Seth interviews Carl DeRosa about the shift to competency-based education (CBE) and entrustment in physical therapy.
Highlights:
- Designing backwards: from competencies to curriculum
- How integration dismantles siloed courses
- Faculty adoption & team-teaching complexities
- The profession's position versus medicine, pharmacy & vet
- University of Arizona’s agile 3‑year medical school model
- Entry‑level “workforce readiness,” especially in the AI era
- The pitfalls of overvaluing NPTE pass rates
- Capstones focused on professional identity, not low-value research
- Building master adaptive learners using EPAs
- Advice for faculty and programs beginning their CBE journey
00:00:01 --> 00:00:02 All right.
00:00:02 --> 00:00:03 So Carl DeRosa,
00:00:03 --> 00:00:06 thanks for joining us on the Hands On,
00:00:06 --> 00:00:07 Hands Off podcast.
00:00:08 --> 00:00:09 Maybe, you know,
00:00:09 --> 00:00:11 I know you a little bit from, you know,
00:00:11 --> 00:00:12 both of us live in Arizona.
00:00:12 --> 00:00:14 You're up there in Flagstaff.
00:00:14 --> 00:00:15 I'm down in Tucson.
00:00:15 --> 00:00:16 But maybe you could maybe we
00:00:16 --> 00:00:18 just start off the podcast.
00:00:18 --> 00:00:19 If you could explain what
00:00:19 --> 00:00:20 your current role is,
00:00:20 --> 00:00:22 maybe introduce yourself.
00:00:22 --> 00:00:24 But you're kind of also one
00:00:24 --> 00:00:25 of these interesting
00:00:25 --> 00:00:27 chimeras in PT who've done
00:00:27 --> 00:00:28 a lot in terms of leadership.
00:00:28 --> 00:00:29 You've been in private
00:00:29 --> 00:00:30 practice and now education.
00:00:31 --> 00:00:32 You've done a ton.
00:00:32 --> 00:00:33 So if you can kind of go
00:00:33 --> 00:00:34 into maybe your journey in
00:00:34 --> 00:00:36 physical therapy and how you see yourself,
00:00:36 --> 00:00:38 that'd be great.
00:00:38 --> 00:00:39 Sure, I'd be happy to, Seth,
00:00:39 --> 00:00:40 and I appreciate this
00:00:40 --> 00:00:41 invitation to just share
00:00:41 --> 00:00:44 some ideas and answer some questions.
00:00:46 --> 00:00:47 I was one of the founding
00:00:47 --> 00:00:48 faculty for the Northern
00:00:48 --> 00:00:50 Arizona University Physical
00:00:50 --> 00:00:51 Therapy Program.
00:00:51 --> 00:00:52 That was way back in
00:00:52 --> 00:00:53 nineteen seventy eight.
00:00:54 --> 00:00:56 And there were no physical
00:00:56 --> 00:00:58 therapy programs in the state of Arizona.
00:00:58 --> 00:00:59 The regents awarded Northern
00:00:59 --> 00:01:00 Arizona University the
00:01:01 --> 00:01:03 program to the surprise of many.
00:01:04 --> 00:01:05 I was recruited out of
00:01:05 --> 00:01:06 California where I was
00:01:06 --> 00:01:08 working and three of us
00:01:09 --> 00:01:11 came at the same time and
00:01:11 --> 00:01:13 we were literally given a
00:01:13 --> 00:01:15 blank checkbook by the
00:01:15 --> 00:01:17 university to put together
00:01:17 --> 00:01:18 what we thought would be an
00:01:18 --> 00:01:20 innovative program.
00:01:21 --> 00:01:24 It was an incredibly stimulating,
00:01:24 --> 00:01:25 exciting time.
00:01:25 --> 00:01:27 I was very young in my career.
00:01:28 --> 00:01:30 And I'd been working
00:01:30 --> 00:01:32 actually in long-term neuro
00:01:33 --> 00:01:35 rehab and then was
00:01:36 --> 00:01:37 transitioning to
00:01:37 --> 00:01:39 orthopedics while I was in
00:01:39 --> 00:01:40 California before I came here.
00:01:41 --> 00:01:42 And they asked me to develop
00:01:42 --> 00:01:45 the musculoskeletal side of
00:01:45 --> 00:01:46 the curriculum, essentially,
00:01:46 --> 00:01:48 at Northern Arizona University.
00:01:49 --> 00:01:51 And then in, um,
00:01:52 --> 00:01:53 I had the good fortune to
00:01:53 --> 00:01:56 meet a good friend, still a good friend,
00:01:56 --> 00:01:57 Phil Sauer,
00:01:57 --> 00:01:59 who studied with James Syriax in England.
00:02:00 --> 00:02:02 And he was working down in Sedona.
00:02:02 --> 00:02:05 And so in nineteen eighty,
00:02:05 --> 00:02:07 we opened up a two person
00:02:08 --> 00:02:09 private practice that was
00:02:09 --> 00:02:11 just focused on spine care
00:02:12 --> 00:02:14 and sort of took the city by storm.
00:02:14 --> 00:02:17 The physicians had never
00:02:17 --> 00:02:18 really worked with any
00:02:18 --> 00:02:19 therapists that were just
00:02:19 --> 00:02:21 focused on spine care.
00:02:21 --> 00:02:24 And we we grew that practice
00:02:24 --> 00:02:26 to a broader orthopedic
00:02:27 --> 00:02:29 spectrum and went into a
00:02:29 --> 00:02:30 collaboration with
00:02:31 --> 00:02:32 physicians here in the
00:02:32 --> 00:02:34 community where we actually
00:02:34 --> 00:02:36 built the first
00:02:38 --> 00:02:41 large-scale musculoskeletal center.
00:02:41 --> 00:02:43 It was an independent
00:02:43 --> 00:02:44 practice with the
00:02:44 --> 00:02:46 physicians in their independent practice.
00:02:46 --> 00:02:48 It had the first recovery
00:02:48 --> 00:02:51 care center in the state for surgery.
00:02:51 --> 00:02:52 And that just meant that
00:02:52 --> 00:02:54 instead of just being an
00:02:54 --> 00:02:55 ambulatory care center,
00:02:56 --> 00:02:59 that we could have patients
00:02:59 --> 00:03:01 stay there for three days.
00:03:01 --> 00:03:03 It's like a mini hospital in a way.
00:03:04 --> 00:03:05 So we built a revolutionary
00:03:05 --> 00:03:07 concept here in Arizona.
00:03:12 --> 00:03:13 At that time,
00:03:13 --> 00:03:14 I was chair of the physical
00:03:14 --> 00:03:16 therapy program simultaneously,
00:03:16 --> 00:03:17 so there weren't enough
00:03:17 --> 00:03:19 hours in the day to do all this.
00:03:19 --> 00:03:21 But I found the hours.
00:03:22 --> 00:03:23 I chaired the program for
00:03:23 --> 00:03:26 twenty years and just as fortunate,
00:03:27 --> 00:03:29 surrounded by some
00:03:29 --> 00:03:31 incredible physical therapy leaders,
00:03:31 --> 00:03:32 Tom McPoyle, Mark Cornwall,
00:03:32 --> 00:03:33 Karen Mueller.
00:03:34 --> 00:03:36 I just was lucky I was
00:03:36 --> 00:03:37 working with the dream team
00:03:37 --> 00:03:38 in physical therapy faculty.
00:03:39 --> 00:03:40 So that's what was sort of
00:03:40 --> 00:03:43 keeping me busy with
00:03:44 --> 00:03:47 practice for we had
00:03:47 --> 00:03:48 practice for forty one
00:03:48 --> 00:03:52 years and and also running the program.
00:03:52 --> 00:03:55 And then about three or four, five,
00:03:55 --> 00:03:56 six years ago, I I
00:04:00 --> 00:04:01 uh was offered a position in
00:04:01 --> 00:04:04 the community to run the
00:04:04 --> 00:04:07 largest orthopedic medical
00:04:07 --> 00:04:08 orthopedic physician
00:04:08 --> 00:04:10 medical practice uh in
00:04:10 --> 00:04:12 northern arizona they asked
00:04:12 --> 00:04:13 if I would serve as the ceo
00:04:14 --> 00:04:16 um running two surgical
00:04:16 --> 00:04:17 centers and managing
00:04:17 --> 00:04:20 physicians and and pas and everything and
00:04:22 --> 00:04:24 I thought, you know, that might be fun.
00:04:24 --> 00:04:25 I mean, people say you're crazy,
00:04:25 --> 00:04:26 but I thought that would be fun.
00:04:26 --> 00:04:27 So I stepped away from the
00:04:28 --> 00:04:29 university and I told them
00:04:29 --> 00:04:30 I'd do this for four years.
00:04:30 --> 00:04:31 You know,
00:04:31 --> 00:04:32 I wanted to do it and I knew
00:04:32 --> 00:04:34 these physicians very well.
00:04:35 --> 00:04:37 And so I didn't have a
00:04:37 --> 00:04:38 learning curve on that.
00:04:39 --> 00:04:42 And just, we had a really successful run.
00:04:42 --> 00:04:43 And then four years to the
00:04:43 --> 00:04:44 day I stepped out, I
00:04:45 --> 00:04:46 I prepared for the transition.
00:04:47 --> 00:04:48 And then I was going to slow
00:04:48 --> 00:04:49 down a little bit.
00:04:49 --> 00:04:50 And then in the immortal
00:04:50 --> 00:04:51 words of Michael Corleone,
00:04:51 --> 00:04:53 just when I thought I was out,
00:04:53 --> 00:04:54 they pulled me back in.
00:04:55 --> 00:04:56 I had an opportunity to get
00:04:56 --> 00:05:00 involved with competency-based education.
00:05:01 --> 00:05:03 And that was at Rasmussen University.
00:05:04 --> 00:05:05 They were a competency-based
00:05:05 --> 00:05:07 education institution.
00:05:08 --> 00:05:10 And they gave me, it was sort of deja vu.
00:05:10 --> 00:05:11 They gave me a blank check
00:05:11 --> 00:05:12 to hire faculty.
00:05:13 --> 00:05:14 I hired ten faculty.
00:05:15 --> 00:05:17 And we developed a
00:05:17 --> 00:05:18 curriculum that got
00:05:18 --> 00:05:21 accredited by CAPTI and everything.
00:05:21 --> 00:05:22 And Rasmussen,
00:05:23 --> 00:05:24 wonderful experience for me.
00:05:25 --> 00:05:27 We had accepted the first class.
00:05:27 --> 00:05:28 They had not started.
00:05:29 --> 00:05:30 But Rasmussen University,
00:05:30 --> 00:05:32 as a for-profit institution,
00:05:33 --> 00:05:34 got purchased by American
00:05:34 --> 00:05:36 Education Institute.
00:05:36 --> 00:05:37 And that's one of the
00:05:37 --> 00:05:39 largest for-profit companies.
00:05:39 --> 00:05:41 And their mission is not
00:05:41 --> 00:05:42 graduate education.
