Aimee Pinnington, Lecturer in Biomedical Science at Keele University, outlines the results of her study on the education, training and development pathways shaping the workforce to improve patient care.
The primary aim of this doctoral study is to identify ways in which access to the biomedical scientist profession and advanced roles can be improved, whilst assessing the impact biomedical scientists have on patient clinical outcomes, and consequently summarise the need for greater resources to support this area.
The first phase of this study aimed to elucidate the perceived barriers around the education, training, and development pathways that biomedical scientists feel need to be addressed to better support career progression and thereby improve patient care.
After securing ethical approval, five focus groups were formed in January–February 2023 with registered biomedical scientists (n=28) from across the UK at varying levels of practice. Focus groups met remotely via Microsoft Teams, and each session was recorded. Transcripts were then analysed using open coding and thematic analysis.
Six key themes were identified through thematic analysis, as well as several further subthemes.
“There was a strong feeling in the focus groups that accreditation of degrees is important”
Accreditation of degrees is seen as being important but requires further refining to maximise impact
There was a strong feeling in the focus groups that accreditation of degrees is important to ensure there is a suitable baseline that students have covered to provide employers, fellow healthcare professionals and the public with confidence in a degree. The example of Lighthouse labs for COVID-19 testing and the associated issues of taking on non-accredited/non-registered staff was used as an example to support this. However, some attendees expressed concerns about accreditation and whether the processes in place are fit for the current workforce/issues within the profession. One attendee stated:
“The accreditation and registration process, I think the IBMS has fallen into a trap… and that, under the pretence of protecting the public, and maybe some elements of workforce planning, really, it’s about job protectionism and what I would call a medieval livery company.” This highlights the need for clarity and communication of processes to alleviate the concerns of some registrants. Other comments were made in support of this statement, including queries around whether accreditation/training status for laboratories in its current form is required given that UKAS inspect training as part of ISO 15189. Several suggestions were made regarding limiting the intake onto accredited degrees, with suggestions that this could be overseen by the IBMS, to ensure quality on the courses and suitability of graduates to enter biomedical scientist posts (see IBMS Response 1, at the end of the article).
Other subthemes relating to accreditation included debate around top-up modules and associated funding. There was also some discussion across the focus groups that the importance of choosing an accredited degree should be clear to students prior to beginning a university course, although responsibility for this was debated. One attendee described the biomedical science degree as being “a victim of its own success” in that the degree has become oversubscribed and therefore capacity to register is reduced at the end of the degree due to placement availability: this feeds into the second theme.
Registration of biomedical scientists is of value to the profession and to patients, but pathways to registration are not as easily accessible as is needed in order to improve recruitment and address challenges in the NHS workforce
There was a general feeling across the focus groups that registration of biomedical scientists is needed to protect the public and to provide a high-quality service that benefits the patient. In addition, the concept that “registration of biomedical scientists aligns us with other healthcare professions” came through frequently in attendees’ comments; this is particularly important in later discussions around advanced practice, which is better established in other professions.
Despite the consensus that registration is of value to biomedical scientists, it was widely acknowledged that there are multiple issues with the capacity to complete state registration, including placement capacity and assessment waiting lists. Multiple comments were made around a reliance on goodwill to get trainees through portfolios, i.e. marking portfolio work at home. Concerns were also expressed around registration portfolio verifications and specialist portfolio examinations being unpaid, as well as an expectation for assessors to invest their own time and money in firstly becoming eligible to be assessors and secondly taking the time to complete the assessments; attendees therefore questioned whether this is a reliable system and, in some cases, questioned where the value of their professional body fees goes to (see IBMS Response 2, at the end of the article). In addition, the oversupply of bioscience graduates who are not eligible for state registration was suggested to be evidence of issues with the current registration system, and again discussions arose around who is responsible for this. Some networks have set up a sharing approach to help clear the backlog, which has been agreed by the IBMS on a case-by-case basis, but this is not uniform across the UK and, therefore, waiting times vary considerably, which again raised ethical issues.
