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Competency-Based Education in Physical Therapy Education:  An Update on Opportunities Being Considered Through the Education Leadership Partnership


Recording of the Webinar: This webinar was held on July 30, 2019.  Here is the link to the recording that we invite you to listen to and share.  You'll find more on this topic at ELC and we hope you'll register to attend!

Description: The purpose of this presentation is to share current opportunities for competency-based education (CBE) being explored collectively by the Academy of Physical Therapy Education, the American Council for Academic Physical Therapy, and the American Physical Therapy Association through the Education Leadership Partnership (ELP or partners).  This presentation will include: background information on why the partners are exploring opportunities related to CBE (too much unwarranted variation, needing to meet societal needs); activities and information used to facilitate consideration of CBE frameworks by the physical therapy education community; current work; and a tentative plan for future action.  A significant amount of time will be dedicated to questions from attendees.

Presenters : Jean Fitzpatrick Timmerberg, PT, PhD, MHS and Steven B. Chesbro, PT, DPT, EdD 

Background: The ELP accepted the APTA Board of Director’s request to facilitate the development of a long-term strategic plan for education, and chose to combine elements of the recommendations adopted from the Excellence in Physical Therapy Education Task Force (EETF) and Best Practices for Physical Therapist Clinical Education Task Force (BPCETF) reports in its approach. These combined elements resulted in the development of 4 thematic areas: (1) Education Research; (2) Outcomes, (3) Essential Resources, and (4) Academic-Clinical Partnerships. The ELP also agreed that a fifth component, clinical education, should be infused throughout the strategic planning process, rather than being compartmentalized, and that any strategic plan for the future of physical therapy education should consider the entire learner continuum (eg, professional education, post professional education, board certification, practice). The ELP choose a phased approach to developing a long-term strategic plan. Strategy meetings were held for the education research component in January 2017, and clinical education in October 2018. This presentation will describe the outcomes strategy meeting held in April 2019. The strategy meetings for Essential Resources and Academic-Clinical Partnerships are scheduled for September 2019 and April 2020. Following the completion of the 5 strategy meetings, the ELP will have a culminating strategic planning meeting where the findings from the strategy meetings, and any new work completed since, will be considered in the development of a long-term strategic plan for physical therapy education. 
One of those recommendations of the EETF suggested, "that a concise set of outcome competencies for physical therapist graduates be identified and adopted." Subsequently, a paper published by the ACAPT Education Research Task Force suggested the need for the profession to, "Develop a robust, longitudinal set of professional competencies." Consideration of using a competency-based education approach has been a focus of both the Education Research Strategy Meeting and the Clinical Education Strategy Meeting, which resulted in a publication in PTJ, a live/recorded webinar, a series of focus groups, and two national presentations. 
Many competency-based education frameworks have been adopted by health professions education groups around the world. While it became clear that physical therapy should not adopt a framework or frameworks just because another group had done so, a question that developed was, “If the physical therapy profession were to move toward a model of competency-based education, what developmental framework(s) would be most appropriate for the physical therapy profession to utilize?” Building on an established framework, “What are the performance expectations of a physical therapist at various points along the continuum of learning?” Establishing specific points in time along the continuum, in particular entrance into clinical practice, would allow the profession to work from that reference in different directions of learner development. Development of a research agenda for education researchers is a critical element in this transformative work that will explore critical questions about learners, the learning process, curricula, faculty development, outcomes assessment, program evaluation, and institutional and organizational structures. The opportunity to develop both a theoretical and practical body of knowledge that is related to the profession’s work in competency-based education is timely and essential. 
The purpose of this Outcomes Strategy Meeting was to discuss the benefits and challenges of developmental frameworks and utilizing this information: (1) Identify a possible competency framework(s) to meet the needs of the profession, and (2) define outcomes of learners entering into practice that are essential to develop PTs who will meet societal needs. While the scope of this meeting may appear narrow in the context of all potential applications along the physical therapy learner continuum, the intent was to focus efforts on some very important foundation components of a potential transition to a competency-based education approach. 
Method: Twenty-three physical therapists representing academic institutions and clinical sites across the nation were invited by the ELP’s Outcome Strategy Meeting Planning Committee, nominations provided by ELP partners and participants, to attend the 2-day meeting. Participants were intentionally selected to ensure broad stakeholder representation, including those of deans, program directors, directors of clinical education, academic faculty, clinical faculty, site coordinators of clinical education, PTA education, and employers. Twenty-six percent of the group were Board Certified Clinical Specialists. Participants were asked to read a series of related articles and reports to prepare them for the meeting. Dr. Carrie Chen, Associate Dean of Assessment and Educational Scholarship and Professor of Pediatrics at Georgetown University School of Medicine facilitated the meeting. 
The meeting included foundational presentations on: the impetus for change in other health professions, competency-based education, key terminology, and various developmental frameworks that have been used by health professions around the world to define outcomes of learners. Participants worked in both small and large groups to explore 6 models and discussed the benefits and challenges that each model might bring if the physical therapy profession chose to move in that direction. The group used a similar process to begin thinking about what competencies physical therapists entering clinical practice should be able to do. Finally, participants engaged in a facilitated discussion about research questions that might need to be considered and pursued as the profession considered its opportunity to purse a competency-based education approach. 

