dismissed due to failed PT clinical rotations. advice?

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mwindsor602

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I have a situation regarding dismissal from my PT program. I was a student that never had trouble with the didactic work, maintaining a 3.8 gpa in my graduate coursework, and having positive reviews from my level 1 (outpatient ortho) and 2 (subacute) clinical. I applied to a rehabilitation hospital for 1 of my final 2 affiliations on the west coast (i live on the east coast), and received a spot there. This was the farthest I had traveled away from home, and I saw the opportunity as exciting. After 6 weeks, my clinical instructor expressed concerns that i would not pass this affiliation due to safety concerns: slow reactions, low insight/awareness, need for prompting. I also struggled with clinical reasoning, I would plan treatments and have great conversations with my CI prior to treatment, but when put on the spot or asked on the fly, i became disorganized in thought. This led to slight defensiveness, and when i was unable to answer, i would be overcome with anxiety.
My ACCE decided to pull me from this rotation, do remediation, and do a repeat clinical in acute care. I struggled with remediation, acquiring the skills and having the knowledge base was fine, but had a huge struggle trusting my judgment and building my confidence. The main concern was consistency and my school told me that if i didn't improve within an additional 2 weeks, I wouldn't be able to go onward to my acute care affiliation. I did make it through remediation.
The first 4 weeks of acute care went well, no concerns or red flags were mentioned at my site visit between my ACCE, clinical instructor and myself. My CI said i needed to increase consistency with my chart reviews and communication with case managers, as well as discharge plan better, but overall, i was at a level expected for a student at week 4 out of 10. I expressed fear to my ACCE at the end that although I feel I'm doing well, I have a fear of regression back. She assured me I was ok. Week 5 came, and I missed a weight baring status on a patient who had a IM rod for prophylaxic measure due to cancer. It was in his written chart, and I couldn't find it. When questioned, I became anxious and frustrated. My CI did show me where the status was after I tried twice. In my midterm CPI, it was stated that active listening was the reason why I was limiting me in accountability and clinical reasoning. My CI said that I didn't come off as intentionally being rude, its just hard when the mind keeps racing and you're not processing info. On week 6, I became distracted by a patient's convo, did not put a gait belt on her, and she had a posterior displacement/lower to ground. my program pulled me from the affil and dismissed me. All of my instructors and advisors have said to me, "no one has tried as hard you have"
My family advised me to see a psychologist, who diagnosed me with ADHD, exacerbated with anxiety. My classmates and past clinical instructors are encouraging me to appeal under this extenuating circumstance and continue on the profession I fell in love with as a kid. I've considered becoming a science teacher, and explored other careers, but with a program dismissal, idk what's still open to me. Thoughts?
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Hmmm...I'd appeal as you have dedicated the time and invested the money. However, I'm also concerned. Safety is a significant factor - "Do no harm".

This is a time when you look back and write down your reflections. Go through these cases and ask yourself what you did and what happened. Then reflect on what you could have done to mitigate any adverse results that occurred. Missing a patient's weight bearing status is a big deal. Okay, you missed it on the charts, kind of weird. Where else within the chart could you have looked for that information, i.e., admission notes, etc. Nothing in the patient's hx indicated that WBS should have been established before proceeding? Was it an EMR? Did you speak to nursing before seeing the patient? Keep asking yourself those questions and answer them.

Also, you mentioned that your defensiveness stems from your anxiety. Many people can mistaken your defensiveness as rudeness. I'd work on that with whoever Dx you with ADHD as academic boards may sway yay or neigh based on 'perceived' attitude alone. For now, I would recommend that when you feel challenged, to just take a deep breath before proceeding forward. It's okay to pause, think, and then proceed.

Let us know how it goes. Good luck.
 
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Safety is definitely the biggest factor in my CPI critiques. My midterm CPI at the last site expressed that I ensured safety and my remediation work harped on this. My safety came into question again after my last two critical incidents, and i questioned how i would be ok for 4-5 weeks, and then fall apart with the gait belt incident.

The records are half in EMR and half in binders that physicians update by hand. his diagnosis wasn't clear to me initially, I failed to link he had cancer and the rod was a prophylaxic measure. The medical diagnosis involved piecing together a narrative written in paragraph form, which includes past hx, procedures, etc. His WB status was in the paper binder. It was the last patient i saw for the day, and my CI was rushing to get out, but i acknowledge this is no excuse as I did not have a clear picture. I tried to find the nurse, she was not in the pod at the time, and I spoke to my CI first prior to finding the nurse. I have learned that utilizing all my resources before panicking is crucial. I completely agree with you on the reflection and brainstorming ways to mitigate adverse effects.

