Advice to the New Clinician

Mindset first

 

The mind is responsible for so many aspects behind our beliefs, actions, behaviors and so many more. Our mindset is our overall view and philosophy of life which is shaped by so many aspects (conscious and unconscious) of our development including culture, prior experiences, upbringing, and so many others. If you ask many practicing clinicians about what determines success with patient care they will say building trust and developing a good therapeutic alliance is 50% or more sometimes when it comes to influencing positive patient outcomes; however, I am not trying to lessen the importance of solid evidenced based clinical examination, reasoning, and interventions as that is equally important.

 

The fact of the matter is that you cannot help the majority of people to their maximum benefit without having your own mind under control and understanding your views and how they bias you. There is evidence indicating that a clinician’s beliefs about a physical therapy intervention can influence the patient’s own belief about that same intervention; therefore, potentially affecting the outcome. There is also evidence showing the power of healthcare provider’s words on patient’s beliefs of their condition. If you view the world negatively, you will find a way to view something as a problem and it will take you to a dark place personally and professionally and I don’t wish that on anybody. If you view occurrences positively, you will find opportunity in everything.

 

An essential characteristic of a successful healthcare provider is being a lifelong learner. One must have the desire and drive to continue to learn to grow and develop otherwise you stay stagnant and increase your risk of burnout. The fact is that we merely learn the basics of certain physical therapy avenues of practice and with the red tape and barriers that DPT programs face there is no way that one can be taught/exposed heavily to each specialty area that PTs can possibly go. There is so much to learn outside of school to be a successful clinician in today’s market that what you learn in school is simply not enough. What we know through research is also ever changing and it’s important to stay up to date.

 

Self-assess yourself first!

You cannot grow as a person and professional if you don’t understand your strengths/weaknesses & biases first. Are you unsure what your strengths/weaknesses & biases are? You first may want to reach out to a trusted individual or mentor who knows you very well and hopefully they will give you honest feedback. Their feedback may shock you as it may match up with what your thoughts, but their feedback may reveal something that you hadn’t recognized. Self-reflection is essential, but we (even people who understand ourselves) often aren’t able to self-assess everything about ourselves and a trusted mentor to point out what you can’t self-assess is incredibly valuable! Being able to self -assess performance is so critical when clinically developing as we should always ask ourselves after every patient encounter:  What went well and what didn’t? Jeff Moore (Founder of the Institute of Clinical Excellence) said on a podcast interview that new graduates should find a trusted upperclassman who graduated from their PT program a few years and has some experience working in the field. That person came from the same educational arena as you did and they’ll have insight on what they felt were the strengths and limitations of what their education entailed now being in the field as this can help point you in the right direction earlier. It is true that people within the same program have different clinical experiences and not everyone is the same coming out from the same PT school, but the didactic material more than likely did not undergo massive profound changes in that timeframe.

If you are unsure how to find out who you are ask yourself these questions for a first step:

 

What am I passionate about?

Where do I want to be professionally in 5 years?

Why did I go into PT?

Where and how am I spending my time?

Are there certain people that I enjoy following?

If I could do anything and money would not be an issue, what would I do?

 

 

It can be rather unsettling to look inward at ourselves to truly as we sometimes may be afraid to know the truth, but the sooner you truthfully self-assess your self the sooner you’ll get on the right path to where you want to be.

 

Finding the right job for you

 

While it is true that there are numerous physical therapy jobs available across multiple settings; the sad reality is that not all of them are the best for everyone. In PT school we always got frustrated when we would hear “it depends” from our professors, but I must say that finding the right job for you does depend on many factors including the following:

 

Where are you at in your career

What is important to you in a job

Location

The practice setting/patient populations seen

The culture of the company

The salary

Mentorship

Other learning/professional opportunities

Benefits

 

 

It is not always possible to have the ideal perfect job with all of these factors coinciding perfectly. You should rank which factors are the most important to you and prioritize those factors when searching for and interviewing for a job. There are pros and cons of every practice environment and clinic and you have to decide what set of pros and cons align best with you based on what you’re looking for.

 

 

How to find the right professional development plan for you 

 

Once you have identified your clinical/professional weaknesses that you need to develop a plan on addressing those weaknesses. I personally am not about building up weaknesses that don’t matter very much (example: A cardiopulmonary therapist would most likely not take a spinal thrust manipulation course as they would more than likely not perform that intervention in that setting), but instead focusing on the weaknesses that do matter.

 

We are never going to know everything about every topic. When I graduated I felt like I knew so much information, but very soon after working I realized how little I actually knew and that there was so much more to learn.

 

Online education platforms are valuable for improving didactic knowledge and are easily accessible, usually cheaper as there are no travel & lodging costs, and you can take at your own pace in the comfort of your own home.

