Connecting the Classroom and Clinic


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Connecting the classroom and clinic is the presentation from the APTAs Combined Sections Meeting in February 2011.

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  • “Thereafter, at any time, when one of these items is in view, the other can be instantly recalled merely by tapping a button below the corresponding code space. Moreover, when numerous items have been thus joined together to form a trail, they can be reviewed in turn…” BushHyperCard is an application program created by Bill Atkinson for Apple Computer, Inc. that was among the first successful hypermedia systems before the World Wide Web. It combines database capabilities with a graphical, flexible, user-modifiable interface.[1] 
  • Strong forces are operating that may change radically the world of scientific and medical publishing. These include:The appearance and spread of the world wide web, opening up the possibilities that authors might communicate directly with readers and that many intermediaries may not be neededIncreasing resentment in the academic community that it is having to pay ever more for information that it effectively produces itselfThe rise of evidence based medicine and systematic reviews in particular, making people understand how medical information is disorganised and “Balkanised” and that finding information is expensive and difficultIncreased understanding of the “information paradox,” which says that doctors are overwhelmed with information and yet cannot find the information they need when they need itIncreased evidence that most medical studies are of low quality and of limited relevance to cliniciansGlobalisation of medical publishing, exposing weak local products to strong international competitorsAppearance of new players—such as HighWire Press, BioMed Central, and PubMed Central—who are trying to capture value that currently belongs to publishersGreater pressure on doctors to base their treatments on evidenceIncreasing recognition that information alone will not change practiceBetter understanding that improved health care will come not from exhorting individuals but by improving systemsThe rise of patient power and doctor-patient partnership, meaning that patients expect access to the same information as doctors and that patients' evidence is just as important as doctors' or research based evidenceGrowing acceptance that doctors cannot work effectively without considerable support from information and decision making toolsThe spread of handheld technology, opening up new possibilities of delivering “just in time” informationDoctors and other health workers have to be regularly revalidated or recertificatedThose doing applied research are becoming increasingly impatient with systems that reward basic researchers but not them, and …
  • We could have a break here to do something. Get everyone to think about how they personally would like to use Physiopedia...
  • July 2008 - Site development startedJan 2009 - Official launchFeb 2009 - First university project beginsApril 2009 - Regis University and Evidence in Motion grant open access rights to fellowship contentMay 2009 - Being used by 4 learning institutionsApril 2010 - First international collaborative student project beginsMay 2010 - First clinical interest group becomes involvedJune 2010 - Over 200 pages of content - 200-500 visitors per day - 30,000 visits per month
  • We could have a break here to do something. Get everyone to think about how they personally would like to use Physiopedia...
  • No Future Access
  • Recognition featured
  • sandbox
  • A content outline has been provided as a template for your patient case. This presentation is not a publishable case report in that you don’t have to include a literature review or supportive studies. This is meant to be a forum in which cases of actual patients with a specific diagnosis are shared to increase clinical knowledge. Please do not include any private information that would identify a patient. Inclusion of images, lab results and informational tables are encouraged. The format used may be a word document or Power Point presentation. The word limit is 2,000.
