This chapter demonstrates how Decoding work can be productively utilized within a curriculum
change process to help make design decisions based on a more nuanced understanding of student
learning, and the relationship of a professional program to the field.
Impact of Decoding Work within a Professional Program
Michelle Yeo, Mark Lafave, Khatija Westbrook, Jenelle McAllister, Dennis Valdez, Breda
Eubank
Introduction
The Athletic Therapy (AT) group at Mount Royal University is currently engaged in a largescale pedagogical and curricular change, moving to a competency-based approach using a
clinical presentation model. This approach “uses a scenario or a clinical case as a foundation to
both teach and measure a student’s knowledge, skill, or ability” (Lafave, Westbrook, Valdez,
Eubank, McAllister, and Yeo, in press). There have been various components to this process,
including the content validation of the clinical presentations (Lafave et al., in press) and a
qualitative self-study on the curricular change process among its faculty members, which led to
the development of a community of practice within the team. The community of practice that
developed “was key to the curricular change process, despite it being often focused on other
elements beyond curriculum, specifically, on the practice and identity of the faculty members as
athletic therapists” (Yeo, Lafave, Westbrook, McAllister, Valdez, and Eubank, manuscript under
review).
Michelle Yeo, a faculty developer working with the AT team, introduced the “Decoding
the Disciplines interview” as another vehicle to delve more deeply into the team’s approaches to
the curriculum. All members of the team were quite intrigued by the concept and agreed it would
serve the self-study process well. As described in Chapter 1 of this issue, Decoding the

Disciplines, pioneered by David Pace and Joan Middendorf, is a process whereby instructors first
identify bottlenecks, or “points in a course where the learning of a significant number of students
is interrupted” (Anderson 1996 cited by Middendorf and Pace 2004, 4). The next step is for the
instructors to engage in a Decoding interview, where two trained interviewers probe to assist the
instructor in first clarifying the bottleneck and second, to “reconstruct the steps they themselves
do when solving similar problems” (Middendorf and Pace 2012, 5). AT team members each
chose a different bottleneck related to their particular courses and experiences with students. As
a group, classroom based, field based, and integrative bottlenecks were all represented, but this
was not pre-determined. Michelle Yeo and Ron MacDonald, two members of the Faculty
Learning Community on Decoding the Disciplines at Mount Royal University (see Boman,
Currie, MacDonald, Miller-Young, Yeo and Zettel, this issue), acted as interviewers for the five
members of the AT team, and the interviews were recorded and transcribed. The interviews were
conducted as a component of self-study by the AT team, with the interviewees acting as coresearchers, reading and coding the interviews. This process yielded deeper insights than by
simply participating in and reflecting on an individual interview. Indeed, the AT team found that
the biggest impact came from reading and reflecting upon one another’s interviews making this
group practice something to consider for the Decoding process more generally.
The transcripts of these interviews reveal thematic support of the framework outlined by
Miller-Young and Boman in Chapter 2 of this issue, eliciting similar ways of thinking, ways of
practicing, and ways of being. While the Miller-Young and Boman interviews were conducted
across a variety of disciplines, these were concentrated with a group of Athletic Therapists, and
thus the results are compelling to consider in this intra-disciplinary context. While the above

themes were present within the Athletic Therapy interviews, additional facets were also evident,
which are explored below.
Important insights emerged relating directly to individual classroom practice within the
context of the curriculum change in spite of some of the interviewees feeling frustrated at the
time of and immediately following the interview. Some overarching insights related to program
design, delivery, and structure. While all of these themes were present to greater or lesser
extents across the interviews, each came forward most dramatically in specific cases, and thus
within each theme we will focus most closely on one or two particular interviews. These themes
are described as: 1) lifting the veil (or, when the problem is not the problem); 2) the emotional
component of learning; 3) unpacking professional intuition in Athletic Therapy; and finally, 4)
disrupting practice in the field. All of these together carry implications for program and
curriculum design, and thus, in sum, the chapter offers a practical example of how Decoding
work can be used within an academic program to impact program design and delivery.
For the purposes of this chapter, pseudonyms have been given to the interviewees, who
were all members of the AT team. All participants are also co-researchers. All are experienced
Athletic Therapists, and they have taught in the Athletic Therapy program for a range of 6 – 21
years.
Lifting the veil (or when the problem is not the problem)
This theme was particularly prevalent in Julie’s interview. Julie chose an apparently
straightforward cognitive bottleneck where students had difficulty remembering and being able
to identify discs in the spinal column in relation to vertebrae. She initially describes the
bottleneck this way:

There is an anatomical relationship between the nerve roots leaving the back and the disc
that would push on it, and students have difficulty in identifying which disc is the one that
would actually have the problem. So they can identify what the symptoms are and where
it is affected, but they can’t identify the cause, the specific location of the cause.
She then goes on to explain the nature of the confusion:
Throughout the regions of the spine, you have the cervical spine, the thoracic spine and
your lumbar spine, and because the size of the vertebra is different in each part of the
spine so are the discs and your spinal cord changes… and so that changes the
relationship as well. That is the part that is confusing to people, you can’t just say “Oh I
have a C5 nerve root symptom, so therefore it is my C5 disc,” and in fact it is not that in
most cases… that is where people are having the problem.
Interviewer: And what do you do to figure out the next step?
Then you go back to your anatomy to understand where does a nerve root exit relative to that
disc and vertebra? Like where does it exit the spine? And … relative to what disc?... it is more
complicated in the lumbar spine because the discs are big and there could be more than one
nerve root that is compressed, but it is the weird relationship between where nerve roots exit and
disc herniations happen that makes it confusing.
Through the process of the interview, Julie drew the anatomy of the spine and discs on
the white board. It was puzzling to the interviewers because the concept itself seemed relatively
simple even for disciplinary novices. A key component to understanding the bottleneck emerged
as the importance of “drawing it out.” While perhaps tricky to visualize when explained verbally,
and certainly Julie uses Powerpoint slides with diagrams as part of her lectures, what came

forward was the difference she noted between students who “drew it out” on the margins of their
exams when tested on the concept and those that do not:
I have tried to give them, “Here is how you draw it out for yourself.” You can see, and
that is interesting to me… I tend to ask a question or two about it on every exam and the
people who generally get it right, many times on the exam I have seen they have drawn
out what I have done or some version of that. Now is it that the people that don’t didn’t
find it helpful? I don’t know… or just didn’t get it enough to draw it? … but I would say
that… not every person who gets it right necessarily drew it, but most do. I don’t ask
them to draw it, but you see beside the question they have done this little thing for
themselves.
The concept of learning through drawing is supported in the learning theory and anatomy
teaching literature (Ainsworth, Prain, and Tytler 2011; Balemans, Kooloos, Rogier, Donders, and
Van der Zee 2015; Van Meter and Garner 2005). Despite the fact the concept seems relatively
simple to understand, students may be challenged with the material because they were trying to
both understand the underlying anatomical theory, while simultaneously trying to integrate this
knowledge into the practical application of a clinical presentation such as a “herniated disc,” for
example. The proverbial juggling of these concepts is often outlined in the cognitive load
learning theory literature and drawing the concepts is one of the teaching strategies that has been
used successfully to manage the cognitive load on the student (McCrudden, McCormick, and
McTigue 2011; Balemans et al, 2015).
Beyond the technical potential discovered of asking her students to ‘draw-to-learn,’
through the process of the interview, Julie discovered that the reason for the bottleneck may have
less to do with a need to ‘explain it’ better and more to do with a lack of opportunity for the

