Reflections From Our Clinical Internships
We all have gone through, or will be going through, clinical internships in one way or another and at one time or another. There are many different types, and it can be difficult to understand how to prepare for one. Here are our experiences from our current clinical internships. Please be aware that these are our own personal experiences in our respective hospitals or clinics. We hope you find the information valuable, but also realize that our experiences may not apply to all internships of the same type of setting.
Joey Masri - Outpatient Neuro Rehabilitation (Day Program)
Structured day program – Each patient comes in every day of the week in order to receive comprehensive one-on-one treatment from PT, OT, speech therapy, psychological counseling, and nursing. In addition, patients are given additional activities, customized to their rehabilitation needs, to serve as an adjunct to their treatment.
High intensity – Patients are there for SIX hours EVERY DAY. It is a huge time commitment, but it has been deemed necessary in order to maximize their prognostic potential.
Patient population – Primarily s/p CVAs of many different types (and different deficits as a result) or Traumatic Brain Injuries (secondary to events such as motor vehicle accidents or collisions in sports). Many patients are referred from an acute setting or inpatient rehabilitation.
Team and family conferences – These meetings occur multiple times during a patient’s plan of care in order to discuss progress of treatment, potential barriers to further improvement, and eventual plans for discharge.
Communication skills with patients – No surprise here. You will be working with these patients every day – they need to feel welcomed and enjoy their time with you. However, they also need to know that you are competent in what you are doing. Patient education can go a long way in instilling confidence within that individual. Which leads me to…
Empathy – These people are down on their luck. No one plans for an injury. Of any kind. Show patients that you care and are committed to making them better.
Ability to work on a multidisciplinary team – In this setting, you are not just a physical therapist (unless we’re talking documentation). Communication with the other disciplines is key in facilitating an optimal rehabilitation experience. You are, after all, a TEAM – and it’s that group effort that contributes to the success of a structured day program.
Knowledge on balance and endurance interventions/progressions – These are two key areas affected following an injury to the brain and are the main focus of physical therapy treatment in this setting.
Knowledge on gait analysis – It is invaluable to be able to critique a patient’s gait and point out specific deviations. Many patients are learning how to walk again and it can be difficult for them to re-learn something that they spent most of their lives not having to think about. Which actually is very important when we’re talking about…
- Safety awareness – Due to their deficits, patients in this setting are typically high fall risks. Gait belts are a must. Also, all attention needs to be on the patient. Being observant and able to recognize when someone is overly adducting their leg or weight-shifting too much to one side can mean the difference between safely correcting their deviation and an incident report.
Coming from an outpatient orthopedic internship, this setting was very different for me. First off, the patient volume is LOW. Think 5-6 patients a day. This is the consequence of a structured day program. Higher volume potentially means decreased quality of care and attention for each patient. Additionally, the sequence that is typical of outpatient orthopedics: using a hot pack for 10 minutes, some soft tissue massage for 15, and then some therapeutic exercise for the remaining 35 is not typical at all in this setting. For example, a session can be spent entirely on addressing bed mobility strategies or strictly improving foot clearance during the swing phase of gait. It is all dependent on what is a functional need for the patient. Finally, each patient is very interesting and unique in his or her own respect. It is fascinating to see just how textbook the manifestations of a CVA can be. For example, the tendency to have impulsive behavior following a right-brain stroke was made very obvious to me when a patient took off in a near sprint when I told him we planned on walking that day. At the same time, patients with similar types of CVAs can present with very different deficits – which keeps things fresh as well. Personally, I have found the experience thus far to be very educational. In addition to gaining more treatment experience (which is always important), I have also taken away information to benefit my handling skills and overall clinical judgment.
Philip Van Dyke - Outpatient Orthopedics
- Inner-city outpatient physical therapy clinic in major southeastern city
- Diverse patient population - all socio-economic backgrounds and diagnoses ranging from standard post-operative to motor vehicle accident to gunshot wound
- Heavy manual emphasis, including the use of dry needling when appropriate
Manual Skills - There is a heavy manual emphasis in my clinic, so I needed to know and continue to practice soft-tissue mobilization, joint mobilization (peripheral and vertebral), and joint manipulation. Dry needling performed is by my CI, but I am not allowed to do so as a student without the necessary additional coursework and PT licensure.
Therapeutic Exercise - Always a must in outpatient orthopedics. It has been necessary for me to know different types of exercises to address specific functional impairments and how to appropriately progress them.
Flexibility - My experience in my particular clinic has required a great deal of flexibility, whether it be with the schedule or with adapting to how my patients come in feeling and adapting treatment for that day (which should be necessary in any clinic or setting).
