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Physiotherapy Competency Exam (PCE) Clinical Component Cancelled for Third Time – Is it Time for a Change?
By: Nataliya Zlotnikov, HBSc, MSc

Written: 30 March 2021
Updated: 8 April 2021

It Happened on the First Day of Spring 

March 20, the first day of spring saw hundreds of physiotherapy graduates spring up out of bed with the anticipation of finally taking the Clinical Component of the Physiotherapy Competency Exam (PCE). 

Yet not all springs end winter.

Shortly after the launch of the exam on early Saturday morning, the Canadian Alliance of Physiotherapy Regulators (CAPR) cancelled the examination due to significant technical difficulties. 

In case you haven't been following, this is the third time that CAPR has cancelled the exam since the start of the pandemic. 

Did CAPR Try?

I have never worked at CAPR and therefore cannot presume to understand the inner workings of their organization. 

We cannot deny that COVID has been such a tumultuous time for all of us, so of course, some technical issues are to be anticipated. 

CAPR is just trying to do its' job. 

And CAPR did in fact prepare itself for the possibility of technical issues, as well as trying to prepare examinees. On 16 March 2021 CAPR posted a Clinical Component Troubleshooting and Contingency Measures Webinar on YouTube.

This video contains a presentation about how CAPR planned to mitigate and manage technical issues related to the 2021 Clinical Component, as well as a segment that addresses troubleshooting and technical questions frequently asked by candidates.

Due Diligence Was Due

CAPR indicated that their virtual PCE was being facilitated through their vendors ProctorU and Education Management Solutions (EMS), with whom they have had extensive preparatory work. 

EMS is an industry pioneer in simulation-based solutions for healthcare training environments and checks out just fine. 

ProctorU is a secure, live, online proctoring service that allows exam takers to complete their assessments at home.

Now, if you enter 'ProctorU' into a Google search, the first thing you see is "ProctorU is TERRIBLE." So you objectively proceed to take a look at some reviews. 

Trustpilot has 272 reviews of ProctorU and a star rating of 1 - bad; >99% of reviewers gave them the lowest review possible. 

Were all 272 reviews written after the March exam cancellation? Good question, but no, most were written prior to this date.

And 'terrible' is one of the kindest words used to describe this business.

Reviews cite lack of professionalism, uselessness, technical issues, stress, waste of time, and more. Referring to the company as absolutely horrendous, incompetent, a joke, and that they cannot be worse. 

G2 also has similar reviews about ProctorU. 

The involvement of ProctorU could be indicative of callous disregard for the mental and emotional well-being of these graduates. Perhaps more thorough research was necessary to afford these graduates and future physiotherapists the respect that they deserve. 

But Why Is the Cancellation Such a Problem?

Below are a few of the reasons why this third cancellation is such an outrage:

  1. Loss of income: Many students have taken time off their jobs to prepare for the exam (three times). 
  2. Decreased wage: Graduates can practice while they wait for their exam, but they're often paid less and are unable to specialize.
  3. Drawn out process: Usually, the exams are taken close to graduation so that all the knowledge is fresh; many students have been graduated for over 1 year.
  4. Debt: Graduates cannot pay back student loans.
  5. Overburdened healthcare system: These delays are exacerbating a shortage of physios in our already overburdened healthcare system.
  6. New immigrant physios: Some new immigrants to Canada, often arriving with families and children to support, with years of physiotherapy experience, cannot gain employment here until taking the exam.
  7. Frustration: Just take a second to pretend that it was you trying to take the exam three times, this one needs no explaining, frustration is an understatement.
  8. Worsened mental health: Mentally preparing yourself for various formats (in-person, virtual) of a life-changing, costly exam three times will take its toll on anyone. In addition, the increased uncertainty and powerlessness surrounding one's future and economic stability further exacerbates anxiety and other mental health issues.  

What CAPR Offered (March 22, 2021)

  • A full refund of the Clinical Component fee to candidates registered for the March 20/21 exam.
  • These candidates will be able to take the exam at no cost at a future date and will be able to maintain their ‘place in line’.
  • CAPR will also provide the March 20/21 candidates with access to professional and confidential counselling services at no cost.

But, Is It Enough for the People?

No, the people (as well as the Canadian Physiotherapy Association (CPA)) are not pleased. And I for one cannot blame them.  

Image source: CTV News 

Many graduates are asking for the suspension of the requirement for completion of the clinical component of the PCE to be eligible for licensure.

The graduates have the full support of the CPA, who has taken a strong and supportive role. A round of applause to the CPA.

