Massage Therapy Body of Knowledge

Comment

Comment by Keith Eric Grant on October 24, 2009 at 12:47am

Mike,

They wouldn't necessarily have to open the state massage laws, although eventual changes (i.e. rationalization) would be a likely result.

If a standard job description were translated into a curricula, as I've previously described, Then a state could conceivably require fewer hours than required. In most places, schools could teach to the extra hours without problem. If not, then it would be explicit what was being cut out and what tasks competencies were being eliminated by conscious choice.

If a state were requiring more hours than required, then the padding would be obvious. A regulatory board might decide that it would be useful to aim these extra hours toward health care inclusion (i.e. expanding the job description) or it might inform the legislature that its required hours exceeds those needed by consensus within the profession and requrest that they be lowered. They would have documented reasoning and professional consensus behind this.

So, it could play out in multiple ways. The decisions, however, would be much more conscious as to the hours, content, and competence connection. Such an approach, btw, is the only way I can see of bringing some rationality to an "arms race" in requirements and hours without clear benefit.

Comment by Mike Hinkle on October 24, 2009 at 12:36am

State boards or state legislators? Would they have to open the state massage laws to do this?

Comment by Keith Eric Grant on October 24, 2009 at 12:35am

Mike,

BC is 3000 hours. Ontario is 2200 hours. Both of these are aimed exclusively at inclusion in the health care system (i.e. they are title acts) and contain no concept of granularity or specialties. It's the whole tamale or nothing. The U.S. could use a more granular model.

For minimum entry, the number of hours from a task to KSA analysis could fall anywhere from 250 hours to 1000 hours, depending on the tasks in the assumed minimum competency job description. It greatly depends on the arguments of what's competencies constitute a minimum competency in the sense of the paper by Wojtzak and Schwarz that I quoted from below. The difference would be that everyone would understand what the likely public benefit would be and what competencies the student and the public are getting for the student's time and money. I feel that this is far from the case now.

Comment by Keith Eric Grant on October 24, 2009 at 12:24am

Missed one element.

You can go from a reasonable entry level set of tasks (job description) to a set of KSAs and from these develop a curriculum. Such a curriculum will have an estimable number of hours (or academic units) for teaching it. This can be compared with the hour requirements in various states. In some cases state hour requirements might be too low; in some too high. This would form a basis for discussions of portability under the auspices of FSMTB. If the states can agree on a set of tasks matching an entry level job description, the portability follows. Eventually, it would mean that some state laws should be changed. but starting this process wouldn't require that. Where states can't agree, it would clarify the differences in job descriptions that they are assuming. This in itself would be a useful step. That in itself would at least clarify the learning gap that a practitioner should be required to fill in going from one state into another, something that rarely can be done now.

Comment by Mike Hinkle on October 24, 2009 at 12:14am

I know what KSA's are. My question is: Will they take more or less time to complete? Will schools be 100 hours like CA or 3000 like CANADA?

Comment by Keith Eric Grant on October 24, 2009 at 12:05am

Mike,

A set of KSAs represent the requirements to perform the tasks in the associated job description competently. A "job description" for state regulation are the tasks and assessments that a practitioner should minimally be able to do in the interests of public safety and public benefit. A job description for health care inclusion would be those tasks that a person must minimally be able to perform to be competent in this setting. If the tasks weren't needed, they shouldn't be included. If the KSAs weren't needed, then there is a problem in the task to KSA analysis. If these KSAs aren't being mastered in school to the necessary proficiency, then people are being graduated and licensed (or certified), who by state standards are not competent to practice. Or they are being sent into a health care context for which they are incompetent.

However, I was not addressing specifically the assessment of individual students (which is a good idea), but being able to develop a curriculum (including kinesthetic practice) that is expected to convey to students the required set of KSAs.

If the BOK is a set of standards, then it needs to have measurable outcomes. I quote the following from: Wojtczak, Andrzej, and M. Roy Schwarz: 2000: Minimum Essential Requirements and Standards in Medical Education, Medical Teacher, 22(6), 555-559. Available from http://www.iime.org/documents/vs.htm

The term ‘standard’ means different things to the different people, and often is used interchangeably with ‘objectives’, ‘outcomes’ and ‘goals’. Sometimes the word is used as a synonym for doing better in some nonspecific way such as “we should improve our standards”, or "the standards are too low". The dictionary definition of ‘standard’ refers to “something set up and established by authority, custom or general consent as a model, example or rule for the measure of quantity, weight, extent, value, or quality”. ‘Standard’ is also defined as a “criterion, gauge, yardstick, and touchstone” by which judgments or decisions may be made. Thus, the word ‘standard’ refers simultaneously to both ‘model and example’ and ‘criterion or yardstick’ for determining how well one’s performance approximates the designed model. Thus, a standard is both a goal (what should be done) and a measure of progress toward that goal (how well it was done). Therefore to be meaningful, a standard should offer a realistic prospect of evaluation to measure whether anyone actually meets it. Without that, it has no practical value.

