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Linda Crane Lecture 2020: Following Your Heart (and Lungs) as a Path to Professional Development

2020; Lippincott Williams & Wilkins; Volume: 31; Issue: 3 Linguagem: Inglês

10.1097/cpt.0000000000000143

2374-8907

Anne K. Swisher,

Interprofessional Education and Collaboration

INTRODUCTION First, I must thank my friends and colleagues who nominated me to give this talk. Rob Dekerlegand, Anne Mejia Downs (Annie), and Matt Nippins—I am humbled. It is fitting that these individuals represent such big parts of my professional life. Annie was my very first mentor and inspired me to pursue cardiopulmonary aspects of clinical practice. She also gave me my first chance to teach physical therapy (PT) students—I taught electrocardiographic (ECG) interpretation. Together we plunged into the process of defining the role of PT for people living with cystic fibrosis (CF). It is through the CF world that I met Rob, who honored me by asking my advice as he embarked on an academic career and later as a member of his dissertation committee. Matt and I also share a passion for mentoring young clinicians into CF care teams. He has taken our first initiatives and carried the banner forward into this exciting new time. Again, thank you, dear friends. By my count, today marks the 20th anniversary of this talk in honor of a great woman—Linda Crane. Although I did not have the pleasure to know Linda, I feel I have learned much about her from attending most of the 19 lectures before today. I have also seen her influence on people in this Section who have greatly influenced me—Nancy Ciesla, the late Scott Irwin, Sue Butler-McNamara, Donna Frownfelter, Ellen Hillegass, Mary Massery, Larry Cahalin, Sandy Cassidy, Dianne Jewell, Ethel Frese, Annie (Mejia-Downs), and Sean Collins. Although this list is not a full rundown of speakers, you can see that I have been influenced by most of them. As I think of them, images flash into my mind of where I met them, work we did together, and certainly, fun we had. I'm truly blessed by knowing each of them. Thank you. The themes of the past Linda Crane lectures is also a collection of the best of our specialty and profession. Integrity, caring, mentoring, excellence, inspiration, challenge, leadership, professionalism, teamwork, improving society and the world, and resilience. Each of these themes has been expounded better than I could do in space I have available, but each theme certainly resonates with me and my journey so far. Speaking of journeys … let me tell you a little about mine. The path is anything but straight, but each twist and turn involves a person or people who impacted me (Fig. 1).Fig. 1.: The author as a baby with her first mentor, her father.GROWING UP My early life was greatly influenced by my father. He was raised in a working-class family who struggled to make ends meet during the post–World War II times. In fact, despite being a bright student, he dropped out of high school at the age of 16 years to go to work in a local factory. Somewhere along the way, he had a mentor who recognized his potential and made it possible for him to get his general education degree, go to college, and eventually to medical school. As he finished medical school, he was again influenced by mentors who recognized a talented mind and convinced him to apply for residency at the Mayo Clinic. There, yet another mentor guided him to pursue a research career in West Virginia, studying the effects of coal mining on the lungs and health of the miners. His research was balanced, and informed, by compassionate patient care as a specialist in pulmonary and critical care medicine. In fact, he was instrumental in creating the first intensive care unit (ICU) at West Virginia University (WVU). This man inspired me to a career in medical sciences but always, always to seek to use what I learned to help people. As the child of an academic physician, I saw both good and bad of that role. Although I was fascinated by medicine, I also saw that being a physician had its down side—being on call, being responsible for everything, missing family occasions—so Dad introduced me to my next mentor. ENTERING THE PROFESSION I'll never forget sitting in Dr. Sandy Burkart's office and being introduced to this profession that held many diverse ways to combine a love of science, caring for people, and having a good family life. I began volunteering in both outpatient and inpatient settings and discovered people who cared deeply but also laughed and celebrated with patients. I was hooked! So, I got my first degree—a bachelor's in PT from WVU. I attended classes in the same building where my Dad had his office and exercise testing lab—even today I tell our students that I literally grew up in the health sciences center! Like many West Virginia-raised young people, I left the state after graduation. Dr. Burkart gave me some more great advice as I was graduating—“Go to a big, academic medical center to start your career.” There I met Annie. She took this headstrong but paradoxically shy, young PT and we marched into the ICU! I soon found this was my favorite place to be. I loved the cutting-edge, “gee-whiz” machines and techniques, which inspired my technological side, but I also loved being the advocate for seeing the whole person connected