Embedded Files
Placement Learning Objectives
Placement Learning Objectives
1) By the end of the placement, I would like to be able to have independently completed a full subjective and objective assessment followed by an appropriate clinically reasoned treatment, with 2 Total Knee Replacements new patient and 2 Total Hip Replacement new patients.
2) By the end of the placement, I would like to improve my understanding of complex pathologies and patient management, I will show this through the completion of a complex pathology presentation including caseload discussion.
3) I will develop my time and caseload management skills. By the end of the placement, I will complete a full independent assessment and treatment of 3 patients with joint replacements in a row within the joint replacement class, including completion of the clinical notes without adjustment needed.
Reflection Method
Reflection Method
I have opted to use the Gibbs Reflective cycle to reflect on my clinical placement experience according to assessment requirements. The Gibbs Reflective cycle will guide me through stages of description, feeling, analysis, evaluation, conclusion and an action plan (1).
Week One
Week One
Description
Pre-exchange
During my first day in placement, my supervisor was moved to non-clinical hours. Department Lead, while organising patient exchanges offered the opportunity for me to take lead under the supervision of two patients. A total hip replacement initial consultation, 4 weeks post-op & a total knee replacement initial consultation, 8 weeks post-op, following inpatient treatment. Having spent the evening preparing via research of knee replacements, investigations into special considerations for the subjective assessment and clinical reasoning of which influences intervention and action planning.
I also, following advice from my supervisor, watched the total hip and knee surgeries in order to be able to depict and describe the procedure and its expected impact regarding trauma following surgical procedures and rehabilitation; specifically its impact upon soft-tissues function, pain & stiffness.
In the end, the Hip replacement patient was a no-show, however the knee replacement patient arrived on time, prompt for the session. This exchange is described below.
During Exchange
At the beginning of the exchange, I correctly introduced myself, my role and gained consent for assessment and interventions, following the check of patient information for data protection and aligning with HCP guidelines.
Moving on to the objective assessment I was able to use information collected during the subjective assessment and initial observation of the patient to check her clinical red flag presentation of her LL swelling to assess for risk of deep vein thrombosis (DVT) and Oedema; specifically the risk of pulmonary oedema. Presenting with swelling of the LL, redness on the anterior shin. Patient tested positive for the pinpoint test, as well as hardness of the calf. Having concerns for DVT, the senior clinician supported in seeking an experienced view before continuing the exchange, as DVT is a red flag, requiring immediate accident and emergency (A&E) referral. The senior Clinician denied DVT, however confirmed fluid oedema and potentially high risk of cellulitis. Having accepted this diagnosis the exchange could continue, allowing me to further practice my clinical reasoning into gait analysis of the patient. My first clinical gait assessment was upon a patient with a pathology influencing gait, as opposed to practice on students and friends. With support from my supervisor, I was able to correctly observe the limitations and compensatory patterns of the patient's gait. The patient displayed a narrowed gait, right side hip hitch and excess right-side lateral flexion.
Feelings
Pre-exchange
Before the exchange, I was nervous, however not apprehensive towards the challenge of leading my first exchange with a patient under supervision on the second day of my first exposure to MSK outpatient physiotherapy. Having spent time preparing correctly, my feelings of apprehension settled, changing to a feeling of nervous excitement in regard to the opportunity to be placed under pressure and rise to the challenge. This was further settled by a practice subjective and objective exchange with my supervisor, of which I received positive feedback, with some areas of critique for improvement.
During exchange
During the exchange, I had feelings of initial apprehension and nervousness in the 30-minute window prior, however, as the patient arrived I was able to draw on the practical experience gained before my mock exchange with my supervisor and confidently begin the subjective assessment. This made me feel confident and empowered to be an effective, empathetic and critically appropriate physiotherapist.
Evaluation
The patient was immediately descriptive of her main concerns, which could have led to irrelevant discussion or tangents. However, I was able to allow the patient to talk freely about her concerns without interruption. To encourage openness through the remainder of the exchange, as well as facilitate our patient-practitioner relationship.
