Revoltes aragoneses durant la guerra amb Castella

A study by Almeida et al. (2006) suggested that undergraduate MSK education for AHPs in the UK is inadequate. They found that the typical undergraduate

89 curriculum for OTs and physiotherapists (and nurses) contained only five to 10 hours of rheumatology teaching over a typical three-year training programme. Hewlett et al. (2008) used a three-round Delphi survey followed by three inter- professional workshops to identify core topics in rheumatology for undergraduate AHPs and nurses. The expert Delphi panel (n=39) comprised representatives from occupational therapy, nursing, and physiotherapy; they produced six essential teaching units and proposed a range of delivery methods. Although the authors included the views of education experts (n=19) via separate interviews conducted over the telephone, they did not include medical experts’ views.

Studies from the US and Canada have described similar inadequacies in MSK education for physiotherapists at undergraduate level (Jette & Becker, 1980; Westby, 1999; Li et al., 2009). Verma, Paterson & Medves (2006) attempted to define a set of generic essential competencies (values, knowledge, attitudes, and skills) for sharing across medicine, physiotherapy, nursing, and occupational therapy, by amalgamating discipline-specific competencies. Moncur (1985) surveyed physical therapists who were also clinical educators, physical therapists, and rheumatologists, in order to identify essential competencies related to managing the chronic problems of arthritis by entry-level physical therapists. The majority of the resultant 80 competencies focused on physical therapy treatment; for example, designing and implementing a physical therapy management plan. However, the authors commented that some competencies would traditionally have been the responsibility of other professionals, including rheumatologists. A subsequent publication (Moncur 1987) reported on the difference in perceptions among the same three groups of respondents. The only statistical differences found were between clinical educators and physical therapists for 20 competencies, which the authors attributed to experienced practising clinicians forgetting what their practice had been like as a new graduate.

In 1999, the CSP published recommendations for ESP practice (CSP, 2000). These recommendations stated that ESPs should possess at least five years’ post-qualification experience and three years’ experience in the specialist field, and that they should have completed a recognized or accredited course. Training

90 currently available to ESPs in the UK includes ad hoc experiential learning in the workplace, masters-level modules and full masters’ programmes, and short courses. Dawson (2006) described a new multidisciplinary course for AHPs at the University of Brighton, resulting from collaboration between rheumatology teaching centres throughout the UK and the Arthritis Research Campaign (now Arthritis Research UK). It included both entry-level and masters-level education and again, it used the competencies defined by Carr & Gordon (2001) as its foundation. The University of Salford offers inter-professional learning in trauma and orthopaedics, and surgical practice for trainee surgeons, GPs, and non-medical health-care professionals. Inter-professional training is likely to become more commonplace and for ESPs, this could promote a greater understanding of their roles and facilitate their professional development. Indeed, one physiotherapist has written about her training in orthopaedics, which was part of the specialty registrar training scheme for trainee orthopaedic surgeons (Kennedy, 2010).

Returning to Canada, Yardley et al. (2008) used a cross-sectional survey design to ask a randomly selected sample of physical therapists (n=500) and employers of physical therapists (n=500) their views on clinical specialist and advanced practice roles. The response rate was 53% and 60% respectively and although they stated that neither role was formally recognized in Canada (nor was there a legislative or regulatory framework to support these roles), 8% of physical therapists identified themselves as advanced practitioners. Overall, the results showed that both physical therapists and their employers were keen to pursue the formal development of ESP-type roles. Li et al. (2009) also surveyed Canadian physical therapists’ views on specialist and extended practice roles using a postal survey and a random sample (n=600) of physical therapists. Although they had a low response rate (47.7%), they found that one in four physical therapists were keen to pursue an advanced practice career in rheumatology. It is interesting that both Li et al. (2009) and Yardley et al. (2008) indicated that advanced practice roles are not formally recognized in Canada, when Campos et al. (2002) and Campos et al. (2001) had already reported on the success of their advanced practitioner physiotherapy roles in paediatric rheumatology. In addition, Lundon et al. (2008) and Lundon et al. (2011) described the Canadian Advanced Clinician

91 Practitioner in Arthritis Care (ACPAC) programme for physical therapists and OTs with experience in MSK disease and arthritis management, designed to address a national shortage of rheumatologists. In fact, the situation in the UK is similar to that in Canada, because neither country can claim to have formal accreditation or regulation systems in place for extended practice physiotherapy roles.

In the US, the American College of Rheumatology published physical therapy competencies in rheumatology (ACR, 2010). These focused on the entry-level physical therapist but also detailed those competencies acquired with experience and supervision. Also in the US, Milidonis et al. (1996) conducted a survey to identify the practice of orthopaedic clinical specialists using a stratified convenience sample of 1,000 orthopaedic physical therapists, 325 of whom were orthopaedic clinical specialists. The overall response rate was low (42%), but 75% of clinical specialists responded. Their results provided a core set of knowledge and skills required of advanced practice therapists in orthopaedics and created a framework for their orthopaedic physical therapy specialty examination. This core skill set related to patient evaluation, design and implementation of care plans, research and documentation, and other professional practice issues.

Chehade et al. (2011) reported on the ongoing implementation of The Australian Musculoskeletal Education Collaboration (AMSEC) being developed through a national consensus process. The project began in 2005, with the objective of developing a core competency framework based on the Bone and Joint Decade curriculum recommendations for medical schools in Australia (Woolf et al., 2004). The Royal Australian College of General Practitioners has adopted this framework and the physiotherapy professional body is currently involved in discussions around their use of the AMSEC framework for MSK physiotherapists.

3.6 Summary

The current situation regarding MSK ESP training and education in the UK is disheartening. It is indefensible not to have a competency and curriculum framework detailing the skills, knowledge, and professional behaviours needed to perform effectively in a MSK ESP role. The absence of a framework results in a

92 number of problems: there is no way of regulating ESP practice, because there is no demonstrable standard; ESPs are facing competition from other advanced practitioners who do have such frameworks supporting their practice; patient care may be suffering; and the risk of litigation may be increasing. Having a competency and curriculum framework would lead to a more standardized approach to ESP practice across different organizations and geographical boundaries, which would assist organizations in their workforce planning and succession planning, and improve recruitment and retention of ESPs. It would also help to clarify the parameters of individual roles and assist HEIs with their development of ESP-specific training programmes. Furthermore, the medico-legal aspects of extended practice, which is discussed in more detail in the next chapter, make it crucially important to establish core clinical competencies for the ESP role.

93 Chapter 4

Medico-Legal Aspects of Extended Practice

4.1 Introduction

The professional accountability within an ESP role extends beyond statutory regulation (Eddy, 2008) and well-defined competencies play a pivotal role. This chapter highlights the key medico-legal issues associated with MSK ESP practice.