Experiences of a New Grad - Part 2/3: Views on Telerehab, Continuing Education Courses, and the PCE delays
By: Sukhbir Manku, BSc, MScPT, Physiotherapy Resident

Welcome to Part 2 of Experiences of a New Grad!

In Part 1 of this 3 part series, PT residents working in private practice settings spoke about:

• How prepared they were to assess and treat patients following graduation,
• What they were looking for in a clinic, and
• If that's changed given their new experiences, their unique challenges as a new grad, and how COVID-19 impacted their practice. 

In Part 2, Sukhbir Manku, PT Resident, will be sharing what PT Residents had to say about:

• Telerehabilitation,
• When to take continuing education courses,
• What courses PT residents would recommend for new grads, and
• WARNING: this is a spicy flavor-packed one > their thoughts on the ongoing PCE delays and how this has impacted their practice and/or wellbeing.

If you're a student, a new grad, PT resident, or anyone with a stake in the game, it's time to grab a snack and get ready for some insightful content!

What are your Thoughts on Telerehabilitation?

If you’ve engaged in telerehabilitation, can you comment on your online assessments or treatment sessions?

The field of telehealth and telerehab has accelerated dramatically following the ongoing COVID-19 pandemic. PT residents were thrust into a world where they needed to learn telerehab at the same time as registered physiotherapists. 

During the interviews conducted, PT residents made comments about the difficulties of telerehab due to technical factors like stable internet connectivity, audio delays, and camera repositioning. Additionally, the inability to physically examine a patient to aptly diagnose a patient leads to a multitude of challenges for many PT residents.

One PT resident shared a troubling story…

“I had to assess an older man with a knee injury virtually. He had some hamstring or MCL issues and it was very hard to get a proper assessment completed and get him on the right track. Now, he’s had substantial deficits… If he had come, we could’ve avoided this. It’s frustrating.”

Despite some of the challenges with telerehab, some PT Residents discussed how they found success as telerehab allows for:

• High-quality adjustments of home ergonomics,
• Efficient pain education and exercise prescription,
• Greater focus on exercise therapy, and
• Greater outreach to communities that normally lacked access to physiotherapy. 

A PT Resident simultaneously working in the public sector noted…

“I’m a big advocate for telehealth and telerehab. The tech world is a place where the healthcare system needs to be. There’s a huge role in healthcare but it is NOT a replacement. It’s been a godsend in cardiac rehab! There’s a lot to be done through educating and strategic planning.” 

Did you take any continuing education courses following graduation? When did you realize you needed or wanted to take these? 

I bet PT students’ eyes lit up with this question. A question students, PT residents, and all PTs continually ask themselves is: “What courses do I need to take?”.

As a self-regulated profession, we need to be up to date on the literature and services we provide so we can best support our patients and clients in reaching their goals. PT residents had a lot to say about continuing education courses and opinions varied. 

Some PT residents took several courses ranging from acupuncture to pelvic floor specialized courses.

One resident mentioned that “it’s almost expected in Toronto everyone needles” and another mentioned they took an intro to needling course “purely for client retention. I don’t really believe in needling but I’m doing it purely for placebo and patient satisfaction. It’s like having to hide vegetables in a meal. Patients often credit modality over movement.” 

Other PT residents mentioned courses by Greg Lehman, noting that his courses offer a broad framework for rehab in general and that general courses to build a critical thinking framework are very useful.

But when did PT residents take these courses?

This definitely varied as some completed courses prior to graduation and others took courses for acupuncture and in pediatrics almost immediately following graduation.

However, a critical theme was noted across all PT residents, eloquently summarized by these quotes:

“You should find what your clientele needs and cater continuing education to that instead of taking things for no reason.”

“It’s hard to apply knowledge if you don’t have people in your caseload that the course would apply to. It’s important to match courses to the caseload.”