Beginning my subjective assessment I was able to follow a logical structure, while also allowing the patient to talk freely, without disruption or a “robotic feel” to the exchange and gathering of information necessary to support clinical reasoning in later stages of the exchange.
During my subjective assessment I could have been done in a more time-effective manner to encourage efficiency of the exchange as instructed by my supervisor in our post-exchange feedback. In reviewing my subjective exchange I had overindulged the patient in her concerns, potentially placing additional worry and anxiety towards her major concern; Swelling in the LL, specifically the calf and ankle.
Following the gait assessment, my theoretical knowledge of the different types of gait and the anatomical relevance of those presentations requires improvement.
Analysis
Analysing the situation I am confident that when allowed to be challenged, I can prepare effectively and be driven to succeed, rather than guided by fear of failure. However, more preparation is necessary for the quick clinical reasoning required. This was shown in my previous placement, in which I would constantly struggle with my clinical reasoning during one-to-one discussions with my supervisor; perhaps due to the pressure of direct recall. However, when allowed to prepare for a complex patient, I was able to approach the exchange with confidence and in a professional manner.
There is a potential pattern emerging for that I struggle with the clinical reasoning under pressure, however with time and the ability to prepare I can confidently reason.
Conclusion
In general, I have learned that I can confidently assess within an MSK outpatient setting with minimal support. As well as that I should continue to remain confident in times of struggle or apprehension. Specifically, during MSK assessment of patients, I have concluded that more theoretical underpinning is required of the anatomical and functional relevance of each joint characteristics and its influence upon clinical reasoning and interventions.
Action Plan
I will dedicate time each week to the theoretical underpinning of each joint, using my supervisors as a guide for my assessment of knowledge and my use of clinical reasoning following on from theoretical understanding.
End of Week Review
Following feedback from all three of my clinical educators I have opted to focus upon aspects of the subjective and objective assessment skills as a focus for individual development as a practioner into the first half of my placement. Alongside deep and thorough learning of the common pathologies and the special protocols, questions and communicative techniques used with these patients. I have began to create more S.M.A.R.T goals for my placement, as opposed to the broad and generic goals set prior to being exposed to the MSK outpatients environement at the RHH.
Goals & Objectives
To Independently complete and document a subjective and objective assessment
Remember and practically apply knowledge of the knee and hip to total knee replacements (TKR) and total hip replacements (THR)
Continue to practice communication and reflect using SWOT and Gibbs cycle
Week Two
Week Two
Description
Informed of a new patient with a suspected MCL tear. I was given the responsibility of leading the subjective assessment and assisting with further aspects of the exchange; specifically the objective assessment. I am specifically reflecting upon my leading of the subjective assessment within reflections.
Feelings
I felt confident in my preparation for the procedure for the subjective assessment and structure to follow from my preparations. I did also feel conscious of the responsibility to lead the initial aspect of the exchange, as to not “over-run” and interrupt the timings of the exchange and interrupt the next patient arriving afterwards.
Evaluation
Having the opportunity to have the opportunity to shadow and discuss knee assessments and clinical reasoning. I found that I was able to use this preparation effectively in order to keep a professional and competent apperance to the patient, in order to assist in building a strong therapeutic relationship with the patient from the beginining of the exchange. I felt I could have allows the patient more opportunity to talk open, through the use of more open-ended, narrative and open-specific forms of questioning, as my subjective assessment was quite 'rigid' in structure, having focused upon not missing any aspects of required questioning.
Conclusions
I started to grow in confidence with subjective questioning structures taught briefly in my studies. I still felt apprehensive as the particular exchange helped me become self-aware of weaknesses in communication techniques in that I often will interuptt a patients communication, remain extremely rigid with the order of questioning, as well as perhaps lacking a rapport with the patient following initial small talk.
