Modernising pre-registration physiotherapy education

Physiotherapy practice is changing: the UK population is aging, more patients have complex conditions and, in line with health and social care policy, care is shifting further towards settings such as primary care.

Physiotherapists are working in a widening range of settings, and placements are becoming more diverse as the profession develops and care changes. There is increasing pressure to provide student placements and a clear role for adjuncts such as simulation based learning (SBL) to contribute to PBL. All physiotherapists need to aid the professions’ development and assist with pre-registration training of physiotherapists. 

KNOWBEST project

The CSP, recognising the importance of preparing a physiotherapy workforce fit for the future, commissioned the University of Hertfordshire (UH) to undertake the KNOWBEST (the KNOWledge,  BEhaviours and Skills required of the modern physioTherapy graduate including the future role of practice based learning) project.

The study team, led by Dr Catherine Minns Lowe, supported by a UH stakeholders group, carried out a mixed methods project (September 2021-March 2022). Dr Minns Lowe thanked everyone who took part and commented, ‘KNOWBEST provided the opportunity to focus on “where we great” as a profession regarding the education of new physiotherapists and “where we need to be”. We’ve really enjoyed carrying out this project and all the thought provoking conversations and discussions during it.’

A scoping review (led by Dr Nicola Heneghan) of contemporary approaches to PBL in pre-registration education specifically focussed upon simulation and the use of digital technologies within physiotherapy education. Following this, a wide variety of UK band 5 role descriptors (such as job description and person specifications) were collected. Analyses of these enabled the identification of the knowledge, skills, attributes and behaviours expected of band 5/newly qualified physiotherapists contained within them. Role descriptors were mapped against HCPC Standards (proficiency, standards of conduct and performance and ethics) and the CSP Code of Members’ Professional Values and Behaviour.

Engagement activities

Crowdsourcing was used throughout KNOWBEST to engage with 12 a priority broad categories of stakeholders, exploring their thoughts about the topic. Engagement activities were multifaceted and varied to ensure appropriateness for each stakeholder/group. These included a dedicated project website (with information, invitations to events, a hosted online survey), webinars, conference networking, Instagram survey, group/individual meetings, social media, discussion for a and emails.

Data were synthesised and focus groups – held with key stakeholders, including one specifically for service users/patients – helped derive the recommendations with the team (which also included Professor Karen Beeton, Dr Karen Atkinson and Dr Anthony Herbland).

Research placements

Five BSc (Hons) physiotherapy students (two from year two and three from year three) joined the team. Each undertook a five week research placement, were actively involved in KNOWBEST and experienced additional aspects of research. Zainab Gaylani and Flo Radones contributed to the scoping review, Ben Clements and Jen Boonin worked on the role descriptors and Jack Rose explored the student experience of being on a research placement. Susan Roscoe, practice team lead, explained: ‘The KNOWBEST project gave us a great opportunity to see how research placements could work and we were able to see how the experience could be suited to students in different years of study. The assessment of the students was undertaken on our existing documentation; having recently started to use the new Common Placement Assessment Form we can already see how much more suited this new documentation will be in these emerging placement opportunities.’

Phin Robinson, director Pure Physiotherapy Ltd

I feel privileged to have been asked to contribute to the KNOWBEST working group looking at improving the clarification and support around new physiotherapists moving into our profession.

Having qualified 21 years ago, and having been involved in educational environments at both under and postgraduate levels, it is brilliant to have been involved in the creation of this project which will help physiotherapists as they move from pre-registered to full qualification and into the workforce.

The range of experience in the working group which was put together for this project brought clinicians and non-clinicians from different backgrounds together. Linking higher education, NHS and independent workplaces, the CSP and patient representatives, it should give an honest and realistic view of how our profession is seen, and our hopes for the sustainability and development of people moving into physiotherapy for the future.

In the working group we focused on elements around supporting individuals progressing into a career in physiotherapy. We looked at the challenges that individuals and organisations face currently and in the future. Some of the challenges may be at personal or individual level, for example physical or mental health. They also include challenges at an employer’s level around competency and expectations.

