Maintaining Core Competency vs Continuing Profesional Development
In March, the Federation of State Massage Therapy Boards (FSMTB) proposed a significant change to state requirements for continuing education (CE). They have termed this proposal MOCC, for Maintenance Of Core Competence.The FSMTB is accepting feedback on the proposal through 30 April.
Looking at reactions to the MOCC proposal, the Associated Bodywork & Massage Professionals (ABMP) have come out in support of it. As Les Sweeney stated:
I have for a long, long time argued with chapters, organizations, and individuals that we need to stop using state regulation of our profession as a means for professional development. We can’t and shouldn’t legislate professional development; we can and should legislate competence.
In contrast, the American Massage Therapy Association (AMTA), has taken a strong stance against the MOCC proposal. Laura Allen has now written two pieces, on 5 March and on 15 April, both strongly critical of the MOCC proposal.
I am going to add my voice to those supporting the MOCC proposal. Going back to the Supreme Court ruling of Dent v. State of West Virginia, 129 U.S. 114 (1889), the legal purpose of state occupational regulation is to protect the public from harms of incompetence and malfeasance. States pursue this goal of protection both by enacting requirements for entry to practice and by continuing oversight of those practicing.
As part of continuing oversight, states do have an interest in ensuring that licensed practitioners stay current on information that might have changed, such as regulations and jurisprudence, and that such pratitioners maintain skills and knowledge deemed necessary for entry but that are rarely used. Recurring training in CPR is a good example for both aspects, catching changes in recommendations since the last training and reenforcing skills and knowledge. So, we need to ask, “Does continuing education, the way it has been implemented in the past, fulfill this purpose?”
The unfortunate answer is that simply requiring CE hours has little or no predictable effect on actual practice. I’d noted that in a column I wrote a while back on Why Most CE Courses are Dead on Delivery. The studies I cited there on CE course ineffectiveness have since been reenforced by an Institute of Medicine (IOM) report on Redesigning Continuing Education in the Health Professions.
For health professionals, continuing education encompasses the period of learning from postlicensure to career’s end. CE is intended to enable health professionals to keep their knowledge and skills up to date, with the ultimate goal of helping health professionals provide the best possible care, improve patient outcomes, and protect patient safety.
The reality of continuing education, however, is far different. Although there are instances of programs focused on those goals, on an overarching level the U.S. approach to CE has many flaws. …
Requirements that are based on credit hours rather than outcomes—and that vary by state and profession—are not conducive to teaching and maintaining these core competencies aimed at providing quality care.
In light of such research and conclusions, it does not surprise me at all that the FSMTB is proposing a policy that would move away from requirements of x hours of CE to renew a license and toward one of providing specific information and training. I would both hope and expect the the material presented came from the ethics lapses and observed injuries that state boards see in their process of oversight.
The state boards and thus the FSMTB have an interest in these matters because a number of state laws contain requirements for CE hours for renewal yet provide no guidance on what those hours should address to further public protection and benefit. Requirements for licensing renewal are both the beginning and end of state board interests. The boards can’t ignore such an requirement but neither do they have jurisdiction to extend beyond it. Note, however, that adoption of a policy or proposal by the FSMTB does not change any state regulatory laws. It simply sets a common direction.
Ultimately, the entire massage profession needs to move away from thinking about hours and toward thinking about objectively-determined core competencies. Until we have clarity on such competencies and on the contexts of practice, it is next to impossible to assess whether or not licensing is fulfilling it’s responsibilities to the public. As recommended both by Les Sweeney and by the IOM report, we need to encourage more thinking of Continuing Professional Development (CPD) and get away from forcing practitioners to chase last minute hours for renewal. It is the role of the states to protect the public and that of the individual and the professional organizations to foster professional development. I see the FSMTB’s MOCC proposal as an overdue step in this direction.
We have to agree to disagree on this one, Keith.
As much as I would personally like to see massage therapy accepted in the general realm of mainstream health care, we aren’t there yet and presently aren’t anywhere close to getting there. We do not have anywhere near the same standards of education and clinical practice required of other health care professions, and the evidence of any actual physical harm to the public is very minimal. State boards (and the FSMTB) tend to keep the general public in the dark with their statistics. I have served on a state board and so have you. How many times have you seen complaints on actual physical harm–stacked up against the number of licensees–and it comes out to a very small percentage. In the five years I was on our board, there was only one such case, and we have licensed 11,000 + people.
As far as ethics violations, those happen in every profession, and in spite of the best efforts, they continue to happen. Last year at the FARB (Federation of Associations and Regulatory Boards) conference, representatives from every realm of medicine and from professions as diverse as social work and funeral homes got up and spoke about their own issues with that. There will always be SOME unethical people, and this plan isn’t going to stop that. Nothing ever will. People who are going to act badly are going to do so no matter how many classes they are forced to take.
Instead of forcing the issue of therapists who have been practicing for years having to prove “maintenance of core competencies,” at every renewal, I would prefer to see this effort directed at creating these types of modules for entry -level massage schools and the states requiring it there–before people are ever turned loose on the public. I don’t think it serves the public to have people who have been practicing for years having to take a no-fail exercise on Ethics 101.
Laura, I’m sure my take on this is influenced by my years at a national laboratory where this type of continuing education was mandatory and also separate from professional development. The Department of Energy, for example, has annual and biannual mandatory training requirements. I thus lived in an environment in which each employee had a yearly training plan based on their job activities and responsibilities. Since I was a first-aid volunteer, my own included refreshers on CPR and on blood-borne pathogens as well as the more general refreshers on security, computer use, and beryllium hazard awareness. Apart from the CPR half-day refresher every two years, this was web-based and on the order of 2-4 hours. I would envision the MOCC training as being along the same lines.
While I agree (and have written on) on the the low incidence of physical harm I do believe there are areas in which training ought to be provided across the board. These include cervical arterial dissections (CAD), deep vein thrombosis, and signs of stroke. I also believe there is value in ensuring that practitioners are aware of universal precautions. I don’t believe that the truth that there will always be bad apples implies that there is not benefit in requiring refreshers on ethics, boundary issues, employer/supervisor responsibilities, sexual harassment, and seeking needed help when the practitioner themself is under life changes and stresses. I see the above as the kind of issues that the states should be requiring both at entry-level and on a recurring basis. These are also the areas of public protection to which I believe the states should confine their interest. I see the MOCC proposal as one step in this direction.
Some indication of massage-related board and insurance actions can be gleaned from the massage therapist records of the public use file of the National Practitioner Data Bank (NPDB).