Open Book


Enhancing Healthy Practice through Self-Reflection: The Next Steps for Continuing Competence

FSBPT’s Continuing Competence Committee has been progressing on a journey to improve healthy practice to facilitate safe and effective patient care. The committee has been working with researchers from Colorado State University to draft a Healthy Practice Resource. This article is based on a 2022 Annual Education Meeting presentation by Alyssa Mitchell Gibbons, Anne Thompson, and Gwenith Fisher.


The Continuing Competence Committee has been working on a resource to help promote healthy practice for several years, which is one element of the Guidelines for Continuing Professional Development. This will be an online, self-guided resource with a three-step process to help practitioners improve their healthy practice: self-reflection, feedback and insights, and connection to resources.
The committee kept in mind four key principles while creating this resource:

  • Evidence-based
    • Theory
    • Psychometrics
  • Modular
    • Short sessions
    • Meaningful units
    • Self-paced
  • Supportive
    • Confidential, people feel safe engaging
    • Links to feedback and developmental opportunities
  • All Levels
    • Full range
    • Relevant to everyone

The resource aims to be accessible, modular, and inclusive of physical therapists (PT) and physical therapist assistants (PTA), regardless of their work environment. FSBPT created the resource for all PTs and PTAs, not just for those professionals in crisis; the goal is for PTs and PTAs to regularly use this tool as a source of self-reflection and valuable resources. These will vary from immediate suggestions that practitioners can implement right away, to more in-depth suggestions, such as education modules.
There are eleven modules, each taking about ten to fifteen minutes to complete. Participants can choose to complete the modules in whichever order they prefer; for example, if physical health is their most important area, they can start with that.


Physical Well-being

Some examples of assessment questions in the physical well-being module include: How much exercise is the practitioner getting? How much sleep? And not just the quantity of sleep, but the quality? This module also has questions about alcohol and substance use, as well as other issues that comprise physical health. If, for example, a respondent has trouble sleeping, the tool will provide resources to address that.

Emotional Well-being

A mental health crisis exists following the pandemic, particularly among healthcare providers. The resource asks participants if they are experiencing symptoms related to or consistent with depression, anxiety, and overall life satisfaction. The resource is not a diagnostic tool; it is a screening questionnaire. The feedback may suggest consulting a psychologist, but it will also provide other resources.

Financial Well-being

Financial well-being is the extent to which people are satisfied with their financial status and able to pay their bills and live the lifestyle they would like. This module includes knowledge and understanding of benefits and retirement plans.

Social and Non-work Well-being

An individual’s work environment, social support, and experiences outside of work greatly influence their well-being. These factors can harm work and enjoyment and increase absenteeism and turnover. Taking a break from work is also essential to having a satisfying life.

Work-related Well-being

Research has shown that too much work can negatively affect physical health, such as less time for sleep, exercise, and other activities. Avoiding burnout, taking breaks, and managing stressors at work can positively impact mental and physical health.

Work Role Support

Practitioners have unique characteristics that affect their work well-being, such as meaningful work, variety in what gets done, and control over their work. Research suggests that if people have some say over aspects of their work, they are better off.

Practice Climate

The module has paths, so it asks a practitioner to choose their practice environment, and the subsequent questions apply to that environment. The tool also allows someone to select two roles, for example, an educator and a practitioner. Additionally, if an educator doesn’t have direct contact with patients, they will not see the questions about patient safety. The tool also includes questions about psychological climate, which refers to the notion of trust. Do people feel comfortable being themselves and speaking up without fear of backlash?

Wellness Programs

Access to wellness programs is often linked to the size of the organization. The resource aims to help people be aware of and leverage their existing resources. It also fills in the gaps to where their practice or institution may not provide access.


With the demographics module, the goal is not to collect identifying information but rather to understand who the participants are and how they relate to the profession. This aggregate data can help researchers determine trends and better react to those trends with the right supports.

Resources for Professional Development

This module assesses the availability of opportunities for mentorship and promotions. Does the practitioner feel supported in their overall professional development? What can they do if they don’t?


Compassion, self-compassion, and climate are critical components of a healthy practice framework to ensure people feel supported and included in the workplace. Is there evidence of discrimination in the workplace? Do people feel not just accepted but included?

Module Example

One module in the tool will help people understand the level of clarity they currently have, how that may affect them, and what they can do about it.
Clarity is essential for workplace outcomes, as documented in many research studies. It helps people understand their role, make choices that align with their priorities, have less conflict with other people, and perform better. It also reduces stress and inhibits performance, leading to frustration and conflict. Clarity is an anchor, a linchpin around which many other things revolve, and it is something that many people have more control over than they think.
While the module uses quantitative measures on the backend to know what to suggest, the goal is not to bog down the participants with numbers. Below is a draft example of what someone may receive based on their “clarity” score.

High Clarity

    • Your job is very clear about expectations! This is an advantage – maintain and use it. 
    • Referring to clear, understood and agreed on expectations can help you reduce other sources of stress and manage conflict. You know what your priorities are; you can align your time and effort to reflect these.

