The following transcript was created using artificial intelligence and may contain typos, omissions, or other errors.

Narrator: Welcome to the PTJ podcast where you can get the story behind the research with insights into clinical application, study, design and future projects planned. Now, here's editor in Chief Stephen George and PTJ social media student lead Gaylan Randle.

Gaylan: Hey, how's it going? Everyone and my name is Gaylan Randle. I'm a student physical therapist at Bowling Green State University. I'm part of PTJ student team. I'm the student lead. Today, I'm going to be interviewing doctor Steven George of Duke University. So I'm going to be asking Steve a bunch of questions about where we see the future of physical therapy research. Steve is the incoming Editor in Chief of Physical Therapy Journal. So, Steve, could you give us a little bit about your background.

Steven: Sure, and thanks for having me. It's a pleasure to be here. And I'm looking forward to your questions and chance to interact a little bit. But as to the question of how I got here, it's a very good question. And there's, you know, long, medium, and short versions, I guess I'll give the short version first. You know I started my career clinically back in the days when physical therapists were trained differently, meaning there was not a DPT when I started training and I worked clinically. And then I got very interested in research and my career kind of pivoted to having more of an emphasis on research. I also started to get involved in the journal around that time as a reviewer and started submitting articles. And then, you know, kind of fast forward to the point where I was interested more in in leadership with the journal. And that's kind of how I ended up being interested in applying for the editor in chief position when it became open and was fortunate enough to be selected for that role. And that's where I am now.

Gaylan: Awesome. So my first question for you is: What developments or trends do you anticipate in physical therapy research and how can we get students to actively engage with and contribute to those evolving areas?

Steven: Well, I think you know that's an interesting question. I think I'll tackle the second part first and then you can remind me about the first part if I forget it. You know student involvement I think is probably best done through people that have experience with research and a lot of times that's your faculty. I'm not going to say that's the only way, but you know, I think that's really for a lot of people, including myself that's kind of the gateway drug, if you will, to being involved on your own is through people that have had experiences ahead of you. And in your training, that's often faculty. If you're lucky enough to go to a clinical setting that is really active in research, I think that really is value added because it provides a different perspective. And obviously, you know, people do maybe more concentrated experiences and a specific lab.

So I think it's, you know, the exposure is really important as a student because you start getting an idea of what the options are for research and all the different ways to do it. And often I think that's what is needed is the fit for, you see something and you can see yourself in in that role and doing that type of research. The journal's role on that is I think is because of the, you know, there's a lot of variability, there's a ton of programs and there's a lot of variability in that exposure and how that exposure can occur. I kind of view the journal as almost a form of meta exposure, if you will to completed research, which isn't the whole thing and it should be completed research that's good enough to get into PTJ so it could provide some examples that may or may not match with what you're seeing as you go along training, but I think it is a way to provide that kind of exposure of what a completed project may look like when it's published, you know who are the teams involved? What are the research questions that they are answering, asking and answering, seeing how they were writing it up, things like that.

So really behind there's the boots on the ground, kind of exposure field exposure and then the nice thing about the journal is it can supplement that by, you know hopefully showing really strong cases of completed research that aren't always done by but typically you know are done by a physical therapist doing you know that are acting in that research role. Does that make sense?

Gaylan: So I'm in that kind of piggyback off of that question. So if it was your mission to get students more involved with you, want to focus more on the journal, would you want to focus more on the institutions, would you want to focus more on faculty or would you focus more on the students?

Steven: Well, I think you know it's an all the above. We need all of those channels, you know active and I can't activate them all. The one I have the most control over is you know the journal, right now. So obviously you know in, in, in talking to you and we'll be getting to know each other better as I assume the editor role and you continue your social media role, you know I expect we will have some ways to think of engaging students. You know my ways might be very different than the ways that you're thinking of. I think that's exciting because I do think you know the traditional model of having someone read the journal article does has limited appeal. There still are some people that will access it that way, but there are, you know, there are other ways we can bring people to the journal and I don't think that's the only way. But I think that's the way you know that I have the most control, I also control about exposure in my institution, and that's something you know that we've worked on or I've worked on both at Florida and at Duke to train physical therapists that are really interested in kind of, you know, taking that leap of faith and having their career be heavily research oriented.

