Indian Journal of Physical Therapy and Research

CONTINUING PHYSIOTHERAPY EDUCATION
Year
: 2020  |  Volume : 2  |  Issue : 2  |  Page : 144--146

Competency-based physiotherapy education


Gaurang Baxi, Tushar Palekar 
 Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Correspondence Address:
Dr. Gaurang Baxi
Dr. D. Y. Patil College of Physiotherapy, Sant Tukaram Nagar, Pimpri, Pune - 411 018, Maharashtra
India




How to cite this article:
Baxi G, Palekar T. Competency-based physiotherapy education.Indian J Phys Ther Res 2020;2:144-146


How to cite this URL:
Baxi G, Palekar T. Competency-based physiotherapy education. Indian J Phys Ther Res [serial online] 2020 [cited 2021 Feb 28 ];2:144-146
Available from: https://www.ijptr.org/text.asp?2020/2/2/144/189938


Full Text



 Competency-Based-Education



Competency-based education (CBE) is an outcome-based educational approach which is organized around a framework of competencies. The curriculum content is designed, implemented and assessed around this framework.[1] These competencies are derived from the expected graduate attributes, and are based on patient and societal needs, ensuring accountability towards society. The CBE framework creates healthcare experts who are “fit to practice” rather than students who are “fit to pass.” For more than 60 years, CBE has been used as a curricular model for training students across various backgrounds and disciplines.[2] Globally, CBE frameworks are used as reference guidelines for certification into entry level practice for various health professions.

Over the past century, education of health professionals is constantly evolving. Recent recommendations call for transformative reforms in health professions education, including physiotherapy education.[3] Curricula across the world describe the “qualities and attributes” required of a “competent physician” and focus on “enabling competencies” for the practicing physician.

 Competency-Based-Education in Physiotherapy: Global Scenario



Competencies expected at entry level practice in Physiotherapy are being followed by many countries. For example, the Accreditation Council for Canadian Physiotherapy Academic Programs, the Canadian Physiotherapy Association and the Canadian Council of Physiotherapy University Programs have formulated the “Essential Competency Profile for Physiotherapists.” They have mentioned seven roles for Physiotherapists who wish to practice in Canada. These roles are of an Expert, a Communicator, a Collaborator, a Manager, an Advocate, a Scholarly Practitioner, and a Professional.[4] Competencies and sub-competencies are elaborated under these roles. Many of these roles overlap at any given time. Competence in all roles must be demonstrated by a Physiotherapist, in order to practice safely and effectively. Similarly, New Zealand has identified 9 core competencies and 63 sub competencies.[5]

 What is a Competency?



In 2009, a team of International collaborators, through a group process, identified and came out with several important key definitions related to CBE.[2] They defined ”Competency” as:

”an observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition. Competencies can be assembled like building blocks to facilitate progressive development.”

The term competency is used for the skill and competence is an attribute of the performer's ability to perform the skill.

 Competency-Based-Education and Traditional Curriculum



In our traditional curriculum, predefined educational objectives are to be achieved by students, who go through a prescribed course of instruction in a specified duration of time. Curriculum updation is slow and occurs after a period of time. Compared to the traditional curriculum, the CBE approach revolves around societal health problems which need to be addressed, identifies the competencies required of graduates to address that problem, and has a customised curriculum which helps the learner achieve the stated competencies.[3]

While traditional curriculum focuses on performance of the learner based on what has been taught, CBE concentrates on coping with expectations determined by stakeholders outside of the educational program [Figure 1]. CBE curriculum produces professionals who are fit to practice in the society, at a predefined proficiency level, to meet local health-care requirements.[6]{Figure 1}

Another major difference between the traditional approach and CBE is the time frame of education.[7] While the traditional approach has a fixed time frame with variable student outcomes, a CBE format has defined student outcomes, which must be achieved, irrespective of time frame. Thus, in CBE, different students may take different time durations to achieve the stated competencies.

A few other differences between the traditional model and CBE are shown in [Table 1] below.[8],[9]{Table 1}

 Developing a Competency-Based-Education Curriculum



Rather than focussing on “What Graduates need to KNOW,” educators must focus on “What ABILITIES the Graduates must possess.” The identified ABILITIES should be then organised as Competencies for a Curriculum. Educators can then work backwards and identify milestones that trainees will need to accomplish as they acquire the predetermined competencies.

The next steps include modification of teaching methods, selecting appropriate educational tasks, experiences, and teaching–learning methods which will help learners develop the desired competencies in each area, and defining the achievements required to be exhibited by the students.

With regards to assessment, more emphasis is to be put on workplace based assessment, which allows for longitudinal assessment. CBE programs and their assessment methods are different in multiple aspects, when compared with conventional curricula. Faculty must receive training in using newer assessment methods. A critical aspect of this is the ability of the faculty to provide feedback based on direct observations of the skills demonstrated by the students.

 Challenges of Competency-Based-Education in Indian Context



There are several key challenges in the implementation of CBE, as there exists an incomplete understanding and acceptance by teachers, learners, and educational administrators.[10],[11]

One of the first challenges is the identification of core competencies expected from a graduate, and coming to a consensus on themA major challenge is faculty training regarding integrated educational strategies within their classroomsIn CBE, student assessment activities are more frequently woven through the instructional modules and designed to provide formative feedback on performance and improvement toward achieving final competence. Hence, incorporating newer assessment strategies will pose another challengeAs with all new ideas, there will be resistance to changeImplementation issues outweigh the advantages.

Introducing competency-based physiotherapy training in India needs to evolve, although there may be a long incubation period of trial and error of different strategies. But with the benefit of the existing curricular frameworks in use in different nations, this period can be reduced. A competency framework suited to our national context needs to be developed, which should also be feasible in our settings and within available resources. A combined, organized effort in identifying general competencies and speciality competencies can be the first step to begin with.

Despite the criticism and implementation challenges, CBE promises to produce competent practitioners, who can apply their knowledge, skills and attitudes in real-life practice. Success stories of institutes initially adopting a CBE curriculum might encourage others to adopt this method, facilitating the evolution of the Indian Physiotherapy Curriculum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: Theory to practice. Med Teach 2010;32:638-45.
2Frank JR, Snell L, Englander R, Holmboe ES, ICBME Collaborators. Implementing competency-based medical education: Moving forward. Med Teach 2017;39:568-73.
3Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-58.
4National Physiotherapy Advisory Group. Essential Competency Profile for Physiotherapists in Canada Toronto: The Advisory Group; 2009. Available from: https://www.alliancept.org/download/9499. [Last accessed on 2020 Apr 25].
5Physiotherapy Board of New Zealand. Physiotherapy Competencies for Physiotherapy Practice in New Zealand; 2009. Available from: http://www.physioboard.org.nz.[Last accessed on 2020 Apr 25].
6Telang-Chaudhari S, Baxi GD, Bhalerao S. Competency based education in Ayurveda: Need of the hour? Anc Sci Life 2014;34:119-20.
7Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: From Flexner to competencies. Acad Med 2002;77:361-7.
8Herur A, Kolagi S. Competency-based medical education: Need of the hour: Let's do our bit. BLDE Univ J Health Sci 2016;1:59.
9Chacko TV. Moving towards competency-based education: Challenges and the way forward. Arch Med Health Sci 2014;2:247-53.
10Lowe W. It's only a matter of time: Clock hours vs. competency. Int J Ther Massage Bodywork 2013;6:3-5.
11Snell LS, Frank JR. Competencies, the tea bag model, and the end of time. Med Teach 2010;32:629-30.