Clinical practice is Research (and Research is Practice)

Research is the March theme on ~Move It~

Once upon a time, a time long, long ago, when I was only contemplating sitting for my NCS and not counting down the days until I would take the most expensive and difficult test of my life, I registered for a preconference course at the Combined Sections Meeting. The course was entitled "Laying the Foundation for Expert Practice in Neurological PT". A prominent theme of this course was differentiating between "intuitive" and "systematic" processing. We were taught that experts were able to synthesize information intuitively without investing cognitive resources in differentiating between plausible and implausible hypotheses. This ability was thought to improve efficiency and allow an expert to focus on an individual's complaints.

I'll be honest. I found this distinction frustrating in its over simplicity. Experts will inevitably be more efficient in processing information gathered from their patients. (If they weren't, we'd have a problem.) But in the world of Physical Therapy, everything is data collection, every touch, every question. Saying that something is intuitive makes light of the empirical process going on beneath the surface. New grads think in terms of T-tests, whereas experts conduct ANOVA.

So granted, there is a difference in the way information is processed.  But whether it's an expert clinician performing an evaluation or an NP assessing gait, hypothesis testing is the bread and butter of physical therapy.  Anything that obscures this fact contributes to the unfortunate divide between research and practice in our field.

Researchers assess whether or not a particular practice works.  They are "practicing" to see if it works.  Clinicians test hypotheses with every modification to a treatment plan.  Why, then, is there such an inexplicable divide between clinicians and researchers?  My hypothesis: the methodological family tree split too long ago.  The clinical language is different because there hasn't been an IRB looming in the background.  Standardization wasn't required.  But in the context of the emerging health care paradigm, in which comparative effectiveness and clinician scorecards will evolve, a common bench/bedside language will be indispensable.  Our branches must re-form a central trunk.

Where do you see the Clinic and Lab colliding?  And for the future, if we don't strengthen those connections, how will we survive?

   Cheers,
                 Ben

Becoming Component Secretary as a New Professional

Since my first Physical Therapy interview at New York University, being an active member in the American Physical Therapy Association has been an interest of mine.  During the interview is when I first meet Dr. Marilyn Moffat. I was fortunate to have her as a source of knowledge and guidance during my graduate school experience and my continued develop as a new professional. As a student, I regularly attended district and Chapter meetings increasing my interest in the governance process. While I was a student, I was selected to be a student Delegate at New York’s Delegate Assembly which is a smaller version of the APTA House of Delegates (HOD).  This allowed me to attain firsthand experience on how our Chapter makes decisions on important issues.

Our New York Chapter has made it easier for students to get involved at the district and Chapter levels. We recently started a new pilot program called the “Student Interns,” which allows one student from each PT school to attend a Chapter BOD meeting where they are paired with a district director to help mentor them.

My active involvement as a student served to increase my involvement as a New Professional (NP). After graduation, I was asked by my district to attend their Executive committee board meetings, where I got to see more of the deliberating processes. After a year, a vacancy in the position of Vice Chair at the Greater New York District of the NYPTA became available and I was elected to position of Vice Chair of our district. During the same time I submitted my name to our Leadership Committee where I got named to that committee. That same year I also was elected as a NY delegate to the HOD where I got to meet a lot of our influential Chapter delegates and gained more valuable experience.

Last summer our NY Chapter Secretary got elected as Vice President which left a vacancy at that position. Shortly after, I got a call from the NY Chapter President and he was acquiring about my interest in serving on the Executive Committee. With excitement I spoke to a few members of my District to get their insight about me serving as our Secretary. One member whom I valued their opinion informed me I was too young and did not have enough experience to do a good job at the Secretary position. They explained the normal progression was to serve as a district delegate or as a Committee Chair first to get a better understanding of the Board and its structure then persuade an Executive Committee (EC) position. 

