https://orcid.org/0009-0001-9666-309X
Figures
Abstract
Background
Advanced Practice Physiotherapy (APP) is a higher level of practice grounded in 4 pillars: clinical practice, leadership, education and research. A critical step toward successful integration and sustainability of APP in healthcare systems is understanding the educational pathway to APP.
Objectives
1) To describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice.
2) To evaluate demonstration of the pillars of APP by the physiotherapist after traversing a post-licensure educational pathway.
Methods
This systematic mixed studies review is reported in accordance with PRISMA and pre-registered (PROSPERO: CRD42024499563). 8 databases plus the grey literature were searched. 2 independent reviewers determined eligibility, extracted data, assessed quality (QuADS) and determined the overall confidence in the cumulative evidence (GRADE-CERQual).
Results
81 studies (18 qualitative, 17 mixed methods, 46 quantitative) were included in a data based convergent qualitative synthesis. 6 distinct post-licensure educational pathways were described and evaluated: Masters level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses and single encounter courses.
Citation: Maddigan K, Davis C, Saville B, Nishimura K, Van Bussel J, Tawiah AK, et al. (2025) The educational pathway to Advanced Practice for the physiotherapist: A systematic mixed studies review. PLoS One 20(5): e0322626. https://doi.org/10.1371/journal.pone.0322626
Editor: Anthony Demont, National Institute of Health and Medical Research: INSERM, FRANCE
Received: December 20, 2024; Accepted: March 25, 2025; Published: May 12, 2025
Copyright: © 2025 Maddigan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the article and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Rationale
Advanced Practice Physiotherapy (APP) is a higher level of practice, grounded in 4 pillars: clinical practice, leadership, education and research [1]. It necessitates distinctly increased skills, clinical reasoning and experience which leads to improved service outcomes, patient experiences and includes providing care to patients with complex needs, both safely and competently [1–11]. APP has been implemented in 14 countries worldwide across 16 areas of practice, though it has not yet achieved global recognition [11]. APPs are most frequently found in musculoskeletal (MSK) care (including outpatient orthopaedics and sports physiotherapy), neurology, cardiorespiratory, and paediatrics. Their roles vary by specialty and region but often include requesting diagnostic imaging, ordering blood tests, performing injections, and independently prescribing or de-prescribing medications. APPs also conduct orthopaedic triage, screening patients in emergency departments and those referred for surgical consultation [11]. The capacity for APP to alleviate burdened health care systems has been demonstrated in several systematic reviews. This body of literature advocates that physiotherapists (PTs) working in Advanced Practice roles, triage appropriately, deliver accurate diagnoses and largely improve access to care and treatment outcomes for a range of patients [3–9].
World Physiotherapy has acknowledged that there is no globally defined educational pathway (EP) for the PT to APP and most importantly that this is a vital gap to be filled [2,11,12]. In the UK, a leading country in the establishment of APP, the EP to Advanced Practice is a post-licensure (PL) Masters level qualification, with an alternative portfolio-based route recognized as equivalent, provided that the practitioner can demonstrate evidence of the competencies of all 4 pillars [1,13,14]. However, a recent global survey revealed that only half of the 112 member organizations of World Physiotherapy agree that PTs should demonstrate a set of defined competencies and possess a PL qualification such as a Master’s degree or PhD to be considered for an APP role [11]. Moreover, a recent scoping review on APP examined education curricula and advocated for uniform standards, emphasizing that despite variations in APP roles within and across countries, standardized education remains feasible [15]. This prior literature offers scaffolding to build upon; however, a significant area recognized by these earlier works that remains unaddressed is the outward existence of a wide range of PL educational pathways (PL-EP) that may lead to APP. Lack of standardized PL-EPs is a key factor that contributes to the slow acknowledgment, growth and integration of these roles into healthcare systems worldwide [11,13,16–18].
A synthesis of the PL-EPs PTs are engaging in to advance their level of practice, and how well the outcomes of these pathways align with the pillars of Advanced Practice for the PT is currently lacking in the literature. Integrating this information has the potential to aid in establishing a standardized educational framework to APP and contribute to APP opportunities, enabling career progression and transferability of roles across settings and jurisdictions to create opportunity for national and international regulation [2,11,15,19]. Thus, a thorough understanding of the educational journey that PTs undergo to become Advanced Practitioners is an imperative step towards standardization of APP, global recognition and widespread implementation.
