Clinician’s Commentary on Miller et al.

For novice physiotherapy students to evolve into entry-to-practice professionals, they must meet the well-defined educational and regulatory milestones required to demonstrate that they have attained the physiotherapy essential competencies necessary to ensure that they are delivering safe and quality care to their patients.² Beyond becoming licensed, physiotherapists must maintain their essential competencies throughout their careers by adhering to regulations and engaging in continuing professional development to ensure that their practice is evidence informed,² although this is a variable and less formal process.

Controlled acts and restricted activities introduce an element of higher risk into a practice, and physiotherapists are responsible for deciding to perform them. They are required to demonstrate that they meet the regulatory standards to safely perform them or delegate higher-risk activities by virtue of their formal education, on-the-job training, and clinical experience.³ In Ontario, physiotherapists who perform controlled acts under their own authority, such as tracheal suctioning and administering a substance by inhalation, must undergo a mandatory self-report professional competency assessment before rostering on their professional college’s public register.³ Research has shown that periodic competence assessments of health care professionals are an important consideration for activities that are low volume, high risk, or critical.⁴

Although the controlled act of tracheal suctioning has a higher risk, it may be a high-volume activity for physiotherapists in certain settings or specializations. Alternatively, it may be an infrequent activity in certain other settings and client or patient populations or for generalists and part-time or casual physiotherapists. It is particularly imperative for physiotherapists who have returned to professional practice after several years absence or who have changed their practice setting or area of specialization to ensure clinical competence for higher-risk activities. Changes in client or patient populations, the introduction of new equipment and technologies, and advances in medical and surgical management all inform clinical practice. Physiotherapists must continually learn and adapt so that they can ensure that their practice is safe, high quality, and informed by emerging evidence.

In their Physiotherapy Canada article, Miller and colleagues addressed the need to assess the clinical competency of physiotherapists who practise higher-risk health care activities by developing a preliminary but updated and comprehensive tool to assess the performance of airway suctioning.¹ This tool was the outcome of reviewing recent literature, adhering to clinical practice guidelines, and listening to the feedback obtained from experienced Canadian physiotherapists in both clinical and academic settings. By addressing the considerations for low-volume activities, Miller and colleagues intended the tool to apply beyond the intensive and critical care environments to a variety of practice settings as well as different suctioning approaches. They also ensured that the tool highlighted the multiple professional competencies that often accompany a treatment technique beyond simply technical skills, such as the judgement to make sound clinical decisions and manage adverse events, and communication. The final iteration of the tool incorporated four domains and 43 supporting competencies.

Although the tool’s utility will be evaluated in a future study, it is essential that any tool that assesses professional competency have the flexibility to be revised and refined over time. The development of this tool took into account consolidated expert opinion because there was a lack of supporting evidence across all practice settings and suctioning approaches; however, as new evidence emerges, the strength of evidence and recommendations is increased by the findings of larger studies, and current, expert opinion will either be further supported or deemed outdated, nonapplicable, or ineffective. This process aligns with physiotherapists’ responsibility to maintain a high standard of professional practice by practising self-governance; committing to lifelong learning and the ongoing professional development of their knowledge, skills, and judgement throughout their careers; and identifying any learning and practice gaps so that they can deliver evidence-based best practice.