After a few lengthy discussions with the President and stating my concerns he ensured me I would do a great job and I was only filling the position for one year. With some hesitation and nervousness I accepted the position not fully understanding what it would entail considering I have never been to a BOD meeting let along serving on the Executive Committee. One of the reasons the president wanted me to become part of the EC was what I could bring to Chapter. Our current President wanted our Chapter to take a new direction and one way to reach this was to get younger members with a fresh perspective. One thing as a NP I can bring to the Chapter is a younger thought and new approach to help bring positive change to our Chapter. Our EC is open to everyone’s’ opinions which allows for discussion because at the end of the day we all want what is best for the Chapter.

Fortunately for me I knew that past Secretary and she continues to mentor me along with the other EC members. This past year has been a little nerve racking yet continues to thrill me as time progress and I gain enough confidence and knowledge. So much so I am running for reelection for the position of Secretary this upcoming April.

Looking back on this past year, I have been very fortunate to have accomplished so much professionally already and hope I can continue to mentor other NPs. I think being involved with a big Chapter like NY offers many advantages because of our size as well as the many opportunities for leadership and involvement. My advice to other NPs would be try to get involved at much as they can commit to; first starting at the district level, then at the Chapter level, and finally at the National level. I was fortunately to bypass the normal progression and go straight to the EC. I am only thankful for the opportunities I have been given so far. As NPs we are the future of the profession and it’s up to us to make the difference.

   Jeremy Crow, DPT, SCS, NYPTA Secretary, NY Delegate to APTA House of Delegates

4,000 to 1

A little over a week ago I had the chance to speak to a group of PT and PTA students in New Orleans. The Student Assembly leaders held a caucus to give their members a better understanding of involvement, governance, and engagement within APTA. During my talk I brought up the fact that there are about 4,000 Americans for every APTA member. I wanted to make the point that our profession's mission, enhancing societal health and function, requires their generation to be impassioned, involved, and willing to acquire new skill sets.

I single out the up and coming generation for a number of specific reasons. Needless to say, no PT or PTA, regardless of talent as a clinician, is prepared to directly influence thousands of consumers. And yet, that is our goal, an excellent and appropriate goal given our skills and ambition in the emerging health paradigm!

So strategically, how can physical therapy move to meet this challenge head on? Looking back to the ratio, we certainly can't expect the number of Americans to decline (nor would we want it to). However, influencing the right side of the ratio, APTA membership, presents an opportunity to shift things in the profession's favor. Clearly, I'm a big proponent for APTA involvement but it's not out of blind zeal. Upon leaving the bubble of academia, it is essential that PTs and PTAs maintain some line of communication with the professional world. Otherwise, as we do not sit for re-licensure, it's easy to become removed from all but the most local issues. If today's students don't feel a visceral connection between our mission and staying involved, complacency, disinterest, apathy, and a shrinking vision are on the horizon. But with a proper foundation and greater investment in leadership development pathways, this risk can be minimized.

Getting back to our societal goals, soon-to-be clinicians and those with several more decades to practice can and should cultivate some special talents. Community outreach must become a focus! Many of us are comfortable with social media and technology. This is a great place to jump off. How can we hook up groups of clinicians with teams of people seeking improved health? (This speaks to Carpe Sanitas and the "Team Wellness" concept that I should probably devote a whole blog to at some point.) And by extension, how do we pick out the smallest, most effective group of clinicians to assist a given team demographic? Who else will be in the group? Exercise Physiologists? ATCs? Dietitians? Nurses? Chiropractors?

PTs can create a program but for it be consumer-centered we must continue to earn our seat at the table. That will mean disrupting our standard practices, collaborating in new ways, and trying new things. If we don't disrupt ourselves, someone else surely will. (For a great read on this theme try The Innovator's Prescription.) What are your ideas for shaking up the status quo or for getting the benefits of PT to a big audience? I would love to hear them.


