In this issue - Physiotherapy Alberta...PT Alberta Issue 1, 2012 | In this issue: p. 2 Continuing competence programs. What’s the value? p. 3 Ultimate form of professional self-reflection

PT AlbertaIssue 1, 2012 | www.physiotherapyalberta.ca

In this issue:

p. 2Continuing competence programs. What’s the value?

p. 3Ultimate form of professional self-reflection.

p. 14Physiotherapists in the news.

p. 17Award winning teachers in the MSCPT program.

... and more

PT Alberta | Issue 1, 2012 | www.physiotherapyalberta.ca1

*The College of Physical Therapists of Alberta operates as Physiotherapy Alberta - College + Association.

Leadership + Regulation

2 Feature editorial3 President and Registrar’s message4 Council news5 Continuing competence program7 Membership update7 Diagnostic imaging7 Restricted activities authorization model

Professional Practice + Development

8 Good practice10 eLearning Center11 Research in focus13 Evidence for practice13 Webinar series

Communication + Marketing

14 Media and other sightings 15 Marketing + advertising program16 Finding balance sponsorship

University News

17 Department of Physical Therapy, U of A

PT Alberta is published quarterly by Physiotherapy Alberta* to communicate policies, standards and other important matters to members. All members are expected to read and understand the regulatory items and material within that apply to them. If you have any questions, please contact us.

StaffRegistrar: Dianne MilletteProfessional Practice: Iain MuirCorporate Services: Joyce VogelgesangCompetence/Practice Advice: Audrey LoweComplaints + Conduct: Nancy ChisholmRegistration: Raelene GrablerAccounting/Hearings Director: Jane McKenzieAdministration Support: Haylee O’Reilly

Council 2011/2012President: Greg CutforthMember-at-large: Erica FarrellMember-at-large: Tress GibsonMember-at-large: Gwen HarrisMember-at-large: Grant IrwinMember-at-large: Nancy LittkeMember-at-large: Candis WhittallPublic Member: Ron CrossleyStudent Representative: Travis JonesStudent Representative: Matt Scott

Physiotherapy AlbertaCollege + AssociationSuite 300 Dorchester Building10357 - 109 StreetEdmonton, Alberta T5J 1N3

T: 780.438.0338 | 1.800.291.2782F: 780.436.1908info@physiotherapyalberta.cawww.physiotherapyalberta.ca

PT Alberta | Issue 1, 2012 | www.physiotherapyalberta.ca 2

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Feature EditorialUnder the Health Professions Act, there is a requirement for all health regulatory Colleges to develop a continuing competence program to provide for regulated members to maintain competence and enhance the provision of professional services. These requirements are part and parcel of a legislative model based on self-governance.

Regulators in Alberta, across Canada and the world have spent buckets of money and many hours developing, implementing and more recently evaluating continuing competence programs. In general, regulators take their cues from legislation. It is in the legislation where one finds detail about what is to be accomplished by the act of regulation, for example licensing qualified people to practice a profession. In the case of competence programs, it is not always that clear. A program to ‘maintain competence and enhance the provision of professional services’ could be many things. As a result, we run the risk of spinning our wheels if we are not sure what the focus is.

Over the years, evidence about the effectiveness of assessment methods has grown. We now have a better idea about the good, the bad and the ugly of a variety of methodologies including self-assessment, peer review and multi-source feedback. We know what the literature says about mandatory continuing education, facilitating educational experiences for health professionals through communities of practice and group or peer support.

Musings about our programDiscussions with the Continuing Competence Committee and Council began in the early 2000’s when it was agreed physiotherapists’ continuing competence program will have a quality improvement focus - rather than an assurance focus - and support each physiotherapist to maintain and enhance individual competence. But, practitioner competence is a highly complex construct. There is not one perfect method of assessment and there will always be shortcomings when addressing something so complex and multidimensional.

As a starting point, we chose methodologies including self-assessment, reporting and examination. We chose these methods considering the evidence plus they fit

nicely with the program goals:

y Promote practice reflection and continuous learning.

y Ensure awareness of legislation, standards of practice and other professional obligations impacting practice.

y Demonstrate public accountability for ongoing competent practice as a professional.

So on the brink of implementing this new program, know that the program:

y is built on evidence

y will add value to you if embraced

y will help you serve your patients better

Yet we also know there is something about being called to account for one's competence that brings about a mixture of fear, anxiety and resistance to feedback challenging our perception of our own competence. We are inherently hard-wired to view such feedback through a len of self-perception which is predominately influenced by an element of self-preservation. The intent of the program is not to bring about any of these challenging emotions but rather, as we have already stated, to support your efforts to be the best practitioner you can be.

Even though there may be limitations associated with continuing competence programs we believe each of you will have a positive outcome by participating.

We are all on the same learning trajectory and will be looking for your feedback overtime. Is this program meaningful? Does it add value to you? Does it make a difference to your patients?

...physiotherapists’

continuing competence

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quality improvement

focus - rather than

an assurance focus

- and support each

physiotherapist to

maintain and enhance

individual competence.


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It’s all about competence.

The focus of this edition of PT Alberta is competence. While physiotherapists have heard about the looming continuing competence program for many years, implementation of the program is here. We trust you are all keen and prepared to participate.

Council and staff have spent years developing, setting policy, piloting various components of the program, and preparing for implementation. There is still a lot to learn but we are confident the elements developed so far have science behind them and will cause you to reflect on your competence in an effort to maintain and enhance your knowledge and skills as a physiotherapist.

Ultimate form of professional self-reflectionRecently in conversation with a Department of Physical Therapy faculty member we talked about the importance of all physiotherapists being involved in the education and mentoring of future physiotherapists. Year over year, approximately 20% of all physiotherapists in Alberta participate in the clinical supervision of students and many of these physiotherapists are the same. Is this really the best we can do? If we increase the number of supervising physiotherapists by 10% that will equal 230 or more supervisors.

