Continuing Education
RONALD J. SEYMOUR, MS, TOM CONNELLY, Jr, EdD, and DAVIS GARDNER, MA
A descriptive study of 903 physical therapists located primarily in southeastern United States was undertaken to determine their attitudes toward continuing education and the types of course offerings they desired. A majority of physical therapists kept themselves up-to-date in professional practice, mainly through discussion with colleagues, study groups, and inservice training sessions. The continuing education courses they preferred were comparatively recent topics in physical therapy education—such as musculoskeletal assessment and mo bilization—specific neurophysiological approaches to treatment of adults and children, and administration. The study also revealed the preferred schedule, length, type, and cost of continuing education courses, as well as the amount of advance notice preferred and willingness to complete preassigned readings. The main problem that respondents had in participating in continuing education was that courses did not fit into their schedules. A majority of respondents favored mandatory continuing education for relicensure. Key Words: Education, continuing; Physical therapy.
The increasing number of continuing education courses offered by academic institutions and profes sional organizations indicates the desire of physical therapists to keep themselves up-to-date. This prolif eration of continuing education courses presents some concerns. For instance, Mote warns that continuing education must not be allowed to become a merrygo-round of conferences, workshops, lectures, and conventions paid for at the patient's expense without the concomitant requirement of improved patient care.1 The American Physical Therapy Association Committee on Continuing Education is similarly con
cerned, stating that the ultimate focus of continuing education is to provide the highest quality of service to the patient.2 The attitudes and desires of physical therapists should be examined when planning course offerings, because continuing education courses should provide information that will improve patient care. Few comprehensive, published studies provide an overview of the current practices, wishes, and needs of physical therapists concerning continuing education.3 Therefore, we conducted a detailed study to determine the attitudes of physical therapists to ward continuing education and the types of courses they desired.
METHOD Mr. Seymour is Assistant Professor, Department of Physical Ther apy, College of Allied Health Professions, University of Kentucky, Lexington, KY 40506. Dr. Connelly is Director, Office of Special Programs, College of Allied Health Professions, University of Kentucky. Mrs. Gardner is Assistant Professor, Allied Health Education and Research, College of Allied Health Professions, University of Ken tucky. This article was submitted November 2, 1977, and accepted August 28, 1978.
Volume 59 / Number 4, April 1979
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An Attitudinal Survey of Physical Therapists
Data for this study were collected through a ques tionnaire mailed to 3,200 active members of the American Physical Therapy Association in eight southeastern states as well as southern Illinois, Indi ana, Ohio, and eastern Missouri. This geographical area was chosen because of its proximity to Kentucky.
399
TABLE 1 Rank Order of Methods and Time Spent in Keeping Up-to-Date with Professional Practices Methods
n
Mean Rating"
1
800
1.82
2 3 4 5
612 873 684 525
1.59 1.40 1.28 1.17
6 7
584 680
1.16 1.15
8 9 10 11
488 426 717 474
1.13 1.12 1.07 1.01
" Rating of 1 = 0-5 hours/month; 2 = 6-10 hours/month; 3 = 11- 15 hours/month; 4 = 16-20 hours/ month; 5 = more than 20 hours/month.
The questionnaire was constructed by the authors and selected members of the Kentucky Chapter of the APTA. The survey instrument was based on Hightower's modification of an earlier instrument.3 Questions were designed to gather information on: 1) Employment setting of respondents 2) Methods used by respondents to keep up-to-date in professional practice 3) Attitudes on mandatory continuing education or reexamination for relicensure 4) Continuing education subjects that need to be offered 5) Preferred schedule, length, type, advance notice, and cost per day of continuing education courses 6) Willingness to complete a preassigned reading list before attending a continuing education course 7) Possible obstacles to participation in continuing education programs.
