The volume of content (knowledge, evidence, skills, critical thinking and reasoning…) has become so extensive that it sometimes seems impossible to cover everything for a Master’s degree within a reasonable amount of time (4 semesters; 6…8…). Now, with the probability of having a doctoral level entry and the additional requirements that will entail, how long a program will be enough yet still be reasonable?

I fall back on the idea that if we teach our students how to learn within the discipline (how to learn a new assessment; how to learn new therapeutic skills; where to find evidence and appraise it…) that we would not need to cover every detail while still graduating competent entry-level clinicians. Figuring out the balance is difficult. Feedback from graduates is often “you didn’t teach enough of_____(whatever it was they needed on the last Level II FW)” and the knee-jerk reaction is to add that in wherever it might fit. That leads to content bloat.

How do we synthesize the core elements of occupational therapy? Do we focus on therapeutic use of self, theory (horrors – why would we do that?), and the above advanced “learn to teach yourself” and trust the rest will fall into place? No – we need the basic skill sets – ROM, MMT, transfers. Wait – how about behavioral health issues? Working in a community? Pharmacology? The snowball advances to the avalanche of content that swamps our students and increases their graduation debt.

It would be nice for the academician to believe much will come together on fieldwork. Yet due to productivity constraints, the fieldwork educators are expecting students to “hit the ground running” and disparage a program that does not teach all they expect. This becomes a vicious cycle, unless there is sufficient communication between the program and the fieldwork sites to belay conflicts.

Clear communications…amongst faculty, clinicians, students, administrators, stakeholders, clients…takes time and forethought. Yet I think that is what will provide the answer to this challenge.

Should we return to an apprenticeship form of learning a profession rather than the hybrid we have now in Occupational Therapy (and other branches of healthcare)?

Too many students seem to only value the clinical experience, else stories of clinical experience, and lectures from experts rather than “book learning”.  Do they not understand that those books/articles were written by experts? That they would learn more (retain more) by putting out the effort to actually understand what they read on their own?  Questions can be brought to class and discussed if class time is not consumed by paraphrasing a textbook.

If we used an apprentice model, we would need many more clinicians willing to teach; which would also mean more agencies willing to potentially lose some productivity due to that teaching. Would it be worth it in creating better (more satisfied?) clinicians than could be created in traditional classrooms?

There is a medical school program that begins by training all students as Emergency Medical Technicians and then has them work simultaneously while taking their med school classes – this makes what they learn immediately relevant.

Do you think something similar to this could be viable for us? Should there be a crash course (6-8 weeks) of becoming an OT Tech and then on-the-job training to either COTA or OTR? Would this divorce the training from the educational degree? Or would there be some new relationships developed that could accommodate both the work and the degree? Could this help students constrain education costs? Could it potentially constrain healthcare costs?  Or would it be too disruptive to even try?

 

The Foundation for Critical Thinking publishes multiple guides for the process of thinking. The aspiring thinker’s guide to critical thinking by Elder & Paul (2009) is a brief, user-friendly monograph. They identify 3 levels of CT. From less to more, they include:

The Naive Thinker, The Selfish Critical Thinker, and the Fair-minded Critical Thinker. The last is someone who wants to make the world better for everyone. Personally I would hope that politicians would have this as their core belief, yet from what we hear/read on the news we have a majority of Selfish Critical Thinkers running many governments in this world. At this time, in the USA, we seem to have too many such “thinkers” in the Federal and many State governments. This is shifting priorities and protections away from the public good and I fear how the earth, atmosphere, and the lives of future humans will be impacted.

The core values of occupational therapy include the promotion of health in individuals, groups, and society. We must seek justice and health for all.

 

Continuing on a theme…critical thinking can be quite difficult. The hardest part may be that we are changing how we receive information (now primarily through video/images rather than text) and while many do think very well in images (Temple Grandin as an exemplar), I am not sure images lend themselves to full argument analysis for the rest of us.

I am currently reading Amusing Ourselves to Death: Public Discourse in the Age of Show Business by Neil Postman, originally published in 1985, but re-released by his son in 2005, and lent to me a few weeks ago by a faculty colleague.  Postman’s argument begins with the differences in both thinking and communicating found at different times in human history. Early on he discusses the high literacy levels in the US during the early decades of the country.

Coupling Postman’s thoughts with Kahneman’s leads to the premise that we must expend much more effort in our personal and collective decision making.  We also need to demand this of our politicians at all levels.  [Cue here the argument, written by many, that we must protect our planet from short term gains that will cause long term harm.]

At least a year ago I found myself saying “You’re never to old to make the wrong decision” and then forced myself to change the self-talk because it sounded so negative (and I surely didn’t want to compound the problem).  I find myself revisiting the statement lately. (That is purely a personal toss-out; not the main topic of this post. I guess I’m sharing so you know you are not alone if you recognize the statement.)

