In the third year, our real work begins. We say goodbye to our 36 classmates and hallway full of fantastic faculty and put our knowledge to the test in a practical clinical setting. We are paired with a Clinical Instructor, a physical therapist that acts as our teacher and mentor for the duration of our clinical rotation. I traveled for my first two rotations, doing 8 weeks in Florida and 12 weeks in New York.
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Reflective Practice
Read my clinical reflections from my first two clinical rotations here: How time flies!
Internship I - Emory L Bennet Veteran's Nursing Home, FL
My two months were spent slowly picking up a full caseload at the nursing home seeing a diverse set of patients from neuromuscular to cardiopulmonary. I made many connections both with my patients, their families, and my colleagues. One of my biggest strengths as a therapist is developing interpersonal and inter-professional relationships to make individuals confident and comfortable with me as a person and future medical professional. I truly enjoy working in a team of therapists, which was one of the best parts about this rotation at the nursing home.
At the end, I was managing a full caseload and completing full evaluations in a timely and efficient manner. I noticed during my first few weeks, many residents who had the ability to walk were still using their wheelchairs most of the day. So, my quality improvement project grew from there. My fellow therapists and I decided to implement a "walk to dine" program for the facility. First, this involved mapping of the grounds and halls to get precise distance measurements. My QIP also involved the screening of all 130 residents (as not all are on therapy case load) through the course of my rotation to evaluate those able to participate in a “walk to dine” program to get more individuals ambulatory:
- Read about the Walk To Dine Program Here: Walk to Dine!
Above are the maps created for the walking program.
Internship II - Lutheran Medical Center, NY
The transition to the acute setting was challenging not only because of the medical complexity of the patients but the fast paced nature of this level one trauma center environment. Ultimately, though I discovered how much there was to learn from not only my clinical instructor but the vast multidisciplinary team working with all the patients in the acute care environment. I found during internship I that I had the time to look up evidence during the day to research the particular presentations of my patients, while in the hospital I hardly had time to sit down (my pedometer had an average distance of 4 miles clocked per day in the hospital !). I had to adjust and develop a method of asking directly, either my CI or the patient’s physician, PA, or nurse if there was something I was particularly concerned about. Otherwise, I had to be diligent to write it down and look it up later.
One patient I evaluated one-day post total knee arthroplasty (TKA) and she was morbidly obese. She was unable to use her ‘good leg’ to actively assist in her knee flexion and extension exercises and I became worried that her active range of motion was not developing as it should. Even though the evidence doesn’t support long term use of CPMs for patients post TKA, I spoke with the orthopedic PA on the case about her prognosis with out one and we ultimately decided to get the machine for her.
While at Lutheran, I created a standardized post-op protocol for TKA patients as well as a home exercise program as there were none specifically for this patient population and we saw so many of them! Click below to access files:
Internship III - Powell Wellness Outpatient Physical Therapy.
Culpeper, VA
“Ummmm, where is Culpeper?”
That was the very first thought I had when I saw this selection on my internship placement paper last year. If you are having a similar query, let me assist you:
So, In January I moved out to little Culpeper (pop 16,370). Immediately, I was struck by the charming downtown adorable little shops and restaurants (which has won awards, apparently there is such a thing as “Main street Awards”), as a cinephile I was very excited by the theater run by the National Archives showing FREE classic cinema, and the gorgeous landscape to bike, hike, and run in. Then I finally visited Powell Wellness Center (PWC), where I would be working. What a fantastic facility! A full gym, outpatient rehab facility with over a dozen skilled therapists, and a top of the line therapy pool (one of only 6 in the country) :
When my clinical instructor was away, I worked with another therapist in the pool. I had no idea what a powerful tool the water can be for such a variety of patients. I worked with pediatric patients that had chronic pain issues from broken bones to individuals with spinal cord injuries. We had such tremendous outcomes in the water.
Working in the outpatient setting was very different than I initially imagined. I had the ability to connect with individuals on a deeper level and develop a relationship with them over the length of rehab. It was fantastic to see the work we were doing in combination with the body’s natural recovery time allowed patients better function with each progressive week. It allowed me to understand the how different comorbidities, ages, sexes play into the nature of prognosis. Ultimately, I can’t believe how far I came in just 13 weeks. In the last month, I was carrying my own caseload and I never dreamed I would be so ready for graduation.
Here in Culpeper, I started my weeks working out with some very inspirational people at 5:30 in the morning… the early morning cycling crew of Powell. Iron men and women that have challenged my body and mind in all the best ways. This morning I was reminded of something very important:
The race isn’t the hard part, it is the training, those months ahead of time that require the dedication, commitment, and sweat to prepare yourself for that starting line. And if you’ve ever run, biked, or swam in a large race, you know how exciting it is when you stand there, early in the morning READY for the challenge in front of you.
Today is the first day of the last week of my last clinical internship before graduation. My classmates will all agree, it has been a long road (almost 7 years of education *phew) and the excitement of graduation just on the horizon is palpable.
But this isn’t the END. It is the BEGINNING. We are at the starting line and it is exhilarating! Who knows what is just around the bend?
Moving Forward....
As we look ahead to the end of our academic tenure at George Washington University and face our final clinical rotation before graduation and board exams we created a short post-graduation plan. read about it here: after graduation.