Becoming a Clinical Instructor

UConn PT at the Golden Gate Bridge, (Thanks, EL!)

It's finally happened.  The University of Connecticut Department of Physical Therapy must have experienced a temporary moment of insanity because they're sending me a student!  A moldable young mind on her path to becoming a physical therapist with aspirations of working in pediatric orthopedics... and since I was willing to take her, they found a way to get a contract with Seattle Children's Hospital.

Connecticut is a small state with five PT schools, so pretty much all of my classmates had to do at least one rotation out of state because there aren't enough spots for everyone to stay close to home for all those students.  And if you have specific interests like pediatrics, your options are even less.  It provided for opportunities to learn about different cultures around the country and different methods and random meet ups with classmates.  I had two rotations in Connecticut, one in Albuquerque, NM, and one in Denver, CO... and my classmates went to New Hampshire, Massachusetts, Arizona, Florida, California, Texas, Utah, New York... and maybe even more places I can't remember! 

I'm super excited to mentor a student. It feels like a way to give back to my alma mater while also having the opportunity to learn from someone who's reading current research and will have their own perspectives on optimal patient care.  I recently read a post in a Physical Therapy Facebook Group from someone about to take their first student and they were looking for advice in how to prepare.  I've also been asking around and reflecting on my own clinical experiences and instructors. I can easily think of some things that went well for me and others that weren't so great.

So, in preparation for her arrival, here are four things I'm hoping to focus on to help her have the best clinical experience possible... and then after she's all done, we can come back and see how it went!

1) Feedback:

I personally don't take feedback well.  Positive or negative.  I don't really like having much praise and I don't like hearing what I did poorly. On one of my clinical rotations, my CI gave me feedback in front of a patient that didn't sit well with me, and when we discussed it later on, privately, I burst into tears. (One of the comments on the Facebook Group was to prepare for tears because a lot students cry from the stress... but I'm not so sure). Talk about a moment severely lacking in professionalism! Embarrassing. As such, I am very aware of the importance of private feedback - unless there is a safety issue.  But being aware of that importance and being able to save feedback until a later time doesn't always occur.

Part of being a clinical instructor is helping a student develop their clinical thought processes for how they evaluate and treat patients.  Feedback is a necessary component of that, and sometimes has to be done in front of the patient - but it can be done in a right way that doesn't scare the student or patient.  From what I've observed by coworkers who have had students, there is definitely an art form to being a good clinical instructor. 

And the feedback goes both ways!  Taking a student gives me more opportunities to have my methods questioned and receive feedback about how I interact with patients and find new ways to improve my own skills. This article discusses bi-directional feedback and explains how when both the student and instructor give feedback to one another, the experience is optimized for both people and there is enhanced learning. How to give the feedback is of course an important consideration.  And when.  Because providing feedback too quickly limits opportunities for students to make mistakes.  And people tend to learn best from their mistakes... as long as the patients aren't going to get hurt.

2) Communication: 

Obviously this aligns with feedback, but deserves its own space.  With my own clinical rotations, I didn't feel like I learned most from treating the patients.  I learned far more from discussing why I chose the interventions I used, studying about techniques or conditions I was unfamiliar with, observing interactions between providers and patients, and trying different things.  Fortunately, I'm a talker, so discussing cases and thought processes came fairly easy to me. Conversely, listening is the bigger challenge for me.  I'm hoping that being an instructor will help me work on my active listening skills, particularly not interrupting mid-conversation.

UConn PT at the Grand Canyon

Communication also includes outlining expectations.  This includes small things like the schedule we'll follow and how to address patients and parents up to more critical considerations such as the sufficient knowledge for patient care.  Preparing for weekly follow up sessions to discuss progress and goals for the upcoming week was essential for my success.  Scheduled meetings are useful, in my opinion, to regularly check in, develop goals, refer back to expectations, and measure progress. I like organization and efficiency, so my instructor who was not very efficient was more challenging to learn from than the more organized CIs.

Also, as I've now had a few PT jobs and seen numerous ways to "skin a cat", I'm becoming more comfortable with the fact that physical therapists can treat differently and still be impactful.  There are exercises or techniques I don't use or I don't like... for whatever reason... but that doesn't mean others can't use them if their reasoning makes sense.  Sometimes I share patients with a coworker and we do things in very different ways... but as long as the patient continues to get better, I have to be willing to recognize that there are multiple roads to recovery.  

3) Practicing skills:

One of the best pieces of advice I got from a clinical instructor was to find a system that I could do well to use for evaluating patients as a starting point.  I could vary from that system as I got more and more comfortable, but I had to have a fall-back in case the patient didn't progress the way I would expect them to.  For me, that system was the SFMA, Selective Functional Movement Assessment, and I still sometimes fall back onto it (or parts of it) now! I wrote about that experience here.  I practiced the assessment on my roommates and on my clinical instructor and read the book on how it worked and also used it on a large number of patients.  Then, towards the end of my rotation, I was able to evaluate patients without using the SFMA, unless I wasn't sure what was going on, and then easily went back to what I felt I was good at.

In addition to evaluation techniques, in the pediatric population I don't find myself using a lot of manual therapy - but there are certain times when I feel it is necessary.  When I was learning manual skills, I needed my instructor to do them to me and have me do the technique back to them.  This way, I could get feedback on my positioning and pressure, but I would also need to use it fairly soon in order to have any retention.  I know that we used down time to practice various special tests, but if I didn't end up needing them for a whole week, it was hard to recall that knowledge later on.  

4) Providing Resources:

One of the suggestions made on the Facebook post came from a student suggesting to provide a few articles that demonstrate some of the mindset and practices the instructor uses.  I found this interesting, because only one of my instructors gave me resources at the beginning of my affiliation and that was, without question, my best experience.  I have some ideas of articles that I've read that have been impactful to my practice, but I don't know that I feel a need to start off that way.  I'd rather see if we think similarly first and share them if we don't, I think... but in the month until she begins, I'm going to give this some extra thought.  

Key resources don't just include papers to read.  I work with a group of incredibly talented practitioners including my sports physical therapist team, but multiple other types of providers share our space.  There are opportunities with other types of rehab specialists as well as providers outside our space but within the company relevant to PT practice that will also help a student grow. Should my student have interests in learning about additional experiences, I'm hopeful that I will be able to help arrange those opportunities. 

Overall, I'm excited to learn as much as I am to teach.  Especially since I'm getting a Connecticut Husky.  I hope she brings a hoodie to take a picture of in front of the Space Needle!