Talking All Things Cardiopulm
This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences.The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Talking All Things Cardiopulm
Episode 58: Part 4 Tackling the MOSC: Building your Case!
Are you procrastinating on completing your MOSC application or just feeling overwhelmed? Don’t worry I got you. Check out this 4 part series of tackling the MOSC to help you plan, prepare and successfully complete your specialty portfolio.
Learn from my mistakes along the way, and hit this application with efficiency and confidence!
In this episode, we get down to the nitty-gritty of building your case. Go through section by section, to describe what’s needed and ideas on how to use your ICF and patient-client management verbiage throughout.
Listen for future use OR dive in with me if you are actively completing this process. I promise this is one that you will be able to use for years to come.
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Linked-In: Rachele Burriesci
Text at 913-308-4494
Welcome to Talking All Things, cardiopulm. I am your host, Dr Rachele Burriesci, physical therapist and board-certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation. Thanks for joining me today and let's get after it. Hello, hello and welcome to another episode of Talking All Things Cardiopulm. I'm your host, Dr. Rachele Burriesci.
Rachele Burriesci:All right, so today is part four of tackling the MOSC. I'm almost certain this will be our last podcast in relation to completing the MOSC application, and what we're going to be discussing today is the case. So in my opinion, this is the most time consuming part of the MOSC, and just a couple of like tips leading into this. I probably have already alluded to some of these things, but I think it's important to kind of state them up front. If you're in the process or know that you have to complete the mosque, whether you're at the beginning of the three year window or at the end of the three-year window, if you know that you're in this cycle and you're like I'm going to start inputting, pick a case that will be easy to write about. Pick a case that moves you. Pick a case that you are prepared for. Pick a case that you're going to utilize a number of different skill sets. Pick a case that has maybe some important external internal factors that you have good reflection points on, right, like, at the end of the day, you get to pick what you are showcasing right, and the whole point of this is that you're showcasing your skill set. So you know, pick accordingly. Pick a diagnosis that excites you. Pick a case that maybe like, for instance, if you're in acute care setting I always recommend people who are in the acute care setting to pick someone that you're going to see potentially more than once, or potentially see for their entirety of their plan of care, and if you maybe have the ability to keep a patient, that would be, you know, if you're writing a case on someone, that would be one to do. And then my recommendation is to fill out this case either during the time that you're seeing them or right after, because it's going to be fresh, you're going to have access to notes, you're going to have access to those conversations that you've been having. You're going to be able to really reflect on how you feel or why you chose something in that moment and I think the case will be much more fluid. And the reason why I'm saying I think is because I've never done it this way and so for future cases, this is my plan for future mosques. So I have completed one of three. I have another two cases to write I'm actually going to start my next one, probably after this podcast and they are retrospective.
Rachele Burriesci:So I have some case information from a few specific cases that I thought were important and kind of held on to. I keep everything with you know, major health condition interventions, like a list of things in preparation for this type of you know case or if I'm going to potentially utilize pieces of it for maybe like an exam question or what have you. Everything is redacted, but sometimes a case kind of pulls you. Sometimes you end up seeing a patient for a few days at a time and, especially being PRN, I kind of grasp onto those when they happen. But they are all retrospective. The ones that I have picked. I remember those people, I remember those conversations because they kind of you know, they linger. You had some sort of connection, you had some sort of impact. That really kind of drives you, and so I do recommend, when you pick your case, that you pick one that kind of moves you in some way, shape or form, whether it's a diagnosis that you like, whether it's the story of the person or their improvement along the time that you've seen them, whatever it might be. And then what I do recommend is that if you know that you're going into a case or you're, you know, seeing someone who you think, oh, this would be a really great case to write about, make sure you kind of plan accordingly, make sure that you are utilizing specific tests and measures. Make sure that you are utilizing at least one outcome measure, maybe even two or three, right? Maybe you add some things in as the person starts to progress, whatever it might be, but plan for it, right. This is your case. This is your time to showcase your abilities, your thought process, your clinical decision making, whatever it might be.
