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Old 20-01-2009, 01:50 AM   #1
Jon Newman
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Default Adventures in continuing education

The topic of this thread is not new but I'd like to explore the topic again. EIM had a thread a couple of years ago (I can't find it or I'd link to it) on the same topic.

What I'm looking for are personal experiences with continuing education courses, links to articles that examine the continuing education "industry" and any other thoughts about continuing education.

I'd also like your favorite examples of what you consider to be outrageous or questionable continuing education (past or present.)

Thanks for anyone who helps out.
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Old 20-01-2009, 02:48 AM   #2
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Regarding the industry of cont. ed I've seen several approaches. Barrett and Sahrmann were both the anti"institute" nature of many. Sahrmann limits hers to 3 courses and Barrett's is one day! NOI and Shacklock have limited numbers of courses as well, but they did not explicitly say this was intentional, although it may have been. Sahrmann made several funny jabs at the institutes and jt. mobilization in general. She'd assist scapular motion and say "Look, I'm a manual therapist!" and laugh hysterically.

The courses I've taken for industrial settings are very expensive and usually involve licensing and proprietary concerns etc. For example, I went through the ASTYM courses right out of school for the clinic I worked in at the time (paid for by them thank goodness). Once I left that clinic I could no longer claim to perform "ASTYM" on anybody as I was no longer under the license owned by the clinic. The tools carried a hefty yearly rental price as I understand. Same licensing agreements exist for at least some of the FCE certifications.

I've always avoided the pyramid of power courses. At first because I thought I wasn't ready, needed more training first. Then because, well it seemed silly.

I've taken a few APTA home study courses. Some were very good, some were mediocre.

I took a strain counterstrain course early on and was very disspointed with the presentation, explanations. I remember the instructor telling the class that anybody focused on the why was probably going to be dissapointed. That was an understatement. I did find the technique quite useful though and was ecstatic to finally be led to some sensible why info once I got to somasimple.

Is that the type of thing you're looking for Jon?
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Old 20-01-2009, 03:09 AM   #3
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I'm looking for articles specifically about (or with large sections about) the continuing education business, their lobbying power both with government and within the medical community.

I'm not looking for specific criticisms of C.A.M. (although I'll take them), but rather on how continuing education is handled.
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Old 20-01-2009, 04:39 AM   #4
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Jon,
So you mean the bigger reach than the nuts and bolts of running a seminar business? Who's scratching who's back? Just wanted to be clear.
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Old 20-01-2009, 04:47 AM   #5
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Cathy I think it's all interesting. I'm interested in whatever people have to offer. I imagine that running a successful seminar business requires some understanding of the bigger reach.
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Old 20-01-2009, 06:44 PM   #6
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Well Jon, I don't have articles. But I have experience - from teaching for a large organization years ago to growing a small seminar business over the past 10 years. As with any organization, to thrive for that length of time means one must be curious, passionate, and determined. Curricula changes over time, as it should. Target audiences change over time. Education needs to reach parents, caregivers and laypeople, as well as therapists. Integrating research and translating it to body logic and real life is an ever evolving task. Taking valuable information out into the world is a formidable task, far too overwhelming for one person alone. But, as I mentioned in a different post, those who chose to make that commitment are not left to walk alone. Help and connections arise.

I cannot imagine any sort of meaningful continuing education process beginning from anywhere else but a place of passion and commitment for the life of the work that is being delivered. Yes there is an integration of sound science, yes there must be a translation to an outline that garners "CEU provider" status. But what brings work to life is living the work yourself. And that draws students to your door, and that grows the work out in the world.

That's my view of things, from this point in time.

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Old 21-01-2009, 02:54 AM   #7
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I appreciate your thoughts Cathy and welcome any others.

Eric Robertson had a related blog entry that I'll add here also.
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Old 21-01-2009, 05:36 AM   #8
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Jon, I was involved in the American Association for Orthopedic Medicine. Gave lectures and workshops at their Annual conventions and such.

They began to offer specific workshops: I did a few, but more and more did they focus on the following:'
"These are all busy MDs, DOs and DCs (apparently the occasional PT did not require mentioning), and we have to give them stuff they can really use quickly and easily in a couple of minutes."

Even then, I was uneasy with this "fix-in-a-minute" approach. So I did my thing - in those days showing poor stability control in different assessments, giving MY take on recruitment exercises and patient education. This last aspect especially got me un-invited to teach after 1999 - the feedback forms indicated that the time spent with patients did not allow for such approaches.

