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Editor's Notes |
jules-rothstein@comcast.net
Members of evolving professions, such as physical therapists, often appear to spend endless hours discussing how to best fulfill the definition of "profession." The discussion often seems irrelevant, esoteric, and elitist. There appears to be little connection to the daily lives of practitioners, the very people who define what we are and who make us a cohesive group. This disconnect costs us dearly and has resulted in a failure to consider issues that can be critical to those who see patients every day. The disconnect also is unnecessary.
We often hear that one of the things that makes a profession is a unique body of knowledge, but we spend little time discussing what this means. We act as if a body of knowledge will fall, fully formed, from the sky. For physical therapists, "body of knowledge" primarily means that we have generated information on how we uniquely manage patients. To some extent, it also means that we have generated information that supports the theory underlying what we do or that allows the development of new ideas. Above all, however, our body of knowledge should deal with the core of our being and focus on our patients and what we do with them.
Although practitioners can contribute, in mature professions, new knowledge is produced primarily by academics. Not only is this part of the job of academics, it often is the only means by which they can be evaluated, and it serves as a mechanism through which they can evolve and renew their expertise. By generating new knowledge, faculties not only contribute to the profession but also repay the hardworking clinicians who teach students in the clinic. If faculties do not carry their load and help practitioners do their jobs better, how can they possibly ask those same practitioners to assist in an educational effort? We need to make contributions to the profession as a whole, not just to the entity that employs us.
The kinds of assertions that I am making here often evoke defensive claims, such as, "Faculty are too busy," "Clinical faculty should not be expected to do research," and "Our institution does not assist us in conducting research." Please note that I never used the term "research," however. I am talking about contributing to our body of knowledge, which is far more encompassing. To consider what scholarship really is, read the article beginning on page 571, where one of the great leaders of American education, Ernest Boyer, offers an expanded view of scholarship, including the variety of ways in which faculty can contribute to bodies of knowledge.
Any institution that does not have the means for all faculty members to contribute in some manner to our body of knowledge should not be teaching physical therapy students. Likewise, any faculty member who cannot find a way to contribute should not be teaching. There is no reason why every competent faculty member, including those whose primary responsibilities make them clinical faculty, cannot generate scholarship. Boyer1 wrote:
Surely, scholarship means engaging in original research. But the work of the scholar also means stepping back from one's investigation, looking for connections, building bridges between theory and practice, and communicating one's knowledge effectively to students. Specifically, we conclude that the work of the professoriate might be thought of as having four separate, yet overlapping, functions. These are: the scholarship of discovery; the scholarship of integration; the scholarship of application; and the scholarship of teaching.
Some of the hesitation to endorse a requirement for faculty scholarship comes from fallacious assumptions. As a student of the 1960s, I rebelled against the publish-or-perish mentality, and I still believe that much of that mentality was wrong and destructive. But much of what I concluded back then was incorrect. Eliminating demands for peer review was not the answer. The answer was, and is, in taking a broader view of acceptable scholarship. By the time I was a student, "publish or perish" had become "get grants or perish." As Boyer notes, they are not the same thing. Many who object to Commission on Accreditation in Physical Therapy Education (CAPTE) requirement F-3 (Each core faculty member has an on-going record of scholarly activities that produce work that is peer-reviewed and disseminated or is in use by professional peers*) either misunderstand or misrepresent not only Boyer but also the term "peer review." Peer review does not necessarily mean publishing in journals such as Physical Therapy. And even if it did, there currently are more than 200 journals (as listed in APTA's Hooked on Evidence database) in which articles related to physical therapy outcomes are published, and there are many other venues, such as APTA section publications. Boyer, however, makes a potent argument that scholarship is not limited to traditional forms of publication. We are an applied profession, and our scholarship needs to focus on areas associated with practice, which means we are not limited to conducting funded research (but such research is, of course, desperately needed).
People who oppose the CAPTE faculty requirement appear to be asserting that those who teach are incapable of the very thing that we expect from those they teach. For instance, what new graduate—and, therefore, what faculty member—should not be able to generate a Case Report or an Update? This is an important form of scholarship, and, again as Boyer notes, it does not have to be published in traditional venues, though he would agree that such publication is best. Faculties owe our clinicians new knowledge!
How do we know whether faculty members know what they are talking about, whether they are current, or whether they use an evidence-based approach? How do faculty members themselves know they are competent? Unless they are willing to be judged, they are exhibiting a hubris we would never allow in our students. The generation of scholarly materials allows us to judge those who judge our students.
Recently, the argument has been made that not every faculty member should be required to make a scholarly contribution, but rather institutions should be judged on the aggregate product of the faculty. To me, that is the equivalent of going to a physicians' group whose physicians, on average, pass the licensing examination, but some do not have passing scores and are not licensed! Is it sufficient if every faculty member who teaches neuroscience has shown competence through scholarly contributions while those who teach orthopedics have not? Our students, and the profession, deserve better.
Our profession has made remarkable progress. Through extraordinary leadership, the DPT quickly became a reality. We now have a vision statement that is expansive and foresees a future that few of us could have imagined only a few years ago. APTA's vision statement includes the following goals2:
Goal II: Academic and clinical education prepares doctors of physical therapy who are autonomous practitioners.Goal III: Physical therapists are autonomous practitioners to whom patients/clients have unrestricted direct access as an entry point into the healthcare delivery system and who are paid for all elements of patient/client management in all practice environments.
Goal IV: Research advances the science of physical therapy and furthers the evidence-based practice of the physical therapist.
How can any of these goals be realized without expansion of our body of knowledge, particularly as it is applied to the practice of physical therapy? Faculty members are in the best position to contribute in a variety of ways, as suggested by Boyer. Instead of clinging to the past and defending self-interests, we must start expecting more from our faculty members. Our Association must help faculty members develop as scholars—which can easily be done when we consider Boyer's definition of scholarship. Developing faculty members who contribute to our body of knowledge, function in the traditional model of the academy, and play their rightful role within a mature profession is not optional.
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