Transcript
Marla: Welcome, Tam Mara, it's a pleasure to have you today on our Practice Growth series. Thank you so much for being here. Thank you for having me. So now you are a professor at the University of Miami.
Tamira: I am.
Marla: And I'd love to hear a little bit more about what you do there. Well,
Tamira: I feel like I've been there my whole life.
Um, I did my DPT degree there, so I graduated from, um. In 2007 and then I went on to work in acute care exclusively. And then I returned to, um, first as an assistant professor helping out in the integumentary course. And then I was convinced to do my PhD there. So then I stayed on doing my PhD. So I've been helping teaching in courses all throughout my PhD career.
Um, I recently graduated in May, got my PhD, and I came on as a full-time. Assistant professor. My roles include clinical education and I'm also teaching in two courses. One related to patient communication and education, and also another course related to clinical decision making.
Marla: Great. Fantastic.
Congratulations on finishing that PhD. Yes, yes. That is a huge.
Tamira: Thank you,
Marla: and I know you've been doing some great research and really interested in research. Yes. So you've done a lot about clinical education, a lot about patient experience. Tell me a little bit about your research. Yeah, so,
Tamira: so my PhD and dissertation work related to patients with heart failure.
As an acute care therapist, I, I just. Noticed that my patients would be coming back to the hospital more frequently than I would expect. And I was like, well, am I doing something wrong? Why? Why do they keep coming back? Am I not telling them the right thing so that they stay out of the hospital? And that's really what sparked my, my, my.
Dissertation work and my PhD work. So my research really focused around trying to understand what it is we know and what it is we are doing as therapists to help patients understand that physical activity is an important component of their management with heart failure. So I did like a three part. Uh, study for my dissertation.
So I interviewed and surveyed physical therapists first to understand what it is that we do, and then I spoke to like the most, um, the population with the greatest health disparities in heart failure. So that's. The black population, they have the worst health outcomes, um, the worst access to care and those kinds of things.
And just try to understand what they understand about it. And then I did a survey of a wider population trying to understand, and it was really, really an eye-opening experience. Um, seeing that there's a lot of lack of understanding of even what the condition is. So if you're trying to educate somebody on physical activity, you can't start there.
You have to start. Explaining, this is what your condition is doing to your body. So this is how physical activity can help. And I think sometimes we might jump in a little bit later down the road just telling people they need to do exercise and that might be contributing to why they might not be following through on it.
Marla: Oh, wow. And were there any big takeaways that you'd say was, you said there was a lot of eye-opening. Yeah. Would you say the biggest takeaway was?
Tamira: Yeah. I mean, I think it was that recognition that. People don't even know when they have certain health conditions. For my study, I did a lot of recruitment over the telephone using a list of patients through a health system that had a diagnosis of heart failure according to the health system.
And I would call people on the phone and be like, um. One of the questions screening questions would be, so are you diagnosed with heart failure? And so many people from that list said, no. So many people said, I have shortness of breath, or I have, you know, they'll tell me all the telltale characteristics and signs of heart failure, but they'd be like, no, but I don't have heart failure.
And so it's really eyeopening to realize that patients don't really. Hear that information, and so that's really where we need to start as therapists as well. You know, we think that that's the responsibility of somebody else, but that information might not always be getting through to the patient. So we need to be ones to make sure that they understand that foundational stuff first.
Marla: Great. And I, I assume taking all of that and teaching in the clinical education, how are you now helping students to be better prepared as physical therapist in their curriculum?
Tamira: I think I learn more from the students when they're in the clinic, um, at this point. But I think with my courses that I'm teaching, like I'm gonna be teaching this essential skills course, which is related to patient communication, I intend to bring in some of these.
I, these findings that I've, I've found that really emphasize that you really need to help your patient through a, a journey. So we'll be teaching things like motivational interviewing and those kinds of things and those strategies to help them make lifestyle changes that have to, um, be long-term, which is something that is hard for a lot of people.
