PT 2000: Nurturing the Profession.

Suzann K Campbell, PhD, PT, FAPTA

Susan K Campbell has amassed a distinguished record as a physical therapy clinician, researcher, and educator over the past 30 years. Her work on the assessment and treatment of infants with motor impairments has led to significant contributions to the development of infant motor assessment tools and efficacy of therapeutic interventions. Her texts on physical therapy for children are widely used by entry- and graduate-level professionals.

Dr Campbell has served as a research mentor and role model to many professionals, and her teaching has produced many clinicians whose interventions have led to clinical breakthroughs. She was the first physical therapist to serve on an advisory board for the National Institute of Child Health and Human Development.

Dr Campbell has been recognized by APTA by a Mary McMillan Scholarship, the Golden Pen Award, the Section on Pediatrics Research Award, the Marian Williams Award for Research in Physical Therapy, the Section on Education's Distinguished Educator Award, the Chattanooga Research Award, and designation as a Catherine Worthingham Fellow.

[Campbell SK. Thirtieth Mary McMillan Lecture: PT 2000: nurturing the profession. Phys Ther. 1999;79:1058-1068.]

I am truly honored to present the 30th Mary McMillan Lecture, especially because I have the unique opportunity to reflect on the opportunities and challenges we face as a profession in the new millennium. As I prepared this lecture, I thought about what would motivate my listeners to action. As I thought about the methods I would use to get across my points, I reflected on the fact that, whenever therapists get together, they love to tell stories about patients. So here I will use stories from my own experience to highlight the content I wish to share.

As I reflected on the needs of the profession in the new millennium, I also believed that we should look at the big picture of how to nurture the profession as a whole. I recalled a line from a recent novel by Rushdie, "The only people who see the whole picture ... are the ones who step out of the frame,"[1] so I hope to frame each issue with my stories in a way that helps you to look first at research, then at education, and finally at practice with a broad perspective. As I do so, I will note the many resources developed by the American Physical Therapy Association (APTA) to assist us in meeting the challenges we face, because I believe that, as never before, we have documents and activities that provide us with much of what we need to guide our professional development into the next century.

Let me begin with my first story. This story is about a cheesemaker's daughter growing up outside a small town in Wisconsin. She attended a rural school with 8 grades in one room. The teacher created a small library--books stored in orange crates, and pillows to lounge on--and the little girl finished reading all the books in the library by the end of second grade. Moving to a larger town and a school where you sat at a desk and worked at what the teacher wanted you to do was hard, and she was constantly in trouble for talking too much. When she was 10 years of age, a baby sister arrived with a brachial plexus injury, and her interest in both infants and pediatric disabilities was born.

In high school, despite being a bright and motivated student, no counselors took her under their wing, and she was not even encouraged to take college prep courses. As a result of a class assignment to learn about a career, she became interested in child psychiatry, but this interest was just a dream--a fantasy--because it never occurred to her that in reality she could ever become a doctor. When she expressed to her parents an interest in going to college, her father said that it was financially impossible. No one told her about scholarships, so she planned to go to a 1-year technical school program, even though she had no idea how she would pay even for that. Near the end of her senior year, the only college-educated relative in her family came to her parents with the offer to help send her to college. At a very late date and totally unaware that she would be attending one of the world's premier research universities, she was accepted at the University of Wisconsin in Madison (UW) and entered the physical therapy program. Once in college, mentors took her up repeatedly, most of them physical therapists. She stayed on in Madison, working at a residential facility for children with disabilities, returned to UW to obtain a master's degree in physical therapy, and after teaching for 2 years at UW, returned to school for a PhD in neurophysiology.

This young woman, of course, was me, and these experiences left me with the intense desire to ensure, to the extent that I could, that no one with the talent to pursue higher education would ever be denied the support to do so. This story about myself--the initial disadvantage and lack of any guidance at all from teachers and counselors until I reached college and my subsequent involvement as student and faculty member in a series of three research universities--will, I hope, inform you about why I've chosen the particular topics of this talk: (1) centers of excellence in research universities, (2) preparation of a diverse work force for physical therapy, and (3) mentoring the clinicians, scholars, and educators of tomorrow for the challenge of evidence-based, coordinated care for the benefit of all patients, including the most disadvantaged among us.

