We all strive to be professional in our roles as medical radiation technologists, but the term “professional” is a contested one. This talk will examine how the concept of “being a professional” has shifted over time, and how various discourses of professionalism manifest in our work and interactions with patients.

1. 2017 W.Q. Stirling Lecture:
Professionals, professionalization
and practice
Delivered at BCAMRT AGC: April 2017
Amanda Bolderston
Radiation Therapy Provincial Professional Practice & Academic
Leader, BC Cancer Agency

2. 1. Definitions
2. Medical Radiation
Technologists (MRTs) and
professionalization
3. Contested territories
4. Professional wisdom
5. The end of the
professional?
6. Conclusion: what next?

3. What does it mean to be professional?
• Is it how you look?
▫ Neat and tidy
▫ Wear appropriate clothes
• Is it how you act?
▫ No cell phones at work
▫ Kind and considerate to
patients
• Is it what you know?
▫ Specialized education
▫ Continuous learning

4. Webster dictionary definition
• Specialized knowledge and often
long and intensive preparation
• Maintaining high standards of
achievement and conduct
• Committing to continued study
• Service to the public

5. Key elements of many definitions
“Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the basis
of a benign moral or cultural code”
Dent and Whitehead, 2002

6. Who is a professional?

7. MRTs?
Images: CAMRT

8. CAMRT definition
• Patient and family centred care
• Interprofessional collaboration
• Commitment to education and life-long learning
• Commitment to the profession
• Acting within legal and ethical boundaries
• Expertise in Medical Imaging and Radiation
Therapy
▫ Quality patient care
▫ A safe environment
Description of practice http://www.camrt.ca/mrt-
profession/description-of-practice-2/

9. Professionalization milestones
• Institutionalized training developed
• Local associations lead to a national association
• The introduction of codes of professional ethics
• Defining entry to practice criteria
• Education shifts to a university, credentials
increase
• Licensing laws and regulation
▫ Policing the boundaries – who gets in, who is out
▫ Public protection

10. MRT professionalization timeline
Adapted from CAMRT News 2017 35(1), p. 5

11. Semi-professions
• Also known as:
• Caring professions
• Quasi-professions
• Vocations
• People professions
• Sophisticated knowledge and skills, but often not
regarded as a true profession
• Many emerged to serve an existing profession (e.g.
nursing to medicine)
• Supervised: lack full control over their own work
Hearn, 1982; Adams, 2010

12. Semiprofessions
• Usually lack the right of privileged
communication between client and professional
• Emphasis on practice over theory
• High percentage of women
• Examples include social work, journalism,
librarianship, teaching, nursing, occupational
therapy and medical radiation technology
Hearn, 1982; Adams, 2010

13. Contested territories
• Professions develop
interdependently
• Control of work
brings professions
into conflict
• E.g. radiographer
reporting in the UK
Abbot, 1988

14. Non-physician clinicians scopes
Bolderston, 2004 (adapted from Cooper, 2003)
• Ratio of NPC to
physicians is rising
• Driven by cost and
increase in
interprofessional
practice
• We can add MRT to this
list!

15. “Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the
basis of a benign moral or cultural code”
Dent and Whitehead, 2002

16. What is professional judgement?
Technical + practical wisdom (phronesis)
Theory: body of
knowledge/education
Intuitive: From
experience/tacit

17. Competencies & skills

18. Practical and professional wisdom
• Phronesis: from Aristotelian ethics
• Used in the “swampy lowlands” of practice
(Schön, 1983)
• Also: Experiential knowing, craft knowing,
know-how, tacit knowing, personal knowing
(Dreyfus et al, 1984)
“Scientific evidence and knowledge are incapable
of rendering the individual, improvisatory, fluid
and artistic aspects of practice” (Clark, 2011)

19. “Someone trusted and respected, an individual
given class status, autonomy, social elevation in
return for safeguarding our well-being and
applying their professional judgment on the basis
of a benign moral or cultural code”
Dent and Whitehead, 2002

20. Professional values
• “Virtues of character”
• Professional morals or codes of ethics
“It is the cultivation of virtues
such as courage, temperance,
justice and wisdom that lie at the
heart of exemplary professional
conduct” (Carr, 2011)

21. Professional values
CMRTO: “The Code of Ethics is intended to help MRTs
choose the right, fair, good and just action”
http://www.cmrto.org/what-we-do/professional-
practice/code-of-ethics/