Marla: Fundamental. Absolutely. I love that you're. Bringing that into the curriculum, teaching the students so that they're more prepared when they go out into their clinical affiliations. Yeah, absolutely. And you have a big focus on the clinical education and affiliation side. Yeah. You are helping place them and get them out in the field.
Tamira: Yes.
Marla: Great. What would you say are some of the biggest takeaways from. Them going out and practicing and what are they missing right now in their curriculum about, as you said, you, you have to learn about that communication, but also transfer that into
Tamira: your Absolutely. So I think our program does a good job of teaching them how to use the medical language and, and switch from when you're speaking to a patient versus when you're speaking to another medical provider, including how to do documentation.
What I hear a lot is that. They wish they had more opportunities to practice that documentation before they get to the clinic. Um, so I think that is always part of the learning curve when they enter a new clinic environment, is we kind of have to ramp up into understanding how to use this electronic medical record system that this, this facility uses.
And it's not always clear like where information should go for them. Um, and they, they always come back and say, you know, I think every course like does a component of like documentation, but we don't get to practice doing like entire notes very often. So that's something that they really say they wish they had more of in the curriculum.
Marla: Great. And how are you currently teaching them right now? To write the notes? What, what, what are you guys utilizing? Um,
Tamira: so, so right now in their first year, they get introduced to the whole concept of a SOAP note. So that's just really, um, either on a Word document or something like that. They're, they're typing a soap in the soap format.
And right now in the clinical decision making course, last year we were using an electronic medical record system. Um. And we would kind of guide them through. How to do an evaluation and they would be entering components in that medical record system and then they would have to also do a daily note so they understand how to do billing, how to to document different treatments of exercises and those kinds of things.
They don't appreciate it at the time. Um, and when students do end up in the clinic environment and they're like, oh, they use that, um, platform that we showed them, they feel like, Ooh, it was worthwhile. Um, we don't get that feedback from some of the other students. They find it a bit tedious. They find, um, the interface was a little bit more challenging to navigate for them.
So they didn't really enjoy the experience or, or. Get the benefits of it as much as somebody who might have lucked out and ended up in a clinic where they use that platform, so.
Marla: Got it. And I know we've been talking to clinic owners throughout and they say one of the, one of the barriers when a student comes in is learning that emr.
Yeah. And they really wanna learn how to treat, uh, but they spend a lot of time just trying to figure out the EMR system. Yeah. So from, from that sense, what are you guys doing in the future? Which I, I know you're, you're excited to be part of. Yes. Yes. Um, to help students just get. Better and real practice before going out into their clinical affiliation.
Right?
Tamira: So we've a transition from using that previous EMR system to now using prompt, which will be starting in the summer with our first cohort of students. Um, we're really excited about it because, I mean, we've kind of gone through the platform and. Done some of the training and the interface just looks just more intuitive.
It's a little bit more user friendly. I think it's more familiar to this generation of students in terms of visually how, how they understand and process using some sort of software system. So I think that would be. A really good thing. Another thing that we had in the past, it, it got shut down during COVID, but we had a pro bono clinic.
Um, and we're planning to start that back within the next year, and that's gonna become a mandatory. Uh, part of their core curriculum that they participate in the pro bono clinic. And in there there will be the documentation system used as well. So they'll have ample opportunity to be able to practice.
So within my course, they're gonna again get the orientation and the introduction to how you use an EMR and then. They'll, they'll be allowed to practice with it. We're actually looking at trying to design maybe an AI bot or rubric that will let them upload, uh, a documentation, a note, and give them kind of feedback on what they can improve.
So that they can have the opportunity to practice multiple times, but it wouldn't be a burden on faculty to have to review and grade multiple notes, but they'll still be able to get some sort of feedback from it. So.
Marla: Great. And I love how you're just thinking ahead and saying, how can we expose these students earlier?
Yeah. Year one class, uh, I'm not sure which class you're starting in. Yeah. But right away and start to give them those components. In the EMR in prompt. Yeah. Uh, and allowing them to transition from what was a Word document to now into the system. Yeah. Um, so tell me a little bit about how you see that being used in the curriculum and maybe what class years or what classes you're
Tamira: using
Marla: it
Tamira: for.
