resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
December, 2011, Vol. 11, Issue 12
CE's: Continuing Education or Corrupt Enterprise
By Elaine Stillerman, LMT
Turn the pages of any massage or bodywork journal, and the list of people (some of them who are not massage therapists) and corporations advertising continuing education classes for massage practitioners is mind boggling.How is a person supposed to make a decision among the countless choices? And more to the point, how can anyone differentiate between a valid educational experience and a business willing to offer just about anything, regardless of factual content, when all of these advertisers have been "approved" by the National Certification Board for Therapeutic Massage and Bodywork?
For years now, I have watched the steady decline in the quality of continuing education courses as the quantity has mushroomed. And I believe the NCBTMB noticed this also because they are interested in changing their approval process, or so I have been advised. So, I wrote them a letter, which also went out to the Florida Board of Massage and was signed by nearly two dozen leading professionals in massage therapy, offering suggestions to improve their approval process and the overall state of continuing education. I have reprinted the letter below:
June 24, 2011
Dear Ms. Sarvello and FBMT Director,
NCBTMB has put forth some promising ideas about reviewing and auditing their Continuing Education (CE) approval process. I am delighted to learn that this necessary review is taking place. In the spirit of your mission statement of being "...an independent, private, nonprofit organization that was founded...to establish a certification program and uphold a national standard of excellence," I would like to offer some suggestions of my own and those of numerous respected professionals, that would guarantee that qualified bodywork professionals are providing this high standard of training.
I have been a licensed massage therapist since 1978, and my CE course was one of the first courses approved by NCBTMB. I have come to many of these suggestions after talking and communicating with dozens of nationally and internationally renowned massage leaders, instructors, authors and massage school owners, and from the feedback of hundreds of students in my classes about the quality of some advanced (credited) courses they have taken, live and non-live. So, I feel I have a good sense of the current status of CE. The picture is not pretty.
Hands-on modalities ideally should be taught in a live classroom setting under the supervision of a qualified instructor. Stricter standards for individuals and organizations must be set. Massage therapy, by its nature, necessitates human touch and human interaction. The best way for a student to learn to feel the delicate flow of craniosacral rhythm is by touching it. The thrill of a baby's movement in its mother's womb can only be experienced with a pregnant woman. The gentle release of a trigger point can only be palpated on live tissue.
But, too many instructors and organizations who are not qualified, or whose information is questionable, are approved as providers each year. The individual seeking NCBTMB provider approval currently has to teach only one course within three years in order to be qualified. Yet, there is no proof required that this course actually took place. The only requirement is promotional material advertising the intended date of the course. In theory, a "teacher" can advertise a class in a specific modality and submit that as proof of proficiency without ever holding the class. Also, NCBTMB currently does not set a minimum attendance. In essence, a class of one student qualifies this instructor. This must change.
I suggest that a minimum of two to three years of full-time experience as a massage practitioner in their field of specialty (after state licensure or certification has been awarded) as the least amount of experience an individual should have before applying for approval. Then, after teaching a minimum of four classes within a year, attendance sheets and anonymous student evaluations (one for each name on the attendance sheet) should be submitted to NCBTMB and FBMT to provide proof of the instructor's or organization's competence in the course and that the proposed curriculum was followed, before approval is awarded.
This way, similar to an internship in many other professions, the instructor gets teaching experience, the course material has time to take shape, and the students have anonymously written their critiques which can provide NCBTMB and FBMT with important feedback. NCBTMB would only have to review a handful of the evaluations to get the information they need for approval or recertification. This is a cost effective way to determine qualification. If the feedback is not supportive of the instructor or course, approval can be denied, suspended until performance improves or revoked entirely.
Some have argued that students often miss out on individualized attention when a live class is especially large. In those instances, teaching assistants should be present to make sure each participant gets some personal attention. I have taught at many schools where a teaching assistant is required if my class exceeds a predetermined number of attendees. This benefits the instructor, the individual student and the class as a whole.
