With sore fingers, burning thighs and deep breathes I triumphantly rested at the top of a difficult rock climbing route on Mt Arapiles near Horsham Victoria. As I enjoyed the view of the surrounding Wimmera plains I felt a tremendous sense of accomplishment at having overcome the challenging climb. I’m sure you have also felt this deep satisfaction and the inevitable longing to take on the next challenge. However, I’m sure you have also felt the frustration and disappointment at never being able to succeed at a challenge that was much too difficult, or being bored to tears completing an activity you felt a baby could complete. That zone in the middle, where something is challenging but still achievable with effort, is known by educators as Vygotsky’s “Zone of Proximal Development”.
In my maths classroom, I regularly used this Zone of Proximal Development to set the questions my students would work on. This allowed them to work at a level that was their next step to learn and grow, and limited the number of students not working due to work that was too easy or too difficult. This important teaching concept is not just useful in the classroom though. It is also used in video games, swimming and martial arts grades, and we can use it with our patients as allied health professionals.
How many patients who are given home exercises actually complete them? I’m not sure on the exact number, but I know its low. There are many factors that affect this but setting exercises within our patient’s “Zone of Proximal Development” can only increase adherence. This includes the language and explanations we give. It is obvious that we would explain an exercise differently to a doctor than you would a builder; but what if the builder was a burnt out medical student who wanted to work more with their hands? How do we know what level of knowledge our patients have? How do we avoid making assumptions about our patients, what they know, and their likelihood of completing their exercises?
One of the best pieces of advice I’ve ever received came from two sources at roughly the same time. One was a podcast with the great TV interviewer Larry King. When asked how he had been so successful as an interviewer, Larry responded “I am intensely curious.” The second was from a much older mentor who wisely told me to “aim to be curious, rather than accusing”. That advice has saved me many times and helped through numerous difficult conversations. It also helps me see past the obvious, overcome assumptions, and get to know clients in a short space of time. It has helped Larry King to bring out the most interesting elements in everyone he’s interviewed for over 50 years.
So now, when I find myself getting frustrated at a student or patient for their lack of progress or work output, I remind myself that the problem may not be a matter of them being lazy or uncommitted. Rather, it could be related to how my content or instructions have connected with them and where they were at in that moment. Finding someone’s Zone of Proximal Development is not always easy, but you will certainly see the positive affect it can have on their learning and growth.
I encourage you to be curious and reflect on how you can better discover and connect to your patients’ world. I promise it will not only improve their wellbeing, but also your skill as an allied health practitioner.