enhancing the organizational value and capacity of the cpa - physiotherapy · 2018-05-11 · the...

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CanadianPhysiotherapy Association

May/June 2018Vol.8, No.3

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physiotherapy.ca | May/June 2018 3

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May/June 2018 | Vol. 8 / No. 3

5 President and Chief Executive Officer Message

7 Why We Need Strong and United Professional Association More Than Ever

10 CPA’s New Strategic Plan

14 Planning, Preperation and Partnership: Congress Montreal18

20 The Collaborative Landscape of the Canadian Physiotherapy Association: Optimizing the Health of Canadians

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30 The Power of Synergy

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37 Clinical Specialty: The Physiotherapist As Part of an Interdisciplinary Team in the Prevention, Detection and Management of Concussion

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What do we want? Philosophical questions may be easy to understand, but they are often complex to solve. We have all been bombarded in the past year or so by surveys, requests for participation in focus groups, polls and other methods for many CPA components to engage with members. Bravo for your persistence and thank you for your participation! These many and various methods of ascertaining what the membership wants and needs, as well as how the CPA membership feels on many topics, is a cornerstone in the process of CPA fulfilling its mission. That mission states that the CPA is the vital link to physiotherapy, and CPA leads, advocates and inspires excellence and innovation to promote health.

Briefly, we paraphrase CPA’s Strategic Plan in terms of goals: to promote the value of physiotherapy, to ensure equitable access to physiotherapy services, to support excellence in physiotherapy and to maximize the capacity of the CPA.

A handy and quick (and sometimes accurate) reference source, Wikipedia, tells us that capacity building is a broad term that encompasses “actions that improve non-profit effectiveness,” via organizational and financial stability, program quality, and growth. Capacity building is also defined as the ability of an organization to “fulfill its mission through a blend of sound management, strong governance, and a persistent rededication to achieving results”, Source: Grantmakers for Effective Organizations. (2003) (p.4).

Despite a disappointing three years, we have made some tough decisions and look forward to a balanced budget for 2018. The participation of hundreds of volunteer PT professionals in the various and multiple activities of the Association, as well as the surveys, focus groups, polls and others, speaks to the “persistent rededication” mentioned above!

Dave Walton added to the conversation through his cross-Canada project of summer 2017. The Strategic Plan, completed in the fall of 2017, brought ideas and concerns, preoccupations of physiotherapy professionals from the grassroots, to the leadership of the CPA. The Values of the CPA document highlights what we feel are the core professional values inherent and essential to moving the profession towards the future.

One of the challenges to physiotherapy in the coming years is how to increase the value and market share of physio in Canadian communities. Once a physiotherapy student has graduated their program and has completed the requirements for entry-level practice, then begins their career-long voyage to increase and deepen the understanding and expertise in an area of special interest (CPA Divisions), developing in an advanced practice or an emerging scope within their practice.

Now is the moment to explore how physiotherapy professionals can become and remain the optimal health care provider in Canada.

Using your voice as our guide, we have identified our strategic priorities. Over the past nine months we have been assessing our capacity and capability as an organization and are busy creating a clear operational plan to execute against these priorities. An important part of this effort has been to create improved accountability and performance measurement. With these critical tools we will be equipped to move our profession forward in a meaningful way.

In this issue you will learn more about the roles of the different components in bring physiotherapy to life, from Ron Knowles, the consultant who helped us forge our recent Strategic Plan. You will also hear from Dave Walton on how Physio Moves Canada will assist with capacity building through the CPA.

The Physiotherapy Foundation of Canada (PFC) launched a fundraising campaign as part of National Physiotherapy Month this year, as you may have noticed through our social media channels. Your donation towards physiotherapy research and education will be tripled in May, compounding the impact of your gift, thanks to the generous philanthropy of CPA and CPA past President Catherine McGinley. More about PFC’s activities are shared in this issue. In support of the physiotherapy profession across Canada, please consider donating to PFC today.

Lastly, there is strength in numbers. CPA’s Recruit-a-Member program rewards members who actively enlist new members, with a credit towards their own membership fee. For more information, visit https://physiotherapy.ca/recruit-member, and spread the word – let’s get to 20,000 members by our centennial celebrations in 2020!

Sarah Marshall, PT, MSc Brad Brookman President Chief Executive Officer Canadian Physiotherapy Association @PhysioSarahPT

Managing EditorKim Tytler

Art DirectionShift 180

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©Canadian Physiotherapy Association, 2018. All rights reserved. No part of this material may be reproduced, stored in a retrieval system, or transcribed in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the Canadian Physiotherapy Association. Requests should be made to the Managing Editor, at 800-387-8679, ext. 231, [email protected].

The opinions expressed in Physiotherapy Practice are those of the authors and contributors, and do not necessarily reflect those of the CPA, the editors, the editorial board, or the organi-zation to which the authors are affiliated.

Pierre AllardMelissa AndersonMélanie BenoitMaggie BergeronBMS Canada Risk Services Ltd.Brad BrookmanLuc J. HébertRon KnowlesChantal Lauzon

Sarah MarshallNicol McNivenSue MurphyTim PaquetteSandy SadlerKathryn SchneiderDenis PelletierDiana Perez Tatiana VukobratDavid M. Walton

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I recently received a call from a good friend in Australia. He described a meeting with one of the state government’s health decision makers during which a new initiative to be rolled out across city hospitals was described. The initiative, aimed at early functional restoration of inpatients through mobilization and exercise, is to be administered by exercise physiologists. When asked why the program would not be administered by physiotherapists, the government rep stated quite clearly that the physiotherapists have come to expect a higher fee for their services but have not adequately demonstrated proportionate value over lower-priced providers. They’ve essentially priced themselves out of the public health care market. There’s a lot to unpack in that little exchange, and I’m using this real example from Australia to distance any emotional reaction, but I want to be clear that this kind of thinking is currently very real and is having observable impacts here in Canada.

Some readers may be familiar with the Physio Moves Canada project in which I traveled coast-to-coast to capture the current state and future directions of physiotherapy practice in Canada. I described the project in some detail in the last issue of Physiotherapy Practice magazine so will direct readers who want to know more to that issue or to the project website (www.physiomovescanada.com). During the project, I had the privilege of engaging with many passionate members of our professional community, innovative big-picture thinkers who are working hard to push the evolution of our profession. I also heard of many fears held by clinicians, some of which described events that sounded very much like the exchange between my Aussie mate and the government rep. Since that time stories have continued to emerge of shifts in physiotherapy, health care, and society that are likely to have significant impacts upon our profession in the coming years. While I continue to choose to be more optimistic about the opportunities than pessimistic about the threats, it is hard to shake the belief that our profession is going to look very different in 10 to 15 years than it has for the previous 100.

David Walton,PT, PhD, Associate Professor Western University, CPA Member since 1999

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This is where we need to place faith in our professional associations, both the CPA and each of the provincial and territorial branches. To be slightly facetious for a moment, while the rest of the world is talking about how genomics, automation, bionics, universal basic income and artificial intelligence are poised to change the landscape of health and health care, many in the PT profession continue to argue on social media about whether

it’s possible to palpate movement at the sacroiliac joint. I suggest that it is time to recalibrate our passions and efforts towards a thriving future. Perhaps not since the 1930’s has it been so important for our entire professional community to rally behind a unified banner and to do so quickly. It is hard to know whether to be happy or disappointed in our professional association engagement, as our community hovers right around 50-60% CPA membership nationally. Canada is a large, geographically and culturally-diverse country and it can be hard to find common ground in terms of branding, value, and advocacy that speaks to clinicians on a national level. There are, and will continue to be, challenges when one attempts to orient a group of over 22,000 mostly very passionate, arguably underappreciated, and occasionally frustrated or disengaged people towards a common goal.

But if not now, when? If not our associations, whose?Those of you who continue to read this likely represent what are perhaps the top 5-10%

of engaged members of our professional community. I’ll openly admit I’ve had my own differences of opinion on direction of the associations in the past, as I’m sure many of you have. We should continue to expect value for our membership dollar and none of us need to be a shill for the associations. Speaking solely as a PT who is passionate about this profession and about seeing it reach its potential toward better health outcomes for all Canadians, I have become convinced the time is now to support our associations and provide them with the resources needed to ensure a bright future for all of us. We need a strong unified voice to represent the clinical community at the levels of territorial, provincial, and national health decision tables, and right now our associations are our best options for representing our profession during those conversations. This issue of Physiotherapy Practice is outlining the ways that CPA builds capacity and provides value for membership dollars. I encourage you to share this with your colleagues especially those who are not members, and if needed, offer to liaise their concerns about value back to the Association leadership. If you need it, remind them that we get a pretty good deal in what we pay for membership (see http://www.physiomovescanada.com/blog/2017/9/30/a-quick-round-of-professional-compare-sys for a comparison of Ontario PT association fees vs. chiropractor association fees). The physiotherapy profession in Canada appears to be standing at a critical inflection point in its professional evolution and now more than ever we need a unified community. Get engaged, make some noise, rally your colleagues, and let’s ensure we can continue to proudly call ourselves physiotherapists.