00:05:43 --> 00:05:45 So long story short,
00:05:45 --> 00:05:48 they pulled the plug on the program,
00:05:48 --> 00:05:49 even though we had
00:05:49 --> 00:05:50 developed the first
00:05:50 --> 00:05:51 competency-based program.
00:05:52 --> 00:05:54 But my phone was ringing off
00:05:54 --> 00:05:56 the hook the next day from
00:05:57 --> 00:05:58 several universities with
00:05:58 --> 00:06:00 physical therapy programs that said,
00:06:00 --> 00:06:01 would you take and lift
00:06:02 --> 00:06:03 that and put it over here?
00:06:04 --> 00:06:05 And one of those was
00:06:05 --> 00:06:06 Northern Arizona University.
00:06:06 --> 00:06:10 And so we developed the, you know,
00:06:10 --> 00:06:12 the total gamut of
00:06:12 --> 00:06:13 competency and entrustment
00:06:13 --> 00:06:15 based program at Northern
00:06:15 --> 00:06:16 Arizona University.
00:06:17 --> 00:06:19 And we just completed the
00:06:19 --> 00:06:21 work we had started at
00:06:21 --> 00:06:22 Rasmussen University.
00:06:22 --> 00:06:24 So that's my short history.
00:06:24 --> 00:06:26 I hope I didn't go too long on that,
00:06:26 --> 00:06:27 but that's practice and
00:06:28 --> 00:06:32 education and then some new ventures.
00:06:32 --> 00:06:34 I've served in the House of
00:06:34 --> 00:06:37 Delegates for a long time.
00:06:37 --> 00:06:37 I think it was probably
00:06:38 --> 00:06:39 about twenty years.
00:06:39 --> 00:06:40 I was Chief Delegate for
00:06:40 --> 00:06:42 about six or seven or eight years.
00:06:44 --> 00:06:46 was the chair of education
00:06:46 --> 00:06:49 for the APTA for a number of years.
00:06:49 --> 00:06:52 So dabbled in a lot of the
00:06:52 --> 00:06:53 different areas.
00:06:53 --> 00:06:55 It's been a great ride.
00:06:55 --> 00:06:56 Physical therapy has been very,
00:06:56 --> 00:06:57 very good to me.
00:06:58 --> 00:06:59 Yeah, it sounds like it.
00:06:59 --> 00:07:01 That thread of craziness has
00:07:01 --> 00:07:01 kind of continued
00:07:01 --> 00:07:02 throughout all your
00:07:02 --> 00:07:03 different roles though, I noticed.
00:07:03 --> 00:07:06 I know, yeah.
00:07:06 --> 00:07:07 Do you remember, I mean,
00:07:07 --> 00:07:09 you talked about Rasmussen
00:07:09 --> 00:07:10 and being drawn into that.
00:07:10 --> 00:07:11 Do you remember the first
00:07:11 --> 00:07:12 time you heard about
00:07:12 --> 00:07:14 competency-based education?
00:07:15 --> 00:07:20 Well, it was actually, you know,
00:07:20 --> 00:07:21 there was a lot of talk in
00:07:21 --> 00:07:22 the medical literature
00:07:22 --> 00:07:24 about competency-based education.
00:07:24 --> 00:07:28 And I knew from some early presentations,
00:07:28 --> 00:07:30 you know, at our national conferences,
00:07:31 --> 00:07:31 you know,
00:07:31 --> 00:07:32 there would be isolated
00:07:32 --> 00:07:34 presentations on it.
00:07:35 --> 00:07:36 And I was intrigued by it.
00:07:36 --> 00:07:38 I didn't know anything about it,
00:07:38 --> 00:07:39 but I was intrigued by it.
00:07:39 --> 00:07:40 But then I got into the
00:07:40 --> 00:07:42 medical literature more.
00:07:42 --> 00:07:47 And they really do try to
00:07:47 --> 00:07:48 control variation in
00:07:49 --> 00:07:51 practice and patient safety is so big.
00:07:52 --> 00:07:56 And being a CEO for physicians,
00:07:57 --> 00:07:59 you realize how important
00:07:59 --> 00:08:04 safety is and we would have
00:08:04 --> 00:08:06 mortality and morbidity
00:08:06 --> 00:08:08 conferences for errors that were made.
00:08:08 --> 00:08:10 So the competency,
00:08:11 --> 00:08:13 the attention to competencies, you know,
00:08:14 --> 00:08:18 what was really elevated, you know,
00:08:18 --> 00:08:19 in the medical field.
00:08:19 --> 00:08:22 And then it was Rasmussen
00:08:22 --> 00:08:25 University contacted me
00:08:27 --> 00:08:28 when they were looking to
00:08:28 --> 00:08:30 start a physical therapy program.
00:08:30 --> 00:08:34 They asked if I would run a summit.
00:08:35 --> 00:08:37 Can you help us run a summit?
00:08:38 --> 00:08:39 and bring in together about
00:08:39 --> 00:08:41 ten physical therapy
00:08:41 --> 00:08:44 industry leaders because, you know,
00:08:44 --> 00:08:46 our focus is competency-based education.
00:08:46 --> 00:08:48 That's at Rasmussen University,
00:08:48 --> 00:08:51 that's their focus, CBE.
00:08:51 --> 00:08:52 And we want to put a, you know,
00:08:52 --> 00:08:54 program here and bring in, you know,
00:08:54 --> 00:08:56 leaders and put together a
00:08:56 --> 00:08:57 physical therapy program
00:08:57 --> 00:08:58 along those lines.
00:08:59 --> 00:09:00 So I said,
00:09:00 --> 00:09:01 I'd be happy to do that because
00:09:01 --> 00:09:02 I was intrigued by it.
00:09:03 --> 00:09:05 And I started to send them stuff.
00:09:05 --> 00:09:07 And they said, well,
00:09:07 --> 00:09:08 this is interesting stuff.
00:09:08 --> 00:09:09 You've been thinking about
00:09:09 --> 00:09:10 this for a while.
00:09:10 --> 00:09:11 How would you like to be
00:09:11 --> 00:09:12 chair of the program?
00:09:12 --> 00:09:14 I didn't even apply for it.
00:09:14 --> 00:09:15 First, I was just going to run a summit.
00:09:15 --> 00:09:16 And all of a sudden,
00:09:16 --> 00:09:17 I'm the chair of the program.
00:09:18 --> 00:09:19 And so it was really,
00:09:20 --> 00:09:22 the stimulus for me was twofold.
00:09:22 --> 00:09:25 It was observing how important it
00:09:25 --> 00:09:27 competency-based education
00:09:27 --> 00:09:28 and a competency-based
00:09:28 --> 00:09:30 framework was for medicine.
00:09:31 --> 00:09:32 I really understood why they
00:09:32 --> 00:09:32 were doing it.
00:09:33 --> 00:09:36 And it was developing from the ground up,
00:09:36 --> 00:09:37 you know,
00:09:38 --> 00:09:40 a program at Rasmussen University.
00:09:40 --> 00:09:42 So that's the history of it.
00:09:43 --> 00:09:45 So I've been sort of living it,
00:09:45 --> 00:09:46 if you would, Will, you know,
00:09:46 --> 00:09:49 for a good six, five, six years now.
00:09:51 --> 00:09:52 yeah I mean it sounds like
00:09:52 --> 00:09:53 it so what are what would
00:09:53 --> 00:09:54 you say if you had to kind
00:09:54 --> 00:09:57 of define what cbe is what
00:09:57 --> 00:09:59 and what epas are that
00:09:59 --> 00:09:59 that's probably going to be
00:09:59 --> 00:10:01 important yeah you know I I
00:10:01 --> 00:10:03 think you know for first of
00:10:03 --> 00:10:05 all copsy based education
00:10:06 --> 00:10:09 is um is fascinating um
00:10:09 --> 00:10:11 because if you like to
00:10:11 --> 00:10:14 teach by using an
00:10:14 --> 00:10:16 assessment method you know
00:10:16 --> 00:10:17 And a lot of people,
00:10:18 --> 00:10:19 that's how they like to teach.
00:10:19 --> 00:10:20 A lot of physical therapists,
00:10:20 --> 00:10:21 a lot of physicians like to
00:10:21 --> 00:10:22 teach like that.
00:10:22 --> 00:10:22 You know,
00:10:23 --> 00:10:25 not I'm going to put lectures up
00:10:25 --> 00:10:26 of PowerPoint slides,
00:10:26 --> 00:10:27 not that kind of teaching.
00:10:28 --> 00:10:30 But this is having someone do something,
00:10:30 --> 00:10:32 correcting them on the spot,
00:10:32 --> 00:10:33 giving them feedback.
00:10:33 --> 00:10:35 You know,
00:10:35 --> 00:10:37 and it's much more of a coaching
00:10:37 --> 00:10:38 model than a teaching model.
00:10:39 --> 00:10:40 So, you know,
00:10:40 --> 00:10:42 we sometimes say we learn by
00:10:42 --> 00:10:43 our mistakes.
00:10:44 --> 00:10:46 This truly is a way that you
00:10:46 --> 00:10:48 learn from your mistakes.
00:10:48 --> 00:10:50 You know, you welcome errors.
00:10:50 --> 00:10:51 You welcome, you know,
00:10:51 --> 00:10:53 in the educational process because,
00:10:54 --> 00:10:55 you know, you coach people up.
00:10:56 --> 00:11:01 And so once you define the end zone,
00:11:01 --> 00:11:03 I always call it with the faculty,
00:11:03 --> 00:11:05 the end zone is the competencies.
00:11:05 --> 00:11:07 And that's the knowledge you have,
00:11:07 --> 00:11:08 and it's the skills you have,
00:11:08 --> 00:11:09 and it's the attitudes.
00:11:09 --> 00:11:10 I mean, basically,
00:11:10 --> 00:11:12 the competencies are knowledge, skills,
00:11:12 --> 00:11:14 and attitudes rolled into one.
00:11:15 --> 00:11:18 And those then,
00:11:18 --> 00:11:20 how do you translate those
00:11:20 --> 00:11:22 into the actual workforce?
00:11:22 --> 00:11:23 That's what the EPAs are.
00:11:24 --> 00:11:25 It's the you know,
00:11:25 --> 00:11:28 it's really the the the
00:11:28 --> 00:11:30 tasks that we do in work
00:11:30 --> 00:11:32 that that that have
00:11:32 --> 00:11:35 embedded in them the knowledge,
00:11:35 --> 00:11:37 skills and attitudes of
00:11:37 --> 00:11:39 that are the competencies.
00:11:39 --> 00:11:43 So the EPA is really an exciting piece,
00:11:43 --> 00:11:45 I think, of this whole process.
00:11:46 --> 00:11:50 And it's not about measuring the EPA.
00:11:50 --> 00:11:53 If an EPA is taking a
00:11:53 --> 00:11:55 history and making a diagnosis,
00:11:55 --> 00:11:56 we do that every day.
00:11:57 --> 00:11:58 It's not about evaluating
00:11:58 --> 00:12:00 the student's performance
00:12:00 --> 00:12:02 on that as much as it is
00:12:03 --> 00:12:07 gaining, them gaining their trust.