KNOWBEST project recommendations

Future of Practice Based Learning

1. Retain a notional 1,000 hours of pre-registration PBL, where 75 per cent or more hours should comprise clinical patient facing PBL and up to 25 per cent for other PBL including SBL and/or other PBL opportunities, for example leadership and research.
2. Champion the use of simulation as an evidence based approach to students applying knowledge and skills to the benefit of patients and carers .
3. Commission a simulation toolkit to expedite the adoption of models of practice involving simulation and related activities through rapid dissemination.
4. Invest in a co-produced authentic ‘simulation library’ of expert patient or actor videos/resources (different settings, specialities, presentations) to reflect contemporary practice and improve understanding regarding diversity. This library should be retained and managed by the CSP.
5. Consider commissioning research to i) generate evidence to further inform the use of simulation in HEI settings ii) explore consensus regarding outcomes to evaluate student development of knowledge, skills, behaviours and attributes and iii) explore how adjuncts to PBL across HEIs and clinical settings might be resourced and shared within the profession.
6. Explore how other large health care providers (such as the independent/private sectors) can offer more opportunities for PBL and promote the benefits of placements across health care sectors and settings.

Graduate role descriptors

7 Promote clear guidance regarding the role of all bands for the profession to promote  equity: KNOWBEST findings offer guidance for band 5/newly qualified physiotherapist roles to be developed, and provides some guidance for band 6 roles.

8 Generate a template role descriptor for a band 5/newly qualified physiotherapist, which meets the professional standards for practice and legislation regarding equality, diversity and inclusivity (EDI).

9 As part of the CSP’s commitment to improvements in EDI, promote inclusivity in tone of band 5/newly qualified physiotherapist role descriptors.

Curriculum content

10 Require pre-registration physiotherapy programmes to map the curriculum to the four pillars of practice when they apply for accreditation/reaccreditation. EDI and digital skills and learning should be demonstrably woven throughout the curriculum.

11 Advocate inclusive curricula involving relevant experience of person-centred healthcare delivery, ensuring students obtain knowledge and experience in a broader set of core specialities, across key health care settings (community, primary, secondary etc) and with different patient populations (for example those with dementia, learning disabilities, mental health, people from a wide range of socio-economic and diverse ethnic backgrounds).

Final recommendation that underpins 1-11

12 Proactively collaborate with managers/ employers and the profession as the nature of physiotherapy practice continues to evolve.

Ben Clements, physiotherapy student

KNOWBEST represents the modernisation of the way in which we progress through our degrees. It shows the proactivity of our future profession by exploring other education modalities that can help us adapt to our ever-changing surroundings. By addressing questions and barriers that have arisen within the last three years, the project can help us ensure that the next generation of physiotherapists are as successful and as well equipped as the last. I thoroughly enjoyed my time working on the KNOWBEST project as the experience allowed me to appreciate the importance of research; inspiring me to become more inquisitive and explorative within my studies and clinical practice. 

It provided me with the opportunity to hone a wide variety of transferrable skills, each of which I believe have aided my professional development. I am incredibly grateful to have been exposed to the field of research and believe that such placements can prove to be a valuable experience to any physiotherapy student.

CSP education adviser Reena Patel

These findings may come as no surprise to you as many pre-registration programmes reflect/are acting upon them. The CSP plays a critical role in shaping and quality assuring physiotherapy education. We are already actively moving forwards on these recommendations, for example, we commissioned the recommended toolkit for SBL (available shortly) and will be reviewing how our quality assurance and enhancement processes can enable our profession to take these recommendations forward. The recommendations speak to all physios: they extend beyond the university setting. Examples include the role SBL has in the clinical setting, the need to improve EDI, and to ensure adjuncts to PBL are authentic. This will assist the capitalisation of the knowledge, skills, behaviours and attributes from the start of graduates’ journeys by the teams and services that employ them.