The Monday Memo
February 17th, 2020 PITT DPT STUDENTS
Navigating the Clinic as a First-Year Student
One of the aspects of physical therapy school that I was most excited about was the clinical education experience. While the didactic curriculum is pertinent and provides a working framework, the clinical experience is where we get to implement what we are learning in class and practice honing the skills that we will be using for the rest of our career. One of the unique assets of the University of Pittsburgh’s Doctor of Physical Therapy Program, and one of the factors that helped me decide to attend the program, is that “the curriculum is designed to emphasize early and intensive integration of [our] students into the clinical environment throughout their educational program.” Unlike most programs, the University of Pittsburgh gets us in the clinic part-time starting in our second semester of the program after just a quick summer term covering three basic science classes and a week of preparatory “Boot Camp.”
The first day of my first clinical experience was a whirlwind. My CI was the only therapist at the site and was running between patients, trying to keep up with documentation while also attempting to orient me to the clinic. Everything was new and intimidating, especially because I had no previous experience as a rehab aide. I figured I would spend most of that first day shadowing and observing my CI, trying to get a feel for how the clinic is run and what a typical treatment session would look like. However, as the weeks went on, I found myself struggling to find ways to integrate myself into the clinical experience. The inevitable consequence of early integration into a clinical setting led me to be plagued by thoughts such “I don’t know enough,” “I am incompetent,” “I don’t want to make a mistake,” and “I don’t want to be a burden.” I felt lost and was constantly looking for ways to be helpful despite what I felt was a lack of knowledge and adequacy. As we began covering more material in our classes, it became a bit easier to try and incorporate information from class into the clinical setting, but I still struggled to find the balance between wanting to practice my skills and not wanting to make a mistake or get in my CI’s way.
Another aspect of clinical practice that our classes did not prepare us for was working with patients who presented with actual deficits and impairments; this is something that just could not be simulated in our lab time during class. There is no predicting who will walk through the doors of the clinic and what they will bring to the table. Trying to figure out how to interact and connect with the patients and do what is best for them given their presentation, symptoms, and therapeutic tolerance also proved to be a great challenge initially. I quickly realized that I had a lot of patient management skills to develop, such as learning how to communicate with patients in terms that they could understand and ensuring their safety while performing their exercises.
Now that I am in my second clinical rotation, the feelings of uncertainty and helplessness have diminished. While there are still moments when I feel as though I lack the appropriate knowledge and skillset to be of any help, I remind myself that I am, after all, a first-year student, and that the expertise will come with experience, practice, and dedication.
I would like to leave the future first year students with a few pieces of advice for when they go out into their first clinical rotation. First, do not feel as though you are a burden. You are in the clinic to learn, grow, and hone your skills, so take control and maximize on the learning opportunity you have been given. Second, do not be afraid to make mistakes. Making mistakes is part of the process; just be sure to take the opportunity to reflect on them and use them as a learning experience. Third, do not underestimate the importance of building rapport and trust with patients. Even if you are unable to practice any physical skills with them or are not sure how to engage yourself with their treatment given their unfamiliar or complex condition, something as little as taking the time to get to know the patient is an important aspect of providing quality care. In addition, there is so much that a patient can teach you about what it is like living with their condition and how it impacts their day-to-day life; the opportunity to converse with patients about their experiences is eye-opening and a privilege that not every career affords. Lastly, be patient with yourself! Never forget that every expert was once a beginner. Fighting feelings of incompetence is not uncommon and representing one of the best programs in the country can feel overwhelming at times, but trust that with a little bit of hard work and practice, you too will become a competent clinician.
-Kimmie Berkovich, SPT