Nurturing Excellence in Research

What do I believe is necessary to nurture the profession in the year 2000 and beyond? First, is building our body of knowledge through research--research that provides answers to questions about efficacy, cost-effectiveness, outcomes, and prevention, but also research that addresses more fundamental questions of motor control, motor learning, and motor development. The APTA is developing a clinical research agenda to identify and answer those clinical and health services research questions that challenge us most, and, as a pediatric physical therapist, I hope that the agenda will not neglect the needs of children with disabilities. Our recent record in regard to children has not, in my opinion, been good. Pediatric outpatient care was left out of our survey of outpatient practice, and the needs of children with disabilities in the educational setting have not yet been adequately addressed in the Guide to Physical Therapist Practice.[2] We must not leave children out of APTA's clinical research agenda.

As we move forward in developing a research agenda, I do not believe we need to fear that the quality of our research will be lacking. In the Tenth McMillan Lecture,[3] Hislop bemoaned the status of our science, saying that it was in a state of disarray and that physical therapy was on the defensive because we had failed to define what physical therapy was. She laid out the foundations of a systems approach to research by physical therapists that has inspired me ever since. I hope she is pleased to see the disability model incorporated in the Guide to Physical Therapist Practice,[2] because the Guide endorses the National Center for Medical Rehabilitation Research (NCMRR) disability model,[4] which is similar to what Hislop inspired us to adopt. What is unique about the NCMRR model of the disabling process is that it reflects a consensus among rehabilitation professionals and people with disabilities about the need for research on a variety of dimensions affecting their health and well-being. I am proud to have been a part of the group that implemented this model as a guide to funding research by NCMRR and to see it incorporated in our practice guide.

Today, therapists are involved in research on all aspects of disability, using a wide variety of research methodologies. Work in patient-related education is informed by qualitative research on the experience of disability from the perspective of the consumer. Research on models of service delivery is growing, and we are making progress toward diagnostic classification systems for a variety of impairments. The work of my own group is aimed at development of a diagnostic examination for identifying developmental delay in newborns.[5]

As a neurophysiologist who left basic science research for pediatric clinical research, I am especially impressed by the work of physical therapists who are pushing the frontiers of knowledge in molecular biology to address the regeneration of damaged nervous systems. And I stand in awe of researchers such as Byl and colleagues,[6] who developed an animal model of repetitive strain injury. This research demonstrated the disorganization of the somatosensory cortex of the brain that results from what we have thought of as a mechanical injury. Because their results are directly applicable to the treatment of humans with focal dystonia, their research is a stunning example of the value of developing animal models of disability. As a result of such research, I have no doubt that we will become "the preferred choice for the prevention and treatment of impairment, functional limitation, and disability related to the neuromusculoskeletal system."[7]

Our research is terrific, and it will change the field in ways we cannot even imagine today. But we need more of it--more researchers, more funding, and more dollars spent to inform the medical profession about our science and its ability to change the outcomes of disabling conditions. Because of my own experience of the difficulty of developing collaborative research relationships with medical and nursing professionals, I believe that lack of respect for our research on the part of physicians and nurses is common. Although APTA has done an excellent job of public relations with consumers, legislators, and third-party payers, I believe that we should now invest more of our public relations effort on informing physicians and nurses about our science.

To look at the big picture of physical therapy research, we should consider the institutional settings needed to support our burgeoning research enterprise. In professions such as medicine and nursing, the faculties in major research universities produce a constant stream of data in support of practice and development of new approaches to patient care. Physical therapy programs in such research universities may become an endangered species as academic administrators reflect on our changing job market, the quality and quantity of our science, and their efforts to deal with the limitations of funding for higher education, especially when they are faced with APTA's position on proliferation of education programs.

My concern, in particular, is for our programs in institutions called "research universities." As you know, US colleges and universities are classified by major mission into a number of groups[8]:

* Associate of arts colleges offer 2-year education programs in line with their vocational mission, including physical therapist assistant education.

* Liberal arts institutions emphasize baccalaureate education.

* Comprehensive universities offer undergraduate education and graduate education through the master's degree.

* Doctoral universities award at least 40 doctoral degrees annually.

* Research universities, in addition to their educational function in undergraduate, graduate, and professional education, have as a major mission the creation of new knowledge through research.

The last 4 types of institutions support physical therapist education. The universities in the Research I and II classifications (which differ based on amount of federal funding for research) represent only 3% of US institutions, or about 125 schools; 88 of these schools are Research I institutions.[8]

In 1970, there were physical therapist education programs in 51 institutions [Mary Jane Harris, PT, Associate Director, APTA Department of Accreditation; personal communication]. Twenty-five of these programs were in today's Research I institutions, and they represented 49% of our training programs. In 1999, there are physical therapist education programs in 173 institutions. Thirty-two programs (18%) are in Research I universities. Although we gained in absolute numbers of programs in Research I institutions over the past three decades, their proportion dropped from 49% to 18% of our education programs.

