Reflections on Continuing Education

By Whitney Lowe

Open up any one of the major trade publications in the massage profession and you can’t turn a few pages without coming across an advertisement for some continuing education (CE) course. In many cases, the course is advertised as an experience having dramatic effects such as radically changing your practice, curing every carpal tunnel condition, or permanently alleviating the suffering of your clients. These claims sure sound exciting, but marketing hype can be misleading and the caveat emptor (buyer beware) precaution should be followed.

A critical look at the CE field must start with considering the purpose and function of CE within our profession. Many professions require CE after completion of basic training requirements. In the healthcare professions, CE is particularly important because there are constantly new developments through research. These research developments can help us create new techniques or further refine methods already being used.

In the massage profession, CE has also become the route by which practitioners develop some area of specialization. The entry-level training in our profession is relatively short and many training programs provide only a taste of some of the different specialty areas. It is often not until practitioners are out practicing that they find their primary areas of interest to pursue with more advanced training.

Another important reason for CE has to do with the process by which people learn most effectively. Constructivism is a prominent educational theory that is changing the way many educators think about learning.¹ According to constructivism, we learn best when we can apply our new educational experiences to models or experiences we already have encoded in our memory. CE is therefore effective for teaching practitioners about situations they encounter in clinical practice. Practitioners already have experience with numerous clinical situations and can more easily absorb the information they are learning, making the learning experience more powerful. Conversely, it is difficult to teach some of the advanced concepts taught in CE to entry-level students because they don’t yet have an experiential context within which to frame their learning. Once they acquire some clinical experience, the learning is far more effective.

Legislative bodies or certification boards that require CE often state their primary purpose is one of maintaining or enhancing professional competence. Yet, organizations continually struggle with attempts to define what knowledge, skills, or abilities define professional competence.

An attempt to define professional competence is beyond the scope of this article, but there are certain characteristics that help us consider its relevance and importance for CE. One author writes, “Professional competence is more than factual knowledge and the ability to solve problems with clear-cut solutions; it is defined by the ability to manage ambiguous problems, tolerate uncertainty, and make decisions with limited certainty.”² These should be goals of any CE program. We’ll look at some of the challenges, benefits, and limitations of the way CE is currently delivered. I’ll share some thoughts and strategies that may help you in choosing good courses and improving the quality of CE in the future.

Challenges for the Current CE Model
Most CE programs in the massage profession are delivered in the weekend workshop format. This format is effective when considering logistics and time, as most practitioners work during the week and it is expensive to take time off from work. From an educational perspective, the weekend workshop format allows the class to develop a deep focus on specialized topics in a short period of time.

However, there are also some disadvantages to the weekend course. In a typical workshop you may only have a few days to be with the instructor, so if you have questions about what you are learning you need to formulate them within those days.

Current educational theory also suggests that people learn better in smaller chunks that can be integrated over time. It is difficult to keep up a focused attention span for seven or eight hours a day, especially if the workshop falls on a weekend when you are distracted by other things in your life. In just those two short days, there may be a large amount of information presented, and it can be challenging to decipher what is most important to focus on and what is primarily supplemental. Some workshops go to a more intensive format where there may be four or five consecutive days. It is inspiring to completely immerse yourself in a topic for that many days, but it is also easy to get burned out after several days of intense study.

CE instructors face certain challenges with the weekend workshop format as well. One consistent challenge is determining the level of complexity for the subject matter. It is common in any CE course to have students with widely diverse experiential levels. Participants may range in experience from those fresh out of school to those who have been in practice for fifteen or twenty years. For the ideal educational experience, activities are designed that build on the individual’s previous experience. With such diverse backgrounds and only one educational activity going on at a time in the classroom, what each participant reaps from the course can be very different.

The focus of learning activities also plays a crucial role in the effectiveness of any CE course. The majority of what we learn in school can be divided into two categories—declarative knowledge and procedural knowledge. Declarative knowledge is knowledge about some topic. Traditionally, we must have some declarative knowledge related to a subject matter before we can learn how to perform the activities associated with that subject. For example, it is important to have some basic knowledge about anatomy before we learn how to perform massage.

Procedural knowledge is that which tells us how to do something. Technique classes in massage school emphasize procedural knowledge in helping us learn massage strokes or proper draping procedures. Learning environments are most effective when declarative knowledge is intricately woven with procedural knowledge.

