WEBVTT

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All right.

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So Carl DeRosa,

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thanks for joining us on the Hands On,

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Hands Off podcast.

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Maybe, you know,

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I know you a little bit from, you know,

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both of us live in Arizona.

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You're up there in Flagstaff.

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I'm down in Tucson.

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But maybe you could maybe we

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just start off the podcast.

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If you could explain what

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your current role is,

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maybe introduce yourself.

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But you're kind of also one

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of these interesting

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chimeras in PT who've done

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a lot in terms of leadership.

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You've been in private

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practice and now education.

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You've done a ton.

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So if you can kind of go

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into maybe your journey in

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physical therapy and how you see yourself,

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that'd be great.

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Sure, I'd be happy to, Seth,

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and I appreciate this

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invitation to just share

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some ideas and answer some questions.

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I was one of the founding

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faculty for the Northern

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Arizona University Physical

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Therapy Program.

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That was way back in

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nineteen seventy eight.

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And there were no physical

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therapy programs in the state of Arizona.

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The regents awarded Northern

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Arizona University the

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program to the surprise of many.

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I was recruited out of

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California where I was

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working and three of us

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came at the same time and

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we were literally given a

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blank checkbook by the

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university to put together

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what we thought would be an

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innovative program.

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It was an incredibly stimulating,

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exciting time.

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I was very young in my career.

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And I'd been working

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actually in long-term neuro

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rehab and then was

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transitioning to

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orthopedics while I was in

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California before I came here.

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And they asked me to develop

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the musculoskeletal side of

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the curriculum, essentially,

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at Northern Arizona University.

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And then in, um,

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I had the good fortune to

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meet a good friend, still a good friend,

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Phil Sauer,

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who studied with James Syriax in England.

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And he was working down in Sedona.

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And so in nineteen eighty,

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we opened up a two person

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private practice that was

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just focused on spine care

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and sort of took the city by storm.

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The physicians had never

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really worked with any

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therapists that were just

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focused on spine care.

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And we we grew that practice

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to a broader orthopedic

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spectrum and went into a

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collaboration with

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physicians here in the

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community where we actually

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built the first

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large-scale musculoskeletal center.

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It was an independent

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practice with the

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physicians in their independent practice.

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It had the first recovery

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care center in the state for surgery.

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And that just meant that

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instead of just being an

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ambulatory care center,

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that we could have patients

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stay there for three days.

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It's like a mini hospital in a way.

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So we built a revolutionary

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concept here in Arizona.

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At that time,

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I was chair of the physical

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therapy program simultaneously,

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so there weren't enough

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hours in the day to do all this.

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But I found the hours.

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I chaired the program for

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twenty years and just as fortunate,

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surrounded by some

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incredible physical therapy leaders,

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Tom McPoyle, Mark Cornwall,

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Karen Mueller.

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I just was lucky I was

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working with the dream team

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in physical therapy faculty.

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So that's what was sort of

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keeping me busy with

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practice for we had

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practice for forty one

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years and and also running the program.

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And then about three or four, five,

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six years ago, I I

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uh was offered a position in

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the community to run the

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largest orthopedic medical

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orthopedic physician

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medical practice uh in

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northern arizona they asked

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if I would serve as the ceo

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um running two surgical

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centers and managing

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physicians and and pas and everything and

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I thought, you know, that might be fun.

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I mean, people say you're crazy,

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but I thought that would be fun.

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So I stepped away from the

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university and I told them

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I'd do this for four years.

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You know,

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I wanted to do it and I knew

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these physicians very well.

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And so I didn't have a

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learning curve on that.

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And just, we had a really successful run.

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And then four years to the

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day I stepped out, I

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I prepared for the transition.

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And then I was going to slow

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down a little bit.

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And then in the immortal

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words of Michael Corleone,

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just when I thought I was out,

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they pulled me back in.

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I had an opportunity to get

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involved with competency-based education.

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And that was at Rasmussen University.

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They were a competency-based

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education institution.

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And they gave me, it was sort of deja vu.

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They gave me a blank check

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to hire faculty.

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I hired ten faculty.

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And we developed a

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curriculum that got

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accredited by CAPTI and everything.

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And Rasmussen,

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wonderful experience for me.

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We had accepted the first class.

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They had not started.

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But Rasmussen University,

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as a for-profit institution,

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got purchased by American

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Education Institute.

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And that's one of the

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largest for-profit companies.

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And their mission is not

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graduate education.

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So long story short,

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they pulled the plug on the program,

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even though we had

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developed the first

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competency-based program.

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But my phone was ringing off

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the hook the next day from

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several universities with

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physical therapy programs that said,

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would you take and lift

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that and put it over here?

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And one of those was

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Northern Arizona University.

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And so we developed the, you know,

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the total gamut of

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competency and entrustment

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based program at Northern

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Arizona University.

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And we just completed the

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work we had started at

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Rasmussen University.

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So that's my short history.

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I hope I didn't go too long on that,

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but that's practice and

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education and then some new ventures.

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I've served in the House of

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Delegates for a long time.

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I think it was probably

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about twenty years.

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I was Chief Delegate for

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about six or seven or eight years.

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was the chair of education

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for the APTA for a number of years.

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So dabbled in a lot of the

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different areas.

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It's been a great ride.

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Physical therapy has been very,

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very good to me.

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Yeah, it sounds like it.

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That thread of craziness has

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kind of continued

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throughout all your

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different roles though, I noticed.

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I know, yeah.

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Do you remember, I mean,

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you talked about Rasmussen

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and being drawn into that.

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Do you remember the first

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time you heard about

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competency-based education?

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Well, it was actually, you know,

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there was a lot of talk in

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the medical literature

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about competency-based education.

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And I knew from some early presentations,

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you know, at our national conferences,

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you know,

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there would be isolated

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presentations on it.

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And I was intrigued by it.

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I didn't know anything about it,

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but I was intrigued by it.

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But then I got into the

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medical literature more.

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And they really do try to

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control variation in

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practice and patient safety is so big.

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And being a CEO for physicians,

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you realize how important

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safety is and we would have

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mortality and morbidity

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conferences for errors that were made.

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So the competency,

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the attention to competencies, you know,

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what was really elevated, you know,

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in the medical field.

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And then it was Rasmussen

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University contacted me

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when they were looking to

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start a physical therapy program.

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They asked if I would run a summit.

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Can you help us run a summit?

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and bring in together about

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ten physical therapy

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industry leaders because, you know,

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our focus is competency-based education.

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That's at Rasmussen University,

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that's their focus, CBE.

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And we want to put a, you know,

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program here and bring in, you know,

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leaders and put together a

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physical therapy program

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along those lines.

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So I said,

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I'd be happy to do that because

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I was intrigued by it.

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And I started to send them stuff.

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And they said, well,

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this is interesting stuff.

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You've been thinking about

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this for a while.

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How would you like to be

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chair of the program?

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I didn't even apply for it.

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First, I was just going to run a summit.

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And all of a sudden,

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I'm the chair of the program.

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And so it was really,

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the stimulus for me was twofold.

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It was observing how important it

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competency-based education

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and a competency-based

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framework was for medicine.

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I really understood why they

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were doing it.

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And it was developing from the ground up,

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you know,

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a program at Rasmussen University.

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So that's the history of it.

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So I've been sort of living it,

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if you would, Will, you know,

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for a good six, five, six years now.

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yeah I mean it sounds like

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it so what are what would

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you say if you had to kind

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of define what cbe is what

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and what epas are that

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that's probably going to be

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important yeah you know I I

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think you know for first of

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all copsy based education

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is um is fascinating um

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because if you like to

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teach by using an

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assessment method you know

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And a lot of people,

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that's how they like to teach.

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A lot of physical therapists,

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a lot of physicians like to

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teach like that.

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You know,

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not I'm going to put lectures up

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of PowerPoint slides,

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not that kind of teaching.

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But this is having someone do something,

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correcting them on the spot,

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giving them feedback.

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You know,

00:10:35.441 --> 00:10:37.243
and it's much more of a coaching

00:10:37.283 --> 00:10:38.864
model than a teaching model.

00:10:39.345 --> 00:10:40.085
So, you know,

00:10:40.365 --> 00:10:42.587
we sometimes say we learn by

00:10:42.668 --> 00:10:43.548
our mistakes.

00:10:44.230 --> 00:10:46.532
This truly is a way that you

00:10:46.611 --> 00:10:48.014
learn from your mistakes.

00:10:48.053 --> 00:10:50.135
You know, you welcome errors.

00:10:50.436 --> 00:10:51.618
You welcome, you know,

00:10:51.738 --> 00:10:53.820
in the educational process because,

00:10:54.379 --> 00:10:55.701
you know, you coach people up.

00:10:56.514 --> 00:11:01.654
And so once you define the end zone,

00:11:01.735 --> 00:11:03.056
I always call it with the faculty,

00:11:03.076 --> 00:11:05.316
the end zone is the competencies.

00:11:05.456 --> 00:11:07.317
And that's the knowledge you have,

00:11:07.356 --> 00:11:08.677
and it's the skills you have,

00:11:08.697 --> 00:11:09.657
and it's the attitudes.

00:11:09.697 --> 00:11:10.817
I mean, basically,

00:11:10.837 --> 00:11:12.557
the competencies are knowledge, skills,

00:11:12.577 --> 00:11:14.538
and attitudes rolled into one.

00:11:15.399 --> 00:11:18.259
And those then,

00:11:18.419 --> 00:11:20.080
how do you translate those

00:11:20.340 --> 00:11:22.561
into the actual workforce?

00:11:22.780 --> 00:11:23.921
That's what the EPAs are.

00:11:24.664 --> 00:11:25.866
It's the you know,

00:11:25.927 --> 00:11:28.009
it's really the the the

00:11:28.049 --> 00:11:30.172
tasks that we do in work

00:11:30.452 --> 00:11:32.615
that that that have

00:11:32.735 --> 00:11:35.099
embedded in them the knowledge,

00:11:35.119 --> 00:11:37.261
skills and attitudes of

00:11:37.621 --> 00:11:39.124
that are the competencies.

00:11:39.625 --> 00:11:43.288
So the EPA is really an exciting piece,

00:11:43.347 --> 00:11:45.889
I think, of this whole process.

00:11:46.490 --> 00:11:50.615
And it's not about measuring the EPA.

00:11:50.815 --> 00:11:53.297
If an EPA is taking a

00:11:53.356 --> 00:11:55.119
history and making a diagnosis,

00:11:55.158 --> 00:11:56.239
we do that every day.

00:11:57.100 --> 00:11:58.782
It's not about evaluating

00:11:58.902 --> 00:12:00.143
the student's performance

00:12:00.243 --> 00:12:02.325
on that as much as it is

00:12:03.322 --> 00:12:07.544
gaining, them gaining their trust.

00:12:07.825 --> 00:12:09.426
That's what entrustment means.

