DPT Portfolios

Professional Goal:

To gain confidence in reading and understanding research literature in order to be a more effective clinician for my patients, a more informed clinical instructor for my students, a more productive teammate for my colleagues.

Career Path and Future Plans:

My introduction to the profession of physical therapy was somewhat by accident. Fulfilling an internship requirement for my degree in Exercise Science, I worked as an aide for a physical therapist that was coordinating the orthopedic walk-in clinic at Student Health clinic at Appalachian State University. That clinician, Lou Ann Kernodle, PT, has been my mentor and advisor for my career path as well as many life choices. Following graduation from ASU, I was accepted to the physical therapy program at UNC-CH and graduated in the Class of 1995. After practicing for a couple of years, I became complacent in my skills and wanted to return to the academic environment. This time I returned to UNC-CH for a Master’s in Public Health (2005). Although I had achieved specialty certifications through continuing education, I was still intimidated to read journal articles and questioned my understanding of the research findings. This is what led me to UNC’s tDPT program. In retrospect, my career has been the epitome of the definition of a ‘life-long learner’.

I have had the opportunity to work in acute care, home health, outpatient orthopedics, short-term rehabilitation, and administration and found enjoyment and challenge in each setting.  However, I am particularly drawn to working with patients following stroke and with patients after  limb amputation.   My goals for the future include passing the Neurologic Specialist Certification through the APTA, volunteering with the Range Of Motion Project in Guatemala or Ecuador, and attaining more teaching opportunities.

Learning Objectives:

1. To gain confidence in my ability to critically analyze research literature in order to apply ‘best practice’ techniques to patient care.

Beginning this program was very intimidating. I limited my reading of research because I did not feel I was able to adequately determine whether what I was reading was credible or not. Evidence-Based Practice II (PHYT752) provided me with the tools to better understand how to appraise an article and understand the article’s content. These tools helped organize and complete my CAT project.

2. To develop classroom-teaching skills, understand learning styles and develop a teaching curriculum that can be applied to a classroom setting.

I was able to achieve this objective through the Physical Therapy Education Seminar (PHYT830) and well as the APTA Clinical Instructor Credentialing course. In the PT Education Seminar we learned about different learning styles and various methods of teaching students with differing learning styles. These concepts were reiterated in the APTA CI Credentialing course. PHYT830 helped me understand my own learning preferences, develop lecture material (PHYT830 PowerPoint) and provided me with the opportunity to discover my enjoyment of the classroom environment. This also provided the incentive to reach out to area PT/PTA programs for teaching opportunities.

3. To improve upon my current level of understanding of clinical lab values, diagnostic imaging and pharmacological side effects and interactions.

This objective was achieved through several courses. In Advanced Patient Management I (PHYT820), I was challenged to stretch my understanding of pharmaceuticals, medication side effects, and drug interactions across the lifespan.   In Advance Patient Management II (PHYT 822), I developed a better understanding of the pros/cons of various types of imaging tools and how to interpret imaging findings. These classes have increased my interest in understanding and interpreting medical information.

4. To become more involve within my community Physical Therapy organization (NCPT).

Advance Practice Issues (PHYT 839) helped me appreciate that my profession is more than just practicing as a clinician; it is about becoming involved in the advancement of the profession. As a new graduate, I was more concerned about passing my board exam and becoming a good therapist. At that time, the idea of advancing the profession was more for those therapists’ in academia. This class, wisdom, and time have enlightened me to the need for involvement in NCPT Association.

Reflection:

When I was considering whether I would return to graduate school, a colleague said to me, ‘You can either enter the program and in two years you’ll be finished with your degree OR you can choose not to enter the program and in two years you’ll wish you had started. Either way, two years will fly by’.   As I reflect upon these words, I am reminded of the time warp of school and how quickly time passes. This program has rekindled my love of learning. I have gained confidence in my ability to interpret research, lab values and imaging. As a result, this new knowledge has significantly altered my clinical practice. The DPT program has elevated my thought process and method of learning to a new level. As I complete this program, I remind myself this is the start of a lifetime of learning.

Professional Goals

To be a life-long educator as a physical therapist to my patients and as an instructor to my students in both the clinic and the classroom.

