When the Team Falls Apart
Estimated Reading Time: 2 minutes
From day one of physical therapy school, we are taught the various roles within the health care system: physical therapist, occupational therapist, speech language pathologist, nurse, and doctor. Each profession has a specific function within the health care wheel—refer, refer, refer; know your place.
I remember the first time this paradigm shifted for me as a new graduate. I was working in inpatient rehabilitation and my patient suddenly became pale and weak. I laid him down on the mat, elevated his legs, and took his blood pressure: 70/40mmHg. That can't be right I muttered to myself. Take it again: 72/45mmHg. Still not right. I called the nurse's extension and she came into the gym a few moments later. I explained the patient's situation. Her reply cut through the air like a bullet: "He's fine, just give him some water and lay him down." I felt that maybe she didn't hear me correctly. I explained again. Her reply was the same. Second bullet.
Not agreeing with her assessment, I explained that I was going to call the doctor and ask for a hold order for the morning (this was inpatient rehabilitation and there was no way this patient could handle 3 hours in a row in the afternoon after missing the morning therapies). "He is going to be mad at you if you do, he never writes hold orders," she said quickly. Third bullet. I made the call only to find out that the doctor was indeed upset with me and refused to write a hold order.
Panic swept over me. Two months out from graduation with my new job and my own license and here I was faced with a dilemma. I had not 1, but 2 members on this patient's health care team who didn't want to perform their roles. What was I going to do? How was I going to respond?
As hard as school attempts to train us on everything, it's impossible to cover every scenario that could potentially go wrong, and believe me, there are a lot of them! As a soon-to-be new graduate, you will also face many situations like this. They are inevitable in an ever-evolving, ever-changing, ever-bustling health care system. People slip through the cracks, but as physical therapy professionals, we have a unique role within the system to help seal those cracks and keep people moving forward in their healing process.
If you want to find out how this story ended as well as how to deal with other similar situations that could potentially come your way, I invite you to join me at APTA's National Student Conclave in Albuquerque, New Mexico, to learn how to navigate these challenging situations to provide the best care possible for your patients.
Join us October 31 - November 2, 2019 at APTA's National Student Conclave — the only conference for students, by students. For the best rates register by September 25, 2019.
Heidi Moyer, PT, DPT, is a board-certified clinical specialist in geriatric physical therapy and a certified exercise expert for aging adults. She is a proud graduate of Angelo State University and provides continuing education at the state, national, and digital levels. She serves in multiple capacities for the Academy of Geriatric Physical Therapy and works in the home health setting in the Chicago area.
Is Residency Training for Me?
Estimated Reading Time: 2 minutes
You're getting ready to graduate and are asking yourself what now. Or you have been practicing for a few years and wondering how you can improve your practice. One of the paths available is to complete a postprofessional residency program. Evidence-based practice and training in the scientific principles underlying practice applications are at the core of residency training, which is offered thorough didactic, clinical, and mentored experiences.
All accredited residency programs meet the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) minimum standards. However, programs vary by type of sponsor, financial structure, and program-specific mission, goals, and objectives. Having unique programs is great because it allows programs to maximize their resources and achieve specific outcomes. The downside is that the prospective participant is often left wondering if they should pursue residency training, when to pursue it, and which programs to apply to.
New evidence has emerged that provides potential residency applicants with data to assist them in making decisions about postprofessional training, including specific residency program characteristics that significantly impact the odds of graduating, becoming board certified, and passing the specialty board certification examination.
And new research has revealed that employers rate residency-trained therapists higher than experienced-matched colleagues in several important domains including leadership, communication, clinical aptitude, scholarship/evidence-based practice, and teaching. During my talk at National Student Conclave (NSC) 2019, the new evidence will be summarized and discussed.
Additional information will be provided about the overall purpose of residency education and how it fits within contemporary models of education, training, and practice. Practical information about the residency application process and timelines for new graduates or early professionals will be discussed. The purpose of this session is to inform potential residency applicants about evidence related to postprofessional education and career development that will assist them in making informed decisions about their futures.
To hear more about why and how to choose a residency program join us October 31 - November 2, 2019 at APTA's National Student Conclave — the only conference for students, by students. For the best rates register by September 25, 2019.
Kendra Harrington, PT, DPT, is director of residency/fellowship accreditation at the American Physical Therapy Association.
Speaking Spanish and Finding My Voice
Estimated Reading Time: 5 minutes
There are 2 things I know to be true and I believe we should all recognize: (1) prejudices exist in our everyday world; the LGBQT+ community, women, and people of color experience this in different ways and at varying degrees, and (2) the physical therapy profession, community, and institutions are not immune to this.
After reading blog posts written by Briana Harris and Michael Cromartie about their experiences as physical therapy students of color, I was inspired to write about my own story as a first-generation Mexican American.
Not long ago I was conducting an evaluation with a patient who spoke mostly Spanish.
