Work-based learning: supporting advanced perioperative practice.
The arrival of work-based learning awards in professional education
offers an alternative route for healthcare professionals looking to
undertake post-registration education. The unique way that work-based
learning integrates individual learning needs with that of role
requirements makes the award an ideal choice for the advanced
perioperative practitioner (APP) who wishes to combine academic study
with professional development. As an experienced and professionally
qualified practitioner (Thatcher 2003) the APP will have an accumulation
of knowledge, skills and experience that may go unrecognised in
The term APP refers to a nurse, ODP or allied healthcare professional who undertakes a role that challenges the traditional boundaries of care within the perioperative environment (Radford 2004), such as that of a surgical care practitioner (SCP). Here Julie Quick, a SCP, examines the changes within post-registration education and in particular describes why work-based learning awards may be an appropriate choice for practitioners working at a higher level of practice.
KEYWORDS Work based learning / Professional education / Perioperative practitioner
Perioperative care (Research)
Medical personnel (Training)
Medical personnel (Management)
|Publication:||Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 Association for Perioperative Practice ISSN: 1750-4589|
|Issue:||Date: July, 2010 Source Volume: 20 Source Issue: 7|
|Topic:||Event Code: 200 Management dynamics; 310 Science & research Computer Subject: Company business management|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
The development of lifelong learning is a continuing theme in healthcare. The DH (1999a, 1999b), NMC (2008a, 2008b) and HPC (2008) all identify continuing professional education as an essential part of professional development. Practitioners working at a higher level of practice within the perioperative environment have a professional obligation to maintain lifelong learning (DH 2006) along with an expectation to demonstrate expanding knowledge and practice (Reveley 2000). However until recently few academic awards were available to encourage APPs to undertake academic study and practitioners looking to complete a higher award often discover that finding one which supports a higher level of practice within the perioperative environment proves difficult for a number of reasons.
A higher level of practice
Firstly, the APP will have acquired a vast array of knowledge, skills and abilities, which will be multifaceted (Benner 1984, Glaze 1998); obtained through learning and experience from fields outside of the original area of training, for instance from medicine, law and management. A large amount of this would have been learned unintentionally (Benner 1984, Spouse 2001, Hand 2006) with some purposely learned, usually without professional academic recognition, as many previous routes that led to a higher level of practice within the perioperative environment were in-house (Lawton & Leslie 1998), unaccredited and inconsistent (Farrell 1999).
Secondly, of the professional accredited courses that have since become available for the APP (Thatcher 2003) many do not form a whole award and result in the attainment of a small cluster of credits leaving the practitioner unsure of which academic route to take in post-registration education. Thirdly, despite a call for practitioners working at a higher level to be educated at graduate level and above (NMC 2005, DH 2006), there has yet to be an explicit agreement as to the level of study that is required (Jones 2005). In order to provide consistency and public assurance, national curriculum frameworks have been developed and implemented for practitioners taking up prospective posts at a higher level of practice within the perioperative environment. However, for existing APPs the responsibility for deciding upon professional education remains predominantly with the practitioner (Girot 2001).
Fortunately, professional academic education in healthcare has gradually evolved. Formerly undertaken in educational institutes away from the clinical area advancements over recent years have acknowledged the previously unrecognised value of work-based learning (Quinn & Hughes 2007). Consequently professional education in healthcare has seen a growth of adult learning techniques and teaching styles (McCormack 2004) that have developed in order to encourage and support learning in the workplace, particularly through:
* Problem solving
* Learning contracts
More recently work-based learning awards have been developed by academic institutions in order to capitalise upon the benefits of work-based learning and to invest in post-registration education.
Work-based learning awards
Work-based learning (WBL) awards provide a relatively flexible academic route for practitioners working at a higher level of practice to undertake professional education by identifying learning opportunities within the workplace. Each award encompasses the six main characteristics of work-based learning, summarised in Table 1. These subsequently allow a programme to be developed by the student that incorporates negotiated units of learning along with the inclusion of a few core units that act as a framework to support the programme of study. Work-based learning awards can be undertaken part-time and can be established at an academic level to support a higher level of practice for the APP. A significant advantage of work-based learning is in the identification of individual learning needs that can also be structured around the requirements of the employer. This flexibility affords benefits to both the APP and the employer that many alternative awards may overlook.
Benefits of WBL
For the practitioner
The APP will bring a great amount of knowledge, skills and abilities to their role that will have been developed over many years, from many sources, with each set of experiences specific to each APP. This variance will result in diverse learning requirements for each practitioner that alternative awards may not recognise. Consequently work-based learning awards enable previous learning to be explored in order to identify learning requirements that relate to individual needs, role development and specialist practice area. A further benefit of a work-based learning award is in the retrospective academic recognition of previous learning by means of accreditation of prior certificated learning (APCL) and accreditation of prior experiential learning (APEL), thereby avoiding repetition of learning. The addition of both APCL and APEL to the award allows a reduction in time and resources for both the APP and the employer, allowing the remainder of the academic work to be spread out evenly.