Rachele Burriesci:Okay, so we're gonna jump in and I have the kind of case outline pulled out, and I actually decided to do this because I kept getting. I kept getting locked out of my GCS case. So let me actually throw one more piece in here. So if you are an AB PTS specialist and maybe you were never put on the MOSC track and you're like oh crap, I don't know what to do, I'm too late, I'm just gonna have to reset again. I was in that same boat. I told the story a little bit about the GCS. It was not a thing when the when I finished the GCS and so I was never like put on that track and I honestly never took the initiative to like put myself on that track, to like notify ABPTS. Hey, I have this specialty. No one has ever told me to do this.
Rachele Burriesci:It wasn't until I was getting close to that 10 year mark that I was like you know what's the plan here? Like is there any information for me? So when I reached out, they opened the MOSC cycles. So I had to kind of retroactively put information in. So just reach out to them. They are very quick to answer their email. So like shout out to the ABPTS for being really quick on responding. And then I do recommend, if you're doing something retroactively like I have a cycle, that's you know one section before ask them to open it for 30 days. If you don't ask for a specific time, they give you like a week, maybe less than a week, and so if you start to go in and you know you get busy with life and you go back in, you're going to be locked out, then you're gonna have to ask for permission again, so on and so forth. So my recommendation to you is if you are behind, don't panic. Reach out to the ABPTS. Explained that maybe you weren't set up on the track. If you have been locked out of a section, ask them to reopen it. You are not the only one. So I'm just going to put that plug out for you, because you know, sometimes there's not information for your specific scenario, and that's kind of how I felt. Okay.
Rachele Burriesci:So one more piece of like reflection, after having like gone through this now multiple times in the past year. When you're writing your case, sit down and write your case. Don't try to do a little bit here, a little bit there, a little bit here, because when you go back in you're not going to remember which sections you really hit. There is a lot of overlap. So if you're working in it in the moment, you're going to be able to catch that overlap kind of throughout. All right.
Rachele Burriesci:So the case itself is, I believe, nine sections in length. Yes, so there's eight sections, and then the ninth section is considered a summary reflection and that's where you add your references. So I mentioned this in a previous podcast. But as you're kind of writing up your case and keeping track of the things that you're doing, if you utilize a specific outcome measure gait speed, 30 seconds to stand, six minute walk test, whatever it might be start looking up your information for articles that support the use of that outcome measure with that diagnosis, so on and so forth, just like you would be creating a lecture of some sort Of the nine sections.
Rachele Burriesci:There are some like asterisk things that you have to fill out. Essentially, you have to fill out nine sections but you only have to fill out two reflections out of that nine and honestly, the first two don't have a reflection section. Okay, so my first piece of advice, before you even start going through the sections, like obviously, read through it, kind of see where things are laid out. I actually copy pasted the sections onto a Word doc so I could work in my Word doc off of the portal, just because you kind of get logged out if it's stagnant for too long and I can save and I'm not worried about it losing whatever. Read through it. Each section has a section of reflection questions built in to sort of trigger or encourage specific verbiage or thought process and kind of pull some stuff out of you. Most of the sections have some good guiding questions.
Rachele Burriesci:The first section, I think, kind of missed the mark, but we'll kind of we'll work through that. But what I do want to say is, before you start filling in the mark but we'll kind of we'll work through that. But what I do want to say is, before you start filling in the sections, I highly recommend that you fill out the ICF chart first. And the reason why I recommend that is because that's going to lay an outline, a foundation for you. And so if you have that created and you sort of just kind of have it up on a second screen or even if you print it out, it's going to make your flow and your other sections much more fluid, and then there's going to be less going back and forth, Plus, you kind of get your ICF verbiage out of the way and you can keep plugging it in throughout the case. That's really what I recommend. That's what I'm going to do in my next case report, all right.
