A model for re-education of physiotherapy practitioners to enable return to the workforce.
Abstract: We explored the key criteria to determine the need for re-entry training and how training programs should be constructed and delivered. Using a qualitative study in an interpretivist theoretical framework, the following participants were interviewed: Australian physiotherapists who have or are planning to re-enter the workforce or re-register as physiotherapists; supervisors who have supported returners; and, chairs and registrars of physiotherapy registration boards in Australia, New Zealand, Canada and the United Kingdom. The interviews showed that the issue of re-education and re-entry to the health professions was considered a difficult issue overall. For the regulators, their position must be to protect the public. However, a clear understanding of the need to consider an individual's position and circumstances was also demonstrated by the regulators, who were supportive of flexible approaches to re-registration. As a result of the analysis, a model for re-registration and re-entry was developed with key deliverables in four sections of initial contact, planning, conditional registration, and training and assessment.

Key Words: Physiotherapy; Health workforce; Re-entry; Recency of practice; Reregistration.
Article Type: Report
Subject: Physical therapy (Usage)
Physical therapy (Health aspects)
Therapeutics, Physiological (Usage)
Therapeutics, Physiological (Health aspects)
Professional development (Management)
Labor supply (Research)
Medical personnel (Supply and demand)
Authors: Sheppard, Lorraine A.
Crowe, Michael J.
Jones, Anne L.
Adams, Robyn
Pub Date: 03/01/2010
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: March, 2010 Source Volume: 38 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 310 Science & research; 600 Market information - general Canadian Subject Form: Labour force Computer Subject: Company business management
Product: Product Code: 8010000 Medical Personnel NAICS Code: 62 Health Care and Social Assistance
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 226728747
Full Text: INTRODUCTION

Health workforces are under pressure to meet current and expanding demands for health care. New workforce models are discussed with an increasing emphasis on flexibility of roles based on competencies that are transferable (National Health Workforce Traskforce 2008). However, strategies to encourage health professionals to return to the workforce should also be considered to increase the health workforce capacity. This includes the need for models for re-education of practitioners who may have been absent from the workforce for extended periods of time. Training programs that respond to a person's requirements and eligibility for registration have the potential to increase the number of health professionals re-entering the workforce in times of continuing shortages.

A review to identify the requirements and programmes for international health professional returners, and particularly physiotherapists, yielded no strong evidence for one approach (Sheppard et al 2008a). The quality of evidence concerning returner programmes across a variety of health professions was very low, however, a number of common themes surfaced. The programmes reported used a wide variety of delivery methods including distance education, face-to-face, multimedia, simulation, and self-directed learning and all returner programmes required the candidate to undertake a clinical practice component. The number of hours that is appropriate for a returner programme, either for theory or clinical practice, could not be identified from the literature. People returning to physiotherapy practice, in most cases, need to find their own learning experiences and, once allowed to practice fully, their own job. This is different from the experience of many nurses within the United States of America where health care organisations recruit returners, pay for them to undertaken retraining, and then provide them with their clinical experience in return for the person working for that organisation for a set period after re-registration (Sheppard et al 2008a).

Understanding the current approaches and experiences of returners and their supervisors was imperative to understand existing models nationally and internationally (Sheppard et al 2010). The main reason for returning to physiotherapy was because the returner wanted to return rather than external factors such as financial hardship. Overall, the experience of returning to physiotherapy has been rewarding for returners and clinical supervisors. Returners and potential returners were highly motivated, keen to learn, and were willing to undertake a period of training to help them return to practice. However, there is only one programme available for returners in Australia to re-register as a physiotherapist. Returners, potential returners, and clinical supervisors thought that a structured programme would need to be flexible to allow for returners' current needs, commitments, and career directions (Sheppard et al 2010). Re-education programs are likely to require some elements of theory and clinical education.