CPA: The Canadian People's Association* 

*Of course, that's a play on words, but the Canadian Physiotherapy Association has really shown up for the people of PT in this dire time. 

Here they deliver a professional, well-thought-out statement on the impact of the PCE cancellation on candidates.

Some highlights from this statement include the following important points:

  • The role of the PCE is to test the essential competencies of physiotherapy practice. The PCE is not the only way to assess that competency. 
  • CAPR needs to be innovative and creative in their approach to ensure that public safety is upheld. 
  • Rescheduling the virtual exam is not an acceptable answer.
  • There is evidence that exemptions can be developed (other relevant Colleges have changed regulation during the pandemic as needed). 
  • Furthermore, candidates of the PCE have substantial training to ensure they meet the competencies required of a physiotherapist. Patient safety is embedded into every Core Knowledge stage of training to ensure entry-to-practice proficiency.
  • Candidates eligible for the clinical component of the PCE have completed over 1000 clinical hours where they have been evaluated and deemed safe by numerous registered physiotherapists and have completed the written national licensing exam.

As a result, the CPA is calling for the following: 

  1. CAPR to immediately return all fees collected from candidates who are waiting on the clinical component of the PCE (CAPR is returning these fees).
  2. The provincial Regulators (Colleges) to immediately suspend the requirement for completion of the clinical component of the PCE to be eligible for licensure in every province.

In addition, the CPA is asking the provincial Regulators to use this as an opportunity to reevaluate the PCE including current requirements, the viability of the testing, the efficacy of the test to meet the required standards, and more.

Ontario's Universities Support 

Ontario's five University Physiotherapy Programs acknowledge the impact of the PCE cancellation and recognize the graduates as important members of the physiotherapy community, applauding them for their resilience in these difficult times. 

They are committed and willing to work with all partners on a solution that will facilitate safe entry to independent practice of candidates as soon as possible. 

Innovation

We cannot deny that COVID has been such a tumultuous time for all of us, however, COVID is no longer an acceptable excuse. 

Healthcare has often been an industry that is resistant to change and risk, and with good reason - we have the lives and well-being of other humans in our hands, you really don't want to take any chances.

But innovation and creativity are the stuff that the future is made of. Current graduates are our future. Treating our future physiotherapy professionals this way is unacceptable.

We echo and support the CPA in their statements. It's time we put people first! It's time for change! 

Status Update 9 Days Later: CAPR is Reviewing

On March 31 CAPR announced that they had retained PricewaterhouseCoopers (PwC), a third-party expert to conduct an independent, external, comprehensive review to evaluate the root cause of the failure associated with the exam and provide recommendations to prevent them from happening again. 

CAPR is also working with their service providers to understand how this failure occurred. Education Management Solutions (EMS), one of their service providers, is conducting its own internal investigation.

CAPR states that they will work as quickly as possible to determine a path forward for future exams but ask that we give PwC the time required to conduct its independent investigation. 

In addition, CAPR is now working closely with physiotherapy regulators regarding issues relating to the licensing process and invites all candidates to contact their provincial registrar for more information.

Here, CAPR also issues a sincere apology to those who have been negatively impacted.

Are They Sincere?

Some of you may doubt the sincerity of the sincere apology, why didn't it come sooner? It is merely a response to all the uproar and negative media attention? Was CAPR backed into a corner?

We may speculate but possibly never know. Only time will tell.  In the meantime, great job community, on all the noise and the positive change that it might engender - leave no one behind!

What Can You Do to Support the Residents and Our Colleagues?

  1. Sign the petition: The purpose of this petition is to advocate for the cancellation of the clinical component of the CAPR's PCE exam. https://www.change.org/p/physiotherapists-cancel-the-clinical-pce-exam 
  2. Join the PCE conversation: FREE Webinar: Saturday, April 10th at 11 am Eastern (8 am Pacific) with Darryl Yardley and other expert panellists. https://mycallhero.com/pce/ 
  3. Write: Send and send letters.
    KidsPhysio created templates for you to use.  https://www.kidsphysio.ca/change/
  4. Dance in solidarity: Post your dance on social (you can see ours below for reference).

We Are With You in This Moment!

We are with you in this moment. 

We understand that this has been a surreal and painful time for so many of you in our community. 

The Embodia team is a click away. Tell us what you think, tell us what you need. 

Embodia Community Dance Video In Solidarity With PT Resident Colleagues

Written: 30 March 2021
Updated: 8 April 2021

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