Connecting the Classroom and Clinic

Connecting the Classroom and Clinic: Use of an International Collaborative Classroom Wiki
Elaine Lonnemann, PT, DPT, MSc
Rachael Lowe, MCSP
Eric Robertson, PT, DPT

Describe and define a wiki, including strengths and weakness as a learning tool
Identify opportunities in which a wiki can be used to enable collaborative learning.
Discuss how course content and student learning can be enhanced by presentation and collaboration in a wiki.
Understand and perform basic page editing functions using wiki syntax.
Identify ways in which a wiki can be used in to enhance continuing competencies and evidence based practice.
Develop ideas for implementing continuing competency opportunities for clinicians and future alumni to create an ongoing rapport with academic programs.
Explore international learning opportunities in physical therapy through wiki use.
Objectives

WIKI:A CONCEPTUAL OVERVIEW
Eric Robertson, PT, DPT
Assistant Professor
Texas State University, San Marcos
Twitter.com/EricRobertson

Describe and define a wiki, including strengths and weakness as a learning tool
History of Wiki’s
Current Concepts in Wiki’s
Wiki as a Learning Tool
Popular Wikis

“Wiki” is derived from
“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.
Wiki

Memex - 1945
Vannevar Bush
Atlantic Monthly, “As We May Think”
WWW – 1990’s
First Wiki – 1994
Ward Cunningham
WikiWikiWeb at c2.com
Origins of Wikis
Life Magazine, 1945

The First Wiki
Can edit the web page within a browser

Editable
Within a web-browser
Wikis are edited using a simplified coding language, often referred to as “Wikitext” or “Wiki Syntax”
Wikis promote collaborative idea sharing
Wikis can control access, provide knowledge, manage projects, or act as a forum, among other things…
Community
Public or Private memberships
EASY!
Small learning curve
Features of a Wiki

The place who makes the code for the website you visit. (Sometimes, they host it too!)
Examples: MediaWiki, Wikidot, WetPaint
Wiki Providers

Wikis are one of several technologies to emerge that have a natural place in teaching and learning.
The Networked Teacher
Connected!
Alex Couros

Learning as the goal
Learn as if you were teaching
Create more synapses?
Understand new information by doing something with it
Intentional Learning
Reflective Learning
Deeper Learning

Traditional
Old hierarchy, gates information, peer-reviewed journals
Current Model
Less gating of information, peer-reviewed journals, but also some social influence
Moving to the Future
Ability to generate “buzz” on social networks, peer-review re-defined, no gated information…
Academic Rewards
Abassi
BMJ, 2002

Example: Wikipedia and the NIH
Collaborative workshops for NIH-funded scientists
Case in Point:

Wikipedia.com
Only 50 employees, $22 million in revenue
Medpedia.com
Written by medical professionals
Wikihow.com
“The how-to manual you can edit…”
Popular Wikis

High-quality Content!

In the classroom (Augur N, 2004)
In residencies (Naik AD, 2010)
In publishing research (Anything genetics…)
Continuing education (Varga-Atkins T, 2010)
“Always-on” learning model
Wikis = Professional Development

Let’s check out an example of a wiki specific to physical therapy…

Physiopedia Demonstration
Rachael Lowe

Site Overview

Physiopedia is an ambitious project that aims to offer an evidence-based knowledge resource for rehabilitation professionals throughout the world.

Wiki
Collaborative
International
Free
Non-profit
What?

Aims?
Unite the profession
Contribute to global health
Improve patient care
Promote our profession

Anyone can read,
only PTs/physios can edit.

Who?
Individuals
Clinicians
Researchers
Educational institutions
Universities
Professional organisations
Clinical networks

Why?
Contribute to developing this evidence based resource for our profession
Build your profile and promote your work
Collaborate with colleagues internationally
Contribute to improving patient care & global health
Contribute to uniting & promoting our profession

Facts & Figures

1 Jan 2009 – 1 Feb 2011
501,180 visits!!
98,597 people

11,511 Cities

177 countries

From all continents

Your work in Physiopedia won’t go un-noticed!!

Navigating

Editing

Basic page editing
Linking and networking pages
Inserting multimedia

Featured Resources

Research
Publish your research in Physiopedia
This is a great way of publicising student work, supporting new researchers and bridging the gap between completing research and publication.
It will then be peer reviewed by the community.

