The PCE was created to flag candidates that could cause harm or injury to patients, or who would be considered incompetent to practice physiotherapy in Canada. Contrary to what students tend to spend most of their time studying, the finer details of physiotherapy assessment and treatment practices are not the most likely reason for failing the PCE. Safety, ethics, and consent are the common reasons a candidate fails the PCE, and likewise are prevalent in most stations and heavily weighted in the marking rubric. If one of these items is missed, it can often mean an automatic station fail. Given these considerations, candidates should become familiar with safety, ethical, and consent considerations so they can act appropriately both during the exam and in their future practice as a physiotherapist. Below we have outlined the top PCE safety fails so you can easily identify and avoid them.
7 Common PCE Safety Fails:
- Failure to gain consent. You must gain consent for all activities (assessment, treatment, and touch) at every station, always. There is no room for error here. This is a very common automatic station fail that is easily avoided.
- Failure to apply wheelchair brakes. Any situation where you will be transferring or moving a patient, the wheelchair brakes must be applied. It is good practice to automatically apply the brakes if your patient is in a wheelchair, even if you don’t plan on transferring them. It forms good habits and you will never lose marks for erring on the side of caution.
- Failure to use transfer belt. Unless use of a belt is contraindicated (as with certain tubes, lines and fractures), a transfer belt must be used for all transfers and ambulation.
- Failure to clear an area before ambulating. Make sure your path for ambulating is clear from obstacles that could become a tripping hazard for the patient. These objects may be planted intentionally, so don’t assume the path will be clear. Check for obstacles before you stand the patient.
- Ambulating in socks (versus shoes or bare feet). Make sure the patient has proper ambulating attire to minimize risk of slipping. If the patient is wearing socks, there will be shoes or slippers placed somewhere in the room. If you don’t see them, ask the patient if they have shoes around – they will be cued to tell you. A quick check of footwear should become part of your routine planning before ambulation.
- Inappropriate ambulation abilities assessment. Since we are talking about ambulation planning, make sure to tailor your plan to the patient’s abilities. For example, a patient with weakness may require a planned break during the session. Not protecting a patient’s injured side during a transfer, or not standing on the affected side when ambulating, are all additional possibilities where the patient can be put at considerable risk. Consider your patient’s individual limitations and adjust your treatment and body position accordingly.
- Leaving the patient in a precarious position. Never walk away from a patient with their feet off ground, without a call bell, or without bed railings in place. Likewise, leaving a patient with truncal control issues unsupported also applies here. Remember, this includes when you leave the room at the end of the station. Never walk away from a patient if they are in a precarious position.
As a final caution on the topic of automatic fails, be sure to identify all contraindications based on the station’s instructions. Common examples you are almost guaranteed to see during the PCE include chest tubes, lines, and positioning with cardiac patients. It’s good practice to take a few moments to jot down all contraindications on your clipboard prior to entering the station so you have a reference while you are working with the individual. For more tips on how to plan and approach every PCE station, check out our blog here.