Last winter in the FSBPT Forum I addressed the evolving role of regulatory bodies. Proponents of licensure characterize self-regulation as an indicator of professionalism and a commitment to public protection and accountability for consumers.ⁱ Physical therapy became one of those professions deemed to meet the requirements of professional self-regulation. Since the inception of the first physical therapy board as a “keeper of the list,” the role of the board has been evolving, initially setting standards, determining what is required to become licensed, and then expanding the public protection role by taking punitive action when licensees were not practicing legally and/or ethically.

The article went on to focus on the new and evolving role of the state board, including remediation of licensees found to have adverse actions. Physical therapists (PTs) and physical therapist assistants (PTAs) spend a considerable amount of time, energy, and money developing their careers, and, for the most part, a professional misstep should not be a career-ending moment. However, boards have not focused on remediation as there are few programs for physical therapists and the outcomes of remediation have not been well studied or validated.

FSBPT has been examining options for remediation and making that information available to member boards. In the course of looking at remediation as an option to improve practice, we also looked at the important role of prevention in helping licensees to avoid adverse actions.

Professionalism, a term that is not easily quantified, is one of the most difficult areas to assess and often causes the most concern about the patient–therapist relationship. It has long been established that unprofessional behavior has a deleterious impact on patient safety and quality of care.ⁱⁱ Research has shown that there is a connection between unprofessional behavior in undergraduate and post graduate professional schools and later clinical practice.ⁱⁱⁱ To remediate professional behavior, one has to first understand exactly what that means, and what the values, traits, attitudes, and virtues are that constitute professional behavior.

The concept of Professional Identity Formation (PIF) is one perspective on professionalism and how a professional identity is developed. Cruess, et al. (2014)^iv recognized that the development of a professional identity occurs over time and evolves as part of the maturation of the professional during the acquisition of didactic and clinical skills. It is important to assess professional behaviors because of their impact on individuals, organizations, and the profession itself. The serious consequences of misconduct establish the need for a prevention model to detect potential situations and circumstances that may lead to inappropriate professional conduct.^v

The difficulty with defining unprofessional behavior is coming to agreement on what constitutes professional behavior. In order to evaluate unprofessional actions one must first establish what professional behavior looks like—what do we expect of those granted the privilege to provide physical therapy services? Can clinicians be inculcated with the skills to self-assess their own level of professional behavior when benchmarked against the norm established for the profession? At what point in their professional identify formation should this critical self-assessment awareness begin? In a study completed by DeLoughery (2019),^vi researchers identified certain professional frameworks that were most common across medical boards. These included—as one might suspect they would for PTs as well—integrity, behavior, respect, and excellence.

With a mission of public protection what could be better from a licensing board perspective than a workforce equipped with tools to avoid error, to practice with integrity in all settings at all times. Consider for example one tool that FSBPT developed that fulfills this objective, prevention and practice excellence, the Jurisprudence Assessment Module (JAM). Developed for the unique needs of each jurisdiction, it is tailored to provide licensees with the opportunity to assess their own knowledge about the law that governs their practice. What other tools could help licensees and boards establish a culture that sees professional behavior as integral to good patient care? Can we develop a way to help licensees self-assess potential gaps in professional development before they lapse in professional behavior?

From the outset the role of the board has always been to protect the public—our evolution from “registrars” through our current growth in remediation has all been toward that end. While we continue to develop options for remediation of adverse actions, it is exciting to consider how we can make an impact in prevention of misconduct an ongoing dialogue as we work together to provide safe and effective physical therapy care.

President Nancy R. Kirsch, PT, DPT, PhD, FAPTA received her PT degree from Temple University, her Masters in Health Education from Montclair University, Certificate in Health Administration from Seton Hall University, her PhD concentration in ethics from Rutgers University (formerly UMDNJ), and a Doctor of Physical Therapy from MGH Institute of Health Professions. She practiced in a variety of settings including in-patient rehabilitation, acute care, long term care, and home care. She owned a private practice for twenty years and currently practices in a school based setting. In addition, she is the Director of the Doctor of Physical Therapy Program at Rutgers, The State University of New Jersey. Nancy has been a member of the New Jersey Board of Physical Therapy Examiners since 1990 and was chairperson of the board for twelve years. She served as an evaluator for FCCPT. Nancy has been involved with the Federation of State Boards of Physical Therapy in the following capacities: she served two terms on the Finance committee and also served on several task forces, in addition to the Board of Directors. Nancy has been active in the American Physical Therapy Association since she was a student. She served the New Jersey Chapter as Secretary and President, and as a delegate and chief delegate to the House of Delegates. She served the national association as a member of the ethics document revision task force. She also served a five year term on the APTA Ethics and Judicial Committee and the APTA Reference Committee. She received the Lucy Blair Service Award and was elected a Catherine Worthingham Fellow from National APTA and received an Outstanding Service Award and the President's Award from the FSBPT.

[i] A. D. Randall, D. DeAngelis, “Licensing,” in Encyclopedia of social work, ed. T. Mizrahi, & L. E. Davis (Washington, DC, and New York: NASW Press and Oxford University Press, 2008) 20th ed., Vol. 3, pp. 87–91).

[ii] Alan Rosenstein,  “Physician disruptive behavior: five year progress report,” World Journal Clinical Cases, 3 (November 2015): 930-934, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644894/.

[iii] M. A. Papadakis, C. S. Hodgson, A. Teherani, N. D. Kohatsu,  “Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board,” Academic Medicine, 79 (March 2004): 244-249, https://www.ncbi.nlm.nih.gov/pubmed/14985199.

[iv] Richard Cruess et al., .  “Reframing medical education to support professional identity formation,
Academic Medicine 89 (November 2014):1446-1451, https://www.ncbi.nlm.nih.gov/pubmed/25054423.

[v] Michael J. Cullen, Mojca R. Konia, Emily C. Borman-Shoap, Jonathan P. Braman, Ezgi Tiryaki, Brittany Marcus-Blank & John S. Andrews, “Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors,”  Medical Teacher 39 (September 2016):1 85-91,  https://www.tandfonline.com/doi/full/10.1080/0142159X.2016.1231917.

[vi] E.P. DeLoughery,  “Diversity in Professionalism framing across U.S. Medical Boards,” Journal of Legal Medicine 39 (2019): 229-234, https://www.ncbi.nlm.nih.gov/pubmed/31626576.