Guidance for Work Based Training for Assistant Practitioners

Guidance for Work Based Training of Assistant Practitioners

The Assistant Practitioner role is defined as:

‘A worker who competently delivers health and social care to and for people. They have a required level of knowledge and skill beyond that of the traditional health care assistant or support worker. The Assistant Practitioner would be able to deliver elements of health and social care and undertake clinical work in domains that have previously only been within the remit of registered professionals. The Assistant Practitioner may transcend professional boundaries. They are accountable to themselves, their employer, and, more importantly, the people they serve.’ (Skills for Health 2009).

Skills for Health1 developed core standards for Assistant Practitioners as a means of helping employers standardise the role. The directorate is using these standards as a means of ensuring consistency in Assistant Practitioner role, as it becomes more widespread. The Calderdale Framework2,3 has been used to identify where the Assistant Practitioner role is needed along with the scope of the role.

The Calderdale Framework training stage (stage 6) comprises 3 parts leading to the development of competent practice. This training methodology has been accredited by Yorkshire and the Humber SHA Clinical Skills Network4 as best practice. The CF training is work-based, and helps ensure Assistant practitioners are able to undertake their clinical roles. Assistant Practitioners also require additional knowledge based training, which for our staff is delivered at University of Bradford (Certificate of Higher Education in professional Support). This course enables the Assistant Practitioners to gain appropriate knowledge to relate into their particular clinical area, as well as supporting the development of professionalism5 which is key to all roles within health and social care.

Calderdale Framework Training 3 Part Training Methodology

The CF training method comprises 3 elements: taught, modelled (simulated) and competent in practice. These elements must be undertaken for each competence, and for the Modelled and Competent step it is necessary to develop and show competence in variations of the overall competency (for example AP01 Assessment of Indoor walking - it would be an expectation the AP demonstrated competence in assessing for all walking aids, with the range of patients seen in their service).

Taught Element

The taught element is provides trainees with the background information and knowledge required to undertake the competency. In the case of Assistant practitioners there is an expectation that they will undertake additional background reading to widen and deepen their knowledge, in conjunction with learning from the Certificate in Professional Studies. The Assistant Practitioners learn elements of assessment and start to explore clinical reasoning considerations and indications for treatment along with indications for when to stop and seek advice. This session builds on the knowledge and experience of each trainee, and utilises case studies. There is no formal testing at the end of this session, however it forms the basis on which to develop competence in a simulated setting (the Modelled element). Signing of the Taught element will only be done by the occupationally competent trainer when: i) the whole session has been attended ii) the trainee has actively taken part and demonstrated their understanding of the competency. iii) The trainee has shown an understanding of the responsibility & accountability of their role.

The modelled element allows the trainee to assimilate knowledge and apply it in their specific setting and develop their clinical reasoning and clinical skills in a safe, supported way6. The Mentor and/or clinical supervisor has an important role in supporting the development of the trainee at this stage. This is done in a graduated way: i) Using case studies (devised by the mentor or clinical supervisor) to explore and develop clinical reasoning. ii) Through observation of a skilled practitioner undertaking the task followed by discussion and explanation of the reasoning and actions as a result. iii) Moving this to joint assessment with a skilled practitioner and the trainee sharing their clinical reasoning

It is important that the modelled phase encompasses the range of solutions in each competency as well as the range of service users likely to be seen by the Assistant Practitioner. The clinical reasoning records should be used as the basis for teaching and learning and trainees should be encouraged to keep copies in their CPD file with reflective accounts. The length of the modelled element will vary depending on the clinical service, and the trainees experience and attitude. It is crucial that the mentor and/or clinical supervisor ensure they are available for sessions with their trainee, and that sessions are booked regularly in order to maximise learning opportunities.

The mentor has an important role in supporting the AP’s clinical skill development and application of theoretical knowledge in practice. They may be involved in the assessment of clinical competence, including the application of knowledge. They should link with the university so they understand the curriculum and modules being studied & should offer constructive comment on AP assignments before submission. Competent Element

This element is a natural progression from the previous stage. At this stage the trainee would move to undertaking clinical work allocated by a registered practitioner. The individual case will have been discussed in detail, and the trainee would be expected to utilise the clinical reasoning record(s) and feed back their actions following their intervention. This would progress to discussion of their clinical reasoning and application of knowledge at supervision and/or mentoring sessions. Once both the trainee AP feels confident and competent to undertake the task/function and their mentor/supervisor agrees they are ready they would be observed and assessed against the competency criteria. If all criteria are met the Assistant Practitioner would be signed off as competent for that task/function. It is important that the competency element of training encompasses the range of service users likely to be seen as well as the range of solutions covered in the competency i.e. the trainee AP may need to demonstrate competence on a range of patients and with the required range of solutions. Assessment of competence must be carried out by an occupationally competent practitioner – therefore this will not always be the mentor. It is important that the mentor liaises with relevant assessors to discuss progress/issues. It is expected that the AP caseload will reflect their developing level of competence. On going clinical supervision, reflective practice and maintenance of a CPD portfolio together ensure competence is retained and further developed.

References

1. Core Standards for Assistant Practitioners. 2009 Skills for Health, Bristol 2. Smith R, Duffy J ‘Developing a Competent and flexible workforce using The Calderdale Framework’ 2010 International Journal of Therapy and Rehabilitation, 17(5): 254 - 262

© Rachael Smith & Jayne Duffy . All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. 3. Developing The Assistant Practitioner Role (case study for NHS Employers) http://www.nhsemployers.org/SharedLearning/Pages/DevelopmentofAssistantPractitionerRol eusingtheCalderdaleFramework.aspx [accessed 2.11.2012]

4. Yorkshire and The Humber Clinical Skills Executive http://www.yorksandhumber.nhs.uk/what_we_do/workforce_education_and_training/ education_and_training/clinical_skills/quality_assured_clinical_skills_and_simulation _training_providers/ [accessed 2.11.2012]

5. Professionalism in Healthcare Professions: a Research Report. 2011 HPC http://www.hpc- uk.org/assets/documents/10003771Professionalisminhealthcareprofessionals.pdf

6. R Aggarwath, OT Mytton et al ‘Training and simulation for patient safety’ Qual Saf Health Care 2010;19(Suppl 2):i34ei43. http://qualitysafety.bmj.com/content/19/Suppl_2/i34.short?rss=1&ssource=mfr [accessed 13.11.12]