Healthy Wealthy & Smart

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Alex Hutchinson on the show to discuss sports journalism. Alex Hutchinson is National Magazine Award-winning journalist who writes about the science of endurance for Runner's World and Outside, and frequently contributes to other publications such as the New York Times and the New Yorker. A former long-distance runner for the Canadian national team, he holds a master's in journalism from Columbia and a Ph.D. in physics from Cambridge, and he did his post-doctoral research with the National Security Agency. In this episode, we discuss: -How to disseminate findings from complex research studies to a layman audience -Attention grabbing headlines that commit to a point of view -Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance -What Alex is looking forward to from the Third World Congress of Sports Physical Therapy -And so much more! Resources: Third World Congress of Sports Physical Therapy Alex Hutchinson Twitter Endure Range Alex Hutchinson Website For more information on Alex: I'm an author and journalist in Toronto. My primary focus these days is the science of endurance and fitness, which I cover for Outside (where I'm a contributing editor and write the Sweat Science column), The Globe and Mail (where I write the Jockology column), and Canadian Running magazine. I've also covered technology for Popular Mechanics (where I earned a National Magazine Award for my energy reporting) and adventure travel for the New York Times, and was a Runner's World columnist from 2012 to 2017. My latest book, published in February 2018, is an exploration of the science (and mysteries) of endurance. It's called ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance. Before that, I wrote a practical guide to the science of fitness, called Which Comes First, Cardio or Weights? Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise, which was published in 2011. I also wrote Big Ideas: 100 Modern Inventions That Have Transformed Our World, in 2009. I actually started out as a physicist, with a Ph.D. from the University of Cambridge then a few years as a postdoctoral researcher with the U.S. National Security Agency, working on quantum computing and nanomechanics. During that time, I competed as a middle- and long-distance runner for the Canadian national team, mostly as a miler but also dabbling in cross-country and even a bit of mountain running. I still run most days, enjoy the rigors of hard training, and occasionally race. But I hate to think how I'd do on an undergraduate physics exam. Read the full transcript below: Karen Litzy: 00:00 Hey everybody. Welcome to the Third World Congress of sports physical therapy Facebook page. And I am your host, Karen Litzy. And we have been doing several of these interviews over the past couple of months in support of the Third World Congress of sports physical therapy. And today we have writer, journalist, author, athlete, Alex Hutchinson who is part of the Third World Congress. He's going to be a part of an informal Q and A and also doing a talk with Greg Lehman, who's already been on. So Alex, welcome to Facebook live. Alex Hutchinson: 00:37 Thanks very much, Karen. It's great to be here. Karen Litzy: 00:39 All right, so for those people who maybe aren't as familiar with you, can you tell us a little bit more about yourself? Alex Hutchinson: 00:46 Yeah, I mean, I guess when people ask what I do, I say I'm a freelance journalist, but if you kind of drill down a little bit, my subspecialty is like, I'm a sports science journalist or even an endurance sports science journalist, which isn't really a job, but it's effectively what I do. So I write for, for outside magazine and a few other places. There's Canadian running magazine and a newspaper in Canada called the globe and Mail, but mainly outside magazine about the science of Endurance sports, sports more generally, adventure, fitness, health, all those sorts of things. A fairly, fairly broad stuff that interests me, I try and look at the science angle of it. And so that means talking to a lot of athletes and sometimes I talk to coaches, but mostly I talk to researchers who are trying to use, you know, research studies, peer reviewed, you know, placebo-controlled, blinded studies to answer questions that a lot of us have when we exercise, you know, what workout should I do or how should I refuel or these sorts of things. Karen Litzy: 01:48 Alright, so you're taking, which I think is great. You're taking the research and you're able to disseminate that out into, if you will, the layman's audience. Alex Hutchinson: 01:57 Yeah, that's the goal. Yeah. And, it's interesting cause I come from a running background. I was a competitive runner. And I was a, a guy interested in science, but there wasn't no, when I was competing in the sort of nineties and early two thousands, it to me at least, it seemed, it wasn't very easy, I didn't even know that there were, you know, thousands of researchers around the world trying to answer these sorts of questions. And I think for me it was in the middle two thousands I started seeing some columns in the New York Times from Gina Kolata. And then from Gretchen Reynolds. Gina Kolata had a column called personal best where she was like looking into the myth that lactic acid causes fatigue. And this was maybe around 2005 and I was like, Holy Mackerel. Alex Hutchinson: 02:37 And she was interviewing scientists who are asking these questions. And I thought there are scientists who care about lactic acid so that kind of started me on the path of thinking that, realizing there's a body of research out there that wasn't reaching interested lay people like myself. So I started pursuing that. And I think today there's a lot more. Like there were a lot of avenues through which exercise science reaches the lay people. I feel like I'm one of those channels, but it's definitely, there's a lot more options for people now, including directly from scientists themselves in places like Twitter. Karen Litzy: 03:13 Exactly. And I think that's where I, you know, in the late nineties, mid two thousands, social media certainly wasn't as robust as it is now. And now you have scientists and researchers being encouraged to get onto these platforms and disseminate some of their information, whether it be through tweets or infographics, podcasts, Facebook lives, things like this. So I think the leap from relatively nothing, you know, meaning researchers kind of doing their research but not having perhaps the means to get it out to a wider audience outside of a journal that not every lay person who reads, you know, having such great avenues to disseminate this information. Do you feel like it's made a difference in the general public? Alex Hutchinson: 04:00 I think it has. It's hard to really evaluate this stuff, but my sense is there's a higher level of literacy or sort of awareness of issues, you know, things like how to fuel that's maybe not just drawn from, I heard it from a guy at the gym or I heard it from my coach who heard it from his coach who is taught by, you know, some guy in 1830 that this is how it works. I mean, I would almost say that we've gone from a place of scarcity to a place of excess that now it's not like you can't find information. Now there's these fire hoses of information just drenching you with 20 different theories. All of which seemed to be supported by scientists about how you should eat, how you should exercise, how you should move, and all these sorts of things. Alex Hutchinson: 04:45 So I started writing about sports science, let's say 15 years ago or a little less than that. And at that point it was like, let's get the information out there. People don't realize that there's information now. It's like there's all this information, let's curate the information. Let's try and provide people with some judgements about what's reliable and what's not. Why we think that some sources of information are better than others. How each person can evaluate for themselves, whether this is trustworthy. You know, and this is obviously not an easy or there's not like one answer to this study's right and this study's wrong, but, yeah, I feel like my role has shifted a little bit from get the information out there to, okay, maybe I can be a trustworthy source of curation where I'm giving people the information, not necessarily telling them what to think, but saying, here's the evidence. Now you may choose to think this evidence isn't convincing enough for you to switch to the, you know, the Aldana Diet or you may not, but here's, here's what the evidence says it exists. Karen Litzy: 05:45 Yeah, and that's a great lead into my next question is when we look at quote unquote fake news and we can categorize that as misinformation or disinformation. So misinformation being like you're putting something out there and you think it's good, but you just don't know that the information is bad versus disinformation, which is, I guess we can categorize more as propaganda. So you know, the information's not correct, but you're pushing it out there anyway. So I think it's important to me. Both of those are fake news, but it's important to make that distinction. So as a journalist, how do you navigate this and how important is it for you to get that right? Alex Hutchinson: 06:27 Yeah, yeah, yeah. Well, getting it right is important to me and I'm glad you made that distinction because I think that's an important one because you know, fake news in the politicized sense is another way of saying propaganda. And I think that's mostly not what we're dealing with in the exercise or the health space. I mean there, there is actually, I mean, you know, let me take that back a little bit there. There are people who are just selling things to make money who are just, they don't really care whether it's true. They're putting steroids into their stimulants, into their strength supplements because they just want people to feel a boost and they're just flat out lying so those people are bad and they're also not that hard to spot if truth be told, if you're critical, what's tougher is the, you know, what you call misinformation rather than disinformation, which is people honestly believe this. Alex Hutchinson: 07:20 Like, I tried this diet, it works for me, and therefore everyone should be doing it. And I read this study that shows that people who do this diet, you know, increase their levels of some inflammatory marker and that proves, that confirms my belief. And therefore I'm going to become an evangelist for this. And I'm going to say that everyone who disagrees with me has been paid off by big industry and blah, blah, blah. And sometimes it's not quite that. I mean, I'm caricaturing it, but people don't have strong beliefs that don't have as strong beliefs about, you know, controversies in particle physics cause we don't have personal experience in particle physics when you're talking about health and exercise and eating and things like that. We all have our, we have our experiences. And so we map that on top of whatever evidence we're experiencing, and I include myself in this, you know, my experiences play into what science, scientific research finds plausible. Alex Hutchinson: 08:12 So that creates a different dynamic. So to answer your actual question, how do I navigate this? Imperfectly like every other human, but my goal in what I write, what I try and do is if I'm writing about a study, this article from my perspective as the one in which I'm able to serve, take the key graph from that study, cut and paste it into my article and then describe what the study was. Here's what they did, here's what they found. Alex Hutchinson: 08:46 I'll take it a step further than that because my role is to interpret. I'll say, here's what I think this means, but I want to make sure I can give enough information to someone who doesn't think that's what it means is also can also see, well that's what the evidence was. And it's like, well no, I don't agree that that should change my behavior or whatever, but I'm giving them, I want to give people enough information so they understand what the study did and what it found. And then the meaning, if I've given people enough information, they don't have to rely on me telling them that this is what it means even though I am going to tell them what I think it means. Karen Litzy: 09:16 If you were to give tips to let's say the layman person, say it's like my mom or you know, your friend who knows nothing about science, he doesn't have a phd in physics, and we'll get back to that with you in a second. But what tips can you give to the lay person on how to spot this misinformation, because the thing is when you look at a lot of articles, they're always citing this study, that study, this study. Alex Hutchinson: 09:47 Yeah. It used to be like, show me the peer reviewed evidence. But yeah, I've slowly realized, you know, and understood that there is a peer reviewed study for everything. And you know, 10 years ago I used to get, I'd see a study saying, you know, hey the, you know, the fruit of this plant, if you take it's going to increase your endurance by 2%. It's like, well if they have a placebo controlled, double blinded study published in a peer reviewed journal, it must be true. I'll write about it. And then, you know, I never did hear about that extractive of such and such a plant. Again, like no one, it never turned out to be a thing. And I sort of finally understand, you know, started to understood the bigger systemic problems, which is that if you have, you know, thousands of Grad students across the country looking for a master's thesis that can be done in six months or an experiment, they can be done in six months. Alex Hutchinson: 10:33 They're testing all sorts of things. And if it's not interesting, they don't publish it. And if it happens by chance to produce a positive result, then they publish it in a journal. So we get this sort of, there's always public positive studies about everything. What I was saying, which is that just the mere presence of a study isn't enough. So there is no simple template. But I would say there are some guidelines like follow the money. If someone's trying to sell you something, it's obvious, but it's surprising what a good rule of thumb that is. And it's why we see so much information about pills and technology. Alex Hutchinson: 11:20 And so little information about, you know, another study showing that sleep is good for you, getting some exercise is good for you because it's very hard to monetize that. And so there's lessons. I don't mean to sound like a patsy or like someone who's, you know, pump promoting my own way of seeing things. But I think there are some sources that are more sort of authoritative than others. And frankly, the mainstream media still does a pretty good job relative to the average blog. Now there are some great blogs out there and you know, and I will say, I started out in this, I set up my own blog on wordpress and I blogged there for five years, just analyzing studies. And then runner's world asked me to bring the blog onto their site and then it got moved outside. Alex Hutchinson: 12:08 So it's not that there aren't good blogs and you can maybe get a sense of what people's agendas are and what their backgrounds are. But, you know, if I knew that, I know in this highly politicized world, I know that this may be a controversial thing to say, but if I see something in New York Times, I'm more likely to believe it than if I see it on, you know, Joe's whole health blog and I read the New York Times and I get frustrated frequently and I say that now they're getting this wrong. And this is not a full picture of this. Nobody's perfect. But I think that people with credentials and getting through some of those gatekeepers is one way of filtering out some of the absolute crap that you see out there. Karen Litzy: 12:53 Perfect. Yeah, I think those are very easy tips that people can kind of follow. So sort of follow the money, see who's commissioned said RCT, systematic review. And, oftentimes, especially on blogs, it can be a little tricky because some of them may write a blog and be like, oh, this is really good. But then when you look down, it's like the blog is sponsored by so-and-so, Alex Hutchinson: 13:18 And that's the reputable people who are acknowledging who's sponsoring them. Then there's the people who are getting free gear, free product or money straight up, but they're not, you know, like there's levels of influence and the people who are disclosing that at least they're disclosing it. But nonetheless, it's, you know, one of the things that I think people often kind of misjudge is when, when someone says that follow, you know, follow the money and the financial influences, finances can influence someone. That doesn't mean that the people who are passing on this message or corrupted or that it's disinformation as you would say that they're deliberately, yeah. I mean, lots of researchers who I really highly respect do excellent research funded by industry. And I think that there's any important information that comes from that research, but I also think that the questions that get asked in industry funded research are different than the questions that you might ask if you just had you know, a free pot of money that wasn't tied to any strings. Alex Hutchinson: 14:16 If you want to, you know, not to pick on anybody, but if you want to know which proteins are best for building strength and if the dairy industry is going to fund a whole bunch of studies on dairy protein, then you're going to have this excellent body of research that shows that dairy protein is good for building muscle. That doesn't mean it's wrong, it just means that we haven't studied what, you know, vegetable proteins or other forms of meat. There's been less emphasis on those proteins so you get a distorted view of what's good or bad without anybody doing anything wrong. It's just that money does influence the way we ask questions and the answers we get. Karen Litzy: 14:53 Great. Thank you. Now I had just mentioned about having a phd in physics. That is obviously not me. How did you end up doing your phd in physics and how does this help you when it comes to writing your articles or writing these reviews of RCTs or systematic reviews? Alex Hutchinson: 15:14 Well, I should first say that if anyone's interested in becoming a science journalist, I wouldn't necessarily recommend doing a phd in physics. It's not the linear path or you know, the path of least resistance. I honestly didn't know what I wanted to do when I grew up. Some advice I got, which I think was good advice to some extent was, you know, if you don't know what you want to do, do something hard because at least you'll prove to people that you can, you know, solve problems and there'll be some transferability of that training. And I think that was true to some extent. And I, you know, so I did physics in Undergrad. I still didn't know what the heck I wanted to do. And I had an opportunity to go do a phd in England, which seemed like a big adventure. Alex Hutchinson: 15:50 So I went and did a phd there, PhDs there are actually a lot shorter than they are in North America. It's just over three years for my phd. So it wasn't, it wasn't like this sort of, you know, spent my entire twenties on this. Physics was fun, but it just, I could see that the other people in my lab were more passionate about it than I was, that they were, they were just interested. They were passionate about it. And I thought, man, I want to, I want to find something that I'm passionate about. So I ended up in my late twenties saying, okay, well it's been a slice, but I'm going to try something else. And, you know, fortunately I guessed right. And journalism turned out to be fun. Fun for me. I don't write, you know, especially these days if I'm writing about exercise and it's not like I need to know Newton's laws or anything like that or you know, apply the principle of general relativity to exercise. Alex Hutchinson: 16:35 So there's not a lot of like direct pay off. But I would say that having a scientific training has helped me be willing to speak to scientists and not be intimidated by paper. You know, Journal articles that look very complex and you know, I have the confidence to know that, okay, I don't have a clue what this journal article is saying, but I know if I slow down, if I read it a few times and if I call it the scientist and say, can you explain this to me? I'm not worried. Well, I mean, I don't like looking stupid, but I'm over the idea is like, it's okay. I can call up the scientist. I know enough about scientific papers to know that probably the guy in the office next door to whoever wrote this paper doesn't understand this paper. You know, science is very specialized and so it's okay to just say, explain to me, explain it to me again. Okay. This time, pretend I'm, you know, your 90 year old grandfather and explain it again. And so that allows me, or has helped me write about areas even when I'm not familiar with them and not be intimidated by numbers and graphs and things like that. Karen Litzy: 17:36 All right. And I would also imagine that going through Phd training yourself, you understand how articles are written, you kind of can look at the design, and you can look at the methods and have a little bit more, I guess confidence in how this study was maybe put together. Versus no training at all. Alex Hutchinson: 18:03 You've seen how the sausage is made and so you understand the compromise that get made. I will say that it was surprising to me how different the physics processes to the sort of the sports science world in terms of just the factors that are there that are relevant in physics. You're never dealing with people. And with the sample recruitment and things like that. An Electron is an electron, you know, for the most part. You know, and this is an important to understand is physics aside by looking a lot of studies, I started to see the patterns and started to understand what the functions were, started to understand how to read a paper relatively quickly. How did you know it? For me to find stories, I ended up looking at a lot of journal articles and I can't read every one of them in depth in order to find the ones I wanna write about. Alex Hutchinson: 18:52 So I have to find ways of, you know, everyone knows you. Yeah, you can read the abstract, but you're not going to get the full picture. You know, you start to learn just by experience, by doing it. That, okay, if I read the introduction, that's where the first three paragraphs are where they're going to give me the context. Because often a study seems very specific and you're like, I don't know what you're talking about. And then they'll give two paragraphs where they're just like, since the 1950s, scientists have been wondering about x, Y, and zed. And then you can go to the conclusions and then, you know, depending on how deep you want to get, you understand where, which part of every paper is written with a specific format and you can figure out where to go with a little experience. And it doesn't require a physics phd or it requires just getting, getting familiar with that particular, you know, subject area. Karen Litzy: 19:35 Nice. And now, you know, we talked earlier about how, you know, information from researchers went from like a little drip to a fire hose and as far as getting information out to the general public, so because there is so much information available, how do you approach designing your article titles and headlines to ensure you grab attention for the reader. So I think that's a great question directed at the researchers who are maybe thinking of doing a press release or things like that to help promote their article. Alex Hutchinson: 20:10 Yeah. This is a really interesting question. This isn't one where my thinking has shifted over the last, let's say, decade. So I started out, you know, in print journalism, writing for newspapers and magazines. I still do that, but one of the things in from when you're writing for a newspaper magazine is you don't have control over your headlines. You write the article, the editor writes the headline. And so my experience in that world was always one of frustration being like, I wrote this very carefully nuanced, balanced article. And then the headline is, you know, do this and you'll live till you're a hundred or whatever. It's like, no, that's not what I was saying. It's terrible. And so I got into this sort of reflects of habit you know, just apologizing for the headlines. Like, Oh, you know, when I talked to researchers, I'm so sorry about the headline. Alex Hutchinson: 20:59 You know, I'm very sophisticated, but you know, that this silly editor wrote the headline and a couple of things help to sort of shift my views a little bit on that. One is the shift to online meant that newspapers and journalists now have a very, very clear idea of who clicks on what. So you understand what it is that gets people's attention. And the second thing is that, you know, when I started my own blog, and then even now, when I blog, I don't have full control of my headlines, but when I was on wordpress, I wrote my own headlines. And when I now as a blogger, I suggest headlines. And so I don't have control, but I am given more input than I used to be on how this article should be conveyed. Alex Hutchinson: 21:40 And one thing that's really clear is that, what people say they want and what people will do is different. And so I remember looking at when the global mail is the Big News newspaper in Canada. I remember when it first started showing its top 10 most clicked articles. You know, in the transition to digital on its website. And of course, everyone says, I hate clickbait. I want to have sophisticated, nuanced conversations. And then the top 10 articles clicked would all be something to do with Brittany Spears or whatever. You know, this was 10 years ago. And it's like, so people click on, people do respond to clickbait and click bait it's bad. But you know, I sometimes I want like sometimes give talks to scientists about science communication and I'll give some contrast between here's the journal article, you know, here's my headline and the journal article will be something that's so careful that you're not even, it definitely doesn't tell you what the article's going to say. Alex Hutchinson: 22:36 You're not even entirely sure what the subject is. You know, like an investigation of factors contributing to potentially mitigating the effects of certain exercise modalities. And you're like, I don't know. I don't know what that's about. No one clicks on it. And so it's like that sort of, if a tree falls in the forest, if you write a perfectly balanced nuanced article and nobody reads it, have you actually contributed to science communication? And so one of the things that I found in with headlines that I'd complain about is I would complain about a headline that someone had written for my article and then, and I try to think why am I complaining about this? And it's like, well it's sort of coming out and saying what I was hinting at, I was hinting at, I didn't want to come out and say, you know, overweight people should exercise more or whatever. Alex Hutchinson: 23:22 Cause that's horrible. No one would say that. But if you sort of read what the evidence that I was shaping my article to be, it'd be like, if you're not getting results from your exercise, maybe you're just not exercising hard enough. I was like, well maybe I need to own the messages. You know, if the headlines to me seems objectionable, maybe it's my article is objectionable and I've tiptoed around it, but I need to think carefully. And if someone reads my article, you know, an intelligent person reads my article and says this in sum it up in seven words, this is what it is, then I need to maybe be comfortable with having that as the headline, even if it's an oversimplification, because the headline is never going to convey everything, all the nuances. There's always caveats, there's always subtleties. Alex Hutchinson: 24:04 You can't convey those in seven words. That's what the article is for. So I've become much more of a defender, not of clickbait, not of like leading people in with misleading things. But if ultimately the bottom line of your article is whether it's a academic article or a press article is, you know, this kind of weight workout doesn't work and you should be okay with a headline that says that. And yes, people will say, but you forgot this. And then you can say, well, no, that's in the article, but I can't convey all the caveats in the headline. So anyway, that's my, that's my sort of halfhearted defense of attention grabbing headlines in a way. Karen Litzy: 24:37 Yeah. And if you don't have the attention grabbing headline, like you said, then people aren't going to want to dive into the article. So I was, you know, looking up some of the headlines from outsideonline.com and the first one that pops up is how heat therapy could boost your performance. And you read that and you're like I would want to find out what that means. Alex Hutchinson: 25:02 And they put some weasel words in there. It's not like heat therapy will change your life. It's how it could boost your performance. And so, and I'm there, it's interesting, I've got conversations with my editor and they, you know, they don't like question headlines. They don't want to be as like, is this the next, you know, a miracle drugs? And then it turns out the answer is no. It's like they feel that's deceptive to the reader. They want declarative headlines that say something. It's an interesting balance but outside has been, they've had some headlines which were a little, you know, there was one a while ago about trail maintenance and it was like the headline was trail runners are lazy parasites or something like that. And that was basically, that was what the article said. It was an opinion piece by a mountain biker. They got a ton of flack for that and they got a bunch of people who are very, very, you know, I'm never gonna read outside again. It's like, dude, relax. But I understand, but I understand, you know, cause it is a balance there. They want to be noticed and I want my articles to be noticed, but I don't want to do it in a deceptive way. Karen Litzy: 26:07 Yeah. And I think that headline, how heat therapy could boost. It's the could. Alex Hutchinson: 26:12 Exactly the weasel word that it's like, it's, I'm not saying it will, but there's certainly some evidence that I described in the article, but it's possible this is something that people are paying or researching and that athletes are trying, so it's, you know, check it out if you're interested. Karen Litzy: 26:25 Yeah, I mean, I think it's hard to write those attention grabbing headlines because like you said, you can have the best article giving great information, but if it's not enough in the headline for the average person to say, hmm, Nah, Nah, nevermind, or Ooh, I really want to read this now the, I think when you're talking about an online publication, like you said, you now have a very good idea as to who is reading by going into the analytics of your website. So I think that must make it a little bit easier, particularly on things that they're going to catch attention. Alex Hutchinson: 26:59 And so since I'm working for outside, I don't have access to their analytics though. I can ask them what my top articles were or whatever. And I actually am careful not to ask too much because I think there's a risk of you start writing to the algorithm. I start with, you know, you're like, oh, so if people like clicking on this, I'm going to write another article that has a very similar headlines. So, when I had my wordpress site, I had much more direct access to the analytics and it's a bit of a path to, it forces you to start asking yourself, what am I writing for? Am I writing to try and get the most clicks possible or to do the best article possible? So I actually tell him when I talked to my editor, I'm like I don't want too much information. Alex Hutchinson: 27:43 I want to know. Sometimes I kind of want to get a sense of what people are reacting to and what aren't. And I can see it on Twitter, which things get more response. But I don't want that to be foremost in my mind because otherwise you end up writing you know, if not clickbait headlines, you write clickbait stories, you know, cause you do get the most attention. Yeah. So I try not to follow it too much and let someone else do that worrying for me. Karen Litzy: 28:09 Yeah. So instead, I think that's a great tip for anyone who is putting out content and who's disseminating content, whether it be a blog or a podcast, that you want to kind of stay true to the story and not try and manipulate the story. Whether that be consciously or maybe sometimes subconsciously manipulating the story to fit who you think the person who's going to be digesting that information wants. Alex Hutchinson: 28:34 Yeah. And I know that happens to me subconsciously. You know, it's unavoidable. You're thinking, well, if I write it this way, I bet more people are going to be interested, it happens a little bit, but you want to be aware of it. And especially, I guess if you're, let's say you're someone who's, you know, starting a blog or starting some form of podcast or whatever it is, clicks aren't the only relevant metric and you can get a lot of people to click on something, but if they're left feeling that it wasn't all that great, then you're not gonna, you know, it's better to have half as many people all read something and think that was really substantive and thoughtful and useful than to get a bunch of clicks. But no one had any particular desire to come back to your site. Karen Litzy: 29:15 Like you don't want to leave people feeling unfulfilled. Yeah, yeah, yeah. Not Good. Well great information for both the researchers and for clinicians who are maybe trying to get some of that research out there. So great tips. Now, we talked a little bit about this before we went on air, but in 2018 you've published your book, endure mind body and the curiously elastic limits of human performance. So talk a little bit about the book, if you will, and what inspired you to write it? Alex Hutchinson: 29:50 Sure. The book is basically, it tries to answer the question, what defines our limits. Like when you push as hard as you can, whether you know you're on the treadmill or out for a run or in, in other contexts, what defines that moment when you're like, ah, I can't maintain, I have to slow down. I have to stop. I have reached my absolute limit. And it's a direct, you know, it's easy to understand where the book came from. I was a runner and so every race I ran, I was like, why didn't I run faster? Like I'm still alive. I crossed the finish line. I've got energy left. Why didn't I, why surely I could have run a little bit faster. And so basically I, you know, I started out with an understanding of a basic understanding of exercise physiology. Alex Hutchinson: 30:32 And, you know, 15 years ago I thought if I can learn more about VO2 Max and lactate threshold and all these sorts of things, I'll understand the nature of limits and maybe what I could have done to push them back. And about 10 years ago, I started to realize that there was this whole bunch of research on the brain's role in limits. And there've been a whole bunch of different theories and actually some very vigorous arguments about this idea. But this idea that when you reach your limits is not that your legs can't go anymore. It's that in a sense, your brain thinks you shouldn't go anymore than that. Your limits are self-protective rather than reflecting that you're actually out of gas, like a car runs out of gas. And so then I thought I was gonna write a book about how your brain limits you. Alex Hutchinson: 31:12 And in the end, as you can probably guess, it ended up being a sort of combination of these sorts of things. Like there's the brain, there's the body, they interact in different ways, in different contexts. So I ended up exploring like, you know, we were talking about this before, what is it that limits you when you're free diving? If you're trying to hold your breath for as long as possible, is it that you run out of oxygen after a minute and then how come some people hold their breaths for 11 minutes? And how does that translate to mountain climbing or to running or to riding a bike or to being in a really hot environment or all these sorts of things. So that is what the book is about is, is where are your limits? And the final simple answer is, man, it's complicated and you have to read the whole book. Karen Litzy: 31:51 Yeah. And we were talking beforehand and I said, I listened to the book as I was, you know, commuting around New York City, which one it would got me really motivated and to want to learn more. And then it also, I'm like, man, I am lazy. There are so many different parts of the book from the breath holding, like we were talking about. And things that I was always interested me are altitude trainings and the how that makes a difference, whether you're training up in the mountains or sea level or in those kind of altitude chambers. Which is wild stuff. And is that, I don't know, is that why people break more records now versus where they were before? Is it a result of the training? Is it, and then, like you said, the brain is involved and so are you just by pushing the limits of yourself physically, but then does the brain adapt to that and say, okay, well we did this, so I'm pretty sure, and we lived, so can we do it again? Alex Hutchinson: 33:08 And that's actually a pretty good segway to the World Congress of sports therapy. Because the session that I'm talking about it that I'm talking with Greg Leyman is on pain. And, one of the things that I find a topic that I find really interesting is pain tolerance. Do we learn to tolerate more. And so, you know, one of the classic questions that people argue about on long runs is like who suffers more during a marathon, you know, a two and a half hour marathoner or a three and a half hour marathoner. It's like, one school of thought is like, well, it's a three and a half hour marathoner is out there pushing to the same degree as the two and a half hour marathoner, but is out there for longer for almost 50% longer so that that person is suffering longer. Alex Hutchinson: 33:56 And the counter point, which sounds a little bit maybe elitist or something to say on average, the two and a half marathoner has learned two and half hour marathoner has learned to suffer more as his learning to push closer to his or her limits. Now that's a total generalization because it's not really about how fast you are. It's about how well you've trained, how long you've trained. So there are four marathoners who are pushing absolutely as hard as any two and half hour marathoner. And there are some very lucky two and a half hour marathoners who aren't pushing particularly hard because they were capable of doing it, you know, at two 20 marathon or something. But the general point that I would make and that I think that the reason that I think the research makes is that one of the things that happens when you train, so we all know that you go for that first run and it feels terrible, Eh, you feel like you're gonna die when you keep training, all sorts of changes happen. Alex Hutchinson: 34:52 Your heart gets stronger. You build new Capillaries, your muscles get stronger. Of course, that's super important. It's dominant. But I think another factor that's on pretend times under appreciated is you learned to tolerate discomfort. You learn to suffer. You learn that feeling when your lungs are bursting and you're panting and your legs are burning, that doesn't mean you're gonna die. It just means you