George Tate

PTQ 024: Tips, Tricks, and Tools oh my! Discussion on optimizing your examination process

On the Quest this week, Dr. Brandon Fowler is our guide through the complexities of a PT eval. Be able to accept a challenge, know that you’re not perfect, and do the best that you can.

Albert Einstein once said that imagination is more important than knowledge. When performing an initial examination on a patient, you have to be able to think outside the box. Skillful use of didactic knowledge in an imaginative way that spurs a patient’s sense of self efficacy is critical in empowering them to take control of their pathology and in developing rapport.

The talented therapist accepts a challenging evaluation knowing that they are not perfect. Physical therapy is a practice. The new PT must accept this and do the best that they can.

Recognize the power of reflection and take the time you need to make sound clinical judgements. As Brandon extrapolates information from the patient he is constantly reflecting on what the patient is telling him and then comparing their report to what is written in the patient’s chart which he reviewed prior to beginning his examination.

Many physical therapists, during the examination process, would compare themselves to a scientist. They make observations, record data, come up with hypotheses, and test them. This process is known as the scientific method.

Brandon is a strong proponent of incorporating the scientific method into his physical therapy practice. Once you have a chance to test the hypothesis, you accumulate more data that will either rule in or rule out your physical therapy diagnosis.

The neat thing about our profession is that we can use the treatment responses we get from our patients to help guide our hypothesis in ways that other medical providers can’t.

When you ask a patient what is important to them about therapy, many will tell you they come for a positive outcome, but it is important to remember that they also care about how you make them feel.

PTQ 023: Physical Therapy – A profession perspective on what it is and who it’s for

At the end of most episodes we ask our guests a couple questions to gather some of their views of the profession. Hear some perspective from inside the profession.

“What is Physical Therapy?”

“Who is someone that can potentially benefit from physical therapy or seeing a physical therapist?”

PTQ 022: An Acute Care Conversation

Welcome to the physical therapy quest podcast where it's all about sharing the experiences from others in physical therapy. We aim to help answer your questions while you navigate the various opportunities in the profession. And now your host George Tate.

GT: So, on today’s episode we’re going to talk a little bit about the acute care setting. I’d like to welcome somebody who’s been behind the scenes for a little bit now. He’s officially committed to join the team helping me out with several things. But Richard Eatinger say hello.

 RE: Hi how are you doing.

GT: I’m doing great thanks for asking. So just a little bit of background about us. We’re lab buddies who sat next to each other for majority of two of the three years correct?

RE: Yeah pretty much every day.

GT: Yep. He scratches my back I scratch his, you know. It’s been a great experience. So right now, we’re on our last rotation and we’re both in the acute care setting. So, as you know the title of this episode is going to be kind of what made you ruled out acute care. We didn’t necessarily rule it out, but we were both set on orthopedic outpatient which is still an interest of ours. I’m actually going to be doing acute care but potentially looking at also squeezing in acute care job on the weekends. So, Richard has been actually talking about potentially trying to have a full-time job and acute it, correct?

RE: Yeah. There was a big surprise to me.

GT: So today we’re going to break down a little bit about what shifted our minds. I’m going to ask him first and just simply walk us through what a day looks like for you what time you get there. Chart review. Just go ahead and start and I’ll chime in.

RE: OK. Well my average day usually starts around 6:00 a.m. Get up have breakfast at the clinic.

GT: What do you have for breakfast.

RE: Pretty much oatmeal every day. I get to the clinic around 7:00 probably I’m 45 and then work starts today and it’s scheduled to go till 430. Some days are a little shorter or some are a little longer. There’s then a chart review. We use epic which is actually really user friendly. So, our review only takes me about probably maybe five minutes ten minutes the most for each patient. For caseload we generally see between, I’d say eight to 10 patients a day.

RE: But right now, I’m working in the ICU, CCU and cardiac wings and yeah like you were saying I never thought that it was something I would enjoy. But I am I’m loving acute care along with orthopedics. But I’m honestly considering a full-time job in acute care when I go.

GT: What brought up the thought that you’re, you know, really interested in acute care all of the sudden when before this setting wasn’t on your radar. Is there anything that you kind of look at you know why you changed your mind?

