CE in the Massage Profession
The continuing conudrum
Summary: Continuing education (CE) is essential in the massage therapy profession, ensuring practitioners stay updated with evolving techniques and maintain high standards of client care. However, the traditional CE model has faced criticism for not adequately guaranteeing ongoing practitioner competence.
Issues with Traditional Continuing Education:
Lack of Practical Application: CE courses often emphasize theoretical knowledge over hands-on skills, leading to a gap between learning and practical application.
Variable Quality: The quality of CE courses can vary significantly, with some lacking rigorous vetting processes, potentially resulting in inconsistent educational experiences.
Compliance Over Competence: Practitioners may focus on fulfilling mandatory CE hours rather than genuinely enhancing their skills, treating CE as a checkbox activity.
Shift Toward Continuing Competence:
To address these concerns, there's a growing preference for a "continuing competence" model, which emphasizes:
Competency-Based Assessments: Evaluating practitioners' abilities through practical assessments ensures they can effectively apply their knowledge in real-world scenarios.
Personalized Learning Paths: Tailoring education to individual practitioners' needs and areas for improvement fosters more relevant and impactful learning experiences.
Outcome-Focused Education: Prioritizing measurable outcomes over merely completing hours encourages meaningful skill development and professional growth.
Adopting a continuing competence approach aims to enhance the quality of care in massage therapy by ensuring practitioners not only acquire knowledge but also effectively apply it, ultimately benefiting both therapists and their clients.
I have previously written about the CE Conundrum that is occuring in the massage therapy profession. (That conudrum is about the battle over which organization will manage and monitor CE for the massage profession.) That is a bit different than what I will cover in this article which is what should be required for CE to continue a massage therapists education after they pass massage school and obtain their massage license.
In 2020 during the pandemic I was involved in the beginnings of a research study on the topic of CE and have now read over 80 published research papers/articles that come from other professions on CE (The study was never completed). CE requirements are set by State Boards of Massage and main reason for existence of state boards are to protect the public from harm. They have set the basic number of hours of education that are required for an entry level massage therapist to start their careers safely. The problem is that most state requirements are not based on competency skills as outlined in the Entry Level Analysis Project (ELAP www.elapmassage.com) that was done many years ago that concluded that 625 hours of specific education requirements were needed to ensure entry level (right out of massage school) massage therapists know enough to safely give massage sessions to the public and protect the public from harm.
The massage therapy profession does not have ANY research on CE and what is needed to continue to protect the public from harm. The Massage State Boards set the CE requirements in each state and it is arbitrarily set by whoever is on the Board. There are so many problems with CE and the CE approval process that it is time for things to change.
Rick Rosen proposed these questions back in 2013 in his white paper and they are still not answered:
“Before NCB and FSMTB continue any further down their respective pathways, we must address and get frank answers to these interlocking questions:
1. Should continuing education be mandatory for renewal of state licensure – and is it essential for the ongoing protection of the public?
2. Given the reported inconsistencies in the instructional design and delivery of CE courses, is it even possible for an approval process to provide quality assurance?
3. Does the cost of compliance for CE providers (both in terms of time and money) bring an equal or greater benefit to the massage therapy field, and to the public at large?
4. What kind of regulatory process – if any – is needed; and which organizational entity is best suited to perform this function?”
From Rick Rosen’s White paper in 2013 (PDF) that led to the creation of the FSTMB’s CE Registry.
Issues with CE Requirements:
CE requirements are set by State Boards who also set the requirements for licensing which are based on what is needed to protect the public from harm. If the board has already set the requirements for education, why is more needed to protect the public?
CE classes do not guarantee competence. A MT can take a class and learn absolutely nothing. There is no testing of competency or skills. Continuing Competence is different than Continuing Education.
The number of hours is arbitrarily set with no research or reasoning as to the number of hours that are needed for maintaining competency and protecting the public. The myth that CE hours are needed continues without any evidence it is needed.
People often take CE classes according to which is easiest, cheapest and least demanding course to take and not by which skills they need to improve or what things could help them the most in their careers.
CE classes are often said to be required to keep up to date on the latest research and theories, yet there is no requirement for a class that does just that. So many MT are still claiming that massage increases toxins and that massage cannot be done in the first trimester of pregnancy. All MT need to be educated on these issues to say up to date.
