Since the inception of physical therapy clinical specialization in 1978, board certification was not life long but was valid for a period of ten years. In order to be recredentialed as a specialist, the specialist had to demonstrate ongoing practice in the specialty area by meeting a minimum number of practice hours and also by either passing the exam again or preparing a professional development portfolio (PDP). Recently, several issues have been come to the attention of ABPTS regarding this recredentialing process:
- Most specialists (88%) have chosen to re-credential using the PDP option. While this shows ongoing activity in the specialty area, there is little quality control regarding the specific activities listed on the PDP and there is no independent assessment of knowledge in the specialty area.
- The specialty councils have repeatedly attempted to revise the PDP to improve the quality of data and the representativeness of specialty practice, but in spite of multiple revisions, there continues to be a shared sense among the specialty councils and the ABPTS that the PDPs do not capture the essence of specialist practice.
- As the number of specialists has increased over the past 25 years, the workload required by some specialty councils (e.g. Orthopedics) to review the PDP documents has become overwhelming.
- A study of recredentialing of multiple health care professions conducted by ABPTS in 2002-03 suggested that most certification boards were not using a portfolio approach.
These issues resulted in the ABPTS deciding to place a moratorium on PDP changes in 2004 and a decision to proceed with redesigning the recredentialing process. One strong theme that emerged from discussions on recredentialing was to move to a model of continued competency throughout the years of certification rather than a one time recertification process as the certification period lapses. Adopting a model of demonstrating continued competency would permit ABPTS to achieve three goals identified as being important to the implementation of a new recredentialing process: (1) reflect successful components of current process; (2) correct flaws in current process; and (3) consider and potentially adopt methods that are successful for other professional groups. The proposed model would provide board-certified clinical specialists with:
- A simple record of clinical practice hours
- A recording of professional development activity
- Reliable/valid evidence of continuous development of clinical reasoning and skill as judged by peers (cases)
- Reliable/valid evidence of cognitive competence with practice evolution (exam)
The American Board of Medical Specialties (ABMS) has addressed this issue with regard to the credentialing of specialty areas in medicine. ABMS established a task force on competence of physicians and this group developed a trademarked program entitled “Maintenance of Certification” which consists of four key elements, including evidence of (1) professional standing, (2) commitment to lifelong learning, (3) cognitive expertise, and (4) evaluation of practice performance1,2,3. In order to assure the consumer of ongoing quality and safety of patient care, there is a need to design recredentialing processes which include evidence of multiple aspects of patient care rather than documenting of practice hours and associated specialist activities.
The ABPTS has developed a model for credentialing that focuses on continued competence of the physical therapist specialist. This new model has been titled the “Maintenance of Specialist Certification” and includes the following elements:
- Professional Standing and Direct Patient Care Hours
- Commitment to Life Long Learning through Professional Development
- Practice Performance through Examples of Patient Care and Clinical Reasoning
- Cognitive expertise through a Test of Knowledge in the Profession
In June of 2009, a work group was established by ABPTS comprised of current and past ABPTS members, and representatives from the ABPTS specialty councils. This work group was tasked with proposing requirements to meet each of the above elements. The outcomes of their deliberations are detailed within this summary proposal.