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Research Reports |
GP Brennan, PT, PhD, is Director for Clinical Quality and Outcomes, Intermountain Healthcare, Rehabilitation Agency, 5848 South 300 East, Murray, Utah 84107.
Address all correspondence to Dr Brennan at: Gerard.Brennan{at}intermountainmail.org
Austin and Graber1 explore the concept of continuing education (CE) in physical therapy as a behavior consistent with lifelong learning and professional development that enables physical therapists and physical therapist managers to meet the challenges of a complex health care system. Continuing education is identified as a key component to negotiating this dynamic process. Lifelong learning is defined as being grounded in personal development that is specific to the individual and the situation (eg, heath care, physical therapy). The aim of this study was to describe the perceptions of physical therapists and managers related to the barriers and resources of CE and the influence of the work environment on CE.
The relationship between CE and patient care was not explored in this study.1 The investigators’ observations of the perceptions of the physical therapists do not appear to articulate a clear and strong linkage between CE as lifelong learning and the process of patient care. As the profession of physical therapy evolves to rely more consistently on principles of evidence-based practice, this necessitates that the delivery of care should link to the evidence in conjunction with the patients’ values, and not necessarily to the physical therapists’ perceptions and values.
If our collective goal as a profession is to deliver care that is evidence-based, as the American Physical Therapy Association’s Vision 2020 statement2 suggests, CE should be viewed as an important opportunity to change practice behavior in a way that will improve the quality of patient care for specific clinical conditions. Quality of care improves when inappropriate variation in the treatment process is eliminated, and continuous improvement is documented by consistently tracking clinical outcomes.3 Physical therapists’ perceptions about CE are not as important as the linkage between CE and the delivery of care to the patient.
The authors1 state that to remain current in the field, CE is of "unquestionable importance." The importance of CE, however, does need to be questioned, especially if it is perceived in the self-serving context proposed in this article. For example, therapists perceived that the CE program met their "individual" educational needs and preferences in terms of personal schedule and topics of interest. The results of the study never once portray the therapists’ concern that CE somehow relates to patient care and the delivery of care in terms of clinical outcomes or costs. Perhaps, the relationship of CE to patient care is assumed and "unquestionable" to the authors, but it ought not be. Moreover, anyone who provides financial resources for CE can legitimately question its importance. Without linking the effects of CE to the clinical outcomes of patients and the practice behavior of therapists, there is little foundation upon which therapists are able to request financial support from their employer to sustain an investment in CE. To be sustainable, the CE needs to benefit the patient and be congruent with the goals of the organization or employer.
The purpose of CE needs to address patient care by improving clinical outcomes and changing practice behavior toward the consistent delivery of evidence-based interventions.4 When approached from this perspective, CE has the potential to change practice behavior in a manner that can result in improved clinical outcomes for patients.5–8 Typically, improving clinical outcomes relies on evidence-based practice and reducing the variability of practice behavior. Physical therapists and managers need to target specific CE goals that are directed at clinical conditions of patients most frequently treated in the department. In addition, departments need an ongoing assessment of outcomes to determine the effectiveness of any CE opportunity in improving quality. This approach helps managers articulate a business case to improve the quality of care and facilitates the request for financial support from the employer to sustain a strategic plan for CE, because it relates specifically to improving the quality of care for patients. The observations of therapists and managers in this study1 do not demonstrate an understanding of these factors that would facilitate a sustainable effort toward CE. If CE is a component of lifelong learning in physical therapy, then it needs to meet the needs of patients first, and hopefully that will be consistent with the interests of therapists and employers. The goals for CE need to be congruent and integrated with the goals of patient care, therapist, and employer.
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