Category: DPT School

I’ve been a new grad physical therapist for almost 5 months now. It is much better than school…just know that and be excited about it. I wanted to take some time to jot down a few (5) things that I feel like have been the biggest learning points since graduating. Here we go.

1. You will practice very different than how you learned in school.

You don’t have to measure everything with a goniometer. You don’t have to manual muscle test every single muscle in the human body, actually, I really don’t manual muscle test much. I don’t go up and down the whole spine doing central and unilateral PAs every eval. I don’t check to see if the SI joint is rotated/upslided/etc. I don’t check if a rib is “rotated” or not. I do check how the patient moves (SFMA), how they respond to repeated motions (MDT) and if a host of other things to see how we (the patient and me) can modulate pain, move better and get them stronger. I try to keep assessment and treatment simple.

2. The evidence is not a hassle anymore.

In school, I felt like we were forced into ‘the evidence by professors.’ It felt like a burden to find references for this or that. I think in school I felt like what we were learning was the newest and best stuff so I thought “what’s the point of looking this stuff up when our professors are giving it to us every day.” Well, once you are out of school, the evidence becomes your best friend. There have been numerous times in the clinic that I have not really known what to do with a patient presentation, gone to the literature and came out with some direction. I have a new found respect and appreciation for research in our field as a new grad.

3. You are in charge of your awesomeness.

No one is pushing you to do anything anymore unless you are in one of the rare practices that constantly challenges each other. How good you become is now in your hands. This truth was both terrifying and relieving at the same time. It is terrifying because you aren’t spoon feed information anymore by professors, and that is hard. It is relieving because you get to grow in areas YOU care about. For me, I have found that recently that I am very interested in pursuing my certification in McKenzie. I can do that. I could go do some Maitland courses, some IAOM courses, get dry needling certified…it’s all up to me, and that is really cool.

4. Patient interaction matters more than [almost] anything else.

How your patient feels about you, the rehab process, the clinic you are in, the whole process is more important to their outcome than anything else. Take away point: care deeply for your patients, have fun in the clinic, and make strides towards having good customer service and your outcomes will improve.

5. When in doubt help them move better and make them strong.

This may seem really simple, but often the simple things are the best things. There have been a number of patients already in my short career that I have not really known the exact tissue causing their problems, BUT I do know that if I create a de-threatening environment, encourage the heck out of them, find ways to decrease their pain and make them move more they will do well. Layer onto all that a well progressed and designed strengthening program and you have a recipe for success with most things.

Ok, so I actually do manual muscle test but not the way you are taught in school. Let me explain.

In PT school I had to manual muscle test coracobrachialis…

In PT school we are taught how to target and manual muscle test every single muscle in the human body…it was daunting and it felt like I would never be able to remember all of it. Since I wouldn’t be able to remember all of the tests I felt like there was no way I would be a good PT, the struggle was real.

Well, now that I have graduated and I practice on my own I have come to the realization that most (almost all) manual muscle tests are a waste of time. Yes…I hardly every manual muscle test anything.

I will tell you the 3 reasons I manual muscle test.

1. Neurological weakness

More than wanting to grade the quadriceps (or even worse the VMO..) a 4-/5 so that I can strengthen it because of this or that. I look to see if there is profound weakness side to side in patients, to help rule in a true neurological compromise, from a nerve root irritation for example. It doesn’t matter to me whether the quad is a 4/5 or 3+/5 or whatever, it does matter to me if there is a profound in knee extension compared to the other side. Most of the good PTs I know use manual muscle testing in this fashion as more of a myotomal test than a true muscle test.

2. To “paint a picture of dysfunction”

Sometimes patients present with movement pattern dysfunction (see SFMA for my definition of movement dysfunction) with areas of true muscular weakness contributing to that dysfunction. I will do a quick manual muscle test on a few muscle groups that I know are weak after seeing a few movement patterns (aka hip abductors in a gross looking squat or single leg stance) to confirm that they are truly weak. I check the hip abductors and extensors often but again I don’t really care if it is a 4- or 4+….it just matters that it isn’t a 5/5. In other words, it’s a way for me to document, to myself/other PTs/ insurance companies, that there is a weakness present. It’s a pretty terrible way to measure progress due to subjectivity and average inter-rater reliability (depending on the study).

