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Journey of a DPT Student

The End of the Road
by Lauren Rosso

There is no simple way to sum up my life since college. Unlike a lot of physical therapy students, I didn't take the traditional path. In fact it may have been the least efficient way to achieve a DPT degree. But looking back, as cliché as it may sound, I would not change a single aspect of this incredible journey that has resulted in a deep love for my career and pure excitement for the future.

We were doing a lot of reflecting this weekend. I started the program three years ago and couldn't tell you a single origin or insertion for the entire musculoskeletal system. I thought I was by far the least prepared to become a physical therapist, and I honestly questioned whether or not it was the right move. For those of you starting your programs, I hope you find comfort in the fact that despite my initial feelings, I have succeeded and excelled in my program. I traveled abroad for a clinical rotation that I will never forget. I passed my boards early. I earned the respect of my clinical instructors and faculty. Don't lost hope -- it gets so much better. My professional growth has been the direct result of the confidence I've gained by allowing myself to be challenged throughout my education. It has been an incredible ride.

Despite an amazing education, I recognize that my most important accomplishment lies in the relationships I've formed at the University of Pittsburgh. I have friends that will last a lifetime and colleagues I can contact for their expertise. There were a lot of tears this weekend as we recognized that departures are looming in the near future. If you had asked me three years ago if I thought I'd create an entirely new social circle who I care for deeply, I would have said you were crazy. It remains that the capacity to build relationships is at its best when you are challenged within that group -- during the worst finals weeks, long clinical rotations, and endless group projects. There is a bond here that can't be broken and I'm so grateful for that.

So here I am, at the end of the long and bumpy road. As with all endings, it feels bittersweet. I can't express my excitement for the future, but a small part of me will always yearn for the days when I was surrounded by some of the best friends and faculty you could ask for. I know I'm not alone in my feelings, as I'm sure many of you who are graduating (or have graduated) have felt the same.

To everyone who has read this blog over the past few years, thank you for your input, encouragement and support. I wish you all the absolute best in your career endeavors and will be forever grateful for the opportunity to chronicle my experiences as a physical therapy student. Let my journey as a new clinician begin!

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Saying Goodbye
by Lauren Rosso

I completed my final day of clinical... ever. I'll never have to sign "SPT" again. I won't need to have notes cosigned. And I will never, ever fill out a self-assessment of clinical skills again. I feel like I suddenly grew up, got kicked out of the house, and all I'm really waiting for is a small piece of paper to tell me that I'm on my own.

It's an incredible feeling, but the reality of it all is about to set in. I likely still have two months or more until I'm able to practice independently. Apparently even though I took the boards early, the processing time for my degree and subsequently my license is going to take a while. (I'm not exactly sure why it takes one month for my degree to be displayed on my license, but that's what they told me).

Saying goodbye is going to be a theme in the next few weeks. It started with my coworkers. I had been at this last clinical rotation for six months, so in a way I started to feel like a part of the "family." It's a long time to be in one place, and you definitely start to integrate into the environment much more when you're around for so long. If I wasn't graduating, I think I would have been even sadder to leave that clinical site, but the prospect of being finished helped to avoid a tearful goodbye.

What's really going to get me is when I have to say goodbye to some incredible friends who will be leaving the area. It seems like a vast majority will be leaving the city of Pittsburgh to pursue job opportunities across the country. I've spent a lot of time with this group in the past three years and I've made friends that will last a lifetime -- even if they are moving 2,000 miles away.

I can guarantee a tearful goodbye next week when we all go our separate ways after graduation. I'm from Pittsburgh, so going to school here was like coming home. But I've also learned to associate my home with a number of my classmates, and it's going to feel very strange to be here without them. For better or worse, we've become a huge part of each other's lives and I'm so thankful for their friendship and sanity throughout this journey. One more week. One more blog. I can't believe it!

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Changing Goals
by Lauren Rosso

With one week left until graduation, I had my most challenging patient-care conversation since starting PT school. One of my current patients, whom I happened to work with in inpatient rehabilitation during my previous clinical rotation, is a very complex case. He suffered an anoxic brain injury that unfortunately was complicated by a transfemoral amputation with a very short residual limb. On top of that, his hospital course was protracted and he has a lot of other secondary complications as a result.

