We're thrilled to welcome Dr Fiona Moffatt to Episode 6! In this episode, Fiona shares her remarkable journey as a physiotherapist and delves into what drives her passion for teaching today. She also discusses her extraordinary research and emphasises the significant role that sports rehabilitators and physiotherapy students play in making a global impact.
This is an episode you won't want to miss!
We're thrilled to welcome Dr Fiona Moffatt to Episode 6! In this episode, Fiona shares her remarkable journey as a physiotherapist and delves into what drives her passion for teaching today. She also discusses her extraordinary research and emphasises the significant role that sports rehabilitators and physiotherapy students play in making a global impact.
This is an episode you won't want to miss!
[Seven Dark Lords - Glad Ghosts plays] Hello and welcome to It's Not Just Physio podcast with me James Coughlan. This podcast is designed for listeners to get to know, our wonderful staff and students within the school, at Health Sciences of Nottingham a little bit better. And I'm absolutely delighted to have Fiona with us today. Hello, Fiona. Hi, James. Have you been on a podcast before? No, no, it's all new. Great. That's all right. I'm a bit scary. Oh, don't be scared of this. Don't be scared. Moaning a little bit now. But before we had someone on before who said they had been on a podcast. Not completely. Not scared me. So this will be all great and all fine. So let's get into it. Fiona, tell us a bit about who you are about yourself and let's kick it off from there. Okay, well, obviously most of the people I guess, who are listening will know me as a lecturer, academic, whatever you want to call it, whether in School of Health Sciences and as a physio. I've been here, since 2013 officially, but before that I was a practicing clinician who contributed the program for a lot of years. you know, prior to 2013. So I suppose, that about me, personally, a runner that's my passion. I grew up in the Lake District, so I prefer not to run on roads and definitely a trail and fell runner. in terms of, you know, me as a physio, I was actually reflecting on this last night, obviously thinking about coming and doing the podcast today. And I was trying to think, how did I get into physio? Because it's a bit of an odd one. Never had physio. I don't think any of my family had ever had physio. and I suspect it was one of those things through careers advice and those kind of bizarre aptitude tests you used to do that's directed you in one way or another. But as soon as I managed to get a little bit of work experience and realize what physio was, I knew it was for me. loved being with people, working with people. I love thinking about how you bring out the best in people, how you support them. You nurture them. and so that's what got me into physio and space, ironically, the same kind of thing that got me into education as well that I idea of nurturing about sharing knowledge, sharing skills and supporting people just to, you know, to achieve and achieve well and achieve highly. Well, I mean, it's funny when you just mentioned aptitude tests, I remember doing those at school about what wants to be. I always remember I think the outcome of mum is to be offensive rector. I think that was always the the outcome. If you've wanted to do anything relatively sort of, you know, practical or anything like that. So and have you built my defense system? Well, still it's still so it's a happen. but that could be a project for, for next year. But so that's really interesting. So as you said, there have been no really sort of influencer physio on your, on your life, but you wanted to do all this stuff and it seemed the way to go. So where did you, where did you, where did you study and train and you get. So I studied at University of Manchester. and it was just, it was just as the, the first degree programs in physio were coming out. So it was really exciting time. and, I loved, loved my undergraduate years, loved being in Manchester, which I know you particularly will be glad to hear. you. Yeah. And so finished in Manchester. Came back to work at Nottingham. Oh don't. Came back. Came to work at Nottingham. and I worked at City Hospital for a while and that was where I made about two hours. Ten some of the students the other day, the first time as an undergraduate, I sat in a lecture and they talked about sputum, and I was like, no, never, ever will you get me involved in that? And then I got to City Hospital and of course, I started doing critical care, started doing thoracic, started doing respiratory medicine. As I actually and quite enjoy this. so I work there and then I went down to Oxford to do yet more respiratory. and I did, again, such a critical care surgical cardiothoracic type focus had an amazing time that, people created such wonderful opportunities for me. So, I got to go to San Francisco and work over in a cardio, cardiac surgery unit in San Francisco for a while. I got involved in this amazing research trial which was looking at, essentially external, left ventricular assist devices for people who weren't eligible for cardiac transplantation. And as a result of that, completely as a, you know, complete surprise to me, went to