From Pillars… to Post

The four pillars of practice are becoming increasingly recognised within physiotherapy education. CSP education adviser Tamsin Baird explores what this means to the profession when graduates enter the workforce

From pillars to post
From Pillars… to Post [Illustration: Paul Oakley]

More universities are embedding the four pillars of practice – clinical, education, leadership, and research – into their curricula, to ensure that they produce graduate physiotherapists who are able to thrive within modern health care. 

This is both supported and encouraged by the CSP, aligning to the KNOWBEST recommendations and reflecting the complexities of current and future practice.

Sitting alongside university classroom-based modules to develop the essential clinical skills of the profession – such as anatomy, assessment, and clinical reasoning – are often modules in leadership, quality improvement, societal health, and research. 

This is replicated when learners go out on placement, with opportunities across all four pillars becoming more common, enabling a valuable insight into the depth and breadth of the profession across different sectors and settings.

Despite this shift in attention to the pillars within physiotherapy education, there remains hesitance as to their perceived value within some of the profession.

Hesitance around perceived value

One of the many challenges in physiotherapy education centres around curriculum content. Careful consideration is given to what is included and excluded within the limited time available. 

With more learning across leadership, education and research what will this mean to most early-career physiotherapists who will work in clinical posts on graduation? The answer is clear – their clinical practice will be enhanced. We must think about how the pillars integrate rather than separate our work.

When faced with a busy clinical caseload, a ‘four pillars’ approach enables the elements to combine to strengthen professional practice. For example, an understanding of the up-to-date evidence-base underpinning clinical management will support effective decision making and inform person-centred outcomes. 

A solid application of leadership skills will drive efficient methods of communication, improve delegation, motivate others to change behaviours and effectively contribute to a team goal. Knowledge within the education pillar will enable empowerment of others, facilitate lifelong learning, and support themselves and others to grow. Learning a new technique, becoming a practice educator, or leading a CPD session are just a few examples of this.

We must not think about these essential elements of physiotherapy practice individually. Instead, consider the real superpower that the four pillars have when they combine.

Let us move forward and not dwell on how things used to be done. As our graduates enter the workforce, their professional development across all pillars must be embraced. Let’s all help to create a modern workforce that supports the evolution of our profession. 

As quoted by educationist John Dewey, ‘If we teach today’s students as we taught yesterday’s, we rob them of tomorrow.’ 

An employer’s perspective

Victoria Dickens is the chief allied health professions officer and a consultant physiotherapist at Northern Care Alliance and has been practice educator to over 35 students on leadership placements using a 2:1 model. She welcomes the fresh eyes and innovative ideas that students offer and sees the immense value of leadership experience in preparation for the modern practice.

‘The four pillars of practice set physiotherapy students up for entering the workplace,’ she says.

‘There are numerous opportunities outside of clinical practice for physiotherapists and ensuring a good foundation across the pillars will position them well to take these.’

A university perspective

Jill Kent, head of department for allied health professions at Teesside University, has been at the forefront of innovatively integrating the four pillars within education, recognising the future workforce needs an increasingly diverse range of knowledge and skills straight from registration.

She says that: ‘With increasing demands on health and social care resources, it has never been more important to apply research to practice, lead and manage change, be resilient to the uncertainty and demands of the workplace and work effectively in a range of teams – learning across all four pillars is central in achieving this.’

A newly qualified perspective

Isla Kenyon graduated recently from Manchester Metropolitan University and is now working at Foundations Physio. She completed a leadership placement working on a project to reduce band 5 attrition and promote recruitment. 

She states this experience was crucial to her development, helping create a strong platform for practice. Isla is directly applying the skills developed within her current role, in her communication, team working and use of data to measure impact which is of benefit to patients, colleagues, and the wider MDT. ‘Employers should recognise the value of students learning across the pillars when interviewing for graduate posts,’ she says. ‘Specific clinical skills can be taught but communication, critical reasoning, reflection, and lifelong learning are harder to develop and are, in my opinion, a better determinant of a quality physiotherapist.’

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