10 minute read
Remember when you or someone you knew was the new kid on the block or just transferred to a new school in the middle of the year and had to scramble to fit in, while everyone had already made a bunch of connections?
Has there ever been a time that you have gone to a foreign country and done something without being privy to all the social mores, leading to you receiving some wild glances?
Maybe there was a time when you got a job in a completely different career field, and had to adapt to a new office environment totally different from your old one.
Regardless, there's something to be said about being the only one in the room.
The only one who fits a certain category that everyone else has little exposure to, experience with, or is just not having to deal the effects of. Everyday interactions don't always add up to being the same as what you are used to. It doesn't always have to be a bad thing, it's just different. Being around different people can actually pose as a major learning opportunity to educate yourself about the world at large and the way things are done in different communities. It also can be a major headache filled with many growing pains. Situations like these often happen in the education system, the health care field, and other spaces.
I can relate because throughout a good deal of my school experience I have been one of the only African Americans in class. Early on, I was one of few in gifted and talented classes, although back then I did not really think very much of it. I noticed that the further I went in my education — with the exception of high school — the fewer people I could find that looked like me and I could relate to.
I am a Nigerian American born and raised in Houston, Texas, so I have simultaneously been thrust into three cultures throughout my life: one as a Nigerian, one as a black man, and one as an American. To top it off, living in this country, to me, means that you have to make a decision and prioritize which cultural hat you want to don in certain situations. Most times, no matter how much advertising this country does of being a melting pot, it forces you to be American first. I think many can relate to wearing several possibly conflicting hats at one time in our lives.
This may seem like a minor setback or even a plus, depending on how you see it, but oftentimes it can lead to something I'd like to call "the look."
Coming into graduate school and the health care field where you engage with many people each day, I was worried about this very thing. Quite frankly, the look arises when you see someone who is doing something or being someone who doesn't fit into your value system (i.e., what you were taught to be normal). The look that comes along with the thought that people can treat you differently than everyone else because your culture or your interests are different. The look of surprise when you find yourself doing well in something when others expected you not to. The look of anger when the way you have fun is different from everyone else's. The look of fear after simply exchanging a glance with you. The look of disgust for simply being present or trying to do the same thing as that others unlike you traditionally do. The look that overall comes from a poor understanding of those who are different from us.
Along with the look can come ill-founded ideas or perceptions that do not make up who we truly are as a person. An assumption that you know less than everyone else for little to no reason. The assumption that you won't be able to accurately answer a question when called upon in class, or that a study guide that you made was created by someone else or you had help. Or even that somehow everyone else values education more than you do. Whenever we receive a critique, we will overreact to it, or just that we are overall too emotional. Anytime a conflict arises you are seen as the aggressor even if you were not the one who started it. A silly rumor is automatically believed because it has to do with you. A patient you are about to see might not want you to be their provider or even in the room. People might not want you to even be touching them. Mind you, you might have not had a single conversation with a person with this negative way of thinking to confirm these preconceived notions, whole-time they still think that way.
The real problem is when these thoughts are acted upon, leading to negative scenarios that can happen when you are one of the few, or the only one in a room. Words don't even need to be said to know the intent behind the action, especially when you've lived it over and over.
To prevent the look, at least in school, we may overcompensate by trying to answer all the questions in class, trying to get the highest grades, aiming to be at top of the class, getting into leadership positions, and overall trying to break free from whatever stereotypes we were unfortunate enough to fall victim to. Trying too hard to not act like something people think you are by default can result, or conversely, you may just assume the stereotype and be even more of it. We may also try to have conversations to change people's perspectives, but not everyone is willing to hear you. Personally, I have had to also think about the issue of appearing militant, too emotional, or like a complainer. Tags all too familiar to African Americans simply voicing their concerns. Someone who people are hesitant to discuss matters with or even talk to because they fear you may "misinterpret" things, "react," or take what they say and start viewing them negatively. You may be viewed as someone who "always" brings up race. Whole-time you were just someone who noticed something that was off. The reality is it is furthest from the case and you just wanted to have a conversation to share your point of view, hoping that it brings about a change and improves the situation.
I personally have often felt like if I even stray from perfection a little bit, then I have failed myself and others. That is an all too common sentiment known by members of the African American community that you must be twice as good to be half as good as others who aren't people of color in this country. I've tried so hard to not let words create mental blockades, and later, turn into physical inaction in my life. I tried to immediately turn negative sentiments into positivity at every turn, realizing that the sentiment came from someone with a limited worldview and it is not an actual fact. Even if the idea is widely accepted, to me it'll still go untrue because I or someone I know are living testaments to the contrary.
