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Striving to Be a DPT

My First Rotation: The Skilled Nursing Facility
by Jocelyn Wallace

My program is unique in that we do our first full-time, 4-week rotation at the tail end of our first year. My first, along with the rest of my classmates, was in the SNF setting. "SNF" stands for skilled nursing facility, or nursing home. I greatly enjoyed my experience in my SNF, which was a 196-bed facility that had approximately 50% long-term care and 50% short-term patients.

The majority of the patients seen by the rehab department were short-term stays for diagnoses such as complicated joint replacements, falls, and neurological injuries. Many of the long-term care residents had been there for years for general failure to thrive, while others had no option to go home due to a need for care.

My biggest takeaway from my experience in the SNF was a general frustration with the setting. Many students are hesitant in the first place to work with a geriatric population. I can't deny that I wasn't thrilled, myself.

However, I enjoyed the population more than I expected. I bonded very well with a lot of the patients and my days were filled with smiles. The patients I saw ranged from 42-101; hardly a boring population! My general frustration came from the way it seems physical therapy is practiced in this setting.

My education and experience thus far have shown two major themes in helping patients see gains; specificity and overload. The majority of the patients in the SNF were given high-repetition, low-weight exercises and rarely seemed challenged. If a patient did not want to try a heavier weight, the efforts to convince them otherwise were minimal.

It seems like there is a lot of room for improvement in how PT is practiced in this setting; however, I realize that it is complicated by billing and insurance restrictions. Either way, I'd like to see changes in the setting during my career.

On the positive end, I have gotten much more comfortable working with patients and doing all sorts of psychomotor skills. I was very pleased with the experience and am excited for my upcoming clinical experiences!

Does anyone have any thoughts on the strengths and weaknesses of working in a SNF setting and how physical therapy is provided?

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State Advocacy Days
by Jocelyn Wallace

I recently attended my state's Advocacy Days in Florida's capital city, Tallahassee. This event is organized by our state's professional association, the FPTA and was focused on current efforts to update our state practice act to give full, unrestricted direct access among some other changes.

The Advocacy Days event was two days in length. The first evening was about 4 hours of training and preparation for the next morning's legislative visits. We heard from a Senator about the value of our input, about the legislative process, key players for the bill and a lot more. A ton of the information was over my head and somewhat overwhelming, but overall it was a great learning experience.

The next morning started bright and early for visits to the Capitol building. We were split into small teams and, after an introductory meeting and photos, we started on our visit schedule. We met with legislative aides, Senators and House Representatives. Of our visits, only one person was particularly unreceptive. The rest went very well! We wrapped up with recaps from the other teams and discussed next steps.

The House and Senate bills are still working their way through this legislative session but regardless of what happens, the experience was great! It was inspiring to show up and help represent my profession, and I learned a lot about who else plays a part in the future of our profession. If your state professional association holds a similar event, I strongly urge you to attend at least once! Even if politics aren't your thing, it's a really valuable understanding to possess.

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News From the CSCS Exam!
by Jocelyn Wallace

On February 7, I sat for the Certified Strength and Conditioning Specialist (CSCS) exam with the NSCA and passed. As I touched on in a previous post, this exam is often sought after by physical therapists and physical therapy students who are looking to improve their knowledge in sport-specific training and exercise physiology as a way to set themselves apart.

I decided to sit for the exam after completing an Exercise Physiology course where we used the NSCA Essentials of Strength and Conditioning textbook. Since many students strive to take this exam during school, I want to share my preparation experience. This is what I think helped me be successful on the exam over roughly six weeks of studying 10-12 hours per week:

Read the Book. The Exercise Physiology course in my program was a very thorough presentation of the majority of the scientific foundations portion of the exam so I had an advantage there when I began to study. While I was familiar with all of the chapters, I still read through them once more and made brief outlines. I read all of the practical chapters twice through and completed outlines of unfamiliar concepts. If you know the book inside-out, you are in a good place.

Practice. The CSCS exam is tricky! Many questions come down to choosing the "most right" answer and using a lot of practice questions was essential for me to nail this skill. I was lucky that my professor wrote and shared some practice questions with us but I also purchased some from the NSCA, including exercise-technique practice questions with video clips similar to what you see on the exam. I also did the practice questions from the book over and over again. These really exposed my weak points.