Action Plans
To best prepare for future patient exchanges I set an action plan to reflect and learn from the example of my clinical educators and experience of physiotherapists working within the MSK outpatient environment to create a system for my learning and practical application in self-directed and independent exchanges. To best understand the advice and discussions following the exchange provided by my clinical educator, I have an action plan for my research into the topics of communication, followed by a question list to discuss with my supervisor and clinical educator at a later date to further my learning once able to assess my application of theoretical knowledge during placement responsibilities.
Goals & Objectives
To Independently complete and document a subjective, objective & treatment plan for a joint replacement and acute patient.
Remember and practically apply knowledge of the knee and hip to total knee replacements (TKR) and total hip replacements (THR) as well as common pathologies of the shoulder, knee and ankle.
Continue to practice communication and focus upon structured notetaking.
Week Three
Week Three
Description
Patient TM is referred into acute MSK clinic for a L. Achilles Rupture who is in training for the police, 5/12 post-operative treatment. The characteristics, function, and blood supply of the Achilles Tendon predispose it to both acute and chronic rupture. This patient was described as having an acute rupture, however a lack of detail as to the mechanism of injury (MOI). In the situation of an acute rupture, patients are usually engaged in athletic activities[1], accounting for 68 % of injuries[2]. I presume this to be the case with patient TM, as a relatively young (43 y.o). Achilles tendon tears may be grouped into 4 types(3). The patient notes from the surgeon and consultant describe the rupture as a Type 3. Meaning a complete rupture with tendinous gap 3 to 6 cm. This is often requires tendon/synthetic graft and this is how the patient was treated operatively. The patient arrived on time to the exchange, describing his happiness with his progress since his last visit. He described working with a professional of an unspecified description, however by description given it sounded like a personal trainer with some form of therapy/massage experience/qualifications/background beginning to skip, despite being 4/12 + 2/52 post. Following Achilles Rupture protocol for achilles ruptures of this degree it describes waiting for month 5 for soft, regressed plyometrics (i.e seated pogo hops), however the patient has began mid-level plyometrics (skipping) earlier than the 6 month mark recommended within the rehabilitation protocol. The patient demonstrated alternate heel-raises and alternate heel-raises with elevating and stationary pogo hops & linear pogo hops without any increases or flares to symptoms, pain or abnormalities of any kind. The patient was educated upon the important of the rehabilitation protocol, as patient was travelling abroad for a police training camp for 2/52 in 2/52. Patient was happy with advise given and happy with education of the protocol.
Feelings
During the exchange I feel confident with my understanding of the ankle/foot anatomy having spent time to prepare and following guidance from my clinical educators began applying this theoretical knowledge to clinical reasoning scenarios from online case studies of ankle/foot pathologies such as achilles ruptues, webber fractures and lateral sprains. I therefore felt confident in my clinical reasoning regarding the follow-up subjective and objective assessments, as well provision of a treatment and home-exercise program (HEP). I felt "taken a back" and a little perplexed when the patient raised that he had began skipping. This was unexpected and as such I was required to think quickly on my feet, remain calm and outwardly confident in order to maintain the strong thereapeutic relationship in formation and the rapport being built up.
During this experience in more independent clinical practice, I was surprised that feelings of confidence towards the proposition when initially presented continued until the end of practical assessment and interventions. This allowed me to conduct a more patient-centred subjective assessment as TM was happy with advise given regarding the accepted achiles rupture protocol. Introducing myself calmly and openly discussing my role and the purpose of my visit in this manner allowed the therapeutic relationship to develop as TM was made to feel comfortable. As we moved from assessment to intervention where my role remained to lead the exchange with further assistance from my clinical educator to assist in provision of advise/education regarding achilles tendon rupture protocol.
Evaluation
Being proactive in my learning and studies allowed me to have a positive experience when given the opportunity to practice Independently. A skill deemed as ‘necessary’ within many job applications due to independence aligning with a ‘commitment to quality care’ as stated within the NHS constitutional values (1). I felt improvement can be made to my research skills, as much of my time was spent trying to locate and utilise reputable resources and case studies, which could have been reduced through more effective use of research search tools.
