Professional Development,

Competence, and Expertise

Delivered by
DR HABIB KHAN PT
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
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 [Link]
the PT, an important part of this process is
learning and incorporating the organization’s
THANK
YOU