to the machines. Physical therapists have such a unique role in this setting. Everyone else is focused on minute-to-minute survival. We assume the person will survive and aim for their optimal function. We are the face of optimism in a very scary place. Never forget that. CRITICAL CARE PHYSICAL THERAPY One of the twists in my career path involves the ICU. Nearly 2 years ago, I was asked by the brand new cardiovascular ICU unit at WVUMedicine to assist in developing an early mobility program for their patients. It has been a true labor of love, learning about many new devices and medical procedures since my clinical days in the late 1980s, but still providing the optimism as we together problem solve how to let patients be mobile, despite the barriers. It is a joy that my colleague and former student, Valerie Knupp MPT, has just presented our program at this very conference. Us “old folks” remember the days of “bag & drag” back when PT did all the airway clearance and progressed to mobilization. While the concept of movement in the critically ill population is not new, the patients are sicker but the research in this area is much, much better. A wonderful intersection of science and compassionate care that makes my HEART happy and my LUNGS breathe deeply! POST PROFESSIONAL EDUCATION After 2.5 years in clinical practice, under the wonderful mentorship of Annie Mejia-Downs, where I learned about heart and lung transplants, CF care and many, many other things cardiovascular and pulmonary, I found I needed more formal education to inform my practice. I left full-time care at UNC Hospitals to pursue a masters' degree in exercise physiology. It was here that I learned that “exercise is medicine” that must be prescribed specifically in order to work. I think this is an area where physical therapists have a unique perspective. We must carefully assess the functions of all the body systems plus the impact of disease or injury, then create a specific exercise program. Exercise, like other medicines, must be dosed—what specific movements? When? How often? Under what conditions? What are the expected effects? What are the signs of overdose or insufficient dose? These questions have driven my academic studies, to a PhD in exercise physiology and much of my early research studies. BECOMING A TEACHER At this point, I began to listen to my HEART and LUNGS—and I realized that helping other people successfully treat patients was just as much fun (or perhaps more fun) that doing it myself. So … the path twists toward the academic environment and my next mentor, Dr. Mary Beth Mandich. In 1994, I was the first faculty person hired by Mary Beth, in her new role as Chairperson of the WVU PT program. She took a chance on a graduate with less than 5 years of clinical experience and a masters' degree. My first roles were to be the Academic Coordinator of Clinical Education (ACCE) and to teach the cardiopulmonary class. Being an ACCE is an entry-level academic job for many people, and it is important to recognize that clinical education develops future academicians, not just future clinicians. Oh, by the way, I was pregnant and my daughter was born in the middle of the first time I taught the cardiopulmonary class! Thankfully, as a single mom of 4 children and a pediatric therapist, Mary Beth prioritized family and showed me how to manage it all. Raising a family while teaching full time and working on a PhD—whew! There were many days when it felt like I wasn't doing anything well. Mary Beth's sage advice? “It's not the quality of any one part of your job or life that matters, it's the complete package!” I have lived by these words many, many days and have spread this message to many younger faculty members. We all take on more than we feel we can do, and we need to be kind to our HEART and let our LUNGS exhale. Now, 25 years later, we have walked the path of academic careers and life together—raising children, losing parents, and all the other things—she continues to inspire my leadership style to give faculty the support, autonomy, and flexibility that they need to juggle it all. We are more frequently talking about retirement and life after such demanding, but fulfilling, careers and I continue to treasure her friendship and mentorship. I guess being asked to give this talk gives me permission to share some of the lessons I have learned along the way. TIPS FOR SUCCESS IN ACADEMIA My favorite cartoon is one called “the Awkward Yeti.” The cartoonist has a brilliant ability to take organs of the body and give them personalities—gallbladder, kidney, a bowel that is irritable, a happy uterus—but my favorite is the heart and lungs. HEART is often portrayed in these cartoons as the emotional side of humanity, whereas brain is the logical side. The best cartoons portray conversations and struggles between these organs. Thus, my theme for today—listening to HEART (and his friends, the LUNGS) as you navigate an academic career (Fig. 2).Fig. 2.: The author holding her favorite teaching illustration, plush heart and lungs.Academics has been called the “3-legged stool.” Faculty must juggle teaching, research, and service continually. Each of these “legs” can be completely consuming, but it is the ability to do all 3 at once that makes a successful academician. Most of us come from the clinical