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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 Aug 31, 2012

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The Seven Roles of Essential Competencies Mapped through Physical Therapy Clinical Education E. Chou, D. Lam, A. Leung, R. Truong, L. Wu, D. Dawes, S. Murphy University of British Columbia, Vancouver, BC Introduction  17 Performance Criteria of the PT-CPI Mapped to the 7 Roles of Essential Competencies  Methods  Phase 1: Mapping of PT-CPI Performance Criteria to PT Roles Delphi Method Experts selected •Academic faculty •PT clinicians •MPT students  17 of 24 performance criteria from the PT-CPI selected for mapping  Phase 2: Determining Change in Essential Competency Repeated cross sectional study design  420 PT-CPI forms from 2009-2011 UBC MPT cohort (n=70) digitally scanned  Data entry form created and tested  Role 1:  Role 2:  Role 3:  Role 4:  Role 5:  Role 6:  Role 7:  Expert  Communicator  Collaborator  Manager  Advocate  Scholarly practitioner  Professional  9. Critical Inquiry  Visual Analogue Scales measured  19. Resource Management  6. Communication  11. Examination  Legend:  Consensus reached?  Performance Criteria converted to Roles  Role scores analyzed YES  Descriptive statistics & paired t-tests  Results Phase 1: Mapping Participants (n= 19) •Academic faculty (n= 5) •PT clinicians (n= 9) •MPT students (n= 5) 2 rounds to reach consensus  2. Responsible Behaviour* 3. Professional Behaviour*  15. Education  14. Treatment/ Intervention  *  Red Flag Items from PT-CPI  PC #  PC mapped to several Roles  PC #  PC mapped to only one Role  Mean Role Scores for Placements 1 through 6  5. Legal Practice Standards* 22. Professional/ Social Responsibility  Mean Difference in Role Score, Placement 1 to 6  100  Role Pairs  Mean difference (mm)  SD  P  Role 1 vs. Role 2  9.23 (95% CI 6.98 – 11.47)  17.41  < 0.001  90  Role 1 vs. Role 4  10.47 (95% CI 5.79 – 15.15)  15.94  < 0.001  85  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 4  Role 2 vs. Role 4  17.13 (95% CI 12.01 – 22.25)  18.02  < 0.001  Role 6  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  95  Role 1  80  Role 2  75 70  Role 7  65 2  3  Placement  4  4. Ethical Practice Standards*  5  6  Paired t-test between Placements 1 and 6 mean scores are statistically significant (p< 0.001) for each Role  Discussion  (≥75% agreement)  Mapping completed  23. Career Development  Performance Criteria (PC) that were mapped to Roles  Analyzed mapping responses NO  1. Safety*  Consensus Not Met (<75%)  8. Individual/ Cultural Differences  13. Plan of Care  9. Critical Inquiry  Consensus Met (≥ 75%)  7. Documentation  12. Evaluation/ Dx/Prognosis  1  Mapping forms and instructions prepared and distributed  3. Professional Behaviour*  1. Safety*  Mean Role Scores from PT-CPI (mm)  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 2: Determining Change 381 PT-CPI forms from students (n=65) were analyzed Inter-rater reliability for data entry Cronbach’s alpha = 0.98  Objective 1:  Objective 2:  Objective 3:  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  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  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  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.  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.  

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