What happened along the way? In 1980, there were programs in 86 institutions for physical therapist education, and 30 (35%) of these programs were in Research I institutions [Mary Jane Harris, PT; personal communication]. A notable addition for its infusion into the profession of therapists of color was Howard University. In the years since 1970, however, when educational institutions went into periods of retrenchment in times of economic difficulty, professional programs were vulnerable. Between 1970 and 1985, physical therapist education programs were closed at the University of Pennsylvania, Stanford University, and Case Western Reserve University--all prestigious Research I institutions--and the program at the University of Michigan was moved from the Research I campus in Ann Arbor to another campus.

To summarize the facts in absolute numbers, we have gone from 25 programs in research institutions in 1970 to 30 programs in 1980 to 28 programs in 1990, and now, in 1999, we find that only 32 of the 88 Research I universities in the United States house physical therapist education programs [Mary Jane Harris, PT; personal communication]. Few of our programs are in the nation's most prestigious research universities, and among our 31 currently developing schools, none are in Research I institutions and only 3 are in Research II institutions.

Although faculty in physical therapist education programs in all types of institutions are expected to do research, support for such activity will always be strongest in the research institutions, where achieving tenure depends on garnering funding for research and developing a strong record of publication and other scholarship. Furthermore, these are exactly the programs to which we should look to develop future scholars for the field. Thus, it should come as no surprise that of our 21 institutions offering the research doctoral degree, 18 are in Research I universities [Mary Jane Harris, PT; personal communication]. To the extent that we failed to sustain education programs in the research universities in the past and fail to nurture such programs now, we will hinder progress in taking our profession to new heights and enhanced respectability through research. If the gap between supply and demand in our job market closes, and if faculty members in research institutions do not contribute to the university's research mission, these programs will again come under attack.

Because educational institutions themselves are, of course, responsible for initiating, nurturing, and terminating education programs, the profession as a whole is not able to direct the development of programs very effectively beyond accreditation of entry-level [professional] education, but I hope to raise our level of concern for these precious resources and offer the following ideas. What we must do first is consider carefully whether we really want to discourage the opening of all new schools. In my opinion, whether we, as individuals or as chapters, wish to support the opening of a new program should depend on the institution's mission and whether it will further the production of new knowledge and new scholars. Second, those who graduated from one of our programs in a research institution should consider supporting their alma mater through being involved in clinical education, teaching, or collaborating in research projects with faculty, and should contribute as generously as possible to the annual alumni fund drive. Those who head corporations and successful private practices should consider contributions to support research professorships or graduate fellowships. Program directors in Research I institutions could form an organization to network, share ideas, and promote clinical research consortiums, as well as to share resources and opportunities for graduate research training experiences such as collaborative distance education. The APTA can assist in forming clinical research consortiums to promote studies with large patient populations, especially on less common conditions that are difficult to study in a single center. The Foundation for Physical Therapy can target fund-raising to benefit the development of centers of excellence in research, specifically in Research I universities.

Although it may seem unfair to target a small number of elite institutions for special treatment, I submit that all organizations providing development funding seek to identify targets of opportunity that will garner the most product for the money invested. We also tend to build up that which we have sadly neglected when new efforts begin. I believe that we are in this situation, but I also foresee the possibility of renewed difficulties in the future as the job market changes, so we need to be proactive.

Educating a Diverse Workforce

Recently, I spent a brief sabbatical at the University of California-San Francisco (UCSF), treating patients in the intensive care nursery. One of my patients was a Vietnamese boy with severe congenital heart disease. He had had an initial palliative surgery, but still ran very low oxygen saturation levels and experienced life-threatening cardiac arrhythmias. He had been abandoned by his mother, who was overwhelmed with caring for his healthy twin at home, but he had a personality that drew everyone in the nursery to him. He loved to play, and I was able to get him to work very hard in order to look at, touch, and listen to a little dog toy I use in therapy.

One day I came in and found his bed empty. In my search for him, I discovered that he had been moved into intensive care after essentially dying during an attempt to reverse another cardiac rhythm abnormality and had been revived with "the big jolt." He lay without waking for over a week, and I went by each day just to touch his hand and check on him. On my last day at UCSF, when I went by to see him, he was awake. I showed him the little dog he liked so much. He looked at me, then at the toy, and then back at me, and a smile like a sunbeam spread across his face. In that moment, I knew once again why I love this profession. But I am left with a nagging question: If his nurse had been Vietnamese, if his social worker had been Asian, if his physical therapist had been Asian, might his mother have been able to stay attached to him, to be there for him? I give yon the image of this little boy struggling for life at a supreme disadvantage as an emblem to motivate us to work harder for diversity in our workforce. It's right, it matters, and the efforts of each of us count.

