Graduating but very Concerned

[ustctaylor]

I am creating this post for my wife who is set to graduate soon with a DPT in Physical Therapy. However, she is has so much anxiety and stress with becoming a PT that she is considering quitting and has caused deep depression. I am so proud of her and I see how hard she works. She is in the final semester which is a final internship. She has already passed all school related tests required to graduate. However, she feels there is so much that she does not know. She feels like she is missing something. The internships have not helped her confidence because she feels that the CI's do things different compared to how she was taught. She doesn't know how to learn from her CI's or build from what she knows. She is deeply afraid of missing something during an evaluation or not knowing something. What kind of advice would you give to someone graduating and entering the field. Did you share in some of the concerns my wife is experiencing and how did you overcome them.

Concerned Husband

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[SATXDPT]

All of these are valid concerns for a new graduate, however her anxiety and depression are the real concern.
Has she spoken to any of the staff/faculty at school? Has she sought any counseling or therapy? I would encourage her to seek help either through the school (which is very invested in her success), or from a private provider.
If you read through this forum, you will see that PTs continue to learn and develop their skills and confidence for years after they enter the work force. Ideally, her first job out of school should be under the guidance and mentor-ship of a more experience PT. If she has had a bad experience under one of her CIs, it is understandable that her confidence is shaky. But if her anxiety and depression are causing her to become too rigid and are impacting her ability to think on her feet and accept alternative points of view, then that needs to be addressed first.

 

[ustctaylor]

Thank for the advice. She is speaking with a therapist and started to address this with staff. I know one of her biggest fears is not catching a "red flag". What advice would you give for that?

 

[Azimuthal]

Thank for the advice. She is speaking with a therapist and started to address this with staff. I know one of her biggest fears is not catching a "red flag". What advice would you give for that?

Your profile states that you’re a PT. What have you done so far to help alleviate some of her anxiety? Surely, you would have some insight for her?

As for “red flags”, we don’t know what we don’t know. If something isn’t right, or is not working, refer back to the physician. If patient is a walk-in, do not hesitate to stop evaluation or treatment and refer to their physician. Learn to build good relationships with referring docs and do not be afraid to request consults and the multi-disciplinary team. When a patient presents with a finding that is suspect for etiologies beyond that of a PT’s scope, education, and training, they get the boot to a higher level of care or correct area of care. As she gains experience, her screening skills will also improve as long as she keeps up with the literature. Her first job after licensure should be with a facility that provides mentorship and has clinicians willing to mentor her. She needs to place herself in an environment that with cultivate her confidence.

I have referred dozens and dozens of patients back to their PCP and sent many to urgent care or ED. Some docs appreciate it, some get irritated by it. I don’t care. Only 4 patients that I can recall were found to need further medical intervention. One with intractable mid thoracic pain - PE. A lady with b/l intractable LBP - kidney stones (we’ll see as she just had removal). A lady post mastectomy, 3 months out from her 5 year f/u from oncologist - mets to lumbar spine. They would have found that one anyways. And one lady with an avulsion fracture distal fib.

 

[SATXDPT]

As for “red flags”, we don’t know what we don’t know. If something isn’t right, or is not working, refer back to the physician. If patient is a walk-in, do not hesitate to stop evaluation or treatment and refer to their physician. Learn to build good relationships with referring docs and do not be afraid to request consults and the multi-disciplinary team. When a patient presents with a finding that is suspect for etiologies beyond that of a PT’s scope, education, and training, they get the boot to a higher level of care or correct area of care. As she gains experience, her screening skills will also improve as long as she keeps up with the literature. Her first job after licensure should be with a facility that provides mentorship and has clinicians willing to mentor her. She needs to place herself in an environment that with cultivate her confidence.