00:12:09.966 --> 00:12:12.246
So it's more about the

00:12:12.547 --> 00:12:15.107
levels of autonomy that you

00:12:15.268 --> 00:12:17.129
give the learner in with

00:12:17.208 --> 00:12:20.990
EPAs than it is about, oh, you know,

00:12:21.850 --> 00:12:23.792
you did it sort of well, but not well.

00:12:24.131 --> 00:12:25.592
It's about trust, you know,

00:12:25.653 --> 00:12:27.874
and trust is sort of, you know,

00:12:28.193 --> 00:12:28.815
black and white.

00:12:28.855 --> 00:12:30.215
You either give somebody the

00:12:30.254 --> 00:12:31.855
trust that you trust them to do it

00:12:32.774 --> 00:12:33.434
And they can do it

00:12:33.475 --> 00:12:35.216
independently or you trust

00:12:35.235 --> 00:12:37.796
them to do it with guidance or whatever.

00:12:38.456 --> 00:12:40.057
So that's why EPAs, I think,

00:12:40.076 --> 00:12:41.437
are really an exciting

00:12:42.298 --> 00:12:45.418
frontier for competency-based education.

00:12:45.437 --> 00:12:47.158
Yeah.

00:12:47.178 --> 00:12:48.298
I mean, just to rephrase it,

00:12:48.339 --> 00:12:50.259
it sounds a little bit like, you know,

00:12:50.299 --> 00:12:52.720
if I had someone in my

00:12:52.759 --> 00:12:54.201
clinic that was maybe a

00:12:54.260 --> 00:12:55.120
student or something and

00:12:55.140 --> 00:12:56.721
they're demonstrating something.

00:12:56.760 --> 00:12:58.522
And then at that point, I feel like,

00:12:59.599 --> 00:13:00.578
I'm good.

00:13:00.639 --> 00:13:02.500
At this point, you're good with this.

00:13:02.559 --> 00:13:03.561
I trust that you're going to

00:13:03.581 --> 00:13:05.201
be able to implement this

00:13:05.221 --> 00:13:06.982
with patients in my clinic.

00:13:07.942 --> 00:13:08.182
Obviously,

00:13:08.202 --> 00:13:09.504
I'm going to protect those patients.

00:13:10.283 --> 00:13:10.764
Exactly.

00:13:10.804 --> 00:13:12.504
And you know, Seth,

00:13:13.225 --> 00:13:15.307
the beauty of the process

00:13:15.447 --> 00:13:18.028
is that traditionally in clinical ed,

00:13:18.067 --> 00:13:19.749
when we would watch a student

00:13:20.606 --> 00:13:22.908
um, with an encounter, a patient encounter,

00:13:23.187 --> 00:13:25.009
you know, we'd watch the whole thing,

00:13:25.289 --> 00:13:29.071
you know, and then you try to sort of, um,

00:13:29.331 --> 00:13:30.731
grade the whole thing.

00:13:31.133 --> 00:13:33.653
But this is a process where, you know,

00:13:33.734 --> 00:13:36.294
I can, I can have the, the, um,

00:13:36.375 --> 00:13:38.696
if the EPA is developing an

00:13:38.775 --> 00:13:40.596
exercise prescription or

00:13:40.657 --> 00:13:43.698
developing a management plan, um,

00:13:44.298 --> 00:13:45.399
That's the only part really

00:13:45.879 --> 00:13:47.198
I've really got to focus on.

00:13:47.539 --> 00:13:47.799
You know,

00:13:47.840 --> 00:13:52.542
the EPAs are it's that particular EPA.

00:13:53.322 --> 00:13:54.363
And so now you give the

00:13:54.423 --> 00:13:56.303
student really meaningful

00:13:56.384 --> 00:13:58.965
feedback on very specific,

00:13:59.144 --> 00:14:02.326
discrete aspects of a patient encounter.

00:14:03.149 --> 00:14:04.850
And, you know, the history examination,

00:14:05.171 --> 00:14:07.111
the development of a prescription,

00:14:07.432 --> 00:14:10.514
the decision to delegate.

00:14:10.734 --> 00:14:11.073
You know,

00:14:11.494 --> 00:14:12.794
you can watch part of what they

00:14:12.855 --> 00:14:15.355
do and let them go to town

00:14:15.395 --> 00:14:17.797
with the rest of the patient encounter.

00:14:18.097 --> 00:14:19.538
But you just need to focus

00:14:19.597 --> 00:14:22.559
perhaps on one or two of the EPAs.

00:14:22.919 --> 00:14:24.740
And the way we've incorporated it.

00:14:26.005 --> 00:14:28.106
um in our in our program is

00:14:28.206 --> 00:14:31.888
that the student asks for

00:14:31.927 --> 00:14:33.207
the assessment it's a very

00:14:33.227 --> 00:14:34.128
different process the

00:14:34.207 --> 00:14:35.629
student will approach if

00:14:35.749 --> 00:14:37.129
I'm the clinical preceptor

00:14:37.168 --> 00:14:38.349
the student approaches me

00:14:38.389 --> 00:14:40.169
and said I'd like to you to

00:14:40.190 --> 00:14:42.049
assess me on epa three and

00:14:42.350 --> 00:14:44.030
or epa five or I want I'd

00:14:44.071 --> 00:14:45.211
like you to assess me you

00:14:45.230 --> 00:14:46.431
know today with this

00:14:46.490 --> 00:14:48.751
patient on epa seven you know and that's

00:14:49.312 --> 00:14:51.052
That's the conversation they're having.

00:14:51.092 --> 00:14:53.054
So our students come back, you know,

00:14:53.095 --> 00:14:55.115
after the first clinical affiliation.

00:14:55.155 --> 00:14:56.697
I mean, a couple of the students had,

00:14:57.057 --> 00:14:57.278
you know,

00:14:57.457 --> 00:14:59.639
a hundred EPA assessments that

00:14:59.679 --> 00:15:02.481
they that were all were all graded.

00:15:03.062 --> 00:15:05.043
And the question always is, oh, my gosh,

00:15:05.244 --> 00:15:06.485
that's too much work

00:15:06.845 --> 00:15:08.206
involved with that for a CI.

00:15:08.485 --> 00:15:10.086
Now, we actually developed the tool.

00:15:10.226 --> 00:15:11.048
It's on the smart.

00:15:11.087 --> 00:15:11.769
It's on a phone.

00:15:11.828 --> 00:15:12.249
It's an app.

00:15:12.884 --> 00:15:13.946
And boom, boom, boom.

00:15:14.145 --> 00:15:16.067
And it's real-time

00:15:16.168 --> 00:15:19.172
assessment of the student doing that EPA.

00:15:19.731 --> 00:15:22.774
And this is not a plug,

00:15:22.794 --> 00:15:24.116
but we work with a company

00:15:24.136 --> 00:15:24.856
called White Coat

00:15:24.898 --> 00:15:26.698
Technologies that developed

00:15:26.719 --> 00:15:28.321
this tool for us that

00:15:28.822 --> 00:15:31.104
allows us to look in

00:15:31.264 --> 00:15:33.505
real-time at the student's

00:15:33.566 --> 00:15:34.927
performance with EPAs.

00:15:36.583 --> 00:15:37.325
Yeah, that's great.

00:15:37.524 --> 00:15:37.705
I mean,

00:15:37.985 --> 00:15:39.746
when I'm listening to you describe

00:15:39.767 --> 00:15:41.769
this though, Carl, this is an podcast.

00:15:41.788 --> 00:15:43.269
So I think that to me,

00:15:43.350 --> 00:15:44.551
having gone through fellowship,

00:15:44.571 --> 00:15:45.772
that sounds a little bit

00:15:45.851 --> 00:15:47.854
like post-professional training.

00:15:47.874 --> 00:15:48.274
I mean,

00:15:48.313 --> 00:15:49.615
you didn't have like an anatomy

00:15:49.654 --> 00:15:51.136
course and you didn't have, you know,

00:15:51.297 --> 00:15:51.537
it was,

00:15:51.836 --> 00:15:52.918
could you do what you were

00:15:53.138 --> 00:15:54.359
supposed to do at a certain level?

00:15:55.019 --> 00:15:57.101
Yeah, that's exactly what it's like.

00:15:57.121 --> 00:15:58.763
And we, you know, I think that there's,

00:15:59.024 --> 00:16:00.605
there's a lot of

00:16:01.285 --> 00:16:03.607
good leadership at the

00:16:03.707 --> 00:16:05.029
residency level of our

00:16:05.070 --> 00:16:06.370
profession where they were

00:16:06.390 --> 00:16:08.273
looking at competencies

00:16:08.633 --> 00:16:09.634
before entry level.

00:16:09.854 --> 00:16:11.255
I mean, they're ahead of the game.

00:16:11.937 --> 00:16:13.258
And so I think there was a

00:16:13.357 --> 00:16:15.279
lot of lessons learned in

00:16:15.360 --> 00:16:17.662
that process that, to me,

00:16:17.741 --> 00:16:21.384
are very reasonable to

00:16:21.445 --> 00:16:25.648
incorporate into entry-level education.

00:16:26.109 --> 00:16:30.011
And I think the other thing

00:16:30.032 --> 00:16:31.232
that's been fascinating to

00:16:31.273 --> 00:16:33.134
me about competency and

00:16:33.173 --> 00:16:34.875
entrustment-based education

00:16:35.035 --> 00:16:39.099
is that it really, really does create

00:16:40.220 --> 00:16:42.162
a curriculum that's integrated.

00:16:42.543 --> 00:16:42.802
You know,

00:16:43.222 --> 00:16:45.505
I think it's fair to say if I ask

00:16:45.725 --> 00:16:47.368
any faculty member at any

00:16:47.408 --> 00:16:48.668
physical therapy program in

00:16:48.688 --> 00:16:49.470
the United States,

00:16:50.410 --> 00:16:51.591
is your curriculum integrated?

00:16:52.326 --> 00:16:54.068
Everybody would say, oh, yeah, yeah, yeah,

00:16:54.188 --> 00:16:55.009
it's integrated.

00:16:55.190 --> 00:16:56.370
We have an integrated curriculum.

00:16:56.770 --> 00:16:57.831
But the reality is the

00:16:57.932 --> 00:16:59.313
student has to figure out

00:16:59.553 --> 00:17:00.615
how to integrate all that

00:17:00.654 --> 00:17:01.696
because everything is

00:17:01.735 --> 00:17:03.937
taught in more siloed courses.

00:17:03.977 --> 00:17:05.140
There's an anatomy course.

00:17:05.180 --> 00:17:06.461
There's an orthopedic course.

00:17:06.480 --> 00:17:08.202
There's a pediatric course, et cetera,

00:17:08.262 --> 00:17:09.403
et cetera.

00:17:09.423 --> 00:17:10.765
Competency-based education

00:17:10.865 --> 00:17:12.787
forces the faculty, right?

00:17:12.906 --> 00:17:14.608
to integrate the curriculum,

00:17:14.828 --> 00:17:16.829
to put unsiloed courses

00:17:16.869 --> 00:17:19.573
together because you start

00:17:19.593 --> 00:17:20.554
with the end in mind.