Moderate Clarity

    • You have some clarity, but there may be areas in which you’d like a little more. A workplace that tries to communicate clear expectations is likely open to questions; when you’re unsure, don’t be afraid to ask. Start conversations with colleagues about how they see the role or seek a mentor; this can help you all identify gaps and improve clarity.

A Little Clarity

    • The lack of clarity in your workplace is probably creating some challenges for you, even if they seem minor. You may frequently feel like you are wasting your time on the wrong tasks, not getting anywhere on your priorities, or not meeting expectations you didn’t know others had.
    • Make a habit of seeking clarification. This might look like restating the expectations you hear from others to make sure you understood correctly, or directly asking others for input about which of two competing priorities you should emphasize.
    • Consider systems that might improve communication about work roles and expectations. For example, updating job descriptions to make sure they are accurate, listing action items after meetings, or explicitly discussing your priorities.

Low Clarity

    • Lack of clarity in your current work role is likely creating several major challenges for you. Setting clearer boundaries about what is and isn’t your responsibility and identifying key priorities will help reduce frustration and spend your energy on what matters most.
    • If you work with a supervisor, make time to talk with them about how you can get more clarity. You may not solve the issue overnight, but you can take steps toward better processes (“If I’m not sure about something, who should I ask?”).
    • If you’re your own supervisor, carve out some time to actively process your priorities. We can’t do everything at the same time. What matters most to you? What do you, personally, need to do yourself and what might you be able to delegate?
    • If you work on a team with others, schedule some time to meet with them to discuss your role and work tasks in relation to others on the team. Consider asking for clarification or expressing some of the challenges you are experiencing with having low clarity about your work role and expectations in relation to others. It is possible that others may be experiencing similar challenges. It may be that talking about this openly is helpful not only for you but for others at work too.


The goal is to provide customized resources to help people with a lack of clarity in their job, both resources they can use instantly and longer-term resources, such as workshops or modules. This guidance helps the participants understand that taking some action is within their control.

Key Goals for Implementation

FSBPT and its research partners are close to finalizing the resource! As they look toward completing and implementing the resource, they keep the following goals at the forefront.

Create a Climate of Trust and Support
Some items in the resource get pretty personal, so there must be trust to get people to engage. The confidentiality of participants must be maintained throughout this process.

Motivate PTs/PTAs To Engage Thoughtfully
The resource doesn’t just seek to give feedback; it also aims to encourage participants to engage in self-reflection. If a participant clicks through the survey without considering their responses, it will not be as valuable. Therefore, the resource must discourage superficial interaction by being engaging and efficient.

Make the Resource Accessible and Appealing
If a great resource is developed, but no one uses it, that doesn’t promote the healthy practice of public protection. Therefore, the resource must be convenient and user-friendly.

Build a Library of High-Quality, Useful Resources
While self-reflection is a major goal of the resource, providing participants with vetted, high-quality resources is essential. Some of these will be immediate, such as a short article they can read. In contrast, others may involve more commitment, such as registering for a multi-day workshop. These suggestions will be highly targeted to the individual’s needs based on their responses. Patients need a safe and healthy practitioner to provide them with care. PTs and PTAs need to have resources to improve their well-being to truly create a healthy practice. FSBPT aims to make this a useful resource that can help provide them with the support they need to create a climate of healthy practice and promote public protection.


Gwenith Fisher, PhD, is an Associate Professor of Psychology at Colorado State University, Adjunct Associate Professor in the Colorado School of Public Health, and Adjunct Research Professor at the Institute for Social Research at the University of Michigan. She earned her PhD in psychology with expertise in industrial-organizational (I-O) psychology and occupational health psychology at Bowling Green State University, a consistently top-ranked program in the field of I-O psychology. Fisher has more than twenty-five years of experience conducting organizational research primarily involving the design and implementation of employee surveys and assessments. She has published more than seventy peer-reviewed journal articles and chapters. She is currently President of the Society for Occupational Health Psychology and a Fellow of the Society for Industrial-Organizational Psychology. In her non-work time, she enjoys spending time with her family and dogs, skiing, hiking, mountain biking, playing ice hockey, and enjoying the outdoors in Colorado.


Anne Thompson, PT, EdD, serves as Vice President of the Georgia State Board of Physical Therapy. She is Chair of the FSBPT Continuing Competence Committee and the Georgia delegate to the PT Compact. She is an adjunct associate professor in the MS and PhD programs in Health Professions Education at the Massachusetts General Hospital Institute of Health Professions. Anne also serves as a board member of the Georgia Foundation for Physical Therapy and is an APTA Certified Clinical Trainer.


Alyssa Gibbons earned her PhD in industrial and organizational psychology from the University of Illinois at Urbana-Champaign. She now teaches about measurement and quantitative methodologies in the Department of Psychology at Colorado State University. Her published research addresses measurement issues in many contexts, including the assessment center method, feedback, leadership, and safety culture. In her consulting role with Fisher Work-Life Solutions, Alyssa is collaborating with the FSBPT Continuing Competence Committee on projects related to the Healthy Practice Framework.