As an athletic training student, I feel the least confident when treating an athlete or patient that I have not been working with, especially if they have a complicated injury or condition For example, when I am at the physical therapy clinic and I am asked to do treatment for a patient that I have not met or treated before, I become very skeptical of what I am doing. I have a million questions like, “Am I doing this correctly? How long do I do this? Is this the right exercise?” I just worry that what I am doing is different, and maybe wrong, compared to what they have had in the past. Additionally, I find treatments to be much more productive when I can comfortably communicate with the patients. When a relationship has been created from the beginning, communication is much easier and trust is more easily established. It is very important for me to have a relationship with the patients in order to feel very confident as an athletic training student. This is not as much of an issue in the athletic training clinic because I know and am familiar with many of those who come in for treatment; however, it poses more of an obstacle in the physical therapy clinic.
I am most confident in the athletic training/ physical therapy clinic when I am working with an athlete or patient that I am familiar with. Also, it helps if their injury is a shoulder. I know that many people are skeptical about the shoulder because of how complicated that it can be, but I feel really comfortable with the shoulder. When I am with someone that I have been working with already, I feel confident about the treatment that I am performing because I am familiar with how they respond to a particular treatment. Additionally, I am able to gauge the progress and the efficiency of the exercises or treatment options that I picked for that day based upon how the patient responds to it because I know how they have reacted to past treatments.
It is super encouraging when I am able to work in a setting where I am confident about my decisions, but I also feel that it is important that I am challenged. I fully believed that if you are not made uncomfortable, then growth will not occur. The more that I am put in a situation where I am less confident, the more that I realize that I need to depend more on my skills and knowledge to be able to make correct and beneficial decisions for the patients.
This week I gained attempts from the PBL from clinical class.
At the current moment, I am pursuing a career in physician assistant studies. I would like to sit for the BOC exam to become certified before continuing my education in a physician assistant program. I began to think about this track when I was considering how to best use my career in the mission field. I had a hard time trying to imagine how I could use physical therapy in missions because physical therapy is more of a long term service. Additionally, I really enjoy the idea that individuals receive experience in a plethora of different specialities, which makes choosing a speciality or changing a specialty fairly easy. Lastly, the most superficial reason is that it takes one year less to accomplish than physical therapy.
I have done a lot of research into what I need to do to accomplish this goal. Each PA program demands something a little bit different. Each program needs patient care hours, and only specific programs will accept athletic training student hours. The only program that I have found that accept ATS hours is the Medical University of South Carolina. Additionally, the prerequisites for each program seem to differ slightly. I have made my schedule for the rest of my time in undergrad to try to accommodate all of the prerequisites for each program that I am interested in, and the only issue that I have had so far is fitting in microbiology. However, if I can take organic chemistry over the summer, then I will be able to fit in all of my prerequisites for each program. I shadowed a PA from a hospital back home this summer, and I am really interested in what she does. She works in a pulmonology clinic and a family practice, and she offered up some very good advice about what I needed to focus on learning while in PA school. She advised me to ask a lot of questions about paperwork and insurance policies. Additionally, she mentioned getting my CASPA application in early to be able to start applying to schools as soon as possible.
I would like to continue feeling out which specialty that I would like to pursue because as of right now, I would like to pursue a speciality in pediatrics, but I would like to gain more experience in other areas. I feel like finding physician assistants in other specialities this summer to shadow would be very helpful for both my resume and my future decisions. I would also like to learn more about different programs that I have not heard of yet.
This week I received attempts from Beth’s PBL in clinical class and five other attempts from the PT clinic with Matt.
This semester I have particularly enjoyed seeing the different types of conditions that walk into the physical therapy clinic. The PT clinic has shown me such a larger variety of injuries and conditions in comparison to the athletic training clinic, and it gives me a more global outlook in regards to the profession as a whole. For example, I am working with a patient in the clinic right now who has a diagnosis of abdominal migraines. The patient has a constant 5-6 pain on a numerical pain scale, and the pain is predominantly concentrated in his legs. His ultimate goal was to be able to ride his bike again, which he has been doing for 20 laps around the parking lot as a warm-up for his rehab session. He has been able to perform each exercise in the clinic easily, but still complains of pain. His case is a particularly confusing one, and I am unsure of what will be deemed as successful at the end of his rehab. Additionally, there has been a patient that I have been working with a lot for about two months. He is recovering from a bilateral rotator cuff tear, where his right rotator cuff underwent a repair. He was completely immobilized for six weeks and has struggled gaining much of his ROM back since then. His pain is gone for the most part, but the lack of range of motion is frustrating for both us and him. Those are just a couple examples of the cases that I have seen that are different from those that I would be exposed from in the AT clinic.