  • Connecting the Classroom and Clinic

    1. 1. Connecting the Classroom and Clinic: Use of an International Collaborative Classroom Wiki<br />Elaine Lonnemann, PT, DPT, MSc<br />Rachael Lowe, MCSP<br />Eric Robertson, PT, DPT<br />
    2. 2. Describe and define a wiki, including strengths and weakness as a learning tool<br />Identify opportunities in which a wiki can be used to enable collaborative learning.<br />Discuss how course content and student learning can be enhanced by presentation and collaboration in a wiki.<br />Understand and perform basic page editing functions using wiki syntax.<br />Identify ways in which a wiki can be used in to enhance continuing competencies and evidence based practice.<br />Develop ideas for implementing continuing competency opportunities for clinicians and future alumni to create an ongoing rapport with academic programs.<br />Explore international learning opportunities in physical therapy through wiki use.<br />Objectives<br />
    3. 3. WIKI:A CONCEPTUAL OVERVIEW<br />Eric Robertson, PT, DPT<br />Assistant Professor<br />Texas State University, San Marcos<br /><br />
    4. 4. Describe and define a wiki, including strengths and weakness as a learning tool<br />History of Wiki’s<br />Current Concepts in Wiki’s<br />Wiki as a Learning Tool<br />Popular Wikis<br />
    5. 5. “Wiki” is derived from <br />“wiki wiki,” meaning quick. It refers to a style of website consisting of a simple syntax used to compose and edit pages by multiple people.<br />Wiki<br />
    6. 6. Memex - 1945<br />Vannevar Bush<br />Atlantic Monthly, “As We May Think”<br />WWW – 1990’s<br />First Wiki – 1994<br />Ward Cunningham<br />WikiWikiWeb at<br />Origins of Wikis<br />Life Magazine, 1945<br />
    7. 7. The First Wiki<br />Can edit the web page within a browser<br />
    8. 8. Editable<br />Within a web-browser<br />Wikis are edited using a simplified coding language, often referred to as “Wikitext” or “Wiki Syntax”<br />Wikis promote collaborative idea sharing<br />Wikis can control access, provide knowledge, manage projects, or act as a forum, among other things…<br />Community<br />Public or Private memberships<br />EASY!<br />Small learning curve<br />Features of a Wiki<br />
    9. 9. The place who makes the code for the website you visit. (Sometimes, they host it too!)<br />Examples: MediaWiki, Wikidot, WetPaint<br />Wiki Providers<br />
    10. 10. Wikis are one of several technologies to emerge that have a natural place in teaching and learning. <br />The Networked Teacher<br />Connected!<br />Alex Couros<br />
    11. 11. Learning as the goal<br />Learn as if you were teaching<br />Create more synapses?<br />Understand new information by doing something with it<br />Intentional Learning<br />Reflective Learning<br />Deeper Learning <br />
    12. 12. Traditional<br />Old hierarchy, gates information, peer-reviewed journals<br />Current Model<br />Less gating of information, peer-reviewed journals, but also some social influence<br />Moving to the Future<br />Ability to generate “buzz” on social networks, peer-review re-defined, no gated information…<br />Academic Rewards<br />Abassi<br />BMJ, 2002<br />
    13. 13. Example: Wikipedia and the NIH<br />Collaborative workshops for NIH-funded scientists<br />Case in Point:<br />
    14. 14.<br />Only 50 employees, $22 million in revenue<br /><br />Written by medical professionals<br /><br />“The how-to manual you can edit…”<br />Popular Wikis<br />
    15. 15. High-quality Content!<br />
    16. 16. In the classroom (Augur N, 2004)<br />In residencies (Naik AD, 2010)<br />In publishing research (Anything genetics…)<br />Continuing education (Varga-Atkins T, 2010)<br />“Always-on” learning model<br />Wikis = Professional Development<br />
    17. 17. Let’s check out an example of a wiki specific to physical therapy…<br />
    18. 18. Physiopedia Demonstration<br />Rachael Lowe<br />
    19. 19. Site Overview<br />
    20. 20. Physiopedia is an ambitious project that aims to offer an evidence-based knowledge resource for rehabilitation professionals throughout the world. <br />
    21. 21. Wiki<br />Collaborative<br />International<br />Free<br />Non-profit<br />What?<br />
    22. 22. Aims?<br />Unite the profession<br />Contribute to global health<br />Improve patient care<br />Promote our profession<br />
    23. 23. Anyone can read, <br />only PTs/physios can edit.<br />
    24. 24. Who?<br />Individuals<br />Clinicians<br />Researchers<br />Educational institutions<br />Universities<br />Professional organisations<br />Clinical networks<br />
    25. 25. Why?<br />Contribute to developing this evidence based resource for our profession<br />Build your profile and promote your work<br />Collaborate with colleagues internationally<br />Contribute to improving patient care & global health<br />Contribute to uniting & promoting our profession<br />
    26. 26. Facts & Figures<br />
    27. 27. 1 Jan 2009 – 1 Feb 2011<br />501,180 visits!!<br />98,597 people<br />
    28. 28. 11,511 Cities<br />
    29. 29. 177 countries<br />
    30. 30. From all continents<br />
    31. 31. Your work in Physiopedia won’t go un-noticed!!<br />
    32. 32. Navigating<br />
    33. 33.
