The Residency Model in Physical Therapy
Medical education in the United States changed forever 100 years ago.
In 1910, Abraham Flexner published a scathing report on the state of medical education in the US. The now famous Flexner Report became a pivotal document paved the way for medical education to produce some of the worlds finest physicians.
One of the most notable aftershocks of the Flexner report came in the form of a wedge between the science-based medical community and fringe providers (including goldfish salesmen). If you wanted to become a physician, you had to fall in line with modern medicine or you were out of the club. Of course fringe providers still remained, but the reforms produced by the Flexner Report facilitated a culture of accountability that reduced the likelihood a goldfish salesman would ever get mixed up with a legitimate physician.
What’s interesting is that this process took an incredible amount of time to play out. The Flexner Report was published approximately 60 years after the American Medical Association decided medical education was worth monitoring. In 1900, the only thing you needed to become a physican was a high school diploma and four years of a medical school curriculum which had minimal standards for completion. In 2000 you need competitive grades at a four year college, a strong MCAT, and participation in extracurricular activities. And that’s just to be considered for entry!
While nowhere near the state of early 20th century medical education, the education of entry-level physical therapists is also undergoing fairly significant reform. Like medicine, this change is happening slowly.
Or is it? One of my most respected colleagues earned his certificate in physical therapy a little over 30 years ago. We rapidly advanced to the BPT in the 80’s, had a temporary fling with the MPT in the 90’s, and now have achieved intergalactic oneness in the form of the DPT. Yet despite the promise and flair the DPT brings, many feel the current educational model for physical therapy is not sufficient to meet the demands of modern clinical practice.
There is little doubt physical therapy education has never been better. Students in DPT programs have a scope of knowledge ostensibly broader than their MPT or BPT colleagues, but is it good enough? If it isn’t enough, what would be enough?
Let me answer the question with another: Is four years of medical education enough to practice internal medicine? Orthopedics? Neurology? Of course it isn’t and that’s precisely why residencies were born. Now no one in their right minds would go see an orthopedist or dermatologist unless he/she were board certified.
The medical profession transformed itself through residency and board certification with Flexner as the catalyst. It’s time for us to undergo a similar evolution.
See you next week!!
Beck AH. The Flexner Report and the Standardization of American Medical Education. JAMA: The Journal of the American Medical Association. 2004;291(17):2139 -2140.