Prep Course for the Virtual Physiotherapy Competency Exam (PCE)
By: Nataliya Zlotnikov, MSc, HBSc
By: Nataliya Zlotnikov, MSc, HBSc
If you stumbled upon our virtual PCE blog in error while looking for the in-person PCE tips, you can find them here:
If you are in the right place, keep reading below.
Like Everyone's Favorite Facebook Relationship Status - It's Complicated
For a lot of you PCE candidates, this has been a complicated, whirlwind of a year.
First, the exam was on, then it wasn't, then it was in person - it has just been a year-long battle.
And now here we sit, facing the first-ever, virtual PCE.
We Understand That You Are Probably Feeling Like This
Free Stress Reduction Tool
So we are providing you with this highly advanced, top-secret stress reduction tool below to assist you with your studies:
Disclaimer: Please do not actually use this tool, we would be terrible healthcare professionals if we were to advise you to self-inflict a concussion.
We Really Are Here to Help!
"Humor" aside, we want you to pass the Practical Component of your PCE with flying colours, or at least colours.
The Canadian Alliance of Physiotherapy Regulators (CAPR) has recently announced that the PCE will now be delivered on a virtual platform.
Given the circumstances, many Canadian physiotherapy students and residents have expressed feelings of uncertainty about how to approach and prepare for the exam. As past PCE-takers ourselves, we understand and we’re here to help you to the best of our ability.
The webinar is now available as a free course and can be accessed by following the link below:
We have also included some detailed key points from the course in today's blog (topics 1-8 below are summarized in the blog).
We end the blog with a sample virtual PCE clinical case video from the course (topic 9 below).
We know today's blog is a long-ish read, but the course was so good we didn't want to deprive you of any information that could make the difference in your passing. Feel free to skip ahead to the sections that are of interest to you.
Topics Discussed in This Course Include
- Comparing and contrasting: Old PCE vs. New-look PCE
- The low hanging fruit: The easy marks you can get on any station
- Avoiding a critical incident: How to avoid getting flagged with a critical incident
- Establishing a healthy work-study balance
- Practice effectively: Tips on how to practice effectively
- Big themes vs. minutia: A review of some high-yield skills and concepts to focus on
- Types of stations to anticipate
- Communication tips: Communication is huge on a hands-off exam
- Sample virtual PCE clinical case
- Test day checklist
1. In-Person vs. Virtual Clinical Exam
Although the method of delivery is vastly different this year, at its core this exam is still an assessment of your knowledge application, professionalism, safety and communication skills.
Virtual Format Main Focuses
This entire year has been a rather unprecedented time.
The virtual exam is brand new, so knowing exactly what we are going to see is a bit of a challenge. At the same time, there has never been such a volume of information about any prior exam - The CAPR has released ample 2021 Clinical Component Preparatory Resources in three modules.
It is also important to remember that the main practice of healthcare has shifted to virtual, this exam will be similar to what a true real-life virtual patient experience is going to be like.
The more that you can focus on the idea that this is not an exam but a real-life patient experience the better you will do.
Erik believes that the focal points of this year's exam will be:
- Clarity of instructions
2. Low-Hanging Fruit
These are the marks that you should be getting on every station.
Much of this stuff is a good 30-50% of what a station is and where the marks come from, so be sure to practice these so that you can grab all those low-hanging fruits.
Low hanging fruit includes:
- Greeting the patient and introducing yourself:
- Their name: Get their name when you first read the station, say what their name is, confirm it, can also ask for their preferred name.
- Your name: Introduce yourself. For example, you're a resident here at the hospital or clinic; whatever the station setting is.
- Explain the purpose of the interaction: Why are you in there? For example, if the station says you're going to teach two exercises to help with range of motion, you have to go in there and first say it.
- Obtain consent (an ongoing process): Obtaining consent is an ongoing process, you don't have to say everything right at the beginning of a station because you'll just talk yourself off a cliff. Just be concise with it.
- Establish baselines and compare at the end of the interaction: Establishing baselines can be just checking in with the patients and making sure they don't have any discomfort and if they do, how are you going to curb that.