    34. 34. Editing<br />
    35. 35. Basic page editing<br />Linking and networking pages<br />Inserting multimedia<br />
    36. 36. Featured Resources<br />
    37. 37. Research<br />Publish your research in Physiopedia<br />This is a great way of publicising student work, supporting new researchers and bridging the gap between completing research and publication.<br />It will then be peer reviewed by the community.<br />
    38. 38. Presentations<br />Why let your work go to waste. When ever you have created a presentation or lecture, put it on-line and showcase it in Physiopedia. <br />Links to self hosted multimedia presentations<br />Open access to high-quality, peer-reviewed content<br />Content is currently being contributed by fellowship programs<br />
    39. 39. Our clients are the same the world over<br /> They suffer with the same conditions<br /> They need rehab following the same procedures<br /> We all use the same interventions<br />Why don’t we collaborate internationally to produce the documents we need…. It’ll give us more time for patient care!<br />Patient Guides , Clinical Guidelines, Rehabilitation Protocols<br />
    40. 40. Projects<br />
    41. 41. 2 years <br />8 educational institutions<br />1 professional network<br />4 countries<br />13 educational projects<br />11 student projects<br />2 professional development projects <br />Projects<br />
    42. 42. Overwhelmingly positive<br />Good learning method<br />Increased confidence to contribute to web-based resources<br />Enjoy contributing to a professional and public resource<br />Like the fact that their work will remain<br />Outcomes<br />
    43. 43. For success<br />Compulsory <br />Formal Assessment<br />Good tutor support<br />Initial face-to-face familiarisation session<br />Use your geeky students<br />Findings<br />
    44. 44. Lets take a look at some of those projects.....<br />
    45. 45. Wiki Use in the PT Classroom<br />Elaine Lonnemann<br />
    46. 46. Goals in the APTA Education Strategic Plan<br /><ul><li>7 Identify and use strategies to effect behavioral change in Physical Therapists and student Physical Therapists to use and apply technology.
    47. 47. 15 Provide opportunities for academic and clinical faculties to develop approaches to teaching using evidenced-based strategies that are effective in promoting learning.
    48. 48. 17 Collaborate with others to develop customized hardware/software applications and medical computer simulations to enhance onsite and distance education.</li></li></ul><li>Pathophysiology of Complex Patient <br />Problems Project<br />Course Instructors: Dr. Dave Pariser and Dr. Elaine Lonnemann<br />
    49. 49. Advantages<br /><ul><li>All Inclusive</li></ul>Disadvantages<br /><ul><li>Time
    50. 50. Group vs. Individual
    51. 51. Underutilized Resource</li></ul>Former Project<br />
    52. 52. Pathophysiology of Complex Patient Problems<br />48 second year DPT students<br />One page<br />One presentation<br />Formally assessed<br />
    53. 53. Infectious<br />Metabolic<br />Muscle<br />Neurological<br />Nutritional<br />Oncological<br />Reproductive<br />Urological <br />Rheumatological<br />Substance Abuse<br />Spondylogenic<br />Disorders<br />Autoimmune<br />Biopsychosocial<br />Cardiac Disorders<br />Connective Tissue <br />Dermatological <br />Eating Disorders<br /> Endocrine<br />Gastric<br />Genetic<br />Hematological<br />Hepatic & Biliary<br />
    54. 54. 1. Definition/Description<br />2. Prevalence <br />3. Characteristics/Clinical Presentation <br />4. Associated Comorbidities <br />5. Medications <br />6. Diagnostic Tests/Lab Tests/Lab Values<br />7. Etiology<br />8. Systemic Involvement<br />9. Medical Management (current best evidence)<br />10. Physical Therapy Management (current best evidence)<br />11. Alternative or Holistic Management (current best evidence)<br />12. Differential Diagnosis<br />13. Case Reports<br />14. Resources <br />15. Recent Related Resources (Pub Med)<br />16. References<br />Template<br />
    55. 55. Lyme Disease<br />Ehlers-Danlos Syndrome<br />Cluster Headache<br />Examples<br />
    56. 56. Examples from CPP-Lyme Disease <br />
    57. 57. Examples from Ehlers-Danlos Syndrome<br />
    58. 58. Examples from Cluster & Migraine Headache<br /><br />
