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| Still Smiling After 12 Weeks at Seattle Children's |
It's funny how sometimes you become something because someone else made it so. You become a mother because you have a child. You become a boss when you have employees. You become a basketball player when the coach picks you to play on the team. I guess you can be a basketball player without making the team, sort of... but it isn't the same. I was a physical therapist before... but my student made me into a Clinical Instructor, a new role that changed my perspective and helped me to grow, and came at just the right time in my career. Can you be a teacher if you don't have any students? Does a tree falling in the woods make a sound if there is nobody to hear it?
For about the past six weeks, I basically sat back and watched... or stayed outside the room completely... as my student worked with the patients we had seen together for the previous six weeks. I attended the initial evaluations and we discussed each patient, how the treatment sessions went, the status of each person, her thought processes, what went well and what could have been better. But for many weeks, she did the patient care and documentation and I worked on a bunch of projects I had lined up. Just before her affiliation with me ended, I read this post from Physical Therapist Phil Plisky entitled "What I Wish Physical Therapy Students Knew About Their Faculty (and all PTs for that matter)." I immediately sent it to her, loving the fact that it outlines key truths that new physical therapists really should know:
1) We don't know everything. Really, we don't! OK, I probably know a little more than she does. But there is so much I don't know... and I learned from her, too! More than she will ever know.
2) Our patients DON'T all get better. Sometimes eight to twelve weeks in the clinic might not be enough to really see it, but this happens. Sometimes it means we can't figure it out... fortunately I am surrounded by a team of excellent PTs that if I feel like someone isn't making progress, I can share them and get another perspective. Sometimes the patient refuses to do what is recommended, which is insanely frustrating, and they are the barrier to their own recovery. Sometimes it just happens, for any number of other reasons. Fortunately, most do get better, but the ones who don't stick with you.
But more importantly, Phil outlines the three keys to becoming a better PT:
1) Did I prepare for each patient session as much as I could? One attribute you can't really teach is putting in the extra effort to prepare. My student beat me to work every single day, had questions ready for when I got in, and I'm sure was looking things up that she didn't know. She asked for articles or resources to learn about treatment techniques and evaluation methods. She asked for opportunities to learn from different providers - like watching surgery or spending the morning learning about biofeedback or with speech therapy. In my opinion, preparedness is a habit that doesn't change - something you value or you don't. It influences how you approach your day, week, and career. I still come early to prepare for my day, I still look at my patient caseload in advance to review diagnoses of new patients in case I'm unfamiliar with something. Some people don't feel this is essential. I couldn't go without it, and I was glad to see that she was a preparer.
2) Did I care/give 100% to each session? In this profession it would be odd to find someone who doesn't care about others, but, to treat everyone you come across with dignity and respect and to care constantly is sometimes challenging. One time we were working with a teenage boy who was grunting responses, rolling his eyes, and being flat out rude. It wasn't a good day for him, and I found it entirely annoying. But that doesn't mean we stopped caring about him or his session. In fact, I asked him if he wanted to leave, and when he chose to stay, we just poured on extra caring and moved forward with the session.
3) Did I reflect? Personally, I had major imposter syndrome as a new grad PT. Reflection was essential to understand that people weren't just getting better because of chance, they were getting better because they followed suggestions I made on how to move differently or load themselves in new ways that made them feel better. As a student, it has to be insanely difficult to work with patients all day long, focusing hard on caring and giving 100% and preparing and not messing up... only to later find time to reflect on each and every single patient interaction, parent interaction, coworker interaction, CI interaction. That's a lot to think about. Mentally exhausting. I do think this is essential for growth, for identifying strengths and weaknesses, to find what has been working for you and what has not. That's why I'm reflecting on being her clinical instructor now. And that's why we had weekly meetings to encourage her to reflect on the previous week, set goals for the upcoming week, and to figure out areas we should focus on. We did a lot of reflecting... both together and independently... and I think it made all the difference.
So I sent her the article and she wrote back.... "you already taught me all this." I guess she had been listening to me all along. (New Grad PTs - you really should click on the link and read his post... it's brief but so valuable and he's far more articulate about it than I am).
Reasons why having a student was really great:
1) First and foremost, having this particular student made me a better physical therapist. Without question. I don't know if this would have happened with a different student. Maybe. That's luck of the draw - and I won this hand with a royal flush. I give her all the credit for my growth over the past three months. She made me think about my patient care decisions by asking questions. Sometimes I'd just ask her the same question back, but sometimes I really had to think about what was being asked. In her first week, we worked with a kid with "tight hamstrings" and I chose to give them strengthening exercises rather than stretching exercises, which is something I do a lot with kids - but that I sometimes approach differently with adults. When she asked me why, I couldn't immediately explain my rationale. That wasn't good enough for me and it shouldn't have been good enough for her or for the patient. So I had to consider my own reasoning, for that decision - and for all my other decisions - and that meant personal growth.
