2/3/2019 0 Comments Reflective Journal #3As we prepare for the BOC, I am feeling very encouraged. Last semester, I didn’t specifically do BOC preparation, so the first practice test went extremely well for me. I increased my scores in each domain except for one. I have been very intentional about growing in domain 4 because I was not in the least satisfied with my score in it last year, and it was nice to see that the work I put in is really paying off. As for right now, I am trying to focus on the material that I don’t have to recall often while in the clinic - equipment fitting, different types of budgets, specific numbers for range of motion, etc. Additionally, I want to revisit rehabilitation progressions to ensure that I am confident in those before I sit for the exam.
Today, we took our second practice BOC exam of the semester, and I am feeling even better than earlier in the week. Today, my overall score increased by 4%, and my domain four score entered into the 90% range. This was about a 20% jump from my last domain 4 score, which was extremely encouraging to me; however, I do feel as if these rehab questions were much more straightforward than they have been previously. What was slightly disappointing was my domain 2 score. It dropped down to 66%, which is the lowest I have received in this domain since we started taking these tests. The questions that fit into this domain covered a much larger variety of injuries and illnesses than before, which included many more neurological conditions that I am not as familiarly with.This decrease in score allowed me to get a greater understanding of what conditions I need to review to not only pass the BOC, but to be a great clinician. These practice tests are by far my favorite way to study for the BOC, but I do also like asking questions while faced with a real life situation in the clinic. I feel like the more practical the situation, the more likely it is that I will retain the information. Additionally, it is encouraging when I see test questions on topics where I have conducted research in the past and have retained the information that I found and read about. I feel like if I continue doing these three things, along with continuing my review of therapeutic modalities, rehab progressions, and anatomy, then I will have confidence when going into the BOC exam in March.
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1/27/2019 0 Comments Reflective Journal #2I feel like there are quite a few problems facing the profession, and they all are intertwined with each other. I believe the first problem facing the profession is the issue of burnout. Athletic trainers often work very long hours with very few days off. I can imagine that in the collegiate setting, athletic trainers can often feel overwhelmed because of the amount of athletes - kind of like “there are so many of them and only one of me”. Being with baseball right now even makes me feel overwhelmed at times, and I am still not solely responsible for the team. It is difficult to keep up with all the athletes and what is going on with each of them. Additionally, it is frustrating when you have a desire to implement certain things, such as a prevention program for shoulder injuries, but you don’t have the manpower nor the space or time to implement the program.
Along with burnout, I believe the underpaying of athletic trainers is another issue that the profession faces. Athletic trainers are highly qualified and extremely beneficial assets to have not only in an athletic setting, but also in other settings such as hospitals, physical therapy clinics, and other business; however, athletic trainers are often immensely underpaid in relation to their education and hours worked. I personally know individuals who have left the field because they knew they could not acquire the income that they desired by being an athletic trainer, one of which moved into dog treat sells and now makes six figures annually. I believe this aspect of the job shows the passion that athletic trainers have for their patients. Lastly, being underappreciated and underestimated is a major problem that athletic trainers face. Many more individuals than I would like to admit still believe that an athletic trainer is a personal trainer instead of a healthcare provider. I have seen coaches actively resist the decisions of an athletic trainer because of a lack of respect and/or lack of appreciation. Another example would be how many people believe that the athletic trainers in the NFL are “waterboys”. We are good at many things, and it is insulting when people believe that all we can do is gather water and tape ankles. No way, we can do all of that AND save your life if we need to. This is the reason why we need to push to educate everyone we can about our profession in hopes that we will gain respect in the healthcare realm and hopefully increase the desire for athletic trainers in the workforce. Wow.. I can’t believe this is my last first journal. Looking back on my time in the AT Program, I am so grateful for what has been instilled in me. I look at some of my peers who have not had the type of training and opportunities that I have had, and I understand all the more how much this program has prepared me not only for my professional life, but also just being a “grown up” in general. We have been responsible for how we dress, duties outside of class, and have been held to a level of professionalism and responsibility that many do not get to experience in their college years. I feel blessed to have a deeper understanding of what it means to be a healthcare provider and that I have been trained to a level that doesn’t just meet the minimum. Despite not wanting to stay in the athletic training field, I know that what I have learned in this program is going to greatly benefit me in my future studies and career based on the standards that I have been expected to uphold here. Going into my last semester, I am going to try to tie up all my loose ends to help transition me into the professional realm. I plan on taking each task by the horns and approaching it with confidence instead of being intimidated or shying around completely a task with autonomy like I have done in the past. I want to take what I have learned about administration and truly put it to the test with the help of my preceptors in hopes of not being surprised by this portion of the field later on.