This conversation caused us to reflect on our own experiences with the development of the profession and the future of those who will eventually succeed us all. By engaging with students, providing student supervision, mentoring new graduates, and counselling would-be student applicants we have learned as much as we have given. Sharing knowledge, teaching and explaining the work that we do not only prepares budding physiotherapists but supports them in integrating what they learn with the reality of health care in the public, private, community, and other sectors. This contribution to our profession is the ultimate form of professional self-reflection. It forces you to keep on top of what is new and emerging in the profession when you might not otherwise. As mentioned in the Research in Focus article on page 11, student learners stimulate thinking about knowledge gaps and their questions push our own learning. It also allows conversation about the future of our profession from the eyes of those keen to learn

and grow, and it supports the ongoing evolution of physiotherapy.

Later in the newsletter (page 18) there is mention of a national survey that will soon be sent to physiotherapists across Canada to discover the barriers and facilitators related to clinical supervision. Please take time to not only consider what you have already contributed to our profession but to continue to be an active participant in finding solutions to keep vital clinical experiences alive and flourishing for developing physiotherapists.

Physiotherapists’ contribution to Family Care TeamsAnother exciting development in the last couple of months has been the announcement of the Family Care Clinics proposed by Premier Alison Redford. Physiotherapy Alberta had the opportunity to participate in a consultation led by MLA Yvonne Fritz on this emerging model of primary health care. We were invited to discuss the potential contribution that physiotherapists could make to a Family Care Team building on the foundation that we have established in both the public and private sectors. While there is not a lot of detail yet on this emerging health care model, physiotherapists are well positioned to enhance primary care services in Alberta, providing assessment and treatment services, case management, program development, and triage or screening roles. Greg will participate in preliminary discussions as part of an Implementation Advisory Team and will update physiotherapists over time.

As always, we like to hear from members - any time and on any issue.

y [email protected] y [email protected]

Greg Cutforth, PT Council President

Dianne Millette, PT Registrar


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Council News Key highlights, discussions and decisions from Council’s January 12 and February 25 meetings.

Audited financial statementsCouncil received the auditor’s report and approved the 2010-2011 audited financial statements. The auditor’s report and statements will be included in Physiotherapy Alberta’s Annual Report published later this spring.

Competence program rulesPhysiotherapist feedback was reviewed and amendments were made to the program rules prior to Council approval.The program rules are posted on Physiotherapy Alberta’s website.

Restricted activities standardCouncil reviewed physiotherapist and external stakeholder feedback. Several edits for clarification were made prior to Council approving the new standard. The standard is posted on Physiotherapy Alberta’s website.

Clinical specialistIn keeping with the Physical Therapists Profession Regulation, Council established the requirements physiotherapists must meet to be authorized to use the title ‘specialist’.

y Council endorsed a national approach and specific recommendations about recognizing clinical specialists in keeping with discussions of the Canadian Alliance of Physiotherapy Regulators.

y Council agreed to approve the CPA Clinical Specialty Program and the American Board of Physical Therapy Specialties as acceptable clinical specialist certification programs.

y Use of title, for those authorized, may include specialist or clinical specialist in keeping with the Standard of Practice on Title and Credentials.

y Council directed the registration team to begin the development of policy and processes related to accepting and approving applications.

Abandoned recordsCouncil discussed the ongoing role of the College in assuming responsibility in the event physiotherapy records are abandoned. Standards related to records management make it explicit that physiotherapists are

responsible for ensuring plans are in place to prevent records from ever being abandoned. It is the expectation of Council that physiotherapists take this responsibility seriously and ensure they are in compliance with the standard. College costs to manage records in the past are significant and it is the view of Council that the general membership should not have to bear the financial cost of records management because of the behaviour of a few. Therefore, unless there is a directive otherwise, the College will not assume responsibility for records.

Canadian Alliance of Physiotherapy RegulatorsCouncil nominated Greg Cutforth as a member of The Alliance Board of Directors to replace Simon Cooke who tendered his resignation in February. Council acknowledged the significant contribution of Simon to the work of The Alliance both as a Board and Governance and Nominations Committee member.

Committee appointmentsCouncil made appointments to the following committees:

y Continuing Competence: Carol Robertsen, Nurudeen Amusat and Rafeeq Ansari

y Registration: Jon Gabbai and Stephen Keating

Bylaw amendmentMinor amendments were made to the bylaws in order to manage the Council transition from the requirements under the Physical Therapist Profession Act to the Health Professions Act. Included in the amendments is the election of the President-Elect and the elimination of one member-at-large position resulting in the requisite number of elected Council members.

Health Knowledge NetworkA decision was made to not renew the Health Knowledge Network contract that provides physiotherapists with access to paid databases. Despite many efforts to increase physiotherapist uptake, the contract cost could not be justified based on usage. Physiotherapists continue to have access to many free database resources including PubMed or PEDro (see page 13 for a complete list).


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Physiotherapy Alberta’s continuing competence program is outlined in sections 17 to 24 of the Physical Therapists Profession Regulation. The regulation provides for a continuing competence program that has three components and within each component there are a number of activities Physiotherapy Alberta may require of its members. (See table below)

ProgramComponents

Possible activitiesApproved activities

1. Competencedevelopment

− Reflective practice review− Continuing professional development

Reflective practice review

2. Competenceassessment

− Examinations− Review of reflective practice records− Interviews

Jurisprudence module

3. Practice visits − Practice inspections− Interviews− Patient/client service observation− Patient/client/co-worker survey− Patient care document review− Equipment safety inspection

None to date

The regulation also requires Council to establish and make available rules for the program and further that the rules may only be approved after distributed to members for their review. The program rules were available for member comment November 15, 2011 and approved by Council January 12, 2012. The program rules, which address various aspects such as frequency and member selection, are posted on Physiotherapy Alberta’s website along with details of the program requirements.