The conversation I'm referencing had to do with adaptive equipment and options for wheeled mobility. The family's initial goals were to progress to the point where prosthetic training could be considered. Despite multiple setbacks we made some great functional gains during therapy, but unfortunately not related to standing balance. Faced with the reality that the most appropriate form of wheeled mobility needed to be addressed, I sat down with the family to discuss the available options.

This was the first time that the family was told directly their son would require a wheelchair for functional community negotiation. Prior to this point, prosthetic training was such a focus that I think we lost track of long-term decision making. I take the blame for this. In hindsight if I had voiced my recommendations, I would have told them that a wheelchair would likely be required. We trialed manual propulsion, but my clinical recommendation was power from a functionality standpoint. In the end, I think the family felt like we went from talking about prosthetics directly to powered mobility. I can understand why they were upset, and I wish I had handled the situation more effectively.

I had long conversations with my coworkers about how I could have changed and improved this entire situation, and the common thread was that early transparent communication is key. Even when it's difficult to say and may not directly align with the family's perception, opening those doors at the start results in a better and less upsetting experience for everyone involved. Lesson learned.

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My First Job
by Lauren Rosso

I'm happy to report that my interview went well enough to yield the ultimate goal -- a job offer! I got two calls on Tuesday (April Fool's Day), one at work and one on my cell phone, however managed to miss both. Not my best performance, but maybe I would have thought it was a joke if I actually did answer. My future boss called back on Wednesday, again at work, to offer me the position. I didn't want to sound desperate, so I initially agreed to take the 24 hours she gave me to think it over. By 4:00 that afternoon, I called back and accepted the position.

The position is full-time in the acute-care setting at a large level-1 trauma hospital. I will rotate every three months between multiple ICUs, a burn unit and step-down units. Acute care is one setting that I haven't had a ton of experience with during clinical rotations, so I expect there to be a very large learning curve and a period of feeling completely incompetent. I guess that's what orientation is for.

The most exciting and terrifying part of this process was getting the "welcome package" with benefits information and expected salary. I saw things about 401K matching, vision plans, health savings accounts, and about 15 other areas I didn't know a thing about. It's overwhelming. I'm thankful for the fact that our program has set up a meeting with a financial advisor before we graduate to talk these kinds of topics out and get some guidance. For a large majority of us, this is the first time we've had to think about any long-term decisions and I want to make sure I'm on the right path. For now, I just can't contain my excitement about the next few months.

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The First Real Interview
by Lauren Rosso

I sat for my first interview on Friday. I was sweating the entire time. I wore a scarf and had to take it off. I usually don't get very nervous for interviews, but for some reason when the interviewer started to go through the benefits packages, I started to realize how important the next 1-2 hours were going to be. Health insurance, you say? You mean I won't just use what the university offers? 401K matching? Percentages, dental, and vision? She had officially sent me into a panic, but I thankfully recovered with enough time to pull myself together before the formal questioning.

Overall, I think it went great. I felt confident, having prepared for 2-3 days ahead of time. I find it most useful to think back on clinical scenarios that have been any number of things: challenging, success stories, teamwork-driven etc. That way, when they ask questions, I at least have a bank to draw from and I don't feel completely caught off-guard. It worked really well. I also go through the usual ahead of time -- strengths, weaknesses, a time when someone was difficult to work with and how I reacted, and similar situations. For me, it takes the stress away of coming up with an immediate answer. If I go in with the sense that I've prepared, then I'm much more confident.

I also prefer to write down a few questions ahead of time. Whether they are based on research I've done about the company (and purely meant to prove that I know something about the organization I'm trying to work for), or if it's to acquire some new information about the position, I feel much more engaged when I have something ready. They are inevitably going to ask you if you have questions, so you might as well put some together. In the end, I think it worked. Apparently I could hear as soon as this week about their hiring decisions, so keep your fingers crossed for me. Either way, I'm happy to have the first one completed and the prospect of my future employment lurking somewhere in the future.

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Big Decisions
by Lauren Rosso
Well, it's about time to start seriously considering what in the world I'm going to do with my life (and where). Anyone who can count their time to graduation in weeks is likely feeling the same way. With exactly four weeks left until I finish my clinical rotation, I'm starting to feel major pressure to find a job, pick a city, and think about the future. I always knew this point would come, and as exciting as it is, the significance of these decisions has been weighing heavily on my mind lately.

