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Considering Competence
Introduction
The College of Physiotherapists and the physiotherapy community promote and
support the high performance of physiotherapists/ physical therapists in their
practice. Integral to this is the requirement that each and every registered
practitioner has the competence to perform safely and with quality outcomes.
Competence is central to the College mandate as entry to practice, professional
conduct and quality management are all based upon the assumption that
physiotherapists/physical therapists will maintain, or exceed, a level of
essential proficiency in any practice situation.
In other words, it is what physiotherapists/ physical therapists actually do in a
patient encounter that is what is important, not what they know or think they can
do. Applied competence in day to day circumstances is what is important to the
physiotherapist, to the public and to other health care providers.
Describing Competence
The term “competence” is used broadly in all areas of the College and within the
profession. Competence is central to the concept of self regulation and is directly
connected to the protection of the titles of physiotherapist and physical therapist.
In general, competence refers to a therapist’s knowledge, skills and abilities and
application of judgement in the delivery of safe, quality physiotherapy care.
Competence is individual in nature, and while any individual’s competence resides
within the general scope of practice of the profession as a whole, competence
speaks also to a specific practice setting, specific clientele/patients, and specific
practice experience. Competence spans a career, and in physiotherapy in Canada, is
based on the essential competencies1 needed to practice in all circumstances.
Using the term competence and understanding what it means and how it is
applied is key to understanding and improving individual performance.
Aiming for Conscious Competence
The term “consciousness”, when connected with competence means that an
individual deliberately considers all the relevant factors in making decisions or
taking action. This interpretation also applies when considering clinical decisions,
professional behaviours and practice processes.
1
Essential Competence Profile for Physiotherapists in Canada October 2009
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To be competent and act consciously means to act beyond habit or routine or
previous success and be able to explain with ease to others, particularly patients or
their representatives, why certain interventions or choices have been made.
Consciousness is not the same as innovation rather it is fundamentally about risk
in performance and assuring an evidence informed approach. It is knowing when
you know what to do, knowing when you need to know more, and knowing when
not to act.
Framing Conscious Competence 2
If conscious competence is the aim for daily practice, to what it is compared and
contrasted is equally important.
Unconscious
Competence
Conscious
Competence
Unconscious
Incompetence
Conscious
Incompetence
The descriptions of other competence concepts in relation to conscious
competence are described as follows:
Unconscious Incompetence
An individual who is unconsciously incompetent does not realize that she/he does
not know how to do the task or does not understand that she/he does not have the
authority to perform the procedure. For example, a physiotherapist/ physical
therapist may perform a legally restricted activity without appropriate delegation
because she/he is unaware that it is an activity not authorized to physiotherapists/
physical therapists. This is unconscious incompetence.
Conscious Incompetence
A consciously incompetent practitioner is aware that she/he does not know how to
perform the task and performs it regardless. For example, the physiotherapist/
physical therapist is covering for a colleague and provides an intervention that is
part of the patient’s plan but with which this physiotherapist/physical therapist is
unfamiliar.
2
Adapted from the College of Occupational Therapists of Ontario
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Unconscious Competence
A person who is unconsciously competent does a task well, but likely could not
explain how to perform the task to others. It may be an approach from routine. If
the individual’s current approach were to become less successful, she/he may not
be able to correct the situation. For example, a physiotherapist/ physical therapist
may intuitively develop a particular approach over a period of time. In many
situations the approach is successful, but sometimes it works less well. Unless the
physiotherapist/ physical therapist understands each component of the approach
and self corrects by identifying what is not working, the patient outcomes will be
less successful.
Conscious Competence
A consciously competent practitioner can perform a task well and understands the
skill behind the task. This individual can explain what works and why. She or he
can deliberately change course when needed because she/he understands the
skills required and the risk context. For example, the consciously competent
physiotherapist/ physical therapist will approach each assessment and
intervention with the opportunity for questioning, the opportunity for shift and
the ability to explain why in all circumstances.
A consciously competent practitioner is one who:
• knows her/his strengths and limits (what he/she does);
• knows the guidelines and rules (the legislation, the standards, the policies);
• makes good choices consciously and deliberately (evidence informed); and
• is able to explain why she/he took a particular course of action.
Unbundling Conscious Competence
Conscious competence as a concept speaks to both risk and performance. This
analysis, when conducted in a conscious manner, happens in a four-stage
sequence.
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Conscious competence links to:
Opportunity
Ability
Judgement
Delivery of Quality Care
•
•
•
•
Opportunity which with
Ability which with
Judgement equals
Delivery of Quality Care (outcome)
“Opportunity + Ability + Judgement = Delivery of Care”
Each stage speaks to a different level of risk evaluation in relation to competence.
Understanding the stages or components within conscious competence supports
safe, quality and ethical care. It enables physiotherapists/physical therapists to ask
the tough questions and to do only what they know how to do and where the
action is supported by patient consent and the available evidence.
Each stage is described below with primary questions identified. An answer of “No”
to any one demands a consciously competent therapist to stop a course of action.
This halt in progress may terminate proceeding at all, may require further
demonstrated evidence, information or materials to proceed, or may offer a
different solution to better assist a safe quality outcome.
Stage 1 -Opportunity
•
•
•
•
Is this activity within the scope of practice of physiotherapy?
Do I know this area?
Is there any applicable law(s) that requires consideration prior to
proceeding? If so what and what is the implication to my practice?
Do the College standards permit my choices?
Is my choice(s) ethical? Does it meet the profession’s code of ethics?
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Plus
Stage 2 - Ability
•
•
•
•
•
Does my practice context support my decision options?
Is my individual sphere of competence (skill) sufficient?
What can I do?
Do the resources of my practice context support my
practice options?
Are the patient’s goals consistent with my care options?
How can the patient’s goals be best achieved?—by me,
by other providers, by an assistant, other?
Plus
Stage 3 - Judgement
•
•
•
Do I have consent of the patient or decision maker to
proceed?
Do I have the specific competencies to carry out the plan?
Are they current? In other words I do do what I recommend.
Does the evidence, where available, support my
considered options?
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Equals
Stage 4 - Delivery of Quality Care
•
•
•
Do I know the evaluation tools to use to measure care
outcomes? Have I initiated their use?
What are the outcomes of the care delivered?
What are the learnings of this care interaction?
How will I change my practice in future?
Summary
Competence, more specifically the ability to be consciously competent, is key to the
safe quality physiotherapy care. Competent physiotherapists will easily shift
between intuitive practice (unconscious competence) and deliberate practice
(conscious competence), yet performing, understanding and explaining what
drives the shift of mode remains essential. This model serves as a cornerstone to
exploring and explaining competence in the public interest.
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