On Critical Thinking

The state of New York recently instituted a policy that physical therapists need to earn continuing education hours in order to renew their licenses. Up until this point, I was just able to pay a few hundred dollars every few years and I’d get to keep my license. This worked out well since I wasn’t practicing, nor interested much in PT.

Now, however, I had a decision to make. Continuing education courses are usually held over a weekend and require the expenses of traveling as well as paying for the actual course. Is it really worth all that to keep a license I’ve hardly used in the last ten years? I didn’t want to have to make that decision. Lucky for me, I didn’t have to.

With a little research, I learned there are plenty of free on-line continuing education courses. As a teacher, I was sure they wouldn’t be nearly as effective, but as a person who doesn’t like to pay much for things not of value to her, it was great. I thought I’d just read through the material, take the test, get my credits and move on.

I figured I’d learn a couple things, but was surprised that I learned things that pertained not just to PT, but to so many other things in my life.

Yesterday, I took a course about falls in the elderly. My grandmother recently fell and broke her hip, so not only did this topic pertain to the nursing home patients I work with, but I could see it from another perspective as well – that of the relative of an elderly person. Had I read the material prior to grandma’s fall, I think I would have said, “Yeah, I know this.” But all of a sudden I could see it in real life, in my life: after one fall, you’re more likely to have another (that happened to grandma), how being on more than four medicines is a risk factor (gram was on a ridiculous number), how the anxiety causes many elderly who fall to never actual regain the function they had prior to their fall (gram shows signs of being headed this way).

This way of taking information and making it personal to you is actually the topic of my course today. Today’s course was on critical thinking, and “personalizing” information is one of the definitions the author gives of critical thinking. Personalizing information is not just taking it in, but actually analyzing it and figuring out how it relates to you.

This prompted me to think about my anatomy students. When we learn the skeleton, I don’t just have them name the bones. They sit in a semicircle around me. Each group of four students has a box of bones in front of them. I ask them to pull out the tibia, then we talk about how to tell if it’s a left or a right tibia. I encourage them to hold it up to themselves, to a partner to figure it out. I show them that the round bump they feel on the inside of their ankle is the medial malleolus. I have them feel the bump just below their patella, and explain that that’s the tibial tuberosity. Then, they find those landmarks on the bone in front of them. I explain that if they put the tibial tuberosity in the front, and the medial malleolus internally, then they can easily tell if it’s a right or left tibia. When they’re taking their test, there’s a little well of happiness that rises in me when I see them feeling for that bump on their ankle.

The course started me thinking what other techniques I could employ to encourage more critical thinking in my students, and how much it helps them to remember information.

So once again, something I thought would just be another hoop through which to jump actually turned out to be something of great benefit. Who knew?

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On location

Not only is there no one job I want for the rest of my life, but I’m starting to wonder if there exists any one place I want to live for the rest of my life.

Places I’ve lived: Scranton, PA; Hyde Park, NY; Asheville, NC; Portland, OR; Boston,MA;  Domdidier, Switzerland; Bethesda, MD

Is it the place or the people or the life you create for yourself?

Those of us that have family that we actually like spending time with have somewhat of a debate.  Do we stay/move back to where our family is even if it’s not a place we ourselves would necessarily choose for any other reason?  Or do we take off and try to make our own life for ourselves in a place we think we’d like more?

Is it really location, location, location as they say in real estate? Or is it something else?

There’s something about living in a town where I walk into a bar and the bartender, whom I don’t recognize, sees me looking around and says “You’re brother is over there.”  How did he know?!

There’s something about living in a town where it will cost $400 to get my piano moved into my new place, but my family knows someone who moves pianos, and my brother and my dad and a couple others jump in to help and we all make out on the deal.

But there’s something to being anonymous.  To making your own way.  Finding a job without using your father’s connections.  Finding a place to live without your parents having seen it first.  Living close enough, yet far enough away.

I don’t know the “right” answer.  I don’t think there is one.  It’s different for each person.  For a few years now I thought I’d become one of the youngest snowbirds – those people that go to Florida (or some other warm locale) for a few months every year when the winters in the northeast make my mood go south.  Can you have the best of both worlds?  I think so.  Or at least I’m going to find out….

