Doctor is Just a Title: How to really experience your #DPTstudent education

The collective here at PTTT appreciate the insights, contributions, and struggles of the #DPTstudent. And thus, we present a new guest post by a current 3rd year #DPTstudent @GabeStreisfeld. Gabe is an eager, motivated student who connected with both Kyle and Eric at #APTAcsm. His insights are both thoughtful and valuable. We also owe him for attending our talks. So, enjoy the read…

Don’t worry, I am not about to argue why or why not the doctor of physical therapy is important, or whether or not we should market it. You can find that argument plenty of other places on the internet. Instead, I’d like to discuss the DPT education process from my perspective as a 3rd year doctor physical therapy student, and why I believe some students miss out on a huge aspect of it.

First let’s pave the way with google’s top answer to “definition of education”:

1) The process of receiving or giving systematic instruction, especially at school or university
2) an enlightening experience

Furthermore, when googling “definition of formal education”:

Formal education is classroom-based, provided by trained teachers. Informal education happens outside the classroom, in after-school programs, community-based organizations, museums, libraries, or at home.

I would argue that formal education is closely related to Google’s first definition. It is the hours spent in class. It is the hours spent memorizing the origin, insertion, and innervation of every muscle of the body. It’s the practicals, competencies, OSCEs (objective structured clinical examinations), and paper tests. The logistics that pave the path between students and those 3 powerful letters: DPT. Formal education can absolutely harbor definition two; enlightening experiences. Although, I sense the busywork and exam-related stress can sometimes interfere with the more contemplative, reflective, and self-directed experiences that many would consider enlightening. Formal education is only one side of the coin, and although I cannot dispute its importance, my observation is most students focus too heavily on the formal only to neglect the potential power of the informal.

Informal education is where definition two takes the forefront. It is seeking those enlightening experiences outside of class. Getting involved with PT organizations at the school, community, and national level; pro bono and volunteer experiences; the conferences; lively social media debates, and self-driven PubMed searches. It is even the critical blogs and podcasts that continuously question and reframe. Informal education is not merely the knowledge gained, but the actual process of seeking that information. It is a unique, learned skill. Informal education allows the student to add her personal interests, inquiries, and discoveries to the DPT. It is where the student can evolve herself , nearly without restraint, to a higher level of critical thinking. You know the saying “it’s not the destination, it’s the journey.” However, why is some of the knowledge, skill, and insight gained outside the classroom unable, or unlikely, to occur in the formal education environment?

Obviously, informal education differs from formal education. There is no set end product. No exams for which to study, or degree to be obtained. This allows the student to focus on the process, present experience, and self paced exploration which can ultimately lead to that sense of enlightenment and profound self- discovery. I have observed formal education struggle to extract such concepts, because the end products of grades, degrees, and expectations often cloud the student’s view of the present experience. And, the narrow focus can also hinder a sense of the bigger picture.

However, investing in informal education pays dividends. It provides motivating power, allows intrinsic self-guidance, and hopefully facilitates the evaluation skills necessary to add perspective to a seemingly endless list of assignments and tests. This facilitates the ability to fully appreciate the intended processes and outcomes of formal education. It is imperative that students and professors alike recognize this connectedness between the informal and formal, because if nurtured properly, it will contribute to the experience and meaning of achieving a doctor of physical therapy degree.

The opportunities that lie within the realm of informal education are equally as important to the DPT program as the concrete curriculum. The doctorate is 3 years of classes, assignments, and exams; but it is also 3 years of potential time. Time to explore the profession we will all be entering; to view the profession, beautiful and ugly, from the inside before actually practicing. Time to map out and dip our feet into the numerous career pathways before embarking on our own professional journeys. 3 full YEARS of time to hone not only our professional skill set and knowledge base, but lay the foundation upon which we build our future careers.

Personally, I feel that informal education has contributed significantly to my personal and professional development during the pursuit of my DPT. It is where my professionalism thrives, and my critical thinking is tested and molded; where my thought processes and assumptions have been challenged. Informal education has only one rule: that you are motivated enough to direct yourself toward improvement. None of your professors can fully guide you in this experience, although they may attempt to initiate a spark through various structured experiences like reflection assignments, discussion boards, research assignments, and compiled portfolios. But, these are still well within the construct of the formalized education process. Potential barriers to informal education include time, resources, and support.

