forum winter2005 3 - fsbpt · federation forum • 3 president continued on page 22 the state of...

Mark Your Calendar 2

President’s Perspective 3

Administrative Staff Corner 4

Legal Notes 5

The Canadian Model of Re-entry 6

The American Model of Re-entry 8

Update on the ContinuingCompetence Pilot Projects 10

Security Watch 11

Lessons Learned about Cheating 12

FCCPT Update 14

It’s in the Mail 14

2005 Boards and Committees 15

Call for Nominations 23

Setting the Gold Standardfor Service and Protection

federationVolume 20, Number 1forum

winter 2005

Passing scores rise and fall, while reasons for sometimes startling score differencesfrom year to year vary. Here are methods used by five schools to reversedecreasing scores.

Emphasizing faculty item writing skills

We were ahead of the curve in an unfortunate waywhen our scores dropped in 2001 while nationally,the average was going up. Initially, there werecomments that the student pool has changed; infact, the maximum variations were only 3%. Ourfaculty then developed a strategy to make sure theycame back up again, and in 2003, scores reboundedto the mid- to upper-90s.

The faculty looked at curriculum relative to theNPTE blueprint; we thought perhaps one faultyarea might be content. It wasn’t. We also contactedstudents who had done poorly on the exam andasked if they would share their concerns with us. A theme that quickly emerged was that the type of question asked on the NPTE was not comparableto the type of questions asked on exams in theprogram. We then focused our attention there.

A MAGAZINE OF THE FEDERAT ION OF STATE BOARDS OF PHYS ICAL THERAPY

on the National PhysicalTherapy Examination

Walter Erikson, ModeratorPhysical Therapy Department, Eastern Washington University

I M P R O V I N G T H E PA S S I N G S C O R E

A theme that

quickly emerged

was that the type

of question asked

on the NPTE was

not comparable

to the type of

questions asked

on exams in the

program.

PA S S I N G S C O R E continued on page 20

www.fsbpt.org

ADMINISTRATIVE SERVICES

703.299.3100 phone • 703.299.3110 fax

EXAM PROCESSING AND SCORE TRANSFER SERVICE

703.739.9420 phone • 703.739.9421 fax

BOARD OF DIRECTORS

E. Dargan Ervin, Jr., President

Chuck Meacci, Vice President

Kathy Fleischaker, Treasurer

Tom Mohr, Director

Barbara Safriet, JD, Public Member

Senora Simpson, Director

Ann Tyminski, Director

Judy White, Director

COMMITTEE CHAIRS

Stephanie Lunning, Education

Margaret Donohoe, Ethics and Legislation

Diane Hanameyer, Exam Administration

Douglas White, Exam Development PT

Pam Leerer, Exam Development PSA

Dargan Ervin, Investment

Kathy Flelischaker, Finance

Peter Petrone, Nominating

James Hughes, Resolutions

CHIEF EXECUTIVE OFFICER

William A. Hatherill

FOREIGN CREDENTIALING COMMISSION ON PHYSICAL THERAPY

511 Wythe Street • Alexandria, VA 22314

703.684.8406 phone • 703.684.8715 fax

[email protected] • www.fccpt.org

Eileen Bach, PT, Chair, Board of Directors

Becky Lege, Quality Review (FCCPT)

ABOUT THE FEDERATION’S LOGO

A beautifully simple yet intricately complex drawing by

Leonardo da Vinci is the focal point of the FSBPT logo.

Taken from the great master’s concept of separate but

connected, each straight line is meant to represent an

individual state board, functioning

independently yet coming together for

support at the focal point—under the aegis

of the Federation. In addition to the aptness

of this lovely metaphor, the Federation is proud to link its

name to Leonardo da Vinci because his pioneering work

paved the way for our modern understanding of the

human body.

THE FEDERATION’S MISSION

To protect the public by providing service and leadership

to promote safe and competent physical therapy practice.

Federation Forum is published three times a year.

Subscriptions may be obtained from Administrative

Services for US$35/year.

© 2005 by the Federation of State Boards of Physical

Therapy. All rights reserved. Unauthorized reproduction or

use of the articles contained in this magazine are punish-

able under federal law. Permission to reproduce articles

may be obtained by writing to Federation Forum, FSBPT,

509 Wythe Street, Alexandria, VA 22314.

2 • Volume 20, Number 1

forumfederation

Note: Committee and task force meetings are for members only.

FEBRUARY

3 FARB Board of Directors • Scottsdale, AZ

4-6 FARB Forum • Scottsdale, AZ

3-6 PT IBRC/EDC • Alexandria, VA

10 President & CEO visit Florida board • Tallahassee, FL

23-27 APTA CSM • New Orleans, LA

MARCH

3-6 PTA IBRC/EDC • Alexandria, VA

11-13 Education Committee • Austin , TX

11-13 Item Writers Workshop • Alexandria, VA

31-April 3 PT IBRC/EDC • Alexandria, VA

APRIL

9-10 Ethics and Legislation Committee • Arkansas

21-24 Board Strategic Planning Meeting • Charleston, SC

27-May 1 Canadian Alliance Annual Meeting • St. Johns, NL

28-May 1 PT IBRC/EDC • Alexandria, VA

MAY

19-22 PT/PTA EDC • Alexandria, VA

JUNE

3-5 Board/Committee Chair Planning Meeting • Alexandria, VA

5-6 Board of Directors meeting

8-11 APTA Annual Meeting • Boston, Massachusetts

20 Submit motions for 2005 Delegate Assembly to Resolutions Committee

23-26 PT EDC • Alexandria, VA

JULY

15-17 Item Writers Workshop

29 Motions/2004 Delegate Handbook delivered to delegates

AUGUST

11-14 IBRC – Item Bank Clean Up • Alexandria, VA

25-28 PT/PTA IBRC • Alexandria, VA

SEPTEMBER

9-12 FSBPT Annual Meeting • Austin, TX

9,12 Board of Directors meeting • Austin, TX

12 Delegate Assembly • Austin, TX

15-17 CLEAR Annual Conference • Phoenix, AZ

23-25 Item Writers Workshop • Alexandria, VA

OCTOBER

8-10 FARB Attorney Certification Seminar • New Orleans, LA

13-16 PT IBRC/EDC • Alexandria, VA

21-23 APTA Student Conclave • Denver, CO

mark your calendar

C A L E N D A R continued on page 19

Federation Forum • 3

P R E S I D E N T continued on page 22

The State of the…NPTE

E. Dargan Ervin, PT

First of all I would like to

reiterate what I am sure that

all of our members know.

The purpose of the NPTE is

to assess entry-level

competence based on an

Analysis of Practice (AOP).

Dargan Ervin, Jr., PT currently works as Director of Administration and Client Services with Atlantic Physical Therapy & Rehab in Myrtle Beach, South Carolina. His

responsibilities require a great deal of operational and fiscal oversight. Dargan’s practice experience includes acute care, sports medicine, outpatient, and industrial

rehabilitation home health. He received the Distinguished Alumnus Award in 1999 from the Medical University of South Carolina College of Allied Health Sciences.

Dargan has been a member of the South Carolina Board of PT Examiners since 1992, and served as chair from 1995 to 2000. He headed the Federation’s Prescreening

Task Force, was a member of the Finance Committee and served as the Federation’s Treasurer before being elected to President. Dargan has also been active in the

South Carolina Physical Therapy Association, serving as its Treasurer from 1984 to 1987.

Dargan received the 2001 Emily Cate Award from the South Carolina Physical Therapy Association for his noteworthy contributions to physical therapy on a local and national level.

president’s perspective

There has been significant attention focused on the National Physical TherapyExamination (NPTE) of late. Because of the controversy surrounding theNPTE and the Transfer Agreement with the APTA, I wanted to take the

opportunity to bring you up to date as to the “state of the exam.” I will cover recentprocess improvements and the current reality that makes the exam program strongeras well as the changes effective this March as a result of the recommendations of theNPTE Commission. I’ll also cover the plans for future improvements.

Entry-Level Competence

First of all I would like to reiterate what I am sure that all of our membersknow. The purpose of the NPTE is to assess entry-level competence based onan Analysis of Practice (AOP). The AOP is performed every five years and itmeasures and identifies what services and interventions are actually beingperformed by entry-level physical therapists. The NPTE, just like otherlicensure examinations, does not test what is being taught in the educationalprograms or what professional associations feel would best support political orlobbying efforts. A passing score on the NPTE demonstrates entry-levelcompetence through a process that utilizes accepted industry standards likethose used by physicians, nurses and many other licensed professionals. It isused by licensing jurisdictions as a tool for consumer protection.