Although there are a number of options available for each component of the continuing competence program, Council has chosen to start with only two:

1. Jurisprudence module:

y Assesses understanding and the application of practice standards, legislation and rules to physiotherapy practice.

y Must be completed every five years.

2. Reflective practice review:

y Promotes practice reflection regardless of role and encourages appropriate learning to maintain and enhance competence.

y Must be completed each year.

Continuing Competence ProgramAll members on the general register must participate in Physiotherapy Alberta’s continuing competence program and successful completion of program requirements is a condition for ongoing registration.

Jurisprudence module – launched November 2011The first jurisprudence module was launched in November 2011.

y Members on the general register as of February 1 are required to complete the module by April 30, 2012.

y Physiotherapists not successful after two attempts will undergo a self-directed remediation program prior to attempting the module a third time.

y Members unsuccessful after a third attempt will be referred to the Registrar.

y Members registered after February 1 will complete the next module available in November 2012.

Reflective practice review – introduced April 2012Members on the general register were notified by email the week of April 9 that completion of reflective practice review activities is now required.

There are four steps to reflective practice review. They are:

Step 1: Conduct a self-assessment

y Read the Essential Competency Profile for Physiotherapists in Canada (2009).

y Evaluate the importance of the competencies in your practice.

y Consider how the competencies apply to your practice.

y Complete the self-assessment form.

y Store the assessment form in a retrievable format.

Step 2: Engage in patient care reflection (if in clinical practice)

y Review and reflect on the chart of a recently or soon to be discharged patient/client using the questions in the patient care reflection tool as a guide.

y Complete the patient care reflection tool.

y Store the patient care reflection tool in a retrievable format.


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Step 3: Develop a learning plan

y Select one learning goal based on your self-assessment in Step 1 or chart review in Step 2.

y Establish learning activities and set target completion dates to achieve your learning goal.

y Record your goal + activities in the Learning Planner.

y Store the Learning Planner in a retrievable format.

Step 4: Implement learning plan + evaluate outcome

y Complete the activities you identified in Step 3.

y Track your learning activities in the Learning Tracker.

y Reflect on impact of learning in relation to yourself, your patients/clients and the larger health system.

y Record the outcomes of your learning in the Learning Tracker.

y Store the Learning Tracker in a retrievable format.

When to completeAlthough the reflective practice review is required annually, it will take two years for physiotherapists to complete one reflective practice review cycle.

y Year 1: conduct self-assessment (Step 1), engage in patient care reflection (Step 2), develop learning plan (Step 3).

y Year 2: implement learning plan and evaluate outcome (Step 4). In Year 2, you will also complete Steps 1-3 of the next reflective practice review.

When to reportYou must report reflective practice review activities when you apply to renew your practice permit. In September 2012, you’ll confirm completion of Steps 1-3 of your first reflective practice review. Thereafter, reporting is expanded to include the outcomes of learning (Step 4) and the assessments and learning plan from Steps 1-3 of your next reflective practice review. (See Figure 1 below). The cycle continues.

Information and supportInformation on the reflective practice review component of the continuing competence program is available on Physiotherapy Alberta’s website and in person.

y Physiotherapy Alberta’s website | physiotherapist section | continuing competence

− Program requirements− Fillable forms− Sample completed forms− Link to Essential Competency Profile for

Physiotherapists in Canada (2009)− Program rules− Continuing competence program webinar

y In person assistance

− [email protected] − 780.438.0338 or 1 800.291.2782

Figure1


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Changes to regulated member registers November 15, 2011 - February 29, 2012.

General register: member meets all registration requirements, may use title physiotherapist and, if authorized, perform a restricted activity.

Provisional register: member may practice only under supervision and must use title physiotherapist intern.

Cancelled member: no longer practicing in Alberta.

General registerCrystal AmundsonNoele ArialJennifer AtkinsonStacey BernardKara-Lee BlaisInnes ChengCharlene ChuVanessa Del FabbroCandace ElliottBrittany ErdmanChristine Fernandez-CaballeroJeffrey GarrettKim GrunlingBonnie Halstead RobsonAbraham HumAmanda JohnstonMegan KavanaughAshley KingSimon KruithofWinnie LauAmy LewsawSheila MahoodZenovia MartynkiwMerrylee McDougallAneta McManesJoey MoRyan MorrisonMeghan MuhleElzette NelShawna Lee PoundAngela PrefontaineHeather RieckDaniel Russell

Ashley RyniakSharon ScottHeather SheddenCrystal ShowersDeborah SkeltonJessica SlivkaNicole TaillonChristine WheelerErika Yee

Provisional registerKimberly GibbsChristina LeAlyson MooreKamalanathan PonnusamyManikandan RamakrishnanMargret ReichelMaureen ToshVanessa VelascoFang YangMan Keen YeungLina Zuluaga

Cancelled registrationsLisa BerndtssonWilna BoshoffAlberto Cachero Jr.Kayla FriesenMarie-Claude GagneGail KingBarbara RobinsonMargaret Wright

News about diagnostic imaging

The College of Physicians and Surgeons of Alberta has added physiotherapists, with appropriate authorization, to the list of approved health care providers who may order specific forms of diagnostic imaging in Alberta. This means physiotherapists who have completed the diagnostic imaging course PTHER 410 offered at the University of Alberta and who have five years of clinical practice experience may now apply for authorization.

This is a very exciting advancement for the profession and more importantly the patients physiotherapists serve.

New authorization model for spinal manipulation and use of needles

Only authorized physiotherapists on the general or courtesy register may perform spinal manipulation or use needles in practice independently. Physiotherapy Alberta no longer maintains a list of approved spinal manipulation and needling programs. Instead, members may now select the education program that meets their specific needs provided it includes as part of the curriculum: theory, practice and final evaluation.