However, the vastness of this informal domain allows for a variety of successful approaches; you just have to be willing to explore the possibilities. It does not need to happen every day, or even every month. It requires no schedule. As long as you remain pro-active, inquisitive, and open minded, informal education will find its way to you, even if you don’t recognize it. This self-directed discovery, the auto-didacticism, prepares us to remain ever a student even after formal education has commenced. This is where I truly believe the title doctorate gains substance, otherwise what is it besides grades on a transcript?

Due to the self-directed nature of informal education, I cannot tell you where to explore. I personally find my informal education at national and state level conferences; by reading blogs, both scholarly and opinionated; following and entering twitter debates; listening to PT related podcasts; collecting, organizing, and disseminating research on topics that I find interesting; engaging classmates in philosophical PT discussions. Even writing a blog post. It does not matter how you conduct your informal curriculum because it is that: informal. The only advice I can give on making the most out of your 3 year doctorate education is the following:

Do not limit yourself to formal education.
Do not think everything you have to learn about being a physical therapist will be taught in school. It won’t.
Learn how to question what is being taught to you, and how to seek your own answers to those questions.
Learn how to ask the right questions.

The profession has much to offer students who demonstrate interest, so take advantage. Informal education is what will make the difference in your education. It will help solidify the foundation of your career. It will give you the bigger picture of our profession, the one we, as DPT students, will soon be entering.

Finally, if you have been, or are planning on, spending your 3 years of PT school just getting through classes “B’s get degrees” style, by all means, you will obtain a DPT. But, then again, doctor is just a title. Remember, the piece of paper you receive on graduation day signifies merely the beginning of your journey, not the end.
Gabe Streisfeld is a 3rd year DPT student attending Thomas Jefferson University in Philadelphia, PA. He is a life-long student of human movement both professionally through his physical therapy education and personally via a variety of physical pursuits including (but not limited to) powerlifting, hiking, parkour, and bouldering.

He’s always been intrigued by human movement and its capabilities. He believes in not overcomplicating the elegant and evolutionary simplicity of the human movement system. We are beings with the ability to adapt and grow in the presence of a stimulus. He yearns to use his knowledge and views on the human movement system to help others understand their capabilities and improve their physical function.

Follow him on twitter @GabeStreisfeld

The Right Call. APTA Public Relations Removes Questionable Podcast

A few days ago Move Forward, the APTA’s consumer targeted website, posted a podcast. The premise was inaccurate, and the conclusions appeared potentially damaging for patients and the general public. I posted a link to the original Facebook post with a brief statement of my disagreement. Via Twitter and Facebook other physical therapists expressed their disappointment with podcast.

@SandyHiltonPT expresses her disagreement
@SandyHiltonPT expresses her disagreement


Historically, Move Forward has published accurate and useful information for patients and consumers including a podcast with Joe Brence and John Ware on Understanding Pain, a post 9 Things You Should Know About Pain, and publicity regarding Choosing Wisely: 5 Things PT’s and Patients Should Question. Yesterday afternoon, Jason Bellamy APTA’s director of web and new media, removed the podcast from the Move Forward website as well as deleted all related Facebook posts.



I commend the decisive action by Jason and the APTA. I agree with decision. And further, I’m encouraged by their ability to respond to informal feedback via the conversations occurring on social media. Personally, I participated in a panel at #CSM2014 The Value of Using Twitter for Branding Yourself and the Profession, and was highly impressed with Jason’s commitment to engagement. Jason stressed that he and others at the APTA are “listening” to the conversations, discussions, and informal feedback ocurring in the realm of social medical (even if just lurking). But, he also encouraged members to actively contact the APTA with suggestions, feedback, and insight. They want to hear from concerned members. And, apparently, they are willing to act on those intentions.

The APTA listens, so speak up. Becoming a member is a start. Using your voice is next. What do you have to say?

Feedback? E-mail
Feedback? E-mail

Agree to Disagree the Less Wrong Way

No, you’re not entitled to your opinion
. Well, so says lecturer in philosophy Patrick Stokes

I’m sure you’ve heard the expression ‘everyone is entitled to their opinion.’ Perhaps you’ve even said it yourself, maybe to head off an argument or bring one to a close. Well, as soon as you walk into this room, it’s no longer true. You are not entitled to your opinion. You are only entitled to what you can argue for.”

A bit harsh? Perhaps, but philosophy teachers owe it to our students to teach them how to construct and defend an argument – and to recognize when a belief has become indefensible.

Usually, agreeing to disagree ends a discussion. But, agreeing to disagree in order to facilitate true debate should actually initiate the discussion. Attack the message, not the messenger. It’s not personal.