About DaveDave Walton is a Physiotherapist and Associate Professor with the School of Physical Therapy at Western University, an Associate Scientist with the Lawson Health Research Institute, Director of the Pain and Quality of Life Integrative Research Lab and member of Western’s Bone and Joint Institute. He currently holds the titles of Western Faculty Scholar, Western Teaching Fellow, and MayDay Pain and Society Fellow. He is an Associate Editor of the journal Musculoskeletal Science and Practice and is currently a member of the Steering Committee of the 2018 Global Year for Excellence in Pain Education.

@uwo_dwalton

Why We Need Strong and United Professional Associations More Than Ever

Get engaged, make some noise, rally your colleagues, and let’s ensure we can continue to proudly call ourselves physiotherapists.


The new CPA Strategic Plan (2018-2023) is a major departure for the Association. For the first time, the Plan was developed with the full participation and approval of all the CPA Components, including Divisions, Provincial Branches, Physiotherapist Assistants, Student Assemblies, and the National CPA. It is equally owned by all the entities that make up the nationwide Association.

Achieving agreement from all Components to the new vision, mission, strategic priorities and strategies that comprise the Plan is a remarkable achievement and one that is still relatively rare for Canadian, national professional associations. As strategic planning and governance consultants, we know of only two other major Canadian professional associations who have been successful at such integrated planning. And, in terms of collaborative planning, some features of the CPA experience place it at the forefront of professional associations. The benefits of unified strategic planning are enormous; for example, resources are applied efficiently and unnecessary duplication avoided. But the greatest benefit is that member physiotherapists, regardless their geographic location or practice setting, are backed up by the unified effort of teams of talented volunteers and staff.

When the process was completed and all the Association’s leaders could step back and reflect on what they had accomplished for the Association, they realized that they had achieved an important by-product - a level of collaboration and unity that will enhance the Association’s ability to serve the interests of its members. That is no small achievement in the Association world which often seems to have all the problems of the larger Canadian federation.

In this article, we will present a brief overview of the strategic planning process used and then a review of the factors that led to the new, shared 2018-2023 Strategic Plan.

The Strategic Planning process consisted of two main phases:• the Planning to Plan phase• the Strategic Planning Phase

Ron Knowles, FCMC

CPA’s New Strategic Plan

12 Physiotherapy Practice

Planning to Plan (May 2015-November 2015)Association leaders realized that developing a shared strategic plan would require very high degrees of collaboration, inclusion and shared decision making. To ensure that would be supported across the complex structure of the CPA and to model the kind of collaboration they had in mind, they decided to start by developing the Strategic Planning process jointly with all Components.

This work was conducted by a Steering Group on which the Divisions, Branches, PTAs and students were all represented. This Group guided the work of the consultants, throughout the process.

It was apparent from the discussions during the Planning to Plan phase, and at the November 2015 Joint Meeting, that the time had come to proceed with a collaborative planning process in which all Components were fully engaged and for which they would be jointly responsible.

Strategic Planning Phase (October 2016-November 2017)A Strategic Planning Steering Group was formed, consultants chosen and the main Strategic Planning process launched in October 2016. The proposed planning steps were executed as defined in the Planning to Plan.

Why the Planning Process Was Successful

An inspiring goalGenerally, CPA leaders across the country were captivated by the compelling vision of creating a more unified, cohesive physiotherapy association, working together in the interests of the profession and of members. People join voluntary associations for a variety of reasons. Many believe profoundly in the value of the work they do and that is certainly true in the physiotherapy profession. Those people are attracted by the idea of contributing to the profession’s development and wellbeing. Physiotherapists in leadership roles within CPA saw this as an opportunity to be part of a big step forward and readily threw themselves into the collaboration and give and take involved. So, from the beginning, key people accepted the challenge of creating a shared direction for the Association.

A Reasonable “Ask”It helped that while Components were asked to agree on and support a shared Vision and Mission and Strategic Priorities, it was understood that each Component will develop its own plans using the shared plan as the foundation or umbrella for plans

that reflect the reality of their individual circumstances. What this means is that all the specific Component strategic and operational plans will be developed to address the shared priorities, but only those of the suggested strategies that are relevant to them. Another way of putting this is that you will see in the Component plans evidence that the shared priorities are being addressed, but in a way that may be unique to that Component. That very reasonable interpretation of “shared” means each Component can wholeheartedly agree to the Association-wide agreement on priorities. The intention is unified, cohesive action and a successful, flourishing Canadian Physiotherapy Association.

Thorough and Genuine ConsultationIn a world where we have learned to be suspicious of consultation for its own sake, CPA’s larger leadership group was determined that the consultation done as part of Strategic planning would be thorough, respectful and above all, honest. Those leaders also explained that, for this purpose, consultation would mean listening and considering carefully and respectfully and, where possible, providing feedback and responding to the input, even where it could not be adopted.

CPA leaders insisted that every member be given a real opportunity to make input - and that occurred. Over 1000 members took advantage of the opportunity to complete the Strategic Planning Survey. Almost 40 people were interviewed individually and another 130 members and physiotherapy stakeholders participated in the Roundtables, in person or on line. All of that made this consultation

process the most comprehensive one in our experience as Strategic planning consultants. All members have access to the reports summarizing input from these sources.

Process innovationFrom the outset, the consultants were asked to go about their task in as innovative a manner as possible. Although the process was innovative, the most innovative ideas came from within CPA itself and less so from the consultants. Two examples illustrate this point:

1. RoundtablesA series of roundtable discussions were held with physiotherapy and health care thought leaders across the country. The purpose of the roundtables was to consider the key issues that had emerged from the extensive consultation phase and to suggest options and alternative approaches to address them. This was an intermediate step between information gathering/consultation and planning. CPA and the Components assembled impressive groups of educators, health care planners, physicians, physiotherapy regulators and physiotherapists working in a variety of practice settings. The idea was to provide the Component leaders with best thinking about leading practices and innovative approaches to significant physiotherapy issues and challenges in the subsequent step in the planning process i.e., the Strategic Planning Workshop to be attended by the Component leaders who would be asked to develop an agreed strategic direction for the Association.

As might be expected, given the senior responsibilities of the people attending, the results were extremely helpful in accessing the best current thinking about physiotherapy in its many professional environments. The roundtables were examples of excellent collaboration and the synergy that results from bringing the right people together in a collegial and constructive environment.

2. Online discussion boards The second innovation also related to the Roundtable discussions. In its own planning work, the Saskatchewan Physiotherapy Association has used a consultation tool called itracks. This tool allows participants from far-flung locations to engage in virtually any kind of consultation process. The way it works is that participants are asked to respond online to questions asked by a moderator and to do so in their own time. In this case, we asked five questions, one per day over 5 days. All participants can see the input of all other participants in real time and are welcome to discuss and comment on it.

CPA leaders across the country were captivated by the

compelling vision of creating a more unified, cohesive physiotherapy

association, working together in the interests of the

profession and of members


CPA’s New Strategic Plan

The itracks tool was new to the consulting team and we were frankly wowed by how enthusiastically participants threw themselves into the exercise and generated some very relevant and genuinely helpful input. To illustrate the scope of this form of consultation, the online discussion boards generated over 390 pages of generally useful input.

LeadershipIt is axiomatic that no profound organization improvement is possible without good leadership. There were many examples of CPA leaders stepping up to the challenge of guiding and enabling this process to flourish. Many, including the CPA President and National Board of Directors, set the tone from the beginning and ensured that the Association stayed the course to create a plan that was truly shared by all Components.

Perhaps the most encouraging leadership development was the way in which leaders on both the volunteer and staff sides emerged organically and informally from all Components and levels of the Association. For example, two members of the Steering Group stepped up to take responsibility for presenting the Plan for Planning process to the November 2015 Joint Meeting. Four of the Provincial Association CEOs/Executive Directors took on the detailed planning for the four in-person Roundtables and a fifth suggested and helped shape the successful application of the itracks tool. The Edmonton-based National President traveled to attend and show her support for the Montreal Roundtable, and did so partly in French. Presidents of Provincial Associations played leading roles in the

in-person Roundtables, to name just a few of many ways in which the leaders of the Association made clear their support and commitment for the process and modelled what collaboration means in practice. Arguably, the goal of creating a shared Strategic Plan would simply not have occurred without that leadership from formal and informal leaders.

