It could be argued that the level of knowledge acquisition required for dressing or holding a pencil is fairly basic; therefore an OT needs to have only an introductory level of understanding of the teaching and learning process. ACOTE's minimum requirements of knowing how to create experiences and materials that address client educational needs are a good place to start, but I believe that knowledge acquisition and dissemination are so important in the lives of our clients that we should strive for greater understanding of education as a fundamental of practice. I believe teaching and learning are actually cornerstones of our profession that, along with our understanding of occupation, make OT unique.
Expanding our understanding of teaching and learning as it pertains to an occupation-based perspective of practice allows us to appreciate the gains in participation that can be attributed to higher-level cognitive skills, including critical thinking and metacognition, and the significant role of OT in this process. This column, the first of two, will consider the developmental levels of knowledge and learning that people identified as lifelong learners seek. In order to be functional and productive members of society experiencing the highest quality of life, individuals must desire, explore, understand and seek out relevant experiences in which to participate. Without knowledge, there is no true occupation. My next column will discuss ways that OTs can conceptualize the teaching process to better assist clients with knowledge development.
The Four Pillars of Learning, as outlined in Learning: the Treasure Within, a report of the UNESCO International Commission on Education for the Twenty-first Century, are phases of knowledge formation that give us a way to view the developmental process of lifelong learning. Each phase describes pragmatic skills that must be in place for mastery. People may or may not pass through all of these phases in their lifetimes, but achieving milestones at each pillar can set the stage for a life well lived.
Learning to Know, the first pillar, involves obtaining the skills required to learn, and developing an appreciation for learning of all types. Only when motivated to go forward-to benefit from seeking additional information to inform life endeavors-will a person gain mastery of the learning process itself. This is where OTs engage therapeutic use of self to facilitate client interest in life, growth and change. This pillar also implies development of concentration, memory and thinking skills-all client factors that are explicitly addressed by OT practitioners.
Learning to Do involves occupational training, or the notion of skill formation. This pillar represents the type of learning we expect of our clients in a rehabilitative or habilitative context. The client factors OTs will be particularly concerned with in this phase are good problem-solving abilities, decision-making abilities, innovation and team skills, all of which are required when an individual is dealing with the ongoing effects of physical, emotional or cognitive difference (congenital or acquired) within our society. Learning to do requires doing and is not reserved for those with cognitive challenges. All clients may benefit from the knowledge of how to better solve problems and make healthful life decisions.
Learning to Live Together addresses the need for individuals to learn to live cooperatively, to understand the experience of others and see the world from their point of view. The development of social skills and the ability to navigate culture and community are important to attain within this pillar. OTs recognize the importance of these skills to an individual's overall functioning, and that one does not learn these skills by reading a book or completing puzzles, but through actual engagement with others.
The final pillar is perhaps the one most similar to OT. Learning to Be recognizes that learning in general should contribute to the complete development of every person-their mind, body, sensitivity, aesthetic appreciation and spirituality. Through the achievement of this pillar a person becomes involved with others and the world in a rich and full way that fits their personal aspirations and abilities. This pillar speaks to the overarching belief in the interconnectedness of the mind, body and spirit, and points us to a process of treatment centered on the many ways OTs can assist clients in living life to its fullest. As with the other pillars, people to do not achieve learning to be without active participation. This pillar speaks to true occupational engagement as a way to grow to become a knowing human.
There is much more to human function than the terminal ability of dressing or bathing or the remediation of tasks to allow for such. Beyond the formation of skills is the ability to reason and problem solve, and to be critically reflective in order to make healthful choices and appreciate the intricacies of participation in living. OTs must understand there is more to people than outcomes-it is the fully developed essence of being a knowing human, gained through participation, that is truly the means and the end of occupational therapy.
Debbie Amini, EdD, OTR/L, CHT, is an assistant professor of occupational therapy at East Carolina University in Greenville, NC. She also serves as the chairperson of AOTA's Commission on Practice. Reach her at firstname.lastname@example.org.