Welcome back to the Healing Pain Podcast with Tessa Wells, PT, DPT and Betsy Becker, PT, DPT, PhD

We always hear the old adage, “you can’t pour from an empty cup.” This is especially true when you look at how we grow students to become practitioners. Before they can take care of and make a good impact on their patients and clients’ lives, they first need to take care of themselves. Tessa Wells, PT, DPT and Betsy Becker, PT, DPT, PhD from the University of Nebraska Medical Center’s Division of Physical Therapy Education have been implementing this. In this episode, they join Dr. Joe Tatta to discuss all about how they promote student wellness during their professional formation towards becoming DPTs. They talk about curricular interventions using a lifestyle medicine approach, taking wellness from the self to others to the community. Hear about their great program and how they impact the students of the profession and society at large. Tune in to this conversation to not miss out!

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DPT Student Wellness During Curriculum Implementation Of A Lifestyle Medicine Approach With Tessa Wells, PT, DPT And Betsy Becker, PT, DPT, PhD

In this episode, we’re discussing how to improve doctor physical therapy student wellness through the implementation of lifestyle medicine approaches in the physical therapy curriculum. My guests are Dr. Tessa Wells and Dr. Betsy Becker. Both are physical therapy educators at the University of Nebraska Medical Center in Kearney, Nebraska. Dr. Tessa Wells holds the Assistant Professor and the Assistant Director of Clinical Education in the Department of Physical Therapy. Dr. Betsy Becker is an Associate Professor. She’s the Program Director and she’s also the Chair of the Department of Health and Rehabilitation Sciences.

In this episode, we discuss what the University of Nebraska Doctor of Physical Therapy Program is doing with regard to student wellness, and how they’re integrating lifestyle medicine into the Doctor of Physical Therapy curriculum. We’ll share some preliminary results from the first cohort that has completed this curriculum. There will be some great takeaways for the broader community of physical therapy education or physical therapy practice if you’re interested in learning and implementing integrative and lifestyle medicine into PT practice.

If you are a physical therapist in clinical practice or maybe you are a DPT educator, and you’re looking for a solid evidence-based resource on integrative and lifestyle medicine and physical therapy, make sure to check out the new textbook called Integrative and Lifestyle Medicine in Physical Therapy: A Guide to Primary Care Health Promotion and Disease Prevention. That textbook was edited by me and another physical therapist, Dr. Ginger Garner. We have over 39 contributors who are all physical therapy clinicians and educators who contributed to it.

You can find that online by going to OPTP.com. If you are outside of the United States, you can also find that on Amazon. Go to Amazon and type in Integrative and Lifestyle Medicine in Physical Therapy. I believe you can purchase it as a textbook in certain countries, or you can purchase it as an eBook for immediate and direct download. Without further ado, let’s begin and let’s meet Dr. Tessa Wells and Dr. Betsy Becker, and learn about some of the innovative and interesting things they’re doing inside the DPT curriculum with regard to integrative and lifestyle medicine.

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Tessa and Betsy, welcome to this episode of the show. It’s great to have you here.

Thanks, Joe. It’s great to be here. Thanks for having us.

It’s great to visit, Joe.

Most of my episodes are one-on-one. I love bringing people together, especially when people have worked on new and innovative projects, especially within the field of physical therapy, especially on this topic of lifestyle medicine. I think it fits so well both in DPT education, as well as physical therapist practice. Tessa, you and I met at the ELC conference a couple of months ago. You had a great poster that I stopped at, and I saw lifestyle medicine plastered across it. I was excited to speak with you and invite you on. It’s great to speak with both of you, but tell me how this project got started. What was the impetus to start to explore this area?

We wanted to look at the student experience overall. We know that with the quadruple aim that well students become well practitioners who can then take care of and make good impacts on their patients’ and clients’ lives. That’s how it got started. I’ll let Betsy talk a little bit about what that looks like at UNMC.

