The influence of a postgraduate clinical master's qualification in manual therapy on the careers of physiotherapists in the United Kingdom

Abstract

Over the last decade there has been potential for manual therapists to extend their roles and develop their careers. In order to explore the career pathways of a group of postgraduate manual therapists and to identify the influence of Master's education on those careers, a postal questionnaire was sent to all graduates from a clinically based programme (response rate 62.3%, $n=48$, with representation from each year over a 10-year period).

All the respondents were still working in physiotherapy and the majority had a clinical element to their role (83%). The new career framework, which seeks to enable therapists to progress their careers and retain a clinical work load is demonstrated within this sample, with 6.2% achieving Consultant Therapist roles, 14.4% in Extended Scope Practitioner posts and 16.6% working as Clinical Specialists.

Positive contributions from Master's education were the status of the qualification, improved clinical skills and increased confidence. Negative factors were less clinical ‘hands-on’ within their roles, lack of time and an increase in management responsibilities. Findings suggest that Master's education has enabled the participants to take on the new roles that have resulted from a raft of political imperatives but further work could explore the issues around positive and negative drivers.

Introduction

In the United Kingdom (UK) the potential role that a manual therapist may undertake has expanded dramatically over the past decade. This has arisen primarily as a result of a number of politically driven imperatives. The NHS Plan (2000) has acknowledged the role of Allied Health Professionals (AHPs) and has given a commitment to ‘expanding the roles which allied health professions play in health and social care, ensuring they can use their skills flexibly and creatively to the benefit of patients’ (DoH, 2000). Within the NHS there was a subsequent commitment to developing AHP consultant posts, with a target of 250 AHP consultants in England and Wales by 2004. The Advanced Letter (DoH, 2001), with arrangements for consultant posts, stated that consultants would be experts in their clinical field and irrespective of the particular field or profession would have four core functions:

• Expert practice.

• Professional leadership and consultancy.

• Education, training and development.

• Practice and service development, research and evaluation.

The Advanced Letter (DoH, 2001) also indicated that there would be individuals who had already taken on extended roles or who were delivering specialist clinical services that operate below the consultant level. Extended Scope Practitioners (ESPs) are defined as those who have ‘extended physiotherapy practice to encompass tasks that may previously have been undertaken by the medical profession’ (CSP, 2005a). The first UK physiotherapy ESP role recorded in the literature was in 1989 and their role was as ‘a first in-line filter system for those patients who may not require surgical intervention’ (Byles and Ling, 1989). Since then, the number of ESP appointments has grown, with the extended scope interest group reporting a membership of 400 (CSP, 2005a).

Clinical specialists ‘work within a particular field and their practice falls within the scope of practice of physiotherapy’ (CSP, 2001) with the roles having core elements of:

• Clinical expertise.

• Clinical teaching.

• Evaluation.

• Practice and/or service development.

The acquisition of a Master's degree is considered essential to attain these new therapy posts. Craik and McKay (2003) and the Chartered Society of Physiotherapy (CSP, 2002) indicate that to engage in the educational and professional development supporting function, Consultant Therapist post-holders will be working to a Master's level or beyond.

During the last decade, within the UK there has been a huge growth in taught postgraduate study, with a 106% increase in Subjects Allied to Medicine between 1996/1997 and 2001/2002 (Sastry, 2004). In 1992, at Coventry University, the MSc Manipulative Therapy programme was developed. It was the first of its kind in the UK and was developed in partnership with the clinical interest group, the Manipulative Association of Chartered Physiotherapists (MACP). In the UK, the MACP is the specialist manipulative therapy group recognised by the International Federation of Orthopaedic Manual Therapists (IFOMT). The IFOMT (2005) vision is ‘promotion of excellence and unity in clinical and academic standards for manual/musculoskeletal physiotherapists’. The MACP has a history of providing formal education and continuing professional development for manual therapists, and recognised the need to offer Master's level study in a taught MSc. The MACP accredited the Coventry University programme, and students become eligible for MACP membership once they successfully complete the postgraduate diploma stage of the course. In the UK, there are now 13 Master's programmes, accredited by the MACP that are based around manipulative therapy, musculoskeletal physiotherapy or neuromusculoskeletal physiotherapy (MACP, 2005).

The Quality Assurance Agency (QAA) for Higher Education (2001) states that post-graduate students studying at Master's level ‘will have shown originality in the application of knowledge, and they will understand how the boundaries of knowledge are advanced by research. They will be able to deal with complex issues both systematically and creatively, and they will show originality in tackling and solving problems’. For AHPs Master's level education offers opportunities to explore practice and develop knowledge and clinical reasoning skills (Alsop and Lloyd, 2002) and according to the QAA (2001) Master's level students will have the ‘qualities needed for employment in circumstances requiring sound judgement, personal responsibility and initiative, in complex and unpredictable professional environments’.

The graduates from the Coventry University MSc Manipulative Therapy programme should, therefore, be ideally placed to fulfil the new roles within the NHS as they have attained a recognised Master's level qualification from a programme that aims to ‘enable the development of senior practitioners into specialist roles within clinical practice, research and educational environments’ (Coventry University, 2001).

The aim of this study was to explore the career pathways of these graduates and the influence of Master's education on their careers. With new ways of working within the NHS and opportunities for consultant, extended and specialist roles, the study set out to establish where these graduates are now working and in what roles, and how Master's education had influenced these positions.