Interview with Dr. John Halle of Belmont University

Dr. HalleDr. Halle has been with the Belmont Physical Therapy Program since 1997, serving as Chair and Associate Dean from 2005 through May of 2013.  He is currently a Professor working within the School of Physical Therapy. His professional areas of interest are in anatomy, electrophysiological evaluation, orthopaedics and sports medicine.  He is a Diplomate, American Board of Physical Therapy Specialties, with his certification as an Electrophysiologic Clinical Specialist. In addition to his academic position at Belmont University, Dr. Halle also maintains a practice performing clinical electrophysiologic testing at Blanchfield Army Community Hospital at Fort Campbell, Kentucky, and has an adjunct appointment within the Department of Medical Education and Administration, at the Vanderbilt University School of Medicine.  At Vanderbilt, Dr. Halle has taught the first year medical students gross anatomy since 2001.

Prior to accepting this teaching position in Nashville, Dr. Halle was the Acting Director of the Army Physical Fitness Research Institute at the U.S. Army War College in Carlisle, Pennsylvania. His other jobs in the Army included working as a staff therapist, serving as a physical therapy clinic supervisor, teaching at the undergraduate level, and teaching for four years as a faculty member at the U.S. Army-Baylor University Graduate Program in Physical Therapy.

Dr. Halle is a reviewer and Editorial Review Board Member for the Journal of Orthopaedic and Sports Physical Therapy, and has published articles in a variety of journals to include: Physical Therapy, Journal of Electromyography and Kinesiology, Journal of Sport Rehabilitation, Electromyographical Kinesiology, Medical Problems in Performing Artists, Percussive Notes, Clinical Anatomy, International Journal of Sports Physical Therapy, and Journal of Orthopaedic and Sports Physical Therapy. He has served as a Specialty Council Member of the Clinical Electrophysiology Section of the American Board of Physical Therapy Specialties (ABPTS), and as a Board Member the ABPTS, serving as the sports section representative. Additionally, he has authored several book chapters dealing with electrophysiological testing and musculoskeletal evaluation.

How did you become interested in physical therapy?

Physical therapy deals with movement and enhancing performance, and I was always interested in how performance could be improved. While I started college thinking that a degree in Engineering might be an appropriate path, I soon found that studying topics that also had the ability to directly impact the lives of others provided an additional level of satisfaction. That lead to changing my major to Community Health, then continuing on to obtain a Master’s degree in Health Education while I worked to obtain the prerequisites that I would need to be accepted into a Physical Therapy Program.

Can you tell us about your work in the anatomy lab? What inspired its establishment in 2014?

When the Belmont Physical Therapy Program was founded in 1997, it was built upon a traditional medical model recognizing a foundation in science, with clinical courses and other didactics built upon that base. Additionally, the founder of this program, Dr. David Greathouse, recognized and publicly acknowledged that the Belmont program would be stronger if associated with the Vanderbilt Medical School, since the two programs did not compete against each other and both were interested in providing excellence in medical education. Since space limitations resulted in this program starting on Vanderbilt’s campus, the two faculties started working together and the physical therapy program was able to share the lab that the Medical School used for anatomy instruction. This arrangement of faculty teaching across both programs continues to this day, but due to a medical school curricular change to an ‘integrated curriculum’, the ability to share the lab space at Vanderbilt ended. Therefore, to continue to teach anatomy with dissection experience for the students and ready access to the donor’s for learning, a new lab space arrangement was required with a different institution, or Belmont needed to bring-up its own lab. Ultimately, the decision was made to create an anatomy lab at Belmont, and this lab with 12 donors was opened in early 2014.

How do the experiences that students have in the lab improve student knowledge and outcomes?

It is not unusual for graduates to comment that “if they had the chance to come back into the anatomy lab, it is not an opportunity that they would pass-up”. There are several reasons for this almost universal recognition that the anatomy experience is important in the development of a physical therapist, in addition to the fact that anatomy is a foundational science that will have application across many of the courses presented. These include: 