Not to be neglected was the realization on the part of Component leaders that the time had come when the required collaboration was not only possible but badly needed. This sense of organizational readiness for strategic change turned out to be farsighted and leadership across the Association is to be congratulated for seeing this and being willing to assume the risks of publicly supporting the approach.

The Culture of PhysiotherapyAlthough impossible to prove, the consulting team felt strongly that one of the strongest success factors was the fundamental culture of physiotherapy and the kind of people who enter the profession. Physiotherapists seem naturally suited for and gifted in collaboration - many of them work in environments where values like inclusiveness, cooperation and mutual respect are givens. It is difficult to imagine how a physiotherapist could flourish without those values and the skills that reflect them. A collaborative spirit seems like second nature for the dozens of people we met and worked with. The Association’s leaders brought those skills and values into this process and the result was one of the most difficult to achieve in the association world – nationwide consensus on overall direction.

Future ChallengesThe Strategic Planning process achieved its primary goals:• Clear strategic direction• Shared ownership of that direction

There will, however be challenges including the well-known challenge of association strategic plans - effective implementation and execution.

In addition, seamless inclusion and collaboration is a very high standard. It is inevitable that there will be times when some people may feel excluded or even disrespected by some future incident.External circumstances may change so radically that they require faster action response that can be achieved by a complex, consensus-driven organization like CPA.

These and other challenges will arise but will almost certainly be met by the same spirit of dialogue and collaboration that characterized the development of the new Strategic Plan. After all, those who accomplished it are unlikely to accept anything less.

About RonRon Knowles, FCMC, has an extensive background as an executive in the private sector, as a management consultant and as a university teacher. He was

with Western Management Consultants for 27 years and is a former National Director of the Firm. Prior to that, he was with Price Waterhouse and Associates. He is a Fellow of the Institute of Certified Management Consultants of Ontario. www.ronknowles.com [email protected]

The Planning to Plan project consisted of:• a workshop with the CPA PALs group at the CPA Conference in Halifax

in June 2015• a teleconference symposium with leaders from other associations• input of approximately 30 CPA leaders across Canada on ways to ensure

that CPA’s forthcoming strategic planning process will be a productive and member-inclusive activity

• a report including findings from interviews and a proposed planning process for review with CPA

• research by the consultants into consultative planning processes undertaken by similarly-structured organizations

• a symposium with other association leaders to share lessons learned in collaborative planning

• development of an 11-step Strategic Planning process and recommendation that it be approved by all CPA Components as the basis for development of a shared 2018-2023 Strategic Plan

• agreement at the November 2015 Joint Meeting

The CPA Strategic Planning process consisted of:• inviting member and Component Input including a member survey that

over 1000 members completed• interviews with other stakeholders• preparation of an Environmental Scan • identification of key issues and opportunities• a series of 11 Roundtable discussions, four held in person in Vancouver,

Toronto, Montreal and Halifax and five online discussion boards in which almost 200 physiotherapy thought leaders participated

• a Strategic Planning workshop in which Association leaders from all Components participated to draft the 2018-2023 Strategic Plan

• a request for input to the Draft Plan to all Components, followed by a request for formal approval of the draft Plan

• a workshop at the November 2017 Joint Meeting to consider implementation, progress reporting and evaluation

• formal approval of the new Strategic plan by the CPA Board of Directors

Planning, preperation and partnership:

Congress Montreal1814 Physiotherapy Practice


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In 2016, the Canadian Association of Physiotherapy (CPA) decided to partner with the Association québécoise de la physiothérapie (AQP) and the Ordre professionnel de la physiothérapie du Québec (OPPQ) to begin planning Congress 2018. The OPPQ have been successfully hosting their profes-sional development conference, Physiothérapie 360o for the past seven years. Over 600 physiothera-pists and physical rehabilitation therapists have been flocking to this annual event. By joining forces, we hope to learn from each other and create the biggest pan-Canadian physiotherapy conference yet.

This partnership is a great example of CPA’s fourth strategic priority: “together we will enhance our collective organizational value and capacity.” We are joining our strengths and working towards creating an unforgettable opportunity for members to learn, network, and grow.

Congress Montreal18 will take place from November 1-3, 2018 at the Palais des congrès de Montréal. It will feature keynote and plenary speakers, panels, e-posters (new this year), and a large exhibitor space. The sessions will be organized by streams (e.g. ortho, women’s health) and itinerary (e.g. pain) when topics have cross-patient population appeal. Registration will be launched May 1st. Early bird pricing will be in effect until June 30th. We invite you to review the program as details get released: www.montreal18.ca.

Since its beginnings, physiotherapy has evolved, adapted, and established itself in its own right, gradually becoming a beacon profession in our health-care system. Congress 2018 in Montréal stands out as proof of that.

Physiotherapy practice has progressively developed as the result of research and development into evidenced-based optimal practice. This optimal practice, leading to convincing results, has come about through collaborative practice involving patients, physiotherapists, physical-rehabilitation therapists, physiotherapist assistants, and health-care providers, both private and public.

I trust that Congress 2018 will give us a chance to make some noise that is sufficiently loud enough for all the policy-makers to realize how and why physiotherapy is an indispensable profession in preventing health conditions as well as in maintaining and improving the health of all Canadians. -Luc J. Hébert, pht, PhD, CD, President, Association québécoise de la physiothérapie

As President of the Canadian Physiotherapy Association, I have had the opportunity to travel the country, the continent, and the world to engage with other physiotherapy professionals, individually and at their various conferences. It is wonderful to see the commonalities that we have with our friends and colleagues from different places. It is inspirational to see how others are finding solutions to challenges that we all, as physios, face: issues about access, challenges with inequity, solutions for leading this profession and advocating for innovations and excellence. As is repeated so often: “we are stronger together” and the combined strength of the CPA, its partner in Quebec, the AQP, and the regulatory college, the OPPQ, will provide a Congress that will inspire you to do better and be better at optimizing the health of Canadians.-Sarah Marshall, President, CPA

CPA’s Congress 2018 will be held in Montréal after a one-year hiatus. Here and there, you can feel the desire to renew relations with colleagues and find out about Canadian achievements in physiotherapy. It›s all so exciting! The Ordre is working closely with CPA and AQP in organizing this fine event. While complying with our respective missions, we can still work towards achieving our common objective: improving physiotherapy practice in Canada. -Denis Pelletier, President, OPPQ

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AQP is pleased to join forces in organizing the year›s largest physiotherapy event, which will be held in Montreal. Congress Montreal18 is a large-scale project that reflects, not only coordinated actions, but also a collaborative co-creation attitude between the 3 organizing bodies. Collaboration is not only an essential skill that all physiotherapy professionals must adopt. It also reflects a strategic aim of our association in mobilizing individuals who share the common concern of advancing the profession. This cooperation is a form of collective intelligence, which yields only our best, as typified by Congress 2018. - Tatiana Vukobrat, pht, M.Sc.,

AQP Executive Director

We are excited to learn from and build on the success of our partners, as we collaborate and work hard to make Montreal18 a successful and memorable event. The goals for this year are to increase attendance and participation in Congress, to provide a program that has something for everyone, and to make Montreal18 the not-to-be-missed physiotherapy event of the year. For me, there is nothing more inspiring than being in a room filled with physiotherapy professionals - Congress has always been the best way for me to recharge my “physiotherapy batteries:. I always leave re-energized, ready to innovate and solve problems, and make changes to my practice. There is no better venue for meeting colleagues, building professional networks, seeing new products, and hearing the latest research and clinical advancements. Watch for our program on the Montreal18 website and register early for the best rate. I look forward to seeing you in Montreal! -Melissa Anderson, Director, CPA

Backed by seven profitable years of holding its annual Physiothérapie 360 event, OPPQ is pleased to be one of CPA’s partners in organizing Congress 2018, which will be held in Montréal. Within the context of this three-body collaborative project, OPPQ is supported by a committee comprised of physiotherapists and physical-rehabilitation therapists deeply committed to the development and expansion of physiotherapy in Canada. As a result, OPPQ in particular has been called on to play a role in designing the conference’s program. Indeed, over the years, OPPQ has developed an approach in developing the program of its annual event that brings together clinical and scientific aspects to satisfy both clinicians and researchers. OPPQ is also always committed to designing programs that touch on all the fields of physiotherapy practice in order to attract and interest the greatest range of physiotherapy professionals, regardless of their various professional interests. OPPQ is therefore working with a great deal of enthusiasm and excitement with CPA and AQP to make Congress 2018 a highly memorable event. - Sandy Sadler, OPPQ Director of

Professional Development and Quality Assurance



NOVEMBER 1 - 3


Joint Executive CommitteeThe Joint Executive Committee (JEC) is made up of one representative from each partner organisation. The JEC is responsible for overseeing the implementation of the Joint Congress.

