The apprentice

Those of you who follow me on twitter may have noticed that I’ve been banging on somewhat about the Department for Education’s consultation on proposals to develop apprenticeship standards in physiotherapy (among several health professions) and the Chartered Society of Physiotherapists’ lack of engagement with its members over what this might mean for the profession.

The proposals form part of the government’s strategy to double the number of apprenticeships and increase the range of higher apprenticeships by 2020, funded by the new apprenticeship levy which will apply to all NHS Trusts from May 2017. It is suggested that an apprenticeship route to becoming a HCPC registered physio may increase the diversity of people entering the profession and improve the ability of hard-to-recruit-to trusts to find, develop and keep their own staff. These are good aims to work towards. What is clear is that this would represent the biggest change in entry requirement to the profession in the UK since we went all-graduate entry in 1992. There appears to me to be an  inherent risk in the development of an alternative entry route to the profession that the two routes may not be equivalent. A two-tier system would be to the detriment of (some) patients, (some) health services and all existing and future physiotherapists. I therefore wanted to try and expand a bit on some of the questions that I have regarding whether an apprenticeship route will be able to offer a comparable experience to the current degree route in a key, but hard to define, component of a physiotherapy programme; namely, the development of critical thinking.

I guess this is where I need to declare my biases. I’m a university lecturer. Somewhat unsurprisingly, I think that the university bit of a physio degree is as important as the clinical placement bit. I think its important for different reasons and those reasons are only partly because that is where students learn “the theory”. I believe becoming all graduate-entry has allowed physiotherapy to grow as a profession over the past two decades. I think this is because going to university is about changing how you think, not just increasing what you know. It is about developing critical thinking skills through exposure to different perspectives, different ideas and different people. Its then about having time, space and encouragement to reflect on those experiences in order to raise your awareness of your own biases and preconceptions in order to challenge them. The current system isn’t perfect but the mix of academic and clinical practice in a qualifying physiotherapy programme ensures that graduating physio students have encountered and learnt from a variety of lecturers and clinicians, with different backgrounds and different ideas about practice, who work in different ways in different trusts and different teams. I believe this is essential in developing the kind of critical thinking physiotherapists able to meet and adapt to the healthcare needs of our changing society.

Apprenticeships are by definition different. Historically being an apprentice meant working for a master tradesman from whom you learnt the skills of their trade. It didn’t traditionally involve questioning that tradesman, spending time with other tradesmen to broaden your perspectives or reflecting on what you might do differently to your teacher-tradesman based on the latest peer-reviewed scientific evidence.

Clearly modern higher apprenticeships are more complex than this. Physiotherapy apprenticeships would involve a higher education institution (HEI) in elements of the training. What does remain the same however is that apprentices are employees of a trust, which would commission a HEI provider to deliver the training, whilst retaining “…full ownership of apprenticeships, designing and owning the content of all apprenticeship standards and assessments”. In the proposal being developed by United Lincolnshire Hospitals NHS Trust and Sheffield Hallam University, an apprenticeship would last 27 months with the “theory” component (their words) taking up 20% of the apprentice’s time (equivalent to 1 day a week) and 80% spent in practice working for their employer. There’s very little detail at this point in terms of how this proposal would be delivered; from whether the 1 day a week is in University with other physiotherapy students, to whether apprentices are supernumerary or included in staffing calculations.

To my mind there are a number of questions that arise from the proposals which need answering to provide reassurance that the proposed apprenticeship route won’t disadvantage apprentices compared to student physios.

  • Will an apprenticeship that is split 80:20 Clinical practice to “theoretical teaching” have sufficient space in the curriculum to develop critical thinking skills?
  • How will the development of apprentices’ critical thinking skills be monitored and assessed?
  • What opportunities will apprentices have to encounter alternative perspectives on practice from outside of their employer trust?
  • What impact will being an employee instead of a student have on the practice educator/apprentice relationship?
  • What impact will being an employee instead of a student have on the trust’s expectations of apprentices?
  • Will apprentices be supernumerary?
    • (Assuming the answer is no) How will apprentice’s time for learning, reflecting and thinking be protected from workload pressures, especially in the current NHS context?
  • What is to stop a trust removing elements of the physiotherapy curriculum that they do not consider relevant to their services from their apprenticeship standards?
  • Will an apprenticeship that is split 80:20 Clinical practice to “theoretical teaching” have sufficient space in the curriculum to develop research literacy equivalent to a BSc(Hons) student?
    • Will apprentice-route physios be eligible to go on to study for an MSc? a PhD?
  • Will apprentice-route physios have a qualification that is internationally recognised to enable them to work abroad?

I would love to hear your thoughts on these questions, or any of the many alternative questions that you think I should have been asking instead. This is a big, complex issue and it deserves a conversation that includes as many views as possible. Luckily, the fab folks at #physiotalk are running a tweetchat on physiotherapy apprenticeships between 8 and 9pm on Monday 9th January 2017 so if you read this in time and have opinions on the apprenticeship proposals please contribute to that as well as letting me know what you think.

Many thanks for reading,

Ben

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