Posted by vanessa on October 15, 2015
Dr. Pamela Duncan
Dr. Duncan is principal investigator on major multidisciplinary grant to redesign post acute care for stroke patients
by Eleanor Chiger, CUDPT 2016
What originally drew you to the practice of Physical Therapy?
I wanted to go into some aspect of a medical profession, and I wasn’t sure if I wanted to be a nurse or go to medical school. I looked up Physical Therapy and was intrigued by the scope of practice and the history of physical therapists being major providers for rehabilitation services, offering hope and opportunity to recover.
Much has changed in the profession and the scope of practice has only grown. How have you gotten to see the field change since you first graduated from Columbia in 1973?
Certainly the educational pre-requisites have changed! Physical therapy has emerged from a profession that was very prescriptive to one where we play a major role in systematic evaluation and in setting the direction of the care plan and recovery. We bring an incredible skill-set to be able to evaluate the functional status of the patient, the neurological and musculoskeletal condition of the patient, and to develop the recovery program and establish a course of treatment.
Congratulations on the [$14 million] grant you recently received from the Patient-Centered Outcomes Research Institute [to study “Early supported discharge for improving functional outcomes after stroke”]. In many ways, this project represents what you just said, that Physical Therapy has become a profession that is leading the processes and procedures. What does this project mean for the role of PTs in transitional care as advanced practitioners?
I think it’s significant that I, as a Physical Therapist, am the principal investigator leading a multi-disciplinary team of physicians, epidemiologists, therapists, nurses, and statisticians to redesign post-acute care. This grant has been the culmination of a career interest of mine, stroke and stroke recovery, contributing to some of the major trials, understanding the trajectory of recovery as well as the specific interventions that might facilitate it.
But we have to move from just a research focus to thinking about how we bring this level of knowledge to front-line care. This is a huge initiative across the whole state of North Carolina to systematically assess the patients for functional and social determinants of health and to be able to work with them, get the right referrals and get them back into their communities.
This is a patient-centered pragmatic trial where we are taking the evidence of practice and the perspective that this is not just about physical recovery, but it’s also about working with patients to self-manage their own medications, their own risk factors, and helping them become engaged and physically active. It’s a huge project thinking about the patient holistically and getting them back into the community. We’ve had a lot of evidence that we can certainly improve physical recovery, but we have to bring it to mainstream practice so we can optimize care.
It speaks volumes for the physical therapy profession that, in this first round of funded pragmatic trials, two of them are led by physical therapists. I’m leading the one on stroke, and [Anthony] Delitto is leading the one on low-back pain in primary care. So while we certainly could not have done it without a PhD, we brought our PT skills and experience to this level of clinical practice and research to make a difference. It speaks volumes about how far we’ve come!
So many new grads look for mentors to help guide them in shaping their careers in the ways that you have. What do you think might be qualities new graduates should look for in mentors?
You look for mentors who truly are driven by a broader purpose. I just gave a commencement speech called “The courage to lead, the courage to learn, and the courage to care.” So in that perspective, part of leadership is having a greater goal than your own individual priorities. You have to identify a medical or social need that motivates you as a mentor to go forward and then surround yourself with young talent who can embrace goals themselves and also move forward with passion when you give them an opportunity. You want people who give you an opportunity to succeed and develop your skills. So I guess the first aspect of a mentor is someone who is not self-serving, but really has the interests of others at heart.
The second one is the courage to learn. In a mentorship, not only are you learning from your mentor, but the mentor should be learning from you. It’s a partnership in learning that’s important. And the third thing is the tie that binds all satisfaction and healthcare and potentially life itself—that you really care. You care about the students you work with and you care about the patients—it’s all about humanistic caring.
As we’ve discussed, the profession has grown so much, but we’ve also set ourselves a rather ambitious vision for the future. Do you have any advice for new PTs on how to achieve that vision, to continue moving the profession forward?
It really isn’t about independent practice, it’s about interdependent practice. The way you move forward is to build great networks of colleagues across multiple disciplines, whether they be physicians, nurses or other therapists. It’s about being confident in your own knowledge and skill set among the interdisciplinary providers and meeting the goals of the team to raise the patient’s health. So the best thing is to learn how to work with other professionals and be confident in the therapist’s role in the contribution to the health of populations.
One of the biggest issues now is population health management and one of the biggest drivers of population health is function. I think that “function first” is a major theme and that is what physical therapy is about. I personally see that this new generation of therapists has tremendous opportunity to bring that perspective and work cohesively with a team to advance health.
So always look outside the box. Don’t always constrain yourself, but think about where you might practice in the future. Do you want to work in communities, or hospitals, or actually be partners in primary care--I think that’s an untapped area in physical therapy now.
It’s about being in the trenches, learning and practicing together. I spoke to the entire stroke team this morning that included everyone from the therapists to the physicians, to the administrators, to the nurses, to the coordinators. I shared with them the common vision, the direction of what these programs are about. It takes a village!
Dr. Pamela Duncan is currently a Professor of Neurology at the Sticht Center on Aging, Gerontology and Geriatric Medicine, Wake Forest School of Medicine.