2007 Pauline Cerasoli Lecture: Sins of the Professional Programs

By Domholdt, Elizabeth

Life changes in the instant. That is the central theme of Joan Didion’s best-selling nonfiction book The Year of Magical Thinking,1 in which she chronicles the year following her husband’s sudden death and her daughter’s life-threatening illness. But we do not need a best-seller to tell us that life changes in the instant. As physical therapists, we know this from working with people who lives were changed in the instant by injury or disease. We know this from our own personal stories of grief and loss. And we know this from Polly Cerasoli-our colleague, the determined, self-reliant, funny, and nurturing Polly Cerasoli-whose life changed in the instant in 1996, when she sustained a severe traumatic brain injury when an unknown assailant attacked her in her hotel room at that year’s Combined Sections Meeting. This annual lecture gives us the chance to honor Polly by thinking deeply about physical therapy education- the work she loved-but this lecture also always reminds me that life changes in the instant.

So while I am hoping to get you to look at professional education from a new perspective during the next 45 minutes, please also honor Polly by remembering that life changes in the instant. And because life can change in the instant, do not waste these moments you have been given-go out on a limb, take a risk, set an outrageous goal, quit doing all the dutiful things that drain your energy, and start doing more things that feed you, more things that help you define your place in this world.

When I was invited to give this lecture, I was still deep into the world of physical therapy in my role as dean of the Krannert School of Physical Therapy at the University of Indianapolis, as treasurer of the Indiana Chapter of the APTA, and as someone who showed up at the Indiana statehouse periodically to participate in the perennial quest for direct access in the unexpectedly complicated political environment of the Hoosier heartland.

But all of a sudden I am on the periphery of physical therapy education. I do the occasional guest spot in the physical therapy program at The College of St Scholastica and I am trying to stay alive in my profession by reviewing for physical therapy journals and by serving on the occasional doctoral committee related to physical therapy. I am deep into the world of higher education administration in my role as chief academic officer at the College of St Scholastica, and I am deep into the adventure of building a new life for myself in a new city on the shores of Lake Superior.

When I was asked for the title of my talk-and, mind you, they asked for a title about 6 months ago-I knew that I wanted to share something about how the professional programs look-and they do not always look good-to someone sitting in the chief academic officer’s chair. And somehow that idea turned itself into the “Sins of the Professional Programs.”

Having decided on a theme of sin, and having a vague idea about there being a set of “7 deadly sins,” I thought I should learn something about these 7 deadly sins and see if I could come up with a set of professional program sins that roughly paralleled the 7 deadly sins. Facing a looming deadline without adequate preparation, I did what first-graders through doctoral students do these days. I Googled the “7 deadly sins.”

Here is what I learned. I learned that some people believe that the seven dwarfs of “Snow White and the Seven Dwarfs” fame represent the 7 deadly sins-Doc is pride, Sleepy is sloth, Grumpy is anger, and so forth. But that is not all. I also learned some people believe that the 7 castaways on Gilligan’s Island represent the 7 deadly sins-Ginger represents lust, Mary Ann envy, Thurston Howell greed, skinny GiIligan who eats all the time represents gluttony, and so forth. After this little foray into the Internet world, I decided that I need not match up my list of sins with the 7 deadly sins.

But before I get around to articulating the 7 professional program sins I have chosen to present, I need to make a several disclaimers-chief academic officers being very risk management oriented, you know.

* First, The College of St Scholastica has many professional programs-including nursing, physical therapy, occupational therapy, health information management, social work, education, and others- so I do not want anyone to leave thinking that I have modeled my list of sins solely on the basis on the physical therapy program at Scholastica. Department Chair Denise Wise and her faculty colleagues are not completely innocent of some of these sins, but they are not the basis for the entire listi

* Second, I did not come up with the list completely on my own. I picked the brain of a more experienced chief academic officer, Diane Fladeland, a nurse and my counterpart at the University of Mary in Bismark, North Dakota.

