Artefact #5

I met a professor as I was just beginning my foray into teaching at CMCC, who has recently retired.  He was one of these guys who was a fantastic performer, and had the swagger to go with his natural abilities as a lecturer and entertainer.  The one area that he told me he always had difficulty with was teaching students how to think.  Or how to think differently than how they already were.  We are dealing with highly intelligent 20-somethings who have already been indoctrinated with the educational ideologies of 17+years of the public school and government overseen post secondary institutions.  So he may be right in saying that others would have had more of an impact on how students think earlier on.  And maybe it is an uphill battle to change fundamentally how someone who had been through this gauntlet of education thinks, but I am hopeful that it is possible.  If we don’t believe that we can teach cognitive skills such as reflective practice, then we have already failed.

At CMCC we like to say that we are teaching the skills of reflective practice and critical thinking to our students.  We provide loads of provocative cases, and ask the students to attempt them, fail at them, research it and then re-play things in their mind in consideration of what they had just researched.  In doing so they can construct their knowledge, and learn how to approach problems differently in the future.  This is all great in theory, but is it getting across?  That’s a question I ponder as a major player in curriculum development and remodelling at CMCC.  I read a quote on twitter today – “We can’t ask teachers to be innovative in their practice while administrators do the same thing they have always done.” -- @gcouros  This lead to some real soul-searching as to whether I am expecting my faculty to model behaviours, which I am not exemplifying myself?  As much as we are providing opportunities for students to develop reflective practice skills, if our faculty do not possess these skills (and more importantly utilize them on a regular basis) how can I as an administrator expect them to model reflective behaviours?  Am I applying reflective practice to my role as an administrator?

I said in a very public forum 3 weeks ago that we don’t have enough hours in the program to teach students everything they need to know to be an effective chiropractor.  Nor should we be teaching them everything they need to know, even if we did have enough time.  I continued that us teaching “stuff” was not in the future chiropractor’s best interest, that the focus has to be on developing a reflective practitioner, a critical thinker, and a life-long learner.  Research changes the way things are done almost at break-neck speed.  The only way to ensure that doctors are able to keep up is to equip them with the skills to do so.  It has been quoted that the time it takes for new research to change practice habits in health care is 8-9 years.  But what is even more disappointing is that the cycle of new evidence into curriculum if often cited as 17 years!!!  If we continue to teach facts, we will always be lagging behind – even if we can shorten that research to curriculum cycle.

I got a lot of flack for my comments in this open forum about the purpose of education and that CMCC should admit to themselves that you cannot possibly teach students everything they need to know.  Not that we should stop trying, but perhaps drowning them in information isn’t the answer for better future doctors.  Perhaps a shift in focus from “stuff” to skills and behaviours is needed.  I didn’t get all negative feedback for my comments, a number of people in attendance applauded me for saying what they already believed.  As we enter a curricular reform process, I only hope that others who are involved in the process and decision-makers open their minds to this way of thinking – that teaching how to think and reflect is imperative to stay current in tomorrow’s landscape.

It is quite a question - whether we “can” teach reflection in practice, or whether we can only create the conditions for reflective practice to take place.  I believe that we can teach these skills, and I have seen a number of students respond and grow in tremendous ways through practicing reflection in various real and simulated situations.  I believe that not only can you provide the environment to foster reflective practice, but you can also provide environments that will foster the development of skills and behaviours of conscious and unconscious use of reflective practice.  As mentioned above, especially in the modern-day rapidly changing health care environment, we cannot expect to learn everything we need to know in school.  But what health care curriculum should be focused on is on stressing the importance of keeping current, developing critical thinking and reasoning skills, and on the honing of effective reflective practice behaviours.  Only then can we ensure that our graduates are equipped for safe and effective care of patients in the years to come.