Application forms may be downloaded from Physiotherapy Alberta’s website | physiotherapist section | restricted activities.


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Good PracticeHelping members apply legislation, standards and policies to real-life practice.

I am concerned about my co-worker’s competence to practice, what steps should I take to address this situation?

DiscussionThe physiotherapy profession places high value on professional self-regulation, protection of the public interest and purports through its code of ethics that physiotherapists have an ethical obligation to:

y Support colleagues and help them maintain high standards of professional practice.

y Take appropriate action when a colleague’s professional practice is not acceptable.

What do these statements really mean when you have to address issues of competence in your co-worker who may also be your friend? Addressing issues of poor performance often requires ‘rocking the boat’.

What the research saysCompetence research themes, presented here in no particular order, says:

y A known risk factor for incompetent practice is working in isolation without contact with peers. There is something about working with others from the same discipline that helps a professional maintain competence. Social psychology research shows we have inbuilt mechanisms where we compare our performance with those around us, which might be a driver for self-improvement giving credence to the adage ‘keeping up with the Jones’.

y Professionals consider trusted peers an important source of feedback on their level of competence and instrumental in helping them to self-directed learning and support changes in practice.

y Human beings of all backgrounds have a hard time accurately self-assessing. Each of us has an innate tendency to view our performance as being better than it really is. While this may seem negative,

overestimating one’s ability is important for survival. Great things can be accomplished when the world is viewed as ‘what it should be’ rather than ‘what it is’. Think of David’s fight with Goliath and sports events where the underdog wins.

In the work world, the challenge is professionals whose practice falls below minimum standard often have a perceptual deficit that prevents them from recognizing they are incompetent. The term ‘unconsciously incompetent’ is the label assigned to this group. With unconsciously incompetent practitioners, self-directed learning strategies are insufficient. Strategies using external feedback (i.e., supervision, mentoring, checklists, videotaped performance) and additional training must be used to help these practitioners attain acceptable levels of practice. All this said, self-assessment as part of a larger process is not all bad.

y Innate cognitive processes cause us to disregard or not act upon performance feedback that does not agree with our view of ourselves (self-concept). A colleague who is providing feedback must strive to present it in a manner that maintains the receivers self-concept but motivates them to change.

... continued


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Steps to address issues of competenceFirst assess if your co-worker trusts you. If so, you are probably the best person to help them understand their practice is not meeting acceptable standards. The method you use to convey this message is important. You want to motivate them to change (self-efficacy) but not destroy their self-concept. It does require finesse to respectfully explain your position, describe what behaviours you consider unacceptable, unsafe or unprofessional while maintaining a positive working relationship.

If the interpersonal approach is unsuccessful or inappropriate, you will want to involve your management team. Usually this includes the manager or clinic owner directly responsible for physiotherapy service and in larger organizations, the human resources and/or labour relations department. Concerns about your co-worker’s competence must be clearly described and multiple strategies planned to resolve the problem. Strategies such as performance check lists, chart audits, clinical reasoning exercises, learning plans, additional training, supervised practice, and mentorship can be used. If mentorship or supervision is one of the strategies, it is best to involve someone the co-worker trusts. All interactions and steps taken to resolve the issue and outcomes should be documented. If these strategies are not successful, contact Physiotherapy Alberta.

By the time Physiotherapy Alberta becomes involved, significant effort by the organization should have occurred to support the physiotherapist in achieving an acceptable level of practice and those efforts are documented. Physiotherapy Alberta uses the Standards of Practice, Essential Competency Profile for Physiotherapists in Canada and the definition of unprofessional conduct in the Health Professions Act as benchmarks for examining issues of competence. Currently Physiotherapy Alberta has the authority to investigate competence related issues through its complaints process. In the future, practice visits may provide another method to evaluate competence through performance.

Under the Health Professions Act, physiotherapists who are employers, clinic owners or managers have an additional legal obligation in matters related to incompetence. They are required to inform Physiotherapy Alberta’s Complaints Director when a physiotherapist (whether employee, contractor or consultant) is terminated, suspended or resigns for reasons of unprofessional conduct (including incompetence).

Rock the boatIf you have concerns about your co-worker’s competence ‘rock the boat’. Create a wave. Approach them and discuss your concerns. In the end your co-worker, their patients, the workplace, and the physiotherapy profession benefit. Physiotherapy Alberta’s practice advisory and competence departments have resources to support your efforts to help your co-worker become a better physiotherapist.

References1. Davis, D. A., P. E. Mazmanian, et al. (2006). Accuracy

of physician self-assessment compared with observed

measures of competence: a systematic review. JAMA 296(9):

1094-102.

2. Duffy, F. D. and E. S. Holmboe (2006). Self-assessment in

lifelong learning and improving performance in practice:

physician know thyself. JAMA 296(9): 1137-9.

3. Eva, K. W., J. P. Cunnington, et al. (2004). How can I know

what I don't know? Poor self-assessment in a well-defined

domain. Adv Health Sci Educ Theory Pract 9(3): 211-24.

4. Eva, K. W. and G. Regehr (2008). "I'll never play professional

football" and other fallacies of self-assessment. J Contin

Educ Health Prof 28(1): 14-9.

5. Kruger, J. and D. Dunning (1999). Unskilled and unaware of

it: how difficulties in recognizing one's own incompetence

lead to inflated self-assessments. Journal of Personality and

Social Psychology 77(6): 1121-34.

6. Miller, P. (2008). Self-Assessment: The Disconnect between

Research and Rhetoric. Physiotherapy Canada 60(2).

7. Ontario, C. o. P. o. (2011). Continuous self-improvement:

a study of ongoing learning of physiotherapists/physical

therapists. Perspectives. Toronto, Ontario, Author. 3: 5-6.

8. Sargeant, J. (2008). Toward a common understanding of self-

assessment. J Contin Educ Health Prof 28(1): 1-4.


