Clinicals

5 Take-aways From My First Full-Time Affiliation

1. Always seek out new learning opportunities

Hospitals can be intimidating, especially if you haven’t spent much time in one before. Patients can be hooked up to so many lines, leads, and tubes, and some can be in critical conditions. It’s easy to be afraid to evaluate and treat certain patients. I was walking through the ICU when one of the physical therapists offered to let me shadow her for the rest of the day. I was nervous to stay in the ICU and felt obligated to return to my unit to treat the rest of my patients, so I chose to not return to the ICU. The biggest thing I regret from my clinical is that I didn’t jump at the opportunity immediately.

It seems silly when I look back on that moment, because I had spent time in the ICU and PCU on two different occasions with another physical therapist. However, on those occasions, I was in my first year and I played a more passive role in the patient’s treatment. I was nervous to be thrown into an evaluation in the ICU, but I wish that I had stayed. You learn SO much when placed in unfamiliar environments, and it’s also rewarding to be able to facilitate functional mobility with people who may have been bedridden for several days or weeks.

I really hope that you take all learning opportunities given to you. I know that it’s super easy to read this and say “duh, I’d never say no!” I thought exactly the same way, and although I normally say yes to everything, I didn’t when I was in that situation. Do your best to say YES as often as you can, even if you think you’re not prepared, you’re not confident, or you’re afraid. There is always a physical therapist nearby, so nothing bad should happen. At best, you’ve performed a great evaluation and learned a ton of cool stuff! At worst, you end up flustered and unsure, but you get help from your CI and still learn a lot.

There are a lot of ways that you can learn during a clinical affiliation. You can observe other PT’s, other careers and attend lectures and continuing education classes. If you want more learning experiences (which you should!), then make a list and see what your clinical instructor can help you pursue!

2. Be more confident – You know more than you think you do

This is pretty similar to #1, but being a little repetitive never hurt anyone 😉 (don’t quote me on that, I’m probably wrong haha)

You’ve completed 1-2 years of a doctorate program. That’s an impressive feat, and truly shows that you are prepared for whatever is thrown at you. Your clinical director placed you at this clinical site because they know you, and they know that you are totally ready for this affiliation.

I completely understand how it feels to doubt yourself. I do it too often for my own good. More than once I wasn’t 100% confident in questions that patients asked me, even if I knew the answer. I was afraid to say the wrong thing, so I let my CI answer just in case. I used blank evaluation and treatment templates to write on when I was with 100% of my patients, until my very last week. On that 6th week, I immediately realized that I was using them as a crutch and could have ditched them WEEKS ago, but I didn’t want to forget to ask my patients anything.

If you missed this article on Imposter Syndrome, you need to read it. Seriously, stop reading this post, click on that link, read the entire thing, and share it with your PT class. I honestly believe that most students have experienced this, and it’s so reassuring to realize that it’s not just in your head. A lot of responsibility is placed on our shoulders as health care providers, which can be even more stressful when your patients are in the hospital.

I know that one little blog post isn’t going to solve this, but I hope that you know that you’re not alone. It’s something that I work on every day, and you can too!

3. Learn outside the clinic

Your affiliations are NOT a time to become complacent and stop learning once you clock out. Sure, it’s amazing to not be in classes 5 days a week. It’s so awesome to be treating patients, to learn from your clinical instructor, and to get some hands-on experience with people that aren’t just pretending to be injured (even though we all have that one classmate that is great at acting!).

It’s the best time to learn, in my opinion. You’re not studying for exams, so you have more free time than you used to. Use that time to really take full advantage of your affiliation. Here are some ideas of what you could be doing:

  • Take notes during the day, and learn more about them when you get home.
  • Relearn your old class notes, especially if they pertain to your clinical setting
  • Read textbooks – you know, the chapters you were supposed to read during class 😉
  • Find some journal articles – I promise, they’re 1000% more interesting when you’re not getting tested on them
  • Read blog articles – See my resources page for the ones that I follow
  • Browse through the cases on Facebook groups – I used to skip past them, but now I try to read through the entire post and all the comments to see what other SPTs and PTs would do in a specific scenario. The Doctor of Physical Therapy Students is my favorite group.
  • Listen to podcasts on your commute, while working out, or while in the shower – I compiled a list here.
  • Talk to your classmates – What did they learn this week? Is there anything you can share with your class?
  • Get on Twitter! – I don’t browse as much as I should, but I highly recommend it! There are countless PTs, SPTs, OTs, Physicians, etc. that you can follow and learn from. Here’s a great list of people to follow from New Grad PT!
  • Attend a conference or continuing education course – Many of them are free, or offer a significant discount for students
  • Watch & Participate in webinars and #XchangeSA chats – There are TONS out there for free on Youtube. It’s a nice segway into podcasts, since you have a video to watch, and you have the opportunity to ask questions if you’re watching live. Here’s a link to past #XchangeSA chats!

