Mastery Part II: Skills and Apprenticeship

ICYMI: Mastery Part I, Finding Your Life’s Task

As I mentioned briefly in Part I, there are two components to Mastery: SKILLS and CREATIVITY. You must learn the skills necessary to carry out your life’s task and become a master in your field, and one you have “mastered” (so to speak), those skills, you can then use creativity to combine skills and bits of knowledge to make something new – the whole can be greater than the sum of its parts.

In physical therapy, the main skills, according to Don Reagan, are:

1.Communication: This is by far the MOST important “pillar” of quality physical therapy practice.  If you cannot effectively communicate with your patients, then it doesn’t matter how good your interventions are! Patients have to do a LOT of their own work in physical therapy, and they are less likely to be compliant if we can’t communicate the what, why, and how to them.  Also, patients are most likely coming to you with pain.  Pain isn’t just physical – it takes a huge emotional toll, especially in someone who’s been in pain for a long time.  This person is going to need to LIKE and TRUST you in order to work with you, and in order for your treatment to work! Building a “therapeutic relationship” with your patients means saying the right things, but it also entails a lot of listening – to what they’re saying AND to what they’re NOT saying.

2.Movement: We are “The Movement Specialists” After all! Movement is both visual and kinesthetic.  Can you spot abberrant movement patterns? Can you see where a patient is limited? Watch them do the thing that causes them pain (if you can do so without aggravating their symptoms); can you spot what’s wrong? Can you prescribe the right movements to correct it? Can you visualize what their body needs to do for their sport, or for their functional task?

3.Manual: The use of our hands, or other hand-held instruments, another thing that separates physios from many other medical professions. Everything from traditional manual therapy to IASTM to dry needling falls under this umbrella, and they are all valuable tools to have in our toolbox.

Our APTA vision statement is to “transform society by OPTIMIZING MOVEMENT to improve the human experience” – so of course we need to have a masterful eye when it comes to appraising human movement.  Further, I believe that even the so-called “passive modalities” that fall under manual therapy have a big role to play in optimizing and facilitating movement (more on that another time…). Lastly…well, you just need to be able to connect with your patients if you want ANYTHING you do to work. So, I believe we need to be masterful in all three of these areas in order to truly be a Master Physical Therapist.

In response to my last article, I want to address the reason WHY we should all seek to be great at our jobs.  It’s not selfish, but it is pretty simple.  The better we are at what we do, the better our patients get – and they’ll get better faster and probably have more fun doing it. Being masterful is, in fact, in the best interests of your patients! That’s why we’re all doing this, right? If you’re in it for the money and fame….LOL don’t go to PT school.

Anyway, In order to hone these skills, you must put yourself through an apprenticeship. This can take many forms, and usually takes many years: remember the 10,000 hour rule. Many of the Masters that Robert Greene described had self-directed apprenticeships – John Coltrane, for example, who bounced around from band to band picking up different styles of music, then spending hours and hours practicing on his own. Others, like Leonardo DaVinci and Michael Faraday, had more “traditional” apprenticeships: they studied under a master, learning that person’s way of thinking and doing, got their coffee (or their wine, I guess, back in the Renaissance days) and then imitated it. Because an apprenticeship generally takes many years, many different methods of apprenticing can be mixed in.

“Your whole life is a form of apprenticeship to which you apply your learning skills” 

For the physical therapist, a large part of this is the academic doctor of physical therapy programs. This is where we learn all of the basic science that comprises the “why” and “how” of many of our techniques; we learn the bare-bones basics of communication, movement, and manual techniques and spend time in the clinic practicing our skills. Many of us spend hours practicing on our classmates, friends, and significant others. This is where we gain the basic, foundational knowledge that allows us to, at the very least, not hurt our patients.

Our apprenticeship phase is not over at graduation; in fact, it’s just begun. To become a master physical therapist, you need YEARS of treating patients. You need to take continuing education courses across a wide range of topics within physical therapy – learn as many things as you can. Much of this can be self-directed, but finding a MENTOR can really streamline the process of mastery.

