This is why we make the big bucks

The last part of the journey through physical therapy school is winding down for the third year DPT students that make up Elon’s graduating class of 2014. Those of us who did not use the five days provided for excused absences have just completed their last week of final internship and those (like myself) that chose to use these five days throughout our six month experience, will be wrapping up our final days at the clinic at some point this week (as late as Friday).

These last few weeks have been a challenge as we have been busier than ever! We have revised our drafts/completed our patient case report, reflected on our experiences and written them out in our contemplations assignment, began to prepare for graduation, and mailed off necessary forms in conjunction to our application to sit for the NPTE (National Physical Therapy Exam), all while trying to balance a full patient caseload.

For some of my classmates, who chose to take the NPTE in other states that offer the exam prior to graduation, I say “CONGRATULATIONS!” You are one more step closer than the rest of us to becoming practicing (and of course PAID clinicians instead of PAYING) clinicians!

That brings me to the two things I have experienced patient’s say to/ask me over the last six months that make me almost laugh inside, as they are just too ironic and opposite of our reality. The first statement I frequently hear from patients is, “That’s why you make the big bucks!” To respond to this statement, I remind them that, as a student, I am actually paying my usual tuition for this experience.  I explain that an internship is like an apprenticeship where I am able to learn through my CI and through hands-on experiences with my patients.

The second inquiry/comment, that requires self-control to keep me from bursting out laughing, has been presented to me in the form of either a question or a statement. When presented as a question, it is usually asked something like this, “So, what do you need to become a PT, a certificate from taking a course, a special weekend training, or something like that?” To this I explain that there’s a little more that’s involved with becoming a PT than that. I then continue by sharing with them the fact that I am actually finishing up my doctorate, which is currently the typical degree requirement. The statement (similar to the question form above) referring to the schooling involved with becoming a physical therapist usually occurs after someone has read my Elon nametag, which lists the title “Doctor of Physical Therapy Student” above my first name. The general response of my patients is usually one of surprise, and the patient will usually state something to the effect of, “Oh wow, so you’re getting your doctorate in physical therapy.” I again reply with the explanation that the majority of students pursuing physical therapy are currently enrolled in doctoral programs, adding that the vision for 2020 is that all physical therapist will be doctors of physical therapy.

I find it interesting that the level of education involved in what we do is so surprising to many people. My hope is that this will change in the future, as I feel a graduate level degree tends to be accompanied by the perception of credibility in the eyes of the patient.

In the meantime, getting back to the final weeks of the long journey through PT school, life resumes along its busy route. Emails continue to arrive in my Elon inbox pertaining to the last week of classes, reminding me that the end of this internship is by no means the end of our PT school experience. We will have a week of school consisting of electives courses, a licensure review course, an exit interview, and a variety of other courses, obligations, and of course festivities. It is an exhausting time, but as the light at the end of the tunnel draws near, I can feel a small spark of excitement ignite as I think of graduation day just a few weeks away. The day we have worked so hard for over the last three years! To think this chapter of our lives is coming to an end seems almost impossible!

We will soon begin the next chapter, the chapter where we become all that we have been striving to be these last three years: the chapter where we become doctors of physical therapy!

Time Flies

Did you know that there are approximately 10,568 different sayings about time??? OK, so maybe I don’t actually know the true number of sayings, but doesn’t it seem like there could be that many?? Regardless of the actual number, one of my personal favorite sayings comes from the one and only Ferris Bueller. In the movie Ferris Bueller’s Day Off, Ferris very accurately states that “Life moves pretty fast. If you don’t stop and look around once in awhile, you could miss it.” So true Ferris, so true. For the DPT class of 2016, life is indeed moving pretty fast. We’re two-thirds of the way through our orthopedic module, we’re starting to conclude our research projects, and we’ll be in the clinic in two months time!!

One of our professors recently pointed out to us that, just as Ferris says, sometimes we forget to “stop and look around.” And how true that is! I think that we’ve gotten so busy recently that we’ve forgotten how amazing it is that, in a relatively short timespan, we’ve come from knowing little to nothing about how to treat musculoskeletal impairments to feeling pretty confident in how to evaluate and treat someone with back pain or leg pain (arm and shoulder pain still to come!).

It’s pretty crazy to think about how fast this year has gone and equally crazy to think about all that we’ve learned in our first year! I’m sure it will only move faster as we continue on into the curriculum but a big thanks to Ferris and to our professors for reminding us to stop and take a moment to be proud of the PT’s that we’re becoming!