Non-live instruction (home study programs, online courses and webinars and distance learning) must undergo the same strict scrutiny and qualifications as live classrooms. While there are many exciting non-live courses, some arguably more efficient and convenient than a live classroom situation, the same strict guidelines must be established for the instructor and the course content.
To illustrate my point, a national massage franchise showed a home study video to their therapists from an NCBTMB and FBMT approved provider for prenatal massage. The description on the course website states "The protocol can be utilized with all women in all stages of their pregnancy including postpartum massage. This will allow the massage the freedom to capture the entire prenatal and postnatal massage market." Anyone who has studied the anatomy and physiology knows that is a misleading and inappropriate statement. The video was full of misinformation and potentially dangerous techniques, especially on the legs, (as so many of those I have watched), but students got 12 credits and an in-house "certificate" to practice prenatal massage.
Since student feedback is difficult to collect in a non-live situation, a careful review of the instructor and course materials must be made by NCBTMB before approval is awarded. Currently, many non-live courses are taught by unqualified instructors and the material is questionable, even potentially harmful.
This quote comes from an email that was forwarded to me. "You asked me to check into the CE National website. I did not go as far as to order any courses. I checked to see and they are an NCBTMB approved provider and in Florida, too. Her name is XX out of Tampa, Florida. They have 23 courses posted on the NCBTMB website. All of their courses are online and must be completed in one year. You open a PDF to complete the courses. They send your certificates to you online. You do not receive any materials. In lieu of the cheaper cost, they want you to allow them to advertise with a banner on your website and are asking you to review their courses and reply back to them with corrections to their courses, which does not sound very professional. If you look at her courses, they do not have much to do with massage techniques." This provider was approved for 48 CE credits for her courses. How can someone offering a program this questionable receive approval?
Student recertification should be based on a maximum number of live classroom participation hours. Currently, students can buy enough home study programs to satisfy full recertification without ever being in a classroom, massaging a client, asking a question of the instructor or receiving personal instruction. The Florida Board of Massage Therapy now approves half their CE credits in this manner. More than half, as much as three quarters of these recertification credits should be in a live classroom, especially when teaching a massage technique is the course objective.
Too many instructors are offering the same modalities. With thousands of approved individual providers and approved organizations, there is redundancy in what is being offered. Unless the course further enhances knowledge or comes from a different perspective or discipline, we neither need nor benefit from yet another neuromuscular class, as an example, when dozens are already being offered. This undermines the qualified courses and eventually corrupts the information being offered. ("Too many cooks...")
While not limiting new entries into the teaching world, approval must be based on credentials, credibility and experience. The information proffered must be original or innovative and not a copy, clone, derivative, reshaping or retooling of existing courses. I have repeatedly heard of novice massage practitioners who become approved providers after limited training and who appropriate existing texts and intellectual property as the basis of their own trainings. This does not lend itself to the high standards of education the NCBTMB and FBMT are seeking.
Rights to published materials. All published books and materials (articles, journal entries, etc) are protected by copyright laws. In order to sell, or in some instances reprint electronically or use these protected materials, proof of a licensing agreement must be part of your application process. Ignoring this is a tacit endorsement of misappropriated and illegal use of protected information to which you may be held responsible. These licensing agreements detail how the information can be used by the party who purchased those rights.
However, this license which permits resale rarely, if ever, permits the purchaser to create a course and profit from it based upon someone else's published work. In addition to proof of licensing, written permission from the author, creator or originator of the work/technique must be provided. Only those instructors taught by and/or contractually sanctioned by the author/creator should be allowed to teach and use this protected information.
I am not suggesting that schools can't use textbooks for educational purposes. After all, that is exactly what textbooks are for. I am suggesting that an individual or organization should not be permitted to receive CE approval unless there is an agreement in place between the originator/writer and the instructor/organization to create such a program for profit. The onus of proof would fall to the individual or organization who wants to use the work, so there would be no cost to NCBTMB.
Limit non-live CE approval to those qualified to teach or to those concerns that have written permission from the course creator. Massage has become a big business and too many non-professionals are putting together non-live programs and selling their course packages with approved CE credits. Just scan any massage magazine or related internet site and "approved courses" pop up by the dozens. The course content is often questionable and serves no other purpose than to earn a living for someone who is not necessarily qualified to teach these courses.
