AMERICAN BOARD OF PHYSICAL THERAPY SPECIALITIES: Enhancing Professional Development through Certification Introductions of Specialty Council members Thank the Geriatric Session for sponsoring the session American Board of Physical Therapy Specialties American Physical Therapy Association

Learning Objectives Upon completion of this presentation, you'll be able to: Discuss the role of specialist certification in advancing your clinical practice and importance to our profession Describe the current areas of specialty practice Provide an overview and describe the process for ABPTS certification and Maintenance of Specialist Certification Program Describe the minimum eligibility requirements and role of clinical residencies Identify top motivations to pursue ABPTS specialist certification Talk is partitioned into two areas of focus. Those interested in learning the nuts and bolts of initial certification Those interested in learning about the requirements for recertification – and specifically how ABPTS will be transitioning into the MOSC cycle from the current 10 year cycle.

The Path to Clinical Excellence The concept of clinical specialization has a long history – with the APTA House of Delegates first approving the concept in 1976. You may have heard that we are recognizing 30 years of specialization this year, as the first three board certified specialists were recognized in 1985. Linda Crane, Scot Irwin and Meryl Cohen 3

Clinical Excellence: Dimensions Knowledge Virtues Movement Clinical Reasoning Multidimensional Patient centered Philosophy of PT Practice Caring Commitment Collaborative process Reflection Specialists embody many important dimensions that are as pertinent today as they were 30 years ago. Central focus Centered on function Jensen GM et al (2000) Phys Ther 80(1):28–43

Clinical Excellence: Potential Pathways Entry level degree Years of experience Continuing education Post–professional residency Post-professional degrees Post-professional certifications Specialization – board certification! It’s remarkable how post professional opportunities have expanded and grown in thirty years. 5

What is Clinical Specialization? A formal process established to: recognize physical therapists with advanced clinical knowledge, experience, and skills in a special area of practice assist consumers and health care community in identifying physical therapists who are specialists address a specific area of patient need Talk about accreditation process for board certification. The National Commission for Certifying Agencies (NCCA) exists to help ensure the health, welfare, and safety of the public through the accreditation of certification programs/organizations that assess professional competence. Certification programs that receive NCCA Accreditation demonstrate compliance with the NCCA’s Standards for the Accreditation of Certification Programs, which were the first standards for professional certification programs developed by the industry.

Key Elements of Board Certification Voluntary You decide Unrestrictive Does not prohibit others Coordinated All areas of specialization managed by a central mechanism: ABPTS

What does Clinical Specialization Require? Broad based foundation of physical therapy education and clinical practice Depth and breadth of knowledge in a specialty area Advanced clinical expertise and skills Knowledge

Purpose of Board Certification Recognize specialists through established testing methods to ensure a defensible process, and a reliable and valid examination Promote highest possible level of physical therapy care ongoing development of science and art underlying each specialty practice Inform stakeholders of physical therapists who are certified in a specialty area There are a lot of steps behind the scenes in order to prepare an examination that is defensible for board certification. ABPTS works with the National Board of Medical Examiners. NBME has a dedicated team that supports all of the examination development – from item writing to establishing a test form and conducting standard setting meetings

Areas of Specialty Practice Recognized through ABPTS Board Certification Cardiovascular & Pulmonary Clinical Electrophysiologic Geriatrics Neurology Orthopaedics Pediatrics Sports Women’s Health

Minimum Eligibility Requirements for Clinical Specialization Certification Current permanent/unrestricted license to practice physical therapy in the United States, District of Columbia, Puerto Rico, or Virgin Islands 2,000 hours minimum of direct patient care as a licensed physical therapist in the specialty area 25% (500 hrs) of which must have occurred in the last 3 years.

Minimum Eligibility Requirements Direct patient care must include activities: in each element of the patient/client management model, as defined in the Guide to Physical Therapy Practice included in the Description of Specialty Practice (DSP) Examination Evaluation Diagnosis Prognosis Intervention 12

Other Eligibility Requirements Specific to the specialty: ACLS certification, Data Analysis Project (Cardiovascular & Pulmonary) Patient reports (Clinical Electrophysiologic) Emergency care certification (Sports) Case reflections (Women’s Health)

Other Option to Meet the Eligibility Requirements for Specialty Certification APTA Credentialed Clinical Residency Program of post-professional clinical and didactic education designed to advance the physical therapist's skill in a defined practice area www.abptrfe.org Residency Curriculum - designed using the Description of Specialty Practice Specialty councils may allow completion of an APTA-credentialed clinical residency to replace all or a portion of the practice eligibility requirements Emphasis on that path – now switching to another path – residency programs. If you are currently in you DPT entry level training – residencies are a way to meet the eligibility requirements in a fairly short period of time.