can't sustain that forever, but you can sustain it for a little bit longer. You can choose to keep holding your finger in that candle flame for a little longer. And there's actually quite a bit of evidence showing that as training progresses, you learn not just in the context of whatever exercise you're doing, but in the context of totally unrelated pain challenges like dipping your hand in an ice bucket or having a blood pressure cuff squeezed around your arm. Alex Hutchinson: 35:35 You learn to tolerate more pain by going through the process of training. And I think it's an interesting area of, I think it tells us something interesting about physical limits cause it tells us that part of the process of pushing back physical limits is pushing back mental limits. But it also tells us something about how we cope with pain and why. For example, why exercise training might be helpful for people dealing with chronic pain, for example, that it's not just endorphins block the pain, it's that you learn psychological coping strategies for reframing the pain and for dealing with it. Karen Litzy: 36:10 Yeah. As a quick example, two and a half weeks ago, I tore my calf muscle the medial gastric tear, nothing crazy. It was a small tear and it happens to middle age people. Normally the ultimate insult or worse, at any rate, you know, very painful. I was on crutches for a week. I had to use a cane for a little while, but I was being so protective around it. And then I read, I got a great email from NOI group from David Butler and they were talking about kind of babying your injury and trying to take a step back and looking at it, looking at the bigger picture. And I thought to myself, well, this was the perfect time to actually get this email because I was like afraid to put my heel down. I was afraid to kind of go into Dorsiflexion and once I saw that, I was like, oh, for God's sakes. And that moment I was able to kind of put the heel down to do a little stretching. And, so it wasn't that all of a sudden my physicality changed so much, but it was, I felt from a brain perspective, from a mental perspective that I could push my limits more than I was without injuring. Alex Hutchinson: 37:35 Absolutely. And it's all a question of how we have the mistaken assumption that pain is some objective thing that there's, you know, you have it damaged somewhere and that's giving you a seven out of 10 pain. But it's all about how you frame it and if you were interpreting that pain as a sign that you weren't fully healed and therefore you're going to delay your recovery, if you're feeling that pain, then you're going to shy away from it. And if you're just interpreting it, if you read that email and it reframes it as this pain is a part of healing, it's a part of the process of, and it's like, oh well I can tolerate that. If it's not doing damage, then I don't mind the pain and all of a sudden it's become something that's a signal rather than a sort of terrible, it's just information. Karen Litzy: 38:15 Yeah. Information versus danger, danger, danger. I just reflected on that and thought, yeah, this is pain. It's being protected at the moment. It doesn't mean I'm going to go run a marathon given my injury but it certainly means I can put my heel down and start equalizing my gait pattern and things like that. And so it's been a real learning experience to say the least. And the other thing I wanted to touch on was that idea of pain and suffering. And I know this can probably be out for debate, but that because you have pain, does it mean you're suffering? So if you have a two hour 30 versus a three hour 30 or whatever, the person who runs it in six hours, right? Because you have pain, are you suffering through it or are you just moving through the pain without the suffering attached to it? And I don't know the answer to that, but I think it opens up to an interesting, to a wider discussion on does pain equals suffering? Alex Hutchinson: 39:20 Now we're getting philosophical, but I think it's an interesting one cause I mean I've heard a number of sports scientists make the argument that one of the sort of underappreciated keys for success in endurance sports is basically benign masochism that on some level you kind of enjoy pushing yourself into discomfort. And I think there's some truth to that. And I think it's an entirely open question. Like are people just born, some people just born liking to hurt or is it something in their upbringing? Moving outside of a competitive context and just talking about health, it's like what a gift it is to enjoy going out and pushing your body in some way because that makes it easy to exercise. And so I think one, you know, this is changing topic a little bit, but one of the big challenges in the sort of health information space is that a large fraction of the people who write about it are people like me who come from a sports background that on some level enjoy, I go out and do interval workouts. Alex Hutchinson: 40:16 Not because I'm worried about my insulin, but because I like it. I like pushing, finding out where my limits are on being on that red line. And so when I'm like, come on, just go out and do the workout, then others and some people find it very, very, very unpleasant to be near that line. And so I think we have to be respectful of differences in outlook. But I also think that's what the evidence shows is you can learn to, you know, like fine line or whatever. You can learn to appreciate some of what seems bitter initially. And if you can then it totally changes then that pain is no longer suffering. Then it's the pain of like eating an old cheese or whatever. It's like oh that's a rich flavor of pain I'm getting today in my workout as opposed to this sucks and I want to stop. Karen Litzy: 41:06 Yeah. So again, I guess it goes back to is there danger, is there not danger? And if he can reach that point of feeling pain or discomfort or whatever within your workouts and then you make it through the workout and you're like, I can't believe I did that. And all of a sudden next time it's easier. You pushed the bar. Yeah. You've pushed them further to the peak a little bit. So I think it's fun when that happens. Alex Hutchinson: 41:35 And I think it's important what you said, a understanding the difference between pain as a danger signal. Cause I mean as an endurance athlete I may glorify the pushing through the pain. Well that's stupid if you have Shin splints or you know, if you have Achilles tendon problems or whatever. Yeah. You have to understand that some pain really is a signal to stop or at least to understand where that pain is coming from and to do something to address it. There are different contexts in which it's appropriate or inappropriate to push through pain. Karen Litzy: 42:03 Yeah. And I would assume for everyone watching or listening, if you go to the Third World Congress of sports physical therapy, there will be discussion on those topics. Given the list of people there, there will be discussions on those topics. There are panels on those topics. Alex Hutchinson: 42:22 Yeah, I was gonna say, like Greg and I are talking about pain, but looking at the list of speakers, there's a bunch of people who have expertise in this understanding of the different forms of pain, trying to find that line, understanding the brain's role in creating what feels like physical pain. So I think there's gonna be a ton of great discussion on that. Karen Litzy: 42:39 Yeah. All right, so we're going to start wrapping things up. So if you could recommend one must read book or article aside from your own which would it be? Alex Hutchinson: 42:50 I'll go with my present bias, which is so, you know, casting my mind all the way back over the past like two months or whatever. The book that I've been most interested in lately is a book called range. I think the subtitle is why generalists triumphant a specialist world by David Epstein. So David Epstein, his previous book was like six years ago, he wrote the sports gene, which I consider basically the best sports spine science book that I've read. And so it was kind of what I modeled my book endure on, but his most recent book just came out a couple months ago at the end of May. And it's a broader look at this whole role of expertise and practice, a sort of counterpoint to the idea that you need 10,000 hours of practice if you want to be any good at anything. Alex Hutchinson: 43:33 So as soon as you're out of the crib, you should be practicing your jump shot or whatever it is. And instead, marshaling the arguments that actually having breadth of experience, is good for a variety of reasons, including that you have a better chance of finding a good match for your talents. So for someone like me had, I just had too much quote unquote grit and decided that I needed to stick with physics cause that's what I started with. And I'm not a quitter. I'd be a physicist and I might be an okay physicist, but I'm positive that I wouldn't be as happy as I am now having been willing to sort of switch career tracks. And so it has a lot of sort of relevance for personal development, for parenting and for understanding expertise also in a sports realm as well. So range by David epstein is my pick on that front. Karen Litzy: 44:22 Great. And we already spoke about what you're going to be talking about at the Sports congress, but are there any things that you're particularly looking forward to? Alex Hutchinson: 44:29 Yeah, there's a whole bunch of speakers, but I guess the one that caught my eye that I would definitely not sleep through is, I saw that Keith Barr is speaking on a panel and that over the last three, four years, maybe, maybe more than that, I've just been really blown away by the work that he's been doing on understanding the differences between what it takes to train for, you know, your strength, your muscles or your heart versus what it takes to train tendons and ligaments. And so I'm really looking forward to seeing what the latest updates are from his lab and from his results. Karen Litzy: 45:04 Yeah. He gave the opening talk at Sports Congress, not 2019 but 2018. And he was just so good. I mean, I was just trying to live tweet and take some notes. I'm really looking forward to that as well. I feel great. Yeah, absolutely. All right, so is there anything that we missed? Anything that you want the viewers or listeners to know? Oh wait, where can they get your book from? Alex Hutchinson: 45:35 Fine booksellers everywhere. I mean include Amazon but it's definitely put it in a plug for your local independent bookstore. It should be, it should be available anywhere. And if you can find my latest stuff on Twitter @sweatscience, all one word and there might be a link to the book that there, but yeah, really, if you Google Hutchinson and endure for any bookseller, they should be able to get a copy of it. Karen Litzy: 45:59 Perfect. And anything we missed? Anything that we want to hit on that maybe we didn't get to? I feel like we got a good amount. Alex Hutchinson: 46:06 I think we covered some good basis. I guess the only thing is, you know, for anyone listening, I hope I'll see you in Vancouver and cause I think there's all of these things are ongoing discussions and there's lots more to learn. So I'm looking forward to the conference Karen Litzy: 46:20 As am I. Everyone. Thanks so much for tuning in. Thanks so much for listening again, the third world congress of sports physical therapy will take place in Vancouver, Canada, British Columbia, October 4th through the fifth of 2019 and so we hope to see you all there. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this week's episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Lynn Rivers on Robert's Rules. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA) and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession. In this episode, we discuss: -What are Robert's Rules and how debate is conducted at the House of Delegates -Different ways to collect votes from the delegates -Point of Order, Point of Inquiry and Point of Information -Can a guest speak during a meeting? -And so much more! Resources: Email: riversl@dyc.edu Robert's Rules for Dummies For more information on Lynn: Dr. Lynn Rivers has 25 years experience as a clinician and 20 years as an educator in higher education. Her clinical experience has focused on adults with neurological disorders and traumatic injuries such as head injury and spinal cord injury while working in a Level I Trauma Center. Before becoming chairperson of the department in 2001, Dr. Rivers was Director of Clinical Education for the physical therapy program. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA)and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor: 00:00 Hello and good morning. This is Jenna Kantor. I'm here with healthy, wealthy and smart and I get to interview Lynn Rivers who knows so much about Roberts rules. Okay. Robert's rules. You know I'm going to actually hand over the mic because I can already imagine me describing it and Lynn going, well not exactly. So would you mind first just defining what Robert's rules is and where it is in applied within the APTA? Lynn Rivers: 00:26 Sure. Well Good Morning Jen. Thanks for the opportunity. Thank you for the opportunity to be able to share just about 28 years that I have sort of gotten myself involved and love Robert's rules of order. So what is Robert's rules of order? It goes back hundreds and hundreds of years. It is the philosophy and the construct of how do organizations, any organization, whether it's a small church board or it's Congress or its parliament in England, how does a civil society with lots of divergent opinions, how do we conduct our business so that there are two principles that are met and the two principles are that the will of the majority will rule, but we must protect the rights of the minority. So it is for the voices of everyone in whatever society, whatever group, whatever meeting that every opinion gets heard and heard with respect. And that there is civility so that when very strong, strong opinions can equally be heard, both sides of the debate can be heard. Lynn Rivers: 01:41 But there is civility and respect. And then when the decision is reached that the minority will agree that the will of the majority will rule. So that those are the two principles. So then the rules, holy smokes, there's, you know, I'm sure if people have looked into it, the 11th edition is 800 pages long and there are so many minutia rules. But the bottom line is that the rules guide how people make decisions about what gets heard and how we make choices. So there are just the word motions is a tenant of Robert's rules of orders. So what is a motion? A motion is just an ask. It is an idea that someone has, that they want the society, the group, the organization to do. I want to ask that we pursue buying a piece of property or I want my APTA to look into this or work on this legislation, create a document for us to help us write. Lynn Rivers: 02:56 It's an ask and then there's a way to make the ask. And so they give guidelines on how you make the ask. And then there are rules of then how do people debate. So you have to write out your ask. It becomes a motion. And then it's agreed during the meeting. It will be, they call it lay it on the table, but it just means say it right. Make the ask for the whole body to hear. And then there is the leader of the meeting who is neutral and just trying to facilitate the discussion and they have different titles. Then everyone respectfully just raises their hand or makes a motion. They have to be recognized to speak. And then when you speak to the motion there are just rules of civility meeting respect that you aren't shouting that you are just speaking to the facilitator of the meeting and you are making your case but you tend not to speak only about the motion, not who made the motion and don't speak ill of any other opinion. You just state your own opinion and the debate goes back and forth and then there's a vote. Jenna Kantor: 04:16 Actually could we go on this a little bit more with the ask, cause there's some things in this that I think is so fantastic with the civility that you are discussing and you guys, anybody listening, all you new grads, anybody who hasn't done house of delegates or been to any of these type of meetings before. You know how easy it is for things to get heated when it should, when it's a touchy subject. And of course within physical therapy we're extremely passionate about what we do. So those issues can get personal very easily. So would you mind going into the process of who is actually getting the eye contact, when you are standing up to speak about something and say it might be something you are quite passionate about, you have a written out exactly what you want to say. Who do you make eye contact with? And how do you address or refer to somebody who may have spoken before? Would you mind giving an example of that so people can get a better idea of how important and valuable it is to keep this going? Lynn Rivers: 05:18 Be Glad to Jenna. So I'm just going to think back to the most recent house. The American Physical Therapy Association taking a stance against firearm violence. And there are some very passionate opinions in the room. So what will happen is in order to not hurt feelings or offend anyone, what happens is that the individual who wants to now speak passionately against the APTA taking any kind of social stance, they make direct eye contact, the room is full of 400 people, face forward. You're looking directly at the speaker of the house, which is the title of the individual who's standing up in the front, who has recognized you to speak and you say, Madam Speaker, I would like to speak vehemently against this. I respectfully disagree with the previous speaker from Oregon who made this claim. Lynn Rivers: 06:22 And I disagree with that. So you don't say, I think Henry is an idiot. You say, I respectfully disagree and you speak about people in the third person and it's amazing how that sort of takes the emotion out. You can be emotional, you can feel passionate about your stance and you could be angry about the thought of an action being taken, but you are looking at the neutral speaker of the assembly and you are referring only in the third person to previous speakers or to a speaker from another state. And it is amazing how that can really deescalate the emotion. Jenna Kantor: 07:08 And then for such a very important debate and which I'd like to say that, you know, it's nice that there's an opportunity for every single motion to be debated on. So whether or not you think it's important, it still doesn't obliterate the opportunity for other people to debate on that, which I think is wonderful as well. But of course these things can go on forever. So how is it handled to end, you know, as a group cause you have a group of 400 people you know, for us at the house of delegates. So how is it handled, you know, to rightfully decide when it's appropriate to stop the discussion and move on to a vote? Lynn Rivers: 07:48 Yes. So again, what happens is, you know, people have raised their hand or we do it electronically now in the house of delegates with a blackberry, you can put yourself what they call in the queue. So you're in line to speak. And so the speaker will monitor and you must indicate to the speaker whether you're speaking for or against it. So they try to balance debate. And at times after a bit of discussion, the speaker will say, at this time there appears to be no one who is in line or in the queue to speak. Are you ready for the vote? Other times, the speaker that we do have an opportunity and in Robert's rules there is a motion it to what is called call the previous question. And all that means is that person has put a motion to say, I think I've heard enough. Lynn Rivers: 08:38 I have heard both sides of the debate. I am ready to vote. And so then if the speaker of the house, the leader of the meeting, observes that there are many people who think it's time to vote, then he or she will ask the body, that group at the meeting, are you ready for the vote? And if there's no objection, then you move to the vote. So it can either be everyone has stopped talking or there has been a lot of balanced debate hearing both sides of the story and enough people have spoken that the group feels they can make a vote. Jenna Kantor: 09:16 I also saw in the meeting, and we're not gonna hit all 800 pages of the book, but I'm just pointing out some interesting things. Sometimes the voting switched between standing between saying Aye and then also the electronic vote via the device. So how does, in this case, the speaker of the house who was running the meeting, how does the speaker of the house decide which way to do the vote? Lynn Rivers: 09:43 Yeah, so certainly, what happens is each organization has also something that's called the standing rules. So we use set rules at the beginning of the meeting. And one of the key rules you decide is how much agreement does there have to be in order to pass that motion to say it's going to go. So for normal business, the actions of the house, we agree in the house of delegates, a simple majority, so just over 50%, 51% of the group. So the default or easiest for 404 was our voting strength yesterday, that the speaker starts with a voice vote. All those in favor say Aye. So she listens to the volume of the ayes compared to the volume of the no's. And many times it's very clear if 300 people say Aye and 100 say no, then it's pretty clear by voice. Lynn Rivers: 10:42 And that's the simplest and quickest. If it's still a vote for simple majority and she couldn't tell by the voices, then we have to use the electronic voting. Within that everybody has their clicker and they vote Yay or nay and it comes up. The standing vote is typically done when there is a vote that is more precious than just a normal business action. It's any vote that is going to hurt the rights of members. And I'll give the example then if you need to know, if two thirds of the people agree, many times the speaker will do a standing vote because that is much easier to see two thirds clear by standing. And that is when there is an objection to calling the question, meaning stopping debate. And because that is a right of the minority to continue to be heard, that is when the speaker calls for a standing vote. And then there was one time, even in the standing vote, she was not 100% sure it was two thirds. So she had us sit back down and do the clickers. Jenna Kantor: 12:05 This is great. So, you know, it's so funny, earlier you mentioned the word Henry and now I'm thinking of the Henry Bar, the candy. And I'm like, oh my gosh, what do these conferences do to me? I'm like, I need sugar all the time to like stay awake. Can we get into some of the language, just the intro that people say when they say parliamentary inquiry, like why do we say that instead of something else? Does it make it more efficient? Lynn Rivers: 12:35 So again, there is a protocol to how one introduces a motion. And one of the first again for civility is whenever you are recognized to speak, you start by introducing yourself so speakers know who you are. We also ask them to state what component they are from, component or state. So I'm Lynn Rivers from New York would be how I would start. And you must be recognized in order to speak. There are three instances, and someone can shout out and not wait to be recognized. Point of order, point of inquiry and point of information, point of order. They there is shouted out and you are allowed to shout it out if you believe what is happening right now is not following Robert's rules of order. We are not doing it correctly and we believe that we have to ask the speaker that. Lynn Rivers: 13:45 So if someone shouts out point of order, all debate stops immediately and the speaker says state your point and that person comes up to the mic and says speaker, I believe it is not in order for this motion to be heard. And there is a reason why we did not have due notice before this motion came. I don't think it's right that we are hearing it and then they would confer and decide whether that member is correct or the speaker rules. No, I do believe it's in order point and I'm sorry I misspoke. Point of inquiry or point of information are very similar. There is no real difference between that. A point of inquiry is sometimes said because people are really wanting data and facts, point of information. People tend to say they just have a question. They don't really understand why the makers of the motion wrote it this way. They don't really understand the intent of the motion. So they are asking a question to better understand the motion point of is just a little more precise if they want to. If someone wants to ask someone else other than the maker of the motions, they understand the motion but their point of inquiry is we'd like to hear from legal counsel is what the maker of the motion asking us to do. Is that legal in all 50 states? So then the speaker will say, is there an objection? Does anyone object to legal counsel addressing the body and answering this person's inquiry? Jenna Kantor: 15:16 Yes. That honestly makes more sense for me. Now listening to that because there was a motion on creating a virtual historical museum and there was a lot of point of inquiries to the board to find out how much work would this be putting on them. Would this be possible for them to take on? And also what would the game plan, where would the financial resources come from? What would we be taking away from? So that makes even more sense. And it's also respectful way to be like, it's just clarification. It's not going to be an attack. We just have a question to like know what this means. And of course, it's pointed in a very professional way of just saying, we really just need to know to get the full picture on if this is a good thing to vote on. So, I'm getting some massive light bulbs here right now. And then I think I want to finish with one more or the Lord knows we could go on forever with Robert's rules. And, honestly, if I really do recommend, yes, it's an 800 page book, but if you're interested in it, read it. Why not? Lynn Rivers: 16:30 Well, and I'm going to say the caveat. Please don't start with that book because you will run away screaming, but please know, and you can just Google it. Robert's rules for dummies is one version. There are about four levels of books. There's Robert's rules simplified, right? So Google Robert's rules and look at the different books and start with the first one and then move up to the next one. That gets a little deeper into it. If you really think you want to fully understand it, you want to join be a member of the national parliamentarian society. That's when you buy the 11th edition of Robert's rules. Nearly revised. Yes. Jenna Kantor: 17:17 Awesome. Thank you so much. And See, this is a perfect example. Why bring the expert on to help? Correct me as I'm going, why don't we just do this? You're like, Whoa, whoa, Whoa, whoa, Whoa, whoa. Well, thank you for helping prevent people from walking away and pulling their hair out. Trying to read it going, oh, I give up. So that's good. I love those dummy books. Those are amazing, Lynn Rivers: 17:36 I guess. But I just want to say the dummy books are not always helpful. Right. But I can assure you for Roberts rules, that book is a great start. If you just want to be able to be a voice at a meeting, not necessarily run one yet. You know, you just want, you want to write a motion, you want to get up and state your opinion and don't want to look foolish. Start with Robert's rules of order for dummies. Jenna Kantor: 18:03 Love it. Love it. Oh, I've been forgetting what my last, Oh yes. So for those who don't know, so at the house of delegates, I'm not sure if this is elsewhere, so you can definitely clarify this, Lynn. So at that house, all the people who are elected delegates sit in, I want to say an organized clump with their states and everything. But then there can be guests attending the event and they are sitting in the gallery in the back. And these are, it's separated in the back of the room. Is it true that they can come up and say point of order or speak to a motion or ask a question and so on and following Robert's rules and when or how, if that is appropriate? Is it appropriate? Lynn Rivers: 18:49 Yeah, no, that's a good question. And the short answer is no. A guest in the gallery does not have the right to state point of order. Point of inquiry, they cannot shut out. But with the permission of the group permission has to be asked, can a guest speak? So guests can be invited to speak. A guest in the gallery can ask a member of the group to request permission for them to speak. So, so there's two things. There may be a member in the audience that knows there's a lawyer in the audience or in the gallery and they may initiate the request, but the lawyer may be sitting there antsy thinking, I have something to contribute. There are guests in the gallery. They are allowed to walk up to a member and say, would you ask the speaker of the House to request permission for me to speak? Because I have something to say. And almost always the body would say yes. If someone really wants to speak. I've never seen a guest be denied, but there must be permission given. Jenna Kantor: 20:07 Thank you. That's very helpful. Well, me as a performer first I see this mic sitting in front of us that's clearly not pointing to the people. You know, anybody sitting in amongst the delegates. And I remember staring and going, I mean, do they want us to sing? What is this opportunity? This mic Beholdeth on us? So no, they give them one for clarifying. But thank you Lynn, thank you so much for coming on and clarifying. Just even giving people a little glimpse of what Robert's rules is and just really learning how valuable it is. I think this will be such a good thing for so many, even experienced physical therapists to really know more of and understand what goes on behind the scenes and why we are following such rules. I'm new to this, but honestly, I really do believe in them because it is not easy to have these hard discussions in a nice manner. Jenna Kantor: 21:01 You don't want to leave pissed off. You want to leave like, okay, that was fair. That was a discussion. I can see why we might be moving a little slowly on this matter or why we might move quickly on this matter. It was eye opening in a very positive way. So I was wondering, Lynn, if people wanted to reach out to you or find you to learn more or maybe even get more guidance if they start finding themselves passionate about getting much more involved in this whole parliamentary process, how could they find you? Lynn Rivers: 21:31 Thanks Jenna. Well, I'm in Buffalo, New York at D'Youville College and I am happy to share my email. It is riversl@dyc.edu. Jenna Kantor: 21:48 Thank you so much for coming on. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Emma Stokes on the show to discuss leadership. Dr. Emma Stokes BSc (Physio), MSc (research), MSc Mgmt, Phd is the president of World Confederation of Physical Therapy. In this episode, we discuss: -Dr. Stokes' journey to becoming the President of the WCPT -Takeaways from the World Confederation for Physical Therapy Congress -Constructive feedback and the 360 review -How to grow your professional network and the two up, two down and two sideways rule -And so much more! Resources: Third World Congress of Sports Physical Therapy Emma Stokes Twitter World Confederation for Physical Therapy Website WCPT Facebook WCPT Twitter WCPT Instagram For more information on Emma: Emma is the head of the newly established Department of Physiotherapy & Rehabilitation Science at Qatar University. She has worked in education for almost 25 years and is on leave from Trinity College Dublin where she is an associate professor and Fellow. Her research and teaching focus on professional practice issues for the profession. She has taught and lectured in over 40 countries around the world. In 2015, she was elected to serve as President of the World Confederation for Physical Therapy. She was re-elected for a further four years in 2019. She has experience as a member and chair of boards in Ireland and internationally in a diversity of settings including education, health, research and regulation. Read the full transcript below: Karen Litzy: 00:01 Hey everybody, welcome to another interview for the Third World Congress on sports physical therapy, which is happening in Vancouver October 4th and fifth of 2019 and we've been interviewing a lot of the speakers and today we're really excited and honored to have Dr. Emma Stokes who will be in Vancouver with us. So Dr. Stokes, thank you so much for coming on. Emma Stokes: 00:29 Oh, thank you so much for the opportunity to chat with you again, Karen. It's always a pleasure. Karen Litzy: 00:34 I know, I know I just saw you in Switzerland and we'll talk about that in a little bit, but before we get into all of that, just in case, there are some people who are maybe not familiar with you, which may be, there are, I don't know, but can you tell us a little bit more about yourself? Emma Stokes: 00:55 Yes, of course. Well, I'm an Irish physiotherapist and I'm sitting in Trinity College in Dublin, where I have the privilege of spending a lot of my professional life. So I qualified as a physiotherapist in 1990 and let's just fast forward to eight years after I qualified, I went to my first international meeting and you know, I tell this story wherever I go in the world, which is, you know, I went to that meeting and I came home. And in that moment, in those days I really recognized that I wanted to be part of the international physiotherapy community. You know, a lot of people ask me that question. They say, well, you know, how do we become part of that? And you know, honestly then I didn't know what that meant or looked like or felt like or anything like that. But as I tell the story and we can come back to this later on, you know, I decided I was going to make myself indispensable. Emma Stokes: 01:45 So I volunteered for every conceivable opportunity that arose, including within the ISCP, which is the Irish side of charter physiotherapists. And in 2015 I was elected to serve as the president of WCPT the world confederation for physical therapy, the global physiotherapy organization of which the IFSPT, which is the International Federation of Sports Physical Therapy, is a subgroup of which the Canadian physiotherapy association is a member organization. And of course of which sports physiotherapy at Canada is a division of the CPA. So we're all connected in this big family and I got to serve as the president for four years. And then last year I decided that I would seek a second term as the president of WCPT. And there was an election in May and I was reelected, here I am, I'm very, very happy to am honored to be serving a second term as president of WCPT. And it's been a long journey and I'm happy to answer any specific questions about that as I always am. Because you know, I think not because I want to talk about myself, but because I think sometimes people look at you and they say, how'd you get there? And I'm happy to share that journey because I think that's a really important question. When you see someone in a position that you want to be in, then you need ask them how do they get there? Karen Litzy: 03:01 Yeah. So let's talk about that. So you volunteered for everything and anything you could get your hands on it sounds like, and I'm sure that helped get your foot in the door and, open things, a crack here and there. So when did you first decide to be an elected official? Emma Stokes: 03:23 I think physiotherapists are nervous about the volunteering thing and the idea that, oh gosh, it would be terrible to volunteer if you had an end game and you know, 30 odd years ago to be 30 years since I graduated next year as a PT, you know, I don't think we had the whole, I don't know the word networking even existed in the way it does now, but I loved getting involved and things. So I was very involved with the Harriers and athletics club here and lives in trinity and I reckon I spent more time with them than I did and my physiotherapy program. I just loved getting involved and you know, when you're a junior physiotherapist or in your, the early stages of your career in the day job, you know, and you'd know this Karen, right? Emma Stokes: 04:08 You don't always have the opportunity to do the things that you want to do because you're maybe limited sometimes in the organization that you're working in. And in fairness, I worked in St James's Hospital in Dublin and there were no limitations placed on me when I started to get momentum, but it took me a few years to get some momentum. So I became a member of the Irish society and I went to a meeting. They needed a member on a committee and that's where it started. And you know, I was on a committee and then I was on another committee and then in 1996 when I was working in trinity, one of my friends whose office was across the Carto said to me, we're stuck for someone on the international affairs committee. Would you volunteer? And I think I suggest more because I was sort of trying to help her out. Emma Stokes: 04:51 Than I wanted to necessarily do international affairs. And then, you know, it started, I just, I knew then the global physiotherapy was where my, I think maybe I was struggling to find my place in the Irish physiotherapy world or maybe the clinical physiotherapy world rather than the Irish. You see that everywhere, the clinical physiotherapy world. And so when I started to do some international work, so I got involved with my first international research consortium and I started to volunteer and so the first international meeting that I went to was 20 years ago. In 1999 and no one paid me to get there. I paid for myself to get there. I was presenting some of my phd research and I had gotten to know, Brenda Meyers, I'd met her once or twice and I emailed her, I said to her, look, I'm here. Emma Stokes: 05:42 Do you need to volunteer? And I was a teller at the general meeting of WCPT I helped count votes. Now you might not think that that's super important which it is. In the governance meeting of WCPT, I counted the votes in 1999 and then clearly I could count and I stayed involved with European level. And in 2003 the meeting was in Barcelona and I asked you about some time, the Irish societies delegation. But I was there with some of my phd students at that stage and some of my own research. And I went to the general meeting and Brenda said to me, well you would you like to be the chair of the credentialing committee? And that's what I did. So in that, that was the time when you presented your credentials in within paper, you brought your paperwork to the meeting and there was something really elegant about that process. And now we do it electronically and it's a little different. And plus I got to meet the presidents of every member organization and WCPT at that meeting. And then I finally got elected to actually the board of WCPT in 2006 and that was a chance I didn't expect to get elected. I was only running to signal my interest for four years later. But I got elected and I guess the rest is history. Karen Litzy: 07:01 Great. And I think the big moral of the story here is that no one's an overnight success. It's not like you one day said, I'm going to run for president of WCPT and got elected, you have to put the time in and pound the pavement, if you will, in order to kind of work your way up. And I think in the days now of social media and everything happening, having to happen immediately. Yeah, it's hard. So what advice would you give to someone who maybe doesn't have the patience these days to put