Gaylan: So let's rewind the clock back to when you were, let's say you were a first year DPT student. What was your approach to research? What were you kind of thinking about research at that time?

Steven: Yeah, I don't know if your clock goes back that far. But I'll, we'll, we'll rewind it. You know, it's a good question and I think you know this is the point where I should say this is an n of one experience and honest. Actually, my first year as a PT student, I probably was not thinking heavily about research. I was thinking about passing my classes. I was exposed to some research in my program at West Virginia University, but I think I was in survival mode like a lot of PT students. When I trained, there was not as much of an emphasis on research. Evidence based practice was not in in each curriculum because it was a different training model. So I think you, your generation and it's not just yours, it's probably last what 10-15 years, there's a lot more explicit exposure to it, and you know both in the curriculum and also just as a profession, we're more mature, we have more established researchers. So it's hard, you know, to say what I was thinking research wise as a first year student. I can tell you, for me, practicing clinically, for I practiced full time clinically five to seven years in that range. You know that's really when I started thinking about research and in particular you know what are what are the questions that patients ask me that I can't answer and that's when I started looking into the literature to see how other people were trying to answer those questions. So for me, you know, I think the training definitely made me aware of it, but keep in mind it was a different era of training for physical therapists and then, you know, working for a little bit and having patients ask me really good questions that, you know, you would like to think you could answer. But realizing that if I wanted to answer it in a scientific manner, of course I could give them my opinion or based on my experience. But if I wanted to give the the scientific answer that it wasn't there.

Gaylan: So I really liked how you talked about evidence based practice. And kind of how far it's come. You kind of indicated that it wasn't necessarily a big deal when you're PT school. One of the cool things about my school is that they're really, really, really strong on evidence based practice. It's like one of the core themes of our program. I actually learned this week that on average, it takes about 14 years from the time we get the information – so say with clinical trials or experiments – to actually get it into practice in the clinics. Is that accurate with what you've seen or kind of experience?

Steven: Well, I think. Yeah. I mean, I think that's an off quoted, you know, kind of knowledge translation to practice statistic. I think it's one of those things that the variability around that 14 years is probably more interesting than the middle. You know, in my experience, I've seen things that are implemented much faster and I've also seen things that we've known for a while that you know still haven't been fully implemented. For me, the way I think both you know as a researcher and also I think I thought this way as a clinician it's really sometimes that that variability around that 14 years like why are some things adopted much faster and why are some things not adopted at all. So I think there are some good models. And I think in general, some of the lessons we've learned is that you know, sticks tend to work better than carrots and things like that, like when people are given incentives, sometimes it takes a little bit slower, but if the there's a system and often it's driven by reimbursement or policy, that forces some of the change it happens a little bit, you know more quickly. So I think it is one of the interesting things and it is something as a researcher that if you want to try to challenge that 14 year middle estimate, it has to be part of your research program and you have to have a plan, you know for how to move things into practice. We as researchers often like to keep things in kind of a beta test mode and then are less excited about moving it into practice. But if you want to move the needle on that 14 Year and have contribute to some of the variability where it's shorter, you know you have to have a plan to move that research into practice.

Gaylan: So now I kind of want to pivot. I want to talk about your analogy of PTJ to Mark Twain. So I want to talk about the analogy of the water and how you want PJT to be able to tell a new story every day. How does that happen? How as a leader, how can you lead that?