00:17:20.794 --> 00:17:22.575
What's the competency you want?

00:17:23.175 --> 00:17:24.576
And then you work backwards

00:17:24.596 --> 00:17:25.877
to develop the curriculum

00:17:25.938 --> 00:17:28.000
based on the course

00:17:28.019 --> 00:17:29.101
learning outcomes that are

00:17:29.520 --> 00:17:31.682
aligned with those competencies.

00:17:31.863 --> 00:17:33.664
So it's a backward design process.

00:17:35.162 --> 00:17:35.241
Yeah.

00:17:35.261 --> 00:17:36.021
And it sounds like that's

00:17:36.041 --> 00:17:38.282
kind of what you did at NAU, right?

00:17:38.323 --> 00:17:39.743
Yes, exactly.

00:17:40.263 --> 00:17:40.884
That's what we did.

00:17:40.924 --> 00:17:42.605
And again, we had a head start.

00:17:44.246 --> 00:17:47.607
We had a little bit of a

00:17:47.928 --> 00:17:51.348
time at Rasmussen with this team.

00:17:51.529 --> 00:17:53.951
And I just want to commend NAU.

00:17:54.931 --> 00:17:55.510
I worked there.

00:17:55.570 --> 00:17:56.372
I love the place.

00:17:57.152 --> 00:17:58.853
But they willingly hired

00:17:59.724 --> 00:18:00.505
all ten of us.

00:18:00.525 --> 00:18:02.967
I mean, when Rasmussen pulled the plug,

00:18:04.007 --> 00:18:05.048
they, on the spot,

00:18:05.087 --> 00:18:07.689
hired all ten of us as

00:18:07.749 --> 00:18:09.650
faculty members to continue

00:18:09.690 --> 00:18:11.069
our work in the competency

00:18:11.109 --> 00:18:13.250
and entrustment-based process.

00:18:13.612 --> 00:18:15.673
And then we kept that going

00:18:15.932 --> 00:18:19.153
while we made the transition,

00:18:19.173 --> 00:18:20.394
the conversion from a

00:18:20.494 --> 00:18:21.775
traditional residential

00:18:21.835 --> 00:18:23.316
program that was not

00:18:23.355 --> 00:18:24.436
competency-based and now

00:18:25.237 --> 00:18:26.959
you know the the residency

00:18:27.219 --> 00:18:29.521
the residential side of our

00:18:29.662 --> 00:18:32.065
pt program is also fully in

00:18:32.144 --> 00:18:32.846
the competency and

00:18:32.865 --> 00:18:33.926
entrustment based uh

00:18:33.946 --> 00:18:35.888
curriculum so it's sort of

00:18:35.949 --> 00:18:38.071
get my juices uh you know

00:18:38.211 --> 00:18:40.173
uh going uh it's been uh

00:18:40.233 --> 00:18:42.416
it's been really an exciting uh you know

00:18:42.977 --> 00:18:44.238
a couple and a half years

00:18:44.278 --> 00:18:45.980
here um you know building

00:18:46.160 --> 00:18:47.401
one from the ground up

00:18:47.461 --> 00:18:49.442
which is a which is once

00:18:49.742 --> 00:18:51.644
you got to have one set of

00:18:51.684 --> 00:18:52.625
strategies to build from

00:18:52.665 --> 00:18:54.106
the ground up and then if

00:18:54.126 --> 00:18:55.147
you're going to convert a

00:18:55.188 --> 00:18:56.348
program that you have

00:18:56.528 --> 00:18:57.630
there's another strategy

00:18:57.829 --> 00:18:59.010
you know how you do how you

00:18:59.270 --> 00:19:00.711
do the teach out of an

00:19:00.811 --> 00:19:02.554
older curriculum and in and

00:19:02.653 --> 00:19:03.775
implement a newer

00:19:03.815 --> 00:19:06.096
curriculum so just fun fun times

00:19:07.340 --> 00:19:08.320
Yeah, I mean,

00:19:08.362 --> 00:19:09.261
you mentioned how we're a

00:19:09.281 --> 00:19:10.382
little bit maybe behind

00:19:10.722 --> 00:19:11.782
some of the other professions,

00:19:11.803 --> 00:19:13.463
which we'll get into maybe in a minute,

00:19:13.503 --> 00:19:14.884
but I'd imagine that comes

00:19:14.903 --> 00:19:16.085
with some challenges.

00:19:16.125 --> 00:19:17.645
Did you get any resistance

00:19:17.665 --> 00:19:19.026
from faculty or what sort

00:19:19.046 --> 00:19:20.166
of challenges did you run into?

00:19:21.430 --> 00:19:25.153
Yeah, I think that the ground up one,

00:19:25.192 --> 00:19:26.314
and I've done a couple of

00:19:26.354 --> 00:19:30.136
presentations at ELC on this,

00:19:30.897 --> 00:19:32.318
building from the ground up

00:19:32.659 --> 00:19:34.140
a little bit easier because

00:19:35.240 --> 00:19:37.061
we hired faculty who were

00:19:37.102 --> 00:19:38.222
interested in doing this.

00:19:38.784 --> 00:19:40.724
So there was no inertia to overcome.

00:19:41.405 --> 00:19:43.007
Now, conversion one,

00:19:43.866 --> 00:19:47.210
it takes a different type of strategy.

00:19:47.250 --> 00:19:48.431
And what I've learned,

00:19:48.471 --> 00:19:49.791
and this is anecdotal,

00:19:50.446 --> 00:19:53.609
But the younger the faculty member is,

00:19:54.290 --> 00:19:57.653
the easier it is to make this conversion.

00:19:57.913 --> 00:19:58.334
In other words,

00:19:58.555 --> 00:20:00.056
the young faculty really

00:20:00.576 --> 00:20:04.180
are a little more adept at

00:20:04.240 --> 00:20:05.601
pivoting and changing.

00:20:05.661 --> 00:20:08.303
They haven't gotten set in their ways.

00:20:08.683 --> 00:20:10.184
I think faculty that

00:20:10.285 --> 00:20:11.346
struggled with it are

00:20:11.385 --> 00:20:13.048
faculty that have been

00:20:13.428 --> 00:20:16.412
Maybe, you know, doing, you know,

00:20:16.432 --> 00:20:17.353
they've been teaching this

00:20:17.393 --> 00:20:18.673
anatomy course or they've

00:20:18.693 --> 00:20:19.315
been teaching this

00:20:19.375 --> 00:20:21.416
orthopedics course for the last fifteen,

00:20:21.498 --> 00:20:22.298
eighteen years.

00:20:22.739 --> 00:20:23.920
And now this is a shift.

00:20:24.121 --> 00:20:24.480
You know,

00:20:24.641 --> 00:20:26.042
where did my orthopedics course go?

00:20:26.624 --> 00:20:26.864
You know,

00:20:27.124 --> 00:20:29.104
it's now integrated in a patient

00:20:29.124 --> 00:20:29.924
management course.

00:20:29.964 --> 00:20:34.105
And there's an obligation in

00:20:34.285 --> 00:20:35.705
Comp C and the trust based

00:20:35.786 --> 00:20:38.445
education that everything is team taught.

00:20:38.526 --> 00:20:39.865
We don't have any course in

00:20:39.885 --> 00:20:40.787
the curriculum where there

00:20:40.846 --> 00:20:41.787
aren't at least six or

00:20:41.866 --> 00:20:43.866
seven faculty involved in it.

00:20:43.886 --> 00:20:46.948
OK, now let me explain what that means,

00:20:46.968 --> 00:20:47.968
because you can see where

00:20:48.008 --> 00:20:49.048
the challenges are.

00:20:49.147 --> 00:20:50.827
That is that you get six or

00:20:50.867 --> 00:20:52.388
seven faculty involved in

00:20:52.568 --> 00:20:53.429
and I'll just call it a

00:20:53.489 --> 00:20:54.769
patient management course.

00:20:55.563 --> 00:20:56.784
This isn't the type of thing

00:20:56.824 --> 00:20:57.765
where I come in,

00:20:57.826 --> 00:20:58.987
Carl Doolza comes in and

00:20:59.027 --> 00:21:00.769
I've got some expertise in the spine.

00:21:00.888 --> 00:21:02.269
I do my two weeks in the

00:21:02.309 --> 00:21:04.252
spine and then I'm out.

00:21:04.452 --> 00:21:05.653
You know, that's all I do.

00:21:05.713 --> 00:21:06.835
And I write the few

00:21:06.875 --> 00:21:08.356
questions for their exam

00:21:08.457 --> 00:21:09.097
and I'm all done.

00:21:10.036 --> 00:21:12.258
I'm involved in that course

00:21:12.298 --> 00:21:13.719
the complete semester

00:21:13.759 --> 00:21:16.461
because I'm contributing to

00:21:16.961 --> 00:21:20.164
the assessment process for everything.

00:21:20.664 --> 00:21:21.945
We try to do what they call

00:21:22.006 --> 00:21:23.146
authentic assessments.

00:21:23.547 --> 00:21:29.172
You try to mimic using OSCEs

00:21:29.211 --> 00:21:31.032
and things like that that

00:21:31.133 --> 00:21:32.835
are authentic assessments.

00:21:33.214 --> 00:21:34.715
And so I'm part of the whole course,

00:21:35.276 --> 00:21:37.717
even if it's not my area of expertise.

00:21:38.096 --> 00:21:39.436
So we've got five or six

00:21:39.477 --> 00:21:40.917
faculty working with fifty

00:21:40.978 --> 00:21:42.458
or sixty students, you know,

00:21:42.478 --> 00:21:43.798
and it breaks down nice.

00:21:43.858 --> 00:21:44.578
I'm working with ten

00:21:44.618 --> 00:21:47.619
students and doing the assessments.

00:21:48.422 --> 00:21:50.182
um but that's a struggle for

00:21:50.362 --> 00:21:52.303
faculty who have you know

00:21:52.542 --> 00:21:53.623
have a more traditional

00:21:53.682 --> 00:21:54.762
model where they just sort

00:21:54.782 --> 00:21:56.003
of did their thing their

00:21:56.124 --> 00:21:58.104
area of expertise uh and

00:21:58.163 --> 00:22:00.065
now they're assessing um

00:22:00.365 --> 00:22:01.984
you know students in areas

00:22:02.025 --> 00:22:03.325
that are maybe outside

00:22:03.345 --> 00:22:05.566
their their comfort zone so

00:22:05.586 --> 00:22:07.086
I think that would that is

00:22:07.205 --> 00:22:08.645
probably you know one of

00:22:08.705 --> 00:22:10.727
the the biggest challenges is that they

00:22:12.851 --> 00:22:14.133
the faculty member getting

00:22:14.153 --> 00:22:15.616
the understanding that this

00:22:15.676 --> 00:22:17.380
is more about assessment.

00:22:17.420 --> 00:22:19.183
This is assessment for learning.

00:22:20.188 --> 00:22:20.428
Right?

00:22:21.048 --> 00:22:22.808
That's why we're doing the assessments.