I'm realizing that I may not be able to have everything I want in one place. I grew up in Pittsburgh, but moved out of town for quite a while during college and post-college soul searching. In coming home, I had the great fortune of spending time with my grandparents, being around for weddings and holidays, and reconnecting with both family and lifelong friends. In the past three years, I've seen how wonderful it can be to be "home."

I was very optimistic at the onset about the job market in Pittsburgh, but it seems that my optimism may have been off base. I'm having a hard time finding my "dream job" here as there are very few inpatient rehab positions (maybe I'm being unrealistic -- I really want to work with the brain injury population, and I imagine there just aren't that many positions in general). It's just not going to happen here. So while my family, friends, boyfriend, and love of the city remain in Pittsburgh, I can't help but wonder if I would be better off in another place.

I'm at a crossroads. Do I choose my career over everything else? Or do I just hope that by taking a position here, it will work out in the end? I've worked for three years to put myself in a position to be the best possible candidate I can be. It's a tough reality when your visions don't quite match the opportunities that are available to you.

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Planning Vacation Time
by Lauren Rosso

I'll write this post as a warning to PT students who have a lengthy clinical rotation leading up to graduation. If you're like me, you'll find yourself six weeks from graduation and realize that you haven't taken much time off since you started the rotation. Despite your desire to keep functioning like a full-time clinician, you'll realize it would be very sad to waste so much vacation time and frantically check the calendar for the days no one else has requested.

Suddenly, you're trying to squeeze 15 PTO days into six weeks and it's just not going to work. You're mad at yourself because you think back to those weeks and months when you didn't take a day off and without realizing the cause, you were completely miserable and your mind was fried. You'll remember the time you showed up at work on a Tuesday and thought for sure it was Friday. Your patience got lost somewhere in there, too. And you think to yourself -- what was I thinking? Why didn't I just take a "stay-cation" and relax? Now it's too late! And now, if I take all of this time off, I'm going to be "that student" who totally blows it in the last month of clinical and everyone is going to hate me forever.

Ok. Overdramatic. But I legitimately have 15 days of PTO to take, and most of it is going to be wasted. At this point, it's almost annoying. I'm taking a bunch of 3-, 4-, and 5-day weekends in the next month. Everyone knows I'm just hoping to be done, and I'm sure they wish I had spread my time out a bit more logically. I just can't help it. So my advice is this - plan out your PTO. Take it periodically and don't forget about it. The end will sneak up on you very quickly!

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Morals vs. Rules
by Lauren Rosso

I was having a conversation with a fellow classmate about interacting with patients outside the clinic, and we got to wondering about what's allowed and not allowed. In the particular case that we were talking about, my friend ran into a patient over his lunch break. The patient, a 20-something male with CP who has a tough time walking, was having lunch at the same place. My friend sat down and finished his lunch with the patient. When they were leaving, he offered to give the patient a ride back to the clinic, which was just across the parking lot but a significant walk for this guy. He offered without even thinking, but wondered afterward if his decision was the most responsible.

Without question, I would have done the same thing. I can't imagine saying goodbye and watching this person struggle to walk back to the same place that I was driving. At the same time, however, I recognize the legalities and risks involved with something as simple as this. So where do we draw the line? I'm sure this is one of many examples I'll encounter over the years. I'm bound to see patients at restaurants, bars, sporting events etc. So what's the best approach? Pretend like you don't know them? Wait for them to initiate conversation?

I feel like I get to know my patients very well during their plan of care. I learn about their lives, work, families and interests. My first instinct if I see them in the community is going to be to ask them how they are doing, not avoid them.

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Mentoring PT Students
by Lauren Rosso

At Pitt, we have certain "benchmarks" that our program has assembled to guide us through the yearlong clinical. As the months roll on, there's an expectation that we will try our hands at role reversal and mentor younger PT students on their journey to DPT Year 3. I had some of my first opportunities to check this benchmark off the list last week. Lesson learned -- I have a lot to learn before I become a clinical instructor.

