Zac Cupples: Continuing Education—The Complete Guide to Mastery
75 . . . That’s my number. No, not that number.
Seventy-five is the number of continuing education classes, conferences, home studies, etc. that I’ve completed since physical therapy school.
Though the courses are many, it was probably too many in such a short period of time. When quantity is pursued, quality suffers. Sadly, I didn’t figure out how to get the most out of each class until the latter end of my career.
Two classes in particular stand out: Mobilisation of the Nervous System by the NOI Group, and ART lower extremity.
Yes, the content was great, but these classes stood out for a different reason. You see, instead of just doing a little bit of prep work, I kicked it up a notch. I extensively reviewed supportive material, took impeccable notes, and hit all the other essentials needed to effectively learn.
I was prepared, and because I was prepared I got so much more out of these classes than my typical fare. The lessons learned in those courses stick with me to this day.
For the stuff you really want to learn, I’ll encourage you to do the same. It’s the way to get the most out of your continuing education. By the time you are done reading this post, you’ll understand why I now recommend a more focused learning approach and fewer courses.
Let’s see how to do it.
Continuing Education’s Purpose
Before attending a course, it’s important to understand where in the learning hierarchy this medium sits.
I’ve discussed previously that continuing education is a supplemental learning experience. Due to its nature, classes can fill multiple voids:
- Provide breadth or depth to your current study area
- Foster skill development
- Create an environment for application
- Expose new learning avenues
- Summarize subjects
- Provide clarification for things left unanswered by other learning methods
- Create dialogue with instructor on concepts you may not fully understand, or even disagree with
- Party (come on, why else would you go to CSM?)
With so many potential purposes, you need to be able to answer the ‘W-questions.’
Why are you taking this course?
Who are you hoping to help?
What do you want to get out of this course?
What question do you hope to answer?
What problem are you trying to solve?
If you don’t understand why you are taking a class, then you will either not get what you want out of the class, take the wrong class and/or waste time and money.
Knowing why may also take you to study areas outside of your norm. Consider when I took the SFMA Level 2 last year. I wouldn’t consider myself an SFMA purist by any stretch. I use portions of the testing as comparable signs, but I just have a different thought process than what they advocate.
You are probably wondering why the hell did I take the class then? If you don’t “believe” in the SFMA, why would you learn from them?
Simple. I didn’t attend to refine my SFMA skills. I wanted some useful exercise progressions for my athletes. Anything extra was gravy. With that goal, I got exactly what I wanted out of the course, and didn’t get frustrated by concepts I disagreed with.
Most every class becomes a victory when you know your why. Regardless of what your preconceived notions are about a system, a practitioner or a person, you can learn something from everyone.
Have a beginner’s mindset, and you’ll be a better clinician for it.
So you’ve decided on what class to take. You’ve gotten your why, you have your course’s purpose. You’re amped. You can’t wait to learn, network and become better at your craft.
Hold your horses, buddy. You’re just getting started.
Preparation is essential to maximizing continuing education returns. You’ll know what questions to ask, where your learning gaps are, what skills need improvement and which concepts need clarification.
Designing your pre-course preparation is quite similar to how I described approaching learning previously. The question you are trying to answer becomes: “How can I learn the most about subject x?”
Here’s how to ensure this happens:
Read the Recommended Reading
You’d be amazed at how many people don’t do this. The recommended materials essentially outline the class. Reading this stuff will not only help with organization, but you’ll be better able contribute to discussions. Read the damn material!
Read it! It’s right there! Read it now!!!!!
What if you aren’t provided any recommended reading? Ask. Write an email to the instructor, asking how to best prepare for the class. Not only will get more out of the material, but you may develop a worthwhile relationship with the course instructor.
Here’s a script you can use and tailor to fit your learning goal:
My name is [Joe Momma], and I’m going to be taking your class in [Antarctica] in a few months.
I want to get the most out of this class, and I was wondering if you have any recommended reads, videos, podcasts, etc. to enhance my experience?
