FRAMING THE FUTURE

Proposal Paper from the Health Science and Technical Workforces

Working Group (Phase 2) June 2013

EXECUTIVE SUMMARY

There is no question that the health care environment is changing constantly, and often rapidly. It is important to ensure that New Zealand has a health science and technical workforce with the skills and capabilities we need now and one that is equipped to adapt to the changes that arise with new technologies and models of care.

To achieve this, we need an education framework that:

  • assists workforce planners to identify future local, regional and national workforce needs
  • gives employers confidence that approved education and training programmes provide science and technical professionals who are work-ready, and who will be able to adapt to new technologies and models of care
  • enables individuals to build on their skills and experience to meet the changing environment, or to support career change, as efficiently and effectively as possible.

The education framework proposed in this paper is designed to enable progression up through an occupational domain (a group of professions related by requisite information and skills) as well as movement across occupational domains, whilst recognising existing knowledge, skills and capabilities, and building on those or adding new competencies that may be required.

Just as the way health technology and models of care are changing, so is the way we learn and teach. Health science and technical education and training must incorporate e-learning and blended learning modes to ensure that programmes of study are more accessible across the country and engage learners in contemporary and meaningful ways.

Framing the Future outlines a proposed education framework and provides examples of how the proposed framework will enable coordination, flexibility and adaptability in the health science and technical workforce, across technician to scientist, and from certificate and undergraduate programmes to postgraduate degrees.

FRAMING THE FUTURE: AN INTRODUCTION

Requirements of an education framework for the Allied Health, Health Science and

Technical workforces

The provision of future patient-centred sustainable health care is dependent on a health workforce equipped with the skills and knowledge to provide effective and efficient services in a constantly changing environment. To achieve this, we need an education framework for the allied health, health science and technical sectors that is adaptable and which enables flexibility in current and future career choices.

The new education framework must also provide new entrants and future employees in the allied health, science and technical health workforces with the chance to choose an education entry point for their chosen occupation.

In addition, a new education framework must be flexible enough to adapt to emerging technologies, changing modalities and career shifts.

The Proposed Education Framework

The education framework for the allied health, health science and technical workforces proposed here supports those entering the workforce for the first time by providing them with a qualification which includes core skills and competencies, occupational domain skills and competencies, and discipline-specific skills and competencies.

Under the proposed education framework, having completed an initial qualification in health sciences and/or technology, a person can change their career direction by completing the required occupational domain skills and/or specialist competency requirements without necessarily having to undertake a whole new qualification. If a person does need to undertake a new qualification, then recognition of prior learning will apply to the new programme of study.

What this means for current and future health science and technology professionals is that, following their initial qualification, they will be able to upskill or change their career direction in more efficient, effective and authentic ways.

For employers, the framework has been designed to achieve a more flexible, fit-for-purpose, future-focused workforce, with reduced costs associated with education and training.

BACKGROUND

Health Workforce New Zealand (HWNZ) was established by the New Zealand Government with a mandate to lead and co-ordinate the planning and development of New Zealand’s health and disability workforce. HWNZ aims to ensure that we have a fit-for-purpose, high quality and motivated health workforce that keeps pace with clinical innovations and the growing needs and expectations of the New Zealand public.

The science and technical workforce is an integral part of our health workforce. There are over 20 health-related science and technical professions in New Zealand’s health sector, comprising around five percent of our health workforce. Many of the science and technical professions are small in number, often working in isolation from each other and from other health workforces.

In August 2011, HWNZ established a working group to report on what we want our science and technical workforce to look like in the future.

HWNZ established the Phase 2 Health Science and Technical Workforces Working Group (the Working Group) in October 2013 to develop at least one multi-disciplinary education framework and to populate it using several example health science and technical professions to show how the framework would work.

BUILDING THE EDUCATION FRAMEWORK

The Education and Workforce Contexts

The submissions analysis in Health Sciences and Technical Workforces Working Group

Report to Health Workforce New Zealand indicated that, across the health science and technical workforce, there is a need for better alignment between service providers and education/training providers and that a more coordinated approach to workforce planning was required. Toward this objective, the report determined that consideration should be given to developing an education, training and workforce framework to ensure New Zealand has a health science and technical workforce that is fit-for-purpose; able to adapt to changing technologies and models of care, and sustainable into the future.