“The overarching concept of ‘grow your own’ staff was prominent in these discussions”
Other subthemes relating to registration included laboratory capacity, conflict arising between staff waiting for registration opportunities, and the notion of waiting your turn in support roles as a “rite of passage”. There was also discussion around a blurring of lines between the roles of support staff and registered biomedical scientist staff in some trusts. In some examples, support staff carried out highly skilled tasks with biomedical scientist supervision and/or sign off, which some attendees felt undermined the purpose of registration. There were also ethical concerns raised about this, i.e. is it right to pay staff at lower bands when they are not state registered but carrying out a similar job role? One attendee commented that “I think it is odd that when you look at the protected title, the title is protected, but the work is not protected”. In contrast, some attendees highlighted that they felt allowing support staff to take on more skilled work kept those (often overqualified) staff more engaged, and better trained in their roles to then progress through their portfolios and become registered; the overarching concept of “grow your own” staff was prominent in these discussions.
Students could be better prepared for careers in labs, which could be improved through a more cohesive approach to design of degrees and placement capacity between higher education institutes (HEIs) and labs
It was widely acknowledged that this is further complicated by not all students on a biomedical science degree wanting to work as biomedical scientists after graduation, therefore, expectations and broadness of the degree need to be considered during the HEI design process. Several attendees asked how HEIs are preparing students for pathology laboratory work whilst at university, and which elements of the registration portfolio can reasonably be covered at an HEI; there is growing work in this area to examine the use of alternative and simulated placement to support registration. A recent employability survey by Hussain & Hicks published in 2022 has informed the creation of HEI workshops and reiteration of HCPC requirements across all levels of study, which is a good example of co-creation between employers and HEIs to enhance the level of graduates. This example highlights the need for a more cohesive approach from labs and HEIs, which will shape course content, application of skills, and manage expectations of labs when receiving newly registered students. This is particularly true, as one attendee commented, because “training has changed and therefore we can’t expect students to have as much practical experience as they used to when completing the logbook”. In addition to the change in logbook vs. portfolio training, HEI benchmarks and degree design have changed, and therefore lab expectations need to be adjusted.
A major concern that was raised under this theme was the suitability of newly registered graduates to be going on to shifts more quickly than they may be prepared for, which some attendees attributed to a lack of clarity in the labs surrounding expectations of newly registered staff vs. fully competent staff (see IBMS Response 3, at the end on the article).
Training capacity in labs is a major barrier for success, affecting both recruitment and retention of new and experienced staff
Lack of capacity for training in labs was raised almost unanimously by attendees and is seen as a major factor affecting both the recruitment and retention of newly qualified staff, but also of more-experienced staff right through to those in advanced roles. As capacity for lab placements is limited, some labs will take a university placement student every other year due to the ongoing need to “grow their own” as well as develop university students, whilst some labs no longer have capacity to take on any placements at all. One attendee queried: “Should labs have to take on a minimum number of placement students in order to retain their training status/accreditation each year?” But there is no formal guidance on this.
There were mixed feelings in some focus groups around altering placement lengths to increase potential capacity, i.e. 14-week co-terminus placement. Ethical issues around the length of training periods were raised here, as well as the notion that lots of funded progression routes (i.e. apprenticeships) are advertised internally only – are we therefore disadvantaging potential future biomedical scientists, or those external candidates who may be suitable for advanced posts? This discussion went hand in hand with the general notion that some employers now expect too much from students and recent graduates, with several examples of conversations across networks on the difference between being registered and being fully competent in the job role, i.e. completing specialist portfolios. More ethical issues were raised here around pressure on newly registered staff and potential patient harm from rushing staff on to shift rotas. One attendee remarked that “an overconfidence in newly registered staff can be quite dangerous”, further highlighting the need for sufficient training capacity.
