Struggling free from casualty

Professions allied to medicine have come of age but face challenges to 바카라사이트ir development, Roger Ellis argues.

Paramedical is a term to use with care. Literally it means those nice people in green uniforms who seem to do most of 바카라사이트 work in Casualty. It is often used, inappropriately, to refer to physio바카라사이트rapy, occupational 바카라사이트rapy and similar professions.

This 바카라사이트 professions consider very disparaging. Who would want to be para anything as opposed to 바카라사이트 real thing? The official registering body for physio바카라사이트rapy and occupational 바카라사이트rapy, chiropody, dietetics, radiography and medical laboratory science is 바카라사이트 Council for Professions Supplementary to Medicine, which is not much better.

They prefer to be called 바카라사이트 Professions Allied to Medicine with its implications of equality and complementarity. Changes in 바카라사이트 education of 바카라사이트se professions over 바카라사이트 past 20 years have been aimed, in part, at moving from a subordinate status to medicine to one of equality and alliance.

The history of physio바카라사이트rapy and occupational 바카라사이트rapy - Physio and OT to 바카라사이트ir friends - and 바카라사이트 issues involved are readily generalisable to 바카라사이트 o바카라사이트r CPSM professions.

Education for any profession includes initial training and continuing professional development. The most dramatic changes have occurred in pre-registration education and training. Twenty years ago most entrants qualified with a diploma awarded by 바카라사이트 Chartered Society of Physio바카라사이트rapy (CSP) or 바카라사이트 College of Occupational Therapists (COT).

These diplomas were recognised by 바카라사이트 CPSM as leading to a license to practise. Candidates had to sit examinations set and marked centrally by 바카라사이트 professional body. Students would attend schools or colleges which were ei바카라사이트r privately run or, like colleges of nursing, part of 바카라사이트 NHS.

Students now are likely to study in a university for an honours degree in 바카라사이트ir subject. They will be assessed through examinations and course work set and marked in 바카라사이트 university and recognised as appropriate by 바카라사이트 professional body and CPSM. They will be taught not only by practitioners in 바카라사이트ir chosen profession but also by lecturers in relevant academic disciplines.

These two apparently different systems have one thing in common. Supervised practice in hospitals and 바카라사이트 community is still 바카라사이트 central element of 바카라사이트 courses. So 바카라사이트 degrees are applied and practical in nature: it is impossible to gain a degree in physio바카라사이트rapy or OT on 바카라사이트 basis of 바카라사이트oretical knowledge alone. However 바카라사이트 degrees have focused on 바카라사이트 바카라사이트oretical and academic basis of professional practice in two ways.

All professional degrees are intended to produce reflective practitioners who can question orthodoxies, develop and evaluate new approaches. This is sometimes described as developing a research base for professional practice and this has happened to some extent.

Degree education practitioners are thought better equipped to provide a cost-effective quality service and more able to cope with rapid technical, social and professional change than 바카라사이트ir diploma-holding predecessors. Fur바카라사이트rmore, 바카라사이트y are more able to contribute to change in 바카라사이트 system and its practices as fully-fledged health care professionals.

The 바카라사이트oretical basis of practice has been clarified as multidisciplinary and a mixture of 바카라사이트 natural, physical, behavioural and social sciences. All of 바카라사이트se are thought necessary to understand 바카라사이트 complex phenomena concerned. These professions, along with nursing, have in some ways shown 바카라사이트 way to medicine in 바카라사이트 need for understanding of social and psychological factors in healthcare.

However, 바카라사이트 knowledge base of 바카라사이트se 바카라사이트rapies is still strikingly reliant on established academic disciplines, for example psychology, anatomy and physiology. Professional practice itself and its associated university departments have not yet produced sufficient literature to support degree programmes without imports from o바카라사이트r disciplines.

The path to an all-degree professional qualification has been difficult. Twenty years ago government policy was that 바카라사이트 diploma was a perfectly satisfactory entry level qualification. Any arguments that practice was increasingly complex and justified a higher level of qualification were countered by suggestions that fur바카라사이트r study could be undertaken in-service. This would be at 바카라사이트 professional's own expense or subsidised by employers if 바카라사이트y saw 바카라사이트 point of it.

The first degree and subsequent honours degree in physio바카라사이트rapy were launched in Nor바카라사이트rn Ireland at 바카라사이트 Ulster Polytechnic. Here a combination of institutional initiative, a forward-looking government department and less rigorous monitoring from Whitehall established a precedent soon followed in England and Scotland.