00:12:07 --> 00:12:09 That's what entrustment means.
00:12:09 --> 00:12:12 So it's more about the
00:12:12 --> 00:12:15 levels of autonomy that you
00:12:15 --> 00:12:17 give the learner in with
00:12:17 --> 00:12:20 EPAs than it is about, oh, you know,
00:12:21 --> 00:12:23 you did it sort of well, but not well.
00:12:24 --> 00:12:25 It's about trust, you know,
00:12:25 --> 00:12:27 and trust is sort of, you know,
00:12:28 --> 00:12:28 black and white.
00:12:28 --> 00:12:30 You either give somebody the
00:12:30 --> 00:12:31 trust that you trust them to do it
00:12:32 --> 00:12:33 And they can do it
00:12:33 --> 00:12:35 independently or you trust
00:12:35 --> 00:12:37 them to do it with guidance or whatever.
00:12:38 --> 00:12:40 So that's why EPAs, I think,
00:12:40 --> 00:12:41 are really an exciting
00:12:42 --> 00:12:45 frontier for competency-based education.
00:12:45 --> 00:12:47 Yeah.
00:12:47 --> 00:12:48 I mean, just to rephrase it,
00:12:48 --> 00:12:50 it sounds a little bit like, you know,
00:12:50 --> 00:12:52 if I had someone in my
00:12:52 --> 00:12:54 clinic that was maybe a
00:12:54 --> 00:12:55 student or something and
00:12:55 --> 00:12:56 they're demonstrating something.
00:12:56 --> 00:12:58 And then at that point, I feel like,
00:12:59 --> 00:13:00 I'm good.
00:13:00 --> 00:13:02 At this point, you're good with this.
00:13:02 --> 00:13:03 I trust that you're going to
00:13:03 --> 00:13:05 be able to implement this
00:13:05 --> 00:13:06 with patients in my clinic.
00:13:07 --> 00:13:08 Obviously,
00:13:08 --> 00:13:09 I'm going to protect those patients.
00:13:10 --> 00:13:10 Exactly.
00:13:10 --> 00:13:12 And you know, Seth,
00:13:13 --> 00:13:15 the beauty of the process
00:13:15 --> 00:13:18 is that traditionally in clinical ed,
00:13:18 --> 00:13:19 when we would watch a student
00:13:20 --> 00:13:22 um, with an encounter, a patient encounter,
00:13:23 --> 00:13:25 you know, we'd watch the whole thing,
00:13:25 --> 00:13:29 you know, and then you try to sort of, um,
00:13:29 --> 00:13:30 grade the whole thing.
00:13:31 --> 00:13:33 But this is a process where, you know,
00:13:33 --> 00:13:36 I can, I can have the, the, um,
00:13:36 --> 00:13:38 if the EPA is developing an
00:13:38 --> 00:13:40 exercise prescription or
00:13:40 --> 00:13:43 developing a management plan, um,
00:13:44 --> 00:13:45 That's the only part really
00:13:45 --> 00:13:47 I've really got to focus on.
00:13:47 --> 00:13:47 You know,
00:13:47 --> 00:13:52 the EPAs are it's that particular EPA.
00:13:53 --> 00:13:54 And so now you give the
00:13:54 --> 00:13:56 student really meaningful
00:13:56 --> 00:13:58 feedback on very specific,
00:13:59 --> 00:14:02 discrete aspects of a patient encounter.
00:14:03 --> 00:14:04 And, you know, the history examination,
00:14:05 --> 00:14:07 the development of a prescription,
00:14:07 --> 00:14:10 the decision to delegate.
00:14:10 --> 00:14:11 You know,
00:14:11 --> 00:14:12 you can watch part of what they
00:14:12 --> 00:14:15 do and let them go to town
00:14:15 --> 00:14:17 with the rest of the patient encounter.
00:14:18 --> 00:14:19 But you just need to focus
00:14:19 --> 00:14:22 perhaps on one or two of the EPAs.
00:14:22 --> 00:14:24 And the way we've incorporated it.
00:14:26 --> 00:14:28 um in our in our program is
00:14:28 --> 00:14:31 that the student asks for
00:14:31 --> 00:14:33 the assessment it's a very
00:14:33 --> 00:14:34 different process the
00:14:34 --> 00:14:35 student will approach if
00:14:35 --> 00:14:37 I'm the clinical preceptor
00:14:37 --> 00:14:38 the student approaches me
00:14:38 --> 00:14:40 and said I'd like to you to
00:14:40 --> 00:14:42 assess me on epa three and
00:14:42 --> 00:14:44 or epa five or I want I'd
00:14:44 --> 00:14:45 like you to assess me you
00:14:45 --> 00:14:46 know today with this
00:14:46 --> 00:14:48 patient on epa seven you know and that's
00:14:49 --> 00:14:51 That's the conversation they're having.
00:14:51 --> 00:14:53 So our students come back, you know,
00:14:53 --> 00:14:55 after the first clinical affiliation.
00:14:55 --> 00:14:56 I mean, a couple of the students had,
00:14:57 --> 00:14:57 you know,
00:14:57 --> 00:14:59 a hundred EPA assessments that
00:14:59 --> 00:15:02 they that were all were all graded.
00:15:03 --> 00:15:05 And the question always is, oh, my gosh,
00:15:05 --> 00:15:06 that's too much work
00:15:06 --> 00:15:08 involved with that for a CI.
00:15:08 --> 00:15:10 Now, we actually developed the tool.
00:15:10 --> 00:15:11 It's on the smart.
00:15:11 --> 00:15:11 It's on a phone.
00:15:11 --> 00:15:12 It's an app.
00:15:12 --> 00:15:13 And boom, boom, boom.
00:15:14 --> 00:15:16 And it's real-time
00:15:16 --> 00:15:19 assessment of the student doing that EPA.
00:15:19 --> 00:15:22 And this is not a plug,
00:15:22 --> 00:15:24 but we work with a company
00:15:24 --> 00:15:24 called White Coat
00:15:24 --> 00:15:26 Technologies that developed
00:15:26 --> 00:15:28 this tool for us that
00:15:28 --> 00:15:31 allows us to look in
00:15:31 --> 00:15:33 real-time at the student's
00:15:33 --> 00:15:34 performance with EPAs.
00:15:36 --> 00:15:37 Yeah, that's great.
00:15:37 --> 00:15:37 I mean,
00:15:37 --> 00:15:39 when I'm listening to you describe
00:15:39 --> 00:15:41 this though, Carl, this is an podcast.
00:15:41 --> 00:15:43 So I think that to me,
00:15:43 --> 00:15:44 having gone through fellowship,
00:15:44 --> 00:15:45 that sounds a little bit
00:15:45 --> 00:15:47 like post-professional training.
00:15:47 --> 00:15:48 I mean,
00:15:48 --> 00:15:49 you didn't have like an anatomy
00:15:49 --> 00:15:51 course and you didn't have, you know,
00:15:51 --> 00:15:51 it was,
00:15:51 --> 00:15:52 could you do what you were
00:15:53 --> 00:15:54 supposed to do at a certain level?
00:15:55 --> 00:15:57 Yeah, that's exactly what it's like.
00:15:57 --> 00:15:58 And we, you know, I think that there's,
00:15:59 --> 00:16:00 there's a lot of
00:16:01 --> 00:16:03 good leadership at the
00:16:03 --> 00:16:05 residency level of our
00:16:05 --> 00:16:06 profession where they were
00:16:06 --> 00:16:08 looking at competencies
00:16:08 --> 00:16:09 before entry level.
00:16:09 --> 00:16:11 I mean, they're ahead of the game.
00:16:11 --> 00:16:13 And so I think there was a
00:16:13 --> 00:16:15 lot of lessons learned in
00:16:15 --> 00:16:17 that process that, to me,
00:16:17 --> 00:16:21 are very reasonable to
00:16:21 --> 00:16:25 incorporate into entry-level education.
00:16:26 --> 00:16:30 And I think the other thing
00:16:30 --> 00:16:31 that's been fascinating to
00:16:31 --> 00:16:33 me about competency and
00:16:33 --> 00:16:34 entrustment-based education
00:16:35 --> 00:16:39 is that it really, really does create
00:16:40 --> 00:16:42 a curriculum that's integrated.
00:16:42 --> 00:16:42 You know,
00:16:43 --> 00:16:45 I think it's fair to say if I ask
00:16:45 --> 00:16:47 any faculty member at any
00:16:47 --> 00:16:48 physical therapy program in
00:16:48 --> 00:16:49 the United States,
00:16:50 --> 00:16:51 is your curriculum integrated?
00:16:52 --> 00:16:54 Everybody would say, oh, yeah, yeah, yeah,
00:16:54 --> 00:16:55 it's integrated.
00:16:55 --> 00:16:56 We have an integrated curriculum.
00:16:56 --> 00:16:57 But the reality is the
00:16:57 --> 00:16:59 student has to figure out
00:16:59 --> 00:17:00 how to integrate all that
00:17:00 --> 00:17:01 because everything is
00:17:01 --> 00:17:03 taught in more siloed courses.
00:17:03 --> 00:17:05 There's an anatomy course.
00:17:05 --> 00:17:06 There's an orthopedic course.
00:17:06 --> 00:17:08 There's a pediatric course, et cetera,
00:17:08 --> 00:17:09 et cetera.
00:17:09 --> 00:17:10 Competency-based education
00:17:10 --> 00:17:12 forces the faculty, right?
00:17:12 --> 00:17:14 to integrate the curriculum,
00:17:14 --> 00:17:16 to put unsiloed courses
00:17:16 --> 00:17:19 together because you start
00:17:19 --> 00:17:20 with the end in mind.
00:17:20 --> 00:17:22 What's the competency you want?
00:17:23 --> 00:17:24 And then you work backwards
00:17:24 --> 00:17:25 to develop the curriculum
00:17:25 --> 00:17:28 based on the course
00:17:28 --> 00:17:29 learning outcomes that are
00:17:29 --> 00:17:31 aligned with those competencies.
00:17:31 --> 00:17:33 So it's a backward design process.
00:17:35 --> 00:17:35 Yeah.
00:17:35 --> 00:17:36 And it sounds like that's
00:17:36 --> 00:17:38 kind of what you did at NAU, right?
00:17:38 --> 00:17:39 Yes, exactly.
00:17:40 --> 00:17:40 That's what we did.
00:17:40 --> 00:17:42 And again, we had a head start.
00:17:44 --> 00:17:47 We had a little bit of a
00:17:47 --> 00:17:51 time at Rasmussen with this team.
00:17:51 --> 00:17:53 And I just want to commend NAU.
00:17:54 --> 00:17:55 I worked there.
00:17:55 --> 00:17:56 I love the place.
00:17:57 --> 00:17:58 But they willingly hired
00:17:59 --> 00:18:00 all ten of us.
00:18:00 --> 00:18:02 I mean, when Rasmussen pulled the plug,
00:18:04 --> 00:18:05 they, on the spot,
00:18:05 --> 00:18:07 hired all ten of us as
00:18:07 --> 00:18:09 faculty members to continue
00:18:09 --> 00:18:11 our work in the competency
00:18:11 --> 00:18:13 and entrustment-based process.
