Good Practice: Continuing Education in the Time of COVID

  •   September 4, 2020

At the start of the pandemic, Physiotherapy Alberta announced that it would cease to post new in-person course listings on our website. The public health orders in effect at the time prohibited group gatherings and it was also thought that the risks of health professionals gathering could worsen the spread of COVID-19.

Physiotherapy Alberta’s jurisdiction is to regulate individual physiotherapists and the practice settings where physiotherapy services are provided. As such, we have provided guidance to the profession and to business owners regarding how to mitigate the risks of COVID-19 as practices were allowed to re-open. However, our jurisdiction does not extend to continuing education providers. These businesses and their locations are not regulated by Physiotherapy Alberta. While we can decline to post event listings on our website, we do not have the jurisdiction to prohibit courses.

Continuing education (CE) providers are private businesses. Like other businesses, they have faced unprecedented business challenges and have had to make radical changes to their business models in response to COVID-19. Many CE providers made a rapid change to online delivery earlier in the pandemic. However, not all physiotherapy education can occur without an in-person component. Some skills simply require hands on practice with patient models and instructor feedback. As such, it is understandable that some CE providers and clinicians alike are seeking to engage in in-person learning.

Given that Alberta is now in Stage 2 of re-opening, most businesses have resumed operations. There are currently no public health restrictions that prohibit CE providers from offering in-person courses. Like other businesses they are required to comply with restrictions related to physical distancing, group gathering size and use of measures to mitigate against the spread of COVID-19.

While some individuals may perceive this as a positive development, it also necessitates caution from the physiotherapist considering taking a course with an in-person component.

Is it a good idea to complete in-person continuing professional education at this time?

Physiotherapy Alberta’s perspective is that physiotherapists should perform a risk/benefit analysis to determine if participation in continuing education is a good idea.

When we contemplate the public interest and our mandate of public protection in relation to CE and COVID-19, Physiotherapy Alberta considers the following:

  • Physiotherapists are part of the essential health workforce, sometimes referred to as the “health infrastructure” of Canada. When health professionals become infected with or have an unprotected exposure to COVID-19 they are unable to return to work for an extended period and this negatively impacts the patients we serve and the health system’s capacity.
  • Although gathering in groups of limited size is permitted under the public health orders currently in effect, there are risks inherent to any gathering. Gatherings of health professionals are not an exception and may in fact pose greater risk, as health professionals may be more likely to have been exposed to a person with COVID-19 through their work than members of the general public. While gatherings are permitted under the current rules, it is not open season. As the Chief Medical Officer of Health, Dr. Hinshaw, has indicated, we all should be carefully considering what gatherings are truly necessary and limiting our activities accordingly.
  • When health professionals gather together in a course context, they are typically drawn from a diverse set of communities and practice settings and could easily become an inadvertent vector of virus transmission between communities.
  • Many physiotherapists work in more than one sector or practice setting. A course offering instruction in a technique commonly used in private practice may easily draw attendees who work in both private practice and extended care settings. An inadvertent exposure to COVID-19 at a course could ultimately prove catastrophic for the patients a physiotherapist serves, particularly if the physiotherapist works with patients at high risk of severe outcomes from COVID-19.
  • There are many forms of continuing professional development that do not necessitate in-person instruction while still enhancing clinician knowledge and skills. While physiotherapists may have a strong desire to complete a course or gain a credential, it is important to remember that such credentials and course work are optional.

So, Physiotherapy Alberta is arguing against continuing education?

No, that’s not the case. Physiotherapy Alberta recognizes that CE is critical to ensuring patients receive safe, high quality and effective physiotherapy services. However, we are concerned about the risks in-person courses may pose. We recognize that there are other ways that clinicians can engage in continuing professional development that pose fewer risks to both the physiotherapist and the patients they serve. It is essential to balance the risks of in-person education against the potential benefits.

We also recognize that this risk/benefit analysis depends on many things, including the specific measures the CE provider has put in place and the unique risks of the clinician and the practice setting/patient population that they serve. We encourage physiotherapists to carefully consider their individual risks, the patient population they serve and the risks inherent to that population, and the measures put in place by the CE provider when choosing their continuing professional development activities during the COVID-19 pandemic.

What should I be considering?

Keep in mind that many CE providers are businesses with a national or international scope. As such, they may or may not be familiar with the Alberta context, orders in place from the Chief Medical Officer of Health, and current trends in infection rates. If a physiotherapist is considering in-person CE, we recommend that they investigate the following with the CE provider:

  • Is the CE provider aware of the restrictions and rules in place in Alberta?
  • What plans are in place to address the restrictions?
    • Are they limiting registration numbers?
    • How will they ensure two-meter spacing between course participants within the classroom?
    • Will participants work with the same lab partner for the duration of the course?
    • What other adjustments are being made to how the course is delivered to address the risks of COVID-19?
    • Are they requiring that masks be worn for the duration of the course?
    • Are hand sanitizer or hand washing facilities available to participants?
    • How and how frequently will high touch surfaces be disinfected?
  • How is the CE provider working to prevent COVID-19 from being introduced into the course cohort?
    • Are they screening participants at the time of registration?
    • Are they screening participants when they arrive on site each day?
    • What are their plans if an individual becomes symptomatic during the course?
    • What policies are in place if a participant becomes ill or is required to quarantine and cannot complete the course (to encourage participants to accurately report their health status)?
  • Is registration limited to participants from within the province or are people travelling interprovincially or internationally to attend?
    • If individuals are travelling internationally (either to instruct or attend the course), is the CE provider aware that travellers are required to quarantine for 14 days upon arrival in Alberta? How is compliance monitored?
    • If participants are attending from other provinces, is the provider monitoring infection rates in those other jurisdictions? Although interprovincial travel is not currently prohibited, it is also not encouraged. Risk of disease spread is increased when people from a province with a high infection rate travel elsewhere.

What about entry to practice education?

Physiotherapy Alberta’s perspective is that entry to practice education is not optional. It is essential that entry to practice education continue to maintain the supply of qualified health professionals able to meet health system demands.

It is true that the University of Alberta and other physiotherapy programs across the country are offering some in-person instruction during the fall term. However, the vast majority of entry to practice education is being delivered online. This shift to predominantly online instruction helps to mitigate the risk of spread of COVID-19 among students and faculty while still meeting the requirements for entry to practice education. University programs are also putting in place other measures to protect students and faculty when they are engaged in in-person learning. Our perspective is that this approach  reflects a balance between the risks and benefits of in-person instruction.

In summary

Physiotherapy Alberta believes in the importance of CE. However, we strongly encourage registrants to consider the risk/benefit analysis of proceeding with in-person post-entry to practice education. Are in-person courses really the best way to enhance your professional skills at this time and in the face of rising infection rates, given that there are countless other ways to engage in continuing professional development?

Physiotherapy Alberta will continue to refrain from posting courses that include an in-person component for the foreseeable future. We encourage registered members to question the measures CE providers have in place to mitigate risks if they do engage in in-person learning.