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Journey of a DPT Student

Caseload Breaking Point

Published November 18, 2013 5:53 PM by Lauren Rosso

I just finished my second week at an outpatient clinic where I see a great variety of patients. I'd say it's split 50/50 between orthopedic and neurologic diagnoses. The caseload diversity is going to be a great learning experience. But until I feel up to speed again with my outpatient skills (especially my evaluation skills), I anticipate a few rocky patches and early breaking points.

As a student six months away from graduating, I know there are certain expectations about where you should be in the spectrum of clinical development, particularly with the orthopedic population. However I haven't completed a full ortho eval in about a year-and-a-half and to be honest, we hadn't even covered our entire musculoskeletal coursework at that point. So when I looked at my schedule for the week and saw shoulder, knee, low-back, and cervical initial evaluations, I felt completely overwhelmed.

I managed to tackle it all, but reflecting on the week I'm starting to feel like the caseload is getting away from me. I don't feel like I've had time to think about each of these patients or develop a plan of care that I feel comfortable progressing. It's always a tough situation to be in as a student because you want to be challenged and you want your colleagues to trust you with as many responsibilities as possible, but there's a very thin line between juggling those responsibilities and letting it all come crashing down.

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As I read the list of diagnoses of patients for initial evaluations in your upcoming week, I too feel a little overwhelmed.  My only true orthopedic outpatient clinical was the first one, two years ago now, and my nervousness about being able to perform is even greater as it pertains to the job I am expected to do in a few months as a licensed therapist on my own.  Now it’s not just about colleagues being able to trust me with a reasonable amount of responsibility, but living up to the expectation and not disappointing them that they hired me in the first place.  I appreciate the helpful advice offered by Emily in her comment to this same post to write down the next day’s schedule to allow time for ideas ahead of time.  I will try to employ that technique.  I also hope to shadow various therapists at the clinic between now my start date to just become more familiar with the facility and how things work, but to also get more exposure to outpatient clinical experience.  For these reasons, I am grateful to have a few months until then!

Jennifer April 24, 2016 8:21 PM

Going into my first day of my final clinical rotation, I was pretty nervous--a big reason for this being that I didn't know what would be expected of me when it came to caseload. I looked at the schedule for the upcoming week and noticed that 2 and sometimes 3 patients were scheduled every hour. There were also times when an initial evaluation was scheduled at the same time as a follow-up visit. By the end of my rotation, I was seeing all patients on the schedule by myself (which usually amounted to 10-15 patients). Not going to lie, there were several days (especially during the beginning of my clinical) where I felt completely overwhelmed. After a few weeks, I began writing down my schedule for the following day. That evening I would brainstorm treatment ideas for each of my patients so that the next day if I began getting overwhelmed by the volume of patients, I could go to these lists of ideas. I found that this really helped me to maintain my sanity and helped to keep my stress level down.

Emily March 23, 2014 10:35 PM

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