We know that the student experience is an ideal location to learn, experiment with lifelong learning, and experiment with wellness behaviors. That’s embedded in the literature. The higher ed environment provides those new opportunities for socialization, exposure to diverse viewpoints, and challenging someone’s personal beliefs and resources. Students enter this environment equipped with various capacities to deal with those new challenges and new information, both academically and socially.

We adopted that integrated approach to address the needs of current students, both on a personal level and well-being in first-year courses. We also designed subsequent courses to meet the needs of the professional education program. We designed a project to broaden the concept of lifestyle medicine to include network support system connections, and psychological resilience and capacity. We are also working with our university partners across the campus to make sure that we have support in place for a variety of needs of the students during a variety of time points across their training.

Lots of good important topics there. I want to piece out the timeline a little bit because wellness, especially within physical therapy, has become very popular in the year 2022 and maybe a little bit even in 2021 as we all faced a pandemic. It sounds like all of you started planning this potentially even before then. You’re ahead of the curve on this in some way.

We could have done that without the pandemic. We implemented our curricular interventions to promote student wellness in professional formation in the fall of 2019. We were in a place where we were implementing these things to prepare students regardless of whether there was a pandemic. We’re seeing good evidence that our interventions are mattering and making a difference. We’re also seeing some differences between the students who entered after COVID as well as before, which is going to be some interesting findings in our study.

It also sounds to me like there’s somewhat or you’ve created somewhat of a curricular thread to weave this information in and out, which I think is great. Often, when something new pops up in, let’s say CAPTE requirements like nutrition, what winds up happening is there’s a 30-minute lecture that’s embedded within a PT program. People take it and they’re interested, and then they forget about it. It sounds like you have started to weave this through the entire DPT curriculum for a student in some way.

The way that we’re doing that is by using lifestyle medicine thread throughout the curriculum, as well as situating it within the social-ecological model. You’re thinking about individuals and relationships and then how that then extends into the community and society. We have the students start by looking at wellness in lifestyle medicine, using those pillars as our anchor point, and then saying, “Where am I at within this? How am I doing in my physical activity? How am I doing in my stress management and my healthy diet?”

They’re able to take that, self-assess, and think about behavior change that they may need to work on for themselves. Also, how they might then extrapolate that and work on that with a client, thinking about the community integration down the road, and how we can take this to a prevention standpoint in society. That goes from self to others to community. We work that all the way across the curriculum.

All six pillars are somewhere within that. For example, certain programs have maybe 1 or 2 courses dedicated to health and wellness promotion. Is your curricular set up like that or is it more like a thread throughout?

It’s a thread throughout and then it culminates with a prevention and wellness course at the end of the curriculum so that they have a nice trajectory into practice. They hit their final clinical education experiences and are able to put these things into practice that we’ve been talking about. They’ve been working on those skills all the way through.

I would add to that. We have the curricular threads embedded in the social-ecological model, but it’s not just the student’s responsibility to be well. It’s not just the faculty’s responsibility to teach the students about being well or patient wellness. We needed institutional support. We took a good hard look at what are our policies. Do we need to modify policies to be more student-centered to support some of these things that we’re teaching? We revised admission policies and looked at attendance policies. What is our tutoring? What about progression through the program and mediation? We wanted to make sure that from the bottom up and the top down, we were living out what we were trying to explore and teach.

Everyone is on board with this basically. How many cohorts have you taken through this so far? Tell us some of the results that you’re starting to see.

It’s a longitudinal study. We’re comparing our outcomes at different times. At matriculation, the start of the program halfway through, which would be about a year and a half later, and then three years later after starting would be at the time of graduation. We’re looking at it across the curriculum. We’re analyzing measures of wellness such as psychological capital, which is hope, resilience, confidence, and optimism.

