When our superiors are in the wrong

How many times have you been told something by a superior and you know it’s wrong but you won’t disagree with them because you feel that your opinion is not valid or you just don’t have enough information to back up your argument? What happens when they are feeding you information you know you should not be getting from them but you listen anyway because it can benefit you? This happens all the time in the clinical context and it really gets on my nerves. 

When preparing for my clinical exam, I know that I may not get any information from my clinician because the exam needs to be a true reflection of what I can do on my own as a physiotherapist and not rely on somebody to help me. Of course I would love information that could assist me because I want to do well but I know in my head that if I did get help I wouldn’t see that as a true reflection of what I can do. So I avoided my clinician the day before my exam and she seemed to appreciate the fact that I was not asking her questions.

But the next day I overheard that some of the other students were asking their clinicians for information and assistance. And it was interesting to see the clinicians’ reaction to the students request.  Some refused, some first refused then started giving hints about the patient’s condition, and one actually helped a student come up with a treatment plan. That’s not fair, is it? How does it help future patients if you are’t willing to put the effort into finding information out yourself? And surely after 6 weeks at a block you should have gained enough learning to make your own sound decisions? Does getting a pass or a good mark outweigh the need for you to be a good physiotherapist? 

And this is where clinical reasoning comes into play. Clinical reasoning is “the sum of the thinking and decision-making processes associated with clinical practice”. What a necessary skill to have. According to Atkinson H & Nixon-Cave K clinical reasoning is becoming a large part of professionalism and is being used to assess students. But do examiners actually pick it up? I would hope that an experienced examiner would pick up that you have a sound understanding of  the patient’s condition and create an effective treatment based on that understanding. If not, I could just get as much information as I want about a patient and memorise it and give a false view of my understanding and do well in my exam. Sure, you get a good mark, but how does that help anybody? In the end, if you just recite things without understanding them then you have actually gained nothing, and neither has your patient. 

The patients that student physiotherapists see in the future are relying on their ability to assess them correctly so that they can treat them effectively. If a student doesn’t put the effort in at university to learn this, then how are they going to behave when they graduate? 

On the other hand, the clinical environment is quite competitive and if a student does badly, does that reflect negatively on their clinician? Is their intention to help you pass in order to make them look good? I think this has a part to play.  I have personally experienced doing well in a clinical exam and my clinician saying that I only did well because she is a good teacher. And I have also experienced a clinician putting unnecessary pressures on students to do well after another student got an A. 

Putting all this information together, I feel that not having competent clinical reasoning would shine through no matter how much external help you get. It is unfair that clinicians assist students because it is not a true reflection of the student’s ability. Next time I see this happening I would like to speak up instead of being quiet about it. 

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One thought on “When our superiors are in the wrong

  1. Hi Kristin. I think that you’ve highlighted a major challenge with assessing clinical competence. There are so many factors that come into play when we try to figure out a student’s ability to work through a clinical problem, that it’s hard for us to know when you actually know and when you’re just pretending. I like to think that most of us can tell the difference, but sometimes I wonder.

    I also wonder about the value of getting a lot of help from the clinician just to get a good mark. I have no problem with students asking questions about their patients, as long as the objective is for the student to gain a better understanding of the patient. If the objective is simply to get a good mark, then both student and clinician are in the wrong.

    As a teacher, I see my responsibility as helping you to develop your insight into the clinical reasoning process because I believe that that is all that matters. Everything else will follow from that (e.g. knowledge, skills and attitude). However, if all you care about are your marks, then you will not improve with any of the above, least of all your clinical reasoning.

    My advice is for you to keep working on the parts of physiotherapy that you know are important i.e. your ability to understand. That is what will make you a great physio. If you focus on understanding, the good marks will follow. If you focus on the marks, you may never reach understanding. The marks will get you through then next year. Understanding will serve you well for the rest of your life.

    Also, thanks for the link to the Atkinson article. It looks interesting.

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