I had the chance to interview Dr. Stacie Fruth, PT, DHSc, OCS recently. Stacie (2009’s Teacher of the Year at Univ of Indianapolis!) is currently the Director of the DPT Program at The University of Indianapolis. You can read more about her here.
The interview is informative & entertaining! We covered something I’ve been very curious about, and it is a special interest of Stacie’s: Physical Therapy in the Emergency Room.
You’re involved in a field that I think is incredibly interesting and we’ll dig into that later, but first tell us your story. How did you end up where you are today?
I’ll assume you prefer I skip the fun stories of my childhood… 🙂 The brief tale of the journey is that I attended the University of Michigan on a swimming scholarship. I started off pursuing a degree in engineering and two years in decided it wasn’t for me, so switched to Kinesiology. I was infinitely more happy in that program, but realized there’s not much that can be done with that degree. So, I headed to grad school at the University of Massachusetts where I earned a master’s in exercise science. I wasn’t jazzed about my career options with that degree either so started exploring, and stumbled across physical therapy. I landed at the University of Indianapolis because, of all the places I interviewed during the admissions process, I felt the most “at home” there, even though the school was dramatically smaller than Michigan or UMass (which I thought would be a negative – and it wasn’t). I fell in love with the profession and the UIndy program and upon graduating, I told the dean that I would be back and I would somehow find a way to teach in the program. I went out into the world and practiced PT (mainly ortho) – truly loving it – but nine years later headed back to UIndy to start my doctoral degree. Two years into that, a faculty position opened up, and I jumped at the opportunity. I’m now in my 11th year of teaching in the Krannert School of Physical Therapy, and recently assumed the positions of Chair of the School as well as Director of the DPT program.
Check out this Podcast interview on Stacie’s book “Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures“. How was the writing process? What were your biggest challenges in writing & publishing the book?
Ahhh…the Purple Book (as it’s affectionately known)! Labor of love? Arduous? Painstaking? I can’t deny that it was a huge undertaking, but I’m very happy with the outcome. I applied for and was granted a sabbatical from UIndy for a semester and that’s really what allowed me to make the most headway. I secluded myself in a cottage in Michigan in the middle of winter for a month and that really helped to get it off the ground. My publisher (Jones & Bartlett Learning) was wonderful from start to finish. They strongly supported this project and put a ton of resources into it. As an untested author, I was absolutely thrilled to get a full color textbook with professionally made videos (and LOTS of them). What helped immensely is that I had taught this foundational material for 6 or so years and had progressively created a prototype of the book along the way. I was actually shocked that there wasn’t a textbook out there that covered these fundamental but essential skills needed to conduct a solid initial patient exam. So eventually, I just decided to fill that gap myself.
I really wanted the book to be useful to both instructors and students, so the biggest challenge was trying to conform to all the different DPT curricular models out there. For some programs (those that teach the basics of the patient exam first, then branch off into more advanced musculo, neuro, etc.), this textbook fits beautifully. For those with different curricular models (e.g. those that teach methods of doing a musculo exam separate from how to conduct a neuro exam), this text isn’t an obvious fit. Regardless, it does cover all aspects of conducting the initial patient interview (and I don’t think that exists elsewhere) and includes nearly every basic test and measure. The more advanced stuff – such as special tests – is left out on purpose. Plenty of textbooks cover that material quite well…no need for me to repackage that information.
I’m currently in the early stages of revising the book for the next edition and would absolutely LOVE to get as much constructive feedback as possible. I’ve got some reviewer comments, and of course the feedback from my own students, but I welcome anyone’s suggestions as I dive into this in the next few months.
Tanzania! Tell us about one of your unique experiences in Tanzania.
What an amazing trip! It was such a privilege to lead that group of 10 DPT students half-way across the globe and observe so many transformational experiences while we were there. I think a personal experience that was very meaningful for me involves a young girl I worked with during my first trip to the same village (Pommern) 10 years prior. She was a very small 4 year old at the time who had CP. Mind you, I’m no peds therapist, but I worked with this girl for several weeks and she took her first steps while I was there. Beyond rewarding. However, knowing that individuals with disabilities often don’t fare well in remote African villages, I always wondered if she would live a meaningful life. When I went back with my DPT students 10 years later, I was able to find this young lady, who was then 15 years old. Her mother (whom I’d spent a lot of time with during my first trip) had died of malaria, so the girl was living with extended family. I was beyond thrilled to find out that she was (generally) ambulatory and had a job doing laundry for her neighbors to help support herself. I have no idea if my work with her made “the” difference, but I’m pretty sure it made some difference, and that’s all that matters. While this was a very meaningful personal experience, it was so cool to share it with the students who came with me when we finally found this girl – to show them that the work they were doing with some of their own “patients” in the village (almost all were very young children) might have a true lasting impact.
A big interest of yours is Physical Therapy in the Emergency Department. How did this start? And, how has it grown?
