Last week I wrote a post about the idea that we might be losing the capacity for critical thinking based on the way in which most of us were taking in information these days. I used the example of a decrease in the time spent reading books as opposed to reading other content material that is digitally provided to us. In this post I’d like to offer an alternative viewpoint.

Social media and different types of digital communication, such as blogs, have created an alternative method for transmitting information. Formerly, information was directed to us in a one-way fashion. We stood in front of the information delivery, be it television, radio, books, newspapers, teachers, or whatever. That information stream came to us in a one-way direction.

Now it’s a different ballgame. With blogs, articles, or information posts to Facebook, it is significantly different.  Not only do you get the original writers perspective, but you get the comments, both pro and con, from various readers. Because you are provided with comments on different sides of an argument you have the opportunity to consider multiple facets of someone’s perspective. The ability to simultaneously hold both sides of an argument is a method that helps an individual develop critical thinking skills.

Consequently, we might even be at a point where we can encourage and enhance the development of critical thinking skills even more effectively than before. However, that is highly dependent on whether or not people spend time reading and considering this content material at a sufficient depth. It is also dependent on whether or not our teachers can encourage us to think about the various different facets of an issue. We will have to shift to a new paradigm about information and learning. No longer can learning be viewed as an acquisition of the “right” information. We must see it as a process of constantly building and breaking down different knowledge structures. This will be a giant challenge for those of us schooled under the old models but having to teach people in these new models.

Information is becoming delivered in ever smaller pieces, and is far more accessible than it has ever been. This easy access to information is a tremendous benefit when you are trying to find some specific pieces of content. Need to find out something about a health condition? Just Google the term and you’ll have dozens of blogs, videos, webpages, PDF extracts and much more. You can learn so much from this easily accessible information. From a learning perspective this seems like a great benefit, and it is.

However, there is a flipside to this which may not be as advantageous. I was thinking about this the other day when talking to someone about how much longer it takes me to read a book than it used to. There are only so many hours in the day and much of my time is consumed by reading web pages, blogs, research updates, and other electronic communications. When does that leave time to sit down and move through an entire printed book? I do think there can be a potential downfall from this process.

One of the things that happens when you read a book is that you have a long and continuous thought process that is strung together through multiple chapters. The author may weave together many complex ideas and show the linkage between those ideas throughout the course of the book. By reading a book and considering these complexities, we build critical thinking and reasoning skills.

One of the things I have noticed in both the classroom and our society these days is that we are demonstrating a serious lack of critical thinking skills. It is entirely possible that our reliance on easy access information has limited our ability, or at least our training, to think critically. As educators we must make it imperative to emphasize the teaching of critical thinking and not rely on outdated models that emphasize simply mastering content. Those days are over and that is no longer a useful educational strategy.

The massage therapy profession sits in an interesting place. It seems to have these two separate identities which share some common ground but also diverge significantly. On the one hand is the practice of massage as what is called a personal care service for lack of a better term. This approach would include massage used in spas, cruise ships, or situations where the primary focus is general relaxation without the intent of addressing a particular health problem. The other approach to massage is when it is used as a health care discipline to address some ailment or pathology.

There has been a tug of war between these two approaches for some time when discussing educational standards and credentialing.  Those who want to make sure there are not unreasonable hurdles for entry into practice (especially for personal care service approaches to massage) don’t want to see rapidly escalating educational requirements. Those who emphasize massage as a health care practice recognize there is no way it will be taken seriously by the health care community unless the educational requirements are increased.

Can we have our cake and eat it too? Yes, I think we can. I do agree that massage is an important skill and there should not be unreasonable barriers to entry for those that want to practice it as a personal care service. I still think it is important for people who practice in this manner to have a solid foundation in the sciences because they are still performing a practice that can have adverse effects on someone’s health and they should understand this thoroughly. For that reason the existing entry level requirements (about 500 hours of eduction in most locales) is a good starting place. Of course it would be better to focus on specific competencies as opposed to hours, but that’s an issue for a different day.