00:18:13 --> 00:18:15 And then we kept that going
00:18:15 --> 00:18:19 while we made the transition,
00:18:19 --> 00:18:20 the conversion from a
00:18:20 --> 00:18:21 traditional residential
00:18:21 --> 00:18:23 program that was not
00:18:23 --> 00:18:24 competency-based and now
00:18:25 --> 00:18:26 you know the the residency
00:18:27 --> 00:18:29 the residential side of our
00:18:29 --> 00:18:32 pt program is also fully in
00:18:32 --> 00:18:32 the competency and
00:18:32 --> 00:18:33 entrustment based uh
00:18:33 --> 00:18:35 curriculum so it's sort of
00:18:35 --> 00:18:38 get my juices uh you know
00:18:38 --> 00:18:40 uh going uh it's been uh
00:18:40 --> 00:18:42 it's been really an exciting uh you know
00:18:42 --> 00:18:44 a couple and a half years
00:18:44 --> 00:18:45 here um you know building
00:18:46 --> 00:18:47 one from the ground up
00:18:47 --> 00:18:49 which is a which is once
00:18:49 --> 00:18:51 you got to have one set of
00:18:51 --> 00:18:52 strategies to build from
00:18:52 --> 00:18:54 the ground up and then if
00:18:54 --> 00:18:55 you're going to convert a
00:18:55 --> 00:18:56 program that you have
00:18:56 --> 00:18:57 there's another strategy
00:18:57 --> 00:18:59 you know how you do how you
00:18:59 --> 00:19:00 do the teach out of an
00:19:00 --> 00:19:02 older curriculum and in and
00:19:02 --> 00:19:03 implement a newer
00:19:03 --> 00:19:06 curriculum so just fun fun times
00:19:07 --> 00:19:08 Yeah, I mean,
00:19:08 --> 00:19:09 you mentioned how we're a
00:19:09 --> 00:19:10 little bit maybe behind
00:19:10 --> 00:19:11 some of the other professions,
00:19:11 --> 00:19:13 which we'll get into maybe in a minute,
00:19:13 --> 00:19:14 but I'd imagine that comes
00:19:14 --> 00:19:16 with some challenges.
00:19:16 --> 00:19:17 Did you get any resistance
00:19:17 --> 00:19:19 from faculty or what sort
00:19:19 --> 00:19:20 of challenges did you run into?
00:19:21 --> 00:19:25 Yeah, I think that the ground up one,
00:19:25 --> 00:19:26 and I've done a couple of
00:19:26 --> 00:19:30 presentations at ELC on this,
00:19:30 --> 00:19:32 building from the ground up
00:19:32 --> 00:19:34 a little bit easier because
00:19:35 --> 00:19:37 we hired faculty who were
00:19:37 --> 00:19:38 interested in doing this.
00:19:38 --> 00:19:40 So there was no inertia to overcome.
00:19:41 --> 00:19:43 Now, conversion one,
00:19:43 --> 00:19:47 it takes a different type of strategy.
00:19:47 --> 00:19:48 And what I've learned,
00:19:48 --> 00:19:49 and this is anecdotal,
00:19:50 --> 00:19:53 But the younger the faculty member is,
00:19:54 --> 00:19:57 the easier it is to make this conversion.
00:19:57 --> 00:19:58 In other words,
00:19:58 --> 00:20:00 the young faculty really
00:20:00 --> 00:20:04 are a little more adept at
00:20:04 --> 00:20:05 pivoting and changing.
00:20:05 --> 00:20:08 They haven't gotten set in their ways.
00:20:08 --> 00:20:10 I think faculty that
00:20:10 --> 00:20:11 struggled with it are
00:20:11 --> 00:20:13 faculty that have been
00:20:13 --> 00:20:16 Maybe, you know, doing, you know,
00:20:16 --> 00:20:17 they've been teaching this
00:20:17 --> 00:20:18 anatomy course or they've
00:20:18 --> 00:20:19 been teaching this
00:20:19 --> 00:20:21 orthopedics course for the last fifteen,
00:20:21 --> 00:20:22 eighteen years.
00:20:22 --> 00:20:23 And now this is a shift.
00:20:24 --> 00:20:24 You know,
00:20:24 --> 00:20:26 where did my orthopedics course go?
00:20:26 --> 00:20:26 You know,
00:20:27 --> 00:20:29 it's now integrated in a patient
00:20:29 --> 00:20:29 management course.
00:20:29 --> 00:20:34 And there's an obligation in
00:20:34 --> 00:20:35 Comp C and the trust based
00:20:35 --> 00:20:38 education that everything is team taught.
00:20:38 --> 00:20:39 We don't have any course in
00:20:39 --> 00:20:40 the curriculum where there
00:20:40 --> 00:20:41 aren't at least six or
00:20:41 --> 00:20:43 seven faculty involved in it.
00:20:43 --> 00:20:46 OK, now let me explain what that means,
00:20:46 --> 00:20:47 because you can see where
00:20:48 --> 00:20:49 the challenges are.
00:20:49 --> 00:20:50 That is that you get six or
00:20:50 --> 00:20:52 seven faculty involved in
00:20:52 --> 00:20:53 and I'll just call it a
00:20:53 --> 00:20:54 patient management course.
00:20:55 --> 00:20:56 This isn't the type of thing
00:20:56 --> 00:20:57 where I come in,
00:20:57 --> 00:20:58 Carl Doolza comes in and
00:20:59 --> 00:21:00 I've got some expertise in the spine.
00:21:00 --> 00:21:02 I do my two weeks in the
00:21:02 --> 00:21:04 spine and then I'm out.
00:21:04 --> 00:21:05 You know, that's all I do.
00:21:05 --> 00:21:06 And I write the few
00:21:06 --> 00:21:08 questions for their exam
00:21:08 --> 00:21:09 and I'm all done.
00:21:10 --> 00:21:12 I'm involved in that course
00:21:12 --> 00:21:13 the complete semester
00:21:13 --> 00:21:16 because I'm contributing to
00:21:16 --> 00:21:20 the assessment process for everything.
00:21:20 --> 00:21:21 We try to do what they call
00:21:22 --> 00:21:23 authentic assessments.
00:21:23 --> 00:21:29 You try to mimic using OSCEs
00:21:29 --> 00:21:31 and things like that that
00:21:31 --> 00:21:32 are authentic assessments.
00:21:33 --> 00:21:34 And so I'm part of the whole course,
00:21:35 --> 00:21:37 even if it's not my area of expertise.
00:21:38 --> 00:21:39 So we've got five or six
00:21:39 --> 00:21:40 faculty working with fifty
00:21:40 --> 00:21:42 or sixty students, you know,
00:21:42 --> 00:21:43 and it breaks down nice.
00:21:43 --> 00:21:44 I'm working with ten
00:21:44 --> 00:21:47 students and doing the assessments.
00:21:48 --> 00:21:50 um but that's a struggle for
00:21:50 --> 00:21:52 faculty who have you know
00:21:52 --> 00:21:53 have a more traditional
00:21:53 --> 00:21:54 model where they just sort
00:21:54 --> 00:21:56 of did their thing their
00:21:56 --> 00:21:58 area of expertise uh and
00:21:58 --> 00:22:00 now they're assessing um
00:22:00 --> 00:22:01 you know students in areas
00:22:02 --> 00:22:03 that are maybe outside
00:22:03 --> 00:22:05 their their comfort zone so
00:22:05 --> 00:22:07 I think that would that is
00:22:07 --> 00:22:08 probably you know one of
00:22:08 --> 00:22:10 the the biggest challenges is that they
00:22:12 --> 00:22:14 the faculty member getting
00:22:14 --> 00:22:15 the understanding that this
00:22:15 --> 00:22:17 is more about assessment.
00:22:17 --> 00:22:19 This is assessment for learning.
00:22:20 --> 00:22:20 Right?
00:22:21 --> 00:22:22 That's why we're doing the assessments.
00:22:24 --> 00:22:28 And you're going to be involved with big,
00:22:28 --> 00:22:31 big, big, big courses.
00:22:33 --> 00:22:34 And like I said, the young faculty,
00:22:34 --> 00:22:36 my experience has been,
00:22:36 --> 00:22:38 it's sort of like your kids.
00:22:39 --> 00:22:40 OK, we'll do it, Dad.
00:22:40 --> 00:22:41 Yeah, that's what we'll do.
00:22:41 --> 00:22:45 Whereas your teenager goes, uh-uh,
00:22:45 --> 00:22:46 I'm not doing that.
00:22:46 --> 00:22:48 That kind of thing.
00:22:51 --> 00:22:51 Yeah, I mean,
00:22:51 --> 00:22:53 so I want to zoom back out a
00:22:53 --> 00:22:54 little bit in terms of what
00:22:54 --> 00:22:54 the profession's doing.
00:22:55 --> 00:22:56 Because I think you're
00:22:56 --> 00:22:57 leading the game here.
00:22:57 --> 00:22:59 You're the first fully CBE
00:22:59 --> 00:23:01 program in the country.
00:23:01 --> 00:23:01 But I know that the
00:23:01 --> 00:23:03 profession's invested a lot in that.
00:23:03 --> 00:23:04 So maybe could you just give
00:23:05 --> 00:23:06 a rundown of what you know
00:23:06 --> 00:23:09 as far as why did we start
00:23:09 --> 00:23:12 investigating CBE and EPAs?
00:23:13 --> 00:23:14 And where are we right now
00:23:14 --> 00:23:15 from what you know?
00:23:15 --> 00:23:15 Yeah.
00:23:16 --> 00:23:17 Well, you know, there's been, you know,
00:23:17 --> 00:23:19 I think I've been able to, as I say,
00:23:19 --> 00:23:20 you know,
00:23:20 --> 00:23:21 sort of stand on the shoulders
00:23:21 --> 00:23:23 of a lot of great leaders.
00:23:23 --> 00:23:26 And we have had some
00:23:26 --> 00:23:28 individuals in education
00:23:28 --> 00:23:30 programs and residency
00:23:30 --> 00:23:33 programs really keep the
00:23:33 --> 00:23:34 conversation going.
00:23:34 --> 00:23:36 You know, they've
00:23:36 --> 00:23:40 gone out on the limb trying
00:23:40 --> 00:23:43 to extrapolate from other
00:23:43 --> 00:23:44 professions that are leading the way.
00:23:44 --> 00:23:46 Like veterinary medicine is
00:23:46 --> 00:23:47 leading the way.
00:23:48 --> 00:23:50 Pharmacy is leading the way.
00:23:50 --> 00:23:51 Medicine leading the way.
00:23:51 --> 00:23:52 Nursing leading the way.
00:23:53 --> 00:23:54 And so they really have
00:23:54 --> 00:23:58 called out and distilled
00:23:58 --> 00:24:01 out some of the wins that
00:24:01 --> 00:24:02 they've seen with these
00:24:03 --> 00:24:03 other professions.