    59. 59. Student Feedback<br />agreed that wiki worked well as a learning method <br />90%<br />
    60. 60. Student Feedback<br />said that they now felt confident to edit and add to a wiki<br />87.5%<br />
    61. 61. Student Feedback<br />of the students would recommend the project to future students<br />85%<br />
    62. 62. Student Feedback<br />said they learned about other disorders from classmates presentations <br />95%<br />
    63. 63. I really enjoyed working on this project. I feel that it allowed me a chance to do something that can be seen by many people to come.<br />Thought this project was an opportunity for us to become more familiar with web-based resources and more importantly contribute to them.<br />I really enjoyed the process and think it's very neat, that my classmates and I have something useful and public.<br />I felt it was a great experience for learning how to contribute to our profession in a very accessible way.<br />
    64. 64. Lessons Learned<br />
    65. 65. PT 655 Teaching & Learning in Physical Therapy<br />Introduction to a wiki in PT<br />Course Instructors: <br />Dr. Elaine Lonnemann and <br />Dr. Beth Ennis <br />
    66. 66. Assignment:<br />Register on Physiopedia<br />Develop a profile add images and links<br />Play in the sandbox<br />- Add a reference or resource from Pubmed<br />Introduction to a wiki in PT<br />
    67. 67. Fully develop your profile <br />(keeping in mind that future employers may view this.) <br />1) Add a photograph<br />2) Add content to each of the following areas on your profile page<br />Name<br />About Me<br />Education<br />Professional Affiliations<br />Professional Appointments<br />Publications<br />Websites<br />Insert a hyperlink to a website within your content<br />Example BU Web Page<br />Personal Web page<br />APTA<br />Play in the sandbox<br />Add a reference from Pubmed or any favorite journal article in the appropriate sections of the Sandbox<br />Assignment Details<br />
    68. 68. Upon completion of this project the learner will:<br />Use a wiki specifically designed by and for Physical Therapists.<br />Create wiki text as the syntax or user interface for editing or formatting text on a wiki page. <br />Edit a wiki page.<br />Create a user profile and profile page within Physiopedia.<br />Add a hyperlink, image or video to a wiki page.<br />Add a reference or resource using Pubmed or current referencing style established in Physiopedia.<br />Objectives<br />
    69. 69. WORLDWIDE PHYSICAL THERAPY PRACTICE: A FOCUS ON PRIMARY CARE PHYSICAL THERAPY <br />Assignment in an Online Course: <br /> Introduction to Primary Care Physical Therapy <br />University of St. Augustine<br />
    70. 70. Patient Access to Physiotherapy or Physical Therapy Services / Entry Point<br />Therapist Preparation <br />Degree/Credentialing<br />Specialization<br />Professional Associations<br />Information about the Patient Community<br />Social/Cultural Influences<br />Delivery of Care<br />Type of Health System<br />Payment System<br />References<br />Template<br />
    71. 71. World Wide PT Practice:A Focus on Primary Care<br />Canada<br />
    72. 72. “Thank you for incorporating current technology (i.e. Physiopedia etc.) into this course—I think it was a valuable experience.”<br />
    73. 73. TEXAS STATE UNIVERSITY EVIDENCE BASED PROJECT<br />Course Instructors: Dr. Eric Robertson, <br />Dr. Rob Wainner& Dr. Brenda Boucher <br />
    74. 74. Present diagnostic methods and intervention strategies or techniques for patients with selected upper extremity (UE) disorders.<br />Search for, analyze, and integrate the best evidence related to a given UE topic to guide physical therapist practice. <br />Develop digital media (web page, images, and video as appropriate) to present findings to the class, other students, and the general body of practicing physical therapists via an open international wiki site.<br />Instructions<br />
    75. 75. Search Strategy<br />Definition/Description<br />Epidemiology /Etiology<br />Characteristics/Clinical Presentation<br />Differential Diagnosis<br />Examination<br />Medical Management (current best evidence)<br />Physical Therapy Management (current best evidence)<br />Key Research<br />Resources<br />Clinical Bottom Line<br />Recent Related Research (from Pubmed)<br />References<br />Template<br />
