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  • Oxford Debate: Specialist vs Generalist Education; Ciccone Declares Results to be the “Closest Ever”

    According to moderator Chuck Ciccone, PT, PhD, FAPTA, the 10th Oxford Debate, held June 23 at NEXT 2017, was the closest in its 10-year history.

    The motion being debated was: “Be it resolved that physical therapist and physical therapist assistant students will demonstrate expertise in a specific focused area of practice immediately upon graduation.”

    The pro team, arguing in favor of the resolution that graduating students should be able to demonstrate expertise in a specific area, consisted of Scott Euype, PT, DPT, MHS; Jody Frost, PT, DPT, PhD; and Frederick Gilbert, PT, DPT. Arguing against the resolution were Janet Bezner, PT, DPT, PhD; John DeWitt, PT, DPT, ATC; and Shawne Soper, PT, DPT, MBA.

    The pro team, dressed as personalities from the television show “The Voice,” led with Gilbert, who interspersed his arguments with a variety of hit songs. After a rousing version of “Ring of Fire,” he said, “We are not ready to treat what’s coming at us in the clinic. Generalists are generally good. But health care demands excellence. Are we prepared for the masses fed up with ‘sick care’?”

    Leading off for the con team was Dewitt, who said, “We are choosing a different path than we expected when we entered PT school. The missteps we take foster innovation and discovery, and that is good.” Citing the view of Gail Jensen, PT, PhD, FAPTA, that the hallmark of physical therapy is the ability to make judgments, often in uncertain conditions, DeWitt said, “Without that foundation, we cannot specialize. We need a robust set of tools to understand the needs of our patients.”

    Next up was Frost. Arguing in favor of specialization, she asked the audience: “Would you see a generalist for women’s health? Or for a spinal cord injury?” She spoke of the need for mentors, posing a question: “Clinicians: How many students chose their specialization after working with you? That’s good. We need specialists in practice. The generalists say they’re jacks of all trades, but there’s no way they could keep up with all the literature and research [required of specialists].” Continuing with the theme of “The Voice,” Frost concluded with a revised rendition of Lee Greenwood’s “God Bless the USA,” with lyrics reflecting the new title “God Bless the Specialist.”

    Soper, supporting the generalist position, responded: “Physical therapy is not about us. It’s about our patients and clients. So, where are they? All over the country. To care for the human experiences, we need physical therapists (PTs) where the need exists. But in rural areas, we have few PTs to cover huge areas. In those areas, it’s essential that patients have their needs met. Consider the patient poststroke or the child with special needs.” If a specialist isn’t where the patient is, “we’re not meeting the needs of society.” Education, Soper said, “needs to support a student’s exploration or else this is an opportunity missed.”

    Then came time for audience comments. Among them:

    “I’m a student and spending so much money. When I graduate, I want to be able to treat every patient who walks through the door.”

    A Florida-based PT said, “I get 7-10 requests a week for referrals. I’ve never been asked for ‘the best generalist.’ It’s always ‘the best neurologist’ or ‘the best orthopedist.’”

    An audience member commented, “We need to become movement specialists first. Then we can go from there.” Another audience member said, “I don’t know what all those letters after your name mean.” A PT based in Alaska said, “Where you care for patients across the state, you don’t know what’s needed until you’re there.”

    Then the program shifted back to the debaters. Wrapping up for the generalists was Janet Bezner, who said, “We have to meet the needs of all the people. Think of all the ICD-10 codes we address. We might see a child or an infant, a baseball player, a professional runner, a homemaker, a steelworker, or a painter. So we have to cast the net broadly to meet the needs of society. We’re not suggesting that there should never be specialists. But that should come after being a generalist.”

    Concluding for the pro team, arguing for specialization, was Euype. He said, “Being generally good is not good enough. We need to have a specialization. Do you want someone poststroke being treated by a generalist?” And, he added, “Students with specializations are more employable.”

    After scoring the debaters and tabulating the audience comments, Ciccone declared the generalist team the winner.

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