Dressed and Ready...at 2:37AM

12:06 AM – A tiny hand nudges my shoulder cuing me to wake-up and let him in my bed. I obliged by helping him into bed and letting him stay for about 5 minutes, after which I was awake enough to realize no one could sleep with a three-year-old (at least not mine). I then scooped him up out of my bed, took him back to his, and then realized he wasn’t wearing any pants. My problem-solving brain kicks in. Why doesn’t he have pants on? Ohhhhh….I remember I didn’t put a pull-up on him before bed, so he must have peed on the bed. But, if that was the case, why does he have a pull-up and underwear on now? As I enter his room I find a pile of wet underwear and pajama bottoms on the floor and wet sheets. He had peed the bed, but woke up enough to undress himself, find a pull-up and a new pair of underwear, and get dressed again before coming to get me. I was impressed. I changed his sheets and got him snuggled back in his bed, a proud mom.

2:37 AM – A tiny hand nudges my shoulder cuing me to wake-up and let him in my bed. What?!? How is this happening again??? I can’t even handle this second wake-up, so I scoop him up and put him in our bed, and try my best to ignore his kicks.

5:34 AM – I slowly open my eyes and begin to focus on this little creature lying next to me. As much as I wanted to be mad that he disrupted my night of sleep, I couldn't hold a grudge looking at that sweet face. My gaze became distracted, though, as I realize he has a black button-up shirt on. “That’s strange,” I think to myself, “He was in a white Thomas the Train pajama top when I put him to bed…both times.” I then peel back the sheets to see a little boy in red dress pants, a new pair of underwear (NO pull-up, mind you), and his black button-up dress shirt. He had got himself dressed and ready to go, in dress clothes no less…at 2:37 AM. As I got up out of bed, I asked him, “Why do you have your dress clothes on?” His response, “I don’t know.”

My son’s recent midnight clothes changing party got me thinking. He is learning new skills like controlling his bladder and dressing and undressing himself. Imperative skills to learn for operating in this world as he grows older. But those of you who already know, potty training is one of the most frustrating teaching/learning processes I have encountered…yet. I want to focus on the outcome and not the process. I want him to be potty trained. It’s simple really, right? You just go in the bathroom when you have to go. But that isn’t how it works. As soon as you start to get it down, the environment changes (grocery store, restaurants, church, etc.) and he forgets everything he knows! Not only is he learning how to control his bladder, but he is learning how to do that in many different situations and to almost three-year-olds it isn’t always intuitive that the same rules apply in every environment. He has to be taught how to navigate new environments and how to apply the skills he already knows to new situations.

As I think about it, the same applies to our patients and students as they are healing from an injury or learning new skills. I can find myself often focusing on the end game -- the numbers, the grades -- too much at times and not focusing on building problem-solving skills that my patient and/or student can apply to a new environment or new task. Today’s world is fast paced, and technology driven. It isn’t enough just to teach our students facts or help our patients achieve full knee range of motion. We have to be in the business of teaching others to continuously think critically and problem solve.

Sure our post-operative patients need to practice going up and down stairs in the clinic before being discharged home, but more importantly they need to be taught how to problem solve when they encounter a different type of stair. There isn’t enough room in any clinic to include every barrier patients will encounter in the world, but as clinicians if we teach them how to be flexible and think critically they will be able to navigate any barrier.

Sure our students need to demonstrate how to perform a hip mobilization before doing that on a patient, but more importantly they need to be taught how to think on their feet, to problem solve through a lack of equipment or unforeseen patient restriction in order to continue to provide the best care. There isn’t enough time in the physical therapy curriculum to teach students solutions to each problem they will face in the real world; however, we can help them develop the skill of problem solving where any issue that arises they haven't seen before, they will be able to figure it out.

Thomas R. Guskey states, “…we must educate students for a continuously evolving information society that demands flexibility, creativity, and initiative.” I needed this reminder. It isn’t enough to educate our students to pass a test…they have to live and work in the real world that demands flexibility, creativity and initiative. It isn’t enough to educate our patients how to navigate a standard curb…they have to live and work in the real world that is an ever-changing environment. It isn’t enough to teach our sons and daughters how to sit on the potty…they have to experience the urges to go, activate the right muscles at the right time, and do that in all different environments.

It is my challenge to you this week to re-evaluate how you are looking at learning.

Are you teaching problem solving skills or are you just teaching the solution? Do you present opportunities to explore and use newly learned skills in different ways or do you rigidly create a learning environment that caters only to learning the facts? Is your class all about regurgitation or do you find ways for students to apply those facts in various ways? This is a challenge for me too. It is a whole lot easier to teach to the test and to get students to regurgitate information, but just because something is easier doesn’t mean it is the best.

Are you outcomes focused or is it about the process?

Also…if you have potty training magic could you let me in on it?