Professional Development,
Competence, and Expertise
Dr. Ammara Munir
professional development and competence
The following questions reflect some of the concerns about
professional development and competence:
1. What is professional development, and how should it be
measured?
2. How should clinical competence be assessed? Should it be
determined by the number of continuing education units (CEUs)
acquired, periodic reexamination, self-assessment, peer review,
licensure, or some combination of these methods?
3. Who should evaluate the competence of a PT or physical
therapist assistant (PTA)—members of the profession, state
licensing boards, employing organizations, peers, or the
individual practitioner?
4. How is professional competence different from
professional development?
5. What responsibility should the profession take for
identifying incompetent PTs and preventing them
from practicing?
6. How should PTs approach professional
development? What resources are available to assist in
professional development?
7. How can a PT use a portfolio in the professional
development
THE PROFESSIONAL DEVELOPMENT
CONTINUUM: FROM COMPETENCE TO
EXPERTISE
Two primary elements of professionalism are
specialized skills and training.
Professional skills are dynamic and contextual; clinical
approaches change based on emerging research, and
they may be applied differently in different
organizations or practice settings
As professionals, PTs also have an obligation to update
their skills. The Guide for Professional Conduct (GPC)
of the American Physical Therapy Association (APTA)
takes note of this:
“A physical therapist has a lifelong professional
responsibility for maintaining competence through
ongoing self-assessment, education, and enhancement
of knowledge and skills”
Scope of Competence
Eraut describes two dimensions of professional
competence: scope and quality.
The scope of competence includes the roles, tasks, and
skills a professional can perform and the situations or
circumstances in which they can be performed.
For example, a PT or PT student who demonstrates
competence in joint mobilization while using a
orthopedic patient in a classroom setting may not have
similar competence in the clinical setting or with
patients with neurological diagnoses.
Quality
The dimension of quality addresses how well the
professional performs these tasks.
Some skills, such as communication of basic
information, do not necessarily depend on quality for
effectiveness; other skills, such as spinal joint
mobilization, have a very narrow scope of competence
but require high quality to be effective.
Meaningful professional development seeks to
enhance both dimensions of competence—scope and
quality
Expertise
Epstein and Hundert define professional competence
in the medical context as
“the habitual and judicious use of communication,
knowledge, technical skills, clinical reasoning,
emotions, values, and reflection in daily practice for
the benefit of the individual and community being
served.”
In addition to technical skills, expertise in physical
therapy involves a blending of cognitive, technical,
psychosocial, interactive, and moral skills.
In a qualitative study of expertise in four specialty
areas of physical therapy, Jensen and colleagues
identified four dimensions of clinical expertise
Dimensions of clinical expertise
1. Multidimensional, patient-centered knowledge base
that evolves through reflection
2. Collaborative and problem-solving approach to
clinical reasoning
3. Focus on movement linked to patient function
4. Sense of caring and commitment to patients
The practical significance of the models and attributes of
expertise discussed in this section is fourfold:
1. Professional development requires activities involving all
four dimensions of practice: (i.e., a multidimensional
knowledge base, a collaborative problem-solving approach
to clinical reasoning, a focus on movement linked to patient
function, and a sense of caring and commitment toward
patients).
2. The development of professional expertise also requires
cultivation of attributes and behaviors such as humility,
passion for clinical work, collegial interaction, and limited
delegation to support staff
3. Professional competence is dynamic, changing
constantly in relation to organizational and contextual
roles.
4. Physical therapists must assess their skills in the
numerous dimensions of professional expertise and
seek professional development in all dimensions,
attributes, and behaviors throughout their careers. In
addition to continuing education courses that focus on
knowledge and clinical reasoning, PTs should seek
opportunities to enhance their personal growth and
interactive skills.
In describing reflective practice, Shepard and Jensen
built on the work of Schon, which distinguished
formal, or technical, knowledge from reflective, or
intuitive, knowledge.
In contrast to technical knowledge, which focuses on
facts and rules, reflective knowledge incorporates the
intuition used in everyday practice.
Reflective knowledge allows the practitioner to solve
the ill-defined clinical problems of everyday practice
that do not match the standard rules and examples of
formal knowledge;
a practitioner with reflective knowledge “holds the
knowledge and skills of a technical practitioner and is
skilled in creative information acquisition and
intervention techniques that can be brought to bear on
any unique health care problem that may be
encountered during the practice of physical therapy.”
The Guide for Professional Conduct urges PTs to use
sound judgment in evaluating continuing education
courses: “A physical therapist shall evaluate the
efficacy and effectiveness of information and
techniques presented in continuing education
programs before integrating them into his or her
practice”
EVALUATION OF COMPETENCE & PROFESSIONAL
DEVELOPMENT
The following are four possible approaches to
evaluation of professional competence in physical
therapy:
● Mandatory continuing education
● Reexamination at set intervals
● Peer review
● Compilation of a professional portfolio
Mandatory Continuing Education
Mandatory continuing education is the most common
approach to ensuring continuing professional
competence in the United States. Many states require
that PTs and PTAs engage in continuing education
Mandatory continuing education is a popular
approach to professional development and one that
may prompt unmotivated professionals to pursue
additional learning
Reexamination
Reexamination would require professionals to take a
written or practical examination (or both) at specified
intervals.
For example, a state board might require all PTs to
take the licensure examination every 5 years. This
approach appears to have the advantage of evaluating
each PT for minimal competence, but it does not
necessarily promote quality or expertise.
Peer Review
In a peer review system, experienced PTs evaluate the
performance of other PTs. Many organizations use
peer review as part of a yearly evaluation process.
A supervisor may review one or more cases or may
observe the PT during an examination or intervention.