As we approach the point when all of our education programs will prepare practitioners at the postbaccalaureate level, the challenge of preparing a diverse workforce in physical therapy for the new millennium is great. Although our education programs have made great efforts to include racial and ethnic minorities in their classrooms, progress has been slow. Our current membership is 10% minority and includes 1.6% African-American or black physical therapists, 1.9% Latino therapists, 4.5% Asian therapists, and only 0.5% Native-American therapists [Johnette L Meadows, PT, Director, APTA Department of Minority and International Affairs; personal communication; March 1999]. Only the Asian category is in line with their current representation in the US population. The figures for physical therapist assistants are similar--slightly higher in each category, except for the Asian category, which is only 1.9%.

To reflect the projected US population distribution in 2015,[11] we need to increase by 8 times the proportion of black and Latino therapists and assistants, double the percentage of Native Americans, and triple the proportion of Asian physical therapist assistants. Can we hope for improvement in these proportions based on those in training? Unfortunately, not much. The APTA student member enrollments in physical therapist education include 2.7% black or African-American students, 3.1% Latino students, 5.3% Asian students, and 0.6% Native-American or Alaskan-Native students [Johnette L Meadows, PT; personal communication; March 1999]. The APTA student members in assistant training have similar proportions, except that black representation is slightly larger at 4.1%. Another concern is that 75% of the minority population in physical therapist or physical therapist assistant education programs is concentrated in only about one third of our schools, and 50% are in fewer than 15% of the schools [Mary Jane Harris, PT; personal communication].

I grew up near the Menominee Indian reservation in Wisconsin, so I have a particular interest in the lack of representation of Native Americans in APTA and in our clinics. National statistics indicate that Native Americans have the highest rate of disability of any group in America.[10] Twenty-two percent of Native Americans have disabilities. The economic engine of Native-American peoples--the gambling casino--is allowing this group to improve the education of its children and to raise their aspirations. Among APTA student members, only 2 Native Americans are currently obtaining postprofessional master's degrees, and only 1 student is in doctoral training [Johnette L Meadows, PT; personal communication; March 1999]. From where will the role models for future students come? In northern Wisconsin, the Menominee nation has built excellent health care facilities with their new wealth and has engaged the UW in rural medical education. But we need the involvement of more physical therapists to participate in clinical education in these excellent primary care settings and to act as role models for Native-American youth. I want to challenge the members of each of our chapters to reach out to increase the numbers of Native-American physical therapists among us and among their own people.

We must intensify our efforts to mentor minority youth, because it will become more difficult to increase the numbers of minority therapists as challenges to affirmative action spread across the country. Research by 2 prominent educators makes it clear that using admission criteria other than race will not maintain the current numbers of minority students in the best institutions of higher education and certainly will not increase them.[11] Using markers for socioeconomic disadvantage, for example, will not suffice as a substitute because there are tar more disadvantaged white students than racial or ethnic minorities. Currently, universities are facing challenges to preferential admissions, but I anticipate that the next challenges will come to special pre-admission and post-admission academic support programs to aid minority students, which are generally not open to others. We will inevitably be faced with an increasingly difficult problem of how to produce a diverse workforce with these challenges to higher education's efforts to be inclusive.

Despite my emphasis on racial and ethnic minorities, I do believe that we should also make special efforts to include students from socioeconomically disadvantaged families in our education programs for 2 reasons. First, the move to postbaccalaureate education and the inexorable progress toward the clinical doctorate as entry credential[12] will make it more difficult for poor individuals, like I was, to imagine themselves as physical therapists. A second reason for making special efforts to include disadvantaged students has to do with their ability to empathize with and communicate with patients from similar backgrounds. Just as we expect that there is an advantage for patients of color to be treated by therapists of color, the ability to understand a patient's concerns is also related to class.

My father, who has Parkinson disease, learned English as a second language and has only an eighth-grade education. His approach to being a patient is to be passive, trusting medical professionals to take charge, but then frequently ignoring their advice because it doesn't make sense to him. Recently, my father was hospitalized for 2 1/2 weeks in a rehabilitation center, precipitated by an increasing inability to get out of bed or a chair. Now, the real basis of his anxiety over this problem was a tear that he would be unable to get to the bathroom in time. This important point was never recognized by anyone in the rehabilitation setting--not the neurologist, not the physiatrist, not the physical therapist or occupational therapist--and, consequently, the problem was not addressed until a member of his family asked to speak to a doctor and told him the problem. As a result, just one day before my father's discharge from the hospital, he saw a urologist, and, as many of you will already have guessed, he had an enlarged prostate. I strongly believe that a half hour of talking with my father and my mother, who spent all day, every day, at the hospital with him, could have resulted in different outcomes for him. He left the hospital stronger but no more functional than when he was admitted. Is this cost-effective rehabilitation? All of the health care professionals with whom my family dealt were well trained, highly competent, and, in some cases, national leaders in their field, but they had no idea how to talk to a man with little education and made no effort to try to find out how he viewed his problems or what he sought from his care.