This list can be daunting, and that’s ok. Try to set a goal for yourself. Pick one thing to do a day. For example, you could follow this schedule:

  • Monday: Spend 15 minutes on Twitter and comment on 5 Tweets (specific to health care)
  • Tuesday: Read 3 blog posts
  • Wednesday: Listen to 1 podcast or video
  • Thursday: Read 1 journal article that interests you
  • Friday: Write down everything you learned this week, and Google anything you want to learn more about
  • Saturday: Relearn old class notes
  • Sunday: Read a textbook chapter

I didn’t utilize my free time as much as I hoped during my affiliation – I always Googled any notes that I had taken at the end of each day, and I glanced through an Acute Care textbook, but that was pretty much the extent of my outside learning. I’m definitely planning on making a similar schedule for my next affiliation, and I challenge you to do the same!

4. Be prepared to spend more time than your scheduled work hours.

This can be common in the hospital setting. My scheduled hours were M-Th 7:30 am – 6 pm. I often arrived earlier than 7:30 am so I had extra time to complete a thorough chart review in the morning. This was especially true on Mondays and Tuesdays. On average, 95% of the patients were new on these days, so I needed extra time to read through all their past notes. Once you do the first chart review of a patient, chart reviews are SO MUCH FASTER when you do another chart review on subsequent visits. You only need to review the new notes that you haven’t seen yet (for the most part, I’m sure there are exceptions, though).

I also didn’t leave at 6PM very often. Occasionally I left around 5:30 pm, but was more often finished around 6:30-7 pm. I’m definitely not complaining about this – extra clinical time is always helpful. Hospitals can be unpredictable sometimes, however. You might see a patient near the end of your day, so you need extra time to complete your notes. You might want extra time to double check the notes you’ve written that day. You might take a patient from someone’s caseload, or offer a helping hand when someone needs a tech. Just don’t be surprised if you have to stay later than you were scheduled.

5. Don’t rule out acute care physical therapy

During my observation hours and part-time clinical affiliation, I was not very interested in the hospital setting. It seemed like the PTs did the same thing with every patient, and observing the PT do everything made for a somewhat boring experience. However, evaluating and treating is so different than just observing. I know it seems silly to say it, but it’s true!

Acute care is pretty cool when you’re (kinda) in charge. Chart reviews are SO interesting because you have the chance to learn about a ton of medical diagnoses and procedures you’ve never heard of before. You get to analyze lab values and vitals, and how they’re related to your plan of care. You’re able to educate people about how to safely move in their environment. You get a TON of experience with family education. You’re able to work on a team with everyone and learn about other health care fields.

I know that acute care isn’t for everybody. I have one classmate that is 100% against the hospital setting, and that’s fine! I was “meh” about the setting before, but now I could see myself working in acute care in the future. I hope that you keep an open mind and try to learn as much as you can about all the possible career paths that a PT can take – you never know until you try!

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Have you noticed any of these themes during your observation or clinical experiences? Do you have any advice to share? Comment below!

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6 thoughts on “5 Take-aways From My First Full-Time Affiliation”

  1. Once again, I wish you had been a classmate of mine. These are great insights. I really like your weekly list of suggested things to do to increase your knowledge. Your experience with acute care was much like mine with neuro. I had been so scared of it, but turned out I knew more than I thought I did.

    The thing I wish I had known before I went on my first affiliation would have been to always ask questions, even when I think I know the answer. As a PT, I liked it when the students asked me questions and I had a lot of information to share.

    1. Wow, that’s seriously the best comment I’ve cotten in a while. You’re so sweet! 🙂

      Yes, that is such a great point!! You can never ask too many questions, and that’s one of the best ways to learn new information. Your CI doesn’t necessarily know if you don’t understand something until you ask.

  2. Thank you for this post. I have been following your blog for quite some time now and I’m happy, I came across it. This will definitely prepare me for when I am going to apply to PT school.

    Thanks
    Channa

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