RESULTS
Completed questionnaires were received from 903 (28.2%) physical therapists. Employment Setting
Respondents were employed in six types of settings: 1) General hospital facility—426 respondents (47.2%) 2) Outpatient facility (including private practice and physician's office)—133 respondents (14.7%) 3) Long-term facility (including nursing homes, ex tended care facilities, rehabilitation centers, crip400
pled children facilities, and mental health)—112 respondents (12.4%) 4) Academic setting—99 respondents (11%) 5) Other (including public school system employ ment, unemployed, and graduate student)—84 re spondents (9.3%) 6) Home Health—49 respondents (5.4%) Methods Used to Keep Up-to-Date in Professional Practice
Therapists were asked to indicate how many hours per month they spent for each method of keeping upto-date. The most frequently used methods were dis cussion with colleagues, study groups, and inservice training sessions. Table 1 summarizes these results. Mandatory Continuing Education or Reexamination for Relicensure
A majority of respondents, 660 (73%), were in favor of mandatory continuing education for relicensure, while 214 (24%) were not in favor, and 29 (3%) had no opinion. When the 660 respondents were then asked if they preferred periodic reexamination rather than mandatory continuing education for relicensure, 50 (8%) responded affirmatively and 610 (92%) said they were not in favor of periodic reexamination for relicensure. Subjects Needed
Therapists were asked to rank, in order of prefer ence, 20 possible course topics. Complete responses to this question were received from 750 respondents. PHYSICAL THERAPY
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Discussions with colleagues, study groups, inservice training Demonstrations, ward rounds, clinics Reading journals related to physical therapy Readings from other professional organizations Continuing education course sponsored by physical therapy school Continuing education course sponsored by APT A Continuing education course sponsored by state chapter of APT A Motion pictures, closed-circuit TV, audiotapes Programmed instruction courses Readings supplied by manufacturers Correspondence courses
Rank
Incomplete responses and failure to rank all 20 topics disqualified 153 responses. The topic most preferred was musculoskeletal assessment and mobilization. The 20 course offerings and the number of first preferences for each offering are shown in Table 2.
A slight majority of the respondents, 462 (51%), preferred that a continuing education course be of fered on the weekends, 227 (25%) chose weekdays, and 214 (24%) selected evenings. For seasonal pref erences, 260 (29%) chose the spring, 243 (27%) pre ferred the fall, and 230 (25%) indicated the summer. The least number of respondents, 170 (19%), pre ferred the winter. Preferences indicated by month are shown in Table 3. Most respondents, 468 (52%), preferred that a con tinuing education course last two days. More than two days was preferred by 219 respondents (24%), and 216 (24%) preferred one day. Responses concerning program format indicated 527 (59%) therapists preferred lecture, demonstration, or laboratory settings. Home study was preferred by 201 (21%), and educational television was preferred by 175 (20%). TABLE 2 First Preferences of Desired Topics for Continuing Education Course Offerings (N = 750) Topic 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Musculoskeletal assessment and mobilization Specific neurophysiological ap proaches to treatment (adult) Specific neurophysiological ap proaches to treatment (child) Administration Cardiac rehabilitation Electrotherapy (EMG, TENS, biofeedback) Spinal cord injury rehabilitation Biomechanics and gait evalua tion Gerontology Burn management Clinical education Sports injuries Arthritis—hand rehabilitation Research methods Prosthetics-orthotics Respiratory treatment Professional issues Congenital skeletal defects Sexual dysfunction Cancer management
Volume 59 / Number 4, April 1979
Number of First Preferences
%
191
25
94
13
76
10
39 38 35
5 5 5
32 29
4 4
28 26 25 23 22 21 17 16 14 11 7 6
4 4 3 3 3 3 2 2 2 1 1 1
Month
Number of First Preferences
%
91 90 87 78 77 76 74 73 71 68 67 51
10 10 10 9 9 8 8 8 8 7 7 6
March April October September February May January November June July August December
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Preferred Schedule, Length, Type, Advance Notice, and Cost of Course
TABLE 3 First Preference of Month for Continuing Education Course (N = 903)
A two-month advance notice of course offerings was the most popular (376, or 42%, of the respon dents), and three months was preferred by 304 (34%) respondents. Of the remaining respondents, 91 (10%) preferred one month, 63 (7%) preferred six months, 55 (6%) preferred four months, and 14 (1%) preferred to be notified five months in advance. A majority of the respondents, 548 (61%), preferred to pay from $10 to $25 per day for a continuing education course. The range of $25 to $50 per day was preferred by 329 respondents (36%), and the smallest number of respondents, 26 (3%), preferred to pay more than $50 per day. Advance Preparation
A large majority of the respondents, 881 (98%), were willing to complete a preassigned reading of 25 pages before attending a continuing education course. Obstacles to Participation
Therapists were asked to rank in order of impor tance to them a list of reasons for not participating in continuing education courses. Inconvenient schedul ing of course offerings was the most frequently cited obstacle to attendance, whereas expense was ranked second. Table 4 presents the results of rank ordering of reasons for nonparticipation. DISCUSSION Methods of Keeping Up-to-Date
The most frequent methods of keeping acquainted with issues in the profession were discussions with colleagues, study groups, and inservice training. Dem onstrations, ward rounds, and clinics were cited as the 401
TABLE 4 Rank Order of Reasons for Not Participating in Continuing Education Courses, Based on Mean Ratings Obstacle
Rank
n
What's available doesn't fit my schedule I can't afford it I don't want to be away from my family There is nothing available in my area My past experience with continuing education is that it is a waste of time and money What is available isn't what I need I have too many patients to care for After a certain age, it is hard to learn new things
1 2 3 4 5
900 901 896 896 892
2.68 2.63 2.45 2.29 2.27
6 7 8
889 887 889
1.99 1.98 1.86
Mean Rating"
