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.