I feel like this revelation of gratefulness of my preparedness will help me to work harder to gain wisdom in this last semester. I expect that this semester will be much more taxing than last semester due to my increased course load and being in season, so I have a goal of staying as proactive as possible. I want to stay at least three days ahead of my coursework if at all possible, which entails that I must utilize my planner with discipline and be more aware of time management. Lastly, I would like to pass each BOC practice test with at least a yellow or a green in each category so that I enter the BOC test with confidence of my knowledge and abilities. To accomplish this, I will need to stay vigilant with my study booklet and be in constant review during my clinical experience hours. 12/19/2018 0 Comments Gen Med Rotation ReflectionDuring my two week rotation at Dr. Handy’s office, I was able to grow my understanding of holistic healthcare. Dr. Handy truly cares for each and every patient he comes in contact with, so it was nice to see that the idea of caring for the whole individual doesn’t have to stop with athletic training. The biggest take away that I had from this rotation was that if a patient has one thing, then they have two things. A patient has two things wrong, he or she probably has three things wrong. Comorbidity after comorbidity.
A patient that specifically stuck out to me was an eight year old female with diabetes; however, it didn’t stop there. She also had epilepsy and hypothyroidism, and she came to the office that day because she was having cold symptoms. Her mom made sure to bring her in at the first signs of illness because her other conditions made even the slightest cold exponentially worse. Dr. Handy prescribed her with antibiotics for an upper respiratory infection, and he told them to come in ASAP if those did not help. I was also able to listen to my first mitral valve prolapse. Dr. Handy told me that the patient had this heart condition before entering in to the office, but then asked me to listen to the patient’s heart without telling me what to look for. I reported that I had heard what sounded like three beats, and learned that I was correct in what I heard. This was a huge stepping stone for me because I have always struggled with hearing and understanding the heart sounds in class. I have a particular interest in cardiology, so this was very encouraging. I was able to sit in while Dr. Handy had an appointment with a patient that was HIV+. The man seemed to have a misunderstanding that he still had HIV because he kept noting that his disease was undetectable on the blood test. Dr. Handy took time to educate his patient on what that meant. He was very gentle, but also clear and stern. The patient also had diabetes, erectile dysfunction, and a heart murmur. The check up showed that his diabetes was being handled well, and his murmur was being maintained well also. Many of Dr. Handy’s patients were also struggling with psychological conditions along with their physical ailments. The main diagnosis was either depression or anxiety. Through my shadowing I learned a quick acronym to help assess depression: SIGECAPS. This stands for sleep, interests, guilt, energy, concentration, appetite, psychomotor retardation/agitation, and suicidality. This was something I was able to take with me into many of my classes. Lastly, I was able to walk away from this rotation with a deeper understanding of medications. I learned how many medications work on the body, thus showing me how they accomplish what they are meant to do. I also have lists of medications for common illnesses or conditions that I will be able to refer back to in the future. In combination with my physiology class, I am much more confident in my pharmacology knowledge than I was 6 months ago, but I know that I have much more learning to do. 12/9/2018 0 Comments Reflective Journal #15This semester I have been grateful for the progress I have seen. My junior year I really struggled with finding motivation to continue in athletic training with zeal because I knew that this field was not where I wanted to spend the rest of my career. Even though I still want to go to physician assistant school, I have been able to be content this semester. This isn’t particularly an example of educational progress; however, this has been the progress that I have been most proud of this semester. As I have mentioned in previous journals, I am very thankful for Cole and Alex for investing into me like they have. In addition to the preceptors I had this semester, I really enjoyed the other students that I was placed with this semester. I feel like they care for athletes similarly to me. They place a lot of emphasis on getting to know the athletes and creating a relationship with them, so it created a fun and fruitful atmosphere in the AT clinic this semester.
Outside of gaining some of my passion back for the profession, I feel like I have been able to fine tune some areas of my clinical practice. I have become much more confident in doing my evaluations, and I have been able to grow in understanding what parts of the evaluations are most relevant to the current problem. In retrospect, I feel like it has taken me more time to find the information that I needed to make a diagnosis. Now it is much easier for me to filter through the information that I receive from the athletes to coax the conversation to the areas that I need. I also feel much more comfortable in creating rehabs. This semester, Cole would allow me to look at previous rehabs for an athlete and create a rehab on the spot that would flow well with the previous exercises. This pushed me in terms of my comfort zone, but I know this has definitely made me a better clinician. Additionally, Cole would ask me why I was doing what I was doing, which pushed me to think about the in’s and out’s of my practice. Overall, I feel like I have been able to not be so high strung in the clinic which I know has been able to relate back to the athletes that I am around. 12/2/2018 0 Comments Reflective Journal #14This past week I had the opportunity to start a freshman football player’s rehabilitation from a previous fibula fracture. The athlete had a contact injury that resulted in a fibula fracture, which then required two surgeries to fix the surgery. Unfortunately, his rehabilitation was scheduled to begin during Thanksgiving Break, so upon his return to school, he was already behind. I was somewhat unfamiliar with his case, so before we started rehab that day, we went over everything that had happened. I found out that over Thanksgiving Break, he had done small amounts of running. He has been cleared for activity, but is still experiencing mild discomfort while walking for long periods of time and complains of numbness on the top of his foot from the surgery.
