Modernising physiotherapy

The impact of the Covid-19 pandemic on physiotherapy education has accelerated digital learning and innovation in practice based-learning opportunities.

Reena Patel explains how this year's pre-registration education review will provide an opportunity to capitalise on these changes and help modernize physiotherapy.

Pre-Reg Education
Pre-registration physiotherapy review

The impact of the Covid-19 pandemic on physiotherapy education has accelerated digital learning and innovation in practice based learning opportunities. There is now an opportunity to capitalise on these changes as part of the pre-registration physiotherapy education review.

The demand for physiotherapy is growing and the future workforce needs to have the knowledge, skills and behaviours required for delivering effective health and social care over the next decade and beyond. The CSP plays a critical role in physiotherapy education, guiding the future direction of the profession.

All registered physiotherapists enter the profession through a pre-registration physiotherapy programme and currently all of these programmes seek accreditation from the CSP to ensure the highest standards of professional quality. The CSP learning and development principles, which guide the CSP’s quality assurance and enhancement work, are underpinned by the graduate attributes within the CSP’s Physiotherapy Framework.

With the population living longer we need to prepare a workforce that can be versatile, who have breadth and depth of knowledge and experience of managing the complexity of multiple long-term conditions. There are many external drivers that help to shape pre-registration education. The pandemic has seen a significant shift in how pre-registration education is delivered and provides a timely opportunity to review physiotherapy education.  

The pre-registration education review will be launched later this year and it aims to engage with stakeholders to ensure the learning and development principles align with the essential knowledge, skills and attributes required of the modern physiotherapy graduate.

In addition, it aims to review the current 1,000 hour practice-based learning requirements including the potential role of simulation based education.

What does accreditation mean?

In order to obtain CSP accreditation physiotherapy qualifying programmes are evaluated against the CSP learning and development principles (see below). The principles set out the means by which appropriate learning and development may be achieved in order to fulfil the knowledge, skills, behaviours and values expected at entry level into the profession.

Please see February’s Frontline feature on pre-registration education, which described how programmes undergo annual quality monitoring. The ultimate purpose of this activity is to ensure that pre-registration physiotherapy programmes are of a high quality and are preparing graduates for contemporary practice.

The learning and development principles are underpinned by the CSP’s Physiotherapy Framework, which is based on the idea of physiotherapy being a complex intervention. All physiotherapy students are required to meet the HCPC standards of proficiency.

Similar to the HCPC, the CSP adopts an outcomes based approach to education. Outcomes based education is a student-centred approach where the emphasis is on what the students are expected to be able to do at the end of their learning experience. It therefore goes beyond the task-based focus of competency frameworks and defines the unique blend of behaviours, knowledge and skills used by the physiotherapy workforce.

Phrases such as the ‘more you learn the less you know’ and ‘you won’t know everything’ reflect and recognise that competence is multi-faceted, dynamic and evolving.

It is more than acquiring knowledge and includes the understanding of knowledge, clinical skills, interpersonal skills, problem solving, clinical judgment and technical skills. 

Practice-based learning

Practice-based learning is a vital component of pre-registration physiotherapy education. The process enables learners to gain the knowledge, skills, behaviours and values required of today’s physiotherapist.

Practice-based learning has historically been termed ‘placements’. And the term ‘placement’ has equally been seen as shorthand for ‘clinical’. It is important to address this fallacy directly, making it clear that practice-based learning is broader than ‘placements’.

Much of a learner’s practice-based learning experience is situated within the university setting or, in the case of degree apprentices, will be a mixture of work-based experiences, university setting and on-the-job learning.

Ultimately it is the student learning and experience, throughout the whole of the programme, that enables students to demonstrate that they have met the graduate attributes of the CSP Physiotherapy Framework of Knowledge, Skills, Behaviours and Values (2011) and the HCPC Standards of Proficiency (2013).

It is a CSP requirement for students/learners to fulfil approximately 1,000 hours of practice-based learning regardless of the route through which they qualify. 

