Today's Guest Post is by Dr. Andrew M. Ball, PT, DPT, Ph.D, OCS, CMTPT on the value of education verses the value of experience. Drew is a contributor over on my other blog, Physio Answers. Follow this link for his bio!
|Dr. Andrew M. Ball, PT, DPT, Ph.D, OCS, CMTPT|
Several days ago a Twitter follower of mine asked for me to examine the website of a physical therapy practice, “Doctors of Physical Therapy,” that employs ONLY DPT’s. His position was that the additional education gained in a DPT program is no substitute for years of clinical experience. Funny thing is, the very same week, I had a beer with a young DPT friend lamenting about “experienced” colleagues under-valuing the formal education in evidence-based clinical reasoning and radiographic imaging that cannot be gained from experience alone . . . especially if those years of experience are simply the same tired year of modalities and exercises over, and over, and over again. Both clinicians thought that I was in a “unique position to comment” on their side of the experience versus education debate.
The reason that I’m in a unique position, is that I not only have nearly 20 years of experience, I’ve earned an MBA/PhD in Healthcare Management, I’ve completed a post-professional DPT, a post-graduate fellowship in neurodevelopmental pediatrics, and a post-doctoral clinical residency in orthopaedic physical therapy.
I’m pretty sure I’m a pretty good therapist, but how exactly is that measured? Patient satisfaction? Functional outcome measures? Efficiency of time from evaluation to discharge? Year and year out I have residents, co-faculty, co-workers, patients and referring physicians comment in amazement of my clinical skills and speed with getting most of my patients better. I’m sure my experience is not unique in that regard, but it’s easy to measure oneself by one’s POSITIVE outcomes rather than by the negatives, but we’ll come back to that in a moment . . .
Personally, when I self-assess, I break down my strengths and weakness into three domains:
(1) Foundational Knowledge (including entry level degree and post-professional DPT)
(2) Technical Skills (thrust manipulation, dry needling certifications, etc.)
(3) Advanced Clinical Reasoning (obtained through residency/fellowship and/or experience, and at least partially demonstrated upon specialty board certification)
I would submit that all domains are equally important, and that neither the DPT, nor experience, results in an immediate mastery of all three.
As a qualitative researcher by training, I am quite familiar with the concept of equifinality --- the idea that the same destination can be reached through various routes. That said, some routes are more efficient than others, and some routes can lead to a false sense of mastery. So while it is true that advanced certifications in the hands of an inexperienced clinician with poor clinical reasoning is a cause for concern, of equal concern is the "experienced" clinician with a single year of experience many years over, no effort toward advanced clinical skills or evidence-informed decision making.
It is also true, and rarely discussed, that the reverse is also true. The years of experience and pattern recognition of clinical mentors can be cultured within a single year of post-graduate clinical residency or fellowship, and the differential medical diagnostics and understanding of imaging studies can certainly be obtained via experiential and continuing education venues other than the t-DPT (although I would argue no more complete and cost effective; experienced clinicians typically are not going that route either). The point is that none are osmotic, and all require some sort of self-reflection and academic effort on the part of the professional somewhat beyond that of simply passing the basic PT licensing exam.
Mastery is assessed patient by patient and not en masse. Clinical skill and lack thereof is not patting oneself on the back on the basis of the patients helped, but by self-reflection vis-a-vis the aforementioned domains through the eyes of patients with whom the clinician has failed.
Let us strive for the day as a profession when we focus less on differences in not HOW mastery in expert practice domains is achieved for each individual clinician, and rather THAT they are achieved. The current state of our professional debate on experience versus knowledge base suggests that we as a profession are content to ask our patients to choose between the two. Clinicians that do simply are not as good as they think, and the public deserves a profession that provides them consistent mastery of each domain, in every practicing therapist.
- Dr. Drew
edit: I have been hit at all the parts of this debate from early on in my career and now 15 years in. I used to tell some students, you know who does not have a DPT? Stanley Paris, Robin McKenzie, or Gray Cook.
On the other hand, it drives me crazy when former students tell me their new boss does not allow them to call themselves "doctor" in the clinic. I think it's a sad state of professional in-fighting that I will never understand. Great points made by Dr. Drew regarding not HOW mastery is achieved, only that is IS achieved. I am in total agreement and have often wished that the majority and not the minority practiced like the best of therapists, and not modality slingers or co-pays to go workout by yourselves in a massive clinic with no 1:1.
Thoughts? Comment below!