With the standardized tool, we’re looking at social capital and measuring connections with others for a sense of belonging. We’re looking at a five-factor wellness inventory. That’s an inventory to identify central factors to healthy living, which align with the lifestyle medicine pillars. Those wellness scores are composed of domains where the acceptance of personal responsibility and choice have positive outcomes on well-being. We only have two and a half years of data for a four-year study.

We’re getting about halfway through, but we’re showing higher wellness scores in several domains in the cohorts matriculating after COVID started compared to before, which we think is so interesting. It’s possible that it could indicate that those students entering professional school were more prepared in terms of healthy living. There was a lot of public health news around COVID. Our study is showing so far that components of student wellness are improving in part to our curriculum interventions and policy changes that are supporting wellness.

These are important, especially given that our curriculum was not delivered as intended at first because of the directed health measures beginning in 2020. We’ve got some work to do in terms of analyzing that data for four years. We’re looking at the connections among students too. Do students connect with other students who are well? What does that look like long term? I can see it being a much longer study than four years.

If I can answer maybe 1 or 2 questions. In some of the data you’re starting to collect and the outcome measures that you’re using, some of them sound like they are looking at maybe common physical health measures. Nowadays people are also interested in some of the more mental well-being measures. How are some of the early data starting to look with regard to mental well-being measures? That’s a really important topic right now in DPT education.

I’m not sure we have it classified as mental well-being. We’re talking about those lifestyle factors or lifestyle medicine pillars. We’re using gold-standard tools that are out there. It’s looking at that resilience and coping. I think that those pieces are not the physical activity piece. By design, that’s embedded in our curriculum. We know that these are skills that help people to be ready for the workforce as a profession. Perhaps it could improve patient care in a professional sense. If you’re well yourself, you’re likely to take better care of yourself and have better outcomes as a student. That’s a reach, but I think that’s where we’re going with our outcome measures here.

I think the resilience factor and positive coping fit well with a mental well-being approach. I totally agree. If you can promote some of these lifestyle behaviors early in their career, then hopefully this will carry through as you’re starting to see. What are some of the takeaways for the broader community, whether it’s the broader physical therapy community or the broader community of PTs in practice?

We’ve gained a better understanding of student experiences and have developed programming to enhance wellness. The message there is this can be done but you have to have a team behind you and those institutional supports. We’re so lucky at our institution to have administration on board with that and able to make some of these changes. That’s one piece that’s important.

We know what their experiences are and have developed this ability to enhance their wellness. We’re seeing that even with students who have come in with that higher wellness. Betsy alluded to that earlier, about those differences in classes. The ones that came in before COVID, and the ones that came in after COVID had higher wellness. Those scores actually still increase.

Even if students are doing pretty good, if we’re doing a good job of purposefully addressing these things, they can still improve, which is exciting to know. We’re working on preparing these students for a long-term career in PT. We know that if our providers aren’t well, it’s difficult for them to provide good care for our patients. Hopefully, that will have the ripple effect that we’re intending. Being ready to be that student of the future, what does that look like? If we’re providing them with good skills now, they should be well-positioned to jump into that role in the future.

I guess we don’t know these outcomes yet. We’re not to that point in our data analysis and even in the collection of data in the study, but thinking about outcomes beyond graduation. We care about the students as practitioners afterward. What does that look like for employment? What does that look like for board rates, licensure rates, and those types of things? I’m thinking about additional measures of success within programs. I think those are things that we can look at and apply.

Betsy, I know some of this fits into a previous scholarly agenda that you worked on, I believe it was in some of the PhD work that you have published. I believe in some of it, you even received an award for it, which is great. How does it continue to fit in with the work you’ve done already? What would your words of wisdom and encouragement be for other DPT programs who are saying, “This might be something interesting to explore. How do we start to massage this in?”

