Blog 23: Senior Project Reflection

1. Positive: I'm most proud of the fact the I pretty much talked for 90 minutes non-stop. I had a bunch of content and I feel that I definitely kept the energy up the entire time. I think I spoke well and gave an entertaining and informative presentation.  I also think it's really cool that I talked passionately about a topic I have zero passion for. It's boosted my confidence in my presenting skills and it feels good to know that I could easily do it again if I had to.

2.a I'd give my block presentation a P+. I think I hit all the necessary points pretty well and I easily reached a full hour of pure content so that's where the + comes in.

b. I'd give myself a P. I did what I was expected to and I did it effectively.

3.  During my senior project I really hated my topic so I think I did a bang-up job setting that aside and grinding it out to deliver a quality presentation in the end. It worked out well that I presented the first day because I've been ready to finish senior project since day one.

4. If I had to go back in time and change something I'd change my topic entirely. Probably something about music because then I could research something I'm actually passionate about and for my independent components I could've done some recording like I've always wanted to.

5. Senior project has definitely made me confident in my ability to hunker down and deliver solid work when I'm required to. I think I budgeted my time better than I did in past years, and I've gotten so used to the stress of long term deadlines that at this point I'm not even worried about college or anything. My senior project definitely helped me narrow down my career options. I know for a fact now that I will never want to be a physical therapist, but I also know that I could really thrive in a medical career if I decided to pursue one. This project has made me realize I have the interpersonal skills and intellectual capacity to talk fluently to pretty much anyone and also digest monumental amounts of information. Even though I went through the process kicking and screaming I feel that senior project has actually changed me for the better and helped me hone skills that were on the back burner for a while.  

Blog 22: Mentorship

Literal:
Hours log - See link on blog
Contact name and place of mentorship - Robbie Faustino, PT aide, Casa Colina Centers for Rehabilitation.

Interpretive:
The most important thing I learned during my time at Casa Colina was probably the flow of hospitals. I watched so many evaluations and saw so many plans of treatment play out that towards the end it became easy to predict the way things would turn out. One of the most interesting things I've taken from my senior project is how the human body is a machine like any other, and can be treated as such in physical therapy. There are treatments with such high rates of proven clinical effectiveness that once the PT gets that eval out of the way, the finish line is already in sight. Even though patients will come in presenting very different problems to the PT, the treatment flows the same way for the most part. The first portion of treatment always begins with tentativeness and anxiety on the patient's part, but later on treatment goes more smoothly as the patient gets more and more comfortable, falling into the routine of performing their prescribed exercises. This kind of thing is good to know and gives insight on why hospitals do things the way they do.

Applied:
The 50+ hours I put in at Casa Colina gave me a lot of insight on how exactly the healthcare system works, and what we need to do to improve it. PTs like Annie, Dave, and Manny have been working in physical therapy for a long time and gave me their views on streamlining medical records and improving patient education in hospitals. Cinnamon and Robbie, PT Aides who did more of the hands on stuff with the patients, showed me how to effectively treat and maintain the body in the event of injury/disease. I talked with a lot of patients about what they thought of their experiences in Casa Colina, which as cool, but a lot of the time I could tell what they thought just based on body language alone. A lot of the first time patients gave off incredible vibes of anxiety and fear, and I think the hectic nature of a physical therapy ward is not very conducive to stress-free treatment. More than one patient also told me that they wished they could have consistency with their physicians, and that having PTs constantly changing in and out with their schedules was tiresome. All this combined with my research on healthcare policy improvements made it clear to me that patient centered care was probably the best answer to my EQ. This care model addressed everything I had learned regarding patient needs and the required conditions for effective care. If I just did research using online sources and print resources, I doubt I would've arrived at the same answer. The PTs and PTAs at Casa Colina were very helpful in nudging my research in the right direction.    

Exit Interview

1.) My EQ is "How can a physical therapist best ensure a patient is effectively cared for in an outpatient physical therapy setting?" My first answer was a thorough initial evaluation, my second answer, proper patient education, and my third, patient-centered care. It was fairly obvious even before I got to my third answer that patient-centered care would be my best answer.It’s easy to see why patient-centered care would be the biggest asset to outpatient physical therapy. PCC brings some of the most important aspects of very effective care models and condenses them into one package. There’s no bells and whistles, and no filler. Every component of patient-centered care has a purpose, and all parts are designed to aid in providing the most effective care possible. The comprehensive care model is tailored to human nature and accounts for medical interventions, access to information and education, environment of care, family involvement, and patient preferences and education. Much like the human body it is working to repair, patient-centered care functions as a well oiled machine, precise in its movements towards effective care and greater than the sum of its parts.