Presentations
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.
Links to self hosted multimedia presentations
Open access to high-quality, peer-reviewed content
Content is currently being contributed by fellowship programs

Our clients are the same the world over
They suffer with the same conditions
They need rehab following the same procedures
We all use the same interventions
Why don’t we collaborate internationally to produce the documents we need…. It’ll give us more time for patient care!
Patient Guides , Clinical Guidelines, Rehabilitation Protocols

Projects

2 years
8 educational institutions
1 professional network
4 countries
13 educational projects
11 student projects
2 professional development projects
Projects

Overwhelmingly positive
Good learning method
Increased confidence to contribute to web-based resources
Enjoy contributing to a professional and public resource
Like the fact that their work will remain
Outcomes

For success
Compulsory
Formal Assessment
Good tutor support
Initial face-to-face familiarisation session
Use your geeky students
Findings

Lets take a look at some of those projects.....

Wiki Use in the PT Classroom
Elaine Lonnemann

Goals in the APTA Education Strategic Plan
7 Identify and use strategies to effect behavioral change in Physical Therapists and student Physical Therapists to use and apply technology.
15 Provide opportunities for academic and clinical faculties to develop approaches to teaching using evidenced-based strategies that are effective in promoting learning.
17 Collaborate with others to develop customized hardware/software applications and medical computer simulations to enhance onsite and distance education.

Pathophysiology of Complex Patient
Problems Project
Course Instructors: Dr. Dave Pariser and Dr. Elaine Lonnemann

Advantages
All Inclusive
Disadvantages
Time
Group vs. Individual
Underutilized Resource
Former Project

Pathophysiology of Complex Patient Problems
48 second year DPT students
One page
One presentation
Formally assessed

Infectious
Metabolic
Muscle
Neurological
Nutritional
Oncological
Reproductive
Urological
Rheumatological
Substance Abuse
Spondylogenic
Disorders
Autoimmune
Biopsychosocial
Cardiac Disorders
Connective Tissue
Dermatological
Eating Disorders
Endocrine
Gastric
Genetic
Hematological
Hepatic & Biliary

1. Definition/Description
2. Prevalence
3. Characteristics/Clinical Presentation
4. Associated Comorbidities
5. Medications
6. Diagnostic Tests/Lab Tests/Lab Values
7. Etiology
8. Systemic Involvement
9. Medical Management (current best evidence)
10. Physical Therapy Management (current best evidence)
11. Alternative or Holistic Management (current best evidence)
12. Differential Diagnosis
13. Case Reports
14. Resources
15. Recent Related Resources (Pub Med)
16. References
Template

Lyme Disease
Ehlers-Danlos Syndrome
Cluster Headache
Examples

Examples from CPP-Lyme Disease

Examples from Ehlers-Danlos Syndrome

Examples from Cluster & Migraine Headache
http://www.migraineartwork.com/distress_artwork.html

Student Feedback
agreed that wiki worked well as a learning method
90%

Student Feedback
said that they now felt confident to edit and add to a wiki
87.5%

Student Feedback
of the students would recommend the project to future students
85%

Student Feedback
said they learned about other disorders from classmates presentations
95%

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.
Thought this project was an opportunity for us to become more familiar with web-based resources and more importantly contribute to them.
I really enjoyed the process and think it's very neat, that my classmates and I have something useful and public.
I felt it was a great experience for learning how to contribute to our profession in a very accessible way.

Lessons Learned

PT 655 Teaching & Learning in Physical Therapy
Introduction to a wiki in PT
Course Instructors:
Dr. Elaine Lonnemann and
Dr. Beth Ennis

Assignment:
Register on Physiopedia
Develop a profile add images and links
Play in the sandbox
- Add a reference or resource from Pubmed
Introduction to a wiki in PT

Fully develop your profile
(keeping in mind that future employers may view this.)
1) Add a photograph
2) Add content to each of the following areas on your profile page
Name
About Me
Education
Professional Affiliations
Professional Appointments
Publications
Websites
Insert a hyperlink to a website within your content
Example BU Web Page
Personal Web page
APTA
Play in the sandbox
Add a reference from Pubmed or any favorite journal article in the appropriate sections of the Sandbox
Assignment Details

Upon completion of this project the learner will:
Use a wiki specifically designed by and for Physical Therapists.
Create wiki text as the syntax or user interface for editing or formatting text on a wiki page.
Edit a wiki page.
Create a user profile and profile page within Physiopedia.
Add a hyperlink, image or video to a wiki page.
Add a reference or resource using Pubmed or current referencing style established in Physiopedia.
Objectives

WORLDWIDE PHYSICAL THERAPY PRACTICE: A FOCUS ON PRIMARY CARE PHYSICAL THERAPY
Assignment in an Online Course:
Introduction to Primary Care Physical Therapy
University of St. Augustine

Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
Therapist Preparation
Degree/Credentialing
Specialization
Professional Associations
Information about the Patient Community
Social/Cultural Influences
Delivery of Care
Type of Health System
Payment System
References
Template

World Wide PT Practice:A Focus on Primary Care
Canada

“Thank you for incorporating current technology (i.e. Physiopedia etc.) into this course—I think it was a valuable experience.”