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The eLearning Center launched April 23 gives members convenient access to a variety of online continuing professional development modules and activities.

Our goalPhysiotherapy Alberta’s goal is to provide members with high-quality, affordable and locally accessible continuing professional development opportunities. With the launch of our eLearning Center we are now well positioned to meet this goal.

eLearning Center

To our knowledge, Physiotherapy Alberta’s eLearning Center is among the first of its kind for physiotherapy colleges and associations across Canada. The platform offers exciting potential to develop a number of innovative learning opportunities and make all of it available to members in one place with a single login.

The eLearning platform allows us to:

y Offer online courses so members can learn at their own pace.

y Include collaborative tools such as discussion forums, databases and wikis.

y Facilitate Communities of Practice.

y Encourage group-based learning.

y Use interactive features to make learning more interesting.

At present, our course inventory is orientated towards regulatory topics. However, overtime we plan to include clinical courses that appeal to the diverse needs of Alberta physiotherapists. Courses now available are:

y Occupational Hazards and Controls for Rehabilitation Professionals

y Understanding Ethics

y Infection Prevention and Control

Communities of PracticePerhaps the most existing feature is the potential to facilitate the development and growth of online Communities of Practice. A Community of Practice is a group of people with a common interest who collaborate to create, exchange and disseminate knowledge or practice in a specific area. A clinical interest group is a good example of a Community of Practice. Bringing a Community of Practice to an online environment allows anyone from anywhere to share in the collective knowledge of the community. Two communities of practice are currently under development:

y Women’s health y Diagnostic imaging

Accessing the eLearning CenterIt’s easy.

1. Just click on the eLearning icon from Physiotherapy Alberta’s website.

2. The first time you visit the eLearning Center you will need to register before you login. Follow the screen instructions.

3. Once logged-in, click on the course or Community of Practice you would like to enroll in or join.

It’s new and we need your feedback and inputOur goal is only met if the eLearning Center meets members’ needs. We encourage all members to visit the site, check out what’s currently available and send us your ideas for future courses.

Contact Iain Muir, Director of Professional Practice, 780.702.5354 or [email protected].

eLearning Center LaunchedOnline continuing professional development and more.


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t Research in FocusIn this issue of Research in Focus Physiotherapy Alberta explores the research available on feedback sources that stimulate self-assessment among clinicians.

IntroductionSelf-assessment is a process in which feedback from external and internal sources is interpreted to assess current performance and promote future learning.1, 3

Engaging in self-assessment for practice improvement is an essential competency of many health professionals, including physiotherapists.2 Effective self-assessment is thought to require both external and internal feedback. Clinicians who use only internal feedback consistently demonstrate a poor ability to accurately assess their own performance. Not all external feedback; however, leads to good self-assessment or improved performance.4

Evidence from physiciansPhysicians lead the way in evaluating how various feedback sources inform self-assessment and ongoing learning. To date, most evaluation focuses on formal programs aimed at stimulating physician self-reflection and practice improvement including the PAR, PIM and PBSG (Figure 2 to the right).

All programs stimulate some improvement in self-assess-ment but not consistently for all physicians. When asked about their perceptions of these programs, physicians provide some important insights about the value of dif-ferent types of feedback in stimulating self-assessment.

PBSG was generally perceived as the most useful method of stimulating reflection and self-assessment. Physicians place high value in learning from each other. Discussions with trusted colleagues help validate their practice or identify knowledge gaps and plan change. Good group dynamics that promote an honest, open and non-threatening exchange among members were key success factors.

The PAR and PIM were viewed both positively and negatively. Data from the PAR generally stimulated thinking about specific feedback in a particular area. Some physicians; however, resented the PAR process perceiving it as an encumbrance on work. Others simply ignored the feedback as they did not view the data as credible or personally meaningful. Data from the PIM was particularly useful to help identify issues with office staff and work processes. As a result some physicians were

able to improve their clinical care and practice systems. Like the PAR, others questioned the credibility of certain measures and ignored the data.

Other sources of external feedback Aside from formal programs, physicians also identified other helpful sources of external feedback.

y Consultation with trusted peers on an unusual patient or getting feedback on clinical care was valuable. Although a useful source of feedback, many physicians reported their practice structure or work schedule did not provide sufficient opportunity for meaningful interactions with trusted peers.

y Patients also stimulate self-assessment. Patients presenting with new signs/symptoms or an unexpected (good or bad) outcome often stimulated thinking and seeking information to fill knowledge gaps.

y Other health care professionals and students stimulated thinking about the physician’s knowledge base. Exchange of information with other health professionals brought an awareness of knowledge and care gaps and suggested areas to be addressed. Student learners stimulated thinking about knowledge gaps and their questions pushed physicians to keep ahead.

Physician Achievement Review (PAR): 360/multi-source feed-

back model. Physician, medical colleagues, co-workers, and pa-

tients complete a questionnaire on the physician’s competency

in a number of practice domains.6, 7

Practice Improvement Module (PIM): Audit of medical records

against pre-defined clinical practice guidelines, patient survey

and office system assessment.8

Practice Based Small Group (PBSG) Learning Program: Physi-

cians participate in monthly facilitated small group learning

involving case discussion, literature reviews and discussions

about challenges of integrating learning to practice for continu-

ing education credits.

Figure 2


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y Educational activities also stimulated self-assessment. Reviewing course brochures helped identify topical learning needs. Attendance at courses provided an opportunity for interaction with colleagues and helped validate existing knowledge or identify gaps.

What physician research suggests is that physicians use feedback from both formal structured programs and non-formal sources. Feedback from trusted colleagues either in a formal small group learning environment or in one-to-one informal conversations was viewed as the most positive means of stimulating self-assessment and learning. The use of formal feedback was more variable. Physicians will discount feedback if not seen as credible or relevant to their clinical care.