second most frequently used method (Tab. 1). These two findings correspond to results of the Hightower study.3 Reliance on colleagues for keeping up with issues in the profession deserves comment. Lauffer has pointed out some advantages of this ad hoc colleague support system, which is personal, inexpensive, and readily available.4 Furthermore, the learner retains complete independence from an instructor or insti tution. Study groups provide mutual support and socialization within a framework of organization.4 Some disadvantages, however, have been identi fied. . Learning may be inappropriate or inaccurate, and the accountability factors inherent in institutional instruction are absent. Colleagues may resent being hampered in performing their primary responsibilities by being consulted too often. Lauffer warns that study groups may develop a closed perspective that dis courages seeking and using external sources for in put.4 Self-instructional methods using correspondence courses, programmed instruction, and motion pictures were comparatively unpopular (Tab. 1). Considerable resistance to self-instructional formats by public health professionals has also been found by Callan, Parlette, and Leonard.5 The self-instructional pro gram offers an ideal solution for those physical ther apists who are unable to travel to continuing educa tion courses. A need clearly exists, however, either for better self-instructional programs or for more infor mation concerning their advantages. Mandatory Continuing Education
Mandatory continuing education for relicensure is a controversial area in which representatives from professional organizations and state legislatures are actively involved. Professionals are exerting internal pressure on their representatives as they seek reliable sources for updating their techniques and acquiring 402
new skills. The public, government, and third-party payers are exerting external pressures on the profes sionals by their increasing demands that current and acceptable practices be used.4 The investigators of this study found significant the fact that a substantial majority of respondents (660, or 73%) were in favor of mandatory continuing education for relicensure. Some states have enacted legislation requiring con tinuing education for relicensure in dental hygiene, dentistry, optometry, physical therapy, and phar macy.6,7 Recently revised legislation in two states requires continuing education for renewal of licenses for nurses. Enabling legislation in two other states permits the state boards of nursing to require contin uing education for relicensure approval. In two other states, nurses who have not been actively practicing for more than three years are required to enroll in refresher courses.4 These examples indicate the activ ity by legislatures to incorporate continuing education in the relicensure of health professionals. Several professional associations require continu ing education for recertification. These include the American Board of Family Practice, the American Association of Nurse Anesthetists, the American Die tetic Association, the American Dental Assistants As sociation, and the American Registry of Clinical Ra diologic Technologists.6'8'9 The American Board of Psychiatry and Neurology is examining continuing education as one requirement for recertification. The American Psychiatric Association requires 150 hours of continuing education credit over a three-year pe riod for continued membership in the association. An example of a difference between legislative and professional associations' requirements can be found within the nursing profession. The American Nurses Association has been concerned with its responsibility for providing leadership and direction by planning, implementing, and evaluating program offerings.4 This association, however, neither encourages nor supports legislation to require evidence of continuing education as a condition for renewal of a license.10 A PHYSICAL THERAPY
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" Rating of 1 = not important; 2 = somewhat important; 3 very important.
Subjects Needed Comparatively recent procedures in physical ther apy practice and curricula were the topics that most physical therapists wished offered (Tab. 2). These include musculoskeletal assessment and mobilization (rank #1), specific neurophysiological approaches to treatment in adults and children (ranks #2 and #3), cardiac rehabilitation (rank #5), and electro therapy—EMG, transcutaneous electrical nerve stim ulation, and biofeedback (rank #6). Patients with conditions that a minority of physical therapists treat were the least desired topics: cancer management Volume 59 / Number 4, April 1979
(rank #20), sexual dysfunction (rank #19), and con genital skeletal defects (rank #18). Reasons for Nonparticipation The first two obstacles to participation in continu ing education on Table 4, "available continuing ed ucation doesn't fit my schedule" and "I can't afford it," correlate with #2 and #4 rankings, respectively, in the Hightower study.3 Respondents in both studies believe that the two highest ranking obstacles to continuing education can be eliminated by appropri ate timing of courses and by reducing costs. CONCLUSION
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somewhat different focus is given continuing educa tion by the Board of Directors of the National League of Nursing. This group advocates a gradual, carefully planned program for legislation requiring continuing education for renewal of licensure.11 Different approaches to continuing education are possible. Therefore, we see the need for further inves tigation to determine physical therapists' preferences on requiring continuing education for professional membership in the Association. Attitudes toward leg islative mandates for license renewal could also be surveyed. The argument for requiring continuing education for relicensure is based on the need for a profession to prove to the consumer its commitment to improve the quality of health care. Mandatory continuing education is one such mechanism for proving this commitment. Schenck finds it "incredible" to assume that issuing a lifetime license to practice physical therapy assures a lifetime of physical therapy practice even at a minimal level.12 If initial licensure guaran tees a defined minimal level of proficiency, licensure renewal must do the same thing.12 The argument against mandatory continuing edu cation as a prerequisite for relicensure is that contin uing education is not equally accessible to all health practitioners.9 The Committee on Continuing Edu cation of the American Physical Therapy Association has addressed this concern. The committee stated that because the members' opportunities for continuing education vary geographically, institutionally, and economically, continuing education should not be a requirement for membership renewal in the Associa tion.13 The impact of continuing education on patient care has not yet been well documented.14 Before continu ing education becomes universally mandatory for relicensure, better methods must be developed for assessment by individual therapists of what each needs to know and of the impact of continuing edu cation programs on professional competence.
