What is at the heart of physiotherapy?

Mike Stewart posted an interesting picture (link) on his Facebook feed a couple of days ago (thanks to Paul Lagerman - The Naked Physio - for the link, and Mike for posting).

Participants on Mike's course were asked to respond to the prompt; "If I designed a healthcare course for students, the first 3 lessons would be...'

The responses proved interesting.

https://www.facebook.com/100008119901926/posts/2199382033675772/

My suspicion is that if you asked any experienced physiotherapist, they are likely to say something similar.

In fact, the evidence suggests that most employers, practitioners, and consumers want their clinicians to have good communications skills, be empathic, flexible, engaged, and mindful, and they want these things more than clinical skills.

And yet these rarely are the first lessons the students learn in college.  And if they are, they are often seen as something nice to have, rather than the 'really important' 'core' subjects like anatomy, physiology, biomechanics, and pathology.

So who's got it wrong here?  Why aren't these things the first things students learn?

Well, one answer is that the participants in Mike's course perhaps took for granted that the students would already have the 'core' knowledge in place.

I don't suppose they were suggesting that communication, empathy, and flexibility should replace anatomy and diagnostics as core subjects (although that might have made for an interesting discussion).  They weren't challenging the sacred cows of physiotherapy professional education, as much as saying that these things perhaps ought to be more prominent.

But there are some problems with this perspective that are rarely discussed.

For one, in my experience, most physiotherapists think that the 'soft skills' are things that can't be taught; that a person just acquires them, perhaps through osmosis or some spiritual awakening, and that they can't be objectified and assessed in the same way as a person can show their ability to perform a good Thomas Test.

And secondly, people believe you can simply 'bolt' adaptability, compassion, and criticality onto the person's professional identity, once you have the 'hard stuff' securely in place.

Both of these perspectives end up relegating the things that a lot of people think are the cornerstones of good, deliberate, and ethical health care practice, to the margins of a student's learning.

Educators find it hard to find ways to interweave the existential and subjective aspects of professional practice into their teaching about exercise prescription and gait analysis, and it's easier to box up the 'other' stuff and move it to a corner of the curriculum where it can feel like we're giving the subject its due respect.

But, of course, we're not doing the students any good here, because the inter-subjective, relational, ethical and professional aspects of our work don't sit apart in clinical practice.  They're not like the unappealing vegetables that you push aside on your dinner plate; they're much more like the stock that makes up a minestrone.  No stock: no soup.

They are hard to teach.  They are hard to define sometimes.  And they can be hard to quantify.  But that doesn't mean that they can be given second billing behind the stuff that we know how to deliver and assess.

It's the work of educators to find ways to take the complexities of practice and staircase them so that our students can learn about the world they're entering.

Why shouldn't a student learn about the basics of compassion in year 1, and then slowly develop their understanding and awareness of it as they progress through their course?  Why shouldn't we do this with the heart and the heartfelt?

Feedback suggests that our reductive models of learning are no longer enough for the kinds of complexity we're increasingly seeing.  Perhaps, then, we need to rethink what really is the core of our curriculum of practice?