Appropriate contexts for re-entry and re-registration for health professionals should emphasise active learning and participation which relate the content to the participant's professional practice. The majority of learning occurs from experience in day to day practice (Jamtvedt et al 2004, Thomson O'Brien et al 2004) and effective professional development requires active participation in learning throughout a professional's career. In other words, activities that engage participants and provide an opportunity to practise skills can produce changes in professional practice and, occasionally, improve health outcomes, whereas didactic sessions, conferences and courses that do not include active participation do not appear to be effective in changing practitioner performance (Australian Capital Territory Health 2005, Jamtvedt et al 2004, Thomson O'Brien et al 2004).

A link is also seen between service quality and evaluation, learning and enhanced patient care with the majority of learning from experience in practice rather than attendance at formal courses (Davis 1998, Davis et al 1999, Davis et al 1995). Knowledge and skills gained from formal activities have been found to have little effect on enhancing practice unless they are linked to experiential practice based learning (Australian Capital Territory Health 2005, Berry and Dienes 1992, Houle et al 1987). However, in spite of the growing literature not supporting systems where hours of attendance are recorded, this continues to be the dominate method of applying professional development, see Table 1.

In comparison, the Australian Capital Territory (ACT) Health Boards recommend that the "health professional will learn best when they are motivated and their continuing professional development [CPD]:

* Is highly self directed--each person is personally responsible for deciding on what CPD activities he or she wants to do

* Is based on an individual learning plan and the learning needs that the individual has identified for his or her self

* Builds on individuals existing knowledge and experience

* Links an individual's learning and practice

* Includes evaluation of the effect of an individual's learning on his or her practice and

* Involves personal review of an individual's learning plan in response to his or her experience" (Australian Capital Territory

Health 2005).

Although the literature was inconclusive on how programmes for returners should be constructed, a format or structure with clear expectations and flexibility appear to be key elements (Sheppard et al 2010). Also, understanding the issues of reeducation to enable registration, yielded two types of potential returner to physiotherapy:

1. Re-registrants--Those who have allowed their registration to lapse and seek re-registration, and

2. Re-entrants--Registered physiotherapists who have not practiced for a period of time and would like training before or during their re-entry to the workforce.

Therefore, a model for re-registration has the potential to support re-entrants to physiotherapy because there is no process for physiotherapists to re-enter the profession if they take some time away and wish to undertake training before re-entering. As a result, both types of potential returner were considered.

The aims of the research were:

* Identify the key assessment criteria to determine the need for and construct for reentry training

* Determine how training programs should be constructed and delivered

* Identify how assessment of competency and how determination of eligibility for registration should be conducted.

* Develop models for the re-education of practitioners who may have been absent from the workforce for extended periods of time.

METHOD

Design

A qualitative study using an interpretivist theoretical framework was adopted. Interpretivism enabled exploration of the feelings and perceptions of participants from a philosophical standpoint. Participants were able to share their experience, explore re-entry issues, and describe its meaning to them (Parry 1997, Veenstra 1999). Ethical approval of this study was provided by James Cook University and the University of South Australia ethics committees.

Participants

Recruitment to understand current models of re-education involved two main groups. The first group consisted of Australian and international physiotherapy regulatory bodies which were interviewed using focus groups and individual interviews. Three separate focus groups were conducted with representatives of the Australian:

* Registrars of physiotherapy boards

* Chairs of physiotherapy boards

* Directors of the Physiotherapy Council. Invitations to participate in the research were also sent to the physiotherapy boards of New Zealand, the United Kingdom, individual provinces of Canada, and South Africa. Some boards in the United States of America were also contacted but no response was received.

The second group consisted of returners, potential returners, and clinical supervisors who had directly supervised re-entrants or re-registrants. Recruitment of returners and potential returners proved challenging as there is no list of un-registered or inactive physiotherapists in Australia and, therefore, no easy way to contact participants. Furthermore, due to privacy laws participants could not be contacted directly where their details were held by a third party. Assistance and initial contact with suitable participants was sought from the Physiotherapy Registration Boards of Australia and New Zealand, who provided their support. This strategy was complemented by a snowballing process of a successive round of emails to health department persons with a network of physiotherapists, the Australian Physiotherapy Association electronic newsletter, and rural health network organisations. Semi-structured interviews were used to determine the opinions of research participants on returning to physiotherapy.