3. To make insurance companies happy

Insurance companies love numbers and progress. Manual muscle tests, while poor at showing progress objectively, are any easy way to show that a patient is improving. I usually will say a patient is 4-/5 to “paint the picture” of weakness and as the patient progresses and is able to complete movement patterns more functionally (again SFMA) I will retest the muscle and document progress.

 

What does this mean for you, the student? My point is not to be lazy in your examination to make you frustrated that you have to learn this stuff, but simply to say when you get out of school (big caveat) you will find that you can spend your time more effectively and get more diagnostically relevant information with other tests.

 

As of today I’m more than halfway done with physical therapy school, on the down hill now. It feels like I’ve been in school for a long time (I guess I’m going on my 6 year since high school…) and I have learned some things. This is a reflection upon the last year and a half and somewhat of a brain dump.

 

10. You have to think for yourself.

I thought school was going to teach me exactly how to treat patients the “right” way. But since starting school I’ve come to find out that there is no one right way. All the things I once thought were unquestionably true are actually hotly debated: modalities (link) and manual therapy (link to one of many long debates on the subject) to name a couple. You have to weigh both sides of the any argument and make a decision on whether or not you will use something clinically.

 

9. Passion trumps talent

At this level of education we have all proved that we aren’t dummies, or we wouldn’t be here. What sets a student apart now is passion for the profession, our patients and personal development. Talented students may finish school with a 4.0 but passionate students are the ones who impact their patients lives and drive the profession forward. Friends I have made like TJ Janicky, Lauren Kealy and Trent Salo are just a few of those passionate students. (By the way, follow these guys on twitter.)

 

8. Pain isn’t as simple as we thought.

This could be an ultra long talk but I’ll keep it simple. Pain is an output of the brain, it is NOT an input from the tissues. Here’s a video that sums the point up quite nicely.

7. Physical therapy may be the cure to healthcare.

Healthcare in American is inefficient (link). We pay a ton for chronic pain (link), heart disease (link), and diabetes (link). We are equipped and positioned well to address some of the biggest problems in healthcare, high cost, low quality, and bad preventative care. Physical therapists are experts at movement and getting people moving can effectively decrease risk of heart disease (link), and diabetes (link). We also can make a huge impact on the cost and quality of care for chronic back pain patients (link).

 

6. There are hundreds of ways to grow as a therapist.

Learning only begins once you graduate from physical therapy school, there are literally hundreds of ways to learn and hone your clinical skills. There are residencies, fellowships, and a host of other certifications (Mckenzie, Maitland, Postural Restoration, International Pain and Spine Institute, IAOM, and NAIOMT just to name a few). There are endless areas to explore and grow.

 

5. Patients are customers

Healthcare is evolving and so are consumers in general. People are more selective than ever, and everyone cares about what they are getting for their dollar. With that in mind physical therapist, especially those in private practice, must adapt to the changing needs of the consumer and meet them. It starts with the acknowledgment that they are customers. For more on this reach out to Jerry Durham…he’ll set you straight.

 

4. Mentors are huge.

This can’t be overvalued…get a mentor or 12. Connect with people who are a step ahead of you in life or in practice and LEARN! It is the job of the mentee to seek out a mentor so find people that are interested in the same things and learn from them. If you love pediatrics there are PTs out there who want to mentor you, business, orthopedics, sports, neuro…you name it. One of the best ways to find a mentor is to join a section of APTA.

 

3. Have hobbies outside of physical therapy

I have found that it is really important to have fun and care about things outside of physical therapy. Maybe you love running, doing triathlons, drinking coffee, painting, volunteering or writing, whatever it is that you love cultivate that passion and grow it. Don’t let your profession be the only thing you care about, it helps you be a more well rounded human.

