Physical Therapist Clinical Education

All PT schools seem to have a similar structured didactic curriculum. Generally the first year consists of Anatomy, basic sciences, and some basic examination courses to frame the mind around the human body as well as get our hands used to touching the body of another person. Then the structured integration of first year knowledge into more clinical knowledge with orthopaedic and neuromuscular conditions. There's a rhyme and reason for the placement of each course within the curricula. Some schools are slightly different, but from as a whole their course placement is the same.

Now, we PT students are ready to be interns and take on true application of knowledge in a clinical setting. We all pay a god-awful amount of money for our schooling (well except for Army-Baylor), but why is that some of us will walk away from our clinical internships ready and equipped while some won't feel ready to enter the professional world? I would be pissed if I walked away from three years of training and $100,000-$250,000 deeper in debt (dependent on school) and I didn't feel I got enough training. A student's clinical education is most important part of professional education, whether it is medicine, nursing, PA, or PT. If the clinical education is the most important, then why are PT students given such intricate didactic structure then thrown to the "clinical wolves" to fend for themselves to literally get the most for their money? Some of us travel internationally, some across multiple states, and some just travel down the road to our respective clinical sites. Most of us have never met our Clinical Instructor (CI) before and have no idea what to expect from our CI.

The kicker is that our clinical education faculty has never met our CI either, so it is completely unknown what the learning experience is going to be; well it is known what type of setting, but that is about it. Clinical education faculty don't have time to visit every 200+ sites that many schools "boast" about.

The 1 on 1 model is a failing model. The model especially fails with the much longer clinical internships for Doctor of Physical Therapy students. It doesn't take much time until the student gets "their own" caseload while their CI also has their own caseload. The intern is now a source of revenue for the clinic and the CI is getting nearly double the billable units (this is a whole other bag of worms). How is the PT intern supposed to learn critical clinical reasoning when the intern and CI's mind is too preoccupied with paperwork and each seeing their own patients. Don't get me wrong, learning to juggle patients and paperwork is an important real world aspect of PT, but it doesn't take a year long internship to learn this aspect. Additionally the model fails because the standardization process is a joke; the clinical performance instrument (CPI) basically determines if the PT intern is safe and communicates with patients through a series of very repetitive questions. Also, many can agree that there are PT's that vary on the spectrum of greatness; Shockingly, there are CI's that vary on the spectrum of greatness. Where's the standardization in this?

The PT clinical education model across the nation is due for an overhaul. A doctor level degree deserves a doctor level of education from beginning to end. The wheel does not need to be reinvented, just give it some studs.

New geriatric residency

The future of PT is expanding at an exponential rate. The need for physical therapists continues to grow as the baby boomer's are getting older and becoming more functionally limited. PT programs across the country are implementing the Doctor of Physical Therapy (DPT) rather quickly and the list of residency/fellowship training opportunities is growing. The University of Delaware has stepped up to the plate in offering another geriatric residency program. I foresee many other geriatric residencies popping up.

Laxative's sooth chronic pain?!

Apparently rubbing a laxative on your skin will take away residual chronic pain from fractured femur. Dr. Gott represents the epitome of all that is stupid. Question your surgeon as if it's the surgeon fault that you fell and broke your frail 70 yr old femur and rub castor oil on yourself. Why don't you just ingest the whole bottle of castor oil and I bet you won't feel your leg pain while you diligently sit on the toilet. Not only that, later within the Dear Dr. Gott piece he offers a diagnosis of carpal tunnel syndrome. I love the definitive diagnosis he makes based off of extremely little information; the differential diagnostic pathway in his head is ridiculous. I'd recommend first off is to seek some advice from a real health care professional that doesn't prescribe woo.

All seriousness and criticism aside here is video from a classic movie.

Back in CO

It feels good to be back in CO. I went skiing at Copper mountain the past two days and had a blast. The snow coverage is great, and I was able to find a few untouched powder spots. Rhea's ski boots gave her the infamous "black toenail." There are generally two reasons for getting a black toenail, both of which are related to the toe getting mashed in the toebox. The boots can be too small, which is why mine turn black from wearing my incredibly tight fitting race boots. The other reason is the boots being too big. This may seem counterintuitive at first, but what happens is that the feet inside the boot have some room to slip around and create a "pistoning" of the toe into the front of the toe box. After some apres ski drinks, Rhea agreed to allow an athletic trainer friend and I to use a sterilized drill bit to hand drill a hole through her toenail in order to relieve the pressure of the blood build up within the nail bed. The treatment worked for allowing her to put more weight through her big toe, but she is still experiencing more pain than desirable. Additionally her toenail is no longer black and has a little mini blood geyser when she puts weight through her toe.

Overall is a good weekend of skiing, hanging with friends, using construction tools on the human body, and rallying the Subaru in the parking lot. Looking forward to more snow-related hi-jinks this winter.

A Brief Me

Welcome to my blog of random ramblings of Johnny May. I'm a 3rd year Doctor of Physical Therapy student attending U. of Colorado Denver and am currently interested physical therapy research, orthopaedics, and manual therapy. I've been meaning to host a blog for multiple reasons, but a whole list of priorities usually allowed me to talk myself out of it. A recent post from NPA Think Tank and a bout of insomnia due to my excitement of moving back to Colorado has motivated me to finally start typing for fun. I've been living in San Antonio for the past 4 months participating as research assistant in a ground-breaking study looking at preventing low back pain in the military as well as interning at Texas Physical Therapy Specialists. The past 4 months has been an amazing experience for participating in research and implementing evidence based practice. Additionally the experience allowed me the opportunity to work directly with as well as meet some my professions leading clinicians and researchers. My classmate, Liz, also joined in on the San Antonio internship extravaganza; her blog has highlighted many of the more interesting moments.

The car is packed and I'm ready to return home. Ready to view Texas through the windshield and rearview mirror.