Why did Physiotherapy Alberta choose to offer the examination in June?
Access to the HSERC building and the standardized patients required to administer OSCE-style examinations is in high demand. The CPE Unit was able to secure the facilities and resources needed to administer the Post-Graduate 2021 Clinical Evaluation in June.
This was the option available to us.
Physiotherapy Alberta has heard from many PCE candidates who are frustrated by the long delays to completion of the Clinical Component of the PCE and calls for Physiotherapy Alberta to act urgently to address the issue. Identifying an alternate examination is a complex process that requires coordination, collaboration, and time. We accepted the first examination dates available to us subsequent to the identification of an alternate examination plan, in order to address these calls for urgent action.
How can the CPE Unit develop a reliable and valid examination in only a month?
While we understand where this question stems from, the fact of the matter is that the CPE Unit is not developing an examination in a month. For over a decade, the CPE Unit has offered an OSCE-style examination that closely follows the examination blueprint and format of the PCE in terms of question design and length. The OSCE developed by the CPE Unit was specifically developed to approximate the PCE for internationally educated physiotherapists enrolled in the University of Alberta’s Bridging to Canadian Physical Therapy Practice Graduate Certificate, to aid their preparation for the PCE.
Universities are in the business of educating and assessing learning. The assessments within the Faculty of Rehabilitation Medicine educational programming are evaluated consistently through a number of processes such as exam analysis and cohort performance over time to ensure assessments are valid and reliable. This differs from the CAPR analysis as CAPR runs a large volume exam on limited dates which requires a different type of process, specific to that exam format.
As Physiotherapy Alberta has previously stated, we do not believe that the alternate examination is a replacement for the PCE under normal circumstances, due to the psychometric properties, reliability, and validity of the PCE. However, under the current circumstances, and with regards to the candidates who are eligible to take the alternate examination, we believe that the Post-Graduate 2021 Clinical Evaluation can serve as a suitable, objective, valid and reliable alternate to the PCE.
With all the challenges and cancellations that the PCE has faced over the past year, how can candidates be assured that this examination will go forward?
If the past year has taught us anything, it is to expect the unexpected. We know that candidates have faced considerable uncertainty and disruption when it comes to the examination process and understand that their faith in an examination coming to fruition has been shaken. Nothing in life is guaranteed, but we are confident in our ability to proceed with the examination at this time due to the following:
- The University of Alberta Faculty of Rehabilitation Medicine has been able to offer in-person labs and practical skills examinations without incident since August 2020, through special permission from the Provost’s Office.
- This has included the ability to offer programming through the Continuing Professional Education Unit, and the ability to complete several OSCE format exams with Covid requirements.
- The Faculty of Rehabilitation Medicine has robust policies and procedures in place to enable in-person instruction and examination. These policies and procedures are based upon Physiotherapy Alberta’s Guidance for Resuming Physiotherapy Practice During a Pandemic, CMOH Orders and Alberta Health’s COVID-19 Guidance for Post-Secondary Institutions.
- As Jason Kenney stated on May 17, 2021, although Alberta is still in a third wave of the pandemic, Alberta’s “case numbers have stabilized, and our transmission rate is slowing down.” Premier Kenney also highlighted that vaccination rates are rising, and it is anticipated that 50% of the population will be vaccinated by May 18, 2021. All of which will be key enablers to the ability to offer the examination.
However, there are, admittedly, risks to proceeding with the Post-Graduate 2021 Clinical Evaluation. Despite these enablers and positive signs, there is still the risk that the COVID-19 situation in Alberta could change for the worse and that the examination would need to be cancelled. We do not view this as likely, but it is possible.
There is no risk-free option. Individuals will need to weigh these risks for themselves to determine the best examination option for their unique circumstances.
Why did Physiotherapy Alberta choose the eligibility criteria identified?
Since they began considering options for an alternative clinical competency examination, Council’s priority has been to identify an objective, valid and reliable assessment tool for an alternative examination process for those candidates who are currently registered and have been waiting for the clinical examination the longest. Those eligible for the alternate examination have not had the opportunity to attempt the Clinical Component PCE administered by CAPR and have now practiced continuously under supervision in Alberta for 18 months, without incident. Physiotherapy Alberta views this as an important and valid piece of evidence to consider.
The inclusion criteria allow Physiotherapy Alberta to be reasonably assured that a balance is struck between the public interest and the need to allow competent, duly qualified individuals who have practiced without incident to enter the General Register during an unprecedented time of disruption to our usual registration processes.
When establishing the exclusion criteria, Council’s perspective was that it is appropriate that individuals who have been unsuccessful on a prior attempt at the Clinical Component of the PCE be assessed with the same, psychometrically sound, and rigorous examination tool on subsequent attempts.
Finally, Council considered the implications of allowing a candidate with a current conduct investigation or history of a conduct investigation which resulted in an investigation and recommendations, facilitated resolution, or conduct findings to complete the alternate examination, and the impact such a decision would have on public confidence that the College had fulfilled its duty to protect the public.