The Internships

As part of my physical therapy program, I had to do four internships.  As I looked through the list of potential sites, it occurred to me that I could use this as an opportunity to see another part of the country. This is something us renaissance souls do quite a bit – we use what we have to get something we want.  I had to do an internship.  I wanted to travel.  Bingo.

I had done my fair share of traveling as a child.  Their were army reunions every two years for the group my dad was in Heidelberg with during Vietnam.  They took us to Virginia, Louisiana, Tennessee.  There were trips to Dairy Queen conventions (dad’s business) that brought us to Florida, Hawaii, and Washington D.C.  In high school, I traveled by myself for the first time – as an exchange student for a summer in Switzerland.  From my host family’s home outside of Fribourg, I traveled wherever the train would take me.

But it wasn’t until college that the idea of plopping myself down in a place where I knew no one became crystallized.  I don’t recall what prompted me to choose Portland, Oregon – perhaps it was the farthest place on the list.

When friends  heard I was doing an internship far from our northeast Pennsylvania university, their first question was, “Do you know someone out there?”

“Nope,” I said simply.

There are a lot of people out there who can’t imagine traveling alone, let alone spending eight weeks in a place where you know no one.  I credit my four siblings with giving me the craving to be on my own at this point in my life.  (See earlier post on doing things alone).

It turns out that outside of Portland we had distant relatives with whom I stayed for my first week.  Then, I moved into housing on the medical campus and was on my own.  I spent every spare weekday moment talking to friends in the dorm and planning my next weekend trip.  I drove down the coast one weekend, drove the Columbia River Gorge another, saw Mt. Rainier and Mt. St. Helen’s.  I don’t know that I spent one weekend in the town of Portland, though it was a nice town.

Five months after leaving Portland, I moved to Asheville.  I knew no one there.  I lived with two medical students – one very sweet North Carolina native, and the other an orthopedic resident with the last name “Cash.”  Mr. Cash sat around the house shirtless with an electrical stimulation machine on his stomach to work his abs.  He thought he was God’s gift to women.  His two roommates didn’t think so.

I toured the sites of Western North Carolina every weekend – the Biltmore, Carl Sandburg’s home, Chimney Rock.  Each week my colleagues at the hospital would give me suggestions as to where to go next – often to places they themselves had never been but had heard were great.  (The same way there are plenty of New Yorkers who have never been to the Statue of Liberty.)

A few months after my return from North Carolina, I found myself graduating. I was one of just a handful of us PT majors who had a job to go to after graduation.  It was the only job I applied to.  Actually, I didn’t even have to apply.  I called a facility at which I had worked one summer and asked if they needed any help.  They said yes.  It was that easy.  The entire class knew that since my sophomore year I hadn’t wanted this degree.  And here I sat with something they all wanted but most didn’t yet have: a physical therapy job.

The Exception to the Rule

T-shirts with “Top 10” lists on the back of them were very popular at my university.  Along the lines of “The Top 10 reasons drinking is better than studying,” for example.

The physical therapy majors decided to make our own shirts.  Ours was titled “You might be a PT major if….”  It was an inside thing.  Most of the 10 items listed only made sense to those of us in the major, and our friends who dared to ask.  I particularly liked, “…if Andre the Giant is a personal friend.”  We had a cadaver in Anatomy class who was massive and we nicknamed him Andre the Giant.  He was so big that he just barely fit on his dissection table.  When you closed the lid, it just grazed the top of his head and the bottoms of his feet.

For those of you that just lost your lunch, I apologize.

Anyway, the one item on the list that was like a dagger in my chest was “..if you’re the exception to the rule.”  There were plenty of rules to which PT majors were excepted.  For example, it was a general rule that you could study abroad in college.  Not PT majors.  It was a general rule that you could take whatever classes you wanted to when in college.  Nope.  Not us.

Having had my department chair laugh in my face when I asked about study abroad on my very first day at college, I knew we were the exception from day one.  And I didn’t like it.  I tried to take Russian one year.  It fit into my schedule, but then the PT department decided they needed to change one of our scheduled classes.  So instead of it being a traditional Tuesday, Thursday class, it was now a Monday, Thursday class.  All 45 of us PT majors were in the same classes on the same schedule, so the department thought nothing of switching.  They didn’t care that this meant that I could no longer take my Monday, Wednesday, Friday Russian class.  I hated being the exception.