Cheers,
Ben

A generation with challenges, vision, and Debt

{This post also appears on the Evidence in Motion Blog. If you don't already know about these guys, check them out!}

We are inundated with speculation about what Health Care Reform (HCR) may bring.  Though the outcome remains uncertain, having practiced less than five years, the long term consequences of HCR will have a profound impact on my career.  Our profession will undoubtedly change as health care evolves.  In order to be prepared for what things may come, each new generation of PTs and PTAs must be more conscientious and more prepared to take action than the last.  As stated in EIM’s mission, we must elevate the profession if we want to meet new challenges.  This leads me to reflect on my own generation’s readiness to step up to the plate.  Are there unique qualities that work for or against our preparedness? 

It’s reasonable to say that I was part of the first big wave of DPT graduates.  When I started looking at PT programs in 2002, it was far enough after the Balanced Budget Act to be optimistic and close enough after the adoption of Vision 2020 to have big dreams.  Physical Therapy was and remains a hot career.  I do remember hearing that reimbursement was better before 1998 but I never experienced that reality.  I only knew that things were changing and, like many of my peers, I wanted to have a front row seat for the new paradigm. 

For me, that meant pursuing the only doctoral degree then available in my state.  I set my sights on Emory University and have never regretted the course that landed me there for three years.  What has given me pause, however, is the wide variability in financial burden I learned about amongst my peers.  Leon Johnson Jr., the excellent and frequent speaker on student finances for APTA, once mentioned that, given our starting salaries, PT students should avoid accumulating debt greater than $40,000.  This was not welcomed news.        

Flash forward, my peers and I live with student loan debt ranging from minimal to six-figures and payment for our services is hardly in a golden age.  More payment changes are on the horizon.  Surely this impacts our preparedness to be involved in professional endeavors.  Are we too busy focusing on repayment to see the importance of advocacy?  Is there apathy?  Or are we more prepared but less inclined to take action?  Each of these is likely in play within the ever growing new PT workforce. 

Debt may constrain us, but certain things work in our favor as well.  Most importantly, we came into a profession with vision.  The adoption of Vision 2020 was an incredibly important step in our evolution.  For my generation, it framed our academic pursuits and our relationships with consumers.  So even as average debt burden went up, professional aspirations did too.  Combined with our technological savvy, we seek to address professional challenges in new ways.  Move It, HoboHealth, NewProfessionalPT, and PTHaven are just a few examples of young PTs and PTAs using technology to bring together our peers.  The next step is to successfully integrate these networks and harness them for professional advocacy.

Our profession needs a place for new members to go to discuss experiences and opportunities.  Investing in these emerging social networks has the potential to significantly influence the next decade of PT and PTA graduates.  As Health Care Reform begins to roll out, this is the first great challenge for my generation.  How can we expand social networks like Move It while benefiting from established, progressive voices like EIM?  What ideas do EIM readers have to share with New Professionals and how can we best collaborate?

   Cheers,

                  Ben

Professional Involvement is this month’s theme on Move It.  Please check us out on the blog and follow us via twitter.    

 

Professional Leadership, my friendly wake-up call from the APTA

I recently had the opportunity to attend a leadership development program run by the APTA staff at my Chapter office. At first I thought . . . ugh, I have better things to do on a Saturday morning . . . but it turned out to be one of those events that gave me a wake up call to improve something that wasn't even on my radar. It was a great reminder of the work it takes to be a leader, as well as the work it takes to be led. At the time of my last APTA leadership event, I defined myself as a "green/gold" leader and communicator, and I still thought of myself this way. Does anyone else define themselves as a color (or two)?

For people not familiar with the color code, a very rough description is as follows: (1) Orange: Action-oriented, fast-acting, and flexible; (2) Blue: Expressive, group-oriented, encouraging; (3) Green: Visionary, analytical, high expectations; (4) Gold: Thorough, organized, structured

As time has progressed, so has the leadership message from the APTA. The speaker had 2 messages that hit home that I thought would be good to share/discuss with this group of other young leaders.