Medication and cognitive behavior therapy has helped with the need to act on impulse/quickly and to actively listen. My last CI acknowledged that I had no intent to be rude, but that I had difficulty processing and owning up to error, almost like a state of confusion. I'm writing my appeal letter now and have spoken with a learning specialist at my school. We've discussed how my methods of organization/studying were effective in classes, but falls apart in the clinical setting. he says that i should base my appeal on the premise that i have a hollistic support system that includes himself, psychology and medication now, instead of just my department. My learning plans always stated what i needed to do, but not necessarily how, and he says that with time and the right professionals, this can work. I was always a student that spending excessive time in the books was more detrimental than beneficiall. simply breathing and seeing the whole picture is what i need to work on.
 
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I am all for your success. My experience has been different from yours but I understand the struggle. I was always just above the 80% cutoff with academics yet seem to do really well clinically. I'll share my thought process with you. I find that the systematic ways I approach things help, especially with a new eval. During chart reviews, I go through and anticipate my needs, i.e., ADs, via home environment, pri/sec Dx, PMHx, Rx, systems review, last recorded vitals, etc. This is also the time to determine if I need an aide. Depending on how my CI likes to do things, I either page/call the patients nurse or consult with my CI (either or first, but both) before seeing the patient. If the nurse is not available, I go to the charge nurse of the day. Don't be timid, that's their job and they usually do not mind. If both are MIA, I go directly to the board, jot down their patient rooms and go hunting. Remember, at most institutions it's a courtesy to check with nursing, not a requirement. But I like them to know that this is our patient and that we are a team today. This rapport is great when that one nurse is also the nurse for more than one of your patients. Your information gathering is then confirmed, refuted or expanded upon during the IE.

Do you have problems with IE's, or any components such as discharge planning?

You mentioned that the WBS was in the written notes. Was this the first time PT has seen this patient?

Last, during your next internship, I recommend a daily diary of what you did and any incidences that occur.
 
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Thanks Azimuthal, I appreciate it. I believe that I was starting to get on the right track of things, just slower to improve. The first week, I had difficulties with room set up, but I came home and really devised ways to be 100% consistent with this. I also refilled my scrubs with grip socks and oxygen tube extension immediately after usage. I had a very hard time w the IE at first, and came home to devise my own evaluation template. The staff were quick at extracting data, and i was slow. I started writing messages on post its to convey to case managers if I couldn't find them. My CI was extremely impressed at how much effort I put into things, and my unrelenting need to improve. My IE did improve significantly after that. Initially, I'd forget to ask something in the IE, and had to go back in the room to ask. Looking back at it now, I always appear as a super organized student, but my organization may not highlight key points, I'm too specific and bogged down by all the details. My discharge planning is good when its straight forward or "cookie cutter," difficulties arise when theres a nebulous/more complex factor: ran out of insurance coverage, borderline short term rehab vs. home with PT, changing condition, etc.

The missed chart review info was a new IE and the first time PT was seeing them. I was encouraged to self reflect (like a diary) but my reflections became factual reports especially w the acute care affil. The self reflections almost became a punishing exercise, my investment in the negatives made me leave behind the positives I had done. After dismissal, my department expressed to me that not everyone can accomplish their dreams, they could not figure out what was wrong with me. as they put it, you could probably pass the boards tomorrow, but you cannot perform. I left with a sense that I was broken without a fix. The learning specialist and psychologist recommend time off with set therapies and strategies in place for me to go back into another attempted clinical if allowed by the school.
 
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You must protest your dismissal. You have invested too much time and money to become a PT. If you had failed your first rotation, that would be a different story. But you said this was your fourth rotation. You should not be dismissed because you are having difficulty in the acute care setting, which is a very demanding environment. You have done well in all your classes and have passed three other rotations, so you are clearly capable of being a PT in acute care. I cannot believe your program is telling you, "not everyone can accomplish his dreams."

I had trouble in the acute setting at first. What helped me to set up a system or a routine so I would not miss steps. I would not only do a thorough chart review, but I would always carry with me a pen and paper and make notes so I would not forget any critical information. As Azimuthal said, always ask the patient's nurse before seeing him. Teamwork is critical in acute care.