So, for me, the class that I teach and I plan to use Prompt in, is the very beginning of their second year. In our three year curriculum. So it's just before they go out on their first clinical experience, which tends to be in an outpatient orthopedic setting. So hopefully, um, I've been on my clinical education side, I've gone out and I've actually encountered students who do use PROMPT in the clinic, and I've spoken to the.
CI who's like, it's been a great transition. They've actually transitioned from the same old EMR system that we were using into prompt, and he's like, it's just so much easier. It's so much more intuitive. So they really enjoy it and the students say, yeah, it's a, it's a great, it's a great way to document, and they wish they had seen it sooner, so they're gonna meet it for the first time with me.
In that beginning of their second year. Um, but I have heard from other professors later on in the curriculum from, um, our neuro rehab professor, our peds professor, and a couple other professors who are interested in using it in their classes as well. We also, at the very end of our didactic coursework, um, we do have the students do an overall, like an osce where they do have to do documentation.
And so we're talk, talking about integrating, using PROMPT while they do their OS C two to make it a more realistic kind of situation.
Marla: Great, great. I love that they're getting that real life experience. Yeah. And getting to be able to play with the system, use it in different ways, um, and through different classes.
Yeah. And we're excited when you open your pro bono clinic again. Yes. And can utilize prompt there as well so they can. Make that application to the pro bono clinic and then to their clinical affiliations as well.
Tamira: Right. Yeah.
Marla: I know that one of the barriers in universities is always financial and a lot of times, especially with a pro bono clinic where you're not making any money, I'd love for you to tell us a little bit about how you are able to utilize prompt with any of those financial barriers.
Tamira: So, in our previous iterations of pro bono, we, we had one, um, and the, we were doing. Paper documentation in our original pro bono clinic before COVID. Since COVID, that clinic got shut down and now we are using, we, we got invited to join the pro bono clinic that's run by the medical students. Um, so that's where we are still able to contribute.
To the community in that sense, but they had their own system, so we have to operate under their system. So it's nice to be able to kind of take back that control and the fact that you offer this to universities as a free offering, um, really makes it an attractive option for us. But I mean, it still has all the components of what we would need.
So it's, it's really wonderful that you guys offer that.
Marla: Great. We're, we're excited to be able to have the students get exposure and just be better when they're out there And, yeah. Reduce burnout. Yeah. Um, that's one of our big goals is really having the systems so intuitive and easy and using ai. Yes. So that, that note rating process Yes.
Goes less and less with that pajama time. Yes. After hour,
Tamira: yes.
Marla: Charting. Um, so we'd love to know how are you thinking of potentially using the AI tools that we have and when are you gonna expose the students to those?
Tamira: Yes. So I think we need them to understand the foundation of how to write a note.
Absolutely. Um, at the beginning. So because this is kind of earlier on in their curriculum and coursework, I don't think I'll be. Unfortunately, 'cause I really love ai. I don't think I'll be the one who's gonna be incorporating the AI tools. But I think some of those other courses that are later on in the curriculum, definitely I'm gonna encourage them.
And I think our leadership in our program is very pro. Efficiency and understanding where healthcare is going when it comes to ai. And so they'll definitely be on board and encouraging those later courses to show students that these tools are available for them to use.
Marla: Great. And I think that's the way to think about it, is you know, it's here.
Yeah. And we need to teach students exactly how to write the note. You can't give them all of that right from the start. They need the foundation and the fundamentals, but exposing to them later on so that they know what else is out there when they get out in the field. Yeah. And they're equipped to be able to utilize that.
Yeah,
Tamira: and I'll, I'll introduce it and inform them that it's out there, but we're not gonna be able to use it in my course. Yeah.
Marla: Got it.
Tamira: Great.
Marla: Do you think you'll use the telehealth portion of it at all? Or the university in some way, shape, or form too?