While I speak to my own situation, this issue is faced by other groups as well. If you don't have the best of confidence in yourself, it's very easy to fall victim to these misconceptions, which can be largely based on an incorrect image portrayed in media or what was incorrectly taught by other people's family members who, themselves, have had little experience around people like you. At a time like this in our society, many people are being exposed to negative stereotypes about every group of people ad nauseam, not just mine. Women in male-dominated fields, different ethnic groups in places they aren't commonly seen, young people in positions normally held by older people, and other groups all experience what I'm describing. The good thing is the more we do and the more achievements we have, help us to dismantle these stereotypes.
For disenfranchised groups, if given the opportunity, they can soar and fly very high in their lives, but for multiple reasons, such as societal barriers or lack of access, they aren't given the opportunity. Stereotypes become some people's reality from an early age, creating yet another barrier for some to overcome. For others, part of the reason is the lack of images or role models out there reflecting themselves. It is harder to achieve something when you don't see anyone out there like you doing it. I can't count how many times I have heard by current and aspiring professionals alike that they didn't see many of themselves while growing up. I also have heard from some that they started their journey all because they saw one person like themselves in their community working in a career that gave them their inspiration. Knowing the affect that you can have on others from simple observation gives me the added push to follow my dreams and advance in life. No matter what anyone says, representation matters. And inclusion matters even more!
While the look can take its toll on us over time and land us in isolated territory, these traumatic experiences have a silver lining: They help us better understand what it's like to be misunderstood and unheard, and allow us to put ourselves in the position of our current and future patients. It is important to realize that the real party who benefits from our progress in life is our patients.
There are tons of evidence saying that better patient interactions can result when your provider has a similar background as you. Patients will feel more comfortable and at ease with providers who can relate to them and can understand their situation. Better understanding comes from shared experiences. It can allow patients to feel included, and thereby feel like have more power over their own care. It's easier to build trust when there's someone who looks like you and talks like you who is you treating you; one is more willing to listen to them when they are giving you medical advice, and ultimately better care can be given. Finally, there is also the psychological impact that suggests that you have a better chance of healing from your injury if you have a better mood about your situation and in general. If these interactions inside the clinic are positive, patients are likely to leave more positive, want to continue to perform activity away from the clinic, and actually reap all the benefits that come with increased daily activity.
The benefits of exercise are numerous and overstated, so I won't spend time listing them all out, but consider the huge impact that you could make in someone's life by just making a good connection with them from the start. In 2018, only 3.3% of the graduates of physical therapy school were African American, that being men and women combined. For men, the percentage is of course much lower than that. The latest census has African Americans making up 13.4% of the population, demonstrating a disparity that is even more alarming when you consider the demographic of who often have major health issues in our country. With that being said, hopefully with more strides made in the near future, not just in representation but in the minds of the population at-large, the look can be one of happy surprise when you walk in a patient's room and a great interaction will follow.
APTA is committed to fostering a culture of diversity, equity, and inclusion within our community. This is a journey, and that journey needs your perspective and support. If you have ideas to increase diversity and promote equity and inclusion, email us at firstname.lastname@example.org.
Mark Agholor, SPT, is a third-year doctor of physical therapy student from the University of Texas at El Paso. Mark is originally from Houston, Texas, where he graduated with a bachelor's degree in kinesiology and a minor in business administration. Mark has been aiming for a career as a physical therapist since he was in middle school, namely due to a strong desire to help his fellow person in need, tacked on with a combined interest in science and sports. Upon graduation, Mark wishes to specialize in orthopedics and to continue a lifetime of learning. He inevitably wishes to help guide prospective underrepresented students into the field of physical therapy and to heighten our presence to better understand and respond to patients' needs. You can connect with Mark on Twitter at @MarktheSPT and Instagram at @made.markk.
PT Student for 2 Years, an APTA Member for 4 Years
1 minute read
When it comes to my experience with the American Physical Therapy Association, one of the first words that comes to my mind is "unusual."
I am now in my second year of physical therapy school at the University of Hartford, and I have been a member of APTA for four years. You might be reading this and wondering how the math on that works. During my undergraduate courses, I felt so determined to be a PT that I thought I may as well get the membership now.
