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Editor's Notes |
jules-rothstein@attbi.com
As another graduation season draws to a close, our profession welcomes a new generation of physical therapists. Never before have so many young therapists been educated in programs that offer the profession's most appropriate degree: the professional doctorate, the DPT.
Holders of this new degree—if properly equipped with knowledge, clinical competence, and humility—can help this profession achieve many long-sought-after goals. Foremost among these goals is the ability to provide evidence-based care in an accessible and cost-effective manner without a burdensome subordination to other professionals. In the best of education programs, students are prepared for this task. In some of our programs, however, little has changed since the days of certificates and baccalaureate degrees.
Our new physical therapists who are prepared to advance the profession need to be aware of the people who made their current status possible: the physical therapists who, over the past decade, have done something truly remarkable by making self-interest secondary to professional necessity. These pioneers did not oppose the move to the DPT, even though they knew that their own status, theoretically, could be hindered by new graduates with doctorates. Instead, these pioneers welcomed the advancement because it was the right thing to do for the profession and because it was an honest recognition of the kind of education that we have already been offering.* Their willingness to see beyond their own personal status reminds us of the true nature of professionalism. I also would include APTA's leadership among those who have made heroic contributions. Those leaders supported movement to the DPT even though many of them did not have terminal or doctoral degrees of their own. The same can be said for the members of the APTA House of Delegates who fostered the development of the DPT.
Many physical therapists are now seeking what is often called the "transitional doctorate," that is, the DPT for those who are already members of the profession. They too should be admired—as long as their purpose is to improve their knowledge and competence and not to simply adorn their names with degrees. I would, however, exclude from this group anyone who seeks what they might call an "advanced DPT" as a credential for advanced clinical competence. This is a degree that has neither precedent nor logic to support its existence. In my opinion, such degrees are "advanced" in name only. Physical therapists who obtain these "advanced" degrees claim to be gaining advanced clinical competence, but instead they receive a degree with the same name as the degree received by those who are entering the profession. Apparently, confusion is the goal; otherwise, instead of calling this creation a DPT, we could, as do other professions, refer to this type of degree as a fellowship or even a specialized master's degree.
Often the very faculty members who supervise the awarding of these so-called advanced degrees obtain the degree themselves, and often at the same institution. The incestuous nature of these relationships belies the fact that there is no mechanism for ascertaining whether these programs really offer education that is advanced or whether graduates are advanced in clinical competence. These programs do offer the successful candidate some initials that they can place at the end of their names (a dubious argument for a program's existence); but again, because the initials are no different from those obtained by people entering the profession, this can only add to the public's confusion and our colleagues' skepticism about our motives in moving toward the DPT.
Graduation is not a time to focus on the negative, however. It is a time to apply the lessons of the past to build a better future. After giving more than 2 dozen commencement addresses, that is a lesson I have learned! In that spirit, I am looking to the happy day when another graduation takes place, one that is long overdue. The word graduation is derived from the Latin word meaning "to step up." Our new physical therapists have stepped up, and now it is time for the programs that educated them to step up. The education of new therapists should be the primary reason that these programs exist, and, if they cannot do this task well, they should be put out of business. Too often, however, "turning out" new physical therapists—as opposed to educating them—appears to be the only reason that some programs exist.
As evidence-based practice moves from a catch phrase to a real challenge for clinicians as well as everyone who teaches, the problem becomes clearer. Students should ask faculty who propose the use of examination techniques, interventions, and anything else clinically relevant to document the evidence for what they are teaching. In fact, students should consider this inquiry to be their job, and faculty should consider it their job to respond appropriately to students. I doubt whether many of us as patients would be comforted by a health care professional who says, "This is what I learned in school. I have no idea whether there is any evidence that it is good or bad, but my teacher sure sounded convincing." When there is little or no evidence, faculty do themselves a disservice by blustering instead of candidly admitting to a paucity of research support. In the absence of data, opinions are reasonable, but it is vital that opinions be identified as opinions and not as gospel.
Faculty members who cannot cite the literature, or who refuse to look for the evidence for and against what they are teaching, are simply incompetent. Teaching the evidence not only is their responsibility and professional obligation but is the hallmark of a scholar. The growth in the scientific basis for our practice in the last several years has been extraordinary. We need only to examine the growing lists of articles in the APTA's Hooked on Evidence database—and those deal only with treatment effectiveness—to see how much information we now have.
If you are a faculty member who feels frustrated because too often you are discussing something has never been investigated or even described in a peer-reviewed case report, I ask you to consider the nature of the problem. Certainly any well-educated clinician should be able to contribute a case report describing and clarifying an intervention and clinical decision making. So should faculty members, especially those who teach clinical courses. Faculty members teaching clinical courses should keep current in part by providing physical therapy services to patients. In that way, they too can add to our literature through case reports, especially case reports describing multiple subjects. Although publishing case reports might be considered a "nice" thing for clinicians to do, it is a "must" for faculty members.
When faculty members bemoan the lack of evidence, I recall Cassius in Shakespeare's Julius Caesar. Amid failure, Cassius observed, "The fault, dear Brutus, is not in our stars, But in ourselves, that we are underlings." In professions, faculty members are the primary generators of research, and they work in environments in which scholarship is nurtured. The time has come for faculty members to follow the model of the clinicians without doctoral degrees who welcomed the DPT. Put personal protection on the back burner, and move forward to create mature academic environments. In these environments where we house our physical therapy educational programs, we should provide the best educational experience and generate new clinically relevant knowledge in addition to basic science knowledge.
Our past focus on education has been fruitful, and APTA's Department of Education has pioneered many efforts that have benefited all of us, including the Normative Model for Physical Therapist Education. Educators are by definition trained in the science of education and therefore can, we hope, be good teachers. But in higher education, something more is expected. Faculty members are expected to be academics, which means they relate both to education and scholarship. Note the use of the word "scholarship"! Given the diversity of possibilities for scholarly contributions, everyone on faculty should be capable of contributing. Clinicians have every right to demand that our faculties do as they do in other professions: supply new knowledge that advances and improves practice.
Most mature professions, I contend, would not have a Department of Education, but rather a Department of Academic Affairs. The name change would allow the extraordinary people who work for our profession to focus on the next phase of our evolution: the maturation of all education programs into respected academic programs. I also suggest that the Section on Education reconsider its name. Once again, I challenge the leadership of that section and the Section on Research to consider merging into a section of "Academic Physical Therapists," providing a mechanism for all those who currently belong to both sections to interact and explore their mutual interests as well as their diverse interests.
When our education programs graduate—step up to the next level—to become academic programs worthy of respect for both their educational and scholarly accomplishments, that will be a graduation that all of us can celebrate, particularly our practitioners and our patients.
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