Board Examination Developed by the Specialty Councils, in collaboration with the National Board of Medical Examiners® A rigorous, criterion referenced exam that tests the application and synthesis of: advanced knowledge clinical skills & reasoning Meryl - Used to be 2 days of paper and pencil testing. Now computerized in 1 day at Prometric centers in US and around the world.

Where to Start? Description of Specialty Practice Self-Assess strengths and weakness Consider patient populations that are familiar and not as familiar Develop a plan and strategy to prepare. Your patients are your best teachers!

Description of Specialty Practice (DSP) Describes the advanced knowledge, skills, and abilities for clinical practice in a specialty area Based on the results of an extensive practice analysis conducted by Specialty Councils and approved by ABPTS Guides the development of the certification exam 17

Components of the Examination* Patient Care Teaching Administration Consultation Communication Interpretation of Research *As defined by a specific DSP

Path towards Clinical Specialization Clinical experience in specialty area Seeking mentors Professional Development Board certified specialists Knowledge and skills Continuing education Post professional clinical residency Post professional education

Preparing for the Board Certification Examination Continuously review and adapt your “path” Use resources from APTA Sections Recommended textbooks Reading lists Advanced Clinical Practice Courses Join a study group Seek the guidance of a mentor Attend continuing education  ABPTS does not approve or review material or course content  Mention poster – addressed how to implement an online support / study group for preparation. Around 2105.

Links to APTA Academy/Section Websites Cardiovascular & Pulmonary: http://www.cardiopt.org Clinical Electrophysiologic and Wound Management: http://www.acewm.org Geriatrics: http://www.geriatricspt.org Neurology: http://www.neuropt.org Orthopaedics: http://www.orthopt.org Pediatrics: http://www.pediatricapta.org Sports: http://www.spts.org Women’s Health: http://www.womenshealthapta.org

Specialist Certification Application Process www.abpts.org On-line Application July 1 – Cardiovascular and Pulmonary, Clinical Electrophysiology and Women's Health July 31 – all other specialties Deadlines for exams APTA Postprofessional Certification and Credentialing All applications are reviewed

Specialist Certification Fees APTA Member Non-Member Application Review $515 $860 Examination $800 $1,525 Total $1,315 $2,385 Board Certification is valid for 10 years

Possible Sources of Financial Assistance Continuing education funds through employer Scholarships Academy of Pediatric Physical Therapy: Carol Gildenberg Dichter Memorial Fund Scholarship

When is the certification exam administered? Once per year, over a two-week exam period Candidates may sit for the exam between February and March 2017: February 27 – March 18

Examination Format Computerized exams, administered at Prometric test centers worldwide www.prometric.com Multiple choice questions including case scenarios, videos, and pictures 26

Recognition of Certified Clinical Specialists Opening Ceremony of APTA Combined Sections Meeting APTA sections and State chapters Inclusion in online Directory of Certified Specialists Only individuals who have successfully completed the ABPTS certification process may use the term: “Board-Certified Clinical Specialist”

Board-Certified Clinical Specialists Who Are They?

Number of Certified Specialists by Year Total as of June 2016: 20,144 individuals

Certified Specialists by Area Cardiovascular & Pulmonary 254 Clinical Electrophysiologic 177 Geriatrics 2,133 Neurology 1,988 Orthopaedics 11,730 Pediatrics 1,615 Sports 1,914 Women’s Health 333 Total in 2016 = 20,144 30

Certified Clinical Specialists: Age Data current as of June 2014

Certified Clinical Specialists: Gender Data current as of June 2014

Certified Clinical Specialists: Work Settings Private PT Offices Health systems or hospital-based outpatient facility or clinics Academic Institutions

Certified Clinical Specialists: Positions Held Supervisor/Director of PT Staff or Senior PT Sole Owner/Partner PT Practice Academic Faculty

Why do physical therapists become Board Certified Clinical Specialists?

Perspective on ABPTS Specialization Initial Certification = Starting Point Mind Set Commitment Continued practice as a Certified Specialist Once start the process – you will part of ongoing development activities. To stay current and advanced in PT practice To be a lifelong learner

Top Motivations to Pursue ABPTS Certification Professional career goal Personal challenge or achievement Earn a credential that reflects advanced practice to patients, physicians, & payers Proof of expertise in specialty area Career ladders within organizaitons Source: Survey of certified specialists (2013)

Mentors with Passion, Patients, & Profession Why I did it…. Staff PT Senior PT Academic role MS / NCS PhD Employment 0-3 3-5 7+ 11+ ABPTS 10 11+ Initial Certification SACE / Neuro Specialty Council / Chair = Years since graduation Mentors with Passion, Patients, & Profession