We conducted a descriptive study of 903 physical therapists to determine their attitudes about continu ing education. These results should not be interpreted as being indicative of the nationwide attitudes of physical therapists, since this study was limited to a specific geographical area. A majority of the respondents kept themselves upto-date on professional issues mainly through discus sion with colleagues, study groups, and inservice training. Topics most preferred as continuing educa tion course offerings were musculoskeletal assessment and mobilization, specific neurophysiological ap proaches to treatment for adults and children, and administration. Lectures, demonstrations, or labora tory settings, rather than educational TV or home study, were preferred as continuing education formats by a majority of the respondents. Two months was the preferred time span for ad vance notice of course offerings. Respondents pre ferred that a continuing education course not be offered in December or during the summer vacation months of June, July, and August. Two-day courses, offered on weekends, costing from $10 to $25 per day, were preferred. Respondents were willing to complete a preassigned reading of 25 pages before attending a continuing education course. The greatest obstacle to participating in continuing education was that avail able courses often did not fit into a respondent's schedule, and the second greatest obstacle was ex pense. A majority of the respondents supported a man datory continuing education requirement for relicen sure but were not in favor of periodic reexamination. This is a significant finding, because valid arguments exist for and against mandatory continuing education. Professional organizations and state legislatures are concerned about this subject, and the various ap proaches taken by other health professions illustrate these concerns. Additional studies are needed to clar-
403
REFERENCES 1. Mote A Jr: Continuing education: Enhancing the quality of patient care. Hospitals 50:175-180, 1976 2. Guidelines for continuing education for components of the American Physical Therapy Association. Phys Ther 52:405-407, 1972 3. Hightower AB: Continuing education in physical therapy. Phys Ther 53:16-24, 1973 4. Lauffer A: The Practice of Continuing Education in the Human Services. New York, McGraw-Hill, Inc, 1977, pp 10-55 5. Callan LB, Parlette N, Leonard AR: Twelve-state survey of
6.
7.
8. 9.
10.
11. 12. 13.
14.
needs and interests in continuing education in public health. Public Health Rep 84:741-755, 1969 Roemer R: Social Regulation of Health Manpower. Washington, DC, Bureau of Health Resources Development, Division of Regional Medical Programs, 1973 Lancaster S: Continuing Education for Health Professions: A Report on Five Major Health Professions. Richmond, VA, State Council of Higher Education, 1976 Mangun CW: Documentation of continuing education: An idea whose time has come. JAMA 222:1053-1054, 1972 Burkett CS, Blood H: Characteristics of hospital provisions for continuing education for physical therapists in California. Phys Ther 55:493-500, 1975 American Nurses Association Continuing Education Guidelines for State Nurses Associations. Kansas City, MO, American Nurses Association, 1974 NLN's Role in Continuing Education in Nursing. New York, The National League for Nursing, 1975 Schenck JM: Physical therapy in the 1970's. Phys Ther 53:381385, 1973 Committee on Continuing Education: Report to Board of Direc tors, Exhibit 15. Washington, DC, American Physical Therapy Association, 1972 Cooper SS: Should continuing education be required for licen sure renewal? Occup Health Nurs 22:7-9, 1974
Writer's Kit Special Price $12.95 APTA is offering this special writer's kit to assist authors interested in writing for PHYSICAL THERAPY and other journals. The kit includes all of the communications tools listed below PLUS, for the first time, the evaluation sheets used by manuscript reviewers and guidelines for editors and reviewers. Now you can use the criteria prepared by the editors of PHYSICAL THERAPY to review your own article before submitting it for publication. Save $3.05 by purchasing all of the following tools for $12.95. Style Manual Fifty-Year Index Five-Year Index Research, Statistics, Communications: An Anthology Manuscripts: What You Always Wanted to Know Photographs that Speak Writing Good Abstracts: It's a Tough Job Writing Book Reviews Instructions to Authors TOTAL
$2.00 5.00 2.00 5.00 1.00 .25 .50 .25 ,25 $16.25
Make check payable to APTA and mail to American Physical Therapy Association, 1156 15th Street NW, Washington, DC 20005.