  1. A tactile experience that allows students to appreciate the way that the human body is organized as three-dimensional beings. Included within this is an understanding of structures direct relationships to function, and how various tissues feel and work (e.g., how a nerve feels compared to an artery, compared to a vein, or the many types of fascia and connective tissue, etc).
  2. To appreciate dysfunction, it is necessary to know what is normal. Working with donors in the lab provides an opportunity to see and appreciate the way the human body is organized and the various systems that need to work properly for health. In examining the way that we are organized, the awesome design that is part of each human being (some would say God’s greatest creation), is in evidence.
  3. Studying in an anatomy lab demonstrates that in addition to an amazing design, we are all unique. There is variability across each individual, and in a lab where a student has the opportunity to examine a number of donors, the fact that the anatomy texts only provide the most common variants and not what may be in existence in the individual that is being examined, is in clear evidence. Seeing that individuals are variable in terms of structures like muscles, nerves, blood vessels, etc. gives the students an appreciation of how each future patient needs to be recognized and treated as the unique individual that they are.
  4. The donors in the lab function as a student’s first dedicated patients, providing access to understanding all facets of how the human body is organized and works. This is an altruistic gift, since the donors receive no direct benefit from serving in this role as a patient, apart from perhaps appreciating that future generations will benefit from the knowledge gained that will assist care provided. As a type of patient, some of the professional characteristics that are associated with patient care are also passed along in the lab. The donors are to be respected, and treated with the understanding that these were people that were loved, and they loved others. Additionally, recognition that the donors maintain the HIPAA rights that each of us have, and will have those protections for the next 50 years. This understanding gives these future professionals the perspective that while an anatomy lab is a place where interactive and fun learning takes place, it is also done with a solemn appreciation for the gift that is being provided in this type of learning environment. The students recognize that the gift is not solely from the donor, but also the donor’s family. In many cases, it will be several years following the death of the individual that final closure occurs with the donor’s family. At our facility, as is in the case in many, the students have a memorial service at the end of the semester to reflect upon the gift provided and the sacrifice that the family has made to provide the students with this type of learning experience.
  5. Working together in small groups promotes ‘active learning’, ‘self-directed learning’, ‘structural epiphanies’, and it requires the students to begin to use a new vocabulary that will be needed throughout their careers to describe what they are working with from an anatomical perspective.  

Working and learning in an anatomy lab has many advantages, with the preceding paragraph outlining some of the more straightforward positives. There have been many articles that discuss the advantages of being in a laboratory environment, rather than simply learning from a computer screen or a textbook. While an abbreviated list, some of those references are provided at the end of this interview 1-7.

You have also participated in recent research on interprofessional education (IPE). What is the value of IPE?

Change also often creates opportunity, and that was the case with the need to develop an anatomy lab at Belmont University. Prior to the development of the lab here in 2014, the sole profession that had access to anatomical donors were the physical therapy students using the lab space within the Vanderbilt Medical School. Once the lab was up and functioning, the Occupational Therapy faculty inquired about using the lab with the prosections that the physical therapy students were doing, and those two professions began working together. The undergraduate faculty also asked about using this space, and they also starting working with the Occupational Therapy and Physical Therapy faculty. This interprofessional collaboration yielded a number of positives, in that it broke down professional silos, created an opportunity for graduate faculty to work with undergraduate faculty and understand their needs and teaching goals, and created mentoring and learning opportunities across the faculties. This was a positive enough experience that an article was published explaining this collaboration (See, Barton C, Williams C, Halle JS, McGrew L. Graduate and undergraduate faculty collaboration utilizing peer observation to enhance educational opportunities for students and faculty: a case example. J Scholarship of Teaching and Learning.183, (published 2 Oct 2018). Also, the presence of the anatomy lab resulted in collaboration with nurse anesthetists’ students from a local institution. This interprofessional collaboration is described in the following publication (Williams CW, Gensheimer C, Halle JS, Moss P. Student perspectives of an interprofessional education experience for nurse anesthetist students and physical therapy students in a cadaver-based anatomy review course. Paper ID: 1104782, OALib Journal, Vol 5:8(August 2018). The bottom line is that the interprofessional education opportunities have created improved learning experiences for all of the students involved, and a strong faculty team that includes both undergraduate and graduate school faculties.

How does your work at Blanchfield Army Community Hospital and at the Army Physical Fitness Research Institute influence your research and teaching at Belmont University?

The clinical work that I am involved with at Blanchfield Army Community Hospital (BACH) is providing electrophysiological testing for active duty service members.  Electrophysiological testing consists of patient evaluation utilizing nerve conduction studies and electromyography (EMG), in addition to the traditional elements of obtaining a patient history and performing a sound physical examination. While this is an advanced clinical skill for a physical therapist and board certification through the American Board of Physical Therapy Specialties (ABPTS) is needed to do this type of clinical care, my PhD and anatomy backgrounds are both applied with this type of patient care. Nerve conduction studies and EMG both require a good background in anatomy, so this type of medical service reinforces and utilizes much of the anatomy taught.  The experiences at BACH also keep me involved with patient care, and that allows me to bring realistic hypotheticals into the classroom for students to consider. Last, the general topic of electrophysiological testing has been the focus of a number of student research projects, that assists students in working through and learning how to conduct research.