In entry-level training there is a strong emphasis on declarative knowledge, although in massage we still receive a good deal of procedural knowledge training as well. The emphasis on declarative knowledge in entry-level training leads many educators to focus attention on the assessment methods used to measure that declarative knowledge. The unfortunate product of this emphasis is an overreliance on written tests that mostly evaluate an individual’s ability to recall information within a short period of time. Testing recall does not necessarily test application of that information. These tests can be effective at measuring declarative knowledge and some limited aspects of procedural knowledge, but they can also divert our attention from more effective learning strategies that would better integrate the two knowledge categories.

Unfortunately, classroom time is limited in CE courses and the two learning strategies are frequently not brought together effectively there either. What we may get is a great informational lecture or interesting treatment techniques presented to us, but making the connection between the two is not always apparent. The best learning strategies occur when you can connect the two together. You should ask yourself: How best do I learn? Why am I performing this particular technique I am learning? Can I explain the reason why it is beneficial and recognize situations where it may be either less appropriate or contraindicated? Can I explain the theoretical models behind what I am doing? These questions are just as relevant whether you are in a CE class about business, energy work, or clinical massage applications.

Distractions to Professional Development
In addition to the challenges mentioned above, there are a number of distractions in our current CE model that also divert attention from having the best educational experience. Massage practitioners are routinely looking to gain credibility among themselves as well as within the healthcare community. This search for credibility leads many practitioners to advanced courses, but it also leads to an emphasis on acquiring or collecting certifications in various modalities. Achieving a certification can be a significant marker of professional advancement. However, too often it can become a goal that misses the fundamental purpose of CE. The reason for taking a course should be more about learning something new to enhance professional development and not just to get certified to gain more clients or more respect.

There is another issue related to certifications that each individual should be asking. Who is offering the certification and what does it mean? A distinction is often made between the “big C” certification and the “little c” certification. A big C certification is one based on a national standard that would involve a detailed job analysis study to support the certification criteria. At the present time, we only have one of those in our profession, and it is the one offered by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). It, however, is a certification only directed to entry-level practice, so it is not actually comparable to other advanced CE certifications.

Certifications in specialty areas like sports massage, neuromuscular therapy, reiki, or medical massage pose an interesting challenge. Because there is no agreed upon standard for the certification, one organization’s criteria for certification can be very different from another. Consequently, two individuals may be certified in the same modality from different organizations and have very dissimiliar sets of knowledge, skills, and abilities. When evaluating any certification program, it is wise to ask the organization or instructor about the criteria for certification and how those criteria were determined. Any little c certification program is only as good as the organization or individual that developed it.

A number of CE courses and modalities are marketed in ways that suggest they have almost magical powers. Claims such as “creating permanent relief” or “curing all low-back pain in just two treatments” stretch the limits of credibility. These types of claims are damaging to our profession because other healthcare providers look at them and see only marketing gimmicks and discount the value or benefit of what is being presented. Massage and bodywork can in many cases produce surprising and exceptional results. However, we must be realistic in what we can predictably achieve with consistent outcomes and not fall prey to unsubstantiated marketing hype, particularly within the time frames we mention.

Another potential distraction in CE is the elevation of some instructors to an almost guru-like status. When the focus is too much on the instructor, attention is diverted from the instructional design of the educational experience. This distraction is a two-way street because instructors can be seduced by all the adulation showered on them. In the process, sound principles of instructional design are either ignored or never developed because there is so much praise of the individual on the feedback forms at the end of the course. The temptation is to let the instructor’s persona carry the course instead of the instructional strategies and activities that make up the course.

The guru status bestowed on some instructors has another downside. Because the individual is seen as so knowledgeable, a power differential can develop so that everything an instructor says is taken at face value. Massage and bodywork are fields that have not yet had the benefit of thorough research conducted to validate the theoretical models we teach from. There is nothing wrong with presenting innovative theories or explanations for a course or modality. The problem occurs when an instructor’s pet theory is presented as factual information and all the participants accept it on face value without critically thinking it through. Practitioners should always be encouraged to question material being presented because that is an important part of developing critical thinking. This critical thinking is essential for any practitioner regardless of specialty.

Additional Considerations
There are several other factors that challenge the effectiveness of our current system of CE. There is a geographical discrimination in the availability of CE courses. In the eastern United States, there is a much greater population density. Consequently, there is a greater pool of potential participants to hold a workshop and more courses are offered in this area. In the western United States, cities are spread much farther apart, and it can be difficult to attract enough students to a workshop to hold it. Consequently, the more geographically spread out the population is, the fewer educational opportunities will be offered in the area.

