DEL Tool to Evaluate Post-graduate/professional Experience

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1 DEL Tool to Evaluate Post-graduate/professional Experience Motion DEL To support the Board of Directors exploration of tools to evaluate post-graduate/professional experience of foreign educated physical therapists in order to assess their readiness to practice in the United States. The board will communicate its progress and report back no later than the 2015 Delegate Assembly. Rationale: The FSBPT Coursework Tool only evaluates the post-secondary education of a physical therapist/physical therapist assistant. This would potentially supplement the current Coursework Tool process by providing a comprehensive analysis of the post-graduate/professional experience of foreign educated physical therapists/physical therapist assistants who are applying for licensure in the US. Response to the 2014 Delegate Assembly Motion The concept of human capital suggests the importance of an individual or group s knowledge, skills, and abilities in terms of their value or cost to an organization. The two forms of human capital people are most likely to acquire within their professional lives are education and experience (Ng & Feldman, 2009). While the advantage of acquiring both formal education and work experience is readily apparent, the importance of one over the other within a particular field or industry is often a matter of debate. In order to better understand this argument, it is important to analyze the perceived professional benefits of both education and experience, take into account the change in perception of education and experience in professional settings over time, and in this case, identify the role education and experience play within a licensure environment. Education as Preparation for Workforce In line with society s views on education, organizations have long employed education as an indicator of an individual s competence, and as a prerequisite in hiring decisions (Ng & Feldman, 2009). In recent years, researchers have sought to address the importance of education in professional settings by studying the relationship between education and job performance, and identifying knowledge, skills, and abilities associated with higher education that translate to positive job performance. According to Ng and Feldman (2009), job performance encapsulates three key areas of work behaviors: core task behaviors the basic required duties of a particular job, citizenship behaviors those extra behaviors engaged in by employees that actively strengthen an organization s effectiveness, and counterproductive behaviors the voluntary behaviors that harm the well-being of an organization. While the findings of a study by Rotundo and Sackett (2002) confirmed that each of these three categories of performance behaviors contribute to overall managerial ratings of subordinates overall job performance, core task performance is often represented as employee effectiveness. Knowledge, referred to as the understanding of information related to job duties (McCloy, Campbell, and Cudeck, 1994), greatly affects one s core task performance. Campbell (1990) further differentiates knowledge as either declarative referring to expertise regarding facts, rules, and principles, or procedural referring to the application of declarative knowledge in practice. Ng and Feldman (2009) explain how education provides students with dramatically larger amounts of both declarative and procedural knowledge, which in turn promotes core task performance due to the ability to complete a variety of tasks successfully. For example, formal education/instruction in anatomy helps students acquire the expertise necessary in becoming physical therapists and subsequently advance in that profession. In other words, schools help students develop deeper competence by equipping students with greater declarative and procedural knowledge (Ng & Feldman, 2009). In addition, Hunter (1986) iterates the notion that higher education increases levels of cognitive ability, which facilitates the learning of job-relevant knowledge and therefore indirectly promotes stronger job performance as compared to individuals without higher education.