404
PHYSICAL THERAPY
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ify the attitudes of physical therapists on continuing education or reexamination as a requirement for relicensure. Acknowledgment. We would like to thank the Ken tucky Chapter of the APTA and the Office of Special Programs, College of Allied Health Professions, Uni versity of Kentucky, for their financial and manpower assistance. Appreciation is also extended to the 903 respondents of this study.
RONALD J. SEYMOUR, MS, TOM CONNELLY, Jr, EdD, and DAVIS GARDNER, MA
A descriptive study of 903 physical therapists located primarily in southeastern United States was undertaken to determine their attitudes toward continuing education and the types of course offerings they desired. A majority of physical therapists kept themselves up-to-date in professional practice, mainly through discussion with colleagues, study groups, and inservice training sessions. The continuing education courses they preferred were comparatively recent topics in physical therapy education—such as musculoskeletal assessment and mo bilization—specific neurophysiological approaches to treatment of adults and children, and administration. The study also revealed the preferred schedule, length, type, and cost of continuing education courses, as well as the amount of advance notice preferred and willingness to complete preassigned readings. The main problem that respondents had in participating in continuing education was that courses did not fit into their schedules. A majority of respondents favored mandatory continuing education for relicensure. Key Words: Education, continuing; Physical therapy.
The increasing number of continuing education courses offered by academic institutions and profes sional organizations indicates the desire of physical therapists to keep themselves up-to-date. This prolif eration of continuing education courses presents some concerns. For instance, Mote warns that continuing education must not be allowed to become a merrygo-round of conferences, workshops, lectures, and conventions paid for at the patient's expense without the concomitant requirement of improved patient care.1 The American Physical Therapy Association Committee on Continuing Education is similarly con
cerned, stating that the ultimate focus of continuing education is to provide the highest quality of service to the patient.2 The attitudes and desires of physical therapists should be examined when planning course offerings, because continuing education courses should provide information that will improve patient care. Few comprehensive, published studies provide an overview of the current practices, wishes, and needs of physical therapists concerning continuing education.3 Therefore, we conducted a detailed study to determine the attitudes of physical therapists to ward continuing education and the types of courses they desired.
METHOD Mr. Seymour is Assistant Professor, Department of Physical Ther apy, College of Allied Health Professions, University of Kentucky, Lexington, KY 40506. Dr. Connelly is Director, Office of Special Programs, College of Allied Health Professions, University of Kentucky. Mrs. Gardner is Assistant Professor, Allied Health Education and Research, College of Allied Health Professions, University of Ken tucky. This article was submitted November 2, 1977, and accepted August 28, 1978.
Volume 59 / Number 4, April 1979
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An Attitudinal Survey of Physical Therapists
Data for this study were collected through a ques tionnaire mailed to 3,200 active members of the American Physical Therapy Association in eight southeastern states as well as southern Illinois, Indi ana, Ohio, and eastern Missouri. This geographical area was chosen because of its proximity to Kentucky.
399
TABLE 1 Rank Order of Methods and Time Spent in Keeping Up-to-Date with Professional Practices Methods
n
Mean Rating"
1
800
1.82
2 3 4 5
612 873 684 525
1.59 1.40 1.28 1.17
6 7
584 680
1.16 1.15
8 9 10 11
488 426 717 474
1.13 1.12 1.07 1.01
" Rating of 1 = 0-5 hours/month; 2 = 6-10 hours/month; 3 = 11- 15 hours/month; 4 = 16-20 hours/ month; 5 = more than 20 hours/month.
The questionnaire was constructed by the authors and selected members of the Kentucky Chapter of the APTA. The survey instrument was based on Hightower's modification of an earlier instrument.3 Questions were designed to gather information on: 1) Employment setting of respondents 2) Methods used by respondents to keep up-to-date in professional practice 3) Attitudes on mandatory continuing education or reexamination for relicensure 4) Continuing education subjects that need to be offered 5) Preferred schedule, length, type, advance notice, and cost per day of continuing education courses 6) Willingness to complete a preassigned reading list before attending a continuing education course 7) Possible obstacles to participation in continuing education programs.
