All right.
So Carl DeRosa,
thanks for joining us on the Hands On,
Hands Off podcast.
Maybe, you know,
I know you a little bit from, you know,
both of us live in Arizona.
You're up there in Flagstaff.
I'm down in Tucson.
But maybe you could maybe we
just start off the podcast.
If you could explain what
your current role is,
maybe introduce yourself.
But you're kind of also one
of these interesting
chimeras in PT who've done
a lot in terms of leadership.
You've been in private
practice and now education.
You've done a ton.
So if you can kind of go
into maybe your journey in
physical therapy and how you see yourself,
that'd be great.
Sure, I'd be happy to, Seth,
and I appreciate this
invitation to just share
some ideas and answer some questions.
I was one of the founding
faculty for the Northern
Arizona University Physical
Therapy Program.
That was way back in
nineteen seventy eight.
And there were no physical
therapy programs in the state of Arizona.
The regents awarded Northern
Arizona University the
program to the surprise of many.
I was recruited out of
California where I was
working and three of us
came at the same time and
we were literally given a
blank checkbook by the
university to put together
what we thought would be an
innovative program.
It was an incredibly stimulating,
exciting time.
I was very young in my career.
And I'd been working
actually in long-term neuro
rehab and then was
transitioning to
orthopedics while I was in
California before I came here.
And they asked me to develop
the musculoskeletal side of
the curriculum, essentially,
at Northern Arizona University.
And then in, um,
I had the good fortune to
meet a good friend, still a good friend,
Phil Sauer,
who studied with James Syriax in England.
And he was working down in Sedona.
And so in nineteen eighty,
we opened up a two person
private practice that was
just focused on spine care
and sort of took the city by storm.
The physicians had never
really worked with any
therapists that were just
focused on spine care.
And we we grew that practice
to a broader orthopedic
spectrum and went into a
collaboration with
physicians here in the
community where we actually
built the first
large-scale musculoskeletal center.
It was an independent
practice with the
physicians in their independent practice.
It had the first recovery
care center in the state for surgery.
And that just meant that
instead of just being an
ambulatory care center,
that we could have patients
stay there for three days.
It's like a mini hospital in a way.
So we built a revolutionary
concept here in Arizona.
At that time,
I was chair of the physical
therapy program simultaneously,
so there weren't enough
hours in the day to do all this.
But I found the hours.
I chaired the program for
twenty years and just as fortunate,
surrounded by some
incredible physical therapy leaders,
Tom McPoyle, Mark Cornwall,
Karen Mueller.
I just was lucky I was
working with the dream team
in physical therapy faculty.
So that's what was sort of
keeping me busy with
practice for we had
practice for forty one
years and and also running the program.
And then about three or four, five,
six years ago, I I
uh was offered a position in
the community to run the
largest orthopedic medical
orthopedic physician
medical practice uh in
northern arizona they asked
if I would serve as the ceo
um running two surgical
centers and managing
physicians and and pas and everything and
I thought, you know, that might be fun.
I mean, people say you're crazy,
but I thought that would be fun.
So I stepped away from the
university and I told them
I'd do this for four years.
You know,
I wanted to do it and I knew
these physicians very well.
And so I didn't have a
learning curve on that.
And just, we had a really successful run.
And then four years to the
day I stepped out, I
I prepared for the transition.
And then I was going to slow
down a little bit.
And then in the immortal
words of Michael Corleone,
just when I thought I was out,
they pulled me back in.
I had an opportunity to get
involved with competency-based education.
And that was at Rasmussen University.
They were a competency-based
education institution.
And they gave me, it was sort of deja vu.
They gave me a blank check
to hire faculty.
I hired ten faculty.
And we developed a
curriculum that got
accredited by CAPTI and everything.
And Rasmussen,
wonderful experience for me.
We had accepted the first class.
They had not started.
But Rasmussen University,
as a for-profit institution,
got purchased by American
Education Institute.
And that's one of the
largest for-profit companies.
And their mission is not
graduate education.
So long story short,
they pulled the plug on the program,
even though we had
developed the first
competency-based program.
But my phone was ringing off
the hook the next day from
several universities with
physical therapy programs that said,
would you take and lift
that and put it over here?