Thank you in advance for your help. I am beyond excited to learn from you.
I sent a similar message to Diane Jacobs prior to taking Dermoneuromodulation, and she gave me a boatload of material. Not only did I appreciate the class more, but we became friends. I know we could go hang if we were at a conference together. Even if course materials are provided, it’s a good idea to send that email.
Read Any Listed References
Oftentimes course references will be listed on the signup website. Acquire as many of these as you can, and make your way through them. You’ll both better understand the instructor’s rationale and be better equipped to critically appraise the material provided. These two factors will aid decision making in concept/technique application.
Read Related Books to the Topic at Hand
Remember, books are the primary exercise. Books can help provide in-depth understanding of the course material. You’ll want to read not only books by the instructor, but others as well. You may even search for books with contrasting viewpoints.
When I took Mobilisation of the Nervous System, I read both “The Sensitive Nervous System” and “Clinical Neurodynamics.” Reading two different neurodynamic perspectives allowed me to ask better questions. I was also better able to critically appraise how certain techniques were used.
For example, the instructor used ipsilateral cervical lateral flexion to provide structural differentiation during most upper limb neurodynamic tests. Whereas Michael Shacklock suggests that the nervous system may not develop enough tension to impact testing with this movement. Instead, it is better to contralaterally sideband the neck earlier in the exam, then sideband to neutral as a differentiator. I would not have known this had I not read that book.
Listen/Watch Any of the Instructor’s Other Work
Many speakers, especially the big guns, will often have content on Youtube, podcasts, blogs, etc. Consume as much of it as you can. These mediums can spark questions, insights and conversation points.
You actually read the required readings, scoured the literature, devoured the textbook (twice) and listened to every podcast the instructor put out . . . ever. You are ready to destroy this course.
Though pre-course preparation is critical, ineffective peri-course planning can derail even the most prepared student.
Don’t let that be you. Here’s what you need to do to make certain you perform at your peak come game day.
Travel to the Class in Style
As the old adage goes:
“No amount of studying survives contact with the redeye.”
Ok I totally made that up, but it serves a point.
If you have any travel hiccups, either intentional or not, game over. You will not be rested, you will miss the course. You will fail. Your clientele will suffer.
There are four keys to acing your travel plans:
Arrive as Many Days Early as Possible
Arriving early is an insurance policy. It allows you to effectively deal with any potential travel setbacks, get settled into an unfamiliar place, and adjust to new timezones. Hell, maybe you can even do something fun while you’re in a new city.
Moreover, you don’t get as effective sleep when you are in a new place. The first night you sleep in any unfamiliar territory, your brain experiences inter-hemispheric sleep. This sleep type involves one hemisphere, usually the left, increasing vigilance in order to protect you¹. Thus, one side of the brain is not as well rested. So spend some extra time at the new location. You’ll have better sleep quality, and consequently, better learning capabilities.
Stay at a Decent Hotel
Sleep is primo for learning, so pick a sleep-friendly spots with comfortable beds. Westin and Sheraton are sleep-friendly hotels². I also like Marriott and Hampton Inn for a more reasonably priced fare. if you are a big spender, the Ritz . . . man, I am telling you!
Choose Flying Times That Prioritize Sleep
That means no red-eyes, super-early or super-late flights. The amount of money saved by skimping on flights is wasted in spades by learning nothing at your class. Give yourself a fighting chance. Each flight should not alter your normal sleep and wake times.
If Changing Timezones, Alter Your Bedtime the Week of Travel
We’ve all been there. We get into a new city and our sleep schedule is thrown out the window. Jet lag typically takes one day to recover with every one hour time zone change².
Here’s how to mitigate it:
- If you are traveling west: Go to bed one hour later for each hour traveled.
- If you are traveling east: Go to bed one hour earlier for each hour traveled.
- Take sleep supplements: I’m a big fan of Doc Parsley’s Sleep Remedy. It has several effective supplements and a small amount of melatonin that won’t impact endogenous production. I take this before bed and it clonks me out quite easily. Per my Ōura Ring, I get much higher REM sleep when I take this stuff.