Materials and methods
This systematic mixed studies review (SMSR) was conducted in line with a pre-defined and published protocol [20], and registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024499563). There were no deviations from the protocol. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist [21] (S1 Table)
Study design and researcher positionality
A post-positivist lens, backed by pragmatism underpinned this review. All authors are PTs working in clinical practice and/or education within a post-secondary institution, all of whom have an interest in APP [20]. The exploration of PL-EPs to Advanced Practice for the PT demands an appreciation for both the objective realities and the practical considerations shaping the professional landscape, as such a mixed studies approach was chosen. An SMSR permitted all relevant and available studies on the topic to be retrieved for a comprehensive synthesis of evidence, capable of producing statements to guide decision-making and policy development given that systematic reviews are considered the gold-standard for evidence synthesis [22].
Information sources
MEDLINE (Ovid), Embase, CINAHL, the Cochrane Library, Web of Science, PEDro, SportDiscus and ProQuest Education databases were searched from inception to 02/29/2024. Grey literature was searched through ProQuest Dissertations and Theses, trial registers (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform) and Google (the first one hundred results were screened for inclusion). The references of included studies were screened to further supplement the search. Where full text studies could not be retrieved, access requests were made via email to the corresponding author.
Search strategy
The search was constructed in collaboration with a Teaching and Learning Librarian at Western University, and was based on 3 concepts: the PT, PL-EPs and the competencies that underpin the 4 pillars of Advanced Practice [24]. KM carried out the searches independently using the search strategy initially developed in MEDLINE that was consistent across all databases, with specific search terms adjusted to reflect database appropriate syntax. Example MeSH terms used to search the PT concept were, Physical Therapists and Physical Therapy Modalities, for the PL-EP concept, Education-Graduate, Education-Professional, Mentoring, Inservice Training, Internship and Residency and for the pillars concept were, Clinical Competence, Professional Competence, Clinical Reasoning, Professional Role, Accreditation, Program Evaluation, Leadership, Communication, Research and Evidence Based Practice. Detailed search strategies, including an exhaustive list of search terms used are available in S2 Table.
Selection process
Covidence [25], an internet-based collaboration platform was used to import all citations, remove duplicates and assist in the process of determining eligibility. Studies were assessed by 2 researchers (KM and either CD, KN or BS) at each screening stage [26]. If it was clear from the title and abstract that the content was not relevant to the objectives, the study was excluded. Full-text copies of potentially relevant studies were acquired and subsequently screened for inclusion. Studies included at title and abstract stage were excluded if a full-text publication was not available and could not be retrieved or was confirmed non-existent after contacting the corresponding author. At each stage if discrepancies existed regarding eligibility, they were discussed between reviewers. Consensus was achieved in each of these cases without requiring a third reviewer to mediate. One study included for full text review was originally published in German. Google Translate was used to convert the publication into English and it was then evaluated for accuracy by a native German speaking PT [27].
Data collection process
Data were extracted from included studies by KM in parallel with CD, BS or KN into a standardised data extraction form. Data items included: author, year, country and method of data collection, sample size, study objective, design and setting, characteristics of the EP, characteristics of the physiotherapist and evidence of the competencies that underpin the 4 pillars [20]. The tool was piloted on 6 studies prior to continuing with data extraction of all studies, and discrepancies in extracted data were resolved through discussion.
Quality assessment
The Quality Assessment for Diverse Studies (QuADS) was used to determine a quality rating for each included study [28]. This tool was suitable as it facilitates a pragmatic understanding of included studies and is designed to assess the quality of all methodological study designs. The QuADS permitted each researcher to reflect and consider components of the study from a substantive position, gauging the extent to which each criterion was met [28]. The QuADS tool demonstrates substantial inter-rater reliability (k = 0.66) [29], face and content validity for application in systematic reviews with mixed, or multi-methods health services research [28]. KM evaluated quality of each included study in parallel with CD, BS or KN. If there was disagreement, consensus on the rating was reached through discussion. The tool was piloted on 6 studies and discussed in a meeting to agree on application of the QuADS criteria [30].