And at the end of the interaction, make sure that what you did, didn't cause more discomfort and if it did how are you going to ameliorate that.
- Appropriately close the interaction and leave the patient in a safe position: Summarize very briefly all you just did so that the patient understands what took place and the plan moving forward.
Leaving the patient in a safe position will likely be the position that you found them in. Make sure that part of the final statement is an opportunity for the patient to ask questions and clarify.
And we can't stress this enough:
When you're practicing, be very intentional with the low-hanging
fruit content to make it automatic.
Because when you're in this high stakes exam,
you will feel nervous and when the nerves start kicking in,
some of these things may go to the wayside.
3. How Much Emphasis Should Be Put on Safety?
BIG emphasis! You want to avoid a critical incident as much as you can.
- 2 minor safety or professional incident = fail
- 1 major safety or professional incident = fail
**A major incident is something that can cause serious harm or death to the patient.
So keep safety in the forefront of your mind as you are practicing the stations going forward.
Do I Have to Do Something to Be Flagged for a Safety Incident?
No! It can be something that you didn't do as well.
This brings us to the topic of omission vs. commission.
Omission vs. Commission
Omission: Not doing something that you should have done to keep the patient safe. For example, not correcting the patient's exercise technique in the presence of pain or discomfort.
Commission: Doing something that you weren't supposed to do that can cause harm to the patient. For example, applying heat over an area of active bleeding. For a virtual example, bed exercises for a total hip or knee patient and you got them to stand.
Things to Always Consider
Some of the things you do or omit doing don't necessarily simply have to do with the requests of the station itself but with the environment and how it was set up, as well as with the patient themselves and what kind of feedback you are getting from them.
- Level of consciousness/comprehension
- Physical capability (both the patient and the therapist)
- Mental capability (aware, understands the task, willingness to proceed)
Customary Red Flags
A few key things that will never change on these exams are your customary red flags.
One of the ways to tackle this is to think about body regions or particular environmental scenarios.
Red flag clearing questions should be automatic:
- Cancer: Unexplained weight loss/gain, night sweats, unrelenting pain.
- DVT: Severe calf pain, swelling, tenderness, warmth, redness, dilated veins.
- VBI/Cervical A. Dissection: 5 D's 3 N's
Note: This is not an exhaustive list; make a list for yourself and have those items fresh in your head.
Bottom line: When in doubt, don't do it.
You don't want to risk a critical incident if you're unsure - it can cost you the exam.
Make sure that you are doing exactly what is being asked of you and if you have doubts or are unsure, it is usually better to reserve a bit more than fall off the end of the cliff by offering every alternative you think exists and creating a safety concern.
4. How Do You Balance Studying While Working as a PT Resident?
Before we delve into this section, we understand that everyone's realities are different and some of the things discussed may not apply to you, for example, you may have dependents and have no choice but to work a lot.
A big reason for not passing this exam is not practicing or studying enough.
- If possible, a few months before the exam, settle on a flexible work schedule with your employer.
- Remember that working and earning an income is important but the time you invest in studying/practicing is time that you are investing in yourself and your future.
5. How Can PCE Candidates Ensure That They Are Practicing Effectively?
Tips to practice effectively:
- Find partner/s/ and practice how you will perform on the test (stimulation): The more you practice the more comfortable you will get. Diversity in partners is also important!
- Try to practice in the space/at the station you will take the test: This leads to context-dependent memory.
- Practice as many scenarios as you can: Be sure to check the CAPR website for clinical case samples.
- Practice, practice, practice the "low hanging fruit": Even if it feels redundant.
- Use rubrics: Mark each other using rubrics provided on CAPR's clinical case samples document.
- Video record yourself for feedback: You'll be on Zoom, why not use that Zoom record function to take an objective point of view on how you are performing.
Setting Up Your Practice Environment
- Find a quiet space
- Strong internet connection: Pro tip from Maggie Bergeron, physiotherapist and co-founder of Embodia - if you are not certain about your internet connection, getting an ethernet cable is such a great solution and works wonders for stabilizing your connection.