The first rehab we did was very successful, and I was able to make many conclusions about his current state. He did not physically appear as if he had suffered from a lot of muscle atrophy, but the strength difference was extremely noticeable. This was highlighted during single leg squats to a box. His unaffected leg was so simple and effortless for him, while the affected leg was very difficult to perform the exercise on. Additionally, he complained of a lot of increased stiffness in the affected leg, which may have increased the difficulty of this particular exercise. I also had him perform some balance exercises to find a baseline of where he was ranged on proprioception. He was pretty impressive balance wise and worked very hard to perform well, specifically on balance exercises. After a few more exercises, we ended the session with a light jog because he really wanted to run some more since he had worked on that some over break. However, during the jog, he obviously favored his injured leg much more than the other. Through this rehab, I was able to keep the session very informal and lighthearted, while also being able to get a really good idea of where he was in the process. Something that I had not put much thought into previously was the level of insight that the athlete had to where he or she was in rehabilitation or their abilities to perform. After speaking a lot about level of insight in my abnormal psychology class, I have tried to incorporate that more into my clinical practice. This athlete in particular does not have very good insight into the depth of his condition; he believes that he is much farther along that he is, even though he is performing fairly well. In the future, I plan to look much more into how the athlete thinks he or she is doing, and base some of the rehabilitation techniques off of that answer. 11/16/2018 0 Comments Reflective Journal #12This week, I was able to design a rehab day with a football player who is six months post-op from his ACL reconstruction surgery. He was cleared to start cutting this week, but was still struggling with feeling unstable on his affected leg. We began rehab with a warm up on the stationary bike, and then we took out the ladder. I wanted to get his heart rate elevated and perform movements that would prepare him for the cutting movements he would be performing later in the rehab. Additionally, I wanted to take advantage of this time to get him moving while also making him think about his movements. I had him start by doing four sets of each exercise starting with two feet in each block for speed. Then we moved into lateral movements for four sets, and then we started doing cutting like movements. He performed 4 sets of ickey, then we moved onto doing two ickey steps forward then one backward. He seemed to have considerable trouble with these exercise, not because of the physicality of it, but because of the mental portion of the exercise. I would like to see exercises like that incorporated into his rehab more often to help prepare him mentally for coming back to play. We ended the ladder with a backwards ickey.
After the ladder, I wanted to work on glute activation before moving into running. I had him perform 2 down and back duck walk with two black mini bands. He has done this often, but this time I asked him to walk forward on the way down, and then walk backwards on the way back. I wanted to make sure that it was targeting different parts of the glutes with each movement. He gave me positive feedback that it was challenging and that he felt it in a different place than just when moving forward. After that, we moved our session to outside. He explained that he had trouble with adding additional, non-necessary movements when he was cutting while running, so we tried to focus on correct mechanics for the majority of the rest of the session. We started with slow running and cutting to ensure that he felt comfortable, then increased the speed. He consistently performed much better as the speed increased, which I believed allowed him to stop overthinking so much about what he was doing and just performed. Overall, I think it was a successful rehab where he was challenged without overdoing it. I felt more confident pushing him a little harder than I usually feel comfortable with, so I'm learning the correct level of how much to push someone and when to lay off. 11/9/2018 0 Comments Reflective Journal #11The clinical goal that I have focused on the most is my first goal: I will practice my use of therapeutic modalities by reviewing parameters weekly with my preceptor. Therapeutic modalities is one of the most difficult portion of being in the clinic for me, right behind designing creative rehabs. I believe that it is difficult for me to remember many of the modalities and their parameters, especially for ultrasound, because it is an area that I am not very interested in. It is easy for me to remember general medicine protocols, emergency care, and diagnoses because those are things that I am very interested in. I have found a trend in my practice where I have a much more difficult time being excited about and remembering areas of practice that don’t easily keep my attention. Additionally, I think this area is a challenge for me because in the back of my mind, I know I will not be using modalities for very much longer in my career. When I travel to China for athletic training, I will not be given the same resources that we have in America, and I will have no choice but to be creative in my treatments. Also, when if or when I get the opportunity to go to PA school, I will not have to apply these treatments very often if at all.
