Final Entry

It’s been five long weeks and clinical placement has come to an end. My initial beliefs and ideas going to a private practice were fairly negative as I was concerned with the level of hands on application I would be able to apply. These issues were certainly evident throughout my placement. I was only able to apply limited hands on skills, which were primarily ultrasound and massage, which are fairly basic. I was hoping to apply passive accessory and physiological mobilisations, as opposed to basic EPA and massage techniques. However, I was able to refine my massage technique throughout the placement.

I also watched patients being treated by the physios most of the time, which after 8 hours, everyday for five weeks, can be quite tedious. I was, after mid assessment, allowed to perform a total of three subjective histories, one on a post accident, which actually resulted in fracture so physio wasn’t applicable, one pre-op knee and one post-op knee. I really enjoyed doing those as I felt like a real physio, rather than a student just watching.

The other main issue I came across was the fact that most patients presented with either back or neck pain, which we haven’t covered as second years, so I was limited in what I was able to do subjectively as well as hands on. I also felt confused watching treatments, as I didn’t understand the kinematics of the treatment techniques, despite my attempts. That was probably the most disappointing aspect about my placement.

I did however, gain a lot of insight in terms of communication with different types of patients, as I was able to communicate with them and gauge an understanding of their journey and how physio has benefited their lives. I also learnt a lot about total knee replacements, particularly post op, as I saw them frequently throughout my placement. I also learned a lot on exercise prescription as the facility had a gym and exercise classes, which was really good to get involved with.

I think the main thing I gained from placement was the exposure and experience. I got to engage with patients about their experiences, which provided me with a lot of insight. I also learned a lot on exercise prescription, as well as to be more confident and assertive in my approach. As I wasn’t really able to apply many musculoskeletal mobilisation techniques, I did refine my massage skills. Overall, it was a good experience, but there was a lack of hands on application, which was disappointing.

Week Five

Situation: I was given the opportunity to witness an Ilizarov frame on a 37-year-old male who sustained a complex comminuted fracture to his tibia and fibula following a motorcycle accident 6 weeks prior. The Ilizarov frame was being used for fixation of the tibia and fibula until he underwent a bone graft. He had the frame for 4 weeks and it was being removed within the next week.

Task: I mainly watched and maintained professional behaviour during the treatment, but I was also allowed to apply ankle mobilisations to increase ankle range of motion and reduce stiffness

Action: I performed ankle mobilisations to the joint. However, as I performed the mobilisations, my hand was hitting the frame, as well as some pin sites beginning to bleed and seep fluid. I had to sit down in the treatment room after my supervisor took over in order to gain my composure as I was feeling nauseas and overwhelmed from the appearance of the frame and the pin sites

Result: There was ultimately greater range of motion at the joint, and I maintained my composure throughout the remainder of the session.

Evaluation: I felt I maintained professional behaviour during the session despite feeling overwhelmed and somewhat disgusted by the bleeding of the pin sites. I was able to remain professional particularly on first seeing the frame as I was shocked, but I remained composed. I also could’ve excused myself from the room if I couldn’t handle it, but I don’t feel it reached that level, as I felt fine within a few minutes.

Strategies: I feel I employed strategies to maintain an adequate level of professional behaviour during the session and was able to successfully apply treatment techniques in a professional manner despite feeling overwhelmed by the appearance of the frame, as opposed to the task. After witnessing the frame, I feel I am more prepared to see similar forms of fixation without feeling as overwhelmed.

Week Three

Situation: This week I was presented with a 26-year-old male complaining of right groin pain. He had a referral from a doctor, which asked to treat his right rectus femoris as he suspected a possible tear. The patient revealed he had sustained a fall off his motorbike 8 days ago onto his back and head, lost consciousness, was sent to the emergency room and had an MRI the day before and did not know of the results.

Task: To perform a subjective history taking assessment, in order to formulate a diagnosis and plan a suitable treatment plan to address his groin pain.

Action: I performed my initial subjective history taking to find that rectus femoris may not be the source of the groin pain as he didn’t complain of pain and was able to do a full squat. My supervisor then retrieved the MRI results, which revealed he had sustained a fracture of the acetabulum and labral separation. As he presented as unsuitable for physio at the present time, with the help of my supervisor, I educated the patient on where the fracture was sustained and addressed his concerns about being able to work.

Result: As he was not suitable for physio, education and advice was the only form of treatment that could be undertaken at the time. The patient was disappointed with the outcome and the knowledge that he may have to undergo surgery and be unable to work at the current time.