Clinical impact of biomedical scientists is significant and underestimated
There was an overwhelmingly positive response across all focus groups on the topic of clinical impact, with all attendees who contributed to the discussion expressing a feeling that they have direct positive clinical impact on patients through their role, and that this is often underestimated. Several reasons were cited for this, from a lack of time for reflection to a lack of awareness of the input of biomedical scientists from fellow healthcare professionals and the public. However, one attendee gave an example of a trust-wide recognition scheme that they were nominated for by a fellow healthcare professional (Operating Department Practitioner) thanks to their input on a complex transfusion theatre case, demonstrating good external awareness and appreciation of the biomedical scientist role in some cases.
“Most attendees suggested that career development and training are important for improved clinical outcomes for the patient”
Most attendees suggested that career development and training are important for improved clinical outcomes for the patient, citing examples related to quality of life and turnaround times. One attendee discussed this in the context of their proposed advanced qualifications, which would “reduce the time patients are bounced around” by allowing them to have direct patient contact, making the patient pathway more efficient. In some cases, attendees gave very personal accounts of how they feel their role impacts patients and where their higher awareness of this comes from, with some examples of personal losses driving their work.
In addition to the clinical impact from traditional disciplines, point-of-care testing (POCT) was highlighted by several attendees as having a huge clinical impact and the potential for growth:
“A good marker of clinical impact could be how well we support POCT as a profession,” said one attendee. This links back to previously discussed themes around training and development opportunities being pivotal to patient outcomes.
Career advances outside of management positions can be difficult due to limited availability of advanced roles/routes to progression
Most attendees expressed that recruitment and retention of specialised and advanced staff are major barriers in workforce development, which can affect patient care (see IBMS Response 4, at the end on the article). Several employers described recruitment difficulties to Band 6 (specialist) posts, citing several contributing factors from loss of automatic progression routes to a lack of funding for further study. There were lots of disparities across trusts, which is likely to further compound the issue. Ethical issues were raised here around the incentives to take on further study/qualifications in an employee’s own time/at personal cost when in fact role development and further training can improve patient outcomes.
Across the focus groups, it was acknowledged that advanced roles for biomedical scientists are less well established when compared with other healthcare practitioners (HCPs), e.g. clinical scientists. Attendees commented that had they been aware of advanced roles earlier on in their career, some of them might have ended up in different roles to their current ones. There was a consensus that awareness of career progression routes could be improved; this awareness needs to be spread beyond students out to those currently in biomedical scientist posts, particularly as there are ongoing changes and updates to advance role routes/requirements.
In addition, not all disciplines have equal access and/or support to achieve advanced roles. Funding variations across the UK were highlighted as a further barrier here, for example the limited funding pot for higher qualifications in NHS Scotland. A lack of continuity across the UK in what qualifications are accepted for specialist/advanced posts was also evident, with some disciplines lacking the more basic specialist qualifications, i.e. highly specialised labs such as andrology, although this is being addressed in the recently released IBMS Long Term Biomedical Scientist Workforce Plan.
Issues around advanced practice are further complicated by the fact that there is no continuity in the job titles used for such roles, adding to the ambiguity around the roles. One attendee described their thought process in choosing “trainee healthcare scientist” as a preferred title to “biomedical scientist” as they felt they would be taken more seriously by medics, which raises issues over the protected title and role awareness as previously discussed. It is clear, therefore, that work needs to be done to instil trust in those working in advanced roles, i.e. from medic colleagues.
“There was a consensus that awareness of career progression routes could be improved”
The final subtheme to fall into this category is that we need to do a better job of promoting our profession to develop our profiles, with patients, colleagues, and within the profession itself. One attendee said: “We should as a profession be shouting more from rooftops and sort of getting involved in things like Antimicrobial Awareness Week, where we can offer diagnostic pointers on the same subject and add extra enrichment value that way to clinical colleagues. I’m not sure if it would be as easy in all disciplines to implement some of those exposure both ways. People to start looking into the labs and as to also start looking out. I don’t know if that would be possible for all disciplines… We try and instil in our trainees and remind our more senior, long-serving members of staff and the impact that they have at the end of the day and how important it is”.