One of our goals is to share our information. How can we take what we’ve done here and share it with other DPT programs? How can they modify it and help us learn? I think that’s a collaborative future I see. My work is focused on social network analysis, so looking at how individuals connect with each other and what those connections look like. Certainly, you can count the number of people in a network. We know that there’s a lot that goes on between those connections. If one person adds to the group or that network, the whole group is better. The premise here is how do connections develop, how can they become stronger, how can they build trust, cohesion, bridge, and be a friend of a friend of a friend?

There’s a lot to be studied. I think those connections start to happen at the DPT training level. When I did my work and what I’ve published are some of the connections that I talked with when I was interviewing faculty members about their connections, they started back in DPT programs. We know it’s a very formative time when lifelong connections are built. We can measure that now. We have software and data analysis to measure connections beyond the count of how strong, how many connections, and how many people are connected to other people who are similar. It was a nice link to think about my work studying faculty connections to think about what students are doing at the very beginning of their career as physical therapists.

It definitely fits in well with the lifestyle medicine precept of social connection.

We know that people who are connected with others have support. That’s part of the coping mechanism. When life gets challenging and school gets challenging, we rely on each other for support, cohesion, and motivation. Whether that support comes from somebody in your family or somebody who’s a friend or your classmate, we need support in different ways.

Tessa, what were some of the feedback that you received at the Educational Leadership conference with your poster? Oftentimes at that conference in particular, there are educators or maybe new educators that are looking for scholarly agenda to maybe start to work toward as part of their EdD or their PhD, or maybe they’re a full-time faculty member that’s looking for something new.

We actually had a lot of interest in our work, which is exciting to hear. We’re not the only people who have implemented lifestyle medicine into our curriculum by any means. There are lots of people out there who are doing this, but we’re doing it in a new and innovative way where we’re thinking about our students as future providers. There are some opportunities to hopefully collaborate with schools, and think about how they might be able to implement some of these things across curricula, and have a broader pool of students to look at hopefully.

Being able to think about how we implemented lifestyle medicine and whole-person wellness as a thread throughout our curriculum was also something that was very interesting. It made it seem very doable instead of those 30-minute lectures on nutrition. We’ve checked that box for CAPTE requirements. It’s deeper than that and it should be deeper than that to allow our students to make changes when they’re out in the workforce.

It sounds like a component of this at some point is more experiential, so it’s less didactic and more experiential for the student.

In the terminal pieces of the curriculum, we have them discuss how they might go out and implement a community-based prevention and wellness program. In my role as Assistant Director of clinical education, I’ve been able to bring those things together and have them look at, “I’m going to this community for my terminal clinical experience. What does that community look like? What are some places that I might be able to pull in wellness? How can I make that impact in that community that I’m going to?” It’s been a good thing for them to put those skills into practice, for sure.

I know you’re halfway there, but have you all been thinking about a next step or a second phase to this research?

We’re always thinking about the next phase. That’s great that you’re asking this question. First, we would like to complete the study that we haven’t intended. That’s our next step in disseminating the information. It’s important to share what we find and contribute to the literature and this body of literature. We’re not unique in physical therapy that we’re having this conversation about how can our professional partners across the healthcare team benefit from some of the things that we’re studying here. That’s probably a big next step. Tessa, I think you have some other ideas. Do you want to share what those might be?

I talked about this a little bit with Joe’s question about that reaction from ELC. Just being able to partner with other institutions would be wonderful to be able to broaden the scope and reach of this. This goes beyond PT. This could have an impact on other healthcare professions as we’re thinking about a team in providing care. We want to be able to take that next step.

It’s been great speaking with both of you. I’m excited to hear that more and more DPT programs are embracing lifestyle medicine in various ways. Both of you and the University of Nebraska are probably ahead of the curve a little bit because it’s quite deeply entrenched in your curriculum, which is great. You’re collecting the data, which is excellent. If people want to reach out to you and learn more about your study or what you’re doing, how can they do that?

They can reach out either through our website or get our contact information that way. I’m on Twitter @TessaWellsPT, so they can reach out that way as well. We would love to talk and collaborate.