Data synthesis
Heterogeneity of study design is an inherent challenge faced in SMSRs. As such, a structured and robust approach was used to connect the stories and numbers into a practical understanding of the EP to APP [31]. The synthesis was carried out using a data based qualitative convergent synthesis, which involved extracting data from studies of mixed designs and synthesizing it to convey convergent results (Fig 1) [32]. Due to the integrated nature of this approach, data transformation was necessary. Described by Pluye and Hong (2014) this was accomplished through qualitative thematic analysis to ‘qualitize’ all quantitative data [31]. This involved interpreting numerical results, often from surveys, questionnaires, performance evaluations etc through an inductive coding process, transforming numbers into words that capture their underlying meaning. By contextualizing the data in this way, findings were operationalized into meaningful explanations. Thereafter, for each objective the extracted data were analyzed using qualitative synthesis methods. A clustered textual description was adopted to address the first objective, and a directed content analysis implemented to address the second [20].The results were subsequently converged and synthesized through joint display in a Heat map [32–34].
Confidence in cumulative evidence
GRADE-CERQual evaluates review findings from a qualitative evidence synthesis, defined as an analytic output describing a phenomenon based on primary study data. Since GRADE-CERQual does not require primary research to be qualitative and the synthesis in this review followed data transformation, this tool was appropriately used to assess confidence in the cumulative qualitative evidence synthesis [37,38].The 13 criteria of the QuADS informed the 4 categories of the CERQual when determining the level of confidence in each review finding. 9 of the QuADS criteria informed methodological limitations, 2 informed relevance and 2 informed adequacy of data along with a substantive assessment of the number of studies contributing to the finding [39–41]. The remaining CERQual component of coherence was assessed considering overall fit between the proposed review finding and the content from the primary studies [42]. Assessment was completed independently by KM and CD. Conflicts were resolved through discussion, not requiring a third reviewer. This tool provides a transparent, systematic framework to determine how much confidence to place in qualitative synthesis review findings ultimately increasing the usability of the findings [37].
Results
Study selection
The search strategy yielded 27,476 studies (Fig 2). After duplicate removal, 23,233 studies underwent title and abstract screening. 172 studies were screened at the full text stage. 81 studies met eligibility criteria for inclusion. At the full text stage there was substantial to almost perfect reliability between reviewers (K = 0.69–0.92) and after discussion there was 100% agreement (k = 1.0), with no need for third reviewer arbitration.
Study characteristics
16 countries across 5 continents were represented in the 81 studies included in this review. Studies were published between 1987 and 2024 spanning a diverse set of methodological designs, 46 quantitative, 18 qualitative and 17 mixed methods. Within the included studies were 2 doctorate dissertations and 1 article originally published in German. A summary of the results from individual studies can be found in Table 2, with additional detail in S3 and S4 Tables.
Quality assessment
A summary of the quality assessment score and converted percentage for each study using the QUADs is provided in Table 3 [30,124]. Study quality ranged 41–100%, with 58/81 studies scoring >75%. These individual scores enable the quality of a study to be considered alongside its results. 12 review findings, summated from the synthesized primary data were assessed using the GRADE-CERQual. The assessment of cumulative evidence determined there to be high confidence in 6/12, moderate confidence in 4/12 and low confidence in 2/12 review findings (S5 Table).
Synthesis Findings
Educational Pathways.
6 distinct PL-EP that may be delivered across any area of practice were recognized in this review: Masters level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses and single encounter courses. Clustered textual descriptions of each pathway are presented below.
Masters Level Education.
9 studies investigated Masters level education [59,72,90,99,102,103,108,112,115]. This PL-EP is delivered over an extended time-period, often spanning 1–2 years. It is accredited, highly structured and held to international standards. In most instances it includes a component of mentorship, aimed at practical skill development and tends to be focused in the MSK area of practice [72,90,99,102,103,108,115]. Distinct to this pathway is the frequent inclusion of research skill development and focus on evidence informed practice. Further, it focuses on the development of critical thinking and analysis, intends to evoke self-reflection in the PT and necessitates formal student assessment (i.e., written or practical examination) prior to granting the academic award of a Masters degree.
Residency and Fellowship Programs.