Career Plan

My career as a physical therapist has taken me from the center of this country and allowed me to venture from coast–to-coast. I have had the opportunity to work with amazing people, in a variety of settings. I have worked in home health, inpatient rehab, and acute care, but found my love in outpatient orthopedics. It is in this setting that I have pursued numerous continuing education opportunities, received my specialist certification and most importantly, discovered my passion for teaching. I knew in order for me to follow this passion and to fulfill my professional goals, I needed to take the next step in my own education. It was the emphasis on teaching and education at UNC’s tDPT program that led me to move here and apply in 2014.

Objectives/ Specific Strategies/Self Assessment

My objectives for this program are:

1. To improve my ability to critically analyze current literature and determine how it may apply to my patient care.

I believe I achieved this objective in EBP II and this was exemplified in my CAT project. I was encouraged throughout this program to not only critically analyze the readings but to find and synthesize other evidence and discuss how it may apply it to my daily practice. This proved very challenging in Advanced Patient Management I & II especially in the topics in which I was less familiar.

2. To gain further knowledge in current evidence regarding orthopedic practice.

I was able to achieve this goal from a variety of classes. For example, in Advanced Patient Management II, I learned about the current research and guidelines in the treatment of neck and back pain. I was able to expand upon what I had learned regarding spinal imaging and create my Capstone Project. I gained extensive knowledge about musculoskeletal pathology in the elective, Advanced Orthopedic Assessment and Treatment, and I know I will continue to refer to my notes and the readings in the future.

3. To learn about pedagogy and its applications as well as have the opportunity to apply this knowledge in an academic environment.

I was able to achieve this goal by participating in the seminar, Education in Physical Therapy, as well as in an elective offered through East Carolina University, Instructional Strategies in Adult Education. It was in these classes I learned not only about teaching, but also about my philosophy and how that shapes me as an instructor. It was my final project for the education seminar that I had the pleasure of putting what I had learned into reality by giving a lecture to the MSK I class this spring. As part of my Capstone project, I created a Voicethread lecture for the Spine Module of Advanced Patient Management II as well as obtained experience in grading and providing student feedback in an online teaching environment.

“The mind, once stretched by a new idea, never returns to its original dimensions.”

-Ralph Waldo Emerson

Reflection

As I reflect on the past two years, I do not even recognize the person I was prior to August of 2015. I had become rather complacent in my way of thinking, but this program has stretched my mind to a point of no return and I am forever grateful. As stated above, I had objectives for this program and not only did I meet them, but I surpassed them beyond my expectations due to the encouragement of the faculty and the curriculum provided at UNC. I now know how to critically appraise the evidence, determine how it applies to my practice and then educate others on the findings.   I look forward to life of continued education, not only for myself, but also for my colleagues and students. Completion of my DPT has inspired me to learn more about becoming an effective educator and to pursue my professional goals to teach the physical therapists of the future.

Professional Goal Statement

My professional goals in entering the UNC-Chapel Hill tDPT program is to gain additional knowledge and experience necessary to transition into an active role in the realm of physical therapy academia as well as take on more of a leadership role in my current practice setting.  I also hope to gain the ability to discern between the various levels of available evidence and research to support and further develop my clinical practice skills in the pediatric population.  Finally, my goal is to bridge my love for teaching on a one on one basis as a clinical instructor to the classroom environment.

Career Plan

Throughout my 15year career, I have developed a love of teaching in the aspects of patient education as well as my role as a clinical instructor.  My goal was to transition this love of teaching into the PT/PTA classroom.  I decided that the UNC tDPT was a great fit for me and my family in order to achieve the education to bridge the gap between my roles as teacher in a clinical setting to the classroom setting.  The journey continues:

Learning Objectives

1. Gain current knowledge and ability to apply up to date evidence based practice in my current job setting on a variety of developmental disabilities throughout the lifespan in the electives course Child/Family Assessment and Intervention PHYT880.
2. Utilize information gained from the Topics in Health Promotion and Wellness PHYT 824 course to: a) expand my role as a physical therapist in the community, b) identify and address potential barriers to healthy behaviors specifically in the pediatric population, c) provide attainable resources and programs for pediatric patients and families from a diverse socioeconomic background.
3. Gain the skills necessary to develop and implement a teaching plan/experience specifically in the area of pediatric physical therapy to a group of entry level DPT students based on the knowledge gained from summer course, Education in Physical Therapy Seminar PHYT 830.

