SAN DIEGO -- I arrived here on Saturday afternoon and have since had the most fantastic time reconnecting with old friends and enjoying the beautiful weather. (Side note- it's really not warm enough to lie on the beach in a bathing suit, but I suffered through it). Now that the weekend is over, I'm finalizing my plans for the conference and it's impossible not to be excited about it.

On the flight out here, I spent a lot of time browsing through all of the potential courses that I can attend. When I finally looked at the master list, I realized I had selected 42 courses and about four in every time slot. I don't know what to eliminate! Even though I'm a "neuro girl," I'm going to attend as many of the ortho, pediatric and education courses as possible. At this point in my career, I still feel like a sponge and see the value in keeping my interest base as wide as possible.

I'm so excited about this week. I feel like there's a certain energy in the air revolving around physical therapy and it's impossible not to get swept up in it. I'm very much looking forward to my first Combined Sections Meeting!

I don't care what anyone says -- it's a very rough internal battle to remember that attending the APTA's Combined Sections Meeting in San Diego is primarily business, not pleasure. I'm finding it very easy to be distracted by the prospective outings that I could go on while I'm there. There's the zoo, kayaking at La Jolla beach, friends in Chula Vista and so many other exciting opportunities. It's 70 degrees, there's an ocean, and it's not Pittsburgh. I can't even sleep when I think about how much fun it's going to be.

And that's when I remember -- I'm going to a conference, not on a vacation. That's not to say that I don't think the academic side of this will be anything short of inspiring (and likely fun, too). I looked at the list of topics and lectures to attend and I was genuinely excited to attend each of them. I also recognize that networking and career development opportunities will abound, which is essential as I enter my final year of school. However, the first thing that comes to mind when I think of San Diego remains the beach and not a conference center.

The upcoming conference will be the first professional meeting I've ever attended and I'm sure there's a lot that I don't even know to expect. And who knows -- maybe my entire attitude will change and in the future, I won't be able to sleep because I'll be so excited about the conference. For now, I can't wait to get to the beach.

With my professional life quickly approaching, I decided tonight that it's about time to go through my Facebook account and clean it up. We've heard about the dangers and pitfalls of social media since the onset of the program, but it honestly didn't bother me before. I don't have anything too incriminating on my page, and I've done a decent job at keeping most of my photos private (at least since I realized that was an option). I really thought everything was alright until I looked at my profile closely, at which point I realized I had some work to do.

I don't know how much truth there is in the warning that employers scan Facebook prior to offering a potential employee a job, but I'd rather not take my chances. Even if my profile is private, I didn't want to risk the chance of pictures from my sophomore year of college popping up somewhere unexpectedly. So that was step one. I put on my "professional" hat and eliminated as many questionable pictures from the public eye as possible. It broke my heart to get rid of some, but I have to be honest with myself -- Halloween photos from 2006 are no longer relevant.

Step two was to really take a look at my list of "friends" to recognize who had access to my information. I never realized that more than 1,000 people were linked to my profile, over half of whom I didn't recognize at first glance. So I'm currently in the process of de-friending the majority of acquaintances from over the years, and making sure the rest have limited access. I figure that the smaller I can make my social web, the better. I'll do just about anything to ensure that I get a job when this journey comes to an end!

I spent the better half of yesterday trying to organize the notes and lecture materials I've accumulated since starting PT school. I'm amazed by a lot of things, mostly the amount of knowledge that has been imparted upon us in such a short period of time, but equally by how much I have managed to forget. I filled 13 three-inch binders to their maximum paper capacity. That's a lot of trees.

Now that the process is over, I can't help but wonder if it's worth it to keep all of this material. Will I actually ever reference it? I can realistically see myself referring to my musculoskeletal and neuro notes, but that's about it. There are other valuable units that I'm sure will one day come in handy -- things like amputations, prosthetics, various outcome measures and legal/professional documents. All in all, that might include four of the binders. I have a feeling that the only time I'll look at most of the material will be to study for the boards, after which the binders will collect dust in an office somewhere until I finally decide to throw them out in five to 10 years.