Tackle Your Weaknesses. While I used practice questions to expose the concepts I was more unfamiliar with, you may be able to do the same with only thorough self-reflection. Either way, it's important to hit your weak points hard. When I purchased the NSCA practice questions, I did the worst on the program design portion. On the real thing it was my best section! That's because I recognized it as a weakness and spent significantly more time on it than other sections.

Embrace Your Experience. As a physical therapy student you will have a significant advantage on the exam. I encountered a lot of blanket anatomy questions that were not covered in the book at all. I didn't study this material prior to the exam and excelled on these questions because of my background as a DPT student. Further, the practical application questions often pulled on knowledge that wasn't presented in the book and I simply had to trust my gut and experience.

If you are considering taking the CSCS exam as a DPT student, it's likely that you have personal interest and experience in the subject of strength and conditioning. You are sitting for this exam for a reason and with adequate studying of the book's contents plus diligent practice, the exam is absolutely doable!

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State Advocacy from a Student Perspective
by Jocelyn Wallace

I have written posts on advocacy in the past that have centered primarily on the concept of advocacy and what it can bring in the way of personal and professional growth. This weekend, however, I had the chance to attend the Florida Physical Therapy Association (FPTA) Student Conclave, and it has me fired up about the practical implications of advocacy on the state level!

During my undergraduate education, I was lucky enough to intern for a State Senator and a political action committee. While not at all related to healthcare, these experiences set me up for a lifetime as a politics junkie. I've seen firsthand the real impact that advocacy for any cause can make on a state or even local level! But why is this important for physical therapy?

Each state has its own laws in place that dictate how physical therapists can practice. In Florida, the FPTA will be working during this legislative session to update the practice act to create true direct access by eliminating our current 21-day rule. If successful, this will be an enormous victory for students and practicing therapists throughout the state. It also sets a precedent for the rest of the country in terms of seeing PTs as primary care practitioners. This is only one issue that the FPTA is fighting for and it serves as a great example of the value of creating a strong professional association.

I'll be attending the FPTA State Advocacy Days in February to play my part in moving our profession forward. I expect to see some victories and will be sure to share the experience.

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Frustrations with PT School: Trust the Process?
by Jocelyn Wallace

It has been 8 months since I started PT school and, on most days, I've been able to keep a positive, enthusiastic outlook. These past two weeks, however, have been filled with frustrations. While I'm a big believer in the move to a doctorate of physical therapy, it often seems like the curriculum has just been filled with busy work and repetitive subjects.

One thing that has been covered ad nauseam so far is documentation. Prior to school, I spent 2 years working as a civil litigation paralegal in the areas of worker's compensation and personal injury. I agree that an appreciation for the importance of skilled documentation is a critical subject in physical therapy school. However, it often feels like we have only gone as deep as to cover the difference between ICD and CPT codes and gait training vs. ambulation; over and over and over again! It leads to a lack of attention from students and nothing is learned.

Another topic we've covered over three separate lectures is searching databases. These lectures have consisted of watching a professor or librarian search different topics and following step-by-step directions to analyze how search results change for terms like "heart attack" and "myocardial infarction." Meanwhile, none of our courses have included any in-depth research assignments where we can put these skills to use. By the time we reached our third lecture on the subject, the large majority of the class was just browsing Facebook.

My intention is not to complain but to highlight the fact that PT school is not without frustrations. We do a lot of exciting, hands-on work but there are many afternoons that seem to just be filling space. I think this time could be better spent. My classmates have all made it into a very competitive graduate program and it seems there is a lot of room to raise the bar and push ourselves to enter this doctorate-level profession as prepared as possible. For example, we could write a paper instead of listening to lectures on different databases, or practice documentation (for a grade) instead of staring at PowerPoint slides about it.

More importantly, these frustrations have brought up the question of "should I trust this process?" My program recently had a 100% NPTE pass rate, but does this mean that students are leaving prepared to be competent clinicians? I think so, but I'm still a big believer in "hacking" your education by reading research independently, seeking mentorship from clinicians separated from the bureaucracy of schooling and, most importantly, questioning everything. That's how I stay grounded when frustrations make me feel like running from it all. Along with these "hacks," I'm willing to trust the process and embrace the frustrations. Hopefully, they'll serve a purpose in the long run.