- Camera set-up (hands and feet in the shot): They will not allow you to tamper much with your camera so make sure that the room is large enough. An exception to this is a very tall person in a very short room - they will allow you to angle the camera up and down
- Test mic and speaker
- Clear your space of any clutter and distractions: There is speculation that they might make you do a wand about so make sure that there are no materials that should not be out and about. Keep the space clutter-free when you practice as well.
- Turn off your phone
- Use same location: If possible, take the test in the same spot that you've been studying (context-dependent memory) - take advantage of this opportunity, you are lucky! Never before has this been possible.
6. How Should PCE Candidates Focus Their Studying? Big Themes vs. Minutia
There is way too much to know on this exam, it's almost impossible to know everything, which is why you really need to focus your studying and separate the concepts into big themes and minutia.
Big themes: Skills/concepts that can be applied to most of the clinical encounters that you will be in.
Minutia: Skills/concepts that apply to only a subset of encounters, trivial at best.
How Do We Differentiate the Big Themes vs. the Minutia?
- Take a step back and think about all of the systems that you will be tested on in this exam
- Think about certain concepts that you've learned in PT school that can fit into all of those scenarios
- In addition to the subject matter, there will also be themes that transcend all these subject matters. Certain types of activities or education pieces can be applied no matter what type of patient presentation we have in front of us.
Below is a non-exhaustive list of things that can be applied in multiple settings and frameworks.
High-yield skills to describe/guide:
- Gait aids: From providing someone with a cane because of balance points or someone who has gone post-surgical and needs to learn how to do proper crutch walking.
- Transfers: See this one year after year. Some of the props we now know are going to be on the exam speak to the fact that transfers are going to be tested even though you are not there to physically do them.
- Bed mobility/repositioning: Coaching or teaching can be done if were talking about the elderly and bedsores, somebody who is actually in the hospital themselves or perhaps even a young person who has a respiratory condition who can position themselves to improve respiratory airflow.
- Posture correction: Seen universally whether directly instructing to tell a patient how to correct their posture or could be innately part of a treatment plan that you have been asked to describe to somebody.
- Cough technique, inhaler use: IMT, PEP, etc.
High-yield education pieces:
- Hip precautions
- Therapeutic modalities
- Home programs/care
- Post-op care
- DPs and PLB
- Energy conservation strategies
- PTA instructions
7. What Types of Stations Should PCE Candidates Anticipate?
CAPR has said that even though the environment is changing and some of the behaviours that are able to be specifically tested around the exam are changing, globally, the essence of the exam is unchanged.
The behaviours are exactly the same, were just replacing the do and including the explain or the show or demonstrate. Therefore, past years' resources can still be of use.
- Subjective interviewing: An increasing trend that Erik and Anthony have noticed is the presence of subjective interviewing on the exam and highly suspect it will appear again.
CAPR understands that in 5 minutes you won't get everything, but you'll get the safety information and all the other pertinent details that you need from this case in order to move forward with it.
- Education: Prompting and making sure the patient understands, giving dosage, parameters and guidelines. Challenge yourself to think about things you normally do to someone and how you can instead educate the patient to do it themselves.
- Instructing individuals through specific tasks that you would usually do physically, step-by-step:
- Exercise Rx
- ROM Ax
- Palpation is a bit of the odd one out as you can't virtually touch someone but can still have the patient do palpation on themselves following your instruction. For example, a patient rolled their ankle, you can have them physically go through the Ottawa Ankle Rules so that you can assess if they need to go for an x-ray.
What Can We Do With This Equipment
The table below was provided by CAPR as the materials you will need to acquire and have in the room with you for the exam.
You can start thinking of how you would apply them to different clinical situations.
Also, just because they made a list of it, doesn't mean you're going to have to use it. They're definitely going to give you a larger list of items than is ever going to be used.
This also doesn't mean that there is a standardized way to use these items.