Product Examples

A common thread throughout my tDPT course work has always been focused on finding additional leisure and community activities to encourage physical activity and social integration for children with and without disabilities.  Early in the program in our Health and Wellness course, I was able to address the topic of the role of the physical therapist in promoting health and wellness in order to address child related chronic health issues.  RISENJ_Assignment2

In one of my elective courses, Advanced Neuromuscular Intervention, I was able to explore the use of dance therapy as an alternative treatment option and leisure time activity for children with a variety of disabilities.  It can be accessed through my neurospecialtopics website:  https://neurospecialtopics.web.unc.edu/dance-pediatrics/

For our Evidence Based Practice II course, I was able to address the topic of hippotherapy as alternative leisure activity for children specifically diagnosed with cerebral palsy.  This was a great experience that resulted in my ability to critically appraise the current evidence available on the specific topic of hippotherapy as an adjunct intervention in order for me to make appropriate recommendations to my patient population. Risen_Assignment5CAT

One of my most memorable moments in the tDPT program was my opportunity to participate in a UNC onsite lecture and lab regarding the administration of the Peabody Developmental Motor Scales-2nd Edition test, as part of my summer course Education in Physical Therapy Seminar.  This experience helped to solidify my intentions to teach.  I hope to be able to return to campus again as a guest lecturer.  Due to the size of this power point presentation, I have provided a student version without videos as well as separate video/patient example for viewing:

Peabody Developmental Motor Scales-2 Student Edition

https://www.youtube.com/watch?v=t0LoA6IVrx8&feature=youtu.be

Finally, I was able to incorporate the themes of my previous projects into my capstone project that focused on the role of the school based physical therapist in promoting physical activity and social inclusion for children with disabilities and their non-disabled peers.  https://dptcapstone.web.unc.edu/category/current-students-spring-of-2017/transitional-students-current-students-spring-of-2017/risen-jessie/

Reflection

My family has always been a priority to me.  My family is Turkish-Armenian and emigrated from Turkey to Germany where I was born.  My parents, myself and my 3 older sisters, then immigrated to the United States when I was just 11months old.  My parents really set an example to me that anything is possible!  They moved to a country where they didn’t speak the language and were able to establish themselves with their own alterations and tailoring business.  They became successful while chasing the “American Dream.” Therefore, I have strived to set that example for my children too.  We have every tool and advantage compared to what my parents came here with (a family of 6 and only 4 suitcases to our names), to do anything that we want to with our lives.  I was determined to do just that as I succeeded in school to pursue a profession in physical therapy.  My path to earning my degree in physical therapy has been a long and complicated one that has led me to pursue my tDPT from UNC.  During the pursuit of master’s degree in physical therapy, my father passed away my first year.  My mother was then diagnosed with terminal cancer during my last semester. These life experiences have shaped who I am and what my priorities are.  As a mother myself now, balancing my family and my career continues to be a priority and the tDPT program allowed me to continue to maintain this balance along with unwavering and loving support of my husband.  I am so grateful for my family and the life experiences that have shaped who I am today.  I plan to accomplish the career goals that I have set forth but the greatest accomplishment in my life will be to set a good example for my family and children that anything is possible with faith, determination, and hard work.

“Hopeful”

A photo from our local newspaper interviewing my family when we first moved to the United States in 1977.  I’m the curly headed baby on my dad’s lap.

Professional History & Goals

1996 and prior – ATC/LAT, yoga and yoga therapy education

1996-1998 – MPT from UNC

1998-2003 – Outpatient orthopaedic, inpatient general, sports medicine, home health, women’s health, and both insurance-based and cash-based practice

2000 – Founded Professional Yoga Therapy Institute (PYTI) and began writing and teaching approved CE for yoga in rehabilitation (interdisciplinary)

2003 to present – Executive Director, PYTI; Owner and Therapist, Crystal Coast Integrative Medicine & Physical Therapy – Cash-based private practice – chronic pain with emphasis in orthopaedics and women’s health; Lecturer/Educator/Course Developer – Multiple CE organizations and universities worldwide

2013-2016 – tDPT from UNC

2013-2016 – writing my first book on yoga in rehabilitation

Teaching at MISTY in Montreal, Canada earlier in 2016

I have been a practicing physical therapist since 1998 and athletic trainer since 1995, with my greatest emphasis on chronic pain management for women using complementary and integrative medicine blended with physical therapy. From 2005, I have also been a mother. This means I have both seen and experienced the inequities that exist against women in the workplace – in both healthcare and corporate sectors.