And, that’s the point. Rigorously critiquing the message, ideas, and reasoning is not insulting the person. It’s the foundation of the evolution of the scientific process after new data or theories emerge. Heated, passionate debate can (and I would argue should) be followed by laughter and delicious beverages amongst colleagues (and even rivals!). These fiercely disagreeing colleagues can even be friends.

You are safe, but your ideas are not

But, we are dealing with humans. Humans with complex emotions, previous experience, and beliefs. Brains that are prone to cognitive biases and logical fallacies, even when explicitly on the lookout for them. We are a messy, social, complicated, emotional bunch. The online experience evolved to Web 2.0 “the collaborative internet” (now even Web 3.0) resulting in the proliferation of two way communication and information exchange on the web. The user is actively involved in collaboration and user generated content. Interaction with both content and people has become an integral, regular facet of the online experience. Blogs, blog comment sections, Facebook, and micro-blogging platforms such as Twitter are a routine part of our social as well as professional lives.

So, how can we foster real debate and discourse that is focused on the issues? It’s simple (kind of, in theory), but it’s not easy. Philosophically, absolute truth is a hard, if not impossible, concept (wikipedia truth). In discussions regarding both science and clinical care, the aim is not to be right (per se). But, rather, to approach a state of less wrong. Such a concept recognizes the evolving nature of our understanding in light of new evidence and insight. The goal thus becomes a proper analysis of the position or conclusion presented including the evidence (from basic science to outcomes studies) but also the logic, reasoning, and prior plausibility supporting or refuting the stated position. This approach applies to online discussion, article analyses, professional discussion, and education at all levels. The disagreement hierarchy outlines the strength, and relative validity, of a counterargument. It provides a formal guide for framing discussions.


Graham's Hierarchy of Disagreement


Why is all of this important?

The online disinhibition effect describes how interactions online may actually be more prone to errors in disagreement and discussion. Whether on blogs, Facebook, or Twitter  endless examples of poor debate are present. Ad homineum attacks (you have no experience in this), complaints of tone (you’re so negative), and down right insults (you’re an idiot). Gross illustrations of both logical fallacy and bias (we’ve all got it, except for me of course).

Sometimes, the lower levels of the disagreement hierarchy are actually true. An ad hominem argument highlighting an individuals lack of expertise, knowledge, or experience may be factually accurate. But, while true in and of itself, it does not necessarily invalidate or refute or counter argue the position presented. For example, a cranio-sacral therapist may argue that I have “no experience” performing cranio-sacral therapy. While true, that does not address my position that cranio-sacral therapy’s explanatory model is indefensible, regardless of the perceived or studied effectiveness of the treatment. Thus, even if it works, it does not work as theoretical presented. And, that is vitally important, and often missed construct, when discussing clinical care. Mary Derrick, @Mary_PT2013, previously addressed the use of clinical reasoning and critical thinking from a DPT student’s perspective.

Thinking, Fallacies, and Biases

Unfortunately, an understanding of the mechanics of debate and the basic fallacies of logic is not sufficient. In order to discuss effectively at a high level we also must possess critical thinking skills. We need to understand and recognize logical fallacies and cognitive biases. We need to understand the basic mechanics of science, mathematics, and statistics. We need to understand what certain studies can and can not tell us. We need to understand prior plausibility. We need to think about our thinking (metacognition).

Even more unfortunate is the lack of teaching students how to think. “Schools of thought” and “gurus” continue to dominate our profession as well as public discourse (see Dr. Oz and the muriad of health and fitness fads). Students, practitioners, and even researchers indoctrinated in evidence based practice volley outcomes based RCT’s attempting to illustrate their positions. Professionals argue with each other about tone, experience, and doing “whatever works.” As Jason Silvernail, DPT, DSc observed in his post EBP, Deep Models, and Scientific Reasoning

When I see my colleagues approaching alt-med treatments asking for outcome evidence, I get justifiably nervous – are they just one RCT away from believing in energy medicine? What we should be focusing on is the absolutely indefensible theory here – it’s scientific reasoning that will help us here, not statistics. Let’s never forget that.

Specifically as the profession of physical therapy and more generally in science and public discourse the conversations needs to continue beyond “lets agree to disagree.”