00:22:24.169 --> 00:22:28.769
And you're going to be involved with big,

00:22:28.809 --> 00:22:31.050
big, big, big courses.

00:22:33.511 --> 00:22:34.791
And like I said, the young faculty,

00:22:34.832 --> 00:22:36.152
my experience has been,

00:22:36.172 --> 00:22:38.712
it's sort of like your kids.

00:22:39.093 --> 00:22:40.413
OK, we'll do it, Dad.

00:22:40.653 --> 00:22:41.834
Yeah, that's what we'll do.

00:22:41.874 --> 00:22:45.375
Whereas your teenager goes, uh-uh,

00:22:45.394 --> 00:22:46.214
I'm not doing that.

00:22:46.234 --> 00:22:48.016
That kind of thing.

00:22:51.038 --> 00:22:51.438
Yeah, I mean,

00:22:51.478 --> 00:22:53.180
so I want to zoom back out a

00:22:53.200 --> 00:22:54.020
little bit in terms of what

00:22:54.060 --> 00:22:54.980
the profession's doing.

00:22:55.000 --> 00:22:56.903
Because I think you're

00:22:56.942 --> 00:22:57.584
leading the game here.

00:22:57.604 --> 00:22:59.404
You're the first fully CBE

00:22:59.444 --> 00:23:01.207
program in the country.

00:23:01.247 --> 00:23:01.807
But I know that the

00:23:01.826 --> 00:23:03.407
profession's invested a lot in that.

00:23:03.449 --> 00:23:04.890
So maybe could you just give

00:23:05.710 --> 00:23:06.871
a rundown of what you know

00:23:06.931 --> 00:23:09.353
as far as why did we start

00:23:09.814 --> 00:23:12.855
investigating CBE and EPAs?

00:23:13.136 --> 00:23:14.397
And where are we right now

00:23:14.738 --> 00:23:15.238
from what you know?

00:23:15.558 --> 00:23:15.719
Yeah.

00:23:16.078 --> 00:23:17.800
Well, you know, there's been, you know,

00:23:17.901 --> 00:23:19.482
I think I've been able to, as I say,

00:23:19.843 --> 00:23:20.403
you know,

00:23:20.423 --> 00:23:21.724
sort of stand on the shoulders

00:23:21.785 --> 00:23:23.846
of a lot of great leaders.

00:23:23.886 --> 00:23:26.250
And we have had some

00:23:26.509 --> 00:23:28.352
individuals in education

00:23:28.392 --> 00:23:30.173
programs and residency

00:23:30.213 --> 00:23:33.217
programs really keep the

00:23:33.257 --> 00:23:34.657
conversation going.

00:23:34.817 --> 00:23:36.180
You know, they've

00:23:36.666 --> 00:23:40.470
gone out on the limb trying

00:23:40.529 --> 00:23:43.090
to extrapolate from other

00:23:43.151 --> 00:23:44.873
professions that are leading the way.

00:23:44.932 --> 00:23:46.294
Like veterinary medicine is

00:23:46.713 --> 00:23:47.535
leading the way.

00:23:48.694 --> 00:23:50.395
Pharmacy is leading the way.

00:23:50.497 --> 00:23:51.696
Medicine leading the way.

00:23:51.797 --> 00:23:52.998
Nursing leading the way.

00:23:53.499 --> 00:23:54.900
And so they really have

00:23:54.960 --> 00:23:58.662
called out and distilled

00:23:58.862 --> 00:24:01.364
out some of the wins that

00:24:01.423 --> 00:24:02.984
they've seen with these

00:24:03.045 --> 00:24:03.986
other professions.

00:24:04.465 --> 00:24:06.587
and made suggestions that

00:24:07.128 --> 00:24:07.868
this is something that

00:24:07.929 --> 00:24:09.210
physical therapy should

00:24:09.351 --> 00:24:11.152
seriously take a look at.

00:24:11.251 --> 00:24:12.333
This is the movement.

00:24:12.894 --> 00:24:15.655
It's almost an international movement.

00:24:15.715 --> 00:24:16.135
Again,

00:24:16.155 --> 00:24:18.778
if you think of some of the original

00:24:18.858 --> 00:24:20.619
reasons why

00:24:22.142 --> 00:24:24.063
competency-based education has

00:24:24.284 --> 00:24:25.124
taken foothold,

00:24:25.345 --> 00:24:26.526
it has a lot to do with

00:24:26.986 --> 00:24:28.287
patient safety and

00:24:28.346 --> 00:24:30.269
eliminating variation in practice.

00:24:30.689 --> 00:24:31.250
And, you know,

00:24:31.289 --> 00:24:32.951
we're typically in physical therapy,

00:24:34.113 --> 00:24:35.815
we don't have high risk

00:24:36.154 --> 00:24:38.076
safety things like medicine

00:24:38.096 --> 00:24:40.599
and surgery and, you know, and, you know,

00:24:40.640 --> 00:24:41.580
and those type of things.

00:24:42.101 --> 00:24:43.742
But we do talk about

00:24:44.182 --> 00:24:46.685
unwanted variation in practice a lot.

00:24:47.426 --> 00:24:49.508
And competency-based

00:24:49.548 --> 00:24:51.910
education drills that down

00:24:52.369 --> 00:24:53.170
to the essential

00:24:53.210 --> 00:24:55.291
competencies and you don't have,

00:24:55.432 --> 00:24:57.032
you can't have faculty just

00:24:57.073 --> 00:24:58.814
teaching what they want to teach,

00:24:59.074 --> 00:25:01.035
you know, what they're interested in.

00:25:01.075 --> 00:25:02.435
They have to teach around

00:25:02.455 --> 00:25:03.395
the competencies.

00:25:03.876 --> 00:25:05.917
So I think that we have,

00:25:06.298 --> 00:25:07.558
there have been so many

00:25:07.618 --> 00:25:09.380
great lessons learned

00:25:09.835 --> 00:25:11.455
from the other professions.

00:25:11.855 --> 00:25:13.375
And we have some great

00:25:13.477 --> 00:25:15.237
leaders in physical therapy

00:25:15.297 --> 00:25:16.738
education that have pulled

00:25:16.778 --> 00:25:17.998
that and written about it

00:25:18.358 --> 00:25:19.239
that they haven't been able

00:25:19.278 --> 00:25:21.799
to implement it at their institution yet,

00:25:22.160 --> 00:25:23.820
but they will, but they, they,

00:25:23.941 --> 00:25:25.260
but they have written about

00:25:25.320 --> 00:25:28.021
it and stimulated the discussion,

00:25:28.061 --> 00:25:29.663
you know, and really seeded the,

00:25:30.363 --> 00:25:32.604
the discussion to, to get us going.

00:25:32.624 --> 00:25:33.845
And then like anything else,

00:25:33.865 --> 00:25:35.345
there's early adopters and

00:25:35.404 --> 00:25:36.625
middle adopters and,

00:25:36.965 --> 00:25:38.248
you know, late adapters.

00:25:38.268 --> 00:25:38.929
And, you know,

00:25:38.949 --> 00:25:41.393
I think we just had the good

00:25:41.432 --> 00:25:43.776
fortune of a team of people

00:25:43.796 --> 00:25:44.917
that wanted to be early

00:25:44.958 --> 00:25:46.259
adapters and make a mistake.

00:25:46.339 --> 00:25:47.642
I mean, wanted to make mistakes.

00:25:47.682 --> 00:25:49.084
We presented what we've done

00:25:49.684 --> 00:25:51.307
at several meetings already

00:25:52.724 --> 00:25:54.047
primarily so people can

00:25:54.086 --> 00:25:55.387
critique it and we just

00:25:55.407 --> 00:25:56.549
have gotten better by

00:25:56.609 --> 00:25:58.332
hearing the questions like

00:25:58.571 --> 00:25:59.753
why are you doing that and

00:25:59.794 --> 00:26:01.516
then we go on I don't know

00:26:01.556 --> 00:26:02.696
why are we doing that let's

00:26:02.877 --> 00:26:04.839
let's switch that up so

00:26:05.180 --> 00:26:06.442
that's how these things uh

00:26:06.541 --> 00:26:07.522
evolve I'd like physical

00:26:07.563 --> 00:26:08.765
theory to move a little bit

00:26:09.849 --> 00:26:11.612
quicker at it,

00:26:11.632 --> 00:26:12.231
because I think

00:26:12.291 --> 00:26:13.673
competency-based education

00:26:14.253 --> 00:26:15.955
solves a lot of the things

00:26:15.976 --> 00:26:19.159
that we've been talking the talk about,

00:26:19.200 --> 00:26:21.602
but haven't been walking the walk on.

00:26:22.643 --> 00:26:23.864
Things like the efficiencies

00:26:23.903 --> 00:26:27.248
in the curriculum and unwanted variation.

00:26:27.828 --> 00:26:30.070
And what's really important to me is that

00:26:30.375 --> 00:26:32.457
This is the way to create

00:26:32.477 --> 00:26:33.657
that professional

00:26:34.198 --> 00:26:37.118
trajectory from an

00:26:37.279 --> 00:26:39.941
entry-level student into

00:26:40.580 --> 00:26:42.781
more advanced practice residencies.

00:26:42.821 --> 00:26:45.703
And this is the route where

00:26:45.923 --> 00:26:47.305
it can happen because the

00:26:47.365 --> 00:26:49.685
competencies are scaffolded.

00:26:49.826 --> 00:26:51.106
They're scaffolded at the

00:26:51.186 --> 00:26:52.047
entry level and they're

00:26:52.106 --> 00:26:55.088
scaffolded at the residency level.

00:26:55.689 --> 00:26:56.990
And there's a clear

00:26:57.029 --> 00:26:59.191
professional pathway that we can

00:27:00.070 --> 00:27:03.634
develop as a profession um

00:27:03.755 --> 00:27:05.317
as we uh you know we

00:27:05.356 --> 00:27:08.519
continue to embrace it so

00:27:08.560 --> 00:27:09.942
let's say I mean let's look

00:27:09.981 --> 00:27:10.843
over our shoulders if we

00:27:10.883 --> 00:27:12.484
kind of imagine that we're

00:27:12.505 --> 00:27:14.567
in a race where's the pt

00:27:14.606 --> 00:27:15.868
profession and where are

00:27:16.568 --> 00:27:17.651
you know where's medicine

00:27:17.711 --> 00:27:20.192
and pharmacy and veterinary medicine

00:27:20.904 --> 00:27:23.326
Yeah, I would say that, you know,

00:27:23.346 --> 00:27:24.307
when I was in high school,

00:27:24.367 --> 00:27:25.567
I ran the quarter mile

00:27:26.429 --> 00:27:27.490
because I wasn't fast

00:27:27.529 --> 00:27:29.270
enough for a sprint and I

00:27:29.310 --> 00:27:30.751
couldn't run long distances.

00:27:30.791 --> 00:27:32.814
So the quarter mile was was my race.

00:27:34.134 --> 00:27:35.615
So I would say if you think

00:27:35.635 --> 00:27:37.958
of a quarter mile track that, you know,

00:27:38.278 --> 00:27:42.840
medicine, pharmacy, medicine.