Your Congress partners look forward to welcoming you to beautiful Montreal, Quebec, November 1 - 3, 2018, at the Palais des congrès de Montréal.

Based on your feedback, we will also include special interest and clinical practice streams as part of the program.

Registration opens May 1, 2018!

Closing Keynote:

Emma StokesPresident, WCPT

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CPA Congress 2018 FP PTP EN+FR Mar29.pdf 1 2018-03-29 4:30 PM

The whole is greater than the sum of its parts.» This quote from Aristotle takes on all of its meaning with Congress 2018 and it›s an honour to participate in this experience. From my point of view, Congress 2018 is a unique opportunity to develop, jointly with my CPA and AQP colleagues, an outstanding program that will leave a long-lasting impression on the professional memories of physiotherapists, physical-rehabilitation therapists, and physiotherapist assistants. We›re looking forward to being there with all of you! -Sandy Sadler, pht OPPQ Chair, Program Planning Committee

“It was important to me that both PRTs and PTAs are represented at the next Congress. I hope everyone will be happy with the Congress planning and that the learning needs of all members of the profession, including PRTs and PTAs are met. The purpose of my commitment was also to respond to members’ needs by finding topics that would be useful to them as soon as they return to their respective workplace.”-Mélanie Benoit, T.R.P., OPPQ

As a past CPA Board member, and a current AQP Board member, I am excited to be on the organizing committee for Congress 2018 because I hoped to contribute an innovative and unique perspective that would help make Montreal18 an unforgettable professional experience. I think that all PTs and PTAs/PRTs across Canada and Quebec will find a rich offering of scientific and evidence-based clinically relevant presentations as well as many opportunities to network with like minded professionals. -Diana Perez, PT, AQP board member

The CPA Congress is a great occasion to stay up to date on the latest evidence base practices in physiotherapy. It is also an excellent opportunity to learn about new approaches available in our profession. This year, with the attendance expected to surpass all previous records, the congress becomes an excellent vehicle to establish/increase your social and professional network. As an attendee you will also have an opportunity to meet and talk to our sponsors. They are the providers of all the equipment/tools we use in our profession. Making contact, discussing your needs as well as your clinic needs and the convenience of on site sampling are assets for you, the attendee of your Congress. See you there! - Pierre Allard, PT, AQP Board member

“I got involved with Congress 2018 to help bring together physiotherapists across the country, from all disciplines and through all levels of experience. We are hoping that Congress can widen your understanding in different areas of practice, and deepen your knowledge in your own area of practice. I am excited to see the Congress unfold with some of the brightest minds presenting in innovative areas of the field and ambitious personalities attending from CPA, AQP and OPPQ!”- Nicol McNiven, PT representing young professionals,

Past President, National Student Assembly

I am happy to be part of the Program Planning Committee for Congress Montreal18. I take this responsibility very seriously. I am learning that CPA and OPPQ members have different expectations, based on their previous experience with physiotherapy conferences. I am working hard to find a balance and to make Montreal18 the best event it can be. I am taking every opportunity to understand participant’s experiences at each step or process along the way, so that I can apply all of that learning to future CPA events. Collaboration with such a dedicated group of colleagues is very rewarding. I am learning from each and every member of the PPC. The best teams to work on are those with diverse strengths and personalities. This one is no exception! We are putting all our strengths together to create an event that all PTs, PRTs and PTAs can benefit from.- Chantal Lauzon, PT, Senior Practice Manager, CPA


By strategically partnering with others to achieve a common goal, CPA will “enhance our collective organizational value and capacity.” By partnering with AQP and OPPQ, CPA and its members are benefitting from fresh perspectives, new ideas and best practices from another professional development event. We hope that you will join us in Montreal.



NOVEMBER 1 - 3

Early bird registration lasts from May 1st – June 30th.

Check out the program and register here:www.montreal18.ca

Program Planning CommitteeThe Program Planning Committee (PPC) is made up of two representatives from each partner organisation. They are responsible for planning a bilingual program that reflects the needs of members of each organization. They started meeting in March 2017. The points of view of PRTs and PTAs as well as of young professionals are represented on the committee.

Organizations for Health Action (HEAL)

Other Health Organizations

CorporatePartners

Patientsand Public

AdvocacyProfessional development

Access to researchPublications

InsuranceNews

CPA National

Canadian Alliance of Physiotherapy Regulators (CAPR)

Physiotherapy Education Accreditation Canada (PEAC)

The Canadian Council of Physiotherapy University Programs (CCPUP)

Canadian Occupational and Physical TherapistAssistant Educators’ Council (COPEC)

World Confederation for Physical Therapy (WCPT) and member

organizations

Physiotherapy Organizations

CPA Members

NationalDivisions

Assemblies

ProvincialBranches

PhysiotherapyFoundationof Canada

The Collaborative Landscape of theCanadian Physiotherapy Association: Optimizing the Health of Canadians


Organizations for Health Action (HEAL)

Other Health Organizations

CorporatePartners

Patientsand Public

AdvocacyProfessional development

Access to researchPublications

InsuranceNews

CPA National

Canadian Alliance of Physiotherapy Regulators (CAPR)

Physiotherapy Education Accreditation Canada (PEAC)

The Canadian Council of Physiotherapy University Programs (CCPUP)

Canadian Occupational and Physical TherapistAssistant Educators’ Council (COPEC)

World Confederation for Physical Therapy (WCPT) and member

organizations

Physiotherapy Organizations

CPA Members

NationalDivisions

Assemblies

ProvincialBranches

PhysiotherapyFoundationof Canada

The Collaborative Landscape of theCanadian Physiotherapy Association: Optimizing the Health of Canadians

Canadian Physiotherapy AssociationVisionPhysiotherapy is your Essential Partner for Optimizing Health.

MissionAs the vital partner for the profession, the CPA leads, advocates, and inspires excellence and innovation to promote health.

ValuesThe Canadian Physiotherapy Association (CPA) will act with integrity and loyalty to members at all times.

The CPA values • The integration of evidence, clinical

reasoning and therapeutic skills in practice

• Accountability to members, stakeholders and the public

• Unity of the profession across Canada

• Fair and democratic governance

• Meaningful, cooperative partnerships

• Proactive behaviour and innovation

• The richness of Canadian diversity

• Clear and concise communication

Promise to our membersCPA’s goal is to provide exceptional service, valuable information and connections to the profession of physiotherapy across Canada and around the world.


The Future of Professional Development is Here

CPA PD MarketplaceMaggie Bergeron, PT, Co-founderEmbodia

Tim Paquette, Career Pathways ManagerCanadian Physiotherapy Association

The development of a national Professional Development (PD) Marketplace started in earnest when the Canadian Phys-iotherapy Association’s (CPA) Professional Development Task Force (PDTF) was struck in August 2013, as part of a revised CPA Strategic Priorities Initiative. The purpose of the PDTF was to study the impact of CPA professional development pro-gram reform and to report on the actions needed to respond in a timely fashion to any recommended changes.

In response to this report, CPA’s then-CEO, Michael Brennan, created a whiteboard image of an idea referred to as the PD Marketplace: a one-stop shop for PTs looking for quality con-tinuing professional development with high quality peer rated courses, tracked in an electronic record. As well, the market-place needed to be inclusive of CPA’s component groups and be inclusive of third-party vendors. But where to start? The search for viable partners was on… and on…and on…There was extensive time spent on finding the right coding format: i.e. open source (more cost effective), and the creation of a matching functions wish-list which would help to more clearly identify the PD Marketplace’s Minimum Viable Product (MVP) criteria. There were several meetings held early in the search process with potential key partners; companies that provided input to the development of a list of functions and features for the PD Marketplace.

Does one size fit all when it comes to a Learning Management System?Certainly not. There are arrays of Learning Management Systems (LMS) options in the Marketplace, falling into three main categories: Custom sites, “Off the shelf” solutions, and Storefront options, each offering a different set of pros and cons and each with different costs, charges, transaction fees, support services, and set-up fees. The CPA developed a list of criteria for the ideal LMS provider:

• Familiarity with the physiotherapy profession• Ability to provide one-on-one coaching to ensure that

instructional design follow best practices• Scalability: Ability to provide a platform and support for

all CPA sponsored PD learning events: webinars, webcasts, online courses, in-person, symposiums, un/conferences, etc.

