ACQ Vol 13 No1 2011

Education, training, and continuing professional development For the many clinical areas not addressed in entry-level training, SPs often extend and maintain their competency to perform various roles through “on-the-job” training, or participation in continuing professional development. The content and methods applied in “on-the-job” training can be varied. Some employers set specific standards and provide robust training to facilitate the acquisition of locally defined competencies. However, this is at each employer’s own discretion. Without defined standards of practice and guidelines for training, the sustainability of these roles is threatened (Kelly, Piper & Nightingale, 2008), and the potential for public harm is increased. Even if more formalised postgraduate training programs existed in the areas of practice that are beyond entry-level practice, there is currently little incentive, or expectation for SPs to complete such training. Without practice or training standards to regulate professional practice, workplaces will continue to claim that they can provide the training “in- house” that is comparable with formalised training programs. Continuing professional development (CPD) provides another mechanism for health professionals to maintain and extend their competency. The existing SPA model of CPD, the Professional Self Regulation program (SPA, 2009d), requires participants to provide evidence that they have participated in a specific number of professional development hours annually, within a 3-year period. However, given the voluntary nature of the program, and the fact that it is only available to members of SPA, it is unable to assure the public of the currency of practice or competency of SPs working across the entire health care workforce, and therefore, does not satisfactorily perform a regulatory function. A career and professional development framework In the absence of statutory registration across all jurisdictions, perhaps the speech pathology profession in Australia needs to explore the development and implementation of a career and professional development framework as a strategy to optimise protection of the public. Such a framework could provide a structure for recognising levels of professional practice by defining the competencies across the continuum of professional practice, and providing a pathway for education and training to enable the relevant competencies to be attained, and maintained. In preparing this paper, a limited review of the relevant literature was conducted to examine the approaches adopted by other health professions in Australia and internationally for recognising different levels of professional practice. A large proportion of the articles reviewed were written by researchers and clinicians from the nursing and radiography professions, as these frequently featured in recent journal publications and select database searches conducted. Many health professions already have well defined and established levels of professional practice that enable the career framework to be easily understood and identified from within and outside of the profession. These levels of practice have commensurate levels of training and educational requirements that must be satisfied in order for individuals to be recognised as operating at a specified level of practice, from entry-level to advanced and specialised levels of practice.

Recognising levels of professional practice Terms commonly used in the literature to describe levels of professional practice including entry-level, advanced scope of practice, extended scope of practice, expanded scope of practice, consultant and expert practice, and specialisation, all of which are often used with varied interpretations of what defines these roles (Casteldine, 1998; Department of Human Services, 2005; Frost, 1998; Fulbrook, 1998; Hardy & Snaith, 2006; Hardy, Legg, Smith, Ween, Williams & Motto, 2008; Manley, 1997; Nightingale, 2008; Price & Edwards, 2008; Snaith & Hardy, 2007). A number of articles reviewed for this paper focused on making the distinction between advanced practice and specialisation. Some perceive advanced practice to be unidimensional, relating to the provision of direct clinical services, where specialisation is multidimensional and implies a level of practice that involves broader goals of improving patient care, through direct and indirect clinical activities (Manley, 1997; Rolfe, 1998). Specialisation can also be associated with advanced or higher levels of knowledge and practice specific to a particular disease, anatomical region or modality (Nightingale & Hogg, 2003). Models of learning theory have also proposed a number of terms to describe levels of professional practice and skill acquisition (Dreyfus & Dreyfus, 1996). The National Registration and Accreditation Scheme, operationalised through the Health Practitioner Regulation National Law (Australian Health Practitioner Regulation Agency, 2010a) enacted in participating jurisdictions and monitored by the Australian Health Practitioner Regulation Agency, acknowledges that various levels of professional practice exist within health professions. This is demonstrated through recognition of registration categories, such as general practice versus specialist registration (Australian Health Practitioner Regulation Agency, 2010b). Specialist registration, and/or specific areas of practice endorsement are recognised through a number of professional boards including the Dental Board of Australia, Medical Board of Australia, Nursing and Midwifery Board of Australia, Podiatry Board of Australia and Psychology Board of Australia. Clinical psychology, neuropsychology, and forensic psychology are areas of practice endorsement for psychology. Orthodontics, periodontics, oral and maxillofacial surgery are examples of specialty fields in dentistry (Australian Health Practitioner Regulation Agency, 2010c) Aggregating the themes discussed in the literature regarding levels of practice and career and professional development, the following elements appear to be important for identifying and discriminating between different levels of professional practice: • levels of education (Hardy et al, 2008; Nightingale, 2008; Price & Edwards, 2008) • knowledge and skills (Casteldine, 1998; Fulbrook, 1998); • scope of practice and clinical experience (Casteldine, 1998, Frost, 1998; Fulbrook, 1998; Goodman, 1998; Nightingale & Hogg, 2003); • involvement in research (Casteldine, 1998; Hardy et al, 2008; Snaith & Hardy, 2007); • role in education, supervision and mentoring (Hardy et al, 2008); • leadership qualities and activities (Casteldine, 1998; Frost, 1998; Fulbrook, 1998; Snaith & Hardy, 2007); Defining competencies across the continuum of professional practice

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ACQ Volume 13, Number 1 2011

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