And one of those was
Northern Arizona University.
And so we developed the, you know,
the total gamut of
competency and entrustment
based program at Northern
Arizona University.
And we just completed the
work we had started at
Rasmussen University.
So that's my short history.
I hope I didn't go too long on that,
but that's practice and
education and then some new ventures.
I've served in the House of
Delegates for a long time.
I think it was probably
about twenty years.
I was Chief Delegate for
about six or seven or eight years.
was the chair of education
for the APTA for a number of years.
So dabbled in a lot of the
different areas.
It's been a great ride.
Physical therapy has been very,
very good to me.
Yeah, it sounds like it.
That thread of craziness has
kind of continued
throughout all your
different roles though, I noticed.
I know, yeah.
Do you remember, I mean,
you talked about Rasmussen
and being drawn into that.
Do you remember the first
time you heard about
competency-based education?
Well, it was actually, you know,
there was a lot of talk in
the medical literature
about competency-based education.
And I knew from some early presentations,
you know, at our national conferences,
you know,
there would be isolated
presentations on it.
And I was intrigued by it.
I didn't know anything about it,
but I was intrigued by it.
But then I got into the
medical literature more.
And they really do try to
control variation in
practice and patient safety is so big.
And being a CEO for physicians,
you realize how important
safety is and we would have
mortality and morbidity
conferences for errors that were made.
So the competency,
the attention to competencies, you know,
what was really elevated, you know,
in the medical field.
And then it was Rasmussen
University contacted me
when they were looking to
start a physical therapy program.
They asked if I would run a summit.
Can you help us run a summit?
and bring in together about
ten physical therapy
industry leaders because, you know,
our focus is competency-based education.
That's at Rasmussen University,
that's their focus, CBE.
And we want to put a, you know,
program here and bring in, you know,
leaders and put together a
physical therapy program
along those lines.
So I said,
I'd be happy to do that because
I was intrigued by it.
And I started to send them stuff.
And they said, well,
this is interesting stuff.
You've been thinking about
this for a while.
How would you like to be
chair of the program?
I didn't even apply for it.
First, I was just going to run a summit.
And all of a sudden,
I'm the chair of the program.
And so it was really,
the stimulus for me was twofold.
It was observing how important it
competency-based education
and a competency-based
framework was for medicine.
I really understood why they
were doing it.
And it was developing from the ground up,
you know,
a program at Rasmussen University.
So that's the history of it.
So I've been sort of living it,
if you would, Will, you know,
for a good six, five, six years now.
yeah I mean it sounds like
it so what are what would
you say if you had to kind
of define what cbe is what
and what epas are that
that's probably going to be
important yeah you know I I
think you know for first of
all copsy based education
is um is fascinating um
because if you like to
teach by using an
assessment method you know
And a lot of people,
that's how they like to teach.
A lot of physical therapists,
a lot of physicians like to
teach like that.
You know,
not I'm going to put lectures up
of PowerPoint slides,
not that kind of teaching.
But this is having someone do something,
correcting them on the spot,
giving them feedback.
You know,
and it's much more of a coaching
model than a teaching model.
So, you know,
we sometimes say we learn by
our mistakes.
This truly is a way that you
learn from your mistakes.
You know, you welcome errors.
You welcome, you know,
in the educational process because,
you know, you coach people up.
And so once you define the end zone,
I always call it with the faculty,
the end zone is the competencies.
And that's the knowledge you have,
and it's the skills you have,
and it's the attitudes.
I mean, basically,
the competencies are knowledge, skills,
and attitudes rolled into one.
And those then,
how do you translate those
into the actual workforce?
That's what the EPAs are.
It's the you know,
it's really the the the
tasks that we do in work
that that that have
embedded in them the knowledge,
skills and attitudes of
that are the competencies.
So the EPA is really an exciting piece,
I think, of this whole process.
And it's not about measuring the EPA.
If an EPA is taking a
history and making a diagnosis,
we do that every day.
It's not about evaluating
the student's performance
on that as much as it is
gaining, them gaining their trust.
That's what entrustment means.
So it's more about the
levels of autonomy that you
give the learner in with
EPAs than it is about, oh, you know,
you did it sort of well, but not well.
