ICE Reflection

Part 1

I think this simulation week allowed me to see how much I have truly learned during this first year of PT school. Throughout the week I was able to continue to build my clinical reasoning skills by using information I have accumulated over the past year. This week also helped me see more realistic patient cases in terms of patient’s home life, personality, and/or cognitive state. This was a good challenge for us to find ways to create strong patient rapport and buy in to our PT services in addition to keeping the patient focused on the mobility/treatment at hand.

I feel like a strength of mine is that I am able to create strong connections with patients in order to enhance their experience. In the future, this quality will allow me to implement more personalized care/goals for each patient. I feel as though this week I was able to cue patients well with tactile and verbal cueing to help with their mobility. Something that I feel as though I did better than expected this week, but is still probably a weakness of mine is changing my plan on the fly. This week I think I was able to be more flexible than I have been in the past, especially compared to when I would walk into a graded practical back in the fall. I do wish I could’ve had a chance for some more hands on practice of this kind of flexibility during the simulation week. With the way my team split up roles though I ended up not performing the gait component, which, most of the time, was the part of the simulation that required editing the initial plan depending on how the patient was presenting with mobility and vitals. Still, this week, I was able to practice synthesizing and using information from earlier in the session in order to establish different scenarios for a patient. This ability to adapt to changing circumstances will come in handy when actually practicing in a hospital.

One of my primary take aways is that treatment does not happen in a vacuum. There’s going to be environmental noise like medical monitors, family members, or other healthcare providers that have the potential to become distracting. This week was great in order to be able to practice how to either minimize those distractions or learn how to effectively work past them. Likewise, the patient isn’t always going to remain stable in treatment, so getting more practice with incorporating vitals into treatment sessions was also super helpful. I think it was really great that a lot of the patients made themselves truly debilitated in their strength, coordination, and sitting/standing balance. This forced us to really work on how to get the maximum mobility we can out of a patient. Additionally, when they were weaker it was great practice for giving closer to max assists to a patient and being cognizant of maintaining our proximity to them. I think it was also great to have a lot of collaborative teamwork. The kind of discussions we had this week were important because we were constantly sharing our clinical reasoning with one another, which led to meaningful dialogue and is something we will want to implement when actually practicing either with other PT’s or healthcare providers.

I do feel much more confident going into working with real patients in a hospital next week. I think this week was a good refresher on the necessary components for an effective eval/treatment session. I also appreciated the practice of writing a SOAP note. Before next week I am hoping to do a general review of what we learned in Rehab 1 and 2. Specifically, I want to work on continuing to review lines and leads management in addition to mobility considerations. I am really looking forward to being able to interact with the patients and be able to see my CI in action as well in order to learn as much as I can from her.

Part 2

Heading into my first day at the hospital, I was definitely excited but also fairly anxious. This was my first time really getting my hands dirty and working in an acute care setting. I felt a little out of my comfort zone, but reminded myself of all the practice and studying I had put in leading up to this. Additionally, I wanted to make sure I gave my CI a good first impression as a representation of not only myself but also this program. Looking back, I definitely felt a little extra pressure too since I had one less day and tried my best to take advantage of every second.

I feel as though I pretty much achieved the objectives I created for this clinical. Looking back, I think I sometimes struggled with fully understanding the expectations of me during this clinical and thus makes it somewhat difficult for me to really know if I am on track or not for the growth/development of my skills as a PT. My objectives were more on the simple side because I didn’t want to overshoot and not be able to get close to achieving them. Having reviewed them though, I probably could have challenged myself more, as I ended up doing things with patients that were more advanced than my five objectives listed. For instance, one of my 5 objectives I accomplished no problem was reviewing precautions and exercises several times with patients/caregivers. Alternatively, something that wasn’t listed in my objectives was being able to perform Max x2 assists with correct body mechanics/hand placements, but that was something I was able to practice and improve on throughout this clinical.

I would say my stronger qualities right now are what this clinical was focused on, which was patient interaction. I loved getting to talk to the patients / caregivers about their home life and educate them on their precautions/exercises. However, I know I still have a lot to work on in terms of my manual skills and treatment planning. I think one of my greatest challenges is being able to slow down and set up my room and patient for success. As noted in my feedback, taking the time to think through what I was about to implement will be crucial to having more of a flow to treatment sessions. I do feel as though this week helped me get more comfortable with the array of hospital equipment we will need to be able to manage when working with patients. For instance, I saw at least 3 different variations of a dinamap with different buttons and equipment to take pulse ox. Same with all the varying hospital beds and differing buttons. Additionally, this week was helpful in working on accurately sizing AD for patients in a quick manner.

Another challenge of mine that I will continue to work on is building confidence in myself. I have come a long way in not beating myself up, but it does still happen from time to time, especially when I feel behind or that I am not excelling in something the way I want myself to. Even though I did do a fair amount of review before my clinical, I think my confidence potentially would have been higher if I had done a little more, which has been a good reminder of why studying/reviewing over summer break will be extremely beneficial. I think it was really great I was exposed to a vast array of medical cases with varying diagnoses to help increase my medical vocabulary. Doing some learning on my own will also be helpful to getting myself more comfortable with understanding and applying the terminology used in the hospital.

I think one of the things I was most surprised about was how much my ability to write SOAP notes efficiently increased as we progressed through the week. My first attempt was definitely slow and a little painful as I tried to find a way to accurately synthesize the information accumulated from the treatment session, but by my last one I was able to get it all written out much faster. I am naturally a more lengthy writer so it was great to be pushed to be concise with my words for documentation since I will be doing a lot of it with this career 🙂

Part 3

I feel as though my CI effortlessly embodies the APTA Core Value of compassion and caring. You could see her become invested in each patient she worked with and made sure they felt seen and heard during our treatment sessions. Her first priority was always to make sure patients’ needs were in order so that they were set up for success when working with us. Additionally, she was extremely empathetic to varying difficult circumstances such as pain, terminal illness, health of spouse, etc. Her concern and ability to empathize allowed for her to learn more about the patients, which then permitted more individualized therapy sessions. It also allowed the patient to be more calm and open when working with us. When discussing what occurred during a session afterwards, it is obvious the dedication she has for her patients. I think it’s also incredibly impressive as a float between hospitals and floors how she is still able to make important connections with patients.

One example of this was with a patient we had seen at the beginning of our treatment day. This patient was not A&O and was pretty much on their own, no caregiver there to help them. My CI was able to make them smile and feel safe during our treatment session. Later in the day when we were around their room, my CI popped her head in to check in on them and noticed them slightly clammy and seemingly uncomfortable. She made sure to check the patient’s temperature to make sure they were not becoming feverish and communicate this to the patient’s nurse. The way she is always looking out for her patients was something really powerful to see and be a part of.

Part 4

Reflecting on these four days in the hospital, I am pleased with myself and am excited to continue to improve myself as a PT. Looking forward to future clinical rotations, I know I need to continue to work to build confidence. Trusting my gut and believing in myself more throughout the process I think will be crucial. Also, just taking a second to breath and think things through before I jump into I believe will improve my performance significantly.

1 comment

  1. Alex – I really enjoyed your post. You have done an excellent job integrating the things you learned this semester, during the simulation week and then during the clinical experience. I know that you will build on these experiences in year 2!

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