Development of a Competency-based Clinical Education Assessment: The ACC

When I sat down with Ms. Wagner, her passion for competency-based education was immediately apparent. She explained that moving from a traditional to a competency-based model goes beyond shifting focus to a different set of curriculum objectives. Instead, it means enhancing the scope of academic and clinical coursework from building a sufficient knowledge base (traditional approach) to developing the full set of behaviours, skills, knowledge, and attitudes that make an excellent healthcare professional (competency-based approach). In speech-language pathology, the target competencies for students and clinicians are encompassed in the seven roles of expert, communicator, collaborator, advocate, scholar, manager, and professional. Each of these roles and their accompanying essential competencies and sub-competencies are outlined in detail in the National Speech-Language Pathology Competency Profile developed by the Canadian Alliance of Audiology and Speech-Language Pathology Regulators (CAASPR).

As the Speech-Language Pathology curricula across Canada have changed to competency-based education, academic assessment and clinical education assessment must also change to ensure that students are developing the competencies taught. The Canadian Entry-to-Practice Exam (CETP) has been recently introduced to assess graduating SLP students on the competencies they have learned in their curricula. However, there is not yet a competency-based assessment for clinical courses. This is where the Canadian Assessment of Clinical Competence (ACC) is valuable. 

This tool (available in both English and French) allows clinical educators to assess their students according to the essential competencies and sub-competencies that make up each of the seven roles of the National Speech-Language Pathology Competency Profile. Student performance is rated on a Likert scale from Early Novice to Entry-to-Practice for each essential competency. 

Ms. Wagner described an important component of the ACC that makes it unique. While other rehabilitation programs have assessment tools that measure progress in the competencies and sub-competencies targeted, the ACC goes a step further and breaks each sub-competency into milestones. These milestones provide a framework where every step in development is concretely spelled out, making it easy for clinical educators and students to establish exactly where the student is in the progression of developing each sub-competency. Furthermore, these milestones guide the student’s next steps in continuing their progress and setting specific goals or choosing activities accordingly.

From January to August 2023, the Canadian Academic Coordinators of Clinical Education (CACCE) conducted a pilot research project to determine the utility of the ACC with respect to validity, cost, acceptability and educational impact. Clinical educators were asked to complete a survey following their use of the tool. The results from the survey have been analyzed and are being used to improve the assessment tool, which is being implemented across Canada. The University of Toronto SLP program will launch the use of the ACC with the Year 1 cohort in 2025 in SLP 1500 – Internship.

Overall, the tool was found to be valid, in that it measures what it intends to – student performance on entry-level competencies in clinical placements, and acceptable in this regard too. During the pilot research project, clinical educators using the tool underscored the value of the milestones for rating student progress. Changes recommended focused on increasing the clarity of how to use the tool. Additionally, the need for further education on competency-based education as a paradigm shift was evident. Thus, the accompanying faculty development presentation was also revised to highlight this and the value of the milestones in scaffolding learning. Future research will focus on student perceptions of the ACC, including its acceptability and overall educational impact.  

The Canadian Academic Coordinators of Clinical Education hope that the Canadian Assessment of Clinical Competence will strengthen the development of competencies of future clinicians across Canada and provide strong guidance to clinical educators on how to help students become better experts, communicators, collaborators, advocates, scholars, managers, and professionals. In our discussion, Ms. Wagner highlighted the roles of manager and advocate as essential components of an SLP’s profession that had previously been undervalued or less heavily weighted than roles such as expert and communicator. 

As a student fresh from my second placement, I certainly agree that the abilities to manage my workload and to advocate for my patients, their families, my colleagues, and my profession were of no less importance than my clinical knowledge. I am sure that future students (and thereby, their patients/clients) will benefit from the additional guidance and structure provided by the ACC to develop the skills, behaviours, attitudes and knowledge needed to be competent in all seven roles of the SLP profession.