Australia Papers - Part 1

Education.

Education, how we acquire knowledge, and how it is passed on, has fascinated me for many years; I have no formal qualifications as a teacher, yet for more than 20 years I have gained experience, and earned a respectable living, by acting, performing, as a teacher.

Let me explain to you a little part of my life history.

In December 1983, I had just graduated from a college of manual therapy, with a diploma of Remedial massage; my reasons for embarking on such a line of study were vague at that time – but the topic of human anatomy captured my attention from day one, and this interest has remained with me.

One month after my graduation, an old acquaintance contacted me; he explained that he had been appointed as administrator of a Newcastle Community College; it was an old institution that offered training courses for adults in many subjects, at what we might refer to as hobby level. He was quite concerned, because a course in massage had been advertised, and quickly filled to capacity – this good news was rapidly followed by the alternate news that the appointed tutor has left town !!

His question to me was, “since you are trained in massage, would you please come in and teach the thirty or so enrolled students ? I explained that the ink was still quite wet on my diploma, and I was not really ready to become a teacher of the subject.

The size of the predicament he had been left with won the argument, and I commenced teaching that week; here is the main point of my message to you readers: much of our education, maybe even the bulk of our education, does not come from text books or class-rooms. It comes from our application of school and book knowledge in our day-to-day activities.

For me to be able to transfer my new-found knowledge to students. I had to be prepared to answer their questions; to be able to answer their questions, I had to have a good understanding of the topic – a better understanding than I had at the end of my training.

I was terrified, and embarrassed back in those days, but I am extremely grateful for the experience that was thrust upon me; when I began teaching on a more serious level, I would tell the students my story, and impress upon them:

• in many topics,  only some of your knowledge will come from books; most of the true learning and education will come from your clients. You listen, you study their ailments, you make an initial diagnosis, to be refined later, perhaps. Now begins a better understanding of, and growth in, the profession.

Approach the leaders of your association, and ask their permission to publish your special clinical experiences; you, and your readers will benefit from this shared knowledge, as I have.

BERNARD SCULLY

NEWCASTLE, AUSTRALIA,

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Discussions have been taking place this week in Australia about the low standard of education (particularly in the subject of human anatomy), that graduate medical practitioners have received. Some of those interviewed expressed the opinion that they felt inadequately prepared for the task of diagnosing musculo-skeletal disorders – many of those interviewed had received only 50 hours of anatomical tutoring during their training.

My comments, based on my interest in the general topic of education standards, are not intended to denigrate these graduates. Rather, I wish to make the observation that advances in general knowledge come at a price: some subjects need to be deleted from the curriculum, to make way for the new subjects.

In automotive engineering, there is little need for a student mechanic to have a deep knowledge of the function of a carburettor – rather, much more time would be spent these days on the overall understanding and relevance of the on-board computer.  The basics of (old-fashioned) fuel injection theory are left to the student with the enthusiasm to enquire further. 

In the study of any subject involving mathematical calculations, the development of the electronic calculator has had a serious effect on the ability of the graduate to perform basic mental computations.

In electronics generally, the availability of the computer as a diagnostic tool, means that the detecting of say, an intermittent fault in a car, is beyond the skills of many technicians – if the computer can’t spot the problem, “come back when it re-occurs,” you might be told.

We can survive without these lost skills, and without this knowledge, in most instances; of course, the older members of the population will mourn the loss of some of these abilities, but the young will say – it isn’t important.

In the area of medical science education, we are not necessarily progressing backwards , but we have reached a dramatic point in our journey; students of medical science have to study, and absorb, as well as they can, far more information about pharmaceutical products, and radiological techniques (to name only two  items), than they were expected to examine, say, 10 or 15 years ago. Consequently, space has to be provided in the timetable to allow the discussion of these additional important matters – the study of human anatomy, and the form and function of skeletal joints, is one of the casualties of this progress. After all, many of the joints in the skeleton can now be replaced with a prosthesis – and there has to be class-room time to understand this new subject of prosthetics!

I have a special interest in the function and the occasional malfunction, of the shoulder assembly. My studies, and my clinical experience over the past 20 years has indicated that almost 80% of clients visiting my clinic reporting shoulder pain, (who were advised to consider surgical intervention), received complete or near-complete relief from pain with simple manual procedures directed at mobilizing the shoulder assembly. When my animated film dealing with shoulder form and function is shown to medical practitioners, they almost always express surprise….one GP remarked to me, “we weren’t taught those details”…

Nothing will be gained by criticizing medical people for not knowing enough – we have an obligation to inform those interested that there is often an alternative to surgery – consult an informed manual therapist.

A significant point can be made here, of vital interest to manual therapists; if the medical practitioner has moved beyond what was originally thought to be basic anatomical knowledge, who is going to inherit the left-behind cases ? I’m not familiar with the situation in the USA,  the UK or elsewhere, but here, in Australia, another group that we call the physiotherapy profession are also on a path of advancement – I repeat, we don’t criticize this progress, but, this progress can help to make our role as manual therapists much clearer, and more relevant.

Let me try to emphasise the point I am making here; the medical scientist has always been expected to understand far more about human functions than is possible. Step-by-step, specialists have been recruited. We have skin, neurological, orthopaedic, gastro, haemo, experts – and, aren’t we usually grateful that such professionals are around when we need them ?

I consider today’s informed, diligent and skilful manual therapist has the opportunity to assume the mantle of musculo-skeletal specialist. Not because we are seeking a grander title, but because we are taking over abandoned territory.

Bernard Scully

May 21, 2010