- Sidebar – Take high dose melatonin as a last resort and sparingly. We want to keep endogenous production high. I usually take about 2-3mg worth if I absolutely can’t sleep.
- Sidebar 2 – You can also use anti-histamines if sleep is just not happening, as these drugs are useful at inducing sleep².
Take Whatever You Need to be Comfortable
Take all the things you need to ensure a comfortable flight. If you are a movie watcher, music listener or napper, bring your stuff. Me personally, I have to have my Bose headphones. Noise cancelling headphones block out any distracting noises, and are essential for travel. Once I pop these puppies in, I’ll either read a book, play a game or nap.
Now that we’ve learned lots about travel, let’s look at the remaining strategies.
Move Prior to Class
Aerobic exercise can both increasing alertness and retention. Getting up a bit earlier and getting even 20-30 minutes of movement in before class can keep you awake and alert for your learning endeavors.
Take Effective Notes
Now that you’ve safely arrived, use whatever is at your disposal to be an expert notetaker.
Find whatever system is effective for you. I personally think it’s incredibly important to expose yourself to the material using multiple strategies. Here’s what I use:
- Highlighter– used to highlight important sections in the manual
- Multicolored pens– While I’m taking notes, I link concepts together by using various colors. If a concept is neuro-based, I’ll use purple, pain is red, orange is power, etc.
- Tabs– If a section or diagram is extremely important, I’ll put a tab by it in the manual, as I may reference this piece quite frequently.
- Audio recorder: One of my buddies does this quite frequently. If allowed, record the lecture to replay course sections for better understanding.
- Smartphone: Used to take pictures or film video when possible
If the instructor uses Powerpoint, and the slides are included in the manual, DO NOT look at the presentation. If you already have the information, there is no sense at staring at a slide. Instead, listen to the instructor. Those words are what you should predominantly take notes on. The only circumstance in which you’ll look at the presentation is if video or new slides are presented, or if the instructor is pointing you towards the slide to make a point.
Also, if you don’t understand something the instructor said, don’t be afraid to ask questions. You are the paying customer, and this may be your only shot to get your answer. Don’t waste the opportunity!
Caffeine is a must, both for alertness and increasing retention.
The latter piece is quite interesting. My good buddy Dr. Mike Roussell turned me onto a study that shows better material retention rate if you caffeinate after learning exposure. The caveat is that this effect was only studied in non-caffeine users. So if you are a regular user, you may consider abstaining from caffeine the week prior to the class. Though I haven’t used this strategy at a course, it has been quite effective for reading retention.
If you want a double-trouble effect, I use Dr. Mike’s Neuro Coffee. It contains a supplement that increases BDNF production, an important factor in learning. It tastes pretty damn good as well.
This part is greatly undervalued. I’m a shy guy by nature, so in the past I have often kept to myself if I don’t know someone at a class. Big mistake. You can network, make friends, find referral sources and have stimulating discussion if you just say “Hi.” I’ve been trying to do this more, and have met a lot of good people at courses because of it.
Phew. So you prepared, travel was smooth, you were well-rested and you did everything right to get the most out of your course.
Now it’s “Monday.” (or Tuesday if you are me, I take the day off after travel). You notice that every patient you have needs what you learned over the weekend.
You haphazardly apply the material, have some successes, and quite a few failures. Then your use tapers off by the end of the week, and you are back to your old self by next Monday.
Congratulations, you are officially a course junkie. A nomad. One who travels from course to course to check off the boxes, but never really implementing anything you learned.
Don’t be that guy or girl. Instead, take your time reflecting, reviewing, learning and integrating the material slowly over time. Find out where it fits in your paradigm. That is the true way of getting the most out of your courses.
Here are the keys:
Review the Materials
You can’t expect to be an expert after a weekend. Continual learning is paramount towards comprehending the new material. The same 6-step method I use to read books is used for my con ed classes. Learn you some!