Debate and arguments need to occur

There are beliefs, models, terms, and ideas that permeate our profession, the health care system, and culture that need abandoning. Can you think of any? Understanding the what and why of clinical care and scientific discussion from a Science Based Medicine perspective:

Good science is the best and only way to determine which treatments and products are truly safe and effective. That idea is already formalized in a movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has limitations and problems in practice: it often overemphasizes the value of evidence from clinical trials alone, with some unintended consequences, such as taxpayer dollars spent on “more research” of questionable value. The idea of SBM is not to compete with EBM, but a call to enhance it with a broader view: to answer the question “what works?” we must give more importance to our cumulative scientific knowledge from all relevant disciplines.

If only it ended there. What about that uncomfortable feeling? Defensiveness, feeling offended, stomach churning. These feelings and thoughts are a result of your mind, your brain struggling with two conflicting ideas or ideals. Cognitive Dissonance

In psychology, cognitive dissonance is the discomfort experienced when simultaneously holding two or more conflicting cognitions: ideas, beliefs, values or emotional reactions. In a state of dissonance, people may sometimes feel “disequilibrium”: frustration, hunger, dread, guilt, anger, embarrassment, anxiety, etc.

Some studies illustrate that when presented with evidence conflicting their current position or understanding, humans actually become more entrenched in that belief or view point. So, without a focus and understanding on these principles of debate, disagreement, logic, and fallacy discussion poses the potential to be detrimental. The debate disintegrating into personal attacks and emotional based offensive points as each person drifts deeper into their current view point. Each party fighting uncomfortable cognitive dissonance, and actually confirming previously held beliefs. Critical thinking and metacognition are needed. Patrick Stokes again summarizes:

The problem with “I’m entitled to my opinion” is that, all too often, it’s used to shelter beliefs that should have been abandoned. It becomes shorthand for “I can say or think whatever I like” – and by extension, continuing to argue is somehow disrespectful. And this attitude feeds, I suggest, into the false equivalence between experts and non-experts that is an increasingly pernicious feature of our public discourse.

So, please, let’s agree to disagree.

Comments On: Building Community & Discourse Through Conversation

Often, intense dialogue emerges in the comments section of blog posts. In my opinion, the discussion enriches the original post. Comments add depth to the post, and benefit the reader. Further, it allows a post to remain dynamic over time as knowledge improves or reasoning changes. A guest post on @MikeReinoldBlog entitled Trigger Point Dry Needling for Lateral Epicondylitis resulted in over 220 comments. At one point, Mike even closed comments. Later, in a decision I respect and agree with, he re-opened the comments section. That post is rich in various content, lines of reasoning, and debates on various aspects of science, physical therapy research, pain, and mechanisms of manual therapy. A true resource. On PT Think Tank, our most commented on post  OsteopractorTM Not now, Not ever currently has 201 total comments. In  Comments Off on PT Podcast @ErikMeira states:

Do I not want the feedback? Do I not want to foster discussion? Not at all. The answer is simple: I don’t have the time to manage it. When I have allowed comments in the past I was bombarded with spam posts. This required constant attention to weed out the crap… The other problem is trolls. Most comments are either blind emphatic agreement or blind emphatic disagreement. Then you get into name calling and weird irrelevant attacks. No thanks. I’m not the only one who feels this way. Look herehere, and here for some much more thought out reasons for not allowing comments on blogs.

I agree that moderation can be difficult. Spammers and trolls are a constant, annoying problem. Spam widgets and spam reducing practices exist. See 7 Ways to Reduce Blog Spam for ideas. For those not familiar, @ErikMeira hosts two fantastic podcasts, PT Podcast (@PTPodcast)and PT Inquest. On his site, he published a fantastic 5 part Science Series.

Once a site decides to have comments open the author of a post has a couple of options:

1. Allow the commenting community to discuss
2. Address critiques or questions directly
3. A combination

For moderation, a policy statement can guide decisions to un-approve a comment(s) utilizing set standards as a reference. I uphold that heated discussion and debate eventually lead to progress, are extremely helpful to readers, act as real time peer review, and illustrate when people are being ridiculous. The more people comment, the more obvious their intellect, intent, and true value (or lack of) is displayed. Comments allow for multiple participants and viewpoints to present and discuss issues. Often, connections are made to other concepts not explicitly explored in the initial blog post. For a reader, following the discussion can engage analytical processes, allow them to follow arguments, and challenge ideas. There is value for the author in the for of feedback, questions, and a forum for further clarification. There is value for the commenting to engage with the author and each other in an archived discussion. There is also value to the reader. Personally, I have extracted tremendous intellectual challenge and benefit from reading through a blog post with a engaged comments section.