Rachele Burriesci:So the first section is the health condition section. As we talked about last time, the health condition is really just that diagnosis, cause injury. Medical piece that opens the plan of care for your treatment. Okay, in the health condition sections they want age, gender, disease disorders and injuries medical diagnosis like your past medical history. The idea of it is that you know it's the initial data gathering kind of thing. This is like the opening sentence Patient is a 38-year-old female with past medical history of asthma, pots and migraines seen in this setting for recent syncopal episode. Okay, so that would be like your opening statement.
Rachele Burriesci:They give some suggested or guiding questions in this one. In my opinion I think it's a little bit off kilter, like it doesn't really help you in the setting. The first piece is that it's an initial data gathering, that initial interview stuff. I'm with you the symptom history, mechanism of action, that kind of thing. But the suggesting questions is asking you about how might your personal biases or some assumptions affect your interview? What is the value of the data that you gathered? What are some of the judgments you can draw from the data? In my opinion, this one the suggesting questions kind of, is a little off, because this is like that opening statement. Keep it simple, keep it factual, give your information. Patient is a blank year old gender with this past medical history presents with these signs and symptoms and is seeing you for this reason period. There's also no reflection section on this first piece, so you don't have to go any further, you just have to give the facts and in my opinion that's a great way to open a case. So move on from it, don't overcomplicate it. My opinion that's a great way to open a case, so move on from it, don't overcomplicate it.
Rachele Burriesci:Section two is generation of the initial hypothesis or the PT diagnosis. So now this is asking you about body structure, function impairment, activity limitations, participation restrictions. So again, this section does not have a reflection. It does have some suggested questions. It states things like can you construct the hypothesis based on the information you gathered? What is this based on your biases or experience? How did you arrive at this hypothesis? How can you explain your rationale? I kind of feel the same way about this section. Those questions are a little bit more leading, more reflective. There is no reflection section, so I really would give your PT diagnosis Patient presents with impairment of gas exchange, impairment of ventilation, impairment of aerobic capacity.
Rachele Burriesci:In the setting of COPD, cystic fibrosis, heart failure, you know, fill in the blank, currently limited by impairment of strength, impairment of balance, resulting in multiple falls, like whatever that piece is. Give that PT diagnosis statement Patient. Then give your hypothesis to it. Patient shows good prognosis due to motivation, prior level of function, external factors including. So you're kind of using that ICF terminology to get your point across. So there are some suggested questions at the end that I think help lead that like how might the external factors affect your exam? How might internal factors affect your exam?
Rachele Burriesci:I would like again we've talked about this before If patient comes in with some sort of limitation due to maybe a new surgical precaution, and that patient maybe is older, and so let's just give an example patients, an 80 or 80, 88 year old male, status post fall resulting in a right hip fracture, now status post, you can either say posterior total hip replacement and then they have those precautions. Or maybe this person now is status post IM nail and something else resulting in non-weight bearing 88 year old male, non-weight bearing is going to have a lot of limitations right Now. This is a very different hypothesis based on external factors. What does their home look like? What does their support system look like? You know what was their prior level of function. All of those things really play into your thought process on that overall picture. So I think pulling in the internal and external factors and prior level of function can really give a good initial hypothesis in that PT diagnosis piece.
Rachele Burriesci:But again, there's no reflection. Keep it straightforward, you know. Stick to the facts with that one. Section three is where the reflection piece starts to build and again, you only need to complete two reflections and I'm just going to double check myself. Yes, two focused reflections, so you could do more, but you're required to do two, just checking myself. Yep, two. Okay.
