Third Year Student Heading into My Second Clinical Experience. Looking for advice/tips.

[gsnts725]

Hello everyone,

I'm a third year student about to start my second clinical experience in a month and I am asking for tips and advice because I want to make it better than my first clinical experience. Don't get me wrong, I enjoyed my first clinical experience a lot and I learned a ton, but I feel I wasn't given as much independence from CI and I struggled a lot with initial evaluations. Going into this second CE, they're going to expect me to be more independent and I'm really nervous that I will struggle. Also, it's been awhile since I treated a patient as my first CE was last July and I haven't been able to practice much since school shut down back in April.

My biggest concern going into this second CE is IEs. With IEs, I felt I got flustered and disorganized because I think my mindset wasn't totally right. Many thoughts were running through my head and I tended to miss some simple things during IEs because I think I kept trying to figure what is wrong with the patient in front of me and it made me nervous that I couldn't figure it out.

Does anyone have advice/tips on IEs? What is your mindset going into it? How do you keep yourself organized? How do you keep yourself calm during the very important first visit with a patient?

Thank you and I hope everyone is staying safe and healthy.

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[ya1]

At my 1st outpatient job, I had a temple which was also used for documentation. So I would just go through it step by step. I would skip steps which are not appropriate for the patient (let's say they complain about R arm, so I will skip LEs exam).
After you do that 30 times or so, it becomes repetitive and you do not need to think much.
You are still a student, so think of more generalized diagnoses (let your CI do the rest): muscle weakness, decreased ROM, muscle hyper/otonicity, overuse injury to THIS tendon/muscle, joint hypo/hypermobility, abnormal posture, lack of balance...
The key to any treatment, do not do anything that hurts or makes pain worse. Do all exercises within pain-free range. This will secure your and patients' safety.

 

[kdubz7w7]

Hello everyone,

I'm a third year student about to start my second clinical experience in a month and I am asking for tips and advice because I want to make it better than my first clinical experience. Don't get me wrong, I enjoyed my first clinical experience a lot and I learned a ton, but I feel I wasn't given as much independence from CI and I struggled a lot with initial evaluations. Going into this second CE, they're going to expect me to be more independent and I'm really nervous that I will struggle. Also, it's been awhile since I treated a patient as my first CE was last July and I haven't been able to practice much since school shut down back in April.

My biggest concern going into this second CE is IEs. With IEs, I felt I got flustered and disorganized because I think my mindset wasn't totally right. Many thoughts were running through my head and I tended to miss some simple things during IEs because I think I kept trying to figure what is wrong with the patient in front of me and it made me nervous that I couldn't figure it out.

Does anyone have advice/tips on IEs? What is your mindset going into it? How do you keep yourself organized? How do you keep yourself calm during the very important first visit with a patient?

Thank you and I hope everyone is staying safe and healthy.

I'm also a 3rd year student and 2 weeks into my final rotation (this should have been my 4th but covid so it's my third and final, just longer than it was supposed to be so I can graduate on time). So far, my CI has had me shadow a lot just to get a feel for the clinic and jump in whenever I want. Last week after watching a few evals she had me start doing the subjectve, and last night I did my first IE on my own, with her with me and perfectly happy to answer questions if I got stumped or lost. So while I am sure every CI is different, you and I are pretty much in the same place and this has been my experience so far. Mostly she had me start on subjectives because I had told her one of my biggest weaknesses is documentation, more so than doing the actual exam, so her approach with me may be different than other students. Her thought process is that as I become more efficient in documenting, I'll be more streamlined doing the whole IE.

Yes, we are expected to basically do all the things as 3rd years, but that is by the END of the rotation. We are expected to learn and grow throughout the rotation - not be entry level day 1 walking into the clinic.

I had the same fears, especially being out of practice from sitting home for so long, but she basically said by the END of the rotation, I am expected to handle a full caseload - as in, 8-10 weeks (or whatever length of time) from now, NOT day 1/week 1.

As far as being lost on IEs - it happens. We had one last week where honestly, my CI and I were both pretty fuzzy about what exactly is going on with the pt. BUT, it was easy to find a few impairments for the pt to begin working on that were related to his goals, and that is where I am starting with him. See what you see and treat what you see. You may not be 100% certain of everything going on with them during IE, and from what my teachers and previous CIs have told me, that stands true forever, not just as students & new grads. That is also what your CI is for. Don't silently panic inside your head - use your CI. I kind of think out loud to my CI and she helps me regroup and reorganize. The patients know I am a student and do not mind in the least. They know they are in good hands since my CI is also right there. I think some of them actually find it interesting to hear us talk about what we are seeing and thinking.

My first day my CI and I talked about where do I feel strong, where do I feel weak, so I recommend doing that. Share with your CI exactly what you just said here and ask them to help you sort it out. Give some thought as to what you think will help you - that is what my CI asked me, which is how we landed on me doing/documenting subjectives as the first step. I know clinic is nerve-wracking, I'm still getting the daily butterflies at the end of my second week lol, but USE your CI & don't pressure yourself to be perfect and treat like you have 30 years of experience.

Have fun! Good luck! message me if you want, since we're going through the same thing!

 

[LostLlama]

3rd year here, too! Making evals more of a conversation has worked better for me. Finding out as much as you can about the MOI, what helps and hurts the c/c, and then finding out whats tight and weak. (My approach would focus a bit more on other factors depending on clinical setting, but OP Ortho is fairly straight forward!) Stretch what's tight. Strengthen what's weak. =)
GL and remember, above all else, to be safe with your patients. If you are unsure about something, do not just push forward and hope for the best - ask!