What I Want Students to Know Before Starting Clinical Rotations
Estimated Reading Time: 9 minutes
We've all been there, safely cocooned in the classrooms of physical therapy school, not worrying about clinical rotations because, well, they're not for a while yet. Then before you know it, they are right around the corner and many of you will come to feel some combination of panic and excitement set in.
Perhaps you were placed in a setting that you were hoping for, or maybe you are going to a geographical location that you always wanted to visit. Maybe you were you able to get your top picks for clinicals, or maybe you ended up with rotations that weren't even on your radar. Either way, the general logistics of traveling, finding housing, and preparing for your rotations can be overwhelming.
You've learned a lot of skills in the classroom, but here are some pointers that I'd like students to be aware of before venturing out on their clinical rotations.
First of all, remember that you are going out on your rotations not only to use what you've learned in school, but to also continue expanding your skills. You're going to be nervous at first, but remember that your clinical instructor (CI) should not expect you to have all the answers, and the CI is likely to be a little nervous as well in an effort to be the best instructor they can be.
It's important going into each clinical rotation knowing your own learning style and communicating this with your CI because likely you and your CI are different. Addressing this early on will reduce the possibility of you and your CI becoming frustrated later on.
Before you even begin your clinical rotation reach out to your CI regarding basic logistics such as parking, dress code, and your typical daily schedule. Inquire as to the volume, age range, and diagnoses of clients with whom you primarily will be working.
Will you be seeing someone every 15, 30, or 60 minutes? Will you have groups? Access to support staff? Are you expected to transition your clients to a tech or PTA after 15 minutes, or are you with them one-on-one for the entire session? What type of documentation system is used? Will you be working closely with other disciplines? Ask your CI if they have any specific techniques or skills that are often used for client care. Knowing this will help you narrow down your focus during any preparatory review regarding understanding of diagnoses and specific tests and measures as well as therapeutic interventions.
It's too easy (and common) to allow our minds to get away from us and think of all the "what ifs," increasing anxiety. Remember, your first day will likely be very low key. You'll get to know your CI, the staff, lay of the land, and a few clients. Most clinics have some sort of formal orientation process, so breathe and remember: the more information you have ahead of time, the calmer you will be.
I encourage you to be okay with the fact that you will make mistakes. Remember, your CI experience is one for learning and growth. Your CI should be understanding of this as well and be there to guide you along the way. Arrive to your clinical with an open mind, positive attitude, and humble approach, all of which should set you up for success.
Now that you've communicated thoroughly with your CI and have had most, if not all, of your questions answered, you can begin your journey as a student physical therapist.
Once orientation is over and your CI is teaching you the ropes, pay attention to how your CI performs evaluations, and then make an evaluation cheat sheet for yourself. This does 2 things: First, you need to remember that you are your own clinician and you don't want to completely mimic your CI; let your personality and skills shine. Second, regardless of whether your evaluation is paper or electronic, there often is not a good flow of information and it's easy to lose your train of thought or to get stuck somewhere in the middle as a result. Having your own cheat sheet will minimize this and you'll impress your CI by being efficient and, therefore, less likely to need your CI to jump in because you forgot something.
In addition, when it comes to initial evaluations keep in mind that not all populations are alike. I find that students often struggle with the prognosis and scheduling aspects of the initial evaluation. History of compliance, co-pays, clinic distance, transportation, and your client's schedule are all factors that may impact the frequency and duration of your services beyond the diagnosis. Do not overlook this.
At last, you're settling in nicely, have completed some evaluations, and are treating regularly. What do you do if you get stumped with treatment interventions?
One helpful tool that I didn't even know about until a few years ago is at https://www.hep2go.com/. You can create an account for free or pay to have some extra perks. Not only does the website provide a professionally laid out home exercise program (HEP) for your clients (people love professional handouts; avoid stick figures), but if you have free time, you can peruse the exercises to spark your own creativity.
Another option is using APTA's PTNow clinician portal, which is also home to APTA's Rehabilitation Reference Center. PTNow's mission is to assist PTs and PTAs in day-to-day practice. You'll find tests and measures, clinical practice guidelines, and so much more.
Be specific with home exercise programs, as clients are not going to recall all of your instructions once they get home. Be sure that you have written instructions specifying reps, sets, hold times, and whether the exercise is to be performed unilaterally or bilaterally.
Pay attention to your client's learning style; would pictures, written instructions, videos, or all of the above be most beneficial? As you build your own caseload, these resources also can be helpful in planning for the next day because it has a lot of great ideas.
