Competence. It’s a word that gets thrown around often, both by physiotherapists and by regulators. What does it mean to be competent? Is competence a binary state: competent/not competent? How does a person’s competence relate to their individual scope of practice? To the profession’s scope of practice? The College’s Continuing Competence Program arises from the legislated responsibilities of the College, established in the Health Professions Act, but is that the only reason why the College has a Continuing Competence Program?
Defining Competence
According to the Health Professions Act, “’competence’ means the combined knowledge, skills, attitudes and judgment required to provide professional services.” From the definition, we can see that competence involves not only what you know, but how you apply that knowledge when providing professional services.
The Competency Profile for Physiotherapists in Canada (2017) identifies the key competencies of physiotherapists across seven domains:
- Physiotherapy expertise
- Communication
- Collaboration
- Management
- Leadership
- Scholarship
- Professionalism
Importantly, the competency profile also identifies several entry-to-practice milestones. An entry-to-practice milestone is defined as “an ability that is expected of a physiotherapist at entry to-practice.” The existence of entry-to-practice milestones makes it clear that there are different abilities expected at different career stages. There is a continuum of abilities ranging from the minimum competences required at entry to practice to the refined abilities demonstrated by more experienced clinicians.
In other words, competence is not binary; it exists on a continuum.
Why?
The Continuing Competence Standard of Practice establishes the requirements to maintain the essential competencies outlined in the competency profile: participate in self-directed, life-long learning to maintain or acquire competence, and participate in the continuing competence program. The requirements of the Standard boil down to two foundational expectations:
- Maintain what you had at entry to practice
- Learn and develop as your practice evolves
The existence of the Standard and the Continuing Competence Program itself stem from the requirement that the College “must establish, maintain and enforce standards… of continuing competence…” for the physiotherapy profession. The Health Professions Act requires that the College develop a continuing competence program that provides for physiotherapists to “maintain competence and to enhance the provision of professional services.”
Beyond this legislated requirement, the College, like physiotherapists, cares that physiotherapists have the knowledge, skills, attitudes and judgment to practice safely and provide quality, effective physiotherapy services to Albertans. We know that the vast majority of physiotherapists take steps to learn and develop their skills on an ongoing basis.
The Connection Between Competence and Scope of Practice
The scope of practice for the profession of physiotherapy is broad and includes a wide range of practice settings, populations, and treatment techniques. At entry to practice, physiotherapists have basic skills across much of this breadth of practice. However, as they gain experience, most physiotherapists narrow the focus of their individual practice to a particular setting, population, or subset of treatment techniques. In this way, a physiotherapist’s individual scope of practice is typically smaller than the scope of practice of the profession.
Importantly, physiotherapists are required to limit their individual practice to those activities that they are competently able to perform. In this way, an individual physiotherapist’s competence dictates their scope of practice. Sometimes a physiotherapist’s individual scope will be quite large and mirror or nearly mirror that of the entire profession. In other cases, a physiotherapist may focus heavily on a narrow area of practice, developing highly refined skills in that area. Their individual scope may be quite narrow, but their expertise is highly developed within that scope.
Some physiotherapists work well within the borders of what is considered “typical” physiotherapy practice, while others may practice closer to the boundaries of what is considered “typical” physiotherapy practice. Knowing where the boundary between what is and what is not in scope for the physiotherapy profession is essential, particularly for those who practice close to that boundary.
Gaining Competence. Does One Size Fit All?
Courses are certainly one way that a person can gain competence and new skills. Some physiotherapists and organizations advocate for mandatory course completions and a specified number of clinical education hours as elements of continuing competence programs. However, if you’ve ever seen someone nod off at a course or sneak out early to see the sights of a conference host city you know that attendance at a course or conference, in and of itself, does not guarantee learning.
To be fair, there are times when course attendance is necessary. For example, if a physiotherapist wants to learn how to perform technical skills that involve physical performance of the skill, such as spinal manipulation or dry needling, they need to attend a course and actively participate in the lab/skill development portion of the course. The CPTA’s Continuing Competence Program clearly enables this type of activity.
However, the College’s view is that courses are not the only way to gain competence, especially when we consider that competence is not just about technical skills but also about knowledge, critical thinking and professional judgment. There are a multitude of other options available for competence development that fit the requirements of the Continuing Competence Program, such as taking part in peer evaluations of an aspect of practice, being part of a community of practice, mentoring other physiotherapists, or being part of a journal club.
Physiotherapists who prefer to attend courses and track the number of hours they spend on course work are able to do so. But one size does not fit all, because:
- Physiotherapists learn in different ways.
- A physiotherapist’s learning needs and, therefore, their learning activities evolve as they progress through their career.
- Different roles have different demands and different resources available to support professional development.
- Some learning objectives don’t pair well with a course environment but are still essential for the learner.
- Learning is not only about new knowledge and skills. It can also be about refining practices or reflecting on critical thinking and decision making.
The important part is not what you did, but rather what you learned. Specifically, how you made sense of what you learned and applied that learning to your practice. Without application to practice, no amount of additional course work will make any difference at all to patient outcomes.
What About the Role of Experience?
Experience counts when it comes to maintaining skills and competencies. Much of what physiotherapists do in their day-to-day work involves the use of technical skills that are best maintained through routine use. That’s why the CPTA tracks practice hours and there is a requirement for a minimum number of practice hours during a five-year period.
However, the type of experience you are accumulating matters. Are you reviewing and reflecting on your patient outcomes, adapting your practice, and assessing the effects of those changes? Or are you on autopilot, following the same processes and approach year in and year out?
“Unreflective accrual of experience does not result in practice improvement;” data collection, analysis, intentional action, and reassessment does. That’s why experience alone is not enough to fulfill the requirements for the Continuing Competence Program.
Conclusion
Respect for physiotherapists’ inherent motivation to learn and improve led to the development of a flexible Continuing Competence Program that recognizes that one size does not fit all when it comes to professional development and continuing competence. One that allows physiotherapists to choose the self-selected activities that best address their learning needs – whether that’s taking a course to qualify for a new authorization or completing an audit to review an aspect of practice and how they can improve.
Leanne Loranger, PT, Manager Policy and Practice