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Semester Three of Nine
by Jocelyn Wallace

This past Monday was the start of my third semester of physical therapy school. My classes include Clinical Practicum 1, Cardiopulmonary PT, Intro to Research Methods and Data Analysis, Gerontology, Neuroanatomy, Healthcare Educator and Clinical Skills 2. Seems like a lot, right? Well so far it doesn't seem so bad! The schedule is not nearly as heavy on exams as last semester and we will be doing a lot of group work.

Another change this semester is that some of the classes only last for a number of weeks. Gerontology, for example, is over in 6 weeks and consists of mostly guest lectures, assignments and a take-home final exam. It also seems like we're going to have a lot more lab experience this time around, with Clinical Skills 2 and Cardiopulmonary being very lab-intensive.

The thing I'm most looking forward to is Clinical Practicum 1. This is not a class, per se, but a series of experiences. We do a few days of orientation on things like documentation and skills review, but otherwise the course consists of four full-day experiences in different PT settings. I get to visit two SNFs, one acute-care setting and the sports medicine clinic on campus, where I've been before.

In 4 short months, I'll be just about halfway done with the didactic portion of the curriculum! I'm very excited to start getting more hands-on experience and really begin to see where my interests lie within physical therapy. I'm certain that I'll have tons of lessons to learn and share on this blog during the semester.

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Getting Certifications in PT School: CSCS
by Jocelyn Wallace

A few weeks before the end of fall semester, one of our professors came and spoke to the class about the value of obtaining certifications during school. He cited reasons such as better job opportunities, better chances at residencies and just as a way to set yourself apart overall. Since we just completed exercise physiology, I've decided to pursue the certified strength and conditioning specialist exam from the NSCA. I chose this certification because I'm personally interested in the subject and feel it carries well to outpatient practice.

I began studying a little bit over holiday break by taking a practice test and starting to go through the chapters. I'm feeling strong on the science and nutrition portions but have no coaching experience, although one of my hobbies is powerlifting and I regularly videotape and critique myself. However, that is the breadth of my knowledge and a good chunk of the exam consists of form critique from written descriptions and videos, so knowing how to coach various lifts is important.

My exam is scheduled in about a month and I plan on studying for it during this upcoming semester. If anyone has any preparation tips, please share and I will post my progress and results on the exam.

Thanks for reading!

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My First Direct Patient Experience
by Jocelyn Wallace

On Tuesday my class traveled to a local senior center to do a community screening. Our class of 51 was divided into groups of three students and we were assigned a patient. We weren't given any background aside from what we gathered from the patient. After completing a history, balance, strength, ROM and various other screens, we were left with a very complicated picture. Overall, the experience left me with a mixture of emotions.

The patient was younger than senior age but seemed to have cognitive decline. There were many apparent health issues that she did not report during the history, such as evidence of cardiovascular problems, loss of protective sensation and gait deviation. The screening took about an hour and we uncovered a variety of potential problems. Our role during the screening, however, was to just take the information, give the patient simple advice, have our professors sign off and then give any questionable results to the nursing staff at the center.

To discover all these pieces to a puzzle but not be able to put them together was tough. The patient did not report any cardiovascular issues but her feet showed classic signs of poor circulation, for example. We suggested to the patient that she visit her physician, but to never know whether it actually happened and what came of it would be very hard to get used to.

On a more positive note, our patient enjoyed interacting with the students and all of the others seemed to as well. Taking a history from a real patient was a great experience and I was surprised to find myself mentally ticking boxes and connecting what I've learned to what may have been going on with the patient. Overall, it was a valuable experience.

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My First Rotation
by Jocelyn Wallace

This week, I found out where my first clinical rotation will be. My program begins clinical at the end of our first year, in April, at a skilled nursing facility. Mine will be in Hialeah, Fla., part of the Miami area. While I'm excited for tons of delicious coffee, I'm super nervous about the language barrier. The majority of the patients will speak Spanish and Creole. I don't speak any second languages.

The funny thing is that I asked for this, as I want to stay in Miami after graduation and understand the benefit of learning Spanish. A large part of my family is Spanish and Cuban, as well, so I've always wanted to learn, but is 5 months enough time to learn what I need to get by? Will this pseudo-immersion experience finally thrust me into understanding the language I've spent all of high school and college taking? I guess I'll find out.