For those that want to practice massage in a health care environment we need to have a credential that designates a higher educational standard—perhaps something like a “massage therapy specialist.” At this level there would be far more attention focused on the necessary knowledge, skills, and abilities that are missing in our current training to prepare people to work as a health care provider. The length of this training program should be constructed by investigating competencies needed by similar health care professionals. It will be hard to predict how that will be converted to hours, but it seems reasonable to suggest this could be at least 750- 1000 hours of additional training above the initial 500 hours that most people currently have.

There will clearly be many obstacles to this process, but other health care professionals are beginning to look at massage as a health care practice. I attended a recent meeting with the Academic Consortium for Complementary and Alternative Health Care. At this meeting it was clear that other licensed health care professions that fall under the CAM umbrella have substantially greater training requirements than massage therapists, yet we face many of the same clinical decisions. We simply can’t continue to be taken seriously as a health care field with only 500 hours of training required. It will take a long time to make this transition so the time is now to get started on this process.

As teachers most of us are interested in how we can get students to come away from our courses with the things we really want them to learn. Yet the emphasis in so many courses is on gathering information that will be needed to achieve a higher score on the exit testing. I’ve watched students in class spend so much time trying to write down everything the instructor says that they miss the opportunity to absorb the overall meaning of the discussion/lecture.

Multimedia presentation is one area where e-learning can offer a significant advantage over the traditional classroom delivery structure. There is no question that you can produce a great live multimedia presentation with lecture and accompanying visual aids- especially if you are a good live presenter. However, one of the great challenges is that once the lecture is over, the students don’t have it to go back to for further study. That’s why so many of them are so frantic to write down everything that is said during the presentation. Many students tape record lectures and this is a great advantage for audio playback, but that misses the important visual aids that are an important part of explaining important concepts.

A well-constructed (and this is crucial) e-learning presentation that includes audio and visuals can be an excellent learning tool because the student can go back to the same original presentation over and over until the concepts have really been absorbed. Research has shown a greater degree of retention and knowledge transfer with high quality multimedia presentations, so I think this learning strategy holds great promise. Our big challenge now is to get people to learn what a high quality multimedia presentation entails and how to produce one.

It has been inspiring to watch the exponential growth of our field over the last 20 or so years. In that time we have seen a host of excellent textbooks published. We have been witness to the emergence of a peer-reviewed science journal devoted to soft-tissue therapy that is now indexed on Medline, the world’s largest medical literature database. There is also an increasing awareness and interest in massage by traditional health care professionals.

I experienced this increased interest first hand several years ago as scores of administrators and educators from the nation’s medical schools gathered at Georgetown Medical School with a group of educators from the complementary and alternative health fields during the National Education Dialogue (NED). One goal of that gathering was to discuss the future of medical education and how it could include greater representation from these CAM perspectives.

Judging from these advances it would be easy to suggest that the massage therapy field is growing, maturing, and the skills and abilities of its practitioners are advancing. There is no question that the number of people in the field has increased dramatically during that time. However, although certain individuals have gone very far, I don’t believe there has been a corresponding growth in the knowledge, skills and abilities (KSAs) of the average practitioner. In fact, I think we have actually been witness to a decline in the quality of KSAs that the average professional displays.

While there is no hard data to back up these perceptions, I have been paying close attention to this for quite some time and talking to many different educators and leaders in the field about this trend. I noticed some years ago that as a continuing education provider, people were coming in to my workshops with less solid knowledge and poorer manual therapy skills. At first I wrote it off as just a widening gap between the advanced work I was studying and what the average practitioner would be likely to know. But then, I started making specific notes about what people seemed to know and be able to demonstrate with quality skills. It was clear that I could no longer rely on people having certain basic knowledge and understanding or being able to perform fundamental technical skills.

It pains me greatly to witness this decline in the quality of our field’s practitioners. But more important is looking at the reason for this decline and what can be done about it. I believe the reason for the decline is very clear. In the last decade and a half we have had a proliferation of schools and training programs to where it is somewhere near 1500 now.

A large number of training programs is not necessarily bad. However, there are nowhere near enough qualified massage therapy instructors to staff these training programs and consequently many programs are being taught by recent graduates or those that do not have seasoned skills, knowledge, or any significant instructor training. This is a massive problem and I don’t know what the immediate solution is, but it seems there is an urgency to look at some form of teacher credentialing or instructor training. What form should that teacher training or credentialing take? This is a discussion we must immediately engage because our future is at stake.