RESULTS
Completed questionnaires were received from 903 (28.2%) physical therapists. Employment Setting
Respondents were employed in six types of settings: 1) General hospital facility—426 respondents (47.2%) 2) Outpatient facility (including private practice and physician's office)—133 respondents (14.7%) 3) Long-term facility (including nursing homes, ex tended care facilities, rehabilitation centers, crip400
pled children facilities, and mental health)—112 respondents (12.4%) 4) Academic setting—99 respondents (11%) 5) Other (including public school system employ ment, unemployed, and graduate student)—84 re spondents (9.3%) 6) Home Health—49 respondents (5.4%) Methods Used to Keep Up-to-Date in Professional Practice
Therapists were asked to indicate how many hours per month they spent for each method of keeping upto-date. The most frequently used methods were dis cussion with colleagues, study groups, and inservice training sessions. Table 1 summarizes these results. Mandatory Continuing Education or Reexamination for Relicensure
A majority of respondents, 660 (73%), were in favor of mandatory continuing education for relicensure, while 214 (24%) were not in favor, and 29 (3%) had no opinion. When the 660 respondents were then asked if they preferred periodic reexamination rather than mandatory continuing education for relicensure, 50 (8%) responded affirmatively and 610 (92%) said they were not in favor of periodic reexamination for relicensure. Subjects Needed
Therapists were asked to rank, in order of prefer ence, 20 possible course topics. Complete responses to this question were received from 750 respondents. PHYSICAL THERAPY
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Discussions with colleagues, study groups, inservice training Demonstrations, ward rounds, clinics Reading journals related to physical therapy Readings from other professional organizations Continuing education course sponsored by physical therapy school Continuing education course sponsored by APT A Continuing education course sponsored by state chapter of APT A Motion pictures, closed-circuit TV, audiotapes Programmed instruction courses Readings supplied by manufacturers Correspondence courses
Rank
Incomplete responses and failure to rank all 20 topics disqualified 153 responses. The topic most preferred was musculoskeletal assessment and mobilization. The 20 course offerings and the number of first preferences for each offering are shown in Table 2.
A slight majority of the respondents, 462 (51%), preferred that a continuing education course be of fered on the weekends, 227 (25%) chose weekdays, and 214 (24%) selected evenings. For seasonal pref erences, 260 (29%) chose the spring, 243 (27%) pre ferred the fall, and 230 (25%) indicated the summer. The least number of respondents, 170 (19%), pre ferred the winter. Preferences indicated by month are shown in Table 3. Most respondents, 468 (52%), preferred that a con tinuing education course last two days. More than two days was preferred by 219 respondents (24%), and 216 (24%) preferred one day. Responses concerning program format indicated 527 (59%) therapists preferred lecture, demonstration, or laboratory settings. Home study was preferred by 201 (21%), and educational television was preferred by 175 (20%). TABLE 2 First Preferences of Desired Topics for Continuing Education Course Offerings (N = 750) Topic 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Musculoskeletal assessment and mobilization Specific neurophysiological ap proaches to treatment (adult) Specific neurophysiological ap proaches to treatment (child) Administration Cardiac rehabilitation Electrotherapy (EMG, TENS, biofeedback) Spinal cord injury rehabilitation Biomechanics and gait evalua tion Gerontology Burn management Clinical education Sports injuries Arthritis—hand rehabilitation Research methods Prosthetics-orthotics Respiratory treatment Professional issues Congenital skeletal defects Sexual dysfunction Cancer management
Volume 59 / Number 4, April 1979
Number of First Preferences
%
191
25
94
13
76
10
39 38 35
5 5 5
32 29
4 4
28 26 25 23 22 21 17 16 14 11 7 6
4 4 3 3 3 3 2 2 2 1 1 1
Month
Number of First Preferences
%
91 90 87 78 77 76 74 73 71 68 67 51
10 10 10 9 9 8 8 8 8 7 7 6
March April October September February May January November June July August December
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Preferred Schedule, Length, Type, Advance Notice, and Cost of Course
TABLE 3 First Preference of Month for Continuing Education Course (N = 903)
A two-month advance notice of course offerings was the most popular (376, or 42%, of the respon dents), and three months was preferred by 304 (34%) respondents. Of the remaining respondents, 91 (10%) preferred one month, 63 (7%) preferred six months, 55 (6%) preferred four months, and 14 (1%) preferred to be notified five months in advance. A majority of the respondents, 548 (61%), preferred to pay from $10 to $25 per day for a continuing education course. The range of $25 to $50 per day was preferred by 329 respondents (36%), and the smallest number of respondents, 26 (3%), preferred to pay more than $50 per day. Advance Preparation
A large majority of the respondents, 881 (98%), were willing to complete a preassigned reading of 25 pages before attending a continuing education course. Obstacles to Participation
