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Continuing Competence Initiative Being Piloted
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Continuing Competence Initiative Being Piloted - March 22, 2008 4:54:35 PM
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jma
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Happened to look at the new revised FSBPT website and came across these. I think everyone needs to read this. See below:
Opinions on this?
"Are You Ready for the PRT? Is Your Jurisdiction Ready?
One new instrument that is in development as part of the FSBPT continuing competence initiative is the Practice Review Tool (PRT). The first Practice Review Tool, which goes live in July 2008, is designed to cover general physical therapy knowledge. All physical therapists will then have the opportunity to purchase the tool to assess their current knowledge, skills and abilities.
What exactly is the PRT?
An exciting, new initiative created by the FSBPT to assist PTs in determining their ongoing competence.
A scenario-based, multiple-choice assessment that emphasizes clinical application of content knowledge. It will include 25 scenarios with four to six related questions with a total of 125 questions.
A tool delivered in a secure, proctored environment.
A scored assessment where the score is released directly to the licensee.
What can my state do to get ready?
The FSBPT will be piloting the PRT with eight states in the spring. The pilot states, that have the regulatory authority to do so, will be issuing pilot participants continuing competence/education credits. Once operational in July 2008, the FSBPT will recommend that states give full continuing competence/education credit for one licensure renewal cycle to PTs who take the PRT and meet the standard for minimal competence.
Does your jurisdiction have the regulatory authority to make use of this new tool? Now is the time to review your statutes and rules to determine if you are ready to give continuing competence/education credit for this new FSBPT offering. "
"The following article was developed from a session given by Mark Lane at the Federation’s 2007 Annual Meeting in Memphis, Tennessee.
Recently, I pulled out an old book that was given to me by my staff at Good Samaritan Hospital in Washington. It included memorabilia including an article I had written when I was Chapter President of the Washington State Physical Therapy Association. I had this great idea that we were going to establish an exam for competence assessment. It was something we really needed. You can imagine how the thought of an exam went over with members of the professional association. I felt like Hillary Clinton recommending healthcare reform back then.
I’ve been working with continued competence for a long time. It’s comparable to the search for the Holy Grail. It’s really an adventure and one of the most difficult challenges that we as regulators face. There is danger in our search for continued competence. There is intrigue. There is mishap. Yet we need to be moving forward into continued competence.
Perhaps it’s not as elusive as we think.
The Citizen Advocacy Center (CAC) had a summit a few years ago in San Francisco. It reported, Patients have every right to assume that a healthcare provider’s license for practice is the government assurance of his or her current professional competence and clinicians themselves would like assurance that those within the practice are current and fully competent.
Unfortunately, assurance of continued competence through relicensure is not the case. Certainly, entry-level competence is critical because that’s the gate to getting into the profession, but we have 15,000 - 17,000 new licensees every year. We also have more than 160,000 licensed practitioners. Once they get licensed, do we just let them go?
The 2003 Institute of Medicine report recommended that all health profession boards should move toward requiring licensed and certified health professionals to periodically demonstrate their ability to deliver patient care as defined by the five competencies identified by the CAC summit - patient-centered care, an interdisciplinary team, evidence-based practice, quality improvement and informatics.
The Citizen Advocacy Center’s vision has several important aspects.
There needs to be a regulatory mandate for demonstrating continued competence. It can change practitioner performance for the better and result in safer and higher quality care for the public.
There should be collaboration. A broadly-based collaboration of stakeholders is absolutely necessary for an effective continued competence program.
The purpose is to assure patient safety and improve the quality of healthcare practice - not to find “bad apples” among practitioners.
An evidence-based approach is essential. Research should be initiated that focuses on examining a link between periodic and continued competence, assessment and assurance and changes in behavior that leads to improved clinical outcomes.
It’s also the clinician’s responsibility. But continued competence programs should be designed as a positive development of the clinician’s career, not as an unwarranted intrusion or punitive burden. That’s one of the challenges we face.
The CAC developed a five-step model that makes a lot of sense.
Develop a routine periodic assessment.
Devise a personal plan.
Implement the plan.
Document the plan.
Demonstrate and evaluate competence.
Continuing education is not necessarily a good mechanism for assuring competence. CAC recommends that we revamp our continuing education programs. The purpose is not to throw out continuing education but to figure out how it fits into a model for continued competence. There is currently no assessment of needs and there is no final outcome in continuing education. Likewise, a test by itself is not the answer.