It's about trust, you know,
and trust is sort of, you know,
black and white.
You either give somebody the
trust that you trust them to do it
And they can do it
independently or you trust
them to do it with guidance or whatever.
So that's why EPAs, I think,
are really an exciting
frontier for competency-based education.
Yeah.
I mean, just to rephrase it,
it sounds a little bit like, you know,
if I had someone in my
clinic that was maybe a
student or something and
they're demonstrating something.
And then at that point, I feel like,
I'm good.
At this point, you're good with this.
I trust that you're going to
be able to implement this
with patients in my clinic.
Obviously,
I'm going to protect those patients.
Exactly.
And you know, Seth,
the beauty of the process
is that traditionally in clinical ed,
when we would watch a student
um, with an encounter, a patient encounter,
you know, we'd watch the whole thing,
you know, and then you try to sort of, um,
grade the whole thing.
But this is a process where, you know,
I can, I can have the, the, um,
if the EPA is developing an
exercise prescription or
developing a management plan, um,
That's the only part really
I've really got to focus on.
You know,
the EPAs are it's that particular EPA.
And so now you give the
student really meaningful
feedback on very specific,
discrete aspects of a patient encounter.
And, you know, the history examination,
the development of a prescription,
the decision to delegate.
You know,
you can watch part of what they
do and let them go to town
with the rest of the patient encounter.
But you just need to focus
perhaps on one or two of the EPAs.
And the way we've incorporated it.
um in our in our program is
that the student asks for
the assessment it's a very
different process the
student will approach if
I'm the clinical preceptor
the student approaches me
and said I'd like to you to
assess me on epa three and
or epa five or I want I'd
like you to assess me you
know today with this
patient on epa seven you know and that's
That's the conversation they're having.
So our students come back, you know,
after the first clinical affiliation.
I mean, a couple of the students had,
you know,
a hundred EPA assessments that
they that were all were all graded.
And the question always is, oh, my gosh,
that's too much work
involved with that for a CI.
Now, we actually developed the tool.
It's on the smart.
It's on a phone.
It's an app.
And boom, boom, boom.
And it's real-time
assessment of the student doing that EPA.
And this is not a plug,
but we work with a company
called White Coat
Technologies that developed
this tool for us that
allows us to look in
real-time at the student's
performance with EPAs.
Yeah, that's great.
I mean,
when I'm listening to you describe
this though, Carl, this is an podcast.
So I think that to me,
having gone through fellowship,
that sounds a little bit
like post-professional training.
I mean,
you didn't have like an anatomy
course and you didn't have, you know,
it was,
could you do what you were
supposed to do at a certain level?
Yeah, that's exactly what it's like.
And we, you know, I think that there's,
there's a lot of
good leadership at the
residency level of our
profession where they were
looking at competencies
before entry level.
I mean, they're ahead of the game.
And so I think there was a
lot of lessons learned in
that process that, to me,
are very reasonable to
incorporate into entry-level education.
And I think the other thing
that's been fascinating to
me about competency and
entrustment-based education
is that it really, really does create
a curriculum that's integrated.
You know,
I think it's fair to say if I ask
any faculty member at any
physical therapy program in
the United States,
is your curriculum integrated?
Everybody would say, oh, yeah, yeah, yeah,
it's integrated.
We have an integrated curriculum.
But the reality is the
student has to figure out
how to integrate all that
because everything is
taught in more siloed courses.
There's an anatomy course.
There's an orthopedic course.
There's a pediatric course, et cetera,
et cetera.
Competency-based education
forces the faculty, right?
to integrate the curriculum,
to put unsiloed courses
together because you start
with the end in mind.
What's the competency you want?
And then you work backwards
to develop the curriculum
based on the course
learning outcomes that are
aligned with those competencies.
So it's a backward design process.
Yeah.
And it sounds like that's
kind of what you did at NAU, right?
Yes, exactly.
That's what we did.
And again, we had a head start.
We had a little bit of a
time at Rasmussen with this team.
And I just want to commend NAU.
I worked there.
I love the place.
But they willingly hired
all ten of us.
