Rules vs Reason

I am a perfectionist. On the enneagram scale, it is a definite type 1. Many enneagram texts name Type 1, “The Reformer,” but I’m pretty sure I relate to the term perfectionist the best. I like rules, and I like to follow them. They feel safe and predictable. A parking lot can be entirely empty, and no one is around, and I still have to follow the arrows going up and down the aisle to get to a spot…drive diagonally through the parking lot, no way! Walk into Walmart through the “EXIT” doors…not happening.

As a student, I excelled because I could follow the rules. Throughout grade school, high school, college, graduate school…I followed the rules. When I had moments of difficulty, I would search and find that there was a different set of rules that I had to follow in regard to that topic and then I would succeed again. Following the rules became a really safe place for me and one that I knew I could always get back to. I loved math classes and hated my art classes. I never felt comfortable given freedom in an assignment to design or create. Give me the rubric and I’ll follow it…tell me to complete the assignment in whatever way feels right and I’ll implode. That brings us to my first co-treating session with my residency mentor as a new physical therapist.

I was so nervous to complete my first evaluation in front of my mentor, but I knew it was coming. I stayed up as late as I could (10:00PM was my bedtime rule) the night before reviewing all my notes. I was ready to follow the rules.

First question my mentor asked me, “What is the purpose of completing the cardio screen before the neuro screen?”

“Ummm…uhhh…” I stammered. I wanted to say because that was the rule, that was the order I was taught. I sat there for what felt like forever just trying to search for a reason and all I came up with was because that’s the order that makes sense. I didn’t have a why. I had never actually thought about the why, I was just blindly following the rules.

As an educator, I contemplate this question a lot. Am I teaching students how to follow a set of rules or am I teaching them how to reason, critically think? As a rule-follower myself, I have to be extremely intentional at employing activities and assessments that cause students to demonstrate their reasoning because it feels most comfortable for me to teach students how to follow the rules. But, here is the thing…the human body doesn’t always follow the rules when it breaks down. Our clinicians have to be able to be flexible with thoughts to identify impairments and when patients don’t always fit the rule. We have to be able to help the patient in front of us, not just expect a cookie cutter patient.

How can we know students are thinking critically? Assessment, but it has to be the right kind of assessment. I know what you are thinking…we do that all the time. We assess with exams and quizzes and practical exams throughout the semester, which are good ways to measure how much knowledge students are gaining, but most multiple-choice examinations can’t differentiate between following rules and thinking critically. So, back to my question, how do we know students are reasoning?

Here are three ways I have found that get me to the answer I am looking for:

1. Asking Why, but without Asking with Why

I won’t belabor the point of why starting a question with why conjours up a whole host of emotional responses because I did that in "What vs Why", but I can’t be remiss without revisiting question asking as a productive way to analyze critical thinking. The goal to determining if the student is thinking or following rules is getting them to identify why they are doing what they are doing. We can do this by asking What and How questions during tasks. For example, if a student is completing special tests of the shoulder before clearing the cervical spine, you could ask, “What information may be better to know before we get to this point in the evaluation?” or “Tell me about your differential diagnosis list and how these test will get you to the answer you are looking for.” The goal is to have them think about the why behind the order they are completing things, not just checking items off their list.

2. 3-2-1 – Muddiest Point

Save yourself about 5 minutes at the end of class to run this quick and easy formative assessment task. Ask students to pull out a sheet of paper and answer these three prompts:

1. What have you learned from this lesson?

2. What do you want to know more about?

3. What questions do you still have?

This has been one of my favorite formative assessment tools to get students to reflect as well as provide real time feedback that I can act on immediately. Although summative assessments have a place, one reason I am not too fond of them is because I get a lot of good constructive information that I cannot do anything with to help those learners because the semester is over. The muddiest point has been a game changer for me to aid in immediate improvement of my teaching style and help for my learners. This quick assessment gets your students to reflect which allows critical thinking to flourish. As soon as a student has to reflect on the why behind a topic, they begin laying down neuropathways to solidify information for easy recall later. This also gets them thinking outside of the checklist and asking them to own what they learned as well as being curious to learn more.

3. Low stakes quizzing

Open ended questions are a great way to give students room to discuss and reflect on what they know and how they are applying that knowledge. In large cohorts, however, it can be time restrictive to have essay exams or open-ended questions on assessments both from time in class to complete the assessment as well as time to grade. In addition, our students (at least in DPT programs) have to take a summative 250 multiple-choice examination to receive their license to practice, so we need to be sure they know how to take multiple-choice exams. Just like anything in life, there is a balance. I have been utilizing low stake quizzing for several years and typically use technology platforms like Kahoot! or Poll Everywhere to engage the students with using their phones/tablets/computers. They tend to find these assessments fun and engaging, but it also provides me with information on how they are doing as a class processing information.

This past semester, I also adopting group low stake quizzing. Each quiz day, I would randomly assign groups of 3 (we have a cohort of 50 students) and provide an all open-ended quiz. All of my unit examinations were multiple-choice examinations so the students would get the practice in answering those types of questions, but during the in-between my open-ended quizzes gave the students to provide their rationale for answering questions. I also liked the group setting because each student could contribute their thought process which causes each student to begin to see topics from more of a 360 degree view, not just their view. One hesitation I had with this setup is some students would take advantage by not studying and riding on their group’s coat tails. My remedy for this was to randomize the groups on the day of the quiz, which really kept the students being underprepared at bay. On my student evaluations, I received feedback that students actually prepared harder for group quizzes than they did for single quizzes because they didn’t want to let their classmates down. That was my plan all along…

There is a perfect time for teaching students to follow the rules, but as the student continues to grow, we need to provide opportunities for their reasoning skills to grow.

How do you promote reasoning skills?