2.) It dawned on me about halfway through my research that patient-centered care actually includes many of the care philosophies related to my other findings. For example, while studying techniques for patient evaluations, I learned that communication is a critical factor to consider while performing a systems review.  In the 2006 NIHCM Meeting Brief, the foundation proposed to increase their focus on healthcare-consumer education in order to yield more effective care in medical practices. Their goal was to combine better patient education with consumer-engagement techniques to ensure patients had every opportunity to make well-informed decisions regarding their health. By looking at the entire picture instead of isolating specific parts of my research, it becomes very clear just how comprehensive patient-centered care is. It feels as though every article I read in the last eight months was leading me right to PCC as the best answer to my essential question. It is without a doubt the best way to effectively provide care for outpatient physical therapy patients.

3.) There weren't too many problems I faced while arriving at my best answer. Like I said, I felt as though the whole research process was sort of leading me to some sort of conclusion. I had this thought like "there's an exact answer to my EQ out there somewhere," and I knew just as soon as I had read the words "patient-centered-care" that that was the one. It became real clear to me almost instantly, and then after that I spent a lot of time researching that one answer. There was plenty of articles on the subject as well so it wasn't too difficult.

4.) The Picker Institute's Practical Approaches for Building a Patient Centered Culture
and Donald M. Berwick's article "What Patient Centered Should Mean" were my most valuable sources. These helped me confirm that patient-centered care was my best answer and provided a lot of other helpful articles/literature in their works cited that helped me expand my knowledge on the topic of PCC and physical therapy in general. Practical Approaches gave me a lot of information on the necessary conditions for PCC to be effective, which makes up a good portion of my paper. Berwick's article gave doctor's opinions on PCC and explored it's strengths and weaknesses, which was helpful in deciding if it was my best answer or not.  

Blog 19: Independent Comp 2

a.) I, Ian Kam, affirm that I have completed my independent competent which represents 34 hours of work.

b.) While going through the course I frequently visited Dartmouth's website to get a better understanding of what I was learning. I was going through the course kind of quickly to make sure that I'd finish it by the time the assignment was due, so the extra source of info was real helpful.

"Basic Human Anatomy: A Regional Study of Human Structure (online version)." -
Ronan O'Rahilly, M.D.
Fabiola Müller, Dr. rer. nat.
Stanley Carpenter, Ph.D.
Rand Swenson, D.C., M.D., Ph.D

 http://www.dartmouth.edu/~humananatomy/index.html

c.) See Hours Log

d.) 
For my independent component I completed the free online course "Anatomy + Physiology" offered by Carnegie Mellon's Open Learning Initiative. It was a weighty course that ended up being more time consuming than I thought, I ended up having to put in a little more time than I anticipated, even while trying to rush through the course the last week or so.

 OLI Homepage^

 "Anatomy + Physiology" Homepage^

INTERPRETIVE :
The course consisted of 15 Units that contained a total of 57 modules.  Each Unit focused on one particular body system and generally had around 4 modules detailing the structures and functions of the system, the levels of organization, the way that the system achieves homeostasis, and the way it integrates with the rest of the body. Every module outlined the learning objectives at the beginning and came with practice questions and interactive bits that checked for understanding of the content. The class as a whole was not graded, but there were three scored tests in the program.

 Examples of Learning Objectives (Cardiovascular system) ^^

 Practice Questions^^

I don't know why the three scored portions of the program were in the last 3 modules. I guess the program is fairly new. At least I know a lot about the nervous system now.

Scored Portions of the program ^^^

APPLIED:
Above all, taking this course has reinforced my belief that the human body, with all it's complexities and difficult-to-pronounce structures, is a machine like any other. With science and technology we're able to predict to a T how the human body will react in virtually any situation, and with that knowledge we as humans can control these vessels with frightening accuracy and confidence. This component has also brought to light how powerful the brain is in it's ability to essentially coordinate every possible function in the body. I can apply what I've learned here to all three of my answers, which is kind of exciting. For one, my first answer is about initial evals and how they are vital to the care process. I now know that most every system in our body integrates with the others, and neglecting to thoroughly examine one part of the body could harm the others.

