Proposed APTA/ABPTRFE Quality Standards Changes for Fellowship Programs
- March 1, 2018
- Posted by: Pieter Kroon
- Category: Uncategorized
As many of you have probably heard, the APTA/ABPTRFE have recently imposed changes to the Quality Standards for Fellowship Programs. Despite a year of diligently providing feedback, the APTA and the ABPTRFE have decided to move ahead without taking any of our input into account.
The most visible change has to do with a change in admission requirements to enter Fellowship Programs. As of January 1st, 2019, Physical Therapists will be required to prove successful completion of a residency training or have passed the Orthopedic Clinical Specialist Exam prior to enrollment into a Fellowship Program. The new admission standards affect all 28 APTA credentialed Manual Therapy programs.
However, there are a few more changes that, once implemented, will profoundly change Manual Therapy Fellowship Training in the USA.
What follows is my letter I wrote to the ABPTRFE with constructive commentary regarding the changes. The more feedback they get from everybody (Fellows in Training and Alumni) the better our chances they might not implement those proposed changes. By all means use any of the information in my letter. The email address to send your letters to: [email protected]
Dear Board Members of ABPTRFE,
I am the Program Director of the Manual Therapy Institute. MTI has been credentialed as a Fellowship Program in Manual Therapy since 1998, and have graduated 354 Fellows to date. We currently have 72 Fellows in Training enrolled and graduate close to 50 Fellows annually. Additionally, I am an Assistant Professor at Texas State University and a private practice owner at Mondo Sports Therapy in Austin TX where we specialize in the treatment of complex orthopedic cases.
I would like to take this opportunity to provide feedback on the proposed ABPTRFE Quality Standards.
Number of mentorship hours: ABPTRFE has changed the rules to only require 75 hours of mentorship. We strongly believe that this will greatly water down the quality of Fellows and therefore diminish the public’s recognition of the advanced level of clinical practice, which a FAAOMPT offers. We also believe this will dilute the term “Master Clinician” which we strongly believe describes all those who have graduated from MTI’s Fellowship program.
MTI strongly adheres to the belief that it is the mentoring process that makes the Fellowship program so efficacious. In fact, MTI believes it is so important, that our standards have moved beyond the required 130 hours. MTI requires that the full 440 hours are spent one on one with the mentor. To decrease the number of hours from 130 to 75 will greatly reduce the efficacy of the mentoring process. It is simply not enough to educate Master Clinicians. We need to keep the minimum required hours at 130.
Equally important, if we lower the standards to 75 hours, we will not be in compliance with IFOMPT standards. This is in complete violation of the original intention of AAOMPT. We need ABPTRFE to understand that the reputation of AAOMPT is strongly grounded in the historical recognition that a Fellow of any subsidiary of IFOMPT has completed a training that aligns that Fellow with the standards of all Manual Therapy Fellows internationally.
An additional problem is that if we move to the 75 hours standard, we will in essence create a dual fellow pool – those who are recognized by ABPTRFE, but not recognized by AAOMPT/IFOMPT. Our professional identity is poor as it is, and to have this thrown in the mix will make the situation even worse.
The standard of admission: Currently, in an attempt to create a standard for admission into all Fellowship programs, ABPTRFE has changed the admission requirements to be satisfied ONLY by completion of an APTA accredited Residency or the passing of a specialization exam. Neither of these can prepare someone for the Manual Therapy Fellowship.
Since MTI’s inception in 1998 it has graduated 354 Fellows, which is approximately 25% of all Fellows in the AAOMPT. Of these 354 graduates, only 12 have entered the Fellowship program as graduates from an Orthopedic Residency Program. The remaining 309 entered by demonstration of sufficient experience in their chosen field of practice. In addition, we do not allow students with just an OCS to enter MTI’s fellowship program. Their psychomotor skills and advanced problem solving skills are simply insufficient to qualify for entry in MTI’s Fellowship Program
Admission requirements for prospective students applying to the Manual Therapy Institute’s orthopedic manual physical therapy fellowship program include the following criteria:
• Graduation from an APTA accredited orthopedic residency program.
