Preregistration radiography education in sub-Saharan Africa: Impact assessment on graduate competence and employability.

Abstract

INTRODUCTION: Sub-Saharan Africa (SSA) faces increasing demands for medical imaging; however, radiography education is heterogeneous. This study examines preregistration diagnostic radiography (standalone or combined with radiotherapy) programmes in SSA, assessing how training prepares graduates for clinical practice. METHODS: A quantitative online cross-sectional survey was distributed to SSA radiography educators, recent graduates, and managers to examine preregistration radiography programme structures, workload allocation, and graduate competence. RESULTS: Analysis of 258 responses from 23 SSA countries showed variation in programme duration and modalities. Curricula emphasised projection radiography and general ultrasound, with limited coverage of Computed Tomography (CT), Magnetic Resonance Imaging (MRI), nuclear medicine (NM), and radiotherapy (RT). Factor analysis revealed that core imaging expertise was the best predictor of graduate competence, with clinical placements being crucial for proficiency in cross-sectional imaging. Competencies in CT and ultrasound demonstrated moderate development at graduation, whereas skills in MRI, NM, and radiotherapy were acquired on the job. Despite comprehensive training in generic skills, both taught and clinical programme characteristics showed significant negative correlation with industry expectations (r = -0.26, p < 0.01 and r = -0.27, p < 0.01, respectively). CONCLUSION: Radiography education in SSA is varied and demonstrates limited graduate preparedness in cross-sectional imaging, with a misalignment to employer expectations. A single-modality exit curriculum model, embedded within a multi-modality threshold competency framework, could improve graduate work-readiness. Better integration of clinical placements and partnerships between academia and industry are essential. IMPLICATIONS FOR PRACTICE: Educational institutions and policymakers in SSA must prioritise curriculum reform that aligns with health system needs and training realities. This should involve implementing targeted strategies to build a workforce capable of meeting evolving demands through enhanced collaborative frameworks, industry-aligned modular curricula, and expanded clinical exposure to cross-sectional imaging modalities.