Analysis
Interpreting the situation across both self-directed learning and clinical experience in combination, I am able to see how comprehensive service within the NHS is provided beyond the biological, psychological and social understanding of symptoms. But in order to adhere to NHS constitutional values, I must seek to be accountable to patients, service providers and also my own professional development in order to become an adaptable and effective practitioner. While being proactive leads to many unpredictable opportunities for further personal development and as such a proactive approach to development is better suited to a healthcare professional, than a reactive approach.
Conclusion
In conclusion, I feel in addition I could have asked more questions of the MDT members during time spent with previous patients with achilles tendon ruptures in order to better understand the clinical reasoning and rehabilitation protocol behind decision-making.
Action Plan
This action plan is elaborated around 2 main lines: gaining some additional knowledge of rehabilitation protocols for common pathologies of the ankle/foot, knee, hip and shoulder.
Practically, I need to keep improving my fundamental learning of rehabilitation protocols to be more evidence-driven. It can be achieved by two main steps. The first step is to spend time reading N.I.C.E and other clinical guidelines and to try to be more focused on the patient by paying attention to words used, personal goals, expectations and non-verbal language. I work on my verbal communication by asking open questions, summarizing, and clarifying when needed. Non-verbally, I try to use more body language and to have warmer behaviour. I try to be more enthusiastic, using more acknowledgement and reassurance. These two main steps can create a baseline towards patient-centeredness, evidence-based practice.
Week Four - Entry One
Week Four - Entry One
Description
I saw a patient JT (acroynm), for his first session. I was under supervision of 2 clinical educators who stayed in one side of the cubicle while observing the consultation. JT sat in front of me and I started my subjective examination. JT is a 56 years old male who works as a self-employed stage installer for theaters. In November 2020, he has had an intense low back and right anterior thigh pain episode. During this period, he saw his GP who referred him for a MRI that he only obtained in February 2021. He was then referred in physiotherapy and obtained an appointment with me 9 months later. When I first saw him, his thigh pain was completely resolved, but he was concerned about the fact that his back felt “stiff” [patient’s term] at the end of the day. He wanted to know if it was normal or not, and if I could show him exercises he could do. During the session, I collected most of my subjective markers, but noticed that the interaction wasn’t smooth, and it’s only after the feedback of my tutors; after the session; that I became more aware of what went wrong.
Although his problem and goals were quite clear, I led the subjective exam with my questions but didn’t listen to him actively and didn’t show enough empathy towards his situation. The patient made a few statements and asked a few questions (“what exercises should I do?” for example) about his problem that I didn’t explore or address during the subjective exam. I haven’t been able to react and interact properly with him. I have missed a lot of verbal and non-verbal cues that could have led me to a more holistic and accurate comprehension of his problem. I failed to deliver a patient-centered care because my assessment was centered on my own perception of what he had and needed, and not on the patient himself which led to a mismatch in the interaction.
Feelings
I had various feelings during and after the session with JT.
Although I haven’t been able to transmit it properly, I truly felt sympathy for this patient and also felt sad about his situation. It impacted his quality of life and I reckon it must have been a tough experience. I felt stressed out because I was taking an exam, but also nervous because I was being observed by my tutors. Even if at this point of the placement I got used to it, I still felt their presence and couldn’t act as freely as if I was alone with the patient as highlighted by Roberts and Bucksey (2007). I also felt overwhelmed by the almost infinite number of criteria that must be accounted for during a session. As stated, I noticed the interaction was awkward but I felt powerless and stuck, because I couldn’t find a way to reverse this situation in action. I put myself under too much pressure during this session and I sometimes struggle to keep up with my expectations. It led to frustration and disappointment, I worked hard before and during the placement to improve, but this session showed that I wasn’t ready yet. Retrospectively, I feel both ashamed and angry because I know I could have done better, which left me quite bitter and remorseful immediately after the session.