the work in? Emma Stokes: 07:35 Yeah. So first of all, I think you have to enjoy the journey. So, you know, I never knew it was a journey in many ways. I guess at some point I knew it was a journey. And I think one of the things, because I've done a lot of reading around leadership and, I think what I've been fascinated about is this notion that just because you try once for perhaps an elected position and you're not elected doesn't mean that you walk away. So that in 2006 now, I don't know would I have walked away. I don't know that I did because I actually think I would've because I think what happened was in 2006 I had no expectation of being elected. But my plan then was to say, look, I'm interested. I know that's going to be another four years before I'm elected. Emma Stokes: 08:26 Or I could be elected. And I don't mind if I'm not elected this time. So I was elected and that was pretty amazing. And interestingly in 2011 and it was suggested to me by a number of people that I should run for president. And I decided not to because I wasn't ready now cause that's another conversation which is about when are we ever ready. But I think I'm very objective about my abilities. And so I had sort of decided that I didn't feel ready in 2011 to be elected as the president but by 2015 given what I had done between 2011 and 2015 I knew that I had the experience, I had the capabilities to be a very effective president from the point of view, I think at least I felt I had given the organization the best shot in terms of the experience that I had gathered. Emma Stokes: 09:33 So I had done a graduate business degree. I had done a lot of governance courses. I had been the chair of the board of charity and I just felt, I suppose I felt from a self efficacy perspective and we talked about this, about our patients all the time. I felt confident going in that not withstanding what needed to be done, I was confident that I was able to definitely demonstrate that I had the experience to be the chair of the board of a charity based in the United Kingdom, which is what WCPT is from a governance perspective. But also that I felt that I had enough experience to at least give a fairly good shot of being the president of the global organization. And there are two quite distinct parts of the road. Karen Litzy: 10:21 Well, and that leads me to my next question is as president of WCPT and for maybe the people listening, if maybe one day that's on their list, can you give a quick rundown of the roles and responsibilities of that position? Emma Stokes: 10:35 Yes. And Look, you know, I think let's just use the sort of a nice kind of balanced scorecard approach to this. So to me, when I ran, when I sought to be elected as president in 2015, I said I would look in, I would look out, I will look to the future. And then I had a little small part of the balance scorecard, which is you know, that quadrant system which was about inspiring. And in a way they map onto the two I think quite distinct aspects of the presidency, which is that you are the chair of the board of an organization and a company that's based in the United Kingdom and that brings governance, legal, fiduciary responsibilities. But you were also the president of a global organization. You are the leader in some ways the first among equals. But nevertheless you are in a leadership role. Emma Stokes: 11:21 And my perspective on that is my job is to bring people together in the global community and that's whether it's the physiotherapy part of the global community or the wider collaborative part of the global health rehabilitation community. So looking in was about ensuring that the organization with working with the board and staff and our volunteers was its best version of itself. Looking out was to start looking at who we working with internationally and what are the international organizations that we're working with. Looking into the future is about leadership. It's about creating the next generation of leaders in physiotherapy. And then the other space was about inspiring. And I suppose for me in the four years, I'm sharing something with you that I have probably not shared with very many people. So in my narrative and the work that I do with an amazing coach is around how do you walk with the dreamers and I've given a few talks that talk about what with dreamers, but it's about that idea of how do you inspire people to do something different, to get involved, to be involved in a different way, to just grow. Emma Stokes: 12:30 I guess just to enable us to sort of amplify everything that we do. And I suppose for me that's very, very, it's an intangible, right? It's that sense of how do you measure that when it's very hard to measure it? Right? And you know, now in the next four years, that hasn't changed. So we're still looking. So I believe we need to still look in, we need to still look out. We just need to look out in a bigger, better way. We need to look to the future. And I feel that commitment from me over the next few years is really important in terms of what are we talking about in terms of sustainability, the next generation of leaders, the future of organizations that are just in their beginning part of the journey. And My blog, which just was posted yesterday, is about, I suppose that other quadrant, now I'm talking about the moon landing projects. Emma Stokes: 13:21 So it's 50 years since, you know, since the first Americans landed on the moon. But I think that 1961 speech that JFK gave about this idea of what, asking ourselves the question about what we should be doing, not because it's easy, but because it's hard to me, you know I've got four years, you know, I'll be president for four years and then I go on and I just do a different part of my life. So if I had one thing that I want to do, it's about, we could be asking ourselves the question as an organization and as a community. What should we do because it's hard. What should we do, because it's right. And, we have to ask ourselves the hard questions. And those things are nuanced and they're just this dissonance in them and they're not easy and they're not going to be done in the four years. Emma Stokes: 14:14 So what are the big projects, what does that decade going to look like? And if you look at who they have two big projects that are focused on 2020, 30, which is, you know, it's almost a decade away. And I think we as a global community and as a global organization needs to be thinking about what are we doing to help answer those questions. So I guess, yeah, does that answer the question? Karen Litzy: 14:52 That's the role and responsibilities in a very large nutshell, a balanced score card and nice framework. Cool. Yeah. No, that's great. Thank you for sharing all of that. And you know, I did feel that sense of global community and working together and learning and open-mindedness, I guess would be a good way to describe the WCPT meeting in Geneva, which was a couple of months ago. I definitely did feel that global community. And I think, you know, social media has its pros and cons and we can talk about that forever. But one of the pros is that it does certainly bring people together from all parts of the globe. And so I really felt, a lot of comradery and felt like I quote unquote, Knew people even who live in Africa or they're in Nepal or Europe or even just across the United States. I really enjoyed WCPT. I thought that there were some, I mean obviously I didn't go to every session cause it's impossible. Well I went to some really great sessions that did bring up some uncomfortable questions and kind of pushed my boundaries a little bit. So I really enjoyed that. But what were your biggest takeaways? Obviously, again, not that you could be in everything everywhere all the time, but what were a couple of maybe maybe two of your biggest takeaways if you can whittle it down? Emma Stokes: 16:34 Oh Gosh. Two really, okay. But let's, let's start with the opening ceremony. So you know, it, the opening ceremony to the board. So we work with the board and the staff work really closely together around that type of event. So the board does not get involved in, you know, what color is the curtain, but we do make a decision about the venue because the venue has a cost implication. So, you know, so do we go for a big room where everyone is together or do we go for a smaller room where there's some breakout sessions? And I think what was really interesting was we had a series of conversations around that and we finally resolved in them, I guess April, of the year before the congress. So April, 2018 but the decision was, nope, we are going into a big space where everyone is together on it. And it meant that, and you will recall this, it meant that everyone had to walk. Emma Stokes: 17:29 It was a short walk from the venue of the opening ceremony to the welcome reception and not happening. It wasn't raining so, and so I don't know that anyone ever understood the amount of forwards and backwards and trade offs on cost and logistics and the walk and everything like that. But, when we made that decision, the decision was, we are a global organization and our strategic imperative is that we are a community where every physiotherapist feels connected to the engaged. Therefore, when we have an opening ceremony, everyone is in the room. And to me that probably has been one of the most powerful memories of my WCPT life is that moment when everyone is in the room and I have experienced it in the audience, but boy experiencing it on the stage, looking out that audience is, you know, I'm never gonna forget that, that that's a memory that I'm gonna have for the rest of my life was that I never imagined, I forgot. Emma Stokes: 18:31 I didn't think that it would in my mind, you know, we're all gonna walk along. It's gonna be 15 minutes. I dunno if you remember this, but it was that snake of people. And it was perfect because you had international physiotherapists rambling on, and they had to walk slowly, right? Because it was enforced because we weren't going anywhere in a hurry when there was, you know, 4,000 as we wove our way along to the opening center to the welcome reception. And to me, I think it was a visual and a physical and representation of who we are, which is that community of people that are connected better because we are connected. So that to me was, it can only go downhill from there. Emma Stokes: 19:29 Right. Cause I was just like, it was fabulous. So in terms of specific content, and I completely love the diversity and inclusion session, and I think that was, you know, that was a focused symposium. It was peer reviewed. It was submitted. It was an amazing team of fabulous physiotherapists from all over the world and a stellar audience. And to me that was, you know, that was both literally and symbolically immensely powerful in terms of what it is that we're doing as a community. And in the closing ceremony I said, you know, I felt that the three themes that came together were diversity, inclusion and humanity. And that's not to take away from the content, the science, the practice content, the clinical content. I'm not taking away from that, but I think what we've started to do is bring us up. Emma Stokes: 20:20 We have started to lift our eyes as a global community. And now more than ever, we need to do that because of the stuff that is happening in all worlds. So, you know, we just need to raise the level of our conversation. Of course everyone needs science and they need evidence informed clinical practice, we need humanity in our conversations. And if we're not doing it as a global community, then I don't know who else should be doing this. And to me, the diversity and inclusion session was babied us. We had an amazing session on education talking about the education framework policy piece. But you know what I think really emerged from the congress was on a big shout out to anyone in education is we need to revive our educators network. We need a global community of educators that are having conversations with one another. Emma Stokes: 21:21 We need to do it. Whatever we can do. I think the other session that that I loved was the advanced practice one because that's a big conversation and it's a big conversation that spans not just high income countries but low, low middle income countries. It's it, you know, if we look to ensuring that we'd have universal health coverage, then you know, the World Health Organization is talking about this billion level of health workforce shortage and we are a solution. We're a solution in so many ways and we need to start having those conversations around how are we the solution. And one of the ways that we are solution is around advanced practice. And then I guess the other one that I just loved, and I'm really sorry that so many people were actually turned away from the door with us doing this. And we went on, we would talk about this was the one that starts to take that editorial from editorial to action. Emma Stokes: 22:13 Then you know, the stellar mines that were involved in that. You know, so Peter O'Sullivan and Jeremy Lewis spoke the editorial, you know, Karim, who was the editor was going to facilitate that session but couldn't because he had other commitments. But he was at Congress, which was amazing. So what we had was we had to have the insurance. We had the physicians, we have physiotherapists from the low middle income countries in that room. And I think what's brilliant is, but you know, there's a, you know, I wouldn't, I'd love to suggest that I was writing it, but I'm not, I'm just, you know, I'm sort of sitting you know, I'm there in the background saying, Hey, look, the bread lines are out there. Emma Stokes: 23:01 You do your work. So we're going to have a nice, I hope, a nice publication around that. But, this is one of the moon landing projects, right? If we want to have this paradigm shift, what does WCPT need to be doing in terms of what does the global community need to be doing? But what can we facilitate around this? This is another moon landing project. What does that look like? You know, how do we change the way and we ensure that the delivery of rehabilitation and physiotherapy is the best version of itself. Karen Litzy: 23:46 It was a definitely a very popular session. Peter O'Sullivan was like, I'm sorry, I didn't know it was going to be that many people there. But it looked really great. I was watching from, I was going to another session, to see my friend, Christina present her research, but it was good to follow along with all of the tweets in the social media from there. And I was interacting and after Boris was like, so what did you think? Did you like the session? I was like, I wasn't in it. And he was like, what? But I thought you were there cause you were tweeting. I'm like, well I can keep up. Emma Stokes: 24:20 Yeah, yeah. And you know, I think one of the things that, so we are, we are a learning journey, you know, and there was a tradeoff, right? So, yeah, I think Peter and Jeremy were really keen to get a very, very interactive session because there was data that needed to be developed from this, you know, so the data being gathered as a result within this session, which is a very interactive, you know, session. And I think that's really important. You go for a smaller room with very interactive session of course, or you go for a big space with 500 people in it and close, you lose a granularity in terms of detail. Plus the editorial was only published in June, you know, less than a year before the meeting. Emma Stokes: 25:18 The other thing, right, you're not planning for years cause I mean it wasn't four years. And so that's where you're trying to do the responsiveness piece, which is, you know, a hot editorial, which was big on big ideas, you know, so, you know, the conversation then well it's of course that's the choice of the editorial, which is big ideas. Now let's just talk about enactment. What does that look like in term, well, A, can it work beyond high income countries, but B, what does it look like in terms of the next steps? So it is, so, you know, I acknowledge that was a big challenge and there was a lot of people who were very disappointed, but it wasn't a keynote session. It was around from editorial to acting what needed to be a granular session. We should talk about, you know, how do we keep that conversation going? And that's where I think things at the meeting that the conference in Vancouver a year later then congress the year after that starts to allow us to start a plan for those conversations to move forward. Karen Litzy: 26:20 Yeah. Yeah. And I think that's a good thing to hopefully bring to, Vancouver and allow people to see, well, what did come out of that WCPT and then how can we expand on that. Excellent. Good. Okay. So let's shift gears quickly. And you kind of alluded to your research earlier and that you were started your research in the 90s. And I know that a lot of your research centers around leadership. So can you talk a little bit about your research, number one and then number two, how does that research kind of guide you in your day to day function within your job? Emma Stokes: 27:24 Yeah, initially my research was very clinically based research. And then in 2010 I made a decision. So first one, let's put it out there I'm not a researcher, right? So I'm not going to be anyone ever with a high heat index. That does not give me joy in my life. My joy is around amplifying other people's research, which is why, you know, my joy is around saying that editorial was amazing. Now let's see how we can get it to the next steps. But nevertheless, I am an academic and therefore it's really important that my research informs my teaching. You know, we are resected at institutions both here in Trinity, but also where I'm working now at counter university. And so it's really important that when we teach, we Emma Stokes: 27:56 are teaching, our research informs our teaching. So in 2010 I had an amazing opportunity to take a sabbatical. I finished my graduate business degree. I'd suddenly discovered that you can actually learn about leadership. And I had suddenly thought, hey, you know what? Let's look the what's happening in physiotherapy research and leadership. Answer nothing at all. And, you know, then you ask yourself the question, well that's fine. You know, do we need to be doing research in leadership physiotherapy? And the answer is actually, interestingly we do because we know obviously more and more about leadership is that leadership is context specific. So it's very contextually informed. It's also very contingent around, you know, what you do on a day to day basis. But increasingly the conversation around leadership and healthcare is leadership is not a role. Emma Stokes: 28:45 It's a mindset, right? You lead from the edges. A loy about transformational leadership? It's moving from the transactional nature to the transformational. And so that's what I was doing. If you think about it, my practice in Physiotherapy was around, you know, working with organizations in either leadership roles or being part of other people who were leading projects and you know, being in the followership role or the participant road. And so I made probably, what's a career changing decision, which is that I actually stopped doing physical research. I said, okay, my research was around professional practice issues. I will research what I practice and my practices is physiotherapy. So I worked on that year with Tracy Barry around direct access and we did it globally. We're now looking at sort of processing the results of, you know, a really interesting survey around advanced practice and the building survey around that. Emma Stokes: 29:38 And you know, so now I'm not that, I'm not the doer, I'm the person that's part of a team and the next generation of fantastic researchers are doing the research. So I want to give a big shout out to Andrews Tollway is doing amazing work on the advanced practice survey and also Emer Maganon, who was done, you know, she was my phd student on my post-talk and she's done a huge amount of research around leadership. And I've had the privilege of being along for the ride, which is fabulous. And that's what you get to do as a phd supervisors. So that's wonderful. And so the research has been around leadership, physiotherapy. We've worked around with the global community around some of the research that's happening and there's very little in physiotherapy and that's a shame. But actually what's interesting is there's more and more and that's good. And there's a huge Canon of research around leadership in nursing and for doctors, their providence is different. And so I don't think we should underestimate doing a lot of really good research around understanding the physiotherapy perspective and understanding and enacting leadership because I think that helps us start to understand where we might have some weaknesses or some behaviors where we're reluctant to get involved. And I suppose that for me is around how do we have those conversations, both from a research perspective but also from a day to day practice perspective. Karen Litzy: 30:59 Right. And then you kind of answered the question of how does it affect your day to day leadership abilities. And I think you just answered that because you're finding your weaknesses as a whole within the profession and I'm sure that can make you a little more introspective to see if you're either contributing to those or hoping to overcome them. Emma Stokes: 31:18 Yeah, absolutely. You know, I think you're absolutely right. I did a really interesting thing of just before I finished my first term as president, and I don't know if that, if you've done this or if anyone has, but I did it at 360. Emma Stokes: 31:32 So I had 11 people do the leadership practices inventory. So I did this and then 11 observers did this and then four people did in depth interviews. Oh, let me tell ya, so first of all, I'm indebted to the 11 people who participated and who gave up their time to do the Leadership Practices inventory about me, but also the four people who did in-depth interviews and they were, you know, so there were people within and external to the global physiotherapy community and Oh gee, that was interesting. You know, that was a, I learned a lot about myself, you know, and you know, and interesting I've done a reflection beforehand, sort of predicting what they might say and there were no surprises. There was a lot of reinforcements and you know, so I obviously, you know, you do the thing right, the 80 20 thing, which is they focused on the 20% of stuff that you're not best at. Emma Stokes: 32:27 And of course I had focused on that. So there was no surprises. But nevertheless it is saluatory to hear people say it about you and you know, and so on a cross, you know, so this wasn't, or three people, this was 11 people saying similar things about me and I've just spent two weeks with my family, Eh, like way more time with my family that I'm spending a long time. And I'm like, Oh yeah, I see where that comes from. Oh, how interesting. So I've done a 360 with my colleagues and I've spent two weeks with my family and yeah. Yeah, you know, I get it a lot of your niece that is seven and nine. They're saying, I think we should buy a to do list notebook. And I'm like, what do you think? I need one. Emma Stokes: 33:09 Oh, yeah, you definitely need to do this, that book. I'm like, okay. All right. So there's seven and nine and they're seeing that list already, you know? So it's fascinating. So I think you get, I think for me it's about where did the data points come from? I'm ensuring that you get them from people who will tell you the truth in a trusting, positive way. And so I do the research and then I do the granular stuff, which is hard, but yeah. But you have to do it if you are committed to being the best version of yourself in the service of the role that you're in. Karen Litzy: 33:47 Yeah, yeah. And in the service of others. Emma Stokes: 33:50 Yeah. Am I going to get any better? I'm not sure. Am I any more patient? Am I better at listening? Am I going to be any better as I'm pressing the pause button? I don't know, but I'm going to try. Maybe try anyway. Karen Litzy: 34:08 You know, I think the good thing is that you're now aware of some of these and I don't think they're faults. But you're aware of that side of your personality. Emma Stokes: 34:22 Yeah. And I think maybe it's not that I wasn't aware of it, it's more that it was reinforced about the impact that it has on people. If you'd ask me, honestly, did I find out anything with the 360 that I didn't know about myself? The answer is no. But has it made me face up to it and acknowledge its impact on others? Yes. And am I taking responsibility for trying to be a better version of myself. Yeah, sure I am. Cause you don't do this without taking it on to the next phase of the journey. Right? Karen Litzy: 34:54 Yeah. You don't just read it and say, okay. Yup. Nope. Yeah. Great. Cool. Well thank you for that. I'm going to look into that. So, you know, we're talking about WCPT and all of these international organizations and you do a lot of traveling and meeting all the different people. So you have a very wide network. So what are your top tips for physio therapists who are trying to build their professional network? Emma Stokes: 35:28 Two Up, two down, two sideways. And we've talked about this before, I think, which this is not my rule. I got it from, and a really good friend of mine who got it from someone else, a colleague of his, and the idea that networking is really natural to some people. Like they just, they're good at, right? Yes. But for a lot of people it's not. So, so I think the first thing is that you do two up two down two sideways route. And I think what's really interesting is when you say it out loud, you can start to use it. And in that way. So, and two up, two down, two sideways is, and so you're at a meeting and you want to be two people who are ahead of you in their journey. Emma Stokes: 36:09 So, you get ready, you identify them in advance or you don't, you just happened to meet them. But, for a lot of people it's about working and saying, okay, these are two people that I want to meet. And you're prepared and you don't randomly want to bump into them, but you have an ask of them maybe or not. Maybe you just want to connect with them because you admire the work that they'd done. And two sideways is two people that you want to connect with who are your peers, right? So two people that you've met on Twitter that you say, okay, I want to meet that person in person, I want to see that person. And then two down or two people who are ahead of you, the behind you in the journey. So students and you know, phd student, you know, so if you're a little ahead of them in the journey, who are they? Emma Stokes: 36:53 You know, and you know, who can you help along the way? So it's really interesting is I think it's a great rule. So you're at a meeting, who are your two up, two down, two sideways. I love it. And really interesting is if you know the rule and the person you're talking to knows the rule, it's great fun. So I was at a meeting where a physiotherapist came up to me and said, have you done your two down? So I had talked about this in the next year, a few months before rounds, and he'd come up and he said, have you done your two down yet? I'm like, sorry. He said, have you done your two down? I said, no, I haven't. He said, can I be one of them? Oh, that's so cool. And I said sure you can how can I help you? And so we ended up having a conversation and I was able to do some stuff for him that was fantastic. Emma Stokes: 37:38 And I thought, hey, you know, that's great. So, I think it's fantastic. So plan for your two up two down two sideways or be ready for your two up two down two sideways. And you know, I still do that. I mean I still think about hooking you. Who are the two people in the world that are going to be helpful for WCPT, who do I need to interact with, you know, and I don't necessarily always know who they are now, but it's in that moment I'm like, okay, I've got my card ready, let me tell you who I am. Do you think I could connect with you about this conversation or this presentation that you made? And so the other thing then is about looking around the room. And I think this is both as someone who wants to network, but also someone who's potentially in a situation where you could open circle. Emma Stokes: 38:24 So it's about physically looking through was a great piece of advice that I got. When circles are closed. So if it's me and one of the person I'm wearing a huddle, that's very hard for someone to come into. And sometimes that's okay because sometimes you are having a meeting and you don't necessarily, you need to have a conversation. But also sometimes it's about how do we keep that circle open to welcome someone in or if you see someone on the periphery to bring them in. Yep. So, so it's about the physicality of the space so that, you know, so sometimes it's about being polite and saying, look, oh, are you having a meeting? Or if sometimes people are having meetings, right? They are genuinely saying, look, we're actually having a conversation. But sometimes it's about looking around the room where you see the open spaces and coming in and saying, oh, hello, I'm so and so knowing that that that circle is open to have someone come in. Yeah. But also I think as people who are in spaces, recognizing if you see someone out of the corner of your eye might be hovering, have the generosity Emma Stokes: 39:29 to bring them in and say, oh, hey, did you want to join us? Well, and sometimes, so for me, a lot of the time what I do is I bring someone in because I know they want to connect with someone and I say, okay, you guys are connected. I'm going to go and I'm going to move on. Karen Litzy: 39:44 Yeah. I feel like Karim Khan is the king of that, by the way. Oh yeah, absolutely. Absolutely. Yeah. Oh, did you want me to come with me? This is exactly, yeah, exactly. Absolutely. He is the king of connecting people like that at different conferences. He's done that for me so many times and I don't know how. I'm always like, what can I do for this man? Because I feel like he's done so much and he's so good. And I love the two up, two down, two sideways. I'm going to remember that when I go to Vancouver. It's a great room. You know, and maybe we need to produce a little card to up to that, like a dance card. Oh that's a good idea. Maybe we can do that for sports congress. Oh I'm definitely doing that. Oh that's such a good idea. Emma Stokes: 40:37 And then maybe one of the sponsors or one of the, you know, cause they could have a little piece of the sponsorship piece at the back. Karen Litzy: Yeah, absolutely. Well I know that, you know, Chris is listening in on this, so I'm trying to shout out to a sponsor. And then if you really want people to kind of get into it, you can kind of fill it out with the person's name and then handed in and win a prize at the end. And I love the bringing someone in and when we were in Switzerland, Christina Lee that I was with and you know, we had met in Copenhagen at Sports Congress and decided that it all stayed together at WCPT and you know, you're just walking around and she gave me a compliment that no one's ever given me before, but it's might've been one of the best compliments I've ever received. Karen Litzy: 41:52 And she's like, you know, you are so good at making sure people are involved in conversations. Like you're so good at bringing people in and you're so good if someone's not saying anything of, you know, making sure there's space for them. She's like, that is, she's like I'm learning from that. Emma Stokes: 42:10 That's fantastic. And it is a great gift of yours because you are so present in the moment when we're having conversations. So you're very sensitized I think to the people in the room or the space that we're in. So you do connect people in a way that is fantastic and it's a huge gift. And I think the fact that you don't even know is that you're doing it means that's a great gift for you. Yeah, I think sometimes, and that's, you know, that is wonderful. So you have, you know, you've internalized that it's probably just a natural part of who you are. And I think for other people it might not be intuitive, but it's a great thing to remember. The other thing to remember is the 20 second rule or the two minute rule, but we have the rule, which is, you know, we meet people all over the world. Some people meet people around the world. You're never necessarily going to remember everyone's name. So I have a rule, which is if I'm standing chatting to someone and the person I'm with who knows me, we haven't been introduced within 30 seconds. The cue is introduce yourself because either A I've forgotten cause I'm so taken up in the conversation. It's not beyond the bounds belief, you know, happens very regularly. Or secondly, I've had that moment where I'm suddenly thinking, Emma Stokes: 43:28 I don't know that I remember this person's name or I'm not sure enough that I remember their full name. Emma Stokes: 43:35 So just introduce yourself, so if you're with me and we're in a conversation, you would always do it right. You'll say, Oh hey, I'm Karen, she's introduced me. That's fine. But, but it's also, it's a very polite way of getting over that moment of she's forgotten. She's taken up with a conversation or she hasn't done it because she's only thinking I'm having a panic. I remember exactly where I met the person. Yeah. I remember their name. And you know, sometimes I put my hand on them. But I can usually remember exactly where I've met the person. Karen Litzy: 44:11 Yeah. I'm good at faces. And sometimes like if I'm with some, like a friend of mine and I see someone, I'm like, oh my gosh, I know this person, I know this about them, this about them. But I don't know their names. So when we go up, we'll start chatting and then I want you to introduce and then I want you to introduce yourself. So I'll prep this, the person I'm with, I'm like, I might know their backstory, I've read them know, but I can't think of their name. Emma Stokes: 44:32 So you know, do the 30 second rule, which is when you're with a friend who hasn't introduced, you just introduce yourself. Karen Litzy: 44:38 Perfect. All right, so let's talk about Third World Congress. What are you going to be speaking on? Emma Stokes: 44:45 Well there you go, on leadership and you know, you know, how fabulous is that? I'm so excited about being there, you know, I'm just, I'm so honored to be invited because I was invited a couple of years ago and, you know, I wasn't necessarily going to be the president of WCPT again. Right. So, and I said to them, you know, what's really nice that you've invited me but you know what, it's great. We just invite you anyway because we want you to talk about leadership. And he would have been the president and that's great. So, I'm thrilled that I was invited to be that. I'm super excited about that. I'm back as the president of the world physiotherapy and, you know, I just, I guess, you know, I love the sports physiotherapy world. Emma Stokes: 45:27 You know, I've never practiced as a sports physiotherapist and it's not my field of expertise, but I have learned so much simply by sitting in the rooms of amazing congresses. And I've learned so much that just simply by Osmosis, that every now and then I say something and I think I sound like I know what I'm talking about. Actually. I'm fairly confident that I do, but how do I know? And then I realize, okay, what I've sat through five keynotes lectures from the stellar people in the field. And it's not that I'm an expert, but I can actually at least point people to the references. So, you know, I think there is so much to be gained from a global community of practice and knowledge coming together and you know, the sports physiotherapy world is incredible and I am so excited and Vancouver is beautiful and the Canadian physiotherapy is fabulous, So bring it on. Karen Litzy: 46:26 Awesome. Well I know, I am excited to go in to learn and you know, there's breakout sessions. I don't know which one to go to because they all sound really great. I don't know what you think, but I think they all sound like it's an amazing program. Emma Stokes: 46:40 Absolutely. It's fantastic. And I think, you know, you know, I get the joy. So I suppose my joy is my privilege and my joy is that I get to dip in and out of so many sessions. And because you know, in a way I am taking different lessons away from Congress. It's like this. So I'm taking away the thought leadership lessons I watched, you know, I want to sit in on the leadership stuff, I want to sit on the policy stuff. But you know, if you're practicing day to day working with people in the sports world, there the richness of the programming is like, where do you start to choose, you know, how do you decide what you're going to go to, to take away, to inform your day to day practice? Karen Litzy: 47:18 Agreed. I think it's going to be great. And again, just for people listening, you're obviously on the Facebook page, so hopefully you can see the banner on top that says October 4th and in Vancouver the Third World Congress of sports physical therapy. But I guess this is going to be on my podcast as well. So Emma, where can people find out more about you? Emma Stokes: 47:40 Oh, so, well, like they want to find any more out, more about us I think actually look at, so WCPT.org is our websites. Have a look at the website because we are going through a major both rebranding, you know, redesign of the website. So it's going to look super different. I think we're going to have some interesting information about our rebranding by October and about the rebranding of the product. You know, the kind of, the idea of what do we call ourselves as a global community and started to merge the space. I'm committing to blogging once a month, which I've failed dismally at, but I am now committing, so just put the first blog out there and yeah, so follow us on social media, like Facebook, Twitter, Instagram, and then look at our webpage but also look at our subgroups obviously because, the world sports congress is being co hosted by the Canadian Division of sports PT and the International Federation sports physical therapy and that's the WCPT subgroups. So all joined up. So yeah, look at the website and I see the early bird is opened on until the end of August for Congress in Vancouver in October. Karen Litzy: 48:55 Yes. Awesome. Well, thank you so much for taking the time out and coming onto as a pleasure. Emma Stokes: 49:00 It's my pleasure as always, and thank you for the opportunity and I will see you in Vancouver. Karen Litzy: 49:04 I will see you then. Thanks everybody. Have a great day. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dan White on the show to discuss evidence-based practice. Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dr. White's research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement. In this episode, we discuss: -What is implementation science? -Evidence Based Practice and how to use Clinical Practice Guidelines -The latest research findings from the Physical Activity Lab at the University of Delaware -Limitations of physical therapy branding and how we can step into the physical activity space -And so much more! Resources: Email: dkw@udel.edu Academy of Orthopedic Physical Therapy University of Delaware Physical Activity Lab Published CPGs For more information on Dan: Dr. Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dr. White received his Bachelor's degree in Health Sciences, M.S. in Physical Therapy, and Sc.D. in Rehabilitation Sciences, all from Boston University. He completed a post-doctoral fellow at the Boston University School of Public Health and earned a Masters in Science in Epidemiology from the BU School of Public Health 2013. Dr. White's research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement. Dr. White is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association. His research is funded by the National Institutes of Health, and the Rheumatology Research Foundation. Dr. White can be reached at dkw@udel.edu Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dan's research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after joint replacement. His research uses large existing datasets to answer questions related to physical functioning and physical activity. As well, he is also conducting clinical trials to lead ways to better promote and increase physical activity in people with knee osteoarthritis and after joint replacement. Dan is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association, the American College of Rheumatology, and OARSI. Read the full transcript below: Karen Litzy: 00:01 Hey Dan, welcome to the podcast. I'm happy to have you on. Dan White: 00:05 Thanks. Great to be here. Karen Litzy: 00:07 And now today we're going to be talking amongst other things, implementation science. So before we go any further, can you give a definition of what implementation science is? Dan White: 00:19 Absolutely. So implementation science, that definition is the scientific study of methods to promote the systematic uptake of research findings and other evidence based practice into routine practice and hence to improve the quality and effectiveness of health services. So essentially it is bridging the gap between science and practice, and it is taking things that we find in laboratories and in clinical studies and literally implementing them into real world, clinics where most physical therapists work. Karen Litzy: 01:00 Right. So then my other question was why should the average PT care, which I think you just explained that, so we need to care about implementation science because this is how we're getting what researchers do in the lab to our real world situations and our real patients. Dan White: 01:16 Yeah. I think practicing as a physical therapist, you know, you can look around and a lot of people do a lot of different things and a lot of things seem to work. Snd I think, if we want a game changer in our practice, that is going to come from a systematically studying people and understanding what are the underlying critical ingredients of our practice that really work and the best thing we have made up today to answer that sort of question of, you know, what is it that really works our clinical practice guidelines that is the, essentially the best body of evidence that has been reviewed by a panel and vetted and made to be digested by the everyday clinician. And implementing these clinical practice guidelines are really the key element that is going to lead to a game changing opportunity for us as a profession. Karen Litzy: 02:34 And when you talk about clinical practice guidelines, I know sometimes people think that you're doing sort of it's cookie cutter and what do I need to follow a cookie cutter recipe for because all of my patients are different. So can you speak to that? Dan White: 02:52 Yeah, no that is a great point. So on the one hand, there is definitely an art to physical therapy and the clinical practice guidelines and evidence based practice is by no means trying to take that away. It's evidenced based practice in general is not cookbook medicine. It is combining the three things and one is what the evidence says, but two it also combines what the therapist's experiences are and then finally it's what patient's preferences and what their feelings are on the whole thing. And it's a combination of all three. It is literally the definition of evidence based practice and these clinical practice guidelines are definitely consistent with that EBP models. So they are not directions or they're not instructions, they're guidelines. They're ways of helping people make informed decisions. And at a minimum, if you consider yourself an expert clinician and knowing what the clinical practice guidelines are, is a big leg up. And definitely key to helping our profession. It doesn't necessarily mean you ascribe them to every single patient. No, that's not what evidence based practices, but being aware of them is by definition, in my opinion, being a good clinician. Karen Litzy: 08:02 So can you give us an example of one of these clinical practice guidelines? Dan White: 08:21 Sure, absolutely. So one of the common patient populations that people treat is low back pain. And Tony Toledo and his colleagues at the University of Pittsburgh and elsewhere developed a clinical practice guidelines for low back pain, and published this and JOSPT in 2012, their paper described that the purposes of these CPGs, our first to what EBP is for a physical therapy practice. And then also to classify and define common musculoskeletal conditions from this classification criteria specific interventions are devised. So for an example, so I don't treat low back pain. This is not my area. So just forgive me for giving a guess here. Dan White: 09:32 One example, is a lumbosacral segmental somatic dysfunction. And this is associated with the ICF diagnosis of acute low back pain with mobility deficits. And, Tony goes on to saying that there's, certain clinical findings with this, including acute low back pain, a buttock or thigh pain restricted lumbar range of motion and lower back pain and lower extremity related symptoms with provocation. And then from that, there are specific interventions that I'm not going to get into that is unique from a different classification. So a different classification, a low back pain is sub acute, low back pain with mobility deficits, which is basically not acute but subacute patient and the symptoms are produced with ingrained spinal motions and there's a presence of a thoracic lumbar pelvic girdle mobility deficits. Dan White: 10:41 And then he goes on and there's these different classification criteria from which there are very specific interventions you're supposed to do. So it's classification and then intervention based on that. And essentially, that is in an ideal world of what a CPG should do. However you're always gonna have the patient that really doesn't fit into one or the other. Let's have somebody who is not quite acute, but they're not quite subacute. So what do you do? And I think being able to first even make that distinction, you have to be aware of the clinical practice guidelines. So knowing that, okay maybe it's going to be a combination of these two interventions because of this person doesn't fit into either one, but see how that approach is already a leg up from not knowing what CPGs are to begin with and what our common classifications is. Does that make sense? Karen Litzy: 11:38 Yeah, that makes a lot of sense. Thanks so much for using that as a really great example for people. And when you're talking about different CPGs, I know that the Academy of Orthopedics, which used to be the orthopedic section of the American physical therapy association, they have all these different names now. It's just made it all so, so much more confusing. But now obviously big proponents of the clinical practice guidelines, but if I wanted to find the average clinician and I want to find some of these guidelines, where do I go? How do I find them? Dan White: 12:14 Sure. So all the published clinical practice guidelines for orthopedics are on the Academy of Orthopedic Physical Therapy's main webpage, which is Orthopt.org. There's a banner that says CPGs and you just click on that and you can get right to all the published CPGs. Karen Litzy: 12:41 Awesome. And we'll have a link to that in the show notes at podcasts.Healthywealthysmart.com under this episode so that if people need it one click and we'll take you right there. So there's no excuse to not know these CPGs after listening to this podcast then because we're going to make it really easy for you. And now you just gave us a good example of how CPGs can work in clinical practice. Are there times where maybe they don't work so well or is there a downside I guess is what I'm trying to say? Dan White: 13:16 Yeah. I mean, again, going back to your original question of, you know, is this cookie cutter medicine and it's not and again, since EBP is a combination of patient preference, the provider know how, and what the evidence is. I mean, there's going to be situations where, you know, a situation's weighted much more towards a patient's preference. Like they don't want you to do manipulation or maybe they want something specific and you're like, well, that's really not called for in this case. And so you don't do the intervention that's prescribed or that the CPG recommends. And that's okay. We're not here to tell people, to command them what to do. They're coming to us for help. And, patient preference is a large part of evidence based practice. I think that's the best example I can think of. Karen Litzy: 14:16 Yeah. And, and I think another, if you're looking at your clinical experience as one of the legs of that stool, if you will, and the patient doesn't have a preference yet, you're sensing as a clinician that there's some trepidation on the patient's part. There's some fear if you were to, like you said, we'll take a manipulation as an example, then using your provider know how you would say, you know, this is not the right time or place for this. And so I think you've got all of that in. So the CPGs is not a cookie cutter oath just because A B C is present you have to do treatment B or treatment a or B. But instead it's giving you a way to maybe differentially diagnose and a way to, you know, be able to maybe give your patient an explanation as to what's going on and then use your judgment, use the patient preference and the evidence to then guide your treatment. Dan White: 15:21 Yeah, exactly. It's just like, you know, when you just meet somebody, you try to figure out who they are, right. And you try to figure out what kind of personality they are. And there's some sort of structure or rubric people use. Like let's say there's introverts and extroverts, is this person an introvert or extrovert in the CPG the first thing that it does is provide you a framework of saying, well, what kind of types of people are there with this type of pathology? How are they a type of person that has, I don't know, this type of this type of disorder or this type or another type of disorder. And from that diagnosis of providing a classification, you can, there are clear treatments associated, with that so back to the party analogy, you know, if you're dealing with an introvert, you know, you, you know that they're not going to be super bubbly and all over. Dan White: 16:10 You have to kind of bring things out of them and maybe take it easy and you know, take it on the slow road. Versus if someone's an extrovert, maybe are going to be doing all the talking. And, you can just be an active listener and be very interested in what they're saying, because they're the extrovert and perhaps, you know, that that's Kinda how it goes. And the CPGs is essentially just it is in the party analogy, a way of just navigating through our clinical practice, to provide best care. And, you know, I think another, medical example that really, stays fresh in my mind is a sort of lifesaving approaches to acute MIs. And, it wasn't the sort of protocol for or clinical practice guidelines for myocardial infarction, weren't developed, when necessarily, right after science discovered that, you know, look, if you do x, Y and z can actually save someone's life. Dan White: 17:20 It kinda came much, much later. And it wasn't until, the university hospital in Chicago, implemented these sort of CPGs for lifesaving approaches to MI that the death rate for acute MI's went way down. And all the medical residents followed, this CPG for treating acute MIs. And, that systematic approach is what made care better. Obviously in physical therapy we're not talking about life or death, but these CPGs have been vetted and are an approach that is systematically used, will produce a better outcomes. So yes, it's, you know, EBP, I'm not changing my story here. EBP is obviously patient preference, provider experience as well as the evidence, but when applied systematically, which means you'd be at minimum aware of what the CPGs are, they should produce better outcomes system wide. Karen Litzy: 18:27 Yeah. And thank you. I love the party analogy and comparing it to that medical example really kind of makes the CPGs a little bit clearer and hopefully people will now not look at them as some sort of cookie cutter program, but instead, as a way to help inform you of your practice, which I think is, yeah, I think it's great. And now, all right, so let's move on from CPGs. Let's talk about, I'm kind of interested in what you're doing next. So you are the director of the physical activity lab at the University of Delaware. So let us in on some of the things that you guys are working on. If you can, you know, I understand you can't say everything, but what are some things that you're working on that you feel like will be part of future implementation science for the average physical therapists treating patients like myself? Dan White: 19:23 Yeah. Thank you for the opportunity. You know my whole goal is just to get patients better. And, I worked in inpatient, acute, acute Rehab for several years. And I always wondered, you know, after I got people independent with bed mobility, transfers and ambulation, you know, would they actually take those, you know, new found independence, and actually resume their daily activities and be active in the home. And that led me to really thinking a lot about this notion of physical activity or, you know, how much do people do. And so, in the area I study, it's osteoarthritis and osteoarthritis is a serious disease that is associated with higher rates of mortality. Dan White: 20:21 And only definitive treatment for osteoarthritis is a total knee replacement. Now, after total knee replacement, people do great with improving their pain, and increasing their function. But there's many systematic studies that show in terms of physical activity, people aren't doing more, they're doing just as little as they did before. And I think that's a real missed opportunity for physical therapists. And I think there's a great opportunity to talk about, you know, being more active and helping patients and it really doesn't take that much. It's just a, hey, so, you know, how much are you doing every day? With smart phones and the use of fitbits, counting steps per day is actually an incredibly effective, a way to increase or one to see where people are at in terms of physical activity and to increase how much activity people are doing. Dan White: 21:19 So just like if you're trying to, you know, lose weight, you usually have a scale and you want to see how much you know, where you're at and what progress you've made. Using a pedometer or using a fitbit monitor to count your steps is an analogy and analogous way of doing the exact same thing. So at the University of Delaware, we are studying what are the best ways, physical therapists and practical ways physical therapists can increase activity in people with knee replacement. And what we've done is we recently published a study that basically found that, it's very feasible to talk about physical activity and do a really quick intervention for people after knee replacement by simply giving them a fitbit monitor. And seeing how many steps per day they're walking, and then increasing that number of steps today. Dan White: 22:19 Our target goal of 6,000 steps per day in a study we did several years ago, we found people with knee osteoarthritis who want at least 6,000 steps per day we're much less likely to develop financial limitation than people who walked less than 6,000. So that's where we use the 6,000 steps per day. That's where we have the goal set up. And, since there is a health outcome associated with 6,000 steps that's our goal. And we see where people are walking and then we start to increase their steps by five to 10% per week. So if you're walking 2000 steps, we increase it by 100 to 200 steps per day more. Dan White: 23:25 And then the next week we see where they're at and we increase it again by another five to 10%. And what we found, doing this intervention and physical therapy is that a one year after discharge from physical therapy. So they've had no physical therapy and no intervention. People pretty much maintain the gains they made in physical activity and their gains are pretty substantial. There was a high percentage of people that met the 6,000 steps per day goal, and maintain that one year out in a preliminary study. And we are currently collecting more data to look at a larger sample to have a little more robust results. In talking with the theme of Implementation Science, what our next step is to do is to implement this intervention in real world physical therapy clinics. Dan White: 24:24 We recognize, you know, at the University of Delaware, we have a fantastic physical therapy clinic. But you know, our clinicians, and the type of people, patients that come here don't represent a cross section of the entire country. We want to see whether this intervention will work in real world clinics. And we've partnered, with a clinic in Lancaster, PA called hearts physical therapy. And we're looking at developing a implementation of our intervention at that clinic, to see, you know, what's the uptake with clinicians, what are the barriers, what are the uptake with patients, where the barriers and how can we make this evidence based practice approach actually work. Karen Litzy: 25:13 Yeah. And you know, as you're saying that I'm thinking, well, hmm, does it matter like these people know that they're in a study. So is that their incentive to, you know, continue on with getting these 6,000 plus steps in a day because you know, we all want to show the teacher that we're good at what we do. Yeah. Right. And then the question is that enough? Like you said, you followed them for a year to really make that a lifestyle change and maybe after a year it is. Dan White: 25:43 Yup. No, those are good questions. So in terms of sort of in terms of like a Hawthorne effect or where you were, you know, you're just doing this because you know you're in this study. First we do have a control group that wears the Monitor. And they did not have the intervention, but we are monitoring their physical activity and know it and the intervention group, in our previously published study, in arthritis care and research, that the intervention group still is walking almost double of what the control group does a one year out. So that's, you know, that's notable. Karen Litzy: 26:36 Oh, one year is a long time and at that point, do you feel like it has shifted to a lifestyle change? Dan White: 26:47 Yes and that's the encouraging part. Like one year out that's a pretty good outcome, for not having any contact with, you know, well not having your original physical therapy for you. And, that's incredibly encouraging for a longterm outcome and actually thinking that there might be large behavioral change. Another interesting thing with our preliminary studies that we looked at adherence or the fidelity of a treatment in the physical therapy clinic. And what that means is how often did physical therapists tell the patient about, you know, ask them about their step goals and ask them about you know, how they're doing. And it actually wasn't that great. It was around 50%. So, it wasn't that this intervention was, you know, so well taken, in my mind, it was more that the patients really grabbed onto this and saw that, you know, look, this monitor tells me exactly where I'm at. And in qualitative studies we've done, or interviews we've done after the intervention, the patients, by and large, they say, look, I know where I'm at, that this monitor tells me, and I know when I have a good day and I know I have a bad day and what I need to do to make a difference between the two. Karen Litzy: 28:05 That's great. And if you can get that from the monitor or the fitbit or the pedometer or whatever it is that you're using, then I think that's a huge win, not just for mobility, which obviously we know we need as we get older and especially after knee replacements, but for a whole host of other health reasons as well. Dan White: 28:27 Yup. Yup. Exactly that. I was just lecturing yesterday to newly-minted rheumatology fellows at u Penn in Philly. And talking about physical activity first, it was interesting to know that none of them knew what the physical activity guidelines are, which maybe, you know, most people don't know what they are, but it's a 150 minutes of moderate intensity activity per week or 75 minutes a week of vigorous intensity. And the reason why these guidelines are so important is that the benefits of health of being physically active are far reaching. They range from not only improved strength and flexibility, but you also have cardiovascular benefits. You have a mental health benefits. There's less the chance of depression, there's less chance of weight gain. Dan White: 29:28 There are a lot of far reaching effects even so that the American College of Sports Medicine Jokes that if you could put the benefits of exercise into a pill, you'd have a blockbuster pill. I mean, it's definitely a huge benefit to be active. And then the second thing is that, you know, for physical therapists, you know, is that something we should address? I mean, that could be something that, yes, typically, yeah. Typically therapists you think with a patient comes in, you know, they have their complaints and, you know, let's talk about, you know, reducing your pain and increasing your range and then getting you back to, you know, where you were at. But our recently published study in physical therapy actually surveyed patients and said, you know, what do you feel physical therapists should talk about? Dan White: 30:24 And they were asked a range of things including weight and Diet and physical activity. And by and large, it was 90 plus percent of patients said, I want my physical therapist to talk about this collectivity. That is what they're there for. You know, that that is a major reason I am here and I want them to ask me about it and to counsel me on it. So I think that's something we should, you know, to embrace and understand, you know, what our guidelines are this 150 minutes a week, understand that. And understand, you know, what our steps per day, what are sort of major benchmarks for steps today. You know, we oftentimes say 10,000, but you know, we found earlier that 6,000 for people, you know, osteoarthritis is a meaningful benchmark. Dan White: 31:15 And then, the last thing I'll say about the physical activity thing is that, American College of sports medicine and the physical activity guidelines from the Department of Health and Human Services, you know, their major recommendation and before the timeline is that it's the saying that some is good but more, it's better that there is a dose response relationship between how much activity people do and their health benefits. So even getting somebody who is completely sedentary to doing at least walking for five to 10 minutes a day, can have a huge change in their health outlook and risk for future poor health outcomes. So, that is a major thing that, you know, PTs need to keep in mind is if I can get this person who I know is sedentary just to do something in adopt that I think is huge win for this patient. Karen Litzy: 32:12 Yeah. And, I think that the physical therapy profession needs to really step up and be the people to step into this space. I mean, this is what we do. This is our space. You know, we should be grabbing those patients who maybe have knee OA, but don't need a knee replacement yet. We should be stepping in. That's our jobs. That's what we should be doing. We should be working with obese or sedentary people of any age before they have to come and see us for an injury. Dan White: 32:46 Yup. Yup. Exactly. My doctoral student Meredith Christianson who worked with Gillian Hawker at the University of Toronto to do this qualitative study on primary care physicians. And essentially the question was why don't primary care physicians recommend exercise and physical activity to patients with knee osteoarthritis. Although despite the fact that every single clinical practice guideline recommends, you know, exercise by and large, the primary care physicians or that we're saying, well, we don't know what to recommend. We're not the experts. And, they would like to refer their patients to PT, but it's not reimbursed up in Canada. So, you know, I think this further underscores the notion that as physical therapists, we should own the physical activity sphere. We should be the ones that people think of, like, you know, well, I want to be active but I have some problems. What do I do? Go see a physical therapist. You are highly educated individuals who know more about biomechanics, more about kinesiology than anybody else in the clinical sphere. And we are the best place to make exercise and physical activity recommendations to people of all types, more so than any other health provider. Karen Litzy: 34:13 Yes. I couldn't agree more. I could not agree more with that. And, in my opinion, and my hope is that physical therapy really starts to move toward that in the very, very near future because boy could we make a big impact in the lives of people around the world if we're that sort of first line of defense, if you will. And isn't it amazing that like, I love that you brought up this not covered by insurance, but people will go and pay for a trainer or a massage therapist, not knocking any of those professions at all because I think they're all very valuable. But people will pay for that and not say, well, can you turn it into my insurance? And then when it comes to physical therapy where, you know we know all this stuff, we have the guidelines, we have the clinical prediction rules. We have the education and it's just not something that people are willing to put money down for. Dan White: 35:27 Yeah, I think there's two things. One I think people will pay if they see value in it. And yes, I think that it's not that we don't have value, but I don't think we're marketing ourselves well as specifically to the larger community. Going back to the implementation science, Workshop Implementation Science Conference and workshop in Providence, Rhode Island this past march and the president of the APTA came and spoke there and he said that, you know, for us as physical therapists, we're really lacking in the sales and marketing sphere. And one of the reasons why is because, well, one of the things is we all call ourselves physical therapists. But what that means is very different depending on where you work. Dan White: 36:33 So for instance, you know, a patient is going to have an eye, a view of what a physical therapist is. In this context. So if they see a physical therapist working in a school, well they'll think all PTs work in a school, and in acute care after a major MI then they think they only worked at acute care, but you know, marketing that we actually are versed in many areas is a challenge we have. And I don't know if that means we start to call ourselves a sports specialist or you know, cardiac specialists or what, but, you know, something along the lines of marketing our idea or marketing our expertise better is a key area of need. And then the second thing is, you know, I think it's okay to ask people to pay for things. Dan White: 37:24 In knee osteoarthritis as people will pay five to $10,000 for stem cells or PRP injections, and, you know, the evidence behind that is, well, let's say it politely, much lower than what the evidence is for exercise is. And, it's just incredible that, you know, if someone's gonna lay down that sort of cash, you know, I think there is a definite market out there for services that are viewed as valuable and having a physical activity or exercise prescription that's tailored to, you know, individual needs, you know, is a clear area of opportunity for our profession, for people with chronic diseases. And, you know, I think a space that we should definitely pick up. Karen Litzy: 38:16 Yeah, there's no question I could not have said it better myself. And I think I'm going to make nice quote on that because you're absolutely right. And now before we wrap things up here, it's the same question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself fresh out of school? Dan White: 38:54 Yeah, that's a good question. The advice I'd give myself is, just do your best to make your patients better. I think that's all it is. And you know, at the University of Delaware, we have people here that work in very different outputs. So we have our clinical faculty that are working, doing a bulk of the teaching for the students. And then we have research faculty or tenure track that teach the PT students, but all have our own research lines. And then we have clinicians that are working in the clinic so very different outputs. But our goal is all unified and that is just to help patients get better. That, you know, and from the clinical side, we are focused on excellence in research or excellence in teaching students the best and latest up to date things and the most effective ways to teaching them. Dan White: 40:05 So they remember not only to pass the test, but to have successful careers. And then from a research perspective, we're trying to look for, you know, what are game changing discoveries to help treat people and help them get better. And then the clinicians are implementing that on a daily basis at the University of Delaware. And you know, again, what makes us, I think, what I think of as a prideful point is that we're all aligned in our goals with trying to get people better. And so that's something that I guess, you know, I've always ascribed to as both a therapist, as a doctoral student and now as a clinical scientist is trying to, you know, my major goal is just to help people get better. Karen Litzy: 40:54 That's a wonderful answer. Thank you so much. And where can people get in touch with you if they have questions? Dan White: 40:59 My email address is dkw@udel.edu. Feel free to email me anytime. Karen Litzy: 41:16 Awesome. Well, thank you so much. Thanks for breaking down the clinical practice guidelines and implementation science, and I love the stuff you're doing in your lab, so thanks for sharing. Dan White: 41:25 Great. Thanks so much for having me Karen Litzy: 41:27 And everyone else, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Kathy Mairella on how to get elected to the House of Delegates and other APTA positions. Dr. Mairella is Assistant Professor and Director of Clinical Education at Rutgers University. Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey. In this episode, we discuss: -How to make yourself known to the Nominating Committee as a potential candidate -Referencing the candidate's manual and seeking guidance from your campaign manager -Candidate interviews and Kathy's experience with election day -The continual pursuit for leadership experience -And so much more! Resources: APTA Engage Website Kathy Mairella Twitter For more information on Kathy: Kathleen K Mairella, PT DPT MA, received a Baccalaureate degree in Physical Therapy from Boston University, and a Master of Arts in Motor Learning from Columbia University. She received a Doctor of Physical Therapy degree from the MGH Institute. Dr. Mairella is Assistant Professor and Director of Clinical Education. She teaches Professional Development I, and Health Care Delivery I and II. Her professional interests include health policy, professional leadership, and clinical education. She has presented on these topics on the national and state level. Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor: 00:00 Hello, this is Jenna Kantor with healthy, wealthy and smart. And I'm here with Kathy Mairella and we are at the house of delegates and going to talk about the process, the election process for people who are running for positions within the APTA. And I know nothing. So first of all, Kathy, thank you so much for coming on. Kathy Mairella: Thanks. This is fun. I'm looking for to talking about this. Jenna Kantor: So for those who haven't listened to any of the interviews that I've done before that were kind of similar, I am totally beginner and I'm just going to be asking step-by-step and learning with you the listener about this process. So let's start from the very beginning. And honestly, I don't even know what that is. So Kathy, would you start, how does it just even start in the first place? Is it a piece of paper you signed? Do you raise your hand in a meeting? Like how do you get the opportunity to run for a position within the APTA? Kathy Mairella: 00:49 So that's a great question. So many, many of the leaders who run for positions at the APTA level started the component level and they often, it means state component mainstay or it can be an academy section as well. Those are also components. So every state has a chapter and then your sections are also considered components. So most candidates who run at the national level have had some level of leadership experience at the component level. And so you start there simply by showing up and getting involved in different activities. Usually if you have a leadership interest, somebody will notice and give you some direction and it helps to get that direction if you ask for it. If you're doing some work on a committee level or a task force level, you can ask the people who are more engaged. Kathy Mairella: 01:55 How did you do this? How did you get started? I started as a New Jersey component leader. I started as a secretary and moved through vice president and president and then to chief delegate. And so I got to know people on the national level through my work as a chapter president and as a chief delegate because that's where you come to a national meeting and you start to connect with people beyond your component. You start to meet people who are either other delegates or serving on the national level. And you develop connections, you develop relationships. When I went to my first delegates, I looked at the candidates who ran and I thought I would never in a million years do that, but I was a delegate and I watched and then people came to me and said, we think you have some leadership, would you be in check? Kathy Mairella: 03:00 And I was totally floored. I did not expect that at all. In fact, I was a member of APTA's nominating committee. So nominating committee members are elected to slate the candidates who run and they start years ahead of time identifying those who are interested. And so I was approached and I thought, not really, no, I don't think I really want to do that, but it gave me the idea of perhaps in the future serving at a national level. Jenna Kantor: I want to pause you just very briefly. Would you mind saying what a delegate is for those who don't know what that means? Kathy Mairella: Sure, absolutely. So each state chapter elect delegates who go to the house of delegates to vote on motions which are ideas, ideas for action. Really the house of delegates is considered a representative body, just like Congress as a representative body. So you are elected by your state or there are also section delegates, but you're elected to represent them in the house of delegates. Kathy Mairella: 04:21 And the house of delegates has about 402 delegates. And so the states with larger membership have more delegates, states with smaller memberships have at least two. They will never have fewer than two. So they call that apportionment. Jenna Kantor: So you're bringing up the delegates cause they're the people who vote for you. So it's important to be introduced to them because it can help your candidacy if you should run. Kathy Mairella: Correct. And when you decide you want to run, it's important to get a sense from people. Is this a good idea? You don't want to put in all the work and then not be successful. So you really do start to observe people who have been elected or people who are doing work within the association that inspires you, that interests you and you know, you can observe them, you can ask them questions. Kathy Mairella: 05:24 You can start to connect with people. And then running for offices really a matter of experience. But it's also a matter of timing. We all have work life integration and we figure out the timing that works best for us. And in my case, I had three growing children. I knew I wanted to serve at a point where they were a little bit more independent. So that determined my time frame. So again, I had been a chapter president, a chief delegate, and then at the end of the time I was a chief delegate. My youngest child was graduating from high school and I thought, okay, this is the time for me to start pursuing that. So, I would observe then you need to know what the positions are. You need to know. Jenna Kantor: So just to run for say, secretary or President or director, you need to know what it means that you would need to know what to do. Kathy Mairella: 06:29 Correct. So, the board of directors at the APTA level is 15 members. You have nine directors and then you have house officers, speaker and vice speakers. So those are two board positions that actually run the house of delegates. And then you have president, vice president, secretary and treasurer. So you would need to know, you know, kind of the roles and responsibilities of each of those. And you can also run for the nominating committee, which I mentioned earlier. So those are the people who are elected by the delegates to determine who the candidates are each year. So, you know, you run through a process that starts immediately after each house of delegates. So we literally just finished the house of delegates today on June 12th, and the next cycle starts for the 2020 election today. And it starts by forms that are available on the APTA website that any member can complete. Kathy Mairella: 07:34 They don't need to be done. You don't need to be a delegate. You don't need to be a leader. You can go on the APTA website and you can put in what's called an NC1 form, which stands for nominating committee one form. And you put that in and as an individual and you recommend someone that the nominating committee should contact as a possible lead for them to slate for office and you can you choose, I think this person would be a great secretary. I think this person would be a great treasurer. And you put in the recommendations for the offices that are up for election in the following year and the nominating committee collects all of that information. They also keep an ongoing spreadsheet of people who have expressed interests cause sometimes people will say, yes, I'd like to do this in the future, on completing a residency now and I'm getting married the year after that and I'd like to practice for three to five years and then maybe I'll be ready. Kathy Mairella: 08:47 They start to keep that spreadsheet and they turn that over every year from nominating committee to nominating committee so that they have a database of potential candidates. Jenna Kantor: I have a question. I have a question about that. I'm definitely a person who wants to work on the board one day. Definitely a dream of mine. And what if I'm in a position where I don't have somebody saying, Oh, I submitted for you. Like what if you don't have something like that? Does that look low upon yourself? I would love to know that perspective. Kathy Mairella: Sure. So the volume of those NC1 forms really doesn't make