00:27:44.061 --> 00:27:45.203
veterinary medicine,

00:27:45.865 --> 00:27:47.205
nursing to some extent,

00:27:47.787 --> 00:27:49.388
are rounding that last

00:27:49.429 --> 00:27:51.511
curve and bringing it into

00:27:51.531 --> 00:27:52.953
that last hundred yards,

00:27:53.394 --> 00:27:54.796
hundred meters to come to

00:27:54.836 --> 00:27:55.616
the finish line.

00:27:56.394 --> 00:27:57.473
And physical therapy is

00:27:57.534 --> 00:27:59.335
probably still at about the

00:27:59.755 --> 00:28:03.576
the hundred ten meter point.

00:28:03.875 --> 00:28:05.395
We're we're two hundred

00:28:05.435 --> 00:28:08.336
meters behind the other professions.

00:28:09.678 --> 00:28:11.637
And not that we can't kick it in.

00:28:11.698 --> 00:28:13.019
We got to run that back stretch.

00:28:13.239 --> 00:28:14.479
But we have to run that back

00:28:14.519 --> 00:28:17.200
stretch a little bit faster.

00:28:17.559 --> 00:28:18.099
I think there's an

00:28:18.180 --> 00:28:19.420
expectation from the

00:28:19.559 --> 00:28:22.161
industry that physical therapy is

00:28:22.671 --> 00:28:23.692
you know better turn on the

00:28:23.731 --> 00:28:24.892
jets a little bit down that

00:28:24.912 --> 00:28:26.452
back stretch so I think

00:28:26.492 --> 00:28:27.893
that's the gap is pretty

00:28:28.233 --> 00:28:30.375
pretty um pretty big to me

00:28:31.375 --> 00:28:32.855
not the gap of knowledge I

00:28:32.895 --> 00:28:34.836
think we've we've we

00:28:34.856 --> 00:28:35.717
probably have the gap of

00:28:35.797 --> 00:28:36.957
understanding it but the

00:28:37.017 --> 00:28:39.278
gap of implementation is

00:28:39.398 --> 00:28:41.019
where where you know we're

00:28:41.298 --> 00:28:42.400
we're rounding the first

00:28:42.440 --> 00:28:43.660
curve at a hundred and ten

00:28:43.720 --> 00:28:45.580
meters and all the other

00:28:45.621 --> 00:28:47.521
professions are are

00:28:47.602 --> 00:28:49.222
rounding that last curve to

00:28:49.884 --> 00:28:51.826
um you know go to the end so

00:28:51.846 --> 00:28:53.066
that's my track analogy

00:28:53.125 --> 00:28:56.907
where we're at yeah man the

00:28:56.948 --> 00:28:57.907
four hundred you ran the

00:28:57.948 --> 00:28:58.588
four hundred that's like

00:28:58.628 --> 00:29:00.789
the toughest it is that's

00:29:00.890 --> 00:29:02.450
the toughest race in all of

00:29:02.490 --> 00:29:04.810
track and field oh and you

00:29:04.830 --> 00:29:06.251
know that's it you know and

00:29:06.311 --> 00:29:07.792
I like I said I I just

00:29:07.893 --> 00:29:09.073
wasn't fast enough for the

00:29:09.113 --> 00:29:11.213
hundred or two twenty um

00:29:11.334 --> 00:29:13.394
and uh and you know the the

00:29:13.515 --> 00:29:15.175
mile you know I get winded

00:29:15.215 --> 00:29:16.655
too fast so that's that's

00:29:16.695 --> 00:29:18.436
where I sort of landed but uh

00:29:19.416 --> 00:29:21.377
We we actually ran the mile

00:29:21.438 --> 00:29:22.939
relay with a team when I

00:29:22.979 --> 00:29:24.118
was in high school and we

00:29:24.259 --> 00:29:26.480
we had the the record at

00:29:26.539 --> 00:29:28.421
our school for a good twenty years.

00:29:29.601 --> 00:29:29.840
You know,

00:29:31.102 --> 00:29:32.462
I think I ran about a forty eight

00:29:32.522 --> 00:29:33.742
second quarter mile.

00:29:33.762 --> 00:29:35.503
So it was good.

00:29:35.564 --> 00:29:36.784
Yeah, that's it.

00:29:36.804 --> 00:29:37.865
That's to me.

00:29:37.904 --> 00:29:39.684
That's the analogy, you know, that,

00:29:39.945 --> 00:29:40.125
you know,

00:29:40.145 --> 00:29:41.786
physical therapy is about

00:29:41.945 --> 00:29:43.207
rounded the first curve.

00:29:43.988 --> 00:29:45.148
And these other professions

00:29:45.189 --> 00:29:46.971
have rounded the last curve

00:29:47.031 --> 00:29:48.634
and are bringing it home

00:29:48.674 --> 00:29:49.395
that last hundred.

00:29:50.798 --> 00:29:52.619
Yeah, I mean, so I'm in Tucson.

00:29:52.660 --> 00:29:53.340
For those that don't know,

00:29:53.361 --> 00:29:55.061
the University of Arizona is here.

00:29:55.122 --> 00:29:57.242
And it's kind of interesting to me.

00:29:57.502 --> 00:29:58.903
I think this is interesting.

00:29:59.025 --> 00:30:00.505
I know a lot of the faculty

00:30:00.526 --> 00:30:02.567
already that are in that program.

00:30:03.186 --> 00:30:04.407
It's a great program.

00:30:04.448 --> 00:30:06.048
I think Tucson really is in

00:30:06.328 --> 00:30:07.069
desperate need of it.

00:30:07.089 --> 00:30:08.471
So I'm really optimistic about that.

00:30:08.830 --> 00:30:10.332
But it's a three-year program.

00:30:10.432 --> 00:30:11.952
And it was just announced

00:30:12.153 --> 00:30:13.854
that the medical school at

00:30:14.295 --> 00:30:15.214
the University of Arizona,

00:30:15.315 --> 00:30:16.576
so the same institution,

00:30:17.217 --> 00:30:18.017
is going to be three years

00:30:18.057 --> 00:30:20.138
now because they're implementing CBE.

00:30:21.259 --> 00:30:23.859
So can you talk about, I mean, to me,

00:30:23.880 --> 00:30:25.259
that kind of worries me a

00:30:25.299 --> 00:30:26.320
little bit as a profession.

00:30:26.361 --> 00:30:27.840
If you're trying to seek the

00:30:27.881 --> 00:30:28.621
best and brightest

00:30:28.701 --> 00:30:30.162
applicants and they're looking at, well,

00:30:30.182 --> 00:30:31.501
I could go to PT or I could

00:30:32.202 --> 00:30:34.643
become an MD in the same amount of time,

00:30:35.683 --> 00:30:36.503
we should be a little bit

00:30:36.604 --> 00:30:37.403
worried about that.

00:30:37.443 --> 00:30:40.664
So how have people implemented CBE?

00:30:40.724 --> 00:30:42.006
I know that maybe initially

00:30:42.046 --> 00:30:42.945
it wasn't designed to

00:30:43.006 --> 00:30:44.546
reduce the length of the curriculum,

00:30:44.566 --> 00:30:45.366
but it seems like there are

00:30:45.386 --> 00:30:46.926
a lot of programs now that,

00:30:46.946 --> 00:30:47.747
especially in medicine,

00:30:47.767 --> 00:30:49.008
that are shorter because

00:30:49.028 --> 00:30:49.988
they're implementing CBE.

00:30:51.064 --> 00:30:51.523
Right.

00:30:51.943 --> 00:30:54.045
You know, I think in my experience,

00:30:54.085 --> 00:30:55.825
it really comes down to the

00:30:55.865 --> 00:30:59.006
ability to unsilo these courses.

00:30:59.666 --> 00:31:01.807
I think that's when as soon

00:31:01.866 --> 00:31:03.728
as you start breaking down

00:31:03.768 --> 00:31:06.788
these individual core silos,

00:31:07.308 --> 00:31:09.828
you start to realize and

00:31:09.848 --> 00:31:11.569
you put them in bigger packages,

00:31:11.650 --> 00:31:14.730
more clinically focused packages,

00:31:15.510 --> 00:31:18.092
you realize how much redundancy

00:31:18.791 --> 00:31:21.134
there is in a traditional

00:31:21.173 --> 00:31:23.015
curriculum and there are

00:31:23.075 --> 00:31:24.276
some things where

00:31:24.355 --> 00:31:25.457
repetition is good

00:31:25.517 --> 00:31:28.057
repetition you know helps

00:31:28.218 --> 00:31:30.079
helps with learning but

00:31:30.119 --> 00:31:32.101
there's others where you

00:31:32.141 --> 00:31:33.422
know you realize after you

00:31:33.461 --> 00:31:34.462
start to package the

00:31:34.502 --> 00:31:35.983
curriculum together in a tighter

00:31:36.953 --> 00:31:38.835
more competency-based approach,

00:31:39.635 --> 00:31:41.537
that you had needless

00:31:41.576 --> 00:31:43.478
redundancies in your program.

00:31:43.498 --> 00:31:44.478
Because a lot of the faculty

00:31:44.498 --> 00:31:45.739
didn't know other faculty

00:31:45.778 --> 00:31:47.220
were doing these things, you know,

00:31:47.319 --> 00:31:48.260
in those courses.

00:31:48.901 --> 00:31:49.681
So just,

00:31:49.800 --> 00:31:52.303
I've always felt that just by definition,

00:31:52.583 --> 00:31:54.963
that this backward design approach,

00:31:55.644 --> 00:31:58.086
where you're, and you know,

00:31:58.105 --> 00:31:59.467
it's driven by the domains

00:31:59.507 --> 00:32:01.248
of competence and the competencies,

00:32:02.523 --> 00:32:04.505
will, by definition,

00:32:05.006 --> 00:32:08.087
eliminate the redundancies

00:32:08.147 --> 00:32:08.989
in our program.

00:32:09.729 --> 00:32:12.852
Now, once you eliminate the redundancies,

00:32:12.951 --> 00:32:15.273
the next level of culling

00:32:15.314 --> 00:32:17.075
down the curriculum is really,

00:32:18.496 --> 00:32:20.617
what does the industry want?

00:32:20.958 --> 00:32:26.122
What do we need to teach to make,

00:32:26.563 --> 00:32:27.743
competency-based is about

00:32:27.804 --> 00:32:29.464
making people workforce-ready.

00:32:30.532 --> 00:32:34.258
And we get a clear vision of

00:32:34.377 --> 00:32:37.583
what entry-level workforce ready is,

00:32:38.002 --> 00:32:39.204
as opposed to some things

00:32:39.224 --> 00:32:40.487
that maybe aren't really

00:32:40.606 --> 00:32:42.910
entry-level or they're not

00:32:42.990 --> 00:32:44.090
really that much part of

00:32:44.131 --> 00:32:45.073
practice anymore.

