I completed the first full week of my six-month clinical affiliation, and things are off to a tremendous start. This past week, I was assigned two patients of my very own who I'll likely see throughout their course of care on the inpatient rehab unit. It might not sound very monumental; however this is the first time that a patient has been "mine" and solely mine, and where I'm the primary decision maker.

There's a completely different vibe when you are a full-time student assigned to a place for a significant amount of time. Obviously the amount of responsibility is much greater than it has ever been, which is likely why I'm acutely aware of the impact that my decisions will have on the recovery processes of my patients.

I find myself coming home at night and planning out my next day. I come up with a strategy for the morning and afternoon sessions, dream up a ton of different interventions, and research anything I don't know. Part of it is that I've developed a huge interest in traumatic brain injury rehabilitation, but the other part is that I feel very new to the responsibilities that have been placed on me. The only thing I can think to do is prepare as much as possible and walk in the next day with more knowledge than I had when I left the previous evening.

I'm excited and nervous to finally start developing my own patient caseload. It seems like the more responsibility that's placed in my lap, the more I start to realize the potential I have to make a different in people's lives. It's an exciting thing to realize at the start of your career!

Please don't be fooled by the title of this post. I don't have a good method by which to accomplish this. However after starting my fifth clinical last Wednesday, I've realized that earning the trust of a clinical instructor is a very tricky game requiring a great amount of patience. I just began the first half of my final yearlong clinical internship on a traumatic brain injury unit at a well-respected hospital here in Pittsburgh.

This technically marks my first experience working in an inpatient rehab setting, and also with a neurological population. Obviously, my clinical instructor is going to have some apprehension about handing me some of her patient cases, which I can absolutely understand. In the end, I'm her responsibility. But I'm eager to get started! So I've been trying to find the best way to demonstrate my skills and gain her trust without coming off like the most arrogant student in the world. Here's what I've found that works:

● Demonstrate good listening skills. When my CI explains something, I honestly try to soak in every word she says. I have so much to learn, and I really try to make it obvious that I'm excited to do so.

● Show interest. I carry around a small pocket notebook to record any questions, new information or ideas that I have during the day. I think it helps to show that I'm a proactive learner, and it's also a great tool to use in any sort of self-assessment.

● Take advantage of situations where you can demonstrate your skills. If another therapist needs an extra set of hands for a transfer, offer to help. If an assistive device needs to be adjusted, do it. We have plenty of opportunities to show what we're capable of, we just need to recognize them. Standing around and just watching your CI doesn't do you much good!

● Know your limits. If I'm completely unfamiliar or uncomfortable with something, I come right out and say it. In the past, I used to be embarrassed to do this. I've found that by admitting to a lack of experience in a certain area, you start to demonstrate that you are very aware of your current abilities and identify where your skills can be expanded.

● If all else fails, focus on the patients. Demonstrate your communication skills, that you care about your patients, and have the ability to interact with them on a professional (and personal) level.

This is obviously not a comprehensive list, nor am I an expert. But these are a few things I've figured out along the way that have helped to speed up the "trust" process. Any other suggestions are welcome! I'm interested to hear if anyone else has come up with some tricks for those first few weeks of a clinical rotation.

I've been fortunate over the past two years to have very few life-related interruptions in my attempts to excel at this whole "PT" thing. However last weekend, right before the start of finals week, I received news that my grandfather passed away. The last week has been a complete whirlwind, and obviously final exams and presentations took a back seat to spending time with family.

I'm not the only one who has gone through this. Many of my classmates have lost loved ones since we started two years ago, and others' "school" lives have been interrupted by more joyous things -- engagements, weddings and even babies. For the record, joyous events can be equally distracting, but that goes without saying for my friends who have managed to raise children during the program. A few good friends of mine have managed to plan weddings, despite some resistance from our advisors. It's definitely possible, but I don't envy them at all.

It's funny how narrow our focus can become when we're caught up in studying, clinical rotations and career decisions as we make our way through physical therapy school. For a while there, I didn't have any interruptions, particularly sad ones. If all of this had happened last year, I don't know how well I'd have handled it. The first year of my program is incredibly intense compared to the second, and I didn't see my extended family (including my grandparents) for months on end.

