Consideration of doctoral level studies as a new route to registration as an occupational therapist

The Royal College of Occupational Therapists (RCOT), as the sole professional body for the profession in the UK, supports, develops and protects the UK domain knowledge. RCOT sets the professional and educational standards for the occupational therapy profession and as such, sets the Learning and development standards for pre-registration occupational therapy education (RCOT 2019), accredits the pre-registration programmes offered by Higher Education Institutions (HEIs) against those standards and monitors the ongoing maintenance of standards in the intervening period. 

RCOT’s Accreditation Process uses the Standards to assess whether a pre-registration programme, and the education provider that delivers that programme, provides learners with the knowledge, skills and professional attributes necessary to competently and ethically meet the occupational needs of the community. The World Federation of Occupational Therapists (WFOT) is a federation of occupational therapy organisations recognised by the United Nations with official standing with the World Health Organization. WFOT sets the minimum standards for entry level occupational therapy education internationally (WFOT 2016). 

As an organisational member of WFOT, RCOT holds the delegated authority to confer WFOT approval to pre-registration programmes. Therefore, RCOT’s Accreditation Process ensures that UK occupational therapy pre-registration programmes: 

• meet the education standards set by the profession in the UK 
• meet the education standards set by the international community
• are responsive to current and predicted local, national and global issues which may affect the profession and the communities they serve 
• produce graduates who are fit for academic award, practice, purpose and the profession 
• produce graduates who hold a qualification recognised in any WFOT member country (RCOT 2019 p2) 

RCOT ‘is committed to ensuring diversity within the profession, its membership, those who access occupational therapy services, its staff and the wider working environment’ (RCOT 2021 p1). It is vital that the learner population is representative of the populations we serve as occupational therapists. To enable this, in part, a variety of pathways currently exist offering degree-level studies (undergraduate and postgraduate) to full-time and part-time students and the introduction of an apprenticeship route (England only) in 2019. The Learning and development standards for pre-registration education (RCOT 2019 p18) state: 

“Standard 1.1 The threshold entry route to the HCPC Register and the occupational therapy profession is a Bachelor’s Degree with Honours. 

• Bachelor’s Degree with Honours 
• Post-graduate Diploma 
• Master’s Degree” 

The World Federation of Occupational Therapists (WFOT) Minimum standards for the education of occupational therapists state a “a bachelor’s degree or equivalent credential’ is required as an exit award from pre-registration studies” (2016 p53). 

Doctorate level pre-registration occupational therapy studies are a recent development within global occupational therapy education and there is a lack of literature in relation to exploring the variety of exit awards for pre-registration occupational therapy programmes and their subsequent impact on professional pathways and career opportunities.

In 2019, the American Occupational Therapy Association (AOTA) published a statement regarding entry-level education confirming AOTA’s Representative Assembly had “determined that occupational therapists may enter the profession at the master’s or doctorate level” (AOTA 2019). 

The Chartered Society for Physiotherapy (CSP) have supported the introduction of this new route to registration within physiotherapy since 2017, with two education providers (both in Scotland) accredited by the CSP and delivering the programme of study. 

RCOT’s pre-registration accreditation team have been approached by a number of established and RCOT accredited pre-registration occupational therapy providers in relation to the introduction of doctoral level pre-registration studies.

“Since the concept of occupational therapy was introduced to the United Kingdom (UK) at the turn of the 20th century, diverse efforts have been made to educate occupational therapists to implement therapeutic strategies that have accorded with contemporary thinking and practice. Strategies have changed over time to reflect not only developing trends in professional practice but also trends in educational theory” (Alsop 2006 p442). 

Nearly 20 years later, Alsop’s observation remains true and the diversity of routes to registration as an occupational therapist continues to grow, influenced by political and practice drivers. The 2017 removal of English government funding to support pre-registration NHS courses (and the associated cap on student numbers) has impacted on both the nature of the educational offering and the demographics of the student population. Additionally, the 2019 introduction of an Integrated Degree Apprenticeship further widened the opportunities to undertake study, and the way in which those studies are completed. 

Since 2017, the number of occupational therapy education providers has increased from 31 to 39 accredited providers at the time of writing, with a potential increase to 47 providers by the end of 2021/22 academic year. The providers offer in excess of 80 pre-registration programmes of study, with a further providers and programmes seeking accreditation in the 2021/22 academic year, demonstrating variety in both the level and design of study for future occupational therapists. 

In 2020/21, 96% of all available RCOT accredited learner places were utilised by providers, with over 2800 students and apprentices commencing studies. 