00:32:45.932 --> 00:32:47.755
I'll go on the limb right

00:32:47.815 --> 00:32:49.155
here and I'll say that

00:32:49.675 --> 00:32:50.957
anybody that's teaching

00:32:51.217 --> 00:32:55.099
documentation five years from now,

00:32:55.259 --> 00:32:56.201
they're missing the boat of

00:32:56.221 --> 00:32:57.041
what's happening in the

00:32:57.082 --> 00:32:59.703
clinic because AI is taking

00:32:59.844 --> 00:33:01.924
over that aspect of it.

00:33:02.905 --> 00:33:05.188
I think diagnosis is going to change too.

00:33:05.347 --> 00:33:05.928
I mean,

00:33:05.988 --> 00:33:09.111
workforce ready is the human

00:33:09.151 --> 00:33:12.073
diagnosis versus the AI diagnosis.

00:33:12.949 --> 00:33:13.190
You know,

00:33:13.269 --> 00:33:14.290
our role is going to be in

00:33:14.411 --> 00:33:16.212
validating the AI.

00:33:16.313 --> 00:33:18.454
And that's what we should be teaching now.

00:33:18.494 --> 00:33:20.396
That's where the focus should be.

00:33:20.477 --> 00:33:23.819
So I'm only giving those examples because,

00:33:24.180 --> 00:33:24.580
you know,

00:33:25.382 --> 00:33:26.883
I want to point out that the

00:33:27.042 --> 00:33:28.163
whole theme of

00:33:28.243 --> 00:33:29.685
competency-based education

00:33:29.786 --> 00:33:30.906
is workforce ready.

00:33:31.561 --> 00:33:33.963
So once you see what the

00:33:34.003 --> 00:33:35.726
workforce is doing and what

00:33:35.746 --> 00:33:36.326
they're needing,

00:33:36.445 --> 00:33:37.747
then that's what you're

00:33:37.886 --> 00:33:38.867
focused on in the curriculum.

00:33:38.928 --> 00:33:41.130
So the efficiency is why the

00:33:41.230 --> 00:33:42.391
U of A Medical School can

00:33:42.431 --> 00:33:43.571
do this in three years

00:33:43.852 --> 00:33:45.272
right now is because

00:33:46.453 --> 00:33:48.836
they're making sure there's

00:33:48.895 --> 00:33:49.737
no redundancies.

00:33:50.356 --> 00:33:51.117
And two,

00:33:51.557 --> 00:33:52.499
and they're doing that through a

00:33:52.519 --> 00:33:53.359
CVE approach.

00:33:53.500 --> 00:33:54.201
And two,

00:33:54.800 --> 00:33:57.063
they're focused clearly on what

00:33:57.323 --> 00:33:59.184
workforce readiness means.

00:33:59.949 --> 00:34:02.071
And I think that's where the

00:34:02.092 --> 00:34:05.275
efficiencies get created.

00:34:05.675 --> 00:34:06.958
We probably underestimate,

00:34:06.978 --> 00:34:07.557
we always have

00:34:07.617 --> 00:34:10.541
underestimated what the students,

00:34:10.681 --> 00:34:11.443
whether the medical

00:34:11.463 --> 00:34:12.264
students or physical

00:34:12.324 --> 00:34:13.204
therapy students are

00:34:13.244 --> 00:34:15.887
capable of in the first or

00:34:15.967 --> 00:34:17.530
second semester, for example.

00:34:18.331 --> 00:34:19.751
We have sort of a

00:34:19.931 --> 00:34:21.492
longstanding history of

00:34:21.532 --> 00:34:23.273
we've got to build all this

00:34:23.333 --> 00:34:24.994
foundational stuff up.

00:34:25.396 --> 00:34:26.396
Got to have all the

00:34:26.436 --> 00:34:27.737
foundational stuff done

00:34:27.956 --> 00:34:30.719
before you can get it to this next level.

00:34:31.396 --> 00:34:31.896
But, you know,

00:34:31.936 --> 00:34:32.556
we've learned with

00:34:32.597 --> 00:34:33.918
competency-based education

00:34:33.958 --> 00:34:35.137
that you can start in the

00:34:35.179 --> 00:34:36.458
first semester with complex

00:34:36.498 --> 00:34:38.679
patients and break it down

00:34:39.300 --> 00:34:41.460
so the student learns as opposed to,

00:34:42.161 --> 00:34:42.481
you know,

00:34:42.661 --> 00:34:44.141
we've got to learn every letter

00:34:44.181 --> 00:34:46.603
of the alphabet first, you know,

00:34:46.663 --> 00:34:48.623
before we can start talking.

00:34:49.244 --> 00:34:49.784
You know,

00:34:50.143 --> 00:34:52.864
if you think about how people

00:34:52.925 --> 00:34:54.085
learn a new language,

00:34:54.471 --> 00:34:55.231
In the old days,

00:34:55.251 --> 00:34:57.532
they learned how to conjugate verbs,

00:34:59.273 --> 00:35:00.914
and this word equals that word.

00:35:00.954 --> 00:35:03.615
And then we soon learned

00:35:03.876 --> 00:35:04.956
that wasn't the best way to

00:35:05.016 --> 00:35:05.918
learn a new language.

00:35:06.257 --> 00:35:08.018
You just have to start conversing in it.

00:35:08.338 --> 00:35:11.780
And it's the same way with CBE.

00:35:11.800 --> 00:35:15.103
I don't know if the parallel

00:35:15.163 --> 00:35:17.143
is a little bit too wide,

00:35:17.603 --> 00:35:19.364
but you just got to start doing it.

00:35:19.826 --> 00:35:22.327
And that's what starts

00:35:22.347 --> 00:35:23.327
showing the competency.

00:35:25.978 --> 00:35:26.878
yeah yeah and you know I

00:35:26.898 --> 00:35:28.500
would say to the students

00:35:28.599 --> 00:35:29.702
and I you know say the

00:35:29.742 --> 00:35:33.286
faculty an anatomy exam for

00:35:33.365 --> 00:35:35.007
example and I'll use

00:35:35.027 --> 00:35:36.469
anatomy and it just as an

00:35:36.509 --> 00:35:39.632
example is not a proxy for

00:35:39.672 --> 00:35:41.835
clinical competence it's it

00:35:41.954 --> 00:35:43.476
it isn't you you've got to

00:35:43.556 --> 00:35:44.538
test the competency you

00:35:44.557 --> 00:35:46.139
gotta you gotta look at

00:35:48.367 --> 00:35:48.648
you know,

00:35:49.007 --> 00:35:50.768
how someone's doing with the competency.

00:35:51.047 --> 00:35:52.088
The anatomy exam,

00:35:52.108 --> 00:35:54.489
the physiology exam isn't a proxy,

00:35:54.768 --> 00:35:56.550
you know, for competence.

00:35:57.130 --> 00:35:58.610
So that's like language,

00:35:58.630 --> 00:35:59.751
like being able to

00:35:59.811 --> 00:36:03.311
conjugate a verb in Italian, okay,

00:36:03.632 --> 00:36:06.172
is not a proxy for being

00:36:06.251 --> 00:36:08.612
able to talk Italian.

00:36:09.432 --> 00:36:11.693
That's why I use it a language, you know,

00:36:11.733 --> 00:36:12.273
analogy.

00:36:13.751 --> 00:36:14.132
Yeah, I mean,

00:36:14.172 --> 00:36:16.172
kind of how it reminds me of

00:36:16.213 --> 00:36:18.074
how maybe I learned to read

00:36:18.114 --> 00:36:19.514
in school and then now my kids,

00:36:19.534 --> 00:36:20.494
they just get this like

00:36:20.514 --> 00:36:21.496
sheet of paper with sight

00:36:21.536 --> 00:36:22.755
words and they just look at

00:36:22.775 --> 00:36:24.958
the word and memorize what word that is.

00:36:25.518 --> 00:36:26.677
Yeah, that's kind of how we read.

00:36:27.398 --> 00:36:28.719
Yeah.

00:36:28.798 --> 00:36:29.599
Yeah, exactly.

00:36:29.739 --> 00:36:30.760
Yeah, exactly.

00:36:30.880 --> 00:36:32.820
And I think competency and

00:36:32.900 --> 00:36:34.262
entrustment based education

00:36:34.681 --> 00:36:37.163
just sort of opens up the

00:36:37.244 --> 00:36:39.023
window for opportunities.

00:36:39.525 --> 00:36:40.105
You know, I think.

00:36:42.809 --> 00:36:44.710
The model is competency and

00:36:44.751 --> 00:36:46.311
entrustment based education.

00:36:46.731 --> 00:36:48.132
But just like we're talking

00:36:48.152 --> 00:36:49.532
about with learning a new language,

00:36:49.753 --> 00:36:52.014
there's a lot of ways to

00:36:52.074 --> 00:36:53.974
bring that model to life.

00:36:54.054 --> 00:36:55.155
There's not just one way,

00:36:55.175 --> 00:36:56.956
but there's a lot of ways.

00:36:57.056 --> 00:36:58.996
It's like learning a language,

00:36:59.016 --> 00:37:00.036
you create different

00:37:00.177 --> 00:37:02.358
scenarios and the person

00:37:02.438 --> 00:37:03.597
learns a language and you

00:37:03.637 --> 00:37:05.159
have conversations, things like that.

00:37:06.646 --> 00:37:08.849
there's a lot of ways to

00:37:09.429 --> 00:37:12.010
figure out how to implement, you know,

00:37:12.130 --> 00:37:14.592
compensating and trust-based education.

00:37:14.612 --> 00:37:15.494
Yeah.

00:37:16.795 --> 00:37:18.996
And maybe so I can hear

00:37:19.036 --> 00:37:20.237
people thinking to themselves,

00:37:20.637 --> 00:37:23.338
the NPTE pass rates, what are those?

00:37:24.219 --> 00:37:25.300
Can you talk a little bit?

00:37:25.320 --> 00:37:26.822
I know we've maybe talked

00:37:26.842 --> 00:37:27.581
before about this,

00:37:27.621 --> 00:37:29.003
but what are your opinions

00:37:29.083 --> 00:37:31.545
on NPTE pass rates in general?

00:37:31.585 --> 00:37:32.646
What does that mean in terms

00:37:32.686 --> 00:37:33.545
of an outcome?

00:37:34.106 --> 00:37:34.467
Yeah.

00:37:34.626 --> 00:37:35.588
How that ties into this?

00:37:36.737 --> 00:37:37.458
Well, you know,

00:37:37.838 --> 00:37:39.438
I think what I want to say

00:37:39.518 --> 00:37:40.739
is I don't want to be taken

00:37:40.778 --> 00:37:41.599
the wrong way.

00:37:42.380 --> 00:37:42.980
They're important.

00:37:43.019 --> 00:37:44.681
I mean, pass rates are important.

00:37:45.661 --> 00:37:47.981
But I think we as a

00:37:48.021 --> 00:37:50.362
profession sort of just

00:37:50.722 --> 00:37:53.403
glommed on to the lowest hanging,

00:37:54.103 --> 00:37:58.606
easy fruit to measure our success.