* Third, faculty in the more traditional academic programs commit their share of a different set of sins, and academic administrators do as well-but I am not talking about their sins today. Today, I am focusing on yours.

* Fourth, lest I sound too holier than thou, I do acknowledge that it was not that long ago that I was committing any number of these sins on a regular basis.

* Finally, I have spent my entire academic career at church- related private institutions. The University of Indianapolis is affiliated with the United Methodist Church, and The College of St Scholastica is a Catholic, Benedictine college sponsored by the Sisters of the St Scholastica Monastery, with whom we share a campus. Higher education is a highly segmented industry and, while I believe that many of these sins cross segments, some will clearly resonate more strongly with those who are at similar institutions.

What is it about these 7 behaviors (Table) that make them sins? Here is the key-all of them, in some way, separate the professional program faculty and their students from the institutions to which they belong. These behaviors prevent the professional programs from being as effective as they could be in helping the institution fulfill its mission and they prevent the programs from taking full advantage of the resources of the institution.

Sin #1: Paying Lip Service to the Liberal Arts

Professional program faculty all know that they are supposed to value the liberal arts and so they are very good, in the right venues, at saying just how much they do. What they do less well is match their policies, procedures, and actions to this platitude.

If professional program faculty really valued the liberal arts, they would either pare back their prerequisites to allow for more exploration during the college years, or they would modify their prerequisites to include a wider variety of courses outside of the sciences. Some physical therapy programs require microbiology-but I might prefer a physical therapist who has studied ethics. Some programs require calculus, but maybe studying painting would help prospective physical therapists tap into a level of creativity that would serve them well when it comes time to plan interventions. And maybe a course in cultural anthropology would be just as useful as the developmental or abnormal psychology courses that are prescribed by some programs.

If a physical therapy faculty member believes that physical therapy is all about the science of movement dysfunction, then maybe calculus and microbiology are just the right prerequisites. But if you believe that physical therapy is about melding the science of movement dysfunction with the art of motivating people to change their behavior, then maybe a broader perspective on the human condition is the appropriate preparation for prospective physical therapists.

If professional program faculty were serious about the liberal arts they would quit admitting students after 3 years of undergraduate study. They would require completion of a baccalaureate degree before entry into physical therapy school. Students who are attempting a 3-year route into physical therapy school have almost no room for curricular exploration; they are typically not able to take advantage of study abroad programs; they may curtail activities like intercollegiate athletics or student government that could develop important interpersonal, team, and leadership skills; and they surely do not have room in their schedules to develop proficiency in a language other than English.

Requiring completion of a baccalaureate degree before entry into physical therapy school, coupled with a pared-back set of prerequisites, would open up prospective physical therapists to the kinds of life-changing, character-building experiences that can happen when freed from a narrow, lock-step, abbreviated undergraduate curriculum that feeds directly into physical therapy school.

If professional program faculty were serious about the liberal arts they would thread liberal arts content throughout the physical therapy curriculum. And, they would not teach it all by themselves. When professional program faculty assume that they can teach all of the ethics or cultural or policy content themselves, they are showing incredible intellectual hubris. Professional program faculty who really value the liberal arts would partner with an ethics faculty member when teaching professional ethics. They would include a module that explores how disability and illness are presented in literature and films-and they would get film and literature faculty members to help them design and offer the module. Rather than bumbling through a superficial presentation of cultural aspects of health care, or the politics of the development of the US health care system, professional program faculty would see if a cultural anthropologist, or someone with expertise in world religions, or a political scientist, would partner with them in these efforts. At the institutions I have worked at, this kind of interdisciplinary collaboration would be welcomed by many of the humanities faculty members. Sin #2: Excessive Elitism in Admission Decisions

When just about every physical therapy program had 10 applicants per available position, everyone knew, even if they did not admit it, that admissions procedures were flawed methods for determining which of many, many capable applicants would get the opportunity to study at a given school.