Coordination and Communication in Caregiving

This example of failed communication shows why physical therapy professionals need to step outside the frame in order to see the whole picture of health care as an extended network of caregivers who need to coordinate care and communicate more effectively. For the past year, I've lived with the Guide to Physical Therapist Practice[2] as I worked on a new edition of Physical Therapy for Children,[13] which incorporates the Guide's terminology and practice patterns. As I've worked with the Guide and reflected on both my own practice and on what I've learned through my involvement in planning continuing education for practicing professionals, the area that seems to me in need of much effort to improve practice is that of coordination, communication, and documentation.[2]

I also base my concern on my teaching experiences because our physical therapist students recognize the challenges of documentation and communication with patients and other professionals. For example, the following is a list of the most frequently mentioned challenges for personal development expressed by the class of 1999 in an exercise on reflection on practice:

* Gleaning information from medical records more efficiently

* Writing clearer notes more efficiently

* Teaching patients more effectively

* Obtaining information from the Internet--both for evidence-based practice and for patient-related instruction

* Learning Spanish

I would personally consider learning Spanish to be a good way to ensure myself a job in a tightening job market. Spanish lessons are now available that are tailored to the needs of health care professionals, and perhaps APTA should become involved in this type of education.

What members of the class of 1999 did not mention is something I emphasize in my teaching methodology: the online processing of information and concise communication. Critical to survival in a managed care environment is on-the-spot negotiation (eg, getting those extra days of treatment in consultation with a case manager in a managed care office). I decided to look at A Normative Model of Physical Therapist Professional Education[14] to see what it suggested for helping therapists to attain this skill. I found an example of an instructional objective: "Develop professional communication skills, including sharing patient findings with other professionals, conflict management, and negotiation skills," but no sample instructional strategies. It is clear, however, that the skill of successful negotiation for case management can be learned only with practice, will not be learned from lecture-based education, and must be grounded in sound knowledge of data on efficacy and outcomes. As Sahrmann emphasized in the 29th McMillan Lecture,[15] we must use the science we have! As for sensitive communication with individuals with limited education, the Normative Model is surprisingly silent.

The Guide to Physical Therapist Practice[2] emphasizes coordination, communication, and documentation as a key component of physical therapist intervention. Yet, in my observations of practice, this is a key area in which therapists really need to step outside the frame and take a long view of the whole picture of truly coordinated care in order to recognize the impact on efficiency of practice of poor communication and coordination of services. Here, I'll continue my story about my father, and it will reflect my strong belief that communication across the divide of class is crucial to rendering effective care and that the impact on efficiency of practice of poor communication and coordination of services is vast.

While my father was in the hospital, one of the things he enjoyed most was riding the exercise bicycle. At discharge, he came to live at our house, and I told him that he could use our bike, but that I wanted him to be supervised the first time he used it because it had moving handles he wasn't used to and I wasn't sure how this would affect his balance. Because a home health therapist was coining for the first time that day, I suggested that my dad ask to try the bicycle while he was there. The therapist told him that he wasn't ready for that yet. A short while later, my parents moved into a new independent living apartment back in Wisconsin, and I arranged for a therapist to visit to help them with learning to negotiate the building. The complex has an exercise facility, and again my father was interested in using the bicycles. When he told the therapist this, she said that he wasn't ready for that! To my knowledge, none of his 3 therapists ever had any communication with each other, and I leave to your imagination what my father thought about their competence. He is now happily enrolled in an exercise class directed by a nonprofessional, and he rides his bike in the fitness center.

Another example of the need for improved coordination and communication in intervention comes from my work on continuing education for rural therapists in southeastern Kentucky, northern Wisconsin, and southern Illinois. In each of these locations, therapists in public school settings complained of the lack of communication from therapists in specialty centers where inappropriate orthotic decisions were often made, frequently resulting in recommendations for equipment that was discarded. We also heard from therapists working in the specialty clinics that they received no information about the children from their school or private therapists, which hindered their decision making. In Kentucky, a woman who was caring for her granddaughter with cerebral palsy had gone to more than one neurologist seeking treatment of the cyst in her granddaughter's head. No physician, and no therapist, had explained periventricular leukomalacia to her, and she was continuing to search for someone who would drain the cyst. A 2-minute explanation was sufficient to deal with this problem on which she had been spending so much time and energy while placing unnecessary demands on the health care system.