• Ability to provide additional value to CPA members• Ability to sponsor various portions of the marketplace• E-portfolio capability and analytics• Creative approach to revenue sharing

The obvious choice amongst all the LMS options in the marketplace was Embodia Academy, led by Maggie Bergeron and her team. Maggie is a physiotherapist and already had a LMS up and running that checked off many of CPA’s boxes for LMS functionality.

Maggie explains that like most physiotherapists, she chose this profession to help others.

Through her journey, she has recognized the importance of expanding her skill set, developing new techniques and remaining current with the evidence, and ultimately, providing a better patient experience.

Maggie started Embodia (originally healthSwapp) for her patients. Patient experience in health care is important, but so is patient empowerment. Maggie has always strived to provide high quality care coupled with appropriate resources to meet the needs of patients. Like many physiotherapists, she provides exercises


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that are a unique blend of her own style of exercise prescription, and the exercises tailored for each individual patient. Maggie used to create Word documents and emailed them to patients, which is a time-consuming task.

How could patients be provided an exercise program tailored to meet their needs while also saving time?Embodia was the solution to this problem. Embodia was initially a digital home exercise tool where health care providers could upload videos of exercises for patients to access from the comfort of their home - without the trouble of printing off dozens of documents. It afforded Maggie the opportunity to shape and share exercise templates to meet the rehabilitation needs of each patient.

Embodia has evolved considerably since then. In the following three years, alongside the app for digital home exercise prescription, Embodia was created to provide online continuing education for physiotherapists looking to develop professionally in their careers.

The inspiration for Embodia came from continuing education course instructors who wanted to share their wealth of information and insights, and from physiotherapists who wanted to develop their professional skills while spending fewer days away from work, their family and social activities.

Thanks to the advancement in personal technology, this no longer should be a struggle. While the Embodia App meets the needs of practitioners and patients with an easy to use platform to communicate and provide home exercise prescriptions, the Embodia Academy allows physiotherapists to learn from experts across the country (and internationally) and choose from hundreds of courses. Today, over 2000 physiotherapists are a part of Embodia Academy.

Moving forwardSo, here’s what CPA members and non-members alike can look forward to as the CPA and Embodia begin to collaborate, create content, and enrich the end-to-end learning experience for all physiotherapists:• A CPA-Embodia website with a library of online continuing

education - a combination of complimentary and paid courses• Best-in-class online education from experts across the country in

easily digestible, bite-sized video lessons• All courses are created so you can learn at your own time, on your

pace. Come back to the lessons at any time• Live webinars to connect you directly with experts and therapists

for engaging conversations that will support your learning• Exclusive promotions for CPA members only • CPA Member Discounts• Access to Embodia for home exercise prescription specially

priced for CPA members

• Key progress and analytic tools to measure outcomes• A community of like-minded, connected and passionate

physiotherapists along with a customer support team at Embodia who are here to listen to your needs, feedback and suggestions

This is the beginning of an incredible journey for the Canadian physiotherapy community.

Ultimately, Embodia is a P2P (person-to-person) business and always will be. Technology embedded in the profession allows physiotherapists to focus on what they are really good at - serving and helping people - and this cannot be replaced or copied by any technology.

Embodia and the CPA can create an incredible network of experienced, evidence-based clinicians who can share their knowledge not just with those who can attend their live classes, but across the country to every physiotherapist from coast to coast to coast.

To learn more about the CPA-Embodia PD marketplace, go to http://info.embodiaacademy.com/cpa-pdmarketplace

About MaggieWhile learning how to dragon boat in 2014, Maggie met a chemical engineer who was learning how to code. Shortly after their summer on the water discussing the biggest challenges faced by physiotherapists, Embodia was born. Maggie is a physiotherapist by trade and brings 8

years of experience in private practice, global health and start up-level product management to her role as co- founder and CEO of Embodia. Early in her career, Maggie recognized the need for an effective way to engage patients in their home exercise programs and a more efficient method for professional development. Maggie is well connected in the health technology community in Toronto and organizes the leading health tech event, HealthTO, which connects the health care and technology communities.

About TimTim Paquette is CPA’s Career Pathways Manager. In addition to leading the PD Marketplace initiative, he is also responsible for managing the Clinical Specialty Program. He can be reached at [email protected]

Embodia and the CPA can create an incredible network of experienced, evidence-based clinicians who can share their knowledge

CPA-Embodia Partnership

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You Are Not AloneProfessional liability (or malpractice) claims are an ever-present risk for any health care professional, including physiotherapists. You’re likely thinking, “No, that would never happen to me”, and you’re probably right. But every year, patients, employers, and others make complaints about physiotherapists to their regulatory Colleges; and physiotherapists are served with statements of claim from lawyers representing injured clients.

Many of the incidents reported to the CPA Insurance Program are based on allegations of behaviours that were unintentional, where the physiotherapist did not deliberately behave in an unprofessional manner or intend to cause an injury to a patient or client. However, it can cost tens of thousands of dollars to defend against even a frivolous complaint to the College and the process can take months to resolve. And if you find yourself on the receiving end of a letter from a

lawyer threatening legal action on behalf of a patient, your legal costs and the costs of any damages awarded to your injured patient can be exponentially higher.

Receiving a College complaint or being served with a statement of claim may very well be one of the most frightening things that you can experience in your professional career. It’s important to remember that you are not alone. You have direct access to a range of professionals, services and information, just by being a CPA member.

Imagine this: a patient lodges a formal complaint against you to your regulatory College alleging that your treatment increased her pain and that you demonstrated a lack of compassion. What do you do? Who can you turn to?

Beyond having access to comprehensive insurance to cover the costs of a claim, it’s important to be aware of and utilize the other support services available to you as part of the CPA Insurance Program.

Beyond having access to comprehensive insurance to cover the costs of a claim, it’s important to be aware of and utilize the other support services available to you as part of the CPA Insurance Program.


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1. Claim Support ServicesIf you receive a College complaint or are named in a statement of claim, you can rest assured that help is just a phone call or email away. Experts at Crawford and Company, the CPA Insurance Program claims specialists, will examine your policy, identify your coverage and assist you with next steps, including coordinating your legal defence if required. Reporting a claim is confidential and will not limit your ability to secure coverage in the future. Communicating with your claims representative will give you the peace of mind that comes with knowing insurance experts specialized in professional liability are working with you to achieve the best possible outcome for all involved.

Crawford and Company contact information: 1-888-218-2346 or [email protected]

2. Pro bono Legal Advice ServicesMembers participating in the CPA Insurance Program also have access to pro bono legal services from Gowling WLG (Canada) LLP (Gowlings), one of the most highly recognized legal defence firms in medical defence and professional liability in Canada. If you have a question that relates to your professional services, such as how to respond to requests for information from third parties, ethical obligations, or issues of privacy and confidentiality for instance, a lawyer will assist you with free, confidential legal advice designed to help avoid or reduce the probability of a professional liability claim or complaint.

Gowling WLG (Canada) LLP contact information: 1-888-943-0953

3. Risk ResourcesCPA and BMS also provide a wide range of industry-specific risk management resources using up-to-date data to address a range of potential issues for physiotherapists and physiotherapist assistants.

Did you know that consistent, detailed documentation is one of the most important things in your legal defence? While this isn’t the first time you’ve heard this, the quality of your records really can be more important that you first think.

Picture this:. A former patient makes a complaint against you stemming from treatment they received 18 months ago. Detailed notes from that day will play a significant role in helping you and your counsel work to defend the claim. How detailed? Essentially, the more detail the better but the key information is date, objective observations, subjective presentation as stated by patient, any questions asked by the patient, any unusual circumstances or behaviour, actions taken and

anything else you believe could be valuable information if called upon at a later date.Check out the resource “Why are your clinical records being requested by legal counsel?” at www.physiotherapy.ca for more tips on record keeping.

CPA and BMS stay ahead of emerging trends, and work to keep you informed. For example, the cyber threat landscape is constantly changing and the health care sector continues to be a common target. If you have data, you have risk. Cyber attacks can come in many different forms and it’s important to be aware and covered.

Visit the CPA website to find numerous practice risk resources including:

• Regulatory complaints• Minimize risk when needling• Claims related to needling• Identity theft• Using electrophysical agents• Informed consent• Occupational risk• Notice of complaint

4. Practice Risk AssessmentBeyond the issue of complaints or claims, your CPA insurance program partners can assist with your insurance-related questions. Are you:

• Opening a practice for the first time? • Changing employers?• Just graduated? • Going on maternity leave?