Then, when the bottom dropped out of the applicant pool in the wake of the Balanced Budget Act of 1997 and its impact on employment opportunities for physical therapists, physical therapy faculty became sudden egalitarians-students who would not have been given a glance before were now given star treatment-sit-down lunches during the interview process when just a couple of years before stale donuts that sat around on a side table all day would have done; signs posted at each campus entrance marking the way to open houses when in previous years finding the open house through a maze of campus buildings was a sort of hazing ritual and any prospective students who could not make their way on time were deemed unworthy of the profession.

And although we found that some of the students we admitted during the lean years were not successful, we also learned that many students with modest undergraduate records and awkward admission interviews became really fine physical therapists. But as we know, the pendulum of physical therapy student admissions has swung again and there is competition for the limited number of spaces-maybe not as much competition as in the 1980s and early 1990s, but surely more than in 2000. As admissions for a given profession become competitive once again, the faculty seem to forget all the scrappy, hard-working students with 3.2 grade point averages that they embraced just a couple of years ago; they abandon them for the polished students with 3.8 grade point averages and all the right answers.

But selecting more academically talented students over less talented students in and of itself is not the sin. The sin is how professional program faculty sometimes treat applicants who have attended their own institution as an undergraduate. Just as it can be hard for professionals to be a prophet in their own land, sometimes professional program faculty do not give undergraduates from their own institution much respect. These are students who invest years of their lives and tens of thousands of dollars in tuition attending a particular college or university in hopes of being admitted to a professional program there.

From my view as a chief academic officer at a tuition driven, private college, qualified professional program applicants who attended the home institution deserve a big admission advantage over applicants who come from other schools. Don’t get me wrong, I would love it if we could build reputation by admitting students from across the country who then return far and wide to spread the good news about what our school has to offer. But guess what, we do not balance the budget with professional program students, whose education is more costly per credit hour than most other programs on the campus. We balance the budget with undergraduates taking lots of lower division courses with a low cost per credit hour. So the next time you are ready to say no to a solid hometown applicant who has been plugging away on your own campus for 4 years in favor of a star performer from out of state, remember who has been paying your salary for the last few years.

Sin #3: Believing the Professional Programs Are Different

Well, of course they are different than other departments or programs. But trust me that English is different from history, and biology is different from Spanish, and nursing is different from education. Too often this sense of difference means that professional program faculty do not see that their issues align with the issues of faculty in the traditional academic disciplines and they do not even bother to engage in campus discussions of issues such as faculty workload or promotion and tenure policies. They are often more than happy to let faculty in the traditional academic disciplines do all the dogfighting with the administration-and then if the outcome is not as they desire, they try to cut side deals because, well, they are “different.”

On the matter of salaries, it is my experience that market forces dictate that professional program faculty are paid more than faculty in the traditional academic disciplines, and even masters-prepared faculty in professional disciplines command higher salaries than doctorally prepared faculty in the humanities. So, yes, the professional program faculty are different in some respects and this difference often puts more money in their pocket each pay day than many of their colleagues in other disciplines.

So you should understand why faculty in the traditional academic disciplines are not very sympathetic to the various burdens that are carried by the professional program faculty-the burden of running a program-level admissions process, the burden of the occasional talk to the pre-PT club, the burden of attending an annual Saturday lunch to thank clinical faculty for working with your students.

Another area in which professional program faculty claim difference is the area of scholarship. Although the physical therapy accreditation criteria make it more difficult to completely skirt scholarship requirements than in the past, some professional program faculty still claim that clinical practice requirements prevent them from being active scholars, that the demands of the accreditation process are so heavy that scholarship just is not feasible, that heavy teaching loads make scholarship impossible. That is a bunch of hooey.

The demands of faculty in different disciplines are different, of course, but I am not convinced that the professional program faculty have it any harder than faculty in the traditional academic disciplines. Professional program faculty do not often teach first- year undergraduates, with their vast range of academic talents, their underdeveloped study skills, their uncertain educational paths, and their rocky explorations of alcohol and sex. My apologies to those of you who are parents to first-year college students.

