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.

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.


  • 1. Connecting the Classroom and Clinic: Use of an International Collaborative Classroom Wiki
    Elaine Lonnemann, PT, DPT, MSc
    Rachael Lowe, MCSP
    Eric Robertson, PT, DPT
  • 2. 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.
    Eric Robertson, PT, DPT
    Assistant Professor
    Texas State University, San Marcos
  • 4. 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
  • 5. “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.
  • 6. Memex - 1945
    Vannevar Bush
    Atlantic Monthly, “As We May Think”
    WWW – 1990’s
    First Wiki – 1994
    Ward Cunningham
    WikiWikiWeb at
    Origins of Wikis
    Life Magazine, 1945
  • 7. The First Wiki
    Can edit the web page within a browser
  • 8. 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…
    Public or Private memberships
    Small learning curve
    Features of a Wiki
  • 9. The place who makes the code for the website you visit. (Sometimes, they host it too!)
    Examples: MediaWiki, Wikidot, WetPaint
    Wiki Providers
  • 10. Wikis are one of several technologies to emerge that have a natural place in teaching and learning.
    The Networked Teacher
    Alex Couros
  • 11. 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
  • 12. 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
    BMJ, 2002
  • 13. Example: Wikipedia and the NIH
    Collaborative workshops for NIH-funded scientists
    Case in Point:
  • 14.
    Only 50 employees, $22 million in revenue
    Written by medical professionals
    “The how-to manual you can edit…”
    Popular Wikis
  • 15. High-quality Content!
  • 16. 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
  • 17. Let’s check out an example of a wiki specific to physical therapy…
  • 18. Physiopedia Demonstration
    Rachael Lowe
  • 19. Site Overview
  • 20. Physiopedia is an ambitious project that aims to offer an evidence-based knowledge resource for rehabilitation professionals throughout the world.
  • 21. Wiki
  • 22. Aims?
    Unite the profession
    Contribute to global health
    Improve patient care
    Promote our profession
  • 23. Anyone can read,
    only PTs/physios can edit.
  • 24. Who?
    Educational institutions
    Professional organisations
    Clinical networks
  • 25. 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
  • 26. Facts & Figures
  • 27. 1 Jan 2009 – 1 Feb 2011
    501,180 visits!!
    98,597 people
  • 28. 11,511 Cities
  • 29. 177 countries
  • 30. From all continents
  • 31. Your work in Physiopedia won’t go un-noticed!!
  • 32. Navigating
  • 33.
  • 34. Editing
  • 35. Basic page editing
    Linking and networking pages
    Inserting multimedia
  • 36. Featured Resources
  • 37. 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.
  • 38. 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
  • 39. 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
  • 40. Projects
  • 41. 2 years
    8 educational institutions
    1 professional network
    4 countries
    13 educational projects
    11 student projects
    2 professional development projects
  • 42. 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
  • 43. For success
    Formal Assessment
    Good tutor support
    Initial face-to-face familiarisation session
    Use your geeky students
  • 44. Lets take a look at some of those projects.....
  • 45. Wiki Use in the PT Classroom
    Elaine Lonnemann
  • 46. 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.
    • 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. 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
  • 49. Advantages
    • All Inclusive
    • Time
    • 50. Group vs. Individual
    • 51. Underutilized Resource
    Former Project
  • 52. Pathophysiology of Complex Patient Problems
    48 second year DPT students
    One page
    One presentation
    Formally assessed
  • 53. Infectious
    Substance Abuse
    Cardiac Disorders
    Connective Tissue
    Eating Disorders
    Hepatic & Biliary
  • 54. 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
  • 55. Lyme Disease
    Ehlers-Danlos Syndrome
    Cluster Headache
  • 56. Examples from CPP-Lyme Disease
  • 57. Examples from Ehlers-Danlos Syndrome
  • 58. Examples from Cluster & Migraine Headache
  • 59. Student Feedback
    agreed that wiki worked well as a learning method
  • 60. Student Feedback
    said that they now felt confident to edit and add to a wiki
  • 61. Student Feedback
    of the students would recommend the project to future students
  • 62. Student Feedback
    said they learned about other disorders from classmates presentations
  • 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.
