Is everyone enjoying their clinical experience?

[buruburudoku]

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I'm a 3rd yr PT student on my last clinical affiliation. Personally I enjoyed my previous clinical affils so much and here I am on my last one hopefully want to finish up without causing any trouble, any make-ups or failing it. During my 2nd and 3rd affils which were all ortho/outpatient setting, one hospital affiliated and the recent one being private clinic, my CIs were allowing me to see the patients and try as much skills, manual techniques, etc as I want. Especially in the private setting, I was dealing with majority of the caseload as she trusted me, I really enjoyed working with high school athletes with ACL reconstruction, LBP pts, etc.. and Here in this acute care bed-side setting I was told by my CI today that I should be more productive and cut out all unnecessary treatments even if I thought patients with prolonged bed rest & generalized weakness in gluts can to glut squeeze as HEP. She said don't bother and don't waste your time. I understand but just don't like the idea that PTs in acute care setting are sort of pushed or forced to focus more on d/c'ing patients asap..(so the hospital can bring in more pts?). I argued a couple of times that I did some things for a reason and I could clearly tell that she didn't like it. (I read it on her face. haha..). I had a strong feeling today that she is serious and will possibly fail me if I don't follow/keep up with the way she wants me to be at the end of this affil..and she is prn everywhere.. stroke, urology, ortho, oncology, ER..good chance to experience all different sides of medical aspects but her caseload is crazy..sometimes minimum couple of minutes to chart review,,used like an aide..and this was supposed be my neuro affil/acute rehab and was assigned to the neuro floor,,,I don't even do any neuro DDx, balance test, Berg..Tinetti etc..I just don't see I can do 100% of her caseload..anyone ever failed for not meeting the 100% caseloads on the last affiliation?

 

[Azimuthal]

Not yet but keep in mind the setting. Most patients are in acute only until medically stable, otherwise it's not justified. I had to learn how to manage my time efficiently and evidence does point to early WB mobility. That's not to discount therex (gait is not possible for all patients), and I don't know why an HEP would be an issue with your CI. I always educated patients in 3 therex they can perform 3-4x/day by themselves if safe. Instructions were in packets I carried or written on their white board. Also, my acute affil had protocols for standardized tests that were performed at the IE, as indicated and at DC for patients with certain conditions. In these instances I was taught to do them at "opportune" times. We also preferred short tests like the TUG and 10mwt during gait training. They didn't add much to the treatment time at all. However, the goal for most patients were for early WB mobility. A 30 min. session usually included vitals, functional mobility training and therex. How much time are you guys given per patient? You guys sound rushed.

Tread lightly with your CI, though. A buddy of mine failed for not pleasing his CI, and was called "arrogant". Don't be that guy.

Now, I'm up for an OP clinic next. My Upcoming CI kicked back my goals sheet, stating "too vague and generalized". I had written my goals based on CPI level of competency guidelines. I had what I wanted to see and do, by what time and at what level of supervision. That's a lot more time and effort many others put in. Not good enough. She sent me 4 goals "I should be focused on", that spanned almost 1/3 of a page each. So, I had to rewrite my goals AND write an apology letter to her (per my program). My DCE is a little worried about how I will be treated but "we will test the waters". I thought my goals were suppose to be "mine". I haven't even started with this woman yet but I'm not looking forward to it.

 

[buruburudoku]

Thanks Azimuthal for your input. This is only my second week and I saw a handful of patients whom we only spend 10-15 minutes, mostly we don't perform vitals..unless the chart says the pt is having a serious BP issue or has orthostatic hypotension, I thought checking vital as I get into the room to see the pt was a must (that's how I was told when I was in other general med acute care hospital..at least..) to establish the baseline and should be documented..don't mention TUG or 10mwt..even when pt is FWB or WBAT..my CI mostly only gives out ankle pumps..sometimes doesn't mention those HEP therex at all..super rushed..sometimes says don't bother asking some of the AAOx3 when she sees AMS on pt's chart..definitely feel rushed..My CI even told the MD "please d/c her asap please, please!" after seeing a pt with AMS from a rehab because the pt was sort of arguing and was mad at my CI. Sometimes seriously concered about documentation ie mentions "saving your own ass so many times.. (I'm just suffocating with all this safety issues lol. but I understand them though..)

