FAQs re: Continuing Competence Exam

1. What evidence supports the use of key features case-based assessment (KCA) to measure competence and responsible decision making in practice?
    
Luckily we can benefit from many costly experiments in the last 15 years. The key features, case-based assessment approach is a written test - a proxy of actual performance, i.e. what you do in real practice. Although visiting each and every occupational therapist in their practice setting, over an extended period of time may have the best validity and reliability for assessing performance, it is extremely expensive. As a result, the committee had to choose the best approach. Therefore, the decision was based on both the cost-effectiveness and evidence.

The evidence suggests that this type of tool should use case-based materials presented in a way that will activate the participant’s clinical reasoning. The key features approach to using cases was an outcome of the first Cambridge Conference, a ‘think tank’ on clinical reasoning (Norman et al, 1992) and was adopted by the Medical Council of Canada for its certification examination. The cases and questions are structured in a way that will test whether the participant can successfully identify the key features that are critical to the successful resolution of a problem. Evaluation of the key feature approach demonstrated higher reliability and validity over other competence assessments (Page & Bordage, 1995; Fischer et al., 2005; Norman et al., 2006).
 
2. Am I expected to be able to answer questions correctly in areas of practice that I have not worked in? Will you be testing my advanced knowledge?
    
We recognize that after graduation occupational therapists focus the development of their competence in specific areas of practice. In April 2010, we surveyed occupational therapists to validate areas of practice, as well as the essential competencies and regulatory topics that they felt were important and were needed regularly in day-to-day practice. This process was the first step in developing a blueprint for the Competence Exam.

The Board has approved the following recommendation from the Continuing Competence Committee.

Occupational therapists will be required to choose from one of the following four areas of practice:

1. Adult and Older Adult Physical Health
2. Adult and Older Adult Neurological Health
3. Adult and Older Adult Mental Health
4. Child and Youth Health

 
3. I am an administrator and don’t work in a clinical role. Will I need to take the Continuing Competence Exam?
    
The legislation and government are most concerned regarding direct client care. Occupational therapists without any direct contact with and/or responsibilities to a client are exempt from writing the Continuing Competence Exam. The recently published Third Edition of the  Essential Competencies of Practice for Occupational Therapists in Canada includes nonclinical competencies and further defines the work of occupational therapists that is not direct client care.
 
4. I just passed the National Certification Exam (NOTCE) administered by the Canadian Association of Occupational Therapists (CAOT). How soon after taking the NOTCE will I have to do the COTBC Continuing Competence Exam?

Undecided. Successfully passing the NOTCE is an important indicator of your entry-level competence to practice safe, ethically and effectively. There are other aspects of competence that may put you into a higher risk category where you will be asked to complete the assessment earlier than other occupational therapists in BC. For example, it might be that we need to monitor and support more closely new graduates working in isolated or unsupported practice areas.
 
5. Will everyone be taking the COTBC Continuing Competence Exam at the same time?

No. The exam will be held every 3 years for 50% of the registrants who are randomly selected for the first sitting in 2014.
 
6. When does the college expect to have the first sitting of the exam?

The current plan is that those who are part of the first sitting will be notified in the Fall of 2013 and will take the assessment in 2014. Please note this is now delayed a year from what was first announced.
 
7. How often do we have to take the exam?

Every 6 years.
 
8. What happens if I don’t 'pass'?

Those who are not successful the first time will get detailed feedback on the areas of weakness and then have another chance to write the exam. If not successful on the second try, those registrants will be provided with the third component: Competence Improvement - a customized, personalized, confidential plan to assist in meeting established standards.
 
9. What exactly is competence?

Competent practice depends on three elements:
1. Context of practice - where practice occurs (the practice milieu including the who (types of clients, groups, populations), what (areas of practice, types of service), where (practice settings), and how (professional roles, funding models) in which individuals may practice. The areas describing the context of practice are interrelated and impact on the essential competencies needed for safe and effective practice.

2. Capability of individual (physical, mental, emotional potential, and facility of an individual that enables him or her to fulfill a professional role.

3. Competencies demonstrated by an individual. This reflects the knowledge, skills, and attitudes to achieve a major part of one’s job; these expectations are set by the profession (Glover Takahashi, S., McIIroy, J., & Beggs, C., 2008). In BC, occupational therapists meet the Essential Competencies of Practice for Occupational Therapists in Canada (3rd ed.) (Association of Canadian Occupational Therapy Regulatory Organizations, 2011).