The move to all-graduate entry to the profession occurred in 1994 (Paterson 1997, summarised by Alsop 2006 p446) and was driven by the need for research to underpin occupational therapists’ practice. Potential occupational therapists in the UK now have the following range of awards leading to registration to choose from, studying on a full or part-time basis: 

• BSc (Hons) Occupational Therapy 
• BSc (Hons) Occupational Therapy - accelerated 
• PgDip Occupational Therapy 
• MSc Occupational Therapy – pre-registration 
• MOccTher – Integrated Masters 
• Apprenticeship – BSc and MSc (pre-registration) routes available

Of the 2020/21 new learner intake, 73% commenced BSc (Hons) programme (11% of these enrolled on degree apprenticeship, and 3% on part-time studies) and 27% commenced post-graduate level programmes. Programmes are also open to European and international students wishing to study the profession within the UK. It is reasonable to anticipate that Brexit and the pandemic will have had an impact on European and international learner intakes. 

The recent pandemic has also impacted on the nature of the studies, with blended delivery (online and on-site) programmes now emerging, further widening the accessibility of occupational therapy studies to the population.

There are number of factors stimulating interest in, and raising the profile of, doctoral level pre-registration education in occupational therapy. Alongside the example set by the United States, there are drivers rooted firmly in the context of the UK, including the need to demonstrate the effectiveness, and cost-effectiveness, of occupational therapy services. 

The Association of UK University Hospitals (AUKUH) Clinical Academic Roles Development Group’s (hosted by the Council of Deans since 2018) identifies that ‘the link between research and better patient care is firmly establishing itself within therapy services’ (AUKUH 2016 p27) and observes that ‘a rich and diverse health research environment helps patients and invigorates the workplace’ (p4). 

The development of an array of career frameworks, including those dedicated to advanced and consultant levels of practice, and the growth in and demand for clinical academic roles straddling practice and academia, highlight the need for and value of research skills and confidence in the professional workforce. The National Institute for Health Research (NIHR) identifies that: 
“a researcher immersed in a clinical setting is in an excellent position to identify what research questions matter to the patient or service user, to the NHS, and to the profession. They are also in a position to ensure that those questions are applicable in day-to-day practice and care, and to interpret and apply research findings in a practical and useful way” (NIHR 2016 p10). 

This publication also asserts that “a successful clinical academic will be able to demonstrate not only that they are an excellent researcher but also that they can lead and inspire others in their clinical field” (NIHR, 2016 p12). 

Workforce planning documents published by Health Education England, the Department of Health (Northern Ireland), NHS Education for Scotland and Health Education and Improvement Wales do not specifically consider the introduction of doctorate level pre-registration studies within the allied health professions. 

However, Public Health England’s draft workforce strategy identifies the essential need for clinical academic roles to increase research output and aid workforce retention. These roles are seen as “an essential next step alongside the Advanced Clinical Practice Framework which places research central to clinical delivery” (NHS 2017 p22). Where suitable clinical academic and advanced practice posts are available, there is scope for doctoral entry graduates to rapidly access these career pathways. 

The introduction of a new doctoral entry route, creating more qualification options, would offer greater flexibility, potentially attracting new entrants to the profession, helping it to evolve. It would support the stance of the Council of Deans for Health (AUKUH 2016) and NIHR (2016) regarding producing graduates who are research-ready and equipped to embed research findings into practice. This pathway would also be expected to make significant contributions to increasing research capacity and capability within the profession and building the evidence base in line with RCOT’s own Research and Development Strategy 2019-24.

Thank you to everyone who took part in our community discussion and consensus-building events and also shared views on social media.

We will now present a report to the RCOT Board: Learning and Development to consider. We’ll also share an open-access executive summary, alongside a submission of the key findings to a peer-reviewed journal.

Look out on social media and in our news section for updates.

Key stakeholders for this project are the RCOT membership, specifically those who are actively engaged in the education of pre-registration learners, and recruitment of new graduates. 

More broadly, stakeholders also include but are not limited to: 

• AHP Leads in NHS Trusts and equivalent in other sectors
• Council of Deans for Health
• Department of Health (NI)
• Elizabeth Casson Trust
• Employers across sectors (including the NHS, social care, private, third sector)
• Health and Care Professions Council
• Health Education and Improvement Wales
• Health Education England
• Pre-registration learners from all existing pathways
• People who access services
• NHS Education Scotland
• Occupational therapy affinity groups 
• Occupational therapy managers across sectors
• RCOT Carnduff Learner Forum
• RCOT members, staff, Council and Boards

For more information, please contact: Dr Stephanie Tempest, Project Lead, Stephanie Tempest Consultancy Ltd, by email: stephanietempest@outlook.com  

Twitter: @setG75