This also helps my third answer in a mind-blowing way. The brain is an unbelievable muscle. It's self-aware; it knows that it's a brain. So, as humans we're also able to learn about and comprehend the mechanics of our brain's vessel, the human body. I can eat a piece of toast and step by step explain exactly what's going on in my digestive system, what chemicals and hormones my endocrine system is sending out, and also how my central nervous system is responding. The fact that one person can be conscious of all that is crazy enough, so the phrase "two minds are better than one" is especially true. The basis of patient centered care is basically to bring multiple individuals together to solve one individual's problem. It's like pooling intellectual and cognitive capitol together, which I've concluded will yield the best possible care. Science has made it so all humans have the capacity to become experts on the body, so it makes sense that multiple experts on the human body would provide better care than simply one expert.

March Post

March has been pretty uneventful regarding senior project. There weren't very many research checks because of powderpuff and other stuff, and I've been ahead on sources for a while now so research hasn't been very intense. I've been going to mentorship at Casa Colina pretty regularly lately, but it's getting really boring. I do the same thing every time I come in and I've pretty much lost all interest, but I'm halfway done with hours so I guess I'm happy about that.

For my last interview I think I'm going to talk to my aunt. I never knew I had a physical therapist in my family so I'm kinda stoked. I think it'll be a fun interview, plus I won't have to go into Casa Colina to get it done. I'm starting to hate that place.

I'm fairly confident about the I-Search paper coming up. I've done a ton of research this year, and I think I'm a decent writer so I'm sure it'll be a cakewalk. Things are starting to wrap up this year which is pretty exciting. I just want to do my 2 hour presentation already and be finished with it all. Waiting around is killing me.

Blog 18: Interview 4 Prep

Answer 3
1. What works in our current healthcare system?
2. What doesn't work in our current healthcare system?
3. From your experience, what would you change about the current system? And why?
4. What are your thoughts on patient-centered care?
5. Why do you suppose healthcare has not shifted into this model of care yet?
6. What do you think the long term effects of a shift into patient-centered care will be?
7. Are there any other healthcare models/theories that may start popping up in the future?

Answer 2
8. What difference does good patient education make in the final outcome of treatment?
9. What would you say qualifies as "good" patient education?
10. What are some outcomes of poor patient education?
11. What would be considered inadequate patient education?

Answer 1
12. What makes the initial systems review so important in physical therapy?
13. Is there any part of the systems review that requires closer attention to detail? Why?
14. Was there ever an eval that you did that went pretty badly? What circumstances made it difficult?
15. How can a PT ensure their initial eval is as comprehensive as possible?

Other questions
16. How can a physical therapist best establish good communication with a patient?
17. Is there any singular factor that will, for lack of a better term, "make or break" the effectiveness of a patient's care?
18. How does patient/P.T relationship affect the overall care experience? How does it compare to the relationship between patient/doctor?
19. What would you say is the difference between "effective care" and "efficient care?" Could you pick one over the other if you had to?
20. (EQ) How can a physical therapist best ensure a patient is effectively cared for (in an outpatient p.t. program)?

Blog 17: Answer 3

EQ: How can a physical therapist best ensure a patient is effectively cared for in an outpatient P.T program

Answer 3:
Implementing the "patient-centered care" model will ensure high-quality care for a consumer participating in an outpatient P.T. program.

• In the past, patient involvement was limited to physicians giving patients the opportunity to ask questions. But if a doctor rattles off a whole lot of confusing medical terminology and follows up with "Any questions?", the patient is overwhelmed and will be inclined to say "no." The patient-centered approach to this involves "inviting" patients to participate in the thought process as to enhance clarification and put everyone on the same page.

• Since patients rely on caregivers to take them through the healing process, it's crucial for all members of the healthcare team to have open lines of communication with both the patient and other team members. A patient's perception that their multiple caregivers are not talking to one another about the plan of care can lead to frustration and feelings of exasperation. In the patient-centered model, care is highly coordinated among healthcare professionals, the patient, and the patients family, with open communication ensuring the care is consistent and thorough.