My IE's were disorganized at first, but they became more efficient and thorough towards the end of my rotation. I'm sure if you work with the learning specialist and psychologist, you will find a way to learn how to do an IE and collect all important data.
 
i gave my CPI to my old clinical instructor with names and locations whited out so that the staff therapist she picked would be unbiased.They agreed that I should strongly appeal, highlighting the conditions listed below. Let me know what you guys think:
1. rehab hospital noted being unsafe. did they formally educate you on all equipment? Did they brainstorm on how rather than you will do (insert blank) to ensure safety?---the answers to both were no. their point being, there's strategies to improve and chunk learning to make it easier rather than telling the student they're slow.
2. did you go over your learning preferences/strengths/weaknesses/goals for your clinical on the first week?---no, my CI was absent the first day, and I was not clear to touch patients until week two, so learning was "as we go along" and I don't think she ever opened up my learning preference sheet to go over essentially how I function. verbal working memory is poor with ADD, paper was discouraged bc it was a dynamic setting. I was losing my mind trying to remember everything.
3. missed chart review, what were the environmental and external factors?--it was the end of the day, staff was rushing, last patient to be evaluated, my evaluation template was detailed but bogged me down, and i rushed the entire process to meet staff demands. staff therapists reading this say it sounds like classic ADD symptom exacerbated.
4. gait belt incident, where was your CI?---um, not in line of vision, at medical rounds. i was distracted by 3 other stimuli: nurse convo outside, physicians, and very talkative patient themselves. also, they read that my midterm cpi said I ensure safety and ask for assistance at all times. 3 days later, the critical incident report states: inconsistent gait belt usage repeatedly on patients with fall risks despite numerous conversations. so, basically a student went from 100% to 5% of consistency in 3 days? something seems off.
5. my past clinical instructors also noted that I'm very calm and composed at all times. I do not throw, scream, shout or act impulsive. When all these critical incidents occurred, I remained professional. The rehab hospital stated I was un-empathetic with one scenario and had no reaction. The CPIs prior to that, in my remediation, and in my acute care stated my strengths lie in establishing patient rapport and relating to people well....so basically I'm a heartless student or mother theresa?
6. these errors, if student was incompetent for sure, these things would have shown up in subacute, there's gait belt usage, oxygen tanks, wheelchairs, etc to handle. staff therapists reading the cpi's feel that I was simply freaking out and never recovered mentally. also, i'm a CNA in home care for 3 years per diem, and have never endangered a patient.
 
my appeals meeting is coming up in 2 days. any advice?
 
What is the format of the appeal? Will you be facing a panel and have a chance to explain the incidents from your perspective? If so, rehearse what you are going to say. Be careful not to sound defensive or put the blame entirely on someone/something else (like your ADHD). Do you have someone you trust that you could role-play with, or could at least act as a sounding board?

If I were on the panel, I would want to see proof positive that you have put something in place so that safety incidents won't happen again. It would reflect poorly on the school, and the faculty members understandably want to avoid that.
 
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I definitely echo what jblil said...I think highlighting the things you did and will continue to do in order to improve and prevent any future safety violations will be key. Good luck, pulling for you man.
 
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the format of the appeal is in a typical lecture room, department chair, someone on the clinical eval committee, dean of health science, and 2 elected faculty members. my parents have decided to attend and thats been cleared by the school to do so. (they wont really talk or say much in the meeting though), and the learning specialist at my school says he'll probably attend. ive been talking to friends and rehearsing my key points, basically answering what happened, the help i've sought, and how with more resources in place this time/drug intervention/psychotherapy, outcomes will be different.
Thanks for the advice guys!
 
my school has rejected my appeal, and i was wondering what career alternatives everyone can think of that would integrate some components of the material i've learned in a PT curriculum?my ideas included becoming a rec therapist or biology teacher. any others?
 
Darn, sorry to hear that your appeal got rejected...

Any interest in being an OT, provided OT schools will overlook your past? That said, if you can afford it, take a week or two off to let things settle a bit. Don't make hasty decisions.
 
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i enjoyed working with OTs, but I'm worried that my failed clinical will affect my ability to get in. ive taken a month off, i started tutoring math and exploring education. however, human biology is not all encompassing of all biology.
 
Go back to nursing school. You probably have all the pre-requisites. There's always demands for RN's. I know one student who got dismissed here and that's what he's doing.
 
the OT and nursing options, wouldn't i be eliminated from those occupations because of the failed clinical?
 
I dont think so no...it is definitely worth a shot. Sorry to about your dismissal man
 
OP - Call up OT and Nursing schools and ask them if they'd consider your application. Do it before you go through the app process.
 