Although access to research articles and APTA news and magazine articles was an interesting aspect to the membership, my favorite part was the chance to attend the 2017 APTA NEXT Conference & Exposition in Boston. Being an undergraduate student in this setting is a nerve-wracking experience; one man told me I was like a PT "unicorn."
What made me love this conference so much was the free goniometers and shirts, which we all know makes the conference. Jokes aside, I attended multiple presentations, but the one that left a lasting impression was the talk on membership, which had President Emma Stokes of the World Confederation for Physical Therapy in attendance. Hearing how some students and practicing physical therapists did not see the value in an APTA membership was astonishing to me, and since then I have strived to become more involved with my membership and making others realize why a membership is not another obligatory payment.
Going through physical therapy school now, I have attended the 2019 National Student Conclave and the Connecticut Physical Therapy Association's annual conference. I've also met and listened to so many dedicated and hard-working professionals and students accomplish new and exciting things, which has solidified why I chose to be part of this profession. It makes me want to strive to be a better PT, and I hope that I can inspire someone else to feel this way when I attend the American Academy for Cerebral Palsy and Developmental Medicine this September to present part of the research that I worked on during this year. Plus, you should never turn down an opportunity for more free T-shirts.
Jason Hubeny, SPT, is a second-year student at the University of Hartford. You can connect with Jason on Facebook and Twitter.
Want to share your APTA love story? Submit it here! Haven't had such an experience or moment? We encourage you to contact William James, SPT, Director of Membership, APTA Student Assembly Board of Directors to discover APTA value and opportunities.
How I Knew Residency Was for Me: A New Grad’s Perspective
5 minute read
For some physical therapy students, the decision what to pursue postgraduation can be challenging. What specialty area, what type of practice setting, or even whether to pursue pursue residency training or not.
For me, I knew I wanted to pursue a residency. In this article, I want to share how I found residency training was for me.
But first, let's define what a residency is. The American Board of Physical Therapy Residency and Fellowship Education defines residency as a postprofessional program that one can participate in after graduation, once they obtain their physical therapy licensure.
This program usually focuses on a specialty area of practice such as neurology, sports, cardiopulmonary, or pediatrics and prepares you to sit for the respective area’s board specialty examination. In addition to preparing you for the specialty examinations, you are mentored by clinicians with beyond-entry level clinical reasoning, exposed to professional development activities, and are given teaching responsibilities (depending on the program). Research on the outcomes of physical therapy residency graduates is scarce, but there are two studies that may be worth your attention.
A 2008 research study by Jones S., Bellah C., and Godges J.J., published in the Journal of Physical Therapy Education, compared professional development and leadership activities between graduates and nongraduates of physical therapy residency programs. They found that there were significant differences between residency and nonresidency graduates, with the residency graduates showing significantly greater rates of participation in postgraduate fellowship programs, board certification in a physical therapy specialist, number of years as a primary clinical instructor of a physical therapist student, frequency of employment as a head instructor or lab assistant in a professional physical therapy education program, etc.
In a 2019 study published in the Journal of Physical Therapy Education by Briggs M.S., Whitman J., Olson-Kellogg B., et al., employer perceptions of physical therapists’ residency and fellowship training were evaluated. The investigators distributed a survey to organizations that employed PTs who graduated from a United States-accredited residency program and asked about perceptions of how employees who were residency and/or fellowship trained performed compared with employees with equivalent years of experience that were not formally trained in a residency and/or fellowship program. The authors found that the respondents rated residency and/or fellowship trained employees higher in domains of leadership, communication, clinical aptitude, scholarship/evidence-based practice, and teaching.
As you progress through physical therapy school, you may find yourself fitting into one of two camps.
The first camp is a student who has a profound interest in one specialty area of physical therapy. For example, maybe you have a passion for cardiopulmonary physical therapy and immerse yourself in the Cardiopulmonary Physical Therapy Journal. You love teaching the material to your friends and working with this patient population during your clinical internships. This student would be in a perfect position to apply for a residency position right out of school.
The second camp is a student who may be interested in two (or multiple) specialty areas of physical therapy, which is actually a good thing. In this scenario, you may want to hold off on applying for one until you have been able to practice for a few years in different settings and discover what you like best. A common misconception is that residencies are only sought after by third-year students, but many #FreshPTs who have been practicing for multiple years pursue residency programs as well.
