Quality in Physical Therapy Practice: Entrustable Professional Activities as a Potential Foundation for Professional Development

• In Event: Competency-Based Education in the Health Professions: Using Applied Research to Improve Learner and Societal Outcomes

Abstract

Background: Physical Therapy (PT) education purports to prepare learners for a life time of practice. In the past decades the profession has expanded in breadth. While physical therapists at graduation are expected to be competent to work across the full width of the profession, much of their proficiency selectively develops based on the setting and patient groups they are working with. For example, a physical therapist working in sports will obviously become increasingly competent in the treatment of sports injuries. However, the lack of exposure to intensive care patients will prevent the building of PT proficiency in that field. PTs' scope of practice determines the quality of their performance.

Problem: In many countries PTs need to apply for full re-registration regularly to ensure they practice with up-to-date knowledge and skills and remain competent throughout their entire career. Continuous professional development (CPD) is necessary for quality professional practice, and to protect patients against suboptimal treatment. Given the differences in scope of practice however, CPD is more difficult to establish than it appears at first sight. Standard re-registration procedures cannot secure a high level of quality across the whole breadth of the profession, first and foremost because of its versatility and contextual dependence.1,2

PTs who choose to change their scope of practice, even with a valid reregistration, cannot be expected to deliver high quality service, but there is no mechanism in place to prevent them from such a transition. For example, a physical therapist specialized in oncology wishing to change to geriatric physical therapy is not required to demonstrate competence in that new domain. Physical therapy organizations currently do not have insight in the level of competence of individual PTs in relevant domains of PT practice.

Proposal: Recent developments in other health professions may serve to support a quality movement in postgraduate physical therapy practice. Entrustable Professional Activities (EPAs) have been introduced for postgraduate medical training and have been adopted in different health professions. EPAs are units of professional practice that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised in a given context.3 While the concept was developed for competency-based education, it has been suggested recently that EPAs may serve to enhance high quality, safe, competency-based practice in health care and be functional to characterize practitioners until retirement from practice. It de-emphasizes the divides between the stages of training and views the continuum from the undergraduate education until retirement as a whole.4 In the physical therapy curriculum as well as in continuous professional development EPAs may well serve as a solution for the issues outlined above.

Conclusions and significance: This presentation will envision how EPAs can help restructure the profession, lift the quality of PT practice, move toward a competency-based physical therapy model and add to a lively and ongoing debate on applying EPAs in the PT profession.5

Authors

• Mirelle JPM Stukstette, University Medical Center Utrecht

• Olle ten Cate, University Medical Center Utrecht