However, after bringing this up to Cole and explaining my struggles with ultrasound and e-stim, he was been very intentional about reviewing parameters with me. He offered me a sheet that helped him in his graduate research on the effectiveness of ultrasound which has been very beneficial to me during treatments. Additionally, he allows me to set up multiple ultrasound treatments, each needing different parameters so that I am exposed to multiple different scenarios in which a modality can be used. I think that this practice and being “forced” to recall the information on a weekly basis has helped me so much this semester. I have also never been much of a fan of using modalities because of the results I have received on myself and the reports I have heard from other athletes, but my preceptors have done a great job at explaining what each modality treatment was for and why it works well for that situation. It has also been really helpful that they understand that I have a hard time remembering and that I would ultimately prefer a different treatment type, but still encouraging to continue to learn about the modalities that I struggle with while also discussing different treatment options with me. 11/4/2018 0 Comments Reflective Journal #10My favorite part of clinical experience this fall has definitely been my rotation with Dr. Handy. Over the course of the athletic training program and its classes, I have found that I am particularly interested in the general medicine portion of what we do. For me, gen med is like a big puzzle - I ask questions to get all of the pieces, and then when I have all the pieces of the puzzle then I can figure out what the puzzle actually makes. I don’t get as much experience with general medicine in the athletic training program, so it was very exciting to me to be able to get 20 hours full of clinical experience that was flooded with general medicine.
This is especially exciting and meaningful to me because it gives me a glimpse into my future. Sometimes I struggle with spending so much time in the athletic training clinic because I sometimes spend whole days doing things I’m not AS passionate about, even though I still take pride in what I do there. However, spending hours upon hours and staying late in the clinic with Dr. Handy was never a struggle for me. I was constantly wondering what was going to be in the next room, writing down different medications and what they do, trying to fit the pieces of the puzzle together for each individual patient, and even at one point, getting moved to tears by a patient suffering from Parkinson’s Disease. I loved that Dr. Handy allowed me to participate in auscultation in most of his patients, and he always asked me what I heard which allowed me to try to work through all the different sounds and the knowledge that I had to put the heart sounds together with the conditions that I knew. It seems like such a small aspect of the whole evaluation, but it was so exciting for me. Looking back on all of my rotations, they have helped me navigate where my passions are and where they do not. I loved being in the emergency room and experiencing the energy that constantly was flowing during that rotation, especially when running down the halls when the nurse I was shadowing was called for a code blue. I being in family practice with Dr. Handy and experiencing something different in each room that I walked into. But on the other hand, I did not at all enjoy my rotation in the wound care clinic, not because it wasn’t interesting, but because I couldn’t stomach it. Additionally, I thought I was going to fall in love with the PT clinic, but I was surprised when I didn’t have the spark I thought I would have for it. All of these experiences have continually affirmed me that I am headed in the right direction for my future career. 10/26/2018 0 Comments Reflective Journal #9As a senior athletic training student, it is getting easier for me to imagine what my “real life” job is going to look like when I graduate. It has also really helped me by going to any off-site clinical placement to understand what professionalism looks like in places other than the collegiate setting: the emergency room, the wound care center, the outpatient physical therapy clinic, and the family practice rotation. By modeling how other professionals act in their workplace and by implementing what I have learned about professionalism by experience and in class, I try to lead by example. However, I also make sure that I am able to maintain my personality and sense of humor while maintaining professionalism. I would never want to work in a place that requires me to lay down who I am as a person for my job - I want to pursue relationships with my patients, have comedic relief during treatments, and have an appropriately relaxed environment to help patients feel at ease when they are under my care.
Having said all of this, there are no students younger than me on my rotation at the moment, but I do have many freshmen approach me and ask for my advice concerning majors, career paths, experience and shadowing, patient care hours, etc. Because we are all pretty close, I try my best to show them what hard work, professionalism, and other good practices in the workforce look like. It is very important to me that I am punctual not only for my clinical experiences, but in all areas of my life if I can help it. Additionally, I never share patient information with anyone, including my best friends and younger “mentees”, and I make sure to share with them why I can’t do that. They respect that I take that part of my profession seriously. Lastly, I try to educate those younger than me on everything that I have learned and experienced throughout my time at Emory. I wish that I had had an older student that was pursuing the same career path that I wanted so that I could learn about prerequisites, patient care hours, application necessities and deadlines, the importance of class planning, and how helpful it is to have useful experience under your belt when thinking about future possibilities. It is one of my passions to invest into people younger than me, so I take a lot of pride in being as helpful as I possibly can to those who are walking where I once walked. |
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