Therapists were asked to rank in order of impor tance to them a list of reasons for not participating in continuing education courses. Inconvenient schedul ing of course offerings was the most frequently cited obstacle to attendance, whereas expense was ranked second. Table 4 presents the results of rank ordering of reasons for nonparticipation. DISCUSSION Methods of Keeping Up-to-Date
The most frequent methods of keeping acquainted with issues in the profession were discussions with colleagues, study groups, and inservice training. Dem onstrations, ward rounds, and clinics were cited as the 401
TABLE 4 Rank Order of Reasons for Not Participating in Continuing Education Courses, Based on Mean Ratings Obstacle
Rank
n
What's available doesn't fit my schedule I can't afford it I don't want to be away from my family There is nothing available in my area My past experience with continuing education is that it is a waste of time and money What is available isn't what I need I have too many patients to care for After a certain age, it is hard to learn new things
1 2 3 4 5
900 901 896 896 892
2.68 2.63 2.45 2.29 2.27
6 7 8
889 887 889
1.99 1.98 1.86
Mean Rating"
second most frequently used method (Tab. 1). These two findings correspond to results of the Hightower study.3 Reliance on colleagues for keeping up with issues in the profession deserves comment. Lauffer has pointed out some advantages of this ad hoc colleague support system, which is personal, inexpensive, and readily available.4 Furthermore, the learner retains complete independence from an instructor or insti tution. Study groups provide mutual support and socialization within a framework of organization.4 Some disadvantages, however, have been identi fied. . Learning may be inappropriate or inaccurate, and the accountability factors inherent in institutional instruction are absent. Colleagues may resent being hampered in performing their primary responsibilities by being consulted too often. Lauffer warns that study groups may develop a closed perspective that dis courages seeking and using external sources for in put.4 Self-instructional methods using correspondence courses, programmed instruction, and motion pictures were comparatively unpopular (Tab. 1). Considerable resistance to self-instructional formats by public health professionals has also been found by Callan, Parlette, and Leonard.5 The self-instructional pro gram offers an ideal solution for those physical ther apists who are unable to travel to continuing educa tion courses. A need clearly exists, however, either for better self-instructional programs or for more infor mation concerning their advantages. Mandatory Continuing Education
Mandatory continuing education for relicensure is a controversial area in which representatives from professional organizations and state legislatures are actively involved. Professionals are exerting internal pressure on their representatives as they seek reliable sources for updating their techniques and acquiring 402
new skills. The public, government, and third-party payers are exerting external pressures on the profes sionals by their increasing demands that current and acceptable practices be used.4 The investigators of this study found significant the fact that a substantial majority of respondents (660, or 73%) were in favor of mandatory continuing education for relicensure. Some states have enacted legislation requiring con tinuing education for relicensure in dental hygiene, dentistry, optometry, physical therapy, and phar macy.6,7 Recently revised legislation in two states requires continuing education for renewal of licenses for nurses. Enabling legislation in two other states permits the state boards of nursing to require contin uing education for relicensure approval. In two other states, nurses who have not been actively practicing for more than three years are required to enroll in refresher courses.4 These examples indicate the activ ity by legislatures to incorporate continuing education in the relicensure of health professionals. Several professional associations require continu ing education for recertification. These include the American Board of Family Practice, the American Association of Nurse Anesthetists, the American Die tetic Association, the American Dental Assistants As sociation, and the American Registry of Clinical Ra diologic Technologists.6'8'9 The American Board of Psychiatry and Neurology is examining continuing education as one requirement for recertification. The American Psychiatric Association requires 150 hours of continuing education credit over a three-year pe riod for continued membership in the association. An example of a difference between legislative and professional associations' requirements can be found within the nursing profession. The American Nurses Association has been concerned with its responsibility for providing leadership and direction by planning, implementing, and evaluating program offerings.4 This association, however, neither encourages nor supports legislation to require evidence of continuing education as a condition for renewal of a license.10 A PHYSICAL THERAPY
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" Rating of 1 = not important; 2 = somewhat important; 3 very important.