Thankfully I had more time this year to get back to a normal life. In light of everything that's happened, thinking about what little time I spent with my grandfather last year makes me sad. So I guess my advice is this for anyone in the thick of their program -- just remember that life will continue to move on, no matter how focused you are on physical therapy school.

Like I said in my earlier post, my class is the most prepared and diligent group I've ever come across. Thankfully, those qualities extend beyond just PT school and even apply to things like cutting videos, writing jokes and prepping to entertain 80-plus people. Classmates searched the Internet endlessly to find the perfect doppelgangers for our faculty. They were a complete hit, even when we likened our neuroanatomy professor to Gandalf from the "Lord of the Rings" trilogy and another professor to Newman from "Seinfeld." We had faculty and class superlatives, embarrassing photos, and ridiculous quotes that we've been collecting for the past two years.

Most importantly, I think the faculty loved it. During our rendition of a "developing child" video we were required to watch at the start of our pediatrics courses, I thought our professor was going to fall out of her chair. They took everything in stride, and I was relieved in the end to hear that no one was offended. The night really highlighted how much I'm going to miss this group in two short weeks once I start my year-long clinical internship. We've had an amazing time together, and I have no idea where the last two years went.

This afternoon at a department-wide scholarship reception, I ran into a student who is a year ahead of me in the program and happens to have a similar clinical rotation as I will have in the coming year. I was picking her brain regarding the hospital, her experience and most importantly who her clinical instructors were. As it turns out, the two clinicians I will be working with during my internship were also her instructors.

I obviously got as much information out of her as I could. I wondered about their personality styles and if we'll clash. (Realistically I can get along with anyone, but I thought it was a reasonable question to ask). I asked her if they were good "teachers," and if she felt like she was able to make mistakes and ask questions when she was working with them. We talked about her experiences, things she would change and some tips to take with me as I approach my start date of May 1.

Luckily, it sounds like I hit the jackpot when it comes to clinical instructors. I was happy to hear that the third-year student holds these two in the highest regard, and feels as though she has learned more from the two of them than during any other clinical rotation to date. She and I have similar personalities, which was reassuring when she mentioned that the two clinicians are mostly looking for enthusiasm and interest in the subject matter on top of dedication to learning. All in all, it sounds like a great fit!

The conversation was insightful and helped calm my nerves a bit, but as I reflected on everything she told me today, I started to wonder if this information should change anything that I do. Even if I'd heard that the clinical is very difficult as a result of the instructors, I'm not sure it would have changed anything. So often throughout the course of this program I've been surprised by my ability to adapt, and I imagine that others have felt the same way. Maybe I've gained some confidence over the years, but either way I feel like I can work through anything that comes my way, regardless of what I may believe ahead of time.

With four short weeks remaining in the didactic portion of our education, the inevitable is happening -- the general attitude of my ever-engaged class is turning down a road toward apathy. I've been here before. At the end of college, my friends and I had similar mindsets as graduation came within reach. But I can't help but wonder if what was comical then is inappropriate now. At the end of a clinical doctorate program, can we use the "burnt-out" excuse to explain our general lack of interest and drive as we near the end?

We're all guilty of it (some more than others). It started with minor complaining and has turned into full-blown rage, particularly when it comes to certain end-of-term projects and requirements. It doesn't help that we all of a sudden have found ourselves in the CAPTE-required portion of the program where so much of what we're learning feels detached from clinical practice, or at least the type of clinical practice that lies in our near future.

I honestly do attempt to keep a positive attitude and "good" work ethic, but it all goes out the window when we're learning about leadership styles and business development models. Most notable, however, is the lack of attendance. As the semester rolls on, more and more people aren't coming to class, sometimes to the point where I get embarrassed by the lack of attendance. There has to be a better way to get people engaged again.

If I designed my own PT program, I would make the last few months revolve around clinical techniques, skills and application. At this point in our careers, we feel like we have the baseline skills to begin practicing as clinicians, and it's very frustrating to sit in a classroom all day long. I'd bring in patients, revisit manual therapy techniques and provide students with every opportunity to have hands-on practice prior to beginning a full-time clinical rotation. Maybe then, senioritis wouldn't be such a huge problem.

