EHJ May 2005, pages 32-33

The CIEH's education department is on a mission to ensure the profession has a sustainable future. Principal education officer Tony Lewis explains

At a recent interview, a candidate, when asked how she might encourage others to accept an unpalatable change in their professional life, said that "communication" was the central issue. She went on to say that the "communication" should focus on explaining that continuing on in the same old way was, ultimately, going to be more painful than making the change. A good answer, but often easier said than done.

In the 1990s, the profession, faced with a significant challenge from the government regarding the competence of its members and of the newly qualified in particular, responded with a series of measures that saw the introduction of:

• an assessment of professional competence
• compulsory continuing professional development
• a new curriculum for all accredited environmental health courses
• a practical training logbook
• a professional examination to assess the level of integration between theory and practice within the student.

An "over-reaction" said the sages who had seen it all before. "Unsustainable" said a number of academic colleagues, while an angry student body said that the CIEH was imposing "too many hurdles for too low a reward". However, the various government agencies, who had given warning of removing enforcement responsibilities from "incompetent" EHOs, were apparently sated by the attention to "competence".

Over the ensuing years, the profession has undergone a significant revival as the UK government and international bodies like the World Health Organization and the European Union have held it increasingly in higher esteem. Even when, on occasions, the likes of the HSE raised new questions about the role of EHOs in enforcement, the measures outlined above afforded a high level of assurance of the "fitness to practice" of EHOs.

DARWINIAN THEORY AND ENVIRONMENTAL HEALTH

Darwin is often misquoted. He never said "survival of the fittest". What he did say was: "It is not the strongest of the species that survives, nor the most intelligent. It is the one that is the most adaptable to change".

While the profession at large was still trying to come to terms with logbooks, professional exams etc. the "worlds" within which EHOs practised had evolved. The technical, legal and skill base for competent practice had grown significantly and courses were struggling to cover all of the necessary material. Issues such as sustainable communities and the emergence of a renewed focus on public health were becoming increasingly important. The demographics of EHO employment were also changing. The private sector was growing and, more significantly, real employment opportunities were emerging within the PCTs and agencies such as FSA, HSE and the HPA.

By 2002, it had become obvious that, in order to meet these new challenges, the profession would need to recognise reality, review itself and adapt or miss out on the new opportunities. Part of that reality is that 40 per cent of the profession are not working as enforcement officers. We should not be producing EHOs but EHPs with the competencies and skills to work in any arena. A further part of this reality is that the lifespan of the body of technical knowledge developed in students during their course has a lifespan of around 18 to 24 months. Consequently, equipping graduate EHPs with real life-long learning skills is crucial for the future.

CURRICULUM 2003 AND THE ELP

Two thousand and three saw the crystallisation of these ideas into a new environmental health curriculum. This curriculum is focussed around equipping students with the skills and competencies to enable them to work with others to select, undertake, analyse and adapt the most appropriate interventions to achieve the desired result. Consequently, a key aim of the curriculum is to empower graduates with the transferable skills of reflection and self-analysis, as well as an awareness of the value of the evidence base.

One of the principle mechanisms being utilised to promote this aim is the new experiential learning portfolio (ELP). The ELP replaces the old logbook for students enrolled under the 2003 curriculum and is focussed firmly on "experiential learning". The concept is not new. Around 450 BC, the Chinese philosopher Confucius recognised the benefits of such learning when he said: "Tell me, and I will forget; show me, and I may remember; involve me, and I will understand".

The wisdom outlined by Confucius identifies the problems associated with the continued use of the logbook, which requires students to "see and do", but doesn't actively engage with them to ensure the development of "skills" and "understanding" that can be drawn upon for the remainder of the professional life. Despite these shortcomings, some students did engage with their training and did acquire the skills to become lifelong learners. However, that was more by accident than design.

Today, the new qualification process requires students to develop into reflective learners as a prelude to becoming reflective practitioners. Hence the key question for students and for current practitioners is "what is this thing called 'reflective learning'?"

REFLECTIVE LEARNING

In its narrowest sense, the reflective learner can be seen as someone who explores their experiences of learning to better understand how they learn, with a view, ultimately, to improve their future learning.

In practical terms, reflective EHPs start to demonstrate reflection by comparing and offering comment upon what they have done in an intervention with respect to:

• legislative requirements
• good practice
• advice contained within official guidance and codes of practice etc.

Participants should record what they thought and felt at the time - whether confidence grew; how they reacted to criticism from a supervisor or manager; what was good and bad; specific strengths and weaknesses; what sense was made of the situation; where the "inspiration" came from and what else could have been done; and the changes in approach that could be taken in the future. For environmental health students, this "recording" will be in the form of a portfolio, but, for more experienced practitioners, recording could be in the form of a personal development log/plan, kept as a part of CPD records.

Professionally, the benefit of engaging practitioners in the process of reflective learning, either via the ELP, CPD or even the APC/APD process, is that a cohort will emerge who are likely to be more self-aware and self-critical. They will also be honest about themselves and open to criticism and feedback, objective in weighing up evidence, open to and prepared to try different approaches, curious to discover other approaches, motivated to improve and more able to carry through independent learning. All of these are key facets of the modern professional. They contrast sharply with the outcomes from the more traditional types of learning such as learning by rote. Such learning can be described as "arbitrary", "verbatim" and with little effort being made to integrate new knowledge with existing concepts in a cognitive structure.

The real challenge, for the wider profession over the next few years, is to fully embrace the concept of reflective learning and practice, fully supported by a growing evidence base. This must become entrenched within the profession if it is to continue to grow. It is only by development of these skills that the profession as a whole will evolve into effective lifelong learners with a real and sustainable future

Tony Lewis can be contacted at: t.lewis@cieh.org