Research
If we are going to have a research agenda, continued competence should be at its forefront. CAC believes that initially we should conduct research to validate and compare competence assessments, assurance and methodologies. There is also opportunity to collaborate with other professionals in such research.
Enabling Legislation
CAC believes we should seek enabling legislation. I am very concerned about the number of states that do not have the statutory authority to implement continued competence requirements as opposed to continuing education. You will not have arguments from the legislators. You will not have arguments from external professions. You might, though, have some arguments from your own licensees who don’t want to have to do this.
Educating Students
We need to make sure that we are educating our students to understand that they have a professional obligation to maintain their competence.
Paying for the Program
The CAC makes a very strong case that licensees need to pay for this program.
Professional Acceptance
We now have much more professional acceptance than we ever had before. The work of the Pew Commission, CAC and other public interest groups has moved continued competence into the limelight. Legislators have moved it forward, as have all of the healthcare professions. And so it’s not so much whether to have a continued competence program; it’s how much work and effort might be involved to implement the program.
Purpose of Continued Competence Regulation
The bottom line is protection of the public. At times we are sidetracked, we have a reaction to something that’s happening and we create a regulation that’s not necessarily doing what we intended to do. So we have to be careful. Regulation for regulation’s sake is not where we want to go.
A Lack of Engagement
We should remember that the opposite of competence is not incompetence but its lack of engagement. When people start losing their competence, they start losing their currencies, they start becoming disengaged in their profession and in their work. So how do we keep physical therapists engaged? And why do they become disengaged? I think there are lots of reasons.
Trying to maintain a life balance is a challenge. Maintaining your practice, your office, your patient load and balancing that with raising a family, with your social obligation and church work sometimes becomes too much for people. They start evolving towards disengagement. A difficult healthcare environment leads to a lack of engagement. For example, all the requirements for documentation make it difficult to focus on treating patients. And there are few incentives to maintain engagement. Continued competence programs should encourage engagement.
Licensing Boards Have Ultimate Authority
In the end, licensing boards have ultimate authority for continued competence. But a collaborative approach dictates that there be an appropriate division of responsibilities and duties between licensing boards, accreditation and certification bodies, healthcare organizations and professional associations and societies in setting standards for continued competence assessment and assurance. While CAC believes these groups should work together, it is the state regulatory boards, as the entrusted entities legally responsible for public protection, which must have the last word on whether the process and outcome of a continued competence program, whether public or private, is serving the public interest well.
At the 1996 delegate assembly, Alabama moved that the Federation continue to address the issue of continued competence to practice physical therapy and report annually to the membership on the progress being made. A task force in 2000 provided the first Standards of Competence. In 2003, the delegate assembly amended the FSBPT vision statement to say that “state licensing boards and the Federation… would achieve a high level of public protection through a strong foundation of laws and regulatory standards in physical therapy, effective tools and systems to assess entry-level and continuing competence, and public and professional awareness of resources for public protection.” Several other motions followed in 2004.
2000 Continuing Competence Task Force Accomplishments
Let’s review the Federation’s 2000 Continued Competence Task Force’s accomplishments. They developed the following definition which was reviewed in 2006 and remains unchanged.
Continued competence is the ongoing application of professional knowledge, skills and abilities which relate to the occupational performance objectives in a range of possible encounters that is defined by the individual scope of practice and practice setting.
This definition does not say that if I am working in an orthopedic clinic, I need to maintain my competence in treating the neonatal infant. It refers to the possible encounters you are going to achieve based on your scope of practice. In an orthopedic clinic, I am not going to see a neonatal infant coming in.
The task force’s discussion paper provided these recommendations:
Reach agreement in principle on the need for proceeding with the development of a national model to assure continued competence
Adopt the definitions of competence and competence
Adopt the regulatory framework
Develop a process for further discussion
Develop a process to develop standards of competence
The task force also came up with some principles of an effective continued competence assessment system:
It should promote continued education and professional development through a physical therapist’s career, and use meaningful incentives.
It should provide the public, including employers, third-party payers and other healthcare providers, with a valid and reliable indication of the competence of licensees within their actual scope of practice.
It should be administratively feasible, affordable, and justifiable in economic terms.
It should incorporate requirements that are acceptable to the profession and based on a national level of evidence.
It should be updated to reflect changes in the scope of practice, occupational roles, technological and therapeutic environments and standards of practice and public expectations.