collect the paper one Sunday morning and found myself on the front page of the Sunday Times, the big image where this the, journalists had been in to capture this moment of this, you know, very significant research project, and unbeknownst to me, as I was just doing some rehab with this patient that had been papped, I think this. So how did I, I mean, I must have been a bizarre, amazing. Well, seeing your face on the front of a national profile. Hey, have you still got a copy of it yet? Somewhere, it's hidden somewhere. It's. Yeah, it's not my best. Look, I have to say, but it was. Yeah, it was completely random. And you sort of look around in the shop as if to say. And because that's when we still bought papers. Don't do that as much now. But, yeah, that was, that was an odd one. And then whilst I was in Oxford, I went to do, I did a masters in Human Physiology. I don't know if I should admit that because I'm going to get all the physiology teaching consent. in London. So again, you know, just amazing time down there and then and then I came back up to, to Nottingham to work in critical care. and I'd been there a little while, and it was at the time when there were real issues in critical care across the country. really high profile news cases as well. You know, it was sort of a real sort of public concern. Not enough critical care beds. probably suboptimal care at ward level that was contributing to, you know, to the situation. and so there were lots of changes within critical care, which included the development of critical care outreach services. And we had some really, really forward thinking consultants, who said, you know, these services should be offered by nurses and physios. So, as far as I'm aware, I was the first physio in the country to do critical care outreach. And across this, hundreds of people now doing it. But again, that was quite a leap of faith. Because it meant being employed by critical care, not physio. So that felt a bit, you know, bit wobbly about that to start with this. But you know, it was a great move. I learned so much, learned so much from a nursing colleagues. and you know, was able then to move into, you know, an extended scope kind of role. and yeah, and then so did that for about ten years. and at which point, as I say, I had been contributing to teaching all that time, but thought it's probably time I got myself a PhD. So, as you do. Yeah, yeah. The university quite keen on people having PhDs. If they're going to want to teach, they, again, another complete leap of faith. So I gave up my job and got a full time studentship to do a PhD, which was in health care but rather tangential. So, my PhD was in an emergency department, and it was an ethnography, which basically means you kind of move in and live there for a bit. Now, you know, literally. But, so that yeah, that was another eye opening moment, spending lots of time in the emergency department and watching how things happen. And, you know, obviously collecting data for that. So so when I finished my PhD, I came to work officially for the university, and have been here since. Where did you do that work? In the emergency department. Why was that? I don't know if I can say. Real barrier for it. It was a large trauma center, let's say. Okay, which which again, you know, it was part of, you know, I've worked in health care for. Eleventy billion years. You know, I, I am old, I don't mind saying so. I graduated in 1991, you know, did my undergraduate undergraduate, was complete in 1991. So I have had, you know, worked in all areas and with all sorts of people that, you know, some of the stuff I saw in the emergency department and the teamwork and the leadership, particularly in those situations, you know, the military kind of position and the communication, the the human factors stuff that goes on there. I learned loads from that. and hopefully that that's what I try and reflect in my teaching, you know, show the, reasoning skills and, technical skills are super important, but it's all those human factors skills, the leadership, the communication, that I really try and, you know, impress upon our students. I, I want to, pick certainly those things you've just said that I absolutely agree. I think that's very evident with the way that you teach and what's come through on the program. It's what makes this program such an inspiring program to be a part of. With those experiences that you've had with those kind of research and those things, is there anything that you can point to today and say that is a result of some of the work you did years ago? Is there anything that you can point to and say? The things we probably assume have always been there were there any key changes as a result of that? You went, oh yeah, that that started to do that as a result. Yeah, I would, I think, you know, a lot of the, the work we've done over the years about so a qualitative methodologies, not always have been, but kind of more recently. So a lot of the research I do is about understanding situations, phenomena, whatever you want to call it. From the perspective of the key stakeholders. So really understanding lived experience for patients, for health care professionals and making sure that things that we change or things that we implement are