On the other hand, I also felt satisfied and happy because thanks to this placement I progressed in many areas of my practice and I’ve implemented countless new “features” in my reasoning.
Evaluation
Looking back at it, some elements of this event were promising.
Firstly, I’ve asked John about his goals, which I rarely did before. Goal-setting fosters the development of patient-centered physiotherapy (Stevens et al 2018). Secondly, thanks to my tutors who raised my attention about this earlier, I didn’t interrupt JT while he was talking. Although interrupting patients came from a noble intention to precise some information in patients’ discourses, Roberts and Burrow (2018) found that it may delay patients from expressing their concerns and decreases their feelings to be listened to. Thirdly, some communication elements were satisfying. I opened by giving a brief overview of the plan of the session and asked: “Do you want to tell me a little bit about your problem first of all?”. This opening sentence studied by Chester et al (2014) has many benefits. Later in the exchange, I introduced the “cauda equina” questions by briefly explaining how elimination and sexual functions might be linked to a back issue. Indeed, my tutors alerted me that without context, patients with back pain wouldn’t understand why I was asking these questions. I also paid attention to use non-verbal cues such as the proximity of our chairs, keeping my posture opened and slightly leaning forward as advised by Hall et al (1995) to favor a patient-centered behaviour.
Despite these positive elements, others hindered the interaction.
One of the main problems was my lack of active listening. JT repeated several times that his back felt “stiff” but I kept steering him on “pain” questions. He even corrected me a few times, sounding a bit annoyed, saying “well, it’s not really pain, it’s more stiffness”. He also clearly stated his goals early in the interaction (Knowing if stiffness was normal or not, and if some exercises could help). However, I kept asking questions and doing physical tests and treatments unrelated with his legitimate interrogations and personal goals. I think the patient didn’t feel listened to, which was detrimental for our therapeutic alliance. Secondly, although essential to build up trust (Hall et al 1995), I also failed to communicate empathy and compassion towards his situation. Albeit his experience was touching, I never acknowledged any of his statements and just said “OK” every time JT gave me a new information. Patients described as important for their therapist to understand that they suffered from their symptoms and to recognize how impactful it was on their lives (O’Keefe et al 2016). I clumsily tried to reassure him by saying that there was nothing to worry about, but I said it too early and it probably had an opposite effect. I asked several questions but they were not personalized enough, which prevented me to see how his problem impacted his personal life as recommended by Froud et al (2014). Lastly, both as a consequence and a cause of my lack of active listening, my non-verbal communication wasn’t developed enough. I didn’t nod, didn’t adapt my facial expressions to what JT said and the tone of my voice stayed globally even. Moreover, my eye-contacts were limited as I was constantly shifting my eyes on my sheet to write down. These non-verbal cues are important in the therapeutic relationship (Testa and Rossetini 2016).
Overall, the addition of these errors prevented me from delivering a “Patient-centered” care defined by Wijma et al (2017) by five major components: a biopsychosocial approach; considering the patient as a person; sharing power; establishing a therapeutic alliance; and being a clinician as a person.
Analysis
Reflecting deeper on this incident helps to figure out why things went this way during the appointment.
Essentially, I struggled to listen to JT actively for several reasons. Firstly, I was nervous because this session was in the context of an exam and I knew I was being watched. I spent more energy being self-conscious and focused on the way I performed, which decreased my capacity to listen to JT actively. It is hypothesized that a higher level of self-consciousness during social interactions can lead to the decrease of potential interaction with other (Tracy and Robbins 2004). Patient-centeredness was introduced to me at the starts of my masters in Jan 2021 and so is a relatively new concept. It has transformed the perception of my role and I try to focus more on what patients say, show and feel, to tailor the assessment and treatments to their specific needs. But when I’m less-focused or for a better use alert, I easily go back into my “default mode”, more paternalistic with less active listening, which was the case here with JT. Recent studies show that patient-centered care is linked with a better satisfaction, outcome, and adherence to treatment (Hurley et al 2017). I hope that over time, patient-centeredness will become my new “default mode”.
