My meeting with the College of Physiotherapists of BC

Last night from 5:30-9pm with Dieter and Yvette by my side, we met with Brenda, Phil and Heather from the College to discuss the issues surrounding the RCA exam.  We created objectives, wrote them down then talked our way through all of them until we agreed it was time to go home. 

Phil ran the flow of the meeting and I voiced our concerns throughout the process in an open and constructive manner.  Phil’s focus was on establishing the history of how we got to where we are today with the Quality Assurance Program (QAP) and my focus was on helping him understand how I/we didn’t like where we are today and why.  I better understand their position from the process, but in no way was convinced or swayed that the Registrant Competency Assessment (RCA) portion of the QAP as it stands today is a good idea.  I believe that they heard my arguments against the RCA and although they didn’t concede that there is a better option, I think I created some openness in their position, which is a good start.

Brenda said very little, but listened and took notes as Phil and I debated the details of the QAP point by point.  He had Heather write out on the board the aspects that were required of the QAP taken from this document on their website.  Please take a moment to open this pdf file and scroll to page 4, there are fourteen points that they feel are very important to the development of the QAP.  I actively challenged them that they currently weren’t achieving the first six points in their current iteration of the QAP with the RCA in it.

We reviewed that the current QAP has three phases to it:
1.    Annual Self Report (ASR),
2.    Registrant Competency Assessment (RCA)
3.    Registrant Practice Support (RPS) 

I applauded the ASR as a good tool, I told them I understand and agree with the concept of the RPS, but I fundamentally disagree with the tool that they are using to choose which registrants get moved on to the third step.  In as many ways as I could, I argued that the RCA is not a valid or reliable tool to measure what they are trying to measure until Phil conceded that they believe it is a measure of clinical reasoning skills which can ‘by proxy’ infer an assessment of competence.  He said it with incredible confidence, but must have known that that is completely ridiculous.
 
Point #3 on the QAP Backgrounder says that the QAP must be “Meaningful and relevant to physical therapist’s professional practice.” With over 3000 physios and countless specialties among us they simply can’t write enough different RCA exams to make them meaningful or relevant to most of us, which is reason enough to not go the route of the RCA.  I think that point is the strongest of them all but I took them to task on each of the top six.  To Phil and the College’s credit they stood behind what they have done so far to create the QAP and succinctly explained why we currently have what we have. 

They have done their due diligence and have been trying their best to create a program that no one is going to love, but they created a juggernaut heading in the wrong direction.  They want to see the RCA through to get the results of everyone writing it so they can analyze the results and I don’t blame them because it has taken them a long time to get here, but it doesn’t make sense to me that we should wait two to three more years for the next group to write the exam.  I believe that if we want change we should expedite the rest of the physios writing the RCA to give the College their stats while we start working on a more feasible plan B that more of us can embrace.

The most common suggestion/request of an alternate option to the RCA has been a program involving Continuing Education Credits (CECs), but to date the College has taken the stance that they won’t meet the criteria of the fourteen points outlined in the document I linked above.  I pushed Phil on this point and his two arguments against it was that requiring physios to take courses may create too much of a financial burden on some of the registrants making it unfair and that it wouldn’t be feasible to administrate.  I argued that that is a way more solvable problem than the fact that they cannot create a valid test that is meaningful or relevant to enough of us.  They focused on the fact that their decision to go the path of the RCA was made years ago and acknowledged that technology has improved substantially since then to the point that administering a CEC program could be made feasible by a properly developed website and system.  They didn’t concede that it was a better option or that they would do it, but I can see an opening there for change.

I told them that I was planning on sending a survey out to the nearing 400 people on my email list with a few questions to poll opinion on the matter of RCA vs CEC.  They said that they want a QAP that allows them to confidently report to the Provincial government with a degree of certainty that at least 95% of their physios have established a certain degree of competency and they feel that the current version will allow them to do that, but I insisted that that statement doesn’t hold much weight if the vast majority of the physios tested don’t stand behind the tool that was used.  Phil’s response: good point.

Given that the College’s mandate is to protect the public, I suggested that a survey comparing the two options for the QAP of the RCA or a CEC for step 2 be given to the physios, a group of other healthcare professionals and a group from the general public.  Given that there is not strong evidence to support either way, I feel that appealing to public opinion for which is a better option to protect them is a logical process.  I know that they have a need to continue down their RCA path a little further, but I think we can build further convincing evidence that there is a better option when they are ready to see it.

I will write a short survey in the coming week and ask that you all complete it.  I will then write one for other healthcare professionals and we can try to engage them and then I will write one for the general public and we will see if we can get a small amount of our own data to present to them when they present us with their data from the RCA results.

I have posted this letter on my blog in order for all of you to respond if you like in the comments section.  You will also see that Phil posted a comment from the College this morning on my original article.  Please stay engaged in this and I will try to keep the ball rolling in the right direction.