In dealing with communication issues such as these, I find Rothstein and Echternach's hypothesis-oriented algorithm for clinicians[16] to be exceptionally useful. Although the algorithm as a whole is an excellent device for reflection on practice, the piece I find most compelling is at the very beginning of the model. They recommend that the first activity a therapist should engage in when approaching a patient problem is to establish goals. Goals are established on the basis of patient interview and history before examining the patient. This idea is often difficult for therapists to understand, but the reasoning is very clear: if goals are established first, they will be based on the patient's expressed needs and reasons for coming to therapy. As a result, goals will be functional, and they will be stated as outcomes in terms the client understands. Not so coincidentally, they will also be stated in terms that other professionals and case managers can understand, thus enhancing coordination of care and reimbursement.

In addition to client-focused goals, we also need to provide educational experiences and continuing education that help therapists to see the whole picture of an extensive and complex care system from the patient's perspective. A most useful activity would involve joint ventures among clinicians, educators, publishers, and APTA to develop a library of patient cases on videotape or CD-ROM that demonstrate the elements of the Guide.[2] address the concerns I've raised, these learning materials should emphasize communicating with patients with limited education about their needs and coordination of time-limited care among the variety of providers patients face in such bewilderment. To emphasize this latter point once more, in my recent experience, the family of an infant was dealing with more than a dozen different professionals on a regular basis.

Mentoring the Membership

Finally, I would like to address mentoring the APTA membership. I have been privileged throughout my career to have been engaged in developing new scholars and have been recognized as a mentor with a number of awards from APTA and its components. Thus, I want to spend the final moments of my time with you sharing some thoughts about recruiting and mentoring current and new members.

My first thought about what to say about mentoring was that I was surprised to be honored for this activity, because it wasn't something I embarked on consciously. As I thought more, of course, I realized that I was simply doing what my mentors, through their example, had taught me to do. And through sharing my story, I know you will understand why these people have meant so much to me. My clinical mentors were Leila Green, Georgia Shambes, Gay Girolami, and Janet Wilson Howle. I learned to write through working with Wally Welker, Mary Clyde Singleton, and Irma Wilhelm. I learned grantsmanship and received deep and lasting instruction in educational methods from Margaret Moore. My husband, Dick, has been my main and still most important mentor, not only because he always thought I could be a doctor but also by teaching me about academic governance, statistics and research methods, and more than I ever wanted to know about baseball, basketball, and football.

With each of these individuals, I had the intense involvement characteristic of a mentoring relationship[17] in which I learned to model their behavior, seek their advice, and respond to their challenges to become better than I thought I could be. Being a mentor can include lots of activities, but let me elaborate on just one of the things that I learned. A key skill of an effective mentor is connecting proteges into the larger network of individuals who can aid their further development and challenge their skills. My memory of attending my first APTA conference in 1965 when I received the Mary McMillan Scholarship is characterized by indelible images of Dorothy Briggs and other faculty members being sure that I met all the important people. It seemed to me at the time to be just one of those things that faculty members did for students, and only now do I realize what it meant to me as a young professional to know the important people in the field before I even had my license to practice. As a result of this example, my first and foremost goal in working with my graduate students is to incorporate them into the larger network of which I am a part. An example is the network of Maternal and Child Health practitioners generated by the training grants offered by that component of the US Public Health Service. The specialty sections of APTA play this important role for many of us as it relates to our practice interests, and I believe that this is an important reason to .join a section. The APTA, of course, is the largest network that we have, and research has demonstrated that contacts made through professional organizations have value in facilitating employment mobility and information flow.[18] The APTA has recognized the need for establishing networks among members with its Members Mentoring Members Program,[19] and I hope all members will offer their services or use the program.

As I took continuing education into rural communities as part of my Maternal and Child Health Service grant work, I became aware of just how few physical therapists out there belonged to APTA. I am aware that individual chapters have worked hard on increasing membership, but in 1998, overall APTA membership decreased by 0.6%.[20] This small overall membership decrease, however, was accompanied by larger decreases in active physical therapist membership of 1% and in physical therapist assistant membership of 3.1%. We need to reverse this trend, so what can you do?

