AMTA wants all massage therapists to be aware of a recent proposal by the Federation of State Massage Therapy Boards (FSMTB) for a program on renewal of massage therapy licenses and certifications. If implemented, it could have significant effects on massage therapy practice, the nature of continuing education and regulation of massage therapy.
AMTA encourages everyone in the profession to examine the proposal and to comment on it to FSMTB from your own perspective. Share your comments by April 30.
AMTA reviewed the proposal and has many concerns with the approach of FSMTB, the proposal itself, its inconsistencies and the lack of support provided for their view. Some of our specific areas of concern are:
- Overall, the impact of this proposal is to lower standards for massage therapy practice. It would shift the focus of professional development from building on the entry level education massage therapists receive to that of maintaining very minimal requirements of public protection.
- The proposal contradicts its stated intent, previous FSMTB statements on the need for continuing professional education and the mission of FSMTB.
- The proposal would take away the freedom of choice of massage therapists to determine their own practice focus and to choose the continuing education providers they prefer to meet their own professional needs by creating a “one-size-fits-all” approach for license renewal.
- The proposal provides no empirical data to support the efficacy, efficiency or necessity for a transition to this model.
Read on for AMTA’s comments and then take a moment to read the full FSMTB proposal.
>> Share your comments on the FSMTB proposal. For more information, call FSMTB at 913-681-0380.
AMTA Comments on FSMTB Proposal of Maintenance of Core Competency (MOCC) Program
In March 2011, the Federation of State Massage Therapy Boards (FSMTB) announced an initiative to create a national program to provide for the approval of continuing education providers and continuing education programs. The stated intent of the initiative was to serve as a centralized clearinghouse for regulatory boards and agencies in the approval of state mandated continuing education. On March 1, 2012, FSMTB released a proposal to remove continuing education requirements from the regulatory process in favor of an online, no-fail self assessment tool to be created and delivered by FSMTB. In the statement, FSMTB says they have left a proposed process for approval of continuing education providers to a later report.
The following analysis is intended to initially explore the impact of the FSMTB proposal and highlight areas for further investigation and any areas of concern. In brief, we find the following issues in the proposal:
- The proposal indicates a fundamental lowering of standards for massage therapy practice;
- It proposes removing current continuing education (CE) requirements in favor of a Maintenance of Core Competency (MOCC) program;
- It does not delineate what would be necessary for continued competence;
- It would provide a “No-Fail Educational Assessment” based on what FSMTB sees as public safety needs and any issues identified in the MBLEx Job-Task Analysis, which could result in no clear measure of knowledge or retention of the information in the assessment;
- Content for the MOCC would change with each renewal cycle making it confusing for massage therapists to know what is required of them;
- The proposal indicates (p. 10) that FSMTB will address standards for approval of CE providers, but then indicates it will be the provider of CE to meet the MOCC;
- The proposal also says the regulatory community should focus on public safety and move away from regulation of requirements for CE that address effective practice content beyond entry level, contradicting the previous statement about addressing such standards later, in consultation with stakeholders in the profession;
- The proposal contradicts previous FSMTB statements on the need for continuing professional education and the mission of FSMTB;
- It implies that human trafficking, prostitution and sexual misconduct are “massage issues”, rather than criminal acts sometimes conducted by those who use massage as a front (p. 11);
- It cites research that supports creating a MOCC-type program in addition to current CE requirements, rather than as a replacement for current requirements. Therefore, the research does not support the proposal;
- It is inconsistent with standards of other health care professionals;
- It would require significant changes to current laws;
- It does not require hands-on education in mandated CE;
- In spite of its claims, the proposal provides no empirical data to support the efficacy, efficiency or necessity for such a transition;
- The proposed program would take away the freedom of choice of massage therapists to determine their own practice focus and to choose the CE providers they prefer;
- It groups all massage therapists together as if they practice in the same manner and in the same environments, ignoring the fundamental diversity of massage therapy practice; and
- The program would neutralize or restrict CE providers, potentially damaging the economics of long-standing, legally operated businesses.
The proposed FSMTB program would remove current continuing education requirements in favor of a Maintenance of Core Competency (MOCC) program developed by FSMTB. The proposal initially states the MOCC program would cover ethics and boundaries, scope of practice, rules and regulations, unsafe massage practices, health alerts, law enforcement request issues, hygiene and sanitation issues (p. 11). The same page says the regulatory community should focus on public safety and move away from regulation of requirements for CE that address content beyond entry level. However, additional information in the proposal indicates the MOCC would also be intended to cover any information in the Job-Task Analysis conducted by FSMTB for the MBLEx (p. 17). This would expand the potential topics for the MOCC program, under FSMTB control and development, to include most continuing education courses currently available and applicable for meeting existing state regulatory requirements for license renewal. This would dramatically expand FSMTB’s role and negatively affect current providers of CE. However, this approach contradicts statements about moving away from regulation of CE content.
