Recently in the British Journal of Sports Medicine an editorial was published titled ‘Clinicians use courses to change practice, not journal articles: is it time for journals to peer-review courses to stay relevant?’. This created a lot of discussion and debate on social media with some strong views and opinions and I’m going to add mine to them now as well.
First things first, a disclaimer, I earn an income from teaching a course on shoulder assessment and rehab, as well as an online education platform which some individuals like to highlight in an effort to embarrass or shame me or invalidate my views on physiotherapy education and post graduate courses. They don’t do either.
I’ve been teaching physios for well over 10 years now and although I’m still a clinician at heart working both in the NHS and private practice, I do now also consider myself an educator, a teacher, a sage from a stage, a guide from the side, or whatever else you want to call someone who attempts to impart knowledge onto others, and I’m very proud of it. Anyway, I have skin the game in this argument and so of course this will affects my views.
Well meaning but misguided
The main premise of the editorial is “journals are well-placed to shape practice if they choose to take an active role in knowledge translation by accrediting quality courses.”. This, in my opinion, is well-meaning but misguided in thinking accrediting continuing education courses will improve the quality of them.
Most of my thoughts on this can be neatly summarized by my mate Erik Meria who did a very nice thread on this here.
I understand and share the authors desire to improve the quality of continuing education within the profession, and agree with them when they say many courses are ‘questionable’ in quality and content. For example, a quick look through a well-known course provider’s list finds courses on quackery such as electro-dry needling, cupping, even myofascial release with sink plungers.
However, having journal editors accredit quality courses will NOT help reduce the number of these bad and questionable courses and could in fact reduce the number of good quality courses even more. Shitty courses will not disappear or be any less popular just because there is an accreditation scheme by a few journals.
Peddling Placebos
The simple reason questionable and dubious courses thrive is due to the demand for them. Many therapists just do not have the scientific literacy or critical thinking skills to recognise that these courses are peddling placebos and snake oil under pseudoscience and flimsy excuses of emerging evidence.
Instead of trying to regulate and accredit those who produce shitty courses, I think we should focus more on improving the critical thinking skills of those who go on shitty courses. Once therapists can start to see that these shitty courses are pseudoscience and quackery that wastes time, money, and don’t actually help patients much at all the better.
Editors Skills
The other issue is that journal editors are the best people to judge what is and what isn’t a quality post-graduate course. I appreciate that many journal editors are smart, intelligent people, and often have good knowledge of the evidence base. Although from some limited personal experience with some journal editors I also know this isn’t guaranteed.
However, being a journal editor is no measure of being a good judge of the quality of a course or another’s ability to teach well. A good high-quality course is at least about the best quality evidence available but this is not sufficient for a good course, trust me I know having been on many courses presenting the latest evidence but in a dull, boring, and instantly forgettable way.
There are many other factors that make for a good learning experience other than just the evidence presented. Presentation style, graphics and visuals, speaker enthusiasm and personality, practical demonstrations etc, the list goes on and on. All these factors are essential for a quality course, not just the reference list.
Conflicts of Interest
The other concern I have with journal editors accrediting others’ courses will be their bias and vested interests affecting their judgement. And I’m not just talking about financial conflicts of interest that the editorial mentioned.
There are many other conflicts of interest other than financial to also consider. For example, I know damn well that many journal editors would not approve or accredit my course due to previous professional disagreements and personal dislike towards me, as well as issues they have with my social media platform, its reach, and my own views and opinions.
Don’t get me wrong I would gladly and confidently submit my course for scrutiny and review to anyone if I thought it would be truly fair and impartial. However, from previous experience of dealing with editors and peer reviewers who reject things on nothing more than personal dislike I know it often won’t be reviewed either fairly or unbiasedly.
I also know from past experience that handing your materials over to those to review and accredit it, who teach similar courses and subjects as you, leaves your work open to being copied and plagiarised as I have seen personally happen to me a few times to my utter frustration and dismay.
So, in summary, I agree with the editorial that shitty courses are a problem in physio, but I disagree that journals policing and accrediting post-graduate courses is the solution. Instead, improving therapists levels of critical thinking and decision-making is the way forward here and then it comes down to the basic economics of removing the demand, and the supply will cease.
As always thanks for reading, and be sure to check out my upcoming non-accreditted but ‘high quality’ evidence-based Painful Shoulder courses below!
Adam
Adam, I agree with you. Here is an example where a lack of critical thinking has resulted in the peddling of misinformation to those undertaking professional education in pain theory and management: http://www.fmperplex.com/2020/10/28/tame-the-beast-does-this-metaphor-really-work/
I don’t think the idea of journals policing clinical courses is well-intentioned. Journals, like medical schools and research projects are frequently used as channels for promoting business interests and are given funding for that purpose, particularly from the pharmaceutical and IT industries. Much of what is promoted as science is agenda-based profiteering, not honest endeavour serving the interests of humanity. The idea to police clinical courses dangerously lines up with the rising current of world-wide fascism – a Nazism re-branded as ‘scientific technocracy’. Education is being pushed on-line where information can be tightly controlled and internet ‘book-burning’ is occurring where facts, opinions and ideas that do not support the technocratic/fascist narrative are being increasingly censored and suppressed. This is happening world-wide, as part of a deliberate policy of control, coordinated by corrupt governments. Freedom of speech, thought and action in all areas of life needs protecting and the policing of clinical courses is just one more aspect of the increasing fascism that needs to be resisted.