Hi, I'm Nick Rainey.
I am part of AOMT's Pelvic
Health SIG and the SIG's
former vice president.
I'm also on the research
committee with AOMT and an
interviewer on the AOMT
podcast through that committee.
Today, we have Natalie Turrentine,
a board-certified
orthopedic therapist at
Rosalind Franklin
University in North Chicago.
Welcome, Natalie.
Hi, Nick.
Thank you for having me today.
I'm really looking forward
to talking more.
Well, we're excited to have you on here.
As I was thinking about what
to do for this podcast,
I was doing some research
and I came across your poster at CSM,
twenty twenty four.
You and some students
presented a poster titled
Prevalence and Faculty
Perception of Obstetrics
Education at the Entry
Level Doctor of Physical
Therapy Curriculum.
When I came across this,
I thought it pertinent for our listeners,
as we've all been in
entry-level programs.
All of us care about the
direction our profession takes,
and some of us are involved
in entry-level programs currently.
As this is an orthopedic and
manual therapy organization,
normally the emphasis is in these areas.
personally love the immense
crossover between pelvic
health and orthopedics.
Since I want more people to
appreciate this,
I thought this would be a
pertinent poster and
pertinent discussion for everybody.
Thank you.
Yeah, I'm definitely in agreement.
So I wanted to start off
with a bit of a broader question.
In your research,
you use the term obstetric
rather than the common
physical pelvic health.
Can you elaborate on the
distinction you see between
these terms and why you
choose to use obstetric in
this particular study?
Sure, of course.
So as you already mentioned,
I come from a lens of I'm a
board certified orthopedic
physical therapist,
and I'm also an academic.
So when I started working on
my line of research,
I really found that I
wanted to find a category
of interest based off of
what I had already seen clinically.
Um,
so the settings that I had worked in
clinically were primarily
outpatient orthopedic.
And I started to notice a
trend that if someone were
to call with any type of
pathology or any type of diagnosis,
and also happened to be pregnant,
that they would
automatically be referred
to a pelvic health specialist,
which in many cases that
may be best case scenario.
But in other cases where
perhaps accessibility is limited,
there may be a little bit
of a disconnect between
what I was seeing
clinically and what I
thought maybe could be happening.
So this is really the
premise of why I wanted to
start learning more and
looking a little bit into
the term obstetrics as
mentioned and our current
practice of obstetrics.
So what this led to is one
of my first research
studies with a student
group was looking at the
opinions of outpatient
physical therapists.
So we surveyed about a
little over six hundred
outpatient physical
therapists to get their
perspective on what was
currently happening in the field.
So we had a pretty good mix
of pelvic health specialists,
orthopedic specialists,
and individuals who
identified of not having
any specialty at all.
And we asked questions about
if someone were to have a diagnosis of,
let's say,
shoulder pain or back pain or knee pain,
what would you think?
What do you think would be
the best person to see this
particular individual?
And overwhelmingly,
with the exception of wrist, hand,
and then diagnoses that pertain to the
These physical therapists
said that a pelvic health
specialist would be most appropriate,
which again, that may be the case,
but we do know that
accessibility can be limited.
So we wanted to see what can
we do to fill in a gap where needed.
I feel like as a profession,
the more generalized knowledge we have,
the better off we can be.
in our ability to not only
diagnose and treat, but also refer.
And I do feel like sometimes
there's a stigma or an
apprehension or maybe a
fear of treating
individuals who are
pregnant and postpartum.
And so my goal and my line
of research and teaching
and advocacy is to make
sure that's not the case.
You know,
if someone comes in and they are
pregnant or they wanted to
return to something postpartum,
that as a generalized physical therapist,
we either know what to do
or we know when to refer.
And so that's why I use the
term obstetrics.
That's great insight.
I know when I first looked at the study,
you know,
I didn't think about it just
from a pregnancy lens.
You know,
when I first looked at the title there,
you know,
what you're saying is that when
people would come in and
they were pregnant,
automatically classed to
the pelvic health therapist,
no matter if it's,
even if it's not
lumbopelvic or specifically
pregnancy related.