I taught a few more workshops for the Canadian branch in 2001 and 2002, but ran into the same problem there. Even with PTs in the groups.
By then, I had already been long infected with Barrett's, Diane's, Butler's et al writings and ideas, and the idea of showing "quick and time-saving techniques for the manually oriented MD or DO" was just not quite what I could provide....As soon as I said stuff like patient education, the groans went up in the crowd....

They did not get attendance with anything less than quick, dirty, AND it had to be "evidence-based".....
Money is not made with doing the right thing, it is in giving what attracts the largest numbers. That meant recipe-style, technique oriented therapies.

I am proud to say, I haven't taught with them since.
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Old 21-01-2009, 05:45 AM   #9
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Thanks Bas. Keep this sort of thing coming.

I guess I should have checked the latest issue of PT Journal. Well, it is still January.
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Old 21-01-2009, 06:45 AM   #10
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Worst course I've ever taken - the APTA Orthopedic Section's "Hip and SIJ" home study course. I did it in 2001, and it was the worst SIJ biomechanical fantasyland I'd ever seen. I think they had 3 separate pictures trying to explain the different between a right-on-left sacral torsion, and a left-on-right sacral torsion.
"You see, when the sacrum counter-nutates..."

The hip stuff was useful and science-based, however.
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Old 21-01-2009, 01:33 PM   #11
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One of the best courses I took was a set of 2 teleconference-style pain seminars (Neil Pearson of Canadian fame). They provided a ton of useful information and references, did not speak to the lowest common denominator and everything was put together just right.

The online webinar from the Pain Division was an excellent experience as well - lots of good references. Work at your own pace, your own time, and a chance to brainstorm, ask, and debate after. Very good experience.

The immensely successful Canadian Orthopeadic seminars/levels - in all their reincarnations and forms - were tedious, formulaic, and generally very difficult (that was actually a "claim to fame" for a while!); also expensive as hell. The required pre-course reading was helpful to a degree - great anatomical and biomechanical reviews, with later neuroanatomy thrown in - but generally, one came away feeling "How am I gonna remember all that?" Of course I did remember with great effort, eventually...

Sahrmann's course was very well organized and had an aura of high professionalism to it. Just like the Ortho-courses. That made them immediately "feel" important - being expensive was part of that.
But once we got into the meat of things, that became secondary to content - at least for me. There were many soaking up the energetic presentations from the professor like the gospel.
Again, the fascination with techniques, assessment tricks, rehab patterns and diagrams and pictures of exercises positions; as well as a clear disdain for things other than muscle imbalances. The "this is very special" aura of these courses.

The ortho and Sahrmann courses are well-marketed, glib in their set-up and hand-outs and impressive with the loooong list of required reading and references - mostly basic sciences and articles. And they have "levels" that makes one feel one is entering a select world of higher education. Well done.
They won't see another dime from me, but: well done.
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Old 21-01-2009, 01:35 PM   #12
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Bas has it exactly right. What I found was that the sponsors wanted me to make promises to the potential attendees that had nothing to do with reality. In the end, I might as well have done that because I found that most of the therapists in the class were far more taken with the entertainment value of the presentation than anything else. Not everyone, of course.

I know of a PT who offers a course titled "Modality use for the PTA" and he packs them in.
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Old 21-01-2009, 01:38 PM   #13
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Barrett, as a course conductor, you are a tool, a commodity to the course sponsors. The product has to have a good yield.
This is where the mix of money making and real value are not well-met.
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Old 21-01-2009, 01:44 PM   #14
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Yea, I know. But I still think that a quality product can be promoted ethically and will sell well.

Of course, I've yet to figure out how to do that.
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Old 21-01-2009, 01:50 PM   #15
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I'm preparing to teach massage therapists in March. My main selling point is that I can teach in French. It seems their main need is anatomy and neurophysiology--a few of them from scratch. We'll see...
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Old 21-01-2009, 02:07 PM   #16
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This is what it takes to offer CEU in WI.

On the other end of the spectrum, here is a list of places Barral Institute courses can be taken for credit. I'm not looking to examine the Barral Institute. I used the link because it demonstrated the wide variety of organizations that require CEU and some of the unique requirements that exist. For example, The International Association of Structural Integrators state "All programs approved at Type II. "

They must have different types of continuing education they require.

Wisconsin, for example, doesn't have different types but now requires a certain number of credits to be taken in jurisprudence/ethics.
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Old 21-01-2009, 03:06 PM   #17
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Barrett, I agree.
One of the possibilities is finding a not-for-profit group, like the Pain Division here in Canada, that is willing, and been shown to be able to put together quality material for a decent fee for the participants. However, there is little to no steady "repeat" work in such formats.