Data analysis

All interviews were recorded, transcribed, and studied using thematic analysis (Liamputtong and Ezzy 2005). Coding began after each focus group or individual interview. To enhance the credibility of the coding process, two researchers listened to each recording and read each transcript multiple times to identify key concepts. After individual interviews and focus groups were coded, the key concepts were brought together to identify overall categories of findings.

RESULTS

Participants

Recruitment to the first group (Australian and international physiotherapy regulatory bodies) resulted in seven international interviews with the Chairs and Registrars in New Zealand, provinces in Canada, and the United Kingdom.

A total of 56 people from the second group (returners, potential returners, and clinical supervisors) responded to the calls for participants. Of these, 38 people consented to be interviewed and a total of 29 suitable interviews were conducted.

Group 1--Regulatory bodies

The issue of re-education and re-entry to the health professions was considered a difficult issue overall. For the regulators, their position must be to protect the public, but a clear understanding of the need to consider the individual's position and circumstances was demonstrated by the regulators, who were supportive of flexible approaches to re-registration. Themes which emerged as key elements for a model of re-registration were acceptability, affordability, flexibility, and circumstances. Acceptability

The program for re-education requires development of a pathway that will be acceptable for re-registration and suit the returners' circumstances that they will return to. Known expectations and requirements are key in forming decisions whether to commence a re-entry or registration program. The information needed to form the requirements also needed to be made explicit to returners. There was recognition that there may be a stigma and loss of confidence for those who have been out of the work force for an extended period, "it can be a daunting experience" (Registration Board 1). Other more administrative issues raised as barriers were availability of insurance when undertaking a re-entry or re-registration program, and the requirement to have information technology skills and access.

Affordability

Support for the person, both financial and professional, was considered imperative to enable them to participate in a re-registration or re-entry program. It was recognised that funding may be required for child care, travel costs, and supervision of the returner. To conduct re-registration or reentry, formalised curricula were also difficult to put in place with small numbers aiming to return at anyone time, making this option uneconomical for both the participants and the provider.

Flexibility

Geographical isolation can be a problem in the assigning of supervisors and access to training programs in physiotherapy. Theory training should be able to occur at a home location leaving clinical placement time available to be conducted in a broader range of geographical areas.

Circumstances

Key variables that made up other models of reeducation and re-registration were also considered. These key variables are time out since practice; time practiced prior to ceasing practice; and, returning to full or limited areas of practice once completing the re-entry process.

Time out since practice was a key component in some models. For example, the approach or model for re-entry varied according to years out of practice in New Zealand, Canada, and the UK. Only New Zealand varied returner programs based on experience prior to ceasing practice (Sheppard et al 2008a). However, no evidence to support this approach could be found in the literature (Sheppard et al 2010).

Further explored was use of registration with no conditions (also known as full or general registration) and registration with conditions (also known as limited or specific registration). Deciding on an individual's re-registration with or without conditions in turn lead to decisions about how re-registration programs were constructed internationally. For example, if re-registration was to be followed by practice in one field of physiotherapy, then re-registration programs could be conducted in one field for the applicant. The registration, or annual practicing certificate, in New Zealand, Canada and the United Kingdom allowed for practice in one field only, rather than providing general registration which implies competencies in all areas of practice. Therefore, the area returning to practice dictated the re-registration programme.

On this issue, the Australian respondents felt that current legislative requirements were constraints. Registration without conditions was the usual outcome of a re-registration program, with conditional registration usually reserved for overseas physiotherapists training to become Australian registered physiotherapists and those under review.

Group 2--Experiences of returners, potential returners, and clinical supervisors

Physiotherapists who had been through a re-entry program had varied experiences. Some respondents found the process overly bureaucratic and off-putting. Others responded well to the known structure and expectations.

[It is] clear at the start regarding their skill level and past level of experience and what support is required. With the UniSA program curriculum and requirements very clearly set out, so not a lot of room for variance with that but also recognise and acknowledge past level of experience. (Supervisor 4)

Supervisors "spend time to identify their strengths/weaknesses and support to maximise the experience in a work setting" (Supervisor 4). Both respondents and re-entrants acknowledged the difference between candidates.

