How I got Accepted into my Dream DPT Program

How I got Accepted into my Dream DPT Program

I remember the happiness I felt when I finally received my acceptance email from Duke. After stalking the student doctor network forums religiously (don’t be like me), and constantly refreshing my email, the moment I had been waiting for for so long was finally here. It has been two months since that email, and it still feels SO unreal.

 

I should probably introduce myself before I continue blabbing on, so HEY, I’m Dashaé Smallwood. I graduated from The University of North Carolina at Greensboro this past May with a Bachelor of Science in Kinesiology, and a concentration in Sports Medicine. Since my senior year of high school, I knew that I wanted to become a physical therapist. Once I put my mind to something, there’s no stopping me. As I reflect on my PT school application process, there are so many things I did to become the best applicant I could be.

First, I committed to applying Early Decision to Duke. This would show the admission’s committee that I was serious about their program, and really wanted to attend. This would increase my acceptance chances as well, as the applicant pool would be much smaller, and my application would be one of the first to be reviewed. Applying Early Decision was also binding, so if I was accepted, I couldn’t apply to any other schools this application cycle. That was fine with me though, because I knew that Duke was where I wanted to be. The Early Decision deadline was August 15th, so I had to make sure that all of my application materials would be ready on time. We were told that we would be notified of a decision by the end of September, and if we weren’t accepted, we were free to apply to other programs. I knew that I wanted to pursue my DPT degree at Duke, so I did everything in my power to have a well-rounded application, and stand out.

 

Observation Hours

Duke’s program didn’t have an observation hour/setting requirement, but they recommended that you have at least 100 hours in a variety of settings. To cover all my bases, I shadowed at an outpatient orthopedic setting, an inpatient rehab setting, a skilled nursing/extended-care/home-health setting, and an outpatient pediatric setting. I ended up with 138 hours total, with at least 30 hours per setting. The fall before I applied to PT school, I shadowed at the hospital near my University (the inpatient rehab setting I previously mentioned). There, I met so many great therapists, and two Duke DPT alum. One of these therapists offered to be my mentor (and eventually write me a recommendation letter), and helped me tremendously throughout my application process. She gave me lots of suggestions to boost my application, and I really believe that they helped secure my spot at Duke. Her first suggestion was to list the types of patients, injuries, and interventions I observed while shadowing on my resume.

 

To set myself apart, my mentor also recommended that I try to shadow at a physical therapy clinic within the Duke University Health System. Not every student has the opportunity to do this, so I was grateful that I lived in NC. At the time, I lived about an hour away from Durham, so I contacted Duke’s pediatric clinic to see if I could set up a one-day shadow experience. Luckily, they actually had an observation program for pre-PT students. Because the clinic only had limited therapists, and so many students wanted to shadow, you had to apply for the program. When I emailed the coordinator (another Duke DPT alum), she informed me that the application deadline for the program was the next day. I told her a little bit about myself, and thankfully, she extended the deadline so that I could get my application in. I was so excited, that I completed the application that night. A week later I was accepted, and I drove to Durham every Tuesday to shadow for four hours. I learned so much at the pediatric clinic, and I got to network with current Duke DPT students, a DPT faculty member, and other DPT alum. I bonded with one DPT alum in particular, and she ended up offering to write me a recommendation letter! This leads me to the next topic.

 

Letters of Recommendation

For Duke, I had to have one recommendation letter from a professor, one from a therapist I shadowed, and another from a person of my choice. I ended up having two letters from Duke DPT alums (my mentor and the therapist from the pediatric setting), and a letter from my favorite professor, who was also the Dean of my major’s undergraduate studies. Having recommendation letters from Duke graduates made me more “credible”. Of course, every program values the opinions of its past students, so it was a good move to have two alums recommending me for Duke’s program.

 

Grades

I graduated Summa Cum Laude from UNCG, and my overall PTCAS GPA was a 3.82. My pre-req GPA was a 3.65, and I had all A’s in every course except Physics I and II, and Physiology (I had B’s in those). Duke didn’t have a minimum GPA requirement, but the average overall GPA for accepted students was a 3.60, and the average pre-req GPA was 3.70. My stats were in this range, so I figured I had a decent chance of getting in.

