SPINAL IMAGING for the DPT CURRICULUM
Colleen Johnson PT, OCS
BACKGROUND
The inspiration for my capstone project emerged from many experiences I had throughout my t-DPT education. First, after taking the course Advance Patient Management II in the spring of 2016, I realized how little education I previously received in regards to imaging, and how much I wanted and needed to learn. To accomplish this goal, I took the opportunity to sit in on the medical imaging lecture by Joy Renner, MA, RT (R) in the Introduction to Physical Therapy Assessment and Procedures class. I also took the continuing education course Diagnostic Imaging of the Spine, by Dr. Charles Hazle offered online through the Learning Center of the APTA. Participating in these two classes not only advanced my knowledge of imaging, but it showed me what the current UNC DPT students were learning and what additional imaging curriculum could be developed.
Secondly, Dr. Carla Hill, knowing my interest in becoming involved in education, offered me the opportunity to assist her in the spine module of Advance Patient Management II during the spring semester of 2017. Completion of UNC’s Physical Therapy Education Seminar and ECU’s Adult Educational Strategies courses as well as viewing the VoiceThreads on how to properly create a Powerpoint presentation, provided a better understanding of the process to develop and deliver new curriculum. This understanding led to the development of my two Capstone products, a VoiceThread lecture and a reference guide.
Lastly, I had the opportunity to witness the use of rehabilitative ultrasound imaging (RUSI) and was intrigued by its applications in physical therapy practice. This led to my CAT project for Evidence Based Practice II, where I researched the current evidence for RUSI thus allowing me to recommend additional content for the spine module. The combination of these experiences became my motivation to add to UNC’s imaging curriculum, as well as assist in the instruction and evaluation of students in the spine module of Advance Patient Management II.
OVERVIEW and PURPOSE
The requirement for imaging content in DPT programs has been well established by CAPTE, APTA, and the FSBPTE.1-4 With direct access and a push for physical therapists to have imaging privileges, today’s graduates must possess a broader knowledge of basic imaging modalities that would include mechanism of action, indications/contraindications, limitations, and risks.2, 3 The ability to recognize indicators for diagnostic imaging is considered an entry-level skill and questions regarding this topic have been included in the National Physical Therapy Examination since 1997.2 In the November 11, 2015 revised Standards and Required elements for Accreditation of Physical Therapy Education Programs, the topic of diagnostic imaging was added as part of the necessary curriculum for entry level practice.1 On May 20, 2016, the Imaging Special Interest Group of the Orthopedic Section of the APTA published a white paper titled “Diagnostic and Procedural Imaging in Physical Therapy Practice” in which they discuss the continued need for on-going and up-to-date imaging content in the entry-level DPT programs.3
In addition to basic imaging knowledge, the Imaging Education Manual for Doctoral of Professional Degree Programs, published in 2015 by the Imaging Special Interest Group of the Orthopedic Section of the APTA, reports that due to the advances in ultrasound imaging (USI), and its adoption by PTs in clinical practice, education in the fundamentals of USI and its clinical applications by physical therapists should be added to the DPT curriculum.3 The scope of both diagnostic and procedural imaging for physical therapy is evolving and the purpose of this capstone project is to contribute to this program’s imaging curriculum and enhance the knowledge of the students and faculty that view my products.
PRODUCTS
Initially, a questionnaire was developed and distributed to the faculty of the UNC DPT program to assess where musculoskeletal imaging is currently taught, what content is covered and what they deem important for entry-level education related to imaging. Their responses assisted in the development of the next two products.
A VoiceThread was created and integrated into curriculum during the third week of the spine module of the Advanced Patient Management II course. The purpose of this product was to review basic radiology terms and concepts, examine the 3 most common types of modalities in spinal imaging (x-ray, MRI and CT), as well as view and evaluate images of common pathologies of the spine.
A quick reference guide was created and distributed not only for the students of the class, but also for UNC faculty and physical therapists. This guide included key points discussed in the VoiceThread as well as links to resources related to imaging that are appropriate for physical therapists.
EVALUATION and SELF-ASSESSMENT
Feedback was solicited and received throughout the development of this project via email and phone calls from Dr. Mike Gross, Dr. Carla Hill and Dr. Ted Boyse, Division Chief of Radiology at Duke Raleigh Hospital and Assistant Professor at Duke University.
Feedback on the VoiceThread was requested from the students of the Advanced Patient II class and collected via an eight-question survey. Based upon the 37% response rate thus far, the scores received from this survey demonstrate that overall this presentation was successful. The highest scoring items (4.82/5.00) were in regards to the benefit of the slides and the content covered. However, there are opportunities for improvement. The lowest scoring item (4.09/5.00) was in response to the question of voice being appropriate. I agree there was some fluctuation in volume and I could have increased the speed of my lecture. I have learned a great deal about the challenges of online education and how difficult it can be to record a lecture versus present live. I hope to have continued opportunities in the future to improve upon instructional skills in both learning environments.
A four-question survey requesting feedback on the quick reference guide was given to the students in Advanced Patient Management II, the UNC faculty who received the initial questionnaire, and seven outpatient physical therapists. Based upon the 25% response rate thus far, the average scores of the four questions being 4.75 out of a possible 5.00. After several drafts, I am happy with the final product which can be a useful tool for both students and clinicians.
Although I am extremely pleased with the products developed for this capstone project, the knowledge I gained from this experience is what I treasure. Not only did I achieve the objective of learning more about musculoskeletal imaging, I have gained, what I assume to be, just the tip of the iceberg when it comes to experience in education. I have a greater understanding of the challenges and rewards that come with teaching and I hope to continue to hone my skills and remain involved in academia.