For the employer
With organisations looking to increase cost effectiveness (Tame 2009) employers may be reluctant to fund courses and release staff regularly from duties when the learning acquired cannot be directly applied to practice (Hardwick & Jordan 2002). The numbers of modules and awards that relate directly to the perioperative environment and to APP roles have, in the past, been limited within post-registration education. Work-based learning awards now allow students to access and develop programmes of learning applicable to their own area of practice. Many allow access to disciplines outside of healthcare that are pertinent to the role of the APP, enabling the development of a coherent award that relates directly to the particular area of practice and role development.
Work-based learning also allows the integration of national learning frameworks and individual appraisals which strengthen the programme further (Hargreaves 1996). Whilst certain core components of the award will remain university-based the majority of the award will be completed in the workplace with support from the higher education facility. This gives the practitioner the opportunity to undertake professional education whilst remaining in the clinical setting--the most important arena for learning (DH 2006). In return employers must provide encouragement and support (Flanagan et al 2000) enabling successful academic attainment and subsequent application of learning to practice.
For the patient
The ultimate aim of post-registration education is to improve patient care, yet less than a third of practitioners undertaking traditional graduate awards feel that their newly acquired knowledge relates directly to an improvement in clinical practice (Hardwick & Jordan 2002). WBL allows an award to be developed that relates directly to the specialist practice of the APP enabling practice to be critically examined in areas that may not necessarily be explored in alternative awards. Best practice can then be identified and recommendations for a change in practice can be made in order to ensure a high standard of care for patients in the perioperative environment.
The benefits of work-based learning are not limited to the practitioner, employer and patient. Additional benefits of work-based learning are listed in Table 2.
An example of a WBL award
A surgical care practitioner (SCP), working within a general surgical team has already gained 30 level three credits from a SCP module and 45 credits from a level four non-medical prescribing course. She is currently undertaking a postoperative pain audit for patients undergoing day case surgery within the speciality and at her last individual performance review (IPR) it was identified that she would head a working group on developing and reviewing trustwide venous thromboembolism (VTE) guidelines. She has a personal interest in research, wanting to examine how the role of the SCP impacts upon patient care.
Table 3 gives an idea of how the individual and employer learning needs identified above are incorporated into a postgraduate WBL award by allowing the APP to access pre-accredited taught modules and self-designed WBL units. Please note that modules, credits and award content will vary depending upon the higher education institution; all WBL programme content will require ratification at the start of the award and the following example is intended as a guide only.
It takes time to train and educate the practitioner in advanced perioperative practice (Thatcher 2003). Learning occurs best when there is interest in the subject (Knowles 2005) and when relevance to the particular practice area is identified (Tanner 1999). Bespoke work-based learning awards allow the APP to combine individual learning needs with that of role requirements resulting in professional and academic development that critically examines specialist practice in order to benefit patient care within the perioperative environment.
Provenance and Peer review: Unsolicited contribution, Peer reviewed, Accepted for publication May 2010.
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Surgical Care Practitioner, General/Vascular Surgical Team, Manor Hospital, Walsall
Currently undertaking MSc in Professional Healthcare Studies (WBL) at the University of Wolverhampton.
No competing interests declared
Correspondence address: Manor Hospitals, Walsall, WS2 9PS. Email: email@example.com
Table 1 Characteristics of work-based learning 1) Partnership between the employing organisation and the academic institution 2) Identification of prior and current knowledge, skills and abilities in order to develop a programme of learning 3) Programme derived through needs of the workplace 4) Negotiation of learning programme approved by representatives from both organisation and academic institution 5) Learning units undertaken in the workplace 6) Assessment of learning undertaken by the academic institution Adapted from Boud and Solomon 2001) Table 2 * Motivation of learning for all * Encourages critical thinking * Balances professional and academic requirements * Bridges the gap between theory and practice * Potential future curriculum expansion for the academic institution (Adapted from Hargreaves 1996) Table 3 Rationale for Unit /module Level Credits inclusion Introductory 4 15 Mandatory module module--taught necessary to a) module a) Recognise prior learning of knowledge, skills and abilities. b) Identify and plan future learning that constitutes the remainder of the award by identifying modules and units relevant to learning needs. SCP module--APCL 3 30 Supports current clinical role Non-medical 4 45 Supports current prescribing--APCL advanced practice Research--taught module 4 60 Supports both employer and individual learning needs. Examining practice-- 4 15 a) Enables critical postoperative pain examination of the relief in patients evidence base undergoing day surrounding surgery WBL unit postoperative pain relief for patients undergoing day case surgery. b) Identifies best practice or enables recommendations for a change in practice. Current treatment 4 15 a) Enables current and prevention of guidelines and VTE in day case treatment in the surgery WBL unit prevention of VTE to be critically examined. b) Identifies best practice or enables recommendations for a change in practice to. TOTAL CREDITS 180
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