First, the speaker presented the results of retrospective qualitative analysis of strong leaders. She described a book (forgive me because I can’t remember the name) that summarized the qualities shared by prominent, successful leaders. They boiled down to: (1) Challenge the Process; (2) Inspire a Shared Vision; (3) Enable Others to Act; (4) Model the Way; (5) Encourage the Heart.

We rated ourselves on these 5 characteristics, but didn’t just pick 1 or 2. This new rating method helped me to see my leadership communication style along a multidimensional spectrum, instead of an absolute. Maybe “encouraging the heart” is still not my strongest area (I think this would fall on the blue spectrum), but it is not absent from my leadership repertoire. Thinking about leadership in this more dynamic way helped me to think about how to progress my leadership skills and to think about what avenues of involvement fit my strengths.

The second new message was about how to utilize volunteers. This topic is important in recruitment of new active members, as well as making sure that current volunteers (including myself) don’t become burned out. The speaker pointed out that each of our volunteers will have different skills, leadership abilities, and interests. Sometimes we assign volunteer tasks to others (or ourselves) based on the one characteristic we know. For example, one could assume that a private practice manager/owner may be a great treasurer. However, maybe that volunteer would be happier with a position that allowed them to take a break from business-oriented tasks. Avoiding our own burn-out, and the burn out of our volunteers will lead to a much more productive professional community.

These 2 new messages gave me a better perspective on my own active involvement and how to grow. Does anyone else have any tidbits of wisdom from your own leadership experiences, a book you read, or different leadership development event?

Miriam

Residency Pros and Woes for the Soon to be New Grad…

I have to admit that when Ben asked me to participate in posting on the Move It blog website, I was flattered and a little (ok a lot) intimidated. I spent a lot of time reading other posts, found them fascinating and then thought… “What in the world am I going to say before I’ve even entered the :Real World:?” (I am a 3^rd year PT student preparing to graduate in May.) But, alas, true to my extroverted personality, I realized I have a LOT to say, and even more to ask. I am honored to be in the presence of these amazing new professionals, and it gives me a lot of encouragement and inspiration as I embark on my journey into the professional world coming up here in May. It is exciting to see all of the opportunities available to me as a new graduate, between residency programs, research fellowships, and multitude of settings and specialties.

Again, however, that intimidating feeling returns. I have had many discussions with classmates of mine about our near (much nearer than we believe) future in this profession. We have spent 3 years of blood, sweat, and tears (well at least some tears for sure) pouring our brains and hearts into this profession we feel passionately about. Now our caffeine riddled, sleep deprived bodies face the reality: How do we put all of this information we’ve learned to its best use for our professional lives?Many students, including myself, are concerned with being “stuck” in an area of PT once they start out in it. What if we (Gasp!) don’t know if that’s definitely the track we want to be on for our entire professional career? While the opportunity for specializing in areas (NCS, OCS, WCS, etc) offer amazing enhancements to the profession, it also adds some pressure to decision making process. Should I specialize right away? If I do, what if I want to change career paths? If I don’t, am I not advancing my career the way I should? Many of the same questions arise regarding residency programs. Several friends of mine are pursuing residencies because of the unique and beneficial opportunities they present.

I myself am/was considering doing a Neurology residency. It would provide me with a wide knowledge base in advanced skills that would not have had the opportunity to master in PT school. I would be exposed to a variety of patients with many different neurologic diagnoses, and it is also attractive to think of being able to sit for my NCS after one year and seemingly “fast track” my career. However, some more practical notions come into my considerations that make me hesitant. This particular residency I am considering, for example, does not start until January. I graduate in May. Though I would be perfectly fine (and happy) to wait until July to begin working, I cannot wait until January secondary to financial pressures (student loans anyone?) and the desire to put my degree into practice! It has been offered as a suggestion to work prn somewhere, but I fear my own personal anxiety of not having a very stable work schedule/ income would make that 6 months quite tumultuous. In an ideal world, I would love to find a place where I could work full time, gain neuro experience, practice my skills, do the residency, and come back to my position. (I know, I’m a dreamer J ). Then there is the question of value for the profession. Residencies are fairly new to Physical Therapy, and have already been met with skepticism, not just from students, but from seasoned therapists. I have listened in on, and endured many “What’s the point?” conversations and have not myself had a very good answer to provide. Any thoughts and feedback (HELP!) would be very much appreciated for this soon to be new graduate DPT.

