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.