resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
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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