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Case Report: A Year in the Life of a Massage Research Curriculum

A Curriculum Retrospective
As teachers and administrators of massage curricula, we have a special task: To transmit an ancient tradition into the hands and hearts of modern pupils. We are charged with striking a balance between the artistry of massage and the constant flux of health care knowledge.

Research literacy is an essential and growing piece of this puzzle. It empowers students to educate themselves and allows them to work within any setting. But, when it comes to teaching research, our challenges multiply. Few of us had rigorous research training when we went to massage school, yet we have to deliver that rigor to our students. Below is a brief report on Cortiva Institute–Seattle’s attempt to construct a research curriculum, as well as a retrospective on its first year in existence.

Our Learning Objectives
At the outset, our learning objectives boiled down to four things. We believed that a successful graduate should be able to reliably:

1. Find & evaluate research articles.
2. Make evidence-informed clinical decisions.
3. Communicate with other health care providers.
4. Write and submit their own clinical case reports.

We conceived these objectives with an awareness of some formidable challenges. Students had disparate backgrounds and varying interest levels. Instructors often lacked expertise and confidence in teaching research literacy. We didn’t have full-text access to most articles, and nobody got paid to conduct studies or sit in the library. All of this had to take place in an existing massage curriculum that already felt crammed for space.

The Process
Cortiva Institute–Seattle was launched in fall of 2007, and the research curriculum spanned two consecutive 10-week classes (totaling 60 hours) in the latter half of a 1000-hour massage licensing program. The first class –- “Research and Clinical Reasoning”– was a broad subject that included some assessment and treatment planning, some basic pharmacology and a first pass at research literacy.

At the end of the course, students were somewhat oriented to the research world, but it was a one-way street. Students did not think of their own work as contributing to the knowledge of other health care practitioners or the general public. This was the task of "Case Report Seminar." In this class, students had 10 weeks to find a client that was of interest, decide on some measurements, conduct a treatment series (of 5+ sessions) and write up a clinical case report between 1500 and 3000 words. We modeled our guidelines on those of the Massage Therapy Foundation’s Student Case Report Contest , but made them significantly more forgiving. Every student had to complete a case report to graduate.

Both classes were refined based on student feedback and instructor experience. They started fairly dry. The material was taught from abstract principles, and in a mostly lecture style. Few real-world examples were used and in-class collaboration was limited. This was stressful for massage students, and we encountered a lot of resistance. Over time, the classes became more dynamic and inclusive of hands-on exercises (live literature searches, measurement demonstrations and student peer review.) Emphasis was placed on process over product.

As instructors became more familiar with the material, they gained comfort in holding students to a rigorous standard. The students remained highly disparate in their interest levels, but they almost universally--and somewhat surprisingly--agreed on the importance of research in supporting the massage profession. While the writing of a case report remained a challenging project for most students, they increasingly reported feeling supported in their work.

Six Recommendations for Teachers of Massage Research:
From this process, I derived the following six recommendations for teachers of massage research:

1. Portray the research world as permeable, interactive and fast-changing.
2. Work frequently from real examples and engage the class in critical evaluation.
3. Perform live literature searches and develop new research questions with the class.
4. Emphasize process over product. Highlight the potential of research courses to transform students’ massage skills.
5. Do not expect there to be universal interest from students, but do work to channel their particular interests and aspirations.
6. Create interconnections between research courses and other components of the massage licensing program.

Each class is still growing and adapting. It is a perennial challenge to grade written assignments in a timely fashion. Our last goal–to integrate research material with other parts of our licensing program–has not yet been realized. Most graduates do not consistently read research in their practice and only a handful have attempted writing a case report on their own.

It’s worth asking –in the midst of such effort–is such a focus on research really worth it? Why not slice that time in half and give students more business training or more technique? Why require students to write their own reports, find their own literature, and do their own measurements? Wouldn’t a shorter survey suffice?

To be honest, it depends. Do we want to create bare-bones practitioners, scrounging at the margins of health care, paying thousands of dollars in workshops for expertise they could have acquired on their own? Or do we want to create confident, communicative professionals, capable of joining the scientific literature, developing their own expertise, and thinking critically about their bodywork? There are significant hurdles–both logistical and cultural–to implementing a successful massage research curriculum. Every school is different. But, I believe the effort is worthwhile and the steps to getting there are feasible.

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