Positive Impact of Board Certification Sense of personal achievement Self-confidence & professional growth Patient care, including better outcomes Increased credibility with patients & referral sources Recognition in clinical, academic and community settings Source: Survey of certified specialists (2007)

How has board specialty certification influenced the careers of Specialists? Opened doors for professional growth Consultations Invited Presentations New job opportunities Leadership & service Teaching opportunities Research collaboration Networking

Service Opportunities Related to Specialization ABPTS Oversees all specialties Specialty Councils Oversee exam development process, MOSC, practice analysis SME Conduct exam standard setting and specialty practice analysis CCE Edit exam items Mentor SACE SACE Write exam items

Employer Support of ABPTS Certification 53% pay at least some of the costs associated with obtaining clinical specialization. 43% give priority in hiring to job applicants who are board certified. Employers value the expertise of specialist. Have high patient care standards Serve as mentors for others Provide team leadership

Value of ABPTS Certification to Certified Specialists 79% report that certification is an indicator of clinical competence 90% report that certification is an indicator of depth and breadth of knowledge in an area of specialty practice High rate (68%) of specialists choose to recertify Source: Survey of certified specialists (2007)

Specialist Recertification: Purpose Verify current competence as an advanced practitioner in a specialty area Encourage ongoing education and professional growth

Specialist Recertification: Requirements For specialists certified before 2013: Direct patient care hours in specialty (2,000 hr) AND Professional Development Portfolio OR Current written examination OR Graduation from a credentialed APTA clinical residency 45

Professional Development Portfolio (PDP) Documentation of professional development activities and advanced clinical practice related to specialty practice, since initial certification Examples: Continuing Education courses Clinical Supervision College/University courses Teaching continuing education or college courses Research presentations Presentations to professional groups or in-services Presentations to community or client-based groups Author or editor of book chapters, journal articles, grant proposals Committee membership in professional organization Consultation

MOSC: Purpose and Model More effectively verify current competence as an advanced practitioner in the specialty area More effectively evaluate professional development and clinical experience Better encourage ongoing education and professional growth Keep pace with the rapidly expanding specialty knowledge base and scientific evidence that guides clinical decision-making Promote improved health outcomes related to physical therapy specialty services

Maintenance of Specialist Certification Licensure & Professional Standing Practice Performance & Clinical Care and Reasoning Cognitive Expertise Lifelong Learning & Professional Development Certification Cycle Year 3 MOSC 6 9 10

Minimum Eligibility Requirements of MOSC 1. Professional Standing and Direct Patient Care Hours Evidence of Current Licensure as a physical therapist in the United States, the District of Columbia, Puerto Rico or the Virgin Islands Direct Patient Care in the Specialty Area Evidence of 200 hours of direct patient care in the specialty practice within each three (3) year submission period Hours accrued in year 10 applied to the next three year submission period Direct patient care in the specialty area must include activities in each of the elements of patient/client management applicable to the specialty practice and included in the Description of Specialty Practice.

Minimum Eligibility Requirements of MOSC 2. Commitment to Life Long Learning through Professional Development Mimics the information captured in the current PDP (professional services, continuing education coursework, publications, presentations, clinical supervision and consultation, research, clinical instruction, teaching) Minimum requirements for each three (3) submission period across three (3)designated activity areas Minimum of 10 MOSC credits, within 2 of the 3 designated activity categories, in years 3, 6, and 9. By year 9, a specialist must have accrued a minimum of 30 MOSC credits, and demonstrated professional development in each of the 3 designated activity categories. A web-based submission/tracking system Recommendations: 1.      Demonstration of a certified specialist’s commitment to life-long learning should mimic the information captured in the current PDP. 2.      The PDP current point system should not be continued in the new model.   3.      Recommend increased flexibility and more direct examples of what would be acceptable while maintaining the current categories for research and practice. a.      Acceptable activities would need to go beyond simple attendance at continuing education workshops. Activities should include: continuing education coursework, publications, presentations, clinical instruction, or teaching. 4.      An individual must demonstrate how their participation in the various activities contributed in some way to the profession. 5.      Documentation of activities should be submitted on an annual basis, covering multiple activities. However, if special circumstances arise for candidates that prohibit an annual submission, it should be taken this into consideration and a extension or waiver for the year would be appropriately granted. 6.      Staff will put together a proposed schedule, including activity areas to be covered by certified specialists, based on the current activity listings in specialty PDP summary worksheets. 7.      Staff will continue to work with APTA’s IT Department to determine how best to secure a web-based system to track continuing competence in a specialty area.                                                   i.    The web-based system should provide an individual account tracking mechanism for each specialist to record professional development activities during years 1-7 of their certification cycle.                                                 ii.      System should be a component of APTA’s Learning Center. However, the development of this module within the Learning Center is currently on hold. Staff will continue to communicate with APTA’s Professional Development Committee to assure we are kept up-to-date on current timelines and developments. 8.      There is NOT an hour requirement in this area but the specialist must show evidence of professional development activities with, at minimum, annual documentation of professional development activities.  These activities include continuing education coursework, publications, presentations, clinical instruction, or teaching.