I was recently accepted to start a residency, and during my residency hunt I prepared a checklist of items to consider that helped me, which I hope will help you as well.
- What geographical location do you want to/plan on moving to? Different areas of the country offer many different things: cost of living, culture, vibe, city vs. rural, etc. If you are trying to avoid areas with a high cost of living, it may be worth it to cross states like New York and California off of your list. If you want to live in a city, it may be necessary to include only big cities in your search for the right program.
- Do you want a residency that is associated with an institution of higher learning or one that is solely affiliated with a clinic and an independent company? They both have their pros and cons and is something to consider.
- What are your career goals? This may be one of the most important bullets and I cannot emphasize it enough. When you are considering residency, you should look far beyond the year or so that the program will last. You really want to be in a program that is going to support your short- and long-term career goals and will nurture you into achieving these. Do you see yourself becoming involved in teaching or professorship after residency? Maybe you want to dive into more of a researcher’s role? The institution that you choose is crucial into playing into these successes.
- What is your personal culture? We all have a set of internal values that we abide by as students and as PT’s. Does the institution you are considering embody the same core values that you do? Workplace satisfaction and happiness is the key to long-term success as a clinician and is a repellant for burnout, so make sure that you keep this in your toolbox as well.
- Research the program’s accolades. Who will be mentoring you? Is the faculty residency trained as well? Many programs actually publish on their website what the outcomes were for the previous residency class as well. The things that you may find in these outcomes are written and oral exam scores, individual assignments completion, etc.
- Reach out to the program’s faculty before you apply! It is an amazing way to break the ice in a more informal manner. You can discuss your interest in applying and then ask them questions about the program.
- Reach out to the program’s current and previous residents. They will be able to give insight on how their experience was in the program, and aspects that they valued most about it.
If you have any questions about residency programs, I’d encourage you to reach out to the APTA Residency and Fellowship staff at email@example.com.
Kyle Stapleton, PT, DPT, is an orthopedic physical therapy resident at Duke University/Duke Health. You can connect with Kyle on Twitter at @kylestapleton10.
Embracing Discomfort: Why Student Physical Therapists Should Be in the Emergency Department
8 minute read
I have learned over the years that the feeling of fear and discomfort before walking into the treatment room never really goes away. I had hoped with years of study, extra training, and certifications that I would no longer have this feeling, but it didn't work. The feeling is still there. Instead, I have learned to lean on my training and use critical thinking to get me through each evaluation, despite the initial discomfort. With experience I have learned to embrace it because it is in that place that I am pushed to become a better physical therapist. If facing my fears makes me a better therapist, how can I teach this to my students? How can they learn to be comfortable with the uncomfortable? It turns out that internships in the emergency department may be one way to do just that.
When I first started in the ED I had a student with me. I wondered how I was going to build the clinical practice with a student following me around. I was fearful because I was representing the field of physical therapy in this novel environment for our medical system. My reputation was on the line. I was also fearful of letting the student see patients because of the complexity and potential risk, but that fear soon subsided. I have been humbled time and time again by what students are able to do by the end of their eight- to 10-week internships in the ED. Not only have the students been able to rise to the challenges, but they have made the physical therapist practice much better. I have learned that the ED is an amazing training ground for instructing students on what it means to become a flexible, independent, critical-thinking PT. More importantly, it gives them the courage to continue into that treatment room despite their fears. Here is a story that highlights exactly that.
The day was over. My student "Alice" and I were about to walk out the door when the ED medical doctor waved us down. Knowing that it was the end of our day, she apologetically asked if we would be willing to consult on a patient for suspected vertigo before she ordered an MRI. We agreed to evaluate the patient knowing that if it was vertigo, we were the right providers at the right time. I smiled and asked my student if she was ready to take on a vertigo evaluation and she agreed without hesitation. Some days we stay late, some days we leave early. It's the nature of ED practice.
We caught a glimpse of the patient from a distance on our way to review the chart. A sense of caution began to grow in me as I took in the details of the scene. The ED was overflowing, and the patient was hooked up to an IV in a busy hallway bed. The patient, an obese minority woman, appeared distressed in the fetal position, holding an emesis bag close to her face. I started picturing the barriers to assessment and treatment. Will the patient be paralyzed by anxiety? Will there be a cultural barrier? Will the patient tolerate a vertigo evaluation? How mobile is the patient? Will we be able to do canalith repositioning maneuvers (Epley) in a hallway stretcher with an IV attached? Where will my student and I sit? I didn't want to stand in the hall next to the bed looking down on the patient the whole time. Ultimately, I thought to myself that my student may just have to observe me on this one.
