Increasing empathy AND ageism?

This is a really interesting study and I hope to dig more into it: Experiencing aging or demystifying myths? – impact of different “geriatrics and gerontology” teaching strategies in first year medical students (BMC Med Educ. 2017 Feb 8;17(1):35. doi: 10.1186/s12909-017-0872-9.

They report that “The “experiencing aging” intervention was associated with improvement in empathy but worsening of attitude. The “myths of aging” intervention was associated with an improved attitude overall and positive view about aging but with no change in empathy towards older persons.”  I trialed an experiencing aging assignment, and in the student reflections and feedback there is a definite increase in empathy; I hope I counteracted any potential ageism by my emphasis on normal and healthy aging and that we can and should challenge our patients in our dosing of exercise.
There are possible issues with the study (the authors acknowledge the results may not be generalizeable as it was a single Brazilian medical school, and the UCLA Geriatric Attitudes Scale might not be the best tool to use), but it definitely gives food for thought, including possible unintended consequences and how to better assess changes in curriculum.
Addendum: In researching this a bit more, I found another study that says the Aging Game (another version of experiential learning) increases empathy and attitudes –

How We Learn

5857112597_eb3787e9c1_zBack when I started clinical teaching for St. Kate’s, I took the APTA’s Clinical Instructor credentialing course, which I would highly recommend if you are clinical faculty or a clinical instructor.  I’m glad I kept the course book, as I found it a helpful refresher for me about learning in the psychomotor domain.

UOP has a great resource for faculty – the Teaching and Learning Center.  Besides presentations on topics related to teaching and learning, feedback on teaching observations, and assisting with problems encountered in the classroom, they also have a Teaching and Learning book club.  The one for October caught my eye so I signed up – Teach Students How to Learn – Strategies You Can Incorporate Into Any Course to Improve Student Metacognition, Study Skills, and Motivation, by Saundra Yancy McGuire with Stephanie McGuire (note: I do not get anything if you click and buy – just putting the hyperlink there if you are interested).  PT students are motivated, so why take the course?  Well, the part about presenting “evidence-based strategies to boost student success in your courses and beyond” caught my eye.  I’m a good clinical educator, and I’ve given inservices and CEU presentations, but I can always improve.  It has given me good food for thought during my my first semester here.  I’ve found it helpful to review how we learn and apply facts, and learn and apply movements, and I’ve tried to adjust my teaching style and the class accordingly.

I also did a midterm feedback form for Patient Care Skills, and gleaned information from it and from the official end-of-semester feedback.  As I’ve written before in the blog, students can be great teachers.  There are some things that are not negotiable in teaching, either because it is required by the course or it is included for a purpose (pedagogy or teaching philosophy), but there are other things students observe that are helpful.  I’ll be honest, I was hesitant in reading them – I’ve read that reviews can be brutal as it is anonymous and some students unload, but these two cohorts are professional and overall it was helpful for next semester and the next time I teach PCS and help with ACP.

Photo credit: New Blooms Pyramid by Andrea Hernandez

One more week to go-time!

I’ve been prepping for classes and working on a draft of my semester research plan.  For Patient Care Skills I have a co-instructor and I have a teaching mentor – I’m excited about this one as it reminds me of having St. Kate’s first-year ICE students.  For Advanced Clinical Problems I’ll be a co-instructor with another faculty leading and another co-instructor from the PT community.  The students have recently finished their first clinical experience; again, it reminds me of St. Kate’s and also being able to take them from the beginnings of their clinical experience and building upon that with a bit of freedom with guidance to increase clinical reasoning.  While it will be a full semester, I’m looking forward to what lies ahead!

I still need to meet with my scholarly activity mentor, but I’ve written a draft of my plan so I can keep on top of it (while trying not to bite off too much!).  As I’ve written before I’m interested in adherence to exercise, and in hip fracture rehab. I’m trying to find out what I can glean from CMS in their data sets – it is pricey but if I can find the info needed it might help.  This article from January 2016 PTJ about more therapy after a hip fracture improves outcomes most of the time (my phrase) is interesting and hopefully I can find data to help find answers and drive more questions.  Did you know that hip fracture mobility recovery appears to follow a sequence?  For a HEP, you might want to consider giving them functional exercises.  Interested in blood flow restriction training (BFR)?  See how it works. California has looked at mortality after a hip fracture which I found interesting (at least the key findings).