Mary, I am preparing a one-day workshop for MTs and other "manual therapists" in March here - through the college. What are you doing - course, workshop, regular teaching?
This is another possible connection for future reference: get on a Board at a University or College, help with curriculum direction and general program "tone", and then "generously" offer to do the first CEU type post-grad course - with full control over content.... Now, I hope that some will actually show up.

Jon, the absolute mess of different requirements from State to State, and from profession to profession, makes me rather pessimistic about consistency and value of CEUs....We are slightly better up here, but not by much.
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Old 21-01-2009, 05:35 PM   #18
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Bas, I'm doing 4 presentations of material of my choice. Total 10 hours.

I'm leaning very heavily on what I have learned here.
Skin, nerve supply, the nature of pain, anatomy review using a digital anatomy DVD, the use of light touch. I bring my diet scales to measure pressure of touch in grams/cm2.

Some of them were "trained" to use very heavy deep soft tissue work. That "school" neglected anatomy and physiology so much their "graduates" could not pass the entrance exams to the provincial association. The association is trying to help make up for that.

Mary
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Old 21-01-2009, 05:49 PM   #19
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Go Mary.


I wonder at what I sense to be slow corralling in of PTs, the colleges' move toward examining everyone's credentials periodically in light of what CE they've attended with no real attempt to set standards of value for CE, just using attendance at CE as a marker of a basic heartbeat.

I wonder at the specialness CE providers bestow upon their offerings, imagining them to be wonderfully valuable and therefore making them hideously expensive.

As someone who has dabbled briefly in teaching, and found it exhausting, stressful, pretty much without intrinsic reward (for me personally - not saying that other people don't get a big kick or lift out of it), I can see that it's a direction I'd be very reluctant to go in. For me, it's not worth the time and effort to build a "construct" and then teach it in a convincing way. I mean, if it's convincing it should be convincing under its own steam, not just under my particular personal real-time tutelage under my... um, august charismatic presence.

I'd rather be a provider, for free, of trails to travel, directions to discern, avenues to avail, thoughts to think, points to ponder, possibilities and speculations and conjectures and deconstructions. Writing is much easier (for me) to do than teaching. Writing can be done while off-clock, without having to make myself appear to be acceptably extroverted and non-neurotic for externally dictated hours at a time.
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Old 21-01-2009, 05:51 PM   #20
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That is funny, Mary. My course will focus on the skin, pain and its neurophysiology (acute and persistent) and light touch...... And some stuff on research and writings regarding what can influence pain (including ideomotion) experiences. Cool.
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Old 21-01-2009, 06:03 PM   #21
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Bas, I'm going to include content from the paper on light stroking of the skin for control of acute / chronic pain. I just love the effect it has on patients with painful hands.

Ole provided it in this thread
http://www.somasimple.com/forums/sho...=skin+stroking

Mary
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Old 22-01-2009, 06:00 AM   #22
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So today I attended a one-day Summit Education course. The topic was relevant to certain areas of my practice, the location a mere 140 miles away. I sat in a room with 54 therapists - school psychologists, teachers, speech therapists, OTs and who knows what else. Not many PTs, I believe. I sat and wondered about context. The instructor insists, according to the research that made this class "Evidence-Based," that context matters more than personal space in the retention of information.

I wonder about the context of the meeting and the unspoken agreements of joining. I listen to the instructor spew myths, unfounded stories, behavioral anecdotes with no correlation to neurophysiology (as he initially promised us). I feel the response of the class at large: sparks and flickers of interest, but mostly, a laid-back "feed me" attitude. I wonder about the nature and purpose of a one-day class. Is there some unspoken agreement that we show up to collect our 6 hrs of CEUs? And have utterly no expectations - and no interest - in acquiring new information that will profoundly change our practice?

I think about the one-day classes I teach. By and large they are geared towards parents, caregivers, laypeople; folks desperate for some information and reassurnace, some hope for breath and a chance to exhale. There is a very particular agreement and context.

I think about the two-day class, where therapists come with curiosity and make a commitment to sit still long enough to make a shift (or, allow a shift to move them). As an instructor, I am accountable in a different way for this class. The context is different. The agreement is different. The results are different.

One day was enough for me today. There were lots of little nuggets in there, but more work for me to do to integrate them in a meaningful way. But I looked around me, wondering if anyone else was taking glimmers of change home with them. Or just a few hours of CEUs.
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Old 22-01-2009, 03:28 PM   #23
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Along this same line of thinking, Barrett asked me to share my attempt to host a Simple Contact seminar here in Albany.