 

GRE

Because I was applying Early Decision, I had to take my GRE early. I chose to take it the summer after I graduated (in July), so that I could fully dedicate my time to studying. I used Magoosh’s Test prep, and their three-month study plan. I studied for about three hours every weekday, and took a full-length practice test almost every weekend. Magoosh’s program was super helpful, and because of it I ended up with a 160 V (86th %), 156 Q (62nd %), and 3.5 AW (42nd %) (316 composite score). My AW score wasn’t as high as I wanted it to be, but it didn’t end up making or breaking my application. Duke also didn’t have a minimum GRE score, but their accepted students usually scored in or around the 50th percentile. I scored above the 50th percentile for each section except for AW, so I was very proud of myself.

 

Extra-Curricular Activities

I made sure to have a variety of extra-curricular activities, and they are listed below:

 

Kinesiology Club, Bronze Leadership Challenge, Kinesiology Commencement Honor Marshall, Club Lacrosse Secretary, Campus Activities Board Member, Alpha Lambda Delta Honor Society, Employee for my University’s Facilities and Game Operations (2+ years), Retail Sales Associate (5+ years), Retail Store Lead/Keyholder (new position), Volunteer for a Summer Enrichment Program for refugee and immigrant youth (42 hours), Muscular Dystrophy Association Summer Camp Counselor (144 hours), Muscular Dystrophy Association Muscle Walk Volunteer (8 hours)

 

 

Personal Statement/Essays

Duke’s program really values diversity and inclusion, so I made sure to talk about the traits and experiences I possess that have prepared me for this type of environment. In addition, I made sure that my essays were very personal, while also remembering to actually answer the prompts.

 

Interviews

Lastly, Duke no longer conducts interviews, so I unfortunately don’t have any experience with this process. I did attend Duke’s DPT information session this past summer though, and my mentor suggested that I treat it as if it were an interview. Taking her advice, I decided to dress professionally, and network as much as I could while there. I was one of the only students who dressed up, so I definitely stood out (in a good way). My mentor advised that I bring copies of my resume (which I did), but I was too afraid to actually give them out. Instead, I introduced myself to whoever I could, just to get my name out there. I interacted with current students and faculty members, learned more about Duke’s program, and also got to tour the DPT facilities. I am glad that I decided to visit Duke before applying, because it further solidified that this was the right program for me.

 

And that’s it! I hope this post gave you a little insight into my PT application process. If you’d like to learn more about me or follow my DPT journey, check out my Instagram: @thecurlyclinician. I love talking to/meeting new people, and my DMs and comments are ALWAYS open for questions! I am excited and eager to start my DPT journey at my DREAM school, and I can’t wait to see what my future holds.

Thanks for reading! 🙂

What I Wish I would Have Done Differently in PT School

What I wish I would have done differently PT school

Prior to physical therapy school and definitely during, 3 years seemed like eternity. Looking back, I am now thinking “it was ONLY 3 years.”  As a PT who has been out almost 4 years, I am now meeting PT students and I am learning things I wish I would have done differently.

Going into physical therapy school, I didn’t have a lot of mentorship. I knew it was something I wanted to do but was basically applying and going through the process on my own. I also didn’t have any expectations and just thought that the purpose of the next 3 years was to help me to pass the boards so I could have a license to practice. Right? WRONG! I didn’t know then that you can audit courses as a student, lacked motivation to reach out to PTs so that I could continue observing/shadowing, and just took every lecture/slide without ever questioning my professors.

Find a Mentor

As a new PT, at first I felt like I was going to “kill it” as a PT my first year. It wasn’t until I was in a clinic seeing 50+ patient visits per week that I realized I had so much more to learn. I was also surrounded by extremely motivated PTs whom I have to thank for their support/guidance. Which brings me to a tip for new grads: do not work in a clinic alone. Find a clinic that provides mentorship and a team of many PTs with different strengths. Most of you probably think that is a given, but I have learned of companies that will hire new grads just to “fill a spot” in a clinic by themselves. This is what I like to refer to as a “PT Mill” but I will save that for another rant, another day.

Audit Courses

Back to my point – as a student in school, seek out courses to audit. You are surrounded by physical therapists with whom you can network. Also, get hands-on experience and learn/apply knowledge. I even had some students in a dry needling course I took a couple of years ago. They didn’t needle but got great experience and one even landed a potential job from a clinic director taking the course.