With the start of our yearlong clinical only one month away, the logistics of having a full-time "job" are becoming a reality. We recently met with the clinical education instructors in our department to cover the do's and don'ts regarding PTO, stipends and general workplace expectations. For a lot of us, this is the first time we'll be considered full-time employees within an organization, so the associated structures and protocols are not something we've ever had to deal with.

Over the course of the year, we're allotted 25 PTO days, which they say reflects the average number of days (including sick and emergency days) that a new graduate will receive from their first employer. To be honest, this sounded like a lot at first until I realized that it includes sick days, continuing education days and vacation time. Either way, it seems fair. I did work for two year prior to coming to PT school, although I was not a full-time employee so many of the nuances did not apply to me. This coming year will mark the first time that I'm bound to an organization as a true employee, and for all of the great benefits that come along with that, there will also be some adjustments to make.

The problem I'm running into is that within the first month, a friend of mine from the PT program is getting married in South Carolina. Without thinking about it (and before we had this recent meeting), I contacted my CI who I've yet to meet in person and asked for the Friday prior to the wedding off to ease the burden of traveling. In hindsight, that was probably a very bold and inconsiderate request to make.

Given, this day off will be within my first month, during which I don't anticipate that I'll be carrying a full caseload, but I feel guilty and slightly foolish for having requested the day in the manner that I did. The more I think about it, the more I realize my current first impression may not be the best. In light of it all, I'm considering sending a follow-up email to retract my request until I have the time to meet with my CI in person.

I'm wondering if anyone out there, students or clinical instructors, has run into a similar problem and how you've dealt with it. Students -- I'd love to know how you went about requesting time off so shortly after your start at a clinical site. Instructors -- I'm wondering how you dealt with and viewed such requests. I'd hate to make a bad first impression at a place where I'll be working full-time.

Two things stand out to me. First, I can't imagine trying to plan a wedding while in school full-time. Moreover, I can't even wrap my mind around having a baby amid all of this. I have so much respect for my two classmates who have newborns at home, yet manage to have continued success in the program. Second, the financial obligations alone are unbelievable to me. I would have a panic attack if I took on the financial responsibility of a wedding or baby on top of seemingly never-ending school loans. I give them all credit -- they're much tougher than I am.

What's worse is that this trend seems to be extending to my friends who aren't in PT school, making for a very busy year. In 2013, I have seven weddings penciled into my calendar, and likely there will be a few more to add. Thank goodness I'm going to have a source of income during my yearlong clinical -- it's going to be an expensive year!

Everyone warned me that this would happen, but just recently I realized it. I've also been warned that when I start working, someone in the PT department will always be pregnant. It's an epidemic! I'm amazed how quickly life is starting to fly by and how rapidly I've transitioned into the wedding and baby portion of my life. Yikes.

In fear that my professors may read this blog, I don't want to give too much away. I'm really wondering if anyone with a similar tradition has any ideas, suggestions or memories they'd like to share. We've recorded two skits that we plan to show at the event, including puns and jokes related to the majority of our faculty and staff, but we expect to do a few live bits as well: reenacting some of our worst exam experiences, mock game shows etc. We've gone as far as having a two-hour block of time reserved each week to meet, plan and practice for the night. It's dedication at its finest, and one of the few things left that can motivate a group with only two months left of class.

The night has historically been a huge success, so we're all feeling the pressure to continue the tradition. For anyone starting their program, I recommend trying to have a similar celebration when you're done. I also recommend keeping a running document of memories and quotes -- even if you don't have a "PT Night," it's a great timeline and diary of the fun experiences that you have throughout the course of the program. Maybe I'm just getting sentimental because I see it all coming to an end, but I'm so glad we kept track.

Throughout the course of this semester, I've been a teaching assistant in the neuroanatomy course required for the first-year students in the program. I was very hesitant at the start to take this on, but I've been happy to see how quickly a lot of the information came back to me. More importantly, I'm realizing how valuable it is to teach material when you're really trying to learn something. Not only does it hold you accountable for having a true grasp of the information, but the repetitive nature of teaching makes it much more difficult to forget. It's a perfect time to be revisiting this information as I'm inching closer and closer to the point when I'll actually start applying it.