Rachele Burriesci:So section three is now entering the examination portion of the case. This is your section where you can just list out the tests and measures that you performed and the findings that you found. So the section itself is very straightforward. You list the tests and measures you performed and what they were, so blood pressure, heart rate, respiratory rate, whatever. And then because I typically do like pre during post, I would have that trend Maybe you have MMT in here, maybe you have a specific balance test, maybe you did a specific special test for something orthopedic related, list it. What was your finding? Just facts, just like you're writing a note right, like, this is just the black and white objective information, and then there is a reflection piece here and so some guiding questions on that reflection is simply like how and why did you select them? Why did you pick these specific tests for this specific patient? To me that's a very straightforward question, very easy to kind of give your rationale here. You can then reflect on these tests and how may they support or negate your hypothesis. Does it help you? Did it help change your mind? Did it help kind of point you in the right direction? Do they have a minimum clinical important difference? Do they have a minimum clinical important difference? So, starting to pull some of that outcome measure information out of this piece, how did you organize the examination? Maybe the order of how you performed each test and measure was important or specific, for whatever reason, and you could talk about that as well. And then, how does your selection of tests and measures relate to the patient goals, right, so they can have a very nice overlay. And then you can have that discussion In section four.
Rachele Burriesci:This is actually where you are going to upload your ICF chart. And then also there is a small section that you have to fill in on that piece. So you upload your ICF chart and then you have to do a small interpretation of your clinical findings, diagnosis and prognosis, so like there's like a small section that you can reflect on your ICF chart here. And then again there's a reflection section and this might be a good one to tackle because it kind of gives you room to talk about why you wrote the PT diagnosis that you did, why you have this initial hypothesis. What's another good suggested question in here? How might other factors such as bodily functions and environmental and societal factors affect the patient? So again you're taking internal, external factors at ICF terminology and how it's going to impact that hypothesis. What's your rationale for the prognosis? Right, there are times that we say, like, prognosis is good because X, y and Z or maybe patients near baseline level and doesn't show good potential for progress. Why, right, Give some of that rationale. And then there's even a suggested question about behavior and motivation readiness. We all know that that plays a huge role in recovery, right? What is your patient's buy-in at this point? And if you have a case where maybe the patient isn't bought in but the family is the one who's kind of pushing this plan of care, you can discuss why maybe you have a poor prognosis right, so you can throw that into the mix. So I think that section actually leads a really nice reflection point.
Rachele Burriesci:I'm trying to see if there was something else on that section four piece that I was missing. Hold on, I'm going to let it load. So apologies for the delay. I've probably been logged out a whole bunch of times now. Yeah, this is the one. Yeah, this is the one. It gives you a section for entry, so like a typing section, and in that section it wants you to talk about, to basically write up your assessment, your synthesis right, so kind of pulling in that thought process from your examination and such into leading into that prognosis piece. So again, there's a little bit of overlap on how they ask the questions, but in theory that evaluation portion is really where you're synthesizing the information and giving your perspective.
Rachele Burriesci:Section five is your plan of care. So you're going to list out short and long-term goals. I recommend that you write you know how many days or weeks you're including in the short versus long-term goals. I want to remind you that typically when you're writing goals, it should be objective, measurable and functional and, of course, timely right. There should be a time component to it. So try to throw some function into it. What's the why? Also, make sure that you're including your patient's goals in that or writing them to reflect your patient's goals.
Rachele Burriesci:In this same section you're going to identify outcome measures potentially, and PT prescription. So your frequency, intensity, how many days a week, how many times a day for how many weeks, that you know that statement. That's going to look very different between settings. So whatever it is that you are recommending for this person In the world of outcome measures in this section see, outcome measures kind of comes in quite a bit. This would be showing that change over time. So, like, what outcome measure is really going to be your? Tell that we've made some clinical improvement as a good MCID. So just make sure that you're thinking about your outcome measures before you pull this information into the case and there is going to be some duplication of information.
Rachele Burriesci:This also has a reflection section and in this section it tells you or some suggested guidances how have you incorporated the patient and family goals into the plan of care? How did the goals reflect your examination and evaluation? It wants you to use ICF framework. Why did you choose the PT prescription that you did? Okay, and then again it pulls in personal, environmental factors into that plan of care. I would also add discharge, right, like what's the plan for discharge? So, again, that's going to look very different from setting to setting. Like what is it going to determine what's the plan for discharge? Are they discharging back to work, to school, to sport, versus to home, to sniff, to acute rehab? Right? Having part of that as your plan of care should also be included. And then why, right? So I think that could be another great reflection piece.