The APTA's Strategic Plan for Membership Development[21] stresses the important role of components and the even more important role of peer contact, that is, one-on-one recruitment. Recently, an article appeared in The New Yorker magazine about a Chicagoan named Lois Weisberg, the head of the Mayor's Cultural Affairs Office.[22] She was described as the quintessential networker, the person who knows everyone and lives to connect them, especially those who differ greatly from each other. In telling Weisberg's story, the author reviewed research on networks and mentioned the 6 degrees of separation concept (ie, the idea that a randomly selected pair of individuals in the United States are connected through an acquaintanceship linkage involving only 5-6 intermediate people[23]). What isn't so widely known is that the research that established this "small-world" idea actually showed that only 1 or 2 people formed many of the final connecting links to a given individual reached through a network. That is, there are many people like Weisberg who live to connect people into their network.

What I propose is that we make use of this idea of the interrelatedness of people and the likelihood that each of us has in our chapter one or more people like Weisberg--people who naturally collect people and like to know everyone. They may not be in the component leadership circle as they may not be the type of people who like following policies, guidelines, and parliamentary procedure. These networking experts should be given the tools to contact every therapist in your state and encourage them to join APTA.

My observation is that nonmembers are out of touch with new developments in the field, are uninformed about how to work in the evolving health care system, and may even lack knowledge of the legal basis of practice, such as state laws regarding supervision of physical therapist assistants or rights of children with disabilities in public education settings. To be mentored, they must first be recruited to belong to APTA in order to guarantee the reputation of our profession, and their dues are important to our ability to carry out the mandates you, our members, provide to our Association leadership for continuing to nurture the profession.

Having mentors who cared deeply about my development and being a mentor for the next generation of clinicians and scholars have been so important to me, but the talent of the clinicians and students I've worked with made being a mentor easy. These proteges are the jewels in my crown and my legacy to you to continue nurturing the profession of physical therapy in the challenging times ahead. With people like our young clinicians, scientists, and educators to build our practice and our body of knowledge and to educate future generations of clinicians and scholars, I believe the challenges I've raised can without question be met.

Acknowledgments

My research and continuing education work mentioned in the lecture were supported by the Foundation for Physical Therapy, the NCMRR of the National Institutes of Health, and the Maternal and Child Health Service of the US Public Health Service. I am grateful to Pai-jun Mao and Demetra John and to APTA staff members Mary Jane Harris, Johnette Meadows, and Lisa Maatz for assistance with research for the lecture.

References

[1] Rushdie S. The Ground Beneath Her Feet. New York, NY: Henry Holt & Co; 1999:43.

[2] Guide to Physical Therapist Practice. Phys Ther. 1997;77:1163-1650.

[3] Hislop HJ. Tenth Mary McMillan Lecture: The not-so-impossible dream. Phys Ther 1975;55:1069-1080.

[4] Research Plan for the National Center for Medical Rehabilitation Research. Washington, DC: US Department of Health & Human Services; 1993. NIH Publication No. 93-3509.

[5] Campbell SK, Kolobe THA, Osten ET, et al. Construct validity of the Test of Infant Motor Performance. Phys Ther. 1995;75:585-596.

[6] Byl NN, Merzenich MM, Cheung S, et al. A primate model for studying total dystonia and repetitive strain injury: effects on the primary somatosensory cortex, Phys Ther. 1997;77:269-284.

[7] APTA Vision Statement for Physical Therapy 2015 (RC 42-97), Interim Report to the 1999 House of Delegates, Appendix A. Alexandria, Va: American Physical Therapy Association; 1999.

[8] Carnegie Foundation for the Advancement of Teaching. Definitions of categories. Available at: http://www.carnegiefoundation.org/cihe/ cihe-dc.htm.

[9] Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050. Washington, DC: US Bureau of the Census; 1996. Current Population Reports, Series P25-1130.

[10] McNeil JM. Americans With Disabilities: 1991-92. Washington, DC: US Bureau of the Census; 1993. Current Population Reports, Series P70-33.

[11] Bowen WG, Bok DC. The Shape of the River Princeton, NJ: Princeton University Press; 1998.

[12] Threlkeld AJ, Jensen GM, Royeen CB. The clinical doctorate: a framework for analysis in physical therapist education. Phys Ther. 1999;79:567-581.

[13] Campbell SK, Vander Linden DW, Palisano RJ, eds. Physical Therapy for Children. 2nd ed. Philadelphia, Pa: WB Saunders Co; in press.

[14] A Normative Model of Physical Therapist Professional Education: Version 97. Alexandria, Va: American Physical Therapy Association; 1997.

[15] Sahrmann SA. Twenty-Ninth Mary McMillan Lecture: Moving precisely? Or taking the path of least resistance. Phys Ther. 1998;78: 1208-1218.

[16] Rothstein JM, Echternach JL, Hypothesis-oriented algorithm for clinicians: a method for evaluation and treatment planning. Phys Ther. 1986;66:1388-1394.