Time out and experience are different. You can not assume that everyone that has not worked for 5 years is at this point, and everyone who's not worked for 10 years is at this point. (Supervisor 10)

Where they actually worked, so f they worked just in paediatrics, that they have to show competency across all the areas, before they can re-enter to go back to paediatrics, that's kind of problematic as well, like that that candidate has bigger hoops to jump through, than another candidate who was a generalist and planning to go back to being a generalist. (Supervisor 10)

The returners just wanted the "potential to demonstrate that you are a competent physio" (Returner 10) rather than focus on time out of practice or experiences prior to ceasing. However there was clear recognition of how practice had changed in the time since ceasing practice. It is crucial to be "brought up to date, EBP [evidence based practice] and enough theory (revision of basics)" (Returner 10). In New Zealand most returners were returning to musculoskeletal practice and focused on clinical skill development.

Experienced supervisors when asked about the difference between returner and new graduates commented:

The knowledge and the understanding of the processes and the philosophy (i.e. EBP, clinical reasoning, research and reading the literature), they are along way behind the undergrads and they're expected to go up and overtake them, within a period of 3 or 4weeks. (Supervisor 10)

Comparing the returner with an experienced physiotherapist, a supervisor commented:

They're at a very inexperienced level, the working experienced physio is kept up to date with technology and is competent with that and comfortable with it, whereas the refresher student's been out of the loop but once they're working the refresher student comes back to the level of the experienced working physio much quicker than a new graduate would. They just take off and do really, really well. (Supervisor 10)

Overall the clinical experience relied on the goodwill of clinical supervisors and their employers to facilitate the clinical placement. Also emphasised was the need to plan career breaks, and stay in contact with the profession or employer to facilitate the return. One Canadian province, British Columbia, observed a trend toward people taking less time away from practice. Perhaps as concepts such as recency of practice is made clearer to professionals and links with the profession during the time away are maintained, then return to practice may be less of a hurdle.

Model development

Using the information from the literature, interview data, and focus groups a model for reeducation was developed (Figure 1).

[FIGURE 1 OMITTED]

The developed model shows the processes for re-registration on the left, re-entry on the right and shared processes (between re-registration and re-entry) in the middle. The model is described in four sections:

1. Initial contact

2. Planning

3. Conditional registration

4. Training and assessment

Initial contact

Wish to re-register / Wish to re-enter

The model begins with a re-registrant who wants to return to physiotherapy or a re-entrant who has maintained their registration and who seeks to update knowledge and skills prior to returning to the clinical practice. The re-registrant or re-entrant typically makes initial contact with one of a range of organisations and networks so they can identify the re-registration or re-entry process. Contacts

The expectation is that a re-registrant would contact the Physiotherapy Registration Board to identify the re-registration process, eligibility and requirements. However, a re-registrant may contact other organisations, networks or individuals. The model recognises multiple initial contact points and recommends development and dissemination of the re-registration process to alternate contact organisations and networks.

The Physiotherapy Registration Board is less likely to be the initial contact point for a re-entrant as they have maintained their registration. However, if the Physiotherapy Registration Board is contacted this model recommends the process for re-entry should be available through the Board, and other organisations and networks.

Information on the re-registration/re-entry process can be developed so it can be readily communicated to potential returners, mentors, and clinical supervisors. Physiotherapy Registration Board

Re-registrants look to the Physiotherapy Registration Board for information on the re-registration process. Processes that support the provision of timely and comprehensive information about the re-registration process to re-registrants will support the model's implementation. Planning

Potential mentor(s)

A consistent theme identified in interviews with potential and recent re-registrants was the need for an identified person to provide initial and ongoing advice on the re-registration process. This model recommends this occurs through the provision of a mentor for each re-registrant. It is recommended that the Physiotherapy Registration Board facilitates the identification, training, and support for mentors to assist applicants in identifying eligibility, areas for knowledge and skill updates, assessment process and provision of ongoing advice. Following initial contact with a Physiotherapy Registration Board, the re-registrant is provided with a list of potential mentors.