Professional program faculty typically have 1 new cohort of students to get to know each year-and in physical therapy that cohort is often fewer than 50 new students once a year. Faculty in the traditional academic disciplines may have 100 or more different students in their classes in a given semester, and they turn over each semester. And at smaller private colleges at least, the traditional academic faculty participate in all manner of out-of- class activities-Saturday] open houses for prospective students, evening meetings of student organizations they advise, and writing reference letter after reference letter for students applying to the professional programs.

So the demands are different, yes. But every excuse the professional program faculty have for not being scholars could be matched with a complementary excuse from the traditional academic faculty. So I really wish that professional program faculty would just quit with the excuses and work to build creative scholarly agendas that complement their teaching, service, and clinical activities.

A final way that professional program faculty express their perceived difference from the rest of the campus is in their aversion to the usual class schedule or semester schedule of the institution. If the institution has the 3:00 hour on Thursdays set aside as an unopposed time for faculty committee meetings, you can bet that somewhere there is an occupational therapy laboratory or a teacher education colloquium or some other such thing going on-and the professional program faculty will say it is because there is no other time to do it. And then the professional program faculty do not participate in faculty governance because they are in class, and then when policies are passed that are not sufficiently flexible in the eyes for the professional program faculty, here they are again looking for side deals because they are “different,” and the cycle continues.

In addition, professional program faculty are quite proprietary about their classrooms, scheduling things at odd hours that cross several sanctioned time slots helps to guarantee that other classes can not use the facilities. No administrator likes the unpleasant task of micromanaging space disputes between departments, so if space on your campus is tight, please just stop with the turf wars, regularize your scheduling as much as possible, and play nicely with the other departments in your building.

Sin #4: Complaining About the Burden of Clinical Practice

This sin is related to the previous sin of “difference,” wherein professional program faculty identify a variety of burdens they believe to be unique to their group.

One of these so-called burdens seems to be invoked more often than others and, in my view, warrants its own sin. This is the burden of clinical practice. In some states some professionals have to maintain a certain number of clinical practice hours to maintain licensure, and so clinical practice is indeed mandatory and not voluntary for those professionals. For others a practice requirement may not be linked to licensure, but is surely linked to maintaining currency and credibility in the classroom. But let’s look at the nature of this burden. First, the faculty member is typically well compensated for assuming the burden. I can imagine that philosophy faculty might welcome the burden of having someone pay them $50 or more an hour to practice their trade for a couple of hours each week.

Second, if a faculty member who has maintained a modest level of clinical practice becomes bored, disenchanted, or out of favor within the halls of academe, he or she can typically find gainful employment in the profession within weeks of leaving the academy. Try doing that in philosophy.

Third, in some promotion and tenure systems this clinical practice burden is accepted as “professional activity” in lieu of traditional scholarship. The historians of the world are not earning a handsome wage for the scholarship they do.

Finally, the professional program faculty are not even the only faculty members who work long hours completing professional practice requirements-the musicians on the faculty perform publicly, typically on evenings and weekends; the theatre faculty spend long, odd hours in acting or directing roles. When musicians and actors enter the academy they understand that they will still need to perform. When the philosophers and historians of the world graduate from their PhD programs and decide to live academic lives, they understand that they are limiting their earning potential and career options, and no one feels very sorry for them if they complain when the predictable outcome-being a modestly compensated professor-is realized. And when clinical practitioners choose to enter academic life, they should understand that preparing practitioners requires faculty who are practitioner-scholars.

Sin #5: Pedagogical Stodginess

There are many, many fine teachers within the professional programs. However, I believe that professional program faculty, on the whole, are a bit stodgy when it comes to pedagogical matters. In the professional programs we still see an awful lot of traditional lectures followed by laboratory demonstration by the faculty member- whether or not all the students Can see-and then practice by pairs of students who may or may not get a visit from the faculty member during the course of the laboratory session.

