Habits of Mind: Student Transition Toward Virtuous Practice

Abstract

ABSTRACT How does one get to be a therapist, one who subscribes to high ethical and professional standards? Current theory and research are used to examine and discuss work with physical therapist students and expert clinicians. The importance of multidimensional knowledge and a collaborative, patient-centered focus in clinical reasoning process are analyzed as foundation for developing deliberative clinical judgment. From this analysis, we propose educational strategies and learning experiences designed to facilitate developing skills and habits of mind that will contribute to virtuous practice. A model for growth through transformative learning is used to reflect on analysis of student moral development. We propose that critical self-reflection is a key component for continued evolution of physical therapy education. Therapists practicing in today's health care system struggle daily with resolving moral dilemmas. Decisions are made about discharge when patients and families may not be ready, decisions that focus not necessarily on how to do what is best, but how to prevent harm in times of cost control. Expectations for students' clinical performance are at an alltime high. Clinical teaching and learning has always occurred concomitantly with patient care, but productivity is now priority. Billable time is highly valued, and there are clear expectations for early competence. Managed care emphasizes accountability from many different parties: patients, employers, providers, managed care plans, payers, boards of trustees, and government regulatory bodies. 1 According to Thomasma, The provider must now regard good of whole and balance this with good of patient, without becoming a troublemaker and losing his or her job. Thus, professional ethics that traditionally subsumed self-interest in favor of patient's benefit must now directly confront self-interest itself as part of that ethics.... One eye is on patient's good, and other is on selfand group-interest.2(p241) Not only is context of delivery system continually changing, our society is increasingly diverse. In a democratic society, there will continue to be a plurality of moral perspectives and a need for health care professionals to tolerate moral differences and uncertainties while respecting and understanding various cultural traditions.3 This multiculturalism is coupled with an increased emphasis on prevention, health promotion, and patient selfmanagement, all of which require expanded knowledge and skill and understanding of patient's world.3,4 The absence of universal coverage for health care and continued reliance on employer-based health insurance continue to limit access to health care and produce increasing numbers of underinsured and uninsured individuals.5 In rehabilitation, focus frequently moves from patient to provider as there is increased competition for scarce health care dollars among professions. The just allocation of health care resources is a critical issue for profession.6 How do we best prepare students to meet these challenges that may begin with individual patient care concerns, but are part of larger institutional and societal systems? One way is to promote students' ability to use reflection or learning by thinking about experience. This is not a new concept, as John Dewey first wrote about reflection in 1930s. Dewey argued that the object and reward of learning is continued capacity for growth and that students develop skills and habits of mind [our emphasis] that will enhance their creativity and problem-solving abilities with respect to issues they are likely to meet.7(p117) Kopelman,8 building on Dewey's ideas, advocates that fundamental foundation for students' ability to identify and solve problems is their ability to use values. These values are essential in application of knowledge and problem solving. …