a difference. It's important to have a few people say, yeah, it would be nice for nominating committee to talk to that person. You're not committing to anything. It simply gives your information to the nominating committee as someone that they should talk to and it just gets you in kind of in the system. Kathy Mairella: 09:47 So, I think for anyone who is interested, you can contact someone on the nominating committee directly. Their list of names and contact information is on the website. And usually they're assigned to a region. So who's ever assigned, you know, if you're from New York, from the northeast, you know, you can directly contact, you don't have to have NC1 forms until you're actually ready to run for office. So once you decide you are ready to run for office, it usually is a good idea to ask a few people. Would you be willing to put in an NC1 form for me? And talk to people kind of before you're ready, you know, do you think this is a good idea? Cause as I said earlier, you don't want to put in all the work and then find out that you're not successful. Kathy Mairella: 10:35 You're spending this time looking at your leadership skills. Learning about leadership. Always growing, always growing. There are some resources. APTA has opened, a new platform called APTA engage. And they are in the process of transferring some of their leadership development resources to that place. When I was on the APTA board, I chaired the leadership development committee and we came up with some core competencies of leadership. So, they were self function, which is how an organization works people, which is managing people's skills and visions. So knowing how to be visionary. And so I would recommend that you would look at all of those areas and they're always, they're not linear. It's not as if you develop self first and then people and then they're cyclical. Right? So you can be, you know, you can work on all of those things and constantly come back to developing yourself as a leader. Kathy Mairella: 11:43 You're always developing yourself no matter how experienced you are. So the nominating committee, these NC1 forms are available between now, which is June and November. Usually it's around November 1st they close and then the nominating committee takes those forms. They look at who the possible people are that might be good to be slated for these positions and they actually reach out to these people. They interview people, to figure out who should be slated for this next year's offices. And they come up with a slate and what they decide how many candidates to slate. So usually if it's an officer position, president, vice president, secretary, they try to slate two people because there's one position. And for director there's usually three positions. They try to slate six individuals for those three. So two for each position is the goal. And that's what they would consider a full slate. And sometimes that's a challenge to get a full slate to get people to commit to run and you have to consent to run. They will call you to say, do you consent? They don't just put people's name on a list. Jenna Kantor: 13:15 So for you, you went through this whole process yourself and several times. Oh my gosh, this is for those who do not know, Kathy, she has the stamina of wonder woman just doing the whole process. So you knew you were going to run. Is there a meeting to teach you about principles or how are you trained for what is to come. Kathy Mairella: And that's a really great question. So the nominating committee members are mentors or guides for you. They're not your advocates because they remain neutral in the election process. But they will assist you with some resources. But then APTA staff who work in the governance department become your assistants as well with the process. There is a candidate manual that contains much of the information and that's available to anybody. You don't have to wait until you're a candidate. Kathy Mairella: 14:16 Any member can go on the website and locate the candidate manual and read lots and lots of information about this whole process. And it really describes the nominations process, the candidacy process, and the elections process. So once the nominations process ends, the candidacy process begins and the nominated committee publishes the slate and the slate goes up on the website. And that's when people find out, it's usually early in December. They usually find out these are the people who are on the slate and then the campaigning begins. And as candidates, you are given a question to answer that goes in written form that goes on the website, on your candidate page. You also have to have your CV that gets posted there and that becomes available to the delegates and to the members to look at who are these people. Kathy Mairella: 15:21 And that's how you get information. The CSM meeting in February is usually the first live appearance of the candidates. When delegates start to pay attention to who are these people who are slated? And so the candidates pick a campaign manager and your campaign manager is the person who helps you. They are your advocate. They are the ones who help you navigate the candidacy and election process. Jenna Kantor: I love that you guys do that. Kathy Mairella: Yeah, and I actually I served as a campaign manager last year and I loved it. It was really a lot of fun. I really enjoyed that. So usually you want your campaign manager to somebody who does understand this whole process and who can again be your advocate, you know, let you know if your hair is straight and you know what you know, look at the things that you're writing and give you feedback and be sort of your sounding board when you have questions on strategy and who should I be talking to and here's what I'm hearing and how do you think I should handle it? Kathy Mairella: 16:38 That's your campaign manager's job. Because they have the job of being your advocates. Do you show up at CSM, you go through the process of contacting people, you know, asking them for your support, putting together your platform. Why are you doing this? Why should somebody vote for you? You have to have a pretty clear picture of why, if you're going to convince people, you know, to vote for you, it's politics. It's absolutely politics. And the thing about elections is that not everybody can win. You have to understand that the delegates vote for a variety of reasons. It's not always personal. If you are not the one who is elected. And there are multiple reasons why delegates will look across the slate at everyone that they're electing. They will be looking at the balance, they'll be looking at geographical balance. Kathy Mairella: 17:43 They'll be looking at age, they'll be looking at male versus female. So they're looking at all of those things for a mix. Again, because your board is a team of 15. Jenna Kantor: I would love for you to go into now the day off, so the day off. So, for those who don't know, at the house of delegates, it begins of course with a bunch of meetings, but the real star time where people are coming together for delegates to start voting on things are the interviews for these candidates. So if you wouldn't mind talking about that experience. Kathy Mairella: Sure. And candidate interviews are identified by potential candidates as being one of the biggest barriers to serving because many members find the idea of doing these candidate interviews to be really intimidating. Kathy Mairella: 18:42 The candidates at this point get at least one of their questions in advance. So you work on that and get it, you get that one prepared. So I ran this year for the office of Secretary. And so there are 20 minutes allotted for your interview. You get a two minute opening and you get a one minute closing and then the other 17 minutes you are interviewed by delegates to the house. They're divided into four groups. And so you how you do this four times, so you do 20 minutes, four times with a break in between each. And really, the delegates can ask you almost anything. And there's a standardized rotation and about who gets to ask the actual questions. So again, because I've done this a number of times, I actually enjoy the experience. The first time I did it, I found it to be, you know, completely intimidating and scary. Kathy Mairella: 19:39 Because it's been identified as a barrier, there's been a lot of discussion about how else can delegates get information about candidates besides these interviews. You know, when you're a board member, you're not necessarily a performer. You know, it's not necessarily about being a good person who answers questions well on your feet, but yet that's how you are being evaluated based on, you know, on these interviews. There's a lot of behind the scenes leadership roles. So this process I think does favor those who interview well for lack of a better term. And again, it scares a lot of people. Jenna Kantor: I get that. I get that. I was wondering for the last question now. So you've done all these interviews, who you finally get to go eat, drink, try to take a nap cause then you're waiting for the votes. So the votes go through. What's that experience? And so the last question, what's the experience of getting the votes and how it ends? Kathy Mairella: 20:36 This is a great question. I had to explain it to my husband the other day. So, the actual election takes place in the house of delegates and the delegates use a ARS device for electronic voting. So it is anonymous. And so they vote for each office and then ARS system tabulates the results. As that's happening, the candidates are asked to go with their campaign managers to a special room and you are handed in your hand an envelope with the results. So you get, as a candidate, you get the results before they're publicly known, which is very much a kindness. So you're not like sitting in the house of delegates getting the results at the same time that everyone else is. So you have some privacy around getting the results. You get that envelope, you either stay in the room, you go somewhere else with your campaign manager, and then you open the envelope and there you see the entire slate with the vote tally and how many each candidate and who you know, who is elected and who's not. Jenna Kantor: 21:57 And for anybody listening of course there can be mixed opinions on how this is run at seeing the tallies, seeing the numbers. I've honestly heard the ying and the Yang version of that, but overall this is the process. So I'm not doing this interview to add on all those opinions. This is just for just that blanket, like this is how the candidacy people running for the APTA. This is how it's run. This is how it works. Of course. Thank you so much Kathy. You just gave all these references for people, for them to look up and find out more details on their own if they really want to see details by details. That's amazing that there's a packet of book you said. The candidate manual. That's amazing. But thank you so much, Kathy, for coming on. This is a pleasure and I cannot wait for people to learn this information though. Kathy Mairella: I think it's really important that this information is shared. I think it's really important that members and potential members know how their leaders are elected and how they can get involved. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Sneha Gazi and Maria Muto on Physical Therapy International Service. Dr. Sneha Gazi is a physical therapist based in Manhattan who specializes in orthopedics and pelvic health. Sneha's desire to bring her skills beyond her immediate reach drove her to start PTIS in the hopes of bringing PT services to underserved populations. Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics. In this episode, we discuss: -How Sneha and Maria started Physical Therapy International Service as students -The logistics around organizing a volunteer event abroad -Roadblocks Sneha and Maria encountered along the way -Advice for those interested in following in Sneha and Maria's footsteps -And so much more! Resources: #PTIS #PTInternationalService #CerveraDelMaestre #Spain PT International Service Website Email: pt.internationalservice@gmail.com For more information on Sneha: Dr. Sneha Gazi, DPT earned her Doctorate of Physical Therapy from Columbia University with a focus on orthopedics and pediatrics. She holds a BA in Honors Developmental Psychology from New York University where she completed a Concentration in Dance and published a scientific article on infant motor learning and development. Dr. Gazi worked at clinical rotations in both outpatient orthopedic practices and acute care hospitals, gaining knowledge on high-level manual therapies and evidence based exercises to help her patients return to the activities they loved. She's treated pelvic pain in pre/post-partum women, rugby players in New Zealand's sports training facility and helped many NY's Broadway and Off-Broadway dancers, actors, vocalists, and instrumentalists to get back on stage. She combines her knowledge of how to rehabilitate lower back pain, neck pain, TMJ dysfunction, sports and dance injuries along with a compassionate energy. Sneha is also a certified yoga instructor and professional Indian classical dancer. She integrates yoga asanas, breathing techniques, guided mediation, and mindfulness exercises into her treatment sessions to enhance her patient's recovery process. Sneha has a strong passion for service overseas and pioneered the first ever Physical Therapy International Service trip to Spain with Dr. Maria Muto. For more information on Maria: Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics. Maria received her Doctorate of Physical Therapy at Columbia University where she began to analyze runner's running mechanics. In recent years, Maria has worked with the athletic population as a personal trainer. She hopes in the near future to obtain her certified strength and conditioning specialist certification (CSCS) to practice both training and rehab with high level athletes. As a physical therapist, Maria's treatment approach is team-based between her and her patients. She believes that getting to know and involve her patients as much as possible within his or her care is the best way to optimize function and maximize movement mechanics for a true recovery. This belief of involving patients within his or her care at this level persuaded Maria to expand herself to this world and discover how to truly connect with others of varying conditions, cultures and fortunes. Maria has now practiced in Italy and Spain. Overall, Maria is excited and eager to continue to learn more about the world and her profession by these experiences. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor: 00:04 Hello. This is Jenna Kantor. I am partnering as a host with healthy, wealthy and smart. And today I get to interview Sneha Gazi and Maria Muto. And they are the creators of physical therapy international service, which is PTIS, where they led the first ever international service trip in Spain, which is incredible. So I'm extremely excited to be interviewing these two. One they're good friends of mine, two their big goal getters. Literally this wasn't any teacher or any mentor telling them to create this service trip. This is something they just found a real hardcore desire to create from scratch. So this podcast is extremely valuable because they are going to be sharing exactly how they did it, maybe a little bit of obstacles, and then hopefully put a fire in your flame if you're considering doing something like this yourself. So the topic for today is very simple. It's just creating a service trip. All right, so first Sneha, would you just mind just saying hello one more time so people can really hear your voice. And Maria, would you do the same? Perfect. Alright, so first question, why did you decide to create a service trip? Sneha Gazi: 01:31 So we had multiple reasons to create a service trip, but two of the main reasons were, one, we wanted to provide physical therapy services to a group of people in a different country who didn't have that opportunity already. So we chose a small town in Spain. They have no physical therapy services in that town and the closest medical services they have to travel quite far to obtain even basic medical services. So physical therapy is sort of a luxury treatment for them in that town. And these are also people who work high levels of labor, their agriculture workers, they do a lot of physical demanding work, so they end up having a lot of physical stressors. So, that's one main reason we wanted to provide a service to people who didn't have it. And then the second reason, our main reason to join with two folds. Sneha Gazi: 02:23 The second one was to provide an opportunity for students to learn in a different setting. So this provides cultural awareness. This provides an opportunity for students to bring things outside of a classroom setting, even outside of a clinical affiliation setting where they have, you know, very structured environment into sort of the blue and an environment where they won't have a chance to, you know, readily look something up on the Internet, but they have to think on their toes. They have to know how to modify a treatment. They have a licensed physical therapist there to guide them throughout to make sure everything is safe and everything is moving forward very well for the patient to have the patients' interests in mind. But it's to provide these students an opportunity where they're kind of thrown out of their comfort zone. Jenna Kantor: 03:05 That's excellent. So, okay, you started from scratch. How did you guys fundraise for this trip? Maria Muto: 03:14 Yeah, so we had three separate events. These were a happy hour events, that we advertised to people that we knew in the local area to come hang out with us downtown, come out and support this service trip. We had great turnout the first two times. It was so much fun to just gather with these people to help promote this amazing trip. Super supportive. It was a true gift, honestly. So, you know, we hope to continue doing this. Jenna Kantor: 03:49 That's great. Yeah. Sounds so simple that you guys were just able to create these social nights and you're able to just make money from that. Was it difficult just to follow up a little bit more money? Yeah. So was it difficult putting together these fundraising events or was it rather simple? Maria Muto: 04:04 Well, the simple fact that we are housed in Manhattan kind of make it easy because there's so many opportunities to go out and explore the city. So, you know, between Sneha and I, and a third member, we kind of were just thinking about, you know, where do we want to be? Thinking about the audience that we were targeting, like young 20s, let's think about the area and location. So we did our research, we contacted, the coordinators of these local areas that we were interested in and things, you know, led to another. And we were talking about deals and we got really great offers and apparently our audience loved it too. So, it wasn't really that difficult. You just have to kind of reach out and speak to the right person. Jenna Kantor: 04:50 That's great. I like how you say it. It almost sounds like boom, Bada Bang. It happens. Maria Muto: 04:56 New York is a land of opportunities so it is put yourself out there and you never know what you're going to get. Jenna Kantor: 05:03 Yeah. So we learned right here, moved to New York is a good suggestion. Did you choose a location then for your actual service trip? Sneha you start to go into this a little bit saying all the benefits of Spain, but I'm sure you must have explored other locations as well. So would you mind telling me that journey? Sneha Gazi: 05:24 So, I actually had the wonderful opportunity before joining PT school to do a Yoga Shiatsu program where I got my yoga teacher certification in this very town. So the way I found that was I just looked up yoga teacher certifications in Europe because that's where I wanted to do it. And I know a little bit of Spanish. So I knew that that would be a little bit easier for me to mingle in with the folks in the town and have a good time and get to know different cultures. So I chose Spain, I ended up going there, made some amazing connections, you know, the smaller the town, the lovelier the people in a lot of ways. Everyone is so humble in that town. Everyone is so open and warm and you know, willing to let you into their homes and their town in their community, which is already so small to begin with. Sneha Gazi: 06:11 So I made some really good friends there and when I was thinking about places, Maria and I were discussing, that was one of our many options. And it also was the one that flew the quickest for us because of that connection that I already had there. So it wasn't easy to do the communication and you know, do the long distance back and forth, emails, thousands of emails, thousands of things to coordinate. But at the end of the day, that was the best route for us to go to because I already had been there before and I had known that it was a safe place. The people were wonderful and I knew that this would benefit both the town in the students and the licensed therapists who are coming along with it to make it a safe working environment and a safe learning environments. And that's why we chose that. Jenna Kantor: 06:52 Yeah. Yeah. That's great. Oh so good that you knew that it was a safe area to cause I know for people traveling overseas that would be a concern. So having that background with Yoga, by the way, power to you being a physical therapist and knowing yoga. Wow, that's definitely given you a leg up for sure. But being able to have that experience before that, that's great. What a great way, how your life and kind of led you to creating something more in this area that you fell in love with through yoga. Jenna Kantor: 07:53 So we talked a little bit about fundraising. Now my mind's going to how much would this cost if I was a student now I wanted to participate. How much did it cost for a student to go and be part of this service trip? Maria Muto: 08:17 So, because this was the first event, we kind of hope that the next following will be similar into what the expenses were for this one. But you know, as a student, finances can be very difficult. So, you know, trying to keep that within our minds. We calculated a fair of 450 euros, that would be per students. So kind of just thinking of the numbers, we were, you know, that's why we had those three fundraising events to try to cover for those costs. So, you know, we were planning accordingly. We did tell the students, which we have three students with us and two licensed PTs, we did tell them that their airfare would be on them. Because we wouldn't be able to cover that. Hopefully as we grow as an organization, we will be able to, you know, create larger fundraising events and have, you know, even more money to, you know, help us move this opportunity along and help you know, out the students, or whoever's participating more. But for the first time, that was pretty much what we had the students pay. So, you know, we'll see what happens in the future. But, it wasn't really that expensive. When you look at a larger scale of what it actually could potentially be per person. Sneha Gazi: 09:46 We have to say what the fundraising money went to. So we have to say that we covered the entire cost for the licensed therapists. 450 euros for two people. Maria Muto: 09:56 The 450 was covered like we provided coverage for the PTs and then everything, the airfares and all that stuff was on their own. Jenna Kantor: 10:17 Selecting students and selecting mentors, I feel like this is almost like a raffle, you know, like who gets it? How did you do this? Was there some sort of like people wrote in letters and mentors. I mean, you were students at this time. So how many professionals did you know at this point to be able to pull in the ideal people to guide you over in Spain? Sneha Gazi: 10:40 Yeah, so the licensed PTs who came on this trip, the way we approached that was we emailed, texted, Facebook message called, kind of in any way, a form of communication to every license PT that we knew and our contacts list, and then ask our friends to give us more context. We had many people show interest, but we knew that we were asking a lot from them because they weren't getting paid to go on the trip. All we were able to do was completely cover they're living, food, transportation in Spain, which was the 450 euros that Maria mentioned, but we weren't going to be able to cover their airfare. So what these therapists had to do, and we are forever grateful for you, Patty and Michelle for doing this. They actually took off of work and paid their airfare to come to be a part of this trip. Sneha Gazi: 11:32 And the two therapists who came in were the ones who were able to give us a commitment as soon as, and we knew that everybody who we reached out to was a reliable, intelligent and wonderful therapist who we knew would be an amazing form of guidance for the students and for ourselves because we were students while we went on the trip. So we knew whoever came in and whoever signed our contract and said they were on board. And you know, there were many who are very enthusiastic about this. But whoever came in first were those. And then in terms of the students, we reached out to several schools. We did not want this to be a school trip. You know, never really was a school trip. This is an independent project. So we reached out to several schools outside of our own school. Sneha Gazi: 12:18 Maria and I go to the same school but reached out to other students to make sure that we get a diverse group of people so we can learn from other schools as well. And we wanted everything to be a sort of from different pockets of the states. So we were able to get three students from three different schools who joined in. A lot of people sent in their applications and we sort of chose based on, you know, their essay of why they wanted to do it and sort of their background on the classes that they had taken just to make sure that we had a diverse group of people but single minded in terms of what we wanted to accomplish, which was service and learning because it's physical therapy international service trip. So yeah, that's how we chose everyone. And you know, that was initially we thought that this was a struggle but we found very quickly moving forward that that was the least of our worries. It was easy to get those. Jenna Kantor: Oh that's so good to hear. Cause I mean putting everything together from scratch is already enough on its own. So that's great that that ended up being a smooth journey for you both. Now, what was your biggest obstacle, because I'm sure you've had many obstacles as you were putting this together, but what would you say is your biggest obstacle that you encountered and how did you overcome it? Maria Muto: 13:30 I'm really glad that you were asking that question now. Just because the last thing that you said kind of segways into my response in that starting from scratch is pretty difficult. So as students, you know, we're trying to think of who do we know, what do we know, where do you know we want to go and how do we want to do this ourselves? You know, as very ambitious PT students, we really tried to, you know, Gung Ho and take sail what this in which we did. But that wasn't really easy to do because of who we are as just students. And with the experience that we had at that given time, which, you know, was a decent amount of experience and, you know, led us to having this project follow through. But I think, you know, we just had to kind of keep on rolling, keep on thinking, make sure that, you know, we had all of our grounds covered. You know, just having the trust in the people that we selected and which we did. So I think that that was hard to kind of try to really piece everything together. But you know, we just kept on powering through. We just really wanted to make this work and we're so thankful that it did. Jenna Kantor: 14:52 We're up to the last question and this is just getting words of wisdom from each of you. What words of wisdom do you have for someone who's listening to this and goes, that's it. I want to plan a service trip now. What do you have to say to that person? Sneha Gazi: 15:20 So there are many, many things that go into planning this trip. I'm going to tell you that it ends up being sort of a part time job, especially towards when you get to the end of the race, when you're putting everything together. It took over a year and a half of preparation. We had many obstacles along the way like Maria had mentioned, but even through that, it did take quite a bit of time to put everything together. So I would say number one is make sure that you have a contact in the location that you want to do your service in A to make sure that this place is a safe learning environment and a safe working environment. And secondly, to make sure that logistically that you have a point person to get information from, to coordinate the patient's there to coordinate the simple things. Sneha Gazi: 16:10 And we had a wonderful lady Alaina, who did all of this for us while we were there and Kudos to her because if it wasn't for her, we wouldn't have been able to do this trip. But she was a local who volunteered her time to put together plints, towels, pillows, sheets, dividers, coordinate the schedule of the patients, get together the schools when we did our educational workshops to coordinate the location, the projector, everything. So I would definitely say you need somebody like that in this location. If you are not yourself able to travel back and forth throughout the year or however long it takes for you to plan it, to get there, you need to have somebody there. And the second thing is to make sure that you know how the money is going to play out from the beginning. Sneha Gazi: 16:56 So making sure you're very transparent with how much is food, how much is transportation, and how much is living costs, how much your supplies, and then devise a plan of how you're going to make this feasible. Like Maria and I had planned before we even got the location, we already started fundraising because we knew this was going to be expensive. So we put together the fundraisers, you know, three months before we even nailed the location down. So I would definitely say, make sure that you have a plan financially to get everything together and make sure that the place is a good place to be in and you will do wonders if you just have those two solid. Maria Muto: 17:51 So everything that they have said totally feel the exact same way. Wonderful, wonderful advice. But I think when you go abroad into another country, be very accepting and welcoming to the new culture that you're in. Embrace where you are, feel it, feed it, do everything that you can. Because at least from my experience, these people are so welcoming and just want to know about you as a person. They're very intrigued that you're American and there's so many other ways that you communicate with people other than just words. But I would advise for you to study up on the language in which that you're going to be treating in because it makes it a little bit easier. But there are other ways to, you know, understand people if you have that language barrier, but for sure, really tried to, you know, embrace the culture that you're in. And I think that would really make the experience even more fulfilling. Jenna Kantor: 18:36 That's great. I actually just thought of something, I'm wondering what Spanish phrase did you use the most there? Maria Muto: 18:46 Because I was speaking so broken Spanish, like I was actually speaking more Italian. I think I would say like siéntese, por favor. Hola. Or Ciao. Aquí. Dolor. Sneha Gazi: 19:05 I think I used boca arriba the most, which is face up. It literally means upwards. Oh yeah. But it means supine. And I had to say, I had to tell people, can you lay flat or lay on your back? And it was very difficult for people to understand this. So one of my patients who spoke broken English was like Boca arriba. Jenna Kantor: For anyone who was interested in starting a service trip. Please reach out to Sneha and Maria. They are huge Go getters. I really, really appreciate you guys coming on here. This is extremely valuable. Thank you so much. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Evert Verhagen on the show to discuss qualitative research and how the outcomes can be useful for clinical sports practice. Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS). In this episode, we discuss: -The difference between qualitative and quantitative research -How qualitative research influences sports medicine and injury prevention research and clinical practice -How to design a qualitative research study and control for biases -What is in store for the future of qualitative research in sports medicine -And so much more! Resources: Evert Verhagen Twitter Email: e.verhagen@amsterdamumc.nl Sports Lifestyle and Health Research Website IOC World Conference Prevention of Injury and Illness in Sport For more information on Evert: Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS). His research revolves around the prevention of sports and physical activity related injuries; including monitoring, cost-effectiveness and implementation issues. He supervises several (inter-)national PhDs and post-docs on these topics, and has (co-)authored over 200 peer-reviewed publications around these topics. Read the full transcript below: Karen Litzy: 00:00 Hi Evert. Welcome to the podcast. I'm so happy to have you on. Evert Verhagen: 00:04 Yeah, thank you very much. I'm really happy to be here as well. Karen Litzy: 00:08 All right, so today we're going to be talking about qualitative research in mainly sports medicine. But before we even start, can you give the listeners the definitions and perhaps the difference between quantitative research and qualitative research? Evert Verhagen: 00:30 Sure. I think that is a really valid question to start with. I believe most people are familiar with quantitative research. It is what we do like in the word already, quantification of a problem by counting, by having numerical data or data that we can transform into statistics. And then we can quantify attitudes, opinions, define variables. And we can generalize that across the whole group of our population. So we can generate averages in given populations and we can compare averages between populations. Qualitative research on the other hand, doesn't go by numbers, it's more exploratory. And we try to get an understanding of reasons, opinions, motivations and instead of quantifying a problem. So, giving a number to it, giving a magnitude to it, we get insight into the problem and it helps us to develop new ideas and our policies. And that can be a precursor to do a bigger quantitative study in which you have an idea of where to look and where you would like to quantify and get some more thought. But you can also do it afterwards, where you have a quantifiable outcome and you want to understand better what that outcome actually means and what it means to your population and in the population. I think that is in essence the big difference. Karen Litzy: 02:06 Yeah. Thank you for that. And, now you have had over 200 peer reviewed articles in different journals and you yourself had done a lot of quantitative research. So why the shift now for you into more qualitative research? Evert Verhagen: 02:22 Oh, it's not the first time I get asked that question. I'm a trained quantitative research. I'm an epidemiologist. I'm a human movement scientist. So I kind of live and swear by numbers. If I can't measure it for me, it shouldn't count that many people think. Now, I learned that through the years, if you can count it, it still doesn't mean anything. It still needs to have a meaning. So a difference between two groups in a trial, it just gives you the difference between the groups in a trial. It doesn't tell you how the individuals within that trial actually experienced it. The same with trying to get your head around an injury problems so you can capture an injury problem in incidences in prevalences, in severity, in numbers of days, lost availability during games. But what does it actually mean for the individual athlete? Evert Verhagen: 03:23 What does it mean for the patient? And the same maybe with treatment outcomes, rehabilitation outcomes. It's nice to know that, you know, you reach a certain degree of range of motion after rehabilitation or reduced level of pain on a visual analog scale. But what is actually the opinion of, of that patient, does that actually align with what you can measure? And if not, where does the different come from? And if you do, it kind of shows you that you're in the right direction. And over the years I learned that quantitative research can only help so much in solving the bigger issues we have where it concerns, prevention targets for presumed prevention. It stops at your number and then you need to do something with it. And the only way to do something with this, it's to understand where it comes from and also to understand what it means. That's where my interest kind of started. Karen Litzy: 04:23 Yeah. And that makes a lot of sense coming from myself from the clinical side of things. And I'll use the VAS scale when you're looking at pain as let's say one of those quantitative points. And I think this is a good example. Looking at the VAS scale, a four or five for me is a very different experience for someone else with the four or five out of 10 pain. Right? And so just looking at that number from quantitative research saying, well, this proves that this treatment, whatever it may be reduced pain by, I don't know, four points on the vas scale. Well, okay, that's great, but then what does that mean for the individual person and that you're just moving it because qualitative someone's opinion. This is an opinion of what my pain is and then we take it to quantitative data, but then it doesn't say how that patient is living with that pain. The pain has decreased, but I still can't walk to the store. I still can't play with my kids. So what does it mean? Evert Verhagen: 05:27 Exactly. I think that what you just said that is purely qualitative talks about what does it mean, what impact does it have as one little, one little thing I would like to specify is that a VAS scale in essence, which is a subjective outcome measure, is still a quantifiable objective measure. It's not qualitative and that is something I run into every now and then in a discussion where people seem to think that a subjective outcome on a scale or a subjective outcome measure in a survey is qualitative. It is not you have to look behind those measures. So why does someone report a reduction from eight to four on a visual analog scale? That is what we're looking at and you're completely right from eight to four in someone who has a seating job for instance. Mostly behind the computer means something completely different than someone who moves from eight to four who has a really active job and we have four is still really limiting for them. Evert Verhagen: 06:35 We may go to athletes, for instance, a pain of four today in preseason maybe or at the end of season when there's no big competitions around, I'm okay, I can skip the training, but a pain of four during competition when has a big game coming up? You probably will suck it up. And even though the pain level is the same, your experience and the burden it gives you is completely different. And those are the things we do work capturing in numbers. And those are the things that make the big difference for the individuals we do our research pool and our target population. Karen Litzy: 07:14 Yeah. And that actually leads nicely into the