I contacted Barrett last November about hosting his class here, thinking that the best way for me to get the material and have a chance to talk with him would be to actually take the initiative to schedule it, rather than wait for someone else. Barrett was more than happy to help. This being my first attempt at hosting a course, I thought that it would be fairly straightforward...make some calls and talk with some contacts and before you know it, the class would be full. I was hoping to get 15-20 participants...nothing too lofty. We set a date for early February.

I asked my employer and he was willing to let us use a great space in one of our clinics at an orthopedic surgical building. Great location...near the Albany airport and easily found off of a major interstate highway. Barrett worked on the course outline and I started collecting names and numbers of places to call. There are several multi-site therapy clinics in this area, as well as many hospitals and nursing homes, etc. I even work per diem for a visiting nurses service, so I have access to plenty of PT's, OT's and nurses.

I started calling everyone on my list...perhaps a 100-mile radius from here. More than enough exposure, or so I thought. Most of the initial contacts were encouraging, with comments like, "Oh, that sounds interesting" to "I'll make sure we take a look at this one." I thought I would have the class filled in 2 weeks.

Fast forward to today. I have had 2 paid participants. One local, one outside Burlington, VT. The local woman works at a large teaching hospital in the area. When I told her that the class was most likely a no-go, she replied that this has happened several times to classes planned for this area. She tried to schedule 2 last year, but both were cancelled due to lack of attendees.

I made several re-calls, hoping that perhaps people had forgotten, or maybe the information I had sent over was carelessly covered over by other bulletins. Most of the responses were the same...some were still interested, others had no idea what I was talking about.

Barrett graciously agreed to perhaps try again later this summer. Maybe some folks aren't in a "class frame-of-mind" in the winter? Who knows. It left me with a sort of bitter taste in my mouth. If a one-day, six-hour class is too demanding, then what's left? And with New York State finally mandating CEU's as of this September, I thought this would be a win-win situation. Of course, I guess I know how that will work...most will wait until the last few months before selecting a couple of cheap, low-quality classes, just to fill the hours as required.

As I mentioned to Barrett, it's ironic to me that there are two groups of therapists: those with a never-ending search for more and better answers, and those that just want to punch the time card and worry about next Monday when it comes. Yet both groups get to call themselves PT's.

Even more ironic, the latest NYPTA newsletter has a plea from our president to encourage current members to get out non-member friends involved. Over half the PT's in the state are not members. Think of what we could do if everyone were involved? Think of the patients lives we could change if there were more interest self-education.

I do know one thing...this won't stop me from the process, and I'm thankful for groups like this which let me know there are others out there like me.
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Old 22-01-2009, 07:30 PM   #24
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Nate,
You describe a process that is quite familiar to me. When I started taking my seminars on the road 10 years ago, the first thing I learned is that a therapist who had already taken a class tends to generate a bit more interest. As time went by I made that a prerequisite for sponsorship, as it was more successful. But if I sent out a mailing of 100 brochures, I would maybe get 10 interested replies and then possibly 2 students. In spite of that, somehow the networks grew.

Also, now that I look back, what I see is that the PTs who attended were the least likely to step forward to gather a crowd for another class. It's not that they didn't find the work valuable - I think it had more to do with our lack of exposure to this part of the process. Most of the networks grew through MTs and OTs. PTs seemed to be the least adept at navigating a marketing process - or even being interested in trying. I know this feeling in myself, and yet had to keep learning how to get my classes out there.

Oddly enough, one consistent theme emerged from my marketing attempts. Many therapists confessed "I just held your brochure in my hand and knew I had to go. I didn't even know what it was about, I just knew I had to take it." Hooked before they even started, those folks bring the next wave in.

It's a big job to grow a small network, and one we must persist with. Good luck on your end.

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Old 22-01-2009, 10:29 PM   #25
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Quote:
Originally Posted by NateM View Post
As I mentioned to Barrett, it's ironic to me that there are two groups of therapists: those with a never-ending search for more and better answers, and those that just want to punch the time card and worry about next Monday when it comes. Yet both groups get to call themselves PT's.
Well put.
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Old 26-01-2009, 12:03 AM   #26
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Although we both describe ourselves as lazy, my brother gets things done in a way that I don't seem to be able to. He recently wrote me with a request that inspired this thread and rather than translate it into something less readable/understandable I thought it best to leave it as is.

Quote:
As you know, I belong to a group that investigates paranormal claims. We
have a cash prize for anyone who can demonstrate paranormal abilities under
controlled conditions. We also investigate and explain ghost sightings,
UFOs, etc.