22. Professional practice: Art &
science?
Image: @sailorhg

23. Professional practice: Art & science?
Nursing is an art;
and if it is to be made an art,
it requires as exclusive a devotion,
as hard a preparation,
as any painter's or sculptor's work;
for what is the having to do with
dead canvas or cold marble,
compared with having to do with the
living body - the temple of God's spirit?
It is one of the Fine Arts;
I had almost said
the finest of the Fine Arts
- Florence Nightingale

24. Professional practice: Art &
science?
“The significance of the affective component of the
role, which initially attracted many radiation therapists to the profession, is that it
provides an important source of professional satisfaction and reward …Unfortunately,
our research finds affective behavior greatly under-represented in both educational
program advertisements and job postings”
Ekmekci O, Turley, C. Therapist, 2008, 17(1) p. 11

25. Gender and more
• Classic professions not
available to women
• Now majority of healthcare
workers are women
• Many new professions are
female dominated
• Health professions said to
be feminizing

26. “Being professional”
• Is often (unintentionally) gendered
• The professional is seen as “not just a man but, to
a large extent, a white heterosexual middle-class
man” (Grey, 1998, p. 584)
• Masculine values traditionally
are control, rationality and
competitiveness

27. #ILookLikeASurgeon
‘Operating Theater’ by Malika Favre

28. Professionalism today
“Professionals are still trusted, to the extent that
they have to be, but that trust is increasingly
mitigated through the process of being managed,
inspected and audited by external actors and
systems”
Dent and Whitehead, 2002

29. New public management
• Dominant management theory of last 20 years
• Private sector models and ideas in public sector
(e.g. healthcare)
• Aim is to improve efficiency and “customer service”
with a focus on competition, incentives and
targets
• Tension between humanistic and economic aspects
of workplace
▫ Professions and managers

30. Managers and/or professionals?
Professional groups
▫ Professionals
▫ Collegial
▫ Scope, standard, ethics
▫ Accountable to
individual patient
▫ Autonomous
Healthcare organization
▫ Managers
▫ Hierarchical
▫ Policies, procedures
▫ Accountable to budget,
metrics
▫ Bureaucratic

31. Impacts of NPM
• “We are all managers now”
• New professional language is about:
▫ Being flexible
▫ Patient (client) choice
▫ Being a reflective practitioner
▫ Embracing lifelong learning
▫ Being market-oriented, entrepreneurial
Evetts, 2009

32. UK Francis inquiry
Between 400 and 1,200 patients died as
a result of poor care over the 50 months
between January 2005 and March 2009
at Stafford hospital in the UK Midlands
Guardian, Feb 26th
2013

33. UK Francis inquiry
• Lack of care and compassion mentioned
repeatedly in the report
• “Doing the system’s business, not the patients”
• Focus on meeting externally imposed targets:
managerialism over professionalism?

34. Final thoughts
• The concept of “the professional” is complicated
and contested
• MRTs are part of the general professionalization
movement
• The growing influence of NPM has impacted all
HCPs
• We are a work in progress, in BC and beyond!

35. References
• Abbot, A. D. (1988). The system of professions: An essay on the division of
expert labour. Chicago, IL: University of Chicago Press
• Adams, T. (2010). Gender and Feminization in Health Care Professions.
Sociology Compass, 4(7), 454–465
• Bolderston A. Advanced practice perspectives in radiation therapy. J
Radiother Pract, 4 (2-3), 57 – 65, 2005
• Carr, D. Virtue, Character and Emotion in the People Professions. In
Towards Professional Wisdom: Practical Deliberation in the People
Professions, Bondi L, Carr D, Clark C, Clegg C.
• Dent, M., & Whitehead, S. (2002). Configuring the “new” professional. In
M. Dent & S. Whitehead (Eds.), Managing professional identities:
knowledge, performativities and the “new” professional. London, UK.:
Routledge

36. References
• Dreyfus, H. L., Dreyfus, S. E., & Athanasiou, T. (1986). Mind over machine:
The power of human intuition and expertise in the era of the computer.
New York: Free Press.
• Evetts, J. New Professionalism and New Public Management: Changes,
Continuities and Consequences. Comparative Sociology 8 (2009) 247–266
• Grey, C. (1998). On being a professional in a “Big Six” firm. Accounting,
Organizations and Society, 23, 569–87
• Hearn, J. (1982). Notes on Patriarchy, Professionalization, and the Semi-
Professions. Sociology, 16(2), 184–202.
• Schon, D. A. (1983). The reflective practitioner: How professionals think in
action. New York: Basic Books