next thing I wanted to talk about and that's, how does qualitative research manifest itself in sports medicine or injury prevention? Evert Verhagen: 07:25 From the research perspective you mean? Or the practical perspective? Karen Litzy: 07:28 Let's take research perspective first. Evert Verhagen: 07:31 On a research perspective, I think it adds a new layer of information to what we already know. And you can think that in multiple ways. It gives you direction to where you would like to go with future research because you understand better your population, you understand their needs, their wishes, their opinions, their fears. You understand, their foci and based on that you can have more targeted either interventions or more targeted outcome measures to chart a problem or to monitor a problem. So it will guide quantitative research in that sense, which I would say is also really interesting in regards to machine learning and the complexity theories that are out there. We can't measure everything but if we get a sense already based on the public, the population where we should focus on it will gives direction to those novel technologies where we do data mining and all that. Evert Verhagen: 08:38 Also on the other hand, if we do interventions or if we do objective measures of what we try to assess in research, we need to find a way to translate that to the population. Research of course it is about putting it in a nice article and publish it in a high impact journal if at all possible. But in the end, and I'm speaking for myself here, I do research because I want to help people, I do research because I have a general question that I feel is valid to ask in relation to an issue or problem I see in athletes. So I want that number to come for athletes as well. And in order to do so, I need to talk to them and get their opinions about how they feel about this number, how they feel they can use it, how they feel they may not be able to use it. Evert Verhagen: 09:38 And based on that I can develop my next steps and I understand better what I did right, what I did wrong. I understand better what it means actually because I have my own opinion. And that's why I think qualitative and quantitative are synergetic to each other. Let me give you a clear example, which may be a bridge also to more the practical side of it. Maybe that's injury definition. If I ask athletes or students and fellow researchers how they would define an injury. Usually they come with the technical definitions. We also have in our manuscripts, like it is tissue damage. It leads to pain. That pain may lead to a diminished performance, maybe a limited availability, which is all fine. And if you ask athletes like, when are you injured? The elite athletes will say, well, pain is actually part of the game. Evert Verhagen: 10:34 I always have pain. I'm used to that and I know how to deal with that. And I will not think this pain is a problem unless my performance is limited, which is already a little bit of a different injury definition. So the problems we see and we have in terms of pain and availability may not even be the problems they perceive to be problems. So we solving maybe something they don't even see to be an issue. Now if you translate the same thing to maybe recreational athletes or novus athletes, people who sit on the couch and say, okay, let's be a bit more active. They're not used to pain, they're not used to how their body reacts to physical activity. So we think they have more injuries, but maybe their perception of injuries is simply different from the perception of injuries we see in most of the papers we read. And I think there's a clear clinical message there is that, perspective, context, experience of the patients you have in front of you determines their perception of the issue they have. But it also determines for you as a clinician what you need to do and how you need to approach that. Because the numbers you see in the quantifiable manuscript that's all based on averages and not on that one single person in front you. And this is where qualitative research can help a lot to understand that. Karen Litzy: 11:59 Yeah, and that makes a lot of sense to me. And as a clinician, I think sometimes we can get caught up in the quantitative data and those numbers and lose sight of the person in front of us. Meaning sometimes we may say, and I see this on social media threads and things like that, which I'm sure you've seen as well. Well this is the study and this is what the study says. This is what you should be doing with your patient. Yeah. Well, there are a lot of nuances to that because like you said, you're talking about averages and not the person in front of you. And, I love the example you gave. What is an injury and what does that mean to different stakeholders within, let's say, injury prevention realm if we will. So the athlete versus the average person versus the clinician? Karen Litzy: 12:56 Well we have three different definitions of what an injury is. So how can we fill those gaps to be a little bit closer? I mean I can say, let's say I'm the average person who's working out. I know I am not anywhere near a professional athlete, but the problem is, and you alluded to it a little bit, is that when people have an injury, they read about an athlete that has an injury and they say, well, this athlete had the injury and they were back at their sport in four weeks. How come I have to wait four months? And I think that's a big disconnect. And maybe that's where getting some better qualitative research and around these definitions can actually help with the perception of what an injury is across the board. Evert Verhagen: 13:49 Yeah, it's sort of framing but it's framing from both sides. It's framing for the patient so you can even better, why it takes for them four months instead of four weeks. Right. And usually in all honesty, by the time a professional athlete is already back training again, a recreational athlete maybe hasn't even seen a therapist. How then can you take a protocol or a guideline based on evidence that shows that on average after four to six weeks you need to be at a certain stage in the rehabilitation phase where that one single person in front of you as already been looking three weeks for a proper therapist to treat the injury and then they come in and they've seen this evidence like you said, but then you would like to know a bit better where they come from, what their context is and what they need to do, which is not shown in evidence is also not what the patient thinks about. Evert Verhagen: 14:55 So having some knowledge about such perceptions and where they come from and what they mean I think can really help to support you in your clinical practice to use the evidence to a better extent. You know, in some of the issues we have in objective quantifiable research also apply here. I would say there is, for instance the discussion started a couple of years ago about we should screen or not to predicting injury actually to see if someone's at an increased risk. And one of the main arguments in there is, well basically what we're doing is we create two normal distributions and normal distribution is the Garcian curve where we think most of the population is in the middle and we have a few outliers and that is nicely distributed. So we have a normal population with our risk factor and a normal population without a risk factor. And if you know, the averages don't overlap too much, then Oh, we have a significant difference. But that negates the outliers on the top side and on the bottom side of both. And then you talk about an average, but there's even an equal amount of people who are in that overlapping phase that we still give the average treatment. And if we understand better why these people are on the outskirts and why are they in a position, we can actually make that evidence for them work. Because we can model it to their specific situation. Karen Litzy: 16:31 Got It. So that qualitative research, like you said, can help to guide quantitative research, which can then help to guide actual treatment practices for the average clinician. In a very simplified, overly simplified nutshell. So yeah, very, very, very oversimplified of nutshell there. Can you give us an example of what a qualitative research project may look like? Can you give an example of what that looks like in it's sort of set up phase and then throughout the project. Evert Verhagen: 17:19 Okay. Well in essence, it looks a little bit simpler because for quantitative researching in big groups of people, because of those averages for qualitative research, you need smaller groups. One issue though is in case of how our specific needs, we would like to have groups that are quite specific. So if we have a group of elite athletes combined to recreational athletes and we want know perceptions about injury, like we were already talking about. That doesn't work because we get too many deviating perceptions in there. So you need to, you need to frame your research question correctly there. And the essence here is that you start doing your interviews until you reached so called saturation. So you do interviews, you get answers, and your next interview will give you a deeper understanding. You get different answers, you get more answers, you can ask a bit further. Evert Verhagen: 18:18 But at a certain point of time, you start hearing the same thing. So you don't add any new information. That's when you're done. And now, depending on your group or your specific focus, that can happen between eight to 15 interviews. So in that sense, it sounds really easy. Then what do you need to do is you need to type those interviews out. So you need to transcribe them. And then the analysis start. And for most people, this is boring, but this is actually where for qualitative researchers me as I'm a changed person. I like that too, because you start to go, so you start to read through the interviews and you start to look for clues of what people say and what it might mean. Now as we need statistics, there are several philosophies you can follow. The different philosophies make a big difference. The same as in qualitative research, but that on the side. Karen Litzy: 19:21 So you go through this series of interview questions and you keep narrowing those questions down until you reach a saturation point and then you can start the analysis. And so then my next question was what set of statistics do you use to analyze qualitative research? And this might be a stupid question. Evert Verhagen: 19:44 No, no, no, no, no. We don't use statistics. And that's not a stupid question because, you know, there's very few ways in qualitative research and arguably the most simple way to go is this so-called thematic analysis. So you do your analysis and you start to find themes in the interviews by coding. So you have overarching themes and within these overarching themes, you find sub themes, and you just report those themes. And that is really interesting because, for instance, if you're looking for barriers towards implementation of an injury prevention measure, you can say, okay, these are named barriers and these barriers can be categorized as time as disinterest or as non belief in the effectiveness. And then within those main categories you can have sub categories of where that comes from. That's I would say one of the simplest versions of how we can use qualitative research. Evert Verhagen: 20:46 Or you can also make it more intricate. You can build models, you can validate models. And for each of those research questions you have, you require a little bit of a different approach thematic analysis is easy. You just sit down, you have just semi structured interview, you ask people, about opinion, about a certain topic, they give you an answer and then basically you say, okay, can you give me an example of that? Can you explain that a little bit further than what you already know, the topics you're interested in. So you want to talk about barriers or facilitators so you can focus on that. You can also go open minded where you say, okay, I just want to know how elite athletes perceive an injury. So you need a different kind of approach of first you need, you would like to make them feel comfortable that they can talk about it, that it's a safe environment. Evert Verhagen: 21:42 You would like to ask them about their previous injuries. So you get a sense of which of those had a high impact. Then you can dive a little bit deeper into, so what did it mean for you? How did you feel, what were the consequences of it personally, how did you recover? Did it take longer or shorter than expected? So you kind of, you kind of follow a story and that story unfolds itself. And if you do it really open, then you can do one interview. It gives you a direction and your thoughts and based on that direction in your thoughts, you look for your next participant and you continue where you were with your previous and then a bigger story unfolds. And that takes a bit more time because you do it by interview. But it's a lot more deep and rich information. But it all starts with the research question I would say. And it's different types of research questions that we have in quantitative research. It's not to compare this to compare that, it's not how big is this problem, but it's really diving into beliefs. It's diving into opinion, diving into reasons. And that can be because of something you did, but that can also be to understand better what's going on in the minds of people. Karen Litzy: 23:17 As the interviewer within these studies, how do you control for that interviewers biases? So you know, the leading question. So let's say you're doing this long form where you interview someone, you get really in depth, they give you their answers, you go onto the next person. How do you not then guide that next person to kind of be like what the first person said and then the third person, like the first and second person. So how do you control for like leading as an interviewer you can lead the direction of that interview really in any way you want. Evert Verhagen: 23:52 Exactly. But isn't that the same in quantitative research? The way you're framing the question, you can already guide people towards answering questions. A really good example I encountered like last year in a project where the premise was that, there was a funding scheme and the premise was that projects that were driven by questions from practice would have a preference. So they asked in a particular sport and a particular association, two older members. Do you think injury prevention is important? That was the first question in a survey. Of course, everybody says yes. Then the second question was if you think it is important, do you feel that an app on an iPhone would be helpful? Yes or no? Of course. Many people say yes. So their conclusion was okay, 80% wants injury prevention and 80% want that in an app on an iPhone. Evert Verhagen: 24:51 So we should have a lot of money to develop such an app was well a disaster. Because they finally developed it and they kind of scoped already with the public what they had of an idea. Instead of really have something driven by the audience. And so I think by in that sense, it's not only applicable to qualitative research. Subjectivity maybe is because you as an interview, have an understanding most of the time on what the topic you're interested in. And that's why in qualitative research. You also see a little paragraph on reflection where the interviewer or the authors explain what their background is, where they come from. And of course it's really hard to take that out of the interviews. It's practice and it takes a lot of self control. You can tell you that and it's not always possible. So that's why you need to be frank upfront that you are a physical therapist and that you ask questions about physical therapy guidance or physical therapy conduct. Evert Verhagen: 25:58 And of course you have an opinion about them. And also of course it is the connection between interview or an interviewee that is important. If you interview someone who thinks you are a prick, you will not get much, much out of it. But if you have a good connection with someone and you really are empathetic, then they will open up. But that requires experience I would say. We do have some tricks in the analysis to reduce that. Two main tricks that may be of interest to say is we call that triangulation where you're not only interview patients but you also interview other stakeholders on similar topics and tried to find connections and similarities between answers. Because if three people from different perspectives say the same thing, that must be something that really counts, right? So it's not one thing and it's not just one person interpreting. That's one. And the other one is you can do is multiple coders. So you have one interviewer and you need to code the interviews. But you can do that with two people separately. Much like we do with systematic reviews where you check for the quality of papers. We have two independent reviews and then we compare notes. We can do the same here too. So you take a bit of that subjectivity out and that preoccupation out. Karen Litzy: 27:21 Yeah. Great. Thank you for that. And now where do you see the future of qualitative research moving? Evert Verhagen: 27:29 Hmm, that's an interesting one. For how a specific field I would say it as a lot of ground we have to cover. We're getting there. There's a lot of interest in it at the moment. There is more and more papers being published at the moment. One of the, not issues, but one of the fears I have is that most of these papers still get published in not the mainstream sports medicine literature that is being read by the clinicians even though the messages are supposed to be targeted to the clinicians or the therapists. So we need to find ways to grasp that clinical message in such a way that it doesn't become this lengthy qualitative research paper and it will become a succinct, easy to read paper with a clinical message though with a constructive, strong methodology. We've been battling with that for a couple of years now I would say. And, I just got the word this morning from one of our PhDs that she got a full qualitative study accepted in British journal of sports medicine. That's nice because that was a journal that said one and a half, two years ago. We're not interested in qualitative research. I think that whole movement is gaining ground and we're finding ways to communicate our messages that it really is helpful for clinicians and it's readable by those journals, which I think are a few big steps we have taken. Karen Litzy: 29:13 Yeah, I would say they're very huge steps because if the research is there but no one's reading it and no one's talking about it, where is it going? It doesn't make the research any less meaningful, but it doesn't make it applicable if no one's reading it cause no one can apply it to their populations. Evert Verhagen: 29:33 Hmm. But you know, the true theory is it's still quite difficult because if you want to write a manuscript that has the full qualitative methods and traditional version of the outcomes, in my opinion and probably people will be mad when I say that, it's kind of dry to read. It's not really interesting to read. So if you juice that a little bit so it becomes interesting and more concise and easy to digest for the more clinical oriented reader you lose a lot of information that for qualitative reader is required to assess the validity and the reliability of what you did. So we're kind of in the middle. We need to have suppression of information in there, in such a paper for the knowing reader that we did right. But it also need to be dumbed down to such an extent that for the unknowing reader, it's understandable and they see the method and understand the clinical meaningfulness of the message. And that is still a bit finding the balance. And I think that is one of the main challenges to do. Karen Litzy: 30:51 I will say that as the clinician, I very much appreciate your trying to kind of find that sweet spot between the dryness of what may be some people would think qualitative research write up would be to this applicable like you said, more juiced up version that a clinician can take and digest very easily. I think there is a space for that for sure. And I look forward to I guess more progress on that end. So it sounds like you're getting there but that there is maybe more work to be done, but I am sure there's always more work to be done, but you know, I think if you can find a way to blend those and make it digestible and allow clinicians to take this information very readily to their patient populations, then in the end, like you said, you got into research to help people. Clinicians are there to help people. So in the end it's hopefully this blending of research and clinical care that's there for one reason and to benefit the person in front of us. Evert Verhagen: 32:14 I believe so, yeah. I believe we can achieve that. I don't think we are there yet still finding a direction. But in all honesty, if you look at most journals 10, 15 years ago, even quantitative research, it was sort of dry, straightforward academic language as well. And we have made big grounds there and I think we can draw on those experiences and that expertise that has been created there. And our field of sports medicine has been in the forefront, I would say. There are some journals who really, really do that really well. And it has helped us to get this topic on the attention. One other sign that is gaining the attention I feel it deserves is for the last two additions we tried to get it on the program of the IOC prevention conference and this year for the first time we got a dedicated symposium on qualitative research in sports injury prevention on the program. So that already shows that in the wealth of proposals they can choose from ours stood out and the topic is found interesting at such a platform. So it's now up for us to grab this opportunity and make it count. Karen Litzy: 33:41 Yes, it's up to you to deliver on in that focus symposium. And just so people listening we will have a link to this, but that's the IOC, the International Olympic Committees Injury Prevention Conference, which is march of 2020 in Monaco. I don't have the exact dates, but I know it's march. I think it's like the 14th and around there. Maybe. I'm not a hundred percent sure. I think it's around there. But we'll have a link to it in the show notes at podcast.Healthywealthysmart.com if people want to check that out as well. So now if you could leave the listeners with let's say a highlight of the talk or a highlight in your opinion of the importance of qualitative research, what would that be? Evert Verhagen: 34:33 My highlight would be that qualitative research gives deeper understanding and deeper meaning to the quantitative evidence we have to use in daily practice. Karen Litzy: 34:47 Perfect. And one more question. I probably should have told you this ahead of time, but I forgot. So I'm going to surprise you with it, but it's the question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself, let's say straight out of your graduate program, let's do that. So maybe even before PhDs happened. So what advice would you give to yourself? Evert Verhagen: 35:22 I would give the advice to just follow your heart and follow wherever your thoughts lead you, don't plan ahead. Karen Litzy: 35:36 That is great advice and so difficult to do. I'm a planner. That is so hard to do, but I agree it's great advice. Evert Verhagen: 35:46 I plan next week but I don't plan two years ahead. So it hasn't disappointed me. Karen Litzy: 35:53 It's worked well. That's excellent. Well thank you so much for coming on. Where can people find you if they have extra questions? Evert Verhagen: 36:05 I'm sure you will share my email address. Karen Litzy: 36:08 I can if you want, or social media. Evert Verhagen: 36:15 Twitter account, just drop me a line there or private message. Karen Litzy: 36:19 Perfect. Evert Verhagen: 36:20 I have a website we should probably post as well. And most of the work we do also in qualitative research will be posted there once it's published. Karen Litzy: 36:32 Perfect. Perfect. So we will have all of those links for all the listeners. So thank you so much for coming on and sharing all this great information with us. I really appreciate it. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! 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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Brenda Walding on the show to discuss Whole-Hearted Living. Dr. Brenda Walding is a Women's Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world. In this episode, we discuss: -Brenda's incredible story of illness and recovery -The 9 Essentials to Whole-Hearted Healing -The importance of the biopsychosocial model in healthcare -And so much more! Resources: Sick of Being Sick: The Woman's Holistic Guide to Conquering Chronic Illness Brenda Walding Website and a Free Gift: Dr. Walding is offering a complimentary 45-minute consult for any woman dealing with burnout or health challenges that has a deep desire to THRIVE. Schedule your consult and see how she may be able to support you in creating a life you love. Brenda Walding Instagram Brenda Walding Facebook Email: risetoradiance@gmail.com Heart Math Website Women in Physical Therapy Summit 2019 Outcomes Summit: use the discount code LITZY For more information on Brenda: Dr. Brenda Walding is a Women's Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world. She currently resides outside of Austin, Texas on the beautiful Lake Travis with her husband and dog. Brenda loves spending time in nature, connecting with her family and friends, dancing, facilitating women's circles, and learning about holistic wellness. Read the full transcript below: Karen Litzy: 00:01 Hey Brenda, welcome to the podcast. I'm happy to have you on. Brenda Walding: 00:06 Oh, thank you so much for having me, Karen. I'm excited to be here today. Karen Litzy: 00:11 And like I said in the intro you are a recently published author of the book sick of being sick, the women's holistic guide to conquering chronic illness. So without giving away the entire book, can you give the listeners a little bit more about your background and your story of illness and where you are and how that led you to where you are today? Brenda Walding: 00:36 Yeah, sure. I'd love to. You know, it's really, I'll give you do my best to give you the cliff notes. It's spans the time period of over a decade. So really I grew up seemingly really healthy and vibrant. I was a collegiate athlete. I played soccer at TCU in Fort Worth. And then I went on to physical therapy school to get my doctorate in physical therapy. And then after that moved to Austin, Texas with my now husband. And during that time we passed our licensure exam, got new jobs, moved to a new city, got engaged, got married, and then after this whirlwind of all these major life events, my health started to rapidly decline. And you know, I was in a busy physical therapy practice and seeing a lot of patients, and you know, all of a sudden I'm just getting weaker and more tired and getting sick more frequently. Brenda Walding: 01:35 And then it got to where I could hardly even get up and down the stairs. I was experiencing chronic fatigue and experiencing, I broke out into these rashes that literally covered my entire body for two and a half years. No one could really figure out what was going on and I just kept getting more and more sick and I was seeing specialists all over trying to figure out what was wrong with me at this time I didn't really know much about natural health nutrition, holistic wellness. I was just kind of in the conventional medical model, taking the steroids and the pills and you know, my blood work had come back pretty normal, so they couldn't really figure out what was wrong. But literally I had oozy itchy rashes, like covering my entire body where I had to pack my body full of ice in the evening to fall asleep and eventually developed in a systemic infection that led me to going on disability from my job as a physical therapist. Brenda Walding: 02:40 And granted, this is, you know, I am in my late twenties, not even 30 yet, so very young. And you know, I got to the point where I thought like doctors kept giving me antibiotics and they were worried that the infection would get into my bloodstream and I thought I was dying. I was really, really at that point of like, okay, I think this is it. And by the grace of God, I had, I took four rounds of antibiotics and a month and a half, kept being sectioned, kept coming back, had pus all in my mouth and throat, couldn't swallow, couldn't hardly eat. So this was a pretty intense experience. And I found this article I was looking, researching and found this article called natural solutions to drug resistant infections. And it caught my eye and I thought maybe I have a drug resistant infection. And it talked about wild Mediterranean, Oregano oil and how it was, you know, healing people with malaria and different, you know, chronic. Brenda Walding: 03:45 Very, very severe illnesses. So I thought I would try it. It's like $20 and I know bought it online and in, within a few days the infection went away. And for the first time in years I got some relief from the pain and itching on my skin. And so that really was the portal to opening me up to natural healing. And I thought, what is it? What do I not know? What else do I not know, you know, about this? And so that really became this entry point into studying natural healing and nutrition. And I started seeing more alternative and holistic type practitioners. And that over time started to gradually heal. I started to get some answers. I was full of toxins. Had lots of infections and a poor ability to really clear toxins from my system. So I started to get more answers, started to change my diet, slow down my life a little bit, you know, as that type a over achieving, you know, hardcore athlete and academic. Brenda Walding: 04:54 And I realized that also was part of the puzzle here ever learning to slow down and then, you know, so for eight years I really focused on healing my body. Like it was a full time job. I was able to go back to physical therapy after a while and start working again. But it really opened up my passion into natural healing and started a nutrition lifestyle company with my husband and helping people heal their bodies through nutrition and lifestyle changes. And you know, it was a slow and gradual process and I started, you know, getting better gradually and then almost to the point where I felt okay, I think I'm almost ready to, you know, start a family. I had a few lingering symptoms but I was like, you know, I'm doing pretty well. Got my strength back. This is eight years later. And then I was diagnosed with breast cancer. Brenda Walding: 05:51 And so this was a few years ago. So this was like, what am I missing? What am I not getting? Cause I was really, you know, dialed in my diet lifestyle. I started meditating. I was really, you know, spent hundreds of thousands of dollars on healers and treatments, natural remedies. You couldn't find somebody more committed to their healing. And it was like a full time job. And I wasn't really living, I was just trying to get better and feel better. And then the cancer diagnosis came and so I had to step back and go, what am I not getting? And I really, you know, I share this in my book. I had to step back and I was in, this is actually, I found the mass in my breasts right before this, we had planned this epic trip to Italy where we were going to start our family. Brenda Walding: 06:50 So it was this tragic, you know, oh my gosh, you know, why is this happening to me? And then, yeah. And so, you know, in the middle of the night at 3:00 AM I'm, you know, tears coming down my face going like, God, what do you want me to do? Because I knew that conventional chemotherapy and radiation was not going to be my path. I just didn't know what I was going to do. And you know, I heard this, I call it the divine whisper that said, if you're going to survive, you're going to have to learn to listen to your heart. And I just felt this immediate peace. And then I started to kind of panic because I thought, I don't know how to do that. I really don't know how. I don't know, like maybe like so many of the listeners and people and my clients that I work with, we're really stuck in our heads so much of the time. Brenda Walding: 07:42 And, you know, my immediate reaction to a challenge would be to research it, to try to figure it out, to strategize. And this was like, no, no, Brenda, it's time for you to really go within and listen and allow your heart to guide you. And, so I knew there was a level of emotional and spiritual, you know, healing too that needed to take place. And so I committed at that point to learn to listen to my heart. And over the next few years I had a pretty interesting and incredible journey through healing, holistically and wholeheartedly I should say from cancer. And it really became the catalyst for me to live in even more extraordinary life. Now I can say that I can access joy and just living a life of purpose and wholeheartedness that I'd never experienced before cancer. And so now that's really why I'm, you know, I kinda quit physical therapy and I'm focusing on helping women, especially women, wellness professionals, to truly heal and thrive so that they can give their gifts fully to the world. So that's kind of my story in a nutshell. Karen Litzy: 08:56 And are you now cancer free? Brenda Walding: 09:01 Yes. So I'm doing great. And yeah I'm doing awesome. And that's really where my focus is now, is helping women to heal and thrive and connect more fully to their hearts. Karen Litzy: 09:15 And quick question on, you know, so you're diagnosed with cancer, you did not do traditional cancer treatments. Brenda Walding: 09:24 I did sort of a mix. I didn't do traditional chemotherapy and radiation, but I did do surgery. So I went to a couple of different clinics in the United States that focus on holistic and alternative cancer treatments. And so I did. It was a pretty wild ride. So we spent our entire life savings and did this treatment but then I also had a mastectomy. Karen Litzy: 09:56 Okay. I guess sort of a combination. Yeah. Cause I just don't want to give the listeners the impression that you don't have to go through traditional medicine when you have a very serious diagnosis as cancer and that, you know, sometimes that is the route that one needs to take. And like you said, combining it with other holistic treatments I think is perfectly reasonable. But I don't want people to think that we're saying no shun traditional treatments. Brenda Walding: 10:27 Exactly. And you know, for me, this is what I do. What I do know to be true is that, you know, a decision made out of fear is never the highest best choice. So when I work with women, where you're working with people on their healing journey is like learning how to really access the heart to be able to tune in to that guidance to make decisions. So yes, you get the tests and get the information from doctors and healers and then trust your own heart to lead and guide you down that path. And that might look like conventional therapy for some people and that might look like alternative therapy for others. And that might look like a combination. So it's really, you know, definitely not shunning conventional medicine. But I knew for me in my heart that in this particular moment, you know, chemotherapy and radiation wasn't going to be my choice, that I was going to do a combination. And it really does differ for each person. And that's the thing is, you know, oftentimes we get scared into, you know, doing things because someone else tells us that we have to do this and we have to do that. And you know, my recommendation is to take the information but also really listen within and let your heart guide your journey as well. Karen Litzy: 11:42 Right. Yeah. Yeah. And I think in combination with your physicians and other practitioners that you're working with as well. Brenda Walding: 11:53 Yes. It's important to have an amazing support team. Karen Litzy: 11:54 Yeah, I just don't want people to think that we're saying, no, don't, don't listen to your doctors, because that would be really irresponsible. But yes, you have to, and it's like what we say within physical therapy as well as you as the practitioner and wanting to give the patient all the available information and guidance that you have and then along with the patient, you make those decisions on what is best. And I think that that is what every healthcare practitioner strives to do and strives to educate patients as best as they can. Give them the knowledge, give them the odds, give them pros and cons and then along with the patient and their support team and physicians and nurses and whoever else you have working with you kind of make that decision on what is best for you. And, those decisions aren't always easy. Brenda Walding: 13:01 No. Yeah. And Yeah, work with people, you know, work with people on your support team that you feel good about. That you feel supports you fully and is in alignment with your values. You know, I definitely navigating this path, you know, I definitely had practitioners that, you know, were trying to force me into something or I just had a gut feeling that didn't feel good. And so to really follow that and find, you know, doctors that are really on board with you and are listening to what you desires are. Because they exist, they exist for sure. Karen Litzy: 13:31 Yes, of course. Of course. Okay. So you've obviously gone through a lot, over a full decade plus it sounds like, of your life. So let's talk about kind of what you're doing now and how you're helping other, like you said, mainly women kind of navigate through a healing process. Brenda Walding: 14:00 Yeah. So like Karen mentioned earlier, that I felt really called to write a book. And so this book really is my love letter to all women and it's applicable to men as well. But you know, it's really all the information I wish I would have had 10 years ago to really truly to heal and to really thrive. Cause it's, I spent eight years really focusing on the physical aspect of healing. And I think that's where we're naturally inclined to as sort of these physical beings is that we're like, okay, nutrition, lifestyle, medication, you know, the various things, focusing on our physical body. But, what I've come to find out that, you know, really looking at ourself holistically, taking into account our mental and emotional and spiritual bodies, so to speak and healing on those levels are equally as important as the physical. Brenda Walding: 15:00 And then this sort of heart centered approach of really learning to get out of the head and allowing the heart to lead. So that is where I call it, like this whole hearted healing or this whole hearted living approach. And so that's what I share in my book along with my story. And, I did research on, you know, what, who are these men and women that were not only healing from catastrophic illness but that were really thriving and using that illness as an opportunity to create an even more extraordinary life and what did they all have in common? And so that's really how I, you know, navigated my journey. And also, you know, taking that research into consideration really came up with these nine wholehearted healing essentials. And I share that in my book. And that's really sort of the framework I use when I work one on one coaching with women. Brenda Walding: 15:55 And then I also do, you know, create a curated experiences, a women's circles and workshops and things to help women to have an experience