Does adding cervical mobilization to shoulder mobilization improve pain, sensation, and function in subacromial impingement syndrome? A three-arm randomized controlled trial.

Continuing education consists of technical updates delivered through activities such as conferences and specialized courses []. In contrast, permanent education in health integrates learning, service delivery, and management, emphasizing critical reflection. According to the Brazilian Ministry of Health [], permanent education takes place in the workplace, where teaching and learning are embedded in daily routines and professional practice [, ]. Together, continuing and permanent education contribute to the development of clinical competence, which is defined as the ability to integrate knowledge, skills, values, and attitudes to act with responsibility, ethics, and efficacy [, ]. The concept of clinical competence is multidimensional, reflecting the intricacies and complexities inherent in medical practice. This conceptual framework is grounded in Miller’s Pyramid, which organizes competence into progressive levels, from knowledge and competence to performance and action, and has been expanded to incorporate the dimension of professional identity []. Preliminary studies have shown that clinical abilities are positively associated with professional confidence and self-efficacy, while also reducing job burnout and enhancing patient safety and satisfaction [, ]. Strengthening these skills is therefore crucial, as they directly influence the quality of care provided to healthcare users []. In a constantly evolving healthcare environment, professionals must continuously update their knowledge and practices to meet the population’s changing needs. Demographic shifts and epidemiological transitions further underscore the importance of continuous learning and adaptation in the field [, ]. Consequently, healthcare practices must align with population needs and community expectations, while also supporting ongoing professional development [, ]. This approach is closely aligned with the principles of primary health care (PHC), which emphasize comprehensive, people-centred services across prevention, health promotion, treatment, rehabilitation, and palliative care []. PHC has been shown to reduce overall health care costs and increase efficiency by improving access to preventive and promotive services []. Moreover, the WHO estimates that scaling up PHC interventions across low- and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030 [].