Build a Tool Box

Try several courses to see what kind of PT you want to be. Take Maitland, Mckenzie, AND Great Lakes (GASP!). Not specifically those, but my point is, do not become a Maitland-ite/Mckenzie-ite/Great Laker. Be eclectic. Build your tool box with tools to use for those patients who do not respond in the way the text book tells you.

Shadow

I went to a physical therapy school that was in a busy city which, fortunately, brings lots of shadowing/observing opportunities to students. Even if it was just an hour or two every other week, I wish I had observed and shadowed PTs to get more insight on the setting I wanted to be in, develop mentors and ask questions, and again, network for potential jobs. Most of the time these will not be paid but the value, depending on how you use it, can be very beneficial. Of course, you will go through clinicals, but they are usually in different settings and one ortho setting can be far different than another.

Question Authority

We learn at a young age in school not to question teachers/authority but I think in grad school, as long as it is done respectfully, it’s imperative – especially in a field that is fortunately and unfortunately very grey and subjective. Ask your teachers the “whys” and “how’s.” They may tell you how to treat a patient with back pain, but as experienced PTs, we know it looks very differently from patient to patient. You will have many failures as a new grad, but rest assured, this is what makes you better.

Don’t Settle

Not to knock physical therapy school because, after all, I wouldn’t be here without it  but you will learn so much in your first year of being a new grad PT, in my opinion. Don’t settle to JUST have a license, but be a kick ass PT. The world of physical therapy is always changing. You are starting to see more and more PTs “brand” themselves, go into private practice, SUCCEED in cash-based PT, etc. This is not the cookie-cutter, khaki and polo-wearing clinics we once knew (which is just fine, if that works for you). Study hard, network, ask questions, and you will be just fine.

Gena Thurston is a physical therapist and Clinic Director with NeuroSport out of Chicago, IL. Follow her on Instagram at @bodybosspt.

 

Inspirational: My Interest In Physical Therapy

I am a 21-year-old college student who loves a good nap (I mean, who doesn’t?) and anything “Grey’s Anatomy.” I have a pretty average life, and at first glance you may not pick up on the fact that I have cerebral palsy(CP). I have spastic hemiplegic CP on the left side of my body. Sometimes, CP seems to be the worst thing on Earth if I am having a really off day when my muscles are super tight and even the slightest movement is rough. I don’t think people realize how tasking everyday activities, like typing for example, is on your body. But CP ever so graciously reminds me of this, and I need to find a new way to do things.

I could start to write some really sappy story about my life and different obstacles that have hindered me because of CP. A story that oozes awe-inspiring language and somehow makes you, the reader, feel bad for me. But I am not going to do that at all. It is time we change the narrative of people with disabilities, as if our stories are only ones that can be filled with sorrow. I don’t ever want people to pity me, because like I said already: I have a pretty average life. We all deal with at least one critical event at some point in our lives that shapes us as a person. CP has definitely shaped the way I view the world and everything around me, and it has done so since birth. I know my world as nothing different than what it is now, since CP has always been a part of me.

Cerebral palsy is the reason I am in college pursuing my passion of becoming a physical therapist. Oh, yeah: did I forget to mention that? My name is Jess Paciello (IG @ceeplife). I am a 21-year-old college student. I happen to have cerebral palsy and there is no way I would trade my circumstances for anything. CP has given me a unique view about life, how to treat others, and most importantly, how to be there for others.

Now I’ll let you in on a secret. As a kid, I hated my physical and occupational therapy sessions. Go figure, right? I should have loved them as a kid with the same level of passion that I do now. And I don’t mean to discount occupational therapists: they are amazing and I did consider it as a career! But for me personally, what really drew me into loving physical therapy was the biomechanics of movement, with walking being one of the main factors. I did not start walking until I was 3 years old. A delay in walking is one tell-tale sign of a CP diagnosis. The motor functions of those of us with CP are delayed, and I think I’ve always been more drawn to the gross motor tasks in my physical therapy sessions than the fine motor tasks of my OT ones.

I have been in OT and PT since I was 18 months old, and I “graduated” from having to go to therapies a while later at 18 years old. Now, it is all up to me. I am in charge of keeping my body running as smoothly as it can. I have basically been my own PT (without a degree yet!) my entire life. I have learned so much about my own body throughout my time as a patient. Now, it is time for me to give back and help others.

