ADVANCED PRACTICE


A consistent finding across the study was that biomedical scientists view the potential of advanced practice positively, recognising its


potential value for patient care, service delivery, and professional development


biomedical scientists, (n=73) across the UK to examine the extent and relative importance of identified themes. The integration of qualitative and quantitative data allowed both depth of understanding and broader generalisability.12 The Theoretical Domains Framework


provided the analytical structure for the study, enabling consideration of influences beyond individual knowledge and skills, and incorporating organisational, environmental, and social determinants of behaviour.9,10


Strong convergence between


qualitative and quantitative findings, identified using Farmer’s triangulation, strengthened the robustness of the conclusions.13


‘glass ceilings’ within their organisations, while others highlighted the absence of structured career pathways beyond senior roles. Importantly, these perceptions were not confined to early career staff but were also evident among more experienced practitioners, suggesting that uncertainty persists throughout the career trajectory. The emotional consequences of


This article will explore the


four key themes identified by the mixed methods study.


Theme 1 Advanced practice does not feel achievable


A consistent finding across the study was that biomedical scientists view the potential of advanced practice positively, recognising its potential value for patient care, service delivery, and professional development. However, this enthusiasm was tempered by a widespread perception that access to advanced practice is difficult and, for many, not clearly achievable. Participants across all career stages


described uncertainty regarding progression routes. There was often limited clarity about the qualifications required, the competences expected, and the opportunities available within their organisation. In many cases, advanced practice was perceived as dependent on local circumstance rather than transparent or standardised career planning. This lack of clarity contributed to a sense that progression beyond senior biomedical scientist level was neither predictable nor equitably accessible. The perception of limited opportunity


was reinforced by reports of few available advanced practice posts and high levels of competition for progression. Some participants described the existence of


these experiences were also evident. Participants frequently described frustration and reduced confidence in their ability to progress, despite sustained motivation and commitment to advanced practice. Quantitative findings supported these observations, with environmental context and resources emerging as the most influential behavioural domain. Geographic variation, limited availability of posts, insufficient succession planning, and restricted organisational resources were consistently identified as key barriers. Taken together, these findings suggest that perceptions of achievability are shaped less by individual capability and more by structural and organisational constraints.


Theme 2 Organisational culture


Organisational culture emerged as one of the most significant determinants of access to advanced practice. Participants described workplace culture as having a substantial influence on whether professional development was enabled or constrained, extending beyond interpersonal relationships to include leadership behaviours, workforce pressures, and institutional priorities. In some cases, participants reported


highly supportive environments in which medical consultants and senior colleagues actively facilitated progression. This support included access to training opportunities, encouragement to pursue postgraduate qualifications, and the provision of mentorship. Such environments were associated with positive experiences of career development and increased confidence in pursuing advanced practice. However,


24 WWW.PATHOLOGYINPRACTICE.COM October 2026


these positive experiences were not universal. Many participants described environments characterised by workforce shortages and sustained service pressures, which limited the capacity of departments to support training and development. Even where willingness existed among senior staff, operational demands often restricted their ability to provide supervision or release staff for study. Variability in access to study leave, funding, and protected development time was a recurrent theme. Some organisations provided structured financial and educational support, while others offered minimal assistance. This inconsistency contributed to inequitable access to advanced practice across different regions and employing organisations. Succession planning was similarly variable, leading to uncertainty regarding future opportunities and a lack of visibility around long-term career development. This prompted emotionally charged responses from some participants, for example: “Don’t even get me started about funding and pathology because I literally could cry. I feel like I am banging my head against a brick wall.” The survey findings strongly reinforced the importance of organisational culture. Environmental context and resources again emerged as the most influential domain, with respondents identifying inadequate funding, limited succession planning, and inconsistent managerial support as major barriers. These findings indicate that organisational culture is not merely a background influence but a central determinant of whether advanced practice pathways are accessible in practice.


Theme 3 Titles and scope of practice need to be clarified This theme was defined by the lack of clarity surrounding the definition and scope of advanced practice within biomedical science. Participants consistently reported uncertainty regarding what distinguishes advanced practice roles from existing senior biomedical scientist positions, as well as variability in how such roles are implemented across organisations. This ambiguity extended to questions of professional identity. While participants generally supported the expansion of biomedical science into advanced practice, they also emphasised the importance of maintaining a clear scientific identity. Concerns were raised that increasing clinical responsibilities could blur professional boundaries or diminish the distinct contribution of biomedical scientists within multidisciplinary teams.


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