Tamira: So with our program, we don't really allow our students to do a lot of telehealth for their clinical experiences.
Um, I know later on that's great that I actually didn't know there was like a telehealth component to it because we do later on in the curriculum, you know, introduced that in some of our health system science courses. I think that's something that I will bring back to those professors, that that's something that they could use, that's a way they can use it.
'cause I, I don't know if we are. We're aware that that was an option as well, so thank you.
Marla: Yeah. We sa same, I I think it's a tool in your toolbox. Yeah. And students should know how to use it. But again, it should be for the right patient and uh, a tool in the toolbox for the whole plan of care Yeah. When needed.
Tamira: Yeah.
Marla: Um, so great to hear that you guys know Yeah. That and can utilize that as well. Yeah. What is your university's thought on just the future of. Of technology in physical therapy? I
Tamira: think it depends on who you talk to. Um, I think the older guard, you know, are a little bit more apprehensive of it, but are slowly coming around to accepting that.
This is the future and this is here to stay. And I think at first we were fearful of things like ai, especially on the academic side where we're the first thing you think about is, oh, students are gonna use it to cheat. But you realize that it's such a beneficial tool to help improve efficiency, to help improve learning, to decrease the burden on faculty, to decrease the burden on clinicians.
I think we were talking before we. Went on talking about like burnout and, and those kinds of things. And I feel like it is a tool that's gonna help reduce that for people. So documentation I think is one of the least favorite parts of a clinician's job as a therapist. Um, we love being with our patient hands-on, um, doing that direct patient care.
Um, so anything that will reduce that time or improve efficiency in that area is. Is wonderful.
Marla: Yeah. There was a survey that just came out from the A-P-T-Q-I that said 47% of physical therapists are planning to leave the field in 2025. Wow. And transition out of clinic care, which is scary you guys. Train them and spend all this time and effort.
Yeah. And they love what they're doing, but it's that non rewarding work, right. Admin documentation after hours that tend to get them a little dissatisfied or disengaged with the field.
Tamira: Yeah. Yeah. And unfortunately, you know, some from the clin ed side, you, you hear some. Experiencing that very early on in their clinical experiences.
It's not like they only experience that once they become a clinician, they're having their CI saying, okay, you get those notes done and I'm gonna leave. Unfortunately, we're having students having that experience, so it starts early, planting that seed that this is. This, uh, field might not be as rewarding.
So yeah. Anything we could do to help mitigate that would be wonderful.
Marla: Yes. Yes. I, I remember, I, I didn't like writing notes when I was a clinician. I would, I just wanted to be with the patient, like you said. Yeah. That motivational interviewing, that therapeutic alliance. And then I would not write a single note until I was done, and then I would write 'em all after hours.
Right. Because I just wanted that interaction to be so. Yeah. Personal.
Tamira: Yeah.
Marla: Um, and that, that's hard. You know, the really good clinicians who wanna be there for their patients don't wanna be spending all day spending all night. Yeah. Getting notes.
Tamira: Yeah. Absolutely.
Marla: Well, in, in addition to that, any other big ideas or thoughts that you guys are doing at the university that you wanna tell us about with your students?
Tamira: I think we do a really good job of always trying to evolve and respond to not just what, you know, our association and society is telling us the needs are, which we, we try to do, but also kind of responding to what our students are telling us in terms of what could be improved in, in our curriculum. So at the.
End of their third year before they graduate, we require all our students to come back and do like a curriculum debrief and tell us what they enjoyed about every single course and what we can be doing better. And what are you seeing out in the clinics that isn't being taught here that we should be teaching?
Because that's now the norm in terms of practice, and we are constantly evolving. Our program to try to meet those needs. And we also do a faculty retreat every year where we talk about what needs to be changed in the curriculum so that it comes from the top that this is something that we always need to be changing and improving.
So I think some of the things that we are doing right now is. Thinking about reintroducing the pro bono, which was always optional, and now we're really thinking that it's gonna be something that's a required part of the curriculum for all students to participate in pro bono and community service. We are introducing more AI technology.