    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.
  • 64. Lessons Learned
  • 65. PT 655 Teaching & Learning in Physical Therapy
    Introduction to a wiki in PT
    Course Instructors:
    Dr. Elaine Lonnemann and
    Dr. Beth Ennis
  • 66. 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
  • 67. 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
    About Me
    Professional Affiliations
    Professional Appointments
    Insert a hyperlink to a website within your content
    Example BU Web Page
    Personal Web page
    Play in the sandbox
    Add a reference from Pubmed or any favorite journal article in the appropriate sections of the Sandbox
    Assignment Details
  • 68. 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.
    Assignment in an Online Course:
    Introduction to Primary Care Physical Therapy
    University of St. Augustine
  • 70. Patient Access to Physiotherapy or Physical Therapy Services / Entry Point
    Therapist Preparation
    Professional Associations
    Information about the Patient Community
    Social/Cultural Influences
    Delivery of Care
    Type of Health System
    Payment System
  • 71. World Wide PT Practice:A Focus on Primary Care
  • 72. “Thank you for incorporating current technology (i.e. Physiopedia etc.) into this course—I think it was a valuable experience.”
    Course Instructors: Dr. Eric Robertson,
    Dr. Rob Wainner& Dr. Brenda Boucher
  • 74. 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.
  • 75. Search Strategy
    Epidemiology /Etiology
    Characteristics/Clinical Presentation
    Differential Diagnosis
    Medical Management (current best evidence)
    Physical Therapy Management (current best evidence)
    Key Research
    Clinical Bottom Line
    Recent Related Research (from Pubmed)
  • 76. Elbow
    Postero-lateral Elbow
    CubitalTunnel Syndrome
    Posterior Elbow Disloc
    Wrist and Hand
    Distal Radius Fractures
    Adhesive Capsulitis
    Posterior Shoulder Instability
    Throwing Injuries & Rehabilitation
    Axillary Nerve Injuries in Dislocation
    Internal Impingement
  • 77. Examples from Texas State EBP
  • 78. The use of Physiopedia enhanced the project.
    TX State EBP Project Post-Survey
  • 79. Editing Physiopedia was easy to learn and perform.
    TX State EBP Project Post-Survey
  • 80. Overall Value:
    Pre: 3.42
    Overall Value:
    Post: 4.37
    TX State EBP Project Post-Survey
  • 81. Learn Others?
    Pre: 3.03
    Learn Others?
    Post: 3.66
    TX State EBP Project Post-Survey
  • 82. We should continue to use Physiopedia.
    TX State EBP Project Post-Survey
  • 84. Professional Development
  • 85. Answer clinical questions
    Promote evidence based practice
    Promote reflective practice
    Informal learning
  • 86. PICO Question:
    For a patient with LBP is spinal manipulation compared to exercises suitable to eliminate pain?
  • 87. Read the article
    Find international
    Find your answer
    Revise the
    Find related
    the evidence
    Research and
    contact authors
  • 88. If the information you are looking for isn’t there……
    Find it somewhere else and add it to Physiopedia!
  • 89. Implement you’re evidence based findings into clinical practice
    Reflect on your learning experience
    Record in your professional portfolio.
  • 90. Prove continued competence....
    Formal learning
  • 91. Continued Competence
  • 92. Goals in the APTA Education Strategic Plan
    # 2
    Promotes continued competence
    # 13
    Promotes the partnership model between the academic program and clinical site
  • 93. Case Presentation
    Continuing Education Opportunity
    for Clinicians
    PT clinical instructors: gain 4.0 contact hours of CE credit at no charge
  • 94. 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
  • 95. Content outline -template for your patient case.
    This presentation is NOT a case report
    • No literature review
    • 96. 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
  • 97.
  • 98. 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
  • 99.
  • 100. 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
  • 101. Projects and Concepts
    for the future of Physiopedia
  • 102. The Future
    CPD programme
    Mentoring schemes
    Clinical networks
    IST training programmes
    Journal club
    International collaborative projects
  • 103. Questions?
    Elaine Lonnemann
    Rachael Lowe
    Eric Robertson