As described before, the lack of perceived empathy and compassion towards JT also had a negative effect on therapeutic alliance; key factor to patient-centeredness (Pinto et al 2012).
The combination of stress and fatigue decreased my capability to be more involved about JT's feelings and to empathize. This placement so far has been aa fantastic opportunity. I have completed it 5 days a week and commuted every week. I invested a lot of energy in it and have had to organise my additional work to compensate the absence with great effect thus far; managing to visit my mother at home to assist in her care following a hip fracture each weekend. Neumann et al (2011) showed that distress was the main cause of decrease of empathy in students. Moreover, in a very positivist way, I’ve always considered emotions as entropy. I used to see emotions as disturbances to neutrality and restraints to objective reality. I under-developed my emotional intelligence to favor my rational intelligence. This false belief decreased my interpersonal sensitivity defined by Hall (2011) as the accuracy in perceiving other people. However, being able to detect, process but also share and express emotions in response to patients would have helped to build up and to deepen the therapeutic relationship with JT.
Additionally, other reasons limited the development of a therapeutic alliance. For example, I never acknowledged the difficulty of his experience. Acknowledgement is a simple, yet powerful tool, that I should have used. It shows patients you’re emphaticizing with their problem, key to create a personal bond essential for therapeutic alliance (Babatunde et al 2017). I also didn’t introduce any “non-medical” question. Casual conversations or “small talks” can be encouraged to break the rhythm from serious questions and “oil the social wheel” (Hiller et al 2015). My lack of personal implication created a disconnection between his complaints and wishes, and my questions and answers. Poor reassurance made me look detached as if I tried to diminish the impact of his problem, which increased the gap in our relationship even more. It created a distance between us, hindered the therapeutic relationship, and decreased his trust in my role. I failed to make him feel as he was a real person which has been rated as crucial by patients in a physiotherapy interactions (Kidd et al 2011)
Conclusion
Reflecting back served to highlight what I should have done differently. I should have listened to JT actively by being attentive to his words, by exploring his beliefs but also by trying the understand his expectations from this appointment. I must have asked more questions to apprehend the impact of his problem on his personal life. I should have maximized the potential to create a therapeutic alliance by improving my verbal and non-verbal communication. For example, by reusing his words and by doing a less scripted and more interactive subjective exam. I also should have empathized more by acknowledging the difficulty of his experience early in the interaction and by being more expressive, replying “I understand” for example instead of “OK”. Non-verbally, I must have adapted my facial expressions to his sayings to look more compassionate and involved. I also should have spent less time writing on my sheet which would have given more rhythm and smoothness to the interaction.
Action plan
This action plan, is elaborated around 2 main lines: gaining some additional knowledge and training my experience by practicing at the clinic.
To educate myself, I plan to either audio-record one interaction with a patient per week and analyze it during the weekends or seek immediate feedback from clinical educators and observers following clinical exchanges. I read numerous scientific articles for this essay, with a particular interest to Lisa Roberts’, Paulo Ferreira’s, Judith Hall’s articles (among others). I loaned and started to read “Motivational Interviewing – Third Edition” by Miller and Rollnick.
I purchased a free copy of a communication/education course from October 2019: “Let’s talk pain” by Osinski T. and listened to a free podcast by Mike Stewart on communication and pain education. In the future, I plan to keep increasing my knowledge on these topics.