2 As a step toward licensure, non-capte physical therapists and physical therapist assistants must have a review of his/her educational credentials in order to determine substantial equivalency to the CAPTE graduate. The credentials review process is a comparison of the non-capte curriculum to the United States standards required by the individual jurisdiction. The educational credentials review is related to entry level education only. Credentialing agencies only review post-secondary education to determine equivalency and do not include an evaluation of work experience or a review of continuing education taught outside of the college or university system. Value of Work Experience Work experience refers to the events experienced by an individual that relate to the performance of a particular job (Quinones, Ford & Teachout, 1995). Compared to education, significantly more research has been conducted on the relationship between work experience and job performance over years. While earlier studies like Fiedler (1970) indicated a week relationship between experience and successful job performance, a meta-analysis by Hunter and Hunter (1984), found a significant, positive correlation between work experience and job performance; this relationship was corroborated by countless studies afterwards. Predictors of job performance are usually chosen because of their relevance to the job in question (Klimoski, 1993). This suggests that the most relevant categorization of an individual s life experiences for predicting job performance is in fact work experience. While work experience seems easy to comprehend and measure, the notion of what best quantifies work experience has been subject to debate. In a review of the work experience literature, Ford, Sego, Quinones, and Speer (1991) found that most studies used time on the job (tenure) to measure work experience. In contrast, other studies have measured experience by counting the number of times an individual has performed a particular task. A more analytical approach has focused on the actual content of the experiences as a critical determinant of job performance (Mumford & Stokes, 1992). While there is an identifiable connection between measures of work experience and job performance, the lack of consistency in the definition and measurement of work experience should be noted. This brief review of different measurements indicates the complex and multidimensional nature of work experience, and provides a realization that the measurement of such experience may not be easy to achieve. Complicating these measures is a lack of a clear definition of competence in work performance. Although the concept of competence is relevant to all healthcare disciplines, a common understanding of what competence is does not exist. A comprehensive review of the literature regarding clinical competency by Watson, Stimpson, Topping, and Porock (2002) yielded little consensus about a clear definition or measurement of the concept of competency. The role of competence in education has grown dramatically as health care employers and educators have identified the gap between education and practice. The Institute of Medicine, IOM (2003) focused on educational strategies to include a focus on competence, and outlined the following core competencies for health professionals: work in interdisciplinary teams, provide patient-centered care, employ evidence-based practice, use informatics, and apply quality improvement. While every worker s experiences differ from one another, it is understandable that increased time and participation in a labor market will allow individuals to develop greater knowledge about how to perform their jobs more effectively and efficiently (Tesluk & Jacobs, 1998). The importance of work experience to an employee s effectiveness is apparent; Yet Ng (2009) suggests that while work experience is likely to provide tacit, practical knowledge less frequently provided by formal education, work experience is best utilized as a means to strengthen the relationship between educational level and job performance. Experiences as a Component of Licensure Review The Foreign Educated Standards committee (FES) began exploring post-graduate professional experiences as a component of a licensure review process in early FEPTs often present with educational deficiencies in areas where experience may be a viable alternative to demonstrating content in the area. Examples of didactic deficiencies that could be met experience are shown below.

3 Diagnosis DIDACTIC DEFICIT EXPERIENCE Worked as direct access practitioner in home country Cultural Competence Integumentary/Wound Care Worked in an international school Attained WCC- wound care certification Post-graduate professional experiences may include, but are not limited to, paid work as a physical therapist or physical therapist assistant, continuing competence activities, volunteer work, academic coursework, publication, and supervised clinical practice. Currently, when deficiencies are found in the education, an individual must satisfy those deficiencies by supplementing past education with additional college or university coursework. Although a jurisdiction may wish to take post-graduate experiences into consideration for licensure purposes, the experiences are not considered in the educational review process. However, since 2010 there are two exceptions to this rule: 1) emergency procedures requirement and 2) the use of Supervised Clinical Practice hours to meet the hours of clinical education requirement. When emergency procedures are completed as part of a Heart Association, or Red Cross - Basic life