I mean, when Rasmussen pulled the plug,
they, on the spot,
hired all ten of us as
faculty members to continue
our work in the competency
and entrustment-based process.
And then we kept that going
while we made the transition,
the conversion from a
traditional residential
program that was not
competency-based and now
you know the the residency
the residential side of our
pt program is also fully in
the competency and
entrustment based uh
curriculum so it's sort of
get my juices uh you know
uh going uh it's been uh
it's been really an exciting uh you know
a couple and a half years
here um you know building
one from the ground up
which is a which is once
you got to have one set of
strategies to build from
the ground up and then if
you're going to convert a
program that you have
there's another strategy
you know how you do how you
do the teach out of an
older curriculum and in and
implement a newer
curriculum so just fun fun times
Yeah, I mean,
you mentioned how we're a
little bit maybe behind
some of the other professions,
which we'll get into maybe in a minute,
but I'd imagine that comes
with some challenges.
Did you get any resistance
from faculty or what sort
of challenges did you run into?
Yeah, I think that the ground up one,
and I've done a couple of
presentations at ELC on this,
building from the ground up
a little bit easier because
we hired faculty who were
interested in doing this.
So there was no inertia to overcome.
Now, conversion one,
it takes a different type of strategy.
And what I've learned,
and this is anecdotal,
But the younger the faculty member is,
the easier it is to make this conversion.
In other words,
the young faculty really
are a little more adept at
pivoting and changing.
They haven't gotten set in their ways.
I think faculty that
struggled with it are
faculty that have been
Maybe, you know, doing, you know,
they've been teaching this
anatomy course or they've
been teaching this
orthopedics course for the last fifteen,
eighteen years.
And now this is a shift.
You know,
where did my orthopedics course go?
You know,
it's now integrated in a patient
management course.
And there's an obligation in
Comp C and the trust based
education that everything is team taught.
We don't have any course in
the curriculum where there
aren't at least six or
seven faculty involved in it.
OK, now let me explain what that means,
because you can see where
the challenges are.
That is that you get six or
seven faculty involved in
and I'll just call it a
patient management course.
This isn't the type of thing
where I come in,
Carl Doolza comes in and
I've got some expertise in the spine.
I do my two weeks in the
spine and then I'm out.
You know, that's all I do.
And I write the few
questions for their exam
and I'm all done.
I'm involved in that course
the complete semester
because I'm contributing to
the assessment process for everything.
We try to do what they call
authentic assessments.
You try to mimic using OSCEs
and things like that that
are authentic assessments.
And so I'm part of the whole course,
even if it's not my area of expertise.
So we've got five or six
faculty working with fifty
or sixty students, you know,
and it breaks down nice.
I'm working with ten
students and doing the assessments.
um but that's a struggle for
faculty who have you know
have a more traditional
model where they just sort
of did their thing their
area of expertise uh and
now they're assessing um
you know students in areas
that are maybe outside
their their comfort zone so
I think that would that is
probably you know one of
the the biggest challenges is that they
the faculty member getting
the understanding that this
is more about assessment.
This is assessment for learning.
Right?
That's why we're doing the assessments.
And you're going to be involved with big,
big, big, big courses.
And like I said, the young faculty,
my experience has been,
it's sort of like your kids.
OK, we'll do it, Dad.
Yeah, that's what we'll do.
Whereas your teenager goes, uh-uh,
I'm not doing that.
That kind of thing.
Yeah, I mean,
so I want to zoom back out a
little bit in terms of what
the profession's doing.
Because I think you're
leading the game here.
You're the first fully CBE
program in the country.
But I know that the
profession's invested a lot in that.
So maybe could you just give
a rundown of what you know
as far as why did we start
investigating CBE and EPAs?
And where are we right now
from what you know?
Yeah.
Well, you know, there's been, you know,
I think I've been able to, as I say,
you know,
sort of stand on the shoulders
of a lot of great leaders.
And we have had some
individuals in education
programs and residency
programs really keep the
conversation going.
You know, they've
gone out on the limb trying
to extrapolate from other
professions that are leading the way.
Like veterinary medicine is
leading the way.
Pharmacy is leading the way.
Medicine leading the way.
Nursing leading the way.