 

2. I learn more on Twitter than class

This may be a bit of an exaggeration but I can’t put enough value on being involved with the profession on social media. It puts some of the most brilliant minds in the profession (and in other fields!) in your pocket and allows you to interact with them. Never before could I ask questions and have them answered by such a diverse and qualified bunch. Twitter also allows me to stay up to date on research and hot topics in the field.

 

1. Loving what you do is paramount.

It doesn’t matter if you are reading the newest research related to the biopsychosocial approach or if you are listening to a breakout session at the private practice annual conference, loving what you do is vitally important. If you love what you do all the other stuff lines up pretty well.

 

 

//picture from http://lifeofayouthpastor.com/take-a-brain-dump/ //

 

Tonight’s #dptstudent chat with Dr. Kyle Ridgeway (@Dr_Ridge_DPT) was geared towards Critical Thinking, what it is and how to do it. Critical thinking is a massive subject that we only brushed the surface of. That being said there were several helpful links to articles and other sites posted that I wanted to collect all in one place. Here is that list.

Hope this is helpful

Helpful Video to start with:

https://t.co/IVEveHHMX5

What is Metacognition?

http://en.wikipedia.org/wiki/Metacognition

http://gse.buffalo.edu/fas/shuell/cep564/metacog.htm

http://edutechwiki.unige.ch/en/Metacognition

http://www.learner.org/courses/learningclassroom/support/09_metacog.pdf

What is Critical Thinking?

http://philosophy.hku.hk/think/critical/ct.php

http://www.criticalthinking.org/pages/defining-critical-thinking/766

A Clinical Reasoning Model:

http://www.ncbi.nlm.nih.gov/pubmed/22276278

Clinical reasoning in health professions (google book)

Science Based Medicine:

http://www.sciencebasedmedicine.org/about-science-based-medicine/

Elements and Standards of Thought:

http://www.criticalthinking.org/ctmodel/logic-model1.htm (this website is dedicated to critical thinking) great resource.

Logical Fallacies:

http://www.logicalfallacies.info/

https://yourlogicalfallacyis.com/

http://en.wikipedia.org/wiki/List_of_fallacies

Cognitive Biases:

http://en.wikipedia.org/wiki/Cognitive_bias

http://en.wikipedia.org/wiki/List_of_cognitive_biases

http://rationalwiki.org/wiki/List_of_cognitive_biases

Don’t be so open minded your brain falls out:

http://skeptico.blogs.com/skeptico/2005/10/the_appeal_to_b.html

Example of Critically Evaluating a Technique:

http://saveyourself.ca/articles/functional-movement-screen.php

A few things from Kyle:

http://ptthinktank.com/2013/11/05/agree-to-disagree-the-less-wrong-way/

http://www.somasimple.com/forums/showpost.php?p=135452&postcount=4

Thanks again to Ben for his continual help to DPT students everywhere.

To MBA, or not to MBA
This topic has come up a LOT in the recent weeks amongst #DPTstudents: Should I get an MBA? These are my thoughts as to the reasons, advantages, and career paths which a leveraged MBA could provide.

First, a little history. Harvard was the birthplace of the world’s first MBA program in 1908. It’s an old degree; recognized, proven, respected. The content in an MBA can be quite extensive – see link. In my mind, I see the content in an MBA to be the study of human behaviors in regards to flow & function of money, services, products, operations, organizations, and perceived value at various levels of social circumstances.

In the end, an MBA is another degree – it confers no license and guarantees only that your mind has been (once again) trained, honed, and shaped specifically for the discipline of making money and administrating business flow.

So then, why is it such a big deal? Why does it seem that at various levels of career paths, upper management is dominated by those who have completed their MBA programs? At the same time, why is it that there are individuals who are filthy rich who seem to have no formal business training at all? And also, how does this fit in with “my goals” as a physical therapist (or physician, or nurse, or entrepreneur, etc.)?