The chart revealed that the patient had a long history of anxiety, psychological trauma, and drug abuse. There were repeat hospitalizations for psychiatric crisis around this date over the past few years, coinciding with the anniversary of a traumatic event. There were also notes from previous physical therapy consultations that stated the patient prefers to have a female therapist and did not allow a male therapist to fully complete an evaluation. My hands were tied. I did not want to add anxiety to this already distressing situation. Establishing trust and calm was the first priority, and Alice would not be able to do that with me, a male, standing right next to her. Despite being a student, she was the right provider at the right time to see this patient.
Alice and I briefly discussed some of the differential diagnosis to keep in mind during the evaluation: stroke, anxiety, panic, BPPV, neuritis, medications, or a combination of things. Alice had seen symptoms of dizziness and/or vertigo from each of these diagnoses during her ED internship thus far. The patient also had a transient history of inability to ambulate, needing a wheelchair, so we discussed potential mobility barriers. Alice had done several vertigo evaluations in the ED, but she had close supervision and a computer with a premade vestibular evaluation to follow. There was no computer in the hallway. She was going to have to do it from memory. One of the skills that Alice struggled with was explaining across cultural barriers the complexity of vestibular dizziness and why she was going to make them feel worse to get better during the testing and treatment. There's only one way to get better. Practice.
Given that the patient was in a hallway, I could observe from a safe distance. Alice grabbed a chair and sat down in the middle of the hall forcing the traffic to go around, creating a safe space to converse. The patient described classic symptoms of BPPV: dizziness/spinning sensation with looking to the left, sitting up, and laying down. Dizziness only lasts 10-20 seconds or so. The patient then opened up about other symptoms of chronic pain flaring up and her struggle with grief due to the past trauma. Alice was excited, the patient literally paved the way for her to give some neuroscience education on how a ramped-up nervous system in the setting of acute anxiety and past trauma can elevate symptoms of pain and even vertigo to the point that it is an emergency. Alice was about to say something, but stopped. She acknowledged the patient's subjective reports with empathy and decided to conduct a thorough physical evaluation before providing education.
The patient tested positive for left BPPV. Neurologic, cardiac, neuritis/labyrinthitis, cervical dizziness, migraine, and medication screens were all negative. The patient was treated with Epley maneuver twice, right there in the hallway with near full resolution of symptoms. Alice had the patient walk around the ED and complete a dynamic balance test. The patient passed the test and was able to ambulate safely without an assistive device. After, Alice sat down with the patient at the edge of the bed. She was able to provide encouragement and then safely provide some neuroscience education. The patient reported feeling much better and verbalized a better understanding of both her acute and chronic situations. Finally, Alice was able to convey her findings and recommendations to the doctor. No MRI was ordered, and the patient was safely discharged to home.
I was speechless. I was proud of my student for taking on this complex, challenging situation, and even more so the restraint. Alice was given the perfect opportunity to chase the patient's anxiety and start educating her, but she didn't. She showed restraint. She ruled out red flags and developed a treatable physical therapy diagnosis with a proper exam first. A common mistake that students (and PTs) make, is providing neuroscience education based on assumptions made from the subjective without a proper evaluation. Alice trusted her training and acknowledged, but was not swayed by, the patient's anxiety. Ultimately, Alice helped the patient feel better earning the patient's trust with a thorough evaluation, therefore earning the right to provide some advice about the anxiety, grief, and its interaction with the nervous system. Furthermore, had Alice declined to take this evaluation, the patient would have likely gotten an unnecessary MRI. She would have been stationed in the hallway for hours, late into the night. The patient's symptoms of vertigo and anxiety would have been medicated, but not treated. Based on my experience there would have been a high probability of admission to the hospital.
This is an example of what a student is capable of doing with the right training and exposure. The ED is the perfect experiential learning site for students to see complex situations every day and practice their evaluation skills. It forces flexibility, critical thinking, and communication across multiple disciplines. The ED challenges a student physical therapist to practice nearly everything that they have learned in school about evaluation, differential diagnosis, and communication at the level of consultant for the medical team. When my students leave their ED internship, they unanimously report that the experience was enormously challenging, yet at the same time confidence building. They thank me for preparing them to take on difficult and complex patients once they start practicing on their own. They thank me for learning to face their fears and embrace the discomfort.