And so they really have
called out and distilled
out some of the wins that
they've seen with these
other professions.
and made suggestions that
this is something that
physical therapy should
seriously take a look at.
This is the movement.
It's almost an international movement.
Again,
if you think of some of the original
reasons why
competency-based education has
taken foothold,
it has a lot to do with
patient safety and
eliminating variation in practice.
And, you know,
we're typically in physical therapy,
we don't have high risk
safety things like medicine
and surgery and, you know, and, you know,
and those type of things.
But we do talk about
unwanted variation in practice a lot.
And competency-based
education drills that down
to the essential
competencies and you don't have,
you can't have faculty just
teaching what they want to teach,
you know, what they're interested in.
They have to teach around
the competencies.
So I think that we have,
there have been so many
great lessons learned
from the other professions.
And we have some great
leaders in physical therapy
education that have pulled
that and written about it
that they haven't been able
to implement it at their institution yet,
but they will, but they, they,
but they have written about
it and stimulated the discussion,
you know, and really seeded the,
the discussion to, to get us going.
And then like anything else,
there's early adopters and
middle adopters and,
you know, late adapters.
And, you know,
I think we just had the good
fortune of a team of people
that wanted to be early
adapters and make a mistake.
I mean, wanted to make mistakes.
We presented what we've done
at several meetings already
primarily so people can
critique it and we just
have gotten better by
hearing the questions like
why are you doing that and
then we go on I don't know
why are we doing that let's
let's switch that up so
that's how these things uh
evolve I'd like physical
theory to move a little bit
quicker at it,
because I think
competency-based education
solves a lot of the things
that we've been talking the talk about,
but haven't been walking the walk on.
Things like the efficiencies
in the curriculum and unwanted variation.
And what's really important to me is that
This is the way to create
that professional
trajectory from an
entry-level student into
more advanced practice residencies.
And this is the route where
it can happen because the
competencies are scaffolded.
They're scaffolded at the
entry level and they're
scaffolded at the residency level.
And there's a clear
professional pathway that we can
develop as a profession um
as we uh you know we
continue to embrace it so
let's say I mean let's look
over our shoulders if we
kind of imagine that we're
in a race where's the pt
profession and where are
you know where's medicine
and pharmacy and veterinary medicine
Yeah, I would say that, you know,
when I was in high school,
I ran the quarter mile
because I wasn't fast
enough for a sprint and I
couldn't run long distances.
So the quarter mile was was my race.
So I would say if you think
of a quarter mile track that, you know,
medicine, pharmacy, medicine.
veterinary medicine,
nursing to some extent,
are rounding that last
curve and bringing it into
that last hundred yards,
hundred meters to come to
the finish line.
And physical therapy is
probably still at about the
the hundred ten meter point.
We're we're two hundred
meters behind the other professions.
And not that we can't kick it in.
We got to run that back stretch.
But we have to run that back
stretch a little bit faster.
I think there's an
expectation from the
industry that physical therapy is
you know better turn on the
jets a little bit down that
back stretch so I think
that's the gap is pretty
pretty um pretty big to me
not the gap of knowledge I
think we've we've we
probably have the gap of
understanding it but the
gap of implementation is
where where you know we're
we're rounding the first
curve at a hundred and ten
meters and all the other
professions are are
rounding that last curve to
um you know go to the end so
that's my track analogy
where we're at yeah man the
four hundred you ran the
four hundred that's like
the toughest it is that's
the toughest race in all of
track and field oh and you
know that's it you know and
I like I said I I just
wasn't fast enough for the
hundred or two twenty um
and uh and you know the the
mile you know I get winded
too fast so that's that's
where I sort of landed but uh
We we actually ran the mile
relay with a team when I
was in high school and we
we had the the record at
our school for a good twenty years.
You know,
I think I ran about a forty eight
second quarter mile.
So it was good.
Yeah, that's it.
That's to me.
That's the analogy, you know, that,
you know,
physical therapy is about
rounded the first curve.
And these other professions
have rounded the last curve
and are bringing it home
that last hundred.
Yeah, I mean, so I'm in Tucson.
For those that don't know,
the University of Arizona is here.
And it's kind of interesting to me.
I think this is interesting.
