I started off the introduction to this series with a disclaimer that I think the academic portion of my physical therapy training was archaic, and I know that I am not the only one who feels this way. By no means is this me saying that academia is not the most important part of a PT”s training. Colleges and Universities are the corner stone of advanced education in this country, providing much of the research that is used to fuel treatment plans and the progression of the physical therapy profession as a whole.
The classrooms are where foundations, principles, and learning methods occur. In my opinion, the first step of education needs to be learning how you learn best. Believe me, you would rather do this in a classroom and lab, than on the fly when a patient is not progressing. Unfortunately, there is not often guidance on learning how you learn most effectively. Upon entering any university or college students be tested on their learning methods, because until this point, most students have been able to succeed by only trying hard. Unfortunately for some, trying hard in PT school is not enough, nor should it be (more on this later). Anyone can try hard, but not everyone can critically think and put all the pieces of the human body together.
Foundational classes like anatomy and physiology, physics, gross anatomy, kinesiology, and psyscho-social management all need to be taught (particularly in undergraduate coursework), paid attention to, and never forgotten. Once you get into PT programs the importance of every class is amplified. Musculoskeletal, neurological, cardiopulmonary, and integumentary rehabilitation are the blocks built upon previous classes, and after this, clinicals are built upon those classes. You can see that if the foundations are not there, then clinicals/practical learning will not go well. I can vividly remember students in my classes saying “why do we need to know this?” to many classes. 1. If you need to ask, maybe you don’t understand your future profession 2. Often the professors would have a difficult time explaining it to the students. 3. These students then checked out once they didn’t get a reasonable answer from their professor. A problem that students and practitioners are having is that the answer to the why do I need to know this question can be answered with the CAPTE thinks you should know it (this will be addressed in a future post). Or another reason it is difficult for professors to answer this question is that their own time in a clinic is limited because of research requirements from universities. This can lead to the blind leading the blind. I can remember vividly, the professors that we all gravitated to when I was in school. They were typically those who were still in the clinic, down in the trenches, and were able to tell us why the information we were being fed was applicable to treating patients.
PT students should not walk into a program, or clinic and be coddled and retaught the basics. Clinicals and PT programs are meant to be advanced learning institutions, not as review courses. PT schools need to have loftier standards. If the APTA wants to elevate the respect for our profession to that of Medical Doctors, the educational standards need to be elevated as well. This is a brief summary of my PT school experience. The PT school I went to started when I was a undergraduate Freshman. You get accepted into the undergraduate PT program while you are still in high school. You are then in the program until you fail out or quit, including all the way through grad-school. 120 of us started. About 60 of the original finished, and we picked up 26 along the way after the third year (this is when the students accepted into the graduate PT program start). Of the 60 we lost, 45-ish transferred out, and 15 or so failed out BUT, after the third year, we lost only 2 students. This basically means that when you got to the graduate course work you were in, good to go, didn’t need to worry. Now the law of averages says that some of these kids would not pass the cut. We needed at least a 75 average in each class to continue on. I know for a fact that this did not happen. There was probation, and extra-credit, and more probation for the same students, but students were just not told “sorry son, you just don’t have what it takes,” even if they didn’t. Don Reagan was telling me of a student that while on clinical gave a patient an object who later choked and died. This patient passed. Although I do not know of any first hand experiences like this, I can safely say, there were students passed through who did not make the grade. There is no shame in not passing a somewhat rigorous doctoral program. If I entered school to get my engineering degree and did not perform well enough, why should I be allowed to continue on and design bridges that will fail? Would it be my university’s fault for letting me continue on when I should have been failed out?
There is a financial benefit for schools not to fail their students. Think of your tuition when you were in school. Now, take that away from the university because you failed. It’s a lot of money. There were plenty of students who struggled. PT school should be no joke. Students should be struggling. It’s 8 hours of class and lab 5 days a week with working, tests, clinicals, and life. People will have a difficult time, and some people will not be able to pass. Yes, at this level there has been testing, and interviewing to make sure that candidates for PT programs are well vetted, but still 2 out of 86 did not pass. That’s like 2%. But who is benefiting from passing students who should be failing, it’s not future patients. We were always told that “we are teaching you to become the therapists we want treating our mothers”. I’m surely not comforted knowing that both of my parents have gone to physical therapy in the past 5 years and may have been treated by someone who should never have been a physical therapist in the first place. Consider my rant complete.
I touched upon the foundational classes of undergraduate and graduate coursework earlier in this post. Although I think some of the content presented to students in my graduating class was past its expiration date, much of it was pertinent, useful, and needed to become a good physical therapist. However, much of the information was presented in a very compartmentalized manner. There is little explanation of how cardiopulmonary topics will effect musculoskeletal topics, will effect neurological topics, etc. The body works as a whole, and my belief is that presenting information to students in an encompassing manner is most beneficial. Panels of professors whose focuses vary instead of one unilateral voice determining what information is taught needs to be the norm, not the exception. This is needed so students can hear how a cardiac surgery can result in cervical spine or lumbar spine pain and other various pathological cascades.
The classroom is the boot camp of PT’s’ careers. You learn to fold military corners, be meticulous, prepared, and even shoot a gun when needed. You become a generalist. You think you know a lot about a lot, but you still have not spent time in the trenches. This is where practical learning (and lab time doesn’t count) comes into play.