What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.

A Personal Endorsement for Eric Robertson #AAOMPT Secretary

Naturally, I’m biased on this matter. So, please consider that as you read this endorsement. But, I also plead that you digest my narrative and what it illustrates about Eric Robertson.

As a #DPTstudent, I was fortunate to be involved in the AAOMPT student special interest group. At the risk of sounding cliche, the experience was transformative. I was exposed to the inner workings of a professional organization, afforded the opportunity to organize events, involved in advocacy, and even saw my beginnings as a blogger. Our student SIG was full of energy and set lofty goals.

Students, often, are eager and idealistic expressing grandiose visions and unconstrained thought processes. This, of course, is positive. A motivated and engaged student does not know impossibility. And, thus can be quite an agent of change, or a least reflection. I’d like to share a story with you about how Eric, without even being formally involved in the student SIG, brought focus and professional growth to the student members one evening.

It was 2009 at the AAOMPT National Conference in Washington DC. The AAOMPT sSIG leadership sat around a table in those classically ill lit and muggy conference rooms, frantically discussing ideas and topics almost at random. Bob Boyles, the AAOMPT sSIG advisor at the time listened to us. It was great times! Eric, who at the time, I had only just met, was also present. Eric also listened to our grandiose plans to save the world, cure hunger, and eliminate back pain. After listening intently, as Eric does, he spoke. With pointed questions and strategic steering he efficiently nudged us towards more meaningful conversation without stifling our enthusiasm nor tempering the discussion. Oddly, I can’t remember at all what he said. I just remember his presence and effect. It was effortless, but profound and has stuck with me as an example of the kind of impact Eric can have in a room.

Eric routinely engaged the students as colleagues, but also challenged in a productive manner. After attempting to write meaningfully for the AAOMPT sSIG he extended an invitation, and opportunity to blog at PT Think Tank, an experience for me that has been a professional highlight.

Over the years, I’ve known Eric to possess a cool demeanor, strong thinking skills, and excellent strategic planning. He’s not afraid to tackle a problem from multiple angles and balances a host of commitments with ease. I know a long time goal of his has been to serve in a leadership capacity within AAOMPT, so his decision was not at all rash. He’s a constant advocate for physical therapy with a knack for concise and clear communication.

I’m indebted to Eric for his guidance along my own career path and the informal, but always beneficial discussions. His unique experiences and point of view could facilitate amazing progress. I recommend him highly and without reservation. His vision, his commitment, and his skills would serve the AAOMPT well. But, don’t take my word for it.

Use twitter to network before your next conference

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Earlier this year I had a very positive experience attending my first physical therapy conference – CSM 2011, in New Orleans, LA.

Twitter was instrumental in the success of my experience. I thought I would take a moment to show you what I did leading up to the conference. Using twitter, I was able to break-the-ice with several attendees in advance so that when I got to the event I had several conversations waiting to happen.

Use this post as a checklist to prepare for your next PT conference. For me this will be the 2011 AAOMPT Annual Conference, Oct 26-31 in Anaheim, CA.

1. Create your twitter account

  • Choose your name carefully. You want to avoiding changing your name down the road as this will force your followers to find you again once the change is made
  • Choose a name that represents the content of your tweets – JSmithDPT for professional content; JoeSmith22 for personal; XFactorPT for clinic content, etc…
  • Really consider including PT or DPT in your twitter name, especially if you’ll be tweeting about #physicaltherapy
  • Enhance your profile. Add a picture, write a brief biosketch (you are limited to 160 characters), add your location, paste in your homepage URL (university profile, facebook page, a zapd page, etc…)

2. Follow other people on twitter by mining a twitter list

  • Twitter has a way you can group twitter profiles with a common interest called lists
  • If you find someone has created a list of conference attendees, you can view the list and find some interesting people you can start following and maybe even reach out to
  • Here’s the list I’m putting together for 2011 AAOMPT Annual Conference
  • This is a good way to find people on twitter because someone else has already done all the work for you
  • You might also want to check out my list of physical therapy related twitter accounts and ask me to add you if I haven’t already

3. Create your own twitter list

  • Once you have seen the usefulness of a twitter list, I suggest you start your own for the conference
  • Start looking for people you know or would like to get to know by using the “Who to follow” feature
  • Also search for an official conference account and add that to your list – AAOMPT actually has one
  • If you find the conference organizer has an account, your can also mine their followers, here are the >1,000 people that follow @AAOMPT, do any of them look familiar to you?

4. Search twitter

  • Twitter is a powerful way to find information instantaneously about topics you’re interested in, so start searching for content related to your conference, “AAOMPT” for example
  • For large conferences, attendees will include a hash-tag to specify that their tweet is related to the conference, such as #AAOMPT11 or #CSM2012
  • As you find people tweeting about the conference, add them to your list

5. Broadcast your plans

6. Even if you’re not going

  • Watch the hash-tag (#AAOMPT11) to see what people are sharing
  • Ask questions, say hello
  • Help promote the event by tweeting: “hearing lots of good chatter from #AAOMPT11 this week!”

7. Go mobile!

  • Everything mentioned above can be done in a browser on a laptop or desktop computer, however, I found that I was much more likely to interact with twitter from my smart phone
  • In fact, I barely looked at twitter for the first 6 months I had my account. It wasn’t until after I got setup on my iPhone 3GS that I really got immersed
  • The screenshots in the gallery below were all taken from the iPhone app Tweetbot ($2.99 in the app store), but I suggest trying the free Twitter for iPhone app first (those on other smart phone platforms can chime in with links to your favorite apps in the comments below)
  • Plancast also has a free mobile app
  • It is also easier to share photos from your smart phone, assuming most smart phones have a camera these days
  • One free photo sharing app that is on fire right now is instagram, which also connects to your twitter account

Gallery of screen shots from my iPhone shows some of the features mentioned above:

In closing…

I hope this was helpful and easy to digest. As usual, we want your feedback on this post in the comments – what did you like, what was explained poorly, what is your story with twitter at PT conferences, did I leave anything out, etc…

If you’d like to read more about social networking in physical therapy, I suggest reading this recent article on the Australian Physiotherapy Association website – “Why social media matters for physiotherapists”

Mike Pascoe – @mpascoe

Can You Write?

US_Capitol_Building_at_night_Jan_2006We know the world is all about Healthcare reform right now…well a lot of it is. I saw that Congress received 150,000 phone calls in one day!

Well, if you don’t feel like calling and can’t get to Capitol Hill for a visit, try writing a letter! Check out this extremely detailed post about writing letters on the AAOMPT Student Special Interest Group blog.