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/

 

Advertisements

Top 3 Reflections from Justin Dunaway’s Total Spine Manipulation course

I recently returned from Justin Dunaway’s Total Spine Manipulation course in Cincinnati from March 11-12, 2017  and this is the 2nd time I have taken this class.  It was a great experience to reunite with some familiar faces and meet some new people that I have followed on social media. I got to meet 3 people who have also taken  Greg Todd’s Smart Success course while in Cincinnati. Justin’s manipulation class was an amazing course with fantastic delivery and content that is truly going to contribute to changing the profession of PT. Justin and Morgan (his wife) are truly inspiring and altruistic people. They are also in charge of the STAND: The Haiti Project which is an incredible organization aimed at  “establishing permanent access to orthopedic rehabilitative services in the country of Haiti through direct patient care and clinical training of its citizens”.

 

I feel that I learned a lot of new modifications to help grow my clinical skills and reasoning as I know that I am very much and will always be a student to the field of physical therapy. Below are the top 3 takeaways that I have made this weekend.

 

  1. Realizing how much I need to Improve on
    • After taking this class in Milwaukee in November, I implemented the techniques to patients that were indicated which resulted in about 1-2 manipulations each day. I got nothing initially and failed frequently and then after modifying and reflecting enough I started to get some cavitations that did help people. This weekend I realized that the successful cavitations that I had gotten on these patients where very low neurophysiologic effect and frankly I was lucky to get the cavitation and how much I need to improve my setups and thrusts. I’ll always be learning and I’ll be a student of the profession forever. I am so happy that I got so much more new modifications and developments with my techniques to continue to work to improve. The process of growth is always an uphill battle with plenty of struggle and failure. I am not afraid of failure anymore and I am starting to learn how to embrace it to push me forward as the saying of “one must get comfortable being uncomfortable in order to achieve your goals” is certainly true.

success

2. Realizing how bright the future of the PT profession is

At this course there were so many students and PTs who were so dedicated to furthering their skills to truly improve to help their patients. There were so many winners in this group who have such admirable mindsets and ambitions to help advance the profession. They were  also so engaged and they truly represent a very bright future of the field of PT.

 

3. The future model of Physical Therapy Continuing Education is here!

1489004320508.png

I have taken now 8 live courses and a handful of online CEUs since graduation and I have learned so much from all of them. The classes that have been the biggest game changers for me include the Mulligan (UQ & LQ and shoutout to Eric Dinkins and Mark Thompson), McKenzie (Part A: Lumbar Spine by Dave Oliver), and the Institute of Clinical Excellence (ICE) courses (Jeff Moore, Justin Dunaway, and Mike Eisenhart).

This is the 3rd class from ICE (http://ptonice.com/ ) that I have taken since being a PT and I feel that the ICE courses are the best comprehensive courses regarding a true eclectic and evidenced-based approach with targeting many aspects of the rehab process rather than just one aspect to create the Physical Therapist Version 2.0. They offer courses regarding many important and different aspects of MSK management from manual therapy, managing athletes, the patient experience, population health and others. The instructors are truly inspiring, passionate, and experts in their content. They offer resources after the course to follow up with for further questions and assistance to help participants continue to grow after the course is over. They have a strong social media presence  and they are very fast to respond to questions. They have mentorship available to help therapists improve their clinical performance to best serve patients. They are continually adapting to make improvements and grow to better serve others and contribute to their mission. They continue to give out free content in the form of blogs and Jeff Moore’s PTonICE podcast which provides such great advice regarding clinical, educational, and some business topics. They are a more than a traditional CEU company.. they are passionate and devoted to their mission and they represent (I believe) the future of continuing education.

 

Have a great week everyone,

Brandon

 

5 Tips on How to Make the Most out of taking a Live Continuing Education Course as a PT

How to Make the Most of taking a Continuing Education Course as a PT   3/5/17

Continuing education is an important method of furthering clinical knowledge and skills that is required to progress the profession of PTs as we need to stay up to date with current evidence to provide the best care for our patients. It is also important that we as  PTs  embrace an eclectic method of patient management as our patients all need different things varying from manual therapy (mobilizations, manipulations, soft tissue mobilization, etc..) , functional movement exercise and loading, therapeutic neuroscience education , and  many others to best serve them. Many states also have specific CEU requirements for PTs. Currently, I have been to 7 live continuing education courses with a handful of online courses and I have learned so much from these courses. My first live course was a lumbopelvic manipulation course and I did all the wrong things after I took the course and as a result I didn’t get much benefit from it (which was all my fault). I have learned some good tips from instructors and from personal experience on how to make the most of taking a CEU course as a PT. Here are my top5tips on how to make the most of taking a live CEU class.