There are many situations where you might require guidance to ensure you’re protected with the appropriate insurance coverage. It’s important to always know what insurance you do and don’t need. As the exclusive broker to the CPA Insurance Program, BMS has a team of knowledgeable brokers who assist thousands of p hysiotherapists each year. Through the dedicated toll-free number (1855-318-6136) or email [email protected] you can speak directly to a broker about your specific needs. They know the right questions to ask to assess your exposures and will take time to provide detailed information on the best coverages to meet your needs.

Your CPA membership continues to enhance in value and provides you superior support. Continue to keep an eye out for additional practice risk resources and events. And if you’re ever in doubt, call or email CPA or BMS. We’re here to help.

There are many situations where you might require guidance to ensure you’re protected with the appropriate insurance coverage.

You Are Not Alone


As a practicing physiotherapist working in a neuro-rehabilitation setting, I became very familiar with the term synergy as it related to stroke recovery. It wasn’t until I took a leadership course that I began to look at the term differently.

Leadership writer Stephen Covey, defines “synergy” as a situation where 1+1 equals something much greater than two. Or more to the point, a situation where two heads are better than one. He describes a process of creative co-operation, or a process where each member of a group brings their thoughts, ideas, values, and experiences to a discussion- and the result is far greater than anything that would have been created by any one individual.

One priority in our new strategic plan at CPA is to “enhance the organizational value and capacity of the CPA.” One of the ways we achieve this is through the development of partnerships and coalitions. To ensure that we get the most return on our investments of resources, human or otherwise, we strive for synergy in all our partnerships. These relationships allow us to increase our advocacy reach and voice, tackle big issues, and build our evidence base.

This article will not include an exhaustive list of CPA’s partnerships, but will discuss a few key relationships and how we work with these groups to enhance organizational value and capacity.

HEAL (Organizations for Health Action) http://www.healthactionlobby.ca As a professional association representing more than 14,500 physiotherapists, physiotherapist assistants, physical rehabilitation therapists and students, CPA is a big voice for the profession in Canada. But there are many big voices in the health care sector, and some are bigger and louder than ours. To this end, CPA is a member of HEAL (Organizations for Health Action), a coalition of 40 national health and consumer associations and organizations dedicated to protecting and strengthening Canada’s health care system. It represents more than 650,000 providers and consumers of health care. By working with HEAL members, we are

partnering with like-minded organizations, advocating for health-related issues with a much stronger voice.

HEAL meets quarterly with the objectives of: sharing information across organizations; working on those strategic issues that are of importance to all members; and meeting with external organizations to discuss policy issues of mutual interest and importance.

One of the most impressive achievements of HEAL was the publication of the report entitled “The Canadian Way - Accelerating Innovation and Improving Health System Performance.” http://www.healthactionlobby.ca/docs/Publications/HEALFedRole_FinalStatement2016.pdf This consensus statement demonstrated an unprecedented level of agreement among health sector professionals and delivery organizations about the role of the federal government in improving the health of Canadians and the care they receive. It addressed many of the challenges associated with the delivery of health care in Canada, and represented a call to action to all levels of government and our country’s political leadership. Work is currently underway to revise and update this document.

Coalition for Safe and Effective Pain Management (CSEPM) http://www.csepm.ca The Coalition for Safe and Effective Pain Management was created in 2017 to draw attention to the problem of opioid overprescribing, and to develop recommendations to promote a better approach to pain management at the practitioner level. CSEPM is a signatory on Canada’s Joint Statement of Action to Address the Opioid Crisis.

The role of the Coalition is to evaluate the most common reasons for opioid prescribing in primary care settings and develop recommendations for practitioners and the wider health care system to assist with patient navigation and prioritize clinical alternatives that can reduce reliance on opioids. By joining forces with these other organizations, the message of improved pain management received a far wider audience

that we could have achieved on our own. The work of CSEPM was published in

an interim report https://physiotherapy.ca/sites/default/files/csepm_interim_report_final_0.pdf

Canadian Deprescribing Network (CADEN) https://deprescribing.org/caden Through our work on the opioid crisis, CPA was invited to join the Canadian Deprescribing Network (CADEN). This group of health care leaders, clinicians, decision-makers, academic researchers and patient advocates works together to mobilize knowledge and promote the deprescribing of medication that may no longer be of benefit or that may be causing harm.

In addition to advocating and educating on the dangers of deprescribing, CADEN is also involved in researching and improving the evidence base for safe medication practices in Canada. CPA is excited to be part of this organization, and is helping to advocate for safer alternatives to medications, especially in the elderly population.

Big OTPT study While CPA does not have the resources to develop and execute large scale research on its own, we are often asked to contribute to or partner with other organizations on research projects. One such project is a Canadian Institute for Health Research (CIHR) funded study through McGill University. This project, entitled “Evolution of evidence based practice: evaluating the contribution of individual and contextual factors to optimize patient care” involves partners and knowledge users from 16 university programs, professional associations, and regulators. This integrated knowledge translation (KT) study is designed to measure and understand how individual (e.g. knowledge, attitudes, confidence, behaviours) and contextual factors (e.g. resources) impact evidence based practice (EBP) in Occupational Therapy (OT) and Physiotherapy (PT) practice.

By partnering on projects like this one, CPA can assist researchers investigate topics important to the profession, help disseminate

The Power of SynergyMelissa Anderson, PT, CPA Director, Advocacy, Professional Practice, and Advancement


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research findings, and continue to build the profession’s evidence base.

These are only a few examples of the partnerships that CPA is involved with. By creating synergy in these partnerships, we can achieve much more than if we were constantly working alone or in silos. One recent example of a successful initiative which we were involved in was the response to the federal government’s idea of taxing health benefits. “Don’t tax my health benefits” http://donttaxmyhealthbenefits.ca was an extremely well organized and timely campaign that was successful because many professions got together to create messaging and were able to get the message out quickly. The public responded and the idea of taxing health benefits was quickly removed from the political agenda.

As health care providers, physiotherapy professionals use synergy naturally. We do it each time we set collaborative goals with patients and each time we attend a team meeting. We know the power of synergy in building relationships with our patients and coworkers, but we need to continue to seek opportunities to collaborate to optimize opportunities and innovations for our profession. As Stephen Covey says, “Synergy is better than your way or my way. Its our way.”

About MelissaMelissa Anderson is a physiotherapist and is CPA’s Director of Advocacy, Professional Practice, and Advancement. She is a proud grad of Dalhousie University in both

Physiotherapy and Public Administration. She previously served as branch president of NBPA, so understands the challenges faced by branches and divisions with limited volunteers. Melissa recently relocated to the CPA National Office in Ottawa, from Saint John, NB.

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Professionalism is an area of increasing focus and concern in many health profes-sional programs, PT among them. Despite “Professional” being one of the seven core roles in the Essential Competency profile for physiotherapists in Canada, the number and variety of “unprofessional behaviour” incidents seen in academia and in the clinical setting seem to be escalating at a rapid rate, causing those of us involved in education to pause and take stock of how we are develop-ing professionalism in our students, and why it appears so hard to do.

In many ways, professionalism preparation begins before admission, as programs attempt to select students who already have personal values and traits that mesh well with the PT profession. Admission to Canadian PT programs is competitive, and many programs use methods such as the “MMI” (multiple mini-interview) to select applicants who not only have academic excellence but who can also demonstrate traits such as leadership and professionalism. Once admitted, “Professionalism” is part of every entry-level PT program curricula

across Canada, and is assessed using a variety of methods including practical demonstration of skills in OSCE (objective structured clinical examination) type assessments. In the clinical setting, entry-level physical therapy students are assessed on the competencies for the “professional” role during their using the ACP (Canadian Physiotherapy Assessment of Clinical Performance) tool. Why then do there seem to be an increasing number of “professionalism” issues being cited, both in students and in practitioners?

Perhaps the first issue is definition. While most of us have a “gut feel” as to what professionalism is (or is not – it is often easier to recognise unprofessional behavior than professional), there is no universally agreed definition as to what professionalism is. Although there are some core elements such as professional communication and cultural sensitivity, professionalism varies significantly between different contexts – what is acceptable in one setting may be labelled completely unprofessional in another. (For example, sports wear may be

very appropriate and considered professional in a sports clinic; the same attire would likely be considered highly unprofessional in acute care.) This makes defining professionalism and professional behavior complex, with resulting difficulty in designing the professional curriculum and teaching professional norms.