Rachele Burriesci:Section six is called interventions, and so, essentially, you're going to list out the interventions that you plan to perform, have performed, however you want to write that. It also suggests that you write it as your approach to the interventions, prioritizing specific interventions. Describe your plan of progression. How are you going to progress said intervention and then any educational interventions, and so I think, as pts, we do a really great job with this. There is definitely going to be some education component in your session. This is where you would add it.
Rachele Burriesci:Um, this also comes with a reflection piece, and this one has quite a number of suggestions, including types of strategies like motor learning, principles behind your interventions, rationale for the choice of interventions, um, how it relates to the primary problem utilizing ICF. Um, how might you modify your interventions for the patient and or caregiver? What's your criteria for modifying? Do you have to coordinate anything? How do you ensure safety communication between team members? So this one could take lots of different formats.
Rachele Burriesci:Don't try to answer every question.
Rachele Burriesci:Pick.
Rachele Burriesci:You know the interventions that you're choosing.
Rachele Burriesci:Why did you choose them?
Rachele Burriesci:How are you going to progress them? How do you choose to progress them? What's your strategy behind your intervention choices? Do you have a specific strategy style? What have you? Are your interventions evidence-based? Those things are things that you're starting to pull for later on, right? So if there's a specific intervention that you like to use I think RMT is a really great example, right? There's lots of literature on benefit of RMT for a number of different reasons, right? So I could work that in if I utilized RMT with a specific patient and then like what was my? Why? Why did I choose it for this patient? What does the research support? So you could throw that reflection piece in there. I think you can spend some time on that one. Don't go crazy. Just stick to the facts. Stick to what you did, think about why you chose what you chose and then you know, literally describe that process.
Rachele Burriesci:Okay, section seven is considered re-examination and basically it just says when and how often. And basically it just says when and how often. So that could be as simple as every 30 days, right? So it doesn't really indicate that you need to now discuss what you did on re-examination In the acute care setting. This might not ever happen, this may never come to fruition. So I think this is one of those things that you could kind of just keep it plain and simple. Like, typically, at 30 days is a normal re-exam time, and so you would just write that. And for me I wrote especially I typically write because we're in the acute care setting.
Rachele Burriesci:Although it might not be an official re-examination, you might be adding examination tests and measures as the days go on, because person has a long length of stay. You are performing pieces of the examination daily based on the person's tolerance, and so I throw that in because I think that's an important piece, right? Like on eval, let's say, I have a patient in the ICU who might still be vented or attached to CRRT. I might not be able to do a full test and measure list that I would normally perform. But as the person starts to progress, I may start adding in some of those exam techniques. So maybe I never see them at the 30-day mark or they discharge before that time. But there were still some things that occurred to basically reassess, re-examine. So that's kind of where my reflection comes in on that, because that tends to be a commonality in my patient population.
Rachele Burriesci:Again, this has a reflection piece. It has lots of guiding questions Evaluate the effectiveness of your interventions. Did you need to modify anything? So this is a good time to say, maybe, that you are seeing this patient on an outpatient basis one time a week and now you hit your 30-day mark. How are those interventions doing? Are they effective? Did you need to modify? Did you need to progress? So there's a lot of ability to kind of reflect on this piece.
Rachele Burriesci:Even though the section the like the mandatory section doesn't really necessitate a lot of information, it gives you the opportunity to say maybe that you overlooked or misinterpreted something or over or undervalued a piece of your exam, Maybe how your therapeutic relationship has changed the interaction between patient and caregiver right, it depends on the scenario. So it gives a lot of room for your take on the situation. So you know, you can kind of run with that one or you can keep it simple Re-examination, when and how often, when Every 30 days, continue throughout, right? Okay, section eight is outcomes. So again, outcomes is back. This one has its own section.
