Training Courses in Medical Aesthetics

By Dr Tristan Mehta / 21 Jun 2016

Dr Tristan Mehta discusses how to successfully create and run a training course in medical aesthetics

How to improve training standards is probably one of the most important issues facing the medical aesthetics specialty to date. As with any medical field, high quality education is necessary to ensure that evidence-based knowledge ingrains into our practice. Training should challenge attendees to continuously advance their own knowledge and understanding, and keep the influence of manufacturers at an academic distance.

Given the exponential growth of aesthetics (£2.3 billion in 2010, and estimated at £3.6 billion in 2015)1 – with new technologies and changing regulations being announced every year – education is more important than ever. However, rapid expansion also brings with it inherent challenges. How do we keep training both relevant and impartial in such a fast-paced specialty? In this article I will look at how to deal with the greatest opportunities and challenges facing aesthetics training today.

The landscape

Medical practitioners are comfortable with formal training programmes, learning outcomes and assessments. We often crave this format of learning because this is how we learnt at university. As we are all aware, however, there is currently no standardised formal training programme in medical aesthetics. So what framework can we use to further our education? Non-surgical aesthetic treatments can be split into four main categories:

  1. Injectable treatments
  2. Energy-based treatments
  3. Skin and tissue rejuvenation
  4. Emerging and novel treatments, e.g. thread-lifts

Within each of these categories, we are seeing various types of course providers. The recent popularity of devices and machines is maligned more than any other field by the fact that training is almost exclusively run by manufacturers for their own devices. Pharmaceutical companies initially ran their own training courses for injectables, but as the industry grew, there became an emerging market for independent, or semi-independent ‘weekend courses’. Several universities now run much lengthier and more formal postgraduate qualifications, which aim to give practitioners a wide scope of knowledge in the various aesthetic modalities – for a considerable cost.

Entering the market

The decision to launch a new training course in aesthetic medicine should be influenced by a few important factors:

  • What is your area of expertise?
  • Where is the current market need?
  • Where might the market need be in the future?
  • What competition is there? Which locations do they cover?
  • Are there any regulatory frameworks that should be considered?
  • What are the relevant recommendations from professional councils, e.g. the General Medical Council, General Dental Council, Nursing and Midwifery Council, General Pharmaceutical Council?
  • What will be the mode(s) of delivery and duration of the course? 
  • How will this differ from what is currently on offer?
  • Can you obtain approval from an insurance company to run your course?

Let us take the example of injectables training (botulinum toxin and dermal fillers). When searching online for ‘Botox training,’ more than 80 courses show up. What might make yours unique?

Given the prevalence of one or two-day courses, you might focus on making the duration of your course different. Perhaps you are able to produce a more rigorous, or a better value course by offering more time with delegates. Alternatively, you might want to focus on a specific healthcare group, such as pharmacists, who have different educational requirements from doctors, for example.

As our sector rapidly changes, the training course launched must remain congruent with emerging trends and treatments. Some examples of change-resistant training initiatives do not focus on specific treatments; for example, anatomy courses or business support/marketing courses are relatively well ‘future-proofed’.

Regulation and accreditation

Regulation is an increasingly hot topic in medical aesthetics – and for good reason: there is no other field in healthcare with so few legal or regulatory restrictions on who may perform treatments.1 Following the controversial 2013 review by Sir Bruce Keogh,1 Health Education England (HEE) conducted a consultation with an expert reference group in 20152 and 2016.3

The key outputs from HEE for training courses are:

  • Training providers should offer postgraduate-accredited training courses, with higher-education standard theoretical learning content and a set number of treatments required under supervision
  • The new qualification requirements apply to all practitioners, regardless of previous training and professional background
  • Practitioners who have already completed training will be able to apply for formal recognition of this from an accredited cosmetic training provider, preventing the need to undertake any unnecessary further education
  • Very short courses, e.g. one-to-two days in duration, will not meet the requirements for Recognition of Prior Learning. This poses a dilemma for the majority of practitioners in our industry, given that the vast majority of training has been delivered over a weekend
  • A joint council is to be formed, which will take ownership of cosmetic industry standards for education and training

HEE offers recommendations, not regulation, however they are just as important. Its 2016 report states, “Although adoption of the new requirements will be voluntary at this stage, it is recommended that the qualification requirements be adopted as best practice and accepted as the standard that the industry should adopt improve public safety and raise standards of practice and professionalism.”3

Running ‘basic’ and ‘advanced’ versions of the same course has also taken some criticism, often seen as an excuse for course providers to make further money from their customers. The GMC has published draft guidelines for doctors offering cosmetic procedures,4 which state that supervised practice is required before entering aesthetics as a doctor. In the same guidelines, the GMC supports the HEE recommendations for training and qualification requirements.

