How might we grow?

[Diane]

Sarah, great paper. Thanks for posting it. :thumbs_up

[nari]

Lloyd, I do not think we can stop the planet overheating - it is partly a natural process, after all, but if we can decelerate our hellbent role of destruction, it will help.

I also think many PTs just work in order to 'get by'; I did that for some years until I got the message to change clinical approaches. It certainly helped a lot.

Nari

[lloyd]

Maybe not to underestimate how many PT's just go to work to earn the daily bread to support the rest of their lives, They just want minimal hastle and energy expendature at work. Just getting by will do. I have days ( weeks) like that and i consider that i've been very fortunate.
There's many personal historical ,social/cultural reasons why our neural networks may not be well primed to be interested.
Ive got two late teen stepkids and they are awesome what they know and can express, although my stepson is painfully dimming his brilliance
with way too much grass.
Things are changing, evolution has not stopped.
If we can stop the planet from overheating and find ways to manage our us vs them biology our grandchildrens children could be magnificent.
many of us already are at least occasionaly.
:love:
Lloyd

[Sarah]

Jason,

Where's the article?? If anyone is interested, I wrote a paper on Teaching Evidence-Based Practice in Physical Therapy Curricula. I think I attached it properly.

Sarah

[Jason Silvernail]

Well, Bas said it first, but I'll second - PT (and training and conditioning for anoop) is not a true scientific field. Being a clinical discipline, it is in many ways "soft science", especially when compared to, say, chemistry. However, things are slowly changing.

Barrett is right in that many other clinical fields (he uses the example of orthopedic surgery) disseminate knowledge and change practice much better than we do, overall. In fairness, some of this may have much to do with the more concrete nature of the practice. We have much more in common (I think) with an internist or a psychologist than an orthopedic surgeon in many ways, and those fields struggle with this as we do.

I think a few trends will start to move this in a more positive direction:
1. Students entering the professions are much more technology oriented, and very familiar with gathering information across several databases to answer clinical questions. I remember my literature searches for my Master's thesis in 1996 - I had to go to the library, ask the librarian, and sit down at an antiquated dumb terminal and search with text commands through several databases - and only a small portion of what I found could actually be had full-text (photocopied from a journal binder or printed off microfiche of course). Now there are literally hundreds of places to look once you have an internet connection! And now the students entering have the desire and facility with the medium.

2. The attitude and orientation of the programs are changing (I can really only speak to US programs here). I think therapy is moving away from the more apprenticeship type training and into independent practice and more responsibility for all that does and does not happen with and for our patients. I really think the practice and educational evolution currently going on in the US has a lot to do with this as well. I think it's obvious we are moving toward a residency-based educational model, and that can only be a good thing for our patients and for our ability to improve the evidence base for commonly treated conditions.

I know everyone says the next generation is "different" but I think that might actually be true this time.

Here's an editorial article (first article in this trade magazine) by Robert Shaw that discusses the problem of diffusion of education and research into the PT community, and how diffusing the material may be just as hard if not harder than creating new knowledge with research.
(having trouble attaching the file - will try later)

[nari]

Wes

I think the 'why' is covered with traditional explanations using words PTs are familiar with, such as muscle/joint/weakness/strength. After all, that is why we are here in our jobs, isn't it.

From there, they can rest assured that if Joe Blow with many letters after his/her name said it, it must be right; and if 30-50% of patients improve after 4-5 sessions, then the approach works. For some pts, there may be an apparent 'cure' - the patient never returns.
Not all PTs think this way, obviously, but it seems many do.

From what I have observed, grads in Oz are taught to criticise and problem-solve from grass roots thinking. Trouble is. 'neuro stuff' isn't taught until 3rd year.....

Nari

[Crazy Pole]

Great discussion so far. Barrett, I can understand your frustration.

My observation is that many therapists are satisfied that they "get results" with their approach(es). I'm certain that nobody here will refute this, but I think it's important. As with most patients, I think many therapists are inclined to be satisfied if they get improvements, and are not necessarily concerned with understanding why, or considering alternatives.

Those that are truly dedicated seem to be the more curious ones, wondering "is there a better way?", or "what are the potential ramifications of any given approach?" Thanks in large part to this forum, my understanding of what I do has changed, but I'm not sure if my patient's results necessarily have. I'd like to think so, but I have no data to support.