Practically, I need to keep improving my fundamentals in musculoskeletal to be more patient-centered. It can be achieved by two main steps. The first step is to practice more active listening, and to try to be more focused on the patient by paying attention to words used, personal goals, expectations and non-verbal language. I also need to ask more questions about the impact of the problem on patients’ personal lives, but also about their perception of the situation as recommended by Diener et al (2016). I need to increase my empathic motivation – the will to engage with the patient – but also my empathic skills by trying to deduce emotions from patient’s verbal and non-verbal language. The second step is to establish a therapeutic alliance with the patient as soon as possible. I work on my verbal communication by asking open questions, summarizing, and clarifying when needed. Non-verbally, I try to use more body language and to have a warmer behaviour. I try to be more enthusiastic, using more acknowledgment and reassurance.
These two main steps can create a baseline towards patient-centeredness.
Week Four - Entry Two - R Knee Pain, Covid Ward Referral
Week Four - Entry Two - R Knee Pain, Covid Ward Referral
vague referral - initial hypothesis & justification - Obs - Subj - Obj - Impression/Problem List - Educator takeover - review
Description
Feelings
Evaluation
Analysis
Conclusion
Action Plan
Week Four - Entry Three
Week Four - Entry Three
Similar situation to Week Four, Entry 1
Description
Lately, I’ve had more success with my interactions and feel like I’ve improved.
I recently saw a 58 years old female patient for right shoulder pain that she’s had for 7 months. Initially, I noticed cues indicating anxiety about her situation. Her face was worried, and she expressed her frustration about not improving. During the examination, I spent minimal time looking at my sheet to keep more eye contact and tried to behave in a more enthusiastic way. During the physical exam, I reused her words by saying “Show me how you reach your hand up” (one of the aggravating factors she mentioned), instead of “Show me your shoulder elevation”. I think it was clearer and gave her the indication that I listened to what she told me during the anamnesis. This time, I empathized by acknowledging her experience quite early by saying “It’s been quite a tough year for you, wasn’t it?”. This sentence was very powerful and her face changed almost immediately. I think she felt relieved that I took her problem seriously. I continued by asking more questions on her social history to determine more precisely the areas of her personal life impacted by her problem. I feel like I had established a therapeutic bond within the first session.
Albeit promising, the interaction wasn’t perfect. For example, I explored her beliefs around her shoulder problem and did a bit of pain education, which didn’t seem to resonate with her. It was probably too confusing after what she’s been told for the last months, or maybe a bit too soon in the interaction. I also tried to be more expressive by saying “Wow, your mobility in elevation is very good” as she had her hand up for example. It sounded a bit artificial, and the terms used could have been less technical.
The lessons learnt with the case of JT helped me to avoid repeating the same mistakes with her and although I still lack consistency, I feel that I start to be on the right tracks
Conclusion
Improving my listening and communication skills is a complex journey. It requires constant effort to prepare the second placement, and ultimately to become a better clinician. This journey opens new ways to trigger a true philosophical shift to patient-centeredness to put patients back in the center of the interaction and to try to see their problem through their eyes.
Week 5 - Student supervision (25 hours)
Week 5 - Student supervision (25 hours)
Assessment, Reasoning & management of unseen patient factors in MSK practice.pptxDescription
Feelings
Evaluation
Analysis
Conclusion
Action Plan
Week Nine - Band 6 Caseload
Week Nine - Band 6 Caseload
Description
Feelings
Evaluation
Analysis
Conclusion
Action Plan
Week 10 - Clinical Management + Organisation
Week 10 - Clinical Management + Organisation
Description
13 - 15 patients a day, 8 - 10 of which are from the band 6 caseload.
Complex clinical reasoning / Band 7 + ACP discussions / Further CPD to support complexity
Feelings
Evaluation
Analysis
Conclusion
Action Plan
Week 11- Using S&C in Physio (Band 5 MSK CPD)
Week 11- Using S&C in Physio (Band 5 MSK CPD)
Description
Using biomechanics and movement analysis knowledge from S&C as well as exercise prescription skills to support the appropriate prescription of exercise for the ankle, knee and hip.
Feelings
Evaluation
Analysis
Conclusion
Action Plan
Common Pathologies and Clinical Reasoning
Common Pathologies and Clinical Reasoning
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