It’s strange to think that I haven’t been a student since 2011. I mean, “we’re always students”, but of course I’m referring to being in PT school. There are things I wish I would have known back then, and after working with students in the clinic for 6 or 7 years, I have some thoughts I’d like to share.
Maybe this will help you feel better prepared for your clinical experiences?
If you haven’t heard the phrase, “experts do the basics well”, then you’re welcome for bringing it up now! It sounds simple and easy to ignore, but please don’t do that. I know that Mark Shepherd posted about this in 2017, too. Let’s go over the reasons why some of the basics are so important to improve upon before you begin clinical experiences:
You’re wasting valuable learning time if you need to re-learn basic exam techniques in the clinic – ie: vitals, reflexes, goniometer skills, common special tests, etc. If your CI is restricted to teaching you basic techniques, then you miss out on discussing other cool stuff! Like evidence, theory, and how to communicate with patients. So, practice your hands-on skills more than you are and have more time to do the other stuff when you get to the clinic. This also wastes the patient’s time and money when things need to be repeated. I guess the silver lining for this one is that your patient may not know if you did something wrong? That’s not the point, though. Be confident and competent with your exam skills before you get to the clinic. Patient’s will throw you off by guarding, pain, or even reporting a weird symptom you weren’t expecting – let’s discuss how to work around those instead of how to do the test.
Your assessment/diagnosis is inconsequential if your examination is done poorly. I don’t really have much to add here because this is relatively self-explanatory – if the test item is done incorrectly then what does your result mean? Is there any value to it? I guess I’m not trying to argue that last point; a test done differently than the textbook version likely still has value, but how do we determine the value and is the interpretation valid? If you’re a student without much experience doing these tests and measures, your interpretation of a variation (or incorrectly performed test) allows for some skepticism. There are many good resources that go over how to do these tests and discuss what the test results mean (Chad Cook and Eric Hegedus have a good text on this). Please, start thinking about what your findings mean and does the clinical presentation and/or imaging match the findings.
Have an open mind to things you didn’t learn in school – including things you learned were ineffective in school. This one is tough, maybe really tough. But remember, EBP is a mixture of research, patient values/expectations, and clinician experience. Here’s a simple scenario: your patient comes in with a history of rotator cuff tendinopathy and tells you she’s excited to finally get in because ultrasound really helped when she had a flare-up last year. Don’t even think about explaining why ultrasound doesn’t work right now. For real, quit it. Explaining how ultrasound won’t have a long-term impact on her tendon may cause you to lose her as a patient and even lose future referrals if she complains to her referring provider – this does happen. Work with your CI on how to gradually introduce her to education and other ways to manage her symptoms. You may be surprised to see what treatments you add and eliminate from your practice, and when or who you provide them.
Communicate with your CI. A lot. Make sure that you let them know what your goals are and find out their expectations as well. It’s easy to get caught up in the grind of patient care, documentation, studying, working on in-services, etc., but make asking for feedback a priority. Getting constructive criticism can be daunting and uncomfortable, too, so make sure you’re prepared to receive it – it’s challenging to take the critiques without getting defensive. Here are some things you should avoid: putting the blame on someone or something else, getting upset/angry, acting as if it doesn’t matter, and questioning the validity. Your CI is probably not upset with you and they don’t think you’re an idiot. Challenge yourself to work on their feedback and follow-up with them to check your progress; this will make both of your lives better! Lastly, your CI is only trying to help you, and it isn’t easy for them to give constructive feedback either. Give them the benefit of the doubt and be prepared to work together.