It’s that time of year when students are graduating, new third years are entering full time clinicals and all of us are reflecting on how quickly school has passed. Every incoming #DPTstudent is eager to learn from others’ hindsight. What do you wish you would have known when you started PT school? What could you have done to learn more efficiently, to save more money and to make better use of your three years? And what did you do right? Do you have any other advice to share with every first year and incoming #DPTstudent? Join in on Wednesday at 9 PM EST to share!
#DPTstudent You don’t need clinical experience…
You need deliberate practice. And, don’t be fooled you still need a lot of it.
The three most dangerous words in medicine are “In my experience.” –Mark Crislip, MD via Science Based Medicine
Especially when you are unaware of it’s caveats and limitations. Per Malcom Gladwell’s Outliers many advocate the 10,000 hour rule regarding the development of expertise. While this is a useful illustration of the sheer volume of practice necessary to develop mastery, it’s likely over simplistic for a concept as complex as expertise in a complicated craft.
The secret to continued improvement, it turns out, isn’t the amount of time invested but the quality of that time. It sounds simple and obvious enough, and yet so much of both our formal education and the informal ways in which we go about pursuing success in skill-based fields is built around the premise of sheer time investment. Instead, the factor Ericsson and other psychologists have identified as the main predictor of success is deliberate practice — persistent training to which you give your full concentration rather than just your time, often guided by a skilled expert, coach, or mentor. It’s a qualitative difference in how you pay attention, not a quantitative measure of clocking in the hours.
Clinical care, research, and critical thinking are no different. It is not experience, as linear measurement of time, but rather quality practice and volume that matters in developing high level skills. Left to its natural devices our brains and psyches are stubbornly prone to bias and errors in rational thinking. Confirmation bias and improper associations such as post hoc ergo propter hoc (since event Y followed event X, event Y must have been caused by event X) are common and often unrecognized. Thus, practice must be reflective and critical. Practice must be varied and evolve over time.
The skills required (mental, psychomotor, interpersonal, and otherwise) are staggering. It involves knowledge of current research, research methods, critical thinking, connection of concepts, connection of knowledge, problem solving, listening, examination, hands on techniques, clinical decision making, and patient interaction.
Evidence is more important than experience.
Evidence can not replace experience.
You can’t have evidence based practice without experience.
Experience is meaningless without evidence.
Experience vs. Evidence. I observe these views that appear to be from separate ends of a spectrum, that appear to be contradictory, but in reality are just different concepts. So, does experience matter? Yes, but…experience as conceptualized and measured in years is both insufficient and incomplete. The focus should not be the mere acquisition of experience; but instead on proper, focused practice with the appropriate processes required to develop the necessary skills for mastery. This is not to say volume is meaningless, even focused practice requires repetition and time for effectiveness. Quantity is ultimately meaningless without quality. Quality is meaningless if it can’t be repeated and refined .
Adam Rufa and Joe Brence of Forward Thinking PT examine the concept of “clinical experience.” Their post series, The Experience Wall, assesses perceptions, memories, and interpretation within clinical care. Joe Brence highlights how experience may not result in linear increases in clinical skill and outlines a new definition of clinical experience:
I propose clinical expertise is not simply gained through practice. It is built through assessment of your ability to think, reason and apply scientifically plausible principles into practice. It requires peer-review. It requires your thoughts and ideas to be challenged. It requires a hint of uncertainty.
New grads should be armed with the latest research, and often tout that they are more “evidence based.” Without “experience” they should rely mostly on didactic knowledge, research, and strong science based logic as they lack sufficient “experience” meaningful practice volume. But, clinicians with years and years of experience may claim that this research evidence alone is empty without time in clinic. So, who is right? Well, both of course.
Knowledge of research does not mean you can apply it. True
Having experience does not mean you are providing “evidenced based” interventions. True
Proper knowledge and experience do not ensure best care. True.
Paradoxes exist, and hacking may be helpful to a broader, more accurate assessment of the hows and whys of clinical care. Appropriate “evidence base” and proper “experience” are separate, but interacting components of developing into a high level clinician. Ideally, these are synergistic principles that contribute to each other, instead of mutually exclusive entities that are developed in isolation. Neither “experience” nor “evidence” ensures accurate research interpretation and application. Knowledge of current literature, appraisal of research, application of science, translating understanding into to practice, volume of clinical practice, and level of clinical ability (ranging from communication to therapeutic alliance to clinical decision making) are all differing skills. Of course, this is not an exhaustive list or conceptual framework. But, in essence, developing as a clinician, no matter our professional age, is more than simply evidence or experience.
