Not Just Graduated, but Competent: Reframing Readiness for Physical Therapist Clinical Practice

• In Event: Advancing Competency-Based Assessment: Evidence-Based Decisions

Abstract

The evolving needs of society necessitate that health professions education prepare learners who are adaptive and can navigate complex systems and meet present and future needs of patients, communities, and society. Physical therapy education stakeholders collaborated to develop a framework for competency-based education in physical therapy (CBEPT) that supports consistent and observable readiness for entrance into professional practice. This paper describes the method used.
A national consensus CBE framework using entrustable professional activities (EPAs) was developed to define outcomes that can guide Doctor of Physical Therapy (DPT) program curricula and ensure learner readiness. EPAs represent the real-world essential physical therapist clinical tasks, the tasks that all physical therapists are expected to do unsupervised at entrance into clinical practice (16). The EPA framework contains both a full description of the activity and the critical competencies needed within the individual performing the task mapped to it (17). Assessment of the EPA examines the integration of those mapped clinical competencies across multiple domains, which aligns with what is needed for safe and effective clinical practice.
An Outcomes Strategy Meeting (2019), with representation from multiple stakeholder groups, recommended defining outcomes across the learner continuum incorporating both EPAs and domains of competence into a cohesive framework for CBEPT, anchoring initial framework development at the point of entrance into practice. Three expert panels were established to facilitate this work: Domains of Competence, Entrustable Professional Activities, and CBEPT Education Research, with each group submitting its findings for publication to document methods, evidence, and results for public use (18–20).
A modified Delphi approach guided the identification and refinement of the framework components. Over the course of multiple rounds, working groups proposed initial drafts of EPAs, domains, and competencies. These drafts were iteratively reviewed and revised based on structured feedback from a national reactor panel composed of more than 130 stakeholders across academic, clinical, and regulatory settings, as well as educators from other health professions. Reactor panelists provided input across up to eight rounds of review, focusing on clarity, alignment, comprehensiveness, and applicability. An open public comment period was also conducted, inviting feedback from the wider physical therapy community and the public.
The combined use of expert-led development, structured consensus-building, and broad stakeholder engagement resulted in a set of performance expectations that reflect shared professional standards and are intended to support competency-based progression toward practice readiness (21).
The rigorous, consensus-driven process designed to ensure relevance, credibility, and applicability across the continuum of physical therapist education and practice resulted in the identification of essential outcomes within 19 EPAs, eight domains of competence, and 54 competencies (21) .
The use of this iterative process to gain national consensus allowed for broad perspective using an inclusive approach that can serve DPT education programs, learners, and society well. A comprehensive program of assessment is essential to provide an overview of learner performance on defined outcomes. This approach ensures that learners are evaluated on a consistent set of standards, supporting their development toward unsupervised practice and ultimately enhancing the quality of patient care.

Authors

• Jean Ann Fitzpatrick, Columbia University

• Gail M. Jensen, Creighton University

• Steven Chesbro, American Physical Therapy Association

• Huiju Carrie Chen, Kaiser Permanente Bernard J. Tyson School of Medicine