Our current big project involves our state's Nursing Board. They are the
organization that gives accreditation for continuing education courses for
nurses. We noticed that a lot of the classes that they were accrediting
were filled with things like theraputic touch, aromatherapy, light/color
therapy and stuff like that.

We created a dummy organization and applied to teach a class, just to see if
they would accept it. The class includes Feng Shui for nurses and a few
other nutty nursing ideas, but it also includes anthropomancy. Anthropomancy
is the practice of telling fortunes by reading human entrails. We also
included some made up words and phrases.

Well, the Nursing Board bought the whole thing hook, line and sinker. So
now we are going to actually teach the course. Nurses will be able to take
it and receive credit for it. It will be free, so the credit will cost them
nothing and it should be a fun course.

We would like the press to cover the course. We'd like to show that our
state's Nursing Board is not unique and CEU courses in many aspects of the
medical field are subject to the same lack of oversight. I know you have to
take continuing education and I was wondering if anyone on your board might
have stories to tell or interesting articles to link to. I'm looking for
this info so when we approach journalists, we can say, "Look, it's not just
this one board in one state, it's a system-wide problem with medical
continuing education. We are not trying to suggest that all continuing
education courses are bad, we are suggesting that it's difficult to tell the
good from the bad when they let anyone teach anything.


Keep in mind, it's two hours of CEUs and it's absolutely free. The last
thing we want to do is rip anyone off or make fun of nurses. Nurses are the
victims of a bad system. We are hoping that nurses will tell the press that
the course was ridiculous (which it will be--but fun) and the Nursing Board
needs to get its act together. They still get credit though, because we are
accredited.

I don't know if you can post anything about this in the SomaSimple Forum. If you can post
something about it, thanks. If you can't, thanks anyway.
Any further thoughts?
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Old 26-01-2009, 12:09 AM   #27
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Holy Sokal, Batman...
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Old 26-01-2009, 12:26 AM   #28
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WOW! Good for your brother. Is your last name really Randi?

Setting up CEU's in Washington state may be even more lax than that. I believe when I set up Diane's course I didn't have to get approval from the PT board (I tried and they told me I didn't need to). All that was necessary was the presence of a course description and handing out of certificates.

See for yourself.
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Old 26-01-2009, 01:18 PM   #29
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Jon,

I am involved in our districts APTA chapter here in NC. This year we a re starting continuing compency requiremetns for PTs and PTAs. The NCPTA is working on a plan to accredit classes for approval in NC. They are requiring 5 references from peer reviewed journals as one of the criteria to get accepted. This however does not limit what peer reviewed journal that comes from, but it is a start.

It also does not limit the fact that they can get approved in state "X" which accredits you for a fee and application to teach and have NC state accept the class for licensure requirement. Our APTA chapter can approve, so can the state board, and there may be a few other companies approved to do so at some other time. That will (IMHO) only minmize the quality to make the money from fees for the aproval company.

I spent time at our retreat discussing avoiding approviong the Reiki and Feng Shui for PT classes. My next task is to get on the board that approves classes.
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Old 26-01-2009, 04:08 PM   #30
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Interesting reading. Here in the UK few courses are ratified or quality assured by anyone other than the course provider. A recent copy of the professional newsletter/journal lists courses as diverse as cranio-sacral and MFR (Barnes style) to kinesio taping to CBT and Mulligan concept with about all else in between. Many of the courses seem to be established about an individual and the capacity to deliver a "good" course. Frankly I don't attend many courses at all any more as my own experience has been pretty average. Too many are packed out with anatomy revision (okay if it's a change in understanding but simply rehashing the same old materiel is not want I want to pay for) and lecturers who can't wait to get away because they are bored with delivering the same course for the sixth or seventh time in as many months. Too many courses do not seem to be updated or in touch with broader professional developments. They teach their way and their way alone and to ask questions outside of this at times to invite contempt - after all they are the expert.

There does seem too often to be passivity about participants where many of us want simply to be given an answer, a mode, a recipe for treating patients rather than having to think about why and what they do and many courses seem to try and cater for this. Given the lack of educational understanding of some of the lecturers that is hardly a surprise.

There are of course those courses which do “exactly what they say on the tin” and you leave inspired and invigorated to storm the walls of your own self–practice with renewed vigour. I have yet to establish how you identify these courses, beyond the obvious, with any consistency and loathe the cost involved in getting it wrong.

The other aspect is once a course becomes established it can become de rigueur for employment which results in a self feeding cycle without critical appraisal.


On a slightly different tack I did come acorss a colleague who practices PT Feng Shui style.

