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Another Perspective on Continuing Education

I applaud you for your Editor's Note (September 2001) regarding physical therapy continuing education (CE). Much of what you wrote resonated with several of my colleagues and me. I have another perspective that I think may be useful in furthering the discussion.

In your Editor's Note, you wrote, "The current CE system does not ‘continue’ anything other than a demonstration of the axiom that there is a sucker born every minute." I have often wondered, as you do, why courses that from every perspective seem obviously shallow in content and absent in science continue to fill up and remain in demand. Well, the answer is simple enough—because that is what the market wants. So, the question is, why do they want it?

I suggest that the reason physical therapists spring from "guru" to "guru" is that they lack a fundamentally sound, rational, and standardized training system from which would naturally evolve a similar form of problem-solving skill. When asked a simple question such as "Why does this patient's knee hurt?" the answers will range from muscle weakness, to a poorly tracking patella, to a tight fascial system, to a pronated foot, and ad nauseum. I have taught at all levels within our profession and have witnessed it firsthand. Physical therapists fundamentally want to do the right thing. Unfortunately, the educational system has not yet consistently shown them what the right thing is.

The educational system does a wonderful job of exposing students to a wide variety of theories. However, many of these theories conflict or even contradict one another. Students typically have reasonably good skills performing a cursory history and a limited physical examination. They falter, though, when asked to develop an intervention and to explain it. Faculty and other clinicians frequently tell students that they will learn interventions "on your clinicals." It seems to me that the place to learn about interventions is in school. This is when we have the best opportunity to change practice patterns and develop critical thinking skills. It is a mistake to leave this portion of a student's training to a clinician who developed clinical decision-making skills from modeling another clinician who modeled someone else, and so on. In school we should be establishing a standardized method of taking a history, performing a physical examination, arriving at a diagnosis, and proposing an intervention. Interventions certainly should be based on evidence, and we should understand the merits and weights of the evidence we use. We should also learn what to do to whom and why. Not why it works, although that would be nice, but which patients should get which procedures. If we could get that far, we will have come a very long way.

Market forces determine to a large extent whether or not products will continue to sell. Of course, that is assuming that one functions in a free enterprise system—unlike health care (a subject perhaps for another editorial). Continuing education courses that are nothing more than a carnival sideshow will still be popular as long as there is a market. If you want to change the CE system, change the students' training.

Doug Kelsey, PT, PhD, OCS, President

Corley & Kelsey Orthopedic and Sports Therapy
7700 Chevy Chase Dr, Suite 202
Austin, TX 78752
dkelsey{at}corleykelsey.com

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