This is the age of technology:

* Lectures can be podcasted so that students can review them at hours of the day or night rarely contemplated by middleaged faculty members.

* Student response systems can help faculty members understand what proportion of the class understands the elegant point a faculty member just spent 15 minutes developing.

* The graphics in contemporary gross anatomy computer programs can help students understand three-dimensional anatomy without exposing them to the health risks of the preservatives used with cadavers.

* Demonstrations can be filmed and shown to the whole class instead of being visible only to the small segment of the group that can gather around the fastest.

* Simulation mannequins can be used to teach some tasks.

* Various technical skills can be taught in more systematic ways than is typical in professional programs.

* Classes that rely on a lot of discussion may actually be more effective at engaging more students an online format.

When it comes to developing higher-level analytical skills, professional program faculty often do not provide students with realistic opportunities to practice clinical reasoning skills. They hold forth a limited number of their own examples, but they do not create compelling scenarios that help students learn to think like physical therapists, or nurse practitioners, or social workers; they do not do enough to teach students how to integrate evidence into clinical care on a routine basis; they do not use simulated patients; and they do not give students opportunities to view and critique their own and their classmates’ performances during patient interviews.

Don’t misunderstand me. I do not think that it can all be done with technology. I believe that the personal faculty-student relationship is exceedingly important. I believe that faculty are important professional mentors for students and that we need to build our programs so that students and faculty have the type of interactions that will produce a long-lasting impact on the professional lives of those students. And I loved gross anatomy as a student, exploring the cadaver that my dissection group dubbed C3PO (I was in PT school during the original Star Wars era), gaining a spatial understanding of the bodies I would be working with as a professional. The traditionalist in me hates to think that this experience might not be shared by physical therapists in the future.

But today we have different tools that can help students develop this understanding, we have different tools for communication in and out of the classroom, and we have new ways of interacting with others. Professional program faculty need to stretch themselves as teachers, embracing new ways to promote deeper learning, new ways to prepare the next generation of practitioners.

Sin #6: Budget Naivete

Professional program faculty are pretty naive about program and institutional budgets, and even program directors may have only have a rudimentary understanding of the financial basis on which the program runs or the performance metrics that are important to the institution.

For example, professional program directors often overestimate their tuition revenue because they fail to account for discounts. If you direct a 3+3 program in which undergraduate financial aid follows students in their fourth year, the discount rate for the first professional year might be as high as 50%, especially since talented pre-PT undergraduates may receive large scholarship packages to attract them to the institution. So if you have 40 students per class and an annual tuition rate of $20,000, the $800,000 tuition you thought you would be collecting for students in the first year of the program turns into $400,000 if all of the students are 3+3 students with a 50% discount rate. Even programs without a 3+3 design may offer scholarships or assistantships that reduce the revenue stream.

But wait, you say. We did some fundraising a few years back and created an endowed fund to support our scholarships. The market is doing well, so the funds ought to be earning a pretty penny that can support these scholarships. You get bonus points for doing some fundraising, and you get points for knowing that endowment funds are invested-that you never get to spend the principal, only the interest. However, most endowment spending strategies combat volatility in the market by paying out based on the trailing average return during the last ? number of quarters. At Scholastica, for example, we base our endowment spending on the average return on our investments for the last 12 quarters. At Scholastica, we currently pay out 4% from the endowment.

This means that a $100,000 endowed scholarship fund generates only $4,000 per year. If you offer four top students in each of your classes (12 students total in a 3-year program) a 25% tuition scholarship ($5,000 per student if your tuition is $20,000), this is $60,000 in tuition that you are not collecting. You would need a 1.5 million dollar endowment paying out at 4% to fully fund those scholarships. And if you only have a $100,000 endowed scholarship generating $4,000 a year, then you are discounting the other $56,000.