[17] Gandy J. Mentoring. Orthopaedic Practice. 1993;5:6-9.

[18] Granovetter MS. The strength of weak ties. American Journal of Sociology. 1873;78:1360-1380.

[19] Members Mentoring Members Directory Alexandria, Va: American Physical Therapy Association; 1999.

[20] Annual Report 1998. Alexandria, Va: American Physical Therapy Association; 1998.

[21] Task Force on Membership Development. Strategic Plan for Membership Development (1999-2001) (Working Document). Alexandria, Va: American Physical Therapy Association.

[22] Gladwell M. Six degrees of Lois Weisberg. The New Yorker. January 11, 1999:52-63.

[23] Travers J, Milgram S. All experimental study of the small world problem. Sociometry. 1969;32:425-443.

RELATED ARTICLE:

Mary "Mollie" McMillan (1880-1959) is remembered as one of the pioneers of our profession and as the founding president of the American Physical Therapy Association. Born in Hyde Park, Massachusetts, she grew up and was educated in England, where she decided upon a career in physical therapy. As the first physical therapy aide to be sworn into service in World War I, she supervised the training of reconstruction aides and came to be known as "The Mother of Physical Therapy" in the US Army. Mary McMillan organized one of the first courses in physical therapy in this country at Reed College in Oregon, and she established the first physical therapy training center in China at Peiping Union Medical College. Her book, Massage and Therapeutic Exercise, was the first corn on physical therapy written by an American physical therapist. During World War II, she treated prisoners of war while enduring the rigors of Japanese internment camps in Manila and Shanghai. Not only did she devote her life to furthering the profession, but she bequeathed a large part of her estate to its future, providing for the establishment of scholarship funds for students in the field of physical therapy. Mary McMillan's selfless devotion to the profession has served as the inspiration for generations of physical therapists, and the ideals and standards she envisioned at the founding of the Association are still the goals we seek today.

The Mary McMillan Lecture Award, established by the Board of Directors in 1963 to pay tribute to Mary McMillan. acknowledges and honors an APTA member who has made a distinguished contribution to the profession. The award provides an opportunity for the recipient to share his or her achievements and ideas with the membership through a special lecture at the APTA Annual Conference. Nominations for the award may be submitted by individual members and components of the Association. Recipients of the award are selected by the APTA Awards Committee, with members representing the APTA Committees on Practice, Education, and Research.

Mary McMillan Lecture Award Recipients

Mildred O Elson, PT                                  1964
Catherine A Worthingham, PhD, PT, FAPTA              1965
Ruby Decker, PT                                      1966
Col Emma E Vogel, PT                                 1967
Helen Kaiser, PT                                     1968
Margaret Rood, PT                                    1969
None                                                 1970
Lucy Blair, PT                                       1971
Margaret Knott, PT                                   1972
Lucille Daniels, PT                                  1973
None                                                 1974
Helen J Hislop                                       1975
E Jane Carlin, DSc, PT                               1976
Mary Clyde Singleton, PhD, PT                        1977
Margaret L Moore, EdD, PT                            1978
Helen Blood, EdD, PT FAPTA                           1979
Florence P Kendall, PT FAPTA                         1980
Susanne Hirt, PhD, PT                                1981
Dorothy E Voss                                       1982
Nancy T Watts, PhD, PT FAPTA                         1983
Eugene Michels, PT, FAPTA                            1984
Geneva R Johnson, PhD, PT, FAPTA                     1985
Dorothy Pinkston, PhD, PT, FAPTA                     1986
Charles M Magistro, PT, FAPTA                        1987
None                                                 1988
Ruth Wood, PT, FAPTA                                 1989
L Don Lehmkuhl, PhD, PT, FAPTA                       1990
Robert C Bartlett, PT, FAPTA                         1991
Marylou R Barnes, EdB, PT, FAPTA                     1992
Gary L Soderberg, PhD, PT, FAPTA                     1993
None                                                 1994
None                                                 1995
Bella Jay May, EdD, PT, FAPTA                        1996
None                                                 1997
Shirley A Sahrmann, PhD, PT, FAPTA                   1998
Suzann K Campbell, PhD, PT, FAPTA                    1999

SK Campbell, PhD, PT, FAPTA, is Associate Vice-Chancellor for Academic Affairs, and Professor, Department of Physical Therapy, College of Health and Human Development Sciences, University of Illinois at Chicago, 1919 W Taylor St, M/C 898, Chicago, IL 60612-7251 (USA) ([e-mail]).

The Thirtieth Mary McMillan Lecture was presented at Physical Therapy '99: Scientific Meeting and Exposition of the American Physical Therapy Association; June 6, 1999; Washington, DC.3