Members of the public are becoming increasingly aware of their need to be actively involved in their own health care. Health care professionals who want to be humanistic welcome this new activism and applaud family members and patients who do their homework. Because family members and patients search the Web for health care information, journals such as Physical Therapy are no longer the province of professionals alone.

Despite this growing consumer involvement, however, few members of the public know about an ongoing travesty that is being perpetrated on their behalf, one that reaps financial rewards for some people but offers questionable benefit to patients and payers: physical therapy continuing education (CE).

In many ways, our CE purveyors are modern-day revivalists, moving from community to community with zeal and a polished act that seduces the listener. They rarely offer evidence for what they say, and they rarely seek credibility by taking their ideas into open forums for careful scrutiny. Some CE presenters have been selling their ideas and techniques for decades but have never found the time to publish so much as a case report, let alone a descriptive paper or a cohort study about people who have been managed using their approaches. (Real evidence, such as data that can be obtained through a clinical trial, would be even better—but we need to start somewhere!)

If this is the state of CE—that is, if CE really is a continuation of how we are educated to become therapists—we don’t deserve the right to manage patients, and any payer who is billed for our services should buy a paper shredder! The current CE system does not “continue” anything other than a demonstration of the axiom that there is a sucker born every minute.

Our accreditation system for the education of physical therapists and physical therapist assistants might have its faults, but at least our schools are allowed to exist only when they meet standards. Nothing like those standards exists for the creation and implementation of CE courses. (You can examine the standards used by the Commission on Accreditation in Physical Therapy Education at www.apta.org/Education/accreditation/accreditation_handbook.)

Where are the standards for CE? If you find them, let me know—and let me know how they are implemented and by whom. In states that require CE units (CEUs) for physical therapists to maintain their licenses, there is a patchwork of mechanisms for CEU approval, almost none of which are related to the quality of the content. In many of those states, we use CEUs to argue with legislators that we are policing our own house and that we are as professional as anyone else. But that masks the reality. Our argument implies that we are doing something to protect the public, when in fact we are doing something for self-aggrandizement and political purposes and to keep the CE industry incredibly profitable. Unless we do something to ensure that CE courses are based on recent, credible information, we aren’t helping patients.

Even at APTA national meetings and at component-sponsored events, there seem to be few demands for speakers to provide evidence or even to discuss whether evidence exists. We book CE presenters as though we were rock concert promoters. We seek the “hot speakers,” and, toward that end, we seem to be willing to promote cult after cult. We want people to attend meetings; I understand the financial pressures. But what about our integrity and our profession’s future?

There are CE presenters who do use evidence and provide high-quality CE, but they are few and far between. How difficult would it be for CE presenters to review the research? If no research exists, they could just say so, instead of arguing that book chapters, self-published monographs, and other dubious sources provide evidence. If we want testimonials, we can tune into a home shopping channel!

Most of the CE purveyors who fill our mailboxes with brochures seem shameless in their promotion of speakers rather than content. They also have learned that by structuring CE courses in a hierarchical fashion under the umbrella of an “institute,” they can (as pool players say) “run the table” with course after course. Who checks on these institutes? Who makes certain that they are serving an educational purpose in a credible fashion? Even a new pair of pants gets a quality check; you can usually find some little piece of paper in the pocket with the inspector’s identification number. The CE institutes get less scrutiny than a pair of jeans!

One speaker has been promising to publish data to support his ideas for more than 20 years. Somehow he never seems to get around to it, but he keeps telling the audience that he has data “coming soon.” Are CE speakers so busy that they never have time to collect data or write a case report? Would we accept drugs that are rushed to market without study? Another speaker, who not only offers CE but runs a residency program, once chastised me in public for demanding evidence. Before a standing-room only crowd, he said my problem was that I did not read the unpublished literature. (As humorist Dave Barry would say, I am not making this up.) When I asked him where I would find this unpublished literature, he told me that he was talking about student projects. I reminded him that if student projects are credible, they can be published, and that such studies often are published in the Journal. The “unpublished literature” remains unpublished, however. If any of us wants to read it, we will need to hire a Watergate veteran to break into his office (without getting caught, of course).

I recently observed a lengthy conversation about CE on a listserv. The members were curious about how much money institutions were offering therapists for CE. They also discussed how the money was being allotted to therapists. In this otherwise thoughtful discussion, the quality of courses was never discussed. No one suggested that institutional resources should go only to those courses that meet minimal standards for content. And no one raised the issue of what CE should achieve.

Why should anyone spend a nickel unless it meets a need? Shouldn’t there be some criteria to guide resource allocation? I believe, for instance, that therapists who need to improve in a given area of practice should be encouraged to attend courses designed to meet that need. Similarly, therapists who need to enhance their skills or to enlarge their scope of practice as part of staff development should be guided to the appropriate courses. Allowing therapists to attend any course they want to attend, regardless of quality and content, seems to me to be a failure of leadership.

We use CE to “show” the public that we are keeping current—but that is not true. If CE courses really were expected to achieve a worthwhile end (and not just a certificate to hang on the wall), presenters would give more information about content—such as whether the course was based on evidence, clinical experience, or theory—before someone chose to take the course.

If CE is to improve practice and provide benefits to patients and payers, we must become critical consumers. The charlatans will disappear from the CE market only when they find their incomes have decreased. Speakers will offer something of substance (data) only when we, as consumers, demand it.

Before you sign up for another CE course, ask yourself whether you want to be part of the solution or whether you want to finance a sham that diminishes physical therapy as a profession—and you as a physical therapy professional.

• Physical Therapy