based on things that are meaningful and matter to those individuals, rather than somebody sat in the ivory towers of academia. So, you know, I think this is probably a good idea. So I suppose, you know, ensuring that our research and our practice is informed by what really matters to our patients and to our workforce. so, you know, the ways in which we manage people in pain, you know, not just jumping in and, you know, offering strategy solutions, but actually listening to what matters to the patient, unpicking what's happened to them over the years and the narratives that they have. Oh, that that, you know, that the information or the narratives that they've been given that they've had, that they've interpreted it in a particular way that have been far from helpful and have impacted adversely on their lives. So, yeah, that that kind of thing of taking that time to undo that. And, you know, present, I suppose, an alternative for a patient and empower them and engage them to be active in their own self-management. You mentioned yourself being a qualitative methodologies, which is and I think what you just said is so interesting because some of my experiences in healthcare, it's not the qualities safe side, but it's the quantitative. So it's all statistics, it's all, you know, in a way. So patients become numbers and it's all about that. How does that make you feel when you see decisions that have been made, which have always, often based on the numbers and not the quality and not the the history of the patient and the feeling of pain, how does that make you feel when you when you say that? Yeah, it's for soon. And actually that was a lot about what my PhD was about because it was about looking at how people move around the emotions departments. It's very much driven by key performance indicators. How quickly can we get people in? How quickly can we get people out again? to and you know that the I can't quite remember the talk in my PhD, but it was about challenging that production line mentality. and of course, the stuff with, you know, very much of the same opinion, but, you know, the system is it's that kind of iron cage of bureaucracy, isn't it? It drives us to do things, and to meet certain, performance indicators and objectives that don't necessarily align with our professional values. So that's a bit of an aside, but yeah, absolutely. And it is hard. you know, we there is still obviously a huge bias towards quantitative data. And don't get me wrong, I'm not saying we don't need quantitative data. Of course we do. I do think there's been a shift. And I actually think there's been a shift since I, did my PhD. You know, there's an a marvelous quote somewhere. Forgive me. I can't remember who did it is it's in a sort of pretty, famous qualitative text where it says that, you know, this history of, somebody talking about, quantitative and qualitative work and one being the work of the devil and the other being the proper way to do things. and thankfully, we have moved away from that, clearly qualitative work being the work of the devil, but, but yeah, I think we're seeing much less of a publication bias towards quantitative. It is easier to get qualitative work, published now. And I think people are starting to understand the place and the purpose of qualitative research. you know, we've seen that with, you know, the MLC guidance and, you know, the the idea that, you know, mixed methods, research is the way forward. It's no good, just sort of understanding the effectiveness of of a particular intervention. We need to understand, you know, how that's going to land in a clinical service. You know, what's the impact of that's going to be who is going to influence who it's going to affect? You know, just because it's effective doesn't mean that it's going to get normalized in practice. There are so many sociocultural factors on which its implementation will be contingent. And, you know, again, that's been a large part of my my research, looking at what makes something work and what makes it not work. Once you put it in practice, might look beautiful in a clinical trial, but in the messy, murky world of reality, you know, things don't always translate so smoothly. And I guess, as you say, that what is the effects is is a big thing as well. What is the what is the effect we're trying to make change, improve, enhance. And people have different ideas of what is effective and what should be effective, right? Yeah. And again this goes back to my comment about academics. Sitting there over time is going well. It's really important for patients that we do this. So it's really important for staff that you know we we do it in this way. Well has anybody asked them what matters to you. Yeah, absolutely. Absolutely. And I think alluding to that, that sort of navigation, as you said, about of finding these different levels of data and insights and trying to work with that. But obviously there can be constraints within places in clinics and places where we work. That's something that I see quite clearly in the way that you teach and you bring through to our students of trying to give them some sort of navigational skills and leadership as well. And I think that's something you feel quite passionately about. Yeah. So for