Residencies and fellowships contain the potential to accelerate development when implemented effectively. The explicit curriculum, reflective practice, and mentorship can result in a more deliberate, critical, and self-reflective form of professional growth and clinical care. But, of course, residencies and fellowships do not guarantee proper mental skill acquisition or development, especially if founded on misguided assumptions or practice theories (but, this is a wholly separate topic); nor are they the only means to foster such growth. I have encountered plenty of physical therapists with bachelors degrees whose critical thinking, clinical decision making, and “evidence” base is quite staggering. And, conversely, I’ve interacted with many residency and fellowship trained physical therapists with doctor of physical therapy degrees whose reasoning and treatment skills were quite suspect. And yet, as Eric Robertson and Lauren Kealy discuss in their post series, The Bane of the New Professional remains significant. New grads are empowered and motivated to engage within the profession, yet some clinics appear to value experience. So, what gives?
Experience is bias.
Evidence is rigid.
Experience lacks rigor and control.
Evidence lacks experience applying to the individual.
There are great janitors and bad rocket scientists. Hacking your education, regardless of your experience, is necessary. These concepts of experience and evidence require critical reappraisal; a reframing that recognizes the necessity of a synergistic relationship. In regards to the myriad of skills encompassed in clinical care, an understanding to the non-linear progression of each. It’s much more than evidence vs experience, evidence or experience, or even evidence and experience. And, it takes practice.
Passing of the #DPTstudent Chat Torch
The #DPTstudent chat was created in November of 2012 and has been going strong every Wednesday at 9pm EST since then. The chat has been recognized by the APTA, clinic owners and students alike as a great tool for networking and learning outside of the classroom. Eric Robertson, one of my mentors and a huge enthusiast of the chat, told me once that he thought the chat was one of the most innovative things to happen to DPT students. I never expected it to be as successful as it has been, but I am humbled and excited about how big of an impact it has made. Personally, I can say that I have learned just as much through this chat and interacting with those on social media as I have inside the walls of the classroom.
Don’t worry- the life of the #DPTstudent chat is far from over! In fact, it will be revitalized and have a new energy to it as several new chat leaders take the reigns. As TJ and I move into our final year of PT school, our energy will be focused on our final clinical rotations and transitioning into the professional world. Before we introduce the new chat leaders, let us take a moment to reflect on how far the chat has come and how many students and professionals it has impacted.
According to Symplur.com, #DPTstudent has had…
30,765,113 impressions
31,213 tweets
2,343 participants <- holy cow!
and an average of 2 tweets per hour, every day, for the past 17 months.
TJ and I will still be active on the chat, but please welcome your new chat leaders!
Tyler Tracy @TylerTracy10
My name is Tyler Tracy and I’ll be starting the DPT program at Texas State University in May 2014. At 31, I am older than the traditional DPTstudent as I am completely changing careers. After completing my undergraduate degree in Criminal Justice, I spent about 5 years working as an investigator where I conducted investigations on behalf of the US government. My wife and I are expecting our first child in September 2014, I have the coolest dog alive, and I’m an absolute sports junkie! I have been exposed to the world of physical therapy through my wife and best friend who are both physical therapists in different settings (pedi and neuro respectively). I have also had the opportunity to see PT from a patient perspective a few times due to breaking 13 bones! I have already gained a wealth of knowledge through the #DPTstudent chats and I look forward to continued growth with Jocelyn, Laura and the other students / professionals who participate with us!
Jocelyn Wallace @Jocelyn_SPT
My name is Jocelyn Wallace and I’m starting the DPT program at Nova Southeastern University, Ft. Lauderdale, in May 2014. I graduated from the University of South Florida with a B.S. in Environmental Science and plans to be a lawyer. After two years working as a paralegal, I knew that path wasn’t for me but I did get experience working for PACs and the FL State Senate. I am excited to apply these experiences to advocate for the profession I believe in. I’ve spent the past year working at a #cashPT practice and have completely absorbed myself in the profession. I even started up the company’s social media plan and got on twitter myself to “practice what I preach”. That decision has already paid off tenfold as I have been given the opportunity to help lead the #DPTstudent chat, learn and connect with countless fellow students and professionals. I am beyond eager to see what the next 3 years on Twitter bring!
Laura Webb @lauralwebb
Hi! My name is Laura Webb and I am a 2nd-year physical therapy student at the University of Kansas Medical Center. I am president of my class, and am involved in the Kansas Physical Therapy Association Student Special Interest Group. In my spare time I like sailing, playing music, training for triathlons and teaching water aerobics. I consider myself a coffee connoisseur, and I love chickens. I’m looking forward to helping out with the #DPTstudent chats!
The transition to these amazing new moderators will be taking place soon, so be sure to follow them and welcome them!
