Science, Certainty, and the Active Learning Lab of COVID-19

In early December, NetVUE hosted a webinar on “The Scientific Vocation in a Time of Crisis.” Judy Ericksen, associate professor of occupational therapy at Elizabethtown College, offered these reflections about how COVID-19 has created an “active learning lab” for students.

I teach in a program that attracts students who have decided early on what they want to do with their lives: they want to help people. They are often drawn to the health professions by personal experiences with disease or disability, and understand becoming an occupational therapist as a calling, something they were drawn to at an early age.

As they move through our program, which is five years in length, they are required to reconcile their vision of occupational therapy with the reality of today’s healthcare environment and this is often not an easy task for them. My advisees who question this early calling seem to fall into two categories—those who discover that health care, e.g. medical care no longer fuels their passion—and those who discover that while their calling came from the heart, being an occupational therapist also requires good use of the head. We describe our profession as being an art and a science and often it is the science that is more challenging for them. 

Our students are exposed to scientific thinking in their first two years when they take courses in biology, psychology, anatomy and physiology, neuroscience, and statistics. Often because these courses are outside of the OT department they fail to understand how they will use this knowledge. Certainly they understand that how the body functions is important and how people think and behave is important but their understanding of how intricately scientific thinking is embedded in the process of occupational therapy is limited. One of the classes where they do some of the work of understanding this connection is in a research course I teach in their fourth year. 

The content of the course is presented through a seven step evidence-based process. The first step of which is being curious about what we do, why we do it, and outcomes, and developing questions that can help to focus our aim of increasing knowledge and improving client outcomes. We begin by differentiating among research, evidence, and practice, move on to the major paradigms of qualitative and quantitative research and their underlying assumptions, and then we start to unpack what evidence-based really means—appraising and applying research in context. During these early parts of the course I ask them to reflect upon how what they are learning connects to other courses and prior experiences; to draw explicit connections. Most often they mention biology and chemistry labs, the experimental process. Only a few of them connect to psychology courses and to the critical thinking that is facilitated so well in the humanities. These subtle connections—which to me are equally if not more important—take some time to emerge. As we move through the semester their certainty in their understanding of how to be an evidence-informed practitioner falters. They learn of instances where what we do in practice is not supported by science and instances where science is silent. And now they have new, different questions and how they make sense of a disconnect between science/research and practice ultimately matters—to them and to their clients.

As we move through the semester their certainty in their understanding of how to be an evidence-informed practitioner falters.

The focus of the course is on evidence-based practice but much of the content involves learning about the different research designs and how to appraise them. The students have known about evidence-based practice since their first year; it is a primary tenet of OT practice along with client-centered care and an occupation-based focus. So they enter the course fairly confident of their knowledge of this concept. 

The disconnect often comes from the notion that science is a set of facts to be memorized and applied, rather than a process of examining empirical events and circumstances and judging the validity of claims. So this pandemic, in which science is unfolding before us all and changing on a daily basis, provides a great backdrop for teaching a research course. 

Max Weber in his 1917 speech on vocation and science postulated that scientists produce “discoveries” that will always be surpassed–so they exist in a moment in time. Certainly technology demonstrates that any invention is fleeting, although some, like perhaps the flush toilet, change less rapidly than say the smart phone. But rarely does the public have the chance to observe science move through the cycle of assertion, critique, revision, assertion so openly. And on a subject that clearly matters and connects to our daily lives. 

And because some non-scientists may think of science as a static list of facts, explanations, and theories, when the science changes, they become skeptical of the scientist as opposed to being grateful that scientific knowledge has advanced. And perhaps all of us, at some time during this pandemic when trying to make sense of the CDC guidelines and state restrictions, have lamented, “They don’t know what they’re talking about! Why do they keep changing what they tell us?”

So when we think about what science can tell us, there are limits to our trust. Science can tell us what COVID is (or hopefully one day it can) but in order to understand it and its spread, we need to know so much more. We need to view COVID within context. We know that it effects people of different ages and races differently—  but what, truly, are the underlying mechanisms that results in these different effects? And we need to know what to do with conflicting information.

In occupational therapy, which is a health science, we have many questions, some of them about physical processes but equally as many about meaning and the individual lived experience. The crux of our concern in occupational science is the relationship between occupation—what people do everyday—and health and wellness. We are concerned with the habits, routines, and rituals that surround daily activities and contribute to wellness or disease. During the initial weeks of the pandemic-related closures our students became very aware of the destabilizing effect of their disrupted routines on their emotional and physical well-being. And this personal experience provided opportunities for deep learning and examination of the science of our profession.

Certainty, in our realm, exists on a continuum. We quantify the amount of uncertainty that we can tolerate. We talk about p values—95% confidence that the outcome was not due to chance. In the social sciences and in the health sciences, where client and provider behavior is concerned, we can never be 100% certain. 

Shepherding our students through their 5 years is as much about teaching them facts as it is about helping them to become comfortable with the dreaded “it depends” response they get early on in most of their classes. “What do I do when I see this?”  “What do I do if this happens?” they ask. “Well,” we, the faculty say, “it depends.” We are always applying knowledge which is to some extent uncertain within circumstances that are subject to change. Helping them to become flexible thinkers who can adapt quickly is a primary mission. 

We are always applying knowledge which is to some extent uncertain within circumstances that are subject to change. Helping them to become flexible thinkers who can adapt quickly is a primary mission. 

COVID has created for us a grand active learning experience in which they, along with us, their faculty, must continually sort through the evidence and try to make sense of it. Living comfortably with this uncertainty depends upon their understanding of the world. Helping students to identify their assumptions about knowledge and how it is generated can help them to situate science in place that enables them to think critically about its outcomes and effectively apply them in practice. 

Through my OT educator lens, it seems that “belief” can allow us to be completely certain, but science, in the moment, never can. My aim with students is to enable them to see science as a process and to embrace that process, uncertainty and all. That our students will live comfortably with this uncertainty may be a pipe dream yet I am convinced if we can help them to identify their values around knowledge and what constitutes “knowing” they will be able to situate science in place that enables them to think critically about its outcomes and effectively apply evidence, in all its ambiguity, in practice. 

To watch the NetVUE webinar, “The Scientific Vocation in a Time of Crisis,” go to this link. You will be asked to register your name and email address and then the video will appear in a new window. If you are a member of NetVUE, the video can also be found in the library at the online community, in the folder marked “Digital Media.”

Judy B. Ericksen is associate professor of occupational therapy at Elizabethtown College in Elizabethtown, Pennsylvania. Her primary clinical background is in school-based practice/pediatrics and mental health. Prior to joining the faculty at Elizabethtown College, she served as a therapy specialist for a large school system in Virginia. Her research interests include occupation-based practice and clinical reasoning. She currently teaches courses focused on research and evidence-informed practice, and writing in the profession. In 2017, she was a participant in NetVUE’s Teaching Vocational Exploration faculty seminar.

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