Support (BLS) for professionals training (or similar overseas organization) no credits are awarded on the Coursework Tool but the content requirement is met. Additionally, the same year it was first considered by FES that supervised clinical practice may be an acceptable option of non-university level hours in jurisdictions where an applicant for licensure is required to complete a supervised practice prior to or at the time of licensure. At that time, the FES determined that candidates may apply less than or equal to 80 hours, or (10%) of the minimum required 800 supervised clinical practice hours, of post graduation, non-university level, clinical work to supplement any deficiency in university level clinical hours. The clinical hours must be performed working in the same capacity as the license, for example clinical hours in the completion of a PTA program in the US will not be acceptable towards meeting the requirement for the physical therapists on the Coursework Tool (CWT). These are the only non-university work recognized in the Guidelines for Interpretation of the CWT used by the credentialing agencies. From ,the FES has done significant work in the area of supervised clinical practice including development of a model and the Performance Evaluation Tool to evaluate the clinical performance of the foreign educated physical therapist. These developments and some real examples of difficulty experienced by individuals that had completed a full United States supervised clinical practice and were attempting to become licensed either initially or by endorsement motivated the FES to look at the policy again. In 2015, the following was added to the Guidelines for Interpretation of the CWT: Supervised clinical practice hours completed in a U.S. jurisdiction as part of application for licensure required by the board, meeting the criteria established by the FSBPT supervised clinical practice model, may be submitted for supervised clinical internship in section E of the CWT. Review of Other Professions In a review of other professions, FSBPT staff was unable to find any examples where professional experience is permitted to be used to waive educational requirements for entry-level licensing. There are examples where professional experiences may be used in lieu of testing or other specific requirements in order to obtain post licensing credentials such as certification. For example, beginning in late 2013 for nurse practitioners that wish to become certified as emergency nurse practitioners, the American Nurses Credentialing Center (ANCC) and the Emergency Nurses Association (ENA) provide an alternative credentialing method to the exam nurses typically have to take to get specialty certifications. Nurse practitioners interested in becoming certified emergency nurse practitioners are required to submit an online application, resume, self evaluation, clinical narrative, recommendations from supervisors, and a portfolio that includes practice hours and continuing education. In another example, the International Society of Nurses in Genetics (ISONG) requires a portfolio for evaluation to credential a nurse as having specialization in genetics. ISONG developed a statement of both basic and advanced

4 scope of practice and standards of care for the genetic nurse. From those statements, the content requirements of the portfolio were determined; portfolio evaluation criteria followed from there. (Cook, et al, 2003) Professional Experience Waivers: Examples in Physical Therapy Education Institutions of higher education often have programs that allow an individual to receive academic credit for learning from experience. Typically, there are a minimum number of years required in relevant, verifiable work experience. Students may be required to demonstrate that the knowledge and skills they have acquired in the work place or through life experiences are equivalent to those gained in an academic course. No examples of academic credit for life experiences were found in Doctor of Physical Therapy education programs however, many transitional Doctor or Physical Therapy (tdpt) programs allow for this practice. Please see Appendix A for full details. Recognition of Prior Learning: Internationally Recognition of prior learning is the process by which a person s skills and knowledge gained from sources outside the traditional, accredited classroom are evaluated to determine his/her competence in a given area. Recognition of prior learning is formalized in many countries including the UK, Australia, New Zealand, Canada, South Africa, and France for a variety of professions including nursing and is often, but not solely, used as a means to grant academic credit. The individual may present information on volunteer work performed, paid or pro bono employment, as well as other related experiences. The information is provided by the individual in a format that will support the claim he/she is making that they are competent when compared to a set of standards or expectation. Professional Portfolios One vehicle to demonstrate prior learning may be the professional portfolio. The professional portfolio has been defined by McCready (2007 p144) as a visual representation of the individual, their experience, strengths, abilities, and skills. Development and management of a professional portfolio is required for multiple health professions in the UK and Canada. The portfolio may be a means to convey the experiences, skills, and knowledge that has been acquired over time. If criteria and standards were created, an individual could use the information in his/her portfolio by mapping the material against