Rachele Burriesci:So describe outcomes that you used of physical therapy, and then this is where they want you to incorporate discharge plan which includes follow-up appointments, where they want you to incorporate discharge plan which includes follow-up appointments, equipment, schoolwork, schoolwork, community, or like re-entry into sport, for instance. So this is kind of black and white. What outcomes are you utilizing to make certain decisions? What is the plan? And then it could say, like what was the outcome of therapy? Right, like what was the overall picture? Were they able to return to sport, return to work? In what timeframe? So you can kind of work that either way In their guiding reflection it kind of gives that same nuance.
Rachele Burriesci:So, was PT effective? What outcome measures did you use to assess the outcome? Right? So it throws in the outcome measures to determine if the outcome was met. Was minimum clinically important difference met? So that is a very, you know, straightforward question. Were they able to return to work, sport, whatever they're doing, in what timeframe? Was it the timeframe that you expected? Did it meet your hypothesis, your prognosis, your plan of care? What might PT look like in their future? Do you have any follow-up plan for this person? Did you have to order any specific equipment? All of that so you have a lot of room for reflection there.
Rachele Burriesci:When they're talking about outcomes of physical therapy, they're talking about the end result and within that end result they want you to talk about the outcome measures that you utilize. So you can see there's some like semantics with words and and things like that. The guiding questions for the most part are very helpful to kind of lead you in the right direction pretty much throughout the whole case, and then the last piece is an overall summary reflection. So basically, this kind of gives you again some room to talk about the whole experience. What was your impression from working with this patient? Did this patient change the way you do anything in the future? Was working with this patient? Has it affected your clinical practice? How does this patient inspire you to advance your expertise or something there's like what's the impact of this specific case on you?
Rachele Burriesci:And typically and this is why I said what I said in the beginning you want to pick one of those cases that really kind of moves you a little bit so that you have some you know passion behind this write up in some way. Right, you have some feelings about it, you have some opinions this way or that way it was really good or it was really negative. Sometimes those polarities can like give you some good reflection points. And then the last piece of this is references. So you need to list out your references for the case. The references should reflect your interventions, your outcome measures. I think those are usually the big areas that you can reflect back. Maybe there's a diagnosis like a clinical practice guideline, like heart failure would be a really great example. I would include my clinical practice guideline for heart failure and then hopefully my interventions and things that I was doing reflects the guidance presented there. Okay, we made it through that whole case. So hopefully going through ICF verbiage and patient client management verbage was helpful before going through the case.
Rachele Burriesci:I think if you're trying to do both at the same time, it's just like too much information. So if you are going to sit down and do this mosque, highly recommend that you listen to ICF and patient client management model before you sit down and start writing up your case. And if you're going through the other piece, part two, just play it. While you're kind of going through it, stop and play, stop and play. Guide through that and you're going to be good to go. If you do this over time or you're planning to do it over time for your future, listen to it now, kind of have an idea of the things you need to collect as you're going through your years, or maybe look for opportunities to step outside your comfort zone, right, like maybe you have an opportunity to teach a class or guest lecture or run a lab or help in a community, something or other. But it sort of makes you think about what kinds of things or what kind of goals you need to set for yourself in order to have some variety in your practice. So that will help you. And if you're kind of last minute like I am, truly, and you're working through this, have a listen and work through it as you're going. So hopefully this was helpful.
Rachele Burriesci:Let me know if you have any follow-up questions. If you need help on a one-on-one basis, I'll have my meeting link down below. If you enjoy this or you know someone else sitting for the mosque, please share it. If you enjoy this or you know someone else sitting for the mosque, please share it. And if you want, drop some stars, write a great review. It is greatly appreciated. Thank you so much for being here, Thank you for listening and being part of this, and I hope you have a wonderful day and whatever you have to do, get after it.
