World First, State-of-the-Art Simulation Lab for Practical Assessments

How the council is leading the world with a state-of-the-art Simulation Lab for Final (Practical) Assessments of Overseas Qualified Physiotherapists

Sometimes humble organisations get the chance to pull off something extraordinary.  And sometimes, just sometimes, it’s worth shouting it from the rooftops.

The Australian Physiotherapy Council (“the Council”) – the organisation over which I now proudly preside – is an independent national body charged to accredit entry level physiotherapy programs and to assess the qualifications, skills and key competencies of overseas qualified physiotherapists for registration and migration purposes.  Doesn’t sound too onerous a role, hah?

Now consider this…

1. General Practitioners refer more patients to physiotherapists than any other Healthcare profession; and
2. With the greatest demographic shift of our time on our doorstep – with the aged population currently at its highest level in human history – the demand for Physiotherapy is increasing at an exponential rate.

And it makes perfect sense when you consider that like GP’s, physiotherapists provide continuum of life care.  Physiotherapists support: school aged children with developmental movement challenges; elite athletes exceed their goals; women’s and men’s health; older Australians in maintaining mobility, vitality & ultimately independence; cancer patients, stroke patients, those with neurological disorders & cardiorespiratory conditions; and patients of all ages with range of motion, pain management, and orthopaedic challenges.

So when you are liable for ensuring that overseas qualified physiotherapists hoping to join our chief allied health profession are not only as academically qualified as domestically trained physiotherapists, but indeed as competent to handle Australia’s diverse range of patients (in terms of medical presentations, demography, age and widely varying cultural backgrounds) and independently practice in a partially self-regulated, first contact practitioner environment…it might be fair to say that this Council has a colossal responsibility and vital duty to perform.

As incoming CEO of the Council, there were a number of challenges the organisation had faced for some time, namely:

1. The growth in demand of physiotherapists in Australia due in no small part to the imminent ageing population explosion and uneven distribution of the physiotherapy workforce;
2. The list of overseas qualified physiotherapists waiting for allocations in the assessment process was ever-growing, as overburdened Australian Hospitals faced the increasing challenge to accommodate and/or prioritise our assessment program;
3. The limitations associated with the current assessment process using real patients to reliably and fairly measure the breadth of physiotherapy practice and competency of candidates; and
4. It just so happened that our national office’s lease was about to expire and a new premises had to be found. Stat.

What might happen if we sourced premises where we could build a bespoke state of-the-art simulation facility which would:

• compromise nothing as far as assessment of clinical skill is concerned;
• truncate waiting lists for overseas-qualified physiotherapists;
• offer highly-trained simulated patients (i.e. actors) with rich case histories that can straddle multifarious health considerations (which is often hard to source with real life patients);
• provide an assessment environment that is clinically authentic by realistically replicating a patient encounter in multi-environments (including hospital, private practice and rehabilitation settings) that cover the breadth of practice;
• improve standardisation;
• allow candidates to showcase the full gamut of clinical skills including physical examination, communication and rapport building, as well as history taking;
• conclusively preserve the excellent standard of patient care in Australia; and
• entrench Australia’s position as a thought leader in the international health assessment space.

Ambitious? Yes.  Punching above our weight? Absolutely.  Possibilities for allied health final assessments both locally and across the globe? Endless.

Objective Structured Clinical Examinations (“OSCEs”) have been used for many years within health professional assessment programs as a measure of students’ and clinicians’ clinical performance. What the Council is trialling however is UNPRECEDENTED.  Rather than assess discrete procedures as per an OSCE, we have carefully designed a scientifically robust trial to determine whether simulation is as reliable an evaluation as the final, single-event comprehensive assessments currently conducted with a real-life patient in our assessment process.

All evidence relating to simulation in training points in that direction.  What we know irrefutably is that simulation exposes candidates to different scenarios, enhances critical thinking, provides the opportunity to practice the management of a patient consult and also exposes candidates to cultural nuances that are indispensable to best practice holistic health care.  And if our hypothesis is right, it will forever change assessments of health practitioners the world over.

Stanford University’s Professor David M Gaba, the world’s foremost leader on simulation in medicine said:

“No industry in which human lives depend on skilled performance of responsible operators has waited for the unequivocal proof of simulation before embracing it.”

The task at hand may be colossal, but the time for waiting is over.  Physiotherapists, like their medical counterparts, improve lives… and they also save lives.  Come July 2017, the Council will embark on world-leading research providing a sound evidence base for Simulation in Assessment.  And if the trial is successful, when overseas qualified physiotherapists complete this new assessment process, the Australian public can rest assured that these physiotherapists will be equipped with the equivalent skills and knowledge to join the ranks of Australian Physiotherapists who are heralded as being the best in the world.