Reflecting on My Integrated Clinical Experience at VCU Hospital

Part 1:

  • What were the primary things that you discovered during the virtual simulated activities? What were your identified strengths and weaknesses?
      • I would say the primary thing I discovered was that in patient interviews, it is often about not just the content of your interview questions but also the way in which you ask your questions. I felt that a lot of the incorrect interview questions could have been at least passable, some even useful to know the answers to, if they had been reworded to be more sensitive and patient-centered. I think that my strengths were in my ability to choose the correct diagnoses and recommendations. One weakness I noticed was that I sometimes was unable to identify the most relevant dialogue with the patient in the case history sections. However, I am hopeful that I will correct this in the live simulation, because I think the manner in which I, and likely all PTs, speak with a patient is unique and thus impossible to adequately reproduce in a set of multiple choice questions. Regardless, I need to work on more consistently identifying the most reasonable dialogue with a patient, as my performance was not up to the standards of an entry-level clinician.
  • What were your primary take-aways from the live simulation activities? What skills were challenging? What aspects went well?
      • My primary takeaway from the live simulation was that I am prepared and ready for the clinical experience. Even though the simulation patients were supposed to be “difficult” patients, I honestly felt no real stress while working with them. With the second patient, it was a bit more difficult to work with her, as she seemingly did not understand anything I was saying. This made it difficult to convince her to do the functional activity we had planned for her to do. However, I was able to adapt to the situation and stood her up for weight shifting, as my partner and I were able to give her tactile cueing to lean to either side, as she was not understanding any verbal cues. Also, at one point during the simulation, when I was relatively close to the patient, she pulled down the collar of my shirt and looked at my chest. I thought I was prepared for anything, but this honestly shocked me. A part of me was slightly offended, as I felt that she had violated my right to privacy, and an equally large part of me was holding back laughter, as I recognized that it was a simulated situation. However, I think I handled it about as well as I could by calmly but sternly asking her to please not grab my shirt collar. The lesson I learned from this is that no matter how prepared you think you are, there will always be at least one unexpected curveball thrown at you, and part of your value as a PT is in your ability to adapt to any situation you find yourself in.
  • Comment on your thoughts about week 2. Are you feeling confident? What skills do you believe you need to focus on next week?
    • Overall, my strongest feelings going into week 2 are calm and confidence, as I feel that I have more than adequately prepared for this experience throughout the year. I am confident in my general competence when it comes to acute care PT, and I have no reservations about asking my clinical instructor for help and for answers to any questions I may have. I do, however, feel a degree of excitement and anticipation for next week. After working so hard in the classroom all year, we will finally have the opportunity to work with real patients in a real hospital setting, as opposed to the contrived situations created for the various practical exams we have taken throughout the year (and for the live simulations). The skills I need to focus on the most are my conversational skills when working with patients, particularly those who cannot speak or hear very well, which create barriers to communication.

Part 2:

  • Describe how you felt heading into week 2 of your ICE.
      • As a whole, I felt calm and confident heading into week 2 knowing that I studied hard all year so that I would feel as prepared as I did. There was, however, a part of me that was eager to finally put all of my knowledge to use working with real patients. The one-day clinical observation experiences we had in our Rehab 1 and Musculoskeletal PT 1 classes were valuable, but we were unable to directly work with any of the patients. Additionally, this most recent clinical experience was 5 days long, which meant 5 times as much observation as the one-day clinicals. Knowing all of this heading into the week made me excited for the opportunity.
  • Describe the progress you made toward achieving your objectives.
      • I achieved most of my objectives. I was on time for the clinical experience every day dressed appropriately to the standards of VCU hospital. Every day, I assisted at least three patients safely and with the proper assistive device during transfers and ambulation. I accurately measured vital signs for every patient that my clinical instructor wanted me to measure vital signs. I put a gait belt on every patient that I assisted during ambulation, every time that the patient ambulated, before they stood up (with the exception of one woman that jumped up out of bed as soon as we entered the room). At the end of each day, I noted at least 2 situations in which I could improve an area of his treatment without being prompted to do so by my clinical instructor. The only objective I did not complete was educating patients on therapeutic exercises, because my clinical instructor does not often use therapeutic exercises, so I only did this a handful of times.
  • Describe the greatest challenges you had during the experience.
      • I think the greatest challenge I had during this experience was learning how to make small talk with a patient during breaks in eval or treatment. I have no problem coming up with questions to ask them that are relevant to assessing their functional capacity and their goals for PT, but I have a harder time starting conversations about random, irrelevant topics. I think this is for three reasons. First, I lack the experience to be able hold a quality conversation while I am setting up the room, so this was often a point in the session that there would be a lull in the conversation. Second, in the setting of a clinical experience, I am more focused on doing everything safely and correctly as a PT than chatting with the patient. Third, I am a bit hesitant to ask patients questions that could lead to sad or awkward answers. For example, I did not want to ask any patients about their family in a way that could evoke an emotional response about the patient not having any remaining family alive or the patient being estranged from their family. However, as the week progressed, I learned to make note of their response when I would ask if they lived with anyone else. If they mentioned a family member, this was a talking point that I could keep in the back of my mind in case there was a period of silence during the conversation. Tricks and tools like the example mentioned above would hopefully come with experience the longer that I worked in acute care PT.
  • Describe what surprised you the most during the experience.
    • What surprised me most was that I enjoy acute care PT much more than I thought I would. Heading into the week, I thought I would enjoy myself, but I did not think I would love it as much as I did. Throughout the week, I had the opportunity to work on the ortho, neuro, psych, and both general medicine floors. Although we worked with some very depressing cases, which made me sad in the beginning, I quickly adjusted to the morbid environment. When I got rid of this sadness on the first day, what remained was a feeling of excited scientific curiosity. I never fully understood how involved in the patient’s case the PTs are. One benefit of this is that the PTs have access to in-depth notes, lab values, etc. on the patient at a level which does not exist in an outpatient setting. This made each case more interesting, as I could read up on their past medical history and learn more about medicine. I would love the opportunity to work part-time in acute care one day.

Part 3:

  • Identify one of the APTA Core Values discussed during the semester. Describe how your clinical instructor or one of the other physical therapists at the site exhibits that core value.
    • I think my clinical instructor exhibited all APTA Core Values during the weeklong clinical experience. Specifically, she displayed altruism on several occasions by helping patients clean themselves after using the bathroom, even though I imagine that is not her favorite part of the job. Also, she went out of her way to rearrange furniture to make sure that one of the patients on the psych floor had a place to sit and eat his lunch in the common room with everyone else, which gave him time to socialize. She didn’t need to do this, and I am sure that all the moving and lifting was physically taxing, but she did it anyway, as it was what was best for the patient. Also, I could tell that my clinical instructor is highly accountable, because she is a team lead for the PTs, which involves extra responsibilities, but over the course of the week I watched her manage these extra responsibilities with ease, not letting them interfere with the care of any patient.

Part 4:

  • Provide any final thoughts or reflections, including what you hope to improve upon in your next clinical experience.
    • Overall, I am very pleased with my first clinical experience for many reasons. First and foremost, I feel as though it is the most insightful and valuable week of experience I have had so far this year. I learned so much about general medicine and the practical aspects of physical therapy in a hospital. Additionally, I thoroughly enjoyed working with my clinical instructor, and I am proud of how I performed during the week. However, I was obviously far from perfect, so I plan on practicing my conversational skills with patients, as well as fine tuning my clinical skills so that they are more intuitive and require less conscious thought. As a final note, I would just like to profoundly thank my clinical instructor for allocating her time and energy to helping me become a better clinician.
Posted in Uncategorized.

Leave a Reply