Connecting the classroom and clinic is the presentation from the APTAs Combined Sections Meeting in February 2011.

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. Objectives

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

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. Wiki

6. 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

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… Community Public or Private memberships EASY! 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 Connected! 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 Abassi BMJ, 2002

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

14. 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

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 Collaborative International Free Non-profit What?

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? Individuals Clinicians Researchers Educational institutions Universities 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

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 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 Outcomes

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

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

45. Wiki Use in the PT Classroom Elaine Lonnemann

47. 15 Provide opportunities for academic and clinical faculties to develop approaches to teaching using evidenced-based strategies that are effective in promoting learning.

50. Group vs. Individual

51. Underutilized ResourceFormer Project

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

53. 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

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 Template

55. Lyme Disease Ehlers-Danlos Syndrome Cluster Headache Examples

56. Examples from CPP-Lyme Disease

57. Examples from Ehlers-Danlos Syndrome

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

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

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

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

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

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 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

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. Objectives

69. 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

70. 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

71. World Wide PT Practice:A Focus on Primary Care Canada

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

73. TEXAS STATE UNIVERSITY EVIDENCE BASED PROJECT 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. Instructions

75. 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

76. 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

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

83. OTHER PROFESSIONAL DEVELOPMENT USING A WIKI

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 guidelines Find your answer Revise the technique Find related research Investigate 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

96. No supportive referencesActual 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

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

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