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  • Writer's pictureBethany Huebner

When the End is your Beginning

“Begin with the end in mind.”

-Stephen Covey

Imagine this. You walk into a classroom on the first day of class and you see a pile of wrapped presents sitting in the front of the classroom. What is your first reaction? What is your first thought? Mine would be, “Hmmm…wonder what is in the presents?” “What are we going to do with them?” “Who are they for?” My curious mind would go on and on with questions until the teacher explained what they were for.

At the start of this Spring semester, I was inspired to try and spark curiosity into the minds of our first-year physical therapy students and try something different. I wanted our first day of class to be different than any first day of class our students had ever experienced. What you expect as a student is to come into the first day of class and review the syllabus, assignments, and schedule then either begin a quick lecture or cut out early. You don’t expect involvement or engagement right away…you expect passive listening and passive learning.

In his book, The 7 Habits of Highly Effective People, Stephen Covey, asks his readers to “Begin with end in mind” in Habit #2. I’ve read this book (a few times actually…I need repetition to actually get things to sink in) and never really converted this habit into action. It isn’t natural for me to be an end game thinker. I have often struggled with inside the box thinking and being very linear with the process of accomplishing a task. Give me a course to teach and I would take the current syllabus and create the steps to accomplish the objectives already listed with excellence. Give me a new course to teach without any objectives or ask me to re-envision a course…I often begin paralyzed. I can take the old and polish out the dust and dirt because I have been trained, but imagining the new product and then reverse engineering it to the beginning has my stomach in knots. I can’t always see the end. I like the safe bet. I have an aversion to risk. I don’t like to be uncomfortable, to lose, to disappoint or let someone down, to be the reason for someone else’s mistake. Visualizing a successful end with all the barriers I create in my head is exhausting.

But that’s just it…the purpose of the habit is to not allow those circumstances to shape you or your outcome…the purpose of the habit is to allow you to shape the circumstances in order to achieve your desired outcome. By beginning with the end in mind, your eyes can focus on the destination throughout all the course adjustments you may have to make along the way. The shortest distance between two places may be a straight line, but getting somewhere fast isn’t always what gets us to the end. I’ve tried to challenge myself this semester with every course assignment, project, and lecture with the idea of, ‘What is the end game here?’ ‘What should my audience be able to do or know after they complete this task?’

When envisioning the first day of class this year, I decided to give ‘beginning with the end in mind’ a try. The end was this: Our students should be able to systematically work through an orthopedic patient’s case for any body region synthesizing all the important subjective and objective information of a patient’s presentation, create a differential diagnosis list and then come to a primary diagnosis, identify a list of problems that are contributing to the patient’s diagnosis, match purposeful and meaningful interventions to the problems list by developing a comprehensive plan of care, implement that plan of care, and decipher proper discharge criteria and planning for that patient. The beginning was this: a first year DPT student who was entering into the course without any examination, evaluation, intervention, or discharge planning knowledge…a blank slate. We had a lot of ground to cover over the semester and I wanted the students to know how big the goal we had set for them was. So, we began with the end in mind.

On the first day of class we played what I called the Nesting Present Case. The students were randomly assigned into groups and given their first present. Inside each present was 4 more presents and they found various tasks in each present that their team had to participate in. I asked them to do things they hadn’t yet been trained to do, for example, answering questions like, “What are the most important/critical/mandatory evaluation components that are standard for any body region examination?” or after reading a case vignette I asked them to come up with a list of diagnoses the patient could have and then narrow it down to the one they thought it was. As the presents went on, I asked them to develop an intervention list to treat the diagnosis they decided it was and also what the discharge criteria should be for that type of patient. The beauty of the whole experiment was twofold: 1. The students actually wrote things on their boards. They didn’t shy away from trying to come up with something and they utilized the knowledge they did have to come up with their best guess. 2. They saw their knowledge gap and realized the importance of what this course was going to teach them. They envisioned the end game through their professor’s lens and were left excited about what is to come.

Implementing this activity made me feel really uncomfortable, but just like the lobster it was a moment of growth for me. It was the moment when I actually internalized beginning with the end in mind and have decided to adopt this mantra with all that I do. Stephen Covey is right, it is a habit to embrace.

Do you begin with the end in mind when you develop new things? How does it look for you? Do you struggle like me with seeing all the barriers first instead of seeing the end?

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Bethany Huebner
Bethany Huebner
Apr 29, 2019

Jim, We do have a handful of students who have completed their Athletic Training Degree and they do demonstrate a better baseline of knowledge than our other majors when it comes to this exercise. However, the leading questions do force them into thinking from a rehabilitation aspect and not so acutely which they struggle more in identifying all the necessary tests and measures that PTs do and how they impact their intervention choices.


Jim Miller
Jim Miller
Apr 29, 2019

Just curious. If you have students who have completed their athletic training degree and are just starting their DPT program, are they better or worse at this type of exercise?

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