Thank you. What I don't like about the states is we have this structure where it's almost like it leads someone to believe that, yes, it's rigid, it's competent. You have these courses and they've been approved for this specific credit. So I think people are under the impression that it's a good course because the state association of physical therapy had reviewers look at it and approve it. And in reality, it's just not the case. There's so much pressure to approve these courses if you did You know, what happens if they threaten to sue? So as a reviewer, it's easy to just tick the box. Okay, fine, I approve it. They paid the money and it's up to someone else to decide whether they want to go. That's not what you're really supposed to be doing.
SPEAKER_01:We don't often audit or question the quality of the courses we take. Well, today we had Seth Peterson on who did some research on this and he revealed some shocking truths about a lot of the courses we take and a high percentage of courses that don't present evidence-based information. Seth has applied this learning to his clinic called The Motive and he also created a company called The Movement Brainery which only offer up courses that are evidence-based and have been audited. In this podcast, Seth revealed some wonderful insights into the research he has done but also some for the young health professional out there looking to kind of nail their first few years of education. Please get stuck into this episode and enjoy it. My name is Michael Risk. This is Physio Explained. All right. Welcome, Seth. Thank you for joining us. Thank you, Michael. We're talking about CPD, continuing professional development. And we were just discussing off-air that even that might have different terms around the world. What are you calling that? And what are the subterms around that, Seth, where you are?
SPEAKER_02:Yeah, I think when you start to get into this conversation, that's probably one of the key things to talk about because there's a lot of confusion when I've spoken with clinicians about this. So as you alluded to, when we were talking off-air, you used the term CPD. So in the US, you'll hear more often the term CE, continuing education, when people are talking about this. And so to back up a little bit, the term that the American Physical Therapy Association has defined as this overarching umbrella is professional development. That's anything, whether you just on your own decide you're going to get some mentorship, You're going to listen to this podcast. Anything that you do that tries to improve you and your ability to practice as a physical therapist is professional development. A smaller umbrella would be continuing competence. And those are rules that We have had in the U.S. at the state level for a long time, decades, and the intention comes from other medical specialties. But this is an idea that clinicians, as long as they're licensed, should prove that they have a certain level of competence. And then within that, one way that you're proving that you have enough competence is that you take continuing education courses that have been approved in the states we have each state. approves their own courses. There's some issues around how that's done because it was put together kind of in a haphazard way. Yeah, that's it. So that's professional development's the big umbrella. Continuing competence is a little smaller. And then CE is this little piece where it focuses on courses within those bigger umbrellas.
SPEAKER_01:Is there any testing criteria for the proving of competence? Or is it simply saying that you've done X, Y, and Z?
SPEAKER_02:No, there's nothing. So that's what's really interesting is over the years, I'm aware that people have brought this up. I mean, are you really showing that you're competent that you just sat in a classroom for a few hours? Maybe we should have something a little bit more rigorous. And there was a paper just a few months before ours got published on continuing education and looking at those courses that advocated for this ongoing competence kind of framework throughout someone's career. And that would include at least theoretically that someone's tested as they go on through to prove that they're competent and the skills that they need.
SPEAKER_01:And Seth, could you direct us and maybe for the listeners who haven't read those papers, what What are those two papers? And then we'll go into kind of what they found and what we uncovered and what the learnings were from that.
SPEAKER_02:Yeah, so I think if you're talking about the two that we published, there was one in Physical Therapy Journal. The co-authors were Kirsten Weibel, Dan Rohn, Brett Halpert, and that was published earlier this year. And then after that was JOSPT. We had a viewpoint on a similar kind of topic. And so the first one was What you might say is a research study. It was a review where we looked at for the whole year of 2020, all the courses that were approved by state associations. So for this competence to show that you're competent, if you take this course, they're approved by these state associations. And we got that out of a kind of an online course administrative site. So we took that, we gathered all those courses up, and then we tried to focus on sports and orthopedic courses again in the year 2020. And then what we did was we asked whether those courses were the interventions specifically that those courses taught. So we did exclude courses that didn't teach interventions. Some things might just give you a rundown on what hip osteoarthritis is. We excluded those. If they talked about interventions, then we looked at whether that intervention that they recommended was supported by clinical practice guidelines. And then if it wasn't, we looked at whether it was supported by any systematic review. Okay.
