We keep repeating:
“The Self-Selected Activity must achieve significant, meaningful and sustained improvements in the member’s personal competence, and either patient care practices or physiotherapy/health-care services.”
Recently, I was asked by a physiotherapist what does this really mean? How do I show this? Furthermore, how do I show this in the mandatory reporting form, the Practice Improvement Record, for the Self-Selected Activity. My response to them was convoluted. I used an iceberg model to help explain a competence-performance model, and how it related to the Program Rules for the Self-Selected Activity and how it is threaded into the Practice Improvement Record.
First, the Program Rules for the Self-Selected Activity state:
“The Self-Selected Activity:
- Must achieve significant, meaningful and sustained improvements in the member's personal competence, and either patient care practices or physiotherapy/health-care services.
- Must always improve (1) PERSONAL COMPETENCE via the acquisition of current knowledge or skills which updates and reinforces existing knowledge or skills or supports the development of new competencies.
- Must improve 2 or 3 (2) PATIENT CARE PRACTICES as evidenced by tangible results which can be measured (i.e., outcomes, effectiveness, efficiency). OR (3) PHYSIOTHERAPY OR HEALTH CARE SERVICES as evidenced by tangible or measurable outputs (i.e., products, directives, indicators).”
Built into the rules are expectations that what you DO for the Self-Selected Activity not only build up your competence, (lead to LEARNing), but also show that you GROW (that you perform better with your patients and/or within your health-care setting). Built into the rules are the concepts of competence and performance.
Competence and performance are considered to be different but interrelated concepts. Competence is the knowledge, skills, and judgments associated with the profession to perform effectively within the domain of professional encounters defining the scope of professional practice. Competence is developmental, not permanent, and context-specific.
Competence is about possessing and acquiring the attributes, knowledge, skills and judgments for being a practicing professional. They are internal characteristics. While some competencies can be measured, (i.e., skill, factual knowledge) other competencies and other contributing factors cannot (i.e., tacit knowledge, attitudes, judgments, personality).
Performance, on the other hand, is the expression of competence in relation to the practice context. Competence + Context = Performance.
Performance is about DOing. Performance is observable and measurable. As one’s practice context is always changing, so does performance. Some days your practice context doesn’t require you to dig too deep into your competence bucket to perform effectively. Other days practice context requires that you dig deep, rely on all of your capabilities, and use a variety of competencies to respond to the demands of a very complex situation. Performance is a reflection of one’s competence.
Let’s look at competence and performance from the perspective of an iceberg model. Performance is the portion of the iceberg that floats above the surface and is apparent to onlookers. Competence is the bulk of the iceberg that rests below the surface and not readily seen by onlookers, nor is it easily measured.
Participation in your Self-Selected Activity is meant to affect both the top and bottom of the iceberg.
As you carry out your Self-Selected Activity, information is sorted, filtered and internalized. You screen information, combine it with your pre-existing knowledge, skills, judgments and attitudes to make new meaning of it. Participation in your Self-Selected Activity changes you, it changes how you might think, your capabilities, and capacity for action. Participation affects the bottom of your iceberg, your competence.
The Practice Improvement Record requires you to provide statements about your reasons for choosing the Self-Selected Activity, how it fits with your practice (current or future), and statements of how it improves personal competence. These statements demonstrate why the Self- Selected Activity was significant and meaningful to you and will show how the Self-Selected Activity changed you, your personal capacity, and your readiness to respond. We are asking that you take some of the information stored in the bottom of the iceberg and explain it on your Practice Improvement Record.
We ask that the Self-Selected Activity enhance your patient care practices or physiotherapy/health-care services and that you report these effects in your Practice Improvement Record. We want to know how the Self-Selected Activity affected your practice, how it improved what you DO, and how it changed your performance with your patients or your work environment. These are top of the iceberg statements. The impacts you report are observable and reproducible. External onlookers should be able to see the impacts of improved competence. The changes they see are measurable, reproducible and sustained. Changes in your performance show that your Self-Selected Activity resulted in significant, sustained enhancements to professional practice.
You will show significant and sustained impacts on practice when you are able to:
- Respond to a question from a patient in a new and more comprehensive way
- Clinically reason more efficiently and arrive at a more comprehensive treatment plan
- Perform a newly learned skill on a patient
- Perform a previously learned skill on a patient quicker and more effectively
- Take on more complex problems or complex conditions
- Make a product or change a process or procedure that improves your work environment
When completing the Practice Improvement Record for your Self-Selected Activity, you are expected to report on both competence and performance
In summary, you will show how your Self-Selected Activity is relevant and meaningful when you draw from the bottom of the iceberg and make statements about its relevance given your personal goals, job demands, and practice context and how it changed your thinking and readiness for action. You show how your Self-Selected Activity resulted in significant, sustained improvement in practice when you discuss performance and accomplishments as in relation to your patient care or health/physiotherapy services.
Questions, comments and concerns. I am always up for a discussion about competence programming and would love for some members to help draw out the competence programming information stored in my iceberg. Contact the Continuing Competence Program - competence@cpta.ab.ca 780-438-0338 1-800-2912782