It should incorporate and encourage improvements in the technology of measurement and evaluation and be linked to disciplinary programs.
The Standards of Competence1
The Standards of Competence is a position statement of the Federation of State Boards of Physical Therapy. They were originally developed in 2000 by the task force and were reviewed and updated in 2006. They assert that it is a regulatory board’s responsibility in meeting its mission of protecting the public to develop standards and measures for assuring entry level and continued competence to practice physical therapy and to also require remediation for those who do not meet the established standards. The purpose of the Standards of Competence is to articulate a measurable degree of required performance for continued competence. Life-long learning includes development of knowledge, skills and abilities in order to meet current standards of practice.
The Standards of Competence fit in two domains.
Domain one is professional practice, which includes professional accountability, professional behavior and professional development. Some of these elements are not on the NPTE and cannot be tested via multiple choice questions. That’s why it’s important that we have a continued competence assessment program that includes tools related to this particular domain.
Domain two is patient-client management and includes examination, evaluation, diagnosis, the plan of care, implementation, the education of the patient and the family and the discharge - basically the patient treatment aspects.
Continued Competence Requires Assessment
The conclusions of the task force were that continued competence requires assessment. One has to make an assessment of competence before he or she can devise professional development or competence education.
Categories of Continued Competence Assessment Tools
The three categories of continued competence assessment tools include observation of performance, simulating a clinical situation and objective tests. Each has its validity, strengths and weaknesses.
Simulation, for instance, has a medium to high validity, while observation of performance has a high validity because you’re actually observing someone in the clinic. The task force recommended multiple approaches and tools in all three categories. And they ended up recommending some initial tools.
Competence Assessment Portfolio (CAP)
The Competence Assessment Portfolio (CAP) is a self observation of performance, but a lot more research needs to be done on whether this is an effective mechanism. CAP is not that complicated. It lets a person assess where he/she has been, look at where he/she is now and do a self-assessment of needs. The person knows where to focus, implements the plan and completes a learning tracker. Then it starts all over again.
Practice Review Tool
The Practice Review Tool (PRT) covers domains one and two and is designed to be an optional tool. We don’t call it a test. It’s an assessment tool. It is being developed in a secure environment as a multiple-choice tool based on clinical scenarios where people have to answer questions related to the scenario that’s presented. As opposed to the NPTE, where you have a brief scenario and four options, this would be a longer scenario with three to five questions based on that scenario. It would contain approximately a 100-120 questions to be given in a secure testing environment. There would be a performance feedback. The pilot will begin in January 2008 and probably conclude in May 2008. We are seeking volunteers to take this assessment tool and provide feedback.
Not Overly Burdensome
An important feature of a continued competence model is that it should not be overly burdensome to licensees. Licensees who already maintained their competence should be able to demonstrate their competence through mechanisms they are already using. The intent is to assure that people maintain their competence. If they are already doing it, that’s absolutely great.
A Variety of Vendors and Tools
It should be based on regulatory standards and be open to a variety of vendors offering continued competence tools. It should incorporate tools that account for variation in learning and skills and development styles.
Optional for Jurisdictions
It should be optional for jurisdictions and allow for jurisdiction variants.
Outcome Measures
Outcome measures may be a score on an assessment tool or a specialist certification. It may be a Practice Review Tool passing certificate, jurisprudence test passing certificate, a final evaluation or certificate of successful completion of a residency program, a learning planner and tracker from the CAP and/or a continuing education course. And it might be a structured mentorship review form. But every single tool would have some sort of outcome measures that would demonstrate that someone obtained the competence or had the competence.
The Licensee’s Responsibilities
The licensee’s responsibilities are to plan continued competence activities based on the requirement, submit an affidavit of compliance with continued competence requirements, maintain records of compliance including documentation of appropriate outcome measures and submit the appropriate outcome measures on request. The system could work very similarly to continuing education.
So what needs to be done? We need to:
Develop criteria for acceptable tools
Oversee, improve and develop a model
Determine tools to meet criteria
Review and modify the model that gets developed
Determine documentation requirements and outcome measures
Develop documentation outcome measurement tools and address any state-specific need
Develop a plan for audit that will not create undue burden on state boards
Develop an optional uniform plan for approval of continued competence tools
Review and revamp continuing education to make it more meaningful
Develop all the measures and quality improvement tools
Conduct research
On Monday, September 10, 2007, the 2007 Federation delegate assembly adopted Motion #DEL-07-08 on continuing competence that will begin to tackle those actions listed above. The motion reads,
“That the Board of Directors be charged to move forward with the development of a comprehensive continuing competence program in support of public protection to include, but not be limited to, the following components:
Continuing competence tools
A framework for integrating continuing competence tools
A comprehensive continuing competence certification program
Appropriate organizational structure. “
Perhaps this is not the search for the Holy Grail.
