• Thursday, February 06, 2014RSS Feed

    From CSM: Portney Calls for Disruptive Change in Physical Therapy Education

    Stating that the physical therapy community has not adequately dealt with change in physical therapy education, Leslie Portney, PT, DPT, PhD, FAPTA, said that disruptive change is needed. Portney delivered the 17th annual Pauline Cerasoli Lecture February 5 on “Choosing a Disruptive Path Toward Tomorrow.”

    “If we don’t move away from the same tools and frameworks that we have always used,” Portney said, “we will find ourselves being forced to when tomorrow comes.”

    She explained that disruptive innovation explains how new products or services become adopted when they serve a new market, are cheaper or more efficient than older products, and effectively change the culture of the product’s use. The printing press, personal computer, retail health clinics, and the first use of anesthesia are disruptive innovations. In contrast, sustaining innovations seek to improve the status quo—such as car engines with better mileage.

    Portney said that most of the changes in physical therapy education during the past 50 years have been sustaining, rather than disruptive. Sustaining is no longer sufficient, she said, and, meanwhile, the sustainability of current business models in higher education is being challenged by “the perfect storm” of tuition increases, student debt, and tuition discounting. These “could make the financial foundation of our institutions untenable.”

    Portney proposed a series of potentially disruptive innovations for physical therapy education, including online education, faculty and curriculum changes, and evidence-based teaching.

    Following Portney’s address, it was accounted that Cecilia Graham, PT, PhD, would be the 2015 Cerasoli lecturer.

    For further coverage of the Cerasoli Lecture and other sessions from CSM 2014 in Las Vegas, watch for the CSM Daily News highlights issue, to be delivered electronically to members after the close of the meeting. Past issues are posted on www.apta.org/CSM.