As a CI, I'm very impressed with students who come in prepared each morning with treatment ideas for the day, rather than flying off the cuff. Not only are prepared students more confident, but they are also more efficient. However, I don't expect any student to go home and stress for hours over this—20 minutes will get you a long way into your daily treatment plan, and time management is key!
Ah, time management. It's difficult, whether you're a student or licensed professional, to balance hands-on treatment and point-of-service documentation. Ask your CI for strategies if you are struggling in this area and adjust as needed.
A common challenge with time management is distractions, and the most common distraction I notice with students (and professionals) is electronics. You shouldn't be texting, checking emails, or on social media while working with a client, and I suggest if this is an area of concern for you, leave your phone at your desk. Also, some clients are very chatty and it's up to you to manage conversation with treatment. Don't lose focus on why your client came to see you.
Reduced distractions and improved efficiency will help you complete your documentation in a timely manner, and documentation is one of the toughest areas for students to navigate because each clinic and setting is so different. I am guilty of writing vague statements such as "continue per POC," "pt tolerated treatment session well," in order to finish a note quickly. However, I learned an awful lot about the specifics of documentation throughout the course of therapist services after my employer underwent a lengthy chart audit process last year. Documentation is often breezed through in school with the expectation that you'll learn what's appropriate when on clinical rotations; however, this is not always the case.
I could write an entire post on documentation, but I will leave you with this: Ask your CI what the clinic specifications are and see if your CI can give you handouts that explain what's needed and why in detail to help you in this process. When in doubt, ask yourself if you are providing skilled therapy. Why is it important that you, and not a tech or family member, are providing the service? How does it relate functionally to the client? What cueing did you provide and what was the client's response? If you were to be audited, or even brought in for legal proceedings 7 years down the road, would you be able to read your own notes and recall who you worked with, what you did, and why?
Now that you've done all of your documentation and scheduled your clients out for a few months, what is your plan if someone doesn't do their HEP regularly or no-shows/cancels often? I find that many clinicians often overlook noncompliance because it can be a difficult conversation to have with a client, discussing how important their compliance is and that if they don't put the work in, D/C may come early. We often don't want to ruffle feathers, but it can be a frustrating and inefficient use of time to have to regularly call and follow up with a client who is making little to no progress because they're not holding up their end of the PT–client relationship.
I enjoy assisting students who are having these difficult conversations because I've seen too many new clinicians who never learned this skill become frustrated at lack of progress, and often not feeling confident in following through with a clinic's potential no-show/cancellation policy, or placing the accountability back on the client.
This also comes back to documentation. If you're documenting consistent noncompliance with poor progress, how are you going to justify continued therapy? Regarding difficult conversations, I hear clients state frequently "I can't because…" or "My doctor says I don't need therapy anymore, and…." Whether it is "My doctor said so" or "I'm too old," it takes a certain skill to steer these conversations back to a place where your client is willing and able to participate.
As a CI, I thoroughly enjoy working with students because I love to teach others the skills that I've learned from my time as a therapist. I love to learn from my students, too, and have yet to work with one who hasn't taught me skills that have stuck with me over the years. In my role as a CI, I feel as though I'm giving back to my profession because I have a hand in mentoring future clinicians.
I'll leave you with this: Remember to stop and take a breath now and again, communicate thoroughly with your CI regarding your goals, strengths, and weaknesses, and to enjoy your experiences. Speak up if you're struggling. Your CI isn't a mind reader and asking for help isn't a sign of weakness. It shows that you are professional enough to ask for help when you want to improve yourself as a student physical therapist before working as a licensed professional.
Jessica Baugh, PT, DPT, specializes in outpatient orthopedic and pelvic health at Mountain Valley Regional Rehab Hospital in Prescott Valley, Arizona. You can connect with Jessica at firstname.lastname@example.org.
Are You Making the National Physical Therapy Exam Harder Than It Needs to Be?
Estimated Reading Time: 5 minutes
If you listen to graduates from prior years, they may have horror stories (or posttraumatic test anxiety) from the National Physical Therapy Exam (NPTE). Even for practicing clinicians who are several years removed from taking this licensure exam, it can still bring up feelings of anxiety.
What this could lead to is procrastinating in preparing for the boards.
I see at conferences or even on social media that candidates, months prior to graduation, are job hunting (even before starting to study for the exam) or planning vacations. Each of these create stress and they tend to stack on top of each other. Now, let's throw in this dreaded topic—your board exam.