Let’s Break It Down!

To MBA:
If you are interested in quickly moving in directions of:

-A corporation
-A health system
-A hospital administration structure
-Formal business training in economics, finance, marketing, supply chain / operations, information systems, human resources, healthcare administration
Then you should pursue an MBA. Most corporate structures, health systems, and hospitals have the utmost respect for formalized credentials, not necessarily demonstrated acumen or success. These organizations are highly risk adverse and don’t like taking chances on wild cards. Additionally, such structures are usually very slow moving and tend to run behind the cutting edge as a safety mechanism – simply put, they don’t want to be the first -one to test the waters.

Specifically in the health system and hospital structure, physician and nurses dominate the command tree. In fact, the culture in these arenas typically prescribe that unless you are a physician or a nurse, your “understanding” and “ability” to demonstrates success in upper management is negligible – even with a doctorate in physical therapy! The only way one can “prove” the ability is with another advanced degree, typically a masters in business, healthcare administration, or public health.

An MBA trains the mind to process information in a systematic fashion in terms of administrating flow of business, finance, supply, human factors, large scheme operations, and market behaviors. It creates a language which most corporations, health systems, and hospitals appreciate and value.

However, an MBA does not necessarily teach you how to open up your own clinic. It certainly requires more grit than an academic degree to become the next Steve Jobs or Bill Gates.

Not to MBA:
-If your thoughts run more to becoming more self made, then the MBA degree may not be the right one for you. If your passions are more aligned with:
-Private practice
-Entrepreneurial pursuits
-“I care more about clinical excellence”
-Or, if you wish to remain at the lead/supervisor or operational manager’s level on the command tree
If these are true, then there is really no need for you to seek an MBA. To be successful in the above, situations will force you to rely upon creativity, innovation, ingenuity, and the “spark.” The creation of a business (ie. a clinic, online service, product, or specialty education) draws more from learning the right content from the right people – and – having the right mentors, stakeholders, and investors.

While an MBA will teach you all of these things, is it really worth it? Most graduate students already have enough debt, do you really want to go through this again? Is this really worth the debt profile you will further accrue just to learn content you can easily ask your peers and mentors for?

Remember, the MBA credential is one which is respected by corporations and organizations. Investors already have strong business sense; they are interested in the profitability of you – your ideas/products/service/skills, and, your work ethic.

Conclusions:
In a nutshell, if you are interested in acute care, acute rehab, the skill settings, or health systems – and – you wish to rise up the chain of command… become a CEO of a hospital perhaps – you will need an MBA. However, if your dream is to own your own clinic… nay, own a chain of your own clinics and publish the next best book on how to rehab a young athlete, you need to work on YOU, not another degree.

I do have to say one thing, however: the content I have learned and the mental training I’ve received from my MBA program thus far have been some of the most enlightening and useful experiences. In fact, I feel that I’ve learned more from this program about “life” than was gleaned from attaining my DPT. For myself, going through the MBA program has been completely life changing.

So then, the question remains: To MBA, or not to MBA. What will your choice be?

Hey Classmates,

There has been a lot of buzz about student loans lately due to the recent passage of the new student loan bill. I wanted to take a blog post to break this thing down in layman’s terms..because that is hard to find on the internet and I feel like its important.  So here we go.

The New Bill

The new bill states essentially that the rates on our student loans are now tied to the rate of the Governments Treasury bond, which is how the government loans money from us..hope that makes sense, if not click on the link. So no longer are loans arbitrarily decided AND no longer are they FIXED.

WHAT DOES THAT MEAN!!??

This means that our loan rates can and will change from year-to-year, based on the treasury bond–which is basically based on the strength of the economy. Meaning that as the economy strengthens, our rates go up, until they hit a ceiling (Direct- 9.5%, PLUS- 10.5%).