Currently, there is a wide and varied range of education and training opportunities for those in, or entering, the allied health, health, health science and technology workforces. These learning opportunities are offered in universities, institutes of technology and polytechnics, and by private training providers; as well as in the workplace. Most of the education opportunities have been developed, and are offered, in isolation from one another with little collaboration, shared learning or credit transfer arrangements; and with limited coordination across the sector.

There are also shifting roles and occupations within the allied health, health science and technical sectors as new technologies and modalities are developed and implemented or as people make career changes. Sometimes these shifts are not communicated to, or adopted by, education and training providers in timely ways so education can lag behind developments in the workplace.

The size of many of the allied health, health science and technical workforce disciplines creates challenges for providing viable education and training programmes acceptable to the wider health sector.

Further, there is no single coordinating entity to ensure consistency in the assumptions used for workforce planning or to ensure that this planning is aligned with overall health sector planning.

Currently, the pathway from education to career choice limits the ability to be sufficiently responsive to changing health care needs. The situation is complex and problematic and raises a number of issues, most of which were highlighted in the June 2012 report.

Guiding Principles for the Education Framework

The Working Group identified the following guiding principles for development of the proposed education framework

Flexible and adaptable

  • The framework must be flexible and adaptable to meet the requirements of existing, changing and emerging occupational groups. It must enable the current and future workforce to expand their skills and capabilities without having to return to the beginning of a new qualification or programme; that is, avoid needing to repeat learning of core or occupational domain skills and knowledge.
  • The framework must also enable career progression and role change by providing a coherent learning pathway from certificate to postgraduate study; that is, from technician to scientist and all roles in between.

Meets the needs of workforce planners, learners and employers

  • The framework must meet the requirements and needs of all stakeholders.
  • Those involved in workforce planning at a national, regional or local level must have oversight and understanding of education and training programmes and have input into graduate numbers and workforce allocation.
  • Learners need to clearly understand the learning pathways they engage with to support career progression and role change.
  • Employers must have confidence that education and training programmes will produce graduates who are fit-for-purpose now and able to adapt to future needs.

21st century learning and teaching strategies are adopted

  • To ensure that education and training programmes are credible they should be delivered using advanced educational technologies complementary to those used by the health science and technology workforce in the workplace.
  • Educational delivery should include advanced e-learning and blended learning modes to advance learners’ technical expertise. Such delivery will ensure education and training is accessible to occupational groups spread thinly across the country and those in rural and urban areas.
  • All educational and training programmes must have significant components of supervised work-based learning.

Resource effectiveness

  • Learning pathways on the education framework should be efficient in terms of time and cost, for learners, employers, providers, and education funding bodies.
  • The framework must enable learners to achieve their career aspirations in the most time-efficient way and at the least cost to themselves and their employers.
  • It is also important for employers that employees can be retained as long as possible on the job whilst they learn; this can be enabled by using educational technologies and avoiding duplication of learning.
  • In this time of scarce resources, providers and education funding bodies are keen to spend wisely. This means the framework must promote coherent educational programmes; enable credit transfer opportunities; ensure programme viability in terms of student numbers and the preparedness of graduates for the workplace; and transparency so as to be able to predict the optimal size and shape of the workforce.

Accommodates local, regional and national workforce development

  • It is important that the framework is flexible enough to enable education providers and employers to address local and regional workforce development variations yet still be able to meet national requirements.

THE PROPOSED EDUCATION FRAMEWORK

Health science and technology professions/occupations have been grouped into occupational domains (see Figure 1). In this diagram, the overall learning needs of the health science and technical workforce have been considered, as the learning needs of each of the occupational domains identified.

There are core skills and knowledge that all those who work in the allied health, health science and technology workforces need to acquire (e.g. cultural competence, communication skills, ethics and professional practice, basic anatomy and physiology, and health and safety in the workplace).

There is also learning that is specific to an occupational domain (e.g. in the Dental occupational domain all learners would require anatomy of the head and neck). In addition specialist knowledge specific to a job/role is required (e.g. a Dental Therapist would require oral pathology).

Figure 1: Health Science and Technical Occupational Domains

The above represents an initial grouping of roles into occupational domains. Further work will need to be undertaken to determine the depth and breadth of learning needed and the type, size and shape of the roles in each occupational domain.

Learning pathways (qualifications and levels) have been mapped against a wide range of roles in the sector, from technician through to scientist. Figure 2 shows a “staircase” of qualifications signalling possible progression from certificate level through to postgraduate study.

At each qualification level, learners can choose to undertake core, occupational domain and specialist areas of learning that enable flexibility of educational pathway choice.

