What classifies as a good CI and what are they expecting from SPTs?

[TheOx777]

To all the practicing therapists out there, what makes a good, well-rounded PT clinical instructor?I have heard a number of horror stories about clinical instructors who are either inept or too lazy to provide efficacious lessons to their SPTs during rotation. This is turn leaves many DPT students behind or ill-prepared to treat patients once they are actually in the workforce. So what should students be attentive of when going on various clinical rotations?

On the flipside, what are CIs looking for from SPTs at various stages in that student's clinical experience? Let's say on the spectrum of the student's first clinical to their last, how does that maturation process take place. What would you classify as entry level or beyond entry level for a fresh DPT?

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[SacPT]

I am a 1st year SPT, currently in the middle of my clinical. I don't know if you are aware, but the APTA has been trying to create a reliable and valid measure of a student's progress through their clinical rotations, called the clinical performance instrument (CPI). This should be what CIs use to grade the performance level of their students throughout the clinical experience. Personally, I believe it is a good guide for the student. In the clinic, it may differ depending on the teaching strategy of the CI. I know several 1st years who are doing basic modalities and palpations, with no introduction to evaluations, ROM, MMT, or special tests which we have come out of our first year prepared to perform. Ultimately, I think it is important to identify the learning style of the student, and progress from there.

 

[TheOx777]

SacPT,

Thank you for your input. I am vaguely familiar with the CPI, because one of the clinical instructors where I shadowed gave me a relatively brief overview of it. I did not, however, see the exact scoring for specific categories. Why do you suppose PT1s are not using the full scope of what was learned in their first year of didactic coursework? I imagine that if it is your first rotation you would "ride the pine" a little while until your CI was more comfortable with you. Do you think it has to do with confidence of one's knowledge, skill set?

Anyway, thanks again and please feel free to update us f you think of anything else during or after your clinical. Best wishes!

 

[mac_kin]

2

 

[TheOx777]

What makes a good CI?
- someone who truly enjoys teaching and is not just taking students as a job requirement or to boost their own CV; energetic, patient, organized...I could write a whole list of synonyms to describe a good CI...

What CIs expect from students:
1. You come prepared and review things at home. Noone wants to repeat the same thing over and over the entire placement. If you don't remember something by the 3rd time, talk about why that is happening - do you simply forget or just don't get it?
2. Take initiative. "Can I watch that assessment?" "Do you mind if I try that technique?" etc. If you are done with your patient, ask to shadow us until your next patient arrives. Jump in to try assessment techniques. Don't ever wait for the CI to tell you what to do. Slowly over the placement you will build up a caseload - you will have a few patients of your own who you follow regularly. If your CI is busy and running around, go review the patient's chart, talk to the nurse, look up their x-rays etc. Don't just sit there and wait for me to say "Ok, now can you check on Mr. X?". Assume that ANY patient that you shadow with your CI or see independently is now also "your patient". Every CI loves the student who comes in early, checks for updates on their patients and then tells the CI first thing "I already checked on MR. X, this is what's new, today we should do this...".
4. Share your clinical analysis!!! CIs know that you don't know all the answers. Poor students will say "I don't know". Exceptional students will say "I think this may mean A, B, or C. I think it is A because during assessment we found ___". It doesn't matter if you are completely wrong but providing a few differential diagnoses is much better than not saying anything at all.

TIPS FOR SUCCESS:
1. On the first day of placement sit down with your CI and discuss your learning strategies (do you prefer to have a demonstration of everything, do you prefer to be corrected on the spot, do you prefer having paper cases to practice with first, etc), your learning goals (3-5 things you want to improve over the entire placement), how to receive feedback***HUGE*** (do you want to get feedback on the spot, do you want to set aside 5-10 minutes at the end of the day to give feedback).
2. Share feedback about yourself - every student wants the CI to tell them how they are doing BUT every CI also wants the student to honestly provide self-feedback. Please tell your CI if you are struggling.
3. Be prepared and take initiative. Come in early if you have to, get updates on your patients, write out your plan of care for each patient, show this to your CI first thing each morning.

This is exactly the type of feedback I was looking for! Thank you so much!

 

[truthseeker]

I have been a CI for 20 years (wow, I just felt really old typing that ) and I couldn't agree with Mac Kin more.

Be assertive, but recognize when you don't know something. We don't know what you don't know.

The prep work before you treat your patients is an excellent point. Chart reviews, hashing things out with the CI before you see the patient, when possible, is a great way to be elevated a bit more in the patient's eyes.

I personally, never quiz or criticize an SPT in front of the patient. However, if I don't feel comfortable with the student's decision making, I never leave my patients alone with them. Speak fluently with the patient, switching between medical and lay terms as appropriate, but speak with professional, medical terms when summarizing the patient's care with your CI or the referring doc.

Well said Mac

 

[jesspt]

I have been a CI for 20 years (wow, I just felt really old typing that ) and I couldn't agree with Mac Kin more.

Be assertive, but recognize when you don't know something. We don't know what you don't know.

The prep work before you treat your patients is an excellent point. Chart reviews, hashing things out with the CI before you see the patient, when possible, is a great way to be elevated a bit more in the patient's eyes.

I personally, never quiz or criticize an SPT in front of the patient. However, if I don't feel comfortable with the student's decision making, I never leave my patients alone with them. Speak fluently with the patient, switching between medical and lay terms as appropriate, but speak with professional, medical terms when summarizing the patient's care with your CI or the referring doc.

Well said Mac

I personally tend to take the opposite approach. Especially early on in the clinical, many of my students' interactions with patients are spend with me asking questions of my student about the patient that is in front of them. I have found that following up at the end of the day is less effective than inquiring about clinical reasoning, or how to perform a special test, or how to accurately grade hip abduction, etc. with the patient directly in front of the student.

