Continuing Competence: The Evolution of Competence

  •   December 5, 2019
  •  Audrey Lowe, Manager of Continuing Competence Program

The great part of working in continuing competence programming for so long is to see regulator’s understanding of the topic of continuing competence evolve. Some of the evolution has been born out of revolution. Most of Alberta’s health professions regulatory colleges have had less than 15-years of experience operationalizing their continuing competence programs, and they continue seek the right model to fit their professional culture. Searching for the right continuing competence program strategy is akin to searching for the “holy grail.” Continuing competence is always a hot topic of discussion when regulators gather together to learn.

Let’s start with two of the fundamental concepts for understanding a continuing competence program, the concepts of essential competence and continuing competence.

Our profession started out with descriptions of essential competencies that focused on “what” physiotherapists do and now the descriptions have evolved to focus on physiotherapist’s “abilities”.

The 2004 Essential Competency Profile for Physiotherapists in Canada1 listed seven areas of “major function for effective performance of physiotherapists in fulfilling their role”. These were:

  • Professional Accountability
  • Communication and Collaboration
  • Professional Judgment and Reasoning
  • Client Assessment
  • Physiotherapy Diagnosis/Clinical Impression and Intervention Planning
  • Implementation and Evaluation of Physiotherapy Intervention
  • Practice Management

Essential competencies were “a repertoire of measurable knowledge, skills and attitudes required by a physiotherapist throughout his or her professional career.” The 2004 competency profile contained performance-oriented, behavioral descriptors similar to statements we currently see in practice standards. Moreover, the profile was weighted toward being applicable to those working in clinical practice rather than those working in non-clinical/administrative roles.

Fast forward to 2017 where the 4th generation competency profile2 has evolved to be role and ability based. Physiotherapists are expected to have abilities in the following seven domains:

  • Physiotherapy Expertise
  • Communication
  • Collaboration
  • Management
  • Leadership
  • Scholarship
  • Professionalism

Essential competencies now describe the “required abilities” of a physiotherapist with descriptors that are much broader and generic. There are bare-bones minimum performance descriptors to outline the behaviours expected of an entry-to-practice physiotherapist. This profile is a better fit for the physiotherapist profession in this modern age where multiple professionals will “do” the same tasks that a physiotherapist does. The 2017 profile is applicable to clinicians and those working in non-clinical roles. It compliments rather than duplicates the detailed behavioral descriptions of good physiotherapist practice commonly found in standards of practice.

Like essential competence, our understanding of continuing competence has also evolved. Here’s a definition pulled from a 2002 presentation on the subject.

“Continued Competence - the ongoing or continued capacity to apply knowledge, skills and attitudes that affect a major part of one’s job, that correlate with performance on the job and can be measured against acceptable standards.”3

Note the definitions focus on measured performance against standards. Fast forward 17 years and here’s what the same person thinks about continuing competence.

“Continuing competence is multidimensional dynamic, changing with time, experience and context.”4 The elements of competence include the 4 ‘C – competencies, characteristics, continuum of practice and context. Now her view of competence looks like this:

COMPENTENCIES

  • Defined abilities (i.e., knowledge, skills, judgment) which can be observed in physiotherapists
    • Essential Competency Profile
    • Practice Standards
    • Job Descriptions    

CAPABILITIES

  • Individual capabilities and personal characteristics
    • Intellectual/cognitive functions
    • Physical ability
    • Psychological health

CONTEXT OF PRACTICE

  • Types of patients and their problems
  • Location of work practice
  • Physical Environment
  • Social Environment and Supports
  • Immediate Situation    

CONTINUUM OF PRACTICE

  • Evolutions of expertise (i.e., Student, novice, competent, proficient, expert)
  • Competence life cycle (i.e., student, field-based novice, independent professional, retirement)

Regulators thoughts about continuing competence have evolved. Therefore, Physiotherapy Alberta created the redesigned DO.LEARN.GROW Continuing Competence Program. The Self-Selected Activity was designed for you to share your continuing competence story in your Practice Improvement Record. We recognize physiotherapists are self directed learners who engage in activities that create meaningful, significant changes in personal competence, and patient care/work system practices. If these activities and completion of the Practice Improvement Record furthers your learning and/or helps you gain insight into your practice, then I am satisfied the program has evolved into one that is useful and aligns with our elemental understanding of continuing competence.

Comments? Contact Audrey Lowe Manager Continuing Competence Program competence@physiotherapyalberta.ca 780.438.0338, 1.800.291.2782


  1. Accreditation Council for Canadian Physiotherapy Academic Programs, Canadian Alliance of Physiotherapy Regulators, Canadian Physiotherapy Association and Canadian Universities Physical Therapy Academic Council. (2004) Essential Competency Profile for Physiotherapists in Canada
  2. National Physiotherapy Advisory Group (2017) Competency Profile for Physiotherapists in Canada (2017)
  3. Glover-Takahashi, S, Hurley, L, Parker-Taillon, D. (April 2002) Continuing Competence: Part of the Continuing Professional Development Puzzle – Presentation for Trijoint Panel.
  4. Glover Takahashi, S., Nayer, M., St Amant, L. (September 2016) Epidemiology of Competence: Understanding Risks & Supports to the Competence of Health Professions with a focus on Physiotherapists.