‘Your career journey is a river’: Challenges and opportunities in Advancing practice education

The ever-evolving nature of radiography is well documented: advances in technology and patient care mean that no two days are ever quite the same. Keeping up with that evolution is always a challenge, but one that radiographers must frequently rise to.

One way that challenge is being tackled is through advanced practice, which is a level of clinical practice characterised by a higher level of autonomy, complex decision making and accountability. Advanced practice is underpinned by the four pillars of practice: clinical practice, leadership and management, education and research. These pillars are a framework that helps healthcare professionals develop their skills and ensure they are improving patient care. Advanced practice is a sure avenue for radiographers and other healthcare professionals to progress their career, develop their skills, attitudes and philosophy.

However, clinical departments need more support in understanding and implementing standards within advanced practice. With recruitment and retention issues plaguing hospitals across the country, ensuring radiographers know the options available to them for advancing their careers may go a long way to helping improve job satisfaction and keep staff from leaving.

To raise awareness of the benefits of advanced practice, it is important healthcare workers know why it is important and how individuals can operate at that level. Fortunately, the teams at Sheffield Hallam University and the University of Bradford are on the case.

To find out more, Synergy spoke to Melanie Clarkson, senior lecturer at Sheffield Hallam University and programme lead for the accredited MSc advanced clinical practice in radiotherapy and oncology, James Harcus, associate professor in diagnostic radiography at the University of Bradford, and Kayleigh Hizzett, an assistant professor in diagnostic radiography at the University of Bradford, which runs an MSc advanced clinical practice (radiography) course that is accredited by the Centre for Advancing Practice.

Melanie Clarkson speaking at UKIO

A holistic approach

Melanie, James and Kayleigh formed part of the research team on a paper published in April 2026 in the SoR’s official peer-reviewed journal, Radiography: ‘Advancing practice radiography education in the UK: An analysis of themes from higher education programmes.’

The overall research project was led by Professor Beverly Snaith, clinical-academic professor of diagnostic radiography at the University of Bradford, and sought to better understand the sustainability and viability of advanced practice education – and what challenges the future might hold.

Melanie has worked with Professor Snaith many times previously on research projects around advanced practice, including writing the enhanced practice schema (along with Kayleigh) and module curricula for therapeutic radiography at her university, and supporting a similar project for diagnostic radiography. Melanie has also led the development of the Non-surgical Oncology Area Specific Capability and Curriculum framework endorsed by NHS England.

Melanie Clarkson speaking at UKIO

Melanie Clarkson speaking at UKIO

James’s background is as a reporting radiographer and musculoskeletal sonographer, but as programme lead at Bradford his main remit lies within advanced practice. James’s passion for and clinical history with advanced practice drove him to get involved.

As a profession, James explains, radiographers can have a tendency to be very task-driven. Since the introduction of advanced practice, the focus of those looking to progress their careers has been on increasing the complexity of tasks for which they are responsible and their level of accountability, in reporting, for example. But, he says, that does not automatically equate to advanced practice. “It’s much more holistic than that,” he explains. “The four pillars of advanced practice are important in all roles, not just advanced practice ones, but there is a misunderstanding that it only applies to certain roles, and not necessarily radiographers. We have to address that.

“It’s more about the level of practice and the level of complexity of decision making, autonomy and responsibility. It’s not about the specific task that’s being undertaken.”

Kayleigh explains that her clinical background is in advanced practice in vascular access. Despite not having previously been part of a research team, she thought the opportunity to develop those skills, in an area that she had invested in for some time, was fantastic.

With this shared interest, the cross-university team were united after NHS England released a set of predefined projects as part of its Professional Body Education Reform Commission, which were led by the SoR.

Across Sheffield Hallam University and the University of Bradford, the team has been working on this research since February 2024. Now, two years later, they’re ready to begin sharing their findings.

James Harcus, presenting at LTWRAP 2025

Kayleigh Hizzett presenting the team’s research

‘There’s a lot of misconceptions’

The team's work on advancing practice (the overarching term used to describe multiple levels of higher clinical practice) began with the Championing EnhancEd Practice in Radiography (CHEERs) project, which aimed to elevate awareness and understanding of enhanced practice within the radiography profession.

Rather than a traditional research project, this phase developed resources to support the community in understanding what enhanced practice looks like.

They created infographics comparing enhanced, advanced and consultant practice – the continuum of career pathways for healthcare professionals that make up 'advancing practice' – as well as what the different pillars of practice meant for different levels. Undergraduate resources, meanwhile, ensured these concepts could be taught to students. “We need to get [advancing practice education] right from the outset, what that looks like,” Melanie says. “We needed to demystify a lot of myths. A lot of people thought advanced practice only involved the four pillars, and that enhanced practice was only a clinical pillar. One of the key findings you’re immediately encountering is that the wider healthcare workforce, including radiographers, don’t even know what advanced practice really is, certainly not for a radiographer.”

James adds: “One thing I’m really keen on is helping the profession understand what we mean by advancing practice. There’s a lot of misconceptions about what it actually means. This research was a key opportunity for us to ask what, as a profession, we need to do to get this right.

“It all goes back to people being defined by their band, or their tasks, or their job title. People say ‘I’m just a reporting radiographer’. Recognising that people working in these roles, whether they realise it or not, are doing so much more than ‘just’ a task is vital. Anyone within any role, regardless of their level of practice, brings so much more than just how we perceive ourselves. We have to think more broadly as radiographers about what we bring to these roles.”