The MOCC program “No-Fail Educational Assessment” would involve content created based upon the public safety needs identified by FSMTB, with input from other stakeholders, if the input is consistent with the FSMTB Job-Task Analysis (p. 16). The no-fail element of the proposal presents a situation in which anyone could take the assessment online, until it is passed, with no insurance that the person completing it is the massage therapist or that they actually know and understand the information in the assessment. It would appear to be a mere formality, with no support presented for how such an assessment would protect public safety.
The proposed program also would lower continuing education standards for the profession, which conflicts with the bylaws of FSMTB regarding “improve[e]ing standards of massage therapy education, licensure and practice…” AMTA finds this approach confusing, contradictory and not in keeping with efforts by the majority of stakeholders in the profession to advance standards.
Continued Competence and MOCC in Other Professions
Much of the research relating to continued professional competency attempts to separate and identify the elements of continuing education and the role of those elements in the regulatory process. The MOCC proposal asserts that the current regulatory model of continuing education is comprised of continuing education, professional development and the newly defined area that is MOCC. While some of the research cited indicates this could be a way to categorize the current model, the same research also indicates a shift such as that suggested in the MOCC proposal is not possible or pragmatic.
The Federation of State Boards of Physical Therapy (FSBPT) article Moving Towards Continuing Competence (2009) cited in the proposal states a desire to differentiate continuing education as professional development and continued competency in the name of public protection. However, the same article states “[c]ontinuing professional education has a place in a continuing competence plan. It is an option; it’s just not, and should not, be the only option.” The result was the FSBPT Continuing Competence Model that is significantly different than the MOCC program proposal. Their Model includes:
- Requiring 30 continuing competency units per two year renewal;
- At least 15 CCUs must be obtained by taking certified activities;
- Certified activities are based upon traditional education;
- Other “Approved Activities” fit into what the MOCC describes as “Professional Development”
Additionally, the current standards of Continuing Competency Activities provided by FSBPT cover areas well beyond the proposed MOCC program. The content standards require activities:
[R]elate to the scope of practice of physical therapy as defined by the FSBPT Standards of Competence, NPTE Content Outline, American Physical Therapy Association (APTA) Guide to Physical Therapist Practice, PT and PTA Normative Models for Education, American Physical Therapy Association Ethics Core Documents, descriptions of Specialty practice, state practice acts and regulations, The Model Practice Act and/or other relevant regulatory documents or other generally accepted professional standards.
The Association of Social Work Boards has also included a much wider scope of topics within the Approved Continuing Education Program. According to the Association of Social Work Boards, the Approved Continuing Education (ACE) Program states “course content must be pertinent to social work theory, methods and practice, reflecting current research and best practices.”
While these standards are more stringent than those of the current continuing education requirements in the massage therapy profession, it is important to remember the substantial differences between the professions’ environments. Currently, physical therapy has a well-defined, agreed upon scope of practice articulated in a model practice act for which model rules are available. While this is a goal in the massage therapy community, it does not exist yet. Further, these important agreed-upon understandings and documents existed prior to the refinement of continued competency standards in the social work profession.
The research cited within the MOCC program proposal does indicate that a program covering emerging issues, ethics, medical errors, etc., could be a worthwhile addition to the currently established continuing education requirements. However, the need for a regulatory requirement for a program as outlined within the MOCC program proposal does not eliminate the need for a diverse continuing education requirement. AMTA does not see CE as something outside of the purview of the regulatory arena. Sources cited within the MOCC program proposal reinforce the need for continuing education. As stated in “National Reregistration and the Continuing Competence of EMT-Paramedics” April 2006 - Research Paper on the Effectiveness of Continuing Education:
There was a statistically significant difference in the pass rate on the comprehensive cognitive exam between reregistered and nonreregistered groups for years four and six,” and, “The reregistered cohorts were more likely to have more self-reported Continuing Medical Education (CME) than the nonreregistered cohorts.” Summarily, four years after taking an initial exam, the results of EMT’s participating in an assessment equal to entry level examination showed, of working EMT’s that did not take CME’s, 59 percent passed this assessment, and of those that took CME’s 73 percent passed. This suggests that over time, entry level knowledge is not maintained, and that Continuing Medical Education (which contains both Continuing Education and Continued Competence/Professional Development activities) will significantly lessen the impact of that deterioration of knowledge.