1The 2006 Standards of Competence can be viewed on the Federation’s public website, www.fsbpt.org. Click on Regulatory Tools/Standards of competence. "
< Message edited by jma -- March 25, 2008 4:25:18 PM >
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RE: Continuing Competence Initiative - March 25, 2008 4:21:58 PM
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jma
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For those that have read this, what do you think of the initiative. What would be your thoughts if this was accepted by your licensing board?
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RE: Continuing Competence Initiative - March 25, 2008 10:25:54 PM
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Tom Reeves DPT ATC
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First of all, I like the idea in theory. If it applies to family practice docs, then we could probably handle it. I almost never treat kids. Am I a pediatric superstar? no. Am I competent, probably. I occasionally treat neuro patients, frequently treat acute patients, and constantly treat ortho patients.
If a neuro PT, one who never or almost never deals with purely ortho patients takes the test, they are going to struggle mightily with the ortho part. What about school PTs? There are exceptions, but many have lost much of their ortho evaluation and plan development skills.
It looks like a good idea, lots of platitudes and good intentions, but it would be like giving a family practice competency exam to a cardiologist. I am guessing they are not fluent in differentiating between impetigo and ringworm. Or the latest in wart removal, or the current incidences of Influenza A vs B. The test would need to be job type specific in my view.
It smacks a bit of the recent (aborted, thank God) attempt to have all PTs have to become certified power mobililty professionals or whatever. That was a money grab, not a serious attempt to protect the safety of our patients.
The plan would need to be more clearly thought out. I think I could pass the test but I would be freaked out about reviewing my stages of head injury recovery, my globus pallidus function, and the current research on debridement (none of which I have used more than 3 times in 17 years)
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RE: Continuing Competence Initiative - March 25, 2008 10:36:52 PM
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jma
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It almost sounds like reviewing and taking the exam over again, although with a different format and less questions. How many would like to go through that again? Hmmmm.
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RE: Continuing Competence Initiative - March 26, 2008 9:56:43 AM
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Shill
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I think my sister is actually taking the pilot test. I asked her if she is getting paid to take it, and she said no. I then asked her if she was crazy, even though I already knew the answer.
Im not sure that it makes a ton of sense, due to specialization, but for global issues, perhaps....I can tell you that I wouldnt like doing it, because I am honest, and this type of thing is among other things another means by which someone can make money. I do indeed understand the idea. However, with requirements at the state level already for ethics and jurisprudence, and CE requirements, I think this is enough for competence assurance. However, I do think that the quality of courses being approved for credits needs to be scrutinized in detail, so that folks who take pixie dust courses dont get credit for things not pertaining to the acutal field of PT.
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RE: Continuing Competence Initiative - March 26, 2008 10:31:37 AM
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jma
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HI Shill. Can you ask your sister how she found the pilot test, whenever she takes it and contrast it between the exam itself?
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RE: Continuing Competence Initiative - March 27, 2008 8:23:22 AM
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Shill
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Yep, will do. She may have just done this last weekend.
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RE: Continuing Competence Initiative - March 27, 2008 9:08:54 AM
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Shill
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Her is her info, whether helpful or not. Let me know what other details you might want, without crossing that imaginary line between divulging important details and gaining a general idea! She happens to be a director of a PTA program, including a PTA board review program, which involves knowing quite a bit about test taking and test making in general. I actually taught this course online one semester, and learned quite a bit about this as well. One suggestion I have for anyone who might need to take this at some time, is to take a review course on test taking, types of errors, etc. Anyway, here is her quote.
"Interesting, challenging.....I won't know my score til June, I guess. It took about 2 hours and 45 minutes. Lots of scenarios and questions to answer. Many things I forgot about (i.e., neuro).
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RE: Continuing Competence Initiative - March 27, 2008 9:55:14 AM
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jma
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Thanks for the update. Was the test formated like the licensure exam itself (i.e question and best answer)? Did the people who gave her the exam give her ideas on how to specifically prepare for it? Or did she just review things on her own? Did they give her anymore information about the exam than what was posted on the website? Curious.