Pushing Practice

I've always been a little indecisive. When I was a kid and someone would ask me what my favorite color was I would say "All of them. No, wait, purple. No, shiny metallic blue. No, no purple with shiny sparkles! Final answer." Well, I guess I haven't changed much in the past 26 years, because it has dawned on me that this is the exact quality that is beginning to shape me as a physical therapist. And, I'm realizing that isn't such a bad thing. Throughout school I loved EVERY topic we covered... even the practice areas I never thought I'd be interested in. I always had trouble choosing sections to be a member of, courses to attend at conferences, and don't even get me started on considering a residency after graduation!

As we went through school, I kept thinking that I'd figure it out before graduation. Well, it didn't happen. So, I decided to create my own little unique experience for my first year of work (now that I think about it, its kinda funny that I was an interdisciplinary major in undergrad... ha ha... I never quite realized how in line that was with my personality!) Anyways, for my first year of work I worked 4 days a week in an outpatient orthopedic private practice, where I was given the opportunity to take my interests and run with them. Little did my boss know what he was getting himself into! The calm quiet orthopedic clinic in a very affluent Atlanta suburb was suddenly filled with dizzy people, kids scooting around on the scooter board that had only ever been used for the occasional balance exercise, Spanish being spoken across the gym, and the occasional screaming baby who just wasn't in the mood for therapy that day (in the newly converted baby treatment room in the back of the clinic.) Outside of my 4 days a week at the outpatient clinic, I worked PRN 1 day a week (theoretically just one day...) at a pediatric acute care hospital, where I got to cover ever floor from ortho to neuro to trauma to oncology to cardiac and even some wound care. I managed to weasel my way into just about every practice area I was interested in.

It was the hardest thing in the world for me when I decided to uproot my life and jobs that I loved to take a new opportunity recently that just kept clawing its way into my thoughts until I gave in. So, I put all of my stuff in storage, said a teary "see ya in a year!" to my wonderful friends in Atlanta, and headed out to Vegas to live the life of a showgirl!!! Well, sort of. I took a job as a physical therapist on a traveling Broadway show.... And we are currently in Vegas for a few months. I work nights, eat in the casino underground dining hall for employees every night, have crazy roommates (a pirate in the treasure island show, an acrobat in cirque du soliel, and a go go dancer!), and still don't believe that this is all actually happening. I've had alot of time to think out here... mostly cause I spend alot of time lying around resting my sore hands!!!! So, I've been reflecting on all the great experiences I've had already in my almost two years of practicing. I've started to realize that I may never fit clearly into a section or a clinical specialty or even any specific job that is out there.... and this has now started to create an idea in my head that keeps clawing its way into my thoughts! And we know how that goes! I know its a little ways off, but I now have this concept growing in my head of what I may want my own clinic to be someday. Somewhere that combines physical therapy, wellness, community, laughter, and life; a clinic I can make my own and push the normal practice patterns that are divided up for us in school.

I'd love to hear if any of you have ideas for pushing practice patterns, as well!!! I'm fascinated with this at the moment. Anyways, to conclude, I'm quite happy to say that once I set myself free of worrying about boundaries and of needing to decide in which area I belong, I am finding myself very much at peace with my identity as a physical therapist. And, also, quite happy that purple with shiny sparkles is still my favorite color. =)