Even when the professionalism curricula have been developed, how and when professionalism elements should be taught and assessed is remarkably unclear. Most would agree that a large portion of professionalism education occurs in the ‘real world’ of the clinical setting during clinical placements. However, this places the burden of assessment of professionalism on clinical preceptors, who are often unprepared for this task. Adherence to “rules” such as a dress code policy or showing up on time are easily assessed but are only a small part of the whole picture of professionalism. Many aspects of professionalism are hard to pinpoint and quantify. It is relatively easy to point a student to the steps they missed carrying out a particular physical


ProfessionalismDifficult to Teach and Hard to Evaluate!Sue Murphy, PT, Grad Dip PT, B.H.Sc (PT), M.Ed, CPA Member since 1980

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assessment; it is much harder to provide feedback on an inappropriate tone of voice or choice of words, which can feel much more subjective and more like a personal attack on the student. Preceptors are (understandably) loathe to take on this task and frequently focus clinical feedback and assessment on the more technical clinical skills that are easier to address, have clear guidelines on which to base assessment, and are often easier to remediate. This can lead to a student with solid clinical skills but with unprofessional behavior being “passed through” their clinical training with little challenge to inappropriate behavior.

Preceptors may also feel that teaching and assessing professionalism is not part of their role, and students should come to the clinical setting with already developed professional competencies, however professionalism needs to be learned and developed as with other skills. A student may initially exhibit weak professional skills but these skills and competencies should and must develop alongside their clinical skills to new graduate level. Targeting learning objectives to developing professional competence is a helpful strategy that ensures these skills are addressed during the evaluation.

The “hidden curriculum” (which can be defined as “what students inadvertently learn in a setting”) is also a strong influence on learning professional behavior. Role modelling by preceptors is a key part of the hidden curriculum, and breaches of professionalism by preceptors are often emulated by students in the desire to “fit in” and succeed in a specific context. Learners are also less likely to understand the nuances of the clinical setting which can lead to mistaken assumptions and understandings about what is appropriate. For example, in acute care, students may not overtly see informed consent being obtained (for example with a confused

or psychotic patient) and then assume that it is “okay” to proceed with treatment whether or not the patient consents. Explanation by, and discussion with, the preceptor is key to making sure the clinical context and treatment rationale are fully understood.

From the academic perspective, courses designed to teach professionalism competencies are not always successful in teaching skills which translate to “real life”. Success in a “professionalism” course does not necessarily translate into professional behavior in the clinical setting, or accurately predict students who will struggle in this area. There is little literature to provide faculty with guidance on the best methods of teaching professionalism to PT students, and even in medical education, where there is a significant body of literature related to teaching professionalism, there is little agreement about a “magic bullet” for learning to be a professional. As with clinical preceptors, academic faculty also struggle with providing feedback and remediation to students with lapses in professionalism, and must work within their University policies in providing appropriate supports and sanctions.

One area that is receiving increasing attention is the development of an individual’s “professional identity” rather than focusing solely on competence in professional behaviors. Development of professional identity or “who one is” as a professional is a complex process and involves integrating the person’s various social roles, statuses and diverse experiences into a coherent image of their professional self. For example, if a female student comes from a background that is hierarchical and male-dominated, it may be hard for the student to take on an advocacy role when discussing client care with an older, male physician. Alternatively, a student may be able to demonstrate excellent conflict resolution in an Objective Structured

Clinical Examination (OSCE), yet appear unable to positively resolve disputes in a clinical setting. This may be because the learner’s identity in that setting is as a student whose conflict resolution skills are inferior to those of their preceptor, or that students should avoid conflict at all costs to pass the placement, in which case they will be unlikely to demonstrate this professional behavior. Professional socialization, clinical placements and experiences during their training all contribute to the development of professional identity, however the short time frame of most Canadian PT programs can limit time available for some of these activities.

So where does all this leave us? Certainly, educational programs need to take a long and hard look at where, when and how professionalism is taught and learned. New complexities of practice, such as the realities of Interprofessional and team based care, emerging roles for PTs in areas such as primary care, and changing consumer expectations raise new questions as to what professionalism means; educators in both academic and clinical settings need to be thoughtful as to how to shape curricula to meet the professional expectations of these new paradigms. Teaching and learning methods need to incorporate strategies to facilitate the development of professional identity as well as professional competence, and ensure that appropriate assessment and feedback (both positive and constructive) is provided across the learning continuum. It may also be time for a national “think tank” on professionalism in the PT profession, brining together educators, researchers, regulators, clinicians and consumers, to determine not only what todays professional milieu demands of PTs, but also to look at how we adequately prepare the practitioners of tomorrow.

About SueSue Murphy is Head of the Department of Physical Therapy, and an Associate Director at the Centre for Health Education Scholarship at

the University of British Columbia. Sue has taught in the professionalism curriculum of the Master of Physical Therapy program at UBC for the last 10 years, and has a keen interest in the teaching and learning of professionalism, as well as in teaching and learning in the clinical setting.

@suem12PT

This article is an addendum to the Professionalism issue, Vol. 8, No. 2


Professionalism

Certainly, educational programs need to take a long and hard look at where, when and how professionalism is taught and learned

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Concussion is a commonly occurring injury in sport and recreation.1 In recent years, the burden of concussion has increased, likely due to improved awareness and management of concussion. As such, there is an increased demand on health care professionals to prevent, detect, diagnose, and manage concussions. Additionally, concussion is a heterogeneous injury and can result in many symptoms (such as headaches, dizziness, unsteadiness, confusion, difficulty concentrating, irritability, and others) and functional limitations.2

Headache is the most commonly reported symptom following concussion.3 There are a variety of headache subtypes that can occur following concussion and may persist.4-6 Diagnosis of specific headache subtype is important and can guide management (e.g.. post-traumatic migraine, cervicogenic headache, occipital neuralgia, tension type headaches).7 Similarly, balance difficulties and dizziness are commonly reported following concussion and may occur secondary to alteration of peripheral sensory input, central processing or efferent output.8, 9 Difficulty with exertion, sleep, mood, concentration, memory, and vision are also commonly reported persistent symptoms and require assessment and management by health care professionals with specific clinical expertise.2, 10 Differential diagnosis to manage the many subtypes of the affected systems is important to guide management appropriately. As such, a multifaceted process to assessment and management of concussion is recommended and typically involves a multidisciplinary team.10

The physiotherapist has a unique skillset and can be engaged on the field/court (from grass roots to elite sport) and in clinical

settings. On field, the physiotherapist can assist with education, prevention, detection (i.e. watching for observable signs and removal from play in the event of a suspected concussion), on field screening, initial assessment and management.11, 12 Initial management includes a period of cognitive and physical rest for the initial 24-48 hours followed by gradual reintroduction of activities of daily living.13 A graduated return to sport and school strategy is then completed once the individual is asymptomatic.12 In the event that symptoms persist, treatment may be of benefit. Current evidence supports the use of cervical and vestibular rehabilitation for individuals that have ongoing symptoms of dizziness, neck pain and headaches and low level aerobic exercise may be of benefit.13 Many of the current treatments supported by the evidence are within the physiotherapist’s scope, provided that one is competent in the specific area. It is also important to recognize when a patient requires engagement of health care professionals with differing types of expertise, such as neuropsychology, psychology, optometry, occupational therapy and physician specialists.2 A toolkit was published by the Alberta College and Association and is intended to assist the physiotherapists with assessment and management of concussion.

There are numerous different messages that are shared with the public in the “concussion space”, often making this a challenge for parents, sport participants, coaches, teachers, officials and health care professionals to maneuver. The Canadian Concussion Collaborative (CCC) is a group of representatives from National Health and Health related organizations that are working together to form a unified voice

in the area of concussion in Canada.14 Ultimately, the CCC is working together to prevent concussions and optimize care through education and implementation of practice. In 2014, the CCC published a summary of two recommendations in the British Journal of Sport Medicine. These recommendations included the following (Fremont et al, 2014 page 1, 2):

1. “Organizations responsible for operating, regulating or planning sport and sporting events with a risk of concussion should be required to develop/adapt and implement a concussion management protocol, based on current best practices, that is customized for their context and available resources.”14

2. “In situations where timely and sufficient availability of medical resources qualified for concussion management is not available, multidisciplinary collaborative approaches should be used to improve concussion management outcomes while facilitating access to medical resources where appropriate.”14

This publication received significant media attention and since this time the CCC has continued to grow and now include fourteen health and health related organizations that meet regularly throughout the year. Current member organizations include: Canadian Academy of Sport and Exercise Medicine (CASEM), Canadian Association of Emergency Physicians, Canadian Association of Occupational therapists, Canadian Athletic Therapists Association, Canadian Centre for Ethics in Sport, Canadian Chiropractic Association, Canadian Medical Association, Canadian Neurosurgical Society,

The Physiotherapist as part of an interdisciplinary team in the prevention, detection and management of Concussion KATHRYN SCHNEIDER PT, BKin (Hon), BHScPT, DScPT, DipManipPT, PhDCPA Member since 1998