Sure, everything else is so much more attractive to spend time on; however, waiting until the last possible moment to prepare for the exam only leads to self-inflicted anxiety and stress. This is where “examzilla" behaviors—like being moody, blocking out and depriving previously enjoyed activities, and having a not-so-pleasant mind-set toward the exam—makes it harder for someone who cares about you to be around you. Don't be that person!
It seems counterproductive to increase your anxiety levels, so here are ways that you can actually reduce the amount of test anxiety you have about the exam.
Change Your View of NPTE
How you view or think about NPTE can have a big impact on the outcome. Your mind is very powerful and can manifest your inner thoughts. If you think it's hard, then it will be. If you think it's long, then it will be. If you think you'll fail, then you might fail. If you think you'll forget things or are not a great test-taker, guess what? That may come true too! So the first thing you want to do is to change your mind-set on this exam.
It's a game (shhh...don't tell the Federation of State Boards of Physical Therapy this!). Just like in the clinic, each question is a puzzle to be solved. Slow down, proceed step-by-step, and you'll get your answer.
Questions are actually patients that you are treating. Think back to your clinical experiences and the patients you worked with. Thinking of the exam questions as people will allow you to apply your extensive knowledge and skills to each question.
Think about PASSing the exam rather than focusing on fear of failure. Have you heard of a self-fulfilling prophecy? If you think it enough, it may just manifest itself. Of course you should prepare for the exam, but also remember you have all of the knowledge and skills.
Dare I Say: Studying Can Be Fun
Studying may not be fun or exciting; however, the material you are studying is to help your understanding of how to help your future patients or clients.
Rather than dread time investment prepping for the exam, you are equipping yourself with valuable knowledge that you'll use in your upcoming career.
It's easy to get overwhelmed with the amount of material that needs to be covered for NPTE; however, finding themes and patterns will help to streamline the content.
Find something interesting to tackle with challenging topics. Think of this tactic as being presented with a “patient with complications," chip away at each topic, little by little.
Be a detective by looking for exam content clues to help improve your strengths and weaknesses.
Go out and observe. Find ways to relate information clinically rather than memorizing (memorizing doesn't work for this exam anyway).
Make Practice Exams Your Friends
The easiest way to reduce the pre-exam jitters is to take practice exams. To beat the NPTE, you'll want to know what kind of beast you are dealing with and becoming familiar with the format of the exam.
Start off by getting your baseline to see where you stand before studying, as this will help direct you toward the areas to focus on.
Treat each practice exam as the real NPTE. Don't try to take a practice exam on a hectic evening when you're tired. Plan a day and time in advance where you can allot focus and time to it.
Simulate the actual NPTE day. Have you ever heard of the idea of practicing something as if it were game day? When taking a practice exam, try to stick with a hard-time limit without interruptions. This will only help you prepare for what is to come on the actual test day.
Practice using the strike-through, highlight features, and paper/laminated pages. The more comfortable you are with these tools and tactics prior to the exam, the less your brain has to worry.
Take a full-length exam (250 questions) and practice with a hard-time limit (5 hours) in 1 sitting to help with keeping your mind-set ready for the real exam.
Reducing Anxiety on the Actual Exam Day
Once the day arrives to take the NPTE, it's time to shine and show what you've got. It's normal to feel nervous and anxious; now, it's about controlling your mind to perform.
To build confidence, dress for success. Dress comfortably, yet ready to impress your patients. Avoid being too casual, as it can make you feel like you're not taking NPTE seriously. You'll want to be able to hold your head up high and keep the mind-set that you are able to handle any patient.
Have a go-to phrase that can help you refocus or keep you calm, such as “Focus" or “You've got this!" Use the laminated pages and write it down so that you can refer to it if you feel overwhelmed.
Remember to breathe! Practice diaphragmatic breathing. Sometimes when getting nervous, you may find that you are holding your breath. So after each question exhale, and then let that patient go. Don't carry the patient over to the next one.
Be able to trust yourself with your answers. Avoid changing your answers and don't overthink the question or answers. Keep everything at face value.
Finally, to help reduce your test anxiety, practice visualization techniques. Each day and night imagine your NPTE success from start to finish. What does it feel like, look like, sound like? Athletes do this all the time for the outcome they want, so think how you want the day to go, even down to the types of questions you'll answer. In general, being proactive is the key to helping reduce test anxiety over time. It's about being consistent in visualizing your success and training accordingly.
Now just remember, you're ready and you've got this! Good luck!
Miye Fonseca, PT, DPT, is founder and CEO of Therapy Exam Prep. You can connect with Miye on Twitter at @TherapyExamPrep.