CPA PCE Town Hall: Questions and Answers

Thank you to all members and candidates who sent questions and concerns about the current PCE exam process.

As a result of work being done by CPA in advance of the latest failure of the PCE Clinical Component delivery, as well as in response to the discussion at CPA’s Town Hall on September 14, 2021, the CPA has developed its three-point plan to addressing the entry practice issues in the province. This plan can be read here.

You’ve asked about a range of topics, from mental health to licensing. Our responses to your thoughtful questions are below.

Many of you are wondering what CPA has been doing to address this issue. An example of your questions:

What is the line in the sand where the national association, that is funded and made up of grass roots members, begins to advocate for its future grass roots members?

What are the specific actions being pursued by the CPA to necessitate CAPR and the Colleges to earnestly and comprehensively review the current accreditation system?

How does the CPA plan to adapt their advocacy for the cancellation of the exam, like your original statement indicated in March?

I am disappointed with the lack of conspicuous, public facing advocacy. Engaging media, particularly reporters with health as their beat, appears to be a tactic that has been underemployed. Another tactic to consider that may apply the pressure that seems to be needed is authoring and distributing an opinion editorial to targeted national media organizations. Such as ones frequently done by the OMA and RNA.

What has the CPA, specifically, done to influence the Colleges or Ministries of Health?

Since March 2020, the CPA and our provincial and territorial Branches have been working hard, advocating for an alternate, rapid path to full registration, a solution that rests solely in the power of the 11 regulators to implement. We have proposed solutions and advocated for legislative changes, waiving the clinical component, increasing clinical practice quality assurance programs, and implementing alternate examinations. We’ve called for the immediate return of all candidates’ fees for the cancelled exams, demonstrated the impact PCE failures have had on candidates, and voiced the concerns of countless candidates over and over. We are as frustrated as you are with the lack of response.

Yet, we know that innovation and solutions are possible. The regulators in BC, Alberta, New Brunswick and Quebec have either ended their reliance on the PCE exam or instituted alternate licensing options. Rest assured that we will continue to work on your behalf and push for a solution that serves the candidates, the profession and Canadians.

In Canada, we operate in a federated model. The CPA is charged with addressing national issues with the federal government and on the national stage. The CPA intends to continue its advocacy role in developing a national, multi-stakeholder discussion on this issue of importance, despite that licensure regulation occurs province by province.

Within the context of the PCE in particular, we work alongside our Branches, to ensure messaging and approaches at the provincial and territorial levels reflect national-alignment but respect provincial autonomy, and each unique jurisdiction. The failure of an exam which is a national solution to a provincial mandate, requires an intricate collaboration of unique messages depending on the College and Ministry of Health. The CPA supports, provides resources and shares with the Branches who own the relationships with, lead the conversations with, and collaborate alongside the Colleges.

Some of your questions were specific, pertaining to the origins or intended purpose of the PCE.

Many are questioning the need for and value of the PCE clinical exam – what benefit does it serve?

How is the public protected by the exam?

These are questions that the CPA has heard from many individuals, including candidates, PTs in practice and from the academic and regulatory community. A professional competency exam is designed and intended to protect the public from less than competent practitioners. Many professions have competency examinations as a step in the pathway to licensure; this step is designed to protect the public and to protect the integrity of the profession.

There is more than one way to assess competence, and the CPA has asked that alternatives to the CAPR-delivered clinical component of the PCE be considered by regulators, in order to attest to the competency of physiotherapists entering practice and to continue to uphold the standard of safety that Canadians expect from our profession. The CPA does not claim to be the experts in assessment and psychometrics. We do believe that this situation warrants a robust discussion with all stakeholders and subject matter experts about the long-term future of entry to practice and licensure for physiotherapists working in Canada. We acknowledge and look forward to participating in CAPR’s Innovation Agenda, on this topic, in the future. We remain committed to a transparent, multi-stakeholder approach to tackling such an important question in a self-regulated profession.

Some of your questions reflected a concern about mental health and wellness:

Why is the CPA allowing CAPR to play with our sanity like this knowing that this exam is outdate and is not valid according to Bobos et al. 2021 ? 

Why is our mental and financial hardships not taken into consideration?

I am currently scheduled to take the Clinical Exam September 18. I have had to reduce my work schedule to 3-4 days per week in order to manage my anxiety before the exam. I had to miss 2 additional days of work due to experiencing an anxiety attack that left me unable to work. Currently, I am the only source of income for my family.

We know that the ongoing issues with the PCE exam place an absolutely unacceptable burden on candidates. We have been clear with CAPR and the regulators about this burden – financial, professional and mental – yet we have not seen a solution that would relieve it. Responsibility for the solution – an alternate, rapid path to full registration — rests solely in the power of the 11 regulators to implement.

We stand committed to being the voice and champions for candidates. We have been dismayed by the experiences you’ve lived, and we won’t stop our advocacy until this issue is addressed.

Many candidates are experiencing distress as they prepare for and challenge the PCE Clinical Component. If you require support during this time and are experiencing distress, there are free, confidential and 24/7 resources immediately available to you:

• English Language: https://wellnesstogether.ca/en-CA/crisis
• French Language: https://wellnesstogether.ca/fr-CA/crisis

Many of you had questions about fairness:

Is there a conflict of interest between any member of the Colleges and CAPR?

Why is CAPR allowed 4 attempts to try to administer the exam while candidates are only allowed 3 attempts? 

My concern is how is the exam valid/reliable and fair if certain residents got to see the questions during their initial exam, and then once again in the “make up” exam. These students seem to have an unfair advantage by both knowing, and having an opportunity to prepare for the question. 

The latest issues with the PCE exam have been very difficult for all concerned. We share in the deep disappointment felt by everyone in the profession and especially the distress felt by all of you. The CPA stands in support of the more than 3,000 candidates who have been in limbo for almost two years now. We know that every candidate simply wants the opportunity to complete the exam and become fully licensed. We have been advocating tirelessly for almost two years for a resolution to this untenable situation.

We remain committed to engaging with CAPR’s Innovation Agenda as an opportunity to examine these very real concerns about the exam and to think critically about the role the exam plays in the future.

Finally, some of you simply wanted to share your frustrations, suggestions and concerns:

I would like to propose some alternatives: Require a supervisor to evaluate our work and to sign off or submit any concerns for further follow up within a year. I think this is the best way to see if we are competent or not. 

I spoke to a physician last month, where they lost their new physio hire in a pelvic health program, due to no PCE exam , and they had no one to supervise her. She said they lost a perfect candidate due to the PCE!  How many more situations like this have been created?

This announcement is outrageous because this exam is a high stakes exam, which determines whether or not candidates can fully practice physiotherapy after 6+ years of post-secondary education. CAPR only allows 3 attempts at this exam, and every candidate has made sacrifices to prepare multiple times for this exam. Many candidates have experienced severe mental and financial hardships due to these disorganized exams. For CAPR to perceive the first 12 candidates as expendable guinea pigs to see if an online testing platform will work during an official national exam shows CAPR’s does not value the physiotherapy candidates or the profession of physiotherapy in Canada.

CAPR’s CEO Message: This message was EXTREMELY distressing (and embarrassing) to many of us students and PT colleagues. A message that claims to know the feelings of us all – as our Dr. Whittaker puts it – these comments were “Paternalistic, unprofessional, and unacceptable”.

We share your frustration. This situation simply cannot continue and we are pushing hard for a resolution from the colleges, who have the sole power to fix this situation. In the meantime, we will share your views with CAPR and the Colleges. We are looking at a new approach to our advocacy and will provide details as soon as we’re able.

Thank you,

Amanda de Chastelain
President