Clinician's Commentary on Mori et al.(1).

Abstract

Clinical education is an integral component of physiotherapy student training,2,3 comprising approximately one-third of all coursework in physiotherapy programmes across Canada. During clinical placements or internships, physiotherapy students develop and apply the knowledge, skills, and professional behaviours necessary for competent entry-level practice, and they are evaluated on these clinical competencies by physiotherapist supervisors or clinical instructors (CIs). At present, most Canadian physiotherapy schools use the Physical Therapist Clinical Performance Instrument (CPI)4 to assess students' performance during their clinical placements. The CPI consists of 24 items or performance criteria that, together, are considered to represent all aspects of physiotherapy clinical performance. Developed in the United States, the CPI has undergone rigorous development and testing and has been found to be a valid and reliable measure of physiotherapy student performance.4 While the CPI's psychometric properties have been established, a recent Canadian study5 identified the CPI and the evaluation of students as a barrier to physiotherapists' offering to supervise a student. The study also confirms anecdotal reports from Canadian CIs that the CPI is lengthy, takes too long to complete, and is not always suited to the Canadian physiotherapy context.5 The new instrument developed by Mori and colleagues1 is a welcome addition to the evaluation of Canadian physiotherapy students, and I am sure many CIs will say it is long overdue! In an era of evidence-informed practice, and in light of the principles of research we emphasize to the students in our programmes, both the physiotherapy community and our students should expect assessments of student performance to be grounded in evidence. Like the developers of the CPI, Mori and colleagues document a systematic and rigorous process for the initial development of their new instrument, the Canadian Physiotherapy Assessment of Clinical Performance (ACP).1 In Phase 1, Mori and colleagues consulted widely with experts in assessment and measurement, as well as with experts in Canadian physiotherapy clinical education. Because the ACP was intended to be a national instrument, members of the National Association for Clinical Education in Physiotherapy (NACEP) and the Canadian Council of Physiotherapy Academic Programs (CCPUP) were invited to participate in the Delphi process, ensuring that the developers received feedback and input from all Canadian physiotherapy programmes before reaching consensus on the competencies to be included in the ACP. Phase 2 gathered feedback from academic experts in measurement and clinical education, as well as from end users (i.e., CIs and recent graduates), on the items to be included in the instrument, their understanding of these items, the rating scale to be used, and their overall impressions of the instrument. Cognitive interviewing is an important step in developing surveys and instruments like the ACP because it ensures that the questions or items are understood by the respondent (in this case, the CI or student) as the developers intended,6 as well as giving potential users an opportunity to provide input on usability. This is valuable feedback for Mori and colleagues as they consider the final format of the instrument; a representative sample of clinicians ensures the instrument will be usable and applicable to a variety of practice areas and practice settings. The ACP is based on the roles and competencies described in the Essential Competency Profile for Physiotherapists in Canada (ECP).7 Physiotherapists practising in Canada should be able to demonstrate the knowledge, skills, and behaviours described in the ECP when they begin practice and throughout their physiotherapy career,7 and our students are evaluated against these markers while on clinical placement. Until now, however, Canadian students have been assessed using an instrument based on US practice standards, which, while similar to Canadian standards, differ in language and in practice context; as a result, some criteria – specifically, those that relate to billing and the economics of delivering physiotherapy services – have not been completed or evaluated.8 Students will be familiar with the roles and competencies of the new ACP, as the ECP or components thereof will have been discussed in their classes. Because it is based on Canadian standards and practice, the ACP's language is inherently Canadian, and thus the instrument begins to address CIs' concern that the assessment instrument currently in use is not applicable to the Canadian context. A single national, standardized online assessment instrument has many benefits. Using a national instrument ensures that the same standards are being applied uniformly to assess physiotherapy students across the country and allows students to move easily between provinces to complete their clinical placements. In addition, a national online database will be a rich resource for research in Canadian physiotherapy clinical education. The arrival of a made-in-Canada assessment instrument for physiotherapy student performance, with sound psychometric properties, is long overdue, and the ACP is sure to be well received by CIs across the country.