My shortcomings are not just from a knowledge standpoint, however I fully recognize that I need more exposure to a number of patient populations before I feel confident in my abilities to teach someone else about physical therapy. What I found more obvious was that I didn't know what to highlight, what to omit, and what to expand upon. I felt like I was basically word-vomiting everything I had ever learned about post-stroke rehab to this poor girl as she kindly listened to my "lesson." In reality, I should have kept my explanations about creative intervention strategies for hemiplegic gait to a minimum. My lack of an organizational teaching process gave away the fact that I had never mentored someone before, both to myself and likely to the younger student.

I was thinking a lot about this over the weekend. The best mentors, clinical instructors and coaches I've ever had found a way to tease out the fundamentals of each task/skill they were trying to teach. Once the fundamentals are mastered, they smoothly progress to implementation and carryover of each skill in a logical and organized way. It takes intimate knowledge of the craft to be able to do this... and I'm just not there yet. That poor 2nd-year student -- neither of us stood a chance!

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Repeat Patients -- Same Approach?
by Lauren Rosso

For the first time ever, I'm treating a patient who returned for repeat therapy after being discharged a month or so ago. This patient, who is impaired following an anoxic brain injury and transfemoral amputation, has been through the medical ringer in the past six weeks.

His first course of care was very challenging, however we made some great progress prior to his discharge. Knowing that multiple medical complications occurred while he was away, I was honestly scared to see how he was functioning when he came into the clinic on Friday.

The evaluation was interesting. I knew what we had measured and worked toward in the past, so I collected similar outcomes. But I couldn't help but think that I needed to be doing more. Unfortunately, I correctly predicted that this patient would be well below his previous performance.

Bed mobility, contracture management and sitting balance were back to pre-PT days. In the middle of the evaluation, it occurred to me that I might have to take a very different treatment approach this time around rather than plugging away at the same old goals that we set last time. A new episode of care with a new focus.

I think it may be hard to phase out the old program and start a new one. It took so long to develop an effective and efficient treatment plan for this patient, and I fear that he and his family may not be interested in taking a step back to work on some basic functional skills that seem more important this time around.

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The End is Near
by Lauren Rosso

I can count the number of weeks I have left on two hands. I've passed the boards. I have one project left, one presentation, and one in-service. All of a sudden, everything seems so quantifiable. I even got the information for purchasing my cap, gown and hood, which is unfortunately quantifiable at $75. Not even the steep price tag can bring me down. It's almost over.

I spent the weekend pulling myself together. I've updated my resume, created online networking profiles, and searched for job postings in a bunch of different places. But it's not all work and no play. I also spent the weekend making reservations for my post-graduation road trip. I plan to take advantage of this, the very last time I'll be without responsibility.

The trip will be three weeks worth of state parks, hiking, camping and adventures in the Southwest and will hopefully fill the outdoor void that I've felt for the past three years. I also hope it will keep the travel bug at bay for as long as it takes me to accrue vacation time.

So here I am. Nine weeks from the end of one chapter and the beginning of the next. Amazing how nine weeks suddenly doesn't seem like enough time to find a career path and close a very important chapter in my life.

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I Passed the Boards!
by Lauren Rosso

I finally received word on Friday that I passed the boards. The West Virginia Board of Physical Therapy sent me a letter, snail-mail style, to inform me that I can sleep soundly and stop worrying. A word of wisdom for anyone preparing to take the exam -- while I very much appreciated West Virginia permitting students to take the boards early, it was torturous waiting for the letter to come in the mail.

Classmates who took the exam in other states found out online three to four days earlier than those of us who were being licensed in West Virginia. Three to four days is an eternity. If you are impatient like I am, you may want to consider the process of score reporting before you sign up!

The most irritating aspect of score reporting actually had to do with the Federation of State Boards of Physical Therapy (FSBPT), the entity responsible for the boards. When you take the exam, you'll be able to visit the FSBPT website to investigate the "status of your request." FSBPT releases a free score report 10 business days after the exam. They will, however, provide an early report for a $55 fee. I found this insulting. I just spent more than $600 on the NPTE -- don't exploit my anxiety. If you know my score, tell me.

Enough of my rant. In the end, all that matters is only minor academic requirements and nine weeks of clinical stand between me, my license, and a paycheck. For a PT student who is ready to graduate, there's no better feeling.