The mentors will require information and training on the re-registration process including:

* Physiotherapy Registration Act and related acts and amendments

* Physiotherapy Registration Board process and requirements

* Documentation of returner's experience

* Development of re-registration plan for individuals

* Physiotherapy entry level competencies

* Education resources available

* Recommended reading in core areas

Although the information required by re registrants and re-entrants is different, the mentor's role is similar for both: help with the process; help with the needs analysis; and, be available with support and advice as needed. This model, therefore, recommends similar access and support for re-entrants as re-registrants. Needs analysis

As the peer reviewed literature does not provide evidence to support specific re-registration eligibility requirements, this model recommends the adoption of a multi-factorial needs analysis. This analysis is a composite of components identified in current re-registration processes across states and countries. The purpose of the needs analysis is for the returner to identify, with the support of their mentor, the requirements to successfully reregister or re-enter. It is not an eligibility test. The process assists in the determination of components necessary to meet the eligibility requirements for re-registration or resumption of clinical practise. If practical or theoretical challenges are used at this analysis stage, they are for the purpose of determining the returner's current and required knowledge. As an example, a needs analysis may use the following to help develop a returning plan:

* Years experience

* Recent practice

* Breadth and scope of work before cessation of practice

* Professional contact since last practiced

* Work intentions and requirements

* Clinical scenario challenge

A needs analysis provides the returner with an informed assessment of their current knowledge and what the requirements are to successfully return to physiotherapy. Develop re-registration/re-entry plan

The re-registration/re-entry plan includes the knowledge and skill requirements necessary to become re-registered or re-enter physiotherapy. The plan may include:

* Shadowing a physiotherapist

* Clinical practice

* Theory

* A combination of clinical practice and theory

* Reading packages

* In-services

* Scenarios

* Simulation training

* Non-physiotherapy specific requirements (e.g. medico-legal changes, police clearance)

Conditional registration

Apply for limited, conditional registration As a re-registrant is not registered as a physiotherapist, the model recommends the option of conditional registration so that clinical experience can be gained. Also, an unregistered physiotherapist can not get insurance to practice which means they can only observe, thus they are unable to gain hands-on clinical training.

Conditional registration may include the following restrictions:

* The re-registration plan to be followed and outcomes endorsed by the Physiotherapy Registration Board

* The re-registrant is always under supervision

* Registration is limited by time

* Registration is limited by area of practice

The conditions placed on the registratant initially need to consider that the person may request conditional registration in one field of physiotherapy, secure employment, and then return at some stage requesting full registration. Appeals process

This allows for re-registrants to appeal a Physiotherapy Registration Board decision not to provide conditional registration.

Training and assessment

Clinical practice and theory

This may be through a university or other physiotherapy provider. Whether clinical practice, theory, or both are required depends on the returner's level of knowledge as assessed during the needs analysis. Information that should be made available to the returner includes:

* Entry level competencies

* Recommended reading in core areas

* Links to education modules available on line or through distance education

* Assessment criteria and tools

A returner will require supervision while undertaking a period of clinical practice. Clinical supervisors/educators will need to have similar training as mentors, such as:

* Physiotherapy related acts and amendments

* Physiotherapy Registration Board requirements

* Entry level competencies

* Education resources available

* Recommended reading

* Assessment criteria and tools

* Adult learning principles

Registration sought

The model recommends provision of the option for a re-registrant to re-register with conditions or with no conditions:

* No conditions--The re-registrant needs to show competence in all areas of physiotherapy, up to under-graduate level

* With conditions--The re-registrant needs to show competence in a specified area or areas of physiotherapy, up to under-graduate level, and may not practice outside this field or fields.

An individual who is successful in registering with conditions has the opportunity to subsequently seek registration with no conditions. This requires the demonstration of competency in all remaining fields of physiotherapy up to entry level. Assessment

Assessment of theory or practical components is not limited to written examinations. Other alternatives include:

* Assignment

* Viva

* Scenarios

* Simulation

Assessment of clinical practice can use a standardised tool such as the Assessment of Physiotherapy Practice (APP) which is currently being trialled and validated (Dalton, personal communication). An alternative for assessment is the mini clinical evaluation exercise (mini-CEX), Table 2 and Figure 2. Norcini describes the mini-CEX "as a way of simultaneously assessing the clinical skills of trainees and offering them feedback intended to enhance their future performance (Norcini 2005). Its validity and reliability derives from the fact that trainees are observed while engaged with a series of real patients in different practice setting and judgements about the quality of those encounters are made by skilled educator-clinicians".