Subjects Needed Comparatively recent procedures in physical ther apy practice and curricula were the topics that most physical therapists wished offered (Tab. 2). These include musculoskeletal assessment and mobilization (rank #1), specific neurophysiological approaches to treatment in adults and children (ranks #2 and #3), cardiac rehabilitation (rank #5), and electro therapy—EMG, transcutaneous electrical nerve stim ulation, and biofeedback (rank #6). Patients with conditions that a minority of physical therapists treat were the least desired topics: cancer management Volume 59 / Number 4, April 1979
(rank #20), sexual dysfunction (rank #19), and con genital skeletal defects (rank #18). Reasons for Nonparticipation The first two obstacles to participation in continu ing education on Table 4, "available continuing ed ucation doesn't fit my schedule" and "I can't afford it," correlate with #2 and #4 rankings, respectively, in the Hightower study.3 Respondents in both studies believe that the two highest ranking obstacles to continuing education can be eliminated by appropri ate timing of courses and by reducing costs. CONCLUSION
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somewhat different focus is given continuing educa tion by the Board of Directors of the National League of Nursing. This group advocates a gradual, carefully planned program for legislation requiring continuing education for renewal of licensure.11 Different approaches to continuing education are possible. Therefore, we see the need for further inves tigation to determine physical therapists' preferences on requiring continuing education for professional membership in the Association. Attitudes toward leg islative mandates for license renewal could also be surveyed. The argument for requiring continuing education for relicensure is based on the need for a profession to prove to the consumer its commitment to improve the quality of health care. Mandatory continuing education is one such mechanism for proving this commitment. Schenck finds it "incredible" to assume that issuing a lifetime license to practice physical therapy assures a lifetime of physical therapy practice even at a minimal level.12 If initial licensure guaran tees a defined minimal level of proficiency, licensure renewal must do the same thing.12 The argument against mandatory continuing edu cation as a prerequisite for relicensure is that contin uing education is not equally accessible to all health practitioners.9 The Committee on Continuing Edu cation of the American Physical Therapy Association has addressed this concern. The committee stated that because the members' opportunities for continuing education vary geographically, institutionally, and economically, continuing education should not be a requirement for membership renewal in the Associa tion.13 The impact of continuing education on patient care has not yet been well documented.14 Before continu ing education becomes universally mandatory for relicensure, better methods must be developed for assessment by individual therapists of what each needs to know and of the impact of continuing edu cation programs on professional competence.
We conducted a descriptive study of 903 physical therapists to determine their attitudes about continu ing education. These results should not be interpreted as being indicative of the nationwide attitudes of physical therapists, since this study was limited to a specific geographical area. A majority of the respondents kept themselves upto-date on professional issues mainly through discus sion with colleagues, study groups, and inservice training. Topics most preferred as continuing educa tion course offerings were musculoskeletal assessment and mobilization, specific neurophysiological ap proaches to treatment for adults and children, and administration. Lectures, demonstrations, or labora tory settings, rather than educational TV or home study, were preferred as continuing education formats by a majority of the respondents. Two months was the preferred time span for ad vance notice of course offerings. Respondents pre ferred that a continuing education course not be offered in December or during the summer vacation months of June, July, and August. Two-day courses, offered on weekends, costing from $10 to $25 per day, were preferred. Respondents were willing to complete a preassigned reading of 25 pages before attending a continuing education course. The greatest obstacle to participating in continuing education was that avail able courses often did not fit into a respondent's schedule, and the second greatest obstacle was ex pense. A majority of the respondents supported a man datory continuing education requirement for relicen sure but were not in favor of periodic reexamination. This is a significant finding, because valid arguments exist for and against mandatory continuing education. Professional organizations and state legislatures are concerned about this subject, and the various ap proaches taken by other health professions illustrate these concerns. Additional studies are needed to clar-
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REFERENCES 1. Mote A Jr: Continuing education: Enhancing the quality of patient care. Hospitals 50:175-180, 1976 2. Guidelines for continuing education for components of the American Physical Therapy Association. Phys Ther 52:405-407, 1972 3. Hightower AB: Continuing education in physical therapy. Phys Ther 53:16-24, 1973 4. Lauffer A: The Practice of Continuing Education in the Human Services. New York, McGraw-Hill, Inc, 1977, pp 10-55 5. Callan LB, Parlette N, Leonard AR: Twelve-state survey of
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8. 9.
10.
11. 12. 13.
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needs and interests in continuing education in public health. Public Health Rep 84:741-755, 1969 Roemer R: Social Regulation of Health Manpower. Washington, DC, Bureau of Health Resources Development, Division of Regional Medical Programs, 1973 Lancaster S: Continuing Education for Health Professions: A Report on Five Major Health Professions. Richmond, VA, State Council of Higher Education, 1976 Mangun CW: Documentation of continuing education: An idea whose time has come. JAMA 222:1053-1054, 1972 Burkett CS, Blood H: Characteristics of hospital provisions for continuing education for physical therapists in California. Phys Ther 55:493-500, 1975 American Nurses Association Continuing Education Guidelines for State Nurses Associations. Kansas City, MO, American Nurses Association, 1974 NLN's Role in Continuing Education in Nursing. New York, The National League for Nursing, 1975 Schenck JM: Physical therapy in the 1970's. Phys Ther 53:381385, 1973 Committee on Continuing Education: Report to Board of Direc tors, Exhibit 15. Washington, DC, American Physical Therapy Association, 1972 Cooper SS: Should continuing education be required for licen sure renewal? Occup Health Nurs 22:7-9, 1974
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PHYSICAL THERAPY
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ify the attitudes of physical therapists on continuing education or reexamination as a requirement for relicensure. Acknowledgment. We would like to thank the Ken tucky Chapter of the APTA and the Office of Special Programs, College of Allied Health Professions, Uni versity of Kentucky, for their financial and manpower assistance. Appreciation is also extended to the 903 respondents of this study.
