By Brett Windsor, PT, PhDc, MPA, OCS, FAAOMPT
Life has become too academic. Certification for this, diploma for that, doctorate for something else. Seemingly, it is now impossible to perform even the simplest of tasks without a certification. How much of it is needed? Really? Is there another way to the rank of expert? Many experts have nothing more than a diploma.Yet in the clinic, it takes no time at all to realize the level of true mastery these clinicians have achieved. It’s always interesting to talk to experts about how they became masters. Three answers are routinely recited:
1. Experts read…a lot. On average, an article or two a day. Perhaps an unusual pathology that presented during the morning. Maybe a piece on anatomy, physiology, or biomechanics. Or, consider a thoughtful debate about the virtues of a certain management technique. Then, at least skimming monthly journals. To that point, what should manual therapists read to stay on top of things? Consider Manual Therapy, JMMT, JOSPT & Spine for a good start. Regular reading helps to deepen and broaden your ability to recognize patterns. It can substitute for experience you don’t yet have. The best do it…often. How much are you reading?
2. Experts value informal learning. Two years ago at IFOMPT, the President of AAOMPT said something rather astonishing; “We no longer do our business in bars”. While this is no doubt true, are we better off because of it? CS Lewis & JRR Tolkien met weekly at a bar in London to discuss matters of great import. Their literary accomplishments were hardly impeded. Informal settings remove barriers. The vestiges of time temporarily blur; deep and more thoughtful discussions occur. Long-term relationships develop and grow. What do you remember more – the course, or the fellowship? Has the fun of manual therapy left us? Are we really better off?
3. Experts value mentorship. Experts crave spending extensive one on one time with people who are better than they. Experts constantly seek to be tested and compared against those with more scars. Is there a better way to learn than by putting yourself in a position to receive constructive criticism from an expert? They’ve made the mistakes, perfected the art. Mentorship helps to develop patterns. Mentorship allows mistakes, but aids in avoiding their repetition. Mentorship stimulates the thinking mind; it asks questions and develops coherent answers. Above all, it creates a life-long professional relationship. Do you have a mentor?
Notably absent from the above is academic preparation. Academics are important; we’re not going back to on the job apprenticeships, although many in medicine believe that’s exactly the direction we should be taking – out of the classroom and back to the clinic. Where are the current trends in medical education? Outcome-based learning objectives, OSCE, reflective learning experiences and narrative feedback. Put simply, the medical education world is rediscovering the value of doing, being watched, and then providing detailed narrative feedback that allow learners to reflect on their own performance. Does PT value reflection? Really?
In many areas, manual physical therapy is on the right track. We recognized the value of mentorship long before most. We developed programs with mentorship at their core. Residencies are becoming ubiquitous; new DPT graduates are strongly encouraged to continue formal learning. The key to long-term learning is mentorship. Mentorship makes or breaks a post-graduate learning experience. In the old days, mentorship was largely informal…today its largely formal. Ah, the yearning for the timeless…the tried and true, that which works. Now there’s a new topic entirely. We’ll get to that…
What say you?
I don’t know if “academic” is the right word. I think academia is a noble pursuit and the dissemination of the knowledge gained through academia is vital to any profession. It is the literalness around academia that is troubling. As you described, everything is based on a certificate, or diploma, or a degree, or the data. One could possess and demonstrate the same knowledge or more knowledge than one who “earned” a degree, but without the literal earned letters, the knowledge is considered less important, or even worse, dismissed.
If being “too academic” is the problem. The problem lies in the effort to validate our academic efforts by rhetorically repudiating clinical knowledge, thus creating unhealthy dissension.
I like the example in the movie of The Wizard of Oz. The scarecrow is given his diploma, and automatically, he rattles off a mathematical formula and ascribes it to the isosceles triangle, when in reality, despite is confidence, it really is a right triangle that he describes.
There are many of us with the certificate, or degree, or the data, who are confident in what we learned, but it doesn’t mean the effective, productive, master clinician doesn’t know something valuable too.
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Appreciate your comments Michael. I think you’ve nicely developed the issues surrounding the ‘problems’ with academia. Academia itself is of course not the problem with PT, but as you’ve pointed out, relying on it to the exclusion of the clinical realm is the larger issue. The proof of this lies in the fact that there are many master clinicians with very little academic preparation, circa 1970’s; the converse is also true.
Thanks for contributing Michael.
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I don’t see this as a discussion of one versus the other. They work together. Academicians want internsips with experienced clinicians regardless of degree. There is mentorship during school as well in the form of structured clinical education.
One important thing is that academics can formally structure post graduate internships so the content is appropraite. What we do not want is an internship that is based on one persons opinion and ends in expensive one on one sessions in the dessert.
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I think there is a trend in continuing education that people value information disseminators with terminal doctorates more than master clinicians’ anecdotes. Peer reviewed evidence is very important, but a master clinician who is informed by the evidence can offer more clinically relevant skills and information.
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Great comments Michael. Brett
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