What measures will be in place to keep candidates participating in the alternate examination safe from COVID-19?
As part of their discussions, the Council of Physiotherapy Alberta carefully considered the wisdom, safety, and practicality of offering an in-person examination during a pandemic. As part of their deliberations, they considered Physiotherapy Alberta’s capacity to offer a virtual examination when other larger organizations had not been successful in their attempts.
Council also considered the fact that all regulated physiotherapists providing direct patient care became eligible for vaccination on April 12, 2021, and that all Albertans aged 12 and over have been eligible for vaccination since May 10, 2021. As such, candidates, examiners and most, if not all, standardized patients will have been eligible to receive their first dose of a COVID-19 vaccination for several weeks prior to the examination date.
Candidates, and many examiners and standardized patients are also physiotherapists who have been providing direct patient care safely with enhanced IPC and PPE measures in place since May of 2020. Physiotherapy Alberta is confident that candidates and others involved in the examination process understand how crucial these measures are and are willing and able to adhere to these measures in the alternate examination environment.
As administrator of the Post-Graduate 2021 Clinical Evaluation, the Faculty of Rehabilitation Medicine Continuing Professional Education Unit of the University of Alberta (the CPE Unit) has the authority to determine the public health measures required to mitigate against the risk of COVID-19 exposure in the examination environment. Such measures will include:
- Use of PPE
- Routine and vigorous hand hygiene
- Screening of candidates, examiners, and standardized patients for symptoms of or risks for COVID-19 prior to their admittance to the examination site
- Cleaning and disinfecting examination stations between candidates
- Limiting exam station duration to 5 or 10 minutes
- Using the larger examination rooms available within HSERC to allow for greater physical distancing between candidates, examiners and standardized patients
- Any other measures deemed necessary to address the risk of COVID-19 and public health orders in effect at the time of the examination
Physiotherapy Alberta and the CPE Unit also advise candidates that although the examination will be an in-person, hands-on examination, candidates will be instructed to limit their direct patient contact to that which is necessary for the task being assessed by an examination station, and to maintain physical distancing at times when skill assessment permits.
How are candidates supposed to study given current restrictions related to in-person gatherings?
We acknowledge that this is potentially a barrier, particularly for those who live alone and do not have family or roommates to practice their skills on. However, we note that most eligible candidates are actively working under supervision, meaning that they have access to patients on a daily basis on whom they have the opportunity to practice and refine their non-technical skills and technical skills related to their area of practice. We also note that within the practice setting, individuals are able to meet and study with colleagues, practicing their entry-to-practice technical skills in areas unrelated to their current practice area, provided that PPE and rigorous hand hygiene are in use.
Assisting with exam preparation is one way that supervisors and employers are encouraged to assist candidates opting to take the exam.
Physiotherapy Alberta has also heard from candidates who have raised concerns about the change from preparing for the virtual examination offered by CAPR in March to the in-person examination offered by the CPE Unit. Given that candidates have spent their academic training practicing their skills in-person on their peers, and that most, if not all candidates, are currently providing in-person care to patients, we do not anticipate that candidates will have significant difficulty preparing for an in-person examination.
However, candidates who find these barriers insurmountable may wish to wait to complete the PCE at a later date, as is their choice.
How will pass/fail be determined?
Stations will be scored on a pass/fail basis, with safety and professionalism concerns factored into the global rating of each station. A candidate must pass 8 of 12 stations in order to pass the examination. If a candidate fails more than 4 stations, they will have been deemed to have failed the examination.
What happens if I fail the Post-Graduate 2021 Clinical Evaluation?
A candidate who passes the examination is deemed eligible to be admitted to the General Register. When Physiotherapy Alberta receives the examination results from the CPE Unit, we will follow our usual registration processes to add successful candidates to the General Register.
If a candidate fails the examination, there are two considerations:
Future clinical competency examination
The candidate returns to the PCE clinical component process. A failure on the alternate examination does not have any impact on CAPR’s processes and rules, including the number of PCE examination attempts a candidate is allowed. The candidate will still have 3 PCE examination attempts.
Registration on the Provisional Register
If a candidate fails the alternate examination, they will remain on the Provisional Register and continue with the PCE clinical component.
The failed attempt at the Post-Graduate 2021 Clinical Evaluation will be counted as one examination attempt for the purpose of administering Section 7(3) of the Physical Therapists Profession Regulation, which states “If an applicant fails the examination referred to in section 3(c) a second time, the applicant’s registration is cancelled.”
If a candidate fails one attempt of the Post-Graduate 2021 Clinical Evaluation and one attempt of the PCE Clinical Component, the candidate will then have two unsuccessful attempts and will not be eligible to remain on the Provisional Register while completing their next attempt(s) at the PCE.
How does participating in the Post-Graduate 2021 Clinical Evaluation influence a candidate’s standing with CAPR and their future ability to take the PCE?