TEXAS STATE UNIVERSITY EVIDENCE BASED PROJECT
Course Instructors: Dr. Eric Robertson,
Dr. Rob Wainner& Dr. Brenda Boucher

Present diagnostic methods and intervention strategies or techniques for patients with selected upper extremity (UE) disorders.
Search for, analyze, and integrate the best evidence related to a given UE topic to guide physical therapist practice.
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.
Instructions

Search Strategy
Definition/Description
Epidemiology /Etiology
Characteristics/Clinical Presentation
Differential Diagnosis
Examination
Medical Management (current best evidence)
Physical Therapy Management (current best evidence)
Key Research
Resources
Clinical Bottom Line
Recent Related Research (from Pubmed)
References
Template

Elbow
Postero-lateral Elbow
Instability
CubitalTunnel Syndrome
Posterior Elbow Disloc
Wrist and Hand
Distal Radius Fractures
Shoulder
Adhesive Capsulitis
Posterior Shoulder Instability
Throwing Injuries & Rehabilitation
Axillary Nerve Injuries in Dislocation
Internal Impingement
Disorders

Examples from Texas State EBP

The use of Physiopedia enhanced the project.
TX State EBP Project Post-Survey

Editing Physiopedia was easy to learn and perform.

Overall Value:
Pre: 3.42
Overall Value:
Post: 4.37

Learn Others?
Pre: 3.03
Learn Others?
Post: 3.66

We should continue to use Physiopedia.

OTHER PROFESSIONAL DEVELOPMENT USING A WIKI

Professional Development

Answer clinical questions
Promote evidence based practice
Promote reflective practice
Informal learning

PICO Question:
For a patient with LBP is spinal manipulation compared to exercises suitable to eliminate pain?

Read the article
Find international
guidelines
Find your answer
Revise the
technique
Find related
research
Investigate
the evidence
Research and
contact authors

If the information you are looking for isn’t there……
Find it somewhere else and add it to Physiopedia!

Implement you’re evidence based findings into clinical practice
Reflect on your learning experience
Record in your professional portfolio.

Prove continued competence....
Formal learning

Continued Competence

Goals in the APTA Education Strategic Plan
# 2
Promotes continued competence
# 13
Promotes the partnership model between the academic program and clinical site

Case Presentation
Continuing Education Opportunity
for Clinicians
PT clinical instructors: gain 4.0 contact hours of CE credit at no charge

From Complex Patient Problems Project
1. Definition/Description
2. Prevalence
3. Characteristics/Clinical Presentation
4. Associated Comorbidities
5. Medications
6. Diagnostic Tests/Lab Tests/Lab Values
7. Etiology
8. Systemic Involvement
9. Medical Management (current best evidence)
10. Physical Therapy Management (current best evidence)
11. Alternative or Holistic Management (current best evidence)
12. Differential Diagnosis
13. Case Reports
14. Resources
15. Recent Related Resources (Pub Med)
16. References

Content outline -template for your patient case.
This presentation is NOT a case report
No literature review
No supportive references
Actual patients with a specific diagnosis
No private information
Inclusion of images, lab results and informational tables are encouraged.
The format -word document or Power Point presentation. 2,000 word limit.
Directions to Clinician

The finished product emailed
After review and approval it will be posted within the ‘case reports’ section of the outline for that wiki page
A certificate will be mailed to the clinician

Academic institution support and appreciation to CI’s for contributions to the training of future clinicians
An interactive forum between clinical instructors (CI’s), students and academic faculty for collaborative learning in contemporary practice topics
Future thoughts

Projects and Concepts
for the future of Physiopedia

The Future
CPD programme
Mentoring schemes
Clinical networks
IST training programmes
Journal club
International collaborative projects
......

Questions?
Elaine Lonnemann
elonnemann@bellarmine.edu
Rachael Lowe
www.rachaellowe.com
lowe.rachael@gmail.com
Eric Robertson
PTThinkTank.com
ericrobertson@txstate.edu

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