I know a lot of the faculty
already that are in that program.
It's a great program.
I think Tucson really is in
desperate need of it.
So I'm really optimistic about that.
But it's a three-year program.
And it was just announced
that the medical school at
the University of Arizona,
so the same institution,
is going to be three years
now because they're implementing CBE.
So can you talk about, I mean, to me,
that kind of worries me a
little bit as a profession.
If you're trying to seek the
best and brightest
applicants and they're looking at, well,
I could go to PT or I could
become an MD in the same amount of time,
we should be a little bit
worried about that.
So how have people implemented CBE?
I know that maybe initially
it wasn't designed to
reduce the length of the curriculum,
but it seems like there are
a lot of programs now that,
especially in medicine,
that are shorter because
they're implementing CBE.
Right.
You know, I think in my experience,
it really comes down to the
ability to unsilo these courses.
I think that's when as soon
as you start breaking down
these individual core silos,
you start to realize and
you put them in bigger packages,
more clinically focused packages,
you realize how much redundancy
there is in a traditional
curriculum and there are
some things where
repetition is good
repetition you know helps
helps with learning but
there's others where you
know you realize after you
start to package the
curriculum together in a tighter
more competency-based approach,
that you had needless
redundancies in your program.
Because a lot of the faculty
didn't know other faculty
were doing these things, you know,
in those courses.
So just,
I've always felt that just by definition,
that this backward design approach,
where you're, and you know,
it's driven by the domains
of competence and the competencies,
will, by definition,
eliminate the redundancies
in our program.
Now, once you eliminate the redundancies,
the next level of culling
down the curriculum is really,
what does the industry want?
What do we need to teach to make,
competency-based is about
making people workforce-ready.
And we get a clear vision of
what entry-level workforce ready is,
as opposed to some things
that maybe aren't really
entry-level or they're not
really that much part of
practice anymore.
I'll go on the limb right
here and I'll say that
anybody that's teaching
documentation five years from now,
they're missing the boat of
what's happening in the
clinic because AI is taking
over that aspect of it.
I think diagnosis is going to change too.
I mean,
workforce ready is the human
diagnosis versus the AI diagnosis.
You know,
our role is going to be in
validating the AI.
And that's what we should be teaching now.
That's where the focus should be.
So I'm only giving those examples because,
you know,
I want to point out that the
whole theme of
competency-based education
is workforce ready.
So once you see what the
workforce is doing and what
they're needing,
then that's what you're
focused on in the curriculum.
So the efficiency is why the
U of A Medical School can
do this in three years
right now is because
they're making sure there's
no redundancies.
And two,
and they're doing that through a
CVE approach.
And two,
they're focused clearly on what
workforce readiness means.
And I think that's where the
efficiencies get created.
We probably underestimate,
we always have
underestimated what the students,
whether the medical
students or physical
therapy students are
capable of in the first or
second semester, for example.
We have sort of a
longstanding history of
we've got to build all this
foundational stuff up.
Got to have all the
foundational stuff done
before you can get it to this next level.
But, you know,
we've learned with
competency-based education
that you can start in the
first semester with complex
patients and break it down
so the student learns as opposed to,
you know,
we've got to learn every letter
of the alphabet first, you know,
before we can start talking.
You know,
if you think about how people
learn a new language,
In the old days,
they learned how to conjugate verbs,
and this word equals that word.
And then we soon learned
that wasn't the best way to
learn a new language.
You just have to start conversing in it.
And it's the same way with CBE.
I don't know if the parallel
is a little bit too wide,
but you just got to start doing it.
And that's what starts
showing the competency.
yeah yeah and you know I
would say to the students
and I you know say the
faculty an anatomy exam for
example and I'll use
anatomy and it just as an
example is not a proxy for
clinical competence it's it
it isn't you you've got to
test the competency you
gotta you gotta look at
you know,
how someone's doing with the competency.
The anatomy exam,
the physiology exam isn't a proxy,
you know, for competence.
So that's like language,
like being able to
conjugate a verb in Italian, okay,
is not a proxy for being
able to talk Italian.
That's why I use it a language, you know,
analogy.
