When I began my #doctorate degree, one of my mentors, Kathryn Osborne, shared that as we start to work through our doctoral programs, we will start to recognize how we think differently than other people and that it can be a bit isolating. She shared that her brother also had quite a bit of education, in what field I can't remember now, but she relished the times they visited each other because they could talk for hours, and he was one of the few that she could really connect in that way.
In undergraduate, most students feel like they are drowning in information, but at the same time, not really learning a ton of anything specific. Nursing students are taught how to be safe, the cardinal rules of clinical practice. Graduate school is much more about honing in that craft, diving into a mass amount of information, still knowing you're just skimming the surface and the real learning will come in clinical practice. Doctoral work, at least in my day, was much more the aspirations of a nurse who had gained some experience, but missed the mark a few times, witnessed too many clients failed and was tired of seeing cracks in the system. This student was the one ready to dive head first into creating a solution for change.
That journey though is about going all in on that one area of practice. It isn't about proving oneself anymore. We've done that. It's about having a mentor guide you, with other experts in your particular niche, so you can thoroughly analyze an exhaustive database of literature on one particular aspect of clinical practice and know it so well, you can see it from all angles, even the angles in the dark, the ones you don't want to see because maybe they butt up against your bias. This awareness helps you hone in on the cracks, if you are brave enough to really acknowledge them. It's a feat you will commit your entire life to better understanding, to evolving, to teasing apart in curiosity and to finding new ways to help others understand the issue, hoping they can then surpass your own work - eternally adding to the body of science, advancing the nursing profession yet one more step.
What happens along the way though, is you start to notice the conversations of others and you break them down, rather than accepting them as truth. It isn't that they aren't valid; it's more that you are evolving your perspectives. You're looking around corners for other potentials. You're asking more questions. You're seeing more cracks in what you thought you knew and what most everyone else thinks they know, and quite frankly, doctoral studies manifest intrusive thoughts significant enough that the makers of Adderall can't even squelch the entrancement.
In my own doctoral work, I found a plethora of misunderstandings in the literature, particularly around definitions but also around results. I found researchers misleading readers. I also found readers, in mass volume, misinterpreting the literature for which significant societal change has resulted, and consequently, society now demands care practices that are grossly contrary to the evidence to their own detriment. I also found bias, manipulation, greed, and stubborn ignorance. Science has its limits, and doctoral work teaches us that while science is fascinating and powerful, it can't always be trusted and almost never do you have the entire story. Question everything you think you might know. Like any relationship, a consistent pattern must be well established before we can really lean in and trust we aren't likely to be fooled.
When your mind is groomed to critically analyze everything you know, then you can't help but do the same even when gathered with friends and the discussions start to dive a little deeper. Maybe someone becomes a bit more passionate, and find you are recognizing the limits of the conversation, the boundaries you must now walk. Too many lack the emotional regulation to really step into a conversation outside their own comfort zone. They don't embrace the joy in entertaining foreign ideas just so they can challenge their own, knowing after this conversation, they are more than capable of returning to their own position but now, with a little more enlightenment.
We also recognize in these more heated discussions that moral issues aren't determined by #science. Certainly it can help us learn about the contexts of any argument, and help us flesh out various aspects that play into these issues, informing our opinions and decisions, but moral issues are subjective. Individuals decide what is right, wrong, good, or bad, and on most topics, even the really impassioned, truth really is elusive. Science can't tell us what art is beautiful, what lyric is most expressive, or what storyline is most imaginative. It can't help us understand the supernatural, although theologians may disagree, as might philosophers, historians, and a number of other scholars, but not a lot is truly absolute. These issues though, while they live outside the limits of science, are still very important to the human experience. No matter the earnest of your friend's argument regarding the article he read on the john this morning, not everything is answerable within the context of science. The sharing, even challenging of ideas, becomes more the focus of discussion, as opposed to conquering a win through persuasion to your side of the argument.
Science also can't tell us what should be done with the scientific knowledge we do acquire. Just because we can, doesn't mean we should so-to-speak. So science isn't everything, but it is important. One of the biggest misconceptions about science is that it proves anything! We are a smidge misled by our high school science teachers in that we believe that if we use the simplified, linear scientific method we can prove or disprove our hypothesis, but in reality, science is unpredictable and it really doesn't conclude anything. In fact, claims of proof become so laughable into your doctoral studies that your ears perk up every time you hear someone say it (especially when they say they read a study that morning on the john that proved xyz).
Science relies on creative people who think outside the box. It is always revisable if warranted by the evidence, and it is these creative thinkers who ask the important questions, the really hard questions, causing us to dive back in to better understand. In fact, I use to teach Advanced Pathophysiology quite often at the graduate level, the weed-out class. It was a real challenge navigating them through the rigor of immunology. This area always caused a lot of whining and moaning among the students; they always feared that was the week that would take them out.
The next week we'd move on, but I'd sneak in a case study in which they had to consult with a family who had declined immunizations for their little ones. Interestingly, 100% of the students, through four-or-five years of teaching, all took a strong stance that immunizations were proven effective and not following the CDC recommendations, bordering on neglect. Some even felt so strongly they argued this fell under their mandatory reporting responsibilities. All it took was for me to say, "so last week you openly admitted you struggled with grasping essentially every aspect of immunology, but this week you are ready to report new parents to child protective services because you are so confident in your understanding? And we didn't even get into the literature on vaccines."
In fact, we aren't even allowed to ask about vaccines, neither parents or practitioners. The infamous pediatrician, Dr. Sears, was called as an expert witness in a case involving immunizations and he asked too many questions which resulted in his license being suspended. We aren't even allowed to sue vaccine manufacturers which is really how our capitalist society regulates itself, and when parents decline vaccinations for their children, blood boils and teeth grit in all corners of the pediatric clinic. Those though who have dug into the literature and criticized every angle of it, on any particular topic, know that true scientists raise questions and challenge even the most confident of scientific conclusions. They question government guidelines. And they also recognize an expert opinion for what it is: more often the position the most alpha expert in the room persuaded the rest of the room to agree, even if that means standing on their neck a bit.
True scientists stay curious. They lean way into their biases in effort not to create blind spots for themselves, or even the profession. One must ask then, if we aren't allowed to ask questions on any particular topic, or especially a specific topic, why might this be so? If we must divert from our moral principles as scientists to avoid reprimand, does this not smell of corruption? Do I know what I think I know?
Science must circle back on itself so ideas can be built upon one another. When we discover new knowledge, we ask what's beneath that and then we still go deeper. Those next steps may take us down a surprising journey, or it may simply validate what we already believed to be true, but to not explore the potential for either because we seek a specific outcome is unethical, biased, and #corrupt. Science is not proving anything. We are never done asking questions. You do not know as much as you think you know and if anything, this is the most profound teaching you attain in doctoral school. I put my life on hold for years to study a single problem and that one thing is the only real thing I can say that I can offer a real educated opinion. The rest is conjecture, maybe in some ways more educated than in others, but largely still conjecture. When you've done exhaustive research and share an opinion on anything else, you always know in the back of your mind, "but I haven't done enough research on it."
Overwhelmed? Good, then I've succeed in persuading you to self-evaluate what you thought you knew. Science is way more dynamic, flexible, unpredictable, and rich than most of us are taught, particularly through our earlier years of study. We aren't often taught how to think, as there is so much content our educators must lay down in our mind's bedrock first. Tinker. Brainstorm. Make new observations. Chat. Debate. Read. Explore. Test ideas. Step out of your comfort zone. Be willing to give up some of your favorite hypothesis, but don't assume for one minute that you think you know as much as you think you do because you read a single article on the john and it concluded xyz.
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