“ I have never let my schooling get in the way of my education”
This is a quote which is often attributed to Mark Twain and perhaps there is some wisdom to be taken from this when thinking about the education of advanced practice clinicians.
I want to focus on two methods of advanced practice (AP) education here and in both these methods education has moved out of the school and the reins have been handed to the clinician, their peers and their mentors.
This doesn’t mean there is no place for “school” in AP. In fact, every discussion I have had about education in Australia, New Zealand and the UK has started with the assurance that all AP clinicians should start with a MSc as a minimum (In Australia this is a MPhty). Some discussions suggest a level of grandfathering or equivalence route and some discussions are more specific about where or what that MSc should look like. Across nations and levels of practice there is wide agreement with Health Education England (HEE) which asserts the importance of Level 7 education. However, we should keep our patients needs and safety at the beginning of all these conversations- do patients automatically have access to better care and services because their AP has achieved a level of education within a university structure?
In Queensland and Victoria they think not. During my Fellowship I was fortunate to spend time with Patrick Swete Kelly who is the Education Coordinator for Neurosurgery and Orthopaedic Physiotherapy Screening Clinics (N/OPSC) in the state of Queensland. Pat and others I have met with believe that an educational qualification at this level demonstrates that a clinician is prepared to work hard, can read, understand and interpret literature and is aware of research processes. Pat suggests that a postgraduate Masters qualification represents a foundation on which to build advanced practice skills and capabilities. In developing the Extension program focus groups were held with APs and service Directors in Queensland; they identified a gap between what Masters programs provide and the requirements of AP roles. A number of my contributors are in agreement with this premise including Paula Harding who was responsible for implementing the AP educational programme in Victoria, Jon Warren who is the previous president of Physiotherapy NZ (professional body) and Damon Newrick who is a member of the Physiotherapy Board of NZ.
Let’s focus on two different methods of assessing quality of AP clinicians’ clinical knowledge and skills. In Queensland I spent time with Maree Raymer and Mark Cruickshank and their AP teams in the Royal Brisbane and Women’s Hospital. Maree is the statewide coordinator for the Neurosurgical and Orthopaedic Physiotherapy Screening Clinics and Multi-disciplinary service in Queensland. Mark Cruickshank is the physiotherapy director at the Royal Brisbane and Women’s Hospital. As discussed above I was also fortunate to meet with the N/OPSC Education Coordinator, Pat Swete Kelly.
Pat has developed, implemented and runs the Extension Programme which is an educational programme delivered to aspiring APs across Queensland. Queensland is 3x the size of the UK and the sheer size of the state has its own challenges which Pat and the team meet through innovative digital solutions including using video conferencing services for training and observational assessments.
Working in Canada I regularly used conference calls to connect the dispersed sites for meetings but in Brisbane I had the pleasure of delivering a presentation to sites across Queensland using their video conferencing facility which was smooth, easy to use and easy for staff to engage with the speaker.
Pat and the program participants (Physiotherapists) use this technology to run their Extension programme. The program is offered annually and runs with dedicated contact time, one morning a week for 12 months. A particularly clever adaption, considering the distance between the participants, is their peer observation process. Patients agree to be observed and the physiotherapists turn on their webcams and their peers observe their assessment on-screen. Participants ask questions, provide feedback and then they reflect on their observations as a group afterwards. Participants present case studies to each other regularly and once a year they present at a Queensland-wide Forum for AP staff working in Neurosurgery and Orthopaedic screening clinics. They also contribute to professional development for other physiotherapists with an MSK interest who access the conference digitally from across the state. Each participant works through the curriculum which has been designed and tweaked over the years. They undertake formative assessment by their peers, local supervisors and Education Co-ordinator and are independently assessed by their educators at the end of the programme.
The participants tend to be aspiring APs, rather than already holding AP roles. During the Extension Program they undertake a graduated exposure to the AP role but are not guaranteed an AP role on completion. They do, however, undertake the program only with the sponsorship of their local health service, who are looking to sustain and build their AP services. Participants receive a letter upon completion which recognises their AP skills and knowledge, providing demonstration of completion and attainment of the level of expertise required of AP roles which is well recognised by physiotherapy service managers . This method also ensures there are AP ready staff in the pipeline ready to step into any AP roles which may arise.
In Victoria their educational process and credentialing system takes a different turn. Research conducted by Paula Harding and colleagues has resulted in the creation of a set of AP competencies which can be used alongside an array of modules. Clinicians self-identify appropriate modules to supplement their learning and achieve a level of expertise and practice which is relevant to their role and their individual needs. This model is flexible and has been adapted to suit AP staff working in different contexts including spinal screening and the Emergency Department. This model is an ongoing process and relies heavily on the adult learning principles of self-awareness and the clinician’s ability to self-select areas for key development. Clinicians receive a workbook as well as the competency framework which they work through at their own pace carrying out a Learning Needs Assessment to help guide their focus.
These two models demonstrate local approaches to the professional issue of equity within MSK post-graduate education which is meaningful to the service and the patients it serves. I challenge readers to consider whether a specified programme of study is appropriate, sufficient and meaningful for every service and every individual clinician. Does this approach automatically equate to safer and more evidence based practices?
Consider Mark Twain’s musing…should we let our schooling get in the way of our education?
Advanced Physiotherapy Practitioner
First Contact Practitioner
Winston Churchill Fellow