Although a fear of negative comments is present, allowing individuals to post dissenting views illustrates enriches the post. Even without any moderation the community of commentors can come to the rescue in the case of poor logic, bad reasoning, misinterpreted references, or just plain nastiness.Comments and the ensuing discussion give blogs their true power. In best case scenarios, they are an example of real time, open source peer review and academic-clinical discussion. We can discuss and collaborate around the world. SomaSimple is a prime example of an open forum. Many view SomaSimple negatively, but they have presented a moderators consensus on the Culture of SomaSimple and Information for Guests which includes the Disagreement Hierarchy. One of the resounding themes of the forum is “Here you are safe, by your ideas may not be!”

A prime case example of “comments on” is the contraversial post OsteopractorTM Not now, Not ever. To date, the post has garnered more than 200 comments. The dialogue was not terse and rather intense at times. Overall, I think the comments section benefits those who read and engage PT Think Tank. I attempted to respond to most comments  and critiques. The commenting community dialogued further. Eric Robertson moderated comments that were blatantly attacking individuals or grossly off topic. In total, less than 10 comments total were moderated (deleted or discarded). One comment by a single individual and all the rest by another. So, overall 2 users and less than 5% of all comments required moderation.

Comments? Comments, anyone? Anyone?

#PhysicalTherapy Hashtag Project 2.0

With #CSM2013 only days away, #physicaltherapist twitter chat relating to the conference will continue to increase. Quotes, links, pictures, and thoughts relating to #CMS2013 will spawn far ranging discussion. Individuals will participate remotely from all over the world. I anticipate the traffic on the #CSM2013 stream to be massive given the increase in physical therapists, students, and other disciplines engaging twitter professionally.

In #PhysicalTherapy Hashtag Project, I discussed hashtags in physical therapy specifically and healthcare in general. I also outlined some proposed hashtags for  the PT tweetsphere. These were meant to categorize links, discussion, and comments regarding specific practice areas and topics including sports, pain, acute care, business, advocacy, and research science. A nice discussion evolved both in the comments section, and on twitter inspiring me to create a follow up post based on the conversation.

The Healthcare Hashtag Project on Symplur continues to curate information relevant to various aspects of healthcare and various professionals within healthcare. Of course, much of the information is also important for public health and patients. Interestingly, the #DPTstudent and #solvePT tweetchats rank 5th and 7th respectively in trending tweetchats. #Rehab generally is 15th on the list of trending hashtags. Impressive! The four main categories of organization are hashtags, tweet chats, conferences, and diseases. I envision this project growing in both scope and specificity to connect various professions (and patients!) while simultaneously allowing for more focused categorization within professions. As introduced in the Physical Therapy Hashtag post, specificity of hashtags for the physical therapist profession adds value to the twitter community. A great feature is a schedule of healthcare related tweet chats.

A while back, PT Think Tank’s Eric Robertson introduced the idea of a new PT hashtag #LivePT to capture statements and sentiments that were more appropriately branded outside the #solvePT tag and chat. Below is the revised list of hash tags. Please review and comment….

Practice Areas

  • #AcutePT
  • #CardioPulmPT
  • #GeriatricPT
  • #ManualPT
  • #NeuroPT
  • #OMPT
  • #OrthoPT
  • #PainPT
  • #PediPT
  • #PelvicMafia
  • #SportsPT
  • #WellnessPT

Other Topics

  • #bizPT
  • #brandPT
  • #cashPT
  • #PTadvoc
  • #PTscience
  • #PTtech
  • #therapycap

Students and Education

  • #PTedu
  • #DPTstudent

Global #physicaltherapy Hashtags

  • #LivePT
  • #PTfirst
  • #PThero
  • #SolvePT

Other Hashtags

  • #HCSM
  • #meded
  • #mHealth
  • #SocialOrtho
  • #SportsSafey

Tweet Chats


Is the list too long? Too short? What hashtags do you utilize and follow? Any tweet chats you participate in or follow? Remember to utilize both the #CSM2013 hashtag and topic specific hashtags for your Combined Section Meetings tweets! See you in San Diego. Tweet with you if not!


Official CSM 2013 iOS App Available

CSM 2013 is quickly approaching, is your itinerary planned? (I know you’ve been networking before the conference)

Here in time to help is the APTA CSM 2013 App. Basically, the app contains most of the information about the schedule, speakers, exhibitors, venues, and San Diego you find be lugging around in the bulky paper directories you get at the registration table.

In lieu of yammering on more about the specific features, I recorded a quick demo of the app using my favorite app of 2012 – Reflector. Enjoy:

Demo of the APTA CSM 2013 Mobile App from Mike Pascoe on Vimeo.