the specific requirements (Casey & Egan, 2010) to demonstrate meeting the competencies, or in the case of a credentials review, a content area. An example follows of how a portfolio could be used to map evidence against a specific credentials review deficit. Portfolio evidence mapped to content deficit Content Area Deficit from Credentials Review: orthopedics Competence Demonstrated by: Ten years as head physical therapist and sports medicine director for Nigerian national soccer team. Evidence of Competence from portfolio: ABPTS Orthopedics Specialization Sports Injury Management Residency completed in Australia International continuing education courses (multiple) topics: manual therapy, therapeutic exercise, functional training, sport specific training, strength and conditioning 2013 Invited speaker on injury prevention at the International Association of Football Challenges of Evaluating Prior Experiences Perhaps the greatest challenge to recognition of experience as meeting a deficit with regard to licensure requirements is the lack of formal curriculum, competency standards, and prescribed learning outcomes surrounding learning by experience. (Hager, 1998) Without formal curriculum or prescribed outcomes, it becomes very difficult to set the criteria that need to be met or the assessment methodologies required. The post-graduate experiences from applicant to applicant will vary, however the goal must be to maximize consistency from one applicant to the next. Indeed consistency from jurisdiction to jurisdiction must also be considered. If there are

5 multiple standards in place for what meets a content deficit, barriers to mobility are created. Experiences allowed by one jurisdiction but no others to meet a deficit may inhibit a licensee s ability to move and continue practice after initial licensure without needing to fulfill additional requirements. Another challenge is identifying which deficiencies are appropriate to be made up with professional experiences. In both educational institutions and on-the-job training, learning outcomes are largely predictable. Workplace learning outcomes are much less predictable. (Hager) Just as importantly, after the deficiencies are identified, it must be determined exactly what experiences and professional development would be appropriate to remediate these deficiencies. A summary of work experience may not be acceptable as this is extremely hard to verify, however a specialist certification may be accepted. The main difference being that the specialist certification has clear expectations and standards and after it is acquired it is easily verified. The most appropriate entity to do a review of professional experiences must be identified. Credentialing agencies employ educational credentials reviewers; these individuals are skilled and trained to review and evaluate academic documents, not non-academic experiences. Credential evaluators have a set of professional standards that need to be followed and may not be comfortable reviewing experiences outside of university or college educational credentials. Boards would need to determine whether this function is best performed by members or employees of the Board or that an independent entity should perform this work. Finally, the question should be raised as to how these experiences would be authenticated. Currently, in a credentials review, some applicants attempt to submit false documentation from a known institution. Post graduate experiences may pose even greater difficulty securing the proper level of background documentation or defining and then identifying what are primary source documents. Conclusion The value of learning through post-graduate professional experiences is indisputable. One does not gain all the knowledge and skills to become competent in any given standard or expectation by sitting in a formal classroom. However, knowledge gained by experiential learning is not strictly equivalent to any course content. As stated by Hager, it may be that trying to use experience as a means to meet course content deficits is the comparison of two things that strictly are not comparable, so a range of other extraneous factors will inevitably shape the outcome. It is not necessarily the argument about the value of experiential learning, but how to place a value upon it. The FES committee originally had as a goal for 2015 to Explore & Develop Framework for Using FEPT s Experiences in Making Up Deficiencies. Although the committee has begun the discussion and exploration of the issues surrounding using recognition of prior learning, at this time the committee has had to shift its priority to updating the CWT in light of the new CAPTE criteria for PTs and PTAs. The FES committee will continue to explore potential tools to evaluate post-graduate/professional experience of foreign educated physical therapists in order to assess their readiness to practice in the United States. At this time, when evaluating the educational deficits of non-capte graduates, the committee would encourage Boards to consider post graduate experiences that are easily verifiable (specialist certifications, advanced practice certifications, etc.) as a means to demonstrate their abilities in the deficient areas and fitness to practice.