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there are only 2 OT schools in my state that I would be able to afford/drive financially, one of them being the school that i've attended. its worth a shot, although idk what to say to them, the safety component is not really a great thing to start off in terms of why i switched over. what do i say?
 
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and thanks for the support guys, i really appreciate it. any other ideas?
 
How did you do in anatomy? There is a high need for instructors there. You could go after a masters first and teach at community college or look to a phd program.

I like the education track too....health sciences or bio, maybe high school level?
 
i did well in anatomy, i had A's to B+s, the anatomy instructor position is something to go for after finishing a master in ed or master of arts in teaching. I do need to come up with a way to explain to admissions my switch without making it unfavorable for me
 
i spoke with an advocacy for disablities lawyer today. she said that due to my red flag incidents, I'm deemed a "direct threat" to patients in healthcare. When asking her how much I need to disclose or say in an interview, or if I could even apply for anything in healthcare, she had no answer. thoughts?
 
If you are a red flag and shouldn't be treating patients, I recommend you consider going into health care administration. You have to accept your limitations. You can make just as much money if not more and you'll be in the same industry.
 
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Yes health care administration sounds great. We have a person at our hospital who coordinates new admits and works on insurance approval for our critical care access hospital. Since you have PT knowledge, this would help you in selecting appropriate patients.
 
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i will email OT schools to see if they would take me based off of my circumstances, and also explore recreational therapy. My alternative industry to go into would be education. As for the MBA, do students shadow administrators?
 
mwindsor602 said:
i will email OT schools to see if they would take me based off of my circumstances, and also explore recreational therapy. My alternative industry to go into would be education. As for the MBA, do students shadow administrators?
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Why not do health administration? If you have red flags, then no OT school is going to accept you. Recreational therapy pays crap. I'm not sure if you need observation hours to go into health administration but you might as well ask.
 
mwindsor602 said:
i spoke with an advocacy for disablities lawyer today. she said that due to my red flag incidents, I'm deemed a "direct threat" to patients in healthcare. When asking her how much I need to disclose or say in an interview, or if I could even apply for anything in healthcare, she had no answer. thoughts?
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NewTestament said:
Why not do health administration? If you have red flags, then no OT school is going to accept you. Recreational therapy pays crap. I'm not sure if you need observation hours to go into health administration but you might as well ask.
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You stated that a LAWYER told you that your red flags deemed you a "direct threat" to patients in health care...how do you think you would get around that with an OT profession, not to sound rude or inconsiderate but these are the facts you're going to have to deal with right now. I agree with the above post on health admin, you should look in to that and not waste any more time on the more "hands on" careers as unfortunately your past is not going to allow you to do them at this point in time.
 
the lawyer is saying that with ADHD symptoms that are untreated, there is a direct threat. with medication and therapy, the direct threat assumption is ameliorated or decreased. she's saying i need more documentation sent to the school.
 
I feel like you will have a hard time with that, especially since you have already been kicked out. Saying you wouldn't be high risk with medication is just an assumption and you would basically need to be back in the clinic environment to prove that one way or the other. I can't see the school being ok with letting you back in to potentially harm patients. A lot falls back on them. I agree with the above, time to focus on less hands on professions, especially considering the increasing amount of competition to get accepted in grad school. Sorry, but I think no way a school accepts you after being kicked out once.
 
i'd go into teaching before an mba, never had a strong pressing desire to do business administration
 
mwindsor602 said:
i'd go into teaching before an mba, never had a strong pressing desire to do business administration
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Then teaching it is! But forget OT/PT. I have dreams of being a professional triathlete but it's not going to happen!
 
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friend of mine mentioned orthotics and prosthetics. thoughts?
 
Alan - I didn't realize things were that bad in the Orthotics & Prosthetics field. Thanks for finding that thread.
 