16 studies investigated residency and fellowship programs [52,55,61–64,71,76,89,94,104,107,113,114,117,122]. This PL-EP extends 1–2 years in duration, is a structured and accredited route that is always focused to a specific area of practice, most commonly MSK. There is an emphasis on the development of evidence informed clinical reasoning and personal reflection. It’s defined by measurable learning objectives and necessitates students to successfully perform on assessment prior to completion. A distinct feature of this pathway is its emphasis on experiential learning and mentored clinical practice.
Accredited Area of Practice Education.
4 studies investigated accredited area of practice education [45,47,67,106]. This PL-EP spans 10 months to 3 years [45,47]. Unique to this pathway is accreditation outside university infrastructure by a governing body such as the International Federation of Orthopedic Manual and Musculoskeletal Physical Therapists (IFOMPT), where there are established standards for competency. It results in the granting of a diploma or certificate upon successful completion of formal assessment. This pathway tends to be focused to the MSK area of practice and includes the development of hands-on manual therapy skills, achieved in classroom environments but also via clinical mentorship [45,47,67,106].
Mentorship.
4 studies investigated mentorship [54,75,121,123]. This PL-EP varies in its duration from as little as 3–150 hours [75,121,123]. It consists of one-on-one as well as small group sessions and is delivered in both online as well as clinical environments. It often includes case studies, group discussion, and observed clinical practice with a focus on clinical reasoning development. It is often focused to the MSK area of practice. Distinct to this pathway is its highly individualized nature, it is frequently self-directed, with ongoing and real time feedback for the PT [54,75,121,123].
Multiple Encounter Courses.
22 studies investigated multiple encounter courses [49,51,58,60,87,66,70,74,79,80,83,85,88,91,96–98,109,110,118–120]. This PL-EP is highly variable in its duration, spanning as little as 8 days up to 1 year [85,98]. It is often narrowly focused to the adoption of one specific skill or theory, though it spans a variety of areas of practice [49,60,74,80,91,109,118]. It is consistently delivered via didactic methods and often includes both skill practice and case study discussions and occasionally includes clinical mentorship. Unlike the previously described pathways, education in this form is rarely accredited, and rarely includes formal student assessment [60,96–98,110]. Distinct to this pathway, compared to a single encounter course is the opportunity and encouragement to practice and review between education sessions as well as built in avenues for feedback throughout [49,51,58,60,65,66,70,74,79,80,83,85,88,91,96–98,109,110,118–120].
Single Encounter Courses.
26 studies investigated single encounter courses [43,44,46,48,50,53,56,57,68,69,73,77,78,81,82,84,86,87,92,93,95,100,101,105,111,116]. This PL-EP can span anywhere from 3 hours, up to 2 days [46,48]. These courses cross diverse areas of practice, but are often narrowly focused to an individual skill, concept or theory [53,73,81,82,95]. It is commonly comprised of didactic methods with components of interactive case studies and practical sessions. Distinct to this pathway is a lack of follow-up or carrying forward of learning over time, as the classification title suggests it tends to be a one and done occurrence. Like multiple encounter courses, inclusion of any formal assessment is rare as is accreditation and clinical mentorship [43,44,68,73,81,101].
Pillars of Advanced Practice.
Table 4 and Fig 3a-f depict the results of the directed content analysis, respectively illustrating the consistency of pillar demonstration among studies and the frequency of competencies underpinning each pillar demonstrated in the PT after traversing each EP [34]. The latter is represented in the form of a heat map [36].
1] demonstrated by the PT. Competencies coded most frequently are depicted in red, while those coded least frequently are in yellow. Descriptions of each competency (.1-.11) available in S6 Table.
Discussion
This SMSR aimed to understand and evaluate the PL-EPs that PTs engage in internationally to advance their level of practice through the lens of an established framework for Advanced Practice [1]. The main findings of this review support that there are 6 distinct PL-EPs that PTs engage in to advance their level of practice. These pathways are categorized as Masters level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses and single encounter courses. There is a high level of evidence to support that 3 of the 6 described pathways (Masters level, residency and fellowship and mentorship) can develop all 4 pillars of Advanced Practice in the PT. However, only Masters level education demonstrated these outcomes consistently with a moderate to high frequency of individual competency demonstration across all 4 pillars. There is low to moderate level of evidence to support that the remaining 3 described PL-EPs (accredited area of practice education, multiple encounter courses, single encounter courses) consistently identified PTs demonstrating only the clinical practice pillar, with no evidence of all 4 pillars in the PT following these PL-EPs.