During the pandemic the CSP has offered temporary flexibility to programme teams to ensure timely progression and completion for their students.  

The Covid-19 pandemic has necessitated a change in models of health care delivery, which has led to innovative practice - including the use of technology enhanced care services. It is clear that students/learners need exposure to this model of delivery in order to prepare them for future practice. Education practice is also changing in the wake of advances in simulation and immersive technologies. 

Simulated practice-based learning is not new in physiotherapy education, role-playing interactions with service users and carers are a powerful way in which universities help students in their development of key communication and assessment skills.

In addition, patient manikins have long been used to help students orientate and develop capabilities in a simulated cardio-respiratory clinical scenario. Variability exists across AHP professional body requirements in terms of whether simulation-based learning can contribute to practice hours.

The CSP’s current stance is that simulated learning can be used to complement rather than replace practice hours, although flexibility has been applied during the pandemic.  

Next steps

It is fair to say that we all share an interest in pre-registration physiotherapy education. Whether you are currently experiencing it, have experienced it or are relying on it to provide your future workforce, everyone has an opinion.

We will be undergoing a formal consultation process and as such are keen that all voices are represented to help shape and inform this important piece of work. 

We are seeking stakeholders who would like to be involved on the reference group. Please contact education@csp.org.uk to register your interest. You will be required to attend monthly virtual meetings during the initial phases of the project. All members will have an opportunity to share their views via focus groups and a survey, so please watch this space.

References

CSP Physiotherapy Framework of Knowledge, Skills, Behaviours and Values (2011) and the HCPC Standards 
of Proficiency
(2013). 

External drivers for change 

  • contemporary health and social care policy 
  • advances in digital and informatics 
  • simulation and immersive technologies
  • role variation specialist/generalist/versatilitist 
  • patient pathways defining the role rather than job titles 
  • roles integrating practice, education and research
  • diversity of health and social care providers
  • focus on prevention of poor health and reducing social inequalities
  • shift to primary care and care closer to home 
  • impact of Covid on longer term workforce planning 
  • decolonisation of the curriculum

    Learning and Development Principles

    Programme outcomes ‘How do we ensure our graduates are fit for practice in their first posts?’
    Programme design ‘How do we ensure inclusivity?’  
    The learning process ‘How do we encourage our students to show initiative and develop anticipatory leadership in contributing to service improvement?’
    Learning, teaching  and assessment strategies ‘How do we ensure our teaching is evidence-based?’
    Interprofessional education ‘How far do our existing inter-professional education activities promote understanding of the roles and ways of working of the other professions?’
    Practice placements ‘Do the placements adequately reflect contemporary practice?’
    Models of practice ‘Do we pay adequate attention to exercise and exercise prescription in our programme, and prepare learners for roles in public health and fitness for work?’
    Research, critical evaluation and appraisal ‘How do we develop students’ competence to use a range of outcome and patient satisfaction measures?’
    Resources and programme management ‘Are staffing levels adequate to support programme delivery?’

    Does the 1,000 hour practice-based learning requirement continue to serve our profession? 

    Is the 1,000 hour requirement the most appropriate way of supporting students/learners to fulfil the knowledge, skills, behaviours and values expected at entry level into the profession?

    As a profession would we trust a move away from hours to an outcomes based approach? What role could simulation play in practice-based learning? What may be the unintended consequences for the profession if we moved away from the 1,000 hour requirement? Do we know of learners who have completed the 1,000 hours but would benefit from more time in practice?

    Conversely, have we have seen students/learners meet the standards of proficiency having completed less practice hours. These are all questions for us to consider as part of the pre-registration education review and it is important we get it right to ensure that the quality of learning is maintained.

    It is important to recognise that placement capacity is not the reason for undertaking this piece of work, it is more a question of: as a profession, how do we deem proficiency at graduate entry level? As a profession, and those employing newly qualified physiotherapists a broader perspective is needed.

    Individually and collectively we need to move beyond our own training experiences and personal assumptions to allow programme delivery to evolve and expand in response to changing population/patient, service and workforce need. 

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