This semester’s clinical experience has also allowed me to make new relationships. I have met so many incredible people in the physical therapy clinic, and I have been able to learn from so many different people in that clinic. Everyone there has a different style of rehab, and it was awesome to be able to pick and choose what I liked most from all the different people. I also have created awesome relationships with the patients in the clinic. I have learned that it is important to be much more gentle, both physically and with my words, when interacting with the patients in the clinic. It has been easy to communicate with athletes, but learning how to communicate with other individuals has been a really fruitful experience.
This week I earned attempts from Beth’s PBL and one attempt in the clinic.
After thinking back to my sophomore year, I wish someone would have told me to just jump right in and ask as many questions as I needed. I wish I would have known earlier that it was okay to not worry about messing up and to just ask for clarity when needed. Therefore, I have been sharing that information with those who are new to the program. I have given them the advice of taking advantage of every opportunity and not waiting until being asked to offer one’s help in the clinic. I believe that taking initiative in the clinic setting helps to build confidence and get over the awkwardness of coming up to someone and taking charge of a situation by asking questions. It’s always nice to see those who are new in the program helping athletes in the clinic with confidence instead of timidity. Additionally, it’s encouraging to me to see them working through hard scenarios in their head or talking it out with another student or preceptor. Their focus makes me want to work harder and be better in the major.
I specifically remember a few older students who went out of their way, and still got out of their way, to offer their help when it is asked for. My mentor, Tori, did a fantastic job at giving me the space I needed to learn on my own, while also being close enough to offer help or guidance when it was needed. I feel like the best thing that Tori did for me in the program was just being a friend. It was very easy to be comfortable around Tori, and she never made anyone feel lesser for asking questions, even if they were “dumb” questions. Additionally, it was always nice to see how hard most of the upperclassmen worked when they were in the clinic, and how they talked excitedly about certain material or a situation in the clinical setting. It was always encouraging to be around people who truly enjoy what they do and how they help others. I hope that once I get back on campus after being off site for so long, that I can bring some of that excitement, friendliness, and openness to the athletic training clinic.
This week I received two attempts from the physical therapy clinic and three more attempts from the PBL that we completed in for clinical class.
The class that has proven to be the most challenging this semester is definitely chemistry. What I find most difficult is remembering which formula to use for specific problems. I also find it confusing and difficult how he uses the flipped classroom approach. It is hard for me to focus on the lectures online and follow along with the examples. Additionally, the examples that are given to us in the homework and in the book that are worked out are the simplest form of the questions the majority of the time. When we get to the homework, the problems get exponentially harder, leaving me confused and sometimes frustrated. Most of the time, a concept does not truly sink in until we go over it in class, but then the homework is already due and graded. Also, it is impossible to answer all the questions that individuals have for all the homework problems in one class period.
However, this class has been accompanied by a huge learning curve. I have really had to focus on the lectures as well as I can to make sure that I absorb as much as the information as possible before going into class. Most of the time, I can do homework anywhere without worries of distraction, but with chemistry I have had to learn to isolate myself to a quiet place to be able to focus on the material and perform my best in the class. It has also forced me to take advantage of all the possible resources that have been provided to us. I always use the slides, the video, and the reading to finish the homework and learn the material. I have found that the videos and readings both emphasize different parts of the chapter, so I feel like using both resources is the best way to absorb the most material. Additionally, I have never been much of a group studier, but this class has pushed me in that aspect as well. It is very helpful to get together to try to learn the new material and learn from each other as well as the resources on moodle. Sometimes I find that my classmates can explain the problems in a way that makes much more sense that I could have ever made out of it. I have also found that my usual note taking skills do not work very well for this class. It’s hard for me to learn by taking the notes from the video or slides, but the best technique for me seems to be just writing problems and examples thoroughly.
This week I have earned attempts from the three sections that were completed in the PBL from Beth’s class.
