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Raising the Bar in Rehab

Can Clinicians Change?

Published November 4, 2008 11:20 AM by Lisa Catenacci
We had a journal club in class today-discussing an article about the development and implementation of Clinical Prediction Rules (CPR).  While we were discussing the article, the conversation led to comments regarding how to change clinicians' decision-making when a newly formed CPR presents itself. 

If a clinician has been practicing for 30 years and determining patients at risk for DVT formation, what are the chances that he/she will stop their old habits and begin using a CPR? I guess the real question is: can you change the behavior of a practicing clinician?

Furthermore, how effective are Continuing Education (CE) courses for clinicians? While the information may be interesting, does it really change how we treat patients? Do clinicians take CE courses because they want to learn-or because they need another 10 hours to complete, and if it has to be in a lumbar manipulation course, so be it?

I'm 24 years old and I've been trained to learn. I can recognize important parts in a lecture, memorize it, and regurgitate it later. I feel like my whole life has been writing notes, typing study guides, reviewing techniques and taking exams. How is the transition made into the clinical world? Will I ever get stuck in a rut? 

Maybe the answer is that it depends on the person. If you have the passion and the will to keep learning, it will come naturally. 

"Get over the idea that only children should spend their time in study. Be a student so long as you still have something to learn, and this will mean all your life." - Henry Doherty


The real question is whether Holistic care is still relevant.  Would you change your views about techniques that have worked for decades in the East?  Do you see the relevancy in Maslow's heirarchy of needs although there is no evidence to base this on.  CPR's are only one of many ways to "see" what is going on with patients.  There are some tried and true techniques that are effective so don't discount them merely because of a new way you were taught.  

Voss, Bobath, et al had no research facility, no big school, little in documentation but they succeeded in showing us a way to treat patients in an effective manner.  As a student you have access to the internet, history of therapy, multiple medical documentation and yet you see a new method and discount the rest.  Are you able to take what was shown to you by what has worked, then use what you now learn, and formulate your own thoughts?

Karen November 11, 2008 10:24 AM

Good questions Lisa.  Regarding CPRs.  I think these are a relatively new concept for most PTs and many detest them saying it takes away from their clinical decision making skills.  However, I disagree.  The ability to recognize an opportunity to use a CPR and recognize when someone falls into that category takes a critical mind.  Being able to predict the liklihood of success is the key to competent practice.  One thing is for sure, there are a lot of PTs who practice "crapshoot" PT.  "This feels stiff, so let's mobilize it!!!"  When in reality, one singe piece of clinical assessment is rarely relevant.  CPRs force one to take a look at a broader piece of the puzzle.

As far as coninuing education, one thing in for sure, PTs tend to go to courses that fit either their:

A. Personal philosophies

B. Time/financial constraints

C. They are forced to go to a particular course.

It's sad that PTs are still flocking to courses such as MFR, strain counter strain and craniosacral courses.  What's worse is that they still count towards CEUs (in most states).  

It takes a personally motivated therapist to look at the quality of a course and understand how it can build upon their practice in a progressive manner.  Rather than keep trying to add to their "bag of tricks" I think most PTs need to spend more time learning how to refine their clinical decision making and further DEVELOPING skills they already have.  I truely feel we learn most of what we need to know at entry level (except for niche fields such as incontinence, etc)...we just need to learn how to develop our ability to apply these treatments in a more efficient and clinically competent manner.  

Christie, Physical therapist November 5, 2008 6:22 PM
Streamwood IL

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