Minimum Eligibility Requirements of MOSC 3. Practice Performance through Examples of Clinical Care and Clinical Reasoning Online submission of one (1) Reflective Portfolio for each three (3) year submission period Demonstrate the clinical care and reasoning utilized and reflect how a patient case(s) has impacted practice Not scored, but screened for completion of required information and reflection Case reflection based on the Women’s Health initial certification case study requirement including an evidence-based component possibly a clinical bottom-line format.

Minimum Eligibility Requirements of MOSC 4. Cognitive Expertise through Examination Recertification examination, comprised of approximately 100 items in year ten. Exam blueprint will mirror that of initial certification exam/DPS, but will reflect contemporary specialist practice and allow a specialist to demonstrate continued competency in general areas of the profession (professional roles, responsibilities, values) Successful completion of requirements 1-3 at each three (3) year submission period are prerequisites Permitted two attempts without loss of credential Demonstrate continued competency in general areas of the profession, such as knowledge areas, professional roles and responsibilities, coordination/communication/ documentation, and patient/client related instruction. 

MOSC: Timeline Recertification Model MOSC Model Transition Period prior to 2013 Transition Period started 2013 MOSC Model Full implementation in 2016 Will present the transition from the PDP to MOSC timeline in 3 formats: figure / text / table – people learn in various ways. All are repeating the same thing. So 2/3 may help you – or 1/3 or all 3!

Transition & Implementation Phase: 2013-16 All individuals who are newly certified or recertified as of 2013 will be subject to the new MOSC process. This will include a waiver of the first 3-year requirements, meaning that board-certified specialists certified or recertified in 2013 and 2014, and those who will certify and recertify in 2015, will be required to fulfill the year 6 (second 3-year) requirements beginning in 2016, 2017, and 2018 respectively.  As of 2016, all individuals who will newly certify or recertify will be subject to the MOSC process, as described, in its entirety.

Timeline for MOSC Implementation   2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2012 4 5 6 7 8 9 10-PDP 1 2 MOSC 2013 3 10-Exam 2014 2015 PDP

For more information contact: APTA Postprofessional Certification and Credentialing 1111 North Fairfax Street Alexandria, VA 22314 800/999-2782, ext 8520 www.abpts.org

Questions

Literature about Specialization or Specialists Conrad S. Taking on the Specialist Certification Exam - And Winning. Perspectives for New Professionals of the American Physical Therapy Association. February, 2013. Stepp DD. Focus your career: Specialist Certification. Perspectives for New Professionals of the American Physical Therapy Association. May, 2010. Bryan J, Blake A. How do other health care professionals view specialist certification? PT Magazine. 2004;12(9):54-57. Bryan J, Gill-Body K, Blake A. How employers view specialist certification. PT Magazine. 2003;11(1):50-51. Thompson M. The role of higher education in the career paths of board-certified clinical specialists in geriatric physical therapy: implications for professional and post professional education. J Phys Ther Educ. 2001;15(2):10-16.

Literature about Specialization or Specialists Hart DL, Dobrzykowski EZ. Influence of orthopaedic clinical specialist certification on clinical outcomes. J Orthop Sports Phys Ther. 2000;30(4):183-193 Milidonis MK, Godges JJ, Jensen GM. Nature of clinical practice for specialists in orthopaedic physical therapy. J Orthop Sports Phys Ther. 1999;29(4):240-247 Ellison J, Becker M, Nelson AJ. Attitudes of physical therapists who possess sports specialist certification. J Orthop Sports Phys Ther. 1997;25(6):400-406

Literature about Specialization or Specialists Smith LC. The decision to specialize. PT Magazine. 2001;9(6):52-59 Edmonds MM. What if? PT Magazine. 1999;7(4):44-49 Wynn KE. Why recertify? PT Magazine. 1996;4(11):68-70 Williams DO. Answering the bell: PTs & school sports. PT Magazine. 1996;4(12):36-39 Woods EN. What’s so special about specialist certification? PT Magazine. 1994;2(2):46-51 Ferrier MPB. One stage in professional evolution. Clinical Management. 1991;11(2):66-70