Every clinical rotation is unique in it’s own way. That statement is true for each clinical, whether viewed from an individual perspective looking at each personal clinical experience or viewing experiences between individuals; there are simply no experiences that are exactly alike. Personally speaking, this internship is proving to be the most challenging clinical rotation yet. I love my patients, my co-workers, and the amount of equipment and resources available at the clinic that I am currently practicing. Like most clinical experiences, while the pros are many, so are the cons. Time… or rather, lack of time is the greatest con. I don’t care for the hour commute to the clinic and the hour commute home, I struggle with the expectations of 100 percent productivity (meaning that 100 percent of your workday you are scheduled with a patient and are not allotted any time away from patient care to document), and the software used for EMR and my work computer in general does not get along with me! Between the computer freezing throughout the day (every day) and the less than user friendly software for EMR, having what seems like a million tabs, dropdown boxes, and folders, I am challenged not to audibly yell my frustrations at the computer while at the clinic!

 

This is my average workday:

   
5:00-6:00am Wake up and get ready to go to the clinic
6:00-7:00am Commute to the clinic
7:00-8:00am Proof-read and enter any documentation not entered from previous day or that I took home to complete (without any identifying information & abiding by the laws of HIPPA)
8:00-8:45am Treat, re-evaluate, or discharge patient #1
8:45-9:30am Treat, re-evaluate, or discharge patient #2
9:30-10:15am Treat, re-evaluate, or discharge patient #3
10:15-11:15 am Perform initial evaluation on new patient; patient #4
11:15am-12:00pm Treat, re-evaluate, or discharge patient #5
12:00-1:00pm If there is not an In-Service Presentation, Rehab Staff Meeting, or PT Staff Meeting, then eat lunch while working on documentation
1:00-1:45pm Treat, re-evaluate, or discharge patient #6
1:45-2:30pm Treat, re-evaluate, or discharge patient #7
2:30-3:30pm Perform initial evaluation on new patient; patient #8
3:30-4:15pm Treat, re-evaluate, or discharge patient #9
4:15-5:00pm Treat, re-evaluate, or discharge patient #10
5:00-7:30pm Edit and try to complete documentation
7:30-8:30pm Commute home from the clinic
8:30-10:00pm Eat dinner, shower, un-pack and repack lunch, etc.
10:00-11:30pm Work on any homework due, check and respond to e-mails, complete any documentation and edit any documentation not finished at the clinic, look over the POC of patients being seen the next day
11:30pm-5:00am Sleep

 

Most people reading this extensive list, which makes up my typical day, can see where things can be more than a little overwhelming! However, as the old saying by Theodore Roosevelt goes, “Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… “ For me, personally, the toughest aspect is performing documentation while working with my patients. Simply working “one-on-one” with a patient can prove challenging to a student. This becomes more challenging in many clinical settings like the one I am at, in which OT, PT, SLP, and cardiac rehab clinicians (and each of their patients) are all working in the same rehabilitation gym. Add over-head music thumping loudly through the speaker system along with the need to multi-task in order perform as much documentation (while exanimating, evaluating, or treating the patient) as possible and one can envision the difficulty a clinician might experience, especially an inexperienced, student clinician! Unfortunately, this is becoming more and more the normal expectation of clinicians in many settings. In a conversation with another clinician, I was told that in some settings within the state of NC, clinicians are now expected to clock out if their patient’s cancel or do not show within a certain period of time of their appointment and clock back in when their next patient arrives. In our clinic, if we have a patient cancel or not show for the scheduled appointment, we may assist the PTs in the acute portion of the hospital if they have a high number of patients on their caseload.

I find some peace and reassurance in the fact that I very much enjoy working with each of my patients. I am also reassured by hanging on the words of a friend, who has been a nurse practitioner for 20 years. Just this past month, my friend shard with me that like job responsibilities in other fields, her job duties as a clinician have never been as demanding as they are now due to the extensive documentation expected in conjunction with the lack of time provided to complete it. My friend shared with me that it is her belief that such expectations of clinicians is sure to change for the better in the near future; that is what I hope as well. I love the field of PT, I love my patients, and I love all the advances in technology bringing hope to those with impairments. It is these aspects that I want to see clinicians have the time to focus on; not becoming overwhelmed by the expectations of productivity or buried under the demands of documentation.

