Why international physiotherapy candidates fail

For many physiotherapists trained overseas, passing the Council’s assessments is a big step towards working in Australia. 

Indeed, assessments are stressful and challenging, but it is a crucial step to ensuring that physiotherapists are equipped with the knowledge and skills that align with local expectations and standards. We know that not everyone passes on their first try, and as you prepare for your assessments, you might wonder what sets successful candidates apart.

Recent research, by Flew and colleagues at the Council, indicates that many overseas trained physiotherapists tend to struggle in similar competency areas when it comes to the Clinical Assessments. These have been identified as common areas of underperformance. The researchers conducted a retrospective (looking back in time) study of past Clinical Assessment results to understand what areas on the assessment criteria (Moderated Assessment Form) had the highest failure rates, and thematically analysed the feedback written by clinical assessors.

Overall, the researchers found high failure rates across multiple areas (77.5% or greater) on the Moderated Assessment Form, although this was variable across the different practice areas assessed (musculoskeletal, cardiorespiratory and neurological). However, there were two areas with consistently high failure rates. The two areas were, 1) the ability to interpret and analyse assessment findings and 2) develop a physiotherapy plan. When analysed together with the written feedback from clinical assessors, the underlying reason for the failure across these areas of underperformance was related to the candidate’s ability to demonstrate and apply sound clinical reasoning to individual patient cases.

Clinical reasoning is a core skill required of physiotherapist in Australia. In simple terms, clinical reasoning is the thought process that is used to make decisions to manage and evaluate patient’s condition. It involves gathering clues (collecting relevant patient information), analysing them (thinking about what they could mean), and then using this information to make a plan (deciding on the best treatment).

Common observations identified by the researchers based on the written feedback demonstrate how candidates struggle with different aspects of clinical reasoning. These observations were identified into three themes, summarised below.

• Planning and prioritising - Clinical assessors consistently reported that candidates did not adjust their plan and treatment based on the patient presentation and findings. Rather, a ‘recipe approach’ was observed. This is when a pre-prepared plan is applied to the patient, without considering the specifics (values, needs, goals and social considerations) of the patient.
• Interpreting and implementing – Candidates commonly struggled with analysing, interpreting and using assessment findings to identify patient problems, and make decisions to select appropriate and effective interventions. Reports of candidates not using their clinical assessment findings to justify and guide their decision making and reasoning were identified.
• Treatment and testing – Clinical assessors commonly observed candidates choosing treatments that were not related to the patient presentation, not adequately progressing or adapting their treatments appropriately, or performing inadequate re-assessments.