Below is some quick brainstorming for these items from Anthony and Erik (try to come up with more):
- 2 chairs without arms
- 1 chair with arms
- Pressure relief
- 3 pillow without cases
- Pressure relief
- Postural drainage
- Isometric exercises
- Splinted cough
- 1 bath towel (not rolled)
- Post-op hip and knee exercises
- 1 band towel rolled
- Positioning: prevent posterior pelvic tilt; neck roll
- Post-op hip and knee exercises
- 1 belt/strap
- Post-op hip and knee exercises
- 1 hand towel
- AROM UE exercises
- 1 stick/cane/pole
- You'll see this during the case
- 2 cans of soup (1 large; 1 small)
- External weight for wrist exercises
- 1 small table or desk
- Balance prop
- Surface for UE exercises
- 1 laundry basket
- Instructing proper lifting technique
- 1 footstool
- Dangling (safety purposes)
- Dangling (safety purposes)
8. What Are Some Tips to Help Optimize Communication Skills?
- In a hands-off exam, communication will be the key to success.
- Distance: Keep distance in mind! Too close and you might look intimidating or like you do not know what you are doing, lean too far back, cross your arms, or sit with one hand on the back of the chair and you may look indifferent, calling into question your professionalism.
Non-verbal communication tips:
- Nod head (active listening)
- Open posture
- Look attentive
- Hand gestures or performance of physical examples
Verbal communication tips:
It's ironic that it's usually these simple things that tend to be where people falter.
Likely because people get so stuck on the one technique they can't remember that they abandon these easy tips which would get them half of the marks they need to pass.
- Introduce yourself
- Explain the purpose of the encounter
- Speak slowly and confidently (even if you are unsure): When people speak online they tend to speak a lot faster and for an exam that's dangerous as your mouth can run a lot faster than your brain can keep up. If that happens, breathe, if you need to, ask for a brief moment to step back and re-read the scenario, which is permitted.
- Use plain and basic language: Let's say you're speaking too rapidly or using medical jargon, the patient will ask you to repeat yourself as they don't understand and you will lose time.
- Repeat back: Repeat patient-provided information to confirm accuracy.
- Consistently check-in
- Invite questions
Will There Be Any Stations Where Consent Is Implied?
If you don't need to get consent the station will say, consent has been obtained.
9. Sample Virtual PCE Clinical Case Study
Now go and conquer that PCE!
You have the full support of the entire Embodia team!
MScPT, Hons. BA Kin
Anthony grew up in Georgetown, Ontario where he spent the majority of his time playing a variety of organized team sports. As a result, Anthony combined his love for activity and passion for helping others to pursue a career in physical therapy. Anthony graduated with a Master of Science in Physical Therapy from Queen's University in 2019, following an Honours Bachelor of Arts in Kinesiology from Western University in 2017.
Clinically, Anthony works in both the private and public health spheres. He currently works at a clinic called Leaps & Bounds: Performance Rehabilitation in Oakville, Ontario, where he treats all types of individuals with orthopaedic conditions. When he's not in the clinic, he divides his time between working in the surgery unit at Credit Valley Hospital and working as a casual therapist for Halton Healthcare's three-hospital system.
Outside of practice, Anthony manages his YouTube channel and Instagram page called "The Canadian Physio Student." He created this social media platform in order to (1) answer common questions and concerns of prospective PT students in Canada, and (2) provide insight into what it's like to be a Canadian PT student. Through social media, he's been able to coach and mentor hundreds of current and future PT students, and hopes to continue to do so for many years to come.
PT, B.Kin (Hons), M.Sc.(PT), M.Cl.Sc., FCAMPT
Erik is an experienced and dynamic physiotherapist who has attained advanced training in manual therapy and the McKenzie MDT system.
He worked primarily with national-level athletes and closely with the local orthopedic surgeons. He is also a faculty member of NOSM (The Northern Ontario School of Medicine) where he lectures and hosts in-clinic orthopaedic mentorship for R1 and R2 physicians residents.
He now assists as an instructor to the program while concurrently qualifying to become a Fellow of the Canadian Academy of Manual Therapists, an internationally recognized, highest possible Canadian designation.