Item Development and Item Bank Software

One of the most significant improvements to our exam program of late is theItem Development and Item Bank software that we have developed. The ItemDevelopment software is an online system that streamlines the item writing anditem development process, which better utilizes our committee members’ timeand speeds the development of appropriate examination items. It allows itemwriters to work from anywhere they have a computer and immediately forwardpotential questions on to item writer coordinators. Developmental work on thequestions is enhanced with this almost real time communication. The Item Banksoftware provides secure storage of examination items and keeps vital statistics oneach item to ensure that test questions are appropriate for use on live examforms. This software is also very helpful in constructing draft forms of the examthat meet strict statistical criteria in preparation for committee review.

Achieving Psychometric Excellence

Our current Assessment staff includes two PhD psychometricians and we arecurrently seeking a third. As a result of recommendations from the NPTECommission, we have taken steps to ensure that our procedures meet the higheststandards for licensure testing. We have organized a Technical Advisory Panel(TAP) that consists of experts in testing from organizations outside of the


administrative staff corner

Jeff Rosa, CBA Moderator

2005 FSBPT Annual MeetingSeptember 9-12, 2005 • Austin, Texas

Cindy Kiely and I, the Council of Board Administrator’s new recorder and moderator, want to thank Steve Hartzell and Nina

Hurter for their hard work organizing the CBA meeting in Philadelphia last fall.

It’s not too early to plan for this year’s annual meeting. Funding should not be an issue. The Federation covers perdiem costs for administrators to attend the CBA Meeting on Friday, September 9, and the rest of the annualmeeting from Saturday through Monday, September 10-12. This includes your flight, your hotel, meals and some

miscellaneous expenses. If you need to come in Thursday night because of flight limitations, the Federation will payfor the extra hotel night. I hope you will do what it takes to attend the meeting—it would be wonderful if all 53jurisdictions were represented.

Council of Board Administrators MeetingFriday, September 9, 2005I think you all know that the CBA’s purpose is to provide member board administrative staff a forum to shareinformation relevant to board functions, regulatory practices, practice standards and issues, licensing processes andsecurity, and enforcement issues in the practice of physical therapy. Our main focus is our mission to protect thepublic by promoting safe and competent physical therapy practice. We come together each year to discuss anythingthat is important to the regulation of the physical therapy profession.

Initial planning for the CBA meeting has already begun. Cindy and I want to look at "best practices" among boards.With the recent turnover in board administrators, we feel that it is important to use the CBA meeting as anopportunity to learn from our colleagues what works and what doesn’t. The topics we have so far are as follows.

■ How is your board responding to budgetary issues in your jurisdiction?■ How have you utilized your website to improve operations?■ Does your board have online renewals? If so, what lessons can be shared with states that have not yet moved to

online renewals?We welcome and encourage you to provide us with additional issues or questions you would like to discuss at the

CBA meeting. If you have any issues that you want discussed, please let Cindy Kiely ([email protected]) or me([email protected]) know.

Motions for the Delegate AssemblyThe deadline for submitting delegate assembly motions to the Resolutions Committee ([email protected]) isJune 20, 2005. The committee can provide the format required for submission, and help your board members draftmotions that are clear and in compliance with bylaws requirements.

Ensure that the issues of importance to your board are addressed at the 2005 Delegate Assembly. As administrators,you can make sure that this discussion is placed on an upcoming board meeting agenda.

It’s not too early to plan for this year’s annual meeting.

Jeffrey M. Rosa has been Ohio’s PT Board Executive Director since 2003.Before that, he spent one year working for the Ohio Board of Nursing. Jeffrey has extensive

knowledge of Ohio’s budgetary issues as well as experience in drafting laws and rules in various jobs in Ohio. He was elected moderator of the Council of Board

Administrators for the 2005 annual meeting.

L E G A L N O T E S continued on page 18


J. Kent Culley, Esq., of the Pittsburgh firm of Tucker Arensberg, PC, has been retained as FSBPT Counsel for legislative and regulatory affairs since July 1994. With more

than two decades of experience in this special area, he has consulted with more than half of the states, either for the licensure board or the APTA state chapters. This

unique background has provided him with experience in a wide array of licensure issues.

T he question presented relates to the issue of term or title protection in practice acts and what types of problems may be created for licensing boards in this

regard. For example, would there be a problem for licensingboards dealing with the title DPT or other academic-type titles?

First, before discussing the problems licensing boards mayhave with title protection issues, the basis for title or termprotection should be examined. Title protection is notnecessarily aimed at the protection of the individualpractitioner, but, rather, title protection serves the purposeprimarily of protection to the public. That is, the public shouldknow with confidence when they choose professional serviceslike physical therapy or medicine, that the term “physicaltherapist” or “physician” and the title utilized by theprofessional like “PT” or “MD” has a basis in an educationaldegree and a legal basis in the law. Simply put, for the benefitof public protection, the use of a term like "physical therapist"and a title like “PT,” the most common designation of aphysical therapist, together with the establishment of a scope ofpractice and clear term or title protection by a legislative body,accomplishes this purpose. It also provides a legal basis forenforcement of the term and title protection. The statutoryrestriction on the use of a certain title, as noted above, ismeant to describe a unique education and a unique set ofskills of one type of professional necessary to provide thoseprofessional services to the public.

Part of the problems licensing boards face dealing withterm or title protection is the fact that the legislature in somejurisdictions have not clearly restricted or protected the use of a term or title with specificity. This causes confusion, first, to the licensing boards that may be attempting to enforce arestriction on the use of a term or title and second, to thepublic, the very body the board is trying to protect.

An example of this from one jurisdiction shows that thelegislature has used the word “may use the letters PT or LPT”or the term “physical therapist” or “licensed physicaltherapist” rather than “shall use the letters or terms,” etc., inconnection with the physical therapist's name to denote thelicensed status and additionally, restricting the use of the title to only a licensed physical therapist. “May” does not, as youcan see, give the board much to back its efforts to preventothers from infringing particularly on the title “PT.” Recently,for example, there were some incidents in several jurisdictionswhere personal trainers used the title “PT” after their names.This caused a good deal of confusion to the public. Withoutspecific statutory language in the practice act restricting andprotecting the “PT” title, the licensing board confronted withan issue like the personal trainers’ use of “PT” could beproblematic!

Another area of confusion for licensing boards (as well as the profession) is the attempt to differentiate between the useof a regulatory title or term for the licensee and the use ofacademic title or titles connoting an academic degree. Thisconfusion is particularly true where the practice act is not clear on the protection of title, as noted above, allowingperhaps the need for the board to interpret. Keep in mind, the licensing board does not usually make the law; they have to work with whatever statute they have in the jurisdiction.

It should be firmly understood by licensing boards (as well as the profession) that regulatory titles are those given by the legislature and academic titles are given by academicprograms upon the successful achievement of a degree. With the advent of the master’s degree and now the doctoratedegree for the physical therapy profession as well as specialtycertification by the APTA, the confusion on the use of titles hasbeen greatly exacerbated. This is true not only professionally but

Term or Title Protection

Legal NotesJ. Kent Culley


Practice may not make perfect, but the amount ofpractice done by a physical therapist before leavingthe field has a direct correlation to the difficulty of

returning to the field. That’s the assessment of Susan GloverTakahashi. Takahashi describes candidates for re-entry as“practitioners who have not been using the tools in theirtoolbox,” for a prolonged period of time, most likely twoyears or more, and want back in.

Types of Re-entry candidates

She emphasizes that re-entry is different than entry, and eachre-entry case needs to be treated differently. There are typicallyfour types of candidates for re-entry:

■ Those that have been sent away.■ Those that are away by choice.■ Those that are licensed and not working. ■ Those that are licensed and not active.The general difficulty with re-entry, Takahashi notes, centers

on a progressive loss of knowledge and skills. The degree ofloss, called decay, is affected in four ways:

Quantity of physical therapy skills usage

These are physical therapy activities that foster deep learning,which Takahashi refers to as “miles on your hands.” Sheexplains that “the ability to work in the future seems to bedirectly related to the number of times those skills are actuallypracticed. Touching one patient every two weeks over fiveyears is not the same as doing those same hours over a one,two or three-year period. It’s that bicycle skill. Twenty yearslater, you go, oh, this has speeds on it, or the handlebars aredifferent. You have to do some re-orientation, but bicycleriding is bicycle riding. You practiced it enough when youwere learning it to get it.”

