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Journey of a DPT Student

Crash and Burn

Published November 7, 2011 6:18 PM by Lauren Rosso

For the majority of my first clinical, I have been doing a lot of observing during the initial evaluations. I recently started to take patient histories, but when it actually comes to hands-on strength or neurological assessments, I haven't done much. For better or worse, this is the system that my CI and I have fallen into. So the other day when I was working with a different PT at the clinic, I was caught off-guard when he asked me to complete the evaluation for a patient with a diagnosis of "gait abnormalities."

First of all, I have never even seen an eval for someone with a neurological diagnosis. All of the assessments I have been involved with have been orthopedic. If that wasn't enough to make me nervous, I realized that I had about two minutes to prepare. I fumbled through the history, not knowing what was relevant to the patient's diagnosis, and too quickly found myself on the strength screen. At that point, I realized I had never done a strength assessment on anyone other than my classmates. Next came the sensory assessment, and I somehow managed to remember the lower-extremity dermatomes. (Considering how nervous I was at that point, I'll never know how I recalled that information). I felt like the entire thing was a train wreck, and there wasn't much I could do about it.

After it was all over, I had to focus the majority of my energy on not bursting into tears - partly due to embarrassment and partly because I was disappointed that I messed up and forgot some very basic things. The PT I was working with assured me that it wasn't as bad as I thought, which I really appreciated. Either way, it was a definite eye-opener. I really need to find a way to practice the elements of a clinical assessment on people who are not in my class.

14 comments

Emily- now that the embarrassment of that failed eval has worn off, I realize that it was a great learning experience.  I definitely realized that I can't function when I'm really stressed out, and have since tried to stay calm when I'm in those types of situations.  I also discovered that it's O.K. to ask questions.  We're introduced as students for a reason!  I'm still fumbling my way through some things, but instead of getting upset about it, I accept that it's all part of the learning process.  Maybe I'm just desensitized at this point!

Good luck on your clinical!  I can't tell you how much more I have learned by being in the clinic as compared to the classroom.  You'll do great!  

Lauren Rosso January 12, 2012 7:35 PM

Hi Lauren! I am a first year DPT student about to go on my first clinical in March.  I can definitely relate to feeling anxious about beginning my clinical only having practiced many of the techniques on my classmates.  One of my professors has assured me, however, that on your first clinical, you are not expected to practice with an entry-level performance.  Hopefully the therapists that you work with realize that, as you are only a first year student, you still have much to learn.  I have heard that a lot of what you use to one day practice as a physical therapist you learn during clinicals.  Thus, I am very excited to put to practice all that I have learned these past several months.  I hope that I learn as much as you seemed to learn.  Thanks for sharing your experience!

Emily January 10, 2012 11:37 PM

Hi,

Just wanted to comment on your post re: 1st Eval.  #1: Don't stress over it-lesson learned!  #2: Communication is very very important between you and your CI.  During my last internship my CI was not very good at communication and was a bit of a bully...I never heard anything positive and was pretty much left to learn on my own.  Instead of just putting up with it and hoping to pass, I talked to the supervisor of the facility who was also in charge of students and my professor at school.  I also looked for other therapists to help me out and guide me and was actually taken under the wing of another lead therapist who noticed my struggles.  I learned that I had to speak up for myself.  These experiences are there to teach you how to become a PT and your CI is supposed to be there to support you.  With many of my past experiences I thought that if I just do what they ask it must be the right thing.  But then during the second half I would learn that my productivity wasn't high enough or that my cases not diverse enough.  I had been doing what they asked and seen the patients assigned to me so I wasn't sure why I was being penalized.  I realized that I should have been more proactive about my education.  If you feel that you need more hands on experience, let your CI know, if the case is too complicated, ask for help/guidance.  That is what they are there for.  I am now a CI myself and I love to have students and pass on any knowledge and skills that I have and challenge them.  If you feel you are not meeting your goals, talk to them, and utilize the other therapists around you.  Most are more that happy to help.  Good luck with the rest of your affiliation.  

PS: Communication is not only important with your CI/co-workers, but also with the patients.  If you master this skill, you will come a long way in your field and become a great practitioner.

Lolita, Acute Care - MPT, SF General Hospital and Trauma Center November 12, 2011 6:42 PM
San Francisco CA

Congratulations on your ankle eval!  As orthopedics go, ankles can be tricky, so don't sell yourself short.

So glad you got back on the horse and had a nice ride!

Janey Goude November 10, 2011 8:08 PM

It sounds like the CI/student relationship is something that a lot of people struggle with!  I really appreciate all of your advice and anecdotes.

I'm happy to say that I completed an eval today and it went much better.  (Given it was for the ankle and not neurological).  I'm happy to have a bit of confidence again.  