6 Appendix A tdpt Program Arcadia University MGH Institute Northern Illinois Univ Richard Stockton Waiver Possible Course waivers based on experience are possible for up to 6 credits. Within the structure of the program students may be permitted to waive one course for which they have already achieved competency through prior course work or Waiver Requirements A waiver for PT 504 Physical Therapist Teaching Methods requires Portfolio Elements that provide evidence of the following: If you submit a portfolio with your application containing evidence of previous experience and/or education, you may receive up to 12 credits of the 15 credits of required courses. You are, however, required to take a minimum of 8 credits after matriculation (including elective courses, if need be), in order to be awarded the transitional DPT.If you have recently taken courses in a graduate or post-graduate program that included this content, or, you are currently involved with research projects or clinical teaching that demonstrates your competence with the knowledge and skills in the course content and objectives for the program, the completion of a portfolio would most likely credit you for that, and exempt you from some course work. Alternatively, if your experience in the course content areas is limited, or it occurred greater than seven years ago and you have not maintained the knowledge and skill, or, you are simply interested in refreshing your skill by taking the courses, you would most likely choose against submitting a portfolio. For each course where you believe you have current competency evidence, write a summary paragraph on the portfolio form that describes your experiences and clarifies why a course credit and exemption is appropriate. Attach that summary to the evidence you ve gathered to support your description (e.g., copy of a course syllabus, a letter from a coinvestigator on a research project that describes your involvement, the citations for your own publications or copy of a published article, etc.), and include the portfolio with your application. Your portfolio is independently reviewed and scored by two faculty members on the Admissions Committee. They make the decisions to award credit for your experience by matching your evidence to the required course s objectives. For any area where there is disagreement about awarding credit, that area will be subjected to review by a third faculty member and final decisions are based on the majority opinion. Physical therapists with the following credentials can request a waiver of up to 2 semester hours in AHPT 744: American Board of Physical Therapy Specialties (ABPTS) awarded Specialist Certification; American Physical Therapy Association (APTA) credentialed fellowship program. See adviser for additional information. Students must be able to demonstrate achievement of the learning objectives of the course for which they are seeking a waiver. Achievement of a course s learning objectives may be demonstrated by: 1. Submitting the syllabus with course objectives and proof of

7 Univ of Incarnate Word Univ of MI- Flint Univ of New England Univ of TX Medical Branch UT Health Science Center professional continuing education. A minimum of 18 credit hours is required to obtain a UIW degree and no more than 6 credit hours can be waived in the program. Students who have prior experience and work that has led to certification or specialization or who have taken courses that may fulfill a part of the curriculum program requirement may apply for a course waiver. Up to two courses may be substituted based on previous coursework; UM-Flint MPT graduates may possibly substitute up to three courses or 12 credit hours. One course may be waived for students by demonstration of course equivalency Up to 6-7 credit hours (25% of degree program) may be acceptable for course substitution/credit waiver; students must have made a B or greater in any courses considered for course substitution/credit waiver. Bachelor s degree-prepared PTs applying for admission into the T-DPT program may request a waiver of two successful completion of the course (transcript with minimum grade of B) taken at another academic institution. 2. Submitting the curriculum/syllabus of a course taught by the applicant. Additional documentation must include a sample lecture/presentation, a sample examination, and feedback from students and mentors. 3. Submitting the syllabus of a continuing education course with course objectives, contact hours, and proof of successful completion of the course (signed continuing education certificate with contact hours). Applicants must submit the following items of documentation: 1. A letter addressed to the Director of the Post Professional DPT Program formally requesting a course waiver for a specific course. 2. Waiver for a didactic course: an official transcript for the course being considered for equivalency (unless it has already been submitted at the time of application) and a detailed course syllabus. The syllabus should include a topic outline of the course including the names of required text books and/or other learning experiences. Course descriptions found in a college catalog are NOT acceptable substitutes for course syllabi. or Waiver for the Directed Practice course: documentation and selfassessment of performance to support the waiver request such as: APTA Board certified clinical specialization (credits for Directed Practice) Residency program in clinical area (credits for Directed Practice) Post-professional master s degree (credits for course work or preparation that is similar to required course) Extensive teaching or management experience Overall contribution to Physical Therapy practice Students will be able to substitute up to 12 credit hours of the new specialization courses being developed for the Transitional Clinical DPT with clinical concentrations in orthopedics, neurology, geriatrics, pediatrics and cardiopulmonary linked to APTA residencies (See the Clinical Certificates section.) Courses taken more than 5 years to the semester in which the student starts the program will not be considered for a course transfer. ONLY be granted if the student has successfully completed (B or higher grade) an equivalent graduate-level course that addresses the educational outcomes in the course to be waived. Work experience is not acceptable for course waiver. Post-professional graduate courses taken for university credit within the past 5 years may be considered for credit transfer and will be determined on a case-by-case basis. The portfolio should contain the following: 1. Curriculum Vitae 2. Documentation as appropriate to reflect advanced competency. This ca include continuing education course descriptions and certificates, eviden