students to apply the information and the assessment processes used to test the learning, whether
in the classroom or in a practical setting. Because the events in the clinical or field placements
are entirely unpredictable, students are often unlikely to encounter practical learning in a way
that neatly synchronizes with their classroom learning. In class, they are often practicing feeling
for anatomical structures on one another. However, a common problem in Athletic Therapy (and
indeed in many clinically based programs), is that there is a challenge in providing a practical
example at the moment where it would support theoretical learning. Julie explains:
The problem in class many times is if someone in the class doesn’t have something wrong
with them we are feeling a whole bunch of normal, and it is not until you feel abnormal
that you go, “Ohhh!” like, “I get the difference.” We can only hope for people to come in
with injuries that we can… people can find that stuff on.
Furthermore, there is a confidence element, which relates as well to the next theme of the
emotional component of learning. Julie comments, “I think they do a better job of it than they
think that they do, it is having that confidence that I am actually feeling something.” A very
significant element of the Athletic Therapy interviews was the kinesthetic, embodied element, of
knowing through touch. This relates to Currie’s exploration in Chapter 3.
There was speculation that the technical knowledge itself may not be valued adequately
in the field or clinical settings, implying a motivational component. Julie describes how she
herself, as a senior student, came to understand the utility of having an in-depth knowledge of
anatomy:
I remember there was an opportunity to take an advanced anatomy class in my last year
of school and I… learned it at a deeper level and I myself had that epiphany of, “Oh my
God, how have I been assessing anything thus far?” realizing how poor my anatomy was,

or how cobweb covered it was until taking that second course, and having a reason to
know it in an applicable way, that, for me, was a very light bulb moment.
Our thinking around teaching underlying theory as knowledge and the separation of this
knowledge from the application has evolved considerably over time (Rose and Best, 2005).
Many professional programs attempt to build clinical competence and in the past, programs
separated the theory from the practice in the hopes it would transfer naturally. However, as we
have come to understand more, the application of theory should be synchronized as part of the
overall learning process and when the two are separated or asynchronous, learning may not be
optimal (Rose and Best, 2005).
What was thought to be a cognitive bottleneck with a simple solution (i.e. ‘explaining it’
better), turned into a different solution whereby students need to focus on the experiences
designed to make meaning of the concept, whether theoretically by drawing it out, or
experientially, by focusing more on the utility of the concept to practice.
Emotional component of learning
As team members engaged in the Decoding process, and drilled down into their own experiences
of ‘a-ha’ moments and critical learning, the emotional component to significant learning in the
field of Athletic Therapy became apparent. For several of the team members, significant learning
experiences in their own practice were accompanied by powerful emotions such as fear and
anxiety. Strong emotions may arise when treating patients and making decisions in front of a
stadium of people, or when thinking about the potential harm caused to patients by missing an
important step in their evaluation or management process. Events that brought forward these
strong emotions often became turning points in their own learning.

In a recent publication, Middendorf, Mickute, Saunders, Najar, Clark-Huckstep, and Pace
2015) have begun to explore emotional bottlenecks as part of the Decoding process. While this
work is focused upon student learning in the discipline of history, and the role of pre-existing
ideas and belief systems, their point that “cognitive and affective aspects of learning are
intertwined” (169) is relevant to our analysis. All of the chapters of this special issue point
towards the important spaces outside of cognitive processes where learning lives, whether that is
Miller-Young and Boman’s ways of practicing and ways of being, Currie’s notions of
embodiment, or Yeo’s hermeneutic dialogic relationship between the discipline and the world
(Chapters 2, 3 and 4, this issue).
In the case of the Athletic Therapy students, the emotional aspects of their learning come
less from epistemological assumptions or preconceptions, and more to do with the immediate
emotions raised by situations creating enormous pressure and anxiety, interpersonal challenges
such as telling a coach a valued player cannot return to the game, or fear in a clinical setting of
harming a patient. These sorts of bottlenecks to learning surfaced in all of the interviews, but
most strikingly in Jason’s. He explains how this learning process was for him as a developing
professional, as he begins to consider how to embed this learning for his students:
That is not something that we teach – something blatant that we teach… people are going
to be yelling at you and you have to gather as much information as you can so you can
explain it to the person… but then how do you manage a situation where all that stuff is
going on and you have to focus on one person? Someone is yelling in your ear… It really
clicked home the first time I had to go on court and it was like, “I am actually
focusing!”… I can feel my heart racing, I am a little nervous, but I am actually talking to
the patient, which is good. And in that same example, we took the patient over to the