Varied context

“People need to try their skills in different environments,whether they are workplaces or patient populations. This isa factor affecting competence, not the ability to work.”

Evaluation and feedback on skills

“Simply put, this means they have someone to talk to—

The CanadianModel of Re-entry

Susan Glover Takahashi


C A N A D I A N M O D E L continued on page 17

The general difficulty with re-entry, Takahashi notes, centers on a progressive loss

of knowledge and skills.

colleagues, supervisors, friends on email, study groups,”Takahashi said. “This can be formal or it can be informal butit is really key. The solo practitioner who works on their owngets to argue with themselves unless they reach out.”

Activities during non-practice time

“It’s what the practitioners are doing when they’re away thathas an effect on their competence when they plan to return.”Takahashi relates, “I spent eight years as a mom working verylittle, dealing with two children with asthma and a frailmother who was unwell. I worked in volunteer positions thatrequired me to think critically about my profession. They werefactors in reopening the toolbox with some confidence.

“Those who have been away and want back have a lot tooffer,” Takahashi said. “Studies suggest that what they didwhile they were away mitigated the decay of knowledge andskills, as did additional learning.” Also affecting theknowledge and ability to come back was the setting theywanted to go back to. The more acute setting, the harder itwas. Notes Takahashi, “It’s one thing to get back on thebicycle. It’s another to join Lance Armstrong going acrossEurope.”

The current management and practice of physical therapy

"The other factor that has changed a lot is how physicaltherapy is managed and practiced and how far away the re-entrycandidate is away from the curve. The rules for how you stackthe tools in the toolbox have changed. The speed with whichpeople are now expected to solve problems is much faster thanpreviously. Also, the increasing specialization and decline ingeneric or hospital-based therapy is having a significantimpact.”

All of which reinforces the concept that re-entry isdifferent than entry.

Re-entry versus entry

“When you treat re-entry as [the same] as entry, you may bemaking a practical decision, and the appropriate decision thatis available to you. But they are not the same practitioners.On entry, you want baseline knowledge. On re-entry, you

want to see how much of that knowledge they’ve maintained.

Determining readiness to return

For those practitioners who are sent away and now want back,Takahashi recommends that regulators focus on why they weresent away. “Usually those who have been sent away have anaspect of failure attached to them either personally orprofessionally or from a competence perspective. The problemis clearly either behavioral or skills based…Remediation orconditions for coming back should be directly linked to theirpersonal profile of education and the incident that caused thelock to go on the toolbox.”

“You need to have a checklist of key questions to ask re-entry candidates to see if they are ready to reopen the toolbox.I think we need to do some rethinking about our role asregulators and practitioner supporters. We need to helptranslate the information affecting practice for the practitioner.If we don’t help them with that, who will?

“It (becomes) unfair afterwards when someone’s made thewrong choice because he didn’t know the consequences of howthe practice has changed. We need to help them make decisionsabout when they work, how they work, where they work.

“All of us have a responsibility about competence,”Takahashi adds. “We know that the factors are who you are,how you think, where you practice, and your deep learningover time. Employers, regulators, educators all have a factoraffecting our competence. It needs to be legally andprofessionally defendable; it needs to be consistent with theorganization’s mandate. It needs to be equally applied andenforced and administratively and economically feasible.

“There needs to be some fairness here. Some systemsdevelop very complicated, onerous re-entry programs whichare thoughtfully and appropriately designed.” However,consider the person who stopped working in the field, butmailed the renewal check every year. They wouldn’t have hadto do anything to start working again.

Canadian re-entry candidates

“In Canada, re-entry candidates are mostly dealt with on acase-by-case basis. There is an examination, both writtenand clinical.” Takahashi notes, “We have found that, seven


The AmericanModel of Re-entry

Suzanne R. Brown

One of the first dilemmas in defining the Americanmodel of re-entry into the physical therapy professiondeclares Suzanne R. Brown, chair of the Arizona

School of Health Sciences, is that there is no model. “If youlook at the definition of a re-entry model in this context, itshould be a pattern of ideal practice or the convention ofpractice. It should exemplify best practices in our field, and in the United States. There is no standard model.”

The model practice act definition of physical therapypractice includes administration, research, consultation aswell as patient-client practice. We have nothing to guide thepractice of educators, administrators and researchers.

What is considered re-entry?

A simple definition might be when a licensed physical therapyprofessional stops practicing for a time and then beginspracticing again.

Why is re-entry an issue?

There seems to be a consenus that being out of the practicesetting in this day and age may decrease the safety oreffectiveness of the treatment provided by the re-enteringprofessional. Brown explains, “At one time, most practice wasunder referral, lengths of stays were longer, there was sufficientreimbursement, and patients and treatments were lesscomplicated.”

But practice today is considerably more challenging. “Thereare more economic incentives to go into higher level and morecomplicated areas of practice,” Brown said. “No one canescape those areas of practice. We have many morerequirements for differential diagnosis and medical screeningof our patients. Patients may not have been adequatelyscreened for even very obvious health care problems. We havemany highly skilled procedures; we have our manual therapytechniques, our wound care protocols, our exercise


prescription, our managed care limits.” Physical therapists areexpected to develop an effective treatment plan that willproduce the desired results within a limited number oftreatments.

“The harm of an out-of-date practitioner working with agood skill set is probably minimal,” Brown admits. “[Mosttherapists] can remember muscle testing, the principles ofbasic exercise, how to walk a patient. If anything, they, asphysical therapists, are timid people. They tend to under-treatand are less aggressive…. The first thing I hear from therapistson re-entry is that they can’t practice within the limits. It’sbecause they don’t know the exercise prescription and how to bespecific. Practice today needs to be on target and not a shotgunapproach.”

Are re-entry programs required?

In most jurisdictions, there is no re-entry requirement if thelicense is kept current. The clinical practice privileges of aninstitution limits practice more than regulation. Re-entryprograms are generally funded by employers, who, by theircontribution, define the parameters of what is included in theprograms. For the most part, employers and practitioners donot see a need for re-entry and retraining.

What affects re-entry rates?

Low unemployment in the physical therapy professionseems to be a factor. A strong demand for physical therapistscan result in employers encouraging physical therapists to return to practice. For instance, currently, there is nounemployment in the field; the average graduate Brownknows has received three offers. Many had jobs before theyfaced the licensure exam.

High unemployment in spouses’ professions may also pushphysical therapists back into the workplace. “We are seeingphysical therapists come back in [to the profession] becausetheir spouse or living partner has experienced unemploymentin their market sector.”

What affects the availability of re-entry programs?

According to Brown, “The re-entry programs we have had inthe past 20 years that I have been in education, whether it befor the impaired practitioner, the temporarily out-of-practiceperson or the person who has never used the toolbox, havedepended on economic models and manpower needs. When

we have increased need and areas of low manpower resources,we tend to have programs available.”

So what is out there for those who desire re-entry?

■ Refresher courses of no standard length—usually threedays to three weeks—that are mostly taught by entry-leveleducation faculty or upper-level supervisors in corporatepositions trying to attract manpower into their business.

■ Continuing education that is normally based on employerneed or practitioner interest, not deficiencies.

■ A supervised work setting where someone says, “I’ll hire you.I promise you a supervisor mentor and we will take it fromthere.” There is no control over the mentor relationship orassessment of the re-entering physical therapist’s competenceor knowledge. It is primarily a skills assessment, notknowledge or attitude assessment.

■ Entry-level equivalence curricula; the school assesses theneeds of the individuals and brings them up to an entry-levelstandard, which allows individuals to do added study inspecialty areas.

■ A set series of courses based on updated knowledge.According to Brown, the issue with this option is that re-entrypeople are often coming from a family where someone isunemployed. It may not be realistic to require someone totake a program that involves substantial cost ($4,500 to$36,000).

