Physical therapists teach or train our patients, based on the results of our examination and evaluation findings.
What, then do we teach our patients?
Do we teach them something we learned in school? Read in a book or a blog? Heard on the street? Do we teach something we learned at a weekend course?
Or, do we teach something new? Something we created or discovered?
Bloom’s taxonomy helps me understand my point. I’ll use Bloom’s to illustrate:
The pyramid shows the hierarchy of the cognitive domain (that is, mental skills) in Bloom’s taxonomy – the affective (feelings and emotions) and psychomotor (manual or physical skills) domain are not represented here although they are equally important to teachers.
Since I prefer to think of physical therapy decision making as the most important contribution that I can make to improve my patients’ lives then the cognitive domain is the one that best illustrates my point.
The Cognitive Domain of Bloom’s Taxonomy
Remembering, the earliest and broadest domain, must be mastered before any of the higher domains can be achieved. Examples of remembering are:
1. memorizing the origin and insertion of a muscle
2. stating the physiology of an electric modality
3. memorizing predictor variables for a treatment based classification
4. recall of Medicare minimal documentation standards for outpatient PT
Understanding is ownership of knowledge remembered. Examples of understanding are:
1. Recognizing a dysfunctional muscle or motor performance test.
2. Discussing the findings of a patient evaluation with the patient, PTA or physician.
3. Training a new clinician in your clinic’s Medicare compliance program.
Applying your understanding is the next step in learning. Examples of applying include:
1. Problem-solving the results of the physical therapy examination with yourself or with peers.
2. Choosing a treatment based on the examination results.
3. Writing the examination findings in a note.
4. Illustrate to a new grad PT the intent behind Medicare’s ‘medical necessity for physical therapy’ requirement for treatment.
Analysis is the next step in learning. Analysis looks at the underlying structure of an argument and examines motives for why an argument is proposed. Examples of analysis include:
1. Why are predictor variables useful for a lumbar spine examination?
2. What types of outcome measures can we use to show progress for specific physical therapy patients?
3. What are the pros and cons of treatment-based classification in physical therapy?
4. Questioning the ethical implications of Medicare’s exceptions process to the outpatient PT caps
Evaluating an argument requires the student to take a stand. Some examples are:
1. Defend the medical model of spinal dysfunction.
2. Defend the biopsychosocial model of spinal dysfunction.
3. Argue that the exceptions process to the PT caps create the perverse incentive for physical therapists to deny needed services to Medicare beneficiaries based on perceived audit risk.
Creating a product in physical, written or conceptual form is the final step in learning. Some examples include:
1. Peer-reviewed research reports, case studies, clinical commentary, letters-to-the-editor and book reviews, blog posts.
2. Bulletproof Physical Therapy Decisions website (soon to be a book).
3. PhysicalTherapyDiagnosis.com blog.
There's an old (and somewhat cynical) saying in physical therapy - there are therapists with twenty years experience and there are therapists with one year of experience - repeated twenty times.
Which one are you?
Patients learn what physical therapists learn about them.
Each day is a new discovery.
Every patient is a teacher.
What will tomorrow teach you?