Portfolio Review: postural competencies

As published in Undefining Folium, ed. by Harry Gammer-Flitcroft and Stewart Hardie (London: Folium, 2019)

PORTFOLIO REVIEW: postural competencies

Guidelines for Professional Progression

i. Your Portfolio

Professional progression relies on the completion of certain core competencies within daily practice.

The Association has found that the existing structures of assessment are not rigorous or reliable enough:

- 360-degree feedback: Too often this depends on the ability of colleagues to adequately understand and measure the core professional competencies, which may be lacking. Furthermore, conflicting opinions are often irresolvable: how to judge an individual anonymously described as both ‘spectacularly manipulative’ and ‘a joy to work with’? There have also been reports of collusion whereby colleagues mutually agree to rate each other highly. Conversely, competitive environments ensure an incentive whereby colleagues negatively appraise others for their own professional progression.

- Direct observational assessments: The association fears that the standards used by colleagues who operate as assessors are too variable and subjective. Merely because a colleague assessing performance permits a certain activity does not mean it aligns with optimal professional standards. The time taken to complete these procedures also concerns the Association; it appears to be profoundly inefficient for multiple practitioners to be repeatedly observing, assessing, and assessing the standards of assessment of each other.

- Collecting evidence of performance: The evidence of personal working standards collated by practitioners is highly edited and selective – it does not reflect their daily practice. The Association is not interested in encouraging practitioners to ‘turn on’ their best performance when being assessed or seeking feedback. Rather, constant standards of excellence should be demonstrated.

Consequently, all core competencies are now measured by the alignment of practitioners’ neural loops with pre-established templates complying with good professional practice.

The brain region that is assessed in this competency is the cerebellar vermis. Postures you have repeatedly exercised during your working hours result in strengthening of certain neural pathways in this region: it is these that now form your portfolio.

Be aware that occasional inappropriate movements are to be expected in even the highest-performing practitioners. These may be acknowledged as noise or glitches within your portfolio. However, with repeated activity, the most commonly utilised neural pathways will come to dominate. It is these that are being assessed. These are likely to be so routine to your professional practice that you will be unaware of them. If they are correct and comply with good practice standards, then you need not be concerned.

We appreciate that practitioners operate in high-stakes environments involving significant degrees of physical and emotional strain. It is critical in these situations that the basic poses and movements deployed are professional, appropriate, and should not be consciously made. This enables full focus on the more immediate tasks at hand.

ii. Good Practice

Standards of good practice should already be clear to you, and are outlined in Good Practice Guidelines.

The following are this month’s updates to ensure your individual standards are up to date. Ignorance of updated standards is never an excuse for poor performance.

Re: Section 3.9.vi: There have been increasing errors recorded in maintaining an empathetic but professional angle between the muscle bulk of trapezius and the base of the C-spine. This should be maintained at a range of 155-175 degrees at all times, particularly but not exclusively during periods of interpersonal dialogue.

Re: Section 19.1.ix: The professional carrying angle at the elbow is now 15 degrees.

Re: Section 20.12.iii:. Never put the position of your limbs at risk to manipulate or manoeuvre the incorrect postural predilections of others. This assistance may reinforce incorrect neural networks.

Re: Section 24.1.i. The propulsion of arms anteriorly, hyperextension of the knees and depression of the pelvis is now a never event. There are no circumstances in which this is now professionally appropriate.

iii. Your Assessment

The following guidelines are to inform practitioners of what they are likely to expect when they attend for portfolio review. Guidelines are to be followed precisely for valid certification to be achieved. Your cerebellar vermis must be submitted fully for valid assessment to take place. Any practitioners not complete in their submissions will fail to progress. At the assessment centre, assessors are present to align vermis samples with templates only: they will not assist with basic preparation of your anatomy. 

  • the vermis is to be removed in its natural configuration; it should be carefully disentangled from ascending spinocerebellar pathways.

  • the vermis is to be unfurled and spread across the stainless steel tables provided.

  • there will be a degree of wrinkling of the tissue.

  • the edges of the tissue should be massaged out towards the edges of the table such that the maximum surface area of the vermis is displayed.

  • at this point you are not to touch the vermis any further.

  • wait until the assessor attends your table; basic cushioned cranium, trunk, and limb supports are provided. Do not attempt to walk or move at this stage. Be aware that your postures without a cerebellar vermis during this stage are not being assessed.

  • the assessor will apply the professional best practice templates to your vermis.

  • this process should take between ten and fifteen minutes.

  • the tables are equipped with an inbuilt sprinkler system of 0.9% sodium chloride which keeps all samples moist.

  • as each template is applied to the folds of the vermis, you will be expected to narrate the basic circumstances of the posture detected; this provides a sense of appropriateness for each element.

  • the contextualisation of evidence detected in your cerebellar vermis is part of the assessment. Posturing that is fully compliant with best practice guidelines but inappropriately contextualised will result in a failure to progress.

  • attempts to conceal certain postures by any means, including introducing unnatural folds within the vermis, deliberate over-drying of the tissue, or trauma such as rubbing, scratching, scraping or stretching of the unfurled tissue resulting in deformation of any neural networks will result in automatic failure to progress. Such behaviour is deemed wholly unprofessional and will also likely result in removal from the Practitioners Association register.

We look forward to seeing you at your nearest assessment centre.

Image: ‘Cerebellar Vermis: Topography and Variations’, Bispo et al., Int. J. Morphol., 28(2):439-443, 2010.