Correct.
Yeah.
And that was my observation.
And I think it could be at
least a little bit
generalized to more of
what's going on in our field,
just based on the research
that I've done thus far.
You know,
that also makes me think of like
a pediatric specialist.
You know,
a lot of times we talk about
pediatrics and not little adults,
you know,
but we're kind of treating the
obstetric patient like that, you know,
the pregnant patient that
we're going to be saying to
the pelvic health therapist
that it must be different, even if it's a
even if it's a shoulder issue or whatnot.
Whereas with pregnancy,
I can feel like there's
some specific
considerations for lumbopelvic hip,
but maybe not for shoulder, knee,
you know, and obviously they didn't,
you know, with the respondents for hand,
wrist, ankle, foot, it sounds like.
Yeah, absolutely.
And not to downplay by any means,
there's definitely a time
and a place where a pelvic
health specialist, they are most equipped,
right?
But I do feel like if we
we reduce some of the stigma and the fear,
as we said,
that we could reach out to a
bigger population.
Our research continues to
change and to advocate for
more activity and more
exercise and the ability to
return or keep up with certain athletics.
And I feel like that's
something at entry level,
we could at least have some
exposure to so that we
could have education for our patients.
That's great thoughts.
So I guess a little more
follow on the entry level.
For those of our listeners
who may not be as familiar,
could you briefly explain
the CAPT requirements
regarding pelvic health
education in general,
maybe obstetrics more
specifically in physical
therapy programs?
Sure.
For CAPTI requirements,
they are broken up into
these things called elements.
So there are a list of
different elements that universities,
institutions need to show
evidence that they're doing.
So for example,
one of the elements that we
have in academics is an
element that makes sure
that we address the anatomy, physiology,
pathology throughout the lifespan,
including different categories.
So including genital, reproductive,
gastrointestinal, and the list goes on.
Once we,
evaluate that element,
then we have to show what
objectives in teaching and
how we really teach this information.
So I use that as an example
because usually these elements,
they give you some leeway
in how you're doing them in
that each institution can be addressing,
for example,
this one particular element
cited a lot of different ways, right?
So not only do we have these
CAPD standards that we have
to show evidence of,
but we also have these other
influencing factors within academics.
So we use the research
coming out of the APTA,
we use the guide to
physical therapy practice,
we use ACAPT information,
and then also the MPTE.
The role that I'm in here at
the university is
is helping in student
support for the board exams.
So we also have to have an
awareness of what is and is
not being tested.
So there is a category under the MPT,
the FSPPT,
that does talk about pelvic health.
So we do have these certain
standards that we have to meet,
but outside of that,
there is some ambiguity as to
how much and in what detail
this information has to be
included in our curriculum.
The APTA has a guideline for curriculum.
That guideline is a recommendation.
It is not something that is
published by CAPTI.
So it is a really good
resource for anyone in
academics who are looking
for a guideline.
But the CAPTI recommendation
in itself is a little bit broad.
And I think that that's
important to bring up in
some of the next questions too.
Well, that was a very detailed answer.
You were the right person to
ask that question too.
Thank you.
You know,
we just went through our reaccreditation,
so I have learned more
about that than I ever
would have known otherwise.
Very good.
Good timing then.
As you said, it could be vague,
a little bit broad,
what the requirements are.
With your detailed knowledge
of that and your interest there,
I'm assuming that you've
worked to do this at
Rosalind Franklin University.
Could you share some
specific ways that you've
successfully integrated
pelvic health and obstetric
education into your curriculum there?
Yeah, of course.
You know,
I'm really proud of the work
that's been done here,
and it's something that we
put some thought into.
So what we try to do is to
thread our content
throughout the curriculum.
So what we mean by that is
within the first quarter,
We introduce the students to
our diverse faculty.
We have individuals who are
specialized in orthopedics,
but also pelvic health and
everything in between.
So we give an introduction
as to what exists,
how we got there and what
resources there are for the students,
even in starting in their
academic career.