Evaluation: The issue I had with the subjective assessment was the detail I was able to gather and record in a short amount of time. I was more focused on addressing the groin pain issue, and did not consider the mechanism of injury as a critical factor in the diagnosis. However, he didn’t present with typical signs of fracture as he was weight bearing and didn’t complain of high pain levels. I found this case very complex and was overwhelmed with the information, and was unable to organise my thoughts and record all the critical details necessary, which made the initial assessment poor.

Strategies: I need to listen more carefully and analyse the overall situation as opposed to focusing on the presenting condition. I also need to learn how to gather more detail by asking more specific questions in order to formulate a more accurate diagnosis. I hope to employ these subjective assessment taking strategies in the next two weeks to improve on my subjective history taking.

Week One

Situation: This week, I was given the opportunity to participate in a physio session of an 18-year-old male patient with recent left minor patellar dislocation. This session was one of a few follow up physio treatments from a prior initial assessment. He presented with recurring anterolateral knee pain as well as increasing posterior knee pain. This was preventing him from returning to work as an apprentice carpenter, and was important that the condition was addressed to allow him to return to work as well as ADL’s.

Task: The main priority of this physio session was to manage the presenting condition to alleviate pain, facilitate healing and promote normal functioning and movement, which would enable him to return to work.

Action: I initially measured his knee flexion and extension to use as a baseline assessment. I then used ultrasound on the anterolateral aspect of his left knee to relieve pain and promote healing as well as massage on his hamstrings to relieve muscle tension as this could have been contributing to his recently acquired posterior knee pain.

Result: After using ultrasound and massage, the patient reported a decrease in pain levels from a 4/10 to 2/10, and was able to gain further range of motion after treatment when compared to his knee flexion and extension at the beginning of the physio session.

Evaluation: The main issue I had was my technique whilst using the ultrasound. As the anterolateral aspect of the knee was quite bony, the ultrasound head was losing contact with the knee and therefore affecting the efficacy and primarily the use of the treatment. There were times during treatment where the contact of the ultrasound head was adequate, but there were more times where contact wasn’t. I need to develop and practice my technique in the future in order to improve the intervention.

Strategies: I continued to practice the use of ultrasound throughout the week with different areas of the body such as the neck in order to improve my technique. I was able to seek advice on ways to improve my application and found I need to employ different strategies such as applying slightly more pressure on the head of the ultrasound as well as using slower circular motions. I used these skills in other sessions and was able to improve on my overall treatment technique.

Initial Entry

I’ve waited two years and the time has finally arrived for my first clinical placement. I am definitely excited and anxious to see what it is truly like to be a physio, see real patients with real conditions, and hopefully witness treatment success and client satisfaction.

I’m going to a private practice musculoskeletal clinic in Mandurah. My first thoughts when I found out it was a private practice were primarily disappointing as I’ll probably be limited in my hands on application of skills and treatment as there are insurance issues associated with students. However, I do like the fact that it’s a musculoskeletal private practice, as I feel most knowledgeable and comfortable in this area of physio.

Nonetheless, after taking the time to think about my true expectations for clinical placement, I realised that although I may be limited in hands on treatment, I’m still going to be able to gain exposure to different musculoskeletal disorders in a real clinical setting. I think the exposure to the clinical environment, liasing with colleagues and experiencing what its like to be a real physio will hopefully be a beneficial and rewarding experience. I’m confident in my communication and musculoskeletal clinical skills, so I’m hoping my first placement will be a positive and successful one.

I’m not sure how the day will be structured. I am working Monday to Friday, 8a.m to 5p.m with an hour for lunch, which I'm sure I will be using to research different conditions and treatment techniques. I know there is a hydrotherapy pool and exercise gym and I will be able to participate in hydrotherapy at some stage during my placement. I’m assuming my day will consist of some physio, some hydro sessions, and some non-contact time, which I’ll either be researching, or doing marketing and promotion for the clinic.

As the student in the facility, I’m not sure what my role will be exactly as it is a private practice and there may be some concerns with how much handling and treatment I'm able to do. I’m hoping that at minimum I will be able to sit in on physiotherapy sessions and participate in hydrotherapy sessions to have a first hand account on professionalism, subjective history taking in a clinical setting and treatment.

My only concern at this stage would be what is expected of me as a second year physio student in a private practice. I’m hoping I’ll be able to get as much exposure and hands on experience as I can, in order to gain the most benefit from the experience. I’m definitely anxious and nervous about starting, but I’m sure once the first week is over, I will feel like a real physio.