We’re very interested in hearing about other people’s experiences. Our website is a great spot. My Twitter is @BJBecko. That is the Twitter handle. I also do a little email here and there, so if somebody would like to email me, I’m happy to read your email and respond. That email address is [email protected]. We look forward to hearing from the audience.

You can reach Dr. Tessa Wells and Dr. Betsy Becker at the University of Nebraska Medical Center in the Doctor of Physical Therapy Program. You can go directly to the University of Nebraska Medical Center’s Physical Therapy Program website and find them there. They’d love to hear from you and collaborate with you on implementing lifestyle medicine into the DPT curricula.

Make sure you share this information with your friends and colleagues, especially physical therapists who are interested in health promotion and integrative and lifestyle medicine in physical therapy. Reach out to me on social media. I am mostly on Instagram. You can reach out to me. My handle is @DrJoeTatta. It’s been a pleasure speaking with you. We’ll see you next time.

Thank you.

Important Links

• University of Nebraska Medical Center
• Integrative and Lifestyle Medicine in Physical Therapy: A Guide to Primary Care Health Promotion and Disease Prevention
• OPTP.com
• Amazon – Integrative and Lifestyle Medicine in Physical Therapy: A Guide to Primary Care Health Promotion and Disease Prevention
• @TessaWellsPT – Twitter
• @BJBecko – Twitter
• [email protected]
• @DrJoeTatta – Instagram
• https://www.UNMC.edu/alliedhealth/education/pt/index.html
• https://www.Facebook.com/alliedhealth

About Tessa M Wells

Tessa M Wells, PT, DPT, CEEAA, GCS is an Assistant Professor and Assistant Director of Clinical Education in the Division of Physical Therapy Education at the University of Nebraska Medical Center (UNMC) in Kearney, NE. Dr. Wells received her Doctor of Physical Therapy degree in 2006 from UNMC and serve as an APTA Credentialed Clinical Instructor for 10 years, practicing in the areas of outpatient pediatrics, acute care, inpatient rehabilitation, skilled nursing and outpatient orthopedics, with a special interest in geriatrics. She became a Board-Certified Clinical Specialist in Geriatric Physical Therapy in 2016, was appointed to the Specialization Academy of Content Experts for the Geriatric Specialty Council in 2022, and continues clinical practice in an inpatient rehabilitation facility housed in a Level-II Trauma Center. Her clinical specialties include geriatrics, inpatient rehabilitation, orthopedics and balance disorders. Dr. Wells’ research interests include interprofessional education, the scholarship of teaching and learning, and wellness across the lifespan. Tessa serves as Nebraska State Advocate co-chair for the Academy of Geriatric Physical Therapy and is on the executive board of the American Physical Therapy Association – Nebraska Chapter as the Central District co-chair.

About Betsy J. Becker

Betsy J. Becker, PT, DPT, PhD, CLT-LANA, is an Associate Professor with Tenure and the Program Director of the University of Nebraska Medical Center’s Division of Physical Therapy Education. She also serves as the Chair of the UNMC Department of Health and Rehabilitation Sciences. A Nebraska native, she holds a Master’s in Physical Therapy degree from UNMC, a transitional Doctor of Physical Therapy degree from the University of South Dakota, and a PhD from UNMC. Dr. Becker’s scholarly activity has focused on several areas of interest including her clinical specialty of cancer rehabilitation, educational technology, and faculty development. She has published seven peer-reviewed research manuscripts, one edited book and six book chapters. She has given international and national invited presentations, peer-reviewed presentations at both international and national conferences, and many poster or platform presentations at national meetings. Her forward-thinking mindset is illustrated by her scholarly activity in using a new approach to faculty development using network analysis. For this work, Dr. Becker was recognized as the Journal of Physical Therapy Education’s 2019 Stanford Award Winner in recognition of her publication, “An Investigation of Professional Networks and Scholarly Productivity of Early Career Physical Therapy Faculty.”