So really to kind of give a
gauge as to these are all
of the things that you'll
be able to do after your entry level.
um, academics.
Then later in the curriculum,
we get a little bit more specific.
So we incorporate some of
the obstetric considerations.
Um, you know, I, I do,
I have a class session
where we talk about just
broad understanding of all
the physiological changes
that occur and how we have
to adapt our examination.
If for example,
we were seeing someone for
their ankle and they were
in their third trimester.
So starting to problem solve,
how will the person feel
most comfortable and safe
in our evaluation technique?
Another thing that I'm proud
of is that we've had the
ability to bring some of
the continuing ed courses to our campus.
And I really think that this
has helped with
accessibility for our
students and community with
some of the pelvic health
and obstetric coursework that exists.
So I think it's going.
Yeah.
I think that, I mean,
if an orthopedic therapist
is seeing somebody for
their ankle to not have any idea how to,
you know,
the considerations for a pregnant patient,
I think it's very important there.
So I think that's great.
You're able to incorporate
that and that's maybe unique, you know,
somewhat to your program.
I can't imagine that's
ubiquitous across programs there.
So that's excellent.
Yeah.
Thank you.
I appreciate it.
We're trying.
And with the continuing education courses,
are those,
do clinicians from around the
community come to those?
Is it just focused on your
students or how do those work?
No.
So we've hosted the APTA
sanctioned courses.
So pelvic health one,
and there's an obstetric
certificate where there's a lab portion.
So we've hosted the labs on
campus and they're open to anyone.
And, you know,
the hope is that in bringing
them locally,
that we could also have some
of our students enroll, which they have,
which is wonderful.
Some of our new grads have enrolled,
but then also anyone, I'm in the Midwest,
so we've had a lot of
people come from the Midwest,
but really from anywhere,
it's open to anyone.
I think that's fabulous.
As a clinician,
one of our recent grads
that we brought on,
she'd already had some
specific pelvic health
training she'd done in an
extra coursework before, you know,
before graduating.
And that really sets her off for the,
you know, the ground running.
Oh, absolutely.
When she started practice.
So that's outstanding.
Absolutely.
Thank you.
I also really liked how you
talked about the faculty
talk about how they got to
where they're at.
I think that's really
important for students to have a vision.
We all know that models are
extremely important in life.
And so they could see where
other faculty have been and
you get that early on,
it sounds like in your program.
I think that's very excellent.
So kudos to you on that as well.
Yeah, thank you very much.
We've all gotten through
different ways and
different pathways to get
to where we are now.
So I think everyone on our
faculty just likes sharing
that and showing that
there's not always a direct path,
but there's
different options depending
on what piques your interest.
So we want to make sure that we expose,
expose our students to that.
So as it going on with
entry-level education then,
so you've been able to
really focus on that at
Rosalind Franklin University.
What do you see as the
primary challenges that
other programs may face in
implementing robust public
health education?
And maybe any ideas on how
these challenges can be addressed?
Sure.
Um, undoubtedly I would say time.
Um, you know,
this is a question that we
specifically asked in our
survey and overwhelmingly
that's what the feedback was, was,
was time in the curriculum.
Um, I could say firsthand, you know,
I'm a part of the curriculum committee.
As I mentioned,
we had just gone through
reaccreditation and we have
a lot of good stuff, you know,
within our field,
we are a pretty generalized
profession in that when
those students take the board exams,
They have a lot of
information about a lot of
interesting things.
So because of that,
time is always of an
essence and you need time
in order to either add
content or make sure that
you're doing things to the
standard in education that
you want to achieve.
So that being said,
I've put some thought into
how we can do this all, right?
How we can still have
generalized information
without adding onto time.
And I guess my thought is,
and this just may be my perspective,
but I feel like we already
do a lot of things in which
this content could be incorporated.
So, you know, a couple of examples.
So we start off,
at least in our curriculum,
we have some generalized sciences,
we have anatomy and physiology.