While we are on this 6-month adventure, there is some reprieve from overwhelming expectations and demanding documentation. One aspect that is different with this internship than from previous clinical rotations is the fact that, during this final internship, we are provided with 5 days that can be taken off for any reason. This is something that I not only appreciate being able to utilize, but something I feel is essential. Like the majority of full time jobs, in which employees are provided time off for rejuvenation, time to spend with family and friends, or time to attend doctor/dentist appointments, these same privileges hold true for us as interns. As students we may need this time even more than we will as full-time employees, for we have course work to complete along with our clinical experience as well as an additional research course we are taking (that requires much time and focus) during this clinical rotation. I just used two of my five allotted days off to enjoy a long weekend in NY to rejuvenate and celebrate the 20-year anniversary of my high school reunion! It’s back to the clinic tomorrow and I feel refreshed and ready to take on the remaining seven weeks of this clinical rotation known at Elon as DPT 805!

Elon DPT Class of 2016 …aka a room full of Sherlocks

It’s hard to believe, but we’re officially a third of the way done with our orthopedic module! The spine has been conquered, and now we’re focusing in on the legs. As we’ve been discussing these oh-so-important structures that get us from point A to point B, I’m becoming more and more aware that treating a patient who presents with an orthopedic condition is like pretending I’m Sherlock Holmes reincarnated as a PT (pardon the comparison but it’s true!). From the moment we lay eyes on the patient and begin to observe their gait and posture to the moment we prescribe them with a home exercise program, we have to take a whole bunch of information and try our best to piece it all together. Sometimes, figuring out a patient’s impairment(s) is easy, and the pieces of the puzzle seem to fit together very neatly. Unfortunately, most of the time it feels a bit like trying to find a needle in a haystack.

So my dear Watson, how do we make this process easier on ourselves? Well first of all we practice! While there certainly are some cases that are just flat out difficult, there are some patterns to look for in many orthopedic conditions. For instance, if I were to suspect that my patient might have arthritis in his or her hip, I would expect him or her to complain of hip tightness/stiffness in the morning, among other things. To further aid our cause, we also seek out the professional wisdom of our professors, and we find out what the current research has to say. While PT certainly isn’t “elementary,” we’re getting a better grasp on our sleuthing skills and learning how to make the puzzle pieces fit!

From “ugh therapy” to “I’m going to miss you”

“Ugh therapy”  “Not you again” “This is going to kill me” “I’m too tired for therapy today” “You told me two more two times ago” “What more do you got?” “Thank you” “I’m getting stronger” “I’m going home” “I’m going to miss you.”   From one spectrum to another we experience the emotional pendulum of a life in its most vulnerable state. We give hope, we give strength, we provide skilled intervention to move that pendulum towards health and life that once was.  Not to say every patient is a success story, but many of them are. As a Physical Therapy student you absorb each experience fully because each novel experience is shaping us and will shape how we interact, reason, and fundamentally function as a Physical Therapist post-December 2015.

 

The 53 students of DPT 2015 are scattered over the nation applying the textbook material and applying our individual lives into the lives of others. Since July 2014 a majority have tackled an 8-week clinical rotation in either a Skilled Nursing Facility or Inpatient setting. Now some classmates have taken an alternative route; some have chosen to have a clinical in Italy. Why one would ever want to travel and live there for 8 weeks is unknown to me…#jealous. In September we transitioned to an 8-week clinical in an Acute setting. Once again some classmates split the country for Belize or have selected a rotation in a different setting such as the ICU.

 

Each rotation has its own challenges, joys, road bumps, confidence builders, and educational opportunities. I’ve felt on top of the world and in over my head in the past weeks. As a DPT student you learn to take it day by day, hour by hour even at times. The clinical rotations make you that much more alert to how you are developing your own set of clinical skills.  I am sure all of us are enjoying life outside of the classroom but truth be told I do miss all 52 faces that I’m used to seeing all day…every day.  I wait impatiently to be reunited with friends at Elon in the beginning of November. From there we will proceed with further lecture, projects, and adventures in the vast city of Burlington.

Have problems with your Multifidus?? Don’t worry, I do too…

Module IV. The fall. The real deal. From the first day we started PT school, we’ve heard a lot about the module in which we currently find ourselves immersed. We heard it was busy. Check. We heard it would involve a lot of research. Check. We heard it would be a time of bonding and a time of surprising fun. Check. And we heard it would be a time where we might forget our right from our left. Double check.

