Second Year Doctor of Physical Therapy students Phil Yoon and Elysse Marcuccella explain how the student mentorship program was created and how it has evolved.
Callan is a second year student, originally from Silver Spring, MD. Her background before school was dancing professionally and teaching pilates. In her spare time, she enjoys hiking, biking, climbing and traveling.
Clinic, that magical place that we dream of as students, where we get to actually treat patients instead of fellow students and paper cases. After almost a year of grad school, Monday through Friday 8-5 pm, (which I started two weeks after finishing up 3.5 years of undergrad) I could not wait. I needed to be back in the real world, interacting with people outside of my class. Long story short, PT is my second career. I had danced and taught for a number of years prior to school. I needed to remember why approximately 7 years of school was a good idea in the first place as I had developed a serious love – hate relationship with PT school that was unfortunately going towards the latter more and more. This was frustrating to me as I love to learn and had really enjoyed undergrad. The more the year of dragged on, the worse place I was in. What I realize now looking back, I was missing context. CE I gave me this context.
I was placed in inpatient rehabilitation at Littleton Adventist Hospital. At rehabilitation hospitals, every patient needs to be able to tolerate at least three hours of therapy a day from at least two of the three disciplines of PT, OT and SP. The patients I worked with generally fell into one of three broad categories: someone with a neurological problem/incident, complex orthopedic (think non-weight bearing on at least one limb) or medically complex (people who had many comorbidities as well as what had brought them to the hospital this time). In this case, the PT’s job was first and foremost functional mobility, starting with how someone was going to move in their bed, transfer safely and get around. This starts with compensatory strategies mostly (assistive devices, etc.) and moves towards remediation. The blessing and the curse of this setting, is that it is a beginning step on people’s path to recovery. So you will likely never see someone return to their prior level of function, but you will get to see people make incredible gains in a short amount of time. Some went from being barely able to take a few steps with maximum assistance, to being able to ambulate with a front wheel walker (moderate assistance) in the span of a week or two.
Which leads to all that I learned from my time there. While I had volunteered extensively before school for different PTs in different settings, but nothing is quite the same as “being” the therapist. This change in roles as well as all the encounters I had with patients during CE I started to show the larger picture, giving me context to all that we had learned in the classroom over the past year and why “it depends” was the most likely answer to any question. A few snapshots of the many unforgettable moments are the following. One of my very first patients really wanted to go home from the hospital, but kept saying “I don’t want to” to the simple proposition of standing up, a task they were unable to do for very long. Facing someone who was apraxic and aphasic, trying to figure out what they understand and are capable of, which contrasted with teaching someone who is toe touch weight bearing on a lower extremity and fearful of injuring themselves further how to ambulate with a walker. Or when I walked into a patient’s room to do an evaluation and they needed to use the restroom and got out of bed even though I had just asked them to wait for me to grab the gait belt and equipment to keep them safe. I had patients use obscene language with me and be so dismissive that I questioned what I had done wrong. These are a few of the many situations I found myself in during my first clinical, and while some were more pleasant than others, I would not change any of them (well, except maybe what I did during these situations).
This all leads back to that idea of context. All of a sudden, the Brunnstrom Stages were not just a list of things to memorize, I had a visual right in front of me. I was able to actually know what spastic, rigid, or flaccid limbs felt like to move. I saw what true weakness looks like – people who cannot tolerate standing for more than a minute without their respiratory rate going up and needing to sit down. I learned the importance of monitoring vitals so you can safely help build up people’s tolerance to physical activity. I learned that the numerical pain rating scale is subjective, one patient may report a 7/10 as they are calmly doing exercises, while another may report a 3/10 through gritted teeth. However, despite how subjective scales can be, it is necessary to have a standardized objective measure to be able to communicate to another PT, other healthcare professionals, how the patient is responding to treatment, as well as to justify your care.
My three big takeaways from clinic that I would like to share are the following:
One, communication, in all forms, is important – from body language to written documentation. Find your own style, but figure out how to be as clear and concise as you can be. Direct what you are saying to your target audience. Don’t just say everything you know. This means you need to be listening to yourself and have the self-awareness to cut yourself off if you are droning or to elaborate/explain more if you are getting a blank stare from your patient. Be diplomatic when you ask questions and always thank people for feedback, positive or negative, as they took time out of their day to help you improve. Basically, all the things we are told about communication in school need to come to life when you have a real patient in front of you. Don’t try to always say things a certain way just because that way is what works for someone else. Own what you say and how you say it, so that you are able to adapt it to your patient. Become comfortable with it so that you don’t have to think as much about what you are saying in the moment. It’s okay to be a little “structured” in the beginning to make sure you remember to say everything or ask all the questions, but make sure it is in a way that makes sense to you.
Number two, be nice to everyone. This is a big one – from fellow therapists, to different personnel of the clinic, to patients and to their families — everyone. A smile, a hello and an introduction go a long way. Everyone deserves this kindness, regardless of whether or not you will see them again, or of how they treat you back. This seems obvious but it is easy to forget this when you are trying to provide the best technical care you can or make sure you have taken the best history you can, or are rushing from one patient to another to stay on top of your schedule. Remember, patients are putting up with you learning as a student in a time when they are vulnerable, clinicians are giving their time and wisdom to help you improve, and so many other exchanges are occurring. This does not mean you are Pollyanna all the time, but just acknowledge people with kindness and you never know how you may affect them.
The last one is figure out how to make corrections early. Be proactive and don’t take a “wait and see” attitude. This is where I went wrong with school, and what I knew I did not have the luxury of doing at clinic due to limited time. In my experience, my clinical instructors (CI’s) were always very positive with their feedback and I felt they were holding back. My first week I was actively asking for corrections, telling them what I thought needed to improve, asking their opinion and always thanking them for corrections. After the first week, when my CI’s and I were reviewing how things were going, I told them that I thought they were holding back with constructive criticism. Some of it comes down to style. My CI is a naturally a positive, polite, and diplomatic person while I am a little more direct, so we had different expectations. While I would always prefer to receive mainly negative feedback, they were not going to do that, so while this was not really resolved, we at least both understood each other and the difference in personalities going forward. So if you are not happy with something because it does not make sense or it conflicts with something else you learned, be proactive. Try to find an answer or a solution that you can live with, which may be as simple as asking a question or looking something up online, or it may require you to adjust your expectations. You are not going to change the system in a day, but simply doing nothing will only frustrate you and leads, at least in my case, to disinterest, which we have all worked too hard to accept.
So now, as I head into the end of this clinical and get ready to go back to school I am happy to report I have regained much of my enthusiasm for school. This is still what I want to do and I still think I will be good at it (eventually anyway).
Post written by Callan Curtis
Post published by Rachel Troup