AlanWattsBlues said:
I'd be leery of O&P. This thread has some insight into the profession:


Maybe this isn't an accurate picture of things. Maybe things have changed. But it definitely would make me think twice.
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I actually remember reading that thread a while back. It's such a small profession that it is actually difficult to find a lot in the way of down-to-earth information regarding it out there on the internet if you're not really looking for it. What you read in that thread is information you will find in relatively few other places. Definitely an interesting read. Though I don't always believe everything I read on the internet as things can often be biased by a vocal minority, it sounds like yet another case of credential creep at best, and a downright terrible occupation at worst.
 
i inquired about the masters program in my area. the director said i meet all the pre-requisites, but there may be difficulty in the placement and completion of the internships, slowing ppl down from graduating. maybe that's the con of pursuing this path, securing residencies/internships?
 
mwindsor602 said:
the OT and nursing options, wouldn't i be eliminated from those occupations because of the failed clinical?
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I am an ex occupational therapy student who was forced to withdraw from my program simply due to academics(grades) and just thought I would chime in since I was browsing the forums. Perhaps it is not my place to give my opinion since I was in OT school but reading your post I do not think you should give up on PT simply because you've failed your last clinical affiliation. As many others have said, you had a high gpa in the program and you've managed to get though your level1 and first(?) level 2 placement. You have clearly proven that you are capable to become a PT if you are able to handle the rigorous coursework and the challenges of fieldwork. You've invested way too much time and money to just give up on your dream and pursue something else. I think the idea of you switching careers is ridiculous. Perhaps you just had a very challenging placement(and I've heard acute care is not a cake walk). With that said, I know of one OT student who was dismissed due to failing her level 2 and re-applied to other OT schools and received several interviews. Now if you've got bad grades it would be a completely different story. If PT is in your heart and dreams then pursue it.
 
hey, i appreciate the words of advice. my problem is, most schools are looking to see how i've improved or grown from the experience, and since my program is not giving me a chance to remediate, i have no way to objectively show that those were simply incidents, and accidents happen. one of my clinical advisors actually told me that not everyone is capable of achieving their dreams, and unfortunately, its a theory that we teach children to motivate them to try hard.

I'm at a point now where most schools are seeking why the switch and what have i done to improve. my university has deemed that my medication and therapy was not enough to link my safety concerns to symptoms and they do not suggest any remediation options. switching industries, such as into education or business, appears to be the only way to move on in my life. I love the field of PT, and rehab medicine in general. at the same time, i want to stay realistic.
 
mwindsor602 said:
hey, i appreciate the words of advice. my problem is, most schools are looking to see how i've improved or grown from the experience, and since my program is not giving me a chance to remediate, i have no way to objectively show that those were simply incidents, and accidents happen. one of my clinical advisors actually told me that not everyone is capable of achieving their dreams, and unfortunately, its a theory that we teach children to motivate them to try hard.

I'm at a point now where most schools are seeking why the switch and what have i done to improve. my university has deemed that my medication and therapy was not enough to link my safety concerns to symptoms and they do not suggest any remediation options. switching industries, such as into education or business, appears to be the only way to move on in my life. I love the field of PT, and rehab medicine in general. at the same time, i want to stay realistic.
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Have you looked at PTA schools? It's an associate degree and can be earned in a very short time and it can pay off loans in the meantime. I was actually just accepted into an OTA school. I literally called the school a couple days ago, told them my situation, and just now met up with the academic counselor. The counselor didn't even ask why I withdrew or looked at my graduate transcript. She immediately accepted my application and my spot is now set to start sometime in august. If I don't get into any OT schools I've applied to I will definitely be attending this OTA program. I think it would be a good back up for you as well so you can learn and get more hands on experience. Then you can re-apply to PT schools once you feel that you are ready(if you still want to become an PT). Just my opinion.
 
Unscrupulous schools will accept anyone since they are really lusting after your tuition $.

The question is, can you (generic "you" here) get placed into clinicals, considering the stuff in your background? Would hospitals let you work as a student-in-training? That is the thing you need to be absolutely clear about, before you apply or re-apply.
 
jblil said:
The question is, can you (generic "you" here) get placed into clinicals, considering the stuff in your background? Would hospitals let you work as a student-in-training? That is the thing you need to be absolutely clear about, before you apply or re-apply.
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I worry about this as well. I feel that schools may see you as a liability and would have a dry difficult time placing you in clinical, most schools won't like the added work nor will the like the added risk that is possible - not trying to sound negative, just going off the information that has been provided here.
 
jblil said:
Unscrupulous schools will accept anyone since they are really lusting after your tuition $.

The question is, can you (generic "you" here) get placed into clinicals, considering the stuff in your background? Would hospitals let you work as a student-in-training? That is the thing you need to be absolutely clear about, before you apply or re-apply.
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Sorry jblil, I am not quite sure if your comment was directly to me or the OP
 
I was simply making a general comment so it wasn't specifically addressed to anyone. If you had to leave your program for any reason, try to get some degree of certainty that you will be accepted for clinicals, before you re-apply.
 
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