Three Things I Wish I Knew Before I Started My Clinical Rotations
Estimated Reading Time: 5 minutes
I graduate this month. It feels surreal. I've learned so many lessons over the last three years, especially during my clinical rotations.
Doing internships during physical therapy school is exciting because it's time to get into the clinic and, you know, do therapist things. No more Scantrons®, very few PowerPoints, but just as many challenging moments. It's a really interesting transition from student to clinician, even though every impressive clinician whom I've shadowed has maintained a student-like curiosity that blurs the line between these roles. Before my internships I didn't anticipate some of the challenges of transitioning from class to clinic. So now that I’m coming to the end of my experience, here are 3 things that I wish I knew before I started my clinicals.
At my first rotation at UF Health Rehab Center - Magnolia Parke with classmates Gabrielle Perrone, Aja Dudley Wade, and Jessica Rescigno.
1. You don't know much.
I showed up to my first internship feeling confident—way too confident. I knew that I had done well in class. I was far from perfect, but I was passionate about evidence-based practice and orthopedics. Since I was heading into a clinic that had a reputation for evidence-based practice in orthopedics, I was amped. I quickly realized that the role of entry-level education isn't to prepare us for everything; that's just impossible. Instead, our education should prepare us to avoid harming the public and to expose us to a variety of common conditions. We'll see a lot of horses, but not many zebras.
I noticed, though, that my profound lack of knowledge was more serious than a stale animal metaphor. I found that my eagerness to "do therapist things" needed a reality check. This tweet from Justin Scola illustrates my point:
I think I passed "Mount Stupid" during my first internship. If I could do it over again, I would go back and tell myself to be prepared to be wrong. I would encourage my previous self to ask for other opinions from more experienced clinicians who have already passed Mount Stupid.
I would also caution against beating myself up for being inexperienced. Even though I didn't feel like an imposter during didactic coursework, I definitely felt it during internships. It's a scary place to be. Cruz Romero wrote a terrific article about imposter syndrome, and I especially love his advice to adopt a growth mind-set and consider moments of inadequacy as signs of growth.
2. Find ways to learn more.
It's tough to feel like you don't know much, so the next thing I would say is try to know much more. Here's where students can really shine because we learn about new research in class, have journal access, and have the opportunity to provide in-services. Keeping up with research is difficult, though. Rich Severin wrote an awesome post about ways to stay on top of evidence, and internships are the right time to start healthy evidence-based habits. I used Feedly to keep up with my favorite blogs, and I used Podcast Addict to listen to physical therapy podcasts during my commutes. It was fun to hear physical therapy podcasts that included a student perspective, like the Knowbodies (now new grads) and the Duck Legs Podcast. Twitter and Facebook are always teeming with physical therapy discussions/debates/rants/tweets (check out #DPTstudent hashtag and follow @APTASA on Twitter and Facebook). I also went to AAOMPT and CSM conferences, and I would tell myself to try to go to even more conferences.
My classmates and I at CSM 2017.
Learning is bigger than PubMed, though. I would have told myself to be a bit more adventurous instead of fearing criticism. During my final internship my clinical instructor (CI) told me, "Don't worry about making mistakes, that's what I'm here for. I'll let you know when I disagree." That advice blew my mind. I am typically pretty terrified of making mistakes, especially when it feels like our CIs might fail us for doing so. In hindsight, I see that my CI approached my internship with a growth mind-set; he gave me the chance to learn. I would tell myself to think about how all of my CIs expected me to make mistakes and to learn from them.
Unfortunately, you might not find yourself at an internship with a CI who wants to mentor you, who wants to guide you through your mistakes, or who wants to learn from you. One of my classmates told me that his internship site—a "successful" outpatient clinic—refused to entertain in-services from students. This classmate told me that his CI explained it this way: "Your in-service would either be about something that we already know or about something that we don't care about." Seriously?! Hearing his story reminded me to be careful about acting like I know everything just because I've been reading journal articles. More importantly, knowledge from research evidence is only one aspect of clinical education.
3. Get ready for feedback.
I would tell myself that regardless of how much (or little) you know, and regardless of how much you learn, you will get tough feedback. I've heard stories from classmates who said they had CIs who said very little. Instead, those CIs kicked back and enjoyed the extra hands-on staff.
My experience was much different. I had CIs who gave a lot of constructive feedback. I had formal, weekly discussions about my progress, and I received some type of evaluation almost every day of my internship. I'm actually thankful for this constructive feedback because I know that I'm better for it.
Even so, it's an emotional challenge to be evaluated, especially if you're passionate about physical therapy and want to be an awesome clinician. Gene Shirokobrod shared a helpful article in the DPT student Facebook group that I wish I had read before internships. The tips to pause, be grateful, and ask questions really improved my final internship.
Ultimately, I think I'm past Mount Stupid, but there's still so much more to do and learn. I'll keep this in mind as I embark on life as a new professional and I hope that you will, too.
Zach Stearns, SPT, is a third-year student at the University of Florida. You can find him on Twitter at @zachrstearns.