Critical Thinking

Hacking your education a student’s perspective

This post comes via SPT Caralyn Baxter @carajbaxter where she highlights some of the processes she employs to augment (i.e. hack) her PT education.

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To begin, I want to say I am thankful for my foundational education.  Without that platform to grow from, I would have no way to fulfill the requirements to earn a DPT degree. Through opportunities afforded to me during my own DPT student career, I have received phenomenal mentorship and exposure to the realm of conducting research because of the investment professors have put into my future as a clinician. That being said, there are major gaps in DPT education, not isolated to one particular school but in the education model on the whole.  While we spend plenty of time studying definitions of statistical tests and practicing obligatory skill sets including palpation of the SIJ, the format of the curriculum does not always lend itself to comprehensive discussion and critical thinking. My goal here is to make students aware of the plethora of resources they have at their fingertips that can and will bring their foundational education to the next level. It’s time we as students get away from the “tweak this/fix that” model and begin thinking outside of the box.

Physical therapists are not “healers”; we are on the journey together with our patients, but it is ultimately in their power to improve quality of life.  This idea is somewhat lost in academia. We are taught to poke and push in specific directions for specific effects, and we are told to expect specific results. The clinical encounter is reduced to a multiple choice question with four answers. This type of thinking, while beneficial for passing a board exam, can lead to a surfeit of logical fallacies, biases and errors in reasoning. In his book Synergy, Mark Latash explains that a word starts making scientific sense and can be used only after it has been operationally defined. Herein lies the problem: if we as students are not aware of the existence of logical fallacies and the meaning behind such terminology, how can we possibly avoid this behavior? (For a great explanation of detailed terminology, see: https://yourlogicalfallacyis.com). Rather than analyzing the information in front of them, students often conduct lab practicals, case studies, article reviews and exams in a method that appeals to authority, evoking a sense of “guruism” in the material we are taught. This type of linear thinking will lead to trouble when we are inevitably faced with the complex patient who walks into the clinic with a presentation that does not fit under a clear-cut diagnostic category. At the 2014 Combined Sections Meeting, Dr. Lorimer Moseley developed an entire lecture around this topic. Dr. Moseley points out that pain and patient presentation are not linear processes, but rather emergent. Their presentations are the result of innumerable variables that have ultimately led them to seek your physical therapy services. How can students succeed in treating patients with linear-designed training when in the real world, patients’ conditions and experiences are remarkably complex? How can we even realize this approach will not lend itself to success when we are not exposed to other unique ways of viewing a problem? Our confirmation biases need to be pushed aside, or, as Dr. Richard Feynman, a famous 20th century physicist put it, “When we go to investigate we shouldn’t predecide what it is we’re trying to do except to find out more.” Once we become familiar with the concept that physical therapy is not a simple “if this, then that,” and we set aside predetermined expectations, we can begin to embrace the unknown, develop questions and hypotheses, and seek out solutions.

It is this idea that brings me to the main point of this blog post. Students (and clinicians) have an incredible opportunity to seek out ways to approach uncertainty from an endless database of literature and social media. Discussions generated by blog posts, forums and Twitter can vastly expand our knowledge base, challenge our thought processes and expose us to the essential skill of productive disagreement in order to advance our profession (see: http://ptthinktank.com/2013/11/05/agree-to-disagree-the-less-wrong-way/). These resources are not meant to give concrete answers to abstract ideas, but to broaden our idea of current best practice techniques via enforcing critical thinking and critical appraisal. For example, what is subacromial impingement syndrome and the associated pain? In school, it’s the superior migration of the humeral head smashing the supraspinatus tendon against type I-III acromions. Broaden your horizon a bit and it doesn’t take much to see there is much more to SAIS—and maybe even the nonexistence of “SAIS”—outside of entry level education.1,2 There is so much knowledge that can and should be taken advantage of outside of formal education and with the ease of accessibility, why not start to think outside of the box?

Where am I now as a DPT student? The more I read, debate, and discuss, the less I know. But I am comfortable with uncertainty. It keeps the profession interesting and will fuel my passion to grow as a clinician. There is value in forming a solid foundation, but an absolute necessity to realize the journey does not stop there. I want to thank everyone who has contributed to my immense growth beyond the classroom walls and suggest a resource list to other DPT students that will hopefully be as helpful to them as it was and continues to be for me:

Twitter: Start out by searching hashtags including #DPTStudent, #SolvePT, #BrandPT, #NeuroPT, #SportsPT, #PainPT, and #Pelvicmafia and you will quickly find an incredibly intelligent group of PTs (and students!) that will challenge your thought process on a daily basis

Blogs and forums (in no particular order):

ForwardthinkingPT.com (this blog), PTThinkTank.comPTPodcast.comSomaSimple.comBodyinmind.orgBBoyscience.comThebodymechanic.caSportsmedres.orgbjsm.bmj.com/site/podcasts/

Acknowledgements: Eric Kruger (@Kintegrate) for encouraging me to write this blog post; Christopher Baxter (@Cbaxter1) and Kenneth Venere (@Kvenere) for their editing expertise

Citations:

1. Littlewood C, Malliaras P, Bateman M, Stace R, May S, Walters S. The central nervous system – An additional consideration in ‘rotator cuff tendinopathy’ and a potential basis for understanding response to loaded therapeutic exercise. Man THer. 2013 Dec;18(6):468-72.

2. Ludewig PM, Lawrence RL, Braman JP. What’s in a name? Using movement system diagnoses versus pathoanatomic diagnoses. J Orthop Sports Phys Ther. 2013 May;43(5):280-3.

 

 

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