Yeah, I mean,
kind of how it reminds me of
how maybe I learned to read
in school and then now my kids,
they just get this like
sheet of paper with sight
words and they just look at
the word and memorize what word that is.
Yeah, that's kind of how we read.
Yeah.
Yeah, exactly.
And I think competency and
entrustment based education
just sort of opens up the
window for opportunities.
You know, I think.
The model is competency and
entrustment based education.
But just like we're talking
about with learning a new language,
there's a lot of ways to
bring that model to life.
There's not just one way,
but there's a lot of ways.
It's like learning a language,
you create different
scenarios and the person
learns a language and you
have conversations, things like that.
there's a lot of ways to
figure out how to implement, you know,
compensating and trust-based education.
Yeah.
And maybe so I can hear
people thinking to themselves,
the NPTE pass rates, what are those?
Can you talk a little bit?
I know we've maybe talked
before about this,
but what are your opinions
on NPTE pass rates in general?
What does that mean in terms
of an outcome?
Yeah.
How that ties into this?
Well, you know,
I think what I want to say
is I don't want to be taken
the wrong way.
They're important.
I mean, pass rates are important.
But I think we as a
profession sort of just
glommed on to the lowest hanging,
easy fruit to measure our success.
And as a result of that,
we've got a whole industry
that has sprung up that's
just focused on helping
students pass the test.
I mean,
I get emails as a program director
from all of these companies,
let us get in front of your
students to prepare them for the NPTE.
And so a whole industry has sprung up.
to help people reach what is
seen as the end goal of
success with physical therapy education,
passing the NPTE exam.
And again, it's important,
or passing it the first time.
Again, it's important,
but it really does nothing
to contribute to this,
the professional trajectory, you know,
the realization that the
students got to have that
now that I graduated,
now my learning is going to begin.
I'm going to be learning now
with patients.
Instead, I got this,
I passed the licensing exam, you know,
I'm done, you know.
And as opposed to thinking like medicine,
thinking, okay,
now I have got to really look forward.
When I was a CEO for the
orthopedic physicians group,
I recruited and hired a
number of physicians.
And I was really struck by
how much time and effort
they put in to making sure
this was the right position for them.
You know,
what's the mentorship I'm going to have?
These are new.
These were, you know,
graduates now just out of
their residencies.
But what kind of mentorship
am I going to have?
You know, what's the environment?
What's the culture?
Because they they were
looking at this as this is
where my learning is going to start.
Right.
This is not now I've got a
job to start paying back loans.
That's that their head was not there.
This was this is where my
learning is going to start.
Whereas I don't think physical therapists,
when they graduate,
have that same mindset.
Like,
I'm going to find the best
environment for me that's
going to help me continue
on my professional trajectory.
Some people need mentorship.
Some people need patient volume.
Some people,
there's all kinds of things
that go into that.
And so we've shortchanged
ourselves as a profession.
with this high focus.
It's an easy cappy box check.
You know,
everybody's proud to put it on
their website, you know, you know,
you know, you know,
ninety eight percent pass rate.
Well, you know,
people could take it two and three times.
So it's it's an artificial number.
And we we should elevate
ourselves in terms of what
outcomes are really, really important.
And like I said, that's
That's an outcome.
But, you know,
if no matter how how poor a
program might be,
there's a whole industry
out there ready to coach
the student to pass the exam.
And so I've always had.
real trouble with us, you know,
just putting so much weight
on what I consider to be
low hanging fruit.
It's an easy metric to look at.
You don't have to do any work to see where,
you know,
how students have done
post-graduation or anything like that.
Who's going on, to me, a more meaningful,
who's going on to residencies?
Who understood their
entry-level education so
well that they went into residencies?
That, to me,
is incredibly meaningful value
over first-time pass rates.
Yeah.
And I think,
I think one of the reasons
that CBE kind of was recommended in this,
this vision for excellence
document that came out from
the APTA was the concept of
creating master adaptive learners.
And right now it's just blows my mind.
We still only have about two
percent of PTs that go on to do residency,
five percent or so that do fellowship.
So there are all these open
slots right now.
And it's, it, it is, I mean, it's,
It seems crazy to me like
we're missing the boat.