many years I've worked with students. So I have this real passion about students as leaders, because I think a lot come in with the mindset that might just want to be a band. Five physio and then say to them, but you know, it's a band for physio, you're a leader, you're a leader in that interaction with your patient. You're you're leading them, you're guiding that individual. You're you're empowered them. You might be an advocate for them, but even as a student you know you're doing that. So, one of the things I've really tried to do is look for leadership opportunities for students. So we've had some amazing things that have happened kind of outside of the curriculum. So we've had students organize students as leaders, conferences for other students. I've had a student who, coauthored a text book with me. so it's a, a guide to clinical placement written for students by students. so, you know, things like that to really just harness students enthusiasm, harness their abilities, and show them what they can achieve. and we've just introduced a new assignment, which, you know, for one of the new modules for the new program, where students at the moment are writing their five year manifesto. So I keep saying to them, it's in my head, it's not a reflection on clinical practice. You're looking forward, but thinking about the impact and the reach that you could have over the next five years. So finishing your your degree and then moving into that kind of early career, and then coming to me at the moment with their, their ideas, oh my goodness, they are absolutely amazing. I'm so inspired by them. And I keep thinking, if these students, even if only 10% of these students actually deliver on this over the next, you know, five years health care and physio and support rehab is in a really good place. You know, the creativity, the humility. you know, that these students are demonstrating is is really exciting. so, yeah, so I'm a huge advocate of students and leaders. and it's it's really important to me. And, you know, one of the develops we've made, which I suppose is aligned to that is the development of the education placement. so just over a year ago, we introduced this, and it came off the back of the curriculum redesign because we really wanted that to be co-produced. We wanted student voice to be kind of with our practice partners and our patients. We wanted those voices to be first and foremost, for the reasons that we've already been discussing. and the students were so engaged and so helpful in that, and we kind of said, why aren't we doing more of this? You know, why aren't we co-producing more? So we we launched the education placement. And, well, I've just been thrilled with how that's grown, how that's developed. it has been just amazing working with all the amazing students who've been through the placement that just phenomenal. They have created the most amazing resources. They've been working with Hallam to create resources for other students. and but also for our clinical educators as well. So again, you know, they're demonstrating these leadership qualities. They, you know, that they create in a real legacy for future students and for future members of staff. and, you know, I hope that they're really getting something from that that you know, that certainly the feedback for, you know, has been, you know, has been excellent. and, yeah, hopefully we've encouraged our students, maybe not immediately, but to think about academia as a career option in the future. But even if they don't come into academia, they're taking all those education skills into clinical practice where hopefully they will be clinical educators for all physio and support rehab students of the future. I think, you know what's evident. And this is on the on the podcast with with with Roger and let's get your thoughts on it. But seems very apparent health care is changing and so and you've all your career you've seen this from you know over you know, many different areas and physio I think sometimes and constitute itself in the I think sometimes it there's times we try and make step forwards and it sometimes shows. We then get we do something that then brings us back and we sort of can't let go of maybe some things we, we liked in the past and it, it seems a little bit at the moment in a little bit of flux. But what seems really evident from, from, from what you say and what you're clearly doing is creating these leaders to go out and try and break boundaries, create new ideas, because it's a strong document. We need to be doing this because the system we probably grew up with a new it's not that anymore, is it? No, no. Absolutely no. And you know, this comes back to the assignment I was talking about. It's about going out there and looking for opportunities and looking at that constant critically, what are we doing and what could we do better? Are we meeting the needs of everybody who's in my clinic, but more importantly, who's not in my clinic? And why aren't they in my clinic? You know, other issues with accessibility? we do. We've been doing a lot of work recently, a lot of research around health literacy, which, again, you know, something I thought I understood. Well, I do understand, but didn't quite realize they did. You know