Options for re-entry programs

TIERED LICENSES. Tiered licensing establishes different levelsof licensing and the qualifications for licenses at each level. “Itmay not be the best choice; it’s the hardest to regulate, thehardest to evaluate, the hardest to justify.”MANDATORY PRACTICE FOR RENEWAL. “As our neighborsto the north have done, we can insist on mandatory practicefor renewal. It’s probably the best way to solve the problem.”SPECIALIZATION CERTIFICATION. “…[S]pecializationcertification within licensure frameworks…is voluntary withsupport from the employment settings. This …change in theculture…will assure that a higher level of specialization ismaintained, although it won’t occur in physical therapy in thenear future.”

Developing an individual re-entry program

The requirement in developing a re-entry program is to decidewhat questions to ask the re-entry candidates. After working

A M E R I C A N M O D E L continued on page 17


2. To provide a tool for practitioners to plan,track and evaluate professional developmentactivities.

3. To assist jurisdictions in the continuingcompetence evaluation of licensees by providing a

standardized tool that can form the basis of an audit. Prior to the presentation, the Washington State Licensing

Board agreed to approve 20 hours of CEUs to licensees whoparticipated in and completed the project. Each licensedphysical therapist will participate in self reflection on theireducation, experience, practice and continuing competencyby developing a professional portfolio. Following thisexercise they must complete a twelve-page self assessmentbased on the FSBPT Standards of Competence, which wereapproved by the FSBPT Board of Directors in 2000.

The assessment is divided into sections for each professionalpractice system: musculoskeletal, cardiovascular/pulmonary,neuromuscular and integumentary. Each section asks questionsabout specific diagnoses within those areas. The participantsare required to track their continuing education courses forone year to determine if the self assessment survey has anyeffect on the choices each person made. The finalrequirement for completion will be to evaluate the projectitself. Once the evaluation of the project is finished, theparticipant will receive a certificate of completion todocument the 20 CEUs that they have earned towards therenewal of their license, a requirement in Washington State.

FSBPT plans to pilot the CAPPS project in one or twoadditional jurisdictions in spring 2005. Once the CAPPSpilot projects are completed, it is our hope that the processwill provide data for the Federation to use in developing acontinuing competence evaluation tool that will be availableto all jurisdictions. ■

“…over 125 licensees have agreed to

participate in a one-year pilot program for

the ...CAPPS project.”

Christine A. Larson, PT, is the Federation’s Director of Professional Standards. She has more than 10 years of experience as a Washington State Board of Physical Therapy

member, and an equal amount of experience in the Federation, as Washington’s delegate to the Delegate Assembly and as member of the Model Practice Act Task Force,

Ethics and Standards of Practice Committee and Legislative Committee. She also served as secretary on the FSBPT Board of Directors.

T he Federation has been working for several years on providing tools that jurisdictions may use in assessing licensees’

ongoing competence. These continuing competencetools include jurisprudence examinations, the portfolio/selfassessment project and the practice review project.

Jurisprudence Examinations

Four states currently utilize computer based jurisprudenceexaminations. These jurisdictions include California Florida,Georgia and Nebraska. Arizona and the District ofColumbia are currently working with the Federation todevelop exams in 2005.

Practice Review

The practice review is in the planning stages and will usemethods of self instruction and self examination similar tothe Practice Exam and Assessment Tool (PEAT) for theNational Physical Therapy Examination (NPTE).

Portfolio/Assessment Project: CAPPS

The portfolio/self assessment project has undergone somerevisions since the kick off presentation on Friday October23rd, 2004 at the Washington Chapter Fall Conference inTacoma, Washington.

Over 75 licensed physical therapists from Washington Stateattended the introductory meeting and over 125 licensees haveagreed to participate in a one-year pilot program for theContinuing Competency Assessment of Physical TherapyProfessional Standards for Public Safety (CAPPS) project.

CAPPS is a formative evaluation process, providing astructured tool for the physical therapist to assess his/herknowledge, skills and abilities and plan appropriate and relevantprofessional development activities, identified by the tool.

CAPPS has been developed to meet the following objectives:1. To provide a standardized tool for practitioners to

assess their knowledge, skills and abilities against theFSBPT standards of competence.

Update on the Continuing Competence Pilot Projects

Christine A. Larson


Security WatchMark Lane, PT

In today’s world, the word, “security” is ubiquitous. Manytimes a day we hear it on television, we read it in thenewspaper, and we use it in everyday conversation. We take

steps to provide ourselves with security from credit card fraudor from computer hackers on our personal or work computers.We patiently wait through long lines when we travel in order togo through airport security. We double check to make sure ourhouse and automobiles are locked and secure.

An Important Value

Security is something we all strive for. It is a value we hold dear.In fact in the last presidential election, national security wasoften cited as the reason that voters selected the incumbent overhis opponent. Indeed “homeland security” is a new federalagency developed to increase national security. Unfortunatelysecurity is not an absolute. We cannot speak in terms of “beingcompletely secure,” we can only speak in terms of being “moresecure” or as “secure as possible.” And we have to always beaware that there is the potential for a security breach at anymoment. The minute we feel secure and let down our guard isthe moment we are most vulnerable.

A New Paradigm

The security of the National Physical Therapy Examination hasalways been of high importance. As we look at the historicaldocuments related to the NPTE, including exam policies, secu-rity is often mentioned. Recently, however, we have had torethink our view of security. Much as 9/11 changed how thiscountry viewed security, the NPTE cheating episodes of 2002made us review our own paradigms regarding security. As aresult we have broadened our definitions and expanded ourscope as it relates to security. We have realized that we cannotsimply maintain policies related to security. Security mustalways be in the forefront of our minds and focus.

Security Watch

In light of this focus on security, we have developed this new

column in the Forum, “Security Watch.” This column willapprise our members and other readers of critical securityissues. We want our members and the exam stakeholders to beaware of the issues surrounding exam security. We want andneed partners in maintaining, improving and monitoring examsecurity. As we impel the FSBPT to become more secure, weask member boards to also continually review their policies andprocedures related to security. You will continue to see articleson cheating and its impact on examinations. We will alsoprovide summaries of actual security breaches related to theNPTE or other examinations in order to make the readershipaware. We will provide opportunities for our member boardsto discuss security issues.

Detection

A good examination security program comprises three criticalaspects: detection, remediation and prevention. Detectioninvolves detecting any security breaches that may occur. Thisaspect includes analysis of items over time to determine if itemshave been compromised. In also includes having a “tip” emailaddress. Did you know that candidates or anyone else can senda report of a security breach to [email protected]? Exam forensicsis another aspect of detection. This involves ongoing review ofstatistics and evidence of significant changes in results over time.It may include reviewing significant increases in exam scores onre-takes or it may be reviewing of significant changes in testscores at one particular testing center. Neither of these changesindicates an actual security breach. They simply provideinformation that needs to be explored further. Web monitoringis another aspect of security breach detection. Since the cheatingepisodes of 2002, we have had to monitor internet websitesdaily. Many mechanisms utilized at our exam test sites such asvideotaping all candidates falls into the detection category.

Remediation

Remediation involves having policies in place to not only dealwith the causes of the breach but to also recover from the breach.

Mark Lane, PT, is FSBPT’s Vice President of Professional Standards and Assessment. He has been licensed as a physical therapist and active in the American Physical

Therapy Association for more than 20 years, serving as chapter president of the Washington state chapter for four years. He was on the Washington State Licensing Board

for seven years, serving a term as chair. Mark has been on the Federation staff since 1998. Previously he directed a large physical therapy department in a rehabilitation

hospital outside Seattle, Washington.

A N O V E R V I E W O F N P T E S E C U R I T Y

S E C U R I T Y WAT C H continued on page 16


A t the September 2004 annual meeting, Judy White(FSBPT Board of Directors), Martha Clendenin (Chair of the Florida Board), Steve Hartzell

(Executive Director of the California Board) and William A.Hatherill (FSBPT CEO) participated in a panel discussionon "NPTE Cheating Lessons Learned." The following are keypoints from that discussion.

The Federation defines cheating as the illicit sharing ofmemorized or recalled questions from the NPTE thatincludes but is not limited to memorization or copying ofany questions from any version of the NPTE or the knowing,reckless or intentional provision, in written or verbal form, ofany questions memorized or copied from any version of theNPTE to or from any other person through any meanswhatsoever.

Trafficking in recalled test items

The discovery of trafficking in recalled National PhysicalTherapy Examination items was initially found on both a testpreparation company’s "discussion forum" and on the Internet,where the Practice Exam and Assessment Tool (PEAT) wasbeing made available. Action was taken almost immediately.