UNKNOWN:So...
SPEAKER_02:Step one, any clinical practice guideline that we could find to support it. Step two, any systematic review. It had to be at least moderate quality that supported it or recommended it. And what we found was over half didn't have any support in either a guideline or systematic review of the courses that were approved for competence. So then our viewpoint expanded on that, made some recommendations and some of the issues that we think are leading to that.
SPEAKER_01:How did that make you feel, kind of uncovering that?
SPEAKER_02:I think I wasn't surprised. It was interesting. This all got prompted because I'm the chair of Arizona as we go through in our course review. And I kind of knew that it wasn't the most rock solid process. And I was talking to Dan Rohn, one of the researchers on both of these papers. And he had just moved to Arizona from Texas. I was like, yeah, I'm getting a lot of mailers about crystals and weird stuff that are physical therapy courses that are approved by the state. So we kind of put our heads together and said, yeah, we can come up with a study and look at this. I kind of knew it wasn't going to be good. I was probably a little surprised it was over half. I think we think about it. It's probably okay to teach some stuff that's not in guidelines. In fact, when people on Twitter brought this up, it's probably... a good idea that maybe there are a few things that are based in theory that aren't recommended in the guidelines for that stuff to be out there but for it to be more than half of our courses i think that was a little questionable and in that first paper in ptj we kind of gathered some things that we thought were statements that were in these course descriptions that were contrary to the evidence. That was table three in that paper. And there's some pretty crazy stuff in that table. So it gives you a sense that it's not just like blurring the lines. Some of these courses are really getting approved despite saying things that just are a little out there. Yeah.
SPEAKER_00:Thank you. Thank you.
SPEAKER_01:It makes me feel a little sad just hearing those numbers and not that it's not in the guidelines, but maybe even evidence that we shouldn't be doing some of those things. Do you think this is potentially the reason why we're intervention driven and there's still a lot of non-evidence based practice around? I
SPEAKER_02:think it's probably a big reason for that. the existence of this non-evidence-based practice. But I've heard from other people, there's just this demand for this stuff from clinicians. I don't know that it starts with the person that's developing the course, but the clinicians sometimes are asking for this. And we talked about different mechanisms to make this happen in our viewpoint. But I think at a certain point, you need to just say that there's this certain line that we're not going to cross with courses. And maybe you make it just a really low bar or... One of the things we suggested that I think is a really low-hanging fruit in the States, we just had a motion to the APTA where we asked them to look at courses. And I still think that probably the easiest thing for them to do is just to make each reviewer affix a little badge to the course. So it's like a way of informed consent for the person that signs up for this course to say that this is the level of evidence that underpins this course. So, you know, going in and maybe a lot of people sign up for the low level stuff. And then we have a problem there that we can address, but at least put it out there.
SPEAKER_01:Yeah. I'm wondering for young health professionals, let's say you're in your first to third or fifth year. Did this viewpoint bring up any tips or advice that you would give to them around looking for courses?
SPEAKER_02:I've had a few people ask me about that, and there's a couple ways that you can go about it. The first thing that I keep coming back to in my mind is when you're that early on in the career, I think it does help to have some sort of basic framework. So is there a good guideline that you can go to? So you just have this general idea of what the guidelines are. And the Academy of Orthopedic Physical Therapy has a bunch of guidelines that are physical therapist-driven guidelines. by different condition. You could go there. Nice guidelines are out from the UK. They have some good recommendations. Those are just some basic things. I think everybody should be acquainted with that stuff. I think another thing is to talk to clinicians that you respect and ask them, what are good courses that you've taken? And that's maybe another way that you could go about it.