RE: Honestly, I’d say it was probably an intimidation factor. I think we go through school and we learn so much out of books and we go to the clinic and there’s a big difference between reading a textbook and you know, knowing a standardized test and then treating a patient. In acute care you’re treating you’re treating patients who are more critical who are relying on you to do the right thing and for their health care. And so, I think that students and new graduates are pretty easily intimidated by that and the responsibility that comes with that. I know I was.

RE: So, I think once you kind of jump in and you’re able to see that there is very much a team dynamic to acute care that the intimidation factor quickly decreases. At least it did for me. So once that happens it’s like I just said, your part of a team. Everybody supports each other. You see a lot of patients on different wings but that’s managed fairly between everyone at the hospital I’m at right now. So, if you get to the end of the day and there’s a wing that has more patients to be seen, therapists from other wings aren’t going home, they’re coming to your wing to help you finish. So, it’s very supportive and it’s very rewarding to me personally because you get to see a more direct effect on your patients. I mean obviously it’s physical therapists.

RE: In outpatient that process can be longer whereas in acute care that reward is potentially sooner. I mean that sounds a little bit like a selfish reason, but that reward is much quicker. You see the results of your therapy more quickly.

GT: Yeah. Actually, very similar situation to me. I’m not going to walk through my day just because it looks pretty similar to yours but really the team dynamic. You know everybody has lists at the beginning of the day. If you’re done with your list you’re going to reach out to other people on your team to cover. There’s a lot more of social aspect as far as cross professionals within the therapy department and the hospital as a whole. The rehab facility where I’m at the OT’s and speech are all in the same area downstairs doing chart review. So, in the morning there was a good opportunity to you know, ask the other professions what’s going on with so-and-so, plan the day to be more efficient and to ultimately provide a better treatment for the patients. So, I definitely agree with you as far as coming together as a team and getting more done and being more efficient with what the patient needs.

RE: Yeah, efficiency is something that stands out because you’re having conversations with the surgeon that just performed the surgery. You’re having conversations with the doctor that’s seeing that patient on a regular basis.

RE: And so, it’s a lot easier to get things done because everybody who you need to clear things who are in general area you are. So, if you think a patient needs specific treatment or you think something will be beneficial, you can go, and you can ask that provider to clear that for you if that’s required in the area that you’re working or just kind of have a sounding board to get another opinion. So yeah that’s a great benefit as well.

GT: I agree. In this kind of setting everybody’s in the same place. If you’re at an outpatient clinic, calling the doctor or the surgeon to get a little tidbit of information that would really make all the difference is a lot harder and less likely to happen. Now I’m not saying it doesn’t happen, but it probably won’t affect your treatment. It’s most likely not going to happen at least from my perspective. But in the acute care setting you can use pagers, you could go to their office, you’re most likely going to see these people walking around on the floor. At the same time, they’re going to be looking for you for your opinion on the patient’s function. So, what is acute care?

GT: Something that describes it as basically, the patient is in an acute state but ultimately, you’re just looking at making them as safe as possible in order to go onto the next setting. You do this by maximizing the functional independence in the allowed time you’re effectively able to treat the patient. That could be a skilled nursing facility, assisted living, and you’re trying to do that as quickly as possible. If they are medically stable, then they could most likely get more effective care at another facility if the qualify and it’s appropriate.

RE: Yeah discharge planning is a huge part of where I’m working. It’s very important that you’re able, as a therapist, to appropriately plan for that patients discharge to make sure that they’ re getting the help that they require when they leave.

GT: Definitely. My C.I. mentions how a lot of these professionals like the doctors, and case management are going to be looking for you because they want your opinion. That highly dictates where they’re going to go next and what facilities are going to accept patients depending on whether they think the patient is appropriate to go to that facility. So, I kind of describe it as we’re not making money for the hospital we’re making care more efficient. Obviously, the patient is always first. We know that but at the end of the day you’re paid for your opinion.

RE: I think there’s just there’s a lot of responsibility that goes with any setting but like I was talking about before, there’s a lot that goes into acute care. It’s important to remind yourself and to make sure that you’re doing documentation review because if you make a wrong click on your documentation you could potentially send that patient somewhere and they could potentially miss out on getting the amount of care that they need. So, it’s just important to be on your game.

GT: So, we’re going to step back a little bit. How long have you been there? Obviously, the same length as me but I’m asking you.