Here is a quick video showing a few things you can do with the APTA CSM 2013 app, which was released on Dec 20, 2012.

Here is the link to the app:


#DPTStudent Tweetchat Analytics

The inaugural #DPTStudent tweetchat took place this past Wednesday, Nov 28.

It was a huge success! How do you measure success? With these analytics of course, taken from the hour that the chat occurred:

66 twitter accounts participated

Most of these accounts were that of PT students of course, but we also saw PT faculty and PT programs participating.

486 tweets issued

This new hashtag stacks up well compared with other established PT hashtags, as illustrated by this fancy chart (note: the number on the chart is > 486 because this chart shows total tweets for the entire day):

 389 tweets per hour, 7.36 tweets per participant

We expect to see these numbers jump once the word gets out about the tweetchat. A figure of 7.36 tweets per participant indicates that although there was a small group, they were all very engaged with one another.

155,083 impressions made

“Impressions” is a metric for how many impressions a healthcare hashtag has made in users’ tweet streams. Symplur computes total impressions by taking the number of tweets per participant and multiplying it with the number of followers that participant currently has. This is done for all participants in this time period and then finally the numbers are added up.

 The influencers

Being atop the mentions column means your tweets were interesting enough for others to respond back to you, the tweets column explains itself, the impressions column shows the heavy hitters whose tweets were viewed by the massive number of followers they have.

The transcript

The topic of the first DPTStudent tweetchat was “Why PT?”. It was a great discussion, one that we suggest you relive by looking at the chat transcript.:

#DPTStudent – Healthcare Social Media Transcript


Tweetchats are a great forum to connect users with a common interest. #DPTStudent is bringing PT students from across the country together the exchange thoughts and ideas in a meaningful way. This is just another example of the power the PT profession can leverage by using emerging media. Let’s keep an eye on this and see how big it can get.

#PhysicalTherapy Hashtag Project

#Hashtags are a robust means of tracking or tagging information on Twitter. They help you manage the fire hose-like nature of the constant stream of information on Twitter. Conferences, tweet-chats, and general topics of discussion all benefit from the use of hashtags. Combined Sections Meeting (CSM) of the American Physical Therapy Association, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), and the Private Practice Section of the APTA all have hashtags surrounding their conferences. The conference acronym is usually followed by the year. For example, #CSM2013#AAOMPT13 (No AAOMPT conference this year because of IFOMPT Conference), and #PPS2012. Functionally, hashtags  group tweets by keywords. For those not familiar check out Twitter’s help page what are hashtags? or the wikipedia page hashtag.

Personally, I have leveraged hashtags to follow and contribute to discussion surrounding conferences (CSM and AAOMPT for example). I  unfortunately was not able to attend #AAOMPT11 or #IFOMPT12. But I did learn, discuss, and contribute via the conference hashtags. The # creates potential for discussion and collaboration on a topic, course, conference, or issue. Unable to attend a conference or event? Participate virtually! Busy during the time of a tweet chat? No problem, you can search the hashtag later to read, respond, and continue the conversation. Wondering what individuals are saying on a particular topic? Search that hashtag. Storify even lets you create and save conversations or stories based on certain parameters.

Outside the PT Sphere

@HealtSocMed claims #HCSM (Healthcare Communications and Social Media) forumlated in January of 2009 was the first global healthcare tweet chat. Other non physical therapy specific hashtags or tweet chats include #SocialOrtho#SportsSafety, #mHealth, and #MedEd.

Physical Therapy Hashtags

Established physical therapy hashtags include #physicaltherapy, #physicaltherapist, and #physioPT. Kendra Gagnon PT, PhD (@KendraPedPT) who has guest blogged here on PTTT, utilizes hashtags in entry level DPT education. Her students tweeted #WhyIchosePT to communicate their reasons for pursuing the profession of physical therapy. Her class used #PTprof throughout the semester. On her blog, Kendra discusses social media communication as a part of the curriculum in a Professional Interactions course.

In some cases hashtags are utilized both as a tweetchat and to track discussion on a particular topic. #SolvePT is an example with weekly tweet chats on Tuesdays from 9-10PM Eastern Standard Time as well as ongoing discussion related to issues pertinent to the physical therapy profession. @SnippetPhysTher (Selena Horner, PT, GCS) discusses the emergence of the hashtag and the tweet chat. The #SolvePT hashtag continues to be an interesting conversation regarding physical therapy.