I have a long road ahead of me, but it will be no more difficult than anything I have already gone through. I cannot wait to work with children who need physical therapy. The reason why I disliked my therapies a child was because at the time, I felt disconnected. Every single one of my therapists throughout my lifetime were all incredibly knowledgeable, but I so desperately wanted someone to really get what I was going through. I wanted someone like me.

 

I hope I am making my family proud through my career choice and how I choose to view CP. But most importantly, I am making myself proud with my outlook on life. If one of my future patients and their families starts seeing the potential I know they have, then all of the schooling will 100 percent worth it. If one of my future patients feels like they are not so alone when it feels like the world is working against them, then I know I did my job right.

 

Managing Difficult Patients

We all got into physical therapy because we want to help people relieve their pain, and help them move and perform better. Besides paper work, one of the most challenging part of a physical therapist’s job is managing difficult patients. By this, I mean a patient that does not put in the effort to get better and may only want passive treatments. These patients are difficult to treat because their dysfunction does not follow a typical pattern and you are having extreme difficulty in making a change to their pain. They challenge a therapists intellect, and can be emotionally draining as well. In my opinion, I would rather have a patient with a difficult dysfunction who will put in the effort to get better as opposed to a patient who is nonchalant and only wants passive treatment. The latter will never get better, while the former will eventually get better as different techniques and approaches are attempted. In this write up, I will give my experiences and how I handle seemingly difficult patients.

Let me begin with patients who simply do not put in the effort to get better but would rather rely on passive modalities and treatment. I find these patients to be very frustrating because although they come for therapy, they are not actively engaged in their treatment. They are with us for one hour every other day or so, but what are they doing for the rest of the 23 hours that they are not with us is the question that needs to be asked. If they are not engaged in the rehab process, then they are most likely undoing every treatment that has been done in the clinic when they go home. There is only so much that you can do in the clinic. This can be very frustrating because your patient might go home with no pain, and when they come back to the clinic, they are back in pain.

An example is a patient who has low back pain from faulty lifting mechanics. After movement modification, strengthening exercises, proper education on lifting mechanics and soft tissue manipulation to the paraspinals, the patient feels good. He/She then goes back to continue lifting with the wrong technique or may not engage in home exercise programs. This makes the recovery process very difficult. The way I deal with these patients is by confronting them. A typical question I would likely start with is asking them if they did their home exercise program. If their response is no, I would then ask why. The next vital question I ask, “Is being able to lift without pain (whatever their situation is) important to you? At this point, the patient will say yes and then you must follow up with so why aren’t you doing your exercises at home? If you feel that you cannot get a patient to engage in their rehab then you should probably discharge them on the spot because you will not make any progress. If they do not appreciate their own health, then you are wasting your time.

This patient described above can be very draining on a therapist, but I find them enjoyable if the patient is engaged and actively working to improve their health. It allows me to think outside the box and this can be used as a good learning tool. The best way to treat these patients is to have intra treatment test. This will allow you to be able to check the effectiveness of your treatment and see what is working and which treatments are ineffective. Another important key when treating these patients is to think outside the box. You cannot treat them like any other patient. Sometimes you have to think outside what is usual or even do a test to an extreme degree to attempt to reproduce the patient’s pain. I have been reading the Anatomy Trains book recently and have come to realize that the body is connected in intriguing ways. I have learned that there are some interesting connections in the body, such as the plantar fascia and the thoracic parapspinals. It is important that if something is not working, you should try something new.

These are some of the hardest patients to cure, but I believe that it is also the most satisfying when you can help them. The reason we follow the PT route is to help others, and it does not get any better than to help someone who may have tried everything else and assumed they would always have pain. Work hard to help those who want to better themselves and learn to let those go who do not want to put in the time to better their health.

Newest Licensed Physical Therapist.. my journey so far

Before I tell you about my experience as a physical therapist, it’s appropriate to give a brief introduction about me. My name is Brenda, and I am from Houston, TX. I went to PT school at the UT Health Science Center in San Antonio and graduated in May 2016, passed the board exam in July (another blog worthy story), and started working two days after notifying my job that I had cleared the exam.

My passion for physical therapy arose as a middle school student volunteering at a local hospital. My interest grew as I interacted more closely with children with disabilities. Also, my mother’s best friend had a daughter with Down syndrome whom I considered a little sister. I observed several of her physical therapy sessions while she was in the hospital and realized it was the perfect job for me. Unfortunately, Kimmie passed away when she was 6 after developing leukemia but the influence she had on my life was tremendous. Fast- forward 12 years and I’m a Doctor of Physical Therapy.