I remember I had a similar issue last year with the required textbooks when I couldn't decide if I should buy them, and later if I should keep them. I thought that I'd really be missing out if I didn't have the books, but in the end decided to get rid of mine. I don't think I'm missing anything. (Everything I need to find out is much easier to track down via Google, anyway). I think I'll come to a similar solution with all of these notes, but probably not before I take the boards.

This coming semester will without a doubt have the least aggressive schedule since we started the program. Where we would usually be in clinic twice per week is now a glorious chunk of free time, with no strings attached and no fine print. And did I mention that our average dismissal time is 2 p.m.? We're done even earlier on Fridays, and have no class on Mondays. I'm imagining many long weekends visiting friends, camping, skiing and doing all the things I wished I could have done for the past year and a half. Student life can be so wonderful.

As I finished typing that paragraph, a sad reality came over me. Despite what appears to be an amazingly open schedule, I need to remember that I'm not just a student but that I'm working toward being a professional. A much better use of my time would probably be to review the essential material that has unfortunately exited my mind. Starting in May, the didactic portion of my education is over and I'll be inching closer and closer toward graduation and full licensure. Yikes. 

Perhaps the best approach will be, as always, to find a balance. I think I'll try to identify the most important information to review and map out a schedule to keep myself on track. That schedule will absolutely include weekend getaways. Here's hoping I can stick to my plan and get the most out of the next few months.

After 19 months of physical therapy school, I find it hard to believe that I haven't decided what type of setting I want to work in after I graduate. I'm getting closer to figuring it out, but I'm still torn between inpatient rehab, outpatient neuro and at least four other settings. When I think about it, I get a little bit stressed in realizing that this is something I probably need to figure out. Tonight I found some comfort (and humor) in listing all of the things I definitely don't want to do.

I'll start with ergonomics. We just finished our ergonomics module and I don't think I've ever been as bored in class. I can usually force myself to pay attention by reminding myself that one day, I'm going to be paid to know this information. This time around, I couldn't do it. It's not that I don't see the value in having a basis of understanding for ergonomics, but I genuinely could not make myself interested in it.

Wound care. In saying this, I recognize that I sound like the typical, wimpy, whiny PT student. However, I don't think there's enough money in the world to convince me to spend my career assessing and treating wounds. The pictures in lecture were bad enough. Hats off to anyone who can stomach wound care -- you're much tougher than I am.

Early intervention. And to be honest, I might extend this to pediatrics in general. I really wanted to be good at peds, but I'm starting to accept that it's not for me, particularly early intervention. I've said this before, but it's not appropriate to cry every day at work. If I worked in pediatrics, I think that would happen. Perhaps if I could work with adolescents only I'd be more inclined to go in this direction, but for now I don't think pediatrics is for me.

Last but not least -- acute care. I just finished my acute-care rotation, and while it was one of the most accelerated and valuable learning experiences I've had thus far in PT school, I don't think I'd enjoy practicing permanently in that setting. My favorite part of physical therapy is the amount of time you can spend with patients if you're in the right specialty. This gets lost in acute care. I wouldn't mind another clinical rotation in this setting since I recognize acute care as an amazing learning opportunity, however I wouldn't want to make a career of it.

It's a short list, but it's something! I'm halfway through the program, so it's time to start narrowing my focus and figuring out what I want to do after graduation.

We recently had to attend the third year's presentations of their performance-improvement projects, the final requirement of the program and what looks like the most frustrating assignment to date. The annual project basically populates an existing database with key information regarding process of care and patient outcome information.