As the patient and I walked into the gym for the 6-Minute Walk Test, from across the room another physical therapist (PT) exclaimed, "Oh, you're speaking your little language. I hadn't heard you do that!"
Almost immediately he disappeared into a treatment room.
I was left feeling this surge of emotion wash over me. I clenched my jaw to remain calm.
I wanted to explain to this person that to belittle my family's native language is disrespectful. I wanted to educate him that the United States (US) doesn't have an official language, and Spanish isn't "little," even if English is more widely used in this country. Most importantly, I wanted to give this person a wake-up call that his little comment had the potential to create a big problem for the patient, starting by eroding the trust in our clinic and our staff.
I should clarify. The PT who made the comment did not have bad intentions. I do not believe that he is a racist person, which cannot be overstated.
From an educational standpoint this clinic was a fantastic learning environment, and overall it was a net-positive experience. In fact, this situation can be a collective learning moment to think about our own prejudices and biases toward patients or colleagues.
However, no matter the intent, that comment is completely unacceptable. Coupling the words "little" and "language" is demeaning to me, and to the 41 million Spanish-speaking individuals in this country. Lastly, in 2019 it is not difficult to find cultural competency information, which is why there is no longer an excuse for lack of understanding.
Proud of my heritage
Spanish is how I communicate with my aunt, and how I used to speak with my grandmother before she passed away. Additionally, when my parents migrated here 30 years ago, it was a distant dream in another universe for their kid to attend graduate school in a mostly English-speaking country. Not only that, but Spanish is spoken in more than 20 different countries in the world. And most important of all, Spanish is a language that many physical therapy patients speak exclusively.
Regrettably, I'm guilty of passively hiding that I’m bilingual in the clinic and making jokes about my culture in certain situations. However, this instance taught me to be actively proud of my own heritage and to carefully respect the heritage of all our patients.
Although there is no single identifiable moment in which I discovered my voice on this matter, I began to notice my growth in simple, seemingly small instances. For example, I now say to patients that last weekend I passed a small Colorado town called Limón, pronouncing it in Spanish (Lee-moh-n), not as Lie-men. When casual conversations with colleagues occur, I'm no longer hesitant to reminisce on coming home to freshly made tortillas and both of my abuelos visting from Mexico. I'm also much more likely to volunteer the fact that I am bilingual and provide patient resources in Spanish.
It may sound dramatic to some, but this personal evolution has been genuinely liberating. The experience mentioned earlier was extremely unfortunate, but I truly appreciate the personal growth it helped inspired.
I've learned that the pillars of "normal" and "professional" in America are constructed with subjective materials and perpetuated by the majority. Consequently, people of color all around you (yes, you) feel the need to conform, causing constant internal battles between "normal" and authentic (reread Michael Cromartie’s description of “code switching” for a perfect example). Refusing to conform usually only results in the majority deeming a person "not normal" and the cycle continues.
Fortunately, being truly comfortable with myself has coalesced perfectly with coming into my own as a clinician and young professional. Overall, I now live more authentically and I hope to be a positive influence for others in similar situations as mine. With this newfound confidence, I also hope to exemplify why diversity is imperative to our profession, starting with sharing this personal experience.
Lastly, if I could emphasize 1 lesson I walked away with it is this: Much like gait patterns and range of motion, "normal," as it pertains to culture and language, is individual to every person.
Do not be ashamed of who you are. You can gain your patients' trust and promote a healing environment simply by being you.
It also underlines the importance of advocating for more diversity within our profession.
Representation within our profession
According to CAPTE, the enrollment rate of Hispanic/Latino physical therapy students in the US is 6%. To further drive home this point, datausa.io, which tracks workforce data, does not even consider Latino/Hispanic as a stand-alone category for active PTs.
I cannot emphasize this enough, better representation is crucial for better patient care.
As I look to the movers and shakers in our profession, whom I respect to an almost reverent level, the reality is that few of them look like me. In my experience, consumers appreciate anyone who tries to connect with their culture, even if it isn’t their own, but I know that would be easier to do if there were more people who looked like them.
The wave of comfort that patients have when they can personally relate to a clinician through language or heritage is powerful. I’ve witnessed it many times over. That's one of the many ways buy-in can occur, which is crucial for success.
My hope is that by sharing that uncomfortable encounter with a fellow clinician, and by telling my story, I can be a familiar face for other Hispanic students, professionals, and even potential physical therapist or physical therapist assistant students.
These factors—being Latino, speaking Spanish, and working in a profession that is 80% white—all collided that day in the clinic. It was a little moment that made a big impression.
Looking back at that now, I’m glad that it happened. But I also want to help ensure things like that don't happen again.
Gracias por leer mi cuento.
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 email@example.com.
Edwin Porras, SPT, is a student at the University of Saint Mary You can connect with Edwin on Twitter @EdwinPorrasSPT.