Category Archives: Renee

Graduation – A Time to Feel All of the Feelings

So this is it, our time as students is coming to a close, as Elon’s DPT Class of 2014 is graduating! I write this blog with so many mixed emotions that I’m not quite sure where to begin. I guess I’ll start by going through each of them; I can assure you that they are not likely emotions that I am feeling in isolation; my guess is that many of my classmates are feeling some, if not all, of the same emotions that I am feeling right now.

Feelings of Disbelief:

-I cannot believe I made it through PT school! For me, I have so many people to thank for making this possible: my husband and my family, my best buddy in school, and all the professors that have given their time and effort to make this a success. I know in my heart however, that the only thing that has truly made this experience a success for me is God’s grace; to Him alone I give the glory!

-I cannot believe it’s over! Where have the last 3 years gone? It’s hard to believe that three years ago we were strangers about to embark on this roller coaster of a ride that is PT school.

Feelings of Joy:

-We’re done and will be graduating next weekend! It’s an exciting and joyful time to celebrate all that we have worked so hard to accomplish.

-I also find joy in reflecting on the lifelong friendships that have formed, the peers that met at school and have gotten engaged and/or married, and looking back at how far we’ve come since our first day at Elon.

Overwhelming Feelings:

-Too much to do! For myself (and some of my classmates) the next 7 weeks will be quite overwhelming, as they’ll include: family visiting for graduation, studying for the NPTE, taking the NPTE, packing to move/moving/unpacking, applying for jobs, interviewing for jobs, and hopefully starting a new job! Oh and don’t forget the holidays; you can add gift shopping, traveling to be with family, etc. to the list.  Yikes, I feel overwhelmed just writing this all down!

Feelings of Hope:

-I am hopeful for my future and for the future of all my classmates. We have worked so hard and my desire is that each of us find fulfillment is what we do, I hope that we help many people and affect many lives in a positive way, and I hope that over the years we all stay in touch regardless of where life may bring us!

In closing, I’d like to extend a great big “CONGRATULATIONS” to Elon’s DPT Class of 2014! I am grateful to have met each one of you and am proud to be a part of the doctors of physical therapy that make up this class. Good luck and best wishes!

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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!

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!

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!

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!

The end is in sight

After a wonderful week off, I hit the ground running this morning! Today started the first day of last clinical rotation for the class of 2014! This clinical is unlike any of the previous for several reasons. To begin, our past clinical experiences have been 2 months in duration and this final one is 6 months. This is the only clinical rotation in which we are also taking another course: DPT 809 Directed Research II.  During this rotation, for the first time, we are expected to be at 100% caseload for a new graduate.  We may also choose to begin studying for the national physical therapy board exam during this experience. So, while this is an exciting time, it is also a very busy time for us!

In preparation to begin our studies for the board exam, we took a practice exam the week before last. This gave us all an idea of the content that we knew well and other areas in which we would need to focus our attention on. After completing this practice exam, I can confidently say that Elon does a phenomenal job of preparing us for this important component of our education. After answering just over 150 test questions, I was relieved to discover that there were only about 2 questions that I was unfamiliar with. This does not mean that I knew all of the answers, as we were told not to study or prepare for this practice exam in advance, but what it does mean is that I had been taught the information and had been exposed to this content at some point in my career as a student at Elon. I am not sure that students from other programs can boast the same of their experience.

In the weeks and months to come my biggest challenge will be to juggle a full time career as a student physical therapist, finding time to take care of myself through adequate rest and an appropriate amount of exercise, and setting aside time for course work and preparatory studies. It will be a challenge, but there’s no doubt that if we’ve made it this far, we will reach the finish line!

Independent Study on Geriatric PT

Observations, on-line courses, on-line course exams, research, reflections, resumé writing, mock interviews, creating brochures… the list goes on. These items comprise the components of this module as I forge ahead through my independent study on Geriatric Care in Physical Therapy.

There are three of us studying geriatric physical therapy during this module known to 3rd year physical therapy students as Selectives. As mentioned in previous blogs, this is the time in our schooling in which we select what we want to pursue studying, with options ranging from orthopedics and neuro which are held on site at the Francis Center, to learning about PT in foreign countries.  Within this independent study there are three of us that have decided to remain local, yet venture off to create our own study in geriatrics.  This trio we’ve created allows us to participate in some things together and also do several things independently and different from one another. For example, while we all are participating in geriatric physical therapy observations, we sometimes participate in observations together at the same clinic and with the same PT, while at other times, we may be at the same location, but shadowing different  PTs; still other times we may observe on completely different days and not be together at all.

The three of us, that are currently studying geriatrics in depth,  are also taking some of the same on-line courses, but also taking some on-line courses more specific to our personal interests. Much in the same way that we are taking these courses, our research is on the general topic of geriatric studies, yet we may be individually researching vastly different aspects of physical therapy in the geriatric population.  I personally have been exploring Parkinson’s Disease to gain understanding of this disease and how PT fits into rehabilitation with such patients, while one of the another two classmates has focused her research on the physical therapy outcome measures for individuals over age 65.

Regardless of whether together or separate on this journey through our independent study, it has been a great learning experience and I am thankful it’s only half over. In fact, I wish it were even longer, as there is so much more I want to learn and explore about geriatric care. Fortunately, we can all continue to be life long learners beyond this Selective Module; in fact, we should remain life long learners throughout our entire careers as physical therapists so that we can grow in our knowledge and pass that knowledge onto our patients by educating them and providing them with the best evidenced based care possible!