From what I can gather (we haven't yet been formally given our assignments), each of us is assigned to a patient population and throughout the course of our year-long affiliation will collect data on appropriate patients, interventions and outcomes. We'll then present that information to the faculty, they'll question our intervention selections, we'll question whether or not we'll pass the program, and then we'll sit down. At least that's what it felt like when I was watching.

The patient populations range from level of mobility independence to general orthopedic diagnoses: neck, low back, knee etc. Your assignment, in general, will reflect your clinical placement. I suspect that I will be in one of the mobility groups, but who knows? The project serves to provide a concrete and inarguable way to track our success as clinicians. Are we selecting the appropriate intervention strategies? Are we recognizing and addressing relative comorbidities that will have an impact on the care that we provide? And, most importantly, are our patients getting better?

Sitting in the audience as a second-year student and retrospectively looking at these cases, I'm sure it's easy to think that I would have recognized clinical prediction rules, classifications and indications for certain treatments. In one year year, I'm sure I'll think differently.

We're constantly being reminded that you can't fix what you don't measure, and I absolutely abide by that. That doesn't mean I'm not dreading the embarrassment of having to present my follies to faculty and classmates. That being said, I think if we complete this project in the way it's intended, we have an amazing measurement tool to reference as we attempt to progress in our clinical careers.

The fact of the matter is that in a year, students or not, we're expected to be competent clinicians and our decisions are going to impact the health and wellness of our patients. I'm glad I'll have a way to see if I'm having a positive influence, and an easier way to recognize what I need to work on.

I'm embarrassed to say it, but it wasn't until last week that I finally got a grasp of the Affordable Care Act and specifically its implications for the future of physical therapy. As part of our "Evidence-Based Practice" coursework, Everette James, director of the Health Policy Institute at the University of Pittsburgh, addressed our class regarding the history and current state of the Affordable Care Act.

I didn't realize the vast potential for the field of physical therapy, but I'm excited about the future of our profession. The individual mandate for healthcare coverage will coincide with the graduation of my class in 2014. I have pathetically little knowledge about all of this, but even I can see how the delivery of care will need to change at that time. Physical therapy will be in the perfect place to step up to the plate! If we can find a way to further prove the value of our profession, I think we'll be in a great place.

Everette James focused specifically on Title III of the ACA, consisting of reducing readmissions, flat fee payment for services, healthcare innovation research funds and patient-centered outcomes. Specifically regarding the available funds for healthcare research, Everette James pinpointed the potential for physical therapy to develop and prove its value.

By demonstrating innovative and less expensive ways that PT professionals can provide care, we can hopefully change the climate of healthcare to focus on services provided by allied health personnel. In addition, with the patient-centered outcomes research institute also developed by the ACA, it seems like physical therapy is in an exciting place. I know it's going to take time for the changes to have an effect, but I'm excited to be graduating from school in the middle of it all.

It's been one month since we interviewed for our yearlong internships, and we're not any closer to knowing what the future holds for our clinical experiences than we were at the start of the semester. As of now, we're hanging on the program's every word as the faculty and staff try to piece together placements for all 54 students and attempt to keep everyone happy. I'm sure it's not an easy job, but this waiting game is torturous.

The longer I wait, the more I start to second-guess the way I ranked my preferences. My top choice was inpatient neuro rehab, which happens to be one of the most competitive internships in the program. With a limited number of placement options, it's a highly contested and sought-after clinical and I can't help but hear the voices in the back of my head saying, "Lauren, you should have picked something else."

It'll all be great if I get what I'm hoping for, but if I'm disappointed I'm obviously going to regret choosing such a competitive field. I'm also starting to recognize "mistakes" I made in the interview as time goes on. The longer I wait, the more I feel like I completely blew it. I know that's probably not true, but the mistakes always linger in your mind for so much longer than the positive parts do.

I remember feeling very relieved when the interview process was over because it was finally out of my hands -- I had done all I could to prepare, and the rest was up to the interviewers and our faculty. Now that we've gone a month without any indication of where we stand, I take that back. I'm not relieved, but instead feel completely helpless! Next year's clinical will be such an important part of my education and career, and I don't know how much longer I'm going to be able to endure this waiting game.