[FIGURE 2 OMITTED]

Interviews of testing the model

A small testing of the model was undertaken with interviews of a potential returner, a registration board member, and a health department employer. The testing demonstrating the usability of the model, together with comments like:

The theory, I want to do that from home, anytime, if I am going to be away from home its only for the clinical placement ... I want to make sure I do enough while I am on maternity leave so I don't need to do a re-entry program. (Potential returner) You have a feeling that the more time they are out of practice the more they need to do to re-register, and there must come a time when they can't reenter. (Registration board member)

In some ways it's no different to a staff member moving into a new clinical area, you support them until they gain confidence and ability, and you slowly reduce that support. Insurance and visiting staff privileges are possible using the volunteer framework. (Health department employer)

DISCUSSION

Although little evidence exists for models based on years out of practice, these have been adopted for re-registration or re-entry. Only general assumptions that the longer out of practice the difference in type of re-entry program required can be made. The comparator adopted for re-registration is usually entry level competencies or beginning level practitioner abilities. However, the re-entry group is not homogenous and the opportunity to demonstrate their abilities is sought by returners. The returner requesting examination using the APP or mini-CEX provides one method of giving feedback to the returner as to their progress towards re-entry. The mini-CEX model is structured so that the 'student' can initiate the assessment and adopting this approach for re-registration and re-entry candidates is appropriate.

Currently in Australia, re-entrants and re-registrants are considered for full or unconditional registration. This approach is not applied internationally. A key decision working within legislative frameworks is to apply conditions or limitations on registration when considering returning to practise. Conditional registration would influence the re-registration or re-entry plan focusing on the area of practise to be returned to rather than all beginning level competencies.

A model that provides flexibility to recognise the diversity of the returner group and their progress towards re-registration and re-entry is needed. A model that reinforces reflection, peer discussion, and application to practice seems appropriate for professional learning. The model developed incorporates four key aspects in response to the literature and interview data but requires further testing beyond the initial interviews asking for feedback on the model. An application to actual cases of returners is needed to understand the implementation of the model.

Key Points

* There is little quality information available on training programmes for health professionals to enable them to successfully return to the health workforce after taking a career break.

* A model for re-entry and re-registration is proposed so that physiotherapists returning to the workforce can have a clear understanding of the pathways available and the requirements needed to successfully return to the workforce in a professional capacity.

* This model is the first attempt to put in place a clear and open system to allow health professionals to return to the workforce and which, with added discussion, could be adopted by physiotherapy regulatory bodies.

ACKNOWLEDGEMENTS

Steering Committee members: Kathy Grudzinskas, Meaghan Poulton, llsa Nielson, Helen Finneran. Research funding provided by the Physiotherapists Board of Queensland, Australia.

REFERENCES

Australian Capital Territory Health (2005): Continuing professional development information for health professional boards. ACT Health. http://www.health.act.gov.au/c/health ?a=sendfile&ft=p&fid=1123023590 [Accessed July 22, 2007].

Berry D, Dienes Z (1992): Implicit learning. London: Lawrence Erlbaum Associates.

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Davis D, O'Brien M, Freemante N, Wolf F, Mazmanian P, Taylor-Vaisey A (1999): Impact of formal continuing medical education: Do conferences, workshops, rounds and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA 282(9): 867-874.

Davis DA, Thompson MA, Oxman AD, Haynes B (1995): Changing physician performance: A systematic review of the effect of continuing medical education strategies. JAMA 274(9): 700-705.

Houle CO, Cypher DB, Boggs D (1987): Education for the professions. Theory Into Practice 26(2): 87-93.

Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD (2004): Audit and feedback effects on professional practice and health care outcomes (Cochrane Review). In The Cochrane Library (Issue 1), vol 1. Chichester, UK: John Wiley & Sons.

Liamputtong PL, Ezzy D (2005): Qualitative research methods: A health focus. Melbourne: Oxford University Press.

National Health Workforce Traskforce (2008): National Health Workforce Forum. NHWT. www.nhwt.gov.au [Accessed July 22, 2007].

Norcini J (2005): The mini clinical evaluation exercise (mini-CEX). The Clinical Teacher 2(1): 25-30.

Parry A (1997): New paradigms for old: Musings on the shape of clouds. Physiotherapy 83(8): 423-433.

Sheppard LA, Crowe M, Jones A, Adams R (2008a): Requirements for re-registration and re-entry of physiotherapists into the workforce in Australia and overseas. Physical Therapy Reviews 14(1): 26-35.

Sheppard LA, Crowe M, Jones A, Adams R (2010): Returning to physiotherapy practice: The perspective of returners, potential returners, and clinical supervisors. Australian Health Review (in press).

Thomson O'Brien MA, Freemantle N, Oxman AD, Wolf F, David DA, Herrin J (2004): Continuing education meetings and workshops: Effects on professional practice and health care outcomes (Cochrane Review). In The Cochrane Library (Issue 1), vol 1. Chichester, UK: John Wiley & Sons.

Veenstra G (1999): Different wor(l)ds: Three approaches to health research. Canadian Journal of Public Health90(Supplement 1): S18-S21.

Lorraine A Sheppard, PhD Professor, Department of Physiotherapy, James Cook University, Australia, and School of Health Sciences, University of South Australia, Australia

Michael J Crowe, MIT Senior Research Officer, Department of Physiotherapy, James Cook University, Australia

Anne L Jones, MPhty Lecturer, Department of Physiotherapy, James Cook University, Australia

Robyn Adams, BAppSc(Phty) Lecturer, Department of Physiotherapy, James Cook University, Australia

ADDRESS FOR CORRESPONDENCE

Professor Lorraine A Sheppard, Physiotherapy Department, James Cook University, Australia. Tel.: +618 8302 2424; Email: lorraine.sheppard@jcu.edu.au
Table 1: Comparison of continuing professional development
Policies across regional physiotherapy registration boards

Location            Criteria               Prerequisite

Australia

Australian        >5 yrs OoP (1)         Interview
Capital
Territory

Queensland        >5 yrs OoP (1)

New South         >5 yrs OoP (1)         CPE (2) &
  Wales                                  future
                                         practice
Northern          n/a
  Territory
South             <100 hrs in            Interview
  Australia         12 mths
                    within 5 yrs

Tasmania          <1,000 hrs in 5 yrs    Application

Victoria          <1,000 hrs in 5 yrs    Application

Western           >5 yrs OoP (1)
  Australia
New Zealand

Physiotherapy     3-5 yrs OoP (1)        PDP3
                    F >3 yrs experience

Board of          3-5 yrs OoP (1)        PDP3
  New Zealand       F <3 yrs experience

                  5-8 yrs OoP (1) F      PDP3
                  >5 yrs experience

                  5-8 yrs OoP (1)        PDP3
                    F <5 yrs experience

                  8-10 yrs OoP (1)       PDP3
                    F >10 yrs exp'nce

                  8-10 yrs OoP (1)       PDP3 and
                    F <10 yrs exp'nce      competence
                                           assessment
United Kingdom

Health            2-5 yrs OoP (1)
  Professions
  Council         >5 yrs OoP (1)

Canada (7)

Alberta           <1,200 hrs in 5 yrs

                  No prac hrs in 5 yrs

Manitoba          <1,200 hrs in 5 yrs

New Brunswick     <1,200 hrs in 5 yrs

Ontario           <1,550 hrs in 5 yrs

Quebec            <1,200 hrs in 5 yrs

Nova Scotia       <10 mths in 5 yrs

Prince            <1,200 hrs in 5 yrs
  Edward Island
Saskatchewan      <1,200 hrs in 5 yrs