Pheminism and Physical Therapy
Several weeks ago, women equality in the field of physical therapy became quite the hot topic on Twitter. We even hosted a #DPTstudent chat on the topic. The essence of several of the online conversations was that in a profession made up mostly women and started by women, there is a higher percentage of men who “make it to the top” / “own clinics” / “are CEOs and entrepreneurs”. Many of the conversations focused on the potential reasons on why this was happening in our profession. The next few paragraphs are my response, as woman in this profession, to those conversations.
First thing is first. The issue of women equality in the workforce is not unique to physical therapy. In fact, it is most all industries. In some fields it is worse than others. My husband works in IT Network Security and he has no female coworkers. Physical therapy comes in high on Forbe’s list of “Best Paying Jobs for Women in 2014” stating that women earn 89% what their male counterpart earns. Not perfect, but certainly not nearly as bad as real estate agents where women are said to earn only 60% of what a man would earn. Woman earning equal pay to male counterparts has been a long debated topic and there continues to be a push for women equality in many fields. Physical therapy still has some work to do to reach full equality, but I am happy to know we are at a better starting point than most other professions.
It is important to recognize that men and women are different. We should be seen as equals, for sure, but women and men tend to be very different creatures. We are wired differently and I’m not just talking about our anatomical parts. Well, I guess in some ways I am. If a couple wants to start a biological family, the woman is the one with the parts to bear the child. Many women volunteer to leave the workforce to raise a family and if she chooses to enter the workforce at a later time, she will earn less money due to her time away. Women have more decisions to make regarding their family and career balance than a man does. This can be mitigated by being with a partner who equally shares responsibility for house hold chores and child care.
I am passionate about women equality. I want to know that I would be offered the same exact salary as my male equivalent. I also recognize that men and women potentially have different needs, requirements and dreams. Maybe her dream is to raise a family. Maybe she wants to own a company. Maybe she wants all of that. That is okay and we as a profession and society have to recognize and be supportive of that. I’m not sure there is a hard and fast solution to women equality in any field but having conversations and raising awareness can only help the issue. So far, the only issue I have encountered from being a woman in this profession is the lack of stylish shoes that still have enough arch support to allow me to stand on my feet all day without pain. I know that the hardest part is yet to come but with recognition of this issue, mentors of both the female and male variety, and a husband who is willing to vacuum, I am set for success to overcome obstacles.
As mentioned before, I’m not sure there is a quick fix or even a planned solution for woman equality in the workforce but the first step is recognizing the issue and starting a conversation about it. Some women involved in the discussion have proposed that we continue this conversation. One such examlpe of this is the PropelHer initiative. Heidi Jannenga, who generated the idea thinks that PropelHer can provide a platform for on campus conversation between faculty and students as a way to explore this issue further. Keep your eyes out for the launch of PropelHer soon!
But in the meantime…perhaps we need to take the dancing approach to talk about women equality. (Super funny Jimmy Fallon clip!)
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRRIL 9, 2014: HOW THE INTERNET HAS AFFECTED HEALTHCARE
I’m sure we have all had an ache, pain or other ailment and immediately went to Web MD to diagnose ourselves. With how accessible information is on the internet, the majority of our patients will at least try and research potential diagnoses for their issues. How does this effect us as clinicians? How do we get patients to trust us if we don’t necessarily agree with what they read on the internet? We often talk about the positive affects of social media on healthcare, but what about the negative affects? Do you think the internet has made our roles as educators more difficult? Let’s talk about it Wednesday at 9pm EST!
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRIL 2, 2014: LEADERSHIP EDUCATION IN DPT PROGRAMS
After discussing women in leadership positions last week, this week we will be talking about formal leadership education within DPT programs. Does your program offer this? If not, do you think it should? Is leadership something that is able to be taught? Let’s talk about it!
#DPTSTUDENT LIVE CHAT TOPIC FOR WEDNESDAY, MARCH 26, 2014: WOMEN IN PT
Happy Women’s History month! To celebrate the accomplishments of women in PT as well as discuss the current issues and future of women in the profession, we will be joined by 3 fantastic women who are leaders in the PT profession. Ann Wendel (@pranapt) is a private practice owner of a cash based PT clinic in Alexandria, VA and is also involved in many side projects such as writing articles on health and fitness for various blogs and magazines. Heidi Jannenga (HeidiJannenga) is the co-founder of Web PT, the leading web-based electronic medical record system for PT. Sue Falsone (@suefalsone) is a business owner and was the first female team physical therapist to be hired in Major League Baseball history. She spent some time with the LA Dodgers.
So what do these women have in common professionally? They have all faced challenges as a woman leader. They have overcome obstacles. They are passionate about having true equality of women and men in our profession by helping upcoming women leaders know their potential. In their personal lives, these women are all very different. They have different hopes and dreams, family and marital situations, and strengths. Yet their passion of shedding light on how to develop women leaders is in sync.
