| Summary: | Competence to practise and the acquisition of key clinical skills in therapeutic radiography is an important issue in the NHS (Department of Health, 2000c) and the undergraduates of today are expected to be fit for purpose as therapeutic radiographers of tomorrow. New ways of working will require a greater understanding of how competence in clinical practice can be achieved and developed across all staff groups in the NHS. Patients' place a great trust in NHS professionals and this trust should act as a motivator for all professionals to develop the highest standards in practice. The issue for educators of these professionals, centres on how to develop training programmes, which reflect the current needs of the service for the benefit of the patients. There is no evidence-base generated through research, which looks at the achievement of clinical competence in therapeutic radiography, nor has there been a curriculum review which, attempts to match learning in clinical practice to achievement of competence. Therapeutic radiography undergraduate programmes have traditionally followed curriculum models based on content or learning outcome derived systems which do not necessarily encourage a more proactive approach to skill acquisition and learning. The enquiry employs action research as one of the key methods in order to identify the skills associated with competence to practise. A focus group interview with one cohort of final year therapeutic radiography undergraduates identifies aspects of learning which students consider necessary in order to achieve clinical competence. The interview is followed up using two of the original cohort (post qualification) to verify further, skill acquisition for competence. A national competence survey, for one cohort of newly qualified therapeutic radiographers, suggests that the level of competence achieved by this cohort is at a level considered acceptable for clinical practice. Some of the more able staff is able to demonstrate higher level skills, which are considered necessary for higher level practice. There were only a small number of newly qualified therapeutic radiographers in the survey who had not yet achieved a satisfactory level ofThis enquiry identifies the skills and learner characteristics associated with achievement of competence such as reflection, adaptability, the need to see learning wholes rather than individual parts and the importance of self- confidence. Models of learning and issues surrounding competence to practise were reviewed and considered in the light of the findings from the action research. It is suggested that undergraduate learners achieve competence through progressive achievement of higher level skills indicative of what might be termed, a `competence continuum model' of learning. There is evidence to suggest that in current undergraduate education for therapeutic radiographers, more consideration should be given to the process of learning as part of curriculum design based on a competence continuum model. In terms of current levels of competence in newly qualified therapeutic radiographers, the findings of this research suggest that extant undergraduate programmes in therapeutic radiography are meeting the needs of the service in the modem NHS. There are opportunities, however, to develop the curriculum for clinical education, which focuses more directly on process. For example the task-based learning approach for the continuing development of clinical competence is shown to be a suitable model for curriculum design for undergraduate learners in therapeutic radiography. Examples of how task-based learning can enhance the current programme are provided in the final chapter of this thesis
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