A rigorous peer review process can provide excellent
feedback that may serve as a basis for professional
growth.
Professional Portfolio Compilation
PT may collect exemplars or artifacts that provide
evidence of continuing professional growth. Many of
those who advocate the use of portfolios emphasize
that continuing reflection by PTs on their practice is
essential to the process.
From this perspective, the portfolio should not be
“scripted” but rather should be based on the insights
of the therapist and driven by that individual’s unique
goals for professional development.
PROFESSIONAL DEVELOPMENT PLANNING
For many PTs the data from each of these evaluation
tools can be combined to create a strategy for
professional development.
However, none of these efforts will be meaningful
unless the PT reflects on the meaning of the items in
the portfolio as they relate to the plan for professional
development.
The Goal-Driven Portfolio
A professional portfolio is a tool PTs and other
professionals can use to organize the many
components of professional development. Paschal,
Jensen, and Mostrom created an outline for the
portfolio used by students in the transitional doctor of
physical therapy degree program at Creighton
University.
It includes the following:
1. A mission statement
2. A self-assessment
3. Exemplars supporting the self-assessment
4. A reflective analysis of the self-assessment (What?
So what? Now what?)
5. A statement of goals
6. Plans for building strengths and addressing
weaknesses
The Process of Reflection and Planning
To begin the process of compiling a portfolio, the PT
should compose an individual professional mission
statement.
The mission statement defines the therapist in terms
of competencies and focuses on what the individual is
currently doing while identifying resources for further
development.
The mission statement should be clear, concise,
meaningful, easy to remember, accurate, dynamic,
powerful, and focused
Self-assessment, is the heart of the process. In the
self-assessment, the PT identifies strengths and
weaknesses in relation to the personal mission.
One approach to self-assessment is a strengths-
weaknesses-opportunities-threats (SWOT) analysis, in
which the PT evaluates strengths and weaknesses
(which are internal characteristics) and opportunities
and threats (which are external factors).
Self assessment also may include input from peers and
colleagues familiar with the PT’s work.
For PTs, a vision statement reflects what they want to
become and how they want to influence the world
around them; it defines the individual’s goals and
values. It also is a clear, concise, meaningful statement
of where the PT will be at some point in the future,
such as 5 years from now.
This process is aided by inclusion of exemplars or
artifacts that support the self-assessment, such as
continuing education certificates, written evaluations,
and journal publications
Reflection on the self-assessment is an important
step, because the PT must determine what the honest
self-assessment indicates.
In the final steps, the therapist should reexamine goals
and make specific plans for building strengths and
addressing weaknesses. Implementation of these plans
should bring the PT back to reflection on the mission
statement and self assessment, creating a continuous
cycle of planning and reflection.
Other approaches can be taken to pursue professional
development; the process of self-assessment and goal
setting may be more important than a product that
reflects that process.
However, a professional portfolio may become an
important resource for future employment and career
choices. Portfolios also may serve as a means of
addressing the issues related to evaluation of
competence.
POSSIBLE EVALUATORS OF PROFESSIONAL
ACHIEVEMENT
Another important issue related to evaluation of
professional competence and development is the
determination of who should be responsible for this
process: regulatory and licensing agencies,
professional associations, employing organizations, or
individual professionals
Many PTs believe that, as professionals, they are
ultimately responsible for determining the activities
and knowledge they need to maintain competence. In
reality, each stakeholder plays a role in the evaluation
of professional competence.
Some argue that because regulatory and licensing
agencies are charged by the state with protecting the
public from incompetent or impaired practitioners,
these agencies should be responsible for evaluation.
Professional organizations may contend that they
alone have the expertise and knowledge to evaluate
professional competence. Because of the knowledge
and expertise required by professional status, it may
be argued that the profession itself, through its
representative organization, should establish criteria
for competence
Employing organizations may take the position that
only they understand the unique contextual
application of the knowledge the professional will use
and that the organization bears the legal and financial
burden of a PT’s lack of competence.
In this regard, mandatory organizational educational
requirements (e.g., cardiopulmonary resuscitation,
standard precautions) also determine professional
competence.
Regardless of the actions and demands of other
stakeholders, each PT must take responsibility for
professional development and commit to a planned
approach that embraces the numerous dimensions of
professional competence.
Professional development that strives for maximum
expertise rather than minimal competence benefits
individual patients, society as a whole, and the
profession.
CAREER ADVANCEMENT
Rozier and associates defined career success as “the
perception of an individual’s employment
achievements over time.”
Although professional development emphasizes the
process of continuous education and improvement in
skills, career advancement focuses more on
professional success as measured by promotions,
salary increases, enhancement of one’s reputation, and
other personal indicators of success
The differences in the career paths of men and women
in physical therapy also appear to exist. A study of PTs’
perceptions of career success demonstrated that PTs
defined career success somewhat differently from
other professionals.
Both male and female PTs defined it more in terms of
internal indicators (ethical practice, improving the
health of the patient, personal satisfaction, and
personal goals) than external factors (high income,
administrative status)
ORGANIZATIONAL IMPACT ON
PROFESSIONAL DEVELOPMENT
Organizations may have a significant impact on
professional development. Obviously, one aspect of
professional competence is the ability to apply
professional knowledge and skills in the
organizational setting.
However, organizations also may shape professionals
through educational offerings and reimbursement for
continuing education
More important, as Smith notes, organizations shape
PTs through organizational socialization, “the process
by which an individual enters an organization and
becomes a fully participating and effective member.”
Socialization is not a discrete event, but rather a
continuous, interactive process in which the individual
and the organization learn and respond to each other’s
needs.For the PT, an important part of this process is
learning and incorporating the organization’s values
and culture