Cultural Competence - Like I said before, I see an extremely diverse patient population; it’s very important to see every patient with an open-mind and never bias how the patient is treated based on cultural or socio-economic differences.
- Communication - Communication is vital in all areas of physical therapy with both co-workers/peers and with patients. I have learned how integral patient education is and how it must be adapted to each individual patient’s learning style.
This is my second clinical rotation in an outpatient setting, but each of them have been entirely different. With another year of didactic work and already having completed one outpatient internship, I have felt like I have a much better grasp on developing a plan of care and progressing it appropriately. Most of the skills that I have used in my internship up to this point have been the same as those used in my first internship, but, now that I have been through all of my coursework, I feel like I have a better understanding of how to properly utilize those skills. Additionally, my CI is an orthopedic certified specialist and completed an orthopedic residency, so I have been able to see how much more there is to learn beyond graduation. The primary lesson I have learned so far is how much I have learned and matured since my previous internship, but more importantly, how much more I will always have to learn (no matter what type of setting).
Vinh Vuong - Acute Care
Patient population: pediatric through geriatrics consisting of bariatric, stroke, wound care, post-operative, cardiopulmonary, cancer, vestibular, Parkinson's and basic fall risk.
Diverse ethnicity speaking Spanish, English, Creole, French and Vietnamese.
Team conferences twice every month to discuss current patient progression, discharge status, and potential upcoming patients.
Interaction with other physical therapists (outpatient, acute care, inpatient rehab settings), physical therapy students, physical therapy assistants, occupational therapist, speech therapists, any type of physician/surgeon, residency students, administrative staff, nursing staff, nursing assistants, and social workers.
Exposure to different surgical procedures
Communication - Important when interacting with patients to develop rapport. These patients are generally in a lot of pain, so being able to properly empathize and communicate effectively will develop a better patient-therapist trust relationship.
Confidence - Even though this is my first exposure towards this setting, portraying confidence around your patient will allow them to buy into your treatment plan. I had a patient on whom I was setting up to perform pulse lavage with a nursing student observing the procedure. Both patient and the student thought I was the leading wound care specialist because of the way I presented myself and was able to explain the purpose of the entire process. After I told them I was simply a student, they were both very surprised and impressed with the level of professionalism that was displayed.
Transferring - In this setting, patients are going to require different level of assistance depending on the severity of their condition. It’s important to always keep proper body mechanics in mind when treating these patients. Even as a young clinician, protecting your lower back will be crititcal to having a long future. Always make sure to stay as close to a patient as possible, never arch your back when squatting over, use your body as the main force component when transferring rather than your arms, and always make sure that the patient is wearing a gait belt!
Professional Judgement - Since these patients are more fragile than your everyday outpatient population, it’s important to read the chart review carefully and understand everything before meeting the patient. Understand why they came to the hospital, additional co-morbidities that could affect your treatment, precautions recommended by the physician, previous treatment approaches from other therapists, vital signs, laboratory values, prior level of function, and their support status. These are all important to consider to make sure that the patient will be treated effectively and safely.
Going through my acute care internship, I have realized that it’s nothing compared to what I initially thought it would be. Initially, I was closed-minded towards the idea of being in acute care. After finishing halfway through the internship, I realize that I enjoy the setting more than I thought. Don't get me wrong, I’m still 100% geared towards an orthopedic outpatient setting but I am grateful for the current experience that I am gaining through acute care. It has given me the opportunity to observe multiple orthopedic surgeries, observe how speech therapists perform swallowing evaluations, observe what occupational therapists go thru when assisting patients with their ADLs, and even become skilled in an area where I would never have thought I would be working; wound care (specifically pulse lavage). I am even able to interact with those ‘scary’ physicians/surgeons when discussing a patient. With all these opportunities, it has given me much more of an appreciation of what therapists do every day in an acute care setting (like cleaning up after a bowel movement…)
Final Thoughts from the EducatedPT Team
You should definitely prepare for an upcoming internship by reviewing necessary materials, so don't take this as us saying not to come prepared, but we have found that we can do all of the reviewing and studying we can prior to starting an internship and still have things to review daily. Do not stress about what you need to brush up on. There will be plenty of opportunities for that and many topics to learn along the way. Go into it with an open mind and a willingness to learn. It is important to always take every opportunity you can to learn something new on your internship. That is what you are there for, so get as much out of it as you can.
As always, we invite feedback from everyone. We would love to hear from you about what you felt like were important takeaways from your clinical internships or from being on the job as a practicing physical therapist.