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Continuing Physiotherapy Education
Competency‑Based Physiotherapy Education
COMPETENCY‑BASED‑EDUCATION
Competency‑based education (CBE) is an outcome‑based
educational approach which is organized around a
framework of competencies. The curriculum content
is designed, implemented and assessed around this
framework. [1] These competencies are derived from
the expected graduate attributes, and are based on
patient and societal needs, ensuring accountability
towards society. The CBE framework creates healthcare
experts who are “fit to practice” rather than students
who are “fit to pass.” For more than 60 years, CBE has
been used as a curricular model for training students
across various backgrounds and disciplines.[2] Globally,
CBE frameworks are used as reference guidelines for
certification into entry level practice for various health
professions.
Over the past century, education of health professionals
is constantly evolving. Recent recommendations call for
transformative reforms in health professions education,
including physiotherapy education.[3] Curricula across
the world describe the “qualities and attributes” required
of a “competent physician” and focus on “enabling
competencies” for the practicing physician.
COMPETENCY‑BASED‑EDUCATION IN
PHYSIOTHERAPY: GLOBAL SCENARIO
Competencies expected at entry level practice in
Physiotherapy are being followed by many countries.
For example, the Accreditation Council for Canadian
Physiotherapy Academic Programs, the Canadian
Physiotherapy Association and the Canadian Council of
Physiotherapy University Programs have formulated the
“Essential Competency Profile for Physiotherapists.” They
have mentioned seven roles for Physiotherapists who
wish to practice in Canada. These roles are of an Expert,
a Communicator, a Collaborator, a Manager, an Advocate, a
Scholarly Practitioner, and a Professional.[4] Competencies and
sub‑competencies are elaborated under these roles. Many
of these roles overlap at any given time. Competence
in all roles must be demonstrated by a Physiotherapist,
in order to practice safely and effectively. Similarly,
New Zealand has identified 9 core competencies and 63
sub competencies.[5]
144 © 2020 Indian Journal of Physical Therapy and Research | Published by Wolters Kluwer - Medknow
WHAT IS A COMPETENCY?
In 2009, a team of International collaborators, through
a group process, identified and came out with several
important key definitions related to CBE.[2] They defined
“Competency” as:
“an observable ability of a health professional, integrating multiple
components such as knowledge, skills, values, and attitudes. Since
competencies are observable, they can be measured and assessed to
ensure their acquisition. Competencies can be assembled like building
blocks to facilitate progressive development.”
The term competency is used for the skill and competence
is an attribute of the performer’s ability to perform the
skill.
COMPETENCY‑BASED‑EDUCATION AND
TRADITIONAL CURRICULUM
In our traditional curriculum, predefined educational
objectives are to be achieved by students, who go through
a prescribed course of instruction in a specified duration
of time. Curriculum updation is slow and occurs after a
period of time. Compared to the traditional curriculum, the
CBE approach revolves around societal health problems
which need to be addressed, identifies the competencies
required of graduates to address that problem, and has a
customised curriculum which helps the learner achieve the
stated competencies.[3]
While traditional curriculum focuses on performance
of the learner based on what has been taught,
CBE concentrates on coping with expectations
determined by stakeholders outside of the educational
prog ram [Figure 1]. CBE cur riculum produces
professionals who are fit to practice in the society, at a
predefined proficiency level, to meet local health‑care
requirements.[6]
Another major difference between the traditional
approach and CBE is the time frame of education.[7]
While the traditional approach has a fixed time frame
with variable student outcomes, a CBE format has defined
student outcomes, which must be achieved, irrespective
of time frame. Thus, in CBE, different students may
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Baxi and Palekar: Competency‑based physiotherapy education

