My Behavioural Objectives were as follows:
1. By the end of the first week, the student will be able to educate the patient on post-surgical precautions and check for understanding with minimal assistance from CI.
2. By the end of the first week, the student will be able to perform an initial evaluation interview with minimal assistance from CI.
3. By the end of the first week, the student will seek to shadow another PT without a prompt from CI.
4. By the end of the first week, the student will be able to reflect on interactions with patients and seek feedback for improvement independently.
5. By the end of the first week, the student will be able to summarize and highlight important information from a patient’s medical record with minimal assistance from CI.
During the first week of this experience, I discovered that handling complicated patients takes many hands and brains working at once and that I lack a lot of experience. However, I can see that after being a PT student for a year, I have improved in the areas that were required. Overall, I knew how to take a patient’s social history, keep them safe, manage lines and leads, and perform the basic tests that need to be administered for a patient. I also thought it was important to have a thorough understanding of the patient’s medical history and not to miss an important detail like NPO or other precautions. All of that was expected based on what we have learned this past year. However, it would be great to have improved time management and overall efficiency during a session, but I am sure that this is nothing that cannot be fixed by time and practice.
My primary takeaway was that I am where I need to be at this point in my education, but I am nowhere near an entry-level PT. What I thought was the most challenging was managing more than three lines and leads, working with a max A x2 patient, and getting social history information from a cognitively impaired patient. What I thought went well is the fact that the patient’s safety was always maintained, the patient was treated with respect, and overall communication went great. I think the basics were covered well overall.
I am worried about next week because I am not sure what to expect. I am hoping that at this point, I can handle taking a social history on my own, making sure the patient knows their precautions, and that they are safe throughout the session. I hope that I can improve in figuring out what tests and measures to administer to a patient during a session. I am also hoping I can get hands-on practice with bed mobility to ensure that it is done smoothly and to observe how my CI manages lines and leads to learning any tricks they have up their sleeves. I am also hoping they have some insight into complicated transfers and how their clinical decision is when it comes to managing a complex patient on their own when they do not have as many hands.
The weekend before being in the hospital, I spent it preparing myself mentally and physically. I made sure to have a relaxing Saturday and a busy Sunday. I reviewed some Rehab, Cardiopulmonary, and Pharmacology material from the previous year. I wanted to make sure that all the hard work I put in this year shows during this week, which was a little excessive in hindsight. The morning of my first clinical day, I was nervous, and I spent it memorizing important values like normal Troponin and BNP levels. I also reviewed my behavioral objectives and the information I needed to gather for my project. I wanted to be as prepared as possible for this experience.
The first day felt more like an observation day, but at the end of that day, I made sure to communicate with my CI that I had some goals for this experience like interviewing a patient for an evaluation, educating them on precautions, and shadowing another PT. The next day, my CI allowed me to interview not just one patient, but multiple, whenever we had an evaluation. She also let me shadow another PT as she had a doctor’s appointment, so it conveniently fit. As the week progressed, I was able to communicate my objectives and fulfill them by the end of the experience with not much trouble. In fact, I was able to do more and help my CI including getting material throughout the session like a telemetry box.
Along the way, I found myself reflecting on my interactions and coming up with a plan to make it better for the next patient. I remember when I was testing a patient’s lower extremity strength, I tripped over my words a little bit and that confused the patient as to what they were supposed to do. I made sure to practice my verbal cueing that day so that the next day I am better prepared and had a smoother delivery. I also picked a couple of tricks from my CI about testing lower extremity strength when a patient is supine instead of sitting, which I have not had much experience with before.
Throughout this experience, my greatest challenges included figuring out the fine balance of when to help and when to not be in the way. My CI did not specify how much she liked me to be involved with patients, but she provided opportunities for me to work with them and I seized those opportunities to the best of my ability. As my CI was working with a patient, I tried to set up the room, tie the patient’s gown, and make sure they have their socks on before mobilizations. I was able to perform a couple of muscle tests and helped with mobilizing patients who needed an extra set of hands. Another challenge was figuring out what information to include in a SOAP note and what information is not relevant. My CI let me practice writing notes after almost 50% of our patients and we compared our notes after. I found that to be a great learning experience and a confidence boost because my CI and I agreed on grading and assistance levels most of the time. I also found deciding on the frequency of PT visits for a patient to be challenging, because I have never practiced it much. My CI seemed to change during re-evals depending on how the patient presented that day and how they are progressing. If they are not progressing, they might need more intervention if they are up to it.
What surprised me about this experience was the way patients were prioritized. The clinician had to make some decisions on which patients to see first. I found that evals and re-evals were prioritized, then those who were to be seen daily, and then those who were to be seen three times per week. However, that can change depending on what was happening with a certain patient that day. If a patient was to be seen next and they are about to go for a CT scan, then they would be seen later. It was interesting to see that in action.
Throughout this week, one APTA core value stood out to me most and that is “professional duty,” which represents the importance of fulfilling the duty of being a PT, taking pride in the profession, and being involved. My CI was great at providing optimal care to patients by being prepared for the session and by meeting the patients’ needs when walking into their room. If the patient needed water, to change their gown, or to be cleaned, she took care of it and helped them. It was really inspiring to see. Not only that, but she was the one who went to rounds and made sure to advocate for patients if it was needed or advocate for the profession if a patient needed PT orders. When my CI educated patients, she did so with their safety and efficiency in mind. She made sure they were aware, and it did not come off like a lecture. It was very effortless, and I was impressed by how she embodied “professional duty.”
I was able to experience the pace of an inpatient PT setting, go to rounds, and experience interprofessional collaboration firsthand. When mobilizing patients, my CI tried to decrease the number of lines if she could to facilitate mobilization, which was a neat trick that I will probably practice if allowed. In just one week, I have learned more than I could put on two pages of text. It was a wonderful experience that solidified my learning from the past year. It made me feel confident that I was on the right track and that I have so much to learn.