ANdy
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Old 26-01-2009, 05:15 PM   #31
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Some thoughts on possible contributors:
  • Our basic education does not equip us with a boloney detection kit.
  • There is a lack of desire to use a baloney detection kit.
  • People are looking for something in continuing ed. they feel is missing from their usual professional literature but they sense is present in the clinic
  • Regulatory boards are at a loss as to how to regulate what gets taught
  • Regulatory boards don't believe it is appropriate to regulate what gets taught
  • There is an element of trust that people teaching will teach reality based material
  • The public trusts health professionals are trying to learn and convey reality based information

Should the continuing education industry (at least that portion that offers CEU) be informationally laissez-faire?
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Old 26-01-2009, 05:28 PM   #32
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Jon, I think our basic education in many countries is full of baloney itself! Especially when it comes to manual techniques, modalities, exercises and pain.
When so many of our colleagues are trained in that manner (cookbook, toolboxes, protocols, opiniated and biased and/or non-scientific profs), it is not that easy to break through to them.
This also creates a "need" for the courses that operate along the same principles.

For a while (not AS much these days), we had ortho specialisation courses and modality courses taught privately by professors at universities.

There is a host of personal stuff that influences professional choices and attitudes, but much is formed at school.

It begins in uni.
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Old 26-01-2009, 05:56 PM   #33
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Quote:
Should the continuing education industry (at least that portion that offers CEU) be informationally laissez-faire?
For the reasons that you bulleted regarding the role and perspectives of the regulatory agencies, Jon, I think the CE industry should remain laissez-faire. Ultimately, the responsibility rests with the professional to practice ethically. I don't think it's within the purview of regulatory agencies to ensure rigorous ethical conduct of professionals. They are there to ensure a modicum of safety to the public. Rigorous ethical behavior goes far beyond safety concerns.

The exception, I think, is in the areas of juris prudence (practice act) and communicable disease. PTs should be required to undergo regular updates in these areas.

Also, Bas is right about all the BS that's picked up in PT school that's carried on afterwords. I'll also add that PT schools have sold out to an extent to train clinicians who will merely fit into a flawed practice paradigm. They SHOULD be loudly bucking this trend, sticking to the science, and producing clinicians who can actually think, rather than warm bodies who can submit ICD-9 and CPT codes all day long.

I'm afraid we've seen a widespread capitulation on the part of PT programs, at least in the US.
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Old 26-01-2009, 06:20 PM   #34
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Quote:
Originally Posted by Jon Newman View Post
Although we both describe ourselves as lazy, my brother gets things done in a way that I don't seem to be able to. He recently wrote me with a request that inspired this thread and rather than translate it into something less readable/understandable I thought it best to leave it as is....

We created a dummy organization and applied to teach a class, just to see if
they would accept it. The class includes Feng Shui for nurses and a few
other nutty nursing ideas, but it also includes anthropomancy. Anthropomancy
is the practice of telling fortunes by reading human entrails. We also
included some made up words and phrases....

Any further thoughts?

I laughed out loud at the idea of teaching nurses anthropomancy. Had a mental image of ladies in white smocks holding up intestines in search of the elusive Life Line.
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Old 26-01-2009, 06:31 PM   #35
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John W., I may be mistaken but in reading your post I get the sense that you think people ought to be able to teach whatever they want as long as they comply with the current lax requirements that exist. If that's true I disagree. We have a peer-review process for simply publishing a study in a journal that most of the people in our profession won't read. There is no such peer-review process for courses yet everyone in our profession is required to take courses (at least in WI.)

If people don't acquire critical thinking skills (a possible con. ed. course itself?) I think it will be necessarily difficult, if not impossible, to practice ethically. The current prevalence of unscientific CEU courses suggests that your hope that individual responsibility (sans incentive) will take care of the problem is counter-evidence.

This does not mean that regulation at the top is the only solution. It may even become unnecessary if other solutions are also pursued. But currently people are taking courses and returning to the clinic thinking that the CEU they earned allows them to ethically practice what they just learned.

I think a system could be created that still allowed plenty of room for creativity and diversity. Maybe we could hash out what such a system might look like right here.
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Old 26-01-2009, 07:11 PM   #36
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Then a solution, Jon, would be to eliminate CEU requirements altogether, except for the specific jurisprudence and communicable disease updates that I suggested.

No regulatory agency is going to come up with an effective way to screen CE courses for acceptable scientific rigor because no one will agree on what an acceptable standard is. And if they do, they run the risk of eliminating potentially valuable information from making it to the CE circuit.