I have also spent the last 18 years in proximity to two of the biggest military bases in the world. Interestingly, mothers and veterans present with some of the same problems, physically and socially. They are isolated, oftentimes the product of fractured care, and have similar issues with chronic pain, oftentimes including PTSD, trauma, and sleep problems. This was the original impetus which drove me to write CE, practice creatively as a therapist, and ultimately, pursue my tDPT back at my “home base” of UNC.

A quote from one of my students in the PYTI program.

My professional goals for the tDPT program were (and still are) to support the profession and APTA’s vision statement by earning the DPT, expand my knowledge in areas of advocacy for access to PT, troubleshoot ways to better serve the public and the profession through collaboration and development of interprofessional dialogue and education, and to pursue research and public health promotion in the use of yoga in healthcare. Quite honestly, starting out I was not sure how I was going to do that while also having just signed a contract to write my first book in addition to maintaining the helm and direction of my own work, coupled with the work/life demands of raising a family with three boys ages 7 and under.

My history in PT practice has led to my persistent work in the use of yoga, founding Professional Yoga Therapy Institute, and now publishing my first textbook on medical yoga methodology this summer, Medical Therapeutic Yoga, which I wrote during my work here at UNC toward my tDPT. My professional goals remain constant as I hope to continue my work in yoga clinical work with research and teaching here at UNC. Some of the projects I am currently working on and will continue to work on in the future include:

• Applying for a grant and leadership fellowship in the Clinical Scholars Program with Karen McCulloch and colleagues here at UNC through the Robert Wood Foundation to address suicide in the military through yoga as an antidote.
• Continuing to work toward researching mTBI and PTSD and the systems-based effects of medical yoga methodology with Karen McCulloch, UNC, and the US military.
• Hopefully joining the faculty at UNC to assist with teaching coursework in the DPT program.
• Plans to formally expand the PYTI program for study of medical therapeutic yoga into Australia, Ireland, United Kingdom, New Zealand, China, Vietnam, and Canada. Plans are already underway for expansions in each country, which is a lifetime dream realized.
• Publication of my first textbook in June/July 2016 through Handspring Pub, Ltd., Scotland.
• Working toward having my book translated into Chinese.
• Shooting companion videos as part of the multi-media interactivity of the book.
• Write a new 16-hour post-operative rehabilitation course on hip labral and femoracetabular repair, due to launch February 2017 in Pittsburgh, PA.
• Travel to Australia to teach medical therapeutic yoga to PT’s – May, 2017
• Travel to China to teach perinatal medical therapeutic yoga to PT’s in a fledgling PT industry – TBD
• 

  Speaking at the Montreal Symposium on Therapeutic Yoga, March 2016. Pictured with my assistant, Naomi, at our PYTI table. Photo courtesy of Michael Green Photography.

  Travel to Vietnam to teach pediatric-oriented medical therapeutic yoga for addressing children’s needs with autism spectrum disorder – TBD (humanitarian aide trip)

• Travel to Canada to teach medical therapeutic yoga to interprofessional health care professionals Fall, 2017; for yoga professionals October, 2017
• Travel to UK and Ireland to teach medical therapeutic yoga Fall, 2017.
• Finish and submit a paper for publication on Diastasis Rectus Abdominis: A Narrative Review.
• Submit proposals to speak at World Congress (PT) 2017 in South Africa, and NATA (athletic training annual meeting) and CSM for 2018.
• Continue to work toward formalizing an organization to recognize interprofessional’s right to use medical use of yoga in healthcare within their scope of practice.
• Continue to work with lay yoga organizations to teach proper scope of practice and referral to PT for yoga injury prevention and education (YogaMate, Yoga University, Yoga Alliance Registry, International Assocation of Yoga Therapists).
• Continue teaching for Herman and Wallace Rehabilitation Institute, MedBridge, and Allied Health Education.
• 

  My (almost ready) book cover top choice (after 6 tries with 4 different artists).