•  Patient centered care places heavy emphasis on the environment in which the care is taking place, and the technology used to facilitate the flow of information. A physical therapy facility with a good design that supports and nurtures the healing process goes a long way. Quality supportive technology engages patients and family members by submerging them in the flow of information and communication.

Sources: 

"Patient Centered Care: What Does it Take?" - Dale Shaller

"The Value and Values of Patient Centered Care" - Ronald M. Epstein, MD, and Richard L. Street Jr. PhD.

"Practical Approaches for Building a Patient-Centered Culture." - patientcenteredcare.org

This answer seems like it could be my strongest answer. The amount of research out there and the pressure to shift to this model of care is really intense, so I think this is definitely the right direction to head in.

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Blog 16: Answer 2

1. My EQ: How can a physical therapist best ensure a patient is effectively cared for in an outpatient P.T program?

2. First Answer: A thorough initial assessment by the physical therapist is the cornerstone of effective care in any kind of therapy, physical or otherwise.

3. Second Answer: Proper patient education will ensure the most effective care in a physical therapy program.

4. Justification:

• When the patient knows what is happening in their body and how it correlates with the interventions they've been prescribed, they are more likely to carry out their treatment and be active in the healing process
• Knowing how the body works (what it can do and how it can do it) is key when it comes to preventing injury in the first place. Educating the public on the the vehicles their consciousness operates will help to prevent accidents.
• When a patient is well informed about their condition and injury, it decreases the chance that they will perform their prescribed exercises wrong and injure themselves further.

5. So far, the meeting brief of "Capturing Value: Increasing Efficiency in Health Care" by the National Institute for Health Care Management

6. My mentor straight up told me that education in physical therapy is more valuable than the therapy itself. Without proper education you could very well be running in place when it comes to the healing process

7. As of right now, I've barely scratched the surface of my second answer. I know just from reading the NIHCM brief that the depth of research I can do on this answer is pretty vast. I'm looking forward to my next interview to see if I can gain some insight on the topic of health care education.

Blog 15: Independent Component 2 Approval

1. For my 2nd independent component, I'll be taking a free online course in anatomy and physiology provided by Carnegie Mellon University's Open Learning Initiative. The class consists of 15 units and a total of 57 different modules to work on. If I spend 30 minutes a day studying and going through the course, I'll have well over 30 hours before the independent component is due.

2. Each of the modules has little quizzes and the units have tests, so I'm planning on taking screenshots and/or printing out my tests and quizzes to show that I actually completed the course.

3. I figure this is a great way to supplement my knowledge on physical therapy while simultaneously going to mentorship each week and applying that knowledge to some extent. I've found that a good amount of the things my mentor shares with me take some time to settle in my brain before I can wrap my head around the concepts, and I think it's because I haven't really taken a straight up anatomy course yet. I had some basic anatomy in sophomore year, but not enough to make me confident in my knowledge.

4. See Senior Project Hours

Blog 14: Independent Component #1

LITERAL
a.)"I, Ian Kam, affirm that I completed my independent component which represents 30 hours of work."

b.)My mentor Andrea Haston DPT, ATC, helped me complete this component by allowing me to shadow her at Casa Colina.

c.) See hours log.

d.) My independent component was 30 extra hours of mentorship.

INTERPRETIVE
There's only so much you can get out of looking up articles and reading medical journals. Nothing really beats the real thing when it comes to medical knowledge. Annie is very passionate about what she does and is very accommodating when I tell her the requirements of my senior project. Every time I go in to do mentorship I learn a little more about anatomy, patient care, and patient relations, all of which are invaluable to forming answers to my EQ. I don't really have physical evidence of my experience, but you can contact my mentor and confirm with her that I put in the hours.

APPLIED
Well the foundation of PT lies in education, and applying knowledge of the body and it's systems to help people get better. I'm not really sure how to provide an example of how my understanding was improved; I'm guessing that would be reflected in my Lesson #2 and Final Presentation grades? I've learned that patient education is key, and that effective care in PT is dependent on both the health care professional's intervention and the health care consumer's compliance and understanding of what's going on. I don't know if that's a good answer. I guess because ALL knowledge pertaining to physical therapy is applied knowledge it's sort of difficult to answer.

