ACQ Vol 13 No1 2011

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ACQ Volume 13, Number 1 2011 33
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)
Defining competencies across the
continuum of professional practice
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);
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.