My first day as a physical therapist was quite the experience. I accepted a position at a small children’s rehab hospital that treats a great variety of diagnoses.  There are three wings in the hospital that house patients based on acuity levels- acute, sub acute, and rehab.

As I entered the building I was introduced to the rest of the rehab team, which consists of 2 OTs, 2 SLP, a PRN PT, and another full time PT.  The director of rehab, who is a physical therapist, had been treating patients due to a shortage in staffing and an increasing census in the hospital. Thus, my first day was just as exciting for her as it was for me.

The entire first day was spent observing patients that would most likely become mine. Diagnoses included; 2 traumatic brain injuries caused by MVA. One of the patients also had heterotrophic ossification in bilateral hips, ankles, left knee, burns over 25% of the body and was non verbal. I also saw a complete T8 spinal cord injury, a 9 month- old shaken baby on a vent, and a 10 year old who suffered a hemorrhage and had subsequent transient ischemic attacks. I met these patients, assisted with therapy as we shared treatment ideas, and was trained on the computer as the therapist wrote her daily notes. Other encounters included meeting the PM&R physician, the nursing staff, and the respiratory therapy team.

Three weeks later, I have a caseload of 6 patients which I see independently and have a tech available as needed. I also have a mentorship 2-3 hours per week. It seems fairly simple until you consider the management of the patient as it relates to physical therapy including wheelchair assessments, orthotic fittings, wound care assessments, rehab rounds every week, plan of care updates on a weekly basis, car transfer training, communication with physicians and families, creating our schedules, answering emails, researching evidence, and completing all documentation in a timely manner.


Nonetheless,

I love my job.

There isn’t anything that

could change my mind

about my choice

for this profession”.


Screenshot_2016-08-27-10-47-00-1

In a short time, I have seen patients progress from being vent dependent to ambulating with stand by assistance, and parents burst out in tears when their child stood for the first time since a traumatic accident. Every patient makes it worth the effort we put forth to create the most effective rehabilitation experience.

 

My experience in managing Chronic Pain

I had checked my referrals the afternoon before and stumbled across this; “Please see Mrs L, a 53 year old woman for management. She complains of persistent pain in her neck which radiates to the head and teeth, difficulty in movement due to radiating pain. Could you please provide regular physiotherapy to her to reduce pain and improve mobility.” The patients medical history; Chiari Malformation type 1 (surgery in 2014), stellate ganglion injection (right) 2015.

Baffled, I knew this was one for some research. I approached my senior, asking about his experience with patients post Chiari Malformation surgery, he looked just as baffled as I was. A Chiari Malformation, types I-IV, refer to a spectrum of congenital hindbrain abnormalities affecting the structural relationships between the cerebellum, brainstem, the upper cervical cord, and the bony cranial base. A long-winded way of saying the cerebellum herniates through the foramen magnum, causing similar symptoms that we would expect to see in a cerebellar stroke; headaches, ataxic gait, altered balance, nausea, dizziness, vision problems.

chiari malformation, chronic pain, physical therapy.

It was clear why this patient had to have surgery. She had undergone a posterior fossa decompression in 2014, which involved a sub-occipital craniectomy and a C1/C2 laminectomy. So, what that meant was careful palpation and no Passive Accessory Intervertebral Movements (PAIVMS) around C1/C2.… At this point I was feeling thankful I had done some research. The next day, I figured I would be seeing a patient with some post-operative neck pain and stiffness, what I didn’t anticipate was the constant neck and head pain of a year duration, bilateral shoulder pain, intermittent pins and needles/numbness in the right forearm complicated by nausea and vertigo, continuous hiccuping and burping. These symptoms left the patient housebound for the past year, and bed bound by 11am onwards, just enough time for her to shower and finish her breakfast. A few red flags later and I left the consultation cubicle to ‘photocopy her reports’, and buy myself some time to figure out how and where to start.

Once I had contacted her neurosurgeon who has been keeping a close eye on her and he ruled out any neurological concerns, I started treatment as you would with any other chronic pain patient. Problem list? Decreased C-spine range, ongoing relentless pain, headaches, assumed deep C-spine flexor/extensor weakness, combine that with no post-operative rehab or education and you got yourself a pretty severe chronic pain presentation.