What we didn’t hear as much about is that it would be a time of realizing that no human body is perfect. We all have faults! The good thing is, most of these deviations are harmless and the vast majority of them just make us unique rather than cause us pain. To prove my point, here’s a fun fact. Did you know that right this very minute as you’re reading this, one of the discs in your back could be slightly out of position? Well if you didn’t know that, then chances are it’s probably not causing you pain, correct?? And therein lies one of the beauties of the human body; it’s not a perfect machine by any means, but it sure is awesomely resilient and adaptable.

For those of you that do have pain that has moved out of the harmless realm, good news! Myself and about 50 other people will be graduating in approximately 2.5 years and will then be more than happy to treat you! All kidding aside, this module and its myriad amounts of information are helping us grow in our ability to repair the machine that is the human body. We’ve still got a lot to learn, but every new technique we practice is getting us to see the bigger picture and is making us more aware that there are a lot of pretty amazing ways we can help people with nothing other than our two hands. Now if only I could remember which one is my right hand and which one is my left….Cheers to Module IV!!

Earplugs are a girl’s best friend

Almost to midterm? Is that possible? It may seem impossible, but that is exactly where the 3rd year PT students are in their last of 4 clinical rotations. The first 8 weeks I was unsure I’d ever start to become more proficient in my documentation or multi-task well enough to instruct my patients, keep them safe, provide them with appropriate tactile cues for technique, and make notes regarding their progress all during their physical therapy session. Be sure you read that last long sentence carefully, I by no means implied that I am anywhere near proficient or that I have mastered the art of multi-tasking, I am simply stating, that I am BEGINNING to become more proficient at my documentation and am STARTING to become more capable of multi-tasking during my patients’ therapy sessions. The outpatient clinic that I am currently at is a far busier clinic than any of those I’ve been at before, and while the software system is meant to be user-friendly, it has been more than just a simple challenge for me to learn to navigate. I did not grow up with computers like most of my peers and my PT school BFF has told me that the one thing that shows my actually age is my decreased efficiency with technology. She has often told me that she forgets I am older than the rest until we start doing something new on the computer and that when my inability, or if I’m lucky, my delayed ability quickly gives away my age!

So, yes, I feel blessed to have this extra time to adjust, adapt, and try to figure out ways of doing things to help me along in these areas I find challenging. I have also learned that earplugs… not diamonds… are a girl’s best friend! Or at least they are in a busy rehabilitation clinic that houses physical therapists, occupational therapists, SLPs (speech language pathologists), cardiac rehabilitation specialists, several support personnel, and at times, many, many patients. I struggle with focus and maintaining attention in a quiet environment, but I believe this type of environment can make even the most focused person deviate from the task at hand.

With the national board exams a short month and a half after graduation, my classmate’s CI (clinical instructor) has been generously hosting a Wednesday night study group session and has opened her home to any third year students wishing to attend. She has been bringing the review material to life as she gives us examples of patients that present with the very symptoms, diagnoses, and impairments were are studying. I am confident that her stories and examples will be most helpful when trying to figure out the correct answer to the board questions in January, as they are making a more lasting imprint in my mind compared with reading and memorizing facts out of a textbook.

Aside from treating patients, documentation at our clinical sites, and working long hours with limited to no downtime, my classmates and I have other responsibilities. We are also enrolled in DPT 809, a research course focused on producing a case report with desired end result being publication. We are very fortunate that there are several professors that lead this course allowing for our class to be divided up into groups of roughly 6-10 students per professor. We regularly have portions of our case report due throughout the six months that we are involved in this course. As we gather information, implement interventions, and assess the progress of our patient, we are able to complete the appropriate sections of our case report that are due, roughly each month, in a more manageable way. As part of our DPT 805 clinical experience, we also have work that we’re required to submit throughout the time that we are at our affiliated clinical site. The biggest, most time consuming, thought provoking, and somewhat stressful assignment that we must complete occurs at mid-term and at the end of our experience is known to all Elon PT students as the CPI or Clinical Performance Instrument. This is an assignment that requires us to investigate the guidance we require from our clinical instructor, our ability to perform simple and complex tasks, the quality with which we provide care, the proficiency of our clinical abilities in simple and complex situations, the proficiency with which we accomplish these tasks, and our overall rating for 18 unique criteria. For some this may not be as daunting a task as it is for me, but I will admit, that this thought provoking task that requires time for reflection and evaluation of self, can feel a little overwhelming to complete at times. I try to complete portions of it as I go along throughout my weeks at the clinic, but regardless of how good my intentions are, I still find myself at my computer for hours the week or two before it is due adding, changing, and completing the final product. With that said, it’s time for me to get back to work addressing the next criteria of my CPI as we are quickly approaching midterm!