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.