world, which is a fast-paced, quick results environment. When your patients have gone home, or your treatments and documentation is complete, the work is done. You can have the satisfaction I used to have in the hospital of literally, “turning off the pager” and going home. The biggest surprise to clinicians entering academics is that the work is never done. You can always be working—reading research, preparing classes, grading exams and papers—and you feel the pressure to do just that! This is a time that you must listen to your HEART. Find ways to draw boundaries between working and not working. Teaching is a calling and we give of ourselves to our students. If you don't replenish yourself, there is nothing to give. Students become a bother or “problems” instead of the great gift of bright, eager future colleagues (Fig. 3).Fig. 3.: The “3-legged stool,” representing the 3 parts of academia.Leg 1: Teaching What happens in the classroom with our students is magic, but it is also hard work. It is extremely challenging to convey understanding from your brain to students' brains. Each individual has a different experience and different ways that of learning. Strive to be creative in how you teach. I will never be an excellent lecturer—in fact, writing this lecture word for word is the hardest I've ever worked for a single teaching session. It is not my style—but I know it will reach some people who learn best from hearing (or reading text). In my 25+ years, I have tried lots of approaches—including singing and dancing—to convey understanding (see YouTube video of the ECG Dance for a great teaching tip). I have enjoyed learning about new technologies for teaching, from the beginning of PowerPoint to videos to simulation, and figuring out how to use them to convey ideas. However, I also make sure my students know that they must also put in the work of learning. It is more than entertainment. Our role is to guide learning, not spoon feed it to passively open mouths. Only then can we prepare clinicians who can evaluate new discoveries and determine how it affects their patients. It has been said that everything we teach in our curricula today will be wrong in the future. Thus, we must strive to prepare thinkers not containers of knowledge. That's hard to do but it’s amazing when you witness it happen! Oh, and learning happens both directions—I have learned at least as much from my students as they have learned from me! Be open to learning from everyone you meet. Leg 2: Research This can be the most exciting and most frustrating aspect of an academic career. No matter what track you are on, there is an expectation that those of us in academia contribute to the advancement of our profession. Research takes the ability to find unanswered questions, work out ways to answer them, and convey what you found. This takes years of time and the ability to persevere through some of the biggest frustrations of life. Ask anyone who has completed a research doctorate—it's not how smart you are, it's how well you can keep plugging along when your HEART is feeling drained and frustrated. It may take years and many dead ends (and manuscript rejections) to get to the reward. We must be driven by a passion for our profession and the deep desire to see it develop and advance. Even in team-based research, there are lonely times. Many academic institutions base annual reviews and promotions on “productivity” in research. This can be exhausting and stifle our natural curiosity. Take the time to let your mind wander—most great ideas come when taking a shower, driving, or taking a walk [see “Musings while Taking a Walk”]. Archimedes reportedly said “eureka” when he was taking a bath! One of the wonderful aspects of academic life is that we get paid to think! Take the time to think. Think about a patient you encountered, a cool video you watched, a student who challenged you—then ask “why?” Listen to your HEART and notice when it beats faster and your LUNGS breathe deeper. Those are indicators that your question is a good one for you to ask and pursue. If you looked at my curriculum vita (CV) and browsed the titles of my publications, you'd see an incredible diversity of words. They all reflect something that has sparked my curiosity and I was diligent enough to find an audience who also thought the idea was interesting. During my time as Editor-in-Chief of the Cardiopulmonary Physical Therapy Journal, I got to indulge my curiosity as I read the incredible variety of manuscripts that were submitted for considerations. Many of you in this audience may have wondered “why did this article get published?” during that time. Under the mentorship of Dr. Jane Eason, I was empowered to indulge my vision of all things cardiovascular and pulmonary as I strived to help authors communicate their ideas as clearly as possible. If you have a question that is exciting you, there will be others who get excited about it, too. Keep persevering to find the right outlet and don't get weighed down by the need to “publish or perish.” Look for smart people who are also excited by your idea and share the work and frustration. Physical therapy is a team-building profession; research is best done with others, too. I have had personal experience in finding collaborators outside the United States. Meeting people in