Thank you

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12 Comments ↓
  • Gary Weare

    Good morning Brent .
    You have put a lot of effort into this and it is obvious , thank you .
    You have presented many valid and objective points to the College and have given them room to breath . It appears that a healthy opportunity to develop a mutual working relationship has been created . Thank you for all of your effort ,

    Gary Weare
    Penticton

  • Kevin Evans, CEO PABC

    Brent,

    Delighted to hear of the promising meeting outcome and the foundation for on-going dialogue.

    Kevin Evans
    CEO, PABC

  • Ronald Miles

    Dear Brent:

    Great job meeting with the college. I think you make some very good points. It is good that you have given us a better understanding of the college’s reasoning even if we don’t necessarily agree.

    I would like to add to your point about continuing education credits as an alternative. I have recently started using medbridge which if we were in the states some of the course can be counted as CECs. Which is a great way to keep up to date if traveling to attend regular courses is financially burdening for some. I imagine that you were already aware of this.

    Thanks,
    Ron Miles

  • Marc

    Wow, Brent. You have gone above and beyond on this process. I applaud your stance and totally support it in as many ways as possible.
    I can’t believe we don’t have more than 400 PT’s on your site.
    Carry on!
    Marc

  • Kate Kennedy

    Hi Brent – thanks for all of your time and energy on this. I think if we want a survey to be valid, we should hire a polling company to do it for us. This won’t be free, but surveys, like studies, need to be well done and controlled to have useful results.

  • Cindy

    It is nice to hear some positive comments.

  • Janet

    Physicians who work in ER settings have to yearly guarantee competency by taking a course that reviews necessary practices and are tested at the end. Can we not parallel this standard? If every 3 years physiotherapists must take a 1 or 2 day workshop that reviews all information the college deems crucial to continuing competency, and write an exam at the end? This seems much less stressful. The cost of the workshop is irrelevant. Ongoing education/credentials is essential to any profession.

  • Callie Camp

    As a soon-to-be new grad, it is really informative (and inspiring) to witness the way in which the BC physio community is banding together, engaging in healthy dialogue, and collaborating with the College in hopes of forming new policy that is representative of our profession. It won’t affect me personally for some time, but when it does, I’ll be glad to know the how’s and why’s of our certification process. Thanks Brent, for stepping into this role, and for capturing the process so succinctly.

  • Lynn

    Thank you for the enormous amount of thought and work you have committed to this process. Having written the RCA, I can say I was disappointed in the quality of the questions and felt the exam as a whole did not allow sufficient scope to demonstrate clinical reasoning, judgement and knowlege. I am in favor of a CEC component within the QAP. Phil’s agrument that requiring courses would disadvantage more rural practitioners is not valid as there are a number of online courses that could be accessed by everyone. Perhaps experts in each area (children and youth, Adult cardio etc.) could select approapriate courses.

  • Margaret Levett

    Hey Brent, thanks for all your work and keeping us up to date on the college and physiotherapists views. CECs appear to be the direction that many would prefer. However my experience with CECs relates to cost and time and whether someone actually did a course that was relevant to practise, that challenges the individual, and not something totally unrelated to the areas of practise.
    Also I’m not opposed to doing an exam. However we shouldn’t need a proctor and it shouldn’t be 3 hours.
    My suggestion is an online bank of questions that propogate so that if 2 physiotherapists are sitting next to each other the questions are different. The time can be 45-60 minutes for all the questions with 45-60 seconds per question. Also we do not work in isolation; we have colleagues, books, journals and the internet to assist us daily, so isolating us with a proctor for 3 hours is not necessary

  • Travis Dodds

    Brent, how goes it? I performed the 2014 pilot RCA and had another chance to participate today. I felt the exam has improved a bit since 2014 in terms of content but still question its ability to help us as professionals. I am not sure if you’ve had any more blog updates since this one. Having just completed (er, taken?) the 2018 RCA and spent a total of 70 minutes unable to log in / getting booted out due to apparent server insufficiency or over-scheduling (we are sorry for the inconvenience as a lot of people are trying to access the system simultaneously)… in the end I was unable to complete the exam in the allotted time due to lack of access to it I got through 25 of 30 scenarios before the final 60 minutes of server errors. So three years after this all happened in 2015 it seems it is being repeated. It’s a frustrating loss of income and/or displacement of scarce time with family or loved ones with little return on investment for those involved, and presumably more to come if we will need to retake it (an auto generated email suggested retake dates of Nov 1 & 3). I just wanted to say thanks for your efforts. Maybe the conversation needs to continue.

    • Hey Travis….I feel your frustration! We had four physios here lined up to write the exam and I am starting to get emails coming in from a new wave of disgruntled physios. Hopefully the College will be more receptive to its members feedback this time…see what happens!

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