As part of this phase, the team also developed a two-day training session for enhanced practice champions – they trained more than 60 radiographers across the four nations, enabling them to take their learning back to their clinical areas.

All of these resources and lessons can be accessed online here.

Tracking strengths and weaknesses

The next project the team undertook in this area had two phases: scoping out the current UK post-registration radiography education provision supporting advancing practice, and exploring future directions to understand the challenges in delivery.

By looking at what information was out there online about higher education radiography programmes, alongside online interviews with higher education institution (HEI) representatives, the team was able to get a broad overview of where it was succeeding and where it was struggling. They identified a total of 49 post-registration radiography programmes, at 25 HEIs, with just under two thirds (64 per cent) of these institutions participating in the research.

Together, the researchers identified four key themes that stopped advanced practice radiography courses from being sustained in the long term:

Viability of post-registration provision
Fragmentation of provision
Ambiguity of levels of practice and accreditation
Addressing the four pillars of practice

If there aren’t enough students interested in a course for it to be viable, a given university simply will not be able to run it, even if the subjects it covers are vital to career progression, service development and workforce transition. One programme lead interviewee said: “It’s just not sustainable… We can’t run the modules with just one student, so we’ve shelved it… they’re still sitting there.”

For some radiography specialties, there are very few courses available, the researchers found and often where the courses are available, only the practical aspects are explored, leaving out the other three pillars. Courses on advanced practice education in dual-energy X-ray absorptiometry (DXA), for example, are rare. The researchers even found that some universities question the need to educate radiography students on the pillars of advanced practice at all in their courses.

Professor Ricardo Khine, James Harcus, and Melanie Clarkson

Professor Ricardo Khine, James Harcus, and Melanie Clarkson

The team’s investigation found there was much less demand for courses in nuclear medicine and therapeutic radiography. They also found that this coincided with less demand for these services within hospitals.

While there was a strong focus on the ‘clinical’ pillar of advanced practice across specialties, the team says, this only highlights the difficulties in integrating the remaining pillars. “Clinical practice seems to want some kind of module that’s going to cover every type of procedure a radiographer could undertake,” Kayleigh explains.

But without a sustainable and collaborative approach to post-registration radiography education, that just isn’t feasible. Support for the future advanced practice workforce is under threat, particularly in some discipline areas. If radiographers in these specialties don’t know what advanced practice looks like for their role, both career advancement and the clinical requirements of departments will be strongly impacted.

To unify the phases of the project, and find some answers about the future, the team delivered a workshop, inviting higher education institution programme leads to Sheffield Hallam. There, they were able to clarify their findings and begin the educational process – as well as start investigating the next steps for the profession.

Their research and its findings can be accessed in full online here.

‘We need to collaborate more effectively’

One of the main changes needed is in universities themselves, Melanie says. The model of how they work is business-driven, market-dependent, and competitive – but over the course of this research project, the team has demonstrated what can be done when universities collaborate.

If universities can communicate regularly and support each other’s programme development, they can collectively cover the gaps in each other’s courses. “However that works, we need to collaborate more effectively, and break down the boundaries of usual business management,” says Melanie.

By sharing their work and developing these programmes together, the entire educational landscape can develop recognition of what’s needed in advanced practice education. Because, James explains, the four pillars don’t just apply to advanced practice. They apply to everybody, regardless of level, from support worker to consultant. “What needs to be embedded in the undergraduate programme is the language that’s used from the get-go,” he says. “It needs to come not just from the bottom up, from students – we need to see it come from the managerial side down.”

If the perception of advanced practice can change within these institutions, it can change across the profession. For example, Kayleigh explains that anyone looking to get involved in advanced practice must recognise the need for that role in their department. “Look at your career journey as a river – taking different opportunities, regardless of the banding of your role, ” she says. “For me, it’s all about how you can develop yourself, take those opportunities and enhance your career. Advanced practice isn’t just a stepping stone for a higher band.”

Those people who are already working at an advanced level, or who have that title, can look at what they are doing and map themselves against the College of Radiographers’ Education and Career Framework and NHSE’s multi-professional framework. If they find gaps, Melanie says, they can have a conversation with their manager to see if there’s a need, and what they need to do to fill those gaps. “I want to see people empowered to reach their full potential,” she adds. “If someone has the word ‘advanced’ in their title, they should be meeting all the capabilities required for that level of practice.”

The team’s findings seem concerning. Postgraduate education in the UK appears to lack the capacity to actually address the requirements of advanced practice, and indeed fails to address the importance of it at all, in some cases. But Melanie, James and Kayleigh’s research is the first step to closing that gap. From the initial conclusions of their study, they have already identified a need for institutions to be more collaborative, particularly in this time of unprecedented financial challenges for higher education institutions.

Historically, education has been driven by clinical demand. Perhaps, the research suggests, it’s time for a change.

Find out more about advanced practice with the SoR

Advanced clinical practice is delivered by experienced registered healthcare practitioners. It is a level of practice characterised by a high level of autonomy and complex decision making. More information about working at advanced practice can be accessed via the CHEERS project.

More information can also be found through the SoR’s Education and Career Framework here.

You can also read about the SoR's Advancing Practice in Radiography Special Interest Group here.

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‘Your career journey is a river’: the role of education and training in advancing practice

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