Frustrated that I hadn’t seen any changes in symptoms, I approached my senior again, who has a knack with chronic pain patients. “Stop asking her about her neck” was the first thing he said, “Yeh, I know she’s chronic but surely I have to keep asking her about how it feels” I replied, “Stop asking her about it, and don’t use the word pain, at all. Ask her how her day was, ask her if she got out of the house.” My interest for chronic pain management kicked in. This was the reality of life for this poor woman, and she was convinced that it would never get any better than this. She had become so sensitized, with an increase in excitability of the spinal cord neurons combined with the theory that ‘significant headache may be produced by scar tissue surrounding the occipital nerves or by fibrous adhesions, binding neck muscles directly to the dura’ post surgery like hers.

Chronic pain patients, as clinically frustrating as they can be, are 10 fold more satisfied when little changes are seen. These patients aren’t crazy, the pain is real, much like we see in neuroplasticity for neurological recovery. Chronic pain uses the same tools, laying down nociceptive pathways and decreasing the pain threshold. I think we as clinicians sometimes discredit a patients pain when it doesn’t fit what we read in text books. So, I changed my management plan. Combining standard chronic pain approach and exercises, I focused on her quality of life and whole body movements. My first goal; “Walk for 3 minutes, 3 times this week” progress to “10 minutes.” After some therapy sessions, she came to see me, crying tears of joy, that she had left the house because she could walk for long enough to get her around the block and back home. Then, I tried the exercise bike and the theraband. Any whole body exercise that I could think of that didn’t focus on the fact that she had neck pain, seemed to help. I decreased the amount of cervical exercises she was doing and got her into our exercise class that she now attends twice a week for an hour.

It’s not the typical approach, but chronic pain is a complex entity and topic on its own, that needs to be considered in treatment. It is hard not to mention the words “pain” or “neck” in a session, but we found out that  distraction from the problem was the lady’s best chance, and she needed to stop reinforcing those nociceptive neurological pathways. By no means to this day is she pain free, and there is a long way to go, but her Lyrica dose has reduced, and she can now leave the house and stay awake after 11 am. She smiles when she walks, and goes out to dinner with her husband like a normal couple. I would call that a triumph.

 

Resources

 

  • Aghakhani, N., Parker, F., David, P., Morar, S., Lacroix, C., Benoudiba, F., & Tadie, M. (2009). LONG-TERM FOLLOW-UP OF CHIARI-RELATED SYRINGOMYELIA IN ADULTS. Neurosurgery, 64(2), 308-315. http://dx.doi.org/10.1227/01.neu.0000336768.95044.80
  • Borisut, S., Vongsirinavarat, M., Vachalathiti, R., & Sakulsriprasert, P. (2013). Effects of Strength and Endurance Training of Superficial and Deep Neck Muscles on Muscle Activities and Pain Levels of Females with Chronic Neck Pain. J Phys Ther Sci, 25(9), 1157-1162. http://dx.doi.org/10.1589/jpts.115
  • Chiari I Malformation Redefined: Clinical and Radiographic F… : Neurosurgery. (2016). LWW. Retrieved 10 May 2016, from http://journals.lww.com/neurosurgery/Abstract/1999/05000/Chiari_I_Malformation_Redefined__Clinic
  • Deng X, e. (2016). Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I. – PubMed – NCBI. nlm.nih.gov. Retrieved 10 May 2016, from http://www.ncbi.nlm.nih.gov/pubmed/25701768
  • Falla, D., Lindstrøm, R., Rechter, L., Boudreau, S., & Petzke, F. (2013). Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: A randomized controlled study. EJP, n/a-n/a. http://dx.doi.org/10.1002/j.1532-2149.2013.00321
  • Munshi I, e. (2016). Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. – PubMed – NCBI. nlm.nih.gov. Retrieved 10 May 2016, from http://www.ncbi.nlm.nih.gov/pubmed/10834643

 

My First Clinical Rotation Experience

On my first ever clinical rotation, my Clinical Instructor assigned me to a patient who he claimed to be “very impatient and grumpy.” He handed me his folder and I looked up his history and learned he was admitted in the Acute Rehab Unit (ARU), had Open Reduction Internal Fixation on his right distal femur, left Below Knee Amputation (BKA), a known hypertensive and diabetic patient, hard of hearing, receiving dialysis and had renal pressure ulcer. This was not exactly the first experience I had hoped for.