As long as our culture is satisfied with results first and foremost, I suspect change will continue to be slow...

Wes

[Bas Asselbergs]

Diane, I agree with you. The model has percolated through the system; my remark was meant to illustrate the resistance many "education-consumers" have with newer models of study.
Your point about the changing of the grads - very true.

[Diane]

Bas, I think many (U's in Can.) have now adopted that model - I know Angela teaches in her program in that manner. Some knowledge "holes" are inevitable, but as has been discussed, the important thing is not to cram peoples' heads full of junk, but rather to teach them where to find info and how to weigh its importance, in a brain that has been taught clinical reasoning and critical evaluation. The grads are smarter than they used to be, that's for sure.

[Bas Asselbergs]

I just want to add this: the McMaster University Medical programme was set up years ago to be a "problem-solving" based education, rather than straight lectures and spoonfeeding. The medical students who signed up at this school were very happy with the set-up and found it enlightening. BUT, the ones who went to other medical schools, claimed that they "just wanted to get the info and data" and "get on with it" - they frowned at the set-up at McMasters. It was an illustration of "you can lead a horse to water"....
Much like this medium: it requires much thinking, there is no prepackaged brainfood, one has to mix the ingredients and eat and digest all by oneself to really "get it" - especially since there is no well-defined end product: a certidicate in this-or-that specilisation or technique.

Yes, PT is at this time a pseudo-scientific profession (in general).

[Diane]

I'm working toward becoming a professor in a professional program and incorporating more active learning techniques and critical thinking into the curriculum (...) PT programs are going this way, but very slowly.

Way to go Sarah! :teeth::thumbs_up

I've also seen that people who are autodidactic have difficulty understanding that it's not so easy for other people to learn that way. Some of it is motivational, some is cognitive, but the reality is, most people are not active learners.

So sad, so true. And their blinkered, follow-the-leader attitude is so reinforced in so many (PT and non-PT) cultural ways that are (mostly) invisible. It's a tough haul, but some of us have to get busy and do reclamation work, both on ourselves and then by showing others how.

[Sarah]

Barrett,

You're right, reading (and actually comprehending) is not the way that most people learn unfortunately. Such is the problem with online learning in general. Traditional teaching methods have involved spoon-feeding information in little bits. People who have gotten their ideas across in the past have developed expensive and tedious courses which involve systematically broken down material, given in small doses over a long period of time (think university). And we're conditioned to think that this is the best way to learn. If something is free and simple.....it can't be worthwhile!
My tactic is, if you can't beat 'em, join 'em. I'm working toward becoming a professor in a professional program and incorporating more active learning techniques and critical thinking into the curriculum. I call my students "creative problem solvers". They think I'm strange but endearing (I hope) From what I've read and seen, PT programs are going this way, but very slowly.
I've also seen that people who are autodidactic have difficulty understanding that it's not so easy for other people to learn that way. Some of it is motivational, some is cognitive, but the reality is, most people are not active learners. We could get into a whole different thread about the educational system and how it fails to teach people how to think for themselves and learn, but that would be another topic altogether...

Sarah

[Barrett Dorko]

Sarah,

I understand about learning styles but find that I am still surprised to find that reading doesn't seem to be just about anybody's style in our business - well, almost nobody. I say this because when I speak of what we've learned that has been published it's all brand new to the class.

I've yet to see any significant evidence that listening and watching has a lot of impact either. If it was so, somebody would show up here with an observation, a question or a new idea. This almost never happens.

[Sarah]

Learning Styles

From an educational psychology perspective, one also has to consider that people have different learning styles. As someone stated previously, the medium itself my be a barrier as well. From my experience, most PT's aren't internet savvy and prefer to learn in didactic and lab based CE courses, versus autodictatic learning that occurs here. To reach the widest audience, one needs to cater to all types of learning styles, so I think it's helpful that Barrett offers courses, and perhaps others will offer more in the future as well (Diane )

Sarah

[nari]

I agree with the conclusions Bernard came up with. I think we do very well, especially this year.
Even if we make one person per month think about another way of approaching patient care, it is a bonus.

Nari