Prospective MTI fellowship students who have not previously completed an accredited orthopedic residency program must meet ALL of the following criteria in order to be considered for admission into the orthopaedic manual physical therapy fellowship program:
• Successful completion of MTI’s Certification Program in Orthopedic Manual Physical Therapy, which consists of nine weekend courses and 3 homestudy courses (145 hours)
• A comprehensive written examination score of 80% or higher.
• Successful performance on an OSCE format practical exam with a score of 80% or higher.
• Interview with the Program Director, Director of Clinical Education, and
• Perform direct patient care for 50% or more of normal daily practice.
• Successful demonstration of professional abilities during the first year of the certification program.
The second option as it is put in place by MTI prepares the student for entrance in the Fellowship program through a stringently structured pre-fellowship program, culminating in a written and practical exam to ascertain they have the requisite level of knowledge, problem solving- and psychomotor skills to succeed in the Fellowship program. This approach works and should stay in place.
Taking this option out puts the economic viability of MTI at risk. Instead of 354 graduates in 20 years we only would have 12. The company would not survive as an independent entity on the tuition of 12 students in 19 years. We would cease to exist as a fellowship program, which means there would be 25% fewer Fellows that graduate nationwide on an annual basis. For a professional organization like the APTA this cannot be a viable option. Our goal should be more Fellows, not less. Programs like MTI, EIM and NAIOMT, that by their specific design, are able to graduate more than the usual handful of Fellows a year, should be encouraged and promoted, not curtailed in their effort to advance our profession and graduate more Fellows.
The newly proposed admission guidelines put an additional financial burden on prospective Fellows in Training. Student loan debt of new grads is a significant problem and this will only increase over the coming years. Residency training roughly costs $15,000 and Fellowship training another $16,000. This adds a hefty $31,000.00 tab in tuition payment alone, and that does not include the cost of lost time at work for completion of supervised hours. Becoming fellowship trained is becoming financially too burdensome, and no small reason why after 20 years of existence the AAOMPT only has approximately 1200 Fellows. For a country the size of the US, that is shameful of course. We should do everything in our power to significantly increase these numbers, as these are the therapists that are the clinical experts and portray the truly high standards that all PT’s should strive to reach. Putting additional limits on Fellowship training will negate all that and will only ensure that Fellowship trained Manual Therapists remain on the fringe of our profession instead of being the standard bearer that every other orthopedic PT looks for as a shining example of what is truly possible in orthopedic physical therapy.
All Fellowship Programs adhere to very high standards and I have yet to see a graduate of any of the programs who is not worthy of the Fellow designation. To assume that only OCS/SCS – and Residency grads are worthy of Fellowship training is doing a grave disservice to the remaining therapists out there who currently can get admitted by completing a year of pre-fellowship training.
There is simply no evidence that a graduate from a residency program, or one who has passed the OCS is better prepared for entry in the Fellowship Program than someone who has passed a rigorous certification program which requires both a written and oral/practical exam
The option to enter a Fellowship Program through admission of evidence of sufficient experience in your chosen field of practice should remain in place. It does not decrease the worthiness of therapists to enter the Fellowship program, nor does it water down the standards of Fellowship training. This has never been proven, and is a solution to a problem that does not exist.
The requirement for FAAOMPT faculty in all programs:
MTI requires that all mentors are Fellowship trained in Manual Therapy. We strongly feel that the mentoring should be provided by those who have demonstrated the advanced skill level, problem solving skills, and most of all the ability to teach, in order to become faculty in a program like MTI that educates Master Clinicians. To become a Master Clinician, you need to be mentored by one, no exceptions. As it is currently proposed, it is actually harder to gain admission into the Fellowship Program then it is to become a mentor, and that is just not right, plain and simple.
Pieter Kroon PT, DPT
Board Certified in Orthopedic Physical Therapy
Fellow, American Academy of Orthopedic Manual Physical Therapists