Before moving on to the next question, I wanted to bring up Motivational Interviewing. Yes, this was mentioned by a PT resident, but as my bias erupts with this statement, I will forever stand on the hill that motivational interviewing is ESSENTIAL to physiotherapy. Or as one PT resident puts it:

“Motivational interviewing is very important and I’ve done courses on this. I wish we learned more about this in school. Everything is health behaviour change but we didn’t cover this much.”

Are there any courses you’d recommend for students interested in pursuing the same field of work as yourself?

PT students’ pupils dilated like their sympathetic nervous system was in overdrive over this question!

I’ll make this concise and simple with a list of course recommendations, including a few Embodia specific courses for your convenience:

1. Pelvic Health Solutions and pelvic courses - Embodia has a huge catalog, here's one to get you started
2. Acupuncture and dry needling - “any basic course to just get you rostered.” 
3. Physio network masterclass
4. Greg Lehman’s Reconcile Pain science and biomechanics
5. Motivational Interviewing courses - This one's been popular.
6. Embodia’s Pediatric courses- Torticollis online courses are highly recommended for pediatrics. Dynamic core for pediatrics may be a good start!
7. Any Neurodeveloment therapy course to support patients that have difficulty controlling movement following a stroke, concussion, or other neurological dysfunctions.
8. Importantly, PT residents often mentioned that it’s important to see what your niche is and then gear your education to that.  Struggle first and learn! 

Here’s a great takeaway:

“Patients appreciate when you say you don't know - fake it till you make it and then research to solve it.”

What are your thoughts on the PCE delays and how has this experience impacted your practice and/or overall wellbeing?

The PCE and CAPR have been the root cause of distress for the entirety of the pandemic. Characterized by ineptitude, lack of empathy, and what others (and myself) have found to be, “shady business”.

The clinical component of the PCE has been cancelled FOUR times since the start of the pandemic, with the most recent being September 13, 2021.

I could go on and on about how completely unacceptable this is and how several of the regulatory colleges of physiotherapy are absolutely complicit, but what matters most is that the voices of PT residents are heard and shared. 

*Note that PT residents were interviewed BEFORE the latest exam failure.

“The PCE is a complete waste of time, money, energy, and resources. It doesn’t test safety. Safety is tested via practice over a year, that speaks volumes. The PCE NEEDS to be replaced with something else. In terms of this impact on my practice…. People will sometimes not book with me because I’m a PT resident. People have lost out on receiving care and I’ve lost income, not only because of the increased difficulty in establishing a caseload with the PT resident title, but because PT residents as independent contractors earn less per patient they see. Also, there’s limitations in professional growth in fields like pelvic physiotherapy.”

“I’m glad you asked about wellbeing. Honestly, the first three months as a PT resident were super upsetting because this was paired with financial insecurity and the lockdown compounded all of this. Once they cancelled the May exam, I stopped caring. No one is taking it seriously, my goal is to do the bare minimum just to pass. People don’t respect CAPR and what they stand for. The Ontario College and CAPR meetings were disappointing, making PT residents feel unvalued. It’s nice to see other physios stand up but it still doesn’t change the fact that this outdated practice impedes someone's ability to be an effective clinician.”

Embodia Co-Founder, RPT, and climbing enthusiast, Maggie Bergeron, sharing the real questions.

“Has it impacted my practice? Quite honestly, no. I still have yet to start studying and my exam is in November. Honestly, I can’t believe this exam is happening.” - As of September 13th, all future virtual clinical exams are cancelled. Does this PT resident have the ability to foretell the future or was this as predictable as the Maple Leafs choking in the first round?

“In terms of impact on practice, I spent every weekend and free moment from May to July studying before the cancellation. This took away from my patient care! Residents are burnt out studying full time and working - researching outdated bull*** for the PCE instead of more recent things relevant to practice and our patients.”