The numbers:

Direct Stafford Loan (unsubsidized)

Old Rate: 6.8% —–> New 2013-2014 Rate 5.41%

GradPLUS Loan (unsubsidized)

Old Rate 7.9% —–> New 2013-2014 Rate 6.41%

Don’t forget about the fees!

The one thing that NOBODY talks about with these loans is the fees. I wanted to briefly bring to light the numbers here as well. These fees didn’t change with the reform, but should still be known. Just incase you don’t know what these fees are, they are the amount of the loan that is removed before you even get the money, but you are still required to pay back the full amount, soo…they suck.

Direct Stafford Loan:  1.051%

GradPLUS loan: 4.204%!!!!!!!!!!

This means that when you pull out your GradPLUS loan you already are in the whole 4.204%…

All this basically means is for now our rates are lower, hopefully they will stay low, but they go up as the economy goes up.

Hope this is helpful, avoid these like the plague.

-Zack

infographic courtesy of: The Daily Californian

Here is the summary from my [first ever] interview with Rockhurst Professor Christina Wisdom, DPT, OCS.  Our topic was physical therapy advocacy and the role of the student.

What is PT Advocacy?

Making our voice heard on issues that affect our profession and our patients.  It’s not just impacting us on a legislation level, but also on a community, group (like the MS Society) and local level by making things better for our patients.

Who is involved in PT Advocacy?

Generally when you see PT Advocacy people are referring to APTA and the larger scale legislative level aspect of advocacy. But PT and PTA students, APTA members, and non-APTA members are all involved and affected. Also patients are a big part of this, they are advocates for the profession and for themselves. Insurance companies and other professionals are also involved and affected by PT advocacy. When we advocate for something, other professions are going to be trying to advocate for their own turf as well.

Who are the biggest “competitors” with PT when it comes to advocacy?

It depends on what issues you are talking about. If you are talking about direct access, then orthopedic surgeons are a big opponent to PTs getting direct access, while internal medicine physicians have come more on board with that. When you are talking about mobilization and manipulation, chiropractors are the biggest opponents to PT [in some states] they have tried to own the right to do manipulation.

What is the overall goal of PT Advocacy/ what do we want?

To create positive change for our patient and our profession. In advocating for the profession we are directly advocating for the patient as well.

Why is this so necessary?

There is a lot of history to this…we have evolved quite a bit from our beginnings. We used to not market ourselves whatsoever because we were very oriented to the medical model. Our role now has expanded so much that it is now important for us to fight for what we are able to do as PTs.

What can we do, as students to get involved?

Lots of things! Going up the chain, going to school-wide or community events and promoting PT–you never know who is going to be there. You could run in to a senator, orthopedic surgeon, etc. Being involved in community organizations and having an “elevator pitch” about PT to be able to explain what we do in a short amount of time. Students can also get involved at the state level in the state chapters of APTA. There is also a lobby day every year in each state where PT and PTA students can go to the capitol and go talk to the legislators. You can also go sit in on a board meeting on the state level. The APTA website is a great tool for students too. There is a section called the “Legislative Action Section,” where you can see who your states legislators are and get information on issues that are being discussed currently. You can also take action on those issues. Students should also attend the National Student Conclave!! The registration is open now and it is a great time to network, meet other students and learn about the profession. Social media especially Twitter chats are a great way to meet other PTs and current issues.

What’s your PT “elevator pitch”?

I’m a physical therapist and I help people improve their movement and function-then I would expand from there.

What are some issues that we are fighting for now?

Many states are still fighting for direct access, or more thorough direct access. Some states are fighting for equal co-pays. Medicare coverage is another issue–some clinics will soon not be able to treat Medicare patients because the reimbursement is too low to cover overhead. Term protection is another issue; basically it is saying that physical therapists are the only people who can perform physical therapy. Most states don’t have term protection; so many chiropractors can say they offer physical therapy.

Students are more organized and focused nationally now then ever and it is very encouraging.

 

Photo: shoutlet.com

Are you going to NSC 2013?