Education and training have always been considered important in aesthetics (by reputable practitioners, at least), but the difference between the two – education or training - what constitutes an adequate level, what specific knowledge and skills are required, and who gets to decide – have long been more of a grey area.
The current consultation around the safe practice of aesthetic medicine in England has brought these conversations into sharper focus, especially with the proposed ‘traffic light system’ raising valid questions about who will have the ‘right’ to deliver certain enhancements.
In summary, the proposed scheme (the consultation for which closed at the end of October) focuses on non-surgical cosmetic treatments that involve the injection of substances or needles inserted into the skin; the application of substances that penetrate the epidermis, threads placed under the skin; and the application of light, electricity, cold, or heat.
Each procedure has been roughly categorised by perceived risk level. Green (low risk) currently includes microneedling, mesotherapy, IPL, and LED therapies, and under current suggestions, practitioners who meet ‘agreed [but unconfirmed] standards can perform these without additional oversight.
Amber (medium risk) includes botulinum toxin and dermal filler injections. For these, only registered healthcare professionals who have achieved a minimum standard of education and are licensed would be allowed to perform these.
Lastly, there’s the Red (high risk) category. This reserves certain treatments for specified regulated healthcare professionals, specifically those regulated by CQC. The treatments currently in this category include thread lifting and hair restoration surgery.
It’s important to stress that we are at the beginning of this process with many changes likely to emerge, but one thing is true – greater regulation and standards are coming. So, from an aesthetics education perspective, what should we expect in the near future?
With discussions around Level 7 diploma aesthetics qualifications potentially becoming the mandatory minimum level of certification to practice aesthetic medicine in England, we spoke to Neil Pybis and Angela Brennan from Skin Appeal Training Academy (SATA). Pybis and Brennan are nurse practitioners and prescribers, with a combined 60 years of experience in nursing and 24 years’ worth of expertise in aesthetic medicine. (Plus, there’s Brennan’s 17 years of experience in Nursing education as a lecturer and Director of the School of Health at John Moores University).
SATA has just been granted permission to deliver a Level 7 Education in Aesthetic Injectable Therapies course by the OTHM awarding body, making it the first Level 7 programme nationally approved by OTHM (one of only two JCCP award-accrediting bodies). SATA is also in the process of joining the JCCP education register, with the aim of becoming the first Nurse-led Academy on there to deliver Level 7 Aesthetic Education.
But what does Level 7 Aesthetic Education mean in practice? The Level 7 qualification aims to provide a sector-standard certification in aesthetics at a postgraduate level, and it is currently open only to suitably qualified medical professionals – in SATA’s case, specifically nurses, doctors, dentists, and midwives and pharmacists.
Flexibly designed for the working practitioner, the SATA Level 7 Diploma in Aesthetic Injectable Therapies will be delivered through a blended learning approach. This will include online learning, self-directed learning, practice observation and supervised practice.It comprises seven mandatory units including not only how to treat with botulinum toxin and fillers, but further insight into anatomy and physiology, assessment and treatment planning, managing possible complications, and education on the latest standards in aesthetic medicine.
“Level 7, aka Postgraduate studies, move us away from the understanding and application of knowledge into analysis and synthesis of a whole range of knowledge, concepts and ideas,” explains Brennan. “We are looking for how the details make up the whole picture and what effect changes in one area can affect other related areas.”
If anyone views aesthetic medicine mainly as the ‘art of doing’, the thought of ‘ideas and concepts’ might feel alien. However, as both Pybis and Brennan are keen to stress, it’s arguably not training that’s going to make the industry safer - it’s quality education. Here’s the difference:
“The terms ‘training’ and ‘education’ are often used interchangeably, but they represent distinct processes with different purposes and outcomes,” says Brennan. “Training is typically a practical, skill-oriented process designed to equip individuals with specific competencies related to a particular task. Education is a broader, knowledge-focused process to provide individuals with a well-rounded understanding of various subjects. It emphasises intellectual and personal development.”
For example, the one-or-two-day training courses for botulinum toxin and dermal fillers are technically aesthetic training – despite their brevity. So are the courses where the training is given out as templates and diagrams, like a paint by numbers.
“The problem arises when practitioners who have undergone this kind of training meet the unexpected,” explains Brennan. “Quite often, training courses are just about the actual task of injecting. There is so much more to the practice of aesthetic medicine. With a Level 7 education in aesthetics a practitioner can apply their knowledge to any given situation. This includes medical and psychological assessment, clinical decision making and risk assessment, understanding of causal factors and how to address these, treatment planning to meet individualised needs, treatment itself, differential diagnosis of complications and aftercare”
“We can train anyone to use a machine, but do we educate them on how to approach the time before and after using that machine?” continues Pybis. After all, doing a treatment is not just conducting the treatment itself – its everything around it, including safeguarding your patients.