CE is required by many states as a means of keeping licensure current. It is also required to maintain national certification. However, if there is a shortage of CE courses in your area, you are at a serious disadvantage when it comes to renewing your license or certification. The necessity of having CE coursework and few opportunities to take classes that might interest you drives many practitioners to take any CE course they can, just to get the credits. This totally misses the point of the requirement for CE in the first place.

The massage and bodywork field is a profession where kinesthetic experiences are an integral part of our practice. As a result, many of the CE classes available focus on teaching new hands-on techniques or modalities. However, it is problematic to assume that for a CE experience to be worthwhile it must include a great deal of hands-on activities. Many courses present valuable learning experiences in business, communication skills, or clinical reasoning processes that don’t necessarily require long periods of hands-on practice. A course should be evaluated for how it contributes to the practitioner’s overall professional development, and this can be done in a number of different ways. Many practitioners erroneously believe they are not getting much value if there isn’t a great deal of hands-on time in the CE class.

There are some interesting new developments in the CE field with respect to computers and online educational opportunities. Computers have had a dramatic effect on our lives, and they are beginning to change the way educational courses are delivered in colleges and schools. We are seeing that same trend occurring in CE courses for our profession now as well. The computer offers some great advantages for learning such as removing geographic boundaries, allowing students to work more at their own pace and schedule, and providing a wealth of additional resources. However, it can also be used as a cheap substitute for effective learning.

As with any new and emerging field, computer-based education has attracted innovators as well as charlatans just out to make money. What most people who rush into computer-based instruction don’t realize is that you can’t just throw a bunch of information on the Web, generate a multiple-choice test, and call it a beneficial learning experience. I am disturbed by the number of online CE courses developing along these lines—especially because the marketing angle is aimed more at making the education cheap and easy as opposed to an innovative high-quality educational experience. Developing high-quality computer-based training is hard work and hopefully we will see more improvements and innovation in this part of the CE field for massage therapists in the years to come.

Facing the Challenges
In this article, I have presented a number of the issues and challenges involved in CE programs in the massage and bodywork profession. As participants or instructors, we need to consider how to address some of those challenges.

What are the best ways to find a CE course that is a good fit? Perhaps the best way to evaluate the multitude of course offerings out there is word of mouth. There are some great discussion groups on the Internet, and these are great places to find out more about what courses you would like to take. Find out what courses your colleagues liked and ask them why. Also find out what they didn’t like. Make an effort to talk to the instructor if you can. Get a sense of the instructor’s philosophy of teaching and learning and see if it fits with the way you learn best. Ask what specific knowledge, skills, and abilities you are likely to come away with. Also, don’t be afraid to ask for the instructor’s qualifications. Remember that just being in practice for a certain period of time may not be the most important qualification. You are not necessarily looking for an experienced massage therapist. You are looking for an experienced instructor. The instructor’s teaching experience is very important for the outcome of a good course.

Most CE instructors spend a great deal of time becoming knowledgeable experts in their specific field. However, becoming an expert instructor involves far more than just knowing your subject matter well. A good instructor must understand fundamental concepts of instructional design and basic principles of learning theory. Because there are few environments for individuals to learn these concepts, most of that learning comes through independent study.

Instructors also have some fundamental considerations to improve the quality of programs being offered. Because there is such a diversity of experience levels in the course, we need to develop educational activities that allow students to gain valuable knowledge or skills, whatever their previous experience.

This article has presented some of the primary issues to consider when evaluating CE in the massage profession. As a teacher of CE courses, I admit my bias in thinking that CE is very important for continuing professional development. It is also a great way to continually refresh yourself and recharge your interest in this magnificent field. However, due to the increasing demand for CE to fulfill licensing and certification requirements, many people have jumped on the bandwagon of offering courses because they see it as an easy way to make more money. Your education is valuable and so are your personal resources. It is good advice to both wisely and carefully choose your CE experiences so they can fully benefit your career.

Whitney Lowe has been dedicated to excellence in massage education for more than fifteen years. He’s an author, researcher, curriculum developer, and instructor. Lowe has a strong academic background including graduate work in psychology, sports medicine, and biomechanics. He’s the director of the Orthopedic Massage Education & Research Institute in Sisters, Oregon. He can be contacted at omeri@omeri.com.

Notes
1. C. Fosnot, Constructivism: Theory, Perspectives, and Practice (New York: Teachers College Press, 1996).
2. R.M. Epstein and E. M. Hundert, “Defining and assessing professional competence,” JAMA 287, no. 2 (January 9, 2002): 226–35.

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