Expertise: Do you already have it? If not, how do we get it? Part 3…
Thank you for returning – Let’s get stuck into part 3:
Here we are back to complete my take on how we can progress from teachers to expert teachers of Pilates.
Complexity requires a different approach.
If pattern recognition isn’t enough what else is there? Hypothesis oriented reasoning (Jones & Rivett 2004), which is also called deductive reasoning (Jensen et al. 2007, Kerry 2009, Kerry et al. 2008). Years ago the first venue I taught in (1998) was a physiotherapy practise, but I didn’t stay there for long, which is another story but, a few years ago I was considering finding a medically based practice to work from. I had realised over my years of teaching that I liked the puzzles complex clients presented with. I was willing to experiment and truly believed people capable of changing for the better when the right combination of exercises was found. Looking back it was often the fact they were bloody-minded enough to not accept the general medical opinions presented to them at the time and were willing to trust me to work with them to find out just what they were able to achieve. Looking back, my shift into a Pilates Therapist was inevitable. A few years ago, when I was looking around for somewhere interesting to work, I asked a friend who is also a doctor specialising in sports medicine (he was in charge of the medical team looking after British athletes for several Olympic games so he seemed like the right person to ask where I should look). I asked if he knew of anywhere interesting for me to approach. His first question to me was to explain ‘how I worked with my clients’ – I told him ‘I made it up as I went along’ – not the reply likely to win over a prospective employer but it was an honest answer none the less. It was the first time I was challenged to think about the way I worked with my clients. Now I can answer this question…
How I explain how I work!
I use hypothesis or deductive reasoning. I listen to my clients’ stories, establish what has meaning for them, assess where they are and what they can and can’t do. I ask questions of them and those who have worked with them. I screen them objectively relevant to their history and goals. This all gets put together, and I work with them to come up with a plan to get them where they want to go. This plan is based on a hypothesis, a theory, we can then test and see if this theory is correct, if it’s not, we find a new one, and so it goes.
Here’s a recent example:
A current client is in his early 30’s and is currently teaching Physical Education at a local high school. He used to play semi-professional football (soccer for those over the pond) and had always been very athletic until a disc problem left him in daily pain. His injury history included a sprained ankle, as well as surgery on both knees, but his current issue was a severe disc bulge at L4/L5 which he is considering surgery for. His goal is to get out of pain and then return to the active life he misses as well as playing with his two young boys. I’ve used the ISM approach, taking into account his history and his belief that the disc is the problem and his goal of being pain-free. We’ve found he has poor pelvic control, reverse knee biomechanics on his left knee and his right foot is poorly aligned and controlled. The hypothesis is that his right ankle is driving his pelvic dysfunction, which is why his disc isn’t happy. We test this by seeing what happens when we correct the alignment of his right foot. The result of this correction is that his pelvic control returns, his left knee biomechanics improve (there is probably a story we can make up to explain this but for now, we know changing his right foot mechanics improve his left knee and pelvic control). So, this is where we are focusing at the moment. This challenges his belief that his disc is the problem, but, his pain symptoms are diminishing, and we may very well be able to avoid spinal surgery if we are correct.
Additional tools and how they fit with Pilates Teaching
As a Pilates Therapist, I use objective screening, which helps to eliminate some guessing regarding my clients’ biomechanics. These screens help to test theories about what may be causing issues for my clients. A clinical reflection is a process of testing my hypothesis and using the results of these assessments to come up with a plan. Sometimes we need to think about the decisions we make and reflect on the outcomes – why things did or didn’t work. This is how we learn and evolve as teachers. Thinking we know it all is not a growth mindset or one that will result in best practice for our clients. We have to be open to being wrong and challenging our ideas and perspectives. Metacognitive reflection means just that. It’s also referred to as reflective thinking (Jones & Rivett 2004) and requires that we adapt and are willing to change, modify or reject our ways of thinking and practicing as new information becomes available. Be open people! I now understand that my’ gut instincts’ guiding my decisions when working with my clients comes from pattern recognition but this isn’t always reliable. What I called ‘making it up as I went along’ is based on having seen many clients over the years and I recognised patterns over time (Gladwell 2005). Today, I still follow my gut but, now I test, screen and reflect to see if my initial instincts are correct.
How long does it take to develop expertise?
Good news people, if we are willing to reflect, pay attention, take criticism, we can gain this experience in a relatively short period (Butler 2000). People can teach for twenty years, but if they don’t reflect or pay attention, they may never become experts. Those who reason, learn, experiment, remain open, read and pay attention to the outcomes they get with their clients are more likely to become experts. Clinical reasoning is an ongoing learning process and is integral to life long learning, and continual development (Kerry 2009). We are open to ‘examine our assumptions and reflect on the validity of decisions made’ (Edwards & Jones 2007). Reflective practice is how we learn, change and develop based on our experiences. We think about what works, what doesn’t and stay open to new ideas. These things together lead to becoming experts- what we at Pilates Therapy Education are all about.
Ericson, K.A., Smith, 1991. Towards a general theory of expertise: prospects and limits. Cambridge University Press, New York
Jones, M.A., Rivett, D., 2004. Introduction to clinical reasoning. In: Jones, M.A., Rivett, D.A. (eds.), Clinical reasoning for manual therapists. Elsevier, Edinburgh, p. 3
Higgs J Jones, M., 2000. Clinical reasoning in the health professions. In” Higgs, J., Jones, M. P. (Eds.), Clinical reasoning in the health professions, second ed. Butterworth-Heinemann, Oxford, p. 3
Jensen, G.M., Gwyer, J., Hack, L.M., Shepard, K.F., 2007. Expertise in physical therapy practice, second ed. Saunders, St. Louis.
Kerry, R., 2009. Clinical reasoning in combined movement theory: rational mobilisation and manipulation of the vertebral column. Elsevier (in press).