This second blogpost from Dina Brooks extends her argument about the role of the CPN in reaching out to the wider physiotherapy community.
In my last blog, Reflections of a quantitative researcher on the CPN Salon, I suggested that we needed to build bridges not walls and encouraged CPN to have more connections with the biomedical quantitative physiotherapy world. Although there was general buy-in to the idea, I was vague in my last blog and wanted to follow up by getting more specific and expanding on the why and how I see this connection happening. Specifically, I wanted to address the risks to the CPN, reasons why the CPN is best positioned to reach across the divide and make some practical suggestions.
Considering the risks to the CPN in reaching across the divide
One of CPN’s objectives is to critique the traditional physiotherapy paradigms that they see as problematic. Given that, would building bridges into the conventional world possibly clash with CPN principles? When thinking about this question, I recall a parallel scenario, a conversation that I had with David Naylor the Past President of the University of Toronto. He had co-authored a paper entitled “Medical education for the 21st century” (http://www.thelancet.com/commissions/education-of-health-professionals). This was a Lancet Commission that highlighted a call from 20 professional and academic leaders for major reform in the training of healthcare professionals for the 21st century. Changes were needed because of fragmented, outdated, and static curricula that produce ill-equipped graduates. In a thoughtful discussion about this paper, I argued the importance of scope of practice and raised issues of encroachments by other healthcare professionals on physiotherapy scope. Dr. Naylor interrupted me in mid-sentence pointing out that the purpose and identity of a profession was ‘completely irrelevant’. The one and only consideration and focus should be what is best for the patient. That was the last time that I advocated for the profession to serve the profession. For example, I am staunch advocate for rehabilitation services in Canada for individuals with lung disease but I do not advocate for our profession to be the singular or even the main practitioner in this area.
A parallel can be drawn from this conversation. The issue of identity and purpose of CPN should be less relevant (or dare I even say irrelevant) than considering what is best for the patients. Reaching across the divide and infiltrating the traditional physiotherapy way of thinking would result in better outcome for the patient and that should be the sole purpose that drives the discussion.
Understanding the term critical
I realize that there is a whole body of literature on critical analysis that I am not familiar with. When I first heard about the Critical Physiotherapy Network, I thought about the act of criticizing and judging a situation or person’s work. That concept automatically results in a “back up” attitude. But what I believe CPN is about is an evaluation of a theory, practice or research approach in a detailed and analytical way. There is no question that some of the conventional physiotherapy paradigms are problematic but I am confident that there are some aspects that we can agree on. As we reach across the divide, understanding of the term “critical” by those that are not part of the CPN is important. The objectives of the CPN were very helpful in helping me understand their purpose (https://criticalphysio.net/cpn-constitution/).
Reasons why the CPN is best positioned to reach across the divide.
Many of the members of the CPN have been trained in quantitative/biomedical sciences before learning the language of critical thinking. For that reason, I feel that they are best positioned to reach across the divide. Let me use another parallel to explain this. During my graduate studies, I was trained in basic/experimental sciences, looking at neuronal activity in the brain of a cat. It wasn’t until I did my post doc that I started working in clinical population. Because of my training in basic science, I can speak their language and I understand experimental sciences. Most basic scientists have not done clinical research and therefore have no idea of “our” language, strengths and weakness. Because of my familiarity, it is much easier for me to reach out and engage them in aspects of research that a clinical researcher cannot address. That is exactly why CPN members are in a better position to reach out to traditional researchers as they understand that world, given that many of them trained in it.
Suggestions for next steps
Here are some suggestions for practical next steps:
- At the micro level, connect with some conventional researchers who would welcome their ideas. For example, in our randomized controlled trial of balance training in pulmonary rehab that stretches across 3 continents, I would really value the thoughts and ideas of a CPN member on the issues of “adherence” in terms of how to conceptualize it. I am aware of other quantitative researchers in Australia, Canada and the UK that would value the perspective of CPN members within their research group.
- The CPN members should consider writing editorial in physiotherapy journals about their ideas. In fact, there is a group of international physiotherapy editors and they have written articles together that have been published in multiple journals. Is it time to consider writing an article possibly about evidence based practice or qualitative research that would be published in all these journals simultaneously? It would be important to choose the topic carefully, focusing on improving patient outcomes.
- Connect with PEDro to see what role CPN would play in their organization. When reviewing articles, could the CPN contribute to a different perspective than the traditional quality indicators?
- Consider having a CPN representative on the special interest groups of WCPT.
- Let’s encourage and organize a debate at the next WCPT Congress or local physiotherapy conferences. A debate is healthy for the profession, would attract more than just like-minded people and expose CPN beyond the converted group.
- Let’s consider a joint blog by a member of CPN and a conventional researcher debating and discussing different views on a topic.
