Exploring Record Keeping, Clinical Reasoning, and Practice Context: Peer Assessment Findings from the Perspective of Situational Competence.

Abstract

Purpose: The College of Physiotherapists of Ontario developed its peer practice assessment (PA) process on the basis of the statutory requirements for quality assurance. We previously reported outcomes from physiotherapists who had two PAs. The aims of the current research were to identify areas of sub-optimal performance on the assessments and explore any associations with the physiotherapists' practice context. Methods: We examined scores from the PAs of all physiotherapists who had two unrelated PAs between 2004 and 2012 (n=117), and we examined assessment reports for those who had specific patterns of sub-optimal outcomes (n=22). We conducted qualitative content analysis on the assessment reports to identify areas deemed to need improvement and the contexts in which the physiotherapists practised. Comparisons of proportions were carried out using Fisher's exact test. Results: The most common area of sub-optimal scores was record keeping, followed by clinical reasoning as assessed by means of chart-stimulated recall. Record-keeping deficits were related to either clinical care or administrative requirements (e.g., documenting patient consent in the manner required by law). At the second PA, record-keeping deficits were predominantly administrative. Physiotherapists with sub-optimal outcomes disproportionately worked in private practice contexts (p=0.026). Conclusions: Ontario physiotherapists generally maintain high-quality practice. Regulatory bodies may consider developing support strategies for meeting professional standards that take practice context into account.