In other words, if we are setting standards for education, they need to have measurable outcomes by which we can assess their validity and reliability in bringing students to known performance levels.

Medical schools have the same problem. e.g.,"He's great with the classwork but has no skill with a scalpel." I remembered that developmental psychologist Mel Levine gave an example of this in an excerpt from his book A Mind at a Time.

Brad loved orthopedic surgery in medical school. He had always been a sports fanatic, and the lure of sports medicine as a career enticed him to endure medical school (which was tedious and difficult for him). He is now an orthopedic resident. Sadly, he has been totally incompetent, possibly hazardous, in the operating room. No one can fathom it; he was such a motivated medical student. It turns out that this bright guy lacks the spatial perception and nonverbal problem-solving skill (a form of mechanical aptitude) needed to function as a skilled orthopedic surgeon. He is struggling with an all too common insidious plight, namely the chaotic career of a person whose interests don't coincide with the wiring of his particular kind of mind. Brad is in pursuit of what he's unlikely to succeed at. He's unaware of this risky discrepancy. He has found no channel for his many assets. The chief of orthopedic surgery has recommended that he leave the department because of "persistent incompetence as a clinician."

There is no easy answer. Only the answer of keeping our focus on what we intend to achieve and working within that focus with problems as they arise.

BTW: School costs rise, partly because we have pushed into the arena of depending on financial aide (Title IV) and the resulting costs of accreditation, record keeping, and management that such aide brings. I looked into some of the system of feedback in Reflections on Market Share.

Comment by Mike Hinkle on October 23, 2009 at 11:12pm

I think you did the best you could with what you were dealt. The BOK is trying to do the same thing.

I used to be a rebel and I would have probably been in agreement with that non-onerous regulation, but the BOK's goal is a set of standards.

My issue with the KSAs is time.

You say this is better, but what if it takes Joey 20 more man-hours to attain "competence" in KSA #12? The rest of the class is on KSA#17. The teacher will be going back and forth. But Jenny flies through hers and wants to go ahead of the class.

Teachers will have to learn new material and a new way of teaching. Our school had two weeks without an A&P teacher. What then? Are you going to have staggard graduations or even have set classes?

I understand everyone's desire for oneness. But this, I see as a possible problematic situation. I think every state in the union could come up with a set number and it would solve almost all the problems that are off-shoots. Instead they face expenses beyond their scope of knowledge. Schools are already increasing their fees with the knowledge, more man-hours are going to be needed.

It would be so easy to do. Every state board/representative body closes the doors and comes out with the number. That number is taken to state legislators. There has to be a way to allow state legislatures to accept these hours without opening up the Act! That would solve it all. Your thoughts?

Comment by Keith Eric Grant on October 23, 2009 at 10:18pm

The final form of the law passed in California had much to do with the Joint Legislative Committee on Boards, Commissions, and Consumer Protection. The joint committee held a sunrise hearing on massage regulation in January 2005 and then, dictated the form of regulation they felt was warranted -- in this case a form of certification sufficient to provide some means of uniform and non-onerous regulation. Before a regulatory law was passed, I was able to capture, with the assistance of Bob Benson and ABMP and using data from the former BPPVE (state oversight of schools), a substantial picture of the massage educational framework in California in late 2004. As far as I know, this is a unique type of statistical picture. While Jeff Forman and I negotiated to an agreed wording of the conclusion, he later took a stance that I felt was inconsistent with the data, leading me to drop plans for publication with JBMT. In deference to this development (which I only learned of indirectly and substantially later), the data on colleges should be taken as being Jeff Forman's with my graditude and the conclusions, although somewhat different than I might have individually chosen, to be entirely mine.

Comment by Mike Hinkle on October 23, 2009 at 9:49pm

And a great member CA is. I met Bob Benson at the annual FSMTB meeting. I feel for the situation CA found itself in. It really is a well thought out format you were able to set up. But I hope the country does not have that many varibles.

Comment by Keith Eric Grant on October 23, 2009 at 9:33pm

Fair enough. BTW, since CAMTC, while private, is still part of the state's regulatory system (as is the California Bar Association), CAMTC is a member of the FSMTB. You won't have to ask. We'll speak up on our own. ;)

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