Figure 2: Framework for National Qualifications for the Health Science and Technology Workforce

THE EDUCATION FRAMEWORK IN ACTION: EDUCATION PROGRAMMES

In the following paragraphs, some existing health science and technology programmes are mapped on to the proposed education framework to demonstrate the applicability of the proposed framework to existing education provision for the allied health, health science and technical workforces.

Undergraduate degrees

An initial mapping of the learning pathways of several existing undergraduate degrees, albeit that these degrees are currently offered discretely from one another, demonstrates that there is:

(a) common content across all of these degrees (core learning),

(b) some content that is shared between two or more degrees within an occupational domain (occupation domain learning) and

(c) some content unique to each of the three disciplines (specialist learning).

The three degrees which were mapped were the Bachelor of Medical Imaging and the Bachelor of Radiation Therapy, which are both in the Imaging Therapy and Sonography occupational domain, and the Bachelor of Oral Health (Dental Therapist), which is in the Dental occupational domain.

Across all three of the degrees mapped by the Working Group, core learning included anatomy and physiology, ethics and professional practice, health in the context of Aotearoa New Zealand, and research methods.

Across the two degrees in Imaging Therapy and Sonography, occupational domain learning included radiographic technique and medical imaging science.

As well, of course, all three degrees had specialist learning unique to their individual discipline.

The education framework enables shared learning components to be recognised across all three occupational domains, providing both shared learning opportunities and recognition of prior learning if a person decides to change careers within or across occupational domains.

Postgraduate degrees

A Masters degree is the entry-level requirement for a number of health (including allied health), scientific and technical careers.

For example, a two-year clinical Masters degree in genetic counselling is the entry level requirement for employment in this profession. Currently, this Masters programme is offered by two Australian universities. Both universities have 200-level (second year undergraduate degree) genetics papers as a prerequisite to enter the Masters degree which means that New Zealand graduates seeking entry to the profession must either be able to and have included, 200-level genetics papers in their undergraduate degree, or must complete these papers separately.

Consultation with Australian programme directors indicates that they would be willing to recognise the proposed Bachelor of Health Science and Technology degree and consider applications from New Zealand graduates of this degree, if it includes 200-level genetics courses. The programme directors in Australia see the value of graduates of the Bachelor of Health Science and Technology having some knowledge of the context of health care in

New Zealand, along with other core knowledge such as ethics and research skills, prior to entering the Masters degree in genetic counselling.

In a second example, for those seeking a career in cardiac or respiratory physiology, graduates with an undergraduate degree are employed for two years as a trainee Clinical Physiologist to gain relevant experience. They are also required to complete a postgraduate qualification with specialist physiology content.

Using the proposed framework, candidates completing the Bachelor of Health Science and Technology within the occupational domain (physiology) and specialist learning (cardiac or respiratory physiology) would be considered work-ready and able to enter a career in cardiac and respiratory physiology directly. Further work-related experience would be required (though not at trainee level) and postgraduate study will be necessary for those wishing to advance further in their careers.

Similar application of the proposed framework would apply to careers in renal dialysis and neurophysiology.

THE EDUCATION FRAMEWORK IN ACTION: CAREER PATHWAYS

Currently, some professions have avenues that allow candidates who have a degree which is not specific to that profession to work and train to obtain recognition in that field of expertise. One example is Medical Laboratory Science where people with a Bachelor of Science degree can work and train to obtain a Graduate Diploma Science in Medical Laboratory Science. They can then be assessed by their peers and, if approved, can apply for registration as a Medical Laboratory Scientist. This can either be completed extramurally or by attendance at courses held at a university.

Under the proposed education framework, a health science professional who wishes to change their career within the health science and technology sector and enter another health profession will be able to do so more easily than they would under the current structure.

In illustration, a graduate with a Bachelor of Health Science and Technology (Medical Laboratory Science) degree who wishes to become a Medical Radiation Therapist will be able to do so in a shorter timeframe with reduced cost implications by completing the occupational domain and specialist learning of the Bachelor of Health Science and Technology (Medical Imaging).

The education framework will also enable career progression for those who have not completed any formal qualifications. For example Medical Laboratory Technicians, who may have learned on the job and been deemed competent by their peers, would be able to complete courses to enable them to gain a higher qualification and progress in that profession. This is seen as an important part of any future workforce development.

THE EDUCATION FRAMEWORK IN ACTION: SHIFTING CAREERS

The proposed education framework will enable health science and technical professionals to move either within or across occupational domains, as demonstrated in the example of dental occupations set out below.