PCE Cancellation - FAQ
This page will be updated as questions are received and answered.
Posted March 31, 2021
Updated June 23, 2021
What happened on March 20th that caused the cancellation of the clinical component of the Physiotherapy Competency Examination (PCE)?
Why can’t we remove the clinical exam requirement?
The requirement that candidates complete an examination prior to registration is written into our legislation. The examination approved by the Board is the Physiotherapy Competency Examination (PCE) administered by CAPR. This includes both Written and Practical Components.
Deviating from use of the CAPR examinations, while potentially possible, would need to be done with considerable caution to ensure that a comparable, objective, reliable, and valid assessment process was completed prior to registration. An exam review initiative started by CAPR in Feb 2020 is still underway and we are looking at alternate styles of meeting needs of stakeholders in today’s environment.
What about the physiotherapy Residents who have been unable to practice, and all those COVID patients who need physiotherapy care?
While individuals are granted three attempts at the examination, after two unsuccessful attempts the risk of having the candidate remain in clinical practice outweighs the potential benefit.
In response to COVID-19 and disruptions to the clinical exam, the NSCP extended all provisional licenses until an exam is available. This means that in NS, exam candidates are currently working as physiotherapy Residents providing essential physiotherapy services to Nova Scotians under the supervision of a physiotherapist, with a range of health concerns and across sectors, including in acute care, ICU, rehabilitation, home care, continuing care, and outpatient orthopedics.
Why isn’t NSCP advocating on behalf of the PCE candidates?
The NSCP has a government-issued mandate to serve the public interest. Our primary role is to register competent individuals who meet the specified registration requirements to practice physiotherapy in NS. We protect the public interest and assure their confidence in the quality of service provided by physiotherapists in NS. We must place public interest ahead of that of the physiotherapy profession.
Physiotherapy regulators from across the country are charged with the same responsibility. Advocating for the profession, including PCE candidates is the role of the CPA.
Why hasn’t NSCP complied with the CPA’s demands that the clinical exam requirement be set aside?
Isn't the NSCP a branch of the CPA, and an association?
This is the third incident involving the examination process. What is being done to overcome the ongoing challenge?
Both the June and November 2020 examinations were cancelled due to COVID-19, the public health measures in effect, and the closure of testing centers which precluded offering an in-person clinical examination. Early in the pandemic, CAPR began to investigate the idea of a virtual examination, and with the 2020 cancellations, plans were made to transition to a virtual examination in March 2021.
The NSCP is currently in discussions with our stakeholders including NSCP’s Council, the Ministry of Health, and regulatory legal advisors to review available options to address our legislative requirements for registration given the ongoing issues.
Is CAPR competent to deliver the national written and practical exam?
As a physiotherapy regulatory body in Canada, the NSCP is a founding member of the Alliance and will continue to work with our peers in physiotherapy regulation in the interest of assuring the public that all physiotherapists practicing in Canada, including nationally and internationally trained physiotherapists, meet the same minimum standard for competence and that the public interest is assured.
Why do we have a clinical exam requirement to begin with? Other professions don’t have a clinical exam.
The PCE was developed in the late 1980s and early 1990s to address the following issues:
- The need for a consistent, equitable and fair entry to practice standard for all applicants for registration to practice physiotherapy, including those who did not receive their physiotherapy education in Canada.
- The need to develop a system of checks and balances to address the public interest and assure confidence, by having an independent organization, separate from those that specify the physiotherapy entry to practice curriculum or conduct accreditation, verify that the education programs were successful in their efforts to develop competent clinicians.
Physiotherapists have long advocated for their role as primary care providers and have sought to have the same standing in the health system as physicians. If they wish to fulfill the role of primary care provider and autonomous practitioner, physiotherapists will need to hold themselves to comparably high standards of competence assessment and demonstration.
Is the clinical exam even valid and reliable?
Examination questions are developed by a team of Physiotherapist subject matter experts from across the country, and the question’s performance on each exam is carefully studied to ensure its reliability and validity. Questions that perform poorly are removed from the question bank. New questions are added to the bank as practice changes.
Each exam question is accompanied by a checklist that examiners use to score a candidate’s performance. Examiners also receive training regarding how to score the station they are assigned. These measures help to ensure that candidates’ performance is scored consistently, despite being tested by different examiners in different locations.
CAPR invests considerable resources into assuring the reliability and validity of the examination.
During the transition to the virtual examination, CAPR has taken steps to ensure that the same psychometric reliability and validity is achieved through the new examination process. More details about the exam blueprint and psychometric properties of the exam can be found on CAPR’s website.
If the clinical examination is so important, why are you doing it virtually?
Prior to the COVID-19 pandemic, CAPR, like other pre-licensure examination providers that typically include a clinical examination component in their examination process, was working to innovate examination processes. These organizations have all been challenged to accelerate the process of innovation process and re-think their exam processes due to the pandemic.