Call to Action

I propose a #physicaltherapy hashtag project. As a physical therapy community lets discuss specific hashtags for practice areas, topics, and ideas. I recently began using #AcutePT to tag some tweets containing evidence and rationale for the physical therapist’s vital role in the acute care environment. The Healthcare Hashtag Project has curated content and hashtags relating to health care topics, specific tweet-chats, conferences, and even diseases!

Below are my proposed hashtags for the physical therapy profession in addition to what we currently utilize. What did I miss? Should we change the wording? Let’s get started…

Practice Areas: #AcutePT #CardioPulmPT #GeriatricPT #ManualTherapy #NeuroPT #OrthoPT #PainPT #PedsPT #SportsPT #WomensPT

#PTscience for research, evidence based practice, and critical thinking relating to physical therapy.

#PTAdvoc for physical therapy advocacy and legislative issues.

#bizPT for business and private practice topics.

#PTtech for information relating to technology and the physical therapist.

#DPTEd for topics relating to physical therapy education and educators, including clinical education.

Hashtags for education and student topics could include #PTedu or #PTschool. Rumor has it that #DPTstudent will emerge as a hash tag topic and potential chat spear headed some of the student leaders in social media. You know @MattDeBole is at the center of that! Also check out @LaurenSPT as well.

And last, but certainly not least, #PTHero for inspiration and greatness within our vital profession.



Direct Access #SB924 & California #PhysicalTherapists

In the past, I have written about how the anti-POPTS (physician owned physical therapy services) movement in California  utilized technology and social media to educate the masses regarding referral for profit. Vist the Stop POPTS YouTube Channel  and for more information.

Recently, a direct access to physical therapy services bill (Senate Bill-924) emerged in the California legislature. Great news!! Well, not so fast. Watch this short 16 second video in which the Assembly Appropriations Committee announces the amendments…

SB924 direct access to physical therapy services. Do pass as amended to require a diagnosis after initial 30 day period in order to continue to treatment. To amend consumer disclosure language and other technical amendments.

Read the entire text of SB-924: Physical therapists: direct access to services: professional corporations. For more legislative information you can visit Official California Legislative Information Webpage. The wording from the actual bill:

The bill would prohibit a physical therapist from treating a patient beyond 30 business days or 12 visits, whichever occurs first, unless the physical therapist receives a specified authorization from a person with a physician and surgeon’s certificate or from a person with a podiatric medicine certificate and acting within his or her scope of practice. The bill would require a physical therapist, prior to the initiation of treatment services, to provide a patient with a specified notice concerning the limitations on the direct treatment services.

Did I mention that this bill would also legalize physician owned physical therapy services?

This bill would add licensed physical therapists and licensed occupational therapists to the list of healing arts practitioners who may be shareholders, officers, directors, or professional employees of those corporations. The bill would also provide that specified healing arts licensees may be shareholders, officers, directors, or professional employees of a physical therapy corporation.

If you live in California, tell the following that back room deals are not OK. Utilize this letter template to write legislators and the governor. Patients deserve better. Seniors deserve better. Their consituents deserve better. California deseveres better. The national deserves better.

Minority Floor Leader Connie Conway @AssemblyConway Phone: (916) 319-2034 Fax: (916) 319-2134
Caucus Chair Jerry Hill P: (916) 319-2019 F: (916) 319-2119
Assistant Majority Whip Rober Hernandez @Roger_Hernandez P: (916) 319-2057 F: (916) 319-2157
Majority Whip Toni Atkins @toniatkins P: (916) 319-2076 F: (916) 319-2176
Asstistant Assembly Floor Leader Mike Allen P: (916) 319-2007 Fax: (916) 319-2107
Floor Leader Charles Calderon P: (916) 319-2058 F: (916) 319-2158
Speaker pro Tempore Fiona Ma @fionama P: (916) 319-2012 F: (916) 319-2112
President pro Tempore Darrell Steinberg P: (916) 651-4006 F: (916) 323-2263
Assemblyman Felipe Fuentes P: (916) 319-2039 F: (916) 319-2139
Assemblyman Mike Gatto @mikegatto P: (916) 319-2043 F: (916) 319-2143
And last, but certainly not least, Speaker of the California State Assembly John A Perez @SpeakerPerez P: (916) 319-2046 F: (916) 319-2146

Follow the #SB924 hastag as well as the following physical therapists on twitter: @ChrisReed1 @Jerry_DurhamPT and @RobertSnowDPT. California based physical therapy program University of the Pacific (moderated by Todd Davenport) @PacificDPTweet and @PittPT Pittsburg Physical Therapy student @MattDeBole. Tweet at @APTAadvocacy and The California Physical Therapy Association @CPTAtweets.

