We Do Not Do The Basics Well

Any PT or PT student that knows me has heard me say “experts do the basics extraordinarily well.”  In fact, this is the motto of my teaching approach for entry-level students, guiding students through foundational psychomotor skills such as the neuromotor screen (dermatomes, myotomes, reflexes), manual muscle testing and goniometric measurement.  I harp on doing these in a standardized and confident fashion with intent and purpose.  I preach to them that these foundational skills pave the way for other psychomotor skills that involve our hands.  The students, as they get more reps in performing these skills, become confident and feel prepared to apply these in the clinical realm.

Have I created an ivory-tower world view?

Let’s now shift from the entry-level environment to the clinical trenches.  A PT is performing an evaluation on a patient who has a condition effecting her lower extremities and is performing a neuromotor screen.  As the PT is running through the exam, he is performing distal dermatomal assessment with the patient’s shoes on.  Better yet, in non-accurate locations.  In the next room, the PT is performing myotomal screening, yet is documenting findings as a numeric grade (i.e. 3, 4+, etc.).  Then there is the therapist who is measuring hip flexion ROM and slaps the goniometer on the lateral hip without any fine tuning of the distal and proximal landmarks.  These are not examples of experts doing the basics well.  Students and new graduates, coming into the trenches with their slates blank, are now subjected to this lackluster performance.  I can only imagine what they might be thinking – that this is another example of a “perfect world” picture of what happens in the clinic.

The Current State of Affairs

This quite honestly makes me sad and frustrated.  It seems we all too often work to refine our manual skills or go through hours of continuing education to learn some specific type of intervention, yet we can’t even perform a manual muscle test through a standardized procedure with any reliability or validity.  Is Florence Kendall rolling in her grave?

The last thing we all want to do in any continuing education course or program is review a neuro screen or goniometric measurements, but maybe we should?  Maybe we should start taking blood pressures without using a machine.  Maybe we should start caring about the difference between a manual muscle test and myotomal screening.  Maybe we should take the time to refine those landmarks during goniometric assessment.

The current state from my point of view is that we are not doing the basics well.  This is a call for us to bring our attention to the basic skills that are foundational to the very skills that we spend the most time working on.  Maybe if we did, we wouldn’t have to spend as much time trying to refine them.

@ShepDPT

6 responses to “We Do Not Do The Basics Well

  1. John Marrujo says:

    Success is neither magical nor mysterious.

    Success is the natural consequence of consistently applying the basic fundamentals.

    Jim Rohn

  2. Jay Grimes says:

    Absolutely agree. This is a major problem in my opinion and one that can very easily be addressed with just a few ounces of effort and conscious thought. As you mentioned, clinicians are not drawn to attend continuing education courses that focus on PT exam or basic skills, and I argue that’s exactly what many need. Nice call to action Mark.

    1. Mark Shepherd says:

      Thanks for reading, Jay. As an entry-level educator as well, you know the importance we place on doing the basics well. The funny thing is, I really didn’t think about this until several years of practice! I realized how poor my own basic skills were as I was focusing too much on more “advanced” skills. I didn’t seem to really progress myself until I started from the foundation and worked my way up.

  3. As I have started to teach more I have realized how unclear in my head many psycho motor skills are. If I can’t explain what I am doing to a student how can I do it with a patient who does not have the same background info? These mental shortcuts have been stuck in my practice and are in the process of being removed.

    I’m not sure where basic skills end and advanced ones begin as it’s a continuum. Maybe experts do not simply do the basics well but rather demonstrate an advanced understanding and application of the basics? That’s what really takes purposeful practice in the clinic.

    1. Mark Shepherd says:

      Thanks for reading and commenting, Bryan. Your point resonated with me regarding the communication piece. So true how this reared some areas in my practice that was subpar.

  4. This resonates with me as well. I’m just now in the first management course of the Ortho Residency, and I can’t express how much benefit I got out of reviewing red flag screening, dermatomal and myotomal patterns/locations, and review of the importance of maintaining as much reliability with measures as possible. I’m 4 years in to practice at this point and reviewing the basics was an exceptionally valuable experience! I was able to poke holes in my current practice for the better.

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