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RE: Continuing Competence Initiative - March 27, 2008 11:29:13 AM
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Dr.Wagner
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Continuing licensure certification is the way of the future. I take a written exam every year with recertification (board certification) every 10 years. I also have 50 CME hours every two years for hospital requirements.
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RE: Continuing Competence Initiative - March 27, 2008 3:44:50 PM
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jlharris
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quote:
ORIGINAL: Dr.Wagner
Continuing licensure certification is the way of the future. I take a written exam every year with recertification (board certification) every 10 years. I also have 50 CME hours every two years for hospital requirements.
But do ER docs, Orhopods, GP's, cardiologists, and pediatricians all take the same test? I guess if you all were retaking Step II's it would be the same; otherwise it's and apples - oranges kind of thing.
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My PT Blog
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RE: Continuing Competence Initiative - March 27, 2008 10:27:03 PM
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pdtoal
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One of my managers took the exam. He noted alot of questions in wound care and acute care, so he found it challenging as he only sees a few outpatient orthos a week. Also, he said that you submit each question so there is no going back after you answer, which is unlike the current licensure test in that you submit answers in 50 question sections.
< Message edited by pdtoal -- March 27, 2008 10:29:40 PM >
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RE: Continuing Competence Initiative - March 28, 2008 12:09:30 AM
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Dr.Wagner
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Oh come on now...there are leaps of differences between a Urologist and Cardiologist...and specialization is the standard in medicine (FP, EM, IM , Peds etc) it is the exception in PT. Therefore, one can expect a large amount of cross referenced knowledge.
Recertification is the absolute way of the future...it is here. Everyone will do fine. Wasn't this expected when the APTA switched to the DPT?
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Moderator of Medical Complexity Forum
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RE: Continuing Competence Initiative - March 28, 2008 12:28:02 AM
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TexasOrtho
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I agree Doc. Again, if the aim is to keep up with the Jones, we need to be willing to swallow the pills that go along with it.
< Message edited by TexasOrtho -- March 28, 2008 12:32:30 AM >
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Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Continuing Competence Initiative - March 28, 2008 12:28:34 AM
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T_Thom
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quote:
Recertification is the absolute way of the future...it is here. Everyone will do fine. Wasn't this expected when the APTA switched to the DPT?
I cross my fingers we get to this point. There are many people out there who could use a refresher (or reassignment!)
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RE: Continuing Competence Initiative - March 28, 2008 9:38:35 AM
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jma
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I agree that this is a good idea. We'll see how this turns out in the end.
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RE: Continuing Competence Initiative - March 28, 2008 3:25:15 PM
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jlharris
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I don't disagree for one moment that our profession needs this. I just wonder with the push for specialization (OCS, GCS, ect and motion to make those who want these to have to complete a residency to do so) and a "generalist" test are going to mesh. I know I'd fail the peds and cardiovascular areas right now. Does that mean I'm unfit to practice in OP orthopaedics?
That's where my apples and oranges came from Dr. Wagner.
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My PT Blog
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RE: Continuing Competence Initiative - March 28, 2008 4:21:00 PM
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SJBird55
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If I were to be tested to determine if I were "competent," I would hope the test would be geared toward my area of practice.
The problem with testing for competency is who determines that the material is relevant and that a particular result equates to adequate performance. What is adequate? Who determines what is adequate? Proving the ability to test as competent still does not necessarily mean the practioner is competent. Taking a test and passing as competent doesn't necessarily mean that clinical behaviors will correlate with test results.
We would probably be further ahead spearheading a national project that defines quality in our profession and then creates a system to measure actual performance. If one is consistently meeting quality standards by one's performance and clinical decision-making, then obviously, one must be competent. If one isn't performing at a defined level of quality, then obviously, remedial work is required.
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RE: Continuing Competence Initiative - March 29, 2008 10:58:36 AM
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Dr.Wagner
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Expect sometime in the not so distant future, when insurance payment will be based upon all therapists in a given clinic are "up to date" on relicensure/certification. Furthermore, employment agreements with hosptitals will likely also require recertification etc.
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RE: Continuing Competence Initiative - March 29, 2008 4:45:58 PM
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jma
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I'm sure the insurance companies are looking into that, if not other things to make reimbursement even harder to get.
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