Research Stories: Karen J. Panzarella, PT, PhD, CHSE
Panzarella, associate professor of physical therapy, immerses students in medical simulations with real actors.
Buffalo, New York – March 18, 2015 – Karen J. Panzarella likes to keep busy. The 17 pages of her CV listing her publications, presentations and posters show how busy, and they also provide a window into the educational innovations that are her passion.
In her time as an associate professor in the department of physical therapy at D’Youville College, Dr. Panzarella has reimagined and refined a key technique for transitioning students from textbook page to practice. Thanks to her impressive ability to turn ideas into successful grants, her department is turning treatment training into performance art.
Dr. Panzarella and her colleagues immerse students in medical simulations with real actors who don’t just parrot back symptoms. They are scripted as characters with well-conceived back-stories, adding human layers to their medical needs as they present students with complaints that have authentic complexity. The cases seem so genuine, Dr. Panzarella said, because the scripts are inspired by experiences faculty members have had in their own practices. Details are changed for patient privacy, but the composite characters are not exaggerations.
Having local actors play the patients has another bonus, Dr. Panzarella says: When the students venture into unrehearsed territory with their questions and treatment options, professional actors can fall back on their talent. “I can only script what the patients say, not the students, but the actors all know how to improvise; they have that experience,” she says. “I’ve seen them asked questions and thought, ‘Uh-oh,’ but they’ve handled it perfectly.” The extra effort to enhance the quality of the simulations provides the realism necessary for students who are just starting in health care, so they can learn how to build relationships with their patients. “The simulations help them understand more about their patients. It’s very targeted. They learn what it’s like to deal with a spouse who is not willing to help or a person who suffering from PTSD.”
There could be cultural issues, language barriers, hidden sensitivities, dietary problems, trauma and religious beliefs that will influence how well patients understand their treatment as well as how they respond to it. Dr. Panzarella has discussed these obstacles in several publications.
“It’s all about patient outcomes. If the patient doesn’t understand ‘what’ and ‘why’ in their treatment, they’re more likely to have problems complying with it,” she said. “Adherence is the No. 1 problem in health care. It all comes down to patient education and communication.”
This leads to her second big area of interest: communication and cooperation among health care professionals. Dr. Panzarella co-chairs D’Youville’s interprofessional education committee and has written extensively on the value of a team approach to patient care and to student instruction. “I’m really big on getting students together from different health care professions early on. When doctors don’t share with each other,” she said, “the patients get frustrated. They are getting the same questions over and over and over, and the treatments might produce mixed reactions and can even result in dangerous advice.”
Breaking down the specialty “silos” is key to the future of American medicine, she believes, and for her, it is starting at D’Youville. The college has eight separate healthcare disciplines and 35 faculty in the interprofessional program. Having worked previously at the much larger University at Buffalo, she sees D’Youville’s smaller size and low turnover as an asset.
“There is a lot of stability here with the faculty and that makes it easier to sustain the program,” she said. “There is no intimidation factor here. We all work together. We are all integral parts of the team.”
The next step will be doing interprofessional simulations in partnership with Catholic Health Systems, and using funds from a recent grant she obtained, taking the program into clinical settings with real patients. “This gives the students practice and value. A session can take four hours. What is interesting is they fumble at first, but then they get better at it,” she said.
Meeting the challenges of the changing healthcare system takes effort, and it takes teamwork. “Whatever I have done professionally,” Dr. Panzarella says, “I could never do alone. Everyone here knows how important this is. People will agree to meet at 7:30 a.m. or at dinnertime, or on weekends—whenever we can fit it in.
“In my ideal world,” she says with a smile, “we would have half a day set aside to meet every week. You need some dedicated time in addition to dedication to make collaboration work.”
Story by Melinda Miller
Photo by Bob Kirkham