bench and having to explain to the coach why they weren’t able to go back in… So I
bumbled around my words and I kind of gave too much irrelevant information when all I
had to say was, “He can’t play…” That was one of the experiences that kind of helped
me learn to… just stick with the relevant stuff.
The role of experience for the novice in moving through difficult emotional bottlenecks
in professional education cannot be overemphasized. The question for the instructional team
became then how to intentionally support such learning experiences. Part of the answer seems to
be becoming much more explicit in the classroom in terms of an instructor’s own experiences as
an athletic therapist: how they themselves encountered and navigated such powerful emotional
bottlenecks (also see MacDonald, this issue).
Unpacking ‘professional intuition’ in Athletic Therapy
All of the interviews raised the concept of tacit knowledge in Athletic Therapy, in the intuition or
gut-level expertise. Different team members expressed this in different ways. All of the
interviews discussed the observational skills, the ‘ways of seeing’ that Athletic Therapists
develop, along with interview skills, manual skills, and the ability to follow a decision tree or
other mental structures in order to arrive at the correct diagnosis and treatment. A common
theme was the role of extensive experience and reflection in the practice of the AT instructors.
The interviews delved into how complex this is for students and the need to break things down
for them, and the struggle and strategies the instructors pursue in order to make the implicit
explicit. This theme came forward most strongly in Erica’s and Kelly’s interviews.
Erica explains the bottleneck this way:
They get so burnt out and they are just like, ‘Just tell me the list. What is the list that I
have to do in order to get through this? And rehab doesn’t have a list; it has a bubble

that you try and put together… I think at the end of the day it is so hard for them to have
to integrate everything in a high volume program.
Similarly, Kelly explains, “So it is putting it all together and I find… that they have each
of the pieces of the puzzle and it is putting it together that is the biggest bottleneck.” In their own
practice, all of the instructors describe an incredibly complex process of analysis and decisionmaking. When probed, they describe how they begin their assessment the moment they have
visual contact with a patient in the clinic, as Kelly describes, “So we are looking for any signs
and symptoms like swelling, bruising, deformities, and you are also observing when they came
in, are they limping? Are they kind of favouring and babying an area?” In a field context Jason
is incorporating his knowledge of the sport, the field conditions, and an intensive observation of
the play such that he will usually actually see the injury occur. Each instructor describes the
importance of gathering a proper history, but this process is highly flexible and requires
judgment throughout. Erica points out, “if you take a good history you have eighty percent of
your answer about the person from the history alone… then as you go through all the physical
testing you are basically testing your theory.” Kelly explains,
They are set questions but they are always geared and pinpointed towards my
conversation with you right? So I am going to start a conversation and I know I have all
these questions I am supposed to ask in a basket and I don’t ask them if I know that I
don’t need to ask them, and I am not always doing it in a rote manner, right? Because… I
am at the point now where I can have a conversation and lead it.
In analyzing the transcripts, instructors began to wonder about a kind of mythology that
may develop of ‘magical’ experts, a perception that Athletic Therapists ‘just know.’ Students
perceiving this myth may become intimidated or overwhelmed by experts’ tacit processes that

appear impossible to decode for themselves. Students watch experienced therapists apparently
skip over steps in practice, yet the consensus is for the expert that one must do each step in
sequence for many, many repetitions before the process becomes internalized. When asked what
they do when they encounter something they haven’t seen before, each instructor describes a
process whereby they go ‘back to basics’ and slow down the steps, and in addition they are quick
to consult with other experts as part of their process. In making these processes explicit for
themselves, an opportunity is created to make this more explicit for students.
Disrupting practice in the field
An interesting tension appearing in the interviews was the relationship between the field of
practice and the academic program. This tension is very common across many professional
programs, where students experience theoretical learning on campus integrated with clinical
experiences (Rose and Best, 2005). While instructors in the Athletic Therapy program engage in
professional practice themselves, there is still often a tension between the field and its perception
of the university and the ‘ivory tower’ as contrasted with ‘practical knowledge.’ Students will
naturally default to the way things are taught in the ‘real world’ of the field. From the program
perspective, instructors can also become frustrated by the gap between contemporary literature
and research and current practice in the field. In working with students, for example, in Paul’s
interview on identifying the correct level for ultrasound, there is a, sometimes unspoken, hope
that the students might become positive disruptive influences in the field. He comments,
I have seen probably three generations of students who have gone through under a
mentor and they all use a cookbook approach, “We will use it at 1.0 watts per square
centimeter for five minutes.” For what? For everything! And that is totally wrong to use
a pre-set, and yet everyone does it in the industry.