ACKNOWLEDGEMENTS
I would like to thank Dr. Mike Gross not only for his advisement on this project but on his commitment to physical therapy education, I have truly enjoyed being your student. Next, I want to offer my gratitude to Dr. Ted Boyse. Your input proved vital to this project I am grateful you offered your precious time to be on my committee. Last, but certainly not least, Dr. Carla Hill, I cannot begin to put into words how much I appreciate all your help to bring this project to fruition. The time and energy you put forth and the experience I gained from assisting in your class is truly invaluable.
REFERENCES
1. Standards and Required Elements for Accreditation of Physical Therapist Education Programs. Standard 7A. Alexandria, VA: Commission on Accreditation in Physical Therapy Education; 201
2.Diagnostic and Procedural Imaging in Physical Therapy Practice. Orthopedic Section, APTA; 2016
3. Imaging Special Interest Group, Orthopedic Section, APTA, Inc. (2015). Imaging Education Manual fro Doctor of Physical Therapy Professional Degree Programs. http://www.orthopt.org/uploads/content_files/files/DxProcImagPhysTherPractice_FINAL.pdf
4. “Federation of St ate Boards of Physical Therapy; Physical Therapist NPTE Test Content Outline, effective 2013.” 2012.
8 Responses to “SPINAL IMAGING for the DPT CURRICULUM”
Debby Givens
Nice work, Colleen. I was interested in what you learned about RUSI. I have some experience with it, in fact, you reviewed one of my studies in your CAT (Herbert WS, et al) in a previous life, my last name was Heiss. I have found RUSI to be an effective tool to help people with LBP to get engaged with the importance of exercise for the low back muscles. It was a real motivator for them. Did you find learning to do RUSI of the multifidus to be challenging?
Colleen Johnson
Oh my goodness I had no idea you studied RUSI! Unfortunately, I have never had the opportunity to perform RUSI myself. I was at a clinic that had received a unit and attended their inservice. It was just this brief exposure that sparked my interest to learn more and make it the focus of my CAT. It seems as though there is quite a bit of skill involved in identifying the musculature but I am sure, like with anything, practice is key. I work with patients everyday that are struggling to engage those back muscles and this seemed like a great tool to facilitate recovery, perhaps one day I can convince my clinic to invest in one.
Thank you for taking the time to read my post.
Colleen
Carla Hill
Colleen,
Excellent work on your Capstone! I too gained a lot from your efforts. Your pre-lecture survey, attending the DPT1 imaging class, and taking the APTA imaging course laid a strong foundation for you to create and deliver a lecture to DPT students in a format that will remain valuable to the UNC curriculum for years to come.
Some additional things you did as part of the Capstone but aren’t really highlighted here are your appraisal of literature related to RUSI as an intervention (for EBPII), addition of content related to RUSI to the spine module (reading and video links) and assessment of student learning via the grading of discussion board posts. What did you find helpful and challenging about reviewing student posts, assigning a grade and delivering individualized feedback? How will your experiences this semester influence your teaching efforts in the future?
Carla
Colleen Johnson
Carla,
Thank you very much! I could not have done it without you! I added a link to my CAT project, as you are correct, that did play a large role in my ability to recommend content for the Spine Module. As far as grading the student posts, I found it very helpful to practice for those two weeks then compare how my assessments aligned to yours. Seeing how our thought processes correlated, gave me confidence to grade week 3 posts. I found it challenging to grade and write individualized feedback when a post was not “incorrect” but just lacked depth of thought, as I wanted to offer specific recommendations on improvement. This semester I was able to fulfill my goals of gaining experience in academic teaching. I was able to give a live lecture, assist in a lab class and in an online course. I confirmed what I had imagined prior to starting this program, although it is very hard work, I truly enjoy teaching students in the academic environment and I will continue to pursue opportunities to do so in the future.
Colleen
KMac
Yay Colleen!!! What a service you’ve done for our students by developing this information for their benefit. I like how you’ve linked multiple experiences together to help you move toward being able to work more with students in the future. Excellent job and congratulations on finishing the program!!! KMac
Colleen Johnson
Thank you KMac!
Jessie Risen
Hey Colleen,
You did a great job on you capstone project! I personally had the opportunity to perform an in person lecture on campus for my teaching experience for our tDPT summer course. I couldn’t imagine the amount of work it took into creating the voice thread you did! It still seems intimidating to me and you did a FANTASTIC job with it. I hope to become as experienced as you in utilizing this type of technology in delivering a lecture/information via a tool like voice thread. After your experience with the voice thread and your recent experiences and observations in onsite classroom lectures, did you develop a preference for what type of setting you would like to eventually participate in with your future pursuits in academia? I personally enjoyed my onsite lecture and lab experience but would welcome an opportunity to try something like this. Again, great job on your project! What an achievement!
Colleen Johnson
Thank you for the kind words, and great question, however I do not have a definitive answer. I quickly realized creating a VoiceThread was much more challenging than just speaking into the microphone. Although it is nice you can re-record as many times as you want to get the lecture just perfect, I missed the instant interaction from the students by being able to answer questions immediately or to see on their faces if they were grasping the concepts. However, looking at the big picture, I believe the world of online education will continue to expand into all academia, including PT programs, and I would like to continue to improve upon my skills to allow myself to function comfortably in both settings.
Colleen