The Medical Council of Canada and Pharmacy Examining Board of Canada are two comparable Canadian organizations which have also been challenged by this issue. The Medical Council of Canada announced in February its plan to transition to a virtual examination in 2021 after postponing examinations in May and October 2020, and February 2021.
The shift to a virtual exam has an obvious short-term benefit of limiting the risk of COVID-19 exposure during the examination for candidates, examiners, and standardized patients alike. This change is partly in response to safety concerns raised by examination candidates as CAPR prepared to run the November in-person clinical examination, which was ultimately cancelled.
In the long-term, the virtual examination may also result in increased ease of access to the exam for candidates.
Why doesn’t the NSCP develop its own exam to meet the needs of University graduates and local PCE candidates?
- How would internationally educated physiotherapists access the examination, or be vetted for inclusion as examination candidates?
- Which organizations have the necessary psychometricians and other technical skills to ensure a reliable, valid, and sound examination?
- Which organizations have the clinical and technical skills to deliver a rigorous examination under usual circumstances?
- Which organizations, if any, could deliver a reliable, valid, and sound examination in the context of current COVID-19 restrictions?
- If provinces opt to employ a local approach to meeting the clinical competency examination requirement, what implications could this have on future labour mobility between provinces? Interprovincial labour mobility was one of the drivers behind the development of the PCE to begin with.
If we were to “go it alone” there would be considerable costs attached to developing the examination, and those costs would be passed on to current regulated members and exam candidates. A new examination would also take considerable time to develop and validate so it is not likely to be a quick solution to the current situation.
Why doesn’t the NSCP trust the results from the Universities end of program Objective Structured Clinical Examination (OSCE), the University physiotherapy programs are accredited programs, aren’t they?
The Canadian physiotherapy programs are, accredited by Physiotherapy Education Accreditation Canada (PEAC), and that accreditation signifies that the program has met the expectations established in PEAC’s accreditation standards. The programs deliver instruction and conduct student performance assessments, including the OSCE, as part of its work to address the accreditation standards. While Canadian educational programs may complete a mid or end of term OSCE there is no requirement for them to.
Similarly, all Canadian physiotherapy programs follow the National Physiotherapy Entry-to-Practice Curriculum Guidelines, established by the Canadian Council of Physiotherapy University Programs. Finally, all physiotherapy regulators, including the NSCP have similar registration requirements such as good character and reputation requirements, and requirements that registrants graduate from accredited Canadian programs or demonstrate that their education is substantively equivalent.
Together, these different groups and requirements form the safety net that ensures that all physiotherapists practicing in Canada meet a shared, minimum expectation for knowledge and performance of the practice of physiotherapy. This protects the public interest in that when receiving physiotherapy care they can be assured that a certain level of competent care can be expected.
No one document, organization or set of standards or requirements alone can achieve this objective. Removing any strand of rope from the safety net weakens the protection it offers, eroding public safety and confidence in physiotherapists. Download the PEAC statement on the role of accreditation for more information on the role of accreditation in the preparation of Canadian-educated physiotherapists for entry to practice.
Why can’t my supervised practice hours count towards meeting registration requirements? Why can’t my sponsor vouch for me and "grandfather"/legacy me in?
More importantly, practice hours or a sponsor reference alone, lack the rigor, objectivity, reliability, and validity of an examination process.
As a regulatory organization we accept that there is not always consistency with all sponsor/supervision arrangements. Although physiotherapy residents and their sponsors have worked hard to fulfill their obligations, particularly during this challenging time, the NSCP understands that the normal scope of any particular clinical practice does not include the entire breadth of the scope of the profession and would allow for a relatively narrow slice of scope that could be observed, supervised and vouched for.
Having sponsors and supervised practice hours serve in place of the clinical competency examination also has the potential to place the sponsors in a conflict of interest. This would be problematic not only for the sponsor, but also from the perspective of assuring the public of the validity of the registration process.
There may also be equity and fairness considerations as some physiotherapy residents may not have secured and maintained full-time employment through the pandemic, impacting their ability to meet a practice hours requirement or secure a sponsor reference.
Finally, most clinical environments do not encompass the breadth and depth of the Clinical Component of the PCE, which is designed to ensure that all physiotherapists entering practice do so with a shared, basic knowledge of the profession, regardless of where they anticipate their career path will lead.
I have had to take time off to study and have lost earnings because of my ongoing status as a Physiotherapy resident.
While it is true that some employers pay a lower rate (either hourly or percentage of billings) for physiotherapy residents, that is a matter between the physiotherapist and their employer and should be addressed directly between the two parties. The NSCP has long held the perspective that physiotherapy residents are regulated members subject to the same Standards as any other regulated member and should be afforded the same rights and privileges.