That’s a long story, but the compact version is that I was hit by a car in 1997 while riding my bike home from work. I landed in an emergency department where I was misdiagnosed (and I knew it, but wasn’t listened to) and handed a pair of crutches still in their plastic wrapping. I remember lying on the bed thinking, “why aren’t PTs here?” I kept asking that question until 2002 when I ran into Michael Brickens, PT who had just started working in the Methodist Hospital (a Level 1 trauma center in Indy). At the time I was nearing the end of my doctoral program and was searching for my final research project. Many years and 6-7 studies later, we’re still going strong. When I met Michael, he was the only PT working in that ED, and the only other ED PTs in the country were in Arizona. Now, the Methodist ED has 2 full-time PTs and 4 per diems (I’m one of them). Indy also has another Level 1 trauma center with 2 full-time PTs (one of whom is one of my UIndy grads), so Indy actually offers the most ED PT coverage hours in the country (pretty sure about that…). Thus, it’s an ED PT research mecca, considering there are only a handful of US-generated published studies out there. I just got one back from PT journal with provisional acceptance for publication so I’m working on that revision now. Stay tuned!
Why is it called PT in the “ED”? ED sounds like something you don’t want to talk about in public… ER sounds exciting. Why “ED” instead of “ER”?
Okay, funny story about that. I was in Starbucks trying to prep for the education session my colleagues and I did at CSM last year. I had a binder of articles and the front of the binder was labeled “ED research.” A guy walked up to me and asked if I could tell him if there were any new treatments out there because “that pill” just wasn’t cutting it for him any more. I kid you not. That was a short but interesting conversation, and I went home and changed the label on the binder! Actually, the answer to your question is simple – the emergency department is just that, a department of most hospitals (with its own specialization, culture, resources, staff, etc.) and much more than just a “room.” So, the terminology has shifted to “ED” in all formal writing/publications. That said, “ER” and “ED” seem to be interchangeable in conversations (even with EM docs).
Let’s say I wanted to work in the ED. How do I prepare for it?
You need broad knowledge in just about every aspect of of PT practice (acute and chronic ortho, neuro, cardiopulmonary, wounds, fracture splinting, multi-trauma, and medically complex/multi-comorbidity). You also need strong differential diagnosis skills. The ability to multitask like crazy comes in handy and you need to be highly independent (ED PTs tend to work completely solo). Something else that’s important is having a high level of confidence in your professional opinions/impressions about patient intervention plans in conversations with the MDs. That said, the collaboration with the ED docs is amazing, and they have come to highly respect PT knowledge and skills. My schedule only allows me to work in the ED about once a month (have done so for 7-8 years) but I’ve worked with patients ranging from 2 to 101 years old, and conditions have covered the spectrum. There is no lack of variety in this setting!
PT in the ED, of course! I’ve got one platform (influence of PT intervention on falls and return visits to the ED) and one poster (comparison of number of evidence-based interventions provided by PTs versus MDs in the ED for select musculoskeletal conditions). This will be interesting stuff to present because the Brits are way ahead of us in terms of allowing PTs to function autonomously in the ED setting. PTs in the UK can see patients with MSK conditions in the emergency setting independently, including the ability to order diagnostic tests and prescribe simple analgesics. This is exactly where we want to go with ED PT in the US, but we’re not there yet….
How much fun was this??
That was definitely a fun study! My colleague, Anne Mejia-Downs, and I had been looking for ways to get the faculty/staff at UIndy to be more active (and have fun doing so) right about the time that Dance Dance Revolution was hot. So, we designed a study and pulled in 6 of our DPT students to coordinate it. We actually got a nice-sized group to participate and the feedback we got from our participants was great! I presented that study at a conference in South Africa in 2008 and also at CSM in 2009. We then did a follow-up study to this one, looking at changes in balance and mood states following 6 weeks of DDR and also got some nice results (presented at APTA Annual Conference in 2010).
Favorite books & authors?
My favorite “fun” books might be a little on the odd side. I have a strange fascination psychopathology and what influences individuals toward some pretty dark/disturbing behavior. I prefer non-fiction in that realm, but fiction based on real events will do the trick too. So recently, the Gillian Flynn books (Gone Girl, Dark Places, etc), but also stuff like the Hannibal series, Patricia Cornwell’s non-fiction books, Peter Vronsky, etc. On a much less gruesome note, I very much appreciate Clarissa Estes’ Women Who Run with the Wolves. And, although seemingly less intriguing, I really like quality leadership books (The Leadership Challenge, Start with Why, etc.) and find they apply to life both from the professional aspect as well as the personal. That’s the nerd/geek side of me coming out!
What are some of the most challenging aspects of conducting & publishing research?
There is not room on 20 pages to list them all! Research is time consuming beyond belief – simply getting through an IRB can take many months. And the last paper I submitted took 2 days just to get the info into the submission portal. Speaking about the research itself, it is so challenging to find the balance between “high quality” and “clinically meaningful” studies. The higher the quality, the more sterile it is (e.g. by the time you exclude all participants with potential confounding conditions, you’ve excluded the typical clinical patient population). So many studies that do get published have such narrow inclusion criteria that it’s quite difficult to apply the results to any of my patients (my folks have lots of comorbidities and biopsychosoical issues). So, it can be incredibly frustrating to create a study that tries to capture typical clinical populations. I think this is why so many studies that were once considered gold standards now can’t be reproduced – that fascinating variable called “the human being” is awfully tough to control.
What’s the best gift you’ve ever received?
I’ll go with the first answer that popped into my head when I read this question. A pony! That was a VERY long time ago – I was 10 at the time – but the absolute blessing that horses have brought to my life since then is indescribable and it all started with that stubborn little pony. The purpose of horses in my life has changed through the years, but what it centers on is the peace in my soul when I’m with them. My relentless focus on work goes out the window and I can simply “be.” A gift beyond words.
Stacie, thank you for this fantastic interview!
Follow Stacie on Twitter: @StacieFruth
Find me: @CinemaAir