I also write this as a challenge to myself and the physical therapy community, a challenge to take students right into the thick of it with you — into those situations we fear that our reputations could be on the line. Give them a chance to fail safely. Trust that the practice we worked hard to build will likely succeed despite us, and it will be our students who replace us. Who knows, in the meantime they might make us better therapists too.
Acknowledgements: A special thanks to the student physical therapists who have been in the ED with me, as we navigated these somewhat uncharted waters.
John Seip, PT, DPT, is a physical therapist working full time in an emergency department as part of an acute care team in a level one trauma hospital in Duluth, MN. You can connect with John on Twitter, LinkedIn, or by email.
The Student Loan Forgiveness for Frontline Health Workers Act of 2020
2 minute read
As the COVID-19 pandemic continues, Congress is gearing up for another relief package, while additional bills have been introduced that assist health care workers who are on the frontlines of this national emergency in an effort to include these measures in any legislative package moving forward this month.
As noted in an April 1 blog posting, Congress has provided some relief for those with federal student loans. However, APTA continues to advocate and support other proposals to provide additional relief for student loan borrowers.
On May 5, U.S. Rep. Carolyn Maloney, D-N.Y., introduced H.R. 6720 The Student Loan Forgiveness for Frontline Health Workers Act of 2020. This bill would forgive public and private student loans to health care workers who are on the front line in response to COVID-19. The bill does the following:
- Creates a program that forgives student loan debt acquired while receiving medical and professional training for health care workers.
- Applies to public and private loans accrued in undergraduate, graduate, or licensing programs.
- Loan forgiveness is not counted as taxable income.
- Eligible to any "health care professional who is licensed, registered, or certified under federal or state law to provide health care and has made significant contributions to the medical response to the qualifying emergency. " Section 9(1)(b)
- Eligible health care services include "treatment of the coronavirus,” assessment or “care of a patient suspected of having the coronavirus,” or patient care in a “setting with risk of exposure to coronavirus. " Section 9(4)
- Providing services through telehealth is included in this bill.
Physical therapists and physical therapist assistants working to end this pandemic would be eligible for this student debt relief, and APTA strongly supports H.R. 6720 The Student Loan Forgiveness for Frontline Health Workers Act of 2020 for inclusion in the next COVID relief package.
Addressing student debt burden and loan repayment challenges remains a top priority for APTA. APTA has advocated to Congress to have physical therapists participate in student loan forgiveness programs, such as the National Health Service Corps, and APTA's Financial Solutions Center offers valuable tools and information to help members make the best financial decisions possible.
Want to make your voice heard and advocate for your profession and patients? APTA offers a variety of ways and assistance to get involved in advocacy efforts that affect the profession and physical therapy patients. Learn more and take action today!
David Scala, Senior Specialist, APTA Congressional Affairs
The Integrated Clinical Experience
3 minute read
It is 6:15 a.m. on a brisk, wintry Massachusetts morning. I am waiting in the well-lit parking lot of a plaza that hosts an outpatient physical therapy and wellness center. It is where I will be spending my next five hours with a new clinical instructor, a full schedule of patients, and a hope that I don’t look foolish.
This is my second integrated clinical experience, a new model that my class is the pilot for in the Physical Therapist Assistant Program at Mount Wachusett Community College. With the integrated experience, which accounts for a total of 40 clinical hours, 20 in our first fall semester and 20 in our first spring semester, we are able to dive into the world of physical therapy while concurrently learning a breadth of skills required to become a PTA. It gives students an opportunity to use what they have learned in the classroom in a real physical therapy setting as soon as they learn the ropes. Students get to observe, ask questions, interact with patients, and explore different settings right off the bat.
My first integrated clinical experience was in a public school system. A setting that I never even knew physical therapy existed in prior to starting the program. Now, I have the chance to explore a whole new setting: outpatient.
The only other car in the parking lot is that of, who I can assume, is my new clinical instructor. My guide, teacher, and a highly skilled physical therapist assistant, D. I do one last sweep of my passenger seat, making sure that I have my notebook, my paperwork, and a large water jug that I will soon find collecting dust under a desk, as outpatient moves faster than I have time to take a sip of water. I check to make sure that my name tag is not upside-down, and I decide that I look presentable enough to nervously approach the door.