Actions taken

IDENTIFYING THE ALLEGED VIOLATORS. The testpreparation company sought to identify alleged violatorsthrough investigative action, internal communications and bycontacting jurisdictions. In addition, the recalled items wereremoved from the discussion forum and a warning notice wasposted on that forum. COMMUNICATING THE CONSEQUENCES. Onceidentified, alleged violators were informed of potentialviolations that included copyright infringement (copyingoriginal work without permission or legal justification),breach of contract and violation of state trade secret laws.An administrative complaint was also filed with the allegedviolator’s jurisdiction.ONGOING MONITORING OF THE INTERNET. The FSBPTboard instituted an ongoing monitoring of discussion forumand other sites.

The National Physical Therapy Examination (NPTE)

Lessons Learnedabout Cheating

$$$


LEGAL STRATEGIES. The leadership of FSBPT designed alegal strategy to pursue candidates trafficking in recalleditems. That strategy focused on the person’s admission ofwrongdoing, a monetary penalty, a posting of a curativemessage and disclosure of other infringing persons. PUBLICIZING THE CONSEQUENCES. Further action camethrough public press releases and notices in studentpamphlets as well as by alerting member jurisdictions andthe academic community.EMPHASIZING CONSEQUENCES TO THE BEGINNING

OF THE NPTE. The NPTE now includes a securityacknowledgement that confirms the test and its contentsare the Federation’s exclusive property and subject tofederal copyright law protection.

Candidates read about possible consequences regardingthe testing period itself, which can include termination ofparticipation, invalidation of results or other appropriateaction. A security brief reminds them that they haveagreed not to copy, reproduce or electronically transmitany of the test’s contents. The penalty, as noted, iscriminal and civil proceedings that actively investigate andprosecute the violator. Any violation may jeopardize theability to practice.STRENGTHENING THE MODEL PRACTICE ACT

LANGUAGE The Model Practice Act now contains thispassage:

"If the board determines that an applicant or examinee has

engaged, or has attempted to engage, in conduct that subverts

or undermines the integrity of the examination process, the

board may disqualify the applicant from taking the exami-

nation. Examples of such conduct may include, without

limitation, utilizing in any manner recalled or memorized

examination questions from or with any person or entity,

failing to comply with all test center security procedures,

attempting to communicate with other examinees during the

test, or copying and sharing examination questions or

portions of questions. Any such violation shall be recorded in

the official records of the board. Board action may include

the following:

1. Disqualify the applicant, permanently or for a specifiedperiod of time, from eligibility for the examination.

2. Disqualify the applicant who has failed the examinationfrom eligibility to retake the examination.

3. Disqualify the applicant, permanently or for a specificperiod of time, from eligibility for licensure.

4. Revoke, suspend or impose probationary conditions on anylicense [or certificate] issued to such applicant.

It further states that, “If an individual is licensed they may be subject to the loss of

their license to practice. In many states, an applicant whose

conduct to subvert or undermine the examination process gives

rise to grounds for board discipline, may not be allowed to

retake the examination, even with different test questions, due

to the applicant’s history of question sharing and the lack of

good moral character.”

Needless to say, some valuable lessons were learned.FSBPT needed to make it an ongoing responsibility to

monitor the Internet and to review preparation courses for taking the NPTE.

Jurisdictions were hesitant to take the lead, preferring to await final action by FSBPT. Some were subsequentlyunable to take action on unlicensed practitioners.

Jurisdictions had differing approaches to dealing with the issue of candidates or physical therapists cheating.

It was a costly discovery, both internally and fiscally.There were 103 items compromised. An enormousamount of time and energy was spent by volunteer itemwriters and staff to replace these items. There was also alegal cost of $100,000 to pursue the offenders. ■

It was a costly discovery, both internally and fiscally. There were 103 items

compromised. An enormous amount of time and energy was spent by

volunteer item writers to replace these items. There was also a legal cost

of $100,000 to pursue the offenders.


FCCPT UpdateFCCPT—Annual Summary of Review Results, January 1-December 31, 2004

Each year FCCPT is asked by the United States Citizenship and Immigration Services, (USCIS) to publish theoutcomes of its previous years certificate processes and outcomes. Reports are published annually in the monthlyNews Briefs, the FSBPT Forum and posted on the FCCPT website, www.fccpt.org.

TYPE 1 Comprehensive Credentials Review* Total Number

Applications Received 792

Evaluations Completed 506

Certificates Issued 222

Certificates Denied 284

Renewals Requested or Issued 0

* For immigration and licensure purposes

TYPE II Visa Screening Certification** Total Number

Applications Received 629

Evaluations Completed 607

Certificates Issued 560

Files Expired after 12 months and incomplete 47

Certificates Denied 0

Renewals Requested or Issued 0

** For immigration purposes only (candidates holding current U.S. licenses)

It’s In the MailThe following items were sent to members since the fall 2004 issue of Federation Forum was published.

If you are not receiving these, please contact Maribeth Decker at 800-881-1430, ext. 227 or [email protected].

■ News Briefs were issued each month via email or fax to all board members, board administrators and committee members.

■ The 2005 National Physical Therapy Exam (NPTE) Policies Manual was emailed to board chairs and administrators forreview.

■ The quarterly faculty newsletter was sent to PT and PTA program directors.

■ Two news flashes were sent to the membership regarding the APTA lawsuit, one in November 2004 and a second inJanuary 2005.

■ A summary copy of the budget was mailed out in December 2004 to FSBPT committee chairs, board members andadministrators.

■ An email was sent to board administrators in January 2005 explaining the changes to the NPTE this year.


2005 Boards and CommitteesDuring fall 2004, elections and board appointments resulted in the following membership on the FSBPT board and committees.

FSBPT Board of Directors

E. Dargan Ervin, SCPresident

Charles Meacci, PAVice President

Senora D. Simpson, DCSecretary

Kathy Fleischaker, MNTreasurer

Thomas Mohr, NDDirector

Ann Tyminski, MDDirector

Judy White, WIDirector

Barbara Safriet, CTPublic Member

Education

Stephanie Lunning, MN Chair

Kathleen A. Cegles, SCMelinda Christianson, MOCheryl Gaudin, LABarb Kraynik, OHChuck Meacci, PA

Board Liaison

Exam Administration Committee

Diane Hansmeyer, NE Chair

James Heider, ORKaye Howerton, FLBecky Klusch, KYAdam Smith, CA

Student representativeAnn Tyminski, MD

Board Liaison

Ethics and Legislation

Margaret Donohue, NH Chair

Seth Coulter, ARKevin D. Heupel, COPeg Hiller, AZCarol Maupin-Wheelock, TNKent Culley, PA

Legal advisorJudy White, WI

Board Liaison

PT Exam Development Committee

Pam Leerar, WA Chair

David Barlow, MAAnne Boyle, TXNoelle Buell, WAMatthew Garber, TXSusi Hoshi-Castoro, VAVicki Mercer, NCRobert Sandstrom, NESusan Shore, CARebecca Welch, TNTom Mohr, ND

Board Liaison

PTA Exam Development Committee

Douglas White, MA Chair

Erin Hussey, WIVenita Lovelace-Chandler, CAJohn Lowman, VAJoan Morse, FLCarol Sawyer, MOTom Mohr, ND

Board Liaison

Finance

Kathy Fleischaker MN, Chair

Patricia Adams, LADonald Chu, CAHeidi Herbst Paakkonen, AZJeffrey Rosa, OHE. Dargan Ervin, Jr. SC

Board Liaison

Investment

E. Dargan Ervin, Jr., SC Chair

Kathy Fleischaker, MNCharles Meacci, PA

PT Item Bank Review Committee

Denise Bender, OK Chair

Phyllis Guarrera Bowlby, NJDeanna Dye, IDFrances Huber, MDSusan Roehrig, ARKevin Van Wart, FLTom Mohr, ND

Board Liaison

PTA Item Bank Review Committee

Scott Romanowski, GA Chair

Karen Cascardi, FLSue Howard, MNMindy Sacks, MDTom Mohr, ND

Board Liaison

Nominating

Peter Petrone, RI Chair

Eugene R. Lambert, MARon Seymour, NYE. Dargan Ervin, Jr. SC

Board Liaison

Resolutions

Jim Hughes, IA Chair

Martha Clendenin, FLDavid Perry, MIJudy White, WI

Board Liaison


S E C U R I T Y WAT C H continued from page 11

A good security plan includes an emergency plan. TheFederation has developed a comprehensive emergencyplan. Within the emergency plan is a plan to continuallybuild and increase the item bank. Also within the planare specific outlines of action to be taken as a result ofvarious security breaches.