For my OP clinic, I was given 15 minutes to do manual treatment at the end of the session no matter what. I know not all clinic/settings have this luxury. Aides would run the patient through some therex when it gets too busy. Whether it was fortunate or not, my OP CI was out of school for 10 years and I was her 'the' first student and we clicked at once, had fun discussing all the rehab modules, talked about journals, case studies, etc, and was always kind enough to answer my dumb questions and gave good insights to solve my 'dumb' qs. With my current CI? I can tell when I ask some questions that might sound a little off from her line, she frowns and always says "what would you? what bother?" After getting that a couple of times I just stopped asking qs and would just religiously say "Yes, you are right." "I will work hard to fix that." As for my goals, when I asked her if she wants me to develop weekly goals and send her she again said "don't bother." haha. Not gonna like this last one.

 

[Azimuthal]

I'd start documenting everything daily and even start an open dialog with your DCE team. I can understand the vitals thing as telemetry and such will let you know before entering the room, but my previous CI told me that if I wanted to do vitals, then do it. She said "I will facilitate your learning and try not to impede it". But no A+Ox3/4??? Uhm, no. Red flag - safety. Because I also use that for IE, etc. to verify my patient. It also doesn't seem that your CI can accommodate a student with that schedule. I'm sorry you're not getting what you can out of this experience.

 

[buruburudoku]

I'd start documenting everything daily and even start an open dialog with your DCE team. I can understand the vitals thing as telemetry and such will let you know before entering the room, but my previous CI told me that if I wanted to do vitals, then do it. She said "I will facilitate your learning and try not to impede it". But no A+Ox3/4??? Uhm, no. Red flag - safety. Because I also use that for IE, etc. to verify my patient. It also doesn't seem that your CI can accommodate a student with that schedule. I'm sorry you're not getting what you can out of this experience.

well..she will religiously just ask name and DOB and usually many pts' are with AMS on stroke floor so there she would stop bothering. Sorry I think I was a little misleading regarding that point. But it's still common we don't check vitals for pts without telemetry..and yes, I think I should state/include everything on the weekly journal that I send to my DCE. Thanks!

 

[markelmarcel]

Some of my best memories are doing A&Ox3/4 with acute care patients... Hands down the best answers I got when responding to "where are you right now?" was a wedding, library and beer garden. Haha.

I had some struggles with my acute care affiliation too... I had just come out of the classroom and neuro and I knew all these fabulous, functional tests (balance testing, TUG, 10MWT, etc) and we had no time to do them. With acute care, your top priority is making sure the patient is safe to return home/to their previous living situation. If they are NOT safe, then it's your job to recommend where the pt. should go from a PT perspective. Sometimes it aligns with their medical issues, and sometimes it doesn't. Screening is your utmost importance with acute care... A quick screen of strength, sensation and yes, mental status and then seeing what their mobility is like.... Beyond that, I didn't spend any time at all doing anything more in depth.

It was a hard adjustment for me when I realized I only had 15-30 minutes to see a patient. But, once I realized that I needed to take a step back, things went much smoother. I'm sorry your CI is not very responsive to your ideas... And I did vitals constantly in acute care, even with the telemetry monitored patients...Especially orthostatic hypotension. Anyway, keep documenting everything and if you need to reach out to your DCE more, then do it. That's what they are there for, you need to make sure that the situation is well-known with all parties, so that your DCE can fight for you, if need be.

And, my last 2 clinicals I didn't get to full 100% caseload, but I was doing a 100% caseload (in OP my last clinical did not allow me to treat straight MC patients, so I did a 100% caseload, minus the straight MC patients as an example.) Even though I technically wasn't at 100% for my CI, I was doing a 100% caseload that a regular therapist would be doing. If your school is like mine, my school told me that it was more like a guideline to catch red flags, not a literal scoring system with the CPI.

 

[truthseeker]

to your glut set example, what actual benefit will an acute patient get from doing such a non-functional activity?
Further, if it is really your opinion that the only reason to discharge someone sooner rather than later is to get another patient in the bed then, probably you are very mistaken.

When I am a CI, I am open to my students' ideas but my responsibility to the student and the patient is to let the student know (privately of course) that there are much better ways to spend that time with the patient. For example, glut sets work one muscle. LAQ work one muscle. Hamstring sets/quad sets work one muscle. these muscles almost never fire in isolation, do not work on anything to do with balance or function or transfers etc . . . Why not work on activities that address those things more directly? Further, if someone is in the hospital for acute illness, do you really think that their gluteal muscles have gotten significantly weaker in the three days that they have been sick? or are they "medically weak" because they are ill? If they get stronger because they are on antibiotics to treat their pneumonia, do you think that strengthening the gluteals via a glut set actually had an impact on their recovery?

Step back and listen to your CI.