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How to prepare for a Mandatory Practice Assessment


At some stage in your career as a physiotherapist, chances are you will be selected for a mandatory practice assessment by the College of Physiotherapists in your province. In Ontario at least (Ontario will be the focus of this blog), a practice assessment is a requirement for all self-regulated professions under the Regulated Health Professions Act (RHPA). Regulating bodies use practice assessments as a way to ensure that professional competency is maintained, and to ensure patients are receiving safe, quality care. The practice assessment gives the registrant the opportunity to meet with a peer assessor, and assess your practice by getting familiar with the professional standards again.

In Ontario, 5% of registrants with the College of Physiotherapists of Ontario (CPO) are randomly selected annually for the mandatory practice assessment. Once you have been selected and have completed the assessment, you are not eligible again for random selection for another 5 years, or even less (another 3 years) if you are rostered to perform any authorized activities.

I was selected this year for a practice assessment after falsely believing I was immune to being selected! To be honest, I was initially quite overwhelmed and frustrated with the process. However, having supportive colleagues and professional bodies really helped, and while the practice assessment is a serious process to undertake, there are some ways to alleviate the pressure and anxiety by being well prepared. It’s also a great process to get all of your professional documentation organized and help you identify your learning patterns or needs. Here are 3 tips to get yourself well prepared should you get selected for a practice assessment.


1) Start Early

 

A. Stay up to Date

Start keeping your professional portfolio up to date from the time you graduate (even though registrants aren’t eligible for selection until 3 years after having an independent practice license). You can populate your portfolio now with materials you have submitted for any professional issues courses during your studies, as this sets the framework for how you will write your reflections in the future.

Keep a running list of courses, workshops, conferences, continuing education sessions and the dates you attended. You can add courses to your online portfolio on the healthSwapp platform. Be sure to keep a soft copy and a hard copy of all your portfolio items. It will likely be easier for your assessor to flick through an actual binder during your practice assessment, but keep everything digital as well in the event that you lose or destroy your hard-copy portfolio items, or need to move overseas.

 


B. Schedule

Once you get selected for a practice assessment, you have 3 months to complete it. Do not leave everything to the last minute! If you are well prepared already, schedule your assessment sooner rather than later to get it over and done with. If you know you have a lot of work to do, pick a date that gives you enough time to get prepared, and develop a weekly schedule to complete it step by step. It needs dedicated time to complete, like any kind of work, and starting it the night before probably won’t cut it.


2) Know what to expect

 

The whole process will seem overwhelming, but in reality it is quite straightforward. There are 4 main components to the actual practice assessment:


A. Practice Questions/Essential Reading

These are the pre-determined questions that the assessor is guaranteed to ask you, so before doing anything else, review these questions and prepare to answer them. Literally type your answers out! The questions will be listed in your Quality Management (QM) registration package online under the “Practice Assessment Forms.” They will likely require you to review your practice against the professional standards, and see how and where your practice meets or doesn’t meet the standards. You can find a copy of these forms on the CPO Practice Assessment information page here.

Your workplace/clinic policy and procedures manual will likely be a useful resource in answering your practice issues and business practices questions, so be sure to consult this manual. If the manual isn’t up to date, update the manual or make sure your clinic manager updates the manual! The manual should also include all samples of forms provided to patients, including intake forms, privacy forms, consent forms, and release of information forms. It should also have the clinic’s privacy policy clearly outlined.

You will be asked questions on the following during your practice assessment:

  • Practice Issues (questions relating to patient safety, privacy, consent, using support personnel etc)
  • Business Practices (questions relating to fees, billing, conflict of interest etc)
  • Record Keeping Evaluation (how patient information is managed, organized and documented etc)
  • Education Verification (ie acupuncture)
  • A course/conference/ or learning activity you have engaged in
  • A patient case where you struggled to find a solution
  • A peer/colleague interaction that has influenced or changed your practice

You will also be provided 6 Chart Stimulated Recall (CSR) worksheets with questions. These worksheets ask exactly the same question, but will be applied individually to each of the 4-6 charts you select so the answers will obviously vary. Once you have selected your 4-6 charts (see below) review the chart against the CSR worksheet to help answer the questions.

B. Chart Review


You will be asked to select 4-6 recent patient charts for review. At least 2 charts need to be from recently disc

harged patients (so will need a discharge summary included). If you perform a controlled act, 

at least one your charts must include a patient where you use one of these approaches. Your charts can be paper or electronic, as long as they are legible. If you commonly use abbreviations in your notes, have an abbreviations list handy for your assessor to be able to understand your chart notes. A list of abbreviations is a good thing to have in your clinic policies and procedures manual in the event another physiotherapist needs to read your notes to continue patient care.