Changes ahead

We moved from MN to CA in June, and I am transitioning into academia next month.  How it happened is for another post, but I gave up a really sweet position with St. Therese and St. Kate’s (a great company and setting, with a wonderful partner for clinical education as Clinical Faculty and Clinical Instructor) for an unexpected opportunity I could not pass up.  I will be teaching (Patient handling skills, Ther Ex, Geriatrics, and Advanced Clinical Problems – a pro bono clinic of sorts) and doing research at University of the Pacific in Stockton, CA.  I am honored and excited by the opportunity.

So what does that mean for the blog?  Well, it will still be primarily about older adults, but will also include a bit more about teaching and research.  I’ve been off the blog and most of SM as we transitioned from the Twin Cities to Stockton; I plan to pick it up after we get settled at home and I get in the groove of things at UofP and find clinic work on the side.  Stay tuned!

“Responding to the Reluctant Patient”

How do you respond to a patient that doesn’t want to participate in therapy?  This is a paper from the August 2016 PTJ, but I only read it just recently.  I had my current student read it, and would highly recommend anyone in the SNF/TCU or acute care (or even HH) read it.  It really opened my eyes to how better interact with the reluctant patient.

Delany C, Anderson L.  From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation.  Phys Ther (2016) 96 (8): 1234-1240.

If you are thinking of working in a SNF/TCU…

I’ve had some students recently ask me about searching for work in the TCU.  I love the TCU setting – the medical complexity, the rehabilitation for all different diagnoses (ortho, cardiopulm, neuro), getting people back home.  If you are looking at TCU’s, these are some of the things I’ve considered when looking for work:

  1. The Medicare rating – 4 and 5 stars is a good starting point; I’ve worked at a 3 and where I was at until July was a 1 for a while (upgraded to a 2 currently) and I would still willingly work there, so I wouldn’t automatically cross one off your list because of this. [edit 5/2: my Dad is now in a TCU in Tennessee – tough searching from a distance.  Consider looking at the ratings also for health inspections and for outcomes – the ones I looked at I’d rather have a higher outcomes rating than a health rating as it looked like the health ratings were issues with documentation, food temp, etc and tended to be isolated incidents vs percent of residents with pressure sores, not returning to prior functional level, etc).]
  2. In-house vs contract therapy:
    1. Productivity will probably differ; from my observation in-house productivity is relatively lower (see my blog post ).   Find out what their productivity expectations are, and what they might have to help you achieve it.
    2. Employee satisfaction: I work at a place with low turn-over – we could get more pay elsewhere possibly, but at what cost?  What is employee satisfaction like? (ask current employees away from the interview time – if you know any prior grads at a TCU ask what they think of their company, or go to a PT Pub Night, or ask classmates what companies and locations they interned at and what they thought about the corporate culture).
  3. Will you be at one site, floating as needed between sites, or doing HH as needed?
  4. Get a sense of how important rehab is to the facility – if they put money into the rehab dept (as it is where a facility makes its money) it makes a real difference.  If the gym is in the basement with no windows and little equipment, it may be depressing to you and to the patients.
  5. What is the con-ed budget?  Companies may offer CEU’s through ACP (the modalities company) or Medbridge and have less of a discretionary con-ed budget.
  6. Mentoring – is there a PT you can turn to as a new grad if you have questions or need help?  Ideally an official mentor, but that doesn’t happen really in this setting (or rarely).
  7. Will you be all alone as a new grad?
  8. Will you be responsible for a PTA (or two???) as a new grad?
  9. What is the typical day like – treatment times, diagnoses generally seen, etc.
  10. How much is TCU vs LTC vs OP?  (I have been in a combined setting most of my career thus far).
  11. Holidays and weekend – how many do you have to work, or are you on call, etc?
  12. Dress code?
  13. Weekend pay differential if you are required to work weekends?
  14. Do they reimburse licensure? (pretty rare in TCU)
  15. What is the nursing: patient ratio (and the NAR: patient ratio)

Motivational Interviewing

I’m presenting a CEU with a colleague and the director of the residency program tomorrow on balance and falls.  Part of my portion is on adherence to fall risk recommendations – I can’t go in depth in this CEU as I have at other times (when the topic was specifically adherence), and it has been a while since I’ve really dug into the literature on adherence in general other than monitoring it via PubMed’s weekly update email.  One of the adherence models used is the Transtheoretical Model (stages of change), which uses Motivational Interviewing, or MI.  In refreshing my memory, I found two good videos on this that I’ll post here.  Watching them reminded me how I found the TTM and MI intriguing, and that I’d like to take a class on it to get better.