RE: I want to say they we’re going into the fifth week.

GT: Yeah, I think that’s right. So how efficient has your documentation been? Have you been able to get in the groove yet?

RE: I actually I have been for the most part. I mean documentation I would say is probably the largest hurdle that I have had at every site because of the questions regarding what needs to go into the documentation. There is just the steep learning curve for all the different types of documentation systems. So, I’d say probably the first week and a half, sometimes two weeks, are just really getting familiar with the documentation system in addition to patient care. So, my days end up being usually a little longer those first couple weeks. I will say definitely by now that I have settled into a groove and I can document fairly quickly.

GT: Another thing I wanted to talk about is the flow of an evaluation or treatment and we’ll start with evaluation. You hear a lot of people wanting to develop a system to effectively hit all my bases when you’re evaluating a patient for the plan of care. Obviously, that’s going to change drastically depending on the setting, but have you able or been able to dial in what an evaluation looks like. Have you become somewhat efficient with that process yet?

RE: I feel like in acute care it’s highly dependent on the patient that you’re seeing. So, when you walk into the room you start evaluating immediately in terms of like their level consciousness and how much you think that they’re going to be able to interact with you in the evaluation process. So, I kind of guide it from there.

GT: What on average how long would you say an evaluation is for you?

RE: For me in acute care I would say between 15 and 30 minutes and usually not much longer than that.

GT: Yeah. Right there with you. Do you Co-treat a lot with other professions.

RE: No actually. Occasionally nursing but I have not seen a single OT since I’ve been there over the five weeks I know they’re there because I review their documentation when I go through. But I haven’t seen any yet.

GT:  Treatments you said were about roughly you know 10 to 15 minutes is that correct.

RE: Yeah usually about 15 sometimes. I wouldn’t say short of 10 I’m usually 15 20 minutes.

GT: What’s the average patient look like for you? I know you vaguely mentioned what floors you were on and the types of patients but if you know 50 percent of your treatments what you would say they look like as far as how involved you are with you know their therapeutic activity gait training how it varies.

RE: I’d say 50 percent of my caseload is probably cardiac surgery patients. We see them post op day 1 sometimes day zero and we’re usually just working on the really basic stuff. You’ll walk in and they’ll be you know sitting up in the chair and you’re working on getting some cardiac exercise protocol and say you’re doing your ankle pumps your long our quads your you know mobility upper arm mobility.

RE:  Then you’re working on transfers. Honestly, you’re getting them up and you get them moving. So that’s it, doesn’t take very long takes about 10 15 minutes and then but it makes all the difference for them.

GT: Yeah. Realizing that these are things that they need to get home safely or to the next facility. Kind of really play your part as far as overall their plan of care and getting back to where they were. Is there anything that you would add, and you can ask me the same question. In this setting you’re going to have to respond to some certain situations. The art of walking into the room and face the unknown is going to be a common theme. On paper you can only read so much and learn so much about somebody until you ultimately walk into the room. I’ve had several instances where I have to check back in with yourself and how you’re acting. I have to make making sure that I’m doing everything I can. But is there anything that comes to mind for you when you hear this situation?

RE: You know I think something I think about is over planning. I think the biggest mistake an acute care therapist can make is walking into a patient’s room having a plan and expecting to stick to that plan.

RE: You can have a general outline but if you are expecting to do A, B, and C. I don’t think you’re going to have a very good time and acute care because the situations that you walk into are so dynamic and the patients that you’re seeing are so critical that their vitals can change very quickly You need to be able to respond to that.

RE: I think having an outline is good, but I think over planning would be a dread.

RE: And you need to begin with people because when you’re walking in these rooms a lot of times their whole families will be in there and you need to be able to have a discussion with them regarding the seriousness of the situation. You also need to make sure you maintain that and a background of hope and that you’re there to help and get everybody on the same page. That positive attitude can make all the difference for a patient’s progress.

GT: Yeah, I agree with you there. One thing that I’ve thought of for my prospective is that I’m at a trauma center. You’re most likely to be working with these patients when it is potentially the worst day of their life.

