In Belgium nearly every hospital has a specialized pain center to treat patients with chronic and / or debilitating pain. As these pain centers developed over the years, they grew as multidisciplinary teams. Since chronic pain is a complex and subjective problem, it is very helpful that several different points of view on chronic pain work together in a patient-centered setting.
Pain education programs have proven their worth over the last years, but would there still be place for improvement? Well, there always is and every program also depends on individual caretakers, the motivation of the patient, the setting … and lots of other factors, like even the weather.
The question I’d like to discuss in this blogpost is the following. Medicine is a science and doctors treat their patients following the latest findings in research, physiotherapists act on a scientific basis, psychologists work scientifically structured, and so on. But what sometimes is forgotten is that ‘education’ is a science too.
So my question is: Might focusing on educational skills of therapists further improve pain education programs?
Within this knowledge, there might be an opportunity to further raise the success rate of pain education programs.
William Glasser (1925 – 2013) was an American psychiatrist that wrote not only about psychiatric illnesses, but also on a broader range of topics, as for example education. His theory on how children learn is very interesting for education, for 3-year olds, as well as for chronic pain patients and for the elderly who like to learn how their I-pad works to skype with their grandchildren. Glasser described the following about the way people are learning:
We learn 90% from what we explain to others.
We learn 80% from what we do.
We learn 70% from what we discuss with others.
We learn 50% from what we see and hear.
We learn 30% from what we only see.
We learn 20% from what we hear.
We learn 10% from what we read.
Do you remember that class when you were 15 years old and you had to listen to those history or geographic lessons of not too motivational speaker – teachers? You will remember it was boring, and what the teacher tried to teach will probably be lost forever in your head, if it even reached your mind while almost sleeping in class…
In education, 90% of the lessons are given ex cathedra, so it is in 90% of the time the teacher who is on speaking terms.
If you compare this with the percentages above, we could presume that it will be the
teacher who is learning the most and the pupils learn only 20% of what the teacher is telling. Luckily today, a lot of teachers learned a lot about learning styles of children and are more and more shifting their lessons into peer-tutoring classes, coaching groups, debates and experience-oriented learning. From passive learning techniques to active learning.
If we look at several educational programs in daily healthcare, they are also given for at least 90% ex cathedra and most of the speakers don’t have any educational background.
I will illustrate this with a little anecdote:
I once saw a little 5-year old boy that was very dedicated to learn how to ride his new bike without training-wheels on the side. But the more his father instructed and told him how to move, the less the boy managed to really learn what was the crux to start riding his tiny bike. The father assumed his son wasn’t ready yet to learn to ride his bike and left the bike where it was.
When a couple of days later a school friend came over to play, the boy was very interested and even a bit jealous that his friend, who was even 4 months younger, already could ride his bike. The school friend was standing next to the boy, both standing over their bikes. He said: I know just a very cool way to start and ride very fast. He placed one of the pedals on top, placed his foot on it and said ‘now you just have to push as hard as you can on the highest knee. He started and one second later, the boy followed the instruction of his little peer. He drove for the rest of his life, and never fell off again.
The theory of Glasser could be interesting when patient education programs are built.
All the more because of a lot of patients at first don’t see the benefit of following a pain program. They are forced into programs, which are often not just focusing on their specific medical problem and some of them are even very sceptic, because they don’t believe that coping strategies, tips, or changes in behavior can work as well as medication.
To handle with resistance or even aversion in patients about tips, scientific information and well-meant opinions, the theory of Glasser could probably give a better solution.
When assembling the content for a pain educational program, at least the same time or even more, should be taken to choose the right pedagogical settings and working methods. Where not the teacher or health expert is in front, but the patient himself, teaching – debating – discussing – listening and supporting peers (pain patients) and active searching for knowledge.
In literature we find a lot of research about the effect of patient education, but very little information about the didactics of patient education or the methods that are used. And that is quiet strange because as we see in research on general education worldwide, the way things are teached have a big effect on the effictivity of learning at all ages.
We can assume therefor that very little research is done and that most patient education programs are given in group and with the teacher or health professional in front of the group teaching.
Since didactics in education by schoolchildren is wide researched and shows better learning benefits for several non – ex-cathedra education methods (commonly known is that Scandinavian countries are doing very well using active learning methods), it sounds reasonable that further research should be done in patient education.
Group therapy versus individual approach, homogene versus heterogene patientgroups, groups divided following their educationlevel, socio-economical standard, type of pathology, age, type of former worktype,...
And didactical workingmethods as: debating- and discussion groups, feedback from peers (patients), working with theorema, audiovisual material, digital apps, home work, group dynamic management, short (1 of 2 lessons) or long term trajects (> 9 lessons).
Want to read more a about patient education or didactics in general? Then the following literature might be interesting. But as we say: just try new things and a good therapist will soon see the effect, if you keep in mind that ex cathedra lessons and teacher-centered lessons are not that effective!
- Essentials of patient education (Susan B. Bastable - 2016)
- Adult education for health and wellness (L. H. Hill - 2015)
- Patient education - a practical approach (R.D. Muma, B. A. Lyons - 2011)
- The practice of patient education (Redman & Yu - 2006)
- Effective patient education (Donna R. Falvo - 2010)
Education in general
Use search terms as cooperative learningtechniques (coöreratief leren), differentiating (differentiëren in de klas) in class, active learningtechniques (activerende leertechnieken), activating didactics (activerende didactische werkvormen), workforms (werkvormen),...