2) She made me think about what I value as a physical therapist. If you had asked me five years ago as a new grad PT what was most important for patient care, I think I would have said getting rid of people's pain. If you had asked me two years ago, I think I would have said getting people back to their favorite activities or to their prior level of function. Now, I think it is most important to connect with patients and form a therapeutic alliance. Some people won't ever get rid of their pain, so to make that the goal sets those people up for failure. Some people won't get back to full prior level of function - and that may be ok, or it may be the hand they were dealt. I no longer want to use that as the barometer of success. We as PTs have to be OK with these outcomes because that's how the human body works - and we have to be supportive of patients who experience those changes. Now I aspire to encourage self efficacy, self confidence, and personal empowerment, particularly with teenage girls. I feel that I have been a successful physical therapist if I find a way to connect to my patients, to build trust, to encourage them to change habits and find ways to move that make them feel good. If I can't connect with a patient, I want to find them a physical therapist in my office who can. I measure success differently now. I don't treat patients the same way as I did five years ago. I don't use the same words to describe what I think is wrong, I don't use the same treatment techniques, and going through this process, I could see my own personal growth.
3) She gave me a chance to watch someone else treat my patients. In my clinic, there are lots of therapists treating their patients in the same space simultaneously. I frequently have the chance to overhear conversations or treatment techniques between other PTs and their patients, but I'm focusing on my own patient right in front of me, and without knowing the context for the other patients, it doesn't make much sense to try to eavesdrop. I already knew that my coworkers and I did things differently. But when someone else is working with your own patient right in front of you, and that's who you're focusing on, it gives you a chance to see similarities and differences of treatment styles and to appreciate that we really don't need to be doing it the same way to be effective.
During her first week, I was honest with her that I didn't want her to be a copy of me, that her treatments could look very different than mine, and that would be OK as long as there was a reasonable thought process behind her choices. I truly wanted her to find her own style and beliefs. I think we achieved this. Physical therapy may be based on science... but really, it's a form of art. My form of PT is a bit loud, somewhat aggressive, sometimes even competitive, and usually a bit silly. Hers is a bit more quiet, patient, serious, and conservative. I doubt mine will change because I've come to love being a goofball all day long, but hers might change as she keeps doing it. Even if it doesn't, both ways work.
4) It's really not that much extra work. Sure, some of the days were a bit longer. And I am super lucky to work for an awesome organization that values these experiences and gave me time each week for meeting with her. I really wanted to have a student in the past and the timing couldn't have been better - for personal and professional reasons - so I didn't mind it. But above all that - every practicing physical therapist graduating in the past eight years needed several clinical instructors to get there - so maybe we should all embrace the opportunity to provide this service and help out our schools for the next group coming through. It feels good to give back, particularly to UConn, because they gave me so much. Sure, the grading system for student PTs, the CPI, is a major pain... but we made it as fun as we could and in the scheme of things, it's no big deal.
5) Lastly, I got SOOOOO much done while she was here that wasn't patient care: I studied for and took the Sports Certified Specialist PT Exam including about forty hours of Medbridge continuing education videos, I prepared for and presented at a physical therapy conference, I wrote a case study and submitted the manuscript for publication to the Journal of Orthopaedic and Sports Physical Therapy, and I started working with the new Seattle Children's Hospital North Pain Clinic that took a lot of learning and early growing pains - all in her twelve weeks.
Reasons why I might take a few years before doing it again:
1) I started to miss my patients! Being a PT is a big part of my own identity and that was gone for a while. I get to play games all day and joke around with kids. I play basketball and soccer and hop scotch and talk about Harry Potter and The Little Mermaid and unicorns and NBA Basketball or March Madness. Part of me was apparently missing the past several weeks. I'm glad to have it back.
2) My level of physical activity dramatically decreased for the past several weeks because I wasn't doing exercises with patients, standing all day, moving around like I usually do. I was confined to a chair, making extra trips to the bathroom across the building just to get up and move, sometimes pacing around the office because I needed to do something else, and I think I became a distraction to the office (more than usual). I gained weight, which is a big problem for me. I didn't sleep well because I wasn't moving around enough. My exercise routine got messed up. But now that I'm back to my usual routine, things are already getting back on track, and I could have managed this situation better, I just hadn't anticipated it and once I let the situation take control, I didn't do a good job turning it around. That's on me to keep track of in the future.
3) I don't know that the next student would come close to how great this one was. And I'm putting it in writing...for her to see... and everyone else to see. As my last words as her clinical instructor... cheering for her as she launches her PT career. And I'm pretty sure I might have been a major pain in the neck for my own CI's, so there's got to be some karma coming if I take more students in the future.
4) I really hate saying goodbye. I'm too sentimental and my emotions get in the way. In fact... I didn't really even say goodbye this time. I took her to the most stressful possible outing - watching UConn Women's Basketball in the Final Four - and then I gave an awkward side hug and ran away. That's probably not a reason to hold off on having another student.
Anyways, best of luck to my student as she graduates and takes the PT Licensing Exam... and to all the other new grad physical therapists. Congratulations on finishing three intense years of learning, and welcome to the real world. It truly is better on this side of things. And the years seem to go by in the blink of an eye.
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