GT: Have you thought about that? That just hits home with me because with that being said you walk in and you know you don’t really expect that patient to want to work with you or to be in a pleasant mood. I mean personally, I wouldn’t be in a pleasant mood either given their circumstance. But I mean that really put things into perspective and goes back to the fact that you can’t always have a plan you just have to be able to have ideas in mind and then basically exactly what you said. See how they’re doing, make changes, and make sure you’re doing everything you can.

RE: Yeah. In terms of moods of patients, I’ve found that almost every interaction that could have been perceived as a negative is just coming from a place of fear on the part of the patient.

RE: They have been through a huge ordeal in their lives. I think that if you approach them with compassion and not a reactive kind of response you’ll find, well at least every patient that I’ve had, has been very kind and are very grateful to be treated with understanding like that.

GT: I would say that despite not being able to have a plan the ideas that you could think of in your head generally based on reading a patient’s chart is more comforting than you would think. Obviously, you’re going to have to think on the run, but I don’t want to make it sound like somebody has to have a plan shouldn’t be in this setting because somebody who definitely develops a system will be just fine!

GT: Is there anything else you would have somebody who is afraid of the acute care setting think about when the outpatient orthopedic setting has always been their first choice.

RE: Maybe the ability of having to think on your feet quickly. I think a lot of therapists like having a moment to be able to think about things and if you care you respond pretty quickly. So, I think that could be something that can be daunting to new therapists entering the field.

RE: But gosh I don’t know. I’ve been having such a good experience it’s honestly hard for me to think about negatives.

GT: Yeah well, it’s a great problem to have. So just to close up a little bit here obviously we are both liking our acute care setting. So, depending on whatever type of person you are and what type of therapists you are. I would not put it in the “do not touch this box.” I would definitely get out there talk to people and shadow. Take away points from me are just really liking the team atmosphere and just kind of going in and being the first call of duty as far as getting up, being mobile, and educating the patient on what that’s going to look like depending on how they’re presenting. So, this whole episode will be linked back to a web page. This is how we usually do it. The episode will live on a Web page and ultimately, we will be looking to bring more resources for you guys as far as the acute care setting. I know we have some charts that we use as far as lab values, tips for transfers. and things of that nature so watch out for that. Do you have anything to say before we sign off Richard?

RE: No. Thanks for having me on.

GT: Really had a great time no problem and Richard, as we said earlier, be a normal host and we’ll look to give his knowledge of wisdom. All right wonderful having enjoyed it.

GT: Thank you so much for listening and once again I love for you to subscribe to my show. If you find this valuable, please share it with somebody else. As always you can visit thephysicaltherapyquest.com for the show notes and more materials.

PTQ 021: Preparing for the NPTE Board – advice with helpful resources

Dr. Beth Ennis joins us to share her opinions on things to consider when preparing for the NPTE Board Exam. After teaching and watching hundreds of students prepare, she has a fair amount of experience backing the opinions she presents.

Over approximately 9 years, Dr. Ennis has helped prepare hundreds of students to take the NPTE board exam. For the few students that have not been successful, the reasons are usually non-academic.

When Dr. Ennis started teaching for Score Builders, she looked into the habits that are often problematic for students. She was always wondering how educators could help students recognize problems early enough to address them before beginning to “crunch” for boards.

Dr. Ennis starts by looking at DPT students as a whole right when they enter the program. She determines the learning style that each student is joining the program with and evaluates if this method can give educators a better idea of where the student might struggle in the program, and also on the boards.

When assessing each new cohort of students, Dr. Ennis and the faculty at Bellarmine University have determined that students who tend to struggle academically over the course of the program tend to have a weak core class GPA. These students tend to struggle in math and science classes prior to beginning their DPT.

Dr. Ennis has noticed an emerging trend as she has observed 10+ years of DPT applicant data. If a student enters their doctoral program with a high GPA but a lower GRE score, this indicates that the student does not have an academic issue. Instead, this student has more of a test taking and test anxiety issue when taking rigorous structured examinations.

When observing a regression model of the last decade of examination data, there is a high correlation between practice examination scores, and a high score on the NPTE board exam.

In order to tackle the board exam successfully, students must have a solid grasp of the examination framework, the setting where they will take the exam, as well as the computer system on which the examination resides. Based on past student successes, this strategy helps the student to control their stress and anxiety, which are the two largest contributors to poor test scores beyond lack of preparation.