That’s where education comes in. “Education equips a practitioner with the knowledge to synthesise all of the myriad of factors that need to be taken into account when performing an aesthetic treatment,” Brennan continues. “It isn’t just the skill of putting a needle into somebody. It’s to do with the depth of knowledge, and knowing what the risks are. Training is task-orientated, but with education, you may not even end up doing the treatment because one of the options is no treatment. You’re never normally told that in a training course.”
Pybis shares an example: “Recently, I had a lady who, on assessment, had literally no movement of the upper parts of the face when she tried to lift her eyebrows. So why had she been to three different people who insisted that she needed a toxin in the forehead to reduce wrinkles? The last thing she needed was toxin.”
Thus, when we discuss the importance of both education and training in aesthetics, inevitably discussions around who has the appropriate background always emerge. For Pybis and Brennan, as with many in the sector, the expertise of registered healthcare professionals is all-important.
“Assessment, diagnosis and patient-centred individual treatment plans are areas in which healthcare professionals have a wealth of experience,” says Brennan. “Their medical knowledge in anatomy, physiology, and pharmacology is there to be built upon and focussed onto aesthetic treatments.”
Furthermore, “the ‘soft skills’ of communication, active listening, observing and risk assessment come much more as second nature to those who have been educated to deal with all manner of patients.” For both Pybis and Brennan, noting their nursing backgrounds, that’s an area that sets aesthetic nurse practitioners apart.
However, there is still seemingly much work to be done. Both experts expressed some disappointment at the BACN’s responses to the recent “traffic light”proposals, for example, especially the restrictions to practice based on CQC accreditation. It has been seen as a missed opportunity to support the education and advancement of healthcare providers like nurses, especially those in specialist practitioner roles.
“If you’re a specialist practitioner, you are an expert in an area of practice, and you often have to have that autonomy of clinical decision-making - knowing what you can and can’t do” says Brennan. “So, I was a little bit disappointed to see that the main tenor of the BACN response was if there’s any risk at all, let’s move it into the red category, which means such treatments could only be carried out in CQC-registered premises. The BACN draft response included toxin and semi-permanent fillers to the face being moved to the red category. Now I know that lots of nurses are working in CQC-registered clinics, but many aren’t.”
“I feel that if you do the Level 7 and you are educated correctly by becoming a specialist in that sector, then there should be no reason for such treatments to be moved,” agrees Pybis. “I think toxins and skinboosters, for example, shouldn’t go anywhere near the red category. The education should be in place for people to be able to carry these treatments out safely and they will be knowledgeable in the event of anything going wrong.”
Yet, neither expert is arguing that there isn’t a need for more oversight of some treatments “With threads, that’s different,” Pybis clarifies. “When they go wrong, they can drastically go wrong, and someone may even need surgical intervention. From that point of view, yes, they should be put in the red category.”
Ultimately, what the sector is probably missing within its currently drafted suggestions is a sense of nuance and clarity on requirements. As Brennan notes, “the next consultation is going to be on education and education standards. Maybe if we’d done that first and we’d established what level and depth of education a person needs before they can get a license in each category, then you could more clearly ask which category things should be in.”
Education again, it seems, really needs putting first, so that practitioners and patients can be suitably protected and, in the former’s case, actually celebrated for their expertise.
“I think at the end of the day, it’s about recognition,” says Brennan. “There’s a lot of misconceptions around the practice of aesthetics and once people recognise that in order to do this, you have to have been appropriately educated, I think it will help to dispel some of the myths. Lots of people don’t think it’s any big deal because they go to their hairdresser and get “Botox”, or they go to their nail salon and get their lips done.”
“My ideal would be to get to a point where the NMC would recognise aesthetic nursing as an area of specialist practice,” continues Brennan. “The Level 7 Diploma could be a big jump towards that because the NMC specialist practitioner programme is 180 credits, with the last 60 credits undertaken by dissertation. The Level 7 course that we are putting forward will be 60 credits, so it’s not a million miles away. If you then top it up with a dissertation, you could move toward the equivalent of a special practitioner education, which is recognised by the NMC. That would be brilliant if we could get to that.”
“I think the minimum standard is going to have to be Level 7 to get this recognition, and that’s what we should be turning around and saying,” agrees Pybis in conclusion. After all, that will only reemphasise and distinguish what high-quality education can look like. An excellent education should be met with excitement, not concern by practitioners within the aesthetics sector.