And I heard the APTA staff,
actually a member,
articulate a vision where
EPAs would be established at entry level,
maybe five years out of practice,
ten years out of practice.
So it would continue after graduation,
which to me sounds amazing.
Like it would totally
revolutionize Con Ed.
It would fill in the
residencies and fellowships
and kind of elevate our profession.
Yeah, exactly.
I mean, I see it the same way you see it,
Seth.
The pathway is with a
competency and entrustment-based model,
the pathway...
from you know entry-level
education um to uh to and
through residency really is
clear I mean it it really
you even a student can can
see it you know um you know
we I I'm sort of proud one
of the things that you know
we've done um with um our
competency and trust based
program is we've sort of
revisioned the capstone experience.
I think a lot of times when
programs changed to doctoral programs,
since there was no thesis,
most programs put in place
some type of capstone project.
And in my opinion,
most of these capstone
projects that I see are, are,
are not a value, you know, the, the,
you know, testing, you know,
student does like a quasi
research project.
they really don't have that
strong of a background in research,
but they're, you know,
doing a reliability study
on hamstring stretching or
something like that.
That's important from a
research standpoint,
but students are doing
meaningless projects.
What's the effect of heat versus cold on,
you know, jumping rope or, you know,
something like that.
And, you know,
I think what the capstone
experience should be
is preparing people to apply
for different residency programs.
And that's where we've taken our focus,
our last one.
I mean,
we're actually to the point of
getting students to,
and even if they don't go that route,
it's in their head that
this is the next step.
This is, your capstone is about
your professional identity.
That's what a capstone
experience should be.
As your capstone project
evolves through a curriculum,
it's about starting to
learn what your professional identity is,
It has how it develops
during the curriculum and then at the end,
what your professional identity could be.
So I think if we shift our
capstone focus to something like that,
we'll have less of this, you know,
graduates dropping out of
the profession because they're, you know,
they're frustrated with it.
They didn't know this is
what it was and things like that.
So I would want to encourage
everybody to look at the
concept of professional
identity formation as the
capstone experience,
rather than the effects of
heat versus cold on low back flexibility.
We don't need any more of
those types of studies.
And students doing
meaningless research projects,
even survey literature from a student.
I get those all the time.
And I go, oh,
why did the faculty have the
students do this?
So that's a strong opinion.
But if we focus a little
more on professional
identity formation as this
thread in a capstone experience,
that's where we're going to
really develop these master
adaptive learners that you pointed out.
Yeah, I love that.
I love that concept.
Carl, just kind of in closing here,
if you had to leave
the listeners, maybe it's a faculty member,
program director thinking
about dipping their toe in CBE,
what advice or words of
encouragement would you give them?
I think the first thing I'd say is,
be comfortable with ambiguity.
I know that's maybe a
different kind of phrase.
But I think sometimes we as faculty,
we're like students.
Students wanted black and white.
wait a minute,
they said that this nerve carries C five,
six and seven,
but this source says it's
only C five and six, right?
They're not comfortable with
that ambiguity.
The students, they want it.
They want to be they don't
like the gray area.
And I think faculty are a
little bit unwilling to
accept that is that we've
we've got to explore.
We can't be doing things the
way we were doing them.
Thirty years ago and twenty years ago.
I mean, if we say
that new knowledge comes at
whatever that exponential
factor is per day.
I mean, it increases.
And we're still doing the
same thing we were doing
five years ago in a
therapeutic exercise lab or
in an orthopedics lab.
Something's wrong that we
say to the students.
The art and science of
medicine is changing
exponentially on a daily basis.
But I'm still teaching the
same way and stuff that I did seven,
eight years ago.
There's a big disconnect there.
So we've got to be willing to explore.
We've got to be willing to
create a little chaos.
It's sort of like a chemistry formula.
It's very difficult when
something's at equilibrium.
You can't make changes if
something's at equilibrium.
When there's chaos,
that's when you can make changes.
So be comfortable with ambiguity,
create a little chaos,
and I think we'll thrive
professionally with those
kind of mantras.
All right.
Carl Rosa,
thanks for your time this morning.
My pleasure.
Thanks for this invitation, Seth.
All right.
Bye, Carl.
All right.
Bye-bye.