Who else may be interested?


Letter to CA Legislators Template (Google Document)
Pitt Physical Therapy Student Site: The Monday Memo

Senate Bill 924
SB-924: Physical therapists: direct access to services: professional corporations
Bill Text with Strike Through Amendments (PDF)

When a Bad Bill gets WORSE
Back Room Dealings by Mary Hayashi & John Perez

Senate Bill 924 Amended by Democrats, would legalize physician kick backs…


The Evolution of Learning, Knowing, & Finding in the Digital Age

photo of classroom by Max Wolfe

Knowledge, information, and intellect are fuzzy concepts. Knowledge may involve the ability to recall specific pieces of information. But, does knowing lead to intellect? The more information the better? And, what information is needed for intellect? Interesting questions, but definitely beyond my philosophical capabilities. Without a doubt these concepts have evolved in the digital age. An interesting piece entitled Connectivism: A Learning Theory for the Digital Age  is worth a read.

In the past, there was an advantage (likely even an incentive) to “knowing” information, because “finding” information was slow, cumbersome, and time consuming. Think about performing a literature review prior to the internet. It was likely harder (both effort and time wise) to find facts, ideas, and concepts. Potentially, this may have lead to slower, more deliberate processing in the form of in-depth analysis and more critical thinking with reflection, analysis, and connecting to ensure strong knowledge recall.

With the advent of new technologies, and the ever increasing speed and ease of information transfer, the paradigm may have flipped. With the proliferation of the internet and search tools, finding information continued to become easier and faster (this does not address or speak to accuracy, validity, or utility of course). Taking the time to truly know, relate, and connect content was effectively de-incentivized as finding it became convenient beyond belief. Even Einstein was quoted as saying “It’s not what you know, it’s knowing where to find it.” For some information and procedures, this is absolutely true. Atul Gawande addressed this very concept in the book  The Checklist Manifesto (which is fantastic! check out this video summary).

But, do the manifestations of this paradigm shift have the potential to be devastating for students and learners, including clinicians, of all types? The incentive for laziness is present. Google search, “the abstract says…”, “so & so tweeted this.” One must consciously recognize the potential traps, and work hard to critically appraise, connect, reflect, and relate to information.

The same is true of evidence based practice. “Well, this article conclusion states X is good for Y.” “The systematic review recommends X for Y.” Now, I am not advocating against evidence based practice, just pointing out a potentially devastating short cut or pit fall. Without a conscious and attentive adherence to prior plausibility, principles of science, and critical thinking, we are all likely to fall victim to “citing the evidence” in this regard. Now, this really is a different topic, for a different time…

With the advent of Web 2.0 and social media technology information is pushed directly to you. For better or for worse, masters of technology and social media with large followings or broad connections have the power to proliferate ideas to large numbers of people, many of whom did not even seek this information. The term “viral” captures this concept accurately, as ideas or internet memes exhibit virus like tendencies. But, even small time social media users can have significant impact if the information they push is deemed useful by those that encounter it, and thus, pushed onward. And, viral growth is born.

The evolution of this technology may prove to be profoundly beneficial if utilized appropriately. People will encounter information in the form of Facebook status updates, tweet thoughts, blog posts, research articles, and news they did not even seek. Technology and social media including blogs, can be leveraged to not only encounter new information (most of which is not purposefully sought after), but to engage, connect, critique and more deeply understand. Both the author and the reader can benefit, as social media now allows the reader, or consumer, to engage via comments and replies. Learners armed with the power of new technology and the cognitive skills to appropriately use it can make a major impact.

In the future, I foresee the potential of these new technologies and paradigms fundamentally changing not just education, but the face of formal science and publishing. Jason Silvernail and I have discussed this before when discussing if industry standards were serving researchers, clinicians, and science. Building on that topic, Diane Jacobs at SomaSimple, recently posted a link to blog post Why Academic Papers are a Horrible Discussion Forum. These insights set the stage for how new technology and social media can be tools of meaningful change in the future of learning, knowing, finding, discussing, and learning.

This anonymous quote summarizes it best

Education means developing the mind, not stuffing the memory

Unfortunately, our education system at all levels seems on the cusp of  failing in this regard. Some of these technology tools, if not utilized appropriate, may have the potential to exacerbate the problem. But, as we have witnessed, technology has the potential to make big changes, for the better.