Pre-registration practice-based learning, as explained by CSP interim assistant director (workforce and education) Nina Paterson
When you’ve worked in an organisation and/or on behalf of the profession for a long time, it’s an occupational hazard that you become a walking memory bank for either the organisation or the profession and its evolution. Despite working for the CSP for nearly 18 years, I’ve escaped that responsibility for a very long time because thankfully I've had predecessors who had been at the CSP for far longer than me.
When I first started working here, I used to playfully tease one such colleague that she must have been at the Society’s inception back in 1894 (around the time that gramophones were patented) so vast was her memory of the profession’s evolution and its critical turning points! She obviously hadn’t been in post that long, but she started at the CSP when ABBA dominated the music scene, so her memory was impressively long!
My colleague moved on to a wonderful and happy retirement and I donned the education mantle. Fast forward nearly two decades…I’m no longer the cheeky young thing that bounced into the CSP full of ideas and enthusiasm. I’d like to think that I still have the ideas and enthusiasm but my hair is now greying, and my body no longer bounces but creaks!
Aside from these obvious signs of ageing, the other confirmation that time has moved on is that I have become ‘that colleague’ – the one that’s supposed to be the walking memory bank! I finally realised this late last year while sitting in a catch-up meeting with the team leading the KNOWBEST project and two of my workforce and education colleagues from the CSP. I realised that all eyes were suddenly on me as we began to discuss the origin of the thousand-hours of practice-based learning that is required of all pre-registration physiotherapy students throughout the UK.
It’s no surprise that the conversation had turned to the legendary figure given that the project, led by colleagues at University of Hertfordshire*, is looking at how pre-registration physiotherapy education best prepares the physiotherapy workforce for the future. An absolutely essential piece of research which will enable programme providers to future-proof their pre-registration curricula and by doing so the graduates entering the workforce as well as the profession at large. No mean feat!
As a significant part of pre-registration education is practice-based learning, our discussion had flowed naturally to an enquiry about why that figure was chosen.
I have actually looked into the origin of the hours before. But even calling in reinforcements from those with better researching skills than mine, we’d come up empty. There have certainly been some interesting and somewhat-less-than-accurate assertions made about pre-registration education through the years floating around, so I thought I would set the record straight, at least about practice-based learning, or ‘placements’ as they’re commonly known.
Has it always been a thousand hours?
No. The profession has employed a number of different models for practice-based learning and the earliest model pre-dates even the CSP or the Society of Trained Masseuses, as it was known until it received its Royal Charter in 1920.
When physiotherapy was in its infancy and still under the supervision of doctors, all of the training was on the job. Very short courses in massage and gymnastic exercise could be undertaken by nurses and the learning from these was taken straight back into the workplace. A far cry from the current apprentice models we have now or even the work-based learning routes that existed before modern apprentices!
At this point, no matter how skilled you became, there was no autonomy. The profession had to wait until the late 1970s for that, while Elvis Presley’s last single Way Down was being released.
But before that autonomy was granted the profession moved far beyond its simple educational start. As early as the granting of the Royal Charter, education became enshrined as a key pillar and with this came a definition of core skills and exams. Physiotherapy education became much more than a few weeks’ worth of courses, evolving quickly into something not completely alien to what we know now.
While the profession has evolved its scope over time, the curriculum has kept pace, or indeed set the pace, for those changes. But what has been consistent is the way that physiotherapy has been taught – there’s always been a focus on practical application. Hardly a surprise.
Even before the move to university setting the Schools of Physiotherapy were focused on teaching theory, providing space for students to practise in a safe environment (on each other), and practise on patients. And during some of these points in the profession’s history practising in the workplace constituted substantially more than a thousand hours of students’ learning.
The thousand-hour requirement really took hold once the profession made the leap into higher education. In 1992, while Whitney Houston was belting out I Will Always Love You, the thousand hours requirement was born. And while I’m on record, I’ll just clear up a still-commonly held misunderstanding…this expectation was set by the CSP, not the Health and Care Professions Council (HCPC) which came into existence as the regulator at a much later point.
Why a thousand hours?
I’d like to say that as an evidenced-based profession the matter was decided after the gathering of much research and determined accordingly, but I’m going have to say that in reality it was a decision taken because it felt about right. The figure was chosen because it was the equivalent to a third of the training schedule at the time – the training then being a three-year degree. We hadn’t even imagined two-year pre-reg master’s, four-year integrated Masters or four to five-year pre-reg doctorates.
Considering how much theory and practise needed to be incorporated within the university setting, the profession deliberated and agreed that what amounted to a third of the time should be spent practising in real world scenarios on patients. It did take into account that students weren’t simply learning theory in isolation but were practising on each other within the university setting before they were able to put their hands on a real patient. Much like they do today.
While it might have come about as a collectively agreed best estimate of what would be needed - it has at least been evaluated continuously using an ongoing iterative process. The mark of whether it worked came down to the perceived effectiveness of graduates within their roles upon graduation. And for that we have 30 years’ worth of feedback given either to each university programme, the CSP and more latterly the HCPC by students, practice educators and employers throughout that period.
How are the thousand hours divided up and what counts?
There hasn’t ever been an expectation on how the thousand hours are utilised within a programme and similarly we haven’t been particularly prescriptive about what counts. What experiences should count has evolved as the profession has, and that has given the profession agility. Each programme is constructed differently but they all deliver the necessary end result.
In terms of placements, some students go out in their first year, others wait until their second. Some students experience back-to-back placements, other programmes evenly space out placements. Some last five, six, eight, or even 12 weeks, and other students are out every week as part of a part time placement model throughout the year. Mostly the models are driven by local placement provider preference, which then becomes custom and practice.
Why does any of this matter?
That’s an interesting question – the profession has always collectively determined its evolution and direction. While the CSP leads the way, it certainly doesn’t just go it alone.
And that’s especially true of the direction of pre-registration education. Preparing the next generation has always been determined through periodic discussion and debate across the profession, so that together we can collectively review, agree and reset the direction of travel.
We’ve had two significant reset points since the move to an all graduate profession. And 2022 is another one of those moments and will be critical in ensuring that we’re on the right path.
My thanks to those of you who have already fed your views into the KNOWBEST project, which launched in September last year.
Those views will influence the next iteration of pre-registration education directly – they will inform the recommendations that the team will put forward to us at the end of the project.
And please know – we are listening!
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