Massage technique classes are often the most popular. These classes are often based on some type of massage that someone has made up or a traditional type of hands on work. They are not required to show if they are evidence based and nothing says who can or cannot teach these classes. Outdated theories are often taught under the disguise of marketing. Their skills are not tested. There is no technique or method that is absolutely required to provide safe and effective massage therapy.
Modality empires are being built because of marketing. Many things being taught are based on an idea, not science.
Hands on classes can result in injuries, being over-massaged and there is no recourse. Getting worked on all day by various skilled therapists is often a problem.
CE teachers are not always really teachers but are people who just have some technique that they know that they want to share. They are not required to have teaching certificates or skills.
Many conflict of interests are apparent in CE classes where teachers provide information to upsell products and other classes.
The high cost of CE makes it prohibitive for many massage therapists.
The CE industry is funded in part by professional associations promoting membership in their organizations and attendence at their conferences, another conflict of interest.
MT’s in favor of CE say that it helps with networking, connecting and that can be done without having to pay for a CE class.
Who needs CE?
Massage licensing requirements are created to protect the public from harm so the laws and regulations are created with the minimum requirements to provide massage safely. The Entry Level Analysis Project (ELAP www.elapmassage.com) has taken it a step further and created a document with the basic competencies required to become an entry level massage therapist. They have determined that 625 hours is the minimum required number of hours it takes to teach what they have found to be the specific competencies. So if massage licensing has set up the basic criteria then why is CE needed? The reasoning would be to keep entry level therapists up-to-date on the things that they learned in massage school therefore CONTINUING their education.
Some of our schools have taught material that is inaccurate and misleading making it difficult to know what people know and understand coming right out of massage school. Myths like massage releases toxins, misinformation about how/why massage works and other things are taught as being true when in fact they are not.
Who approves CE classes?
The National Certification Board for Massage and Bodywork has been the main agency that approves CE classes. They are notorius for allowing classes that are not evidence based and are even silly. Many states require and allow classes approved by the NCBTMB to be used for state licensing renewal requirements. As I have previously explained, the Federation of State Massage Boards (FSMTB) has created a CE Registry that has specific class topic requirements and many that the NCBTMB appove of are not allowed. They have created standards for teachers and topics. See their CE Standards and Registry Guidelines (PDF).”
The FSMTB does not accept courses that are outside of the massage therapy scope of practice.
Some unacceptable course types pertain to: Advanced science, Applied Kinesiology, Animal massage, Bamboo, Chiropractic assistant, Crystals, Crystal bowls, Dancing, Diets, Dry needling, Electric stimulation, Energy work, Exercise, Feng Shui, Herbal remedies, Homeopathic remedies, Light therapy, Martial Arts, Meditation, Non-biological science, Nutrition, Personal training, Pilates, Psychology, Qi Gong, Sea shells, Social work, Spirituality, Supplements, Tai Chi, Therapist Self-care, Tuning Forks, Ultrasound, Weightlifting, Yoga.”
Advanced Training
Massage therapists right out of massage school are trained for work in the wellness/spa sector of massage therapy. The general training in massage school gives an overall view of some of the medical conditions so they can be aware of these when working with clients. The Medical Care sector requires more training and skills to be able to work with various diseases and conditions such as headaches, carpal tunnel syndrome, back/neck injuries and cancer care. Currently we do not have tiered licesning to separate the two distinctions and only have Board Certification as a way to show that massage therapists have advanced training yet the requirements for Board Certification currently are less than what is required for massage licensing in most states.
CE is different from Professional Development
There often are conflicting ideas about the purpose of CE. Some health professionals see CE as a means to attain credits for the licensure and credentialing they need to practice their occupations. Employers often view CE as a way to keep staff up to date and to improve quality. Many regulators believe the purpose of CE is to maintain competence and improve quality. (current data is insufficient to determine how much CE is really needed to maintain competence, to support learning, or to affect performance. Institute of Medicine (US) Committee on Planning a Continuing Health Professional Education Institute. Redesigning Continuing Education in the Health Professions. Washington (DC): National Academies Press (US); 2010. 1, Continuing Professional Development: Building and Sustaining a Quality Workforce. Available from: https://www.ncbi.nlm.nih.gov/books/NBK219809/).