                                Requirements for
                            re-registration/re-entry

Location          Requirements           Check

Australia
Australian        Supervised             Practice
  Capital         practice               report
  Territory

Queensland

New South         Clinical               Practice
  Wales           practice               report

Northern
  Territory
South             Clinical               Practice &
  Australia       practice               Uni report
                  and theory

Tasmania          Re-education,          Practice report
                  practical
                  assessment, or
                  clinical place

Victoria          Supervised             Practice report
                  practice

Western           Supervised             Practice report
  Australia       practice
New Zealand

Physiotherapy     3 months               Report 1 & 3
                  oversight (4)          months

Board of          6 months               Report 1, 3, &
  New Zealand     oversight (4)          6 months

                  3 months               Report 1 & 3
                  supervision (4)        months

                  6 months               Report 1, 3, &
                  supervision (4)        6 months

                  6 months               Report 1, 3, &
                  supervision (4)        6 months

                  Pass: 6 months         Report 1, 3, &
                  supervision4           6 months Report
                  Fail:                  1, 3, & 6
United Kingdom    Retraining plan        months
                  and 6 months
                  supervision4

Health            30 days                Forms counter-
  Professions       updating (5)         signed (6)
  Council         60 days                Forms counter-
                    updating (5)         signed (6)

Canada (7)

Alberta           310 hrs                Evaluation by 2
                  clinical (min          physical
                  40 hrs in each         therapists and
                  of the 3 major         review by
                  areas)                 College (9)

                  PCE8 F 480 hrs         Mid and final
                  clinical (min          evaluation by 2
                  160 hrs in each        physical
                  of the 3 major         therapists and
                  areas)                 review by
                                         College (9)

Manitoba          PCE (8)                Examination

New Brunswick     PNE (8)                Examination

Ontario           College Review         Examination
                  Prog (10) or
                  PNE (8)
Quebec

Nova Scotia       PNE (8)                Examination

Prince            PNE (8)                Examination
  Edward Island
Saskatchewan      PNE (8)                Examination

(1) OoP: Out of practice

(2) CPE: Continuing professional education

(3) PDP: Professional development plan

(4) Oversight = Support and assistance by peer; Supervision
= Performance monitoring and reporting by peer

(5) Any combination of supervised practice, formal study, or
informal study

(6) Updating forms to be counter-signed by peer

(7) No criteria identified for British Columbia,
Newfoundland F Labrador, Yukon Territory, Northwest
Territories, or Nunavut

(8) Physiotherapy Competency Examination (PCE): Comprises of
Qualifying Examination (QE) [written] and Physiotherapy
National Examination (PNE) [clinical]

(9) College of Physical Therapists of Alberta

(10) College of Physiotherapists of Ontario

Adapted from Sheppard et al 2008a,

Table 2: Competencies assessed by the MiniCEX *

Competence        Descriptor of a Satisfactory Trainee

History           Facilitates patient's telling of story,
Taking            effectively uses appropriate questions
                  to obtain accurate, adequate
                  information, responds appropriately to
                  verbal and non-verbal cues.

Physical          Follows efficient, logical sequence;
Exam              examination appropriate to clinical
                  problem, explains to patient; sensitive
                  to patient's comfort, modesty.

Professionalism   Shows respect, compassion, empathy,
                  establishes trust; Attends to patient's
                  needs of comfort, respect,
                  confidentiality, Behaves in an ethical
                  manner, awareness of relevant legal
                  frameworks, Aware of limitations.

Clinical          Makes appropriate diagnosis and
Judgment          formulates a suitable management plan,
                  Selectively orders/performs appropriate
                  diagnostic studies, considers risks,
                  benefits.

Communication     Explores patient's perspective, jargon
skill             free, open and honest, empathetic,
                  agrees management plan/therapy with
                  patient.

Organisation/     Prioritises; is timely, Succinct,
Efficiency        Summarises.

Overall           Demonstrates satisfactory clinical
Clinical          judgment, synthesis, caring,
Care              effectiveness, Efficiency, appropriate
                  use of resources, balances risks and
                  benefits, awareness of own limitations.

* originally published by Norcini, 2005,
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