Greg Mitro
Reflection Paper- Clin Ed II
August 7, 2015
I was at Community Memorial Regional Rehab Center in South Hill, Va for B slot this
past summer. I worked with two CI's, Valerie and Danielle, during my time there
and worked Monday through Thursday from 8 am to 6 pm. I saw a great variety of
patients ranging from pediatrics, vestibular, to orthopedics. Most of the patients
that we worked with came from the doctors at Community Memorial Hospital that
was associated with the Rehab Center where I was located. The clinic I worked at
had three full-time therapists and three part time therapists, as well as one PTA and
two OT's. The clinic was attached to a gym with nice workout equipment and plenty
of cardio machines that were available for us to take advantage of. There was also a
small pool for aquatic therapy for patients who were unable to tolerate therapy on
land.
Initially, I had a difficult time figuring out a good flow of running tests and measures
on initial evaluation patients. I felt comfortable asking patients questions and
obtaining all the subjective data, but I had tough time using my critical thinking
skills about what to do next. I was always able to get all my objective data but I
found that the patient would have to turn over a lot and switch positions. This not
only made the initial evaluations take a longer time but the patients who were in a
lot of pain had a difficult time transferring from supine to prone, supine to sit, etc.
After a few evaluations, this became significantly easier for me and so did the
problem solving process. A few things that helped were to write out a basic plan
and flow chart that made my evaluations much more efficient, easier on the patient
and helped me understand what to focus on with each patient.
One day I was able to view surgery at the Community Memorial Hospital which was
right down the street from my clinic. I observed Dr. Patel and he performed a total
hip replacement, medial and lateral malleolus fracture ORIF, and a hardware
removal of a distal radius fracture. I thought it was interesting how he used X-rays
to make sure the fractures were in line after the ORIF. I am glad I got the
opportunity to observe surgery because it definitely changed my outlook on how
much pain patients experience with total joint replacement surgeries and I can now
better explain to them why they are so sore for a weeks to months.
By the middle of my rotation, I was taking about 80% of the case load from both CI's
and handling all of the initial evaluations. I felt comfortable treating all my patients
and was forced to document my notes more quickly due to the increase in number
of patients I was seeing. I believe that my greatest strength was adapting to taking
such a heavy patient load early in my 8 weeks. My CI's both mentioned to me that
they had never had a student jump right into treating patients on their own as
quickly as I did. I believe that both of our orthopedic classes prepared me best for
this clinical. Other PT's and PTA's told me that I looked very comfortable in the
clinic and were amazed that this was my first full-time clinical rotation. I know the
reason why I feel so comfortable in the clinic setting is due to my two years as a PT
technician. I think that job helped me be aware of my surroundings and using every
piece of equipment and device to my advantage.
The most surprising part of the clinical was the population of patients that I was
working with. About 75% of the patients were on disability and did not have jobs.
Many were low activity level, low income, and low education level. I was used to
working with a more active population and initially it was tough for me to think of
home exercise programs for people who had a low motivation level and may not
have been able to read. I was giving them way too many exercises for homework
without realizing that they would never do all of them if any. It was challenging
progressing patients' exercise program who were used to sitting at home all day.
These patients needed very basic exercises and were unable to do higher level
activities.
The only time that I felt uncomfortable during my rotation was when I was working
with an older lady who was very pleasant but also very conservative with how she
dressed and talked to me. I had been working with her for about 10 treatment
sessions and she told me she had a burning sensation in left groin area from where
they had made an incision to fix a torn muscle. We went into a treatment room with
my CI and she uncovered the incision that had been giving her trouble. I tried to
take a look at it and then she stated that she would be more comfortable with my CI
(who was female) look at it and I leave the room. I respected her wish and left the
room while my CI removed a staple that was still stuck in her incision line and
giving her pain. After they came out of the room, she apologized and just stated that
she would rather "have a woman look down there than a man". I understand why
she might have felt uncomfortable with me performing the inspection and removing
the staple, but I also wonder what would happen if there was not a female PT
around to remove the staple. I had no problems working with this patient from
there on out and she was grateful for everyday I worked with her, but it was a little
uncomfortable for me to be sent out of the room when I knew I was capable of
professionally inspecting her incision line. I know that it can sometimes be a little
awkward for males to treat females and females to treat males with groin issues but
it was it was definitely a learning moment for me. My CI and I discussed the matter
and just told me to be sure to tell the patient exactly what I was planning on doing
when in that situation.
I believe that I progressed towards my behavioral objectives throughout my
rotation in South Hill. I thought it was great that my CI's made me come up with
weekly goals for myself and discussed them at the beginning and end of every week.
My goals that I initially wrote for my clinical were more geared towards acute care
setting because that's where I believed I was going to be at. That being said, I know
that I made great strides in my documentation and figuring out the most efficient
way to complete my notes. I felt much more comfortable performing initial
evaluations and was able to think more clearly while in the treatment room with the
patient.