PT abroad: Lessons from teaching in India

For two weeks in May, I spent time volunteering at Christian Medical College & Campus (CMC Vellore) in Vellore, Tamil Nadu, India. The main purpose of my trip was to provide useful information to the therapists on evidence based assessments and interventions for neurologic populations. I was really excited about the opportunity to gain insight on the similarities and differences in providing patient care in another country as well as helping patients and participating in education in a completely different way.

CMC Vellore is one of the biggest teaching hospitals in India. It has one of the country’s top medical school programs as well as many other undergraduate and graduate level programs. It is a multi-specialty hospital with acute, rehab and outpatient services. The hospital is very busy and there are long waiting lists for every service in the hospital, including therapy. Patient stays range from a few weeks to a few months.

During the day, I was able to observe and consult with the therapists in the various departments in the hospital. I spent time in the neuro multidisciplinary clinics, where physiatrists, neurologists, physical therapists, occupational therapists and speech language pathologists are able to consult with patients and their families as a team. I also worked with PTs in the ICU, acute care, rehab and outpatient departments. This was time dedicated to collaborating and integrating techniques taught in class. This afforded an opportunity to explore the similarities, differences and overall challenges that the therapists experience in the clinic. For example, I learned about the amazing spinal cord injury protocol they utilize to help people with injuries as high as T10 ambulate again. There are not many handicap accessible places in south India, making ambulation a big priority for patients. While we do not use a lot of protocols for patients with neurologic dysfunction in the United States, it was very cool to see that they also work really hard to develop programs to help their patients truly reach their goals. Another trend I noticed that felt close to home was observing how hard the therapists work to involve family members as much as possible. In fact, in the rehabilitation program, it is required that a family member or caregiver stay with the patient in order to facilitate home exercises and safety. One of the biggest differences I noticed was time constraints. Being able to spend a full hour with a patient definitely seemed like a luxury compared to the 15-20 minutes the therapists at CMC Vellore get with their patients.

The lectures were about an hour and a half long, held each evening at the end of the day. From the time I spent with the clinicians during the day, I was able to adjust and modify my lectures to make them as relevant as possible. The class participants ranged from physical therapy students to neuro specialists. When I arrived to Vellore, I came with two weeks worth of content to discuss evidence based outcomes and assessments for specific populations. I taught most of the material I brought, however, I also had to make many adjustments to the content and flow to more directly address the needs of the therapists.

The overall theme of the course was how to integrate the International Classification of Functioning, Disability and Health model (ICF) into practice to create plans of care that are more patient centered. This concept was discussed through the use of outcome measures, evidence based interventions and documentation. I was able to use a combination of lecture and lab each evening to integrate these concepts. It was clear from day one that the therapists are taught and treat in a more impairment based paradigm. Initially, it was difficult to engage the therapists to think and problem solve in a patient-centered model. For the first week I wasn’t sure if the therapists were absorbing the content because the material was new and different. However, my fears and worries diminished by the second week, when the therapists developed plans of care with effective interventions and outcome measures based on the ICF model. With only two weeks, I knew changing the culture of their practice would be difficult, but by the last day a few therapists shared that they had incorporated neuroplasticity into their sessions with success! It was exciting to see therapists apply the concepts into practice; reinforcing to me that my teaching strategies were effective and that the therapists felt their time with me was worthwhile.

Overall, it was a great experience in learning and growing as a physical therapist and as an educator. It was a unique opportunity to collaborate with like-minded therapists and problem solve practical issues they have for implementing evidence based practice and to promote standardization of outcome measurement and treatment approaches. It was so interesting to see how therapists and interdisciplinary teams work together to reach similar goals, even though health systems and populations can vary. Doing service as a volunteer overseas has been an interest of mine since starting my career and it was so amazing to help patients and other clinicians in a different country.

By Pamela Ressler, PT, DPT, NCS