Hi Dina,
I’ve really enjoyed reading your blog posts and wholeheartedly agree with the idea that the real challenge in the CPNs project will be to build bridges, not walls.
In the early stages of the CPNs founding, I suggested that we emphasize our wish to be ‘a positive force for an otherwise physiotherapy’, and I also suggested that we engage in as much ‘inward’ critique as ‘outward’. Your posts present a great beginning of exactly this, so thank you for them.
It was curious for me to read your comments about ‘understanding the term critical’ as I had coincidentally just taken a note in my ‘to research in the future’ list along the lines of: What is ‘critical’? What do we mean by critical? Why be critical, why practice critique?
So to add to your action points, I think it might be interesting to do some research into the various understandings, meanings, etc. of ‘the critical’ that are prevalent within and outside of the CPN and see what we can find out, where we might want to go with it, or position ourselves in relation to it.
Personally, I agree that the term critical creates resistance and a back up attitude in those that are not inherently drawn to its sound, (philosophical) history and implications. It is for this reason that I also suggested the CPNs prefix as a counterbalance. Until today though, I don’t think the term critical is particularly helpful for building bridges, and curiously, just yesterday thought whether we couldn’t alter it to something like ‘Conscious Physiotherapy Network’, or else (the latter, of course, being an effort to not mess around too much with a young organization’s very recent branding, etc.).
‘Conscious’ might not be the ideal term, but I wonder whether we couldn’t find another that resonates more positively at first glance (diverse, … ?). It is certainly true that one should judge a book by its cover, but I would say that first impressions still matter. This would also not minimize the importance attributed to our critical thinking and engagement with physiotherapy, but would maybe put it in the context of why, or what we are doing this for, or better yet, who.
I haven’t commented on other posts before, so am not entirely sure if this is something we do here, but I hope this is in the right place or finds its way to it.
Again, thanks for your post.
Best wishes,
Filip
Thank you Dina for sharing your thoughts. I thought that in response to your call for a more detailed understanding of ‘critical’ I’ll say what I think it means, and in a spirit of sharing offer my response to the salon in Cape Town.
For me ‘critical’ means that we ask ‘who wins?’ as Foucault said (Hall, 2001). Who gains through this research, this view of the world – perspectives that are perhaps so taken granted understandings that we scarcely see them. It’s rooted not in ‘qualitative research’ (although there is overlap) but in social science theory, which means politics (thanks Jenny Setchell for your recent blog), economics, sociology, anthropology, social geography etc. So what I heard at the salon (and people always talk to the converted, they’re the ones that listen – at least to start off with), was some brilliant ‘look at from this angle’ research. This was from physiotherapists who were primarily focussed not on what we do, but on the difficult to see sociocultural forces that direct us to do what we do, whether we are aware of these drivers or not. We also thought about the impact of this on the people around us, including patients. They, of course, are aware of the impact of our input, but frequently are not in a position to say, as often we don’t think to ask.
Naturally, the disadvantages for marginalised groups of people, e.g. black and minority ethnic people, people who are overweight and people who are disabled (to name a few) emerged during discussions. Our positivist professional history, defines who we are and the positions we defend, but to focus on ‘truth’ and ‘fact’, runs the risk of forgetting how we are positioned by the world around us and just how slippery these issues of truth can be in an unequal world.
The atmosphere at the salon was intensely humane, not in a patronising ‘nice’ kind of way (although people were nice), but in a really respectful and thoughtful way – particularly to those who are not usually shown it. Maybe it’s not the critique itself so much as how you do it that matters? Should one be kind as one ‘speak truth unto power’? Let’s think about that one as we grapple with issues of justice and equity.
The salon was amazing, it didn’t have all the answers; I didn’t notice any in fact, just lots of questions, as sense of getting one’s head to a place where practice could be thought of differently. My thanks to all involved.
Hall, S. (2001). Foucault: Power, knowledge and discourse. Discourse theory and practice: A reader, 72, 81.
Thank you for your article. I will briefly comment on two points I think you make and I wholeheartedly agree with. Firstly the aim of a profession and how this should not be overshadowed by its interests in jostling for position among other professions. Secondly the apparent eristic or confrontational side of the term “critical”. I think that these matters are intimately connected in the following way: It matters hugely for one’s credibility to be at least as critical of one’s own beliefs and conclusions, as of those of others. This means to subject one’s own ideas to the same stricture of examination and to reserve the same willingness to re-evaluate them and not demand unconditional authority based on them. Simply put, conflict of interest plays a role here, wherefore it must be clear that the interests of the patient must be the obvious goal of any suggested contribution. If we, individually and collectively, exercise this kind of critical thinking the sting disappears from the term “critical” I suggest, and both intra- and inter-disciplinary progress will be made.