Results/Outcomes: After many rounds of discussion, the participants came to consensus that identifying standards of performance for physical therapists at various points along the continuum of learning would be helpful for all stakeholders. The standards of performance may: 

1. Assist students in understanding what is expected of them and if they didn’t meet the standards there could be focused instruction and learning to foster their development
2. Assist academicians in designing curriculum to allow students to achieve the standards as well as design remediation for those who need additional support to reach that point.

3. Allow clinicians to feel comfortable that all students, regardless of what program they come from, will have demonstrated competence in the identified standards of performance. This will allow clinicians to design appropriate workplace learning activities and feel comfortable that students will be safe working with patients on particular activities.

Participants felt that a combined framework of Entrustable Professional Activities (EPAs) and Domains of Competence (DOC) would be most beneficial for the physical therapy profession. EPAs are observable and measurable concrete clinical activities that represent the day to day work of a professional that require proficiency in multiple competencies. They should be executable within a given time frame and completion of the activity leads to a recognized outcome. These professional practice activities can be “entrusted to a sufficiently competent learner or professional.” DOCs offer a more analytical approach to defining outcomes that would be helpful when attempting to delineate where a student may be actually having a challenge and require some remediation. After examining different domains of competence utilized in numerous health professions, participants indicated that the domains utilized by Canadian physiotherapists aligned best with the physical therapy profession. The group felt that slight modifications to the Canadian PT DOC would be needed. 

Participants began to develop a list of the EPAs they felt represented what physical therapists entering practice should be able to do. Thirty-six items were generated from all of the small groups and the facilitator placed those identified in one of three categories: patient evaluation and management, additional direct patient care activities, and other related patient care activities. In small groups, participants selected a suggested EPA and used the Equal rubric (Taylor D, 2017) to evaluate the draft for quality and structure. 

Next Steps:
A call for volunteers to serve on an EPA panel, DoC panel, Research Panel, or Communications Panel was sent to participants of the Outcomes Strategy Meeting, with a deadline of April 25, 2019.  There was a sufficient response to have an appropriate number of individuals in each panel; however, due to a desire to have more clinician involvement on the DoC panel, three clinical community partners (who also served on the planning committee) were invited to serve.
A “next steps” planning call was held on April 26, and the following was determined:
  1. That an executive summary should be prepared, along with a PowerPoint Presentation, and submitted to the ELP for review and comment at its meeting scheduled for May 10, 2019.
  2. That a more detailed Outcomes Strategy Meeting update should be provided at the June face-to-face meeting.
  3. A modification in the proposed stakeholder feedback process was recommended based on the outcomes of the meeting.   The revised strategy includes continuing with the 90 minute session at NEXT, focusing on the ELP’s phased approach to developing a long-term strategic plan for physical therapy education including a focus on CBE from the Education Research Strategy Meeting, Clinical Education Strategy Meeting, and Outcomes Strategy Meeting.
  4. Recommended leads for the panels were identified, as well as a first draft of panel assignment.
  5. A timeline for the work of the panels was discussed.
  6. A framework for guiding the work of the panels was discussed.
  7. Per a recommendation of the meeting’s facilitator, an email will be sent to Dr. Bob Englander, who co-facilitated an EPA webinar for the ELP in April 2018, to ask for feedback on our plans.  Dr. Englander was a facilitator of the Association of American Medical Colleges EPA development, and will be a valuable resource if he is able and willing to assist.
  8. The tentative plan is to:
    1. Use panels to draft a first set of EPA’s (anticipate 6 month from start),
    2. Refine the Canadian Physiotherapy DoC (anticipate 3 month from start),
    3. Draft a research agenda, and  (anticipate 2 months from start)
    4. Create a communications/launch strategy (ongoing, with a launch at NEXT presentation).
    5. Significant discussion with Dr. Englander will include the use of videoconferencing as an approach to panel work.  
  9. Delphi studies will be initiated following the work of the EPA and DoC panels.
  10. To ensure transparency, a regular update on these activities will be provided to the ELP.  A revised stakeholder feedback plan will be developed as the work evolves.  There is a recommendation that the outcomes of this work be published as soon as possible, whether in a self-published monograph, or some other form, and be provided to the ELP ahead of their culminating strategic planning meeting tentatively scheduled for October 2020.   

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