My initial encounter with my patient was very challenging. He refused physical therapy because he reported a pain rate of 10/10 on assessment. After many failed attempt at persuading him to cooperate with me for treatment, he finally obliged. I managed to do as much therapy in just a few minutes. At the initial stage of rehabilitation, my patient could not ambulate more than 12 feet with a Rolling Walker (RW), he could only do 2 sit to stands before giving up due to pain in his right Lower Extremity (LE). He had difficulty avoiding obstacles during Wheel Chair (W/C) propulsion, a safety precaution for his left LE. Every therapy session with my patient was tough. Sometimes, he complained of excruciating pain at the left BKA and patellar tendon area which prevented him from walking. Also, I had no in-depth knowledge about prosthetics and amputations prior my encounter with my him, so I had to acquaint myself on management procedure. He had dialysis every MWF, and that meant I constantly had to don/doff socks depending on his pain level on his right LE when standing or ambulating.

About two weeks into rehabilitation, my patient was sent to a Skilled Nursing Facility (SNF) right next to his house. Before he left, he could perform sit to stands Min A with RW for steady balance and verbal cueing, and ambulate 65 feet X3 with RW. Wheel chair propulsion was 80 feet X 3 with standby assist for verbal cueing on sequencing. On his last day of therapy, he said to me, ” Vince, I want to thank you for all your hard work and always putting up with me when I was being difficult and didn’t want to try.” I felt really encouraged to know my persistence was acknowledged. We said our goodbyes and parted.

On the last day of my clinical rotation, I was told there was someone on the line who wanted to speak to me. So, I hurried over to the phone in the call room and to my surprise, it was the “impatient and grumpy” patient. He told me he had bad review about the hospital, B*****, that he hated the food, the service, and the nurses that attended to him, and that it was generally a bad experience for him. This pretty much explained his uncouth behavior on our first meeting. He was quick to add that the only thing good about his stay at B***** was the ARU. He then told me he was now walking Mod I with RW. I joked and asked him if he wasn’t running yet?!” He replied, “Not yet, but hopefully one day. I wanted to tell you good luck in your career and I hope somehow when you get a job, they send you to my house.”

I finished clinical rotation at B***** a few weeks ago feeling pretty confident and excited about my career choice. This first experience made me glad about my decision to be a PTA. I gave hope to someone who did not believe he could ambulate before leaving ARU. Even though ARU involves basic bed mobility, transfer training, gait training, and W/C propulsion e.t.c, I have come to understand how these basic functional mobilities play a huge role in patient rehabilitation.

I’m glad I get to help people with their difficulty in functional mobility and build their confidence. It is an amazing feeling knowing you have managed to impact and changed a persons mindset positively by showing care.

Here is a consented image of me(right), a colleague and and my patient.

My First Clinical Rotation Experience

Memoir of a Student Travel Therapist

When I was younger, I was told by an old man that I looked like someone who would travel the world. Today, I am proving him right.

I’m a Doctor of Physical Therapy student, and I have just begun my third year in Physical Therapy (PT) school. I have a strong passion for traveling, but most times, school gets in the way. Fortunately, my school offers amazing study abroad programs every summer. In my opinion, being a student is hard and studying for a degree in doctorate program is even harder, but looking forward to the abroad programs makes it all easy and worth it.

In my Freshman year, I struggled through chemistry and the only thing that kept me going was the fact that I would travel to Rome, Italy for three weeks in the summer. Having something to look forward to propelled me to pass chemistry and basically helped me get through the Freshman year. Luckily, one of the four people from my school going to Rome was in the same class and program as me. I never actually met Alyssa until the day of orientation in Rome. Now, she is one of my best friends and I do not know what I would do without her. Alyssa and I did everything together in Rome. We were each others support system when we felt homesick. Neither of us had ever been out of the country before, so this was an amazing experience for both of us.

In my second year of PT school, we continued to be each others rock as we tackled two semesters of physics and anatomy class. This was one of the hardest year in all my years of education but thankfully I made it through. Once again, the only thing that kept me focused on passing classes, besides the fact that I would be dropped from the program if I failed, was that I was going to be traveling to Florence in the summer for another study abroad program. While in Florence, I took two classes unrelated to physical therapy. I took the Science of Wine Tasting and Making, and the Epic History of Italians and their Food. I traveled to different wineries and restaurants and learned how wine is made and how to eat like an Italian. It was really a great experience to meet new people, learn about a different culture, ideas, places and foods.