While other professions have investigated the ability to create a MOCC-style program, the necessity to differentiate components of continuing education and the efficacy of doing both, the application has been limited. According to FSBPT, 33 states require continuing education for Physical Therapist license renewal and 8 states require continuing competency for renewal. However, the eight states requiring continuing competency do so in a manner consistent or similar to a traditional continuing education approach and do not place limitations on content matter to the extent proposed in the MOCC. And, they do not mandate an exclusive provider of any subject matter.
Similarly, Chiropractic Occupational Therapy continued to follow a more traditional continuing education mandate without mandating an exclusive provider of content in any subject matter. While fewer states require continuing education for Registered Nurses, those states predominately embrace a more traditional continuing education mandate without mandating an exclusive provider of content in any subject matter. The North Carolina Board of Nursing does utilize a more creative approach to continuing education/continued competency, but the approach still allows practitioners to choose education and their approach to continued competency. And, there are no mandates for an exclusive provider of education.
Despite the lack of a MOCC-style program, the physical therapy regulatory community is able to require coursework to address legal and public safety issues within a traditional continuing education regulatory framework. Currently, five states require physical therapists to complete continuing education relating to current health/medical issues and eight states require ethics and law related coursework. Ten states require chiropractors to complete continuing education relating to current health/medical issues, ethics and law coursework. Much like these professions, massage therapy addresses public safety issues within the current regulatory framework. Approximately 30 percent of states currently requiring continuing education for massage therapy licensure renewal require coursework that includes ethics, law and/or hygiene.
Should the MOCC program proposal be accepted within the industry, AMTA and other industry stakeholders would need to work to amend massage therapy statutes in many states, to accommodate the changes. While many other industries have looked into including a MOCC-style program in their regulatory requirements, none of the professions cited has looked to limit providers of continuing education/continuing competency beyond establishing minimum requirements for providers. The MOCC program proposal requires content and delivery of education to be limited to FSMTB.
The current regulatory framework allows practitioners to complete coursework they choose, so long as it meets applicable quality standards and the content is appropriate. Several states take additional steps to create categories in which a certain amount of education must be completed. However, the actual courses themselves are not dictated. This allows practitioners to choose coursework that meets their needs, as well. A practitioner working in a resort may not have the same needs as a practitioner in a hospital. While each of these practitioners need to complete ethics coursework, the current system allows them to choose a course that most applies to their situation and individual needs. Also, practitioners currently have freedom to not only choose the eligible coursework they complete, but also the provider of that coursework.
The MOCC program would only have one provider of content, FSMTB. FSMTB would decide the nature of the content. Because the content would be ever-changing, the amount of content and the content priority would be inconsistent between renewal cycles. AMTA and other industry stakeholders would be able to provide commentary, but neither they nor massage therapists would have any authority in determining content, including what content to include and exclude. Additionally, the exclusive nature of the program would not allow for competing MOCC programs to count towards meeting renewal requirements.
In spite of the assertion in the proposal, we see no empirical data presented to support the supposition that the MOCC program, as proposed by FSMTB, is necessary, effective or efficient in serving the needs of the public, the professional community or the regulatory community. If anything, these case studies demonstrate risks in knowledge retention and comprehension when standards are lowered. The exploration by other health care professions to differentiate continued competency from professional development and advanced practice in the current paradigm of continuing education has been unsuccessful, as clear delineation into each category is not possible. The MOCC program proposal even acknowledges the basic continued competency program proposed is left open to anything within the MBLEx Job-Task Analysis. Yet, the proposal says the regulatory community should focus on public safety and move away from regulation of requirements for CE that address effective practice content beyond entry level. We find this element especially confusing and contradictory.
Other health care professions have consistently supported the fact that each category within the realm of mandated continuing education is necessary to lessen the deterioration of knowledge. The health professions that have supported defining continued competency have generally not supported the elimination of mandated continuing education in favor of a program such as MOCC. While some have embraced the need to address the maintenance of core competencies, they have done so within a more traditional continuing education framework, similar to massage therapy. Additionally, no professions have made any notion of moving to an exclusive provider system. Some regulatory bodies do provide educational courses for the licensees under their jurisdiction, but none have made themselves the exclusive source for mandated learning. The ever evolving nature of content as proposed leaves a great deal of uncertainty about what the final product would be. The inability for the professional community to create content and prioritize content leaves a significant power differential between the regulated and the regulatory body.
Beyond the lack of empirical data support for the MOCC, the inability to clearly delineate what is necessary for continued competence, the inconsistency with other health professions and the exclusive nature of content creation and delivery, the MOCC program removes choice for practitioners with a “one size fits all” approach. The result is a loss of individuality in meeting continuing education mandates and a failure to address the realities of the profession and its place in effectively serving diverse health needs. We believe, meeting the needs of the practitioner and the public is not possible in the proposed MOCC program.
For more information, contact Joe Roth, Government Relations Manager at the American Massage Therapy Association (AMTA).