Note, this is not criticism, but an active learning approach that I found to be more effective for me and my students. Essentially, I use the HOAC (Hypothesis Oriented Algorithm for Clinicians) as the framework for clinical reasoning. My students are exposed to this the first day of their clinical (if they have not been previously). It then is used on EVERY patient interaction that the student has with a patient.

My expectation is that they come willing to learn, understand the basics such as anatomy, biomechanics, etc., and do the reading that is required of them during their clinical affiliation. If they have those things down, are not afraid to be wrong, are willing to engage in reasonable debate/discourse, everyone enjoys themselves, and we are able to deliver high quality, cost effective care to our patients.

 

[truthseeker]

I personally tend to take the opposite approach. Especially early on in the clinical, many of my students' interactions with patients are spend with me asking questions of my student about the patient that is in front of them. I have found that following up at the end of the day is less effective than inquiring about clinical reasoning, or how to perform a special test, or how to accurately grade hip abduction, etc. with the patient directly in front of the student.

Note, this is not criticism, but an active learning approach that I found to be more effective for me and my students. Essentially, I use the HOAC (Hypothesis Oriented Algorithm for Clinicians) as the framework for clinical reasoning. My students are exposed to this the first day of their clinical (if they have not been previously). It then is used on EVERY patient interaction that the student has with a patient.

My expectation is that they come willing to learn, understand the basics such as anatomy, biomechanics, etc., and do the reading that is required of them during their clinical affiliation. If they have those things down, are not afraid to be wrong, are willing to engage in reasonable debate/discourse, everyone enjoys themselves, and we are able to deliver high quality, cost effective care to our patients.

Let me clarify. I don't wait until the end of the day, we leave the patient room and I ask questions, and give immediate feedback. I agree Jess, delaying until the end of the day doesn't work.

 

[TheOx777]

I don't know if it has happened yet, but has the APTA or other bodies of researchers began to gather evidence about where students typically seem to shine and where there may be glaring weaknesses as it relates to the CPI data. If so, do you guys/gals(as CIs) expect this to be reflected in curriculum changes across the continuum of basic sciences, clinical sciences, psychosocial dynamics, common sense, etc.

Also, given the fact that you guys/gals have dealt with innumerable students over the years, can you tell that certain programs unequivocally better prepare their students to succeed or at least have a greater modicum of success than others? If the answer is yes, then do you imagine the APTA making a "strong recommendation i.e demand" that programs have a more uniform curriculum. I understand that funding may be a major issue for many programs, yet it would seem that we somehow have to get to some uniformity as to what we are teaching across the 200+ schools. I do not expect that any one curriculum will mirror another, but the gap in one program's curriculum to the next is seemingly gaping quite frankly!

 

[truthseeker]

I don't know if it has happened yet, but has the APTA or other bodies of researchers began to gather evidence about where students typically seem to shine and where there may be glaring weaknesses as it relates to the CPI data. If so, do you guys/gals(as CIs) expect this to be reflected in curriculum changes across the continuum of basic sciences, clinical sciences, psychosocial dynamics, common sense, etc.

Also, given the fact that you guys/gals have dealt with innumerable students over the years, can you tell that certain programs unequivocally better prepare their students to succeed or at least have a greater modicum of success than others? If the answer is yes, then do you imagine the APTA making a "strong recommendation i.e demand" that programs have a more uniform curriculum. I understand that funding may be a major issue for many programs, yet it would seem that we somehow have to get to some uniformity as to what we are teaching across the 200+ schools. I do not expect that any one curriculum will mirror another, but the gap in one program's curriculum to the next is seemingly gaping quite frankly!

I have worked with students from probably 10 different programs and I can say with certainty that it has much more to do with the student than the program. I think the CI has to be able to tailor the teaching style to the students learning style. Give praise when needed and criticism when warranted.

PT students are "prescreened" if you will for academic ability. There are, however, the list makers and the thinkers. It is hard to get a list maker to think sometimes. The converse is much easier.

It would be nice if all schools would delineate between those things that are "fact" and those things are "thought to be". Also, if terminology was consistent would be nice although that is not too terribly variable.

I think it will be hard for the APTA to quantify specifics. They might be able to quantify in generalities what would predict success in the CI:student relationship.

 

[TheOx777]

I have worked with students from probably 10 different programs and I can say with certainty that it has much more to do with the student than the program. I think the CI has to be able to tailor the teaching style to the students learning style. Give praise when needed and criticism when warranted.

PT students are "prescreened" if you will for academic ability. There are, however, the list makers and the thinkers. It is hard to get a list maker to think sometimes. The converse is much easier.

It would be nice if all schools would delineate between those things that are "fact" and those things are "thought to be". Also, if terminology was consistent would be nice although that is not too terribly variable.

I think it will be hard for the APTA to quantify specifics. They might be able to quantify in generalities what would predict success in the CI:student relationship.

Truthseeker,

Very insightful stuff! Thank you!

 

[TraumaPT]

I second Mac's post wholeheartedly; beautifully said, sir or madam!

Do not worry about whether you have had the coursework for the patient group you expect to see in your affil. The placement process for SPTs is hindered by a paucity of clinical sites; you ACCE/DCE may not be able to place each student in a spot that syncs nicely with the didactic training.

I accept my students just as I accept my patients: first I assess where they are, and then I know where we begin.

Be open about your learning style and areas you have not had the opportunity to learn yet. Many of my students come to my acute hospital without any neuro training; that just means they will be ahead of their classmates when they get back to school!

Show me your thinking process. Join me in speculating. Be curious!

And please bring a black ballpoint pen. That is all.