Members of the audience who have had me for a research course know that I am perfectly capable of continuing along this mathematical vein, but I will spare you any more computations and try to keep it conceptual. On the revenue side of the equation, program directors often overestimate revenue because they forget to factor in discounts, they forget to factor in attrition, and they overestimate the revenue from endowment sources. On the expense side, program directors often underestimate expenses, failing to appreciate all of the indirect costs associated with running a college or university. For starters, you have to pay the salaries of everyone who does not produce revenue-the admissions staff, the financial aid staff, the library staff, the student affairs staff, and the facilities and grounds staff, and of course someone has to pay my salary.

Before a program returns money to the organization, it also has to pay its share of the utilities, its share of the expenses associated with repaying the bond that funded construction of the new wellness center on campus, its share of snow removal costs, and so forth. And every campus has its own budgetary quirks. At St Scholastica, for example, we incur a staggeringly large bill almost every year for tuckpointing our signature building, Tower Hall. For those of you who do not work in a gothic tower, tuckpointing is a form of masonry maintenance that involves noise, power tools, and close to half a million dollars each year.

Maybe there are some wealthy, well-endowed higher education institutions out there that are making money hand over fist, but most colleges and universities work hard to make ends meet. And there is a symbiosis among the various academic programs. Lower division courses in the humanities cost the least per credit hour to offer, in part because enrollments are good in general education courses, the faculty are the least expensive on campus, and there are few laboratory and supply costs. On the other hand, costs per credit hour are among the highest for the professional programs, because of higher faculty salaries, laboratory and equipment costs, and, for some programs, the high cost for faculty supervision of students in the clinic. For many colleges this mix of disciplines is critical for survival: humanities offerings by themselves will not attract enough students to stay in business, and professional program offerings by themselves are too expensive to be sustainable. In addition to straight financial performance measures, many Boards of Trustees gauge institutional performance on the basis of a limited set of variables often known as a “scorecard.” Knowing what the scorecard variables are, and how the physical therapy program feeds into these variables, is important for programs that want to operate strategically within their organization. If one of the scorecard measures is undergraduate retention, you might think that this is of no concern to a graduate physical therapy program.

Except that it does matter if you have a 3+3 model and undergraduates who do not get into the physical therapy program after 3 years leave the institution to finish elsewhere. And even if you do not have a 3+3 program, it matters if the PT faculty are dismissive of pre-PT undergraduates, who feel underappreciated and leave to finish elsewhere. Other common scorecard items include student-faculty ratios, the proportion of alumni who contribute to the institution, student entry characteristics such as GPA and board exam scores, and the amount of external grant funds brought into the institution. Savvy program directors will know which variables are tracked on the scorecard-and they will understand how their program contributes to or detracts from the attainment of benchmarks for these variables.

If you are at an institution that values and tracks external grant funds, then that is where you ought to be putting your efforts. If your institution is making a big push to increase the proportion of alumni who give, then you ought to be putting some effort into alumni relations. You need to know what matters to your institution-financially and otherwise-and act accordingly.

Sin #7: Intellectual and Social Isolation

The final sin is intellectual and social isolation. It is so easy for professional program faculty to separate themselves from the rest of the institution. They have passionate ties to their profession and may feel more allegiance to that profession than to the institution.

Their curriculums are often self-contained and do not require collaboration with faculty from other disciplines. They may have dedicated program space because of specialized equipment needs, so they do not have to negotiate schedules with anybody and they may be physically isolated from others on the campus. And, of course, clinical practice or clinical supervision draws them off campus unless they are at an institution with clinical facilities.

Recently, all of the school deans at Scholastica briefed our Board of Trustees on the state of their schools, and I told them that our board did not want a whitewash, that they really wanted to know what was going on, warts and all. Ron Berkeland, our dean of the School of Health Sciences, illustrated this sin using a great analogy that I have modified just a bit. He said to think of an upper middle-class neighborhood with rows of similar good-sized homes. The neighbors might occasionally invite each other over for a cocktail party, and they would admire each others’ homes, but then they would go back to their own home still convinced of its superiority. And if someone suggested that they should combine their designer swing sets to create a large shared playground in a community space, well, they would all have reasons why their particular swing set was needed for their particular backyard.

