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Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
June, 2007, Vol. 07, Issue 06
Show Me Your Outcome Competencies
By Keith Eric Grant, PhD, NCTMB
In early 1984, I spent a month at the Esalen Institute practicing core shamanic methods in a small group led by Michael Harner, author of The Way of the Shaman2 and founder of The Foundation for Shamanic Studies. During sessions, Michael always was the model of focus and professionalism. Outside of the sessions, however, he was animated and social. And at dinner, we never had a problem figuring out where our group's table was, with Michael's laughter that could be heard across any crowded dinner hall. Often, the laughter came in recounting some scene from his favorite movie, "The Treasure of the Sierra Madre." Thus, we came to know the opening quote quite well. I also was given a model of being flexible and learned to shift my personal presentation to fit the needs of the context. That flexibility has been a "competency" of some of the best teachers I've had the privilege to learn from, which leads me to the real theme of this column. With apologies to Dobbs and Gold Hat, if you are the bearers of "high standards," where are your outcome competencies?
My fellow columnist, Ralph Stephens, and I both like to shine light on where we feel massage training and entry requirements fall short. In the inimitable words of baseball player and manager Yogi Berra, however, "Our similarities are different."3 For me, another Berra quote succinctly captures the root of the problem: "You've got to be very careful if you don't know where you're going, because you might not get there." The licensing and certification of massage practitioners likely has been lowering their competence.
It's not so much the licensing itself as it is how licensing has interacted with mainstreaming and training. At one time, teaching massage resembled teaching martial arts, a system of tacit knowledge conveyed from expert to student. The expert may not have said a lot, but they knew how to look at you while you practiced and would keep you at it as long as they felt there was "something missing." Consider that system to be history, now that we have explicitly defined entry requirements. Explicit requirements don't add to a tacit system; they replace it. You get what you explicitly value. The catch is that we haven't defined the outcomes we value; only the total hours and some blocks of hours in vaguely defined subject areas. Career colleges and community colleges teach to what we defined. Students self-select for their ability to match our explicit requirements. We are getting what we asked for, as long as graduates meet the entry requirements. You expected something else, perhaps?
Don't complain about getting what you asked for; do the work of defining the outcomes comprising what you want. Here's the recipe: Insist on differentiating between "high requirements" and "high standards." Standards lead to observable outcomes while requirements don't have to. Define a job specification for an "entry-level practitioner." Define all of the contexts in which you believe the job is done. For each context, break the performance into tasks. Get feedback from the stakeholders in each context. For each task, create a list of required observable competencies or, if covert, competency indicators. Define the needed proficiency levels. Get more feedback. Merge the individual lists of competencies into a master list of competencies, taking the highest proficiency level at which each occurs. Implement a plan to identify applicant learning gaps and teach them what they aren't doing. Assess the results, and modify definitions and teaching methods to obtain the outcomes you want. Reward yourself for creating something that meets specific goals for stakeholders and is a clear guide to schools and students in reaching them. Then go back and assess the results again. The beauty of this method is that all levels are explicit. If you compare your competency standards with someone else's, you can track down the exact source of differences.
The best resource I've come across for going through all of this is a set of books authored by Robert F. Mager called The New Mager Six-Pack.4 I'm of the opinion that no one should be allowed to talk about standards without first being required to demonstrate an understanding of what's in those books. Consider it an entry-level requirement for a "standard discusser" position. The books are clear, readable and filled with examples.
Your efforts, should you accept this mission, won't be alone. New resources to do information handling are coming from the venues of technology and distance learning. (I recently blogged about this: "Guidelines, Learning Objects, & Competency Definitions."5) The Massage Therapy Foundation's Best Practices Committee is actively working on an open and transparent creation process for evidence-based guidelines. At a March meeting of the committee, I co-located with Whitney Lowe in the physical world. Whitney has embodied a lot of the outcome-based concepts in an online clinical reasoning course.6 The course uses an open-source educational framework that supports working through case studies, first as small groups and then as individuals. I particularly like that the environment provides built-in discussion forums to teach students the ability to solve problems by interacting with mentors and peers; a refreshing walk away from the idea of pre-canned answers for everything. Finally, I've been following my own project to create a library of massage competency definitions.7 I'm grateful to a number of people on different massage e-mail lists for their contributions. You'll find their names next to the competencies they suggested.
While I've been discussing massage training, the same process works for personal and business goals as well. Define where you want to be. Define what being there looks like and what skills you are using. Set up a plan to close the learning and experience gaps. Implement that plan and you'll be heading where you want to go. Remember to enjoy the journey and the people you meet along the path.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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