Licensure, Clinical Competence, And The Role Of Physical Therapy Education

Physical therapist education is something that I have been involved with for many years. I have seen both sides of the coin - the didactic educational side, and the clinical instructional side. I have also experienced the process of accreditation, albeit with a physical therapist assistant program.

There is always talk of "preparing students to take the licensure exam". However, the sad reality is that accreditation and licensing exam standards don't always reflect the current status of research and/or clinical guidelines in the profession.

So here's the question: is the goal of physical therapy education to get graduates to pass an exam, or is it to train competent clinicians - or both?

It would make sense that educational curricula and accreditation standards should reflect the current status of the research in the profession. Academia should represent the cutting edge of a profession, no? Aren't they always promoting "evidence-based practice"? Acceptable standards of safe entry-level practice - as assessed by a licensure exam - should also be consistent with current research.

It all sounds good - in theory.

When posed the question of "why do you have this or that in the curriculum", academic faculty will oftentimes proclaim that the students will need the information in order to pass the licensure exam. Not because it makes them better clinicians or promotes science-based practice. No, it is because you will need it to pass the exam.

Modalities? Gotta have it to pass the exam. Decades-old research on therapeutic exercise? Same response. And don't even get me started on palpation (and all the palpation-based techniques that exist) and how the scientific literature repeatedly confirms poor inter-rater reliability and thus questionable validity in the assessment process. Yes, same response.

Last week, I went to a conference that presented data that is squarely opposed to the academic community - and I expect that very few in academia will do so much as squirm let alone proclaim a need for change. In an outcomes database of over 8,000 clinicians, 6 of the top 10 best performers in low back pain in the physical therapy world are MDT-trained clinicians. What makes this difficult to comprehend is that the typical physical therapy student will get no more than a 1 to 4 hour MDT module in the course of their whole program! Oh, and if it is presented at all, it will be done as just another treatment "tool" and not as a clinical reasoning or assessment algorithm.

Why? Because, as I am reminded, "students need to pass the exam and MDT doesn't have much weight on it".

What's wrong with this picture? Whatever happened to "evidence-based practice"?

Before anyone gets in a huff about this, the phenomenon isn't and hasn't ever been specific to a type of degree (be it Bachelors, Masters, or Doctorate). They have all committed similar sins. Don't worry, the same sins have been committed in many other clinical professions. Just make sure you pass the exam.

So remind me again - are we training graduates to pass a licensure exam, or are we training clinicians to become clinically relevant and competent? When did these entities become mutually exclusive? And why do they need to be?

Photo credits: comedy_nose

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