Read the References
Courses are continually updating their references. Pick which ones seem interesting to you, and go through them. Now that you have the course under your belt, you’ll have something to anchor the new material to, enhancing retention.
Reflecting is something we don’t do enough of. Think about all that you learned in your course. Ask yourself where this material fits in your philosophy? Who could this help? When wouldn’t I use this intervention? Answering these questions streamlines material implementation.
Pick One Client to Implement With
Yes, one. Only one to start. But go all in. You’ve decided where this fits in your philosophy, so use that technique and see what happens. You’ll learn regardless of success or failure.
Organizing Your Course Selection
I often think about the infamous “If I had to do it all over again” question. What courses would I take or not take.
If you are a new grad or just getting into outpatient orthopedics or performance, this section is for you.
While I won’t go into every single course to take, I think the following classes will give most everyone a foundation to learn from. Here’s where I’d start.
Step 1 – Explain Pain or Therapeutic Neuroscience Education
Though I joke about the pain science purists, these courses are foundational for understanding pain and client interaction. We want to be as nonthreatening as possible to our people in pain. These classes will change your life
Step 2 – Bill Boissonnault – Art and Science of Medical Screening
You’ve never heard of it right? It’s too bad. If clinicians wish to be primary care people, then this class is essential. The best clinicians know who they can’t help. This class teaches you how to do that in spades. Sadly, I couldn’t find where he offers this class, so you’ll have to do some sleuthing.
He also happens to have the best mustache in physical therapy, which a systematic review has also shown to further enhance the learning process.
Step 3 – PRI Primary Courses + Impingement and Instability
You knew these courses would eventually come up.
I have yet to go to coursework that puts the movement together as well as these guys do. Techniques are effective and anatomy education is second to none. Some concepts can get a little out there, even I will admit, but if you go with the framework established in step 1 & 2 you can still learn a great deal.
I would take Myokinematic Restoration first, followed by Postural Respiration, then Pelvis Restoration and lastly Impingement and Instability.
Step 4 – FMS level 1 & 2
Rehabilitation is not just about getting people out of pain. It’s about building resilient people. Fitness is a means of meeting that goal. I really like the FMS exercise progressions and they teach a lot of the basic lifts quite well.
Step 5 – Manual Therapy Courses
Exercise ought to be our primary means of helping people, simply because they can’t take our hands with us.
But we all know sometimes a client needs a local input. Manual therapy is an important means of meeting that need.
I do recommend having a variety of inputs at your disposal, as everyone’s needs will differ. I classify manual therapy based on input intensity. Pick 1-2 in each category:
- Low intensity: Dermoneuromodulation, Mulligan, Maitland
- Medium Intensity: ART, Static manual contact, massage
- High Intensity: Dry needling, manipulation, trigger point therapy (or tender point therapy if you want to fuss about semantics)
Step 6 – Certified Conditioning Course
Once you’ve developed basic constituents, strength, and power, you ought to learn about conditioning. Building capacity is what allows clients to keep the changes we’ve established over the long haul. Joel Jamieson is the guy for that, and his online course is a great means of learning his stuff. Really good manual.
Step 7 – Precision Nutrition Level 1
I discussed in Movement Debrief Episode 2 about the need to expand our scope. Educate clients on simple nutritional strategies can pay huge dividends. The folks at PN do a great job with this.
Yeah. It’s a lot of work to get the most out of your classes. Do I do the above with every class? Absolutely not. Sometimes I go learn as an excuse to hang out with friends. But utilizing as many of the above concepts as possible will make you more than a course junkie.
It’ll make you better at your craft.
- Understand why you are attending the class
- Prepare in advance by consuming related material
- Take travel seriously
- Take notes effectively
- Review, reflect, and implement
- Prioritize course selection
Continue your education with Zac’s recommended instructors:
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1 – Tamaki M, Bang JW, Watanabe T, Sasaki Y. Night watch in one brain hemisphere during sleep associated with the first-night effect in humans. Current biology : CB. 2016;26(9):1190-1194. doi:10.1016/j.cub.2016.02.063.
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