"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Wednesday, July 1, 2009

Physical Therapists and Bloom's Taxonomy

Teachers have used Bloom’s taxonomy since 1956 to organize their work and identify their activities.

Physical therapists teach or train our patients, based on the results of our examination and evaluation findings.

What, then do we teach our patients?

Do we teach them something we learned in school? Read in a book or a blog? Heard on the street? Do we teach something we learned at a weekend course?

Or, do we teach something new? Something we created or discovered?

Bloom’s taxonomy helps me understand my point. I’ll use Bloom’s to illustrate:
Hierarchy of Bloom's Taxonomy

The pyramid shows the hierarchy of the cognitive domain (that is, mental skills) in Bloom’s taxonomy – the affective (feelings and emotions) and psychomotor (manual or physical skills) domain are not represented here although they are equally important to teachers.

Since I prefer to think of physical therapy decision making as the most important contribution that I can make to improve my patients’ lives then the cognitive domain is the one that best illustrates my point.

The Cognitive Domain of Bloom’s Taxonomy

Remembering, the earliest and broadest domain, must be mastered before any of the higher domains can be achieved. Examples of remembering are:

1. memorizing the origin and insertion of a muscle
2. stating the physiology of an electric modality
3. memorizing predictor variables for a treatment based classification
4. recall of Medicare minimal documentation standards for outpatient PT

Understanding is ownership of knowledge remembered. Examples of understanding are:

1. Recognizing a dysfunctional muscle or motor performance test.
2. Discussing the findings of a patient evaluation with the patient, PTA or physician.
3. Training a new clinician in your clinic’s Medicare compliance program.

Applying your understanding is the next step in learning. Examples of applying include:

1. Problem-solving the results of the physical therapy examination with yourself or with peers.
2. Choosing a treatment based on the examination results.
3. Writing the examination findings in a note.
4. Illustrate to a new grad PT the intent behind Medicare’s ‘medical necessity for physical therapy’ requirement for treatment.

Analysis is the next step in learning. Analysis looks at the underlying structure of an argument and examines motives for why an argument is proposed. Examples of analysis include:

1. Why are predictor variables useful for a lumbar spine examination?
2. What types of outcome measures can we use to show progress for specific physical therapy patients?
3. What are the pros and cons of treatment-based classification in physical therapy?
4. Questioning the ethical implications of Medicare’s exceptions process to the outpatient PT caps

Evaluating an argument requires the student to take a stand. Some examples are:

1. Defend the medical model of spinal dysfunction.
2. Defend the biopsychosocial model of spinal dysfunction.
3. Argue that the exceptions process to the PT caps create the perverse incentive for physical therapists to deny needed services to Medicare beneficiaries based on perceived audit risk.

Creating a product in physical, written or conceptual form is the final step in learning. Some examples include:

1. Peer-reviewed research reports, case studies, clinical commentary, letters-to-the-editor and book reviews, blog posts.
2. Bulletproof Physical Therapy Decisions website (soon to be a book).
3. PhysicalTherapyDiagnosis.com blog.

There's an old (and somewhat cynical) saying in physical therapy - there are therapists with twenty years experience and there are therapists with one year of experience - repeated twenty times.

Which one are you?

Patients learn what physical therapists learn about them.

Each day is a new discovery.

Every patient is a teacher.

What will tomorrow teach you?

Free Tutorial

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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