Evidence from physiotherapists A recent pilot study exploring how physiotherapists learn in practice conducted by the College of Physiotherapists of Ontario10 reported similar findings to physicians. Preliminary results showed that:

y Physiotherapists learn best and mostly from each other (peers).

y Physiotherapists are frustrated that performance feedback is mostly provided by those unfamiliar with their clinical performance. Most physiotherapists expressed a need for greater feedback about their clinical practice.

y Physiotherapists identified that relying only on one’s own self-assessment was insufficient; it needs to be combined with other learnings. Asking peers, colleagues and patients for feedback presented more accurate information to inform learning.

Implications for practiceThe data, although limited, suggests physicians and physiotherapists value feedback from peers, colleagues and patients above other sources of feedback but both groups identified that practice environments do not always provide opportunity to engage in meaningful feedback from peers. Physiotherapists, in particular, desired feedback on clinical practice yet feedback is often provided by non-physiotherapist managers and does not address clinical practice. Formal group-based learning, while not specifically explored in physiotherapy, is positively accepted and meaningful to physicians.

In summary the more meaningful strategies to inform self-assessment and learning are:

y Formally or informally seek feedback from colleagues and peers (e.g., patient consults, one-on-one discussions).

y Engage in more structured or formalized practice-focused group learning opportunities (e.g., grand rounds, Communities of Practice).

y Seek opinions of colleagues when presented with challenging patients or to confirm routine clinical care.

y Interact with other health professionals. y Learn from students.

References1. Epstein RM, Siegel DJ, Silberman J. Self-Monitoring in

Clinical Practice: Challenge for Medical Educators. Journal

of Continuing Education in the Health Professions. 2008; 28:

5-13.

2. National Physiotherapy Advisory Group. Essential

Competency Profile for Physiotherapists in Canada. 2009.

www.physiotherapy.ca/PublicUploads/224032Essential%20

Competency%20Profile%202009.pdf.

3. Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of

physician self-assessment compared with observed

measures of competence: a systematic review. JAMA. 2006;

296: 1137-1139.

4. Regehr G, Eva K. Self-assessment, Self-direction and the

Self-regulating Professional. Clinical Orthopaedics and

Related Research. 2006; 449: 34-38.

5. Lockyer J, Armson H, Chesluk B, et al. Feedback data

sources that inform physician self-assessment. Medical

Teacher. 2011; 33: e113-e120.

6. Lockyer J. Multisource feedback in the assessment of

physician competencies. Journal of Continuing Education in

the Health Professions. 2003; 23: 4-12.

7. Violato C, Lockyer JM, Fidler H. Changes in performance:

5-year longitudinal study of participants in multi-source

feedback programme. Medical Education. 2008; 42: 1007-

1013.

8. Duffy FD, Lynn L, Dindura H, et al. Self-assessment of

practice performance: development of the ABIM Practice

Improvement Module (PIM). Journal of Continuing Education

in the Health Professions. 2008; 28: 38-46.

9. College of Physiotherapists of Ontario. Continuous self-

improvement: study of ongoing learning of physiotherapists/

physical therapists. Perspectives Newsletter 2011; 3:

5-6. www.collegept.org//Documents/Perspectives/

PerspectivesVol3Issue1_111121.pdf.


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Webinar Series

Upcoming webinar

Best evidence for post-operative Bankart and rotator cuff rehabilitation. Find out how to use the new post-operative shoulder rehabilitation guidelines for Bankart and rotator cuff repairs.

The consensus and evidence derived post-operative guidelines were developed by a multi-disciplinary team of surgeons, physicians and physiotherapists from the Edmonton region. The guidelines provide a common platform from which physiotherapists, surgeons and physicians can work. The hope is that the new guidelines will lead to improved, standardized care for post-operative Bankart and rotator cuff repair patients. Available at http://www.rehabilitation.ualberta.ca/en/ContinuingProfessionalEducation/ShoulderRehab.aspx

Date: May 17, 2012 | Time: 8:00-9:00 a.m.

Presenter: Judy Chepeha, PT, PhD, Assistant Professor Department of Physical Therapy, University of Alberta.

The webinar series resumes in September and will be introduced in eNews when the line-up is finalized.

Recorded webinars on Physiotherapy Alberta’s website

y Acute chest care best evidence y Anti-gravity treadmill y Auto insurance accident benefits y CanWell Program for cancer survivors y Early mobilization in the ICU y Falls prevention y Malpractice insurance y Musculoskeletal pain + interferential current y Pelvic health conditions y Screening the dizzy patient y Spinal manipulation clinical prediction rules y TRIP database y Wound management guidelines + best practices

A number of free resources and databases make it easier than ever for busy clinicians to find evidence-based information. Searching is often fast, requires no special knowledge of search terms and often returns evidence summaries, systematic reviews and clinical practice guidelines.

TRIP database y Free search engine. y Pulls search results from 26 databases. y Access to evidence synopsis, systematic reviews,

clinical practice guidelines, e-textbooks, and patient information.

y Access to some full text articles.

PEDro database y Free database. y Critically appraises randomized control trials,

systematic reviews and clinical practice guidelines specific to physiotherapy interventions.

y 21,000 reviews.

Centre for Evidence-Based Physiotherapy y Website that collects and disseminates articles,

systematic reviews and practice guidelines relevant to physiotherapy.

y 2,500+ records.

Physiopedia y Think Wikipedia only for physiotherapists. y Like Wikipedia a collection of web pages to

contribute, gain and share knowledge about physiotherapy interventions.

y Physiopedia is driven by experts and presents an evidence-based approach to care.

PubMed y Free search engine based on Medline. y Almost equivalent search capabilities to many

paid databases (e.g., Medline, CINAHL). y Some access to full text articles. y User friendly.

Links to these databases are posted on Physiotherapy Alberta’s website under ‘Finding Evidence for Practice’ located in the Knowledge Center.