Though I was unhappy in my chosen college major, I stuck it out.  And was determined to make the best of it. In my sophomore year, I applied to be an RA.  This, I was told, was another rule to which we PT majors were exceptions.  Faculty, staff, and other students were incredulous when I told them I was applying.  “Junior year is the hardest one in the PT program.  How can you be an RA and a PT major at the same time?”  No one could recall a PT major who had done it in recent years.  I was getting really sick of people telling me what I could and couldn’t do because I was a PT major.

I applied anyway, but was not accepted.  I secretly wondered if it was because someone in residence life thought a PT major couldn’t be an RA.  I applied again the following year.  This time, I was wait listed.  And the summer before my senior year, I was asked if I still wanted the position.  Of course I did!  And I was right – it is entirely possible to be an RA and at PT major.  In successive years, I would watch as PT majors in the classes below mine became RA’s.  I’m not saying I broke ground or anything – just that I was thrilled that they had someone ahead of them that was not the exception.

So I sometimes wonder if the lifestyle I choose to live now isn’t really just like a teenager revolting against their parents – only in my case, I am revolting against a college program that I felt boxed me in.  I couldn’t do what I wanted to when I was in college, so I’m doing anything I want to now – and for the rest of my life.

The College Years

I get asked a lot how it is that I came to live the lifestyle that I do.  The one by which I’ve decided there is no one full-time job that will interest me and so I choose not to have one.   So I’m going to start a series of posts on how this all came to be.

I did what most people around me were expected to do – I did well in high school and went off to college.  I had the experience plenty of college students do: during my sophomore year, I didn’t like my major and wanted to switch.  The only problem was that, up until this point in my life, I had done everything my parents expected of me.  They did not expect me to switch majors.

As the oldest of five children, the plan was to go to community college for two years and then to a four year school.  I screwed up the plan by picking a major that was highly competitive to get into.  We knew I could get into a physical therapy program with my high school grades.  If I waited two years, to get into such a program as a transfer student was even more competitive.  So I went to a private school as a PT major.  In other words, if I wasn’t a PT major, there was no reason for me to be at this school.  The thought of transferring seemed even more intimidating than switching majors.

During my sophomore year,  I was dating an older man.  “Older” is a relative term.  I was 18.  He was 24.  At 18, 24 is definitely older.  I had only finished one year at college and he had already been out for two years.  It was a whole other world to me – the one in which you were out on your own, working, unsupported by your parents, no longer living under their roof.  The thing that, in hindsight, was really great for me was that he, unlike my parents, didn’t see any reason for me to stay in a program I didn’t like.  He was the first one to say to me, “Well, if you don’t want to do PT, what do you want to do?”

I knew the answer.  I wanted to study languages and go live in Europe for a year, if not longer.  I’d had a taste of it in high school.  I took French and spent six weeks one summer living with a french-speaking Swiss family on a farm with 10,000 chickens.  I thought about taking a year off between high school and college to study abroad, but didn’t have the nerve to just apply and do it.  I was still at the point in my life that if my parents didn’t suggest/encourage it, I didn’t do it.  Not that they discouraged it.  I just didn’t push so they probably figured I wasn’t that interested.

Or they thought I could study abroad in college.  So did I.  I should have known from that first day sitting in the auditorium.  All of us PT majors sat there with our parents.  The department chair finished her speech and asked if we had any questions.  I asked if we could study abroad.  She laughed.  (Dramatic pause to recognize the significance of this moment.) I had not, at this point in my life, learned to follow my heart.  If I had, I would have walked out the door right then and there.

So, with the boyfriend’s encouragement, I set up a meeting with the chair of the Foreign Language -Business department.  He graciously listened and then gave me his verdict: he didn’t recommend I switch.  He told me I would probably be disappointed by the major.  He explained that it was obvious that I loved languages and would love to do this, but that most of the students in the major just picked it because they didn’t know what else to do.  Coming from the PT program full of extremely driven, motivated students, he didn’t think it would suit me.

He did save me from one thing: I detest corporate America.  A business major would not have been the way to go.  I can still recall sitting in the cafeteria with a business major as she explained to me the importance of wearing pearls on an interview she was about to go on, and the emotion she showed when explaining to me the color suit it was imperative that she wear (blue, not black, though I don’t recall why).  I thought it was the craziest thing I ever heard.

So I stuck it out in the PT program.  But I started to go against the grain a little bit….