of some of these things. So that's kind of what I'm up to now. Karen Litzy: And can you share with us what your wholehearted healing 9 essentials are? Brenda Walding: Yeah, I'd love to. So the first one is taking responsibility for your health and your life. And that really, it just, it kinda comes down to so many of us, we kind of rely on other people, maybe it's even relying on a doctor or relying on, you know, other people to tell us what to do or to have authority over our life and our health. And this really is just taking your life and your health in your own hands, stepping away from that victim mentality and really taking ownership of everything that's ever happened in your life and taking responsibility for you right now so that you can be in the driver's seat of your life and what happens moving forward. Brenda Walding: 17:06 And so the number two is creating a vision. And this is really, I have a mentor that I said, it's better to be pulled by your vision than pushed by your problems. And so there's a lot of research that has come out in the realm of quantum physics and the power of imagination of using our mind and elevated emotional states to actually change to affect us on the level of our DNA. And so I really got fascinated with the work of, you know, like Dr Joe Dispenza and Greg Braden, and really tapping and honing in the power of imagination and vision when it comes to healing. So that is something I really work with, with people to do is like what is it that we want to create and when we tune into that and imagine and tap into that elevated emotional state, that really helps to begin to pull that event towards us, whether that's healing or creating more of what we want in our life. Brenda Walding: 18:12 And number three is thoughts and beliefs. So just learning to manage our mind and harness the power of our thinking mind to create healing and really looking at beliefs because our beliefs are our underlying beliefs can be something that is really in alignment with our vision and what we want to create. Or it can be subtly sabotaging if we don't really believe we're worthy of healing or we have beliefs that are contrary to what it is that we really want. So that's a piece I think often a lot of people overlook. And number three is feel your feelings. And so that is sort of tapping into that emotional part of healing, which I feel like there's a lot of energy that we deplete in waste because we are dealing with a low to moderate level of anxiety and stress a lot of the times. Brenda Walding: 19:12 And that has a really huge impact on our physiology. So there's that whole element, it can dive into that more. But that's number four. Number five is nutrition. So really looking at what we're putting into our bodies, the quality of food, but not just what we eat, but how well we're able to digest and absorb and assimilate that food. Number six is live to thrive. And so in this essential, I really dive into lifestyle factors. So this is where exercise and movement and connecting with nature and getting sunshine and play and you know, these different how we go about living our life on a day to day. And then the next one is connection and relationships. So really looking at the quality of our relationships and, you know, found that in our relationships. Brenda Walding: 20:17 That's where a lot of people can experience a lot of emotional drain. And we know that how our emotional state, you know, negative quote unquote depleting emotions affect our physiology. So really looking at the quality of our relationships and this piece around authentic connection. And I love this topic because this was actually a huge blind spot for me in my own life, is really learning what true connection really was, which is, you know, the ability to be, this sense of being, feeling connected energetically and being able to be seen, heard and valued and deriving strength and sustenance from the relationship. And, you know, there's so much research on the impact of chronic loneliness, you know, we're so disconnected. We're connected very much with technology, but there's so much loneliness. I think it was one study was talking about how chronic loneliness is equivalent to smoking, like several cigarettes a day. Brenda Walding: 21:25 And the impact that has over time on our body of not being connected with one another in a deep and meaningful way. So that is a really incredible piece to look at. And then we have self love and self care, so love yourself and that really can encompass a lot of different things and can be an even bigger conversation. But really I found underneath it all is really healing and thriving is about all about truly falling in love with who you are and loving your life. And how does one do that? And then finally trust and surrender. So I found that, you know, of all the people that I researched, they all spoke about elements of really having this higher power that they were trusting, trusting, you know, source God, trusting within themselves, you know, and surrendering the outcome really learning to trust and as a power bigger and greater than them to guide them on their path. And so that is the last one is learning to trust and surrender. Karen Litzy: 22:36 I mean, that's a lot. Brenda Walding: 22:38 Yeah! Karen Litzy: 22:40 That's a lot. But if you think about it and break those down, that's as human beings kind of what we need. So it seems like, oh my gosh, this is so daunting. This is so much work. This is going to be work. But if you take each one individually and break them down, I mean, it's pretty simple. It's what we all need to be happy and healthy and live our lives. So I get it. I'm on board. Brenda Walding: 23:04 Yeah, exactly. And you know, like I said, they intention really was to create this holistic healing living roadmap. So it's like these are, I wanted to like, I've got this, all of this information downloaded and experienced in my life over the decade and I got the little bits of information here. Oh, you need to learn about nutrition. Oh, okay, great. I will focus on that for many years. Oh, okay. I need to understand how my emotions impact my health. Okay. You know? And so I got these little, these, this information and different from different books or different teachers. Then I realized like, oh, really, it's really about it. All of these things. And they're all important to really living your best and most full life. And it takes all of those things to some capacity to really, really live and thrive. And it doesn't, you know, like you said, you know, you don't dive in and try to do them all at once, right, yeah, you focus on one thing and you began to implement that. Brenda Walding: 24:08 And that's why coaching is really amazing. It's like I had so many coaches and mentors and teachers that helped me begin to integrate all of these pieces. And so it's helpful too. Yes, my book is a good resource, but it's also helpful to have, you know, someone that can see your blind spots and can see, oh, hey, you know, let's dive into, you know, there's this emotional piece that you have held on to all these emotions from the past and that's taking up a lot of energy and negatively affecting your body. But I didn't really see that. And so let's work through that together. So there's a lot of things that can be helped when you have someone to help you move through some of these things together. Karen Litzy: 24:52 Sure. And how has your training as a physical therapist, how does that play into the role that you're doing now with coaching? Because I know there are a lot of physical therapists who might be looking for nonclinical roles or nontraditional roles. So how has your training helped prepare you for what you're doing now? Brenda Walding: 25:09 How has my physical therapy training help me in what I'm doing now? Well, I think, well, and you know, I actually had the really beautiful experience recently of going back and doing some physical therapy part time. And so I've been able to kind of go from both directions. See the difference, how my training up until this point with all of this work has made me and even different, physical therapists how I interact. So from that perspective, I can, and I think there's a lot of value for physical therapists and any healers or practitioners to interact and address the patient or the client from this holistic perspective. Knowing that coming in this person with chronic pain or this, you know, ailment has, there's many pieces. Generally speaking, generally speaking, especially if it's a chronic issue and that it's more than just the physical aspect, oftentimes that there's an emotional piece and that there is a mental piece perhaps. And so being able to relate to that person in their wholeness can help me be a better overall practitioner to be able to offer some insights or how to relate to that person and help them, you know, experience a greater outcome. Karen Litzy: 26:37 Yeah, absolutely. And you know, it's that shift from a strictly biomedical to a biopsychosocial framework of treatment, which we talk about all the time on this podcast. I'm sure people are sick and tired of me saying it, but that is the way things should be in healthcare. So I will keep saying it many, many times. Now before we finish up, is there anything that maybe we didn't touch on that you're like, oh wait, I really want the listeners to know that. Brenda Walding: 27:10 I think really a piece that I think is really helpful, especially for practitioners and you know, I don't know much if we'll have time to go into this, but this, I am a heart math certified coach and really we look a lot about energy management. And so we waste a lot of energy in the domain of emotions and repetitive negative and repetitive thoughts. And that affects our physical abilities and our physiology. And so really learning to manage our energy. And we do that through being able to get into a coherent state. So getting our heart, mind and emotion and energetic alignment through slowing down the breath and experiencing elevated emotional states like love and gratitude and can actually get the heart into a smooth coherent rhythm, which impacts the way that the rest of the body feels and how it can heal. And so I think if we learn some techniques, as practitioners to help manage energy we can improve outcomes for our patients and our clients. So this is sort of that combining of going beyond the physical and that heart math has some really incredible tools so that you can check them out heartmath.org I think it's a really great tool for a lot of practitioners. I just wanted to throw that out. Yeah. So I think that, yeah, that's helped me a lot in my own coaching on and with physical therapy. Karen Litzy: 28:48 Great. And we'll have all of that info at the show notes over at podcast.healthywealthysmart.com. So if people want to learn more about heartmap.org they can just go click on it and you're there. So thank you for sharing that. And now the one question I ask everyone is, knowing where you are now in your life and in your career, what advice would you give to yourself as a new Grad right out of PT school? Brenda Walding: 29:16 Right out of PT School? So I would definitely, I wish I would know now is really learning how to listen and lead from my heart. I feel like I got myself into a position where I was burned out running ragged, just trying to do the best I can as a new Grad. And I've missed a lot of the cues, you know, internally of Hey, slow down. These other aspects of your life are important to you. And you know, I think that was really the catalyst for me to start to get burnt out and sick. And so really to slow down and really listen to my heart is what I would tell myself. Karen Litzy: 29:42 Great Advice. And burnout is real. This year at the women in PT Summit in Portland, we have a whole panel on burnout. I'm really looking forward to listening to, cause I am not part of this panel. I'm not part of the creation of it. It was sort of pitched to us and I'm really excited to hear what the women on that panel have to say. Cause it's a thing and I think it's happening more and more with the newer grads because they're trying to work more and more. They've got student debt out the yes. What? Um, so I feel like it's a real thing, you know, and like you said, just to take a moment to slow down and focus on other parts of your life is, is something that that can help. So thank you for that. And now where can people find you if they have questions? Where can they get your book? Brenda Walding: 30:49 Yes. So you can find me. I'm in the process of creating, readjusting my website. So right now you can really connect with me by emailing me at risetoradiance@gmail.com. And then I'd also love if any of this resonated with you, if you're a woman that is dealing with burnout, exhaust exhaustion. I love working with wellness professionals. If you're interested in some of these heart math tools that I use, I'd love to hop on the phone and I'm happy to offer your listeners a complimentary 45 minute consult. Karen Litzy: 31:32 Oh, that's awesome. Brenda Walding: 31:34 Yeah. So if you'd like to take advantage of that and you can go to www.Brendawalding.com and that is my calendar link. And so you would just set up a time to chat with me. Okay. And I love hearing your stories and hearing where you're at and what you need most support with. So happy to do that. And then my book is coming out in hard copy at the end of this year, but you can find it on Amazon. Karen Litzy: 32:02 Perfect. And you'll give me all the links. I'll put all the links up on the podcast website under this episode so that way people can get to you, they can chat with you. And thank you so much for offering a session for everyone. That's so nice. Brenda Walding: 32:21 Yes. Awesome. I look forward to connecting with some of you. Karen Litzy: 32:24 Great. And, again, Brenda, thank you for coming on and sharing your really incredible story. And we are all very happy that you are today healthy and happy and moving forward. So thank you so much. Brenda Walding: 32:39 Oh, thank you, Karen. I enjoyed it. I enjoyed being here, so thank you for the opportunity. Karen Litzy: 32:44 And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

LIVE from the NEXT Conference in Chicago, Jenna Kantor guests hosts and interviews the teams from the Oxford Debate which covered the question: Is Social Media Hazardous? The Pro team consisted of Karen Litzy, Jimmy McKay and Jarod Hall. The con team consisted of Ben Fung, Jodi Pfeiffer and Rich Severin. In this episode, we discuss: -How each of the debaters prepared and crafted their arguments -Bias and how to research a question openly -The importance of respectful debate on controversial subjects -And so much more! Resources: Jimmy McKay Twitter Rich Severin Twitter Ben Fung Twitter Jarod Hall Twitter Karen Litzy Twitter Outcomes Summit: Use the discount code LITZY For more information on Jimmy: Dr. Jimmy McKay, PT, DPT is the Director of Communications for Fox Rehabilitation and the host of five podcasts in the category of Science & Medicine. (PT Pintcast, NPTE Studycast, FOXcast PT, FOXcast OT & FOXcast SLP.) He got his degree in Physical Therapy from the Marymount University DPT program and a degree in Journalism and Mass Communication from St. Bonaventure University. He was the Program Director & Afternoon Drive host on the 50,000 watt Rock Radio Station, 97.9X (WBSX-FM). He has presented at State and National Conferences. Hosted the Foundation for Physical Therapy research fundraising gala from 2017-2019 and was the captain of the victorious team in the Oxford Debate at the 2019 NEXT Conference. Favorite beer: Flying Dog – Raging Bitch For more information on Rich: Dr. Rich Severin, PT, DPT is a physical therapist and ABPTS certified cardiovascular and pulmonary specialist. He completed his cardiopulmonary residency at the William S Middleton VA Medical Center/University of Wisconsin-Madison which he then followed up with an orthopedic residency at the University of Illinois at Chicago (UIC). Currently he is working on a PhD in Rehab Science at UIC with a focus in cardiovascular physiology. In addition to research, teaching and clinical practice regarding patients with cardiopulmonary diseases, Dr. Severin has a strong interest in developing clinical practice tools for risk assessments for physical therapists in a variety of practice settings. He is an active member within the APTA and serves on the social media committee and Heart Failure Clinical Practice guideline development team for the cardiopulmonary section. For more information on Karen: Dr. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit. Through her work as a physical therapist she has helped thousands of people overcome painful conditions, recover from surgery and return to their lives with family and friends. She has been a featured speaker at national and international events including the International Olympic Committee Injury Prevention Conference in Monaco, the Sri Lanka Sports and Exercise Medicine Conference, and various American Physical Therapy Association conferences. For more information on Jodie: Jodi Pfeiffer, PTA, practices in Alaska, where she also serves on the Alaska Chapter Board of Directors. For more information on Jarod: Jarod Hall, PT, DPT, OCS, CSCS is a physical therapist in Fort Worth, TX. His clinical focus is orthopedics with an emphasis on therapeutic neuroscience education and purposeful implementation of foundational principles of progressive exercise in the management of both chronic pain and athletic injuries. For more information on Ben: Dr. Ben Fung , PT, DPT, MBA is a Physical Therapist turned Digital Media Producer & Keynote Speaker. While his professional focus is in marketing, branding, and strategic change, his passion is in mentoring & inspiring success through a mindset of growth & connectivity for the millennial age. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. Super excited to be talking here because I am at the NEXT Conference in 2019 in Chicago, Illinois. And there was an awesome debate an Oxford debate and I'm with almost all the team members. So that being said, I want to just interview you guys on your process, especially because everyone here is either extremely present on social media or uses social media. So it's funny that we had these two opposing teams really fighting different arguments here where everyone pretty much is on the same page that we all use social media. It's great for business. There's no denying. So as I ask my questions, would you guys say your name because people aren't going to necessarily, well maybe for some recognize your voice and also say what team you were on, whether it was team hazardous, which was correct me, Jimmy, which was the pro argument. The pro argument was saying that social media is hazardous and then the Con team was team Blues Brothers, which I've learned from Ben Fung it would have been the star wars theme except it had already been used in the past and they needed to be original. So that being said, I want to start off with #teamhazardous. What was your individual processes with finding your arguments since each of you are very present on social media? Jimmy McKay: 01:39 Jimmy McKay team #hazardous. I think first of all, this was a very difficult argument for our opponents because, well, first of all, we didn't get to pick which sides. A lot of people think that we've vied for the sides. We were literally just asked if we wanted to do the Oxford debate and then been given a side and given a team. So I want to make that very clear. I think they did a great job. I was keeping track of all the points that I would've hit if I were on that side, I thought that was the uphill battle. Because people, when they found out we were pro social media it was like, oh, you don't like social media. But if you read the prompts for a debate very closely, it's like, is it hazardous? Jimmy McKay: 02:18 Not is it good or bad? Right? So we agreed like all the things that the con side said, we agree with it's fantastic. It should be utilized. But just like PT why do we take the NPTE for example? Because if improperly used physical therapy could be hazardous. So that's why we take a test that makes sure that we're a safe practitioner of physical therapy. So, my thought process was I went on social media and wanted to grab all the kits, right? Like emojis and gifs and videos and Beyonce doing dances because that's what people resonate with. But then focus on the things where I think it falls short. Everything falls short, right? There's no Shangri-la and social media is no different. So just focus on the issues that stood out, right. Jimmy McKay: 03:01 So all I had to do is can I just ask, what do you love about social media? Like what irks you, you know, what are things that you wish were better? And as you heard from tonight, I think in past Oxford debates, sometimes it was hard to get four or five speakers to ask questions. And I think they had to cut them off because everybody, it resonates with everybody and it's super personal, right? I mean, what was the stat? How many people, I mean minutes that people spend a day, 140, 116 minutes a day Jimmy McKay: 03:29 It's probably hard, so it's super personal for people but I think again, the argument from the other side was just is really hard. I mean, I think you guys were put in a corner. But here's the funny part. Like you defended it, I think you defended that corner pretty well. So that was my process. Karen Litzy: 03:50 Hi, Karen. Let's see, #teamhazardous and yes, this is also my podcast, so that's, yeah. Karen Litzy: 04:00 So my process was pretty easy because I had just spoken about social media and informatics at WCPT in Geneva. So I was able to use a lot of that research and a lot of that information to inform this debate. And what I wanted to stick to was, I wanted to stick to the idea of fake news, the idea of misinformation versus disinformtion because there are different and how each one of those are hazardous. And then the other point I made was that it's not individual people, it's not individual groups, it's not even an individual platform. But if put all together, all of the platforms add in misinformation and disinformation, add in people who don't know the difference between something that's factual and not. So if you put it all together, then that's pretty hazardous. But the parts in and of itself maybe aren't. And then lastly that social media is a tool we need to really learn how to use it as a profession because it's not going anywhere as the team concept. It's not going anywhere. So the best way that we can reach the people we need to reach is by using it properly and by making sure that we use it with integrity and honesty and good faith. Jodi Pfeiffer: 05:22 Hi, I'm Jodie Pfeiffer. I was for the con team blues brothers. I got to be the lead off person as well. So I really just kind of wanted to set the tone. It was a hard argument. Everybody uses it. I would like to think most people try and use it well we know this isn't always the case and it is a really useful tool for our association and for our profession. But there are times when it is not, we were trying to just, I was trying to set the stage for my other team members to give them things to work off of, give everybody a little introduction of the direction we were going. And I also tried to play off of our opponents a little bit as well because you know, really their argument that they made so well kind of proved both sides, how good it is and the hazards. So yeah, that was the direction that I went. Jarod Hall: 06:20 This is Jarod Hall. I was on the pro team #teamhazardous and I remember when I was asked to be on the Oxford debate panel, the same day I was scrolling through social media of course, and I saw Rich Severin on Facebook saying, Hey, look, I was selected to be for the Oxford debate. And I thought, man, he's super well-spoken. This dude knows his stuff. He's going to come in strong. And then like I checked my email an hour or two later and I had been asked as well and I was pretty floored. I didn't know what to say. And they're like, do you want to do this Oxford debate and what side do you want to be on? And of course I said, I'm super active on social media. It's been helpful for me to find mentors and it's really positively influenced my career. I want to be on the side that's pro social media. And they said, cool, you're on the opposite side. Jarod Hall: 07:21 And I thought to myself, oh, ouch. Okay, I need to look at this subjectively. You know, I need to, I need to step back away from the situation and look at ways that either I myself have been hazardous on social media or things that I've seen that were hard for me to deal with on social media. And, when Karen and Jimmy and I were strategizing, you know we kinda came up with a couple of different points. We wanted to 8 mile, you guys, we wanted to 8 mile the other team and kind of take the bullets out of your gun. We wanted to address the points that we knew you would address. And Karen did a really awesome job of that because we knew you guys were gonna come with such a strong argument and so much fire that we had to play a little bit of defense on the offense. Jarod Hall: 08:07 And Karen got everybody hyped up and then our strategy was maybe, go the opposite way in the middle with me and maybe bring a little bit of the emotional component the other side of emotions and have people reflect on what does it feel like to feel not good enough? What does it feel like to see everybody else's highlight reel on social media when in reality, you're doing the day in the day out, the hard grudge, the hard trudge, you're putting in so much hard work and all you see is everybody's positive stuff around you. And it can, it can be a really defeating feeling sometimes. So we wanted to emphasize, you know, a lot of the articles that have been coming out across the profession about burnout and how that could potentially be hazardous. And you know, obviously we're all in favor of the appropriate usage of social media and when done the right way. Jarod Hall: 08:55 But to take the pro side of this argument, we had to reflect on how could this really actually pose a hazard to us both personally and professionally. And, you know, I think that that's one of the things that directed our approach. And it was a hard thing to do to take the opposite side of, you know, how I position myself. But, all of my own errors on social media were really good talking points and learning points to drive home the discussion. And, you know, we just knew that the other team was going to have such a strong argument. We knew that it's really hard to ignore the fact that social media has connected us. It has allowed me to meet everybody sitting at the table with. It's allowed me to have learning opportunities and mentorship and it's allowed me to have business opportunities that I wouldn't have had otherwise. So we knew that the argument was just, it was going to be tough to beat. And, you know, I think that the crowd just resonated with everything that was said from both teams. And at the end of the day we were able to shed light from both sides on a really difficult topic and have people, you know, reflect on it and really have some critical thought. Ben Fung: 10:10 Ben Fung here. I was a part of the con team. So that was so difficult. Pro Con. So I mean like it was interesting. I had a very similar experience when they asked me to be on the Oxford Debate. They're like, hey, you know, we'd like you to captain the team. I was like, okay, great. What am I debating? Or like, then when they would actually did tell me, they're like, oh, it's about social media. I was like, okay, yes, I'll do it. And then they're like, okay, you're on the con team. And so immediately I thought like, Oh, I have your job. Like I have the team, you know, #Hazardteam, I needed to somehow slam on what much of my success had been attributed to, you know, and I was like, okay, that'll be a tough job. Ben Fung: 11:01 Right. And then what's interesting is that, you know, then they sent me the prompt and I was like, oh no, no, no, I'm against the against statement. So I'm pro social media and, you know, then the other side I can promote this. And it was actually only in retrospect that I was like, oh, it can be an uphill battle. But then I decided just personally not to think about it from that perspective, from my, you know, debating approach cause we're trying to present, you know, we're trying to present a point, more importantly, just engage the audience, you know, because, the Oxford Debate in the past, for the most part it's been really positive and entertaining. But then in some past years have gotten a little too intense I think for the audience and some afterthoughts. Ben Fung: 11:40 So I just wanted to make sure that the thumping in the background stops, but also that you know, people were engaged, entertained, you know, that generally said some critical thought. You know, like those might've come into this being maybe a con member goes over to pro and vice versa. But really, you know, it was just really, really fun. You know, as people, I was like, you know, I know all these folks, it's going to be so much fun. And you know, if we can bring even like an ounce of the kind of energy that I know we all have and put it together, that stage is just going to be vibrant. So, you know, from what I can tell, that's what happened. And, you know, I'm very pleased regardless of who won, but congrats you guys though. You guys did a great job. Rich Severin: 12:32 And this is Rich Severin, was on the con team, which is again this incredibly difficult to kind of, yeah, team blues brothers. That's a better way to go about it. Everyone's said it, you know, this was, it's a difficult topic. You know, I asked like, who were, you know, were on the other teams, you know, realizing that, you know, we're going against some of the people who have, you know, some of the largest profiles in PT, social media and Karen and Jimmy and like, they have a really tough task here. I'm interested to see how they're going to go about this. Cause it's like, I even, I was like, man, I'm kind of glad I met on that side, but I don't know if I could somehow think of a tweet quoting me and like saying, 'PTs social media is hazardous' or whatever. Rich Severin: 13:12 But anyway, realistically the Oxford debate, you know, it's to present a topic that's challenging, that's facing the profession and dissected and debated. And that's kind of the beauty in having fun. And I think everyone there had fun. I had a lot of fun. And it was just, it was just good. And I think, you know, the pro team, or #hazardousteam, you know, they did a really good job. It's not an easy topic to debate because again, social media is kind of a tool in a lot of the problems are kind of the human nature in a certain stance on a platform. But, you know, addressing the issues of burnout, addressing the issues that people wasting time, fake news, misinformation, you know, those were our, you know, those were all good things, but you kind of brought to light throughout that debate. Rich Severin: 14:04 And I think our group, you know, came across with obviously with a good argument, but, you know, Karen came on the short and a little bit today. But, you know, it was a great spirit's good spirited debate. It's a lot of fun. It's a great time and having these conversations about tough issues, having to kind of take some time for introspection and looking through things was enjoyable. And enjoying hearing other people kind of, you know, doing the same. You guys definitely did like, I think put a lot of time into researching and discussing topics cause it's a serious issue, you know, our younger populations growing up using social media in middle school, you know, and it will, you know, the topic I thought you guys would get into was like the bullying and esteem issues that are happening and the mental health issues, anxiety, depression, it's linked to social media, you know, and whether or not that's the cause or it's a vehicle for that outcome. Rich Severin: 15:03 So like, you know, I do agree with the safe #safesocial, right. Like you know, and it kind of led to like kind of on our side too. It's a tool and how you use it, it's kind of really an issue and I think you guys brought a really, really good light to that issue. So yeah, I was like, it's a great spirited debate and the crowd had fun. I mean dressing up as the blues brothers in Chicago, right? I mean, so, so much fun. Jenna Kantor: 15:28 Thank you so much. Now, I just want to leave it. Not Everybody needs to answer this, but I would like if anybody would like to do a little last words in regards to this debate, whether it be some sort of wisdom on doing an Oxford debate in general or pretty much what rich started to do on when he was just last talking in regards to social media being hazardous or not so hazardous. Would anyone here like to add onto that as a little like last mic drop, which is your outlet. Rich Severin: 15:54 I think we've hashed out the debate on both sides pretty well. Which I think, again, it's the spirit of the debate is they present both sides. And that's kind of where I'm getting yeah. Is that we need to have more of these kind of conversations and discussions. And you know, to me it's almost kind of a shame that this is the only really time in our profession. Like, you know, at a high level where we have these discussions where both sides do their due diligence and say, like, legitimately argue, like, you know, and like arguing is not a bad thing. Right? Debate is not a bad thing if it's done well done amongst colleagues and friends and with mutual respect and we need to have more of that. Rich Severin: 16:39 Social media is not necessarily a bad thing, but arguments necessarily a bad thing, but it's how you go about doing it. So, you know, I would encourage the profession to have more of these outside of just the Oxford debates. Well, when it was the women's health section, they did one on dry needling a couple of years ago and that was awesome. And I'd really encourage and support that again, you know, so that's my little, I don't know if it's a mic drop or not, but we need to debate more and do it well. Karen Litzy: 17:29 Rich, I totally agree with that. And this is the thing, we were able to do that because we were in front of each other and we knew that there is no malicious intent behind it. We can hear each other. We know that we're smiling at each other, we're clapping for each other and we're kind of building each other up. And I think that's where when you have debates on social media, as Jarod attests to and Rich, sometimes those spiral into something that's really not great. And so I think to have these kinds of discussions in person with our colleagues and it's good modeling for the next generation. And it just, I think, you know, social media has a lot of great upside to it. There's no question, but there is nothing that beats in person interactions. Karen Litzy: 18:20 And I think that that's what we need more of and I do see that pendulum shifting and you do see more in-person things happening now. But I agree. I also thought it was like a lot of fun and I was really, really nervous to do it and super scared to get up on stage and do all of this. But then once it started, it was a lot of fun. Jenna Kantor: Thank you so much you guys for taking this time, especially after, literally right after the debate. It is an absolute pleasure to have each of you on here. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Andrew Tarvin on the show to discuss humor in the workplace. Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace. In this episode, we discuss: -How to construct humor and learn the skill of humor -The benefits of humor for the individual and the organization -Types of humor that are appropriate for the workplace -The importance of the "Yes, and" mindset -And so much more! Resources: Andrew Tarvin Website Andrew Tarvin Twitter Andrew Tarvin Facebook Andrew Tarvin LinkedIn The Skill of Humor TedX Video Humor That Works Website For more information on Andrew: Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace. Through his company, Humor That Works, Drew has worked with more than 35,000 people at over 250 organizations, including Microsoft, the FBI, and the International Association of Canine Professionals. He is a bestselling author; has been featured in The Wall Street Journal, Forbes, and Fast Company; and his TEDx talk has been viewed more than four million times. He loves the color orange, is obsessed with chocolate, and can solve a Rubiks Cube (but it takes like 7 minutes). For more information, please visit, www.drewtarvin.com and connect with Drew (@drewtarvin) on Twitter, Facebook, Instagram, YouTube & LinkedIn. Humor That Works is available on Amazon and wherever fine (and funny) books are sold. Read the full transcript below: Karen Litzy: 00:01 Hi Andrew, welcome to the podcast. I am happy to have you on. And now today we're going to be talking about humor and why humor is important in the workplace and in life. So the first question I have is you say humor is a skill, so how is it a skill and can that really be learned by anyone? Andrew Tarvin: 00:28 I think a lot of people have this question or this belief, like, you know, humor is just an innate ability, right? You're either funny or you're not. I will say that I've done over a thousand shows as a standup comedian and spoken word artist, storyteller, et cetera. I have spoken or performed in all 50 states and 25 countries and on one planet. This one. But when I went to my high school reunion and people found out that I did comedy, they're like, but you're not funny. And that's because, you know, growing up I was never the life of the party or the class clown. My senior year. I was voted teacher's pet. So much more of an academic, much more quiet. You know, I'm a very much an introvert. And then I started doing Improv and standup in college and admittedly was terrible when I first started out. Andrew Tarvin: 01:22 Like we often are in a new skill that we try, but with practice and repetition I got better. And so I realized that, you know, really there there's an art and science to humor. And so what we do with our organization, with humor that works is we teach people the science. So we teach things like comedic structure, things like a comic triple things like timing and understanding how to like position things in different, you know, strategies that humorous use between say association or incongruity or a story, et cetera. All of this kind of science stuff that's easy to, you know, this conceptually you can learn and then there's an art, there is an art piece to it, right? There is, you know, some of that comes from your own perspective, the thing that you like and that you improve with practice and repetition. And so what we say is, you know, with the skill of humor, we can help to teach anyone to be funnier not necessarily, you know, across the board. Funny. It's not like, you know, you can magically teach someone to be so funny, they're going to magically have a Netflix comedy special, but you can learn certain things that are gonna take whatever your base level, you know, ability to use humor is now and take it up to the next level. Karen Litzy: 02:30 Okay. So let's break this down a little bit because I know the listeners love to get these little nuggets of knowledge that we can start applying today in our life and in our workplace. So you said that with your company that you can teach people what is comic structure and timing. So can you first tell me, cause I don't even know the answer to this question, but what is comic structure? Andrew Tarvin: 02:55 Yeah. So there's certain things that, you know, there's certain ways that you can structure a sentence or a joke that make it more effective. So, one of the big things is, is learning to put the funny part of the punch line of something at the end. So a great example of this is, I think it's a George Burns quote that says, 'happiness is having a caring, a close, tight knit family in another city' right? Which I think is a pretty funny, you know, a humorous line. That line doesn't work if you say, 'happiness is having a family in another sitting who is in another city who is carrying and close and tight knit, right? So you put the funny part, the unexpected, the surprise piece at the end, right? So that's just a simple structure thing. It's kind of the structure of set up and punchline another example of that is something called a comic triple. Andrew Tarvin: 03:52 And so a comic triple is anytime when you have a list of three things, the third item is something unexpected. So, for example, when I give my, you know, when I'm talking about some of the clients that we've worked with, we'll say, you know, we've worked with organizations such as Microsoft. The FBI and the International Association of Canine Professionals. And so that last one is just something different, something unexpected where it's like, okay, Microsoft, okay. Corporate FBI, all that's kind of interesting. They seem serious. That's kind of cool. International Association of Canine Professionals. What does that mean? Right? So it, and again, we put that at the end. So simple things like structure or things that you know, kind of anyone can learn. And that's a starting point. The other thing that's kind of important to understand, maybe not necessarily specifically about comedic structure, but about the skill of humor, is that humor is more broad than comedy. Andrew Tarvin: 04:46 So a lot of times when we think of humor, we do think of comedy. We think of funny, we think of laughter, we think of jokes. But humor is defined as a comic absurd or Incongruence, quality causing amusement. So it could be a joke or it could be just something a little bit silly or something a little bit different that you do that doesn't necessarily make someone laugh, but maybe it makes them smile. And that broader definition means that, you know, maybe you're not a great joke teller, but maybe you're good at telling stories or maybe you're not going to storytellings or jokes, but you're really good at drawing interesting visuals that will get people to pay attention. Right? So that's, that's part of what we mean by this skill. Karen Litzy: And what about timing? How do you teach timing? Andrew Tarvin: 05:33 It can be a tough one to do, but that's, that's where the practice and repetition comes from because even as standup Comedians, like, you know, Seinfeld or, Ellen or that kind of thing, when they're doing new special, when they're going to new materials, they have to get it in front of people to see, okay, where do people actually laugh and how long of a pause should it have. Cause sometimes the difference between getting a big laugh and no laugh at all is how long you pause or how long you allow someone to get something. So, one example within timing is a lot of times when people are first starting out with humor, they'll say something that's actually pretty funny. And they'll leave a brief pause and then they'll start talking again right away. And this is something called stepping on your laughter is if someone starts to kind of laugh, but then you start talking again, people will stop laughing, they'll shut down the laughter response because they want to hear what you say next. Andrew Tarvin: 06:25 And so sometimes one of the hardest parts is a brand new comedian to learn. And sometimes you have to be quiet a little bit longer because it takes the audience a second to actually get the joke to then process that it is a joke process that it is funny and then start to laugh. And that, you know, you need to be comfortable kind of in that short silence to allow them to then laugh and then also to not talk while they're laughing so that, they kind of finish that laughter out as opposed to stopping at short. Karen Litzy: 06:50 And I would imagine if you're up on stage and your, you know, telling the story or joke that time from the end of you finishing your sentence to a little, maybe pause to laughter building must feel like it's an hour. Andrew Tarvin: 07:10 Yeah. It can feel like a really, really long time, especially as you've, if you do a certain joke over and over again or one that you know, that works because as you went, you think about it and like, oh, that's funny. I want to share that you've already thought about and processed why it's funny. And so you're like, oh, if they don't get it immediately, they must not think it's funny and it's they've never heard that construction of those ideas together before. So for example, I love puns and wordplay and I recently tweeted out, you know, that I'm a pale person. The only time I get Tan is when I do trigonometry. Andrew Tarvin: 07:47 And that joke, particularly when said verbally is it's talking about get Tan. So Tan being short for Tangent. Exactly. So the only time I get there is, you know, it takes a while. It takes a moment for people to be like, wait, why is that funny? Is that a joke? That doesn't, you know, what is what is, you know, that has to do with trigonometry. Oh wait, 10 to there was like cos sign and tan like, yeah. So it takes time for that to happen and you have to get comfortable kind of in that silence. The other thing to, to recognize though is that that's true specifically of, kind of planned humor. Things like conversational humor. They don't necessarily, one you may not have, it might not be a preplan thing, but even conversational humor, something that can be learned and something that can be practiced through, you know, drawing on some principles from improvisation. Karen Litzy: 08:40 Right. So now I actually took a number of Improv classes to help me with the podcast to help me, like you said, just carry out a better conversation and to yes. And, and all of that. So can you a little bit about improvisation and how that can help with general conversations, especially let's say at work. Andrew Tarvin: 09:05 Yeah. So, you kind of mentioned the fundamental mindset of improvisation. The key that really helps with a lot of that in that is the mentality of yes and, where yes. And is really about kind of taking whatever was offered and building off of it. And so that can be fantastic for conversations. In fact, if you're ever in a conversation and you don't know what to say next, you can just simply yes. And the last thing that was said, so like you can even take, you know, the stereotypical small talk example of, how, how about this weather, right? So I'm in New York. It's sunny, it's 85 degrees. Someone asked me, how about this weather, if I'm say at a networking event, right. Or say one-on-one with a client, how about this weather, I can be like, yes, it is, it's beautiful out. It's, it's sunny out now. You know, if you weren't at this meeting, if we weren't interacting right now, how would you be out enjoying, you know, 90 degree weather? Right. And then so that gives him a chance to be like, oh well, you know, I'd go swimming because it's hot out or I'd stay indoors because it's too hot. Or I'd go out on the bike, you know? And that turns a conversation that was about weather into something more interesting about like in getting to know that person in terms of things like their hobby. Karen Litzy: 10:16 That's great. I love that because that networking and going to those kinds of events is always so daunting. And especially as an entrepreneur or a small business owner, you kind of have to do those things. Andrew Tarvin: 10:30 70% of jobs are found through networking and, and to your point, entrepreneurs, I'd say it's a way that a lot of people drum up business. And I learned that pretty early on as an introvert, you know, going to networking meetings, like you said, is daunting. It's a little bit awkward. And so for me, I developed a three step process for being able to network with people. And that yes, and piece is the third step is how you continue the conversation is just to continue to build off of what was said. Karen Litzy: Nice. What is step one? Andrew Tarvin: Step one is to ask interesting questions. And so, you know, if we think about Dale Carnegie and how to win friends and influence people, you know, great quintessential business book, he said that you will get, you'll make more friends and a month by getting people interested, by being interested in other people than you will in an entire year in trying to get people interested in you. Andrew Tarvin: 11:24 And so what that translates into is basically getting other people to talk and then shutting up and then listening to them. And you know, if we go to a networking event and we have the same kind of boring questions, the same, you know, what do you do type questions and at least the same boring answers. And that's not distinguishable. That doesn't stand out to anyone. And so instead of you, if you ask more interesting questions, so simple questions, you know, what's the coolest thing that you've worked on in the last three months? That a lot of times people, you will end up answering the question of what do you do, right? They'll say, oh, when I was working at blank. But it gets him to think a little bit differently. It gives him a more interesting response and you can actually kind of connect a little bit closer. Andrew Tarvin: 12:11 And that's an example of something that's a little bit in congruent. So maybe it's not laugh out loud funny, but it is something a little bit different that maybe gets people to smile a little bit more or at least thinking a little bit differently. So that's step one is to ask interesting questions. The second step is to tell a compelling stories. So when someone asks you a question, right? Sometimes we hear this advice of like, Oh, you've got to ask people questions. That's how you build rapport. But if all you ever do is ask them questions and never answer anything that they say, it starts to feel like a weird interrogation. Or like why is this person being so closed off? And so when someone asks you a question rather than just giving a yes or no answer, you can give a little bit of a story or a little bit of a background. Andrew Tarvin: 12:54 So if they're asking, you know, why did you get into healthcare? Why did you get into physical therapy? Or why didn't, you know? Rather than just being like, oh, it was fun. Like, you know, oh, growing up I always felt like this, or I was an app. Like just giving that background allows people to connect with those ideas and maybe they don't connect with physical therapy. But if you're like, oh, well growing up when I used to play soccer, I felt like this. And then on to the next thing, people are like, oh, I played soccer as well, and now you've created a connecting point with this person through a shared interest or a shared commonality. Karen Litzy: 13:25 That's great. Thank you. Those are great tips. And finally finishing up, like you said, using the yes and to continue that conversation is great. Now since you brought up health care and physical therapy, a lot of the audience, are in those professions. So sometimes humor in that workplace can be a little difficult cause there are times where we have to be pretty serious. So can you kind of talk a little bit about how using humor at work can even work when we have to, you know, sometimes give bad news? Andrew Tarvin: 14:01 I think your is a great point and this is something I think for, for all professions to, to recognize with humor is that it's simply another tool in the tool belt in the sense that it's not something that you're going to use all the time. 100, you know, 24, seven and everything that you do. It's, it's true that there are times that humor may be inappropriate. And, one of the ways that we can avoid inappropriate humor is by following what we call a humor map. And the map stands for your medium, your audience, and your purpose. So your medium is how are you going to execute that humor? Is it an email? Is it in a one on one consultation or conversation? Is it in a phone call? Is it in a presentation to a bunch of people? Because that medium impacts the message, right? Andrew Tarvin: 14:47 The second piece is the audience and who you know, who is the, what do they know? What do they need and what do they expect? Because when you're using humor and say communication, you probably are, you do want to deliver on what that person needs while doing it. Maybe in a way they don't just 100% expect by adding a little bit of something different can add be that humor component. The other thing is also understanding your relationship with that person because you know something that you, if you have a client that you're meeting for the very first time, that's going to be very different than the humor that you might use with the client that you've been working with for 15 years, right? You've got to know each other a little bit better. And then the final piece is the purpose. Why are you using humor? Andrew Tarvin: 15:27 And this is the most important one. This is why as an engineer, I like it because humor can be effective in using or achieving certain goals. So you could use humor as a way to get people to pay attention. Or maybe you use humor as a way to build a relationship with someone to build rapport, right? If you're meeting a client or if you're just now starting to work with someone, you can find a way for you to both laugh together. You kind of show that where you're standing on the same side and then after you've built that rapport, then if you have to get more serious news, that's, that might be when you become a little bit more serious or a little bit more somber or whatever. Right? So again, it's just recognizing that it is, it's a tool. It helps us achieve certain goals and that when we have those as goals, it might be the appropriate tool to use. Karen Litzy: 16:10 Great. I love it. And I like that acronym of the humor map. That's really easy to remember. Now let's talk about, we're talking about humor, right? There's maybe good humor, bad humor. What is the type of humor one should kind of stay away from in the workplace? Andrew Tarvin: 16:34 I think that's a great question. So to give it a little bit of additional context, a psychologist Rod A Martin defined four styles of humor. He said in general, humor kind of falls into these four buckets. The first bucket is affiliative humor and this is positive inclusive humor. This is to me, I think of like Ellen Degenerous, like her style of humor, her TV show, it's very positive, upbeat. Everyone is included. There is no target, if not aggressive. It's not calling anyone out. It seems like team building events in the corporate world or activities that you may be doing with your clients or your patients, right as positive and inclusive, everyone is included. The second style is self enhancing humor. And this is a humor where the target is kind of yourself, but it's positive in nature. To me it's kind of best summed up by, there's a great Kurt Vonnegut quote that says laughter and tears are both responses to frustration. Andrew Tarvin: 17:33 I myself prefer to laugh because there's less cleaning up to do afterwards, right? It's that idea of like when we're thinking about the challenges or the hardships that we have to go through day to day, it's finding the humor in them so that you laugh about them instead of cry about them. So that's another great form of humor and that's, that's kind of like, you know, finding ways to make your own work more fun. It's, you know, listening to music when you have to go through email or you know, rocking out to a song and you're in the car on the way home, or you know, these small examples of things that are just improving your life day to day. A third style is self-defeating. Humor, self-defeating humor as a negative form of humor where the target is yourself. And so this is, you know, Rodney Dangerfield. Andrew Tarvin: 18:15 I get no respect. That's kind of poking fun at yourself. And this can be a great form of humor when used one in a high status position. So if you are a presenter that sometimes adds a little bit of status to it, or if you're the boss or the CEO as a way to reduce status. Differentials can be very good. And it's best used when sparingly. So like you don't want to use it as every single joke that you do, but every now and then on occasion, and that can be a good form in many ways. But if it's used too much since people started to think like, oh, this person isn't confident or they're not actually good at what they do, or you know, they're throwing a pity party and I don't know if I laugh or not. So there's some limitations to that one. Andrew Tarvin: 18:55 And then finally there is aggressive humor and aggressive humor is a negative form of humor where the target is someone else. You're doing it to try to manipulate them or try to make fun of them or that kind of thing. And so that tends to, to not be appropriate in the workplace. It includes things like sarcasm and satire, which can be okay in a group setting where you're all very comfortable with you, with each other, and it can be a very good form of Catharsis. So I know a lot of like say doctors, surgeons, we do some work with emergency first responders. They sometimes have a dark sense of humor as a group, because it, you know, serves as Catharsis. They see so many stressful, so many crazy things that they need some outlet to relieve that stress. And so that type of humor can be helpful there. But again, only when it's a very close knit group, when the relationships are kind of already formed and you know that it's going to be seen as catharsis and not seen as aggressive. Karen Litzy: 19:52 Yeah. And I think we've all been in those situations where you're just sitting there and it's like awkward. Like this did not fall the way that the person intended it to. Andrew Tarvin: 20:03 Yeah. And that's why, you know, if you stick to the other three forms a lot more, you're going to be, it's gonna be a lot better. And, and that's the other differences, again, we're not trying to teach people how to use humor to become stand up comedians. Cause yes, absolutely tons of comedians or kinds of comedy shows, you'll see a lot of sarcasm, a lot of satire, a lot of aggressive humor. But that's not our goal. Our goal is using humor so that we get better results. Karen Litzy: 20:29 And so that was my next question. You just led me right into it. So let's talk about results. What kind of benefits can, let's say myself as an entrepreneur or within an organization, get from humor at work Andrew Tarvin: 20:44 It's great question. And as individuals, there are 30 benefits at least that we found. 30 plus benefits from using humor in the workplace that are all backed by research case studies and real world examples. And so they range from ways to improve your communication skill as a way to, you know, for example, do you use a little bit of incongruity, get people to pay attention a little bit more cause they're like, oh that person just made me laugh. That's a little bit different than what I was expecting. Now I'm listening and paying attention, to helping with creativity and backed in one study they found that kids to watch a 30 minute comedy video before trying to solve a problem. They were nearly four times more likely to solve that problem in kids. You watched either a math video or no video at all. Andrew Tarvin: 21:28 So we can use humor as a way to kind of just warm up the brain to be able to think about things a little bit differently. Give ourselves a different perspective. We can use it for things like relieving stress so we know that, you know, stress by itself is not a bad thing, right? As a physical therapist, you know that you have to stress muscles to some extent in order to get them to grow. That's what we're doing when we're working out is we're breaking down muscles, but then they grow when we rest and we feed them and the body, our capacity for being able to do work is the same thing. We can stress, you know, we needed a little bit of stress to sometimes get to that next level in terms of productivity. But if we never relieved that stress, that's when we see an increase in blood pressure and increase in muscle tension, a decrease in the immune system. Well humor can help counteract those things. When we take a break to actually laugh, we increase oxygen flow through our body, we relax our muscles and we boost our immune system as well. So we can use it for things like that as well. Karen Litzy: 22:25 Well they are all really great benefits especially to use at work. And now these are, like I said, these are all great benefits. So why is this not being implemented more? Why aren't more people quote unquote funny at work? And I know that's not the right term, but I think that's what people think. Right? Andrew Tarvin: 22:46 Right. Yeah. And what we say kind of with humor in the workplace as a goal isn't necessarily to be, to make the workplace funny, but it is to make things a little bit more fun. And you ask a very, I think, important question to say, okay, why don't people use humor more? And we wanted to do the answer to that. So we ran a study through our site and we found that the number one reason why people didn't use humor in the workplace as they said that they didn't think that their boss or coworkers would approve. Karen Litzy: 23:12 Interesting. I can see that. Yeah, I can totally see that. Andrew Tarvin: 23:15 Right? Yeah. Cause if you work in a culture and no one's really laughing or smiling all that much, then you're kind of like, oh, I guess it's not welcome. I guess it's not what we do here. It's a, you know, quote unquote serious workplace. And the reality is that 98% of CEOs preferred job can edge with a sense of humor and 81% of employees at a fun workplace would make them more productive. So I think people actually want it. It's just that we're still stuck sometimes in this old mentality that work has to feel like work and we don't that well, we're human beings. And humor is an effective way to reach human beings. And so if we want to be more effective in what we do, we have this tool that we can use. And I think specifically for entrepreneurs and leaders of others or team leads and stuff, that's an important thing to recognize is that if you're the leader of a team or an organization and people don't constantly laugh or people don't kind of have that sense of humor, it doesn't seem like you might be part of the reason why. Andrew Tarvin: 24:12 And it's probably not intentional, right? You probably like haven't gone out to be like, all right, let me squash any remote mode of fun. That happens every single day. But if you don't use it yourself as a leader, if you don't encourage it, if you never laugh or smile in the workplace, if you never kind of express some humor or share a little bit more about yourself, people will kind of take whatever the leader does and say, this must be how we have to act. Karen Litzy: 24:36 I mean things trickled down from the top. There's no question. It makes me, as you were saying that the thing that came to my mind was the movie the Devil Wears Prada and Meryl Streep's character who was just, I don't think she cracked a smile except like the very end of the film. And you can just sense the tension among everyone that worked below her. Andrew Tarvin: 25:02 Exactly. And I think we, I think we need more, we need more metaphors to the movie devil wears Prada. So I'm happy that we've gotten there for this. But I think you're exactly right. How the managers behave does tend to set the tone. And, but with that being said, one of the things that, you know, I'm a big believer in is that, you are responsible for your own happiness. And so even if you do work for an organization or you do work for a manager or a leader who doesn't really use humor, I think that it's still up to you. You choose how you do your work every single day. And, and it's not really the responsibility of your manager, your coworkers, or your patients or clients or customers to make sure that you're having fun, right? That's an individual choice that you make. And hopefully they don't detract from that. But even at a minimum, like they can't control how you think. Right. One of the things that I like to do when getting bored and emails that I'll start to read each of the emails in a different accent in my head. And this is something kind of fun, something a little bit different to do and no one can stop me from doing that, right? No manager could come up and be like, hey, you're reading emails in the accent in your head. Stop it. Karen Litzy: 26:10 Yeah, totally. And so when you go into these companies, you go into Microsoft or in working with the government, how do you enter into those situations to kind of explain to them that using humor in the workplace is important? Because I would have to think you have had to encounter some hard nuts to crack. Andrew Tarvin: 26:38 Yeah, absolutely. And in conveying the value of humor is a little bit of a challenge. You know, no one really thinks of humor as a bad thing. They typically don't think of it as kind of a nice to have. But to me it's a must have. If you just look at kind of the statistics, if you look at the numbers, you know, 83% of Americans are stressed out at work, 55% are unsatisfied with their jobs and 47% struggle to stay happy leads to 70% of the workforce being disengaged. And then Gallup has estimated that's a cost on the US economy of about $500 billion lost, you can do the math of that. That's, you know, you take the number of employees and all that. It's an average of about $4,638. Andrew Tarvin: 27:29 And lost productivity. And so then when you're starting to talk with people, so if you're talking with Microsoft or other organizations and saying, Hey, if you know 70% of your workforce is disengaged and each one costs you $4,700, now they start to see like, oh, okay, there's numerical losses here. Because if you look at the benefits of using humor, we talked about some on the individual level, when an organization uses humor, you see an increase and you one create a more positive workplace culture. You see an increase in employee engagement, you see an increase and company loyalty, see a decrease in turnover. And on a lot of organizations, you also see an increase in overall profit. And so when I'm talking with the organizations, it's talking about the business benefit of it. It's recognizing that, you know, well, as a gross simplification of it, I have a dumb question for you. Andrew Tarvin: 28:22 But it's still wants you to kind of answer it, but, would you rather do something that is fun or not fun? Fun, right? Yeah. You'd rather do something fun. So if you were to make your work a little bit more fun, probably stands to reason that you might be a little bit more engaged in it. Or if you were to make your kind of conversations with your patients or your clients a little bit more fun, you might see that they might be a little bit more willing to actually want to go to them or pay attention in them. So that's a big part of when you consistently use humor, that's when people are like, oh they actually look forward to that meeting. They maybe know that it's going to be hard or they know that, you know they're going to have to do some work, but they're like, at least it's not going to be terribly boring. Andrew Tarvin: 29:10 At least it's not going to be awful and that's that fun component. And so that's kind of the higher level. And then we have a bunch of studies and a bunch of background kind of back all those things up. But that's been the messaging is like, this is again, it's not about let's all hold hands, Kumbaya. You know, we should all enjoy our work just because we're happy. Go lucky. It's more of here's a strategic use of a tool that will get you better results. And here's all the research that says that it has done that. Karen Litzy: 29:42 And when, when we're talking about humor in the workplace, it doesn't mean like your boss coming out and doing a standup bit every morning. Andrew Tarvin: 29:47 Exactly. Yeah. Right. It's more about making it a little bit more fun. It's more about bringing the your humanness to work. Right. And this is one of the things that I'll share with my corporate audiences, you know, I'll say to an entire room full of people is I'll be like, you know what my guess is that many of you, and this is probably true of your listeners as well, many of you are likable people at home, right? And then they go into the workplace and something changes right? At home. They laugh with their friends, they smile, they make jokes, say, are conversational, et cetera. Maybe a little bit silly, you know, maybe they sing in the shower, they dance in the kitchen, whatever. And then they go into the workplace and something changes. They put on a work face and they feel like they have to be like a robot with no emotions or anything like that. And that's not effective for the way that we work today. Maybe that made sense, the industrial revolution, whereas all about efficiency and the most widgets that you could produce. But now when humor, interactions are important now when your emotions impact your ability to be, say, creative or productive, we have to manage the human experience. And humor is just one effective way to do that. Karen Litzy: 31:00 And so if I'm hearing you correctly, when we're talking about bringing humor into the workplace, it's really about being kind of open and trying to be a little bit more yourself and perhaps letting your guard down a little bit to allow yourself to be present and to, like you said, be funny or to not be so serious all the time. Or to, you know, have more conversations where you're injecting your personality. Because I do think most people have funny things to say in conversation. We're not all like Debbie downers. Yeah, I'm green. And so is that kind of what you're teaching when you're going in and talking about humor outside of, you know, how you talked in the beginning about timing and about the comic triple and having those unexpected things at the end of your sentences or punchlines if you will. So you're kind of teaching these tools, but in the end, as the worker or as the company, it's sort about changing the culture. Andrew Tarvin: 32:10 It is. Yeah. I think that's a great articulation of it. So in the book we had a book that just recently came out and it's called humor that works with missing scale for success and happiness at work. And, you know, we talk about 10 humor strategies for using humor in the workplace across five different kind of key skills at work. And so if you want to use humor to improve your productivity, you know, you can gamify your work or play your work and here are the steps how to do that. Or if you want to use humor and connecting with people here as a way to, you know, kind of a three step process we mentioned earlier about and that's a way to build empathy with someone. But at the end of the day, the bonus strategy and I think kind of what articulates what you're talking about is the biggest thing that we encourage. Andrew Tarvin: 32:52 The biggest takeaway, and I would say the same is true of your podcast listeners, is to simply think one smile per hour. You know, what's one thing that you can do each hour of the day that brings a smile either to your face or the face of someone else. And so that could mean, hey, if you like telling jokes and you want to learn more of them and you have that, you know, like you like that witty kind of feeling great, do that. If instead you're about to, you know, get in traffic and you know, like how can I bring a smile to my own face? Like, Oh, well let me maybe listen to a comedy podcast on my way home from work so that I laugh and show up more present for my family when I get there. These are all just small choices. And to your point, I think everyone, everyone has a sense of humor. Andrew Tarvin: 33:35 I think it might be a very specific sense of humor and sometimes you don't always see it, but I think everyone has one. And so it's like, okay, how can you leverage your sense of humor to bring that smile to the workplace? And the other thing is directing that you don't always have to be the creator of humor. Instead, you can be kind of the conduit of it or the shepherd of it where you know, you don't have to be the one that makes a funny joke. Maybe you find one online and you added as a pss or the end of a long email. Or you find images online using a creative Commons license and have that in your presentation as opposed to having a bunch of slides with just full of text. Maybe you watch a Tedx talk that you think is really, really good that you really like and you like, you share that with people to say, Hey, you know, let's try to incorporate this type of thing a little bit more. So you don't always have to be the creator of it, but you can be that source of it, that shepard of it. Karen Litzy: 34:24 Yeah. Great Advice. Thank you so much. That really helps to kind of break it down in my mind. And I would assume in the listeners minds as well. And you know, before I have one more question that I ask everyone, but before I do that, you had mentioned Tedx and I do want to mention that you had a great tedx talk that's been viewed millions of times. I watched it, I loved it. Where can people find that talk? Andrew Tarvin: 34:48 Ah, yes. So they can find it. If they just Google my name, Andrew Tarvin, Tedx, it'll show up. Or they Google a skill of humor. Tedx, it's on the official, you know, Tedx Youtube Channel. If you just Google my name, it's one of the first things that comes up and you can getting near your, a fantastic story about my grandmother and we go in and talk. It's funny, it goes into a little bit of that deeper dive of the scale of humor and for me at a, yeah, that can be a great starting point for people. And I know plenty of people have used that as a thing that they share out where they're like, hey, you know, I want to incorporate more humor into the workplace. People don't necessarily know why. So let me send this out to my team and say, Hey, this was a funny talk that I really like. Maybe it should encourage us to have a little bit more fun in what we do. Karen Litzy: 35:31 Yeah, I really enjoyed it. It was a great talk and it was funny in that bit with your grandmother is classic Classic Grandma classic grandma's stuff. So everyone listening, definitely check out the TEDX. It's really great. And like I said, before I finish, I usually like to ask everyone the same question. And that's knowing where you are now in your life and your career. What advice would you give to yourself as a new Grad? Andrew Tarvin: 36:00 As a brand new Grad. Two things kind of come to mind. The first, is more tactical and I would say do stand up comedy earlier, frequently. Just because one, I love stand up. I love doing stand up. It's I think one of the hardest forms of public speaking you will ever do. Karen Litzy: 36:22 Yeah. I would never be able to do it. I give you all the credit in the world. Andrew Tarvin: 36:26 Well, one, you absolutely could do it if I could do it. Anyone. But it is intimidating, but it's made me much, much better as a speaker. In fact, that I think the reason that the Tedx talk has been successful is because I did a lot of stand up before it to work on it, to practice it, to try jokes. And it's where I've refined, you know, my sense and my skill of humorous, I'd say do that, you know, first. And then I think the other thing would be get more clear on the articulating the value of humor. It took me a while Kinda to your point, you know, why do companies hire this? At first I was like, no, humor is just a brilliant idea. Shouldn't everyone see that? And the reality is that no one cares about humor and the workplace, like in terms of they never think of it as something that they need. And, and they know that they need communication training or leadership training or they know that they need to improve morale or they know that they need to help people relieve stress. It just turns out that humor can be the tool to do a lot of those things. So getting more clear on how humor can be beneficial, I think would've helped my personal career a little bit more and would've gotten me out to sharing this message with more people sooner. Karen Litzy: 37:32 Great. I love it. And I don't know that I would ever do standup. But you're making me consider it. Like even when I took, even when I took improv classes, I had like an Improv teacher come to my apartment cause I was too nervous to go to a class because I didn't want to screw up. Andrew Tarvin: 37:51 Yeah. But here's the thing though is you just rock this, this podcast and plenty of other ones in the future. That's all Improv as well. Karen Litzy: 37:58 I know that's why I took the class, but I don't know. There's something about being, I dunno, it's a fear. I should probably, I'm working on my public speaking. I've been working on that for the past year. But yeah, I think taking an Improv class in front of actual people and with other actual people would probably only benefit me. But it's just so darn scary. Andrew Tarvin: 38:21 It is. That's why you have to, you have to leverage that one light, that one evening that you like, have that like, you know what, I should do it. And then you sign up real quick and then force yourself to like go and there were only reason why I say that is is because I'm a big believer. Improv is fundamentally changed my life because as I mentioned I am very, very much was an introvert and everything growing up and that's how I kind of got into this and so I'm a strong believer that anyone listening, you know if they have the capacity, if they have any slight interest in it, I think should take an Improv class because it teaches you life skills. In fact, one of the most popular blog posts that we have on our website is 10 life lessons from Improv. So much application. It teaches you the human skills to interact with other people on ways to be more present, to think on your feet, to be able to react quickly, to build your communication skills and your confidence. Like there's tremendous number of benefits and once you get used to it, it's so much fun to do. Karen Litzy: 39:19 All right, I'll think about it next time UCB has like a one on one class. Granted that's upright citizens brigade for those who aren't, I guess in New York. They may not know that. If I can make the cut cause those classes fill up in about five minutes. But maybe I will do it this time. We'll, we will see. And now you mentioned your blog. Where can people find you? Andrew Tarvin: 39:42 Yeah, so if they're interested more in the human in the workplace, if they go to humorthatworks.com we have a bunch of, you know, blog posts out there about different topics on humor. There's a free newsletter to sign up to. There's a link to our new book that has a lot of resources there as well. I information about our workshops and coaching and all that kind of stuff. And they want to connect with me directly. They can find me @drewtarvin on all social media. So whether that's Linkedin, Instagram, Facebook, Twitter, a recently discovered, I still have a myspace page. So if my space is your jam, then you can connect with me there as well. Karen Litzy: 40:23 That's amazing. Well thank you so much, Andrew, for coming on and sharing all of this great information on how to use humor in the workplace. So thank you so much. Andrew Tarvin: 40:35 All right, sounds great. Well, thank you so much for having me, and hopefully this was valuable for the listeners. Karen Litzy: 40:41 I'm sure it was. And everyone out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes