Towards a competency-based curriculum in physiotherapy

I’ve been thinking about the concept of competency based education (CBE) in relation to the altPhysio series that I’m busy with. I’m drawn to the idea of CBE but am aware that there are some criticisms against it, especially from a theoretical and pedagogical perspective. This post is a short note to clarify some of my thinking around CBE.

I started with Frank et al. (2010) Toward a definition of competency-based education in medicine: a systematic review of published definitions to get a bit of an idea about how others think about CBE and to have a working definition of the concept. From the article:

We identified 4 major themes (organizing framework, rationale, contrast with time, and implementing CBE) and 6 sub-themes (outcomes defined, curriculum of competencies, demonstrable, assessment, learner-centred and societal needs)….From this research we have developed a proposed 21st century definition of CBE for medical education, namely:

Competency-based education (CBE) is an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centredness.

I quite like this definition of CBE and think that it addresses some of the concerns that are commonly levelled against a CBE approach. This is far from a foregone conclusion and there are still many contrasting points of view. But for my purposes this was a good place to start, especially since I’m looking at a physiotherapy curriculum, which has a significant emphasis on clinical performance, as opposed to another programme that emphasises different outcomes.

I’m obviously also interested in the use of technology, and Tony Bates’ The strengths and weaknesses of competency-based learning in a digital age was useful in this regard. From the post:

Competency-based learning is a relatively new approach to learning design which is proving increasingly popular with employers and suits certain kinds of learners such as adult learners seeking to re-skill or searching for mid-level jobs requiring relatively easily identifiable skills. It does not suit though all kinds of learners and may be limited in developing the higher level, more abstract knowledge and skills requiring creativity, high-level problem-solving and decision-making and critical thinking.

I’m not sure that I agree with the last bit; it may be limited in developing higher level, more abstract knowledge and skills like problem solving, decision making and critical thinking. I think that CBE does not inherently preclude the possibility of developing these skills. The fact that it may not doesn’t mean that it can’t (IMO).

Then there’s the CanMEDS framework, which is another piece of work that I’m a big fan of. Without going into the detail CanMEDS is a way of thinking about the different roles that a physician must demonstrate proficiency in. Again, this framework seems to be a great place to start when looking at a CBE curriculum.

canmeds-2015-diagram-e

So that’s how far I’ve gotten with looking at CBE as a possible basis for a physiotherapy curriculum. If you know of any physiotherapy curricula that are currently competency-based, or are aware of any other resources that you think would be good to read, I’d really like to hear from you.

Note: The featured image of this post is a map of the London underground that I wasn’t familiar with. The point I was trying to make is that there are many different ways of getting to the same end point, and it might be useful to allow people to take the route that most suits them.

4 Replies to “Towards a competency-based curriculum in physiotherapy”

  1. Thanks for the comment, Karen. I think that a new approach to a curriculum would allow us to design something inclusive from the ground up, rather than what we currently do, which is modify – within strict constraints – the existing system. We’re still trying to force “access” into a system that is built to resist it. I hope that there’s enough interest around this idea to push it forward.

  2. Thank you for this Michael – really interesting ideas. It is so good to see the point being floated that as long as people have the abilities to get to the goal, there should be different ways available to enable the whole spectrum of individuals to achieve it.
    Oh does this sound like accessible, inclusive education……..?!!

  3. Love the visual analogy of your (re)mapping of London Underground. With regards competency-based approaches to design/delivery/evaluation of qualifying physiotherapy curricula, approach taken by the CSP may be of interest?
    CSP’s Learning & Development principles http://www.csp.org.uk/professional-union/careers-development/career-physiotherapy/learning-principles
    CSP’s Physiotherapy Framework – follow the link from http://www.csp.org.uk/professional-union/careers-development/career-development/professional-frameworks
    These documents are used by programme providers to develop physiotherapy curricula that produce physiotherapists who are able to meet the needs/expectations of contemporary professional practice across a (changing) variety of settings/practice environments/occupational roles.

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