00:37:59.458 --> 00:38:00.818
And as a result of that,

00:38:00.978 --> 00:38:02.458
we've got a whole industry

00:38:02.679 --> 00:38:04.298
that has sprung up that's

00:38:04.318 --> 00:38:05.500
just focused on helping

00:38:05.519 --> 00:38:06.619
students pass the test.

00:38:06.659 --> 00:38:06.900
I mean,

00:38:07.019 --> 00:38:11.440
I get emails as a program director

00:38:11.521 --> 00:38:12.900
from all of these companies,

00:38:13.240 --> 00:38:14.202
let us get in front of your

00:38:14.222 --> 00:38:17.623
students to prepare them for the NPTE.

00:38:17.842 --> 00:38:23.184
And so a whole industry has sprung up.

00:38:23.931 --> 00:38:28.094
to help people reach what is

00:38:28.153 --> 00:38:30.954
seen as the end goal of

00:38:31.755 --> 00:38:34.715
success with physical therapy education,

00:38:35.157 --> 00:38:37.898
passing the NPTE exam.

00:38:37.918 --> 00:38:40.798
And again, it's important,

00:38:40.818 --> 00:38:41.958
or passing it the first time.

00:38:43.500 --> 00:38:44.960
Again, it's important,

00:38:45.541 --> 00:38:48.202
but it really does nothing

00:38:49.320 --> 00:38:51.782
to contribute to this,

00:38:52.543 --> 00:38:55.465
the professional trajectory, you know,

00:38:57.708 --> 00:38:59.889
the realization that the

00:38:59.929 --> 00:39:01.411
students got to have that

00:39:01.952 --> 00:39:03.393
now that I graduated,

00:39:04.775 --> 00:39:06.936
now my learning is going to begin.

00:39:07.496 --> 00:39:08.797
I'm going to be learning now

00:39:08.818 --> 00:39:09.539
with patients.

00:39:10.018 --> 00:39:11.740
Instead, I got this,

00:39:11.981 --> 00:39:13.983
I passed the licensing exam, you know,

00:39:14.083 --> 00:39:15.264
I'm done, you know.

00:39:15.885 --> 00:39:19.507
And as opposed to thinking like medicine,

00:39:19.606 --> 00:39:20.567
thinking, okay,

00:39:21.007 --> 00:39:24.469
now I have got to really look forward.

00:39:26.349 --> 00:39:28.552
When I was a CEO for the

00:39:28.612 --> 00:39:30.311
orthopedic physicians group,

00:39:31.492 --> 00:39:33.693
I recruited and hired a

00:39:33.773 --> 00:39:34.855
number of physicians.

00:39:35.835 --> 00:39:38.657
And I was really struck by

00:39:39.137 --> 00:39:42.398
how much time and effort

00:39:42.898 --> 00:39:46.019
they put in to making sure

00:39:46.500 --> 00:39:49.981
this was the right position for them.

00:39:50.668 --> 00:39:50.849
You know,

00:39:50.989 --> 00:39:52.829
what's the mentorship I'm going to have?

00:39:52.869 --> 00:39:53.811
These are new.

00:39:53.851 --> 00:39:55.992
These were, you know,

00:39:56.012 --> 00:39:57.152
graduates now just out of

00:39:57.172 --> 00:39:58.152
their residencies.

00:39:58.512 --> 00:39:59.753
But what kind of mentorship

00:39:59.813 --> 00:40:00.594
am I going to have?

00:40:00.634 --> 00:40:01.673
You know, what's the environment?

00:40:01.713 --> 00:40:02.594
What's the culture?

00:40:03.054 --> 00:40:04.295
Because they they were

00:40:04.315 --> 00:40:07.036
looking at this as this is

00:40:07.097 --> 00:40:09.018
where my learning is going to start.

00:40:09.438 --> 00:40:09.657
Right.

00:40:09.717 --> 00:40:11.438
This is not now I've got a

00:40:11.539 --> 00:40:13.840
job to start paying back loans.

00:40:14.400 --> 00:40:17.101
That's that their head was not there.

00:40:17.621 --> 00:40:18.822
This was this is where my

00:40:18.882 --> 00:40:20.422
learning is going to start.

00:40:21.621 --> 00:40:24.344
Whereas I don't think physical therapists,

00:40:24.364 --> 00:40:25.184
when they graduate,

00:40:25.224 --> 00:40:26.644
have that same mindset.

00:40:26.684 --> 00:40:26.864
Like,

00:40:27.264 --> 00:40:29.065
I'm going to find the best

00:40:29.146 --> 00:40:31.447
environment for me that's

00:40:31.467 --> 00:40:33.327
going to help me continue

00:40:33.608 --> 00:40:35.750
on my professional trajectory.

00:40:36.670 --> 00:40:38.030
Some people need mentorship.

00:40:38.070 --> 00:40:39.952
Some people need patient volume.

00:40:40.012 --> 00:40:40.552
Some people,

00:40:40.692 --> 00:40:42.172
there's all kinds of things

00:40:42.213 --> 00:40:43.313
that go into that.

00:40:44.914 --> 00:40:47.496
And so we've shortchanged

00:40:47.556 --> 00:40:49.277
ourselves as a profession.

00:40:50.039 --> 00:40:51.780
with this high focus.

00:40:52.521 --> 00:40:54.503
It's an easy cappy box check.

00:40:54.824 --> 00:40:55.224
You know,

00:40:56.065 --> 00:40:57.826
everybody's proud to put it on

00:40:57.865 --> 00:41:00.527
their website, you know, you know,

00:41:00.827 --> 00:41:02.989
you know, you know,

00:41:03.010 --> 00:41:04.971
ninety eight percent pass rate.

00:41:05.311 --> 00:41:05.811
Well, you know,

00:41:05.831 --> 00:41:07.632
people could take it two and three times.

00:41:07.672 --> 00:41:10.255
So it's it's an artificial number.

00:41:10.456 --> 00:41:12.976
And we we should elevate

00:41:13.016 --> 00:41:15.259
ourselves in terms of what

00:41:15.358 --> 00:41:17.740
outcomes are really, really important.

00:41:17.760 --> 00:41:18.822
And like I said, that's

00:41:19.454 --> 00:41:20.335
That's an outcome.

00:41:21.436 --> 00:41:22.577
But, you know,

00:41:23.557 --> 00:41:26.500
if no matter how how poor a

00:41:26.559 --> 00:41:27.780
program might be,

00:41:28.380 --> 00:41:29.360
there's a whole industry

00:41:29.420 --> 00:41:30.501
out there ready to coach

00:41:30.541 --> 00:41:32.682
the student to pass the exam.

00:41:33.443 --> 00:41:35.125
And so I've always had.

00:41:36.150 --> 00:41:38.373
real trouble with us, you know,

00:41:38.512 --> 00:41:40.014
just putting so much weight

00:41:40.074 --> 00:41:41.434
on what I consider to be

00:41:41.876 --> 00:41:42.956
low hanging fruit.

00:41:43.077 --> 00:41:45.157
It's an easy metric to look at.

00:41:45.398 --> 00:41:47.300
You don't have to do any work to see where,

00:41:47.400 --> 00:41:48.181
you know,

00:41:48.221 --> 00:41:49.021
how students have done

00:41:49.081 --> 00:41:51.023
post-graduation or anything like that.

00:41:51.762 --> 00:41:53.525
Who's going on, to me, a more meaningful,

00:41:53.565 --> 00:41:56.367
who's going on to residencies?

00:41:58.507 --> 00:42:00.248
Who understood their

00:42:00.409 --> 00:42:01.771
entry-level education so

00:42:01.831 --> 00:42:04.512
well that they went into residencies?

00:42:04.713 --> 00:42:05.552
That, to me,

00:42:05.592 --> 00:42:11.737
is incredibly meaningful value

00:42:12.277 --> 00:42:14.760
over first-time pass rates.

00:42:15.545 --> 00:42:15.806
Yeah.

00:42:16.045 --> 00:42:17.246
And I think,

00:42:17.286 --> 00:42:18.228
I think one of the reasons

00:42:18.728 --> 00:42:21.010
that CBE kind of was recommended in this,

00:42:21.530 --> 00:42:22.650
this vision for excellence

00:42:22.710 --> 00:42:24.532
document that came out from

00:42:24.572 --> 00:42:27.092
the APTA was the concept of

00:42:27.173 --> 00:42:29.014
creating master adaptive learners.

00:42:29.155 --> 00:42:31.036
And right now it's just blows my mind.

00:42:31.076 --> 00:42:32.396
We still only have about two

00:42:32.436 --> 00:42:35.898
percent of PTs that go on to do residency,

00:42:35.938 --> 00:42:37.960
five percent or so that do fellowship.

00:42:37.981 --> 00:42:39.121
So there are all these open

00:42:39.181 --> 00:42:40.722
slots right now.

00:42:40.762 --> 00:42:43.164
And it's, it, it is, I mean, it's,

00:42:43.523 --> 00:42:45.085
It seems crazy to me like

00:42:45.105 --> 00:42:45.905
we're missing the boat.

00:42:45.985 --> 00:42:49.347
And I heard the APTA staff,

00:42:49.447 --> 00:42:50.228
actually a member,

00:42:50.648 --> 00:42:51.909
articulate a vision where

00:42:52.389 --> 00:42:55.291
EPAs would be established at entry level,

00:42:55.471 --> 00:42:57.391
maybe five years out of practice,

00:42:57.452 --> 00:42:58.492
ten years out of practice.

00:42:58.512 --> 00:43:00.934
So it would continue after graduation,

00:43:01.373 --> 00:43:03.994
which to me sounds amazing.

00:43:04.034 --> 00:43:04.835
Like it would totally

00:43:04.896 --> 00:43:06.597
revolutionize Con Ed.

00:43:06.617 --> 00:43:08.137
It would fill in the

00:43:08.177 --> 00:43:09.958
residencies and fellowships

00:43:10.018 --> 00:43:12.039
and kind of elevate our profession.

00:43:12.661 --> 00:43:14.463
Yeah, exactly.

00:43:14.503 --> 00:43:17.724
I mean, I see it the same way you see it,

00:43:17.744 --> 00:43:18.103
Seth.

00:43:19.465 --> 00:43:23.865
The pathway is with a

00:43:23.985 --> 00:43:26.447
competency and entrustment-based model,

00:43:26.827 --> 00:43:27.728
the pathway...

00:43:28.447 --> 00:43:30.329
from you know entry-level

00:43:30.389 --> 00:43:33.972
education um to uh to and

00:43:34.012 --> 00:43:36.893
through residency really is

00:43:36.954 --> 00:43:39.096
clear I mean it it really

00:43:39.115 --> 00:43:41.498
you even a student can can

00:43:41.677 --> 00:43:44.000
see it you know um you know

00:43:44.019 --> 00:43:47.782
we I I'm sort of proud one

00:43:47.822 --> 00:43:49.083
of the things that you know

00:43:49.123 --> 00:43:53.067
we've done um with um our

00:43:53.186 --> 00:43:54.507
competency and trust based

00:43:54.929 --> 00:43:57.130
program is we've sort of

00:43:58.311 --> 00:44:02.875
revisioned the capstone experience.

