Monday, January 06, 2014

Sitting around in an airport, thinking about critical thinking

I have all this flight delay going on right now - sitting around waiting to take a plane that's two hours late. Bad weather in Denver or something.

Anyway, I've been sitting around all afternoon; what a wonderfully busy day it has been in internet land (Facebook, Twitter..).

Kyle Ridgeway posted a picture I made re: critical thinking, in this very nice blogpost on the topic. 


I have had not much success trying to include this sort of theme in my own teaching. DNM is what I ended up with after I did a big batch of critical thinking about manual therapy, years ago. It was built from the ashes of what was left after I deconstructed manual therapy to death, had burnt off all the mesoderm, had incorporated Melzack and pain science into my brain.
But... it's slow to catch on. People assume it's just a reorganization of clinical reasoning. They don't understand why mesoderm should be left out. 

Kyle says, 
Because of the focus on evidence based practice, which inherently (overly?) values randomized control trials and outcomes studies over basic science knowledge and prior plausibility, students continue to learn interventions and techniques while routinely asking “what works?” Questions of “how did I decide what works?” “why do I think this works” and “what else could explain this effect?” also need to be commonly addressed in the classroom, clinic, and research. Such questions require formalized critical thought processes and skills.
I agree.
Basic science knowledge I favour is evolution and embryology. Do you know how hard it is to get people excited about these two fields of biology? I'm sure by now Louis Gifford knows.. I think both those fields should be incorporated into formal PT undergrad education. It would make it SO much easier to learn pain science and why neuroscience is so important. Why the nervous system is the thing to target, to think about, to clinically reason about. Not the meat. Not tooth fairy science based on meat theory.

It wasn't me who cracked this code... I had the good fortune to study manual therapy with a DO (doctor of osteopathy) who insisted that these two science fields were foundational. And I'm pretty sure he was right. I remember eating it up. It made total sense. I had had prior exposure to evolutionary biology in university, on one of my many forays there back in the 70's. I trusted it. Embryology was kind of like evolution, it tied in, just speeded up to nine months of unfoldment instead of millions of years. But it was all in there, including the start (the start we all have) as a single cell organism. In the case of human, a fertilized egg cell. Then the mad unfoldment orchestrated by genetic activation and chemo gradients, led by ectoderm, full of cells yearning to be close to, moving toward whatever in that expanding embryo smells so good to them..

It was possible, with this sort of knowledge base, to see a human as an event, not a collection of parts. A verb, not a noun. A development through time, not a done deal at adulthood. It was possible to see pain also, not as a "thing" but rather as a rough patch we all will have to learn to endure, and for most of us, not as a permanent situation.

The DO took great pains to try as well as he could to teach critical thinking AND clinical reasoning, and how to combine them. I think at least some of it must have rubbed off.

Anyway, Kyle's post was one thing that went right today. Thank you, Kyle, for including the picture I made a long time ago.