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Learning to Speak P&O
By Ronald A. Roiz 
According to linguist Stephen Krashen
, there are two ways to develop the ability to speak a new language: acquisition and learning. Acquisition is an unconscious development of grammatical understanding, while learning is the conscious study of language. It has been found that learning may be more useful to beginners, but to become a proficient speaker acquisition plays a more significant role. Moreover, Krashen describes three categories of speakers who self-monitor what they are saying or what they are about to say. An "overuser" constantly monitors his or her speech and may impede the ability to have a smooth conversation; the "underuser's" monitoring allows the speaker to converse, but with the potential for errors; and the "optimal user" is able to efficiently monitor without breaking the flow of the conversation. I have found significant similarities in P&O education and training.
School is a great place to learn, though some might argue that on-the-job learning is more beneficial. The program at the Georgia Institute of Technology is where I obtained my basic understanding of how to treat patients, the different tools available to use, and how to "do no harm." However, once in a residency (as you may have read), I found it enlightening to acquire knowledge by direct observation and practice. Repetition and, at times, failure elucidated the nuances of different patients and orthoses. That is not to say I was not cautious.
When I began my residency, I was definitely an overuser. I constantly reflected on what I had learned and pondered whether what I was doing was correct. I was able to treat only a few patients at a time because most of my time was spent auditing my own decisions. As time progressed and I wanted to become more efficient, I relied on past experiences and lowered my self-monitoring. I became familiar with classic presentations of patients who suffered strokes, had knee replacements, have spinal compression fractures, etc. With these people I had to spend less time thinking about which orthosis would be most beneficial. Instead, at this stage I was able to become more fluid with my history and physical evaluations, my casting techniques, and the bane of everyone's existence-the paperwork.
Now that I am nearing the end of my residency and have far more independence, I find that I have to balance between overmonitoring and minimal monitoring. This seems natural to me. For the patients I am comfortable with, I know that I can treat them efficiently and confidently. However, for those patients who have unique clinical presentations, I am willing to go back to books, the Internet, or other clinicians. On the other hand I try not to over-analyze to the point that I cannot treat the person. As with any conservative treatment, the more complicated problems may require multiple attempts to find the right solution. I have found that as long as you are careful and conscientious, making sure you are doing no harm, there is no need to be defeated with your own preoccupations. To people who have struggled even making an utterance in a foreign language, I suggest to simply speak and realize you will make mistakes. The way I began to speak Spanish was to reduce my self-monitoring until I became comfortable with expressing my thoughts. I then transitioned to an optimal user by furthering my formal studies and continued acquisition through practice.
Though this principle of acquisition may apply to the medical world, a strong knowledge base is necessary. This way, practitioners can reduce their conscious monitoring without fear of making any grievous mistakes and actually improve their patients' physical situations in an efficient way. When you learn to speak, the worst you can do is make yourself seem a bit foolish, but when it comes to other people we hold a much greater responsibility. Fortunately, I have found many clinicians who have put in the effort to learn, whether or not it was done formally, and have become optimal users. They combine basic learned knowledge with clinical experience and sufficient monitoring to catch themselves from doing anything harmful. With time and practice perhaps I can get to the point when I stop thinking, but hopefully I won't. Ronald A. Roiz is a resident at the Rehabilitation Institute of Chicago (RIC), Illinois. He is a graduate of the MSPO Program at the School of Applied Physiology at the Georgia Institute of Technology, Atlanta, Georgia, and will be sharing his experiences as he completes his residency. 
Table Of Contents - June 2008
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