Most of us, when we hear the word “Mentorship”, think “Residency” or “Fellowship”. Now, these can be really excellent ways to get guaranteed mentorship and focused clinical practice (“practice” meaning both the act of seeing patients and the more simple definition of “repetition”) BUT you have to be ABSOLUTELY CERTAIN that what the residency entails is what you need, is in line with your goals, AND that the person assigned to mentor you is someone you connect with and are willing to learn from. In his talk at Duke R2P, Don was quick to point out that residency and fellowship are not the ONLY ways to get good mentorship, or apprenticeship. Find someone that you want to learn from, and who is willing to impart knowledge to you in return. Greene makes it clear that a mentor-mentee relationship flows in both directions, so it is best that you have something to offer them as well. As Don says, you have to be willing to work for less pay. To move your family to the middle of nowhere. Sure, not every apprenticeship or mentorship requires such things, but you have to be willing to do it to work with the right person.

More on mentorship:  In this video, Dr. Jeff Moore talks about the need to truly give yourself over to your mentor in order to get the most out of that relationship. You have to ACTUALLY open your mind to knowledge, to take your mentor’s advice without questioning it.

Don also pointed out that there is a difference between an apprenticeship and a mentorship. As I mentioned above, mentorship is a two-way relationship; they genuinely want you to be better than them at the end, so it is okay for you to question their beliefs, force them to tighten up their arguments, to take what they’ve taught you and build on it. It might be better to seek mentorship AFTER you’ve had some apprenticeship, because an apprenticeship is more of a one-way street. You are succumbing to the Master, you are, in this phase, like a sponge just soaking up as much knowledge as you can. You may question some of your Master’s methods in this phase, but it’s probably best to jot down your uncertainties and save them for later. During your apprenticeship, just focus on learning everything you can.

And as I’ve said, your “Master” during apprenticeship can be a lot of different things. Don did a traditional, direct apprenticeship with Gray Cook where he spent 1:1 time learning from him, then, in clinic, did his best to imitate Gray. For me, right now, “Duke DPT” as a whole is my “master”. I hit my coursework pretty hard – and of COURSE there are things I question, things that seem a little outdated – but I keep my mouth shut and take notes anyway because…well, I can’t get those years of practice without a license, right?

Beyond the classroom, I soak up as much info as I can. I read books. I try my best to read most of JOSPT every month (another reason to get an APTA membership, people!) I attend R2P sessions to hear from experienced clinicians and learn movement analysis; I take continuing education. I write for this blog because it forces me to think and research. I am part of two research teams at Duke, one clinical trial and one systematic review. And I have human “masters” to learn from here too – I’m lucky to have lots of truly masterful clinicians to learn from, and I make it a point to soak up everything they say and watch closely what they do!

So…how DO you go about finding the right mentor for you? Don and his team talked a lot about connection and shared values. When you’re interviewing for a residency or a job, don’t just look for the benefits package and what your day to day schedule looks like – don’t even give too much credence to what the “mentorship” structure is like! These are all subject to change. Really observe the person in front of you, and try to discern their values. And take a step back and really process how you reacted to them! Do they make you feel welcome, engaged? Do they get you fired up? Or were you put off by them? These subtle, nonverbal cues mean a lot when it comes to finding the right person or place to learn from during your apprenticeship and mentorship periods.

Acquiring these skills is a long process, and in physical therapy, you cannot do it alone. You need books, a degree, a license, scientific literature, and master clinicians to learn from. Bonus points (and a better chance at Mastery) if you learn from other fields too – shadow surgeons, study evolutionary biology, take communication courses, take business courses. And if you’re a sports PT, go play some sports!! Only when you have put in the time and effort to learning, knowing, and INTERNALIZING these skills, can you put your creativity to work and create mastery.

Stay tuned for the final installment, Part 3: Cultivating the Creative-Active Phase

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