Canadian Paediatric Society, Canadian Physiotherapy Association (CPA), Canadian Psychological Association, College of Family Physicians of Canada, National Emergency Nurses Association, Ontario Medical Association Sport Medicine Section, Ontario Neurotrauma Foundation, Parachute and the Royal College of Chiropractic Sport Sciences. I have had the opportunity to represent the Canadian Physiotherapy Association (CPA) on the CCC for the past 3 years. The CCC has also developed evidence informed tools for sport organizations and the public to help interpret the large amounts of information and media that are available. We have recently also developed the following documents: 1) Four characteristics of a good Concussion Clinic, 2) Top 5 key messages from the 5th International Consensus Statement on Concussion in Sport, 3) Road Map for implementing Concussion Management Policies and Protocols in Sport and 4) Recommendations for Policy Development regarding Sport-Related Concussion Prevention and Management in Canada.15-17 The outputs are available in both English and French and are developed and are updated as the evidence evolves. The resources from the CCC can be found at the following link: http://casem-acmse.org/concussion-related-position-statements-tools/#CCCtools

Prime Minister Trudeau has also had an active voice in concussion and has asked the Minister of Sport and Persons with Disabilities and Minister of Health to work together to “implement a pan-Canadian concussion strategy and raise awareness for parents, coaches, and athletes on concussion treatment.” https://pm.gc.ca/eng/minister-sport-and-persons-disabilities-mandate-letter, https://pm.gc.ca/eng/minister-health-mandate-letter

Not only the federal government is involved since all governments are taking this issue seriously. As part of this initiative, a Federal/Provincial/Territorial Working Group on Concussion in Sport was created in 2015 and brings together multiple sectors that are stakeholders in the area of concussion, including education, health, sport and government. The former Governor General, the Honourable David Johnson, also has a special interest in this area. In December of 2016, the Governor General’s Conference on Concussion in Sport was held at Rideau Hall and was broadcast on a live webcast to increase awareness and attention to the issue of concussions in sport – the title of the event was “We Can Do Better”. You can still view the entire conference and its segments at: http://www.cpac.ca/en/programs/public-record/episodes/49980911

There is an effort at a national level to improve the prevention, detection and management of concussions in sport. Parachute Canada is a national charity dedicated to preventable injuries and is leading a national initiative to harmonize concussion management in Canada. In July of 2017, Parachute published the Canadian Guideline on Concussion in Sport. http://www.parachutecanada.org/injury-topics/item/canadian-guideline-on-concussion-in-sport

In these guidelines, a multidisciplinary approach to concussion assessment and management is recommended, with the physiotherapist recognized as a valuable member of the team. National Sport Organizations have also undertaken a review or creation of their return-to-sport protocols with the help of Parachute, in order to ensure harmonization of them with the Canadian Guideline.

Concussion is a complex problem. However, when managed appropriately the majority of individuals recover in the early time period following injury.15 The physiotherapist has a unique skillset and is a valued member of the team of health care professionals across the continuum of care in concussion, from prevention to detection to management of concussion. Development of knowledge and competence in concussion and understanding the appropriate timing for referrals to other health care professionals is imperative to optimize care. Research is ongoing in this area and clinical practice is continuing to evolve as new discoveries are made. Thus, ongoing professional development in concussion and evidence-informed practice is key.

CLINICAL SPECIALTY PROGRAM

About Kathryn Dr. Kathryn Schneider is an Assistant Professor and Clinician Scientist (Physiotherapist) at the Sport Injury Prevention Research Centre, Faculty of Kinesiology at the University of Calgary. Her research focuses on the prevention and treatment of sport-related concussion. Her previous work has identified a large treatment effect using multimodal physiotherapy and vestibular rehabilitation in athletes who have persistent symptoms following concussion. She is a Clinical Specialist in Musculoskeletal Physiotherapy, a Fellow of the Canadian Academy of Manipulative Physiotherapists, has expertise in vestibular rehabilitation with her clinical practice focused on treatment of athletes with ongoing symptoms following sport-related concussion.

She was recognized by Avenue Magazine as “Top 40 Under 40” in 2012 and was the recipient of the Vestibular Disorders Association (VEDA) Champion of Vestibular Medicine Award in 2015. Invited speaking highlights include the 4th and 5th International Consensus Conferences on Concussion in Sport, International Olympic Committee (IOC) medical meetings at the Sochi and Rio and PyeongChang Olympic games, World Rugby Medical Commission Meetings (2016), MLS/US Soccer concussion meetings (2017) and the Canadian Concussion Harmonization Meeting (where she presented the latest evidence from the 5th Consensus statement to the National Sport Organizations) (May, 2017). She represents the Canadian Physiotherapy association on the Canadian Concussion Collaborative and is a member of the Federal Government Working Group on Concussion in Sport. She has worked with many athletes, from recreational to professional and has developed and instructed many continuing educations courses for physiotherapists and health care professionals (including the IOC Sport Medicine Physician Course) in the area of vestibular rehabilitation, cervical spine treatment and sport-related concussion.

The physiotherapist has a unique skillset and is a valued member of the team of health care professionals across the continuum of care in concussion, from prevention to detection to management of concussion

References: [1] Pfister T, Pfister K, Hagel B, Ghali WA, Ronksley PE: The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sport Medicine 2016, 50:292-7.[2] Schneider K: Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. JOSPT 2016, 46:613-6.[3] Benson BW, Meeuwisse WH, Rizos J, Kang J, Burke CJ: A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program. Canadian Medical Association Journal 2011, 183:905-11.[4] Heyer GL, Young JA, Rose SC, McNally KA, Fischer AN: Post-traumatic headaches correlate with migraine symptoms in youth with concussion. Cephalalgia 2016, 36:309-16.[5] Zasler ND: Sports concussion headache. Brain Injury 2015, 29:207-20.[6] Pinchefsky E, Dubrovsky AS, Friedman D, Shevell M: Part I - Evaluation of Pediatric Post-traumatic Headaches. Pediatr Neurol 2015, 52:263-9.[7] Pinchefsky E, Dubrovsky AS, Friedman D, Shevell M: Part II - Management of Pediatric Post-traumatic Headaches. Pediatr Neurol 2015, 52:270-80.[8] Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ: Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther 2010, 34:87-93.[9] Schneider K, Meeuwisse W, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, Emery C: Cervico-vestibular physiotherapy in the treatment of individuals with persistent symptoms following sport-related concussion: A randomized controlled trial. Brain Injury 2014, 28:796.[10] Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz K, Hinds S, Leddy J, McCrea M, Turner M, Johnston K: Approach to investigation and treatment of persistent symptoms following sport-related concussion: A systematic review. British Journal of Sport Medicine 2017, 51:958-68.[11] Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider KJ, Kissick J, McCrea M, Dvorak J, Sills A, Aubry M, Engebretsen L, Loosemore M, Fuller CW, Kutcher JS, Ellenbogen RG, Guskiewicz K, Patricios J, Herring S: The Concusison Recognition Tool 5th Edition (CRT5): Background and rationale. BJSM 2017, 51:870-1.[12] Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan J, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvorak J, Sills A, Aubry M, Engebretsen L, Lossemore M, Fuller G, Kutcher JS, Ellenbogen RG, Guskiewicz K, Patricios J, Herring S: The Sport Concussion Assessment Tool 5th Edition (SCAT5). BJSM 2017, 51:848-50.[13] Schneider KJ, Leddy J, Guskiewicz K, Seifert TD, McCrea M, Silverberg N, Feddermann-Demont N, Iverson G, Hayden KA, Makdissi M: Rest and specific treatments following sport-related concussion: A systematic review. British Journal of Sports Medicine 2017, 51:930-4.[14] Fremont P, Bradley L, Tator CH, Skinner J, Fischer LK: Recommendations for policy development regarding sport-related concussion prevention and management in Canada. BJSM 2014.[15] McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio SP, Cantu B, Cassidy JD, Castellani C, Davis GA, Echemendia RJ, Ellenbogen RG, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz K, Herring S, Iverson G, Johnston K, Kissick J, Kutcher JS, Leddy J, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider K, Sills A, Tator CH, Turner M, Vos P: Consensus Statement on Concussion in Sport - The 5th International Conference On Concussion in Sport held in Belin, October 2016. BJSM 2017, 51:838-47.[16] Fremont P, Schneider K: New Recommendations on Sport-Related Concussions: Stronger Methodology, Practical Messages, and Remaining Challenges. Clinical Journal of Sport Medicine 2018, ePub.[17] Collaborative CC: The top 5 key messages from teh 5th International Consensus Statement on Concussion in Sport Edited by Collaborative CC. 2017.

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