00:24:04 --> 00:24:06 and made suggestions that
00:24:07 --> 00:24:07 this is something that
00:24:07 --> 00:24:09 physical therapy should
00:24:09 --> 00:24:11 seriously take a look at.
00:24:11 --> 00:24:12 This is the movement.
00:24:12 --> 00:24:15 It's almost an international movement.
00:24:15 --> 00:24:16 Again,
00:24:16 --> 00:24:18 if you think of some of the original
00:24:18 --> 00:24:20 reasons why
00:24:22 --> 00:24:24 competency-based education has
00:24:24 --> 00:24:25 taken foothold,
00:24:25 --> 00:24:26 it has a lot to do with
00:24:26 --> 00:24:28 patient safety and
00:24:28 --> 00:24:30 eliminating variation in practice.
00:24:30 --> 00:24:31 And, you know,
00:24:31 --> 00:24:32 we're typically in physical therapy,
00:24:34 --> 00:24:35 we don't have high risk
00:24:36 --> 00:24:38 safety things like medicine
00:24:38 --> 00:24:40 and surgery and, you know, and, you know,
00:24:40 --> 00:24:41 and those type of things.
00:24:42 --> 00:24:43 But we do talk about
00:24:44 --> 00:24:46 unwanted variation in practice a lot.
00:24:47 --> 00:24:49 And competency-based
00:24:49 --> 00:24:51 education drills that down
00:24:52 --> 00:24:53 to the essential
00:24:53 --> 00:24:55 competencies and you don't have,
00:24:55 --> 00:24:57 you can't have faculty just
00:24:57 --> 00:24:58 teaching what they want to teach,
00:24:59 --> 00:25:01 you know, what they're interested in.
00:25:01 --> 00:25:02 They have to teach around
00:25:02 --> 00:25:03 the competencies.
00:25:03 --> 00:25:05 So I think that we have,
00:25:06 --> 00:25:07 there have been so many
00:25:07 --> 00:25:09 great lessons learned
00:25:09 --> 00:25:11 from the other professions.
00:25:11 --> 00:25:13 And we have some great
00:25:13 --> 00:25:15 leaders in physical therapy
00:25:15 --> 00:25:16 education that have pulled
00:25:16 --> 00:25:17 that and written about it
00:25:18 --> 00:25:19 that they haven't been able
00:25:19 --> 00:25:21 to implement it at their institution yet,
00:25:22 --> 00:25:23 but they will, but they, they,
00:25:23 --> 00:25:25 but they have written about
00:25:25 --> 00:25:28 it and stimulated the discussion,
00:25:28 --> 00:25:29 you know, and really seeded the,
00:25:30 --> 00:25:32 the discussion to, to get us going.
00:25:32 --> 00:25:33 And then like anything else,
00:25:33 --> 00:25:35 there's early adopters and
00:25:35 --> 00:25:36 middle adopters and,
00:25:36 --> 00:25:38 you know, late adapters.
00:25:38 --> 00:25:38 And, you know,
00:25:38 --> 00:25:41 I think we just had the good
00:25:41 --> 00:25:43 fortune of a team of people
00:25:43 --> 00:25:44 that wanted to be early
00:25:44 --> 00:25:46 adapters and make a mistake.
00:25:46 --> 00:25:47 I mean, wanted to make mistakes.
00:25:47 --> 00:25:49 We presented what we've done
00:25:49 --> 00:25:51 at several meetings already
00:25:52 --> 00:25:54 primarily so people can
00:25:54 --> 00:25:55 critique it and we just
00:25:55 --> 00:25:56 have gotten better by
00:25:56 --> 00:25:58 hearing the questions like
00:25:58 --> 00:25:59 why are you doing that and
00:25:59 --> 00:26:01 then we go on I don't know
00:26:01 --> 00:26:02 why are we doing that let's
00:26:02 --> 00:26:04 let's switch that up so
00:26:05 --> 00:26:06 that's how these things uh
00:26:06 --> 00:26:07 evolve I'd like physical
00:26:07 --> 00:26:08 theory to move a little bit
00:26:09 --> 00:26:11 quicker at it,
00:26:11 --> 00:26:12 because I think
00:26:12 --> 00:26:13 competency-based education
00:26:14 --> 00:26:15 solves a lot of the things
00:26:15 --> 00:26:19 that we've been talking the talk about,
00:26:19 --> 00:26:21 but haven't been walking the walk on.
00:26:22 --> 00:26:23 Things like the efficiencies
00:26:23 --> 00:26:27 in the curriculum and unwanted variation.
00:26:27 --> 00:26:30 And what's really important to me is that
00:26:30 --> 00:26:32 This is the way to create
00:26:32 --> 00:26:33 that professional
00:26:34 --> 00:26:37 trajectory from an
00:26:37 --> 00:26:39 entry-level student into
00:26:40 --> 00:26:42 more advanced practice residencies.
00:26:42 --> 00:26:45 And this is the route where
00:26:45 --> 00:26:47 it can happen because the
00:26:47 --> 00:26:49 competencies are scaffolded.
00:26:49 --> 00:26:51 They're scaffolded at the
00:26:51 --> 00:26:52 entry level and they're
00:26:52 --> 00:26:55 scaffolded at the residency level.
00:26:55 --> 00:26:56 And there's a clear
00:26:57 --> 00:26:59 professional pathway that we can
00:27:00 --> 00:27:03 develop as a profession um
00:27:03 --> 00:27:05 as we uh you know we
00:27:05 --> 00:27:08 continue to embrace it so
00:27:08 --> 00:27:09 let's say I mean let's look
00:27:09 --> 00:27:10 over our shoulders if we
00:27:10 --> 00:27:12 kind of imagine that we're
00:27:12 --> 00:27:14 in a race where's the pt
00:27:14 --> 00:27:15 profession and where are
00:27:16 --> 00:27:17 you know where's medicine
00:27:17 --> 00:27:20 and pharmacy and veterinary medicine
00:27:20 --> 00:27:23 Yeah, I would say that, you know,
00:27:23 --> 00:27:24 when I was in high school,
00:27:24 --> 00:27:25 I ran the quarter mile
00:27:26 --> 00:27:27 because I wasn't fast
00:27:27 --> 00:27:29 enough for a sprint and I
00:27:29 --> 00:27:30 couldn't run long distances.
00:27:30 --> 00:27:32 So the quarter mile was was my race.
00:27:34 --> 00:27:35 So I would say if you think
00:27:35 --> 00:27:37 of a quarter mile track that, you know,
00:27:38 --> 00:27:42 medicine, pharmacy, medicine.
00:27:44 --> 00:27:45 veterinary medicine,
00:27:45 --> 00:27:47 nursing to some extent,
00:27:47 --> 00:27:49 are rounding that last
00:27:49 --> 00:27:51 curve and bringing it into
00:27:51 --> 00:27:52 that last hundred yards,
00:27:53 --> 00:27:54 hundred meters to come to
00:27:54 --> 00:27:55 the finish line.
00:27:56 --> 00:27:57 And physical therapy is
00:27:57 --> 00:27:59 probably still at about the
00:27:59 --> 00:28:03 the hundred ten meter point.
00:28:03 --> 00:28:05 We're we're two hundred
00:28:05 --> 00:28:08 meters behind the other professions.
00:28:09 --> 00:28:11 And not that we can't kick it in.
00:28:11 --> 00:28:13 We got to run that back stretch.
00:28:13 --> 00:28:14 But we have to run that back
00:28:14 --> 00:28:17 stretch a little bit faster.
00:28:17 --> 00:28:18 I think there's an
00:28:18 --> 00:28:19 expectation from the
00:28:19 --> 00:28:22 industry that physical therapy is
00:28:22 --> 00:28:23 you know better turn on the
00:28:23 --> 00:28:24 jets a little bit down that
00:28:24 --> 00:28:26 back stretch so I think
00:28:26 --> 00:28:27 that's the gap is pretty
00:28:28 --> 00:28:30 pretty um pretty big to me
00:28:31 --> 00:28:32 not the gap of knowledge I
00:28:32 --> 00:28:34 think we've we've we
00:28:34 --> 00:28:35 probably have the gap of
00:28:35 --> 00:28:36 understanding it but the
00:28:37 --> 00:28:39 gap of implementation is
00:28:39 --> 00:28:41 where where you know we're
00:28:41 --> 00:28:42 we're rounding the first
00:28:42 --> 00:28:43 curve at a hundred and ten
00:28:43 --> 00:28:45 meters and all the other
00:28:45 --> 00:28:47 professions are are
00:28:47 --> 00:28:49 rounding that last curve to
00:28:49 --> 00:28:51 um you know go to the end so
00:28:51 --> 00:28:53 that's my track analogy
00:28:53 --> 00:28:56 where we're at yeah man the
00:28:56 --> 00:28:57 four hundred you ran the
00:28:57 --> 00:28:58 four hundred that's like
00:28:58 --> 00:29:00 the toughest it is that's
00:29:00 --> 00:29:02 the toughest race in all of
00:29:02 --> 00:29:04 track and field oh and you
00:29:04 --> 00:29:06 know that's it you know and
00:29:06 --> 00:29:07 I like I said I I just
00:29:07 --> 00:29:09 wasn't fast enough for the
00:29:09 --> 00:29:11 hundred or two twenty um
00:29:11 --> 00:29:13 and uh and you know the the
00:29:13 --> 00:29:15 mile you know I get winded
00:29:15 --> 00:29:16 too fast so that's that's
00:29:16 --> 00:29:18 where I sort of landed but uh
00:29:19 --> 00:29:21 We we actually ran the mile
00:29:21 --> 00:29:22 relay with a team when I
00:29:22 --> 00:29:24 was in high school and we
00:29:24 --> 00:29:26 we had the the record at
00:29:26 --> 00:29:28 our school for a good twenty years.
00:29:29 --> 00:29:29 You know,
00:29:31 --> 00:29:32 I think I ran about a forty eight
00:29:32 --> 00:29:33 second quarter mile.
00:29:33 --> 00:29:35 So it was good.
00:29:35 --> 00:29:36 Yeah, that's it.
00:29:36 --> 00:29:37 That's to me.
00:29:37 --> 00:29:39 That's the analogy, you know, that,
00:29:39 --> 00:29:40 you know,
00:29:40 --> 00:29:41 physical therapy is about
00:29:41 --> 00:29:43 rounded the first curve.
00:29:43 --> 00:29:45 And these other professions
00:29:45 --> 00:29:46 have rounded the last curve
00:29:47 --> 00:29:48 and are bringing it home
00:29:48 --> 00:29:49 that last hundred.
00:29:50 --> 00:29:52 Yeah, I mean, so I'm in Tucson.
00:29:52 --> 00:29:53 For those that don't know,
00:29:53 --> 00:29:55 the University of Arizona is here.
00:29:55 --> 00:29:57 And it's kind of interesting to me.
00:29:57 --> 00:29:58 I think this is interesting.
00:29:59 --> 00:30:00 I know a lot of the faculty
00:30:00 --> 00:30:02 already that are in that program.