    Comments

    a good start would be to have an addition of more bridge programs, especially geared more for PTA's that have a lot of experience. A lot of PTA's have the knowledge and experience to be successful in a transition, but don't have the resources. similar to the rn to bsn bridge...
    Posted by T SHAWN HOWARD on 2/6/2014 7:49 PM
    This is a great statement. What have we done to prepare graduates to assume the title of Doctor of Physical Therapy. New grads come into the work place without the depth of knowledge and experience that is expected of someone that is being addressed as Doctor. Many migrate to Home Health because of money. How can educators pass on the concept of ownership of the profession
    Posted by David Mallgrave on 2/7/2014 8:21 PM
    As a prospective PTA student, I am relieved to read what I have observed in the PT community. I conversed with A&M, UT, UH, and Texas Tech representatives for transfer day at my CC. Two of the universities’ B.S. programs in Health for Allied Professionals require fifteen additional hours of the same general information classes than a B.S. for Public Health. One more semester can “prepare the student for pre professional practice?” Also, my PSYCH 2306 classmates introduced themselves as PTA program applicants a month ago, but do not understand physical therapy to be a “profession to own”. I do not know for certain that my classmates do not respect PT. However, as a certified personal trainer and PT Tech, I can say my fellow PTA classmates do not exhibit general health knowledge. I believe educators are not required to pass on ownership, but identify students who bring that strength and encourage them to engage others. PT needs "disruptive paths" and scientific progression. We need a battle cry.
    Posted by A Rose Strohmann on 2/9/2014 12:48 PM
    I completely applaud the thought that we need to have a disruptive change in our profession. However, I think we need to do some heavy lifting first and that starts with a three tiered approach to some house cleaning. If we are to be successful in the future we need to have a solid foundation for our actions. The first real change that we need to adopt is the notion that is as physical therapists, we are now a specialized entity. As a manager for regional medical center, we routinely struggle with the notion of how do we market or push therapy. Therapy in general does not appeal to the masses. If going to be successful we need to have an enticing mechanism of cultivating those clients that are going to best benefit from our services. Frequently I am engaged with inquiries about specialized clinics and services that are offered. It is not uncommon to do 2-3 tours per week with potential clients and customers. The inquests always focus around a particular sub specialization. Individuals want to come see the pulmonary rehabilitation program, the lymphedema clinic, or have questions about our manual therapy. They have special needs that need to be managed in the prosthetic clinic or they're interested in dry needling. Despite having a general framework as an entry-level therapists, physical therapy has progressed to an entity of specialization. We must embrace this and further leverage the way that we market and appear to potential clients. The second round of foundational work that needs to occur is true competency at the specialization level. The next frontier for physical therapy is within physical therapy. We have the capacity to vastly improve the clinical thinking of our therapists. Not clinical thinking on the didactic or the distant front, yet critical thinking on the ground with the patient, and with day to day progressive therapy. We can all list examples of "going through the motions therapy "through the guide to physical therapy practice, our clinicians have the capacity to completely reframe the physical therapy encounter. Therapy should be dynamic and progressive, we should not accept a three sets of 10 mentality or a stand alone flowsheet framed progression of therapy. Therapist should understand milestones in diagnosis based progressions and they should also be able to recognize outliers and course correct as needed. We should always be able to answer the question: why are we doing this now? We should expect that therapist are competent in not only understanding the rationale of each individual therapy session, yet fully explaining this in a concise manner to our client base. I'm far less worried about the therapists who are debating the merits of research on the Internet and far more worried about individuals who are doing 30 to 60 visits of the same mat exercises. Our clients need to be confident that we can either move them along in therapy or help them get to the provider that may best assist their issue if we're not seeing results. Lastly and perhaps the most challenging of the foundational cornerstones of change is becoming fluid across the specializations. Therapist need to understand that we must become investors of the brand regardless of where we sit on the spectrum. We need to be able to speak at a concise level to the merits of our peers across the various practice fields of physical therapy. And what exactly are we talking about here? To truly be a competent therapist, the next time someone catches you in conversation and says " what are PT's doing with pelvic pain? ", a competent therapist needs to be able to answer that question and do so in an articulate manner that supports the merits of the brand. We need to be so confident that we can assert why physical therapist is involved in WC & seating, running, cancer rehab, lymphedema therapy, manipulation, ICU and critical care that whoever is listening is immediately drawn to the notion of "I can't imagine the physical therapist not being involved in that". Now you don't have to be able to speak to it at the level of presenting a poster, yet you need to be articulate enough that it conveys the message of why the unique clinical skill of only a physical therapist should be considered for this idea. The days of saying "acute-care physical therapists just walk patients "or" dry needling? What's that it's just crazy I wouldn't do that" are simply plain gone. You need to explain why a PT is working with a telemetry client as well as a ergonomic assessment. If the therapist can't speak to the brand and do so in a way that is both supporting and honest, I would argue that that therapist is not confident to be part of the brand. I'm absolutely certain there's other foundational work that needs to be done. Once we get our house in order, we can go be as disruptive as we want and shake up the world.
    Posted by Brian Finch on 2/11/2014 8:54 AM
    I agree with everything that Brian has shared above; and, after attending CSM2014, I can say without a doubt that if we want to know what needs to be done differently in the education of future PT's, all we need to do is ASK THEM. I have never been so impressed with a group of students as I was with the students at CSM. What a dynamic, amazing group of people. They asked relevant questions, had ready answers to my questions, and said over and over "We're here, we want to be a part of this!" Just as the days of a passive patient are over, the days of the unempowered student should be coming to a close. We can work with the DPT Students as a community to help them lead the way into the future!
    Posted by Ann Wendel on 2/11/2014 1:54 PM
    On-demand same day PT appointments. Becoming a member of a patient centered primary care team. Ceasing the same tired PT exercise program each session. Dispatching non-evidenced based rehab approaches. Telephysical therapy. The list goes on! Be confident enough to blaze your own path. Be a pioneer!
    Posted by Alan Petrazzi on 2/11/2014 6:33 PM
    Thank you for the kind words Ann. And I think I speak for most students that we do want to be heard and as stated at CSM2014 it's time we start closing that gap between clinicians and student relationships. I would also like to say I agree with what Brian shared above. The one thing that does stand out to me and that I am concerned about is moving to an online education. Online education has been suggested to help lower student debt. This might be the case but I think our education will suffer. I'm in a program where the majority of my classes are "hands-on" and help us to develop our interpersonal skills. How am I supposed to develop this in an online program? How am I to attain a "hands-on" skill on a web page? I can completely agree with a hybrid program where some classes would be taught online, such as health policy, clinical reasoning, pharmacology, ect. I think an online hybrid would help us students to develop accountability and responsibility. But, the majority of the curriculum moving online makes me think our full potential as PTs is being jeopardized. My other question is about how an online education would save money? I will admit my knowledge lacks in this area, but at my school we have one set fee. An online class isn't cheaper than a class in real life. How would this help the student debt issue?
    Posted by Justin Rice on 2/11/2014 6:45 PM
    For Physical Therapy to have a consistent brand message, it needs to have consistent care delivery with standardized models of intervention that are based in evidence. I don't think we're there yet. (Dry needling included)
    Posted by Joshua Cohen on 2/11/2014 7:49 PM
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