This was met with agreement by other attendees, in that promotion of our profession would enhance the “unseen” clinical impact.
Conclusion
The emerging themes identify several barriers to access to the profession and advanced roles, as well as the potential clinical impact biomedical scientists can and do have. These data give biomedical scientists a voice on key issues related to the education, training, and development pathways of the profession, and contribute supporting narrative to the recently released IBMS Long Term Biomedical Scientist Workforce Plan. Identifying key barriers in relation to accreditation, registration, training, education, progression, and clinical impact of biomedical scientists will allow the profession to develop strategies to overcome such barriers, which will hopefully improve career pathways for biomedical scientists and subsequently have a positive impact on patient care.
IBMS responses
Response 1
The role of the IBMS is to maintain education and training standards and provide the four HCPC-approved routes to registration for biomedical scientists. Rather than promoting extended routes to registration, the Institute provides the quickest route to registration by completing an IBMS Accredited BSc (Hons) degree and a period of clinical training, with completion of the IBMS registration training portfolio. In the UK there are now 62 IBMS Accredited BSc programmes and 16 IBMS Accredited degree apprenticeships to allow colleagues to earn while they learn. Each cohort intake is decided by universities and is out of the control of the Institute, although we monitor the resources required to deliver high-quality programmes through annual monitoring and detailed scrutiny at the five yearly accreditation events.
Response 2
The Institute is working with UCAS to disseminate information about the importance of choosing an IBMS Accredited degree for HCPC registration and created the “Become a Biomedical Scientist” campaign in 2023. Further, funding to support the cost of top-up modules has been released by both NHS England and NHS Scotland recently. The limited number of clinical placements is a shared frustration. A lack of capacity in the laboratories to take placement students and lack of funding for these placements is a priority issue for the Institute and part of the current Strategy. The Chief Executive is working with a variety of external bodies on prioritising a suitable solution. Raising the profile of training is another key strategic aim of the IBMS. The verifier and examiner roles are integral to delivering the education and training for our profession, developing and sharing good practice and supporting career progression around the UK. Portfolio assessments are embedded in clinical laboratory culture. More IBMS “Train the Trainer” events were delivered in 2023 than ever before and there are sufficient verifiers and examiners to complete all portfolio assessments per year, if everyone completes two assessments. The cost of the IBMS qualifications has intentionally been kept low to allow broad access and the introduction of an assessor payment would cause a significant increase in the fee; however, we continue to review how we recognise assessors’ contribution to the profession.
Response 3
The IBMS accreditation criteria require practical and technical skill development to be mapped and all programmes must also be mapped to the latest QAA Subject Benchmark Statement for Biomedical Science. All clinical specialisms, plus near-patient testing and quality management, must be evidenced throughout the taught modules. IBMS Support Hubs have focused on placement preparation and employability in 2023 and Tahmina Hussain’s work on placement preparation and employability project outcomes will underpin more Institute resources in 2024.
All registered biomedical scientists must also abide by the HCPC Standards of Conduct Performance and Ethics and work with managers and HR colleagues to manage the risk associated with a newly qualified colleague working independently without having the required knowledge of the subject area. The standards state:
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
Response 4
The IBMS is continuing to be a visible and vocal supporter of our profession at the highest levels, highlighting the work and contribution made by biomedical scientists. We have produced the IBMS Long Term Biomedical Scientist Workforce Plan, demonstrating the flexibility and capability of our workforce. We are promoting the value of biomedical and other scientific staff’s involvement in diagnostic testing in settings outside of the laboratory in Point of Care Testing: National Strategic Guidance for at Point of Need Testing. We are commissioning research into the true value of biomedical scientists in the clinical pathway, starting with bowel cancer. We are also continuing to drive advanced clinical practice qualifications in conjunction and with support of medical colleagues, giving biomedical scientists access to new and better roles in the clinical team.
Image credit | Grundini-Ikon