By Ronald De Vera Barredo, PT, MA, GCS
Identify the Gaps Reconsidering the issue of continuing competence. When looking at the pace of technological and scientific advancements in the health care profession, I am convinced of the continuing need for health care professionals to acquire the current knowledge and skills consistent with new developments in the industry. Unless these professionals take on the challenge of attaining, maintaining, and advancing their professional competence in an evolving health care system, they may eventually find themselves with ineffective, antiquated, and less efficient means of health care delivery. In fact, I venture to say that health care professionals are in agreement on the need for practitioners to keep themselves clinically updated. The demands of consumer groups, professional associations, regulatory agencies, accrediting bodies, federal and state mandates, and other stakeholders in the health care industry further validate this necessity. The question for us, therefore, is not whether we keep ourselves continually qualified, rather, how do we maintain our continued competence as health care professionals? Assessing qualifications Identifying competency expectations is difficult because of the complexity of the issue. Whereas a beginning practitioner may be considered a generalist, a more experienced one may have developed expertise in a particular area of clinical practice. The question that begs to be answered, then, is whether or not both practitioners are subjected to the same standards of competence. Perhaps the answer to this question lies in the fact that initial or entry level competence should not be confused with ongoing or continuing competence. While the acceptable measure of initial competence is the licensing examination, measures of ongoing competence are varied and, at best, lacking in consensus from the professional community. Moreover, issues such as depth, breadth, and method of assessment still need to be addressed. Consider, for example, the following questions: Depth of assessment. How should the assessment of continuing competence of a health care professional working primarily in a research facility differ from that of a full-time clinician or an academician? Breadth of assessment. How should the practitioners be assessed in knowledge or skill? Should a clinical practitioner working in a neurologic hospital be subjected to the same competence expectations as another clinical practitioner working in an orthopedic hospital? Method of assessment. How should continuing competence be measured? What method of assessment should be utilized? Rising Above In looking at ways to maintain and assess continued competence, I am intrigued if not overwhelmed by the number of assessment tools, mandates, and strategies that are utilized across the various health care professions. The laundry list includes, but is not limited to, periodic reexamination, mandatory continuing education, educational outreach, peer review of on-site performance or portfolios, self-assessment, and national standards of professional practice. Although these strategies have their inherent strengths and weaknesses, there seems to be no agreement on which strategies are most effective. I am perhaps one among many who believe that there is no one tool that solely meets the tests for cost-effectiveness, consistency, and validity. Instead, the judicious selection of the right combination of strategies is necessary. The most often utilized tool to maintain clinical competence is perhaps mandatory continuing education. Health care practitioners need to engage in a minimum number of educational activity hours, including attendance at professional seminars and workshops as a requirement for license renewal—the presupposition being that participation in these activities would translate to ongoing clinical competence. Although arguments for and against mandatory continuing education abound within the profession and among professionals, I echo the sentiments of Barb Sullivan, president of the Illinois Physical Therapy Association: “I’ve come to realize and appreciate mandatory continuing education for what it is: a minimal requirement to hold licensed physical therapists and assistants accountable for seeking out professional education in the interest of better serving the public.” Concurrently, however, I contend that health care professionals need to rise above the minimal standards set forth by any professional body or regulatory mandate. Toward this end, I submit that prior to engaging in professional activities and attending any continuing education workshops related to the attainment and maintenance of clinical competence, practitioners need to engage in a methodical process of personal reflection, professional triangulation, convergent action, and professional review. Expanding Professional development Personal reflection is not unlike self-assessment. It involves looking at our current practice with the intent of determining not only how to improve our skills and knowledge, but also, and more importantly, how to deliver care in the most effective and efficient way possible. In doing so, we are able to identify gaps in our current skills, knowledge, and practice and develop strategies to narrow these gaps. However, unlike self-assessment made in the context of annual employee evaluations, self-reflection is not a slave to a set of procedures or cluster of criteria. Instead, it goes beyond the vague generalities of institutional mandates and, instead, focuses on the specific professional needs of the clinicians, as identified by the clinicians themselves. Triangulation involves using multiple data sources in order to create a better representation of the issue being studied. I believe that the assessment of and need for continuing competence strategies should not be limited to the self-assessments of health care professionals themselves. Assessments from other sources such as peers and supervisors should also be considered in order to provide a more complete picture of what clinical practitioners need in the context of their professional responsibilities. Information obtained from triangulating self, peer, and supervisor assessments is a powerful tool in contextualizing the specific professional needs identified by clinicians. Consequently, the professional growth and development of health care professionals also translate to the improvement of the programs and institutions they represent. Only after health care practitioners identify the professional gaps, and only after they have contextualized these gaps within the framework of the institutions’ they should they proceed to engage in a number of educational activities and continuing education workshops. Therefore, instead of blindly fulfilling the minimum requirements necessary to meet the mandates of professional associations and regulatory agencies, health care professionals are able to take a more proactive stance in their professional development efforts. They do not become limited to what is required; rather, they expand the range of professional development activities to include not only workshops and seminars but also a number of professional and educational activities that enhance their clinical practice. Professional review involves peer-reviewed evaluations of one’s efforts and actions. More specifically, I submit that these efforts and actions be evaluated on how clinical practitioners have narrowed the professional gaps they have identified early on in the process. For the clinical practitioner whose educational and clinical activities are being peer-reviewed, I suggest the development of a professional portfolio illustrating the practitioner’s goals and development over time. The portfolio is the product of, and cannot be separated from, the personal reflection, professional triangulation, convergent action, and professional review processes required to produce it. Ronald De Vera Barredo, PT, MA, GCS, is a geriatric and management consultant and the director of the Physical Therapist Assistant Program, Kaskaskia College, Centralia, Ill. He can be reached via email: rdbarredo@kc.cc.il.us.