Germany, Australia, Ireland, Sweden, Canada, and other countries who share similar passions has allowed me to travel to all these places and see how clinical practice, teaching, and clinical research differ (or are the same) in different cultures and health care/academic systems. The more I travel, the more I find we have similarities. Physical therapists/physiotherapists have a curiosity about human movement—a shared human experience that transcends language and culture. However, be warned that writing is the hardest part of an academic job, especially for people who spend all day talking. It takes self-discipline to make yourself put words on paper. It also takes quiet time to get the words flowing. Most faculty members put writing last, as it is hard and we are always interrupted by tasks that break our focus. However, it is essential for your own career and the profession, so it must be prioritized. Create a block of time and guard it fiercely—even just for uninterrupted thinking. Leg 3: Service Part 1: Institutional and Professional Service The final leg in the 3-legged stool is service. Physical therapists are, by nature, helpers and task-oriented “do-ers.” In an academic setting, that translates into tackling the work that keeps a program, unit, or institution running. I have found that committee work has been very rewarding and taught me skills of team building, organization, and faculty development. From my first assignment to the curriculum committee (where novice teachers first get to see the big picture of an educational program), to promotion and tenure (where sometimes the Wisdom of Solomon is needed to balance objective assessment of peers' performance with personal relationships), I have learned from every task. I voluntarily served on the Institutional Review Board for 6 years. Most people thought I was crazy and that it was a thankless position. I found great pleasure in helping novice researchers navigate the regulations to allow them to pursue varied and interesting research questions. I also learned so much that improved my own research. It is important for an academic career that faculty members gain exposure and recognition for their home institutions at state, regional, and/or national levels. Fortunately, there are many opportunities for service within the APTA. My first exposure to this type of service was through item writing for the Cardiovascular and Pulmonary specialty exam. I found such camaraderie and passion for doing the work well that I was willing to say “yes” to the next levels. This led to serving the Section as the specialist committee representative, which got me a seat at the table for the board of directors meetings. I found new mentors in the people who invested their time and talents to move the Section forward. Getting to know past presidents of the Section, Steve Tepper, Dianne Jewell, Ethel Frese, and Dan Malone, has enriched my life and taught me so much about good leadership! Once you say “yes” to serving the APTA, you will never be sorry! The people you meet, the chance to share ideas and roll up your sleeves to work side-by-side will enrich both your professional and personal life. You will never experience the Combined Sections Meeting the same way again—sometimes it's exhausting, but always it's energizing. Explore different types of committee service—be an abstract reviewer, be an item writer, be a nominating committee member—each type has much to teach you that will be valuable in your career and lead you to some great places! Part 2: Clinical Service For physical therapists, service almost always includes clinical practice. I have found that providing patient care is essential for informing my teaching and my research. Credibility as a teacher is greatly enhanced when you can relate an anecdote from a patient you just encountered. Being in the clinical environment also reminds me of what my students need to be prepared to do and what they need out of my classes. The best clinical research questions come from seeing real issues of real patients and what we discover in our research will substantiate or refute clinical care. I have often said that I have spent my whole career working with patients with life-threatening conditions. People sometimes wonder if that's “depressing.” I find it incredibly rewarding to be able to walk a journey with people who are pondering the really important aspects of humanity—why am I here? How can I impact the world? How do I relate to my family and friends? It is a great honor to be part of that process and I have learned so much from my patients. They have mentored me about LIFE! The other reason I have focused on clinical care for people who are critically ill, people awaiting transplants, people living with cystic fibrosis, people undergoing the journey of cancer, and most recently, people struggling with addiction, is that this is where I have found my place within high-functioning, compassionate, and effective interprofessional care teams. I have always loved the ability to have a unique expertise (human movement) within a collaborative team. I love the dynamic teaching and learning that happens in these settings. We also share the emotional highs and lows that are integral parts of life with these diseases and conditions. It is not surprising to me that some of these colleagues have pursued