Chapter 67 Competence and Professional Development Patricia A. Hickerson Crist

Learning Objectives After reading this chapter, you will be able to: Discuss the professional expectation of and individual accountability for pursuing continuing competence and professional development. Differentiate the terms competence and continuing competence and explain the multiple variables influencing each concept. Describe the basic differences in competence expectations for OTs and OTAs.

Learning Objectives (Continued) Understand how to demonstrate competence on an ongoing basis through self-assessment, individualized professional development, and portfolio preservation. Identify available resources and the steps in the process of creating a relevant professional development learning plan including beneficial learning activities for plan implementation. Consider the important role of certification, licensure, and advanced and specialty certifications for practice. Compare and contrast the merits of practice competence and practice excellence.

What Does it Mean to Be Competent? Competence – Knowledge (critical thinking), motive, trait, characteristic , clinical reasoning, or skill to achieve a specific goal or perform job responsibilities Competency – Actual performance of competence by comparing one’s practice outcomes with a specific criterion Continuing competence – Dynamic evolving process requiring life-long learning

Entry-Level Competencies Professionals acquire requisite knowledge, skills, and attitudes for entry-level practice by completing academic and fieldwork education from an accredited educational program Accreditation Council for Occupational Therapy Education (ACOTE®)

Continuous Learning and Improved Practice Performance Why should you remain competent? The skills and abilities of all practitioners fade with lack of practice, feedback or administrative/systems support The explosion of knowledge makes it difficult to maintain and focus learning Need the ability to translate knowledge discoveries into practice particularly given that knowledge must attend to need for client-centered care within various cultures Pressure from complex health care and social systems that prevent changes in practice

Continuous Learning and Improved Practice Performance (Continued) Each practitioner’s goal is to establish, maintain and update professional performance knowledge and skills to offer service delivery that is effective, safe, ethical and accountable Who is keeping an eye on you? AOTA, NBCOT, State Associations, and External Agencies (for institutional accreditation of all service providers)

Factors Affecting Competency Competence is a core professional value because of the risks to clients and the image of the profession when poor or substandard intervention results Incompetent, even unethical evaluation, intervention planning or intervention processes or outcomes, may result in harming to the client which could lead to: Permanent functional limitations; Non-reimbursement; and Raise the legal liability (malpractice)

Resources Influence on Competency and Professional Development Professional organizations, certification agencies, institutional accreditation programs and state regulatory groups each play a role in defining and applying standards AOTA State Professional Organizations NBCOT Government-based, state regulation of practice

Triangular Model of Continuing Competency Moyer’s Triangular Model identifies the key elements contributing to ones success in remaining competent: Analysis of job responsibilities and roles Quality improvement expectations as a practitioner and for one’s employer Code of ethics Continuing competence is dynamic, multi-factorial process as a result of complex responsibilities and expectations

Who Determines if Someone is Competent? State regulatory authorities and NBCOT share information on credentials, professional conduct, and regulatory and certification renewal issues State regulation: OT practitioners on regulatory boards make recommendation to the legislators regarding the standards for qualifications State laws and regulations affect the practice of occupational therapy and how the intent of the laws will be carried out

Who Determines If Someone is Competent? (Continued) NBCOT: Initially certified for 3 years following the examination Application for voluntary renewal is every 3 years and requires ongoing position-related continuing education documentation

Planning and Engaging in Reflective Professional Development Identification of indicators that prompt self-assessment Self-assessment using tools such as job descriptions, regulations, employment annual reviews, environmental scanning of practice-related developments, publications (standards and guidelines for practice and evidence), service delivery outcomes and self-assessment tools Reflection on identification of educational needs or gaps in knowledge and skills for competent practice Development of a competence improvement plan

Planning and Engaging in Reflective Professional Development (Continued) Implementation of the competence improvement plan Documentation of professional development activities retained in ones’ portfolio Implementation of changes based on new learning Critically analyze the outcomes resulting from using new competence in one’s specific practice Demonstrate continuing competence through one’s daily practice habit and routines

Choosing Effective Learning Approaches Continuous reflection is essential: What are my outcomes in relation to predicted ones? How can I improve effective, efficient competency use? When does the approach work best or worst? What are cues that I can use to move forward? When is use beneficial? When should I withhold use when cues suggest difficulty or failure in achieving desired results?

Selecting Effective Learning Approaches Contemporary workshops or classes Photo-voice adapted to self study Reading from quality professional publications Problem-based learning Structured observation Experiential learning activities: Role-playing with staff Key is self-directed learning Story-telling utilize a variety of resources to ensure quality Case history reviews Simulated practice

Professional Sustainability: Mapping and Documenting Sustainability – capacity to persist Engagement in continuing professional development Long-term maintenance of one’s knowledge and skills Reflect on these questions to create a personalized map or plan for professional development: Where are the gaps between my current competence and what is expected or possible? What new learning will fill these gaps in my practice competence to ensure best practice?

Professional Sustainability: Mapping and Documenting (Continued) Transitional portfolio – Thoughtful engagement with artifacts created during one’s career in relationship to professional goals and desired roles

Changing Areas of Practice or Re-entering Re-entering professionals: Individuals who have practiced in the field for a minimum of 1 year AND have not engaged in the practice of occupational therapy for a minimum of 18 months What is recommended: Engage in mentoring or supervision Study published evidence Engage in related formal educational activities Auditing classes on campus Goal-directed, quality continuing education Enroll in an academic program (clinical doctorate)

Practice Excellence Exceed Standards! Intertwine researcher and theorist in practice Know your limitations Continuously reflect on your practice Engage context as an essential contributor Value the dance between the art and science of practice Commit to goal-oriented professional development related to specialized practice

Conclusion Rapid changes in health care, knowledge and technology require constant reevaluation and modification of the OT role Our clients, their families, our employers, the profession and the public expect OT and OTAs to provide the highest quality services possible Professional development is managed systematically through reflective self-assessment of: (a) outcomes, (b) job responsibilities, and (c) future trends