From Physiotherapy Alberta’s perspective, a candidate’s decision to pursue the Post-Graduate 2021 Clinical Evaluation should not have any affect upon their standing with CAPR and their “place in line” to complete the PCE. Indeed, a candidate’s examination registration status and the information collected at the time of their registration for the examination is categorized as private information and is subject to the provisions of the Personal Information Protection Act.
In accordance with PIPA, Physiotherapy Alberta will not be releasing the private information collected at the time of registration for the Post-Graduate 2021 Clinical Evaluation to any party other than those contracted to administer the Post-Graduate 2021 Clinical Evaluation, specifically the University of Alberta Faculty of Rehabilitation Medicine Continuing Professional Education Unit.
CAPR would not be aware of the candidate’s decision to pursue the Post-Graduate 2021 Clinical Evaluation unless the candidate disclosed this information to CAPR.
When can I expect to know my results from the Post-Graduate 2021 Clinical Evaluation?
The University of Alberta has advised that they anticipate having results to candidates and to Physiotherapy Alberta within 2 weeks of the examination.
How did Physiotherapy Alberta set the fee for the examination?
The fee for the examination has been set at $750.
Physiotherapy Alberta is committed to offering the examination on a cost-recovery basis. We are not seeking to generate a profit from the administration of the alternate examination. Unlike established examinations, we do not have historical data regarding costs to draw from. As such, we are taking a conservative approach to fee setting, to attempt to mitigate the risk to the organization and to our broader base of regulated members while also seeking to be fair to candidates.
What is labour mobility and why does it matter?
The Canadian Free Trade Agreement (CFTA) is an intergovernmental trade agreement signed by all federal, provincial, and territorial governments. Its objective is “to reduce and eliminate, to the extent possible, barriers to the free movement of persons, goods, services and investments within Canada and to establish an open, efficient, and stable domestic market”. Chapter 7 of the CFTA addresses labour mobility and aims to enable any worker regulated in one province or territory to become regulated in another province or territory.
Historically, the PCE administered by CAPR has served as an important enabler of labour mobility as all Canadian jurisdictions other than the province of Quebec have adopted the PCE as one of their registration requirements. With the use of the Post-Graduate 2021 Clinical Evaluation, Physiotherapy Alberta’s registration requirements will differ from our historical registration requirements and from those employed in other jurisdictions. As such, other jurisdictions may seek to impose barriers to labour mobility for those individuals who wish to gain admittance to the General Register in another jurisdiction through this process. For example, a physiotherapy regulator in another jurisdiction may attempt to argue that there is a material deficiency in skill, area of knowledge or ability of affected individuals.
We do not believe that there are legitimate labour mobility issues; however, this is a risk that candidates must be willing to accept if they choose to apply to complete the Alternate Clinical Examination administered by the CPE Unit.
Physiotherapy Alberta is required to ensure our registration practices are consistent with the CFTA and accept "permit on permit" recognition where there are no material deficiencies in scope, competencies, and level of independent practice between registration categories between provinces.
Beyond labour mobility, how else might my choice to complete the alternate examination affect my career?
Physiotherapy Alberta’s government mandated role is to determine if a candidate meets the requirements for admission to the General Register and to register qualified, competent physiotherapists. Information is collected through the application process to determine a candidate’s eligibility for admission to the General Register. Section 119 of the Health Professions Act specifies the information that may be disclosed to the public, and this does not include the examination completed.
Our experience is that at the time of hire, employers will confirm that an individual is registered with Physiotherapy Alberta, and which register they are admitted to. Successful completion of the Post-Graduate 2021 Clinical Evaluation will mean that a candidate is eligible to be admitted to the General Register. This may affect their employability in certain sectors and practice settings, and their ability to pursue some continuing education opportunities.
The relevant regulatory consideration is whether you are registered. Physiotherapy Alberta manages that process as this is our government mandated role.
Why doesn’t Physiotherapy Alberta permanently adopt this alternate examination for Alberta Provisional Registrants?
The College has developed this alternate examination specifically to address the needs of qualifying PCE candidates who have been on the Provisional Register for the last 18 months. This is an option available to those who do not wish to wait for their first opportunity to register for and complete the Clinical Component of the PCE.
However, the College continues to support the PCE process administered by CAPR to evaluate entry-to-practice competence. The PCE is the gold standard for entry to practice assessment for physiotherapist interns due to its reliability and validity. As already noted, the PCE is a key enabler of labour mobility for physiotherapists in Canada.
No single Canadian jurisdiction has the resources and capacity to develop and administer an examination comparable to the PCE on its own.
Although Council has heard requests that the PCE, both written and clinical be abolished, and that Physiotherapy Alberta develop a permanent alternative to the PCE, this is not an action that would be taken lightly. Council has committed to reviewing Physiotherapy Alberta’s registration requirements in the future, once current, pressing issues have been addressed.
We will continue to work with our partners across the country to ensure the CAPR clinical component examination can be administered safely and consistently in the future.