spiritual training, as have I, in response to what we witness. LAST, BUT NOT LEAST… So, to conclude this talk, I want to share some random things I have learned from 32 years in the profession, 25 years of an academic career, and 53 years of human experience. Cultivate an “attitude of gratitude.” We are all given gifts that we did not earn, from life to physical comforts, to health and relationships. In a global political and social climate that wants to focus on the negatives, it is not easy to be optimistic. Look for those opportunities to be positive and share them. I have a planner in which I record at least 1 thing for which I am grateful every day. Looking back over a week, month, or year helps me see the good even when I have a “bad day.” Be humble as a person, but be a passionate advocate of your program, institution, and profession. This has been a hard lesson for me to learn, as someone who is naturally shy and avoids the spotlight. I have overcome this by recognizing that I am an ambassador for my University, state, country, gender, race, and religion. Strive to leave those you encounter with a positive impression of who you represent. As my Irish Fulbright Commissioner told me, when I was despairing of the global image of the “ugly American”—YOU can change that impression to those you meet. Learn from everyone and every situation. I tell my students who are getting ready for their first clinical rotation that their real teachers are the patients they are fortunate to encounter. I have learned from (and been mentored by) patients, students, colleagues, and my family. I believe that our purpose on earth is not to reach perfection but to learn every day how to get closer to it. Seek to improve the world. Find ways to give of yourself and your talents. This may be as simple as smiling at a stranger. I challenge each you to “give away” 3 smiles today, which means smiling at someone who doesn't smile back. You'll be amazed how hard that is to do! Look for ways to use your interests to help. I enjoy crocheting and have made many, many crib blankets for our children's hospital. I get the fun of picking yarn and patterns and creating something, but double joy knowing that someone else will get to use it. Be on the lookout for things you can do—walk dogs at an animal shelter (or cuddle kittens!), pick up trash along the route where you jog, help organize a community garden, and donate vegetables to a local food pantry, be a “buddy” for athletes in your local Special Olympics organization. I have found that love is limitless. The more you give out, the more is replenished. The HEART beats strongly! Care for all aspects of your health—physical, mental, emotional, and spiritual. I am very interested in how human beings make sense of the great mysteries of life. Even being a scientist, I recognize that life, love, meaning, and purpose are not things that can be objectively measured. However, they are issues that all humans must explore [see “Around the World in 80 Faiths”]. Take time to explore your own relationship with the Divine. Find ways to replenish your spirit. Physical therapy is a calling, not a job, and we need to recognize signs of compassion fatigue and help each other recharge. Movement is good for all aspects of health. Make it a priority to be active each day. Find ways to make it your “me time,” or even better, time to commune with the Divine. HEART sometimes gets bruised or broken—let it heal and let LUNGS breathe in a renewed spirit. Travel and explore. Seek to learn about other cultures. Try new things, especially if they make your HEART beat fast. If it feels both exciting and a little scary, that's a sign that there is much to learn from the experience. “Fake it till you make it.” It is OK to be nervous or unsure, but don't let it stop you from trying. Life is about trying, not succeeding, and each time you have a good experience, you gain confidence. Twenty-five years ago, I could not have contemplating addressing this audience. Now, I am excited to be here giving this talk. “Imposter syndrome” is common to everyone the first time. Just keep trying. Be open and share yourself with people you encounter. You are a unique creation and have much to teach others. In this talk, I've shown my willingness to be silly, to be silent, to dance, and sing. Don't hold back. Know when to stop. You may be wondering by now if I truly know how to do that, but I promise, I'm almost done. Listen to your HEART and when what you are doing becomes stale, routine, or just doesn't make it eager to beat, find ways to make a change. For teachers, it might be revising a class or creating a new one. For researchers, it may be a new population, condition, or technique. In service, there is always a different committee or task force that will be eager for your unique voice. Similarly, seek to mentor and develop the next person who can take the task even further than you can imagine. Each of you has enriched my life and “it is well with my soul” (see story about writing of this beloved hymn). Thank you for allowing me to share my thoughts, my journey and reading my advice. I hope you have found something that resonates with you. Now, “Take Me Home, Country Roads”! (feel free to hum along…) You may now consider yourself an honorary resident of “Almost Heaven, West Virginia.”