Ron: Sorry, I lied. I guess, I went on a tangent while responding to your last e-mail.
I think we both agree that our theory and practice do not mesh. However, from what I gather we probably are looking at different causes and solutions for it. In my humble opinion, the reasons are: 1. Many of our theories are not backed by strong "evidence". If manual therapy twice a week for 4 weeks for the wrist joint post Colles' fracture yields the desired functional wrist movement for my Harley guy to go biking again, why will I do basket weaving or upright painting for 5 days a week? Why should I or my insurance pay for this? Vice-versa, if true occupations alone in Parkinson's produces better and quicker functional outcomes than practicing coordination exercises, why would I choose the latter? 2. Overall, historically as a profession we tended to emphasize a little too much on the qualitative aspects of our care versus quantitative outcomes of our interventions. While qualitative issues are important since we work with people, third party payors need (as Jimmie said) 'hard' evidence that OT works. 3. Theories are usually rosy and actual practices does have thorns. Our theories at times try to produce a cookie- cutter effect. Our textbooks do not emphasize 'evidence' behind let say Rood's versus Bobath versus PNF, etc.. 4. Our curricula are packed with theories with inadequate allowance for nurturing and practicing clinical skills. Our fieldwork is usually a rushed experience, more of observance than 'practice'. So once our new grad is out most often in either a busy hospital or a rural, hard-to-staff SNF, all they have is there bulky textbook and theory to shape their practice. 5. Many of us, try to take a reductionist view of what OT is or should be and explain it based upon our comfort zone/ setting. We are trying to see a profession by the modalities we use, which are many and can differ from case to case. In my not so humble opinion, I believe we can at least help minimize this gap between our rhetoric and practice by- 1. Basing our curricula on evidence ( Not because my teacher said so, but because a randomized clinical trial proved it so). 2. Establishing a strong foundation for practice with clear understanding of our roles out in the field, knowing what are focus is, and what all tools we have -OTs are experts in..... and use.....(the framework should be a good guide) 3. Become an 'outcome' focused/ result oriented community versus theorizing just the philosophical basis of our existence 4. As I said before, our entry-level master's must be upgraded to allow more content and time to prepare our practitioners with proper mentorship/ fieldwork experience, more opportunity to strengthen/ 'perfect' their skills before they actually 'practice' ( Isn't that amusing that in healthcare, all we do is practice, we never achieve perfection !). May be, we ought to learn from the residency requirements for MDs/ DOs. It is here where they probably learn the most. Our fieldwork should be focused and directed as well. 5. For folks already in practice, I believe AOTA through state associations/ licensing boards should educate practitioners on the scope/ framework of OT. Make it a compulsory CEU to be completed (like we have one on Ethics in Ohio). 6. Accept the diversity and wide scope of OT with its holistic appeal. OTs that are hand therapists, pediatric therapists, industrial therapists, DRSs, LVTs, community-based therapists are all OTs, just like the gastroenterologist, otolaryngologist, orthopaedists are all physicians. Lets not divide our profession based upon the modalities we use or by the clientele demographics we serve. But unite based upon our focus on human occupations as it relates over a life-span. Do we have academicians on our board that can shed some light on this subject? Joe A quote from my earlier e-mail :- I believe the knowledge base has certainly grown to an extent that we need an expansion of our programs and make it more directed toward clinical practice versus just practicing theory. -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
