15- FOXcast PT: Rebecca Craik At Our Geriatric Residency In PT Capstone

Becky: Old people are just spectacular: They have so much wisdom and knowledge. It’s a different work ethic. Nobody listens to them, so they really, they really like to share their stories and their stories are meaningful. And, a little thing can make such a difference. It’s just such a rewarding experience.

Jimmy: Welcome to FOXcast PT, a podcast for clinicians made body clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Welcome to FOXcast PT. I’m your host, Jimmy McKay, and joined now by, I’ve got, I’ve got a great intro for ya – graduated from the first PT Masters class at Duke University, great school; received her Ph.D. from Temple University School of Medicine; spent the majority of her career at Arcadia University as a faculty department chair and now Dean; has been funded to conduct research associated with plasticity, movement, and recovery; past president of the APTA section on research; and was editor-in-chief for PTJ. Probably a shorter list of things you haven’t done.

Welcome to FOXcast PT, Becky Craik. Yeah! Welcome to the show!

Becky: Thank you.

Jimmy: You were sitting on the panel for us – we’re recording this at the PT home office here in Cherry Hill, New Jersey for FOX Rehab. And we had our Capstone – our students present. That’s got to be tough to be a student up there.

Becky: Oh, I can’t imagine being the students, I can’t, because they’ve spent that whole year…

Jimmy: Making something.

Becky: Right. And then we’re going to give criticism? It’s a really, it’s a delicate balance.

Jimmy: How do you prepare for that? Because this could be a teaching/learning moment for anybody, whether it be a one on one with someone you’re mentoring, a student you’re teaching in school, formally or informally. How do you prepare to give really constructive feedback?

Becky: It’s a really good question. I think trial and error. I don’t I don’t think that’s a good way to do it. I think pulling out what’s positive and helping them understand that the criticism isn’t about them.

Jimmy: Right, it’s not personal.

Becky: Right – at all! It is just about the data and you should welcome criticism because it only makes it better. But that’s hard to do.

Jimmy: It is still a little, ah, a little nerve racking.

Becky: Yes, exactly!

Jimmy: You know.. .

Becky: Exactly! It is, it’s really scary for them.

Jimmy: And that is the thing – it’s hard, it’s hard probably to separate. You’re saying make sure you know the criticism is not about the person it’s about the research or the presentation. But it’s also probably good to know that going in is the presenter. This is about your project, this isn’t about you because it can be daunting! And then you’ve got 200 people you’re standing in from of saying it.

Becky: Well and I remember when I gave my dissertation at the neuroscience meeting they were, in the audience were about 300 people. When I stood up almost all of them left because the people that preceded me were really famous. Then I got up and maybe they were 25 left. I had seven minutes to present. The first slide was backwards and upside down!

Jimmy: Oh, your kidding me!

Becky: And it had all of the variables, and it was… and then the pointer went out! So it was like everything went wrong! There was this great big tall stick – I went over and grabbed that. I talked with the slide being backwards.

Jimmy: You did not!

Becky: I did! Well, while the guy was fixing the other slides. When I was finished there were no questions, and that’s bad – that’s bad!

Jimmy: Why is that bad?

Becky: Because that means they didn’t understand, or it wasn’t interesting. So I think that’s the other, sort of, message is: if you’re presenting something that welcomes comment that means you’re doing, that’s the beginning.

Jimmy: OK.

Becky: That’s really important.

Jimmy: That’s discussion.

Becky: Correct.

Jimmy: That’s scientific discussion on how we proliferate.

Becky: That’s right, right. That’s right. That’s exactly right.

Jimmy: So talk, talk about PTJ and being an editor. That’s a pretty cool experience!

Becky: It was a wonderful, wonderful – well you should talk to Alan Jette now ’cause he’s the editor.

Jimmy: Yeah

Becky: But I really loved that job. It allows, it allows the editorial board to keep current with all the stuff that’s going on in our field.

Jimmy: That’s the pulse!

Becky: It is amazing. So, so you are watching as new themes emerge. You’re, you’re getting to see new investigators emerge, um, strong clinicians. So you really feel like you’re right in the middle of all that’s new.

Jimmy: Yeah! How long did you do that for?

Becky: I was editor-in-chief for 10 years.

Jimmy: And how long were you, how long have you been involved with..

Becky: The Journal? Forever.

Jimmy: Yeah, yeah.

Becky: I mean, it was more than 30 years that I was involved with the Journal.

Jimmy: Talk about the research that you were funded to conduct. That’s got to be pretty exciting? Is someone, someone saying: “Here’s money go do, go do that research you’re interested in, and we’d love to know the answers as well.”

Becky: Well, Kate Mangione at Arcadia and I were really interested in hip fracture. I was interested in the mid 80s. Katie got interested in the 90s. She was a geriatric clinical specialist so she has a real love for old people. We worked with University of Maryland, University of Connecticut, and Arcadia. And so it was three sites and a multi-site trial, a randomized controlled trial, looking at two different interventions. It took us, I think three times to get funded.