Just as in the case of copyright regulations, reputable businesses should have contractual agreements with creators of techniques. Once proof of this agreement is demonstrated, CE approval can be awarded. As an example, this letter came from a hot stone therapy expert: "I am appalled at some of the things I have seen regarding stone therapy. I have had therapists call me and want to order stones because they just became certified in stone massage. I ask them where they have learned and their response is, 'online.' Then I ask, 'have you ever had stones in your hands?' Their answer is 'NO.' How can anyone say they are certified when they have never had stones in their hands? Also, I took a stone massage class online to see what they had to offer and was surprised at the number of statements that simply were not accurate. The temperature they suggested was too hot to work with safely, contraindications were either over done or not mentioned, and they didn't use proper equipment."
Organizations should be required to hire CE approved, independent contractors. It is a conflict of interest to allow national massage franchises, massage schools or massage corporations to offer their own in-house courses taught by their own staff, unless that staff member has independent NCBTMB or FBMT approval. There is no quality control in such situations.
As an example, I recently learned of a national massage franchise that offered a hot stone therapy class at one of their Florida locations. The course consisted of students watching a video for about an hour, an exam (10 questions) and a brief demonstration by a senior massage therapist who never studied hot stone therapy. They stood around a massage table and the instructor proceeded to place the stones on the treatment table, not even asking for a student volunteer. None of the students even handled the stones. Yet they all received 16 CE credits for this from NCBTMB and FBMT because this business was approved. This clearly does not meet a "national standard of excellence."
In another example, a leading instructor offered to teach her modality at a massage franchise because the information being provided by this business was incorrect and potentially dangerous. The response was, "I'd rather get sued than spend money on continuing education." This business was approved by NCBTMB.
The vetting process for course content must have stricter guidelines. With the thousands of providers dispensing information and course credit, how can a student know which one to choose? They often take the least expensive course that will provide them with the most credits. But in the end, what are they being taught? Is the information correct? Is the source material reliable? Is the instructor able to impart the information from experience, or is he/she just reciting chapter and verse? One person, or even a team, in your organization cannot possibly comprehend the subtleties inherent in all the known bodywork modalities. So how is competency determined by the NCBTMB?
As another example, the leading instructor of Dr. Vodder's Manual Lymphatic Massage recently wrote me and said, "Just yesterday I received a very scary link to someone offering compression bandaging courses by video. This is totally unethical in my view and has the potential for causing serious harm to patients and our profession."
The course material used to create CE courses must receive as rigid a review as the providers by independent specialists in each field. If the NCBTMB and FBMT are granting provider approval, this must be part of the cost of doing business. I have been in this glorious profession long enough to have watched it grow from the shadows of obscurity, to an explosion of modalities and public acceptance. In the beginning, we fought for professional status and the recognition of the power in our hands. I regret to say that, once again, I am fighting for the dignity of massage therapy. The examples I cite are not isolated incidents, but rather endemic.
I emailed and conferred with dozens of respected massage leaders, school owners and business people about your review process and I have received overwhelming support for my ideas. The dialogue was animated and is on-going. Not everyone agreed with all the points, but all agreed that changes are essential if we are going to see the profession of massage therapy grow and go in the right direction. It was their input, comments and experiences that helped shape the final revision of this letter. The undersigned signatures represent a fraction of professionals who want to see this process improved.
This letter will be published in my next column in Massage Today. I truly hope I can publish some credible changes along with it.
Elaine Stillerman, LMT
cc: ABMP, Les Sweeney, President
Author's Note: As of September 20, 2011, NCBTMB has told me that they are examining their CE approval process but have not provided me with any of their ideas. None of the other organizations have responded to my letter. The choice is yours: you can continue to degrade the profession and your skills by supporting questionable educational sources or you can elevate yourself and massage by learning from professionals who have the skills, knowledge and ability to teach you. Like the adage says: "you get what you pay for."
Click here for previous articles by Elaine Stillerman, LMT.
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