Steven: Well, I think you know, we need to make sure people understand that, you know, PTJ has a fairly broad, you know, interest in topics related to physical therapy and rehabilitation. So we don't want anyone to make assumptions about the type of article. Obviously, we want to provide some guidance and that's why we have you know, instructions for the authors and we highlight maybe areas that we may be more interested in. So we want you know, we don't want people to think that this is a narrower strip of physical therapy and rehabilitation than we want it to be. I think you know, we also need to think about areas where the field is going and where we intentionally want to go. So there may be some areas that we want to solicit, you know, articles from if we feel like they're underrepresented in our Journal but they're an important area to go. And I should say again at this point, although I am charged with leading the journal, these are not decisions just made by me. They're decisions made with input from our editorial board or associate editors, authors, we try to get some information from people other than me because that’s just the best way I think, to represent a journal that has a broad constituency. Where we want to be consistent with the mighty Mississippi is to make sure that you know what is published is represents high level, you know research and that's an area where you know we want to make sure there are certain standards and that those standards are applied in the review and you know I don't want that to be confused with not you know, wanting to have it tell a different story each day. We can still have a good representation of practice areas. We can have a good representation of stage of career for authors. We can have good representation of patient populations and still maintain high rigor in each of those.

So that's, you know, that's how I kind of view it and then my role as a leader is just to make sure that the people making these decisions feel supported and also you know that we're exploring the areas that we need to explore so that the journal reflects changes and adaptations and evolutions in the in the field.

Gaylan: That's beautifully said so for my.

Steven: Thank you.

Gaylan: My last question. My last question. What advice would you give a student looking to be in your position one day?

Steven: That's a, you know, it's a really good question and I you may be able to tell, I'm not a super prescriptive person. I think the biggest thing is you need to get some experience outside of your clinical experience and research. You know the challenge of this is you, you do have to have some experience in one area because that's kind of how research goes, but I think, and this is just my opinion, but I think as an editor, there's some benefit to having broader exposure to different research designs and different research areas. And, you know, unbeknownst to me, my interests, my intellectual interest in pain as a clinician really kind of led to the opportunity to be involved in a lot of different patient populations and a lot of different research designs, which is good training to be an editor without really even knowing it.

So you know for someone just starting out and if they have a goal to be involved, you know as an editorial board member and eventually editor in Chief, I think part of it is to have that fundamental center where you're known for some expertise and then also be willing to explore, you know, other designs, other patient populations because I need to know a little bit about how things are done across a wide area for me to have, you know, some input. I also need to know who can help me when we need to go deeper in an area that I that I'm not familiar with. So you know my thought on that is it's a little bit of you know I need to know enough about some things to know there's credibility or we need someone to further investigate that credibility.

And I think the other thing is it it's really helpful to be curious if you're thinking of because I do constantly learning not only from my own research, but from, you know how other people do things and just to be curious about why, why did they choose to do it that way? Because a lot of times there's a really good reason you know for why someone did something and I don't have to. If I'm curious, I don't have to make the decision without asking them you know why? Why did you do it this way? Are others doing it that way? You know things like that. And then the last thing I would say is persistence is really important because it takes a lot of rejection to build your research record and that's rejection of manuscripts, that's rejection of grants, that's rejection of proposals. So I think that persistence part when people pull up a CV and they see, you know, how accomplished you are or not. There's a reporting bias there because unlike you know, sports and baseball, we don't often list our attempts there so you don't get a true batting average or free throw percentage. So you know when you only get to see the shots that were made it sometimes gives a false impression that you know, batting 1000, but I can assure you it's nowhere close to 1000. And that's something we talk to people, you know, research trainees, because I think they start really paying attention to that and, you know, letting them know that yes, I have that grant listed as funded, but you didn't see that it took me 4 times to submit it to get it. I didn't put that on there. I just put that it was funded. So I think that curiosity and persistence are things that you know can kind of drive you in the direction.

Gaylan: I love your analogy to sports. How you just kind of you. You see, everybody sees the home runs you hit and nobody sees the strikeouts and the at-bats that didn't go too well.

Steven: Yeah, or hitting into a double play a couple times, right? So.

Gaylan: Yeah, well, that was all the questions I had for you. So I want to thank you for your time. And I want to wish you the best of luck.

Steven: I look forward to interacting with you more. You know, I'm. I'm hoping this isn't the last time we're talking together and maybe even there's some other podcast things that we can work on, but I, you know, I'm really looking forward to learning about more about you and your role and keeping the journal moving forward. So thank you.

Gaylan: Thank you.

Narrator: You'll find more APTA podcasts like this one on Apple Podcasts, Google Play, and Spotify, or by visiting apta.org/podcast. Thanks for listening.