00:30:03 --> 00:30:04 It's a great program.
00:30:04 --> 00:30:06 I think Tucson really is in
00:30:06 --> 00:30:07 desperate need of it.
00:30:07 --> 00:30:08 So I'm really optimistic about that.
00:30:08 --> 00:30:10 But it's a three-year program.
00:30:10 --> 00:30:11 And it was just announced
00:30:12 --> 00:30:13 that the medical school at
00:30:14 --> 00:30:15 the University of Arizona,
00:30:15 --> 00:30:16 so the same institution,
00:30:17 --> 00:30:18 is going to be three years
00:30:18 --> 00:30:20 now because they're implementing CBE.
00:30:21 --> 00:30:23 So can you talk about, I mean, to me,
00:30:23 --> 00:30:25 that kind of worries me a
00:30:25 --> 00:30:26 little bit as a profession.
00:30:26 --> 00:30:27 If you're trying to seek the
00:30:27 --> 00:30:28 best and brightest
00:30:28 --> 00:30:30 applicants and they're looking at, well,
00:30:30 --> 00:30:31 I could go to PT or I could
00:30:32 --> 00:30:34 become an MD in the same amount of time,
00:30:35 --> 00:30:36 we should be a little bit
00:30:36 --> 00:30:37 worried about that.
00:30:37 --> 00:30:40 So how have people implemented CBE?
00:30:40 --> 00:30:42 I know that maybe initially
00:30:42 --> 00:30:42 it wasn't designed to
00:30:43 --> 00:30:44 reduce the length of the curriculum,
00:30:44 --> 00:30:45 but it seems like there are
00:30:45 --> 00:30:46 a lot of programs now that,
00:30:46 --> 00:30:47 especially in medicine,
00:30:47 --> 00:30:49 that are shorter because
00:30:49 --> 00:30:49 they're implementing CBE.
00:30:51 --> 00:30:51 Right.
00:30:51 --> 00:30:54 You know, I think in my experience,
00:30:54 --> 00:30:55 it really comes down to the
00:30:55 --> 00:30:59 ability to unsilo these courses.
00:30:59 --> 00:31:01 I think that's when as soon
00:31:01 --> 00:31:03 as you start breaking down
00:31:03 --> 00:31:06 these individual core silos,
00:31:07 --> 00:31:09 you start to realize and
00:31:09 --> 00:31:11 you put them in bigger packages,
00:31:11 --> 00:31:14 more clinically focused packages,
00:31:15 --> 00:31:18 you realize how much redundancy
00:31:18 --> 00:31:21 there is in a traditional
00:31:21 --> 00:31:23 curriculum and there are
00:31:23 --> 00:31:24 some things where
00:31:24 --> 00:31:25 repetition is good
00:31:25 --> 00:31:28 repetition you know helps
00:31:28 --> 00:31:30 helps with learning but
00:31:30 --> 00:31:32 there's others where you
00:31:32 --> 00:31:33 know you realize after you
00:31:33 --> 00:31:34 start to package the
00:31:34 --> 00:31:35 curriculum together in a tighter
00:31:36 --> 00:31:38 more competency-based approach,
00:31:39 --> 00:31:41 that you had needless
00:31:41 --> 00:31:43 redundancies in your program.
00:31:43 --> 00:31:44 Because a lot of the faculty
00:31:44 --> 00:31:45 didn't know other faculty
00:31:45 --> 00:31:47 were doing these things, you know,
00:31:47 --> 00:31:48 in those courses.
00:31:48 --> 00:31:49 So just,
00:31:49 --> 00:31:52 I've always felt that just by definition,
00:31:52 --> 00:31:54 that this backward design approach,
00:31:55 --> 00:31:58 where you're, and you know,
00:31:58 --> 00:31:59 it's driven by the domains
00:31:59 --> 00:32:01 of competence and the competencies,
00:32:02 --> 00:32:04 will, by definition,
00:32:05 --> 00:32:08 eliminate the redundancies
00:32:08 --> 00:32:08 in our program.
00:32:09 --> 00:32:12 Now, once you eliminate the redundancies,
00:32:12 --> 00:32:15 the next level of culling
00:32:15 --> 00:32:17 down the curriculum is really,
00:32:18 --> 00:32:20 what does the industry want?
00:32:20 --> 00:32:26 What do we need to teach to make,
00:32:26 --> 00:32:27 competency-based is about
00:32:27 --> 00:32:29 making people workforce-ready.
00:32:30 --> 00:32:34 And we get a clear vision of
00:32:34 --> 00:32:37 what entry-level workforce ready is,
00:32:38 --> 00:32:39 as opposed to some things
00:32:39 --> 00:32:40 that maybe aren't really
00:32:40 --> 00:32:42 entry-level or they're not
00:32:42 --> 00:32:44 really that much part of
00:32:44 --> 00:32:45 practice anymore.
00:32:45 --> 00:32:47 I'll go on the limb right
00:32:47 --> 00:32:49 here and I'll say that
00:32:49 --> 00:32:50 anybody that's teaching
00:32:51 --> 00:32:55 documentation five years from now,
00:32:55 --> 00:32:56 they're missing the boat of
00:32:56 --> 00:32:57 what's happening in the
00:32:57 --> 00:32:59 clinic because AI is taking
00:32:59 --> 00:33:01 over that aspect of it.
00:33:02 --> 00:33:05 I think diagnosis is going to change too.
00:33:05 --> 00:33:05 I mean,
00:33:05 --> 00:33:09 workforce ready is the human
00:33:09 --> 00:33:12 diagnosis versus the AI diagnosis.
00:33:12 --> 00:33:13 You know,
00:33:13 --> 00:33:14 our role is going to be in
00:33:14 --> 00:33:16 validating the AI.
00:33:16 --> 00:33:18 And that's what we should be teaching now.
00:33:18 --> 00:33:20 That's where the focus should be.
00:33:20 --> 00:33:23 So I'm only giving those examples because,
00:33:24 --> 00:33:24 you know,
00:33:25 --> 00:33:26 I want to point out that the
00:33:27 --> 00:33:28 whole theme of
00:33:28 --> 00:33:29 competency-based education
00:33:29 --> 00:33:30 is workforce ready.
00:33:31 --> 00:33:33 So once you see what the
00:33:34 --> 00:33:35 workforce is doing and what
00:33:35 --> 00:33:36 they're needing,
00:33:36 --> 00:33:37 then that's what you're
00:33:37 --> 00:33:38 focused on in the curriculum.
00:33:38 --> 00:33:41 So the efficiency is why the
00:33:41 --> 00:33:42 U of A Medical School can
00:33:42 --> 00:33:43 do this in three years
00:33:43 --> 00:33:45 right now is because
00:33:46 --> 00:33:48 they're making sure there's
00:33:48 --> 00:33:49 no redundancies.
00:33:50 --> 00:33:51 And two,
00:33:51 --> 00:33:52 and they're doing that through a
00:33:52 --> 00:33:53 CVE approach.
00:33:53 --> 00:33:54 And two,
00:33:54 --> 00:33:57 they're focused clearly on what
00:33:57 --> 00:33:59 workforce readiness means.
00:33:59 --> 00:34:02 And I think that's where the
00:34:02 --> 00:34:05 efficiencies get created.
00:34:05 --> 00:34:06 We probably underestimate,
00:34:06 --> 00:34:07 we always have
00:34:07 --> 00:34:10 underestimated what the students,
00:34:10 --> 00:34:11 whether the medical
00:34:11 --> 00:34:12 students or physical
00:34:12 --> 00:34:13 therapy students are
00:34:13 --> 00:34:15 capable of in the first or
00:34:15 --> 00:34:17 second semester, for example.
00:34:18 --> 00:34:19 We have sort of a
00:34:19 --> 00:34:21 longstanding history of
00:34:21 --> 00:34:23 we've got to build all this
00:34:23 --> 00:34:24 foundational stuff up.
00:34:25 --> 00:34:26 Got to have all the
00:34:26 --> 00:34:27 foundational stuff done
00:34:27 --> 00:34:30 before you can get it to this next level.
00:34:31 --> 00:34:31 But, you know,
00:34:31 --> 00:34:32 we've learned with
00:34:32 --> 00:34:33 competency-based education
00:34:33 --> 00:34:35 that you can start in the
00:34:35 --> 00:34:36 first semester with complex
00:34:36 --> 00:34:38 patients and break it down
00:34:39 --> 00:34:41 so the student learns as opposed to,
00:34:42 --> 00:34:42 you know,
00:34:42 --> 00:34:44 we've got to learn every letter
00:34:44 --> 00:34:46 of the alphabet first, you know,
00:34:46 --> 00:34:48 before we can start talking.
00:34:49 --> 00:34:49 You know,
00:34:50 --> 00:34:52 if you think about how people
00:34:52 --> 00:34:54 learn a new language,
00:34:54 --> 00:34:55 In the old days,
00:34:55 --> 00:34:57 they learned how to conjugate verbs,
00:34:59 --> 00:35:00 and this word equals that word.
00:35:00 --> 00:35:03 And then we soon learned
00:35:03 --> 00:35:04 that wasn't the best way to
00:35:05 --> 00:35:05 learn a new language.
00:35:06 --> 00:35:08 You just have to start conversing in it.
00:35:08 --> 00:35:11 And it's the same way with CBE.
00:35:11 --> 00:35:15 I don't know if the parallel
00:35:15 --> 00:35:17 is a little bit too wide,
00:35:17 --> 00:35:19 but you just got to start doing it.
00:35:19 --> 00:35:22 And that's what starts
00:35:22 --> 00:35:23 showing the competency.
00:35:25 --> 00:35:26 yeah yeah and you know I
00:35:26 --> 00:35:28 would say to the students
00:35:28 --> 00:35:29 and I you know say the
00:35:29 --> 00:35:33 faculty an anatomy exam for
00:35:33 --> 00:35:35 example and I'll use
00:35:35 --> 00:35:36 anatomy and it just as an
00:35:36 --> 00:35:39 example is not a proxy for
00:35:39 --> 00:35:41 clinical competence it's it
00:35:41 --> 00:35:43 it isn't you you've got to
00:35:43 --> 00:35:44 test the competency you
00:35:44 --> 00:35:46 gotta you gotta look at
00:35:48 --> 00:35:48 you know,
00:35:49 --> 00:35:50 how someone's doing with the competency.
00:35:51 --> 00:35:52 The anatomy exam,
00:35:52 --> 00:35:54 the physiology exam isn't a proxy,
00:35:54 --> 00:35:56 you know, for competence.
00:35:57 --> 00:35:58 So that's like language,
00:35:58 --> 00:35:59 like being able to
00:35:59 --> 00:36:03 conjugate a verb in Italian, okay,
00:36:03 --> 00:36:06 is not a proxy for being
00:36:06 --> 00:36:08 able to talk Italian.
00:36:09 --> 00:36:11 That's why I use it a language, you know,
00:36:11 --> 00:36:12 analogy.
