Saturday, July 21, 2007

thoughts about teaching clinical reasoning

Teaching someone a skill is not necessarily a difficult thing. Skills are concrete, task-like, discrete, and relatively well defined.

I have always tried to avoid teaching my students skills because it is my opinion that they need so much more than skill (although sadly they clamor for skills more than they clamor for background knowledge and understanding).

Instead, I try to help my students develop some degree of critical reasoning, problem solving ability, analytical capability, and appreciation. I believe that these attributes will carry them farther than will the mere acquisition of skills.

This is a stretch for many of my students - these demands take them places where they have not really been challenged before. As a result I notice that their confidence is dramatically decreased when they are taken beyond the stages of rote memorization. Because certitude is important I do not accept questions when I have asked them for answers. "Are you asking me or are you telling me?" are the most common words heard from me in the classroom.

I will never forget when my most quiet and passive student eeked out a hesitant and tentative response to a question asked of her... marked with the typical fading voice at the end of the statement, lack of eye contact, and raised intonation typically associated with a "is ______ the right answer...?" response.

Immediately, the class saw it coming as I rose and loudly questioned back, "I don't know; are you asking me or are you telling me?"

Then I heard something that I have not heard from her before. Right back at me she replied, "I think I am mentioning it. I'm not telling you, but I do think that I am mentioning it."

Stunned into silence, I nodded and accepted her response. This, I thought, is progress.

Monday, July 16, 2007

Plato's response to the state of 'certificates' and 'certification' for sensory integration

I received my "certification" to administer and interpret the Sensory Integration and Praxis Tests in 1992. I believe that the test battery was published in 1989 so it was still fairly new at the time I was certified. At that time there was a certification examination that you had to pass. I don't know how psychometrically sound the SII program was - but they claimed that it was a certification program. SII never wanted me to 'recertify' though - which is a little scary.

In the past twenty years the Sensory Integration and Praxis Tests have not been updated and there are no new norms. I have never heard of an occupational therapist talking about the Flynn Effect or heterosis so I don't know if anyone believed that there is a useful lifespan of an assessment tool. Some OTs still use the old Bruininks-Oseretsky test that has 25 year old norms - they just got around to updating those norms recently but I still see a lot of reports with the old test given. Personally, I (mostly) stopped using the Bruininks in 1995, and I stopped using the SIPT heavily around 2002. I don't get nearly as many requests for the SIPT anymore, but I still administer it episodically.

OTs are a little funny with using old and outdated things, I guess. That is not a good characteristic. Maybe we would be less willing to use such outdated material if more information was readily available about the problems with this kind of material.

I got to thinking about this today because of an article that appeared in the Advance for OT magazine about Sensory Integration International. According to the report, SII is barred by the Superior Court of California from conducting business. If you do a Google search you can find a lot of people complaining about being charged for goods or services that were never delivered. That is an embarrassing thing to find if you are Googling 'sensory integration' on the web!

So I got my certification from SII a long time ago - and I imagined that by now it was a worthless certification anyway. The news reported in Advance for OT makes SIPT certification that much more worthless. If the reports in the Advance for OT article are true, this case is essentially as bad (and comical) as a modern day Doc Terminus.

There is a new/competing SIPT certificate now that you can get from Western Psychological Services. I am not certain how useful certificates are that don't require competency testing or that don't require any kind of recertification process. At least they acknowledge some conflicts of interest: "Note: WPS receives financial consideration for publications recommended for use during the Comprehensive Program in Sensory Integration through USC/WPS. Individual course instructors may be authors of such publications and as such may receive royalties or other compensation."

I have hope that therapists and consumers will learn to be savvy about these things. I would bet that WPS and USC know that they don't actually have a "certification program" and that is why they are careful about their wording about receiving a 'certificate' and not a 'certification.' Still, they claim that their certificate "acknowledges basic competency." That is just about as close to the line that their lawyers let them walk, probably.

For a profession that wants to be taken seriously and to have the concept of sensory integration taken seriously these are not good signs.

Most consumers don't spend time on the NOCA website ( and don't know about standards of certification programs. Because consumers don't spend a lot of time on these sites that means that ethical professionals have to educate them about certificates and certification programs.

I encourage OTs to gather more knowledge about certification and certification programs. The example of Sensory Integration International makes an interesting case study in how a good idea being promulgated by well-meaning professionals can go very badly - very quickly.

What is the truth about sensory integration and certificates and certification? Like the people in Plato's cave - we have to have a willingness to 'see' both the unhidden and the hidden information. I'm glad that Advance for OT published that story - but still a little sorry that it took so long to really 'bring the issue into the light.'

I also have hope that the USC/WPS program will distinguish itself in ways that the SII program never accomplished. They have a real opportunity and could start by clearing up the whole certificate/certification issue. Then they could get to work on updating the norms for the SIPT. ABC Therapeutics will volunteer as a normative testing agency if anyone ever takes on this project.