take different time durations to achieve the stated
competencies.
A few other differences between the traditional model and
CBE are shown in Table 1 below.[8,9]
DEVELOPING A
COMPETENCY‑BASED‑EDUCATION
CURRICULUM
Rather than focussing on “What Graduates need to
KNOW,” educators must focus on “What ABILITIES
the Graduates must possess.” The identified ABILITIES
should be then organised as Competencies for a Curriculum.
Educators can then work backwards and identify milestones
that trainees will need to accomplish as they acquire the
predetermined competencies.
The next steps include modification of teaching methods,
selecting appropriate educational tasks, experiences, and
teaching–learning methods which will help learners develop
the desired competencies in each area, and defining the
achievements required to be exhibited by the students.
With regards to assessment, more emphasis is to be put on
workplace based assessment, which allows for longitudinal
assessment. CBE programs and their assessment methods
are different in multiple aspects, when compared with
conventional curricula. Faculty must receive training in
using newer assessment methods. A critical aspect of
this is the ability of the faculty to provide feedback based
on direct observations of the skills demonstrated by the
students.
CHALLENGES OF
COMPETENCY‑BASED‑EDUCATION IN INDIAN
CONTEXT
There are several key challenges in the implementation
of CBE, as there exists an incomplete understanding
and acceptance by teachers, learners, and educational
administrators.[10,11]
1. One of the first challenges is the identification of core
competencies expected from a graduate, and coming
to a consensus on them
2. A major challenge is faculty training regarding integrated
educational strategies within their classrooms
3. In CBE, student assessment activities are more
frequently woven through the instructional modules
and designed to provide formative feedback on
performance and improvement toward achieving final
competence. Hence, incorporating newer assessment
strategies will pose another challenge
4. As with all new ideas, there will be resistance to change
5. Implementation issues outweigh the advantages.

Introducing competency‑based physiotherapy training

Figure 1: Differences between competency‑based‑education and
traditional curriculum[3]
in India needs to evolve, although there may be a
long incubation period of trial and error of different
strategies. But with the benefit of the existing curricular
frameworks in use in different nations, this period can be
reduced. A competency framework suited to our national
context needs to be developed, which should also be
feasible in our settings and within available resources.
A combined, organized effort in identifying general

Table 1: Differences between traditional education and competency based education

Traditional medical education Competency based education
Content Subject centric Learner centric
Focus is on content (“knows”) Focus is on outcomes (“does”)
Teacher responsible for content Shared responsibility between teacher and learner
Time Emphasizes time based learning De-emphasizes time based learning
Teaching-learning Focuson knowledge acquisition Focuses on knowledge application, attitude and skills
Little opportunity for feedback Feedback is incorporated in the process of training
Teacher driven Learner driven
Assessment Summative Formative
Indirect, subjective Direct observation, objective
Methods include written and viva Methods directly assess desired competency
Norm referenced (as compared with peers) Criterion referenced (compared with Objective standard variables)

Indian Journal of Physical Therapy and Research | Volume 2 | Issue 2 | July-December 2020 145
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Baxi and Palekar: Competency‑based physiotherapy education
competencies and speciality competencies can be the
first step to begin with.
Despite the criticism and implementation challenges,
CBE promises to produce competent practitioners, who
can apply their knowledge, skills and attitudes in real‑life
practice. Success stories of institutes initially adopting
a CBE curriculum might encourage others to adopt
this method, facilitating the evolution of the Indian
Physiotherapy Curriculum.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Gaurang Baxi, Tushar Palekar
Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth,
Pune, Maharashtra, India
Address for correspondence: Dr. Gaurang Baxi,
Dr. D. Y. Patil College of Physiotherapy, Sant Tukaram Nagar, Pimpri,
Pune ‑ 411 018, Maharashtra, India.
E‑mail: gaurangbaxi82@gmail.com
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146 Indian Journal of Physical Therapy and Research | Volume 2 | Issue 2 | July-December 2020
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DOI:
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Received: 28-04-2020, Revised: 11-05-2020,
Accepted: 21‑09‑2020, Web Published: 04-01-2021
How to cite this article: Baxi G, Palekar T. Competency‑based physiotherapy
education. Indian J Phys Ther Res 2020;2:144-6.