00:36:13 --> 00:36:14 Yeah, I mean,
00:36:14 --> 00:36:16 kind of how it reminds me of
00:36:16 --> 00:36:18 how maybe I learned to read
00:36:18 --> 00:36:19 in school and then now my kids,
00:36:19 --> 00:36:20 they just get this like
00:36:20 --> 00:36:21 sheet of paper with sight
00:36:21 --> 00:36:22 words and they just look at
00:36:22 --> 00:36:24 the word and memorize what word that is.
00:36:25 --> 00:36:26 Yeah, that's kind of how we read.
00:36:27 --> 00:36:28 Yeah.
00:36:28 --> 00:36:29 Yeah, exactly.
00:36:29 --> 00:36:30 Yeah, exactly.
00:36:30 --> 00:36:32 And I think competency and
00:36:32 --> 00:36:34 entrustment based education
00:36:34 --> 00:36:37 just sort of opens up the
00:36:37 --> 00:36:39 window for opportunities.
00:36:39 --> 00:36:40 You know, I think.
00:36:42 --> 00:36:44 The model is competency and
00:36:44 --> 00:36:46 entrustment based education.
00:36:46 --> 00:36:48 But just like we're talking
00:36:48 --> 00:36:49 about with learning a new language,
00:36:49 --> 00:36:52 there's a lot of ways to
00:36:52 --> 00:36:53 bring that model to life.
00:36:54 --> 00:36:55 There's not just one way,
00:36:55 --> 00:36:56 but there's a lot of ways.
00:36:57 --> 00:36:58 It's like learning a language,
00:36:59 --> 00:37:00 you create different
00:37:00 --> 00:37:02 scenarios and the person
00:37:02 --> 00:37:03 learns a language and you
00:37:03 --> 00:37:05 have conversations, things like that.
00:37:06 --> 00:37:08 there's a lot of ways to
00:37:09 --> 00:37:12 figure out how to implement, you know,
00:37:12 --> 00:37:14 compensating and trust-based education.
00:37:14 --> 00:37:15 Yeah.
00:37:16 --> 00:37:18 And maybe so I can hear
00:37:19 --> 00:37:20 people thinking to themselves,
00:37:20 --> 00:37:23 the NPTE pass rates, what are those?
00:37:24 --> 00:37:25 Can you talk a little bit?
00:37:25 --> 00:37:26 I know we've maybe talked
00:37:26 --> 00:37:27 before about this,
00:37:27 --> 00:37:29 but what are your opinions
00:37:29 --> 00:37:31 on NPTE pass rates in general?
00:37:31 --> 00:37:32 What does that mean in terms
00:37:32 --> 00:37:33 of an outcome?
00:37:34 --> 00:37:34 Yeah.
00:37:34 --> 00:37:35 How that ties into this?
00:37:36 --> 00:37:37 Well, you know,
00:37:37 --> 00:37:39 I think what I want to say
00:37:39 --> 00:37:40 is I don't want to be taken
00:37:40 --> 00:37:41 the wrong way.
00:37:42 --> 00:37:42 They're important.
00:37:43 --> 00:37:44 I mean, pass rates are important.
00:37:45 --> 00:37:47 But I think we as a
00:37:48 --> 00:37:50 profession sort of just
00:37:50 --> 00:37:53 glommed on to the lowest hanging,
00:37:54 --> 00:37:58 easy fruit to measure our success.
00:37:59 --> 00:38:00 And as a result of that,
00:38:00 --> 00:38:02 we've got a whole industry
00:38:02 --> 00:38:04 that has sprung up that's
00:38:04 --> 00:38:05 just focused on helping
00:38:05 --> 00:38:06 students pass the test.
00:38:06 --> 00:38:06 I mean,
00:38:07 --> 00:38:11 I get emails as a program director
00:38:11 --> 00:38:12 from all of these companies,
00:38:13 --> 00:38:14 let us get in front of your
00:38:14 --> 00:38:17 students to prepare them for the NPTE.
00:38:17 --> 00:38:23 And so a whole industry has sprung up.
00:38:23 --> 00:38:28 to help people reach what is
00:38:28 --> 00:38:30 seen as the end goal of
00:38:31 --> 00:38:34 success with physical therapy education,
00:38:35 --> 00:38:37 passing the NPTE exam.
00:38:37 --> 00:38:40 And again, it's important,
00:38:40 --> 00:38:41 or passing it the first time.
00:38:43 --> 00:38:44 Again, it's important,
00:38:45 --> 00:38:48 but it really does nothing
00:38:49 --> 00:38:51 to contribute to this,
00:38:52 --> 00:38:55 the professional trajectory, you know,
00:38:57 --> 00:38:59 the realization that the
00:38:59 --> 00:39:01 students got to have that
00:39:01 --> 00:39:03 now that I graduated,
00:39:04 --> 00:39:06 now my learning is going to begin.
00:39:07 --> 00:39:08 I'm going to be learning now
00:39:08 --> 00:39:09 with patients.
00:39:10 --> 00:39:11 Instead, I got this,
00:39:11 --> 00:39:13 I passed the licensing exam, you know,
00:39:14 --> 00:39:15 I'm done, you know.
00:39:15 --> 00:39:19 And as opposed to thinking like medicine,
00:39:19 --> 00:39:20 thinking, okay,
00:39:21 --> 00:39:24 now I have got to really look forward.
00:39:26 --> 00:39:28 When I was a CEO for the
00:39:28 --> 00:39:30 orthopedic physicians group,
00:39:31 --> 00:39:33 I recruited and hired a
00:39:33 --> 00:39:34 number of physicians.
00:39:35 --> 00:39:38 And I was really struck by
00:39:39 --> 00:39:42 how much time and effort
00:39:42 --> 00:39:46 they put in to making sure
00:39:46 --> 00:39:49 this was the right position for them.
00:39:50 --> 00:39:50 You know,
00:39:50 --> 00:39:52 what's the mentorship I'm going to have?
00:39:52 --> 00:39:53 These are new.
00:39:53 --> 00:39:55 These were, you know,
00:39:56 --> 00:39:57 graduates now just out of
00:39:57 --> 00:39:58 their residencies.
00:39:58 --> 00:39:59 But what kind of mentorship
00:39:59 --> 00:40:00 am I going to have?
00:40:00 --> 00:40:01 You know, what's the environment?
00:40:01 --> 00:40:02 What's the culture?
00:40:03 --> 00:40:04 Because they they were
00:40:04 --> 00:40:07 looking at this as this is
00:40:07 --> 00:40:09 where my learning is going to start.
00:40:09 --> 00:40:09 Right.
00:40:09 --> 00:40:11 This is not now I've got a
00:40:11 --> 00:40:13 job to start paying back loans.
00:40:14 --> 00:40:17 That's that their head was not there.
00:40:17 --> 00:40:18 This was this is where my
00:40:18 --> 00:40:20 learning is going to start.
00:40:21 --> 00:40:24 Whereas I don't think physical therapists,
00:40:24 --> 00:40:25 when they graduate,
00:40:25 --> 00:40:26 have that same mindset.
00:40:26 --> 00:40:26 Like,
00:40:27 --> 00:40:29 I'm going to find the best
00:40:29 --> 00:40:31 environment for me that's
00:40:31 --> 00:40:33 going to help me continue
00:40:33 --> 00:40:35 on my professional trajectory.
00:40:36 --> 00:40:38 Some people need mentorship.
00:40:38 --> 00:40:39 Some people need patient volume.
00:40:40 --> 00:40:40 Some people,
00:40:40 --> 00:40:42 there's all kinds of things
00:40:42 --> 00:40:43 that go into that.
00:40:44 --> 00:40:47 And so we've shortchanged
00:40:47 --> 00:40:49 ourselves as a profession.
00:40:50 --> 00:40:51 with this high focus.
00:40:52 --> 00:40:54 It's an easy cappy box check.
00:40:54 --> 00:40:55 You know,
00:40:56 --> 00:40:57 everybody's proud to put it on
00:40:57 --> 00:41:00 their website, you know, you know,
00:41:00 --> 00:41:02 you know, you know,
00:41:03 --> 00:41:04 ninety eight percent pass rate.
00:41:05 --> 00:41:05 Well, you know,
00:41:05 --> 00:41:07 people could take it two and three times.
00:41:07 --> 00:41:10 So it's it's an artificial number.
00:41:10 --> 00:41:12 And we we should elevate
00:41:13 --> 00:41:15 ourselves in terms of what
00:41:15 --> 00:41:17 outcomes are really, really important.
00:41:17 --> 00:41:18 And like I said, that's
00:41:19 --> 00:41:20 That's an outcome.
00:41:21 --> 00:41:22 But, you know,
00:41:23 --> 00:41:26 if no matter how how poor a
00:41:26 --> 00:41:27 program might be,
00:41:28 --> 00:41:29 there's a whole industry
00:41:29 --> 00:41:30 out there ready to coach
00:41:30 --> 00:41:32 the student to pass the exam.
00:41:33 --> 00:41:35 And so I've always had.
00:41:36 --> 00:41:38 real trouble with us, you know,
00:41:38 --> 00:41:40 just putting so much weight
00:41:40 --> 00:41:41 on what I consider to be
00:41:41 --> 00:41:42 low hanging fruit.
00:41:43 --> 00:41:45 It's an easy metric to look at.
00:41:45 --> 00:41:47 You don't have to do any work to see where,
00:41:47 --> 00:41:48 you know,
00:41:48 --> 00:41:49 how students have done
00:41:49 --> 00:41:51 post-graduation or anything like that.
00:41:51 --> 00:41:53 Who's going on, to me, a more meaningful,
00:41:53 --> 00:41:56 who's going on to residencies?
00:41:58 --> 00:42:00 Who understood their
00:42:00 --> 00:42:01 entry-level education so
00:42:01 --> 00:42:04 well that they went into residencies?
00:42:04 --> 00:42:05 That, to me,
00:42:05 --> 00:42:11 is incredibly meaningful value
00:42:12 --> 00:42:14 over first-time pass rates.
00:42:15 --> 00:42:15 Yeah.
00:42:16 --> 00:42:17 And I think,
00:42:17 --> 00:42:18 I think one of the reasons
00:42:18 --> 00:42:21 that CBE kind of was recommended in this,
00:42:21 --> 00:42:22 this vision for excellence
00:42:22 --> 00:42:24 document that came out from
00:42:24 --> 00:42:27 the APTA was the concept of
00:42:27 --> 00:42:29 creating master adaptive learners.
00:42:29 --> 00:42:31 And right now it's just blows my mind.
00:42:31 --> 00:42:32 We still only have about two
00:42:32 --> 00:42:35 percent of PTs that go on to do residency,
00:42:35 --> 00:42:37 five percent or so that do fellowship.
00:42:37 --> 00:42:39 So there are all these open
00:42:39 --> 00:42:40 slots right now.
00:42:40 --> 00:42:43 And it's, it, it is, I mean, it's,
00:42:43 --> 00:42:45 It seems crazy to me like
00:42:45 --> 00:42:45 we're missing the boat.