Just before I left for my trip to Florence, the director of our study abroad program approached me and asked if I would want to stay in Europe for another four months to be the teachers aide in Lugano, Switzerland. Of course I said yes! As I am typing this memoir, I am sitting in my apartment in Switzerland after a day of hiking in the mountains. Life is Great! I guess this all fits into my future plans of becoming a Travel Physical Therapist after graduation, so that I can explore the States while helping people regain mobility and get their lives back after injury.

Traveling has opened me to new experiences, valuable skills and ability to navigate the world. Hopefully, I will continue to travel throughout the rest of my college experience to help prepare me for the future.

Here are some pictures of beautiful places I visited during my stay in Rome and Florence:

Leaning-Tower-of-Pisa
Leaning Tower of Pisa
Conquering Mountain Vesuvius, Italy
Conquering Mountain Vesuvius, Italy
Ponte Vecchio, Florence, Italy.
Ponte Vecchio, Florence, Italy.
Coliseum, Italy
Coliseum, Italy
Lago, Ritom, Switzerland
Lago, Ritom, Switzerland

 

Top of Duomo, Florence, Italy
Top of Duomo, Florence, Italy

 

San Salvatore, Switzerland
San Salvatore, Switzerland

Follow Rebecca’s blog: travelingptblog.wordpress.com

 

 

 

Is a skilled Nursing Facility the Right Setting for me?

I dreaded inpatient clinical rotation as I was never a fan of general inpatient rehabilitation due to the repetitive nature of the job and because it gives society a false sense of what physical therapists do.  I have spoken to many people who say “You walk people in a hospital right?”  This is the most degrading question as a physical therapist because we do so much more than just walk patients. With this in mind, I was placed in a new skilled nursing facility (SNF) in the Riverside area. I had earlier heard bad stories about skilled nursing facilities and was a bit worried about the experience that I would have at this facility.

Have you ever thought that something was going to be terrible, and it ended up being the total opposite? That is what I experienced at skilled nursing facility. I believe that my experience started off on a good note because of my impression on entering the facility. The building was a large sized rehab area and inside of it reminded me of a hotel. It had a rehab staff of about 40 individuals, this included PT, PTA, OT, COTA and SLP.  It was one of the nicest nursing facilities that I have ever encountered and the majority of the patients were there for temporary rehab instead of long term. The patients within the facility are all generally the same, they are there because they cannot function at home by themselves in a safe manner.  The main goal of a SNF PT is to get the patient safe and functional in ambulation, transfers and activities of daily living.  This is similar to a general inpatient hospital where you walk with the patient, strengthening exercises and practice transfers.  Once a patient is able to do these activities at a safe level and is able to go home, he/she will be discharged from care.  This was not the most exciting setting and did not require as much thought process as an outpatient orthopedic setting.  There were also patients that would occasional have an accident and make the circumstances a little more difficult, but it can be expected.

So why would you want to work at a facility like this? From my experience, the first reason is that your initial impression of a facility you are yet to encounter does not indicate whether or not you will enjoy working in that environment. But, this skilled nursing facility provided me with communication skills and practice of basic skills like documentation.

The second reason is that if you like working with older people then this may be the place for you.  Many of the patients have great stories and can tell you a lot about historical events because they were there when it all happened.  For example, one of my patients was a boxer in his younger days and actually defeated a famous boxer twice.  You never know who you may meet in a SNF setting. Another reason to work at a SNF is the pay is great and the hours are flexible.  If your goal with PT is to make money and have a relaxing job this may be the way to go.  When I use the word relaxing, I mean it is relaxing to the brain, not physically challenging.  There are some very difficult patients that you may encounter. For example, a patient who is non weight bearing on 3/4 of her extremities or a patient who has dementia and is very combative.  It is not always the easiest job, but it does have its perks.

To summarize, keep an open mind when going to a new rotation or job because you never know what you may learn.  If you have the correct mindset, you will always gain experience and have a good time regardless of patient population and clinical setting. I would also recommend a SNF for one of your rotations as you may realize that you actually enjoy that setting and want to enter into that field.  If you have any questions about different settings, feel free to send me an email at jjcardoza5@gmail.com.