Other than the language fears, I'm very excited. The facility is a short commute from home and upperclassmen who've been placed there have enjoyed the experience. I've never spent much time in a nursing home so I'm not sure what to expect, but I'm hoping to have a chance to use what I've learned about wound care, transfers, assistive device prescription and more. It's exciting to realize I've actually learned something that may be useful to others in a few short months!

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PT School Interviews
by Jocelyn Wallace

It's about that time when applicants to physical therapy programs are getting calls and letters for interviews. They may be the scariest part about applying to PT school, but interviews are actually a lot of fun. I wound up at a school that doesn't interview but still learned a lot from the interview process about how to make the best of the experience:

● Dress the part. This is essential! I suggest closed-toe shoes, pants or a knee-length skirt, a blouse and a jacket. Some people at my interview wore t-shirts, sneakers and tiny mini skirts and dresses. While kind of silly, the way you dress is your first impression.

● Be prepared. Understand issues going on in the field of physical therapy, such as the APTA's mission, be prepared to discuss why you want to be a PT and why you want to go to that school. My interviewer asked me very detailed questions about my background and how I thought certain experiences applied to being a PT. I'd suggest going through your resume with a fine-tooth comb and reflecting on how seemingly unrelated experiences could make you a better professional.

● Have fun! If your interview is anything like mine, you will get to meet other applicants, current students and various faculty. You'll get a tour and maybe free breakfast. Try to enjoy the process, it really is a lot of fun. We choose PT school because we like to be around people, so embrace the opportunity to learn, even if you don't get admitted.

I hope these are helpful tips! Please feel free to ask any specific questions in the comment section below, I'd be happy to answer in more detail about my interview experiences.

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My First National Conference: NSC 2014
by Jocelyn Wallace

While researching and applying to physical therapy schools last year, I couldn't help but notice all the buzz about NSC, or the National Student Conclave, an annual student-centered APTA conference. Twitter was full of exciting posts about NSC and I remember it was one of the first things I looked into attending once I was accepted to a program. This past weekend, I had the chance to go and I have to say it far surpassed my already high expectations.

When other students urged me to go to NSC, I assumed the great programming was why they liked it so much, but it offered so much more than that. While the conference was loaded with inspiring discussions on leadership, advocacy and post-grad life, plus some more practical information on things like residencies and financial planning, the best part was the people.

NSC is an incredible networking opportunity. On top of the programming and exhibits, there were nightly social events like a PT Pub Night and PT-PAC Halloween party. I'm on the introverted side and I still left with dozens of new contacts! More important than networking though, was the incredible energy these students had.

It's often hard to dredge through endless studying and tests and stay motivated. At NSC, you get to be surrounded by the most motivated, involved and inspired DPT students in the country. Their energy was absolutely contagious. For me, this went beyond the typical value of networking. It gave me perspective on the real, tangible impact that we, as students, can have on this profession.

That makes going through the motions of school exponentially more fulfilling. I think Dr. Eric Chaconas (@echaconas) said it best, "People here today at this conference are the ones that are going to make a difference." This is our profession and being engaged in it is an obligation and a privilege.

I have to sum up with a quote from Jerry Durham (@Jerry_DurhamPT) who tweeted to newly elected APTA Student Assembly Board of Directors VP, Rob Hofschulte (@Rob_Hoff), "Keep pushing, WE NEED you kids to push (regardless of what those around you say)." Attending NSC gives you the energy you need to keep pushing, is tons of fun, and I urge any student considering attending to go!

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Choosing the Right PT Program
by Jocelyn Wallace

This time last year, I was just starting to hear back from PT programs and had attended my first interview. Choosing what schools to apply to and, ultimately, where to attend, was one of the hardest decisions I've ever had to make. Here are some of the things I considered to be most important:

Location/Commute: The first thing I considered was location. I only applied to programs that were in places I had family support and knew I'd like to live after graduation. Of course, family support is not an option for everyone, but location still affects cost and quality of life. I wound up attending a program about 10 minutes driving distance from the house where I live with family for minimal cost.

Cost: The cost of the programs I applied to was a huge consideration. The debt we have to take on as DPT students is enormous and should not be overlooked. I still wound up at a very expensive program, but I did not apply to programs costing more than $90K in total. This eliminated a ton of private schools and out-of-state programs from my list.

