So far the questions, and the reasoning behind them, have been relatively straightforward – even self-evident. But with Question 7 of The Explain Pain Assessment* things get more complex and some background knowledge is essential – conceptual change, missing bits, single and multiple grain misconceptions, sandstone and sandcastles. Metaphor and some imagery will help us here.
First up conceptual change. We can consider that learning takes place in the presence or absence of pre-existing knowledge and concepts. Learning in the presence of pre-existing knowledge often requires conceptual change as the knowledge and concepts held may be inaccurate to varying degrees.
Conceptual change often involves cognitive conflict when pre-existing (less accurate) knowledge comes up against new (hopefully more accurate) information. In clinical encounters it is very common to come across pre-exisitng, inaccurate ideas about the body and pain, and with humility (it is after all 2018 and our knowledge of how humans experience pain is far (far) from perfect!), we refer to these as misconceptions.
Inaccurate knowledge and beliefs (misconceptions) can be held at various levels indicating both how strongly held the knowledge is and how challenging it can be to change. Here are four levels that you should know about, some examples of each to help you pick them, and a few thoughts on how to deliver education tailored to the level of misconception.
What kind of misconception does the learner hold?
Question 7 seems simple, but the answer is complex. There are no questionnaires or assessments to determine an individual’s level of misconception, but listening carefully, questioning further, and developing a strong therapeutic relationship will give you a sense of how to pitch your education to maximise the benefit for that person in front of you.
As always, questions, comments and discussion welcome below.
Knowledge driving health