As my hands reach toward the cold handle of the glass door, I quickly give myself a pep talk that I am here to learn and it is okay not to know everything, every patient condition, or every muscle in the body that might come up today. I am new to this still, my palms are slightly sweaty, and that is okay.
Inside, I was enamored by the clinic. I only had a few seconds to take in the room. The vast aerobic exercise equipment that lined the windows, the main rig that housed TRX straps and served as a post to tie exercise bands to, the multiple stations complete with patient tables, computers, and jars of cocoa butter, and of course, many hand-sanitizer units sprinkled throughout.
Within a few moments I was greeted by D, in sneakers, khakis, and a black polo tee with the clinic's logo printed neatly in the upper right corner. He showed me where to hang up my belongings and gave me a quick tour. We settled in a small patient room where there were items I recognized from my classroom, and my nerves began to ease. There were multiple goniometers, resistance bands, pillows, and an empty patient table, ready for our first real live patient.
D and I quickly went over our day ahead — a schedule chock full of patients — and my nerves returned in the form of true excitement. Our first patient would be at 6:30 a.m., a woman with plantar fasciitis. I just learned about this condition in school and rapidly tried to pull up PowerPoint slides and text boxes from our books in my mind. "This will be fine, I got this," my pep talk continued.
The patient walked in with a smile, happy to see the familiar face of D. There was an unspoken bond of trust between the two, something that I look forward to with my future patients. D introduced me and I grinned excitedly, ready for the next 30 minutes of testing, treating, and retesting.
We entered the treatment room, and I stood slightly awkwardly in the corner as D went through a seamless subjective interview with our patient. Her foot was feeling better in terms of pain, but she was now experiencing some numbness on the medial aspect of her foot. I realized that we did not cover this curveball in class. The nerves came back briefly, but soon disappeared when I realized that perhaps none of us, not even D, knows just yet what might be causing the numbness. Again, I am reminded that I am new, I am learning, and that is okay.
Our patient hopped on the treatment table and D handed me a goniometer. This would be my first time taking a real live ankle-dorsiflexion range-of-motion measurement on a real live patient.
We had just reviewed this in class, and even though it felt like my first practical while I held the foreign goniometer in my hands, as soon as I started palpating our patient's landmarks to measure, I eased into how natural it all felt.
In the classroom we practice on our classmates, who we've built trust with, who know the patient positions to be in, who know where their fibular heads are, and who know to expose their body parts that need to be palpated. In the clinic with my first real live patient, I realized that she didn't know all this and I would have to gain her trust and explain what I wanted her to do in a matter of seconds. Something that we are only told in school, but never truly experience no matter how good of actors we are.
With the integrated clinical experience, we as students are able to build our patient lexicon and soft skills, all while still learning our hard skills in school. As I explained what I needed my patient to do and measured her ankle dorsiflexion three times for accuracy, I was thankful for this opportunity and gained a slight tic of confidence, which propelled me through the rest of the day.
With each patient more complex than the last, with orthopedic conditions that I haven't touched upon yet in school, I was eager to get my hands on the action in any way I could. I watched D use manual therapy and massage on patients, and he put me on the spot several times throughout the day, including asking where Tom, Dick, and Harry are, which at that point seemed like asking me to find Waldo at the finish line of the Boston Marathon.
The morning came to a close as fast as it began and I felt energized by the past five hours. As I wrapped up the day with D, I thought giddily to myself, outpatient is where I am meant to be.
Over the next five weeks, I continued to learn orthopedic conditions, treatments, assessments, and practiced on my classmates in the classroom. Each Thursday morning of those five weeks, I eagerly parked my car in the clinic parking lot, smiled at the shining street lamps, gathered my things, and with a newfound confidence, entered the clinic and participated in the best hands-on learning experiences that could be offered.
Each time I arrived at the clinic, D put me on the spot in front of patients, asking me to hypothesize along with him what may be causing their hindrances, having me critique their form, taking measurements, manual muscle testing, coming up with and teaching them exercises, and even had a few subjective interviews thrown in there.
Each week, what I learned in the classroom I used in the clinic, and what I learned in the clinic I used in the classroom. My nerves still washed over me with every question that I was asked by D, but I always reminded myself that this was all still new, I am learning, and I am so lucky to have found this career path.
Stacey Lipkin, SPTA, is a student at Mount Wachusett Community College. You can connect with Stacey on Instagram at @staceylipkin.