DPT Knowledge Formation - curricular timing

Last year, after months of blogging about ideas that had built up inside me for close to 20 years, my position and direction changed to embodying these ideas into a DPT professional education curriculum. There are some blogs about the curriculum (here in particular), but with more time and progress it seems as if it would be useful to start pointing out some of the curricular features that are particularly poignant to the knowledge formation process.

By the “knowledge formation process” I mean the formation of knowledge for practice in a DPT student towards entry level practice (and beyond). This should not be confused with the “knowledge development process” which in this curriculum refers to how empirical evidence becomes knowledge (i.e. enriches, expands, elucidates our understanding of the causal network that is pertinent in any given clinical encounter). So, by these definitions, knowledge formation is an intra-individual process and knowledge development is an inter-individual (community, society) process. Of course, there are close interactions between these two processes.

Before talking about the importance of timing for curricular content sequencing (systematic learning experiences aimed at knowledge formation), let’s consider a very familiar scenario. Perhaps you have never heard of a particular word. Then you learn this word and it just seems that suddenly the world is filled with this word, and the concept that the word represents seems like an important concept for understanding the world in which we live in. For example, this was my experience when learning about abductive inference. Suddenly there was a word and concept that explained so many of the inferences that we make in clinical practice, that provided a framework for reasoning about clinical reasoning. With this general familiar scenario in mind let’s consider timing for curricular content sequencing.

A universally accepted “a priori” in DPT curricular content sequencing is anatomy and physiology. This is easy to accept. So much of DPT knowledge is founded on this core knowledge.

There is another set of curricular content that I believe to be foundational to all of PT practice - neuroscience in general, motor control and learning in particular. These areas should be covered prior to all major coursework on examination, evaluation and intervention for patients with particular diagnoses. They do not have to come prior to learning the psychomotor skills or general understanding of examination, evaluation and intervention, but they should come prior to specific coverage - for example in a patient case with “X” condition, letting “X” be in the set of al diagnoses (that is all body systems, not simply the neurological system).

My interest and thoughts on this topic are greatly influenced by my “home” when it comes to physical therapy professional and scholarly work (cardiopulmonary). If a physical therapist considers cardiopulmonary separate from what we offer as physical therapy completely (including our understanding of the full movement system, which is highly dependent on neuroscience, motor control and motor learning) then patients with cardiopulmonary impairments that receive physical therapy are not receiving physical therapy, they are getting exercise that many professions could be providing. When a student learns about providing physical therapy to a patient with cardiopulmonary impairments they should already be familiar with neuroscience, motor control and motor learning so that the inclusion of these founding concepts in the integrated reasoning about the patient can be explicitly recognized and utilized.

There could be several examples provided. If the professional identify of physical therapy is related to the APTA’s vision, then this identify is pointed toward transforming society through movement. Therefore, let’s educate future clinicians in such a way that they are equipped when they are learning examination, evaluation and intervention to recognize the concepts of neuroscience, motor control and motor learning as important for understanding the world in which they are being educated to transform.

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