00:44:04.036 --> 00:44:09.141
I think a lot of times when

00:44:09.181 --> 00:44:12.724
programs changed to doctoral programs,

00:44:14.045 --> 00:44:15.347
since there was no thesis,

00:44:16.106 --> 00:44:17.728
most programs put in place

00:44:17.768 --> 00:44:19.630
some type of capstone project.

00:44:20.507 --> 00:44:22.349
And in my opinion,

00:44:22.409 --> 00:44:23.469
most of these capstone

00:44:23.489 --> 00:44:26.231
projects that I see are, are,

00:44:26.512 --> 00:44:29.155
are not a value, you know, the, the,

00:44:29.175 --> 00:44:31.356
you know, testing, you know,

00:44:31.416 --> 00:44:33.139
student does like a quasi

00:44:33.199 --> 00:44:34.280
research project.

00:44:34.983 --> 00:44:36.164
they really don't have that

00:44:36.204 --> 00:44:37.844
strong of a background in research,

00:44:37.885 --> 00:44:38.965
but they're, you know,

00:44:38.985 --> 00:44:40.605
doing a reliability study

00:44:40.684 --> 00:44:41.945
on hamstring stretching or

00:44:42.005 --> 00:44:42.726
something like that.

00:44:43.385 --> 00:44:44.246
That's important from a

00:44:44.286 --> 00:44:45.065
research standpoint,

00:44:45.385 --> 00:44:46.246
but students are doing

00:44:46.286 --> 00:44:47.347
meaningless projects.

00:44:47.467 --> 00:44:49.887
What's the effect of heat versus cold on,

00:44:50.487 --> 00:44:53.847
you know, jumping rope or, you know,

00:44:53.907 --> 00:44:55.028
something like that.

00:44:55.789 --> 00:44:57.889
And, you know,

00:44:58.009 --> 00:44:59.570
I think what the capstone

00:44:59.630 --> 00:45:01.170
experience should be

00:45:01.985 --> 00:45:04.327
is preparing people to apply

00:45:04.367 --> 00:45:06.248
for different residency programs.

00:45:06.349 --> 00:45:07.909
And that's where we've taken our focus,

00:45:08.010 --> 00:45:09.070
our last one.

00:45:09.110 --> 00:45:09.231
I mean,

00:45:09.251 --> 00:45:10.371
we're actually to the point of

00:45:10.431 --> 00:45:11.972
getting students to,

00:45:12.072 --> 00:45:13.954
and even if they don't go that route,

00:45:14.574 --> 00:45:15.675
it's in their head that

00:45:15.735 --> 00:45:17.076
this is the next step.

00:45:17.255 --> 00:45:20.717
This is, your capstone is about

00:45:22.858 --> 00:45:24.719
your professional identity.

00:45:24.940 --> 00:45:26.260
That's what a capstone

00:45:26.320 --> 00:45:27.260
experience should be.

00:45:29.461 --> 00:45:31.342
As your capstone project

00:45:31.782 --> 00:45:33.902
evolves through a curriculum,

00:45:34.603 --> 00:45:36.864
it's about starting to

00:45:36.925 --> 00:45:39.706
learn what your professional identity is,

00:45:40.702 --> 00:45:42.164
It has how it develops

00:45:42.184 --> 00:45:44.085
during the curriculum and then at the end,

00:45:44.385 --> 00:45:46.425
what your professional identity could be.

00:45:47.025 --> 00:45:48.067
So I think if we shift our

00:45:48.106 --> 00:45:50.248
capstone focus to something like that,

00:45:51.128 --> 00:45:54.028
we'll have less of this, you know,

00:45:54.389 --> 00:45:55.530
graduates dropping out of

00:45:55.550 --> 00:45:57.331
the profession because they're, you know,

00:45:57.371 --> 00:45:58.532
they're frustrated with it.

00:45:58.572 --> 00:45:59.771
They didn't know this is

00:45:59.811 --> 00:46:01.432
what it was and things like that.

00:46:02.273 --> 00:46:03.873
So I would want to encourage

00:46:03.914 --> 00:46:04.893
everybody to look at the

00:46:04.954 --> 00:46:06.574
concept of professional

00:46:06.635 --> 00:46:08.416
identity formation as the

00:46:08.456 --> 00:46:09.836
capstone experience,

00:46:10.456 --> 00:46:12.257
rather than the effects of

00:46:12.358 --> 00:46:15.119
heat versus cold on low back flexibility.

00:46:15.820 --> 00:46:16.780
We don't need any more of

00:46:16.800 --> 00:46:17.659
those types of studies.

00:46:17.719 --> 00:46:19.081
And students doing

00:46:19.601 --> 00:46:21.101
meaningless research projects,

00:46:21.181 --> 00:46:24.603
even survey literature from a student.

00:46:26.204 --> 00:46:27.304
I get those all the time.

00:46:27.344 --> 00:46:27.925
And I go, oh,

00:46:27.985 --> 00:46:28.985
why did the faculty have the

00:46:29.025 --> 00:46:29.945
students do this?

00:46:31.947 --> 00:46:34.548
So that's a strong opinion.

00:46:34.588 --> 00:46:36.309
But if we focus a little

00:46:36.329 --> 00:46:37.230
more on professional

00:46:37.289 --> 00:46:40.532
identity formation as this

00:46:40.952 --> 00:46:43.594
thread in a capstone experience,

00:46:44.434 --> 00:46:45.675
that's where we're going to

00:46:45.976 --> 00:46:49.177
really develop these master

00:46:49.197 --> 00:46:52.519
adaptive learners that you pointed out.

00:46:52.980 --> 00:46:53.599
Yeah, I love that.

00:46:53.860 --> 00:46:54.780
I love that concept.

00:46:55.601 --> 00:46:57.583
Carl, just kind of in closing here,

00:46:57.943 --> 00:46:59.063
if you had to leave

00:46:59.925 --> 00:47:02.889
the listeners, maybe it's a faculty member,

00:47:02.949 --> 00:47:04.190
program director thinking

00:47:04.231 --> 00:47:06.733
about dipping their toe in CBE,

00:47:07.596 --> 00:47:09.398
what advice or words of

00:47:09.438 --> 00:47:11.960
encouragement would you give them?

00:47:12.181 --> 00:47:17.146
I think the first thing I'd say is,

00:47:18.077 --> 00:47:20.039
be comfortable with ambiguity.

00:47:20.599 --> 00:47:23.119
I know that's maybe a

00:47:23.219 --> 00:47:24.679
different kind of phrase.

00:47:26.021 --> 00:47:30.503
But I think sometimes we as faculty,

00:47:30.583 --> 00:47:32.003
we're like students.

00:47:32.023 --> 00:47:33.403
Students wanted black and white.

00:47:34.184 --> 00:47:34.443
wait a minute,

00:47:35.244 --> 00:47:37.985
they said that this nerve carries C five,

00:47:38.065 --> 00:47:38.804
six and seven,

00:47:38.864 --> 00:47:40.184
but this source says it's

00:47:40.264 --> 00:47:41.885
only C five and six, right?

00:47:42.326 --> 00:47:43.626
They're not comfortable with

00:47:43.646 --> 00:47:44.606
that ambiguity.

00:47:44.646 --> 00:47:45.646
The students, they want it.

00:47:45.766 --> 00:47:47.166
They want to be they don't

00:47:47.186 --> 00:47:48.286
like the gray area.

00:47:48.887 --> 00:47:51.146
And I think faculty are a

00:47:51.166 --> 00:47:52.248
little bit unwilling to

00:47:52.327 --> 00:47:55.628
accept that is that we've

00:47:56.309 --> 00:47:57.409
we've got to explore.

00:47:57.789 --> 00:47:59.228
We can't be doing things the

00:47:59.268 --> 00:48:00.168
way we were doing them.

00:48:00.208 --> 00:48:01.929
Thirty years ago and twenty years ago.

00:48:02.230 --> 00:48:03.369
I mean, if we say

00:48:05.382 --> 00:48:09.704
that new knowledge comes at

00:48:10.264 --> 00:48:11.804
whatever that exponential

00:48:11.864 --> 00:48:13.445
factor is per day.

00:48:13.505 --> 00:48:14.445
I mean, it increases.

00:48:14.786 --> 00:48:16.266
And we're still doing the

00:48:16.326 --> 00:48:17.547
same thing we were doing

00:48:17.646 --> 00:48:18.827
five years ago in a

00:48:18.887 --> 00:48:21.088
therapeutic exercise lab or

00:48:21.188 --> 00:48:22.387
in an orthopedics lab.

00:48:22.407 --> 00:48:23.809
Something's wrong that we

00:48:23.869 --> 00:48:27.869
say to the students.

00:48:28.489 --> 00:48:29.510
The art and science of

00:48:29.570 --> 00:48:30.710
medicine is changing

00:48:30.811 --> 00:48:32.692
exponentially on a daily basis.

00:48:33.612 --> 00:48:34.492
But I'm still teaching the

00:48:34.532 --> 00:48:37.454
same way and stuff that I did seven,

00:48:37.474 --> 00:48:38.173
eight years ago.

00:48:38.534 --> 00:48:40.394
There's a big disconnect there.

00:48:40.695 --> 00:48:43.335
So we've got to be willing to explore.

00:48:43.356 --> 00:48:44.197
We've got to be willing to

00:48:44.237 --> 00:48:45.617
create a little chaos.

00:48:47.757 --> 00:48:50.579
It's sort of like a chemistry formula.

00:48:52.000 --> 00:48:53.900
It's very difficult when

00:48:54.681 --> 00:48:55.762
something's at equilibrium.

00:48:55.802 --> 00:48:57.722
You can't make changes if

00:48:57.842 --> 00:48:59.143
something's at equilibrium.

00:49:00.123 --> 00:49:01.043
When there's chaos,

00:49:01.364 --> 00:49:02.764
that's when you can make changes.

00:49:03.085 --> 00:49:05.126
So be comfortable with ambiguity,

00:49:05.166 --> 00:49:06.505
create a little chaos,

00:49:06.967 --> 00:49:13.128
and I think we'll thrive

00:49:13.148 --> 00:49:15.389
professionally with those

00:49:15.409 --> 00:49:17.411
kind of mantras.

00:49:19.918 --> 00:49:20.358
All right.

00:49:20.418 --> 00:49:21.081
Carl Rosa,

00:49:21.101 --> 00:49:22.623
thanks for your time this morning.

00:49:23.166 --> 00:49:23.987
My pleasure.

00:49:24.047 --> 00:49:24.588
My pleasure.

00:49:24.608 --> 00:49:25.771
Thanks for this invitation, Seth.

00:49:25.791 --> 00:49:27.996
All right.

00:49:28.036 --> 00:49:28.297
Bye, Carl.

00:49:28.318 --> 00:49:29.059
All right.

00:49:29.079 --> 00:49:29.280
Bye-bye.