Prevention

Prevention is probably the most important aspect of a securityplan. As the adage states, “an ounce of prevention is worth a pound of cure.” Prevention in an exam program includescontinual warnings to candidates so that they are aware of their obligations when they sit for the exam as well as theconsequences of cheating. Prior to seeing the first question,candidates must click on an agreement stating they will not sharerecalled questions. A good security prevention plan also includespolicies related to frequency of item use and strict retake policies.Other aspects of prevention include the security measuresimplemented at the Prometric testing centers such as notallowing candidates to take personal items in the testing room.

Prevention also includes education of stakeholders such as thefaculty of physical therapy programs. Students need to knowthat if they cheat, they may loose the ability to ever practicephysical therapy. Licensing boards may be able to educate thosecandidates from different cultures where values may differ tounderstand the implications of cheating in this culture.

Many of the recommendations provided by the 2003 NPTECommission, an external commission that reviewed pass ratefluctuations of the NPTE, are related to prevention. Amongthese are many of the NPTE changes that are being implementedin March 2005. Included among these changes is increasing thenumber of forms and assuring that no candidate ever sees thesame question twice. Another recommendation is providing theexam in sections.

Review of our Security Program

In 2004, the FSBPT participated in an external security auditof our exam program. This audit, while recognizing many ofthe things we do well in relation to security, also identifiedareas for improvement. The Federation is currently working onimplementing many of the recommendations provided by thisaudit.

Physical Security

The Federation goes to great strides to assure physical securitywhich includes security of the building, the servers and the itembank. If the reader visits the Federation offices, this will becomereadily apparent. The building is only entered via a secure passcode. Guests must sign in and are monitored while in the

building. Beyond this, areas in which staff works on theexams have additional security. Great lengths are taken toassure the security of the item bank and the exam questions.

Security policies and procedures are carefully followed. Inaddition to having an audit of the security related to examdevelopment process, an audit is also scheduled to look at thesecurity of the servers and the systems. This audit will includelegitimate hackers who will try to breach the security systems toassure that they have sufficient safeguards.

Security Involves You

A comprehensive exam security program involves more thanassuring the security of exam development and administration,it also involves our member boards. Since member boards areresponsible for approving a candidate to sit for the exam, it iscritical that each member board have policies and procedures inplace that assure only qualified applicants sit for the exam. Thisauthor suspects that policies and procedure vary widely betweenmember boards—some boards being extremely careful, whileothers may be not so careful. Other stakeholders also need to beinvolved. Educators including clinical educators are critical forhelping instill professional values in students.

Security will continue to be an important term in the world,in this country and in relationship to the National PhysicalTherapy Examination. We hope to continue to educateourselves, our members and the stakeholders of the manynuances and issues related to examination security. As we dothis, we can work together to continue to maintain theexcellence of the NPTE program and assure it will continue tocarry out its critical function related to public protection.

Cheating in the News■ Lance Ulanoff, in his article, Bamboozled with Technology of

May 27, 2004 in PC Magazine online, states that every stepforward in technology provides an opportunity to createnew technology to beat the system. Ulanoff cites the dialingsoftware that has been used to override American Idol’s“one vote per person” phone system. His research showsthat phone system hacking or “phreaking” has already beenaround, but has been evolving to overcome new technologydesigned to thwart the old tricks. He points out that withnew opportunities to cheat, contest and test organizers findthat they need to be proactive.

■ Houston’s School District has created an investigative teamand tougher testing practices to decrease the amount ofcheating in its schools by teachers who are pressured to makesure their students pass the state’s assessment tests. They haveinstituted a hotline to report cheating, which goes directly tothe Inspector General. ■


with dozens of transition students, Brownhas a potent list of questions.

“We have to address questions on manualtherapy. What is your experience? Wherehave you learned basic mobilization and the concepts ofmanual therapy? Do you know the psychotic mental healthdrugs? The anti-anxiety drugs? The hypertension and cardiacdrugs? These are things that cross practice and reflect thecomplexity of practice today.

“Do you know about tissue healing in wound care andnewer protocols? Do you know about the cardiovascularlimits in exercise prescriptions? Do you know about assistivedevices? Do you know what a CPM is, and do you knowabout automatic IV pumps?”

Addressing the additional problems facing foreignstudents, Brown said that compassionate caring practice isreally not a concept in many countries where medicine ismore socialized. Treatment planning is also not a universal

concept. “On the other hand, many of ourforeign therapists don’t have as much difficultywith the concept of providing care and limit oftreatment plans.”

Brown believes it will take six to eight months of part-timeeducation to adequately bring someone up to today’s entry-level program. The cost averages $130 a day; it costs $3,000to $7,500 per person, done correctly. A larger problem,though, is that there are not enough re-entry people in onearea to make this type of education worth while. Brown points to a web-based education as the most feasible.

In summary, Brown says, “Licensure without competenceassurances allows out-of-date practice and that is not just aproblem for practitioners re-entering the practice setting. Allphysical therapists need updating as professions transition to ahigher complexity of practice. A coordinated effort must bedeveloped between regulators, educators and professionalassociation people.” ■

Suzanne Robben Brown, MPH, PT, Associate Professor, is Director of Physical Therapy at AT Still University, Arizona School of Health Sciences. Suzanne has thirty-one

years experience as a physical therapist with eighteen years in education. She received her physical therapy professional education from the University of Oklahoma,

her masters in Public health from the University of Oklahoma Health Sciences Center, and completed doctoral level studies in higher education administration from

Oklahoma State University. Suzanne has served on many professional boards and committees including serving as a Director of the American Physical Therapy

Association and on the Oversight Committee for the Transitional Doctor of Physical Therapy. She currently serves as Treasurer, Arizona Chapter, APTA. She is the

founding Chair of the Physical Therapy Department at ASHS, having joined the Arizona School of Health Sciences in 1995. In 2003, she received the Lucy Blair Service

Award from the American Physical Therapy Association.

C A N A D I A N M O D E L continued from page 7

A M E R I C A N M O D E L continued from page 9

Susan Glover Takahashi, PT, BSc (PT), MA (Ed), PhD. Susan has considerable expertise in the description and evaluation of competency as well as regulatory policy

frameworks. She was previously the Executive Director of the Canadian Alliance of Physiotherapy Regulators where she oversaw the credentialing and examination

programs. Susan is the currently the principal of SGT & Associates Consulting, which provides client-focused support in the areas of competency assessment, regulatory

policy and educational and testing design. In addition, Susan has served on the Board of Directors for the Foreign Credentialing Commission on Physical Therapy

(FCCPT) since 1998.

years after graduation, the chance of successon the test diminishes for both active andinactive practitioners.” To that end, otherfactors are considered. “The applicant will berequired to demonstrate integration…of knowledge, skillsand abilities into physiotherapy practice. We’re going to belooking at the portfolio to see that they had lots ofopportunity to practice and we’re going to find out if theyknow how to assess, how to treat and how to diagnose,”Takahashi said.

Canadian licensure renewal

“For those who are already licensees in Canada, weare requiring that this integration of practicecompetency be 3,200 hours full-time work within a

period of not less than two and not more than three years. It’sessentially a free pass on the exam.”

Takahashi concludes, “You have to balance statutoryauthority, information and evidence-based decision making.How often did they ride that bike and how often did they oilthose wheels when they weren’t riding?” ■


L E G A L N O T E S continued from page 5

most likely by the regulatory bodies dealing with practiceissues including title restriction or protection. Unless aspecific legislature in a jurisdiction has adopted an academicdegree, such as “MPT” or “DPT,” the protection orrestriction of such title by a licensing board is not legallyappropriate. Clearly, such protection of these titles cannotcome from the profession or individuals' adoption of suchacademic degree titles. Licensing boards should resist gettinginvolved in the controversy and confusion over theseacademic titles, particularly where the statute and languageare clear in the protection and restriction of the physicaltherapy terminology or unless the legislature has madesuch academic degree titles regulatory titles and bestowed them with appropriate protection.