Jimmy: Raally.

Becky: Yeah.

Jimmy: Is that average?

Becky: Yeah, that’s average.

Jimmy: Really.

Becky: And then for a little while, because there were so many people that kept on coming back, you’re only allowed to, to apply two times…

Jimmy: Wow.

Becky: And then you had to come up with a new topic.

Jimmy: Wow.

Becky: So, it’s not easy!

Jimmy: No!

Becky: Um, so when we received the award it was the happiest moment of our lives.

Jimmy: I bet!

Becky: It was just, it felt like you’ve achieved what you always… an RO1 from the NIH. It was spectacular. Then the reality set in…

Jimmy: Well then you gotta go do it!

Becky: Right, right. And you have to deal with all the personalities of the people…

Jimmy: Oh…

Becky: And patients disappear. You know, whatever, whatever you’re researching – when you finally get the money to do that, all the patients disappear.

Jimmy: Really.

Becky: I don’t know what happens to them! But anyway, doing research is important.

Jimmy: What would you, what would you say to someone who’s listening, who is thinking about doing some research, getting into it, what are some good tips or things to pay attention to?

Becky: Well, I think the guys, the two women who presented today are a good example. So, this residency allowed them to play with data. What it should have taught them is how much they don’t know. But if they liked playing with the data and asking questions, then you have to have that curiosity. If you have that curiosity and passion, you should go and get trained.

Jimmy: Yeah.

Becky: Because it’s so hard to do research without being trained formally.

Jimmy: Sure!

Becky: Especially the kind of research we need now, which health services research, which is what FOX is getting into. Um, but the foundation raised three million dollars…

Jimmy: Yeah.

Becky: Because it recognized that we don’t have enough health services researchers. And it’s been, I think they have 20 and they’re in the third year – they have 26 publications already! I mean, it’s remarkable how well… that, and they have fellows and postdocs, people getting their Ph.Ds. That’s what I’d love to see is, is if you have the passion follow it. You don’t have to be the principal investigator. You can be the master clinician on a study. But you just, you should participate anyway.

Jimmy: Yeah. And we need more of that, right?

Becky: Absolutely.

Jimmy: I mean that’s what they said 10/15 years ago when we wanted to get, you know, things evolved like this. We need to be backed by it. Implementation science.

Becky: What is it.

Jimmy: What is it?

Becky: What do you think?

Jimmy: Just so people know , I asks guests before they come on the show: “Hey, could give you three things you’re excited, want to talk about.” And then I on purpose don’t research things I don’t know, because I’m like: “Well I’m going to research it wrong, or I’m going to take the wrong spin and I’ve got to be passionate about it.” How to practically apply it?

Becky: Right. The assumption has always been, well there’s a 17 year pipeline from the discovery until it gets…

Jimmy: 17 years.

Becky: 17 years. That’s the average.

Jimmy: Wow.

Becky: Until it gets implemented in practice.

Jimmy: Wow.

Becky: Right! That’s the traditional path. And it’s called a pipeline ’cause it starts out with like whole bunches of information and it trickles down to the little bit…

Jimmy: Right.

Becky: That actually gets into practice. I think the reason that it’s been that way is because you publish it, you present it, and you assume that clinicians are just going to be so excited.

Jimmy: Take it and run with it!

Becky: And yeah, and adopt it.

Jimmy: So what actually happens in the life cycle of research.

Becky: You mean on the implementation side?

Jimmy: So we think it’s you publish it, everybody loves it, they implement it. What actually happens?

Becky: Well, so, so there’s a whole science and their journal’s called implementation science. There are a lot of outstanding scientists in PT in Canada and in the Netherlands and some in England. Here in the United States where physical therapists are just getting involved in implementation science, how do you present the information in a way that the clinicians understand it? And then when, when they understand it how do you make sure that they implement it. So then it’s continuing to check on them, review, remind them, follow up…

Jimmy: It’s 17 years.

Becky: 17 years from a discovery to practice.

By then we’ve figured something out, or maybe that thing we figured out is no longer, we figure out it’s no longer valid!

It’s really frustrating because with information coming out so quickly it’s really difficult to keep up. And it is going to take 17 years for a discovery to be implemented, back to your point, something might be out right now that’s more effective than what we’re trying to put into practice.

Jimmy: Right. Wow.

Becky: So I think those are all the competing interests that make… again my passion right now is to get PTs to go back and get their degrees in implementation science, so that we know what tools to do to assess, we know how to train clinicians to take on the change. You know, change is hard.

Jimmy: Yeah.

Becky: But it shocks me how long it takes from something that comes out, that used to come out and PTJ that was just a no brainer to me, and not see it being used in the clinic.

