Education, not training

Education director and nurse prescriber Angela Brennan looks at the different purposes and outcomes of the interchangeable terms

In the context of changes in the statutory and professional framework and the introduction of the licensing system for practitioners, I would like to explore why I think the emphasis on education and away from a one-day training course is vital for the development of aesthetics as a recognised branch of medical practice. I will also explore why education should be at Level 7 and why only registered healthcare practitioners should be following this path.

The terms “training” and “education” are often used interchangeably, but they represent distinct processes with different purposes and outcomes.

TRAINING

Training is typically a practical, skill-oriented process designed to equip individuals with specific competencies or abilities related to their job or a particular task. It focuses on preparing individuals to perform specific functions effectively.

Examples of training in aesthetics can be seen in the one or two-day training courses for botulinum toxin and/or dermal filler treatments. This training is often focused on specifically where and how much to inject, sometimes even with templates for injecting given or advised. The problem arises when practitioners who have undergone this training meet the unexpected. It is simply not possible to cover all the underpinning knowledge required for safe aesthetic practice in these types of events. The focus is on the technical skill of injecting with little if anything on the consultation process, the legal and ethical framework, the differential diagnosis of presenting complications or any kind of deep understanding of the product the students are taught to inject. Neither is there any kind of objective assessment. There is not necessarily any kind of blame attached to either training providers or students who undertake such programmes. This kind of training has been allowed to happen and flourish in an unregulated medical sector.

Product manufacturers also provide training to aesthetic practitioners in individual products — a particular brand of botulinum toxin or dermal filler. Sometimes this is free, sometimes at the cost of purchasing specific products. The purpose of this training, which is usually very short, is to get practitioners used to working with a dermal filler that may have different product characteristics than others they have used. Booklets may be provided describing one or another type of rheology, molecular weight or cross-linking processes used. However, without a deep understanding of the theory of these aspects of product characteristics, it is unlikely that proper comparison and choice of product can be made for optimum and safe clinical outcomes.

As someone with a background in specialist practice in the NHS and nearly 20 years of experience in nurse education, it seems impossible to me that we would ever allow even an experienced nurse or doctor, to practice in an area of specialism with such little preparation.

It is true that, when many of the more experienced aesthetic practitioners started in aesthetics there was very little choice in the type of preparation for practice. It is possible, and indeed likely, that many experienced nurses or doctors brought with them all the skills and knowledge acquired through their previous education and practice and applied these to aesthetic practice. However, specialism brings with it the need for not only new learning but also focus on directing their existing knowledge and skills to a new area of practice.

EDUCATION

At its core, education involves the acquisition of knowledge, it is that broader, knowledge-focused process aimed at providing individuals with a well-rounded understanding of various subjects, concepts, and ideas. It emphasises intellectual and personal development.

The skills acquisition involved in education focuses not only on practical, and technical skills but also cognitive skills such as problem-solving, critical thinking and communication.

Education also contributes to personal growth and development in that It fosters self-awareness, and the formation of values and ethics, it fuels innovation and progress within a field of study, it encourages creativity, and the development of new ideas.

Education equips a practitioner with the knowledge to synthesise all the myriad factors that need to be considered when performing an aesthetic treatment.

Assessment, diagnosis, and patient-centred individual treatment plans are areas in which healthcare professionals have a wealth of experience. Their medical knowledge in anatomy, physiology, and pharmacology gained through education and practice is there to be built upon, expanded, and focussed on aesthetic treatments. This is why only registered healthcare professionals should be undertaking this journey into deepening knowledge and skills and, through critical thinking, reflective practice and research expanding the boundaries of aesthetic practice.

However, that expansion and focus cannot be achieved superficially in a short period.

LEVEL 7

Level 7, in the academic world, is classed as postgraduate. Postgraduate studies move us away from understanding and application of knowledge to analysis and synthesis of a whole range of knowledge, concepts, and ideas. We are looking for how the details make up the whole picture and what effects change in one area can have on other non-related areas. We are looking at ideas and concepts through a critical lens, learning and building further knowledge from what we already know.

Level 7 education is designed to provide in-depth knowledge and expertise. Note that word – expertise.

Experts possess a deep and extensive knowledge base in their chosen field including both theoretical understanding and practical insights. They excel in solving complex problems related to their field of practice. They can identify issues, analyse them systematically, and propose effective solutions. These abilities are often based on a deep understanding of the underlying principles in their field, and they can make informed and strategic decisions, even in situations with uncertainty or limited information, because they draw upon their knowledge and experience.

Level 7 programmes are structured to challenge students intellectually and academically. They explore complex theories, methodologies, and concepts and can therefore apply these to many different situations within their area of specialism.

Within postgraduate-level studies, there is a contribution to the academic discourse. Postgraduate education contributes to the advancement of academic knowledge and the development of new theories, practices, and technologies. It plays a vital role in the evolution of the field of practice.

It is important to note that expertise is not a static state but a dynamic one that evolves. Level 7 education provides students with the abilities and desire to continue learning and continually improve their knowledge and practice.

It is essential as well, that Level 7 education programmes adhere to standards that are rigorously applied and monitored. There must be certainty around the value of a Level 7 education programme in aesthetics, both for the practitioner and the public.

Following extensive consultation and many years of lobbying, we as registered healthcare practitioners practising or looking to practice in aesthetics are hopefully soon to be in a position where we have access to appropriate postgraduate education where the quality has been standardised and monitored. It is not enough anymore to decide to offer a Level 7 programme, and then, the next week, it is being offered. There needs to be a careful mapping of learning outcomes against agreed practice and knowledge standards. There needs to be a recognised quality assurance process for all aspects of teaching and assessing which can be gained through awarding bodies. The Joint Council for Cosmetic Practitioners (JCCP) currently recognises only two awarding bodies to meet these exacting criteria, these are Ofqual Regulated Awarding Organisation (OTHM) and Vocational Training Charitable Trust (VTCT). Potential students on Level 7 programmes need to be aware of the knowledge and practice standards that a programme must match. These will continuously develop over time as happens with pre-registration programmes in nursing and medicine.

It is to be hoped that in the future, the Nursing and Midwifery Council (NMC) will recognise aesthetic nursing as a specialist practice area. The developments in postgraduate education for registered nurses can only help towards that aim.

ANGELA BRENNAN

Angela Brennan is an aesthetic nurse prescriber and education director at SATA Level 7 Training Academy in Liverpool. She has been a nurse for 39 years, an aesthetic nurse for 12 years and spent 18 years in Nurse Education at Liverpool John Moores University, with the last five as director of the School of Health.