And from my perspective,
I feel like if we had a
conversation about, for example,
the physiologic changes that occur,
pregnancy you know we don't
have to go into too much
depth but at least have a
touch point early in the
curriculum then we could
build on that later in our
clinical sciences we could
maybe supplement some of
the cases that we discuss
and use a case in which
someone's in their second
trimester they're a one
month um after they're
having a baby and they want
to get back into running
or one month and they have a
certain occupation.
You know,
we could use this case
information in things that
we already do in order for
us to have repetition and
improve the comfort level
of our students in working
with these individuals.
You know, as I think about,
I'm a clinical instructor
and for most months out of the year,
we have students here at
this clinic and I'm continually
I don't know about surprised,
but how much that, you know,
things they do remember
from their entry level education,
you know, I'm just like,
there was this one slide, you know,
two or three semesters ago, you know,
there's one little
discussion that they log away.
And then when it becomes pertinent,
they can bring it out.
And so, you know,
I think that approach is
you're discussing,
Even just being here in our clinic,
if our students have some of those,
a slide here, a conversation there,
it would benefit them at
those moments when it's needed.
It may not be every day for
a lot of clinicians, but when it's needed,
that's how a lot of our education is,
that we don't use it.
Until the one day that it's needed.
Right.
The one day where it's really important.
Right.
And at least you could look
back at a discussion that you had.
Right.
That otherwise maybe you wouldn't.
And so stuff like that,
it does take some time,
but we're already doing a
lot of things where this
information could be incorporated.
And I think it would be for
the better good for those
couple of people that that
really need it.
Do you have any examples to
illustrate the importance of this topic?
Maybe where there was a lack
of obstetric or pelvic
health education and it
negatively impacted patient care?
Sure.
So I'm sure there are some
specific examples,
but I think something that
really sticks out to me is
some of the responses that
we got in our research.
So
You know,
an example in one of the studies
that I had talked about,
we had over six hundred
physical therapists respond.
So it's a pretty good amount.
And in that research study,
about eighty seven percent of them.
So that's five hundred thirty ish.
Physical therapists reported that patients,
they did not receive enough
information about their
physical well-being during
their pregnancy.
And that number went up when
we asked about patient
education after their pregnancy.
It was about ninety six percent of
our physical therapists,
so people within our
profession said that
individuals did not receive
enough education.
And so those numbers,
those stand out to me in
that there's something that we could do,
right?
If a big chunk of the PTs
that were at least answered
the survey are saying that
they don't think that
patients are getting the
education that they need.
We know that information is,
really crucial for wellness
and well-being and even
seeking out medical attention.
So I feel like having the
knowledge that there is
something missing is enough
for me to say we should do better.
Right.
And I think that that that
was a primary base for why I
wanted to start looking at
what is happening even
nationally at the entry
level and why I wanted to
start having this
conversation here and just
trying to advocate for
change or trying to
advocate for the ability to
incorporate this
information so that we can
better serve our patients.
Well, I think that was a
That was a great answer as well.
So, you know, outside,
it's difficult to have
maybe a specific example where, you know,
because we're getting about
to provide some level of care,
but if the patient and the
provider side both feel
that there's information lacking,
you know,
that means the patient is wanting it.
The provider,
the physical therapist knows
that they would like to be
able to provide more,
but they don't have it themselves.
So that's a great
a great answer on how,
if we can have a little bit
more to give them,
then both people are gonna be,
both sides are gonna be
appreciative there.
Yeah, that's the hope.
Any other thoughts that you have,
anything you'd like to
share with our audience
before we finish today?
That's a loaded question.
No, I think- The floor is yours.
No, you know,
I'm proud of what we've achieved so far.
I'm proud of the changes
that we've made at our institution.
And I just hope that, you know,
we continue to see progress.
I think that we will.
I'm optimistic.
You know,
we have certificates where they
never existed before.
I'm continuously reading of
new research and protocols
where they never were there before.
But I think that as long as
we continue conversations
like this one we're having today,
that we're on a good trajectory.
There's just more work to do.
Cool.
Well, thank you very much, Natalie.
I appreciate you coming on today.
Yeah, thank you.
It's been nice talking with you.
I appreciate it.