  Expand medical therapeutic yoga education to offer seminar series through PYTI in clinical specialties ranging from neurology to chronic pain to pediatrics.

• Continue consulting with, and teaching at, universities in Canada and the US to include medical therapeutic yoga methodology in EB practice and Health Promotion coursework.
• Grow my work in policy advocacy at the state (NCPTA) and national (APTA) level for use of CIM (complementary and integrative medicine) in the PT scope of practice.
• Continue blogging (www.gingergarner.com) to increase awareness about CIM in PT scope of practice and for patient advocacy for improving access to PT services

tDPT at UNC

In hindsight, I feel quite privileged to have been able to pen my first book while completing my tDPT at UNC. The timing was exactly as it was supposed to be. My work on the tDPT has enriched both my clinical and writing work, without a doubt, and I hope to remain close to UNC and academics through continuing my work in education and research. My book will be published in June/July of this year, and represents the largest body of my work completed while at UNC.  The book is representative of many courses I took in the tDPT program, including advanced practice (I and II), the summer education class, and the health and wellness course, for starters. One of the notable papers I completed for the advanced practice course was GGarner Vestibular_Case_Study+Algorithm. My book website will be launched soon, www.medicaltherapeuticyoga.com, and news of its release can be found at www.facebook.com/medicaltherapeuticyoga. My capstone also represents some of my work done here at UNC as well, Facilitating Health Promotion in Physical Therapy Using Yoga. Additionally, there is my instructional design project on executive functioning in autism, found below.

Reflections

Having fun with the spine at the photo shoot for my book.

All of the coursework I completed as a part of my tDPT work at UNC was beneficial, however I think the most important class was Nancy Garland’s Professional Issues course. Without action on our part to secure the future of physical therapy through policy and legislative efforts, there would be no use for, or avenue to use, clinical or evidence-based practice. Second, the flexibility of UNC to allow me to pursue coursework outside of the given electives was also a gift, and very valuable in my professional development. While I spent a good 5 years studying instructional design with a PhD mentor from Duke University, the semester’s work I did at ECU in Instructional Design with Dr. Patricia Slagter van Tryon was immeasurably valuable. My final project, Development of an Operational Executive Functioning Skillset in 4th Grade Children, pushed me beyond my comfort zone by allowing me to creatively delve into a completely different substrate of my work as a physical therapist and educator.

Teaching yoga in rehab at AT Still University during my time at UNC. We are demonstrating partnership theory relationship through shoulder-to-shoulder “ganesha mudra.”

A beach break while teaching yoga as medicine for health care pros in Emerald Isle, NC

The program has also provided me with enormous collaborative potential, leading to outside research and community activism with Karen McCulloch, work on my book with Dr. Stephen Porges in the psychology department, and making connections in military populations that will allow for improving delivery of healthcare services through yoga for a long time to come. As a lifelong learner, my education does not end with my tDPT. Thousands of hours logged in writing and teaching continuing education, blogging, advocacy work, not to mention my book, definitely increase my passion for learning and continuing to teach. My oldest son, who is 10 years old, asked me the other day, “Mom, are you still going to get that PhD too?,” to which he followed with, “I don’t know if you need two doctorates Mom.,” with a smirk. I shot back with a laugh, “You are right Michael, but just because I’m no longer in school, it doesn’t mean Dr. Mom won’t keep on learning for the rest of my life.” “Yes, he said, you are right.” Hearing my son respond in the affirmative about lifelong learning, especially my child with autism, who struggles with learning disabilities and self-confidence, was the greatest gift this tDPT program could have given me. Thank you.

Family photo captured during the mid-range of my time at UNC

A big thank you goes to Kmac and my family (what troopers they are to handle my annual teaching schedule, writing requirements, and school demands) – who also well handled and accommodated by need to extend my attendance in the program for a full year – after I had to undergo an unexpected hip reconstruction and my oldest son’s diagnoses with autism spectrum disorder. I could not have done it without faith and hope in you and in the Greater Good that lies beyond the stars.