Competency-based training for advanced scrub practitioners

Jan Clement discusses the development of an in-house competency-based training programme for the advanced scrub practitioner role.

In 2003 the Perioperative Care Collaborative (PCC) released a positional statement regarding the non-medical perioperative practitioner working as first assistant to the surgeon and it was within this statement that the new title of Advanced Scrub Practitioner (ASP) was widely used. Also in 2003 the Independent Healthcare Association (IHA) produced a document which provided assessment criteria for the ASP role in the format of competencies and in 2004 BUPA Hospitals Ltd set out the responsibilities of those undertaking the role and their assessment of competence. These three documents provided the impetus for a BUPA Theatre Education Strategy Group to be formed and the solution, to a growing need, developed.

The aim of this article is to review the rationale and development of an internally devised assessment framework.

The statement from the PCC (2003) and the document from the IHA (2003), provided guidance for all operating departments; however with the release of the new BUPA policy in June 2004 it became imperative that, in order to meet internal and external audits, BUPA Hospitals’ individual operating departments must comply with the policy.

A theatre education strategy group was formed consisting of five senior theatre practitioners and the Clinical Education Manager for BUPA Hospitals. The team were chosen for their legal experience and diverse perioperative expertise. During the first meeting the target group for assessment, practical solutions and the effectiveness of available resources were discussed.

It was felt that the target group would consist of experienced theatre practitioners who had gained knowledge and skills experientially. Their knowledge and skills needed some form of assessment and acknowledgement without the need or desire to undertake a lengthy academic programme. As Sutton (2005) remarked, why remove experienced practitioners into a classroom when they could be assessed clinically through a nationally agreed assessment tool?

From these discussions it became apparent that there was not a national resource which would be suitable for BUPA Hospitals requirements. It was therefore necessary to design a credible assessment framework to meet the needs of the IHA Positional Statement (2003). Beesley (2004) suggests that to develop and manage a robust competency framework is a complex task but, if successful, it allows practitioners to reach their full potential through continuous professional development to a specific standard of competence.

The Nursing and Midwifery Council (NMC, 2003) defines competence as ‘Possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision’.

To develop an effective competency-based development programme, each competency was reviewed and the knowledge and skill requirements discussed. Gradually, collective professional judgements on minimally acceptable requirements to fulfil the competency were agreed. As in National Vocational Qualifications ‘ranges’ or ‘scope’, seeking additional information regarding specific answers, were noted.

An example of competency and minimal acceptable requirement:

Competency: Demonstrate proficiency in the safe use of the camera and telescope during minimal access surgery (MAS) in the clinical setting.

Minimal acceptable requirements:
a. Relate the safe use of MAS equipment, including set-up and trouble-shooting.
The practitioner’s answers should include a) Insufflator, b) Video equipment, c) Camera, d) Light source, e) Instruments, f) Telescopes.
b. Identify potential MAS-related hazards and how these can be minimised.
The practitioner’s answers to include visual limitations of scope when monitoring and maintaining visualisation of operative field e.g. surgical smoke obstructing surgical view, light – glaring or insufficient, poor picture quality, cautery (monopolar and bipolar), direct coupling, capacitive coupling, insulation failure, laser and/or ultrasound, trauma to surrounding tissues through incorrect insertion of trocars and mishandling of telescope or instruments
c. Demonstrate safe manual handling techniques when transferring or positioning a patient - including correct use of manual handling equipment, team work.
Maintain the dignity of the patient to the best of their ability - including restricting access to others while positioning, covering the patient when possible.

The competency frameworks was designed using a student-centred approach, therefore, some practitioners would be able to provide all the evidence immediately while others would need to refresh their knowledge and skills. To aid practitioners a substantial resource pack was provided detailing all the underpinning knowledge necessary to attain each competence. For example, the above competency had the following resource:

Beesley & Pirie (eds) (2005) NATN Standards and Recommendations for Safe Peri-operative Practice NATN and Clarke P, Jones J (eds) (1998) Brigden’s Operating Room Department Practice. Edinburgh: Churchill Livingstone.

As the project progresses format of assessments and assessors was discussed. It was imperative an occupationally competent professional assessor was chosen. A surgeon’s signature would be required from each specialty the practitioner practised within.

Assessment of knowledge could be through interviews, group discussions or a workbook devised. This workbook was designed by myself from the education group’s minimal requirements. The document was then cascaded through the virtual network of BUPA Hospitals Ltd. In addition, reflective comments, production of a portfolio and surgical logbook were also required before a final ‘sign off’ by the theatre manager. These competencies and assessment requirements are incorporated within the job description of an advanced theatre practitioner.

The document was launched in January 2005 at three regional locations. The initial reaction appears positive with many mangers appreciative of very specific resources and guidance to successfully implement the policy.

This good practice article has discussed how BUPA Hospitals Ltd took a pragmatic approach to the role of the advanced scrub practitioner following a modification of an operational policy. Experienced practitioners were offered a competency-based assessment framework while less experienced practitioners are being offered university-accredited perioperative programmes. Devising educational and assessment frameworks requires commitment and dedication from experienced practitioners to ensure credible standards of professional practice.

Janice Clement
Director of Nursing

Beesley J (2004) Managing competency within the perioperative setting, British Journal of Perioperative Nursing, 14(2), pp 54-58, 60-61.

Independent Healthcare Association (2003) Position Statement: The Role of the First Assistant (Advanced Scrub Practitioner) in the Independent Sector. London: Independent Healthcare Association.

Neary M (2003) Curriculum Studies in Post-Compulsory and Adult Education. A Teacher’s and Student Teacher’s Study Guide. Cheltenham: Nelson Thornes.

Perioperative Care Collaborative (2003) Position Statement: The provision of the non-medical perioperative practitioner working as first assistant to the surgeon, British Journal of Perioperative Nursing, Supplement, August.

Petty G (2001) Teaching Today. Cheltenham: Nelson Thornes.

Sutton J (2005) Open Forum, readers letters. The First Assistant Role, British Journal of Perioperative Nursing, 15(1).