I am finally finishing “Thinking Fast and Slow” by D. Kahneman, thanks to a book club on campus. This book is teaching me that, like most humans, I do too much System One, quick think when I really need to parse out and appraise what is important. It is just so challenging to do, most of the time. However, it is fascinating to discover that even more disciplines than education, philosophy, and psychology actually analyze critical thinking. Kahneman won a Nobel Prize in economics.

For a number of years I have been working with small groups of people to determine the best ways to teach critical thinking within occupational therapy (and medicine, and other disciplines) and while there is a lot of agreement, there is also the concept that critical thinking is discipline specific, so ‘must’ be defined differently depending upon context.

When considering clinical reasoning it expands the issue exponentially. Some people do not separate the concepts, others do. I am in the later camp.

I am still seeking answers. Please feel free to weigh in on whether you believe  CT is distinct within OT and, if so, what makes it unique.

I ask forgiveness/tolerance in advance – this post is tangential to this blog. I just needed to express these thoughts.

• Have we lost touch with reality? Or are we just too insular to realize that reality differs depending upon who we are, where we live, and what we invest in ourselves?
• Have we totally lost the concept of personal responsibility?
• Do we no longer believe that the work we do results in the life we live?
• Have so many of our schools been starved that we no longer educate all of our citizenry so that they can think critically about how the present affects the future?
• Are people so brainwashed by television and other media that they do not see the bigger picture of what makes a responsible life?

I fear that too many of our children have not had an education that enables them to think independently (and that this has been happening for decades, so many adults cannot/do not think deeply and independently).

I know that too many of us have no idea how people different from ourselves actually live and what challenges they face.

I know that the media (all of it) portrays ways of living that most of us cannot even aspire to, yet that way appears to be THE way to want to live.

Yes, I believe the economics in this country are terribly skewed and need to be repaired.

I believe that people deserve an education and healthcare.

I believe people need to live their own lives by civil standards, but may not impose their values upon others who are living by their own civil standards.

I believe that we must recognize that the constitution was a document written in a specific period of time and must be interpreted in that light (as Ginsburg and Warren have each pointed out).

I believe that Congress needs to strip the ability to tack on amendments to resolutions so that issues can be dealt with directly. I also believe elected positions should have term limits, the same healthcare as the public, and no retirement benefits beyond those accrued during the time served (similar to any other regular job, and yes, knowing that many regular jobs do not offer any retirement benefits).

I sincerely hope we can find the means to increase dialog to resolve our challenges.

I’ve been reading about clinical reasoning today. I remember when occupational therapists first started using the term. It was a confusing time; anxiety-provoking – what was this new concept??  Then we realized that it was something we had been doing for a long time, but now it had a name.  Of course, it changed a lot over the next thirty years and is still being tweaked regarding what we call it now, how we describe it, how we teach it…

Then there was Evidence Based Practice. Another “new” concept that was not so new, but had a new name. Similar horror reaction to needing to learn about this new concept and then similar accommodation when discovering it was not as strange as initially thought.

I’m sure there are other concepts that fit this profile (sensory integration?).

I wonder what the next will be.

Once more time has vanished and my resolve to post regularly failed; though not as severely as in the past (months, not years). This post is more personal than professional (if you want to skip it).

Some challenges had come up for me that had me saying: “You never outgrow the chance to make poor decisions” (or something to that effect.  I used it for a few weeks and then realized it was terrible self-talk, so stopped repeating it.

I recall marveling at a fieldwork student (decades ago) who had such positive, natural communication with school children – it was a kind of talk I had heard of in personal growth workshops, but had not experienced a lot of personally. Hence, the marvel that it could be done so easily and by one so young. It still takes conscious effort to keep my general talk, and self-talk, universally positive. I suppose I should just accept that fact, just as I still need to force myself to exercise despite the lofty goal of a fit body. I guess it is similar to any other habit…just got to do it long enough to make it natural. I just fall back on the thought that positive thoughts make so much more sense than negative, why aren’t they the natural way for me by now.

I should (and here I hear the voice that says “Don’t should on yourself”) think of myself as in Recovery – from negative thoughts – and that Recovery is a journey, not a destination.  That takes a lot of the burden off.  Glad I came back to post.

I find this so true – even in higher education (though with contextual differences):

The Hard Part

Especially so when combined with memory-overload intensified by stress.  It is challenging to be a therapist for yourself as you are employed full time to be a therapist/educator for so many others. It requires some therapeutic intervention to stay on top of all of our responsibilities and attempt to maintain balance within our lives.

No sooner did I post on habits, then this post came along (beginning with a post on Creativity – also intriguing) and I thought, sleep is a domain of occupational therapy, why not post this link?  So, enjoy:

http://www.brainpickings.org/index.php/2013/12/16/writers-wakeup-times-literary-productivity-visualization/