Will information be sent to sponsors and employers about this current situation?
New messages and important updates are being sent directly to all Physiotherapists registered in Nova Scotia and posted on the website as well.
What would happen if I just didn’t bother to finish the examination process?
Once examination services are resumed, physiotherapy residents will need to fulfill the requirements for registration within a defined period of time. Failure to do so will result in suspension or revocation of provisional registration.
Any person practicing Physiotherapy without a license is committing an offence under the Physiotherapy Act and subject to significant fines and/or imprisonment. These significant enforcement provisions underscore the importance of ensuring that only those who are appropriately qualified and licensed engage in the practice of physiotherapy in this province and hold themselves out as physiotherapists.
Is Nova Scotia considering creating its own exam like the approach taken in BC and Alberta?
- CAPR is working on providing a solution and will beat any timeline that NSCP could meet in designing its own.
- CAPR has in-house knowledge and 20+ years of experience designing and delivering competency exams for the Physiotherapy profession in Canada.
- NSCP does not have the expertise in house, nor the resources to hire external consultants to design a similar exam. This is a fundamental reason for NSCPs membership in CAPR, as the resource sharing with other provinces allows for a more robust credentialling and certification process than if it were sole sourced by NSCP.
- Despite the recent cancellations of the PCE exam NSCP continues to have confidence in CAPR as an organization that has consistently provided valuable services to the NSCP including administration of the national competency exam.
- NSCP does not agree with the approach taken in BC and Alberta and have expressed that to those regulators. NSCP is committed to a national standard for qualification and competency. While we understand the context and rationale for provinces designing their own exams, we feel doing so weakens the national process by providing potential “backdoors” to credentialling that undermines public confidence in the regulatory system.
- NSCP continues to believe in the importance of a national standard for entry to practice, and that the PCE continues to be recognized as a leader in evaluation services both nationally and internationally.
If modified exams are run provincially, similar to what is happening in BC and Alberta, will they be recognized in other provinces?
Right now, alternate exams are only being offered in AB and BC to those who have been registered since before March 11, 2020, in that specific province and are still waiting for the clinical exam. Nova Scotia does not plan to design and run its own exam.
It is possible that regulators may have to accept transfers through CFTA once they have practiced in their home province under a full license, but as stated above will be determined at the government level.
The NSCP does not agree with fracturing the entry level competency evaluation process by having individual provinces administer exams. The NSCP is advocating for national entry level standards to be maintained.
What is the cost of each exam? Will applicants be reimbursed if the exams are cancelled again? Has the exam been validated? If so, how? How soon should we be expecting to write the exam?
If it continues to get postponed, how long will graduates be granted interim licensing for?
Why do we have to write this exam when we've done OSCE's throughout our schooling; isn't it enough for the schools to confirm that we're competent through OSCE's and five supervised placements?
- University exams are not intended to be competency evaluations. They are designed to provide evidence that students have met the learning objectives of the course for which they are delivered.
- The OSCE is not an accreditation requirement, and therefore schools may or may not choose to use these evaluation methods to examine student learning or may choose modified OSCE’s that better match course objectives than those used for national licensing.
- Third party evaluation is considered the gold standard for OSCEs to limit the possible bias that may be introduced by having individuals that know and teach the students run the OSCE.
- The evaluation of clinical placements is not based on metrics that have been validated for the purpose of establishing a threshold for competent practice and national licensing. Tools used for evaluations in clinical placements are designed to capture the objectives of the course and the learning trajectory of the student through their education.
- It is not expected that a student be at the level of “entry-to-practice” in all of their placement evaluations, particularly those preceding their final placement as students have not yet completed the educational requirements of the MScPT.
The Medical Council of Canada (MCC) announced they will no longer require the practical exam for Medical Residents moving forward. Why can’t this be done for physiotherapy?
Physiotherapy does have mentorship; however, this is quite different from the post graduate training requirements of the MCC. Mentorship is non-standardized and therefore subjective. Mentorship was set up to develop a mentoring and learning relationship for entering practice. It is not a validated evaluation tool but an indicator of areas to further develop. Not all provinces have it and it is different from province to province. Each school has slightly different programs and clinical experiences and that is why a non-biased national exam run by a third party is so important.
It is important to realize that CAPR has been looking at alternative ways to evaluate competency since before the pandemic. However, the research, development and psychometric validation takes many months to complete. CAPR’s current immediate focus is running an exam that is valid and will clear the backlog as soon as possible. When the pandemic first hit CAPR’s focus was on developing a virtual written exam to get new graduates qualified for provisional licensure so they could enter the work force and begin consolidating their knowledge and skills. Unlike the MCC, Physiotherapy does not have a 12-month post graduate training program to fall back on for evaluation of competency that would enable us to drop the clinical as it is and work on a new innovative plan.