Ultimately (and perhaps unfortunately), insurance companies are currently effectively the only regulators of training in our industry. Any course must be approved by an insurance company if it is to engender new skills to the practitioners.6

Accreditation

Given that nurses are now required to revalidate each year,5 CPD points are an increasingly valuable asset. Application for CPD accreditation can be made through the CPD Certification Service website or other CPD accreditation providers. Having your course CPD accredited can make it more appealing to those practitioners who seek funding to attend your course.

Ofqual (Office of Qualifications and Examinations Regulation) regulates qualifications, examinations and assessments in England. Most recognised qualification e.g. A Levels and NVQs are regulated by Ofqual. Training centres can work with awarding bodies to directly accredit their qualifications with Ofqual, although this process is typically lengthy and will require months of qualification development.

Costs

There are several costs associated with setting up a training course that need to be considered. These include:

  • Medical malpractice insurance and product liability insurance (around £2,000)
  • Marketing (variable cost)
  • Venue hire (variable cost)
  • Clinical equipment e.g. product, consumables and a sharps bin/clinical waste bin (variable cost)
  • Trainer hire (variable cost)
  • Handouts and associated printing costs (variable cost) – note: pharmaceutical companies and manufacturers may be willing to team up with your course, if they can market their products and devices to your students
  • Refreshments and lunch (roughly £15-20 per delegate)

Initial setting up costs will vary mostly on the venue used and the modality, which is being trained, but on average, running your first training day may require an initial investment of more than £4,000. In order to make a profit margin of 20%, fees must cover 120% of the cost of running a course. For example, if your course costs £6,000 to run, then revenues of £7,200 must be made. Assuming you are taking eight students, this would require a student fee of £900 each. This is a fairly typical price for a training day in aesthetics.

Recruitment of ‘models’ can actually be a source of revenue for a training day, but come at the expense of a logistical headache. HEE Part 12 explains how it is acceptable to offer promotional discounts on aesthetic treatments on the basis of medical education. The difficulty is not gathering the volume of patients; but in fact ensuring they are appropriate for the aesthetic treatment in question. Each patient or ‘model’ as some courses call them – will need to be screened prior to the training day, to ensure there are no medical contraindications.

Spread the word 

In a highly competitive market, how can we get the attention of our customers? Our digital connectivity has significantly reduced the cost of marketing – any course can reach out to thousands of practitioners with a website and social media.

Trust and transparency

As a result of this online accessibility, the playing field is now level, so what matters the most? Trust, leadership and transparency. Success now is not dependent on being the low price leader, but the high trust leader. Price is no longer our strongest negotiating tactic – we are drawn to transparency. Reviews and referrals are of utmost value so ensure you ask all students to write a short testimonial or fill in a feedback form that can be used in future marketing upon completion of your course. Ensure the students have given permission for you to use their name and/or feedback for this purpose prior to sharing any information. For the first course, it may be worthwhile asking a couple of colleagues or industry peers to provide a written or filmed recommendation to aid your marketing tactics.

In a professional arena, it is important to resist making meaningless claims such as ‘The UK’s Number 1 Course’. Claims like this are patently unfounded, and trust is our most valuable commodity in business right now. Instead, think of creative and honest USPs to promote your training course.

Targeted marketing 

Training courses have the luxury of plenty of targeted advertising opportunities. Of particular value are the targeted monthly magazines and journals to specific healthcare groups. Direct paid advertising can be taken advantage of, alongside editorial opportunities. Google Adwords is another common paid-for tool for targeted marketing based on search keywords. Be aware that prescription-only medications such as botulinum toxin are disallowed from this.8 Social media marketing can also be highly effective in targeting specific healthcare groups, often requiring minimal amounts of investment. Letting the audience know that you are up-to-date will engender trust – and Twitter is the best option we have for this. Are you regularly Tweeting original content? It is also important to note that you should never buy Twitter or Facebook followers – it is often obvious that you have done so and, ultimately, you want to develop an engaged loyal audience over time. Industry conferences and exhibitions are also a great place to market your training course. We have more than five national industry exhibitions each year. These events are the perfect opportunity to build trust amongst your profession through networking, alongside marketing to new practitioners entering the specialty.

What makes a good training course?

