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The Seven Roles of Essential Competencies Mapped through Physical Therapy Clinical Education Chou, Emily; Lam, Daniel; Leung, April; Truong, Richard; Wu, Lily 2012-08

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Introduction The Seven Roles of Essential Competencies Mapped through Physical Therapy Clinical Education Discussion Methods Conclusions Clinical placements enhanced the students' essential competencies in 5 Physical Therapist Roles.  PT-CPI may not capture students’ performance across all Roles.  PT-CPI may require revision to align with the ECPPC. The purpose of this study was to evaluate change in MPT students' essential competencies during clinical placements. Objectives: 1. To map the Physical Therapist Clinical Performance Instrument (PT-CPI) to the seven Physical Therapist Roles 2. To determine if the essential competencies of MPT students change during clinical placements 3. To estimate which Physical Therapist Role(s) demonstrate the greatest change from the first to sixth clinical placement Study population and tools: UBC Masters of Physical Therapy (MPT) students •Completed 26-month program with 6 five-week clinical placements Physical Therapist Clinical Performance Instrument 1997 (PT-CPI)1 •Used by clinical instructors to evaluate MPT students’ performance •Used a Visual Analogue Scale (VAS) for the 24 Performance Criteria Essential Competency Profile for Physiotherapists in Canada 2009 (ECPPC)2 •Described 7 Roles in which PTs must demonstrate competence Phase 1: Mapping of PT-CPI Performance Criteria  to PT Roles Delphi Method Phase 2: Determining Change in Essential Competency Repeated cross sectional study design Objective 1: Performance criteria were not equally distributed across Roles: •There was an over- or under-representation for specific Roles •Performance criteria may be redundant and/ or they may be comprehensive in capturing different aspects of the Roles Roles 3 and 5 were not represented: •PT-CPI does not inform whether students gained competency in these Roles Objective 2: All Roles changed significantly (p= 0.05) •Clinical education may have a positive change in MPT students' essential competencies •Similar trends of improvement in mean scores across the 5 Roles Greatest improvement from placement 1 to 3, with little variation from placement 3 to 6 •PT-CPI  and/ or clinical placements may have a ceiling effect3,4,5 Objective 3: Role 1 showed greatest change in competency •Involves clinical skills that are developed throughout clinical education Roles 2 and 7 showed the least change in competency •Encompass attributes developed prior to placement 1 Role 1 had statistically significant change  in competency as compared to Roles 2 and 7 •Clinical education may help students to improve specific Roles  more than others References 1. American Physical Therapy Association. Physical Therapist Clinical Performance Instrument. 4th ed. Alexandria, VA: American Physical Therapy Association; 1997. 2. National Physiotherapy Advisory Group. Essential Competency Profile for Physiotherapists in Canada. 2009. 3. Proctor PL, Dal Bello-Haas VP, et al. Scoring of the physical therapist clinical performance instrument (PT-CPI): analysis of 7 years of use. Physiotherapy Canada. 2010;62(2):147-154. 4. Straube D, Campbell SK. Rater discrimination using the visual analog scale of the physical therapist clinical performance instrument. J Phys Ther Educ. 2003;17(1):33-38. 5. Adams CL, Glavin K, et al. An evaluation of the internal reliability, construct validity, and predictive validity of the physical therapist clinical performance instrument (PT CPI). J Phys Ther Educ. 2008;22(2):42-50. Participants (n= 19) •Academic faculty (n= 5) •PT clinicians (n= 9) •MPT students (n= 5) 2 rounds to reach consensus Results 17 of 24 performance criteria from the PT-CPI selected for mapping Experts selected •Academic faculty •PT clinicians •MPT students Mapping forms and instructions prepared and distributed Mapping completed Analyzed mapping responses Consensus reached? (≥75% agreement) YES NO 381 PT-CPI forms from students (n=65) were analyzed Inter-rater reliability for data entry Cronbach’s alpha = 0.98 Role 1: Expert 1.   Safety* 9.  Critical Inquiry 11.  Examination 12. Evaluation/       Dx/Prognosis 13. Plan of Care 14. Treatment/       Intervention Role 2: Communicator 7. Documentation 6. Communication 3. Professional  Behaviour* 8. Individual/ Cultural Differences 15. Education Role 3: Collaborator Role 4: Manager 22. Professional/   Social Responsibility Role 5: Advocate Role 6: Scholarly practitioner 9. Critical Inquiry 23. Career  Development Role 7: Professional 1. Safety* 5. Legal Practice     Standards* 4. Ethical Practice     Standards* 3. Professional     Behaviour* 2. Responsible     Behaviour* 19. Resource   Management Consensus Met (≥ 75%) Consensus Not Met (<75%) Red Flag Items from PT-CPI * Legend: Performance Criteria (PC) that were mapped to Roles PC # PC # PC mapped to several Roles PC mapped to only one Role Phase 1: Mapping 65 70 75 80 85 90 95 100 1 2 3 4 5 6 M e an  R o le  S co re s fr o m  P T- C P I ( m m ) Placement Role 1 Role 2 Role 4 Role 6 Role 7 Paired t-test between Placements 1 and 6 mean scores are statistically significant (p< 0.001) for each Role E. Chou, D. Lam, A. Leung, R. Truong, L. Wu, D. Dawes, S. Murphy University of British Columbia, Vancouver, BC Visual Analogue Scales measured Data entry form created and tested Descriptive statistics & paired t-tests Performance Criteria converted to Roles  Role scores analyzed 420 PT-CPI forms from 2009-2011 UBC MPT cohort (n=70) digitally scanned Role Pairs Mean difference (mm) SD P Role 1 vs. Role 2 9.23   (95% CI 6.98 – 11.47) 17.41 < 0.001 Role 1 vs. Role 4 10.47 (95% CI 5.79 – 15.15) 15.94 < 0.001 Role 1 vs. Role 6 3.12   (95% CI 1.24 – 7.49) 20.34 0.158 Role 1 vs. Role 7 12.79 (95% CI 10.32 – 15.25) 20.23 < 0.001 Role 2 vs. Role 4 17.13 (95% CI 12.01 – 22.25) 18.02 < 0.001 Role 2 vs. Role 6 10.67 (95% CI 6.66 – 14.67) 19.12 < 0.001 Role 2 vs. Role 7 5.47   (95% CI 3.25 – 7.70) 16.88 < 0.001 Role 4 vs. Role 6 0.35   (95% CI 4.58 – 5.29) 16.80 0.886 Role 4 vs. Role 7 10.47 (95% CI 5.79 – 15.15) 15.94 < 0.001 Role 6 vs. Role 7 12.27 (95% CI 8.82 – 15.72) 16.58 < 0.001 Phase 2: Determining Change 17 Performance Criteria of the PT-CPI Mapped to the 7 Roles of Essential Competencies Mean Role Scores for Placements 1 through 6 Mean Difference in Role Score, Placement 1 to 6


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