Paul identifies the complexity of determining the correct level for ultrasound as a
complex bottleneck for students, but further, this is compounded in the field where students do
not see it done correctly by practitioners. Paul explains, “I think they just don’t value it because
they hear people in the industry say, ‘Who cares, it doesn’t really matter…. Ultrasound is
useless,’ and yeah, the truth of it is the way you are doing it is useless, but if you do it properly it
is actually quite useful.” The hope for disruptive influence occurs when “what you are trying to
teach them that is more sophisticated than what you see in the field.” Through the process of the
Decoding interview, Paul began to expand on this notion:
We don’t want to create… we are not trying to educate technicians, we are trying to
educate critical thinkers… that is why we are in this problem with ultrasound, why so
many people do it wrong because we have educated technicians in the past and they just
followed a recipe…. I know I want to make a change in the way people practice… I want
them to make decisions.
This idea came forward in several of the interviews in different ways. Professional
programs rely on the practical knowledge of clinical or practicum placements in order for
students to have the opportunity for critical experiential learning. Yet, a tension is created when
the practice modelled in the field is not always ‘best practice’ as conceptualized by the program.
At the same time, practitioners can become frustrated if they feel university instructors are out of
touch with ‘the real world’ of practice. This tension lives itself out in the learning of the students,
who do not always know how to understand or work within this tension productively. Students
are seeking clear guidance and guidelines in what for them are potentially intimidating contexts,
where they are asked to perform skills they are only just beginning to develop, and integrate
theory and practice in a complex decision-making processes.

Program and curriculum design, curriculum, delivery, and structure
All of these insights fed directly into decision-making within the program and fueled further
discussion and inquiry. At the time of this writing, a second phase of the study is underway about
the impact of the new curricular approach on student learning. The AT team will be collecting
longitudinal data from students as they progress through the program.
There are a number of curricular delivery outcomes that have resulted from the Decoding
experience. The course sequencing and laddering of the curriculum was evident before the
experience, but has been significantly reinforced by the experience. For example, it was critical
to design the program in such a manner that practical experiences (formal tutorial and practicum
courses) are scheduled simultaneously in the same semester so students could see the theory and
practice links. Furthermore, it helped to design individual lessons whereby the theory was
complemented and reinforced by practical learning activities in either the lecture or the
accompanying tutorial. Again, bottlenecks in student learning are often thought of as merely
cognitive in nature, but they may also be motivational whereby students only see connections
and relevance of theory when there is a very specific practical outcome associated with them.
The team began to think about the notion of ‘experience’ versus that of ‘education,’ for example,
the difference between depending upon chance exposures in the field, versus thoughtful,
simulated, or intentional real-life exposure with application and debriefing, based on specific
learning objectives. The former is wishful thinking, the latter is mindful. Finally, it became clear
that there is a need for careful professional development for clinical instructors to increase
awareness of their own tacit knowledge, helping them to articulate the implicit as they work with
students.

References
Ainsworth, Shaaron, Vaughan Prain, and Russell Tytler. 2011. “Science Education. Drawing to
Learn in Science.” Science (New York, N.Y.) 333 (6046): 1096–97.
doi:10.1126/science.1204153.
Balemans, Monique C.M., Jan G.M. Kooloos, A. Rogier T. Donders, and Catharina E.E.M. Van
der Zee. 2015. “Actual Drawing of Histological Images Improves Knowledge Retention.”
Anatomical Sciences Education 00: n/a – n/a. doi:10.1002/ase.1545.
Boman, Jennifer, Genevieve Currie, Ron MacDonald, Janice Miller-Young, Michelle Yeo, and
Stephanie Zettel. 201X. "Overview of Decoding Across the Disciplines." In Using the Decoding
the Disciplines Framework for Learning Across Disciplines, New Directions for Teaching and
Learning, no. xx, edited by Janice Miller-Young and Jennifer Boman, pp-pp. San Francisco:
Jossey-Bass.
Currie, Genevieve. 201X. “Conscious Connections: Phenomenology and Decoding the
Disciplines.” In Using the Decoding the Disciplines Framework for Learning Across Disciplines,
New Directions for Teaching and Learning, no. xx, edited by Janice Miller-Young and Jennifer
Boman, pp-pp. San Francisco: Jossey-Bass.
Lafave, Mark, Khatija Westbrook, Dennis Valdez, Breda Eubank, Jenelle McAllister, Michelle
Yeo. (In press.) “Content Validation of Athletic Therapy Clinical Presentations in Canada.”
Athletic Training Education Journal.
McCrudden, Matthew T., Montana K. McCormick, and Erin M. McTigue. 2011. “Do the Spatial
Features of an Adjunct Display That Readers Complete While Reading Affect Their
Understanding of a Complex System?” International Journal of Science and Mathematics
Education 9: 163–85. doi:10.1007/s10763-010-9236-1.