  • Value for money
  • Accreditation (CPD or Ofqual)
  • Relevance in terms of technology or regulation
  • Small group sizes for practical sessions
  • Credible medical academic faculty with relevant training faculty
  • Centrally located or in a major city
  • Formal collaboration with recognised institutions

A one-day course schematic

  • 09:00 Ice-breakers
  • 09:10 Agenda
  • 09:15 Learning outcomes
  • 09:20 Initial theory
  • 10:30 Coffee break
  • 10:45 Further theory
  • 12:30 Hot lunch
  • 13:30 Practical session
  • 14:45 Coffee break
  • 15:00 Examination
  • 16:00 Certificates
  • 16:15 Feedback
  • 16:30 Up-sell further 

Practicalities and pitfalls

In my opinion, the future of theoretical learning is distance-learning via online education. The vast majority of practitioners enrolling onto your course will therefore be more excited about the practical elements as this is not something easily taught online – as such, the practical elements should be where your emphasis is. Furthermore, HEE recommends that at least 50% of a course should be dedicated to practical experience.2,3

Name

Basing the name of your training course (or clinic, for that matter) around your own name or reputation is a double-edged sword. On one hand, your credibility may bring in customers, especially if you have carved out a niche for yourself in a certain field or technique. However, you are exposing your personal brand to a large degree. Businesses are inherently risky and the unfortunate truth is that most businesses do not succeed, which may have an impact on the other business ventures you are running under your personal brand name.

Venue 

The venue for your course is an important decision. Will it be part of your existing clinic? What capacity do you require? Do you need to hire a Care Quality Commission (CQC) registered premises for the specific procedures you are offering training in?6 According to the CQC’s regulations, the premises where care and treatment is given must be clean, suitable and appropriately located; the equipment must also be clean and suitable for the purpose of the procedure and must be maintained, stored securely and used properly.7

Hiring premises can be difficult when starting out – the venue needs to be booked in advance, but you can’t guarantee that you will fill the space. As your course becomes more popular this becomes less of an issue. But when starting out, it is advisable to run with smaller group numbers and run the course through your existing clinic.

Delegate experience

Taking into account various practitioner backgrounds and experiences can be challenging. An experienced trainer will notice which delegates have more experience and tailor the teaching session accordingly. Some practitioners may need additional support and are usually not shy to get their money’s worth through taking the trainer aside when necessary. Trainers are encouraged to regularly ask learners whether they are keeping up and happy with the pace of learning.

Another inherent challenge to offering training to a wide multidisciplinary team is factoring in the undergraduate experience each group will have already had. Common undergraduate areas covered by all healthcare groups should include the patient consultation, health and safety, and ethics. HEE Part 12 breaks down the requirements for learning for each professional group, for example, clinical healthcare professionals such as doctors, dentists and nurses are not required to study certain areas already covered during their undergraduate years - for example, clinical governance and accountability and professionalism.

Conclusion

Running a training course in medical aesthetics is a very rewarding experience. The ultimate rewards lie in challenging yourself to stay up-to-date, whilst in the process making connections with, and leading, the next generation of practitioners. Of critical importance is ensuring your training course is future-proof, and right now this requires taking a serious look at the regulatory frameworks emerging in 2016. 

Disclosure: Dr Tristan Mehta is the founder of Harley Academy, a training centre, which awards accredited qualifications in aesthetics in-line with HEE guidelines. 


References

REFERENCES

1. Keogh et al. Review of the Regulation of Cosmetic Interventions’ Department of Health, (2013), <https://www.gov.uk/government/ publications/review-of-the-regulation-of-cosmetic-interventions>

2. Health Education England, ‘PART ONE: Qualification requirements for delivery of cosmetic procedures: Non-surgical cosmetic interventions and hair restoration surgery’; (2015)<https://hee.nhs.uk/sites/default/files/documents/HEE%20Cosmetic%20publication%20part%20one%20update%20 v1%20final%20version.pdf>

3. Health Education England (2016) ‘PART TWO: Report on implementation of qualification requirements for cosmetic procedures: Non-surgical cosmetic interventions and hair restoration surgery,’ <https://hee.nhs.uk/sites/default/files/documents/HEE%20Cosmetic%20publication%20part%20two%20update%20v1%20final%20version.pdf >

4. General Medical Council (2015) ‘Draft Guidance for all doctors who offer cosmetic interventions’ <http://www.gmc-uk.org/Guidance_for_all_doctors_who_offer_cosmetic_interventions_consultation_english__2__distributed.pdf_61281552.pdf>

5. NMC, Revalidation: Your step-by-step guide through the process, The Nursing and Midwifery Council (2016) <http://www.cosmetic-insurance.com/training/>

6. Care Quality Commission: Quick reference guide to regulated activities by type of service (2015) <http://www.cqc.org.uk/file/4792>

7. Care Quality Commission, ‘Health and Social Care Act 2008 (Regulated Activities) Regulations 2014,’ Regulation 15: Premises and equipment, <http://www.cqc.org.uk/content/regulation-15-premises-and-equipment>

8. ‘Healthcare and medicines,’ Google Advertising Policies, 2016 <https://support.google.com/adwordspolicy/answer/176031>

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