SPEAKER_01:Yeah. We were also discussing that to renew your registration in Australia anyway, where I'm from, it's effectively an online form. You pay a fee and you have to tick a few boxes that says you've practiced a certain amount of hours in the year and you've done a certain amount of CPD. But that certain amount of CPD is not really tightly defined and we are asked to keep a journal. And within that journal, there can be things like reading a journal, listening to a podcast, doing an online course, doing a live course. But it's fairly loose criteria and there's definitely no level of what was the accreditation or the evidence at this course. That's effectively what you have to do to deem yourself competent and renew your registration. What have you seen in the States and globally?
SPEAKER_02:Globally, I'm not quite sure what other countries have to do. I'm always interested in that. We were talking about that and that was interesting to me. In some ways, I like it, but I think in some ways, what I don't like about the States is... We have this structure where it's almost like it leads someone to believe that, yes, it's rigid, it's competent. You have these courses and they've been approved for this specific credit. So, I think people are under the impression that it's a good course because the state association of physical therapy had reviewers look at it and approve it. And in reality, it's just not the case. There's so much pressure to approve these courses. If you decline someone, what happens if they threaten to sue? So as a reviewer, it's easy to just tick the box. Okay, fine. I approve it. They paid the money and it's up to someone else to decide whether they want to go. That's not what you're really supposed to be doing. Yeah. And so it's almost like you're giving an impression that it's been reviewed pretty thoroughly. So at least where you are, be loose, but it's loose for everybody and everybody knows that. That's a little different.
SPEAKER_01:Yeah. After doing that paper in the viewpoint, how would you recommend the listeners attack their year of PD? So if it was like an athlete and you had 12 months and you're doing periodization or this is what we're going to do in a year, how would you do that? And how do you do that? Do you try to do one or two live courses a year? Do you have a certain amount of journals you read a week, podcasts? How do you look at that? And I wonder if going through this has changed your view at all.
SPEAKER_02:I think first and foremost, especially now, I think you have to be looking for mentorship above everything else. Mentorship from a high-quality mentor is better than any course that you can take. And the research that's looked at this is pretty clear. The weekend courses, the retention isn't that great. People don't practice what they learned in the course for very long. So those longer-term things, mentorships, even for a little bit heftier price tag, that's worth it taking one of those versus multiple little weekend courses, in my opinion. So that's one thing that I would do. I did a residency and a fellowship, and those things were great. They're a little bit more rigid, but if you want to progress, you need that. You need tough feedback. So I think there are a lot of things that have popped up in that realm. So that would be one thing. As far as journal articles and stuff, hit on the major ones and just check in every once in a while. JOSPT is a good one. PTJ is a good one. Physiotherapy, journal of physiotherapy, all the different PT journals. And then look over at what the other professions are doing every once in a while. I'm interested in the spine. So I take a look at spine and spine journal every once in a while and see what they're coming out with and how those guys are thinking, which is totally different.
SPEAKER_01:And talk to me about the movement brainery And the inspiration for that and exactly what is it as well for the listeners? Yeah.
SPEAKER_02:So that was interesting. As we did this, this was in 2020. As we're doing this study, we all had a little bit more free time on our schedules. And so I was like, maybe I'll just come up with my own course. So at least we can compete with some of these not great courses that are out there. And so that was the original idea is just have some local in-person courses. So we did that. We have a couple of in-person courses locally here in Arizona every year. And then we have this primary care physical therapy course we run a couple of times a year that's online. And that's a longer term thing. So what I'm talking about, I think if you can be steeped in something and have articles for a little bit longer, I think you can get better retention. And the in-person courses, we have this follow-up virtual session a month later. So we're trying to see, can we like get retention better? Can we just up the game and continuing education? So then the most recent thing is we're coming up with a mentorship. So that is what I'm the most excited for because I think the benefit is going to be huge.
SPEAKER_01:Thank you, Seth. That's awesome. Where can people find out more about you and these things?
SPEAKER_02:Yeah, so the movementbrainery.com, that's the website for what we were just talking about. Pretty active on Twitter. That's at DrSethPT.com. Yeah, anybody can shoot me an email. Probably the easiest one is just hello at themovementbrainery.com.
SPEAKER_01:That's a nice email handle. I like that. Thank you so much for covering this with us today, Seth, and blocking out some time in your day. I really appreciate it. Of course. Thank you, Michael.
UNKNOWN:Thank you.