How do we know what we know ?
Dr Joe Muscolino DC
How do we know what we know ? This may seem like a strange question . After all , most of us are probably more concerned with the knowledge that we acquire rather than how we acquire it . But , examining this question is not just an exercise in abstraction ; it can improve our client practice skills because it helps us choose what techniques we want to learn and place into our toolbox of treatment techniques .
Our approaches to acquiring knowledge can be divided into four models . They are : 1 . knowledge imparted by an authority , 2 . gleaning knowledge from research , 3 . testing the new knowledge in our practice , and 4 . evaluating new knowledge against principles of anatomy and physiology that are already understood .
Authority model
The authority model rests upon knowledge being imparted by an individual who we respect and place in a position of authority . This is probably the most common approach to learning . It begins in school , where as empty vessels , we sit and try to absorb as much as possible of the knowledge of the teachers who are assigned to our classes . This method of learning is often called sage on the stage because the teacher is the sage standing on the stage in front of us . We also place the authors of our textbooks as sages that we learn from . The authority model of learning usually continues after graduation . As practicing therapists , we subscribe to magazines devoted to our field and read articles by more sages . And we further our knowledge base by attending continuing education workshops where continuing education instructors are sages who present their techniques for us to learn .
The authority model rests upon the idea that wisdom is passed from mentor to pupil and we are enriched . However , there is a three-fold danger to this model . First , this model assumes that each authority is truly a knowledgeable and wise expert ; this is not always the case . As brilliant as some sages might be , there might be some aspects to their knowledge base that are lacking ; or the perspective they present might not fully encompass the entirety of the knowledge area that is being taught . They might even hold some beliefs that simply are not true , and therefore present some incorrect information . But how are we to know ? How do we choose which pieces of information are pearls of wisdom that we should hold onto and use with our clients , and which pieces would best be discarded ?
This dilemma lies at the heart of the second problem , which is that the authority model often discourages independent and creative thought .
Instead of critically thinking through the information given to us , the authority model often presents cookbook recipes that are to be followed . We trust the information because we believe in the infallibility of the authority . This is especially true in the world of continuing education where charismatic instructors might not explain the anatomic and physiologic basis for their technique protocols and might offer only their successful case studies as validity of their technique . A good maxim might be : Beware of case studies . Anyone who has been in practice for a few years can cherry pick out a handful of miracle case study success stories from all the clients they have seen .
And the third problem is likely the most vexing of all . What do we do when two ( or more ) authorities we trust disagree with each other ? And looking at the world of continuing education , it does seem that many authorities are convinced of the superiority of his / her own technique over the techniques of others . Who do we choose to trust more when this occurs ?
Research model
The second approach to learning is to look to research for our answers . Research is based on the scientific method , which relies on a very simple and logical concept : if something works , it should be reproducible . It would seem that the
12 | vol29 | no1 | JATMS