00:42:45 --> 00:42:49 And I heard the APTA staff,
00:42:49 --> 00:42:50 actually a member,
00:42:50 --> 00:42:51 articulate a vision where
00:42:52 --> 00:42:55 EPAs would be established at entry level,
00:42:55 --> 00:42:57 maybe five years out of practice,
00:42:57 --> 00:42:58 ten years out of practice.
00:42:58 --> 00:43:00 So it would continue after graduation,
00:43:01 --> 00:43:03 which to me sounds amazing.
00:43:04 --> 00:43:04 Like it would totally
00:43:04 --> 00:43:06 revolutionize Con Ed.
00:43:06 --> 00:43:08 It would fill in the
00:43:08 --> 00:43:09 residencies and fellowships
00:43:10 --> 00:43:12 and kind of elevate our profession.
00:43:12 --> 00:43:14 Yeah, exactly.
00:43:14 --> 00:43:17 I mean, I see it the same way you see it,
00:43:17 --> 00:43:18 Seth.
00:43:19 --> 00:43:23 The pathway is with a
00:43:23 --> 00:43:26 competency and entrustment-based model,
00:43:26 --> 00:43:27 the pathway...
00:43:28 --> 00:43:30 from you know entry-level
00:43:30 --> 00:43:33 education um to uh to and
00:43:34 --> 00:43:36 through residency really is
00:43:36 --> 00:43:39 clear I mean it it really
00:43:39 --> 00:43:41 you even a student can can
00:43:41 --> 00:43:44 see it you know um you know
00:43:44 --> 00:43:47 we I I'm sort of proud one
00:43:47 --> 00:43:49 of the things that you know
00:43:49 --> 00:43:53 we've done um with um our
00:43:53 --> 00:43:54 competency and trust based
00:43:54 --> 00:43:57 program is we've sort of
00:43:58 --> 00:44:02 revisioned the capstone experience.
00:44:04 --> 00:44:09 I think a lot of times when
00:44:09 --> 00:44:12 programs changed to doctoral programs,
00:44:14 --> 00:44:15 since there was no thesis,
00:44:16 --> 00:44:17 most programs put in place
00:44:17 --> 00:44:19 some type of capstone project.
00:44:20 --> 00:44:22 And in my opinion,
00:44:22 --> 00:44:23 most of these capstone
00:44:23 --> 00:44:26 projects that I see are, are,
00:44:26 --> 00:44:29 are not a value, you know, the, the,
00:44:29 --> 00:44:31 you know, testing, you know,
00:44:31 --> 00:44:33 student does like a quasi
00:44:33 --> 00:44:34 research project.
00:44:34 --> 00:44:36 they really don't have that
00:44:36 --> 00:44:37 strong of a background in research,
00:44:37 --> 00:44:38 but they're, you know,
00:44:38 --> 00:44:40 doing a reliability study
00:44:40 --> 00:44:41 on hamstring stretching or
00:44:42 --> 00:44:42 something like that.
00:44:43 --> 00:44:44 That's important from a
00:44:44 --> 00:44:45 research standpoint,
00:44:45 --> 00:44:46 but students are doing
00:44:46 --> 00:44:47 meaningless projects.
00:44:47 --> 00:44:49 What's the effect of heat versus cold on,
00:44:50 --> 00:44:53 you know, jumping rope or, you know,
00:44:53 --> 00:44:55 something like that.
00:44:55 --> 00:44:57 And, you know,
00:44:58 --> 00:44:59 I think what the capstone
00:44:59 --> 00:45:01 experience should be
00:45:01 --> 00:45:04 is preparing people to apply
00:45:04 --> 00:45:06 for different residency programs.
00:45:06 --> 00:45:07 And that's where we've taken our focus,
00:45:08 --> 00:45:09 our last one.
00:45:09 --> 00:45:09 I mean,
00:45:09 --> 00:45:10 we're actually to the point of
00:45:10 --> 00:45:11 getting students to,
00:45:12 --> 00:45:13 and even if they don't go that route,
00:45:14 --> 00:45:15 it's in their head that
00:45:15 --> 00:45:17 this is the next step.
00:45:17 --> 00:45:20 This is, your capstone is about
00:45:22 --> 00:45:24 your professional identity.
00:45:24 --> 00:45:26 That's what a capstone
00:45:26 --> 00:45:27 experience should be.
00:45:29 --> 00:45:31 As your capstone project
00:45:31 --> 00:45:33 evolves through a curriculum,
00:45:34 --> 00:45:36 it's about starting to
00:45:36 --> 00:45:39 learn what your professional identity is,
00:45:40 --> 00:45:42 It has how it develops
00:45:42 --> 00:45:44 during the curriculum and then at the end,
00:45:44 --> 00:45:46 what your professional identity could be.
00:45:47 --> 00:45:48 So I think if we shift our
00:45:48 --> 00:45:50 capstone focus to something like that,
00:45:51 --> 00:45:54 we'll have less of this, you know,
00:45:54 --> 00:45:55 graduates dropping out of
00:45:55 --> 00:45:57 the profession because they're, you know,
00:45:57 --> 00:45:58 they're frustrated with it.
00:45:58 --> 00:45:59 They didn't know this is
00:45:59 --> 00:46:01 what it was and things like that.
00:46:02 --> 00:46:03 So I would want to encourage
00:46:03 --> 00:46:04 everybody to look at the
00:46:04 --> 00:46:06 concept of professional
00:46:06 --> 00:46:08 identity formation as the
00:46:08 --> 00:46:09 capstone experience,
00:46:10 --> 00:46:12 rather than the effects of
00:46:12 --> 00:46:15 heat versus cold on low back flexibility.
00:46:15 --> 00:46:16 We don't need any more of
00:46:16 --> 00:46:17 those types of studies.
00:46:17 --> 00:46:19 And students doing
00:46:19 --> 00:46:21 meaningless research projects,
00:46:21 --> 00:46:24 even survey literature from a student.
00:46:26 --> 00:46:27 I get those all the time.
00:46:27 --> 00:46:27 And I go, oh,
00:46:27 --> 00:46:28 why did the faculty have the
00:46:29 --> 00:46:29 students do this?
00:46:31 --> 00:46:34 So that's a strong opinion.
00:46:34 --> 00:46:36 But if we focus a little
00:46:36 --> 00:46:37 more on professional
00:46:37 --> 00:46:40 identity formation as this
00:46:40 --> 00:46:43 thread in a capstone experience,
00:46:44 --> 00:46:45 that's where we're going to
00:46:45 --> 00:46:49 really develop these master
00:46:49 --> 00:46:52 adaptive learners that you pointed out.
00:46:52 --> 00:46:53 Yeah, I love that.
00:46:53 --> 00:46:54 I love that concept.
00:46:55 --> 00:46:57 Carl, just kind of in closing here,
00:46:57 --> 00:46:59 if you had to leave
00:46:59 --> 00:47:02 the listeners, maybe it's a faculty member,
00:47:02 --> 00:47:04 program director thinking
00:47:04 --> 00:47:06 about dipping their toe in CBE,
00:47:07 --> 00:47:09 what advice or words of
00:47:09 --> 00:47:11 encouragement would you give them?
00:47:12 --> 00:47:17 I think the first thing I'd say is,
00:47:18 --> 00:47:20 be comfortable with ambiguity.
00:47:20 --> 00:47:23 I know that's maybe a
00:47:23 --> 00:47:24 different kind of phrase.
00:47:26 --> 00:47:30 But I think sometimes we as faculty,
00:47:30 --> 00:47:32 we're like students.
00:47:32 --> 00:47:33 Students wanted black and white.
00:47:34 --> 00:47:34 wait a minute,
00:47:35 --> 00:47:37 they said that this nerve carries C five,
00:47:38 --> 00:47:38 six and seven,
00:47:38 --> 00:47:40 but this source says it's
00:47:40 --> 00:47:41 only C five and six, right?
00:47:42 --> 00:47:43 They're not comfortable with
00:47:43 --> 00:47:44 that ambiguity.
00:47:44 --> 00:47:45 The students, they want it.
00:47:45 --> 00:47:47 They want to be they don't
00:47:47 --> 00:47:48 like the gray area.
00:47:48 --> 00:47:51 And I think faculty are a
00:47:51 --> 00:47:52 little bit unwilling to
00:47:52 --> 00:47:55 accept that is that we've
00:47:56 --> 00:47:57 we've got to explore.
00:47:57 --> 00:47:59 We can't be doing things the
00:47:59 --> 00:48:00 way we were doing them.
00:48:00 --> 00:48:01 Thirty years ago and twenty years ago.
00:48:02 --> 00:48:03 I mean, if we say
00:48:05 --> 00:48:09 that new knowledge comes at
00:48:10 --> 00:48:11 whatever that exponential
00:48:11 --> 00:48:13 factor is per day.
00:48:13 --> 00:48:14 I mean, it increases.
00:48:14 --> 00:48:16 And we're still doing the
00:48:16 --> 00:48:17 same thing we were doing
00:48:17 --> 00:48:18 five years ago in a
00:48:18 --> 00:48:21 therapeutic exercise lab or
00:48:21 --> 00:48:22 in an orthopedics lab.
00:48:22 --> 00:48:23 Something's wrong that we
00:48:23 --> 00:48:27 say to the students.
00:48:28 --> 00:48:29 The art and science of
00:48:29 --> 00:48:30 medicine is changing
00:48:30 --> 00:48:32 exponentially on a daily basis.
00:48:33 --> 00:48:34 But I'm still teaching the
00:48:34 --> 00:48:37 same way and stuff that I did seven,
00:48:37 --> 00:48:38 eight years ago.
00:48:38 --> 00:48:40 There's a big disconnect there.
00:48:40 --> 00:48:43 So we've got to be willing to explore.
00:48:43 --> 00:48:44 We've got to be willing to
00:48:44 --> 00:48:45 create a little chaos.
00:48:47 --> 00:48:50 It's sort of like a chemistry formula.
00:48:52 --> 00:48:53 It's very difficult when
00:48:54 --> 00:48:55 something's at equilibrium.
00:48:55 --> 00:48:57 You can't make changes if
00:48:57 --> 00:48:59 something's at equilibrium.
00:49:00 --> 00:49:01 When there's chaos,
00:49:01 --> 00:49:02 that's when you can make changes.
00:49:03 --> 00:49:05 So be comfortable with ambiguity,
00:49:05 --> 00:49:06 create a little chaos,
00:49:06 --> 00:49:13 and I think we'll thrive
00:49:13 --> 00:49:15 professionally with those
00:49:15 --> 00:49:17 kind of mantras.
00:49:19 --> 00:49:20 All right.
00:49:20 --> 00:49:21 Carl Rosa,
00:49:21 --> 00:49:22 thanks for your time this morning.
00:49:23 --> 00:49:23 My pleasure.
00:49:24 --> 00:49:24 My pleasure.
00:49:24 --> 00:49:25 Thanks for this invitation, Seth.
00:49:25 --> 00:49:27 All right.
00:49:28 --> 00:49:28 Bye, Carl.
00:49:28 --> 00:49:29 All right.
00:49:29 --> 00:49:29 Bye-bye.