Prior to coming to Belmont University, I had the opportunity while in the U.S. Army to work and function as the Acting Director of the Army Physical Fitness Research Institute. This is an organization that educates senior leaders on human performance, provides facilities to enhance fitness across psychological, physical and medical domains, and strives to optimize the wellness profile of individuals as they age. As referenced previously, I have always been interested in human performance and the mission of this organization fits well with my health background and desire to serve others as they worked to optimize their health. In a general sense, this is also one of the goals of the profession of physical therapy, working to optimize health and prevent injuries. As is the case with the electrophysiological testing, elements of this background are incorporated into the information presented and taught at Belmont University.

What aspects of your work are you most proud of?

A saying that we have had at Belmont since the inception of this program in 1997, is that “our students are our credentials”. That has expanded with the graduation of twenty-plus classes, to “our graduates are our credentials”. The thing that really makes teaching at an institution like Belmont University rewarding is seeing bright, dedicated individuals come to learn a profession, and the growth and sense of confidence that they develop over their time at this institution.  They develop a new medical vocabulary, become aware of what it means to be a professional, and are able to implement the Belmont Mission statement that reads in part, “bringing together the best of liberal arts and professional education in a Christian community of learning and service”. Watching the students matriculate and go to whatever location they are called to serve others, is the element of teaching that is most rewarding.

The School of Physical Therapy also functions closely as a team and that is an integral reason that it has been successful over the years. As noted previously, working with other professions and the undergraduate faculty at this institution to grow that team, is another area of pride.

What advice do you have for those considering a career in physical therapy?

Physical therapy is a great profession. Physical therapy, like medicine in general, is also quite broad, with individuals that practice as generalists, as well as advanced clinical practice that now spans nine recognized board-certified specialties (Cardiovascular and Pulmonary, Clinical Electrophysiology, Geriatrics, Neurology, Oncology, Orthopaedics, Pediatrics, Sports, and Women’s Health). Additional areas of specialization also continue to be developed, including a Wound Cares Specialty that is close to obtaining specialty recognition. With the broad scope of the profession and the number of specialties that are part of physical therapy, those considering a career need to be aware of and consider a number of factors. While an abridged list, key items to consider include:

  1. Why are you motivated to go into the profession? It is a long haul, typically three years beyond a Bachelor’s degree, and it will require some drive, sacrifice, and perseverance.  Knowing your motivation and how serving others factor into that motivation is vital
  2. Along with knowing one’s motivation, take the time to understand the profession. This requires spending time with one or hopefully several physical therapists, and both quizzing them about the job and taking the time to shadow them. As noted above, prior to starting a three year program, one needs to be quite certain that this is a job that they are well suited for and will be a job that can engage them throughout their professional career
  3. Find a mentor that one can call upon at all stages of applying to an accredited program, if that is a goal
  4. Visit a number of programs and find one that matches your learning style and one in which you feel at home when at that institution. There are a number of very good programs throughout the country (things like first time and overall pass rates can be obtained from the institutions webpages, or from the National Physical Therapy Exam Pass Rate Reports, and a prospective student should consider those that feel like they would fit well with a program
  5. Keep grades up to maximize options. Along with this, know the application cycles, since application to a program typically occurs over a year before the prospective student expects to start at that institution.

Good luck!


References:

1. Aziz MA, McKenzie JC, Wilson JS, et al. The human cadaver in the age of biomedical informatics. The Anatomical Record (New Anat.) 269:20-32, 2002.

2. Granger NA. Dissection laboratory is vital to medical gross anatomy education. The Anatomical Record (Part B: New Anat.) 281B:6-8, 2004.

3. Elizondo-Omana RE, Guzman-Lopez S, Garcia-Rodriguez MDLA. Dissection as a teaching tool: past, present, and future. The Anatomical Record (Part B: New Anat.) 285B:11-15, 2005.

4. Rizzolo LJ, Steward WB. Should we continue teaching anatomy by dissection when …? The Anatomical Record (Part B: New Anat.) 289B-215-218. 2006.

5. Gunderman RB, Wilson PK. Exploring the human interior: the roles of cadaver dissection and radiologic imaging in teaching anatomy. Academic Medicine, Vol. 80:(8)745-749, 2005.

6. Garment A, Lederer S, Rogers N. Let the dead teach the living: the rise of body bequeathal in 20th century America. Academic Medicine, Vol. 82:(10)1000-1005, 2007.

7. Hasan T. Is dissection humane? Journal of medical ethics and history of medicine. 4:4, 2011.