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Interpreters
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I had my first evaluation via interpreter this week, leaving me certain that I'll attempt to learn Spanish when I'm done with school. There are a few things that I realized when the interpreter was translating the eval. First of all, interview "cadence" is not something you usually think about. I was uncomfortable and novel to the situation, stumbled over my words and awkwardly inserted pauses into my questions, which ultimately made me lose my train of thought. It took a while to figure out, but thankfully the interpreter managed well enough.

Second, body language is essential. At first, the interactions felt cold. I really rely on basic conversation, including small talk, to build rapport and make patients feel comfortable. That, obviously, was impossible during this evaluation. What I found was that by paying attention to my body language and interaction with the patient and his mother, I could build a similarly personable relationship without using "spoken" words.

Third, efficiency is key. For what normally would have taken 10 minutes, just obtaining a history through the interpreter took at least 20. When I looked at my watch and realized how much time was passing, I found myself prioritizing the key parts of the exam and saving the rest for subsequent visits. Efficiency is definitely a skill that we students develop over time. I'm not quite there, so this was a huge challenge while at the same time being a great lesson.

I never would have imagined I could learn so much from reflecting on one evaluation. I'll work toward my goal of learning Spanish after this semester is over, but in the meantime I need to master my interpreter-aided evaluations and treatment sessions. It's a fun challenge.

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You Know What You Know
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I have 60 hours left between now and when I take my seat at the testing center to begin the National Physical Therapy Exam, otherwise known as the "boards," the reason I've lost all social skills, and why I can't remember the last time I had a beer. If you've been following the blog, you'll know that I decided to take the boards prior to graduation, which means that studying occurred concurrently with a full-time clinical rotation. (For those of you who are confused, certain states permit applicants to sit for the boards prior to graduation as long as all requirements are met. Visit the NPTE website for more details).

From what I understand, the majority of students spend 6-8 weeks studying "full-time" for the boards. Often this includes preparatory courses; however my program doesn't offer those resources and I doubt I would have been interested in taking a study course even if they did. So I navigated the waters with the help of some classmates and recent graduates, giving it my best shot to cover the information included in the O'Sullivan text. I guess my only fear is that my cumulative time spent studying, which occurred in shorter bouts nearly every day before or after clinical, isn't enough. It's tough to tell what I've learned, absorbed, and forgotten completely.

Another interesting aspect to taking the boards early -- I wonder how I'm going to feel if I do pass the exam? Will I lose any and all motivation to complete my final project? Will I resent my clinical rotation? And will this really make me more appealing to potential employers? There could be some very advantageous qualities if I manage to pass. Just ask me in two weeks if this was all worth it.

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Falls -- They Come in Threes
by Lauren Rosso

Just over a week ago, I had my first experience with an incident report. All in all, it wasn't a big deal. A patient of mine with T11 paraplegia was attempting to stand from his wheelchair to complete a 10-meter walk test. As it turns out, his brakes (even when engaged) barely work. He went to push up from the chair, it started to slide backward, and he basically dipped himself down onto the floor. Minor incident report. No harm, except to my ego.

Six days later. Much bigger deal. Another patient of mine s/p TKA with an extensively complicated orthopedic history has been in PT for 12 weeks now. She has been dealing with the chronic effects of brain injury since she was 17, the same incident that caused her to have bilaterally fused ankles. Surely not a good prognostic factor for TKA recovery. We've been addressing any and every aspect of balance, strength, flexibility and mobility in the attempt to avoid another knee surgery, but it's been a rocky road.

I put together an obstacle course of familiar activities to encourage functional knee flexion. I wasn't really on high guard at the start (big mistake) as she was ambulating over quad canes, which she has never had trouble with before. I didn't even have time to react when she caught her foot on the cane, was unable to catch her balance with her bad leg, and fell to the ground faster than I've ever seen. On the way down, she hit her head on a step. All in the middle of the gym.

I was completely mortified, as was she. Thankfully she's fine. I kind of wanted to walk out of the clinic, turn in my ID, and call it quits on this whole "PT career." Now, I'm waiting to see if falls really do happen in threes. I'll keep my fingers crossed and gait belts on until I know I'm in the clear.

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