“There’s NO experimental evidence that the PCE is valid - just upholds the status quo. It’s a manner for CAPR to just have jobs and doesn’t positively affect patient care. It gets tricky when CAPR is an amalgamate of the colleges… who evaluates the evaluators, right? Nothing happens when this gets called out, this whole experience has made me pessimistic about making changes. It sucks. I haven’t been thinking about it at all and in 2-3 weeks I’ll have to start studying. It’s crazy, I’ll be taking time off work a year into practice to study for this outdated exam.”

A systematic review by Bobos et al (2021) suggests the clinical PCE is not a valid or reliable measure of competency for physiotherapists

“So much has been said. Overall, it’s just disheartening. You’re out there trying to help people and there’s this looming shadow. There’s these constant stupid conversations where you have to explain that you’re a PT resident. You can’t tell me what I do or know is different from other physios. Paid less for the same amount of work, it’s frustrating!”

“It’s unsettling to see people that hold positions of power be totally against anything; very much “I’m gonna put you in your place”. It’s just unsettling. Is this a political game? $5 million and they can’t get a virtual platform to work. Embarrassing. All of the other health disciplines can figure it out but we can’t. This isn’t for the best for the people, just sounds totally political for people in these organizations to make easy money.”

“This whole debacle has been a struggle. My beliefs are that the PCE is not the best measure of competence, especially for people like myself that are in a specific niche. I don’t work with those working in acute setting and yet I’ll be tested on this.”

“CAPR is absolutely corrupt. It makes no sense to pursue a virtual PCE. I do not understand how this ‘protects the public’, pure money grab if you think the virtual exam is going to be reliable and valid in any way… The threatening of Bahram Jam is also ASTONISHING.”

Speaking of APTEI founder Bahram Jam... He surveyed the perspectives of PT residents towards the PCE, CAPR, and the CPO and, "surprise", what's been echoed in the interviews is echoed in the survey. Check it out below.

“I’m at the point where I have to do it… There are consequences to being a PT resident. Patients sometimes perceive this as a negative as patients may choose to have treatment with non-PT residents.”

“It’s important to have some standards but I don’t think a general PCE exam is the way to do it. There’s this big argument about patient safety from the college and I think there are ways to ensure safety. OT’s only have a written exam, SLP’s have ongoing work experience. Existing therapists are evaluating our documentation and quality of care, how is that not better than the exam?"

“About wellbeing… moments the exam went on and off changed the way I could prioritize my schedule. Right now I’m experiencing the most anxiety, all my evenings and days off to prepare for the exam and this does NOT translate to anything I’m doing in my practice. I wanna put my patients first but instead I spend a lot of time studying for this exam. I know the consequences of this and know if I don’t pass, I have to stop what I love doing… Stress from the exam adds a lot of financial stress directly and indirectly as the exam is very expensive AND I have to take time off to study.”

Final Thoughts

Absolutely heartbreaking what PT residents have had to put up with. The Colleges and CAPR have failed PT residents time and time again, putting their practice and wellbeing at risk and by extension, affecting the care of the very patients the regulators (and all physiotherapists) want to keep safe.

I'd also like to give a shout-out to Bahram Jam and recommend giving this blog a read as the survey above is only the tip of the iceberg. Bahram Jam, an absolute gold standard advocate for PT residents and students, has a lot to say about the CAPR and the PCE. His findings and story are mind-blowing.

What’s Next?

The third and final part of the Experiences of a New Grad blog will be published soon! PT residents talk about how:

• They’ve managed patient self-discharges,
• The crossroads between business and patient care,
• Work evaluation metrics, and
• Their best pieces of advice for new grads and students about to graduate. 

Resources

1. Bobos P, Pouliopoulou DV, Harriss A, Sadi J, Rushton A, MacDermid JC (2021) A systematic review and meta-analysis of measurement properties of objective structured clinical examinations used in physical therapy licensure and a structured review of licensure practices in countries with well-developed regulation systems. PLoS ONE 16(8): e0255696. https://doi.org/10.1371/journal.pone.0255696
2. What About the PCE? Crucial New Research, CAPR Updates, Advocacy & Allyship