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EDITORIAL

Ensuring Quality

Are We Doing Enough to Protect Our Profession?

Brueilly, Kevin E. PT, PhD

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Journal of Physical Therapy Education: December 2019 - Volume 33 - Issue 4 - p 257-258
doi: 10.1097/JTE.0000000000000134
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Quality assurance. Merriam-Webster defines it as a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met.1 When evaluating quality, the standards defined and used in the systematic monitoring and evaluation dictates whether the determination of quality exists in a generalizable form. If the standard implemented for the evaluation is viewed to be of utmost rigor and collection methods are sound, the reader is much more readily able to make the assumption that a quality “product” exists from the evaluation results. Conversely, using standards in an evaluation that can be interpreted by the reader as questionable in the sense of information collected, the methods of collection used as flawed, or inappropriate interpretation of that information can cause doubt as to whether quality in the product truly exists. Therefore, quality is an interpretation from others of how and to what extent the evaluation meets the needs of any group or user. The interpretation of quality assurance in physical therapy education is subject to these same concerns. Thus, the purpose of this paper is to introduce the question whether we, as a profession, are doing enough to assure the level of quality that is necessary to protect our future and thus the care we provide to our patients and clients we treat.

Accreditation of educational programs is a mechanism of quality assurance.2 Institutions and academic educational programs choose to undergo a voluntary process of accreditation by both national and specialized accrediting agencies in an effort to allow the users, other institutions and the public at large, to recognize the quality they have to offer in their academic institution and programs. Other institutions realize the presence of quality as to qualify and be recognized because “accredited” implies that the institution has satisfied the reviewing agency as meeting basic standards of accreditation. This recognition allows the possibility of transfer of previously earned academic credit by students among participating institutions. This is made possible because the accepted set of standards that ensure quality are mutually accepted by the regional accrediting associations that have accreditation purview of the institution, empowered by the Higher Education Act (HEA).3 This regional accreditation status also allows the public to recognize that quality assurance exists within the institution identified as being accredited, thus attracting students and employees to their institution, presumably choosing them over an unaccredited institution or program. Specialized accreditation, also empowered by the HEA, is through national, specialized private agencies, and is available to specialized programs through specific specialized accreditors that evaluate for components of program specific quality.

In physical therapy education, we enjoy a specialized accreditor that is very familiar with the practice we use for our patients and clients. The Commission on Accreditation in Physical Therapy Education (CAPTE) grew out of a long history in specialized accreditation that began with the first list of American Physical Therapy Association-accredited schools published in 1926.4 The CAPTE commissioners are formed by a cross section of 31 individuals who are supported by 10 staff and use hundreds of on-site reviewers to examine and report on findings in the defined standards of excellence known as the Standards and Required Elements.5 Another document, known as the Rules of Practice and Procedure, contains the official operating policies, procedures, and practices by which the CAPTE make judgment of program compliance.6

Similar to the profession of physical therapy, pharmacy education has recently transitioned to the clinical doctorate (PharmD) as the entry level degree and also enjoys specialized accreditation by persons closely engaged with the practice of pharmacy. The Accreditation Council for Pharmacy Education (ACPE) is a specialized accreditor that accredits professional degrees in pharmacy.7 A Doctor of Pharmacy program accredited by the ACPE allows public recognition that the program is judged to meet the minimum standards established as determined by the profession. The standards and key elements of the training of a pharmacist describe minimum requirements of all programs to achieve and maintain accreditation status. The standards were developed by “a broad range of constituents interested in an affected by pharmacy education.”7(p. iii) The standards reflect both academic and structural process-related elements of pharmacy education, and most read very similar to that of the CAPTE Rules and Standards. However, one main palpable difference between pharmacy standards and physical therapist standards exists in the Section II: Structure of Process to Promote Achievement of Educational Outcomes, Subsection IIA: Planning and Organization, Standard 5: Eligibility and Reporting Requirements, Key Element 5.1: Autonomy.7(p. 3) This section describes an organizational structure of the university in which the program housed must exist as an autonomous unit organized as a college of school of pharmacy. This requirement of organizational autonomy in an institution ensures that every program that trains a pharmacist is now an educational unit with direct access to the administrator who has control of the resources and decision-making responsibility over the college or school of pharmacy.8

Physical therapy education has no such requirement, and where no requirement exists, variations, to the better or worse, occur in all varieties. Physical therapy education programs have a plethora of organizational home bases within the institution, ranging from a component of an academic medicine stand-alone department to a component of the now outdated structure in health care of an allied health science department, and every possible known homes that can be imagined between these 2 extremes. What this organizational structure soup then causes is often an unequal distribution of financial and decision-making resources within the college or school where the physical therapy unit resides. Physical therapy education programs often suffer because of this inequity.

Perhaps it is time that we, as a profession, need to have the discussion of revising our professional standards to strengthen the guiding and governing documents of education. Perhaps a revision that requires the formation of future schools of physical therapy be designed and present programs redesigned with required autonomy that affords unimpeded access to the financial and decision-making resources of universities. Is it time to discuss what could be gained and what could be lost? Could changes such as the organizational structure that pharmacy education has pioneered further assure quality exists in our educational processes? Perhaps it is time to begin these discussions as a way of strengthening our position in the health care team. Accreditation has been a major force in shaping higher education in the United States.9 Physical therapy education is the only community that can decide whether this is a change we should consider and to move to effect any change that is warranted. Our profession is watching. Our patients deserve our best. Are we there yet? Are we doing enough?

REFERENCES

1. Merriam-Webster dictionary on-line. https://www.merriam-webster.com/dictionary/quality%20assurance. Accessed September 30, 2019.
2. Pagliarulo MA, Accreditation: Its nature, process and effective implementation. Phys Ther. 1986;66:1114–1118.
3. US Department of Education. Accreditation in the United States. https://www2.ed.gov/admins/finaid/accred/accreditation.html. Accessed September 30, 2019.
4. Evans PR. Accreditation-vehicle for change, part I. Phys Ther. 1978;58:151–155.
5. American Physical Therapy Association. CAPTE, Who we are. http://www.capteonline.org/WhoWeAre/. Accessed September 30, 2019.
6. American Physical Therapy Association. CAPTE rules of practice and procedure parts 1-16. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/RulesofPracticeandProcedure.pdf. Accessed September 30, 2019.
7. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Accreditation Council for Pharmacy Education; 2015. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed September 30, 2019.
8. Guidance for the Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Accreditation Council for Pharmacy Education; 2015. https://www.acpe-accredit.org/pdf/GuidanceforStandards2016FINAL.pdf. Accessed September 30, 2019.
9. Evans PR. Accreditation: A vehicle for change, part II. Phys Ther. 1978;58:439–444.
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