Azimuthal is right. I had a diabetic patient with leg pain that did not coincide with any injury. I referred him back to the PCP because I was concerned that he had PVD and I was worried he might have a clot that could be disturbed while I worked with him. PCP cleared him to continue with therapy. As a new graduate, you only know what you've been taught, the rest you learn from experience.
I hope your wife finds her first job in an environment with the right level of supervision and mentorship so that she can overcome her anxiety and continue to develop her skills and confidence.

 

[ustctaylor]

My apologies, I am not a PT, I am not sure how I was tagged as a PT. I will try to get that fixed. Thank you the response. I am showing my wife all of the encouraging words.

 

[wiseOldPT]

I had a horrible clinical experience that destroyed my confidence in PT school. The CI would make every scenario seem like life or death, and now with many years perspective, I can see that that was not the case. I think often as students we are so afraid of messing up, and focus on just not screwing up rather than just focus on doing good, and that'll take care of the rest most of the time. I'd recommend talking with faculty she's comfortable with. It might not be the clinical ed faculty, but maybe someone she's had a class with that can reassure her she has intact clinical decision making skills. In terms of finding a job, besides just mentorship, setting might matter. Maybe she'd feel better in a setting such as inpatient where many people have their eyes on the patient. Might give reassurance that something will get caught if something is a red flag. Also, just remember, no one is perfect. Yes, we are trained to pick up on red flags and that is very important, but we will likely miss them every now and then, just like every provider out there!

 

[truthseeker]

In PT school, you learn the basics, how to problem solve, and how to learn. In clinicals you apply some of that but should be challenged by a more experienced PT. Once out of PT school, you take the framework of what you learned (remember, its the basics) and apply it to real patients who have more than one problem, depression, work stresses, family stresses, old surgeries and misconceptions etc . . . I really don't practice anything like I did when I got out of school. I use the basics every day to be the foundation of what I do with my patients, but I don't do the basics. If your wife's CIs practiced like they did when she got out of school, they wouldn't be very good therapists.

It will come.

 

[starrsgirl]

She will be fine. Agree with above, I would address anxiety and depression for your wife....that sounds like more of a factor than her specific schooling or background. I've been out of school 2 years and am continuing to learn...but that said, we are RARELY in a place to kill anyone. Yes, we have to be thinking about things that don't seem right...but we don't prescribe meds, we don't cut, we don't use anesthesia, most PTs don't order imaging or labs. It's pretty hard to mess up too bad. Meh, maybe I think of something i should have checked after a patient leaves...then I check it on the next appointment. Physical therapy school sets us up for ideal practice of direct access and being an independent provider, I haven't found that environment in too many places....ie we practice at a lower level (sadly).

My advice is try it for 6 months. It usually takes about that long to really feel like you work at a place and know what to do. Recognize that physical therapy varies a lot among practitioners...she gets to choose her own style when she practices. Look for a place with good mentors and a bigger team of therapists (ie don't go into a place where she will be the only therapist or 1 of 2 or something).

 

[ya1]

Concerned Husband
[/QUOTE]

Of course we don't know much when we graduate from PT school! We learned the basics in PT school and if she passed all the requirements, she IS ready to start! We will learn the rest with experience. My advice would be: 1. Do not go to work in a fast pace clinic right after graduation (it will just add to her stress). 2. Shop around: if you do not feel that your co-workers are supportive and helpful when you need them to be during the first couple of weeks at a new job, leave that clinic and find a better more supportive team. 3. If you have zero idea what to do with a patient, tell that to the patient and refer them to another PT (in your clinic or send them to a different clinic). 4. Make sure there is at least 1 other PT in your clinic who you can go for an advice. I have asked PTAs advice as well since many of them have much more experience than I do. 5. For red flags, if in doubt, do not do that. 6. If something causes patient more pain, do not do that. "No pain, no game" strategy is not good for a new grad who has doubts about safety of treatment, I believe.
After working a month or so she will see that many patient cases are repetitive, so she will be able to start building her routine.
I have been also using templates for documentation which saves me a ton of time.
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[ustctaylor]

Thank you so much to everyone that replied!