8 Wayne State Widener University courses: Clinical Research and Current Issues in Musculoskeletal, Neurologic, Cardiopulmonary Physical Therapy and Orthotics and Prosthetics. Core courses may be waived if the student demonstrates competency in course content. A total of 24 credit hours in residence at Wayne State University is required. A maximum of three courses (9 credits) may be waived. APTA specialty board certification, evidence of faculty teaching in a PT pr etc. 3. Waiver Request Form (see attached on subsequent page) Students may ask for a waiver of a specific course under the following conditions: The student has successfully completed a graduate level course of equivalent content, depth and breadth as the core course. The student can demonstrate higher level learning or advanced clinical practice. (certifications, clinical research, university teaching) The student will create a portfolio presenting evidence of learning and relevance to professional development plan. A waiver for PT 656 Neuromuscular Tissues requires that prior coursework must be at the graduate level, and completed within the last seven years at time of matriculation. The student must submit the following: Course description, course syllabus, written documentation of content A waiver for a course in the Clinical Practice Series (PT 705 Orthopedic Physical Therapy; PT 706 Neurologic Physical Therapy; PT 707 Cardiopulmonary Physical Therapy) requires APTA Clinical Specialist Certification or prior post- professional coursework that may either be university-based or continuing education and total at least 42 contact hours in a particular specialty area. The student must submit the following: References Campbell JP. (1990). Modeling the performance prediction problem in industrial and organizational psychology. In Dunnette MD, Hough LM (Eds.), Handbook of industrial and organizational psychology (Vol. 1, 2nd ed., pp ). Palo Alto, CA: Consulting Psychologists Press. Casey D, Egan D. (2010) The use of professional portfolios and profiles for career enhancement. British Journal of Community Nursing, 15, 11, Cook, Sarah Sheets et al. (2003) Portfolio evaluation for professional competence: Credentialing in genetics for nurses. Journal of Professional Nursing, Volume 19, Issue 2, Fiedler FE. (1970). Leadership experience and leader performance: Another hypothesis shot to hell. Organizational Behavior and Human Performance, 5, Ford JK, Sego DJ, Quinones MA, Speer J. (1991, April). The construct of experience: A review of the literature and needed research directions. Per presented at the Sixth Annual Conference of the Society for Industrial and Organizational Psychology, St. Louis, MO. Hager, P. (1998). Recognition of informal learning: challenges and issues. Journal of Vocational Education & Training, Volume 50, No Hunter JE. (1986). Cognitive ability, cognitive aptitudes, job knowledge, and job performance. Journal of Vocational Behavior, 29, Hunter JE, Hunter RF. (1984). Validity and utility of alternative predictors of job performance. Psychological Bulletin, 96, Klimoski RJ. (1993). Predictor constructs and their measurement. In Schmitt N, Borman WC, & Associates (Eds.), Personnel selection in organizations, pp San Francisico, CA: Jossey-Bass.

9 McCall MW, Lombardo MM, Morrison AM. (1988). The lessons of experience. New York: Lexington. McCloy RA, Campbell JP, Cudeck R. (1994). A confirmatory test of a model of performance determinants. Journal of Applied Psychology, 79, McCready T (2007) Portfolios and the assessment of competence in nursing:a literature review. International Journal of Nursing Studies 44: Mumford MD, Stokes GS. (1992). Develpmental determinantsa of individual action: Theory and practice in applying background measures. In Dunnette MD, Hough LM (Eds.), Handbook of industrial and organizational psychology (2nd ed), pp Palo Alto, CA: Consulting Psychologists Press. National Council for State Boards of Nursing. (2005). Business book: NCSBN 2005 annual meeting. Chicago, IL: Author. Ng TWH, Feldman DC. (2009). How broadly does education contribute to job performance? Personnel Psychology, 62, Quinones MA, Ford JK, Teachout MS. (1995). The relationship between work experience and job performance: A conceptual and meta-analytic review. Personnel Psychology, 48, Rotundo M, Sackett PR. (2002). The relative importance of task, citizenship, and counterproductive performance to global ratings of job performance: A policy-capturing approach. Journal of Applied Psychology, 87, Tesluk PE, Jacobs RR. (1998). Toward an integrated model of work experience. Personnel Psychology, 51, Tilley DS. (2015). Competency in nursing: A concept analysis. The Journal of continuing Education in Nursing, 39, Watson R, Stimpson A, Topping A, and Porock D. (2002). Clinical competence assessment in nursing: Review of the literature. Journal of Advanced Nursing, 39(5),