The physical therapist, having gained any basic oradvanced degree related to physical therapy, or a specialtycertification, is still professionally and by definition, aphysical therapist. The bestowed academic degrees, toeliminate such confusion, should reflect the fact that theperson is first a licensed physical therapist followed by anyacademic or specialty degree like MS, Ph.D. (DPT) orOCS or the like. The Model Practice Act (Third Edition) is instructional here. Section 4.02, Use of Titles and TermRestrictions, Paragraph A, recommends quite directly usingthe letters “PT” in connection with the physical therapist’sname or place of business. Section B gives the needed titleprotection to restricting the use of the PT title as well asother similar titles utilized to describe the status of thephysical therapist in practice. No doubt the list in ParagraphB could even be expanded in view of the continuousinfringement problems experienced by the profession andthe licensing boards and the possible additional adoption ofan academic degree as a title.

Again, adoption and protection or restriction of any typeof academic degree titles should be left to the considerationof the legislature. Use of additional titles by the licensedprofessional may tend to confuse the public and provideunnecessary administrative burdens to the various licensingboards whose job it is to regulate the statutory practice ofphysical therapy and provide public protection.

J. Kent Culley

Excerpts from Section 4.02 of the Model Practice Act forPhysical Therapy, published by the FSBPT

4.02. Use of Titles and Terms; Restrictions;Classification of Violation

A. A physical therapist shall use the letters “PT” inconnection with the physical therapist’s name or place of business to denote licensure under this [act].

B. A person or business entity, its employees, agents orrepresentatives shall not use in connection with thatperson’s name or the name or activity of the business, the words “physical therapy,” “physical therapist,”“physiotherapy,”“physiotherapist, registered physicaltherapist,” the letters “PT,”“DPT,”“LPT,”“RPT,” or anyother words, abbreviations or insignia indicating orimplying directly or indirectly that physical therapy isprovided or supplied, unless such services are provided by or under the direction of a physical therapist licensedpursuant to this [act]. A person or business entity shallnot advertise or otherwise promote another person asbeing a “physical therapist” or “physiotherapist” unlessthe individual so advertised or promoted is licensed as aphysical therapist under this act. A person or businessentity that offers, provides or bills any other person forservices shall not characterize those services as “physicaltherapy” or “physiotherapy” unless the individualperforming those services is a person licensed as aphysical therapist under this [act].

C. A physical therapist assistant shall use the letters “PTA”in connection with that person’s name to denote[certification/ licensure] hereunder.

D. A person shall not use the title “physical therapistassistant,” the letters “PTA,” or any other words,abbreviations or insignia in connection with that person’sname to indicate or imply, directly or indirectly, that theperson is a physical therapist assistant unless that personis [certified/ licensed] as a physical therapist assistantpursuant to this [act].

E. A person or business entity that violates paragraphs (B)or (D) of this section is guilty of a [cite specific legalsanction].The board shall have authority to impose a civilpenalty, in an amount not to exceed [specify number of


dollars] per violation, against any person or businessentity that violates paragraphs (B) or (D). In addition,the board may seek an injunction against conduct inviolation of paragraphs (B) or (D) in any court ofcompetent jurisdiction. For purposes of this [act], theboard, in seeking an injunction, need only show that thedefendant violated paragraphs (B) and (D) of this sectionto establish irreparable injury or a likelihood of acontinuation of the violation.

Discussion:

Two of the most significant sections of a practice act are 1) the scope of practice, and 2) title protection. The statelegislature, acting to protect the public and on their behalf,grants scope of practice privileges and imposes certainrestrictions on the use of titles and terms. The use of thetitle “physical therapist” connotes a unique education and a set of skills with the potential to provide beneficial serviceto the public.

Title protection encompasses names and titles, as well as the letters and abbreviations that are associated withprofessional degrees. Paragraph B above addresses all suchtitles, designations and abbreviations applicable to physicaltherapy.

The terms “physical therapy” and “physiotherapy” are notgeneric terms and only physical therapists are entitled totheir use. The claim that physical therapy is a generic termis misleading, and legislatures should be made aware of theimportance of protecting any such related terms that implyphysical therapy is being provided.

“PT” is the most common designation currently used byphysical therapists, although it is not the only legaldesignation. It is desirable to have a consistent standardthroughout the profession and from state to state. Thisstatute clause emphasizes that “PT” is the consistentstandard. There is a prohibition against substituting but notagainst adding other letter designations indicating anacademic degree (e.g., MS, PhD), professional degree (e.g.,DPT), certification (e.g., ATC), or honorary status (e.g.,FAPTA), but all such additional designations should followthe standard “PT” designation.

Paragraphs C and D, above, add much stronger titleprotection to physical therapist assistants. In view of otherdisciplines that may claim they are providing “physicaltherapy” and delegate the provision of modalities to officestaff or aides under their supervision, this clause becomesvery important. It should be noted that this is one areawhere title protection is granted without a correspondinggranting of a scope of practice. Physical therapist assistants,while being granted title protection, do not practicephysical therapy. They assist physical therapists in theprovision of physical therapy services.

A well-designed title protection section or provision is ofconsiderable importance in a court action where titleappropriation or misrepresentation is at issue. See, e.g.,Bureau of Professional and Occupational Affairs v. StateBoard of Physical Therapy, 701 A.2d 292, 294 (PA.Cmwlth. 1997) affirmed, 556 Pa. 268, 728 A.2d 340 (PA.Supreme Ct. 1999), prohibiting the use of the term“physical therapy” in chiropractic advertisement. ■

2005 Continued…

NOVEMBER

5-6 Ethics and Legislation Committee • Alexandria, VA

17-20 PTA IBRC/EDC • Alexandria, VA

DECEMBER

2-3 Finance Committee Meeting

4-5 BOD Meeting

2006

SEPTEMBER

8-11 Annual Meeting • Portland, OR

NOTE: The PT and PTA Exam Construction and ReviewCommittees have been renamed the PT Exam DevelopmentCommittee and PTA Exam Development Committee.

C A L E N D A R continued from page 2


This required intervention with the faculty,as not everyone was using multiple choice orcomputerized grading and item analysis. Weworked to develop the faculty’s ability to writetest items by bringing in a consultant for anitem-writing workshop. Those faculty memberswho were comfortable using item analysis also discussedtheir work with other faculty members. Faculty memberswere encouraged to visit the FSBPT website for insight.

We also renewed the emphasis on the patient scenarioformat. We felt that we had moved away from an emphasison skills and toward an emphasis on teaching theories andprinciples and allowing students to do problem solving andcritical decision-making based on theories. There was simplynot enough practice in applying those theories to patientscenarios.

Finally, we stressed the importance oftextbooks with students, emphasizing textbookstudy as opposed to class notes in preparationfor the exam. We noted that the exam is basedon current practice, rather than classroomteaching of what we would like it to be.

Recommitting to multiple choice items

Lower scores first got our attention in 2002. The facultyinitially looked at the curriculum because that was in ourcontrol and we felt we were doing a good job in terms ofblueprint and content outline. However, in the early 2000s,we began moving from pure philosophy to a case base and inadvertently abandoned multiple choice questions.Philosophically, we felt that other assessment tools weremore in keeping with the learning activities and instructionalmethods.

But students who had once been good test takers told us they had been losing that skill while in our curriculum.As a result, we decided to make a philosophical shift and re-commit to multiple choice and become much better item writers. Three faculty members are item writers for the NPTE exam; we asked them to help the rest of thefaculty appreciate and improve their test writing skills.

We continued to encourage students to do a lot of self-assessment after exams. Students were also encouraged toconsider taking an examination and preparation course. In the past, virtually none of our students utilized thecommercial course unless they had failed the first time. The class embraced that idea and organized a test preparationcourse at the end of the curriculum. The students picked upmost of the expense.

We have also tried to shift to computerized testing. Wewere concerned with cheating, as we thought a few studentsvisited web sites during the test. We are now waiting fortechnology to improve before we proceed further with thistype of testing.

In the last semester, we tried to put much more emphasis on the NPTE expectations. We told students what they should expect in terms of studying and broughtformer students in to provide feedback. We tried to set adifferent tone on the difficulty and consequences of theexam, pointing out that by no means is passing the exam a given.

PA S S I N G S C O R E continued from page 1


Focusing on patient-scenarioquestions

As the lone full-time faculty member at theschool, I was very troubled by the sudden dropin scores in 2000-2001. One of the first issueswe looked at was test design, specifically, how wewere writing multiple choice questions. Because we wererelying on adjuncts, it was very difficult to have a lot of controlover the exams.