This week I was able to perform another evaluation on a patient in the clinic. The patient came in with a complaint of pain on the side of her foot that had been persisting since her most recent ankle sprain on August 22 of this year. She had a bad sprain in April of this year which took six weeks to heal, but healed completely with no lasting issues. While squatting in August, she lost her balance and felt immediate pain go through her foot and ankle. She tried to give it time to heal, assuming that it was another sprain, until weeks later she went to the doctor. She had a negative x-ray, and that is when she started coming to the physical therapy clinic. She presented with palpable tenderness on her styloid process of her right ankle at the insertion of her peroneus brevis. She had pain with joint mobility of her metatarsals, and complained of pain that occurs consistently throughout the day. The patient stated that the pain resides at about a four out of ten consistently throughout the day, and higher on days when she is on her feet more often. There were no obvious deformities or discoloration, and the patient had been wearing a brace when working out since the injury.
At first, I thought that the patient had point tenderness at her calcaneofibular joint, but after further examination, I decided that is was primarily pain along her peroneus brevis. After talking it over with Matt, I was right in my assumption that the patient was experiencing peroneal tendinitis that began after her sprain in August. In the AT clinic, we have had some athletes experience tightness in their peroneals; however, I have not seen a patient that presented quite like this one. It was very encouraging to be able to complete an evaluation and feel confident about what the patient was experiencing. Additionally, one of my goals for the year is to better my rehabilitation programming, and I have been able to plan this patient’s program which has been going really well. She already reports feeling less pain throughout the day. In the future, thinking back to this experience will help to trust in my knowledge that I have gained thus far to make good evaluation and rehabilitation decisions.
This week I had nine attempts from Beth’s PBL and one attempt in the clinic.
This week I was able to have a very unique evaluation opportunity. I received multiple phone calls from my sister and my mom while I was clinically experiencing with Hannah. When I checked my phone, I immediately called them back and tried to figure out what was wrong. My sister had had an accident at her gymnastics class where she thought her spotter said to do two backhand springs, but he only told her to do one. He spotted her on the first one, but did not expect her to keep going and did not spot her on her second backhand spring. When she went back the second time, her arms gave out and she landed directly on her back. She had bruising on her spinous processes from the impact, but had intense shoulder pain. There was no bruising or obvious deformity along her shoulder or upper back, but she had pain in the midrange of her range of motion that was relieved when she got to the top of her range of motion. She could not bring her arm across her chest due to pain. I instructed her on how to do an empty can test which was positive. She was point tender in the middle of her deltoid.
When my mom arrived home, I instructed her through FaceTime on how to perform an anterior apprehension test, which was negative. I also instructed my mom on how to perform active and passive range of motion. The active ROM was very painful, but the passive ROM caused no pain at all. I checked back again with her later that night, and she had pain with shoulder flexion around 30 degrees, when before the pain began around 45 degrees. My first concern was that she had injured her rotator cuff muscles; however, that next morning she was still in some pain but was able to function fairly well. She took volleyball off for the rest of the week, and is now ready to play again after some good rest and stretching.
This experience showed me that it is important to keep a level head. I am very protective over my sister, and my first instinct was to advise my mom to take her to the hospital because of her pain level. However, after asking her lots of questions and finding signs as well as I could through the phone, I had to go against my instinct and advise my mom to not take her to the doctor just yet. Luckily, I believe that it was a minor muscular injury that was able to quickly heal with rest. This experience helped to remind me that it is important to be rational, even when the first response tells you otherwise.
This week I had three attempts from the PBL that we did for Beth’s clinical class on head and face injuries.
I have been lucky to be able to clinically experience with a bunch of different preceptors, some who are still at Emory and some who are not. Each preceptor has been unique in their personalities and treatment styles, so I have been able to adopt a lot of their quirks as my own quirks.
The first preceptor that comes to my mind when reflecting on influence is Zach James. I always noticed that Zach never appeared stressed out and would take time with each individual who entered into the athletic training clinic for treatment. Zach made every person feel heard when they were telling about him about what was wrong with them. Additionally, Zach was always encouraging during rehabs with athletes. There was always a positive vibe during the rehab, which made the process much more fun and enjoyable. Now and in the future with whatever job or activity I am involved in, I hope to implement the same kind of positivity, empathy, and ability to stay calm in stressful moments the same way that Zach did during his time at Emory.