This is my first experience with formal "teaching," and it's making me consider what I want to do with my career. I'll be graduating in just over a year, and obviously between now and then I have a lot to get through. But as I get closer to having a true career path, I'm starting to wonder if teaching is something I'd like to consider. If I find my niche and start to feel comfortable with a specific patient population, I think I'd really enjoy being an adjunct faculty member. That being said, I have no plans to pursue a PhD... ever.

I'm wondering how long it takes for people to be able to teach? Do clinicians need 10 years of experience before they're considered, or does it not matter? I don't know what I want to do, but I'm excited that my interests are so vast. It's finally within grasp!

To start, I'm realizing that the "business" side of PT is far beyond my current understanding of the scope of physical therapy practice. I've spent so much time in the past two years trying to master my clinical skills that I neglected to see this side of things. Financial analyses, readiness assessments, investment profiles, payback periods, capital -- it's all part of a vocabulary that's foreign to me. Perhaps it's because I'm not a very business-minded person, but I'm amazed that clinicians are able to transition into these types of responsibilities assuming they've had no formal business education. It's just unbelievable to me! I don't even know how to work an Excel spreadsheet.

I'm also impressed by the available resources that I've come across while researching electronic health record implementation. From the step-wise approach to how to implement an EHR at HealthIT.gov to the APTA's "Understanding and Adopting an Electronic Health Record," I can see that a great deal of time and effort has been spent easing the burden of such a massive undertaking. (Side note: It also makes me much more inclined to continue being an APTA member after graduation).

While I find myself overwhelmed throughout much of this process, I'm also impressed by how much I'm learning. I don't necessarily see myself wanting to own an outpatient physical therapy practice, but I have a new appreciation for the clinicians who take this leap. I continue to be amazed by the scope of this wonderful profession!

Now that we've finally learned our placements for our yearlong clinical rotations, we can start the planning process for our capstone projects. The project assigns groups to a specific patient population based on the practice setting where we're working, and each group is responsible for creating a database for their respective population.

The database is an extensive record of each patient's course of care, including evaluation techniques, intervention strategies and outcome measures. It allows each of us to look critically at what we're doing in the clinic and assess whether we're actually making our patients better. (Now that I've learned the parameters, I'm less intimidated than when I watched the third-year students during their presentations, which I previously blogged about).

I've been assigned to the "Assisted Ambulation" group, since my first placement is in a rehab setting. A number of other group members are in similar settings; however a few are also working in acute care. We're in the process of selecting which outcome measures to include.

The previous classes utilized FIM-ambulation, FIM-sit to stand, and gait speed. We received feedback from them, and it seems like gait speed was the most difficult to collect, particularly for those in the acute-care setting. Each of us can see the value in keeping gait speed as a measure; however I can see the challenge. If anyone has suggestions for other useful outcome measures, please send them along!

The project will offer a great method to track my progress as a clinician. The overarching goal of this project is that each of us improves as a clinician by assessing measurable outcomes, and retrospectively seeing if our interventions have caused improvement. It's a large undertaking, but I know it will be valuable to have down the line.

During the first six months of the rotation I'll be at Mercy Hospital, a large urban hospital located in downtown Pittsburgh. The placement is on an inpatient rehab unit where I'll likely work with a neurological population -- stroke, spinal cord injury or traumatic brain injury. (There's a chance that I'll be on a general rehab unit, but I'm hoping to be placed in the former). This hospital has one of the most respected rehabilitation units in the city, particularly for the population that I'm interested in.

I'm slightly intimidated by its reputation, but I know that a large hospital is the perfect place for me to start. There will be complex patients and a lot to learn, but it's exactly what I'm looking for as a student. The other benefit of the Mercy placement is that I'll have the opportunity to be exposed to other units, facilities and medical procedures that I wouldn't have the chance to see at a smaller hospital. I'm hoping that I'll occasionally get to observe surgical procedures and transfer to other units (acute care, trauma etc.). It's the perfect place to learn!