Professional development is different than CE. Our professional associations are responsible for professional development, not a board of massage whose main purpose is to protect the public from harm. Board Certification is the next step in a career in massage after basic massage licensing and needs to be developed into a program that really shows that a MT has advanced training. The NCBTMB has a very rocky history and has lost the trust of most of the profession. Currently, the NCBTMB is working to rebrand it’s self and is now mainly funded by the AMTA until they can get their feet back on the ground. Whitney Lowe wrote a great article The Future of Advanced Massage Credentialing about why we still need National Certification. He explains that we have 3 options in advancing the profession: Tiered Licensure, College Degrees or National Certification. We are far away from Tiered licensure and college degrees (although there are a few schools offering AA/AAS degrees and one school offering a Bachelors degree.)
Solutions
Since there is little actual harm to be prevented in the delivery of massage services, mandatory CE for license renewal is of negligible value in ensuring public safety. This is not to say that CE cannot help a MT further their career and skills. If a MT wants to do that they can. It should not be mandated through having to take CE that they often find useless and a waste of money. This is not to say that there are very good teachers out there teaching fabulous methods and techniques.
Make required CE a more formal class that needs to be required learning for every massage therapists that will include things like the latest research, the latest anatomy, kinesiology and pathology findings, and make sure everyone is on up to date on the same things. This could include some of the new trainings that are being asked for like implicit bias training, trauma informed training and issues in human trafficking. This could also include things like basic Science Literacy which is often not included in basic massage school.
Make Professional Development the responsiblity of the Professional Associations and have them create formal systems to review course material and create requirements for CE providers that will require them to show the research and evidence for the claims that they make. Have claims reviewed by the Massage Therapy Foundation (or some research informed body). AMTA had the right idea when they talked about creating an entry exam for their organization back in the late 1980’s.
Other issues:
Misuse of terms like CE and CEU: Ensure that the use of the words Continuing Education (CE) and Continuing Education Unit (CEU) are clearly defined in laws and advertisements for classes.
1 CE = 1 clock hour of training….. 1 CEU = 10 hours of training.
List of Massage Continuing Education Requirements by State.
Redesigning Continuing Education in the Health Professions. Show details Institute of Medicine (US) Committee on Planning a Continuing Health Professional Education Institute. Washington (DC): National Academies Press (US); 2010
Misuse of terms Certification vs Certificate
Professional certification is the voluntary process by which a non-governmental entity grants an often time-limited recognition and use of a credential to an individual after verifying that he or she has met predetermined and standardized criteria.
This means that true certification is issued by a third-party organization with an established body of knowledge . There is often an exam and/or significant project outside of coursework and continuing education requirements.
So for example: If there was a Certification in something called Medical Massage, it would be a test that is created by a third party organization that has done extensive research into the skills and knowledge that a Certified Medical Massage Therapist would need to know. Teachers would be able to have classes and teach the information and give a certificate of completion so the person could apply to take the Certification Test that would be given by the third party org that created it – (which we do not have).
See also:
Institute for Credentialing Excellence: https://www.credentialingexcellence.org/Accreditation/New-to-Accreditation/Certificate-vs-Certification
Article from Whitney Lowe that explains the details:
https://www.ncbtmb.org/
NCBTMB is Certified too! https://www.facebook.com/NCBTMB/posts/4863113480468108
Resources:
History of CE in the massage therapy profession.
https://www.massagechangeslives.com/history-of-ce-in-the-massage-therapy-profession/
The CE Conundrum: https://www.massagepracticebuilder.com/the-ce-conundrum/
White Paper: Continuing Education (PDF) in the Massage Therapy Field Proposal for an alternative to state and national regulation. Rick Rosen
Redesigning Continuing Education in the Health Professions. Redesigning Continuing Education in the Health Professions. Institute of Medicine (US) Committee on Planning a Continuing Health Professional Education Institute. Washington (DC): National Academies Press (US); 2010
Audio File
"Hi everyone, let’s talk about continuing education in the massage therapy profession. While CE is vital for staying updated on new techniques and maintaining high standards of care, it’s not without its challenges.
One major issue is the focus on fulfilling required hours rather than ensuring practical application. Too often, CE courses emphasize theory over hands-on skills, leaving practitioners without the tools they need to improve their practice. The quality of courses also varies widely, with some lacking the rigor necessary to truly advance the profession.
This has led to a growing interest in shifting from traditional continuing education to a model of continuing competence. Instead of just logging hours, continuing competence focuses on practical assessments, personalized learning paths, and measurable outcomes. This approach ensures therapists are not only learning but applying their skills effectively.
By adopting this mindset, we can elevate our profession, improve client care, and make continuing education more meaningful. Let’s move beyond compliance and focus on competence.
Thanks for listening, and let’s keep working to advance our profession together!"