We had the pleasure of attending a site visit at the Western Pennsylvania School for Blind Children last week. We had the opportunity to work in small groups with a therapist and a child to perform an evaluation, and we'll return this week to follow through with our intervention. Talk about a learning experience! This was the first time in the pediatric curriculum that we actually performed an examination and evaluation of a child, and there's probably not much that could have prepared me for it.

Pediatric evaluations are a completely different beast. I felt like I came to the table with an assortment of clinical skills, but not one of them was useful. I hadn't considered how to adapt them to a patient who was non-verbal, and I've never had to think about creative and exciting ways to perform a functional evaluation. I unfortunately hadn't considered any of this before I sat down with the patient. Even the smallest assessment items required an entirely new approach. As unprepared as I felt, it was such a great learning experience to actually get to work with a child and force myself to think on my feet and adapt my skills on the fly.

The entire experience made me realize how amazingly patient and energetic pediatric therapists must be. I don't know if I'm cut out for it, but I absolutely loved the experience and I'm looking forward to going to back to implement our treatment plan.

I wanted to write this blog to help out some friends with a huge and exciting student-led initiative to gain support for the Foundation for Physical Therapy, a fund that supports research opportunities that will progress the evidence base of our field. This project encourages all PT and PTA schools throughout the country to participate in a triathlon challenge. Each school, led by a student team captain, will ask members (classmates, friends, family and anyone who wants to participate) to join their cause.

Starting at CSM on Jan. 22, all team members will track their mileage and fundraising progress on a central website. Team captains will be given a "Strategies Packet" to help them maximize their effort with membership recruitment and local sponsorships. Throughout, participants will share their experiences on the site. It's a challenge that not only promotes a healthy active lifestyle (and let's face it -- as PT students, we're not always the best at practicing what we preach to patients), but also serves as a way to unite students and contribute to the future of our profession. 

I'm new to the APTA and student involvement, so I'm including a statement from my classmate Matt DeBole, one of the brilliant and motivated people who came up with this initiative:

"The Log'N Blog will enable the over 450 PT and PTA programs in the country to easily make a significant contribution to the Foundation for Physical Therapy for research. We're especially excited to enable a method that's simple to use, very social and competitive and makes significant impact on our profession. As students, we need to understand that we can make a difference, and the Log'N Blog is one incredible way to become involved."

On Thursday morning, please send positive vibes my way. At 8:30 a.m., I'll be working my way through my first true competency practical. The exam will reflect basically everything we've learned in our musculoskeletal course series over the past year and a half, and the most comprehensive evaluation we've had up to this point. No one has quite figured out the implications for failing this practical. Will we get kicked out? Put on probation? Publically humiliated? I think we're afraid to know the answer... just in case.

I'll admit -- I should have started preparing for this much earlier than I did. I was hoping that once I sat down to review, most of the information would come back to me and I'd only have to take time to revisit the manual interventions. I wasn't completely wrong, but I wasn't right, either.

As always, I'm amazed at how much I've forgotten over the past year. I've been rereading some old lectures and I have to laugh when I see concepts, written in my own handwriting, that seem completely new to me. How am I ever going to pass the boards?! I'm not completely hopeless, though. At least it's much easier to learn this stuff the second time around, which leads me to believe that somewhere in the depths of my developing PT brain, these concepts are just dying to be remembered.

I go back and forth between doubtful panic and calm confidence. I'm hoping that a bit more preparation will push me toward the latter, but who knows? What I do know is that when Thursday is over, I'm going to be very relieved.

I'm happy to report that I'm confident and satisfied with the way my interviews unfolded, despite my absurd level of nervousness beforehand. I had three interviews in total, and by the time the last was over I wanted to walk out and high-five everyone. It's amazing how much energy that level of alertness and attention requires, and then how mentally drained you can be when it's over. 

