Unlike other healthcare fields, such as physical therapy or occupational therapy, massage therapy is actually two primary “tracks.” The first track is geared towards the use of massage as a personal care service, with a focus of general relaxation and wellness enhancement. While massage performed for personal care can enhance health, the focus of this track is not the use of massage as a specific treatment. The second track is the use of massage as a healthcare modality. Massage therapists using massage as a healthcare modality address pain and injury complaints, from the mild to the severe, or other issues of compromised health for an individual.
There currently exist no state licensure credentials that distinguish personal care massage therapists from those using massage as a healthcare modality.
Public safety is the primary issue when evaluating the need for CE. Sometimes the public safety concern is conflated to issues of hygiene or ethics only. However, massage as a pain or injury intervention and treatment modality is anything but benign. When performed inappropriately or for a medical condition where it should not be used, there is clearly the potential for harm to the client. Those working with massage in this capacity must be familiar with the contraindications, assessment and treatment protocols, as well as the cognitive components (anatomy, biomechanics, condition specifics, etc) that function to inform the therapist’s work with their clients. (In addition to the number of other skills that contribute to quality care such as client relations, care and clinical experience).
Right now, for the massage profession it is inappropriate to remove provisions for maintaining licensure that require advancing the education and training of therapists beyond the entry level.
While CE is genuinely debatable for massage therapists working exclusively within the personal care track, it is not for those applying massage as a treatment modality for specific healthcare needs. Without a method for discriminating between the two tracks, CE requirements need to be maintained for the entire massage profession.
Why Continuing Education Must Remain a Requirement
There are many good arguments in favor of continuing education in the massage profession. Below are the primary points that frame the importance of the issue.
- CE fills in training gaps in basic education: The minimum requirement for licensure in many states is 500 hours of training. Even in a top-notch 500 hour program, this is nowhere near enough time to prepare an individual for the complexities of clinical practice that are required for advanced therapeutic massage treatment. While many schools are increasing their requirements and trying to prepare their students for the higher expectations of today’s clients, there is no standardization in curricula to meet this particular goal and no state licensures specifically for this type of work.
- CE develops clinical competence: It is through the gradual and continual efforts to develop clinical competence that a massage therapist develops their professional skills to a level sufficient to treat clients with musculoskeletal conditions. The Accreditation Council for Graduate Medical Education (ACGME) has noted that clinical competence is not the achievement of a static set of skills. Rather, competence is something developed over time as an individual continually invests in their own self-improvement. The ACGME has described six core competencies that should be developed by medical professionals, which are a very good model for skills a massage therapist in the healthcare environment should aspire to as well. They include: patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills, and systems-based practice. 1
- CE protects the public: With few exceptions, massage therapists today seek to boost their clientele and practice by taking advantage of the demand for therapeutic massage. If CE is not mandatory many will not choose any training above and beyond their entry-level training. This is simply not adequate for the many complex clinical decisions faced in addressing compromised health conditions. It is through mandatory CE that massage therapists address their knowledge and skill gap so they can practice in a manner that is competent, effective, and safe to the public. Continuing education is currently the graduate program in the massage therapy field.
Currently, the massage profession by default is set up with a built-in reliance on CE. As the massage profession develops and its healthcare track matures, perhaps it will seek accrediting evaluation criteria that emphasize its role as a therapeutic treatment (similar to the programmatic accrediting criteria for physical therapy and occupational therapy). We must also move away from the idea that CE courses have to be about learning a new technique. There are many important aspects of clinical practice that are not taught in entry-level training and are not about learning a new movement with your hands.
There is a strong history in every healthcare profession of continuing education requirements in order to maintain the competence level of practitioners. Massage therapy should be no different.
Resources & Recommended Reading:
- Heffron MG, Simspon D, Kochar MS. Competency-based physician education, recertification, and licensure. WMJ : official publication of the State Medical Society of Wisconsin. 2007;106(4):215–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17844712. Accessed September 5, 2012.
- Campbell C, Silver I, Sherbino J, Cate OT, Holmboe ES. Competency-based continuing professional development. Medical teacher. 2010;32(8):657–62. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20662577. Accessed August 27, 2011.
- Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226–235. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11779266.
- Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evidence report/technology assessment. 2007;(149):1–69. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17764217. Accessed September 5, 2012.
- O’Neil KM, Addrizzo-Harris DJ. Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135(3 Suppl):37S–41S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19265074. Accessed August 3, 2012.
- Davis D, O’Brien MA, Freemantle N, et al. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA : the journal of the American Medical Association. 1999;282(9):867–74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10478694. Accessed September 5, 2012.