  1. Realize that Failure is Normal and Practice, Practice, Practice!

The first time that we do anything new there is a high likelihood that we will not be very good at it… THIS IS NORMAL!! As a student I really struggled with performing spinal manipulations and I had very low success of manipulation as a student. I realized the power and benefit of having manipulation in my PT toolbox and I decided to go to classes to get better. After going through some great manipulation courses from Jeff Moore and Justin Dunaway, I felt like I was able to get the setup for most of the manipulations, but I couldn’t get the thrust down while at the course. I realized that I’d never (or very rarely) get free time to practice on a colleague so when it was appropriate for a patient: I WENT FOR IT…AND FAILED A LOT, BUT I KEPT AT IT! If I did the technique and it wasn’t successful, I went through a lot of self-reflection and reviewed my videos and notes and adjusted and KEPT GETTING AFTER IT TIL I GOT IT! 2 techniques that I really struggled with was the upper cervical and CT Junction Manipulations and it honestly took me 2 months after the course before I successfully got them down and now they’re much easier to do and I am having a much higher success rate.  A word of caution: If one does not adapt or implement the techniques, then you’ll never develop them. A final note on this point: Don’t let the thoughts/beliefs of other therapists in your clinic dictate how you treat/what new stuff you implement as you’ll never grow to your potential.

2. Do an In-service on it

If you know the content and skill, teach it!For me it was better for me to progress and work on my skill refinement  on my own first and learn tips from my mistakes as I feel that I was able to offer much more insight to the group when I gave my presentation. Some companies require an in-service if the employer paid for the course.

3. Make References for Easy Review

Many classes that I have been to provide a manual of content and techniques/indications and I recommend making a file folder or notebook of all your content. I’d even bring it out in  the clinic with me right after a class so I could very briefly review it before doing the technique. Taking a video and writing detailed notes has been very helpful for me as I feel that I learn something new/have a deeper understanding each time I re-watch the videos/read my notes.

4. Don’t abandon a new technique so soon!

A common saying that I hear from numerous PTs includes “That technique doesn’t work” which I personally think requires an open mind and further self-reflection first.  I strongly urge you to make sure that you make sure that you have the right patient indication for the technique (right area and right amount of vigor), good verbal priming of the technique you’re going to do, and correct implementation of the technique to the appropriate level of the patient as an error to any of these components can result in an unsuccessful response. It’s true that different techniques have their own set of pros and cons and I think as long as a PT says that they don’t do a certain technique anymore because this one is more effective that’s cool as I have been there.
5. Feel Free to make modifications as needed for your patient when the time is right!

I recommend that one does the technique as taught at the course frequently first until you really get the technique down, but then I think that then you can modify the technique as needed for a particular patient to have more success.

Hope these help,

Brandon

5 Habits to Eliminate to be a Happier Person

When  I first started out working as an independent physical therapist, I had a lot of bad habits that over time had contributed to me burning out very early in my career. I felt frustrated and even wanted to consider leaving the field of physical therapy altogether and start over, but then a classmate saved me by introducing me to the podcasts of inspirational leaders in the field of PT including Jeff Moore and Greg Todd. I started to listen to them regularly and I also pursued self-development through podcasts and audio books and I started to implement these strategies into my daily routine. I’d like to share 5 habits that I’ve eliminated since I started working that have made such a positive difference on my mindset in the workplace and life in general.

  1. Trying to please everyone

It’s okay! Accept the fact that it’s not possible to be liked by everyone.  I am not saying that one should not do their best to provide the best customer service everyday as it is so critical; however, sometimes no matter how much/what you do there will always be people who will not be happy or like you. I did my first Periscope video a month ago (and will be doing more soon) and there was someone on my comments section who was posting rude comments. One of my mentors said that there are a few ways to react to these people 1.Quit  2. Step back from what you’re doing &3. Push forward. The best way is to push forward!! If we let people’s opinions influence all that we do, we’ll never grow to our highest potential!

2. Fearing Change

Change is defined as “to make or become different” and this is something that I still struggle with today. Our world is constantly changing and evolving as there are so many changes that have taken place in our world within the past year. If there  was no change then so many aspects of our lives would be nowhere close to what it is today. It is possible to be afraid of change due to failure or success. When I started out, I was very afraid of change out of fear of failure and it truly limited my growth as an individual and therapist. I’ve learned that failure is one of the most powerful ways of learning and becoming better.Personally speaking, I embrace change as a new physical therapist as I feel that if I don’t change/grow then I slowly drift towards burnout and I treat people now different than what I did even a month ago as I’m continually learning and adapting.

 

3. Living in the Past

We can learn from the past, but if we stay there,we’ll miss out on the present! I used to really dwell on  my failures early on (and still do to a small degree today) to the point where it significantly limited my ability to work on the present. I am all for reflection, but I feel that there’s a line between healthy reflection and unhealthy dwelling on the past.

4. Putting Myself Down

What we think and believe has such a powerful effect on so many aspects of our lives and what we think can either help or hinder us. When I made many mistakes as a young therapist, I was very hard and negative on myself and my mindset was so pessimistic as I truly thought that I was a failure. I have learned that if my mindset was negative, then my life overall tended to be negative. I modified to self-reflect on the positives and the areas for improvement and maintained a positive mindset.  Seriously  having a positive mindset makes a world of difference as you see things in a different light.

5. Overthinking

When you overthink something does it usually result in a positive thought or a negative thought? For me, overthinking resulted in a negative thought 99.9% of the time which would result in me overstressing. I have learned to keep it simple and go with my gut intuition especially with school testing as the more I thought about the question the more likely I’d select the wrong answer when I should’ve stayed with my first answer choice.I do believe that there is a line between overthinking and healthy level of planning, but overthinking for me tended to do more harm than anything!

 

I hope that you all have enjoyed this list and thank you for reading!

Have  a great week,

Brandon