Curriculum Style: Some programs employ "problem-based learning." The concept is somewhat above my head, so I'd suggest looking it up, but it didn't sound like it was for me. I do well with a traditional model of lectures, labs and tests and didn't want to stray away from that. I did not apply to any programs with problem-based learning models. Further, some programs have curriculums and faculty with a heavier emphasis on a certain setting. From my uneducated perspective, I tried to choose a program with a very well-rounded curriculum, because I have no idea where I want to work.

Professor Specialties: I'm lucky to attend a program with faculty who have very niche specialties including wound care and lymphedema specialists, cardiopulmonary experts, NICU and more. I didn't consider this while applying but I'm now very glad that I've had the exposure to these professors. I'm not sure whether this is typical at other programs, but I would definitely ask what specialties professors have and, perhaps more importantly, whether they're still active in clinical practice. Having specialized, active professors has already given me invaluable perspective on my vast opportunities for practice.

Overall, I think cost and location were my most important decision-making factors and, despite the other great things my program offered, I'd have chosen a cheaper but still well-located school if I'd had the opportunity. Still, if cost and location are equal, I'd move on to weighing factors pertaining to the quality of the program.

I'd also like to note that the school's NPTE pass rate is important; however, it seemed to me that most programs were in the high 90s, so that didn't wind up being a contributing factor to my decision.

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Service Learning
by Jocelyn Wallace

This weekend, I completed my first service learning activity. Along with a team of two other girls from different programs, we presented to approximately 40 high school students about what diabetes is and how to prevent it. My portion of the presentation was on "Exercise and Diabetes."

While service learning activities are a requirement of my program, I still really enjoyed the activity. The students were more engaged than I ever expected and thanked us a lot for our time and the information we shared. They asked tons of questions and at the end of the presentation we played a Jeopardy game. It was clear they had really retained some of the information!

To complete my service learning hours for the year, I have to give the presentation two more times. While there are some kinks I'd like to smooth out, I'm very glad to have taken part and feel like we are really making a difference, however small.

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Managing a Routine in PT School
by Jocelyn Wallace

One of the toughest parts of PT school is staying on top of my routine. Aside from school-related studying and activities, I prioritize weightlifting, eating as healthy as I can and finding time to spend with friends. Here are some ways I stay on top of it:

● Become a morning person. I've been forced to become a morning person, waking up between 5 and 5:30 a.m. to pack for the day and go to the gym before class at 8 a.m. I think it has definitely increased my energy throughout the day and contributes to my ability to focus in class. So many things can come my way during the day that working out in the afternoon never worked. Waking up early really hasn't been so bad!

● Meal prep. Even if I'm utterly exhausted, I pack my lunches (and sometimes dinners!) the night before. I'm not as on top of this as I should be (some classmates prep for the whole week), but I can definitely see the value in getting healthy meals ready. It's good for your body and your wallet.

● Don't work yourself to death. Your grades are never as important as enjoying life, in my opinion. Of course, the goal should never be to just pass and learn as little as possible; however, if you find yourself studying every waking moment just to get straight A's, you may want to reconsider your priorities. You're going to burn out someday and backing off a bit could even help your grades! I go out at least once a week.

I hope some of these tips were helpful. After the past 1.5 semesters, I don't think anything has been as imperative to my success as prioritizing my outside life!

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Benefits of PT Student Involvement
by Jocelyn Wallace

This week I was awarded a grant to attend the National Student Conclave. The grant covers airfare, hotel and registration to the conference. Of course, I was very happy to receive the grant but was also eager to share with my peers the benefits of being involved. The grant was through my university and any student, from any program, wanting to attend a professional conference was eligible. However, I was the only PT student to apply, although the application only took a few minutes.

Of course, not everyone is lucky enough to have programs like this at their university. Some other sources for professional development help may include your state chapter of the APTA, scholarship programs from hospitals, other organizations and more. A quick Google search can often turn up great results! Another great suggestion is to ask faculty at your program.

Already found a scholarship or grant to apply for? It seems the best way to make yourself competitive is to get involved. I'm a member of the Executive Board for the Private Practice Section National Student Special Interest Group, which I think really helped improve my chances for funding. More importantly, I sincerely want to be involved with the group and am excited to work with them, so the added benefit of new opportunities is just a plus. Find what you love, get involved, and doors will open!

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