That is the same kind of behavior that professional programs often exhibit. Eveh though Ron identified program isolation as an issue for the School of Health Sciences at Scholastica, and I have used his analogy to illustrate this sin, I do want to go on record and brag about how our health professions programs sometimes cross disciplinary boundaries to do some very fine work together: they are working together to incorporate the use of electronic health records into their curriculums-and we have even been able to leverage this educational innovation into a commercial product that we are selling to other institutions that want their students to be competent in the use of electronic health records. They have developed an interdisciplinary health care leadership course. And I have heard rumors that the pro-bono occupational therapy clinic on campus might go interdisciplinary in the future.

But as good as these initiatives are, there are many more opportunities for our health professions programs to work together. And if it is difficult to get the professional programs within an academic unit to collaborate, it can be that much more difficult to bridge the gap between professional programs and the traditional academic disciplines.

Beyond the intellectual isolation described above, professional program faculty may be socially isolated from the rest of the campus.

Professional programs may develop their own rituals that have little to do with-and may sometimes conflict with-activities surrounding campus-wide rituals like commencement; the faculty may segregate themselves at lunch time, or be segregated because of location and schedule-some of this of their own making. And, at institutions with Division II or Division III athletics, a certain proportion of traditional academic faculty members support students by attending their events, but I rarely see our professional program faculty at a hockey game-even when we are having a winning season.

At the beginning of this talk I asked you to think about Polly Cerasoli and about how life changes in the instant. During the body of the talk, I put on my chief academic officer hat and went on a rant about the ways that professional programs fail to live up to their potential within an institution. To close, I want to take off that hat and go back to being just me, talking to you. Knowing what I know now about how an institution works, if I were to return to a physical therapy faculty or director role, I would do some things differently.

* I would coerce someone in the humanities to help me design something into the curriculum that forces students to forget-at least for awhile-about ground reaction forces and trigger points and sensitivity and specificity of diagnostic maneuvers, so that they can think deeply about what it means to be human and how the process of illness, injury, or disablement shapes one’s sense of self.

* I would take a more charitable view of program applicants who attended the institution as undergraduates. And in the matter of probations and dismissals, I would take a hard line in matters of safety and competence, but I would be less judgmental and more developmental in matters of style and attitude.

* I would quit using “but we are different” as the opening argument in the quest for resources or policy changes.

* I would remember that no one wants to hear me complain if I find an opportunity to earn good money practicing my profession.

* I would try something really outrageous in my teaching. Maybe I would even learn to text message and download music.

* I would figure out which performance measures matter to the Board of Trustees, and I would learn how well the PT program stacks up. And if the Board is

interested in a bunch of things that are not compatible with preparing outstanding practitioners, well, I might not stick around very long.

* Finally, I would make intellectual and social connections with colleagues outside of physical therapy-I would go to an interesting sounding PhD defense in another department; I would take a long lunch, go to the campus art gallery, and strike up a conversation with anyone else who happened to be there; and every once in a while I might even join some other faculty volunteers in serving midnight pancakes to undergraduates during finals week.

The sins, as I have defined them, are largely sins of pride and isolation. Our pride in our profession is good, right up until it alienates and isolates us from potential collaborators and from the very institutions that give us our professional homes. I hope that each of you will consider these sins in the context or your own work and will craft redemption strategies that match you and your institution and your life. The work I have been doing for the past 18 months has not diminished my pride in the profession of physical therapy, but it has connected me with other professions and other disciplines and other people in ways that have nourished me more than I could have ever imagined. I wish the same for each of you.

REFERENCE

1. Didion J. The Year of Magical Thinking. New York: Alfred A Knopf; 2005.

Elizabeth Domholdt, PT, EdD1 FAPTA

Elizabeth Domholdt is vice president for academic affairs and professor of physical therapy at The College of St Scholastica, i200 Kenwood Avenue, Duluth, MN 55811-1499 (bdomholdt@css.edu).

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