that the full impact, I suppose, of that we've been doing a lot about, you know, around physical activity and that sort of, you know, health literacy around that and particularly around blue space and, you know, swimming outside and all those kind of things that are really popular. And you make that assumption that, well, of course people can, you know, why wouldn't they go and walk by a nice body of water or why wouldn't they? You know, go and try some open water swimming. You know, we know that that isn't a possibility for everybody. It might be around accessibility. You physical accessibility, it might be about financial accessibility. It might just be that we've not created a narrative. As you know, health care professionals or health advisers that, you know, that's something that is for someone like you. So we need to, you know, we just need to be more creative. We need to, you know, ensure that everything that we do is really equitable. we, you know, the thing that keeps, one of the things that keeps me awake at night is, you know, the kind of growing health inequalities, you know, and that's a real concern. And it's a real passion for me, again, to get that across to our students, to say, you know what even little thing could you do? You know, even if you just help one person, then that one person can go on and help, you know, and then it's that domino effect, isn't it? so yeah. Yeah, absolutely. And again, we've been talking about that throughout. I try and the students are probably sick of me because I, you know, try and sort of bring that into to all these different modules, about, you know, think about your influence, think about your reach, think about your impact. and what can you do just to level up, I suppose, and make life a little bit better for somebody who hasn't had the advantages that a lot of us have had? Know, how do we make sure that everybody has the same opportunity to live a healthy and fulfilling life? Absolutely. And I think that's the role. That's the future of physiotherapy. That's our remit. That's, manifesto. Yeah. absolutely. And I was just going to ask, if you may, you made a really good comment about trying to and, you know, saying, look, we can maybe change someone's life or help someone's life and they may then go on and, you know, that kind of domino effect to such as so many examples that you might have had of something where you've done something it could been recently can be back when you in clinical practice that you thought, oh yeah, that, that that was one of those moments. Oh gosh, you put me on the spot. Now. I don't know. I think I like to think, I suppose it's that pay it forward, kind of mentality, isn't it? And I think one of the things that's really important and has always been really important for me as a clinician, as, an academic, as a researcher, you know, as somebody who holds like a strategic, you know, leadership role within the school is about just a bit of humility and a bit of kindness. you know, one of the things that I always said to students as a clinical educator is, you know, welcome. I love having you here, and I hope to learn as much from you as you learn from me over the course of the next, oh, 5 or 6 weeks, whatever. and I've tried to practice that, you know, throughout my career and, and even now, and I've had, you know, students who've come back to me years down the line as educators who've said, you know, we do that now, too. You know, dad, I hate that whole didactic power, dynamic situation. You know, nobody learns in that kind of environment. So I hope that perhaps I've spread the love a bit and shared that. And people have adopted that kind of approach to leadership as opposed to didactic top down command and control, where generally people don't thrive. Yeah, yeah, I think that definitely happens. I think your outreach, your influence has been massive. And even I can say on a personal level, I was sadly, I wasn't taught by yourself. I wish I had been, but even when I was working and I was thinking about academia and things like that, and then we got in touch, you know, and it was even you, you know, you aren't really known me, but you were still like, you put your time and effort into me. I remember those discussions and chats even that was many years ago now. And kind of look what sort of, you know, you stuck with me here for a bit. I think, look what happened there. So I think that it's evident in what the students say in that outreach is, is just fantastic. And I think that seems to be such a big part of the new course. And you know, we've had this big change around this year. and that's really kind of the, the long term. Well, it's a continual work in progress, isn't it. But that's for long term. So vision. So, you know, where do you, where do you see things sort of going in the line of what you said about leveling up. And that's where physio needs to be. I guess that is the big picture going forward now rather than the conventional just muscles and bones, I guess. Yeah. And I think one of the things it when I went to work for outreach and you know, as I said, we had this consultant who, you know, was really forward thinking. And one of the things he said, just really, really pro physio, as a medical student, I believe, had