    76. 76. Elbow<br />Postero-lateral Elbow <br />Instability <br />CubitalTunnel Syndrome <br />Posterior Elbow Disloc<br /> Wrist and Hand <br />Distal Radius Fractures<br />Shoulder<br />Adhesive Capsulitis <br />Posterior Shoulder Instability <br />Throwing Injuries & Rehabilitation <br />Axillary Nerve Injuries in Dislocation <br />Internal Impingement <br />Disorders<br />
    77. 77. Examples from Texas State EBP<br />
    78. 78. The use of Physiopedia enhanced the project.<br />TX State EBP Project Post-Survey<br />
    79. 79. Editing Physiopedia was easy to learn and perform.<br />TX State EBP Project Post-Survey<br />
    80. 80. Overall Value:<br />Pre: 3.42<br />Overall Value:<br />Post: 4.37<br />TX State EBP Project Post-Survey<br />
    81. 81. Learn Others?<br />Pre: 3.03<br />Learn Others?<br />Post: 3.66<br />TX State EBP Project Post-Survey<br />
    82. 82. We should continue to use Physiopedia.<br />TX State EBP Project Post-Survey<br />
    84. 84. Professional Development<br />
    85. 85. Answer clinical questions<br />Promote evidence based practice<br />Promote reflective practice<br />Informal learning<br />
    86. 86. PICO Question:<br />For a patient with LBP is spinal manipulation compared to exercises suitable to eliminate pain?<br />
    87. 87. Read the article<br />Find international <br />guidelines<br />Find your answer<br />Revise the <br />technique<br />Find related <br />research<br />Investigate <br />the evidence<br />Research and <br />contact authors<br />
    88. 88. If the information you are looking for isn’t there……<br />Find it somewhere else and add it to Physiopedia!<br />
    89. 89. Implement you’re evidence based findings into clinical practice<br />Reflect on your learning experience<br />Record in your professional portfolio.<br />
    90. 90. Prove continued competence....<br />Formal learning<br />
    91. 91. Continued Competence<br />
    92. 92. Goals in the APTA Education Strategic Plan<br /># 2<br />Promotes continued competence<br /># 13<br />Promotes the partnership model between the academic program and clinical site<br />
    93. 93. Case Presentation <br />Continuing Education Opportunity <br />for Clinicians<br />PT clinical instructors: gain 4.0 contact hours of CE credit at no charge<br />
    94. 94. From Complex Patient Problems Project<br />1. Definition/Description<br />2. Prevalence <br />3. Characteristics/Clinical Presentation <br />4. Associated Comorbidities <br />5. Medications <br />6. Diagnostic Tests/Lab Tests/Lab Values<br />7. Etiology<br />8. Systemic Involvement<br />9. Medical Management (current best evidence)<br />10. Physical Therapy Management (current best evidence)<br />11. Alternative or Holistic Management (current best evidence)<br />12. Differential Diagnosis<br />13. Case Reports<br />14. Resources <br />15. Recent Related Resources (Pub Med)<br />16. References<br />
    95. 95. Content outline -template for your patient case. <br />This presentation is NOT a case report <br /><ul><li>No literature review
    96. 96. No supportive references</li></ul>Actual patients with a specific diagnosis<br />No private information<br />Inclusion of images, lab results and informational tables are encouraged.<br />The format -word document or Power Point presentation. 2,000 word limit. <br />Directions to Clinician<br />
    97. 97.
    98. 98. The finished product emailed<br />After review and approval it will be posted within the ‘case reports’ section of the outline for that wiki page<br />A certificate will be mailed to the clinician<br />
    99. 99.
    100. 100. Academic institution support and appreciation to CI’s for contributions to the training of future clinicians<br />An interactive forum between clinical instructors (CI’s), students and academic faculty for collaborative learning in contemporary practice topics<br />Future thoughts<br />
    101. 101. Projects and Concepts <br />for the future of Physiopedia<br />
    102. 102. The Future<br />CPD programme <br />Mentoring schemes <br />Clinical networks <br />IST training programmes<br />Journal club<br />International collaborative projects<br />......<br />
    103. 103. Questions?<br />Elaine Lonnemann<br /><br />Rachael Lowe<br /><br /><br />Eric Robertson<br /><br /><br />