Mike Hoy provided the example in NC where they are apparently proposing that courses have 5 peer-reviewed journal article references for accreditation. I know for a fact that John Iams of PRRT fame can come up with at least 50 peer-reviewed articles that one way or another "support" his approach.

I'm afraid of the unintended consequences of top-down regulation of CE courses. But I am open to other approaches that respect the autonomy and self-regulating behavior expected of professionals.

By the way, I know that the vast majority of my colleagues possess critical thinking skills. Whether they use them or not is a different matter. How to incentivize or motivate them to use the skills they have is the relevant question. How would requiring such and such criteria for CE courses compel anyone to use their critical thinking skills? It seems that would do exactly the opposite, i.e. let some panel somewhere use their critical thinking skills for the "dullards" out there who don't use their own.

That's professional paternalism, and I think fails to effectively address the problem.
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Old 26-01-2009, 07:15 PM   #37
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IMHO infection by memeplex is definitely a communicable disease. Maybe an update on that once in awhile would be acceptable. Unless it's too late and infection by memeplex is already endemic.
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Old 26-01-2009, 07:34 PM   #38
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I have to admit that I feel in agreement with what John said.

The fact that many PTs go home thinking they received a valid CEU from taking 12 hours of "Energetic Basket-Weaving" is testament to THEIR poor critical thinking. And likely to their poor university curriculum.

This is where for some of us, the extra time spent as a clinical instructor or supervisor to uni-students really can make a difference! That is where the profound changes should be made.
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Old 26-01-2009, 07:45 PM   #39
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I have considered the self-defeating proposition of a top-down only strategy which is why I took care to suggest that it isn't the only solution and that eventually it may not be required. Right now, it seems we have a problem.

Just as states may have specific requirements for topics such as (like, such as) jurisprudence, they could also create different areas of education such as basic sciences, treatment specific outcomes (with practice) courses, theory, humanities, etc. They could require X number of CE credits with a certain number coming from the various areas. Certain areas may require a greater degree of rigor in terms of what it takes to get approved. The process of obtaining approval for CE would have a peer-review component that requires more than a clerical staff making sure the forms are filled and payment submitted. I don't have a way of knowing if such a process would get rid of more chaff than wheat.

Quote:
Then a solution, Jon, would be to eliminate CEU requirements altogether, except for the specific jurisprudence and communicable disease updates that I suggested.
That is a possible solution and if enough studies like the one referenced in post #9 come to a similar conclusion then it may be the very best solution.
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Old 26-01-2009, 09:03 PM   #40
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Good post Jon.
From my perspective, here in Ontario our Regulatory College has established a "professional portfolio" that needs annual updating with many educational/professional development aspects in it. From logging Journals read, community hours (high school career days for instance, or speaking to Rotary), to attending a convention or participating in on-line discussion - all is fair.
The portfolio also requires one to establish annual objectives for further growth and ways to accomplish those - first identify "weak areas" (in anything related to practice of PT), then set goals and ways to attain them.

This portfolio is to be kept up-to-date, and can be requested for viewing at any time by the College.

There are no specific CEUs, no specific "good or bad" stuff, as long as it is within the Standards of Practice, Code of Ethics, Scope of Practice and the law. And then it is up to the individual PT do much better than the many MFR, CST, TT groupies.....
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Old 26-01-2009, 09:59 PM   #41
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New Brunswick just started the Professional Portfolio. I don't do the self analysis thing--just chuck in a record of all my activities.

Do you suppose SS could supply us with "certificates" or letters of participation? That's what one uni does for those who participate in their M.O.R.E. program. We are asked to review a few papers each year for their newsworthyness and relevance to our own field of practice.

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Old 26-01-2009, 10:09 PM   #42
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Do you suppose SS could supply us with "certificates" or letters of participation?
I think that might negate the overall purpose of SS, which is to explore. Anyone can tell that you've been here Mary, because you've left an internet trail, if anyone wants to check.
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Old 26-01-2009, 10:23 PM   #43
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we need the little face with its tongue sticking out.

I did not expect to be taken seriously.

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Old 26-01-2009, 10:53 PM   #44
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I think the issue of how the Universities are teaching core material as noted by John is critical to this discussion. UK wise the Uni.'s delivering PT have too often adopted a systems approach to education. "These are the skills you need and this is how to use them..."

This seems to me to be the very anthithesis of good University education which should seek foremost to demand of the student that they learn to think. Critical thinking should be core, not post graduate as by that stage the passive approach has been inculturated and for many and so ingrained they do not move beyond it. Hence any old stodge becomes accepted as long as it is delivered with some "authority".