We looked at every one of our exams and realized we were lacking patient-scenario-type questions. We have sincestarted identifying sample questions and are putting themon the exams to let students know that this is the level ofthinking that will be required. We do, however, throw thequestions out if more than half of the class gets them wrong.

We revisited questions and content concerning ethics, lawand the scope of practice for the physical therapist assistantand are currently trying to re-write all the questions to makethem more like a case scenario. We encourage students toattend a review course.

Before the last clinical, we have two seminar courses that donot require exams, but address management issues and qualityassurance. We also administer a test that students believe willbe graded. Instead, we give it back to them to be used as a self-assessment tool. Finally, we give four different versions of asample exam to develop areas in which they are weak.

Developing a comprehensive exam

I believe there are multiple variables concerning improvementof the passing grade. For instance, at the same time wefinally received funding for more students, we had adramatic reduction in the number of applications. If you go from 650 to 150 applicants and at the same time increasefrom 24 to 40 available openings, you have some newdynamics.

Seven years ago, we initiated a written comprehensiveexam that used a multiple choice format, and the faculty waseducated on how to write a good question. We felt it wasimportant to have case studies on the exam, so we includedabout eight or nine on the exam. About 140 questions areasked over three to four hours. I should note this is still apencil and paper exam; we are not comfortable withcomputers.

We use this comprehensive exam to measurecurriculum, to learn who these students are andhow they perform relative to the curriculum,how they perform in the clinic, and, finally,how they fare on the exam. When the test iscompleted, we emphasize self-assessment.

We also emphasize the consequences, but these are in the form of corrective behavior. We bring low-scoringstudents in, and pose questions to them in an open bookenvironment. They then have to go get the answers.

We still have some concerns that students may have onlyused curriculum to prepare for a test, and that textbookassignments are being ignored. We are continually tellingstudents now that they need to need to read those chaptersto prepare for the exam.

Students are allowed to come back for a week ofreview

We have always had a good pass rate, although this year, our passrate dropped. We knew that our applicant pool has dropped, yetoddly enough, students who had difficulty on NPTE were notthe students who had problems on their clinicals.

At one time we had a comprehensive exam, but found thecorrelation between that and the national exam wasn't verygood. Now we have comprehensive practical exams thatencompass anything up to that point. Students like it betterthan one more multiple-choice exam. By the way, we havealways shared the test content outline and its wording withthe students.

Something that has also worked for us is having thestudent come back for a week at their option. We pull allthe exams, have them retake those exams by looking up theanswers and then visit with a faculty member. So far, it hasworked. Test-taking ability, I think, depends on content,inherent test-taking skills, preparation and the depth ofreading skills required. ■

We looked at every one of our

exams and realized we were

lacking patient-scenario-type

questions.


FSBPT. This group will review and study our exam activitiesand provide feedback and direction to strengthen the NPTE.Human Resource Research Organization (HumRRO), a non-profit research organization, will be performing the outsideaudit of the 2004 exams and will report their findings to the FSBPT Board. Also, later this year we will be seekingaccreditation by the Buros Institute certifying the higheststandards in licensure testing.

Exam Security

In addition to processes to ensure examination quality, weroutinely perform activities to maintain physical and electronicsecurity for the examination program. As a follow up to theInternet cheating three years ago, we continue to monitorInternet chat rooms and other sites where copyrighted examquestions can be posted. We also perform security exercises onour own systems and networks to prevent intrusions byunauthorized persons. These security measures will also helpto continue to protect exam candidates who provide us withvery sensitive and personal information. We accept thisresponsibility and take it very seriously.

We have changed the way the NPTE is delivered tocandidates to reduce item exposure and protect the integrityof the exam questions. In March 2005, the NPTE will bedelivered in segments to the candidates. The exam will bebroken into 50 question segments, or sections, with a 60minute time limit. Candidates may not go back to priorsegments once the candidate submits a section. Also,candidates will be allowed a 15 minute break after completionof the second segment that does not take away from the totalexam time.

Enriching the Test Question Item Bank

The NPTE Commission strongly recommended that weenrich the Test Question Item Bank. Starting in March 2005,we will be increasing the number of pre-test questions on eachexam from 25 to 50. This will help produce more live examitems each year and help make the Item Bank stronger. Anadditional 30 minutes will be added to the time allotted for completion of the exam with no extra charge to thecandidates. We continue to explore methods for improvingour pre-testing process, including assuring that as many pre-test items as possible end up “passing” the statistical criterianeeded to become operational items. The newly implementedItem Bank and Development software can help us to this end.

A Commitment to Research

In 2004, the Federation Board made a financial commitmentto research by creating a Research Reserve Fund totaling$30,000. The 2005 Budget includes up to $100,000 forresearch expenses. The Board has approved a ResearchProgram and the 2005 Research Agenda. All research projectsmust support the mission of the Federation. There is currentlyan ongoing research project related to the exam that willprovide information that we can use to learn more about the exam and the candidates. Such research and learning can be used to strengthen the program. We have a ResearchReview Committee that reviews each research proposal andapplication. The committee consists of research expertsoutside of FSBPT staff.

Future Enhancements

Future enhancements to the NPTE include increaseddevelopment of exam questions that use visual items. Thisincludes increased use of pictures and the introduction ofvideo based questions.

Exam Registration

We have continued to improve the exam registration process.The electronic delivery of Authorization to Test (ATT) lettersenables candidates to schedule an examination even faster.This can further reduce the time it takes to enter theprofession once they demonstrate entry-level competence by passing the exam. We are also working to get all 53jurisdictions online with the exam application and scorereporting system. Currently 45 jurisdictions use the system.We have seen the time from testing to licensure drop to aslittle as one day with some states that are using the onlinesystem. We continue to solicit feedback from candidates andjurisdictions and will implement changes that improveservices as long as security and consumer protection are notcompromised.

As a Board member of a licensing jurisdiction, I value the NPTE and am glad that our Board has a licensingexamination that evaluates entry-level competence based onthe highest industry standards and is reliable and defensible.As President of the Federation of State Boards of PhysicalTherapy, I will work to make sure that the NPTE remains a valuable tool for all of our jurisdictions. ■

P R E S I D E N T continued from page 3


FSBPT DELEGATE ASSEMBLY ELECTIONS • SEPTEMBER 12, 2005

CALL FOR NOMINATIONS Positions available: ■ Director ■ Treasurer ■ Member of the Nominating Committee

The FSBPT Nominating Committee will meet this spring to prepare a slate for the upcoming election. If you are interested in running or would like to nominate someone for one of these positions, please send your nomination ASAP to theNominating Committee ([email protected]). Job descriptions can be obtained by contacting Maribeth Decker at 800-881-1430, extension 227 or [email protected].

FSBPT Nominating CommitteePeter Petrone, Gene Lambert, and Ron Seymour

I suggest the following individuals be considered for nomination:

Position

Name

Email address

Daytime phone

Member making nomination

Email address

Daytime phone

CRITERIA FOR SLATING CANDIDATES

A. Eligible to serve, if elected.

B. Consent to serve, if elected.

C. Experience related to the Federation:■ Offices held, committee appointments■ Demonstrated effectiveness in elected office or

appointed position■ Active or past member or administrator of

a licensure board

D. Personal characteristics:■ Leadership skills■ Decision-making skills■ Consensus-building skills; team player■ Ability to think and express self clearly■ Ability to meet deadlines/goals/objectives■ Parliamentary procedure/knowledge/experience■ Present understanding of critical licensure issues

E. Geographical location of recommendednominee

F. Professional experience of recommendednominee:■ Past as well as present experience■ Current positions held■ Area of primary work

G. Minimum Requirements:■ Treasurer: A member or former member of a

Member Board.■ Director: A member of a Member Board,

administrator of a Member Board, or an AssociateMember.

■ Nominating Committee: Widespread knowledgeof the membership; identification of leadershipcapabilities; and knowledge of Federation bylaws,functions, and responsibilities.

Federation of State Boards of Physical Therapy509 Wythe Street Alexandria, VA 22314

FIRST CLASS

Setting the Gold Standard for Service and Protection

forum winter2005 3 - fsbpt · federation forum • 3 president continued on page 22 the state of...

Documents