How much do you value your training officer?

Passing knowledge from one generation to the next is fine for legends and fables, but not for laboratory training says Georgina Lavender. Here she gives us an overview of how biomedical training has changed – and what to expect in the future

HISTORICALLY, practical laboratory training has been in-house and largely unregulated. Formal education of biomedical scientists took place in Higher Education establishments and Universities, and there was no mechanism for the two to necessarily meet as a cohesive unit.

The Council for Professions Supplementary to Medicine (CPSM) “logbook and viva” route to registration was an attempt to standardise the criteria to be recognised as a trained professional, but only 25 years ago, to be state registered with the CPSM only required evidence of a formal qualification and a letter of recommendation from your employer. When the responsibility for the registration of healthcare professionals passed into the hands of the Health Professions Council (HPC), laboratory medicine was forced to sit up and take notice.

Traditionally, laboratory training had often been left to the experienced members of staff, who were instructed to show more junior staff what to do. A technique often known as "Sitting with Nelly" - the assumption being that the euphemistic Nelly was the oldest, wisest person around and therefore the best person to pass on skills to the next generation. This roughly translates to the "see one, do one, teach one" routine, and so skills in biomedical science passed through the ranks. Then along came HPC and Clinical Pathology Accreditation (CPA), with very different ideas. They required proof of training, they required the maintenance of specific standards, they spoke in the language of education rather than science. And, they gave the laboratories no choice but to pay attention. Laboratory training had to change.

The CPSM required a trainee biomedical scientist to complete a “log book”, a series of subject related tick boxes, and then pass a viva - an oral examination with one internal assessor - usually a senior member of the department that the trainee was employed in, and an external assessor, a professional peer appointed by the CPSM. This method of assessment, while better than nothing, lacked standardisation and consistency, as was the training offered to complete the log book. The HPC introduced evidence based assessment in the form of the Registration Portfolio, a series of structured professional standards, that a potential applicant to the HPC professional register would be required to meet and have hard evidence to support the fact that those standards had been met. With every trainee BMS having the same portfolio, and being required to provide evidence for identical standards, there was, at last, a level playing field for registration.

There were other major changes afoot within the National Health Service. The restructuring of the staff and pay scales, Agenda for Change, was accompanied by the introduction of the principles of the skills escalator, a mechanism to allow the progression of staff from one pay band to another, removing the traditional ceilings that had previously accompanied certain posts. Also within Agenda for Change, each individual post was given the task of developing the post holder by introducing the principles of “gateways” into each pay band, thus ensuring every NHS employee continues to improve within a post, introducing the concept of life-long professional learning within the mechanism of the Knowledge and Skills Framework (KSF). KSF was introduced to give each individual NHS employee a series of educational targets, be they practical or theoretical, to meet as they progressed through a particular pay band.

So, what of the training officer in all of this? Suddenly, the role changed

Knowledge and Skills Framework gives each individual NHS employee a series of educational targets

overnight. The training officer was required to teach a trainee member of staff the knowledge required to meet the particular HPC Standards, they were required to assess and provide evidence that a trainee had met both theoretical and practical standards, they were required to produced assignments that could provide evidence that all staff were competent in a given number of procedures, they were asked to consider KSF gateways were being met, and to be able to provide evidence as well, for  both up and down the pay scales. What on earth had happened to “Sitting with Nelly"?

Traditionally, training officers had been required to be a good biomedical scientist, with an aptitude for passing on their own acquired knowledge to others. Suddenly they needed to be trained teachers as well. Some training officers embraced the changes, while others ran scared. When the Institute of Biomedical Science (IBMS) launched the registration portfolio as a means of assessment on behalf of the HPC, for many training officers, this was the first time in their professional lives that they had come up against an educational document as opposed to a scientific document. Training officers who were already involved in more formal education were far better equipped to deal with the challenges of evidence collection to meet the assessment of learning outcomes.

Clearly times have changed, and a training officer needs to be able to wear two hats. They need to be both a competent biomedical scientist in a particular speciality, and be a formal teacher or trainer. In other words, they must be able to wear both a scientific hat and an educational hat themselves. Training officers now have to provide assignments to meet specific learning outcomes, and arrange assessment and evaluation of the processes involved. The buzzwords are to be able to prove competence for a particular task, but often, the very person who has the responsibility for assessment of the rest of the department is the person who has not been proven competent to take charge of the task in the first place. Forward thinking managers already realise that good training officers need the knowledge base from an educational qualification in teaching and training in order for them to properly perform their role. Also, the very person providing evidence for the competence of scientific staff in the laboratory, needs to be able to provide evidence for their own competence in the process of setting and assessing learning outcomes. The skill of being able to teach and assess others is akin to peeling an onion layer by layer. Remove the top layer and what appears to be underneath is no different to the original object, but start to peel back that layer too and there may be a surprise lurking that requires a change of direction and strategy. The layer must first be removed in order to find out. Teaching and training others follows the same pattern: the same strategies are suitable for some 95% of learners, but just occasionally there is a surprise and the old, familiar tactics fail to have any impact. The skilled training officer is able to recognise this immediately and has a barrage of educational weapons at his or her disposal in order to take action to meet the same outcome by an alternative means. Unfortunately the development of these skills are not necessarily inherited, and need to be both learned and practiced.

The other resource rarely available to a training officer is time. Training officers are usually senior members of staff with other responsibilities, and the amount of time that is needed to develop training and education, plan and execute assessment is usually underestimated by those on the periphery of the processes. Training officers now play a large role in the department in connection with maintaining training status, CPA, accreditation with other bodies, co-ordination of Continuing Personal Development (CPD) for all staff, and many have inherited this position, alongside a primary service provision role. When asked about the problems associated with being a training officer, the majority will say the biggest hurdle is that of finding adequate time to allocate to the tasks required of the post. When those members of staff receiving training are asked about their particular problems, the coin flips over, as the biggest hurdle to their own training is being able to find the time in the training officer’s day where they can jointly address the training needs of the trainee.

The current pressures are such that service provision and adherence to deadlines are now uppermost in the priorities of laboratory staff of all levels. Training and personal development of staff are frequently shelved at the expense of that service provision. The two fundamental resources for a training officer are having the time during the working day to give attention to training issues that the role demands, and to have a formal qualification that demonstrates that the training officer has the very knowledge and skills required to be able to train, assess and prove competence in others. The importance being placed on education and accreditation is ever increasing. It is time that similar importance be placed on the staff who hang the very principles of knowledge and assessment together, and that they are adequately resourced to do so.