Quickly Find Evidencefor Practice


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Mediaand Other Sightings

Pacing yourself when starting on New Year’s activitiesEdmonton physiotherapist Simon Cooke from Kinsmen Sport Center Physical Therapy Clinic was featured on a January 6th CBC Edmonton Radio Active broadcast. Host, Kim Trynacity, interviewed Simon on tips and strategies to prevent injuries for those starting on New Year’s resolutions to exercise more.

Men’s health injury preventionCalgary physiotherapist David Lindsay from the University of Calgary participated in a live Alberta Health Services twitter discussion on men’s health and injury prevention on February 9. During the one-hour discussion participants submitted their questions to David on topics related to injury prevention and management.

Your first physiotherapy visitEdmonton physiotherapist Judy Black from South Edmonton Physical Therapy & Sport Rehab wrote a very informative article on ‘what to expect from physiotherapy’ that was featured in the spring 2012 edition of Family Health Magazine. Family Health is distributed to over 100,000 Albertans through doctor’s offices, hospitals, health units, Canada Safeways, and some pharmacies in Western Canada.

Ask The Expert – runner’s kneeEdmonton physiotherapist Stephanie Dumont, Coronation Physiotherapy, wrote a full-page article on how to recognize and treat runner’s knee. The advertorial, sponsored by Physiotherapy Alberta, appeared in the spring 2012 edition of Impact Magazine. Impact Magazine has a circulation of over 400,000 throughout Alberta and British Columbia. Fifty-five percent of Impact readers are female, well educated and have an active lifestyle.

A veteran learns to walk without legsEdmonton physiotherapists Jane Flett and Stacy Rivalin from the Glenrose Rehabilitation Hospital were featured in a February 27 Canada.com news article that followed the story of Major Mark Campbell’s recovery following a bomb blast and the loss of both legs. Both Jane and Stacy were quoted extensively throughout the article on the challenges veterans face during rehabilitation.

Physiotherapists presenting at the Alberta College of Family Physicians SymposiumKaren Van Heyst, Barb Mikkelsen and Sheelah Woodhouse presented workshops on the following topics:

y Diagnosis and treatment of lympedema and cancer - Karen Van Heyst

y Management of positional plagiocephaly and torticollis in infants - Barb Mikkelsen

y Three Dirty Words (Doctor, I’m dizzy!) - Sheelah Woodhouse


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Positioning physiotherapy + raising its profile.

Update on 2011-2012 Marketing and Advertising Program.

Paid mediaTwo main strategies were selected:

1. AD bars (the bars that divide grocery orders on the conveyor belt) were placed at checkout counters of various Safeway, Sobeys, Co-op, Sunterra, and T&T locations throughout Alberta. AD bars appeared in a total of 65 locations from December 5 to January 1. The AD bars included a QR smartphone code that when scanned directed the customer to Physiotherapy Alberta’s website.

2. Rink board advertisements in full colour were placed in 35 ice rinks throughout Alberta for 52 weeks. Rink boards reach a broad range of audiences with active lifestyles - players and spectators - male and females - young and old. It is reported that approximately 46% of parents in Canada watch amateur sporting events at local arenas. Check out your local arena to view Physiotherapy Alberta’s rink board.

Website developmentThere continues to be many opportunities to improve the site particularly with respect to the Knowledge Center. We are currently exploring strategies to drive more traffic to the website using Google AdWords and taking advantage of search engine optimization.

Social mediaLast fall we started using Twitter to connect with and push information to target audiences including members, public, government, and others. Our strategy is to highlight research, innovative practice models and patient stories that highlight the effectiveness and value of physiotherapy. Currently we have 140 followers and growing. Please join us on Twitter@PTAlberta.

Music in Motion sponsorshipPhysiotherapy Alberta was a sponsor of the 2011 Music in Motion event to raise funds for bone and joint research in Alberta. The two gala events in Calgary and Edmonton raised over 1 million dollars. Proceeds will be used to:

1. Support physiotherapy and rehabilitation research at the University of Alberta.

2. Fund the creation of a world class Bone Research Laboratory for McCaig Institute for Bone and Joint Health and Alberta Bone and Joint Health Institute.

Tradeshow representationThe Alberta College of Family Physicians Symposium in Banff, February 23-25, provided an opportunity to network and promote physiotherapists to over 350 family physicians. Physiotherapy Alberta’s booth material highlighted the role of physiotherapists in chronic diseases (e.g., diabetes, COPD, arthritis, cancer). Many family physicians were interested in learning what physiotherapists can offer in the management of these conditions. Overall family physicians who visited our booth were very supportive of physiotherapists and would like to see better integration of physiotherapists into the primary health care system.

New member material

y Facts sheets focusing on physiotherapy’s role in COPD, knee osteoarthritis, active aging, diabetes, and cancer posted on our website. The facts sheets provide an evidence-based overview on the value of physical activity and physiotherapists’ role in managing these conditions. Please use these resources when promoting the profession to doctors, policy makers, insurers, and program managers.

y Funky 17 x 11 inch office table stand highlighting what physiotherapist do and the many conditions they treat. The table stand includes a tear-off sheet listing various funding options for physiotherapy. Available for members to use to educate their patients, the public or referral sources. Available while supply lasts. Call or email with your order!


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For the second year, Physiotherapy Alberta sponsored Finding Balance - a province wide campaign to raise awareness and prevent falls among Alberta seniors.

Physiotherapists were featured in the campaign launch held at an Edmonton seniors facility on November 4, 2011. Greg Cutforth, Council President, shared personal stories and perspectives about the importance of falls prevention. This was followed by an interactive demonstration of simple balance exercises from Edmonton physiotherapist Cindy Grand.