Some of us are more. Open to it than others, but we are all helping each other along. Um, particularly with using technology that helps with assessments and grading of, of work. You know, our class sizes are growing.
Marla: Yes.
Tamira: Um, you know, we we're the same. Number of people having to grade more work. So we're trying to find efficiencies in those areas as well.
So embracing AI in that way. And we are just trying to do more in terms on the clinic ed side of strengthening our partnerships with the clinics and the community. So we do hear and we do meet with a clinic advisory board. So clinicians who support our program by taking our students, we ask them what are.
Well, how are students doing for you? Is there anything that we need to be doing in our curriculum to help support them so that, that when they get to you, you're not having to do some of the catchup work that should have been done on our end. Um, and so we do that as well, and. We have a really great community of clinical partners who give us great feedback.
Um, and so we on the clinic ed side, are always trying to evolve and improve for them as well. 'cause we recognize that, again, being a clinical educator and a clinical instructor is a voluntary process and we wanna reduce that burden on those clinicians.
Marla: Oh, that's fantastic. What is the most surprising piece of feedback or enlightening piece of feedback that you may have gotten from what you did with the students, with coming together with the faculty or asking your clinical partners?
Tamira: Um, I think overall. People are pleased with what, what we do at, at University of Miami. So I think we are doing a good job. I think they say that more than other programs. We really try to listen. Um, and we hear that from the students. We hear that from the clinics as well, so, so I think we're doing a really good job about that.
I'm fairly new to the. Faculty side, even though I feel like I've been there for a really long time. So it's, it's really nice to know that I'm joining a community and a program and a department that really takes the time to listen to what the needs are and make those changes and is willing to make those changes.
So that's one.
Marla: Yes. It's great to have the fresh perspective come in and be able to, uh. Bring different, different ideas to the more safe for sure.
Tamira: Yeah.
Marla: Um, and then being a researcher, are there any thoughts that you may have introducing this documentation, introducing AI or, or anything that you're doing with the clinics that, or the students that you could potentially do a research study on later down the line?
Tamira: So, um, I am, I mean, my head goes in a million different directions when it comes to research right now, but I am interested in some of the education research, uh, talking and going to some of the education sessions here at CSM. Um, just having a better understanding of. The stressors of students when they go on these clinical experiences.
And I know like certain things like the documentation and not being familiar with things like that are things that add to their stress of being in a new environment. So it would be interesting to see if we incorporate some of these strategies to give them more exposure, whether. That that burden and that stress level kind of comes down.
So that's one of the things I'll be interested in pursuing, um, from an education perspective.
Marla: And it'll also be really interesting to see if some of those students end up choosing clinical affiliations that have prompt, right. Yeah. Maybe as their first or second, just because they feel more comfortable.
Yeah. And then that'll give them that ability to go anywhere else after that as well, right? Yeah. So love, love hearing where your mind is headed with research. Yeah. And how we can help impact, um, just like you guys starting a pro bono clinic and saying how, how happy you are to bring that back. We're really happy to be able to do this pro bono for the universities and see how it's impacting the students Yeah.
And the universities in a positive way. Wonderful. It's been a pleasure having you on the show today. I gotta thank you so much from us and all the listeners, so much insightful comments and what you guys are doing. I hope that inspires other universities to also think big and to be incorporating some of this technology into their programs.
Tamira: Yeah, I'm really excited. To be starting to work with you all, and I'd love to be able to give you feedback once we actually start with the students. Right now we're still doing the onboarding and the training of us as faculty who are gonna be able to support the students through their learning with this, with this tool.
Um, and so I'll be. Happy to continue to be in touch with you as we go through this journey.
Marla: Great. And feedback. We are just like you, which you said you guys love the feedback you wanna hear, we wanna hear that as well. We grow and thrive off of that. Yeah. So look forward to a really fruitful partnership.
Tamira: Wonderful.
Marla: Uh, and continuing to make this better.
Tamira: Yes. Thank you so much for having.