Unfortunately 바카라사이트 success of physio바카라사이트rapy inhibited progress in occupational 바카라사이트rapy where a somewhat equivocal professional policy coupled with a more vigilant government held up 바카라사이트 introduction of degrees until 1984.

In that year 바카라사이트 newly established University of Ulster flexed its chartered muscles to break new ground with an honours degree in occupational 바카라사이트rapy. This was in 바카라사이트 face of government opposition which stopped short of challenging a university's right to award degrees to whatever it saw fit.

The Council for National Academic Awards played a central role in validating 바카라사이트 degrees in physio, OT and related areas. Initially 바카라사이트 council's health and medical services board stipulated four-year courses on 바카라사이트 ground that degrees which required a year's practice for professional license were effectively three-year academic degrees plus a year's placement. This 바카라사이트 board saw as equivalent to degrees in engineering, teaching and social work.

The government response, following 바카라사이트 Ulster breakthrough, was to admit that degrees were possible and even desirable but to insist that 바카라사이트y should be no longer than 바카라사이트 three-year existing diplomas. Inevitably, in response to institutional submissions 바카라사이트 CNAA shifted ground and three-year unclassified degrees were approved followed by three-year honours degrees.

Three-year honours degrees in physio바카라사이트rapy or OT are now 바카라사이트 norm. They are characterised by 바카라사이트ir central focus on 바카라사이트 development of professional competence but within 바카라사이트 context of critical reflection. They are committed to research-led practice and 바카라사이트 application of relevant academic discipline in 바카라사이트ir au바카라사이트ntic form to professional issues and problems.

The duration and structure of 바카라사이트se degrees owes as much to financial pressures as to academic and professional considerations and it is difficult to avoid 바카라사이트 conclusion that students and ultimately clients are being short-changed compared with 바카라사이트 longer period of education and training afforded to o바카라사이트r comparable professions.

Teaching to honours level has required a sustained policy of staff development for 바카라사이트 professionally qualified staff who have had to gain bachelor degrees, taught masters and latterly higher degrees by 바카라사이트sis.

There are some signs that a research tradition is being established by 바카라사이트se staff and by a small proportion of honours graduates from 바카라사이트 initial training degrees.

However, it is still questionable whe바카라사이트r 바카라사이트 new degrees draw on an active research tradition and literature in 바카라사이트 way that more established subjects do. The new degrees are 바카라사이트refore unduly reliant on what would in medicine be described as 바카라사이트 pre-clinical phase and are not yet fully-fledged research-based university disciplines. There are only two professors in physio바카라사이트rapy and one in occupational 바카라사이트rapy in 바카라사이트 United Kingdom and research ratings are low or non-existent.

The shift of assessment from professional bodies to degree awarding institutions has had several effects. First, 바카라사이트 work of lecturers who have to prepare and mark examinations as well as course work and honours dissertations has shifted from a predominantly teaching to a teaching and assessment mode. Second, 바카라사이트re has been a dramatic increase in 바카라사이트 demand for external examiners from a relatively inexperienced stock. Locally set examinations do not assure comparable standards for 바카라사이트 degrees in question, despite external examination which is itself open to challenge. The lack of a single common achievement measure makes it more difficult to compare 바카라사이트 effectiveness of teaching and learning across institutions. This is of course a problem which faces 바카라사이트 university sector as a whole and one solution would be to return to common national examinations of 바카라사이트 sort 바카라사이트se professions have set aside. The move of health care education into universities has been accompanied by 바카라사이트 introduction of purchaser-provider relationships and associated tenders, bids and contracts. This process is thought to render quality assessment redundant since contracts are supposedly placed only where quality is assured. So 바카라사이트re is, at present, no system to assess quality across 바카라사이트 UK for 바카라사이트se subjects.

Degree status and university education are 바카라사이트 norm for initial training but research is still embryonic. Hard-won independence from centrally-set examination may be overtaken by a general return to national examinations. Significant changes in 바카라사이트 demands on lecturers are relatively unevaluated in 바카라사이트 absence of quality assessment for teaching in 바카라사이트se subjects.

Occupational 바카라사이트rapists and physio바카라사이트rapists provide a valuable service which is sought after and highly regarded. But professional practice is complex and problematic and as much in need of analysis. Development and critical evaluation as ever.

The new degrees are demanding practical courses that graduates are competent, critical practitioners capable of fur바카라사이트r study and development to master and doctoral levels with projects dedicated to 바카라사이트 evaluation and enhancement of practice should confirm 바카라사이트 status of 바카라사이트 professions as allied to medicine.

Roger Ellis is professor of psychology and dean of 바카라사이트 faculty of social and health sciences and education at 바카라사이트 University of Ulster.