A high percentage, if not all, DPT programs provide a solid foundation of didactic knowledge to students. So, if it is not an academic issue, then where do you start? Based on Dr. Ennis’ opinion, you go back over practice examinations and determine why you missed each question. This why can be broken down into several different categories.

Did you no know the information? This is the easiest thing to fix, just put it back in your brain! Our contributors at the PTQ recommend flash cards and self-quizzing of the material. Re-reading the information, while a start, is not the most effective way to learn.

Did you narrow down your choices and just miss a key word? Mistakes such as missing key words and not reading the question correctly cannot be fixed by studying! Take your time. You need to recognize the difference between these types of errors and knowledge deficits, or you will not be able to address problems in your study habits efficiently.

Should you work on a temporary license? It depends! Dr. Ennis has seen students work full time and end up passing, but this is a strategy that she doesn’t recommend. Remember, life still happens when you are studying for the boards. Time management is critical.

If you do decide to work part time as a way to keep your mind in the clinic, when it comes time to take the boards, remember that you will not necessarily be quoting last week’s JOSPT. Each question undergoes a review process that takes a year or more before it ends up in front of you on exam day.

At the PTQ headquarters, we recommend taking a glance at the Federation of State Boards of Physical Therapy website to read about what goes into making a question.

GOOD LUCK!

Sincerely,

PTQ HQ

PTQ 020: Physical Therapy is more than In/Out Patient. How to better align your personality, passion, and profession for a harmonious career.

Anna Padilla speaks from experience as she discusses how to better align your personality, passion, and profession for a harmonious career as a Physical Therapist.

Anna is a physical therapist and strength and conditioning specialist. Her business focuses on bridging the gap between physical therapy and fitness, while bringing as much specialized care to people as possible. The gap between finishing the plan of care and patient return to sport or fitness is an area that is often missing from patient care.

Anna shares her wealth of knowledge with The Physical Therapy Quest this week. She came to a point in her career where she wasn’t happy with the traditional outpatient experience and decided to take a leap to chase her passion.  Several other guests including Greg Todd and Danny Matta also decided to take the leap and branch out on their own.

After starting her own gig, Anna’s practice gave her a niche that drew in clients and gave her a new sense of freedom.

“When you work for yourself you can set boundaries.” This is something important that new physical therapists should start to cultivate. “You have to be comfortable with what you can handle.”

“We are giving a service. The patients will have their own goals, but as a care provider you have to have confidence in your skills and your programing. I really think it’s important for physical therapists to continue in their education because it’s such a responsibility that we are given, and it really shouldn’t be taken for granted.”

“Keep yourself educated and always learn more to stay on top.”

“Confidence can allow your patients to relax. Being confident in yourself and how you want to authentically help this person really goes a long way.”

“There are so many options out there in Physical Therapy. It’s a beautiful thing, but with all of those options, how does someone find where they fit? How does someone pick the right path?  I think it goes back to understanding your personality, what experiences you’ve had, how you’ve been molded, and your unique qualities that can help people.”

“Think about the lifestyle that you want to live and what will allow you to do that. This really comes down to putting a value on your time and your energy exchange and being confident in what you’re providing.”

“This is who I am, this is what I do, and these are the people that I’m best for.” See what Anna is all about and follow her journey on Instagram as well as her own website.

“For anyone out there wanting to do their own thing, find what makes you different, focus on it, and hone those skills.”

PTQ 019: Find and rate your clinical instructor!

Rate My Cl is a website made by students for students that allows you to find and rate your clinical instructor. It's a protected site where healthcare students can safely and anonymously add, rate, and input helpful tips for their fellow colleagues.

Share Your Experience

I had the great opportunity to talk to the three 3rd year DPT students who created this awesome platform. Listen in to see what it’s all about.

Wouldn’t you love to share your experiences and relationships that have been built with your clinical instructors?

Find out if your clinical instructor is a jokester, if they’re encouraging, or if they will be watching you like a hawk.

Knowing a few details about your clinical instructor prior to your first day can make all the difference.

Get involved and make the clinical experience better than it has been before.

Quotes From the Creators 

“Being students we saw a need to enhance the clinical rotation experience by giving a little information about the CI”

“You have a better idea of what you’re getting into and can try to avoid the bad stories”

“Go into each experience open minded”

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