The chat this Wednesday will focus on many of the themes discussed in Sheryl Sandberg’s book Lean In. Haven’t read it? No worries! Watch her 15 minute TED talk here and be prepared to be enlightened and empowered. The conversation will be open, honest, and at points, potentially challenging. This chat is not just for our fellow females but also for the men so that we as a whole profession can be elevated. As Sandberg points out in her book: In the future, there will be no female leaders. There will just be leaders.
See you Wednesday at 9pm EST! The live chat link will be posted on Twitter and Facebook a few minutes before go time.
I will leave you with a few of my favorite quotes from Lean In that truly resonated with me…
“The more women help one another, the more we help ourselves. Acting like a coalition truly does produce results. Any coalition of support must also include men, many of whom care about gender inequality as much as women do”
“Success and likeability are positively correlated for men and negatively for women. When a man is successful, he is liked by both men and women. When a woman is successful, people of both genders like her less.”
“There’s a special place in hell for women who don’t help other women.”
“There is no perfect fit when you’re looking for the next big thing to do. You have to take opportunities and make an opportunity fit for you, rather than the other way around. The ability to learn is the most important quality a leader can have.”
#DPTSTUDENT LIVE CHAT TOPIC FOR WEDNESDAY, MARCH 19 2014: THE PT-PAC!
“The vision of PT-PAC is to become the #1 health professions PAC providing the resources to create a network of Congressional champions on physical therapy issues.”
The APTA’s political action committee (PAC) is the sole fundraising organization that provides access to and influence of legislators to champion PT legislative interests at the federal level!
The PT-PAC is the direct voice for physical therapists and their patients to the governing bodies on capitol hill and they work hard to ensure that the rights and needs of both our profession, and more importantly, our patients are upheld and continuously brought to attention.
The PT-PAC is funded by contributions of APTA members that understand the importance of a strong voice and presence among our law makers. Those who donate annually make an investment into the future of their profession! When we look at the current political climate and the struggles faced by physical therapists today (Medicare Therapy Cap, SGR, Loan Repayment etc.), we can’t help but wonder how would the story be different if EVERYONE played a role in contributing to the PAC and advocating for the profession.
This weeks #DPTstudent LIVE chat we will be joined by @PTPAC representatives Michael Matlack and Lindsay Still, who will give us a better understanding of how the PAC operates and why member initiative is crucial to the future of physical therapy!
To learn more about the PT-PAC Click Here!
Post written by TJ Janicky (@TJ_Janicky)
#DPTSTUDENT LIVE CHAT TOPIC FOR WEDNESDAY, MARCH 5 2014: STUDENT LEAD ADVOCACY COMMITTEE!
Are you a DPT student who is looking to get more involved but just doesn’t know how? Do you want to find out what’s going on in the PT world beyond the classroom? Do you want to play a role in determining the future of your profession?
Advocacy is the answer.
Join us on Wednesday, March 5 for the #DPTstudent chat as we talk #PTAdvocacy with TJ, Brooke, Eric, Eric, Trent, and Ryan. Discussion topics will center on involvement opportunities for students, access to advocacy materials, and the upcoming APTA Federal Advocacy Forum in Washington, DC on April 6-8.
Merriam Webster defines advocacy as follows:
ad·vo·ca·cy: noun : the act or process of supporting a cause or proposal : the act or process of advocating something
Notice the definition above says NOTHING about politics or legislation; Advocacy involves much more than just Capitol Hill!
The student-lead Professional Advocacy Project Committee has taken on the challenge of informing students and professionals alike about opportunities to be advocates for the profession. The expansive topic of advocacy has been divided into three goals by the committee:
1 – Create an informative handout with involvement resources that will be distributed annually to first year students
2 – Promote current opportunities for advocacy to students
3 – Develop educational materials to reach other healthcare professionals and the public
Join us on Wed March 5th at 9pm EST to talk about it!
Post written by Ryan Buus and Eric Uveges
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, FEBRUARY 26, 2014: PT 4 PT – AN ADVOCACY COMPANY
During this week’s #DPTstudent chat we will be joined by Chris Mulvey who is one of the co-founders of a company called PT 4 PT. Currently, they are selling packs of electrodes for $1.97 per pack and of that money, 50 cents is donated in your name to the cause of your choice. They are calling this effort the “Our pack for your PAC”. During my conversation with Chris, who I had the pleasure of meeting at CSM, he was telling me all about the how, the why, the what and the future of PT 4 PT. Check out their website for more information and certainly tune in this Wednesday at 9PM EST as we chat with Chris, via Google Hangout about his company. You can also follow PT 4 PT on twitter @PT4PTorg.
Next week’s chat will also focus on advocacy. Stay tuned!