The ABCs of competence development in physiotherapy education

The undergraduate physiotherapy programme at the University of Namibia is in its infancy, with the first cohort graduating in 2022. The programme lacked a defined set of competencies for undergraduate students and entry level physiotherapists developed and agreed upon by all relevant stakeholders including professional associations and regulatory bodies. Most of the regulations and guidelines were developed prior to the implementation of the physiotherapy programme and have not yet been reviewed. The current system has resulted in producing graduates who lack clear-cut competencies that are responsive to the Namibian and international rehabilitation standards.

This project offered an opportunity to identify and supplement specific competencies to add clarity, strength and content to the current competencies for undergraduate students and entry level physiotherapists in Namibia. The project involved four steps from June 2022 to May 2024. First, the scoping review yielded a set of competencies from global physiotherapy frameworks and their accompanying specific knowledge and skill activities required to achieve each competence. Second, the key informant interviews explored the experiences and perceptions of faculty, clinicians, students and external examiners on the existing competencies of the physiotherapy programme. This culminated in proposals of contextually relevant competencies the programme can revise and strengthen and those that could be added. Based on the first two steps, a draft competence framework was developed.

Third, the Delphi consensus study allowed physiotherapy stakeholders (students, interns, junior, senior, faculty, external examiners) to reach a 97.7% consensus on the set of competencies that are contextual and relevant to Namibia. Last, content validation was conducted with five experts and two final year students on each competence and its accompanying knowledge and skill learning objectives for the following: I-CVI (item-level content validity index; Universal agreement (UA); S-CVI/Ave (scale-level content validity index based on the average method); and S-CVI/UA (scale-level content validity index based on the universal agreement method). Interestingly there was a high (>0.9) S-CVI/UA in terms of patient treatment, clinical reasoning, health promotion, community physiotherapy and ethics and low (<0.70) S-CVI/UA in terms of diagnostic reasoning, research capacity building, quality improvement and collaboration.

Despite a wealth of literature on developing competencies in health care, there seem to be limited and inconsistent methods for developing competencies in physiotherapy. Recent literature has associated development of competencies with several methodological steps.¹ An important outcome was the implementation of this project following a multi-stepped methodology.

Initially the project envisioned including training on the validated competency framework. This could not be done due to lack of funding. However, posters were developed for faculty offices, lecture rooms and handbooks for clinicians, external examiners and students. The physiotherapy faculty developed their own domain (musculoskeletal, neurology and cardio-respiratory) clinical competencies drawing from and utilising this framework. Development of competencies is a challenging task in view of continued evolution of competencies as new approaches and techniques are developed. Significantly, we need to understand the context particularly in developing countries to ensure success in introducing and implementing competence-based education.

Tonderai Washington Shumba: Conceptualization; methodology; investigation; validation; formal analysis; data curation; project administration; writing—original draft. Ara Tekian: Supervision; project administration; writing—review and editing; methodology; conceptualization.

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The Ethical Clearance Certificate was issued by the University of Namibia Decentralised Ethics Committee (DEC) (SAH08/22 – 24/07/2022) and Ministry of Health and Social Services (Ref: 22/4/2/3).