MacDonald, Ron. 201X. “Intuitions, Instincts, and Intercultural Crossings: Decoding
Disciplinary Identities.” In Using the Decoding the Disciplines Framework for Learning Across
Disciplines, New Directions for Teaching and Learning, no. xx, edited by Janice Miller-Young
and Jennifer Boman, pp-pp. San Francisco: Jossey-Bass.
Middendorf, Joan, Jolants Mickute, Tara Saunders, Jose Najar, Andrew E. Clark-Huckstep,
David Pace, with Keith Eberly and Nicole McGrath. 2015. “What’s Feeling Got to Do with It?
Decoding Emotional Bottlenecks in the History Classroom.” Arts and Humanities in Higher
Education 14 (2): 166-180.
Middendorf, Joan and David Pace. 2004. “Decoding the Disciplines: A Model for Helping
Students Learn Disciplinary Ways of Thinking.” In Decoding the Disciplines: Helping Students
Learn Disciplinary Ways of Thinking, New Directions in Teaching and Learning, no. 98, edited
by David Pace and Joan Middendorf, 1-11. San Francisco: Jossey-Bass.
Miller-Young, Janice, and Jennifer Boman. 201X. "Uncovering Ways of Thinking, Practicing
and Being through Decoding across Disciplines." In Using the Decoding the Disciplines
Framework for Learning Across Disciplines, New Directions for Teaching and Learning, no. xx,
edited by Janice Miller-Young and Jennifer Boman, pp-pp. San Francisco: Jossey-Bass.
Rose, Miranda, and Dawn Best. 2005. Transforming practice through clinical education,
professional supervision, and mentoring. Elsevier Health Sciences.
Schmeck, Annett, Richard E. Mayer, Maria Opfermann, Vanessa Pfeiffer, and Detlev Leutner.
2014. “Drawing Pictures during Learning from Scientific Text: Testing the Generative Drawing
Effect and the Prognostic Drawing Effect.” Contemporary Educational Psychology 39(4): 275–
86. doi:10.1016/j.cedpsych.2014.07.003.

Van Meter, Peggy, and Joanna Garner. 2005. “The Promise and Practice of Learner-Generated
Drawing: Literature Review and Synthesis.” Educational Psychology Review 17(4): 285–325.
doi:10.1007/s10648-005-8136-3.
Yeo, Michelle. 201X. “Hermeneutics of Decoding.” In Using the Decoding the Disciplines
Framework for Learning Across Disciplines, New Directions for Teaching and Learning, no. xx,
edited by Janice Miller-Young and Jennifer Boman, pp-pp. San Francisco: Jossey-Bass.

MICHELLE YEO has been a faculty developer and faculty member in Mount Royal
University’s Academic Development Centre since 2007.

MARK R LAFAVE is a professor and Certified Athletic Therapist. He has been at Mount Royal
University since 1994.

KHATIJA WESTBROOK has been a faculty member in the Department of Health and Physical
Education at Mount Royal University since 2005.

JENELLE MCALLISTER has been a faculty member in the Mount Royal University Health and
Physical Education Department since 2006.

DENNIS VALDEZ is an Assistant Professor in the Department of Health and Physical
Education at Mount Royal University. As a Certified Athletic Therapist he serves as a field
practicum supervisor and practitioner.

BREDA EUBANK has been a faculty member at Mount Royal University's Health and Physical
Education Department since 2009.