Aesthetics is largely absent from undergraduate medical, dental and nursing degrees. Further, it is only briefly featured in postgraduate medical specialty training such as dermatology, plastic surgery and oral and maxillofacial surgery.
Training in aesthetics is undertaken with independent providers, alongside a smaller but growing offering from suppliers and pharmaceutical companies. The absence of a widely accepted and formally accredited training pathway in aesthetics creates confusion and presents safety issues for patients and practitioners.
I believe we should be working collaboratively towards the creation and accreditation of a formal training pathway that leads to ‘specialists’ in aesthetics, in the same way that my specialist training in the NHS will lead me to become a consultant oral and maxillofacial surgeon via a nationally recognised training pathway.
An increasing interest in aesthetics
My argument is founded on my experience of working as a full-time NHS oral and maxillofacial specialist registrar, an aesthetic practitioner and trainer. I see both sides of the debate: on the one hand, there are plummeting staffing levels, grave recruitment and retention issues in the NHS, while on the other hand, there is little to no provision or flexibility for enabling practice in aesthetics for junior healthcare professionals (HCPs).
To deny that junior HCPs are interested in aesthetics is denying reality, and I urge my unconvinced NHS colleagues to accept this. The continuation of the current approach, which forces junior HCPs to make a binary choice of one or the other, is having catastrophic effects on the NHS.
The aesthetics industry also has much to lose from the perpetuation of the current training pathways available for the next generation of injectors. The standard of existing training providers and courses demonstrates wild variation, with knock on effects for both practitioners and patients.
Incorporating aesthetic education
Those arguing against amendments to incorporate aesthetics into undergraduate and junior training may say it is unethical and unwise to dedicate time or resources to a private field of practice. The idea of ‘promoting’ a non-NHS career to those undergoing training that is partially
NHS-funded seems counter-intuitive, and professionals may feel uneasy about dedicating time to aesthetics at the expense of teaching in areas tasked with saving lives and treating diseases.
These arguments fail to withstand basic scrutiny today. Doctors, dentists and nurses are leaving the NHS, be that to work abroad, take time out of training or pursue a full-time career in aesthetics.1 I would argue that we need to go further than finding a way to accommodate or tolerate dual careers; we should promote excellent levels of training in aesthetics, apply standardised pathways and extol the benefits of working in the NHS alongside working in aesthetics where professionals wish to do this.
Incorporating aesthetic education in early years training will not tempt HCPs away from the NHS. What we can do is promote dual careers in a positive way with an acceptance of reality – upcoming generations of HCPs are interested in aesthetics. They are interested in the clinical aspects, research opportunities, treatment innovations and potential to offer a fulfilling, financially rewarding and promoting career.
A clear training pathway
The solution is simple: standardised education and training in aesthetics, encompassing career pathways, ethics and regulation should be incorporated across junior training schemes. Getting early years training right is key to shaping our industry’s future and promoting patient safety. Achieving this requires collaborative working across the industry, with representation from training providers, regulated and statutory bodies, and stakeholders from the NHS and private aesthetic sectors.
This must not become an echo chamber consisting exclusively of existing proposals and ideas – controversial and novel ideas must be on the table.
Currently, postgraduate courses are available to those wishing to undertake further education in aesthetics. While these may be of value, it’s my view that they do not correspond with formal and recognised specialist training. As a trainee surgeon, I may choose to do a Master’s in Surgery, and I have a membership of the Royal College of Surgeons, but it is upon completion of a recognised national specialist training pathway with a Certificate of Completion of Training that I become a specialist consultant facial surgeon.
I accept this may be controversial, but I want aesthetics training to have parity with other fields of clinical practice.
A standardised programme could commence with exposure in the later stages of undergraduate training, focusing on ethics, regulation and the interplay with emergency medical, dental and nursing practice. There could be subsequent years of optional training that would be mandatory for anyone wishing to practise, with a minimum educational requirement, forming a core part of this.
In view of the introduction of a minimum educational standard and licensing scheme in England over the coming years, this approach will be important.2 Beyond the minimum educational requirement, there would be advanced practice modules, allowing individuals to become specialists after sufficient training and assessment.
A dedicated training pathway
Training pathway reform in aesthetics is overdue; getting training right at the early stages has an impact over the lifetime of a practitioner. Language use, qualifications, terminology and self-declared levels of practice create confusion for both practitioners and patients.
Moving towards an accepted training pathway that forms specialist practitioners, fit to face the challenges of an expanding and innovative industry will be beneficial to the specialty.