There are both parallels and distinctions among the EPs described in this review. One commonality is the dominance of MSK, with 68% of the studies focused to this area of practice. This is coherent with the current global landscape, a 2024 international cross-sectional survey regarding APP identified that over half (53%) of survey respondents worked in the MSK area of practice [18]. Nonetheless, each defined pathway had unique identifiable components permitting its categorization. The key elements that contributed to distinguishing each pathway included the timeframe, the frequency of engagement, accreditation status, inclusion of clinical mentorship, avenues for feedback, and requirement of formal student assessment. The clustered textual descriptions that arose from this synthesis are in line with previous literature that has characterized Masters level education, residency and fellowship programs as well as mentorship for the PT [15,125–128]. However, the classification of accredited area of practice education, multiple encounter courses and single encounter courses are novel to this review. Previous literature has defined educational interventions that encompass these groupings with varying terms such as professional development, continuing education and learning activities [129–132]. Until now, the common patterns within these PL-EPs have not been integrated in a way to allow for a wide lens evaluation of their role in the pathway to APP.
PL education for the PT has previously been appraised from a different angle. A recent set of sister quantitative and qualitative systematic reviews set out to understand PT’s beliefs and perspectives regarding their experiences of PL education, and in parallel evaluate what was common about the experiences that enhanced their practice [130,131]. Interestingly, the PL-EPs which failed to evidence all 4 pillars of Advanced Practice in PTs in the present SMSR (single and multiple encounter courses), share many of the characteristics of ‘learning activities’ described by Leahy (2020) to be void of ‘worthwhile learning’, such as largely didactic engagement of limited frequency[130,131]. The PL-EPs that evidenced all 4 pillars shared extensive commonalities with the factors identified by Leahy (2020), as required for ‘worthwhile’ learning such as, reflection, mentorship, opportunity for feedback, and substantial time [130,131]. These reviews conclude that for PL education to be ‘worthwhile’ i.e. successfully impact the PT, they should include active approaches, such as peer assessment, mentored patient interactions, connected activities, time to practice, trustworthy resources and activities that take PTs out of their comfort zone. These conclusions are in line with the findings presented in this SMSR, and intriguingly, may explain the mechanisms by which the described PL-EPs successfully impacted the knowledge and behaviours of the PT such that embodiment of the pillars of Advanced Practice was detectable.
To our knowledge no previous study has looked to provide evidence of the pillars of Advanced Practice in PTs after traversing various PL-EPs. However, findings pertaining to this objective are largely in keeping with what previous literature has alluded to. In 2023, Peterson argued that while weekend continuing education courses (i.e., single and multiple encounter courses) can be an efficient way to refine or learn new skills, relying on them to improve knowledge and behavior towards an [advanced level of practice] is at best questionable [132]. A contrary finding in this SMSR to previous high-quality literature from the UK, is the lack of support for accredited area of practice education as a trustworthy and reliable pathway to APP [13]. The finding is supported here by a low level of confidence in evidence however and therefore should be interpreted with caution [37,39,40]. Other healthcare professions, particularly medicine and pharmacy have embraced a model of post-professional education in the form of residency and fellowship programs as well as ongoing mentorship across different areas of practice for many decades [127]. Program directors of these residency programs are asked to document how their residents achieve proficiency in 8 domains of competence that in keeping with the findings of this SMSR, map to the clinical practice, leadership and education pillars, but are void of the research pillar [127,133]. Reiterating that while these PL-EPs do well to cultivate competencies aligned with 3 of the 4 pillars, they fall short of providing a comprehensive framework.
