Clinic Life: Keep Swimming
When I finished my didactic curriculum at University of Maryland-Baltimore my emotions were rampant. I felt a sigh of relief, excitement, and then uncertainty. The last step before going to full time clinical rotations was passing a course known as Clinical Qualifying Measures (CQM). A review of all the material we learned over 3-4 weeks culminating into one moment. You treating a patient case with a medical actor while being videotaped as we’re assessed on our clinical skills and time management. It was an intimidating experience on paper, but ended up not being so bad after all. However, the stress of treating one patient always had me wondering...How would I treat patients every day for the next 33 weeks? Let give you some keys to success on the road to graduation.
1. Prepare vs Procrastinate
Usually for most programs there is a small break for students prior to initiating clinical rotations. In that time it would be good to be informed about the environment you’re going into and the patient population. It’ll put you in a good position to hit the ground running to become immersed in clinical work with the rehab team and make a good impression on your clinical instructor. However, you will be working ~40 hours a week for in our program’s case 11 weeks. That workload can take time to get adjusted to and cause true fatigue. Thus, it would be in your best interest to take advantage of the time to yourself so you go into the experience fresh and relaxed.
As you get into the routine of clinical rotations make sure to create an adequate work life balance to take care of yourself. Spending time in extra-curriculars, knocking out some gym workouts, or just doing whatever it is that makes you happy is important. At times, different components of a clinical rotation can be stressful whether it be a long commute, high patient caseload, and/or complex patient cases. Thus, it is important to take the extra time to avoid burnout during your respective rotation.
3. Use Your Resources
As a 3rd year student, I made various cheat sheets in preparation for my CQM experience. Those cheat sheets were all based on clinical settings. Some examples of items of interest are listed below:
Skilled Nursing Home: Geriatric Outcome Measures MCID/cut off scores, fall prevention patient education, Neuro exam components
Outpatient: Examination by body region, special tests, MMT, exercise list by impairment, general post-op exercise progression protocols (for reference)
Acute Care: Normative vitals/lab values, lines & tubes, mechanical ventilation types, postural drainage positions
Some other personal clinical gems of mine (not endorsing you need, but were helpful for me):
PT Clinical Notes: A Rehabilitation Pocket Guide | Ellen Z. Hillegass
Good for the SNF, Inpatient Rehab, Acute Care. Nice to have as a new graduate as well.
Includes the following:
O2 and assisted ventilation tables
Lab values: abnormal values and causes
Outcome measures and terminology
CPT Codes for Reimbursement
Posture and Gait Assessment
Cognitive, Coma, and Mental Status Scale
Functional and exercise tests
Ortho Notes: Clinical Examination Pocket Guide | Dawn Gulick
Good for Outpatient. Nice to have as a new graduate as well.
Includes the following:
Medical Red Flags
Illustrated Special Tests
Test Sensitivity & Specificity
Illustrated Pain Referral Patterns
Illustrated Palpation Pearls
Abbreviations & Symbols
HEP2go [hep2go.com] – create exercise programs for your patients. Programs can be exported via text or email for your patient’s convenience. Very user friendly.
You don’t have as much one-on-one patient experience as your clinical instructor and surrounding clinicians. However, you do you have the most up-to-date knowledge and clinical skills to help your patients. Don’t feel pigeoned holed into being a “student physical therapist”. It may be tough starting out but each day and each week your confidence should be building in various components of your clinical rotation experience. The energy you exude, the focus you demonstrate, and the first impression you make on each patient will guide that patient experience from initial evaluation through discharge. So, not only are first impressions important, but every interaction after matters just as much. If you are confident in your abilities, your patient will become confident in you.
Challenge yourself. Challenge your instructor. Challenge your patients! We have an opportunity to implement all the tools in our toolbox that we’ve accumulated throughout PT school. Think of your rotation as an opportunity to bring all those skills to the forefront. Ask your clinical instructor questions throughout your rotation. Be honest when you don’t know something. It’s alright to have teaching moments throughout your rotation. In fact, to become the best clinician, you should be asking questions and learning from mistakes. This is your time to learn and refine your skill set. At times your philosophy of treatment may not align with your clinical instructor, but all branches aren’t cut from same tree. Bring your rationales, evidence, and clinical reasoning in a respectful manner to grow as a future clinician.
You may not feel confident starting out. You may have some days you’re staying late doing documentation. You may have some days your eval went a little over on time. Does that make you a bad PT student? Absolutely not. Clinical rotations were one of the most rewarding experiences in PT school for me. I grew as a clinician and began to understand the impact I could have on my future patients. Take a dive into your future and keep swimming folks. You’ll be great!
Feel free to reach out if you want more advice or have questions!
Facebook: Mike Ukoha