The campaign events created several media opportunities. Greg Cutforth was featured in a front-page Edmonton Journal article, provided TV interviews for CBC and Global Edmonton and live radio interviews for Free Radio Grande Prairie and CFCW (Northern Alberta Station). Cindy Grand made an appearance on Global Edmonton Breakfast TV to talk about falls prevention. In Calgary, Kathy Harbidge was featured on Shaw TV. Thanks to Greg, Cindy and Kathy for being great representatives for the profession.

Preliminary results indicate this years’ campaign was the most successful to date. Over 600,000 posters and flyers branded with Physiotherapy Alberta’s logo were distributed to pharmacies, hospitals, libraries, and seniors centers throughout Alberta. Paid media, in the form of newspaper articles, reached roughly 246,000 Albertans over the age of 65, and nearly 580,000 Albertans through advertising in a total of 71 publications across Alberta. According to the post-campaign survey results conducted by Leger, the campaign was most successful in convincing Alberta seniors:

y Preventing falls is relevant to them (60% up from 41% pre-campaign).

y Preventing falls is an important issue (90% up from 82% pre-campaign).

y To take precautions to prevent falls (45% up from 37% pre-campaign).

Cindy Grand, PT, demonstrating balance exercises

Greg Cutforth, PTCouncil President


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Department of Physical Therapy

Award Winning Teachers in the MScPT Program Each year, faculty and students submit nominations recognizing innovative and excellent teaching that stands out. This year’s Faculty of Rehabilitation Medicine Teaching Awards recipients are:

y Faculty Teaching Award - Mark Hall, Assistant Professor and Academic Coordinator of Clinical Education, Physical Therapy. Excerpt from nomination: Mark has a passion and energy for teaching that is infectious. He is an educational leader in the integration of teaching technologies, particularly the use of simulation. Collaboration comes naturally to Mark and he is generous with his knowledge; he is always willing to help others with their instructional design. Mark’s teaching accomplishments are numerous, he embraces innovation and is not afraid to try new things.

y Graduate Teaching Assistant Award - Jorge Fuentes, PhD candidate in Rehabilitation Science. Excerpt from nomination: Jorge brings a wealth of experience to the classroom, which he freely shares with students and other instructors. In the classroom, Jorge has a natural ability to stay calm, listen to students and assist their learning in a variety of subject areas. He is often in demand as a teaching assistant (TA) and graciously takes on new TA roles.

y Sessional Teaching Award - Kim Dao, Physical Therapy. Excerpt from nomination: Kim’s area of interest and expertise is in neurology, but she has proven that she can teach in many different content areas, from movement analysis to vestibular rehabilitation. Kim is a competent clinician and has been able to translate her skills into the classroom, creating an excellent learning environment. Kim modifies her teaching style to meet the needs of students and they truly appreciate the time she takes to ensure they comprehend content and master skills.

y Clinical Educator of the Year - Jon Gabbai, Calgary Clinical Education Coordinator, Physical Therapy. Excerpt from nomination: Jon has a definite passion for student learning. He has made a concerted effort to enhance the student learning experience at the Foothills Medical Centre by developing in-service education sessions and shadowing opportunities on other units. Jon has gone above and beyond to ensure students get the most out of their clinical placements with him.

y RMSA Excellence in Teaching Award (Physical Therapy) - Barb Norton, Clinical Assistant Professor. Excerpt from nomination: Barb shows respect, encouragement and genuine concern for student learning. She is an invaluable resource and is able to effectively share knowledge from the field with her students. Her positive attitude and warm smile is appreciated by all.

Left to right: Jon Gabbai, Mark Hall, Barb Norton,

Jorge Fuentes and Kim Dao


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MScPT 2012 AdmissionsThe Department has received 560 applications for the MScPT program this year, an increase of approximately 100 over application numbers for each of the last three years. With the opportunity to attend on three different campuses, applicants were asked to rank their preference. Results show there is significant interest in the new Calgary MScPT satellite program and continued demand to attend the program at Augustana Campus in Camrose and the main campus in Edmonton. The Multiple Mini Interviews will be held this year on Saturday April 21. Thanks to the many volunteers who offered to participate.

Bridging Program for Internationally Educated PhysiotherapistsThe Department of Physical Therapy and the College of Physical Therapists of Alberta are sponsoring partners in a five year project funded by Health Canada’s Internationally Educated Health Professions Initiative to develop and deliver a bridging program in 2013 and 2014 for Internationally Educated Physiotherapists (IEPTs) who reside in Alberta.

The Bridging Program will be housed at Corbett Hall and will provide assessment, academic courses and other supports to assist physiotherapists educated outside of Canada to fill identified gaps in knowledge, skills or workplace experience, to learn how to manage cultural differences, and successfully integrate into the Alberta workforce. The Bridging Program also is intended to improve performance in the Physiotherapy Competency Examination.

The project is in the early start-up phase. The focus is on understanding the needs of IEPTs

who reside in Alberta and developing a vision for a sustainable bridging program to meet those needs. The program will capitalize on the academic and technology strengths of the Department of Physical Therapy.

Carol Puri, PT, MHSc has joined the Department as the IEPT Bridging Program Director. Carol invites communication with potential applicants, clinical preceptors or mentors at [email protected] or 780.492.7431.

Physiotherapy student clinical educationSurvey coming your way in May

What are the attitudes of Canadian physiotherapists towards the supervision and evaluation of physiotherapy students?

We want to hear from you!Do you have an opinion about physiotherapy student clinical education? What are the reasons you do and do not supervise physiotherapy students?

Researchers at the University of Alberta are conducting a national study on the factors that influence Canadian physiotherapists’ decisions to supervise physiotherapy students.

Even if you don’t supervise students your opinion is important. Keep an eye on your email inbox. The survey will be sent out in May.

Canadian publications mail#40063092

Return undeliverable Canadian addresses to:

Physiotherapy Alberta Suite 300, 10357 - 109 Street Edmonton, AB T5J 1N3