Ultimately, Masters level education was the only pathway to consistently show PTs demonstrating all 4 pillars of Advanced Practice. Considering the required pathway to Advanced Practice in other healthcare professions such as nursing, these results are not surprising, nor is the existing literature to support the impact Masters level education has for nurses in all 4 pillars [109,12,134]. Multiple studies have previously supported Masters level education as a critical stop on the journey to developing clinical expertise for PTs, which is also supported here by the breadth and depth of demonstration of the clinical practice pillar [125,126,135]. However, the critical findings in this review support that Masters level education is likely the optimal pathway to developing the remaining 3 pillars of Advanced Practice as well, a fact that until now has largely been supported by observation, anecdotal evidence and expert opinion [1,11,18]. The high level of confidence in the finding that Masters level education is the most consistent pathway to embodiment of the 4 pillars of Advanced Practice for the PT is a critical step toward firmly establishing APP in healthcare systems internationally.
Strengths and Limitations
This SMSR was novel in its exploration of the potential PL-EPs to APP for the PT through the lens of the well-established pillars of Advanced Practice [1]. Rigorous methods were employed at all stages, including a robust search strategy, a complete parallel review approach [136], the use of valid and reliable research tools [28], including assessment of the confidence in evidence supporting the review findings using the GRADE CERQual [137] and lastly the inclusion of a positionality statement of the researchers to enable readers to interpret the findings and judge trustworthiness in their own context [138,139]. Despite these strengths, this review is not without limitations. Studies included were conducted in 5 of 7 continents. While the results are largely representative of EPs engaged in by the PT internationally, applicability of the findings across countries should be considered with caution as global differences in healthcare and education systems may limit generalizability. Additionally, this SMSR facilitated a comprehensive synthesis of diverse evidence but required a pragmatic integrative approach to accommodate studies with varied aims and heterogeneous data sets. The process of qualitizing quantitative data for synthesis introduced inherent challenges, particularly regarding the depth and nuance embedded in qualitative data. While this approach allowed for a unified analytical framework, the transformation of numerical findings into qualitative themes inevitably involved interpretive decisions by the researchers. These decisions, shaped by the coding framework and analytical lens, may have influenced how meaning was constructed from the data, with potential implications for the richness and contextual depth of the synthesized findings. Thus, while this method enabled a more cohesive synthesis, it is important to acknowledge that some intricacies of the original quantitative data may have been lost in translation, highlighting a key consideration when drawing conclusions from qualitized data [31,38,28,139].
Research Implications.
There is an opportunity to further characterize the effect PL Masters level education has on PTs. Particularly, well-designed prospective cohort studies would be of benefit to gain greater insight into the magnitude of the effect and the mechanisms by which this PL-EP impacts the PT. This research is particularly needed in countries such as Canada, where APP is on the forefront of change for healthcare systems and PL Masters level educational programs specific to APP exist [19]. The aim of healthcare research is to better the lives of the end-user, the patient. As such, the current findings should be taken forward in the way of implementation science, to investigate how PTs with PL Masters level education that embody the 4 pillars of Advanced Practice, impact patients and healthcare systems. Lastly, there is a need for studies of high methodological quality investigating accredited area of practice education to improve the certainty of evidence of this pathway as it lends to APP.
Conclusions
This review highlights 6 distinct PL-EPs that PTs pursue to advance their practice. These EPs are categorized as Masters level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses, and single encounter courses. High level of confidence in the evidence supports the ability of 3 of these pathways—Masters level education, residency and fellowship programs, and mentorship, to foster competencies across all 4 pillars of Advanced Practice. Masters level education is the only pathway that consistently achieved these outcomes with a moderate to high frequency of individual competency demonstration across all 4 pillars. There is low to moderate confidence in the evidence suggesting that the remaining 3 pathways—accredited area of practice education, multiple encounter courses, and single encounter courses—primarily support the clinical practice pillar, with no evidence of comprehensive competency development across all 4 pillars.
Supporting information
S3 Table. Objective 1 data extraction and coding.
https://doi.org/10.1371/journal.pone.0322626.s003
(DOCX)
S4 Table. Objective 2 data extraction and coding.
https://doi.org/10.1371/journal.pone.0322626.s004
(DOCX)
S6 Table. Advanced Practice pillar competencies.
https://doi.org/10.1371/journal.pone.0322626.s006
(DOCX)
S7 Table. List of all studies identified in literature search.
https://doi.org/10.1371/journal.pone.0322626.s007
(DOCX)
Acknowledgments
Christy Sich, Teaching and Learning Librarian at Western University (London, Ontario, Canada) for support with reviewing and shaping the search strategy.
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