My First Clinical Affiliation: Journey to becoming a Clinician

It’s been a while since the last time I made a blog post.  My good friend Craig Bowen recently started his own blog which inspired me to start back up again.  You can find his brand new blog here at and can follow him on Twitter @Craig_P_Bowen.

I just finished my first clinical affiliation of my #DPTstudent career last Wednesday and I have to say, it was a whirlwind of a journey. I learned a whole heck of a lot about physical therapy and most importantly, about myself.

First day of clinic!

The physical therapy program where I’m attending, we complete all of our musculoskeletal coursework during out second year of PT school.   This sets us up for our first clinical affiliation after the conclusion of second year, which has to be in the outpatient setting.  In theory, we should be able to handle most simple orthopedic impairments we come across in clinic.  Unlike most of my classmates, I was at a main facility compared to a private outpatient clinic or a satellite office.  Being at the main site did have its perks.  I was able to see a little of everything ranging from the pediatric patient and the geriatric patient.  I’ve had the opportunity to work with patients with a prototypical joint replacements as well as pediatric patients with impairments such as a knee flexion contracture (non-neurological in nature) and a recent PCL tear; those patients were a lot of fun to work with!  I’ve met some pretty interesting characters along the way and they have made the journey lots of fun.  It was also cool to have a couple of third year students from my program near the same facility; we had our weekly lunches together which was fun!

The first couple of weeks of my clinical affiliation was mostly observation; you know, get the lay of the land, familiarize myself with the treatment area and documentation, which as an EMR (WebPT).  Each week after that, my CI would gradually ease me into treating patients.  At first, I would have one patient at a time so I could get comfortable treating and documenting at the same time. During initial evaluations in the beginning of clinic, my CI would take the subjective history and I would do the objective measures part.  Gradually I would progress to treating two patients at a time and performing the whole evaluation with supervision of my CI.   I would eventually be responsible for most of the caseload with the exception of a couple of patients; my CI had a neuro caseload previously before I started clinical, so she had neurologically involved patients that were still on our caseload.  It was worthwhile to observe and eventually help treat with my CI for those patients as we have nuero and cardiopulm next semester.

I even got to observe ReWalk Robotics in action for a patient with a SCI and same day surgery at the local hospital. I was able to follow around a Sports Medicine Orthopedic Surgeon for a well known professional sports team.  I was able to observe an AC joint resection, reverse total shoulder replacement, lateral meniscus repair, TKA and a RTC repair with biceps tenodesis.  All the staff was in the OR were friendly from the PA to the OR nurses.  I found that talking to the vendors was most helpful as they were able to guide me through what was going on in the procedure as well as ask them about the hardware being using in the procedure.  Yeah, I thought it went pretty well up until midterm.  That’s where I hit a little road bump in my clinical.

ReWalk Robotics

After midterm I felt myself hitting a roadblock.  I felt I was not making progress towards the final goals of the CPI; to be advanced intermediate in all categories. I felt I was going through the motions and not developing any critical thinking and clinical decision making.  At times, I felt like I had no idea what I was doing.  I never felt so lost in my life.  I was so nervous with performing initial evaluations and had difficulty with progressing patient’s POC.  I had to do something about the way I was feeling.

 I spoke with my CI during lunch about my concerns with my perceived subpar performance and lack of progression in clinic.  She was more than understanding and developed a plan to help me get back on track.  For the next week, we met early in the morning and during lunch to go over our caseload.  At the end of each week, we both reviewed how it went and set goals, both mine and my CI’s, for next week.  During our conferences, communication between us improved as I was more open to voicing how I felt with treatments and POC and my CI was able to adjust and give crucial feedback to help me improve.  I listened to every word she said and even bought a Moleskine notebook to keep notes in so I could refer to them in the future; it was most helpful when I would jot things to ask my CI when I didn’t have time then and there.  I even reached out to some collegues about the way I felt and asked if they felt the same after their first clinical.  To my surprise, they felt exactly the way I felt.  It was good to know this wasn’t anything out of the ordinary and I was experiencing something that normally happens on your first clinic.  After communication between my CI and I significantly improved and a pep talk with my peers, I started feeling much more confident and competent which reflected in my treats and evals.

In hindsight, I think I was my own worst enemy during clinic.   During my clinical, there was also a third year student from my program.  To put this into perspective, his requirements for clinic are to be practicing at entry level by final term whereas I am expected to be practicing at advanced intermediate.  I think what happened subconsciously, I wanted and expected myself to also be at entry level for this clinic.   I think this was because of a couple of reasons:

1.  Everyone in clinic, including my 3rd year colleague, was practicing at Entry Level or above and I thought I had to be there to keep up

2.  Having all of my musculoskeletal coursework before clinic, I thought I should be competent in treating musculoskeletal impairments.

3.  Decreased communication with my CI and myself in the beginning.  I was unaware of my CI’s expectations and goals for me as a student and I did not voice my concerns earlier.

I was so hard on myself and put such unfair and unrealistic expectations on myself during those few weeks to be “Entry Level”.  In the end, it was a huge learning experience for me learning about physical therapy and myself.  I now know what to look for in a clinical and how to better prepare myself for the next clinical affiliation.  I can’t thank enough my CI and my unofficial second CI for helping me throughout my clinical affiliation.  They truly are amazing people dedicated to giving back to students and the profession.  Thank you so much, I appreciate all of your help!

So in summary, here are a couple of things I learned on my first clinical affiliation.

Things I learned about clinic and myself.  

  • I have much to learn about physical therapy; you are at your first clinical, you won’t know everything.
  • Be confident; “fake it until you make it.”
  • Take notes and ask questions
  • Always ask for constructive feedback to improve yourself
  • Set goals with yourself and your CI
  • Communication with your CI is KEY!
  • Have a good social support group ie classmates, professors etc.
  • Look at the impairments and make a problem list
  • Focus the POC on achieving the goals
  • Get used to being uncomfortable; it’s where the magic and learning happens!

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