Secondly, I think of Hannah. Hannah relies a lot on manual therapy, which is something that I am also a big fan of. I admire that she would choose to do manual therapy over a treatment that may be easier or less time consuming. Her choice to pursue manual therapy over other types of treatment has encouraged me to practice massage therapy and trigger point more, making me much more comfortable performing this treatment on athletes and those in the physical therapy clinic. Additionally, Hannah also presents with a very positive attitude whether she is having a good day or a bad day. I admire the type of care that Hannah shows the athletes. For example, when a volleyball player had a season ending injury a week or so ago, it was evident how much Hannah really cared and how much she wanted to help her athlete. I hope to show these attributes when I am practicing in my profession.
Lastly, I would like to mention Melissa. Melissa truly cares about her athletes, but she refuses to get pushed over or disrespected. Sometimes I have trouble asserting myself to people I do not know very well, but watching Melissa has shown me that there is no reason that I should be disrespected or talked down to. Each preceptor has had an unique impact on how I practice/would like to practice athletic training, and I would have to write a book to speak of it all.
This week I had 3 attempts in my clinical book from the vignettes in our PBL in Beth’s class.
This week I was able to work on my personal clinical goal of gaining a better understanding of the different populations and age ranges that I could potentially be involved with as an athletic training student. This week I was back in the athletic training clinic because of the inability to be at the physical therapy clinic. Because of this, I was back to helping and clinically experiencing with athletes instead of the older, non-athlete population. The difference is exponential, and I feel like I was able to learn from being back in the clinic, as well as apply what I had learned in the PT clinic to the athletic training setting. This week I gained a new appreciation for the athletic training setting because of the upbeat and more rigorous atmosphere. Sadly, it is easy for me to become almost uninterested from time to time in the PT clinic because of the nature of the injuries and the different goals that people in the PT setting have set for themselves. I believe that all the goals set, regardless of the setting, are important, and it has been so beneficial to see the difference in goals between the two settings.
For example, most of the time the main goal for an athlete who is hurt is to get back to competition to play at 100% of their ability. In contrast, some examples of goals in the PT clinic are to be able to walk up a flight stairs without difficulty or to be able to get into a bathtub without assistance. Both of these examples in my eyes hold equal importance in relation to the individual that they belong to, but the path to reach these goals are often times very different. In the AT clinic on Friday, I lead a shoulder rehab on a shoulder injury. The athlete was ten weeks out and was expected to be throwing a baseball again within the next thirty-eight days. However, in the PT clinic, I am assisting with some rehab with a man who had his shoulder surgery in April, and he still has very minimal range of motion. I feel like I have gotten a lot better at reading the patient and understanding the importance between the individual and their wants and needs.
This week I had seven attempts from the PBL #1 that we completed for clinical class with Beth.
This week, I got to evaluate my first patient at the PT clinic. The patient was a 17 year old male soccer player who had a history of hip pain. He had been to the clinic once before for rehab on his ankles; however, hip pain was never mentioned. The patient claimed to have hurt it last spring when he was in season for his high school team, but never saw his athletic trainer or took time to recover. He said that he “just played through it”. He found that the only thing that helped the pain after his high school season ended was to rest. Unfortunately, each time he would try to practice after that, he would experience the pain again. He is taking some time off from his club season because of the pain in his hip/groin area. The patient stated that he feels the pain when he does a deep squat, sprints, walks up stairs, does “over the gate” stretches, and spreads his legs apart as if he were in a butterfly stretch. After completing an initial evaluation, I spoke to Matt and suspected hip flexor tendinitis. He confirmed my diagnosis and we began looking at treatment options. I was able to decide what stretches he took home to do, and the stretches and treatment he had done that day. Additionally, Matt let me decide his treatment for his following visit (with his guidance, of course).
I think that his experience really helped me find my footing in the PT clinic. Thus far, I have felt somewhat uneasy while clinically experiencing at my off-site. I do not feel like it is because of the atmosphere or the people, but because of the difference in populations from the PT clinic to the AT clinic. With that being said, I felt much more confident with this patient though, most likely because of his age and that he is an athlete. I believe this helped towards one of my goals because I have been able to work on rehab progressions. This patient was a good stepping stone into the PT clinic because it was somewhat in my comfort zone, but my limits were still pushed by having to think about how to progress his rehab. Overall, I feel like it was a beneficial step in my learning journey that I can use in the future to gage my progress as I move forward in the PT clinic.
This week I only had one attempt to put in my clinical packet, unfortunately.