 

 

If you are looking to get better at improving a psychomotor skill or hands-on intervention (joint mobilizations, thrust manipulation, dry needling, etc) then live courses are the way to go.

 

Many newer clinicians struggle with effective communication/education/developing therapeutic alliance with their patients. Of course clinical skills and knowledge are equally important as well, but if the communication aspect and patient-provider alliance is not there than it is very likely will not matter how good your treatment program is as the patient will not have the best outcome if they even show up again.

 

 

It is fantastic when an individual has such a desire to learn and grow that they are exploring different resources across many facets which is an amazing characteristic; however, I do not recommend taking various continuing education classes from many different schools of thought in a short period of time and especially to the newer clinician as integration of everything early on is very challenging. The phenomenon of paralysis by comparative analysis is very real and can significantly limit one’s development and lead to problems. Have you ever gone to a CEU class and the instructor was AMAZING and incredibly smart that you felt intimidated to even try it as you wouldn’t be anywhere near as good as they are and that you are so insignificant? It happens. It can also come from hearing so many different perspectives that it can confuse you about what to do that you are paralyzed and you don’t move forward and feel overwhelmed. It may be better to focus from one school of thought initially such as McKenzie, Maitland, or whichever you chose to initially get a good starting system and then branch out to the others when you are solid in that initial system. Being eclectic and drawing from many sources is valuable and I am a strong advocate for it, but I must advise caution with how one does it.

 

 

 

Finding a great mentor

 

Mentorship is when a more experienced/knowledgeable person helps to guide a less experienced/knowledgeable person and mentorship is so critical to every clinician, but especially for the newer clinician as the first few years of their career has a lot of impact on their future career.

 

I am a firm believer that you can always learn something from everybody, but that doesn’t mean that you have to believe in/agree with everything that everyone does/says. For example: i worked with a therapist in my first job who had an amazing ability to connect with people and build therapeutic alliance and I did learn a lot from that therapist, but I did not believe in their treatment paradigm with doing specific core exercises for core stability for most patients with low back pain.

 

 

Finding a mentor involves finding someone who is doing what you want to do and represents who you want to be like. It is okay to have mentors for different professional considerations including, but not limited to a clinical mentor, personal mentor, business mentor, etc. You must be open to taking and implementing feedback as .feedback is meant to make you better and it is not personal.

 

Someone taking their time to mentor you is a big commitment, so be sure to not waste both their time and yours and take it seriously and work hard at it. The mentee should help the mentor in some avenue to their ability to help provide value to the mentor as any healthy relationship is built on reciprocity.

 

 

Understanding the Pros & Cons of Social Media for PT Development

 

Social Media certainly has benefits when it comes to learning and sharing information, but it also does have some limitations and concerns that need to be taken into account.

 

Cook et. All wrote a viewpoint on this from the January 2018 edition of JOSPT  in which they reported benefits of social media including “quick method of information dissemination, ability to reach many different people in different roles, and can be used as a mechanism for post publication review”. To add onto this, the dialogue that can be established and the ability to network with people is profound. There are many innovative people who are doing some amazing things who I would not have heard of through other avenues.

 

 

There are also some limitations and concerns with social media as well and to start with the viewpoint from Cook et. All  (https://www.jospt.org/doi/abs/10.2519/jospt.2018.0601?journalCode=jospt)  they reported limitations including “proliferation of echo chambers, we don’t have evidence that supports social media’s  influence on patient outcomes/clinician learning, and the people with the loudest and populous voices may not be the most qualified”. While I do agree with these drawbacks I’d like to provide some perspective on the last concern mentioned which is the people with the loudest voice may not be the most qualified. First, I do agree with this limitation and I completely agree that it is real and that it’s a problem, but I can partially see why it’s happening and I don’t see the solution to that as being simple.

 

It is rather ambiguous on what qualified means as I think we need a more comprehensive definition of this. Publication record is great, but publication record alone doesn’t guarantee that someone is the true expert on a topic.

 

 

The people with the loudest voices and big followings clearly are very effective marketers and are viewed as valuable to their audiences. Online presence matters today and if there is no online presence it significantly decreases the chance of that person being found/recognized by many people (maybe this is the millennial in me talking).When I consider any service to potentially purchase I strongly use word of mouth from trusted people and based on what I can learn about them online.  I know that there are many very qualified people who do not have much of an online presence or are not being as effective of marketers as the people with the huge followings and I do think that this does negatively affect them and the profession. In my opinion, the loudest voices will not stop as it has worked for them and some of them have financial incentives with this as well, but we can encourage and help those most “qualified” to have a better online presence and marketing strategy and educate students on how to analyze something to see if it has merit or not.

 

 

The Physical Therapy Quest Podcast recently interview Dr. Cook for a podcast episode in which he dives into more details on this paper which is available here: http://thephysicaltherapyquest.com/ptq014/

 

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