Be sure your charts meet the record keeping standards outlined by the CPO. You can learn more about standard for record keeping here, or read the guide to record keeping here. The record keeping checklist is particularly useful when writing and preparing your charts and need a quick reference. You can access this reference here. If you are a new grad, review this now and develop good record keeping habits early.


C. Portfolio Review

Your professional portfolio is mandatory and should be comprised of documented learning/professional development activities and a description of learning outcomes to demonstrate evidence of ongoing learning and improvement. A common misconception is that the portfolio is simply a list of courses you have attended and the certificates demonstrating your attendance. While these should certainly be included in your portfolio, you will need to have much more than just proof of attending courses.

Your portfolio should also include learning plans, SMART learning goals, a reflection on outcomes of learning activities and reflections on practice. The CPO has a host of resources to help assemble your portfolio that you can access here, but it can be overwhelming to know which resources to include and how they relate. I will break it down and expand on creating your portfolio in section # 3.

The CPO official guide to creating your portfolio can be accessed hre.

D. Knowing professional standards

 

Knowing the professional standards and practicing in accordance with the standards is vital to maintaining professionalism and meeting the criteria for your practice assessment. It is recommended that you review and have a general idea of the professional standards prior to starting your practice as a physiotherapist, but in reality, many of the standards only make more sense in context (ie. once you start practicing so you may find you need to review them periodically from time to time throughout your career, especially as the CPO regularly updates and amends standards).

If you have professional practice questions, consult the standards. If you are still unclear, contact the practice advisor for clarification. As mentioned above, you may need to consult the standard to be able to answer the practice questions posed by the assessor during a practice assessment. All the CPO standards can be found here, but I personally found the following guides, standards and briefing notes the mosts useful for completing the practice assessment questions:

 

3) How to produce your portfolio

 

The CPO has an extensive professional portfolio guide with numerous resources and links, but it is overwhelming to know where to start, or whether all these documents are necessary to complete. In reality, none of the CPO portfolio forms are actually mandatory, but it is mandatory to set learning goals and reflect on the outcome of your learning. If you find it easier to just type or write them out, do that. If you find the CPO resources useful, incorporate them at your discretion. Just remember it is the reflection component that is important, not how the document is formatted.

What Next? In a nutshell, you are expected to demonstrate ongoing professional competence. What you will be expected to document annually should be structured in the following way:

Identify a thought provoking professional experience: Reflect on this experience. What worked or what didn’t work (this can be with a patient, substitute decision maker, colleague, support staff, on a course etc).

You can use the CPO’s identification of learning needs, skills for learning questionnaire, critical incident reportor reflection on practice forms to complete this step.

An example of a thought provoking incident might be: “struggling to resolve a patient’s acute low back pain”, or “suspecting child abuse and my mandatory reporting obligations.”

→ Goal Setting: Identify what you want/need to learn from this experience and write it out in the form of a learning plan and SMART goal. You are likely familiar with SMART goals by now, but in case you need a refresher, SMART stands for the following:


You can use the CPO’s SMART learning goals form to complete this step.

An example of a SMART goal might be: “To improve assessment and treatment skills in patients with acute low back pain by completing the McKenzie Part A Lumbar Course by September 30, 2016.”

Learning Activities: How do you plan to meet your goals and learn? What resources do you have? How will you know you have learned?

You can use the CPO learning plan form to complete this step. This is also a good place to cross reference evidence of learning such as continuing education course certificates, conferences, publications, literature reviews, inservices etc.

An example of a learning activity documented might be the SMART goal as above, and a resources statement such as: “ McKenzie course notes, McMaster University Course Notes, Netter’s Anatomy Textbook, xxx article on low back treatment” and the McKenzie Part A Lumbar course certificate.”

Evaluate and Reflect on Outcome of Learning: What is the impact of your learning? Did you meet your goal? If not, why not? How has it changed your practice? Is there any further learning required?

You can use the CPO reflection on outcomes of learning activities form to complete this step.

An example of an evaluation/reflection of a learning outcome might sound something like: “ I completed the McKenzie Part A Lumbar course and was able to immediately apply the assessment and treatment techniques into my practice. After 4 weeks of tracking my patient progress following the course, I have noticed that I am now able to discharge my acute low back patients in less than three visits, instead of the previous 5-10 visits. Although I feel confident in my abilities to assess and treat acute low back pain, I feel this is limited primarily treating low back injuries that are classified as a derangement. I feel that if a low back condition is classified as a sacroiliac joint (SIJ) issue, I am less confident in treating this condition with the McKenzie method. For future learning, I need to explore other treatment techniques that assist with treating SIJ pain.”

Finally, it may help to get a portfolio started by thinking of a table of contents. I’ve included a sample one below for your reference. For what it is worth, I met the criteria and completed the QM process! Wishing you all the best if you have just been selected, or get selected in the future!




Registered Physiotherapist
Business Development Manager at healthSwapp
@healthSwapp

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