ANdy
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Old 26-01-2009, 10:57 PM   #45
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Andy - re your post 44, exactly. (Like your E. Bear signature line, by the way. )
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Old 27-01-2009, 01:31 AM   #46
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Quote:
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Then a solution, Jon, would be to eliminate CEU requirements altogether, except for the specific jurisprudence and communicable disease updates that I suggested.
That is a possible solution and if enough studies like the one referenced in post #9 come to a similar conclusion then it may be the very best solution.
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No regulatory agency is going to come up with an effective way to screen CE courses for acceptable scientific rigor because no one will agree on what an acceptable standard is. And if they do, they run the risk of eliminating potentially valuable information from making it to the CE circuit
I think it's worth a try. I may be the only one and luckily for everyone I'm only in a position to voice my current opinion. We accredit schools, create clinical practice guidelines, peer-review articles to determine fitness for publication, etc. I don't believe that it couldn't be done but think that it somehow doesn't seem worth it.

On the other hand, eliminating CE requirements would force people toward journals to find out what's new. Of course they would only be exposed to what makes it through peer-review which has it's potential drawbacks.

I suppose there are discussion forums and blogs however that allow for dispersion and examination of potentially valuable information that doesn't make into journals or the postulated CE filter process.

Personally, I enjoy the CEU I take and would miss it if it were gone or only obtainable through online tests or the like. One unofficial value that CEU courses have is networking/discussions. While I personally struggle with this aspect I routinely observe that it is highly valued and important.

Is the current system good enough? How would you (anyone) change it if you could?
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Last edited by Jon Newman; 27-01-2009 at 01:55 AM.
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Old 27-01-2009, 01:45 AM   #47
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This seems to me to be the very anthithesis of good University education which should seek foremost to demand of the student that they learn to think. Critical thinking should be core, not post graduate as by that stage the passive approach has been inculturated and for many and so ingrained they do not move beyond it.
Andy,
I recall way back when I was a PT student at UAB, the faculty tried to implement a problem-based learning (PBL) model in a couple of the 2nd year courses, which I suppose was the latest application of adult education theory to counter the very thing you're describing above. The problem with PBL was that the instructors seemed just as confused about how to teach using it as we students were to learn from it. Everyone was frustrated and confused most of the time, and the process seemed very inefficient. PBL lacked a cohesiveness that to this day I can't quite put my finger on.

Perhaps they've worked out those bugs now. I don't know.

Does anyone have any experience with problem-based learning from their PT/university education? Did it teach you to think?
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Old 27-01-2009, 03:06 AM   #48
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I don't think anyone could have taught me to think back then. It's something I started doing a few years after I graduated. Starting to enjoy it, now.

Mary
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Old 27-01-2009, 03:15 AM   #49
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John. They began piloting PBL at UTMB-Galveston toward the end of my schooling. It was a disaster. I can see the possible advantages, but you really need complete buy-in from the student standpoint. When you are dealing with 20-25 year olds with fairly immature reasoning skills (just tell me what's on the test), PBL doesn't seem to hit the mark. For those students who crave a deeper understanding of what they see and do in the clinic, PBL could be pretty powerful in my opinion.

I think our pre-PT curriculum makes PBL very difficult as we place a strong emphasis on traditional modes of teaching and assessment. After 16 years of this basic educational model, we completely reverse this model and teach them to think upside-down. I'm not implying one is better than the other (not an educational specialist), but the inconsistency makes it difficult to integrate.

Ultimately, no matter how you flavor the information the individual must be willing to process it on an increasingly higher level to be competent in their chosen profession. Right now we are still in the "Awaiting instructions...." mode in which something isn't so unless shown to us. We could have the greatest educational model ever devised, but the individual still must be willing to walk through the gate.

Think about it. Great clinical minds have been developed in the absence of PBL curricula, and utter goofballs have been trained under traditional models. It makes me think that no matter what we put out there, there will always be the wants and want-nots.
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Old 27-01-2009, 03:20 AM   #50
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Yes, John. It was introduced many years ago at McMaster University for Medicine. It was also implemented for PT.
I have been exposed to the results both from MDs and PTs who had placements in my clinic in the 90's (the MDs in a special programme for their family practice segment - they had a progressive professor who made them visit a PT clinic and shadow a PT for a few days). They did quite well in their general attitude towards problems and their choices of management - the MDs were quite aware of their shortfalls in MSK medicine, and the PTs were not set in their (or their professors') modus operandi.

But this is from the 90's......I would like to see what direction those PTs are looking in now.
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