future planning could take place, which allowed the group to fully grasp the challenges, strengths, and weaknesses of existing programmes. This permitted the development of a mutually understood language with which we could rewrite ‘The Student Radiographer’ story for the benefit of a new programme curriculum, and therefore laying a solid foundation upon which the new programme could be built. 

Challenges such as the limitations around learner placement capacity, the difficulties with navigating multiple higher education providers, and the obstacles around overall staff engagement were explored. Also addressed were areas of improvement in learner engagement, to identify how the university could better prepare the learners for their first clinical placement. This was a useful opportunity for academic and clinical partners to explore expectations, both in terms of our retrospective contributions to learning, as well as the expectations of how the learner should bring themselves to their education. From this starting point, a clear and accurate viewpoint could be formed, which then guided realistic perspectives. The collaboration benefitted from the culture of the team being one of problem solving, rather than problem focussed¹². This in turn led to more effective use of time, as the group worked to overcome challenges rather than being consumed by the problems themselves. This approach formed the very foundation for positive change. 

The key question here is ‘how was this transparency created?’ Firstly, it is important to build a team with unique and expert representatives in their subject areas or roles. Those who will have insight and understanding, and therefore can foresee the potential challenges¹³. Secondly, a team that has a shared drive or vision helps to maintain focus on the goal and remain engaged with the problem-solving tasks. As described by Wheelan, Akerlund and Jacobsson¹³, “form a team only if there is a goal that requires collaboration among members with unique competencies.” Lastly ensuring there is a platform underpinned by mutual professional respect, achieved by good working relations, ensures that collaborative teamwork is more likely to succeed¹².

Ultimately, it is important to understand that academic and clinical partners are telling the same story when designing and providing radiographic education, however, they are often just using different languages from different perspectives, which leaves room for misunderstanding and barriers to progression. For this collaboration to succeed, we had to translate our languages into one that was understood by the whole team, and that translation starts with active listening to reach understanding¹⁴.

Naturally, to enable successful teamworking, effective communication is paramount. The collaborative team had a proactive focus on all members remaining open, friendly, and approachable in their interactions. This was created by removing the need for hierarchical structures within the team. We were all considered equal partners in our contributions, which is in keeping with the literature on effective communication¹⁵.  

One of the challenges around our communication was that it was remotely, over MS Teams meetings and emails. The team’s approach to communication was to encourage sharing of thoughts and opinions, whilst engaging in active listening to ensure understanding. As Fayzullayeva¹⁴ explains, listening is a critical skill that plays a significant role in effective communication.” Whilst this method more easily enabled the team to convene, it did have potential for focus and direction to get lost in translation with the effect of information overload¹⁵. To mitigate the effects of this, the team benefited from having a central person who coordinated the virtual space and set up the meetings. 

There was an unspoken understanding that input from all directions was to be supported and respected. There was likely no need to actively define this approach as the group had shared visions and goals for the project, which is a key ingredient of an effective team¹². This culture empowered the group to build on the momentum of enthused participation, which was key, as it then encouraged a safe platform for members to express themselves honestly without fear of negative response. 

Modelling the Values 

The EBCD approach, through active participation of all stakeholders, ensured the outcome met their needs and values. 

We were mindful from the beginning that this was a new venture and working with a range of stakeholders brings a rich diversity of expertise but also strong opinions that could challenge the integrity of the process. In collaborating, we took a person-centred approach, with civility being a priority. Civility involves being kind, respectful, considerate and fostering a positive and productive environment¹⁶. Civility helped to build rapport, trust and mutual respect. It created an environment that encouraged effective communication and collaboration between stakeholders. It also reduced the potential for conflict and promoted a harmonious working atmosphere. There was an inherent understanding that any question generated was from a perspective of curiosity rather than challenge with the shared end goal of developing a curriculum fit for purpose for training and retaining our local workforce. 

Each stakeholder bought their own experience, service pressures and their requirements of the programme. The goal was to make the underlying beliefs, priorities, and preferences of all stakeholders visible and integral to the design process. Ethical considerations around individual values, fairness, ensuring equal voice, conflict of interest and respect were clearly articulated and were again integral to the design process.

Taking a person-centred approach ensured that all stakeholders felt valued and respected; it placed the individuals involved at the heart of decision-making¹⁷. In our experience, this meant actively listening to each stakeholder's needs, preferences, and values, leading to better stakeholder satisfaction and outcomes. 

Balancing kindness with objectivity was the key to fair and effective decision-making in this collaboration. While empathy and understanding are important, it is also crucial to remain impartial and fact-based¹⁸.  This balance ensured that decisions were not swayed by personal biases or emotions, leading to a more equitable and balanced outcome while maintaining professional integrity and trust between all stakeholders. 

Conclusion

The curriculum shaped by this collaborative effort stands as a strong educational blueprint, that is in keeping with current clinical practice and therefore set to deliver efficiently prepared diagnostic radiographers into the future workforce. 

On reflection, the group inadvertently started with the end in mind. This was likely a result due to the coming together of like-minded, proactive individuals who sat within positions of relevant skillsets and knowledge, and who shared a passion for futureproofing our local radiographic workforce. 

Open, transparent dialogue was fundamental in allowing effective communication for the benefit of forward project momentum, and the encouragement of constructive feedback further solidified the success of the collaborative outcomes. 

The unanticipated and interesting outcome of this work was in its more subtle benefits seen in the ripple effect of positive practice that far outstretched the initial collaboration. A community of networking has been created that the team are still benefiting from in other projects and incentives. There are channels of communication now open, that were not there before, which has allowed for more fluid engagement and therefore effective management of the resultant learner placement experience. There are more opportunities now open to both the academic and clinical partners, as a result of the working relationships forged and the understanding of the mutually beneficial nurturing culture that followed across the establishments. 

The most motivational element of this collaboration was the fact that the work will make a difference to the education that is happening right now, for the workforce of the future, and in securing that future, we secure the quality of our services for the benefit of the patients we serve. 

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