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!

To Our Donors, We Say Thank You

Imagine, if you will, spending 2 days a week (and sometimes more) with someone for 7 months. What do you think you’d be able to learn in that amount of time??  Hopefully, if you got along well with said person, you might become good friends and/or you might learn some really impactful things from them. Now imagine that this person is actually a human cadaver who has donated their body so that you could learn from them……totally different right?? Maybe not as different as you might think.

Allow me to explain. In the 7 months spent in anatomy lab, our donors imparted invaluable knowledge upon us, just as you would expect would happen when getting to know a living, breathing human being. They taught us about life and death. They taught us about what makes up the portal triad of the liver. They taught us about the popliteal and cubital fossas. Perhaps most importantly, they taught us what a mind-bogglingly intricate and amazing machine we’ll be trying to fix and mend for the rest of our careers as physical therapists.

One thing you might argue is that the metaphor certainly must break down when you introduce the idea of friendship. Indeed, while friendship is a term that can’t fully be applied here, I for one felt a bond with my donor, a bond built from a sense of thankfulness and the same kind of bond that a student might feel with a teacher. In addition, friendships were certainly formed with my lab partners, and I credit this largely to our donor bringing us together to implement teamwork and strategy in ways that are completely unique to this experience.

At the end of our last day in lab, I had the sense that a great relationship was coming to an end. I think that the gift that our donors gave us is often underappreciated, and I found myself realizing that I had at times taken our donor for granted. However, as I reflect on the experience, I can say that I am incredibly thankful for this one of a kind experience, and I can definitively say that I will carry the lessons learned in the anatomy lab with me for the rest of my career. So here’s to our donor as we thank them for their wonderful gift.

Turning my frown upside down

The only words to describe my reaction when I learned that my DPT 805 clinical rotation had cancelled was extreme disappoint and fear. This was the last rotation of my career as a doctor of physical therapy student! I vividly can remember back to when we submitted our request for placement and within just two short days my first choice responded with a “yes.” Yes, they would be willing to take me as a student for six months; I was ecstatic! I was the first student to get a reply, and while many other students soon received replies many of the responses they were getting were an answer of “no.” Then just a few months before I was to start at my first choice private practice outpatient clinic, I received the e-mail that everyone dreads, the e-mail I was all too familiar with (as three clinical rotation facilities had cancelled on me for previous rotations).  The e-mail read: “Stop by my office at your next earliest convenience as I need to discuss your 805 clinical rotation with you.”  While this e-mail stated nothing that would lead one to believe this meant that the clinic had cancelled, I recognized the familiar words from the past and immediately got a sinking feeling in my stomach.  Of course, I checked this e-mail late on Friday afternoon and all the professors were gone for the weekend, which left me two and a half days to mull over what this meant and I what my options might be.

Early Monday morning I knocked on my professor’s door only to receive confirmation of what I, in my heart, already knew: my clinical rotation site had cancelled. My only option now was to make my selection from a list of sites that agreed to take a student, but that none of my classmates had taken the offer on. This, from my perspective, was like getting to choose from the left-overs, the rejected sites, those sites that nobody else deemed worthy to accept. So, I did what I thought was best; I began to closely investigate each of the sites by looking at their website, but more importantly looking at comments left on the Moodle site from students that had done a clinical rotation there in the past. Randolph Hospital stuck out like a sore thumb, but in a good way! Every review and comment about this facility and its staff was positive. It seemed as though the students that had been there had nothing but great things to say about their experience. The only problem was, this site was roughly an hour away from where I live. Would the commute be worth it?

Currently, now three weeks into my clinical, I can answer that question with an astounding “yes!” Not only is this clinical rotation as good as I had imagined my first choice to be, I can honestly say that I think it is much better! Despite the commute and the long hours, that often make for a 12+ hour workday, I can’t imagine that any placement could possibly be better than Randolph Hospital. My clinical instructor is more than just an outstanding physical therapist; he truly is a clinical instructor. What I mean by that, is that he is my instructor, my teacher, and my mentor. He shares information with me that is very useful to my clinical practice, he quizzes me and asks me thought provoking questions throughout the day, and he asks me things like: “what do you think went well with the patient” and “what do you think you could have done better or improved on with the patient.” He takes personal time each day to do these things and it is evident that he cares about the experience he creates for his student. In addition to having one of the best clinical instructors possible, the other rehabilitation staff members at the hospital are also amazing. They made me feel at home from the very first day and three of the physical therapists at the hospital are even Elon graduates! Another component of this experience that I am grateful for is the fact that I am blessed to have the experience to work with some really exceptional patients; I am seeing a variety of patients and my patients have been such a pleasure to work with.

It’s only been 3 weeks, but I feel confident to say this is going to be a life changing experience. To think back to how devastated I was when my original site cancelled to where I am now, I want to leave you with this thought: If you find your travel plans on the road of life to change on you unwillingly, take a deep breath, keep your head up, and remember it may be more of a blessing than a curse!