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Letters and Responses |
This letter is written in response to the September 2001 Editor's Note titled "Are You Financing a Sham?" In the Note, Dr Rothstein contended that it is a rare occasion when a physical therapy continuing education course provides scientific evidence, or even discusses what evidence exists, for a topic. He argued that most continuing education courses are primarily testimonials. He also stated, "Even at APTA national meetings and component-sponsored events, there seem to be few demands for speakers to provide evidence or even to discuss whether evidence exists."
We submit that the Neurology Section of APTA offers continuing education courses based on evidence. And here is our evidence. The Neurology Section's 2001 Combined Section Meeting (CSM) preconference program included 3 keynote speakers. The average number of articles listed in a PubMed/MEDLINE search for these 3 speakers was 86 (SD=81). In 2002, the Neurology Section will offer 2 pre-conference courses. There will be 10 keynote speakers. The average number of articles listed in a PubMed/MEDLINE search for these 10 speakers was 40 (SD=53). The median number of publications for our 13 CSM 2001 and 2002 preconference keynote speakers was 30 articles. This number of articles would suggest that we have credible speakers.
But quantity of articles is not everything. What about the quality of the articles? The journals in which our keynote speakers publish include, but are not limited to, Advances in Neurology; Brain; Brain Research; Developmental Medicine and Child Neurology; Experimental Brain Research; Gait and Posture; Journal of Applied Physiology; Journal of Biomechanics; Journal of Comparative Neurology; Journal of Gerontology; Journal of Neurology; Journal of Neurophysiology; Journal of Neuroscience; Muscle and Nerve; Journal of Neurology, Neurosurgery, and Psychiatry; Journal of Vestibular Research; Movement Disorders; Neurobiology of Aging; Neurobiology of Learning and Memory; Neuroimage; Neurorehabilitation and Neural Repair; Neurosurgery; Physical Therapy; Presence: Teleoperators and Virtual Environments; Progress in Brain Research; Science; Somatosensory Research; and Somatosensory and Motor Research. This list, which contains journals at the forefront of science and physical therapy, suggests that our presenters publish in credible journals.
But does the Neurology Section demand that all speakers have publications in refereed journals? Of course not! Some of our speakers do not have publications in refereed journals. When this is the case, speakers are asked to present the evidence–their job is to review the literature and explain how they apply research findings to clinical practice. In addition, we often "pair" research and clinical experts so that the researcher reviews the literature and the clinician presents case examples demonstrating how they apply research findings to clinical practice (see 2001 CSM preconference course for an example). In addition, our speakers are expected to include references in their handouts. In summary, we expect speakers to provide evidence, and when there is no evidence for a topic or an application, then we expect our speakers to state that there is no evidence.
Participants in our courses are also expected to be "critical consumers." Speakers participate in question-and-answer periods during which the audience has an opportunity to question speaker viewpoints or interpretations of the literature. The program committee anticipates that these sessions will be exciting and challenging, and we ask all of our speakers to participate. The question-and-answer interval provides time for in-depth discussion and gives the audience an opportunity to scrutinize a speaker's viewpoint–several of our question-and-answer sessions are scheduled for longer than 1 hour. In addition, some speakers are asked to participate in special interest meetings and roundtables to provide an opportunity for further discussion.
An added feature of programming is that we disseminate selected education presentations in Neurology Report. This allows Neurology Section members who cannot attend a conference to expand their knowledge through our issue on conference proceedings. The invited papers are peer-reviewed (nonblinded) and edited. The process of translating a presentation into an article often clarifies and expands on points that a presenter or an audience discussion raised during the course. Among the notable contributions to Neurology Report that originated from CSM programming are: a 2-part series on the use of body weight–supported treadmill training for people with stroke and spinal cord injuries (see volume 24, issue 2), a 4-part series of articles titled "How to Teach the Examination and Intervention of Weakness and Spasticity" that was complemented by a commentary from a researcher-educator in the field (see volume 25, issue 3), and contributions from non–physical therapists who may not have typically published in Neurology Report (see Patla in volume 25, issue 3). Our programming translated into print is so well received that we obtain numerous requests from both within our country and abroad to reproduce the publications.
Now, are we perfect? Of course not. We have presented programs where speakers failed to offer evidence for what they said. Occasionally, this occurs because "we have not done our homework"–that is, we failed to evaluate a speaker's credentials properly. But sometimes this occurs on purpose. Some speakers and groups have been selling their ideas and techniques for decades, and many therapists attend their courses. Therapists rave about these speakers. We have invited these speakers so that the audience can scrutinize their ideas. Typically, these speakers decline to speak at our meetings. But when they agree to speak, we think the scrutiny of ideas provides important mentorship for physical therapists who "believe everything they hear."
In summary, the evidence suggests that when a physical therapist attends a Neurology Section continuing education program, he or she is not "financing a sham." Participants can expect speakers who offer evidence for what they say and speakers who are excited to participate in open forums for scrutiny of ideas. Dr Rothstein, we think we are part of the solution. We are proud of our continuing education and CSM programs.
Neurology Section, APTA
Neurology Report
Neurology Section, APTA
I believe that the letter writers miss the point when they contend that not all the presenters need to publish. They create a dichotomy between "researchers" and "clinicians" that I did not. I am confused as to how you really know someone is a "clinical expert" unless that person has published something somewhere. Primary research is not the only kind of publication that matters. I recognize that this may be very difficult; however, I see no reason why the section does not require "clinical experts" to have published case reports or similarly appropriate materials. Only when people publish can their "work" truly be judged in the public arena.
I contend that criteria for speaker selection should be noted. This would provide potential attendees data on which they could base their decisions about continuing education. The justification for speaker selection appears in this letter to the Editor, but had there been no Editor's Note, this justification would never have been detailed in a public manner. The promotional materials for the courses offered by the Neurology Section differ dramatically from each other. One course has goals that center on the "evidence" for various aspects of neuronal plasticity. Another course has goals that never use the word "evidence" and that suggest a focus on theories and points of view. I am not suggesting that the latter course is evidence free, but I am contending that unless those who offer courses that are based on evidence and utilize appropriate speakers describe this in the promotional materials, potential attendees will not have this essential information. Is there a section policy that guides programming? One that characterizes the types of courses that will be held and what will be expected of speakers?
Although I salute the efforts of the Neurology Section and the desire of its leadership to go on record defending their courses, I must take issue with the remark in the letter that "evidence" suggests attendees at these courses are not financing a sham. Nicholson et al have made an argument–a forceful argument–but they have not provided evidence. Evidence might consist of outcome data about what people learn or, better yet, how course attendance has helped in practice.
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Physical Therapy 2001 81: 1500-1501.
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