Jimmy: So let’s take the communication aspect out of it.

Becky: Okay.

Jimmy: Okay. It actually arrives on your desk and you consume it one morning before clinic. Is it personal bias? Is it… what is the, what is the fear? Is it because no one else around me is implementing it and I’m not bold enough to change? What? What do you think it is?

Becky: Well, I don’t know, that’s a good question that we have for everything.

Jimmy: We should do a study on it.

Becky: Right! So, yeah, exactly. Because why do PT students who are trained to be professionals in school go into the clinic and become service providers. Why do they lose that ability to want to make change and leave.

Jimmy: Creativity, wonder…

Becky: Yeah, it’s just fear. You know, I think fear is a reason. Lack of peer support. I’m sure there are, there’s a whole systematic list of resistance by administration.

Jimmy: It doesn’t fit into this clinic’s model is what you’re saying.

Becky: Yeah, yeah, yeah, exactly! And then I think the other really important point is just because one article was published with a good idea doesn’t mean that it is a good idea.

Jimmy: Right.

Becky: So you have to wait to have a meta analysis where there have been multiple studies…

Jimmy: Right.

Becky: That sort of synthesize it. And then there are umbrella analyses of meta analyses to really make sure that the change that you’re going to implement is meaningful.

Jimmy: People have to decide when they’re going to jump on it.

Becky: But I have seen the, the places where I’ve seen change happen most effectively or where the clinician’s still have time for a journal club and they sit and talk about change together – they implement something as a team rather than one person trying to fight…

Jimmy: Do it alone.

Becky: Yeah, yeah. And when you look at implementation science it’s something that you would go in and train the whole team to do, not just one individual.

Jimmy: Yeah. All right well fingers crossed on that because I think we need more of it. I think what we live in an age where you have, you know, a cell phone in your pocket that can do so many amazing things. Sharing of ideas – that’s kind of, that’s sort of the goal that I went to Robyn Kjar and Tim Fox here and I said: “We can share ideas for really smart people to other people who are begging for ideas.” And I hope that’s what this show does in its, in its lifespan.

Becky: I hope you’re right. In 2016 Arcadia had a symposium – we brought thought leaders from the Greater Philadelphia area in health care and said: “What do our students lack? What do healthcare students who enter into the current today’s workforce miss?” And they said data analytics. All right, so here we are again: big data.

Jimmy: Right, right, right. We know that’s the way it’s going.

Becky: It’s exactly right. Um, how do you code appropriately? What’s the electronic health record have in it? Are you collecting the right kinds of data for your discipline? I mean, so it’s all around stuff that isn’t necessarily paid attention to and we don’t have time to teach it all!

Jimmy: Right. there’s no room! Where’s you room?

Becky: Right. Right. Right. And they said leadership training. Again, back to the communication piece! So all that, those features that after you graduate you need to keep working.

Jimmy: Keep working! They hand you the piece of paper, you’re wearing the wizard suit… You’re not done yet! You’re actually just getting started – good luck!

Becky: That’s right! Well that what I say – research, you know, it’s just you keep on doing it again!

Becky: Researching! Right! Break it down. So we have a tradition here on the show called your FOXtale. So why did you choose to work with older adults specifically in the field? What’s the reason behind that?

Becky: You mean a personal reason?

Jimmy: Yeah!

Becky: Mark and I have lived together for more than 40 years and we chose not to have children but to take care of our family. So he had five aunts and uncles that we watched die.

Jimmy: Wow.

Becky: And my mom and dad lived with us on the weekends, um, for 30 years.

Jimmy: Wow.

Becky: So we watched them age and die. And I’ve been, I’ve had medical power of attorney for faculty members at Arcadia because they’re single and they don’t have anyone. Old people are just spectacular – they have so much wisdom and knowledge. It’s a different work ethic. Nobody listens to them so they really, they really like to share their stories and their stories are meaningful. And a little thing can makes such a difference. It’s just such a rewarding experience.

Jimmy: Yeah.

Becky: And the hip fracture literature, I mean you fall down break your hip – that’s not a big deal, it’s a broken bone. But the…

Jimmy: Slide…

Becky: The impact that that has on someone who is 80 is huge. Very few of them return to how they were prior to hip fracture. And so you just say: “Oh, I’m sure they just need more PT.” And we can get them back and make them more functional. I mean you just, those are the reasons.

Jimmy: Yeah. I love those reasons. Those are the best reasons ’cause they’re people reasons!

Becky: Yeah.

Jimmy: Those are, that’s the best reason of all is your “who.” Becky Craik, I appreciate you taking time out here at the capstone event.

Becky: Thank you.

Jimmy: Can’t wait until we come visit at Arcadia as well.

Becky: Yes, thank you! Thank you very much.

Jimmy: Thanks for listening to FOXcast, a clinically excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.