The second half of the rotation will be spent at an outpatient facility that sees a heavy volume of patients with neurological diagnoses. They also see orthopedic patients, so I'm glad that I'll be able to work with both populations as I'm still lacking confidence in my assessment and intervention skills. I have heard that a number of patients with spinal cord injury are seen at the clinic, but I'm not sure. Either way, I'm grateful for the split between the inpatient and outpatient settings.

At this point in my education, I feel that I need to be exposed to as many settings and scenarios as possible, so these assignments are perfect for me. It's so exciting to realize that my career is within grasp, and I'm in a very good place to prepare myself for it.

This weekend I had to stretch my already-struggling assessment skills to the virtual world during a Skype session with my uncle. He's been having shoulder pain for the past few weeks and sought out my opinion via e-mail. We chatted back and forth about his symptoms, onset and pain, and he eventually tricked me into the session by suggesting that we Skype so I could see my 1-year-old cousin. Turns out he had a hidden agenda.

First of all, my confidence with all things outpatient musculoskeletal is at an all-time low. I haven't been in that sort of setting for a year now, and even when I was there I felt my assessment skills were lacking most of all. This was and is particularly highlighted with shoulder pathology. Maybe it's because we covered the shoulder in such a short time period and I didn't have the chance to assess many patients after the didactic portion was complete. Either way, when faced with the "video" eval, I was caught off guard. Luckily I had my notes within reach and my uncle, understanding that I'm still a student, was as patient as ever. (Hey -- he got a free assessment so he can't complain).

What I really took away from the experience was how valuable it is to be physically present during a patient assessment. It was so much more difficult to figure out even the most basic ROM restrictions without being able to place my hands on my "patient." The Skype session was, however, a great lesson in communication and trying to explain special tests and exercises with only the use of words. It's definitely something I need to work on, but for now I'll appreciate my face-to-face patient time, at least while I'm still in the learning phase.

I just returned from my first trip to the APTA's Combined Sections Meeting, and I'm left with a variety of feelings about the experience. Overall, I would consider the trip a success, but there were definitely some aspects of CSM that left something to be desired. I did a lot of reflecting on the flight home, and here's what I came up with.

There were some very enlightening and intriguing lectures about emerging research that really served to supplement my current knowledge base. I attended a lecture about pediatric lower-extremity injuries and the differences between treating children and adults, as well as how their injuries develop. We've had limited exposure to pediatric physical therapy, so it was great to attend a lecture that addressed some questions I had regarding pediatric treatment. I was also very intrigued by the research of Amy Bastian. I unfortunately missed her lecture, "Cerebellar Contributions to Sensorimotor Function and Learning," which I heard was fantastic, but I was really excited to hear her talk during a different gait lecture.

As exciting as some of the lectures were, others were a letdown. I will take partial blame for my disinterest in some of the lectures -- I went out on a limb in selecting some that I'm really not interested in. Others, however, namely some in the neurology section, left very much to be desired and I was disappointed. In an effort not to make enemies I won't name specific lectures, although most took place on the first day. This unfortunately left a bad impression, and I was much less motivated and excited about subsequent days of the conference. Other lectures, while interesting, were exactly the information we have recently covered in class. I suppose that speaks volumes about the faculty at Pitt, but I still wasn't thrilled to sit through a repeat lecture. I'll just have to be more careful about what I select next year.

I was very proud of a few of my classmates, which alone made the trip worth it. Matt Debole, who is on the student board of directions, was nothing short of inspiring as I watched him fill his days from start to finish with lectures and meetings without a single complaint. My other classmate Eric Lehman was recognized by the Orthopedic Section as "Student of the Year." We all went to the awards ceremony and it was great to see the University of Pittsburgh so well represented. Another cohort of my classmates successfully launched Log ‘N Blog to raise money for the Foundation for Physical Therapy. It's wonderful to be surrounded by such involved and exciting people!

I'll definitely have to change the way I approach CSM next year, but I think I'll go back again. I hope I can iron out some of the kinks to make CSM 2014 an absolute success.