had like a month's placement on a neuro rehab unit. So I had really got good insight physio. And they said, you know, one of the things I really, really value about, physio and, you know, obviously I'm including sport rehab in this unit because they're taught in a similar way, other clinical reasoning skills and the ability to really problem solve, and to work in a team. And that was their rationale for saying, I think that's why we should have physio in this outreach, this new outreach service, which obviously covered a whole trust. and I think, you know, to some extent that's where a strengths like and, you know, I am not belittling our technical skills. Of course I am not. but I think we are so much more than that. I think we have huge capacity to, you know, identify and work with a whole range of stakeholders across networks. I think what we need to do is think more creatively about who our stakeholders are. you know, it's not going to come as a surprise if I say, you know, there is not enough money in the health system and there never will be. There will never be resources to meet the demands. The demands will always outstrip that. So we need to think differently about health. We need to start working creatively with our, grassroots, you know, community based groups, who are supporting people in a really effective and efficient way. And so we need to be working together, you know, that I've worked with, so I mentioned that I've been doing work around blue space and open water swimming. So, you know, I do a lot of work with Swim England. you know, we've been saying, how can we work together to improve opportunities for people with long term conditions? So we've been creating a whole host of resources for, you know, how to get back into the water if you've had a stroke. In fact, one of our sport rehab students, helped us write that one of our alumni might, you know, we've been, working with an amazing, absolutely inspirational woman and group, called Mental Health. mental health swims. And again, this is a group based on volunteerism and communitarianism. They come together, there's over 100 sites around the UK now. Just started from a small group of people who said, you know what, when I get in the water, when I get in the cold water, I feel better. You know, my anxiety reduces, I feel less depressed. And actually if other people join me in that, even better. So they meet on a monthly basis supporting each other. So it's things like that, you know, physios, we should say no, we couldn't say these things are amazing. They work really well. How can we feed into those? How can we feed our patients into those? How can we contribute not takeover. You know, they they do what they do really, really well. And but how can we learn from them? How can we collaborate and work together. And I think that's the future. And that addresses those kind of financial issues. We, we we are more creative. We need to use those. you know, there's community based assets to support the more sort of traditional health care. And I think getting our students exposed into thinking like this now can only be a positive thing. It can, you know, we kind of kind of have to rely on, hopefully to drive these changes that are going to need to be made. But I think sowing those seeds now, it's going to be really fascinating already. What some of them have done, what the potential is going forwards, which is which is going to be great to to watch and see. Just sort of lastly, going back to those sort of where we all now we have students about to embark on exams at the moment. You know, there's there's first years and second years. And we've also got students hopefully going to be graduating shortly as well. It's a bit of a bit harsh to say, can you just give one bit of advice for for students? Because it depends on the situation, but I think it'd be really good to hear about from your experience and your expertise. Is any just general advice, a bit of Fiona moffatt advice that you'd you could give to someone or someone listening to this of maybe just a bit of life, or how to navigate on the course, anything you think could be worth listening to. Yeah, I think dream big. Don't think I'm just a student or I'm just a band five physio. You're not. You are a whole bundle of possibility and opportunity and you know, wherever you are on the program or wherever you are in your career, you have got something, you know, unique skills and insights that have the potential to really change people's lives for the better. It might be months of work working with a patient, or it might be a five minute brief intervention, brief conversation. It might not even be something you do. It might be something that you signpost and say, I know somebody who can help you with that, but your influence is huge. You, your influence on each other is huge. You can support one another. the peer mentors, you know that that you know where, oh gosh, this can sound so cheesy. But you know, we are this family and we can support each other. But, you know, as I say, dream big. You have the potential for huge impact. Go use it. Go exert your influence. Fantastic. I think that's a great place to end. Fiona, thank you so much. Thank you. And, she said she showed up and have gone away.