The first interview was with the VA Pittsburgh Healthcare System, and was definitely the one I was most anxious for. I had to pace the hallways beforehand because when I sat down, I felt like I was going to fall out of the chair. As it turns out, it was completely unnecessary. The interview, while very structured, was exactly what I'd prepared for. They allotted enough time for my lengthy list of questions, and I left the interview even more excited about the possibility of having an internship with the VA. They allow of lot of flexibility with placements, so I could potentially get a very diverse clinical experience. Exactly what I was looking for!

The last two interviews were with the inpatient and outpatient groups of the University of Pittsburgh Healthcare System, with whom we are obviously closely tied. After the VA interview, these were pretty easy. I have a much stronger interest in inpatient rehab than outpatient orthopedics, so I prepared a lot for the inpatient interview, which also went very well. 

My goal at the beginning of this process was to put myself in the best position to get a diverse and challenging yearlong clinical placement. My two top choices (VA and inpatient neuro rehab) are among the most competitive, so it was important to interview well and display my skills and interests. I think I was able to do that. Now the painful process of waiting for the final decisions begins!

This is it! The moment we've all been waiting for! On Wednesday, my classmates and I will attend the interview(s) for our year-long clinical placements that will occupy our third and final year of the program. From what I've heard, the clinical education structure at Pitt is much different from other programs, so I'll give you a bit of background to provide a better frame of reference.

During the fall and spring semesters of years one and two, we have part-time affiliations that we attend twice per week. (The other three days we're in class). In that time, we're meant to experience both inpatient and outpatient PT. Our full-time rotations start during the summer between the first and second years, and we finish the program with a year-long clinical placement. For the year-long rotation, we can choose to spend 12 months in an outpatient or inpatient setting, or we can spend six months in each. I have decided to split my time between inpatient and outpatient so I can get the widest spectrum of experience.

I'll have three interviews on Wednesday. One will be with the inpatient team at the University of Pittsburgh Medical Center (UPMC), one with the UPMC outpatient team, and a third with the VA Pittsburgh Healthcare System. I suspect that each will have a very different structure, but aside from that I'm not sure what to expect. I've never had a formal interview before. Apparently we can expect scenario-based questions, strengths, weaknesses etc.

I'd love to hear some input from any of you who are part of the interview process for your organizations, including the classic "Dos and Don'ts" that you've seen over time. While I'm not completely stressed about the interview, it does carry a heavy burden for the rest of my time in PT school. I can also see how important it is to my career path. That being said, I'd love to be as prepared as possible when Wednesday morning comes around.

I guess my initiation as a PT student is finally complete -- today was the first time a patient refused to work with me after I informed him that I was a student. In a way, I'm surprised it's taken a year and a half for that to happen. At the same time, it was completely unexpected and I'm sure my facial expression didn't hide my surprise. This was the first time someone demonstrated even slight unease at being treated by me, a student, let alone completely refusing.

After I got over the initial embarrassment and slight annoyance, I took some time to think about the situation and I didn't take it personally. I actually wondered whether I'd do the same thing if I didn't know anything about physical therapy or what my treatment would entail. This particular patient was just a few days out from a total knee replacement and in a lot of pain. I can imagine that any sort of uncertainty or perceived "subpar" care was the last thing he was interested in. At first, I felt myself becoming slightly defensive but I'm proud of myself for handling the situation professionally and with a lot of understanding (even if it wasn't necessarily how I was feeling inside).

This whole experience was a very valuable lesson in displaying confidence in my skills and also in dealing with patients when they are unhappy with you. I was a bit timid with the next few patients who came in, but I had to remind myself that while I'm not yet a fully licensed physical therapist, I'm still a capable and intelligent person. A year ago, I probably would have had a very different reaction. It's amazing to see how far I've come in such a short time.