January Extra Post

This month has been kinda hectic considering we had the second lesson presentations. I didn't procrastinate on my lesson as hard as I did last time, and it turned out a bit better because of that. I also practiced presenting with a stopwatch at home, which helped me on the timing. Last time I hadn't practiced beforehand, and I ended up having to really rush towards the end of the ten minutes. This time I was able to set the pace more comfortably.

The research I've been doing regarding my second and third EQ answers has gained momentum, and I'm starting to find the sweet spot when it comes to picking helpful articles. The only problem is that my possible answers may be too specific, and a lot of the journals and articles I'm finding are telling me the same things. I may have to change my approach a little bit so I have room to explore the answers more in depth, or I may have to come up with new answers. But regardless of all that, I'm sort of settling into the groove of senior project. I nailed my Lesson 2 presentation, and I know the final senior presentation will be a cakewalk.

One complication came up with my mentorship; my mentor is changing her hours, and soon she won't work on Saturdays anymore, which means it'll be harder for me to do mentorship considering the only other day I can go is on Thursdays. I may have to find another mentor to supplement this future loss of mentorship opportunity.

Blog 13: Lesson 2 Reflection

1. I'm most proud of that fact that I delivered over 15 minutes of solid research content, and it didn't even feel like very long. It came really easily to me, and I'm kind of stoked on how much information I've actually absorbed over the past couple months.

2.a I'd give myself a P.

2.b I turned everything in on time and I hit every bullet on the far right rubric column pretty much on the dot.

3. I think my presenting style works well with my topic. By that I mean, a lot very technical topics like medicine or engineering are pretty boring to hear about in a presentation, but since I present in a more active and conversational manner, it's good for capturing the audience's attention.

In my PowerPoint presentation, I had more topics than I had time to cover, so once I realized this, I decided to ask the room what they wanted to hear about instead of just carrying on with the planned slides. This gave my lesson a more interactive feel, and also freed up more time for my activity and conclusion. It was a good move in hindsight.

4. I would've scrapped some of my slides If I could go back, or at the very least planned out how I was going to present them a bit better. I found myself sort of rambling at some parts and in my mind I was thinking "dude stop talking about boring old ACL injuries," but it was too late to stop mid explanation. Next time I'll rehearse run my presentation a couple more times at home to work out more of the kinks.

5. Possible answers:

• "collaborative care"
• A strong healthcare team 
• putting the healthcare consumer at center of focus  
• prevention/prehabilitation

Blog #12: Mentorship 10 Hours CHeck

1. I'm currently doing my mentorship at Casa Colina Centers for Rehabilitation

2.  My contact is Andrea Haston DPT, ATC

3. I've done a total of 16 hours.

4.  I do a lot of observing at Casa Colina. I watch my mentor treat patients and listen while she explains anatomy and PT concepts to me. I also talk to the patients quite a bit. I learn about what they're going through and what exercises my mentor has prescribed them to help them get better. I help out in maintaining the PT ward as well; I throw dirty linens in the laundry basket and replace them with clean ones, wipe down tables, and make ice packs when one of the PT's/PTAs needs them.

Blog 11: Holiday Project Update

1. Over the break, I did some more hours with my mentor. It was pretty slow since I went in a few days before Christmas, but hey, hours are hours right? I also did a little catching up on research checks. I went back and finished notating sources I hadn't completed.

2. The most important thing I learned from the hours I did was that physical therapy can be very physically and emotionally draining for the patients. I was observing my mentor work with a woman who had shoulder pain for the past year, and all of a sudden the woman sort of broke down, like not really crying, but not really not crying, you know? Regardless, she appeared to be very distressed. I overheard her say how she was just tired. Tired of the pain, tired of not being able to handle simple motor function, and tired of being tired of all that stuff. Sometimes the marginal improvements from weeks of physical therapy can be underwhelming at best. I know from personal experience how frustrating it is when you feel like you're not recovering, or not recovering fast enough. That's just something that really stuck with me from this mentor ship experience. The emotional toll can be severe, and it's something you don't really stop and think about 'till it's staring you in the face.

3. If I could interview my mentor, Andrea Haston, again, I'd definitely interview her for this 10 question. She's very knowledgeable and passionate about her work. If that's not an option, I'd have to go with her co-worker Manny. Manny is a PTA, so he works directly under my mentor. He gives off this vibe of wisdom, which I think is rad. He's definitely someone I'd be down to interview.