Lauren Rosso November 10, 2011 6:29 PM

had the very same awful experience 40 years ago at my 3rd clinical.  they wanted a PT to just come in and do the job not a student that was there to learn.  It got so bad that when I contacted my Professor, he left it up to me to finish the clinical at that time.  He knew me well and I had gotten great reviews on my other 2 clinicals.  Well I was just devastated thinking I would not finish PT school.  At my last clinical, I got great reviews.  I did not have to finish the 3rd clinical and did graduate.  It sure was a difficult time but I learned alot too from that experience.  Just keep plugging along.

Dana Wilcox, Physical Therapist November 10, 2011 11:47 AM

Lauren,

Communication can be challenging for anyone.  It totally compounds in a student clinical situation where the student feels completely powerless and can be fearful of putting themselves in a bad position.  I remember being intimidated by CIs.  Sometimes it was a matter of our personality differences made it feel like they were unapproachable.  If you aren't comfortable bringing the situation up to your CI or your clinical liaison at the school, talk to a professor you have good rapport with and get his/her input first.  

Unfortunately, this is a perfect set up for a bullying situation.  NOT saying that is what is going on here.  But what happens is similar to what it sounds like you are going through.  In a bullying situation, the one being bullied often talks themselves out of believing it could be happening.  They reason surely that can't be what is happening, not in the professional situation they are in.  They assume since they have so little experience/knowledge, this must just be how it is supposed to be.  So the situation continues on and the person finds it more difficult to approach because it has just become the norm.  The sooner you address the issue, the easier it is.

At a minimum, discussing this with your professor can help you know and set realistic expectations for future clinicals.  You can even approach it from that perspective..."I really got thrown for a loop and I'd love for that not to happen again.  Can I tell you what happened so you can advise me on how to better prepare in the future?"  That way you aren't laying blame, just asking how to improve.  This could totally be a case of miscommunication.  Happens a lot in student clinicals and with professionals in clinics everyday!

Best of luck!

Janey Goude November 9, 2011 12:41 AM

And Katy- Any time you need an assessment, let me know!  I obviously need the practice!

Lauren Rosso November 8, 2011 10:35 PM

Thank you for all of the advice and encouragement!  After a day like that, it's nice to be reminded of the bigger picture.  

Sanjiv- You make a really great point.  I had been hoping for the past few weeks to get more involved, so when I was actually given the opportunity to perform an eval, I wanted to take it and appear confident.  Lesson learned!  

Janey- I'm still trying to figure out the CI/student relationship.  It's such a strange balance between expecting too much or too little, and adjusting from there.  I recognize that it's a professional relationship and this type of communication is a very important part of the learning process- but it's so much harder than I though it would be to bring up issues that I'm having.  

Toni and Dean- thanks for the encouragement.  I wish this whole "learning process" would just speed itself up already!!

Lauren Rosso November 8, 2011 10:29 PM

No one does well the first time.  As as I CI I can safely say I expect students to make mistakes.  You can't learn unless you try.  Neuro evaluations can be difficult.  Focus on the positive.  Remember the patient doesn't know any better. He or she is just happy to have someone trying to help.  

I work with exclusively with neuro patients and I miss things.  Next time will be better. You did the best that you could do at that moment in time.  Remember identifing gait deviations is only half the battle.  The real struggle comes after the fact when you figure out why they happened.  

It will get easier.  

Toni Patt November 8, 2011 5:29 PM

Lauren,

Like Dean said, it will get better.  Firsts are always frightening.  Sanjiv's suggestion is also well taken.  Never be afraid to admit what you don't know.  Always ask for help.  One good thing to come out of this is that you were able to identify a weakness of your clinical to this point.  Don't be afraid to bring it to your primary CIs attention.  If he/she isn't responsive, talk to the professor who coordinates the clinicals to get counsel.  Regardless, you need to give this information to the coordinating professor.  He/she can use it to make clinicals better for other students.  Clinicals are a learning opportunity for all involved!

Janey Goude November 8, 2011 2:02 PM

It WILL get better, I promise. You are spot on, you only need to practice.

Dean Metz November 8, 2011 1:16 PM

Hello Lauren, interesting reading about your first experience of evaluating a patient. As a manager at a clinic for physiotherapy in Ottawa, Canada, I can relate to your situation. By birth I was an engineer and a business man. I recently started our own clinic with my wife. I was a big learning curve for me. Studying the guidelines set by the college of physiotherapy was the first step for me. I am sure with time and experience you would walk through such situations.

Just a suggestion: If you are not familiar with the type of ailment, do inform the PT so they can guide you through the process.

Sanjiv

Physiotherapy Ottawa November 8, 2011 12:48 PM

You can come assess my aches and pains any time. I'm just up the hill!

Katy Lev November 7, 2011 7:43 PM

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